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020-1131-10-010
WisFonsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saf+ and Building Division INSPECTION REPORT sanitary Permit No: 538733 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gostovich, John B. & Celeste I Hudson, Town of 020 - 1131 -10 -010 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /00.4 $ 1J /✓� 6 J 19.29.19.626 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. J , 30 0/. Ada . 1 1S Septic Benchmark Dosing / AI M `75 v ✓ L X70 AV, 05 Bldg. Se4der Holding St/Ht Inlet _ TANK SETBACK INFORMATION St/Ht Outlet 7 . �f3 95� 5 lA TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet k)e,5 Lo = 7Z '7 3 .7 7 S tic� 3/ .54 ✓� DtBottom // 57 � yo Dosing / T / 1 Header/Man. Aeration Dist. Pipe Holding Bot. System .Z C:�5. PUMP /SIPHON INFORMATION Final Grade 3. 3 Manufacturer / / Demand St ver // ZO �lilJr�, GPM iJ 76 M OS Model Number n A) 3 TDH Lift/ .3 Fricion Lo� System HeajiJ TD ,F1, 6 r� lV 1CO Forcemain Length Dia. Dist. to Well / W SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PI 7 DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - 3 3 j `` SETBACK SYSTEM TO P/L BLDG i WELL LAKE /STREAM LEACHING Manufacturer. �, r INFORMATION CHAMBER OR Typ Of H �' /6br w UNIT Model Number: DISTRIBUTION SYSTEM d- 1,5 Header /Manifold � Distributio x Hole Size x Hole pacing r ent ffoir Intake Pip Length Iy Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only �- Depth Over Depth Over xx Depth of Seeded /Sodded xx Mulched T Bed/Trench Center Bed/Trench Edges Topsoil Yes E] No des No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 870 'i0 Strawberry )c ane Hudson, WI 54016 (SE 1/4 NW 1/1 P,+ 4 19 T29N R1 9W) Strawberry Point Lot 2 Parcel No: 19.29.19.626 1. Alt BM Description= = H 0 G - G 5 FP r.,,, .J . t c„ �^a . u� P 4 � — � I 2.) Bldg sewer length = 1 � amount of cover = 1 /o C4— In 4, Plan revision Required? ❑ Yes No Use other side for additional informati n. V SBD -6710 (R.3/97) Date Insepctor's ignatur Cert. No. r ACV V J >51 4 v/v y� fi eommeree.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix i seo n s i n Madison, WI 707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commeroe 40 Sanitary Permit Application State Transaction Num In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approp ove ental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Applicati forms for state -owned TS are submitted to the Department of Commerce. Personal information yo pro be used for secondarJ 870 Strawberry h]ii3r+e fa w{, p urposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application Information - Please Pr *t All Information Property Owner's Name Parcel # 020 - 1131 -10 -010 John Gostovich &Celeste Koeberl Nov 2 " . • t Property Owner's Mailing Address p CRUZ Property Location P.O. Box 205 INNING ON /NG COU NTY Govt. Lot City, State Zip Code Phone Numb SW %, NW '/4, Section 19 (circle one) Hudson, Wl. 54016 715- 386 -5240 T 29 N; R 19 E or w II. Type of Building (check all that apply) Lot # El 1 or 2 Family Dwelling -Number of Bedrooms 3 2 Subdivision Name rft Block # Plat of Strawberry Point El Public /Commercial - Describe Use Na ❑City of ❑ State Owned - Describe Use CSM Number ❑ Village of Na LKown of Hudson 15 /5 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System .-pl a c ement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal 11 Permit Revision 11 Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner i IV. T of POWTS System/Component/Devi Check a ll that apply) LX t on- Pressurized In -Groun ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil 6 Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Tre , At ent Area Information:45 Infiltrator 4" standard chambers & 3 pr. end caps & SymTech STF100 effluent filter Design Flow (gp Design Soil Application Rale(gpdsf) Dispersal Area Required f) Dispersal Area Propo ed Of) System Elevatigly 450 gpd 0.50 gpd/sq. ft. 7 900.00 sq. ft. 917.40 sq. ft. 95.50' 41 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 0 New Tanks Existing Tanks a Septic or Holding Tank Na 000 1,000 1 1 An own X Dosing Chamber 750 Na 750 1 Na I Wieser Concrete X VII. Responsibility Statement- I, the and rsigned, assume responsibility for' a on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber/'s Signatur MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 715) 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 511020 VII oun /De artment Use Onl X pproved Disapproved Permit Fe e Date Issued Issuing A Signature eason for D en $ '�7✓ OD �� Zt�L �Q IX. CondigggrgiftME"easons for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All sack requuemerAs must.be maintained att per applim* code / a�, Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD -6398 (R. 02/091 Valid thm 02111 E 'an�S �1 :Tap o/cv e /% Elegy : /AJ. Sa ¢ vQ /cta GOn �'Eb yr .,�sd 5id;hq. Elev _ /cr�.ys,� • so;/ byu /6�lcE� 9 3 � � SepE.'cta. K /►tan /id /e � EX�:S�i'nq �r'ad� eIQ.U,' On / 6' - c,0,7,--r Sohn 6as&llc.l e C'e /esZe Sao vb�ry L1-. f/u.�,son cJ /. Sy<J /6 Sec. /9 >..29e..,, /90, ag azo - /i3 /- /o - 0/0 04(aare4 4PProx. /otd�o.,� 364o(roo,., a �� 6r✓'r;ed�a,s /i�1C� QiS;o/sneC E /erC = /dU.00� i a-4) / Or'CC4 CenC�.t = o�5.cli/!q = /�• 5• , Propo s-c/ t o e s ai Con ece- 3. 