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HomeMy WebLinkAbout022-1014-10-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divis�)n I► INSPECTION REPORT Sanitary Permit No: 408283 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: p Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 7 6 4 14P 2 Permit Holder's Name: City Village X Township Parcel Tax No: Delander, Mike I Kinnickinnic Township 022 - 1014 -10 -100 CST BM Elev: Insp. BM Ele BM Desc 'ption: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic < Benchmar S 2. !. � S d b. p Dosing � � Alt. BM V Aeration Bldg. Sewer - .0 9s /S Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet �^ TANK TO P/L ` WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic > J wJ �j � � �� Dt Bottom Dosing Header /Man. r r�� - 7. 1 Aeration Dist. Pip f / yi1 �` 7 OS Holding - Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer S 6 Demand St Cover Model Number � / / /' "? Q TDH Lift Friction Lop SysteT HeAd T Ft .1 2,I5 538 Forcemain Le gth�1 Dia t} Dist. to We / SOIL ABSORPTION SYSTEM 7 jf BED/TRENCH Width Length / No. Of T h PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /6G BLDG WELL LAKE/STREAM L ACHI Manufacturer. INFORMATION CHA OR Type f ste 2 � �1 / U Model Number: S (� DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacin en to Air Intake p Pipe(s) !J ! ( fi Length Dia Length�� Dia f Spacing 3_ L I SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only t t r D Over �- dial �/:d pth Over xx Depth of xx Seeded /Sodded xx Mulched ed rench Center ] /Trenc h Edges Topsoil p Yes �] No Al Yes rJ No COMMENTS: (I nclude code discrepencies, persons present, etc.) Inspection #1:_ /L Jn lnspection #2: 10 1 -30 /0Z- Location: - 988 County Rd N Roberts, WI 54023 (NE 1/4 NE 1/4 6 T28N R18W) NA Lot 1 Parcel No: 06.28.18.81A �K fo 1.) Alt BM Description = cy 1 �Vr 2.) Bldg sewer length = 5- r - amount of cover = ! 3.) Contour =� � Plan revision Required? Yes Use other side for additional information. o t -- 3o j 6 SBD -6710 (R.3/97) Date Insepctor's Si nature Cart. No. *AVIS . " Safety and B� aildin�s Division 2DI w, Washington Ave„ P.U. Box 7162 Consin Madison, WI 33707 - 7162 Sits Address oe nrtment of Co mmerce S -- z 33`5' Seainry Permit Number Sanitary Permit ApplUcatfon �{p In wcocd w�h Comm 8'3.21. Wis..Adm. Code, pbtsonai iAtaraxeattaut you provide 0 Check if Revision M Law 1!. 1 m' 1. Appliadw 1af� - Pieate Prb t AI! Infermatioa Stu» Pfau l.D. Number Prams owme"s Name C E I t/Ep parasi Number d e y p iny Owner's Minn 2 5 2002 • i n X3`4 t� lrs �E %• S G T o�� N. R /8 City. State Zip Code dI, CUN7Y LQt Number Block umt bar ' � OFFICE Subdhisiou Nome M Number �• • �.� �l ` �y��� �G S 75,E p r.3' � d B. Type of SWI&ng (desk all tbat appl G'City [3 1 or 2 Faatiiy Oweuitq f - Number of Bedrooms el 6'1� Ov1n�e ❑ pubWetimraial - Describe Use C SwA Owtod Plarest Rand M Type d Petraaitt (t neck only one boa an line R (numbeft gaheme for internal use). Complete line Bit &"Ill abk) A. ra 8 13 Raplacetaaot of 1 6 ❑ Addition to For Coin ttge i 0 New 2 Repleoata»u Syesa ar erg Mpok Ofay Exisft stag Data Lasued 8, D CMa if Sanitary PMit Previwukv Issued Permit Number Pi►, Type of Pttraait: (C all teat apply)(n mbering scme is for internee use) 44 L Noa - Preaaui:ed La-GMW d 2 Mouw �� 47 © Sand Filter 50 ❑ Coeutn+eud Wadsmd 2217 Proaaaised 1104mtuul 41 8014ft Tack 48 El Singh Pass S1 [2 Drip Line C �l�, 7 ' 1 rOClr - f 43 0 At -Untie 46 L Aerobic Tvuuent Uni 49 :2 Reeirc 30 ❑ Other ! J V. Del t Area � It on: Dedgoa C Age bispersal Arse Sou Appil"doo Percolation Rita stem ovation TIna1 Grade Rwim Proposed ytaro(Gdomaysisq•Ft.) (MIn -R" L�davation �Dd ,orl to a� , ,!