HomeMy WebLinkAbout004-1012-95-001 St. Croix County Planning and Zoning Wednesday, October 04, 2006 at 8:24.48 AM
Detail Sanitary Information Page I of I
Computer #: 004 -1012- 95-100 Sub /Plat: NA Section: 6
Parcel #: 06.28.15.87 Lot: 1 TN /RNG: T28N R15W
Municipality: Cady, Town of CSM: Vol. 17 Pg. 4618 1/41/4: SW 1/4 NW 1/4
_..._.... ...... _.__- . -
Owner: Achtehhof, Joe 569 270th Street Woodville, WI 54028
State Permit: 9946 Issued: 12/12/1980 POWTS Dispersal: Non - Pressurized In- ground Permit: New
County Permit: 276 Installed: 12/17/1980 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer /inspector As Built Plumber Other Reouirements Additional Notes Money Owed
Harold Barber Yes Lorenz, Wayne file with 2000 replacement mound permit $0.00
Tom Nelson Signed Off: Yes The as -built and inspection report document a
1000 gal. septic tank (pre -fab concrete), not a
1500 gal. tank. Either it was replaced between
1978 - 1999 or a mistake was made by plumber on
tank sizing for replacement system
Owner: Acterhof, Lorraine 569 270th Street Woodville, WI 54028
State Permit: 353384 Issued: 04/10/2000 POWTS Dispersal: Mound 24" or more suitable soi Permit: Replacement
County Permit: 0 Installed: 04 /18/2000 POWTS Detail: NA Bedrooms: 3 WI Fund: No
POWTS Pretreatment: NA
Notes
Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed
Kevin Grabau >4/1/00 - Not Required Helgeson, Bennie Existing house now on Lot 1 of a 2003 lot split $0.00
Kevin Grabau Signed Off: Yes CSM #741092, used existing septic tank (plumber
reported 1500 gal. size) to new 750 gal. Midwest
dose chamber and mound cell 5'x 75' and
abandoned original conventional trench system.
See original permit and as -built showing 1000 gal.
tank to 2 trenches on west side of house.
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
4/18/2003 04/20/2006
- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
—
Wisconsin Department of Commerce County
PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT S�, CV�1
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ,- ,i ;3 S `7
Permit Holder's Name: ❑ City ❑ Village M Town of: State Plan ID No.:
Y I &d 6 2 1 `Fsa = 70 4 S . !b
CST BIM Elev.: r Insp. BM Elev.: BM Description: Parcel Tax No.:
44ZS CN.z5' CST A-1 R"A �U�- IGI7 - 95'C7L�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic pp ` Benchmar Z S c?�,�70 °/ Z5 '
Dosing YV\ octy Q ���8 Cn �✓'(vc� g
Aeration Bldg. Sewer ----
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet , 30
TANK TO P/ L WELL BLDG. Air Ve ntto Intake ROAD Dt Inlet (o 91 -3 0'
8 8 3 r
Septic > I OD ti �p r �- ( NA Dt Bottom �,
Dosing - )z I o q r > 13D NA Header/ Man. 12:mS4—
Aeration NA Dist. Pipe 3,Z5 T2 CS'
Holding - Bot. System 3. "t
PUMP/ SIPHON INFORMATION Final Grade 3
Manufacturer &&A Demand
Model Number GPM
v ste
DH Lift kv Friction S m.
k to• L .1� I a S TDHc(.�3 Ft
Forcemain Length 3 r Dia. u Dist. To Well > r 30
SOIL AB RPTION SYSTEM
TRENCH Width — r Length 1 No. f enches PIT No. Of Pits Inside Dia. Liqu pth
DIME J S DIMENSION
SETBACK
SYSTEM TO P/L I BLDG I WELL LAKE /STREAM LEACHING of re r:
_ BE
INFORMATION Type Of CHAM
r r Model Nu r:
System: �� 1 H S z ZO7 OR UNIT
DISTRIBUTION SYSTEM
Header / Ma fo c � Distribution Pipe(s) r u x Hole Size x Hole Spacing Vent To Air Intake
Length Length 3i 3 Dia. /2 Spacing �� ( "
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 1 q ti 6
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No []Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) �3
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Plan revision required? E] Yes X No
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- SBD - 0 FI3/9 - - - /" - Date Inspector's Signature Cert No.
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Safety and Buildings Division
Nvisconsin SANITARY PERMIT APPLICATION 201 B . Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. ST CROIX
• See reverse side for instructions for completing this application State Sanitary Permit Number
35 - 3 3V
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number SITE ID 185968
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N TRANS ID 289450
Property Owner Name Property Location
LORRAINE ACTERHOF SW 1/4 NW 1/4, S6 T28 , N, R 15 F/(4tYW
Property Owner's Mailing Address Lot Number Block Number
569 270TH STREET N/A N/A
City, State Zip Code Phone Number Subdiv ion Name or CSM Number
WOODVILLE WI 54028 1 (715)698-2680
II. TYPE OF BUILDING: (check one) ❑ State Owned 0 !ti Nearest Road
vilae Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town OF CADY 270TH STREET
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
004- 1012 -95 -001
2 ❑ Assembly Hall 6 E] Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Ch a box on line A. Check box on line B, if applicable)
A) 1. ❑ New ® Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an
______System ____ __System _____ ______ Tank Only Existing System ___ Existing
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 [M Mound 0 ❑ Specify Type 41 []Holding Tank
12 Q Seepage Trench 22 Ll In- Ground Pressure , , ' 42 ❑ Pit Privy
13 ❑ Seepage Pit r X 43 ❑ Vault Privy
14 ❑ System -In -Fill 90, 8 c6
VI. ABSORPTION SYSTEM INFORMATIO .
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
7 91.80 Feet 94.09 Feet
VII. TANK Capacft in gallons Total # Of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank Or Holding Tank 1500 1500 1 ® Cl ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamberl 750 750 1 IMTn ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu is Signature: (N Sta s) MP /MPRSW No.: Business Phone Number:
BENNIE HELGESON 20292 715/772 -3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE SPRING VALLEY WI 54767
IX. COUNTY/ DEPARTMENT USE ONLY
Q Disapproved S nitary Permit Fee (Includes Groundwater Date Issued issuing Agent Signature (No Stamps)
X Approved E] Owner Given Initial Surcharge Fee)
Adverse Determination SCD l y-10-2-00
X. CONDITIONS OF APPROVAL / IREASONS FOR (,DISAPPROVAL: t P L4 u Ii
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
Visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
January 21, 2000
CUST ID No.268093 ATTN• POWTS INSPECTOR
ZONING OFFICE
HELGESON EXCAVATION INC ST CROIX COUNTY SPIA
W1229 770TH AVE 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 01/21/2002 Identificati ers
Transaction ID N 894 0
Site ID No. 185968
SITE: Please refer to both identification numbers,
Site ID: 185968 above, in all correspondence with the agency.
