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HomeMy WebLinkAbout018-1064-80-250~ C7 Ul Q ' ~ '9 C7 d .+ I ~ ~ ~ ', i a ~ ~ ~. i v ~ , m I ~ 3 m ~: ~ ~ I ~ ;: ~ ~ ~ ... ~ ~ h o ~ o ~ ~ v ~~ `~ i I c ~ = o ai O rt O y ~ fJ ~ ~~.. ~ N ~ n' ~ O CD s ~ y N b y ~ ~ _ ~ O ~ ° 3 O i ' A Q w I y T n ~ ^t O O T~ O ~ O n 7 -I A O ~ Oo W ~ ~ N a • n y O W N ~ 3 y 7 O O ! ~ ~ ~ I ~ v D -_ N m a N m <i~ ? y a o ~ 0 W O ~ i N ~ ~ 0 ~ „' ~ ~ O I ° ! ~-° o ~ N ° ° N I T ! ! - Ut m ~J ° ° m '~ n r N ~ I y o o ' N ~ a ! ~ o o ~ ~ , I -' ~ ! I o- O O ° ' °Y O - - I -~ ~ ~ ~ ~ /ny! ~ N N to ~ o ~ Z D . v s < ~ v v v ~ A ! (.p ftD N N ~ A ! I = m d _ ~ m ! W . . y ~ ! `z N I j ~- c I °~ z a ° z z~ ~ I o ~ D D o , ~' O 7 I 1 N v ~ d ! O ~ I O ' ( IF O C ~ 1 I ~ d C I ~ I 7 ~ -~ to N A Z A ~ :P ~ ~ •• '' Z N O ~ ~ cD I a ~ ' ~ o z ~ ' ~ $ ~ I a ~ I I ' y I z ~ ~ ~ A ~ I A o m I ~ I Q ~ I o. ~ ~ O ~ T G I a a I m y o ' I i I ~ o I A I i a ~ z ~ I ti ° I o I ti I ~ ~ 'b b I ~ ~ ~ I o O ~' F ~ I o •- I ~ S .~ , Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, 6.15.04 (1)(m)l. Permit Holder's Name: ussell, Francis ^ City ^ la e T n of: ~a~mQnc~"~ownship CST BM Elev.: l b~ Insp. BM Elev.: loo BM Description: ~ r TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W~'Sr (rC QSf (/ v Dosing l r ~( ~d A ion _.-------~ -- Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ S / / 7-3.~ 3d / 3~ / NA Dosing ~ ~ 7 / ± ~ 3 r NA Ae NA Holding PUMP /SIPHON INFORMATION -~ 5 Manufacturer ~ J" Demand Model Number ~ GPM TDH Lift ~ Lriction,Z ~ Syste~ TDH t Forcemain Lengthj"3~ Dia. HHZ ~~ Dist. To Well ran ~nr~nnT~~u ramie-Tr~~ i 1 .f. -, ELEVATION DATA Count~~ CTO1X Sanita{~Rprrhit No.: State..3SPIaVVnGGIDbbJJNo.: ParcebT~ ~~)64-80-000 STATION BS HI FS ELEV. Benchmark d z~l ~ ~,~ ~ t. Bldg. Sewer ~ O ~ ~ Ht Inlet ~' ~ . 9 l 3. ~/ Ht Outlet Q d ~ _I Z , Dt Inlet 4 Z . ~( Dt Bottom b S',S Header /Man. Q , ~~ ~ ~ Dist. Pipe ~ Bot. System ~ -~ S~ ; Y Final Grade St cover S/ ~' C w~~riownrrww~r~r~ivi 5j ~ ~~5 bDl BED /TRENCH Width ~ Length No. Of Tre ches PIT No. Of Pits Inside id Depth DIMEN I N ~ ~ ~ ~ D N G Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION TypeO ~ ~ / AMBER Mo tuber. System: - -~~ 7 ~ OR UNIT DISTRIBUTION SYSTEM Header / Manif Id / 1 Distribution Pipe(s) ~ r x Hole Size ~ ~ x Hole Spacing Vent To Air Intake Length ~ Dia- L Length ~~ Dia. ~ Spacing ~ [/~~ ~ ~~ `~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil s ^ No ^ Yes No CpMMENTSS: I I co Iscrepa c p ns ec ion d Location: 'T91 lb~t~i Street, Hammon, ~i Se~~~ ~/' 1/4 29 T29N R17W) - 29.29.17.441 1.) Alt BM Description = ~ (~.