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HomeMy WebLinkAbout028-1016-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538842 0 GENERAL INFORMATION (ATTACH TO PERMIT) State 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: Christianson, Lee J. Rush River, Town of 028-1016-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ddb /3 VIA I GST 12.28.17.85b TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3. /d3. /c>n Septic Benchmark 4• /Ol, 6 , I p ~I Alt. B 7.Z ( 1 (0' 3JI ooo Aeration ~ Z e.~w r-' Bldg. Sewer ~~eti A St/Ht Inlet 4/ St/Ht Outlet TANK SETBACK INFORMATION F. I J TANK TO P/L WELL BLDG. VyQt to Air take ROAD Dt Inlet Q Qq o ~ v! J Septic % 1 )560 / Dt Bottom f 1, b / Dosing $7 / 6(O, 17 -97 / Header/Man. ` C 97.7 Aeration Dist. Pipe 99 7 Holding Bot. System 9 Final Grade PUMP/SIPHON INFORMATION 1116. 7 O.s / b~ Manufacturer and St Cover 7 Z 9 to (=)O C, S PM J .ate Model Number W - ~'t '3' / I- ~1 ' ~ ` C$G~ G CJ ~J T 41 r 911p- MP TDH 11-ift~ FrictionLoss System Head TDH F i Forcemain 1 Lengthy of 1 21 Dia. It Dist. to Well i / SOIL ABSORPTION SYSTEM BEDITRENCH Width ength No. Of Tr nch PIT DIM N~ SIONS No. Of P4!-- Inside Dia. Liquid Depth DIMENSIONS / L ees SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR TypMb._) ystem, ^d 3t /Z'9 A UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution j, Ix Hole Size, i / Ix Hole Spacing Vertttlto Air Intake Pipe(s) ~~Qr/J Length Z. ✓ Dia Length O 0 o s Dia Spacing 1 7.1(0 -1 1 11-n jk SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 7xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / "7 Bed/Trench Edges Topsoil ; es ENO " Yes `q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Inspection #2: / / Location: 2037 50th Ave a Baldwin, WI 54002 (NE 1/4 NW 1/4 12 T28N R17W) NA Lot 1 Parcel No: 12.28.17.85b 1.) Alt BM Description = P.) I PI r~ytl yyi 2.) Bldg sewer length - amount of cover = f Plan revision Required? ❑ Yes No Use other side for additional information. , 1 Ws 4Cert. No. SBD-6710 (R.3/97) Date commerce.wi.gov and uildings Division County EIEb hingt n Ave., P.O. Box 7162 • CY'0 ;,,se i sco n s i n Madison, 53707-7162 Sanitary Permit Number to be filled in by Co.) Department of Commerce Sanitary erml pati n State Transjacptio~niNurmb~er In accordance with s. Comm. 83.21(2), Wis. A Cod j F2 I 1F(gWrdfiEt the appropriate governmental unit is required prior to obtaining a sanitary ~rirPith s for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. ersonal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. ^v~~ 1. Application Information - Please Print All Information 11114 Property Owner's Name Parcel # ~~r✓ C ri ,~.~o 016-SD 000 Property Owner's Mailing Address jJ Property Location (45-9) z o 3 7 ~D K Pi G t City, State Zip Code Phone Number ~ 12- J f ~ ~ / i1 ~f p /4 s/<~Section 'e- 53'17 T ~O N; R / irele rte II. Type of Building (check all that apply) Lot # i Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms , Block # I ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM N her El Village of 3 I Town of 5Z V, ;in III. Type of Permit: (Check only one box on line A. Complete line B if applicable) GGG A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil Mound < 24 in. of suitable soil x 6 ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil 71 ion Rate(gpdsf) Dispersal Area Requir d (sf) Dispersal Area Pro osed (sf) System Elevation O 7 ~ ` /393 a 0 r-I 14" VI. Tank Info Capacity in Total # of Manufactu r Gallons Gallons Units Ut/ J Z-44te 14 § UP U New Tanks Existing Tanks o „ y y c"e a U un 't~ ~n w C7 0. Septic or Holding Tank e o- s X Dosing Chamber / e VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Nam(Print Pl is Signature MP/MPRS Number Business Phone Number 31:)(2 / u C>4 In, , , /</,z,- ~ Plumber's