ST CROIX County, Town of CADY; 569 270TH ST, WOODVILLE 54028
SW1 /4, NW1 /4, S6, T28N, R15W
Facility: LORRAINE ACTERHOF 569 270TH ST, WOODVILLE 54028
FOR: REPLACEMENT MOUND, 450 GPD
Object Type: POWT System Regulated Object ID No.: 644214
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes p•O•
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in C
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use: APPF
1. This plan action is subject to designer comments on the plan.
D pi SAE
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular
to the direction of maximum slope.
3. Vehicular traffic is prohibited in the area 25' beyond the down slope edge of the mound. SSE CORD
4. The existing septic tank must be inspected for structural soundness, size and baffles and must be brought
into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state
approved tank must be installed.
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. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 01/11/2000
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
PATRICIA L SHANDORF , P TS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services `
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE. STATE. WI.US WiSMART'code: 7633
MOUND SYSTEM DESIGN RECEIV
Residential Application J APB 1 2 000
INDEX AND TITLE SHEET
SAFETY & BLDGS DIV.
Project Lorraine Achterhof 3 bedroom residential mound
Owner Lorraine Achterhof
Address 569 270th Street
Woodville, WI 54028
Legal Description SW1 /4NW1/4, Sec. 6, T.28N., R.15W.
1.T.S
Township Cady County St. Croix
Subdivision Name Lot No.
Of Parcel ID Number 0041012 - 95-001 S()�AHGS
Plan Transaction Number
cSPOND
Index and title sheet Page 1 �-j
Mound calculations Page 2 6
Mound drawings Page 3
Pres. dist. calcs. and laterals Page 4
TDH and pump tank drawing Page 5
Pump performance curve Page 6
Site plan Page 7
Attached soil evaluation report Page 8
Designer Bennie Hel eson License Number 220292
Signature Phone No. 715- 772 -3278
Date 11/15/99
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Wis. Slats.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
SBD- 10462 -E (R.05198) Page 1 of 8
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 gpd maximum design flow.
Inch - pounds Metric
Residential or commercial? r (r or c) (y or n) G � Replacement system?
Creviced bedrock site? n (y or n)
Slope 4 %
Wastewater flow rate 450 gpd 1703 Lpd
Depth to limiting factor 30 in 76.2 cm
In situ soil infiltration rate 0.6 gPd/ft` 24.4 Lpd/m`
Contour line elevation 90.8 ft 27.68 m
Use standard fill depths? I x OR Design depth? in cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
0.125, 0.156, 0.188, 0.219, 0.25,
Center or end manifold a (c or e) Hole diameter 0.25 in 0.281. or 0.313 inch only.
Lateral spacing 0.00 ft Use 0 lateral spacing for trenches.
Estimated hole space 5.00 ft Not a final calculation.
Number of laterals Pump tank elevation 84 ft Outside bottom of tank.
Forcemain length 25.0 ft Forcemain diameter 2.0 in 1 .5, 2 3 or 4 inch only.
2.067 in Actual I.D.
HOLE DIAMETER CONVERSIONS
1/8 = 0.125 1/4 = 0.250
SYSTEM SOLUTIONS Inch-pounds Metric 5132=0- 9/32=0.281
Estimated daily flow 450 gpd 1703 Lpd 3116=0.188 _ 5/16 =0.313 0.313
7/32 Absorption cell
Design load rate & area 1.2 gPde 375.0 W 34.84 mz
Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd/m
Design width (A) 5.00 ft 1.52 m
Cell length (B) 75.0 ft 22.86 m
Depth of cell (F) 905 lin 1 24.1 cm
Sand filter
Upslope fill depth (D) Eft, in 30.5 cm
Downslope fill depth (E) in 36.6 cm
Basal area required (gpd /infiltration rate) 69.68 m
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.5 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.18 ft 3.10 m
Up slope toe length (J) 7.50 ft 2.29 m
Down slope toe length (1) 10.20 ft 3.11 m
Total mound length (L) 95.36 ft 29.07 m
Total mound width (W) 22.70 ft 6.92 m
Project: Lorraine Achterhof 3 bedroom residential mound
Transaction Number: Page 2 of 8
MOUND PLAN VIEW
observation pipes (typical)
E. 22.7 ft ::::•: :::•:::::.. A A 5.00 ft 1.52 m
6.92 m ......:::.......:.:................:B = 75.0 ft 22.86 m
W J= 7.50 ft 2.29 m
K I= 10.20 ft 3.116
K = I 10.18 ft 3.10 m
95.36 ft
29.071m typ. obs. pipe
(anchored securely)
I = down slope dimension = absorption cell (Ax
J = up slope dimension = plowed area (LxW)
K = end slope dimension 6" (152 mm)
MOUND CROSS SECTION
subsoil cap D = 12.0 in 30.5 cm
lateral topsoil � H E = 14.4 in 36.6 cm
invert 92.30 ft =
9.5 in 24.1 cm
elev. 28.13 m J F G = 12.0 in 30.5 cm
T ASTM C33 E H = 18.0 in 45.7 cm
Sand Fill
Sys. 91.80 ft y 4
elev. 27.98 m 90.80 ft contour
27.68 m elev. 4 % —�
slope
D = upslope fill depth plowed layer
E = downslope fill depth Note: Absorption cell media will consist
F = absorption cell depth of aggregate and pipe with laterals
G = subsoil + topsoil depth at cell wall centered across AxB media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Project: Lorraine Achterhof 3 bedroom residential mound
Transaction Number. Page 3 of 8
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 1 5 ft 1.52 m
Length (B) 75.0 ift 22.86 m
Lateral specifications
Number laterals 1
Holes/lateral 15 holes
Lateral length (P) 72.33 ft 22.05 m
Hole diameter 0.250 in 6.35 mm
Lat. dis. rate 17.48 gpm 1.10 Us
Sys. dis. rate 17.48 gpm 1.10 Us
Hole spacing (X) F 62 iin 157.5 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) Place X in red
"X" one choice 11/4 in (32 mm) box of chosen
from the options 1 1/2 in (40 mm) x x diameter.
provided. 2 in (50 mm) x
3 in (75 mm) x
Manifold diameter Pipe d Design options Design
Designer must 1 in (25 mm)
X' one choice 1114 in (32 mm) None required.
from the options 11/2 in (40 mm) No choice necessary.
provided. L4nE n (50 mm)
5 mj 00
Dis tribution system contains: 1 Lateral(s)
LATERAL DIAGRAM - END CONNECTION
Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area.
