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030-1087-70-000
FSa nty: St. CrOIX Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT ita ry Permit No: 579082 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Law, s.15.04 (1)(m)]. 2601502 Personal information you provide may be used for secondary purposes [Privacy Parcel Tax No: I City Village Township 030-1087-70-000 Permit Holder's Name: Harshbarger, Roland & Joan TOWN OF SAINT JOSEPH CST BM Elev: Insp. BM Elev: BM Description: Section/ I own/Range/Map No: 30.30.19.315C TANK INFORMATION Unl/J~ ELEVATION DATA TYPE V-b MANUFACTURER 9`5 CAPACITY STATION z63 ELEV. J Benchmark Septic To" J,n 2, %t 16Z.`31 Dosing a YJ 1+ Aw ? . 17. I W ~ ems' Bldg. Sewer ~ Aeration Holding St/Ht Inlet r St/Ht Outlet /oq q3 TANK SETBACK INFORMATION , ll TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt inlet '76. V 01 Septic r s Dt Bottom 1 3(v 15 Dosing Header/Man. 4 7, '4 7 71415 '7Z 2 Aeration Dist. Pipe 9 9 - e/ Holding Bot. System C? Final Grade 77.1 PUMP/SIPHON INFil ON Manufacturer / DePmand StCov r ' I (y X1"7, L~ Q,t se.- ZI7 t Model Number 5 GO ~+~o~s~. . `~5 ~S• gG TDH Lit friction osz System HtiadS~ TDtIG, 71 lizz Forcemain Length Dia. r~ Dista~..t~o Well _;7 / d d ~ SOIL ABSORPTION SYSTEM BEDITRENCH Width ~ Leng~~ No. Of~renc as PIT DIMENSIONS No. O Pits Inside Dim= q.-,d\ th DIMENSIONS e SETBACK SYSTEM TO P/L 4d BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type System: ' I UNIT Model Number: a I 7Z. 9n DISTRIBUTION SYSTEM 8 Van Air Intake Header/Manifpld Distribution Dia Z . e -3 Length x Hole Size x Hole Spacing i 1. S Length-3- Dia Length ' Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only xx Depth of xx Seeded/Sodded xx Mulched Depth ' Bed/Trench Over Bed/Trench Center Edges ~ Topsoil ' 1;4- `-~as 0 No Yes R No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / LL /5 Inspection # Location: 340 CTY RD E k Flo O-su 1.) Alt BM Description = - " I /"-j 2.) Bldg sewer length - amount of cover Plan revision Required? Fla] Yes _2~No Use other side for additional information. Date Insepctor's Signa a Cert. No. SBD-6710 (R.3197) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 340 County Road E located at: SE 1/4, NW 1/4, Section 30 , Town 30 N, Range 19 W, Town of St. Joseph , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be. functioning properly. Most recent date of inspection or service 8/21/2015 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons min----- Tank Capacity: 1200 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) John Schmitt (L• ensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 8/21/2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional services Chapter sup and s. 145.06, Wisconsin Statutes') or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 'M~w am County ~o"~"vy 4i ` Industry Services Divi ' n St. Croix SEp 14 ? 0 1400 E Washingto Sanitary Permit Number (to be filled in by Co.) S R P.O. Box 7162 'OMMUN i duty Madison, WI 53709.;,7j 62 70 :51 / O~ DCVELOP ""`~410r+~4~ Z Sanitary Permit Application State Transaction Number 2601502 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit / is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Same 1. Application Information - Pl se Print All Information ~b Property Owner's Name Parcel # Harshbarger, Roland & Joan 030-1087-70-000 Property Owner's Mailing Address Property Location 340 County Road E Govt. Lot City, State Zip Code Phone Number SE t/4, NW '/4, Section 30 Houlton, WI 54082 (c' cle one) T30N R19Eor 11. Type of Building (check all that apply) t3~ # ® 1 or 2 Family Dwelling - Number of Bedroo 1-11 Subdivision Name ❑ Public/Commercial - Describe Use a c.Q w&e Block # [:1 City of ❑ State Owned - Describe Use Li Village of CSM Number A,J 7L ®Town of St. Joseph 65> X / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous t Numbe Wd ate il t;ed Before Expiration Plumber Owner -7'71;;g / (p / IV. Type of POWTS System/Component/Device: (Check all that apply) ,a AU,2~r- 7D - 76y ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade M Mound > 24 in. nf-suitable ~soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (s Dispersal Area ProP9sed (sf) System Elevation 600 Rate(gpdsf) 1000 2474 96.71 0.6 VI. Tank Info Capacity in ab Gallons Total # of Gallons Units Manufacturer U n IO N A. U V y L0 New Tanks Existing Tanks 2 0 n w C7 a. Septic or Holding Tank 1200 1200 1 Week's ® El E] 1:1 ❑ Dosing Chamber 750 750 1 Wieser ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' e MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 147 616 150th Ave. Somerset, WI 54025 VIII oun /De artment Use Only Approved approved Permit __F.',eeec Dat Issu Issuin gent Signatur ~Ow ' n Reason for Denial $ (oW , IX. Cond l W%Vftsons,04for Disapproval _ fow 3) sal can must all wit_ s ! mairitl ~ _ (1(~ _ f" l W f 1 A ,M.` at per.msns"nt plan proAd@d by..plymber. 