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HomeMy WebLinkAbout020-1491-05-000 Department vi Commerce PRIVATE SEWAGE SYSTEM `Buildings'6ivision Count y: INSPECTION REPORT St. Croix .AL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ..al informa you provice may be used for secondary p urposes [Privacy Law, s.15.04 (1)( m)]. 363895 . rmit Holder's Name: ❑ City ❑ Village ❑ jown of: State Plan ID No.: ;t. CT0d 1 SCOW amp. I Hudson T wn hi 3IS T - T,.,,s.64„ • lb CST BM Elev.: Insp. BM Elev.: BM Description: IW I Parcel Tax No.: eY0,of I t,.Jo• Cst 1&* 4. 1 (� ,,, .,, se lo.o' 020- 1016 -60 -000 TANK INFORMATION r04 b ELEVATION DATA (3, Z�. 0 Zs TYPE MANUFACTURER CAPACITY ST TIO BS HI FS ELEV. Septic L, Bench' rk 7W ©, ( 0 Dosing P k_,L4,,C� 2. Alt. BM = 77 Bldg. Sewer St/ Ht Inlet I q�v � (, p' TANK SETBACK INFORMATION St/ Ht Outlet fl•►l taIZS� tto TANKTO P/L WELL BLDG. Aeintake ROAD Dt Inlet �S.p ,57 -3C Septic > IW t ? tee ^-64- NA Dt Bottom ' c� S rJ _ g i r Dosing �.� tcso ti NA Header / Man. ,Aera 2 �� op roo� ff�, NA Dist. Pipe r Holding Bot. System S b i PUMP/ SIPHON INFORMATION N Final Grade Manufacturer (-Z Wo T �k St cover .2,� ,Model Number ca�S 5 PM Z }Z 3b 10 ' c b ` O � Lift 43,pc� Lriction I System TDH . 0Ft Z. . (�'' 1 13 H ead Forcemain Length I Dia. 3 Dist. To Well * SOIL ABSORPTION SYSTEM e _4pe,-cc 4bMtTkENCO Width Len r . Of T nches PIT No. Of Pits Inside Dia. Liquid Depth DIME I 11 - YD C & I DIME NSI ON SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man CHAMBER aytu rer: 1 .•n^ ` lV S "`.,- INFORMATION Type Model Number: System: on\). >v* >30D > 3bo - OR UNIT aGi DISTRIBUTION Y M Header / ani Distribution Pipe(s) x H �Hole Sp acing Vent To Air Intake Length Dia — gt Dia - SOIL COVER , ••�,� ressure9yystems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No E] Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: 03/08A7 Inspection #2: o3 /i Location: 965 Alexander Road, Hudson, DUI 54016 ENE I/4 NE 1/4 13 T29N R19W) - 13.29.19.73 1.) Alt BM Description= / k 2.) Bldg sewer length= r� - amount of cover = �� 99111k ttl;- Plan revision required? ❑ Yes �No Usk of er si � dditional i © 2/ D 3 So (R.3/97)��� Lw a e K dGs _ n Inspecto ' S na re Cert. No. -�-• —�� ��.� . � Gam`- �C �- �,,Q ADDITIONAL COMMENTS AND SKETCH s r SANITARY PERMIT NUMBER: w 3 i E N A , Y� , 3 . e . 3 E E , F r E e , 3 , i cl - Z.. E i a � v ... j. r E , E j } E v �. t w , E i Maiden Rock. WI 1- 800 - 32548456 Portage, WI 14800- 362 -7220 Fond du lac, WI 1-800 -641 -5937 _ NIE NEReeneurE Website. www.�nne serconcrete.co m T . ceo ( Y, L_' S Sew "t' Gew-P - - nil sw W LzK L SePT ► e S k 8 wb� 51st is I0 Ix, C_ ) ^ $S = z- Yo t fie/ , <r'lrc • I °•'f 2 La) Cg f � T S'sE AwAo kw ""C e.�1Gtt�S w�3T S�p� T'II. /, 0 (, •� _ 9 �k. o G I .-t-f - C(Z. T4 ►) (.:Fr 94.0 r � r Z) �•3S' = 93. �3 V V-7-0 = Cm Ot 2) ,7. �• Q3.68 r 3) $•'� _ `h. 3Y I `l . _ °1t. oz 3) .34 - Q3. YY `�) q•SS 9I.Z3' ( 10.ct7. x '0q.c% Y) 8.36 = lz-Yt' - ' I S) 11.00 _ 8q. .78 12. Utz. - x.36 `1. cl%f = 10.8'f r G 12. .70 _ 4$.a8 r pf. = ab. �o` 6 ) IZ as - 35" I $ .24 1 - = 0 R•Sa .. � 1`�.�4- X66 a, ���)�. .I(. y3 l Is.�o : BS. Ol 5. n - Sf.. S�' I (4) (.. S'f = Ss, Sb' 1) lv.ts - mot- (, t:L = 8S. �B' 7. *cf $4.30' I I },85� = 92..93 I° :. 10' 11) 18.68 82•6o 19.34' - SI.�o' II I.24' = 83•�Z /o. - �2.oa' 1i) t9•�o - W. C9 � ?1• o = �`i.�4� 121 11. 30 s Sl• I�' ► ?•`f1► - �9. 9H lz,) Zl.t o 3g ,18 Z2.�S` = X8 .03' 13 12.2} 13 i (3. sa s ��•`�O` '71.. w 14•S = 7S- Tp 90' 1y. 49 = ?•�S r 2s. (0 : }r.4s� I7 •St = �'f-� 15� r`f.'fL - �a .9�f Ir .mss = ' CA) Ib� f . �o - .� (p) i w� )`. 14. = 71.Tl �� l�� t = X3.66' kP� I = �'z. so` 1� I �. o - �s. Yo I S• ys _ �`t- � ` 1`b) 14 •86 x �Z.sy ) Z.l o }l. r 414.25' . 93.90 C 1q. 5S C I D IS.T • lljw I • `(*r- = `tS•30 I 530 30 �1 f ( { Project Name: Computations By: Date: Location: Checked B\: Dale: Title /Item: She. t:: Of: L v v . f a , o r' I � V l t �. SEP.- 22'00(FRI) 11:21 WIESER CONCRETE TEL:1156475181 Y P. 001 TMIUNG SEMINAR DATE: NOVEMBER 13, 2000 TIME: 8:00 A.M. - 3:00 P.M. PLACE: THE FRONT PORCH W7562 HWY. 10 ELLSWORTH, WI 54011 (1 MILE WEST OF ELLSWORTH ON U.S. HWY. 10) PREREGISTRATION IS APPRECIATED: PLEASE RSVP BY OCTOBER 31, 2000 715- 647 -2311- WIESER CONCRETE DENISE OR YVONNE 8:00 A.M. - 8:30 A.M. REGISTRATION COFFEE AND DONUTS PROVIDED BY I.H. LARSON & WIESER CONCRETE PRODUCTS, INC 8:30 A.M. - 9:30 A.M. GUEST SPEAKER: DAN JENSEN (DEPT OF COMMERCE) TOPIC: PRODUCT APPROVAL 9:30 A.M. -10:30 A.M. GUEST SPEAKER: ROMAN KAMINSKI (DEPT OF COMMERCE) TOPIC- CODE UPDATE AND HOW IT AFFECTS YOU 10 :30 A.M. 12:00 P.M. GUEST SPEAKE=R: PHILLIP LUNDMAN (PETERSEN SUPPLY LLQ FAST UNIT INSTALLATION OPERATION TROUBLE SHOOTING & MAINTENANCE 12:00 P.M. - .12:30 P.M. LUNCH PROVIDED: SPONSORS INCLUDE: (EXHIBITS DURING LUNCH) PETERSEN SUPPLY LLC FIRST SUPPLY GROUP NORTHWEST CASCADE -STUTH WIESER CONCRtZE PRODUCTS, INC 12:30 P.M. - 2:00 P.M. GUEST SPEAKER: MARK PREVOST (FIRST SUPPLY GROUP) SAND FILTER INSTALLATION OPERATION TROUBLE SHOOTING & MAINTENANCE 2:00 P.M. - 3:00 P.M. GUEST SPEAKER: BOB HAMILTON (NORTHWEST CASCADE NIBBLJER INSTALLATION OPERATION TROUBLE SHOOTING & MAINTENANCE IT OPEN TO POWTS INSPECTORS, MISTER PLUMBERS, MASTER PLUMBERS RESTRICT® SEINER, , 30URNEYMEN PLUMBERS RESTRICTED SEWER, CST, POWTS MAINTAINERS r - ` � t Safety and Buildings Division •ISCOnSIn SANITARY PERMIT APPLICATION 201 Box Was h ington 3 h Avenue In accord with ILHR 83.05, Department of Commerce '`` 0. Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the ear►; on %per not less^ County than 81/2 x 11 inches in size. ate Sanitary Permit Nu • See reverse side for instructions for completing this a kc r a tion �`� �" � Personal information ou p rovide may i `' " �' y p y be used for purposes _. � � ± [Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. sj Cam' State Plan I.D. Number I. APPLICATION INFORMATION - PLEA 5E PRINT L 1 1,8 = 3 I s3 Property Owner Name 4 Property het` S T , N, R E (ore Property Owner's Mailing Address Lo ` b Block Number to City, State ip Code P one Number SoWiv*en -Name or CSM Number L 2— von. r E F B ILD NG: (check one) ❑ State Owned ❑ It� ge Nearest Road ^ Public 1 or 2 Family Dwelling ❑ Vil a - No. of bedrooms Town of G! I A LAW � " I Ct III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Q2 p — eylle — ip 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 Ej Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Z New 2 ❑ Replacement 3_ Q Replacement of 4. E] Reconnection of 5. ❑ Repair of an ______System System Tank Only System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12)ZSeepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit 3� 3X / /� . 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System lev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 06.0 Elevation�� 0 0 — .(O / � Feet ,?y"Y®v*eet VII. TANK Capacity et in gallons Total # of r Prefab. Site Fiber- Ex per. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic A p p New Existing strutted Tanks Tanks rte/ Septic Tank or Holding Tank Z no ❑ ❑ ❑ ❑ ❑ Lift Pump Tank Amphan Qksm6er ❑ 1 ❑ I ❑ I ❑ Vil . RESPONSIBILITY ! ITATEI fi ENT / te 5 n on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stam #*WPRSW No.: Business Phone Number: tier's A dress treet, Cit , St e, p ode): d �r> I wZ IX. COUNTY f DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) [] Q Owner Given Initial I Surcharge Fee) Adverse Determination 5 CJ7 5 27rZec k)-. 1�___ X. CONDITIONS 9F APPROVAL / REASON! APPROVAL: � ar1P SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS t , 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 PermitTrancfer/ 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 s Y m is t be installed. ll. 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 plansmust r 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 mainstwater 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,gection of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) aCl sizing information. n GROUNDWATER SURCHARGE i 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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. c Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Vi�consin www.commerce.state.wi.us Department Of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 16, 2000 CUST ID No.691727 ATTN: POWTS INSPECTOR ARTHUR L. WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/16/2002 Identification Numbers Transaction ID No. 315379 Site ID No. 127490 SITE: Please refer to both identification numbers,, Site ID: 127490, Rolling Ridge Girl Scout Camp above, in all correspondence with the agenc St. Croix County, Town of Hudson NE1/4, NE1 /4, S13, T29, R19W FOR: Description: Commercial Non - pressurized In- ground System Object Type: POWT System Regulated Object ID No.: 662363 The submittal been reviewed f r c of conformance with applicable Wisconsin Administrative Codes e sub tta described above has b e o 0 o pp and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code 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. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • An alarm must be incorporated into the duplex alternating controls which would be activated in the event of pump failure, simultaneously switching the remaining pump to dosing on each cycle. The alarm must remain on and be shut off manually. • 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 private sewage system 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. Stats. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a potentia l for a law suit that may delay the effective date of the code so this status may or may not change. c ARTHUR L. WEGERER Page 2 5115100 y I I pr"6 1 or- LOCATED IN THE NF 1/4 OF THE Nf_� 1/4 OF SECTION 13 , T Z-g N, R t9 W, TOWN OF SdN , 17. CIZUUC COUNTY, WISCONSIN. INDEX PAGE 1 of 10 TITLE SHEET PAGE 2 of 10 PROJECT DATA PAGE 3 of 10 PROJECT DATA PAGE 4 of 10 PLOT PLAN c!9 PAGE 5 of 10 PLAN VIEW -CROSS SECTION ,n PAGE 6 of 10 LEACH CHAMBER DETAIL m PAGE 7 of 10 GREASE INTERCEPTOR SPECS. PAGE 8 of 10 SEPTIC TANK SPECS. D 1'77 PAGE 9 of 10 PUMP CHAMBER SPECS. 0 , L"D PAGE 10 of 10 PUMP PERFORMANCE CURVE W ,� � ® o M cn C y P .. C . U' p l on aiiy 6 Of COMMERCE ,)EPA Y DgDtLD1NGS PREPARED FOR 0 F p1V►S10 �''. ONp NCEST.CROIX GIRL SCOUT CAMP te 400 S . ROBERT STREET SEE ST.PAUL, MN 55107 �'` ,0 : A wEOER£R 0.816 V iLLSWORTN, wrs. PRE PAPM BY I G 14 � ti«.. «...r 4 �'S WECGEE�EiZ E3 C3 I L TEST I NG �� AND . S - ?_ .00 DES I C3M SEFZV I CE P.O. BOX 74 421 N. MIN ST. RIYEP FALLS. NI 54022 715 -42`., -0165 JOB NO. PROJECT DATA Page Z of 1p This dosed conventional in- ground system will serve a proposed building which will contain a kitchen and dining hall serving 2 meals per day for a maximum of 400 Girl Scouts. There will also be a multi- purpose room with a maximum of 400 people per day. 6 employees are anticipated with a shower being provided for employee use. 14 floor drains are proposed. ANTICIPATED WASTEWATER Dining hall w/ kitchen and toilet- 800 meals X 11 gal = - -- 8800 gpd Assembly hall- 400 people X 2 gpd = ----------------- - - - - -- 800 gpd 6 employees at 20 gpd = ----------------------------- - - - - -- 120 gpd 6 showers taken at 15 gpd = ------------------------- - - - - -- 90 gpd 14 floor drains at 50 gpd = ------------------------- - - - - -- 700 gpd TOTAL = -- -10510 gpd SEPTIC TANK 10510 + 750 = 11260 gal minimum capacity required. Two 6000 gallon tanks by Wieser Concrete Products will be installed in series to provide 12,000 gallon capacity. ABSORPTION AREA 10510 gpd - .8 loading rate = 13137.5 sq.ft. of absorption area required. Two equal system areas are required due to the system size with each being 75% of the total area required.. 13137.5 X .75 = 9853.1 sq.ft. of absorption area required per cell. Each cell will receive alternate doses of at least 1315 gal.per dose. ( 10510 - 2 = 5255 gal - 4 doses per day = 1313.75 gal /dose) Each cell will contain 18 trenches each 3' by 112.5 with 18 units of High Cap acity Sidewinder leach chambers per trench. g P Y p ch. This will provide 10,125 sq.ft. of absorption area per cell. � � �0 l �L i PROJECT DATA Page 3 of 10 GREASE INTERCEPTOR C= H +G +H 2P C= SOOX3X6 2X2 C= 14400 4 C= 3600 gal. minimum capacity required. A 4200 gallon tank by Wieser Concrete Products will be installed. PUMP CHAi -IBER A 2000 gallon Wieser Concrete Products tank with duplex alternating pumps will be installed. 1b. 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PAGE f o r I O • FN �r � = a '` . ♦ � co co p d N iwf �b c ..�s � n n N c a I `� CD n a w a c, n O 3 u ~ ' (D I �, a r r t �c 0. : E c z It'll a _ �D 3. � 4Lh I'7 0 `— H 9 cn CD CD • N s1 ca CD CD 0 a rt < 0 CD l< 3 NFT 0 w rD C L O O 1 G7 CD C� wcn x D7 �Q33 6 ~ cr W ,C z u N CA 1 N 144 - I 3 a no a L <. � (D O S m > > �— Invert 11'—} N s fD K V1 y 5 E 981" 77" O 96" r r- - - - - -- -' --- - - - --I 1 I 1 88f I I I I 1 I 1 I is Dr 0 I D r 0 I I \ 5 " I 5 I I . 5 " � m + + i I i• I I I I i 1 24" .I � I i II 1 I L O Z N v ' m r D n m O 2 co g m O >z O 0 z �_ 0 m_ozmzo Z a m 0 N TW O =0 G) =OI*1�r VJ �7 O N T N N n Oc ��C erg.. �.. r �w /� p oc m� mZ� (omo rn v Zrml > Nr Us C/) '>'A D �= O D \ VI C m 0 9 Z O ' DA WN s G ab nm rn > r p L7 m (n OD V) p i r� Z :< t�+1 4 _I (7t =1 N r f ? D Tt m D N UCJ D \ r O M O p m 0 c Z CO cn •-I 7C n I m [ N m ° z rn O m m T p O o Dm O M o rz O Ono g n ' PUMP CHAMBER CROSS SECTI AND SPECIFICATIONS' PAGE °1 OF LO VENT CAP 4" C.I. VEkIT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE JUIJCTION BOX COVER WITH WARNING LABEL � 10' FROM DOOR, IZ'M11J• WINDOW OR FRESH AIR IIJTAKE ca A i y' MIN. 10' MIU. CONDUIT — "' -. --- ._ - - -- 18 "MIAJ.� - - - - -- PROVIDE -- IMLET AIRTIGHT SEAL . � I II v APPROVED JOINT A Tank construction shall comply I I ( APPROVED JOIAI with approved with ILHR 83.15 and ILHR 83.20 I I pipe extending I I ALNZM 3 feet Onto p Install duplex alternating controls with the alarm I i 1 system being incorporated into the.duplex controls solid S O l l. which vill'be activated in the event of pump failure. I I 0w Both S 1 d e S O f simultaneously switching the remaining•pump to I C dosing on each cycle. ( i tank. ��`� I�1 I-LEV. F7 PUMP,, __J OFF e D 81.v0� CONCRETE CLOCK APPRWE K15Cit EXIT PERMI'fTED ONLY IF TANK MAIJUFACTUR0.R HAS SUCH APPROVAL 1 310 gEppl SPEC.IFICAT10kIS DOSE . 'W\ MML C MCIZ TI►0 K MAtJUFACTU0.ER. TANK 512E : `Z C�00 GALLOAIS S 5'. zLLe�`['}2.IJ Sk�yl MOTE: PUMRSANO ALARM ARE TO DC ALARM M/WUFACTURLR: INSTALLED ON SEPARATE CIRCUITS MODCL 1.IUMBCR: Pv' P P -FORE C��vE Vii: )6 10 ' i uoulas Submersible Effluent Pump ..A.., i o 3885 APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously Specifically designed for the • be provided in starter unit. bronze impeller available as without damage. following uses: Shaft: threaded, 400 series an option. ■ Bearings: Upper and • Homes stainless steel ■ Casing: Cast iron volute lower heavy duty ball bearing • Farms • Bearings: ball bearings type for maximum efficiency. construction. • Trailer courts upper and lower. 2" NPT discharge adaptable • Power cord: 20 foot g p ■Power Cable: Severe duty • Motels for slide rail systems. rated, oil and water resistant. • Schools standard length (optional ■ Mechanical Seal: SILICON Epoxy* o seal on motor end • Hospitals lengths available). p Single phase: CARBIDE VS. SILICON provides secondary moisture Sin ha • Industry Sin and h se —16/3 SJTO CARBIDE sealing faces. barrier in case of outer jacket • Effluent systems Stainless steel metal parts, damage and to prevent oil with 115 V or 230 V three BUNA -N elastomers. wicking. prong plug. SPECIFICATIONS • 3 /4 -1' /z HP —14/3 STO with ■ Shaft: Corrosion - resistant ■ 0 -ring: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. W maximum. • Y2 -1'/2 HP —14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads. On GSA against component damage AGENCY LISTINGS • Capacities: up to 128 GPM. listed models — 20 foot on accidental reverse rotation. • Total heads: up to 123 feet length SJTW and STW ■ Motor: Fully submerged in 0 Canadian Standards Association TDH. are standard. high -grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat UL Underwriters Laboratories carbide -rotary seat/silicon FEATURES transfer. carbide - stationary seat, 300 ■ Impeller: Cast iron, semi- ■ Designed for Continuous series stainless steel metal open, non -clog with pump- Operation: Pump ratings are parts, BUNA -N elastomers. within the motor manufacturer's • Temp erature: out vanes for mechanical seal P o protection. Balanced for recommended working limits, 104 (40 continuous 140 °F (60 °C) intermittent. METERS FEET �g,a , A �, o#- ar,Pec a,. C • Fasteners: 300 series stainless steel. 90 ! I sERIES: sss5 • Capable of running dry 25 ao ` ! i SIZE: r ' SOLIDS -E1 RPM: VARIOUS without damage to I -� -- — .sGPn� = I components zo vE,oH l sFr Motor < 20 s I i Single phase: _ E0 •'/3 HP, 115 V, 200 V, 230 V, U i 60 Hz, 1750 RPM;'' /2 HP, z 15 115 V, 60 Hz 3500 RPM; 0 40 w E05H HP -111 HP 230 V, a 60 Hz 3500 RPM. 10 30 I oa ' • Built-in overload with 20 automatic reset. _ I k • Class B insulation. 5 Three'phase: 10 • , _ I I 67 ; w hHP 1 /z HP 0 , 2 0123 0! o I o . 460 V, 60 Hz, 3500 R PM- i l . 0 10 20 40 50 60 70. 80 90 100 110 120 130GPM • Class B insulation. a 1 �° 3o m3m 29 keJ ©1995 Goulds Pumps. Inc. r Wisco mWnZepa*Twt of Industry SOIL AND SITE EVALUATION REPORT Page _I - Labord Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but r G not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to near "U j ad. Q - t L o APPLICANT INFORMATION- PLEASE PRIN PN R VIEWED BY DATE Lz PROPERTY OWNER: PROPERTY LOCATION r z . ,:: 'l LOT � 1/4 /,0Z. 1/4,S/3 T� N,R E (o -57, C PROPERTY OWNER':S MAILING ADDRESS t:OTI# BLOCK # SUBD. NAME OR CSM # ift X7- 2- CITY, STATE ZIP CODE HONE NIBg I f ❑VILLAGE OWN If NEAREST ROAD [ ] d ' ` [ ] New Construction Use R esidential Addition to existing building j ] Replacement j/] Public or commet*64c'iii Code derived daily flow gpd Recommended design loading rate � bed, gpd 1ft trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate — bed, gpd /ft — trench, gpd/ft Recommended infiltration surface elevation(s) F® v4v lbn,roux It (as referred to site plan benchmark) Additional design / site considerations �m!