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HomeMy WebLinkAbout026-1020-80-000 f - Wiscodsin Department of Commerce Count PRIVATE SEWAGE SYSTEM y Safety and Buildings Division 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)1. 353269 Permit Holder's Name: ❑ City ❑ Village ❑ Tpfwn of: State Plan ID No.: H alle Builders Town of Richmond as2 -091 CST BM Nev.:- / Insp- BM Elev.: BM Description: < < Parcel Tax No.: / .0 CST 9 V 026 - 1020 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic --� A Benchmark Dosing C Alt. BM SC.e Aeration Bldg. Sewer ll o. qZ 10 /00.5-( Holding St /Ht Inlet Ll" If o.y Z )o.s'3 6D.3 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet ---- Air I Q &,'Y3 7 D ff l Septic ' / NA Dt Bottom � o Dosing NA Header /Man. to }_q,3 Aeration NA Dist. Pipe lob Y3 2'� D Holding Bot. System Iol.LF3 p PUMP / SIPHON INFORMATION Final Grade #6 6 Manufacturer Demand St cover �• 0 3,40 Model Number 9L0 q GPM ( o -`f W . 0 05� TDH Lift �.SZ LrictionD 5� Systema TDH to-5 ' Forcemain Length / Dia. 2 " Dist. To well SOIL ABSORPTION SYSTEM I (� BED EN I N Width , Len th� 1 0.0 PIT Of P Inside Dia. L' uid Depth DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Moe acturer: SETBACK , CHAMB er. INFORMATION Type O n I System: Ma9�' >[01 r J (SO OR UNIT DISTRIBUTION SYSTEM Sr tr�",ks i, > / SO Header T fold u Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Z Length 3(o r Dia. � u Spacing # 1 4 - 11 5-3 of SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over L1 7Bed,/ th Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center t � Tren ch Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: 2 it /,G' Inspection #2: 3/3 a>7 Location: 1793 95th Street, NewR 'chmond, WI 54017 (NW 1/4 NE 1/4 to T30N R18W - 6.30.18.72G = w3, o 1.) Alt BM Description 2.) Bldg sewer length= —/ / - amount of cover = � 3C 5v . ( coves. ' 3.) onto = to S, (A-Z = / 3 )� 3 /oa.o9 7 Y') ra!� 5- r t sel r. r. r 1Sf wea c� n a� r7 Plan revision required? ❑ Yes No Us oth side f or dditional informatI n. S D -6710 (R.3/97) Z 3 2 f6 Date Inspector's Signature Cert No. y, �Q - ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: € " m� E m _ ,._ -�� { 3 I 4..r � .�. A.w.�»#^aw..«..�� «,:;�i ....mew�..u�......ex+.w. �.,.,«�w�.�p....... +.+.......� - .�,..�.,.m.. .�w.�.».{..m. >..,,� .. .. �.....� � � ..w�.+ .....��..i.. 4 a I � S rt 3 gg 9 i III S EE t f E s — , _ , i . -& r7g3 �s" . Safety and Buildings Division 1 SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 8 yy r �." Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) fort W m, n pVer not lest.., coup than 8112 x 11 inches in size. • See reverse side for instructions for completing this - Wica on `` State Sanitary Permit Number Personal information you provide may be used for secondary purpos ; s '.: - Qi u l y ❑ Check if revision to previous application ; , [Privacy Law, s. 15.04 (1) (m)]. Q E -- ' �' State Plan I.D. Number ° ... 'U S_2�3 _ 1. APPLICATION INFORMATION - PLEASE PRIM ,I O "� Prop y nerNa I Pr pe `L_ ion /I C -t 1, S T Q, N, R /rE (or} l Property Owner's ailing Address Lot {Vu Bloc Number ity, State Q Zip Code Phone Numb r Subdivision Name or CSM Number n II. TYPE OF BUILDING: (check one) ❑ State Owned 0 !t earest Road Public 1 or 2 Family Dwelling - No. of bedrooms 0 ro w a n OF 4 ,4J , 111 BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 30. - 7 26 1 ❑ Apartment/ Condo e_ Z 6 -/ 0 7- «zrC1 0'6 G 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 E] Replacement 3 ❑ Replacement of 4 E] Reconnection of 5. E] 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 21e� Mound 0 