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HomeMy WebLinkAbout030-1083-10-000 AS BUILT SANITARY SYSTEM REPORT OWNER Atl AC 61ip, 4 TOWNSHIP SEC. - T_N -R W ADDRESS AO - Z ST. CROIX COUNTY, WISCONSIN. h/UDSQti Gins S - VU' (0 SUBDIVISION X 6,6 LOT `o zfe" S LOT SIZE PLAN VIEW Distainces and dimensions to meet requirements of H63 lnl-EVERYTHING WITHIN 100 FEET OF SYSTEM f I di ntie North � A row �' +01�;t� - i SCAL - V , EKT 2f F P IS TV ol� La 'T BENCHMARK: (Permanent reference Point) Describe : Z/& , E piPt sir kA►ens lWe /ixIc ' Elevation of vertical reference point: 100,0 Slope at site: 106 Za � SEPTIC TANK: Manufacturer: WE I S € 4s' Liquid Capacity: 1 poo 614 / /arU Number of rings on cover : Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons V 1 -- t -- r f mn�hnl o nnvnr DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR / "310 SAFETY & BUILDINGS LABOP,& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 • ><CONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number: (lf —ill ad; ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAM OF PERM I r ] ADDRESS OF PERMIT HOLDER ' /`/ -Jyr� INSPECTION DATE: BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: M P7rAPRSW N County: Sanitary Permit Number: n `.J SEPTIC TA / HOLDI TANK,: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COV V - / /� PR ED: PROVI l ! (���V / sf / YES ❑NO O BEDDING: VENT D VE MATL. HIGH WATE 'ROAD: PROPERTY WELL: BUIL G: VENT T FRESH / ALARM UN Z 0 AIR INLET: 1 / l.i ' / k /J LJ S ^l YES O ❑ ❑Y S NO �. DOSING CH MBER: MANUFACTUR ER BEDDING: LIQUID CAPACI P P O P /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: P P DC OLSop RATIONAL PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCEBETWEEN "uNE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO SOIL ABSORPTION SYSTEM. Check the soil olst at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a vv e, co truction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: ��.aeh= "'�'+WIDTH� LENGTH J NO.OF DISTR_ PIPE SPACING. COVER i°e INSIDE DIA.. #PITS. LIQUID TRENCHES. ,�f' MATERIAL' DEPTH: B RA' P� ABOVE COVER. ELEV INI PE EIkV. N DISTR. P E R� L: P PES: TR L RTV WELLj BUILDG. A VEN FRESH MOUND SYSTEM: 3 N 7 L Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteri for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER. TEXTURE. - RMANENT KER RVATION WELLS. YES NO ❑YES ❑NO DEPTH OVER TRENCH; BED DEPTH OVER TRENCH /BED DEPTH OF JO OIL. DDED SEEDED: MULCHED: CENTER EDGES. /' ❑ ❑YES ❑NO [:]YES ❑NO ❑ PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATE AL SP ING: GRAVE EPTH BELO IPE FILL DEPTH ABOVE COVER. TRENC S - k` PUMP M OLD 5T IPE MANIFOLD MATERI NO- DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. L S� "n ELEV.: ELEV. D LE PIPES. DIA.: d HOLE SIZE HOLE SPACIN DRILLED COR LY. COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑Y ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: ❑YES ❑NO ❑YES ❑NO 1'• 33 / �j, 2Z / �• Z Z_ 4 I .3 G %•r3 Sketch System on Retain in county file for audit. Reverse Side. ° + TITLE�� DILHR SBD 6710 (R.01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON; WI 53707 Attach plans for the system on paper not less than 8' /z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Pro erty Owner: Mailing Address: �'Z L�/(� sp. 3 S AVe Ar G l�ovq�v Property Location: City, Village or Township: County: _/ �!