/� S Ca in Toad Ntuaber msnuf� Prefab Sits teel Fiber Plastic VI. Tank Ipfo t CraUons of Tanu Concrete Constructed Glass 0 (1 �L14 X- VII. Reg statement- 11 the assume ras ni far da NumberPOW" dwwn on the atteehsd Plumber's NUM (PriaU Pk=ber's Signature &esiaass Phone Number Plumber's Address (&tom,Y• 9 =1 zip Cads) (No Stamps} VISi. Count 111e sent the f?al Sanitary Permit Pee iinclades Groundwsur Date Issued issuing Agent Sigttaaue roved Q Disapproved Sumbarge F C] Owaar Given Initial Adverse 2 — Data CondUUM of AppVOW/Rragoas for Disapproval /Ln.ty� VAC e a"91 — Aaae6 eeasPie►e 66 6A Catet7 aslr) for dw � oa papa' 1w less thaa g 11 sa sae SBD -6998 (R. 05101) PLOT PLAN ' Scale 1 "= L[ C)' 'Page 3 of N� O 20' op P w c�� is > S 0 l°1ZC. m M0Vhi1 Zs' Fi m - Z" � vc F. `M.. s•z BM�a.. C7' OVL / / 3 �� rn L1�0 rn� � rn, i C. 1L1 l 1 �j O N 'MP OF II1z!DIp. Pvc �L(=El - NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be 1 Zbo /$Op gallon capacity manufactud by 1j1 �� GU 1 C re w/ A 18 o o Z 4. Bench mark r 3�-- Pf-80U 5. Divert surface water around system to prevent ponding at the uphill side. 4 Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188 -2439 TDD #: (608)_26-4 -8777 \*i C www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary July 12, 2002 JUL 2 2 2002 CUST ID No.267341 ST. CROIX COUNTY ATTIC• POWTS Inspector ZONING OFFICE ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/12/2004 Identification Numbers Transaction ID No. 768169 SITE: Site ID No. 647909 Mike Delander Please refer 'to both iidentification numbers, 988 Cth N Hwy above, in all correspondence with"the agency. Town of Kinnickinnic St Croix County NEIA, NE1 /4, S6, T28N, R18W FOR: Object Type: POWT System Regulated Object ID No.: 861573 Description: 600 gpd design wastewater flow mound system. 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Maintenance information must be given to the owner of the tank explaining that periodic fie filter is required. Access to the filter for cleaning must be provided per Comm 84 product apprd{ t di F,o • A Sanitary Permit must be obtained from the county where this project is loc d in ac�E e the requirements of Sec. 145.135 and 145.19, Wis. Stats. S 01- F � si • Inspection of the private sewage system installation is required. Arrangements for shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits ARTHUR L WEGERER Page 2 7/12/02 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101 .12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 -� Fee Received $ 175.00 Balance Due $ 0.00 Thomas J Perkins POWTS Plan Reviewer, Integrated Services (262)521-5064, 7:30 -4:00 tperkins @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 TITLE SHEET Page of BOUND SYSTEM FOR A --I BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P C CZ. 'o ! 9.q� C R. 6 14 9 LOCATED IN THE Nk 1/4 OF THE N (�: 1/4 OF SECTION E, , T Z8 N, R ly w, TOWN OF k,1 Y-,l NLJL('_ 1J) p , SZ'• C. eU LX COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR F'11 cE 9 tv b "a b PREPARED BY WEGEIZEF? SO I L- . TEST = NG AND. - DES S Gfii S�t�V = CE P.O. Box 74 421 N.Main St.�� River Falls, WI 54022 X � Phone 715-425-0165 A $`�? •� / Fax 715- 425 - 6864 AAT E - WEGE HEA s 6915 •_ J bILSWOR �jl • vA �� JOB NO.' - Mound System Management Plan page Z of `] • Pursuant to Comm 83.54, Wis. Adm. Code Seotic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L 8005, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent pending. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. - No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. 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. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at 11S -3E3 b- 1 4 013 aT (Imm ( The system installer at 1 �$ — 3 8 — 3l �/ S OR J M P N1Z The tank manufacturer at L _ � _ 8yS L-J �}Z The effluent filter manufacturer at "1Is— Z�LI — S yZ The pump manufacturer at -- `6 30- 8 ZU- uS 6cwLnS PLOT PLAN Scale 1 "= L[ (�' •Page a of LOP Y "Due is > s o' � -Wm M oVM'::� $ S' o F AND > vc IF, *I. R�.L C5��sT.1 .11zs Tp ON F�l i 3 oT r1 OF etc. Lst- , q 6.0 V FF r �17, • o rvor ct�r�P>� tr ov2 �1 71 '1Z � � 3 • rn, 3 - , . 0- 1,J. we �►1 t ( = L- , I Uo .p ' aN Nfq L. 1 N Z t " M -- -- 1 ON - MP OF I I IZ .Dl A. PVC 4� LpE , . NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( 2 required). 3. Septic tank to be l Lbo J$ Do gallon capacity manufactured by 4. Bench mark i�, �� --�,�U — 5. Divert surface water around system to prevent ponding at the uphill side. Page Ll Of 1 Approve Synthetic Covering AST.H C33 Distribution Pipe Medium Sand Topsoil -'� _ H = -"`� a' Is -= F giev- 3 E , b y. % Slope Distribution Cell of Force Main Flowed 2" to 2- Aggregate From Pump Layer Ft E 0-� b Ft. CROSS SECTION OF A MOUND SYSTEM F 0 Ft. G 0 -S Ft. A D I Ft. H Linear Loading Rate = q,.b GPD /LN FT B - 7 Ft. Design Loading Rate = 0.3gGPD /SQ FT j !� Ft. J S Ft. K 8 Ft. Position L 3 Ft. of Force Main W Z g Ft. L � . L ► -Observation Pipe A o-a- -- B _ -- - - - - -- ---- - - - - -- - = - -- -��� -- 6 W f - - - - - -- - - - - - -- ----- - - - - -- ---- - --�--0 '? so - Distribution 1 „ i • Cell of z to 2 J aggregate Observation Pipe (anch secarely) - PLATT VIEW OF A MOUND SYSTEM! Distribution Pipe Layout Page S of 7 Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45 fitting to a point within six inches of the f1naI grade. Terminate the ends of the laterals with a valve,'threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. PVC FV = �vC Lateral Manifold Lateral X X X XIZ Xr2 X X x X Lateral Lenoth — Lateral Length — P Distribution Line P rftcCE soX — —o S 0._ - G Q ��V C FOzC.0 r1 P 33 Ft, Hole Diameter J � Inch S - Ft, Lateral n l Inches) X Y Inches Manifold Z• Inches Force Main " Z Inches of holes /pipe l7 Invert Elevation of.Laterais a 6•S Ft. _ - Combination Sept Tank and PLIMP CHAMBER CR0S5 SECTIOIJ AMD SPEC ' PAGE 6 OF 7 -NEWT CAP WEATHER PROOf JUUCTIOU BOX . Y C.I. VENT PIPE APPROVED LOCKWG 210' FROM DOOR., &WHOLE COVER PjIV -hUDOW OR FRCSH u'E'+RtJ1uG LAg�L, w rhlx�� A�P INTAKE awiDut G RaC� E 11JLET PROVIDE - -- — ;,'� AIRTIGHT SEAL { Approved Approved joint w/ I joint w/ PVC pip 40 a . i' ALARM PVC pipe • I r C ( { oW CLEY D.$3fT T i I PuxP --� --� I � OFF 0 - COUCRETE IZ sV . q 0 , n o' DLOCK (RISER, EXIT PERMITTED OIJLy IF TAWK MAJJUFACTURER HAS SUCH APPROVAL 13"APPRO"'M t N4 SEPTIC E 5PECIFICATIQUS DOSE TAxiKS MALIUFACTUSLCK: WUMBER OF DOSES: S•0 PER OAS TAM SIZC : 1Z1 O 0 GALLOWS D05C VOLUME r ALARM MAwuFACrUFZCR: S S ttU S ,j 2EL�,tS I.WCLUDIAJG 6ACKFLOW: 1 3 .y GA LLON: MODEL WUMBER: 10 CAPACITIES: A- is ►UCHES OR L( Do• 3 SWITCH Ttfpr: Y CCJ`Z - t MAWUFAGTURCA: GoV�. pS , ? 11'' GALLOys PUMP g = _ ` IAICHES'OR `l y' S G�LLOt�S O'S MODEL WUMHER: C- � INCHES OR 133 GALL � D= INCHES OR ZZZ GALLOWS SWITCH TYPE: C°_C1ZLj �U`5RE 'F�I� =SD TO 6E p. 6 DOTE: PUMP AMD ALARM A MIMIMUM DISCHARGE -RATE L� 1. 