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HomeMy WebLinkAbout002-1005-50-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saf'ty and Building Division ` INSPECTION REPORT Sanitary Permit No: 499160 0 GENERAL INFORMATION (ATTACH TO PERMIT) ,gtate Plan ID" No: Personal information you provide may be used for secondary purposes [Privacy Law, s,15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Graf, Todd & Lori Baldwin, Town of 002 - 1005 -50 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 03.29.16.44B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt, BM Her Aeration _, f Bldg. Sewer j Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet t ' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom L Dosing , I Header /Man. (}D S Aeration Dist. Pipe , •p 1 t r 1 C U'Ti • G Holding - ".. Bot. System 4 •_a _ 5,91 ' Fill Grade PUMP /SIPHON INFORMATION 0 : Manufacturer Demand . St Cover Grp GPM GQk Model Number I T V cE•.. . a ._ j H Lift Friction Loss System Head TDH r Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTIbN SYSTEM BED /T _ENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHINN Manufacturer: INFORMATION CHAMBER OR Type Of System: ' UNIT ` Model Number: DISTRIBUTION SYSTEM -* > ._ ;t >;, adr /Manif d x Sp cing He Ai P. tea - , ; s — r f Length e Distribution Hole Size x Hole Pipe(s) - Dia Length ;t fDia Spacing I r SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes 1 No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: t' A / - , L';, Inspection #2: -- f -- t ✓!, w�.(:..- ' I"'•.wr+ -ti Location: 1112 245th Street Woodville, WI 54028 (SE 1/4 SW 1/4 3 T29N R1 6W) NA Lot 1 Parcel No: 03.29.16.448 1.) Alt BM Description 2.) Bldg sewer length ^ �,sL - . "d a aJ w *•1 t„ �; s — r` i '� *7 .°"L,1'pV �1)'L"E+d' • ,� �L l - - 3 j 1 amount of cover = st �� + Plan revision Required? Yes ' 1 No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) u,rictivo lUIJ tc:ca rAA /Ib 360 4Va13 51' GRA W ZONING 100 03 Safety and Buildings Division Cozen s, 201 W. Ww4hingwrl Ave P.O. Box 7162 - C t Madison, WI 53707- 7162 Sanitary Permit Number to be filled in Co.) ,sCOn{�'` Department Of Commerce (608)26G -3)51 Sanitary Permit Applica State Plan 1.D. Number In accord will( Comm 83.21, Wis. Adm. Cod . 'nlennation you p may he used for secondary purposes 'vacy �.1nr a Project Add (if different than mailing addraa9) 1. Application Information - PlensePrint fu atioo \ � L � = f/iZ. 2_q5 5 � QrD Pr70A Owner's Name 06 E L l I ptock N is A Loc% r sr. Property Owner's Mailing Addrm 7y Property Location City, State Zip Cello Phone Number '�a /� yZ• Sat)on %,,! ' t 5 Y ® (� C6 ' 5 3,1-1 1 (circl ) //•'7 T N; R�y.,, ti 1 I.I. Type of Building (check all that apply) ` 1 I or 2 Family Dwelling - Number of Bedrooms i� �, -- Subdivision Naive CSMM Number ❑ PubtletCommcreial - Dewibe Use ❑ Stale Owned - Describe Use l 2�` \ Y1- ❑City _❑ Village kTownship of ` III. Type of Pel trait: (Check only one flwx on lice A. (ompktt line B if applictlblc) 6 760 A ' n New System ReplaWt t System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System K~ B. ❑ Permit Renewal U sennil Revision List Previous Pennit Number and ride tss urtl' ❑ change of" ❑Permit Transfer to Nctv Before L-:xpiratibn Plumber QNner trf I'01VCS S stem: Check all that a l D ❑ Nov -Pressurized In -Ground X Mowtd > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Crround ❑ fIotdit+g "1 "ank ❑ Peat Fitter ❑ Aerobic Treatment Unit ❑ Recireulatj Sand Filter ❑ � Recirculating Synthetic Media Fitter ❑ Leaching Chamber ❑ Drip Line ❑ Gmvcl -less Pipe ❑ Other (explain) a (�1 Lem V. Dis I/Treattnant Arcs Information-. Design Flow(SPd) Design Sail A licAtion Rat s Dispersal Area Require f) Dicpental Arco Propaa System Eton tun 5 ® ✓ H d 5 25 '16th Z 3� qq ° ✓ VI. Tank Info M Capacity in Total Number ' Ma nofaeuaet Prefab Site Stod Fit>Gr Plastic Gallons t3aliana ufunits Concrete Glass Ncw / Tw i lt srg /- l t � M �, r Tanks Tanks L^� t"�L. ♦ie 1. Septic rr I Inldin�•'fnak •�) AerohicTreatn'irm(Jit �[ on Dosileg C:hatnber V VII. Responsibility Statement- 1, the undcrsigaed, assume responsibility for installation of the POWTS shown an the attached life" Pill bee's Name (Print) / Plumper' Si u MP/MPRS Numb Business Phon Numlx r Plumber's Address (Street, City, State, Zip Code) 4 SC 4 ,S'iei .C.lr'l /,f1 / >�'te /G'G:�1A01t�7✓ �: �1 VIII Cuun cva rtmcnt1Jse0nI v Atip -vcd Disapprov Sanitary Perrget Fee (includes Groundwater Date tsct " lssaiuD veer Sian Surcharge Fee) aC7 c , N ven Reason fo ia1 J(..� / K.c IX- (:onditions of Approval/Ressons for Disapproval - ^_.,. •- ..._,.__.. ___ SYSTEM OWNER: 3) ti 64 -Q - i. Septic tank, effluent fiker and ' 1 __ ((�'�((�� / dispersal cell must all be. services / maintained �, e.�I s .� +Q_ r` /� C-A'lt c: - 1,4,s/ / t as per management plan provided by plumber. GG 2. All setback requirements must be maintained �'� ` �• II as per applic" code I ordinances. Z/ � � A e •,S 6C At h complete plam (to the ConNly qtly) t bii tytteM ewe per not kas thaw 51l2 x 11 inches in site ( x // nn J fto�dl l f4 bC; �. Ire. - eve SB© -6395 (R. 0 1/03) _ !d'tiQci.jao_fz� l 1r•- AO 6 dvLja,,- G� Go F< -5o ;l edW. Ax, td 6e E %3ti/�q grade a ie&/ iiISPCC�e�✓ � S�rac�ura,f Soc��d/k'�t yt'' (/ C e // �,�,;oi � � b.e a.5.e� c%v, ec✓ a P.cr ev d e. N ta / /�c✓Q>� / o cc�l� ds��.�e. SEklswJy, Sea. 3, T. 2- ,P 16 A) T . off' Lea y/0 o a . i °° o o o D, 1 I N promcd ;x8. ?41' 136.6p r / /1•S " C- e,11. TWO (Z� /S a.f /, "X5S.xg G cJ's CI»c, S IF ,,. C'or,cr BctJy�P 8.111.: To pF Pa rn o c,/a1Ad \ /non ho% Co des: 4.3s a rr, eo/ 603 0-11 2uS14 toVL jrce,nA%17 a<o bD b a 5 _ D 1 i ,,e v.7A rta 2s�S�$Erec� -� Pe/' Code . E,Y�SL 44 f e . � l �U • So;/ ed ��•+� �n 6P E"6 r�, ♦ E,1.3tiv �rc�c/e elegy i/1 SPC C t<eG✓ �or Sz<r u c -Soa n d/�St � SG4 � : / � , /e- usc{✓,� S� ;Ea6 /e. �Xi`s�.�9 � A { # /1 a,6 e(� ec✓ a /� er ea d e. T off✓ $ Lori' G.a >r,ore�. 5,:,+1Tcc 1 e{� /lia'+t,C,'' /L4 - 6� SES�ySt. Sew. 3, T. z9i1� A o IF' ° � O 1 , I I � Pro /Y1'ou.� a dS CG //. 7Wo (Zj G�,f'isfin uJ �"s �rlC. ,� i� � , � �' � P W %g "o�,F'•ces S r r ' I EX,St<i U.)te�J >CdYC main . Cc»cret 8eU9Ir 6. /11 .: T� of'Pu.,., l o c./a,nd�- / Du m ��wn b« /non hole Cod ,Qssu.,ned elci }6,' 5y 56cm. b an CL s - Dr i de v - AY Eo 2srS'� 56 rtc� -� Per code' • r Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 AUG TDD #: (608) 264 -8777 RECEIVED isconsin www.commer isco govsb, Department of Commerce www.wisconsin.gov Jim Doyle, Governor, Mary P. Burke, Secretary August 28, 2006 CUST ID No. 225410 ATTN: POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING ST CROIX COUNTY SPIA 321.WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/28/2008 Identification Numbers Transaction ID No. 1314989 SITE: Site ID No. 717313 Todd & Lori Graf Please refer to both identification numbers, 1112 245TH Street above, in all corres ondenc . with the a enc . Town of Baldwin St Croix County SE1 /4, SW1/4, S3, T29N, R16W Subdivision: CSM in Vol. 19; Pg 4983 - lot 2 FOR: Description: Three Bedroom Replacement Mound System Object Type; POWTS Component Manual Regulated Object ID No.: 1093365 Maintenance required; Replacement system; 450 GPD Flow rate; 12 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N.0.1101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall. be met during construction or installation and prior to occupancy or use: . • This system is to be located and constructed in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of th e tank explaining that periodic cleaning of the filter is required. Access to the tank/filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. P.O.W.T.S. Conditionally APPROVED PAUL R KOEHLER Page 2 8/28/2006 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 `� \ Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: James K Thompson, A.C.E. Soil and Site Evaluations Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DEW ON Residential Application —n INDEX AND TITLE PAGE 3> :1) C M m 0 Project Name: Todd & Lori Graf 3 bedroom Residential Mound 00 ►—+ G �= o m Owner's Name: Todd K. & Lori K. Graf 0 C:) O Z Owner's Address: 1112 245th Street y Woodville, WI 54028 Legal Description: SE1 /4SW1 /4, Sec. 3, T.29N., R.16W. Township: Baldwin County: St. Croix Subdivision Name: CSM Vol. 19, Pg. 4983 Lot Number: 2 Block Number: na Parcel I.D. Number: 002 - 1005 -50 -100 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Paul Koehler License Number: 225410 Date: 07/27/06 Phone Number: (715) 246 -2660 Signature: - Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) 1Jc1 aI V, v Version 3.0 (03101/01) DIVISION Of SAFETY AND BUILDIgGS Pagel of 9 SEE CORRES NDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) W Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00; Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal - - -- coliform of - 36 inches. 1.501 Peaking Factor (e.g. 1.5 = 150 %) 450.00 Design Flow (gpd) 12.00 Site Slope ( %) 97.60! Contour Line Elevation (ft) 12.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 112.50 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 0.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 1.50 Estimated Orifice Spacing (ft) = 6.08 ft /orifice 2.00 Forcemain Diameter (in) 175.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.87 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 28.55 Forcemain Drainback (gal) 9.23 Vertical Lift (ft) 50.90 5x Void Volume (gal) 3.49 Friction Loss (ft) 79.45 Minimum Dose Volume (gal) 19.22 Total Dynamic Head (ft) 30.48 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options I choice in. dia. options I choice 0.75 1.25 1.00 1.50 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 805.12' Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 21.76 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 805.12 Dose Tank Capacity (gal) Sim/Tech Filter Manufacturer 21.76 Dose Tank Volume (gal /in) STF -100 Filter Model Number Wieser Concrete Manufacturer Project: Todd & Lori Graf 3 bedroom Residential Mound Page 2 of 9 Mound Plan View T 1/10 B •'•'•'•. . . . . . . . . .. . . 