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HomeMy WebLinkAbout016-1051-95-025 pYlT�4yp ` Industry Services Division Q/ 9$ RECEIVED 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) p$ P.O. Box x-1612 m, ,,, . OCT 14 N l j Madison,WI 53707-71f2 + I / Q plication State Transaction Number In accordance with SI;9 ), rs.A , `:Code,kiui�ff this form to the appropriate governmental unit 2 T (o j�O 2_ is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address(if differen)Iran mailing address) purposes in accordance with the Privacy Law,s. 1 S.04(1)(m),Slats, I N S S ? /0 4/1 :57ZE /dr I. Application Information-Please Print All Information J Property O N Parcel')/ # - /a S9 S D Z 70 6 -f t Property Owner's Mailing Address Ye, / Property Location / 3(0 /I J 1 i4 5y 34* X/ Govt.Lot ) ( !� City,S,ta�te�/ Zip Code Phone Number s � '/<, Sction 7, :3r WZJ 9;V,01, 1S�` Q p 149 7 N R 1,5'�cirEclre one IL Type of Building(check all that apply) - Lot# 91 or 2 Family Dwelling-Number of Bedrooms Subdivision Nan e A( � A ❑Public/Commer6al-Describe Use ,/' -•.l Black# �`��o alit_ IOW ❑ City Of F]State Owned-Describe Use _ I Qr QK �p CSM Number ❑y'Village of (� At own of 6LaIJX 2� T mr . Check oK one box on line A. Complete line B if applicable) A. New System Replacement System ❑ Treatment/ITolding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 210 — IV.Type of POWTS S stem/Cam onent/Device: (Check all that apply) ❑Non-Pressurized ht-Ground ❑ Pressurized In-Ground ❑At-Grade J?J�'vlound?24 in.of suitable so Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) 0` V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Dispersal Area equired(st) Dispersal Ar Proposed(st) System Elevation 40-0 Rate(gpds 4P111 2 "o /rr 0,41/' �0 v4l VI.Tank Info Capitally in , Gallons Total #of C e ° °2 Gallons Units v -2 New Tanks Existing Tanks w =M a. U in ti an w 3 Septic or Holdi k &0,0,9 �- MP _ C(// ❑ ❑ ❑ ❑ Dosing Chamber 6W4910 ❑ 1 ❑ I ❑ ❑ V11.Responsibility Statement- i,the undersigned,as respons' ' r installation of the POWTS shown on the attached plans. Plumber�(Print) Plu er's i MP PRS Number Business Phone Number -/1%41. Plumbers Address(Street,City,State,Zi ode) 4 t:--,a0 9 70,f /f � VIII.County IDe artment Use Only ❑ Approved ❑ Disapproved Permit Fee Date issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ IX.Conditions of Approval/Reasons for Disapproval 3 l a't0�1�t.nt.o Yx f 1 ��Q 1/lv SYSTEM OWNER: w/vq � P� .- 1.Septic tank,effluent filter and Y'M�o �/J,,..,,/ dispersal cell must be serviced/maintained /�t1 C {�1, ���X��' Z da, 9 All�Pthnck re as per management plan provided by plumber. Of p pp o c m c pl o tem and sub t to the Cwnty only on paper not �,less`than�8 in it inches in size L o as per licable` de orc�rn�an s. � � AC., 'lIV5 ►' (lice ( rsKl�fi Z`' Gt n,P� SPS 33+ S BD-6;9R R04ila) d)� ���►� ' I a TODD L SINZ Page 2 10/3/2014 • SPS 383.22(7)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 insuectors. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS,383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services 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 letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 CJ�� �`�l This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2 ,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WiSMART code: 7633 a charles.bratz @wisconsin.gov Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm I I z�l�oti4t,RT DIVISION OF INDUSTRY SERVICES n 3824 N CREEKSIDE LA HOLMEN WI 54636 3 + s K Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov �OssroNAtiS� Scott Walker,Governor Dave Ross,Secretary October 03,2014 CUST ID No. 139462 ATTN.•POWTS Inspector TODD L SINZ ZONING OFFICE TL SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751-5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/03/2016 Identification Numbers Transaction ID No.2463682 SITE: Site ID No. 806733 Lavern Laberee Please refer to both identification numbers, Town of Glenwood above,in all correspondence with the agency. St Croix County SWIA,NWl/4,S23,T30N,R5W FOR: Description:Mound/Three Bedroom/Sloping Site Object Type:POWTS Component Manual Regulated Object ID No.: 1506111 Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System:Mound Component Manual-Ver. 2.0, SBD-10691-P(N.01 101,R. 10/12), Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01 101,R. 10/12); Effluent Filter 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. ONOIT No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, G App stats. ,r of The following conditions shall be met during construction or installation and prior to occupancy or use: p�p St �S Reminders PS Ott OF�%01Ji • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. SSE • Per manual cited above,limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,excavation,vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank,and a minimum of 50 feet from the absorption area.chs.NR 811&812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis.Stats. • Inspection of the POWTS installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stat MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Lv; , Project Name: Lavern Laberee's Septic for new home. Owner's Name: LaVern Laberee Owner's Address: 1455 310th Street Glenwood City Wi 54013 715-308-1887 Legal Description: SW1/4 NW1/4 S23 T30n R15W Township: Glenwood County: St Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings ,ONALLY Page 4 Lateral and dose tank Page 5 System maintenance specifications t OVED Page 6 Management and contingency plan SAFETY AND Page 7 Pump curve and specifications 1NAL SERVICES Page 8 Tank specifications IDUSTRY SERVICES Page 9 Plot plan ORRESPONDENC Designer: Todd L Sinz License Number: MP139462 Date: 09/23/14 Phone Number: 715-235-2644 Signature: (e6g7ned Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01, R. 10/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for fecal coliform of-36 inches. 1.50 Peaking Factor(e.g. 1.5= 150%) 450.00 Design Flow(gpd) 10.00 Site Slope(%) 100.00 Contour Line Elevation (ft) 22.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ftz Are the laterals the highest point 1 Influent Wastewater Quality(1 or 2) e g p in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.188 Orifice Diameter(in) 4.00 Estimated Orifice Spacing (ft) = 11.84 ftz/orifice 2.00 Forcemain Diameter(in) 200.00 Forcemain Length (ft) Does the forcemain drain back? Y 76.