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HomeMy WebLinkAbout020-1491-12-000 ~ N O t ~ ~ l ~ A eo I .~ ~ 1 I ~ ~ I ~•~• •• I ~ a~i ~ u=i o o~~ I ~~ v o', o N 7 j LJ d~ ~' fD 7~ N 3 OD CO n N 3 Q~ ~ 7~l• ~p f~D n N ~c c I W °' Oi U' O l _ c~ rn °' < m o °- 0 0 -p c~i l a m v y n d I °• o~ n m ~ ~ ~ ~ c ~ c 3 ° ~ c 3 I 1 0 N N ~ ~ ~ I cn ZD C erp~a. nl I ~ v> v D m m Dy ~ a X• I m c ~ jm I ~ 3 a '" o o y ~ Q o I fD O ~ ~~~ I N K CD O Z ~ W N !• O N ~ ~ ~ (yd N I x I ~ ~ ~ v 7 I ~ a z 0 0 0 z I o ~° I ~ ~ ~ ~ ~ ~ I ~' o ~ ~ ~ to yr to ~ I ~ m ~ I o ~ m ~ A ~ °' I o' ~ m ~ m ~ v I m i a l ~ n m I ~ I n, co K y a ~ ~ z O C -i Z T ~ M 1 ~~ ~ 1 ~> > °-{ 7 ~ O v y I ~ y y ~ C < A C ~ ~ N (O (D A D C W (D . O .y . W fD I o. 3 . ~ rn I o n 3 Z I ~ ~ N c ~ I Z ° ~ u, I ~: o. I ~: I ? I ~. W ~ I a 3 I I p I y Z I f I V ~ I O O N d Q N N ~ ~' O Q S Q I _ G m ya. o_ : ~ I noi+y a : E N O o C y N o I ~~~~w ~ I w~ov I ~ ~ ~ ' o •°•' I ~ ~ ~ o m w y~ n N N ~ p ~L W o • I M ~ I ~ N O ' 3cc 2 - 'm m I o~ d o I ~~ I a m m o I o a m~ ~ G1 •+ . d ~ N ~~ V N F ; d ~ I ~ O ~ I N y 5'm ~ I ~ tp y O ~. y N O ~ ~ Q - ~ ( D f ~ I ~° I 3 ( I p I p ~ Q O L O ~- c ~ ~ ~ eo A ~ ~ M ~ W VJ N '1 J rn v v ~ c Q C7 ~ o a X c°o a°o °_' ~_ ~ ~ °~ ~ co (~T oW °w D X ~ ~ ~ a O~ O~ O~ ~ ui vi vi o 'o ~ O a bpi v y. w ~ m ~ m o- . a N C fn Z = ~ ~ o c 0 0. ~ o N ~- N < ~ C _ =h N ~ O- O O ~ ~ O c c. ~ ~ a °o 3 !~? Z O c C a ~ ~ 3 ~ o S'~v d~' ~ .~. C W N O. N O ~ ~ O rn o w C ~ b °~ o y o c 3 .. o. •• ~ w 0 m N ~ 1 N A 2 <D m ~ W Z z ~ m ~ A d rte. V! •~ eI~ I•~I O ^e ~1 O ~• 0 ~• a a A A A '~ ti „~O O tin h ~ A ~ V W AS BUILT SANITARY REPORT / ~., Owner S'T, C',~a~.L~c ~'t'/tL ~©orT C,~-/zrA - OF1~-r'C~S ~ ;`, -- Address ~6o S• R©l3h"RT Ste' t . r City/State ~'f ; .~,~.uG, itrr~y. S"S'/o 7 ~ _~, ,.. I _~ #/jy,^~~h~~ "'Y. f ,t ~~ll'I"t, ~ P-~ ~ ° ~, ~ ~:~ `r ~'t ~' ~~r~ ~~' Legal Description: f ~ ~" .. _ .. Lot Elock -- Subdivision/CSM ~ ~ ~~3 6.SZ '/4 ~, '/< ~J Sec. f 3 , TAN-RJ~W, Town of ~GtpSo.tJ PIN # ~y~ y~ 9 t3. tct.l~?,~( 3 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: iT'~ank manufacturer 4/~'..~s'~TL Size ST/PC~____ /;/~,~etback from: House 7~Q_' Well ~ P!L 7d0 ~ Pum~~ manufacturer w uL Model ED v y Alarm location ~,~~, FF~~' ~/ y- / v~ 6~'-L T~q,,vts ~ 2 cr/ z.~.d~'L F,~TFRS (HOLDING TANKS ONL" ~ Setbacks: S Meter locatic Alarm locati SOIL ABSORPTION SYSTEM: Type of system:.~Z~cf/ Width 3 Length /0 o Number of Trenches s Setback from: House~,.~ Weller P/L9_~ Vent to fresh air intake > /A9 ~ ELEVATIONS: Description of benchmark ,~be ~~ ,t/i~.~, ,~ Of' sssrs~CL Description of alternate benchmazk a ~ . Building Sewer ~- 2- ~8. Y9' ST/HT In et93~ps 93.G~ S Outlet ~ PC Bottom 7~.6~~ Header/Manifold '!'~ Top of ST/PC Distribution Lines ( ) ~t~:l~ ( ) '~S. 98 ( } Bottom of System ( ) ~ ( ) ~y ~'~ ( ) Final Grade ( ) ~- /D4,D ~~ ( ) ~.~t yRc~ Elevation ioe. o O~ ^ Elevation ,~/a y,~ ' 8~. s t3~ PC Inlet Py. / ~, ~ ' Manhole Caver s s y7 0 (} Date of installation 3 I1/ / Permit num r 353 I / 9 State plan number -zy sy~9 Plumber's signature License number 2~ //~U ~ Date / / od ,. Inspector ~//..~~ ST. CROIX COUNTY ZONING DEPAR'C AC RtIR T CAN~TAQV QGDl1QT Completc pbt plan ~ vR©p ~x s + ..j Y ~ . ~8 ~ ~~-` ~ ~ ~ ~ NOTICE: Please provide the following: o ~ ~ ° $-N 4 • A plan view sketch showing everything within 140 feet of the system. ~ ~ o~ u ~ ~ ~ ,, u $ ~, ~ ~~~~~, • Two horizontal reference points to center of septic tank manhole cover. ~t ~- ~ a .0 O ~ ~ '+ • Show alternate benchmark, if applicable. .~ -~' a -PLAN VIEW ~ ~ . ~ ~ ~ p ~ (,° 0 i ~ ~r ~ ~ M ~ ` V 7 ~ • •- _ , q --- , '~~- h N ~ 4 ~ ~ ry M ~W ~~, t~ ~ N M qq 'K ~ ~ v ~ b X: I ` ~~ t1 ~` i J ~j I ,~ _ _ ~ ~ ~ N' ~' ~ t° ~ a ~ ~ ~ ~ I c ~ ~ _ INDICA E NORTH ARROW r M 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, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ®Town of: Girl Scout Cam of St. Croix Valle , Town of Hudson CST BM Elev.; ~ Insp. BM Elev.: BM Description: r (30 . D / S ~. ~e C ~ GS'I S InA~ r ~rvn rr~~ vnwrr~ r ww TYPE MANUFACTURER CAPACITY Septic~I Q.c.O~~-5 ~ z g « ~~ c~ 1~ ° rt ~~ TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ~"1 ~teor >!60 / >/oa' NA 9er~3ig~ ~" °~ 5 )oD r NA • n 3 w u ~,, NA Holding `' " PUMP /SIPHON INFORMATION / ~ ~; Manufacturer S i, ``p Model Number ~~ C f GPM TDH Lift ~~ Lriction Y~. Systems TDH,p,+{~ft H ~ Forcemain Lengt):~,. Dia. ~,~/ Dist. To Well SOIL ABSORPTIO SYSTE ~L) ca..~.~ ELEVATION DATA County: St. Croix Sanitary Permit No.: 353119 State Plan ID No.: Parcel Tax No.: 020-1016-60-000 STATION BS HI FS ELEV. Benchmark '~,~ pg. Z ~~~~ / Alt. BM Bldg. Sewer ~ s ~ t ~ t7 ~` St/ Ht Inlet ( I`{. Zi ~-Z ~ Stl Ht outlet C! ~~, ~~, q3?"~r Dt Inlet Dt Bottom Header /Man. -y /o .o ! ~$. ~{2 r Dist. Pipe 36 S t°'`f0 r 8 0 2 ot. System «, So 6 ~ L' final Grade +~~+ g"~ ~ r 99.5~- I St cover T L fv• 3° - ~-} loZ. IZ q~.~~-r ~. ~ 4- s~, ~, sv ~ r. ~ z ~ )0.80 ~~-(oZ` TRENC Width L gth No. T nches ~~ p1T No. Of Pits Inside Dia. Liquid Depth DIM 3 ~ ~ v DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ~~ INFORMATION Type O ~ r CHAMBER Model Number: System: ~(~ S3~ yiw OR UNIT DISTRIBUTION SYSTEM Header / Manif 1d Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dal Length ia. pacing i 3Q SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over N ~ Depth Over xx Depth Of xx Seeded J Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 0`f/o2/ oo Inspection #2: -~1-' L,o~c~at~'on: 65 Alex 1~,er,~Road Hud o WI (N 1/4 NE1/4 ection 3 29N-Rl W) - 13 29 19.73 - ~j - Cs ~ ~ ~ Plan revision required? ^ Yes [~( No _ ~--~! Use other side for additional information. ~` G-~ fGb ~1 ~ ~b SBD-6710 (R.3/97) ~ ~a~~ C1a~~l:,t~xa~°",~nspedor's Signature Cert. No i' r t 9 ~.ISCO/15%11 SANITARY PER a IC In accord with IL `~. s. e ~••~j Department of Commerce ~ ' ~rt+ ~~ ~~,~' [L, s Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, Wt 53707-7302 • Attach complete plans (to the county copy only) fort stem, on paper ess~ `O _ c unty ' than 8 v2 x 11 inches in size. to ~ ~ • See reverse side for instructions for completing this a )~tion ST D~X ~ -: Sate Sanitary Permit umber ,~,.~. Personal information you provide may be used for secondary purposes \ xOR~N ,,/'~~ \' ~ " Check if revision to previous applicatwn [Privacy law, s. 15.04 (1) (mj]. ` E -'~ __. s1 `~~ r State Plan LD. Number I~IIiQ r ~.~ I. APPLI ATION INFORMATION- PLEASE PRINTALL IN" ZY~~ Z "' Property Owner Name Property Location ~ G f'GDGtT ~' ®~ ~ !