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020-1002-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 582036 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)j. Permit Holder's Name: City Village Township Parcel Tax No: Robert & Brenda Plumm TOWN OF HUDSON 020-1002-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Av (31M, i GST 07.29.19.5E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic AX4 2,66 Benchmark i Dosing Alt. BM n Bldg. Sewer l~ 7i ~G~ i 29~ Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic Zo Dt Bottom g~ to3 / Dosing ! t / Header/M n. 756 75 36301,64-- /Q Z ~~d Q Aeration Dist. Pipe X07 /.6l -3 Holding Bot. System / a le, f PUMP/SIPHON INFORMATION Final Grade~ ! /,/y~ , q • 6-7 9 Manufacturer Zb Demand SICover La Jam ` c3~, ss GPM a v Model Number / f 9•~ . TDH Lii', FnctionLoss System H~M, DP • ~5 t T ,Z, 9 T t Forcemain Length Di 1 Dist. to well 7 C~ c3 J SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~56 3 SETBACK SYSTEM TO P/L BLDGG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION Type System-:L CHAMBER OR ✓~A~v 1~' ,I UNIT Model Number: DISTRIBUTION SYSTEM I~-I l ! 11 Header/Man'rfo~ Distribution x Hole Size role Spacing vent to 4LrIIntakRN Ja Pipe(s) S Length Dia Length Dia Spacing S tf- / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ✓ Depth Over Depth Over xx Dep f xx Seeded/ odded xx ulched Bed/Trench Center q 2 Bed/Trench Edges Topsoil No Yes ® No COMMENTS: (Include/ code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1037 PHEASA TR .111~ e 1.) Alt BM Description Q \ GD J~~~ - IBC C~Q,~ ~1 ✓l1~,0 2.) Bldg sewer length ~ / - amount of cover Plan revision Required? Fw] Yes 'N(No Z3 f (p ~j Use other side for additional information. Date Insepctor' S' nature Cert. No. SBD-6710 (R.3/97) err County g% CRD >C Safety and Buiidings Division { D 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) S 2r:l3 Cn ~~astoK~t~ State Transaction Number Sanitary Permit Applic Nlf} In accordance with SPS 38321(2), Wis. Adm. Code, submission of - 00040UM bvernmental unit is required prior to obtaining a sanitary permit Note: Applicatio ~ Q miffed to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal infd' you prove may3e use econdary /Cal oses in accordance with the Privacy Law, s. 15.04(1)(m , Stats. / 7 &60-1" L Application Information - Please Print All Information Property Owner's Name Parcel # 20136RT ; BRiNVA PJV MM Oz.O -/OOZ- 90-0e-o Property Owner's Mailing Address Property Location /03 7 f 6fAJE 45,4AJ 7_ -FR _A i C_ Govt Lot City, State W1. Zip Code Phone Number N 1/,, !5U) 1/t, Section HODS Q .5 (P51' 3300-6.50 /I~(circle one) T / N, R / % E on ---TTT II. Type of Building (check all that apply) 2 Lot # N/!r A Subdivision Name - NA J I or 2 Family Dwelling -Number of Bedrooms _ ,ate ❑ Public/Commercial -Describe Use Block# IV/4 ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use c t e7 g UDS' . N114 Town of cc, W ~'J (Ti L 6- IdW_ 3 F+ 1 ~J~ III. Type of Permit: (Check only on box on line A. Complete line B if applicable) G A ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) a~- EZ List Previous Permit Number and Date Issue/ B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS System/Com onent(Device: Check all that a l Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding T;W-77 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Applicahon Rate(,,pdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System 9ation Lie 6'(0 ,-I h -7150 ?4 - 7 Ar:f - 'VA -d VL Tank Info Capacity in Total of Manufacturer w ox A Gallons Gallons Units Lc U° y New Tanks Existing Tanks ~dJ 1 ° 2 Septic or Holding Tank Dosing Chamber 0 O GvE~KS X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POW'T'S shown on the attached plans. Plumber's Name (Print) Plumber's Signature -N P8APRS Number Business Phone Number 12D 15E~ZT -,{(f AT- z7-63 75 715, 77a• Z. Plumber's Address (Street, City, State, Zip Code) 4/ 7! 7 lel VIII Dun epartment Use Only A If Permit76,;0'4& ee Date sued/ Issuing nt Sign e proved n Reason for IX. Cond' >easons for Disapproval 3 n t tank, etHua~ttan~' J 1Jfb pied! J I S ✓Yla.rf 4is{6rsal cell must all ~1lNl@9R l F3~19! Y ea aspar ynanagoment plan ptovid@d g)► pIN ,.F Q.4, VW e55 4C~0 2.:A~,~cktequlMftQn*fiy 11 d IV / as per appllC" 06& ~r Attach to complete plans for the system and submit to the County only on paper not less than 8 ra 111 inches in size SBD-6398 (R- 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 2913,5 T Bp 7- Owner's Name: PLU/1M Ce Q, 3 ?6 ' Jo/lay Owner's Address: 10,37 1 f LIDS a Gy i S . ~S ~o /42 Legal Description: 7, F Township: TT U~✓ County: -5 T • G ROI Subdivision Name: A)/4 ATX U-fS ~ (30uA_)g5 5O/'c Ui~--y << Lot Number: N114 c~ Parcel ID Number: ©Z©- l©62. / 69 ~pR S 011- 5 W I & Page 1 Index and title QV IRE D ; 50d- WI (CATI 0-K) Page 2 Plot Plan a Page 3 System Sizing & Cross-Section 75-o SQ. -FT-. T01~~}L-• P, -re G • p• Page 4 Filter Specs C e y Page 5 Maintenance Information F Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat p Attachments: Soil Test & House Plans 7 35 Designer/Plumber: ( Gh fi License Number. -Z (O Date: Phone Number 7/ 7 7,;? 7 Z Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). ~D~M yq. 1~5 i ~N S4Ew't2 ~T g /-1/- 0 ~d 50 6,Y ~ ~'D /kA . 