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Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size." • See reverse side for instructions for completing this application State Sanit~ar Permit Num9er The information you provide may be used by other government agency programs Check iT revyiSi6rf tb prr~vious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 15, ` ° ( Property Owner Name rope t Location ,rJyff/4 l 1/4, S T , N, R (o VV). Property Owner's Mailing Address Lot Number Block Number I r7 Cj Y►.G 5 City, State Zip Code Phone Number Subdivision Name or CSM Number Wits -c , ~2--- ( ) II. TYPE OF BUILDING: (check one) State Owned L] City Nearest Road ❑ Village - ❑ Public X1 or 2 Family Dwelling - No. of bedrooms own of -;2 t4a III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 y New 2. ❑ Replacement 3_ ❑ Replacement of 4. E] Reconnection of 5_ ❑ Repair of an _ ystem System _ Tank Only Existing System ----Existing System B) A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 2!~/lound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 2 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requird (sq. ft.) Proposed (sq. ft.) (Gals/dg/sq. ft.) (Min./inch) Elevation 10 - Feet ©S= 8 Feet VII. TANK Ca in galloacitn s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tank Tanks Septic Tank or Holding Tank IYt'~y/~Cl~ bfCt ` ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber '6r& ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: /17 14 1 Plumber's Address (Street, City, State, Zip (-ode): IX. COUNTY/ DEPARTMENT SE ONLY ❑ Disapproved Sanitary Permit Fee (In`ludesGroundwater Date Issue Issuing Ag ntSi ture (No am surcharge Fee) / Approved I ❑ Owner Given Initial i < Adverse Determination Al n;A -z X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 0s/94) DISTRIBUTION: Original to County, One copy To. - i'our sanitary permit may be renewed b... ai iy nevv criteria in the ,Visconsin Administrative Code will be applicable. III revisions to this permit must be approved by the permit issuing authority- :.hanges in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the ounty prior to installation )nsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever iecessary, usually every 2 to 3 years- Fr you have questions concerning your onsite sewage system, contact your local code administrator or the State of operty owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the ;stem is to be installed. ype of building being served. Check only one and complete # of bedrooms if 1 or 2 Familv Dweliir Building use- If building type is public, check all appropriate boxes that apt Type of permit. Check only one on line A. Complete line B if pern,; Type of system. Check appropriate box depending on system tyE Absorption system information. Provide all information request. -)k information- Fill in the capacity of every new/or existing tank, list the total gallons, inufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/si,. (ding tanks for this system. Check experimental approval only if tanks received experimental product approv<. !_HR. Instal'in r.I'imhor;r+ ,r ~i 4 _ sponsibility statement. dress and phone number. unty / Der)artment Use Aucle the toiiowing: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic 1k(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon -iks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; horizontal and vertical elevation reference points- C) complete specifications for pumps and controls; dose volume; ,vation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. 