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- POM TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 -3121
800 - 962 - 5227
ST, CROIX ZONING REPORT NOO 03136/01 PAID 1
ST. CROIX COUNTY REPORT DATE. 3/28/41
4 COURTHOUSE DATE RECEIVED: 3/27/91
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
2,1 �0 "6�
� S=2 -f /
OWNER: ALbert 6 Pauta Putirskis
LOCATIONS Rt. 2, 1870 -30th Ave., Baldwin
COLLECTORS ML, Jenkins
SOURCE OF SAMPLE: Kitchen faucet
COLIFORNii 0 /100 at
INTERPRETATIONS Bacter i o tog ica L ly SAFE
NITRATE -Mif 2 ppm
Above 10 ppm exceeds the recommended Pub L i c
Drinking Water Standard.
Coliform Bacteria /100 at
Nitrate-Nitrogen, mg /L
LAB TECHNICIANS Pam Gane
WI Approved Lab No. 19
* pF.WDEPEµDE�i
P
V D
z { Means "LESS THAN" Detectable Level Approved by:
o PROFESSIONAL LABORATORY SERVICES SINCE 1952
may- 4/
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
C4 Hudson, WI 54016
Telephone - (715)386 -4680
{ The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form is essential so that the property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING --------------- ------ - - - - -- -FEE: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION - - - - -- -FEE: $25.00
(Determines if system is properly functioning at time of
inspection)
Property owner's name Albert & Paula Putirskis
Property owner's address Rt. 2, 1870 30th Avenue Baldwin, WI. 54002
Legal Description 1/4 of the 1/4 of Section I-S , T &'IV -.R
Town of Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER
Color of house Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm o r I n d i v i d u a l requesting s e r v i c e s : First Bank of Hudson / H ammond
Telephone Number 796 -2211
REPORT TO BE SENT TO: First National Bank of Hudson /Hammond Office
_915 Davis Street Hammond, WI 54015
Closing date May 1 1991
Signature I 1.1 W
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
. 911 FOURTH STREET • HUDSON, WI 54016
_ - - (715) 386 -4680
!W
Mar. 27, 1991
First Nat'l Bank of Hudson /Hammond
915 Davis St.
Hammond, WI 54015
To Whom It May Concern:
An inspection of the septic system on the property
of Albert & Paula Putirskis, located at Rt.2, 1870 30th Ave.,
Baldwin, WI was conducted on March 26, 1991. At the same time a
water sample was obtained for testing. The results of that
testing will be sent to you as soon as we receive them back from
the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in any
way warrant or guarantee the continued proper functioning or
operation of this system. it is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
Sin erely,
*Ma s
Assistant Zoning Administrator
cj
L-
I
L'
Wisconsin Department of Commerce P IVATE SEWAGE SYSTEM County: Sanitary St. Croix
safety amo Building Division '
INSPECTION REPORT nitary Permit N o:
(ATTACH TO PERMIT) 395175
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law s. (1 )(m)]. 61913 tr rftK. 11 /
Permit Holder's Name: City Village X Township Parcel Tax No:
Putirskis, Albert Rush River 028 - 1024 -70 -000
CST BM Elev: Insp. BM Elev: I BM Description:
(10 . 0 f t . C) U"
TANK INFORMATION ELMIATION DATA 0, 1 )
TYPE MANUFACTURER CAPACITY STATION /Z BS HI FS ELEV.
Septic Benchmark ,
Dosing / l.r Alt. BM
Aeration I � Bldg. Sewer 3A7—
[
Holding St/Ht Inlet f
2 •o q2 -��
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic t / I LID , Dt Bottom
p > IUD > Ise � 35
Dosing t t I I , Header /Man. (� 3. 4 9
t�
Aeration Dist. Pipe 3 • /
Holding Bot. System I SD f
Q Q5• ►D
Final Grade
PUMP /SIPHON INFORMATION L_urr lZ
Manufacturer Demand St Cover
GPM
Model Number �• � � �• Z -L � , � � r
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
ISD Z
SOIL ABSORPTION SYSTEM
BEDITRENCH Width f Length I No. Cf3remshe PIT DIMENSIONS No. Of Pits Inside Dia. IL&VkJ1 Depth
DIMENSIONS
SETBACK SYSTEM TO P/L jBLDG IWELL LAKE/STREAM LEAC NG anufacturer.
INFORMATION CHAMB R
Type Of System: ti r , zJ �l -^ IT Model Number:
A&C)U.N /� /f3'D
DISTRIBUTION SYSTEM
Header /Manifold Distribution ( O I 4 THole i ize It x Hole
P Spa Vent to Air Intake
k /I
Pipe(s)
�0 Length Dia Length �3•� Dia '' Spacing 8
SOIL COVER ressure Systems Only xx Mound Or At - Grade Systems Only i� 6 ZO tl
t Depth Over Depth Over xx Depth of Seeded /Sodded lched
,� Bed/Trench Center Bed/Trench Edges Topsoil xx (n] Yes F111 No u
No [Is Yes no No
t
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: O / / Inspection #2: — 7` --
Location: SW —SE Section 15 T28N —R17W 1870 30th Avenue Parcel No: 15.28.17.143A
1.) Alt BM Description =
2.) Bldg sewer length= ,, olp C
- r amo ' u - nt of cover = ZLf �tr1�'�
'•� a�J2__ ate- a;�f (.. 2,4 —
Plan revision Required? � Ye�� � � - �� q ��•
Q - 08 14 ' di
Use other side for additional informat
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
I
n �---
Sa�utary Permit Appucano a � Q q �
In accord with Comm 83.21, Wis. Adm. Code, personal inforroation you provide ❑ Check if Revision
may be used for seco ses Priva Law, s15. 1 m) lap I.D. Number
I, Application Information - Please Print All Information j
Parcel Number / ij .