7 V, w~Ey~ S,T. off 0 of /3m New xcs a l(0 ,3g (30 mP~ Ill AIX w MA E •2 ~Jocu raec /O 3, , o Neu, M; pf~l~ E ,~1t 1-REACAZ2),x 6W L O sv Z -~/OCR ~ , ® p a a a ` ~ I ► ~ ~ i Z R>iU 3 ~D a t 1 1,10 11 SyyT~M 95.80 d If. lei I ' ~ 1 e ~ t o 1 1 1 1 ~ 1 I 3,x 5o ' 95.0 ~f , 5~~t1~ 1 = 2D q q, yo a. PIAA/ +k SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page -3of 9 G73 e T ,-.v /3lMvfl.4 .P~UA~ Project Name: ("IbWr e+F Cell J Per Cell _ ft Cell Width Total No of 'rOAL So ft Cell Length 5U sq ft EISA Per Cell .3 ft Cell Spacing 2 5 a sq ft Total EISA Manufacturer Model Laying Length EISA Rating EZ12031-1-5ft 5.0' 25.0 Infiltrator EZ1203H-1 oft 10.0' 50.0 Z ~o u-) 2 CNfe l petjra 2 Gravelless Leaching Unit Manufacturer: Gravelless Leaching Unit Model: EZ 62. o 3 H - /0 -r--f H vvi d Typical Cross Sec Finished Grade ft Observation Pipe with 1.41 approved cap or vent 7• ■:<>:<>>:::< Soil Backfill ~o b > > Geotextile Fabric 7• •1 ft Infiltrative Surface 12 in 7 11 5 1 5 TGM gl NLtiS it q3` ft Limiting Factor i 3 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License Date: SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page lof Project Name: 5 Vji 1 5 N/ r y Ilgzof Cells Per Cell ft Cell Width Total No of ft Cell Length sq ft EISA Per Cell _ 3 ft Cell Spacing Z 5o sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 ~•Z ~/oc~ l tN~«r~~r-o2. ~o . Gravelless Leaching Unit Manufacturer: Gravelless Leaching Unit Model: EZ' 1203 H 0 rim I Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent V/ V( vi 1(/ BEEP*9 Soil Backfill > > > > : Geotextile Fabric 1 ft Infiltrative Surface ~Yy~M ) 12 in ~3• It Limiting Factor 0(0 (~H in Slotted and Anchored Vent/ F Observation Pipe with Cap I I Plumber/Designer Signature: License Date: a SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page 3 of Project Name: 5 uMi f5 uN ! r s Nas*f Cells Per Cell ~J ft Cell Width Total No of t( 1[0ft Cell Length SO sq ft EISA Per Cell np'' 3 ft Cell Spacing Z50 sq ft Total EISA LOWEST 7"t~-Gc, Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: ~/0 w =aT►•1 TRAM R CC, Gravelless Leaching Unit Model: E7-1203lf -/D F7"• Gow~5 T '7T/ "61L GPI # 3 G1~t5f ~~v qq-10 Typical Cross Section Finished Grade ft Observation Pipe with ii approved cap or vent ~a- lfi VV Or u/ ,..■■■■■■e--- Soil Backfill U4 Geotextile Fabric ft Infiltrative Surface SySr 12 in C II ga.9 ft Limiting Factor - in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License Date: ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer TP Ai L-. 71.0. V OS49 ( . 5 1~ 4/ ~p Mailing Address /037 PAEASI+A)T- d Property Address (Verification required from Planning & Zoning Department for new construction.) Flo • / f ,v Zyl o zo- /~Z - 9©• o~-o City/State UpSo Parcel Identification Number LEGAL DESCRITTILLON Property Location N G 114,30 1/4 Sec. ~ , T ~l N R ' ~ W, Town of l ► ~~So~ Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes ko Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE AND O WNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you 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 §SPS. 383.52(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. Uwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 & e 171YI2 DATE !J IGNA OF APPLICANT(S) ***Any information 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. 04/12) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) 13981WA Dob ~(UMM ppo ' This is to certify that I have inspected the existing septic and/or dose tank presently serving the followin residence: n (Street address) /0 37 Pk5ASAA.; T - T located at: /VE '/4, 1/4, Section, Town N, Range_L~_W, Town of I~) o , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service S141 `Ie R ~2 4 / S Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: / 0VV Construction: Prefab Concrete X Steel Other Manufacturer (if known) : a) x1z' co 0 ca4 e. cc Age of Tank (if known): Z 5 f yE~l k S Permit number (if known) 12oi3E-R►' LF~(cAT- 7~J (Licensed Plumber Signature) (Print Name) z~Ce3? S (Title) (License Number) MP/MPRS tio0. 3 o/ S (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) el)Rev. lC go D 9/2008 ZOLLER EFFLUENT PUMP MODEL, 98 F' HEAD CAPACITI' CU tiVE MODEL rren'r 3 7/6 !/e A- 16/6 25- 3 5/6 1 - ta~ _ _ e 1 3/16 5 - ! 1/2-11 1/2 NPT pw , U.S. aulONS - 1H2 Lncfls 10 50 60 _ 7-0 . _._so sU 160 0 FLOW PEP MINUTE 210 TOM Uy"Aurp prAn,~t r[1l lroiuT[ [/ILVtHT iVrO pnrAt[NN4~•'O1"us Ilk, tr 12 UMr►tIMIM RtRf1t ltAtt,a t.rRt •u [ r-tR !i [ra < t0 i.~ of 2at 20 tl to i170 s r _!±!k vege - CONSULT FACTOpy FOp SPECIAL APPLICATIONS • ltdctricet efleatelors, for duplex ° IL" 00d with en alarm. systems, art ev'Iltabte and s Mercury float 6wilches are available for controlling sin9to and 0. M*cN%*ai sllemsiots, I& duplex eyelems, ere available with of o three phase systems. wkhou term nvlicheN' aoL"s Piggyback mercury post ewdchea available for variable level long cycle are corttrots. Slenderd ett models - WtlQ _hl 30 Ib, • r "ELECTION 6•rtec l~,p. t, inPtprtlaoa[o rrud OUIb6 Model y he•ph Gonirol 9elecllon t. etnptePlpprb km0ireurn+chWcalswhch,rtoexrerndconuMr abed. P M~)t Am R switch- Mist ka ifi or double r M-" 61m~rlsx__ nu tt■ FMD~iti. RXpybtckmercury.#OW -Aft ulo 06 ~ 5• Mechutkd themetor 100012 or 16~0015, _ , Dire 2 1 Y41.2.1 lL_ M o MOI12, lo lor corgct "w" or E1 ctrk d Ake n4jor, y Eee 2~0 1 R _ 1 or !_9 7 du Mt fto"t twNeh 10-OZ2S aci conk., sc d , ' ? 2 66- 0 F p t2) a NO^ R It. o-a [ygem. y • act►vatae ,Peony, 5 a 1 t 6 half h9b " { Pek". brxtlori (R) M.f wiled In elm. p4r to, cow. ~C 10' ►Ji S119lrt connect i. r-e TT1 l+ote l for w Iw► or t1 +rt..__..,rr t1st Tw t'X"0y1tt M rtUp,,,,r heels Pr0elyiy M0r b eu Urn Atrer~oe FuM1tt TMctrkOr ARernuo~r N. ' IIMs 4 A[ kubadton Ncentr U c ti: iwe-w CAUTION P~ 0o• a"PA r1Aow: •nd R mp4x Ca,td tPay f64 Meen,-d el-wrk4 "ll ItrM*t i A4 lose --rtn4 0rlrlnt •AsJkl w 4-00 k,~A Want N.tlan.t E -Iy 904-0 •Ac.utd 6- roRawMtholaJ. 10111A), t-air10 C040 (NRCf en4 Me reoup-Uon,l R.I,rr 0nQ _ For 1-19us1-181 conditions a reRE ERiV EO POW"'ED DESIGN serve dngineered into 1119 design of o,ie - ptrmn. MAIL 1Q•r.0. dOX r63I7 O• //C'/~ trxfirvies.