3 J : j Observation Pipe — W B:' ........ .. .. I ......................... L Mound Component Dimensions A A24.00 ft E 29.76 in H 1.00 ft K [ jmft ft B ft F 9.50 in z 17.68 ft L ft D in G 0.50 ft J 7.26 ft W 450.00 (ft Dispersal Cell Area 2438.96 (ft Basal Area Available 4.00 (gpd /ft) Linear Loading Rate 11.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.39 (ft) - G H � rrrrrrrri 2 ririrrr�.. I F rrrDispersalCellr' 100.10 (ft) Lateral rrrr rrr . . tera 99.60 (ft) — ► — Invert Dispersal Cell Elevation E ...... .' ' ,', {• ] • i • i i.. ; •'; 'i `i _-; _- "-; 'i'_, _ i '; _-; ;. %. `i i ] ; _`.;.._.l 7311- )� -; : ~ 1 „i�i, i i ii J ~ 97.60 (ft) Contour Elevation 12.0 % Site Slope Geotextile Fabric Cover Shading Key $° T Dispersal Cell See lateral details on Topsoil Cap c 1.5 ft :;; Page 4 for number, rrrrr Subsoil Cap 5 �;. size, and spacing of © ASTM C33 Sand F � � • - °•`° � • laterals. Laterals are F [ Tilled Layer c H 0.5 ft o'rypical Lateral equally spaced from Q5 Aggregate v c .• the distribution cell's �--- A ---* centerline in the distribution cell (AxB). Project: Todd & Lori Graf 3 bedroom Residential Mound Page 3 of 9 Center Connection Lateral Layout Daigram P I IF X ')1+02 ' x12 +' laterals 4 force main of PVC 3ch 40 (per COMM Table 94.30 -5) Holes drilled on the bottom of the lateral, 0 - Turn -up w1ballvelve or cleanoutplug equally spaced Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.52 ft Lateral Length (P) 55.48 ft Orifices per Lateral 37 Lateral Spacing (S) 0.00 ft Orifice Density 6.08 ft /orifice Lateral Flow Rate I 15.24 gpm Manifold Length 0.00 ft System Flow Rate I 30.48 gpm Manifold Diameter 0.00 in Total Dynamic Head 19.22 ft Forcemain Velocity 3.11 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ---► -:t Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 805.12 Gallons Volume 21.76 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.60 404.77 B 2.00 43.52 C Pump off elevation (ft) C 4.40 95.71 90.87 D 12.00 261.12 D Total 37.00 805.12 Dose, tank elevation (ft) 3" Bedding un er tank. 89.87 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number PE41 f Pump Must Deliver 30.48 gpm at 19.22 ft TDH Project: Todd & Lori Graf 3 bedroom Residential Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Country Side Plumbing Phone (715) 246 -2660 POWTS Regulator's Name St. Croix County Zoning Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once eve 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •..........••• M Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution g Lateral Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Todd & Lori Graf 3 bedroom Residential Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, . filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Todd & Lori Graf 3 bedroom Residential Mound Page 6 of 9 NGOULDS PUMPS Submersible Effluent Pump J PE "Werr pump SPECIFICATIONS MOTOR FEATURES Pump — General: General: ■ Corrosion resistant • Discharge: VA" NPT • Single phase construction. • Temperature: 104 °F (40°C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and submerged- • Built-in thermal overload pro- cover. fully su • Solids bmerged- " tection with automatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil - filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently • Manual models available. shaft. lubricated for extended Specially designed for the * service life, uses: Pumping range: see PE31 Motor: service powered for continuous • Mound Systems performance chart or curve. • .33 HP, 3000 RPM PE31 Pum p. • 12.0 Maximum amps operation, • Effluent/Dosing Systems 50 GPM •Shaded pole design ■ All ratings are within the . Maximum c a p a city: • Low Pressure Pipe Systems working limits of the motor. • Basement Draining • Maximum head: 25' TDH PE41 Motor: in Quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM cord, 20' standard length, Dewatering • Maximum capacity: 60 GPM • 75 Maximum amps heavy duty 16/3 S1TW with + Maximum head: 29' TDH • PSC design NEMA 5 -15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug, • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. / • PSC design ■ Mechanical seal is carbon, METERS FEET ,/ _ ceramic, BUNA and stainless 40 .... J..:.., MODELS: PE3t, PE4t, PE51; Steel. 1 a -.r E „ aa, ■ Stainless steel fasteners. 35 + HP 3a, .so 10 2 GPM . . .. ... 1r , ;. Il _... — I - AGE14a !LISTINGS }..,. 1 FT T ; ? i � . A . , ... 1 C us r ,z p a nd 8 nd C5A 22.2 1 8 l ) ` ( gy Cal>adian Standards Association O .. t Fie #LR3854 1 Q 15 �"""�I Goulds Pumps is 150 9001 Registered ;..'...i...'. i I 1 + I 0 0 _ �30 _— 20 3 40 — 50 60 7 70 GPM ' .o.m m:n:r+um SccAO /u /CC Cc: ree� m3 /h Goulds Pumps 0 5 10 CAPACITY CG 2002 Goulds Pumps 11T Industries Effective November, 2002 w n /p OPE31/41 ( T / TOO 121 H'9d 3(IISA?JX110Z) 9L9Z 9VZ 9% YVd Z :ST 9009 /LZ -'LO - ORIGINAL. .r• 1999 Wisconsin Department of Commerce e.•+"'"' °"IL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site Ian on County p paper riot less than 8%: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 002 - 1005 -50 -100 Please print all information. Reviewed ¢y 1 , Date Personal information ou provide Y Pr may be used for secondary W�� (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Todd K. & Lori K. Graf Govt Lot SE 1/4 SW 1/4_$ 24 y fi Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# '"" E ,t 1112 245th Street 2 CSM Vol. 19, Pg.4983 City State Zip Code Phone Number I City _,J Village 01 Town Nearest Road Woodville I WI 1 54028 (715) 684 - 3949 Baldwin 245Th Street f New Construction Dce: W1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial till Flood plain elevation, if applicable na General comments and recommendations: Soil suitable for mound with 24" of sand fill to be placed on 97.60' contour, syst. el. = 99.60'. Boring # Boring Pit Ground Surface elev. 97.85 ft. Depth to limiting factor 24 "� in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - *Eff#1 `Eff#2 1 0 -8 10yr3/2 none sit 2fsbk dsh as 2f,1 m 0.6 0.8 2 8-20 10yr4/3 none sl 2fsbk dh cw 1vffm 0.6 1.0 3 20 -24 7.5yr4/4 none sl 2csbk dh cw 1vf,f 0.6 1.0 4 24-32 7.5yr4/4 f3p 7.5yr518 sl 2csbk dh cw 1vf 0.6 1.0 5 32-46 5 r4/4 f2d 7.5yr5 /8 & scl 1 csbk mfi - 1 of 0.2 0.3 y mid manganese con. Boring # I Boring 16 Pit Ground Surface elev. 97.77 ft. Depth to limiting factor 1 8 " in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " Eff#1 'Eff#2 1 0 -10 10yr3/2 none sil 2fsbk dsh as 2f,1m 0.6 0.8 2 10-18 10yr5/4 none fsl 2fsbk dh cw 1vffm 0.4 0.8 3 18 -28 10yr416 f2f 7.5yr5/8 sl lmsbk dh cw 1vf,f 0.4 0.6 4 28-40 7.5yr4/6 m2d 7.5yr5/8 sl 1 csbk dh cw 1 of 0.4 0.6 5 40-51 5yr4/4 f2d 7.5yr518 scl 1 csbk mf - 1 of 0.2 0.3 Effluent #1 = BOD? 30 < 220 m and TSS >30A150 ' Effluent #2 = BOD <30 mg/L and TSS S30 mg/L CST Name (Please Print) Sign ure: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Os la, WI 54020 7/2512006 715 - 248 -7767 Property Owner Todd K. & Lori K. Graf Parcel ID # 002 - 1005 -50 -100 Page 2 of 3 3] Boring # Boring sm Pit Ground Surface elev. 94.00 ft. Depth to limiting factor 12" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-7 10yr3/2 none sil 2fsbk dsh as Alm 0.6 0.8 2 7 -12 10yr5/4 none Ifs 0 sg dh Cw 1vffm 0.4 0.8 3 12 -17 10yr5/4 f2d 7.5yr5/8 Ifs 0 sg dh Cw 1 V 0.4 0.6 4 17 -24 10yr4 /6 f2f 7.5yr5 /8 & sl 1 msbk dh Cw 1 of 0.4 0.6 mid man anese con. 5 24 -40 5yr4/4 f2d 7.5yr5/8 scl 1 csbk mfr - 1 of 0.2 0.3 F-1 Boring # --� Borin Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 F-1 Boring # —I Boring J Pit Ground Surface elev. fl. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Conststence Boundary Rods in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. •Eff#1 "Eff#2 • Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg /L " Effluent #2 = BOD -E mg/L and TSS <_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) A.C.E. SON & Site Evak abonS • so;r ed or /ass 34);6z6le ♦ EXi�3�'c/ ��ac e e (e�' S cyyscvly, See. 3, T K. /6 GJI, 7,--, O+` Qa yy A 0 .y i ` 1 'L4 � I r 4m- 60 a'f `` 8( i / / , / g MpC�wvl L+Cr ,f / na n ft o% Ca V ! SS c,,m &o/ i — Dr ve war 6a 2 SE re c c/ • z St. Croix County Planning and Zoning Monday, September 18, 2006 at 9:31:32 Am Detail Sanitary Information Page I of,/ Computer #: 002-1005-50-100 Sub/Plat: NA Section: 3 Parcel #: 03.29.16.446 Lot: 1 TN/RNG: T29N R16W Municipality: Baldwin, Town of CSM: Vol. 19 Pg. 4983 1/4 1/4: SE 1/4 SW 1/4 . . . . ............. . . . . . . ......... -- . . .... . ......... -- - . ...... . . . . . . ........... . . ... ....... . . ..... . .... ............ Owner: Graf, Todd & Lod 1112 245th Street Woodville, WI 54028 State Permit: 499160 Issued: 09/08/2006 POWTS Dispersal: Mound 24" or more suitable soi Permit: Replacement County Permit: 0 Installed: POWTS Detail: NA Bedrooms: WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspecto As Built Plumber Other Requirements Additional Notes Money Owed Ryan Yarrington NA Koehler, Paul $0.00 Not determined Signed Off: No - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Owner: Harer, Robert 1112 245th Street Woodville, WI 54028 State Permit: 18776 Issued: 08/25/1981 POWTS Dispersal: Pressurized In-ground Permit: Replacement County Permit: 158 Installed: 09/02/1981 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Harold Barber Yes Boldt, Everett File this permit with the 1983 holding tank permit $0.00 Tom Nelson Signed Off: Yes in archives. 