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HomeMy WebLinkAbout020-1439-29-000 County y Safety and Buildings Division 6Y, n~' A S , r. 201 W. Washington Ave., P.O. S B 162 Sanitary Permit Number (to be filled in by Co.) T ` p OCT t ~ 2 20 15 Madison, WI 53707-716 ? T. CROIX COUNTY ~ ~gIaZ J 041 INITY DEVELOPMENT Sanitary Permit Application t`TransactionNnmber 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 Pro~lect Address (i ffe e than Wing + the Department of Safety and Professional Servies. Personal information you provide may be used for secondary .i{ C1b1~ dt LdWj I ( X purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. /j U 1. Application Information -Please Print All Information ~.[-aT Gi T ® Property Owner's Name v Parcel # at - A('urp qdj k,,J r 7 7 I~IdGl) Property Owner's Mai ing Address Property Location l s t a 5 S 3 `j 61-1 Govt. Lot cX City, State ~;1617// Code Phone Number /4 1/4, Section 4~ ,QCC /}~/n .J/~ i~ -(circle on II. Type of Building (check all that apply) !Q Lot # T o~~ N; R E oit~W Ol 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name O lc ~ Bloc l f"'(J ❑ Public/Commercial -Describe Use 1~ a JS fe; ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 3 ~ T rl' 1 I cL Town of c~dfr III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) p A' -KNew System ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued R. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner Vi W. Type of POWTS System/Component/Device: Cbeck all that apply) 2~Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of 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 Rate( f) Dispersal Area Required (sfj Dispersal ea Proposed (sf) System Elevation OVA 4s-~~ ~ o `r a 113 a 7l0 9- 6 -q1 C- 7 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o e v New Tanks Existing Tanks o 7 m 0 5L5 a U v V w 0 0. Septic or4iQ1di&r-Tiffik Dosing Chamber { VII. Responsibility Statement- I, the undersigned ume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI ber' Signature MP/MPRS Number Business Phone Number J~Y Plumber's Ad ress (Street, City, State, Zip Code) VIII. _Gounty/Department Use Only Approved Permit Fee Date Issued Issuing ent Signature rven Reason for Denial $ T If 16/ t)6 r/a 3 IX. Conde tPA oWeasons for Disapproval a M ra 1 1 " 'tank, eff tant,fMer end 3) 0 dispersal cell must all be services I maintained *$perlnanagement plan provided by plumber. aZ se6ok'K requivemeft,n st be naintained as PW a code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 12111 inches in size SBD-6398 (R 11/11) Plot Plan Page Of P'operly OhvnerY Los, c. LegaiDesCitlon 'iP I-~ ~ iac 011ups,= (except where noteu SEi 4 OF E c' 4i 3U~ _ > @ l 2s Tz4, Ric( WJ~ CF M+.t~Sgx! gT C{ iZ~tX s ~ 1 i~S~/b Si A4 QZy ~~C%~S T North I ~l4.r/I )V..XTO Ph -I, ~ r y'0 = TW -volt Prey j G r35~r~~~rG Zg x~~ ~~..AtL1~ /VEW wr`s Assal ED i r,Qao~t. Sd mac. e v J00, Ott 4 >zs-'U 5EPT1C -fAXK 7,50 7v iz S~lkb' JW rRtu= -7ry g1, Site Location.. ~,!Co YL CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITtE -PANE Project Name: R y D EL nlss Owner's Name: PAR l t.CE R V DC- L Owner's Address: 2-1-36 /VI t NN E 1+A HA AVE. 0 ~'Au~, ~ytn1 SSllq Legal Description: PRT. pP yy DF r~(~ N6t~~l Sep, 'rZq~11, 1Z(g vt1 Township: ffu7~5c~~9 County: eRoI~C Subdivision Name: 1W-blaQ PONtjs Lot Number. 7_q Parcel ID Number. 0 ZO -I y3q ;zq-ppo ~,R®~®sgtttuiufrtUbiiiioo Page 1 ot Platitle e1®~~ Page 2 In Plex and 1 Page 3 * MARY J® page 4 _ System Siztlter scesSestion *I pecs HUPPERT - Pa e 5 D 1559 9 Maintenance Information RIVER FALLSZ Page 6 Management Plan W'1 Page 7 St Crobc Cty Septic Tank Maintenance Form 40,~+,r~►`~~~~` Page 8 Warranty Deed ~~~~~►►unul~u7luuttat~~~~`` Page 9 CSM or Plat Attachments: Soil Test & House Plans T-MK s> PR MP C v-RVE Designer lumber. _ /ARy z'o .I.t.u ftf - License Number. Date: ~ -607 Date: Phone Number 7/S-42C,-171S' Signature 0 Designed Pursuant to the in-Ground Sol Absorpton Cornponent panuai for pDv-S Version 2.0 SBD-10705-P (N.o 1/01). -pa€)e 1 Plot Plan Page Zof t7 ProPer'y 0wner R v L +V0M!5., XA e-, ~ &tY8r,. Sob &Nwie Ksu-y 1» _ 40 ft Legal CTtP~IO~ t o r 'Al D ice.' P&. S. t-r-T._ ~P..xCe w Wkere nota ff S-`h4 OF ThE AIe'14- . Z5 TZ~IA~, RioW►_ _ aCk ll1e t ?OWA) OF 1~ s gT CR a~C tzn~s~2 l tiSE SI Z+OZy A&VA5 Nor& #i =Top of w2Y0R PIPE ~-'rO 8b• t ~ h >25 = to 50410 lmK 7150` z s~ W TREE= 1 ocgzjJo a Z~ - Y .D . R0,Vt s -TAJC.t Page -,-of-_ 1- or 2- Family Dwelling ln:ffgMfld Soil Absorption System .1c 11 Coma- " Daily Wastewater Flow (DWF) = 3 # of bedrooms x 1S0 gal/dav/bedroom = 46V ga1/day Design Loading Rate (DLR) or Soil Application Rate= D • l gpdW (per SPS Table 383A4-1,2, or 3( Required Distribution cell area = DWF IqO gal/day + DLR d+`7 gpd/fe = ky, SAO R2 # Chambers = Required Distribution cell area g9 Z. f~2 ft2 : 2l) ft2/ unit ELSA = 33 Chambers chamber manufacturer and model: BSI Q44( 4 6swb -o Az Actual Distribution Area =Total Chambers distribution area R2 + /0-7- ft/ unit ELSA End Cap Pair = 7Z1, ZR2 Crams-Section In around Sod Absorption Svstem~}: Max Smy Depth =limiting Factor 11-4F- inches - 36 wwhes = inks or le. 3 3 feet 4- Schedule 40 PVC vent pipe: with vent cap AS~TM# 17 j 12 inches minimum 12 inches Minimum 90 ft T1 FG g I ~`i DO f t T3 Final Grade (FG) ft 72 FG tZ inches Soil Cover j?= inch Chamber Height Trench 15ystem Elevation Trerectt 2 System Elevation Trench 3 System Elevation ft ftg 9Z _,5FO ft 36 inch minimum separation from Trench Bottom, of System & Limiting Factor Separation j Limning Factor = W/, inches Plan View ingmwW Soil Absorption Svsfiem (3-cell). below ground surface Trench 1 ft Modi fy header/ -EW- ft Leaching Chambers r design as 4( Trench 2 needed. 