/ i4 1i4, S T ~ , N, R E (or Property Owner's Mailing Address _ Lot Number Block Number Q9 ,~' ~ ~ -r--~' City, State Zip Code Phone Number Subdivision Name or CSM Number L N 2) ~, ~ II. TY E F B LDING: (check one) ^ State Owned ~ !t~ =~i( yy Nearest Road Public 1 or 2 Famil Dwellin - No_ of bedrooms '"'~' ~ Town OF O III. BUILDING USE: (If building type is public, check all thatapply) arcel Tax Number(s) ~ ~ ~, ~~ 1 ^ Apartment/Condo .ZD _ !O!6 r d 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 ~I 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one boron line A. Check box on line B, if applicable) q) 1. New 2. ^ Replacement 3. ~ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an -__ System ________System_____________TankOnly______________ Existing System ________ ExtstingSystem B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued --- V. TYPE OF SYSTEM: (Check only one) ~ c' Q~,,~~"S ~ Non-Pressurized Distribution Pressuri d Distribution Experimental Other 11 Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 Seepage Trench 22 ^ In-Ground Pressure , 42 ^ Pit Privy j 3 Od Z V - 43 ^ 13 ^ Seepage Pit ault Privy 14 ^ System-In-Fill '~G ~ .~ VI. ABSORPTION TEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate ~~ystem~lev 7. Final Grade h l ) q7. E ev to quired (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inc ~ Q /® L Feet ~pt eet VIL TANK INFORMATION a acft in altos g Total # of Manufacturer s Name Prefab. ite Con- l ber- Plastic Exper. N E i i Gallons Tanks concrete Stee glass. App ew x n st strutted T nks T nks Septic Tank ar Holding Tank Z ~ ~' ^ ^ ^ ^ ^ Lift Pump Tank rc:~~r / ^ ^ ^ ^ ^ VIII. RESPONSIBILITY TATEMENT Et// Z,~~,~ f+~1~RS I, the undersigned, assume responsibility for installation of th onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Stam ) f4fP111'JIPRSW No.: Business Phone Number: ~- ... Z t~'e - 6.t'6 umber's Address (Street, City, State, 2 Code): v IX. OUNT / DEPARTMEN USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuin Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) ~ ~ j ? ~' ~ Adverse Determination _ . ~, rX. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: / ( ~ ( ~' SBD- s DISTRIBUTION: Original to County, One copy To: Saf ty & Buildings Division, Owner, Plumber 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 tothe county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) mint 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, 608-266-3151. - ~ . • 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 is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab onsite constructed ;and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc,), address and phone number. Plumber must sign application form. IX. County /Department Use Only. . , X. County /Department Use Only. {omplete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points;. C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer, D) cross section of the soil absorption system if~required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practiceswvhich can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. isconsin Department~of Commerce September 16, 1999 OUST ID No.259518 Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 2648777 www. commerce. state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary ATT7V.• POWTS INSPECTOR ZONING OFFICE ULBRICHT & ASSOCIATES ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 09/16/2001 Transaction ID No. 245429 Site ID No. 167594 SITE: Please refer to both identification numbers, ST CRO]X County, Town of HUDSON above,. in all correspondence with the agency. NE1/4, NE1/4, S13, T29N, R19W Facility: GIRL SCOT CAMP /AMERICA 965 ALEXANDER RD, HUDSON 54016 FOR: Description: NON-PRESSURIZED IN-GROUND SYSTEM /REVISION TO TIN 212826 Object Type: POWT System Regulated Object ID No.: 452294 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 ter 101.01(10), Wisconsin Statutes, is responsible for compliaa~e with ~ code rerquiremen ,;~, ~~. ~:ir ~ ii~so~!+ii~ira~lw°~'il~le~~,a~usi~' ~atd., aMM9~1' ~~. "~' .~ , . ~~, ,. slla~ r`~val. - r= 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincere , ~; TE PAG L , P WTS LAN REVIEWER II Integrated Services (608)266-2889 , M , 0745 - 1630 HRS PEPAGEL@COMMERCE.STATE. WLUS cc: SCOUT GIRL SCOUT COUNCIL OF ST CROIX VALLEY DATE RECEIVED 09/03/1999 FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 BALANCE DUE $ 0.00 WiSMART code: 7633 ORIGINAL c. . ' U~.aF1~G1-I-~' & A~~QCIA~~~'~ CQ. 655 O'N~il Road • Hudson, WI 54016 715-3a6-f31 t35 A REVISION TO DIL}iR PLAN ID # RECEIVED SEPp2 ~./f ~. PROJECT INDEX I?eg. Designers of Fngineerbrq Systems Priv;~fe Sewage Consuff»nf 212826 (2-24-1999) DATE Aua. 31, 1999_ OWNER Girl Scout Council/St. Croix Valley PHONE 715-386-S1~A- ADDRESS 965 Alexander Rd. Hudson,Wis. 54016 PIN 020-1016-60. NE1/4,NE1/4, Sec.13, T29N,R19W LEGAL DESCRIPTION CSM 344842, Vo1.565,Pg.45. 'T'OWN OF Hudson COUNTY St. Crofx CSTM David Fogerty #221180 LOCAL AUTHORITY/ SUPERVISION St. Croix County Zonina De}~t~_ PROJECT DESCRIPTION: New construction. For proposed 2 small seperate office buildings (summer seasonal occupancy only). Day camper offices, with up to 6 employees each building, and 3 floor drains. Daily estimated wasteflow per building: 270 gals. Total for both buildings, connected to a single common treatment system is 540 gals/day. Soils are very permiable (.7/.8 GPD/ft2) suitable for a conventional inground system. Proposed: 2 trenches on a 12% slope, using INFILTRATOR high capacity trenches ("Side- winder" models), each 6'2' section with an approved capacity of 31.8 sq,ft. The minimum required sq.ft. for trenches is 675. Proposed: oversize the trenches, using 16 sections per trench, i.e. each trench shall be 3'x100' or 508 sq.ft. Total proposed trench capacity shall be 1016 sq.ft. Each small office shall be provided with 2 1000 gal. precast septic tanks in series (Wieser Concrete Co.). The second or final septic tank for each building will be provided with a Zabel filter, and with an approved above ground locking manhole cover for servicing convenience. Effluent lines•tying into a common lift pump tank shall each have a frost proof cleanout (c/0) ahead of the junction to the pump chamber inlet. Pg . 1 PLOT PLAN V I EWS `~~~~~``P~~~- N' C4N ,~ Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEW ~' ~~»--M-.`Sj~. ti ~.:•• tiff Pg • 3 PUMP CHAMBER SPECS ~ CROSS SECTION. a ~•'~ R08ERTW ~,~ Pg • 4 PUMP CURVE & SPECS . ~ = U(,BRICHT "~ id• HuosoN, ~n ~'~ • ' ~ ~ 'I1i1s desl.gn For 1.nsF.ai.t.ati.on is based entirety on measurements, elevations, l:+ndsr_apA condlt)oiis (slcpeQ etc. ) and soil ~?ul.tability provided by CS'IM 221180 'i~1P :1f'f t1r:~r•v n0 1.1 .. .......... __ ~.