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028-1017-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Perrnit No: 574394 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: Cottle, Leah E. I Rush River, Town of 028-1017-10-000 CST BM Elev: Insp.BM Elev: IBM Description: Section/Town/Range/Map No: 1,00 , p 1 J 00 u R J) 1 / 12.28.17.87 i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic .zk chm)a�trk> ry /D/ t /C'6 C�J 6+ 1� u Dosing 1 Alt. SM Aeration Bldg.I Sewer / A h �Ile v 4- -47 L,? r L S Holding Ht 4 Inlet l -�. � St/Ht Outlet lvvc� �jc TANK SETBACK FORMATION /� /0 2 • Z TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet t r S Septic r l I l Dt Bottom pat _ Dosin �. eader/ an. 2 ? bo r tiu ry 5.31 !D/. 2 Aeration v h Dist. Pipe 5,3 " - T7 • 571/ %off 0 /!� Holding Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number �j� I ' J/ _ ` TDH Lift Friction Los System Head TDH Ft ��} 3 .S -7 7, Q Ni 4t �i v c _�_ Forcemain Len D a Dia. // Dist.to Well f✓ /�rZ $C /Z . SOIL ABSORPTION SYSTEM , BED/TRENCH Width Length No.Of Trenches/ PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS — ( SETBACK SYSTEM TO P/L E JBLDG WELL LA / REAM L ING Manufacturer: INFORMATION Type System:! ` �� >�� i O'l/ C UN R OR Model Number: DISTRI T N SYSTEM / l V / Heade Manifold Distribution „ /��T/Yt x Hole Size jx Hole-Spacing lVent to Air Intake /� Pipe(s) C1 �. ' / 3 53 Z /ZS y i �' Length Dia Length D U- Dia Spacing SOIL COVER x Pressure Systems Only xx Mound 0 At-Grade Systems Only Depth Over Depth Over xx Depth of- xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges psoil c ? _! Yes No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /0 / / / In pe ' n#2: /6/ ffy/ Location: 1 th Street Baldwin WI 54002 SW 1/4 NW 1/4 12 T28N R17 NA Lot 1I No: 12.28.17.8 47 200 ( �M 1.)Alt BM Description= U�p tGVm �n " �0 3 �� 2.)Bldg sewer length -amount of cover= Plan revision Required? Yes No �( Use other side for additional information. / Date Insepct s S gnature Cert.No. SBD-6710(R.3/97) st ko i 1, Y janK 01,6 DO t-0 b� ws ` V S , pr ( 4 t 411 s X102- j'd t w,%v S 1 Z, T 2S N, =tyAA' 0Z$- 1017- /0 - 000 ) q b 1 �> < Ph 7 ---- ----- --...... -----_- c X15AV, r ' County Safety and Buildings Division �-4 e— 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madis WI 53707-7162 G AI 3 `. S�Q TlI it Applica ion`n Stat Transaction Number In accordance with SPS"383.2 , ��Code,submission of this form to the appropriate governmental unit � I s I .7/Z - .I-.(!✓-a�5`�7 is required prior to ob n � it. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of S� esslonaI Servies. Personal information you provide may be used for secondary purposes in accord the Privacy Law,s. 15.04(1)(m),Stats. y' 'g-ac I. A licatio ormation-Please Print All Informatio ? Property Owner's Name 1� Parcel# Z e-S.A eo Ile r -ff-- 04-1017 —LO—oO Property Owner's Mailing Address Property Location �� G� Govt.Lot , City tate Zip Code Phone Number r�y, /<, Section l (Y k. (�/ i ��GI G 2�- ``G 2 �CIG �(�l!�{ /i I(cfcle one) 11.Type of Building(check all that apply) Lot# T u X N; R_�fca E or w 1 or 2 Family Dwelling-Number of Bedrooms / Subdivision Name Block# ❑Public/Commercial-Describe Use ❑City of El State Owned-Describe Use CS//M++ Number I Village of v��� �G� �•�G-f!G' Town of 4 s R7!/_e e 111.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑New System �-'-� ❑ Treatment/Holding Tank Re p lacement Only Other Modification to Existin g System(ex p lain) B. El Permit Renewal El Permit Revision ❑Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner t ' IV.Type of POWTS System/Component/Device: Check all that apply) !' l' ❑Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade Mound>24 in.of suitable soil ❑ Mound<24 in of suitable soi � Fu ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaUTreatment Area Information: Desi n Flow(gpd) Desi n Soil Application e(gpdsf) Dispersal Are7Ruiired(sf) Dispersal Area Pr sed(sf) System Elevation ✓® / c � �� �7y� 26 It VI.Tank Info Capdcity in Total #of Manufacture Gallons Gallons Units t D o New Tanks Existin ks c y " R d w U m y m ti 0 P. Septic or Holding Tank Dosing Chamber• &V J VII.Responsibility Statement-I,the undersigned,ass me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum s Signature P S Number Business Phone Number Plumber's Address(Street,City,State, 'p Code) VIII,County/De artment Use Onl Permit Fee Date I sued Issuing Age-nt S ature Approved El Disapproved $ ❑Owner Given Reason for Denial II'I IX.C ions of Appproval/Reasons for Disapproval - TE OWNER: M 1.Septic tank,effluent filter and c" f'=7tir�u dispersal cell must be serviced/maintained r _' G c7 as per management plan provided try plumber. �� S��7� ��^�� 2.All setback re uire as per applicable f fdffMfit€ si.ni or m and submit to the County only on,paper not less than 81/2 x 11 inches in size r law ��l �t��L:�✓!X vv, -�-t��n.w '� ' ' � f�"� �C'Gle1 - ,.L i� �' .�`%.y?�l�� - = , �D-6398(R. 11/11 � Y • lt-- 1�--(G�,(�,x --�r-�- c �.:�k.�.�" cif � aEeA"A DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay ds www. g �G ps.wi. ov/sb! ° www.wisconsin.gov Scott Walker,Governor Dave Ross,Secretary September 12, 2014 CUST ID No. 223475 A7TN PO KITS Inspector JOE STANG ZONING OFFICE STANG PLUMBING&ELECTRIC ST CROIX COUNTY SPIA PO BOX 263 1101 CARMICHAEL RD `IdOODVILLE WI 54028 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN AP-PROvAL EXPIRES:09/12/2016 Identification Numbers Transaction ID No.2451312 STTE: Site ID No. 805398 Kristem Miller Please refer to both identification numbers, 471 200 Th St above,in An correspondence with the Town of Rush River St Croix County SW1/4, NWl/4, S12, T28N,R16W Lot: 1, FOR: Description:Mound Object Type:POWTS Component Manual Regulated Object ID No.: 1499783 Maintenance required; Replacement system; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from orighwal grade; System(s):Mound Component Manual -Ver. 2.0, SBD-10691-P(N.01/O1,R. 10/12),Pressure Distribution Component Manual-Ver. 2.0, SBD-10706-P(N.01 101,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner,as defined in chapter 101.01(10), Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P(N.01/01,R 10/12)and the'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Sy "K1Nit0" SBD-10706-P(N.01/01,R 10/12). �v►tVV Lx APPROVED The building sewer and distribution network piping shall be of material listed in Tftm-O�INAALEP' Wis. Adm. Code. DIVIS10 # N OF IN�V.4'" In the event this soil absorption system or any of its component parts malfunctions so a create a th hazard, the property owner must follow the contingency plan as described in the approved ISO s. I additi tf,the owner must comply with the operation, maintenance and monitoring duties as desc ' If the mound component manual. A copy of this information must be given to the owner upon c **We project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). JOE STANG Page 2 9/12/2014 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 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. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2,Integrated Services T�VitAl `I code., 3 (262)397-6005, Fax: (608)283-7481 julia.Iewis@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services. Additionally, all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. } MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIr-M Residential Application CEIVCD INDEX AND TITLE PAGE AUG 1 4 214 Project Name: Miller replacement mound IN DUSTRY SERVICE S Owner's Name: Kristem S Miller Trst Owner's Address: 471 200th St. Baldwin, Wisc. 54002 Legal Description: SW1/4 Nw1/4 S12 T28N R16W Township: Rush River County: St.Croix Subdivision Name: Lot Number: 1 Block Number: Parcel I.D. Number: 028-1017-10-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Report Designer: Joe Stang License Number: 223475 Date: 08/12/,44 Phone Number: 1-715-684-5166 Signature: Designed Pursuant to the AND Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01), and both ''�1/�CE$ SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)and '�y SERVICES Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N. 01/01) Version 7.0 (R. 03/2012) Page�ESpOND ENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5 = 150%) fecal coliform of-36 inches. 600.00 Design Flow(gpd) 10.75 Site Slope (%) 100.00 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 85.001 Dispersal Cell Length Along Contour(ft) = 7.06 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.53 3.53 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 1.77 0.125 Orifice Diameter(in) 1.50 Estimated Orifice Spacing (ft) = 5.36 ft2/orifice 2.00 Forcemain Diameter(in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft)x 1.3 13.05 Forcemain Drainback(gal) 8.59 Vertical Lift(ft) 76.71 5x Void Volume (gal) 3.44 Friction Loss(ft) 89.76 Minimum Dose Volume (gal) 0.00 In-line Filter Loss(ft) 46.14 System Demand (gpm) 18.53 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x 1.25 x 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information 1000.00 Total Tank Capacity(gal) 1700.001 Septic Tank Capacity(gal) 37.00 Total Working Liquid Depth (in) Wieser Manufacturer 27.03 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1000.00 Dose Tank Capacity(gal) Best Filter Manufacturer 27.831 Dose Tank Volume (gal/in) GF10-8 10x18 Filter Model Number Weiser Manufacturer Project: Miller replacement mound Page 2 of 9 Mound Plan and Cross Section Views . . T 1/10 B . . . . . . . ..:.:...:...:. . . . .. J Observation Pipe 33 ' ..°`.�°a� bxgg%�pa Po g%zxaaxW� ,RR xmR F%# . "r•. .•.* r : are : r .•• - W . 1 . . B# L Mound Component Dimensions A 7.06 ft E 21.11 in H 1.00 ft K Aft ft B 85.00 ft F 9.50 in z 13.51 ft L ft D 12.00 in G 0.50 ft J 5.20 ft W 600.10 (ft2) Dispersal Cell Area 1748.30 (ft2) Basal Area Available 7.06 (gpd/ft) Linear Loading Rate 1 8.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.79 (ft) , .,.. H F 101.50 (ft) Lateral .'. ........... Dispersal Cell 101.00 (ft)-01— Invert Dispersal Cell ::::Q:;:;:::::; Elevation E :: •: D :: : : . : 3 ::::::::::. 100.00 (ft) Contour Elevation 10.8 % Site Slope -�`- Geotextile Fabric Cover Shading Key fl. — Dispersal Cell See lateral details on 1� Topsoil Cap c °L 1.5 ft � „.µ.„;;g g�=: .=a a Page 4 for number, Q {{"' Subsoil Cap 0 °.a m$#�° °Mg�g$$gg size,and spacing of ASTM C33 Sand :a 2 =;°� °������� °." . _. __«� _; laterals. Laterals are Tilled Layer d 0.5 ft `°g'Typical Laterals F equally spaced from the Aggregate c °«„ ° a°aa°pa�s,►�tg distribution cell's centerline in the A ution cell (AxB). Project: Miller replacement mound Page 3 of 9 Center Connection Lateral Layout Diagram Force main connection aria tee or cross to manifold at any point. Laterals are identical P S •=Turn-upvdballvalve or I�x I<-02 I 0241 Laterals MorcemainSch40PVC cleanoutplug per SPS Table 384.30-6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.52 ft Lateral Length (P) 41.80 ft Orifices per Lateral 28 Lateral Spacing (S) 3.53 ft Orifice Density 5.36 ft2/orifice Lateral Flow Rate 11.53 gpm Manifold Length 3.53 ft System Flow Rate 46.14 gpm Manifold Diameter 2.00 in Total Dynamic Head 18.53 ft Forcemain Velocity 4.71 1 fUsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and 00 SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented < Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 1000.00 Gallons Volume 27.83 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.81 551.24 B 2.00 55.66 C Pump off elevation(ft) C 3.23 89.76 92.91 D 10.90 303.35 D Total 1 35.931 1000.00 Dose tank elevation(ft) 3" Bedding u er tank. 92.00 Alarm Manuafacturer SJE-Rhombus Controls Note: Switches Alarm Model Number Tank Alert 1 J containing mercury may not be used in Pump Manufacturer JGoulds this system. Pump Model Number 3887 EP05 Pump Must Deliver I 46.14 gpm at F 18.53 ft TDH Project: Miller replacement mound Page 4 of 9 n z X N D M 61" 86" D Z D 42" n z M M nNM = 0 M M UP 41" 0 / _ \ A 4" CAS x N ( N M m 3" 36" 4" I I I n S r,I I = UP 38" I o r / 4" CAS \M / N V I m g c M p O N O A D C '�D� 39" 0 N ° K> -N1 M m r I OM> (n m �U�O M x;o C-) x D z 0 M n -1 z O ?�'�� A nv n M z D �N �� mZ Zr-� 0 nCc) 0 O�Z > Z pmaZ my0 ODD Z c>a xx vrcn v LlF,-4 - il00a NOV =a:oe =xr� IFz v)v Nm \m BCD r-iz 0 �Zc° AV)C: �r�<*1z�_� �i*�, ANN (n r- AZ� xN = m Z D0 -N-IZ9 nng VAFO'ODON sxpN\ -D Z oRl -0 n D co I-.. $' M N v a v yN vv nZ OD n� N N� NN p O° s1mP G� s n O o v a Z o' D A m n� v v�im°D lim rc,+4+. O nc)- Zn O O z m u n t..l i-.