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012-1032-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GED'iERAh INFORMATION (ATTACH TO PERMIT) Po.~~~ai infnrmatinn vnu provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. permit Holder's Name: City Village X Township Stoddard, Darrell Erin Prairie Townshi SST BM Elev: Insp. BM Elev: BM Description: c rnnr~t tru~nclueTintu EL ATION DATA TYPE MANUFACTURER CAPACITY Septic 2ui s ~`~ ,~ #Z 0 D c~ S~v Dosing I Gs ~ O~~ Holdin -rnNK SFTHACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septicst ~ (06 r > ~'~ ~ ~ Z / Dosing ~~t7 ~ f ~~~ ~pC~ r Holdin PUMP/SIPHON INFORMATION ~ 3 S f Manufacturer Dema d 4 GPM Model Number /5 TDH Lift Friction Los System Head TDH/ Ft Forcemain Le~gth Dia. Dist. to Well ~ 2 •• --.. _ _.. ~ ....,~T~.. o ~ _ -i-- l County: St. CroiX Sanitary Permit No: .395272 State Plan ID No: Parcel Tax No: 012-1032-30-000 STATION BS HI FS ELEV. Benchmark ~ ~ ~~ ~~ /~~ 3 ~ 3~ Alt. BM . Z Bldg. Sewer t Inlet ''`~ ~ Z S, t outlet ~ ~ ~# F• ~'~ r 4(,• Z 3 ~' !e Dt Inlet / 2. z 92, y.s~ Dt Bottom ~' , L O Header/Man. (} ~• ~ A Ilt_~ Dist. Pipe ~- ' ~ Z Bot. System ~ ,Zv d. 42. Final Grade St Cover # G.~~ ,Zr ~ los VVIV AYV V BEDlTRENCH I\~ ~~V.~v.v. ~... y-- .--- - Length No. Of Trenches Width PIT DI SIONS No. Of Pits Inside Dia. liquid Depth DIMENSIONS ~ ~ ( / 1 / V SETBACK P/L BLDG WELL SYSTEM TO LAKE/STREAM LEACHING u cturer: CHAMBER O INFORMATION Type Of System: ~ ~ ~ / r ~ ~' ~ UNIT Model Number. 6 G / 6 DISTRIBUTION SYSTEM {•~ Header/Manifold Distribution x Hole Sized x Hole Spacing Vent to Air Intake 3 i a Pipe(s) r ~ i r' ,3 ~ 3/ /i 3 ~ l/ i~ Length Dia Z Length Dia /Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No ~~ i ~v`QM~IS:~(Includ~~ d~iscre~ensigs, persons r nt~e`tc)!~e') Inspection #1: ~°r~~~o 1.~_ Inspection #2:~/~/~ C Location: 2061 16 Avenue NL+w R~ch,(m~ownd•, WI 54017 (NW 1?/4 NW 1F4 13 T30N R17W)oY Parcel No: 13.30.17.1906 1. Alt BM Description =q~r/ a q~ Yon / lLT dl.[.GtS f Gt~Ipr l `! r~~ ' ' ""' "" ~~ 2.) Bldg sewer length = ~ J _ e ~ ~J `la ~ ~f" ~~ti su ~,~p~ P. G~r ~r/ UC Way - amount of cover = 'l/Nrv_}fir ' ~ e+t, 11 6 ~~ ~~er 5fa3ft~ ~ rr lava-5 ~e ~i+-.~G/y !Z" 3.)Contour= "QS'•((o~ 7~~^^ ~~ZO w'f' '~ ~ ~~' / !~ p~Q ct~l~ocar 4tov ~'> (ocv~ n4.svbers 4iGr~ i Plan revision Required? ^ Yes ] No ^~ Use other side for additional information. L Cert. No. Date / f~ r^, Inse~p[ctor's Signature ( / ,/ / ,~(_ / SBDy6~710 (R.3/97) (t L ~ SGI,AIwI I~ ~ LJ ~~ ~j~/ ~'Iicn~. Gwru4~` s ~l9 /vr~/ 7D N~.A~+ U~ r Safety & Buildings Division Sanitary Permit Application 201 W. Washington Ave. '~` In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 Madison, WI 53707-7302 rr.-r~r~~-i~`F~:~,~t~ ~~i.veie~wr~cr+ Personal information ou rovide ma be used for secondar ur oses Y P Y y p p (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach com lete lans (to the count co onl )for the s stem, on a er not less than 8-1/2 x 11 inches in size. County 'ST. utol x State Sanitary Permit Number 0 Check if revision to previous application 39Sa~-2 State Plan I. D. Number ~0~~-9'~~. I. A lication Information -Please Print all Information Location: Property Owner Name Property Location / C f + pa-~.' `" ~2. ~ / ~d ~Cl ~ a ~,.~~"t2' /ll l.J 1 /4 /1~GJ 1 /4, S I T ~ i7,N, R p~~) W Property Owner's Mailing Address Lot Number Block Number o2Gl~l 14.0 ~ ~v~ ~ f City, State Zip Code Phone Number Subdivision Name or CSM Numbe ~>I ~ ~- P ,'rig w, ~w n ~ ;;~; ; ~ yo /) (~~/ ~ > ~ Y 6 ~ ~ l l~ C.ta~'~ 3~f6 ~Y'l (~ ~ P SSO II Tape of Building: (check one) ~ ~ City ~ Villa e €~ 1 or 2 Family Dwelling - No. of Bedrooms: `' g 0 Public/Commercial (describe use): .~ Town of Q r~ n ~ ~~~~ ~ ~ 0 State-owned t n /1 III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road /~ O Y~ A) 1. ^ New System 2. ~2eplacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem O/,~.'~ ~3~- 3U'' ~~ O g) Permit Number .~ . O _'~ q~ ~ 3 ~ ~ Date Issued i A Sanitary Permit was previously issued /~ R• N. A, IV. Type of POWT System: (Check all that apply) -~ ' l _ ^Non-pressurized In-ground O~Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized I -ground r 1 ^ Holding Tank ^ Single Pass ^ Drip Line * 9S• O / a e. ^ At-grade ^ Aerobic Treatment U it ^ Recirculating ^ Other: V Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation boa ` ~ o p ~' 7~- ~ I v o ~,~- • '-~ ~----- 9 ~, 0 9 ? , g ~' VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~ l / ~ 7~v nn Ji.1..5 ~aa-.. 