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034-1022-70-000
PAGE OF G ary ?- .Ar(4.h0Ooc� CROSS SECTION OF A BED SYSTEM SOIL FILL 2-" OF AGGREGATE DISIItIBUTIOIJ PIPE -I APPROVED SJAITHETIC COVER MATERIAL OR 9" OF STRAW OR MARSH HAy /-\\\ 4o' OF %2 - Z'/2 , AGGREGATE . � 8 ELEV. OF FEET_.. DISTRIBUTIOM PIPE TO BE AT LEAST 16 IiJCHES BELOW ORIGIRIAL GRADE ARID AT LEASTZO ►RICHES BUT NO MORE THARI H2 INCHES BELOW FIRIAL GRADE MAXIMUM DEPI - H OF EXCAVATIORI FROM ORIGIQAL GRADE WILL BE 1 �'�.- IRICHES MINIMUM DEPTH OF EXCAVATIORI FROM ORIGIRIAL GRADE WILL BE INCHES SIGHED: a "' LIGEMSE WUM5ER: DATE: -Z/ rckn 0 V I C Y1 a� X15 Lj 2S' 3" SV ID 40 3 X Or1 *N, 750 Gj Pur1p Ch<m�cr 1 000 „\ l4r k U 1 t (.Jell - Top OP(Je11 loo 10 o.crc. P O rC e� VCD ti Page _ Of _ G CL r �� C"� rq h o v 1 Perforated Pipe Detail 0 End View )Perforated End Cap ,�' PVC Pipe � deg Holes Located On Bottom, S Are Equally Spaced \ S • w PVC Force Main From Pump .7 PVC Manifold Pipe Distribution Alternate Position Of Pipe Force Main From Pump Lost Hole Should Be Next To End Cap End Cap Distribution Pipe Layout P � 3 R �� S X Y is Signed: & ZI,,. Hole Diameter � Inch License Number: Lateral I Inch(es) f y Manifold - Inches Date: ,r / ,� -- ,9 —T Force Main 3_ Inches Bulletin CL2.1A July 8, 1983 • For Homes * Farms Trailer courts Model 3885 0 Motels (Supersedes Model 3870) Schools . , -- Submersible Hospitals Effluent Pumps Industry Effluent S anywhere effluent or drainage must be ► "' disposed of quickly, quietly and efficiently. Heavy -Duty Solids Handling Dependable Capability to 3 /4 " 1/3 11 H. P. 60 Hz I Single Phase 115,230 Volt. I � !� /liil��l • , i�t:i ;Illl;.ilf(_�(I.� 1 /2, 3 /4, 1, 1 H.P. 60 Hz 1�1 ,1:., 1 , ,,,.., ii 1!r ,n I n ii i. I 1 I Ill llllml, Single Phase 230 Volt. Three Phase 208 -230, 460 Volt. h 11 : I _ I:+1,1 ,. . I 90 _ -. ,__ �'�1,.It 80 70 , mopg� 3845 W uN 1ON 170,0450 4 60 W 50 Q 40 3� - _ '._ __.._ �• '"^' ii�:.l.l�, I �.,. 1 „null, ,� I i 111 wEO3M p 0 20 SPECIFICATIONS ARE SUBJECT TO CHANGE 10 WITHOUT NOTICE. 0 $ 0 10 20 30 40 50 60 70 80 90 loo 110 120 ` [QGOULDS PUMPS. INC. GALLONS PER MINUTE SENECA FALLS NEW YORK 13148 ` r PAGE OF PUMP CHAMBER CKOSS SECTION A JD SPECIE ICA110MS VC MT CAP H% .I. VENT PIPE WEATHER PKOOr APPROVED LOCKING l __ 25' FROM DOOR, JIIAJCTIOA! BOK' _ J MANHOLE COVER WIWDOW OK FRE5H 12 MIL1. Atli INTAKE - GRADE I - `I" M11J. 18 "MIN. \���� ---- -- -� -- PROVIDE IAILE T AIRTIGHT SEAL I APPKO`JE U JOINT A I I APPROVED JOINT, W /C.1. PIPE. I III W/ C. T. PI''E EX'UNDING 3' I II ALARM EXTEFJDING 3' ONTO SOLID `;��IL_ I II ONTO SOLID SOIL Ila ; ► ON c►tv X15.33 PUMP - OFF CONCRETE BLOCK Ito 903 KISEK EXIT PERMITTED GtJLy IF TANK MAWLIFACTURE -R HAS SUCH APPROVAL SPEC.IFICATIOKIS - -PTIC AND 1 , )SF TAgw MANUFACTURER: tJUMBEk OF DOSES: _ PER DAy lAWK SIZE: _1_,Z_Q _ GALLOIJS DOSE VOLUME: - GALL ALAK MANUFACTURER: _ CAPACITIES: A =_! 7__I►JCHES OR 319 #9 GALLO"S MOULL FJUtAbER: _ 8= 2 _' INCHES OR 2-14 GALLO SWITCH T!JPE: / �hy C= - 1 - 5. 1IN CHES OR 216 GALLOAIS PUMP MANUFACA UREK: _ lr b . 1 Y S D= 1 n INCHES OR 170, 1 GALL01.15 MULIEL NUMBER: -I�oL S LS WDTL: PUMP AND ALARM ARE TO BE SWITCH TYPE: — 4f - r( .�•._L/ IMSTALLED ON SEPARATE CIRCUITS PUMP DISLHARGE RATE: / -- - 7 GPM VERTICAL DIFfiERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. P ) FEET + MI►JIMUM METWORK SUPPL4 PRESSURE . , , , , . . , , _ 2 . 