8 L GPM INSTALLED OQ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUO- 015TRIBUTIow PIPE.. S'b1 FEET 0.13 + tAIMIMUM AIETWORK SUPPLY PRESSURE , ; _ . 6 • SO FEET -0 x L, 3' FEET OF FORCE MAIN X 3 .Sq_ F � 3,ps _ (� 100 FCFRICTIOU FACTOR.. FEET TOTAL 0! 1JAMIC. HEAD = 15 _LZ --_ FEET As per manufacturer gal /in. Liquid depth 3 b`I Goulds PProE 7 Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent dry without damage to heat transfer. ■ Motor Cover. Thermo las- • Homes systems components. tic cover with integral handle Available for automatic and • Farms Motor: and float switch attachment p • EPO4 Single phase: 0.4 HP, manual operation. Automatic • Heavy duty sump g Points. • Water transfer 115 , 230 V, 60 Hz, 1550 models include Mechanical Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: RP M, , FEATURES ■Bearings: Upper and lower 115 V, 60 Hz, 1550 RP heavy duty ball bearing Pump: EPO4 built in overload with III EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING /a maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. •Total heads: up to 24 feet. with three prong grounding ®R- Canadian Standards Association ✓ r _ • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running: I dry without damage to s 30 i components. I Pump: EP05 e i — �� I • Solids handling capability: o 25 i /' maximum. W - -� ---- - • Capacities: up to 60 GPM. 6 20 I i • Total heads: up to 31 feet. • Discharge size: 1 NPT. a l – • Mechanical seal: carbon- c 5 is ! ! �s zz rotary/ceramic - stationary, j • 4 BUNA -N elastomers. 0 — EP05 Temperature: 3 to 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 5 1 41.8 0 00 10 20 30 40 I 50 GPM 0 2 4 6 8 10 12 m °/h CAPACITY ®1995 Goulds Pumps, Inc. Effective May. 1995 83871 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ty Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Coun 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. Please pri �for wn # dvacy l Reviewed by Date Personal information you provide may be aw, S. 15.04 (1) (m)). 8- 6 — 0 Property Owner Property Location 7 Q �r- ' �' G e�-e,� Z �� � 6' 2002 Govt. Lot IV 1/4 � 1/4 S � T lip N R � � E (Ord Property Owners Mailin Address L LTZOI tiOIX COU[v Lot # Block # Subd. Name or CSM# iNING OFFICE City qtate Zip Code Phone Number E] City ❑ Village ' Town Nearest Road ❑ New Construction Use: [2p Residential / Number of bedrooms _ 3 - y Code derived design flow rate Sa U 0 GPD [31Replacement ❑ Public or commercial - Describe: Parent material L11 Flood Plain elevation if applicable General comments SyS t,,,l and recommendations: // I p �'O!'ITUU( UlE'V' �'� a Boring # ❑ Boring O d Pit Ground surface elev. ft. Depth to limiting factor - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /1`1 in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. *Eff#1 *Eff#2 © -/o 1 S , V ,rw, �f s AJ ®Boring # ❑Boring [� pit Ground surface elev. ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / C 7s * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Prin Signature / CST Number Address Date Evaluation Conducted Telephone Number S BD -8330 (R07 /00) Property Owner ht r 7 Parcel ID # Page of ❑ 9 3 Borin # Boring ®pit Ground surface elev. ft. Depth to limiting factor - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 - 1 0 /0 3 � . rnab r l � . s Z �'c ZmSb i F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. coil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L