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HomeMy WebLinkAbout028-1045-60-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: 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)]. 353270 Permit Holder's Name: Cl City []Village ❑ T3qwn of: 7 Plan ID No.: Te stra Bob Town of Rush River wy8 7",r�owt5. 1p CST BM E lev.: In BM ST w sp. BM Elev.: Description: Parcel Tax No.: vo . o P Q c- :` cuk 1 028 - 1045 -60 -200 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS j e j o IlLg FS ELEV. Septic a"16 � Benchmark (2. 04- , Z / ( " Dosing Alt. BM ! 3 � �. 3� p f4 Aeration Bld Sewer ' �' Ia 9 ' p 1 2 92.o3 ' Holding St / Ht Inlet TANK SETBACK INFORMATION St / Ht Outlet TANK TO P / L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic > / Ofl 3 3Z NA Dt Bottom ) g "a Dosing t� ` ` tt --- NA Header /Man. Aeration NA Dist. Pipe 4 Jo `(O 93•ZO Holding Bot. System PUMP / SIPHON INFORMATION Final Grad Manufacturer St cover t Wo del Number e GPM a Wt 1 ]' ��• TDH I Lift -k.o Friction . 1 3 Syste TDH m2�$o Ip.�t •o tf �, mead 4 $ Forcemai n Length 1 () ' Dia. Z 6d Dist. To Well SOIL A PTION SYSTEM ��" -f ' " : ar W Z &,. '6° JN4�t TRENCRJ Width r Length RS r N . O Trenches PIT No. Of Pits Inside Dia. Liquid epth I • `f 3 I 1 I DIM SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA NG Ma urer: SETBACK INFORMATION Type Of CHAMB + , Mo a Num er. System: �� /o J "'R�j �� OR U DISTRIBUTION SYSTEM �°� `'? >` 5 - s - S Header /Manifold a Distribution Pipe(s) u x Hole Size x Hole Spacing I AntToAirIntake Length —_ Dia. 2 Length '92 Dia. Spacing 50 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 ❑ N ❑Yes []No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: t1q/2.'Ff °p Inspection #2:-- -f--f; Location: 2009 County Road YY Baldwin, WI 54028 (NW 1/4 1/4 36 T28N R17W) - 36. 3A -20 1.) Alt BM Description= CN- p -F-�++ �" �� ��jj 6 �' ` ' � I T° 2.) Bldg sewer length= �10 - 1, 3 44 / j 9�^' ��y � �, - amount of co ntou r C11�so PI rev q e es No r3 Use other side for additional information. p- IO SBD -6710 (R.3/97) Dat IL Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH + SANITARY PERMIT NUMBER: s { i 3 + i F i r 's 3 3 i 4 s 3 t ! a n , <_... _ i i y . 9 a j J '01 1 �•£b r 1 ailicaq 0 b) ' • ob = 0 A) ' v 1 ) u , j Safety and Buildings Division SANITARY PERMIT APfLIC -ATION 201 W. Washington Avenue N* - A , t: I " ;�` } P O Box 7302 Department of Commerce In accord with Comm W� )Ade1+:e' ` Madison, WI 53707 -7302 z� • Attach complete plans (to the county copy only) fort yem, of less County than 8 1/2 x 11 inches in size. ;� <<�• rLL► ,S T • See reverse side for instructions for com letin this licat' tate Sanitary Permit Number p g I pp An; 1 �, 0 �; � i Personal information you provide may be used for secondary purpose$ ,T C40X t -- Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numb 1. APPLICATION INFORMATION -PLEASE PRINT IN ; Property awner Name o . ho 9 bA tion ..e 0- Tr 1i4, S 3( T ,2 Rr , N, R! 7 E (or A! Prope tyOwner's Mailing A dr ss Block Number tO d Cit , St to Zip Code Phone Number Subdivision Nam CSM Number -4 X z 1 (,71j - e or ) 68f/ :?i� c I SS - 7 II. PE F BUILDING: (check one) ❑ State Owned ❑ it� Near t`Road C] VII age Public 1 or 2 Family Dwelling - No. of bedrooms 0 Town O F 4.11 At. III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3 46 , , ( —7 , 2Z S 4 2-o 6� 1 ❑ Apartment/ Condo - 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. ,g New 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System ________ System - Tank On[y 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 11E] Seepage Bed 21� Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure / A 42 ❑ Pit Privy 13 ❑ Seepage Pit i ( �x / 43 ❑ Vault Privy 14 ❑ System -In -Fill t by / c l8: 6 Q VI. ABSORPTION SYSTEM INFORMATION: Ili 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.