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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579030 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Z -15, Sy 5-0 Permit Holders Name: City Village X Township Parcel Tax No: Neumann, John Pleasant Valley, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: (rv---, f3 20.28.17. TANK INFORMATION ELEVATION DATA (o. Z 1 / Ob. 21 /OC5 TYPE MANUFACTURER o SS CAPACITY STATION BS HI FS ELEV. 7. SSL 67.8 db Septic I , 1 5 Benchmark /Q~ W 1 e. 5 e- 7. 7 W - Dosing w 2 v-- ~J 756 Alt. BM ✓ r! c~ZA- ld / 3!7 )fion Bldg. Sewer 8 I Holding St/Ht Inlet g Z4 9 7 5~ X7`7 ~ TANK SETBACK INFORMATION St/Ht Outlet 7 7 TANK TO WELL BLDG. Vent t Air Intake ROAD Dt Inlet G1~ 8:93 9 7 Z9 Septic I Dt Bottom 1 4 `~/3 S lo > /cb / z Dosing / 72. /M' qZ 45 Header/Man. 7-:53 1d0 • zq ~j Aeration Dist. Pipe -7.5 /1J17. Holding Bot. System $ . 116 PUMP/SIPHON INFORMATION Final Grade S 16 7 Z/ „ Manufacturer Demand St Coyer ~1 g~ 3S f~ a1 T yv~~tP~ GPM C Model Number 35 / w6a 0 C77, A TDH Lift Friction Loss System Head TDH I . ~5 / , 6 3 3.2-5 /6.1 Forcemain 1 Length , Dia. , / Dist. to Well Ild z / a SOIL ABSORPTION SYSTEM No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width / Length " i DIMENSIONS G 75 Q e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O System: 24 $ { 7 /_!i UNIT Model Number: DISTRIBUTION SYSTEM nit- Header/Manifold Distribution 2. 1/ / Ix Hole Size p Ix Hole Spacing Vent ~q A71nta 01 Pipe(s) 3 3 ! /r j Length 3 Dia Z Length !3 W Dia `5 Spacing / Y w SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only %--jVXej-" Depth Over Depth Over xx Depth of d/Sodded xx Mulched I B ed/Trench Edges Topsoil xx Seede C ®No es No BedfTrench Center j >Syn / S COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 'g /L_Y_/✓~ Inspection #2: 'W/ 1-7/ / 717- '~X• ~ ✓ 11D Location: 204 162nd Str t Hammond, WI 54015 (SW 1/4 SW 1/4 20 T28N R17 ) NA Lot'I~ttil rcel No: 20.28 Ca J.e'- Geµs~'0r►~. b/AGJ 1.) Alt BM Description = , \ I 2.) Bldg sewer length= /Z S4~ ~~L~+✓ D~ Lj ( -amount of cover = o~QQ/ ' 7 ~{Z a nn dfK~- ~J/I G Cy J 6. S Pe-C.- r Plan revision Required? Yes No S( L Use other side for additional information. - 7] Dp~te Insepctor's Cert. No. SBD-6710 (R.3/97) r`1 Ate/ 11 1 ~Witlft ow $I A VW Oft County S7' Safety and Buildings Division p S " N I r iry q 5 201 W- Washington Ave., P.O. Box 7162 Sanitary Permit Number (to filled in by Co.) p, U I , Madison, WI 07 16 rt"NT 'O animry Permit Application S~/Transa°t,°~n^N"mber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Y is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different ~ ailing mess) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ,L. 70 purposes in accordance with the Privacy Law, s. 15.04 1)(m), Stats. ~t/T~ 4 n , 54 1. Application Information Please Print All InformaAbs, Property Owner's Name G,V.. / Parcel # e ! A -10i, Al F LL M iPIBC14 0Ay-1d.2 8-c10 -00 Property Owner's Mailing Address Property Location 4,~ -b ~L ,7 ~ ~p~ f 4 a A w S r Govt. Lot City, State Zip Code Phone Number ~j i,3 Section J- 6 14AMM0/D W J SW O 1 7K "746 o7-'] 13 8 (circle one T ~ R 17 E o>~V E Type of Building (check all that apply) Lot # N; ® 1 or 2 Family Dwelling - Number of Bedroo- C,3- ms Subdivision Name 6k ~ Block # El Public/Commercial - Describe Use ❑ City of 115 J- . Q ❑ State Owned-Describe Use 4>r! CSM Number ❑ Village of / ~I1 ® Town of P4 CASANr VAI.Le V X ?S a.. l~a t 13q III. Type of Permit: (Check only one boa on line A. Complete line B if applicabl Ad- A. M New System El Replacement S System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued Y B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 6 J ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade il Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalfTreat ent Area Information: Design Flow ,)J Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Propose f) System Elevation /4/ -0 1 1+ / / A-S 9 - . (o VI. Tank Info Capacity in Total # of Mamikctuier Gallons Gallons Units ' U-+4--1P- _ 2 U New Tanks Existing Tanks / Off` o i W ~ 'SZ a U rn ~ ~ w V c. Septic or Holding Tank /0,00 O /600 t Dosing Chamber 7 So O .7 V 7 a VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number t- A-Lr eEA N r c N vzlx E o~ A 3-> z 10 ?r s~'7 y 3 Plumber's Address J (Street, City, State, Zip Code) 6-7 d 5 w SAY 0 ;2 kAp une artment Use Onl proved El Disapproved Permit Fee e ed Issuing ent Signature en Reason for Denial" / / IX. Condi Weasons for Disapproval 3 rte V 4.Septic tank, e1'flus0 MW W(I lA I dispersal cell must all be urylces / mitir_tai~ ; t..J/ T 0 IN. CA?C~ as per management plan provided by plumb$r. 4. s tc requiter 9nt* Must ate jrt intai d. as pel`app mble codi l adiftn , Attach to complete plans for the system and submit to the County only on paper not less than 8 L2 z 11 inches in size SBD-6398 (8 11/11) The area 15 ft, below the downslope edge of the Soil Absorption System must remain undisturbed. pL D7 ?LA T ~/Nc-- 5~~} Ic ; / = 36 0 Z: 944k-#06- 13M #2 SET Y~ PVC h 9Cu.3~ ~o ~ CbN ~3 1~I 17, 9o Gon,fn~~ C~ 40L 32 woc),EA) 15725EG. r-,pyf&D a o 3s`°~ a P Rh h- r kTTL15 , I s&T F o f/ S~acKA-p~ T° p ~ p ~ ~ 7 sO 0 60Pvc Pi p.e. o 10 w IE 5ER /ooo 0 ScPTI c ~wk S E w Ejz„ 