HomeMy WebLinkAbout004-1077-50-100
.,_:,:orur.Ccparmerlofcmm~'c' PRIVATE SEWAGE SYSTEM Couvy St. Croix
Safety anc Ru :m'q nivisii:u
INSPECTION REPORT Sa•aary PennRNo
GENERAL INFORMATION iA I I ACI I TO PERMIT) slate Plan IC Na
Pc•snral irfnrmal an •i o.. :npv de may t<usod f,r se eonJary purposes Pnvacy La', >.ri C4 Iltimj]
'erm t -IrdI<_q's Nu n'= Ciry `.ril 3bwns'rip Pacel Tae No'.
Betchkal Properties {John Ell TOWN OF CADY 004-1077-50-100
Cs- P., Eler insp. W l UR1 Ccsnipt ne gent in. T+Y,: Mange.'Idap IN
9 a", _ l0 32.28.15.5026
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS El
eAj D Benchmark / r y3 /of J / 1 yet
N a ) 9/ .
Old( g /dCn An. eM l ?r5 ^~s 193
9 , o
rr Bldg. Sewer
s. sz (THoldin~ SI+HI Inlet
TANK SETBACK INFORMATION stHtOupet /Z - zq .0ot/
TANK TO I 'HELL DLDG. ion r. At I tare ROAD DI Inlet 1_r gY ' O
Ij-•\t ~p fi
Sa••tic / DI Ba:unr•r
A7 e~ Sa T
-7
Flw` 7 Sa / j k r Header:rgan.
26 / Dist. Pipe
Il:;lding _ Hot System I
d
PUMP/SIPHON INFORMATION F ral Grade
Manufact.rre• I Demand St Cover
~•C , ti ("Prot iii ~l Lo g' 3 5
Atc uc Nr.m,^,er
TDH L h Friction I ass System l 11-H Ft
FartAmaut Length Da. Dist. m'v`: ell
SOIL ABSORPTION SYSTEM
UFDITRFNCH :4i?l' Lengtr no ri' T .h PIT DIMENSIONS No. Of Piss Irside C a. Liq. d De t-
DIMENSIONS a J ti `
SEF13ACK SYSTEM TO Ill BLDG WEII LAKEiSTREAM LEACHING DAon.;lacb.n+:
INFORMATION CHAMBER OR
T';pe O' System ti- UNIT Muds' N,,,T,W.
DISTRIBUTION SYSTEM
Ir r,JU't~lanr'e'J Drs n•nrm-~ x !hlu S to x Hole Spate rg :r to Fir tekP.
r'P.IS> ✓
uuyh ?ia I.yn jP'. Dia 5cln:.
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
I'e:;l' O,er I nrlr 'k ♦ X De; t•t o' ,=_eCerlr, ode PC %xMulrhed
1 -I ',J Ccnt, r zJ'1`e +_h Ecge: Ves Na Yes INC
COMMENTS: di'dude code disriepercicies. persons present. etc. Insoecion #1. Inspection #2
Location: 2853 10711 AVL
~w S y / OUK. S
1 i At BM Description = ~ `a~
2.i Dfcg sewer length = Slo
- arnount of ccver = 7 yZ it 61l y ' _ / ~ I j
Plan revision Required' Yes >o fJ2.. L~3/'yy../~~
Use other side for adcitional information
Dale Ins lot'sr at..re '_Cw N~
SRD 5i'C (!i fII6/i
`yyPAXT1r{\~ _ !'1 Ecoal Industry Services Division V ( r""
C
pS 541 1400 E Washington Ave
s,, 1
r.o Box 7162 Nauman 11cuna Number loo h• Wiled in M't'n i
P
S a Madison, WI 53707-7162- 0
Sanitary Permit Application BQA Statcllartsactionvumhcr
lit a! ordanec „il6 NI N 3X ]1! 1 \y Adm. I odc. ohno,it n of tin, fond to the appl pnn.A eosernmcmal unit AA
is 1equivod plnu ('Mallon:., 1m ,n ernif Nile Appli:aliun loons tin stalcrowncd 110\4 I -Sarc suhmiucd h.