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation V 15 19 ,37,s 3 /. L 9 6 Feet Feet VII TANK Capacit gallo Total # Of r Prefab. Site Fiber- Exper. INFORMA ION Gallons Tanks Manufacturers Name Concrete Con steel glass Plastic App New Existing strutted Tanks Tanks Septic Tan or . H g Tank 000 1 111 0 7 ❑ ❑ ❑ ❑ ❑ Lift Pump Tan /Siphon Chamber ( I 6oc) 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) Plu Signature: (No S i P o.: Business Phone Number: 7_ 2 14Y71 71 .a( e 1 > Plumber's Address (StreekCity, State, Zip C ��,,ee ): 3 >Z IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee {Includes Groundwater D ate Issued Issui Agent Sign tur (No Stamps) Ap proved pp []Owner Given Initial d1D Surcharge Fee) Adverse Determination S X. CONDIT O S QF APPR L REASONS FOR DISAPPROVAL Zvi SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 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 orplumber 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: 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 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. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone, number. 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 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 Joss; pump performance curve; pump model and pump manufacturer; D) &oss section of the soil absorption system if required by the courRy; 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 1 groundwater. T e monies collected through these surcharges are used for monitoring groundwater contamination investigations d establishment of standards. I , Safety and Buildings 10541N RANCH ROAD A HAYWARD WI 54843 ' TDD #: (608) 264 -8777 1sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 29, 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 APPROVAL EXPIRES: 11/29/2001 Identification Numbers Transaction ID No. 279484 Site ID No. 184572 SITE: Please refer to both identification numbers, Site ID: 184572 above, in all correspondence with the agency. ST CROIX County, Town of RUSH RIVER; CO HWY YY, BALDWIN 54002 NW1 /4, SW1 /4, S36, T28N, R17W Facility: BOB TERPSTRA CO HWY YY, BALDWIN 54002 FOR: MOUND SYSTEM, 450 GPD Object Type: POWT System Regulated Object ID No.: 638479 This approval is for a mound system to serve a new 3 bedroom dwelling. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: P � :N.' 1. This plan action is subject to designer comments on the plan. Con tail 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. I 3. The area 25' below the downslope edge of the mound must remain undisturbed. S 4. The designer proposes to install a Huffcutt 1000/600 gallon combination tank. PARTM 5. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). ►t)NQF ._ A copy of the approved plans, specifications and this letter shall be on -site during construction and open to 5EE COR9 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 c espondence may be ; made to me at the telephone number listed below, or at the address on this letterhead. Sinc y, DATE RECEIVED 11/15/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA L SHANDORF , PO T PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 A MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET 1 s� 1`0"` Project BOB TERPSTRA 405 `9 Owner BOB TERPSTRA I Address Legal Description NW SW S36 T 28 NR 17 W Township RUSH RIVER County ST CROIX Subdivision Name Lot No. Parcel ID Number 008- 1086 -30 Plan Transaction Number T.S. mally Index and title sheet Page 1 N Mound calculations Page 2 JF COMME Mound drawings Page 3 TY AND GS Pres. dist. calcs. and laterals Page 4 ,�, )/� TDH and pump tank drawing Page 5 ESPONDENCE C� Designer D NIS GILLE License Number 221471 Signature Phone No. 715- 268 -6637 Date 11 -7 -99 Notice Tampering with this Fie by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, wis, Stats. Personal infomyation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 )(m)). SBD- 10462 -E (R.051W) Page 1 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) Y Replacement system? Creviced bedrock site? n (y or n) Slope 1 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 27 in 68.6 cm In situ soil infiltration rate 0.3 gpd/ft 12.2 Lpd /m Contour line elevation 98.6 It 30.05 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 specs& y design fill depth. Center or end manifold (c or e) Hole diameter 0.2 in 0.125.0.156.0.188, 0.219, Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. 0.25. 0.281. or fl.313 Inch only. Estimated hole space 4.00 ft Not a final calculation. Number of laterals Pump tank elevation 88 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 Actuall.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 F - 4 - 50 -- 1 gpd 1703 JLpd 3116=0.188 5116=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) 4.79 gpd/ft 59.4 Lpd /m Design width (A) 4.00 ft 1.22 m Cell length (B) 94.0 ft 28.65 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) 12.5 in 31.8 cm Basal area required (gpd /infiltration rate) 1500.0 ft 139.35 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 (I) 10.06 ft 3.07 m Up slope toe length (J) 8.30 ft 2.53 m Down slope toe length (1) 12.00 ft 3.66 m Basal adjustment made. Total mound length (L) 114.12 ft 34.78 m Total mound width (W) 24.30 ft 7.41 m Project: BOB TERPSTRA Transaction Number: Page 2 of MOUND PLAN VIEW observation pipes (typical) J 24.3 ft = 4. A ft 1. A 00 22 m 7.41 m - B 94.0 ft 28.65 m B J = 8.30 ft 2.53 m 1 K 1= 12.00 ft 3.66 m K = 10.06 ft 3.07 m L L _ 1 114.12 ft 34.78 m typ. obs. pipe (anchored securely) 1= down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LxW) K = end slope dimension U e' (152 mm) T MOUND CROSS SECTION subsoil cap D = 12.0 in 30.5 cm lateral topsoil H E= 12.5 in 31.8 cm invert 100.10 ft F= 10.0 in 25.4 cm elev. 30,51 m F G = 12.0 in 30.5 cm T ASTM c33 H = 18.0 in 45.7 cm D Sand Fig E Sys. 99.60 ft -a y elev. 30.36 m 1 98.60 ft contour 30.05 m elev. 1 % --.� slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media wig consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across Ax8 media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: BOB TERPSTRA Transaction Number: Page 3 of PRESSURE DISTRIBUTION CALCULATIONS Absorption cell inch unds Metric Width (A) 4 ft 1 1.22 Im Length (S) 94.0 Ift 28.65 m Lateral specifications Number laterals 1 Holes/lateral 23 holes Lateral length (P) 91.67 ft 27.94 m Hole diameter 0.250 in 6.35 mm Lat dis. rate 26.80 gpm 1.69 Us Sys. dis. rate 26.80 gpm 1.69 Us Hole spacing (X) 50 in 127.0 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) _ Place X in red W" one choice 1 114 in (32 mm) box of chosen from the options 1 1t2 in (4c mm) diameter. provided. 