Proper Owner's Name 19 U 2 p - 10,2
J .t ►� f t r ` S . d
j� / / d _t /
T ! n e property Loca
Property Owner's Mailing Add ess n / `/ (
`l)(v"( -,> k S
S` r�b;I3 T�YN,R E
d ? U
Zip Code Lot Number Block Number
City. State
� , ��
Subdivision Name CSM Number
II. a of Building (check all that apply) , / " OCiry
r 1 or 2 Family Dwelling - Number of Bedrooms DVillage
❑ public/Co jai - Describe Use O1N°ship
(+ r- q COl1NTY r Nearest Road C 4 U r-
❑ State Owned 1x v �.`�' tt F1cE 3 !, C-
I X 6 t f iatrdl e). Complete line B if applicable)
III. Type of Permits (Check only one box on line A (numb For County use
A. 1 New 2 Replacement stem 3 11 Replacement of 6
Tank Ont S stem
stem Date Issued
B. ❑ Check if Sanitary Permit Previously Issued
Permit Number
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
47 ❑ Sand Filter 50 ❑ Constructed Weiland
44 ❑Non - Pressurized In -Ground 217 Mound 51 � Drip Line
22 11 Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass
45 ❑ At -Grade
46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 0 Other
V. D' ersal/Treatment Area Information:
Dispersal Area Dispersal Area Soil Application Percolation Rau System Elevation Finial Grade
Design Flow (gpd) m /Inch) Elevation
Required Proposed Rate(Gals./Days /Sq.FL) (M -
�00 03 03 J, j5;i qG,
Ca ei in Total Number Manufacturer Prefab Site Sleet Fiber Plastic
VI. Tank Info h' Glass
Concrete Constructed
Gallons Gallons of Tanks
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement I, the and A. assume respnnsgMy for instanation of the pOWTS shown on the attached plans.
Plumber's Name t) Plumbe Signature
MARS Number Business Phone Number / G
Plumber's Address (Street /` C ity, State, Z
` • ode) // / -C b
VIII. Cozen /De artment Us =0n Date Issued Issuing Agent Signature (No Stamps}
e (includes Groundwater
)kAPproved ❑ Disapproved
11 Owner Give
dD 8 ao(
Determination
IX. Conditions of Approval/Reasons for Disapproval n n
�,� �_ 1S .n4atlorlf'il�. �- '°�r�AtMMG Tam
&A9
eompide plans (to the t:ounty only) far the system on paper not less than 81a x 11 inches in size
SBD -6398 (R. 05101)
r
PLOT PLAN
- Page 5 of 7
Scale 1 "= '40 '
wEt,L 1 S > 2 00` Q cF M nvM'�, 5ITIE -
t3rmthrwj - 1-2z• tuo.0' aj co-zNM or- BWCkC w�.lzwecy.
jam1{ :LL LUZ_0' ONJ J 51pi 6T SE CD1`Z - NNR.
oz IV O , O Z6 - 11 ZY - 1 O _,..
L tw � - OF - 1'1 P-e Pi't1�@ LS - > - -10 O_ -F? M. r'I u r,� .
fl s PE2. CODE
T� Ffri L'LsD
DR.nrJ�J F��Lp y. B b \ 2"
7 �
0.
ll 7
0
3
n v �
P � /
a -Z
t tu0 efimpk r
oVt \STu�i -a
� 1
%
N ,
93.7 /
L't . a S. I '
p • 3 1 Tb
30 'n+- Au E
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Septic tank to be l .ztw /Boo gallon capacity manufactured by
M kD J E STZNQQ Al 4T AV <2- W /ZPn3e:!- Er-FL Fl LToz
4. Bench marks SQE >PCBoyt
'S. Divert surface water around system to prevent ponding at the uphill side.
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSEWI 54601 -1831
1' y 1 TDD #: (608) 264 -8777
visconsin `+ `3 www•commercestate.wi.us /SB
Department of Commerce "'' far _. 1 Scott McCallum, Governor
Oc,uNrF�GE Brenda J. Blanchard, Secretary
March 09, 2001
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: 03/09/2003 Identification Numbers
Transaction ID No. 619133
Site ID No. 626823
SITE: Please refer to both identification numbers,
SITE ID: 626823, Albert Putirskis above, in all correspondence with the agency.
St. Croix County, Town of Rush River
SW1 /4, SE1/4, S15, T28N, R17W
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 782537
1
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P
(R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
SBD- 10573 -P (R.6/99).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of
the mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• A correctly sized, state approved effluent filter is required. 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 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 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 3/9/01
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 02/26/2001
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. to Fri. 7:15 AM to 4:00 PM
jswim@commerce.state.wi.us W SMART code: 7633
i
TITLE SHEET Page 1 of - 7
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P
CCZ b/ q _�; CR. 614
LOCATED IN THE Std 1/4 OF THE SE 1/4 OF SECTION 1 , T Z-$ N, R 17 W,
TOWN OF TZ -%Vk �zl\j 1- c- IZ4)1K COUNTY, WISCONSIN.
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUh1PING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
F1L�LZT L?vTltzS -c_� _- C
lay -_30 `te FFB f�
BR•�.,�w1n1 w r
'$ 4"` 1
°re
PREPARED BY ,-
WEGEF:ZEF;Z SQ I L . TEST S ntG
AND.