9~ , 5D cora--ook ---x 5 ti L'1 0 PROP05E r~ 3 I-t0ME5~M* B 3 = t~, , ~ C OPUt/v yo A y s0vf4- PRO, ~av ce, tc~q r- 6f UV otiPTj1vT DIVISION OF INDUSTRY SERVICES °N 3824 N CREEKSIDE LA y° ® HOLMEN WI 54636 3 S -3~ Contact Through Relay Ps http://dsps.wi.gov/programs/industry-services www.wisconsin.gov slol~i Scott Walker, Governor Dave Ross, Secretary June 01, 2015 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/01/2017 SITE: John Neumann Identification Numbers John 1 ND St Transaction ID No. 2545450 Town of Pleasant Valley Site ID No. 812775 St Croix County Please refer to both identification numbers, SW1/4, SW1/4, S20, T28N, R17W above, in all correspondence with the agency. FOR: Description: Three Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1536377 Maintenance required; 450 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the CONDIT4 requirements of Sec. 145.19, Wis. Stats. APPR • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with DEPT OF S the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. PROFESSION • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank of IND% explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be providaWSON per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation o EE CORK soil compaction is prohibited in this area. • A cony 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 ROBERT W ULBRICHT Page 2 6/1/2015 Y Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 erard M irn POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am 4:00 pm WiSMART code: 7633 jeny.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ULBRICHT & ASSOCIATES CO. 7i5. 77,? • 4qq Z 281210th Ave. • Spring valley, Wl 54767 Reg. Designers of Engineering Systems Private Sewage ConsuRants r 6 MAY 1.1 2015 PROJECT INDEX ':'~,IaSTRY SERUK-'Plan I . D . # ~~7 -75 Date MA/ 7-;2 0 /-5' Owner JoH N NE2t M~A/N - Phone 715. 7 F!( Address ZZZ 1(92 ""4 ST. I AW-f OMD Descri ption~_.__... ~ ~ I 5015- Legal Le w 1{6 A"e r-ARM 5 / Tom' . Sw XV S10 y~ 56c . z Z) .T• z R pIM oaf I oz8 • yo • ooo ' Town of PIEASAASr VAMEY County ST cRo( K C.S.T. R .7AL6R ilk T 2--1637 5 Installer wih4T~/Z Local Authority/ uoervision 5-t•. Gi20I~C C4 ZONjA3G..- PRMECT DESCRIPTION Naw C0M s°T1Z0cT1 o,3. FOR A 3 Bevp-00M t4 oMe- IDES i 5 N I)R I L y WASTE FIo k3 t s ysn TESTED S iTE i S So it'AQIE" Fa k A GONV eFA3+(O JAL MouNp SySTE-M N ZtSi~~ RPPROU* SAND fill . VERY R15COMMEWEI? - lAj SfprlJER. 5 h0'11L0 A,+ Gv 1&5~R 66?AjC,9E7v,1 joker, -5T co pROVI'P6. A-r rAc,-roRy, 6'XTarRioR M~NHo jai tvM !N 005 TAR GOATIm oN (3&-K 714m kS , AND All Ri Sep- [Zi~Gx S , 5/ 7r h f s es .48t,i 544 Gu.+ !y !~!!N!lfUflilltflfJlrll~ ` . Ns % ROBERT W. ULBRICHT S~ CAS, . NUM N. Wl S C~.s I G13~', . FyC" Pg.l PLOT PLAN VIEWS Pg.2 SYS'T'EM CROSS SECTIONS & SYS EM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDESHOWS DETAILS OF LATERAL CLEAN OUTS). Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. P9.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems it (Version 2.0 SBD-10691-P(N.01/01) and "Pressure Distribution Component manual. For Private Onsite Wastewater Treatment Systems" (version2.0) SBD-10706-P(NOl/01). t The area 15 ft, below the downslope edge of the Soil Absorption System must remain undisturbed. P~ DT ?LA N ~ff 5 T z%Nr 5C~}IG ; 36 soy L /~:T s FIa yg ED, rI of L, co,°+n°R. I IAJES /V RUC j~t H 9Ca.3t~ ~ ~ 0 Cbv 133 11 .3 ~5• - 35--. a. q7, 90 coiv4our~_ o 32 a„ ° 35' of Wc~VPEA) 15725ez- F-p ~ a ° PUc R hi L. c q-TTL i5 ~M 5. T cZ c C t 7p p or ~~7- ~ W iES 7 50 BUG i ,e ° P/C 6N C105 Re Q p ° W i E:5E R / 000 10' 1 PTIc r auk o 13 L D C~ ' _ 101.50' M 5 E w E S0 y L1 CoN+pu ~c Y 5 ~ T F- OL JAW ~W a ~,RopoSE n 3 ~E/~kr'1 ~ (r I-F0 M E 73 = 17, q0 Exi yTiNG-- Aiel ve- 5Z=97,6 13 3 = q6,v HQ ,~r e ~ 50vf4,.. PRO, 1,AJA. J ~ ~Ov ce, ` O l~ ~vw ar M©uD wi Tti T3eD f Dt STRif3uT+nN 2.t Agg+erSATE' rkickjG'S3 P,pr~c- . °F T°P so i EL, w~ TE~i4l~G/.fL S Ys rE~NA EVA r;0&3 Uu i F©R M T'o ~ ,u N J i ~i9•~S r- Nowa PlowRa -rcpSor,_. fl/ Illy f//~~% Oda 5 q SlopE FoRce. uu~ FoRM M,M N 1 l;vA-noa Um M-R 7 70, X> 05 Fr. 2-05 lmvF-Rr o F GI JATGRA•IS 160-15' F gZ F T • q •8 • TOP of Rock f • S F--r- i H [o F q- T E R A S 00 f LA N V►Ew o F M©u jD w• rte BED G cN rRAL a, " FURciz MAW A (p FT-35'L - . I 13 75 Fr 13 T yy _ t D w Fr w F r w 341 3 t3ED or- To I Agg 1zE-6-ATE- oC3SE R VAT1 OX) Pipes /pcrtT%a.~s : +o IC) FRo x4 ENp/ a PSRMti,vE,uT MARL-ERs ~7~j~S G/e,'A.t3 Oc7% S wLC ~ 1 REG?uiRED BASAL„ AQe = `DAi~y whsrFFJow 1150 soft- w-farRA-nue C APAC ry sa. F r. PROPOSED BAS,M AReN = ~ X (A t z) a'0 t R. T. PIC Observation pipe Distribution cell - Fill material Cover material (ASTM C33; fin ayregatet Tilled area <--Slope Force main Figure 6. Cross-section of a Mound System Watertight cap . Top of 4" min. dia. lead hing _ Repair couplings h' 9 chambe Slot 6" min. min. 4 in.. Infiltrative surface Water Closet Collar Bar(3B" mi dia.) Figure 8 - Observation Pipes ~M i~7 3 Its _ 9, 41 C ff f1'~ /f / S7"-oel c 6 Vii'!