HomeMy WebLinkAbout030-2088-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
561045 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Bender, John & Patti St. Joseph, Town of 030-2088-90-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/60 c ~ z; . `d 34.30.19.749
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER n CAPACITY STATION BS HI FS ELEV.
Septic Z.~ Benchmark
A 3¢ 167. 7 polo. 3
Dosing CQ t 7 Alt. BM
AeQUea Bldg. Sewer
Pr-,, F a 6 ice: Tonk. 4, 5 9
Holding St/Ht Inlet V
TANK SETBACK INFORMATION St/Ht outlet
TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet `
Septic :;r 50 Dt Bottom
J . a
1:5. 7Z.
Dosing 7 56' 7 66 Header/Man. t
i r n.-
Aeration Dist. Pipe
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
Q~ S GPM
3;7 ily)
Model Number / d
'PT
=ft, Friction Los System Head TDH Ft
/6 2.56
Forcemain Length ! IDia. If Dist. to well
5 J~D
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. ]Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System:
Ivi
UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Ve o Air Intake
Pipe(s) c
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sy ms Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil I Fa Yes 0 No 0 Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 1235 Oakwood Lane Hudson, WI 54016 (NW 1/4 SE 1/4 34 T30N R19W) Deerfield Lot 9 ParcelLNo: 34.30 .749
1.) Alt BM Description w 54 K
2.) Bldg sewer length
- amount of cover /l~
J
Plan revision Required? 0 Yes o
Use other side for additional information. LIQ _
SBD-6710 (R.3/97) Date Insepctor ignature Cert. No.
County
Safety and Buildings Division St. Croix
0 = w 201 W. Washington Ave., P.Q. Box 7162 Sanitary Permit Number (to be filled in by Co.)
P$ 1tZ~~1 Madison, WI 53707-7162
A~ aQ~ o ~ .A 5~ ~ b~ 5
Sanify- ermit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate e unit A)k
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are itted to Project Address (if different than mailing address)
n
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1 m , Slats. Same /Z1315 a W ov
L Application Information - Please Print All Information
Property Owner's Name , Parcel #
John & Patti Bender 030-2088-90-000 7~9
Property Owner's Mailing Address Property Location
1235 Oakwood Lane Govt. Lot
City, State Zip Code Phone Number _ NW SE _ %a, section 34
(circle
Hudson, WI 54016 715) 549-5611 T -30 N; R 19 E ol~
11. Type of Building (check all that apply) Lot #
Y1_1 or 2 Family Dwelling - Number of Bedrooms C) Subdivision Name
Plat of Deerwood Ilk I ❑ Public/Commercial -Describe Use Na ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
Na Q-row of St. Joseph
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A' ❑ New System ❑ Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain)
Addition of septic tank & Filter
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner #240749 issued 8/07/95
IV. Type of POWTS Sys tem/Comonent/Device: Check all that apply) ` '
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitaw soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component ❑ Pretreatment Device (explain)
V. Dis rsal/Treatment Area Information. A PL-525 uent filter to be installed at outlet of 2° chamber.
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation
450 Gpd LDGpd/Sq. Ft. ASTM C-33 sand 375 Sq. Ft. Existing Na 102.85
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units a o
New Tanks Existing Tanks
U rn v V~ w C7 G1+
Septic or Holding Tank 827/411 To be abandoned 1,238 1 Wieser Concrete X
Dosing Chamber 800 To be a doned 800 FDL Triple X
VII. Responsibility Statement- I, a undersigned, asume responsibility for in taliation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's ignature MP/MPRS Number Business Phone Number
M
James K. Thompson s- PRS 30021 715) 248-7767
Plumber's Address (Street, City, State, Zip e)
340 Paulson Lake Lane, Osceola, W1 54020
VIII. Coun evertment Use Only
Permit Fee Date Issued Issuin gent Sign re
Approved sapprov C, es 'ft 13
r Given Reason for nial $ 5a
IX. ConditS", kf*SReasons for Disapproval
1. Septic tank, effluent filter and 3) 61eY a )PA,
dispersal cell! must all be services I maintained
as per management plan provided by plumber.
2.. °"set)ack requirements must be maintained
At "
Pet appics i* code / ordinance
Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 11/11)
Index & Title Sheet - Septic/Pump Tank Replacement
Project Name: Bender Septic/Pump Tank Replacement
Owners Name: John R. & Patti L. Bender
Owner's address: 1235 Oakwood Lane, Hudson, WI 54016
Site address: Same
Project Location
Subdivision: Lot 9, Plat of Deerfield
Legal Description: NWl/4 SETA, Sec. 34T.30N., R. 19W., Town of St. Joseph, St. Croix Co., WI.
Parcel ID 0302088-90-000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Replacement Treatment Tank Crossection
Page 4 Pump Chamber Sizing Calculations & Cross Section
Page 5 Pump Performance Curve
Page 6 Filter Specifications
Page 7 Septic Tank Maintenance Agreement
Mater PI ber Res 'cted Service: James K. Thompson, Dept. of Comm. Credential #30021
. . .
Signature: 1-- Date:
Page 1 Of 7
Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01)
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\ cn WLP1280/800-ML TRIPLE
m DRAWN BY: SME SCALE: 1 4"-1'-0" PRE-POUR:
° I SEPTIC MANUAL MIENER conCIETE REV.
\ Z W3716 US HWY 10 MAIDEN ROCK. VA 54750 DATE: JANUARY 2010 DATE:. POST-POUR:
° REVISED JAN. 2010 800- 325- 8456 RLE: N1P M-800 FM
3 -f 7
Bender 3 bedroom Mound Pump Chamber Calculations
1. Force Main:
Diameter 2"
Length 50'
Flow rate 40.00 gal./min.t
Friction loss 1.65' (50')(3.30 ft./100ft.)
2. Total dynamic head:
Min. supply pressure 2.50'
Vertical lift 13.25'
friction loss 1.65'
Total dynamic head = 17.40'
3. Lateral discharge: 37.44 gpm
4 laterals @ 30', '/4" orifices spaced @ 48" = 37.44 gpm minimum discharge rate
4. Existing effluent Pump discharge approx. 40.0 gpm at 4.08 ft./second @ 17.40' TDH
Manufacturer: Goulds /
Model number: WE0311 L
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and
Comm 16.28 WAC 4 in. min.