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft)x 1.3 32.62 Forcemain Drainback(gal) 24.79 Vertical Lift(ft) 67.38 5x Void Volume(gal) 2.75 Friction Loss(ft) 100.01 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 24.90 System Demand (gpm) 30.791 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. I options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x I x 3.00 2.00 x 3.00 x Gallons/inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.00 Se tic Tank Capacity(gal) Total Working Liquid Depth (in) Huffcutt Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 640.001 Dose Tank Capacity(gal) Lifetime Filter Filter Manufacturer 15.231 Dose Tank Volume(gal/in) I LT1/8 Filter Model Number Huffcutt Concrete Manufacturer Project: Lavern Laberee's Septic for new home. Page 2 of 9 Mound Plan and Cross Section Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t . . . . . . . . . . . . . . . . . . . . . . . .::::::: — J 1110 B Observation Pipe I• 5 A . . . . . . . . . . . . . . . . . E • . . . . . . . ........ : : : : : : : : : : : : : : : : : : : : : : : : : : : : : I :. :•:•:•:•:.:.:.:.: : : : : : : : : : : : : : : : : : : : : : : : :•:•: : : : L Mound Component Dimensions A 6.00 ft E 2 1-2-01 in H 1.00 ft K ft B 75.00 ft F 9.50 in z 13.11 ft L ft D 14.00 in G 0.50 ft J 5.67 ft W[Aft 450.00 (ft2) Dispersal Cell Area 1433.04 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.96 (ft) —► ,nrii.,.... H -,rrrrrrrrr rriiiii... G I F rrDispersal Cell 101.67 (ft) Lateral 101.17 (ft)—► — Invert Dispersal Cell .::::: Elevation D - 100.00 (ft)Contour Elevation 10.0 %Site Slope Geotextile Fabric Cover Shading Key T Dispersal Cell See lateral details on 1�® Topsoil Cap 0 c 1.5 ft Page e 4 for number, M Subsoil Cap 0 o r '` ' '`` size,and spacing of laterals. Laterals are Q ASTM C33 Sand 1° � "'."' ' '•'�'��'� F equally spaced from the Q 5 ft Typical LatpraTilled Layer 0. distribution cell's © Aggregate V o centerline in the •A. * distribution cell(AxB). Project: LaVern Laberee's Septic for new home. Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered overt the A&8 dimension �=Turn-up wlbalIvaWeorcleanoutplug P rAll at erals are identical IF X�I Holes drilled on the bottom of the lateral equally spaced rce main connection via tee or cross to manifold at any point. Laterals Morcemain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 4.08 ft Lateral Length (P) 73.44 ft Orifices per Lateral 19 Lateral Spacing (S) 3.00 ft Orifice Density 11.84 ftz/orifice Lateral Flow Rate 12.45 gpm Manifold Length 3.00 ft System Flow Rate 24.90 gpm Manifold Diameter 1.50 in Total Dynamic Head 30.79 ft Forcemain Velocity 2.54 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and-� SPS 316.300 WAC 4 in.min. Disconnect _�_ Tank component is properly vented iz E- Alternate outlet location Forcemain diameter Huffc_utt Concrete Manufacturer 2 in. Capacityl 640.00 Gallons Volume 15.23 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 22.96 349.62 B 2.00 30.46 C Pump off elevation(ft) C 6.57 100.01 ~— 76.88 D 10.50 159.92 D Total 1 42.021 640.00 iF Dose tank elevation(ft) 3" Bedding un er tank. ~— 76.00 Alarm Manuafacturer SJE Rhombus _—� Note: Switches Alarm Model Numbeq Tank Alert AB Duo T containing mercury _ may not be used in Pump Manufacturer JZoeller s this system. Pump Model Numbe Bn153 -- Pump Must Deliver 1 24.90 gpm at 30.79 ft TDH Project: Lavern Laberee's Septic for new home. Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name T L Sinz Plumbing Inc. Phone 715-235-2644 POWTS Regulator's Name St Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 f:2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for ponding and seepage once eve 3 ears Other Call T L Sinz Plumbin for our service needs. Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •..�•.....•.•. ............... Grade .� 6-8" Diameter Lawn i Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Lavern Laberee's Septic for new home. Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-10691-P(N.01/01,R. 10/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01,R. 10/12)]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 SPS 383.33,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. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Slats. 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. 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 wi th in the tank i t 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 as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. 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 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency 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(s)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 absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 PUMP PERFORMANCE„CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 15111.523153' PER-MINUTE so EFFLUENTAND DEWATERING 14 4 1 :I ? 12 40 MODEL 151 152 153 Je 15L Feet Meters Gal. tilers Gal Llters Gal. Liters 1 10 5 .1:5 50 189 69 261 1T 291 i JO 10 3.0 4S 170 fit 231 .70 265 a 131 15 4.6 J6- 144 SJ 201 81 231 ,1.0�:.. 44 167 Sj.,,: 197 , 2 8 20 6.1: 29 • 1 at a �r 25 7:6 2g 12 159 a 20 30 ...9,1 .::.. ..23 °.,97 ...., .3J z 125 ... 22 85 35 10.7 - .. 4 15 �,.. 40 12.2 ii /2 I 10 shut-of Head: 30 n (9.1;n) 39 n.(11•Bm) as n•(1J.am) j O14SOaB 8 0 80 90 100 GALLONS LITERS 40 l0 1 0 1 0 2 240 280 320 360 FLOW PER MINUTE 014909A Model 151 Model ..:1:52.1 153 CONSULTIACTORY.FOR &1132 1111 SPECIAL APPLICA�':IONS:; „B J2r;J2 151 Timed dosing p.anola available.Electrical alternators,for duplex systems,.Are available and 327132 supplied with'an alarm, -`� 3 27132 Variable level control switches are available for controlling ® J7/3 single phase system:. •Double vIggyback variable level.float switch are available for varlable'level long and Short cycle controls. •Sealed Qwlk•Box available for outdoor installations.See FM 1420, •over 1301.(5.4•C,)special quotation required. I i /:.. }... .C. .. I 12116 ' � r3..7®rtes 1111118 1i111i ti3 MOtS control selection s ve Model Volt}-Ph Made Am a Sim lax Du lax N151 1115 1 NOR 8:0” 1 2 or 3 eN1S1 115 i... A'te e:0 included 2 or 3 1 2 0(3 - SK2064 E151 90 '.t t:'',Non.. ; SK2444 BE151 230 1 Auto:::t:>•3.2 Included 2or3 N152 115 1 Non a•3, 1 2 or 3 BN 152 115 AtilO 8.5 Ineludod 2 or 3 152. 0 1 an 43 2or3 1 3 :. U 0, 4.3...,..Included 2 or 3 N1 11 0n.; f05 2or3 BN153 115 1 Auto . 