I?ES I GrV SF_ERV I CE
P.O. Box 74 421 N .Main St. �,�ocax�eep
River Falls, WI 54022
Phone 715- 425 -0165
Fax 715- 425 -6864
Iq t
•V -T.S.
' 6915 A
.O EltbWpNTN, ;
P diti.o"ally i
Con
A R P
R0� E � r .�........
j tl ®'� +.�
DEPARTMENT DF COMMERCE �%al"�w
DNIS1 F F 7 AND BUILDINGS 't . _ 0�
SEE GORR PONDENCE
JOB NO. 0O -3 Z9
Mound System Management Plan Page Z of 7
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
Pump Tank - - - Vzoo 1800
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 for frost protection.
Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD- 10572 -P (R. 6199)] and local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be
sealed watertight upon pon the completion of service. An opening deemed
unsound,. defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system Into proper
operating condition.
..- _
Quest t
ions on he operation - or maintenance - this - -- .. -- - stem should b
directed to the County Zoning office at - ltS_386 -4680 or to the
licensed plumber who installed the system.
PLOT PLAN
- Page 5 of 7
• Scale l' 40 '
WELL. 1S > 20U' 'U kJ or MovhA 5JTJ�.
la h�- -- �. tuo, oN cos t OF - BWCi - V_0vLWAJ"-
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o • 3 � 1 Tb
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NOTES:
I. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required) .
3. Septic tank to be t Z.cw /Soo gallon capacity manufactured by
' A 1t:� ZTQ1 Pl?- LCA-4T,1AV o- W /zr ►3tZ Er EF TS'
4. Bench marks SQE " oUe_
5. Divert surface water around system to prevent ponding at the uphill side.
Page 4 Of 7
Approved Synthetic Covering _
ASTzi C33 Distribution Pipe
Medium Sand
H G
il
To so '" ___ —
p - - -- a F E? ev . � S. I
3 E p.
u
b
. % Slope
Distribution Cell of Force Main Flowed
Z" to 2- " Aggregate From Pump Layer
D • y Ft.
E Ft.
CROSS SECTION OF A MOUND SYSTEM F o $ Ft.
G o. s Ft.
A q Ft. H 1. 0 Ft.
Linear Loading Rate =a.0 GPD /LN FT B 6 - 7 Ft.
Design Loading Rate =o.39 GPD /SQ FT j 14 Ft.
J 8 Ft.
K 1 o Ft.
a e Position L S Ft.
of
- Force Main W 3 I Ft.
I - Observation Pipe
0 _r- - - - - -- ----- - - - - -- ------- - - - - == - - - -�
A a -I-- -- - - - - -- --- - - - - -- -------- - - - - -- --- - --
/b - - - - -- - - - - - -- -- ----------
---- =---- --�- -o
Distribution 1 n
Pipe
Cell of � to 2�
aggregate
Observation Pipe
(anchor sec=e1Y)
' ' PLAN VIEW OF A MOUND SYSTEM
Distribution Pipe Layout Page S of 6
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 tum or 45 fitting to a point within six
inches of the final glade. 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.
�= LCCcgS B�ti_ -
T
PV C F\4C PV C
Lateral Manifold Lateral
x x x x l xl2lxa _ f x x x x
Lateral Lenoth — Lateral Length — p
Distribution Line
• P -� � r�cc.��s soX
— —o
Mpsutw�o
S
ti�uC 1 =oA.C� ri�N
P 3 3 Ft. Hole Diameter / /S Inch
S 3 Ft. Lateral n Inches)
X --q Inches Manifold Z• Inches
Force Main " Inches
# of holes /pipe 1
Invert Elevation of.Laterals g S- (o Ft.
Combination Sep4c:Tank and
PL7-MP CHAMBER CROSS SECTIOIJ AND SPECIFICATIONS ' PAGE
VEUT CAP
WEATHER PROOF
JUUCTIOU BOX .
ti C.Z. VEIJT PIPE APPROVED LOCKING
110 - FROM DOolt, I ")JHOLE COVER w1'M
.iIMDOW OR FRESH wARIJIIJG L.1�gEL..
sp 1olJ i'IPE ALR IMTAKE corsDu�r
' FlNlg 6 •+nw.• S
t� 9 3 S- I
G zero E I
i
UJLET �" PROVIDE I --
TAIRTIGHT SEAL I I
Approved Zmlpo- r_wr� A I Approved
joint w/ I joint w/
PVC pipe i I ALARM PVC pipe
6 .I it
C i
ow
CLEt! �b -� S FT
PUMP --J
OFF
D -
COUCRETE
REV 8b -o'o' e�OCK
- RIS ER EXIT PERMITTED OIJLy IF TAUK MA M UFACTURER HAS SUCH APPROVAL 3 "Ap> re
�BEp7 t N[e
SEPTIC f SPECIFICATIOKIS
DOSE
TANK MALI UFACTUR.EK: IJUMBER OF DOSES: y
. PER DAB
TAMK 51ZC : _ 1 Z00 lS Op GALLOAIS DOSE VOLUME r
ALARM MAUUFACTUFUR S•S• �� SV3TL INCLUDING OACKFLOW: 1 •y GA LLONS
MODEL IJUMBER: LOl "W CAPACITIES: A 2O INCHES OR L4 11 • O GALLOUs
SWITCH TtIPE: _ 11-1 g = IIJCHEi % 0R L - 1.1
_ G�+LL0115
PUMP l WJUFAC �
TURCIt: Z0L�Z CK) . C: - IUCHES OR GALLOU5
MODEL IJUMBER: Iy0 INICHESOR
CALLOUS
M- ° CVZ
SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE 4 S
MIUIMUM DISCHARGE • RATE GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWCEIJ PUMP OFF AUD.- DISTRIBUTID PIPE.. �• 8 FEET
f MIUIMUM METWORK SUPPLY PRESSURE , . . , 6-so FLET
+ 1 S S FEET OF FORCE MAIN X 3 S9 F oo FACTOR.. S•S6 FEET
TOTAL OyUAMIC. HEAD all FEET
As per Manufacturer 2 1.0 S gal /in. Liquid depth
C� Cu�Z or- 7
W W HEAD CAPACITY CURVE TOT DYNAMICHEAD(CAPACITY SingleSeal
W „ „ PER MINUTE J 7/e a 1 / 4 Weight 53 lbs.
