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'W0 0 0`isili Department of Commerce PRIVATE SEWAGE SYSTEM County
Safety and Buildings Division St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar�P��r,�Vo.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(
Permit Holder's Name: ❑ City ❑ Village ❑ T6Wn of: State Plan ID No.:
James, Tony Kinmckinmc Townsh p
CST BM Elev.:- Insp. BM Elev.: BM Descriptio : Parcel Tax No.:
® S t/ L f/ 022- 1065- 10 -0f0
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic w' < Of Benchmark
Dosing Alt. BM
dad .
Aeration Bldg. Sewer csk. N _ (, 1 -5P
Hold' St/ Ht Inlet -
TANK SETBACK INFORMATION
TANKTO P/L WELL BLDG. Airl to ntake ROAD
Air I
Septic > Zae ; ��' Z�l'Z� NA Dt Bottom
Dosing 7 Z p�' J t' ' } Z + s NA Header / Man. �c y,z W
A A Pipe
Dist.
Holdin Bot. System 3 d . ,Z
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 2 1 k Demand St cover z� 00 �
Model Number ( -� .OAGPM
TDH Li 4. Friction System TDH Ft
a, L
mead
3. z� /d.
Forcemain Length >- I Dia. 7 rr Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tre ches I PIT No. Of Pits Inside Dia. Liquid Depth
D IMENSIONS 1. s DIMLfQQN
SYSTEM TO P/L I BLDG WELL LAKE STREAM ING I maffilT acturer:
SETBACK CHAMB
INFORMATION Type O
System: 7 200 4v3 p—S OR T
DISTRIBUTION SYSTE
Header / Mani oltf Distribution Pipe(s) �� �/ x Hole Size x Hole Spacing Vent To Air Intake
i
Length Z � Dia. Z,,/ Length Dia. Spacing s 3 /� /r
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) c7S 9
Inspection #1: /o lILl0d Inspection #2: /6i l /IZ / oo
Location: 1375 Friar Tuck Lane, River Falls, WI 54022 (NW 1/4 N 1/4 23 T28N R18W) - 232818353
1.) Alt BM Description= 4,0
2.) Bldg sewer length =3o'
- amount of cover
`�. Ge�o l
Plan revisi equired? ❑ Yes No
Use other side for additional information. Q Fg -FIS
SBD -6710 (R.3/97) Dao Inspector's knature Cert. No.
l
ADDITIONAL COMMENTS AND SKETCH T
SANITARY PERMIT NUMBER:
_
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3 �
y Safety & Buildings Division
7_
Sanitary ermit Ap 201 W. Washington Ave.
rY PP PO Box 7302
"Wisconsin In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302
Department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
[Privacy Law, s. 15 state owned.
Attach com lete plans (to the county copy onl r th s, se , o r not less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number c if revision topre application State Plan I. D. Number
.5
5l� CO- 3 U 3 Z d Z 4-
I. Application Information - Please Print all Informat on, 7 Location:
Property Owner Name 1 Pl4pgrty tjo�
y �
1/4 1/4, SI^-3T ,N, RIR or W
Property Owner's Mailing Add r s 1 51 ��n Lot Number Block Number
6
Ci fate ��� Zip tode�f 7 one Number , ' �' Subdivision Name or CSM Number
II Type of Building: (check one) ❑ City
❑ I or 2 Family Dwelling – No. of Bedrooms: — ✓ ❑ Village
❑ Public /Commercial (describe use): ❑ Town of
❑ State -owned r j A h / �,/ .7 'n / G
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
A) 1. S New System 1 2. ❑ Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System 6 22 '/e 2O f C�� z -/l ies /8
B) Permit Number L 3 . L . � �. 3 S'r/ �� z 's, LP t?. T 5'
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
' 3 At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dispersal/Treatment Area Information: Z r'
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
5 U 4-3-e I z -' iq llzS / J /a 2. s
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
kF ;L
VII Responsibility Statement 7 L T
I, the undersigned, assume res onsibilit for installation of the POWT S s own on the attached plans.