� �N �C W NOn Dr ED C% p0OV Ow O a <° z °w Ln O N N Z C O m m I p AA- ;z C7 I r m m -I W n 560 p Z Z 0 0 m-IM 007 ��'D s a m z 8 p 'o -1 .m D n mO v ; v v 3 C� C N ov r C7—D Dp Cn�m m < v A H D 0m v Z o D Drp r� W;n D -_) �J 'Z Dv a D z ��� °o� �o� o O 0 r � z � F r' -ipm .v0 ( Z 'S m m 2 O N z A �C o z o y A � O � � o m� m p -I n `� z r c r� O Z O r N Z M ;o M M r m = WLP1000-MR MIEBER COIICAETE DRAWN BY: SME SCALE: 1/4"=V-0" PRE-POUR: M REV. SEPTIC MANUAL DATE: JANUARY 2010 DATE:. W3716 US HWY 10 MAIDEN ROCK, WI 54750 POST-POUR: \ ° REVISED JAN. 2010 800-325-8456 FILE: RM000-MR Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stang Phone 715-684-5166 POWTS Regulator's Name St. Croix County onimg Phone 715-386-4680 System Flow and Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1700 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.1 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished i....•....60066 ............... Grade 6-8" Diameter Lawn ♦ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Miller replacement mound Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-10691-P(N.01/01),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01)]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 SPS 383.33,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. 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 Commerce. 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. 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 as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 mg/L TSS, 10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. 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 ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as 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. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)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 absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Head GaM�Per Poem (ft of water) No. �°n minute EPOS 1 Impeller 5 53 - 2 Base 10 6 10 46 62 3 Pump Casing 15 36 55 8 4 Mechanical Seal 20 21 46 5 Ball Bearings 7 25 0 33 6 6 0-Rings 9 30 - 11 7 Power Cord 5— ' 8 Oil Filed Motor 4 s 9 Motor Housing) 3 Stator Assembly 10 Motor Cover z METERS FEET :..--------- -- ----- -- - --------- ._... ---- ------ 10 9 301 -i1 N-5GPM — 2.5 FT -- 2S i _ S 3 6 20 i c 15i 4 O 3 10 --- — _ i 2 -- .....EP04 i OL. 00 10 20 30 40 s0 GPM L I 0 2 4 6 8 10 12 rr3/h CAPACITY 3 OLD- M bb `0001600yy , s�P-t 4� Ao VL, u 1 � _. � ►�✓.sCs�Q 181 O 14 Tirs-t 47 yo r �d 5`v �1y /Jwly� 512, TaBN, PT-030 OZg- 1017- /0 - 000 wis.Dept of Safety and P�onal servi L} SOIL EVALUA EP � Page 1 of 4 Division of Safety and Buildings �� ^�9.71 to at!(cewb SPS 385,Ws. Adm. Code GG pM�EN► County St.Croix Attach complete site plan on p 1 x 11 inches in size.Plan must include,but not limited to reference pant(BM),direction and Parcel I.D. 028-1017-10-000 percent slope,scale ord' ns,north arrow,and location and distance to nearest road. Please print all information. Re** Aed Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Location Kristen S Miller Trst ■ Properly Owner Property Govt Lot SW 1/4 NW1/4 S 12T 28N R 17E(or) ❑ Property Owner's Mailing Address Lot# Block# Subd.Name a CSM# 471 200th St. 1 CSM Vol,13,Pg.3736 City State Zip Code Phone Number ity 13VVi®age own Nearest Road Baldwin Wisc.1 54002 1 ( 7115-6845102 200th St. ® New Construction Usej3 Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD El Replacement ❑ Public or commercial-Describe: Parent material Sandy Out wash Flood Plain elevation if applicable N1 A ft. General comments Z(JC%C% t n C: k t t i j' (_l Zh i�� GZ.Ic?� �I -�'� 3S-i i/J and recommendations: Mound system contour 100.00 Existing 1000/600 gal,combo tank used for septic add 1000 gal.pump tank F71 Boring Boring Q Pit Ground surface elev. 100.00 ft Depth to limiting factor >120" in. Sol Appkadw Rate Horizon Depth Dominant Color Redox Description Texture Structure nce Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Coat Color Gr.Sz.Sh. qm *fm 1 0-6 10YR3/3 — I lfgr dsh as 3 0.4 0.6 2 6-15 10YR3/5 — sl lfbk dh c, 2 0.4 0.6 3 15-32 7.5YR3/3 — scl 2mbk dh cw 1 0.4 0.6 4 32-120 7.5YR5/6 – s osgr ml cw -- 0.7a 1.0 --F--T F2 Boring# ® Ong 95.7 32 0 Pit Ground surface dev. it Depth to limiting factor_ in Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure ary Rods GPDAt 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 1 0-6 10YR3/3 — 1 lfgr dsh as 3 0.4 0.6 2 6-19 10YR3/5 — sl lfbk dh cw 2 0.4 0.6 3 19-32 7.5YR3/3 — scl 2mbk dh cw 1 0.4 0.6 4 32 7.5YR5/6 f1 d2•5YR 6 scl lfpl mvf ova - 0.0 0.2 •Effluent#1=BOD >30<220 mg/L and TSS>30 5 150 mg/L 'Efflyerit#2=)M, <30 mlyL and TSS<30 mg& CST Name(Please Print) Signature CST Number Thomas W.Gedatus 962178 Address Number Stang Plumbing&Electric P.O.Box 263 Woodville,Wisc.54028 8/11/2014 715-684-5166 SBD-8330(R11/11) Property Owner Kristen S Miller Trst Parcel ID# 028-1017-10-000 Page 2 of 4 BPi oring# Boring 100 24 E] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 3 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 01 ff#2 1 0-6 10YR3/3 --- 1 Ifgr dsh as 3 0.4 0.6 2 6-15 10YR3/5 --- sl Ifbk dh cw 2 0.4 0.6 3 15-24 7.5YR3/3 --- scl 2mbk dh cam' 1 0.4 0.6 4 24-60 7.5YR5/6 fld2.5YR4/6 scl Ifpl mvf cw - 0.0 0.2 F-1 Boring# �!Boring 11 Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * fr#1 02 Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 3 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 * ff#2 *Effluent#1=BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS<30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. OD-8337rest(R 11/11) 00�' �C� w•^j LY Nw Yq, 5 �2, TZgN , R Nrl:flm* 02-9- 1017- /0- 000 -�d w r. o'fl IZ,erg h 12'.vc r 1W S Ac�cc.5 9f'So I q7,S i -78 J y i csT �1= 4,6 z� g 3 pr LAI F5 4 rj] LO 3 9 t, C14)a C-r� ti f f � t I � � x ��D• S �! '70 r 90\AsE C) to rl ! �iM _ El . rot?. oO ulna-P+ I N �r L LO 0 IM Ea y Post PaI Z i i t ........_,.._.�.. .._..,_....._ '....,_,....._.... _.,.w.�._.....__.._...M ........_. ....... ._.... ...... ............. ..._.... .. .............. ..... ....__ ..,...__.__.._.___ ......._........... _.......... i 1 { S Cso AW LU vi ? a Z Eby .gyp i O m�` L o�o C . y O tad m� CV N F t. ......... .............. .. .....___ .._.._..f"... .. ...�.. ... ....;.... .. + g» C U�c e-+ 0 8 (fag 14 o-P y ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTI.EICATION FORM Owner/Buyer R- Mailing Address Property Addresses w (Verification required from Planning&Zoning Department for new construction.) City/State /d G✓ A2 44 r Parcel Identification Number LEGAL DESCRIPTION Property Location 's �'/, , (4 4--- '/4 , Sec. PZ , T :?kN R_/ !W, Town of �4S <'�e< Subdivision Plat: , Lot# Certified Survey Map# of 1 Z , Volume , Page# Warranty Deed# (,'1 (, ( ?j (before 2007)Volume , Page# Spec house 11yes0no Lot lines identifiable❑yes❑no 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§SPS.383.52(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. I/we,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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. 