4 inch Header Sch. Trench 3 ~ J _ 4 ft with end caps Draw O for a Vert and ! for Observation Pipe above. They vA be located R from the end of the cell. Vern pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. qWC) Fitters PL-M EMUEAff ALTER Polytok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm aO08 t (gallons per day) making it one of accesamy the largest commercial filters in its won fesWle class. It has 525 linear feet of 1/16' fittration slots. Like the Polylok PL-122, the new Palytok FL-525 has an automatic shut off ball installed 9% snow teen with every filter. When the filter is of 1/16' removed for cleaning, the ball will filbudon slots R - ' for a float up and temporarily shut off 10,®00 QPD the system so the effluent won't leave the tank. No other Mter on the nmwAnt can make that cairn! r W_ PL 525 Maintenance: The'P6525 Effluent Fitter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified ) by an alarm when the filter needs Cis door servicing. Servicing should be done by a certified septic tank Automatic skut-atf pumper or installer. bM when of 1. Locate the outlet of the Us. Patat aos 6A15AW septic tank. S A".640 2. Remove tank ever and pump tank if marry. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull P6525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6' outlet pipe. If the fitter is not centered undue the bade into septic tank. access opening use -a Polylok 6. Insert the fitter cartridge bade Extend & Lok or piece of pipe into the housing making sure to center filter. the fitter is propedy_aligned and 4. Insert the PL--525 filter .into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. f feb-26.2013 01:22 PM St. Croix County Plan/Zoning 715-386-4686 POWU OWf#W8 ~AANtl . to MAMA IiT PLM rum mYiEIN S1fi1B1 ~IQATIONOt Cw1Nt DEl , H pA:.~S Sq~C - M# # 8apdo Tank CrpeoAtr I. C00 m 13 NA Tank UXE51K D NA oee~ati PPA gMuenr AC~ber Manufioa~r CYLDK 0 NA N~anbar of 8edtoaNe~ D NA am"O t moor &Smdd Nnenbor of Ple6ie Fio~tt► t7eeib S Z~ Q NA NA. PUWO Tank Caper (1056 O NA d flow Oew#4 y 3o~y mmy t~ Tank Menukomw W tiEsEi`t t2 NA Dedgn flow fps*, WSlineotad x 1.5t LISO PMV Malt z{}E D NA Sol APPOOmOn ~ 0, fb" tai " 9 13 NA Sandand Aelfae~ amaky mwwwmaw PtMeaneeant !Ante Fib. 01 A Om m DION 00 ~ D SwWV&svd F%w tl POK Fftw 00*4W"W Q"m Dwmnd MWJ sip a*& U NA n MS*w W Aeration Ci WftW Tod Ougnnded 9opde MW s1 MO mg& Q 1 [1 Odw. Pralesated Emme Q,~y M dMV ~ MEPN*d CAN O NA tlioct1a dod Q wm D=wW MMW nO s~ TOGA ~ensd OWs MW 980 mq& D "A 0 i Cl In-6eound Fiaw Cattfoeen igaoenetrta Moen! *10• ote 000 AMMMe O D mound © Otiear: Modnaen fhftlale she 14 in