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In -Gr and Pressure f I 42 ❑ Pit Privy 13 []Seepage Pit r K g 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation / /S - z I P S` T? S-- /, Z_ 103, Feet Feet Cap acit y VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septi nk or Holding Tank - C) /67 (40 i `❑ ❑ ❑ ❑ ❑ ❑ ift Pu Tank /Siphon Chamber God l 00 ❑ I ❑ 1 ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Pjtrniber's Signatur Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (St City, State, ip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) P Approved [ Given Initial 2 Surcharge Fee) Adverse Determination 7o2S � [/ _f 4A4k X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ,t/a pff _ opx� SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. � 2. 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. Changes in ownership 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 Divisionr- 608 =266 -3151. - To be complete and accurate this sanitary permit application must include: C I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 ail 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. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Pfumbermust 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 tank(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. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 '\Visconsin www.commerce.state.wi.us Department Of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 22, 1999 CUST ID No.221471 ATTN.• POWTS INSPECTOR ZONING OFFICE DENNIS J GILLE ST CROIX COUNTY SPIA 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identificati rs APPROVAL EXPIRES: 10/22/2001 Transaction ID rf. 252083 Site ID No. 17938 SITE: Please refer to both identification numbers, Site ID: 179385 above, in all correspondence with the agency. St. Croix County, Town of Richmond SW1 /4, SE1 /4, S5, T30N, R18W Facility: Hallie Builders, Inc. - Proposed Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 496277 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: • 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. 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 10/11/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us Wx MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET SYSTEM P R`vAtE SE WAGE Project HALLE BUILDER INC. ca Owner HALLE BUILDERS INC. n E Address HWY 64 E D N6S NEW RICHMOND WI 54017 ENCE IFT SEE GORRESP Legal Description NW NE S6 T30 N R 18 W Township RICHMOND County ST CRIOX Subdivision Name Lot No. 3 Parcel ID Number 026 - 102080 -000 Plan Transaction Number Index and title sheet Page 1 Mound calculations Page 2 RECEIVE Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 OCT Q 8 1999 SAFETY & BLDGS DIV. Designer DIE4NIS GILLS License Number 221471 Signature Phone No. 715 - 268 -6637 Date 10 -6 -99 Notice: Tampering with this rile by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Slats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 )(in)]. SBD- 10462 -E (R.05/98) Pagel of MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch- pounds Metric Residential or commercial? R (r or c) (y or n) Replacement system? Creviced bedrock site? n (y or n) Slope 6 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 26 in 66.0 cm In situ soil infiltration rate 0.4 gpd/ft? 16.3 Lpd /m Contour line elevation 102.0 ft 31.09 m Use standard fill depths? X OR Design depth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold (c or of Hole diameter 0.25 in 0.125, 0.156, 0.168, o.21s. 0.25.4.281. or 0.313 inch only. Lateral spacing 6.00 ft Use 0 lateral spacing for trenches. Estimated hole space 4.00 ft Not a final calculation. Number of laterals Pump tank elevation 90 ft Outside bottom of tank. Forcemain length 100.