the Dep.lnmcnt of `,Es , mi Pr I ,wllal Sent I An.ntal ulhmnaollr, \Tm provide m:w he used lit xatlJ:u I ml rot Address Pf dil7crenl drat ntailine address)
u ocsill aieuldm:., L~. the rl,aay I n%, 15 lth l iln, Stal, MI;In Avenue
1. A iliralion Information - fleaY rint; All Information _
Potpi:a) Owncr o Namc r IYuccl a
Bctcilkal I'repcmc; I orated Panncrvhi Otll-107-jo-lllo
Propnts Owner's Nlmlmr address Plopeay location
330 S N' Snerl
Govt I.It
I It\, Snnc /1p Codc phone Nunlher NI''%,,\%k Section 32
1.n1'r ra,c. k\ 1 ;4601 1rcle one)
_L 12x\ R15 li o*
11.1 ype of Building (check all that apply) ode Lot g i, - -
❑ I or 2 I'anuk Dwclliu_ \umbn of Bedrooms NA Subdouion Nmnc
6R% NA
❑ Public Tommerclal- Dc,alhc I I,c 0 1 _ O sus Block _ WIN. ❑ Snnc Owned Dc,CrIN Ilse ❑ VJlave of
CNM Nulnher
LL , f~~ Q Town of Cady
IIL'fy c of I rmitl (Check onl, one box on line A. - nfp Cie --Ii rie If I a)
4. ❑ New S)ACm ❑ R( PI;1eemeol \\AICIo Irealment 1In1dw- I aok Rcpkwemcm Only ❑ other Modification to Ixlsting S\stcn, Ic\plain)
Il. ❑ Perna Renewal 0 Perron Rc\ia.on ❑ Change.4 ❑ Permit *1 runsl'er In New I.ut Previous Pcrnut %kiroberand pD~ate Issued
Below I \piralion Plumber owner 320261
IV• I ype of POW TS Sy Stern !Compunctu' Dcv_icE (C heck all that-upp4W
❑ N n l'imurlnd In-Ground ❑ Pre,suo/ed In-l round ❑ :\I-ora, ' ~ Mound - 24 in. of\unahlc E] Mound 24 in of sui ahk s r:I
El Haldmp tank ❑olher Ui.pcaal Conq,oncnuc\plaini retrealmenl e%Ice(e\plainl
V. Dis crsall'I'rea ent Area Information: _
Design I km Tepdt la n N.nl \pph: k r. Dispersal Area Required tall Disper\al Arco Pror.scd htl Sslcm I'Icvauon
15i1 Ratu_pd,l) t~ 95.(lll
VI. Tanklnfo Ip1n,m
v
( dl rev Total n nl s
Alanuf a"' c y v
t.allens limb
f 1y lank. . I O 5
ScpliCw llolJing l m, Cl(lool I()Ini ?DII(I 2 Nlcscrlc;tr Col rclc!VLidw\~~sl+crr~iJ ❑ U F] 11 El
Desire'Ulandxl ^58 I Midwcstarn ❑ 0 ❑ ❑
VII Responsibl lit) Statement- 1. the undrr,lgned, aswmr responsihihry for installation of the PO\N 1 S shown on the attached plans.
Plural a sVona- Pr -11 Plu~ , 1ej )Tturc ~ • I nIP+\IPRS Vwuhcl liusnms. I hone Numhcr
7~-`/L~l% eT-7611 stir. -
John Schmitt
Numho - Addre " Nicer. C'1n, Stale. Zip Code)
616 I S ° ave. Sanlcr,ct. WI 54025 Q _ si,~} IVrf'(1 _
VIII County''Department IL se Only _AAA
\pt.rvcd 71 Deapprovcd Pemtil c_ ])aatcJJ/c tied/ J Is.ui A!•ult signaler
7 0%ner (ivcn Rea,.m lirr D nil S 5/ 'p0
Cond'i~$$1o S o' a c Uisapproral /J -
Y.
uhper:ln cell aunt all be . eE
*8'pw mar.3cem2nt PILr p,."ia.=1 bV.Jtl,nbe -
2. Aj e!!Eltic WLli nen s m116t Lt .r. r..1. II E
• pot pr7lable ax5l,.rrf ctl.
Atach o..... nplrn• plan, tar Ihr ,y,Trm u d suhlnfl to The foune, only on paper ool le. Item a 1.1 A I I inches in sire -
SBD-6 i7% t R63! 141
SYSTEM PLOT PLAN AA
C:eS:gn 710.0 44C aallonsnuy
Project Name: Betchkal N
- - - - Mtacn design flor.::alc;ala!iom •c-
P: oleo Naaress: ccmmeremi plans
SWI- Symno:. A BP! Elevatior cr 8y Pipe tda?enals'.451I; Standarc Sca1B. 1" = 50•
BIv1 .],,%,jD!lon. Too of >amp Tan: mtWo, -ab,- 384.30-5 & 384.ab r.
66 90 19C
131,12 Svmnol .'J 13M Elevation 4' scr 40 =rL kSTtd C2ec` z2z
Ciid Je rnnlion i ../l
Slope radlecl Y Testec f,rc 1~ 7 z am r
Vuell Symbo. id appli:.anlei
Natos: vcie•_.
50 Acre Parcel
10th Avenue R.W
t
I lli
I
I I
I I
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t I
a)
I
J I I
I
C
a Existing 1000 gal
septic tank
Proposed
WLP1000-MR Existing 750 gal.
w/Polylok 525 pump tank
/ 27'x95' Mourn
wi 5'x75' cell
Well I
% BM1 a63
Il ~
B1
Driveway _
B2
/3 Bedroom pole buildi g
;"house
Fence
i
\M ~ tr
I
- - - Page-~
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: Belchkal Properties LTD :Iarlnership
Owners Name: Betchkal Properties LTD Partnership
Owner's Address 330 s 6th Street
LaCrosse, WI 54601
Legal Description: NE1/4, NW1/4, S32, T28N, R15W
Township Cady
County: St. Croix
Subdivision Name: NA
Lot Number: Block Number
Parcel I.D. Number 004-1077-50-100
Plan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Specifications
Page 4 Effluent Filter Information
Page 5 Septic Tank Maintenance Agreement
Page 6 & 7 Existing Tank & System Certification
Page 8 & 9 Warranty Deed
Page 10 CSM or Plat
Attachment 1 Existing Mound & Pressure Distribution Design
Attachment 2 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MI'RS 223760
Date: 10/9/2018 J( Phone Number: 715-760-0486
Signature:., x- 111
In-Ground Soil Absorption Component Manual Version 2.0 SBD 10705-P (N. 01/01)
Page. 1
F-SYSTEM PLOT PLAN
Design Flmv. 450 aallnns0ay ~
Project Name: Betchkal E N
- - - Aeaclt design flow calculations for
1 Project Address 2UT,, IMn A'e,%e, commercalplbns -
BMI Symbol* A Bfvt Llevation. 91.8U' Pope Matevals t ASI M Standard
Scale: 1" = 60'
BM Desuiption. Top of Pump Talk manhae 7 eb,es 384 & 384 30-3 0 60 90 "20
BM2 Symbols Q BM Llevafion. SCF 40 PVC ASTM 79665
AM Desuiption. I 2' SCN 40 P'dC :.,STN DI?d5 -
Slope Gradient of Tested Area (5Mj 1 v2' SOH 40 = _4S7t't CI?54 15,
''Well Symbol pf applicable)
Notes. N\ w,' -
50 Acre Parcel
10th Avenue R/W
I I
I I
I I
I I
I I
I I
a~
c
J
r I
C I
a
0
I Existing 1000 gal
I septic tank
j Proposed
I I WLP1000Y(BM MR Existing 750 gal.