¢ S ys)'�i'ih — ft�G.a< s - ff�'!1s ow ✓� Parent material flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE I SYSTEM IN FILL H LDING TANK U= Unsuitable for system 4S ❑ U ❑ S OU 7 OS ❑ U ZS ❑ U I ZS ❑ U XS ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench L IL -7 77 6 — CS 'P 4C rn L m Ground 3 _ / ; _ 1)1,5 ps G rrr L — — elev. Depth to limiting factor Remarks: Boring # .' D - rFs .r vF - .e Ground r~ '� s ®S�r 7. S elev. /cp. ft. Depth to limiting factor > R6 Remarks: ST Name: — Please Print v Phone: r A ddress: fo T3 � off- 3 Signatu e: Date:/ e 22 Numb D PROPERTY OWNER Gcizc seats - Ir rre ffc SOIL DESCRIPTION REPORT x Page 2- of o PARCEL I.D4 G2o --le/6 - � a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour" Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w' - s r� - z — rn dF c m� �s Ground 3 f - — Ms 40 �►�- elev. rP6. y ft. Depth to limiting factor >13 Remarks: Boring # L 4) Z5 Ground 3 - - 2, - s y — " v G M — — _9 elev. 1 jL•,L ft. Depth to limiting factor 7 r 7a Remarks: Boring # _ LS X Ground 3 / - - r �►S vS .n —' — .� elev. nip ft. Depth to limiting factor >k_ Remarks: Boring # Ground 12 -5-110 7. � - S y elev. Depth to limiting factor > /0 Remarks: SBD- 8330(8.05/92) Wisconsie }Department of Industry SOIL AND SITE EVALUATION REPORT Page 4 of 3 Labor .Otid Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code - COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. /D/ -- APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION nj4 GOVT. LOTV 11VC1 1/4,S TZ N,R E PROPERTY OWNER':S MAILING ADDRESS LOT # B # SUBD. NAME OR CSM # _ . �' S .3 ` .3 1 C PHONE NUMBER ❑CITY []VILLAGE OWN I NEARESTROAD z New Construction Use [ ] Residential / Number of bedrooms [ J Addition to existing building I ] Replacement �/J Public or commercial describe jg ;g �E' Code derived daily flow gpd Recommended design loading rate _2 ed, gpd /0 gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations ,gE o,v /�ti ck�,rJ WerE€ A1ArF Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUNn PRESSURE I AT -GRADE I SYSTEM IN FILL HOLDING NK U= Unsuitable fors stem S❑ U El U S U ❑ S U ❑ S U [IS U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ::..; 2 s- /L /o - _ � s os� n, � cs � r -7 Ground 3 /Y - 7 -,r -V -- s SSG hi — — 8 elev. J ft. Depth to limiting factor i Remarks: Boring # - ZZ Ground elev. ft. Depth to limiting factor 7/0 Remarks: CST Name:— Please Print Phone: 6 Address: , v wT' Signat of Date: CST Number: PROPERTYOWNER eM 3r,-671 1C rtC#C,00 SOIL DESCRIPTION REPORT Page, of '3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourt Lary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench < 3 o - s o— L L z A , 2 -.2 , 3 . 6 1 -- 2 Gs ' n, .� Ground -7 6- ry L F S 07() AmJ r � .. elev. _ ��ft. 15 ,- v- 17P 7-5- s ;eC L — .7 F Depth to limiting factor I Remarks: <7 A-V 010 r o C. - - e&fr 0*2 7 1 Boring # z G s- S L ►� dx , ; Ground Al" A"& elev. -7 2,k: - ft. Depth to limiting factor 7 %jz Remarks: ' Boring # S W ZZ v FR Ground 3 7 -/ ; -- 6 m 5 -- - • 7 elev. 3L 7 ft. Depth to limiting factor Remarks: Boring # ,.......,..,,..,.. 1VOTE- A N_riv - - - Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) t r ` ~ Z N " v 4 ai m m F � a x � r Z � � Q � � t -L p I i I p � � O i 0 i 0 000 i C4 Q- ol, a 4 �.: Ob y ' O to cn Q Q! I f i i i i i j i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 4_ OWNERSHIP CERTIFICATION FORM rBuyer ailing Address Property Address Dep artment for new construction) (Verification required from Planning ep City /State G� .� Parcel Identification Number 0-Z LEGAL DESCRIPTION i T� N -R Town of Property Location /� i /4, / <, Sec. Z L Lot # Subdivision �--- -- Volume page # Certified Survey Map # y L� �y Z P3 1, Z , page # Warranty Deed # 2.x,1 yL , Volume - Lot lines identifiable yes E3 no Spec house ❑ yes O no SYSTEM MAINTENANCE ce of our se tic system could result if needed p re ma tur e a l nsed pumpern Improper use.and maintenan �whatsyou Put into the system Y P consists of pumping out the septic tank every three years or sooner, Y can affect the function of the septic tank as a treatment stage in the waste disposal system. a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Department verifying that (1) the on -site wastewater disposal system master plumber, joumeymanplumber , restrictedplumber or a licensed pmnPe se tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), P tie to maintain the private sewage disposal system with the standards Uwe, the undersigned have read the above requirements and ah Zoning Office within 30 et b the D the Department of Natural Re sources, St Croix County stating that your septic system has been maintained must be compreturn Wisconsin. Certification set forth, herein, ass y D e p artment of Commerce and leted and days of the three year expiration date. i DATE SIGNATURE OF APPLICANT OWNER CERTIFICATION our knowledge. I (we) am (are) the owners) of are I (we) certify that all statements on this form deed tru recorded e in Reg ster of Deeds Office. the property described above, by virtue of a warranty DATE / SIGNATURE O APPLICANT being revoked by the Zoning Department. * * « #•* �+ • 'on that is mis- represented may result in the sanitary permit Any i * * * ** a pplication: a stamped warranty deed from the Register of Deeds office deed Include with this app of the certified survey map if reference is made the warranty a copy 7(h iME4T NO 1 STATE I3AR OF WiS(').. � rORM 2 WARRANTY DEL: y .. ly ; ._ His svAi t t t ')ATA 3.1.842 VA� 555 _ . 45 REGISTERS 0!=i=I:,E - lY rics ;+t'u, Ma cQlr Busit and Mdry B. Bush, brother ST- Cc:OIX CG. as joint te; --,nts - - - R E7C'd. - - D of ov _ A.0. 1 .; 7 1 i-•an•or :on,eps and warrants to Girl Sc ")ut Couricll Of St- Cro ix Valley,; t ) =)Q_ P r't" aka Girl Scout - Council_of St. Croix Valley, Inc. _ f 4' y ar of 0 b „1 i - - -_ - Grantee _ i Fift Thousand, Five Hundred and for a valuable consideration /100th (S no s ---- _-- - - - - - - -- _ < 53,500.00)---- . - - - - -- _ ._ _ - --------- - _. A St- Cro ix Count State ofWiscinsin: the following described real estate­ in __ y• C ;!. nwcx; , d CiI'1/r Vi,-;- i fax Key x _ : This is not homestead property. :i 1. The South Half (SI) of the Southwest Quarter (SV!), Section 12; 2. The North Half (N) of the Northeast Quarter '(900 of the Northwest Quarter (NWk),Section 13; 3. The Southeast Quarter (SIX) of the Northeast Quarter (NEk) of the Northwest Quarter (NA), Section 13; 4. , hat part of the North Half (N of the Northeast Quarter (NEV lying rRt'�NS�ER Northwesterly of the Town Road, Section 13; 5. The Southeast Quarter (SL%) of the Northwest Quarter (NWk) of Section 13. FEE ALL in Township 29 North, Range 19 West part c This Deed is executed ft anpul?ose of fulfilling a re d recorded with the Register of for St. the and County, .�reof dated July 27, 1972, in book 490, page 552. Exception to warranties: Hudson, Wisconsin sf October ,'� 77 Executed at — - - th,s- -•'� . - -{ day ot-- - - - --- -- • 19 —. � L (SEAL) -SIGNED AND SEALED IN PRESENCE OF Malcolm Bush Mar Bush - - - - -- -- — y r� (SEAL) I (SEAL) Malcolm Bush and Mary B. Bush __ -- - -- - -- Signatures of - - -- 7 . authenticated this o2l� day of October - _ - _ _ - Richard P. Rivard _. Title: Member State Bar of Wisc.rnsin or Other Party Aut:iorized under Sec. 706.06 viz. i STATE OF WISCONSIN } ss. County. day of Personally came a me,this the above named __ _ .. _ - /. �, ,�y. y, r �:u ,gar• - r 9` �' �:. .� "�."" � � < . � +� 3"''3 �s�'!`�''` t � �"�Q•.k�. �� i STATE BAR OF W'SCOWSIV- FORM '. DOCUMENT NO. u.:'. WARRAPM DXAD VOL 64 L Fri: . 1 :3 t. SF'.` r w[s�RtEO FOR F[c OR0,�.3 Oar U I 377528 William G. «.1A. . and Martha C. White, husband REC94MRS OFFICE ...................... ••....._.._................._. ' anS�..Wi;' ....a &....iQ1,11t--- t..�?wnt s.> .8ran[�XS. ST C OIX ..... "..._... . CO., WI& ............... . .. ...... .........I..,.................. ............................................ Recd for Rwwd ft rd .............. .......... .................. - -- .. .._..... .. ......... cenrpta and .. warranis to rirL.S.Gaut...COunc"i 1...^f.- .SG�..Croi x. d of June A.D. 19 Valle_ y.,_9 rantPA........... . .......................................... at 1:00 M. _ ......._......_....._.... • ......................... ..............................• — �gMer N ...................... . ....... .........._.._... .............................._ I............._......... .......................... tlw hawwins described real estate in .............. ..S.kA--- C r.QL X ..........(.ounty. Wta0e of wisoonsin: Tax Key No ....... ............................... ,1 Northwe st Quarter (NW'k) and West Half of Northeast Quarter g (W� of NEB) of Section Eighteen (18), Township Twenty -nine d (29) North, of Range Eighteen (18) West, St. Croix County, Wisconsin, except that part of the West Half of Northeast Quarter (Wk of NEk) North of the highwpy. This warranty deed is given in satisfaction of that certain Land Contract dated June 23, 1972, and recorded in Volume "485" Pg. 608 as Document #310942 in the Office of the Register of Deeds for St. Croix County, Wisconsin. This .. _. i S -X10.0 -... homestead property. - j&kK (is not) Exception to warranties: ! Any liens or encumbrances created or suffered to be created by the Grantee, or the heirs or assigns thereof. T .