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only. 2.067 in Actual I. D. HOLE DIAMETER CONVERSIONS 1/8 =0.125 1/4=0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9132=0.281 Estimated daily flow 450 gpd 1703 JLpd 3/16=0.188 5/16=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpdW 375.0 ft 34.84 m Linear loading rate (LLR) 11.84 gpd/ft 146.8 Lpd /m Design width (A) 10.00 ft 3.05 m Cell length (B) 38.0 ft 11.58 m Depth of cell (F) 10.0 in 25.4 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 19.2 in 48.8 cm Basal area required (gpd /infiltration rate) 1125.0 ft 104.52 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (1) 10.90 ft 3.32 m Up slope toe length (J) 7.20 ft 2.19 m Down slope toe length (1) 19.60 ft 5.97 m Basal adjustment made. Total mound length (L) 59.80 ft 18.23 m Total mound width t.W} 36.80 ft 11.22 m Project: HALLE BUILDER INC. Transaction Number: Page 2 of i MOUND PLAN VIEW observation pipes (typieai) J 1 6. A= 10.00 ft 3.05 m 3 Sft A 1 7 .22 m B = 38.0 ft 11.58 m — W --- --- B J 7.20 ft 2.19 m 1 : I K i= 79.60 ft 5.97 m K = 10.90 ft 3.32 L , F 59.80 ft 7 8 - 2 - - 31 m typ. obs. pipe (anchored securely) I = down slope dimension " = absorption cell (AxB) J = up slope dimension = plowed area (LxW) K = end slope dimension JW 6° (152 mm) T MOUND CROSS SECTION subsoil cap D = 12.0 in 30.5 cm lateral topsoil ►� E = 19.2 in 48.8 cm invert 103.50 ft F = 7 0.0 in 25.4 cm elev. 31.55 m F G = 12.0 in 30.5 cm ASTM C33 H= 18.0 in 45.7 cm D Sand Fill E Sys 103.00 ft W `� -a elev. 31.39 m 102.00 ft contour 31.09 m elev. 6 % slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media vain consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: HALLE BUILDER INC. Transaction Number: Page 3 of PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 10 Ift 1 3.05 Im Length (B) 38.0 ft 1 11.58 Im Lateral specifications Number laterals 2 Holes/lateral 9 holes Lateral length (P) 35.33 it 10.77 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 10.49 Igpm 0.66 Us Sys. dis. rate 20.98 gpm 1.32 Us Hole spacing (X) 53 in 134.6 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) Place X in red "X" one choice 1 1/4 in (32 mm) X box of chosen from the options 1 1/2 in (40 mm) X diameter. provided. 2 in (50 mm) X X 3 in (75 mm) X Manifold diameter Pip diamete Design options Design choice Designer must 1 in (25 mm) - X" one choice 1 1/4 in (32 mm) X Place X in red from the options 1 112 in (40 mm) x box of chosen provided. 2 in (50 mm) x X diameter 3 in (75 mm) X 4 in (100 mm) X Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the dravvin s at right and dragging the diagram into this area. Laterals centerea over the A rK 13 clinnenslon Last hole ,frilled next to end cap Qnylcap P Ali laterals are identical 1¢ x - �� Holes drilled on the bottom of the lateral 5 equally spaced Force main connection uia tee or cross to manifold at any point. Laterals & foroe main of PVC Soh 40 r = permanent end marker (per C 3 IM Table 83.30 -5) Inch -pounds Metric Lateral length (P) 35.33 It 1037 m Lateral spacing (S) 6.00 It 1.83 m Hole spacing (X) 53 in 134.6 cm Manifold length 6.00 It 1.83 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 in 50 mm Forcemain diameter 1 2.00 l in 1 50 I mm Project: HALLE BUILDER INC. Transaction Number: Page 4 of TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 12.40 ft 3.78 m Are laterals the highest point in the Friction loss 0.80 ft 0.24 m system? Yes W here. Total dynamic head 15.70 4. m ff no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.3 