I w/Polylok ump tank
t I 7
27'x95' Mou
o I I ` w/ 5'x75' cell
Well ~S B3
1
Driveway B2
'3 Bedroom pole buildin
i house
❑ ❑~~---o ❑ ❑ ❑ ❑ ❑ ❑ o--o---❑---'r-~~--,:~-o- -=zee i
Fence
Rage 2
I
111 11 -t:t,- '~7L-i1 i1-
J
-anr,_ 1~^d u'vC nr. ~clnr. ~aroa W M 'NGOa N=,'AVn - AM- s" 41ts.-Y lYnNVW Oild3S \ -
3~., - » N 3138000013831M 8VI-000IdIM
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Page 3
I
r II
O
at~ns nPrerar~,...,...,.. Zalx.l P1-5251'.IF f I UC III IIII
-l~l IIIIPI
the Pl. 525 Filter is rated for 10,1100 (-;PD (gallons per Jay) making it one of the largest fillers in its class. It has
525 linear feel of l; 16'• filtration sluts. Like the Polvlok PL-121, the Polvlok PI.-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning. the hall will float up and temporarily shut off
tho Systcnt so the effluent won't leave the tank
-
f :Varm :witch
ILak'd for 10,01111 Gl'll (gallons per dav). - - - I ` i25 linear feet of I/ I6" filtration. (;PD) ! (Optional)
Acrrpls I" PVC
Accepts 4- and h" ti( l ID 40 pipe, J rxlen,iun Handle
Built in gas dolleclor.
Automatic shut-off ball when filter is removed.
r
Mann accessibility. ILated Car
10.(")GPD
At, epts PVC extension handle. t ` liR
'~riCR S75 I.inras FI.
Ideal lot residential and rnm mercial waste Iluws up to
10.1100 gallons per day (GPll). Io"
- hillranon slots
1. Locate the outlet of the septic tank.
Rernove the tank cover and pump tank it nccess try .
I Glue the tiller housing to the •I" or 6" outlet pipe. It
the filter is not centered under the access opening use a
Polylok lAwrid & Lok or piece of pipe to center filter_
'I_ Insert the PI: 525 filter into its housing. -
Certirtied to
Replace and SCCUru the septic tank cover. NSF/ANSI Standard 46
The PI -525 HfILIVnl Fillers will operate efficiently for LO -
several years under normal conditions before requiring
I leaning. It is recommended that the filter be Ileaned
every time the tank is pumped, or at least every three
years. If the installed filter contains in optional alarm,
the owner will be notified by an alarm when the filter
-_r Gas Urllrt9or
nerds servicing. Servicing, should IN, done bV a certilieJ
septic tank pumper or installers Automatic
1. Locale the outlet of the septic tank. shut-On Ball
2. Remove tank cover and pump tank if neve%sary.
3. Igo not use plumbing when filler is removed.
T Pull IT-525 cartridge out of the housing.
5, Hose (ill filler over the septic tank. Bake sure all solids fall back into septic lank. to
6. Insert the filter cartridge back into the housing nmkmst
sum the filter is properly aligned and completely insert(-d. Polvlrrk, /.an•t & Bra liher, arcrPt (wady Installs
7. Replace and se(ure septic tank cover. the SmartPdtcry- switch and alarm. into Cxi'ling lank,
Poly'lok• Inc. 3 Fairfield Blvd. Wallingford. CT 0(492 Toll Fn t S T"6',9565 F:ee 203.28-1.8514 ixivlv.polylok.com
Page 4
ST. CROLX COUNTY
F?T=C ~ IvL4L~'TE:~ANCC ? Gi2cElvfE.'vT
TD C
C -~W:NTERSIP CER"fl'FTCATION FORM B ETC k KA
L- r 1PRaPER ' 5
LI Tie
5 t`+ ~i .'000G'/ice
I.4ziling Address 5 7.
~U7
P-D")e:7s' Address r
Vm-intntiar required from Planing & Zoumg D-partment fa: new construction.}
C;dy- IU77 - So ~co
Cin~'Stau ~ R 1 rJ~l~y+ w l Par; el Iaentifi:.a-~onNum'tvx
LEGAL DESCRIPTION ~hR~EL
er
yr /vC 2-P ~ i 5 l., )
proms- Locarian ~ ;..Sec.. , T own
S,ihcv sign .'Iu:. -f v p- up- Y ED 50 A CAA- ~'1 R C v"- L.o".
Certified Snr,•ey Map Volume page X
R'arrann' Deed r °51 G 33
(b--fore 2++Q7 Volume - -
?ec house 0 yes no Lot lines idenrfiable 7 yes n;,
';A'STENI MAINTENANCE AND OWNER CERTIFICATION
Improper use aid Tpl'Imn~cc of v,+;tr se?rie s•sics toad r snN inrtz- rem =-cve fa::cse.:c hx,die wp_aL-c. rrope-
` aDW-r=c:c cams=-s of ptmmping ott the sc,ic tstk eve., three vea-< or saoner, if needcc, y a lie-nsod pzn?e-. N vo_ ~;n m,•
_1c n•sem cat affc.:t :be function Of the septic rani: as a tea:rnem stage x the. wash dis?osz} system. Owner mzintc=L !