105 Included 2or3 SELECTION GUIDE . E153 230 .1 Non 5.3 1 2 or 3 BE 53 30 1 Auto S 3 Included 2 or 3 1. Single piggyback variable level 11oat switch or double piggyback variable level float A cAUT1 N switch. Refer to FM0477. All Installation of centrois,protection devices and wiring should be done by a qualified 2, See FM0712 for correct Inocel of Electrical Alternalor EPak Ilcenso electrician.All electrical and safety codas should be followed including the most 3, Variable level control switch 10.0225 used as a control activator,specify duplex(3) recent National Electric Code(NEC)and the occupational Safety and Health Act(OSHA). or(4)float system. RED DESIGN 1 RESERVE P:OWE , For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump: ,<^ �—----- MAIL T6,-P.O.BOX 16347 Louisville,KY 40256.0347 manufaclurers of.. SHIP 70:.:M49 Cane Run Road w I �70� I m Loufsv111e,KY 40211.1961 oV.fl/tY 0444V rJrNCE�9Jc7. ,A (502)778.2731 1(800)928-PUMP MF `Q W(502)774.3624 hKP1 1/W4rwsa9 0 Asom F-------------- w I I I I I D C ' � r m � I D I y -1 N D Z w V A 7C r �� r 55' t'1 = m ---- 47' 8' i n a rq p r i Q C 3' 44' CA G O ri I��1 UI tNJI N r*1 Z y-4 !O 0 v A m CAC c� I- iO�j m wL------ a 20, 2' m r w °c a ra D r � � o All/ A a, .r-. 'l < r „ A m o Z < 0 r+i d m > a 00 a d a = N \` 1 ]3# L u=Al Io N n oA O C1 D n cmj Z m t' a m z It It H '� Cf-"I f<'7 r m o c-) a m oN m H? A3 Dcl) N m A a m -4 m tzp m > m 45' 1 10' A C-) ?= H C3 0 42' < t'D-Di m� Cp A z'O O w D m;o O C-) < C;o N m a r p yz � A D N ti Z HURCUTT 4154 rd STREET � N.P.C.A. CERTIFIED PLANT PROJECT, CHIPPEWA FALLS, WI 54729 a�� & 1,000/600 GALLON ` Q MEMBER OF: PUMP OR SEPTIC TANK c o n c R E T E i n C 1715) 7723-71 1 . (800) 924-1516 NATIONAL#WISCONSIN PRECAST CONCRETE ASSOCIATIONS FAX (715) 723-71]1 ■ www.huffcutt.coro �- ;w'/ Alp) oe _-- X1. - S posy �rG p„� /s pVgff 1041 o� �Dp ay 0 SOIL EVALUATION Rte' pa cf RECEIVED ;n vm WO VAL�. c� ^ canjal�e : notbw n mx if�ln abL Plan mwt `is PwcW*skMWd9 57-9._-h25_ ST.CROIX C N Ty Dab „OMMUNITY 0 go Z - p y PfopwwLocomn GW&Lot �GJ 7141i1I(�/f{4$ Z T��j N R E j l�f Pqx*oxm�smdlkQlAddMW Lot#- 8iod�# sad Mrne orpSW /-'rL,f0ul 0,4A(,�Jf L613T(v�,r- %.5-1gf) > ►� tr ee 3 +bdeas d �os�aee 2 oonime�-oncom pautnuallm FOW PWM dwmd=itappIcabb r .J 4r.A Si `Q-^' i$o T 7 0,,,,,�-e k"-,S"Q D f a bOO r7�Z Fsofng# �i pit fm Hoftm -DqM Ombn*Cdm lb t omawm Tea Skudm (woe Bowdoy Rams Y3 5Y y .5 Z,,,s W'S'r ZFl C5-C c� s to%� apit cam ►. IL DW&ID b*rf? -I- Hatwn 0mM DonimmtCdm rAftDascftdm Teas s C=Wdwm Botu dwy Rods GPM f2 NUMB tom.ft CMIL cobr A 6t Sc Sii .EM 6"5 65t'leylpi Anb-vUZ_ _,51 0-6' I (�� �p �! r�etd 75S c 3D W l •a6�5f wd sKiYlW1 T i`" /S�f `E1=HOD s>90_22�lIpA.seldTSB>�<9$p * a Tie fleet.of8ft oW Pr+nfieW"knim ffi m qW WWW*wviwPoW4wwd=Vqm JfT=wW ce to saxes services or mod ma4ciat in� £off co�ttbe depe�mp�ffi�pg-�6 31ST ar 1TY RAY• it ,t ..t mm�/W WN BEER Warms mm ..; ►.!� ■ r • � .mot' ;,. + .-. mmm mm M��Mmmm mmm � bQ. �t•u��. Z a� 361 V 1`�V� ., •. e r iGC�a-o227$7?i rJ -�1=1L1� 5� ra3,ao(q Ur V G/U 4 t- -�.�hit l If3 0 i; • cT /'fin IX COUNTY SEPTIC TANK MA1NTENAN(ar: AGREEMENT AND r O'WNERS142 CERTLr1CASI0N VO;RM ti Mailing Address �� r© ert Y Address P - - - ► ���� __..r. (Verit�nn )?I:rerluireA fYn I Plnnniaay..Pr..Z_ning PnpartnZent SOY 1aCw conshr].Ctl 11 ) City<State (- l�Gt/DDa C1 Y, I � ParcelIdentifie-,itionNumber eb ............. PrapertyI.ocatioII�w ifa l�.f 1, t/a , Sec. ,T ?oNN R Town of ��Z._h100 Cz .