gal 46.6 L back to tank? ( "x" one) Minimum dose 123.0 gal 465.6 L Y Drain back 17.4 gal 65.9 L No Dose volume 140.4 al 531.5 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels junction box - -'� disconnect grade levels " aRemate W. vent pipe electric as per NEC 300 and outlet Comm 16.28 WAC location 18" (46 cm) min. wall of pump approved chamber or outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on f siphon device as necessary pump on B C Grade levels PUMP 91.1 ft - pump tank manhole = 4" (10 cm) Off elev. 27.8 m minimum above finished grade D - vent =12" (30.5 an) minimum above finished grade 90.0 tit Pump tank elevation 3 " (75 mm) of bedding under tank 1 27.4 lim bottom of tank Tank manufacturer HUFFCUTT Pump tank capacity 12 gain Pump tank volume 600 gal Pump manufacturer IZOELLER I Inches Gallons Pump model number 198 1 c A 26.3 315.6 'as B 2 24.0 Alarm manufacturer ILEVEL ALARM a C 11.7 140.4 Alarm model number JDVL I o D 1 10 1 120.0 Project: HALLE BUILDER INC. Transaction Number: Page 5 of 7 /? - •� -�-�- C 1/4 �y "GAD CAPACITY CURVE 4 ; MODEL "96" t•+ 4 5/8 l ® -E I 3 5/8 + 4 15 y 4 j � 16 z 1 1 /2 -11 1/ NPT --� s 0 m __� U.S. GAILLkINS 10 10 JO 40 60 60 70 80 7 InERS 160 140 W 01!R MINUTE = � TOTAL O� nN4,pWPRF MINUTf flatuaNTArgOlwAtaRx•n ' CAPACM "SAD VNrr"lN PEET METMiee CALa ORS 3 1.52 12 273 10 3.05 61 731 1 S 4 $7 AS i 70 / 3 r. i 5 70 GIG 26 as 49A VALVA 23 _j aK5let CONSULT FACTORY FOR SPECIAL APP LICATIONS • Eleetricat alternators, for duplex systems, are available and Variable level goat switches are available for controlling single supplied with art alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with Double piggyback variable level float switches are available or without alarm switches. for variable level tong cycle controls. 5FLEC t ION GUIDE Standard all models - Wei ht 39 1be. - Ys H.P. 1 irltswal float operated 2 pore Meehan lost switch, me external Control required. 2. Single piggyback vatiame level float switch or double piggyback varlable level, t�esA core of >seleeeran flostswitch. Refe to FM0477 tNOAef -Ph Will Anm Lhallax 3. Mechanical alternator 10.0072 of 10 - 0075 1 Auto 9.4 t of i A 7 4. Sae FM0712. for correct model of Electrical Alternatar, E -Pak. 1 I N90 9 4 f 5 Control switch 10.0225 used as a control activator, specify duplex (3) or (4) Ose 30 1 Au 4.7 1 r 1 6 7 r 4 float system 8. Four f4) hole J - Pak, Ivnotw r. ox for watertight connection or w1red4n age 230 1 Non 4.7 2 or 2'd a 3 or 4 d 5 aiinplex or duplex operaocn 10.0002 7 Two (2) hors J•Pak, for watemight connection or splice, forkubnMtknonadtNboMl2allerproduc lanfertp onComanationburur,IM0614;A' CAUTION c+41b9 l9gytsck All installation of controls, protectwn twice and waling should be eoaa by a qualltted vanabNlavalS itches FMO47 EDsatnauAternsbr, FMtNeA ;Mechen"AlleffAW,PM0s96;9umpi licensed electrician. All slect, reai and safety codes Should be followed Including the most 3ee11119e ®sins, FM04117; and Single Phase Sbapex Pu" ControlfAlarm Systems. FM0732. recent National electric (, oar tNEC) 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. +Ara. To! P.O. Box 1041 - ` ������ SN IP 7 0 , +rJa, 49 t0 ?36.034? ManldiGtMers of 0 BNf� 1p: M 49 C" Pulp %d# " r 507t 8 rr i (SM) sza pv+up �.YR«1�,. S..►�r '" FAX(502)?? 36 r Ll y.72r, IS i I 9 �e es�eD S bbl W iscons in Department of Commerce SOIL AND SITE EVALUATION Division o� Safety and Buildings Page / of Bureau of integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not foss than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and s percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # D 4 .