1 A t°.YreC1~ a pir4pkllbb 006 / 06~, Attach to complete plans for the system and bmit to the County o 1 n piper not less than 8 1/2 x 11 inches in size SBD-6398 (R03/14) PLOT PLAN N Project Name: Harshbarger 4 Bedroom Mound Legal Description: SE1I4, NW1I4, S30, T30N, R19W P.I.D: 030-1087-70-000 Subdivision Name: High Ridge Court 1 st Addition Lot 29 SCALE: T' = 40' Township: St. Joseph Parcel Size: 4.910 Acres County: St. Croix Contour Line Elevation: 95.96' Cell Dimensions: TX 100' 4 inch Sch 40 -ASTM D2665 System Elevation 97.71' Mound Dimensions: 118.31' x 28.80' 2 inch Sch 40 -ASTM D1785 Slope: 17% 11/2 Sch 40 -ASTM D1785 BM1 Elevation: 100.00' To of 2" PVC pipe BM2 Elevation: 97.13' To of existing septic tank inspection cover ■ Backhoe Pits: Existing Tank: 1200 allon Septic Tank New Tank: 750 allon Dose Tank with SIMITECH STF-100 Effluent Filter fr Z_- 7i I ..1 7147 / i - - ► ExiSTING i i PeAlli i 614 E i-lcl.0 f 1 L, 5CN t~~ C - _ CE d 150 CAL Dos TAn1r. Ex~S~ Inks TECH S-Ti-/E?~ gt~t 12-vU"AL TAA;K ~ i I I r 63 ~i 1 ~ ~ ~ ~ GR~.A~r g\ bplvt- ~ 1 ~ ~C 9O Y R / ►til C uNT~? P'I) C Page 11 ~~~tivT'uF~ DIVISION OF INDUSTRY SERVICES roe 3824 N CREEKSIDE LA HOLMEN WI 54636 D S ~a Contact Through Relay e hftp://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~O s~o 5~ Scott Walker, Governor Dave Ross, Secretary September 10, 2015 CUST ID No. 223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/10/2017 SITE: Identification Numbers` Roland & Joan Harshbarger Transaction ID No. 2601502 340 County Rd E Site ID No. 816807 Town of Saint Joseph Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SETA, NWl/4, S30, T30N, R19W FOR: Description: Four Bedroom Mound System / 17% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1553923 Maintenance required; Replacement system; 600 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, 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 CONDO 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, APP stats. DEPT OF The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESSIO DIVISION OF IN Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. -16 ; 1~ • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with SEE R the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stats. • The existing POWTS Tank shall be inspected for structure, size and work baffles. If it is found to be deficient in any way, it shall be made compliant or be abandoned per SPS 383.33, W.A.C. and replaced with a code compliant tank. • 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 SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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 JOHN F SCHMITT Page 2 9/10/2015 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 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swiin@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Y MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Harshbarger 4 Bedroom Mound Owners Name: Roland & Joan Harshbarger - n ~0 ES Owner's Address 340 County Road E Houlton, WI 54082 Legal Description: SE1/4, NW1/4, S30, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: NA Lot Number: 3 Block Number Parcel I.D. Number 030-1087-70-000 17®NALLY Plan Transaction No. ROVED SAFETY AND Page 1 Index and title NAL SERVICES Page 2 Data entry )USTRYSERVICES Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications w Page 6 Management and contingency plan E Page 7 Dose tank specifications FENCE Page 8 Effluent filter information Page 9 & 10 Pump specifications and curve Page 11 Plot plan Page 12 Septic tank maintenance agreement Page 13 Existing Septic Tank Certification Page 14 Warranty deed Page 15 CSM or Plat Attachment Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 8/18/2015 Phone Number: 715-760-0486 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) Am v~ R' Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for _.r 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal conform of 36 inches. 600.00 Design Flow (gpd) 17._0_0 Site Slope 96.96 Contour Line Elevation (ft) 1p-_27.00 Depth to Limiting Factor (in) ✓ 0.60 In-situ Soil Application Rate (gpd/ft) Distribution Cell Information J 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.0 Dispersal Cell Design Loading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest o~ int in the distribution Y Pressure Disribution information network? Enter Y or NJ (C or E) -Pressure Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft~ 4 Number of Laterals of the highest point. _ i 0.156 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 ft2/orifice 2.08 Forcemain Diameter (in) 10000 Forcemain Length (ft) Does the forcemain drain back? Y a 85.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 11.38 Vertical Lift (ft) 90.53 5x Void Volume (gal) 3.79 Friction Loss (ft) 106.84 Minimum Dose Volume (gal) 0.50 In-line Filter Loss (ft) 43.08 System Demand (gpm) 3 20.21 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection y in. dia. options choice in. dia. o bons choice 0.75 _ 1.25 x 1.00 1.50 x x _ 1.25 x _ 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) r 120pgOpSeptic Tank Capacity (gal) Total Working Liquid Depth (in) s Concrete ~ Manufacturer gaUin (enter result in cell B49) Wie er Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Polylok Filter Manufacturer 20.28 Dose Tank Volume (gal/in) (525 Filter Model Number Wieser Concrete Manufacturer Project: Harshbarger 4 Bedroom Mound Page 2 Mound Plan and Cross Section Views 1/10 B J Observation Pipe : :K r 1'~ l A W .1 i.. o - T 2 L Mound Component Dimensions ft A 6.00 ft E 21.24 in H Aft ft K [Alft B 100.00 ft F 9.50 in 1 ft L ft D 9.00 in G 0.50 ft J W 600.001( ft2) Dispersal Cell Area 2474.49 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.50 (ft) G Z F Dispersal cen 97.21 (ft) Lateral 96.71 (ft)-► Invert Dispersal Cell] Elevation 41. 