5 FEET + — _ FEET OF FORCE MAIN X ��f F rirr.F KICTIOkI FACTOR,. ,?5 FEET -- TOTAL DtIWAMIC HEAD = _L4! M FEET 74 t 00 s4 CXI �MC1c�" IJJTEKAIAL DIMEWSIOAiS OF TA1JK: LEKIGTH ;WIDTH ;LIQUID DEPTH �) I t l�{,7 O J «Q /I WORKSHEET - PRESSURE DISTRIBUTION NETWORK DESIGN PROBLEM Design a pressure distribution network for a bedroom home. The site characterisitics are: Depth of groundwater or bedrock in. Landslope Percolation rate min. /in. Distance from dose chamber to distribution system ft. Elevation difference between pump and distribution system ft. Step 1. ESTIMATE WASTEWATER LOAD Step 2., SIZE THE ABSORPTION AREA A) Area required B) Select length 2 C) Width is r D) I will use a -vL manifold. Step 3. SIZE DISTRIBUTION PIPES A) Hole size I will use is in. B) Hole spacing I will use is 3 C� in. C) Lateral length is 0_ ft. D) Lateral size in. Step 4. DISTRIBUTION PIPE DISCHARGE RATE Step 5. SIZE MANIFOLD A) Manifold length ft. B) Number of distribution pipes = C) Manifold diameter. �� in. f Step 6. SIZE THE FORCE MAIN A) System discharge rate _ B) Force main diameter C) Friction loss will be ft. /100 ft. Step 7. TOTAL DYNAMIC HEAD A) Vertical lift ft. B) Friction loss ft. C) TDH = ft. Step R. SELECT A PUMP Step 9. DOSE CHAMBER SIZE Step 10. DOSE VOLUME ISO x S o C!" �r< a - 70 'f DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION BOX LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISIONNAME: NE 4 S , / t o /T 29 N/R 15 E (or Springfield COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St, Croix Virgil Larson RR USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I S: A TESTS: ®Residence U nknown N/A New 1E R t 9/13 9/15/62 RATING: S= Site suitable for system U= Site unsuitable for system 111 CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: rYSTEM-1 N-F I L L HOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS ❑X U 0 S ❑U ®S ❑U ❑ S DU [:]S ®U I I n- Gro P ressure If Percolation Tests are NOT required DESIGN RATE: SYSTEM I If any portion of the lot is in the under s.H63.09(5)(b), indicate: 103 t 4" Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS AMC (Amery) S&il map sheet X56 BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. G HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -1 60 104'-101 /c 83 54" 10* Bl sl 36* bn sl 14 al B -2 72" 105' 4" 5 8* \ 9 * bl sl 41" bn sl 22* el B-3 72" 105 • 58" 90 blsl 36" bn sl 27" cl B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWEL NG IN RVAL - MIN. PERIOD 1 PERIOD2 PER PER INCH P - 1$ 0 5 No /o _13- j 0 1 I 1 20 P- 2 2011 4, 4 7 No - 0 o 4 4 7 P-3 * ,00 No a6 3 3 3 3 P PLAN VIEW: 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 .p1an - the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION Z 0 jo 3.3 3 f E cF L INt . -_.. , Rk PW . P 3... � o ScAlt (h Q . Rn } POA0 OF ; REPORT ON SOIL BORINGS • AND S AFETY & sUIL INDUSTRY, DIVISION LABOR AND `; ,PERCOLATION TESTS (115) nnaDlsoOiv BOX 3�o HUMAN RELAT1 L OCATION: SC TOWNSHIP /MUNICIPALITY: LOT NO.: r LK. NO.: SUBDIVISION NAME: �/ S V T29 . N/R 1.5 E i.,KW Spr ingf i e 1 COUNTY: 8R' iU " E 'S NAME: MAILING DD S St. AX 3. -rgil .!..arson 11SE DATES OBSERVATIONS MADE NO. B DRMS.: CO A DESCRIPTION: ` STS: FIFIE Residence s EI New I 1 �)n 3Wn 1,J ®Replace ,'l13 /d 9/i RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: S S EM- IN- FILLHOLDING ANK: RECOMMENOED SYSTEM: (optional) ❑ S ®U 0 S ❑U S ❑U ❑ S ®U E] S ®U I ln�Ground Pressure If Percolation Tests are NOT required DESIGN RAT< :. SYSTEM If any.portior of the lot is in the under s.H63.0915►Ib ►, indicate: 103 '4A . toodphain, indica Floodplai e l e vation: f PROFI LE: DESCRIPTIONS I'I;P4G -2 (11,14r ) Sbil map sheet #56 ,r BORING TOTAL DEPTH TO GROU N DINATER4 NEHES E A ACT R OF S IL•VWITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0 B -1 60 10 4 'v10 54 " 10 " .B1 S 36" n s 1 14 01 /v B -2 72" 105' 4" 540 9" b.1 sl 41" bn -s1 22" el B -3 7 2" 105• /os 53 " 9 " blsl J6" bn al 27" al B- B' _ PERCOLATION TESTS TEST DEPTH WATER IN HOLE T TfiIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFT RSWELLI`NG INTERVAL -MIN. P RI D RIOD2 R -PER INCH P -1 1 e �'� ,ip ! 