7S G " ~ ^ ^ ^ ^ av ~.. ~ Gc.. ~: c. ~ ~ o~~ 1 ~:.~ I~ ^ ^ ^ ^ VII Responsibility Statement I, the undersigned, assume res onsibility for installation of the POWTS shown on the attached lans. Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number Wt~l~-~h N~~,~U.'IJ ~, ~ ~ ,~a~ ~e~ -~j~-~~4-33~a~ Plumber's Address (Street, City, State, Zip Code) 9~ `7 t~ ~~ R - ~ ; ~ yo a~ ~ VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signa ~re (No stamps) Approved ^ Owner Given Initial Adverse Sur arge Fee) ~ ~ Determination 32~. ~ ?.0~1 IX. Conditi ns of pproval /R asons for tsapproval: / ~ ~~ Q ~ ~ , 1 w.a~w e DoT ~t ~ 4- ~,Q~,~~ ~~~~~-~~i~f is C~~Qp,,~f~ol,cl'tT~`~ F~.eoaPl~-~= 20 >N ~ G N1 imp/ RECEIVED ST. CROIX COUNTY ZONING OFFICE 7-1 NOV 27 200 AI 1 sr cRoox CERTIFICATION STATEMENT ` OOW FOR UTILIZATION OF AN EXISTING SEPTIC TAN ' N "1/16°PFICE c , This is to certify that I have inspected the septic tank presently serving the v a A 5t, residence located at : tV 'A Alb) /, Sec . / 3 , T 3o N, R !7 W, Town of E, 1 t� /./. o , St . Croix County, Wisconsin. 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 l f ! ' 0 / Did flow back occur from absorption system? Yes No ;)C (if no, skip next line. Approximate volume or length of time : gallons minutes Capacity: /co o Construction: Prefab Concrete X Steel Other Manufacturer (if known) : Age of Tank (if known) : (Signature) (Name) Please Print `1^'t P 7 7/15 (Title) (License Number) /1 - of (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) . inn Name (L a '' Signature C_k. 0.114��.e MP/MPRS Pyti ,, t 32.E !a?- /3. 30,i7, 12a/3 .~ ~ ~ ~ ~ ~ , o ~ w ~~ ~` ~ ~ ~ ~ d~ v 4 ~ ~ ~ ~ - t~ ~~ ~-- ~ `\ ~ q ~ Jr , ~ ~~ ~ ~ n ~ ~ ~ W ~~ ~ ~ ~ ~ ~ , ,a ~ ~~ ~ ~ '~ ~~ a. " ~~ ~ ~ ~ 0 `-_o tu~4a ~ ~ ~ ~ ~ a' 1~ ~ ~ ' I~ M~ ~" ~ v1 ~ ~ 3. ~ ~~ fir= -= ~.-- . f ~' o ~- --__ r~ ; ~ N -......~.. Z 1~ (~ '~' `i` ; `OC 2 ~ ~ ~ ~ • ~ ~ ? M m ~ ~ ~ ~~~. ~ °r M ~U -~ r V ~ N ~ ~ ~ ~ O ~U 2 ~ ~+ i , 0 ~ ~ ~ ~ ~v __ 4 ~ o, _ ~~_ ... .ss ~ ~ ~~ /, ~ B ~a 'Fis U~ . ~' ~ ° d C5' -f'" , - ' -~ ~ ' ~ J ~~'' ~ ~ ~ ~ S V ` ~ ~ p' ~ ~ r ~ -~ _ 9 '' O 1 ,~ ~ o0 `' 4 ~ '~ o 1 - M Q- - __._ 4 m -~, _... s~'_ ~ ~HL~RICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 715-386-8185 RECElVE® AUG 0 ~. 2001 PROJEC I~ NDEX ~ BLDGS. DN, Plan I . D . ~ ~~ ?__9 ~2 __._____._._ Dwner 9~,p,pE~ L STD DD.g,~ j) Address ,~ p ~ ~ /(P D d-~ ~ vim. Legal Description GD % #' / ~ ~'S~y !> D f7 Town of ~/pjN ~7~'/9-//p/~ County ST; G~'Di )(. C.S.T. /~, ?i1j~Rl~C,~T Z ZG 31S -- Installer ~~ l /(JJ~~t(Ji`~~~ Local Authority/ Supervision PROJECT DESCRIPTION Replacement system, for a 4 bedroom sized home. Design/estimated daily wasteflow=600 gals. Soils are fairly permiable (.4 GzD/Ft2) but seasonally saturated at 30". A long narrow mound system using 12" of approved sand fill is proposed. P.O.W.S ~. Cnt~c~~~~~oa~~~~y ~', RDB~RT W. ~. UIB;tlCHT ~~ D1160 ~' `: HUDSON. WI _: ~~. d~~~ ~~'~%,,~5 I G ~~'4~°a• Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OtJT5 ) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems " (Version 2.0 SBD-10691-P(N.O1/O1) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD-10706-P(NOl/Ol). Installer shall carefully inspect, and certify that the existing precast septic tank (assumed to be 1000 gals.) is code compliant. If so, then an additional 750 gal. septic tank (750 gals. from Wieser Concrete Co. Maiden Rock, Wis.) shall be added in series and fitted with a Zabel filter (see pg.5). Reg. Des)gners o/ Engineering Systems Private Sewage Consultants Date 3~~-y ZS.. 2~~~ • Phone 7/~' ~'~~ ' SS/ tp r --- ~ °~ ~ o ~~ .r--'~ l- --- - _ w O ~~ S % Go % Gi,v~ vim. • , •~ . W ~, .sZ o ", ~ ~ ~ o ~ ~. G ~ ~ ~' ` ~ ~ ` n ~ Z a ~ ~~~'~ ___- -~ ~ ~ ~~ ~' o ~ ~ v ~ ~ =. . ~ -r ~ "s~ii sa p.-s. „ m ~ cs eo -~ ~" ~_ ~ ~ ema. ~ c~ G __ 1 ` ,. 1 X1.1 G ~ ~ ~ Z G ~~ d . ~ v ~o ~ ~~ ~ . ~ . ~,,~ -; ~= ~ '~ o a~~ ~ ~. ~ y -- b^ ~ ~ O rn r ~' ~ o ~ ~ ~~ ~ ~ ~ ~ ~~~~ m~ -. ~ ~, ~ o oa ~ ~ o ~ -ti ~o ~ S° ~ y ~ -° ~~ ~ ~ ~ ~ ~ ~ p@p eF % rn • CPOSS SECT IOJ OF Mook) D -- cv i r ho 13eD Oed OF % ro pi STRi(3o1 of ' I� ASgeL- ATE- & , ThickA.sFSs P1P �N �- or Topsoil_ /AJ/ T.E,Pl/r/AU�L-. s ys r E M cyo 's. l�\ e levAriew WY% FoR M Tom ^1N � 4 9�- o u, I I 1- �iE �. 