-cs?oasti es are specified in ESPS.. and in Cnap:er 12 . S_ C--:)ix County Sa:dta Ordinance.
n-?rapery cw= agrees to submit to St_ Croix County P)a:,ning & Zanin<_ Dcga anent a cc-~jcaaon for::, siped '-v the -
ewne and by a master plumber, jot^neyman aitrnS_-, m-n ict-d pnL-nbc- a- a licensed pumper verif}•icg taat (d) the on-site
wasttwattt lisp: sal s}'stem is in aropcr ope-ariec condmot) ard~ or after irspenon and p=pmg ~Ss.cessay), the septic tank ic.
less than L3 full of sludge.
I'we, b- undo-siped hive. -ead the alvve -equi-cmens and agree tc maintain tie pr'vace sewzee disposal r:vsnm with ,nc
staadar:'s set forth, herein, as se, by the Depar~meat o: Szfe'y Aud Professional Stn ices and the Daparment of i ansa) Resotr'ces,
State of R =oasm Cer-: f atio swing &,,a vntp s^-ptic system has ;em mainniin::d mist be compi-red and retumed to ine st -:rem:
Cotmty Planning & Z~a:ng Deparonent within 30 days of :b- ti-e vea- -xpi~tion :ate.
L'we eetify tha- zL' sat-m-n's oq~itis fort as t^v: to :he bcs of mviou: }mowledge. _w; a .•`3e. isle :,,r.nor(c>...._
proper aescnbed above, by virtue of a tv Seed recorded it Reests of Deeds O'-t
Number of bedroomF7
IGVATL OF a2PLICA1VTi"cj D__I-
•'•Anv in:om)on tha: is m:-Represented may tsul: ~ t~,t sani:a-y?ern`. bei:rg revaked by :he Planning & Zorrng D-pa^^T
Lnclude u•i'.:h's apalira'inn z reC_• 6d -J wa-rar'`-" cloar' +~orv ctr R-us. f Dc-._ Cri cc an' a ,C,7% of ae c.,^ e'_ nza
:f
ref-tenet is made a 3,e'a_-u> dee.
'RD'. G4'1-1
Page 5
ST.('Ro l Ot N I ZONING OI'I ICE
CERTIFICATION S I ATENIEN I
FOR IL IIIJZATION 01, FIXIS I INGSH"I"IC IAN K(S)
This is to cell; v that I havc in,;pecled the cm,tin-~ set~li~ ~:nd w dog. tank
prescnth ,chin--, the follovvnr= resi lenec: t3ETOAKf►L
I11~.'etadv'Iv si JO{ItJ QETGh-KAL ~pp-op'Ef-TLES located
at:Aj ,vW ticction _~Z lo\\n L~ R.In_c (S W.
own o _CAPY fit. County Wi. Consin.
Upon inspection, I cel-litv that I have found the ulnk( 1, to the kc.t of my
kmm11-d,,e. III conform to the rryuircmc;lts ofConun. S4.25. and it (they)
appear(. t to be functionin y properly .
M~_y q
MOM ?'eCc'nl dale UI lll~l)Cetloll U!' SC[-\-ICS
Did iloc, back UcCtlr from absorption Systet117 Yee Ao X
(it no. skip ncm linc.i
Approximate voluutc or length of tinge: - LaHons minutes
Tank Capacity: 1000 ST. ~S0 P/C-
( vn,ttuctton: Pr\lab ('oncrctr Stcci Wier
-Nlanlll'acttl,er(ifkno\\ni: MEf,>wE5Zp J PREC~lSZ- Sb~T tf99)
A,e of Tank (il'kno\\n): f q -
Pcrntil uulnbcl- I if l.no\\ nl jZ 0 2.61 -
~i T013EPT ZA L,13 C- (AT
(I, CCm,e\I Plumber SlgnatUlcl (Print Name) -
LZCe37f
CIitlc) (I Icen.C Aumbct) M,1) MPRS
)ate)
Form lobe contpleicd by licensed plumper (Dept of Commerce Chapter
and '---'5.0(. Ah i:con,in Sultutes) or ticzn ctl dispo er (NR I I = yyi~consir.
\Jnunl u;ilire Code
Page6
SYSTEM I NSPE-cTEV IS 6,4p,--( JE- of HhAJaLv'l
ITS ~2oPo~ED j~ 2si ~y, w ~sfe w h'+k Fldcc) -FRol-,
j'GA S 4-R v c,~ u„~ i f w l/ S,P.t v e
'o 6 T-
x1*57~,u s y Sf S;~/ ~S -~/r s
Sj2,4- c~OAS.
L ~P~ S Zzc~37 Y
z01
Page 7
AAR WWI
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KM r,f i+. it - ~ .4
4f.J ,~`0 t 1
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.-i' / y fs
of 'r,
♦ Clgx
li
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Page 10
- S/T~ fjvi7~esS ' ~ 8y 3 /D ~ fJv-2 Sl~,Ciu~ //a,~ 4J/ sY7G ~
ASafey and Buikli gs Division
SANITARY PERMIT APPLICATION 201 E. WasNnglon A".