dbt p NA 13 NA DNA DNA 'VAm rAft t fwdoaNetlG w~woeer sad aepdo fault dNaM : D NA MAMf>>'EIMANW E salrleli Eenttee !1Wdw kalpmv haepeot, adon of tenlle) TAthmtwm Umn once evaey: 3 13 iff"Mm ftWedaewn fl i DNA pump am eoneaeete oft hen oonehined ebop aad soon G*mb aw4*d 141 of tank voMm O MA mot I GdW may, c law .3 0 1~Hadl■ela 9 r D MA At but elecn any: O kMW PeNtp` POW GGM8ft j A mWm At beet ana ~n►: ~ vl D ~ LFkmh'mt era k and P~ toet At bm mm @My; 13 ar: 13 NA At lest a mm rwey: o yes" 3 NA MANTSIANCN ~p a t+U4 ~ Of taadce .net dip ed eel eta be Mr r hlunOf t nadr blr an bduMM one of the *4w AA g goaeeaa Inns! Moiede of fS to; B Ajmhgmkw or ~ ellasaa+er flea "k" of Combined ta"W0I o % kiaeWy m aay MI lot or w h s.wdwww,~, , ftrAdle Mato. To* dudw wed mm and to cteaok for any made dP maim The AWwW "M OW be my in .0 Ron ON A so of efftw on to vwXw m GfAeMet bwb In 1w oban, of smm* cm in glowed aRfeoe. AM " to - 2.1 for any pang" rdew ft of do loud fork" vidwhy °n ft eevextd oeeefaoe mq► irdloate a faiirgt oolttNflOn and regelree When dee aombb " a of dLul" and mum in of the tank dW be remw A d by a sW tonic its attddnd pal or move of on tarok volueeea. the antke wboomm AA*dvwAwO CodL "oe Swde%g opsrater .d dwpoeea of in aeeoedtnas vft dmpbr N" I la, AR adeer sa*M kwkmft bat not MOM W the MMMM of ant anldL end any mvWft * %br4* of 912 nwrdhw et,.It 1,e h PO ar si . P + inert AMfarmad by a osrdflsd P!OYVTffi fix. A asrdioe report shah be pnrri" to the hmW foggy auft ft rw* 10 da" of ooeepjgjjn of any serAgo OML reb•zb-2013 012Z PM St. Croix County Plan/Zoning 715-386.4686 START UP AM 01tFItRTM fw NOW "Noboodon. PdOr m um Of tba POWYS do* tlsa me tetd,11d for as ~ ~prarkeoes ar adrar air.rromtm of nW kr4wk Vw h o8Wrerre praosp atwifec dam *I d IPetsaimIW. If Pave hdai o onoantrdi Adam a demeebd haw the aNnmeab W m owd by s 1-0 prierm ugs. sltsrstr smart aP 411011 net Neotr wish =9 - o dldmm we *am at Ow kWftWlvo aurfaw. Uw* Howe 08411010 DWO tab my flt above rwmd hi0hmmow krsk. VAm pow in astorso, tits amomae waeaowoaer VA be ibs dipana{ + 1R oas doeq, atiaio1ip lies Oft Md amt r b ft boobiP or VWJW s► diAapa of dOWL To avid thk dmetion hams sm as t to of tits Pump ft* rim mm v by a OwtW s9onoifg opal prar w nwm ft power m the effluent Pump or concom a Per or pOWM Il er fo amft in n10nva~t e<Paa11aB , Pump 4anksk to r+eatois w a no kvak Whim that punm tEdL 0 1 feet down v4ld~dos over taM4 and dow" coft 00 W dd" Of Park evr, or G*An kit OW" or compoy the was YAM dWe of ally mum or ojVm& ad absoMft SML Fbduc*n w obnk lbs of tM folw#ft *um the weaeND om W IM I may ieya+ m tiro porfonr10tos and probeg do ft of 1110 M wlpesl olgetetme bertgc eoeabmet eotmn weber treproaDera: doatat tinmm; dlaporw tadrdagon drah (mm pumpl wwr. frab and rNSetdrim