Disconnect
Tank component is properly vented Alternate outlet
location
Forcemain diameter
Wieser 1280/800FDL Manufacturer 2 in.
Capacityl 815.10 Gallons -T
Volume 21.45 gal/inch A
6 T Weep hole or anti-
Dimension Inches Gallons B siphon device
A 19.50 418.34
B 2.00 42.90 C Pump off elevation (ft)
C 4.50 96.46 93.00
D 12.00 257.40 D
Total 38.00 815.10
Dose tank elevation (ft)
3" Bedding under tank. 92.00
Alarm Manuafacturer SJSJ Electro, Systems
Alarm Model Number 101 HW
Pump Manufacturer Goulds
Pump Model Number WE0311 LL
Pg. 4 of 7
GOULDS PUMPS Submersible
Effluent Pump
3885
PROSURANCE AVAILABLE FOR RESIDENTIAL
APPLICATIONS.
i
APPLICATIONS ■ Shaft: Corrosion-resistant Single phase: ■ Bearings: Upper and
stainless steel. Threaded • Built-in overload with lower heavy duty ball bearing
Specifically designed for the design. Locknut on three phase automatic reset. construction.
following uses: models to guard against • All single phase models ■ Power Cable: Severe duty
• Homes component damage on feature capacitor start rated, oil and water resistant.
• Farms accidental reverse rotation. motors for maximum
• Trailer courts Epoxy seal on motor end
• Motels ■ Fasteners: 300 series starting torque. provides secondary moisture
• Schools stainless steel. •'/3 and '12 HP- 16/3 STOW barrier in case of outer jacket
• Hospitals ■ Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil
• Industry without damage to three prong plug. wicking. Standard cord is 20'.
• Effluent systems components. • 3/4-2 HP -14/3 STOW with Optional lengths are available.
■ Designed for continuous bare leads. Three phase: ■ 0-ring: Assures positive
SPECIFICATIONS operation when fully • Overload protection must sealing against contaminants
submerged. be provided in starter unit. and oil leakage.
Pump •'/2-2 HP -14/4 STOW with
• Solids handling capabilities: /4" maximum MOTORS bare leads. AGENCY LISTINGS
.
• Discharge size: 2" NPT. ■ Fully submerged in high- ■ Designed for Continuous
• Capacities: up to 140 GPM. grade turbine oil for lubrication Operation: Pump ratings are Tested to UL 778 and
• Total heads: up to 128 feet and efficient heat transfer within the motor manufacturers CSA 22.2 108 Standards
.
TDH. recommended working limits, By Canadian Standards
■ Class B insulation. Association
• Temperature: can be operated continuously c us File #LR38549
1041(40°C) continuous without damage when fully
140°F (60°C) intermittent. submerged. Goulds Pumps is ISO 9001 Registered.
• See order numbers on
FEET
r r
reverse side for specific HP, McT40 1 1 30 20 V~EISHIN.., 7._... RPM~3`soo LIDS
volta e, phase and RPM'S
available. 35~ &
110r _ . , _ _11750 .
WE20H ( - 5GPM - I
FEATURES 30 - 100,
i s FT I
901 H
$
■ Impeller: Cast iron, semi-
25-
- j
open, non clog with pump out 80i E1gH
_ - .
vanes for mechanical seal 70. 07Fl J-7
protection. Balanced for 20 60
smooth operation. Silicon
H
bronze impeller available as 1 5 50; WFO05
0 0
an option.
10
30tuuEOM
■ Casing: Cast iron volute type T"
for maximum efficiency. ' .Il 20 wlo3L _ _ _ _f .___.I..__:
2" NPT discharge. 10,
1
■ Mechanical Seal: SILICON 0L 0
CARBIDE VS. SILICON 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM
CARBIDE sealing faces. 0 5 0 15 20 25 30 35 m3/hr
Stainless steel metal parts, CAPACITY
BUNA-N elastomers. 37.s~~f~Rm•Mtntf~~pm•+_ Q~F Goulds Pumps
y 2002 Goulds Pumps ITT Industries
Effective October, 2002 www,goulds.com
B3885 ~J O r- 7
. o ® ;r Filters
PL-525 EFFLUENT FILTER (COMMERCIAL)
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD Alarm
(gallons per day) making it one of accessibility Accepts PVC
the largest commercial filters in its extension handle
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16°
removed for cleaning, the ball will filtration slots Rated for over
float up and temporarily shut off 10,000 GPD
the system so the effluent won't
leave the tank. No other filter on
the market can make that claim! Accepts 4" & 6°
SCHD. 40 Pipe'
PL-525 Maintenance:
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the k
installed filter contains an optional
alarm, the owner will be notified ..r
by an alarm when the filter needs
servicing. Servicing should be Gas deflector
done by a certified septic tank ! Automatic shut-off
pumper or installer. ball when filter
is removed
1. Locate the outlet of the U.S. Patent No# 6,015,488
septic tank. 5,871,640
2. Remove tank cover and pump
tank if necessary. PL 5525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL--525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4 or 6 outlet pipe. If the
filter is not centered under the
back into septic tank. access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
I
P~.&o-~7
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
0~ nerl o L,, 6~, L • 6,af 7 c%✓
NlailingAddress L-611-'_
Property Address 5e" e
_
(Verification required from Planning & Zoning Department for new construction.)
Cite: State Parcel Identification Number 0 30 - 9~ -660
LEGAL DESCRIPTION
Property Location'/4 , SEt/, ,Sec., T -3--)NR 119W, Town of Clo5ep/,
Subdivision Plat: 0-e2,~-Wc/Z),1 , Lot # 9
Certified Survey Map # IlQ , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house Ohs e-ro-_ Lot lines identifiable es S,41-e
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
inLiintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
'wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Plannin-
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we ant/are the owner(s) of the
property described above, by virtue of a wawa y deed recorded in Register of Deeds Office.
Nun ber of bedrooms e3
SIGNATURE OF APPLICANT(S) DATE.
*Any inforniation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
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Parcel 030-2089-10-000 07/13/2007 04:33
PAGE 10F 1
li
Alt. Parcel 34.30.19.750 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
i
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - BENDER, JOHN R & PATTI L
JOHN R & PATTI L BENDER
1235 OAKWOOD LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1231 OAKWOOD LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 3.010 Plat: 1901-DEERFIELD
SEC 34 T30N R1 9W PT NW SE LOT 10 Block/Condo Bldg: LOT 10
DEERFIELD 3.01 ACRES
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
34-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 2000/238 WD
07/23/1997 1096/144 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.010 78,900 0 78,900 NO
Totals for 2007:
General Property 3.010 78,900 0 78,900
Woodland 0.000 0 0
Totals for 2006:
General Property 3.010 78,900 0 78,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DUS TME'A1T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
N
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNS HIP/MWi[ OMC MTY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
NW 1/ SJ/4 34 /j 30 N/R 191(od VY St. Jose h 10 n/a Deerfield
COUNTY: OWNER'S BLX eBWAME: MAILING ADDRESS:
St. Croix S, Henning & D. Norell 665 Walsh Rd., Hudosn, Wi. +54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: (PROFILE DES RIPTIONS: PER OLATION TESTS:
~esidence 3 n/a EaNew ❑Replace 7-10-92
7-3C-92
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: r YSTEM-INS~-FI1ILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑ S ®U 14s ❑ U ® S ❑ U ❑ S fi" 1 U ❑ S E311 hound
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n/~
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS page 42 AT1C2
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B_ 1 60 106.13 none >60 - ' - ,7.5yr4/4, sil.; 2 -
7.5 r4/4 sl. very hard.
r , L.; 11- , si -
2 65 106.18 none >65 0-11, 10 _
B- 7.5yr4/4,sl. very hard, ~0-6 , 7.5yr4/4, sl.
108.60 0-12, 10yr 12- , si
B_ 3 60 none >60 28-60, 7.5 _ 1 G
B- r /
B-
B-
P TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH
P i
i
P- 9 94 30 1 30
P- i
P-_
P-
P-
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 elevatio g the direction and percent
of land slope. 10
SYSTEM ELEVATION 109.60
I I 1 I 1
1
9 M
'4"
ob 3
3
a _
E
.
f
A0
3
3
r
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.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 7-30-92
ADDRE S: CERT TION NUMBER: PHONE NUMBER (optional):
155 200th. Ave., New Richnond, Wi. 54017 715-246-6200
CST SI RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
l
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include;
1 . Complete 1' I1 description;
2. The w most clearly indicate whether this is a residence or commercial project;
3. MAXIt _J "lumber of bedrooms or commercial use planned;
4. Is this or replacement system;
5. Cc;E,i ;,e suitability rating boxes. A SITE. IS SUITABLE FOR A HOLDIN T NLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbieviat ions shown here for writing pt( 'e descriptions and comp ing the plot plan;
7. MAKE A LEGIBL diagram acc ~tely locating your ' )cations. Drawing preferred. A
nark and I elevation referer, pint are clearly date permanent;
9. Co ~ c: late boxes ~ dates, names, adrl,,~ flood pla, ition test exemp-
tion, if te;
10. If the if i n (such aS flood plain, elevation) does not apply, ply e box;
11 . Sign th,. a;id place your current address arid your certification n
12. Make legih' copies and distribute as require=l. ALL SOIL TEST`? e WITH THE
LOCAL AUTHORITY VVITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cot) Cobble (3 - 10") SS - Sandstone
gi Gravel (under 3") LS - Liniesto
- Satz . HGW - High t,
- C S~ -d Perc - Perco
S rid W Well
:l B,dg - L ~I.
is - Lo<-ny Sand > - G
'sl - Sandy Loam < t
'I - Loam Bn - lsr~,
iA Silt Loam BI 1, <
si - Silt Gy y
~cl - Clay L( Y iMIJ
sci Sandy il R
sicl - Silt, C n - I
sc S611dy
s,c - =y Clay ,J, 1.
' `C y cc Common,
pt t . ruin N/Iany, n
d distinct
p promi'HVV L - ligh vl
r . ~Six general soil ;exr.at sr1l?ac
fol liquid waste disr)G_~ BM Beni 1i
VRP - Wri,c.;
TO Ta .ER:
_T t report is thr fir l Curing a :-utary I- Tile co y rr,.cluest
v c iris -oil „"I'd pr;(-, A cr, le ;)rivate
1 a perrn;t ication me st the ap, r order to
Fhe sanitary permit musi be oh d pi for 3cti in,
1
STC - 104
AS BUILT SANITARY SYSTEM REPORT a
a a (4 39 d ~s
OWNER )
ADDRESS/;s
SUBDIVISION / CSM#_LOT #
SECTION Tr N-R
,3 W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
a ~ ~ys
IIN CATENORTH ARROW
Provide setback and vati n information rse of this form.
Provide 2 dimensions to ce er of sep is tank manhole cover.
1
BENCHMARK:
ALTERNATE BM: /
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:_ - 14 ~
Liquid Capacity:
Setback from: Well
House Other
Pump: Manufacturer_ /,~~ti~
Model# ) _~z Size
Float seperation
7 Gallons/cycle:_
Alarm Location- 412
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop, line:
Setback from: well:-+_
House Other
ELEVATIONS
Building Sewer` ST Inlet
l/ 7 ST outlet 9l 5/8
PC inlet__2,,~_ PC bottom C
Pump Off
Header/Manifold Bottom of system
Existing Grade
Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County
abor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
240749
PegittSSJ~Gtliald~t'` NaHN ❑ City ❑ Village (A Town of: State Plan ID No.:
l1VVUULLlc St. Joseph
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
L r . A9500243
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic G✓v Benchmark 5
7 G1, J)
Dosing i~ / F'6v
. rP, ~•o 0(0, 3~i
CIL
Aeration Bldg. Sewer 11,0151
, 015 ' 30 9 7 Ing /eInlet o7,0g4,, / s 761
TANK SETBACK INFORMATION St/ Outlet '
TANK TO P/ L WELL BLDG. Venttc ROAD Dt Inlet
Air Intake 3 ro. l
Septic 5Z l > SO' 4 NA Dt Bottom
9
Dosing 56, > SO' d 7S ` NA l k/ Man. 20 /d Sk
Aeration `NA Dist. Pipe
Holding._- Bot. System S
- S,Q a~ a
PUMP /SJRNV~ INFORMATION Final Grade
Manufacturer Demand Q '
Gc i_.a_k + a,, I d l C. q
Model Number 55,
GPl1~l rn ; !a:, y d3
TDH Lift Frictio I S stems TDH Y Ft
1
oss Fi 9 y
3
L
Forcemain Length Dia. h " Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. OfTrenches PtT- No. Of Pits Inside Dia. th
C DIMEN h~. -
DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA Manu acturer:
SETBACK _
INFORMATION Typeo z~ r CHAMBER Mo a Num ut!F .
System: We. s~ (n5 OR UNIT
DISTRIBUTION SYSTEM
H FRRanifoI
d Distribution Pipe(s) x H I iz x Hole Spacing
oeS a To e
11 1 Vent T Air Intak
7
Length -3Di
z, 'I I ~ a Length ?Jo pia. ~ Spacing ~'T /
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION St. Joseph.34.30.19W, NW, SE, Lot 9, Oakwood Lane
- c. .
C. l,' . i' .c rr l ifr
U0 Y' fl
lsl~_
b
Plan revision required? ❑ Yes
Use other side for additional information. lp"~
7 p 9
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
L
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
r^~tiL.riR SANITARY PERMIT APPLICATION Bureau and Buildiing Water ureau o off Builn Water Systems
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 8112 x 11 inches in size. ~
e See reverse side for instructions for completing this application State Sanitary Perm`iit/`Nu er ;
The information you provide may be used by other government agency programs El CheR ~it revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION -
Prope y Owner Na Property Location A:q
1 - 1/4, S T, N, R t{(o
Property Owned s Mailing Address 16t Number Block Number
pCity ;ate Zip Code . Phone Number Subdivis ame or CSM ber
ill Nearest Road
1 E 111 D ING' (check one) E] State Owned O ~ City
Public 1 or 2 Family Dwelling - No. of bedrooms .-I-- Town OF /
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
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. rV New 2. Q Replacement 3. Q Replacement of 4. Q Reconnection of 5. Repair of an
B) Existing System
System System Tank Only- Existing System
❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
I 11 ❑ Seepage Bed 21,ZLMound 30 ❑ Specify Type 41 ❑ Holding Tank
f 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
775- Feet Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber Plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank l ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the ndersigned, assume responsibility for inst la ' e osite sewage system shown on the attached plans.
Plu b Nam Plumb "s Si tur amps MP/MPRSW No.: Business Phone Number:
PI mber9s Addre (Stre t, G State, Z p Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater ate Issued Issuing enhnatu~re(No a s)
Surcharge Fee)
r
A<PProved ❑Owner Given Initial
Adverse Determination
X. CO ITIONS F APPROVA / ~tEASONS F ~D/ISAP RO AL:
!Zp ~V t r'~~?'jl~~
SOD-6398 (R. 05/94) 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 onsitesewage 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:
1. 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.
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 tl5 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.
r.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 3, 1995 2226 Rose Street
La Crosse WI 54603
K 0 CONSTRUCTION
KIM 0 CONNELL
308 MIDPINE CT
STAR PRAIRIE WI 54026
RE: PLAN S95-40808 FEE RECEIVED: 180.00
BENDER, JOHN
NW,SE,34,30,19W
TOWN OF ST JOSEPH 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 me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
6n Sorenson
Plan Reviewer
Section of Private Sewage
(608) 785-9336
SHDA-7997 (R. IWN)
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division
Labor and Human Relations REVIEW APPL, CATION Bureau of Building Water Systems
'Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188
Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606
Phone(715)634-4804 Fax(608)785-9330 Phone(608)267-5119 Phone(715)524-3626 Fax(414)548-8614
Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3533
INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office
where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have sti ns on what information to
submit. PLEASE PRINT VERY CLEARLY. A sample of a .completed form is on the reverse side for your reference. e5 W" 4080_8
1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time:
Appointment Date Review Name Plan Identification Number
-7m-, ~ 9S- Z~AA)s -
2. PROJECT INFORMATION If this review is a revision or extension to your existing
plan identification number, provide that number here:
Proje Name
City Village [ZTown Of: County
I
Project Location /
GOVT. LOT A/Jt) 1/4, 1/4, T N,R or
3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type 1 (include new and existing tanks)
Up To 1,500 gallon septic tank $110.00
A At-Grade 1,501 - 2,500 gallon septic tank $120.00
H Holding Tank 2,501 - 5,000 gallon septic tank $160.00
M ® Mound 5,001 - 9,000 gallon septic tank $200.00
N Non-Pressurized In-Ground(Conventional) 9,001-15,000 gallon septic tank $300.00
P Pressurized In-Ground Over 15,000 gallon septic tank $500.00
O Other: Up To 1,000 gallon dose chamber $ 70.00
1,001 - 2,000 gallon dose chamber $ 80.00
Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00
4,001 - 8,000 gallon dose chamber $120.00
D ® Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 .
P Public Building Over 12,000 gallon dose chamber $160.00
S State-Owned Building Up To 5,000 gallon holding tank . $ 60.00
5,001 -10,000 gallon holding tank ~0.00
Code Derived Daily Flow _ gpd Over 10,000 gallon holding tank .
A ED..
Experimental System (additional one time fee) A . 300
Check If Replacing Existing System .
Revisions To Approved Plan Z . 44 $62 .
Petition For Variance: Setback .
Petition For Variance Site Evaluation $ 225.00 O~V . .
Plumbing $225.00
Revision $ 75.00
Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00
(other than a proposed subdivision)
Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00
Subtotal: /15?0_
Priority Review: Enter same amount as Subtotal: 0
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ,/20
5. SUBMITTING PARTY INFORMATION
Telephone No (include area code & extension) Company ame Contac 7,, ?n3V
(ys- >
'7 9/
No. & Street Address 0r .O. B x City, To n or Vill State, Zip C de
I Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers.
z Revision fees are not applicable to temporary holding tanks or extensions to existing approvals.
NOTE: Fees are pursuant to Wis Adm. Code, Chapter ILHR 2, and are subject to change annually.
The information you provide may be used by other government agency programs [Privacy Law, s. 15.04 (1) (m)).
SBDW-6748(R.09/94) OVER
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O O. m (A c v; w S w n m • C n m < N (p 3 C t*
•T O 7 u• a D 7 'O 3 N r+ m O e+ m 7 'p Z• N O O_ m a n rt n m
r+ m m 7 O w. 7• • rr
o v, r CLCrtCr m-0 r+~ n -nmv e+10 w w ~m n 7 -hm w 0, 3 c n m o
n a a 0 cO m n 1, m o -nm n e+s Q n m rL rt c- r* a 3 d N -mow 3 n
,-r n w - 7 - IA 3 7 0 V+ U, • m C r r+ • c, 7 •J m '
a s m nartwn J - m nao sm << o ~c 1 0, n-I 3 7 - dm w 3 7c'IID w e 0,=i
m
J O m v n 7 0 0 7 m z n 0 /0 y =-o N l0 7 n 7 a- la N r* 7 <
O.
n Z O O, n S n o, O C+ C 7 A • r+ G O_ m
0- m nn7 oooEm 7 0) -10 70 S m n o 0,m e+ -i m my NZ o
'O • h .c C m a CA r* f+ 7 'A n • O. O. rt w 7 w n c = r+ -h << -h x m a
< y N ~r*o o tic 0 w o m 0 *0 0) ° N b-4 N f C+ > s~•0 Pv
co
O n n• n W D• CA 7 0 m K r+ w w 14 M+ d~ mS N -S (D a r~+ • m S w o In
rt C
-hm m C7Nm l< -hm 7 0 m~•On7~• w m = w 7w
u+ o v7M (A 0nrrnVI ncomml (A nee v rt =0 v o 17 7 (<D ~o s 3
rt - n CO7w rr rrwa<<. m0 S m r+-0 m a to 77CL
s {u
o (A o m 9 m w 3 V, -h C c 0 3 _ j rt
rD O- cam. c r, S a o n r+ O a 1 m 0 VI Co n n 7 n j O 1* 0 (T 3 <
a m rt
LA m m tai (D r+7 0 m 7 7 •7 n C 2 m m O« o n J
n t+ n rt a 7 rt- 7 3 • O. O rt O' ~ r+ w ut N a 3 7 a O S rt
S m In rt m << O rt 7 N
3 c 0_ 7 r+ r+ o-n cc 7 << a -h o
m a c o oio n v 0 of -hrt out ut -n H n 0. c m m 0, C .0
n
n 7 n 7 C m << "O O << J O rt 7 n 3 O_ m O -h a m
• r+ C 'C
o m w u, v r+ 0 n r* C m m tr In r► F o 0 s n <
7 c a n ar►O m Imo Z a.0 m
ut rt o 7 G co- (4 a co n y IA n F a a n w+, W 7 I n m
c N m
r+ S .0 rr w 7 O y -~(a d w ( D (D mt 7 (FD
u,m cvm on ~m
m m m n C* CL
O
o5.-4®808
WORKSHEET - MOUND SYSTEM DESIGN
PROBLEM: II
Design a mound system fora
The site characteristics area"
Depth to groundwater or bedrock
in.
Landslope %
Percolation rate
Distance from dose chamber to distribution system ft.
Elevation difference between Dump and distribution system ft.
Step 1. WASTEWATER LOAD /sdx3a,~yp~~-~~ gal
Step 2. SIZE THE ABSORPTION AREA
A) Area required ■ -,<fsD ;'/~~,.✓~>'e/y
sq. ft.
B) Bed or trench length (B) ft.
C) Bed or trench width (A) ft.
^r"
r:
D) Trench spicing (C)
~o
" r!.. wastewater load .24 (jal/ft2/day B = ft.
~te►~ eT s
Step 3. MOUND HEIGHT
A) Fill depth (D) ft.
B) Fill depth (E) D + slope ft.
C) Bed or trench depth (F) _ ft.
D) Cap and topsoil depth (G) _ ft.
E) ap an tops 1 depth (H) ■ J_ir ft.
Zign:
• Licenue 1,u:
gate .7
of -/6
Step 4. MOUND LENGTH
A) End slope (K) _ CD + E + F + H x 3 ft.
lx~lx
B) Total mound e te(L) = B + 2(K = g,3 ft.
gy,
Step 5. MOUND WIDTH
Al) Upslope correction factor
A2) Upslope width (J) (D + F + G)(3 (factor) ft.
/74, 9S r/ )(,A2y,,
B1) Downslope correction factor =
B2) Downslope width (I) _ (E + F + G)(3)(factor) _ ft.
Cl) Total mound width (W) for bed = J + A + I = C;2 L ft.
C2) Total mound width (W) for trenches
J+ +
(no. trenches -1)(c) + A + I = r I(L ft.
Step 6. BASAL AREA
A) Infiltrative capacity of natural soil gal./ft2/day
B) Basal area required = wastewater flow f
natural soil infil native- cdpacit = sq. ft.
Cl) Basal area available for bed for sloping sites =
Bx (A+I) 5,s
sq . ft .
C2) Bas are4 avail le for trench for sloping sites
B W /J + A sq. ft.
C3) 1 area available for trench or bed for level
i es = B x W = sq. ft.
sign:
License
7-
Date:
4 0 8 8
Step 7. DISTRIBUTION SYSTEM
7A) SIZE DISTRIBUTION SYSTEM
1) Hole size = in.
2) Hole spacing = in.
3) Distribution pipe length 4) Distribution pipe diameter in.
5) Spacing between distribution pipes =f_ in.
6) Distance from sidewall to distribution pipe in.
7B) DISTRIBUTION PIPE DISCHARGE RATE ft.
1) Number of holes per pipe =
2) Flow per pipe 8~ /,I7P~~j~k= GPM
7C) SIZE MANIFOLD
1) Manifold is _ central/ end
2) Manifold length = ft.
3) Number of distribution lines =
4) Manifold diameter in.
7D) SIZE FORCE MAIN
1) Minimum dosing rate GPM
2) Force main diameter _ in.
y
3) Friction loss = 7S ft.
7E) TOTAI DYNAMIC HEAD
1) Vertical lift =ft.
2) Friction loss = ft.
3) System head 2.5 ft. _ ft.
Total dynamic head = ~ft.
Licen~~
Date _
895-40808
7F) PUMP SELECTION
1) Pump selected will discharge /,0,_ GPM at _L ft.
total dynamic head.
2) Pump model and manufacturer 1
7G) DOSE VOLUME
1) 10 times void volume of distribution lines gal./cycle
2) Daily wastewater volume 4 doses/24 hrs. a- gal./cycle
3) Minimum dose volume = 4ziL gal./cycle
7H) DOSE CHAMBER
1) Minimum capacity required = s-w-- ysv. gal.
UcQnse :.`u:
Date: 7- ~7 9S
I
w ~✓~s~s~- S- 9 ,5 - 4 8 0 5
~jx
~"~/l5//~~N ti *~i~'i~...., '%J'~' y,v +x a• sit 4 r;`~-.i~`~.~', ~
~Y
y yS a
- - I II
ys
i
Pag/`e__k
V
Straw, Marsh Hay, Or
Synthetic Covering Distribution Pipe
m Uo m Sand H G
• •
Topsoil F
_ 11 E D
Force Main Plowed Layer
% Slope
Bed of 1S"-21111
Aggregate
Cross Section of a mound system Using DFt.
A Bed For The Absorption Area E Ft.
i F Ft.
p~Ft. G 1~ Ft.
i B / yr Ft. H_Ft.
Ft
Signed• - .
I, iFt.
YY~-Ft .
License ?D
7 'S W Ft.
Date:
t«l
D(
K r e~ t '•th tY_~'
Alternate Position of
Force Main
I L
I
rte; t.v
J rvat'h Pipe f_ K _r
B -
i---------------
A ~ Forc Main
W '
Distribution Pipe Bed of 1s11-211"
IAggregate
observation
I Pipe Permanent Marker
Plan View of Mound Using a Bed For the Absorption Area
~v ~ r ® Jc'~w
Perforated Pipe Detail
n
nd View
)Perforated
End Cop ' PVC Pipe
~ e Holes Located On Bottom,
J Are Equally Spaced
e
P
PVC Force Mawr
PVC
;/~l'
MaNfold Pipe ` v'•
6 1 p1~
" 1Z
Distrib•stian Forge'
Pipe'
Lost Mole Should Be
Neal To End Cap
End Cap Distribution Pipe Layout_ Ft.
R
S
X _ Inches
/ Y Inches
Signed: - Hole Diameter Inch
Lateral Inch(es)
License Number : Manifold "-Inches
Date: Force Main " 2 Inches
# of- holes/pipe
Invert Elevation of Laterals.& / -Ft. 31`x_
r ~tri a
En A. • s Z
N
} ~ b
ct
N
N
fD
I _j
. f1 V `
rt
,s y
M ~
o
ro
K ~
c `D
~p N
N
b m
d-==3.~.-_------- e
N
'c rt W
o
U~ 's
r rr rrr r
• rrr r +
r r r r r
~ r r r r rr
r r r r r r r r r r
rrrrr t
rrrrr
rr C M
r+rrrr y
n ra
U
.4
F,
w
K
a
a
c~
f '
PAGE OF 1G.c_
PUMP CHAMBER CROSS SECTIOiJ AND SPECIFICATIONS
S95-40808
VENT CAP
H*C.I, VENT PIPE
7 WEATHER PROOF APPROVED LOCKING
JUNCTIOAI BOX MANHOLE COVER
25' FRAM DOOR,
WIQDOW OR FRESH F MIU.
AIR INTAKE
' I I
GRADE
IB'MIIJ.
COIJDUIT
\ 11l
INLET PROVIDE I
AIRTIGHT SEAL I I i I V
APPROVED JOINT A " III APPROVED J010
W/w. PIPE ( I I ( W/4w. PIPE
EXTENDIN¢ 3'"Y::~,`~„1 p I II ALARM EXTEIJDIUC. 3'
01JTO SOLID SOIL ~TM. } I I I ONTO SOLID SOIL
.l A° Nr 1 i w' ~ I
• /mar PUMP OFF
CONCRETE BLOCit
l a=•
RISER EXIT PERMITTED OWLIJ IF TANK MANUiA(:TURER HAS SUCH APPROVAL
SPEC, IFI.CATIQQS
,:PTIC AND
vSE TANKS MANUFACTURER: IJUMBER OF DOSES:' PER DAy
TA►JK GIZE : _ GA LONS DOSE VOLUME: ZZZ GALL0IJS
ALARM MANUFACTURER: ' CAPACITIES: A=s~LL-INCHES OR ..sS'/ GALLOQS
MODEL ►JUMBER:
d= -2 IWCHE5 OP, _YT GALLOWS
SWITCH TYPE: C= 7 INCHES OR ..cst 1 GALLOQ5
PUMP MANUFACTLIRER: D= 41INCHES OR LLa OALLOQ5
MCmEL NUMBER'. , /Z NOTE: PUMP AND ALARM ARE TO BE
SWITCH TYPE: INSTALLED ON SEPARATE CIRCUITS
PUMP DISGHARGIL RATE
VERTICAL, DIrr'ERENCE bETWEEN PUMP OFF AND OISTRIBUTION PIPE.. <i~ FEET
+ M yIIMIIKUM NETWORK SUPPLE PRESSURTTE//. 2 5 FEET
_L_>_ FEET OF FORCE MAIM X /-gyp F/ooFLFRICTION FAGTOR..FEET" vln
TOTAL •,~Ot3WAMIC HEAD = FEET I~.L
IQTERIJAL. DIME IONS OF T UK: LEIJGTH ;WIDTH -;LIQUID DEPTH
31GIJE1) LICEUSE WUMBER',
3-~~~_ DATE:
ai, y
1 J~.
'Performance
P f}Cow Curv
es uf~ s K~~x~
FEET ~ ~ ~ (j ~ 8 j,
METERS 890
25 MODEL 3885
80 SIZE 3/4" Solids
WE/5H
70
I 20 WE10H
60
WE07H
15
WE05H
40
:TT:
10
WE03M
30
20 WE03L
5
10
0 0
0 10 20 30 40 50 80 80 90 100 110 120 GPM
I I
0 10
20 30 m3/h
CAPACITY
MGOULDS PUMPS, INC.
METERS FEET sB*CA Faun NEW rpaK , .
120MODEL 3885
35 110 WE15HH SIZE 3/4" Solids
30 100
90
25 80
70
20
60
O
H
WE05HH
15 50
40
10
20
5
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
I
0 10
20 30 m°/h
CAPACITY
1986 Goulds Pumps, Inc.
Effective July, 1985
CiW
DEPAfTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
.'LABOR 4ND PERCOLATION T E TS P.O. BOX 7969
® `I 0808 MADISON, WI 53707
;'IUMA'N RELATIONS (H63.09(1) & Chapter 1405V g151
LOCATfO • SECTION: TLOT NO.: BLK. :
NO. SUBDIVISION NAME:
W 1 S8j4 34 /T 30N/R 19bor)W St. Joseph 9 n/a Deerfield
COUNTY: OWNERS 'S AM T-M-WING ADDRESS:
St. ;,'roix S. Henning & D. Norell 665 Valsh T;d., Iludosn, Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDR COMMERCIAL DESCRIPTION: I STS:
Piesider 3 n/a ®New OReplace 7-10-92 7-30-92
RATING: S- Site suitable for system U- Site unsuitable for system
CUNVEN I I NA MOUND: IN-GROUND -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
❑S Mu HS ❑u ❑s CMu ❑s ®u ❑s 00 mound
If Percolation Tests are NOT required DESIGN RATE: It any portion of the tested area is in the
under s.H63.09(5)Ibl, indicate: n/a Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS page 42 MTC2
BORING TOTAL ELEVATION DEPTH T R N WATER•INCHES A A TER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. -OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B. 1' 65 99.90 zone >65 0-13, 10yr4/3, L.; 13-48, 10yr , si 48-
7.5 r4/6, sl.
2 65 101.60 none >65 0-9, 1 yr , L.; - yr , Si l.; 39-65,-
13- 7.5yr4/4, sl.
- yr - Yr si
B 3 66 101.60 none >66 35-66, 7.5yr4/4, sl. hard till
B-
1 B.
i
j B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP N WATER LEVEL-INCHES RATE MINUTES
(NUMBER INCHES AFTER SWELLING INTERVAL-MIN.
PERIOD I PERIOD 2
PERINCH
,
p. 1 24 none '10 30
P. 2 24 none 30 i f
I
P- 3 24 none 30 30
P.
P.
'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
ontal 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
;f land slope.
)YSTEM ELEVATION 102.60
Pc $
P I oo n .n jl
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707
HUMAN RELATIONS
(H63.0911) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/PALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
d 1/4SII/4 34 /T 30N/R 19Lo0 w St. Joseph 9 n/a Deerfield
COUNTY: OWNER'S 'S NAME: MAILING ADDRESS:
St. Croix S. Henning & D. Norell 665 Walsh 11d., Hudosn, [di. 5401-6
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER AL DESCRIPTION: ®New El PROFILE DESCRIPTIONS: PERCOLATION TESTS:
M
1 1 3 n/a Replace I 7-10-92 7-30-92
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
asc~u HS OU ]S Hu ❑s®u OS[~jo Mound
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS Page 42 Ali?C2
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1"', 65 99.90 gone >65 0-13, 10yr4/3, L.; 13-48, 10yr4/4, sil.; 48-65,-
7.5yr4/6, sl.
2 65 101.60 none >65 0-9, 10yr3 2, L.; 9-3 , si -
B- 7.5yr4/4, sl.
3 66 101.60 none >66 0-15, 10yr4/3, . - 10yr414, si
B- 35-66, 7.5yr4/4,sl. hard till
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PER PER INCH
P- 1 24 none 30 1
P- 2 24 none 30 114 '-24
P- 3 24 none 30 t-1 30
P
P-
P-
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 land slope.
SYSTEM ELEVATION 102.60
I k l -
I
..~..G.,, t.., L .//)J((.,:.._~- .fig.....
t KY~1 - i ; 1.1✓V t 7
3
F^i
3
E!`
~
S
16
a . €
a
~ Ste, ~ ~ ~ t
r 0~)
T 1
T
0
I, the undersigned, hereby certify that the s 'I'ds ~rted on f ere made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorde d h~}q o ~F h sts are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 7-30-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, 14i. 54017 2298 Z15-4k6-6200
CST SIGNA
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
-
DILHR-SBD-6395 (R. 02/82) OVER
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a comp and accurate soil test, your report must include:
1. Complete ption;
2. The use it clearly indicate where is is a residence or commercial project;
3. MAXIMU` r if bedrooms or con iT use planned;
4. Is this a nE 'ent =ystern;
5. Complete w„ rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYS-I E RULED OUT BASED ON SOIL CONDITIONS;
0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE dia.]ram accurately locating your test locations. Dry wing to scale is preferred. A
separate sheet may be -1 if desired;
8. Make sure your b==r * and vertical elevatio,-i reference point ar own, and are permanent;
9. Complete all app boxes as to dates, names, addresses, floor a, percolation test exemp-
tion, if appropriate;
10. ' ire information { flood plain, elevation) does riot apply, p . in the appropriate box;
11 _ -'n ertr your current address and your certification, nr1t,-
1 and distribute as required. ALL SOIL TESTS M'. LED WITH THE
I r ;L AUTHOI`ITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL_ TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Gobble (3 - 10") SS - Sandstone
gr - Gravel (under 3") LS - Limestoi
`s - Sand HGW - Nigh _
cs Coarse Sand Pere- Percot',
reed s - Medium Sand W - Well
fs Fine Safi(] Bldg - Building
Is - Le,my Sanct > - Greater "]-bars
sl - Loam < L- ; Than
Bn B,
si Gy - Gr
Y _ )w
Loarn R -
V,
~i Imn Many,
rn Mu:.k (,I - distin
P - proir,
High v, ,
Six soil
w. Bench
Vraticr~` Pc~,,t
TO THE OWNER:
t report is th, it g a sanitary permit. The - y or the DepartmOrtt IIHV uc::St
this rrr'r ti; field prior to permit iss '?nce- ^ inl- (p , r,
:id a applic:a=- n must be suhmitted ;)'the 1 arc gar, r ,
obt . n a p y permit must be obtained ar i p. ti
' - ♦
PLAT OF ®E(F i E L®.
VEY
OF THE SEI/4 AND IN PART OF THE` SWI/4 OF THE SEI/S ,:2A 3 ' AND SECT16N 34,
OF CERTIFIED
THE NWI/4 N S RI I '
'
ST. JOSEPH;.' ST. CROIX COUNTY, WISCONSIN; INCLUDING PART OF LO
IX COUNTY' REGISTER OF DEEDS OFFICE',, DOCUMENT' NUMBERr 438728..
, PAGE 1989 AT THE ST.CRO
DEO IN VOLUME 7
CURVE DATA utlun . ' •u~an tK R
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: : n•:1'rr•' S44-34`43.6`111f • 44,52
s 109.00 u ss ~i. ~i .4
sols 00 30.03 _ _fH'fl N'W '20161• 203.21" 11 t'• 'I .I U) LLA
I a '
L UNPLATTED LANDS 01 a 'ol x
NO11TN LILAC OF 11111C fEW OF SECTION 14 SO' Ial WI CLw to . _ 1 .
a.e9 4e
I~r :
5e9.27'37*E 1321.14' ~i M w
MI +
37.+s• 6b6.00 +40.00' ~1 Y
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a 4I TEYF01•ARY so FOOT MOWS UA
n S R CUL-OE-fAC. I _ LJI• ~i
18 Y« 8 C - I of I• 'SCAL'E IN f FF_
1
R S \ LOT 8 JI Z1 1 r'r'•~ =:'=wo.
\I, I S O . 100 '
a : Oil . 131.2.7 $0. IT.
T 6 •00 N LOT' 7 CENTER 3.01 ACRE:
J i' cui W R
x0 a0., F7. 130.0677ACRESSO, FT.
ACRES 6.0
301 :
/j . 1 PLAT LOCATION
'oao 0 / , I06IN Av[eyt
?may
19•r)' 7'C aN 1{ ti rl~' V
030.16'
.0 •4 o
• ;-rte
LOT 9. i A.
11146.61 FT.
0.41 ACRES 0 '
410.
»I~7 _ x•----3
LOT . 5 MIY[
.2 ST Si. FT. 4 s 51 ,
n h .I a+1 -«1
13 ACRES LOT 10
t•. 131.290 so. FT. ° I • • Y
• 3.01 ACIILS lee' I Tl m3 .
,i' >j :Or• I•s.oo' I yl 41 • . 'r
s99•n'37•c 1 06.04 3 f4, 1L.~/W7~ i XI JI SECTION 34, T3pN,•R19W
474.4•' 411.42' ~~~J nn'• ZI 01
• IN• 100' ; 1
00
-i1
-is
O Z: ZI
LOT 4 ! I 11 „ LOT 14 .8 ~ 01 :3' LEA .
130,679 So. FT.. LOT 1•_ ; 130.481 $0. FT;
3.00 ACME f 136.241 $0. FT-
ACES ACRES
i~ n I
° 3.11 ES 3.00. \f~• xY.•t _ • COUNTY StCT10N YONOmli - fC
tA. F61R19.
' 1 • 1. wai MK •FOVNO
' , • • 1 ,
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER i?Q, 41L ~ ry-W tL-- G L VS !2 / 3
MAILING ADDRESS r s--
PROPERTY ADDRESS
-
J
(location of septic system) I ease obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION to 1/4, ~&iC 1/4, Section T 0 N-R / Y W
'SOWN OF ST. CROIX COUNTY, WI
SUBDIVISION l
r' ► Z.,~ LOT NUMBER`
CERTIFIED SURVEY MAP , VOLUME PAGE 10, LOT 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 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 systems agree to
keep their system properly maintained.
Tlie 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.
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 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:
St. Croix County Zoning Office
Government Center
1101 Cannichael Road
Hudson, WI 54016 11/93
S T C - 100
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 1 e~ ~11Ad Y^ Z" gam
Location of property 4(&)_1/4 t r, 1/4 , Section 3e , T $O N-R__L2_W
Township !6-' S Mailing address 1a,~53 13de,
e.
Address of site
subdivision namel-j"~e„Q.r- FI.&Jj Lot no.
other homes on property? Yes No
Previous owner of property
Total size of property 4-
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this pr erty being developed 9j (spec house)? Yes No
Volume ✓ and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY 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. and that I (we) presently
own the proposed site or the sewage disposal system 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.
oci ature of Applicant Co-Applicant
X 7 /~~-/~s
hatp of i cinitiir~ il,itn cif S i rinatiirP
530546 Y.,;. 1127PAGE517
WARRANTY DEED
60CUMENT NO. We SP.ea Ro..r,.d rw Recording Data
ST.CE ~Ca,vil
THIS DEED made between KEVIN F. LOHMETER and tw.-a ftw
DEBBIE J. LOHMEIER, husband and wife, Grantors and JOHN JUN 2 Z 1995
R. BENDER and PATTI L. BENDER, husband and wife as joint
tenants, Grantees, ut 11:30 A-fJ
WKnessetb, that the said Grantors, conveys to Grantees the tt05ir" d c r '.:3
following described real estate in St. Croix County, State of
Wisconsin: aea/D
f~~/D¢
Lot 9, Plat of Deerfield in the Town of St. Joseph, St. Croix County, Wisconsin.
y
21
.00
This is not homestead property.
TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-of-way
of record, if any.
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Kevin F. Lohmeier and Debbie J. Lohmeier warrant that the title is good, indefeasible in
fee simple and free and clear of encumbrances, and will warrant and defend same.
Dated this day of June, 1995.
SEAL)
VIN /F. Wf5tMER
,G!,le 'ire (SEAL)
DEBA
STATE OF ILLINOIS )
Ss.
W 1A1NERq6# COUNTY )
Personally tune before me this pq day of June, 1995, the above-named Kevin F. Lohmeier
and Debbie J. Lohmeier, to me known to be the person, who executed the foregoing instrument and
acknowledged the same.
D
OFFICIAL SEAL
JAMES A DAVIS Notary Public, State of Illinois
NOTARY PUBLIC. STATE OF 1LUNOPS My Commission Expires: 9laG/9~
My COMPASSION UPIRES:osnSAIG
THIS INSTRUMENT DRAFTED BY: RETURN TO: 4-
Barry C. Lundeen
MUDGE, PORTER, LUNDEEN & SEGUIN, S.C.
110 Second Street
Post Office Box 802
Hudson, Wisconsin 54016