750 , 9a. P urn/OC " 6 4i — W /SrMTcl- .577 160 61/414«6 -C','I 4,e i s bx //e dQ E/4 .np d'sckar�e. bra ve/ ' c l20 (2p -eC( .b 3(0/4C 97 9B` ,�l E� rou� 1, Syst -tw reA. P�dpose�d,3p&salW /4 f .z.X (,z: 'Tf (� ire news a-6 - �ccf1•�nc� 7 r`nc 5 x44 ccc✓a. 5 /vPes t,�. rou� 6yS 9.o G�C.r,✓, �,�;- -oi Siccry�a a✓o+�+arC4w •S, �rau'bar�y P . zoo' /� r Dose - Conventional POWTS Index & Tilte Sheet Project Name: John Gostovich & Celeste Koeberl 3 bedroom Replacement POWTS Owners Name: John Gostovich & Celeste Koeberl Owner's adress: P.O. Box 205, Hudson, WI 54016 Site address: 870 Strawberry Drive, Hudson, WI 54016 Project Location: Subdivision or CSM: Lot 2, Plat of Strawberry Point Legal Description: SWv4 NW1 /4, Sec. 19, T.29N., R. 19W., Town of Hudson, St. Croix Co., W I. Parcel ID #: 020 - 1131 -10 -010 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcuaations Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Pump Chamber Calculations & Tank Cross Section Page 8 Pump Specifications & Performance Curve Page 9 Parcel map Page 10 Septic Tank Maintenance Agreement Page 11 Waranty Deed Attachments: Soil Veirification Report Mater PI ber Restri ed Service: James I Thompson Dept. of Comm. Credential A 300321 Signature: s Date: Page I Of 11 Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 /01) n ca/t : = !Vo • �el ¢ 1.3 5 / E on s 7aPo,, We //. I – Ivf _ /ev. 6 -`o,/ e bn �y'E by i Mmr/sr= �,E /t /E . •rr(: ( ao6�,n or ?C. - * Soi/ eda /u ¢ 'on by Sr dFnq . Elev. : ict�. yS, � �E Topo {ejCisEi�a Se/,'cfa.+�/rfa.�lW /e A EXiS,inq �rarte 2 /FU C'ovcr: /.Erai /�tncc /ocafcd �GZ / /e /ieu ° 0 Sohn loas�aricl � Cr / <s�e x'oe6eii' 570 y L1-. f/ cJ /. syv /6 , n o �o�z, P/a6 oF�ra�bc/ }r �' , dram st. crei r Ca, 4.2� �0 c,/ a cuo - /i3 /- /a - o/o be ;n� 0 1( acres Ew3�'n � rti.�c 3 bedroovy — � 60 ca on o K 6r✓n'cd aS /iqC Qss:a(sncC � E /trl -540061 / SfJa C N 4.fq +Q �r �c ro? : z,o �f� ✓c ��� f K ic» r(t' c� at (�o EEorn .9!1,39 98. zQ� 3 Propo sec/ LA); e s ar Cp„ erc-�¢ 750 5 a. 4 cc..,/o C. (.a,., be r W /-41MTec�- 577 /Cv �';lEeri�5bt / 0" - 1/ 0 4v �drivc �E r!o Qp�a�CCla.ble 3(opt 97 98� �/ tftir0u -0k SysE�.yt arm• P /dPoscc/ d,3p&,sa/ W/Q 6 .v X (oz: i 'Tkrtc (i,) 6 rercAesa - e 3 "t6z' /16 46 Q p �n�'/ [/ O�L►' nQ_� n5,y►1 Q�ait� �Af O//S � /UPl. S C�.rOU� Pcr-&eI7 4c 6 0 s e/eu. - 6 be 9SSa.' P. o r �� DISPERSAL CELL SIZING CALCULATIONS 1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft. 3. Absorption area required: 900.00 M. ft. 4. Absorption area as proposed: 917.40 sq. ft. (45 chambers total) Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.t EISA 900.00 sq. ft. — (3 pair endcaps)(5.80) = 882.60 sq. ft. 882.60 sq. ft. /20.00 = 44.13 chambers required Number of trenches: 3 @,, 15 chambers ner trench Trench width: 2.83' Trench length: 62.00' Trench spacing: 9.00' on center Total system area w/ 5' trench spacing: 21.00'x 62.00' (�, 3// Soil Absorption System Cross Section y9.ap ft 98.ca- 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap % so ft Leaching --► Chamber SO ft System Elevation 3.0 ft &.O ft ( ft 9 Soil Absorption System Plan View ft 3.y ft &P,Q ft Leaching Trench 1 Chambers 4° Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model EISA Rating 20.0 sq ft per chamber Soil Application Rate ©.. S gpd /sq ft �5D 0 gpd Design Flow - 0, 5 7- Soil Application Rate :- .20.0 EISA = Chambers i 3 rows of /s chambers each. Page of Dose Conventional POWTS Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. If the septic tank is fitted with an effluent filter, it 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. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed wate rti g ht upon the completion of service. An opening � P P Y P g 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed at the pump discharge, it shall be inspected and serviced as necessary. Soil Abaorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to Jim Thompson at (715) 248 -7767 or your County Zoning inspector. SIM/TECH FILTER SIM/ C14 FILYER SimlTech Filter The GAG Sim/Tech Filter is unique to the industry, engineered to provide maximum protection for your sanitary pressure system. R' The Sim/Tech Filter has been designed as an effluent filtering device to assure small holes in the distribution piping remain unclogged. Pressure distribution systems are very effective in treating effluent, but only when holes remain open. Many of these systems only partially fail, causing contamination of ground water long before the system shows any visible signs of distress. Placing a filter just before entering the forced main is a simple solution. The filtering device installs by simply screwing onto the discharge port of any effluent pump, thereby filtering out contaminants before they enter the distribution system. Thus, maintaining even distribution of effluent. The GAG Sim/Tech Filter protects any pressurized system including: Sand Filters - Spray Irrigation Systems - Pressurized Chambered Systems Recirculation Sand Filters - Mound Systems Zast1 Jnst.allation - O-oko /ylaintenance - fconomicd - Sxtends life o� ',Nain4ie1d - Jmp>roves S f �luent cuahty 6V even T)ist7i6utiori - jdea( �o4 "'. luent 'udmersi6le urn s - Can 6e used in both Residential and t j Comrnezcial �ppllcatlons t O rder # Model Description List Price STF -100A2 STF -100 GAG Sim/Tech Filter (field assembly) 468.95 Simi s, The STF 110 