1 0 1 1 , T 20 P- 2 20- 1.0 113 30 4 4 4 71 P- # a °To 30 3 3 j 10 P l P P- PLAN VIEW: 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 slop. SYSTEM ELEVATION 03 S' a Uj .. t � Form - S 'T C - 104 AS BUILT SAN iTARY SYSTEM R OWNER A trg4 n ov, ' eA 'TOWNSHIP to SEC. 'T _aN -R 5' W ADDRESS /r I4-Le) ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I V r `90 w I G rt 4 i O n � INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used TO 0 f k/ ll _P,ARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS _ABOR & KUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 1 CONVENTIONAL IXALTERNATIVE E Plan I.D. Number: assigned) ❑ Holding Tank `M In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE Gl PetAanovich R. R. 1, Gtenwood City, WI ID 3� - 8'y 1 2 1 o d BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF, PT, ELEV.: NE SE, Section 10, T29N-R15W, Town o6 Spki.ng6ie d Name of Plumber. MP /MPRSW No.: County Sanitary Permit Number: Stephen Al 5184 St. Croix 54983 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LSM P OVI ED: PR `t5 `�- �(- -' ES ❑NO NO BEDDING: VENT DIA. i V NT MATL.: HIGH WATER NUMBE O ROAD: PROPEFFFjjj,,,TV WELy: BUILDING: VENT TO FRESH ALARM: / — NE:" / LAIR INLET: O FEET FROM LI ❑ YES ❑ O ❑ YES ❑ NO NEAREST . DOSING CHA ER: MA UFACTU DER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPH N MANU 1RER. VY G L ABEL L , O OC CKI � NG COVER ¢°td�'� ❑YES ❑NO 7Sa L) 05 ��^ -"�`S S ONO P L�SYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER O PR OPERTV WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN < FE FROM LINE JAIR INLET: PUMP ON AND OFF) I l / YES ONO NEAAEST l9 Yz SOIL ABSORPTION SYSTEM. Check the soil moisture at th depth of plowing FORCIs LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN, CONVENTIONAL SYSTEM: WIDTH ILENGTH . NO. OP DISTR. PIPE SPACING. COVER PIT INSIDE DIA.. #PITS: LIQUID TRENCHES. MATERIAL: DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR NUMBER (}F PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET. ELEV. END. PIPES: LINE: AIR INLET: MEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES El NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ❑NO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL: SODDED SEEDED. MULCHED. CENTER. EDGES: OYES 1:1 NO ❑YES ONO OYES 1 NO 'RESSURIZED DISTRIBUTION SYSTEM: T ' $ WIDTH. LENGTH. NO.OF LATERAL ACING. GRAVEL DEPTH BELOW IP FILL DEPTH ABOVE COVER t71ir "N(.t TRENCH S: �/ Z MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR PIP) DISTRIBUTION PIPE MATER L & MARKING: ELE ��// ELEV' DIA. ELEV. PIPES_ DIA: .E � tkAN a7�� 1 /03.� /�� OI.[RBI1iT HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED I z R PLANS: " YES ONO / YES ONO 4MENTS: PERMANENT MARKER OBSERVATION WELLS: NUMB OF- PROPERTY WELL: BUILDING: - FE°t" LINE ❑ ❑ YES NO YES RE l3:T 1 .03 � 4�i 14 _�; 6 . for audit. Ole ESINAT � LE: it /82) unsc°^si^ APPLICATION FOR SANITARY PERMIT (�IDI C,e� / �( C OUNTY oEPRRnTOR (P � B 67) UNIFORM SANITARY PERMIT # MIO1JSTRV .LFV3M&1_MJmCir/F7El1iT10r15 7 ) •� — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS /�� �- !,') s'�/O /•3 IL P - = 4•a r v 1 G �. / PROPERTY L ATIONq: 114S 1/4, S / ,';P , , N, R /.5 (or) T N OF: ro Ie'/�H LOT NUM ER JBLOCKNUMBER SUBDIVISIO!p NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER � s Q.a.�l �y 0 3 8-4/ 7 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 [� Public (Specify): THIS PERMIT IS FOR A: ❑ Tank Replacement ❑ Repair . Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank ❑ System -ln -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound .ice. In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity f 4010 Lift Pump /Siphon Chamber SG! Manufacturer: 6 'S G0 G 0 PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 0 Private ❑ Joint ❑ Public Z 11 I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatu MP /MPRSW No.: Phone Number: T.' A x'k L A � • t � PlumberT Address: r Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El Disapproved C 'I ��� `/1 El Owner Given Initial � ,; y34tW / .� O Q 7 Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DIILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber • D I L H R APPLICATION FOR SANITARY ARY PERMIT re+ � l�� �� oewaraTmenT oc (PCB 67) UNIFORM SANITARY PERMIT # VMEN� WIOUSTRY, LRGOW 6 h rnf%n MLATOnS — Attach complete plans in accord with s. H 63.05, Wis. Adm, Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION 1 /4s 1 /4, S 0 . , N, R/ .rig WA TOWN ` OF : Rol + rt / r.L Gt/ LOT NUM ER JBLOCKNUMBER I SUBDIVISIO NAM E NEAREST 4ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER .1pt 57T c of+7dC TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FORA: ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modifica IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ 'Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ 'Holdglkank n System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy El p 1yy J`7v4 ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System Thai Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site g +� t. Plastic rrtt Gallons Tanks Concrete Constructed Steel Fiberglass Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity r r r Manufacturer J IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity /,0+©© Lift Pump /Siphon Chamber r'o Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): O ® X Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP /MPRSW No.: Phone Number: Plumber' Address: Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 71 Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DiLHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber rw Safety and Buildings Division -(��DILHR PLAN APPRO A Bureau of Plumbing P.O Box 7%9 o ❑ General Plumbing Pla dison, WI 53707 Private Sewage Plans 14 61 G Fu r ephone: (608)266-3815 2 */,y, 198 ----- ------------ ------------ mill Project Name Project Location - Street No. or Legal Description G ❑ city ❑ Village Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. if construction has not commenced before theexpiration date, new plan approval must be obtained. X FOR PRIVATE SEWAGE PLANS: This approval will expire two years from,the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director zz If Questions Plans Approved By: Date A pr ed: Contact 10 cc: S DPS El H&R & Rec. San. Date County El ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other SS0,6670 (9/811 Mb 100a) Cj q : ST Wfl and . And ° iturn - or . lv�► '; Pe�rtn Of this Farm Wit �.. BttiA1J'OP PL � �� FCC, •� ays �_ DATE:' 06/26/ j PROJECT:.. Petranovich, Gar - Residency .4a(g) T NE,SE,10,29,,15W Tn Springfield Aaby- Plulalbing, Heating & E St. Croix WI 124 Main Street Woodville, WT 54028 PLAN ID. # 84-03847 DETACH HERE` Petranovich, Gary Residence 84 -03847 _P R OJECT NAME PLAN ID. This is #a a�cnolrrr rac pf a fyour Mans and specifidaflons forth> a vg4ndicatad pre*t x k Preliminary review indicates the required fee is $ 40 Fee_Received !s'$ Underpayment ,- Please submit tl additional fee. Overpayment — Refund forfroc+ati Plan accepted #tir review,, Plans being returned.:.