___~. _ . -- _ -- - - ~. ~• =b. '~ ~ ~ ~ ~ ~ ~ ~ ~~ ~~ ~ ~ ~ o ~ ~ ~o m y ~ ~ ~ ~ ~~~ ~ ~~~,~ ~i (`j ~ ~ ~ O ~ ~~ ~ ~~ c ~ ~A f' ~n '~ ., ~~ O '~ %~ _-~- i I~~ ~ ~ ~~ ~o ~ ,.~ ,, 11 O Q ~b o ~ V~~ ~~ ~~ ~\ ~~~~ m~~ y~~ ~ ~~ ~ ~ ~ ~' ~ ~ ~ ~to~ y~~. ~~ ya. ~~~° ~,~~ o~ ~~~~ O ~ ~ d y ,~~ m~ z~ ~~ o. ~ ~~ ~ ~~ ~; o ~ ~./ ~ ~ ~_ ~. ~. z m a ' ~ N ~ rn rn ~. Q ~_-_ ~i~ ~~ ~' n ~N~` ~b rn ~ ~ ~ 1 w ~' i y ~./ .~ ---~.___..___________~ . i 0~ ~ ~~ ~ z ~ ~~ ~ _~ ~~~ ~ R ~ ~ ~ q, ~ ~ _ _ ~~ ~ • ~ ~ ~ ~ ~~ ~.~' Q~ . i l I ~../ ~ I I _~__. wll ~I~ c~~- ~~ N x l l 1 1 ~/1'~~~ ~ C '~ i I 1 1 w ~ ~ I ,•~I N I~O~ ~I II it 11 ~~ _~ 1/~_____ 1, ~s ~~ Ti~~ti c ~ ,, -~ ~{i ~-~ T ;v~G r ~ ~~., i9Pf'~eU~l> Usti 7- c,~ jd P~ 40 /~~ . "z._ FiNi S /f~ED -~ sc~ , yro K ~ s ysT~,~ ~~~ r,~~,v<~, s~f,~~G /~ 3 "X /oo~ ~~ 'sue//s'~~,~~~ CRo SS .S~c Tio~ ©~ T~~~v~s ,~ 2ls~w G- lN~i,L ~if'~4 7-d~E's ~ . Gv i~ 3/. ~ SQ. FT ~ TU T~9 L. /a-~i~ S E~ Tiv•v 1 1~~ ~ ,, M a~7~ ,, ~~ a,~ irJSpE'c T/ov ~/~,, I/// sc~ , Qo ~I -- -~._. ~/it// S QED 9~~-ate= ~8• ~ ------. o~ .~ I3 ~~ti~ ~~ ~~L ,E'~9~t'~1~ TiiP~~, iz1' ~. j 4"C, I. VENT PIPE PUMP CHAMBER CROSS SECTION ANq SPECIFICATIONS ~ 2S' FROM OoOR, WINDOW OR FRESH ~ AIR INTAKE / 0 r1~A~~ ~~~V~iT/o n/ 9 ' ~-„'., ~ ~/ 3 Lo ~~Ev~+n• oti ~3.~ INLET ~~~ APPROVED JOINT \J~C.Z. DIPS e'.XTENDIAIG 3' 01JT0 SOLID SOIL r ~~,33 ELEV. FT '~ecat~ r, K io~l ~~ /~ v!1 f A B D ,,~-VEIJT GAP WEATHER PROOF JUAICTION BOX 12"MIU. •• GRADE I i CONDUIT ~-- E 51~ K ~N ~ o~~~M gg~~ 1~ • 1,~3 APPROVED LOCKIAIG MANHOLE COVER /~,/ lv~fi(N/~ul~ ~A/3E~ 4" MIIJ. V ~~~. ~\~; PROVIDE I AIRTIGHT SEAL I ,~ wt CI•~~ ~~ .I .. PUMP -~,r,~- ,~ ~J ~. ~ BLOCK RISER EXIT PERMITTED OIULy IF TAAIK MANUFACTURER HAS ~. ~ I B" MI IJ. tl~ ~I~ (I APPROVED JOIUTS I'I WfC.I. PIPE ~ ~ ALARM EXTENDIAIG 3' I ONTO SOLID SOIL b ON i of F Z/SE 3 0,~ ~10iPE' eF Sitvfl j,.3~GY~iv ~' ~v~ SUCH APPROVAL SEPTIC E t~ SPECIFICATIOI~JS DOSE ~ 1L S~~ P~Ewls~ 3 TANKS MA1.IUFACTURER: IJUMBER/Ofd OSES: PER DAy TAIJK SIZE : ~ °'Z ~ ~ GALL0IJ S DOSE VOb~L''UME JS ALARM MANUFACTURER: G~~~.Z ~G~'~'f INCLUCIAIG BAGKFLOW: ~~~ GAttOf`15 MODEL 1JUMBER: 1~~~ v' 'L' ,.J CAPACITIES: A=~/~ ~ IAICNES OR ~ ~ GALLOAIS SWITCH TYPE: ~~~T w~f~..- 8= ~ IAICHESOR -C~ GALLOIJS 20~/~~~ _ F3 Zo D PUMP MAIJUFACTURER: ~y C- IAICHES OR ~n GALLOIJS • MODEL /JUMHER: _ / '/ ~'~~'i~P / ~~S ~ D=~INCNES OR ~`~O GALl01JS SWITCH TYPE: .~~SS7 ~~~'` ~,~.~`~~~ IJOTE: PUMP AUD ALARM ARE TO BE • MI-JIMUM DISCHARGE RATE GPM INSTALLED OIJ SEPARLATE CIRCUITS VERTICAL DIFFEREAICE BETWEEN PUMP OFF ANO DISTRIBUTIOAJ PIPE.. "'~~ FEET fiA~l~ S~~G'S^~,~ -I- MIIJIMUM NETWORK SUPPLY PRE URE .. ~_ FEET EAG(n, ~ ~ O~"' .Y{ P~ -F- 75 FEET OF FORCE MAIRI X f r ~ F/po FtFRIGTIOIJ FAGYOR..~ FEET ~~'Ur ~ S .Z S ~ ~7 FEET `i '~~I TOTAL Dy1JAMIC NEAb = ~.-- // ~/ i i IIJTEttNAL bIME1JSIOIJS of TAA1K: LEI~.IGTH /~ ;WIDTI-I ~` •~LIQLIID OEPTH ~~ Vaip I~aG v~~. ~N L~ T 7-0 f-oi~ 7S o~ ~ -~ p l~C = ~~, 3 hr's . 1. e $ ~ >~ te- to- 1 ZOLLER EFFLUENT PUMP MODEL 98 IIEAb CAPACITY CUnVE ~____ MObEL "911'• /" /~ - e !/~ / 6/A •~ , ~~~. e - _ t 1/t NPT -~ e_ _ .1. MLLONS to ~o ~'~ . uttAS ------- --~-~---lu 60 0 eo eo ~ :/o ~ FLOW PER MI iE tout D1N+~u ~ + e aw~trwr~e 1 ~~ t1VAt111' r~ tlNI1NMIN , /Rt R1RRf eAlf lrflf ~' , I.fs 1R >•r~ f W fl 2~1 ~ 1 l.el le Iro alo :e fs lxk vetve ~~+ J 5/11 -L ~ CONSULT FACTORY FOR SPECIAL APPLICATIONS S Etectricsl ellerrletors, for duplex systems, ero ev:lllable end • Mercury Moat rwllchos are ava0able for co ~uPPN~d wAh en elerm, ntrolling single and ~.~ischarttcel eMernetae, Idr duplex byetsms, ere ovelleble wNh a • bouWet Ise sbec ms wAhoul Norm OtvMc)1•s. P 9gy k mercury Iloal swdches ara available la verlebls Isval bng cycle controls. 8lendard atl models - Wslght 99 IbN • ~y 11•p, •ELECiION OUIbE • . N Oerlee - !. !In le 1 1. H 0 r Fn0o0UYb~ek mac ~ rrweherJeal ewheh, no erlerrul oorwol required. r`lodel Y h_ P •.ph ^ Conlret ~9~leojlon ury IIoN fwNch or 4oubb p!~py~k mercury, ~ Alod• Am f Olm lest f~eh. peter b fMOlI1. -~- ~-~.-, 1_ ulo 0.6 P-_-- ._ Duplet a. Meehenkstehernslor i00077a f0001i ' -~ ~ ---1-~ - 1. 6es FM01 tZ, for ootreet moiler of Elecklcal IUlernelor, "E.P~+~ 000 Zip 1 ~ p--- 9f ? ~ ~ 0. Mercury gruor I~t ewNeh t0~ .~ 1EN !~0 1 ~ , ; 1 a 1 a 7 dupbe (~ or t1) IbU ry~letR y • oorNrol tLegvgq .peCNl• ~ l .. ~ a 1 t 0 0..f ~+111 ~ "1 P.k". )unetlor j Ewt ror ~r a drplee epet.do,l to oooZ, i,N eonneelkxl a caked-h elm• t. rre f>y heN'J teR", for weler110r~1 eem..~_•, ut fpaot. ~~h{•~~~~y~R.~~~~~•~ ~"k~r /fb/11M~Me4kt1 Mr nN'0 ~ CemNnr,tlon NaMr -Ato6r/; AN MubNillef d eeet..r...~_~~__ CAUTION ~.._.~^• ~~ O~efe. (' Ie. e..~~_. _ _ - - ~ ~~: IJuthan4J Ir.._.._. _ '~~ISCOnsin SANITARY PERMIT APPLICATION Department of Cgmmerce - In accord with ILHR 83.05, Wis. Adm. Code • Attach complete plans (to the county copy only) for the syst,~prt.pa~et-~t' e county than 8 trz x 11 inches in size. '~~ , I S ate Sanitary • See reverse side for instructions for completing this app c~~on R~CEIVE~ 1 Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 ber Personal information you provide may be used for secondary purposes q ~j .® heck if revision to previous application [Privacy Law, s. 15.04(1) (m)). t t s' ~ i~~J 2 ~ ~: t to Plan LD Number ~ . I. APPLI ATION INFORMATION -PLEASE PRINT NF R N 1 . Property Owner Name /` L Cam- '' ' ~cat'rcin= ,'~a; Tz , N, R ~ E (or~ Property Owner's Mailing Address ~ t . _ LotNuro er Block Number y- ~ ~( - ~~ City, Stat ~ Zip Code Phone Number StiE>division Name or CSM Number - ~ ~ y~yz ,~~ o ~ ~ ~ . T PE F B I G: (check one) ^ State Owned o it Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ^ Village Town OF D /L /~ III. BUILDING. USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ Apartment/Condo 1- ® " ~~ 2 ^ Assembly Halt 6 ^ Medical Facili ursing a 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sale /Repair 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home rk 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office / ry 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one o on lin A. heck boron line B, if applicable) A) 1. ~ New 2. ^ Replaceme t 3, Replacement of 4. ^ Reconnection of 5. ^ Repair of an ______System ________ System ___ _ ~__ Tank Only__~___________ Existing System ________ Exlsting System B) ^ A Sanitary Permit was' vio sly issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only on G,~ ~3/, ~ s~ ~ ~ `36 t~: ~ Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12~Seepage Trench 22 ^ In~~-Groynd Pres re ~ 42 ^ Pit Privy ~$ ~ °~ ea.