Laterals centered over the A & B dimension end cap
P
Last hole drilled next to end cap iE X I Laterals & Force main of PVC Sch 40
Holes drilled on the bottom of the lateral (per COF+Ar+A Table 84.30 -5)
equally spaced • =permanent end marker
Inch-pounds Metric
Lateral length (P) 72.33 ft 22.05 m
Lateral spacing (S) 0.00 ft 0.00 m
Hole spacing (X) 62 in 157.5 cm
Manifold length 0 ft 0.00 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 1.50 in 40 mm
Forcemain diameter 2.00 in 50 mm
Project: Lorraine Achterhof 3 bedroom residential mound
Transaction Number: Page 4 of 8
TDH and Pump Tank Drawing
Total Dynamic Head
Operational head 2.50 ft 0.76 m
Vertical lift 6.90 ft 2.10 m Are laterals the highest pant in the
Friction loss 0.14 ft 0.04 m system? Yes "x' here.
Total dynamic head 9.54 ft 2.91 m If no, what is the highest elevation
Dose Volume downstream of pump? - �
Dose is > 10 times lateral volume Forcemain drain
Lateral void volume 7.6 gal 28.8 L back to tank? ('x' one)
Minimum dose 112.5 gal 425.9 L x Yes
Drain back 4.4 gal 16.7 L No
Dose volume IF 116.9 gal 442.5 L
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole cover with
weather proof warning label and locking device
grade levels junction box grade levels
disconnect
aftemate
4" vent pipe electric as per NEC 300 and E - out
Comm 16.28 WAC location 19'(46 cm) min.
wall of pump k' - approved
chamber or outlet joint
combination tank
A Provide 1/4" weep hole or anti -
alarm on siphon device as necessary
pump on B
_ Grade levels
pump 85.4 ft C - pump tank manhole = 4" (10 cm)
off elev. 26.0 m minimum above finished grade
D - vent =1 2" (30.5 cm) minimum
above finished grade
84.0 ft Pump tank elevation
3 " (75 mm) of bedding under tank 25.6 m bottom of tank
Tank manufacturer Midwestern Precast
Pump tank capacity 19.5 gal /in
Pump tank volume 750.75 gal
Pump manufacturer 113oulds Inches Gallons
Pump model number 3871 - EPO4 o A 16.5 321.9
v� B 2 39.0
c
Alarm manufacturer ILevelArm I C 6.0 116.9
Alarm model number JDLV I p D 1 14 1 273.0
Project: Lorraine Achterhof 3 bedroom residential mound
Transaction Number: Page 5 of 8
M OD EL I 1 M
Vertical • Pump • 0' •0
Su bmersible Effluent Pump
1
5 ry I. Y,
a 71 w1,
.A �
' { I
{ •� 4 r'tl i r w' ' i
GOULDS
E
f
t-
Pump Specifications
' /3HP METERS FEET
Up to 40 GPM 10 i
MODEL: 3871
Discharge size 1 NPT IT 30' i
Solids: I N ' maximum 6 I }
Motor 7 . 25
I
Single phase: 115V C3 6 20
Materials of Construction
U ' I i
Brass /thermoplastic a S 15 L EPOS
-I
Features and Benefits Z 4
s�70 1 -_' - -- i -
*Top suction eliminates ,r3 ,—� Ero4
impeller clogging. 2
• E. • _ 0 O I i. -_'L.- 20.. -___.' 30 ._-.- - _ 50 _... IU S. 61111
Corrosion resistant
c �_ 40
L_..
• I loaf actuated switch. 0 2 6 6 10 12 m
METERS FEE' Pump Specifications Features and Benefits
' MODEL DVP03
4 h6 and 7 HP •EPO4 impeller- semi -open design
6 20
5 Up to 60 GPM with pump out vanes to protect
15 i Maximum head to 32' mechanical seal.
a 4 Discharge size 1 NPT • EP05 impeller - enclosed design
0 3 10 Solids: 3 /4" maximum for improved performance.
0 2 5 Motor • Rugged glass - filled thermoplastic
1 All motors feature ball casing and base design provides
bearing construction. superior strength and corrosion
O 5
TO 15 20 25 30 35 40 U.S.GPM resistance.
o z n e B 10n11/11r Single phase: 115V
CAPACITY Materials of Construction Cast iron motor housing for
Cast iron efficient heat transfer, strength,
Thermoplastic and durability.
Stainless steel -Corrosion resistant threaded
stainless steel shaft.
-Available for automatic and
manual operation.
• CSA listed models available.
All Models are designed for continuous operation and feature stainless steel hardware.
PS.
V .Scor l w Depailment of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
AC.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8'/= x 11 inches in size. Plan must County
include, but not lmnited to. vertical and horizontal rer f�►?, direction and St. Croix
percent slope, scale or dimornsions, north arrow 8h distance to nearest road. Parcel I.D.#
APPLICANT INFORMATION - P � a < i e 004 - 1012- 95 -0Date
Personal information you provide maybe iilipoeas• Law, 5.15.0-4 (t) (m /0 — zrm
Property Owner , _ P operty Location
Lorraine Achterhof j ¢ c r <: Gait. Lot S W 1/4 NW 1/4 S 6 T 28 N,R 15 W
Property Owners Mailing Address ;..; : " 4t # Block # Subd. Name or CSM#
569 270th Street
City ate ip:C AA46 City OCll 270Th Stream
e ZTown Nearest Road
Woodvill WI 54q28 715- 698 -268
struction U Z Residen1aM u bedrooms 3 ❑Addition to existing building
Repl t ❑ Pubic Or commercial describe
Derived dad 450 gpd Recommended design loading rate •5 bed, gpd/ft? 6 trench, gpolftz
P ftss�wfiw rea required 900 bed, ft 750 trench, ft- Maximum design loading rate .5 bed, gpd/ft .6 trench, gpdr
Recommended infiltration surface elevation(s) " 91.75' at 12° above 90.75' c onkw. ft (as referred to site plan benchmark)
Additional design / site Considerations Existing system and soil conditions qualify for Wisconsin Fund program. Existing system elev. = 92.00'.