• '/a • %4S /T N/R E (or) W sy. OSt � H- T x Lot Number: Blk No.: Subdivision Name: fox'ejQO.AL Nearest Road, Lake or Landmark: State Plan I.D. Number: A* 44A, ,_/1 (If assigned) TYPE OF BUILDING Number of ❑ Public ❑ Variance ❑ Other (specify)* Bedrooms: 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -1N STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE'. INSTALLATION MENT • (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER N MANUFACTURER: Ct/� /S /tIG.Q_ �Q� /AJ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSE (Square feet)• New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ax 5-3 FT• ❑ Alternative (specify) ❑ Seepage Trench Water Supply: / Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plum r: Si e: MP /MP o : Phone NumH@r: Plumber's Address: Name of Designer: Z I Toe 5T rt/o� 11uDS0 A�) W/ S . COUNTY /DEPARTMENT USE ONLY /11 ignat re of Is A t: Fee: �� Date: APPROVED Sanitary Permit Number: l' !L� DISAPPROVED C;� D GVG eason for Disapproval: Alternate course(s) of Action Available: "nge of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stalhition. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHRSBD-6398 (R.07/81) A Ens o •eAee )i3f6eS 1.0 NI y DEPARTMENT OF v,1J REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS LA N his P *� PERCOLATION TESTS 115 DIVISION LA'�OR AND ( 1 P.O. BOX 7969 HUMAN RELATIONS 1 ) �M WI 53707 4. Ind (H63.090) & Chapter 145.045) 4 - ff� �� /�'aR___ LOCATION: SECTION: -. T /MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: /T 3ON /R 19 E (ar) W 5.1- 70 sep/f- jAx A E Z_wx Al e l Ljs. COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 51. (Rd Aar Ric, & G 6"), z/0 Svv, 3 S � Avt . �yi:v��a � %S�/�!/',v,� SS Z USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DE C TI _ I ONS: ER AT ON TESTS: Residence New ❑Replace Dt;T / y f L 1 OG f , ? RATING: S= Site suitable for system U= Site unsuitable for system J(.; 0` ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ® S ❑ U El $ [Z U $ ❑ U El $ U ❑ S ] U Co , U Ufv r1dA1,fL 4-f iV e,00 APE s : 1 6v g: R 'yyrW1ou#L = 9'/5 So •FT 1 ¢� "x 53 Fr• If Percolation Tests are NOT required DESIGN RATS If any portion of the tested area is in the under s.H63.09(5)(b), indicate: 1_ [ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH (N, ELEVATION OBSERVED EST. IGH ST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACKY B Moe 4.4 4��W 2,5.f Aj # &6 e 5;� cs. B- Fr �o„ N 6 sL,iy "� a. L,� -oR• 3 "R.� L " , S C L w i �1'ST, co fro .t! O,P - � y B- 3 //f �.�6 - >11,- 7 sue, s "�R�L�•a sue, y ,� .� D� - 07j � �/� /, "a " � te -G �, y .4v: L � , , "ZY 8A). s; �, -2 ­6A s� 7 - SAID B- S Y 79, '� ?'�o- > ys /0 `4 6 Y. S1, /00 '" Z •'13. . S L. kl -84. SL- - o.9 -"A !N BE st v `w f/gArt-0,0S PERCOLATION TESTS TEST . DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL -MIN. P RI D 1 PERT D __PERIO 3 __PER PER INCH P- 6 0 o 2,n Z P- P- y a o G �o P -_ P-3 15, Z6 5 • P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot �plla Show the surface elevation at all borings and the direction and percent of land slope. &MM OF 4XCi4141f7W 134 d HALL /%� eX,4C7'L y ,2,5 FT, /QQ %dZtT /30g k W .2 SYSTEM ELEVATION gT 6 1nV, -r1,W of 9'a, "T . �F7' / m _ ._._ _. _ E F jrf Lo /il/ -9-4 t P i l �� F 131 i I X C OW _ Q 1 �3 E 3 _ _. _ i p 6G r a of o,AJ -Ais ) PA&,65" DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR LATIONS A ND