Plu mber's Name (print) Plumber's Signature (no tamps): MP/MPRS N o. o . Business Phone Number
/
Plumber's Address (Street, City, State, Zip Code) t5 01
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
^Approved 11 Owner Given Initial Adverse Surcharge Fee
/ " Determination 3 Z SQQ (0 / ( Z C C/ C) M
IX. Conditions of Approval /Re for Disapproval: ' 4 r5 n / 5
6 ( Or�t 5 `r.9 k - FRy�< r! SrCler. C j-, �l�owe� ova Pva %oe r1 '. 1p(aw5
, �K etnOl�ie / r
Ko"e W;1( rep;I ` ke // rew.oucz� 9 /.
4e "L/%
r �/ti¢iF•i s ;� A( yor.fvs SFvc�C tGCi — �
h.'��er be W <✓iPdSe ✓VeeeGl ve✓ /A�lk'�I�� rn ✓e r S lllGoGtnlvlGhd�iL
r Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
Visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
September 1, 2000
CUST ID No.691727 ATTN.• POWTS INSPECTOR
ARTHUR L WEGERER ZONING OFFICE
421 N MAIN ST ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/1/2002 Identification Numbers
Transaction ID No. 429164
Site ID No. 194
SITE• Please to both i eRhQcation numbers,
Site ID: 194904, Tony James above,'in all correspond ce th <the agency.
St. Croix County, Town of Kinnickinnic
NW1 /4, NEIA, S23, T28N, R18W
FOR: ►—
Description: Three Bedroom At-grade System - Revision
�w
P � Y
Object Ty POWT System Reg Object ID No.: 670200 C
R
Q
J YP Y � J
The submittal described above has been reviewed for conformance with applica V�' omm ve Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. p9v e c ges will
become an addendum to the lans previously approved. All other portions of the installation s conform to the
P P Y PP rove P
original approval. 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
"At -grade Component Manual Using a Pressure Distribution System for Private Onsite Waste Treatment
Systems" SBD- 10570 -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 dunes as described in section
at -grade component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• A septic tank filter is required. Maintenance information must be given to the owner of the tank explaining that
periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm
84 product approval conditions.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
A copy PP P P 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
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
ARTHUR L WEGERER Page 2 8/31/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 08/11/2000
FEE REQUIRED $ 60.00
FEE RECEIVED $ 60.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us WiSMART',code: 7633
,= TITLE SHEET Page 1 of
AT -GRADE SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the At -Grade Component
Manual SBD- 10570 -P and the Pressure Distribution Manual SBD- 10573 -P
LOCATED IN THE NW 1/4 OF THE MZZ 1/4 OF SECTION Z3 ,T Za N,R 1F, W,
TOWN OF `—V M M tC'Yr-W QlQ ST. (!Z \X COUNTY, WISCONSIN.
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN ��
PAGE 3 of 7 PLOT PLAN �► Cl
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT " ye ee
PAGE PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION—
of 7 PUMP PERFORMANCE CURVE
01 k
PREPARED FOR
P.O.W.T.S.
T3K3 s _. Conditionally
ROVED
DEPARTMENT OF COMME BU
DIVISIO S T
PREPARED BY SEE CORRE NDENCE
WEGEt�ER SC3 S L .TEST = NG
AND .
7DES = GI<V S�RV I CE
P.O. Box 74 421 N.Main St oN6 �snN0!
River Falls, WI 54022
Phone 715 - 425 -0165
Fax 715- 425 -6864
= :2 l s
i A�EnERER }
i D-015 P
ar:u'6Yrp/1FM,
4 44 7, _ "
l t'rlS -ti Pnv Z S 1� 1LQX)1b) OX3 OF PR- eVLOUS -Y
JOB NO.
At -grade System Management Plan Z
of
' Pursuant to Comm 83.54, Wis.Adm. Code Page
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 Qommerce, Safety and
Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At -grade Component and Pressure Distribution System
No trees or shrubs should be planted or allowed to grow on the component. Plantings may
be made around the perimeter and the component 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 component is not allowed. Cold weather install-
ations require the component to be heavily mulched for frost protection.
Influent quality into the at -grade system may not exceed 220mg /L BOD5, 150 mg /L TSS and
30 mg /L FOG. Influent flow may not exceed the 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 ponding.
Ponding levels should be reported to the owner and any levels above 4 inches considered
as an impending hydraulic failure requiring additional, more frequent monitoring in
accordance with Comm 83.52 (2).