± l~ ~ Z ~- 3X~ 43 ^ Vault Privy 13 ^ Seepage Pit 14 ^ System-In-Fill ~¢ S' ~+TG D VI. ABSORPTIONS E INFOR ATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Galslday/sq. ft.) (Min./inch) % - yT~n Elevation jj ,$'D , D Feet 7~ Feet VII TANK Ca ant . INFORMATION in allo s g Total # of Manufacturer s Name Prefab. Site con- l Fiber- Plastic Exper. New Existin Gallons Tanks to ~ t t d stee glass App T nks T nks ~ Z EL /~T ~~ rut e s Septic Tank or 11e4ding-1:enk z Z ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ~ ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY ATEMENT ~~ ~foT ~/,•v~ .. - I, the undersigned, assume responsibility for installation of he onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St ps) 10?P11bRPRSW No.: Business Phone Number: / G~ ~ ~i '~ a~ ~~ ~d 7 Gs( P um is Address (Street, City, State, ~ Code): IX. COUNTY / EPARTMENT SE ONLY ^ Disapproved Sanitary Permit Fee (~ndudesGroundwater ate SSUe Issuing Agent Signature (NO Stamps} ^ Approved ^ Owner Given Initial surcharge ree> Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DIS7RtaU710N: Original to County, One copy 70: Safety & Buildings Division, Owner, Plumbw INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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 ownershippi•,plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted_to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must~be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. ._ _, 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 is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. -Plumber must sign application form. IX. County/ Department Use-0nly. X. county/Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction' loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 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. ~. isconsin Department of Co{pmerce- - - SANITARY PERII~IIT APPLICATION {n accord with ILb-R 83A5, Wis. Adm. Code Safety and Buildings Division 201 VV. Washington Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less county than 8 tie x 11 inches in size. ~ { S'; • .See reverse side for instructions for completing thisapptication state sanitary permit Number Personal information you provide may be used for secondary purposes ^ check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number L APPLICATION INFORMATION -PLEA E PRINT ALL INF RMATION S Property Owner Name Property Location ~ L -- ~ i4 tia, S T ~ , N, R ~ E (or Property Ovvner's Malting Address Lot Number Block Number ~ ~ City, State ' Zip Code Phone Number Subdivision Name or CSM Number II. TY E F B ILDING: (check one) ^ State Owned ~ !t Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ^ Vo~ag of r? ~/ ~/Z ~/~ 111. UILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) 1 ^ Apartment /Condo -Z - a ~' ~O 2 ^ Assembly Hall 6 ^ Medical Facilit ursmg a 10 ^ OutdoorRecreational Facility 3 ^ Campground 7 ^ Merchandise: Sale Repairs 11 ^ Restaurant/ Bar/ Dining 4 ^ Church /School 8 ^ Mobile Home rk -- ~ 12 ^ Service Station /Car Wash 5 ^ Hotel !Motel 9 ^ Office! ry 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one o on line heck box online B, if applicable) A) 1. Q+New 2. ~ Replaceme 3. Replacement of 4_ ^ Reconnection of 5_ ^ Repair of an ______System ________System___ ___TankOnly______________ Existing System ________ Exist{ngSystem B) ^ A Sanitary Permit was vio sly issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only on G,1 X3/,~'s~ ~ ~ X36 ~. ~ Other Non-Pressurized Distribution Pressurized Distribution Experimental 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ~eepage Trench ` ~22 ^ In-Grou d Press e ~ ~ 42 [] Pit Privy ~ ~~ ~O ' ' ~ • Z. -- .~ X . ~,2 13 ^ Seepage Pit rn^ ~+ 43 Q Vault Privy s Q`~ leas .-- ~~ 14 ^ System-In-Fill ff~ C ~ ._ ES ~~~'GT OIL` VI. ABSORPTIONS TE INFORMATION: pL.[oc~J 1. GallonsPer Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev, 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (GalsJday/sq. ft.) .(Min./inch) T - 97-~ Elevation O S~D , , D Feet l~~Tp2iAFeet VII. TANK 1NFORMATION Ca out in'~allons TOtdI #Of r Manufacturer s Name .Prefab. Site con- l Fiber- plastic'.. Exper- New Existin Gallons Tanks ' to ~~ t t d stee gloms App. T nks Tanks ~ ,2,~/fE L I` rut s e Septic Tank orHe~din~-T.i>twk ~ Z ,~' ~ ^ ^ ^ ^ ^ Lift Pump Tank !Siphon Chamber i ^ ^ ^ ^ ^ VIII. RESPONSIBILITY S ~ ATEMENT s~-,~ ~tnT ~/Q~ .. I, the undersigned, assume responsibility for installatidn,of a onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Sta ps) I'dtPfMPRSW No.: Business Phone Number: ` 7 ~ ~~ ~--- / LZ~/~'~ / / ~~loSf~ P umb is Address (Street, City, State, Zi Code):. ~ ~' G S O~ iX. COUNTY / D PARTMENT SE ONLY' ^ Disapproved Sanitary Permit Fee ~'nc'udes Groundwater ate ssue Issuing Agent Signature (No Stamps} ^ Approved ^ Owner Given Initial _ surcbargeFee) Adverse Determination - X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6396 (R.11I97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber - _ INSTRUCTIONS , : , ~~ ~,~_. 1. A sanitary permit is valid for two (2) years. 2. Your sanitary. permit 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 mustbe approved by the permit issuing authority- ... . . 4. Changes in ownership or plumber requires a`Sanitary Permit Transfer / Renewat~o>Im I('SBO-6399) to be submitted to the~~ ~~ county prior to installation . 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licerssed pumper vuhenever necessary, usually every 2 to 3 years. b. If you. have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin; Sa#ety and Buildings Division, 608-266-311, - - ~ ~ ~ _ 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 isfor tank re{~lacement, reconnectip~, ar 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. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and -- manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic,'pump/siphon-and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DIIHR. . . VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, et4 ), 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 11 inches must be submitted to the county. The plan must include the following: A) plot plan, drawn to scale or with complete dimensions;l~ailion of holding tank(s);'septic "- tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and I,aJces; ;pump p~ 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; e{evation differences; friction loss; pump perforrrlance curve; pump model and pump manufacture.