Parent material loess over weathered dolomitic limestone residuirn. Food ain eievati0rt, if NA ft
S=Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank
&Unsuitable far system ❑ S ❑ U ® S ❑ U F S ❑ U El ® U ❑ S ❑ U ❑ S ®t1
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPDff
Horizon Texture Consistence Boundary Roots
Bering# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -8 1Oyr4/2 — Non sil 2fsbk mvfr as 2f 0.5 0.6
2 8 -16 1 Oyr5/4 None sit 2msbk ds cs if 0.5 0.6
Ground 3 16 -36 1Oyr4 / 4 None sl 2msbk dsh cs if 0.5 0.6
elev -
88.46'ft 4 �-40 7.5yr4/4 f2 f7.5yr5 /8 -s1 Icsbk dh aw - 0.4 0.5
40 -56 I r5 /4 None LSBR Om dh - - NP NP
Depth to 5 Oy
limiting Horizon #5 consists of 2 - 6" by T thick limestone fragments comprising >50% of horizon. Voids and crevices between limestone fragments filled with
factor 10YR514 sl & 10yr416 scl —
6 '
Remarks:
Z 1 0 -12 1Oyr4 _ None sin 2fsbk mvfr as 2f 0.5 0.6
2 12 -16 10yr 5/4 None sil 2msb ds cs 1f 0.5 0.6
Ground 3 16 -30 10yr4/4 None sl 2msbk dsh cs if 0.5 0.6
elev
89.91'ft 4 30-40 7.5yr4/4 fZf7.5yr5 /8 sl Om dh aw - 0.3 0.4
Depth to 5 40 -52 10yr5/3 f3 /2 LSBR Om dh - - NP NP
limiting _
factor --
30, —
Remarks:
CST Name (Please Print) Sign Telephone No.
da mes K. Thompson 715-248-7767
Add A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake lane, Osceola, Wl 54020 11/14/99 3602 1129
W . 'PEInY OWNER: Lonai w AcMerW SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL LDf 004-1012- 95-001 A.C.E. Soil & Site Evaluatiow
Horzon � Depth Dominant Color Mottles Structure GPD/fF
in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Bou ndary R oots ge T
3 1 0 -9 10yr4 /2 None sil 2fsbk mvfr as 2f 0.5 0.6
2 9 -14 10yr5 /4 None sil 2msbk ds cs If 0.5 0.6
Ground
elev 3 14 -30 10yr4 /4 None A 2msbk dsh cs if 0.5 0.6
91.15! ft 4 30 -36 7.5yr4/4 f 2f7.5yr5/ 8 sl lcsbk dh aw - 0.4 0.5
Depth to 5 36 -50 1 0yr5/4 f 3d10yr8 /2 LSBR Om dh - - NP N P
limiting
factor Horizon #5 consists of 2" - ti by 7 thick limestone fragments comprising >60% of horizon. Voids and crevices between limestone fragments filled
30' with 10YR5/ sl & 10yr4l6 Is.
Remarks:
4 1 0 -9 10 /2 - None sil 2fsbk mvfr as 2f 0.5 0.6
2 9 -14 10yr5/4 None sil 2msbk ds cs If 0.5 0.6
- --
elev 3 14 -30 10yr4/4 None gr. is 0 sg ml cw if 0.7 0.8
94.25'ft 4 P,3 6 7.5yr m2fd.5yr5 /8 gr. sl Icsbk dh aw - 0.4 0.5
Depth fo 5 36 -50 5yr4/4 f2f7.5yr5/8 cl 0m dh - - NP NP
limiting _ —
factor
Remarks:
Ground
elev
Depth to
limiting -- - -- _ -- --
factor
Remarks:
Ground — - - -- --
elev
Depth to - - -- -
limiting —
factor
Remarks: _ -- -
170 S {• R. 0 '3
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently_
serving the teQ i nle C�i �'P ►7d� residence located at:
S &Z :, �;, Section T�_N, RRW, Town of
_ A V Y . Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced:
Did fl w back occur from absorption system?
Yes No (If no, skip next line)
Approximate volume or length of time: U grA)6WF f gallons minutes
Capacity: r�0
Construction: Prefab Concrete Steel Other
Manufacturer: (If known):
Ag of Tank (If known):
(Signature) (Name) Please print
Jai.
i�
( ' - e) (License Number)
(� zq g9
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �, I�rr< :� Ah /P�/
Mailing Address a�7o'
Property Address 669 do e
(Verification required from Planning Department for new construction)
City /State � l l dt- eZJ1 Parcel Identification Number
LEGAL DESCRIPTION
U
Property Location �� ' /a, I A) ` /4, Sec. �, T, 23 _4R�_W, Town of Q (�
Subdivision 4) , Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # _C/ 8�'9 , Volume X57 , Page #
Spec house ❑ yes fA no Lot lines identifiable R yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix 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 Zoning Office within 30
days the three year expiration date.
` SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
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.
l
t--
=&OFAI GN.DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
No. 56P—EXECUTOR'S OR ADMINISTRA DEED. Chapter 316.
C Milt[* CO.. MILWAUKEE
298893
To All To Whom These Presents Shall Come
1 ....................... Donald Hagen
1
.. ................. . . .g -- ...... ...... ..................... P of the.-Y44'A99"_of
in the County of. St. x Croi
.......... ........... I .................... State of Wisconsin,....A4Tir�trator
.................................... of the Estate of
Ben Johnson
.......... ....... .................... .......... --------- deceased, late of ................ Croix
.... Croix " ""
Wisconsin, send Greeting:
WHEREAS, by an order made by the County Court of ...............