PERCOLATION TESTS (115 P.O. BOX 7969 SON, WI 53707 MADI �� (H63.09(1) &Chapter 145.045) 19 ,'E,v A(�,�, Avce_�__ LOC TION: SECTION: S H IP /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1 / 1 / 2- A- N /RI? E (or) I TOWN Fox ? cd T i��Us COUNTY:. OWNER'S BUYER'S NAME: MAILING DRESS: 5 . ew /x Pg7" (, I)o L D USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMM RC AL DESCRIPTION: PROFI E DESCRIPTIONS: PERCOLATION TESTS: ITAResidence 3 - v l W New ❑ Replace I Q�� RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN- GROUND PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U ❑ S KU ®S ❑U EIS ❑ S ®U j If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicat Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) // q U � Av yy sue, �s "�,� -6A) . sZ,1 y ,, o,� s�, i� H ��gy. B- (O / l d • �� �4� 7 y CL w ,.cu k 0.v :), '-*o A. B yy "A Ga ,; ,2 „ p,F? .sL w , ff �/oysi � S "yy C / , G y. Sz , c i o -Afo s .g r 16 "oA J'L � S co' k 13A -6,y. S4-, 3 �f , ZY.1 . , �o L S I f /Poc,Pe;(5 Aollza '56Z- !O'' - o,Rsz_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERT D 2 PE RIOD PER INCH P- P- P- P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 1 _ _ - ----- J E , � I Y 4, v4f T4 e+ l j�iax 7 ;V0 0 & Id' Ile; o 77* L _ I N E � E 112 l , i o A +6- , 5_3 v 3 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 1 C DIVISION LABOR V NDLATIONS PERCOLATION TESTS (115) MADISON W 7 (H63.090) & Chapter 145.045) LOCATION: SEC ION: r-. TOWNS /MUNI IPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: N� 1 / �/ l /T J ON /R1 I E I r) W ,-mss f . s�p/)F Foxk ' T P /R/ us COUNTY: OWNER'S BUYER'S NAME: MAI ING ADDRESS: 40/x v USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL ON: AL DESCRIPT PROF LE DESCRIPTIONS: I FSERCOLATI O TE STS: Residence Q `�� New ❑ Replace ���/� RATING: S= Site suitable f system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) EIS ❑� EIS ❑� ❑ $ ❑� ❑ S ❑U EIS ❑U Sic If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Fl i n d icate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- CCU SS �� D B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PE RIOD PER INCH P- P- P- P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. I SYSTEM ELEVATIONI __ �.._ _ ,._., �-A r ,� r !1 __ _ _ g _ .__� E F o _ E 3 'pl1� - � 3 1c ..Jbeiell • �--� 0� /E'�tloLL �� PLB �7 A� & Pi or and CRO �ii S SIDE � SGo�Es T Q iV P A N v4x f. et a � /foR2 • � Co,P,c�£P. gar ipo,v /`- u� EST A&IfoX. boo fr �e /y DA I I � ' �t�FiP�CE Sv(3DidIStQ�J �' D oT ,s 77� I . 1p Gi�v�• lr SAT /o l� o o F 7' 3 fi • � I � � (fo . S vEW f�f I i I � ovc�P9!/ I /o Fr. will AF r/i�PE c SS la AC - for .SOU O I C N d,PAi u f 464P S�f A7� COPE-. P,Po J�E6T Per /Yc T � o � dy f i�PiflS Pi vrSio � T/11� � � \V/ 1S ' �v, -1 a 71 4 See. 2q 7-30 Al A, , / ul M , Nun f 1 ` f �� f,taoloSF a A/S,E" Fresh Air Inlets And Observation Pipe Approved Vent Cap >- S "d f f' 5 Minimum 12" Above Final Grade N i N ► �+0!� 01' 4" Cast Ir nn ST. CROIX COUNTY TONING DEI'ARTMENT AS BUILT SANI'T'ARY REPORT Owner Csw. Address City /State ST cROrx Legal Description: Lot_ Block Subdivision/CSM # ''A & 2q, T—�ON -RAW, Town of PIN # S� - SEPTIC TANK -- DOSE CHAMBER -- HOLDIN�TANK INFORMATION: Tank manufacturer 4.