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020-1016-70-000
e n, `� c* f l = d f c d o d 1 CD CD CD ID o m v 0 -U CDi CD CD i • 4/ A A A z w z z Z�T z o co G) 2 2 n o W C z - o � � N O N CD O O 41 N t7 OD _ N N N Ca �_ d W NO `C • 7 N fPr c CD a (85 N n a s iA3 Cn n p �_ r n O F•1' CD 7 O W 7 c O7 co p c co O C N N c N N 0) CD CO -� - "S a. a cr C: CD CD 0) d Cb e d CT !: c') m oo y � CL ° ° ° *° v Q ° m c o C a n ;n z D a n cr rr z D A C D N G X p N G X ��:, O N C O, ; c < I � co _ _ < I m _c _ G. ^' 0 0 j O CD O CD co CC) C.fl CO CND °o o ° °' o rn rn U' O (0 0 Cn N o o D D D � 6 I x x x 0 j 9 C) 3 O 7 �.�+• !�I • C O O 0. 0O c O c ¢¢ a O O O a l�r T C Cn 'D G G ID - 1 c -•I -4 -4 X O C . cD N N co p y N N o p N t0 V1 Q v v a 3 a v v v a 5 a CD v v a ° Q CD CD I m o l CD m o l m 01' o rn 0 CD C = CD c CL `° c �' N 3 Z T ZMT zcn D D CD Cp c D CD p c CD cL CD (D a (D CD fD 7 O 7 N Ll t3 N C4 O Ln tD N c6 O N a O_ c CD N c W CD j CA ! CD (T �_ '.1 CA CL 3 a A? o co co o CL f' z CL CL z 3 3 ° 3 p 3 3 �. 3 .. m H ; CD N N C/1 N W N a O ? 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O_ D) Z @_ a to O O Z A n O A Z O O 1 ,� CL 3 z O :: � 3 'O Ja 1 O N 0 _ fl1 G C a p U O o o 7 N co) -. m am S. _� _ o CD O W N 'fl N N° N -o(6 O O 7 = °3d ymE C CD o loo 0' z a m 0 = — o.a'E'm fD 0 a° o m fD a so ° m R o 10 >SO 0 �° u a 77 o m s � o E °v N� CD ,< o00 Vr 9.9 ,ay o 6-'o E; = a --o(o ~�° ao m 3 6 - .1 v v m a= y CD ° w - CL _ cn 1 G 0. ry CL N O n ap p N- o S fD CD o p 7<� a a?O O O Ac N E a -< a 3 '< n� 3 ' per ° N m f< o ��; D ' N m n p cu o c -0 c� o o ?o ° - � 3 y - saa .. N y o O = y c o0 sc °d m m o ° c�D n� 3 3i M. CD N y O ? a �- •° N N f ' O N w N 3 N �_. ° N N O ° a o ° c o F; n O m o m '00 d O W x N CD y V CL a b 7 b W I a O A O 0 C �A i � a I APPLICATION FOR SANITARY P&NIT for INSTALLATION OF A S'PTIC TANK (Sec. 144.03, Tis. Stats.) A. O drN aR OF PROPERTY e (/ /✓ ,r � } Address (Strep, tl � ty , d / B . LOC aTICN OF PRCP ZTY �nFHu��.E SEPTIC TANK IS TC B INST_ �LLED Check 1. City Maiddrgss County one: 2. Village cs+.,�/1�-•� , . �f l e 3. XTown 1--; 2 C. IN)TALL -,Il Give L-i Ans`e um er Ke d f Wisconsin Restricted Licensed Sewer y Plumber Services 4to) N e / Adcjxess fl .'v�t't.4' �� --f-� D. SPTIFICATICNS OF 8 TANK Size in gallons: (check one) 1.X_1,000 Gal. 5. _. 4,000 Gal. 2. _1,500 Gal. 6. _ 5,000 Gal. 3.,2,000 Gal. 7. w If over 5, 000 gal., give capacity. 4. 3,000 Gal. Materials: 1 Prefab concrete 2. Poured concrete 3._Steel 1 . TYPE OF OCCUPANCY 1. ____ Sin< *le Family residence 3. Commercial establishment 2. Mu-Itiple family residence 4. Industria establishment F. APPKXIMAT� NbIZKai OF Ph,PRS0NS SERVED DAILY G. PE,RCCLATICiv TEST MADE 1. X Yes 2. No Date By whom �.0 Y (To be completed by County C erk Date a-plication is filed an fee paid /j Permit issued (date) Permit Number Countya Clerk J' l Percolation :-date Minimum Absorption A in Square Feet per Bedroom Minutes Required Normal With With With Both For ?grater to F-.11 Plumbing Garbage Automatic Grinder and One Inch Fixtures Grinder Washer automatic lasher it 2 5 65 75 85 3 60 75 85 100 4 70 85 95 115 5 75 90 105 125 5 - 10 100 120 135 165 10 - 15 115 140 160 190 15 - 30 150 180 2.05 250 30 - 45 180 215 245 300 45 - 60 200 240 275 330 60 - 90 240 290 325 400 Play p O °•� ° y POD �a Op m O O - - - - - - - to VI O m - 0 v tv C c ny o H I '2d t d H C!] �] O - - - - - �' .. 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L 4J .-. 4- u 0 0 0 4J . 0 E L r^ m 4- •- O 0 m 0 4J m w c 1 0.0 N 0 m m O c c N^ m r E c u c 0 3 41 m u O fl 'O L . W 0 0 m - 4) O 4) 4J 0 N ....._ ._ L O > .0 •- m > r L 0 r (n +- C 4) L m O L L 4J 0 L L 3 4J 4 - r O L O 0 41 N a O > > 4J L .- ._ u 4J 3 u 4 0 C^ 0 0 u a. 4J >. L 0 C CL a C 0 0 4J m 7 0 L 0 • L a 4- • 4J 4J •- >• 0 0 L 0 r m L 0 0 3 7 L 4- 4- 0 0 0 0 0 c m m m r L 0 3: c C c C H '0 u a W 4J N 01 N r N '0 a -- O L G- 'O L Q•- 3 3 u 4► - 0 4J m m 0 3 •- I �i N M �' ►[r.+�zra �r r j�,& 1969 LOCA'T'ION stre or 'g � ci�y o township county OWNER Mailing address 1 ��'t!� ARCHITECT OR ENGINEER ,�i��•��u� PLUMBER / l�l%''� _ /c � >. Address �..c ` ��.1 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed; / Existing building New building t' Addition If addition to existing building attach detailed memo for each. () Restaurant or dining room . . . . Seating oapacity (10 sq.ft- /person) O Motel O Hotel O Cottages Number of units; Regular Housekeeping 2 persons /unit 4 persona /unit �, TOTAL NUMBER OF UNITS O Bar or cocktail lounge . . . . . Seating capacity (10 sq.ft. /person) { ),Nursing or retirement home Number of beds OMobile home park.. . . . . . . . Number of units - dependent - nondependent O Service station . . . Number of oars served (daily) O Sohool a Number of classrooms Meals served Yes_ No Showers provided Yes No�� O Factory or office building . . Nunbor of persons (total all shifts) O Residence Number of bedroo f✓, � Other - specify 2. Indicate whether or not the following facilities are connocted; Food waste grinder . . . Yes No Dish%ashor . . . . . . . Yes No Automatic clothes crasher Yes No l te_ 3, Fill in the appropriate information for the folloring as indicated; Septic tan}; oapaoity pitzmod Normal septic tang; capacity required k s 50% inorvaae for FWG or AN Total septic tank capacity required, Percolation test results - ATT ?_CH PR F:3OLATIO J TEST RSPORP S —'-W Seepage trench bottom area planned , width , linear feat , depth f i Seepage pit planned , outside diameter �� ; � depth below inlet depth Seepage trench bottvA area required � width , linear feet Seepage pit required g� outside diameter , depth below inlet Signature of person completing form; STATE BOARD OF HEALTH, PLUMBING DIVISION J P. 0. Box 309, Madison, Wisconsin 53701 Address: Z ,__ 1,..,.. Approved: Date { _ y .. �. /� � -:- Date O 2 "? IS y' TP43 APPMOVAL !S EASED ON STATE FLUi.93- ING CODE KQUIPEK -NTS AND PES Ki EXEMPr THE INI)TA 4'uN Fac-as -JTY, V!L• LADE, TOWN; WP OR CiiUITY Rt�:iLlrTltfi o PEF,m;r` E Q , j i i;: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St, Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 420625 0 GENERAL INFORMATION r - (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Parcel Tax No: Girl ScoutCamp St. Croix Valley I Hudson Township 020- 1016 - 70-000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benc w r av vbU yv�. Dosing /^^ Alt. BM ew /o�• 1 /(oZ / IL Aeration N , L Bldg. Sr / c ,�•� 7 13. 8 t� o ding St/Ht Inlet SUHt Outlet TANK ETBACK INFORMATION fi� 3 •L ��• v TANK TO I P/L WELL BLDG. Vat to Air Intake ROAD Dt Inlet N n/ - S.Qf✓ Hof h p �'l��r - F7. Septic �' I / 7 25 /S7" ✓ Dt Bott a►.A�c � �i y� � � 0 ��• i g J 2. Drl' / 7 0 > 7 4i/ H r /M�� � Aeration P Dist. Pipe Z U g Z /0 3a t o Holding Bot. System 1 03 • i o S'f 9�' o • l ot4 Z- Final Gra e PUMP /SIPHON INFORMATION 5 -01/07 - / ' Manufactur n St C,ove GPM ICJ d Model Number / �j._.,r•� L � �. TDH Lift Fiction L�� System d TDH t ^�,� 1. V ugly /0 r v Forcemain Le th Dia. t Dist. lo Well 41 2 , 2 't/r► m r SOIL ABSORPTION SYSTEM .{y — h h e C1 -/>' d BEDITRENCH Width I F Len th No. Of Tren s PIT D MENSIONS No. Of Pits Inside Dia. Uquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING anuf u : — / INFORMATION CHAMBER OR Ty - System: > -Z`YJ > I ode r: �� [ rMl Numbe V�11 DISTRIBUTION SYSTEM/ G , ,vyy _ a�G' Header /Manifold Distribution x Hole Size x Hole Spacing Lent t Air Inta Pipe(s) 4 1 Length Dia /f Length / Dia Spacing SOIL COVER Pr ssure Systems Only xx Mound Or At - Grade Systems Only Depth Over I - h Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Cente i Bed/Tre h E e Topsoil 170 t_ [M] No P ® No r COMMENTS: (Inc ude code iscre encies, persons present, etc.) Inspection #1: ( / _/ Inspection #2:// Location: 400 E Robert St St. Paul, MN 55101 (NE 1/4 NE 1/4 13 T29N R19W) NA Lot N r {7' Parcel No: 13.29.19.74 1.) Alt BM Description 4C6 ✓EJ�Gre -� ���' -� �/ 1���y " 2.) Bldg sewer length = ' �/ � i 4s 15Lkvvyrr,r' - amount of cover Plan revision Required? j Yes o j Use other side for additional information. ` 1 Date Insepctor's Sign ure Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division Calmly - 1Al W. wasdington Ave., P .O. Boa 7D82 T �i�•�X /fiCdllSlll . Main, WI 53707 - 7 Site Address Dep artment of Commerce / 3 l ee 4Cqr Sanitary Permit Application �°°�`'' c - 2 In accord with Can 83.21, Wins. Ate. Ceder, persma{ itdorntaton you provide Q Cbeck if Revision my be aaed for Privacy Law. sl5. 1 m L AW11cation Intonation — Please Print All 101brID0 ion State Plan I.D. Property owner's Na roe I � 02 Parcel Nuu Property Own ws M ailing N (Y y Lownon 7 W �'� 1��. =/�-Tl : S 1. cRO�X c °F cE N _. rn - u ; S : N. x/' City, saw Zip 6 I" Number Btosc Number A 4v Subdivision Name CSM Number II. Type of Building (Check all that apply.) 13415ty ❑ 1 or 2 Pan* DweUiog - Number of Bedrooms B'PublWC.ommercW - Desea -e Use O m'fowag ' ❑ State Owned 7 Nearest Road III. Type of Pt ra t: (Check only one boa on Ime A. Numbering is Per internal use.) (Campkbe roe B, if a�ppacale.) A. ID New 2 61,6... System 3 ❑ Replaoaa>mt 611 Addition to 7 FUr Comity use stem Tank S ystem B. DCbeck if Sanitary Permit Previously Wood Permit Number Date Issued no 00 IV. Tltpe of POWT Ste: (Cbeck ad drat apply. Nwabering is for internal tare.)• C 5 't 44 Gr Hou - Presahriaed hWUrom d 210 Mound 47 ❑ Sand Mier 30 D (gutted Wedand � .5'( �OOOS • C 22 ❑ Pressurized lo4round 41 D Holding Tanis. 48 D Single Pass 51 Drip Line C/ 45 ❑ At-Grade 46 DAembic Treatment Unlit 49 ❑ Recirculating 30 DOdwr V. ent Area Information: Design Flow (WQ Dispersal Area Dispersal Area Sots Application. Pe maluim Rate System � Grade Required Proposed RweM&./Dayv3q -R -) (Mier lludh) c -2 �c1• �- /e J C - iot•� VL Tank Info Opacity io Total Number Mamw fauer Prefab Site Sad Fiber Plastic Gallons GaRm of Tanks Concrete Coestructed Glass New Tangs Tanta Septic N-UoMft-T=k D-ft Cl 0ce V VII. R t y Smtem=t h the mderj%p4 asstane te is taBabiat of the POW TS diown.n the attached plans. s Na me (ill Plu mber's � Voure RS Number Business Phone Number MA r d' Fogerty Plumbing &Perk �.� // J� i ^ Vf" -�df Plumber's ss 'Zip /s = .� - Spooner. Wl 54801 VIII. Use ontr Disapproed Dam blood (No Stamps} AWroved ❑ Del ner Ni Fee) �� M Cmffi=,Df A = r✓ �P i a�osc�? u�CQ /-- Apish —pick Nas On the County ody) for the systene ou paper not less thsr Ei/2:11 hshes i• sim w� u�v� � � v�.a�vt.aQe -r��� �-•uQ � � -�u�.� r - PLOT PLAN Page S of 9 kale c t UD_, 0 , O#J ) o F U N soz P�GL b o f 8.3 _ 4 �or E v\sm tj G Boo 0 6th. wMP'I" • � �`�c. \S'T')N G ZSuO GR 4 SAC �'� o . 3s t.F 1NS7tiA � 1Aj 1��Z UNC...��� , r 1, A Z S' OF 4.� P y c �R TROOP !}Du • xwn V E Y_ P � h l � . Safety and Buildings - 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 N* 6 consin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary December 10, 2002 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/10/2004 Identification Numbers Transaction ID No. 817920 SITE: Site ID No. 654139 St Croix Valley Girl Scout Troop House Please refer to both identification numbers, Alexander Rd above, in all correspondence with the agency. Town of Hudson St Croix County NW1 /4, NE1 /4, S13, T29N, R13W FOR: Description: Commercial Non - Pressurized In- Ground POWTS - 1278 Gpd Object Type: POWT System Regulated Object ID No.: 884854 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. 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 state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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 See. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. P 0 VV s rZ j T jf �'t.,�. ,P ��y isin tuc. R-0 ARTHUR L WEGERER Page 2 12/10/02 Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 i TITLE" SHEET Page_ . f of A DOSED CONVENTIONAL IN-GROUND SYSTEM tQzL S c.j%r emu,un F&w This plan has been prepared in accordance with the Conventional Soil Absorption Component %-Ifanual SBD- 10567 -P (R.6/99) Tot rated in the N� 1/4 of the N � 1/4 of Section 1 1 , T Zq N, R 13 W, of l- }�pSdN ST c�uj �x County, '.WTisconsin. INDEX Page 1 of 9 TITLE SHEET Page 2 of 9 SYSTEM MANAGEMENT PLAN Page 3 of 9 PROJECT DATA Page 4 of 9 PROJECT DATA Page 5 of 9 PLOT PLAN Page 6 of 9 PLAN VIEW -CROSS SECTION Page 7 of 9 LEACH CHAMBER DETAIL Page 8 of 9 PUMP CHAMBER Page 9 9 PUMP PERFORMANCE CURVE PREPARED FOR VP U_ef G 1 P-�. SCOUT' 010.1 L RECEIVED S . �� ���zr snz_lz! r - DEC = 6 2002 , r�tJ ss 1Q - 7 SAFETY & BLOGS D'A1 PREPARED BY LVEGGRER SLR I L .TEST 2 hiG AMID . DES I G�i SERVICE - P.O. Box 74 421 N.Kain St. River Falls, K 54022 Phone 715- 425 -0165 Lu Fax . 71 425 -6864. `� i r 6'Jt5. f' V I V - E YgNa avit �NGS ' SFF JOB N0. OZ— Z &S SYSTEM MANAGEMENT Page Z of q Management and maintenance of this system, is critical to. proper operation and longevity. The system owner must be provided with a complete set of plans including this management section. GENERAL Proper functioning of any type of on -site waste disposal system is dependent on the amount of water entering the system and the quality of the water. The lower the volume of water and the lower the level of contaminants, the more efficient and longer lasting the system will be. Typical system components include a septic tank to settle out and break down solids, an effluent. filter to filter out small particles and absorption cells to dispose of the water in a manner which will protect the groundwater and public health. RECOMMENDATIONS 1. Install water saving devices when and where possible. 2. Repair any water leaks as soon as possible. 3. Do not pour greases, oils or chemicals into the system. 4. Do not dispose any paper products other than tissue into the system. MAINTENANCE 1. The septic tank should be inspected by a licensed pumper every 2 years or less and pumped if necessary to remove solids and scum. 2. The effluent filter must be cleaned periodically to remove any accumulated particles. It should be washed back into the tank at 6 month intervals or as per the manufacturer's recommendation. 