2 in (50 mm) X X 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) one choice 1 114 in (32 mm) None required, from the options 1 112 in (40 mm) No choice necessary. provided. 2 in (50 nun) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 1 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drau+ings at right and dragging the diagram into this area. Laterals centered over the A & 8 dimension end cap 4 P --'I Last hole drilled next to end oap lE X — Lateral- tk force man of PVC Soh 40 Holes drMed an the bottom at the latarai (per COMM Table 84.30 -5) egvapy spoced • = permanent rod marker Inch -pounds Metric Lateral length (P) 91.67 ft 27.94 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 50 in 127.0 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 lin 50 mm Forcemain diameter 2.00 lin 50 mm Project: 808 TBRPSTRA Transaction Number: Page 4 of i TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft MO.38 m Vertical lift 11.30 ft m Are laterals the highest point in the Friction loss 1.26 ft m system? Yes W here. Total dynamic head 1 m If no, what is the highest elevation Dose Volume downstream of pump? �] Dose is > 10 " ti mes lateral volume Forcemain drain Lateral void volume 16.0 gal L E L back to tank? ("x" one) Minimum dose 160.0 gal L x Yes Drain back 17.4 gal L No Dose volume 177.4 al 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 I t weather proof , /� warning label and locking device grade levels function box disconnect g� levels -.... � alternate 4" vent pipe electric as per NEZ3OO Comm 16.28 kx anon 18" (46 cm) min. wall of pump �---- approved I chamber or outlet joint combination tank A Provide 1!4" weep hole or anti- alarm on siphon device as necessary pump on B C Grade levels pump 88.8 ft - pump tank manhole = 4 cm) Off elev. 27.1 m minimum above finished grade D - vent = 12" (30.5 an) minimum above finished grade 88.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 26.8 Im bottom of tank Tank manufacturer HUFFCUTT Pump tank capacity 12 gaUn Pump tank volume 800 gal Pump manufacturer [WELL ER I Inches Gallons Pump model number 198 c A 27.2 326.6 'ro B 2 24.0 Alarm manufacturer ILEVEL ALARM m C 14.8 177.4 Alarm model number DVL o D 6 72.0 Project: BOB TERPSTRA Transaction Number: Page 5 of Nw scv s �7as' IL l)'1 '��► r� �� f!/� �� loo r �l� e.Qu� ` ioo 5 i yew„ i `` ` � c , 5tt ,elow�o ' Absorpha m r u�l r;m,:uj or - sturbed. t �: P ry o ser� e , . �� ►rt�ty ! dSOPA I V `Y C iMIV •••w.wltr� �'�`r b .V.Y. b .•.r„ ,.w ..nu..,,, to 46 ot U'. 4 o test �e.w ♦ f •� r' J ItlAU W"IM�A' r r �• '• t "!t . •,• ! 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J t�j :.�a i +MNIriM. oo 1 Adtl Irk.. al► t► ago" i&* !. • 1 . .. »� f.wi If.lr " 1a+.. •�:YP + . ltf�r • i+MMF+.Mf x 1�AfNi•.w NIdw41 0 sOP 14. w•q (:,r 40, 4.# ri1 . r: f ff�:RAI +Mlf." al@ M.�1RI! 14 41W !1. call lap .r.l 1.. ••.. , +y ff�rr fy f�N rl . ow' `Mw'V•IdM1�lfMlw, *if/it trlA• `lIM hr♦ + w.qe la, • rw�r ,.. ,. w • w 400. ANIIwI **.a a ..y w ` b � ~ faMr��s l i t tAtNA1p►WJ tA/'tl,tJW�i1 's J'vMbf� u .. ''�11�y !,k is 6•1,:P1v0, itl ;olt!I 4M.1. w,.... - ... . .. ... I apt bot 4"1 WUu NOV 05 ,' 99 '12: 36PM AND !tA ,• �. , •• .. — .... ' • . •. • •• . • , 1 P 3 - 'na loA *1" A Sule,n9s In accord with iL,HR 13.05, WIS. Adm. Code � `� COUN — If Bch ootrod ske plan on paper not teas than S 1/2 x 11 inahes in site, Plan must incrude, but r 8 direaion