HomeMy WebLinkAbout018-1058-30-100St. Croix County Planning and Zoning
Monday, August 14, 1006 at 8:36:59 AM
Detail Sanitary Information Pagel oft
Computer #: 018-1058-30-100 SublPlat: NA Section: 26
Parcel #: 26.29.17.398B Lot: TN/RNG: T29N R17W
Municipality: Hammond, Town of CSM: 114 114: SE 1/4 NE 1/4
WYNVEEN, STEVE E�, Ne', Section 26
Route 2 T29N-R17W , Town of Hammond
Baldwin, WI 54002 ?th *VULLUC-sd
address of site: same
Permit No. 102828 11-25-87 Dale E. Hudson
Conv. Replacement
St. Croix County Planning and Zoning
Friday, !a!y 29, 2011 at II:49: SO AEI
Detail Sanitary Information
Page I of 2
Computer#: 018-1058-30-100 Sub/Plat: NA Section: 26
Parcel M 26.29.17.398B Lot: 1 TWRNG: T29N R17W
Municipality: Hammond, Town of CSM: Vol. 11 Pg. 3171 114 114: SE 114 NE 1/4
Owner:
Wynveen, Steve 784 2001h Street Baldwin, WI 54002
State Permit:
268628 Issued: 09/04/1996
POWTS Dispersal:
Mound 24" or more suitable soi
Permit: New
County Permit:
0 Installed: 09/04/1996
POWTS Detail:
NA
Bedrooms: 3 WI Fund:
POWTS Pretreatment:
NA
Notes
Issuer/Inspector As Built
Plumber
Other Requirements
Additional Notes
Jim Thompson Yes
Wilson, Michael
Money Owedro
Jim Thompson Signed Off: Yes
soil report and state -approved plans for new $0.00
mound location. Permit issued to allow completion
of mound - see permit #262449. see also permit
#399615 for installation of a 2nd mound on this lot
Maintenance
with sanitary easement recorded.
Scheduled Pump Date Pumped
9/4/2002 7/28/2003
7/28/2006 7/8/1999
7/8/2002 11 /25/2002
7/28/2006 10/19/2006
10/19/2009 10/7/2009
10/7/2012
Owner:
Wynveen, Steve 784 200th Street Baldwin, WI 54002
State Permit:
County Permit:
102828 Issued: 11/25/1987
0
POWTS Dispersal:
Non -Pressurized in -ground
Permit: Replacement
Installed: 11/25/1987
POWTS Detail:
Bed - Seepage
Bedrooms: 3 WI Fund:
POWTS Pretreatment:
NA
Notes
Issuer/Inspector As Built
Plumber
Other Requirements
Additional Notes
Tom Nelson No
Hudson, Dale
Money Owed
Not determined Signed Off No
E NE 1/4 Route Avenue. Proposed
$0,00
ins 1
to install a bed with 000 gal.al. septic & 800 gal.
dose tank connected to a trailer home on same
property approximately 45' south of an existing
house and septic system. Nothing filled out on
report and no as -built to indicate that the system
was installed
St. Cro& County Planning and Zoning
Friday, July 29, 2011 at 11:49: SO AM
Detail Sanitary Information Page 2of2
Computer a: 018-1058-30-100 Sub/Plat: NA Section: 26
Parcel 0: 26.29.17.398B Lot: 1 TNIRNG: T29N R17W
Municipality: Hammond, Town of CSM: Vol. 11 Pg. 3171 114 114: SE 1/4 NE 1/4
Owner: Wynveen, Steve 784 2001h Street Baldwin, WI 54002
State Permit 262449 Issued: 05/21/1996 POWTS Dispersal: Mound 24' or more suitable soi Permit: New
County Permit: 0 Installed: 06/27/1996 POWTS Detail: NA Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/Inspector As Built Plumber Other Reauirements Additional Notes Money Owed
Mary Jenkins No Wilson, Michael System area destroyed. Jim inspected tanks and $0.00
Jim Thompson Signed ON: No required a new mound plan be approved by state
and a new permit issued. 3 permits filed together
in 19% archives
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS"'''')
SUBDIVISION / CSMf
SECTIO ^����,,�
�TN-RAW, Town of
ST. CROIX COUNTY, WISCONSIN
IAT S
-- ,utf seLpack and elevation information on reverse of this form.
Provide 7 djmnnc;,,,,- .
i
BENCHMARK: 04 , 0
ALTERNATE DM: `
SEPTIC TANK / PUMP CHAMBER / IiOLDING TANK INFORMATION
Manufacturer:e Liquid Capacity:
Setback from: Wella(& %0 House— Other
Pump: Manufacturer
��L�1'� Modell 9 E-4Size_
Float seperation Gallons/cycle-/2�2
Alarm Location
;SOIL ABSORPTION SYSTEM
Width:./ Length 4(—
g Number of trenches
Distance & Direction to nearest prop. line:
—
Setback from: well•Q/House V4 Other
ELEVATIONS
Building Sewer Z VZ ST Inlet._ , 7!7 ST outlet
PC inlet__ PC botto��!�
Pump O f f 1,z_Z
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:Cj
INSPECTOR:
3/93:jt
Wisconsin Department of Industry,
Labor and Human Relations
�afgty and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Permit Holder's Name:
VI age Town of:
WYNVEEN, STEVE
ND
T BM Elev.:
Insp. BM Elev.:
BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG.
Vent to
Air Intake
ROAD
Septic
NA
Dosing
NA
Aeration
NA
Holding
PUMP / NFORMATION
Manufacturer (� , e and
Model Number � . P
TDH LLoss
ift Frictio S tem��' TDH (�Ft
Forcemain Length -7491 Dia. " Dist To Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County:
ST. CROIX
Sanitarl68628
State Plan ID No.:
Parce Tax No.:
a�
A9600320
0 NO
r ME
St/ Ht Outlet
wi a�
a
Mwl'��
_mm�
BED/TRENCH
DIMENSIONS
Width r
Length ��
No. Of T enches
PIT
No Of Pits
Inside Dia.
th
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LE
anuacturer:
SETBACK
CHA R
de
ype /lr..-�-
�
�
'
M e Numr:
INFORMATION
System: M d
>/,O
�
NIT
.1� DISTRIBUTION SYSTEM
Manifold
Dia
rLength]2�,
Distri ution Pipes
Length i3 / Dia. Spacing O
x Hole Sae „
x Hole'Sping
`i
Vent To Air Intake
x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
xx Depth Of
xx Seeded/Sodded
I I
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Tol:
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
�, � ��,,�� � ), �
(OC4ION�ilC►Mb[OND.26 2�1' ; NE;J2I�04- `
Plan revision required? ❑ Yes B' —0 2
Use other side for additional information-
SBD-6710 (R 05191) Date Inspector's Signature Cert No
(o'� 1
q
SOIL COVER
Depth Over
4qp
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
�p Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water System
201 E. Washington Ave
In accord with ILHR 83 05. Wis Adm Code P O Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less
County _
than 8 112 x 11 inches in size.
S �•
State Sanitary Permit NurrLber
• See reverse side for instructions for completing this application
The information you provide may be used by other government agency programs
66walk it (civiwn to previous applicatxm
State Plan I.D. Number
lPrivacy Law, s. 15.04 (1) (m)l
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATI N
1
Property Owner Name
S GiA, vet-.