MODELS "140/41 EFFLUENT AND DEWATERING
+ 5/e
Ft. Meters Gal.
Lt r s.
14 45 5 1.52 91 344 0 3 7/8
o
' 10 3.05 84 318 +
12 40 15 4.57 75 288 0 c
1 40,4 140 20 6.10 68 257 1 1/2 - It t/2 NPr
35 25 7.52 59 223
10 30 9.14 49 185
30 - 35 10.57 38 144
40 12.19 21 79
e ,
25 45 13.72 5 19
Q Lock Volve:
6 20 46' 12 5/8
x Zd `11
4 5/16
0 15
J 4 14) • a z SK1524A
a
0
2 �. �-
5 3 7/8 � 6 1/4 si
+ s/6
0
1 Weigh I t73 lbs.
U.S. GALLONS 10 20 30 40 510 60 70 80 90 100 110 o y 7/g -
LITERS 80 160 240 320 400 o +
0 FLOW PER MINUTE o
010940 p
1 1/2 - 11 1/2 ?*1
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and supplied 1613/32
with an alarm.
• Mechanical alternators, for duplex systems, are available with or without 1
alarms. -�
• Control alarm systems are available for 1 phase pumps used in simplex 4 5/16
system. See FM0732. SK15248
o Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable SELECTION GUIDE
level long cycle controls. 1. Single piggyback variable level float switch or double piggyback variable level
• Sealed Qwik - Box available for outdoor installations. See FM1420. float switch. Refer to FMO447.
• Over 130•F. (54 special quotation required. 2. Mechanical alternator M -Pak 10 -0072 or 10 -0075.
• Refer to FM0806 for 200° F. applications. 3. See FMO712 for correct model of Electrical Alternator E -Pak.
4. Variable level control switch 10 -0225 used as a control activator, specify duplex
(3) or (4) float system.
5. Four (4) hole J -Pak, junction box, for watertight connection or wired -in simplex
140 Series - 53 lbs. 4140 Series - 73 lbs. or 2 pump operation, 10 -0002.
14014140"' MODELS Control Selection
Model Model Volts-Ph Mode Amps Simplex Duplex
N140 N4140 115 1 Non 15.0 1 or 1 & 5 2 or 3 & 4 CAUTION
E140 E4140 230 1 Non 7.5 1 or 1 & 5 2 0 r3 & 4
BN140 BN4140 115 1 Nan 15.0 t or 1 & 5 2 or 3 & a All installation of controls, protection devices and wiring should be done by
BE140 SE4140 230 t Non 7.5 1 or 1 & 5 2 or 3 & 4 a qualified licensed electrician. All electrical and safety codes should be
followed including the most recent National Electric Code (NEC), and the
" Double seal Pun" amevafllewdhopt rwmoisture sersore. Seal FalirdlcatorWdav allableinNEMA1orNEMA0 Occupational Safety and Health Act (OSHA).
contrel panels.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
w MAIL T0: P-.0. BOX 16347
Louis 3649 Cane Run Manulachirersol..
SHIP T0:3649CaneRunRoad G
® Louisville, KY 40211 -1961 Q�PUMP9 S.vcE X9347 "
PUMP �� (502) 778 - 2731.1(800) 928 -PUMP
FAX(502)774.3624
e
fjt}nentot Comm erce SOIL EVALUATION REPORT Page 1 of 3
Dnrisiop.of Misty anildings
in accordance with Comm 85, Wis. Adm. Code
n
County ST C�Z-o Y,
Attach � ►pldt�q�t pla n papgr not less than 8 1/2 x 11 inches in size. Plan must
in ut p�gt N vertical and horizontal reference point (BM), direction and Parcel I.D.
�� ,,.per cent slope, sl,�r dimensipns, north arrow, and location and distance to nearest road.
V� ' 2 lI�e�se print all information. Re iewed by Date
nal in�rQiation �ou,pr6vide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). �.
Property Owner`_ Property Location
r7L�E?1ZT 1z>U-T L lZ S 1 1 S Gout 44L S 1/4 SE 1/4 S \ S T 2- N R 1- 2 E (or&W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number ❑ City _. ❑ Village ® Town Nearest Road
w I (`IL9 g9 Rvs �1V�2 30 "!!} AVE_
❑ New Construction Use: 10 Residential / Number of bedrooms �_ Code derived design flow rate b 00 GPD
(Replacement ❑ Public or commercial - Describe:
Parent rrraterial _ 6 LPse. -\, ftt . Tl l - - Flood Plain elevation If applicable
General comments
and recommendations: k i 4 K b LS`[ Z-L 13U U hJ C -E-L-- .