!"sin In accord with ILI IR 83 05. Wis. Adm. Code P.O. Box 7989
Department of Commerce MaRSon. W1 SMI-7969
a Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 w x 11 inches in size. 57r- 6co/• x
is, See reverse side for instructions for completing this application Slate Sanrtar,Yl(Pe'Cr~rmt Nurmmbbleerrr
The information you provide may be used by other government agency programs U Chuck.) revision in weH we epI111ralmn
[Privacy Laws. 1504(I)(m)I. State PfdnID N mber
1 PPLICATION INFORMeeA-TIQ^ N - PLEAA^SE PRINT ALL IN_4RMATI i 3 ~S 9
Propertyow Name
~rC!•+FL i~^ ~asarer(/L(r/Ivf.S 32- T ZO .N,R /5E(or6D
Property owner's M ling Address Lot Number Block Num ben
D SOJ Cr
City. 5iat ~;~k l f/ 7Tp Code Phone Number subdivision Namea CSM Number ~i• a ~G _
JiU~ luR.•,•~
! $YfoI. (G i2 r of /00
11. TYPE OF, : ((heck one) ❑State Ownedt Nearest Road 1
Public or 2 Family Dwellin - No. of bedrooms n gown of espy /G '(U~ '
111. BUILDINGUSE: (If budding typ public. ched as that apply) Parcel Tax Number(,)
1 ❑ Apartment/ Condo (70 y 1677 S
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 f-1 Service Station/ Car Wash
S ❑ 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. n New 2. X system 3, [1 Replacement of 4, ❑ Reconnection of 5. E] Repair of an
System System Tank Only _ ExistingSistem -Existing System
_
8) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued _
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurised Distribution Experimental Other
I1❑Seepage Bed 21XMound 30❑Specify Type 41❑HoldingTank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 n System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION: IJ 7-O
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Per(. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) O Elevation
ZSG ~S Z Feet Feet
Ca act
VII. TANK in gallons Total 41 of Prefab Site Fiber- Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel Blau plastic App
New Exislin slructed
nk T nks _
750 Asa ~o 0 ❑ ❑ ❑
Vlll. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached - plans.
Plumber's Name. (Print) Plumber's Signalu :(No Stamps MP/MPRSW No. Butm en Phone Numbod
;eO Pael- Z6(-1WQ47_ 2u3"ZS ~ls 3P~ ' CBS
Plumber's Add ess (Street, City, State, lip Code)
S :
6" A"e-t ffUD,sOIj 424 S
IX. COUNTY / DEPARTMENT USE ONLY
❑Disapproved Sanitary Perm,l nee 0•""'°'^~"°'bxan Date Issued ksuing Agent Signature (No Stamps)
NApproved ❑OwnerGivenlnitial n n0 Z/9b
Adverse Determination (196 I~
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
i
SBD®agt117967 tMixnunoR: Qlgin•1+•[•uMr.Ow•<•P7 r•: waryswaairy. olnslon. p••rr, vlunbr - _ - -
ST. CROIX COUNTY ZONING D jfD itE
AS BUILT SANITARY RF
R_Crr1VE0 {a
owner tJ O je&V j~EV ~ A..% hAj D cn ~ n /Qp v
I %t.
' t> !939 ~,P'~ S
Property Address 2-604`4 10el- z- R
,J
City/State SDiPi.t9/r ST G;4 0X
Legal Description: etc "`t; y - -1, 7
Block __3 Subdivision/CSM # / ` F t .
Secy TLS'N-KEW, Town of Cr¢ PIN # O Oi/ /0 7 7 O
SEPTIC TANK - DOE CHAMBER - HOLDING TANK INFORMATION: '
Tank manufacturer f V C Size ST/PC 10 / 4 Setback from: House Well _ P/L
Pump manufacturer 1_feyj _r Model AE
Alarm location.--.
(HOLDING TANKS ONLY)
Setbacks: Service road Aze to ntake Water Line
Meter location /
Alarm location _
SOIL ABSORPTION SYSTEM:
9E0 /
Type of system: /f 0(1-V Width 5 Length 7s Number of Trenches
Setback from: House Well ~io0 P/L~ Vent to fresh air intake 5D
ELEVATIONS: -s ins k5 /3.y 0 2-
l F 9Y 1 2r.,
Description of benchmark 111P e~ sf ~~G 3/!~ ~'c Elevation G
Description of alternate benchmark To A_ of 1016/- _111?a41e_ Elevation
Building Sewer d fo ST/HT Inlet U-2-5 ST Outlet - d 9,07 PC Inlet
5C7tr'c T-?NK x%33 (nd ,t''St~ts,
PC Bottom 9q.(05 Header/Manifold 5S (O Top ofWfPC Manhole Cover,
Distribution Lines O I J G00
y~d ' `IiPA'DE E><r'snvlr Zlbvs'.~°
Bottom of System(
( )
Final Grade ( ) / 7 ( ) ( )
i~tiy 3~0/ /3C,£lsy
Date of installation Permit number State plan number
Plumber's signature License number Date
/jf} 2( M/
Inspector W//yQf a~n Sf
- ComnIam pmi PIM o
Roo
~ pR1GtNA~ _
W sconorn Department of Convnarce PRIVATE SEWAGE SYSTEM (-,Umv
safety and IYmldings Division ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) ;anitar520261
Personal Information you provice maybe used for secondary purposes (Pnva:y I w. S.15.04 (1)(m)). _
Permit Hulder'[ Neme: 'I I-) Cty l I Village ; Town of I Slate P!dn ID N. ANDERSON, GORDON & IRENE LCAU7(
CST BM EIev Insp UMtle• BM Deu•+phun: narce le
- I U04-1077-50-000
TANK INFORMATION ELEVATION DATA A9800449 _
TYPE MANUFACTURER CAPAOIY STATION BS HI FS ELEV
Septic /R rfA-f Mae BenchmarkT
J•~~
Dosing
Aeration - - Bldg Sewer •~8,O•.~~j 8~• /
Holding- - - St/eIrtlet //•25j F38•ZS
TANK SETBACK INFORMATION StlUt Outlet 6~9•n7
TANKTO P/L WELL BLDG. Arlntakc ROAD Dt Inlet
Septic >/ooh 104J NA Dt Bottom y8s (o~
Dosing - I too, 1:11 22' -I J2 NA Header/Man.