Address (Street, City, State, Zip Code) 6) / . a, vv J , Y,~ j G , VIII. oun epartment Use Only pproved ❑ Disapproved Permit Fee Date sued Issg Agen ign e (/02 q I 120 El Owner Given Reason for Denial IX. o VNAIFJF4)val/Reasons for Disapproval ep is tank, effluent filter and dispersal cell must tz,lb&n,~o-w { pO~ m J0,3_6 all be serviced / maintained as per management plan provided by plumber. Q J _ 2. All setback requirements must be maintained lS~nb as per applicable code/t)rdin Attach to complete plans for the system and submit to the Co ty only on pap not less than 8 vi x 11 inches in size SBD-6398 (R- 02/09) I E Vtt~4" JCr / i I ~ CX/S~inq ~ la~✓C C i'F • jO CLLZ~edNr a,~u'~y S~c~ ,Gem ,zc37 ~50'1~`fEdE. ~/clw: h, S slGOs Lo-Z C.5wl vof Sr~./,Z7~ 17&J~ 7/7 7Z.0 W. 573. 02 - - =T S~. Gro;YCo.fu:% FXis-c:rt ~a6e/~•/~~/eli.it,`$~ci ~einq 5/~a~/a.s CY"-;i' /,z'xSo' l c bCZ r, I CX~s`, / u~' ('ten r sep i "SFk a/dei/. def~~n;nec✓ t ccpcr rite. / jtra dc~+z/,'~~e r,`E-y mlis 6c ~1la~don ~~e~ast tc~,e54/'ecrFre- i p~;er~o reeor3 c art. \ M 8. rv. Too X"/" I ~rCj~StQ ~7'(ou..-,C~4.~ /7• ~J~,I'/G2~5~'% /I t' s'x 90' ~s,4 a / Ce Two C7-j D / e Calm o{fin /a ~~/s 46 /y'x8B s-6 "Y""15 „ ! of < QF o L./(o, 5ys~s >7 5.'dft 4,t 1."). CorncroF~ • is 6efJ/aeed 8~B.SrJ'~rm,~/.' L o`/ ~(SS~,iiYt1C e/%vQ~io~-► =/GD.Gt`J," \ 9(.• 5v lee, •,ul S , , ' ' i/ 1 ~cF'~ ~l ~ou~l, sys~~ ar•e4 ~.~83 - ♦ /c9o.oJ Qt hs i I i feu % la s 73. &2 ?y~~9nRT~TO~ Safety and Buildings d m 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay 9 i. S www.commerce.wi.gov/sb/ www.wisconsin.gov o SSIONPNI Scott Walker, Governor Dave Ross, Secretary August 23, 2011 CUST ID No. 220853 ATTN.• POWTS Inspector DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. ZONING OFFICE 820 MAIN ST ST CROIX COUNTY SPIA - PO BOX 78 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/23/2013 Identification Numbers Transaction ID No. 1983742 SITE: Site ID No. 770731 Lee Christianson Please refer to both identification numbers, 2037 50TH Ave above, in all correspondence with the agency. Town of Rush River St Croix County NE1/4, NW1/4, S12, T28N, R17W Lot: 1, Subdivision: CSM Vol 5 Pg 1278 FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1330359 Maintenance required; Replacement system; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual -Version 2.0; SBD-10706-P (N.01/01); Effluent Filter 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. 11, 4i • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. ,Y Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and . 9"f - dispersal are prohibited. ~ 12-1 • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. E CC • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE ` AUG - a 2GJ Project Name: Lee Christianson 3-bedroom residential mound Sf.r_ l~r ~ f''I lI r Owner's Name: Lee J. Christainson Owner's Address: 2037 50th Ave. Baldwin, WI 54002 Site Address: Same 1 Legal Description: NE1/4 NW/4, Sec.12, T.28N., R.17W. Township: Rush River County: St. Croix Subdivision Name: CSM Vol. 5, Pg. 1278 Lot Number: 1 Block Number: Na Parcel I.D. Number: 028-1016-80-000 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 Attached Soil Evaluation Report Designer: Dale Hudson License Number: 220853 lonalty Date: 07/13/11 Phone Number: (715) 684-3378 4MD 001, TOFCOWERC Signatureiez,, ~.EY NG3 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both ~dESPONDENCIc SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 f Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) I R 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 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 450.00 Design Flow (gpd) 11.00 Site Slope 98.50 Contour Line Elevation (ft) ir _30.00 Depth to Limiting Factor (in) r 0.60 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information ~90~001 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00, Dispersal Cell Design Loading Rate (gpd/ftz) 1 ! Influent Wastewater Quality (1 or 2) Are the laterals the highestkoint in the distribution _Y_ Pressure Disribution Information network? Enter Y or NJ (C or E) E Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.15 Estimated Orifice Spacing (ft) = 5.36 ftZ/orifice _ 2.00 Forcemain Diameter (in) 70.