I The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SM4330 (R.07100) Property Owner hr r t.7 Parcel ID # Page of 3 ❑ Boring g �� in. a Bonn # pit Ground surface elev. � ft• Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPDlft EfF#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 0 /v 31-3 " - 3 Y6 31 - . y a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in ' coil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 PD1ft E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E ff#1 Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ' Effluent #1 - BOD > 30 < 220 mg/L and TSS 30 _ 150 g/L - s The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fonmat, please contact the department at 608 - 266 -3151 or TTY 608-264-8777. SBD4330 (R07/00) PAGE - 2 OF� NAME 4 -en t r t Z 1 OT# LEGAL DESCRIPTION ��X /1C ,S T Z a .N. R. 65 fo'gp SCALE: 1"= y� go o k BM 1 ELEVATION /0 (� cr•��� ��' BM 1 DESCRIPTION �� P y✓ �C � BM 2 ELEVATION 9S Jn BM 2 DESCRIPTIO SYSTEM ELEVATION 9G • 0 0 SYSTEM TYPE Mou S�( cze pyN W CONTOUR ELEVATIO 9S .S too v S.Q k a v' �a t "'•SIGNATURE DATE G�� 06/27/02 THU 08:52 FAX 715 38; 4686 ST CRX CO ZONING 0 004 VASCbnsin Department of Comrrrercg SOIL EVALUATION R EPOR T Page ri of division of Safety and Buildings in a000 dance with Comm 85, WAS. Adm. Code /� Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must County _ � ( t•: ' include, but not limited to: Yertioal and horizontal reference point (ON), direction and parcel I.D. Percent Slope, scale or dimensions, north arrow, and location and distance to nearest road. tl ec � L. "J Ploasejod rr Reviewed by Date Persmat Infomprovide lation you p may be r. sva rty Owner Property Location �,,�, -. JU `J 2 6 2002 Govt. L ot �V i re 1/4 S 6 T Z 0 N R ) F-(or Property Owner's Maiiin Address lot * Block # SUM Name or CSM# z0 4AG 0FP(,C City p ,, to 7 p a )ne u er ❑city C] villago Town Nearest Road LA ❑ New Construction Use: (3 Residential I Nun 3er of bedrooms 3 – Cale derived design flow rate ©d GFD Weplacement ❑ Public or commercial - Describe: Patent material _ T, Flood Plain elevation if applicable 1{'� ft Generdl comments $Y,S�w1 Q. /4 (/ • f and recommendations: rOiZ icUf' C!f Vr (� ❑Baring Fit Ground surface elel , R. Depth to limiting factor --Lo— in, Sal Appllcation Rate Horizon Depth Dominant color Redox D rscription Texture Structure Consistence Boundary Roots GPDM In, Munsell tau. 8z. ( ont. Color Gr. Sz_ Sh. "EttiMM7 'Eff#2 d /p is 3 = 9 24 7s= r Ile, SG. rnshf r?7 r Boring # n Boring 1.� pit Ground surface elev ft. Depth to limiting factor F t in. Soil Application Rate Horizon Depth Dominant Color Redox D tscrption Texture 8tflicture Consistence Boundary Roots GPD/ft= _ in. Munsell Qu. Sz. ( ont. Color Gr. Sz. Sh. 'E"l "Et*2 I o" l �(ni � rrl4 �� S �✓ r ZI IS Mont 01 = BO0, > 3t? < 220 mg1L an(; TSS > < 150 mg/L • Effluent 02 = 800 c 30 mg /L an d TSS c 30 mglL CST Name (Please Prin _ Sipnat� CST Number r1✓1 - l ' F�_r - r i' • .� -3e:n Cr Address Address Date Eval uatlon Conducted Telephone Number S BD- 93301R07/00) FROM : Schumaker Plumbing FAX NO. : 7153663121 Jul. 23 2002 07:19PM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFIC FORM Owner /Buyer c�lr�RIE IV� Mailing Address c '' c < Property Address `"1 lXi C +u U M t) c � l `� � 40, , �� (Ve � rif i ication required from Vanning Depamnerrt for new construction) City /State _ I`'LI'1'�I �� I ��.