p t1< aC Nm,- mew -P "'thil P*km" pew aentt~ey aepOW tampons; and wamer m tww brine. wrap.; AeAl~aolv~tT 1AAka the POWYS fs% and/or i pw#rm ndV taleen oat of eanrbs thD fogowtip wap4 Miap ii. taimm m brnea then rile aystrn in w"§* and sassalst "Woned in conipsknce with draptar cow 83.33. Wioondn Adndnhnrathte 4~WW • A# plpkta to lefts WO PRO Ad be dbowm cmd and the abandoned pips upmbW SWW. • The oontwror of an tw" and palm ~60 mmvW and pnopo* dhoon d of by a AoptW ljervioitr0 ppd. • Afmr P MWQ. vii tanks and pia shah bs eomv and atd ismawd Or their oovwv ramowd and the veld open fmw WO $4 owd or woollen hn soil mau riaL OONTOGIMM PLAN ff~ a be rep@k I tM foiiowiio noeewaea haw been;, or mum pe W", 10 provkla a code oompka JW A adbebb mphosrrmrrt am ham boon wdugsd end mW be uttod for the Icwtiorr of a roppoemwt we abwrpiion arcs dould be potacted loom d a and won and dmuld not be lyd &VW up" by ad Pmpased 8bU tw% lot BOND and Wass. F kw* to potent In rephu mment ens VA aesuIt In the need ft a clew soB and db mdaation to eslablbh s atdpible mphowmawam Repbommant slrst4ma must 00m* WO the take in affect at *a flare. Q A s<nea6fs rapkio•rrrmrrt area m not rieftbb due to setback ardim sob 11whodona- ftaft aclmwm in pOWT8 W a holder left awry be MUM w a >aet re n lb p 11, C tits fined pOW T& The aft bw not ban wnb* d to WWOV a suksbie replown a welL tlpon IdWro of fjw POWYS a ss8 wl cite 'tevsk"ItIm nwrea be pmf=. sd to boats a callable repioo"Faw ON& lOwif no area b avva6ie a holding W* bD>treuamaeaMetaccent O a~ tits lased flowT8, 13 Mound and aWada aS mbmorptlpn strste m mat be reoovwteaetsd in plans fos..ft tmewvd of the ,1, at to i ativa surfsos. Aasonatruatbaa of arch aystams rewist com* vm to ndw in affect a: that tbrw. <-<W » . PWW AND OTMK T WAT `TANU MAY COMAW IMMAL MMM AMWR nqUfflC*W-j e"jCieEN. W WO W#' A O&M- PUMP C" QTtMw-TMATWNXTTA= ANT c9=4's-, POW T3 iN3TAilAt Pt1WT5 MAMIITAMfdi Name OWN S w i-c-r 1Wma ~Nlt1 lS ~ ~ tT'C NNW ~►5= g 2 i -'-ft°8Z" F phone r77;3: gZ ~ _ t "z- Bffr*Wm rtPatA r:t~cAt. ri®arAArawy Aun+onr, Mom r EM DARR~tlS Sep-r~c. 5~2U(C~ ~ LR011C uNT, F"bWomW ~(?r5} '4zs- foe- 4.3' z 84' w it n it >ts 1 C 'O 'Q ! O ! ~ ii~ r 1 I e LO-) D i x 41' v u N ps m c 1 D C> 2 C y A Dg 2 N m m cn O oV 2 Z yyO Z Z O 0 Z Z O C Fn Fn apcn m m AZ C) rq Z~Z A o~~' QAD GAc:w*9=c0wfZp m m W O Fuf +p DO DAO ROO ~go~cZi 2 ~FZ U) C) x D s \NO D >y-4 y o ~®-PN~w ' 0 Zg o p~ N11~ m w~,po O C7 p a < a O N D + 0 Gi O sv O) 2 .Z C R~i z A D ~lw I~*! imp_ tD v tQ D O r~*I 1 C) m r r*1 0 D O r Z >0 0 Vl D ,fir 0 M mN-1 N N to 20 C X-C Oi 0 V Zm3 2 0 n -0=1 DC Z ~1 C 2 ~ r- D t C) 0 ~ m r m T WLP1000 650-MR ~ BGtE:1 r - 1' REV NO. DAM \ SEPnc MANUAL lit MAYM orswr REV. JAN. 2008 1° a mac o MTL- OA)m" 2ooB 800-325-8456 nm-um oo am-ia~ ~ HEAD GPACf1Y CURVE MODEL "Wr 30 4 5/11 a _ zs e g 6 3 5/8 is f -l- ° 4 O ,o 43/16 g z s 0 1 1/2-11 1/2 WPT us Ci1L.tANS 10 20 3e 40 50 60 7a so tJ75 a 80 160 240 FLOW PER 11611E MWEX 98 60 CYME L VA Feet GWW Yewm tAers s 12 t3 213 m of 3 t 231 is 4; 4$ 170 12 lsr rY.e as .