~ ~yy ~ (,v4~ ~ ~~~ t~ ~j~ ~~~~ 2.) Bldg sewer length = 3rf S / ~,) ~k y Dc~ ~~ !, C vca~ ~ ~o ~i '" ~~ -amount of cover = ~ (~ / / / / Y ' ~ ~` ~(/y 3.) contour = ~; 2 to r~ ~; S Q" ,~ ~~e ~i~f p~y~s 51~ 2(~ .~br j~' Q e~S C~ S l r~ ~,(/ Kw~ ~ ~~~.. G(fJfc~.~- Plan revision required? ^ Yes ~ No Use other side for additional information. ~ ~~ SBD-6710 (R.3/97) Da a Inspector's ig ature Cert. No. ~. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r ~ I e o __. __~. .,~ ~_ S~ ,R. t , ~ .~ > .m~ __ m_ ..~. _. ....E ~ .._.~ _ ~ w. -- a _. mma e _~ I ; _e .. I _ ..,. P _a ~ _P ~~ .~ ~ ,.. i i ..~. e~ __ °~ _ .~ 3 .,.. ~ e®. ®~ ~ ~ ~ ~ g 6 __.. ...» ~M ~_ v ..3_ _...~ ~~ € ....r m ? _. ~ _ _.....___...i a ,, w:~ _ : _. _ _. .... _~~ a. ~ ._ e a~ __ __.~_ ae ~~_ , ~ ~ ~.. ~~_ ma_ .,m~~ ,~ e.m .. ~ ~,aa ~,. _.._ S iii"`i'~i[e+ ~~^~r^r. SANITARY PERMIT AP .L TION ~. ._., In accord with ILHR 83~'GV~s.~P.dm Code- ~" ,t • Attach complete plans (to the county copy only) for the system, gtlp>er dot less; than 8 v2 x 1 1 inches in size. t '. • See reverse side for instructions for completing this application ._ The information you provide may be used by other government agency programs ~, , -,~ ~. (Privacy Law, s. 15.04 (1) (m)j. r/ ~ Ir P ' Safety and Buildings Division Bureau of Building Water System 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 county S Cr-o< to Sanitary Permit Number 3~o z~'~` Check if revision [o previous application - ate Plan LD. Number ~ ., I. APPLICATION INFORMATION -PLEASE PRINT ALL INFO ~IVPATION ` ~, ~/ 'f Pro erty Owner Name K Property Loci ~ n ~~ ~iaViw-;~fi4, 5.2 T .~ . N. R j ~) W Property Owner's Mailing Address t Lot-Nnmb'er Block Number `11 I /oo '~ ~ ctnr..m~~ w . s Y o is Cit State , Zip Code Phone Number Subdivision Name or CSM Number n~n.~n.a~+-~ ~ ~ ~' ~l c / s h> 57'46 - ~ II. TYPE OF BUILDING: (check one) ^ State Owned ^ city ^ Village Nearest Road +,rit ~I ~ G ~ '~ ^ Public 1 or 2 Famil Dwellin - No. of bedrooms Town of o . • III. BUILDING USE: (If building type is public, check all that apply) ` Parcel Tax Number(s) Zoo ~~s~'h~ s~ra~``~ °/$-/D6y- 8 Z ` ` ms / / q 1 ^ Apartment/Condo 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other. specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ^ New 2. ~ Replacement 3- ^ Replacement of 4. ^ Reconnection of S- ^ Repair of an ______System ________System~,____________ Tank Only______________ Existing System _________ExlstingSystem B) ^ A Sanitary Permit was previously issued. Permit Number ~,,Q, Date Issued ^(, R-• 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 Pressure l 42 ^ Pit Privy ~ / / '~''~.