1983 VVisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater- -,-he monies collected through these air(karo,-s a for nnorttr,- ; ou;`,.fwt?ter rnntarrlination investigations Wisconsin'Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and., Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GELNERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Pla o.: DULLINGER, DAN & JAN X CST BM Elev.: Insp. BM Elev.: BM Description: EAU GALLE Parcel Tax o.: 022-20-1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG. A irintato ke ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER ModeINumbe,: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold I Distribution Pipe(s) I x Hole Size Ix Hole Spacing I Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded 7x❑ Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.29.28.16W,NW,NW,222ND STREET Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No ~ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SAKI IA PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ojCt 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S CZ 9- . ED 2- 4 9 PROPERTY OWNER PROPERTY LOCATION OC P) ~ Ttt blill% 11'/a, S 2 / T ~N, R (or PROPERTY OWNER'S MAILING AD RESS LOT # BLOCK # 1-70 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD State Owned O VILLAGE: tt ❑ Public Xo - r 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) ' - m~- 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13E] Other: Specify IV. TYPE{{ OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.,I~.New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 51:1 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21/.'ElMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE C' I REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) / 16547 ELEVATION U 1 I , ~ 3 7~ G~ , # Feet Feet VII. TANK CAPACITY Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete stCon glass App. Tanks Tanks Septic Tank or Holding Tank [1000 1 G 1r b iti ~rC~t~ L77- -ELf ift Pump Tank/Si hon Chamber, rejw , VY ' K ' VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: GG_u c.,e S3 Plumber's Address (Street, City, State, Zip Code): IX. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater [Date ssue Issuing ent Sign ture (No S ps) Approved Owner Given Initial Surcharge Fee) Adverse Determination /t" G~-/ ' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber -a sanitary permit may be renewed G teria in the Wisconsin Administrative revisions to this permit must be app ,anges in ownership or plumber regt. bmitted to the county prior to install ,site sewage systems must be prope mper whenever necessary, usually e~, zerty owner's name and m re the system is,to be inst of building being served ding use. If building type is W.. Sri ~ : • r~ of permit. Check only one in line A. Complete line B if pc sir. y of system. Check appropriate box depending on system -)rption system information. Provide all information reque information. Fill in the capacity of every new and/or exisi,,;; s and manufacturer's name. Indicate ic, pump/siphon and holding tanks f(: arimental product approval from DILI -ponsibilitystatement. Installing plum etc.), address and phor scale or with complete din. Jng tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water sere: ams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement sys y.s; and the location of the building served; B) horizontal and vertical elevation referencepoints; omplete specifications for pumps and controls; dose volume; elevation differences; friction