� Subdivision 1 :N, -- - � _..�_�.,.__ . ' ! .. , r,ot# ---- 'Certified S.urvO,mAp.## VW - ___.._. _._ volrtn>4 .` _ ,. >ago#�.__.— WRrrauty Deed,#' l ' — _ Volu.tile / O Pago $ ec house' es no Lot lines icientif n able es ' R:::: y' i S. QWN z CERUE11CATION Iittpioper use apd rr imonaiice.of your septic system could result iu its pramature failure tc:hand 10,wastes, prvl]er niainteria 4 consists of. ur iping,out the'sdptic tank every three years or sooner,if ne(:ded,by a licaused 6 caper. V+rltttl:you put into the aymtom eantaMeot t'ho'ftinotion Of the septip.tank as u tr,;ntinwj,t stage iaa foie waste dispusu1 Syskzm; Q�'u !: I'rlWlllt4r]i1[1CG raspotisibilitlesi artsApcciti .d in Comm 83.52(1)Anil in Cfaapmr 12-St. Croix County Sanitary Ordinance t ' 1'ha;pippof%y;';;,'.lYtlgx.agi�erb'to,aub3nit to ut. croi-A Cottony PlaIw;; ;& i:i+ttiub L)�I+ttlLtttcttl u c;Ct li}14 tiara'tbti»;mt.8rtdd by foie }, Uwrier grid:bye'rtr�t��ly �};j,ptupeyihptiplurnber,restricted plumber o'r a liceitsec7 pua��per verlfyiuLa i;�t(1)flan o.n=sett: wastRwater dispe'shl:cytsteui'is i�►,praper opernting condition and/or(2) after impaction and pumping(if n c ssary),4 o septic tank is odes tiiart.l/3:tll:sifs:luclae:: . It .Uwes tha'undersigtied:1mve read the above requiromuu'ts nand agree to naa.it:ttai$ flee priva're sewtig q sposal system avial toad SLRYdiI'tjS JGt.futtla;�Ia:FCirA,'7I�1:;yCt. by,Q%a Duparcmant of Cornmerct and the]:lcparrment of Natural Xesout•c��� siatc:rat•Wisconsin. Cerafictifipn stating that your*opt tc system has been rimintained wart bu cvmpi(:wd land rr,tunied.to the s., `roiK County Phoinin.g& Zoning•Deps rbnextt within.30 dAji.of the three year expiration date. I/we ctzt'iiy th S:all'.stateingttta tizt this¢form are tme to tilt best of my/our knowledge, 1/wc:a. at'-(�le 0. net(s)of Cliff. p>operiy dcktibed 4baye,by:vi>rttie.ofa Watranty deed recorded in Register of Deeds Office. V APPLICANT(S)SIQNA,T"CJR.�E..OF: TS) �' ! 17.a.Tr.. ***Any information'that isp tWsrcpresented may result in the sanitary per init being revoked by the lalannin ` Zoning epartiinnt. I wolude w4h this'.application a recorded yvWanty deed fzora tlio Register of bonds Office and a copy of Ilia 0 rtitiad swwey snap if reference-is tuade,in the.warranty!deed,' ... t TO 3Jtid n-117M3df1S SNOSMO 817VL99ZSTL 9Z tt7O VTOZ/80/01 ,d • Vacmmmr M+D .fie ,'s7'ATfS •A�. COlr�-•JFO1W stAmnam".Oslo i.7���f.•a�� rMtiR �R,CE R S�EQ r?rt'rte�: MISTcfi �stss'scitso. �t..ie tAat,�.ra�"site^3z�M �: .._ ?,�t fil Iz• ��� - - .'• ST:,�C�C?0'Jf CO.. k�lS:' • mss ' _ 'L`«.3 a Grantiar d ��C -. .�►.A D and.�.� ''_rwi .a .A'r p.vP 3 8+a'i .t...�.�r��w 'i_..�:�p-'g="y � 4'r..:�i•'�': p �r :�t,�,��ryr rA�r'1 'r .��•��—rt' - ,��1:r.; i a i8''L"�9 - _ �'Y- '��� � ae1�,.c• .t6 ,tifbsral" �a ts.Ytaw.for'pV3uabie coal! ft,lo a , Vestal e�cols aa. a5etsmrs to t'yaoiee the IfioUO tag dem--[bed at Wimotmomakm: CT i ry 1/4 ^-Z' la ctlan 23 �•1%s XCP.,:t r�4i�^. 