~_Q) crassse~tion of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing informatit~n . _ . - _ e~ ...... --------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGIE 19$3 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. „ ' ~ ~ iscoinsn Departmentof Cggrmercey~,r SANITARY PERMIT APPLICATION In accord with IL,HR 83.05, Wis.Adm. Code ~ Attach complete-plans (to the county copy only) for the system, on paper not less than 81/2 x 11 inches in size. • See reverse side-for instructions for completing this application Personal information you provide may be used for secondary purposes [Privacy L'aw, s. 15.04 (1) (m)]. Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 County State Sanitary P rmit Number ^ Check if revision to previous application State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFO RMATION ~ Property Owner Name Property Location _ ~ va 1/4, S T , N, R / E (or Property Owners aping Address Lot Num er Block Number Cit ,State Zip Code Phone Number Subdivision Name or CSM Number `~"c;r 1. ( ) ~ ~ ~ - ~ e Z 1. E F B I I G: (check one) ^ State Owned ~ !ty Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ Towan of ~ ' ~ Z / I11. UILDING USE: (If building type is public, check all that apply) arcel Tax Number(sj 1 ^ Apartment/Condo ~ - , O 2 ^ Assembly Hall 6 ^ Medical Facilit ursln a 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sale /Repairs 11 ^ Restaurant/ Bar/Dining 4 ^ Church /School 8 ^ Mobile Home rk 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office / Fac~,ory 13 ^ Other:- specify IV. TYPE OF PERMIT: (Check only one of on lin~ A heck box on line B, if applicable) A) 1 _ I~ New 2. ^ Replaceme t ~ 3. Replacement of 4. ~ Reconnection of 5_ ^ Repair of an ______System -_______System -__ _ Tank_Only-______~__--__ Existing System ____-__` ExistingS~stem ~~~ """' ~~~ '` B) ^ A Sanitary Permit was evio sly i d. .Permit Number Date Issued e s--s-u V. TYPE OF SYSTEM: (Check Only o ` s ~ ~ ~ ~ 3~ ~ G ,,~ X 3/ ~' ,~ ~ Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 42 ^ Pit Privy 12 eepage Trench ~ 22 ^ In-Ground Press re ~ f 13'~Seepage Pit ~~' `= ~t.,.,.~5 ~-} Ica ~ . ~ ~ -' ~ ~ Z -- 3,~](Z ,~ ' 43 ^ Vault Privy 14 ^ System-In-Fill ~ ~~ -- ~ ~,T VI. ABSORPTIONS TE INFORMATION: /^GLOty 1. Gallons Per Day 2. Absorp_ Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) j 9~. G? Elevation ~ ~ f' Feet ~ t, .Feet 1i/II. TANK Ca clt a INFORMATION Ir1 g la lon$ Total # Of r Manufacturer s Name Prefab. Site Con- l St Fiber- plastic Exper. N E i i Gallons Tanks Concrete ee glass App. ew Tanks x st n Tanks ~,, Z.~~EL ~t17 lZS strutted Septic Tank or t~~l.~~ng Tank ~, ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ' ^ ^ ^ ^ ^ VIII. RESPONSIBILITY S ATEMENT --- _~-~-.~- ~~r? ~/~,y , , . I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber`s Signature: (No Sta ps) MRMAPRSW No.: Business Phone Number: t. umber's Address (Street, City, State, Zi Code): IX. COUNTY/ ARTMEN I~SE ONLY ^ DlsapprOVed Sanitary Permit Fee OndudesGroundwater ate slue Issuing Agent Signature (No Stamps) ^ Approved ^ Owner Given Initial Surcharge Fee) Adverse Determination X. CUNDITIUNS Uf APPROVAL /REASONS FQR DISAPPROVAL: SBD- 6398 (R.11197) Dt5TRt7ltlTloty: original to County, One copy To: Safety & Buildings Division, Owner, Plumber .. INSTRUCTIONS u F . > ,, ~:~~~_ .~ 1. A sanitary permit is valid for two (2) years. ~ ~ ' 2. Your sanitary permit may be renew2d before the expiration date, and at a time of renewal any new uiterja in the. . Wisconsin Administrative Code will be applicable. 3. All revisions to this permit mustbe approved by the permit issuing authority. 4. Changes in ownership or plumber requires a'S~anitary Permit Transfer'/ Renewalform'(SBD-6399) to be'Subriiitted t{othe county prior to installation 5. Onsite sewage systems musttie properly maintained: ~'he 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 4ocal code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. ~ . _.. ~. 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 is to be installed. ~ " II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes thatapply. IV. Type of permit.' Check only one on line A. Complete line B if permit is fQC tank replacement; reconnection, or repair. V. Type of system. Check approp.rjate box depending on system type. , VL Absorption system information. Provide all information requested for numbers 1 through 7. ' VII. Tank information. Fill in the capacity. of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval.from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix,(e.g. MP,:etcJ, 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 8112 x 11 inches must be submitted to the county. The plans must include the following: A) plot pla~i, drawn to state or with complete dimensions, location of holiiing 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) crosssection . of the soil absorption system if required by the county; E) soil test data on a 115 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. ' .. , - _ _ ~, , ~ . _s ~- - SANITARY PERMIT APPL1tATION ~~iscons~n Department of Cojnmerce ~ In accord with II~iR 83.05, Wis. Adm. Code • Attach complete plans (to the county copy only) for the system, on paper not less than 8 v2 x 11 inches in size. • See reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)]. Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 County < ~~ ~- State Sanitary Permit Number ^ Check if revision to previous application State Plan I.D. Number .i I. APPLICATION INFORMATION -PLEASE PRINT ALL INFO RMATION ./. f-"~'~~'l Property Owner Name Property Location ~''~` : ~ r r, ~- . ~ .~r~. r - ~.-,~ ,,. j; 'L-ti4 ti4, S r T ~ , N, R ,r ~ E or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phon e Number Subdivision Name or CSM Number / ~~ ~ 4f. L- 1 ° In ^f y rrd.. )`.' t _"' .!~ r' ~r /f ' t t t -~ ~ J ~~er~ f 2 II. TYPE F B ILDING: (check one) ^ State Owned o !t~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ Town OF ~~%/,~ c ~' ~_,%~G`2 ;-~'.:'~. III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ Apartment/Condo -".=~ ~` - ~'~'.- ~G"' 2 ^ Assembly Hall 6 ^ Medical Facilit ursing a 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/ Repair 11 ^ Restaurant/ Bar/ Dining 4 ^ Church /School 8 ^ Mobile Home P,~rk ~ 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office / Factory ~ ~~ 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one,~ox on lint? A. `Check box on line B, if applicable) A) 1. ~ New 2. ^ Replacement 3. ~ Replacement of 4. ^ Reconnection of S_ ^ Repair of an -_____System ________System ___~_- ,~ Tank Only______________ Existing System _______, ExtstingSystem B) ^ A Sanitary Permit was ptevio sly issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only on ~ , > ` k, ~~ ~ , ~ ~ ~, ,~' ,~ ~ s~. Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed , 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank ~ ~ ,. 42 ^ Pit Privy 12~"Seepage Trench 22 ^ In-Ground Pressure ~ ' ~ ~`' ` t~ ,. 13 ^ Seepage Pit 43 ^ Vault Privy " ~`"`~"~ ~°~ ~ ~~" ~'~ ~ -~ -- .? X ~z `~ ~- ~{ 3..~,...~ r-- 14^System-In-Fill l,~, ,~ - ^~ /r ,::~~ ...~_ ~=?~ ~:,~,~ rrT1. VI. ABSORPTIONS TE INFORMATION: 1 ~1~c--;~ 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) T - ~i'~ ~ Elevation 1 l ~... ,,~ ~' ` ? ~ ~ '-~ ~. ~%~ , L.~ Feet c'd'~ •7,~''ti~ Feet TANK VII Ca aat . INFORMATION in allo s g Total ll # of Manufacturer s Name Prefab. Site Con- l St Fiber- Plastic Exper. N E i ti Ga ons Tanks con to ee glass App ew Tanks x n s Tanks Z,, ~.,,~ ~,,.-s~ ~~.~~ ~~ strutted Septic Tank or i~wk ! „ t , _... ~'. f' a ~ ~..~ , r 7 F~12.. ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ~ r -- ~ ~ / - ,-T ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY S ATEMENT ':______ --,~. ~~~~ ,~;,, l,~ir . ~ , ' - ; I, the undersigned, assume responsibility for installation of t1te onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) WFWMPRSW No.: Business Phone Number: ~. .•, ._ - ~~ . ; ~. Plumber's Address (Street, City, State, Zip Code): '" ` IX. COUNTY/ EPARTMENT SE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) ^ Approved ^ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OFAPPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at 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, 608-266-3151. 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 is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online 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. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 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 _.~. ,~~ ~, '7~ ar W t February 24, 1999 `~._,.1 CUST ID No.259518 ~' ULBRICHT & ASSOCIATES 655 O'NEIL RD HUDSON WI 54016 „ R . °~ ~~ i ~~ l' Safety and Buildings rP `~ PO BOX 7162 MADISON WI 53707-7162 Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY 1101 CARMICHAEL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 02/24/2001 Identification Numbers Transaction ID No. 212826 Site ID No. 167594 SITE: Please refer to both identification numbers, ST CROIX County, Town of HUDSON above, in all correspondence with the agency. NE 1/4, NE 1/4, S 13, T29N, R19W Facility: GIRL SCOT CAMP /AMERICA 965 ALEXANDER RD, HUDSON 54016 FOR: Description: NON-PRESSURIZED IN-GROUND SYSTEM Object Type: POWT System Regulated Object ID No.: 452294 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: -~ The graveliess system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and chapter Comm 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. 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. Inquiries concerning this correspondence may be made tome at the telephone number listed below, or at the address on this letterhead. Sincerer; ; DATE RECEIVED 02/23/1999 ~ .t `~ FEE REQUIRED $ 190.00 FEE RECEIVED $ 190.00 ~~~ P E PAGEL~~ TS PLAN REVIEWER II BALANCE DUE $ 0.00 Integrated Services (608)266-2889 , M - F, 0745 - 1630 HRS PEPAGEL@COMMERCE.STATE.WLUS WiSMART code: 7633 ORICII~AL. u~.~~i~~~ ~ ~~~~~~~r~~ ~o. 655 O'Neil Road • Hudson, WI 54016 715-386-8185 PROJECT INDEX '''cD FFg Z ? X99 ~I r a o~lv. Reg. Designers of Engineering Systems Private Sewage Consultants DILHR PLAN ID # DATE OWNER Girl Scout Council/St. Croix Valley PHONE 715-386-s~~R ADDRESS 965 Alexander Rd. Hudson,Wis. 54016 PIN 020-1016-60. NE1/4,NE1/4, Sec.13, T29N,R19W LEGAL DESCRIPTION CSM 344842, Vo1.565,Pg.45. Hudson St. Croix TOWN OF COUNTY CSTM David Fogerty #221180 LOCAL AUTHORITY/ SUPERVISION St Croix Countv Zonina Dent~_ PROJECT DESCRIPTION: New construction. For proposed 2 small seperate office buildings (summer seasonal occupancy only). Day camper offices, with up to 6 e mployees each building, and 2 floor drains. Daily wasteflow per building: 220 gals. Total for both buildingsconnected to a single treatment system is 440 gals/day. Soils are very permiable (.7/.8 GPD/ft2), suitable for a conventional inground system. Proposed: 2 trenches on a 12% slope, using INFILTATOR high capacity trenches ("Sidewinder" model), each section measuring 6'2" long, with approved capacity of 31.8 sq.ft. A total of 20 sections shall be_used, for a total of 636 sq.ft. of trenches. The minimum required sq.ft. is 550. Each small office shall be provided with a seperate 1000 gal. precast septic tank (Wieser Concrete Co.), each septic tank provided with a Zabel filter, and an approved above ground locking manhole cover for servicing convenience. Effluent lines tying into a common lift pump dosing chamber shall each have a frost proof clean out (c/o) ahead of the junction to the pump chamber inlet. Pg . 1 PLOT PLAN V I EWS ~ ~~paramtnnf Pg.2 SYSTEM CROSS SECTpp7,QN~,,•~~&}}~~~~k''EM PLAN VIEW SPE~$~1CON~ii,~ Pg. 3 PUMP CHAMBER SPEC" d~tt~RO TION. ~ °~~~1$ •---~ s'j~'~.y Pg. 4 PUMP CURVE & 5~~. S a j`w, ~-, 6V d ~' ~ { 11~~RICitT C (~, ~y~ ~ o~~e~ P"`~Q ~'~NC~~~ ~ <~ '~~ i HUtISOti, INl j S ~ ~''of ~S ~.~' ti~G~R~~ ~~ ~~fr~~~'~rrnur~~i~t~U~~~~~~~ S ~~~~~ This design for installation is based entirely on measurements, elevations, 1 ~nrl oe~~r~e r~r~r.Ai 4 ~ ~.v.~ / nl ~...~..-. ..~.. \ -....i ....5 t ....5 4-. L.1 1 S 4.. ...-.~...3 .i...i L... nC'i7~,f 2 L ~~~`~ m ~, ~ ~ ~~:~~a~ y I ~° m y~~~~~ ~~~ ~~ ~~ Zy ~~ ~~ r 0 R~ ~~ h T ~ ~~ ~~'~ ~y~ y~7° ., 1~ ~ ~ ~~ ~Q ~~ ~~~ ~~ boy y~`~ o~~ ~~~ ~ ~~ o~~~ a ~~ ~o~ ~~ ~ o~~ ~~ ~ i rn~ z~ ~ ~~ ~ -!~~ ~~- .. 11 ~~ 0 a~ ~~ ~~ ri ~s ~~~ N ~ ~ \ ~. n e ~~ 4~ ~ ~-~ ~ ~~ ~~ rt ~- ~~ ~~ , o~ ~~~ ~ ~ ~~~~~ ~ ~ .~ 0 0 ~'\ m w ` ~' ~ N ~ U ~ a NX n ~ ~ ~rn ~• o ~~ w rn ~~ ~~ ~; ~~ b ~m ~ ~ ~ ~ o ~' a ~ ~ - ~ ~ z~ ; Q ~ ,~ ~ ~~ :~ ~ ~ o o~ ~ O , a_ ~ i ~. ~. d I}i I I ~;,, ~ I / I ~ c 'I ;~ I~ Q wl I I' I I I. 1 ~ r ~~~ I~w N ~ i.---) I x I ( N I'~ II 'IAN f°) i~ N ~' 1/~ a, ~ a~~~ .__--,__ ~ rL.._ /9Pl di~OlJ~jJ U~,(~ T C~/d y,~ 5'r.~. ~ av ~.t/SpEc T/ov ~/~ ~~i^/. ~ 2 ~' 4a p(7 i ~,~. ~ - ,, M ~,v~~~x~r-o~' 5c~. ~o --L-~~c .