3. Periodic inspections- at the observation pipes shoulh be made by the owner to determine if any ponding is taking place in the absorption cells. If consistent ponding is taking place, a licensed- plumber should be contacted. CONTINGENCIES If the soil absorption cells fail to accept wastewater, replacement cells should be installed. Additional site and soil evaluations may need to be -done and additional plans may need to be prepared and approved by the Safety and Buildings Division of the Department of Commerce. Questions about the .operation or maintenance of this system should be directed ".to: The County Zoning Office at LlLbQ ST. clt�6IK .The system installer at 1 S - 63S- bug F06MT The tank manufacturer at V3 0 -32.5 —��S6 ki ie5L -IR 3Z q� S1 . The effluent fil t'er manufacturer at $�$ -aqq- The leach chamber manufacturer at k0c) - z t =�c(3 b �IL1F1L D1R The pump manufacturer at - - -- PROJECT DATA Page of This non - pressurized in- ground system will serve an existing building with overnight use by 30 Girl Scouts in the winter months, 4 employees and 2 floor drains. There is a kitchen area, but food will be brought in and not prepared at the site. The building will be used by 120 girl scouts.in the summer months as a staging area with bathroom use only. The system is designed for the winter use only as more wastewater will be generated at that time. The summer and winter use will not occur at the same time. There is an existing 2500 gallon precast concrete septic tank, a 3000 gallon precast concrete pump tank and a 1500 gallon grease interceptor with an existing 18' by 79' in- ground pressure bed. The septic tank and pump tank will remain in place with the grease interceptor being replaced with a new tank. ANTICIPATED WASTEWATER camp, day and night use 30 persons X 25 X 1.5 = 1125 gpd employees ------- - - - - -- X13 X 1.5 = - - -- ---- 78 gpd floor drains ---- - - - - -- 2 X 25 X 1.5 _ -- - - - - -- 75 gpd Total = 1278 gpd SOIL ABSORPTION AREA 1278 - .7 t 5 = 366 if t 6.25 = 59 units of the standard infiltrator leach chambers are required. 4 cells, each 3' by 93.75' long with 15 units per cell will be installed. SEPTIC TANK maximum 2 year inspection cycle 1278 + ( 11.61X17.04X2 ) + ( 46.77X17.04 ) 1278 + 395.7 +797.0 = 2470.7 gal minimum capacity required. The existing 2500 gal septic tank will remain in place with the tank being inspected and serviced at a maximum of 2 year intervals. A warning label must be installed on the manhole cover as per code, or the cover will be replaced. PROJE DATA Page of PUMP TANK The existing 3000 gallon concrete tank will remain in place. A Simtec STF -100 effluent filter will be installed in the discharge line . A warning label will be installed on the manhole cover as per code or the cover will be replaced. GREASE INTERCEPTOR The existing 1500 gallon grease interceptor will be abandoned and replaced with a new Wieser Concrete 1000 gallon grease interceptor tank. Model WEHD1000 C = MXGXH 2XP C= 30X3X6 _ 2X1 C= 270 gal A 1000 gallon tank will be installed. WEHD1000 GREASE INTERCEPTOR TANK SPECIFICATIONS CAPACITY: 1000 GALLONS DIMENSIONS: WALL: 3 -1 BOTTOM: 5 COVER: 6 MANHOLE: 24' I.D. HEIGHT: 66 -1/8' O.D. OUTSIDE DIAMETER: 86 -1/2' BELOW INLET: 54 -5/8' LIQUID LEVEL: 46 -5/8" SPECIAL FEATURE: 'POSITIVE SEAL' V- SHAPED JOINT CONNECTION BETWEEN TANK AND COVER AND OUTLET: INLET TOP VIEW a' BORE MATH STOP FOR QUIK -TITE, FERNCO SCALE: 1/4' .. 1' CASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: AS SHOWN LIQUID CAPACITY: 21.50 GAL /IN LOADING DESIGN: 12' 0' UNSATURATED SOL WEIGHT: COVER 3,000 LEIS. TANK: 7.000 LBS. FLOTATION: OUTLET _ INLET WITH SATURATED SOIL TO TOP OF COVER: 1 -1/2' OF SOIL OVER COVER -NO FLOTATION n 3' OVER COVER OFFERS 1.4+ SAFJETY FACTOR ,Am CUSTOMIZED TANKS: n 1 . TANKS CAN BE CUSTOMIZED CONTACT W IESER CONCRETE n 3 2 i MACeN ROCK, W /PCRTAOE, N /FOND DU LAC 1K SIDE VIEW 800- 325 - ;456 SCALE: 1/4' 1' MODEL WEHO1000 GREASE INTERCEPTOR JANUARY 2001 me wJOICO a PLOT PLAN -Page S of C t Scale 1'"= S D' kil- 00, 0 oIJ Yup vF QcrU+v O-:vP -- ✓ Val 'tt �2.. �-. 1 �O • S • S ' k •, � ., k _ __ ► 0 . 7 3 S 8�3 � SST► N � 0 0 b iJFt � ASS �o� J � e�-\SM N G 300 0 6ftt- whP'�tt�,k �o s�LL () U r L-t• �oS,S ZTT 3, CUSS S�C.j��iV- -- _ � � 1�LS�Ct.�3V'�'1U►`1 �U:'C TO r v; - r 7 oF- 9 0 o fl • m t 0 -� � m o N Z a a v CU o N w 0 Tt N CD V X =r O Q fl 3 o cr Q m n �NVERT --.j M V • n o i _ PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE g OF VCKIT CAP - (C-1- VENT PIPC - WEATHER PROOF APPROVED LOCKING MANHOLE 10' FROM DOOR, JUIJCTION 80X ' COVER WITH WARNING LABEI WINDOW OR FRCSH IZ�MIV• AIR INTAKE I GRADE I I . I 4' MID. _ I �• ' COWDUIT 18 MID. �—'— _ IIULET • PROVIDE I __ _— T AIRTIGHT SEAL I I i I I I N\I.Z 'I APPROVED JOINT/ A _ _ I I A PPROVED ,1OIIt1T I ►`� S T"I�1.L R S) M Tk'� ST F� 10 0 I I s EFF V Zvi^ Fl L`ii!�iZ 1 0 - 11-tl_zr I I I e l��rtip �LSCt�tZ_G��_ �rsU� , - I II ALARi✓1 - I I - � 1•SU I LLEV..___ P OFF Ft I UMP � ' —� 0 COMCKETE aLOCK Y RISER EXIT PERMlTIED ONLY IF TAWK MAIJUFACTURER HAS SUCH APPROVAL T*APPRw9i -ISEDOINQ - SPECIFICATIOUS DOSE TANK MANUFACTURER: wt��Z ? - 0>\1C DUMBER OF DOSES: •i�9 PER DA4 TANK SIZE: 3�0 (3 GALLONS DOSE VOLUME Z S 3 • . INCLUO►N� aACI�FLOw: ALARM __MAN LLAC.TURlrR: S `25fi LS GALLONS MODEL V.UMHtR: �� �kW 3WITG14 TYPE: CAPACITIES: A_ ZS WCHESOR � ���•C.Jfr��Lf \ . 8 = INCHES OR 9 G r LLOIJS PUMP MANUFACTURER: G0�j ADS C: INCHE5 OR S51 " 0 CALLOUS MODEL NUMBER: fz� 0 S D: INCHES OR1 060-9 GALLONS SWITCH TYPE: w' LZ R- of J\ �1'l(L-= 30o's•9 DOTE: PUMP AND ALARM ARE TO DE MINIMUM DISCHARGE RATE Z1 • O GPM INSTALLED ON SEPARATE CIRCUITS 0 VERTICAL D►FFEREIJCF DETWEEN ►JO PULP OFF A.DISTRIgUTt B ox Z Lf S okl PtPE, FEET t mINIMUM NETWORK SUPPLY PRESSURE .. , , , .. , -FEET ` 1SS- �. 1 FT. .. _ - FEET OF FORCE MAIN X `O _ � FT.FRICTIOU FACTOR. � • S0 _ r TOTAL 0 JAMIC. HEAD - Z�-�6 .FEET As per manufacturer • gal /in. Liquid R , Goulds J _*�G E °\ °i= Submersible Effluent Pump F 3871. 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. 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 points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■Power Cable: Severe duty • Dewaterin RPM, built in overload with preset at the factory. g automatic reset. rated ail and water resistant. • EP05 Single phase: 0.5 HP, ■ BQarings: Upper and lower SPECIFICATIONS 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 AGENCY LISTING •Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes far • Total heads: up to 24 feet. with three prong grounding mechanical seal protection. C" CamadianStandards AssociaGon • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (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. • Capable of running, dry without damage to s 30 1 { f components. Pump: EP05 8 Z , . C, o ` • Solids handling capability: c 25 —�- 1 /4 maximum. W 7 4_ • Capacities: up to 60 GPM. 6 20 i ;�� • Total heads: up to 31 feet. f 1 . • Discharge size: 1Ih NPT. z 5 1---� _ • Mechanical seal: carbon- 0 15 �� rotary /ceramic- stationary, i � a 4 I BUNA -N elastomers • Temperature: 3 10 ± ' 104 °F (40 °C) continuous 140'F (60 intermittent. 2 5 1 f t �..y/ 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 awn,, Wisconsi Department of Commerce SOIL EVALUATION REPORT Page — ! L of 3 Division of Safety and Buildings in accordance with Comm 85, 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 Pam{ I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 - 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 _ _ Govt. Lot f,/ Iv 1/4 I/4 S/ T2 N R l E (or D Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# S o T -C � S Phone Number Villa . State Z Code Cl ❑ C ❑ a Town Nearest Road 9 ci ty State city (7i - ) 0- 1 ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPO ❑ Replacement Public or commercial - Describe: TiRORP &E -- .��AC= Parent material Flood Plain elevation if applicable General comments s2.rA EG£df�� OaS ©tr SrT t6 44C^4- 11 / � and recommendations: `T �" I I a Boring # Boring Ground surface elev. _107- .y h. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 7 /.3- 6 - A i 3 -7 - — s - S 7S 7 2- Boring # Boring Pit Ground surface elev. _ IP"7 ft. Depth to limiting factor >� in Soil Molication Rate Horizon Depth Dominant Color Redox Oescnption Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Aid aF49 s ,1 - 3 .Iv L 3 7-2f S F 0 — ' Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Number CSWO (Pl ���m "Ung & Perk Testing i netarar ''mil/ A ' AddresssC 7 M cKenzie Date Evaluation Conducted Telephone Number Spooner, WI 54801 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 ,\, Visconsin www.commerce.s i n.gov Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary December 13, 2002 CUST ID No.267341 A77N. Plumbing Inspector ARTHUR L WEGERER MUNICIPAL CLERK WEGERER SOIL TESTING & DESIGN SERVICE TOWN OF HUDSON PO BOX 74 429 STAGELINE RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/13/2004 Identification Numbers Transaction ID No. 817895 SITE: Site ID No. 654139 St Croix Valley Girl Scout Troop House Please refer to both identification numbers, Alexander Rd above, in all correspondence with the agency. Town of Hudson St Croix County NW 1/4, NE 1/4, S13, T29N, RI 3W FOR: Object Type: Sanitary Drain & Vent System Regulated Object ID No.: 884844 Plan Type: Addition; 1 Grease Interceptors The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • Comm 83.07(1)(b). This approval does not include the private onsite wastewater treatment system. Refer to the before- mentioned code paragraph for requirements on POWTS submittals. • All notes and spec's listed on the plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. C'`'' Sincerely, Fee Required $ 70.00 ' 1 Fee Received $ 70.00 Balance Due $ 0.00 1 Herman J Delfosse rr . Plumbing Plan Reviewer 2 , Integrated Services WiSMART code: 7657 1Uz� (608)789 -5535 , Mon -Thur 6:45 - 4:30 Fri 6:45 -10:45 hdelfosse @commerce.state.wi.us cc: Girl Scout Council of St Croix Valley Donald D Hough, Plumbing Consultant I1, (715) 634 -4804 i r TITLE SHEET Page of y for A grease interceptor to serve a girl scout troop house kitchen. Located in the U /4 of the NE 1/4 of Section 13 , T R Ii W, Town of 1 - tL,pS 0 Q _ S �R o) k ' County,'-Wisconsin. INDEX Page 1'of 4 TITLE SHEET Page 2 of 4 PROJECT DATA Page 3 of 4 PROJECT DATA Page 4 of 4 PLOT PLAN PREPARED FOR ST- Cz zo1.X G1 Su.. Scour »v(!JL �l o s . iz_ oa Z snz Ql 7 S`�• C� A�J I. -� "N 5s) 0 PREPARED BY Wa(SE= S0 3: L_ . TEST 2 "CC AND DES G SERV CE O f, �q q P.O. Box 74 421 N.Main St. I River Falls, WI 54022 wrerF. Phone 715- 425 -0165 SWOR TM, euswaN Fax . 715-4 25-6864 , `S. �^ I . •M I �f� RECEIVED JOB NO. C>Z_Z6S DEC - 6 2002 SA ETY & BLDGS DIV. i; cG c 2iE rtTY ^"i) RUILDINGS PROJECT DATA Page 2 of This non - pressurized in- ground system will serve an existing building with overnight use by 30 Girl Scouts in the winter months, 4 employees and 2 floor drains. There is a kitchen area, but food will be brought in and not prepared at the site. The building will be used by 120 girl scouts in the summer months as a staging area with bathroom use only. The system is designed for the winter use only as more wastewater will be generated at that time. The summer and winter use will not occur at the same time. There is an existing 2500 gallon precast concrete septic tank, a 3000 gallon precast concrete pump tank and a 1500 gallon grease interceptor with an existing 18' by 79' in- ground pressure bed. i The septic tank and pump tank will remain in place with the grease interceptor being replaced with a new tank. ANTICIPATED WASTEWATER camp, day and night use 30 persons X 25 X 1.5 = 1125 gpd employees ------- - - - - -- 4 X 13 X 1.5 = -- - - - - -- 78 gpd floor drains ---- - - - - -- 2 X 25 X 1.5 = -- - - - - -- 75 gpd Total = 1278 gpd SOIL ABSORPTION AREA 1278 - .7 - 5 = 366 if - 6.25 = 59 units of high capacity sidewinder leach chambers required. 4 cells, each 3' by 93.75' long with 15 units per cell will be installed. SEPTIC TANK maximum 2 year inspection cycle 1278 + ( 11.6 ) + ( 46.77X17.04 ) 1278 + 395.7 +797.0 = 2470.7 gal minimum capacity required. The existing 2500 gal septic tank will remain in place with the tank being inspected and serviced at a maximum of 2 year intervals. A warning label must be installed on the manhole cover as per code. or the cover will be replaced. •, PROJ DATA Page 3 of PUMP TANK The existing 3000 gallon concrete tank will remain in place. A Simtec STF -100 effluent filter will be installed in the discharge line . A warning label will be installed on the manhole cover as per code or the cover will'be replaced. GREASE INTERCEPTOR The existing 1500 gallon grease interceptor will be abandoned and replaced with a new Wieser Concrete 1000 gallon grease interceptor tank. Model WEHD1000 C = MXGXH 2XP C= 30X3X6 _ 2X1 C= 270 gal A 1000 gallon tank will be installed. WEHD1000 GREASE INTERCEPTOR TANK SPECIFICATIONS CAPACITY: 1000 GALLONS DIMENSIONS: WALL: 3-1 m J I COVER: 6' MANHOLE: 24' I.D. HEIGHT: 66 -1/8' O.D. OUTSIDE DIAMETER: 86 -1/2' BELOW INLET: 54 -5/8' LIQUID LEVEL: 46 -5/8' SPECIAL FEATURE: 'POSITIVE SEAL' V- SHAPED JOINT CONNECTION BETWEEN TANK AND COVER TOP VIEW INLET AND OUTLET: 4' BORE WITH STOP FOR QUIK -TITS, FERNCO SCALE: 1/4' - 1' CASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: AS SHOWN LIQUID CAPACITY: 21.50 GAL /IN LOADING DESIGN: 12' 0' UNSATURATEO SOE_ io WEIGHT: COVER 3,000 LEIS. TANK: 7,000 LBS. FLOTATION: OUTLET _ _ _ _ INLET - WITH SATURATED SOIL TO TOP OF COVER: 1 -1/2' OF SOIL OVER COVER -NO FLOTATION ^� 3' OVER COVER OFFERS 1.4+ SAFJETY FACTOR CUSTOMIZED TANKS 32 , TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE ROM MAMEN ROCK, W /PORTAGE, M/ FONO DU LAG IM SIDE VIEW 800- 325 -8456 SCALE: 1/4' - V MODEL WEHO1000 GREASE INTERCEPTOR I JANUARY - 2001 rxc WEM0100M PLOT PLAN ` -Page L1 of Scale 1 "= S p' 'S' - CI_ .1 oo.o' o&J Yup OF 1NS \�t�e`nUti �frP t V7 B. 1 8.3 Z' pve F7 19s'appmW does not include plans for the private sewage system that is required for this project. These plans must be submitted and approved before construction of the project is started: Wisconsin Department of Commerce SOIL EVALUATI. ORT Page of 3 Division of Safety and Buildings �. in accordance with Comm 85, Wis. Adrr ode Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P!hllt +L J include, but not limited to: vertical and horizontal reference point (BM), direction and Pam D, percent slope, scale or dimensions, north arrow, and location (and distar" ;Vearest road. Please print all information. �; 7 C�i , L Roaae Date .,C)i:+ I Personal information you provide may be used for secondary purposes (Priyikcy Law, s. f(tp�))• OZ Property Owner n C O ' ( t- ' ,4 ` 4,(/ 1/4 S 3 T 1 N R E (or Go Property Owner's Mailing Address bt # i " o Subd. Name or CSM# d J — L Sre City State Zip Code Phone Number ❑ City ❑ Village 7 Town Neares Road ( 2) 7 — S ZPAI ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD Replacement /0 Public or commercial - Describe: ZB O Parent material L/ /txH�/t f���� SO ����'� Flood Plain elevation if applicable ft• General comments Z ��.