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.501 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 11.42 Forcemain Drainback (gal) 13.08 Vertical Lift (ft) 81.26 5x Void Volume (gal) 1.77 Friction Loss (ft) 92.67 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 34.60 System Demand (gpm) I r-`1,ELajteraI Total Dynamic Head (ft) Diameter Selection Manifold Diameter Selection options choice in. dia. options choice 1.25 x 1.00 _ i 1.50 x x 1.25 _ . 2.00 1.50 x - x 3.00 i 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 750.36 Total Tank Capacity (gal) 1000 001 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 20.28 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.36 Dose Tank Capacity (gal) Zabel Tilter Manufacturer _ 20 28 Dose Tank Volume (gal/in) !A1 00 !Filter Model Number ;Wieser Concrete Manufacturer Project: Lee Christianson 3-bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views t 1/10 B J Observation Pipe K ti •5 A W .l. B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I • • • • . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . Mound Component Dimensions ft A 5.00 ft E 12.60 in H [Aft ft K gift B 90.00 ft F 9.50 in z ft L ft D 6.00 in G 0.50 ft J W 450.00 (ftftz) Dispersal Cell Area 1393.66 (ftz) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.79 (ft) ► ♦ H G1 F Dispersal Cell 99.50 (ft) Lateral 99.00 (ft)-*I - Invert Dispersal Cell [ t Elevation D E i : : i 98.50 (ft) Contour Elevation 11.0 % Site Slope Geotextile Fabric Cover Shading Key Q. T Dispersal Cell See lateral details on 1❑ ® Topsoil Cap o 1.5 ft Page 4 for number, size, Subsoil Cap N o and spacing of laterals. © Laterals are equally ASTM C33 Sand F ® Tilled Layer 0.5 ft Typical Lateral spaced from the distribution cell's © Aggregate 10.0 centerline in the A distribution cell (AxB). Project: Lee Christianson 3-bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Latrralsctntort4ovtrthtA&,Sdrmtnsion 0aTurn- upvrft»IIvslvaorclean outplug P PFoi rils art i.ltnticA If X -+I Holos drilod on tht bottoan of tho laioral S equally spaced mart cco nnecuon via tee or eross to manil-old at any point. Late-, als 6 force main of PVC Sch 40 (per CUAM Table 84.30.5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.16 ft Lateral Length (P) 88.56 ft Orifices per Lateral 42 Lateral Spacing (S) 2.50 ft Orifice Density 5.36 ft2/orifice Lateral Flow Rate 17.30 gpm Manifold Length 2.50 ft System Flow Rate 34.60 gpm Manifold Diameter 1.50 in Total Dynamic Head 21.35 ft Forcemain Velocity 3.53 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and 0 Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacit 750.36 Gallons T Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.43 394.05 B 2.00 40.56 C Pump off elevation (ft) C 4.57 92.67 86.42 D 11.00 223.08 D Total 37.00 750.36 Do♦ se tank elevation (ft) 3" Bedding un er tank. 85.50 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert SJE1011421 Pump Manufacturer Goulds Pump Model Number EP05 Pump Must Deliver 34.60 gpm at 21.35 ft TDH Project: Lee Christianson 3-bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone (715) 684-3378 POWTS Regulator's Name St. Croix County Zoning Dep't. 