~ 43 ^ Vault Privy 13 ^ Seepage Pit C~ X 9/ 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFO~RMATIO 3 ` ~ Fi l G El 7 d 6 S p p o na ra ev. . e ystem . . Area 4. LoadiPSg Rate 5. Pert. Rate Area 3. Absor 1. Gallons Per Day 2. Abs r ~ t ~-0 ~ Required (sq. ft.) Proposeod (sq. ft~ (Gals/day/sq. ft.) (Min./inch) ~ Elevation B~F '[ ~ 5 m t w ~ 3 ~ 9~ / /~ s et oos ee pp i lo . . , . VII. TANK INFORMATION Ca acit in allo s g Total ll # of k r Manufacturer s Name Prefab. Site con- steel Fiber- Plastic Exper E i i ons Ga Tan s concrete glass App New x n st strutted Tanks Tanks eptic or H~I~.ank /oo p /flo0 ^ ^ ^ ^ ^ L Pump an nn rF,amber ~~~ SD r ® ^ ^ ^ ^ ^ ONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MPlMPRSW No.: Business Phone Number: Plumber's Address (Street, ~ Mate, Zip Code): ~ ~ ~~ Qf 6 ~ R O~,~o,,,~"d ; O IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee ('n`iudes Groundwater ate Issue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) `¢ 3 2 ~ Ov ~ Adverse Determination Z Xy.~ CONDrITIONS OF /APPRO,[V~AL// REASONS FOR_/DISAPPKUV/AL: ~(suc>'p(ajs~ ~ ~~ ~ (®K) ~/ 71' etGr ~F'~ s~S/~in~- /~ ~C QA'IG~Gr ~~r C.~R~~, SHD-639H (H. OS/94) DISTRIBUTION: Original to Court y, One copy To: Safety & RuilJingi Diva.ion, Owner, Plummer INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county priorto installation ~... . 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815, _ To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system isto be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. Vli. Tank information. Fill in the capacity of every new/or existing tank, list the total galleons, 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 isto fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 1 1 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 1 15 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ~ ~ ~scons~n Department of Commerce June 08, 2000 OUST ID No.226375 ROBERT W ULBRICHT 655 OTTEIL RD HUDSON WI 54016 eatery ana ~smiauiys PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary ATTN. POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/08/2002 Identification Numbers Transaction ID No. 321464 Site ID No. 193571 SITE• Please refer to both identification numbers, Site ID: 193571, FRANCIS RUSSELL above, in all correspondence with the,agency. ST CROIX County, Town of HAMMOND; 160TH & CTY TRK TT NW1/4, NW1/4, S29, T29N, R17W FOR: Object Type: POWT System Regulated Object ID No.: 667118 MOUND DWELLING 450 GPD 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 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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/installation/operation. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otential for a lawsuit that may delay the effective date of the code so this status may or may not change. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. S' rely, ~~ AMES B QUINLAN , POWTS PLAN REVIEWER Integrated Services (608)266-3937 , 7:00 AM 3:30 PM MON / FRI JQUINLAN@COMMERCE.STATE.WI.US ~` cc: FRANCIS RUSSELL ~~i~~ a~ DATE RECEIVED 06/02/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7,633; ~'. UL~BRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designerso/Engineering Systems 715-386-8185 Private Sewage Consultants RECEIVED JUN 12000 PROJECT I ND~FETY & BLDGS. DIV. DILHR Plan I.D. # Date ~~0~ 1'7' Q20~"Z~ Owner ~~~,V~~•s iE (JSSE LL Phone 7/S • 7~/G ' ~ fr 2-/ Address ~9/ /~a ~ sT ffff~I.~t dv!~ ~~• s~/C~/S Legal Description p/,V O/~ /d~ t~•~Cj. p-~ NW NW, See c. ~. Q , T z ~iV, R / 7 cv Town of ~f^-~M ~,v~ County S7~ C (?D i 1~ C.S.T. ~p(.~E~-~- L-~2tSE 2.ZCo(53 Installer Local Authority/ Supervision ST-, ~ ROf X CTy ~,~ 1 NCr ~~. PROJECT DESCRIPTION ~9' ~c'~p~.~~E~ r ~ i- sys i , ~til o v~vt~~ ~oz a,,,,_. ~X t S T'i~G- 3 /3 E-vvrpM . fl~~i.e . ~ST'i ~ ~T~o ~~r~y w~ S 7-~lo~v = ys~o ~s . Say/S ~~ s/a~v~~ ~~~,.' ~i3/.~ ~„~ •~~ ~~ ~~ l~ 3 Z T~/~,e. ,`10Utiv ~'YS7~-~_ ~ ~ U~ ~o ~ covfm~ ~ ~~ , oL /V'(,r'rr- 7~'i Eif"%~I~vi 1`~ ~ff-~t~s ~'IiOGV,I S'7`~'N ~, ~/~('n` S T- e~ : /~,~iDtiiovre ~/S: > ~S-~'~~G ~ 2l f~ ~ i ~. i1,v J~id'~Dv.-~ f}130Gt-~ ~jP~. ~ a cLc~:v /Lj~.,v~,v-~, Pg.l PLOT PLAN VIEWS ~~~ ~ CCU ,f' S Pg,2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS r< r,,,,..,,._y ~, Pg , 3 PIPE LATERAL LAYOUT °" ~ `~~' ~ _ ~~ j'~'' ~~~r~a; .V^,= ,~ "•"` ~ - ' ~: ~ ROBERT ~' ULBfl)f~f1' P ~ .4 DO I _k !~ a 9 S NG CHAMBE I~ : ' . ~'" R CROSS SECTION ~ .~ ,,.~ ~ ~ . ~ : ~ p~~~ Pg . 5 PUMP PERFORMANCE SPECS e~Pa~TMf~r c~- c rv7~~c 'L~- r% ~~DIVI~SiO~~~ JFETYA~U~~~;'~y~~ ~~. ,.. ~ - ten,,,, S I G~ (; ~ nnrmm~mn~an~ I This design for installation is based entirely on mea uOements,Nelevat;.,r~ landscape conditions (slonee p~~ ~ ,~a ,.^ - -~- - •, ~~ D -tit ~ 7-- ~rn~r D~ -W D 0 ~ ~ ~~ZZ G o wm~n ~~ w°D~ d ~ `~~uTiO ~ ..~ O l7 ~~_ mid ~ ~~ ~ 7DDZ ~~~ ~, c ~ ~ o ~~ N o ~ Q ~ ~ r~~y ~ w ~~ I O ti ~ ~n ~~ o_ I ~ i- D ~ y ~ ~ ._ _ ,_, ~.. Q ~ o ~ o ~~.~~ dG b ~~~ n ~ ~~ ~ o , ~° ~ ) ~ ~ ~, ~~b ~ ~,~~ `~ ~ ~ ~~ ~ ~ ~ b ~ 0 y ~ 3 ~~ j. ~ ~ ' i .~ ~ .~" -~ ~' \ 70~~....._.. ...