.................... .... County, on the
------ - of ...... 0� 19.- •-- -•• - -,
^ (i9 Donald 1, the said
in my capacity of ..._ A qTipistrator
........ . ............... ............... of said estate, was authorized and empowered to sell at puk4i&_
(orb private sale the real estate of said . B en.. ,J.o_h_ns.on_... . .. .. ................. ..... .. deceased, hereinafter described;
.... .. Johnson .. .... _..
WHEREAS, in my capacity aforesaid, 1 hav@-giw"4)oR4-w-reEt*ife& by no
further or additional bond is required pursuant to the order of the Court;
WHEREAS, in my capacity aforesaid, I have entered into a contract for the sale of said real estate with
L_qr�rqine_._AQhterhof hu wife,
/,subject to approval of the Court;
WHEREAS, in my capacity aforesaid, I have made report of my proceedings, upon said order, to said
County Court of said County and the Court having concluded that the said contract is for the best interests of
the estate, and having on the ---- - - " - -- .. ......... day of ....__....__ 4 f) -------- 1 19- 69..... made an order
confirming said contract and directing a deed of said real estate to be executed and delivered to the said
Jose h J ...... Ae-h-terti --- and --- L orra i ne and/ wife,
.. . .... .. ... ... --- -- -- -- -- ------- -- - -- ----- ....... upon performance of all the
conditions of said contract by ..... theT to be performed;
AND, WHEREAS, all the conditions of said contract have been fully performed and the purchase money
has been fully paid according to the terms thereof;
AND, WHEREAS, it appeared to the Court that such public sale was legally made and fairly conducted
and that the sum bid thereon was not disproportionate to the value of the property, or, that a greater sum
cannot be obtained, and the Court has directed a conveyance to be executed;
NOW, THEREFORE, KNOW YE, That 1, the said ....... Donal-d.-Hagen
..........
in my capacity of ......... ..Administrator
................ -----------------_- ------- aforesaid, by virtue of the power and authority in me vested
as aforesaid, and in consideration of the sum of ...
ao�Q
D to me in hand paid by the said AQ. ... Achterh9f...and
w,
the receipt whereof is hereby acknowledged, do hereby grant, bargain, sell and convey unto the said II
as joint tenants,
....... hTim-and-assigns, all
of the following described real estate in the County of .........
rQix ...................... , State of Wisconsin, to-wit:
e
Southwest Quarter of Northwst Quarter (SW of NWk) of Section Six
.......... i ..... Tw enty -ei ...... .... .... . ... i4 ..... ifi ........ o .. ........ � lwi6 ... i ..... t ........... (Q
;Ki .&_ ........
P Nor 0 R n West own of
.......... ... qX!9ix Wisconsin.
. .... ....... ... . . . .............................
................................... ............................ ....................................
...................................................................................................................................................................................................
.......
.................................. .............................. ........................................................... .....................................................................
..
-------------------------------- ------------ * ------------ * ............... ..................
7 , r ............................... ............................... i�
..........
. ........................................................................................
...- ..•-- ......- ••• .... ............................ FEE
........................................................ . . ........ ........................ . ..............
................... ... ........................................
. .........•• ... . ........................................................... . .
............... . ...................
........... 7 ................................................ W ....................................... ........................... ..-.
.... . ......................................................
. .....................................................................................................................
. . . ......... ... . ..........
. ....... . .......
-A'0641J Z
7- A— -J P771� g
* 8 OR ADUDUMTO I$ "!
DUD -L
................................................................................................................................................................ . ............................
...... ......
• ............. ..................... . . . ....... . ................................ . ..................................... ............................... . .. . . .. ..............
........................................... . ........................... I ....................................................................................................................
....
...........................................................................................................................................................................................
............
................................................................................................................................................................... I .......................
...............
............................................................
............................................................................................
............••• ...•••
.............................
...............................
........................................................................................................
......••................................. •..•..••.•• .....
...........................................................................................................................
........................................................................................................................................ ............................. . ................
I .................
-------- - - - - -• •• -• •-
.......... : . . . . . . . . . . . . . . ....................... ...................•••... * ....................................................................... .......
. ...................... .........................
..................................................... . ...................................... .... ...................................... ....... .............................
.......................
.................................................. ................................................ .............. : .......................
.............................................................
........................................................................................................................................................................ : ......................
.............
.....•..•.•................•................ ..................................................................... .................. ......-••-•---------------.............----•--••--------
---•--
TO HAVE AND TO HOLD the above bargained real estate to the said ... JPe.'?P)j- J 11-t )VjjQf-.Wid..L.Qr!r
I! ... jjaj=.tenants.... .......... h6 r9 - Q M- ee8 i gj* , 4•0"VRR.,
IN WITNESS WHEREOF, 1, the said ---- .............. Danald.Hageri
as•. ..A'dmiuistratQr ------- ---------------- ------------ aforesaid, have hereunto my hand and seal this .....
day of ........... .. 4 +r4 --
. ..19...61...
hereunto hand and seal this ------
u Administrator
Signed, Sealed and Delivered In Presence of .......... ... .. ---------- - - - - -- (SEAL)
0 6ij
onal -'�en-
Adm:Lnistraor
------------------ -------- ------- ----- --- ---- -- ............ .. ...... ............. of the Estate
----------- (2 Ben Johnson
---- -- ---------------- of .....
-- ----------- t ---- ---- Deceased.
Pearl Grotenhuis
STATE OF WISCONSIN,
St. Croix ss.
...... ......... ........... ........................ .. ............
On this
---- --- _ - -- - day of. ........... ._ v
. ...... 1969... before me personally appeared
......... Donald Administrator
.... .... .. .. ........ ..........• ... ..• ... ............. known to me to be the - -• ...............
Ben Johnson ...........
.......... I deceased,
late of .... .......
01 County,
0
nit n 0 *ie ion in the within conveyance, and acknowledged that .......... executed the same as such
A R
--- -------------- trator
- Vjj
. . ....................................... ri Y r e uses an
,freely and voluntaril , f t he d purposes therein expressed.
......................... ............................. I ........... ...............................