M l hl l wl l,►�1 l�� OF Sf \� FI LL.
❑
Boring # Boring :...._ _
. ...
® Pit Ground surface elev. 4 4- 5 ft. Depth to limiting factor z- 3
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
'Eff#1 'Eff#2
o =io t�231z _ sir zsb�c`Fh
2 b Z3 i
3 3 1 S'-IIi 5/8
F-11 Boring # ❑ Boring
® pit Ground surface eiev. q Z- 7 ft. Depth to limiting factor Z O in.
— T` Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 � - Z. S`K231�f Cl Z•S�1tZS 1 � c� � • yti1U - _ � c� ,-� .
' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig to CST Number
Arthur Z: Wegerer - 0 0 -=3Z.9 _ 220254
Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 N. Bain St. River Falls, WI 54022 -00 715 -425 -0165
Property Owner PuTI tZS k t S Parcel ID # Z�� l Page Z of 3
Boring
Boring # ❑
pit Ground surface elev. ' 3. 7 ft. Depth to limiting factor Z in.
Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
o - $ 1.0`18312 — s'i 1 Z `�sb12 m `�►- cS \ v�' • S . . g ,
lO 2 31t; - S CI - � Dk WC1- C� - , �l •�,
3 iO -�lZ �b�rZ s�Y 1� -s Lf 2 S /g
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil Application Rate -
Horizon Depth Dominant Color Redox Description . Texture Structure Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L -
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SOD -6330 (8.6/00)
PLOT PLAN Page 3 of �
f Scale 1' =Hp '
WE;Lt 1S " IUk1 cr moV" SITe.
Q�^1�� _ Lz 10.0' ov co��10� a� s►zlcFc w�°nlzwrsy,
Br` *Z - �- 1U2.0' o,v pUS� S IDI►vG 1�T SE CoRti1Er2.
�� -lST•. 5� - tpr , � C'�e�1. ltd ►vO, o zg- iOZy -'�o
k-,
1'0 i L�
DCznrJal Rip 1 4 BD\Z. -M
' N
` � t�0 �10T e0�'►PR� -T
/ OR \STv�La
s3 �� T) ►� -ASR,
N
7 V� �'J 'rl-'J IL C?L . 93.7
'gOTTUw1 OF CL -Ti.L
L °t S -
o • 3 � 1 Tb
1° l0 �t ST.
30 , T - W Au E
ll- l - 715 425 - 0165 220254 �0 _3Z9
CST Signature Date Telephone No. CST No'. Job PTO.
ST CROIX CUUN - n
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
()Wner /Buyer _ l �7 e ri: Pktf f (� " S
Mailing Address
Property Address
(Verification required from. Planning Department for crew construction) - --
State
LEGAL �` Parcel Identification Number
Ii ,E,GAL DESCRiPTIQN
i
�
/ L4 S� T : d N -R 1 �7, TQwii of
Property Location < 'I <, /,, Sec.
Lot #
Subdivision
Certified Survey Map #
Volume Page It
U
Warranty Deed # 3
c / �(� t/olurae --- -� Pa ##
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SySTEA'i l"'IANCE'
Improper use and maiatananceof your septic system could result in its pre naiurc c p� s d « i 3a you put intoo the sys erte
consists of pumping out the septic tank: every dines years or sooner, if needed by a� system. can affect the function of the septic tank as a treatment stage in the waste disp
D a ce�catior; form, signed by the owner and by a
- %c property owner agrees to submit to St. Croix Zoning eP erverifvina tbat;? }the on - site wastewaterdisposal system
urmstorplumber, journeymanPl'm ' restrictedplumber or a licensed prong
is in Proper operating condition and/or (2} offer inspection and Bumping {ii neccsss-y), the septic tank u less than 1/3 full of skudge .
eats and agree to ntsurtartr the private sewage disposal system with the standards
Ilwe, the undersigned have read the above tegttirem _
sct forth, h as set by the Department of Commerce and o e D
eted amen r Of No d to R sours °i S tate
Co mty Zoning Ofii °within 6�
staring
that Your septic s}=stem has been maintained must b completed
d of the three, year expiration data. f 3
DATE
S APPLICANT
OWNCR CERTIFICATIC
I �we) certify that a ll statements on this form ate Gus to t he.
d �n Re o f Decd: O �a`c. 1 %�t •: ; art (argi) the ou ncrtsl of
b7 v.rtuc of a �=art3nty deed recnrde g
tits property deserihed above, ' 3i
,9 IU4 DATE
IG �TnUMR APPLICANT
#t *fFd
Any information that is uris-representr -ay result in the sanitary permit bcisg revok:d by the Zoning Department
—include tyith this application. a stamped warranty decd froth the Register of Deeds office
a copy of the certified survey reap if rc;cacree is made :
it the �vst a.i} dc.rd
4 r?OCUME"IT N WAI'�RA ®,.ry }�C�/�{ THIS S PACE RESERVED FOR - jrco41) DA *A
STATE BAR t O FF E WIS / C 1 O WISCONSIN FORM F 2 --1982
R05441bG OFRCE
Frank R. 1'h� +mson Jr.,, and Berdenia I. ST. CIVIDIX CO., •
_.. ...- ...... ........ .... . .........
. -
I'tiom son , hushand and wife ..
....