` ; No -fee has been remitted.Plarls submitted with.no femwill be Additional inforrfiation4kWilred, hell in rc l Plata iiorar ❑ Cornplete data relattcxe i a © Aa drtu i inforrr+aticin sfi "all.be submitted in duplicate un- Q2 copies of PLO soar bse�� � � less,specifically noted. ❑Deed restriction required . � � r � a [Q Plan not legible or , permanent. ❑ Condominium declaration,."t ❑ i trtfcrrtnation submitted shall be signed, dated and, sealed or stamped rn.aaco rd with *action H 63.08(2)(a) Wisconsin " .�0`' ° ;§ Admttllstratrve mode. ❑Affidavit enclosed..: !V. Holding Tanks ❑ Profile of holding tatnC shoes i .aar nd „ , manufacturer if precast.' Co�dt rleiai sf #1 , Distribution Systems (Mound or In Ground Pressure) site constructed.. ❑ plication for: use of art alternative system si ned b owner y 4 9 y ❑Holding tank agreement stgne by ariClcatr4 o Ap f ai afcd notartzecf:. €'1 capyl government (sample anal© dy € 4 t . ❑ CaUnty 'requiread r1° fir). ❑Design calculations ❑Reason for installsng".hs�#dsrt$'tt1�i# slat' t ; for pressurize distribution. ❑ Soil boring & percolation f county {1 copy) test &; © Plot plan showing locatlor► of nl� la ey(t• ❑' Cross sec low f e % QPipe. lateral layout. s to any buildxnq, llr� rig; tAlter ❑" Plan system PIC1 pan. p r .. .. � !� l ;r _� rte; tot hnes,�' ❑Vert#icattsan of deption Status Form by County. (1 copy) Eta. Provide bencr+lPd!bur� y5 D y�e i Private PtStsa( ;l't15 �' • V. L © Calculations for" total lift' ❑'Grout l'slope Wcittt 2` sin entire area'vf'soil, absorp lion system extendir 2S` on all sides: a gins pumped per cycle: " . �} Elevation of permanent reference, point (benchmark). ❑'Size, length ' & depth'of force tnai;nk ❑ Lckaltiorr of area suitable for replacement system - ''provide ©Detail &mode( of purinp or atrEt►nlatic slphotts trtlEtng soil data, size, pump ctitrves dravrwn 04 Graf assts �E ❑ Plot plan .showing lot':stze and all lateral d►stancBS from 0 ross section of lift pump ta0kr,. � o ssvve' disposal,: system: to buildings, lot lines', well „water, siphon(s)•' v ' course, twicnming pbol5 water service piping, Etc. ❑ Cbnstruetton detail' of septic, holding or lift pump tarns if i sit arddr ucted- or if precast. Vl - Systems'In Fill (Fill rn tbe� c� er p Cotrttrufoh dad <triad' rosssection of� "'sail absorption' ❑ Tot at area ; filled:(fN,." t, sj( _' before. side scope ;' ❑ Soil boring 5 i;p cola ion. test on 115 or�m� bw by cer- ❑ f Uspth and type s it fi11, i , titled snWtesCer ff `Colxlr} ❑'Copy of on$rte i ll ` PLAN APPROVAL Safety and Building Division � DILHR Bureau of ..umbin ' P.O Box 7969 s El General Plumbing Plans Madison, wl 53707 Private Sewage Plans Telephone: (608)266 -3815 - ------ --- Mae , Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village Town of: .1� � ���., \ , C Ro \ ?C The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved ". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the departments approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. �I El FOR GENERAL PLUMBING PLANS: 4 b This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. X FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent 7 Bureau Director If Questions Plans Approved By: Date Appr ed: Of Contact cc: ❑ DPS ❑ H &R & Rec. San. Section Z � � County ❑ Local PI ❑ Facilities Need Analysis Secti , ,n ❑ UW -SSWMP ❑ Plumber ❑ Department of Agriculture DILHR -SBD -6099 (R. 01/84) ❑ Owner 11 Other APPLICATION FOR SANITARY P T " " DIL HR" (PLB 67) U SANITARY ANITARY PERMIT # - DEPFlR„Tr71EnT OF .. H'IOl{STgV, {.g9S/Q 6 MIJPMdn iiElPT10n5 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/ x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS 7"0 1"1 .00 L