has well over 1/ ile of filtration dia with over 319 cubic inches u: , of open area to eliminate cloggin The 2,2 square inches of filtering surface <# allow a flow rate of over 1200 GPD, i i to 1/16 inch diameter. This incredible amount of filtering surface is achie the unique shape of each triangular bristle, which more than ubles the filtering surface, with no uniform holes or slots to plug. rder Model Des i tion List Price ST 10 STF - 110 Disposa eptic Tank Filter (yellow bristle) 23.86 6 -5 j �. ( Wtf Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► 1� Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer _r 2 in. Ca aci 750.36 Gallons Volume 20.28 gal /inch A _ Weep hole or anti - Dimension Inches Gallons B siphon device A 19.00 385.36 B 2.00 40.56 C P ump off elevation (ft) C 4.00 81.08 -t 90.50 D 12.00 + 243.36 D Total 37.00 750.36 Do se tank elevation (ft) 3" Bedding under tank. 89.50 Alarm Manuafacturer SJ Rhombus Tank Ale_ rt Alarm Model Number SJH 1011421 Pump Manufacturer ;Zoeller Pump Model Number IBN 53 Pump Chamber Calculations 1. Force Main: Diameter: 2" Length: 25' Flow rate: 38.0 gal. /min. Friction loss: 0.825' (25' forcemain)(3.30ft. /100ft.) 2. Total dynamic head: 7.33' Min. supply pressure: 0.00' Vertical lift: 6.00' i Forcemain friction loss: 0.83' / Effluent filter friction loss: 50' (/ ✓ 7 (Sim/Tech STF 100A) 2 3. Pump selection: Manufacturer: Zoeller Model number: BN 53 Pump will discharge approx. 38.0 gpm @ 7.33' TDH (Flow Velocity 3.876 ft. /second) 4. Dose chamber: Wieser WLP 750 - MR - 37.0" as 20.28pal. /inch ( 760.36 gal. actual) Sizing: A) One day holding capacity: 19.00" = 385.32 gal. B) Alarm setting: 2.00" = 40.56 gal. C) Dose volume: 4.00" = 81.12 gal. (450gal.)(20 %) + (.164)(25') = 94.10 max. dose D) Reserve storage: 12.00" = 243.36 gal. TOTAL 37.50" = 760.3b gal. Pg. 7&A �l TOTAL DYNAMIC HEAD /FLOW 2 U- PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/5 57/59 EFFLUENTAND DEWATERING 6 20 MODEL 53/55/57/59 = Feet Meters Gal. Liters 15 5 1.5 43 163 0 4 10 3.0 34 129 a 10 15 4.6 19 72 009097 Shut -off Head: 19.25 ft. (5.9m) 7� 2 5 3718 83118 45M 1 12 -11 12 NPT I 10 20 30 0 50 GALLONS x` � 37/8 LITERS 0 160 + FLOW PER MINUTE 4 CONSULT FACTORY i ! ! FOR SPECIAL APPLICATIONS • Variable level float switches available. • Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. • Alarm systems available. ! 10 v1e I I • Duplex systems available. ! ! I i 33132 j SKOW Singl Seal Control Saledon Listings SELECTION GUIDE Yodel Volts Phase Mode Amps im ex Du ex CSAJ UL 1 1. Integral float operated mechanical switch, no external control required. M53/55 & M57159 115 1 Auto 9.7 1 — y y 2. Single piggyback variable level float switch or double piggyback variable level N5365 & N57159 115 1 Non 9.7 2 3 or 4 & 5 y y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 y If • BN57 115 1 Auto 9.7 _ N y 3. Mechanical atlemator'M - Pak' 10 - 0072 or 10 BE53/57 230 1 Auto 4.8 y y 4. See FMO712 for correct model of Electrical Alternator. 3/55 05 & 057159 230 1 Auld 4.8 1 y y 5. variable level control switch 10 -0225 used as a control activator, with Electrical E53/55 & E57159 1 230 1 1 1 Non 4.8 1 2 3 or 4 & 5 y y Alternator (3) or (4) float system. Single piggyback switch inducted. ♦ cAUn For informalion on additional Zoeller prodixts refer 10 catalogon Piggyback Variable Level FloatSwitches, FMO477; All installation of controls rotaction devices ces and wiring should be done by a qualified BectricalAiternator,FM0486, MechanicalAlternator,FM0495; Sump/Sewage Basins, FMO487; andSingie Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Conlrol/Alann Systems, FM0732. most recent National Electric Code (NEC) and the 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. - -- — MAIL TO PO. BOX 16347 - - -- -- �Al� 1(5 ouisvil le, Ky 40341 Manuf H1P To. 3649 CanRn Road acturers ol. . Louisville, KV 4211 -1961 htfpJ/wwwxoeUercom AA 77 &2731 • i (800) 9 PUMP �+ Pur+PS Sv CE /999 J I �O FAX (502) 774 -3624 ® Copyright 2004 Zoeller Co. All rights reserved. A ► -� .. - • � •� 3 7 R rig +r ��q rp AF . l ., Jf 4.07 AMES 62 OF PP41KE �"�" ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner O Mailing Address A O• oS #"dsoyi Property Address �Td Sf cif errl� A VC (Verification required fro Planning & Zoning Department for new construction.) City /State / Parcel Identification Number 020 - 1131 -10- LEGAL DESCRIPTION '/ Property Location 5 W 1 /4 , /70) 1 /4 , Sec. / 9 , T � N R /9 W, Town of j4c -S0-) Subdivision Plat: � 'Q t,Jbd/Y'y bl•�� , Lot # Z Certified Survey Map # , Volume 44 , Page # q Warranty Deed # (before 2007)Volume , Page # Spec house❑ )Rwz � Lot lines identifiable & es 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of WisconsUL 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 warranty deed recorded in Register of Deeds Office. Nujnber of bedrooms SI F APPL ANTIS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) ttOc:ux.t�rvT hIQ. WARRANTY DEED r� * >IIS sF�ce IiGSEfIVEO FUA HECOnCi.HG on *.. STATE: 'AR OF WISCONSIN FOitTd 2- 19821, li 3tec• for Rea -vfo JAIAES V..- .HI RSCx,... . ... AUG 2 3 19 93 ................. ...................... at 1 -30 .......... .--- •.... .... y t ." j7 convevs and warrants to -- CELESTF.,J. ,KOEBERL .. and . JOHN R I� �; - ... • .. ............ - ' �4�.'C�V. ?.�::,. ::isb.arcd..