1 e ° • \ • . I-3) : : II , SANp • , • • /// //RI IN plowmo T o p so i L �// NI CI uu i FORM 4C 7 SIoPE FORCE l p Mhi� IVATto� vu0ER BED 95. o ' .1) /7 v T. — ELEvArlo►J S — , E /, "1 / Fr. • INV Rr OF 1 ,., IATsRA ( s 16/SS0 F s u - F T. • Top of Rock y(o, c� a. G. . S Fr. H /, U FT. • Top OF i y « 7 ,)' IATERAIS (o .t0 I I PLAN V1Ew or MouA3D - wlrtt 13ED CEAv PAL_ �Z F°Rc� MAW 6Fr. I- -- L. - . I B /o° Fr - - - 1 K I/ F r I T - B 1 1 L iZz - - - _- -_- -� Fr 1 0 o 1 T 8 w ' _ - __ _�_ _ __ __ �_ _. 1 7• FT - K -rl a i 1 / " r r 0 w Y w 2-7 Fr V ger, 6F %." T , 1 " FVc (Appel? A g91PEhrE 013SERVATioo _ nn r "It irES /0c47-/dcl5 /0 1/ • /ifrIM --eta "'.�-( . PERMAotoT MARkER5 REcquiRED (3AsAl. AReh ` 1Aicy whsrEflow lj soft_ 10-fi 1rPAT►,E cf/ - - c APhri Ty • 6ek. Fr, PRoposEv B,etsM AIReA = 13 X ( A + I ) , , ) ( sad. FT. (W S S S 6-7/0,0 of Ay,oa u v \e T . Observation pipe --N, Distribution cell 6.. / 6" fill material - Ff #--� -Cover material {ASTh4 C113 s ' . •f fine �.. - � -� aag,egato� ----- t Tilled area {.- -Slope \- Force main Figure 6. Cross-section of a Mound System -Water tight cap .�� Top of 4"ruin. dia.` leaching III imi ,Repair couplings chamber,_ Slog_ I III ) 6"min. ruin. 4"min. Infiltrative surface• ' II Water Closet Collar Bar(NB"min. dia.) Figure 8 -Observation Pipes r C060/4//45. <94V:03,,e0, Cc6.0)AL___C J.) SE- PL0���� �9/�/� 'ot��i7 / s` 1- t i (j.C )1/ _-- 'r if/ t Y/ //e l4 .6 C T°/) f`, // „ A 10/ ,17 .. ToTA L 4/9Te_.?,4 e_ ^e. C e.) C )c ) ( ,) 1 `4-74,47S ,i yl,� a�7 ) c c c c c ( /1i�or e- Sig t)12i// 4,147 ,i.,/5 I I+ r� t�1> 4- 57:41 C33 if(c it ____—_________ --;,--2,—___ --------- I( Vo _ 7ti1/ d sa'G s7of4-e- - '}t30f6 •-- DIsTP f30110 PipE LAyoO7— P n_\\ .100 i\-... v ______. 4 R ,._____ __ s ,— i(o/F i-y \ Z \ �` ___________ 0- 11)E. _\ P Fr ----- -\ \-- -\ sf. R 3- 0 Fr ceoTRA L_ r o Rc E M Ai'N x 3 IW cNE. \0 Fr. of PUG y locHf; • ( VARI.A6LE ) i oTAL VOID UOIv�1f~ GALS pi5T^� c� o i f) 1� ��(,, T414 L (/O/01E /1MF1ER INcN hrER� / 'I' °F � 7/vaA'K .J- ►NcI1 s eE ,Tr , L MJ1� t �-c�LD 17, � G � 's . FORCE- MAID j, lkic-F{E .S . 4/=- or 1101E5/ Pi PE' / 7 I..mERr E LEVATio0 OF LATEMQn15 S Q .UT=PSE SIDE p� 7 ). o ' EI= [ ________________________ h r't-t i N A(_ c/o T)rT>4r'L n JDE jAi (_ . y PE R ro�. hT� � P' p� D �'t'� �CDSiy ' •cxiovE Ail )Rill f3VRRS i ____\ ___________----_, Y R • Nolf; S loci TEb co 3orroM EQU All Y SPACE 0 INSTRiavllUly viSC11AR &-E RATE poR EAch LA-t" R,1 L. fgip, 0ti' 5 //, 2. 2 To TA L Di5 -tRt [3UT100 DiScFjARGE- FATE ro R N -r- woR k 1/11 J G L / M1 ,0 . e a•5- Mi*tofmuAA ItEAD . 1.)E i 6 F A L- / Al°&-.5 oA) - cA tiD of Mto) 5,4iP40,e I 17/4/0E '' /30 X,1/t SCEs s- J YF�1/�`i,�L�" -D SGvE / d 2 v ,e _ Kitede.de 1-0 r9P7,,7 (70 eft lo to /A_ /9 z-P(7 _ erre /DE/PEER/1-7-&-p 1' �w /34// !//9 /U� G'9ram.�- • PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS — P4c,£ I ©F to / // ,46 ^ ✓-V E►JT CAP I �I r E > lO • 7 O ((,/.V DOL �, �00�, 4/� /A) /4 A v� _ I T VENT PIPE ^ WEATHER PROOF APPROVED LOCKING //__ JUNCTION BOX MANHOLE COVER g.4. l' D 12"MIN. I c./ Cvf1,c4la>( OM/ f/'A0 " ccIE U/17/0n/ GRADE \� I _ — ,,MIN . Y/i , �_ I , I 4 MIAIB"Mai. / CONDUIT-ti -- a � A/ v ` \ cIEvir /ti 1 -- -r 1 9c).0 _ --- - ———-- d IAILET PROVIDE I ------ r�_.._--_y_ _I-- ---------------------------- • AIRTIGHT SEAL I i APPROVED JOINT A q,) /A,I PIPE KI001 i I i APPROVED EXTENDING 3' 1Y`OII� 6 II ALARM EXTEEIDIPIG 3' JNTO SOLID SOIL I I ONTO SOLID SOIL sc4 ,10 Pc (B $� 03 `1D 3 ` I ► s� , 90 ��� I OtJ /0.10 c 1 ELEV. FT.--'- __J ' PUMP—� [ O. // OFF Z'SC 3 0,e D 1.'1 o ( /tio,PE- sF P %D,✓ I t ✓ BLOCK S��P �((le ( Vi f /LV/-'G-- X RISER EXIT PERMITTED ONLJ IF TANK MANUFACTURER HAS SUCH APPROVAL --K SEPTIC E SPE CIF ICATIDL1S / / DOSE f D �N f-e 1 TANKS MANUFACTURER: �rGsC� / NUMBER OF DOSES: I PER DAy TANK SIZE : /01,731 GALLONS /DOSE VOLUME ALARM MANUFACTURER: LeVEG 4/4,em co INCLUDING BAGKFLOW: !L� GALLONS MODEL NUMBER: '.1). U. L ' CAPACITIES: A= /0 INCHES OR / GALLONS SWITCH TIPS: irL.4,4- / B- 2 INCHES OR 'J O GALLONS PUMP MANUFACTURER: MEM-7 5 C= 5.1 INCHES OR ,/'2`' GALLONS MODEL NUMBER: /t9E go D= /G .