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. Number of bedrooms SIGNATURE OF APPLICANT(S) 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.04/12) 1001093 STATE BAR OF WISCONSIN FORM 7—1998 BETH PABST TRUSTEE'S DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD 09/05/2014 08:00 AM Andrew P. Miller, as Trustee of The Kristen S. Miller Revocable Trust EXEMPT * NA dated November 22. 2010,for a valuable consideration conveys without REC FEE: 30.00 warranty to Leah E. Cottle, Grantee,the following described real estate TRANS FEE: 1395.00 in St. Croix County State of Wisconsin: PAGES: 1 *single --The above recording information verifies that this document has been electronically recorded Si returned to the submitter Recordinq Area Name and Return Address 515, a ut 0i rt aijiC ua G> v >c ��i.ru� ;Ytiiit 55`131 028-1017-10-000 Parcel Identification Number(PIN) This homestead_property. (is) (is not) Lot 1, Certified Survey Map recorded September 29,1999, in Volume 13, Page 3736, being part of the Southwest''/.of the Northwest'/.of Section 12,Township 28, Range 17 West,Town of Rush River,St. Croix County,Wisconsin Dated this�day of 2014. (SEAL) (SEAL) Andrew iller,Trustee Trustee (SEAL) (SEAL) Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ) ss. St.Croix County authenticated this day of r7<7/t b day of ersonail da me before me this P ,2014 the above named Andfew P.Miller.Trustee of the Kristen S.Miller Revocable Trust dated November 22.2010 to me known to TITLE: MEMBER STATE BAR OF WISCONSIN e e person who executed the foregoing (If not, n t merit and ac nowledge the same. authorized by§706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Burnet Title-Scott Tranby Notary Public,State of Wisconsin 5151 Edina Industrial Blvd,*500 Edina, MN 55439 My commission is permanent. (if not,state expiration date: 14-11967 ) (Signatures may be authenticated or acknowledged. LINDA K;AEMER Both are not necessary.) NOTARY PUBLIC STATE OF WISC NSI "Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co,Inc. TRUSTEE'S DEED FORM No.7—1998 Milwaukee,Wis. St. Croix County 1001093 Page 1 of 1 Parcel #: 028-1017-10-000 09/29/2014 08:10 AM PAGE 1 OF 1 Alt. Parcel#: 12.28.17.87 028-TOWN OF RUSH RIVER Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner KRISTEN S TRST MILLER 0-MILLER, KRISTEN S TRST 471 200TH ST BALDWIN WI 54002 Property Address(es): '=Primary 471 200TH ST Districts: SC=School SP=Special Type Dist# Description SC 0231 SCH D BALDWIN-WDVILLE SP 1700 WITC Notes: Legal Description: Acres: 14.532 SEC 12 T28N R1 7W PT SW NW BEING LOT 1 CSM 13/3736 14.532AC Parcel History: Date Doc# Vol/Page Type 11/29/2010 927702 QC 12/30/1999 616275 1481/144 WD 07/23/1997 424/487 05/17/1990 458691 871/88 LC Plat: "=Primary Tract: (S-T-R 40%.1601/,GQ Block/Condo Bldg: 3736-CSM 13-3736 028-99 12-28N-17W LOT 1 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/10/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.000 45,500 258,400 303,900 NO UNDEVELOPED G5 8.532 15,000 0 15,000 NO Totals for 2014: General Property 14.532 60,500 258,400 318,900 Woodland 0.000 0 0 Totals for 2013: General Property 14.532 60,500 258,400 318,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 222 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 co o� cC /y 9 G' N CERTIFIED SURVEY MAP VERN VANDENBERG Part of the Southwest 1/4 of the Northwest 1/4 of Section 12, Township 28 North, Range 17 West, Town of NW COR. SEC. Wff wSt. cFoix County, Wisconsin. N / 1/2"IRON BAR FOUNDI .� N LINE SW//4 NW 1/4 2 ATr '` LANDS S00.07.37"£ 33.00''IL N 89•?8'27"F 6/2.39' N 89-50'27"F U.001 3' 3 .00'i 379.39' CENT�RL/NE I Q y 100•"', W i � 3 3 I BARASE a h _ WEL'° ED a 4 Z: -r BARN 2 )I I SNED 3 z! 3 I \ = W D I M I DWFL L INS b Wf • O 'O� `O , _ � _ 2I t o b 2 I { s SEPTIC A _j y O i ? a! ! N j o I i LOT / N W I a W z I �^ •O i 14.131 ACRES W ~ m y I` J p 633.026 SO.FT. ^ Q N M W q O i m /3.790 ACRES M J R C O y J W e00.4972 SO.FT. O Q Owner's Address: 471 200Th St. Baldwin, WI 54002 33.00 I i s/s.o4 This instrument drafted by N Laurence W. Murphy L04 N 90•00•00"W 648.04, BOR/NBSO 4 ' LOT 2 M1— I-b J;. J 3.000 ACRES J 0b b E1/4 COR. SEC.12, T28 N,R 17W, b i 217,803 SO.FT. b 4.746 ACRES EXC.RA 1P.K. NA/L FOUND)D D R.O.W. M COII b M 206, 719 SO_ FT. Vj S.00' ' 648.94' 4&33.72' &90.00'00"W 5282.66' £/W 114 LINE W 1/4 COR. sec.12. T 2&N, R 17 W, APPROVED /RA1 L ROAD SPIKE FOUNDJ UN P L A T T E D LANDS BT.CROIX COUNTY SCALE / •= zoo• Dn Zd1i9 and Parka Committee `�p%_ �S�C'O 1„A YaS 0 so- too- 200' ` �i yi S E P 2 9 1999 1 'LAUR � E = m W M R'PHY ' C= L if+:pt recorded within 30 days of = 713 = i LEGEND: ippra\%l d616 % O Indicates 1" x 24" iron pipe weighing 1.13 mind ro�rslshft. p p € i; /411n. ft. set IVER FALLS....-" X� -P A Indicates fence. 9�'•. WISC.•,.�' R (10.0') Indicates previously recorded data. �i �� •LANDS sa••a.�aw's.fa`�� SHEET 1 OF 2 Vol.13 Page 3736 /W ' ,sa and �p PRIVATE SEWAGE SYSTEM ount : r INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal irdormation you provic.'e may be used for secondary purposes [privacy Law, s.1 5.04 (1)(m)]. 353319 Permit H er i Name: Q City Q Village QXrown of: State Plan ID No.: filler Andrew & Kristen Rush River Township T BM E v.: Insp. BM E ev.: BM Description: Parcel Tax No_: .o` 74 - =CST g 028- 1017 -10 -000 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1aro boo Benchmark , ,63 4kf• o' Dosing u Alt. BM . l 9 g Aeration Bldg. Sewer , S8 90.05 / Holding St /Ht Inlet 2, TB g , IS' TANK SETBACK INFORMATION St/ Ht Outlet -^ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Septic >1 >Z5 NA Dt Bottom IZ.So B2.15' Dosing I' " " w� NA Header /Man. 4, Aeration NA Dist. Pipe 5•61 ) : 9(." Holding Bot. System 6 . 47. 