^ Dated this .. - "..- 1 June .5� - _ _. day of .. "(SEAL) .. "... _ .... (SEAL) .............. . William G. White .(SEAL) r- ..... (aEAL) • Ma.rth,3. C. White >.: AZJTHgN'fICATION ACKNOWLEDGMENT signatures authenticated this . ----- _ ..... -, day of STATE OF WISCONSIN ' IE St. Croix Ccuucy. Personally came before me, this St _ . _day of ` William June 1982 the above named _ • ... .......... __...... G. white and Martha C. White TITLE: MEMRER STATE BAR OF WISCONSIN (if not, ..... --- _ authorized by § 706.06, Wis. Statr ) cn o LO VI O cn a O p Q O p to \:C i O o N M 41 .O vp - N dr <30 en !Y li i • � cf1 O a ,.; C l 0 U ,r 1 U I tj �Gapartment of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings -z Page Z of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code County Attach Attach complete site plan on paper not less than 8 1/2 x 11 inches 1 8 $ 1 include, but not limited to: vertical and horizontal reference point action nd C percent slope, scale or dimensions, north arrow, and location a nce n p ad. Parcel I.D. # APPLICANT INFORMATION - Please print all i tirnat• r J Reviewed by Date Personal information you provide may be used for secondary purposes nv y LaW ' S ( 15741 Property Owner t'y Location L r _ ' ' =t#�al<to4 �/F_ 1/4� 1/4,S / T Z NCR E (o� Property Owner's Mailing Addre Lpt Block# Subd. Name or CSM# 2� � T vas. s �s ys yy�yj Ciy State Zip Code Phone Number ❑ City ❑ village Town • Nearest Road ss jo ( 2) 7 -i 3s Gi o.J 0A R.D. ,c W-P El New Construction Use: ❑ Residential /Number of bedrooms Additieftexisting building ❑ Replacement Public or commercial - Describe: /_tL SCOUT I�z Tcf/&.fl Code derived daily flow gpd Recommended design loading rate ­`- bed, gpd/ft . y trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd/ft -e trench, gpd/ft Recommended infiltration surface elevations -3 fZ- - t 3,6 _ ft (as referred to site plan benchmark Additional design /site considerations vv < 1 ry440 W ro.-VroUR Parent material - - Flood plain elevation, if applicable ft S = Suitable for system , C�onnventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 1 S ❑ U as ❑ U as El as E3 U ❑ S [�U ❑ S [`U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench o- 3 a 2 LS f S /G p L7- — G L — — •� Ground elev. Depth to limiting factor Remarks: Boring # _ o- 7 , 7 z Z - s - 6 s� s .c M FA e- 3 37-9 - 7 .5 , y d — S S G L Ground elev. Depth to limiting factor � j in. Remarks: CST Name (Please Print) Signature Telephone No. yr 1 t t Address Date CST Number 2 // •�� r SOIL DESCRIPTION REPORT d PROPERTY OWNER Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 / -G ,0 - 2 -- Z 5 L , 8 2 -3G 7, s - Ground 3 _ elev. Depth to limiting EE .(JOVE eV T,a factor >�in. /1 - eZ,>X1xg , Remarks: Boring # � Z �, - / S e El Ground _ 5 !NL .P elev. Depth to limiting factor Remarks: 3 -zo9d C4/toi.7 — Jrl oc,'r oX 7 Ho,gr2,01d Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/(t2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # f / R- .a c 7 9 Ground elev. Depth to limiting factor '' "' Remarks: Boring # L 3 1 2.> -91- L S Ground elev. V f - 11 —1 Depth to limiting factor ' //.P "' Remarks: SBD -8330 (R. 07/96) I � N 0 f v I j v i i N i w w rz 7 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings�Divkjon INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353117 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: Girl Scout Carnin of St. Croix Valley, I Town of Hudson 2315 ='Tro -s. 11A. CST BM Elev.:. Insp. BM Elev.: I BM Description: Parcel Tax No.: I • ` C = cSK vu r 020 - 1016 -60 -000 TANK INFORMATION ELEVATION DATA t3. X 13 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �SbfL Benchmar 2 2— JID lam, Dosing Est56tZ_ Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFO TI N St/ Ht Outlet TANKTO P/L WELL LDG. Air i to ntake ROAD Dt Inlet Air Septic ( 4 > roo 1 NA Dt Bottom Dosing NA Header / Man. Aeration 5 °� NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Al Manufacturer s Demand St cover Model Number & .5 GPM TDH Lift Friction System TDH Ft m Forcemain Length D . Dist. To Well SOIL ABS RPTION SYSTEM REN H Width Length No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 3 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeOf CHAMBER ModVINumber System: ( J� 7 1dp A _ OR UNIT -C qj" LA DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x �Ie acing Vent To Air Intake Length Dia- Le Di Spac SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No [:]Yes ❑ No O TS: c cjeOncies, persons present, etc.) Inspection #1:0`F/ 14/00 Inspection #2: �A S > Location: 965 A oa , udson, WI 1/4, NE 1/4, �ct�gn 1 T2$N- R�19W) - 13 .19.7, j -3 gl 3� 3 - 9 y t 7, �,� ( - I ( L6 s' S v4. 1 0 0.10 Plan vision required? ❑ Yes MNo 144 1 Use other side for additional / i � n _ form tlon. C1 a- SBD 6710 (R.3/97) A YCC�a e 4'1�- O(Z, t o - Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: emd 3 .. kliv i 1 7P ° r i r a 1 S ° _. ....... .. Ew. F & } r , e _.. f � R 9 t � t ,° } e i i (ff ° P i a 1 z t E © ®d n i r 3 r t / € Y L > a r w � g 3 S � 5 E i ? i �. . __ ... . d m . , ° , a� _a...� . e.,.,,.__. ° ` ......... .. ..�.�.... _. ,. .._,�.... _ .. . �, a — . _.r.M� ......,.,i �..aa . ., _ � .. _ . ...° .. . _.• ......._ .� S.S. _ . C. _..........' C °`� � � ti• 0 d P h u r V V V '04 � N 3 r Safety and Buildings Division Vi sconsin , SANITA RY PERl�A1 � ON 2 01 W. Washington Avenue y � �- . `� P O Box 7302 Department of Commerce In accord with Com . 0 is. Adm. Codex! Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) fo kt Sys , cap;not �te_3 County than 81/2 x 11 inches in size. �r ; • See reverse side for Instructions for completing thif s.;kp, a ° � y State Sanitary Permit Number i �� Personal information you provide may be used for secondary purposes-' ,_ C} , j �Ca , ,' ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. \, " " State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT Z Property Owner Name \ ZP o y Location /a 1/4,5 T , N, R/,? E (o Property Owner's Mailing Address Lot Number Block Number City, St a Zip Code Phone Number Subdivision Name or CSM Number G O c > - S' s it II. TYPE ❑ ❑ Nearest Road BUILDING: (check one) State Owned —_ ❑ village Public 1 or 2 Family Dwelling - No- of bedrooms Town OF Gr O /kE III BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo D —10 le 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System ________System _____________ Tank Only_____ ________ Existing System ____ ____Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) g4,06 — fvAe, Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 [] In-Ground Pressure i 42 E] Pit Privy 13 ❑ Seepage Pit ,� 3� 375 , %�f— 43 ❑ Vault Privy 14 ❑ System -In -Fill Gitoz "474IM-L VI. ABSORPTION SYSTEM INFORMATION: ,;t s R&.04e/ 1. Gallons Per Day J! ? X7, . Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate r Zl ev. 7. Final Grade equired (sq ft.) P posed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 70 PIP "E s ��� AL S_ F7•1 eet G /t✓Feet Cap acity VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existin strutted Tanks Tanks Septic Tank Sep or+WkhrygTv* ❑ ❑ ❑ ❑ ❑ Lift Pump Tank der Q 1:1 1:1 El 1:1 1:1 VIII. RESPONSIBILITY ATEMENT �� Z.%BE �rA *rX 04 I, the undersigned, assume responsibility for installation o the onsite sewage system shown on the attached plans. t Plumber's ame: (Print) Plumber's Signa o St ps) MP /MPRSW No.: Business Phone Number: t 12 (� 7 d ress reet, City, State, Zip ode): O Z � � Ya 2 NTY / nPPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determinatio I on i K . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS P 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained." The septic tank(s)'M'ust be pumped by a licensed pumper w - hen4v`;b C 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 Y. . Wisconsin,-Safety-and Buildings Division,-606- 2664151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed 11. 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 newior existing tank, list the total gallons, number of tanks and F. 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 scaTe 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( ' akes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of he building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; frictionloss; pump performance curve; pump model and pump manufaktur r,�_D) cross section of the soil absorption system if required by the cou'rity; E) soil test data on a 115 form; afd' 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. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 8visclonsin TDD M (608) 264 -8777 www.commerce.statemims Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 09, 1999 CUST ID No.267341 ATTN: Rod Eslinger WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/09/2001 Identification Numbers Transaction ID No. 239586 Site ID No. 178033 SITE: Please refer to both identification numbers, Site ID: 178033 above, in all correspondence with the agency. St Croix County, Town of Hudson NE 1/4, NE 1/4, S13, T29N, R 1 9W Subdivision: CSM Vol 565, Pg 45 #344842 Facility: St. Croix Valley Girl Scout Camp FOR: Description: New, 3 Service Bldgs, Conv Sidewinders Object Type: POWT System Regulated Object ID No.: 484081 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with I the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Slats. 