`g INCHES OR 7 L� GALLONS SWITCH TYPE: P/7$'y 4 , C/<- F'O4 r7-- NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 1/ -5 GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. •� FEET -TA/JP S f EC s T_ i + MINIMUM NETWORK SUPPLY PRESSURE 3 -1-5 FEET 6ACGL t o `)A () IC1 + ✓° FEET OF FORCE MAIN X 14/i FX0ELFRICTION FACTOR.." ' FEET t(?()r ZS !<• 75 n/S. = TOTAL DIJ AMIC HEAD = FEET .1 /0 1rg6 „ yo 1/INTERNAL DIMENSIONS OF TA►JK: LENGTH ;WIDTH ;LIQUID DEPTH A ' tsc z t& - 1/'-7- /1611 - # 4/ (/°1- XIS 3 °rn' /` / SEPTIC TANK, per Comm. 83 . 44 ( 2 ) (c) shall be equipped with an outlet attached approved filter device (Zabel fliter ) . Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less ) inspection & servicing by a licensdd service pumper . I� sof - M E 4 0 Series M'ijei's® 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 i 1 T T j 1 1 T j T T 1 1 1 40 — 12 35 _ — 10 w 30 cc IL W Z 25 , Z O •-• w 20 • _ 6 qOq UJ J _ H 15 - J O 4 F- 4 F- O 1 0 _ - 1- 2 0 - 0 0 10 20 30 40 50 60 70 00 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company•1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289--1144 FAX 419/289-6658 Telex 98-7443 K3326 7/91 Printed in U.S.A. . . . , .. . ME40 SERIES . 4/10 HP Effluent and Drain Water Pumps POWER&FLOAT CORDS PLUG DIMENSIONS Quick-connect,watertight Replaces switch assembly fittings are interchange- for manual operation. 1 able,replaceable from IN NET pump exterior. * �1 (3a.ln R) ,, ' Discharge MECHANICAL FLOAT SWITCH l 1- �i s) Mercury-free.90°angle d 1 "i" . 'F �' operation. . (144mm)- J ■' _ 11.68 (2965mm) - -, i.......0..!.-"—-11111111=....,==37 r r , ,„, '.' III 1 � 1 1 1MOTOR HOUSING i ', "ON't, Cast iron for efficient r f�heat transfer. 1--� I �= OVERLOAD SWITCH _`T—1 1 °) �, `_1 \__f J Built-in to protect against _ _ �� overload conditions. ��Oi riji:. , 4/10 HP MOTOR E J 3a OFF" R • i 1.0•I i!i!I Mi I k:4./1/ 1600 rpm,60 Hz, 115 or N= 230V,single phase.Oil- _ cooled and lubricated. if '/ E 0 ROTARY SHAFT SEAL •^,f/ §I 1 [ , 1 f 'Carbon,ceramic faces. ����� i it I,��1 t I eJ 1 ,w __ `` -� iii. N . 0. :_�♦�` PERFORMANCE CURVE .•`�� ` ` ` ♦ \ \\\V,... , CAPACITY LITERS PER MINUTE ���I�� `. 0 50 100 150 200 250 300 Tsn v `FN I l 1 I 11 i 1 l l I I I i "l M1 0 -r 12 VOLUTE/IMPELLER SEAL RING — I o Maintains high efficiency 30 w and reduces recirculation, u. w 25 — e a replaceable, Z ENCLOSED TWO VANE 3 20 _ 6 IMPELLER High efficiency,passes HIGH EFFICIENCY ABS , '5 , H 3/4"spherical solids,with VOLUTE — F stainless steel wear ring. Corrosion resistant,Passes 0 - 3/4"spherical solids. 1/" — 2 THRUST WASHER,SLEEVE NPT discharge. BEARINGS _. 0 0 Enhance smooth operation 0 i 0 20 30 40 50 60 70 80 90 100 and extend pump life. CAPACITY GALLONS PER MINUTE K3319 5/92 a F.E.Myers,A Pentair Company Printed In us.A. MyerS 1101 Myers Parkway Ashland,Ohio 44805-1923 419/289-1144 FAX:419/289-6658,TLX:98-7443 4a 4a - -' Pg. 6 of 6 Mound System Management Plan ,~_ _ Pursuant to Comm 83.54, Wis. Adm. Code ,,- Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and . Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mglL BODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. ContinQency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. SEF. REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO 'TNTS SITE, DESIGN, AND COMPONENTS PAGE 6 REJERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM "^ M POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance/inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: S~. ~C.oiX ~~y 2o.v ~ N G- ~-~T'" . * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: ~ ~~~T~ y~G~U/l/~- /{E,v~y , * Licensed servmce / inspection agent other than installer: ~EN ~o~~~ 3 ~~ • ~.l~a * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shove~lring, etc.) across the area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and desi;royed. This system was designed for a maximum wastewater flow of ~p ~ gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 9. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover ,(the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system.. It IS NECESSARY TO REGULARLY WA`PER THE VEGE`T'ATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover/manhole). Only a licensed properly qualified person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. Pv~rP T~ti~s YE~~y, i . k~ s ~ ~ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary August 08, 2001 CUST ID No.226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 655 O'NEIL RD HUDSON WI 54016 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/08/2003 Identification Numbers Transaction 1D No. 667912 SITE: Site ID No. 634196 DARRELL STODDARD Please refer to both identification numbers, TOWN OF ERIN PRAIRIE, ST CROIX COUNTY above, in all correspondence with the agency. NWl/4, NWl/4, S13, T30N, R17W LOT: 1, CSM V.2,P.550, 2061 160TH AVE FOR: DESCRIPTION: REPLACEMENT MOUND SYSTEM / 600 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 806373 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 10].01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this lette head. Sincere FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 ~A Ux.. E ER E PAGEL POWTS PLAN RE IEWER II ,INTEGRATED SERVICES WiSMART code: '7633 (608)266-2889 , M - F, 0630 - 1500 HRS PEPAGEL@COMMERCE. STATE. WLUS cc: DARRELL STODDARD t i`~t i, '~.: b t is z~ g - 3 -~ / Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ....•., .:.~. rte.. ..., ec \A/:. AJ. I'.~ Page ~ of - --_. __..__ _.. _.. __...... ~~, ...~. ....... ......vv Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must _ _. County S7'; li/PQ/r~/ include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. D/~ . ~Q 22 ~ , ~~ J~ ~3 Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~' Q PropertytOwnert~ ~' I~~G // ~~~D~~~~ Property Location t L t ~W 1 G 4u~ ~~ 3o /7 ov . o / l4 S T N R ~ (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City ~~w Slate Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road ^ New Construction Use: ~ Residential / Number of bedrooms Code derived design flow rate ~O D~ GPD Replacement ^ Public or commercial - Describe: Parent material ~~EYS OU~I° OE.~1$'E 7~7~1s Flood Plain elevation if applicQab-le N ft. General comments ~j'j TE .SV ~T/~//~~ j~d/t' GO.(J~ /1/~9~P/ed Lv ~yO V.-[~~? ` and recommendations: SyST~~y . __ , / Borin # ^ Boring 9~p . ~P ~ S ~'~ `~ ,. g 3 ~~~ - ~.Pit Ground surface elev. ft. Depth to limiting factor G-d(f. • • ~ ""'~~ '' Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~• • GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ~ °'g ~y/P3,~3 L 2~S K ~ cs Z t •S • ~ 2 •30 ~o!/R ` ----- SL /7`shk nMf/P ~' S / f . y . Go ~ . ~ 7•S ~ ~ s H o TS .SGG /7~S~I~ ~ ~ ~ . Z • 3 IJ ~Xt ST!- G- SYS T iS srr 1~ ~' N~ - c o E ~ / ,vj SpiGS - S~.fSout! S~¢ Sd ~ G s' . Boring # ^ Boring ~ r,O 5•S.S . ® Pit Ground surface elev. 7 ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Etf#2 ~ ~•/~ ~oyRs G /fsb,~ ~esti s ~f . y . ~ 3 3 7• S yR c 2 ee rt o 'r~' S L ~-~+ fi' cs - • Y - ~. /D ' ~ ~•sYi~ f ^,rt ~o ~S S~- ~hsSi~ ~V~FI- 3 S /D Z d~ ^"^ ~nruem ~ r = uws > su ~ z~u mgn_ ana I ss >au _< i 5u mgiL -•~~ 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ~ ~ - ~ Signature ~~~~J~-t~~ G~~~®^ _ _/ CST Number (~o~E~T ZIL t ~l~~ / z.2f.~3"]S Address Date Evaluation Conducted Telephone Number Ulbricht & Associates Private Sewage Consultants NbTt 855 O'Neli Rd. Hudson, Wis. 54018 ORIGINAL /1-/~p~'~s jd Co.t'.~,~ . ~ 3 • o ~ i~ ~ . h~~v,~v~ . , -- ~,v ~r ~~.~rfr~,v~ L. 7~v ~a'P. /dam `mss i s. % ~%~- ~ 2,¢,~~G ~~T~ sl'S T~yl y~~s ~D ~ l9~~~D /ti S'am'%~s , ~. Sfo vv~~ o/~. - io 3~ • ~ o • ~ Property Owner Parcel ID # Page Z of Boring # ^ Boring y 3.8~ S. J.S '~ Pit Ground surface elev. it. Depth to Ilmiting factor 3~_ in. S Horizon Depth Dominant Col R d oil Application Rat in or M ll e ox Description Texture Structure Consistence Boundary Roots GPD/ft~ . unse Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0.7 ~oYiP3 - [. ~fsh~ ~CSti cs z ~ , S ~' • z • Zo 7.SY~ Y SL /f'ShK fiP w ~~- . y . ~~ o •3 ~s R GS ..S • 70 /O 4 M o TS CL M S ~U.C ir+n B~1 • , ~ ~ , S YR s/~ ~.,~ , f Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ( 'Eft#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant C l R Soil Application Rate in o or M edox Description Texture Structure Consistence Boundary Roots GPD/ft' . unsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 m9/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L 'The Department of Commerce: is an equal opportunity service provider end employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8770 (R.6/00) \\ ~ s ...-~- ~---. ~` ~ W O Ehs% 1 n .S O W O i~ io •" ~ v~ ~ ^ O ~~ ~~ 3 o, o~ z~~ y ~ ~~. _• ~ f'+ Q ~~ G G-o T" Gi.v~ G ~ d r .S~ d ~~ V .