Property Location
C714#jj�-114,S.26 T_2 ,N,RE(or&
Property Owner's Mailing Addre;s
oT GO T—� Sr—
Lot Number
Block Number
ity, Stat
Zip Code
Phone Number
Subdivision Name or CSM Number
II. TYPE BUILDIN : (check one) ❑ State Owned
�_
o ity
age
Yiiwn
Nearest Road
< J�
Public or 2 FamilyDwelling- No. of bedrooms
t OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
(:5>/?-- /4)
1 ❑ Apartment / Condo
2 ❑ Assembly Hall 6 ❑ 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: (Check only one box on line A. Check box on line B, if applicable)
A) 1. )4,plew 2_ ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
Syr tem -- System _ Tank Only -___ _ Existing System-- Existing System
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�Aound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fil I
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade
Required (sq ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
y� -3-7J'— s— / Z _ S9 s� Feet aJP' Feet
VII.
INFORMATION
Capacit
in gallons
g
Total
Gallons
# of
Tanks
Manufacturer's Name
Prefab
concrete
site
con-
Steel
Fiber-
glass
Plastic
Exper
App
New
Existin
strutted
Tank
Tanks
Septic Tank or Holding Tank
�CXr4
Ui �sei'//�
❑
❑
❑
❑
❑
t ift Pump Tank /Siphon Chamber
❑
❑
❑
❑
❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature. (No Stamps) MPRSW No . Business Phone Number:
hr. 1r l s C L✓.' L ro • t f, tJ 4 �
Plumber's Address (Street, City, State, Zip ). Coode
146U S
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved
Sanitary Permit Fee (nducli fGrwridwate,
ate ssue
Issuing Aggrnt Signa re (No amps
A roved
pp
❑ Owner Given Initial
aya�,i� surcha,ge Iel
�Q1 v
Cj✓//
^Oe1*
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
S1341.6398(H WWI 131"RIaU nON Ung,nai b) IOUN I. I xrwPY io: suvrye wuwen!'mn:w..,
i"
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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, 608-266-3815.
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.
III. 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.
Vlll. 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-
0
IX. County / Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 8 112 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.
OPTIONAL WORKSHEET
I. MOUNOSYSIEM
y'SL
1.
Wastewater Load, Total Daily Flow•
gal.
Use s. ILHR 83.15 (3)(c)
Adm. Code and PROVIDE A DETAILED
LIST OF SUING ON PLANS.
��
�.67
2.
Depth to Limiting Factor •
It.
3.
Landslope =
S- %
4.
Distance from Dose Chamber to
Distribution System •
/DO ft.
5.
Elevation Difference Between
16
Pump and Distribution System •
ft.
6.
Absorption Area Sizing:
Area Required •
sq. ft.
Bed or Trench Length (6) •
(/�
ft.
Bed or Trench Width (A) •
ft.
Trench Spacing (C) •
ft.
7.
Mound Height:
Fill Depth (D) _
fL
Fill Depth Downslope (E)
ft.
Bed or Trench Depth (F) •
f fL
Cap and Topsoil Depth (G) •
ft.
Cap and Topsoil Depth (H) •
ft.
9.
Mound Length:
�O'
End Slope (K) `
ft.
Total Mound Length (L) •
ft.
9,
Mound Width:
Upslope Correction Factor •
J�C2,!'
Upslope Width (1) •
ft.
Downslope Correction Factor •
! /�
Downslope Width (1) •
ft.
Total Mound Width (W) •
.2. fL
10.
Basal Area:
Infiltrative Capacity of
Natural Soil -
___ l__ galjsq,ftjday
Basal Area Required •
ep. fL
Basal Area Available •
-L $4. fL
11.
If Standard Tables from Chapter ILHR 83
are used, Indicate Table M
_
12.
For the Distribution Network, Use NumbersS•14 In Section 11.
11. IN -GROUND PRESSURE SYSTEM
1.
Depth to Limiting Factor •
ft.
2.
Landslope •
%
3.
Percolation Rate •
minjin.
4,
Proposed System Elevation •
ft.
5.
Wastewater Load, Total Daily Flow:
gal.
Use s. ILHR 83.15 (3)(c),
Wi .
Adm. Code and PROVIDE A DETAILED
LIST OF SIZING ON'PLANS.
Required Septic Tank Capacity •
gal.
6.
Absorption Area Sizing:
Percolation Rate •
min./In.
Area Required •
sq. rt.
System Length •
ft.
System Width =
ft,
7.
Distribution Pipe Sizlryt:
Holc Sic •
_ !_L in.
Holc Spacing =
_,�. ft.
Lateral Length -
021 ft.
I.alrral Sirc
in.
lateral Spacing
_ It.
DmIatlLe Irntll 1illrWAI su Pilrc
k.
Uhtrlhulion Pit* Divcharge Raw
Number I lulrs
of Prt-Pipe
-�
I luw Per Pipe
i. a2, gpm.
4.
Manifold 5LInIt:
I ype WED or Una) CG h t,e.-
Length = _ if,
Diameter • In.
na. Y. f.A.1.. .. L11.1,
If. INGROUND PRLSSURE SYSTEM-Contsnued-
10.
Force Main:
Minimum Dosing Rate =
a d'.oP spin
Diameter =
in.
11.
Total Dynamic Head:
System Head
2.5 ft.
Vertical Lift =
do ft.
Friction Loss' /.Jf I
_ ,Y ft.
TDH •
I9.9 ft.
12.
Pump Selection:
3 g
Pump will discharge at least
gpm
at .2 Q ft. total dynamic head.
Pump model and manufacturer: ��r: -�• rt
4/nn (iG
13.
Dose Volume:
10 Times Void Volume of
Distribution Lines •
3L• Qgal.
Daily Wastewater Volume +
4 Doses In 24 hrs. _
/l.2. Sgal.
Backflow •
gal,
Minimum Dose
gal.
14.
Dose Chamber:
Volume •
gal.
Ill. CONVENTIONAL PRIVATE SEWAGE SYSTEM
1.
Wastewater Load, Total Daily Flow •
gal.
Use s. ILHR 83.15 (3)(c),
Wis.
Adm. Code and PROVIDE DETAILED
LIST OF SIZING ON PLANS.
2.
Required Septic Tank Capacity •
gal.
3.
Percolation Rate •
min./In.
4.
Absorption Area Sizing:
Refer to Table 2 in ch. ILHR 83
and PROVIDE A DETAILED LIST OF
SIZING ON PLANS.
Required Area •
sq. ft.
Length =
ft.
Width •
ft.
Number of Trenches •
Trench Spacing •
ft.
S.
Distribution System:
Lateral Length •
ft.
Number of Laterals •
Lateral Spacing •
In.
Distance from Sidewall to Pipe •
In.
System Elevation •
It.
IV. SYSTEM4N•FILL
Fill In All Items from Section III
V. SEPTIC TANK S (� 6 - 3 O 8 '7 '�
1. Capacity • 1J 9 gal.
2. Manufacturer:
3. Show Site Constructed Tank Details on Plan
VI.
DOSING TANK
1. Capacity •
2. Manufacturer:
3. Pump Manufacturer:
4, Pump Model:
5. Orscralinit Head
6, 1-low Rale=
7. Show Site Constructed Tank Details on Plans
gal.
It.
gpm.
VII. 1101.U1NG *1 ANK
I. Capacity • gal.
2. Manulacturer:
3. Shrew Site Conslfuctcd Tank Details on Plans
-SHOW ALL INFORMATION ON PLANS -
i
i
N�
NJ
mNJ
u��
mom0
JOE
No
�iiiis�i�
0
Straw, Marsh Hay, Or
;• Synthetic Covering Distribution Pipe
1 Medium Sand
H G -
Topsoil-% I IF
I 3 0
�t Slope Force Main Plowed Layer
Bed of h"- W
Aggregate
I
Cross Section of a Mound System Using
A Bad For The Absorption Area D Ft.