loss; pir ormance curve; pump model and pump manufacturer; D) cross section of th 115,form; and F) all sizing informa - - - number of -inniaF,! ^n~lnrt°Cf throunh thpco c=srcharaes arp tlcarl for monitnrinn oroo,in(iwater, around- SAFETY & BUILDINGS DIVISION z ' State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application T 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BRUCE WEBSIER Owner: DAN & JAN DULLINGER RT 3 BOX 231 173 222ND ST ELLSWORIH WI 54011 BALDWIN WI 54002 RE: Plan Number: S92-03248 Date Approved: October 5, 1992 Gallons Per Day: 450 Date Received: September 16, 1992 Project Name: DULLINGER, DAN & JAN Location: NW,NW,29,28,16W Town of EAU GALLS County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance w'iLn any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW PETITION - NEW MOUND SID 6423(N. 01/91) f SAFETY & BUILDINGS DIVISION 1 ' State of Wisconsin Department of Industry, Labor and Human Relations BRUCE WEBSTER Page 2 Inquiries concerning this approval may be made by calling (608) ?66 ?889. Sincer Y, PETER E. PAGEL Section of Private Sewage Division of Safety and Buildings PPP013/0009n/ 5 cc: DAN & JAN DULLINGER _--Private Sewage Consultant Y County - UW-SSWMP A Plumbing Consultant Owner __-Plumber _-Environmental Health SBD-6423 tR. 01/91) ft. 1~ AL SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations October 2, 1992 DANIEL A DULLINGER 173 222ND ST BALDWIN WI 54002 Petition No. S92-03248-P i Dear Mr. Dullinger: i Re: Daniel A. Dullinger - Residence Private Sewage System NW,NW,29,28,16W Town of Eau Galle, St. Croix County, WI Your petition for a variance to section ILHR 83.23 (1)(d), Wisconsin Administrative Code, has been reviewed. The petition has been approved. The rule being petitioned requires that a new mound system site have a minimum 24-inches of suitable natural soil. The variance requested was to install a new mound system on a site with 17-inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely, R c er, Archi tech Director, Office of Div si n Codes and Application (608) 266-3080 RM:732WPP4 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Bruce Allen Webster, Plumber SBD 6828,B. 01 ,1911 r et, jv Y ~ L l N C 3y 1 T CAP ~ u 77 ac 4 \ IY C +i S 4 \ 1 r 'a . r a u rq f / AQ Cr C 1 1 N 4 ' -o c of /6 t, Tc, llf~~~V w 2- $lr-- Y/ I C• .r V".1 7 T()'ni to C5 V C S ~f y rvl / (,,U siV i $EWA~LiE SYS onditional . F, E INDUS PRIMA E 0 S ..(IONAL WORKSIALET ~7 Page __0f . MOUND SYSILht 1. Wastewater Lased, Total Daily Flow=_ H. IN-GROUND PKLSSURL SYSTEM-Con unued- 'Use s. ILiiR 83. 15 gal' 10. Force Maras' r (3) (c) Minimum Dosing Rate Ll Adm. Code- and PROVIDE A DETAILED Rpm LIS1 OF SIZING ON PLANS, Diameter in. / 1: Depth to Limiting Factor cf~ 1 I. Total Dynamic Head: 3. Landslope = ft. System Head = 46 2.5 ft. 4. Distance from Dose Chamber to Vertical Lift ft Distribution System = I11 Friction Loss=1:0S•IS-/r,'J -r ft 5. Elevation Difference Between ft. TUH = (t Pump and Distribution System ■ 12. Pump Selection: 6. Absorption Area Sizing: ft. _i3 Pump will discharge at least y ( 1 ~ gpm Area Required = 3? at -1-~ ft. total dynamic head. Bed or Trench Length (B) 0~r0 sq. ft. Pump model and manufacturer: zap/l„r- Bed or Trench Width (A) = ft. ~ / ~r7 Trench Spacing (C) ■ S ft' 13. Dose Volume: Mound ch Sp : ft. 10 Times Void Volume of 7. Height Fill Depth (D) = 1. C7 Distribution Lines 1 b --_M--._ gal. Fill Depth pownslopt (E) ■ d ft. Daily Wastewater Volume 4• Bad or Trench Depth (F) ■ v .)