� PazceE Identiricauon Number ? _ LA LEGAL. _DESCRIPTION Property Location 'vim t /4, (�E 'V4, Sec. , T. j N -R�W, Town of _ I ►�� ' 'rJt� Subdivision , Lot # Certifled Survey Map # ,Volume , Page # Warranty Deed # ( 0-L& A a( . Volume 22:1, Page # Spec house 0 yes ! no Lot lines identifiable Q yes 0 no SYSTEM M:AWE 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 is the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a musterplumber, journeyman plumber, restrictedphnaber or a licensed pumper verifying that (1) the on -site westewaterdisposal systein is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than V3 full of sludge. I/we, the undersigned have read the above requiremcuts and agree to maintain the private sewage disposal system with the standards act forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of W iscoasitr. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Officc within 30 days f the three ear expiration date. Ov2. 16NATORE OF APPLICANT DATE OWNER CEE TIjj,CAT�IQN I (we) certify that all statements on this form are true to the best of my (oar) knowledge. I (we) am (are) the owner($) of the to rty describ above, by virtue of a warranty deed recorded in Register of Deeds Office. r� ;l da Cy ATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warrarAty deed from the Registat of Deeds office a copy of the crtified survey map if reference is made in the warranty deed I i 07/24/62 TAD 10:45 FAX 715 386 4687 REGISTER OF DEEDS 10002 r STATE BAR OF WTKDMIN FORM 1 - 1998 66AS066 KATHLEEN N. NALSH WARRANTY DEED REGIggT� OF DEEDS ST. CROIx Co., Ur Doct ME11rf8 FOR IEM This Deed, ma k between Frederick G Lenertz aka 01 14 9:40 RO Prederick C. Lenertz, Sr_, aingle t81IdIANTY WD EtEIIPi a Grantor. COPY WY FEE: a0d Miclwel E. DelAnder and Barbara A Dela er COPY FE : FEE: 1E55.20 Jlusbatud anti a RECMUS FEE: 11.00 PINS: 1 Grm ce. Granmr, l 8 valuable consideralioo, coveys to Grantee the following► described teal eute in Sr_- Croix County, State of Wisconsi (tbe "Properly"): Mm "A Rv Addmm i to lancer D a andcr%epfja tt 98 C N N Robe s, w 54023 022 1014 000 PW=3 ran64man Nmeher (1'M) This is not homartead property. Lot 1, Certified Survey Map filed as Dctutnext No. 665753 loeat� 15 .vrt of The Northeast 1/4 Of the Northeast 1/4, Section 6, Township 28 North, Range iB Nest, Town of Rinnickinnic, St. Croix County, Wisconsin. Together will all aMwtmam netts, We and Were m none Grantor warrants that the title to the Property is good, mdafemable ill out* fee and free and drar of cuminbraoces except 1)atcd dds j7k d°y of _1Zeremher 2001 " 4 0. omt (SEAL) (SEAL) •t rgdQn%1 • Aer►ErtL Frederick G. Lenertz • ( SP.At.) (SEAT.) r � AUT11UMCATION ACKNOWLEDGEMENT Siguanve(s) JULIE A. WILSON State or wiscorntn, aenUanica jW OF e N .9j PeaNdia came before at � 27th day of December OZ 01 , the above rained Frederick G. Lenertz a ka Fr rick G_ _Lenert CY.. b`i no1N bar S tt11eA o. '10 - 115 Get41u►wiv eh ' fL.t t .. .... TITLE- MEMBER STATE BAR OF WIS CONSIN to (if nos. etc Moan to be the person who executed Me forego* am borized by ¢70646, Wis. Start.) iaaroment and acknowledge the rime. THIS MTRUMENr WAS Coldwell Banker Burnet 1.33202 J f � 1301 Coulee Road NoWlAm State of WWousio UWann. W 1 5401E mmimna u pp �a� ana01. (f AOt,_SGnD a%prrAliWn Bete ( Sippaturm maybe wtbootiwtedor acknowledged. iW arc 41b 1 �ri� ) not necessary) wl' dais in .. Hank bs radon A7Y eAK Ace °*n .a Ce..W wARRAM VERD roam Ito. t - tma waw.aft. WiL f , Ozzk QBQd St '10A W / a0 N LL C W 9 N W - U&IM' � 6M M 2e EAST LN-AE of THE NEi 1001H 