2006 system being inspected by Countryside Plumbing/Paul Koehler and he thinks there may be an IGP for the house. This is an existing farmstead, dating <1979 Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/2/2005 - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — -- — — — — — — — — — — — — — — — — Owner: Harer, Robert 1112 245th Street Woodville, WI 54028 State Permit: 34779 Issued: 01/14/1983 POWTS Dispersal: Holding Tank Permit: Replacement County Permit: 0 Installed: 01/14/1983 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspecto As Built Plumber Other Requirements Additional Notes Money Owed Harold Barber Yes Boldt, Everett This was for a trailer home on the parcel that was $0.00 Tom Nelson Signed Off. No removed according to Grafs. - - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — �'4 r ,. '} �.� . t � i.+' f .J ,3 � w v !} � i' S i�, !j. � y` �� i t -�y vvr ran vv ova+ yr.,.v rata ,yu uvv 'X"Vv 01 VAA Vu Gunlav Wuu4 A , O ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of �! FILE INFORMATION SYSTEM SPECIFICATIONS owner TODD &LORI GRAF Septic Tank Capacity ) p pcj� g al ❑ NA Permit # Septic Tank Manufacturer W ��; �; g O N A DESIGN PARAMETERS Effluent Filter Manufacturer S «, �c� d NA Number of Bedrooms " 0 NA Effluent Filter Model ❑ N46 Number of Public Facility Units I7 NA Pump Tank Capacity ', o gal ❑ N 4 Estimated flow (average) S© '4 gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) 3 w® gal/day Pump Manufacturer �* �, ❑ NA Soil Application Rate L Y S Z:) al /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ U Fats, Oil & Grease (FOG) 530 mg /L 13 Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection © Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) Q K Biochemical Oxygen Demand (80D 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade C&Mound Fecal Coliform (geometric mean) 510 ofu /100ml Cl Drip -Line O Other: Maximum Effluent Particle Sire 7Y in dia 13 NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent, Other: ❑ N MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: .3 month(s) (Maximum 3 years) ❑ Nit years) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ N/i Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ Nit year Clean effluent filter At least once every: 3 ❑ month(s) Q Nit years) Inspect pump, pump controls & alarm At least once every: © month(s) ❑ Ni, �,ye Flush laterals and pressure test At least once every. ❑ month(s) ❑ Ni. c:61-year(s) Other: At least once every: 0 month(s) ❑ NAI Other: .eC year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfac3. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:3, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmerlt units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. vai cii V lur, l c: ca rt1A 1 10 400 4000 J'1' UKA (;U LUNE% 191 uu5 Page 21 of Zi START UP, AND OPERATION For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other cherrlicils that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the pump controls to restore normal levels within the pump tank Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fait; foundation drain (sump pump) water; fruit, and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; uil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: CI A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkm system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area % ill result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWYS AA technology a holding tank may be installed as a last resort to replace the failed POWTS. !v� T m alua • . ?K 7=I , fbR- A/� �NSM -TI r .. lk ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NC T ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK, UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone 2 L� ` Phone 1 SEPTAGE SERVICING OPERATOR (PUMPERI LOCAL REGULATORY AUTHORITY Name Name �-r G(�Q ( 201 ou Phone Phone '� /S— �'��._ &9 (:) This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411). (21 & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSHIP CERTIFICATION FORM Owner /Buyer TODD & LORI GRAF Mailing Address 1112 245TH ST Property Address 1112 245TH ST (Verification required from Planning & Zoning Department for new construction.) City /State WOODVILLE WI Parcel Identification Number 00 2 - 1005 -50 -100 LEGAL DESCRIPTION Property Location SE y , SW y , Sec. 3 , T 29 N R 16 W, Town of B ALDWIN Subdivision CSM Vol. 19 P9 4983 , Lot # 2 Certified Survey Map # , Volume 19 , Page # 4983 Warranty Deed # , Volume , Page # Spec house 0 yes O no Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms A& '. rar, J, SMNATUkt OF APP ICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 7 9 5 6 1 6 3 y VOL 19 PAGE 4983 KATAEEEII' R. REGISTER OF DEEDS RECEIVED CERTI FI EEP SURVEY MAP 05/24/2005 04:1 LOCATED IN THE SE1 /4 OF THE SW1 /4 OF CERTIFIED SURVEY MAP SECTION 3, T29N, RI 6W, TOWN OF BALDWIN REC FEE: 13. COPY FEE: 3.00 ST. CROIX COUNTY, WISCONSIN PAGES: 2 LEGEND �i 1" STEEL SURVEY MARKER FOUND w � 1 5/16" O.D. IRON PIPE FOUND N N1/4 CORNER O- SECTION 3 0 3/4" X 18" IRON REBAR SET WEIGHING v ¢ uj OWNER • 1 1.50 LBS. PER LINEAR FOOT Z z TODD & LORI GRAFF -X -X EXISTING FENCELINE ¢ 1112 245TH STREET w O WOODVILLE, WI 54028 1 1 100' ROADWAY SETBACK LINE Q m I g I i0 P 75'SETBACK FROM WATER y SURVEYOR ( �3! U' U EDWIN C FLANUM Id Z cn I x NORTHLAND SURVEYING, INC. m I ° g lCs� SOIL TEST ¢ P.O. BOX 14 5' j - ��- m y ROBERTS, WI 54023 6 ° 43'21 "E 1317.63' A 555.55' _ � FENCELINE IS 20'= "_k 717.64' 750 68' '33.041, c SOUTH OF LOTLINE 1284.59 -� NORTH LINE OF THE SE7 14 OF THE SWt /4 z 1 m Z O � 2 - m LOT 2 cn cn 20.00 ACRES INC. R/W 0 0 y Q 871,369 SO. FT. LOT 7 n � = N 18.61 ACRES EXC. R/W m 20.01 ACRES INC. R/W 810,656 SO. FT. Z 1 m 871,472 SO. FT. HOUSE to m m v 5 8 O o 7 R a 9.42 ACES EXC. R/ W �' Z � v I Q 846,074 SO. FT. O ISTING DRIVE 0 NOTE: SHED ----- EX- - - - -- (n r L7° N ACCESS TO LOT 1 SHALL BE AT THE SAME LOCATION AS BARN ; O 1 o THE EXISTING FIELD DRIVE. _ _ 8 N ❑° ° ICJ "' 01 i BENCHMARK N89 °8'15"VH I � 1 lm m W TOP OF REBAR TO BENCHMARK P C MARK 'm m 1� w A ELEV. = 1223.88 202.2T ELEV. = 1216.99 / i iC9 m / I 1 p. 1� I T 1 - v j 133 33'1 DRY RUN � .. .. ..... I ESQ Y'i i / i'.. . .. .. ... _ IL a SOUTH LINE OF THE SW7 /4'•'-am N87 °40'S8"W 1284.62' � 769.63 .1 i • 769.64' N87 °40'58"W 1317.87' 540.23 / SW CORNER N87°40'58 " 2 635.73' - - 1 I � SECTION 3 LSO t4 'U — — — TH AVENUE s, /a coa rveRl r C I - - - -- I dOQ I---------- - - - - -- SECTION I � II I M_Mn_Pd/Q�CC�D L�GIIGJD� I ei� I Oo oCnVlo ON WOOL. 2 pao X34100 I l I - - - - - -- -�- - - - - -- I SCALE IN FEET 1" = 200' i THIS INSTRUMENT DRAFTED BY SAM ADAMS 1 idiom i JOB NO. 05-31 DATE 4 -18 -05 SHEET 1 OF 2 SHEETS 200 O 200 Vol 19 Page 4983 1 J 2 2 9 7 E 0 3 8 STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., MI RECEIVED FOR RECORD This Deed, made between Robert W. Harer and Sandra J. 07/01/2003 09:30A)1 Hoogenakker f/k/a Sandra J. Harer Grantor, and Todd K. Graf and Lori K. Graf, husband and wife, as survivorship marital property. Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EXEIWT # described real estate in St. Croix County, State of Wisconsin (the "Property") REC FEE: 13.00 (if more space is needed, please attach addendum): TRANSFFEE: 162.00 COPY CC FEE: The Southeast Quarter of the Southwest Quarter (SE -1/4 of the SW -1/4) PAGES: 2 of Section 3, Township 29 North, Range 16 West, St. Croix County, Wisconsin. This deed is given in satisfaction of a land contract dated September 4, Recording Area 1984 and recorded in the St. Croix County Register of Deeds office on September 11, 1984 in Volume 696, Page 191 as Document Number 396228. Name and Return Address Bakke Norman, S.C. 900 Main Street PO Box 54 Baldwin, WI 54002 Together with all appurtenant rights, title and interests. 002- 1005 -50 -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated his day of May 2003 * Robert W. Harer * Sandra J ooge4ikker AUTHENTICATION ACKNOWLEDGMENT Signature(s) Robert W. Harer and STATE OF WISCONSIN ) Sandra J. Hoogenakker ) ss. ST. CROIX County ) authenticated this day of Mav 2003 Personally came before me this day of Mav , 2003 the above named Robert W. Harer and Sandra J. Hoogenakker * Thomas R. Schumacher TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the persons) who executed the foregoing authorized by 4706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Thomas R. Schumacher BAKKE NORMAN. S.C., Baldwin. WI Notary Public. State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (800)655 -2021 www.infoproforms.comSTATE BAR OF WISCO WARRANTY DEED FORM No. 1 - 2000 9 J 2297N 039 ROBERT W. HARER / SANDRA J. HOOGENAKKER SATISFACTION OF LAND CONTRACT / TODD & LORI GRAF ACKNOWLEDGEMENT STATE OF ) ss. COUNTY OF�� ) Personally came before me this '7 '" l day of May, 2003, the above named Robert W. Harer, to me known to be the person who executed the foregoing instrument and acknowledge the same. RAMP s SHAMICA MITCHELL M a A &. - e NOTARY PUBLIC-MINNESOTA rgcr.l WE*W I.�.s1,ioo� Notary Public, State of • My commission expires: ACKNOWLEDGEMENT STATE OF ) ) ss. COUNTY OF X�) Personally came before me this d ay of May, 2003, the above named Sandra J. Hoogenakker, to me known to be the person who executed the foregoing instrument and acknowledge the same. Notary Public, State of My commission expires: St. Croix County Planning and Zoning Friday, September 08, 2006 at 10:08:26 AM Detail Sanitary Information Page I of J MMIN Computer #: 002-1005-50-100 Sub/Plat: NA Section: 3 Parcel #: 03.29.16.44B Lot: 1 TN/RNG: T29N R16W Municipality. Baldwin, Town of CSM: Vol. 19 Pg. 4983 1/41/4: SE 1/4 SW 1/4 - . . . . ........ -- - ......... . .......... ........ . . . ....... . ...... . ... . --- ------- . ........ -- . . . . ....... . . . . . . .......... ......... ... . .......... . . ......... ............... .. . . Owner: Harer, Robert 1112 245th Street Woodville, WI 54028 State Permit: 18776 Issued: 08/25/1981 POWTS Dispersal: Pressurized In-ground Permit: Replacement County Permit: 158 Installed: 09/02/1981 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Reauirements Additional Notes Money Owed Harold Barber Yes Boldt, Everett File this permit with the 1983 holding tank permit $0.00 Tom Nelson Signed Off: Yes in archives. 2006 system being inspected by Countryside Plumbing/Paul Koehler and he thinks there may be an IGP for the house. This is an existing farmstead, dating <1979 Maintenance Scheduled Pum Date Pumped 1st Notification 2nd Notification 3rd Notification 9/2/2005 - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Owner: Harer, Robert 1112 245th Street Woodville, WI 54028 State Permit: 34779 Issued: 01/14/1983 POWTS Dispersal: Holding Tank Permit: Replacement County Permit: 0 Installed: 01/14/1983 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Owed Harold Barber Yes Boldt, Everett This was for a trailer home on the parcel that was $0.00 Tom Nelson Signed Off. No removed according to Graf s. - - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — AS BUILT SANITARY SYSTEM REPORT OWNER Qza,^� TOWNSHIP �+ S E SL .3 SN -R &W ADDRESS - ST. CROIX COUN WS��� SUBDIVISION LOT L $ PLAN VIEW Distances and dimensions to meet requirements of H6,3 OW VERY THING WITHIN 100 FEET OF SYSTEM un+ A tt - I' Ide t' A. R I di a e o th Arrow SC L : BENCHMARK: (Permanent reference Point) Describe: 1o/ , e // caslrl Elevation of vertical reference point: O��/'®" Slope at site: 2 SEPTIC TANK: Manufacturer: GcJEe 1�S Liquid Capacity: &100 Number of .rings on cover : Tank manhole cover elevation: 1�'2- Tank Inlet Elevation: 9j 3' Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Z-ellee Number'of gallons 0 60 Number of gal. pump set for a cycle / 3o gallons; total capacity o distribution lines gallon: size of pump P head; gallon per minute p ; horsepower name of pump and model number G 3 ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number ot pits teet diameter feet liquid depth seepage pit in e�pe- elevation bottom of seepage pit elevation feet. SEEPAGE BED . SIZE: number of tines A� width 7 " lei`igth 5 the depth SEEPAGE TRENCH: width length PERCOLATION RATE_ AREA REQUIRED _3 - 7Sa AREA AS BUILT 3 INSPECTOR DATED_ �� G � PLUMBER ON JOB LICENSE NUMBER E S W AA ' Rev. 9/76 REPORT ON SOIL BORINGS AND PERCOLATION TESTS e +; WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES t9 P.O. BOX 309, MADISON, WISCONSIN 53701 MA F - A LOCATION: NE '/4, SE ' / <, Section ,TQVN,R"E (or) W, T ownsh ip or Municipality s Lot No. , Block No. County �r u iwslon Name Owner'slBuyers Name: R 10 b ele, e K Mailing Address: OLD 441)oogl✓ /,Me, TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT X ALTERNATE SYSTEM ____�__ DATES OBSERVATIONS MADE: SOIL BORINGS ' ;TO - -'/ PERCOLATION TESTS 6 & 9'1 SOIL MAP SHEET > NAME OF SOIL MAP UNIT A ^'� G Z A M GA PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE BOLE AFTEF INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 If k P eZ 14 if q It « IT P- n n u r / 0 r Am 7 P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK r� OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B � /e� .LM B _ if 09 t o it is 36 0 N O M 0 FL It /601 It JAR 'for 04a B- B - Wl�_ Z AJG v CJSG /� - d • Re SSc��a G S Sz�GM B— A P eCAus G o F K !L L- tW r9-+ eK PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy �� 73 o .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. yf .. ' — ' } 0 ovSe _ -� .. _ N lot ........ O vVitiq o/ a I O - --4 - P- 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the proledures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) c I�d �' Certification No. Address w i ►`� 5 Name of installer if known L Copy A —Local Authority CST Signatur llrl�" A .0 6/;:�� i t Wit' _ � � , _ �� r. , � , t.•� i' � � ; ti �.- - ..+.., 1 x: ST. CR01 X COUNTY W1 S C O N S IN ZONING OFFICE 796 -2239 HAMMOND, WI 54015 low June 26, 1981 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Robert Harer property located at the NEk of SEk, Section 3, T29N -R16W, Baldwin township, in St. Croix County revealed suitable soils to a depth of 49 inches, below which seasonable high groundwater was.noted. This site should be suitable for an in- ground pres- sure system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:sl DEPARTMENT OF INDSISTRY, INSPECTION REPORT FOR SAFETY & BULIDINGS LABOR , HUMAN RELATIONS ALTERNATIVE PRIVATE n DIVISION P.O. BO.- 7 969 SEW GE SYSTEMS v BUREA PLUMBING MADSSC!.!*. ❑ Mound Pressure Distribution NAME OF PERMIT HOLDER: T DDRESS OF PERMIT HOLD INSPECTION DATE: PLAN ID UMBER: BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: R ELEV.: F. PT.E LE ll y Q SEPTIC TANK: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: PROPERTY LINE: WELL: BUILDING: MANUFACTURER: ?.;' {:,; DOSING CHAMBER: MANUFACTURER: LIOUIC� /C C ©CITY: PUMP MODEL: PUMP MA OF CTURER: WARNING LABEL LOCKING COVER � V PROVIDED: PROVIDED: fn ❑ YES ❑ NO ❑ YES ❑ NO GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL: �,� PROPERTY WELL: BUILDING: AENTTO RESH DIFFERENCE BETWEEN F-1 YES C1 NO rflf >' LINEf_ PUMP ON AND OFF - � N SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBU S YSTEM:. gc, • :': ' ::• :, : °"" °, WIDTH: LENGTH: NO.OF SPACING CENTER LENGTH: DIAMETER: MATERIAL AND RKIN N E THES: TO is }; � C � MANIFOLD: PUMP: _ - MANIF LD PIPE MA RIAL AND !j;M JNO.DISTR DISTR. PIPE DISTRIBUTIO PIPE MATERIAL & MARKING: $•h DIA.: �/ -. -__. -. PIPES. DIA.:..) t/G } •Gc. HOLE SIZE: HOLE SPACING: DR LE CO RECTLY: DEPTH OF GRAVEL OVER PIPE VERTICAL LIFT CORRESPONDS TO APPROVED .....:.... . • -- � PLANS: �� J�-� Y S ❑ NO l ES ❑ N E SOIL COVER: TEXTURE: DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DQPT F OPSOI SODDED: SEEDED: MULCHED: CENTER: EDGES: r+ ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: SIG TITLE: DI LHR -SBD -6227 (R. 05181) T REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit� State Septic 00-P- NAME V1V�j � / TOWNSHIP Z St. Croix County I,OCATION OR s 6 _Section, Lot # _ Subdivision 'IPTIC TANK Size gallons Number of compartments J Distance from: Well V Building______ — _ 12% slope Highwater _ PUMPIN CHAMBER Size gallons Pump Manufacturer — Model Number MOLDING TANK Size gallons Number of Compartments Pumper Alarm System_ tistance from: Well Building 12% slope ABSORPTION SITE Bed Trench Distance from: Well Building__ __ 12% slope Highwater_ ABSORPTION SITE DI MENSIONS Width of trench ft Required area it. Length of each line _ _ ft Depth of rock below tile in. Number of lines Depth of rock over tile in. Total length of lines_ „_________ ft Depth of tile below grade__ in. Distance between lines ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover: PI D IMENSIONS Number of pits _ J — Gravel around pits yes no Outside diameter ft Depth below inlet ft Total absorption area _ _ ft Area required _ ft INSPECTED BY TITLE___ _ APPROVED DATE 198 REJECTED DATE_ _ 198_ REASON FOR REJECTION _ 7 State and County State Permit # �� PLB 6 P rmit A lic tion County Permit # Permit Application J'Y-. CRa ix for Private Domestic Sewage Systems County * DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required Z &X � ` State Plan I.D. # 1 — A. OWN OF PROPERTY Mailing Address: B. LOCATION: jE % _;�_ Y4, Section , TjJ N, R & (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Towns C. TYPE OF OCCUPANCY: * Commercial *Industrial *Other (specify) *Variance Single family _ ( Duplex No. of Bedrooms 3 No. of Persons 6 D. SEPTIC TANK CAPACITY /00 0 Total gallons No. of tanks 0/%1 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement x Lift Pump Tank or Siphon Chamber ©D Total gallons Prefab concrete X Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement x Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X Length 5 - Width— 7 Depth --?CLTile depth (top Z1 of Line Ted Seepage Pit: Inside di eter Liquid Depth No. of Seepage Pits Percent slope of land � n Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ O n am e as l on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certifie Soil Tester, / NAME e- 7 �OL f C.S.T. # 4 — 54 / 51 and other information obtained from (owner /builder), 71 p Plumber's Signature MP /MPRSW# /YIP(L! Phone # 7/S 6Jp� Plumber's Address L r PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. e a € € 3 i e e € e 7 7 7 7 w a i 7 i r 3 s r r F 3 i r, saes t e3.m� ., r E f f € r r x r € 7 �e r ' € p l € m { e r 3 i , r E � .. i s I Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY 4 Date of Application .$�� Fees Paid: State /" C unty &V Date Permit Issued /%jeeted (date) Issuing Agent Name Inspection Yes�No State Valid# Date Re — -- , WI 53,101 1. county (white copy) 3. owner (green copy) DIVISION Cw " Revised Date 7/ 2. state (pink copy) 4. plumber (canary copy) 17g lip VI •' 3 W Si f - 8 6! f N 5 IK i t; Z IP f. v � -err i J i Dt i b PA V9 G a b Cl O State Of WkORS1R ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION - Bureau of Plumbing p ` P.O. Box 7969 Madison, W1 53707 Plan Identification Number 8� call L J PRIVATE SEWAGE SYSTEM ONLY— ` P The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by Q �.