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. Sincerely, DATE RECEIVED 07/29/1999 FEE REQUIRED $ 240.00 FEE RECEIVED $ 240.00 Dennis R. Sorenson BALANCE DUE $ 0.00 Wastewater Specialist (608) 785 -9336 dsorenson @commerce. state.wi.us WiSMART code: 7633 DOSED CONVENTIONAL SOIL ABSORPTION SYSTEM Page \ of FOR LOCATED IN THE N E 1 /4 OF THE NE 1/4 OF SECTION ,T N, R 19 W, TOWN OF s a K3 , Sr. LK COUNTY, WISCONSIN INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 of 7 PROJECT DATA PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 LEACH CHAMBER DETAIL PAGE 6 of 7 PUMP CHAMBER PAGE 7 of 7 PUMP PERFORMANCE CURVE J U L 1999 PREPARED FOR L ' = _ ST C� lX V NtA L f G L :`L - SETS -- `1llo s. tau 1Z-T STIZ.ZE ,e � e �moo`eee� - g ARTHUR L M O WEGERER 6975 P PREPARED BY Et h . •..n.M WE CE; EFcER AQ S L ? =ST 11VG ��►!j ±� �' G1<V SF =F W I CE F.O. BOX 74 421 K. MIX S7_ RIVE. FALLS. VI 54022 715 -4 — Lx-0 165 JOB NO. PROJECT DATA Page Z of - 7 This system will serve 3 bathroom buildings at the St.Croix Valley Girl Scout Camp. The anticipated use is a maximum of 40 persons per day per bathroom with 1 floor drain in each building. System sizing is based on 5 gpd /person (outdoor sports facility) which appears to be the most logical sizing criterea. ANTICIPATED WASTEWATER 40 persons at 5 gpd = ---------- - - - - -- 200 gpd 1 floor drain at 50 gpd = ------ - - - - -- 50 gpd Total per building = 250 gpd Total effluent from 3 buildings = 750 gpd SEPTIC TANK 250,+ 750 = 1000 gal. minimum capacity req'd. A 1000 gal Wieser Concrete septic tank with a Zabel Filter will be installed at each building. Effluent from the 3 buildings will flow by gravity to a 1250 gal Wieser Concrete pump tank which will then dose the proposed trenches. 5 trenches, each 3' wide by 37.5'long with High Capacity Sidewinder Leach Chambers are proposed. 750 gpd - .8 = 937.5 sq.ft. absorption area required. 5 X 5 X 37.5 = 937.5 sq.ft. provided, 1GE 3 of i s I 1 -- i S � i Pv c j I of L4 i 0 :'lv zv�m Te rot 1 1 1 g . vll 3' CL 80 ullnr� 7 6' 4 � tGx ,;� s L= `� PvC �1 �Gl1 CPt�flC1 L) U N�:-Jl'S - Vt L-eNQ4 F 'tits O 6c - AASE SYS'" =jM tom. 8,1 C 02 zitionally PPRO t SI OF SAFETY ILDINGS �7Y �� SEE CORRESPONDENCE L u L 1 CD ocf La I N • m E MT I � � Rill c ;N b o m W a I ►��! I I ca -+o co i�! C p Till tt co i m� a o � �1. ►. �.. I"lpll m Ch J 1. ti 1 s r i x - 'T, ay I. co cn (DD ��. � n CD x cc (Q � �_ J !! + t == G r (n f7 Q. � Q (D I CD < cr — (D n (D �< = - ++ p O J CL m 0 0� I a (D CL I c a `=Q(n CO (a x � CD 3 I I I C- c Q I co ca - O S � =3 -- Invert 11'— � e 1W u s (D H I i kA PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS ' PAGE OF - 7 VEIJT CAP 4 "C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE JUAICTION 80X 7 10' FROM DOOR, COVER WITH WARNING LABEL � 12�MIU. WINDOW OR FRESH I AIR INTAKE GRADE A L #• i M" Mild. I 18' MI IJ. CONDUIT � -- 11� IAILET PROVIDE _- . r AIRTIGHT SEAL APPROVED JOINT A Tank construction shall comply I I APPROVED JOIN with lttm 83.15 and 44,Hk 83.20 1 1 1 ���: - I I� ALARM a ' i II I I 1 I ON C - -GLEN. 8y, b"7 FT G �S � � PUMP -� ' � OFF SV $N '� �It. COMCRETE &LOCK IV co it �� 1 3 4- ADPS2oVED PERM�D ONLY IF TANK MAAIUFACTURE.R HAS SUCH APPROVAL�� � 5 �. -''G� 5PECIFICATIOUS DO st , � S � u E� N l W l�� (2wi CGZ. . S TwNK M �$EIQER: tvur► OF DOSES: 3 PER oAy 5 GALLONS DOSE VOLUME z ALARM . - M/WUFACTURCR: E S INCLUDING DACKIF60W: MODEL ►.!LIMBER: yt') CAPACITIES: A= Z�. 1>VCHESOR -123 'x' " LL OW3 SWITCH TZIFE: 'Q Z `� . 5= INCHES OR f " GQLLOW5 PUMP MANUFACTURERR: C= $`lZ I1JCHE5 OR Z. '� 6 '� GALLOWS MODEL NUMBER: 3 lb tP0 D- `a 2l3•�{ INCHES OR GALLOWS SWITCH TYPE: NOTE: PUMP AND ALARM R TO DE MIMIMUM DISCHARGE RATE 3 7' L lq GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE 6ETWEEN PUMP OFF AUD_DISTRIBUTIOW PIPE.. 11-22 FEET +- 1 6 T W O R K —SUPPI.y —p R E S S u R -E .. . . . . . . . 2-s- ; rr. e T- + S FEET OF FORCE MAIN X 2' 14 F 31 frFKICTIOU�FArroR.. 06 FEET TOTAL DtJQAMIC. HEAD = 1u 39 FEET DIAMETER — a INTERLIAI. DIMLWSION�i OF TAWK: LENGTH — ;WIDTH ; LIQUID DEPTH Li -7 Z BOTTOM AREA — 231= ' GAL /INCH AS PER MANUFACTURER = z 6 _6 GAL /INCH - 7 GL!uc Submersible E fflu e nt Pump ' EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: manual � operation. Automatic and float switch attachment • EPO4 Single phase: 0.4 HP points. Heavy duty sump 115 or 230 V, 60 Hz, 1550 m odels include Mechanical • Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS EP05 Single phase: 0.5 HP, heavy 115 V, 60 Hz, 1550 RPM, FEATURES duty ball bearing Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING /4" maximum. • Power cord: 10 foot with pump out vanes for --� • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding n EF05 Impeller: Thermo • Discharge size: 1 NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 j • Capable of running dry without damage to s 30 i components. i > �fSGPM Pump: 8 p: P05 � � - - 2s IT • Solids handling capability: c 25. /4 maximum. Q W • _ Ca ci a ties: u t 0 60 GPM. , P P U s 20 I • Total heads: up to 31 feet. •Discharge size: l'' /z "NPT. Z 5 - - - -- - -- _ — - - • Mechanical seal: carbon-0 15 rotary/ceramic - stationary, 4 BUNA -N elastomers. o EP05_ • Temperature: 3 10 •— 104 (40 C) continuous i EPO4 140 (60 intermittent. 2 5 , I 1 0- 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m /h CAPACITY @ 1995 Goulds Pumps, Inc. Effective May, 1995 838%1 I i , c wiso"in Department of Commerce S0!U EVA UATION Division of Safety and Buildings Page o -3 Bureau of Integrated Services in accorda with %61LHR 83.6 is. Adm. Code f Attach complete site plan on paper not less than 8 1/2 x 11!inGl s In size. Plan must = County include, but not limited to: vertical and horizontal reference point (B )�e onyanitggq _ S'T` C,CD� percent slope, scale or dimensions, north arrow, and locati�rt d di ce t6rne dC7 i7 �g (road. j r. parcel I.D. # GCS Fig. APPLICANT INFORMATION - Please print all i ti�N c,��„ R ed by Date Personal information you provide may be used for secondary purposes (P 4W : 15.,04 (1) (m)). °, C — C -?" —r ii Property Owner,'• Cj�x Property Location G �D L �� NC• Govt. Lot �— 114�� 1/4,S 1 T ,N,R E (ot� Property Owner's Mailing Address' Lot # Block# Subd. Na e r CSM# f j�- Sr• l City State Zip Code Phone Number ❑ City ❑ Village [Town Nearest Road '0 1 kou 1 41207 1 (. 1 12 - ) 2 — ,CJ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement Z'Public or commercial - Describe: Code derived daily - flow _ gpo Recommended design loading rate f _7r bed, gpd/fl trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd/ft * j trench, gpd/tt Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material food plain elevation, if applicable tt S = Suitable for system I Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U= Unsuitable for system S U �D s OU PIS ❑ U PS ❑ U ❑ s O U ❑ S u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 2 2 G• S "�3 �� L r Ground — -- elev. � / "ft Depth to limiting factor Remarks: Boring # _.Z .f Ground elev. / , Depth to limiting factor 4i- in. Remarks: CST Name (Please Print) Signatu Telephone No. Addre Date CST Number PROPERTY O WNER SOIL DESCRIPTION REPORT Page - of _ ..L� UT j l� PARCEL I.D- si �O�U —!�— 2 Boring # Horizon Depth Dominant Color Mottles Texture Structure .Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench 3 - 3 a --All - SSK G _ ----- c s /fir c S • � 7- - Ground _ _ Z : •� elev. Depth to limiting .s in. 4 Remarks: ,p Boring # s Fsi3K t AQ Ground , J — elev. r r �, /A � Depth to limiting 7 Irl r- f T in. Remarks: Horizon Depth Dominant Color Mottles Structure Consistence Boundary Roots PD in. Munsell Du. Sz. Cont. Color Texture Gr. Sz. Sh. Bed , Trench Boring # O _Z ALI S c • A S c S,d feu 3 -37 s -_ Z D s G L S Z Ground — .,r— ev. , Depth to �r limiting t fa or In. Remarks: 14C. y > SAW VILL Boring # L j Ground elev. ft. : i Depth to i limiting factor in. Remarks: i SBD -8330 (R. 07/96) Alp PAVE FOOOM PLUMBING W Perk Tester i Plumber 03233 #32gg F ROW z y 97.6 DIN '54023 Phone '749 -3656 7 /'9 x �0 p 41 r DAY Ll4 #V ol& Ccv4`T) ac0�• I go , r I k / P,? TA TAU I TRi�rG i 0 � 0 o' A �z � ( c/ 1 1 Cr l Cq w b +f - - 7rit �.v cl�d� or�t � Z x vYlsoonsi Department of Commerce SOIL AND SITE EVALUATION Ohris"i of Safety and Buildings Page of 3 abreau of k egrated services in acxo s. 11-HR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 12dze. Pia( pltst County Include, but not limited to: vertical and horizontal e a� T e Rezx percent slope, scale or dimensions, north arrow, lion to ne4rest feed• Parcel I.D. # t APPLICANT INFORMATION - Pleas t iligli5oput/ 9 Reviewed Date Personal Information you provide may be used for rposes 15. 