21 ' 5% av IN 63 PUMP / SIPHON INFORMATION Final Grade 2 .:K , 9 1-88 1 Manufacturer p_LLC Demand St cover S.o2 8q•(oi ' 33 Model Number rj 3 GPM ! qa • 4(" TDH Lift 4.:'O Frictiol . System TDH lo-Z5 Forcemain Length 1 0 5 Dia. Z " Dist. To Well SOIL ABSORPTION SYSTEM AW 4REN _ C _ W Width Leno th , No O Trenches PIT No. its Inside Dia. e DIMENSIONS D IM E N S I ONS SYSTEM TO P/L BLDG I WELL LAKE /STREAM L C G M acturer: SETBACK CH M INFORMATION Type r e Num r: System: Cvtx%l. I� �- 73 - -0 O IT DISTRIBUTION SYSTEM Header/Manifold a Distribution Pipes) �I x Hole Size x Hole Spacing Vent To Air Intake r '• 16U Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade ystems Only Depth Over Depth Over xx Depth Of xx eded /Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil ❑Yes Q No Q Yes Q No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: 0 - f /I °'O lnspection #2: • — t -- ' Location: 471 200th Street, Baldwin, W1 54002 (s 1/4 NW 1/4 12 T28N R1 7W) 12.28.17.87 -Lot 1 1.) Alt BM Description 2.) Bldg sewer length= x{55'.0' - amount of cover = > 50- CAX� • (� _ I . L .S,e,�l� P� 'L - 3) 4 E c,.o T � - A Plan ion required? ❑ Yes � No Use other side for additional information. o( 1 )4 d Q SBO -6710 (8.3197) Date Inspector's ignature Cert. No. y J ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i t 3 , E < : v E 4 i i B E E g a o ° x a � F 3 a R e g e 6 v a n x i { € • s s t € P � a < 11! < j E .cm. w..,R s e A s c F � a s x &4 s .. e F 'hi consin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353319 Permit Holder's Name: ❑ City ❑ Village ❑ Tgfwn of: State Plan ID No_: And rew & Kristen I Rush River Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 028- 1017 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS H1 I FS ELEV. Septic Benchmark �Z " q • 0 q , 6D Dosing Alt. BM `f• 19 I y Z4-1 p `f Aeration Bldg. Sewer �� 5B �o •oS` 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 ( Z b" 12 •S `��I, 3 Dosing NA Header /Man. 44 6' 5 5 . Aeration NA Dist. Pipe + ` O •ZO % to Holding Bbt. System , c PUMP/ SIPHON INFORMATION Final Grade ! Z' " S A � Manufacturer Demand St cover t J / A` r 5. 02 Model Number �3 GP o� i r Z -11 TX Vv TDH Lift ek Friction OL , System TDH Forcemain Length/o Dia. 2 N Dist. To Well S0ILP,B ION SYSTEM 91.Qf TRENCV Width I Lengt 1 No. Tenches PIT No. Of Pits Inside Dia. Liquid Depth DI � DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER � model Number: System: Q "Ieo "' 3` OR UNIT DISTRIBUTION SYSTEM Header/ Njanifold K Distribution Pipe(s)( , L k x Hole Size Spacin Vent To Air Intake Length Dia. Length 0 Dia. 'S Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over` xx Depth Of kx Seeded/ Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil El Yes E) No ❑Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: 6 /yy /Inspection #2: 44 Location: 471 200th Street, B41dwin, WI 54002 (SW 1/4 NW 1/4 12 T28N R17W) - 12.28.17.87 -Lot 1 1.) Alt BM Description= "- 2.) Bldg sewer length= 415.,l - amount 01 cover= >47 P � - f _ Plan revision required? ❑ Yes KNo Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No T r '� •} Safety and Buildings Division ■ SANITARY PERMIT APPLICATION 201 W. Washington Avenue f Lonsrn In accord with ILHR 83.05 Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 5 r0_ 1 q"n1>( • See reverse side for instructions for completing this application State sanitary Permit Number- 3 (Q Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. Y / z 6G ,4 (/ State Plan I.D. Number I. APPLICATION INFORMATION - PL• EAST / PRINT ALL INFORMATION Property Owner Name Property Location A ,. 4 S L„ t1 /4 rt W14, S T 2 ,?, N, R 1 E (or) Property Owner's Mailing Address Lot Number Block Number n e Cit State Zip Code ` Phone Number i Subdivisi n Name or CSM Number IL TYPE 0 F B IL ING: (check one) ❑ State Owned ❑ V 112 age Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms town of dS >v t/� p© ��► 57` 111. BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) L d} / ap 4 - 1 ❑ Apartment/ Condo O -2g_ l 1 7 r 1 0 - d ac> 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. tg Replacement 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 Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed r 21 E] Mound 30 E] Specify Type 41 [] Holding Tank 12 Seepage Trench P v 1'n , 22 [] In -G round Pressure r 42 E] Pit Privy 13 Seepage Pit 2 k X S - Z = b 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area D. Absorp. Ares 4. Loading Rate 15. Perc. Rate 6. System Elev. 7. Final Grade ReVL d (sq. ft.) P oposed (s . "ft.) (Gals/d y /sq. ft.) in. /inch) evation L11-6 VT 901 7 3 q'ieet VII. TANK Capacity gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in structed Tank Tanks eptic Tan w-F4e &" -T-ank /CGG �j ( •,eqe ❑ ❑ ❑ ❑ ❑ I PumpTa 190humehaniberl ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIff — g - ESPONSIBILITY 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 Stam ) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination - Z Z. S. da X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: (�(ee Ip(e it = +G Q , l)P.k S7 -" S)/57 Ntrcf T f1� avf c� ��• G s�t . ��,.c /� i s > 3s. 409k.-ker l afl be i- . ovc ,4,44- e4j �,,wkie— m-P caw kowtc, SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, ow her, Plumber INSTRUCTIONS {• r ' 1. A sanitary permit is,valid for two (2) years. Z. Your sanitary permit may be renewed before the expiration date, and at a 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. Changesin ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic 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 sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: 1. 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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone ndmber., Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tabk(s),`septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump 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 for monitoring groundwater contamination investigations and establishment of standards. " PLOT PLAN Page A of SCALE n -- '•� .. �"� . ray .. • 8 � ! a � STPC'ti:t.:�.�- ---... V-q,c �cr^'y s.z kn,4131 w o u sm m 3 DORM, G a h �C J ®� �F�z a x.,i M tY� • �.,.oe� oN '.�'.� . :':::'L'+� a ": p' :? . ' : : '6''.'►'� SuV -G {T pUh +� 1 �1 i : y�'C� p`D pasr- _� � s._s `�: c�. oi►!._ ,o�.k;.�quC, _.r-� ^cam 'tom �r. _.. .__:... _: �: � � . 1 liI -17 L/v cj - 7 17 rAC.0 OF 11".17 A!1 Inlst. / And Ob.slvallun App—.d V.ni Cop Mlnlm�m 17� Abo.. ad• lU .)' Abo•. Plp. ___ -_ _ Co.r Iron 70 llnol Grad. Vent Pip. M. 0 14-Y Or S n1A.lic 1'. lnp Yin l' 1 0.*, r Pl p. Dlarlbullon - Pip. O O O O O — To. P. n PIP .01h PIP . d P.