� �S]'�� �•S l},�p . FpLLmtrJ and recommendations: f'yST�)�'f S-� /VV T Boring # Boring pit Ground surface elev. _ �Zy ft. Depth to limiting factor 7 AP f in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 LS Z G er — 7 A 1 3 / -S Boring # Boring Pit Ground surface elev. ei2A L ft. Depth to limiting factor > A/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 S— 3 S we G G — . 2 7 _ G __ Wf ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Number CsT F9j$ i i�ng & Perk Testing 28 nature— D _ - Address McKenzie Rd. Date Evaluation Conducted Telephone Number Spooner, WI 54801 y� — 2 _ D/ /— /� �3 -�_ y'�D �S'• yDZ - -0,/ vd c�tc t Property Owner �ri1 • �/1C>L' 1/ �',>~l sMOY Parcel ID # 0 2 Page 7 of Boring a Boring # / ft, Depth to limiting factor 7 1 in. Pit Ground surface elev. /Ih3'. jggr f Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 _ Z p 7 /. Z Z — 7 .Z .a4�Z 30 7 vG E r ' a Boring # Boring Pit Ground surface elev. lQ� ft. Depth to limiting factor > 9� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rXArC 'Eff#1 'Eff#2 ' L IT 2 G 2 �p a Boring # Boring Ground surface elev. _ /��•� ft. Depth to limiting factor 7 !d in. JV Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure C Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Z oil 'Eff#2 /us mS� ♦fs — �- ,� - L-v tA- - z L - - Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608866'-3151 or TTTY 608 -264 -8777. _ SBD -8330 (RAM) r 1 --- Tiv— GR o�u�v� p R�3 S rrR� � Fogerty Plumbing #221180 28288 McKenzie Rd Spooner, Wt 54801 2 ,ri�,t/�ld' eW-FX- 57r6l (715) 635 -9609 A �! � �v Lo4C ,�1ocv,U FxOZ'C-'C) foLt 0 C[E/¢R 1��6 =i}'GT. �1'I, rod+ B, l '£� NO r& sU cam , AOAS ' Or�sr C / 7 ,'.Ivk =k�7XOX7Y �, X RA 9^404 N� Lork kaw o = F-E' Tjv���^ eTroN .tad wo""gw� EL� LDS, CAP 6t9va > S �/ZOlYl AAIr 1AAI Of �/� Loj Lti✓� tc�t- r-/�z'x/ ��© FROM Keith Knudtson FAX NO. : 17157967023 Jul. 17 2002 05:19PM P3 'lug u0 Ue Ur:SUR EOGERTV PLUMBING 17156355286 p.l ST. CROTX COUNTY ZONING OFFICE CSRTrFICATI.DN STATLI40M FOR UTILI2ATIQN or AN EXISTING S LcpTIC TANK This iS to certify that I have inspected the septic tank presently serving t-he 0-A AW r .+r y►Reo� residema located at: A=- _#, oe�i. Section ty T - 2�N. bF Tovn of . Upon inspection, Y certify that I have found the tank and baffles to be in good ccrAition, a:ld it appears to be funrtionnq properly. Last time serviced-: _,fZ Aid flow back occur f ox = � r a bsorpti on rg + system. Yes No (If ho, skip next line) Approximate volume or length of time: gallons, minutes Capacity: as�� Construction: P+afab Concrete. steel M nufaaturer: r known) : Age of Tank (If known): .4Awr .�-.�- a ,� Z (Sign •�` 3n ) Nam please print A A � •� _ , s J,� �r !� s� �� / 91 s (Title) n (License bufter) Date Form to be completed by licensed plumber (9.145.06, Wiseonsin Statutes) or Licensed Disposer (NR il' wfsconxin Administrative Code) ------------ -------- -- - - - -_- Plumber (applying for sanitary parmit) Certification: In accepti--q r above statement regarding existing septic tank Condition, 2 certify that the tank to the best of my knowledge will confOrat to the requfroments of xW 83, wig. Ad>r. Code (accept far inspection opening over outlet baffle). Signature MP /1!�►RS FROM Keith Knudtson FAX NO. : 17157967023 Jul. 17 2002 05:19PM P2 , uunalMb 17156355298 p 1 i t5•� f� d' s��fS ST. CROIX COUNTY 2ob1INc oFFI:E CERTIFICATION STATEMENT FOR OTIL7:ZATION OF AN EXISTING SEPTIC TANX This is to oertily that I have inspected the aaptic tank presently serving the !4G tr,, r rZgft � residence located at: section Lam_ T2.z.K, R .J,2,_ W , Town of �,,, Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: & /3A/ Did flow back occur From absorption system? Yes go (If no, skip neat lime) Approximate vol=e or length of time: gallons � minutes capacity: Construction: Vrafab Concrate steel ^ Other Manufacturer: ;rf known): Age of Tank (If known) : 4AW -el' /9J% 1 40 & r IC!! OU a�l. (Signature) (Name) Please print (T (License Number) 7.1?- -�0� Date Form to be compieted by licensed plumber (5.145.36, Wisconsin statutes) or Licensed Disposer (NR 113 Wisconsin A dministrative Code) Plumber (applyinq for sanitary permit) Certification: Xn accepting the above stateft regarding existing septic tank condition, I certify that the tank to the best of my kncwledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature Mp /MPRS_� FROM Keith Knudtson FAX NO. : 17157967023 Jul. 17 2002 05:18PM P1 - - -r ��� uurratrit� 1 lIb63S5286 p, 1 l ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This i8 to certify that I have inspected the septic tank presently serving the AA Aw _razal 1.geo = residence located at: k, SectiOn 4 , T R Zf__ ToWn of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: f Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: / eo O Construction: P:^Bfab Concrete steel Other ?, Ma►nufacturer: ;Yf known) : 'we of Tank (If %noun) : �..- -- (Signature) �r/- /V �k 17 (Name) Please priri� t` r " (Title) (License Number) Date Fora to be completed by licensed plumber (9.145.06, Wisconsin Statutes) or Licensed Disposer (NR 3.3.3 Wisconsin Administrative Code) - -- -_- ----- - - - -- Mumber (applyi -14 for sanitary parmit) Certification: x n accepting the above stat,= regarding existing septic tank condition, I certify that the tank to the best of Toy kncwladge will conform to the requirements of ILMR 33, Wis. Adm. Cade icxcept for inSpeCtion apOring over outlot battle). Name Signature Mp /1�RS Na. t-f. Warraatr Dw hort Form (STAT! OF WISCON91N) (8m 236.16, Wla. 8tatueft) J Farm Na. 6 PubUebed tW 2" CLYa Soft • 6Vatta Wr Co. 28 3 6 5 2 VOL ..' PAEE Malcolm Bush a /k /a Malcomb Bush, Malcom Bush and Tbi Jnhenturt MadebyH. Malcolm Bush, and Mary Bush, brother and , sister grantor s , of St. Croix County, Wisconsin, hereby conveys and warrants to Girl Scout Council of St. Croix Valley grantee of St. Paul, Minnesota vli"Wwrir"MS,for the sum of Nineteen Thousand ($19,000.00) Dollars the following tract of land in St. Croix County, State of Wisconsin: Northeast Quarter of Southeast Quarter (NEJSEJ); South One -half of Northeast Quarter (S}NEJ), and that part of North One -half of Northeast Quarter (NJNEJ) 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. ) <wGISTIdR3 OFFICE ST. CROIX CO., WIS. Rec'd for Record this_ 11th day of__ cbA.D.19_66 M I � � Regl e► of eeAs I,I t11ii S G Cc N 0 3 n d _1 Cc n N O y p n d N O N p O O C w N • -+ O ID Z 3 CD CD CD 3 (D m to n Co co i-+ I ou o� m rJ z rn co a m O Z > CD in � m cn o o 0 co �C (D 3 ta y to C Cn z cn G D v) z u) -C D a o CD cci D cn y cn m � D co' ID CD a CD W o o 3 O O 3 O O CD ? CD O N O O CL i Q (� p p C ;p n r N to N N N O M M v cn z z 0 0 0 1 ' �_� o �a o C M n�i o l w G Z N N °- 7 7 3 a CL ,� v O O cooz Z v O w O 1 n o r 5 s O N c o o CD C C = cp =, z a Lrj o. 3 0 3 p ° m a m o CD Z 0 n CL A Z O v v Q 3 _. W M m cio W eD m - Z CL a ; p �► Z y � r D A w O o Ch CD CL nCD i D o F w m p xp� nm y 3 O G? O ?C. Fn Vi ?� S CL O <. p '0 X y ^ ^' :+ N x• Q CD haw R - „cn„V �� O CD o- 07 y R. SC V < CD d � CD CD O ��'v (D CD 0 D� c m y d *o @ C° m a n'i DDS o 0) cc m Eo w m °� c ID ID d ID o c ro o° m_ m m m m ° c n� oaf N N N f � A d CD 'W (D 0 0 p N y N p�j �. 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C a, 7 y° d y ° . :daS O M a N aQS A O 0. � Q7'3 ...�� p �O aQ; fD Q-SO 7 O 07 aTQa:ga 7 o rv� ° oa aC Q :3 0 NO ° v Q ) :U V O O a x (D o CD C c�i 3 � o o m 0 C 3 S § o =° a ° x am m co ° x a° m I o o °- a, � n y� CD CDD pp N f0 O 9 0 0 0 0 N V O O i O 0 CL N Parcel #: 020 - 1017 -10 -000 01/18/2005 04 :11 PM PAGE 1 OF 1 Alt. Parcel #: 13.29.19.77B 020 - TOWN OF HUDSON Current X,' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ST CROIX VALLEY GIRL SCOUTS INC GIRL SCOUTS INC, ST CROIX VALLEY ` 400 S ROBERT ST ST PAUL MN 55107 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 SCH D OF HUDSON M�Cac k -- � . SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A -NOT AVAILABLE SEC 13 T29N R19W SW NE NW CAMP & Block/Condo Bldg: BUILDINGS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 08/23/1995 Description Class Acres Land Improve Total State Reason OTHER X4 10.000 0 0 0 NO Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 001 -WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 020- 1017 -00 -000 01/18/2005 04:04 PM PAGE 1 OF 1 Alt. Parcel #: 13.29.19.77A 020 - TOWN OF HUDSON Current X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ST CROIX VALLEY GIRL SCOUTS INC GIRL SCOUTS INC, ST CROIX VALLEY 400 S ROBERT ST ST PAUL MN 55107 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 30.000 Plat: N/A -NOT AVAILABLE SEC 13 T29N R1 9W N 1/2 OF NE NW AND SE Block/Condo Bldg: NE NW CAMP & BUILDINGS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/2311995 Description Class Acres Land Improve Total State Reason OTHER X4 30.000 0 0 0 NO Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 001 -WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 600 At _I r ^ ^� 1 �. .`S'�{.J� 1 I i r %r 1 , ' ■1 f ■ }� } o ER ' MAY 1 ING IWZAIJ- I . MI ROOF.., c t' , ..� r ,I•• t Y '• 1 _� ' ;�-. i .t �` � 5 fi 1 � ,,.:' ,t " " ?''1�• �r� 1•, �,:''- •, I ��$ ; . t °•. %ma I i d f ` � i ' i �' •\ % � ) I j j f � S �• � 'I 1 t ' \ , � j , I I GvJ S c cow °`1 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP U b,, d SEC .J TdN -RffW OWNER /9L SC a�T _. 1�A.I <jL - - - ADDRESS U b O A_ f -- 1.4 2 1 ST • CROIX COUNTY, WISCONSIN. -- �Vill SUBDIVISION _ LOV SIZF/ f PLAN VIEW 020 1017 -0 - 7 - 7A . Distances and dimensions to meet requirements of H63 �� //�� y YTHING WITHIN 100 FEET OF SY STEM i I t o t Arrow -_ BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: 1 00- n _Slope at site: SEPTIC TANK: Manufacturer: � 1 Liquid Capacity: /� rigA L Number of rings on cover Tank. manhole cover elevation: Tank Inle E levation: _lank Outlet Ele vation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle _ gallons; tota capacity of distribution lines gallon: sire o� pump head; gallon per minute _ horsepower _ ran name of pump and model number — Type of warning evice HOLllING TANK: Manufacturer _ Number of gallons Elevation of manhole Typpe of warning device SI EPAK'E PIT SIZE: - Numfier oi' ptts meet iameter feet liquid depth seepage pit inlet - pipe- elevation 1 of e PP ,>a i7P ni t- P Pvn i on feet. 4V IV, i as , j k { , > ^`fir 1►1r� ��7VfY Y'YI G7r77S!! Y MUNICIPAI,i SUBDIVISION NAME: 1 .E E} 'A PATES OBSERVATIONS MADE �Re u, � �• t ,r '62 i •'' AT ; • INGs'S Site i suit `' n.•r} p 7 /tom )N O qj F lt: SY$TF,M,: pptigr�l� ' a 77 111 A4 g 'eia 6 9 off ., I) portion of the lot Is in Xhe ,d F . Isl4. indiggte Floadplain (kle tiara r 44 i�`- SS (`w�.npI H T NS Q 1 r 4 9. :e Y(d f+t= � . ��✓�� �� °F'Tj �!1+*R'1 ,. i t� � ��. 1 .:( 1 { t �� 7�{ M r MI N A., c CHARAZ $ IL WI " � ' KNE&S, CQt.QR;. �94TI�tiA��xM T ` BSE VE E 'A88 Y N.4+ p ON CK ). • . x„7r rF � :t ! *�^ � :� �F �. N'l�� M F 1G" �'� Fp s'�... - ;, +'�'►. - &. � - 'F }��'� ,�. r'�f�F �r�� �:�MO�Mi►4��/ �� rIF7'S Q�U r!' � � i Tt R #! r RT IF �s (�A E , k , - •A. tha +dima ofjpla soil areas: `Irdlc sGa a ar d(stancas.'p aM f'what t !I'RI$ the 6 4 1 1 9 11 are the h4ri- mt� F 4 +�a P� ( At 41 np� ar f I @4tiQn end pgrGent •`� ` *�'? L rgt ti JA "•",•" ._ _ 1' .._ .� x r b 1 + y 15 lt _ _ Al 5 ,a uo ' JC,� ,W O Vic' in +mi x yVS1� 'tom accord with the proce'd speoi�iec p F ? gli �� „ ,����� ►>st Q m� kng�l� And peli�f x �N TED DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR r �! SAFETY & BUILDING LABOR, &'HUMAN RELATIONS DIVIS101 P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS ) +, BUREAU OF PLUMBIN+ NAADISON, WI 53707 je CONVENTIONAL ❑ALTERNATIVE StateP 1D N.D. Number (I r assigned ) ❑ Holding Tank ❑ In- Ground Pressure 0 Mound NAME OF PE MIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: fe2 P! c.ou6,t Cot.Ao� 1 , D, Si. ciro ' x 1 e BENCH MARK (Permanent reference point) DESCRI IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. `( 0 LO Y(t S ! `Taal a - 9 tq I,t.� [un, of Plumber: MP /MPRSW No.. County Sanitary Perron Number: )(0 C $ SEPTIC TA /HOLD( TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ❑NO OYES ONO BEDDING: VENT DIA.. VENT MATL HIGH WATER ROAD: PROPERTY WELL BUILDING. VENT TO FRESI ALARM LINE. AIR INLET. F YES ❑NO ❑YES ONO DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: ?;a PROPERTY WELL BUILDING. I VENTTOFRES (DIFFERENCE BETWEEN LINE AIR INLET PUMP ON AND OFF) DYES ❑NO SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing a,fi r LENGTH 131AMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into awire, construction shall cease until the soil is dry enough to continue.),a,x CONVENTIONAL SYSTEM: WIDTH LENGTH I N O. OF DISTR. PIPE SPACING. COVER $ INSIDE DI PITS LIQUID $ THENFHES MtiAL: DEPTH: I h , A L FILL DEPTH UISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL NO. DI v PROPERT WE BUILDING. VENT TO FRES LINE: / J� AIR INLET BELOW PE ABOVE ABOVE COVER Et E V. INLET ELEV. END IA PIPE � Y' , .. � .