~XY101,560311 a. dC 1 CHIP to, 3 60Q4`A(Werr ly>t aRUlaciwers oi. , r trk4,ep h, KY 4r?16 a - _ _ T _ (50tj 1%6•PTJI 'w FAVOR) TTI-3671 ~/A/IlY /~et~OS „3/A[Y X if _ - - X f POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner R05ERT 71 j3RLcNPA plum M Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer W 1L,5&-K ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer S/M rEC ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 5 T /00 ❑ NA Number of Public Facility Units )9~'NA Pump Tank Capacity gal ❑ NA Estimated flow (average) 30-0 gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Ll gal/day Pump Manufacturer T OEII~/e ❑ NA Soil Application Rate gal/day/ft2 Pump Model .ZS Y~ N- P ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter eat Filter Biochemical Oxygen Demand (BODb) :_220 mg/L ❑ NA ❑ Mechanical Aer n ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfecti ❑ Other: Pretreated Effluent Quality Month erage Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand 5 S30 mg/L / In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspe olids (TSS) :_30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Col' orm (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: / ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 0 year(s) Clean effluent filter At least once every: month(s) ❑ NA [J year(s) ❑ month(s) Inspect pump, pump controls & alarm At least once every: j A year(s) ❑ NA Flush laterals and pressure test At least once every: month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T site A( (v aluati ^ / a o ing~ank be ' e ai e . ?9 D4411"3 7Tb,- ?':b PC- A/ Ga"S R (IG?L D ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS Th/ S ~G-A, POWTS INSTALLER I- POWTS MAINTAINER Name TZ 0 (37.8.7- ?mot L-T3 R (Gln-r- Name 5T -5UE- 1f 05W1 G Phone 7/ . 77;t, - -l q q Z Phone 1715 - -70 3 -S33 7 SEPTAGE SERVICING OPERATOR (PUMPER) • LOCAL REGULATORY AUTHORITY Name ~T-7 (,~~f! Ck7 Name ~T. CPO ( 0UX/ 20A[PU Phone 7/ .j - ~f Z Phone (alD This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page 71 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T N aluati Ifu IvP18CU111811t C11821 is fl a o ding ank be " e a. e T'RD+-1131TE2!. FD R- A16~J 6Z l 577eUC- . O"J ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS T`ij / ~ 15 /1 T G h }J ( y S T /yL POWTS INSTALLER POWTS MAINTAINER Name T05F_R.7_ -~4L.3R(Ck-t- Name /i'/U Phone Lt GQ Z Phone 7C'5 -7D3 -o033?. 7 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 'P- C) B 74 L13 ( ck_r Name S-(-, oUtil ZoAJ1XJ Phone 7/-5 - -7-7c?, O Z Phone / 3 gCO- (O 1CD This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. . s Wis. Dept. of Safety and Professional Servicep% ALUATION REPORT Page of Division of Safety and Buildings REC Ob in accordance with SPS 385, Wis. Adm. Code p ~j county ~r'r G ~ p l ~ ttach complete site plan on paper not less thaSE /22 ?l 7nn" in size. Plan must i clude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0 Z 0 p ercent slope, scale or dimensions, north a8TWGWIMclaQb)@hWdistance to nearest road. /d Z 90 OVD Please prr7Sq i"f0 ma~ n OPME T Revie d by Date Personal information you provide may be used for secondary. purposes (Privacy Law, s. 15.04 (1) (m)). towty Owner Property Location / tcO~JC.R r M Govt. Lot Abe' 1/4S 1/4 S Ta~ N R E (or W Property Owners Mailing Address Lot # Block # Subd. Name orcjrm# /o37 PkASAOT TR City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road o. ~{~pSvN wI 5101(p (&5( )339-&5ol Hu1250ti A~~ s ar RAiL, ❑ New Construction user Residential/ Number of bedrooms Code derived design flow rate GPD ] Replacement ❑ Public or commercial - Describe: Parent material /045U 40&WR 5.4Aj OV f '7 / S Flood Plain elevation if applicable qt-A ft. General comments and recommendations: C/4RLcFULLy 451,4,c lAAer /f AM-)( Spot Tested a tewor t~> GOM~t ~UDA-T/ON S ~/~E' /~lJ A W%n l NMWd system (pO.WT.B ) ,(7 17 1 Boring # Boring C/ Q 2 1 1I ` Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 l o- to ioyR 3 5L I R s O k n~ R C5 f. 4 •7 z 0 -2-0/0 yR LO 2f 5(a - ^UfR c5 if /.o o-~ ~~SyR 5 S/L f 5bg R q.,,5 . , (o oO L - 7 10 yR r3A,005 m4. 5ce 5 D A -AL C4, 17 /o R G o SL R o YKIL-PiNii Boring 9 3 ❑ Boring # X" Pit Ground surface elev. ft. ° Depth to limiting factor 9'0 in. Soil A lication Rate Horizon , Depth Dominant Gotor . Redox Description Texture Structure on$istence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. ff#1 ff#2 ` z 5 s L Zf s h~~ Aw; v-F c a L. z,v" scifie s 3 17-2 -7 , 51 5) Cie ` nMU-f P- C-5-, 6P /10 o w ~s o, s~ ~ i 6 PbGk& ?`5 G F * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L tf , EfFluent #2 = BOD < 30 m9/L and TSS < 30 mg/L s- CST Name (Please Print) ignatur CST Number 'R013 EIZT- 'ZtC.j3 R i G ~ T~ z-2 & 3 75 - Address Date Evaluation Conducted Telephone Number /o ff` Ave' S cN Wily lot, 400&-a~-.1615 715--77a. 2- 54-74-7 SBD-8330 (R] 1/11) o 52T' Plum oD'o- iooz- Qo goo 2- Property Owner ~ ~ Parcel ID # / Page of ❑ Boring # ❑ Boring Pit Ground surface elev. O Oft. Depth to limiting factor in. ca Soil Application Rate z Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 l C)- /0 i0 yR3-3 L ZTShk. I-AA vfR 3f , 6 • 4' 2 0 -a /0 5 51 L- f s b fm R cs - - (49 - 00 3 0 =3 /o S S~~ 2-f S_kk AIK-- c - - 8 r7, " L 2 k tM-F R = d Boring~# Borjng n FV-1 9. pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. S7. Cont. Color Gr. Sz. Sh., * ff#1 * ff#2 /o Vk 3 L s hl~ ` nr~ -F r~ CS l I- . ~o Z o K y L/ s bK /m -P C'S _ y - o to R 51L I-Fs hk 4m -F I' c s , 30 - ~o Sc C.. D N1 o D rt A L ..5 A-T ~ ow F3 jr/ a mAs 5'-fj000fo /mss Sf!'