Harold D. Olson
cold D. Olson, Attorney • Notary Public,, .... S-t. --- QrQiX --------- County, Wisconsin.
a My commission is permanent
94 C!
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03 03 4J
Aconsin Department of Commerce SOIL AND SITE EVALUATION Page - 1 of _3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I.D #
004 - 1012 -95 -001
APPLICANT INFORMATION - Please print all information. - - - - - - -- - --
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed By Date
Property Owner Property Location
Lorraine Achterhof Govt. Lot SW 1/4 NW 1/4 S 6 T 28 N,R 15 W
Property Owners Mailing Address Lot # lock # Subd. Name or CSM#
569 270th Str eet _
City State Zip Code PhoneNumber ❑ City [] Village ElTown Nearest Road
Woodville WI 54028 715- 698 -2680 Cady 270Th Street
New Construction Residential / Number of bedrooms 3 UAddition to existing building
l Use:
Replacement U Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ft .6 trench, gpolft
Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate .5 bed, gpolft .6 trench, gpd/ft
Recommended infiltration surface elevation(s) 91.75' at 12" above 90.75 contour. ft (as referred to site plan benchmark)
Additional design / site consideration Existing system and soil conditions qualify for Wisconsin Fund program. Existing system elev. = 92.00'.
Parent material loess over weathered dolomitic limestone residuim. Flood plai n elevation, if applicable NA ft
S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S® U H S❑ U ❑ S H U ❑ S U ❑ S z U ❑ S U
S OIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Conslstenc Boundary Roots - -Bed
Trench
1 1 0 -8 — 1Oyr4 /2 None - sit 2fsbk mvfr as 2 0.5 0.6
2 8 -1 1Oy r5 /4 None sit 2m ds cs if 0.5 0.6
Ground 3 16 -36 I Oyr4 /4 None sl 2msb dsh cs If 0.5 0.6
elev-- - -- -- - - - - -- - - - - - -- - -- - - - -- - - - - - -- - - -- - - - -- -,- - -- -
88.46'ft 4 36 -40 7.5yr4/4 f2f7.5yr5/8 sl I csbk dh aw - 0.4 0.5
Depth to 5
[I
40 -56 1 Oyr5 /4 None LSBR O m dh - - NP NP
limiting Horizon #5 consists of 2" - 6" by 2" thick limestone fragments comprising >50 of horizon. Voids and crevices between limestone fragments filled with
factor 10YR5 sl & 1oyr4/6 scl.
36" - -
Remarks: - - - - - -- - � -- - --
2 1 0 -12 1Oyr4/2 None - - sil 2fsbk mvfr as 2f 0.5 0.6
2 12 -16 I0yr5 /4 None sil 2msbk ds cs if 0.5 0.6
- - -- - - - -- - -- -
Ground 3 16 -30 1Oyr4 /4 None sl 2m dsh cs if 0.5 0.6
elev- - - -- -- - -- — - - - - - -- - - - - -- - - - -- - - -- -- - --
89.91' ft 4 30 -4 0 7. 5yr4/4 f2f7.5y sl Om dh aw - 0.3 0.4
Depth to 5 40 -52 I Oyr5 /3 f3d10yr8 /2 LSBR Om dh - - NP NP
limiting - - -- __ _ - - - - -- -- -- - - -- - -- - - - - - -- _- -- - __ _ ,
factor
30"
Remarks: _. _ —.. - -- - - - - --
CST Name (Please Print) Signa e: Telephone No.
James K. Tho 7 - 248 - 77
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, Wl 54020 11/14/99 3602 1129
OROkM OWNER Loffaine Achterhof SOIL DESCRIPTION REPORT itza Page 2 of 3
A.C.E. Soil &
iARCEL LDJ 004-1012-95-001
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots — GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T rench
1 0-9 1 Oyr4/2 None sil 2fsbk mvfr as 2f 0.5 0.6
2 9-14 10yr5/4 None A 2msbk ds cs If 0.5 0.6
Ground
elev 3 14-30 1 Oyr4/4 None sli 2msbk dsh cs I f 0.5 0.6
----------
91.15'ft 4 30-36 7.5yr4/4 f2f7.5yr5/8 sl 1csbk dh aw 0.4 0.5
Depth to 5 36-50 10yr5/4 f3d10yr8/2 LSBR 0M A NP NP
limiting -- .-- --- - ___ --,- --- -- -- -i -- --- -- ------ -
factor Horizon #5 consists of 2" - 6' by 2" thick limestone fragments comprising >50 of horizon. Voids and crevices between limestone fragments filled
30'
with 10YR5/4 sl & 10yr4/6 Is.
-------
Remarks:
4
0-9 1 Oyr4/2 None sit 2fsbk mvfr as 2f 0.5 0.6
- --- ------
2 9-14 1 Oyr5/4 None sil 2msbk ds cs if 0.5 0.6
Ground
elev 3 14-30 1 Oyr4/4 None gr. Is 0 sg ml Cw If 0.7 0.8
94.25'ft 4 30-36 7.5yr4/4 m2fd.5yr5/8 gr. si Icsbk A aw 0.4 0.5
Depth to 5 36-50 5yr4/4 f2f7.5yt5/8 cl orn dh NP NP
limiting
factor
30" ------ -------
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
----- - ------- - ------
Ground
elev
Depth to
limiting
factor
Remarks:
s 170 Sf R. 30 '3
w �r
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6*9 z70 St• Eleda �'Gn
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G33��>�o EaSf �Or�°• �i'nP
okkoftin-DepartmentdCommerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
AC.E. Soil &Site Evaluations
Attach complete site plan on paper not less dean 8% x 11 inches in size. Plan must
include, but not limited to vertical and t7p nt, ft3AA), direction and j j Q cou nty St. Cr
percent slope, scale or d'irnernsions, n and distance to nearest road. .D .#
APPLICANT INFORMATION �(irinta- *frrmatiom a 004- 1012- 95-O Dato
Personal information You provide may be f ndarY (Y. s.`15.04 (1) (m)). Y
- 10-Z,e�
Property Owner P, pe Location
Lorraine Achterhof i ' �= err G SW 1/4 NW 1/4 S 6 T 28 N,R 15 W
Property Owner's Mailing Address x J " L ' # # Subd. Name or CSM#
569 270th Street �uN?Y ° ` A `
Stale ip �= OCR ®Town Nearest Road
city Woodville WI 54Q28 715 -698- 6 .. 270Th Sweet
® New Construction Use: 0 Resider bedrooms 3 ❑Addition to existing building
❑ R*icement ❑ Pubic or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpoff .6 trench, gpdff
u rea required 900 bed, t>z 750 trench, ftz Maximum design loading rate •5 bed, gfxllftz
.6 trench, gPdlff?