(lordlod Pips 8slor P. 0 — Coupllnp 7.1minsllnp AI 110,101, 01 s,61sm SOIL TILL UIsr T1 ►.1 PIPE APPROVED ,S4WT)1E,TIC COVER '—y MATF-aIAI- OR 9 OF g'rRAW 2 " Of A G&q r(,AIE OR MARSO WJ r� l'1C NE N,E!_OW OR I(, VOAA,L G AIDE A,W A j L ,L N 5 1 i t }r 1 '4 1 1 r r. L, r, I I_ J, f I /\),j '12 W,C lv L I. .L O W E,l lW,I�L r MAXIMUM P - E P I I 1 ,;,1 " I�- X� / � � t I �u ►.� 1"fP oM OIL I G NJ A L 6 9 A DF- 'J I L L P'I L � � � ki WN F s MI- Y,,LrV0m QCI"V;I '`'I C�161.01L ( WILL BC 3 Its CPT-' S I l IG E1,i 2 f 7 ComI)i na t-i on Sept-3-c-'Tink and PIJMr CHAMBER CROSS SECTION ARID -SPECIFICATIOKIS' PAGE 3 OF vc T CAP WEATHER PROOr - L jLj&JCTIOM BOX I. VEMT PIPr APPROVED LOCKIMG F - MPQI40L[ COVER PQIV ROM DOOR �M OR FRIESH ,A,iv WTAKE F PPOVIDE A!RTI(.H'r SCAL- i I II A APPROVED JOIkjTr A.PFROVED Jc)lkj-T I I I I W/C.I. PIPE�F'c- 41c rIPj:b9K-<%, J%'IT) oo riwt ion I I AL ARM s h;i I c ()m 1) 1 v w i Ch f TIP" d P 3. 0 ��' ow v f T. PU OFF I I r1 � C � 9 L T I — 13" APPo P K-Kr" C)"CJ IF TA HAS ','JCVH4 APPR OVAL- BLDO i N(w .SPF C FICAT SEPTIC DOSE I f5ER OF DOSES: 3, 4 - DAb jLtj Ki M A Ll U! A Ur U ,i/, 2 Dos VOLUME 4 TAWK !)IZC GALLt 7 IlUcl Lin & 8ACKFLOW: GALLONS -ARM MAUUFAC7 MODILL /4 .� CjkrACITIrS: = IUCHCS OK - 100, 4' LLO&j5 r y IWCHF S ---:ZXY% LLOlj5 SWITCH 'T lf"F: It cw s RKHES OR Pump tl�AWJUF A(l ('vL It: D w INCHES OF L L 0 U j R c L y Ii I)T U '",!MP AMD ALAFL ARE TO 15L MIMI M ��J OW 5[ XRATI CIRCUITS ljfl� r, I �, r A P, R A T f —YjL P VORTICAL DIFF L FAJ,'CC rF-T W I IJ 01 1MP OF( FWjTl2IiflLJT(0Il f*tPI FELT + M I jj I M U M ki C I P UL,"PRf . . . FEET _&,. , FEET OF FORCE MI" X q'.�YU X + , ioo fi,F RICI 101.1 Al(ToR. FEET - rCTAL 0 HEAD = F T Pump chamber D 1 AM F7E R ILITLKLIAL- DIMLWSIDKJ� OF IA�J'K.' L CKI&TH _,WIDTH —;LIQUID DEPTH pnTTr)M :AREA GAL/INCH A", --__GAI,/TNCH HEAD CAP I CURVE 3 7/8 6 I/a 3o MODEL `98 4 5/8 a 25 11 0 • i 5 ` I 3 5/8 6 } 15 1S •Z3 O i 1 � i 4 o t0 3S.J 6 2 5 1 1/2 -11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 60 70 8 LITERS 80 0 240 0 FLOW PER MIND r 1 TOTAL DYNAMIC HEAD /FLOW PER MINUT EFFLUENTANO OE WATERING CAPACITY 12 HEAD UNITS/ IN FEET METERS GALS LT � 5 1.52 72 273 3 10 3.05 61 231 15 4.57 45 17 4 3/ 16 20 6.10 25 Lock Valve 23• \ ^ l 6x1102 CONSU FACTORY FOR SPECIAL AP 1CATIONS • Electrical alternators, for duplex syst ms, are available and • Variable level float s 'tches are available for controlling single supplied with an alarm. and three phase syste • Mechanical alternators, for duple systems, are available with • Double piggyback variabl evel float switches are available or without alarm switches. for variable level long cycle ntrols. SELECTION G E Standard all model - Weig 39 lbs. -'/2 H.P. 1. Integral float operated 2 pole mechanical swit , no external control required. 98 Series 2. Single piggyback variable level float switch or double piggyback variable level, Control Selection float switch. Refer to FM0477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) 098 230 1 Auto 4.7 1 or 1 & 7 float system. E98 230 1 Non 4,7 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. 7. Two (2) hole J -Pak, for watertight connection or splice. ForinfonnationonadditionalZoellerproductsreferto catalog on Combination Stalter ,FM0514;Piggyback All installation of controls, protection dev ces and wiring should be done by a qualified Variable Level Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator,FM0495; Sump/ licensed electrician. All electrical and safety codes should be followed including the most Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. 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: P.O. BOX 16347 Z 7AZI Louisville, KY 40156 0347 Manufacturers of. . L L j_ / � L C //r SHIP TO: 3649 Cane Run Road /- Loui,svil le,KY40211 -1961 Qvaurr/&,W L O. (502)178.2731.1(800) 928 -PUMP FAX (502) 774 -3624 III - Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Pag 1 of Labor.and Human Relations g -- Divisiofi of Safety & BuilIngs in accord with 1LHR 83.05, Wis. Adm. Code Attach complete site Ian on paper not less than 81/2 x 11 inches size. a in '�'' ST• C�ZIj � Atta sin z P{ n must cl de� not limited to vertical and horizontal reference point (BM), direction and % of slope, scald or PARCELI.D. # dimensioned, north arrow. and location and distance to nearest road. ' o $ - 1 p l'� - { d APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION IEWED`BY DATE - x3• - PROPERTY OWNER: PROPERTY1 Q0AT10N` �►JD', ffi�IJi7 �Z- CZISTL� 1�1 L Lll��? GWTrtiafi �In� 1 t(4,5 ZT �-`d ,N,R ��7 E (0(@ PROPERTY OWNER':S MAILING ADDRESS • 1 ,SURP.NWORCSM# L3 3-13 CITY, STATE ZIP CODE PHONE NUMBER E]CITY (]VILLAGE (MOWN ' NEAREST ROAD ►�tfv'fJ Po US wfN SS�IfO ({,(� °lZS -bL6q TZvSI� lZIUX12 z-(3o `n+ ST, [ ] New Construction Use [x} Residential / Number of bedrooms 3 j ] AdditiQn to existing building p4 Replacement [ ] Public or commercial describe Code derived daily flow 'AS O gpd Recommended design loading rate bed, gpd/ft - - trench, gpd/ft Absorption area required b '4 3 bed, ft bZ - S trench, ft Maximum design loading rate bed, gpd/ft - S trench, gpd/ft Recommended infiltration surface elevation(s) oto • ` Z ft (as referred to site plan benchmark) Additional design / site considerations S EI;i7 lQCr1� 1'0 INS *rL.C-CaZ apt.) l�'P' kGE_ 3 Parent material S 7M-gZ b OLTk.J A N Flood plain elevation, if applicable NA It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S O U Z S O U 0 S O U a s O U 9 S O U OS RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bandary Roots Bed JTrench 0 - °1 I o4 V_ 31 i — si I z'gsbk >��� �S — • s Z cl -1 b L 0 `'l tz. 3� �, s t 1 Z'F Sb1t t „ - c S - . 5 - 6 Ground 3 116 -ul0 S W 3Ly 6 ZrnsN>k 5 . L elev. � `LIt 40 90 .� .5`'1 1Zjly lS c3 S3 M 1i Depth to L limiting factor btj Remarks: Boring # C-S _, s Z �� Z b -z6 -�. $ `tR 3l — Gt^ �, g Zmsbh 1ti'►`I cS — � .1 � � -� --i- SIt 23eu - 1 s o S9 >n I - -� •g Ground elev. ° _O It Depth to limiting .� I�t� 1 Remarks: CST Name: Please Print Phone: Arthur L. We erer 715- 425 -0165 dress: egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI. 54022 ' Signature: J p - 00 -0.Z Date: 1`kZ -?moo Numbe PROPERTY OWNER - t SOIL DESCRIPTION REPORT Page Z. of , PARCEL I.I).# Z�— l Ot7.IQ Depth Dominant Color Mottles Boring # Horizon in M Texture Structure Consistence Roots GPD /ft unseil Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTmnch t`�3 ;:,. o LO `-t 6i 3LZ - S 2.