. .... _....... .... ................. day of F 19 84
II)er;t A. P;itirski,s and PatiIa Gt 3:45 P M.
concrvs and ..arranta to .. --------- . ...._.- ..._-- -- _..._...- .----
J . Pttt i c sk t,., and -. w i f e as j(� i nt
. _..._ ..
tenant .S "tw of UOWr
_........__.__......_ - _..........__...- .....- •.. ----• --
_. ...... _.. - ........ ....... .. .......-------
.... RETURN TO
�C. ♦3rX �7
�. ✓er t•JIS ', C'
the following described real estate in -.__. .. St.e._.Cro.ix ................ county,
State of Wisecnsin:
lax Parcel No: ..............................
The Southwest. OLtdrter of the Southeast. Quarter
(SW SE.` - of Sectien Fifteen (15), 'Township
Twenty - eight. North (USN), Range Seventc -n
West (R17W), except the West 345.73 feet thereof.
This !.? homestead property.
(is) (Ysxifoi)
Exception to warranties:
r` I t Dated this -...- -- __....- -- day of ._ .February_ ___ 19. 1
__. - - (SEAL) ���� �--. —� CCYi�?� (SEAL)
- - - -- -- - - -- ' -- - Frank R....'Thomson,JC..
............. _...._(SEAL) _ - ,,. t r�. �. c;, ���� (SEAL)
Berdoni T. Thomson
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ...................... ...... ............................... FTATE OF WISCONSIN 1
ss.
authenticated this ...____day of ----------- ..- ------- .__ -, 19 ------ Personally came before me this _ ...... _-day of
--•- -_FS3�_[:Id.�tCy__ . .... ........ 19_.x:1.. the above named
_-- ---- ------ -- - ----- --- -- ------= ------------------
a F: r_an.k_. R.,...Th�.m " r I • : 1 r ' ¢.[1 .. t.I: _E n La
• T . I`ho of
- -- -- - - ---
TITLE: SfEMBER STATE BAR OF WISCONSIN
-- - - - .._...__._ -.
(If not, .- ---- -- -- -- . -- - -- -- -- -•- -- .__....... .... - - J'���rinrr►rpb - ...
Slf E ��i
authorized by 1 706.06, Wis. Stats.) to m e 1, no•. n to be the person av-'!�__, lo.�xFUfEdd the
for ing instrument and ac e4e tile r"_e., 0 ��
T, INSTRUMENT WAS DRAFTED BY � ,•' �,f
1�1 YY
homers c` - "4 - "---_- -- -- t t�
• ..
....._.. -.. •� • M
r1nr1 FT► T 1 c rt f Gt i'e t T ( Iry I. i (ho Id G
....
.. ............ . E3a 1 d in....ly.i..._.i 1_Q4K ......... . . . .. ...... Notary i ubhc �t- - •..(� o i PU -
(Signatures may be authenticated or acknowledged. Both My Commis' is permanen %Ifs+ bt...jatp'e�thp�un
are not necessary.) • h e, d�C t
date: Mit y +,' 4.)
t iff Jl `11 :' "
•*7wmea of per n• eiSninq in any capacity xh—M be typed or printed balnw
STA N o- W ISCONSIN Stock No. 13002
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
395175 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: Village X Township Parcel Tax No:
City
Putirskis, Albert Rush River Township 028 - 1024 -70 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
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 BLDG WELL LAKE/STREAM LEACHING Manufacturer.
INFORMATION Type Of System: CHAMBER OR
Y UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes [0 No Fn] Yes [W No
COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1870 30th Avenue Baldwin, WI 54002 (SW 1/4 SE 1/4 15 T28N R17w) NA Lot Parcel No: 15.28.17.143A
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
3.) Contour =
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
Date Insepctoes Signature Cart. No.
SBD -6710 (R.3/97)
Sanitary Permit Appucauon j a q / I
In accord with Comm 83.21, Wis. Adm. Code, personal information you Provide 0 Check if Revision C�
tna be used for secondary ses privet Law, s15. 1 m to lap I.D. Number
I. Application Information - Please Print All Information / .
Parcel Number
/
p f Owners Name ) (t '9 ) V � p - 10 2 ,,/ _ '� v •- U (�
fl 1 k (h e- .1-t .1-t i4 1 i� 5 -'5 p�perty6Iocadon
Property Owner's Mailing Address
y 4
Zip Code S l T N R E
I (J U / I.ot Number Block Number
City. State .itane•Tm►n�; �,,,
,'
Y\ �` Subdivision Name CSM Number
Slq
OCtry
II, of Building ( check all that apply)
J J l
Number of Bedrooms _( ❑Village
1 or 2 Family Dwelling -
- ownship
❑ Public/Comm r ialDescnbe q ;. � }NTY Nearest Road
❑ State O \YOed Fl�.iE..�
I )C u Y . Complete lete line B if applicable) (/ C
"iat�cii�1 : e) P
lII. Type of Permit: (Check only one box on line A (numb .fo;.
. For County use ;
A I `�, New 2 Replacement stem 3 0 Replacement of 6
Tank Onl Existin S stem Date Lssued
S stem Permit Number
B. ❑ Check if Sanitary Permit Previously Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
21 Mound 47 0 Sand Filter 50 0 Constructed Wetland
44 0 Non - Pressurized In -Ground 510 Drip Lim
410 Holding Tank 48 0 Single Pass
22 ❑ Pressurized In-Ground 410 ❑ Other
45 0 At -Grade 46 ❑Aerobic Treatment Unit 49 0 Recirculating
V. D' rsaVTreatment Area Information: Percolation Rate System Elevation Final Grade
D'
rsal Area Soil Application Elevation
ed
Design Flow (gpd) Dispersal Area Proposed Ram(Gals./Days /Sq.FL) (Min./Inch)
Required � S '
� o 3
0 () X03 / U. y4,
Manufacturer Prefab Site Steel Fiber Plastic
VI. Tank Info Capacity in Total Number Concrete Constructed Glass
Gallons Gallons of Tanks
New Existing
Taalcs Tanks ,
Septic or Holding Tank v � (J U i e S t<
Dosing Chamber e
VII. Responsibility Statement I, the and , assume response iity for installation of the POWTS shown on the attached plans.
