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AS BUILT SANITARY SYSTEM REPORT
OWNER ,d- w rl-a s LC LLah~ TOWNSHIP : F ✓'-t.~~~ y
SECTION T-2 ,.N-R ZL W
ADDRESS ~S6f 5><~a~'~ ST. CROIX COUNTY, WISCONSIN
~~a mryrD~✓ J ~1 e/~
SUBDIVISION 4 't1 _LOT : LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
4ay
.2 5,
e t
1 ~
1?i' Clea n d w
77-
a 0
i y
a^ i I / f p ~ ~
~GST ~ !e ~
a 1'r
c.n-e r 41 ~
1
I~
f
------INDICATE NORTH ARROW
~e 1 v~ ~ oh car//e~4 d G-- ~L /mod
BENCHMARK: Elevation and description: 7' /m 6~ ► aF J~f~~~/ oS
Alternate benchmark
SEPTIC TANR:Manufacturer: r I; Liquid Cap. °~b «60
Rings used:-CLManhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear X Ft. /001"-
From nearest prop. 1 ine : Front , Side,, Cam, Rear Ft . /yu
No. of feet from: Well J , Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
B
PUMP CHAMBER
Manufacturer: 6di'ejV('.Il "I <Jc Liquid Capacity:
Pump Model: ~7S Pump/Siphon Manufact.: ~oetlPf Pump Size A.
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: L P-lel 1)&k n. Switch Type: Location
Distance from nearest prop. line: Front-, Side, Rear Ft. looms`
Distance from: Well ado Building ZS-
SOIL ABSORPTION SYSTEM
Bed: X Trench: Seepage Pit:
i
Width: Length 6 3 Number of Lines: Area Built-;~ZyJ
Exist. Grade Elev. Proposed Final Grade Elev.
/J,
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear Ft. 3Z
No. feet from well:--2-L6
, No. feet from building ~7f
HOLDING TANK
~lr
Manufacturer: l7 Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE : PLUMBER ON JOB: LICENSE NUMBER: V
6/90:cj
I
:.w
'LOCATION: PLEASAANT VALLEY 7.28.17.59B SW SE STEEPLE DR
Wisco.isinDepartmento In ustry, PRIVATE SEWAGVSYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Bu0clings Division ST. CRO X
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERA,4L INFORMATION 180261
Permit Holder's Name: ❑ City ❑ Village [XTown of: State Plan ID No.:
ULLOM, DENNIS A & DIANE M PLEASANT VAL
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
dp, C1 0 024-1011-50-000
TANK INFORMATION `d r~ fzf~r /s,,Y81~ EVATION DATA A9200338
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic G '1C~ l s c c Benchmark
I' ill
Dosing r:- tc/~?cf T~ :s
Aeration Bldg. Sewer
Holding St/ Ht Inlet -7,Y V
cI L, Ur
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG_ Ventto ROAD Dt Inlet
Air Intake
Septic > D0 a 3c X75 7/77 NA Dt Bottom p37 0 lJ.
Dosing -/0 G X /75- ; -7 - NA Header / Man.
Aeration NA Dist. Pipe ,L)
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand * . /c~;
Z Q.+ .t x... j .
Model Number ~y A GPM Y
I Loss Friction I Systema Head TDH~~2 Ft
TDH Lift
Forcemain Length Di a. 't Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH WidthQ Leng h / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS u DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuacturer:
SETBACK CHAMBER
INFORMATION Type O Mode Number:
System: 111 171 a 3S' /V / OR UNIT
DISTRIBUTION SYSTEM
Header/ Manifold Distribution Pipe(s) j x Hole Size x Hole Spacing Vent To Air Intake
Length 0 Dia. 02 Length ~0/ Dia. IN" Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over I I Depth Over % ' xx Depth Of t , xx Seeded/ Sodded xx~Mu✓lched
11 iv
Bed/Tr nchCenter Bed /Trench Edges Topsoil tp 12/Yes ❑ No es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. i,
SBD-6710 (R 05/91) I o,p Date Inspector's Signature Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
GAU
e
14
f P
CQ m _ _ _ f
r
- - ~ r ~ ► ICif
i
SANITARY PERMIT APPLICATION
D~~.HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ,
STATE SAN TA PERM #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. 1:1 Chec d revis on to p evious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMB R
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
Je,mn ader'1 SL.JI % Sr S T ~ N, R 17 (or)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK
/5'0/ Sk le
CITY, STATE ZIP CODE PHONE NU ER SUBDIVISION NAME OR CSM NUMBER .5d < 7f5 25 VP
4WROAD
111. TYPE OF BUILDING: (Check one) 11 State Owned O VILLLL.AGE 1 5 ~ / NEAR
c► ~ 0r
ARCEL AX NUMBER() d TL
❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms ! P10
III. BUILDING USE: (If building type is public, check all that apply) ld ~l
1 ❑ Apt/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 in line A. Check line B if applicable)
A) 1.0 New 2. 5d Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 PS Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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
6" aV( a yl 7 T 71rO feet 94.3 Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank /fib 2 Z+ P C
1,0644 El +L
Lift Pump Tank/Si hon Chamber W f
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum~r's Name (Print): Plumber's Signature: (No mps) rP/YeBaWAG.: Business Phone Number:
✓ ~Gti 3 Z ? ? 7 z-3 2 y
Plumber' Address (Street, City, State, Zip Code):
2
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (IS lodes Groundwater ate Issued, Iss ' gent Signatur tamps)
rcharge I pproved ❑ Owner Given Initial -4
Adverse Determination 1 =9202
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. ,Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
• All revisions to. this permit must be approved by the permit issuing authority.