`� w1`F es - •5 6 ................, Z g_33 �•s�ttz 3 � G�-lg csb m Ground 3 33_9 - ) -5 1 1►Z 3l elev, qS.y ft. Depth to t limiting t �� i ? to D - Remarks: Boring # s Ground i elev. i i ft. t Depth to - € limiting factor _ i Remarks: Boring # 0.� �• :::' :jv I i i 1: I : ". '•: +kY•':'•i:ti: t+.:hiii::ti Ground elev. I ft. Depth to limiting factor Remarks: 3oring # i around 31ev. ft. )epth to imiting actor Remarks: _ •n n•i•�nm.,r „„ • PLOT PLAN Page 3 of 3 SCALE 1 "= y0 ' �o Tom _ s�x� "1S. _L�•iepuu - - - -- -_ :PrT R `r'�16i�sCZ �l- ZinPOty i�}i�1 'SttowlJ 0 4e c. B.2 off° C�x % ? �� ' . Z/ / .o ti L o q• . 1 -V y � B -3 8 , 1 �y sr � t »r1 t t 3 SDC� -M ��w1C x WL L-L L00.o` o+J .S:PLwe ' em uv1� GRouk .� Qlnw --lS ";P -S T" t`1 - w ttL L J- - - L.UT: UN LS 5 Ftr.Ulti TELL - Cr ysrp�l.C, : :z Ttz we1tes t H _ :5'>c 56: S' Ltd6._AJ/ Pr_ G1z. _ : ukjknL_ ova �t%Y]?l- 6uTicYJ l :P_NS__cfR_____.- fl�Lry Z zZ.oZSy �- VL - to 00 ( 71.5 ) 4L-0165 ` CST Signature Date Signed Telephone No. CST # - - - -- - - - - -- • -- -- - - -• - - .._............,.,., COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but- ST'• X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION p �k3tZiTLZQ f k)D �- ILsr %j "L LLl GOVl`t SW 1/4 NV- I Z-T _ ,N,R E (oQW PROPERTY OWNER':S MAILING ADDRESS • - LOT # BLOCK # SUBD. NAME OR CSM # L4 1C) Z4 wfts l3U2ty 1) u 1�_ - S - \ - I CSM Uot-- t3 t 3131 CITY, STATE ZIP CODE P HON E NU BE bZ69 [ []VILLAGE DOWN ' NEAREST ROAD 1.1 N `kY; C BLS ►+IN f 0 ( PvSl+ �Zw E\z Zv o `r* ST. [ J New Construction Use Residential / Number of bedrooms () AdditiQn to existing building [54 Replacement [ J Public or commercial describe Code derived daily flow 4S O gpd Recommended design loading rate bed, gpd/ft2 _ trench, gpd/ft Absorption area required b'4 bed, ft S trench, ft Maximum design loading rate bed, gpd/ft •8 trench, gpd/ft Recommended infiltration surface elevation(s) "Q- - `a �- �- ft (as referred to site plan benchmark) Additional design/ site considerations S 0;:7 fTG; 3 Parent material S Oku'T A M Flood plain elevation, if applicable Nf) It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S❑ U S ❑ U � S ❑ U aS ❑ U IS S ❑ U ❑ S RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bourxlary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITrw& 1 o -q loK�31z - sL� z`�sbk rn�v �S - 5 A. to 'm_ 31� M ' CS 1st -s -L Ground 3 16 -�I O - S I 2 3l y GrS L Zrn S b1z ryt -�. ft 40 9 0 -? • S`'1 k7-3) V I s a S g Yvt. I Depth to limiting factor Remarks: Boring # � a -6 �0�.2�1z - sl z.�b� r�-'�• - E -�6 • S LIP- jI - Gt� 4 Z mS bk l�� /' 0--s 3 6-18 - 41 L 31y i s v S 3 rn Ground elev. ° - o It Depth to limiting factor Remarks: CST Name: - Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.0. Box 74 River- Falls,WI. 54022 ' Signature: 00-01- Date: _%00 CST Number 220254 r L 1 �O 10 0 yb . t B:I C e wt tt z �r, 3 BDRM �Oh1� x 'e7L LO .0:0` :o►J -5 ::? V ,. ►'fHuvE : GRAUk lti =_�I`` T VOD i�O3T- � -- ez< 9 .0 °'' oP_o _t ooh _ C s7 -.._ - 1Cif LET' : :utif_� _ _tS s' F= fzuM_T>z�-wclfl`s , -- - tvc� =1U - 1 = ►� sTiCtt��1Z , - - -- - -- - -- - - - -- - -- - _ - - fl : i'"� �:_ _ �(,Z," _ �-U V t�?_ C3� C�Sz: _fit ��"1?t _B�� t1+�1 :. [� l: A._l'� _ _�R _ ..__ . -- 71 IFUG IE]ZIM flCLTY - - S�L�: cn�pL�Z• _ = L- E��- l`J :- �- �► - -_ - - - -- _ - - - - - - 13- 1��g�� Lam►^ =iP = �7tit�- ��. :C�'j �� � .1bZ'z -�v� t���, ° 0 - o Z zzoZSy t - 1Z — 20Cta ( 715 ) 49,5 9 CST Signature Date Signed Telephone No. , CST # • Q. PROPERTY OWNER 'P- 1 SOIL DESCRIPTION REPORT Z PARCEL LD.s< O 2- `2� —LO II—IQ Page _ of . Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots Gr. Sz. Sh. Bed T re rrtdh >x< <� »; »;:< Z $ _� 3 �• Sit 2 3 1 y Gr � g lcsbk mU +� Ground 3 33 -9 7•S`ilZ 3 1 elev. qS.Y ft. Depth to limiting factor Z" t t Remarks: Boring # _ T�k +Y M.. . . . . . . . . . . V:2. {Al:v:xk Ground i elev. t ft. t Depth to - limiting factor i E Remarks: Boring # t Ground t elev. it. Depth to limiting • ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM O wner/B uyer Ll,N IlYl57�� h i �Io m Mailing Address 402jk 1A1aAj k t W Property Address 7 ll�pleel__ lea n (Vuificatioa rcquimd from PU=iag Departmeat for new eonshuetioa) City/State �alral {nJ Parer Identification Number LEGAL DE Property Locations_ /, 61 l w ,4, Sae. _ / 2 . TAN -R 1 W, Town of ? ✓s /i R/ Subdivision Lot #mil. Cat fied SmTey Map # — �/ IQ Volume / . Page # 3 7 ,3 Warranty Deed # / Volume L I r _ page # I Spec house 0 yes [A no Lot Bats identifiable Cl- yes ❑. no TRANCE Imp , ��ldrrsnitmits ooasists of Pig out dc �P& tank - � • . • - to handle Rastas. Properma�anoe can i= of re SmiOa of dye cVay &= � or. if tuoadodby t lk=od What ynn pat.iato dye system u taa�as: ti�rzbmeatstage RiutaI.ty�aiy, m p sgrc« to abarirto St QroiX zoning DVp aft t it foam, s by *e ow= and by a is is P =dctodphambe O cats= cdpwpwvcffyiag dua(l)&coa ProPa operating ooadition and/or (2) after ionaad . � scptictaakis icss �aa If3 �icll of 3r[udgc. the tmdatsigo,cd Rare trod the abort and sgzoe to maiatzin Sue Vemie sewage disposal system Rri& ft smadaids fotd�, ivatia.RS caby d e of and &c Dqmancut that Y tystcca Boca amst be of Kaftd Rasour� Statc of W ==in.. C«#"ficatioa days cf the throe yrar cxpiatioa date. Idad and to die St: C mix County zoning Office withun 30 TURF OF APPIdCArTi' L�;Z Q9`/ DAIS OWNER CFRTFWCATl`ON I (we) e«tcfy that all statcm,cnis on thus foam ate uw to the best of my (our) lmowlcdgc. I (we) am (arc) the owner(s) of dc=bcd above, by virtue of a taaaty dood rmor+dod in Ragiew of Deeds Office. X a / TUBE OF APP DATE « « « « «« Any information that is rs-e+epe+escaW taay tusalt in the samWy rx:t=t being rovohtcd by the Zoning Depart went. «• «• «. s« Include frith this application: a etanpod wumaty dood from the Register of Doody oificc a copy of the cedifod t wcy map if tcfco = is made in the warranty decd , Ap s 16275 • �(' KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECINtO Vernon A. Vandenberg a single person conveys and Warrants to Andrew 12-30 -1949 10:45 M P. Miller and Kristen S. Miller, husband and wife, the following described real estate in St. Croix County, State of Wisconsin: EMT 1 DEED CERT COPY FEE: COPY FEE: TRMWER FEE 405.00 RECORDING FEE: 10.00 PAGES: 1 Record Area Name aril Retum Add j A, INOCorma10 10'n : ue `Q P.O. ox 2120 � �" Baldwl , WI 54002 LO I liJ 028- 1017 - 10-000 4. Z. 1 0 9 (Parcel Identification Number) Lot 1, Certified Survey Map recorded