� - N �Jb� -�'! - �S�QV�t?'C� a LI �,r �\ �q and received for approval on �.j��� - - The soil and site evaluation was conducted by t ^���Ar S � • �° \�� T SB The site meets th soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a \ n e_&Vnn'�'M "C' C'� Q Wastes from the building will discharge to a r `� O gallon capacity septic tank which will discharge to a ZLd l al - gallon capacity pump chamber from which a pump having a capacity of —�I 7 gallons per minute against a total dynamic head of L —feet will discharge through a inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS B County Other / `1 Enclosures O D A mes Sargent, B trector Dtt_HR -58D -6159 (R. 7/81) y - WORKSHEET - PRESSURE DISTM BUTTON NETWORK DESIGN PROBLEM Design a pressure distribution network for a _ ' bedroom home. The ;ite characterisitics are: Depth of groundwater or bedrock in. Landslope, 8 % Percolation rate 1 min. /in. Distance from dose chamber to distribution system / / /_ ft. 9# Elevation difterence between pump and distribution system 3 ft. ll) Step /Vf/ ESTIMATE WASTEWATER LOAD 45-0 C� N � • �'� � ` Step 2, SIZE 'rHE ABSORPTION AREA A) A1'MA 1'iiillllloil R1 �JU R) Select length C) Width is 7� D) I will use a CP ZK4K manifold. Step 3. SIZE DISTRIBUTION PIPES A) Hole size I will use is B) Hole spacing I will use i ,3( in. i C) Lateral length is o? 5 ft. D) Lateral size _ / _ in. ,1��'oN: I •''' Step 4. DISTRIBUTION PIPE DISCHARGE RATE R • • M p oAy eP • i BAi- o.NiN. •� ` • Step b. 5I /1 MAN110L0 A) Manifold length ft. 4• B) Number of distribution pipes = _ 81 r C) Manifold diameter __ /_� in. Step 6. SIZE THE FORCE MAIN A) System discharge rate B) Force main diameter C) Friction loss will be Ce ft /100 ft. Step 7. TATAL DYNAMIC HEAD A) Vertical lift ft. B) Friction los 4;a-- ;� I I' C) TDH ft. . Step 8. SELECT A PUMP Step 9. DOSE CHAMBER SIZE l4ys. 14eseR�� �� N b y o ut, .4L 11 -x „ Step 10. DOSE VOLUME (10 ^� ) HIGH HEAD EFFLUENT PUMPS ===mom mm�,—Wwmm IFA Inn. : I Ic 4. u j a m si+ V. lu it 3 oc a b v .�ui�iuiih y \ 11 ' ' �� � � ,`��, •••..YY�•• ,III b 3 E "^ J : . a0 a ry 0Z En b Q J � U `ot � 7• .��� t .•• ti,� lo t f ill off Q IL J g .. o w R ECEIVED '� - 3 PL U 19 81 �► c. MBlN� E vi 3 o W �J r 0 .y 3 z 8102475 s It 14) CL Q u1 �» e1 �• . J 'q- 4 Q OZ Li 4- tt I a J (� a' "v : k Q N >. s 0 q. I V Q o c 0 CI Q i J d Ala M lu o p IZ VIC IC I ie RL � s C chi -2 OJ 024 T 4; r . _ U y ? Ik) to Ul NJ � o a ... 3 r � 3 ��'� � • ri ` � ' -' CL• 1 D ta VIC p � I• I '�, O C!. J � f N �f! � J � � to �_ 1 Q • ii IL + � W - Q v 3 -T tit 8102475 c--., State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION r — Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Number L_ Re: � R��EIVC U � . . PRIVATE SEWAGE SYSTEM ONLY— �.i � - E co S E P 2 1981 ZONING OFFICE l The Bureau of Plumbing has reviewed plans, site survey information and installation details for the co 8 alternative private sewage system to be installed at the above- mentioned location. The plans and specifications were prepared by and received for approval on The soil and sitq- evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a Wastes from the building will discharge to a gallon capacity septic tank which will discharge to a "S gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a--inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS By: County Other Enclosures - EistiCl DI LHRSBD- 6159 (8. 7/81) mes Sargent, B erector srp 'sr clrkd' +s} ro. f" IQ �: , �7 urew Sao; #c y daP 8'y 6a ` �!SO Att urOd.s.Ereay'a6yas�s as suo►t{ dwnd �!"t h �- �• " IAdoa {,' ounoa UL*jj lU4" lo.iSaj }io5' duel �U 0t , 4t!IjB li, 401.lioS @p <" s.3► dtdaes "vawrtta o6 or ;1u+ 1 l Fcas' t#n+y+3 "Aye` !S: w aAW", 16uIPM4 [] -** 6ulppy io al!#o 0 sic - L Bu.1 '{Adoa t! pa�lnbai uoFla!Ilse► peetj" "Pena 09 l"i! ;o se S) : ;ci asn;palsd!3!lue " ©� anElelat elayduro Q o(- }'.aaisa3 tlospr}yltao palO}tiwo 5l t N3 uo{sl uc�l'.!ejerl`i.6� yta8 .. - wash uond rosqe: lips ;o u6i as -sson pue I!e3ap uo!lonalsuoo 0 ' iseaa�d; xa�nl3e ;nuew "duel ao pax alrs;J duel dwnd l}!1 ao Bu! ploy 'p!idas ;o I! uo!ipnalsao3 0 , „}O - O 'iSM of )tuft Bu!pyoq ago w alsAs lesods!p Ofiemas woa; saauels!p leJWi 11e pueazw:s -Io1 I moys uelcl I o ld •elep I Se I 1!as ap!noid - wolsAs luawa3eldei .w; e1gnIns "eele ;o u04e30-1 f u lod'eKtumpi wouewnd 10 4101 1en 8 13 [1 pts lie uo;SZ 6u!pualxa waisAauo!Idiosge y!os;o ease aj!iva u! stnoluoa Z y ;!nn a+ p punot swelsAS lasods allemeS aleA!Jd 'IN; •eJeuaalls ;o ma!A ueld C] ino cel teaalel ad !d punow ;o uo!I3as ssaa3 E uoiInq!ilsip paz!jnssaid jo; suoileinale.o 4!sap o (Ado3 I,) paambea aysuo Aluno3 * {u sAs eleuaalleue ;o asn jo; uoileoilddV) 801 8ld gn (swalsAB launayy }- swelsAS iesods!a aftmes olewa o Ild !I •pasolaua HASP! ; ;y ❑ WZ 9914 :Vollaas LAW pie Of pookmeis' 'pau6!s eq 11e4s Po4juarins uouewao ;u! Ilb' Q `lueuewaad so alq!Ilal 'aeala lou sueld palmu h ) ssalu 8;sak}�d!;cra pa!+�ugns eq Ilaefcra�ewao ;u+ Ieuo!lppd : 11 # +, Q F + 1 o R ut !spwgnS u Inbat ucr!ieutao ;ul Ieuo!ilppv' •pownlar 6u!oq sueld WWA"B ul 14 4 K Mm S vu *IM pexl!u qn sueld IWIllwaa uaaq SIN aa; ON . & tuaw ed yap: ! as ;.Ie sa r r3 l uiaa 'pe )pa yo s!,$AO" " Jooneo DM ayl - ;o auo :fuIPjAoJd : _ , ivausdaapun - -} IuwAsdxO ;otag pauarrlat "o4 s! jpvtOo3e ueW • . A 51 p iltr tw.a�% AiWAO U °tale t82 !p r! Asecuus!la r u!-oAoqa suX";lel+� o3. J. t • 4 `. ..... a«* nr.,+ w..... ..r- ea.w..« f* --•«. '#`.ae ai X ZOW Ul, it f511y ' :IS 3a A3uno3 ts PLC #l19 ui uI `�4t�# 4 #!d gtPlQS `� JsiMltt!}{ .34*qEV :133tOad oimr qj HI M ,ter 4t . 3A .. VIP r"a"s• , ss,' , �.aw.c.%' ,�.,. >. 'f " , , . n.,a, . ".,.>+a- .:Y #z„ R ti S 1.�'.. v' - f. '� !' - 'r•$ 'gy a is Or ; a Y, . F t .S k x i SAY VAR; Mrs 11 Wil UZI .Y'. r try '�h • $� y t �. r +�' � � pY c : y Ix 4� ,r a:• _ ,..n _ �skcxk"i k zit • ! ' .rit .��.. • - i f ,• �d OV s 2 1 x t ' 19,4 PROJECT Ajteru&-tk** System bet' 'kie Res �* : O Jj t � $.' 3 TOM Of PLAN tD. DETACH HE ME 7 777�77r' - taa,+ AME _ tWlW4 quked iri' $' Plan.accep for leiflaw t't�46V� i& x fee is being retrtrned l eca#asft f men nderpayn nt { � ►vidirlg.one'o the two " .ies.al ve is decked; remit C6,4 t fee io orne payment No fee ttasybeen rerrtiitteti: was su ittod with no fees WiiFl�e held i "abeyance: � ,^ r {, " _' bs iog returned. - "itional information requked:. E BELOW. 1, ° 'f� . i� Sutarnission � ` O A€c ditional information shall be submitted in triplicate unless specifically noted. Q Plants _not.clear legible or permanent.., . t rt lcsr►"s r# ritte ' §#saFl fae,'signe ;ieiiic3•or stamped in accord with Section H 1�2.2F(7)44 Y � EI Affidavit enclosed. #lv. i thamate sewage Disposal Systems Wound siecns #;. "tf58 (Appli on for use of analternate system}., . C� County onsite required (1 copy). ❑ De si gn caicuAns for pressurized distribution "& ❑Cross section of mound. ❑ Pipe lateral tayo ❑ Man view of alternate:, e, � dF lIk,.Private Sewage: Disposal Systems CI G r ound slope with 2' contou inentife area of soil absorption system extending 25' on all sides. ' 0 Elevation of permanent reference point {benchmark). L Won of area suitable for replacement system - provide soil test data. . v r - _ , Plot plan showing in size arid all: lateral distances from sewage disposal system or holding tank.to bl , o C'oostruction detait'of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. t , x :. 011 c nsiruction detail and cross- section of soil absorption system. � ,- I Spit boring -and v eroolaion test :onir - li't5 corripfeted by certifedsoi# tester, (4 copy }: ' 1 data relative t+o anticipated use of bldg. Q 3 copies of Pl B enclosed. ` peed restriction required 0 copy). t1.rioldingTanks Profile of holding tank. Holding'tank agreement signed by owner -arid local unit of government (sample enclosed) 0 Reason for installing holding tank soil test or statement from county (1 copy). ; " Lift Lift Pump ,1Calcntations for total lift_.{mp.discharge, head and gains pumped per cycle, length & depth of force main �`� }:t7 all- &'nxxlel of pump or automatic aipla+ans includ r g size, pump curves; drawcVawn and' atterage °fil +�rar � ; 0 cross section of lift pump tank showing .pumpfs) or 0phon(s). do.l~tll°4Fill rtlsearcor °+suasai+ L f� E - f4lted 3 eslge>of trioth before side slope begin). " }� r' #:v = 9 A is � r , 1 Si a. " h P S 35c 5 -" q1+ •. 4 r — — — a — — — ._-. -r -+. — — _... — — , i s r ..s v' a _ - * ' e . k i±at', .;,r �- x n .?t, ., _ :'� Y' bra A l op d €: r. i r r i .. q & Y �y ' •:. -. .: ., .. - - r:._��.. "fi A' 4 d Y Si x k A All I PROJECT. t x • U, TWIM of Aim tfLAN t t s ". 1 ; t a:s iw DETACH 14ERE "e. s �x.� op �x a�i`cd {- 1' ""`....- *...aww....sy„.....,.,, c••:i s a a.. A Fujf i b bei �.Keturned C1# QY @{K1 a rl ��tid. ane c�f;tharty ` ' , is raaen o- .•, ���:.FBKnIt W''@�.f fee Iri pay ment s beer► rerriitted F►lat►s submittal #'�i^'�t' WfeesIvill b44 held idabeyar4e; ng ret d * t � to al information required 3 Lei 5dka�tissior•. f Additional information stall be somltted: in triplicate unless specifically- 'noted. � z Plans not dear, legible or permanents! f in or a€tion submitted ShOlf be signed, �seeled-or -stamped °in accord. with I%ctior► H fl2 25� Via) 1 Affidavit enclosed. C .GOunty onsite required (r1 copy(, pesign sal ons for pressurized distribution C�,Cross section of mclur�l� :.'O Pipe latexal la ❑ Plan view of alternate. tl.. private Sewage Qispossl:SysteKns {.Ground slope with °2' contours in entire area of soil absorption system extending 25' on all sides; 0 Elevation of permanent reference point (benchmark Location of area suitable for replacement system - provide soil test data. Plot plan showing lots size arui -alt "lateral distances trom.st wage disposal system or holding tank to bldgs, :lot -fi Con "struction detail vf- septic, holding or lift pump tank if site constructed or tank manufacturer if © Construction detail and cross section of sail absorption system. Y ring anti perms test 1.16 corn by car ed soit #ester (l copy): :.' _eta data r.81 &�tt�:artticipa ed use atblov"03 "vopies bunlr66 enclosed. bead restriction required { 1 copy(. �#oWing T�n�cs - �f of holding tank. . l"*Pg -tank agreement signed by owner and local unit,of:government (sample.ei�cls*sed ►. 0 Reason for installing bolding tank soil test or statement from county 01 copyl.: }r .: w. Lift Pulp C�l,atrcr�. >.fc�c.t+at :.l lift star °tie h � i �, nsAK �.