~5 ft. 4 Doses In 24 hrs. a 9FO y ft. gal. Cap and Topsoil Depth (G) ■ i .pt9 Back flow = ,16`i` ISO 2L gal. Cap and Topsoil Depth (H) ■ ft. Minimum Dose = ft. 14. Dose Chamber: gal' 8. Mound Length: End Slope (K) = 2 • Volume = ?sn gal. Total Mound Length (L) ■ ft. - 9. Mound Width: ft' 111• CONVENTIONAL PRIVATE SEWAGE SYSTEM Upslope Correction Factor ■ • 6(n i• Wastewater Load, Total Dally Flow = UpsiopeWidth(J). It, Use s. ILHR. 83.15 (3) (c), Wis. gal. Downslope Correction Factor ■ t Ad m. Code and PROVIDE DETAILED Downslope Width (1} L157 OF SIZING ON PLANS. Total Mound Width (W) ■ ft, 2. Required Septic Tank Capacity = -aR gal. 3, Percolation Rate ■ 10. Basal Area: min,/ Infiltrative Capacity of 4. Absorption Area Sizing: Natural Soil = 0/; Refer to Table 2. in ch. ILHR 83 Basal Area Required = v ga1•/s4,ft/day and PROVIDE A DETAILED LIST OF Basal Area Available ■ T-- sq' ft' SIZING ON PLANS. I'10O sq ft 7<, Required Area = 1 i. If Standard Tables from Chapter ILriR 83 L - ft. (t. are used, Indicate Table # ength = 12. For the Distribution Network, Use NumbersS•14 in Section ii. Width = ft ~V) ~'?1 ;r f~. Number of Trenches = il, tW~ROti v PRESSURE SYSTEM Trench Spacing = ft 1. Depth to Limiting Factor T S. Distribution System: 2. Landslope = ft' Lateral Length = ft. 3. Percolation Rate ■ % Number of Laterals = 4• Proposed System Elevation ■ 12 - j/` mrn' lateral Spacing Lft. Distan in. 5. Wastewater Load, Total Dail Flow: ce from Sidewall to Pipe = in. Use s. ILHR 83. 15 (3) (c) , Wl' . :21. System Elevation ft. Adm. Code and PROVIDE A DETAILED 1V• SYSTEM-IN-FILL LIST OF SIZING ON PLANS. Required Septic Tank Capacity ■ ! ?5 Fill in All Items from Section III 6. Absorption Area Sizing: gal. , Percolation Rate = V. SEPTIC TANK Area Required = sqmin./in. 1. Capacity = I v o~ . ft. gat. System Length = 2. Manufacturer./V~ ~ff wP.;~ r,rCf System Width = ft. 3. Show Site Constructed Tank Details on Plan 7. Distribution Pipe Sizing: ~ ft. a I Holc Siic ~ Vt, DOSING TANK Hole S/ ctnt = a in. s,nd 1. Capacity Lelcr-d Length • -r', ;,17n, ft' r3 >r 2. fd,rnufacturcr: gal. Lator•d SiiC J. Pump M.rnuldcturcr- 1 .'It'ral }hdcing 1,U in. ~34, Pump Model: it. X11 5. Opcrrting Herd= I I)i,l,nru' Irnm %idt.w.111 In Pipe ( L, irr 3y.4V f p H. Dist rihuiintt PiiiC Uisch,trKc R,ur: ' 6. I low Retc _ Number of 1 D Pcr Pipe r/ 7, Show Site Constructed Tank.Details on Plans / gm law Pcl I'i1ivx R S- Ma I low s gl"n• VI 1. IIOI.UING I ANK I YI)C (LUnICr or und) GG +t t I. Capacity = gal. Length = 1. Mrnulrclurer: _ Diameter = it. 3. Show Site Con%iructcd Tank Details on Plans in. rJ~cs-3 ~ -SHOW ALL INFORMATION ON PLANS- DILHR SBD-6761 (R.03/62) • Page-LUf Distribution Pipe Detail For A Four Lateral Network Alternate Position Of ~ ~ nd Cap Force Main < 'A 1. P PVC Distribution PipeF rn ain i P PVC Manifold Pipe,,_ Holes Equally Spaced On Bottom S X X l/ Last Hole Should Be Next To End Cap P-'-J~Ft. s3. Ft. X Inches f Signed: Y I nches License Number: Hole Diameter Inch Date: Lateral Diameter ~a Inch(es) Manifold Diameter -210 Inches Force Main Diameter ~ " 0 Inches Tl # Holes Per Pipe Invert Elevation Of Laterals 10 --P--Ft. Page Of i' t Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ ~o; oS= ~ 2 I 6" Topsoil - - H - G /91- 77 F 3 E D e p0 ~.9 f CID B.bd 'Of 2 - 2 :2 Force Main Plowed Aggregate - Layer D K9 Ft. Cross Section Of A Mound System Using E ~J0 Ft. G A Bed For The Absorption Area F-`~~ Ft. G /-a Ft. Signed: 4 A.- 411)4- - - A S Ft. H 5 Ft. License Number: g 70 Ft.: -n G - ? K !2 Ft Date: ~ J L 9Q Ft. J o Ft. Alternate Position of I 1`1•~- Ft. Force Ma i rW ~9~11 Ft. Cis ~`7 a 1 r~ Observation Pipe •-----T cin fly o ~:Distribution Bed Of '2 z 2 Pipe l Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area PAC;F 6 ~F PLIf~P CRAM?.