S /. `/ Ft.
F , 7-r- Ft.
AFt. G / Ft.
B� /�Ft• 6t H—Ft.
Signed: 4 X / o-4 Ft.
E�3T�m L 6 7• b Ft.
1 Fib
Date: V - M 26!�&Ft.;
�. p �E�p,T10NS
US AND
DEPAFITMEND��SION OF SAFET'�
• NOE SPONCE
n�S E CORRE
Alternate Position of
Force Main
I
I L —~I
Observation Pipe
r____ B
A Forc4Xain
w____ M
1
i Distribution Pipe LBW of �"
Aggregate
i
Observation
i I Pipe Pezaanent Marker
F.. _
'PI" Vier of Moaad Osinq a Md the IAbeosoa kN
• S96-30877 '
w
ik
0
.19d six
wt w•
rvc /
UWAN rW
,1u�•r..a h•u�. of
rate Mdo
Lost mb am" N
MW Ti W CA, a _.
. L. oat P .La? Ft.
TMENT Of INDUSTRY, LABOR AND
KUMAN RELATIONS R Pr
DEPAR s
DIVISiCN OF SAFET`r AND BUILDING X q_ IAe11Rs
r Al r ..
gEE CORRESPONDENCE Hole Dla"ter Inch
signed: _� s c.✓.. Lateral " � ,,: Inch(es)
Ltcenss Nueber: Manifold v Inches
9 I For* N00 " tnchei
Date. ,_._..,9 J2. of .
/ • holes/pi
QvhCr
wyM�«� Invert Elevation of Leteralda"
SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE E
>_25' FROM DOOR, WINDOW OR
FRESH AIR INTAKE
FINISHED GRADE 4" CI RISER
6" MIN.
ABOVE G ADE
18" IN. 6,� MAX.
:4
INLET
I()N
\ATER TIGHT SEALS4 �� BAFFLE� iCI B
3' — —SOLE SEWAGE SYSTEM CSOIELEVs-FT. -i—
w D
S96-30877
WEATHER PROOF
JUNCTION BOX APPROVED
WITH CONDUIT MANHOLE COVER
W/ PADLOCK 6
WARNING LABEL
1— —4" MIN.
4
I'
GAS-
TIGHT� ,
SEAL
i
I
n� a a1 c 0J
IPID`�STKY. � 8$�BVED BEDDING UNDER TANK
DEPAATMENDflISIOy OF SAFETY A�
CIFICATIONS
cl7-'E_QORRESPONDE�yCE
APPROVED
JOINTS W/ CI
PIPE 3' ONTO
SOLID SOIL
** RISER EXIT
PERMITTED ONL
IF TANK
MANUFACTURER
HAS APPROVAL
CONCRETE PAD
SEPTIC /
TANK MANUFACTURER: L/,esers NUMBER DOSES PER DAY:
TANK SIZES: SEPTIC 000 GAL.
DOSE - GAL.
ALARM MANUFACTURER:
MODEL NUMBER:
SWITCH TYPE:
DOSE VOLUME INCLUDING
FLOWBACK: /18.5 GAL.
CAPACITIES: A =
3, 1LINCHES
=
31sj/ GAL
B =
2
INCHES =
15$,K GAL
PUMP MANUFACTURER: 574- k,'Te- C = 13 INCHES = /22,g.2GAL
MODEL NUMBER: 510U&L D = �/ _ INCHES = ^q _SAL
SWITCH TYPE: lrC•+
REQUIRED DISCHARGE RATE_Y GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WA
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /6 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2.5 FEET
+ lQ FEET FORCEMAIN X A FT/100 FT.
TOTAL IDYION ANAMICHEAD /cl, 9 _ FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _; WIDTH ; DIAMETER ,
LIQUID DEPTH 'S0 X,,~ S« '
f
SIGNED: tz Z_,Z t c..0 LICENSE NUMBER: lYC" DATE: S- /9 _k—
MTO-MITE'
Corrosion -Resistant Submersible Effluent Pump
nI ITI INF DIMENSIONS SECTIONAL VIEW INSTALLATION DIMENSIONS
I
ORDERING INFORMATION
Max.
Load Phan
Catalog No. HP Amps Volta Cycles AUtomatic
PWEL4C01A 4/10 8.5 115 1/60 YES
PERFORMANCE CURVE
a
CAPA=- UTIMS PM M"M
ii Go n I00 in ISO in -I m0 $ 2
T.
IS a w
I6'
r12
, I
M1.
SF
` STA-RITE Sta-RRe Industries, Inc., 293 Wright St., Delavan, WI USA 53115 (414) 728-5551
a WICOR company CUSTOMER SERVICE: (800) 243-1742 FAX ORDERS (24 HRS.): (800) 243-3792
.. S470SEP (EAR UW) Printed In USA
ORDERING INFORMATION
Max.
Load Phan
Catalog No. HP Amps Volta Cycles AUtomatic
PWEL4C01A 4/10 8.5 115 1/60 YES
PERFORMANCE CURVE
a
CAPA=- UTIMS PM M"M
ii Go n I00 in ISO in -I m0 $ 2
T.
IS a w
I6'
r12
, I
M1.
SF
` STA-RITE Sta-RRe Industries, Inc., 293 Wright St., Delavan, WI USA 53115 (414) 728-5551
a WICOR company CUSTOMER SERVICE: (800) 243-1742 FAX ORDERS (24 HRS.): (800) 243-3792
.. S470SEP (EAR UW) Printed In USA
Wisconsin Departmentbf Industry, SOIL AND SITE EVALUATION
Labor'and Human Relations Page of y
' Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference pant (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D
APPLICANT INFORMATION - Please print allInformation. Revie
Personal information you provide may be used for secondary purposes (Privacy Law, s. 16.04(1) (m))• AI' ij 2 C 10-0p
Property gwner Property Location Sr [; i i.
Govt. Lot 1/4 S (V N,R0. E (06
Properly Owners Mod Addrew Lot # BkSubd. #
CRY Ste Zip Code Phone Number ❑ ❑ Vllage ® Town Ff0jiiik RoW
( )
(� New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow -4<g� gpd Recommended design loading rate Z,22bed, gpd/ft2�_trench, gpd/ft2
Absorption area required . TZfL bed, ftZ _ �t Ch, 1112 Maximum design loading rate bed, gpd/ft2 Z- � trench, gpd/ft2
Recommended infiltration surface efevatkxt(s) ft (as referred to site plan benchmark)
Additional design/site considerations' II �//
Parent material �:- ,d1��l6r0.1 L. t,l'1164M2 Flood plain elevation, if applicable f It
S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U unsuitable for systeml ❑ s ®U ® S ❑ U ❑ S FZ U I ❑ S [4 U ❑ S ® U ❑ s Z u
Boring #
13
Ground
elev.
��t.
Depth to
limiting
factor
30� In.
Boring #
13
Ground
elev.
Depth to
limiting
factor
,?&In.
CS
SAIL AFSCRIPTInN RFPART
Mottles
Qu. Sz. Cont. Color
Remarks:
=1".1
F
�� eras
Remarks:
Date
Telephone No.
CST Number
r ! PROPERTY OWNER _ SOIL DESCRIPTION REPORT
PARCEL I.D.#
Page , 2 of*`_�
Boring #
13
Ground
elev.
Depth to
limiting
facto
In.
on
Mottles
M
Remarks:
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
_n.
Depth to
limiting
factor
in.