~U GG Y D~4 S, . ❑ Boring "WN5U/ r/t'Ql~'- FOX /.u C- OUAjd $'KST~tirS ❑ n # round surface elev. ft. Depth to limiting factor in. 1 Soil Application Rate P ; s Horizon bep h Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr S . Sh. * ff#1 * ff#2 5 pct L WSTAI(AXIOM NoT~5 : ©~D S sr: RoM Au . ! Z .4Y r o,v iEG ED VIA 109 T~6 V- a F EVAIF a-2 Z +A jL .c~ U, C_ D D 1 0 0 LeVbL AN1J A l l S! r! 1 M V T E 07&.C W LtJ FA (Z L C 1 1~ eTo A I V M. l 1 V o f 3 -1 -a i4- R 1n m mR 1z T" - U VE Al AA 6W AREA C) JJ~ 9-.-2o * Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L ~j) [Z~Co~r~ uD~D~ Z1S£ ~-x f-lou.~ 1oc 1,55 TRe0 . The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate forrr2at,'contact the department at 608-266-3151 or TTY through Relay. MD-5330(R11/11) oB5P-7" ! l UM 0D'0- /002- F0 -boo 2- Property Owner Parcel ID # Page of - Boring # Boring / I Pit Ground surface elev. D Oft. Depth to limiting factor 91? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 1 0- /0 /D yR 3 3 L z-Fs,b~ 1"Av fR rU 3f 2 D - Z/D 5 1L 7f 5 N-PR CS , CP 3 n -30 /o s si L 2f 5bk nM-- c - '6 . C 36 7 L 2 k (M -F Boring.1 7. Boring ❑ Pit Ground surface elev. D fL Depth to limiting factor 30 in. Soil A lcation Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh., * ff#1 * ff#2 I ©-8 /0Vk 3 L 1f5hk ft c-5 l F ./4/ ll~ Z - 0 ,e y ` /-F5 hK /w► -9 C'.5 / - 0 /b 9 51L l-FS hK -Fl CS 30 -(e /D SGL DM O 0 ~7 Sfj~0Gfo /mss - 5,+- GG Y eA n # ❑ Boring -Z A) S~ 7-AS /,~F- Foxe 6- L') U Aj d S {KS' TAMS i round surface elev. ft. Depth to limiting factor in. t' Soil A lication Rate Horizon Dep h Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. S So- Sh. * ff#1 * ff#2 to 5 7-A 10kT 1QQ N TSS t O S sr. R oM A L) . 1111 A> T Co.imac. ED Vii4 VAluar o F TL,12iE- e-WserZ+ W Ili kooc. CSR= t hAUD -2 kE . a ~E5;; v c R&A3 S-i 13o )t o A4 v 1501 .2 c. Auo A It 5 T'pa WA ! C_ ! ! M v 5T E a?a c ~v ` d NO'D` d >E ~4!D of Fr. 1! v 3 ~4- TZ7- e T C In D m R T" 7! f 'l i Z * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L ~~j) jZ~co r~LUDE-~s Z1S~ ~-Z f-lou~ KOCK)J,55 TR~N~HS . The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate forrriat.'contact the department at 608-266-3151 or TTY through Relay. S13D-5330(R11/11) t~ OFF v /0 0 1) we( d 5,7; ~~KS 3 WRH y / TOE' ° f g"R D R s ; 73M 0 ;z TO P OF M~~tio%,sT~N u CooE~ d,v pIle = 9/, SS lEY 5 OR l!o ~ 38 ` M.aoN to raecF ~~sr- ~ o X Ar, /03 . q ~I 1 i ,I iI tI iI 'i tI 19 I , I i 1 ~ i . I I I i I i to l ini 101 , I I I I I e ~1 04 i 6 f RON ~q9 95,0 A = j3f~-Gl~Gt Dom' T'j 6 9,0 pL O'r PMA/ o a) i h 0 d 00 0. o C ~ I !p ~ co I o a) O I o Q~ O)G I ov h C)00 M CL c - w a_ N I > a m LO I ° ° z OO I LL_ o ~a aci 3 c I E Q ax) I a) O M v ~ I E rv c I LL ~ L r I- Z a m I O Z I N a) Z E c H r a) a) _0 0) w a, Q I r+J a) a) NU) O O O O I •N IL U N N N N I C O V V O O O O a) Q - N N Z I- Z O Z O O N Z I I E ~ I L - (D v O I a N d i a) I 0 in d o v U) co cn I- ~a_ z • r n 0 0 0 n IL IL IL a = (mil m 0 CO •(•0 N N m U i- rn rn } I N l!') N O M 00 C) I N M O . I O E N N O co a) O O ~ E Cl) N d ml N c O r f~ ur N r MO '6 Q fn a) ~l O O O i N C O C~~C++ O c a) U O O a) 7 U7 co C) 3: rr G'i O W O a) a a U Q. 0) 0 0 N~ C E E C a) M M v W p C Y 1 L o y 7 N N r N 0 L) u, a a`) I- c a°i o r N fl 7 7 O N E E U •N 0 0 2 co O Z N fn ~ ~ w I r~ ~ ~t ~ = E I V ~ L `m m a EL a r`0 E CL u 2 (D c c u± c r A 0 a O in v • • ~ Sag/ JO_ AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP so-J SECTION T Z y N_R Zf W ADDRESS /03 7 l4efs t , % 'Tif',ti L ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT:~-LOT- E_ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Cev- P107 INDICATE NORTH ARROW BENCIDjARR:Elevation and description: B~Ac./C SDG1C Alternate benchmark TQ 0 °F ~ovSE - ~x~Srrti / 6-4104 ~ c~o.~x p lam" J~/c ®,e IfT SE Ti. moo. r~ SEPTIC TANK:Manufacturer: 4~0 Liquid Cap. "'eao Rings used: 3 Manhole cover elev: 1910. 92. ' Tank inlet C/0'0 4* Final grade elev: elev.. Tank outlet elev.: x,04. Yy No, of feet from nearest =:Front 1/0 Side From nearest prop, T ear line.Front Side~~60 Rear Ft. No. Of feet from: Well 6 2 / Building: - 6 (Include this information in the above plot plan (2 reference dimensions to septic tank) ) SEE REVERSE SIDE At Z (3(o of PUMP CHAFER Manufacturer: Liquid Capacity: Pump Model: ?00 Pump/Siphon Manufact.: Zwllek Pump Size y2 Elevation of inlet: Bottom of tank elevation y Pump on elev.: Pump off elev.: Gallons/cycle•: ~T /^j Alarm: Man.: Switch Type: NRavR F/° -Location t/ovS4 w > /o a Distance from nearest prop. line: Front_, Si a r_ Distance from: Well Building 30 S "K G o ' SOIL ABSORPTION SYSTEM 3 7i~t s 5'y- Sol 5~~z Bed: Trench Seepage Pit: Width: 5 Length"54` "~O2 Number of Lines: 3 Area Built 3 /07S' /05 /02.0' /07.5 /o S -e 72- Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: Z Y A 3 6 ~ W, s Z No. feet from nearest prop. line:Fv&nt1n , Side , R___ No. feet from well: Sy No. feet from building yS ' HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of b tom t Elevation of inlet: No. feet from nearest pro ine:Front , Side , Rear Ft. No. feet from: Wel , building , nearest road Alarm Manuf urer: INSPECTOR: ~/M 7~SOti DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT X116. MF"TER PLUMBER LIC. NO. 3307 M.P.R.S. "~ni jtr. TALLER & DESIGNER LIC. NO, 00663 LQCATION: HUDSON 07.29.19.5E NE SW PHE~~aa,,Sp, ~g~a,IL Wisconsin Department of Indu§try, PAIVAYE SEWAGE SYSTEM County: LabQr and Human Relations INSPECTION REPORT 'Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.: 171514 Permit Holder's Name: ❑ City ❑ village [Town of: State Plan I o.: BUSICK, RICHARD L & JOYCE HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No.: 