~ °O _. ~. ._ -- -~ f`~ ~ 4 __~__,0 ~ •~, ''o ~ G ~1 Z. ~~ ~ ~ ~ -P c ~ ~ ~ ~ ~ = c, `~ Z ~ ~ `h ~~ d. r „ ~~ On ~~ ~~ y a,b z y ~ ~ ~~ ~_ ~. w I° ~-~. ~n d1 O V ~~ ~~ Q V ` ~v ~~~ Q Z G ~, o. ~ ~~ ~-~. . ~r ~w -_~ ~ 0 -'- ~ ~, ~~ b ti ~' ~ ~, ~~~o ~ ~~ ~ ~ ~ ~ ~~.~_ ~ ~ o' ~ ~ y 0 a_ , ~O _~ rn r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ °~~.r,x Mailing Address ~ o' ~' property Address -~~ ~ -~ (Verification requ City/State Vi.~ ~ ti~=~~-~ 5 ~~ I L v ~ fv-a- + ,~ ~ fired from Planning Department for new construction) - . Parcel Identification Number o ~ ~ - i ° 3 ~ - 3 ° - `' ° `a LEGAL DESCRIPTION n Pro erty Location /~~ ~ i/4, ~ W '/., Sec. i 3 . TAN-R~W, Town of ~~~ ,'"`'~"'`~- P Subdivision C 5 v-~ t1 ~ . 'a~ {~ ~ ~ ° Lot # ~ Certified Survey Map # 3 '~ ~ ~ `{ '~ , Volume ~ -, Page # ~ ~ ~ Warranty Deed # y ~ ~ to ~ ~ , Volume ~ ,Page # ~' ? ~ Spec house ^ yes [ono Lot lines identifiable ($~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mamtenance consists of pumping out the septic tank every throe 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. The properly owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeym,anplumber, restrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) aRer inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. sal m with the standards Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispo syste set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of WisconsO c~e~thin 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning ys of the three y ar expiration date. ~, / O ~ DATE SIGNATURE OF APPLICANT OWNER CERTIFICATION g ( ) the owner(s) of I (we) certify that all statements on this form are true to the best of my (our) knowled e. I we am (are) e property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE artment. ****** ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Dep ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATE $AR'OF WISCON$itN FOR![ 3--1/Rt QUIT CLAIM DIrIEt~ ,V6: ~- _.. __-Qarrell-,G,-,-Stoddard and Sheryl,-M.,.-Stoddard,-----. -_}~usband--and--wife,--. "°'-"" Wit-cl:ima to ............................................................................................ Darrell G. Stoddard and Sheryl--M.-• Stocldard,~--• .....-. us>~an¢..and:_w~fe.-a$-.~uryiyo~ship-marital--,-,---• ----•--Property --•----.............----••----•--- - -- - ----- --- - --- --- -- - - -... tha following descrit,~~d real estate in .........$.t,~...C>rQi~t ................. Connty, State of Wisconsin TNIt MACt IlttiJlYto /Oa AtC0/W/N• DATA REGISTER'S OFFICE sr. cox aa, Hn R~t'~ 1a~ Rrtord aJBNo 41991 U ~pW-of0~ Lot 1 of Certified Survey Map as recorded in Volume 2 of Certified Survey Maps at page 550 as. Document I3o. 346744 beirlq a psrt of Northwest Quarter of Northeast Quarter (NW 1/4 of NE 1/4) of Section 13, Township 3n North, Range 17 West. c•~~', „ ~~ ~~~ This deed is given for the purpose of reclassifying the property as survivorship marital property. This ----is________________•--- homestead property. (is) (is not) / Dated this ----------•--- ....--IL.--••---------------•-- day of ---•----- . .....................•-•-•-----------------••---•--•-•-------•-----• (SEAL) e _------------ ------ ------•- ... ----- ---•------ - - .. (SEAL) AII?SSNTICATION Sisnatnr.(.) ___Darrell__ G....stoaaara__ and_ ._Sa1~3<Y~._.I!~:_.. $tQddardl__ husband _•and___ wife t aath ted this IL'_f'`ds of.. Jdnudry_--__-~ ly_91 --,,ll /n1 •.__ _ dith , A.-- Remngtan___ ________ TITLE: YEItBER STATE BAR OF WISCONSIN iluth° sea by ¢ 705.06, Wis. Stata.) THIS INSTRUMENT WAS DRAFTED BY -_---REMINGTON LAW OFFICES - - ---- - J tthh p~~,, udi - R--mi-----ton ------ - - --------------- 1~ Ri hm ~ ~~ 54017 ....... mil..----- ~----.°- n---e-------------------- (Signaturea may be authenticated or acknowledged. Both are not necessary.) Janu3rY..--------•-•------------•-----------• 19.91 --saw-v--`• `~-~'~"!.Y/. ~-........ (SEAL) . _-Darr~ll•-G.--_ Stoddard -- --,- ------ -n-._ . - ~'~!~••~- _~'J-•,~~~~-. (SEAL) r, _ . -YO, M. ~~o~.Ida~3 ACHNOWLSDOIItBNT STATE OF WISCONSIN --------•------•-----• ................Connty. 1 ~ Personally came before me this ________________day of --------••--•-•--------------•------------~ 19...-.--- the above named to me known to be the person ______._____ who ezecated the foregoing instrument and acknowledge the same Notary Public .............. _ .._.