Boring #
Ground
elev.
ft.
Mottles
or
OIU
Mw
MMM=M��M=�
Remarks:
Depth to 1�
limiting
factor
—in. Remarks:
SBDW-8330 (R. 08195)
t
411 X// .tCe 7kJ
1�ce J
4-1
.P„`_ ;Or� - -t
wiscomm Department of Industry,
Labor and Human Relations
A�dfety and Buildings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
ST. CROIX
Permit Holder's Name: ❑ City ❑ Village 9 Town o
WYNVEEN, STEVE I{
CST BM Elev.: Insp BM E ev.: BM Description:
CI CVATInk1 r%ATA
TAKIV IwCnIPMAT11171IIt1
TYPE
MANUFACTURER
CAPACITY
Septic
;P�r/ Ci,C
cjy
Dosing
L
SDU
Aera to
Hol
TANK SETBACK INFORMATION
TANK TO
P/ L
WELL
BLDG.
AirI tontake
Air
ROAD
Septic
NA
Dosing
NA
Aera
ding
PUMP / SIPHON INFORMATION
Manufacturer Demand
Model Number GPM
7DH Lift Friction S stem TDH Ft
Forcemain Length Dia. Dist Towell
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
47
/W. 46
U 61CA31y,
Bldg. Sewer
St / Ht Inlet
St/ Ht Outlet
Dt Inlet
r�
Dt Bottom
Header / Man.
Dist. Pipe
Bot. System
Final Grad
I • vx�
P
Ot Prts
Inside Dia Liquid Depth
Ma u
BED/TRENCH
width
Length
II
No Of Trenches
DIMENSIONS
SETBACK
INFORMATION
SYSTEM TO
P / L
BLDG
WELL
LAKE /STREAM
LEACHING
CHAMB
O IT
Mo a Num er:
Type
System:
+�—
nirTninl ITI/1a.1 CVCTCM
1J171 nlvv 1 Iv•. + • +• •-•�•
Header /Mam old I Distribution Pipes I x Hole Sae I x Hole Spacing I Vent To Air Intake
Length Dia Length Dia Spacing
Cnu rnvCo v laroceuro Svctems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulched
Bed I Trench Center Bed I Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HAMMOND.26.29.17W, SE, NE 200TH ST
ICY
' I'. ; l�.-r>d c�//I P c,✓ /i sic.: r
434?00C q
c�.� C�2Plan revision required? ❑ Yes ❑ NoUse other side for additional information.58D-6710(R OSHt) te Inspector's Signature Cert No
ADDITIONAL COMMENTS AND SKETCH .
SANITARY PERMIT NUMBER:
��dd�, � �!_ " �K(' � �r'rn'`-� G.t.Q i»��il�� •y),¢,c,�r �y.� isa-nO�
SANITARY PERMIT APPLICATION
In accord with ILHR 63 05, Wis. Adm Code
A..
Safety and Buildings Division
Bureau of Building Water Systems
201 E. Washington Ave.
P O Box 7969
Madison, WI 53707-7969
w1iIV1I%V FJIQIp ttv Lrlr cvunty copy only) Tor the system, on paper not less County
than 8 112 x 11 inches in size.
S T (f✓
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs
0 Check rIrevkkMf id;reviou kaiN(T (Privacy law, s 15.04 (1) (m)I
State Plan I.D. Number
I. APPLICATION INF RMATI N - PLEASE PRINT ALL INF RMATI N -S
Property Owner Name Property Location
a 114 r,L 1T4, S 2.Z T 2 ;' r N, R J E (ortW
Property Owner's Mailing Address Lot Number Block Number
�2Co ST —�
City, State
Zip Code
Phone Number
Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned o City Nearest Road
_�
Public or 2 FamilyDwelling- No. of bedrooms ITOF ,� -, _2 c-�, X
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/Condo I p- lcS-r— 70
2 ❑ Assembly Hall 6 ❑ 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: (Check only one box online A- Check box on line B, if applicable)
A) 1./23llew 2- ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
System Tank
------System ------ ---- -Only Existin S stem Existing System
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 >914-ound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 [:]Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2 Absorp. Area 3- Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Final
Required (sq ft) Proposed (sq. ft-) (Gals/day/sq. ft.) (Min./inch) Elevation
c�
L /! P`iL Feet
city
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab CSite on- Fiber- Plastic Exper
Existin Gallons Tanks Concrete Steel
App
jNe glass
T nks strutted
Septic Tank or Holding Tank
- s
C ta- �
❑
❑
O
❑
❑
tiff Pump Tank /Siphon Chamber frti El El El El El ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans -
Plumber's Name: (Print) Plumber's Signature: (No Stamps) "PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State. Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
[]rApproved
❑ Disapproved
❑Owner Given Initial
sur<nar�iftf
nitary Permit Fee 1INI'me' crow d.4e,BR4
Issue
Issue g Agent Signature (No Stamps)
Adverse Determination
��
Plk
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: qv V
%HO.6398 (H 05N4) DISTRIBUTION Original Io (ounly. On ropy To: S01ty 6 Rwhh.9i Diemion, owner, Plumber
INSTRUCTIONS
. v.
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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, 608-266-3815.
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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. 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.
Vill. 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.
40-144.
SAFETY B.BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box7969
Madison, Wisconsin 53707
State of Wisconsin
Department of Industry, Labor and Human Relations
May 16, 1996 1340 East Green Bay Street
SUITE 300
Shawano WI 54166
WILSON PLUMBING
410 HWY 46
AMERY WI 54001
RE: PLAN S96-30335 FEE RECEIVED: 180.00
WYNVEEN STEVE SUSAN
SE,NE926929917E
TOWN OF HAMMON COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above -referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to ■e at the number listed below. Please refer
to the plan number shown above.
Sincerely,
1Keith _Wilkinson
Plan Reviewer
Section of Private Sewage
(715) 524-3627
saUA,10= OL1"4)
,FJE k/c�,�J.Ed
• 78� o?Cb'�S
&,iZ,:j Jf spa
.SEA„✓t � l IV9�►!xP// j
7Fr.�All 7/60 '
f•o�
syr.
l'b. rR - f L,4J,
S�f
I w�`f er
S
v
S96-30335
r GG
$o
PCwk,s�r
-T Q�
4 Ts
ONSITE SEWAGE SYSTEM
FillOIJEI)
►ATIUNS
/ tJDUSTRY, LABOR AND NUMAN RE
LOONS
96 DEPARTMENT OF 1
DIVISION OF SAFETY AND BUILDINGS
SEE COR SPONDDENCE
! Straw, Marsh Hay. Or
43 3 Synthetic covering
Nedium Sand
I
I
1
.!�-i slops
S V 6- V O 3 3 5 w, ,
Distribution Pipe
1 G
Forci Main
Layer
a" of V-2Y
A,ggsegate
Coss Section of a mound System Using D.
h Had For The Absorption Area H_Ft.
tom_ tt.
A�_Ft. G i Ft.
9— yin• 63 H— ' Ft.
Signed: x_!
L�
License # :
Data: S-/r 96 Njy]�fr_-Ft.
Lei..)& e • ONSITE SEWAGE SYSTEM
PROVED Fi ELATIONS
DEPARTMENI (IF iNDUSTRY, LABOR AND HUMAN
Alternate Position of DIVISION OF SAFETY AND BUILDINGS
Force Main
L i
J
nervation
B v_
Observation
Pipe 1 Hem of %"-23i"
Paaukasat
L
1 /
plan View of Mound Osirq a Md For'tha Ab� Area
WON
w
S96-30335
1 grft "N .