( I OT'f"I �D V� 1 V I MOUNDD SYSTEM: 3 J',q 1 4.15 f►� V V • Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER TEXTURE :: P2 RMANENT MARKERS J OBSERVATION WELLS OYE ONO OYES ONO DEPTH OVER TRENCH BED DEPTH OVFR TRENCH 11111 UEPTH OF TOPSOIL SEEDED MULCHED. CENTER EDGES ONO i OYES 0 N DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: s °+ F WIDTH. LENGTH NO OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER I TRENCHES: T w MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFTCOVE7RMTATFRIAL DISTR_ STR_PIPE DISTRIBUTION PIPE MATERIAL& MARKING ELEV.. ELEV. DIA. ELEV. S DI HOLE SIZE HOLE SPACING DRILLED CORRECTLY : VERTICAL LIFT CORRE SPONDS TO APPROVED T T� PLANS ❑YES O NO OY ES ONO M CM . PROPERTY WELL: BUILDING- COMMENTS. PERMANENT MARKERS: OBSERVATION WELLS: LI NE. 1•$ID 14 ❑YES El NO ❑YES ONO D ;A to ax 7. 3 s oN oM of P) P4 JA Sketch System on R ai " county file for audit Reverse Side, SIGN TITLE. y � i DILHR SBD 6710 (R. 01/82) �F_ DEPARTMENT OF APPLICATION SAFETY& BUILDINGS 14DUSTRY FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. if designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: COUNC GTRT. SCOUT ST. CROIX MILEY HUBSON WISCONSIN, 54016 Property Location: City, Village or Township: County: NF Y4 '/4S 13 iT 29 N/R 1 JXor) W HUDSON ST. CROIX Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: McCUTHEON Uf asslW) 8203465 TYPE OF BUILDING Number of Public* El Variance* E3 Other (specify) Bedrooms: 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: /\ v Owner's Name as Listed olSof Test Report (If other than present owner): Private El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP /MPRSW No.: Phone Number: A/ ( ! Plumber's Addr s: Name of Designer: s A) 115 COUNTY /DEPARTMENT USE ONLY Si=reof ' g A t: Fee: DAPPROVED Sanitary Permit Number: �� ❑ DISAPPROVED Q eason for Disapproval: �I Alternate course(s) of Action Available: I Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink- Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) Department of Industry, Labor & Human Relations ' Division of Safety & Bldgs. S late of Wisconsin Bureau of Plumbing Platting & Fire Protection .;, P.O. Box7969 Madison WI. 53707 Tel. 608- 266 -3815 INALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT �+ TYPE OF APPROVAL STREET AND NO. f i CITY OR TOWN UNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, James Sargent- Bureau Director PLANS REVIEWED BY: DATE: i cc: DPS -OWS Owner DI LHR Local PI Plumber H & R (2) ,County - ` Mfg. Rep. Bur. of Health Fac. & Services DILHR SSD -6099 (N. 06/80) Rec. & Env. Services I i SBD 6678 (9/81) (Plb 100a) STATE OF WISCONSIN DILHR E)etac�l And-Return Upper � `- DIVISION OF SAFETY & BUILDINGS Portion Of This Form W ith BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 608 - 3815 J f DATE: PROJECT : '"2pt.�at'c- svc..�4 7"'te G �1 f�'.c.a -+-� �I • /�. PLAN I # `., DETACH HERE PROJECT NAME PLAN ID. # — I nis is to acknowledge receipt of your plans and specifications for the above indicated project., Preliminary review indicates the required fee is $ (� - /W Fee Received is $ - 13 Underpayment Underpayment — Please submit the additional fee. ❑ Overpayment — Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. []No fee has been remitted. Plans submted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. I. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. El Affidavit enclosed. IV. Holding Tanks ❑Profile of holding tank showing vent, manhole alarm anc manufacturer if precast. Complete construction details if II. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit o and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statemen' for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist ❑ Cross section of system. El Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road ❑ Verification of Exception Status Farm by County. (1 copy) Etc. Provide benchmark with elevation reference point. III. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallon tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system • provide [] Detail & model of pump or automatic siphons including soil data. size, pump curves, drawdown and average flow rate GPM. k ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s)• course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer' if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross - section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trencl system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. ST. CROI X COUNTY W I S C O N S I N FyH h Office of County Surveyor P. U. iiox 227 Hammond, WI 54015 .796 -2239 I I fuly 15, 1982 D. I. L. H. R. Plumbing Section RE: Rolling Hills Girl Scout Camp To Whom It May Concern: The addition to the seepage area is all that is required. The installed septic tank of one thousand gallons is adequate. I If you have any further questions, please contact this office. Sincerely, Harold C. Barber Zoning Administrator wjo I ' I r Department of Industry, Labor & Human Relations W isconsin of Safety & Bldgs. State of 1 � isconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608 - 266 -3815 IN ALL CORRESPONDENCE REFER TO PLAN IDENTIF ICATION NO. -� NAME OF PROJECT �` � "L / i n e C- C !C -7l r •I C � tx 1'f� �L L 1 w TYPE OF APPROVAL STREET AND NO. / CITY OR TOWN CQUNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements., It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto matically void this acceptance. Sincerely, James Sargent- Bureau Director PLANS REVIEWED BY: / ' DATE: /// r \% L. a C i t L i _... . cc: DP3.OWS ' Owner DI LHR Local PI Plumber H & R (2) 6 'u ^Y Mfg. Rep. Bur. of Health Fac. & Services DILHR SOD - 6099 IN. 06/80) Rec. & Env. Services vv vim' 608 -266 -3815 DATE: PROJECT: �. -i-C , ;Y��c Cam: 7 t-t_t . t.•f� :t'"C 4_t C- PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # 0 This is to acknowledge receipt of your plans and specifications for the above- indicated project / r— Preliminary review indicates the required fee is $ '��� Lt� �� Fee Received is $ `' ❑ Underpayment — Please submit the additional fee. ❑ Overpayment — Refund forthcoming. Plan accepted for review. ❑ Plans being returned. No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. I. Plan Submission Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically rioted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks LJ Profile of holding tank showing vent, manhole alarm ar manufacturer if precast. Complete construction details 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. Application for use of an alternative system signed by owner [] Holding tank agreement signed by owner and local unit and notarized. 0 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations �_� Reason for installing holding tank. Soil test or statemei for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dis ❑ Cross section of system. ❑Pipe lateral layout. ances to any building, wells, water service piping, wat, ❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service roa ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ( J Calculations for total lift pump discharge, head and yalloi tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide [] Detail & model of pump or autumatic siphons includir soil data. size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pumps) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. Vl. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross - section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trenc system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). El Copy of onsite report by county or district staff. -2- f' " o Ce 2 ,1 SQ. �7" r f y Z. .M i.viAl v S12Z:" © 1/ 1 6.5 %' v A4, ?E� L- �7�v�`i #63 . //(> /S 4,e. .2 -2-) A S 15011-41,1f, Wzc) CG�SS / /JE,PG y � J 1 1 A $0 "' x l somas x l V O SQ . fir. ►'N i-A 0 SQ. f7 �► Mum, �►�,�� _. _ . 1071 sa• f,. �� y s�. >c; yy 7 sa. f � RECEIVED JUL 21 1982 r � PLUMBING BUREAU C ��� . L ON I O UA C1,A 49 7 70111,5 c , - jcA -L c-C r i /A / /7/l. t G / 17 i- / p Q ( 7 U �O Ac si .V E /i RATE wESr for �, yr FEti Pt-(:)r and CROS SECT10N PIANS QQ N vr�CTic/jL /P� 'Pr is - - - - - - 31, • - _ - - - - - - - - - " io a . FT N BOTTOM O E�(iSTi.✓ l Y �(p Y f UE,v r l�ipE , 9aY a '• �, go � �T- 3 7 -t, o /E UA % %pt1 of vE Af PT o , �t¢�/�ovEv tv is�k 1ANk �s ADD . D o � � . TES r `, 4, �Xi S j/A R _ D 7�GT PR Sb L S' LOV 101r 0eo X /sTi�vU- tiC ( N w See 3% z /V, el' l) PLUhisma 6A/ED �77 1, � • ,Q i :TiONS �97E i O F ` D U 1 Ji .1 Vt -- �ic; — sue.' -A�r Inlets And Observation Pipe �lEVAlioU o r ~- Approved Vent Cap f-, )) gf. g X Minimum 12" Above AWSS /�Ep Final Grade RECEIVED JUL 211982 PLUMBING BUREAU, 30 Above Pipe 4 Cost Iron 6� Vent Pipe To Final Grade p ),Y100 TO /� FD ,. Ad U nrc h / / & • PL (o PLor and CR0 w£ T fo �•,ut ,� fEtic� S Ecr 1 0 N P I A N S fx ��� 5 y .. R R o fi. � ° ate 2 5 13ofTOM y aff o` " 6AW7lo.-i - - -- -- -- - - -�--- /30 TTO - FT. o 38 I o I 3 �T S %�E'wACLI o c e O 117 ~ � h u �Z, 501 L ►"" a � � k;,;,v� R ^. J � ��S` a P A OEPAR - Eh I L �iL�IJI V.V J� :_ .•J UJ11 L � �1 �1 D 11-67 /E U. vaeT ArI➢ �ocK ���G S�DUT Cov.U�iG ,S'7� CicyX FT, w ►� 1 C6- . ti� — NLv St�T i3 Tzy,� W OU E 0 1 EVA1 ioA) Of f r 7�AT� I `� ti is goo• -- 1 ', �� - dy P Fresh Air inlets And Observation Pipe a I N 04 007cSO �- Approved Vent Cap Minimum 12" Above G� Final Grade 6/lrV. l ra o� c (3 4" Cast Iron 30 Above Pipe - To , Final Grade Vent Pipe RECEIVED JUL 21 1982 P �7 (''i.pT and C0 5 5 T P I A N SEC 71 0N N P! S Tic 1�Vle s4ze 1�e_ HOME SITE SANITATION CO. SEPTIC CLEANING SEWER SERVICE PVAy� ep CGE�►�U �'Oj��it� �f'��D l� ROUTE 3, O, EL ROAD HUDSON SCONSJN 54016 G�' PuM Eii' WJ /N -S f Mf�i(//ibC Sit /31j r r G STi 4 f>i5 ils OTI OA) �o X P�Po 1F6 r I'N M611i,'i I Cu - 91 211v—' 5recj. 13 /1 No X - Sy c�9��tTio v �o A y y N /y ox S4 �v 0 t Ly 10 go 77 x Fresh Air Inlets And Observation Pipe — Approved Vent Cap Minimum 12 Above Final Gr ade Above Pipe _ 4 Cast Iron Io Final Grade Vent Pipe RECEIVED Unr ch U— A, 1111 n 1 100 Plb. # 60 1/78 PROJECT DETAIL DATA SHEET / J/ NAME OF BUSINESS lr ilpG .5ep 60'jj61'L 7�ie ✓7 -eleD /X vA�� — -- -- Al ?o w,u �yvGuov LEGAL DESCRIPTION NZ /�/ CT 13 �T� 9 J OWNER Gl, 5 007 LOU.UG /L MAILING ADDRESS y� S • Ahx5r r 514 — 51 6 t y ,50 (" r!i Sf_ A L- Z I P _SSA0 7_ ARCHITECT, ENGINEER, 19e,*5 ��'G�/ ADDRESS 72 2 A4 9 X. 06 5T PLUMBER OR DESIGNER y ,p0 , //�� // Q5 ��/ / iUOX � 17' UDSOV Z I P J�yDI (y TELEPHONE NUMBER 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building Addition ( ) Apartments and condominiums . . . . Number of bedrooms ( ).-Assembly hall . . . . . . . . . . Seating capacity ( ) Bar . . . . . . . . . . . . . . . . Seating capacity # of meals served ( ) Bowling alley . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Number of sewered sites Number of unsewered sites Total number of sites (X) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons (X) Day and night Number of persons ( } Catchbasin . . . . . . . . . . . . . Number ( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons ( ) With kitchen Number of persons ( ) Dance hall . . . . . . . . . . . . Number of persons ( ) Dining hall . . . . . . . . . . . . Number of meals served daily ( ) Dog kennels . . . . . . . . . . . . Number of enclosures ( ) Drive -in restaurant . . . . . . . . Inside seating capacity Car - service -- Number of car spaces ( ) Dump station . . . . . . . Number of dump stations ( ) Employees ( total of all shifts) . . Number of employees ( ) Hotel ( ) ( ) Cottages . . . . Number of units with 2 persons per unit . Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( ) Mobile home parks . . . . . . . . . Number of sites ( ) Nursing homes . . . . . . . . . . . Number of beds ( ) Parks . . . . . . . . . . . . . . . Number of persons ) Toilets ( ) Showers ( ) Restaurant . . . . . . . . . . . . . Seating capacity ( ) Dishwasher and /or disposal? ( ) 24 -Hour service ( ) Retail store . . . . . . . . . . . . Total number of customers ( ) Schools . . . . . . . . . . . . . . Number of classrooms Meals ( ) Showers ( ) Self service. laundry . . . . . . . . Total number of machines _ ( ) Service station . . . . . . . . . . Number of cars served dairy ( ) Swimming. pool bathhouse . . . . . . Number of persons ( ) OTHER . . . (Specify) . . . . . . . RECEIVED COMPLETE OTHER SIDE JUL 2 11982 PLUMBING BUREAU � d 2u, indicate whether the following facilities are present. Floor drain yes X_ no Number of drains _ _ Food waste grinder yes no �_ Dishwasher yes no X Automatic clothes washer yes no --X Number of clothes washers 3. Septic tank capacity Holding tank capacit Septic or holding tank manufacturer ��,) lS i� C'D.CIG�Q� -e- �.� /��N 6"( 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches depth number of trenches _ T- SEEPAGE BEDS: total square feet - I ✓ LP width X�57'11v1 6 1's �T, Fr To RaT'Io�, r "T s �AI. of length of bed 3� depth 1. 0 ��t�.tU�fTiynl `r. 7 SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signat� e of person completing form: FOR DEPARTMENTAL USE ONLY Address �2 Z �,(l $ No,k 0. UI�SD,t/ > �1 S Z i P Telephone Number 3�Cp ' 2eJ -0 7� Date o N ol n N O $ ro n d � 1 7 W W 3 CD • A W m m 0 o I_ m 0) v' o o �_ c w n `C • (D 3 < ' C o 7 (D N - N N CD C 1�1 `A\ Q W n W O I O a W CD � to w p 7 O 1 CD 3 ! x o N O C c° O N° o m ° o a, °' A t9 C (n C. " C N 3 > ' Q7 O CA w c O 0 1 W n (D cn `D ° O c I CD �' m W a o. CD co rn a x CO O °� a W N CD 4 OZ pOj 0 (D 00 N D O CL (D �7 O 0 K I OZ O CD C") O C rn W m D S . C. x ro !mil a ro ro ro� o - n o m 1 0 � C to N co ^ I n C fA fA ca O C CD 3 o ro O O a O A N A W _ O y W CD CO CD 3 m a l 3 c+ CD 0. » 0 1 a �. a z Z W ° czz= ° C-4 Z' O C -^ m O v O o D �_ � O o c O CD 7 C O 7 N CWn CL CD N O (D 1 C N < co co C W a 2 L a 3 7 CA z 7 (O z j Co O ..a 0 C y a rn 0 v C v Q ? C) 3. cn -i a W aW �OW J Z o 0 3 A 3 i 3 m C o N y ;o G CD m A 0a C =r C EF J Q CD CD O CCD a N Q 0 7' C CL .�.. m w yCA v c fo�W v c 7 CD 0 Z n. I Sd0 N y tC z a i. Cn d C 8 0 m N O [D o 7 n O N S C O 7 co d O W CD W y K W 0) N�� W� � A O y M V O7 N S C' y 0 I V �p C ^'3 N A lQ � W _ 0 7 a N ,Q, 0 7; Ca H `r n 0 Cn D S 7 7 -n 1 ~` r L N O C a 0 00 CD W 0 0 7= O C CD l) 7 I W0 W O O C H a A ti 0 0 'O CD CD O 00 0 0 :E g O (D O (D TJ I I O! I O i ~' ti N tment of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix ng Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT)" - 1 GENERAL INFORMATION State Pla ID No. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: St. Croix Girl Scout Council I Hudson Township 020- 1016 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: .� f loo . a SC . ,n�a�. cr�cc' .r.L • t3. Z 9 • i g , '! s'� -/i�t TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B8 HV FS ELEV. Septic Benchmark j• ZZ ol.2z o � o l Dosing Alt. BM Aeration Bldg. Sewer 3.38 Holding t Inlet / TANK SETBACK INFORMATION t Outlet 1D 47/.,0S- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t S �f Dt Bottom l ab Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L IBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Mode! Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil �L ❑ Yes [] No ❑ Yes l� No 1 COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: T / 3 1 / C 1 Inspection #2: Location: Hudson, WI 54016 (SW 114 NE 1/413 T29N R1 9W) NA Lot — rcel No: 13A9.19.75 a P 1.) Alt BM Description = t •`�S ��-- -� f� 2.) Bldg sewer length - amount of cover = +�►• t� �`'�' T - - - -_ - - Plan revision Required? Yes F] No �� I Use other side for additional information. __ y� G /date Insepctors Signature Cert. No. SBD 6710 (R.3/97) 0 O / � / � �� 4 C !!�"� �� , �/ St/ st: to County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road �,t•�4 Hudson, WI 54016 -7710 tP (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not thdn 8-102 1 inches in size. County Sanita Permit # ❑ Check if revision lo vloils application pd � 1. Application Information - Please Print all Information (:0 tion: <W Z1 /t/ 3 Property Owner Name 114 114, Sec .0 0 _ ,2 N, R E OF Property Owner's Mailing Address of umber Block Number City, State Zip Code Phone Num r' f -•_ - ubdivision Name or CSM Number -a v 11 Type of Building: (check one) amity ❑ Village Mown of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: Public/Commercial (describe use): i ❑ State -owned Nearest Road _ 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax umber(s) A) 1.0 Repair 2. ❑ Reconnection 3. ❑Non- plumbing . ❑ Rejuvenation 1 . ap. /9 U2 p _ /0 /(0 40 - 06 Sanitati Permit B) JZf State Sanitary Permit was previously issued Number Date Issued IV. Type of POWT System: (Check all that apply) ( � v U [Z( Non - pressurized In- ground Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line _ ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating' ❑ Other V. Dlspersallfr atment Area Information: d 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade 1. Desig n Flow (gp } p p Elevation Required Proposed (Gals. /day /sq.ft.) (Min. /inc h ) VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con - Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non -plu ing sanitation system. ro1P/fNPRS No. Business Phone Number Plumbers Name ( rint) Plumbers Si nag (no st s): .� 7�5 aza P Issui lumbers Address (Street, City, fate, Zip Co ) Lim VIII. County Use Only I Disapproved Sanitary Permit Fee Date Issued 1 Agent Signature (No stamps' Approved Owner Given Initial Adverse 2 e r r Determination ;0 rCondiltions of Approva l /Reasons for Disapproval: QQdoM 3 4rlvC- !3E'"1U4' _A;;4 I' 1�ie �,c' °S ,r !- 1z,"�� 74 iN� S & )4)645 v rE� „etc T,� ct�. i lv� �r /keg r 53 r � 1 pm � � f'cdt4E 9- pe,lt� l i 1 f�ce1) n el D�i�yG Gtir�irJ, _ . __ __ i - -- _ . — - -- � �� ___�._�,. I _... _-- �--�-- - i � 1 , 1 I ` r � I i 1 � I � i 1. � � '. i i _ __ __ y i i � � ', I � 1 i I � � ', _.a - - -. •....____._ .. __..._. —.�... _._.._.� _._a.— __. ___._.� � ._..._� _�_._� .... ..�.___ t � ... _r_ .��_.� ._��_ ' ' _�. —_ .' .� _. _. __ � i ' � � I 1 l i � , � � � ( I ',. 1 j � ___. ' I , ---F ._ _ , -- -- — � .__ { b -- 1 �. � _. i � ` I , , i I t j I � i i � j i i � j j i � . f � is r i l � � f , � -- — _ .. t i i i '_ I { � i i � , __ ...__ _ ... _.. ___.:_ _ _ __... i - � � ___T__ _ _ _ _ - _. :... .._.. _ _. _ _ —_. � � � � � _ i - i � i i f— I i r � � i � _� a ,. —= ,_ ti � i � 7 ._ _. i � . '� i �. ., 1 r _ , - _ i 4 �- �.: —___. _. _ �_ _'_' '1 - 1. - 1 _ �. _ ? __. _ __ ._....... 1 �� ' i .. I � .— I - 1 � � i r PPY } 4 � i ! !! � I ;.. � 1 i i i ;._ ,. � _._ _ _.. _. i _ _ I r i � i I j l 1 � � , 1 r � I I i i � 1 � � r i ,I i 1 ` L. � w ___ - -- -_ ___ _ _�__ _ _ __ � � i _ �. ______�___ .r--- � -- - � - . -- i _, .. ._ � r — ?•?sconsin Department of Commerce SOIL EVALUATION REPORT Page / o f L ' Division of Safety and Buildings in accordance with Comm 85, 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. AY—j— — O -E- -/Ifs' 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 Govt. Lot Ap o 1l4 . 114 S TZ ' N R E (q0% Property Ownees Mailing Addr ss Lot # Block # I Subd. Name or CSM# eg�r City State Zip Code Phone Number ❑ City [] Village Town Nearest Road 71 /v4 ` I] New Construction Use: ❑ 4 0V Residential / N f bedro de derived design flow rate GPD r or ,r 0 Replacement Public or co at - De b � Parent material «f�Isdi elevation if applicable ft. General comments O O' I I and recommendations: S.T Cox CP G> - Boring !/�i��-T •" F—/1 Boring # ,/� Pit Ground surface elev. 92._q_ ft. Depth to limiting factor > /DL in. Soil Application Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 �-- L Gf /$ Fh L / z _or 3 _ 3 I s- ,s= -- c . z X02 — JeA �' h►► L . l F-1 Boring # ❑ Boring pit Ground surface elev. fL Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color G r. . Sz . Sh. •Etf#1 'Eff#2 • Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 _< 150 mg/L uent #2 = BOD, < 30 mg/L and TSS < 30 rttgll: - ,CST Name (Please Print) ignature�_ CST Number ' .� " / �a Address Fogerty Plumbing & Perk esting Dat Evaluation Conducted Telephone Number 28288 McKenzie Rd. Spooner, WI 54801 ��-� �/ — �D•t —�'!�` Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 �[F'S�rDE'tC� I r - + We ' < - 'c.# 4— ,ta Gv.�► 'zr/ XXOA1,G A5WI .vV Selelroorx Aa ®,t wm77- vW-s. �otri GxcW /�CiniC,E'flr D�iei�f/L G1 �i•�1irJ, 9.?. S/ i ft-,fcp t' - GA'/ a Parcel #: 020 - 1016 -80 -000 01/18/2005 04:10 PM PAGE 1 OF 7 Alt. Parcel M 13.29.19.75 020 - TOWN OF HUDSON Current 1 X_' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner GIRL SCOUTS INC, ST CROIX VALLEY ST CROIX VALLEY GIRL SCOUTS INC 400 S ROBERT ST ST PAUL MN 55107 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 13 T29N R19 SW N CAMP & BUILDINGS Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/23/1995 Description Class Acres Land Improve Total State Reason OTHER X4 40.000 0 0 0 NO Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 001 -WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �jjr �LVU.�Co� tc�tci v. TOWNSHIP SEC. T ';N -R_� W SA ffc G� A /e ADDRESS O ST. CROIX COUNTY, WISCONSIN SUBDIVISION /v LOT LOT SIZE /vim PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e J 5 1.4 A C2 )5;v f INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used � c Elevation of vertical reference oint: p 16� Proposed slope at site: SEPTIC TANK: Manufacturer: 4"/1 irL Liquid Canacity: / 6-ern j PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: X Width: Length: — Number of Lines: 2 Area Built: zd Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Ft . jQ Number of feet from well: / 75�f Number of feet from building: / `7"/ W (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line; Front, O Side, O Rear, r, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: ` T DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILL.. LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIO P.O. ROX 7969 BUREAU OF PLUMBIN MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE I State Plan I.D. Numbe r: lIf a -gnetO ❑ Holding Tank O In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HO DER: INSPECTION DATE: r;, tt Scout Counc. �� S .Choy 400 S. Raetc St., S 1'aut, MN 5510 BENCH MARK (Permanent reference point) DESCR RENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SW NE, Section 13, T29N -R19w, Town o6 Hudson Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Roge)L Timm 3224 St. C hokX 58873 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK I ET E TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER l , ' PROVIDED: PROVIDED. DYES ONO ❑YES ❑NO BEDDING: VENT D�IA VENT MATIL. HIGH WATER I fyEST"IFROM' UMSCA OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRIES / N. Q ALARM: LIN E: IAIR INLET: YES O Q/ OYES ❑NO It1EARES"T � — � j DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: I OYEs ROVIDED: DYES ONO DYES 1:1 No ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF !PROPERTY WELL BUILDING: VENT TO FRIES (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) DYES ONO NEAREST .SOIL ABSORPTION .SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER. JMATLRIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: ° °" WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID :GN a TRENCH S. }(/�J MATERIAL: IT DEPTH'. it $ � U (� ,�,� (/ t � �. GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: N STR(. PR OPE TY WELL: BUILDING: VENT TO FREE BELOW PIPES. ABOVE CO VER. ELEV. INLET. EL V N P FEET FROM LINE: AIR INLET. �z z G oa 9 /-�' �°Xe ST MOUND SYSTEM: 7 z 4.9 91 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DYES ONO OYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL: SODDED SEEDED: MULCHED CENTER. EDGES: DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: # :I WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: ri MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: + �y ELEV.: ELEV.. DIA.. ELEV: PIPES: DA: Fd1f... Ak IISI ftlUT[bN '' HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED 11,11 R'M.✓M 1 PLANS. OYE 1:1 NO ❑YES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ] FE MBE1'{ OI", PROPERTY WELL: BUILDING: f_a, LINE DYES ONO OYES ONO tAlke Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) Uimco^sl^ APPLICATION FOR SANITARY PERMIT D ILHR (PLB 67) OUNTY DEPRRTmEr1T OF UNIFORM SANITARY PERMIT # InDU5TRy, LRBOR 6 MUR7Rr7 RELRTIOnS — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION CITY: 1/411 1/4, S 13 , Ttq, N, R Iq (or) o N O a LOT NU B R BLOCK NUMBER NAME NE T ROAD, LAKE OR LANDMARK STATE PLA I.D. NUM rv�1 I SUBDIVISION �1��- �4 TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms: 3 TO Public (Specify): 111,4 THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair 9 Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed 9 Seepage Trench U Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity IV Lift Pump Tank /Siphon Chamber Holding Tank capacity tv Manufacturer: IVR IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 yf,5 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature- MP /MPRSW No.: Phone Number: I -5i y I (715 ) .381oS.6(0 Plum er' ddress: Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: F Date: El Disapproved 91 � V G El Owner Given Initial f a[ l� T Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber , Y INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type o)ush.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms etc.) location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size separating distances, distances between beds if appropriate, tank locations effluent line from tank (s) 9 9 P P p 9 , (s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private Y sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i APPLICATION FOR SANITARY PERMIT S T C 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 6 it Location of Property 4 13 Section 3 T Z _ N - R _ W Township - //U Mailing � Mailing Address Subdivision Name Lot Number A, Previous Owner of Property 1111yi Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes -- No Volume -5 10 and Page Number a j(, as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OI'' THE FOLLOWINC x 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. P ROPERTy'OWNFR CERTIFICATION I (we) cuti.6y that apY statements on .this ,foram ane tAue to the best o6 my (out) k.nowtedge; that I (we) am (ane) the owneh (s) L ±hv. nn„oe Lty de6cAi,bed in thda .LnAonmati.on 6o4m, by vi tue o6 a waAAanty deed tecotded in the 04 jice of the County Regesteh aj Deeds as Document No. ; and that I (we) p4e,6entby own the proposed z to 6oA the. sewage dis pozat system (ot 1 (we) have obtained an easement, to nun with the above descA bed ptopmty, Got the eo►vstAucti..on o6 said system, and the same has been duty teeotded in the Oj6ice a,the Con it Regizte,. o� De-e.6, nz Document No. X ,« i r f3OCUMEW NO. Qum 0"M n ®tn STATtt: OF WISCONSIN -FORM to ' TNI• •PAC[ RR1[RV60 RRCORDINO DATA This indenture, made Icy . �1'rL. Saut.. Cunei a£..SL. -Grol x f; REGISTERS OFFICE I' »Ila11a)4_ .. ..... .... ..... _.. _ _ » ST. cftolx cb.. wls. ._ M i M esot j duly organized and existing under and blr vhtue of the laws of the State of ' Reed for ReCW'4 ihlS - _2� K grantor, of 47.. .. - -- - - ». 1C.11�XgPXJW6)iK day Of_�•il ��__A b. 1 7�t herebq quit - claims to. a...wlji ans.In...na.1::.f. = ti M ....» ....... grantee », of.:.»,�1;....�LQ.i.X.»» _ :....�....» .._ Re County, Wisconsin, for the sum of ... Oni .l?r hir... al -00 9A -- and. - ther.» ad r of N �glater of oeods -- and ... xa.l.uahle..conslxiaraxlnn» .::...:....» . ». :.». ...... » ........................ the following tract' of land in ............... St rO1X _ County. RETUR TO State of Wisconsin: ............... _ ..... ..._ ... ........... ....... ..........._....:.............. ...... ». i, Girl Scout Council 47 W. 9th St. __t.Paul _Yinn. 55102 Northwest Quarter (NWl /4) and West Half of Northeast Quarter (WI/2 of NE1/4) of Section Eighteen (18), Township Twenty -nine (29) North, of Range Eighteen (18) West, St. Croix County, Wisconsin, except that part of the West Half of Northeast Quarter (W1 /2 of NE 1/4) North of the highway. Northeast Quarter of Southeast Quarter (NE1 /4SEI /4); South One -half of Northeast Quarter (S1 /2NE1 /4), and that part of North One-half of Northeast Quarter (N1 /2NE1 /4) south and east of the town road as presently located, all ' In Section Thirteen (13), Township Twenty -nine (29) North, Range Nineteen (19) West. 1. South Half (S 1/2) of South West Quarter (SW 1/4), Sec. 12; 2. North Half (N 1/2) of North East Quarter (NE 1/4) of North West Quarter (NW 1/4), Section 13; 3.. South East Quarter (SE 1/4) of North East Quarter (NE 1/4) of North West Quarter (NW 1 /4), Section 13; 4. That Part of the North Half (N 1/2) of North East Quarter (NE 1/4), lying northwesterly of the Town Road, Section 13; 5. `South East Quarter (SE1 /4) of North West Quarter (NW 1/4) of Sec. 13; ALL in Township 29 North, Range 19 West. EXEMPT In Witness Whereof, the said grantor has caused these presents to be signed by ..... .Ardls. ... H rmis ............. ». ........................ ............................... its President, and countersigned by ...... Alar a.. Iny ax t. ..................... » ........... » ................................. .. ., its Secretary, at .............................................................. ............................... Wisconsin, and its corporate seal to be hereunto affixed this ».... » ................... »: .......... day of ....... April ............................., A. D., 19...7�k -. SIGNED OD SEALED N P OF .G.I.RL ... SCi1UT --- C.OURC- I.L. »OF ... ST.... CRO.M.YALLEY.- _ - , //� .. gate ame '♦ ` /V/ ........... C orporate N . ............................... ...... ... GJFSrie'� _» ........ »..... » »_ .. »..._ »..» 1�avid Ardis Harrison President Caro lyn O COUNTERSIGNED: R: Pe ... .................... »..Y - -... ».... Verone Pratt STATE OF WISCONSIN 55 Additional notarization .. ..... ..... .......Pn1k.........._......... County. on back. Personally came before me, this ........................ .. ....................... day of ... ...... .. ...... Apil1 ......:........ Xxxxxxxxxxxxxxxxxxxxxxx "xxxxxyjcxX MKKX.... Al a�1 �. :. :.... .... mt:� of the above named Corporation, to me known to be the personX who a ted the foregoing instrument, and In sy RDC1lOkaGKJCXb(Secretary of said Corporation, and acknowledged that 14tlff�executea the f/ as sud} of said Corporation, by its authority. H . y STC - 105 r _ y H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County x 0 OWNER /BUYER `` �Y " c5t -� �• .o�C�/ 47/i R0U1'E. /BOX NUMBER L2 JT Fire Number CITY /- STATE > Cc / `eg Z I S % PROPERTY LOCATION: Section /3 . `1LN, R W. Town of �`'� , St. Croix County, Subdivision , Lot number . Improper use and maintenance of your septic system could result in its premature 'failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sourer, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat - ment.stage in the waste disposal system. St. Croix County residents ma be etibi :e to receive a ;rant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on - site wastewater disposal system.is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. C • f I /WE, the undersigned, have read the above requirements and agree u to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- n ment of Natural Resources. Certification form must be completed and returned to the.St. Croix County Zoning Offi,pe within 30 days of the three year expiration date. SIGNED i DATE St. Croix County Zoning Office Sy`CjQO%�' P.O. Box 90 Hammofid, W1 54015 715 -7.)6 -2239 or 715 -425 -8363 Sign, date and return to above address. 1 > O 'o C_ « E o f- C c r ep o Eoo >`o Env... o rm °r o (D 1-- m m cmo 0 , 0 0 cm - 0 c o o ti m i m •- � yL� � tm� cmm - m td co W O 0 * 0 3 'M N ; O Cd z N c v`��� : ow b f Q m a >% — `tm o° F' = ad .0 c m IV o a �Nt- 0 Om w o C W 3�v00'v �0 W c° 3 c 0 °1 v =0 a o to &- m0 0 C-0 o CM 4) o `�S p m m " +=' td ►' O = a 0 9 0 O N O _ 7 Q N O m> OM p1 r a: c U. _ m a) Q aCL' _ Nia c ° C m � ° t N CC N ►. v- 0 c 3 cL �..7 to r- rn °v o E 75 0 E c +. A o ca H o ca ��,c ° «« 30= ctm r cc CM Co - wmm0 m d, « U 0 SE N N m` O. ca 5 C C m w 0 i V O C p m v) m 0 a 01 0 - 0— m m 'o Cl m O C =_ �" o v E c o N p ° o rna Ev d 3 r• c p>,��mc N N AA ." O E C S N G DEP_4RTMENT OF REPORT ON SOIL BORINGS AN D SAFETY & 13l DIVISI I S7RY, DIVISION LABOR AND P.O. 79K HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, 1 WI 30 X 5370i 1116 & Chapter 145.045) LOCATION: SECTION: OIV. .i.! UNICIPAI_ITY: LOT NO.: QLK. NO.: SUQDIVISIQN NAME: _ J� /N� 13 /TZIN /R /gE o) � upso"/ NA, MA. L Cd - UNTY: NE /BUYER'S NAME: MAILING ADDRESS: � Ivj ��rtcIt<I i &Y S� oz p+ USE C A?_C �E ' S HdIM N'[' [C- 1 0 v M P P-OLLI WaATES OBSERVATIONS M ADE ° I -..1 DC INO. BEDRMS.: COMMER IAL U I" ESCCRIPT10N: PROFILE DESCRIPTIONS:) R OLA ON 1 Sls: L �Residence `3 N-/1, ❑New Replace 4 9/2318 4 I / X I - P A, c -1Q 5 a al L S rJIz r- A I; DT Ps Cz RATI S= Si te sui table for system U= Si unsu itable for system M E NTIONAL: MOUND: IN -GR0 D- HOLDING NPRESSURE: SYSTEM -IN -FILL OLDIN TAN RECOMMENDED SYSTEM: au�i [Z s aU Ti's ❑u ❑u_ [is ®u K: �4�tu. ��'x 7,(.' aE� !f Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the qq under s.H63.09(5)(b), indicate.: of ,� ! '� Floodplain, indicate Floodplain elevation: EGI MA L �j o I t_S Pr E TO F1=E PROFILE DESCRIPTIONS wAI_*�-}Eb I ( DvE 'ta ti OR.IZ.ON BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION `` OBSERVED EST. HI HEST TO B IF OBSERVED (SEE ABBR ON BACK.) 5p _ Av onlE �! / /,UO' O ' 3 L L� Z•SQ' Ro pA) L oo L T, nA )•/1�A 5 w I-Io� I Z ONS of 0.03' R fl $ M� _ B-2 8pd S,bS A/oAJE °7 x.0(3 O, SD' I31_ L� t, SO' �� MSS H OP I2 0.33' 5L L; e- •Z 0 ' 8 L•G 50' LT. Brl m E5 w op - moAuS o rJ M E S _ I g_ i DtGIM�FI. PERCOLATION TESTS L=EFT I . T DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL -IN.C"ES RTC 4 E MINUTES NUM BER AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERT D2 Rt D E 'ER INC H___ A > , 4 .75 Kj M E z - < < PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. IndIka5e scale or distances. Describe what ara the hor zontal and vertical elevation reference points and show their loc on the plot plan. Show the surface 6evation 2 at! borings and the di*. and percen of land slope. N OTt ; AR- WA N I- A-V_ Zo- I QEQ, V 1 TLeL • 0PA IE SYSTE=M ELEVATION y /.moo eX��v�� -A O,V r M r-r- �ia xl nn vwl jZH >Q TN R- E 00 �- �MEuT, i- 0cr,T70nl SKE_rc-N I i SOIL flop- I hFbL TEST ,� , I I mda raN I i ! o � � i t O! I , . Y I : x b , � f IN \L O J �._ I _ .. _ - � :io _, __ __ �.:�1 5T1 IJ 6r_ N? ! ° ! P f L TN K � EN TO p d T i I i a r'oVffF. r -LEV. i O LL i I i 1 i i JOB .5 cm, I cc) u ,c.1 v S�. Cr d i,►� Va lF�t� ROHL & TIMM EXCAVATING z OF 310 Arch Street SHEET NO. , HUDSON, WIS. 54016 CALCULATED B/Y�] " Z! 4 d DATE � - (715) 3868664 CHECKED BY r PlC a, DATE SCALE �ctS�r�ic ... ............ , :. /GF�D .......... Fp (f 5 'x 5v - 7 rertc111A s, .. .... �3 _... T' v 10 _ln fAll/r d. too ..... 'f�xd ..... . 4 4 ins r`flr1 ► E- -- 112. --- .. IN pop t y v Q .......... + /1 � ...... � j GA k ............... . PRODUCT 2041 � Inc., Groton, Mass. 01671. lr IS CO t� ' � J C�OI.�rICt� 0 '�- �Ti C�'D11, ;. ROHL & TIMM EXCAVATING �os SHEET NO. v OF 2- 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY r � DATE (715) 386 -8664 CHECKED BY Z DATE_ SCALE ;........... : _.... ... ... "� y egs�_ iron .... �:��? -5 . - - t pdGT r _ �o`� o G 4 � - - — PRODOC72041 eas Inc., Groton, M— 01471. I ilt EPA ENT OFJ:NDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ASOi HUMAN R ELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL XMALTERN E State Plan l.D. Number : ryy (lf assigned) ❑ Holding Tank i n n- Ground Pressure Mound 8667951 NAME OF PERMIT HOLDER: ADDRESS OF FERMI `HOLDER: INSPECTION DATE: O St.. Croix Valley.: ' � Girl Scout Council 400 S. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: AEF. PT. ELEV.: ICSTREF. PT. ELEV.: NW NE, Section 13, T29N —R19W, Town of Hudson Name of Plumber. MP /MPRSW No.: Sanitary Permit Number: r " S v t. William Schumaker 6382 Croix 88448 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY - . TANK INLET ELEV.'. TANK OUTLET ELEV. WARNING LAB LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ONO BEDDING: VENT CIA.: VENT MATT, HIGH WA ER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: - AIR INLET: DYES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: J PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO DYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL' BUILDING. V N TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: ]NO. BED /TRENCH WIDTH: LENGTH: TRENCHES: DISTR. PIPE SPACING M PIT jI N1ID)E DIA #PITS D P7N DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL NO. DISTR NUMBER OF PROPER Y WELL: BUILDING: V NT TO FRESH BELOW PIPES. ABOVE COVER: ELEV. INLET. ELEV. END: PIPES_ FEET FROM LINE: AIR INLET. NEAREST -s MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ONO SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES'. DYES ONO DYES ONO I DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIOTW LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR, PIPE J MANIIOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: ELEV.: DIA.. ELEV.: PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUI LOING: FEET FROM LINE: DYES 1:1 NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TIT LE. DI LHR SBD 6710 IR. 01 /821 ', SANITARY PERMIT APPLICATION COUNT „ In accord with ILHR 83.05 Wis. Adm. Code STATE SANITARY e&44 PERMIT# 8'8'y dl F —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. G —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION L S aej f' , ` I j I le iz I tla '/a ' /a, S j T , N, R 1 E (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME , �'b 0 S 5 k' a o- as CITY, STATE ZIP CODE PHONE KUMBER Lj CITY NEAREST ROAD, LAKE OR LANDMARK VILLAGE : TOWN OF X14 gZ-17d 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in P. Check # 2,3 or 4, if applicable) 1. a. 1:1 New b. 9 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. ❑ Conventional b.% Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. i® Mound j(IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑ See a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3, ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): d" 7 Feet ❑ Private ❑ Joint ❑ Public CAPACITY VI. TANK Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank as n'll Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system ho on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PRSW No Business Phone Number: P lumber's Address (Street, City, State, Zip Code): Name of Designer: Vill. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # 7d CST's ADDRESS (S reet, City, State, Zip Code) Phone Number: - t I X A. v-7 w �' s y OlI was a/4 IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate ilssuin Agent Signature (No Stamps) A Approved ❑Owner Given In Surcharge Fee Adverse Determination l T L X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be property maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years: 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed: It. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved, Complete plans and specifications not smaller than 8'/i x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. -----------------------------------------------------------------------------------------------------------•---------------------------------------- - - - - -- - -- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundy� ate, — included the creation of surcharges (fees) for a number of regulated practices which WiSCO in`s e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that bureed (>?asltre' is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis tered by the Department of Natural Resources. These funds are used for monitoring g oun - t water, groundwater contamination investigations and establishment of standards Groundv : , ;t's wort". protecting. sac -6398 iR.03 86} SANITARY PERMIT APPLICATION C OUNTY ( �t " DILHR In accord with ILHR 83.05, Wis. Adm. Code ' `,, STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. - -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION '/4 '/4,S T ,N,R E(or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD, LAKE OR LANDMARK ❑ VILLAGE: 13 TOWN OF: II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable) 1, a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1, a. ❑ Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. El Pit Privy d. ❑ Vault Privy e. El Mound f. k] IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑ seepage Trench C. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ❑ Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ## of Prefab. Fiber- Exper. INFORMATION New xi Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank ❑ Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST ## CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: L Property owners name and mailing address. Provide the legal description where the system is to be installed; II Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for alt septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the f result of over 2 years of steady nego *iation and public debate. The groundwater bill Groundv ..WOI' included the creation of surcharges (fees) for a number of regulated practices which Wiscort in'S can effect groundwater. The surcharoe took effect on July 1, - 1984. All of the water that buried reasum. f� is used in your building is returned t:" the groundwater through your soil absorption systern or the disposal site used by your holding tank pumper. � c The r collected through these circharges are credited to th;, groundwater fjnd adminis- tered by the 'department of Natural R, sources. These funds are used for rnonitorir ;g ground- � water groundwater contamination in,- estigations and establisnmr, it of standards. aroundwate i; s worth protecting. sr3e -says 1n.o�is�l DiLHR SANITARY PERMIT APPLICATION COUN , In accord with ILHR 83.05, Wis. Adm. Code r ' r STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. i —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION ' /4 %4, S T , N, R E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK ❑ VILLAGE: I Q TOWN OF N. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. F Mound f. Z IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4: ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ❑Private ❑Joint ❑Public CAPACITY VI. TANK Site INFORMATION in allons Total # of Prefab. Fiber- Exper. New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank I E l ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: I � I SBD -6398 (formerly Plb -67) (R. 03186) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT, y APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licer)sed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address Provide the legal description where the system is to be installed; 11 Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ili. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV, Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in 91 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; Vill. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8' /s x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers, wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------- - - - - -- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the , .1 77�1 result of over 2 years of steady negotiation and public debate. The groundwater bill Croundvater- included the creation of surcharges (fees) for a number of regulated practices which Wiscor -isi 'S can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried treasure � is used in your building is returned to the groundwater through your soil absorption ; 6 system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund admisnis- teretc by the Department of Natural Fasources. These funds are used for monitoring ground - t water, groundwater contamination in. estigations and establishment of standards. Groundwatr-, it's worth protecting. SBD -6398 (8.03/85) DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY & BUILDINGS 146USTRY, r C DIVISION 2 BOB NDATIONS PERCOLATION TESTS (115) MADISON W 7 (1-163.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: �w /4 '/a TRH /R 1°1E (o ( — -- COUNTY: OWNER'S/ UYER'SNAME: MAILINGADDRESS: t4pp G Zl SCgbr c uv +v C L OF ST; CROUc V LSE `! ST, PNQ L f-I N 5S) 0 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: ❑Residence N k • 6liLL S owr C m p E]New (Replace RATING: S= Site suitable for system U= Site unsuitable for system M ENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: R SYSTEM: ECOMMENDED SYSM:(optional) ou ®s �s ❑u ❑ s au E:] s ®u � 111SuFrr lC l OVT ftV,krq If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: - F indi Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GR UN DWATERtfd0mmI!3 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IS# ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 �'4' 8�•S' ev e +�+c�T@ z,y� o•y'b1z6Y bn sI T ; l•0�8nS1; 1• Si * B 3 6.8 q1.o' )vc�►vE✓ > 6 $' �.o' - 4• z' YBn `FS 1 b' 3r, 1 s k.)/ 6r 4 5.1 q8.�' wec(Lo 3.U' wtidr 1.6' d,�6' << ;Z,S' CIS; 1.5'larn'neJst SI_ B- S S• Z' q0.2' wET cm 2. rywT Z.y ` p.9 ' it �,3'Br 1� 3.o'ZBr, vst s I - 1. L4' q ' > - 1 - 4 1 o. a' B- `7 5.$' oj$, ` ►l w.a'TQ Z-S' O.7' W L TS ' \.W e G4- w /Deus1LZR6nS1 8 6,0' ZDV,b' 11 VnoT 3.0` \. tc ; o•21'Dtz6y$rS) ;3. S' NZ 1 6 ' A S I - -- B q 6I.S q.S' �r 7 q• o•g "8n �s'TS ' °I•D' Yt�n f S N0 6-Q, qS.o' u 7 �.o' o.�,� ►, � s.�' If PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER ROONeS AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PER PER INCH �Ql P_ I 3, 7 ' Z �s t I LV4R 83.09 S d < 3 a P Z • Z' — Z G `'S� t� k4wAv )AJ < ,Z P7)"UT> =s < P- 3 $' Z < 3 9S.5 P P I p_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. $v�"�ONI OF �� �• SUI � S`I -ES( SYSTEM ELEVATION eL. g3 0 � t I �► 1- �� too ._ tTb 6 Ci1� �tf CSF`M E JIV P1 #� 3 IS 93 _ T..._ r i i E ! 2 1 0 = _ S cab i 3 i 3 1 A0 l � �f 4 C � INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6.395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2_ The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systerrr; b. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A MOLDING TANK ONLY IF ALL, OTHER SYS"T"EMS ARE RULED OUT BASED ON SOIL CONDITIONS; ei. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0_ Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10 If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sian the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob Cobble (3 - 10 ") SS - Sandstone gr - Gravel (under 3 ") LS - Limestone s - Sand HGW - High Groundwater cs -- Coarse Sand Perc - Percolation Rate med s - Medium Sand W- Well fs Fine Sand Bldg - Building Is - Loamy Sand >- Greater Than sl - Sandy Loam < . -- Less Than �l - Loarn Bn - Brokvn *siI -- Silt Learn BI Black si - Silt Gy - Gray cl Clay Loam Y Yellooi scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles se - Sandy Clay w/ vvith sic - Silty Clay fff - few, fine, faint X - Clay cc - common, coarse pt - Peat mm - Many, medium r» - Muck d - distinct p - prominent HVVL High water level, Six general soil textures surface waiter for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point i TO THE OWNER: D DUS,r Y ",T OF REPORT ON SOIL BORINGS AND S AFETY &BUILDINGS IN DUSTR, DIVISION LABOR AN ` PERCOLATION TESTS (115 P.O, BOX 7969 FtUMIaN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: ;cwt/ 1 /4 ZTz N/R t°I E — COUNTY: OWNER'S UYER'SNAME: MAI LING ADDR SS: Llpp S• `Z UB EiLT S $ T_ Gl Zl. SCOV1' CoU 1�1 O < L- OF S\ . el`o1X ST. CR V L�E`>' ST PA U L 1-1 tJ SS) 0_7 USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: I PROFI E DESCRIPTIONS: P CATION TESTS: ❑Residence N A • 6LTZL Sc�OI�T" GY't p New IRReplace RATING: S= Site suitable for system U= Site unsuitable for system CO MOUND: IN- GR OUND- PRESSUYSTEM -IN -FILL OLDING TANK: RECOMMENDED tx SYSTEM: (optional) � S ❑u ® RO S ❑U �S ❑U RE: S ❑S � ❑S ®U NV \�'�9 r ZGP BED If Percolation Tests are NOT required DESIGN RATE: w' I If any portion of the tested area is in the under s.H63.09(5)1b), indicate: Floodplain, ' L Floodplain, indicate Floodp elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATERtNG"tS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHltI¢ ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 — 7- 1 4 , an. 8 , e. MOT - Z q 0.y'D1z6Y at1 S( TS; 1•o'TMsI 1• - ) 'LtLof B- Z. q ' t3 r. 1- 1.4' Z s, b e8.6' v 3.0 rr,"TC�Z.S' N - STs; 4.0 is tu1�6�s� �S B- 3 Ea• ®' R 1.o' - 4.Z' YQn-�S'l l i�h 1S w /6h L4 SX wEZ Z 3.6' wN67 3.6' d.6' '� � z.8' b�1s; 1. S `Qn `aeist s ) B- S Z' @ Z.3' 'nm67 (I Z.y' p.q ' If \.3'Br, 1'�'S 3.o'li$n ztgw,5 = S I `7.W 1.� 7 - ) •y' O.8' 't i6• `V' Yn S B - `7 S. 3' X 1$•4' ►► v�AO`T Q Z 131 L TS ' �•4' l�►� L • 3 1'Br G� 15 w /DC LsTz$as! g f>•O' _ 1�b.6' �r �hoT@ 3.0' \.-1' t� o• 'DtzG/$nS) ;3.S 51 B q,$► q.S' li 7 q•�' o•$' �>7 4'S `CS ' °I•D' YI'^ S 10 6.� aS•o' It 7 Io.O' O Qtr 11 ; S.Z' tl B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER IN4944 S AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PER PERIOD3 PER INCH ZLED P -. P P _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 7% ;Z>�-_ -Be-Z) �. S 3uRk1tARA�_ S�ATTRE ��I-Ek SYSTEM ELEVATION g 3 •� _ V. 7 _ _ 1. oo�o of 1`� :a n wo I I ` _ t= v I I 34. - j t i ' - i — z4 � f - I / t Sl � � � I � i mod.._ p � � 1 lie.>c lag �, t 't ',e5 r' f / slab" RZ v 0 sC. 4 , , 12m a tiFL> 2. 1 � I Sv t't�'t'� ( ) i 'u his V4 tG C� i . ! I J r ii T C ST C- 105 [ a * SEPTIC 'LANK MAINTENANCE AGREEMENT f St. Croix Cuunty t1lJ`JI•.is /hUYE v( /� _u}'�'r �'�- -1 - - -- ' - / I < p �S (3 F ire NuIII bur 1:Ut1'f l:/ t;t)7. NUtlLiL:I< / /e X - - - - -- - - -- f I C PROPERTY I.Ut:AT 10N:---- T �a> `�_- ��tc L aon Town of St. Croix County, 3ubdiv is.iun Lot number - -`_• I improper use and maintenance of your Septic , em could result in its prematurc'iailure to haudte wastes. L'ioper maiuteuaace con- I sisC:; of pumping out the septic tank every threw years or sooner, i a l sc ,L ic. tank gum�er. What you put into 1 i i n eeded, b Y ce se -- - - - - -- - -- �1 - -- - -- - - - - -- 1- _ t the System can affect the function of the septic tank as a treat- Mont stage in the waste disposal syst St. Croix County residents qVy be eligible to receive a grant for a maximum of 60% of the cust of replact!mvnL of a fait.ing system, which was in operation prior to July 1, 1078. 5t, Croix County accepted thts program in August of 1980, with the requirement that owners of gil new s agree to keep their systems properly maintained. T he property owner agrees to submit to St. Croix County Zoning a certification turn, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- y) , the septic tic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 .lays pri or to three year expiration. I /WE, the undersigned, have read the above requirements and agree s e w a ge disposal o maintain the private 5 system in accordance with h P the standards set forth, herein, as set by the Wisconsin UeparL- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED - —- - — -- St. C - oix County Zoning 'Off ice P.O. sox 9t tlammo'aid, WI 54015 715-7 1 16-2239 or 715 -425 -8363 Sign, date and return to above address. s r APPLICATION FOR SANITARY PERMIT S If G - 100 This application form as to be completed in full and signed by thc: owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,( "spec house ") , then a second form should be retained and completed when the property is sold and submitted to thi - office with the appropriate dt,ed recorcii.n;. Owner of Property Location of Property Id Section T r J N - R W Township Lac Mailing Address J2 �UX s ^ l Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Q J , Date Parcel was Created Are.all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 2K3 as recorded with the Register of Deeds INCLUDE WIT THIS APPLICATION ONE OF THE FO LLOWING : 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eehti.6y that aee statement6 on thus 6onm ane taue to the best o6 my (ouA) knowledge; that I (we) am (ane) the owneA1a) o6 the pupeA.ty deseA.ibed in .thus in6onmation 6o4m, by vi tu.e o6 a wa4Aanty deed neconded in the 066ice o6 the County Regtisteh b6 Deeds as Document No. • 7 q �c ; and that I (we) paese►ztey own the proposed .6 to 6o,% the sewage d.�sa•2 s ys-tem (on 1 (we) have obtained an easement, to nun with the above desc4i.bed pnopeA.ty, bon the eomtAuc ion o6 said system, and the same had been duP-y neconded in the 066.i.ce �hGE 1 c)F - 7 T x IN- GROUND PRESSURE SYSTEM •' L1. 19 FOR +�6 LOCATE THE )�W ) JyOF THE 1 /Q V.-OF SECTION T Z9 N, R i9 W, TOWN OF o� , sue'. C2o 1x COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 of 7 WORKSHEET PAGE 3 of 7 PLOT PLAN PA GE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 DOSE CHAMBER PAGE 7 of 7 Pte' PERFORMANCE CURVE PREPARED FOR G1RL S CpU1UCIL V �LLS Y 1 400 S . Rv8 E2T ST R.�ET RECEIVED OC T 0 3 1986 PREPARED BY PLUMBING BUREAl i WFGERER, WEBER AND ASSOCIATES BOX 74 421 N. MAIN STREET RIVER FALLS, WISCONSIN 54022 � og5it ' 0100tv Oz eo n ° .,�..�...,,•. s, s S ARTHUR L weoeAEw s �1 pA15 P • EILS ` $ % was. f j °ems '•••. ».....v'' , ,a► �r� D ES I G i sm t I SoB'* 86 - \ S II I 1� 6F pE7e S pti S �'1F�X • 11J F3l.�G . Z FW �!v S j�1J`T1C1�f'c`� VOl.U1�lE - g Z x S O C�i'sl_ = J O O GP D. �-�ORp`S70V�1 1�R� ca' ZZ �a,�QS�tzpl �4tz.� �•,� O'D ,4l' S EP`r1 tvk- : 1 �/�1 L`1 V l�� v C r� r� v �-�v 2�l Ta b Pv ► -ti C, t� i�Y�l �3 3 00 CARL . W t �� �R Gv� e12�T� I�R o'CTS 1. rnA -, b Les j\.o I NC, C 0-XY-r \`1(3 6G A2u U) DEA L R '(✓1 . S ez:i P PcGE�-- O F 7 R pUr� p �� ►�'D 1'c L t�Cz.t�'1 � ��',P. . RECEIVED n c T 01 1986 PLUMBING BUREAl l k PLOT of Scale s � Ooes fwt i tlode plans tot the Rener31 _ ♦ NoRIN Iwtt t " r 61er P iping to ?hc septiclh pl ans ng ro ,lh�t uvrnotiree for t{wedrtGetore`constwdion on this P iiust be cub'ms UAW. UAW. aPP � 0 I PL1gt.5 r I ..� .0118 x �EL 95.7 ' z4 ° teak. Q: 1 f /1/ 3 r f it 40oF4 cr 1 1 I dar 2 a ! II 1 . / A ce G . PvC E�8$.o �a`�88 S O � � � � ABANDONEQ $N►flltRPZ� / f / / ,4►� F��tEU. an 3 01 A COj uo "" s so I p }tUNtAN 10NS 11607 } OA P'% GS a LAA �:, 1NDU YY AN aE•E � RECEIVED - OCT 0 3 1986 PLUMBING BUREAU v N OTES 1. Elevations shown are existing ground elevations bos sid e s e of each tan 2. Install cast iron pipe 3' onto undisturbed soil bo 6 required) 3,. Install, p markers at end of each lateral. re aired) 4. Install '4 observation pipe with approved cap. q 5. Septic tank to be - ZSob gallon capacity as,manufactured by w 1 E.SER C�y.►CF��E p�u�wT S 6. Bench Mark- Elevation Bt I ' E�- 1 °° � �'� \'� 3r� woos STtt }�E E SSj C C AjCX— L of I ---1 c GTZq� YIAX. � So1L E=1LL -� ApjP9j:�,\3EO Sy &YM4 = c- CoUER F�A�'�T -a f'1�- oR, q� °F oR 1 /Z, 70 z z P.0 -.cam Coed � _ EIVED OCT 0 3 1 �,...CF SAr ANO s 986 s et on ONOENC� _ PLUMBING BUREAI �� Lr� G - o— — — Z 1JE3.1T NARICE,R 6 O . 2� PvC F HR�N ,� Fc�n wnp CHAt'IStR x Page — U T _ Perforoted Pipe Detoll 0 L7 602r End View Perforoted End Cop \e PVC Pipe _ `la��s ac re Holes Located On Bottom, S Are Equally Spaced s RECEIVED (�E iZYt ANE1.lT PVC Force Main (' T U 1986 M AF2K�LS From Pump 'LUMBING BUREAI f / Q PVC Manifold Pipe \\"— Alternate Position of Distr ution / Force Main From Pump P e Lost Hole Should Be Next To End Cap End Cop Distribution Pipe Layout P \Y\ C S 7Z X so Nf\ 6 � p f ?�dfi'( Y �0 1*V\ EP A[, , Hole Diameter 1 /5' Inch r) • ""Er HI1 Tr, - n 1 Inch(es) -, Lateral 1 ON OF SAFETYq,V 1 11V " RELATtnr Manifold Z Inches QUILDINGS °o ry ` e " Force Main Z. Inches SEA {;p E.SP(jND�NCE v z n s � �T 2EV t'�T ST �{U l,� t-� I �C'J.IM �'► x=11 -� 1 LLD W S,3 P.eF G ��. �0 I � � PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS pe, -E of '7 VENT CAP 4 "C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTIO" BOX MANHOLE COVER 25 FROM DOOR, 12 "MITI. °t � WINDOW OR FRESH INTAKE GRADI 'i" MIIJ. L -0-:v. 8 8 I Lam. I I B" MI IJ. COIJDUIT 18 ° JOIN. PROVIDE IKILET ZFV. g3•S AIRTIGHT SEAL I I I I I I I I i s`t APPROVED .700 APPROVED JOINT A I II WI C: =. PIPE W/C.I. PIPE PLUM � ;�� pp I I I ALA M EXTEt`IDIAIG 3 °f l j'LQ� OWTO SOLID Sc EXTENDING 3' '. I II. pIJTO SOLID SOIL B 0j�. v I I Q 7 ow el j ,• ��p HUMAN RELATIONS .ZS - ABCR AN E LEV. FT. p p � NIEN Or ID ,�� L 14tSI D OF SAFETY AN PUMP -=� � OFF RECEIVED ,r o 3198f pEBPONDEPdCE �.