-----. T~~ti ~ ~ r/ i~ 1~/, ~-~ Tj ~. s ys r~M , CRo SS S~cTio~ ©C T~PEti~~~s 21~~w G- ~i . ,~~G To „~ N~ 7~~- ~s w~~ 3/. ~ SQ. FT ; Tv T~- L p-~ s ~-~ T-ia.v • ~// 1 AP~~ a~~~ 1~ `~ ,, K ~,v~~~X~To~' a,~ icls' p Ec T/ov ~ /~, Sc~, Qo ~-z-~~c "Z. Fi:v i S ~~D 9iP•4-~~= ~~%~ "~~ F/i~// S /f~E"D 9~~9L= 98• ~ Ti~~~ ~ ~ LO ,, .. ~ -~°~u~' . , ,, ' PIiMP CHAMBER CROSS SECTIOIJ AND SPECIFICATIONS VENT CAP ti"C.I. VENT PIPE , WEATHER PROOF APPROVED LOCKIAIG ~ 25' FROM DOOR, JUAICTION BOX MANHOLE COVER 12"MIU. ... .. w/ IvA~Gu~,ol~ /i9/$E~ WINDOW OR FRESH ~ I ` AIR INTAKE I CJ/pAD~ ~~~f,~iT~On/ 9"~ GRADE I I `i"MIN. 18"MIN. COIJDUIT ~-- / \ 3Co~ ~:~ __-_______ ~IEY•~n' o~v ~` 93 ° ~ 111 =__ INLET PROVIDE I "~" AIRTIGHT SEAL I I i I 1~ ~/ I ~~E I III v APPROVED JOINT A INS,{~~'C I III APPROVED JOINTS 1JiC.I. PIPE I .~VM 1 I I I b//C.I. PIPE EXTENDING 3' ~O~ Q I II ALARM EXTENDING 3' • OLITO SOLID SOIL B ~~~~ ~ / ` I I ( ONTO, SOLID SOIL . / ~~ C3 J I I • ELEV. D FT. PUMP-~ '-~ SE O 1 1 OFF ~ 3 D ~ q ~- ~ ~lO~t'E eF ~^~ K 'g~D01~ ~" I S~~vl> 1 BLOCK _ .~--. ~- RISER EXIT PERM1TCEb O-JLy IF TANK MANUFAGTLIRER HAS SUCH APPROVAL SEPTIC E SPEC.IFI~GATIOAIS DOSE ~ GtJ 1~5~`,Q:~~ P~E~tsr- Z . TANKS MANUFACTURER: IJUMBEP22FODOSES: PER DAy TANK SIZE : ~~ GALLONS DOSE VOLUME. /s ALARM MANUFACTURER' G~7~Z ~G~M INCLUDING BACKFLOW: ~ ~~ GALLONS MODEL 1.1UMBER: //~~n~ v' L , CAPACITIES: A= ~~~ ~ IIJCHES OR _.'~L= GALLOAIS SWITCH TYPE: ~~/~"T ~~~~ ~ ~= L INCHES OR ~~ GALLONS PUMP MANUFACTURER: ~y~~~/~~ C = ' -' tAlCHES OR z~ GALLONS MODEL NUMBER: 7 ~a" ~P •~~S ~ D= ~~ INCHES OR ~7S GALLONS ' , SWITCH TYPE: -• NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE 9ETWEEN PUMP OFF AND DISTRIBUTION PIPE.. ~~3 FEET *A~~ S~1~trs^~' ..~/~ ~- MINIMUM NETWORK SUpPLy PRE URTTE~~, .. /~',_ FEET ~AL~. ~ 1 O~" .Y{ P l~'i. -~ ~~ FEET OF FORCE MAIN X ~'~'~ F/IOOiT.FRICTION FACTOR.. FEET ~/'1~J1~S 2s -- TOTAL Dy1JAMIG ,HEAD = /~' FEET ``ii ~A~S • N / // i/ INTERNAL DIMEIJSIONS OF TANK: LEIJGTH / ~ ;WIDTH ~` -,LIQUID DEPTH ~~ l/aiD hOL v~r~ fob 7S .' off, ~ „ p !~C ~a, ~ ~s , ~N LET To d~ o~ /~ ~ k = ~'% Q P~ Yof y- a, ~' rora Dtruua ~rwyrrovr rl~t u•,~urt /rrrurrn use awarrwwe ~ tiv~cr~f VNIIfM~N -ttf Mt/tPf nAlf trrtf ~ Lf: )~ )rs w s os el x„ to 1 sr le no zo ire n fs Lock Vnkf ~~' '1~ CONSULT F1ICTORY FOFi SPECIAL ApPUCATIONS ~ Eklefricel eAetnelors, for duplex systems, ere evallable end ~ ~upplled wllh en eterm. Mercury Iloal swilche9 are evallable for controlling single and -.Mtl~cltertlcei ellernelae, Idt chlplex eVetems, e-s oveilable wllh or a Dtwbleh I A ebeck mercury Iloal swAchea are evallable to wAhotA Norm tivllcftee. P 99Y r varlebis Isvel bng cycle conlrole. 8tendud all models - WNphl 9y Ibe • ~/, If.f , eEIECTIONOUIbE ' 1. r#trerd boN oplraleA !polo rnocfi•nlefl ervlteh, no e+Aemd oonUol Ifquhfd. N llari~f -'---~----- • !. slnpl~ plppyb~ek m~reury rby twhch or double hlodd Y he•Ph Control 9fieollon owhch.IblabfAlO/)), aieY~kmfreury,eoU ~`~ klodf Amt elmebx _ 4u ift 0. MeehenkaJrJrornslor IOOOM« t0O01S, -.~____ i j4 ~ ulo 0.6~ ..~1 p1~:L - 1. 6~e fib) It, la oon~el meld d Elsetrkal AMfrnat«, ••E•Ptk". ~, 0~~ ----t- --~Q~- ~ ~.$.g3-! ~ 6. Moreury Nrnor Ilpy Iwtleh t0-0Q!S ,ui«) y ~ eonud neNvgor 1:N !~0 1 Auto 1 t « 1 L) _ dupltrr !~ « III 11oq ararorn "pfeMy 1 NO.". 1 T ~ owl 0 1 f1 .- 7 a 1 0 ! E' fpM~"•N) ~ "~ Pok". lur,cdori bo>< br Mfilyllpfy rerrnoctbn a wktrd~h dm• ). lwe a d"~~ oMr~l IO oool. I[I heN 'J -aA". kx wMfrYelA Dorn...-...M eP~ F~~~~yM M fY~MyM, I~>~'M4r Mfdytll NIM b Wak+q on CemELv,don Bun« fMOEI l; AM Iml.llalloe d eonirolf. ael.dle,.' ~Ur110N_. _,-.- - -. I~Mk Alr~~.r:.. iflllblt){ EMe4kM Maieda, 11~ba6A: 1l.,eh..Ld ~r.._..-• - - - .' - 0 1/1 6/e / ~/le FLOW PEfi MINUtE 1 1/l-11 1/1 HP- Department of f;,ommerce SOIL AND SITE EVALUATION tx:alon rit~afery and Bufaings I~Jiueau olritegrated services in accord . ILHR 83.09, Wis. Adm. Code Page -~ of ~ < ~ g ~ /r ' Attach complete site plan on paper not less than 81/2 to e. P(an'rAu~, ~~ krdude, but not Umited to: vertical and horizontal ref l~ pdnfr(Q~~~~ and \ ' percent sklpe, scale or dimensions, north arrow, ~d• lion an~ nearest Par~i I.D. # ~ r APPLICANT INFORMATION -Please ~ iall ~dl~forni~t~od;?~~ ~ ri;! _~ Re "~ ~ ~' Date Penionel information you provide maybe used for seconds . pn~OSes (P .15.04 (1) ' `~ d...~-, ~ -- `Z Property Owner ~ 20NIC<IGOFf • r -, tocafion t 1/4,S 1/4 ._. T ~ ,N,R E (~ A,GLE - G+ ~ E Property Owners Mailing Add ess j ~ t ' t # -- Block# ~- Subd. Name or CS~W,~ ~L L ~~ `~3 ~~ ~ o E' T City State Zip Code Phone Number ^ Ciry ^ Village ~ Town Nearest Road ,•t L I~,U v ( z) ~ - X3.5- a ,¢L,. i4N ~ F' /t !~. Addition to existing building ^ New Construction Use: ^ Residential /Number of bedrooms nt lacem ^ R ~ Public or commercial -Describe: e ep Code derived daily Bow gpd Recommended design loading rate _,...Zbed, gpdfft2 p trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ~_bed, gpd/ft2 - S' trench, gpd/ft2 Recommended infiltration surface elevation(s) ~A'~'~R4 ,,;,ira.., ~R~ ft (as referred to site plan benchmark) AdditionaldesigNsfteoonsiderations No /JLTE.Cti/¢TE .~T 7fftS S'~TF •-S~E `ur^s'T ~LoT G~/4w~'N~r Parent material Flood plain elevation, ff applicable ft S Suitable for system Con entional ~ ~M~ou/nd ^ U ,-,~u~ ressure YJ 5 ^ U AT-Grade S ~ System i~n,Fl~II- ^ S ,1~ u Holding Tank ^ S ~'ti" U Unsuitable for system ^ U 1a 5 . Boring # Grour-d elev. /aft. Depth to firnidng fador //~JI 1. SOIL DESCRI PTION RE PVRT l M ttles Structure R t GPD/ft2 Horizon Depth in. or Dominant Co Munsell o Du. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary oo s Bed ,Trench l o- _~ L c s ~ F . 8 2 - S" ©S~ L - -- ; . ~ t- .~ , ( . ~v 4~ ~ Remarks: H .7 Boring # Z f&o Ground elev. /fin Depth to Amidng / v - - ~~ io - _ ~ ~ ~ ~ vF ~ s -=- , -z3 .s - L - ...-- -- s Z G v SG ~- ~- .- - . ~ 9 / 7 ~ ; fi~ ' ~ ;~ factor >~~in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number ~fi / 3~, ~n/3~lLTS t,~~' SS~o~ 3 ~i/i~/f>' .~.z ii~'G \, SOIL DESCRIPTION REPORT ~PROPER~1f OWNER ~~ f~oc.r c~Jm~ -PARCEL LO.i G2.~ ~/vl~- ~ BOrirtg # 3 9! 6 Ground elev. /o_ZLit Depth to limitlnp factor ~ /~/ In. Boring # Ground elev. /oo~ft Depth to 9 factor >1L~in. Boring # j 96.6 Ground ~~ ~ea~ runitlng facer Boring # Ground elev. tt ~ ~ ~n9 factor Page 'z ~ \ Horizon Depth in. Dominant Color Munsell Mottles Glu. Sz. Cont Cobr Texture Structure Gr. Sz. Sh. Consistence Botxidary Roofs 2 Bed . Trench ~ ~ - y s ,r' ~s r' ~ . ~ 3 - 6 - 5 z F s~31~ ~ F~ - .r~,.~ - ~•S - 3 ~ "- S 0 S~ of L -` .~: ~ , ~ x,56 ..U \~ ; Remarks: ,~ -3 -~,~,~jen~v~ n, sL ~~l~o a ~,.elsod -~ - F B L ~S ', ~' ~ - - .~ 6 '-~ o sue- L .-- , ..