and % of sloe I r I.Q. 0 yet lirnitsd v'ittlC al and harizontsl sf etenee Point ( Mj, p , ees e o simenslom;d, Rath snow, and location and distsnoe to nearest road. 4PPLICANT INFO RMATION-PLEASB PRINTALL INFORMATION PATi PROP Wii j OINIY$R: PAOPU 7 LOCATION c & GOW, LOT 1/4 114,5 T ,N,q 7 ' 4P) w P OP . OWNER':S WUNG ADDRE38 BLOCK It ± SUBC. tdAt�{Q Clp C9M K CITY STATE U I TY (:j vtLLAG9 2FOWN INWIST 10' �1 . c�ls� �l�l- 930 j �� - I a, 7R.4 y pd Now Consbvdton Use J AaeidentlstJ I Ns:rssber of bedrooms ' ( ACC eds}ing bulldL,g ! [ Public cr acrssmardW describe Cade d"ed dilly flow 4en_ gpd , Recommar+440 design badin; Ito _ bed, gPdf!tg, . .wench, gpd/ tx Absorption arse required JV P bed, 9 LtO..Q iwh, 0 Mtudrnum desi loading rata NP bec, gp&0 . _S Irenoh, gpd* Aecommanded indlt scan surkee alwatien( _,_.. q9 �(a —. ft „�, ft (as referred to site plan bera:trno) ' Addidonal design I silt colmiderdans 9, at e�"s Ur 419C ds..A j ,6-ft,k ,thd 01AV S5 Vvcko— Parent nsatlris! (Q e �,�,. f� 1 / Fload pwrt etevttian pliable Nom. tt d Sui a �yttfe D •BROUN M[MIRj I ItT -0M7 51'sjS>�I �I1 R�LL ICL01NS TAW ` "s `' p u s r� u D s kLi C s 8.�i us ICU SOIL D98CRIPTION WORT ortrig # Horizon Depth Dominant Color• Motto Texture Structure Consaraen� Aoab GPD/ j . ire. Munsell Cu'. Sr. Cant Color Gr. Sz. Sh• Y Bed IWI i C. � t o• s,f :zms a I x rn s� rrourad 3 � �' 5 . + 3 it. d-/ + c • 1~ 7i0 ,5 Wpm to " 3 13 se I C k 1 "t'} A' AS sC Ramstrksl; � Wing 0 , / a 10 4A s �a w , iz c ' irpurtd � l Upth to flow limltln�, � • .JCL Ramstrkt . F �fa:nat— AEea:e Print Plw�e�r W&J r — rlK: r J 5 7. - 1: • .a P.4 AWN SOIL DiSCRIPTiON RS:P4RY pa --- lit i Structure ' GPOltt . 3oring It Hortaon Dept Dominant Color Textu MotlliO . ConteY Rows Bed in, Munsetl QU. Si Cork CWcr Car. St. Sh. 3 m CI �F S 3roa�d 3 Dw .S S Ice 710 ' i .. . NE radar Rernarks's ' SaIng Li around . i • - Remarira: ' Boring +ir Dow fa f_ecitat Remuiu:' s Boons N 4 Ground D IP � ,. n9 OV 9 12 :38PM ANDERSEN COR vi d 1 � � ! 1 o� Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ^ of Labor and Human Relations Division of safety Buildings in accord with ILHR 83.05, Wis. Adm. Code LRE 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical a nd horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. G – O APPLICANT INFORMATION– PLEASE PRINT ALL INFORMATION DATE L11 2 PROPERTY OWNER: PROPERTY LOCATION Chu GOVT. LOT � 1/4 1/a,S3 T AR f h W PROP51TY OWNER':S MAIL G ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 3 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE OTOWN TNEAREST ROAD /JG S OO,Z (/ - v y �(] New Construction Use Residential / Number of bedrooms [ J Addition to existing building j ] Replacement (] Public or commercial describe Code derived daily flow 6 �5_'o gpd Recommended design loading rate NP bed, gpd/ft gpd/ft Absorption area required &P bed, ft /500 trench, ft Ma)dmum design loading rate _ bed, gpd /ft , 3 trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations AR n, gi sur)nc,t. 4-1 breg?4 ue T LOy - -5 rvAA--. Parent material Flood plain elevation, if applicable n//A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem [Is ®U ®S ❑ U ❑ S ®U El S ®U C1 Eau ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tw& s FQ � _ C�ii kv? Ground 3 /- 0 S/3 S 1 Y elev. �. — Depth to limiting factor Remarks: Boring # nx'tdw oy o - 10 Jo 4k 3 l :' C n 1Z r z .::.. -A 3 Ground l y 22 ft �. wAl Depth to i limiting factor .26_ or Remarks: X' CST Name Print Phone: sc , A