�rid._w�.fs . aa.. �asr�3 .ta�...auic�i,xpx>�h:�8._.... I t c. a .�t .r f• = � `; ... ..... ......... .. ..... ........ .... .... ..... .. .. .. ... .............. ... it PCfUnH TQ .._.___ _ ... -.._. .. _..- ... ... .. - .... .... i t _.St.Croix ..... .County. I he following described rea: estate to . . .. ....... ....... - -- -- _:- ---- -- ___ .._ —_ —.- -- ,— .- _- -'- - -z t Stitt.: .,f R'ine..nnin. !! Tax Parecl No: .............................. �I I! iI ii ii Lot 2, Plat of Strawberry Point, Town of Hudson. � �,'�toc L G 1'Y3 tt• > •. t coo I � ,i i s ThiN is not_.._.._,, homestead property. (is) (is not) Exception to .warranties: Subject to easements, reservations, restrictions and rights -of -way of record, if any. IJilted this ! / ........... ......... day of .......,1.c7.a/lly / to .93 . .(SEAL) • James V. Hirsch ...... ........... ............(SEAL) _. _.._. (SEA1.) AUTHENTICATION AC3KNO W 7.r:DGMENT r Signature(s) STATE OF WISCONSIN 53. ______________________ ________ .......... $t • Croix °-------•-•-° ---------------- --------County. �[ authenticated this __...... day of ................ ........... 19... -. -` ,f rsonally c e befort me this ....! j .._..-..day of ..... 19.9 ... the above named ` << - -•-•-. •- -- .......................... _.. Il '- ------ ---- -•- - - --- • - ---- -- --•- ............ ..•.............. •--•-.............. .__.. ......................... r - --- ••-•--- -- --------- ---- •-• --- is TITLE: MEMBER STATE BAR OF WISCONSIN ...... ................... -. ........ it (If not ..................................... . ---- ...... _.. --- - J ,�N+•tu�of# , - t! authorized by § ^ •06.06, Wis. Stats.) `mot,. Ztirs+� to me know Ptii�� .._.... n. 9 posSP{i��� _ _... who executed the foregotng inle and ac ^e tite same. Tr11S INSTRUMENT WAS DRAFTED 6Y '� TAR Robert W. Mudge, Atty. b� x . .. t7?��l� G: t 1 . t?$3oT -� s oy f . . ...... ...... .. .• -• -• ---------------- . .._._.•. r .. .........--- - - -- -- ° -... Not^ Pub ,_... ?t C..;;nt }'. ., B ... v, - f�icrnfat. ;arng mnv tv. ,.�a ^........G : , :.0 w.fu'hcu. t >u.n - .,:• ••••••••,., � ^' .+fi i.O.. .. .a« ii: is ii .. u: n are not necessary.) date: 19 - ,1 •Nnr.:rs of Doan nn a to nr.c ennnfitr ch..�C.t iia ty ro-t nr prina.•d b.•I• th.�,r .ic raa•:I•a•. =- WAIMANTY DESn STATF. DAR OF WTSCONNMTN W:s.:nnS LCQ.1' 81.1nk Cam, .... FORM No. 2 — ['.:�2 1,I,t>V I,Ik. -o t4•s.:..ng�n 2234 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 020 -11 1 -10 -010 Please print all information. Revie d By Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). a X A Property Owner Property Location John Gostovich & Celeste Koebed Govt. Lot SW 1/4 NW 1 S 19 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. NamJ or CSM# 870 Strawberry Drive 2 Plat Of Strawberry Point City State Zip Code Phone Number City _J Village sM Town Nearest Road Hudson WI 1 54016 1 715 - 386 -5240 Hudson I Strawberry Drive New Construction Use: J Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement —J Public or commercial - Describe: Parent material Glacial Outwash Flood pl in in at( n, if�app na General comments 4 ( d� D 0 �� fC.e 9 and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gpd /sq.ft. /day loading rate. Proposed trench elevations to be 95.50'. Existing dispersal cell to be abandoned. Boring # I Boring Pit Ground Surface elev. 98.06 ft. Depth to limiting factor 71 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/2 none Ifs Osg ml cs 2fmc 0.7 1.6 2 9 -18 10yr3/3 none Ifs Osg ml gs 2fm,1c 0.5 1.0 3 18 -28 10yr4/6 none Ifs Osg ml aw 1fmc 0.5 1.0 4 28 -50 7.5yr4/6 none Icot & gr Osg ml aw lfmc 0.5 1.0 5 50 -71 10yr4/6 none $ I Osg ml cw 1 fm 0.7 1.6 6 71 -81 10yr4/6 f2f 7.5yr5 $ Osg ml aw - 0.7 1.6 H#4 displays a high clay content. Loading rate adjuste4 to reflect reduced permiability of horizon associated with high clay content. P - al Boring # J Boring Pit r 71" � Gr o und Surface elev. 98.06 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/W in. Murrsell z, Cont. Color r h. *Eff#1 *Eff#2 Qu S Co t Co o G. Sz S 8 81 - 89 7.5yr4/4 &106/2 f2f 5yr4/6 fs &fscl cemented /1fsbk dsh /mfr - - 0.2 G.3 * Effluent #1 = BOD? 30 < 220 m /L and TSS >30 < 50 mg /L * Effluent #2 = BOD <30 mg/L and TSS S mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson K 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/3/2010 715 - 248 -7767 E" a 'ores /Grl.Co' Soy / eda /ka�b.��E b s� l E . (�1 o.h oF$c irt�e • .Soil eda lu ct Elo. by wl r/a 6 rl yy 16 . ,k,104 /wh EX s �' 7ra� 2 /erg' �' EX,3E,' s�o % tray /�- c.�ec /oca,fco� Sohn ' d Gles 7�oe 810 .�fra�vbt ,y f/K,dson u7/. sy�J /6 �ud tUn, S t.C'-Oix Co y c� /. t o c,/. 