4.' Changes iri 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. r .
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed:
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
Ill. 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 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 prm; and F) all sizing jnformation.
GROUNDWATER -SURCHARGE.
1983 Wis onsin 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, ground-
water contamination investigations and establishment of standards.
%
SBD-6398 (R.11/88)
L.L.H.R. 83.08(2)
P R O J E C T INDEX SHEET
Owner : - t.vu t 5
Address:
Site Location:
.7 opr Ale4sviv 7-
Project Description:
ex i-s T% N G- 44 S 4
r s.~ ~ up
lpk~e 11:4646" v -cam /r~' ►r .d
7" l „
14 14114o 411v Z2 SY 5
P ~ I's b0e-),0,0
s
Page 1. PLOT PLAN VIEWS
Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS
Page 3. PIPE LATERAL LAYOUT
' Page 4. DOSING CHAMBER CROSS SECTION
Page 5. PUMP PERFROMANCE SPECS
i
i
PLUMBER:
f
DATE: -7- I'f `/7 - - SITE EVALUATER/ DESIGNER
I
SIGNATURE
HOMESITE SEPTIC PLUMBING CO.
$55 O'NEIL RD., HUDSON, WIS. 54016
47 ROBERT ULBRIGHT
' A%. MASTER PLUMBER LIC. NO. WWWD
MrNN. UoTALLER & DESIGNER LIC. N0.00663
JU L 17 1992
'DES I-
i
T o,~~C, T o s...~ PLOT PLAAJ
13 ,'1Rt v vo r
I v,Prys . f C✓ •v e e E 7C /4410
y~
4 -r a I9sa- of
~/Elr4r/aN = /00,0
o,, rcer
v~y z,~ ~~IA~I roPU sc't ct : yo
l3q c~ ffoE- ~o rTS
pOA)
AP'j -
iu.)g M n = ~Ff /'s Tea y S,~9vEs
fAl
PO
f ,
r.E LEU4 OruS
v~uf I 96 40 S7, y2
~ OUG uv~~ ~ cl ~ , 2 ~
3
cc.,,~~ o ?ate L,:ve' 9G.3o
T,q.V K
\ 3 ZVO
C ~N D!'ST u,P/3 ED
`1 p ~ o
ONSITEE `l; CE S, F 1
DEPARTMENT OF 1""SJS"; Y, IJt RELATIONS
' DIVISION OF SAFE~YH~~i) Ll.fl~l'S
SEE CORRESPONDENCE u„d 1 S tiD
f Prior To Plos;ring= Installer will carefully
shift or orient mound position ( toe line
and area under bed aggregare) so growid 9 7,
elevations across slope are as uniform as
possible. Suggested elevations (staked on
site with lathe markers) are shown herein yOM{ SITE SEPTIC PLUMBING CO.
and on pg. 2. tt~, O'NEIL RD., HUDSON, WIS. 54016
ti ROBERTULBRIGHT CSI`
Ma' TER PLUMBER LIC. NO. 3307 M.P.R.S.
R 'S~Pd. !P Lei l "R b aES*KR LIC. NO. 00663
RECEIVED
S Tit /,E p,~ „U L 17 1992 Al 1,14-
Z i
v T 5
A
- Page ZOf S
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
Topsoil 7. FQ
-J E
3 .
i "
ii
Z % Slope
Bed Of ,'-2 (Force Main Plowed
5u9~ESTEo Nlvvtil~ z~,cr~;o,~~~ Y6
Aggregate Layer
T~~ Gi:vE v~►7-iD.v
D l Ft.