7~ , " ~72~LcSf Si c~ h~ TANK INFORMATION ELEVATI N DATA A9200280 g p Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /~-e Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet Septic >/O' (p ' --o' NA Dt Bottom Z~ - zQ Dosing O)~ - / -~o ( >X / NA Header / Man. 71 Aeration NA Dist. Pipe Holding Bot. System 162, PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM AW#W TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION s DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O Ccm V-, r CHAMBER Mode Number: System: ~(dre~e5 LSD s C~ / I( OR UNIT DISTRIBUTION SYSTEM Header N41ani4s'd ii Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 12fl: Dia. Length -:5L Dia. C/ Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over [Bed th Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil El Yes E] No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) X.x' ~ sr cazre~ of 6C7 9s~ , 71413 z2 Plan revision required? ❑ Yes 040 4 114 ` se other side for addition ,11inforMation. U'91 a S D-6710 (g 05/91) ' 0.V Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILH mill SANITARY PERMIT APPLICATION 0ILH In accord with ILHR 83.05, Wis. Adm. Code COUNTY ` STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /J'~, 8% x 11 inches in size. eck if revision to/previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 1414 PROPERTYWNER PROPERTY LOCATION /e1•GAA* P 13v~!Gk /V~'/a54)Y.,S 7 TJf N,R I9 E(oro PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /0 37 -ST 7;F* ,Z_ CITY, STATE O~ ZIP CODE/ PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY „ NEA ST ROAD ' ( ) ❑ State Owned VILLAGE hf~jpj,0~ Af" S T ❑ Public Vl1 or 2 Fam. Dwelling4 of bedrooms PAR EL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) o Zo loo I - ~67 _00 0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 © Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit 2w Pressure , 43 ❑ Vault Privy 140 System-In-Fill 3 j G(,~ s ea e_& JT Q VI. ABSORPTION SYSTEM INFORMATION: /O 3.5- /0 7.5- 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 7 9~ / 4 d Feet I S Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank X 0-00 Lift Pump-Tank/Siphon Chamber f VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu bar's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: R• V IhX /G47_- , 330 7 1(71r) 3h9414'5- Plumber's Address (Street, City, State, Zip Code): &5 D'w~1L ,20 1P,So,v LvsS 5'f /40/~ IX. UNTY/DEPARTMENT USE ONLY ❑ Disapproved ~Y& (includes Groundwater Date Issued ssuing ant Sign a (No S mps Approved ❑ Owner Given InitialSurcharge Fee) ~1 Adverse Determination 'W XK X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety A Buildings Division, Owner, Plumber INSTRUCTIONS r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 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 & 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-4escription 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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 #He 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 systerm if required by theLcounty; E) soil test data on a 115._fdrm; and F) all sizing informlatign. 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 m.QnitQring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ~~3o-yL ~5 _ I3 o /1- y- 07 AJ +ti HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ' INN. •INSTALLER & DESIGNER LIC. NO. 00663 I sys~~M sysTEM 5 ~~~'0 Sys7{~~ l03' S~~'r4 sog4E - ~ -z4 C 1 1. r~^ i I , r 7n P 64 loy,33 1 I , r o I i I I ► i Sy~~ ~ IC -FAR R I'G. .Ile i ~p UEri° - 1I LI 1 N 1 I 1 v 1 1 I 1 I I p 1 r pip a 1 } iaLET ro 2.vo ~r Go, 103.5-6 13 1A) L To M J~ i3o~ ~ ~s r D,~op 6oX ~ ~ - t /C v~I rro,U - /do• Q ~ ~R. P ~3vSi'c%' ' ► z l0q, e14, ek y I f~ IIDM ~ ~R i,~ CJ "i lti I6 Lj) a` /Vtj E~~STi;v ~ /goo S u~ _ Gv i sc 7ir- pv, • APPLICATION FOR SANITARY PERMIT STC-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 p:rmlt Issuance. -Should this development be Intended for resale by ovnet/contractoc,(spec house), thcn a second form should be retained and completed vhen the property Is sold and submitted to this office with the appropriate deed recording. www-----------------w------------------------r----------------r-www------------ Ownsr *of property r` ~~C""►~ ~~S~,G/~ Location of property AIC_ 1/4 1/1, Section T~~ Jt•R„/_V Tovnship Vpjrey Mailing address _1037 Address of site ltsbdivislon naps • ' Lot number Previous owner of property ' Total site of pate 1 ' pate patcel was created Ara all cornets and lot lines Identifiable? x Ye■ 0 It this property being developed fat regain (spec house)? Yes Volumm 1 `and Page Humber as tacotdsd vlth the Register of Deeds. -------------------rr-r-r------- INCLUD9 WITH THIS APPLICATION Tilt FOLLOWINCI A VAARAHTI DIRD which Includes a DOCUMENT HUMORR, VOLUNK AND PAOt NUNB[R, and the BtAL Or Tilt RBOIBTRR OP DRIDB. In addition, a certifled survey, if avallable, would be helpful so as to avoid delays of the reviewing process. it the deed description references to a Cestifled Survey Nap, the Csttlfled Survey Map shell also be required. PROPERTY OWNER CBRTIFICATIOH I(Vs) certify that all statements on this form are true to the best of my (out) knovledge) that I (we) am (ate) the owner(s) of the ptoperty described In this Infotmatlon form, by vlttuo_ of a warranty deed recorded in the office of the County Register of Deeds as Document No. I -7,w 7 presently own the proposed alto for the sewa a d'[ I and that t have obtained an easement, to tun with the above discclbedatpcoperty,(wlot hthe construction of said system, and the same has been duly recorded in the Office a Vnty Ae la et of eds~ as ocument No, I. 11 nature of owner Blgnatute of Co -Owner (if Applicablal 4te signstuta Date of Slgnatuts k VOL his Wife- Hp}M tae--- end warrants to. _Eioftro_Le sumac aid husband &W wife. as 10. t , # vakw6k consideration a y UWfi lbwime described rest estate is _ _ S it _ Coas+ttr, ltatset/laer`IS,. 