Aeration NA Dist Pipe Y.az S
~L1S
Holding Bot. System ?s--. 0 G
PUMP / SIPHON INFORMATION Final Grade 5A&.-
Manufacturer a Demand °j ~kj µ~af J6 -Lde+.
~.J, _
Model Number 98.26
_ ! 0 a5' GPM ~B '1.142- (04./e
TUH Lift OJT Friction 5 System • TDH •;.tSFI 01111 27 ~ r0 (a0.. 3 1f Z.[
Lo's N~0 Forcemain Length 5Zt Dia 2 L1 Dot towedR• g g
SOILABSOR 7I N SYSTEM ~/G CoVG. ~Z
Nu Un,u +ns+dr Um 4owd OaPth
TRENCH w+dth / Length No. tT riches LLA
IM N510 Manu acturer.
LEACHING
SETBACK SYSTEM TO P/L BLDG /STREAM
INFORMATION ype" "-i CHAMBER n4o-e Num er.
system :rl OR UNIT
DISTRIBUTION SYSTEM
_
_ _
Header /Mar j7t~IQ1 + U+sU ibuLUn v+pe s , ~ I ta~ S<p[r x rlnle :peung Vent To Arr Inca r
Length D-a iLength Dia. spa❑nq - - l.Y 1F8
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only -t
DeVth Over Ucpth O ver zx Depth of zz Seeded lsudded zz Mulched 1
Bed drench Center BeA Wrench Edges I IDDSOd L7 Yes p NoL]Yes D N.
COMMENTS: (Include code discrepancies, persons present,elcl
LOCATION: C Y 32.25 2,NE,NW 2843 10TH AVENUE
l >kotok) - ff-W- r(b@ ~/lcgP
c, ~SXJA--Ot- 9`f.Of (BsQsl.Tt 8-13-49_ s,/
- Tl ~tr.Ars` ~~y
® /NS , gQ1= ~t trt t t• - Cs_ et
Plan revision required? ❑ Yes ❑ No$ I~ ~I
Use oth s{de for additional iin-fgLmalion 4 R ~ t , 1 I L_~1
S~h¢ 's7~ IgKi 1'^"' CbltQ/ Date ,•Igspe[tor"ss[/~~atJw/e Cert NO
D671D (Ras7) Y CME - 1fD //"T/~• J`~6 (5--_
ee.k c. tuw. p E> 1.~>t A&d S - -7 7 / 3
~ T M a. ~S i~
ti W ~ v ,.1 ,
\ ° D , t
tlC \7 ~ ~C h ~ a I ,
f y t~
r ~
> t t
r if 1 r
~ !IJ
t t r,
1~ k
M o
I
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s t \
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J 4
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41
M Q$ 9 v
• Safety and Buldings
15837 USH 63
EUIYWARD VA 54843-8107
Visconsin Tommy G. Thompson, Governor
Department of Commerce VVlalam J.Mccoshen,3ecretary
August 31, 1998
CUST ID No.226375
ROBERT W ULBRICHT
655 O NEIL RD
HUDSON WI 54016
RE: CONDITIONAL APPROVAL identif
APPROVAL EXPIRES: 08/31/2000 Transaction ID o. 136859
Site ID No. 15803
SITE: Please refer to bothidentification numbers,
Site ID: 158033 above4in all correspondence with the agency.
ST CROIX County, Town of CADY
NE 1 /4, N W l /4, S32, 728N, R 15 W
GORDON ANDERSON RF.PI.ACEMENT MOUND
FOR:
Description: REPLACEMEN"r MOUND
Object Type: POINT System Regulated Object ID No.: 418366
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
This plan approval is for a 450gpd mound.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This plan action is subject to designer comments on the plan
• Correspondence Note:
• Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the outlet
filter will be required. Outlet filter to be installed per manufactures recommendations and product approval
stipulations.
A copy of the approved plans, specifications and this letter shall be on-sire during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
constructi oo/instal lation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincere/eff P.0.
DATE RECEIVF:DOS/25/1998 COllill
TOM BRA PLAN REVIEWER FEE RECEIVED $ 18a 00 APP R
DEPAR1hSt NT
Integrated Services BALANCE DUE S 0.00 DIVISION I SAFE
(715X634.3026 , M - F 7:45 AM TO 4:30 PM
TBRAUNC3a COMMERCE.STATE.WI.US
COR~'E,
ULBRICHT & ASSOCIATES_ CO.
655 O'Neil Road a Hudson, WI WIG PAP, Designers afEmax o wsy:mmr
semege tiatuA.vds
715-386-8185 P'"',
PROJF(`T INDEX
DILHR Plan I.D. A 13&85` 9 oait 8- 27 - 79
owner ~Oxvv-" I~VAkSo,E> ophone 71' • zZGf
Address 320 f//wo) C7 4Y 19 0/'v///'e &7 S- yo.z L?