E ~ Ft.
- Cross Section Of A Mound System Using , - Ft
A Bed For The Absorption Area F F / Ft.
A~ Ft. H /S Ft.
Signed B Ft.
License Number: K /0 Ft.
.
L Ft
Date: J $ Ft.
Alternate Position T Ft.
of w L7 Ft.
Force Main
Observation Pipe
° \Force Main
rF
Y
\ Distribution Bed Of 2"- 2 1
Pipe Aggregate
Observation Pipe Permanent Markers
C~1Npt~~ ~VG ~ rGC.
Plan View Of Mound Using A Bed For The Absorption Area
y
RECEDED
SEE 0f.iRRESP0N ,`Jtrf J U L 1
OFF' r P k
1 DES
ai
j!,
i
Page -3 Of
/A'S r ~alE
i Perforated Pipe Detail
V, 6A r Ak 1/141I)AIC
F
jt~ VACv,9i Doti
End View
)Perforotta
End Cop y~. PVC Pipe
1 io'o~`~ce
Moles Located On Bottom,
\ Are Equally Spaced
R '
Q
PVC Forcn Main
Q PVC
Manifold Pipe
Alternate Position Of
Distribution Force Main
Pipe
Lost Hole Should Be
Next To End Cop
End Cop Distribution Pipe Layout P 3,~9 Ft.
R S' p
:i
X ~lf Inches
s
Y X00 Inches
Hole Diameter Inch
Signed;
Lateral Inch(es)
License Number: tt
~ Manifold L
Inches
Date: Force Main Inches
# of` hales/pipe
Invert Elevation of Laterals 9, 3 Ft.
P/-5 7-RI'Bur'10,) pl*5e~4,ee .P~97_~. rJ c cl~ r~r, / y ,t,,,,
PA,t. O T i 5 , J' z- 7
x/715 TA' /a U T/(9n) 2) /'S G~ 'Ap 'O'l1 r- /4'0-.,~
► RECEIVED
~ t
GEC:
JUL 17 1942
i'
A.
SEPTIC TANK & 'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE & !WEATHER PROOF
4 25' FROM DOOR, WINDOW OR JUNCTION BOX 'APPROVED
FRESH IR INTAKE WITH CONDUIT MANHOLE COVE.
FINISHPp GRADE 4" CI RISER W/ PA':i,0f 6
'
6" MIN. WARNING LABEL
~
ABOVE GRADE --1.,.. _4" MIN.
IN. 6" MAX. at~C
' INLET
~VS WATER TIGHT SEALS _ GAS- ; `
VS TIGHT 4
4~~ BAFFLE A SEAL APPROVED
CI PIPE 4 ALM JOINTS W/ CI
3' ONTO B ON -PIPE 3' ONTO
SOLID 'SOLID SOIL
SOIL C '
PUMP OFF ELEV. yo_ ,0T 1 . OFF` RISER EXIT
D PERMITTED ONLY
IF TANK'
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER 'T'ANK
CONCRETE AD
Cqo
_SPECIFICATIONS
SEPTIC / DOSE G(J/ESeoe
TANK MANUFACTURER: NUMBER DOSES PER DAY:
TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING
DOSE 6000 GAL. 9 FLOWBACK: GAL.
ALARM MANUFACTURER: GEV&L CAPACI'T'IES: A = 36, INCHES 7"p0 GAL.
MODEL NUMBER:
. SWITCH TYPE: /41C (y~lej7- B = 2 INCHES = 2~' GAL.
PUMP. 'MANUFACTURER: ZOO &fe C = 4- INCHES = 152 GAL.
MODEL NUMBER: 9 ORH£eC~ f7)
SWITC~i TYPE: D = Z- INCHES = 2- GAL.
REQUIRED DISPHARGE RATE yO GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE- ry FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2.5 FEET
+ .5~0 FEAT FORCEMAIN X 2,62- FT/100 FT. FRICTION FACTOR I-3 FEET
UmL $ D TOTAL DYNAMIC HEAD', _ 12- Z FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH 93 ; DIAMETER j n Al
LIQUID DEPTH
SIGNED: LICENSE NUMBER: DATE:
1/fs8
Gr'r
w,..
_s
DIVED
4 ~
- t c L_-1r ° ► J li i_ 17 1992
OFF, 7 IT
li- U.