1 Property Owner ZUNtWOFFIC rty Location _ COf� Lot �� 114 1/4,S T AR E (oOD QrgL Property Owners Matting Add ess Lot # Block# Subd. . N e CSM# T _ YoL �7 - r Z 44j;7- 41 JF qty State Zip Code Phone Number ❑ City ❑ Tillage m Town serest Road lrG � 2X2 - �] New Construction Use: ❑ Residential / Number of bed Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd eoommended design loading rate — gpd/ft • . F trench.9PF Absorption area required bed, ft trench, ft Maximum gn loading rate _ bed, gPdlfl tre . nch. 9Pd/ft Recommended infiltration surface elevation(s) &T4 4 (as referred to site plan benchmark) Additional design/site considerations NSG T=AAALTE(1 — - owi+eterial - - �c / ('uIA cod plain Uen o, If applicable S Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ u ❑ s ❑ u ❑ s ❑ u ❑ S ❑ u ❑ s ❑ u ❑ s Cl u SOIL DESt RIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /112 in. Munseli Ou. Sz. Cont Colo Gr. Sz. Sh. Bed , Trench — 45 fS X Iky /-A S .� .s t 5 L — S r,✓ e- 8 4 Ground 3 31-1A Xw — ": o acv. n 6 012 7, r Depth to limiting factor Tom? in. Remarks: – r r X W1 K D O '/� r Boring # L S FS m F .7 .p Ground `� - — - G A4L elev. qsx d fc. • Depth to H liirniting factor in. Remarks: CST Name (Please Print) Signature Telephone No. MEL vFc�R t D/ 7 `s6 Address Date CST Number // ,Y MIMI Dorrinant Color Munsell �F�� �� ' a 4 �Z:8 w 0 Q o � `Y• � h - � S 4�- � M n� I t� (► tr W v r' � Nk 14 �, a N acct •�- Ik 1 L ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 0 - er Q-F 1Z All 4Z' S" /C 7 Property Address (Verification required from Planning Department for new construction) City /State _ h Ge, 02M 4 Parcel Identification Number 0-1 -- /©/�o— LEGAL DESCRIPTION Property Location Ay, %., ,4 - '/,, Sec. ZL� T -R W, Town of A{ a DSO/J' Subdivision , Lot # Certified Survey Map # `-- Volume , Page # Warranty Deed # Volume , Page # Spec house O yes O no £��� Lot lines identifiable P yes O no SYSTEM MAINTENANCE - Improper use and maintenance of your septic systenicould 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 the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croi Zoning Department a certification form, signed by the owner and by a master plumber, jqumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system 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 an I 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 b completed and returned to the St. Croix County Zoning Office within 30 daCsoysof 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 -APPLICANT DATE * * * * ** Any information that is mis- represented may resul 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 !fw 8•�. M�rrub 1�M --dtiort wa lb WATIN Of WIeC NSM) e« it, Wr sa. F X46 t taanmw a am t300 a..s wmr 283652 von - T U PA - UE Malcolm Bush a /k /a Malcomb Bush, Malcom Bush and Us 3nbenture, MadebyH. Malcolm Bush, and Mary Bush, brother and sister grantor s , of St. Croix County, Wisconsin, hereby conv and warrants to Girl Scout Council of St. Croix Valley grantee of St. Paul, Minnesota ap"WXgYdb KH thesumof Nineteen Thousand ($19,000.00) Dollars the following tract of land in St. Croix County, State of Wiscom Northeast Quarter of Southeast Quarter (NEISEJ); South One -half of Northeast Quarter (SINEI), and that part of North One -half of Northeast Quarter (NINEI) south and east of the town road as presently located, all in Section Thirteen (13), Township Twenty -nine (29) North, Range Nine- teen (19) West. , r I c�rc�IJThR_Y O FICE ST. CROIX CO.. Wki. Recd for Record this_ 11th_ day of__"".,uQb_____A.D.19_E at__P • 4 P :, M Regi e► of eeAc In Mitntoo ilIIt)tctct, the said grantors have hereunto set their hand s and seal s tl 9 day of March ,A.D.,1966 Signed and Sealed in Presence of _ '�"�`�'�� L z 1 z 'j (SEA. 1 Malcolm Bush / /ZQ i �i/ .(SEA. _ F � )fary Bush Hugh F. Gwin ..(SEA. Catherine H. Pos sus .(SEA, Otatt of Ultoconoin, St. Croix ss ' County. Personally came before me, this day of March , A. D., 19 66 above named Malcolm Bush and Mary Bush, brother and sister apartment of Commerce SOIL ANp°�1� ATION ion of Safety and Buildings Page of ,.. Bureau of Integrated Services in accordant tl} s "fLHR Adm. Code v Attach complete site plan on paper not less than 8 1/2 x 11 inch Iize. C6,unty include, but not limited to: vertical and horizontal reference poi,t (64(AA), direction and y B percent slope, scale or dimensions, north arrow, and location ah�J l tan Acwealel It ro � �. Prhel I.D. # s, s APPLICANT INFORMATION - Please print all infdrtf►$I�ion.- viewed by Date Personal information u provide may be used for Yo P Y secondary Purposes (Pn t�r04�(1) (m)). ' Property Owner ` Property Location szo l — Cr 9L C fcjvt: Lot '4 1/4N� 1 /4,S /3 T z 9 ,N,R J E (or Property Owner's Mailing Addrbss Lot # Block# Subd. Name or CSM# yoo s C7 f)V_ T r # 3vyP Z City State Zip Code Phone Number [:1 ty ❑ Village m Town Ci Nearest Road S P' I A 5 5 - 5/c z) z2- — b > I 15Z 4Q' w --- A. Z New Construction use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd j� Recommended design loading rate bed, gpd/ft ,F trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate _ 7 bed, gpd/* trench, gpd/ft Recommended infiltration surface elevation(s) 17WE1C 7b ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank u= unsuitable for system S❑ u ZI S ❑ u z S ❑ u I ❑ S m u I Cl S p u [Is m u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g Texture Consistence Boundary Roots -...:: in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed , Trench Ground elev. Depth to limiting factor LEI ?in. Remarks: Boring # - 01S 6:f L .7 Ground elev. 97, z ft. Depth to limiting factor > in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number �o k 0 7; T VC-1 SOIL DESCRIPTION REPORT 'Iq PROPERTY OWNER �G s�OUT G. /1� Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench L M 1 -:7 )-c' Ground elev. / 60.8 Depth to limiting ; factor Remarks: Boring # l k7 le - Z — Z- /�i L S C . 7 ; y 2 - - -s LS I=UX ml- z t �? Ground elev. /0010 it Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP �2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring Ell # L S G r D Z S- 3 s` - s �— L S .1 3 V 3-e-7 7. S e Sys Ground elev. / 0012 ft. Depth to ; limiting factor ? Remarks: Ocuit/ FT�,vE Fn/ qES a .� Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) DAVE FOGERTY PLUMBING Licensed Perk Tester & Plumber 53233 8328 Road ROSE� SIN 54023 Phone 749• 56 �yq # d = 541, T ©� ®� �RX4A' eF 42 Al �lFU; /�Ef ti -- jo D Tf,�isrz�tlf P/ p Ir # 1 V*s' zs 101-F SEA v im- � 4 �i 7,wx N Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353118 Permit Holder's Name: ❑ City ❑ Village Town of: ate Plan ID No.: Girl Scout Camp of St. Croix Valley, Town of Hudson 2 2Trvµ5o **4 lk; � CST BM Elev. :- Insp. BM Elev.: BM Description: rcel Tax No.: L O I 00 „� v-- e�� j 020 - 1016 -60 -000 TANK INFORMATION ELEVATION DATA ,9 t 3 .1,9 ` ` ` 13 TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV. Septic 3 SI 5 '� ar� I1CM Benchmar ( Do j n ,�� /Co. v Dosi ng Lj Z S b Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Aenttake ROAD Dt Inlet � `� q 3. ZZ r Septic zoo ` >z C — - NA Dt Bottom (5 2 -`f L Dosing �� C NA Header It Man. Aeration NA Dist. Pipe _ Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade (0.0 Manufacturer Demand St cover `f`fO 99.0 Model Number GPM TDH I Lift Friction System TDH Ft Forcemain Length 0 'P eZ " Dist. To Well SOIL ABSORPTION SYSTEM (( 4m&kTRENCHJ Width f Length No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 2 DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: r 663 o INFORMATION Type Of CHAMBER odel N mber. System: CortJ, >200 }loU OR UNIT , � m tv DISTRIBUTION SYSTE Header / b a� f old � stribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:0 / N /00 Inspection #2: 4-4 Location: 965 Alexander Road, Hudson, WI (NE1 /4, NE1 /4, Section 13 T29N -R19W) - 13.29.19.73 - - r"j . ( �"`E1 — 9y 9Z Lim .. 93.45 Plan revision required? Yes ❑ No bs 0� - other side for additional information. ec SBD 6710/97 4 Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i # E E 3 r e 3 f < , e y r 3 i s , S e E Q t @ , ­ ..._..� m ,..a.; a 33 x 8 , E # I s v f t € e V t < i 7 . q ts -wz m v� i # E 3 1 # # ffi # q . f v 3 3 # S # I E F #m r r # , 1 � # L 4 f Ilz> i� � V /, � e t z 74 n y i p J w 0 CA KIP ✓ . 0 , ' Ni 1 . 4 . 4b (713 00 rn L 0 N I - Safety and Buildings Division *6 ons i n SANITARY PERMI CATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Co �Ne .0 1 Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) f syst*, ,@ paper � t ss County than 81/2 x 11 inches in size. • See reverse side for instructions for completing t i � pplice {ion ��� + " State Sanitary Permit Number Personal information you provide may be used for secondary pur osfe CJ OX _ ❑ Check if revision to previous appl3riio [Privacy Law, s. 15.04 (1) (m)]. 3 , State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT L I �IIA 3 a Property Owner Name _ P ocation L 7" C l� 1/4, S T , N, R E (orkv Pro erty Owner's Mailing Address vt Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number GlL O 2 ) L. II. TYPE OF BUILDING: (check one) ❑ State Owned it k Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 111 13UILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Iii. � •1�i.