2 ; AZl that part of all} or Section T-W-lo, llnM6l hip, described as follows: Co~Mnais. slit Vt-cormor of Section 7-19-19; theaoe s a3^ . A otioa 7 for 1567.1 feet to the point oL t1+ Once continuing 9 along said ! line taa©e.of 270.93 feet to an trove pipe t 'Ming 1838.03 feet s of aid w *mrt4W #Aomg the * line of said net; tbomoa 8 %mW ' ssid Section 7 at a recorded distance of '_J W.0 feet ; thence W and parallel with distance of 332.54 feet; tbeace x and'pstal 7 for 157.0 feet; thence 8 and parallel 104. corded distance of 61.61 feet; thence 9 a".`°" Section 7 for 650.0 feet to the point of y' amore or less, subject to a road eisement Or, of the w 33.0 feet of the above described' II ' .ingress and egress to the above tract:.aPlIS - ids and egress, being 33 feet an ~ac14 0 e~lintneline : Beginning at a point on the t 'muceptbn to warranties: Hudson, Wisconsin FEE y ~ UGNED AND SEALED IN. PRESENCE OF n ~~a C_ _ pLilli~ y , siSuataree of _ NIA %tp /nMtcatod this day oI_ i Title: Member State Her of'/iscmais W., Autboeisad mder Sec. 706.06 •ia. • STATR OF tUKONS"f Cottaty. a.. ! Pereweaatyr ceanrMltr! me, this 4m of _ .`LL aiatwir ttataN . _ _ ~8 sr Stq~twl9 M tM tw.a~ who ssecuted the toeeSaist tmstramest arM atdsaewla t " w .'C'am Y 61 :.4 ~ - '"4^'_",►S: ""ice{ N Y . ~ ~ {y yL _ ` eiFtCfa~ .wfl~~.T~au! Y a..7. , 'S. :1 • .i i v . _ ! 17 . 4 M► of sectioe l-99-19, Wdom a ' * up, f liN at said Qectibs 1; 4 1~M0~1 j ~E .ftatleo ! at a dint"" at, =a~irr or' lass, to a; petst itQ F ' MrOdias 9; them" W and paral 'Mltt T; grit a distance of M feat t nns of t" Nntsolins t1isY' ` wi tL as a# *"st, Imp `A,; of sa# tract being 1~ feet, K w IMO ti foot wide tract as measured' _e tftdai sl it and r otrictive covenants. recorrO A* et the'gessAer of heeds for at. Croix count'. : k n' x F~ -r4 t y ^t..'..,~.I•_~,£~"i.i f..ir~r.-..9~r• !.:,..a s_a ...3 ..k1 L4."lot y. s 44 RZ Inv , ;;1,A 1401 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT 3 ' / T~ St . Croix County OWNER/BtTVE ROUTE/BOX NUMBER 103-7 Biro Number CITY/STATE__zzV,P 0_-0 ZIP w. .A 7 3. PROPERTY LOCATION: .rid Section T 2fN R ff!;A 1 it ' y ` Town of U~~lJit~ , St. Croix County, Subdivision , Lot number...' Improper use and maintenance of your septic system could result is its premature failure to handle wastes. Proper maintenance cop sists of pumping out the septic tank every three years or sooner$ if needed, by a licensed septic tank pumper. What you pUt Sato the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing systems 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 systems properly maintained. ` The property owner agrees to submit to St. Croix County Zonings certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper vsri- fying that (1).the on-,site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (ii nec- essary), the septic 'tank is less than 1/3 full of sludge said scum. Certification form will be sent approximately 30 days prior to three year expiration. o I/WE, the undersigned; have read the above requirements and"Agres &A to maintain the private sewage disposal system in accordance with-. .M the standards set forth, herein, as set by the Wisconsin Depart- ~t ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off:Lpe within 30 days. of the three year expiration date. SIGNER DATE St. Croix County Zoning Office P.O. Box 9$: Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 4 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Ric4lixp residence located at: N~ 1/4, VW 1/4, Sec. - , T 2l N, R 17 W, Town of 14 V p-S e9^-) Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced :r"4 -e icy Z' Did flow back occur from absorption system? Yes NoY (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /06 50--es Construction: Prefab Concrete Steel Other Manufacurer (if known): & pE-15'jf-~p CQ~~ Age of Tank (if known): 1- (Signature) (Name) Please Print (Title) (License Number) WAY Y7 -~i a- (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening/ over outlet baffle) Name T 2whye6rSignature A4,k4emia-IMPRs 33 5/88 Laorirtsin Deportment Relations Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relati , Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach cbmplete 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. # dir--. ision, j, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE l A ZF ULYz - 9z PROPERTY OWNER: PROPERTY LOCATION US C~ GOVT. LOT Az' _ 1/4:5601/4,S 7 T zy N,R If E(o PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE O TOWN NEAREST ROAD /f u DSo ,v 4) /S S~/~✓G (715) 3 PG - - y y v~S- 0 7. 1'ti aSrf vT PArI [ ] New Construction Use [,c ) Residential I Number of bedrooms -3 Addition to existing building Replacement Public or commercial describe Code derived daily flow ys~ 9Pd Recommended design loading rate bed, gpd/ft2 - trench, gpd/ft2 Absorption area required bed, ft2 ~00 trench, ft2 Maximum design loading rate bed, gpd/ft2 • trench, gpd/ft2 Recommended infiltration surface elevation(s) -s'-~ If 9L • 3 j ft (as referred to site plan benchmark) Additional design / site considerations ~s~ o.~ap x a r ; T - Y~ vcl, s UN G y - p v S/o~lr e Parentmaterial fl'*ci~/ Flood plain elevation, if applicable It EXCES SOU S O E_ % -O~~JO U J/~ rMUnistuitable ble for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK for system ®S ❑ U ❑ S ® U ❑ S ❑ U 1:1 S ® U El S ®U ❑ S 53U ACS z/C/ /~.tiE7ef' S/ So.'