4 95.96 (ft) Contour Elevation 17.0 % Site Slope Geotextile Fabric Cover Shading Key a c. I Dispersal Cell See lateral details on Topsoil cap 1.5 ft Page 4 for number, size, Subsoil Ca H c and spacing of laterals. Cap Laterals are equally ASTM C33 Sand :5 F spaced from the " a i Tilled Layer d ft T ical ~aterai vp distribution cell's Q~ Aggregate o centerline in the - A distribution cell (AxB). Project: Harshbarger 4 Bedroom Mound Page 3 t Center Connection Lateral Layout Diagram Force main connection via tee or cross to mardfold at arl pant- Laterals are identical "I " { P_ Turn-upvr7bal► valve or ~Fx4-1-2 Laterals &fonceman Sch 40 PVC cleanoutplug per SPS Table 384.30-6 Holes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 49.34 ft Orifices per Lateral 20 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 fC/orifice Lateral Flow Rate 10.77 gpm Manifold Length 3.00 ft System Flow Rate 43.08 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.21 ft Forcemain Velocity 4.40 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect - Tank component is properly vented F- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 In. Ca acit 750.00 Gallons T Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.71 399.80 ✓ C B 2.00 40.56 Pump off elevation (ft) C 5.27 106.84 85.83 D 10.00 202.80 D Total 36.98 750.00 . _ c c:i ity (A) kc)t) t11 tS 4 • k Dose tank elevation (ft) Bedding under tank. 85.00 Alarm ManuafacturerJE Rhombus Note: Switches Alarm Model Number TANK -ALERT AAB -_-J_ _ containing mercury may not be used in Pump Manufacturer Zoeller this system. Pump Model Number 1153 Pump Must Deliver 43.08 gpm at 20.21 ft TDH Project: Harshbarger 4 Bedroom Mound Page 4 Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt Phone 715-760-04_86 POWTS Regulator's Name St Croix County Zon~nc__ I Phone 715-760-0486 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity. 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fta Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for ponding and seepage once eve _3 years.,- 0 IM--r Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • • • Grade 6-8" Diameter Lawn - Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Harshbarger 4 Bedroom Mound Page 5 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection.. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10" cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continoencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition, If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project. Page 6 M-09.0 :31U 95t~8-5Z~-008 09L*9 IM 'NOON N301VW OL AMH Sn gtL£M Z -anOd-iSOd 3Jtl0 00/06/00 31tl0 ivnNVV4 OI1d3S o w LLJ 8nod-38d wo-,L=b L 31tlO5 dOM 75 NMtlL10 31302101 = 8W-05LdlM u) \ W w J Q > o J z U co 0 LLJ J W o 0 0" OC (n w Z oo v0 d N V) ~ V) a 0 ~ V)\~ pOm 0 r,- C) P Q 'ww U Z o o z C) z -j Ln S w Q a v a ^w v CL p d o b CD aWW,00p mLn ww 0 D \ z~ cn " a & I.n V ~j>~x a m~m QQ tOW N F- J a U' Y q a I,,- W x UW~ M w< J mW(n N Un O Q z to Q d z W h- fn j~ C9 \ W U5 Q I- 0 z 0i 3: 0 4 12 p JF OQW O~,~j Q <<w W CO F O0 ~O z -j Q O J~~z5~M-95 ©U6 01>is ¢ PPRO O z a. xx ~U 3mU2m0m:3 Qd CQ9 d~0 U UZ <0 U= Z Q v) ~O z F- O LA- LLI 0 z z Q 0 4 O - - F- U H U J Q W N 1 Q (n N W W U D "0,7 Q W ~ O d D' LLI CL 04 W - I I U l~ a /tea\\\ 5 cn in Wm I~ 5 --I 5 Q ~I Q o ~ w w w N O zl „Zb 0: R w D 1~8 03 mOM Sd z W Q N Y z a Page 7 1 .l f~ PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS .FILTER J 1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020 Boyne City, M149712 Ear 231-582-7324 Email-_~_ ~;~=nicchcni Web "%kNti rif. tiEm[ach ci~r7i INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter (end opposite of the cap) to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap & on the side of the filter). Always install the filters in a position where they can be easily serviced. 'Always use caution when starting threads to avoid cross threading'. Plumb force main into the 2" sch 80 PVC union. "We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface**. For;, 6 a c1~ccl.. ;awe: ss insiailed it ~---hnuld Od'r' Df~ w,ftE-;r tnt- cAA ,0~t arr the, i0_.:€. SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Note that in cold conditions the filter cap maybe d0fcult to remove. Keep the fitter in a warm area or pour warm water over the cap before removing. Once' the filter is installed in the tank it maintains a stable temperature and removing the cap will not be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove'/" plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within its range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alann switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13, 2005 Page 8 SECTION: 2.20.047 Q&AelTYA'"14B A5114rF ISNYFM1919 /0110 Product ion pted - ® upersedes here reflects iins at time / / 1108 of publication. Consult factory lJ regarding discrepancies or inconsistencies. MAIL 70: P.O. BOX 16347 • Lwisvft KY 40256.0347 Visit our web site: SHIP T0: 3649 Cane Run Road • Louisvt KY 40211-1961 www.Zoell er com (502) 778-2731.1(800) 928-PtW • FAX (502) 774-3624 COMPARE THESE FEATURES • Durable cast iron construction 15111521153 EFFLUENT SERIES • Model 151 comes standard with a glass-filled polypropylene base (For Pump Prefix identification see News & Views 0052) o Corrosion resistant powder coated epoxy finish mmATE 31) • Stainless steel lifting handle "DOSE M Assembled with stainless steel bolts • Non-clogging engineered thermoplastic vortex FOR SEPTIC TANK - LOW PRESSURE PIPE (LPP) impeller design AND ENHANCED FLOW STEP SYSTEMS Model 151-113 HP passes W spherical solids 8"M EFFLUENT • Model 152 -.4 HP passes 3/4" spherical solids SUBMERSIBLE • Model 153 -1/2 HP passes %4" spherical solids 1'/i " NPT DISCHARGE ~ w Motor - 60 Hz, 3450 RPM, oil-filled, hermetically sealed, automatic reset thermal overload protected Model N152/N153 • Carbon/Ceramic seals CHOUS High Head C Effluent • Upper sleeve bearing and lower ball bearing running TesbdIDULSlmdWUL77B in bath of oil awc dacm SWn"d CSAW W 109 - 20 ft. UL Listed power cord with molded 3-wire plug • 1 %s" NPT vertical discharge N10DELS AVAILABLE • BN and BE standard models include a 20 ft. variable N1511N152/N153 & E151/E152IE153 nonautomatic level float switch BN151/BN152/BN153 & BE151/BE15ME153 Level • Operates at temperatures to 130°F (54°C) in effluent • 1113-4g& t~ 'p 1 15Vor2WV Ft°ate"`tcr' applications • All models include a 1 %s" x 2" PVC adapter fitting Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. POWDER ,a COATED i TOUGH' Z/7" Model BN152/BN153 MAIL TO: P.O. BOX 16347 High Hewed Louisville, KY 40256-0347 Effluent SHIP TO: 3649 Cane Run Road Louisville, KY 40211-1961 (502) 778-2731.1(800) 928-PUMP FAX (502) 774-3624 Manufacturers of... Z ~ m Copyright 2010 Zoeller Co. All rights reserved. Page 9 ru PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 151/1521153 PER MINUTE sa EFFLUENT AND DEWATERING 14 45 153 MODEL 151 152 153 12 ao _ Feet Meters Gat. LAers Gat. Liters Gal. Liters 9 35 152 5 1.5 50 189 69 261 77 291 = 10 t0 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 e 25 151 20 6.1 29 110 44 167 52 197 a 25 76 16 61 34 129 42 159 6- 20q 30 9.1 - 23 87 33 125 15 35 10.7 - - - - 22 85 q 40 12.2 - - - 11 42 t0 sMtt-otrHew: 30 0. (9.1m) 38 ft. (11.6m 44 ft. (13.4m) 2 0145086 s ,6 26 36 ,a 5a 56 as 93 Model 151 Models 152 / 153 GALLONS 67132 67132 LITERS 0 40 80 120 160 200 240 280 320 3110 3 718 45/8 374 -4 518 FLOW PER WNUTE 0145M - - CONSULT FACTORY FOR p. 37A 3 SPECIAL APPLICATIONS 370 3 7M I • Timed dosing panels available • Electrical alternators, for duplex systems, are available and NPr supplied with an alarm I I y i • Variable level control switches are available for controlling I _ single phase systems j • Double piggyback variable level float switches are available for variable level long and short cycle controls • Sealed Qwik-Box available for outdoor installations - See It 11/16 121/8 f FM1420 - • Over 130°F (54°C) special quotation required I 415118 $3M 15111521153 Series i SK2444 sK2o84 15111521153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2or3 BN151 115 1 Auto 6.0 Included 2or3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 N152 115 1 Non 8.5 1 2 or 3 ~IEasy assembly" BN152 115 1 Auto 8.5 Included 2 or 3 (pump & discharge pipe 5 1 On or not inducted.) E15 0 to Induce or 15 Non 1 or BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 §E153 230 1 Auto 5.3 Included 2-.r 3 SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variattie level OPTIONAL PUMP STAND PIN 10-2421 float switch. Refer to FM0477. ' Reduces potential clogging by debris • Replaces rocks or bricks under the pump 2. See FMO712 far correct model of Electrical Alternator E-Pak. • Made of durable, noncorrosive ABS 3. Variable level control switch 10-0743 used as a control activator, specify duplex Raises pump 2• off bottom of basin (3) or (4) float system. • Provides the ability to raise intake by adding sections of 1 %z• or 2° PVC piping a catmoa • Attaches securely to pump All Installation of controls, protection devices and wiring should he done by a qualified Accommodates sump, dewatering and effluent applications licensed electrician. All electrical and safety codes should be followed including the NOTE Make sure float is free from obstrtletion. most recent National Electrical Code (NEC) and 010 Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2010 Zoeller Co. All rights reserved. Page 10 PLOT PLAN N Project Name: Harshbarger 4 Bedroom Mound Legal Description: SE114, NW114, S30, T30N, R19W P.I.D: 030-1087-70-000 Subdivision Name: High Ridge Court 1 st Addition Lot 29 SCALE: 1" = 40' Township: St. Joseph Parcel Size: 4.910 Acres County: St. Croix Contour Line Elevation: 95.96' Cell Dimensions: 6' X 100' 4 inch Sch 40 -ASTM D2665 System Elevation 97.71' Mound Dimensions: 1118.31'x 28.80' 2 inch Sch 40 -ASTM D1785 Slope: 17°l0 1112 Sch 40 -ASTM D1785 BM1 Elevation: 100.00' To of 2" PVC pipe BM2 Elevation: 97.13' To of existin se tic tank inc ection cover ■ Backhoe Pits: Existing Tank: 1200 gallon Se tic Tank New Tank: 750 gallon Dose Tank with SIM/TECH STF-100 Effluent Filter l 7'15 7147 EX/Sr1NG PeAw ~ r h IGt: r7 1 Pal' S C14 1"o P y'C . 