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 ft2 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 eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears 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 Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Lee Christianson 3-bedroom residential mound Page 5 of 9 ,GOULDS PUMPS Submersible Effluent Pump EP04 3871 EPO5 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and low-cr grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses heat transfer • ~ffrjenT syste s is Casing and Base: Rugged • domes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation. Auto- resistance. SF Canadian Standards Association • 'r1e3vy duty sump matic models include • water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Soiicls nal ahilg capability float switch attachment points. maximum 0 EP04 Impeller: Thermoplas- m Power Cable: Severe duty • C: pacries ufr to 60 GPM tic Semi-open design with rated oil and water resistant. • total heads: up to 31 feet pump out vanes for mechanical • i~i~Chalg'r s!zt 1'/r" NPT seal protection. • ^echa,~,ca! sea carbon--stationary, 3UNA-N elastomers • Temr;erature. 04~F L40 C) continuous 4' O Ci intermittent, METERS FEET io 300 series -a-less stee' 3c---_ r t- S GPM • Capable of running ~J ~ly utdamage to zs tL s~ - w TL1ef ruors 7 f,9otor:~- - • Ff _4 S nyie prase: 0.4 NF, 'r 2 or 230 V 60 Hz, 1550 a Rp%1, built in overload with y automatic reset. 4r • EP05 Single phase: 0.5 HP, o I EPOS 15 or 230V, 60 Hz, 1550 3 ~F ~PiJ built in overload with EPO4 automatic reset 2 • Power cord: 10 foot s standard length, 1613 1 C SJTOW with three prong r grounding plug. Optional 20 ° uo 0 20 30 46 50 GPM foot length 16/3 SJTW with three prong grounding plug n H o 2 r ~n (standard on EP05). CAPACITY Goulds Pumps „r_.- ITT Industries ter,2ct:,e Septoml-, coot w , 7 o r 53911 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, ano shall maintainea in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] 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. It the filter is equipped with an alarm, the 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 BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 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 flushea 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. Contingency 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 • ~ ~/Cvi e ✓aiucztla~~/mot I • /aCCL-'LICd~iJ~a~(JrrL~y I 6, F- t SUS ~e . 1-e ,2037 5c-6`rE dE . /T~~; fin- ,~~~'u.s~,F,•~E,, ~u,2E~/C~~_ ~G-mac I ~XiSr:rt ~abe~~'/E~-/C~^S~cr ~i¢inq S~f~G'ac~"cs o CXI,3 ' /.Z' x BC ' r b'cn C~nCre~Se~ t~6a~dcn cs Pcrc~kL1,\ j tru ~c~i' ~ ty /Y! k S C~ 6C 7~ rv1G..~~Q% ~ ~ i (~ro~s~a C/4~ ~k/GLS s/; Cover F lei y6. I ~ s'X 9G' ~S,ocr~sa/ CL//, .TuJd (.zJ J /a{Pra/sQ6/y "x8B_S6'"41 f8„ O/'i`r~CBS Ceo(ov~L,/(c ~.5 S{3'Y~ ' \ be,v ae~an98.5ZI'Cc' y1~'X~/ ` o I `~,'tl%nq ~i /1.cJ. Corn~rof~CO~c \ B2 ~ssu~-rcc/ elvvQ-6'o~-, _ /oD.Ct9,' c} h i r / ; ✓ re qe~ u _ i' l `rc a h~ou 5ysf~~ area /oo.y a h;ul~ s V)i Ca.iC Il 7 f e I 4s I I I i i~ RECEIVED 2248_ Wisconsin Depa~ rtm nt of C ercl 5 20 11 SOIL EVALUATION REP Page 1 of 3 Division of Safety a d Buildings in actor ance with Comm 85, Wis. AdmeLA.C.E. Soil & Site Evaluations ST. CROIX COUNTY ~ p County Attach compl lope 11 inches in size. Plan must St. Croix include, but not limit o: ve nce point (BM), direction and V' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. -028-1-016-80-000/ Se Please print all information. Reviewed y ` Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2~fl' kj'j~ S~oZ)/ Property Owner Property Location Lee J. Christianson Govt. Lot NE 1/4 NW 1/4 S 12 T 28 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2037 50th Ave. 1 Na CSM Vol. 5, Pg. 1278 City State Zip Code Phone Number _j City _j Village ✓l Town Nearest Road Baldwin WI 54002 715-684-2587 Rush River 50Th