HEADI s
11s
110
-
• 34
PA 32
i 105
CiURIWIE 30 100 -
85
28
90
26 85
24 80 MODEL
EFFLUENT
an •J Q 75 MODEL 18g
DEWATERI165
l/ NG = 22 70
_U 20
-65--
Q
Y 18 __60-
S5
16 50 MODEL
0 163 MODEL
F 14 45 168
12 40- 1
3S- k
10 MODEL
30 MODEL
137, 139 165
$9 GE and 6 25
IAIA
~G 6 20- MODEL
P~T
15 .MODEL 18T
7
•
10
h + air MODEL
~ak I 2 5 53, 55.
57,59
0
i GALLONS 10 20 30 40, 50 60 70 110 90 10(1 110
2• !0,
LITERS 0 80 100 2.0 320 400
75 -
FLOW PER MINUTE
70
29
, f I I 5,:
18 MODEL
t] 295
I' ~ w
a s = 10 I
~ ,1 V
114 MODEL
;i Z ? 294
G 12 I
i, j MODEL
415
O 10 283
IN,
MODEL Iii"
• - -1 -
310
6
, MODEL - -
6 282 -
15 Nf,
•
110- 1 4MODEL Tjq.
2 57, 288
l:
o 3280 ON MfNers Loop
GA1LLDV! 10 20 30 40 50 60~ 70 60.1 9o 100 1110 120 130 140 "15P 160 T 160 180 P.O. Box 16347
-yr I E- + LouNvlge, Keaf~cky 40216:
LI,TEIf 0 00 160 240 320 400 480 560 640 720 (50?) 778-27.1
} r
t FLOW PER MINUTE
r
17W l
S9
- t .1
- '9I Cast Iron Se Bois CAPACITY
1`1EAP UNITS_ IN
Feat Meters Gal. Its.
~I • Automatic or Non-Automatic. 5 1.52 07 21E .l
111 • 112 H.P., 1 Ph., 115V or 230V.
rte...- 10 51 183
• Non-clogging vortex impeller design. 15 4.§7 43 169
20 610 "27 104
Passessphere).
Lock Valve: I . '
Y' • 1,12" NPT discharge.
• F.t at operated submersible (Nema 6) mech-
anical switch. 97 s~,w.
• Automatic reset thermal overload protection. u~ +ie sG•222s
• Stainless steel screws, guard, handle and arm and
i~ seal
assembly.
J UL 17 199%'_
• Watertight neoprene "0" ring between motor and
al I pump housing. nvDp~~f,fii` I`7 y .
ev, HIV .
i N97, non-automalic, available packaged with a piggyback mercury
4 float switch.
irw
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
COUNTY
ST le l X
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. _501 1_
oN SiTt
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION M, 71fi~~tT/o RESVITtiOrtP Sc.J -7- /0- !P'2
PROPERTY OWNER: PROPERTY LOCATION
le KRS ~11MM i 5 u (10 ,1 GOVT. LOT Sw 1/4 s-' 1/4,S 7 T ZO N,R / 7 E (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
/50 / STEM" / -Z;W .
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE E TOWN NEAREST ROAD
s~ois (715) yz.s- .
[ ] New Construction Use [/C] Residential/ Number of bedrooms [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 6000 gpd Recommended design loading rate ed, gpd/ft2trench, gpd/ft2
Absorption area required -OD bed, ft2 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 G trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site co erations
Parent material 5C$ 76 G,f'ii✓ - /~/,4c~~1 7-111 Flood plain elevation, if applicable 41711- 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 O U ❑ S W U ❑ S ®U ❑ S EJU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxtdary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
07T /O yiP 312 .2
, tiw s6,~ ~ s z~^ .S G
c -i~ io ye yl~ -f A4 2. 2- . s .
Ground 6" 25 /0W
elev.
ft. C S-G0 /DyX 500 S V9 S S~ I ,f~ Sb k
.y s
Depth to
limiting
factor T
12
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CST Name:-Please i NEIL RD., HUDSON, WIS. 54016 Phone:
Address:
MASTER PLUMBER LIC. N0.3307 M.P.R.S.