750 GAL 005E TAN 1-, i=K/.STINfc c w'+ SrsM/TCC\ S7F-It~0 g ►y,nGrFL 1 i 63 ► l ~ i y BcOlc 001M i2.y~~ a 6 l NoLsS+= 1 `l P, V R ~ ►n? Co(,IIJT`I Pl) t Page 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Roland Joan Harshbargor Mailing Address 340 County Rd E Property Address /I erification required from Planning & Zoning Department for new construction.) City/State Moulton, 1 54082 Parcel Identification Number 030-1087-70-000 LEGAL DESCRIPTION Property Location '14 , N t1, , Sec. 30 . T 30 N R 1 W, Tawn of St. Joseph Subdivision Plat: Lot # Certified Survey, Map # Volume Page # Warranty Deed # (before °?007)Vvlume Page 41 Spec house ®yesolo Lot lines identitiable Oyesono 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 heeded, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(, 1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to subunit 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 II ) the on-site wastewater disposal system is in proper operating condition andior (2) after inspection and pumping (if necessary). the septic tank is less than 1 /3 full of sludge. Irtive, the undersigned have read die above requirements and agree to maintain the private sett;gage disposal system with the standards set forth, herein„ as set by the Department of Safety= And Professional Services and the Department o€'Natural Resources, !Mate 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, t,'we certify that all statements on this form are true to the best of my our knowledge. I'we atn'are the ovvner(s) of the property described above, by virtue of a tv~r anty deed recorded in Register of Deeds Office. J Number of bedrooms /17115 SIGNATURE, or 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. (RED'. 04/12) Page 12 R ,P, EIVE® Department of 32 C/ E2 `3' ` 20Safety and SOIL EVALUATION REPORT #1797 in accordance with Comm 85, Wis. Adm. Code Page 1 of 4 ' Z sRefx o~Pr~4~SlOna) Services pF~/ G~ Schmitt Soil Testing, Inc. ~0MIaQ =1QW pl~iiMMFF'br1'paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I . Please print all information. 030- 087-7 -000 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Rev By bate /4 /5 Property Owner 7Property ion Harshbarger, Roland & Joan SE1/4, W1/4, S30, T30N,R19W ck # SubdNa or CSM# 340 Cty Rd E CSM Vol. 7 Page 2052 City State Zip Code Phone Number City [l Village ❑ Town Nearest Road Houlton WI 54082 651-402-1387 St.Joseph Ct . Rd. E ❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Glacial Till (Santiago Series) Flood plain elevation, if applicable NA ft, General comments Area is suitable for a mound system. System elevation is 96.71 based off a contour line established at 95.96'. Slope of area is and recommendations: 17%. Depth to limiting factor is 27". Boring # 0 Boring / Pit Ground surface elev. 96.70 ft. Depth to limiting factor 27 - in. r-Ef. Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 1 0-4 10yr3/3 none sil 2mgr mvfr as 2m2vf 0.6 0.8 2 4-20 7.5yr4/3 none sl 2msbk mvfr gw 2f,2vf 0.6 1.0 3 20-27 7.5yr4/6 none sl lmsbk mfr gw 2f lvf 0.4 0.7 4 27-72 7.5yr4/4 m2d 10yr6/6 sl 0m mfi 10yr6/2 0.2 0.6 ❑ Boring # ❑ Boring ~n. Pit Ground surface elev. 96.70 ft. Depth to limiting factor 29 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfF#2 1 0-6 10yr3/4 none sl 2mgr mvfr cs q2m2f 2 6-20 10yr4/4 none sl 2msbk mvfr Cs 3 20-29 7.5yr4/4 none sl 2msbk mfr gw 4 29-68 5yr4/4 c2d 7.5yr6/6 scl lmsbk mfr 7.5yr6/2 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS S30 mg/L CST Name (Please Print) Signature Thomas J. Schmitt CST Number Address Schmitt Soil Testing, Inc. 227429 Date Evaluaiion Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 8/5/2015 715-760-1978 SBD-8330 (R.07/00) Property Owner Harshbarger, Roland & Joan Parcel ID # 030-1087-70-000 Page 2 of 4 F3 ❑ Boring / Boring # pit Ground surface elev. 93.81 ft. Depth to limiting factor 28 in Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application G Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-6 10yr3/4 none sit 2mgr mvfr as 2m2vf 0.6 0.8 2 6-18 10yr5/3 none sil 2msbk mfr gw 2m,2f 0.6 0.8 3 18-28 7.5yr4/6 none sit imsbk mfr gw 2m,2vf 0.4 0.6 4 28-42 7.5yr4J4 c2d 7.5yr6/6 7.5yr6/2 sl Om mfi cs 0.2 0.6 5 42-76 5yr4/4 c2d 7.5yr6/8 7.5 r6 1 gsl 0m mfi 0.2 0.6 F4 ❑ Boring / ]Boring # Pit ✓ Ground surface elev. 94.92 ft. Depth to limiting factor 21 in. Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A G D2n Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-8 10yr3/4 none sit 2fsbk mvfr as 2vf 0.6 0.8 2 8-15 10yr5/3 none sil 2msbk mfr gw 1vf 0.6 0.8 3 15-21 7.5yr4/6 none sicl 2msbk mfr gw ivf 0.4 0.6 4 21-47 7.5yr4J4 c2d 7.5yr6/6 7.5yr6/2 vgrsl lmsbk mfr as 0.4 0.7 5 47-76 5yr4/4 c2d 7.5yr6/8 7.5 1 sl Om mfi 0.2 0.6 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = GODS < 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 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 bf 4 Cobd6ded - r - Y: # Y _ Co nducted For: _ _ Sc,h mitt-&_ o Ex ua ing,L nc.; Name Roland &-d Thomas J. Schmitt,,CST 227429 ea Iarshb rger Address: 340 Cty Rd E SB6 Valley view Trait - City, State, Zio. HOu ~ ton, 5 082 f ~ _ S*er*et,WI-W26 0ne71 60-1978 Ph PID. 030-1087-70-000 ign®tu Lpt No. - - 10 LOgal besFcnptiOn: --S9lf4 fifW f4 S303?30N, RriVy Badkhde P` - TpwnshiPCounty St; Joseph Township St- Croix County- Belnch Mank 1 1. 100.Q6 of 2'' Pvr Pipe. f ~ - - - 8,&6chjMa* 2 V. 917.-39 to vf~i„spe gip{ r lc ti Sl 1 e % Sdale I"= 40 Contour Lijne EievOtion' 95.96 - COntbur din e Lent gth~ 10;0' « x i -ci _j » r , - J / _ _ / i r - _plNFrt~[,0 r r - t_ F y f - - _ t 1 - -r~ 77 : : .5" - dfZL; 1 /7% - ► i - - - r r - , - l 00 c OC) o mot. C r iii k m is - • s A N ■■o m mI $rg QQ~ y' y O a < cgs -a v~ mQ O z O a ~i 3 m 2 a n °a 7n" 22 ~$oA~N~Am o 3a 8' cr o i a33 L m O S Q m g N O -0 0 o 3 0 d ~l ID O 4 v (D m ~ m o I ' ~ O n obi o a o o W o °w ~C • CD 3 m cn C- is ° i. cn 1:1 L. c CD N 7 O CL S w O OD, N O A V CD 0 Ut O 3 C) 0 C) F N n j C) 0 to w C C j O O a s N W O ~ rn 0 ° V o m I i 0 o co CO U) n .fir. CO) CO) rn :3 a C) OOO~nI N• _ cnof a4 O O n Z c D N N co o (T v v o (n o m o CD ca N " y N 5. Cl N O O Z N I o DCDo O p a :3 a ~ CD ti• CD m v) m C (p N (D W N a 3 p (D o N A Z v d A z 3 p' C/) W O W O m o C Z p ~ A Z7 Z I H ~ (D I .o I a A n (D n N O m_ C Z o N m I , II I I' t I a I I ` fi I j I lv O ~ I A O .q O ` . N O p O CD i, ~ y Parcel 030-1087-70-000 07/29/2005 04:42 PM PAGE 1 OF 2 Alt. Parcel 30.30.19.315C 030 - TOWN OF SAINT JOSEPH 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 ROLAND N & JOAN C HARSHBARGER * HARSHBARGER, ROLAND N & JOAN C 340 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 340 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.910 Plat: N/A-NOT AVAILABLE SEC 30 T30N R1 9W PT SE NW NOW KNOWN AS Block/Condo Bldg: LOT 3 CSM VOL 7 PAGE 2052 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11/08/2004 779190 2691/13 EZ-U 08/11/2004 771402 2636/309 WD 02/20/2003 710409 2147/445 TI 12/21/1988 443990 830/49 0C mo 2004 SUMMARY Bill Fair Market Value: Assessed with: 5505 264,500 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.910 98,800 161,400 260,200 NO Totals for 2004: General Property 4.910 98,800 161,400 260,200 Woodland 0.000 0 0 Totals for 2003: General Property 4.910 57,900 130,300 188,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 313 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 7 CA$ 04 5;,r -6 K5 1 ` \ 1 1 t. ~f 13 ` - PR /N Roe r,,. OIT it I I ( t L- I,&qr-Sy5TeH 04 i 730 ~}G~LCS~ ®~~,~yF T 'NE 1 ~P N G' Lxf'T~ ORIf 6- 13 Y"., DR4401)vb- Pole' ,f~iY IS. Parcel 030-1087-70-000 07/29/2005 04:42 PM PAGE 2 OF 2 Parcel History: cont. 490/244 Wise-;r,rl 60partment of Commerce EVALUATION Division of Safety and Buildings SOIL AND SITE Bureo'u of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Page of Attarh complete site plan on paper not less than 8 112 x 11 inches in size. Plan must tY include, but not limited to: vertical and horizontal reference point (BM), direction and FFP-arcel percent slope, scale or dimensions, north arrow, and location and distance to nearest road. I.D. if APPLICANT INFORMATION - Please all i 7h - e a Personal information you provide may be used for se n Review y Date da~rypurpose (Priv y Law, s. 1'~.04 (1) (m)). Property Owner 7 l~ ."VIZ-~ -Property Location ^ o~ Cur h 4 f v G vt. Lot 1/4 Y&X/4,S T N roperty Owner's mailing Address 3d ,R `C~ fir) W T o / n~ # Block# Subd. Name CSM# city 7 /C ~ f 'State Zip Cod$",:: r a20~~ ~Z- ~7/~ ~fi`„`,_ City ❑ Village Town N rest Road ❑ N n Use: El Residential / Number o bedrooms %til eplaceme t ❑ Public or commercial -Describe: Addition to existing building a e en ved daily flow gpd Absorption area required bed, ft2 2 Recommended design loading rate bed, d/ft2 trench, ft gp trench, gpd/ft2 Recommended infiltration surface elevation(s) Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable forsystem Conventional Mound U = ound Pressure AT-Grade Unsuitable for system ❑ S ❑ U ❑ s ❑ U System in Fill Holding Tank ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles in. Munsell Qu. Sz. Cont. Color Texture Structure I Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 / ~ of ~ Bed ;Trench L. a m r ~ o?c Ground ,7 6^ ® /-1 .10 /t7)16/? o7C elev. 9.4 ft. y a a 6 s~ c w Depth to limiting factor t r n S g u~`dcsn p in. Remarks: r L i S" .2rPSr~ f -4-~ ii Boring # 6 ~ an E✓ C A, a 3 Fit Ground sC& u &fear elev. Depth to limiting factor .O in. Remarks: r ,dye y~ a CST Name (Please Print) n Signature / ~~cs J Telephone No. Address r' Date CST Number SOIL DESCRIPTION REPORT Page of PROPERTY OWNER a. 4 PARCEL I.D.