September 29, 1999, in Volume 13, page 3736 being part of the Southwest % of the Northwest '/. of Section 12, Township 28, Range 17 West, Town of Rush River, St. Croix County. Exception to warranties: all easements and restrictions of record. This is homestead property. Dated this, day of riXC4, �q 'Vernon A. Vandeberg AUTHENTICATION ACKNOWLEDGMENT M NT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this day of I� e,AhrX, . lgRg the abov n A. authenticated this day of Vandeberg to me known to be the ted the foregoing in rument and ackn c signature I -t type or print name signature / type or print name Q _ ltib.ci7�e0•' TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St Croix County, WisconsN. s { ►, (If not, authorized by §706.08, Wis. Staff.) My commission is permanent (If ) not, station date: THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capeCity should be typed or Thomas A. McCormack printed below their signatures. Baldwin, WI 54002 Inf —uftn Ar (-1on b Company Fond du lad. VVIrC"n W0455.2021 Ir ulkla `" CERTIFIED SURVEY MAP VERN VANDENBERG Part of the Southwest 1/4 of the Northwest 114 of Section 12, Township 28 North, Range 17 West, Town of N W COR. SEC. /2, J NA Q Wg � .�t. CF0ix County, Wisconsin. d p� I !/2" /R ON BAR FOUND! �° b N L /NE SW /14 NW //4 QNPL ATT -Q , N I �M� LADS *00•07 "E SJ.00' N B9•SB' ?7 "E @(2.39' '' T J .00'1 379.39' N89•SB'27 "f 33.00' tENTIRL /NF j ` F /OO''" y I a x I � BgRABE Q vl �_ WFLLe� BARN 2 1 (A h i ' SNED h 2 Q o la. I .1D W 41 DWEL C /N@ A ><1 2 s[rr/c a n d H o a Q b Z LO N W 1k W Z m ti I /4.33 gCRFS W ~� CO J I M1~ 1 k Q h ° e 633, 028 SO. FT. a ° I v4 /J. 790 ACRES J ` N ' 4 o y I W soo, 672 so. Fr, o Owner's Address: 471 200Th St. 1 0 1? Baldwin, WI 54002 MI' This instrument drafted by N { 0 15 .04' ►. Laurence W. Murphy O� QI I f i N 90 00 ' 0 0 - W 648.04 I 1 f SOIL BOR /NRS'0 Z I LOT 2 9.000 ACRES n b' b E/ 14 COR. SEC. /2 , r 2 N, R /7W, b � 1 O 0 i 217, sos SO. Fr. 0 �I �I w f f 4.746 ACRES EXC. ROAD R.O.W. M /P•X• NAIL FOUND) O I I 1 206, 7/9 S0. Fr. "� 4 Q9B. 94' .2 4SJJ. 72' V/ 2'1 B /3.91' VVV N ,90-0 0 - 00 - ; 3282.68' E /WI 14 LINE W //4 COR. SfC. /P, TPB N, R /7W, I RAIL ROAD SP /X E FOUNOI UNPLATTEO�N APPROVED �,,,�����„• SCALE /° =200' sT.ewl)(COUNTY �� ++•p 0 30' too 200' Soo' 400• Soo' Soo' Lenhg .J� 1`� \SG0 .IV ,iSS� S E P 2 91999 : ••..... / • LAUR S '• Ifeot na°NedwiM30 m W MI FiPFt c LEGEND: app*4dab d e � 62 713 ' � O Indicates 1" x 24 aPP shall t . IVER FALLS, AQ " iron pipe weighing I.13andNDWn. ft. set -t— *Indicates fence. WISC. A r a ~ R (10.0') Indicates previously recorded data. , 49 F � LAND S a SHEET 1 OF 2 Vo1.13 Page 3736 PAGE OF rk(3 SUTIOW Min SPACEFIC�T1D�•i5 VEI.iT CAP wCATHLR rXOOf f ,. JULICTIoN box w "C X. VLul PIPC �.YYROVCO LOCK1►.iG FvOrt �/rIAIJNOLf. COVEK "I A DOOR. 0 wr ¢..rll�e: t A.PtiEL. .raUDOW i.fll I'G.[SI{ ? t Aj�t tIJTA►[.L .. i _got PROVIDE -- w .____...._ —_,. —�- IURIP,&mT bCAL I ! APPROVED JOI I�! r.PPKOVED JOIRI'!� I (! W/C•I. PIRf /! 1 r 'Lln w Q TI 's t r u hLP.iZ1A sh.s l c c >mp 1. y I I ou (I 1..Y.. F �.l Of F a COUCRCTE Hf. -OLIt 3" i.9" `, ueu,q tr t \t IT -l: m0T(.P iAlt.`i Iv ' r: r ',tFACTURCR tree SijrW APPKOUAL t\(?f HOSE IJt1MJLR OF DOSES: r_ --- -•�PEK DA`tl A,f la �+ 4�}rR rx I�IRt�rpl' ' Tnlaai ;'I; Qd E , al _cz�a5 i�OS4 VOLUME iuc�uOfI.16 �.�,_►.Yt.ow: ...� -� (,1tiLi.a]+.� n,� �((�� - - ---- O , O C& Aa _,1U ltilaMi OR f3 =. � f MILS DR �IOR,t C_ �� G •Iut HE$ OR .� ��3 GALLOIA -,� PUMP M,.AUI�,IF.l�f_T►JR11L1C:, ,.,_� . r _ — txnnrinF I�II!"lIt .?.'._ <�_. -- rf� ok 51.fa7f,�t T+9p A1DTC: PUA AI)a At A.Itn Alts TO 6L INSTALLED OU SEf'AI:AYf fIRCUITS f"!1A1P1�lIM la1SG t4+>�RbE I'�ATE _:.� l„PK /y i � ytR�ICA� ►fF�aE uCE QETWC t! ['LtlhP Off Aua [l15Ta[HU7KAI PIPE __ _._ FEET + xls Matt gas Te.JF_ICg K SUPPLE Yu r IK [ _ _ CC7 cl~T OF I:ORCE mAlm X2 �loatcFRICTInIJ iFACTOR_•. TOTAL n'tI..1AMlG I�IEAQ = ! -I FEET DIAMETER _ -- Pump Cha"hP r T REIAL. +!?I�tC.4tS,f/!!S AF 1ltllK: LEb1C�TN -- :wIOTlt ;LIQUID CIEPYH RCT"m AREA ?_31= __ -- GAL/INCH rn F- • w w CU R VE 4� /a 6Y4 --T HEAD CAPACITY C W "53 -55" SERIES 45/a 25 e TOTAL DYNAMIC HEAD/ I 4 FLOW PER MINUTE EFFLUENT AND DEWATERING • �- CAPACITY + 20 HEAD UNITS /MIN —1 Y2 - Q 6 FEET METERS GAL LTRS 43/16 11 1 /2 NPT = 5 1.52 43 163 m V 10 3.05 34 129 15 4.57 19 72 l 15 19.25 5.87 0 0 Q Z 4 D ..1 10 F O ~ 2 5 9 0 1 "US 10 20 30 40 50 3 GALLONS LITERS 0 80 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS I. Piggyback Mercury Float Switches • Available with special cord lengths of 15 available. 25', 35' and 50'. • Variable level long cycle systems • Alarm systems available. available. a Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non - automatic 15 ft. SELECTION GUIDE M53/55 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts -Ph Mode Amps Sim lex Duplex 2. Single piggyback wide angle mercury float switch or double piggyback mercuryfloat M53/55 115 1 Auto 8.0 1 or 1 & 7 — switch. Refer to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10 -0072 or 10 -0075. D53/55 230 1 Auto 4.0 1 or 1 & 7 4. See FM -712 for correct model of Electrical Alternator, "E- Pak ". E53/55 230 1 Non 4.0 2 Or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10 -0225 used as a control activator, with E -Pak (3) or (4) float system. 53 Series - Wt. 23 lbs. -.3 H.P. 55 Series - Wt. 25 lbs. -.3 H.P. 8. Four (4) hole "J- Pak ", )unction box, forwatertight connection or wired -in simplex or duplex operation. P/N 10 -0002. 7. Two (2) hole "J- Pak', Junction box, for watertight connection orsplice, P/N 10-0003. For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; CAUTION Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alterna- All installation of controls, protection devices and wiring should be done by a qualified nator, FM0495; Alarm Package, FM0513; Sump /Sewage Basins, FM0487; and Simplex Control licensed electrician. All electrical and safety codes should be followed in addition to the Box, 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. O OLl�L� ©I 3280 Old Millers Lane Manufacturers of .. . � P.O. Box 16347 •Louisville, Kentuck 40216 (502) 778 -2731 •FAX (502) 774 -3624 �,Q /TY P UMP9 �� ��.�- � �, � � �� U � - ���� �, ��� 'V'S'n NI OHM daOOS WdOc! qc SJtYSSS W 1 -11i I"1151 S4U lUI 77 777 T WO M 36Ni1 1336WnN 3000 yauy S lI13OW 0 xv:j 0 NOISN31X3 839WnN 3000 V3liV SNOHd =10 W W `d 3 W 11 alvo W 'b E10:3