^P Size ST/PC / � t ' _�_ Setback from: House �00 Well !oa P/L Pump manufacturer 'L Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width S Length 7-S' Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark /�lw �r �Bu (o(w ' Elevation Description of alternate benchmark Elevation Building ` g Sewer ST/HT Inlet ST Outlet � t�s PC Inlet PC Bottom (J Header/Manifold , / Top of ST/PC Manhole Cover Distribution Lines ( ) 9 ( ) ( ) Bottom of System 7, 4- 3 ( ) ( ) Final Grade ( ) ( ) ( ) Date of installation crmit number 1 F State plan number 1 ^� Plumber's signatur License number 2 Y, 17 Date Oa Inspector Complete plot plan .r 7Y Are %y SE yy 1 ' VVI a r d dam►- �'.,; t �� ;� �v � ys ♦y m� �c�,r 'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX .GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 315954 Permit Holder's Name: ❑Tity J O VSac�e � Town of: State Plan ID No.: ARLSON, JEFF SS CST BM Elev -: Insp. BM Elev.: BM Description: Parcel Tax No.: Ck �7f l 030- 1083 -10 -000 (IFU l i3Z> � �' a1 TANK INFORMATION ELEVATION DATA A9800342 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S-cl Bench Dosing WveSeV Cub f L3 tA Ig`if1 5-.11. o'l Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet a. Air ���✓ g�'�7 Septic - fi NA Dt Bottom /A ( 12, F 0 Dosing f - 7z NA Header / Man. 7 Aeration NA Dist. Pipe 2 .L,3 Holdin Bot. System 'P. Z3 �3 17 PUMP/ SIPHON INFORMATION C Final Grade Manufacturer Demand Model Number GPM TDH Lift ,1.23 Friction �7 System -Z TDH C ' Ft e Forcemain Length Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM BE / ENC Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Licl Depth l s� DIM DIMEN I NS SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC Manufacture . INFORMATION Type CHAMBER � � �--- Mode Number: Syste ,p I U � OR UNIT DISTRIBUTION SYSTEM q Header /M Distribution Pipe(ss),,, �� x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 3 7 Dia. Spacing r f / �� ('/ i 7 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over i1 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges 12, Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) , 1D'° 9�2 /a ►23 10 O.°` 2 LOCATION: ST. JOSEPH 29.30.19.299C,SE,NW 1374 FOX RIDGE TRAIL X96.27 9S -�fE' wtj pc, Cc�yt3,,� f —F / _ 9`71 U � �a� 9� -a� 3 - ��� f✓✓It.'G w J Plan revision required? ❑ Yes CO Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's nature Safety and Buildings Division • SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue NVI scons i n P 0 Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ,' C/b • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes 11 check if on to previous application [Privacy Law, s. 15.04 (1) (m)). S , n n p State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N W 752-R-7 Property Ow Na , P open ocation �s !�' 1 /4 / /4, 5 t 21 7 T 30 , N, Rt E (or) Property Own is Mailing Ad ress Lot Number Block Number City, Sta e T Zip Co a Phone Number Subdivision Name Number �s�. . ' �l016 ( �) TV _ 3 / z sty IL TYPEOF BUILDING: (check one) ❑ State Owned ❑ !t S e j;;& Nearest Road ❑ Vll / l � Public ER 1 or 2 Family Dwelling - No. of bedrooms own OF of 7Y . III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 99, 30. / 9. a 9qc 030 X063 o 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 le Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System System Tank Only Existing System ________ _ __ ______________ ________ Exlstin�Syrstem 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 