- /0 Q Ce -- a c v APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secoidary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property location l Govt. Lot 1/4 1/4,S T 3 Q ,N,R f E (or)4f Property Owner's Mailing Address _ Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number -- Nearest Road ❑ City Ui iage ® Town 9 New Construction Use: Residential / Number of bedrooms � Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow $'(� gpd Recommended design loading rate _ ro bed, gpd /ft gpd /ftz Absorption area required 3 7S _bed, ft` 1i ,S _ __.trench, ft2 r Maximum design loading rate j bed, gpd /e Z trench, gpdift Recommended infiltration surface elevation(s1 �p , _ _ft (as referred to site plan benchmark) Additional design /site co eratl0n Parent material Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system El S i� J S U ❑ S ®U ❑ S a U ❑ S K U ❑ S 9 U - 7 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft S Consistence Boundary Roots god .Trench in. Mansell Qu. Sz. Cont. Color Gr. .:z. Sh. VFSg /h` Ground Depth to limiting fa or I n . Remarks: Boring # Ground 0 n�ft Depth to limiting factor Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 0 14 SOIL DESCRIPTION REPORT Page s - PROPERTY OWNER • PARCEL LOA Boring Horizon Depth Dominant Color Mottles Structure. 2 g Texture in. Munsell Ou. Sz. Cont. Color Cr Sz Sh Consistence Boundary Roots Bed ,Trench f 641D 7 .P�sJ� S L slsjt' _ vF 4�l yn IDA 7,01N Ground b 7. S .It,�. �j��/ D • L �� 1�_ _� M i r — / ft. F Depth to limiting factor _. in. Remarks: Boring # Ground I ft. Depth to limiting - -i factor in. Remarks: Horizon Depth Dominant Color Mottles Structure In. Mu Qu, Sz. Cont. Color Texture Gr. Sz. Sh. Consistence 8ounda Roots D/f ry Boring # Bed . Trench e Ground - _ - -- elev. ft Depth to limiting -- factor in. Remarks: Boring # — 3'r Ground elev. Depth to — - _- -_ —_ -- __ limiting factor In. Remarks: SBO -8330 (R. 07196) I I ' 1 I , I f r s I ; �L F' : I j 1 I I { t 1 ; I ' I I ow �� __....d...__. .__. .. _ .__ •.....__�. �..,_. _,._gyp _ .._.._, I_.. _... -�_. i _i � _ ____� . ___L._._.,.. .. _._.1... Y 0�1 i i I I Wisconsin Department of Commerce SOIL AND SITE EVALUATION D;,vision of.Safety and Buildings Page —L of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ca r 0 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner I Property Location A_� & L V711 Govt. Lot Nk) 1/4 1 /4,S T .3 ,N,R /r E (or)6 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 4 7 City State Zip Code Phone Number ❑ City Vi lage JE Town Nearest Road sYo ( /n )-2 ® New Construction Use: (Residential / Number of bedrooms Addition to existing building ❑ Replacement '� // El Public or commercial - Describe: 'Y Code derived daily flow S0 gpd Recommended design loading rate _ bed, gpd /ft /� trench, gpd /ft Absorption area required 17.' bed, ft S trench, ft Maximum design loading rate L bed, gpd /ft / Z trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site co eration Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank u= unsuitable for system ❑ S® u 7 s❑ u ❑ s ®u ❑ s ®u ❑ s ❑ s R u SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Iny Ground 4 [ / elev. 3 S SdS ' ft. Depth to limiting fac or �in. Remarks: Boring # m x �� 1 5'� .21 IOFSI�/� r� Ground elev. Depth to limiting factor Remarks: CST Na (Please Print) Signature Telephone No. Address " CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z- oof PARCEL I.D.# r Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 D •i101 .P�,, / l r SL 1h Ime aW l S Z V&A 7,S 4 114 S 1/t` dF 614-/ Ground elev. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ........................... .......................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 1 /67"0" �. .-.� Two o` I I h I 4 c I I I i I I i I w t 3 � I I I I i r ST CROIx COUNTY SEPTIC 'ANK MAINTEN AGREEME ?NT AM) I I � OWr , ERSHI CERTIFICATION FORM Owner /Buyer !'i0 jj Q I�Ll y (rC'� Mailing Address Propetly Address _� ✓ _ (Verification required frou i Plannim$ DopaMent for new construction) City /State a' �'C itr�nDAJ %Ji _ Parcel Identification Nrunber © — p Zo — 8 ? L E GAL,, DESCRIPTIO Propel Location , N C ''V., Si C. T - 2 qY- R_jr.W, Town of �i L r►�o. o �. Subdivision Certified Survey Map # 3g4p 1.2 volume .�._? Page # 5 ,10 .._ Warrant Deed # 34a Page # Spec house 0 yes 0 no Lot lines identifiable 9 yes 13 no SYSTEM MAINTENANCE Improper use and maintenance your se; pc system could result in its premature failuxe to bandie wastes. Proper mainten —ce consists of pumping out the septic tank every thro a years or snorter, if tteeAod by a licensed pumper. What you put into the system can affect the fumction of the peptic tank as a tma meat stage in the waste disposal s ystem. The property owupr agrees to subunit to Ste Oroix Zoning Departrneut a enrtifloation form, signed by the owner and by a master plumber, Journeyman plumber, restrictedpk Ember or a liceaaedpumper verifying that (1) the on -site wastewaterdisposal systetn IS in proper operating condition and/or (2) after in:' eetion a►ad pumping (If iseeeasary), the septic tame is less than 113 full of dodge. Vwe, the undersigned have read the above requirri Hants and agree to maintain the private sewage disposal systern with the standards set forth, herein, as set by the Departrmettt of Com a and the Depart: :font of Natural Resouroea, State of Wisoonsln. Ctx1ifioation statimg that your septic system bag been maintainel l must be completed and returned to the St. C f6bc County Zoning Office within 30 WIGNAO year a ion date. / � 19 1`1' APPLICAY17 DATE OW NER CERUF TA ION I (w) c eztify that all statements on this : irm are true h7 the best of my (our knowledge. I (we) am (are) the owner(s) of pro art j deSCri dab e, by virtue of a watrl Zty decd reedr iu Rtgirter of Deeds Office. 9/ 99 GNA OF Ap�LICA24T� DATE ..s4.r. «.v Auy inform that is mis represented rr ay result in the sanitary permit teeing revoked by the Zoning Department. •'•* �• Include with this Application, a stamped wirr itty deed from the Register of Deeds office a copy of the a rtified survey inap if reference is made is the warranty deed DOCUMENT NO. STATE BAR OF WISCONSIN - FORM 2 '281 WARRANTY DEED d% s+ ♦ THIS SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE James A. Jirchuw and Catherine R. ST. CROIX Co., WIj. Jarchow, husband and wife. Rec'd. fcr Record this 3 day of Dpe:* A.D. 19 79 — --- ---- at conveys and warrants AA. j.,Mes 0 6 4� �, deputy RETURN TO Wesley W. Halle the following described real estate in County, State of Wisconsin: New Richmond, Wis 54017 L Tax Key No. _- Lot Three (3) of the Certified Survey Map filed in the St. Croix County Register of Deeds office on January 18, 1978, in Volume Two (2) of Certified Survey Maps TRAN�SFEIR on Page 540 as Document No. 346182, s 1 0 A being a part of the Northwest quarter of Q- - -- FEE the Northeast quarter (NlVh of NE;), Section Six (6), Township Thirty (30) North, Range Eighteen (18) West. This Warranty Deed is given in partial satisfaction of that Land Contract dated August 10, 1977 and recorded in the St. Croix County Register of Deeds office on August 17, 1977, in Volume 559 of Records on Page 246 as Document No. 342397. This is not homestead property. (is) (XXX Exception to warranties: Dated t1lis _ - 26 th _ day of November 1979 • (SEAL) 4— (SEAL) Jame r_chc)w (SEAL) (SEAL) — C&thex - jne -- R- Jarchow AUTHENTICATION ACKNOWLEDGEMENT S.gnature. authenticated iris - - day ,f STATE OF WISCONSIN November 75 i 9- SS. N/A County. Personally came before me, this N/A day of N A 7 i't.