General
This system shall be operated in accordance with Comm 82 -84 Wis.Adm.Code and shall be
maintained in accordance with it's component manual SBD 10570 -P (R.6/99) and local and
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 at -grade component fails to accept wastewater or begins to discharge wastewater to
the ground surface, it may be necessary to install an aerobic pre- treatment unit or
replace the component. Additional site and soil evaluations may need to be done and
additional plans may need to be prepared and approved by the Department of Commerce,
Safety and Buildings Division.
Questions on.the operation or maintenance of this system should be directed to the County
.Zoning office at 1,1,5_356 -4680 or to the system installer.
„ _ Y PLOT PLAN
3
Scale 1"= Lip' - Page of
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e
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Ll�J LS77--- I66 .- --
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4” observation pipes with approved caps. ( Y_ required).
3. Septic tank to be v 3oo /60d gallon capacity manufactured by
W \ Z1 Z)_Z d�&204LE' e
4. Bench mark. S �3oUE
5. Divert surface water around system to prevent ponding at the uphill side.
L
5' B 5
I � ,
T i
Y
,A
T o — o _J
W C �w�o
a -
5 , 't o as�c, Via•+ k.eus - � rte. b .
-T. 1/6 B
1/2 B j
A
C= 3 � Linear Loading Rate= 3• GPD /LN FT
L �S Design Loading Rate= (Z�.Y GPD /SQ FT
Distribution
Observation Well �szzrQ -ft __ - Lateral aLw. �oI -S
Fa brie
- ±�v :: �ot•� - - -_ J, Soil
2 Cover
A 2 C A ^'2 —5
l
i I l
Plan Vied and C rc<-s Section of a Wisconsin At -grade Unit with 'Iwo
Absorption Areas With in a Single Unit on a Slcping Site
Distribution Pipe Layout page S of 77
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 final 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.
`t P_ 1 CTj L �,\ SS
�vC
Lateral Manifold Lateral
�Late x x x x2 x!2 x x x x
Length — Lateral Length — P
Distribution Line
hrutr -c��o
• Z =nczc� nt�w -
P Ft. Hole Diameter Filch -
S ' Ft. " Lateral " ; . Ipch(es)
X ' Inches Manifold T-._ Inches
Force Main " ,Inches
# of holes /pipe ►9
Invert Elevation of- Laterals ioi. Ft.
Sc)-16 6PI-I
Combination Segt;.c. Tank and
PUMP CHAMBER CROS5 SECTIOM ARID SPECIFICATIOIUS ' PAGE OF
VELIT CAP WCAT14EK PROOF
JUIJCTIOU BOX .
'1'C.I. VEMT PIPL APPROVED LOCKIAIG
1 10' FROM DOOR, !","WHOLE COYER ;-J11H
�fIA1DOW OR FRESH u'NP LA6El.,
u� FIFE ALIUTAKE cor,,CuIr
W /F1' zC r. ttr e4rp t
6` . I i `( IM 11.
7f z 7 z 7- - Z
IB'hIIU.
a• PROVIDE I - - - --
IA1 LE T .� �" AIRTIGHT SEAL
Approved
z>�$�. H� I I Approved
� III joint w/
joint w/
ALARM PVC pipe
PVC pipe a I I
I I
I I oU
c I I
a 2.7 S I
LLI- Y. fT. PUMPS "
OFF
D COLT ETE
�`L�V• q Z. UG BLOGK
- RISER EXIT PcFm ED OIJLy IF TAIJK MAUUFACTURCR HAS SUGH APPROVAL UDD
SEPTIC F SPEc,IFICATIOUS
DOSE
TAWK5 MA►1UFACTURCR: -W K-52Tz IJUMBER OF DOSES: PER DAy
TA SIZE: GALLOAIS DOSE VOLUME z
ALARM MAIJUFACTURER: SS - r1ZLl S1IZTt)7j IAICLUOiAIG 5AGKFLDW ���`b C, ALL0fJ
MODEL uu MBER: l V�LAJ CAPACITIES: A= ` 11JC14ES OR C.ALLOUs
SWITCH TyPC: $ _ IIJCHES'OR 33' S G�LLOIJ5
PUMP MAMUFACTURCK: C= IUEHES OR � GALLOUS
MODEL UUMBEM 13 D= 9 IAICHES OR GALLOUS
SWITCH TYPE: IJOTE: PUMP AUD ALARM ARE TO K 3
MIUIMUM DISCKARGE RATE S2-1 o GPM INSTALLED DU SEPARATE CIRCUITS
a
VERTICAL DIFFEKEMCE BETWEEU PUMP OFF AUD- .D15TRIBUTl01.1 PIPE., g FEET -q1,4(
+ MIUIMUM NETWORK SUPPLY PRESSURE . . . 3 'ZS FEET
- 1 F T.