t C A L.rAIL w ® 0 40./C1 T C.v, .s`/a/s PROPERTY LOCATION P 114S 1/4, S A . , N, R, Irll (orA TOWN OFF: 3 , 0 0 A/ N I A l 'r LOT NUM ER JBLOCKNUMBER SUBDIVISIO NAME NEAREST OAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER lic ,s' / / -G o-oW TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: J ❑ Public (Specify): :J THIS PERMIT IS FOR A: # ❑ Tank Replacement ❑ Repair JUL Replacement Soil Absorption System ❑ Revision ❑ Privy 6 98 El Alternate System ❑ Reconnection ❑Petition for M i 'cation J IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. El Seepage Bed ❑ Seepage Trench F-1 Seepage Pit ❑ Holdirig- wj ❑ ' "`' .System -ln -Fill El Ln- Ground Pressure ❑Vault Privy Pit Privy ❑ Existing, For Which AP%164 1Permit Is On File, Permit # issued An Existing System That Has Been inspected And Is Compliant As Far As Soil Conditions. JUL 61984 Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity r. Lift Pump Tank /Siphon Y t r_a.l ''� 8d u Holding Tank capacity - Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: F Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon ChamberQ Manufacturer: " Odw G li' PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 01 '0 - '0 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown.on the attached plans. Name of Plumber (Print): I MP /MPRSW No.: Phone Number. Plumber' Address: Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial __J Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: JUL - 6 1984 ©ll,HR -SBD 6398 (R. 5/82) 'DISTRIBUTION: - Original to County, One Copy To; Bureau of Plumbing, Owner,SAMTY & g�- - EZ::: APPLICATION FOR SANITARY PERMIT 'r OUNTY LHR (PLB67) UNIFORM SANITARY PERMIT # 6..,,,.n..L. r / / � ry �q 3 7 a Y V 'S — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ®' �! � /, ' j � I , f� 7` d'-1 1 1 L,r� . a a 6 Y PROPERTY LOCATION 4111w: 114 1/4,S /A , V1, N,R / S'll (or) TOWN OF !-! 0�l.� LOT NUM ER IBLOCKDJUMBER SUBDIVISIO NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 1.19 -r1f s7 'c le ®.qw , a 3 S'h� 7 TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound .�<In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity f ©© Lift Pump /Siphon Chamber r47 Manufacturer: 'S C p y C j %, jr_jj_ PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): O Q Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatu MP /MPRSW No.: Phone Number: Plumber' Address: r Name of Designer: z 4 1 ,,4 vA 7 � a cs ;�G� Gu I " ��� T A ti COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: f Date: El Disapproved U�� O 7 A pproved ❑ owner Given Initial (� Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 11 a r •� ?f.� ran o U lc � -�- -Q n ►�,� S c, ► q e- cA , o' Lj x9c��.�r d� . I o0O T,. k c .� 0to . 10 c,crc pa rc c Ir. ► CcnSC. G a r.I t r h V t 3 "' Perforated Pipe Detail t I • N aW t- � , p J J End i Partoroled i ` End Cop 1� PVC Pip e K � 4 d� oc , a r, V�s�a Mol" Located On Bottom, S Are 'Equally Spuced \ � S X Q PVC Force Main From Pump PVC Manifold Pipe Distribution Alternate Position of Pipe Force Main From Pump Lost Mole should Be Next To End Cop j End Cop Distribution Pipe Layout P 3 R (� S _3 3 X Y Signed: � � /' Hole Diameter Inch �./ �y Lateral t' it Inch(es) License Number: `'� Manifold 't _- Inches Date: `/' / —�— 3 Force Main tt 3_ Inches �Lt — „o PAGE OF o ;ec. c •1, dam ,,, _ C: KO IJLCTi K"l } A BLD 3 J TLM SOIL FILL Z" OF AGGREGATE D15 KIbUI IOKI PIPL - APPKUVEU b)UMYHETIC COVEK MATERIAL OK 9" OF STRAW OK MAKSH HAy �,. � n o lj�. (oUF % - a /z AGGKEGATE ELVV. OFI�FEE --.. = , DISTRIBUTIOtJ PIPE TO bE AT LEAST __0 IKICHES bFLOw ORIGi"AL GRADE AUD AT LEAST?