-E VE N1 B E R STATE BAR 0FVVtSC0NSIk1 the above named 4"!n') ny y 70606, 1Ls. Stats) NZA ✓as drafted by DOAR, DRILL, NOP14AN, BAKKE, BELL & SKOtq to me known t o be tne person who executed the foregoing in- New Richniond, WI 54017 str and acknowledged the same. eir—lc),y sotr' are rot N,Diary Public County, Wis. Yj Co is permanent. (it not state expiration !ate 3E�182�� CERTIFIED SURVEY MAP NW 1/4 - NE 1/4 - SEC. 6, T 30 N, R 18 W A FPR =VISION D. D N 1/4 CORNER DOES ISJf �A1.N P.,(,VAL FOIE —" SEC. 6 . ^ c;T CZ SEPTIC SYzJEM. (� � -7—<L ' REFER TO F.62.10. .":.'.""�+ --� z N z- A , • ;. , N �.•�P L cn APPROVED W W Z N Rp` c o C': y�. Li . m m V. - 5� ..\��Q .Z Q• 18 1`J78 a o o I � 0�: J Aid z ml C, J• 0u,lil $i. C.ZDiX COUNTY z =f I N 1 COIA��_;i'`NSIVE PARKS PLANNING Q �+ ° N 2 0 -19 ' - W ZONING COMMITTEE N _ 1 66.01' ' AND m oa / P • I N 88 ° - 37 =20 E 8 6 36.7' i X02 '- 51 ' w 90 °- 57 =09" 010 w I 428.15' 200 o.a 00 � to 9� ' w 166 � ���S. `OOa V V p TOWN �,P.• 0t•. w J r1. `.PC�• .�r.•j�l `' ROA D 5 . p Z m o LOT 3 m _ '° 5.02 ACRES o f ✓��� '� 0 . COV "L OF t:'�ti cP cU- Di'Ji5'O'J Ao 0 ° ,2'� cn re � . J \r, ".! FOR N 880 I HOT o_ I.0 ' 4 36.6 7' 4 V143 SITE C E. ' ,.. o , �R TO 1,�3.�0. OD v� N 88 00' -29" E rn o tP 276.70' J �y co w 6 -� EXISTING 66 o O p N 88 0 - 37' -20 E w HOME S 117. 18' O D 0 vN. �P�O \ N O \ LOT 4 t° \ - ' 8.62 ACRES °i d \ \°\ r+ �-3� S3, 113 S 88 00' -39 w \ 832.06' \ \ N 25 40 =03" W �O,• \3 3 � 82.97' P (�• y \ 3 � JNP� • \, Pt�� • \ 200 100' 0 100' 200' LEGEND SCALE IN FEET r FOUND I" IRON PIPE I" X 24" IRON PIPE SET, WEIGHING 1.68 LBS. /LIN. FT. THIS INSTRUMENT WAS DRAFTED BY R.M.W. FOUND R. R. SPIKE JOB NO. 77 -66 r� ` 54407 .. VUI,. 2 ?,A G! 4C C,RTIFIi:I) , iURV"If MAPS HUDSON. t Z ST. CROIX COUNTY, III. �� � O � � J V J (Continued next page) r;�...� SUR_.,�y`" oat - � ` n� 3 Parcel #: 026 - 1020 -80 -100 11/15/2006 10:31 AM PAGE 1 OF 1 Alt. Parcel #: 6.30.18.72G -10 026 - TOWN OF RICHMOND Current 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 GARY A & SHANNON M OLSEN O - OLSEN, GARY A & SHANNON M 1793 95TH ST NEW RICHMOND WI 54017 ,_ Districts: SC = School SP = Special Property Address(es): - Primary Type Dist # Description ' 961 179TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.340 Plat: N/A -NOT AVAILABLE SEC 6 T30N R1 8W 5.02A IN NW NE LOT 3 CSM Block/Condo Bldg: VOL 2/540 EXC AS DES 78/26 FOR HWY PROJ 15 - 8 -2 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 06- 30N -18W Notes: arcel History: ate Doc # Vol /Page Type ^ G 1 /24/2001 637287 1578/268 AD 05/19/2000 623310 1512/107 WD 200t SUMMARY 11 #: Fair Market Value: Assessed with: 0 Val U ions: Last Changed: 06/19/2002 Descriptio Acres Land Improve Total State Reason RESIDENTIAL G1 3.340 46,400 210,300 256,700 NO Totals for 2006: General Property 3.340 46,400 210,300 256,700 Woodland 0.000 0 0 Totals for 2005: General Property 3.340 46,400 210,300 256,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 519 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ArcIMS Viewer Page 1 of 1 _ . gam ,- 1.`r+�.+'�n•'a.R' J�*;'�. '+�( t Y c I ? ' 72 E csm Vo Z PG 549 s � 15L3 ?I�x3 E - NW 2 NW- NE 6 75B -10 "' 72Q10 72G•id 72A10 m r. 71 TN RICHMO D; ss f. Gi 72C 8 72H http: //72.21. 