31PS. Petit :youth . o 'C1he MF C�Drnc ?f 9; feet Tea 1l }`. a the srorezalA 3�ct�cn 2�; 111i�t.ce g Tti t '•,'.raV`` 11 ys:Q1.C� a =3 0454 :1.'4rvt- Chonce �'I ��`�S '�°F4+;.i t�?a�C@ 11 '�� U.... also Q .v;�:�l also ex*094 the parcel d,eed6d ',� _st. .S'chrl r s.;Ls `d pl�c' E,ai i�'0,_it*i�P �_:"�, :�Z:+t"` 's=[:x►'3.i'�t'.L' ?, 3s3 i stu;s? .� cazt�aesi oiit4� 'LC::rs, xt���.arT.c 'i:.'.'.: 1J2 of the T1 1,�`?•4. o� S: rorA�;.;` �,O-i ,: .ex I o°^t, *�a '�1:t4!"tR�'z.st^t r�tc 1Q sad •' �y' .:.' ' '`�: ., .• -t~ .a n:' �r( f11rlr� 'also EtaCtl6r"r �' x �2'• rte► 1, * l;3. t:� ea4 2 8t�' # '�' :�.'•.. ' r� srr•,•s+A ht +rY a V*dexio.'I t:c nd BanVz of St. �`mtal.• �x�_ l: l�: ittia'.:lvliw.. } ust.tisr. ����_�. ALSO, Part a� trig im 1/ .�� t* :r8 ..s f n.l. paarts .© tiztt _`:, "s �'� o�J rise : : ?.:�� 4ll section 22 cownsh3 30 I�iclzth, � � :e'f�bGC'�, Gritit'�Y rah fit. Cro-LA ��+s.�e vs: 2ca.COnsi'iya •ra�x-C p�z�lt..�1�.1a►T. .f awscrie .r.: Cctiitr`ai•t(�tt!(i� :sx d:'.hslsa s'dt 1 f1� of :asa.1d eation�Z2'� 'lhenf� ' c r~rsz r t a r`eesii �a-st z~ the si it o c T010'."• r,';SSimms 400-rim .44�% '_°r?o rr:�•O-z1aa -treat 86d2 :�'F1'et':' 'h*� ic_2 .:SoL?�Y3 ,.AS6 :reef,,.' .r Lvss , to *hoe 0.,:art(; rig^ •m' -uey off' state TvAnIc Ai_iW_,eky 12#j' Thirri;%o . ^r-jd s,��t't ' , �w.a' ve `s�:�: :+:$st*z-1v r1a;1At- Q±-t jLY off' S'to e. Tr'unic FIISKw. A.V ..7� cit t-V omit) *See Clack side for cart.i't�t7;ed, de•ecript�cn 711 1 Togtrll+or ritIt all xiagylat tha huraditatnenta and appurtenanedc tlwrmLmto m'rjvogi[gg; •ecttaJ+tIt that the title is apeod. indetlanatlrle in fee ximpte and trees and Mesa of eatevulbzwacei: a Fcep't= -V-FJLJAS 111 MW`'iii WOO-rant and defend th'e stills*. _ �� Opted titia - � ___ .w.»—day of. �ttif - r 'Z9 Sr-+. • r flJ . ?r LA T^(SEAL) (SEAL) .(SEAL) SS.r L i_�Yt�ed'y (34AL.). s41 9 -.v " --........_-._. ... AVT04214TfCA-rioN ACK1tC1YfL OGMIti'1T i natures autbantis d i 19615P-dair aF n't'a? uF �LSCOtY511r } Q } Pars ;ilfv came before 17, this day of f. the abyve nomod TITLE, MEMBER STATIE RAR OP WISCONSIN yTe 1�?; r. .'Z L�shy px.l nj A1 41f not. authorised by 1706.06. Win. Stars.) _--- Thit instrument was dsarfted ey - ,,.... ri lcr...•� !,:. to me known to be the Petso who executed the fore- going instrument and acknowll dged}he Sams. f 7 (Signatures may be authenticated or acknowledged. Both area not nedlessary.) Notsfy Public_,..,.•,._ fir.^ sir - rrty. Wia. my commo.xJun is patnimrs-1110 (If 1644, ztJt• Cx soon date:— 19 ) rrfafnas of pe►ea+a aig'MiAg in snip captltlty onus( bt eypee4 or printed b0ow their signatt,ros. - •• WARCf ARTY DE6A-6TATS Irr.K 00' WISCONSIN. FORSe HO. '+-077 i TO 30Vd n1VAa3dns SNOSWaO 8VV2S9ZST2 ZE :b0 bTOZ/60/01 •• � .. ' .• ..• . ' VOL •.6=30 SAS: .' SM 1/41; .T-he^_Cei y^.rFaB- Stlom 1*'ynE :. 7':� ^_° 'a��C -.^:-±�� :E-f•� �• '�-d'_�- . S,Outhaast 1/4, tt? the ".!oint T •'�E,':SC:."'�tTf:� -�.$ �'033�'+SiS CQ*.:.:r°�r1,'-Cy'. ��' .r:Ss� r`w3�,'� •... L�`` si�.°t) .,:i°l:+•w.•:.": ...�_ -. ri'1�5i11C� itSt �7Z foetj r..•hencC 60v4'„-; ?`"O �Qat ; ^-E .- g ig Th,(Frme 'South �--3+7 ,i$'!!t; Thence 9�F2 feet, t= • "!'h�nf:le CoSxLL-iulrx� L';�:st: e5o mac; :,,.J- css- 7.�aw; :''�s�c=" :��-'�'.-:��^:� a:'$uY ;. r'F'���j.R1G8 west v4 tilt@ j;,or t—aaS -'e:'' . riCht -L`'^*.':€� Ii rnCr.!" along + o 4"'`h 'It+t ^4 fir:° '•..,��'0 Stat_9 Tt"'Y3L':dk H1dIFP':2M�= ZZ`.s ="c.