/s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft y_ Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiench y y 3 s/ ; F sh/c~ CS 3,,y X S Ground C ~G 7 S Yh `y S h& X elev. Depth to /,v 571 v c Tom' C - limiting factor r, i Remarks: Boring # yi2 7"5- Y"e }i'::\ti::} i. Ground elev. 0 7.3 G It. PRA his test Site Depth to limiting or con - i face, Remarks: 4 '~'i4-5 GUT, 0 F""F` CST Name:-Please Print HOMESITE SEPTIC PLUMBING CO. Phone: :3 006 Address: 655 O'NEII: RD., I lUBSON, WIS. 54946 d ROBERT ULBRIGHT Signor+ure: Date: ! f ~Z CST Number: MINN. INSTALLER & DESIGNER LIC. NO. 00663 p 2_.. M-PERTYOWNER SOIL D PION REPORT Page of PARCEL I.D. # Boring # Hofton Depth Dominant Color Mottles Texture Structure Consistence Bourcl3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench le, Y/ e / Ground 7"~6 ;75yit~ 1.f, Shy M^-F2 X , ..5 elev. Mpg. 5~ ft. Depth to limiting factor ~ 9l0 S Remarks: '75-Y4 Boring # D /4 /a a o-3Cv Rorie 5/6 sb/c~ es t f • y S *70 -7,T YX vf Ground elev.,~ Ale - 57e,441 //Y -5-4 7v Alf -7W Depth to limiting T 36' r factor Remarks: 1007TZ'D i9-7- 36 " - 14114 S S/0Z- s7A" cl c 7 0 Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ronn around elev. ft. Depth to limiting } factor Remarks: SBD-8330(8.05/92). PUMP CHAMBER CROSS SECTIOIJ AND SPECIFICATIONS sI VENT CAP 4"C.I. VENT PIPE ! WEATHER PROOF APPROVED LOCKING JUIJCTION BOX MANHOLE COVER f I 25' FROM DOOR, lvrftA#lA>' AlSel I WINDOW OR FRESH 12"MIU. I AIR INTAKE I 4 y/~ADt' ~&Ol-rlo~v GRADE z 'i" MIN. I I. ~ ~ 18"MIIJ. + 0 it COUDUIT - 0 36, ~lEv~fi' ow g~.C7 PROVIDE I WLET AIRTIGHT SEAL -7 nnE A h I Y 0N. I III APPROVED JOIIJTS APPROVED JOINT ~C.I. PIPE IN /~(N V~ I III W/C.I. PIPE IJEXTENDIIJG 3' ~ I II ALARM EXTENDIIJG 3' ONTO SOLID SOIL 11 I I I ONTO SOLID SOIL B gy N I I Oki y L,O c ' 3. ' ELEV. FT. 1 PUMP OFF D 3 k op~ I Cr BLOCK I II , 4A P ion lE VA r RISER EXIT PERMI"Il•ED OIJLy IF TA►JK MANUFACTURER HAS SUCH APPROVAL SEPTIC SPEGIFICAT IOU S II DOSE l~E> 's CO.vCJ!pL.7f= 46 TANKS MANUFACTURER: IJUMBER OF DOSES: PER DAS ta. ©O /(z TANK SIZE: GALLOMS DOSE VOLUME y5 GALLONS 1 ALARM MAMUFACTURER: y~L AG-?X~ INCLUDING BACKFLOW: /360 g~F ~ y ~~.v. MODEL IJUM6ERN: CAPACITIES: A= INCHES OR 3 ~ GALLOAIS y CUp SWITCH TYPE: 7- B= 2 INCHES OR GALLO►JS aE ~ PUMP MANUFACTURER: ZOE/~ ~ C= 7 INCHES OR GALLOLIS MODEL NUMBER: y //0 V D=/5,7 INCHES OR 32-/ GALLONS SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE 2'0 GPM VERTICAL DIFFERENCE 15ETWEEM PUMP OFF AND DISTRIBUTION PIPE.. FEET -rq~k S(CS ' ' O~ p lV1 ,9 MINIMUM NETWORK SUPPLY PRESSURE . FEET EA CGA, . + / Q FEET OF FORCE MAIN Y, 7~ F~o FT FRICTION FACroR.. / FEET 0A IC 2 0.5 TOTAL 09UAMIC. HEAD = FEET INTERNAL. DIMENSIONS OF TAUK: LENGTH ;WIDTH -;LIQUID DEPTH 1 'I UolowIr rf? /~"D BUG - ZS ~I 5 T o MCSITE SEPTIC. PLUMBING CO. d' 6 0 D'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT _TER PLUMBER LIC. NO. 3307 M.P.R.S. 43TALLER 6 DESIGNER LIC. NO. 006M 1 _ ~9. ASE 7 - wit rn HEAD CAPACITY CURVE 3 7/8 61/4 MODEL "9€t" 30 4 5/8 25 3 5/8 ft"ftftft x 1l m 6 + + 15 + 4 3/16 i, .I 4 ro 10 1 1/2-11 1/2 NPT 2- 0. U.S GALLQNS 10 20 30 40 50 60 70 80 UTFJ25.' 80 160 240 L 0 FLOW PER MINUTE - TOTAL DYNAMIC HEAD/FLOW PER PWj UTE - EFFLUENT AND DEWATERING CAPACITY 12 t: HEAD UNITS/MIN FEET METERS GALS L'rRS 5 1.52 72 273 10 3.05 61 231 /Ij 1~ #1 15 4.57 45 170 L_J 3 5/16 20 6.10 25 OS Lock Valve ~i CONSULT FACTORY FOR SPECIAL APPLICATIONS e Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm s~yitcheS• variable level long cycle controls. SELECTION GUIDE Standard all models - Weiht 39 lbs. - ``h H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. ' M98 11,5 1 Auto 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. 1398 230 1 Auto 4.5 1 or 1 & 7 - 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- N' 230 1 Non 4.5 2 r2&6 3 or 4 & 5 plex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quell, . ,t Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0486; Mr:chanical Alternator, tied licensed electrician. All electrical and safety codes should be followed indud- FMD495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). j RESERVE POWEFED DESIGN For'4nus6al conditions a reserve safety factor fs agineered into the design of every Zoeller pump. MAIL T0: P.U. BOX 16347 ` Louisvilf,., KY40256-0347 Manufacturers of... . 0 n ~~~Q 01 SHIP 70: 3280 Uki Miales Cane Louisville, KY 40~ 166 QUAI/7Y 1011M,05 fiNCf ;~aF (501) 778-2731 FAX(502)774-3624 REPT111 HUDSON ST. CROIX COUNTY ZONING PAGE 1 08/03/92.10-:57 " REQUESTS FOR INSPECTION WORK SHEETS FOR: 8/ 3/92 AREA: JT _ - Activity: A9200280 8/ 3/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 07.29.19.5E,NE,SW, PHEASANT TRAIL Parcel: 020-1002-90-000 Occ: Use: Description: 171514 Applicant: BUSICK, RICHARD L & JOYCE Phone: Owner: BUSICK, RICHARD L & JOYCE Phone: Contractor: ULBRECHT, BOB Phone: Inspection Request Information..... Requestor: ROBERT ULBRICHT Phone: Req Time: 11:08 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 ' Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNT/ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but TT 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. o~ .j ZG-° /06 Z ` 7i~ ✓ REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION y2 _ yz PROPERTY OWNER: PROPERTY LOCATION US G GOVT. LOT iU~ 1/4 5u1 1/4,S 7 T Z5 N,R If E (or o PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QrOWN NEAREST ROAD #UDSo,~ /S .SY~G (715 ) 3 A~ 3 [ New Construction Use Fc ] Residential ! Number of bedrooms Ad ' ion to existing building l~ Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 ' trench, gpd/ft2 Absorption area required NA