� adanc��lkttiszpunti��tr.cie e� a depth of forces fvlmi: ' .rrtiCcirsi ofp.ar.akftt#ic sipfexrtcluding sfaa. ltuntes de; mad aver l r stif f li1pump 'xOak s60a►'uj�'pu�r►p�skar Ww tll +x #se �►rior. tsa plaresCrrtisicica4�` l ���`''�•� ,� ,:`� �f:�+s0ii:�.s�de�3lope-t�g(n?* -��.� ^� �' 'r' 7p. r Mv WA oil AP 4 ` * A ` '� ; b p n _.-. — a .-- ..>- .... �. - .s,,.- --- -^ ,w.. -r- 4E+'�g'^ -- — ..e �..wr. +s+. e... _._. _._. � -�. - a+�iy}'��P'°�➢��� .�i As 9 fi K..p Y� a.' . +`. .. - s 'y .# 1M1 t, : k �a T! o� A . - i r E , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, CC DIVISION BOX LABOR HUMAN REDLATIONS PERCOLATION TESTS C11J, MADISON W 53707 LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: T NO.: LK. NO.: SUBDIVISION NAME: N E I S0/ 3 /T 29 N/R I� (or) W gCoiAwin-_ E r COUNTY: OWNER'S BUYER'S NAM MAILIN AD R SS: St Croix Rob vt h r Rt. 1 w oo(Av*%\le_ sh W1 USE DATES OBSERVATIONS MADE NO.BEDRMS.: I COMME R AL DES RIPTION: ICI ��Residence ❑New XReplace EFICOLATION RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSUYSTE -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) as []U as ❑u RE: S os ou as 0 If Percolation Tests are NOT required DESIGN RATE: If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO R UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED E HEST TO BEDROCK IF OBSERVED (SE ABBRV. ON BACK.) / /1 0 B-5 07o' �o ��1# B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN, PERI D 1 PERIOD P D3 PER INCH P- P- ; �� Q bit- P _ v I/ P -- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION So i9cr�s Q' R _ 7 . tN _ I O f - Ta p es 1\ . � _ ,® ._._ {- - O/ d __11 bb co k' Yl it I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print ): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): ST SI URE: _ I:NT o� REPORT ON SOIL BORING 'jW fit) T R e tMOR Aft PERCOLATION -STS ( 115) . HUMAN RELATIONS TE y A I TQWNSHiP MUNICIPALITY: NQ: SUB : ::'� ;� p I 7.9 N/R (or) a �t C OUNTY: OWNER'S/BUYER'S NAM LI R ! o vl 1e USE DATE$i3PSERVATiatm♦il ? NO. B 1 COMMERCIA! Residence ❑New Replace RATINoi: S= Site suitable for system U- Site unsuitable for system € NVENT; idAt: IMOUNO I -G S E -FIL OLDING TANK: RECOMMENDI SYSTE u ❑s cu s u EIS au a :. DESIGN RATE: k &, If Percolation Tests are NOT required If any portion of the lot is in the ..under s.H63.09S5►tbi, indicate; l= loodplain; indicate;Fioodptain elevatitHt: -s PROFILE DESCRIPTIONS BORING TMAL E ER ­l ht S H RA TER OF SOIL WITH T NUMBER DEPTH IN ELEVATION OBS V TO BEDROCK 1F OBSERit D ( j .'.. B- /es q0 t p / r /r �r'"'�t tfe� l J , r .'. t� tt PERCOLATION TESTS w ` TEST DEPTH WATER IN BOLE TEST TIME DROP 119 WATER LEVEL WER INCHES AFTER§VELLINQ INTERVAL-MIN. PERIOD I OD .:" P. P- Q �� '. N n P- , P- PLAN YtEVM: Show locations of percolation ,tests, 'soil borings and the dimensions of suitable soil areas. Indicate scale or discaneaxsktbeirlt zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and Fd of land slop. SYSTEM ELEVATION 140 Lj to i j 3� C7 a % i J P (" 13 CO n r a i B _ i I the undersigned, hereby certify that the soil tests reported on this form were made'by me In accord with the Proed % cures methodp_spedfisdi ib'"n Admilmistrative Code, and that the data recorded and the location of the tests are correct to the best of rriy knowlocille and tieFlif. NAM print : ✓� , G TESTS WERE COMPL ED ON: ADOR S: ERTtFICATI N UMBER: I PHON v. sd eye. Nn R� tgy xa Y �Y3 t • r yam. "" � M � F 'P' y } 4 � }Y $� + � s �/'` ^!YyS } �f� 1 ".R':.{` � l . J =''4 —tip' i �Y4O iS$;(" \v� tltl sMA y[i ✓"..P?etb 4'IYr,j ' � ' .Ji t 3 �a `� # i } �.,: { .Y . Y ,a ' . ii { ABBREVIATIONS FOR CERTIFIED i6k' TESTERS i+dr 'Alf ' � •. '`- ' "Ca. s., .:� � r'�Yi g , �r _f' ;'� � � ..,(�r r 1�,� � •_tP "d €: � ti y $oil�ep€�rates- anle>r �f . + ,? a.x„ .rl� � ✓:. t, , .. , � : �,,'h )�Ug• p. d � �rY ;'37.'�T1tl' st 4nc . t ° ` BR.— Buck E� stone gr Gravel (under 3" �' l'rrne� toe i ''€� qtr � r'ar:a?'t€ Aj ! } fir. rt1!:f _ med s — , Medwtr,$aad ' e wo — W1611 ©fined rr - MW I) MWI)'� - r Is — : oaawr•$l nd SPD SOrt7ewlhaf i - k # 1 — Loam f — wo t° f' _Silt Ltrem < .. - -.Bui t s x = Greater{ than scl Sandy Clay Loam Brown .1 4W .— Silty Clay- loam k +� _. . ac SSandy Clay Gy - Gray f # �� ., — 1 d Y -- yel1WAF .. , .. 'c — Clay d .: dlui x Red.. -� 1o1oa iA! A V 6 ?.fit 1✓53,# +v-i f — ' 4 7 4 fgw,_finejaiat, 1 s� . " S }x gr�lo}I._texture mm- for h9uA.v9 . d}spq�i tga water lanai, t _ !.k£yso? to -- :..- 8ienc"ark • `. :.z . •:r a�fl5•~S;�,i (r �:> �'�a' tr:.. lgp�^.. VRR Vertical Referervce Point Y 0�. A. t 'r r~ >F , v _ � t `1 _. e`,.`5i, .c e. 4 r•t I n { +�4 tt,l,ff `t... ! ?fl;. ` 'Q'.:_ '+}+Z += .:1Q.. 1+:hJi '!Y1e tj}fF'•'! : d $'x� � 3J' Y'3 !' eF9;- ye S tY `�Ll, `.:70, :Tt;i �drre "+. i Via., @s f' % . 1 ;� !T it d 0`� x t ST. CROIX COUNTY r�x5 - 41 I � WISC0NSI N _. ZONING OFFICE Lm MA RAILA 796 -2239 (HAMMOND) 425 -8363 (RIVER F A L HAMMOND, WI 54015 Q UARTER L V P U M P I N G REPORT r ZZ ST. CROIX COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 DDS Nf/ IJ . �l1- 5 L/G HAMMOND, WI 54015 715- 796 -2239 oa 715- 425 -8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PIMP NAME OF PUMPER: LOCATION OF DISPOSAL SITE: 7"��/�I� /) / (J, ,Q�r� //, S '42 A IV E' NUMBER OF PERSONS CE: USE: YEAR ROUND SEASONAL (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED c�o0 THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1985 OWNERS SIGNATURE BALANCE FORWARD 2 _-d- -- . .. .. ._ ... . ..... .............. _ _ _ _ . ........... .. ... . . .. .......... ...... ...... ____._. _ ._.. m n $ ............................. ....... _. ..._.._.__............. ......... ...._............ .... .. .. ... .._... _... _..._....._...._.._........... .... ... . _ 5 . .� " ,e . ............ .... ....... ...... ........... . ... _ .... .._.....__...__.. ............ _........... _ . .......... ... ..... ... .._ .... .. _........_....... ....... .... ... ._....... _....._....... _�...�... N F ...... . . .... ... ..... _ ........... ...... .......... _. .... _._.,__......_...«._......... ----- ......._ ... ...... ............. _ ... _. .... ........ .................. ...... _. ..._...._....._. ..._........ _..._.. .._ ^r PAY UST AMOUNT LICKNESS CESSPOOL SERVICE IN THIS COLUMN N Zd 4 �, azy cp o i i i, !I l - �- �� i r _A s a ? 8 ST. CROI X COUNTY W I SC 0 N S I N ' # joy �F ZONING OFFICE yq le Ax a 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) mow, HAMMOND, WI 54015 QUARTERLYPUMPINGREP0RT ST. CR01X COUNTY NAME J A r, RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 q�� 715- 796 -2239 an 715 -425 -8363 TOWNSHIP �(,(/ PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: & r-ejjj?(?w LOCATION OF DISPOSAL SITE: � l N ���y NUMBER OF PERSONS L ENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED � a000 THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985 OWNERS SIGNATURE e ; • «�+rK�°T "Sj'� "'�'�_'. tti, �. -" � 'art +� 's :.. �=' � .+ "� i j I C� 1 ._ .. ., •gym' � t..t ,:3� '. wilwillollil'i M DATE � INVOICE NUMBER / DESCRIPTION I CHARGES I CREDITS I O+eLANCE l BALANCE FORWARD .. ..... 1 ......... ..... . ..... _._ _ ._...... ...... .._ ......._. .... ... ....... ....... .. ...... _ ......_ .._.... _ ..._ . ....... .. .. ....... i . ...... ............ .... ... ._ ._.........:_ ._ ...... ._ _._... _.... . ...... ..... .. .. .. _ ....... .......... -- ....... .. ........... . .... _ . . . .... _ . .... ........ ._ ...... ..... g; o --r., . 147 :. PAY LAST AMOUNT LICKNESS CESSPOOL SERVICE V IN THIS COLUMN w� ._, ? L_ ON 0-4004!v i K ro % °•r 1 ...,�rs' s.� ....r<v.- �sut+' -'tt '�� 'Li.� ` .t-ov., •,�`. Yix`� tier •C 2. R•! - pjx + ,• ;c I�G ^Fz ^mi��t. -esi• i�it�h a. .J a MF,.ia�"'�;�: -c-� `_ �..,:', a: �•:si =sz #:, `"• -_ �„� i�+�+°.�°j.� x, aEr?; `-'�.e srwC�•'�_ � t s ST. CR01 X COUNTY ` WI SC 0 N S I N ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (R I V E R F A L LS) HAMMOND, WI 54015 t Vii` Q U A R T E R L Y P U M P I N G R E P O R T ST. CR01X COUNTY NAME �Qr'i � RETURN COMPLETED FORM T0: ADDRESS �QLL7`L° ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 �/ Ile 7� q HAMMOND, WI 54015 715- 796 -2239 on 715 - 425 -8363 TOWNSHIP �(,� l(l/,/ Il Q PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER NAME OF PUMPER: /-fi A LOCATION OF DISPOSAL SITE: :Jv"� NUMBER OF PERSONS LIVIN CE: _ USE: YEAR ROUND SEASONAL (CHECK ONE) JANUARY FEBRUAR MARCH DATE VOL. PUMPED �DA/TE� VOL. P UMPED DATE VOL. PUMPED � 0 0 THIS REPORT MUST BE RETURNED NO LATER THAN MAY 15, 1985 OWNERS SIGNATURE h . ill P INVtNCI[ NUk4emER / CIBSCltPT10N I CMARAM ( C, BALANCE FORWARD ocnl-- u -air• ti�X ��, - _ ..... _ ..... . ...... .. .. .... _..... . .. -. T S . _._... .... ..... ............... _. .... •u .; __...._... . ..... . ......._......... . _. .. ._.. _ r t r yr. t �_ ......... _ ..... _. ................... _ .. .... _ . .... _ _...._.. _....._...._. M ir ' . �(._i� ►IW IJII V1 l7alf PAY LAST AMOUNT:. - LICKNESS CESSPOOL SERVICE /VT IN THIS COLUMN ••`r•t$ Y �,:;• ^ t . :;.� .+ �"." mgr a• � G*�' v� x '' r� ,} :> °rt' !=. 8 K ..•..tx I ,.'�:•".. ... tea. tea : .cY4r,A rR l t ;.iL i. T ' S T. CROIX C O U N T Y y " > • �y a 4j fi WISC0NSI N I V7 bl �" �`' _ ' t * {• ; ` �� /, rp o `oy ZONING OFFICE 4 - : 16 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, W 1 54015 Q U A R T E R L Y PUMP I N G REP O R T ST. CROIX COUNTY NAME: RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE. B 6W r HAMMOND, WI 54015 715 796 - 2239 or 715 - 425 - 8363 TOWNSHIP: PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: c LOCATION OF DISPOSAL SITE: 7;2 9m , I E Of NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND_ SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1985 OWNERS SIGNATURE mj:12 -83 F > ST. CR01 X COUNTY o C WI S C O N S IN ZONING OFFICE 796 -2239 (HAMMOND) 'z 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 �U A R T E R L V P.0 M P I N G REPORT ST. CR01X COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS. ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 adw / 6 li)IT ,Cjl/��' HAMMOND, WI 54015 r 715 -796 -2239 on 715- 425 -8363 TOWNSHIP PLEASE PROVIDE THE INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: -' %I D O �l Z LOCATION OF DISPOSAL SITE: � NUMBER OF PERSONS LIVING IN RESIDENCE: a USE: YEAR ROUND SEASONAL (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED 7 a 600 'zw ad. T HIS REPO MUST BE RETURNED NO LATER THAN OCTOBER 15 1984. OWNERS SIGNATURE OzC - ST. CROI X COUNTY �, , ,�►, ,.r � 6 W I S C O N S I N G4 CF140 ZONING OFFICE 6,�, 9 796 -2239 (HAMMOND) �t 25 -8363 (RIVER FALLS) HAMMOND, WI 54015 U A R T E R L V P U M P I N G R E P O R T Jv/ - - -- ST. CR01X COUNTY �v E RETURN COMPLETED FORM TO: ADDRESS L ST. CROIX•COUNTV ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715- 796 -2239 an 715- 425 -8363 TOWNSHIP ���,( /l //}'f PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOAPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVIN E: 1 yv � xZ `°. a � USE: YEAR ROUND EASONAL (CHECK ONE) APRIL MAV JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED C'�oltox.- y a 5� THIS REPORT MUST BE RETURNED NO LATER THAN JULY 15, 1984 OWNERS SIGNATURE AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. 3 'T29N - R,/ / ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION Aq LOT AX LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 lnl -EVERYTHING WITHIN 100 FEET OF SYSTEM 35 ZI - a - - — r 1 I di ate or'th�A royo -- - - _ -- — - - . . SCAL BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: T r Liquid Capacity: Number of rings on cover : Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer �/�, �,- Number of gallons ZOOO Elevation of manhole cover Type of warning device a,-� SEEPAGE PIT SIZE: uN er ot Vits feet diameter feet liquid depth seepage pit inlet pipe- elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length the depth SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED /- %y PLUMBER ON JOB LICENSE NUMBER J ?--5-.�? DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 7969 MADISON, WI 53707 1:1 CONVENTIONAL ID ALTERNATIVE State Plan 1.0. Number: ❑ Holding Tank ❑ In- Ground Pressure El Mound aewnad) Mound )S2 06, 7-J O NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 0 r BENC H MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV: CST REF. PT. ELEV.: S C 'V � 3 T' .`✓i o 'K I (" (ti) Name of Plumber: MP /NNRiWMo.: Cou ty: niterY Permit Number: SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ARNING LA LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH NUMBER OF ROAD: ROPERTY WELL: BUILDING: I VENT TO FRESH J ALARM: FEET FROM LINE: AIR INLET: DYES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO I I I I ❑YES ❑NO ❑YES ❑NO. GALLONS PER CYCLE: PUM AN rilIN1 L RA IoNAL: NUMBER OF PROPERTY WELL: BUILDING: I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI AIR INLET. PUMP ON AND OFF) I ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAtN CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: T1N57 TRENCHES DISTR. PIPE SPACING: MATERIAL: PIT INSIDE DIA *PITS DEPTH DIMENSIONS GRAVEL DE TH FILL DEPTH UISTn PIPE DISTR. PIPE I I MA IAL NO. DISTR. MBE ELL: OF W BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER. ELEV. INLET ELEV. END: PIPES. FEET FROM LINE: AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ❑NO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TEXTURE: PERMANENT MARK RS: OBSERVATION WELLS DYES ❑N ❑YES ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED: SEEDED: MULCHED. CENTER: EDGES: DYES C] NO DYES ONO 1:1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH LENGTH. TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PU MANIFOLD DISTR, PIPE MANIFOLD MATERIAL NO. DISTR. DIS 1 DISTRIBUTION PIPE MATERIAL a MARKING ELEV. ELEV. DIA. ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS Y ❑NO []YES ❑NO COMMENTS: ANENT OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ERM DYES L_�NO ❑YES DNO NEAREST Sketch System on Retain in county file for audit. Reverse Side. r7 1 L DILHR SBD 6710 (R. 01/82) APPLICATION DEPARTMENT OF SAFETY &BUILDINGS INDUSTRY FOR SANITARY SAFETY LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property ner Mailing � Address: d 4a 0-f ,t3 ZK/ ✓j lie 61,; 1 , S ' Property Location: City, Villa a or Township County: E ' /4 3 /T�9N/R /4 i(Or) �4L w / :a Cgoix Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned d cx 06 7 TYPE OF BUILDIN �� J Number of ❑ Public* ❑ Variance ❑ Other (specify)* M6 b/ Bedrooms: 1 or 2 Family *State Approval Required. b TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY : 2 006 OW E X X LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: , 7 4e EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑' Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installat• n of the private sewage system shown on the attached plans. Name of P bar: Sign e: MP /MPRSW No.: Phone Number: Plumb ddress: Name o d esigner: 04 4, dc J; -j ail,t'S LVGAff /do�G f COUNTY /DEPARTMENT USE ONLY Signature Is ing A n : Fee: + 4� oat :) Sanitary Permit Number: /lA APPROVED DISAPPROVED 7 Reason for i pproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. I DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink- Owner, Goldenrod - Plumber DILHR -SBD -6398 (13,07/81) r � / � y r. yy�..y�! -At ' «Y3a�; �.'{`y�� 7" ��' � r r ► d Mi!.rw.�w+rwrM+j.yyf 4 a eo t , y vJ Y 4 o IL40 y CO . CEO AI it MP 1 ` yyyyt r Ro{..mob gt 1 ! f - A i. ► t � i. i + � nw arm V .o � w r, ''pi. •Y ' a LAM y � 1 a• �{ '!." q'rf r �w µ"!' � n f � *� ,y '"� �!, it w.. a ts.. .,�i t t � - f ►� a. i t y <4 t 1- 4' [. t w • w � �� 1 4�.G M�1 ! 1V!\ r ' + r At o r Yo — 77� + i i A'Io wo lwc � f , r r Moo �a x ~ Department of Industry, Labor & Human Relations e Division of Safety & Bldgs. k�f 31t8te o� Wisconsin Bureau of Plumbing Platting & Fire Protection ", P.O. Box7969 Madison W1. 53707 Tel. 608 - 266 -3815 INALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. ` NAMEOF PROJE T TYPE OF APPROVAL '..a s s STREE�T AND NO. .T ----^ .316 Q L" CITY OR TOWN 1COUNTY ISTATEIZIP r OWNER Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. I The architect, 'professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code- requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed.. Failure to obtain local permits will auto- matically void this acceptance, Sincerely, S Cl�fre� James Sargent- Bureau Director PLANS REVIEWED BY: _- DAT cc: DPS4[1lIY .> Owner DILHR Local PI Plumber H & R (2) Mfg. Rep. Bur. of Health Fac. & Services DILHR S9D -6099 (N. 06/80) Rec. & Env. Services f ! - Y SYSTEM ELEVATION B R U M4 _ �- �# 3 o mob Ir- m OR le d n .. ms s EKES -�� TN ? ' .off' Na usF oib.4'�''tie q OF �° ` /h o b.. /•�0�►t /00,0 � 1 83 p R,v e t 44 Department of Industry, Labor & Human Relations C Division of Safety & Bldgs. S tate of Wisconsin - Bureau of Plumbing Platting &fire Protection •. P.O. Box7969 Madison W1.53707 Tel. 608 - 266 -3815` IN ALL CORRESPONDENCE art ,-.,""' ,- REFER TO PLAN IDENTIFICATION NO. O ,,°S''"`^'3'C'. ,J�^C F, - �.•:..� '.."'t./ / ...:a �v� r ,t� `�` ��! NAME OF PRO T j TYPE OF APPROVAL STREET AND NO. .,;, CITY OR TOWN COUNTY �-t STATE ZIP Gc Ig 701983 OWNER Olt, Gentlemen: Examination of plumbing plans and specifications for the above- mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of - plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan- omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed_ failure to obtain local permits will auto- matically void this acceptance. Sincerely, James Sargent- Bureau Director PLANS REVIEWED BY: ! DATE: cc: DPS6I S'? Owner DI LHR Local PI Plumber H & R (2) tiunSx. Mfg. Rep. Bur. of Health Fac. & Services DI L R S9D -6099 (N. 06/80) Rec. & Env. Services SBD 6678 (9/81) (Plb 100a) -�` STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With B UREAU OF PwMBII 201 E. WASHINGTON AVE. RM 178 Any Return Corresponden ���?'__ P.O. BOX 7869 07 MADISON, WI 53707 608 266 } Cf Jgn r PROJECT: -rte DATE: / d� ����Ct Z-- � � �C ,- �'� , J f T . L C r � t � 16 d - PtAN-M # DETACH HERE PROJECT NAME PLAN ID. # U 7 D This is to acknowledge receipt of your plans and for the above indicated project. Preliminary review indicates the required fee is $ Fee Received is $ Underpayment - Please submit the additional fee. ❑ Overp - Refund forthcoming, v ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be Additional information required. SEE BELOW: held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ °Additional information shall be submitted in duplicate un F- copies-of.fLB 60 enclosed." less specifically noted. El Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. Cl Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. K Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑ Plot plan. course, lot Fines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons'including soil data. size, pump curves, drawdown and average flow rate GPM. El Plot plan showing lot size and all' lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). ` course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. V I. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross - section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer ❑ Depth and type of fill. tified soil tester 0 Copy). ❑ Copy of onsite report by county or district staff. ;r NOTE: As specified in H63.18 (4 A) Wisconsin Administrat_iv(, , Code this document is to be recorded in the Tract Index, to- cated at the CQu.nty Register of Deeds. At the time of Sani- t1ry Perwit Application, a cope of this agreement, with the 8 8 ecording dates and numher should be submitted to this office. co 0 181983 HOLDING TANK AGREEMENT of This Agreement is made and entered into this day of eGem .e 19 b'�, by and between the F w.