�� 1 ❑ Apartment / Condo — —X-0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 [:]'Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. r/i New 2. E3 Replacement 3 [3 Replacementof 4 E] Reconnection of S E] Repair of an 1' ° ________ System____ _________TankOnly______________ Existing System ________ Exi sting -- -- - ystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM (Check only one) 3 4 X09t7Yf iGa ,A406:X Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 []Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit Z X xx W. 43 Vault Privy 14 ❑ System -In -Fill /�' r ege! VI. ABSORPTION SYSTEM INFORMATION: 1944 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate Syste% ev. 7. Final Grade equired (sq_ ft.) Proposed (sq. ft.) Gals/day /sq. ft.) Min. /inch) / 9J• �JJ Elevation SD s 2 ✓ Feet X Feet Capacit VII. TANK in Ca allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ff- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank ❑ 1 ❑ ❑ 1 ❑ I ❑ VI11. RESPONSIBILITY OATEMENT r �L p�jLS I, the undersigned, assume responsibility for in of onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum is Signature St a /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zi Code): IX. COUNTY / DrEPART USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuin gent Signature (No Stamps) * Surcharge Fee) Approved C] Owner Given Initial q Z 1 Adverse Determination t X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: alt >,r j � 4,11 b" :;2 b<wdC;i e el p e r^- CA'lt. SBD -6398 (R. 4199) 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 prior to installation 5. Onsite sewage systems must be properly maintained"The sepfic'lank(s) be pumped`by alicensed 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 . Wiscon"ia, Safety and - Buildings Division,-608= 266 - 3151.E - To be complete and accurate this sanitary permit application must include: I. Property owner's nam"nd 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 namejndicate 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, eta.), address and phone number : Plum.ber must sign application form. IX. County/ Department Use Only. W r 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 plari,`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 Zdunty" E) soil test data on'a 115 form; and F) alrsizing information. ---------------------------------------------- - - - - -- - - -- GROUNDWATER SURCHARGE 1983 WisconsinAct 410included the creation of surcharges (fees) for a number of regulate& practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 ,\Visconsin www.commerce.state.wi.us Department Of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 04, 1999 CUST ID No.267341 ATTN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/04/2001 Identification Numbers Transaction ID No. 239170 Site ID No. 178033 SITE: Please refer to both identification numbers, Site ID: 178033 above, in all correspondence with the agency. St. Croix County, Town of Hudson NE 1/4, NE 1/4, S13, T29N, R19W Facility: St. Croix Valley Girl Scout Camp - Bathroom Facilities FOR: Description: Dosed Non - pressurized In- ground System Object Type: POWT System Regulated Object ID No.: 483570 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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 private sewage system 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. Stats. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the the Zabel filter is required. Access to the filters for cleaning must be provided per Comm 84 product approval conditions. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code 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. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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. WEGERER SOIL. TESTING & DESIGN Page 2 8/4/99 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 07/27/1999 FEE REQUIRED $ 240.00 FEE RECEIVED $ 240.00 &r M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSMART;code: 7633 DOSED CONVENTIONAL SOIL ABSORPTION SYSTEM Page \ of FOR LOCATED IN IN THE N E 1 /4 OF THE NE 1/4 OF SECTION Z TOWN OF , T 9 N, R 1 W, Ytv�SOti , &r. 1K COUNTY, WISCONSIN INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 of 7 PROJECT DATA PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW-CROSS SECTION PAGE 5 of 7 LEACH CHAMBER DETAIL PAGE 6 of 7 PUMP CHAMBER PAGE 7 of 7 PUMP PERFORMANCE CURVE C3 ' �t R PREPARED FOR V E �ocn�w�� D co . f . PREPARED E CUt�K�s? PREPARED BY ARTHUR 4 WEGEPER G 8915 P 6itSWOg7N, WEGEFcER SOIL TEST = !V G L EL . AND DES.2 Gam! SE <'W ICE � Y sh w F.U. B0I 74 421 X. KAIX ST'_ _21 _11 RIVES? FALLS. YI 54022 715- ��`, -41b5 m JOB NO. C194 -T PROJECT DATA Page Z of - 7 i This system will serve 3 bathroom buildings at the St.Croix Valley Girl Scout Camp. The anticipated use is a maximum of 40 persons per day per bathroom with 1 floor drain in each building. System sizing is based on 5 gpd /person (outdoor sports facility) which appears to be the most logical sizing criterea. ANTICIPATED WASTEWATER 40 persons at 5 gpd = ---------- - - - - -- 200 d gP 1 floor drain at 50 gpd = ------ - - - - -- 50 gpd Total per building = 250 gpd Total effluent from 3 buildings = 750 gpd SEPTIC TANK 250 + 750 = 1000 gal. minimum capacity req'd. A 1000 gal Wieser Concrete septic tank with a Zabel Filter wil l be installed at each building. I Effluent from the 3 buildings will flow by gravity to a 1250 gal Wieser Concrete pump tank which will then dose the proposed trenches. 2 trenches, each 3' wide by 93.75' long with High Capacity Sidewinder leach chambers are proposed. 750 gpd - .8 = 937.5 sq.ft. absorption area required. 2 X 5 X 93.75 = 937.5 sq.ft. provided. i i i I I 0 1N \t\p� W! l'j'LG!} C.ItVy� S� DL W 1 /vOL 3 YG Lt'R'C -� 6' aeTwE �CF -*►• 11.�V• LL. 0� 'EST ��s - - � 1 lJniQZ Rte? sop' P Sr[ x 4 w°e � % 1 i yon 2Cyk1R�.2 isa• /'� L occTiW S -H P+iay I - Scgl�, �}1G.1� -� Cf��1'�y S1p�w1F,i�� -12- �bCCttr'�1B��S t - 6' ti,� pvt alS^CCC�6u1���5 3' g3_ZS. �ni�SL� G �T -f1'DE �K VAT- WL - - - - -- �45'�tly� So« F+.u- O O Aza) - °1 S • O P�'S a� iL s�, e K m o (Q �/ 1 T _ �^ fYi � r � ltl�l7 . e Y d, x •. �\ � r �...��� r a. � �I (T 11 ° —` x i N_ m SIP sa N o � T go CO I I I CD cp co rr z I I i •• a � -•%./� >� Jl pia 1 6. %:- N a s I I I>• �► I r5 � [ F III iI — I CD 'COD 0 x C�C -n e o -� C CD 11 `�� I I i O �f 0- 0 C CL o CD a .p O 0. L to C CD 0 CA cr y °mo R ma � CD f m I G7 I � �Q�� I T I w(a x a 0 Off • • G M x m 00�C 3 a I (,, y a t 0 C• � SU � _ (D s -- Invert 11'— ►� CD 9 � � rr CD s (D c to r K a PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOMS ' PAGE 6 OF 7 VENT CAP 4 "C.Z. VENT PIPE -fr f WEATHER PROOF APPROVED LOCKING MANHOLE '— 10' FROM DOOR, JUUCTIOIJ Box - COVER WITH WARNING LABEL WINDOW OR FRESH 12�M11l. AIR INTAKE - I GRADE `I' MIN. CONDUIT 18'rIIN. �� -- -- -- - - -- , 11� IAILET PROVIDE 7 AIRTIGHT SEAL APPROVED JOIIJT A Tank construction shall comply I I APPROVED JOIiJTS with ILHR 83.15 and ILHR 83.20 I I I I I ALARM e �I II I I I ON C i CLEV. FT. PUMP OFF H D Sa.S CONCRETE BLOCK - R15ER EXIT PERMITTED ONLY IF TANK MAI,JUFACTURER HAS SUCH APPROVAL— ApPRovED 61<DDIR 5PECIFICATIOKIS DOSE _ TACK MAM UFACTURFiR: '� ` �� � '- � C NUMBER OF DOSES: 3 ' 3 PER DAS TANK SIZE: ZZ SO GALLONS DOSE VOLUME t ALARM PAUUFAC.TUFZER: S -_ •ZLk2:Z S`fS` -,-r-! IP►ICLUDING OACKFLOW: �'�' CrALLONS MODEL AIUMBER: Lam\ CAPACITIES: A= 9 WCHESOR _2 S ` 4 GALLOIJS SWITCH TYPE 2 S 3.3 B = IIJCH£S OR GQLLOIJS PUMP MANUFACTURER: GOV�-AQS C= 22 ' 1 I. tNtHES OR ''2.Zb'1 GA MODEL NUMBER: 3 - U�{ D s INCHES OR Z L �' 4 GALLONS SWITCH TYPE: �ZI- (JR'Y' NOTE: PUMP AND ALARM ARE TO DE b,6 MIWIMUM DISCHARGE RATE GPM IN5TALLED ON SEPARATE: CIRCUITS VERTICAL DIFFERENCE BETWEELI PUMP OFF AUO.DISTRIBUTIOW PIPE.. , FEET + MIAIIMUM NETWORK SUPPLY PRESSURE .. . . . .. .. . . FEET -I- L IQ FEET OF FORCE MAIN 'A L, ' — 1 q F Yo ty.FRICTIOU FACTOR. �' FEET '= TOTAL OtIMAMIG HEAD = 4,�9 FEET DIAMETER INTERNAL DIMILW510W� OF TANK: LENGTH _ ;WIDTH L1, 1 lZ w ;LIQUID DEPTH -- BOTTOM AREA - 231 ' GAL /INCH AS PER MANUFACTURER = Zb. ail' GAL /INCH Goulds Subm erslbl e Effluent Rump J ' EPO4 EP05 APPLICATIONS e Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Motor: Available for automatic and •Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical RP points. • Water transfer 230 V, Hz, Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, , built in overload with automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING —� • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. CO. Canadian Standards Association - • Total heads: up to 24 feet. with three prong grounding EP05 Impeller: Thermo a • Discharge size: 1 1 /2 " NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F or "AC ". rotary/ceramic- stationary, three prong grounding plug improved performance. ) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running - --I dry without damage to 9 30' components. SGPM Pump: EP05 8 I 25 Fr • Solids handling capability: c 25 3 /4 "maximum. a • Capacities: up to 60 GPM. X 6 20 I • Total heads: up to 31 feet. • Discharge size: 1 NPT. a f • Mechanical seal: carbon- c 5 15I rotary/ceramic- stationary, BUNA -N elastomers. 