21%rMound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] -Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft. (Min. /inch) ,,� Elevation 3 Capacit � 7 � - 1 • ` � - Meet `f / Feet VII. TANK in a llo n Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer r s Name Concrete Con- Steel glass Plastic App New Existin strutted TanksA Tanks � T e — pt _ ic _ Ta _ nk f an X 1 M tt/eCf_Ql ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank amber 2< 4.,-e ew— I ® ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Sign ure: No to MP /MPRSW No.: Business Phone Number: lumber's Address (Street, City, State, Zip Code . 3 �s� J^�' vl IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Is ng nt Signature (No Stamps) A roved SurcnargeFee) ` r pp ❑ Owner Given Initial /r> 00 1 l Adverse Determination V X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 N visconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary July 14, 1998 CUST ID No.639165 FEATHERSTONE EXCAVATING INC 368 TOWER RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 07/14/2000 Identification Numbers Transaction ID No. 117527 SITE: Site ID No. 14863 ST CROIX County, Town of SAINT JOSEPH Please refer to both identification numbers, SE1/4, NW1 /4, S29, T30N, RI1?W above, in all correspondence with the agency. JEFF CARELSON FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 32006 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. There was no cover page associated with this bound volume. Refer to s. Comm 83.08(2)(a)., Wis. Adm. Code. 2. Concerning the mound system plan view, K =11.66 feet and L = 100.33ft. 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. 7 0 ely, DATE RECEIVED 06/30/1998 � FEE REQUIRED $ 180.00 L S PLAN REVIEWER II FEE RECEIVED $ 180.00 Integrated Service BALANCE DUE $ 0.00 (608)266-2889, M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE. STATE. WI.US - i E _ - - - - jo - 6 l a s i _I Ewif(� ! 4� ! L. 4 I r - pP ! ! diti � - ' g ENT Of E P4 1D1 ORD qjs i i j I d 4 a.�►r,�'�e..: �le,,� � ��� �.�' � Nun ; I ! ia AJIF a = CORRECTION NEEDED _ 1' _ Fi) 'h -- - - - - - 1 ..4- - -L _ + _. 1` -T_ -- + -- } -_s.__ -- _ yam, , f r . _. -�•%(� I J L.. – _ .... -r - - -r —I -- ' Qt i , ��} � _L : ` Vv - -- - i J rC Vel -44 i , . , l- -- -- , , sty ff -�- - f : : I ^ i __ _ C� f , A/ W , 3 ; m o ,-t 6��o sic A� - Av sene-t t- ti , , r ave /3 - 7 q .ti �� molds e k C� 5' '(a ,x- J y,-., L A.-Jd .SL( C19:2 .-- OL*o comebt CROSS SECTION 4" C. 1. VENT PI °E —•-+ T 4ATHER -PROOF WITH APPROVED VENT JUNG':OM AQa 2l" t.0. KAtMOfLE *SSEt~ CAP. •25' FROM 12" MIN. i WITH APPROVED LOCKI%G COVER BUILDING CONCUI • 66/lff 5 164 's I � n / k- PVC FORCE MAIN �i 731 APPROVE: J014TS WILL BE USED f vu�s OFF CONCRETE BLOCK y"' ;p ' VERTICAL LIFT: 160"l DOSE VCLuME 04M - 4fGAI DRAINBACK SVSTEM PRESSURE: 2.S' 'uALMOSE j 1 *FRICTION LOSS: PIUMP: �- (2� jyodec 4 1$ TOTAL DYNAMIC HEAD• /q{& y t1vER� A - T 00 FORCE MAIN x j Yy T30 ' • 1,,Q .... k54 P,�-e //Ole sC4�� tt rsisGP��G�t f a 4;7 - r ---- -- . r 3 3 P r, to , ""'a'" HEAD CAPACITY CURVE 3 7/e a 1/4 WO MODEL "98" 4 5/8 S 3 5' Z5 B 6 m + + o 15 - 4 3/16 4 9 to 1 1/2 -11 1/2 NPT 2 S 0 U.S. GALLONS 10 20 30 40 50 60 70 60 LITERS 90 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER M"M EFFLUENT AND DEWATERINO CAPACITY 12 HEAD UNITSOOMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 3 5/16 20 8.10 25 95 Lock Valve 23' I CONSULT FACTORY FOR SPECIAL