- ,," -~ / ~ ~ ~ ~ / • ~ ~. ~' V` / ~ ~ ~ ` i i r ` r > > ~7 CL7 O ~~ "~_ 4'7 CT ~_~ ~0 ` ~ An 1 ` III. °~ m ~~ ~~ ~ '° ''~ ~\ • , • • I ~ v~E R T' o F ~ I r4T~ R r4 (S ~ ~ ~ ,~ ,, ToP of dock I~•3~ s ysr~µ ~g•~ EIEV~}'1'~ °iV Page Z Of S Straw, Marsh Noy, Or Synthetic Covering Distribution Pipe Medium Sand H G Topsoil ~ :____ :____:~, _J I E ~ ~; . 3 ~~ ~wIFDRM ' y ~a Slope Trench Of Z~~- 2i2 Force Main Plowed Q'? s~ Aggregate Layer Undisturbed' 0 ~ ~ Ft. Soil E ~ 2- Ft. Cross Section Of A Mound System Using F • SS Ft. Trenches For The Absorption Area G ~ CJ Ft. A y Ft. H / S Ft. B ~y Ft. K ~ 2 Ft. ~ ll8 Ft. J $ Ft. Alternate Position of Force Main I ~Ft. -~.. W 2(o Ft. L J I ~-- 8 K A'r----- --- - ---~ W Observation ~ Pipes I y~o Distribution ~ Trench Of 2 ~ - 2 Pipe Aggregate CE~TRA~, MAui Fc~t.p D~sT~~(3uT~o~ PIpE NETwoR k T~T~L UD~v~r~ o~ NET-amore ~ ~y 7~ ~'~S . P _---- -+•r .! ...f Dig-~R1~3uT1arJ LATERAIS ~N~ ~~P 5 ~. `( x X i F'UG F;oRGE ~ AsT Nn t E s N h 11 t3E NE~r Td ~Nn SAP ~ Fr ~N~ERr ~ tEVAr~o~ 99.0' VotD Vc~luM~ ~oR 35 ' d ~ ~ ~~ ~o RcE M I4i N S, 7 gA~s. T~EI~FvRArED P-PE ~ETAi L ~~ ~ 1 I-- •I VARiA(3LE y Y otsr~NCE P y5 ~ r R X ~~ i~ch~s Y -~--8----- ~ -~ ~ ~ ~ 5 Np1ES Ic~cATEU o~ ~ ~~rroM sH qtl f3E (,2 v hll~~ SN/~~ED . Hote DiAH~TeR L atERA ~ +' MAt~I FoLU n ~oRcE M/lirU ~~ #~ o~ I~olES/ P i p ~. y~ ~~ . <~., i ~ ~' t N . ~- ~N. ~~ DISTRi f3uTlc~iV UtSc.HARC~~ RATE PER LgTER/ll., /~• 7Z ~^I /M~~', PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4~~C.Z. VE~JT PIPE 25' FROM DOOP„ WIIJDOW OR FRESH P.IR IAITAKE ~/'A pE. ~ ~E b'17~0 n/ q1 ;a ' !~ ~ ~'- S,(~ 9~ ~~y ~ 11JLET ,~--VENT CAP WEATHER PROOF JUIJCTION BOX 12"MIU. GRADE E A ~N5 aN K ~ ~o~~ B - g~ N ,. c 1. D ~•~ 1 a COIJDUIT I I `-- V `~ PROVIDE AIRTIGHT SEAL F.PPROVED JOINT IJ~C.I. PIPE ~XTENDIAIG 3' ONTO SDLID SOIL. G3 ELEV. g~. FT. 1 33 PUMP -~ `~E DPI,' ~ k io,J ~~ /E v,h f BLOCK P~yE_~_°F--s_. r APPROVED LOCKING MANHOLE COVER w~ lu~1,fN1NC~' ~f1 /3E i I I I .~ --~ 'i° MIIJ. 1 ~. = I B" MI IJ. III III APPROVED JOINTS III WfC.=. PIPE III ALARM EXTEIJDiNG 3' I I ONTO SOLID SOIL I I~ oN ~I a OFF 'Z/SE 3 ~~ ~.- RISER EXIT PERMI'TT'ED ONLY IF TANK MAIJUFAGTURER HAS SUCH ~1o,PE ~~ ~~ APPROVAL SEPTIC E SPEC.IFIGATIO~.IS DO 5 E Miflll~E'ST~7~,y ~,~c ` ~r- ' S PER DAy 1' r TANKS MAIJUFACTURER: IJUMBER OF DOSES: !Sd GALLONS TAA1K SIZE : ~SO ~~~ DOSE VOLUME /O ,Q,/ G~~~L. ' I,~ ~ ' GAE~oNS INCLUDING BAGKFLOW: ALARM MAAIUFACTURER: ~,/~~ /~ MODEL NUMBER: ~' ~~ L' ~ , GALLOWS L INCHES OR .s CAPACITIES: A= SWITCH TYPE: ~~0~~ ? , B= 2 INCHES OR -/~~,,~ GALLONS ZoE/LEJp C=~IWGHES OR ~ ~~ GALLONS , PUMP MANUFACTURER: ~ ~ ~~ I t ~ LONS A R L 2' /3' ~ MODEL NUMBER: - ''l r y G L INCHES o D = ~ I~~r SWITCH TYPE: P~~~Q~~'K NOTE: PUMP A1JD ALARM ARE TO BE MM ,,~~ GPM ATE CIRCUITS INSTALLED OIJ SEPAR MINIMUM DISCHARGE RATE~ L 9 fi~~F SEC'S "~~ VERTICAL DIFFEREAICE BETWEEAI PUMP OFF AA10 DISTRIBUTIO FEET N PIPE.. _ ~- MINIMUM NETWORK SUPPLY PRESSURE 2.5 _, FEET E/1GLl.. ~ ~ ~{ P . -F ._'r_~ FEET OF FORCE MAIN X 2~G-L F~oFi.FRICTION FACYOR.. ''` ? FEET .~-/,VG'S !~ 7S I `~ (7 ~ ~Z = TOTAL Dy1JAMIG HEAD FEET = ~ ~ IAITERNAL bIME1JSIONS OF TANK: LENGTH ~ ~+ ;WID`fH `~ / ~~LIQUID DEPTH *, ~P~. S d~ S =-, ZOELLER EFFLUENT PUMP MODEL•'98 ~, , t`lOW PER MINUTE roru orwu+q Ntggr ,,,urt } flrlVlNr 1W0 OtWA1tIY„0 ~ e~-~crrr VMllltlMlN I![T Mtt[RO a-rs erns 10 ~ ~ 1f Try et tt ~ ~ ~ Uo ~n r! Iro ~ o! lock Vngh `T, . 11 CONSULT FACTORY FOR SPECIAL APPLICATIONS ~ Electrlcer eMerrtelors, la duplex systems, ere available end suppNed with en alarm. a Mercury Itoal swdches are avallable for controlling single and ~.M~rkst aAsrnetae, idr duplex systems, are avallable with a e pa,a~ Ise systems. w~hlxri Nsrm ewMches. p ggybeck mercury Moat switches are avallable for varleble level bng cycle controls. 8lsndsrd eN models - Wsiphl ~0 Ibs - ~/, H.p, N l.rlos - t. r,r•oraaa.reportlsA: °ELECTIONGUIDE •. ~ moeAonleal.wheh no o r Atodd A19a Y h~P •~_ Abdo Am ~ Control 3N.etlon almatox d , x !. eln t. i ornd earUol loqutrod. C P OOrb.ek moreury Rory owhch a double t~i0ybaek maeury, Moot twhch, rbr.r b fM0/71. 110 t uto 0.6 ~``-' ~ J ~ L _ u loll - ~. Moehurlcal ohorneta r0 001 a 10-0011 6 OOtI 2~0 1 ~_ /L . ~413~l- 1. 0o FAAOI IZ, tar oorr~ct mod.l d Eteclrlcai AhorMra, ,•E Pok~• 6. Alorcury Nruwr (teal twh h tE0° t~0 t ute '~ T 1 a 1 t 1 c TO-0Q23.IM!d 4 y ooryrol uellvtalw .ptregt• dupl.x (0) o- Iq (bol.yuant 1! .>1 x 1 ~ .. ~ a 1 t s .. , s' it~.Nl I+oa "1 PaR". wne8ari bwe for y ~+narbn or wkod~h dm• pM+r a dupbo oP+r~n to ooo~ , 1. Ne ~ lrel. `~.-, .• l ~ ~ a woltrMplrl eem..__...y ~ FM ~~I~ M Www M4r M.d - r uc N « b wab0 en Cembinr.eon sun., ru,,.... -.T 1/s 1 !/1 ~ a/e ~°. . a s/e • n t ~ ~/It- t i/Z-It 1/2 NPi Labor and Human Relations ~ v ~ ~' ~"~ ~~ v ~ r ~ c c v r ~, v r- ~ ~ v ~. n c r v n ~ raya ~ ur Division of Safety ~ Buildings In aCCOrd with ILHR 83.05, WiS. Adm. Code ' +~ .. COUNTY _ . • 'Attach complete site plan on paper not less than 8 U2 x 1 f inches in size. Plan must include, but Sr~ • C/20 / X not limited to vertical and horizontal reference poirrt (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to ~aarr~sf~o~d: of -• ~(b APPLICANT INFORMATION-PLEASE PR1NT,.