0 4 I EP05 • Temperature: ~ 3 10 104 °F (40 °C) continuous C4• 4 140 °F (60 °C) intermittent. 2 EPO4 s 0 00 10 20 30 40 50 GPM L -L 0 2 4 6 8 10 12 ml/h CAPACITY 1995 Goulds Pumps. Inc. VT,sconsin 09partment of Commerce SOIL A ND- E EVALUATION Page °f ,pivision of Safety and Buildings g -'� Bureau of Integrated Services in accordart f W IS. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 1 �incN in si ��QQ� st \; 'l County include, but not limited to: vertical and horizontal referencepp1ht (BM), IOt I'd °'7 X7 C Z • percent slope, scale or dimensiong, north arrow, and locatloh,and distance to nearest road_, parcel I.D. # _ 20 p/ O APPLICANT INFORMATION - Please print ' L or s- matNC y� Re 'wed by Date n Personal information you provide may be used for secondary purpofvacm)).'� r Property Owner / � ` • i Pto L ation C � U-Y/� SCOGr w� y /57 1 /4Nr+ 1/4,S �3 T� N,R E (or Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road I W c biz ) Z Z 7 .J:F- ffu © AF ,New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate . 7 bed, gpd /ft • k trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate . 7 bed,'gpd/ft . X trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) c Additional design /site consideration Parent material 4 alw G ( 4 —t --- AA Al Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system Ers ❑ U �TS ❑ U 2r S ❑ U I ErS ❑ U cis 0 CIS �U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench • D Ground 3 2 38 0 5 elev. 7 ' ft. 4 1 ' Depth to limiting fa in. Remarks: Boring # — 7 /d — 2 Z O 2�c�cJ ,� z,EyV As G O D 7,71 ?, - .3 �' s L — 7 �o o yr _ g Ground - y . — S — S elev. 1p.2- ft. its Depth to limiting factor 7 1�— /4 n. Remarks: 2 CST Name (Please Print) Signature Telephone No. y 312— Address Date CST Number �G fc �,� f )SOIL DESCRIPTION REPORT -3 PROQERTY OWNER' Page 2 of w� PARCEL I.D.# 16 Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ?A 7 21 _ 3 57 Ground ` , -T— C S elev. j —SA Depth to limiting factor Remarks: Boring # LG f GS Ground �,s elev. eft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 2 t sj 2 'w ' J Ground - mss"` — elev. Depth to limiting factor / in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) r DAVE FWJXTY Pt,U[�BING Lic ehsed Park Tester d Plumber �. #3rt2y33 93289 ROBEf�TS, M S R oad 554023 Phone 749 -3656 A ®� w/fTf - '� �i1ucF_T, �F_r�, Prate, rFCSo 8h 76 /p SA �vr`f T, dr9� r R� E X02, s fz <�n rCAU T" = sfiru�t�aT� ffo/C�zc`v✓ w�.zYrl S SA " / yti .�9 Lo cvrST S�,lzr -.��E r < i f r f QQ r hY • 70wf y ye ti iso II dz_ ti2 O e 2� Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divis)iomof Safetq and Buildings Page / of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and s - r luzK percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # zo — v��— o APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ` � SCOLD ovt. Lot yN` 1 /4Nr+ 1/4,S �3 T� N,R E (or oy Property Owner's Mailing Address Lot # Block# Subd. Na r e o o l .CSM# �� ,# City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road I OV1 4P/4) Z - 2 _ 7 ffuv © C .0"New Construction Use: ❑ Reside teal / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate . 7 bed, gpd /f1 • - trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate . 7 bed, gpd /ft . trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations - mO r Parent material 4 tr//�Sfl Flood plain elevation, if applicable X ;F ft S = Suitable for system Conventional Mound In Ground Pressure r ATT -Grade System in Fill Holding Tank U = Unsuitable for system Z-S ❑ U a s 1:1 U ❑"S [I U 2I S ❑ u ❑ s /❑ [D S SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench © ' • D s s Ground Z 38 S O M Z C S el ev . ft. _ _ 7 89 7- , Depth to limiting fa t �in. Remarks: Boring # -7 /o— i i L o2�'N f�,�z.Eiv s o o.. 3 i 3 21-5 .? - 3 S 0iL S — 7 '. d Ground - y — S S IYf g elev. Depth to limiting factor ?A4in. Remarks: CST Name (Please Print) Signa Telephone No. U� o�c^ r / Address Date CST Number r. PROPERTY OWNER 6 � 7 4 G fCeee;r g( SOIL DESCRIPTION REPORT / Page � � of � - = L PARCEL I.D.# D- 20' 14 — &e Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o' o 3 /f Ground ` - 1 — e C .S elev. � - 7 Depth to limiting factor Remarks: Boring # 21 <f- .... 93•S S .?J - 3 --- lyi5 L — .(S Ground elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # P1 3 _ .2•S . 7 Ground ZJ elev. Depth to limiting factor T 192 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) DAVE FOUM PLUMW4G Licensee Perk Tester & Pinmber #3233 03289 Fitts Road 8014 , WISCONSIN 54023 Phone 749 -3656 1 7cor elf Y 9SS x = /1o�cr�vG Shrr1 LL Gvr4�T, dA� 7�R� t 02, S fz.W6G�D = s�7 r zow 1 , f �k may^ titi '7r rely ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address yon Property Address 1 '$ 11r e v (Verification required from Planning Department for new construction) City /State §G/DS�t /, Parcel Identification Number 0.A0 — LEGAL DESCRIPTION Property Location '/4, Ll/E '/4, Sec. /3 , T -R _ W, Town of Subdivision , Lot # '— Certified Survey Map # Volume , Page # — Warranty Deed # �Z , Volume -V,44= , Page # Spec house D yes O no �i�/h�� !� f Lot lines identifiable yes O 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 the septic tank as a treatment stage in the waste disposal system. The prolerty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, jqumeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system 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 retumed to the St. Croix County Zoning Office within 30 days of the three year expiration date. 'asL e�o 2 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 APPLICANT 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 Nw B i. rl�rr�ab lw/ -eDort To+m IRATD 01 QIeCOsm a.. 1 {. W la etagttr laea x.. • raw.e.a 4 tw ca.b.l.a ► quiet ' 283652 VOL TW PAGE Malcolm Bush a /k /a Malcomb Bush, Malcom Bush and Tbis 3nbenture, m adebA Malcolm Bush; and Mary Bush, brother and sister grantor s , of St. Croix County, Wisconsin, hereby corn and warrants to Girl Scout Council of St. Croix Valley grantee of St. Paul, Minnesota X7 KWW4rdb NH thesumof Nineteen Thousand ($19,000.00) Dollars the following tract of land in St. Croix County, State of Wiscom Northeast Quarter of Southeast Quarter (NE}SEj); South One -half of Northeast Quarter (SINEI), and that part of North One -half of Northeast Quarter (NINEI) south and east of the town road as presently located, all in Section Thirteen (13), Township Twenty -nine (29) North, Range Nine- teen (19) West. r� rr - - - -- _ ►�cM'tiIJThR -1 0:-�F6CE SST. CROIX CO.. Witt. Recd for Record this_ 11th day Pt, M + Regl e► of eerie tj artment of Commerce SOIL AND SITE EVALUATION of 3 cl afe and Buildings Page umau of Integrated Services in accordance with s. W4ft 99, Wis. Adm. Code ri Attach complete site plan on paper not less than 8 1/2 x 11 inches in site Plan mu n include, but not limited to: vertical and horizontal reference point (B directio an o, percent slope, scale or dimensions, north arrow, and location and d' tarige to n relc I. D. # APPLICANT INFORMATION - Please print all inforpaton.', � Reviewed by fa o Date Personal information you provide may be used for secondary purposes (Privack LaW,, s. 15.04 (ty, :' Property Owner Plop l?ti�f c lion,: � 4 aT / 44 �.. � tL f / c ��, lout. Lot T /4� 1 /4,S T N,R � E (o�V Property Owner's Mailing Addresd Lot }. 010c0V Subd. Name or CSM# City State Zip Code Phone Number Neare Road ❑ City E] Village � Town S T I MN 3 ( /a /-� )z27 - 8Y3_5_ 0 a zz wp 0 New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial -Describe: 5 1 r�A±� e TTCf/ ®od Code derived daily flow gpd Recommended design loading rate gy bed, gpd /ft , 1' trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate =7 bed, gpd /ft trench, gpd /tt Recommended infiltration surface elevation(s) ft a d to site benchmark) Additional design /site considerations " Zz co r r 7 fir✓ /�' � Z �-TG/Z !U!`t T Parent material Floo p va ion, if applicable ft S = Suitable for system Conventional ,MMoou -nd In-Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system E El I= 1 s ❑ U L r1 a ❑ U 1 ❑ S l 'U 1 ❑ S [R'U ❑ S +❑"U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 6 -7 - L r3k M vF /z Ground 7, 6� M L elev. J , ft . y LA -- 41 s L >c s ,ax r" VF—r 17 s — , o 10 Depth to — limiting factor Remarks: 057- 70 Boring # d // - 3 z L S e A r /Z d' �- I I- to -S 6 ` S Z �G M V F A F ©• Q Ground elev. g3s ft. Depth to limiting factor >f[Yin. Remarks: /t/ Tel CST Name (Please Print) Signature Telephone No. ,r_ c7m - 3Gs� Address Date CST Number K / ZZ /� a SOIL DESCRIPTION REPORT PROPERTY OWNER Page 7 H PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench n4 V Fe 9q 2- Ground /7r I/FI W elev. , f ff. 7 -S /h S Scar Al — — Depth to limiting factor 2/2-A Remarks: Boring # - 3� o — S Ground elev. Depth to limiting factor > ZA n. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # f- S 2 7. L X Z c 1 F q -2 .3 �y l0- f K W .J Ground - 7• s - S d /y/ — .� . elev. p1� ft. Depth to limiting factor >1Yf-in. Remarks: Boring # 44CA7 d Or 011- C t4 7 0 P N+ ER,gt Ground elev. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Z m N IL O cl lk LA V � v q b v ki e w P