N
y v••.it
Iw«Ma hNl1r of
01wolliM VMS* MNQ
.
FOS
LAW WN show Be
wd Ti w CAP
Lewd w ILa iim_,yout P Ft.
R _= r
' s
x_qtoolwi
Y y irAclr'et T
�ysl eo Hole Diameter —.Inch
signed: Lateral ! inch(es)
Onitold a Z : lncirles
uau� E�
I Li aNR�`�pr� I fora Mrtin " IVA"
l Drtte. boles/Pipe,,,,b_,�' .
cooft
IAvert Elevation of Latemis t...
o�VpQ�MENON���� No�NGE
I�' C., E p � •
SEPTIC TANK E PUMP CHAMBER CROSS
SECTION AND SPECiF1CATI0N:j
•
S.96-30335.
4" CI VENT PIPE 12"
MIN. ABOVE GRADE
WEATHER PROOF
JUNCTION BOX
APPROVED
>_ 25' FROM DOOR, WINDOW OR
WITH CONDUIT
MANHOLE COVER
FRESH AIR INTAKE
W / PADLOCK E
FINISHED GRADE
4" CI RISER
WARNING LABEL
6" MIN.
MIN.
ABOVE G ADE
�r
18" IN . 6" MAX.
`; �
INLET pNSITE
Z
G
®
GAS'
TIGHT
SEAL I
VED
„
4 �
RE�pi1p
At
' ALM
JOINTS W/ CI
Rk Lp,ROR
CI PIPE END01 OF SAFE.ly
3 otmb�
AND BU ^
\ t
B
ON
,
PIPE 3' ONTO
SOLID SOIL
SOLID
SOIL
- AN"
'►" FT •
-�—
OFF
*+ RISER EXIT
P�iiFJ�T}C
PERMITTED ONLS
D
IF TANK
MANUFACTURER
HAS APPROVAL
31' APPROVED BEDDING UNDER TANK CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE NUMBER DOSES PER DAY:
TANK MANUFACTURER: LJesc-f
TANK SIZES: SEPTIC 000 GAL.
DOSE Soo GAL•
ALARM MANUFACTURER: -IST C-cp-
MODEL NUMBER:
SWITCH TYPE:
PUMP MANUFACTURER:
MODEL NUMBER: Fr S r
SWITCH TYPE:
REQUIRED DISCHARGE RATE cpg,0_y GPM
DOSE VOLUME INCLUDING
FLOWBACK: _ GAL.
CAPACITIES: A = 2 12INCHES = , 3I J.1) GAL.
B = 2 INCHES = 11. FY GAL.
C = 13 INCHES = L, zZ GAL.
D = h_ INCHES = jcL GAL.
PUMP E ALARM WIRING AS PER ILHR 16.23 WAC
/o FEET
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • : 2.5 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE hI
' FEET
+— FEET FORCEplAIN X /, 7�/ FT/100 FT.
TOTALFRICTION
NAMICAHEAD • _ • FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH
WIDTH ; DIAMETER ,
LIQUID DEPTH .SO �/� Sc. tJ77',
S�cci-
�^• e �i�- LICENSE NUMBER: -7YP' DATE: ---/64L
SIGNED:
8
HEAD CAPACITY CURVE
MODEL "98"
10 201 30 401 50
e0 160
FLOW PER MINUTE
TOTAL DYNAMIC HE.AOrrLOW PER MINUTE
EFFLUENT AND DEM TERINO
CAPACITY
HEAD
ukrrm I
FEET METERS
GALS LTRS
5 152
72 273
10 305
61 231
15 457
45 170
20 610
25 95
Lock Vales 23'
240
70
1 1/7--11 1/2 \'p-
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available with or • Double piggyback variable level float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
'h H.P. 1. Integral float operated 2 pole mahuw`eI switch, no external contra required
Standard all models - Weight 39 lbs. -
2 Si le'
s! Sodas Control Selection
Model
Volts -Ph
Mods-1
Amps
I Simplex
I DUVWX
M96
115 1
Auto
9.4
I or 1 & 7
—
NOS
115 1
Non
9.4
2or2d6
4&5
D98
230 1
Auto
4.7
1 or 1 a 7
—
E98
230 1
Non
4.7
2or2&6
1 3or4&5
ng piggyback vadable level float switch or double piggyback vanable level,
float switch. Refor to FMO477.
3. Mechanical sliammor 10-0072 or 10-0075.
4. See FM0712. for correct model of Electrical Alternstor,'E-Pak'
5. Control switch 1D-0225 used as a control activator, specify duplex (3) a (4)
float system.
6. Four (4) hole •J-Pak'. Junction box, for watertight connection or wed-m
simplex or duplex Operation, 10-0002.
7. Two (2) hohl'J-Pak', for wa ie t ht connection or apt e.
CAUTION
Fm wOwm.00n on nddeonal 2.o.aw produas r►* to cataog an Comt.lation Starts', FMO614; AS insiailatlon of controls, WOftctlon dahrices and arhing should be loot by a qualified
Pegg ybrA van" Level Swschea. FMO477; Electric Nwna w. F1140488; Msdhariul Aaama. licensed electrician. All electrical and safety codes should be followed Including the
lor, FMOM. Alarm ParAage, FMD513. Sump/Sewage Brim, FM0487; and Slmpin Coma Boca, meat recent National Electric Coda (N!C) and the occupinio,al Safety and Health Act
FMD732. (OSHA).
n
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
WL To. P.O. BOX IIN7
lddseiRKY 101SB W47 fANlulltllnntrsd..
0 dHiTO: 3287 Old MinLris
1 oiiMs.ItY MO %IAurrPLNIPs SrcF /9A79
PUMP !O- (SM77&2731 • I(Mm92a.vuHP
4/ FA) (5W)774 W4
I. a10uND SYS INi.. Waelewa(er low. ToW DAW Flow
Mt
Use a. IWR 113.15 (3) (c)
Ada. Cods and PROVIDE A DETAILED
LIST OF SUING ON PLAW
] r
t.
Depth to Lwow%F"w•
I L
i
3.
Laaddops •
���
4.
Oilla•u Iron DaM CbMer N '
•
0• IL
Dnuwwwo SriNW
S.
Elevation Diflewlw Ratwan
10
Pulp ad owtlbrl a Sid w •
14
6.
Ablwpum Area Wits;
_„
1h'
Ana 1904WW •
r=r�
IL
Red a Traatll luytb (R) •
�7-�l�
lls
Red w Tt$WA Wwa y►l •
Treacb SHda{ 10 •
IL
7,
Mau"
FluW GW (Dl •
tL
F W DeNb D•w"1W (1) •
%
Rap or DaiF) •
r
Cap ad Tnra ago IGI •
TGO
fL
Cap and TOPIa11 OaNs (N) •
k
a.
Monad WSW (
Ead Slope K) •
�
b IL
Tow I WAIW LaNEM W •
f.
Moiled wi"
upon•WW&%(1) fatty
p. WMta lq•.
uwlo•
_ _
� SL
00 - esL•p co"N" Farr •
�1.- IL
Down"" wMs (1) •
Tow Mood WIdM (111 •
-�.1+�• IL
10.
Raeal Awat
Inllltratiw ca►asky at
Neutral sat • '
Raw Awe RN•Mw • '
w p.
11" At" Awllabla •
aF R'
11.
If Standard TOn howCWw IIJM
63
aue'used, iodicata Ubla
tl
12.
Fw W DWtWMiM 1MRnit, UM NwlMta Enid M Sa11Na IL
It. IN -GROUND PRESSURE SYSTEM
1.
Depth to N11119119 FaMw •
2.
Lasdllap •
).
Mocowt M Raw •
a.
Prp•Md SyMM EMwaMW •
S.
waaawawr Land, Tow)p� uWby F��....
se Us. IUM 63.15 (3)(c).
Aden. Cop and PAMDE A 09TAIL91
LIST OF SIZING ONfLANS.
Roa•Mad Soplk Tam CAPaalq •
6.
Al wNwn Am SUING
Wral"I" Rao •
Awe RoO&MN •
Systare Lays •
Sy.ww Wma •
T.
Dwrlbrtwn ►Ipa UAW
HOW SIN •
hale SPMAM •
A.
Lawtal La11WI
Lateral Slra
I.Awal %P"bd
Ilwam" saw swrwal to FWa
N.
INJrWrllrn P4r• WrdeYNt Ravi
NlwbarIM 1b14•In Fur
L A
1 km Per Pilo �
9
Manllald siI '
I yM (•rnI 0900 C e
Ltys IL
IL IN(.UOUNUPItL>t>tU1lL>tri1LM�.Mllnwa•
IR.
force
m "
Mtnlnwnl OarW Raw f •
A"
Plarlw •
I► .
I I.
Tow Dyawk head:
Sv~ Naad •
3.S IL
verikal LW • r ? v p
Frku" Lou •
^-��� IL
�.�.� 14
TDH ■
14
12.
Faop Sdmom
�Z
Pw1/ dYtMata/ at MNM Yw
at La. a. Iwl **"it "at
P11NiP so" ad w1a i z ° • C ` ,
••
13.
Owis Vablwa: y� ii ; .
M
Titu
p wW Lbm
Data wamwaw Vebwa
1113a •
, f
1�.
i Daan MI.
IMAN" •
SAL
..1 d.. s
MMIwt11N D4" •
•• . Eel•
16.
Oaw�
•
--lid,
IIL CO}IVENTIGMAL PRIVATE SEWAGE SVSTEM
1.
wm awswt Lad. T*W Data Flay •
.---. I &
Use R. ILKR 913.15 (3) (c) r
ilia.
Adw.CAN abdraw$" DETAILED
LIST OFtWZING ON PM.IS.
3.
Raqukw swig Tall Cw►"wlr •
• 11L
3.
F•raalm" am •
do-mommalo.• n1R,11R,
6.
Abear0d" Ana WkW
#Af*V to Table 2 la l;b. UdU 03
aid ►ROVIDE A DETAILED LIST 0/
SITING ON PLANS.
Raawww Ana •
.•.�� M. IL
Lays •
� /4
WMs •
� 14
N•rabor of TIa•rbaa •
��.
Tnadl Somilla •
�� k
s.
Dbulb•lien Syewnli
LMwal Loylb •
ems-• a4
NIwMr M Lamb •
��
LAWS Spathe •
lar
Dwane Ira. SMaww is PW
M.
Slat m Ewwlw •
..----..16
Iv. MTEMO-FILL
FIN Is All IIIRIa Iww iatlaa W .'
V. SEPTIC TANK S 9 6- 3 3 3 5-
I. G uft ■
3. Ilat dsd ww: -
3. Sbaw SIw CAftw W Taw DaW ""W
VL DOSING TANK
• 1. Ca►alMy • �.�
3, 11atllllauwars
>. ►anlP MwddaWwr:
6. Pw1p Mwlak
f. alwab N llad•
a, flew Raw•
am
. �. whew sty c.wlt�wd TaMt oalaMl«Fr./
.
I'
VII. 1111LWNu TANK --
1. Caya*v •
2. 11anlllA A Mi
3. wort si a Caftwd"m Tao no* «FUw
-VW ALL WFOAM YM ON MA*-
Wid6w
Ubor'a&HumFtrnelafiondusoy, SOIL AND SITE EVALUATION REPORT
•labor an�Human fielaEons
Division of Safely 3 Buildups in accord with ILHR 83.05. Wis. Arim rnrta
Page _,/ of
- -
COUNTY
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and bcation and distance to nearest road.
P�
APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION
]EWE EIVFD AE
PROPE OWNER:
PROPERTY LOCATION I
GW. LOT 1/4 �1/4
PROPERTY OWNER': LING DDRESS
CITY, AT 21P CODE PHONE NUMBER
1 i
LOT t I BLOC SUB .1XE gR 0 UyTy
ONING OFF!
❑CITY ILLAGE IUOW , , NEAR
—
M New Construction Use pCj Residential / Number of bedrooms [ [ Addition to existing building
X Replacement [) Public or commercial describe
Code derived daffy blow 0 gpd Recommended design loading rate /, .-? bed, gpdM' /,..2 trench, gW12
Absorption area required bed, f12trench, 112 Maidmum design loading rate J. bed, gpd/ft2,/tren0, gpdJlt2
Recommended infiltration surface elevations) 97 It (as referred to site plan benchmark)
Additional design / site considerations _
Parent material Flood plain elevation, 'd applicable It
S = Suitable for system
U= Unsuitable for stem
CONVENTIONAL
❑ S R U
MOUND
®S ❑ U
IN-GROU D PRESSURE
❑ S U
AT-GMDE
❑ S U
SYSTEM IN FlLL
❑ S [O U
HOLDING TANK
❑ S ® U
III
Ground
elev.
matt.
DoOto
limiting
law
-2�
Boring #
13
Ground
elev.
yin
Depth fo
limiting
taw
-30
SOIL DESCRIPTION REPORT
MM
Remarks:
PROPERTY OWNER SOIL DESCRIPTION REPORT
PARCEL I.D. #
Boring #
El
Ground
Vt.
Depth to
limiting
factor
TIM-
9 wM
PA
KY, A
=�Mz
mon"
ME
Remarks:
Boring #
o
Ground
elev.
— It.
Depth to
limiting
factor
Remarks:
Boring #
7:
Ground
elev.
n.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
n.
Depth to
limiting
factor
Remarks.
SBD-8330(R.05/92)
.��✓.�� k�I spa
,46R 3eF3
3o
,2,.
4,gwk;ljt
381��0 �aF
A
STC-los
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix Cuuaty
OWNER/BUYER +
MAILING ADDRESS 1 I S T.
PROPERTY ADDRESS 7kC/ ?lj,!9 ik
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION,F_ 1/4, N F�_ 1/4, Section ? to T_Zj ( N_R_IL�_W
TOWN OF ay) j"
SUBDIVISION
ST. CROIX COUNTY, Wl
LOT NUMBER
CERTIFIED SURVEY MAP , VOLUMEf250 PACE L/ L ZLOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of repinccntcnt of a failing system, which was in operation prior to July I, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
1/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED
DATE: S=(� - 9'6
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016
11 /93
S T C - loo
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------
Owner of property S+-eve U?aA)Af,
Location of property/5 K . 1/4 /`/Fal/4, Section T 2q_N-R_4L7_W
Township ��Gmnnrsd Mailing address���/ pnalti gf
n . �
Address of site %g'y ? 0(1- t a i i i,---
Subdivision name
_ Lot no. _
other homes on property? _-X—Yes No
Previous owner of property /D &,,,„ �,(/T��
Total size of property __9$0 4<«s
Total size of parcel
Date parcel was created I",
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house*))?� Yes _,X_No
Volume and Page Number as recorded with the Register
of Dee4.S0
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A 14ARRANTY
DEED which includes a DOCUMENT
NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF
DEEDS. In
addition, a
certified
survey, if available, would be
helpful so
as to avoid
delays of
the reviewing process. If
the deed
description
references
to a Certified Survey Map, the Certified
Survey Map
shall also
be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. � 7gg 77 , and that I (we) presently
own the proposed site for the sewage disposal sy:.tcm or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been dUly recorded in
the office of the County Register of Deeds as Document No.