__.Connty, Wis. My Commission is permanent. (If not, state ezp::ation date- ----------------•--•--- - 19. ,) ~f Qum ca.~uK assn.. BTATR nAR OP w18CON31N -O!W Na. ! - Ift3 wiaeonsit Letal Blank Ca, (,K, Milwaukee, wax 34E''74~ M M C IFIED SURVEY MAP NW I/4-NE I/4-SEC. 13, T30N,R17W I/4 COR. EC. 13 - N O U W W N "N W W~ o mo w ~ '~ W o Wz o ~ J~ O 0 ~~3z Q W ~ ~ ~ O W (~ W . ~ zxz j ~F"orn Q M fA m°~"a 100' 50' O 100' SCALE IN FEET ~~!~ ~ ~ Qv ~O J?. vP ~~~0 •5 . e._ v. <~ ,+~ ~LrrEN c. ~r ~~ ,~~ NYHAG:N ;;: S-1407 ~~ HUDSON, r 'j•g"~~~6~6~li~gg BARN ,O O ~O ,O N 88°-19'-13" W 346.25' ~O , ~ Il Z ~/ ~ 7 ~~ 05.. P.• ~ ~• J~Q~ V SURVEYORS CERTIFICATE: 0 O N 3 M 0 o' O `~O X00 00 , CO. MON. N.E. SEC. CORNER SEC. 12 N I U W rn Z _ _ J ~ ~ I.. O ~ Q W ~ ~/ 1922.42' " P. K." N.E. SEC. COR. SEC. 13 ~~~ 'O~ . ~Qv~ •v t~ . J, LEGEND O I" X 24" IRON PIPE SET WEIGHING 1.68 LBS./LIN.FT. -~/~ LINE NOT TO SCALE THIS INSTRUMENT WAS DRAFTED BY R.M.W. JOB NO. 77-109 I, Allen N.yhagen, Registered Land Surveyor, hereby certify that in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and Section 5.4.2. of the .St. Croix County Zoning Ordinance and under the direction of Derrell Stoddard, I have surveyed, divided, a.nd mapped said parcel of land, that such 'survey correctly represer_ts all exteri or boundaries and the subdivision of the land surveyed ar.~ ±hat this land is located in the NW 1~4 of the NE 1~4 of Section 13, T-30-N, R-17-W, Town of Erin Prairie, St. Croix County, Wisconsin, futher described as follows; Commencing at the NE corner of said section 13; thence N 88-19-13 W along the North line of said section, 1922.42 feet; thence S 01-40-47 W, 33.0 feet to the South R.O.W. line of Country Dam Road, and the point of beginning of this description; thence S 01-40-4~ W, 382.0 feet; thence N88-19-13 W, 346.25 feet; thence N 01-40-47 E, 382.0 feet to the R.O.W. line of said town RD. thence S 88-19-13 E 346.25 feet to the point of beginning of this description. Above described parcel contains 3.04 acres. vol. 2 Page~O APPROVED CERTIFIED SURVEY MAPS ST. CROIX COUNTY, WI. APPCGVAI C~~ i~~;, 1,1::J;:.f ;U;D;YiSIGN Dos r.; :.; r.; :-:.,~; ~~~„c.vA~ FoR FEB 15 1978 B;~I~~c~:~ ;;. r~ o: s~~rlc sY:;rEnti. REFER TO I-182.~0. ST. ~ .-~.;~ _ . J,.rY Volul¢e 2 Page j5~ COMP.;E4EV51v_ PnxiCS FUNNING, AND ZONING COMMITTEE ~r, r Ep '~o~ 1978 ~a t ~"+~''"~ M M N 88 °-19'-13 " W ih _ CENTER LINE COUNTRY DAM ROAD M M 9p S 88°- 19'-13" E 0 `00. `00•. 346.25' O ,O O~ ~O o LOT I W N 3.04 ACRES ao M O d ~.1 z SHED ~t J~ R~cc~ivEO `~~ ST. CROIX COUNTY ZONING OFFICE ~~ NDV Z 7 20p1 .Y- $T GppX CERTIFICATION STATEMENT ~~ ~~ OvllM~Y FOR UTILIZATION OF AN EXISTING SEPTIC TAN y° ;~,,, ' fi~a~ ~r This is to certify that I have inspected the septic tank presently serving the ~ aa.'v~s~ ~ residence located at: /~W 1~, /V~ 1/+, ° St. Croix Sec . ~, T 3o N, R ! 7 W, Town of ~,~~ ~" ~R- County, Wisconsin. 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 l ~ - ~' - ~ Did flow back occur from absorption system? Yes No~ (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Joo 0 Construction: Prefab Concrete ~( Steel Other Manufacturer (if known) : t~J.~~d..o.., Age o f Tank (i f known) ~~( ~ c~a- l f eti ot/ e. c~ ~ ~ ~~ l `e. (Signature) (Name) Please Print ~'1 ~ Ga ~ ~a 7 7!~ (Title) (License Number) !!-lo~o~ (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 regardi certify that the tank, to the best of requirements of ILHR 83, Wis. Adm. Code outlet baffle) . Name C~ ~~~~ Signature MP/MPRS ng existing septic tank condition, I my knowledge, will conform to the (except for inspection opening over c~ a.s~o.¢--v~-~ ,2z~ ~~o ~~~~ ~3.3~, ~ ~, /~~>~3 AS BUILT SANITARY SYSTEM REPORT OWNER ~ ~c~~/,grC!' ~ TOWNSHIP~~~i ~,- ,.~ ~, SEC. TAN, R~,W p.0. AD ESS , i_. , d,,~ ~/7 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE _~~;y--~ S PLAN VIEtd Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM ^.~ ~~ ~~~ ~, ©~ ~ ~. ~~ ~~ i~. a° i -~ SEPTIC- TANK (S) MFGR. /~,~,iC~,^p`~Y~~ COI~ICRETE ~~ STEEL N0. of rings on cover U Depth („'~ DRY WELL TRENCHES No. of width engtn area EED no. o~ lines widt~~ lengt~Z area l~~ dept o top of pipe ~- '' AGGREGATE roc'-1~ _,7~ AREA AS BUILT ~~ ~ ?ERK RATE '~ AREA RE~UIREI ~,/5 DISCLAIMER: The inspection of this system by St, Croix County does not imply complete. compliance with State Administrative Codes_ There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. INSPECTOR . ~ DATED -:~ '..