� L � COAICRETE BLOCK �`�'• 'L MBING BUR RISER EXIT PERMITTED ONLsS IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOAlS DOSE DIES(. Cd p r -\Im b aWC fS HUMBER OF DOSES: :) PER DA, TAWKS MA NUFACTURER: L� �L v,3 e TANK SIZE: 3 00 GALLOUS DOSE VOLUME 4 4 7 ) , ) GA1_Lo S • INCLUDIMC, BACKFI -OW: )4 LARM MANUFACTURER: MODEL LIUMBER: 1�1 `A IA) CAPACITIES: A= z ' INCHES OR \\a GALLOi 13= 2 IIJCHES OR GALLO' 5WITGH TYPE: GALLO r= —bimr-HESOR PUMP MAN UFACTURER: W1�R S = \S — GALLO M p INCHES OR MODEL NUMBER: SWITCH TYPE: INSTALLED Z� - MOTE: PUMP AND ALARM ARE TO BE �� , INSTALLED ON SEPARATE CIRCUITS MImIMUM DISCHARGE RATE GPM VERTICAL DIFFERENCE BETWEEU PUMP OFF ARID DISTRIBUTION PIPE•• FEET + MIUIMUM NETWORK SUPPLY PRESSURE � . .. .. 2.5 FEET �–) FEET OF FORCE MAIN X 1-B9 F /ooFZF RIC'TlOU FACTOR. FEET TOTAL DyIUAMIC HEAD = --- Z—Z-S FEET S� _ q • �l AY► E�'R . IAITERAIAL DIMENSIONS OF TAIJK: LENGTH ;Wit) $$ . -LIQUID DEPTH I � PIS PER w1ANVFAC'1vR�"�, k 22) cJ8•��/ �Rt.�1h• $oTTo r-1 '" 510 3 CONSTRUCTION FEATURES POWER CORD -10 ft. or 20 ft. long, has grounding type plug, to plug directly ` into 115 or 230 volt receptacle for 1 manual operation or into series switch CORD SEAL BUSHING C ord plug for automatic operation. For - 3 phase, cord is supplied without plug, for connecting directly into control box. n t: CORD SEAL BUSHING —Cord is potted ! - CAPACITOR HOUSING into high strength plastic bushing with _ Polyurethane resin for leak proof seal. ,. 8EQEIVEE _ This eliminates possibility of grounds, due to hot lines touching housing, as t 3 19 plastic bushing acts as an insulator. CAPACITOR HOUSING —For single f j phase motors start Capacitors are in ,a MOTOR 4J g RE stalled in separate cast iron housing that bolts to motor housing. Capacitors can PUMP SHAFT be replaced without dismantling motor. '' -x=;, u MOTOR HOUSING —Heavy cast iron epoxy coated. Motor stator is pressed MOTOR " into housing for perfect alignment and `; r best heat transfer. }' MOTOR— Single phase motors are of MECHANIC 41 the permanent split capacitor type with SEAL = - FASTENERS no starting switches or relays. Have built in overload protectors. Motors are oil filled for bearing and seal lubrication MOTOR' - and for heat transfer. Three phase BOTTOM PLATE motors have 3 leg overload protection _ in the control box. IMPELLER PUMP SHAFT -303 stainless steel, heat i = shrunk into rotor for permanent drive Shaft is threaded to receive impeller. - MECHANICAL SEAL —Rotary shaft seal has carbon and ceramic faces for VOLUTE CASE positive seal. All metal parts of seal are t 303 stainless' steel. IMPELLER— Special "Tornado „ type. No + S - close clearance to cause clogging or binding. Cast iron epoxy coated. VOLUTE CASE —Cast iron coated inside PERFORMANCE CURVE and out with baked on epoxy paint. Has CAPACITY -LITERS PER MINUTE full 2 inch open passage for solids. 400 500 600 700 Support legs provide proper clearance o ioo 200 300 for solids to enter pump. Provided with 2 inch or 3 inch discharge flange. sa �= x 4, `:_ 10 MOTOR BOTTOM PLATE —Cast iron 32 4 epox coated, mounts to motor to make - r key• �-� `' ' , P Y t s a complete motor assembly that bolts to 30 $ at. vRi i. x. +.la •^. 28 �O r �► p y i Q pump volute case. ,-► ,Y 8 W Complete assembly, including impeller, W 2s iy >� Ari 4 ' }' can be lifted from pump case. z 24 7 _ bearing is sleeve r. BEARINGS—Upper 9 n 22 type with thrust washer to take up w Rs ' s x20. �yo9 ° y .�Fq . � _ ; , _ f►.- � thrust. Lower bearing is ball type for S radial and thrust loads. Bearings are is °;' FA "� ^` 5 lubricated with oil in motor. ° is `', M FR - - Y FASTENERS —All screws and bolts are is - u a 18-8 stainless steel. Easily removed after years of exposure to sewage water. 12 9 - INTERCHANGEABILITY — All castings, 10 ' except impellers, are the same for e �fi - 3 /a - 1 HP pumps and for single or s _. _'- =- w • '” 2 three phase. 0 20 ao 00 so s0 X t i20 140 160 Is0 200 CAPACITY -GPM Reduces inventory for repair parts. �. E. NtLi S �o C�A6E ) 3F y 4� aJ �� SC-CYVT 4 7 9 - n - 1x4y,�_A NW � OF T}t IJ� ) Jy OF S � 77 o>J F3 , T 2-9 Q, R �9 w, �- ° w►� or= 1•�-v�SO�, ST• c-Rv�x C.�v,,��, W) S�>,,SJ/J 1►JOI =X P R 6 1 c 1 o f t-•{ PR Z of y C. A\ C-Q N n Q�G L 3 OF e Ll OF QR, LzE'U �o�-- -- \RL CrJk3�e.► OF liZvBEZT ST. ST• �AU�- �'1 SSJ IPRETPN 2� $ L f tivEG Ems, we-a�EFR 1-rKjo P\SSbc S y Z 1 ►.v . " f� , r, S r. S v u" 2 f�'i' p R e yyp� mq� ARTHUR 4 ` WEG_REp o cv 6915 F VD 61LS190RTH, Q r O� WtS. $ •S o •' N 01 � FZI�• W��� -£9c. 860 88 8 6 �aB V- 1 S`7 SIZITSG /�S ��? tLl1�2 8Z•3y C S� C b� 2, b - 1 C Z x P_ C Zx3 C = 3�0 - - TtkE EX 1S`nlQG seP - `i'PC�tL oF_1S6o GG;� LWi C-Wlj:-KC- tom{ W) L l- Z3S MZi I F1 S -fiZ! CK-) L-V k, I N -V'�j E t� Cil�►1 R� TS OF G�� 11UT�C�l�(2 5 >gS SeF PhGE y OF 4(- I s 77dv G Tick is Fo U AvD To SE 11J S%-3CI4 A cj3jkjb)T)O •l IT GA tJCS 3� lL) uD 1 F1 Gb - To - Tz-e f-1 o V e: `TN -- - - Lvt�S�12 ��`�. n1ZC�l�v STS- �Rt cf�S'1 C�1L�tr� ,4npR�vgL �c�. qo -o�- o�oS_I�— 8608886 Scale 1'r =SO, E���T As S l+cw� 3 /S1i15 SNEC"T \S ph GE 30E-1 pF 4c PP i� c�u�la PL PsN 3t 8607X151 - S CZEU 1S - TO S tt VW GRE�S� PLUMBING i ivdR� This approval does not include plans ter the private sewage system that is required for this Poled. Those plans must be submitted and approved before construction em of the project is started. APP DEPART OF IND TR LABOR AND H MAN RELATIONS MVi N FETY AND B INGS r � , SEE CORRESP DENCE 1 I 1 ' ( EL 95.7 81 J-1 'o 1 , i g c =zU o/41� Q G. r 1 et (96 v C E�88A y, o air O V w Q EL�gg3' I ' EacISVuG bv.4WeL I / 1v BE A9+ua�o�a WFLL / / A►ap �«L'EO, , �icrsru� Nsoo GAL. course • i2' x / ,' ssp•nc - mA4k - m 8E honrFrez� AS A CE4`Mp FOR hc�1 c Ei EN Q^ / / / / / sEE Fia6 E �l O �� C `5 A � P �\ 86088 A t t_E I • : V� N OTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install cast iron pipe 3 onto undisturbed soil both sides of - tanki 3. Install. permanent markers at end of each lateral. ( 6 required) 4. Install4" observation pipe with approved cap. ( required) 5. Septic tank to be - ZSoe gallon capacity as manufactured by ` 6. Bench Mark- Elevati on Brl I �� �� o' ou "x 3" woot� ST'h Ir gh412 - r 99,6' %% IC . 0 Brl 44 "a E L . Ba J co>J Coti, c•T-E- PPc'D l.�EUT PO v 0888098 Sh _ Z+�- 4\ac�►tr' S � tit Z\3L�! �-d,_ mc�aaddV �o S.�'►���+8 zlo S.L.- l,Tla4LlPtbS Ott C`1�da `c�yvtli �Sl1'� "1'1�5c't► C41 �z S gc7c�od� !; .lgvu - a\tf Z r "1'1'd -L5 tUJM 1a -ZNie[ 'Eit0�,hZ 1'L�d -�Srll i �--- Sq4EI-d ti'o\{AcA - -1- - 1 1 � h_ - Ylhl15N 1 Z8 � LLci�S �.;- �'Z1'� rt �7� ' - t H9 O a 5 � � N�.i.S \ x';•t STATE OF WISCONSIN- DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township Z(TK %X NW k NE k 13 IT 29 N/R 19 E(or)W Hudson St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Girl Scout Council of St. Croix Valley 400 S. Roberts St., St. Paul, MN 55107 I (We), the undersigned, hereby make application for an alternative system on the above - described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to i arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have-been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR -SBD -6413 N. 05/81) My Commission. "--vires: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NW 1/4, NE 1/4, Sec. 13 , T 29 N, R 19 fcxu dt W Town dWM0ffikMp5Nc Hudson Street Address Lot No. , Block , Subdivision Landowner's Name: Girl Scout Council of St. Croix Valley The application for this site is for: ❑ new construction use. H replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: �.1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numTers issued to of ) ]one of the applications needing a quota number. The quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (....for an application on file prior to February 1, 1980. (_.]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Q a failing conventional soil absorption system. a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here.0 I certify that the above information is true and accurate to the best of my knowledge. e7� Name Thomas C. Nelson S1 re County Official Title Assistant Zoning Administrator Date September 92 1986 DILHR -SBD -6158 (R 12/82) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPECTION REPORT Sanitary P it N (ATTACH TO PERMIT) 19 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: St. Croix Girl Scout Council I Hudson Township 020 -1016- -000 CST BM Elev: Insp. BM Elev: BM Description: 100. St I I cyo•ro % - ASPAV kAd =. c LT i�PA 13 q .ta•�`{ �Vj TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS 0 FS ELEV. Septic �y� Benchmark 144 Dosing Alt. BM 2.Z Aeration Bldg. Sewer / S Ht Inlet, V � / 1 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic } ( r 48 ' DtBottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer De St Cover Z r Z t, Model Number TDH Lift Friction Loss System Head I T DH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR YP Y UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 Fal Yes f No I (] Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: CA- 3 /1 Inspection #2: Location: Hudson, WI 54016 (NW 1/4 NE 114 13 T29N R19W) NA Lot Parcel No: 13.29.19.74 1.) Alt BM Description = C�M W •� .- t 2.) Bldg sewer length = %) G „�, - amount of cover Plan revision Required? U Yes No Use other side for additional information. �1 _ Date Insepctor's Signature C . No. SBD -6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN ' In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road t. Hudson. WI 54016 -7710 (715)3864680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. anitary Permit # ❑ Check if revision to previous application F�! ) 0 I. Application Information - Please Print all Information Location: Property Owner Name 1/4 _ 14, Sec ' e G_ T 2 N, R 1 E (or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number rStat e-owne 7 - BIZ ng: (check one) amity ❑Village Town of ily Dwelling - No. of Bedrooms: mercial (describe use): T'lloioA ^�_ d "`�"7�� Nearest Road 11. Type of Permit: (Check only one box on line A. Check box online B if applicable) Parcel Tax Number(s)) / A) 1. f� Repair 2. ❑ Reconnection 3. ❑Non-plumbing 4. E] Rejuvenation 0 2 D -!0 /L o - 00 0 Sanitation Permit Number Date Issued State Sanitary Permit was previously issued r6O79,s/ G IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ❑ Mound ❑Sand Filter ❑ Constructed Wetland 0 Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑Drip Liner ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade a Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation 1 7 /Vzz Ssrc /�J`rAc/f� sm f, 6 I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks E . _ ( g .8 ❑ ❑ ❑ ❑ II. Responsibility Statement d /S O 44 coH I, the undersigned, assume responsibility for repair / reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non -plu ing sanitation system. Plumber's Name (print) Plumber's Signature (no st s): 'khWMPRS No. Business Phone Number nA Plumber's Address (Street, City, St Ate, Zip Code) f'f ' o S' III. County Use Only Disapproved Sanitary Permit Fee Date Issued Issui Agent Signature (No stamps) Approved Owner Given Initial Adverse Determination l 2 �' a kA IX. Conditions of Approval/Reasons for Disapproval: l 1 ftm't'j I /cST— �S Ga,C N,C� 70 �,e��i9�,� E wE/t G,tWC &4.r"'F -%.t/ y,[omp !� . Jj IV.A 0o f 1�AW y L 1�1.�,VW 61W S 7,_XC > Nk l 7a r,�, �a f/ ^ tis� sr /!� srH TO Aff .�'/>► n . 8� 7 -17 -0/ Wisconsin Department of Commerce SOIL EVAL1N R€�'nRt ;� Page __� of 3 Division of Safety and Buildings -� in accordance with Comm 85 is ' Ct ,m County Attach complete site plan on paper not less than 8 1/2 x 11 inches in si a: plan rn include, but not limited to: vertical and horizontal reference point (BM), ton an ID. , percent slope, scale or dimensions, north arrow, and location and dist nearest r. Please print all information. ' " "' \\ c,� i Date Personal information you provide may be used for secondary purposes (Privacy La1N,4% 04 (1) (m)). U ' Property Owner 1�r a Loca y S' C Ot L Go t r 4� I/4 S T N R l E (or?g s Property Owner's Mailing Address Lot # ubd. Name or CSM# T T, `� S City State Zip Code Phone Number ❑City ❑Village Town Nearest Road ( / ) Zjj —CAA ❑ New Construction Use: ❑ Residential / Number of bedrooms .. _________ Code derived design flow rate GPD [I Replacement � Public or commercial - Describe: • Parent material �GL2`�(/��{ __-- �____ -- ____ Flood Plain elevation if applicable _ 4& ft General comments '.� �1r EG£d�l`tOa .V©- SrT #f 44CA � /yW f/�r 1?'V and recommendations: `l ❑ Boring # Boring Pit Ground surface elev. _�O_Z .y ft• Depth to limiting factor >l /� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 6: — , 1 3 7 Boring # Boring � tt. Depth to limiting factor > �� in. Pit Ground surface elev. _ ,(�j__ Soil ifatitxt Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 Eff #2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 7 A 1 _r 17- _ S F I G Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS 30 mglL CST Number Cs��� tyl� M & Perk Testing v ' Address C enZle Date Evaluation Conducted Telephone Number Spooner, WI 54801 f Property Owner � Parcel ID # Q —lam oAG Page - ; — L of Z Boring # a Boring [� pit Ground surface elev.1Qf� j _ . Depth to limiting factor > LZ _ in. 53� ff Soil Applicaltion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2- - 30� L — 2 -3 0- 7 S- E 6 6 •7 y _ = �z I— E] Boring Boring # ff, Depth to limiting factor _z? in _ . Pit Ground surface elev. _LO�Q Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#GPDIffEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. .7 I, 2 v -7z G z S S ❑ ❑ Boring # Boring Ground surface elev. � 7 in. Pit _� _ ft. Depth to limiting factor M.Eff#1 on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 Z 7. 7— S s 9 Slf? S / Z- a rt/ uJ otC E Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 3%) mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 6 =3131 or TTY 608 -264 -8777. _ i M -8330 (RAM) r ; 1 y r /3' x = L MA /_ X po � oQ � �,�_ Glzmu�vD p�� NaT 'Afre#4 7b fi�ftGt�t/� � Fogerty PlumbMg #221180 28288 McKenzie Rd. Spooner, W154801 -'� --� ,wrtr/�lf ' l�X1E� E6cd. (715) 635 -9609 , �-..� ,too cm �x lm w �tJ .too wofiav�✓V � L�6F'� ,00 Loci' ,[ld cull -Rusw �ci Sc�LE YO' FX VZ PO 4--- 4) G LE/¢JC i -w-r., ", IV Bf / 1116 � 10 NO CF-sr= TU xdtDE7VCt X c• / OD.f i 11 4eek *eaV sglF ?A "eTzvti �v tuoyt, V� EL� /3 GO B, - CA O w .ONr, /11117 of f y .s r�m �t/rJ Lof L,rn1� u�rr-t��✓ 3� p r