APPLICATIONS fill e Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. e Mechanical alternators, for duplex systems, are available with a Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs - 1 /2 H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or rouble piggyback variable 9111 Series Control Selection level, float Model YOM-Ph Mode Amps Simplex E switch. Refer to FMO477. M98 115 1 Auto 9.4 1 art &7 — 3. Mechanical alternator 10 -0072 or 10 -0075. NOS 115 1 Nan T 9.4 2 or 2 & 6 3 or 4 & 5 4. See FM0712, for correct model of Electrical Alternator, "E -Pak ". D98 230 1 Auto 4.7 1 or 1 & 7 — 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. E98 230 1 Non 4.7 2 or 2 & 6 3 & 5 6. Four (4) hole °J -Pak ", junction box, for watertight connection or wired-in simplex or duplex operation, 10 -0002. 7. Two (2) hole "J -Pak ", for watertight connection or splice. CAUTION For Information on additional Zoeller products refer to catalog on Combination Starter, FM0514; Ali installation of controls, protection devices end whing shouild be dorm by a gtraYMd pll0back Van" Level Switches, FMO477; Electrica! ARemator ,FM0486;MechaniwlAHemator, licensed electrician. All eMMAeat and safety codes shouidbe followed including the meet FMI0495; Alarm package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Box, recent National Electric Code (NEC) and the Occupational Satiety and Health Act (OSHA). FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. A(AR TO. P.O. BOX 16347 Louisvi k, KY 40258-0347 Manulacfurersaf. . l D o SHIP TO 8280 Old Mrlbrs lane Lovisyk KY 40216 Cw rrP as Sw'cE /939 � PUMP !O (sot) 779 - 2731.1(800) 928 -PUMP FAX(502)774-3624 a, ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently � eI•yilp the G�¢JLL S?�Iti -IV.VE residence located at: t toM W , S W h, Section Z 9 T 30 N, R 19' W, Town of 57 JoSEpIf $�Cc�� Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. O �9.3D•• ZINC Q Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: lzro gallons minutes Capacity: 1252P Construction: Prefab Concrete_ Steel Other Manufacturer: (If known) : W e (S•t/' A of Tank (If known) : ignature) ( ame) Please print e s (Ti e) ( tense N mbe Dat Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection ope }n o ver outlet baffle). Name Signature /MPRS @ Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and kluman Relations A Page–j— of Division of Safety and Buildings Z,;�Kinches dli / yyith s. ILHR 83.09, Wis. • �`` Attach complete site plan on paper not less than s�izzee. Plarfmupt County / include, but not limited to: vertical and horizonta p Y ectiort ind� ST � rQ percent slope, scale or dimensions, north arrow andAocation a to nearestlroad. Parcel I.D. # D APPLICANT INFORMATION - Pleas w xY M 4 083 prfnf all IIf��g�0ih.- 1 ; .,, Re ed y Date Personal information you provide may be used for seco�ry.kurposes (e w, s. 15.04�(1� (�i)). r t Property Owner J / Rr erty Location e rY Car /So r i' .r ^' j � \'� k�ovt. Lot L C 1/4 //� 1 /4,S a� T _?d , N,R If far) w Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /-?7 ,d 7ia. Ci Stat Zip Code Phone Number Nearest Road El city El Village N Town d Ya. ❑ New Construction Use: ® Residential / Number of bedrooms Addition to existing building CR Replacement ❑ Public or commercial - Describe: Code derived daily flow < IS – O gpd Recommended design loading rate • Y bed, gpd/ft trench, gpd/ft Absorption area required 3 "75 – bed, ft 3 7S trench, ft Maximum design loading rate . bed, gpd/ft • S_ trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations 50 �P.1 Parent material n Ir, C - Zi l Flood plain elevation, if applicable ft EUE Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system ❑ s K U 9 S El U ❑ S , U El s ®3 u El S ® U – 1 S �' U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground j / _ /A. S d v tv G W .2 � Depth to `� .