-0 IKACHES bUT 1.10 MOKE THA►J LIZ IKICHES BELOW FIIUAL GRADE MAXIMUM DEPT 11 OF EXCAVATION FROM OKIGIIJAL GKADV- WILL BE _ IKICHES MINIMUM DEPTH OF EXCAVAIAOM FKOM OKIGIWAL GKADL WILL 6E INCHES LIGEMSE KjUMBER: ' DATE: mg9 ,_'..• ( '.� '� �' � �O. 0AL, C C) F PUMP CHAMbL K CKO55 S[CTIOM AhJD IL'Al JUKJ'; VCIJ CAN W C A I 14L K PKL)br At'VK0VLD LUCKING WHOLL CCJVk:K FI<C/I\ UL,(,K, -T WIMDOW OK FR 1. 5 H AIM INTAKE t;KAL)L- 4" MIN. ) DUIT ' IN IAN 14 k 1 AL r API'KU\JLIJ JGIN A -ioiN W/ C . 1. P I P E A LAKM LXTLKIUIWL. 3' OWT(•• LUL-ili '.GIL, UKI SOLID 40 G COLICKLI L bLOLK — - - - ----------- L) q 3 3 -- -- -- - - -._ __ _ -. -X- K15LK EXI IILKMIII'LU Cj"LtJ IF 1A) kiilti -'jUL-H AIIVKL)VAL SPE I F I G A - 1 - 10NJS I'T I C A N LJ T LIKE M A ki U f A LT u k L. K DA.'j TAWK '..ILL 6 A L. L. 0 �J S DCJSL VOLUME: &L-kKrl, MAkILI J ALT U K � k: r A= .-X,-IIQLHL, OK -IS-,9- MCibLL kJPtAbLK: 19.4GALLOW.1 IkjL.HL � OK -- — SW T J 1 f.; C, CA c IMLHL4 GK 2 GALLOMt I'llml M A W I I I A( I L J K L K'. --L Lts- �.-Q,� L D I KI L ii L � L, k< JILA- GA L L 01.1` L � L L kJ U M 0 L K'. ( �) EL� HO I L- I'LiMl' kKIL) ALAKM AIAL - 1 - 0 GL Z)wllch lUt)TALLLU OM SLI'AKATE CIKCUITS Fu(AP DISLHAR"L KATE. ------7 2 — Fm VLK 0Ikk0(LKiLL bLTWLLU eUtAl' Off- A►ID bi..)1 Vil'L.. P) VLL ♦ MWIMUA NETWORK SLJPFI-4 VK[ + 70 F OF FOKLL MAIN I FEET JUN 2 611984 TOTAL UtJIJAMIL HLAD = FLLT v, - 7 ,, e4 0 s4t IWTLKWAi- 0IMLW!4icWE OF TAQA: _-WIDTH -LIQUID C)CV-fH Bulletin CL2.1A . July 8, 1983 Fo H ofrius Farms Trailer courts Model 33$5 0, Motels (Suljulsudus Mudul 384 Schools r Submersible 4 Hospitals Effluent Pumps Industry' I Effluent Systems anywholu effluent or drain► age m ust bu „ disposed of quickly, quietly and efficiently. I it Heavy -Duty Solids Handling Dependable Capability to V4' i Ya 'h N.P. 60 Hz I� {......u,.. IJ1Y Single Phase 115,230 Volt. ' h, 3 14, 1, 1 H.P. 60 Hz Single Phase 230 Volt. Three Phase 208 -230, 460 Volt. 1 11.,,11 1111 ,. JU .. .... Ito w 44 1 1 �1 1111 ill 'I I MOPk� 311U4 fit M 1140/4140 w h eU - ......,. _ _.. _ _ _ _ _ ^......._ � , , t:Q N Uj 40 �r�►�t1- ,,. ._,.- ... ...,.- - 11 1 I I 1 ul Ir 11 .. X111 I ..1 11. 1 I Ll WEUUM 3u 7'1 r y�,. .1 •� Jt .- �,.... , ....� .�. .. .. .- .. ,._ .. .......... ....... - I r WIIII�1 I NUIICLIiL ;WJECI IOCIIANGE lU { -. U U ' - 0 20 30 40 so su io BU uo too 1110 120 'L�GOULDS PUMPS, INC. GALLONS NE11 MINUTE `.�Lra CA 1-ALtS h W Y(A4K IJ140 f / I INDUS TRTMENT�JF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION HUMAN NDATIONS PERCOLATION TESTS 1151 / P.O.`BOX 7969 MADISON, WI 53707 LOCATION: SECTION TOWNSHIP /MUNICIPALITY: LOT NO. BLK. NO.: SUBDIVISION NAME: N a 1 / s t /1 .)9 N/R 15 E (o s py i>:t8n ld COUNTY: OWNER STBUYER'S NAME: MAILING ADDRESS: St. Croix Vir6il Larson � k(h USE __ DATES OBSERVATIONS MADE NO. BEbRM_ S COIVIMEni lA escffiPTION: I - WOrIL�6ES 'ATPT)_ M,; a VM ATITESTS: Residence �Unknjwz I N/A -- NewRePtace 9/l j/d2 9/15/CS2 RA S= Site suitable for system U — = Site unsuitable for system CO N NVENTIOAL MOUND T IN- GROUNL)PRES --URE SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) �U — L� ❑U s ❑ u S_�U [- EY-1U in- crou rrusyura ll Percolation - T asts tire NO (ree ui,erl DESIGN RATE: SYSTEM ALE 1 If any portion of the lot is in the under s.Hb309(b)(b) indicate: I jt( p — — 10' �� Flood lain, indicate Fluodplain elevation: PROFILE DESCRIPTIONS 102 -2 (Amovy) .Sddl map dheet #56 BORING1 TOTAL f' 11 TO (R UNDWATER INCHES CHARA ER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEP H IN, ELEVATION 013SEIIVED EST. HIGHEcT TO BEDROCK IF O BSERVED (SEE- ABBRV. ON BACK.) B-1 60 104'..10 54" 10" 131 al j6^ tin sl 14" 01 lo5 \ B -2 72" 105' 4" 56* 9 4 Ill sl 41" bn s1 22" cl B 3 7 1051 ° ' S 5tj" 9" b1:�1 jlo' ua sl 27" el B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME D ROP IN WATER LEVEL- INCHES RATE MINUTES P- 1 lt3" iVp _ /OL MIN_ ytl�io_] - __—— Net3,.00 2 --- pEtalo PER INCH NU INCHES AFT INTELvA_ U 1� _ 1 L 1 � 20 P- 2 i 20 1, No P. " ) No j j P- P - -- ILAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ontal 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 ,I land slop. SYSTEM ELEVATI N / ' y'" /o 3.3 3 41 1 Pia N:tc i I as 1'04 99 i. o b(LALF� I ir e Ae YF i � � �•L d S.1G i0 7. 