ddress: sy s/ Signature: a• Date: CST Number. / 9 � �5 PROPERTYOWNER kyle >on «rdn - SOIL DESCRIPTION REPORT Page —of PARCEL I.D. # 0033 - S Depth Dominant Color Motes -Texture tructure Consistence Roots ed - . Boring # Horiz on in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends >< 0 Ground y/ Gro - /� �2 fo 3 A elev. -- I b y e 6/y Depth to limiting factor a � Lino Z I Remarks: o �t j Boring # _ W Ground elev. ft Depth to limiting factor Remarks: Boring # P Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. _ ft . - Depth to limiting factor Remarks: FROM :*ALLE BUILDERS INC FAX NO. : 1 715 483 1341 Dec. ODEC 07 '99 01 :33PM ST CROIX C'OUNT'S` SEPTIC; ;'ANK MARTMNANCE AGREEMrjNT ANI) OWN ERSHIP CER'T'IFIC FORM Owticr /Buyer Mailing Address _ ; � �� - __._ bo a Propetty Address _� 00 1 (Vatifteat4o required 61; t Plaaatog Department for new construction) City /State �iA� I n / _Parcel Parcel Identification Number 0 ak LAGAL DT ON Properly Location _A±k� %, _5412 %, 81 C. , T 8_ N•I�_ 1 W, Town Of Subdivision .� _ _.� T Lot 9 Certified Survey Map # / ! g 3 , Volume ,�� s Page # 3 7 Wa Deed # _ Ce 101 _ v o l ume f q S Page # -- -- Spec house 0 yes no Lot tines identifiable C3 yes ❑ no SYSTE M MAINTEDj&N_CE Improper use and maintenwmeof y►m sel Ac sy8tem could result in Its premature Failure to handle wastes. Propermaiueeautce cotuisu of pmping out the septic taint every tlrrt a years cc molter if a6eded by a licensed pumper. WbAt y6u put into the system csa affect the function of the eeptin tank as a trot tment stage is the waste disposal system. The property owuer agrees to submit to St, Ctom Zoning 0cputrnent a certification roan, signed by the owner and by a master plumber, jourueya=plum6er, restrietedpl: umber or a lieewedpumposverifying t6t(1) the on -site wastewater disposal ayatem 11 to f!t`oper q nerstizg 6Sn&i —n a n&fear (7) pfi'or ir: �cotio!i ittl ¢llt:^+...,'± - (U becca;&.yy), ILa soptic Lu%k is less thin 113 full of sludge. llwe, the undersigned have read the above requires vents and agree b) maintain the private sewage disposal system with tht standards set fortb. herein, as set by the Department of Com aerFe and the Depasttaent of Natural Rem;W'eea, State of Wisoonsla. CCti4 catioa stating that your septic system has been maintainei. I must be completed sad Worbed to the So GYeik County Zoning Office within 30 days of the tbxee year expiration date. X l SIGNYATM OF APPI.I A DATE Ow NEFt RTIJI. T�QN I (we) testify that all statements on this : tml are true at the best of my (our) knowledge. I (we) am (are) the owners) of the p, e described above. by v' t,e nf a wa rra zty deed recorded iu Register of Duds Offi ' 07'j� - V S,GNATURL' OF AI?LIC:AN ' DATB 08.v,' Any iafotmation that is ruis represetlted rr aJ result in the sanitary permit being revoked by the Zoxxi,uy, Uopartrnent. 0400 • r Include with this Application: a stamped wart Laty deed from dto Register of Deeds office a copy or the C rtified survey snip it reference is made so the warraalty deed - .t s '�- b Lys r►dsr or ; mils Lyle It GWdarsoa and so* tw" " t *JG Sorda K wWW=t, kaband and wife, aaatirtr so and WfffWb to Bob A. Twpsfra, a , ► PW=. 1 PV ft p desEx�ad real estate in St *ok may, Stmt _ �' . 