~~[~.~ tNFORMAT)ON R D Y DATE ,~ v PROPERTY OWNER: f ~• ° PRQFERTY LOCATION F2 uSS ~ ~ GOVT. LOT 1/4 1/4,S T ,N,R ~ ' tl~ W PROPERTY OWNER':S MAILING ADDRESS ~ . ~ , ; ~~ LOT; BLOCK # SUED. NAME OR CSM # / ~ S~, • . CITY, STATE ZIP CODE 1'~» PI~QJVE NUM '!~ ^CI~'Y ^VILLAGE ®iOWN NEAREST ROAD (J New Construction Use (K] Residential / Number.of bedcoomsy ,` ~~ ~ (]Addition to existing building J,hQ Replacement (J Public or commercial desCrrl~e -~--N'~ Code derived daily Bow ~~ gpd Recommended design loading rates 2 bed, gpd/ft2. 3 ~ ch, gpd/ft2 Absorption area required~2So bed, ft2 ~.SUD .Wench, ft2 Maximum design loading rate ~? _b/ed, gpd/ft2~,~trench, gpd/ft2 Recommended infiltration surface elevation(s) q~-S ~ ft (as referred to site plan benchmark) Additional design /site considerations e v /'' Parent materials/c~ C~ a. zli~~~ Flood plain elevation, if applicable /y~i~ ft ~, S =Suitable for s stem CONVENTIONAL MOUNO IN-GROUND PRESSURE AT GRADE - SYSTEM IN FlLL HOLDING TANK I U =Unsuitable fors stem ( ^ S IBU ®S ^ U ( ^ S ~U ®S ^ U ^ S ®U ^ S (~U SOIL DESCRIPTION REPORT Depth DominantColor• Mottles T Structure i nce C t Roots GPD/ft Horizon in. ~ Munsell Qu. Sz. Cunt Color exture Gr. Sz. Sh. ons e s Y Bed ~Trerrh i o-$ ~.S Rz•sfz s~ I m~ c s s 1. ' 3 _yz s ~ 5 J. ~ sbk `(-'! F2 14• S • 1 ~/ ~ ,'`/ , ~~ I ~ o R t ~.o n ~ ~a 4~.c~ ~ L~.3 .2 - 3 " a cE ~ V ~ S ruD ~r't" ~~rmer n51 S ehc.e n o ca Var l~/` (o Y` Remarks: ~ b roi~ r1 ~"t su tt "~ ~ 3 ~ 1~~.~low ~. IUu fc ~ J 8 t Q_ 5 e z%z 5. ( 2 v-~ sbk Fle C s 3 ~ , ~' .2 8 - 3 2 s 2 '~ ~l• ~.. ,Z yn Sb k l~ Ft2 G S ~Z. •~ s , b r 3 z-~y s ~l ~ s~. 1 c$ b k m ~R G 5 ~~ ,~; s~ S 1P6-18 •~ ~' R `110 5 c.. I Y''! ~i - - NP z Remarks: CST Name:-PleasePrint~v~Crt ~,t$~, Phone: `S ~~~- g3b~ ' ddress: ~) ~, ~ G l 30 ~' St : e ; s sy?sl Signature: ~I v/ c. Date: CST Number. 3/ ao a2~G/S PROPERTY OWNER F~RANICI S~uSSC.I,~ SOIL DESCRIPTION REPORT Page~of PARCEL LD. # Ulf - I bL ~ - ~O -00~ ~ ~ t Boring # v 3 ~~ti «> Ground e1~2 ft. Depth to limiting factor ~, ~_ Boring # ?~::~ 'r~:;^;a i~:, ai$ac.:e.:y:::n. Ground elev. ft. Depth to limifing "• factor Boring # .: :~: ~~ :. .;;,~µ~~t~ r } Jcdi'M:aati:::: Ground elev. ft Depth to limifing factor Boring # ~v :S v4;{~ Y >ni~ 'ry u• `mi~:~~hVY Ground elev. ft. Depth to limiting factor rizon H Depth Dominant Color Mottles ~ Texture Structure Consistence Y Roots ~ GPD/ft . o in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed (Trerx~ I o-~• ,SR,z•s/ sl ~Z r'') sbk MFR GS 3M .s ~- ~ ~-,2 •~ ~ .y/ s~ l 1 ~ sb ~ r~ F~ G s . z ~ . 