06 az - 1131 /a - o/o o,� ac re-1 &,.56. gp /oc 4'0,? &( 36ta/roo,,, o E/crl = /�• oo' / a-fC& ddncr t St/Eia �� �cis�irq ✓try \ IL CL-6 te*C00" • ' /� OrSf'ck/19 : /dv.73P \ S - Is ' s kt Pv v \ give r10 2 p er- 6 /e 3 (opc 91 �� �• t G. ro ug l. 5ys�n ?A. SEra�barrj/ l ri ve- or � L4^ i�cn `iparl�{aiusrr9.29.19.62IVA'II� SEWAG`�(STEM ERRY LAN Count y : Labor and Human Relations INSPECTION REPORT '~ Safety and Buildings Division T. CROIX (ATTACH TO PERMIT) Sanitary Permit No-.. GENERAL INFORMATION 9 1999'83 Permit Holder's Name: ❑ City El Village R Town of: State Plan ID No.: ev.: nsp. M fl o ev r : 'BERT BIVI Description: Parcel Tax No.: 020 - 1131 -10 -010 TANK INFORMATION ELEVATION DATA A94010012 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer [ Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 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 Syste ! TDH Ft L oss Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing 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 t Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑Yes ❑ No I Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 19.29.19.626,SW,NW,LOT 2,STRAWBERRY LANE Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. Y ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4, 4erriel- 4," DILI -- SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY moms _. .. - 5 STATE SANITARY PERMIT # –Attach complete plans (to the county copy only) for the system, on paper not less than f Q1-09X 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 I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 1 0y- DOOD f PROPERTY OWNER L PROPERTY LOCATION c G 7blfAl 6 OS O yr �ES7E /� 54) '/4 N W' /4, S [ �j T -1- 1 , N, R /l E o W PROPERTY OWNER'S MAILING ADDRESS LOT # L BLOCK # 2 2- 2 bf i S CITY S ATE , ZIP CODE PHONE NUMBER SU DIVISION NAME OR CSM NUMBER 57 7_ , ' /;W �Iiy,� S Sl6 S G� �G P ( , 7 - ®P 5722v PO /:v T - II. TYPE OF BUILDING eck one) CITY NEAREST ROAD ❑ State Owned ❑ w GE ; ❑ Public 1 or 2 Fam. Dwelling -# of bedrooms L PARCEL TAX N III. BUILDING USE: (If building type is public, check all that apply) OZ _ 11 / / — 0/0 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 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 (Chene in li ne A. Check line B if applicable) A) 1. El New 2. acement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 El Pit Privy 13 El Seepage Pit Pressure S/ 43 ❑ Vault Privy 14 ❑ System -In -Fill Ste° �- 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION W(9 S <3 F�_ 0 Feet ' Feet VII. TANK CAPACITY Site ing lExis Total # of Manufactur 's Name Prefab. Con- Steel Fiber- Plastic App. INFORMATION New istin Gallons Tanks oncrete glass App. Tanks Tanks 1 v�57P E�Ci�Tj� structed Septic Tank or Holdina Tank goo 11 IYOO 2- El Lift Pump Tank/Siphon Chamber M - 0 Vlll. 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) NIP/MPRSW No.: Business Phone Number: � jRe T ?. L X312 i Ctt7' lk)e d 33� `� 7 <s 3�G - �l� Plumber's Address (Street, City, State, Zip Co e): IX. COUNTY /DEPARTMENT USE ONLY E:] Disapproved Mary Permit Fee (includes Groundwater Date issued 1 Issuing Agent Signa [gppr,,ed Owner Surcharge Fee) Given Initial �� Adverse D termination O1 l X. N IT�ION�S F APP OV EASE FQR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Peer* ?it,Transfer /Rene^wal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The r i <_ tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years 6. if you have questions concerning your onsite sewe.ge system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending en system type. VI, Absorption system information. Provide all informat on requested in ##1 -7. VII. Tank information. Fill in the capacity of ever, new andlo, R ;icfi= , tank list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site uo ,,:eructed and tank matefial. Complete for all septic, purrttj'siphcn and holding tanks for this system. Check experim�-nli i! approval only if tanks received experirriental z roduct approval from Dll-HR. Vlll. Responsibility statement. Installing plumber is to fill in nar -e license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign, application form. IX. County /Department Use Only X. County, Department Use Only. Complete plans and specifications not smaller than 8' /z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, draw— to .scale r.�r with complete dimensions, location of hooding ;. =nK(s), septic tank(s) or rather treatme it 1*:=r , buiidir J veils; writer mairs /water service; streams and lakes; pump t Jnhon tanks; (list bo4es; soii aosr.—,i ur± systerns; replacement system are a"d the location of ``he. au : ,;l'ng served ' 7 h izontal and 11r .Ievat` ^r'; reference points; l com ete specificatio far urn s and conrls ;lose volume elevator differences' friction loss; m C) p. p umps c ion s, pu p performance; curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing °Information. --------------------------------------------------- - - - - -- ---------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act,410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used t- Tio^ %ir -n;,g groundwater. ground- water contamination investigations and establishment o� standards. I SBD -6398 (R.11/88) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road •Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # s boo Date ( 24 L) a 0 4 P .5 &0 S * C)R C C. 3 _ _ ._ Cs1�,• (" - ff p(P Owner C � iayr koa 5aR Phone 7 1 5' 3 PCo - 52- yo Address 223 41A 1fE(ZS - r Sr. 5T• PAU L, 55105 Legal Description 4„ - - Plhr of 5TRAw (SEIQIQ r sw, Ncv , stc. 19 1'2.q N, R ►q c-D Town of t4 u County ST• GQot'� C.S.T. R o6eRT - 7AL%Ri ckT CS T - )-- yP)- Installer Local Authority/ Supervision Sr. c.Rot• X C o v PROJECT DESCRIPTION TLi.0 �X�STiNC� 0�7.Mvfi'�co of ,¢ 3 �� �Ui /I NFEV 7'�D 134F /¢/3�.uODVtcO w�i�t� 14 P�DPOSED SMi¢ /� A RT STUDIO f5 t3uCLr, r STU1910 GOO( I4 i�_ ,4. $t't,..1 t< � C 1& fd K 't]�_k o wA-I Foe S 7-4 d L y — Tk Lo ( A A'o AvO�•rro c. w 0W Aj eF145 Cc� 6 U LD A3 0A A4 A I y w,� sT � Flow A ►3ov E H kr Tie 9 eAJIFR i A.) rtGa. 40U t* S F ( 4 5 e) s 5 tN t14- h e eA of 3.2- 13 y 9 5 AR E - Su -i 81- OP c&A.5U -x3 j AL T QaWc , &4�'S Lok1 w►'i( p oUE Sr2_6p 'f-0 S,=k A Q- (3iEDRm . koM e- (Coco gm.Cjs / `C� �x i STt>J S4zP7-1c T.quK LOW fie Re - (� ��+n it- �' 2A.A SEpT'tc TANK kpO w &C /t t�DEl7 . S�'Nc t- eX c• $TtA3 G- C3 LD� . Pg.l PLOT PLAN VIEWS $e� t (S So Z)6; EP A ,j 1Z L.i•r T puM p SThrt'a-j 15 Pg.2 SYSTEM CROSS SECTIONS &SYSTEM PLAN VIEWS �j ec_ ESSAA e`` +`,` 05 129.3 PIPE LATERAL LAMUT Pg. DOSING CHAMBER CROSS SECTION ���1 .4 r '� �., Pg. PUMP, PERFORMANCE SPECS Z. ULBROff IT o HUDWK miiit� G(TQ Arr�DREss P70 5 T R A-w tic FRR �•� . VJ U pS o A0, W I'S , 5 y a S *RAW 86RD y Gw fArerRie .. ?,E�i¢AJSFOiPME� � 30 /3�4 cr�p p rr S W v 8� = T OP MOST porn r at= w eo 'EIE VArlo, j = /oo, p ' i c 2 ,? 13 y � �'rSnvl s ysrE'•�+ � � � � a � , �it�gitifr'E [I) Ui� UCA)T ! Z a me 1 000 6OR UA A Al IS E R L i �\ O % \ \1 %A \ x i SYSTEM SYSTEM Al i :' - goU . DEPT. OF INDUSTRY, LABOR & HUMAN RELATION ' p �� c ' , S T i5 ISION OF SAFETY A�} BUILDINGS j Ge O --' SEE CORRESPONDENCE r72,� v so' PA'o�o �� S9 4 - 00 0 091 k 04 i i RE � zrsE Ex��snN �- i000 t �ooE Z•. s° • A e ce-4s T s q r�c T, C v 007«r 9y. �z ' lN !JE'S�G -t1 E — Ml�it'S 3,30 - 7 _ .. L A WS Ali A U AL P5 ..1 of Fresh Air Inlets And Observation Pipe T,pE,UC C __Approved Vent Cap Minimum 12 "Above Final Grade 0 O Final Grade p 4" Cost Iron ?j3 Above Pips — Vent flpe' "to Synlhetic Covering Min. 2' Aggregate Over Pipe Distribution — Tee Pipe 0 0 0 0 0 ce ' Aggregate 0 Pertbroled Pipe Below Beneath Pipe 0 — Coupling Terminating At S y5T&M Bottom Of System 9�0 Fresh Air Inlets And Observation Pipe 7 r : �;. �-- -- Approved Vent Cap Minimum 12" Above Final Grade d /s A l) � T OF INDUSTRY, LAP01" & liUMANDINGSTI{iPBS ISION OF SAFETY A " S'0 Above Pipe — 4" Cost Iron SEE CORRESPONDENCE-yo Final Grade Vent Pipe' Synthetic Coveri Min. 2" Aggreg Over Pipe Distribution —Tee Pipe —' 0 0 0 0 O XI.o w ,•, A Pertbroled P ipe Below Beneath Pipe — Coupling Terminating At 5 ySTEM 2W Bottom Of System Inlets -And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade 4" Cost Iron ZZ Above Pipe — Vent Pipe' 10 Final Grade Synthetic Covering Min. 2" Aggregate Over Pipe . :A Distributi Tee Pipe o o p o 0 fo " Aggregate 0 Perforaled Pipe Below Bepealh Pipe 0 " Coupling Terminating At Bottom Of System PUMP CHAMBER CROSS SECTION AKJD SPECIFICATIONS VENT CAP 4 "C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIKIG JUUCTION BOX MANHOLE COVER 25' FROM DOOR, T !.,/ (v� 1AM1 WINDOW OR FRESH 12 "MIN. AIR INTAKE fA4Pe mATIOAJ GRADE 1�. , COIJDUIT ` -- ---- - - - - -- 55 \ ---- - - - - -- C IEv�n o ti 11� PROVIDE I --- -- 2 INLET AMTI HT SEAL qa. 8 o� I I I v APPROVED JOINT A IN I I I I W/ P C.IVPtPE OINTS W/C.I. PIPE I n,(�()� I ( I EXTENDING 3' 0 ` / - I I I ALARM EXTEWDING 3 ONTO SOLID SOIL ONTO SOLID SOIL e o � ON %3 C C z s , b- F 1 DUSTRY, 1.r�F'OA HUMAN �I�Al ONS I ELEV FT. ' 1RN IlF SAI~ETY N „ oop{ pi - -j OFF K `g� D OI 4�(Evftfi0'J ORRESP NDLE RIS EXIT PERMITTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E S P E C I F MCAT OU S DOSE w E EkC5 coo C�eit CO . TANKS MA NUFACTURER: IJUMBER OF DOSES: PER DAy TAAIK SIZE: 10-0-0 GALLONS DOSE VOLUME ALARM MANUFACTURER: �Ur.L AL � ' INCLUDING BACKFLOW: i53 GALLONS dux Il MODEL,,UMBER: �' U L CAPACITIES: A= 2O INCHES OR / GALLONS SWITCH TYPE: ME FIOAr B= 2 ' INCHES OR Y GALLOAJS PUMP MANUFACTURER: ZOe! (GR C = INCHES OR 1 CALLOUS MODEL NUMBER: -7 P YZf P t15 U D= -0- INCHES OR 2(02 GALLONS SWITCH TYPE: KaSy(n4c )- tZkoRy FIoh NOTE: PUMP AND ALARM ARE TO BE + {j y INSTALLED ON SEPARATE CIRCUITS MIIJIMU _M DISCHARC RATE - aE _ 0 GPM VERTICAL DIFFERENCE DETWEEU PUMP OFF AUO DISTRIBUTION PIPE.. FEET TAak + MINIMUM NETWORK SUPPLY PRESSURE . FEET EAdol. 0�" + FEET OF FORCE MAIN X 1.5* F YoFtFRICTION FACTOR. - - " 45 FEET oA 2.0 ���. TOTAL DYNAMIC. HEAD = =L- FEET Y Roupip 9� INTERNAL DIMEWSIONS OF TALJK: LENGTH ;WIDTH - ;LIQUID DEPTH A poi 0 Vdlur�E Fo(2 L 6 �., " PUG FoleCEF ,MA i,,A-) • W 5 DES T E le VAri o._) O f FoPCE' M Aim c.K.�o l 5 T PR (FCAS T D i'STR.i Q U rtoo a o)c,_ 7 ToTAL VERTICA-L L-1' j T' D tfpEp_eAj CiEi7 F(�o m p L) I ►of/ +0 'Di STR i 8 v 1 B 0)(_ G - 7 as ► LA HEAD CAPACITY CURVE 3 7/a 6 ' i j MODEL "98" l 30 4sa. a I' F : 2 §k16 4 O 1 s 4 - ( to 2 _ 1 i/2 -11 1/2 NPT : p .1• o_ _ ._ ._. ..._:..... U.S. GALLONS 10 20 30 40 50 so 70 a0 y LITERS IRI I!AN so 1 60 240 v 0 FLOW PER MINUTE TOTAL DYNAMIC NEAOrrkOW PER IIirWTE J: � EFFLUENT AND DEWATEAING `% •" CAPACITY 12 HEAD UNITS/MM I FEET METERS GALS L(RS A 5 1.52 72 10 3.05 61 231 2J1 'v 15 4.57 45 1/0 _ ^' q 20 6.10 25 05 3 5/16 Lock Valve CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, l6r duplex systems, are available with or • Double piggyback mercury float switches are available for ! � "..without. alarm switches. variable level long cycle controls. vl � SELECTION GUIDE Standard all mode - 39 lbs. - Weight /2 H.P. I. Integral IWI operated 2POW mechanics! switch no external control required. piggyback mart i I 96 Series 9 - 2. Single mercury Moat switch or double fa29Yback mercury, float •� 9 y Control Selection switch. Refer to FMO477. .i Model Volts -Ph Mode Amps Sim lax Du lex 3. Mechanical alternator 10.0072 or 10-0075. ' ' M98 115 1 Auto 9.0 , 1 or 1 d 7 — 4. Sao