•a , hereinafter called an o e, here nafter Falled called t e I We hereby acknowledge that application has been made for a building permit on the following described property, to wit: P or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. We also acknowledge that said property cannot now be served by a municipal sewer or septic tank —soil absorption system. Therefore, as an inducement to the County of 6,eo i x 'to issue a sanitary permit for the above described premi we h ereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbin ode relating to holding tanks. Any time the Town or Mua*640a44ty of At.dw. through its Plumbing Inspector or Health Offi- cer, necessary to pump out the subject holding to , the Owner sha ll have saline pumped out in twenty -four (24) hours, or 01.) Al S ll. will have said work done and charge same back to Owner and place same on the tax bill as a speci charge. The Owner further agrees that the Town or Minty of ALd ma enter upon the propert' - ae`s- cribed above at any reasonable time, t i ns pect, or pump and haul_ wastes from the subject holding tank, 2. owner afire ' S to pay all charges and costs incurr by the 'j, or Municipality of Rtid .v for inspection, pumping, hauling or otherwise servicing an iima n a n ng a subject holding tank in such a man- ner as to prevent r ny nuisance or health hazard caused by such holding tank. dc✓a> ,� C�eR9 shall notify the Owner of any such cost which shall pa y th e Owner within thirty (30) days.from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of: nuisance, and said tax shall be collected as provided by — Wisconsin Statute DILNR -M -6123 (8.3/81) t Page 2 3. Owner agrees to have a quarterly pumping report submitted to the local government and the county which will state the Owner's name, location of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and the disposal An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted to the Department of Industry, labor and Human Relations by the governmental unit responsible, per section 145.01 (15), Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code. 5. This agreement ill remain in affect only until the sanitary permit issuing agent. in J'-/, g R ar x County certifies that the subject pro- perty is served byeither a pub c sewer or a septic tank --- soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree - went may be cancelled by executing and recording said certification with re- ference to this Agreement, in the Tract index indicated above. 6. This agreement shall be binding upon the indica governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this 7 S day of e �► TOWN OR MUNICIPALITY OF ��1.�1t w OWNERS by 11'.4 a4dYZi 4z:t� t!� by - STATE OF WISCONSIN Personally came before me� this 1 % , day of 1J C j'M rFiL , 19 the above named <(' •, E L� . 2 M <t N , to me known to be the p�ers os q — , whole,xecut - ed the f instrument an acknowledged the same. . 1 � THIS INSTRUMENT DRAFTED BY My commission expires: ST. CROI X COUNTY s W1 S G O N S I N / 4 ; t . Y l y V 3 Y '`,* Z O N I N G OF F I L E 796 poet 0 666ice sox 227 181 19 R. Hammond, Wl 54015 O W N E R P U M P E R OF f /CF A G R E E M E N T , z PLEASE BE AvvIsEv, That unt.i.t you ane again noti6.4ed, 1 witt con.t/I.act with l •NRi s �. �� k�N e s s 06 4 icKwcs s C: e ss I p00 4 6 - e- V. ViAconain, (Pumpeh), Jan the punpoae o 4emoving, att w aete 6 4om the aani,.taay &yatem to be Located on the pnopetty and 6 utune home site Located in St. Cnoi x County, W.i.acon.sin, Towrtb«,i.N u6 %�A�- c{�✓� being in the 4 0 6 the % o6 Sec. c.7� , T. N. -R. W. (o t mo ne 6u.tty deec4ibed as 6ottowe: ) Dated thsa -yC day o6 _ 19 �� . .fr (OWNER) State o6 W.idcon6inl bb County 0 St. Uo. x ) Peaeonnattyappeat bejone me this day 06 � - the above named 43 rtz- �}L?,roy Q to me , nown to a he pekAon who executed t e oh.egoing inbtnument and acknow.tedged the same. N ot any u ltia, t. Ckoix C ounty, Wl My Co mm .„ (ce p e ml� n,t ), t E x p vc ea 1 /�9f1 , M 1, C heaeinbe6oa.e ae6 enn.ed to as Pumpe4, jo•i.n i(he a o�neement to the extent that 1 have a eonttac.t with Ownek ae 460ue 6tAted. f PUMPER ) ST. CROI x COUNTY WIsC Z Q N I N G t� F f I C E 796 - 2239 Poet 0666 Box 227 Hammond, WI 54015 0 W N E R P U M P E R A Q R E E M E Al T PLEASE SE AUVISEv, r haJt un.t.it you ane again n o ti6ied, I w.i.tt conJt get with cIl S ely e s s' 06 1 l 1 c-k'We_s5 � vi.4C.Q►Oin, (Pumper). 60-1. the punpo4g 06 temoving aet wad,te 64om the 4ani -t4AY 40tem to be .toca,ted on the pnope4ty and - 6atu4e home Otte located in St, Cxoi v Coun.tn Wizconein, Town-4hiN vb being in ,tha cS! �� a6 the 9�i� 06 Sec. T. N. -R. t 04 m;o U A utt y d ea c ed a4 6 o t.t ow4 = Llaxed th,i4 day o6 19 , IOWNER I ­'A State 0j oji..acoft4in1 eo Coun.tt d St. C40ix1 Pvtaonna," a N PPea!x be me •thie 1 a 6 (l°LC:���t� 19 the above named o me nawn xo Te Ala e P"40d who exece e t e oh.e #o4;ng i n4 , t4 ument and { aeknow edged the aame. Wl o aAy ic, ,' nvxx oun 'y, My Calm. (iA pexman.t) (Expi4e4 /o, Notary Public = State of wiscornsin M, Cv Lres or 10, 19 S e• I, C` ,s M G,cK,�¢s Y a Sion Exp s hexe.cnbe oae n.e eA4e za ae Pump n, join 44 . the q a o v e ag4eeog =t •t a e xtent t hat I have a cantxact with 0wnelt a4 above started, * °O,� N 0TARY (PUMP M PUB, LI .. � `ham j �, k r+'...fp A XpE r'/Mt1. �V/ AqS . '''tr'regaoMSLAti► NOTE; -As specif in H63-18 (4 A) Wisconsin Admini5tr.at.i "Code this document is to be recorded in the Tract Index, lo- cared at the County Register of Deeds. At the time of Sani- , tary Perwit Application, a copy of this a- reement, with the "? recording dates and num� should be submitted to this office. HOLDING TANK AGREEMENT This Agreement is made and entered into this , �, day of C. 19,,,x,,, by and .between the i,,✓"",� hereinafter called here na te -al ed We hereby acknowledge that application has been ode for a building pandit on the following descrlhed property, to wig: or that continued use of the existing premises requires that a holding U be installed on the property for the pur pose of proper containment of sewage. Me also acknorledge that said property cannot now be served by a mun sewer or septic tank — soil absorption s P Therefore, as an inducement to the County of fit, Coe n i x to issue a sanitary permit for the above described premises, we hereby agree ' and' bind ourselves at s follows 1. Oomr agrees to conform to all applicable requirements of the P1u�ibin 4od to holding tanks. Any time the T;,, p N ie4l -ity of d w „ through its Rl umbi ng t nspector or Health Of f i - cer, e necessary . out the sub holding to * A the Owner shall have same pupped out in twenty -four (24) hours, or � q w ,✓ Q A shy %P Milt have said work done and'charge same back to Owner a pace same on the tax bill as a specV charge. The Owner further agrees that the Town or Ml y of A 4, w N may enter upon the property"" 'es- cri bed above at any reastuna a one, d nspect, or pump and haul wastes frm the suolect holding. tank. 2 Owner agrees to pax all charges and costs incurred by the I= or Municipality of a�4ci44.4 Pl for inspection,. putm►ing, hauling or otherwise servic ng an maintail n9 the subject hol ding tank in such & man- ner as to prevent r aba an nuisance or health hazard caused by such holding tank. N 6 X e-0_k shall notify the Owner of any such cost which shal pa y Own ithin thirty (30) days from the date of notice and in the event that the (toner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll a s a special assessment for the abatement of nuisance, and said tax shall be col lected as provided by r '. Wisconsin Statute. DILHR -SBD -6123 (R.3/81) y, } Page 2 3. Owner agrees to have a quarterly pumping report submitted to the local government and the county which will state the Owner's name, location of the property on which the holding tank is located, the p umper's name, the dates, volumes pumped and the disposal An annua pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall b submitted to the Department of Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 (15), Wisconsin Statutes, 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Cade; 5. This agreement ill.remain in affect only until the sanitary permit issuing agent ,i,n 44 f ?� ,,. County certifies 'that the subject pro party is served b pu"' c sewer or a septic tank soil absorption system that complies with ch. N 63, Wis. Adm. Code, In addition, this Agree - ment may be cancelled by executing and recording said certification with're- foreace to this Ag reement, in the Tract Index indicated abov 6. This agreawt sha be binding upon the indicated governmen unit and the Owner or heirs and assignees and shall run with the deed, WITNESS our hands and seals this day of Tfl OR MUNICIPALITY Of O WNERS by by STATE Of WISCONSIN Personal come before me-this day of C /- 7 4,15A 19� the above named = ,Vi) 4 , � h a t N o ` known to be the pe#a„& execu e t e o . go ng nstrneh do ockno w l d ''� edge the semis, ®� � � �x�,��. ,. THIS INSTRUMENT ._ , ,� �. DRAFTED BY: ct� p P C B l.. 8 C 1 'dg¢� r Wi cc) My commission expires; a dear,iN ae as ► Notory Public = State of Wisconsin Nv C: c. i,ir.issinn Expires Mor. 10, 1985 `- ST. CROI X COUNTY w , � 4 , r r • 31 WI SC O N S I N f ah t �`"' ZONING OFFICE 796 -2239 }, HAMMOND, WI 54015 DIVISION OF SAFETY & BUILDINGS PLUMBING DIVISION j P. BOX 7969 MADISON, WI. 53707 Dear Sir: An onsite investigation for the property located in Section 3 T29N R16W Township of Baldwin, in St. Croix County revealed that the soils are unsuitable for a conventional or alternate type of system. Therefore the St. Croix County Board of Adjustments has granted Mr. Robert Harer approvalfor a holding tank on his property. Should you have any questions, please contact this office. Yours truly, �Qi24�'� -GZJ Harold C. Barber, Zoning Administrator