~1 ~>j 4 3/16 iax sAs CONSULT FACTORY FOR SPECIAL APPLICATIONS ' EWCWc i aftna m for duplex syshom are avakkis and - VariaWo level float sudchos are avalabie for conbof q single stlppt3d wilfl an alarm and >#ree ptme systems. WKhardcal adienrae, r N for dupiwc , acs avxwkbie - Double pogybedc variable iavd float swftchas are aaa6able wda or vaVm nt alarm mwMae& for vadobie level long cycle ccm * ols. SELEC-nM GMF Standard an models -Vlielgtlt 39 lbs. -'/z H.P. 1. ~aao4 0Pew1sd2PdeaiadmiaaiWAUk Ru®daenaFooiMiol~quwd .,Sends 2. Sxq ft piggy' I %u*d ne ierd foal swill ar&Mft pgpyUetit variable lard. /.'armme selec6ml foalseidL ftfhrbn%AT_ Yodel 11POns.P11 Yede 3 Yedraniwla0na1or104I2or104W8_ M8f 118 1 Ar11e 8.4 1or1&'r - 4. SbsrtMi'12.tilrtoorrectmadeicfEb*ic lAfemalor_ fm 115 1 Non 9.4 2 art 6 6 3 or4 a 5 5 a 104M used as a aonYd atf tor. gmciFtr dapku (3) ar (4) an 23D 1 hiio 47 lortai7 (L Emir(4)honeJ-PAkAw *wbmfor Gommmomoruke" Ego 230 1 Non 4.7 2orZ&G 3or4&5 sa,eP19K-&gftKapetaion,1 N)MM Z Two M)hobJ*WforwMai1W co rnecionorspke. L'r1UTM ForibiwiioRm adofool aostlrP wnrb cmkbg m F(M' er* 19 -o"- tird Smb*m All hwAaffition of controls, protm:dm deriees and wking s6wdd be dare by a quaffied 67faW. Rid electrician. AN okchialand saietycodes sb=M be faromd indudng Ube amt ~eP~SeSiwfne~nAwpC--mb f#Rf.9 kAkw %p1wK nxnffl PA*" Etechk Cole MG) WA the o aaf safety mW HeaM Acct is RESERVE POWERED DESiG For ling Cori Moris a reserve safety Uckor is erq*xm ed hAD the chsigrt of a very Zbeher pump. - tnrlxxor PA tlmC1if17 _ JariNi.61f -'4iYliildeemd._ t~ ~7ak ,7PALlieetioriad . taei7ris JI1(a?M-1~'I b11pr11iwwrmMlrcew FAK(W i C% 3~-i ~yD~L 440MF S ~ti - PUMP tNM'iidEit CRaSS SEtTM4 PAST OF Ai1iD SI'EUF1GTtONS „r~W_4-iEAt- VEWT CAP c. 1. VE NT PME - WEATHEwacoF wPPROVaa L0CKtt+t6 ,AtN[TtOA1 a" E cow" MNTM • ~ 25' FROM 0001[, W#4047W OR FRESH t2'MtU. Lr1"L AIR A)TAKE GRADE ! 16, i II,paLL 1 _ 44 COUDUIT - - J t~ IA/LET PROVIDE - i AIRTtGIiT SEAL APPROVED JONT A i w/c.=. PIPE APPRWIMD ,tMTS ///.L PIPE EXT£NDtU& 3' 11.1 ALARM VUEUDIUG 3' OUTO SOLID SOIL ( I am SOLID ZWL . t t ! j Oli ~ G - ELEV. FT 0" Q COI►i[RETE lsUOCK RISER EXIT PERAI'I Ea OUL3 W TAUIC MAt1LW=T(J tX HAs; 3=14 APPROVAL 3" APP1ioVEB 6EQQtneG urldoe.Tl4witc. - SEPTIC E SPECIFfCATtOUS DOSE ,O TAUK% MAMUFACTURER: Wlk Zl2 LXMWR OF DOSES:- So AV/ -PER DAM TAsix SIZE : - (050 SALLOr,IS HOSE VOLUAC ALARM MAWIFACTUILER: ziloNo:mit S lwx"otuG "CKI L~. t;ALi.ONS AODEL LJUJASCR: _-i~ M CAPACMES: A. Z► Iw1CW OR t, L-ous SWITCH TSPE: Bu SUCHES OR SALLDUS jg~g PUMP MALKWACTURCK: --~'-LL t a J~IyCNES OR GALI,OUS NIODCL UUMOt:1t. 4qg D:-~.L ...INCHES OR GALLOUS SWITCH TYPE: UOTE: PUMP AMD ALARM ARE TO bE MIAIIMUM DISCHARGE RATE GPM ))WS~TTALLFD OU SEPARATE CIRCUITS VERTICAL DIFFERELICE bETWEEM PUMP OFF AUD DISTRIBUTION PIPE.. FEET + MIjLUMUM NETWORK SUPPLY PRESSURE ~~e;.... 