# 2 Mottles Texture Structure Consistence Boundary Roots Boring # Horizon Depth Dominant Color Gr. Sz. Sh. Bed Trench in. Munsell Qu. Sz. Cont. Color Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Structure GPD/ft2 Mottles Consistence Boundary Roots Bed Trench Horizon Depth Dominant Color Qu. Sz. Cont. Color Texture Gr. Sz. Sh. in. Munsell Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor 'n. Remarks: SBD-8330 (R. 07/96) - - - ac) fl PCl9 i , 7.4 L 75" - 740, i ' I I i T I : i I I I 194 - Form-STC- 104 • AS BUILT SANITARY SYSTEM REPORT OWNER ic~iTOWNSHIP 577 SEC. T N-R W ADDRESS la 7-1 ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•T.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM / C, I I r 4. li~Ty i 6c' v 1 CG'S LL INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used T01,2 Elevation of vertical reference point: Proposed slope at site:/gam, SEPTIC TANK: Manufacturer: -Liquid Capacity: /_;17 e%i Number of rings used: Tank manhole cover elevation: 9 .7,.3- Tank Inlet Elevation: iJ~' Tank Outlet Elevation: Number of feet from nearest Road: Front, Side ,O Rear, O feet From nearest property line Front,0 Side,0 Rear, O feet Number of feet from: well ew, 0 building: ~'f` -6- (Include this information of the above pplot plan)( 2 reference dimensions to septic tank). CPR RRUFRCF CTnP P CHAMBER Ma acturer: Liquid Capacity: Pump Mode Pump/Siphon Manufacturer: J'Aafpp Size Elevation of inlet: Bottom of tank eleva n: Pump off switch elevation: Gall per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest operty line: ront, O Side, O Rear, Ft. er of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: 36) r Length: Number of Lines: Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ( Rear,O Pt. s c~ Number of feet from well: 76 Number of feet from building: !2 7' (Include distances on plot plan). EEPAGE PIT ize: Number of pits: Diameter: Liqu depth: Bottom of seepage pit elevation: Area Built Has either a drop bo or distribution box O been used on any o e above soil absorbtion sytems? (Chet ne). HOLDING TANK Manufacturer: Cap ty: Number of rings used: Elev o of bottom of tank: Elevation of inlet: Number of feet from nea st property line: Front, Side, O Rear, OFt. umber of feet from well: Number of feet from building: Number of feet from nearest road: larm Manufacturer: Inspector: = Plumber on job Dated: 41 License Number : C"'a 3/84:mj I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 y~y~ ` `MiONVENTIONAL ❑ALTERNATIVE State Plan l.D.Numb er- ' IIf assigned) Ill. ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER. INSPECTION DATE: Edward G. Brown Rt. 1, St. Joseph, WI 54082 -j-4/1 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SE NW, Section 30, T30N-R19W, Town of St. Jospeh Name of Plumber. JMPIMPRSW No.. IC,,,,,y Sanitary Permit Number: Donavin Schmitt 3205 St. Croix 79150 SEPTIC TANK/HOLDING TANK: MANUFACTURER: { LIQUID CAPACITY. TANK INLET ELEV TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER P OV ED. PROVIDED - lV{ YES ❑N0 ❑YES NO BEDDING . VENT DI, VENT MATF HIGH WATER NUMBER OF ROAD PROPER W~ B VENT O FRESH 4 J ALARM FEET FROM LINEILAIR ❑YES O YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. 1 1J -101111) CAPACITY PUMP MODEL PUMPrSIPHON MANl1F AC TOTER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED' ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIO NAL NUMBER OF PROPERTY ELL BUILDING (DIFFERENCE BETWEEN FEET FRLINE IVENTTOFRESH' AIR INLET' PUMP ON AND OFF) ❑YES ❑NO NEAREST W -D SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JOIAMF TEI MATERIAL AND MARKINQ 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: BED/TRENCH WID~C) LENGTH NO. OF r STR PIPE SPACIN(, COVEN NSIUE UTA -PITS LIQUID S THEN (:HFS MA RIAL PIT DEPTH DIMENSIONS / PP~~ GRAVEL DEPTH FILL DEPTH UIST H. PIPE UISTR PIPE DISTR PIPE MATERIAL NO DIST I TNEAREST UMBER OF PROP Ty WELL BUILDING. VENT TO FRE H BELOW P PES AB(Z E OVER ELEV INLF I ELEV ENU PIPES LIN LE EET FROM Q' AI N_~}T 61 15(-io-3 ! C 2G 7 / 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PF It MANE NT MAHKF HS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED = F TOPS 71- SODI JEF UFD MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO. OF L NO JGJAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD ISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV. CIA. ELEV. PIPES DIAJ DISTRIBUTION INFORMATION 111OLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: EET FROM LINE' ❑YES ❑NO ❑YES ❑ Sketch System on Retp~h in count Me or audit. Reverse Side. (GNAT URE. TITLE. DILHR SBD 6710 (R. 01/82) I 0 ~ wlsconsln APPLICATION FOR SANITARY PERMIT COUNTY DILHRA (PLB 67) - OEPRRTTT 1EnT OF UNIFORM SANITARY PERMIT # InOUSTRV,LRBOR&HUMRn RELRTIOns / 9/ yo -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS • - ~y Cr . ZOR&LAI 1, 5 25, PROPERTY LOCATION CITY: F 114 ' 1/4, S ' , T30, N, R E (or) oWN LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED -!U rNA 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: i New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tans ncrete Constructed Septic Tank Capacity I A/ Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): N53 ~ 0 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): Signatur /MPRSW No. Phone Number: "t _-e ( 7151 SY - ~ Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El Disapproved / ~ frJ b( ❑ Owner Given Initial G~J Q u bI Approved Adverse Determination Reason for D# p val( Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original'to County, One Copy To; Bureau of Plumbing, Owner, Plumber 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 of use (i.