1`7 .2)s4..) DEPARTME OF REPORT ON SOIL BORINGS AND SAFETY &'BUILDINGS INDUSTRY, UIV1510N LABOR RELATIONS PERCOLATION TESTS (115) MADISON, INI 53 II UCAT10N — SECTION TUWN o1lP /MUNICIPALITY LOT NO : I fil - K O. N: SUBDIVISION NAME NIL 1 / std to /T'y N/R 1!� E ( ° -�W�- - �Nr itt, t > .;1 1(.oUNIY . -_ OWI411f'S /tfUYFl1'SNAM[ - - -. IMAIL INC. 11DUFlESS :it. Cruix Vir "moll ru( USE DAI ES OUSEHVA FIONS MADE NO f1FORMS. COMMClV IAI DESCRIPEIUN PROFII_C DCSCRIP710NS I /l PERCOLAYIOWYESTS: I�el Hesidunee _]New Replace I l ci2 I •) /d2 Uiiknowc1N /A �— HATING: S- Site surtabla for system U- Sue unsuitable for ayatetn r 4)NVFNTIUNAL _ _ - - LO -- SY I ��11 l MOU IN- G , r Y_S I E M I Pll L HOt.DINC, TANK: HE(•UMMk :N D E M (uptiun"I ) � L_ J S CX�U - �XJ S ❑U_�- Lx - uU_ I_Li S LXjU_L� S � r ru�aurd _ - - - - - - -- iI Ne-culauun less "-u NUl redo --etl DESIGN HAZE ISYSTEM [L FV.I It "ny po-uun of [fill lot is m the -- -- — ntlar� ..riG9�u91bllb► tndit ate: - -- I l�� t 4 "_ I Fluudpfaui [nthc"te F loodill till elevation: PROFILE DESCRIPTIONSX) -2 (Acutii•y) ::i6il wall lyhaet //5 BORING TOTAL P 1I O GR( UNOWATE14 INC H IS CHARACTER OF SOIL WITH THICKNFS, COLON, TEXTURE, AND DEPTH NUMU i UEPIH IN, ELEVATION QBSEfIVEU IIC.' rO IJED HOCK IF UIiSLHVEU (SLI! AHBIfV. ON HA CK.) g 1 60 104'..10 54" 10 « 131 al J6" bn sl 14" al .. 10 ,%33 \ 1 13-2 72" 10 5' 4d 5 tl• y bl al 41 bn al 22" el g_ 3 72" 1051 105 '° 5d. y" blal uu 31 27 - el B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR 0 P IN WATER I. E -I NCHES RATE MINUTES NUMBER INCHI.-S AFTERSWEL ING INTFHVAL -MIN. _. "- - f _._ - -r - -- . - -- --- .Y € PEH INCH No [ /0 33 0 1 1 1 20 ��— P 2 I 20" rL No 4 - 71 « 0 No / Ju 30 (} P- 'LAN VIEW: Show locations of percolation tarts, soil borings and the ti-nlunyluns of suitable soil afeds. Indicate scale or distances. Describe what are the huri- , ntal and vertical elevation reference points and show thair location on the plot_ plan. Show the, surface elevation at all borings anti the direction and percent [ I"nd clop. . SYSTEM ELEVATI N © _�- /0J. 3 3 a « I I a3'� �+ �1 i I 1 1 i 1 I rage 'G NOVt(,� Perforated Pipe Detail 0 End View ) Perforated End Cop PVC Pipe �" ae�� Holes Located On Bottom, ,p Are EQually Spaced \ S PVC Force Main * From Pump P .7 PVC Manifold Pipe Distribution Altetnate Position Of pipe Force Main From Pump Last Hole Should Be Next To End CophL. "._. End Cop Distribution Pipe Layout P 30 //� /y/y� I any -'•, v � •V �' -- R ,, 8 4 JUL 6 1984 s F Y is Signed: ,,��,v� Hole Diameter Inch ` � Lateral I Inch(es) License Number: �/ �y Manifold_ Inches Date: / — I ? • T Force Main Inches 1 Page _ T -0 no -Fyo -3 9y7 G a r./ ?tJ ru h 0 V I a Perforated Pipe Detail 0 End View �Pillrforolod End Cop PVC Pipe Holes Located On Bottom, S Are Equally Spaced \ S PVC Force Main From Pump P .7 PVC Manifold Pipe Distribution Alternate Position of Pipe Force Main Froik -pufnp Lost Hole Should 6e Next To End Cop � / End Cap Distribution Pipe Layout P 3 R — t 6 1984 JUL 61984 s 3. 7 'Q y X Y is Signed: _ �,. ,�/�r,' Hole Diameter Inch Lateral It I Inch(es) License Number: / g y Manifold — