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STC - 104
AS BUILT SANITARs4 SYSTEM REPORT
OWNER }
ADDRESS
u? /i A~ I~ST
SUBDIVISION / CSM# LOT #
SECTION. --)_T~~j N-R lg W, Town of
ST. CROIX COUNTY, WISCONSIN 5
PL VIE
SHOW EVERYTHING W HIN-"00 FEET OF S 'STEM
A
gm
a
a~
y~
3t1
INDICATE NORTH ARROW
Provide setback and elevation information on revs rse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
A
r
BENCHMARK:
7G~nFI f
ALTERNATE BM: T.~ &Qb. JOT,
i
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: 7 v
Setback from: Well House= Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length/ Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well:- House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom 2~ Pump Off
Header/Manifold Bottom of system !2fL,
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: S~
INSPECTOR:
3/93:jt
wiscon in Department of Industry, PRIVATE SEWAGE SYSTEM County:
` Labor and Human Relations INSPECTION REPORT ST. CROIX =
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
WILSON, VINCENT X.
CST BM Elev.: i Insp. BM Elev.: retiriim-
BM Description: Parcel Tax No.:
C/Lj
TANK INFORMATION ELEVATION DATA d a~ - p/~~„ems
TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV.
Septic r,~ a i ty,.E~ ~y Benchmark (a 1l/!>, GZI
Dosing v
Aeratio Bldg. Sewer d/, ?-S-
Holding St/ K Inlet V(;,
TANK SETBACK INFORMATION St/~K Outlet
TANKTO P/ L WELL BLDG. VVe
Air nttake ROAD Dt Inlet ZS D. S6
Septic C ~k NA Dt Bottom h? Z3 F~11 ' de(
Dosing ?SIB V 1> NA Header / Man. 96
Aeration Dist. Pipe 5
,a
Holding Bot. System p
PUMP / S 1m INFORMATION Final Grade
_D ,4
Manufacturer emaridM
Model Number (]ac ~~dG M
System TDHFt
TDH Liftq,151 Friction 0
1 Head
Forcemain Length (Q!jl Dia. 3 Dist. To Wei
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengt No. Of Trenches PIT No. its Inside Dia. Liqui epth
DIM N I N
DIMENSIONS
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING u
INFORMATION Type Of p,,..,.. r , CHAMB Model Num er:
O System: c 8 y OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole SSiize,, x Hole Spacing Vent To Air Intake
Length DA Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded T'xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil C] Yes ❑ No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Star Prairie.2.31.18W, SE, SW, Cty. oad H
Pvislongwred? Yes
Use other side for additional information. `e) /j
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
i
Safety and Buildings Division
v~ia.'■''■r"a 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 1/2 x 11 inches in size.
0 See reverse side for instructions for completing this application State Sanitary P `rmit Number
b149%1
The information you provide may be used by other government agency programs ❑ Check 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 ywwner ame Property Location
~ 1/4 1/4,5 T , N, R (or&
I_ A 111,-tAJ I :5LIJ - -
'
Propert V/ O ers ilin ddress Lot Number / Block Number
City Stat Zip Code Ph ne Number Subdivision Name or CSM Number
1. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
❑ Village
,
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
111. 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. P New 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
System 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 fS Mound 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
Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min Inch) Elevation
y Feet Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank - /Zoo ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber F El El El 1:1 1-1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans.
Plumbe 's Na e: (Pi Plumb rs Si a r a ps) MP/MPRSW No.: Business Phone Number:
e='7 / - _Z
u ber s Address Street, ty, St $e, Zip Code)
: '
J
hem
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued LIssuing Agent Signature (No Stamps)
Approved ❑ ~ surcharge fee)
Owner Given initial 0 Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's narrre and mailing address. Pr'oyide 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) oir 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.
Wisconsin Department ofIndustry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division
Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 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) 524-3633
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 q~ti I oAwh t ir~,or~ga * to_
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. a 4f 04 L} U I j7 `1t1
3
1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time:
App int ent Date Review Name [Plan Identi ication Number
G S c^ J
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 Town Of: County
e,sh, R.) ~2'
Project Location
GOVT. LOT 1/4 114 S . T N .R or
3. APPLICATION FOR . FEE COMPUTATIONS FEE SUBMITTED
System Type (check one):, System Type r (include new and existing tanks)
Up To 1,500 gallon septic tank $110.00 1h9
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 p ?tom 5,001 - 9,000 gallon septic tank $200.00
N ❑ Non-Pressurized In-Gft3und (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- 4,000gallon 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 T-
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 $100.00
Code Derived Daily Flow gpd Over 10,000 gallon holding tank $150.00 .......4?
❑ Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00
Revisions To Approved Plan 2 $ 60.00
Petition For Variance: Setback $100.00
Site Evaluation $225.00
Petition For Variance ~
❑ Plumbing $225.00
Revision $ 75.00
Groundwater Monitoring - Per Site $ 60.00
❑ Groundwater Monitoring (other than a proposed subdivision)
❑ Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00
Subtotal:
Priority Review: Enter same amount as Subtotal: ~I'leg
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 5. SUBMITTING PARTY INFORMATION
Telephone No. (include area code & extension) Compa Nam Co t ct Person ~
( )
No. & Street Address Or P.O. Box City, Town or illage, State, Zip Code
I Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers.
2 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.
SBD-6748 (R. 07/93) OVER
q a a'/v
S94-40743
WORKSHEET - MOUND SYSTEM DESIGN
PROBLEM: /
Design a mound system for a Allva<Z /
The site characteristics are:
Depth to groundwater or bedrock ~ in.
Landslope
Percolation rate ,G fo~tx~~lq,~` ern.
Distance from dose chamber to distribution system ,Z;U2 ft.
Elevation difference between aump and distribution system ft.
Step 1. WASTEWATER LOAD ~s-p~ ,~4,PX ,fsQ gal.'
Step 2. SIZE THE ABSORPTION AREA
A) Area required ■ = 375-
~~Z:i: sq. ft.
B) Bed or trench length (B) _ eft.
a: C) Bed or trench width (A) ft.
M;
: D) Trench spacing (C) _
Wastewater load .24 gal/fC2/day S = ft.
I tr`e%►c es-
Step 3. MOUND HEIGHT
A) Fill depth (D) ft.
B) Fill depth (E) D + slope (AJ~•~~ ~L, ft.
C) Bed or trench depth (F) _ r- ft.
D) Cap and topsoil depth (G) zo ft.
AVa topsoil depth (H) ■ ~1~ ft.
~,iRn•
• L,iconue 12u: _
~T 1~ or Ju
- - S94-4074.3
Step 4. MOUND LENGTH
A) End slope (K) ■ (D_~ E1+ F + H x 3 = /4-? ft.
B) Total mound len(th (L) B + 2 ■
(K) &f t.
11~12f
Step 5. MOUND WIDTH
Al) Upslope correction factor ■
A2) Upslope width (J) ■ (D + F + G)(3)(factor) ■ ; ft.
(/7.83 t-/)( )(875) y-Vg
Bl) Downslope correction factor =
B2) Downslope width (I) ■ (E + F + G)(3)(factor) _ .14,ff ft.
(iat--SS*/)&) (//S) -/0,ZX
Cl) Total mound width (W) for bed ■ J + A + I ft.
C2) Total mound width (W) for trenches
J + + (no. trenches -1)(c) + + 1 ft "001
Step 6. BASAL AREA
-
A) Infiltrative capacity of natural soil gal./ft2/day
B) Basal area required = wastewater flow
natural soil infiltrative-capacity sq. ft.
-OTo % , 6 = 7S0
CZ) Basal area available for bed for sloping sites =
B x (A + I) /,3$rs,-S~ sq. ft.
C2) Bas are avail le for trench for sloping sites ■
B W ~J + q 1 sq. ft.
7 J
• C3ABasal area available for trench or bed for level
■ B x W = sq. ft.
Sign:
Liconse Nu:
lam,?
Date:
Step 7. DISTRIBUTION SYSTEM S 9 4 - 4 0 7 4 3
7A) SIZE DISTRIBUTION SYSTEM
1) Hole size = in.
2) Hole spacing = XC2 in.
3) Distribution pipe length = _ilydrr
4) Distribution pipe diameter = in.
5) Spacing between distribution pipes in.
6) Distance from sidewall to distribution pipe 2:~Z in.
7B) DISTRIBUTION PIPE DISCHARGE RATE ft.
1) Number of holes per pipe
2) Flow per pipe Z GPM
7C) SIZE MANIFOLD
1) Manifold is ,z _ central/ end
2) Manifold length ft.
3) Number of distribution lines
4) Manifold diameter in.
1D) SIZE FORCE MAIN
1) Minimum dosing rate = GPM
2) Force main diameter, in.
3) Friction loss = p8~av ft.
7E) TOTAL DYNAMIC HEAD
1) Vertical lift = ft.
2) Friction loss = ft.
3) System head 2.5 ft. _ S ft.
4 Total dynamic head ft.
aign
Licer
eve
94- 40743
7F) PUMP SELECTION
1) Pump selected will discharge GPM at ft.
total dynamic head.
2) Pump model and manufacturer
a §V
7G) DOSE VOLUME
1) 10 ti s void voltime of distri ution lines = gal./cycle
2) Daily wastewa~er volume 4 doses/24 hrs. _ (j ,gal./cycle
3) Minimum dose volume = gal./cycle
7H) DOSE CHAMBER
1) Minimum capacity required = yJ~,~~- gal.
Sion
•/r~_
Licvnsu ','u: Date
o
J by 0/ S94-40743
//~~~Y- off'/~~~ • ~~ia~ o ~
S,~~re %K - bJfk~s /aaoy t-~
% ~=~0 l sc~tlE ~
r~f~~'s;~ ~7s9
0
t~
f r _ r...JJJIIIIII!!!~"sssjjj
o f~„t•. As 'ilcS~cN~D ;rtE n1ET~ek CS~Ty ,~~.~~3.~y~r<
Jan iufx l'2 PrL , /T TrNc 7~:~,P ~E~\V tRS ?3 f ry:: uJtt~c ti iS
v~~~. ~~E Z'' ~r.m„ ~a+~cJA~o t ..~t.-~~a►
E~cEE{~S aj t~ C~'~ AT ~~13~ TFt~c f~l F:E~Gm,t~En3UcA
~,~vPaudkoill ~um: L~tAn7~t tS 1f1V~tlY ~ECer»rnEr1~~~
S94 - 40 43
Designer.,
Pate.: Non-Woven Filter Fabric
4" Observation Pipe
~.Distribution Pipe
ASTM- C 33 Sand /
H G Alter. Pos, of
Topsoll \ r Force Main
E
1
\ 1
% Slope
r
Bed Of %Z~- 2 ? Force Main Plowe d
Drain Rock From Pump Layer
.f
Cross Section Of A Mound System Using
- ,aA or The Absorption Area
G
A~Ft. H
B Ft.
Ft.
K1p-s' Ft.
Alternate Position L LL-Z-~l Ft.
of
Force Main k' Ft.
L
J 14 Observation Pipe
-2 1 i Force Main
p
W to (0 From Pump
C -
3r o Distribution Bed Of 2
Pipe Drain Rock
1
4~Observation Pipe Permanent Marker
Pipe or Rods.
Pion View Of Mound Using A Bed For The Absorption Area
PAGE_/p OF 16)
1
PERFORATED PIPE DETAIL S94-40743
and
DISTRIBUTION PIPE LAYOUT
Perforated Schedule 40
PVC Pipe
End
Cap e • '
aa1oe \ 4
a~9 Holes Located On
Bottom Are Equally
k ' Spaced
End s
Cap
Schedule 40
l PVC Force Main
~t
Last Hole
Should Be
Next To c-,---
End Ca 2
p non; ,
Owner's Name: pfeet
Plumber/d s gn rignature: x_ inches
y inches
Date: License No.:_ Hole Diameter inch
Lateral Diameter -~~.••l._ inch (es)
LT S,r~f~~~E~ ~.ti~•n Force Main Diameter inches
- 3" Fo'_`• m Holes per Lateral
1 feet. Invert Elevation
of Laterals
Page -]7 of 1~.
m
- m•
.,,r.
w
r,
A
a.+ r,
o ~a
4J I
44
44 D
114 m - Cl
W
Q - -
t~ ~
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a 4
m ~
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-rl •rl
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a
)Z Sloh/ PAbf ~ Of
PUMP CHAMBER CROSS SECTION AND SPECIFICATI NS
V E A!T CAP
y VENT PIPE WEATNERPR 00F APPROVED LOCKING
JUWCTIOM BOX MANHOLE COVER W ITK
25' FROM DOOR, WARNING LABEL
WINDOW OR FRESH I2'MIU.
AIR INTAKE
GRADE
yMIAJ.
I IB' Mlu. kl~ COIJDUIT
PROVIDE (
IMLET
AIRTIGHT SEAL I III
I III
r-T
APPROVED JOINT A I III APPROVED JOIUTS
W/ PIPE I III M//" PIPE
EXTENDIM6 3' I II ALARM ONNTTO O SOLID SOIL
OWTO SOLID SOIL I II OOIL
D I I
I I OIJ
C I
LLEV. FT. PUMP----
b OFF
0
COWCKETE BLOCK
RISER EXIT PERMIlrED OIJLy IF TAWK MAWLIFACTURER HAS SUCH APPROVAL.
3" +4pPKoVEa 6EDpING tandc~ TI!.►.sK
SEPTIC E SPEC.IFICATIOAIS
DOSE
TA►JKS MAIJUFACT URtK: IJUMBER OF DOSES: PER DAB
TA WK SIZE: x GALLO S DOSE VOLUME
ALARM MALJUFACTURCR: S -i< S IMCLUDIMG BACKFLOW: A GALLONS
MODEL IJUMBER: 11V1 WIJ CAPACITIES: A L-IMCAES OR S GAtL0u5
SWITCH TYPE: B = 2 IAICHES OR GALLOWS
PUMP MA►JUFACTURER: C 3 ' IIJCHES OR yo/Z CALLOUS
MODEL AIUMBER: lfgZZ - D = INCHES OR GALLONS
SWITCH TYPE: MOTE: PUMP AWD ALARM ARE TO BE
MIMIMUM DISCHARGE RATE ~GPm, (~.Q INSTALLED OM SEPARATE CIRCUITS
VERTICAL DIFFEKEUCE BETWEEIJ PUMP OFF AUO DISTRIBUTIOM PIPE.. FEET
+ MIUIMUM METWORK SUPPLY PREE~SSSSUR~~E//. . . . . . . . . . . 2./5FE.ET
+ LL- FEET OF FORCE MAIM X _LLF/oo►r.FRtCTIOU FACTOR.. 7R FEET
TOTAL 09MAMIC HEAD = ! pJ~ FEET
IMTERtJAL DIMElWJ OQfi OF(T K: LE:W TM iWIDT14 LIQUID DEPTH
SIG),JE LICENSE NUMBER'. ~ ~ PATE:
Goulds
Submersible
Effluent Pump
3071 Vo5
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast Iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermopias-
components. tic cover with integral handle
• FarmsS Motor: manual Available for operation. automatic and Automatic and float switch attachment
• EP04 Single phase 0.4 HP, points.
• Heavy duty sump 115 or 230 V 60 Hz; 1550 models include Mechanical
• Water transfer RPM, built in,0 Hz; overload with Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering preset at the factory. rated oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, heavy duty ball bearing
FEATURES
115 V, 604z, 1550 RPM, ,
Pump: EP04 built in overload with ■ EP04 Impeller: Thermo construction.
• Solids handling capability: automatic reset. plastic Semi-open idesign
1/4' maximum. • Power cord 10 foot with pump out vanes for AGENCY LISTING
. Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. CP• Canadian Sla OS AnWation
Total heads: up to 24 feet. with three prong grounding _
• Dischar a size: `1'/2" VPT. Plug. Optlonaf20 foot ■ EP05 Impeller: Thermo-
• Mechanieai seal: carbon- length,l6/3 SJTW with plastic enclosed design for (CSA listed model numbers
improved performance. end in F or AC
rotary/ceramic-stationary, three prang grounding plug
BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
1040F (400C) continuous superior strength and
14011F (600C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running - - y
t*
dry without damage to s 30
components.
Pump: EP05 a - ~ - -
• Solids handling capability; 0 2s
% maximum.
• Capacities: up to 60 GPM. X 6
•,Total heads: up to 31 feet. 0
• Discharge size: 11hN NPT. z 5 - -
• Mechanical seal: carbon- c 15
rotary/ceramic-stationary, 4
BUNA-N elastomers.
• Temperature: 3 10 continuous
1 0°F (60°C) intermittent. 2-
-
g
1
01
00 10 20 30 40 so GPM
t
0 2 4 6 8 10 12 m3/h
K7 Stt~/ CAPACITY +
PM
01995 Goulds Pump", InG. Elective May. 1995 ,
a
B3
71 ,
r_ S4,4-40743 PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CA,P
4' C.I. VENT PIPE WEATHER PROOF / 'APPROVED LOCKING
A1JHOLE COVER
JUIJCTION BOX
~ 2S~ FRAM DOOR, 4FU. r
WIAIDOW OR FRESH I
AIR IW•fAKE I
GRADE I +
ti :i ~~Kp M(IJ.
„ IW /Alm.
INLET PROVIDE I -
AIRTIGHT SEAL I I i I V
I I ROVED JDIWTS
APPROVED JOIIJT APP
W/C.Z. PIPE VE v. 1L, " r)
, E~• rte, v r• r W/C . I . PIPE
L~ Ttte i I I EXTri mm JG 3'
fXTEND1Al~s 3~ Vk+AT frL'YCn~~ ~e 1 in] 'L" IS 14.1 ALARM OJTO SOLID SOIL
O►JTO SOLID SOIL p`A
C w ~ N ~s✓I, f} RG.v ~c ~o~ L.-+4~ ric: r, I I
PUMP "-J OFF
D~~ Dti ter,
COUCRETE 9LOM
RISER EXIT PERMITTED OQLd IF'TAWK MAULNACTURER HAS SUCH APPROVAL
SPEC IFI.CATIOIJS
1;PYIC AND _
US6 TANKS MAQUF'ACTUkER: IJUMDER OF DOSES: PER DAy
rnl
TAWK SIZE : GALLOIJS DOSE VOLUME: ~oZ--~~ ALLONS
ALARM MAMUFACTUR•£R: CAPACITIES: A= _11.104ES OP. GALLOQS
MODEL QUMBER: J191 _J/tt.) _IWCHES OR GALLOWS
C=_GZ -IWCHESOR 1s GALLOUS
SWITCH TYPE:
PUMP MAWUFAC.T LIRE R.
M011EL NUKbER:.bJi;e, MOTE. PUMP AND ALARM ARE TO BE
Zt, IUSTALLED OW SEPARATE CIRCUITS
oW11CH TYPE:
PUMP DISCHARGE. RATE - GPMj
VERTICAL,DIFF'EREIJCE bETWEEU PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSU E/. 2 5 FEET
+ /S(? FEET OF FORCE MAIN X~ /oo ftFRIC-f IOU FACTOR.. FEET I. `I6
TOTAL 0ylQkMIC. HEAD = -Lli-LS FEET I Z•S 311
• ~i%~...r r_'•e Sys
IQTERNAL DIM W510105 OF TAIJK: LEA]GTH --;WIDTH J~LIQUID OEPTH
I
J~
LICEIJSE QUMBER: DATE: ~
51 GQE D:
p,M1~ 11y~jui~f Y ,y~ yhl:'b A47qe °r.
` 'stn TY7,W~'1 u Wi{p b ry!f'.,,. •k Wn 1W,nii
Performance
Curves Pumps
.
METERS FEET S94a4O743
90
X/
MODEL 3885
25 80 N.- + SIZE 3/4" Solids ra~Yst
WE15H
70
X 20 WE10H
60
0
l'- -:Z
15 50
WE05H
40
10 30 WE03M
20 WE03L
5
10
0 0
0 10 20 30 40 50 60 X70 80 90 100 110 120 GPM
I -L -j
p 10 20 30 m'/h
Z: ~APA~ITY
MGOU LDS PUMPS, INC.
SeE-CA FALLS FEW YOAK 13146
METERS FEET
120 MODEL 3885
35 SIZE 3/4" Solids
15HH
110 EWE
100
30
90
25 80
70 .
20
c:
60
0
~ WE05HH
50 ~
15
c
40
10 30
20
5
I
10
0 0
0 10 20 30 40 50 60 70 60 90 100 110 120 GPM
p 10 20 30 m'/h
CAPACITY
Effective July, 1985
•1985 Goulds Pumps, Inc. C3885
"!*c'onsin'DepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page, of .3
Labor and Human Relations
Division of Safety & Buildings in acc i h I HR 83.05 Wis. Adm. Code
o9~ Q 4074 COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP RTY OWNER: / PROPERTY LOCATION
GOVT. LOT 1/4 1/4,S T ' / N,R(or 14 PROPERTY OWNER':S MAILING, AD RESS LOT BLOC # SUBD. NA OR CSM #
Cl STAT.~ / ZIP CODE PHONE NUMBER CITY ❑VIL GE MOWN NEAREST ROAD
New Construction Use pCf Residential / Number of bedrooms [ ] Addition to existing building
[ J Replacement [ ] Public or commercial describe
Code derived daily flow ^ D gpd Recommended design loading rate _bed, gpd/ft2-trench, gpd/ft2
Absorption area required _ bed, ft2 trench, ft2 Maximum design loading rate ^ • _bed, gpd/ft2_ Zj trench, gpd/ft2
Recommended infiltration surface elevation(s) _ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
t uitable for system CONVENTIONAL MOUND 7 1 IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
nsuitable fors stem E3 S ®U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S ®U ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Mrdary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr&
Ground
elev ysyCs~~
ft. Ao A610
Depth to
limiting f,
factor
Remarks:
Boring #
.12 ,2
I Id r, ..J
_ C.
Ground ys
elev.
/e,-,~ft.
Depth to
limiting
factor
2_
Remarks:
CST Name:-Please Print / Phone:
Address:
Date: CST Number:
Signature:
PROpERTYOWNER' _.a SOIL DESCRIPTION REPORT Page~of
PARCEL I.D. # S94-40743
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
$ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
n`\\
~::%iii\3:vnVtt
7
C" ZY
Ground
elev, s" s
ft. /
Depth to
limiting
factor
Remarks:
Boring #
h\\
:4\:iiGti \~'AV\1k
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
\c
Ground ~
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
xw
Ground
elev.
ft. ~I
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
• S94-40743
Ap of /PPE E,(/~ o
x
~ I
I
MrS /
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 4 of .3
Labor and Hp n Relations
Division of S%fe & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP PITY OWNER: / PROPERTY LOCATION
GOVT. LOT 1/4 S~j 1/4,S T N,R i(or Ve
PROPERTY OWNER':S MAILING AD RESS LOT BLOC # SUBD. NA OR CSM #
CI STAT ZIP CODE PHONE NUMBER CITY' ❑VIL GE ®fOWN NEAREST ROAD
e'/ Lj - ~J~_ -I'/'--- I
(ylS)
T
New Construction Use pCJ Residential / Number of bedrooms 3 [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow _~7J G/ gpd Recommended design loading rate ,/,,,-V bed, gpd/ft2_,~2-trench, gpd/112
Absorption area required 3Z,~L bed, ft2 trench, ft2 Maximum design loading rate _2,'2 bed, gpd/ft2 ,L,2_trench, gpd/ft2
Recommended infiltration surface elevation(s) ,s l ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material S", 'Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S ®U ❑ S ~U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
J..-
Ground l _Ai
elev ys°s 8
ft.
Depth to
limiting
factor
Remarks:
Boring #
4 &.2
Ground y„- 8
elev. s -
yft.
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Phone:
Address:"
Signature: Date: CST Number:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page,--2 of.';
y ._a
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trench
ZT A)
}n{
Ground _
elev.
ft. -
Depth to
limiting
factor
. ~d
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
t"
M1ti'
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
0/d 11141t 0,94
k
rl L
6 ~
i
i
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Vincent G. Doreen L. Wilson
MAILING ADDRESS 1248 Old Mill Rd. New Richmond Wi.54017
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION SE 1/4, SW 1/4, Section 2 T_ 31 N-R1_W
'SOWN OF Star Prairie ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , 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.
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.
UWe, 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 xpiration date.
SIGNED: G
DATE: A4
St. Croix County Zoning Office
Government Center
1 101 Carmichael Road
Hudson, WI 54016 11/93
t~ '1 L - 1 U U
't'his application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies W1.1-1-
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 r:et.ained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
owner of property _V-incept G. Doreen 1. Wilson
1LocaL.ion of property SE 1/4 Sid 1/4, SecLion _ 2 f ,r - 31 N-I3 18 w
Township Star Prairie ma i. 1.iIIg 1dc.1 re!: 1248 Old Mill Rd.
TTew Richmond Wi-. 54017
Address of site
Subdivision name Lot: no.
Other domes on pi_.-operty? - YC X tlo
I'revi_ous owner of pi-opert.y Rosetta M. Wilson
'rot al Si e of property 7~✓ acres
'I,otal size of parcel
Date parcel was created
Are all corner_-, and lot lines icaciit.:i t i r blc:' -Ye:. - I!o
Is this property being developed for (,_pe.c house)'' No
Volume and Page Number recorded with the Regi.stel-
of Deeds.
INCLUDE WITH `PITT, APPI.TCATLON THE F0j,L,0WINC:
A WARRAN'.I.'Y DEM) which includes a D0Ct!1,11,;1VI' NUMHEJI , VOLUME AND PAGE
NUPll31;1: AND THE Sl,:AI., OF lTG_1_S111l.;ll O1• OE'E'D I . An Z.tdd i_t i orl,
cer-tifi.ed survey, i.f available, would be, helpful so of to avoid
del,lys of the reviewing process. IL' the cler,d dc:;cr.ipt.ion
refer-ences to a Certified Survey M<cp the CerL-1 lei-ed Survey Map
s11,111 :11.so be r-eduir.ed.
PROPERTY OWNER CERTIFICATION
I (we) certify thzlt all statement:; on this form rirc true to the
be,-,t-. oi' my (our) }:nowl.edde tal<~t 1: ('vac) ~m ( ire) tlic'. ownr-+r:~(s) of: the
property described in this inf:ormati.on form, by virtue of a
~~~,c r ~ anty decc.l rec:orde d i.r1 the of l: i_cc? (d thc: County Po( i:~:tcr. of
Deeds as Document No. S~ and that f (we) presently
own the proposed site for the sew lge disposal system or. 1 (we)
obtained an easement, to run the above described property, for the
construction of s;aid system, and the same has been duly recorded in
thc_, office of the County Register of Deedr_-. a!s Document No.
;,tcln~lturc oC Applicant Co- 1"ppi -cant-
I),,to of-' S:i. nature 1)1-it(' of. S.ryn<1tu1-
DOCUMENT No. WARRANTUED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WIS(,0' NSIN FORM 2-1982'
532885
i
v . 13f '5
Rbc~d stir
_ ..Rose ~a..M....WJJs n.
AUG 2 2 x.995
a {
. , ~ •
4r ~@
7 V 14 3.15 P.
conveys and warrants to ........Vi.ncent..G. Wi•1 son DQre.en_.. P~ •a,.:aa..S,~=~
trb
. i~ X Va
RETURN TO I
~i YL~Q ~l
!it rKw
2U g c
---emu) crar.d. u'I
the following described real estate in _..$t....C.rO.7X ...........................County,
State of Wisconsin:
Tax Parcel No: 2, 31...18.27 .
.
rr
F..
SE,SW,Sec2,T31N,R18W
ET.,
is n^t This s_ n.9t..._._.._... homestead property.
(is) (is not)
Exception to warranties :
Dated this --_...sixth--•---....----•-•...._..... day of au1-y---------------------- 19.9-4....
- ---------•-------------...__..•--...•-----.......(SEAL) U.t'tJLA~JAo.n./"7 ........(SEAL)
setts...--.Wi_].san Vincent G....Wi-lson
- ........................(SEAL) •--•----------.(SEAL)
* * ----Doreen-L....W.iIson--•.
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
.
------t------- County.
authenticated this ........day oi ' .9..._. Personally came before me this ...1. ......day of
_i1~-C_ USX 192y.5. the above named
tQs~°-1 4s Gt~~.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. State.) to me known to be the person .`x......... who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
ROBERT J. Wilson
Notary Public i~7"/'Z~--County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commi ~~i1on its permanent. (If not, state expiration
are not necessary.) C
date: .__4 :44 . 1E • 19.
MIE C. KAENZ-
'y
*Naaues of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR•OF WISCONSIN Wisconsin Legal Blank Co. Inv.