`r:-w•-=r9.'j'!y'2°.l 7 ;,) a�'c.;- 'fir.• %� :i-�'; -i' d:':'a � Zola.ei.�' ' I r I I I I i 'I • I I i I • I I 1 Z0 39Gd f ivm3dns SNOSW�JO BVPZ99ZSTL ZE :b0 17T0Z/60/0T Wisconsin Department of Health and Social Services Plb. #67 10/64 Division of Health PERMIT APPLICATION for PRIVATE DbVESTIC SEWAGE SYSTEMS P USE BLACK A. OWNER 0, PROPERTY TYPE Oil JS... BLA„K Ihh Name �' Address (Street, City, Zip Code) t ; County B. LOCATION OF PROPERTY WI,?RE SYSTFTI 14ILL BE CCNSTFCUCTED, ALTEREL OR EXTENom) J Check One: CITY' VILLAGE LEGAL DESCRIPTIONS TOWNSHIP 1� �� !jr _;/ (l,r C. IS LOCAL PERIIT REaUIRED FOR TH YES NO �-- � / PEWIT NUMB..R D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION ' f REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NLMER Or TANKS TO BE INSTALLED: i? •" _/ E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence Commercial Industrial Other :�' (Specify) " Number of Persons to be Accommodated Number of Bedrooms y) ^ F. APPLIANCES, ET-Cs Food Waste Grinder YES NO Automatic Clothes Washer 'y YES NO Dishwasher YES �V NO Automatic Potato Peeler YES "NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number' of Lines Seepage Beds Length—Q-% Width' Depth 11111 -/ Tilp Size _2_/_No. Lines 7 J Seepage Pits Inside diameter f' L Liquid Depth �\ P E R C O L A T I O N T E S T Test Depth Characte_- of Soil Hours Water Test Time Drop in Water Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last 4To Fall 1st Wetted OverniZht in Minutes Last Period Last Perio Period'One Inch Example P- 0 3618 Top Soil 10" C19LI 2611 25 Xes or no 30 1/2 1/2_ 112 60 12, RECORD DATA ROM MIiJIMUM OF 3 TEST HOLES j ompute size of absorption a.-,a in accord with H 62.20 Wis. Administiative Code. S 0 I L B 0 R I N G S - Minimum 36" Below Prop osad Absorption System ^i oring Total Depth Depth to Ground Water_ Depth to Bedrock umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Ino?".Ps Example - 0 72" 72" Black Top Soil 12"• Clay 1811• Sand-18"• Gravel 241, RECORD DATA FROM MINIMUM OF 3 BORE HOLES _ COMALFTR. (Yi NRR STnv I , Is the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Codes and that the data recorded and location of test holes are correct to the best of my knowledge and belief. �1 4 NAME /".. .- /� I //' TITLE (Type or Print) REGISTRATION NO. or MASTER PLUi13P R LICENSE No. ADDRESS tJ 41.:'I DATE �l ;" SIGNATUtRE --7 i MASTER PURR ER MAKING APPLICATION MP Signatures �. li .'" Licensa Number: -- MP RSW (To be Co pleted by Issuing Agent) J Date of Application � �% /�� Fee Paid Permit Issued (date) ��✓ Permit Number_ IV Agent (name) For`�.,d" Town, Village, City, Countys etc. (Specify) Notes The appli'ation cannot be considered for filing until all of the above questions are answered and the fee paid. Agepts will forward application, the fee of $10.00 and Copy (b) of the j Permit (yellow copy))to the Di"fon of V 4tf. Checks anA/money orders s 61d be made payable to the Division of Health. / Do not write in space below — FOR DEPAM ENT USE ONLY DATE RECEIVED 1 1 C ACCEPTED BY ����- RETURNED (Initials) (Date) tsee Corres.) FEE RECEIVED VALID. N0. ��• J� ` PERMIT NO. �t a l C' (Yes or No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COMMENTS: �I I i