3 FEET ♦ PEET OF FORCE MAID X Q&!FXrtF ttCTIOU FACT0R..,,_0A,A FEET TOTAL D%UAMIG MEAD J 7,7-z -FEET --IUTEKUAL OIMEUSIOUZ OF TAIJK: LC3`•TH -,WIDTH j LlautD DEPTH J 75.7 7- Wisconsin Departrrlent of I evices Division of Industry Services y SOIL EVALUATION REF' Page 1 of 3 ST CROIX Cik~~WNF nnca with SPS 383, was. Adm. Code Attach complete sAd_W%Y a fR I I1I2i1 VKra~T County ST. CROIX r x 11 indles in size. Plan must include, but not limited to: vertical and horizontal rellerenoe point (SM), direction and Parcel I.D. 02 - 1439 - 29 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print aN iTnlfornodon. by Date Personal Wdonnabon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property owner Property Location 0 ED RYDEL HOMES, INC.(Buyers: Bob&Connie Kelly) Govt. Lot SE 1/4 1/4 S 5 T 29 N R 19 W Property Owner's Maw Address Lot # Block # Subd. Name CSM# 2138 Minnehaha Avenue East 29 Indigo Ponds City State LP Code Phone Number Elcity © Village own Nearest Road St. Paul, MN 55119 ( 651) 402 - 1470 Highland Drive E] New Construction UseM Residential / Number of bedrooms 3 Code derived design ttw rate 450 GPD ® Replacement ❑ Public or commierrial - Describe: Parent maternal sandy Flood Plain elevation if applicable N ft. General comments Conventional In-ground trenches 0.7 loading rate and recommendations: FTI Boring # d Boring Q Pit Ground surface elev. 98.90 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenm Boundary Roots GPD/Pf in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -0102 1 0-12 10YR2/I - 1 3fabk mvfr cs 3vf-co 0.6 0.8 2 12-23 10YR3/3 - is I fsbk mvfr cs 2vf-co 0.6 1.0 3 23-69 7.5YR3/4 - cos Osg ml cs l vf-m 0.7 1.6 4 69-100 7.5YR3/3 s Os dl - 0.7 1.6 Horizons 3& 4 have so gr, few cobs. JI 2 Boring # 0 Boring 0 100.60 112 Pit Ground surface elev. ft. Depth todlo9 factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDdf in. Munsell Qu. Sz. Cant. Color Gr. Sz. Sh. -Eff#1 -01#2 1 0-4 10YR2/1 1 3fabk mvfr cs 3vf-co 0.6 0.8 2 4-14 7.5YR3/2 _ sl if-mabk mvfr cs 2vf-co 0.4 0.7 3 14-42 7.5YR3/4 - cos Osg ml cs 1 vf-m 0.7 1.6 4 42-112 7.5YR4/4 - s Osg dl 0.7 1.6 Horizon 3 has 25-301/6 gr, few cobs. l Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:< 150 mg/L ffluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) CST Number Mary ]o Hu rt Hollister's Soil TSgmi & Desi gn) !