Signature: INSTALLER & DESIGNER Date: 7~ /Q 2 CST 2PZ
PROPERTYOWNER SOIL DESCRIPTION REPORT Page Z 9fv
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 'GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
16
4 3
Ground
elig ft. - GO /0 yie S/~P c' 2' s S/ / f, SDK' - r
Depth to
limiting „
facto~
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
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factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAM
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Y0K.SrrE SEPTIC PLUMBING CO.
a t,.lv O'KEIL RD., HUDSM, WIS. 54016
ROBERTULBRIGHT CS j- Z y~i
o:i&. M3`R PLUMBER LIC. NO. 3307 M.P.R.S.
j k rlf` i+r 1 FR & DEWWR LIC. (40.00663
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT ~
St. Croix County
r
w
OWNER/ BUYER r
0
ROUTE/BOX NUMBER 1501 ',5:)4een/P A, Fire Number 15'o f :J
to
CITY/ STATE S ( 'C ZIP y51VW5 r
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PROPERTY LOCATION:'. 5&J 4', Section T '77 N, R/W,
, St. Croix County,
Town of P,448/ I/4//
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed *septic tank pumper. What you put into
the system can aTTect Fe function of the septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
whic 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 County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2) after inspection and pumping (if nec-
essary), the septic,tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
H
I/WE, the undersigned have read the above requirements and agree o
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart- ::r
ment of Natural Resources. Certification form must be completed .z'
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED - \,o-
DATE c~ -16
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
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 permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property /0~
Location of Property S LJ Ic •S'C , Section rf , T 78 N-R /7 W
Township Pl24sa o tAJXe
Mailing Address Is 1 S"~erD/.P 0"
R1/Gv~s sszoys ~iS -!5~Ka I6
Address of Site
Subdivision Name
.Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? I)< Yea No
to this property being developed for resale (spec house) ? Yes No
Volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeda. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
i (roe) cvt,A6y that at.t itatementh on .thus ohm cute tAue to the best o6 my (ouh)
hncwtedge; that I (we) am (ahe) .the owneAkl o6 the phopenty ducAi.bed in .thiA
.inAohmati.on 6a m, by vUhtue o6 a waAAanty deed kecoAded in the 066.ice o6 the
Corint Re9us ten o A 6 ah Doeume
yy n.t No.
c•un tl,e ; and that i (We) pneaen,Lty
pnoposed Aae bon the 4ewage cUApoh dyh em (on I (we) have obtained an
CdA tmen.t, to nun with the above deheh,ibed phopelr ty, 6o& the eonAtAuc ti.on o6 dai.d
s ya.tem, and the same ha.e been duty heco ided in the 066tce o6 the County Re9i6teh o6
Vttde, as Voement No.
SI Oh OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED _ DATR crrtrn
i~
-r 7Mf' l Q......`.. p
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..J•r«»»ww+. . ,
R:
1 . -1 ..i.yy..e... • MU •AL& Wmal
« woo ~ ` R~a«,7~JMSMrA ................111 » /
F'. - Ts,: ~ Vii'..........
o►~rth": "a' of W% of Oft of Saeatiom 7, Township 28
Y ~
HA M BD rM SATISFACTION OF A ~
r
' T4f1„ 1600imm OCTOM 21, 1991 f4 VOLUM S
t
2780"•
OA, X*t'
x
won Any, Dud a31 ,easemnta, coveaants, resetvatifta
"of , "Words, 'if any.
dw . .October u.. ~
„ - Vicki... s.
x.. ~..rki.„ a. _ .(SAL) - -
",.~l!■ CATION s.
♦ozxowLaaoatf*x!
STATZ OF WtIc"Um
- ~4 is
1f~-fir! r
ItM►~i. 8&sd.). .
t&.19" lo~otnt ti be.
the PW"m'
w ` ~x
'tMl~ mognmMew WAR DRnRno my
?&Btu*
~YI~► a, Itp Cow~i iow to permaum (if,
I~riw. aat i~ am 0"W010 dhaadd M v.a M r4i" lialr ~Irwwrs c:
dt" am
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r ST. CROIX COUNTY COURTHOUSE
911 FOURTH ~REET • HUDSON, WI 54016
15) 386-4680 '
July 14, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite investigation of the Dennis Ullom property, located in
the SW1/4 of the SE1/4, Sec. 7, T28N-R17W, Town of Pleasant Valley,
St. Croix County, has been conducted with the assistance of Robert
Ulbricht, CST #2482.
This onsite revealed suitable soils north west of the existing
dwelling to a depth of 26", which meets the requirements of the
A+4" rule. This site is suitable for a replacement mound having
12" of sand fill. .I
Should you have any questions, please feel free to contact this
office.
N
Since ely,
ames K. Thompson
Assistant Zoning Administrator
cj