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) 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 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. 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/contractpr,("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 04VA Location of Property S,,c_it AL&I-It, Section C7 , T3 N - R c W Township Mailing Address tr r S T, Subdivision Name Lot Number NA ` Previous Owner of Property 131-20)) l EGU A11-2 .C~ Awn Total Size of Parcel ~,L9~Z S~~ivor3,oic Date Parcel was Created 23 Z, 22-9 ' 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 - as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 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) eent.i6y that att statements on thi.6 6onm ane true to the but o6 my (ouA) k.nowtedge; that I (we) am (cute) the ownen(s) o6 the pnopehty deaehibed in th.ia .in6o4mation 6onm, by vi tue o6 a wannanty deed neeonded in the 066.iee o6 the County Reg•taten o6 Deeds as Document No. ; and that I (we) pneaentty own the pnopoaed & to bon the sewage pos a ystem (on I (we) have obtained an easement, to nun with the above de cti.bed pnapenty, bon the eonstnucti.on o6 )aid ayatem, and the same has been duty neeonded in the 066ice o 6 , .ate County Reg.i )ten o6 Deed6, as Document No. :3 i., 9 `t ) . OTURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ` DATE SIGNED H Z H a ST C- 105 r r • a SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a OWNER/BUYER LjjW/+~J/) /,3/ 06VA./ ROUTE/BOX NUMBER R%,I Fire Number .CITY/STATE 5/, o7e)54~4A ZIP S14f1 PROPERTY LOCATION:syE__jt, )VUJ 1, Section 3o , T 3,C3 N R W Town of 5%6 75e N St. Croix County, Subdivision A/A- . Lot number A1.4 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. St. Croix.County residents may be eligible to receive a grant 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. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v 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. SIGNE DATE 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. v I ` (D w C C N o N (p fD n n N O_ o °3 wwwa~i 5 `<:3 3C o ~o '(D '(D ~p a' Q is 79 Cm(a :3 (0 a g oo ~m aN A COD ID CD ?(O 0 v co o 3 O. O n tQ~ W O (D C p w O C (C = O G S 7 = wC = N 1 w O p ,c c- C r- 3 a 00 T. jwrn ova ~ w -.vv D < N N ~co Q ? mv,: oDc_(T CDC G) G p = w C~ ~C w i w° a Q cD 7 w O p o ~m N mM~roZ n (Ji 0 N g 0 D Z w = ~w r•~~v m s cD m CD CL C o 0 3ch(00 n a CD CD N C (D 0 Er (O M ~(7 O m wva 2wo v;wa a C D 0= Mo. C 0 m~ C m v 3 CD ~ MO ID B- m CD S (D (7 O w S ° ° alo w3m~_~'~ O ° o N. o t° D 0 c ao* aicCCwo m w w (D - :3 CCD avi a a ao Q3 ° ACA c`~~~ ~~~'o=rm3 m ~ D. ~ G) cQ ' o (n N ° c a o o a c C CD m C 0) CD g~3 °O-moo°°3 =r c am ~o :3 ca. 0 < o o` : TMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IDUS USTRY, DIVISION N LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 JMAN RELATIONS \ MADISON, WI 53707 ` (1,163.090) & Chapter 145.045) ATI N:~ E ION: TOWNS HIP/~: OT NO.: BLK. NO.: SUBDIVISION NAME: S w'/ 30 /T3o N/R/98(or tr 'aase A - - JUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: . Cm;x 1 wAr ~oL✓A/ a ox S_io sf. 7-ose Gc/,'s yaz- :E NO. BEDRMS: COMMER A ESCRIPTION: DATES OBSERVATION MADE Residence PROFILE NS: A N TESTS: N ❑New Replace 3u- X~ S~ MAP l %TING: S= Site suitable for system U= Site unsuitable for system SA pZ s-'#'✓ 1-:4 f~t XU:9/+Z )NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM: (optional) (CIS DU f~S DU ZS E]U DS 9U OS R111 oe,~ ~•o,~,./ e~ 3u~xs(c,' Percolation Tests are NOT required DESIGN RATE: If an tder s.H63.09(5)(b), indicate: any portion of the tested area is in the Floodplain, indicate Floodplain elevation: PR FILE DESCRIPTIONS )RING TOTAL/ ELEVATION P HT R UNDWATER-ft#Crit: CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTF4 1MBER DEPTHw, OBSERVED S I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ' or 6' 00, 0' maw o B S,r/ 0 t3•, si PERCOLATION TESTS TEST DEPTH/ WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES JMBER ~IWQ6iE6 AFTERSWELLING INTERVAL-MIN. P RI 5 RATE MINUTES RI D PERIODJ PER INCH V, 3 0 3 0 7 JAI o X 3.4 o 3° s 9 i 5-3 )T PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- tal 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 and slope. (STEM ELEVATION 93, o ' 4e 6 fle Alt, fie F, s .on - - f - - ,mac o I 0 0-V pa/o: _ I ceen e,►-~ ; c~,~ Foust, J/J3+d got (v . SS _JN F r 4 I Sc 1i9 il'e died j - , I 77-77 V~ l Sloe he 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 ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. MME (print : TESTS WERE COMPLETED ON: t l . C~ /vx"e' /43 V 1,,2 - O )DRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ueP/ vP lGdlvv s /s y ;71f / CSST~~Qh{ATUR s~~~))jjjj1~ r STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LHR-SBD-6395 (R. 02/82) - OVER -