230.178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 11/15/2006 REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itaAy Pehm.i.t �O F State Septic NAME rownah.ip St. Ctoix County •_ Location Section -- SEPTIC TANK y- Size ga.t.tone. Numbers ob Compantmentz I ViAtance F,%om: We.t.t 12$ on gneateA a.tope 6t Bu.i.td.ing jt. Wet.tandd H.ighwateA a it. DISPOSAL SYSTEM D.iatance FAom: We.t.t 6t. 12$ on gneateA A tope g #. Bu.i.td.ing 5.t. W et.tanda Ft. • H.ighwateA $t. FIELD DIMENSIONS: --- Width o6 tAench it. Depth o6 Aock be.tow t.i.te .in. Length of each tine it. Depth o6 na_ck oven ta.te .i n. Numbers, o6 tin e.6 Depth o6 t.i.te be.tow gnade .in. Tota.t .tength o tines _6t. S.tope o tnench in pen 100 it. Viztance between .tineb Depth to bednock Tota,t ab.a onbtion anea jt Depth to gn.oundwatet Ty a Covet: Pa StAaw _ _ •• Requited anea St2 T yp � en a P ix DIMENSIONS: Numbers. o 5 pits G anound p.itz yes no Out6 ide d:iameteA fit. Depth b e.tow .in.tet it. 2 Tota.t abaaAbt.ion anea 6t Z AAea %equited St rM INSPECTED BY TITLE APPROVED ,DATE 191_. REJECTED ,DATE 191 _. -7iN) EH 115 • WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES • DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH • P.O. BOX 309 MADISON, WISCONSIN 53701 �rr��,,�� REPORT ON SOIL BORINGS AND PERCOLATION T STS LOCATION: / I+t� '/4, flm Section , T , R/h�#'or► W, Township or Municipality A A 'r�A Lot No. , Block No. County • ,� Subdivision Name Owner's Name: k! Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS �� �7 y 7 � PERCOLATION TESTS SOIL MAP SHEET a SO L TYPE `rruti PERCOLATION TEST , 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 t BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P - 3 LA 3b 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) z YC _ TS s # - ?., B- 2 9�L, s c ,� �/� -7 s -> n PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of s 'table areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Ind' to slope. nC m g r FE­4, I ~ ` h � 7Z I tN r i I, 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) ~ ­k r' Certification No. Address 3 L&I Name of installer if known CST Signature COPY A —LOCAL AUTHORITY State and County State Permit P L B'6 7 . Count Per Permit Application Y 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: B. LOCATION: _410 % '/4, Section T -3O N, R (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 No. of Person D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in-Place Steel Fiberglass Other (specify) New Installation Replacement — Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in - ace Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate otal Absorb Area sq. ft. New _ Replacement Alternate (Specify) Seepage Trench: , of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: gth 9 Width_ _Depth '`7 Tile depth (top -2Y_" No. of Line : Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land I _ Distance from critical slope WATER SUPPLY: Private Vioint ❑ Community ❑ Municipal ❑ Owne name as Iisted on EH 115 if other than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that 1 have sized the effluent disposal system from the EH -115 prepared by the Cer 'fled Soil Test r, NAME _ C.S.T. # 4Z and other information obtained from (owner/builder). Plumber's Signature M /MPRSW# 4 Phone # -- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. R � 4 e a € r , t j S a _ 9 3 z r a } s f € t e �a ., L"_ 4 x t 55 { 7 I E _ t t ( S t Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE NLY Date of Application ��� Fees Paid: State /J�D® Co t C� Dat _� _� 1 � Permit Issued /mod (date) �/- Issuing Agent Na Inspection Yes_�___No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 '