bed, ft2 ~4 d trench, ft2 Maximum design loading rate bed, gpd/ft2 • ~O trench, gpd/ft2 Recommended infiltration surface elevation(s) S,ee loo! -3 ft (as referred to site plan benchmark) Additional design / site considerations ~rs~ yrr'op /30A 21s7,rliS 417-1o„j - _reC 46 t 010 Z- Y - oti 51o1%2 Parent material fr'/~ciy/ ril/ Flood plain elevation, if applicable ft Le"KCESS~[7~ S o E O /YO UNL7 S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U [IS ®U EIS ❑ U ❑ S JR] U ❑ S ,®U ❑ S 21) S~5 ~/I /~•yE32~ S/ Soy/S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 716 1777 4 3 S/ ; f YhA~ /A vf,C C S 3 Ar 13 loi,e z, shy .w,,~,~ s X Ground G' 0 ~Co 7 Y/2 717 5/ f) S h& N-F e elev. /O/ • 0 ft. ~~'ZD,✓ G f T/,vG O ~jif'rt v~~t_. Depth to /,v o T0~ E limiting factor Remarks: Boring # D-/O /D'/, tif{:i vryt~~iiv:+ Z C a-y~ 7s °S I-f X Ground elev. /07,34, ft. Depth to his test site DROVED limiting for convention I septic SySt-ern. Remarks: '4 150''' 7- D,J 40A S C VT 0 Fl-~ CST Name:-Please Print HOMESITE SEPTIC PLUMBING CO. Phone: Address: ROBERT ULBRIGHT Signature: Date: CST Number: r rNN. INSTA.LLEP & DESIGNER LIC. NO.00663 Lfl. / f' Y2 2 Z PROPERTY OWNER BSOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T-w& w ©7 /oY,F zz7 shk L/-f4 es X , s y 7.S yid y/ f Sh,t -5- Ground elev. Jog, s~ ft. Depth to limiting factor X910 Remarks: ~IJ~PT~ of 8 ff~ ~Pr2o-~ ce,~r.►. ~,s /hoc f'f? S of ~s ye/-~-.S Boring # >i /ors Ground elev. ft. Depth to limiting .4 r 36 factor .36 L Remarks: ~iolT~ f> AT 3(9 1',~e7%"G- Boring # Ground elev. ft. Depth to limiting factor L Remarks: Boring # 1A -A I Ground , elev. K." 17 ' ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) fit, ~o,c.J s y572,,-i t14 T;dVs 13 107,36 0 2 k, 1-.r , I, 3 I lUO TES ?aS~"" ~~d~a ~J'o D i S %t' ~e' , .:~:-..'J S-~!~ Ii~ie „J'!~ r~!/ C/t~°.t/C'v //y T,PE-vim r .,v G- T ~ l l p y Svc' f~S7~ J ~~.5/ ~l'.N ~IJ/~. ✓ d!/ /fox 0 Al &49;ed11 slopo , ro v i ~ UU 1 flj 0 •J } I xy j _ 3 HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT I NJS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO.00663 i j i t'~c ISTivlr iODO S u_P. i CDc>c,~" - ;'V Try _--r-- '~i~Qy'~' S ~~1 ff ri U ew I- Aj ~-OR 23/ Alt { i GOMfftRCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800- 962- 5227 FAX 715 - 962 4030 REPORT NO.: 53423/01 PAGE ST. MIX CWNTY GOVERNMENT REPORT DATE: 12/01/93 CENTER 1101 CARMICHAEL ROAD DATE RECEIVED: 11/29/93 HUDSON. WI 34016 ATTN: THOMAS C. NELSON OWNER-. Richard Busick LOCATION: 1037 Pheasant Tr., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 11-29-93 TIME COLLECTED. 9:05am r f F~~` SOURI:E OF SAMPLE: K tchen faucet (Retest) DATE ANALYZED211-29-93 TIME ANALYZED1#2:00Pm " „a- , 1 COLIFORM,MFCCS 0 /100 mt INTERPRETATION: Bat ter i o tog i ca t ly SAFE NITRATE-N: < 1 ppm * Above 10 ppm exceeds the recommended Public Drinking Water Standard. *NOTE: Nitrate result from a sample submitted on 11-12-93~ Report 4526644 **NOTE1 This sample, reed 11-29, smells strong with chlorine, which causes an interfence in testing for Nitrate Y RESULTS: FAX'Q ON:, ~Lt, a3 PHONE[? ON: 1~ 3 a CALLER: LAB TECHNICIAN: Pam Gave Off.\NDEVENpfNl. s ss WI Approved Lab No. 19 o • V Z < Means "LESS THAN" Detectable Level Approved bYr ° PROFESSIONAL LABORATORY SERVICES SINCE 1952 "y, r ~3- ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE M - - ~Q/n~%elieC • HUDSON, WI 54016 944=10199 1 715) 386-4680 y SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 ❑ Septic $25.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection) 14,4 ,C i)S/Requested by: Owner: Address: ~C_ Address: City & State: , 1 City & St. Zip Code - 3-46 J Ee Zip Code: Telephone N°: Telephone N°: ~3$ - BL7K Property address (Fire N2 & Street) : 3 7 -e Location: Sec. , T N, R W, Town of St. Croix Co., WI. Tax ID N2 Parcel ID N4 020 - -dam House color: 0&4 Realty firm: 4 Lock Box M -kn * Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: T;tq IS lv~,Ylht~JC' Date: ilk- 1: Previous Owner's Name(s): <'"f 10 Have any of the following been observed? - ❑Y Slow drainage from house. f~ ❑Y Sewage Back-up into dwelling. ❑Y Sewage discharge to ground surface,/.-y road ditch or body of water. $ ❑Y ;161 Slow drainage from the dwelling. 6 ❑Yi Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: ~~2, ~rq OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd OAt-Grd ❑Mound Approx. size. 'X OGravity ❑Dose OPressurized Ft .2 OBed. OTrench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEPTCTENCIES []Other ❑Unknown Septic tank Setbacks: ❑House_. OWell ❑Prop. line []Other Dose tank Setbacks: OHouse': OWell OProp.'line ; ❑Other OLocking cover OWarning label OPump/Floats" ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: []House. OWell ..OProp. line 00ther ❑Ponding: ❑Discharge: General comments: INSPECTORS SKETCH OF-SYSTEM LOCATION N Inspector Title ERCIAL TESTING LABORATORY, INC. iin Street, P.O. Box 526 Wisconsin 54730 962 3121 962- 5227 715-962-4030 ST. CROIX COUNTY GOVERNMENT REPORT NO.: 52664/01 PAGE 1 CENTER REPORT DATE: 11/16/93 1101 CARMICHAEL ROAD DATE RECEIVED: 11/12/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Richard Busick LOCATION: 1037 Pheasant Tr., Hudson COLLECTOR: Jim Thompson DATE COLLECTED: 11-09-93 TIME COLLECTED: 4:00pa1 SOURCE OF SAMPLE: Kitchen faucet f DATE ANALYZED:11-12-93 f TIME ANALYZED:11:00ae i COLIFORM,MFCC: 3 /100 m( INTERPRETATION: Bacteriologically UNSAFE NITRATE-N: ( 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml ~i Nitrate-Nitrogen: mg/L 1d J? NoV 2 E~ joo C)r io COU . LAB TECHNICIAN; Pam Gaue OFF/Cc V\NDEVEIppf 9 ` ~ r' WI Approved Lab No. 19 O ; d 5A t Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952