Ave. New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ✓_f Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for replacement mound system with 6" sand lift placed on 98.50' contour. System elevation to be 99.00'. C/n G/u~lLi Boring # I Boring / FT] J Pit Ground Surface elev. 98.17 ft. Depth to limiting factor 30' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 *Eff#2 1 0-10 1Oyr3/4 none sl 2fgr mvfr cs 2vf,f 0.6 1.0 2 10-20 1Oyr3/6 none sl 2msbk mvfr cs lvf,f 0.6 1.0 3 20-30 7.5yr4/6 none gr Is Osg ml cw 1vf 0.7 1.6 4 30-65 7.5yr4/6 f3d 7.5yr5/8 gr Is Osg ml aw - 0.7 1.6 5 65-71 1Oyr4/6 c2d 7.5yr5/8 vfsl Om mfi - - 0.2 0.5 Boring # J Boring v Pit Ground Surface elev. 92.79 ft. Depth to limiting factor 36° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 1Oyr3/3 none sit 2fgr mvfr gw 2vf,f 0.6 0.8 2 16-23 1Oyr3/6 none sit 2fsbk mvfr cw 1vf,f 0.6 0.8 3 23-30 1 Oyr4/6 none sicl 2fsbk mfr fw 1 of 0.4 0.6 4 30-36 10 416 none scl 2fsbk mfi aw - 0.4 0.6 5 36-66 7.5yr4/6 c2d 7.5yr5/8 grf s 0 sg ml - - 0.7 1.6 * Effluent #1 = BOD? 30 < 220 mg/L an TSS >30 < 50 mg/L ' Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signal e: CST Number James K. Thompson 5-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/19/2011 715-248-7767 Property Owner Lee J. Christianson Parcel ID # 028-1016-80-000 Page 2 of 3 3]Boring # J Boring del Pit Ground Surface elev. 98.63 ft. Depth to limiting factor 37" in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none I 2fgr mvfr cs 2vf,f 0.6 0.8 2 9-22 10yr4/4 none sl 2msbk mvfr Gw 1 vf,f 0.6 1.0 3 22-37 7.5yr4/6 none gr Is Osg ml aw 1vf 0.7 1.6 37-62 7.5yr4/4 f2d 7.5yr5/8 gr Is Osg ml aw - 0.7 1.6 5 62-72 10yr4/6 f2d 7.5yr5/8 sicl 1 msbk mfi - - 0.2 0.3 ❑ Boring # Boring ;J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fV in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 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. Soil @ Site Evaluations E' ✓Qlua'~Jo~,/Jr~ A 65ylslt~in made e le i,- • /O~L~/U~oprlL~y Sz~c/ T Scale: >Pef 'r-2 A ,x o,37 50 ¢`,4 de. C.J/. s rlcaz C6w va( S ./,Z7 fZ.o.CA). 573.02 St, C-110 ",v •,cJi g6ae c7 ,w At 1e4-it17e-/C/ue17' {-4^i ~ EX:sfr al ysev' I 61r ol,sNe a /~e!/. ! I EXis~%n~ ;la90a P. &,tl C reC Sep~.c l I Strad nJ:mfr ri\ ,m4sZ- 6ea'tw~►ine~ l ~ ~o/'iol /YCo~~~rOr~. ! G. ! ! /E. . : Tpa~ S.T rvta-~XQ/,, ! ! Cover EIeJ~= J6.sLZ. ~ j ,0- S:d%ng 4 /l.u? Cornu'oF`te~c~e. 82 l ~ j rfssu.n~/ e/u/a.~oy, = /oo.a~ • 5 ' 1? 7 e i~% S~oPeir~uSyst area B3 ♦ ~DO.oy qe l1;9s~ ~ ~✓e off' ~'r~ e 3 z% ~~.~4xdsloae oE---~"Xi s~'~rq well I ~ l; n e 573' 1Jy. 3 0F'3 :Jul-29-2011 11,25 AM St. C X County Flan/Zoning 715-386-4686 1/21 w ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREE 4tP 1 Z ZQ11 AND ~kotx couhv aiNG g ZONING OFF" GE OWNERSHIP C RTIFICATION FORM uyer e i or cp Y../ Mailing Address ZO-L _7 SO ~w~ Property Address -j a ✓n (Verification required from Planning & Zoning Department for new construction.) City/State _/31/ GJ i h W , Parcel Identification Number 67-9' /D/ 4 $0 - DOD LEGAL DESCRIPTION Property LocationN%4 , Alk V4 , Sec. LZ , T.ZLN R_13 W, Town of easl ! Ye y' - . Subdivision Plat: , Lot # _ Certified Survey Map Volume 5 , Page N _/zv7g . Warranty Decd # (before 2007)Volume Z5 , Page # . 3D Spec house 13 ye5xno Lot lines identlfiabile~wyes ❑ 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 rut imo 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 5t, Croix County Planning & Zoning Department a certification form, signed by thv 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), ilia septic tank i% less than 1/3 fall 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) ol'the property described above, by virtue of a warranty deed recorded in Register of Deeds Office, Number of bed oms SIGNATURE OF APPLICANT(S) IRATE ***Any information that 1s 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 certiticd sut-vvI' map 0' reference is made In the warranty deed, (REV. 09/07) /.