IMPRS Number Business Phone Number
Plumber's Name [) Plumbe Signature n n 3 C( � 5 n l L k y`
J oe- 6 vl �S l l
Plumber's Address (Street try, State, Z" / 2
VIII. Cozen /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Disapproved Surcharge Fee)
a° 8 �(
❑Owner Given Initial Adverse � 32S
Derermination
EK. Conditions of Approval/Reasons for Disapproval -
� A�•�.tQo•�. sue. s� tom- e� P,^ � 1� �3 c
ch complete planr (to the County only) for the system m papa
not less than till! x 11 !aches to size
SBD -6398 (R. 05/01)
I
ST CROIX COUNTY
SEPTIC TANK MARqTWANCE AGREEMM
AND
()W NERSHIp CERTIFICATION FORM
ow 9 e- rt P nertBuer y Al I i e �rt �Z: I
Mailing Address
p Address (Verification required from Planning Department for anew cons truction)
C) � �- /O;k 2
city"State
Parcel Identification Number
I x &
. �,GAL _DESC�RIPTION e,
Property Locatio
own of
V4, Sec. W ,T
Subdivision
Certified Survey Map # Volume Page it -------
Page It
'Warrauty Deed ## Volume
Spec house. 0 yes ❑ no Lot lines identifiable 13 yes no
SYSTEM MAINFEN-A-NCE
could result in i
I mpro p e r use and maintenance Of your septic system NV you pu t into the system
consists o f pum out the septic tank` every ft cars or sooner,
c an affeJ the function of the se pti c tank as a treatment stage i t h e wa ste disposal sYsteri`
* f s igned by th owner and by a
cat or
The property owmr agrees to submit to St. C Z Departny-'at 8 cerdfl on - s i ts: gerdisposalsYsterD
*&' 9 t£
sat
plumber, res td o t a iplumber or a li pumper ve 1 TM on s ' W W t1/3 f o f sludge,
Mas tp, r plumberjotr,
is i proper operating condition and/or (2) after inspection and pumping (if o ecessa - y }, the sep tic tank is less t s
Maijjt_aia the pr , s ystem with the s tandard
priv Sewage disposa 5
d h read the above requir=euts o
and agree to - State of Wisconsin. Certific
l[we, the undersigne o f C ommerce and the Depastmeutorvatural Resources.' Colinty7-,viaingfficcwitbin- 1(3
- as set by ft Department M
sct fora" helciu mu st be co mpleted and remmed to the St. Cro
','ta sys t e m, has been maintained , that your s eptic s
d ays o f the three year expiration date.
DXT-P
SIGM 4ftjF—APP (our j- I arn (ale) the O"ne
()WnR CE I a this form ale t . ue , t the. best of MY
I ( certify that all st atements
proper described above, by virtue o f a warran deed r ecorded i R of Dee& 3
DATE
�PPLJC��
I G'N1,1 A TUU RUE PLI ANT Any result in the sanitan' b r evoked by the Zoning Department,
mfomlation that is this represented may
Dec& office
a stamped Warr anty deed frorn the RcIbstcT Of adt in the Wat-ality d,-Cd
Include `pith this aPP"cat'" f t h e ce rtified survey MP if
a copy 0
c v, o o f 3 d o d r�
C c 3 �1
m e� 3o v to •
rr
I O
CD d < O t O O T C o N N O c w� c i N ° C •
< c ( 3 C w O co O Ul jV Hy
cD ao °n M CD m `° Z a y S Co p
-, c y CD N N
N N° v d N y m in
°!
CD CD CD
3 o j ° °' $
to N v ' N y 77C O
A co C j
v fn Z D a U)
CD D �' o ca y N a °°
A c n IW o o y CL IW o o w
N
3 0
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..f z
o CD A co c D lei
A N N CD
cn O O d y 00 00 0 y co) M
a ° 3 c
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gg c gg Z
v v CD M v G -
o 7 ` M <D y N CD
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CL
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=� D D o D m 0 0
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O ° O n
CD
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a 3 3 7
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Parcel #: 028 - 1024 -70 -000 03/29 /2006 03:01 PM
PAGE 1 OF 1
Alt. Parcel M 15.28.17.143A 028 - TOWN OF RUSH RIVER
Current i X, ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
ALBERTA &PAULA PUTIRSKIS O - PUTIRSKIS, ALBERT A & PAULA
1870 30TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description * 1870 30TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 14.300 Plat: N/A -NOT AVAILABLE
SEC 15 T28N R1 7W SW SE EXC W 845.73 FT Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
15- 28N -17W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/23/1997 682/606
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
82869 232,400
Valuations: Last Changed: 09/02/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 35,000 163,200 198,200 NO 05
UNDEVELOPED G5 4.000 7,000 0 7,000 NO 05
PRODUCTIVE FORST LANDS G6 7.300 23,800 0 23,800 NO 05
Totals for 2005:
General Property 14.300 65,800 163,200 229,000
Woodland 0.000 0 0
Totals for 2004:
General Property 14.300 21,200 104,300 125,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 108
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
LZ'.L%. A. IJ A 0 1 L47L L11,K VAL
A� TOUNSHIPh tj, /(T U�K' SEC. '15 T,)j N, RLZj
NER
3. ADDR�SS L4, - 7 ST. CROIX COUNTY, WISCONSIT
3DIVISION LOT LOT SIZE
PLAN VIEW
& dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
A ------------
J_
TANK(S)
MFGR. _ CONCRETE
NO. of rings on cover___ Depth DRY WELL-
- ,NCHES NO. of 1 3 width length �)V area
J no. of lines width length area
depth to top of pipe_
3REGATE L t 5 (
IK RATE 3 AREA REQUIRED AREA'AS BUILT
, ;Claimer: The inspection of this system by St. Croix County does not imply complete
- �Pliancewith State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
.tem operation. However, if failure' is noted the County will make every effort to
- cause of failure.