-r_R CROSS SECTIOIJ AKJG SPECIFICA-rIOKJS VENT CAP `1"c. I. VEMT PIPE WEATHERPROOF APPROVED LOCKIhJG } Z5' FROM DOOR, JUNCTION BOX MANHOLE COVER 1 WWOOW OR FRESH I2"MIU. AIR JUTAKE GRADE I I ~ I y.. MIN. 'CO►JDUIT 18"MIIJ. 11~ IM LET P OVI I I } A T I G A L I I I r pC~ I III I II ALARM 4 I5 I I I ! c *APPROVED I I oN JOINTS WITH I i ELEV. FT APPROVED PIPE ~d 3y9f , 3' ONTO PUMP OFF SYS., l ` D SOLID SOIL r CONCRETE BLOCK t RISER EXIT PERMITTED OI ILy IF TANK MAUUFACTURZR HAS SUCH APPROVAL a SEPTIC E s.PEC±FI'r_ATIOIVS DOSE TAKIKS MAMUFACTURER: / - n ~JUMBER OF DOSES: PER DA4 TAl:9K SIZE: GALLONS DOSE VOLUME 'ALARM MAAJUFACTURER; Lri v` ~t SY,~rrr INCLUDING 6AGKFLOW: GALLC MODEL KlUMB . EK: 01 H LA/ ~r CAPACITIES: A=INCHES OR 3o SWITCH TYPE; GALLC r~~vcvv~: n~ B = INCHES OR GALLO Pu(l)p MANUFACTURCR: -_rr>ed(,~ C = IIJCHES OR y0 GALLO MODEL k1UMBER: , D= INCHES OR GALLO SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE MikJIMUM D►SCHARGE RATE Z' L L GPM INSTALLED ON SEPAR(,TE CIRCUITS VERTICAL DIFFEKE'WCE BETWEEN PUMP OFF AND '`=I iTRIBUT10N PIPE., ~GI O FEET + MIAJIMUM NETWORK SUPPLY PRESSURE . . . . . _7T_ FEET + FEET OF FORCE MAIN 5( LL, FT,/ 3 t loo Ft FRICTION FACTOR..- FEET TOTAL 0'3MAMIC. HEAD = FEET o INTERNAL DIMEpf510NZ OF rAUl(: LEk1GTH 'or ~ ;WIDTH ;LIQUID DEPTH 51GUED: LICENSE kjUMBER. V ! J DATE. f I I Y C:UKvt w • HEAD CAPACITY CURVE ~ EFFLUENT MODELS c; I I TOTAL. DYNAMIC HEAD/CAPACITY PER MINUTE - I _ EFFLUENT AND DEWATERING - t - - t ~-r SERIES 57-0 E7 06 1;17.139 tell 163 166 166 180 108 169 ' I FT. LV4 Od. Lb► t3N. Ltrt lad Lri Gd. l.8'4 1381 LV4 ())4L Lta. Gel LM. C3Y Lln. tad. lb4 tlal 1V4. - I I 6 1.52 d3 1 68 212 72 273 iW 394 106 4p1 61 231 at 231 68 410 tea .667 166 6,7 .7 10 a06 34 129 46 174 61 231 79 ,100 100 37 01 231 41 23t 68 220 148 NO tat 672 -4 15 4.57 19 72 36 tat 45 170 64 w 91 3" 00 227 eo 227 6B ;20 laz a37 ,d5 s19 { - - - f 20 610 15 57 25 % JO 130 82 310 69 213 00 227 6e 220 1 3el 51 30 6 140 6 r 25 782 t 30 74 2B0 67 2+6 62 413 58 220 128 484 1 33 ball 30 9.14 66 66 240 290 68 220 90 340 68 210 121 468 927 4?vi 47 1218 - - - - 46 174 4e 172 66 2f06 7, 283 60 220 106 397 114 431 1 6 70 21 34 1829 21 BO 1 33 60 16 '87 6 N 43 ''181 36 136 68 230 D0 2'60 185 &9 62 197 61 1W 70 266i _ TTI _ - I yI- 38 24 M - I 114 iG W _ 27.43 14 63 32 121 28 I 0 ~ 37 37 204 _ t oo X0.46 _ is ve 21-n 110 3200 1 - - - 7 a6 e 1 j J' Lo<kb Ive +925 2176' ?J 28' E8' 60' BT 73' 116' DI' 112 1 I I EFFLUENT & DEWATERING } Warning: Model 185 should not be subjected to less - j 65I - i C than 30 feet TDH. I ~ ~ - 1 l-- - Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. F I I h9 f --I- ~ 9: ~ I I SEWAGE & DEWATERING c,ALLONS I ,10 1 ,(:-0. 1 WARNING: Model 293 should not be subjected LITERS I 91) 1G0 24' 41X1 4C0 `1511 to less than 15 feet TDH. 0 N Q W ~ 24 _ 80 - I - I--- I-.-- -t- - - TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING ! 75 - - - - E 1-----~---- - _ 22 SERIES 262 266 267 268 282 284 292 293 294 295 70 ----1- --I F7 M (,al Lim Cal Ltn GaL lfn Gal Ltn Gal L", Gal irlr8. Gal LIM Gal 1,Vs. Gal 11LI.78. Gal Ltn- 1 6 _ 20 90 ' oi l 484 8 481 128 {64 130 492 180 681 140 S'JO 196 112- 225 862- 3qa 0 `7_ - , ?4 489 181 685 205 776 65 - _ S dI Sl 725 6 _ _ r-- ~ - - - - - - ' - _0 6 10 - 0 89 50 tE9 50 769 63 238 tss 618 ~O6 101 130 1A1 _16_5'w3_ 185 I00 60 7 90 % 38 10 36 10 30 33 126 106 401 87 113 tt9 160 1;568 +68 R3 18 8 60 - - - 1- 1 25 7 62 76 286 68 257- 106 Pot +36 bt6 153 660 ~9 9.11 43 163 47.176 90 340 121458 140 530 16 55 4a 12.19 19 50 109 94 358 115 435 0 15.24 59 220 89 337 50- ---L-___ 9 1829 13 49 59223 -ls 25 95 1 u 'a0ve 18' 215 ' t 215 ' 26 35' 42' 50 62' 77 i 45 1 - - _I - - - - - - - 12 40 -1 - - --I - - - - i _ i I I I 10 30 -i--T--- - 1 _ I 293 51 I I I I 25 1---- - - - - 6 20 - ---t - I is- 1 i o - I - + - - - j- - - l + 2 - - --I I ~ I ----I - 292 ----I - I 262 266. 