^r! am - YOi. DOCUMENT NO. 571159 REGISTER'S OFFICE SATISFACTION OF REAL ESTATE MORTGAGE BY LENDER T, CRrji C°.C?.. W) t:sc'd ~^r ~acoro' . The undersigned Lender certifies that the following is fully paid and satisfied: JAN 1 z 193 ~ Mortgage executed by Lee J. Christianson and Nancy S. AM 9 Christianson, husband and wife, each in his or her own right f Re Isibr of t)eeds B to Lender and recorded in the office of the Register of Deeds St. Croix County, Doc. 471376 of Wis., as No. - Rectxainq Area (Reel) (Records) (image) -Nam and Refwn Addre in (Vol.) anR of (Mortg's). on (page) 490-491 E w 1N covering the real estate described below: TQO Main Street Part of the Northeast Quarter of the Northwest Quarter Baldwin, W1 64ou,~ (NE-,'- of NW1) of Section 12, Township 28 North, Range 17 West, Town of Rush River, County of St. Croix, State of Wisconsin, described in Volume 5, of Certified Survey Maps, cut Identifier No. page 1278 as Certified S-ar_vey Number 1278. ❑ If checked here, read estate description continues or appears on attached sheet. i , STATE OF WISCONSIN Dated December 3, 1997 County of St. Croix First National Bank of Baldwin NaMEof M 1 This instrument was acknowledged before me By w-a--_ December 3,1997 on Title 5eniorice President j I by Dale R. nsen T Pederstuen a Jensen (Names of person(s)) as Senior Vice President & Vice President Attest (Type of authority. a9. officer, trustee. em if any) of First National Bank of Baldwin .~'`Av~6i ~,~~~N Title Vi Presid t UtbS;~~`r~•aooao....~o~A~d~ (Name of party on behalf of whom instrument was exec / A^~nj n A L 6[eJerry a pederstllen e r b(~( V l • Tfi§trument was drafted by. Notary Public, Wisconsin 'u' t National Bank of Baldwin/Sarah Weiske My Commission (Expires) (is) fry OR PRINT) Type or print name signed above. Parcel 028-1016-80-000 09/13/2011 01:35 PM PAGE 1 OF 1 Alt. Parcel 12.28.17.858 028 - TOWN OF RUSH RIVER Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CHRISTIANSON, LEE J LEE J CHRISTIANSON 2037 50TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2037 50TH AVE SC 0231 SCH D BALDWIN-WDVILLE SP 1700 WITC Legal Description: Acres: 4.800 Plat: 1278-CSM 05-1278 028-83 SEC 12 T28N R1 7W 4.80 AC NE NW LOT 1 OF Block/Condo Bldg: LOT 01 CSM 5/1278 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 925/309 X91 7-98 2011 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.800 41,300 222,400 263,700 NO Totals for 2011: General Property 4.800 41,300 222,400 263,700 Woodland 0.000 0 0 Totals for 2010: General Property 4.800 41,300 222,400 263,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 140 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 o CO) 3 0 01 0 C7 `r1 47 o C n d ai O O v a c N N • IV T j O N N C0T1 .y. CO = co E; 4 O lAl n. t9 a O O m N CD = Cl) '00 O 00 T m c >y U' 3 m o ? (a (A = N CD = O Q C L Q Q v Cl) C D C a o m o' N oo d co (D c 3 0. CO cyl o O J i ~ ~ N D Co (D CD N o o W co 0 r- CO) r 3 c E z 000?• 0 ao z ~y CL v~ to to o D Oy _ 3 v v CA o O Ill C~D+ N O CT N T m (a d ~ N N !D = O z N z w z Q D CD O l M N• CD I ~ C N M. fD W (D O. n 3 7 OZ ~ -4 CA O A Z fCDf v a A (z 3 a. N W m co z c 3 a A c z w Z f A W O > 0- C2- cc G O N C O - z a CD co CD N x d 0 N O Q C CD CL N m N O H A 0 N O O 0 d0 ~i fA O ti N O ~ b O 10- Parcel 028-1016-80-000 03/18/2005 02:32 PAGE 1 OF 1 F 1 Alt. Parcel 12.28.17.85B 028 - TOWN OF RUSH RIVER Current X_; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " CHRISTIANSON, LEE J LEE J CHRISTIANSON 2037 50TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 2037 50TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 4.800 Plat: N/A-NOT AVAILABLE SEC 12 T28N R1 7W 4.80 AC NE NW LOT 1 OF