:ASES AND OILS SHOULD BE DISPOSED THROUGH THIS SYSTEM.
*INSPECTOR
AO_
DATED PLUMBER' ON JOB
LICENS E NUMBER
z yi -
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itaxy Pexm.i ---- y�2
State Septic X39/
NAME - iL� - . �, `u�vu' Township ! �� ° ` St. Croix County
Locax.ion a� SE %, Section /,5 TL �N, RI W
SEPTIC TANK
Size gattons. Numbers ab Compaxtment.s
T ,
Distance Fxom: Wett 700 { it. 12% on gxeatex ztope���
Bu.itd.ing it. Wettands
H.ighwaten it.
DISPOSAL SYSTEM
Distance Pnom: Wet it. 12% on gxeaxex 6tope — it.
Bu.itding 2- it. Wettanda Pt.
2 .
H.ighwatex it.
FIELD DIMENSIONS: %Z S
Width o txench 5° it. Depth o ro below t.ite 2- in.
Length o f each tineit. Depth ab xacfz avers .i
�te .i n.
Number, o6 tin � Depth o4 x.iZe below grade o .in.
}
Totat .length aj tines �it. Stop ab trench in pen 100 it.
Distance between t Inez f t. Depth to b edxo ck - it.
Totat ab.soxbt.ion area 6t2 Dept to gxoundwazex -- it.
.. Requ.ixed area bt2
PIT DIMENSIONS:
Numbers of pits Gxavet axound p.it.a yez no
Outside d.iametex b��' Oepth betow inte.t it.
iJ 2
Totat ab d o xbtion axea it z
A
Axea nequ.ined it2 rn
INSPECTED By TITLE
APPROVE , DATE 191
REJECTED ,DATE 191
i
EH 115
• WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: %, SE' /4, Section S , TON, R 1 9 Wr. W, Township o isip� 2V gN lel�)Rlz
Lot No. , Block No. County S1'> CR0 X
� Subdivision Name
Owner's Name: 7r _
Mailing Address: yzlov� Z> 12�ox> VIS "13AL -bko j0 w 1
TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT X
.DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS R/Z& B 1-1
SOIL MAP SHEET C-1° " SOIL TYPE L
PERCOLATION TESTS
r TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P �� .�5, �� R►3h S I , V� IS �LT �gs /� "'��$.
P- 1 s i i b i N3 7 n S 1 j 1 g 1.56 a D //y Z /.v
P 3 j 5 � �� ; n -s , .Z Z z i. 1� 3 D Z. 31y Z���S!
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B ti `7 bra 7 72 S ; 1 6; R�t�
B 7 _ z Z 1 S, t$ h la; T3 n S, ZY; t Js aA k 1 Z
B 3 2Z ►�o� 7Z T,1 r,$),z�;3r, S 1�:13hlsW /�, l6
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on th the location and square feet of sui ;able areas. Indicate number of squire feet of absorption area
needed bl Ve �'l occupancy. � C o 09k - t - Tr�Ht�S 9 5 4 TA ED Indicates . cale
or di and vertical reference points. Indicate slope.
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) r :, V � L ` �G�52 2 Certification No.
S
Address �ZoUTt_. Z
Name of installer if known
CST Signature
COPY A —LOCAL AUTHORITY
P L
State and County State Permit # /
67 Permit Ap County Per #
f A'
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
T A S
c Gam- h
B. LOCATION: '/4 Y , Section, T.W N, R E (or) W Lot# City _
Subdivision Name, nearest road, lake or landmark Blk# Village_
Township
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance
Single family _&,!< Duplex No. of Bedrooms J? No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES O # of Bathrooms
Automatic Washer X— YES NO Ot er (specify)
E. SEPTIC TANK CAPACITY /fVV Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement _ Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ,.7 2) 3) _ Total Absorb Area q.
New Addition Replacement LoO * Fill System
Seepage Trench: No. Lin. Feet I S4) Width Depth l Tile Depth t%A No. of Trenches —
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size 'y
•I
Percent slope of land /4 Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared
by the Cert'fied oil Tester,
NAME i.. Tk lJ.t' �� Wn, rJ -•=N- C.S.T. # and other information
obtained from % j (owner/builder).
Plumber's Signature MP /MPRSW# �� � Phone * -,
Plumber's Addr 1A/
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
#6 S !
Do Not Write in Space (glow FOR DEPARTMENT U E ONLY Q
Date of Application U Fees Paid: State 1 0, 00 County 0 Date '
Permit Issued/ (dale) Issuing Agent Name
Inspection Yes No Valid# Date Red d
1. county (wh,te copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 6/1/76
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