Sign tur of Applicant
S-1� - ?G _
Date of Signature
A-p
Date of Signature
DEPARTMENT OF INDUSTRY,
LABOR BE HUMAN RELATIONS
P.O. BOX 7969
MADISON WI 53707
E-�, NEk, S26,T29N-R17W
Town of Hammond
7th Avenue
INSPECTION REPORT FOR
PRIVATE SEWAGE SYSTEMS
CMONVENTIONAL ❑ALTERNATIVE
❑ Holding Tank ❑ In -Ground Pressure ❑ Mound
SAFETY III BUILDINGS
DIVISION
BUREAU OF PLUMBING
swe PNn 1 O Nemec,
III F.Rp1KFl
NAME OF PERMIT HOLDER
ADDRESSOF PERMIT HOLDER
INSPECTION DATE
Steve Wynveen
Route 2 Baldwin WI 54002
9ENCH MARK IPFrmF,IO 110.vw. PmmI DESCRIBE V DIFFERENT FROM PLAN
REF. PT. ELEV.
ST REF PT ELEV
N.me of Plenlb'
MPx RSW No
Cevm v
r
mlwr mn Mumbv
Dale E. Hudson
6629
St. Croix
102828
SEPTIC TANK/MOLDING TANK:
M ANUF A[T LITER
APACITY
TANKINLETELEV
TANK OUTLET ELEV ARNIN L LOCKING COVER
PROVIDED
PROVIDED
OYES ❑NO
❑YES ❑NO
BEDDING VENT OIq
VENT MATL HI
L
NUMBER OF ROAD
ROPFRTV WELL
U0.pING V NI OFR H
OYES ONO
L
FEETFROM
LINE
AIR INLET
NO
NEAREST
^......... wwM LIUUIO CAPACITY PUMP MDOEL PUMPrSIVHON MANUF ACTURER WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
❑YES ONO DYES ❑NO ❑YES ONO
GALLONS PER CYCLE: PUMP ANI CONTROLSOPERATIONAL NMBER OF PHOPFRIY WELL BUILDING VENT H
(DIFFERENCE BETWEEN FEETUFROM LINE AIR INLFT
PUMP ON AND OFF) DYES ONO INEAREST go
SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing FORCE LEN, MAM11IH MATIRIAL ANDMARKINI.
or excavation. III soil can be rolled into a wire, construction shall cease until
the soil Is dry enough to continue.) MAIN
rnuLreutL.0 .. n ...
BED/TRENCH
WIDTH
LEN H NO a F
DISTR PIPE SPA INC,
V
IN",IIII VIA
PITS LIOUID
DIMENSIONS
TRENCHES
MATE RILL'
PIT
UEPtu
V L H
PIPES LOW PES
ILL D H
ROVE COVER
UI N I DISTR PIPE I
FIEv INLET EIFv ENO
1 A IAL
NO DISTR
NUMBER OF Y
WELL BUILDINE'i VENT 101 H1;5I
PIPES
FEET FROM LINE
FROM
AIR INIIT
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑VES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL VER TEXTURE PFHMANEN MAHKFHS 011SEHVATIONW111%
DYES ONO DYES ONO
DEPTH OVER TRENCH BED DEPTH OVER Hr DEPTH OF fOPSOq SODDED Sff DfU MULCHED CENTER EDGES
❑YES ONO DYES ONO OYES ❑NO
rncJJV n ICCu YIJ
I "lout IUN
SYSTEM:
BED/TRENCH
WIDTH
LENGTH
NO.Of
TRENCHES
LATERAL SPACING GRAVEL DFPTN BLOW PIPf
ILL DEPTH A V C v H
DIMENSIONS
MANIFOLD
EV
U
ELEV
MANI LD
DISTR PIPE
A I.O.A FRIAL
NO UISTH
DI 1
IIISTHIBH I N E MAT1141AI a HKINI,
ELEVATION AND
DIA
ELEV
PVES
DIA
DISTRIBUTION
INFORMATION
HOLE SIZE
HOLE LACING
ILLEO ORRECTLv
COVFR MATEwIAI
VEHfIr4l OF C R SIONOS TO Avvunvnl
Sketch System on
Reverse Side.
DILHR SBD 6710 (R. 01/82)
PI ANS
❑ YES
Retain in county file for audit.
Zoning Administrator
PERMIT APPLICATION
COUNTY
EED&HRIllSANITARY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size.
STATE PLAN I.D. NUMBER
-See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PETITION
FOR VARIANCE ❑ YES ONO
NO
PROPERTY OWNER
5'�e,• e ��✓
PROPERTY LOCATION
E y 9Wtr 1/4, S 1�X, T,z9, N, R /7 0 (or) W
PROPERTY OWNER'S MAILING ADDRESS
01Z01117
LOT NUMBER
BLOCK NUMBER SUBDIVISIOIy,NAME
%VA
CITY, STATE
ZIP CODE
PHONE NUMBER
CIITYY%JA
// NEAREST ROAD, LAKE OR LANDMARK
VILLAGE : yQ/Yl/1"IO/?LJt r7.
TOWN OF Awe .
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms it 1 or 2 Family OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, i1 applicable)
1. a. ❑ New b. IM Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a.0Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In -Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. 0 Seepage Bed b. ❑ See a e Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 13.
(Minutes per inch):
ABSORPTION AREA
REQUIRED (Square Feet):
14. ABSORPTION AREA
PROPOSED (Square Feet):
5. SYSTEM ELEVATION
6. WATER SUPPLY:
Z �
7 �=r
L;J
/
go r5,O Feet
®Private ®Joint ❑ Public
VI. TANK
INFORMATION
CAPACITY
Total
Gallons
#of
Tanks
Manufacturer's Name
Prefab.
Concrete
Site
Con-
Steel
Fiber-
glass
Plastic
Exper.
App.
L
structed
Septic Tank or Holding Tank00
%
Lift Pump Tank/Si hon ChamberO.d
r .
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
a /e E . sort �a� i,/rb, ` Z
Plumber's Address (Street, City, State, Zip Code)* Name of Designer:
zo P2o11.9%✓ , , sye o Z.
Vlll. SOIL TEST INFORMATION
Certified Soil Tesler (CST) Name CST #
CST's ADDRESS (Street. City, State, Zip Cade) Phone Number:
1SnX / /-/% e rL7 .S of Z -7/AZ' I Z(21 �G
IX. COUNTY/DEPARTMENT USE ONLY
r�
LEI Approved
Disapproved
❑ Owner Given Initial
S nary Permit Fee
I 1
Groundwater
Fee
a
a e
Issuing Agent Signature (No Stamps)
Adverse Delermination
+ PO
(S{ry{[�charge
''�^ p
�pC.J �p %
X. FOR DISAPPROVAL:
71MMENTS/REASONS
n
cone --------
-�-ww--,I m. w w) via i rntsu 11UN* ung.nal to County, One Copy To: Bureau of Plumbing, Owner, Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years,
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include
1 Property owner s name and mailing address Provide the legal description where the system is to be
installed;
II_ Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment. 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling,
III. Purpose of application: Check only one in ##1. Complete #2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 814 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; dosing or pumping chambers; 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.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983. Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law, This change in statutes was the
result of over 2 years of steady negotiation and public debate The groundwater bill Ground I — `-
included the creation of surcharges (fees) for a number of regulated practices which Wisco in's
can effect groundwater The surcharge took effect on July 1, 1984 All of the water that buried reasure !r
is used in your building is returned to the groundwater through your soil absorption
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards Groundwater, _
is s worth protecting.