�.5� � y r'IS M � �►,/ � +7 _ limiting 5WL90 S �/ .l /� $` i2 �/-� L r S �r • �o factor ,'L in. Remarks: Boring # - i2 313 .:5 d fo C 2 3 o - e cllv M.M Ground ys = 6 13 MIP I o 111 'c C / q c t,✓ P elev. / 4-7 lvlq Depth to limiting factor a,Q_in. Remarks: CST Name (Please Print) Signature Telephone No. - ,7& r-1 I S l iS r5lp -- Address Date CST Number 1/a Ile V ,/ p UL s o�3 N Q i = toP d f G on c,-��e /I /e r �o osier., os NGcJ Corh a *� b a. Lk 8S 9 Tra, I t l S/ - o clec �c b DU POS eJ , si n � 0 to" 99 .2 7t, S /ore &3 QM r n � Cr �so'1 J, a l37�/ . -PoX 2 ,'c�9 � Tad 6T o /v /iDkliel, , t T, S — VO9.z 7w,, e 07/29/98 WED 17:02 FAX 6129818802 Carsource Q001- From-:-Todd Fea hersione To: JEFF CARELSON Date: 7129/98 Time: 16:51:55 Page 1 of 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ,n a / /NEMHIP =TIFICATION FORM Uy+er Cam[ f'r�r Mai ft Address Prop«ty Addre m (YarifMdan nxpirod fm m Planaing Depanoml for ncw coamtcuot aa) c;ity4taft 9o-& l•L� ` Pa=t i dentifiowian N=dw O ©— /08 -1 O. LEGAL DESCRIPTION Propddy I�oaatioat V.. Y < <, See- T "Mr p SsiibdivWon Lot # Card 6m vey hfap # 3 . o d ` Jl0 Volume _ Page # ZL WSrr� BWA ; _ �a x.13 _ Vohmme Pago # w3es 0 no Eat tines idenEifnble OW yes Cl. no toosaadmaamamaaeeof] roartiecys0rme, oaidasmltfa its � •esoat�r�' evlsaa�cws�es P�upesmazr:e ' of pnmpmg outdo sepeio u* cvay ibma Ycw dr aees4 if smoe;lded by a 1i*0sedpaMvx Wbat Taa pa! 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LSIGH ATIM21 AZPL=AW DAUB OVI NM ER I ( ) dZU eu gbft=Cnb OU his fflUR aro t=ao to du beat of my (obr) deaesWle ge. f (We) sm (ato) ehe `aaoe:(s) 4 d' tbG abam by vitae of a wamk s ty deed new&d in Regisirr of Dodds OMcd. 91 f APPrICANT DATE •se+e+wri ia l ionnaWa That is ads! rewAtedmy = t at else sanitary pemait being ;Z by GO Zoning Dgm m=L ** iaelse�e Ritb this tioa: a a mpesd wanaaty dwd ft= do Rezinct of Doe& offim a copy of ffi¢ omd&d savey map if sefex+mm is wade: in the waroeaty decd n �.. FORM N0. 985-A MGNMI.r Canprry® Stock No. 26273 $2468 CERTIFIED SURVEY MAP LOCATED IN THE SE1 14 OF THE NW1 /4 AND THE SW1 /4 OF THE NE1 /4 OF SECTION 29, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN _LOT < M — 4 — � CERTIFI -SURVEY 1 m fn) SCALE IN FEET V.3, P614, 349471_ IOZI ID�I I v 1 0' 2 00' 409' _ — — — — S 89 20" E S 0 66 cn 1.5 5' � w N oN O D wo S 86 056'38 "E M 33.00 ® Q L• 3 W Lu C OD a Q � , 41 I z Z w `� ® � 6 q&' \ V A CAI I m - b` p N y.. Q \y N m co 9 0B 0 cn c I _ o w •S O , y' I N N APPROVED i v W N CA _ - LOT 9 0 Nov z 17w N C IO.OIAC.± 436,181 S.F.± ro - I N CLU DING PRIVATE ROAD C " +. C`?JiX Co-a: i ; - CA 9.53 AC-± 415, 198 S.F. ± Co PARKS PL IN'iING EXCLUDING PRIVATE ROAD a N A >T .1 OD i �- E 1/4 CORNER _ SECTION 29 O T30N,R19W N 89 45'46 "E 2024.46' OD S 89 804.4 6' ^? 622.46' 182' EAST -WEST 1/4 SECTION LINE W 1/4 CORNER POINT OF BEGINNING CENTER OF SECTION 29 SECTION 29 T30N, R19 W UNPLATTED LAND T30N, R 19