Recommended infiltration surface elevation(s) -r 9 1.75' at 12- above 90.75' contour. ft (as referred to site plan benchmark)
Additional design I site conSlderatlonS Existing system and sorl conditions qualify for Wisconsin Fund program. Existing system elev. = 92.00'.
Parent material loess over weathered dolomitic limestone residuum. Flood n elevation, I aWkable NA ft
S for system Conventional Mound In Ground Pressure AT -Grade System in Fill Holding Tank
tIClJnsuitable for system EIS ®u ®S ❑ u ❑ S ®u ❑ S ®U I ❑ S ®u ❑ S E U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPDIft
Texture Consis Boundary Roots
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 1 0 -8 10yr4/2 None sil 2fsbk mvfr as 2f 0.5 0.6
2 8 -16 1Oyr5/4 None sit 2msbk ds cs If 0.5 0.6
Ground 3 16 -36 1Oyr4/4 None sl 2msbk dsh cs If 0.5 0.6
elev
88.46 ft 4 3 -40 7.5yr4/4 t2f7.5yr5/8 sl Icsbk dh aw - 0.4 0.5
D tD 5 40 -56 10yr5/4 None LSBR Om dh - - NP NP
Depth
limiting Horizon ii. c insists of 2 - r by 2 - thick limestone fragments comprising >50% of horizon. Voids and crevices between limestone fragments filled with
factor 10YR5/4 sl g 10yr4/6 sit.
Remarks:
Z 1 0 -12 1Oyr4 /2 _ None sil 2fsbk mvfr as 2f 0.5 0.6
2 12 -16 10yr5/4 None sil 2 msbk ds cs If 0.5 0.6
Ground 3 16 -30 1Oyr4/4 None sl 2msbk dsh cs If 0.5 0.6
elev - —
89.9t'ft 4 30-40 7.5yr4/4 f2f7.5y sl Om dh aw - 0.3 0.4
Depth tD 5 40 -52 10yr5 /3 f3dl0yr8/2 LSBR Om dh - - NP NP
limiting
factor --r
30'
Remarks:
Tel No.
CST Name (Please Print) Sig Tel ephone - 248 No.
James K Thompson Date ST Number Ref#
Ads A.C.E. Soil & Site Evaluations
340 Paulson Lake lane, Osceola, Wl 54020 11/14/99 2 1129
oLOPERTY OWNER. torraineAdrtediof _ — SOIL DESCRIPTION REPORT 1129 Page 2 (Yi 3 -
PAIMEL Ul It 004- 1012 -95-001 A.C.E. Soil &Site Evaluation
Horizon Depth Dominant Color Mottles Structure GPDff
t.
Texture Gr. Sz. Sh. � onsistenoe j Boundary Roots Bed ; Trench
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in. Munsell Qu. Sz. Con
3 0 -9 10yr4/2 None sit 2fs bk mvfr as 2f 0.5 0.6
2 9 -14 10yr5/4 None sil 2msbk ds cs If 0.5 0.6
Ground
1
F elev 3 14 -30 I Oyr4 /4 None sl 2msbk dsh cs 1 f 0.5 0.6
91.15'ft 4 30 -36 7.5yr4/4 f2f7.5yr5/8 sl Ic dh aw - 0.4 0.5
Depth to 5 36 -50 10yr5/4 f3d10yr8 /2 LSBR Om F dh - - NP NP
limiting
factor Horizon #6 consists of 2" - 6" by 2" #** limestone fragments comprising >50% of horizon. Voids and crevices between lirnestone fragments filled
30, with 10YR514 sl & 10yr4/6 Is.
Remarks:
4 1 0 -9 _ IOyr4 /2 None sil 2fsbk mvfr as 2f 0.5 0.6
2 9 -14 10yr5 /4 None sil 2msbk ds cs If 0.5 0.6
Ground
elev 3 14 -30 10yr4/4 None gr. is 0 sg ml cw if 0.7 0.8
9425' ft 4 3 6 7.5yr4/4 m2fd.5yr5 /8 gr. sl 1 csbk dh aw - 0.4 0.5
Depth to 5 36 -50 5yr4/4 UV.5yr5 /8 cl Om dh - - NP NP
limiting
factor
Remarks:
Ground - - - - - -- - -- -- - - - - --
elev
Depth to
limiting
factor
i
Remarks:
Ground
elev _
Depth to
limiting
factor
Remarks: - - -- - —
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REPORT OF INSPECTION - INDIVIDUAL SLWAGE SVSTtM
San.i.tany Penm-i.t
State SepticAff
TAME Township_ St. Ca.oix County
SecU on 4 M Subd.iv.ia. ion
• I P T I C. TANK
Size Z na Number. 66 compan.tmentA
ietanee 6num{ Wett Bu.itding 12% a.tope
H.ighwate4
'LI MPING CHAMBER
Si ze. yatton4 Pump Manu,6aetune4. Model Number
O LDING . TANK
Size gattona. N•umbea. o6 Compantmen
Pumpe)L Ataam System
lcatanee 6aom:• Wett Building 12% a lope_
H.ig hw a
Ii SORPTPON SITE
Bed The.neh I K
(stance 6Kom: Wett Building +f 12% slope
Highwaten
WSO RPTION SITE DIMENSIONS
.Width o6 thench � At Req u.i red a're'a, ll At
Length u6 each tine �.�_ D ep 6 to eh bex t•ile___._.___.4.n
Numbers o6.' tine, Depth u aoeh uven tike_ Z- y _in
TotuX rength 'u6 linea � t) 6t Depth u6 tale below grade_ _! i.n
Diatani:e between tines 6t stope u6 thench An. pen 100 At
I u l u, ab v &p.ttiUn aheu �d y � ;
6t , hype u 6 ,Co ven.: ape un a tn.aw
IT D I M(NS I ONS �!^
Numbe4 a6 p.i.tA Gravel around pc'ta yea _ nu
Outai-dg diAmeteA 6t Depth below intet 6x
total abaon.ption�aKea 6t
'Arta 4equi4ed At
NSPE_CTED• '�°`��..�. TITLE
.1 DATE / D 19 8
A JE CTED DATE ` 198
A ASON FOR REJECTION
A
*Pt State and County State Permit # 7
Permit Application County Permi # 07 7<0
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:
B. LOCATION: _'31L) 4 '/4, ection T R E (or) ot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: * Commercial * Industrial * Other (specify) Variance
Single family V/ Duplex No. of Bedrooms �� No. of Persons
D. SEPTIC TANK CAPACITY ; Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured -in -Place Steel Fiberglass Other (specify)
New Installation 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 Replacement Alternate (Specify)
Seepage Trench: 1- No. of Lineal Ft. / 00 Width s — Depth —Z Tile depth (top No. of Trenches %tom
Seepage Bed: Length Width Depth Tile depth (top No. of Line
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land Distance from critical slope
WATER SUPPLY: Private ®' Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if othe 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 Soil Tester
NAME ° C.S.T. # and other information
obtained from (owner /builder)
Plumber's Signature * Phone # !o�J 3- ,�j 2 Za
Plumber's Address �*-sr
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.