0M R7 M UM rEY 12'1 WE 952. • w,� 0 RIV�3 m M 0 1 Z e y O§ z �W� W gv cl -� g Z rr WON IL 000 w 0j J O)•-z / W2 rl V r O 0 � � Wao� m� m * WEST UNE OF THE NEU4 OF THE NEI A V i rii m 4- W ; - awas�� � V p Y Oz / 0 43 0 A m F r - w . ®� 3.vbp0.6ES tib99 Ol mNK1SSV '0 Z O NOLL039 3O WON 3H130 3Nn HS}30N 3Hl OL 03ONBUS -43U 3UV SONUv38 00 =333 9k1M °333 Ac 0 jw Sts} T002 -EL - LOML/M%3LVO aD SW O33H NVM AS 03L* - dO 1NV3nntils" SJHJ a1 IM" _, MU I ii i r S4334 SUSI935 NSitlfl - ii -Szj uuy C00o Sma 30 aMS TIRN 1006 aor X11• / '• • • 1 law .•A NNE 0 IN ■ ■ ■■;R�! Lei ■■ ■,fir /i�.''1' ■ ■l� ■��Ir!? ■■ ■ ■ ■�i ■ ■■ ■ ® ■ ■OMENS INOM 1N!G■■■ ■I■■■■ ■��� ■ ■ ■��r ■ ■ ■■■ ®■1■ ■I■ HWOM11■■■ ■■ ■ ® ■ ■■ ■ ■ ■� ■ ■MINNOW ■ ■1 ■11!!1■■■ ■■■ ■■ ■■ ■ ■ ■ ■ ■ ■ ■ ® ■■ ''�i ■ ■ ■tl iiriWON IN■■■■ rr�.�...�■■t!�■ius ■ANNE maim- ri■ - - �," . ■■■ ® ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ . - . ■■■■■■■■ ENO ■■■■■■ ■ I' I: I• I •1 • I: e • AS BUILT SANITARY SYSTEM REPORT PMR , TOWNSHIP SEC. T N R W 0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. T' ' 3DIVISION tOT LOT SIZE . PLAN VIEW i •Distances.& dimensions to meet requirements of H62.20 SHOW_EVERYTHING WITHIN 100 FEET OF SYSTEM � f Y 1 4 F St¢ 1 I dipate orthj. Atrota SCAL f(PTIC TANK(S) MFGR. CONCRETE STEEL NO. of rings on cover �epth DRY WELL ►.NCHES NO. of width length area -� J no. of lines width length area depth to top of pipe ItGREGATE '(�!C RATE AREA REQUIRED AREA AS BUILT hSciaimer: The inspection of this system by St. Croix County does not -imply complete A*pliance with State Administrative Codes.. There are other areas that it,is.not; passible ,o inspect at this point of construction. St. Croix County assumes no- liability for j ystem operation. However:, if failure is noted the County will make ever ; ,effbrt <.td' etermine cause of failure. AEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ' DATED PLMWt ON JOB LICENSE NUMBER "t ?1 REPORT OF INSPECTION - INDIVIDUAL SEWAGE'SySTEM - San.ita&y Pe&m.it e?'3 State Septic f fz& 'JAMS Towne hip S�.. C� Dix COun ty — r � 1_oca-tion Section__&_Lat � Subd.ivi,6 ion : , E PTIC TANK S ze_ " gatZone Numben of eompan.tmen -t,5 Oi.b tance. {nom: WeZt ty o ?� 8u� 2ding j 1,20 6, ope Highwaten i , U MPING CHAMBER Size gdttlon¢ m Manusactu&e& Modet Numben MOL DING TANK _ S i z e gad EanA en'` ar�panmen Pumpen S( *..c.m D�e tan ce Aum: WeP,� - Buitd.ing 120 e.Eope_ J f tigh en_ . . ABS ORPTIO N SIT Bed Trench _ • )4_6 tance %6nom: WeU Buitd.ing r2$ etope H.ighwa.ten %8S ORPTION SITE DI_MEWMNS Width 0 .t&ench Z,,5" At 'Requ.i&ed anea At Length o6 each Zinc _5,7 6z Depth of hock below -tite z in Numbe& o6 Zifee ,;5. Depth o6 koch oven tite 2 in To.tat. x:ength.. 64` Zinee . L` / 6 t Depth o .tiZe be.Eow g&ade_ j6_f i Di,6 tanee between .iinee ' 6t Stope o -t&ench .in. pen 100 At 1o kut Ab4u&ptiun a&. C it Type o6 Coven: Pape& o 'e .t&aw - R, 1 T DIMENSIONS Nu mb e/L-. a6_ -pj:fi3. •._..._ G&ave a&ound p.i-te yes no p betow inte-t 6-t To.tat u abeo&ption anea , Z A&ea %equ.iaed '� 6x INSPECTED BV TITLE 1PPROVED DATE 198 'ZE JECTED DATE 198 REASON FOR REJECTION yio L J _ State and County State Permit PLB 6 7 p County Per Permit Application , for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY ¢— Mailing Address: k f t r tZ /�I !