n S•oZ 3.1
+ FEET OF FORCE MA►tJ X �pFCFRICTIO►J FACTOR.. S FEET
TOTAL DtWAMIC. HEAD = S.S FEET
As per manufacturer lb -`76 gal /in. Liquid depth 3G I,
• -�4 13/15 7 7/16 -�
w W HEAD CAPACITY CURVE MODELS 137/139 6 1/8 J I
MODELS 137/139 Ft. Meters Gal. Ltrs. _
a I 5 1.52 93 352 ° , 4 13/16
zs 10 3.05 79 299
6
zo 15 4.57 64 242 °
y 20 6.10 36 136
z S1 __ o 1 1/Y - 11 1/2 NPT
15- 25 7.62 8 30
4 137139 30 9.14
0 10 Lock Valve: 26 fl.
2
T5
S •t
13
0 I
U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110
T
LITERS
80 160 240 320 400 1 .4
0 FLOW PER MINUTE
SK373 _
009921
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Three phase pumps are available in 200/208V, 230V or 460V. • Variable level control switches are available for controlling single and three
• Electrical alternators, for duplex systems, are available and supplied with phase systems.
an alarm. • Double piggyback variable level float switches are available for variable
• Mechanical alternators, for duplex systems, are available with or without level long cycle controls.
alarm switches. • Over 130 °F. (54 °C.) special quotation required.
• Combination starters are available for 3 phase pumps. • Refer to FM0806 for 200° F. applications.
• Control alarm systems are available for 1 phase pumps.
i
137 Series - 47 lbs. 139 Series - 51 lbs. SELECTION GUIDE
Single Seal Contra Selection Listings 1. Integral float operated 2 pole mechanical switch, no external control required.
Model Volts -Ph Mode Amps Simplex Duplex CSA UL
M137/139 115 1 Auto 10.7 1 or 1 & 8 - Y Y 2. Single piggyback variable level float switch or double piggyback variable level
N137/139 115 1 Non 10.7 2 or 2 & 7 3 or 5 & 6 Y Y I float switch. Refer to FM0447.
BN137 115 1 Auto 10.7 - Y Y 3. Mechanical alternator M - Pak 10.0072 or 10.0075. Refer to FMO495
D137/139 230 1 Auto 5.8 1 or 1& 8 - Y Y
E137/139 230 1 Non 5.8 2 or 2 & 7 3 or 5 & 6 y y 4. Combination Starter. Refer to FM0514.
H137/139 200.208 1 Auto 6.2 1&8 Y N 5. See FM0712 for correct model of Electrical Alternator E - Pak.
1137/139 200.208 1 Non 62 2&7 3 or 5 & 6 Y N 6. Variable level control switch 10 -0225 used as a control activator, specify duplex
J137/139 200 -208 3 Non 2.6 2&4 3 &4 or 5 &6 Y Y (3) or (4) float system.
F137/139 230 3 Non 2.6 2&4 3 &4 or 5 &6 Y Y
6137 460 3 Non 1.4 2 &4 3 &4 or 5&6 N N 7. Four (4) hole J-Pak, junction box, forwatertight connection forhardwired simplex
6139 460 3 Non 1.4 2 &4 3 &4 or 5&6 N N operation, 10 -0002.
No molded plug "Single piggyback switch included. 8. Two (2) hole J -Pak, for Watertight hardwired Pconnection or splice, 10-0003.
Pumps must be operated in upright position.