fM0712, for correct orodel of Electrical Alternator, "E -Pak" ' N98 115 / N n 9.0 2 or 2 d 6 3 or 4 b 5 5. Mercury sensor float switch 10-OM used as a control activator 4mih' D98 230 1 Auto 4.5 1 or 1 d 7 _ duplex (3) or (4) float system. I 230 1 Non 4.5 2 or 2 IG 6 3 or 4 b 5 6. Four (4) hole "J- Pak ". Junction box, for wateltight connection or wired -in aim- 4 7 pkx or duplex operation, 104)002. , I' •;i 7. Two (2) hole "J-Pak", for watertight connection or splice. s ' For information on additional Zoeller products refer to catalog on Court „n :non Starter, FM0511; CAUTION All inataltalion of conlrala, protection devitxts and wirkq should be done by a awli Pi99Yloack Mercury Switches, FM0477; Electrical Alternator, FM0486; ti4:chanical Alternator. lied Nceneed electrician, AN electrical and aafety codas should a followed 4tclud• FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO4e7; and Nam r FM0732. PMs Conhol Box, ins the awsl recent 1114111 Eledrk Code an (NEC) d IM Oa mpational Sooty and Health Act (OSHA). RESERVE POWERED DESIGN For* unusual conditions a reserve safety factor is dn' into the design of e,/ery Zoeller pump. t MAIL TO: P.O. 80X 16347 t' (ouiswU-n 040256 -0347 Manufacturers of... Q n SHIP TO: 3280 Oh Millers lane N N LL la:;svi „r'. Kr46716 A . Qu,�1nrAWvs.fuvcE Aff (502) 778 -2731 ,e FAX (502) 774.3624 t 1� 1 s I-M- ^- Ppp.FSS : k70 57 a0i40y I.v. tf U1) SoA) .cvl s sgol(o - 7(5 - 3 . - SX'' 0 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code C ^LINTY 5T. cR o�• x Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: d ESi-E �D ,! PROPERTY LOCATION G 2 f0 oN G•OS d R t r GOVT. LOT SW 1/4 �!lW 1/4,S I/ T / N,R IF E PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I 5UBD. NAME OR CSM # 22-3 Am tt cp s T sT': 2- FCAT op 57jp40iS&70kr ,-° oi,uT - M CITY, STATE ZIP CODE PHONE NUMBER []CITY pp VI L LAGE OWN NEAREST ROAD 5T hu,=. rt t'va • 5 5105 ((*1 1) &9t- F3l'G tf oaSo' 1 674 - 140460el 441. N� N . r ; I New vonstruction Use [ Residential / Number of bedrooms 3 8 �R�5 . �`' [) Addition to existing building s�.�s�� .tip w.�N� �iQo oS� , T Sp [ �ieplacement - w�'fG, s.:�,e �- 7•o.�3T'. P Code derived daily flow (9 D gpd Recommended design loading rate • 7 bed, gpd1ft • 1' trench, gpd/ft Absorption area require bed, ft2 �S� trench, ft Maximum design loading rate • '17' bed, gpd/ft * - trench, gpd1 t Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent terial 5c--5 57 - Pl Flood plain elevation, if applicable NSF' It t'p T t "G `►�, S = Suitable for system o )LENT U ❑ L MOUND ❑ U IN•G U ESSUR AT- C�ADE U S IN FILL HOLDING TANK U = Unsuitable for system L $$ Id'$ Et 0 CAS ❑ U ❑ S Bt DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft O in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twich �- f Sbk- 'U4 iM^ 7 , 0 io y 31 15 hK M, v fR s 3'F • 7 •8 `�_ Ground 32— to yR• Y -FS 0,f f A GS CF' • S �. Y�' ft. $3 yl'6 5 /D yR Y i s 5� /,of S,be �w►•f t �t•� .S O Depth to C S- 78 /f Y limiting Remarks: AL A oP 5V rrABjE' oa 1 - Y Fok m oo j D TYoE SYS 3 . Boring # 2 lC YA 3 (1 [5 / J, S&1K nitvfP- �5 f •? . .} y 2-> lot - iy /oY,�3 lS l,�w► R�frz C_5 C t *51 59 5 yR 5 1& o ► c, S5 - CS Ground d elev. CZ - /O YA W S• ©, A", S ^",� �" ' • ? ' , .t tom- Depth to limiting n fact a v Remarks: It P EA O F PIT ## --).._ S 0 ?T 1 3 1 E fotf - Gd a u eA-t Tf a.-' "-L- S yS T'• '� CST Name:— Please Print 'P0 pjj-L p - Z4 L j5 R C kT-• Phone: 715_ 3 ,?(o _ R1 g S Address: &57_5 Q' N eFf L �fl • u DSO.J 1. $ y 01 - (- o f CS T M 2-44? 2 0 Signature: Date: CST Number: - s � t • 6L �,,� /P�fo1�E� ED . � tires S-y. Stf 'Ul�I'O T., . � J p r? / '� j f.�- / S �O•�d�> OS E!�• /v /�" �'� ff /GtT S . p }\ � J S " 6tJi %l �. • A l 57 pt� y� . PROPEMYOWNER GOSTOV/ G SOIL DESCRIPTION REPORT Page 7 of 3 PARCELIM4 LOT 2 — 5'tOeA d (36�RPr POr'A-�T Depth Dominant Color Mottles Structure GP r-. ' Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Botrrdary Roots Bed reridi D - /O /o ye 3 S f bK vfi� S 13 o w /o ,� 3 - S I A f 5,6& Ao s 3 f Ground C r 2 D -S S y k 51 S +G,e C CS 0 . . ft. C 2, 4 7 w Depth to C 3 - yo /o k 5 f S Of. 5 P I N limiting fact r „ t f C-77'0C - fir w • J� Remarks: � Boring # N �} a b / Y/c 31Z — lS /, f she �►+v�i2 5 • 7 Ground C r S OMA s / .P. CS • ? glev. D C- Depth to 04 limiting E,�- U /110 j' SU .r / �� O U !� s factor 4 j Remarks: SD %lS /dLJ �Y� �!f "� sl>�TI> �ie /,yf�iPdU�vl� SyS7`t� Boring # b s -is Ground elev. C, D - �.,sye 5 S D. S �,,�� CS • ? • 8 9 7 . 7fl ft /DYleSI� S O ,� .7 8 Depth to 1� limiting factor Remarks; !� Boring # ,. nav > >` I Ground elev. n. o Depth to limiting factor Remarks; eon oonnio nc,nn• c` 15TRA w 3CRA y L ev Tf iC . prrs SC,gC.E l �� 3p $�= TOP mosr polar ou ti �1t V�TiO�J = /00 t 3 5 f7 7 0 0 133 � �C�S r,,vG- S y STE•�i NO ,J 73. r RCCOIAMC o C7 SyST£M EIGVIlTf0�1 9S O 38 I Y" cs 1 o ve+�T I � O v 3Z h v 3 IleVeti 5 ... .... �¢, SD � - i ` P,po�osEo I S 7 UDI' O w P ,e CYAS r S WA T' av7�£r 9y. zZ 1w,rder 1' ► ! i � 4 J 1 � I s, IAAe�S P 70 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ( -057601' -A ��O/3�'L residence located at: 1/4, 1/4, Sec. ly , T Lf N, R If W, Town of #VPy "Li Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /Ov-z7 SAC /, Construction: Prefab Concrete Steel Other Manufacurer ( if known) : lvi.