� 1�'t S k-d [c�1 3G h S B. LOCATION: ' / 4 ' /4, Section _, T_ N, R_ E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township AAAop C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family k _ Duplex No. of Bedrooms 3 No. of Person D. SEPTIC TANK CAPACITY 6CL> Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement OK Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM:, Percolation Rate — Total Absorb Area sq. ft. New Replacement x Alternate (Specify) Seepage Trench: No. of Linea Ft. WAdth Depth Tile depth (top No. of Trenches Seepage Bed: — ' Length A idth li Depth j, Tile depth (top — No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private I�T Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other th pre owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil est • p/ NAME S kJQA C.S.T. # �7 49 00 6 and other information obtained from Aw (owner/builder). p Plumber's Signature MP /MPRSW# 1,1251 Phone # 4 PS -1 9 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. _, .... .. �e . i �. f g ] t T 1 � ! w m i E i j r t i � t � 9 ( r p f Do Not Write in Space Wow FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fes Paid: State /�I County Date / a Permit Issued /R ( ate)' G Issuing Agent Name Inspection Yes State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 J EH 11 5 Rev. 9/78 < REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: rr P '/,,JV Section � ,T N,R (or)(gTownship or Municipality Lot No. , Block No. County S ubdivision Name Owner's/Buyers Name: /, 4 P O-tZ 4- 4 - s!, . / !" A S Mailing Address: #xd S o i1 TYPE OF OCCUPANCY: Residence x No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW—REPLAC MEN ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: OIL BORINGS �I y PERCOLATION T QCf SOIL MAP SHEET �� NAME OF SOIL MAP UNI PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTEF INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— P— P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B — / 6 f t /G // !/ B- " 6 ` �' io ` r c aa" L B— B— B- B— PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the I n th locatio and square feet of suitable areas. -indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. v 4 1 ? tef tie _ �3- . s _.. .n_ _ _.�-------- .. � � e N r� e r , 1 7�q JYd a � � 3 dpo _ I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. 1 � Name (print) 7 LA4 , 5' h Certification No. Address MCI .Name of installer if known Copy A — Local Authority CST Signature A l�� t ��e � e v►�"� T Q � °ran s 4 s o� jr� e�ti fi n eti `O I L y I ' 1 I I i i 1 I I� - i I � ! .' -13843 REPORT ON INSPECTION OF SANITARY PERMIT # ( 1 / P Name and Address of Permit Holder Person Persons at Site (2 )Date of Inspec on _'P _+ :2, _'__ zLz_'O� I r s, icens o ns a ing Plumber Time of Inspection 3 3 INSTALLA ION CONSI S F: []Septic Tank []Seepage Trench []Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System (Permanent re erence oin Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES []NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer of gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? []YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or line; ft to ordina h water mark of lake or stream; ft to edge property Y e 9 � 9 of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE H: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? []YES ❑ NO Floodplain? ❑ YES Q NO DILHR -SBD -6095 N.0 /8 Signature of Inspector ,r ti `. 1 ' Tx.)..:1 trill w non 1 I ..._ T { , r ' : t � TO Alt t _ y + 1 tt e 4 i s° 33 w 1 y;- P IZ H{} 4 1 ryx _ F E �y t .. - •..� l C r ! iD M A MADA Sop;, r r� f� r a r..� i f t F� i•'. 3 L1 ' � ` f,�}.' � a f" €� J qr. f�. 4 jW ' e oo WHOM ! M 0 10 ? Y �r