~` r . ,~ . ~ `1, Remarks: Horizon Depth Dominant Cobr Mottles Texture Structure Conslsience Boundar Roots P in. Munseil (2u. Sz. Cont Color Gr. Sz. Sh. y Bed ,Trench ~ - - -- LS r~vf' r ' . ~ - -- o G fslL ' . 8 3 0 02 ..~'3 S - - ~.8 ~~ ' ~'~~ ,~ , ~ , . Remarks: # Z -- ~. 0 7~ ~co~ -~"' Remarks: SBD-8330 (R. 07P96) i , ., r `~ 3 ~~ ~~~Z~~ l~l ~ ~~ ~- ~~ ~` ~~ 3 a S / ~ V ~ ~ ~ ~ U ~ ~ ~ 0 4 v v ~~ ~,` O b ~ h ~ ~ ~ ~ ~ ~ p q ~ ~~ V k ~ ~ a Q ~ ~ Q b ~ ~ q ~ ~ ~ ~p\ Iv `~ M ` e ~ ~ ~ ~ ~ p ~~ n Il ~~ k v Q et r ~. 4 I b _ * \\ ~ a•--~ ` r ~ " a X~' ` ~G ~ ~ ~ S °#al~ ?C v C . o T,.. ~~~ . N ~ ~ n h S s , ~ ~ 1• n ~ o ~ 1,~ ~ ~ ~ 3 W Y` ~ '\ 3 ~ ~ `~ v ~ * '~ 1 J u i I '~r ~MM~-1'~+~"~ of ~°"'r"erc~ SOIL AND SITE EVALUATION Dhrisiotr of Safety and BuNdings Page _L_ of 3 Bixeau of integrated services in acxo s. ILHR 83.09, Wis. Adm. Code • a ~_.r / r~ Attach complete site plan on paper not less than 8 rxhes i size. Ple(t County include, but not limfted to: vertical and horizontal a ce ction peroent slope, scale or dimensions, north arrow, lion to ne~estYoad. p~ I,D. # APPLICANT INFORMATION -Pleas t all~~igSo ? ~~• ~ Reviewed by oats Personal information you provide maybe used for rposes (P . x.15.04 1 _ )• r _ ._L property C+wner tCE rty Location .. ~ _~~ COU Lot ~~ 1/4 ~ t/4,S ~ ,N,R E (o~ Property Owners Mailing Add ess Lot # Block# Subd. N~me or CSM~Y, J z83~5"~- `oL. l City State Zip Code Phone Number ^ qty, ^ Village m Town Barest Road G ~ (v/Z ~ -did' ~-,~ /p.~ E X11 New Constn~ction Use: ^ Residential / Number of bedrooms Addition to existing building ^ Replacement ~ Public or commeraal -Describe: Code derived daily flow gpd Recommended design loading rate . 7 bed, gpdnt2 • ~ trench. 91 Absorption area required bed, ft2 trench, ft2 Maximum design krading rate.~_bed, gpd/ft2 . ~ trench. gpd/(t2 Recommended inftitration surface elevation{ ~~1w¢1~+1 9~ 5~ ~ ft (as referred to site is 1" .:-- - ' (E r • Additional design/site consid9ratlon - .2 ~ ,. x. ~~ - plain elevation, if appli - ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank ^ S ^ U U = Unsuitable for system ^ S ^ U ^ S ^ U ^ S ^ U ^ S ^ U ^ S ^ U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure i B d t R GPD/fi2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cons stenge oun ary s oo Bed ,Trench a- - - ~ ~ ~r~r Fiz S .~ .z ,~ - 6 - s ~ ~ ~ ~ a 3 .~l-~ s • y r-- s s ,ter rv - y+~ `. ~ d ~, r- y 6 -- s v~ ~/L _ , 5~• ' Remarks: 3 - - ..:; y - - ~ - G - - , ~ _~ Ramarkc• _ ..... .._..._..w_ CST Name (Please Print) Signature Telephone No. ~~ Date CST Number ~a,~ ~~~ SOIL DESCRIPTION REPORT PARCEL I.D. Boring # 3 y3. Ground ~elev~.~ 7• • ~p it Depth !~ NmKin9 factor > twin. Boring # y 9y6 Gnwnd elev. ~•l~ ft ~~ factor > 1~6~,. BOriTIg # S ~'S Y Ground elev. ~Q•.~ft. ~P~ ~ Iimtting factor Tin. Boring # f ~~ f~.. !;.___. __..i3 Ground elev. ft. Deptn to Nmhing factor M ;~_ 3 Page .2 ad _r Horizon Depth in Dominant Color M N Mottles Texture Structure Consistence Boundary Roots . unse C1u. Sz. Cont Color Gr. Sz. Sh. Bed ~ Tr8r1Ch - ro- - __ - ~ F s z~ Z - o-S' (~ s -.r G .. S ~O - L ~, Fs rrJ - ~~ • ~eU' ; Remarks: _+~ ~ --Thar. ~ f6~a ~ ~ ~s - m - ~ ~' ss- ~ 5 /Lf FS - s -~- n .S - s O G - -- 8 ~Z Remarks: rJ%fr~T Tv ~iU~.~iflT~~ Horizon Depth Dominant Cobr Mottles Texture Structure Consistence Boundary Roots GP ~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trench - - 3 ~- ~ f~F c .~' - 2 0- ,?- s - 3 ~- s ~ S/~ kJ 1 . 7 ; ~, • v~ Remarks: Remarks: SBD-8330 (R. 07196) ,. ~ G ;_Z ` t3 ~ p ~ 2 ~ z W d ~~~_~ ~ ~ ~ ~~ ~ v ~~ ~ ~ ~` u 4 °j ~~ ~ v P ~ a N M ~~ ~ ~ '`~ ~~ ~~ ~ w ~ o ~ ~ v ~~ ~ ?, o~,~ ~. ~ v ~ ~ ~ ~ ~~~ ~~°, ~~~ o~ 0 _~ 1 i 3 3 L, ` ~t V ~~ > I ~ t ` ~ I W I j o "' * "' . ~ l'-~ ~ 1 l 1 - ~ ~ l ~ ~ ~ lv ~ ~ ( - *~ ~-K .k .y c v ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address yon .s: ,~D/~'/z/' Si''r 1'~^; ,7 ~,G ~ y ~'J'/C~ 7 T Property Address (Verification required from Planning Department for new construction City/State ~G~DS~t/, u-~ Parcei Identification Number PJ-ZD - l4/for ~~ LEGAL DESCRIPTION Property Location /r/,~ '/,, Ll/~ ''/4, Sec. /? , TAN-RL~~~4~, Town of ~uDS'O~/ Subdivision Lot # "- Certified Survey Map # ~- Volume '-~ ,Page # - Warranty Deed # ,-3Ucl ,R 4Z - ,Volume ~-~-= ,Page # Spec house ^ yes ^ no ~~`~-~cc Lot lines identifiable ~1 yes ^ no SYSTEM MAINTENANCE Improper use. and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of thc septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposalsystern is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. (~~ , ~ ~ / / SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE O~ANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** 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 INN'1 r -~, ;,» oor.uM~Nlner ~ /~ ~ ~ I j ~ !~ _ ~, s ~, !\ LNC-. .tlF1fE I w~l~ wi~s~ to ~ ~'ll ~~~ ,~ ~ t Y' j;)! ~~ )i 'tl_ -. ~. ':II;: DUCUMtNTARY ( O} ~~.~ ~ `i~ ~: l~~ f. ,; •~ .~~ "'~ I ~GOU~DS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/a" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/i" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA-N elastomers. • Temperature: 104°F (40°C7 continuous 140°F (60°C) intermittent. • fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length,16/3 SJTOW with three prong grounding plug. Optional 20 foot length,16/3 S1TVV with three prong grounding plug (standard on EP05). ®2000 Goulds Pumps Effective February, 2000 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller. Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. METE 0 x u a 0 Submersible Effluent Pump ~~ 3871 EP05 ^ EP051mpeller. Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effident heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upperand lower heavy duty ball bearing construction. AGENCY LISTING ~' Canad'wn Stantlarr~ Assodation (CSA listed model numbers end in "F" or "C".) Goulds Pumps is iso soot aegiscered. 10 12 m31h caPaaTv Goulds Pumps ITT Industries ~ ~. '. , lT ~'~ ~~ R t J~IA ~rli~ r4N~ 4", a ~ a^~t ~~ ` ` o ~ `K. yc ~'" ~ ~ L ~ t { 2' ~ ~ j ~~ xti ~~ ~,~\ ~ ~ a f \ "' }~ ~',t . ~ ~, _ ~~ ~ '1~ r -~. r 1. ~ °' l ,~l . ~ ~ . \ { x ~~ '~ f ~ ~ )+ { t ~ 't.~ ` ~.~ ~ , ~ ~ ~, ~ It F 1 A x " 'i~~.~ ~ ~~ /~ ~ _ ) , v ~ !y?~ I 1~ ~ a ~t~. ~ ~ ~' \ i F "~--''""ti ~' ~ ,.. ~ ,fit ~... /'~ Y ~' ~ ~ , 9 y~ t 4 A It~. ,~ T~' t }~ ht yM~ AL~ ~~ .r. 4 } X ~ ~, ~ t r ,\ 1,~ ~...~--f ,~~~~ k~u a ~.r ~ Y L~~~ ~ / ~j/, 1 rte'/ `"~ 1~~ ~ `\ `` f ~ ~ ~ o .~ X 1 ~~ //,f ~ /`~ ` ( ~, r-- ~,v11, ,~ ~t ~, t ~ J ^~ i 1 _ S ;, I / ~ ~_ ~,,~ J --~' ~ ~`~ ~ 1 , /~"'`! ..jam ~~~~~-,~-----~.~ r, \~~ ~'f ~ ,~ x ~ 1 , ;~ ~` } _, ., :.. f ~,