Three phase units require a control switch to operate an external magnetic or combination starter. CAUTION
All installation of controls, protection devices and wiring should be done by
For information on additional Zoeller products refer to catalog on Combination starter, FM0514; a qualified licensed electrician. All electrical and safety codes should be
Piggyback Variable Level Float Switches, FMO477: Electrical Alternator, FM0486; Mechanical Altema - followed including the most recent National Electric Code (NEC) and the
tor, FM0495; Ajar Package, FM0732: and Sump/Sewage Basins, FMO487. 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: P.O. BOX 16347
% ri7,, Louisville, KY 40256-0347 Manufacturersof..
f "' SHIP TO: 3649 Cane Run Road
Louisville, KY 40211.1961 Q[[q( ?y PUMPf 9/1 9/1 190 9
(502) 778- 2731.1(800) 928 -PUMP
FAX (502) 774 -3624
x r " SAFETY AND BUILDINGS DIVISION
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
isconsin
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
At -Grade System
Onsite Verification Report
Are the soil and landscape features accurately reported on the
Soil and Site Evaluation Form
A—Yes no
If no, provide a further description by including an onsite
report, which may consist of a soil profile report, or provide a
brief explanation below.
If yes, what other type of Private Owned Waste Treatment System
(POWTS) could be used?
�A I&M.
County Official Signature Date
w I 'VE S . 23 T Z8 8
Property Location
' ►S 6k9� mo b► ni G '�� r�. C�
Landowners Name
SBD- 10513(N.11196)
�4&&inDeparbmntoflydustry SOIL AND SITE EVALUATION REPORT Page�-0f -3
Labor and Human Relations
'Division of safety s Buikfings in accord with IL.HR 83.05, Wis. Adm. Code
COUNTY
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 (Bluff, d PARCEL I.D. #
direction and % of slope, scale or p Z2 _ � � 1 6S - Z.O
dmensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION IEWEO IY DATE
-/�
PROPERTY OWNER: PROPERTY LOCATION
Tu N`1 R& ` Q-VA , :S)N t kZ S G9W -L•6F Nw 1/4 A Je 1 /4,S 7-3 T Z- t ,N,R i $' E (o G
PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
Z3 _
CI STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD
lRlue2 Ftt -LS,W[ sqoz-Z NS) ( 41S -s9t 7 I 'FV-trm'rXidt L1M
New Constnxtion Use P4 Residential / Number of bedrooms [ ] Addition to existing building
j J Replacement [ ] Public or commerdal describe
Code derived daily flow. b 00 an d Recommended design loading rate bed, gpolit — trench, gpolft'
PTT G%kb%
Absorption area required %WO bed, ft — trench, ft Ma)dmum design loading rate s bed, gpolft trench, gpd*
Recommended infiltration, surface elevation(s) 1.04 > 9 _ft (as referred to site plan benchmark)
Additional design /site considerations R'f t'\k�?Q'O T) - G %ZA b% >Jlt o' mm' TZ�GG RZ-6 kT . luf(W&J G R Tt
Parent material N (a Flood plain elevation, if apocabte A It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system ❑ S ILU I IRS ❑ U I ❑ S [RU Iq S ❑ U EIS Q U [IS IR U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch
\ 0- a . -) .8
Z ,_Zb lby� 3/6 1-� tcsb►T YvtU�- c� — •5 .l
Ground to 4
elev. - nn
\tV j ft 38 -4 1 p `1 R 7 l �C S O S 9 M� Ck, • S • ( o
Depth to S X1 -6 1 u`t tt ! �,s Lf \z s /8 o M `I • S
limiting
factor
Ll 1
l
Remarks:
Boring #
Z 2 6 z�. toy tZ X16 ��s l csWc m v'k
3 zq -Yp 1 U'l R y/ — _�s o s g M 1 rki — s
Ground
elev. L/"s t IZ y ti slid �_S �*� m •`[
/I V t ao.s ft
Depth to t
G Ito '
tip t n
ST CROIX
Remarks:
7Name:- Please Print Arthur L. We erer P �� 715 -425 -0 J
egcrer Soil Testing -& Design Service -P.O. Box 74 River Fa11s,WI 54
Signature: -�� ^ �� -� Date: " Z9-c17 CST Ntm lw.
M0 057"
2 / lx
PROPERTY OWNER �rt'C'f"1�;5 SOIL DESCRIPTION REPORT Page 3 of
PARCEL I.D. # 0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
O .(0 1rs l R ZIX - \S vA U °VS . .