Legal Description PIN (90Y-1077.5"0. - AW7 Pit-- /Op
s% C/?O/•JC
Town of County
C.S.T. k90%YE)e7 YWI*/ -4 - 7-//S77- Installer -
Local Authority/ Supervision
PROdFCT DESCRIPTION
2- --3
?cr,a-f. ffiX~i It04,e • ~~s~h r~ ~>t:~y ads7<t>`~i~, -
43-0 daps . -
W.T.S, \
~ ) 'guy
s~~€ stT~GQY -23 OF OF COMMERCE
EY AND SUllo
P,tl.°ok4oseD q/ uS7'tf C. a Levy t/ilz'rQOZO /'dU 57
[J7 t / Su-vn~ ri GL _ ENCE
,f v ~Pp~ov~ Go ~~<i v5 ~l> ~ ~/oz s" viciu r
P9.1 PLOT PLAN VIFWS ""'"1envrayvei'i
s'P~SCONS
P9.2 SYST[M CROSS SECTINB R SYSTEM PI.A!I VIEWS
P9.3 PIPE LAI[RAI LAYOUT 0 BR~IDMT
01160
uDSOM, va ,
P9.4 DOSING. CHAMBER CROSS SECTIOIIZ
Pg.5 ri!MP PERFORMANCE SPECS
design For Installation is based "u.irely can
E
npatrtfranents, elewat{wla,
Ibe ant~!r-cu ! conditions of hio ( nptslY-s n , apessntc fPpo,)r LIZ, soishal l l r sultomaablln lf.ythnpsolrowl ded resptbyuln C I S bl14 l
of he cs f. if.y~
or the c ,Ttl.
Any use rt this vOWTS design ty any licensed, lanba , or any
related unlicensed parties or persona (eacaatsre, 1 borers)
shall not be construed as an n .mptlon of responn lb lily by
N. designer (ot the wrkmanebl V, cnne[ruot ion, Pl e[ vent,
substitution or selection of any components not ape pled, or 1
any aesunptlnnn by tha plan tor that any tins pncl [Ind cnml'onwnes
are state approved or prop,,, or the etfecte or p r Judgement
it sulking under edvwree damaging vesther [unditi.n. (vet/[,oxen
aolla) by any such parties or persons.
see
I ~
x
N
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M a U ~ p ~ w z~ a
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BeD of ra
/ 1 y21 A59eo5ATE
DiST Riq~T~ov
P; pi ^+rr
L rpi cA-.v c>r SYSrEH
OF TOP.Sait
' Ei IEVA rIDy
V"ir-OPM VOE i 1, H .6 / 77•d
I- E
r
SAoD _
%J/ PlewaU T-opsni l_
vii FORM
/ qn S1OPF FORCE
Nhi..r 61EUATTOa Uu DE{j
~O O
(3ev
D A0 Fr. ESE VArlo~) 5
E 0 fr '"%)CRT- OF 2 ' IATE'RA(S 17 70
1-np aP Rock /~[77
!I /•S FT, °P °F IATERAIS 95lv8
PLAN VIEW OF MoU),)p - wir•H 13ED
e.~D
FoRcr MAiO A S FY
L I 13 IS F r
k 10_ Fr
Il
I I
0
,
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i `9 N I W ;Z7
FT
\ BED of
PVC CAPPED To t °
oBSERVAT100 A99RF~IAT-L
PIPE S
PERNAOPIT MARKERS
9e(,V(REP 13A;AC ARr-A _ TAIL ft)AZrEr low 7C9
sOl~ 41i; iTRAfIUF -
CAPA•iTY S4. FT,
PROPOSED I3ASM APeA 1 (A + r
75 3- Y-
.,pit nr.. r+AU, (o l.li I1r572_ - - - - f3ut''oti, plE't= tiRt`woR k - -
' TotAr_ VoLu..,t` of LATERAL. A., L_T-woIP.K
DI STRIfjUTlo Al
le a RAI
H u o c A F J?!A /s r flh/E N~rT 7a
tl i=-y-- -1 - x - 1-
['UG; ~O RCF
MAitJ
LAat 1{ole 010 1it_
Nf-fl Ta Kub [AP
vo1D voltmc- FoR 35 rr.
- ' ~nls
]:uv6Rt F-.It=.vAt-ro.u of ~ FORcE Mniu I
'l ~JO
Ri oFArFl7 PIpE Dr -,q, I
- - Ilole+ Ic,cATeO oN
-I- _`__`r7 13aTten st{All (3E
vntlnnl_F y egiuhll\l 5pALeD•
r brstAr,cF
I' i {IoIE UiAM&TeR ru.
I` N/A- LATERAL-- ~ -2- rA/
MAO%FoLD ^
/R r.,r1.FS Foece "Aik) l7 b.r..l.rs d{_ oF• ({DIES/ pi PF. f/.
1w,rR~r3u-rroA~ Uryc IIAV GF RAIE (tFR LATERAL Zz•23
I OJAI- DI r kAR i.r 12 Al r- trF. to 0p L2.2'1
pj . 3 of 5
i
I
WMP CJIAMaI.a CROSS ACTJOU WO srEUVUaTIOUS P+yF 4eF S
rOT rnP
4 C.L. VIIIT FIP C
W[AI1168 PROOF APPROVED LOCKIUG
duur.r lou nax MAUf1OLE COVER
za'rxen Do^R G~wA.fAlmr.-!nlgE~
M MOO."' OR F Rfau IYMOI.
All, W-TAKL
/ APf If U47/On/ GRADE -
1F F / . I 4•MIU.
9e-o" i- p MIU.