3 3 y-33 • .s2 S~G S,C 1 c s6k Mv~2 G's If ~'~/ , 5 y 3-~ •~ sQ 8 Remarks: Remarks: Remarks: ~ . Remarks: ~ . ~ F Owtt~et'Buyer ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER"I"iFICATION FORM R :Mailing Address '7 Y l l lc ©t~. ~f; rl. ~ . ~yD rs Proptxty Address ' (Verification required fmm Planning DepactYixent for new construction) (;~ity/5tate ~~ CJ - Parcel Identification Number GAL DESCRIPTION d 18 ~-- ic~~'--80 ~-o©o ~' O Propet#y .Location /~ r"J :, N' (,~ %., Sec. ~ T~N-R~,;ZW, Town of ,. ;, Subdivision Lot # ;.. ;C,~ert#Q~d S_ arvey Map # `4jolume .Page # wstcz~tnty Deed # ~ !o o ~ "? 8 'V'olume 3 ~~ .Page # ~ to ~3 ,:: ~; , Spot douse D yes ~ no Lot lines identi5able D yes (~ no ;~~~ ,~~~ Iaatuopa~sesadm,oeofy~oarscpticsysGemconld r~itm itspt~aefa~neto l~andte~rastts. Pmpermaiotcaanoe of oat ma P taalt ~y ~ y~ err soon, if n~oodod by a licensed pamper. What mto the am'stliact~tbe fim~oa of the sic tamlc-u.a-h~m~artstag~e is waste y'~ P~ ~~a3-s~- ~- _ ~ :' _ 17x P~P~Y~ owner s8roes to :trbmh to St. Qroiz Zooing ~ a ratification form, signed by the owne~c and'by a ~ 1~~ymaapUambe~restricbod Iumbaora +~ ~ p liccns~.tpraapcr vaifymg that (1) tha oa~ite Rras~watadisposal sysOetrc ~ ~ is Pte' ope=atiwg condition and/or (2) niter inspection and pamping.(if ncoessary), the teptic~tank is less .than lf3 full of shrdge. ~;. , . ~ 1~atre ratd tfre above n~ and agrx tex anaintaia ire private se~avage disposal sysbcm with dbe standards ~' net ~ort~, ..u t~ by lire Dopartmwt of a and the of I!Iatural Resoaroes; State of Wisconsin. C,ectifcxtica si /fit yogi szpti~c system has boea maiatainod mast be oompfctz°a3 and reburnod to the St. G~+oix Cormty Zoning Office within 30 days throe year ~ lion date. '; ~' ~ ~~// t/~/1 ~ ~ ~CitdAZURL~ OF APPLICANT DATE n O~VNTR~ CER1'TI?TCAZTON I (we) certify that all statements on this form arc true to ~~rA best of my (our) knowledge. I (we) am (are) the owner(s) of Ply ove, by virtue of a warranty flood rxori~+~;c,3 .in ~Legister of Dads Office. ~. ~ OF ~1'LICANT DATE «s«ss« My iufon~atioa that Is mis-represeatodmay t+esult is the sanitary pgrmit being revoked by t~e,7~[ining Deparhnent. s~sss ,` 4« Inclnuk with this application: a stamped warranty decd &nm the Register of Deeds office a copy of the certified:urvey map if reference is made in the warranty decd v 111-1~1 JI1:.\'I.UtI i '„ II/N'1'NI: \'1111i1~ ~ • ~ ~ ~ g ~~I r. ~ ~ • nu* 1 >~ 1 `111..151 \1I:\ ~1 .: 1'1:11 ti'1,\'1'1:4 '~ I`Il:it\\I itlt l:\I I ~~ I\'11:11\\I. Itl:l l:\tl: ' ~t'1' • ~11 .11 /~• ~ i ~ i ~ 1.~~1i li. . ~ ~ 11111.1, ~\ II ;