/ vtsTRICWT(OP 'Ptpc LAXOuT Pg. 3 of G CENTRAL. FORGE MAtu P Isr ( 5T Note = I 17.28 V ToTAL V0t_-F'\101UME OF NETWORK R 2 y NI- 35 X = 34-. ,N~tics TOTAL VdtD VOWIAC o F FORCE MAN 5.7 5 Ads . INVERT El.EVNADD. !s ~'IQ of LATERAJ5 3 , Hole PjAc►H E TE R i N G(~► S CAR HEFull 'RemovL- Ott( l..PtT~ E t~R.itltp RfICE "BORR RIB L S i, INGl7Lc5 Ma* % Po L- p * K01aS 10CATED o1J 2 FORGE MA1jJ iNckk s 1301TOMI eVWLy 2-- 5PAcr-D. t WE 5 PER 1 ATI=RAL 'DiSTRtt3OTioN cell ARZq PE'oR.F SCE P-e\)ER5E 510E FOR 'T'ERMINAvL % DP-TAIL ~ Y,( PEtZ OT(S FoR r Ho1e5, ICI SCG AkRe RATE To BE / . (P /(P INNS peR MINUTE PER t4o(E . b1STP-l bo-r low Pi 5 ch AR E RiVre FOR EAc k IATER I g. 5g TnT i sTRi 3~TIoN PISCk/~tige RATE (=oR N 32- 3 A(S M ihj a.5' M i N i `SETA t l_ o F ID ~iPS ova- 1l- i "Platy 13oX /-RUC 4- 13411 M A PUMP CHAMBER CR055 SECTION] WD SPECIFICATICIMS f),17 VENT CAP I t VENT PIPE WEATHER. PROOF APPROVED LOCKING JUMCTIOAI BOX MAIJHOLE COVER ~ ~ T✓E+Af GRADE y~ 'a I 4" MIA]. IT tDu ~t t IN LE } PROVIDE ► '.:_v- `7-------- - AIRTIGHT SEAL I I I I I I APPROVED JOiAJT A ,Ny { I i I APPROVED JOItJTS 1J~ PIPE /IAN {'I) { ► W/ PIPE 11 CXTENDIAIG 3' iJd A- i( '~•O" I I { I ALARM EXTF-K1DIMG 3' ONTO SOLID SOIL ~D { 1 I ONTO SOLID SOIL q1•~ 37 t3~• ON qa a ELEV. T. ; i i __J PUMP OFF~C 3 A BLOCK S/¢1V1~ G f l i~ 1 c'~ RJ~11L~ RISER EXIT PERM11TED [3QI_9 IF TANK MAIUUFACTURER HAS SUCH APPROVAL. SEPTIC F SPECIFICATIQtJS DOSE jjV f E$C~ co TAMKS MAIJUFACTLJRER: WMBE~tOF DOSES: PER DAS 75 TAMK SIZE: d GALLONS DOSE VOLUME. ! Q ALARM MAMUFACTUKER: "V INCLUD)AIG BACK.FLOW= GALLONS MODEL MLIMBER: V L, CAPACITIES: A= 1 INCHES OF, ~~t© CALLOUS SWITCH T.9PE: F l &k T 2• INCHES OR GALLOkJS PUMP MAMUFACTURE R: Z Wr-HES OR V / ® GALIOlJS MODEL )DUMBER: T D=15' C° INCHES OR 3113 GALLOUS SWITCH TJPE: Pr6&i I3ArK m--r MOTE. PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE~aPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE 5ETWEEU PUMP OFF AUD DISTRIBUTIOM PIPE..FEET T ~ ` MIUIMUM NETWORK SUPPL`J PRESSURE . 3. Z5 FEET ; ` jy F + 3 5 FEET OF FORCE MAIN X z • S9? FYo FT FRICTIOU FACTOR._ FEET Q, 2 TOTAL_ DyJMAMIC. HEAD = UL I FEET 37 I►DTERNAL DIMEMSION5 OF TAUK: LENGTH ;WIDTH ;LIQUID DEPTH . P1z00V(,r" MPROVA L --ti -fok Gc9' 5ER C&-0C KeTF- PRMCAST° ppo EP TI c-, TAI N K SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (te e ?0L1L-0C 1 Pt~nnvcr fllter). Tank shall have an approved above ground locking manhole cover for regular (every A' ROAL MO'P:G 12 months or less) inspection & servicing by a licensdd service pumper. 05/07/2015 09:39 7156475181 WIESER CONCRETE PAGE 02/03 :arod-asod :3utia W1110/00 '3t.va09L*9 Uh 'NOOH N3alVw al AMH sn 9tLvA ianMdW 3I1d3S t- ~ 'A38. I- LU ~anOd-3ad „0-,t=ati t --A'3V3S doAh~A 31380000 z ~~~m ~W w or ~W m En T m re LA CL y l p ° o (A < a Q ~Wq O® D%OP -K 0 ~lr Z z 0 d z Q w ttr~yy o ci = LL c W UWUS`~. ( 4JU ggG N = MM :U5 w; Q cm, CiVie. . (A 11 CL ad w F j 10 N0! m o eirk C4;E z s ~0=IN 3LLp1~ O LW o~zw ¢ " co V W co ow Q o~ a ~ ~yJ zn~a z ° z xLc z mu MOOD 3KtC7 0 Udo z N op 0 ° x ~z V) 0 dc a ad 'V) w v a- ~ J w r- N U „Ob tL t ~y I) a ~ ~ W S'd.7 „b T. Q ae£ do In m J CL £ IT „t6 do 0 Li w R WI N aZb 0 w W 4 Y z P~. ZOLLER EFFLUENT PUMP MODEL 98 p HEAD CAPACI CUnVE MODE 9r3 7/1 6 1/4 a 3/a 2S- ~ ere 1 -4 3/11 - i 1/2-11 1/2 "PT nAL10NS 10 20 Ln'" - - _ 30 _ 40 50 64 TO - so 0 ISO 240 Flow PER MINUTE latat A)yNAyp NtAwtow w An.ruit 190MINI Axe aswaryry ""y, tArAclly 11 _ VNItfAAtl4 Fitt 111ttne aat~a: !lift I I'm 18 ?ra to 9.01 et a:n iK 4.71 40 70 &to ire t 25 03 CONSULT FACTORY FOR SPECIAL APPLICATIONS 1 Electrical ailenlalors, for duplex systems, are ava4able and IWP4d with an alarm. 0 Mercury float switches are available for controlling single and ~.M~f►anicett altatnalole, I& dttpfex evelems, are available wNh or o three phase systems. w~houf Metro itvMrh+1. Double piggyback mercury float switches are 'eve able for varlabfa level long cycle controls. _ _ __,_9iandardAll Ddals- W*10 49lbsr 1. N„I.Q„rno,lo 51ELffoltoNUUIDE N lstlas RR _ P®raftfd 2 Polo'Wil-rcal swheh, t,o sxlernrt caantrof rsgidtad. ft'4 Control S•lectton : +ZlnQlapio9ffisekmereuty!lostfAnc~h doubts ° Y haPfi M M98 odK Am ! elm IeK - ewhch. Astor to fMONt. AiDyback mercury. Vaal 1 i0 ! Auto t-6'7 } tx - "f Du irK 3. MachaAAlcai &hetneiol 100072 or "Is, 4. &a FMOI12, For caitecl model or Ebclricd AherrAalac, 0911 230 e. MelkNy "n" ft,., #witch 10.0323 "E.Pak ,used !3D d 1 Non E' p 131 _ tot IbW syslem. . a1 Al t ontrO activntot I . 2 1 l ! at~ 9 s s f In hri. ° 1 P.x . jur aj r; Wit.,.Iy P4• or d-I.- oWr~ tow, 1w+sonnectlan M wired In stm. T. twe I$ hNe ®d rok". Im A+atsttiptAl at apAlp. Ifs~~yy„~~~`~'~~ McA+cr 10. b eaAaloQ on CanWn,.~o„ Bl~q« f 1 r ~11t rt~ kU ttlleOR; t'vcfi X14, AN InstaNrlw al s CAUTION fibt7! w tad:aos 13. *1-1101"000 ~ nat~ 1 enkal AHsrnaloe. °^tfots, F"'CU- 4{aae ®nd Ae4In i# ' u+0. 1aa891; and R:mptsx CeAasd Uo0. ns4 rosn6*4 stema-140, AK atawb.