: n Z 6 z9 �(W1 R 3/L — l `Fs 1 e-z �k ck, - -S
Ground 3 Z.9 -yS Z `1 — `�S b S9 wf Ct� S
elev,
ft. y u 8 tie` t tz�ly �s slg `�s n*, wt v'F►- •y •S
Depth to
limiting
fact; S
I
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to i
limiting !
factor '
1
Remarks:
Boring #
13.
i
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
F
Remarks:
SBD- 8330(R.05/92)
s PLOT PLAN Pa 3 of
✓ SCALE 1 "= LAW
( FrU hit: TveW,
S1�2 woou
N FoW-esr MO
- _ -
rt��i'��
fly" oir�. PvC PePB
N�Y'rR.. �\" t�►R_ Pines .nom
8.I
Et..too 3 ��o
OOAiR)vR l''LV' a. v���t
\ t ° t o
�l3l�tl8vnty�y Pi P@ = tOp g' t -
O`s�lwhw PtP�
►r ex e4 z 101.3
0 141 1 1 � L q-)-lkAI
. (7 7 5 425 -0165 00576----
U T — signature Date Signed Telephone No. CST #
r
'I
I
(C
c!
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
j Mailing Address /
Property Address
(Yuificatioa rNuirrd from Ptaaaiag Department for new constcuetioa)
CitylStatc 7,� �� Parrcl '
Iiutifieatton Number — & 1 2 - z -/ I G S - X
LWAL DESCRIPTION
Property Location l�l�! ' /<. Sec. TN -R I L W, Town of _Ki c (C ivNi �-
Subdivision
Lot # - .
Certified SmTey Map # Volume . rage #
Watraaty Deed # l `-13 I Volume # 3
Spot house ❑yes 13 no Lot lines ideaffAle [I yes ❑. no
SZF-Ni N...
o o aad oy , �uPCOaldtcsaltiaits
asists ofpctiefauretohaad iewastcs.Pmpermaiaaoe
caw 'sft of a fu'n9 c ut de of tbeSq)d0 tank CvM7 throe yc= or sooac. if =c&d by t Tie =dpmmp= What you put.into Ere system
upti'ctaalc'ss -a tcr�m�� is 8se �raste&sposaisyste�, . - - _ -
Tlr- p ow= agrvcs to submit - to St: CLO& Z6d g D i , odffimtioa form, signed by -ft cw= and by a
' - P>azt�odphrmbaoriTicc=d
u mPmPaoP ngoondiiioasaarar(Z) a impccti(aaud �Y��t(1jtEbeca4itcwast fiisposatsystem.
.Cf ty), the scptictank-is ius Aran M faH of sludge-
good IrM rod the abow and agroe to maiimtzia five priv=te sewage disposal system wi& * M'c staadai�is
by dw Depattmeat of Cmmcrva and dye Dcpartmcat of Nat=d R=oar ocs; State of vrwoosia.. Catifcatioa
da o that system has bocce mgd"n0d mast be oomplded and reUmed to the St. Croix County Zoning Offix withia 30
t , cxPimd0a date.
GMAT
DALE
oR �'R�'laR7rc010N
we) «rafy that all stateaLents
the
on tbrs foam arc t= to the but of my (our) kaowicdgc, I (we am (arc) the owner( of
7 tre. by virtue of a warmaty dood roeor+ded in Reg6la of Dads Office.
A OF APPU,
DATE
ss« «ss information that is tnts
map result is the sanitary permit being tevoked by the Zoning Department.
«« Include with this affliction: a dmpod %=city deed from the Register of Doody ofree
a Copy of the xttifed survey map if reference is made is the warranty deed
I
t IM HAR 01
WAR RAN IN 1)111)
uO CU "AI -N r NO VOL PACE R
a t iscon�i11 coo - - , o�
`I��iden, Inc•.) - - _c
;,-. coax err, rn
_ f F
I Anthon C: I.cir2 i3. a.` �
JUL 5 ,cgs
husband, and wif(l, 8:30 + A',�
tt r Et. v; ois EOUIT VIC
TITL SERES
U TF,
SECOND STREET
HUDSON, wi SA0
10 "
North 11alf of the Northeast Quarter i N1 /Z of N FI/4) of Scction tiunthcr 1'v c:nn -three
Township :Number Twenty -eight t'_S) North. Range Number Eighteen (18) "'cst. County of
St. Croix and State of Wisconsin. H�U
Excepting Therefrom any part thereo, included within lots I 4 inclusi\e of Certified
Surrey Map filed June 6, 1996, in VoI 11, Page 31 IS. as Document No. 545925
I TANFE13 S
is not
restrictions . -Ind r. hts- of -e:rty of cor', if any.
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