~~' l - ~~ PLUMBER ON JOB LICENSE #~ ~ - ~ 3 ~~~. ~~ S~f,~ . RFPOP.T OF ITISPECTTO?1--I:JDIJIDUAL SL'T~IACE DISPOSAL SYSTEi~i • ~ S~~tnitary Pernit •• r ~ State Se is O •'~' ~ ' T0~•II~SHIP e~-s~. ~ • t. Croix County r.DTTC TA'TK . ;ize gallons , ~Jumber of- Conparta~ent , ~~, ~ • Distance From: '~~ell ~ ~ ft. ~ 1270 or greater slope ~ fi. r ~ Building ` °~ft. Wetlands ~ f: Iiighiaater ft. DISPOSAT., SYSTE~7 ~,_Tile Field or Seepage Pit(s) Distance From: ~ ~~ell ~~(~ f ft, 12% or €reater slope ----#L Building; __~~ ft. Wetlands ~ f;. FIrLn r~iFhwater ft. ~ ~ . Total length of lines ~ ~ ft. i~ur~ber of lines ~ : Length o£ each line ~ft, Distance between lines ___f~__ft. Width of file trench ~ ft. Total absor tion area -=-.~ P ~v Z, G~ s q. f t. Depth of rock Uelor file ~~ in. Depth of rock over the ~ in. Cover ._ ~nver~.ro~k Depth of file belov~~ grade a30 in. SZoPe of trench ~in _ er 1~1~) ft. Depth t;o Bedrock `- ft. Depth to groundwater --' ft. PITS ~~utnber of pits ts'de d' m ter ft. Depth below inlet ft. Gravel a-rou d *~' s i no, .Total absorption area ,. sq. ft. Square feet of se page trench bottom area required __.. l S SquarQ feet of s epa . n' ar required - Inspected by: Title: ~•~ Approved _ ~ . ~ ~ Date ~ 1970 . Rejected- Date 197 . • ~ ~ ~ C..U d EH 115 . WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 ~ ~~, REPORT ONrS~OIL BORINGS AND PERCOLATION TESTS LOCATIOIVr: '/4,I~L'/4, Section ~, T~, R[.~~(or) W, Township oridl~TllCl'polFry ~ ~" I ~ ~'4'r' ~ ~-- Lot No. ,Block No. ~~ _ _ _ ~ ___ County s ~- dJ~ Owner's Name: //~~ ~~ T' Mailing Address• l~/c2QQ~~^~ E- ~~7 ~ ~ ~ ~ TYPE OF OCCUPANCY: Residence ~-~ No. of Bedrooms ~ Other EFFLUENT DISPOSAL SYSTEM: NEW ~f AcD~DITION REPLACEMENT DATES OBSERVATIONS MADE/: //SOpIL BORINGS ~i ' L ' Z ? PERCOLAT N TESTS ~~~ ~d ~ ~~ SOI L MAP SHEET ~ " / ~`' J SOI L TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- BER INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED HOLE AFTER SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P~ ,C[~N / ~ ~I /i Z ~(~V ~/~ 3 ~/Z ~~~ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) `~ G 7 ~ `~ ~~" i,C. ".C y ~' T ~~ S~ Z M / ~ y i PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indi~',te number of square feet of absorption area needed for building type and occupancy. ~ ~ r Q~ L/ 3 D ~ IQ'~/~9 i~i~b~/E.~ Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. D t~ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief-.c Name (print) _ ~~~ r ' `~ ' ~ _ _, If ati~l No. ~ ~ Name of installer if known CST Signature COPY A -LOCAL. ITY PL8~7 State and County Permit Application for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # State Permit # ~ County Permi # County Mailing Address: B. LOG~KTION: yam'/'/4, Section f~; TAN, R 1 ~7E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township~~~ ~4r'~~ C. TYPE OF OCCUPANCY: Commercial Industrial *Other (specify) *Variance Single family ~/Duplex No. of Bedrooms ~ No. of Persons D. TYPE OF APPLIANCES: Dishwasher `'~~ES NO Food Waste GrinderYES "'IVY # of Bathrooms Automatic Washer ~1=S IVO Other (specify) E. SEPTIC TANK CAPACITY /~~j Total gallons No. of tanks _~_ *Holding tank.. capacity Total gallons No. of tanks New Installation [~ Addition Replacement _ Prefab Concrete 1~ *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ~ 2) 3) Total Absorb Area ~_sq. ft. New ~//~ddition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length ~~/ Width /Z ~ Depth ~~ Tile Depth ~ No. of Lines Z ~~. Seepage Pit: Inside diameter Liquid Depth Tife Size Percent slope of land ~z ~D Distance from critical slope ~~ I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certif' Soi! Tester, NAME 9'ty L S fC rrL C.S.T. # '~ oZ 9 ~ and other information obtained from ( a (owner/builder-. Plumber's Signature MP/MPRSW# t~ sS Phone #~`+~6-~`~~~ ~iumoer~s Haaress PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). u~ ~Ld . _. Z r~~s. . _ ~o ~ _ _ -yo~ -~~ ~- A. OWNER OF PROPERTY Do Not Write in Space Below - OR DEPARTMENT USE ONLY Date of Application Fees Paid: State i ~ Count ~ Date Permit Issued/ date) _Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1 /76