~lMan1 as/ 4 ehO~id N ~,ns ~y e u+y 0Asst assent kal".1 ft-t& C °N aKs slK.uut 6+ IoKows.d ucet.ed. j, sle INyc1 and we NesKh Ad (-$..A CooepaUansl 9ately aRd For RESERVE POWEpED DESIGN urlusufi conditions a reserve r;a(ely factor le dnginea►ed lrtl®the design of 046.rY Zoeller pump, MAll IQ-r.O. SOX 1634r F ZZ7TII t .fT l +r~r64, xh' 40?56 OV7 Maou/aclurers 0l , , , 11(1t rO; 3 86 01, dopers rant rrwr<t,: xy r016 48 2r1r rAr,Rez) 774-3624 t`~ur~ ws Smarr 1.f'39 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page b of FILE INFORMATION SYSTEM SPECIFICATIONS Owner p "KI N Gu~AR NN Septic Tank Capacity /OZ-0 al ❑ NA Permit # Septic Tank Manufacturer W j j 5a/Z ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer POLY to 4-K ❑ NA Number of Bedrooms ~j ❑ NA Effluent Filter Model 52 .rte' ❑ NA Number of Public Facility Units ~12MA Pump Tank Capacity 750 al ❑ NA Estimated flow (average) -300 al/day Pump Tank Manufacturer a erse-2 ❑ NA Design flow (peak), (Estimated x 1.5) q50 gal/day Pump Manufacturer Z p e`t ~ (2, ❑ NA Soil Application Rate 99 YZ "P ' al/da /ftz Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 m /L ❑ NA 9 ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 m /L ❑ NA 9 ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ■ Mound Fecal Coliform (geometric mean) <_104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size X in dia. ❑ NA Other: Other: ❑ NA ❑ NA Other: ❑ NA ''Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ year is year s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) fi] years (Maximum 3 years) ❑ NA Clean effluent filter At least once every: i' 0 month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA KYear(h) Flush laterals and pressure test At least once every: ❑ month(s) Other: ~7. year(s) ❑ NA At least once every: p earth(s) ❑ NA Other: y ( ) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any"ponding of'effluent on the' ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory'authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR,.113, Wisconsin Administrativ&Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized com_ ponents,,pretreatment units, and any servicing at intervals of 512 months', shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page t~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are. defected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts, condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter SPS 383.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not `available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. L~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative I surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT` TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS R POWTS INSTALLER POWTS MAINTAINER I-) Name VJ kLTG P- ¢ AA V I 116 Name 14, G Phone -IT ' 3,3-z"-2' Phone ,(5 •70-3 - 33 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ;L 7 Name GV 06,01 Name <jT- <•R.ot X GAj.. !Z~ d NI /V(-- Phone l j C1 O 3 3 Phone 3 g ~p " 7 a 0 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Revised 3/29113 '7(5 " 386 • S02 77 _Tt € 41P, Installation and Maintenance Instructions Installation Step l Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed. 4) Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring it is secure. Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the.filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other incidental or consequential costs. Contact: mike@iifetimefilterllc.com Phone: 502-724-2231 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Yt Mailing Address ~2 =GJ_ aD .Sr Property Address ;0-7 2a ,el I7- (Verification required from Planning & Zoning Department for new construction.) City/State H W ; Parcel Identification Number a 2 t 6,Z8 " qD ' ° 0 0 LEGAL DESCRIPTION Property Location $ W , 5 4> , Sec. ~-O , T 8 N R / 7 W, Town of L) Subdivision Plat: , Lot # Certified Survey Map # , Volume - , Page # Warrant)- Deed # - q ®t/ (before 2007)Volume . Page # Spec house 0 yes IN no Lot lines identifiable a yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the svstem can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements o this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a arranty deed recorded in Register of Deeds Office. Number of bedrooms 3 S l:7 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) fed x ,r wool J a - ` JI, 40 Y ,9 Pi .A a . A~ u r. t ° ~a • A q~ A mL 5+ n~~~r LIM K J Af n.i 1 ' Y Zk ~ S'y R~ r I' X AY.i Y 'IG t ,a<S < ta, , I at~71v . o- . ; , Iva x Parcel 024-1028-40-000 07/17/2015 04:12 PM PAGE 1 OF 1 Alt. Parcel 20.28.17.171 024 - TOWN OF PLEASANT VALLEY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - NEUMANN, JOHN S JOHN S NEUMANN 222 162ND ST HAMMOND WI 54015 Property Address(es): * =Primary * 222 162ND ST Districts: SC =School SP =Special 2,O Type Dist # Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Notes: Legal Description: Acres: 40.000 SEC 20 T 28N R1 7W SW SW TOWNSHIP PLEASANT VALLEY. Parcel History: Date Doc # Vol/Page Type 07/23/1997 719/566 Plat: = Primary Tract: (S-T-R 40%160'/4 GL) Block/Condo Bldg: * N/A-NOT AVAILABLE 20-28N-17W 2015 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/24/2015 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 33.320 7,000 0 7,000 NO UNDEVELOPED G5 0.680 200 0 200 NO OTHER G7 6.000 37,100 277,100 314,200 NO 05 Totals for 2015: General Property 40.000 44,300 277,100 321,400 Woodland 0.000 0 0 Totals for 2014: General Property 40.000 44,300 264,500 308,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 141 Specials: User Special Code Category Amount it I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 - AI nn 4 Wis. Dept. of S ~i~l:wfes:i~(arvices SOIL EVALUATION Page ' of Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code JUN County 5-r. C ROl Attach comp Ian on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 1fliWlK:Cve""Wd horizontal reference point (BM), direction and Parcel I.D. QZ 4/ . Z (1 , y~ . p p p percent QMM6WTYlQki`+='s0f~lll farrow, and location and distance to nearest road. d , Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner d Property Location ZSC)40 NEuM AIVAI Govt. Lot Sw 1/4 w1/4 /?