267, 268 - - - 284 294 285 0 GALLONS 10 20 30 40 50 60 11 70 00 I 90 100 110 120 190 140 150 160 170 160 190 200 210 220 230 4-, 1 LITERS 0 80 160 240 320 400 k 400 '~'ir• ^,itSO,.±.Iw~h 640$. 111 i,pi ° '~rt I t . SL~i.i2d7«'.y:9.:.AS.L7171b:4all.lh a .~.+maarwaswF+~.,..c^re~xaamn4er.Tw~nntsm~-r.~-:^- --_.+~a.c.~ in accord with ILl M 83.05, Wis. Adm. Code - COUNiY Attach comploto silo plan on p3po( not loss than 8 1/2 x 11 inchos in sizo, flan must includo, but ~y_0 r not limited to vortical and horizontal roferunce point IBM), directicn and / of :;logo, scalo or PARCEL I.D. R dimonsionod, north arrow, and loc; lion and dislanco to nonrost road. _ ' WED APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT10~, REVIE By DATE PROPERTY OWNER: MIOPER TY LOCATION F r~ - Y ' ao 1 r ~r ! rJUw p drT h ~r vY GOVT. LOT NV Y 114A14/ 1/4,S `1 1 T rr N.R (a PROPERTYCWNER;'S MAILING ADDRESS t(tt « -I [VD K K SUpp, NAMF. OR CSM w ~I}Tj~ ' E~ Ir3~~~~1 ✓~Mr,isSryr_Y.~. V-01 New Construction Use Residential / Number of bedrooms j J Replacement ( ] f ublic or commercial describe-_i Code derived daily flow C U - gpd R(~commended design loading rate bed, gpd/ft2__ trench, gpd9P Absorption area required 37 f12 trench, ft? Noximurn design loading rate -bed, gpd/ft2__ trench, gpd/ft? Recommended infiltration surface eievation(s) 5 _ft (as referred to site plan benchmark) Additional design /site considerations Parent material _ - Ur°ssr~ ____Flood plain elevation, if applicable /1`:-' n S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTB W FILL HOLDING TANK U= Unsuitable for s stem El S au MS ❑ U ❑ S B U ❑ S >S U ❑ S ~ U ❑ S U Swll•rR SOIL DESCRIPTION REPORT t Depth Dominant Color Mogies Texture Structure Consistence Bou-day Root, GPD/f Boring # Norizo in Munsell Qu. Sz. Cunt Color Gr. Sz. Sh: Bed Trams c 3v 6, 6,5 j - - - - F - 0.57 rr3~ -y i - - - - Ground r,, Ct i V- _ C i - C r7 5 VF ~ ft. 0 d,~ t rj~ ~ ~ $ wR 61s 1 ( r ~e r C. W { w~ 33- Depth to limiting i~~ S 1 I f ~k factor 30' , - - - FY- n' 1-7 V rli 5/6 faP - 5 Yom! c% - G c> rr F; ; - _ t ~ .r-- i n . 8 57 67- I.~ Y>' - li=2 5 SIB sic Boring # - v~- 0,5 t..: :Mx 0 ~f7 YR 3/2 S I F ab~ M I , 3 Ground,. --2 - - rI t ( V~- elev. ~i - ~7-33 c~-_ I t ah~ U 133-35 n,SYia 'n 2. YC 6 - sa,Gl---' Ot fr-- C's Depth to actor r lo f 3`-` V 16 Ylri 5 yr (ac - - n. t r I f L ' `0 L ►n i ! C 1'I Remarks: CST Name:---Ploasu Print ~ Phone: ~IL _t CST Number. Signature: - i nr^ r/ ~'1.~• ~ /`~a~- SOIL DESCRIPTION Depth Dorninant Color Mottles Structure GPD/f Boring # Horizon in. Munsell Qu. Sz Conl- Color (exture Gr. Sz. Sh. Consistence t3ccrr ~y Roots Bed in^ i Ground t )0 V~' G t elev. , ~ ol, 7 ft: y 2 y ~R ~~y F x 9 ct c 5 1 X U Depth in 5 33- `!2 Y ,a,~`~ CS limiting factor 6 H -5~ to Y9 1 f t . 14 ! c Remarks: _ Boring # Ground - - ' elev. Depth to - limiting factor Remarks: Boring # - Ground elev. Depth to limiting factor _ Remarks: - Boring # iiS 2<:; Ground elev. Depth to limiting (actor - Rernarks:---'~ pp, ('(ot Pl~~ jdl vq J, ttiJ,, kpo,,t Lorex +f'c~ 0, ~W lb 11 N~ V` c ~ d 7LSt+f R s4r ~GU~f~ ~owrr5 Loci.