� (�►.f /-Q Age of Tank (if known) : (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ''� Plumber (ap p l ying pp ying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for _L:,; inspection opening over outlet baffle). Name ROB t� T" ZII�R( � Signature A4-P/MPRS 3 � 5/88 i SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations January 28, 1994 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S94 -00009 FEE RECEIVED: 190.00 GOSTROICH & KOEBERL SW,NW,19,29,19W TOWN OF HUDSON COUNTY OF ST CROIX NON - PRESSURIZED IN- GROUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. yely, r Quinlan Plan Reviewer Section of Private Sewage (608) 266 -3937 SHD -6423 (H.00JI) r � I �SD-v XIS. 5 6 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER BUYER Cf /�� j ADDRESS Z� �� s� FIRE N O UMBE CITY /STATE 5 1' P 01-4t )kZIA � z p 5 ,5 C� PROPERTY LOCATION: 1/4 , "� 1/4 , SECTION , T Z/ _N -R l/ W TOWN OF hWf St. Croix County, SUBDIVISION ' 5 1 W13W✓ l � % , LOT NUMBER_ 2: 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 /We, 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 Offi er with 30 days of the three year expiration date. SIGNED- DATE: j ���J 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 permit issuance. Should this development be intended for resale by owner /contractor,(spec house), thenia 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 4e/&-5'7 `� 10 ST ejet Location of property S /4 ti 1 /4 1 Section if , T �j N -R T W �D�Sa Township , Mailing address 2 a-3 AM &nr 5 '7' 57' A , /J,v . SS !OS Address of site �7b S� w13 f>�S8 -� G 5 d Subdivision name 5 � P 7'� �- Lot no. Other homes on property? - yes--- No .1 S Previous owner of property Total size of parcel f Date parcel-was created Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house)? _ Yes _ ! :: and Page Number as recorded with the Register of Deeds. ------------------------------------------------------=----------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes odes 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 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. -'S-^ t 3Z , and that I (we) presently own the proposed site for the sewage disposal system or I we P Y ( ) obtained an easement, to run the - a bove described property, for the construction 0 n f said system, and. the same has, been duly recorded in the office of County Register of deeds as Document No. �. S gnatare of applican o- applicant ate of signature L Da o Signature f DOCUMENT N o. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BA* OF WISCONSIN FORM 2 —1982 50432 jrw.. r (►r_i7j-T H OFFICE ST CROIX Co., Reed fur Record -- ............................................................ JAMES - -u_. HIRSCH•>••-----------•---•------•----- •------- •------------ - - - - -- .................. AUG 2 3 1993 ------ --- - -------- •----- - - - - -. -------------- - - - - -- ................... ............................... 1:30 P. conveys and warrants to - CELESTE J. KOEBERL and JOHN B. 6)� GQSTQUO, ...hw9band..and..T�a £e.. . m X�. >� -- survivQr- Ship - - - -- � e � - -- Pr •- - - - - -- ---------- ----------- - - - - -- ............................... --• .............. - - - -•- ........................ -- - - - - -- ............ ............................. ......... ----------------•-------------------..--. .......................... .........----...---------- ... RETURN TO .............. .................................................................................................... the following described real estate in _ St. Croix ................... County, State of Wisconsin: Tax Parcel No: .............................. Lot 2, Plat of Strawberry Point, Town of Hudson. MA,NSF'Eh 0QS I I f This is not homestead property. (is) (is n ot) Exception to warranties: Subject to easements, reservations, restrictions and rights -of =way of record, if any. �j AI Dated this �— .---- -•----- - -- ---- -- --- --- -- -- -- - - - -• -- day of --- - - -.. /r ,_ f ur`i -� -- -- ---- -• - -- --- -- -- -- - - -- -- I - - -• (SEAL) - - - -- - - - - - -- (SEAL) James V. Hirsch - - - - -- .(SEAL) -- - - - - -- - - - - -- -• - - -- ........................ ............... (SEAL) . ................ .. . . . . .. AUTHENTICATION ACKNOWLEDGMENT Signature (s) ............................................................ STATE OF WISCONSIN ss. ----•------•-------•---------•--------------------------------- •- •-------- - - - - -- St. Croix ........................ County. authenticated this ........day of ......................... 19 - - - - -- �P rsonally came before me this ---- 1 / ........day of IL.5 ..., 19.93 - -. the above named `jg$..VI- -Hiryge -------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ......... N ----------------------------------- authorized by § 706.06, Wis. State.) .` �,y P� �ii, to me known �r�....__ who executed the foregoing in and ac > we the same. THIS INSTRUMENT WAS DRAFTED BY : N.QTA ► v+'s Robert W. Mudge, Atty. - - - -- G ~Yt1N�i i�7$ . ." --•------------•--------------------------------- --- ---- -•-- ----- --- ------ - - -- -- Notary Pub ------ - -- - -• X - - -_ - - -- County, Wis. (Signatures may be authenticated or acknowledged. Both My Commiss not, state expiration are not necessary.) Q date: - -- ---- •- •- •--- ...._., *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. FORM No. 2 — 1982 Milwaukee. Wisconsin