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Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application /� -/a - 1?G Fees Paid: Stat County b-o Date - -
Permit Issued /Reiected (date) f ,2- /a X40 Issuing Agent Name c ,
Inspection Yes No State Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy) Revised Date 7 /1/78
EH., 115 Rev. 9 / 7$
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
J 141
LOCATIO %<, % <, Section ,TN,R I (orownship or Municipality
Lot No. , Block No. County
O j,, Subdivision N ame `}
Owner's /Buyers Name:
Mailing Address: f , O
TYPE OF OCCUPANCY: Residence — No. of Bedrooms COMMERCIAL ~'
EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM =TH
DATES OBSERVATIONS MADE: S BORINGS l Q g&
2 PERCOLATION TESTS ,1
SOIL MAP SHEET �� QaL _ , NAME OF SOIL MAP UNIT �Q1 3 Aw u' l ad"A ISIL14
3,l
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 AFTEF INTERVAL MIN /IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P—
P—
P_
P—
P—
P— j
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- AZ U 3 . 6
B - 2 a 1
B 7. r
B y 't' Z ®
B
B-4 I A 97 07
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the pl t I cati nand 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 ve f r ce ints. Indicate slope. �'o F .Zw34Tir��.t jOit�EJ� /t�E/Ge
ree AcEPf�
PIP I
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I, the undersigend, hereby certify that the sal tests reported on this form were made by me in accord with the procedures 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) / Certification No.
Address
.Name of installer if nown
CST Signature
Copy A —Local Authority s
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13-170
REPORT ON INSPECTION OF SANITARY PERMIT #
(1 ) Name and Address of Permit Holder Person /Persons at Site _(2 )Date of Inspection
d6 f
� Time of Inspection
e, ress,, cense o. o ins tai ing Plumber
�
3 INST LAT ON CO7it S OF: eptic Tank ❑ Seepage Trench ❑ Dosing Chamber
❑ Seepage ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System
(Permanent reference Po in Describe:
Elevation of vertical reference point: Slope at site:
(5)MATERIAL AND DEPTH OF SEWER:
(6)SEPTIC TANK: Manufacturer: Liquid Capacity:
Tank Inlet Elevation: Tank Outlet Elev:
# ft to lot or property line: # ft to well
(7)DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines gallon; size of pump head; gallon per minute ;
horsepower ; brand name of pump and model number
Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO
8 HOLDING TANK: Manufacturer # of gallons ;
construction depth to the cover ft; If septic tank is
being used are baffles removed? YES ❑ N0; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑ N0; Wired? OYES ❑ NO;
Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe - elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPAGE BED SIZE: ft width; ft length; tile depth;
li.neal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed ft.
11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft;
tile depth ft; ft to well; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes,
water courses or drainage ditches; elevation of tank discharge line entering seepage
trench ft.
(12) Has system been installed in area indicated on EH 115? ❑ YES [:] NO
(13) Has system been installed in floodway? ❑ YES []NO Floodplain? ❑ YES ❑ NO
DILHR -SBD -6095 N. /80
Signature of Inspector
EH 11,5
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION J '/4, .L''1+ /,, Section _-GL TaN, R a E (or)(WV Township or Municipality C�
Lot No. Block No. County St C ro I X
Subdivision Name
Owner's Name:
Mailing Address: /
TYPE OF OCCUPANCY: Residence y No. of Bedrooms Z) Other
EFFLUENT DISPOSAL SYSTEM: NEW L ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE Cj_b0x'L6hA 66�
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 AFTER INTERVAL MIN /IN
BER 1 f 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P_ O r 1 +C 1/" t 4 Y 4 t
V 30 4 6LJO 0 yl b 1 q
tr Q q I I
cd a -4 .
t e k4 `t-'��"� SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THtqKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B 13 n s , 1 +7 8
►I 1�
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. q C , Indicate scale
or distances. Give horizontal and vertical referen i e.
d)
4 1 Ap i kl).e
y
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
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) V ►, z, k r L. e e Certification No. � S ' S te-
Addres R�UC� l'1 Jle
Name of installer if known
CST Signature - 22u'`-J7lY-�l.P y
COPY A —LOCAL AUTHORITY
St. Croix County Planning and Zonin
Thursday, July 07, 2005 at 9:47:34 AM
Detail Sani tary Information Page I of I
Computer #: 004 -1012- 95-100 Sub /Plat: 40 acres Section: 6
Parcel #: 06.28.15.87 Lot: 1 TN /RNG: T28N R15W
Municipality: Cady, Town of CSM: Vol. 17 Pg. 4618 1/4 1/4: SW 1/4 NW 1/4
Owner: Acterhof, Lorraine 569 270th Street Woodville, WI 54028
State Permit: 353384 Issued: 04 /10/2000 POWTS Dispersal: Mound 24" or more suitable soi Permit: Replacement
County Permit: 0 Installed: 04 /18/2000 POWTS Detail: NA Bedrooms: 3 WI Fund: No
POWTS Pretreatment: NA
Notes
Inspector As Built Plumber Other Requirements Additional Notes Money Owed
Kevin Grabau >4/1/00 -Not Required Helgeson, Bennie Existing house now on Lot 1 of a 2003 lot split $0.00
Signed Off: Yes CSM #741092, used existing 1500 gal septic tank
to new 750 gal. Midwest dose chamber and
mound cell 5'x 75' and abandoned original
conventional trench system
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
4/1812003 04/01/2005