1 CouomT- ~ -
3.0 - - - 11
Im r,
g7.0' } 1
:w, PROVIDE
I :,-a
-J -LI--_- AIRTIGHT SCAL I lil V
I I
APPRovrD Jami w iIJ51nE~! I Ilj APPROVED Ja TS
la/c. T. FUr ~aM ' I III W/C.T. PIPE
Lx FEUDIUG :5' <T.O'~ I III ALARM E%TC\1Olur. 3'
C%JTO SOLID SOIL 0 VV~~. / I ` I !I l OgiO 501.10 SOIL
tl / I ( 1 D
OU
OF I
r I IV 91 POMP-~ Orr Z/SE" 3rra(
SAA O
0 Ik ~rDO I 1ILOCR
!l. RFSL.R [KIT PLRMIRED OMLIJ IF IAUN MAUUFACTURCK 11AS SUCH APPROVAL
5
SEPTIC i _31'C GIFILAT IOAIS
DOSE
/tS/G70Lsinal
TAQ NS In AUI•f ACT 110.7 R' _ A1ZdJ7- (JUMprR OF DOSES: ~ PER My
TAUK SIZE[ _?$O 6AU.OA15 DOSE VdLu
6LUME /p
ALARM MAUIHACrURFR: LPOEL~e /PYI'e IMCLUmuG SACKFLOW: ~'0 GA5L OU5
ttOOEt AJUMDER: CAPACITICS: Ae Mf mcs OR o GAUAUS
I Sq•ITC 11 Tvrn ME~CVp/ `~Q/~r - p= Z 14CWESOR ;~s, 4ALLOUS
PUMP nnwlrAETUn%R: !OE//t ' •~IOr NFS OR IIE%GALI 0us
.1nryrL A)UMDER'. 28--ff_ 0" IHc NESnR 25Z"6ALLOUG
SWATCH TYPE: I1291--WTE: PUMP AMD ALARM ARC TO Pit
MINIMUM DISCHARGE RAPE _ ~LGPM INSTALLED Oki 5v PARArC CIRCUITS
VERTICAL DIrr EIITAJCE ELTWLEU PUMP OFF AMD O15TRIpUTIOU PIPL l Fr.LT TANF SP(L'S
F- AIIMIMUM NETWORIK SUPPLY PRESSURF//.. _2i iCCT E/iCQ, 0IV 9A
1 3S _ FEFT OF rORr,E MAIU X /i/O F/ppMtRIt NOAI TA<TOR.. r~! FEET 7
- 757
'1OTAL.D94AMfC, MEAD I E E T
❑JTENIJAL UIPSENS'.ONS OF I%tJR: LEU6TU( ;WIDTH F/ jLIQUIO DEPTH _76/
HEAD CAPACITY CURVE
_1 Jp / I/1
- MODEL "91)"
m _ e
p y
29-
p / s/a
69 3 Is- - - _ ° +
/11
6- I 1/1-11 1/1 h,1
U.S.AS _ io 1 10 /o _ b b N ea
b b
0 flow PER MINUTE 110
r~~wnar::riiu nn
=•'b__ YVr4V,N 11
YpM.
m •e° u m
.81
« a1Y ~ YA
15/11
w v`N• --xf at-T
.
-1
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• ElBpdcm Mnnmlora, Iq dupba aYYema, ar, av~llage argl
"11PWled wah an alum • MwC"Y 1100 $WkChe0 010 OVsdablo for cof U UU,
a Mschanic0 Mernalge, itjr du Ily„ P114se aymems. wlgm alamnWchea 0yllplns, ere avellabip with q • g p and
Doubt, Piggyb,ck mercury so, ,waGres are eve Mbw Iq
VW l•bl, bvel lon0 cycle commis.
Rlandardall mod•b 30 the 11.P. rwpnrmY 604coo,"m
NauM~ _ _ ] Nryrr vhura ArmNC ~~M~~M11q •'•'1^Y'~nYa npyw.
YYd~_I YMH YYA• M Gnha Y•MeYw__-- wMrh NV«biYJ1»W anY «Ya,aawa. K]OrlU muYwr,aaJ
-"-°e 1!! I a sp. a u.a,ww.e..n.1w 1o 12 IoOYIa
i~ IE_ -1 - 1 aN•fWrl],IV ONrocI,«,yaEWAy JWn1w,"E-PLL'.
L _
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f
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r]r•q Oapl«oP•,•a>'l lOOppa W"MWY•wwabnw wYM Yr.N
1, Two I]I Iw4 "J PLL". kt nYWY1,r WYb. J VON
iv FlN.•Yy,«~iwbr
RN 4.. Wt Mann MnY
i vY,~VM,rW»I:fY.YAY,YN~, «L~~w•aV n.,•VEwY .WrM,«tl'•; 4MW41MM•rY C.YIraY
'VMf. /4rw lyl,Y..IWNIa;
ib1Y e„MYwW. y,. rYt«r: w Mp•. C w yW' M E,«W .N•I~Wn Y yyyy«1,,,~ WY'1 •M." A•
M w..r N.1Nw u..«, c.u 111.9 w ~n, w r.~•w w
N..Y M r0•wA w„fy,yr Y.IV♦ y
For unusual RESERVE POWFPED DESIGN
conE11lbna a ro""E"' "T"'Y lector iY Ongineaed IrYO the design d 04" Zo011er pump.
/~7r ISNO 10:J lO NAE rap J071 Pall1 % Z,91 Z, Q Z7 to l $0 0q" L6f w
t117 401,16 /a
Ei c; le Qarurr/~]VA/ Xwr /jff
1117UI • lATh'OIP AI J17f