01 VVlsocxairr W. Now and tlrYrm After Thamse A. *C m * 740 Mob St: Ir.tdr�, w, saooa ` �Paral Ioo IWatt�j Pert of the Northwest Quarter of the Southwest Quarter (NW Y of SW Y) of Section Thaiy -six (36), Township Twenty -eight (28) North, Range Seventeen (17) West, St Croix County, Wisconsin, described as follows` Lot Three (3) of Certified Survey Map filed November 13, 1998, in Volume 13, Page 3557, Doasnent No. 591983. TOGETHER WITH, AND SUBJECT To, that certain joint driveway easement in cm wrm with the owner of Lot One (1) of said Certified Survey Map, which easement rights shall run with OW land, and further sU*d to the terms and conditions of Out certain Agreement regarding said driveway dated Jurte 24, 1999, recorded June 28, 1999, in Voluaw 1437 of Records, at Page 265, as Document No. 606118, office of the Register of Deeds for , Wisconsin: tA Exception to warranties all easernents and restrictions of record. This is riot homestead property. Dated this 2& of September, 1999. 1 K. an AUTHENTICATION ACKNOVAEDGMENT Signature(s STATE OF %SCO(SW ST. CROD( COUN Y Penlondy ,erne belbre me Qris 20th day of September, 1989, the abare nerved Lyle Gunderson; &U LyN N. authenticated this _ day of _ Gunderson and Sonja Sonja K Gunderson b an kwm b be the s) %Vw eroearted the brepoirq knhu next and the owns. type or prht name Mw or pft TITLE: MEMBER STATE BAR OF WISCONSN nrreeThoreesA MbCamedc " �" i (U not Notary Pubic St Cnok County, Z t authorized by § 708.08, Wis. Slaw.) My commweion is pert : nc*. THIS INSTRUMENT WAS DRAFTED 6V Thomas A. h!cCormack *Nem.e a persons WW ft h &V c dmM Baldwin, : 54 +'x! Drum d below VwN ava kne. rra�se.Pww.r..r<c..Mrq rwirtaawlra.MR ' �ooeeeam+ = r ' - NOV 05 '99 12:35PM RNDERSEN CORP P.2 c 9e_,o, a! �:�1 ne:�, r,��, •��: rcr,;,ra,:• n;, iYllir' ".^'. m �'�• s Air j yr 1la.d, �►!>• / /�/ Vag' 1 71 &" 2�9.�V, l7f7ip' TOMV OF F .Rl'V,&�,k S'T, rp vrx Cr *N7'Y. per IN OWNER 0 o6l:MINUM couNrr SECTION e QRNCR I.TLE GUNDERSON APNUMCNY rowNC SAS kwy a,aLO w l 1• IRON Pip£ rcumD 5�ao2 v 1• 4 24' I NCIN AiRE SET ✓EiGHINC; ^I'JTC 1,42 LSS, TER LINEAR FOOT , 1- TRGN PTRC roubop N46•17000'E 100' ROADWAY S.rBACK {,INE' 0.6$ FEET PROM COMPUTCD P154ITION X STCCL. su;%VEI' MARKCR aCT x m }ir RECrION CORNER TIES Q $ 'i �• -`' fd�.�i m RAIUMAD Sp,KE tC4Ni VI /A C GR, ° SEC.' ;Is ML TEST �� � _ A s9 4a.. El/4 c(iR, Sec. .as � g0'00`t �E � `EAST ��y_ - VESY I/4 LINE .�. JDIN DRIv� a C,T•i,_ a . LINE DATA . TA86i 117 NQ"IKR AIRECTIaN D;STgNCE ' ru �qT C. v '`� � a90•a0'GG•e 66.00• y a 4,001 A s!►0'a0'00•E 66.00• w 5R� 706 A 2 SQ. FT. 1a �Q S00.331•ee ";/ 3l3.Op• , iI 3 ®s AC. E7 r- R.V $90.00'00'C 5p, t• T. < 5901130'00•C db 00 �'; , 1p0•'� • 56,Qd' i U11TPG.� TTY 9 �' �5 v O' 'E ,C) 4 I A►, n. i7gr .19 � $� W C O T'\� 3 T g43 A R S ' T. 1 ' / gASCMEIJ� 1�r'.i \� - 5g' 1 �t r 50. C41 - eo 0 z�xC \R Vi rl let �+ ` / te a• � Sg3 � ' �` •\ ` \� L•' nr NWIri: i E ar T DI�TME a'wl /4 � 7� +���:�6`•W ��14,Jh1� i Sv CDIi, BUILDStJIi$ ARE PADWIDITC:) WITM;N TMf DRAINAGE CASCMCWT, THIS INSTRUMENT LE IN FCET . nRA1P r Sy E4 FLANU Jot N 9B -8d • o 0 V0I.130aye 3537 g�1 / 9 - eaa f ' r CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 1/4 OF THE SW 1/4 OF SECTION 36, T28N, RIM TOWN OF RUSH RIVER, ST. CROIX COUNTY, WISCONSIN. OWNER LEGEND LYLE GUNDERSON • 1' IRON PIPE FOUND 149 HWY. '63' BALDWIN, WI 541 1' X 24` IRON PIPE SET WEIGHING SQOOZ 1.68 LBS. PER LINEAR FOOT • • • • • • • • • • • • • • • • • ROADWAY SETBACK LINE CAS SHOWN) w z o NOTE QA = ~ w 1' IRON PIPE FOUND N46`17'00'E X STEEL SURVEY MARKER SET ~ u °o 0.65 FEET FROM COMPUTED POSITION FROM SECTION CORNER TIES to o m RAILROAD SPIKE FOUND w o Z w N W1 14 COR. ♦ SOIL TEST w z � SEC. 36 E1 /4 COR. w J o rir S90'00'00' j SEC. 36 w l/T o �- © 1 g 283.3 ! 