_0 TZ? N R 17 E(o W Property Owners Mailing Address Lot # Block # Subd. Nam or CSM# ST ~f0 ~FGR~' F~R~-t 2.2.2- . A0 Z /"A City State Zip Code Phone Number ❑ City ❑ Village ®Town Nearest Road f &WAID IOL 51/0 l s (715 )791. 713 P 1r-A5haT \411 y /6 i. Md- S7_ New Construction Use: Residential / Number of bedrooms Code derived design flow rate G GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material /OES5 OUM -FiK9 &QM .~,t Flood Plain elevation if applicable N ft. General comments and recommendations: / Area - Spot Tested suitable for a mound (P.O.W.T.S.) system using Z I sand 1*11. 45,'r5 0 Boring Q NA-~.~. Boring# l?• 10 5A-T0RAI- E/~ P/] ~ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 l 0'5 /0YR 3/4 L 2* 509 ftVf4 Cs 3-f . Co . 8 Z 5.1 o YP, ik4 51 L f 5W fm-F R C- 5 /f .8 3 f- 15 -7 5Y 510 SG /-F s bk tw► -FR cw Y .7 5r.39 5YIZ S cz.d, Mor5 5CL l-Fsb,~ Nn f~ - Z • 3 ~o R~ M L Boring # Boring 77• ?0 S. S . Pit Ground surface elev. l ft. Depth to limiting factor V in. Soil A lication Rate Horizon Depth Dominant Cotor Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 o-5 /oltz 3q L- 2.Ajj SbX MU'fR. C5 . & 2 5-17, /6 YR 11P q bK fm f R- c 5 /-F . g 3 /z• ig -7.51R s s~ ~fshy t"cto • y 8.3 5 yR c:Z A M6r5 SGL -F 56K w t2 - • 2 /0 R a*L a•5y (e 2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number 'I~- ba~g.-r Z(t.C3Ri C6 T 70-4i 6~r 2Z. (o -3 75 Address Date Evaluation Conducted Telephone Number Z~IZ lb AA • 5v%ro ~k4 W1. 5y1(0 Amikk 30 Ably 715• _71A• 4 q f Z SBD-8330 (R11/11) T 1~ . Property Owner EUMANnJ Parcel ID # 0 Z~ /o,a 00 1{o 000 Page Z of 3 F3-1 ❑ Boring Boring # 9 n J~'~' Pit Ground surface elev. ft. Depth to limiting factor 2d in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 0-6 Al) yR 3/ 1- 2, sg/ VFe C5 3-F .6 .8 z /z /9) YR 2 f sbk /w 2 c5 / -F . 6 . k 1.2-2.0 s yR s s /f'sbk Am -FP- c w y D • 7•5Y9 6 c~. M0• -5; 5cL lic-5k D av-t4 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in., Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Zth i ting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Te e Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 i Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 1/11) Property Owner J. 1JEUMA40 Parcel ID # oz~f. /DZ8 yp• 0,90 Page Z of 3 Boring # ❑ Boring 71~ Z~ 2-0 S. S . Pit Ground surface elev. 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence oundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 0-(0 /o YR 3 z SbK VFe Z & • /z /D YR 61 2 f sbk zo 7.5YR s 5L-- I-F5b& ~IQ c w y .7 ' 7 5 YR C M d fS 5 CL ~S6 M'I f/2 Z 3 D ~ Boring # ❑ Boring ❑ Pit Ground surface elev, fL Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 Boring It ❑ Boring ❑ pit Ground surface elev. ft. D th to limiting factor in. KSoillApplication Rate Horizon Depth Dominant Color Redox Description Structure onsistence Roots /ft 2 in. Munsell. Qu. Sz. Cont. Color Gr. Sz. Sh. ff#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD e < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 1111) bTT ?LA t,J _ .r y-- ~ffST diiVC • = LAh~a~' (~M 2 5E r 3 I sa,'L /~i7"S >=rA W, rod 6f ~ co,v+00R IwES 30 CbN dyea`~. 133 11I qT 7o CDidour~ GL BZ 30 'o 30 131 woopco 15-r.-EL- ~1~ y a O SST I ~PrI L C. "VrT 3M 9 SfocKA'PE Top v~ we v'p~ ix V, coa+ook M r 5 y L~ K a pRopo5E D 3 j3El fl 1-foA4 V M' 3~ = y7,go~ ~XisriNG- vE" /32 -7 ft S 3 ~ E c~2iuRn,, yo pr~,ey S a v t4-- PRO, L-liv e.. J ~ o_ -Fev er r Z H O fD ~ N~ ~ i n N I 3~ n O C O C1 ~ ~ z a N• a ~t ° a c Q rt 0- H pd (D D) C) "a CD 1 0 n (D 0 z In H F P3j Fl E O X w ~0 0 ° i-n o a C a o y c o No O U] H Jqj 0 fa CO CD 3 3 C A O C w IV IV ft lJ1 \ C Z Z N N 3 co_ 'O M -4 CD = \O N N 3 O0 O O N OA N ~o IQ O o `7 1 C H I 1 m (n z D ip a oo w Iv (D co' O N a N o V NZF'~ 9 a IW ooaj 3 co m 14 Pd M O 'b y 1 ~~o p E C N ago ado O o c w En Q N 4-4 3 Co r c E H (D 3 v O a `o£ rt OOOa p N• o Z co o 0 z ry,~ 0 (A CO) ca > "'a ~ N N O O l~ H' O 00 = N ' tr 31 w 3 E o `D d ri) rt a Z N O D D o a ry~ C CD c II a 3 CD -1 fn I ° ~ A Z T I 7 V) N W ~ O CL z A ;U 3 -4 I -NO A W N O n m ? y Ll rt N Q N G. N C j oZ a CD N 7 O H CD Sy a (D a CL e A CD O O a 00 - w ~ O d0 O O 69 ~ N O C Q O d ~ ~ ti DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR AFETY & BUILDINGS LABOR WHUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 SWI,SV',,, S20,T28N-R17W ❑CONVENTIONAL UALTERNATIVE State Plan I.D. Number: Town of Pleasant Valley ❑ Holding Tank ❑ In-Ground Pressure RXMound "IT-67227 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John Neumann 1124 Knollwood Drive, River Falls, WI 54022 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber MP/MPRSW No. County: Sanitary Permit Number: Thomas A. Wang 3231 St. Croix 99102 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 41 f~ (,_;0 AO IDED: PROVIDED: V J / YES NO ❑YES NO BEDDING: VENT DIA. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VE T FRESH y ALARM: FEET FROM / LINE -rte L AIR I L ❑YES O I ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: FLIjID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACT~I RER. WARNING LABEL LOCKING COVER PROVIDEDPROVIDED: YES LINO (`J- lT (L./"+/ ❑YES LINO [-]YES LINO LE: AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FR ESH GALLONS PER CYC PUM (DIFFERENCE BETWEEN I / FEET FROM LINE' CO ) AIR INLET: PUMP ON AND OFF) I YES NO NEAREST ✓ SOIL ABSORPTION SYSTEM. Check the soil moisture at t He depth of plowing LFa ,TH 1111111TIR MATERIAL AND MARKING ~17 or excavation. (If soil can be rolled into a wire, construction shall cease unti=FRCE the soil is dry enough to continue.) CONVEN TIONAL SYSTEM: WIDTH- LENGTH: NO. OF DISTR. PIPE SPACING. COVER [INSIDE DIA.. PITS: LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH: DIMENSIONS CJi GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV. INLET. ELEV. END. PIPES: FEET FROM LINE: AIR INLET: NEAREST 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 NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS YES LINO ES LINO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED. CENTER. EDGES- C YES NO 1.5 a ❑YES NO YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: / e #I' DIMENSIONS 3 2 l MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV, , V V DIA. n Ev.~ ~6 PIPES 0: A.: DISTRIBUTION g 7' INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: YES LINO YES LINO COMMENTS: PERMANENT M ARKERS: OBSERVATION WELLS: NUMBER OF PR PERTV WELL: BUILDI~JG: FEET FROM LIN ~_N ES ❑ NO YES ❑ NO NEAREST V Sketch System on file for audit. Reverse Side. TIT SIGN Zo~innlg AditL#}strator DILHR SBD 6710 (R. 01/82) 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: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; Il. 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 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) pidt 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 haw. This legislation is more ti 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 Ater included the creation of surcharges (fees) for a number of regulated practices which Wiscohi in's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. c 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 ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) EZ: LHR S ANITARY PERMIT APPLICATION COUNTY 57 In accord with ILHR 83.05, Wis. Adm. Code ~1?o1 °STAT SANITARYPERMIT# 9/U --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. _ O 7Ga 7 -See reverse side for instructions for completing this application. PETITION y~ 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PROP,OWNER PROPERTY LOCATION e % S Pb T P N, R! E (Or W PROPERTY OWNER' MAILIN ADDRES LOT NUMBER BLOCK NUMBER SUBDIVISIO E o q o d d~ AT Y, STAT ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK J~r n VILLAGE : IR Flf II. TYPE OF BUILDING OR USE SERVED: Ua I /e /n ~ v-CJOd 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. El New b. C-Replacement c. ❑ Replacement of d. E1 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.eR Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. IR 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): C % .160 Feet ©Private ❑Joint ❑Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank X DOD t' ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ~D Al 0 ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plu r' Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: r gas f'~'~~ b4li YO R Plumber's Addres (Street, City St e, Ziq Code : Na o esigner: / IAJ VIII. SOIL TEST INFORMATION Certified oil Tester (CST)Ma mg CST #~2f.^xd CS 's ADDRE S (Street City, Stat ' Zi Code) Phone Number: le ,9 e) t) IX. COUNTY/DEPART ENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial rcharge Fee Adverse Determination ti hW 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 APPLICATION FOR SANITARY PERMIT STC - 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 Lj JAPI 1 C(,pl/J hA Location of Property ✓ ~t S CcJ hL, Section T_ ~L,--J~Y N-R~ W Township Hailing Address Address of Site l' Subdivision Name .Lot Number Previous Owner of Property 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 C _ and Page Number _ZLl as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- encea to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (toe) ceAti.6y that att 4.tatement6 on zhi4 ofcm aAe tAue to the best o6 my (ouft) knowledge; that I (we) am (aAe) the owneA(sf 06 the pkopehty denschibed in .thiA in6o4mation 6o)un, by viiLtue o6 a waA.anty.deed uro&ded in the 066.ice o6 the Countyy Regd,ateA o6 Deeds ass Document No. and that I (We) pneaentty own .the phopoaed A to bon the sewage dtApos s ys em (oA I (we) have obtained an ea.aement, to nun with the above deachi•bed p&opehty, 6ok the con6tAucti.on 06 aaid aya.tem, and the same has ~ge~n/ P-~, uZy A cohded .in the O66.tce o6 the County Reg.ia.teA o6 Veed&, ab Poement No. 0 .~62 • I V SIGN Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) C/- _ S DATE SIGNED DATE SIGNED _r DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 TNIS SPACE RESERVED FOR RECORDING DATA r QUIT CLAIM DEED r ~lc!~:t 8 ' ;AGE AEr tisISTEt2S OFFICE - - i;;,-+ ST. CR04X CO., WIS. a. for Record this 3rd The _ Firs............................ Ntina_Batilc - o _ Baldwin. Roc Baldwin, WI r a U.S. - Bankng-Corporation..-..---•-_----- day of Sept. A. D. 1985 quit-claims to John S. Neumann and--.. • at 8:30 A , M. __o__a_n M__. - _ N _e iutlaru~, h and wife as Joint Tenants_ James O'Connell ham* of Dowl Kathleen H. Walsh, deputy `N11 the following described real estate in ~ • County, RETURN TO State of Wisconsin : The Southeast Quarter of the Southeast Quarter MhSE~) of Section N' ineteen 19 th e Southwest ( Quarter of the Southwest Quarter (SW4SWh), and the East One-Half of the Southwest Quarter E' SVi`h), and the Southwest Quarter of II, the Northwest Quarter (SWS4tNh4a) of Section Twenty (20), Tax Parcel No : all in Township Twenty-Eight (28) North, Range Seventeen (17) West. The Grantor herein hereby relinquishes any and all right that it may have to the above described real estate, as the result of the filing of that Stipulation and order between the Grantor and Grantee as dated January 9 1984 re6oorded February 2, 1984, ary in Vol. 681, on pages 444-447, as Document No. 3909(24 in the office of the Register of Deeds for St. Croix County, WI aA yi D1 rT.k~y/a~{yr grF rr ~M KItiS ` i ;y 4ro`^IZ?~>7Y" 4`h~ t'~i~ V t1rCRei7a }M C c ( is riot . This . homesthad property. j (is) (is not) i Dated this day of August 19 85 THE FIRST IONAL BANK OF B.XId7ln IN (SEAL) . &~ldW*-- (SEAL) BY: Dae W. F rn, Presid t Authorized officer ' (SEAL) (SEAL) py: - Doug as Wynvee Asst. Authorized1 Officer Vice President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN County. I ST. CROIX authenticated this day of ..........................119 Personally came before me this day of August 3-°- 19$$ the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. Stats.) to me known to be the person who executed the + foregoing i t ument and acknowle a the same. THIS INSTRUMENT WAS DRAFTED BY , Leo A. Beskar Attorney - Rodli, Beskar & Boles, 5.C. '---Shelda J. Th pson River. -•Falls-,--WI--54022----------------_------•---. Notary Public Rotary Public - State of Wiscone nty, Wis. j (Signatures may be authenticated or acknowledged. Both My Commissio^c, Iwolk acxpiration are not necessary.) date: 19 ) i i I -Names of persons signing in any capacity should be typed or printed below their signatures. i NGM+llercomperryfrvil STATF DAR OF WISCONSIN StOCI( No. .3003 _ E'c^-:~.g1 FORA No. 7 19R+ H z H • a STC - 105 r a y SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z t7 ~j 3 OWNER/BUYER 1~ezl G f M ROUTE/BOX NUMBER 2Z, jZ ~h&Lv, N Fire Number CITY/STATE ZIP 0 I PROPERTY LOCATION:-b Section T c7 N, R l W, Town of /7 l St. Croix County, Subdivision Lot number,_----. I 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 sooner, 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. may be eligible to receive a grant for St. Croix County residents 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. yo E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with M. H the standards set forth, herein, as set by the Wisconsin Depart- ro 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 DATE / ✓ 6 D / St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. J p r1 2v (`I C-~ n S LJ 'f y S t.J'f y S e 2- Z°v N 17 W i f0~ d. E S~ S~~M II', mall to UOIZ Y,r g\aQe. 31 G~PF~~h1 G1~}\., r- v' moo n pa~• I~ l: +o Contovr ,uo `l ~IO~ ~UC iDfCt l'"l~' n V c~ I A too., gl,e~ -rys ~ : ~ Y12 Co~~~r S},e~ N)`~ J a RECEIVED SEP 2 81987 / PLUMBING SECTION '0 z t RECEIVED ~ Page _ Of SEp 2 81987 r1CTION Straw, Marsh Hay, Or pLLAABING, , Synthetic Covering Distribution Pipe Medium Sand G O ~~op II ------yu= PIGS I =-1 E D 0 rtilit<< All \ H~ \~~~~aS Bed f -2-2 (Force. Main Plowed ? Q\ gate From Pump Layer ~ Gr \~~~pF D . D P~~ ' 0\`~\S\~~ 0NpENGE p Cross Section Of A Mound System Using E 1.2 G~~P A Bed For The Absorption Area F ,7S S c 1,0 A Ft. H 1. 5 Sign fi Ilk, B ~1 Ft. License Number: --T-I I 1 2. Ft. J Ft. Date: K ..I D Ft. Alternate Position L (,r-, Ft. of Force Main W Ft. L d Observation Pipe B K r-------- A I- ----------------------I Force Main W ° - 7_--____ From Pump ~,Dislribulion Bed Of 2"- 2 2r Pipe Aggregate 1 Observation Pipe Permanent Markers Plan View of Mound Using A Bed For The Absorption Area •i RECEIVED SEP 2 81987 Page _ Of _ PLUMBING SFGTIM' fit oPw ~ P tblbte~t P~ eto~~ 0 '.A E End Goo A~~ \``~F SN VC Pipe' Hotel Located On Bottom. A ~C~CjPO S Are Equally Spaced GU S ~k' II PVC Force Main ' From Pump V PVC / Monitold Pipe \ Oµl f d)v t ldn Allernolt Poelllon of Force Main From Pump Lou Hole Should Be Neel To End Goo End Cop Oielribulion Pipe Layout p R S _ X V I ( Y - Signed: hole Diameter Inch Lateral Inch(es) License Number: Manifold Inches Date: Force Main Inches Q 71 DE)'AR T MENT OF REPORT ON SOIL BORINGS AND SAFETY & 6 DIVISION INDUSTRY, 1 P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: O N MUNICIP IT~ LOT NO.:BLKK.. NO.: SUB ]VISION UNTY'I'V014 00 TN ER' BUYE 'S NAME: M ]LING A RE S: 'a'~j f7 r O ro X DATES OBSERVATIONS MADE USE PR FILE DE CRIPTIONS: PER O AT10N TESTS: NO. BEDRMS.: COMMERCIAL DESCRIPTION: Residence New Replace 5 RATING: S= Site suitable for system U= Site unsuitable for system K: RED MENDED, SYSTEM: (optional) CONVENTIONAL: MOUND: 11 IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLTed", o s ®u sou o s ~u a s ~u ❑ o (,fl l0 DES IGN If any portion of the tested area is in the required If Percolation Tests are NOT I under s.H63.09(5) (b), indicate: Floodplain indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B .9,Db n ADD sd>n 3yd A k C I F1 B- a ~h d~ ~6 ~`,btOfs 471 O .o .oo (fit /s'o8n ~5'D~ S ~ ~ by g t o 6 B- B- S'.lrb 3.00 o o J6 G ;.60,80 S 1Ga- w ffA4 B_ a r Ct f ~dt 44 /ia ~s t-9, ov PERCOLAT ON TESTS TEST DEPTH'. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 jR'l OD2 PER IOD 3 PER INCH / ad P- 2 PP- P_ 51- a a 2y ' o de* P- P- 17 s 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. SYSTEM ELEVATION P` E Pa s 68P3 - - i i 41 ` i EP. _ i i ~ ( I , t r f Q~, T1~ ; i f ~ ( t t i 3 I , - - 'S ee~ i PrPs ; Q ir-- D f 1 10 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pri Wa : TESTS WERE COMPLETED ON: 10 Dif A,, , ADDRESS: ~ ~ eu~ ' sy~a~ CERTIF C eTON NUMBER: PHONE NUMBER (optional): d Y~ ~ sP CST S LIRE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D.ILHR-SBD-6395 (R. 02182) - OVER - PAGE OF PUMP CHAMBER CROSS SCCTIOM AAIO SPECIFICATIOIJS VENT CAP r l REGE~ SEp 28 1987 VENT PIPC WEATHER PROOP APPROVED LOCKING FROM Ju1JCTION BOX MANHOLE COVER .~I1B1~G REGT~n~ DOOR 4 OR FRCSH, It~M11J. I 91 TAKE I GRADE I `I' MIAJ. I I B' MI AI. COMMIT ~ h ~&VIDE i . INLET AI BHT SEAL L I v ~ I NED JOINT/ A APPROVED JOINTS PIPE 09, /C.I. PIPE IDIUG 3' ALARM CXTE16101114 31 SOLID LOIL \~`,1 I II ONTO SOLID 1601L Q I ON GE _ ~ OFF p t. _ pl~c~Q D CONCRETE BLOCK KISCK EXIT PERMITTED OI.JLy IF TANK MANUFACTURLR HAS SUCH APPROVAL J /►e'PRnv~D ~ OOINE~ TIC l SPECIFICATIOK E 1~. L .IKS, MANUFACTURER: MBER OF DOSES: I PER DAy TAWK SIZE : SO IJU GI LLONS DOSE VOLUME 1IZl .S iIQO5'> %RM MANUFACTURER' I inV, W[rz/l.fi INCLUDING DACKFLOW: CALLOUS MODEL NUMBCR: IJ1 ~L~ I' CAPACITIES: A= 11S INCHES OR 319S'2 GALLONS SWITCH TYPE: `Tn v g=. a INCHES OR I s5 GALLONS 'o1P MANUFACTURER: (7 C, IOC C=-7. 5 INCHES OR 30S'2 CALLOUS MODEL NUMBER: J 1 Dm INCHES OR _1 a GALLOMr, SWITCH TYPE: 1 MOTE: PUMP AMD ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MIIJIMUM DISCHARGE RATE GPM (TICAL DIFFERENCE BET WEEU PUMP OFF AND DISTRIBUTION PIPE- FEET ` "l 1-11-) MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.55 FEET Soo FEET OF FORCE MAIN *A Ac", F/pQ FCFRICTIOJ FACTOR-IoLf FEET TOTAL OtIUAMIC HEAD = ~•5 FEET 'ER rL, 01 LWSIONL OF TAIJK: LEAI6TH / I WIDTH ► LIQUID DEPTH s ~ • Ij EO: LICEOSE HUMBER. OAT E:~_ , ST. CROIX COUNTY ~y h WISCONSIN ' ZONING OFFICE 796-2239 (HAMMOND) 14 1 rI 425-8363 (RIVER FALLS) HAMMOND, WI 54015 September 28, 1987 Cl 07 2.2 1 Division of Safety and Plumbing Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the John Neumann property located in the Sw4 of the SA of Section 20, T28N-R17W, Town of Pleasant Valley, St. Croix County, revealed suitable soils at a depth of 2.50, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator Bulletin CL2.1A 0 For Homes July 8, 1983 • Farms 2$~g81 GOULDS • Trailer courts SEF Model 8885 • Motels (Supe(sodes Model 3870) to Schools • Hospitals Submersible EHluentPump Effluent Pumps • In duStry • Effluent Systems Pump Specifications anywhere effluent Solids Handling Capability to'/:': or drainage must be Discharge Size disposed of quickly, " 2° NPl Semi-Open Impeller quietly and efficiently. 3 vanu di,t,lyll Ihr,:.ulud oil yhalt I hree phasu unr15 usu uupull<n k,Lkimt to prevenl acc dental back-uff. Pwnp out varies on backside of impeller for protection of mechanical seal. Casing Volute type for maximurn efficiency. Stainless Steel Fasteners Heavy-Duty Solids Handling S+,10s 3+u) slulliluc,:; S10e1 fur corrosion Dependable Capability, to 3/4" lusislance Mechanical Seal Ceramic vs. Carbon sealing faces, stainless steel sprang and bona N elastumers. Maximum Temperature 1h, 1/2 H.P. 60 Hz _ 160°F. Capable of Running Dry Single Phase 115, 230 Volt. without damage to components. Motor Specifications the 1, 11/2 H.P. 60 Hz Motor Fully Submerged in high grade turbine oil for permanent lubrica- Single Phase 230 Volt. Three tion of bearings and mechanical seal and Phase 208-230, 460 Volt. efficient heat dissipation. Motor sealed from environrnenl by rugged cast iron enclosure. Bearings Heavy-duly all ball bearing construction. 0 Stainless Steel Shaft Series 300 stainless steel for corrosion resistance. Threaded shaft. Single Phase Units All single phase units have built-in thermal 90 overload protection with automatic reset. 80 Three Phase Units Overload protecuun in starter unit. 208-230 or Q} y y 460 volts Threaded shah 60 Flz operation t 70 Power Cord kl" LL 10~ia i y rn` Water at id oil resistant. Epoxy seal on rnotor end 60 c a v aces as a secondary n+uislure harmer in case of i damage to outer jacketing. Corrosion resistant W f gland riot. x 50 17 U + t tv r+ a x T t r t Single Phase Units < 40 H.P. models equipped with 15' of 16/3 L " ' "t # ' S SJTO with 3-pruny grounding plug. ; , 1, 1'. H P. 0 3 models equipped with 15' of 14/3 STO power cord. 0 20 > Fes' ~k 4° I t, SPECIFICATIONS ARE SUBJECT TO CHANGE 10 it! v 4" A r WITHOUT NOTICE. 0 !r" y : ti t" 0 10 20 30 40 50 60 70 80 90 100 110 120 MGOULDS PUMPS, INC. GALLONS PER MINUTE U 5ENECA FALLS tEW MURK 13148