=.a ~v Not to scc('f- i~ 3- i ' 'I`6 3 ! ,r r SLR/y l I5w'r1 Oi X13 ~ 3 f4f s L.~PVCehzow ,~b~Yfht1 100 q8t 5 (.rvay~rrH QO✓Z. ~ :Ibl,2 3 1 a ] f v o, < P_n ~OVC ~ a 3 e~x 2 $ b 4Lip. wo v ~COn I ard Labor anDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page of Labor d Human Relations 'Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code - COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER. PROPERTY LOCATION GOVT. LOT 1/4 y' 1/4,S T N,R Fix) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 0TOM NEAREST ROAD [stew Construction Use [ }--Residential / Number of bedrooms [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ❑ U D S D U ❑ S ❑ U I 7 ❑ S ❑ U ❑ S El U ❑ S ❑ U SOIL DESCRIPTION REPORT B ring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft [o~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. I , Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting fq factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page of, PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed' Trer& 13 Ground elev. ft. Depth to limiting factor Remarks: Boring # .Ground'.. elev. ft. I Depth to limiting factor Remarks: Boring # Ground elev. , i ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SDD 8330(8.05/92) i ST. CROIX COUNTY x. r 6g .u . - WISCONSIN 1 ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Aug. 12, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Robert Kachelmyer property, located in the NW1/4 of the NW1/4, Sec.29, T28N, R16W, Town of Eau Galle, St. Croix County, WI., has been conducted with the assistance of Bruce Webster, CST# 1902. This site was located in the south western most portion of the parcel. This onsite revealed suitable soil for onsite sewage disposal to a depth of 17" while meeting the requirments of the A + 4" rule. This site should be suitable for new construction using a mound septic system having 19" of sand fill. Should you have any questions, please feel free to contact this office. rely, mes Thompson Assistant Zoning Administrator cc: file S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ t 'R PC ADDRESS-[,,"?/ FIRE NUMBER CITY/STATE /Z L I ,,I ZIP_ PROPERTY LOCATION :'1 1/4, / 1r 1/4, SECTION T N-R L' W TOWN OF CL;L /,J , St. Croix County, SUBDIVISION , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 treatment 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)• the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/Ile, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. SIGNED: `v~rtil~ ~:~~r=C k DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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 pormit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), then,a second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. ---f------------------- Owner of property Location of, property -11/4 ~ 1/4, Section / N-R W Township Mailing address Address of site .c Subdivision name Lot no. Other homes on property? --yes No Previous owner of property P~-I Total size of parcel 9 Date parcel-was created Are all corners and lot lines identifiable? Yes ~ No Is this property being developed for (spec house)? Yes LNo Volumes and. Page Number -/12 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. ,In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. Lfoar" i< and tha I (we own the proposed site the sewage disp salt system) orreI a (we ) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of county Register of deeds as Document No._ ` H 44 Signature of applicant applicant - Date of signature Date of Signature L