3 � 4842.15' _ EAST - WEST 1/4 LINE � H A 5 L690 00 E 7 415.37' N �- C.T.H. "YY" 3 0 ri o ri O LINE DATA TABLE " a r' ............ • • • .... p NUMBER DIRECTION DISTANCE ¢ N Q S90`00'00'E 66.00' ww W r N LOT 1 c !�2 S90'00'00'E 66.00' ui 4.001 AC. vi a Q3 S00 °33'46 "W 33.00' .� 174,262 SO. FT. 0 c �D ® S90`00'00'E 66.00' q , w 3.786 AC. EXC. RW 3 a ssn q- 5 S90'00 66.00' > 164,911 SO. FT. z Ns� , © N00`32'29 "E 33.00' �! (u cov o Q7 S00�33'49 "W 33.00' o a Cl o Q8 500 32 2 Z �° UNPLATTED LANDS • 590 °00'00 "E 900,04' -- _ --_ _ A �o ♦ ♦ a. ♦ ♦ Lv S90`00 "W 283.15' v_ s d• N N LOT 3 y w cu (U = � 15.250 AC. o LOT 2 664,311 SQ. FT. co 15.200 AC. EXC. RW o . Z 10.000 AC. `��� 662,133 SQ. FT. 435600 SO. FT. d 9.950 AC, EXC. RW 9� 3 tO 433,422 SQ. FT. Z q ; 3 F` w M v� ('r) X1 1 � ✓� �- o w w J _ Q w (n w [~ i 3 �; 787.87' 527.04' a! SOUTH LINE OF THE N89 °51'36 "W 1314.91' NW1 /4 OF THE SW1 /4 UNPLATTED __LANDS SCALE IN FEET V = 200' 200 0 200 400 THIS INSTRUMENT DRAFTED BY ED FLANUM JOB NO. 98 -86 Safety and Buildings 10541 N RANCH ROAD 4 HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 29, 1999 CUST ID No.221471 �'' v ATTN. POWTS INSPECTOR -ZONING OFFICE DENNIS I GILLE " -- $T CROI ( COUNTY SPIA 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 ( - � "I DSON _VVI 54016 t RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 11/29/2001 ` J1 ransaction ID No. 279484 Site ID No. 184572 SITE: °✓ "� Please refer to both identification numbers, Site ID: 184572 above, in all correspondence with the agency. ST CROIX County, Town of RUSH RIVER; CO HWY YY, BALDWIN 54002 NW1 /4, SW1 /4, S36, T28N, R17W Facility: BOB TERPSTRA CO HWY YY, BALDWIN 54002 FOR: MOUND SYSTEM, 450 GPD Object Type: POWT System Regulated Object ID No.: 638479 This approval is for a mound system to serve a new 3 bedroom dwelling. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. 4. The designer proposes to install a Huffcutt 1000/600 gallon combination tank. 5. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). 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 11/15/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA L SHANDORF , P TS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US W SMART code: 7633 M HEAD/CAPACITY CURVE HEAD CAPACITY CURVE EFFLUENT NON 2M ■ ����Im�aomm�im ® ®mm�mmm ®m ®m ®mmmmmm ® ® ®m mtmt�m�m�m ®m0mo ®mom ®m ®mmmm�ea ®� ®an EVEN I ■ c►\■■ i��a�m�m�m ■�m�mm ®mmm ® ®�mmomm�aaa ® ®aa \■\ ■■ I�m�m�� ■■�m�m�mmr�m ®mmm�m�m ®mm ®m ■�a�m�m�m�m�m�mmmm ®mm ® ®mmm�m ®mm \� ■ ■1 \ ■I��m�m�m�m�m�mmmm�■ ®mom ®mmmmm ®m ,. ■ =■I � ■ ■ ■■i ■■ ■ ■ ■ ■ ■ ■ ■■ ■ii ■mm ® ® ©oo�® . \■\\ I�I��m�m ....�m�m�. ■�mmmmmmmmmmmmmmmm \��111 ► ■■■ ■■ ■ ■ ■ ■ ■■ \� ■��� \ ■■■■ ■ ■ ■ ■ ■■ N 601,01111111 k" MOEN less than 30 feet TDH. Iq 10 1 . 1 1 0 LN ME ONE column-explosion proof pump, see FMO219. ■62 ►11, \` i ■ ■■ \� ■ ■ ■ ■■■ 407 1 ■■EM■ ■ ■ ■ ■■ ■�i \i1111 ■ \ ■� ■ ■■■■ - ■ ■11IIIII►l1\ OR NO\■ ■mom , !�11■11►I 1► ■ ■\ \ ■■■■ ON I ■ .11 ■[:�. ■ ■ ■ ■ ■ ■ ■■ M HEAD CAPACITY CURVE SEWAGE ------ - - - - -- SEEN ■ ■■ ■ ON ®o ®,�o�o�o ®om�mmmmmmm ® ®� Noun ■■mom ■imp ®oomo ommmom ® ®mo ®m =mo . S\■■\` \NONE 1 ®�__= ���o� °mmmmmmm ® ®o omomo ■r■1■■►N■■In M INN 1111111111110,111116 go N MEMNON No 1111 Model 293/4293 0 M M N should not be subjected to less than 94,01111 ONE ME i.1111 16 OUR. a s I ,R J I '�3 t � •} G f t k O O �o K a, b 0 I j 9 IC OD o\ ' 9a W�. ' c98 S w C j i 3 14 ► Y � . E - r t t y � t ? C. I I x JrI �'