~'-l 224832 Address Date Evakotii1iftonducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 10 - 20 - 2015 715 - 426 - 1775 SBD-8330 (807/13) Property Owner RYDEL HOMES, ING_(Buyer:Kell Parcel ID # 020 - 1439 - 29 - 000 Pap 2 of 3 Boring M94.90 Boring a Pit Ground surface elev. ft- Depth 10 limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ConsWence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Etti#1 TRW 1 0-6 10YR2/1 I 3fabk mvfr cs 3vf-co 0.6 0.8 2 6-17 7 5YR3/4 sl Ifabk mvfr cs 2vf-co 0.4 0.7 3 17-32 7.5YR4/3 - is Ifsbk mvfr cs 2vf-m 0.7 1.6 4 32-66 7.5YR4/4 S OSg ml cs lvf-f 0.7 1.6 5 66-104 7.5YR3/3 - s 0s9 dl - 0.7 1.6 Horizons 3& 4 have some gr. few cobs 1( C, l ❑ Boring # ~ ~9 ~i t pd Ground surface elev. R. D to ' factor in. Soil.Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munson Qu. Sz. Cord. Color Gr. Sz. Sh. *Eff#1 -Effi#2 Boring F-I S #Boring Pit Ground surface elev. ff. Depth to kn#ing factor in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Mures Qu. Sz. Cord. Color Gr. Sz. Sh. `EfF#1 "Eff#2 Effluent #1 = BOD5 > 30 < 220 ng& and TSS >30:5 150 mgA. ' Effluent #2 = BODS < 30 mglL and TSS < 30 mg& SBD-8330 (807/13) Plot Plan Page-3'of Property Owner Y DE L J~~ S Y,9K. BOB ~ &NMe Ksu-y 4(o ft gal Desci*iion L01 zq- Tip it 0.0 PQA; Q c -r (ezcept where noted DF sFE' y ©F rut A, 11, L -m vJ _ Backkoe PH J-DWA) CF H Y, i~ttSNS~~ ~Ozy A~ North 1 .hJKTjf P), Ti)P Of C 51,~RuaYdR pi PE 'ABOVE ,3> 6 R$jLA;D Ass►kMEp lpp,L~0 yzs'to sEPTIC rAg( 9 -750 'rD 6* 4 41 ~ 471 $~tikZ SFd J~1► TRF.Ex kv • Site 5aw~ Loca oli: k S;T~ ~C. y*1 §~6 v -r e .T J T rn/c ~s mrmo urauw.--t icvsueo i in°io'nr`uca'iniwrci V 91.9191 M.£01640oS -IT ~ , it:~r.~ nunsm sm a Z <Waao u.roa7 a.co,cssa. ~ \k 4 ~ \ _ . -auwm _ , nil gill Zz Tsrs / / `/.t .a.w.yacncm I-A E Riau jt% Q \ T4A+E'~`+.~N, ;,rte ` K•>= 'a 44' SIN ~Ea C :Dj 'till Ail 924 Nil Val a Q ~r3- a•.. \ a b~ ` ~5D I \ CL lit 0 5q a 1T1 Z t, Et hhhJ--- 888 i 333 Ee . 1 ~t L? His r Il ~ / z 5~ ~ 1 sY~ ~ 8~y ~y - I I ~ ~'RA ~ A yA 00 ![fi V ~S t3~~asoaal =xj "~insi`m'wro wmc-w,ox vriwc~'• f m lI f ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ('v Mailing Address ~ S ss~ Property Address -1 71 q ~d a ( (Verification required f lann n ti ra ` 1 & Zoning Department for new construction.) City/State Parcel Identification Number cc` d LEGAL DESCRIPTION Property Location, V. y4 , Sec. T N R-Ile' W, Town of Subdivision Lot # Certified Survey Map # / o/'` Volume , Page # Warranty Deed # , Volume Page # Spec house. yes no Lot lines identifiable 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 system 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. 1/we, 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warr~fity d ed recorded in Register of Deeds Office. Number of bedrooms SIGNAT OF APPLIC (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. 08/05)