Block/Condo Bldg: CSM 5/1278 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 925/309 2004 SUMMARY Bill Fair Market Value: Assessed with: 6920 240,600 Valuations: Last Changed: 10/2011998 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.800 16,300 127,500 143,800 NO Totals for 2004: General Property 4.800 16,300 127,500 143,800 Woodland 0.000 0 0 Totals for 2003: General Property 4.800 16,300 127,500 143,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 140 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER 2e 4XZ/fj/, TOWNSHIP SEC. /2 T2FN, R 17W ADDRESS ST. CROIUNTY WISCONSIN. SUBDIVISION LOT LOT SIZE COQ ~c~r~s' PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ape ctv~ sf c %c s 1 p+ O e e ~C a Q Holm f. I i Yo. I di, a e ozth Atrow j SCAL SEPTIC TANK(S) /a00 MFGR. ~eel~S CONCRET STEEL 90 of rings on cover U Depth ~5~ - PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO GALLONS Per Cycle _ TRENCHES NO. of width length area BED NO. of lines width length ~n -area 9Vl0 dept to top o pipe NUMBER OF SEEPAGE PITS Outs icTe -diameter total pit area AGGREGATE /Z PERK RATE AREA REQUIRED a AREA AS BUILT 9GD Disclaimer: The inspection of this system by St. Ctoix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED 9~ 11-0 0 PLUMBER ON JOB LICENSE NUMBER 4X~ • f . REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sanitany Penmit State Septic /TS" SS_ NAME' dl ~ Townehip St. Cnoix County Locatiom /1/ [SEPTIC W V Section TANK Size ga.t.ton.6. Numbers o6 Compantment.6 D.i4tanee Fnom: Welt 12$ on greaten a,tope -it _ ~ . Bu•i.td.ing it. W et.tand.6 Highw.aten' it. DISPOSAL SYSTEM ViAtance From: Wet.t 12$ on greaten 6 tope sly Bu.i.td.ing 0 it. W et.tand.6 Ft. • H.ighwate)t, FIELD DIMENSIONS: Width o6 then ch 1, it. Depth o6 no ck b e.tow t.i.te_22~=in . Length of each tine it. Depth o6 rock oven tite_y~ .in. Numb en • o 6 Zi.n es 0Z Depth o6 t.i.te b eZow gnadeal2.in . 17! Tota.t .length o6 tines,/( (7 it. S.tope o6 trench .in pen 100 it. D.iAtanee between Zine4 Lit. Depth to bednoefz St. Tota.t abz onbt.ion anew 6t2 Depth to gnoundwatenzZ-it• Requ.ined area t2 Type of Coven: Papit o S aw PIT DIMENSIONS: Numbers o6 p.i G)Lavet around p.ita yed no Out6.ide d.iamet S Depth b e.tow .in.tet it. 2 Total abaonbtion area it z A Anew nequk.ned it2 rn r,L INSPECTED TITLE APPROVED J , DATES 19 REJECTED OVATE 197. EH, 115Rev. 9178 V, REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES < P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:I_E'/a,l'/4, Section .-,TgA N,R10(or) W, Township or M*ftineipaky ~l C>S/~ ✓e /C Lot No. , Block No. County n Name Le-;_ e-~ ivr/o Owner's/Buyers Name: L~ Mailing Address: TYPE OF OCCUPANCY: Residence X No. of Bedrooms c3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 4- ZKO _ L_PERCOLATION /TESTS 8r / eO SOIL MAP SHEET NAME OF SOIL MAP UNIT ~~w/,~ cSrLf ~o9m PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- S. 4- u S! rL a0 rr Y,+y /a"' A C) /0 O P-3 ~I rr t l o~ it oZ o P_ ly q NO P- S~ rI 511 if O lo 3/4/ 1 31,4 Jr /rP 611 rl a 8' a r, a /z 5 l SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- / a" y 4. a~L 4" L , o " B- a" y r r rl w If " B- ° y rr n It B- a ° rl / rl ' 113- (0 1 72 '51 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the locatiop and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. a -o~ Vas. fell, £ ~ RK f rep ~ ~ _ E E o pttr O t4 N OC- I 'Ab0 ~.o , • o , E s State and County State Permit # ~r PLB 67 µ yr Permit Application County Permi for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY / Mailing Address: 4 e e- I ji :5.0 ri lt~41, ti t B. LOCATION: /X/.6- '/4 NW Section Ag T N, R 17 6 (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township US 14 ✓e x_ C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance Single