SBD-6398 (R.03/86)
r
4
APPLICATION FOR SANITARY PERMIT
610W�l1h]
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - L- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property STc ✓� u/%�7,ie C/�
Location of Property f $ �14, Section ,ZG , T 9 N - R 7 W
Township 1471"Ir) or��
Bailing Address_ ,2 ZRe7
Subdivision Name
Lot Number
Previous Owner of Property 1V%nK-v/n Peen
Total Size of Parcel Ps
Date Parcel vas Created
Are all corners and lot lines identifiable? X Yea No
Is this property being developed for resale (spec house) ? Yes X No
Volume- �p� and Page Number 6 / _ as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
Warranty Deed l
2. Land Contract
3.• Othe'r recordings filed,with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Nap, the -the Certified Survey Hap shall also be required.
--------------------------------------
PROPERTV OWNER CERTIFICATION
I (We) CM ll y that astatements on th.ia 60tm aae true to .the beat o6 my (ouic)
knowledge; that I (we) am (a ce) .the owneA ls) o6.the
thiA
.in60tmati,on 6otm, by vihtue o6 a wath.anty deedneeon.dedp n the 066iceductibedo6n.the
County RegiateA o6 Deeds as Document No. 7 8 9 and .that I (we)
p4eaenttyown .the pnoposed site got .the sewage dupo,6EF,60tem lot I (we) have
obtained an eaaement, to tun with ,the above desat•ibed ptopetty, bon the
cona.btuction o6 said system, and .the same has been duly hecotded .in .the 066.iee
06 the County Reg<,ateh 06 Deeda. as Document No. ),
SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED
STC- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 5 e-ye
ROUTE/BOX NUMBER /n/• Fire Number
CITY/STATE �QI�G,�,�!% ��ZIP SS�OdZ�
PROPERTY LOCATION:/z%-, /VE/'C, Section_, T�`7 N, R 17 W,
Town of fyQ/!I/!? St. Croix County,
Subdivision AIX Lot number•
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new .2.emsagree to keep their systems properly
maintained
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on -site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Offilce within 30 days
of the three year expiration date.
S I G N E D
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
H
0
E
t
Ln
x
H
ro
44
DEPARTMENT OF
INDUSTRY, REPORT ON SOIL BORINGS AND
LABOR AINDUSTRY,
HUMAN RIEDLATIONS PERCOLATION TESTS (115)
(H63.0911) & Chapter 145.045)
SAFETY & BUILDINGS
DIVISION
P.O. BOX 7969
MADISON, WI 53707
LOCATION--. —79ECTIO / /4 i'�zmv"
/ 1 1�/R /7� (or) w TOWNSH�� NICIPALIT T NO.. BLK. NO.: SUBDI VI/S111 NAME:
COUNTY: AM
LING ADDRET§----
USE /
. B CO R 10
)aResldence /1 ❑New Replace
RATING: S• Site suitable for systam
DATES BSERVATIONeMAnr
OFI LE DESCRIPTIONS: —PERCOLATION TESTS:
7-/3 - 7
ONVEN 1'
S UP
®S ❑u
M lu
OC MH
O�GTANK:RECIMENDf
SV-7/ tionall
IIf Percolation Tests'are NOT required DESIGN RATE: If any portion of the tested area is in the J/J under s.H63.09(6)1b1, indicate: N� Ivey Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING
NUMBER
TOTAL
DEPfHYsi.
ELEVATION
P HT R UNDWATER-INCHES
CHARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
OBSERVED
HE
B- /
7. a'
10
gy,,Vq
A16 n
7 70
�• ' • 5 ,,8 ',
B Z
Z7r33
93,5G /
Alone
> G , 33
L
46 ,r QQ rr
• 7 YL
OA/ L
i
B-
s.
B—
lci: PERCOLATION TESTS
Itzi
NUMBER
DEPTH.
+NGess
WATER IN HOLE
AFTERSWELLING
TEST TIME
INTERVAL -MIN.
DR IN WATER V L -INCHES
RATE MINUTES
I
,
P-
,3 •
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PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori.
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of lend slope.
SYSTEM ELEVATION 9d 15410 /
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 the location of the tests are correct to the best of my knowledge and belief.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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PLIMP CHAMBER CROSS SECTION AND SPECIFICATIONS
PAGE Z OF
--VENT CAP
`I•C.I. VENT PIPE
WEATHER PROOF
JUNCTION BOX
� 25' FROM DOOR.
WINDOW OR FRESH 12•MIU.
AIR INTAKE
GRADE
.. I
CONDUIT--
i
la•nIN.
INLET PROVIDE
fAIRTIGHT SEAL
APPROVED JOIWT/ A
WlC.I. PIPE
EXTENDING 3'
OUTO SOLID SOIL B
C
0
APPROVED LOCKING
MAUHOLE COVER
I MIW.
III /
ICI APPROVED JOIUTS
III W/C.I. PIPE
II ALARM EXTENDING 3'
i t ONTO SOLID SOIL
I D ON
I
PUMP
OFF
COUCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MAUUFACTURER HAS SUCH APPROVAL
SPCCIFICATIOU
PTIC AND i _ JLS
SE TANKS MANUFACTURER: LC/ee F� IJUMBER OF DOSES:Z/ PER DAy
TANK SIZE:GALLONS DOSE VOLUME: 1-S'0'58 GALLONS
ALARM MAUUFACTURER: `stT� CAPACITIES: A= Z�'�✓ INCHES OR ���'[jsGALLONS
MODEL NUMBER: B=,INCHES OR yZL_ GALLOWS
SWITCH TYPE: mee,C9 C=_ ff 73' INCHES OR /501Y GALLONS
PUMP MAUUFACTURER' �OG.Il D= ZZ INCHES OR 20'1 GALLOIJS
MODEL DUMBER: -3885 NOTE: PUMP AND ALARM ARE TO BE
SWITCH TYPE: -- /f%r'r e-ay-V IUSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE RATE 70 GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AUO OISTRIBUTION PIPE.. 75 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE , • , . . • , 2.5 FEET
+ LY�� FEET OF FORCE MAIN X 'O FppTFRICTIOU FACTOR_. FEET
TOTAL DYNAMIC HEAD =/'S FEET ,,//-7
IDTERUAL DIMENSIONS O,F/TAA1�K: LENGTH [_;WIDTH _L—.LIQUID DEPTH
SIGNED: /✓� Z- • I Ircalcr llllmn�". ti1A/_! 74 _ ____ 1/_/47_Pr/
S-five lvyr�vee/I
Performance
Curves
METERS FEET
90
25
80
70
20
60
a
50
15
40
10
30
20
5
10
0
0
U
Submersible Effluent
Pumps
MODEL 3885
SIZE 3/4' Solids
'V "' 'u 9u au W 10 80 90 100 110 120 GPM
0 10 20 30 m'/h
CAPACITY
(� GOULDS PUMPS, INC.
SDECA FALLS NEW)OW ows
METERS FEET
12(
35
30 10C
9C
2s 8C
70
s 20
i so
0
15 50
40
10 30
20
5
10
0 0
MODEL 3885
SIZE 3/4" Solids
-- — "" .v au w 100 110 120GPM
0 10
20 30 m3/h
01985 Goulds Pump, Inc. CAPACITY
Effective Julv. 1985