family _X Duplex No. of Bedrooms _ No. of Persons o~ D. SEPTIC TANK CAPACITY /000 Total gallons No. of tanks OAN e HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete _X_ Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate -Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: X Length--L-Width 4471 Depth 6 ° Tile depth (top) aRSL' No. of Lines 7-wn Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- 1~2 271 Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted 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 Certified it Tester, NAME C° e47 0vL f C.S.T. # 6'~'V and other information obtained from ^j (owner/builder). Plumber's Sign u e MP/MPRSW# M - 4q F 9 Phone # 7/5' 6EV - 937P Plumber's Address , 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. Z,/ Ll CJC.~nJf f ~0 ~~S' m ~ Q6` ~ - lvoK~ lT~~eS -k~ leS ~A- E E ~ b© t1 m~ cb~ Q, 100 / ~L r ~X _.v7 .Dd /0 f7 N; Monica Lucht Subject: 538842 - Boldts/Christianson, lot 1 Location: Rush River Start: Mon 10/10/2011 10:30 AM End: Mon 10/10/2011 11:30 AM Recurrence: (none) 028-1016-80-00 12.28.17.85b 2037 50th Avenue 1 1 Submersible Effluent PlImp E11Wnt Nnn 3885 APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously Specifically designed for the be provided in starter unit. bronze impeller available as without damage. following uses: • Shaft: threaded, 400 series an option. • Homes stainless steel. ■ Bearings: Upper and • Farms • Bearings: ball bearings • Casing: Cast iron volute lower heavy duty ball bearing • Trailer upper and lower. type for maximum efficiency. construction. courts 2" AIPT diSCharQe adaptable • Motels • Power cord: 20 foot for slide rail systems. ■ Power Cable: Severe duty • Schools standard length (optional rated, oil and water resistant. • Hospitals lengths available). ■ Mechanical Seal: SILICON Epoxy seal on motor end • Industry Single phase: CARBIDE VS. SILICON provides secondary moisture • Effluent systems • Y3 and'/2 HP -16/3 SJTO CARBIDE sealing faces. barrier in case of outer jacket with 115 V or 230 V three Stainless steel metal parts, damage and to prevent oil prong plug. BUNA-N elastomers. wicking. SPECIFICATIONS • 3/,-1'/2 HP -14/3 STO with ■ Shaft: Corrosion-resistant ■ 0-ring: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. Wmaximum. • %2-1'/2 HP -14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities: up to 128 GPM. listed models - 20 foot on accidental reverse rotation. • Total heads: up to 123 feet length SJTW and STW ■ Motor: Fully submerged in SA Canadian Standards Association TDH. are standard. high-grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat 1K Underwriters Laboratories carbide-rotary seat/silicon FEATURES transfer. carbide-stationary seat, 300 • ■ Designed series stainless steel metal Impeller: Cast iron, semi- for Continuous parts, BUNA-N elastomers. open, non-clog with pump- Operation: Pump ratings are • Temperature: out vanes for mechanical seal within the motor manufacturer's 1040F (400C) continuous protection. Balanced for recommended working limits, 1401F (60°C) intermittent. • Fasteners: 300 series METERS FEET stainless steel. 90 • Capable of running dry 25~ 80` w16H - ' - - 'SERIES: 3885 SIZE:/,' SOLIDS hout damage to RPM: VARIOUS ' components. `--'sGPM - Motor 20 70; WE10H - ~SFT T { Single phase: W soy , • HP, 115 V, 200 V, 230 V, ° wEOZH- `T_- 60 Hz, 1750 RPM; %2 50 HP, a i5 115 V. 60 Hz, 3500 RPM; 0 40 - ' i - ' -1 / H P WE/ HP _ 230 V, 60 Hz, 3500 RPM. 0 10 30' • Built-in overload with wE03L. = •--ZQ --i-- automatic reset. 20, • Class B insulation. 5 - _ Three'phase: 10' i , iL_t_ I i • '/2 HP -1'/z HP:200/230/ 0 ° 460 V, 60 Hz, 3500 RPM. 0 10 20 30 40 50 so 70 80 90 100 110 120 ' 130GPM • Class B insulation. , 0 10 20 30 m3/h CAPACITY 1945 Goulds Pumps. Inc. Effective Mav. ' 995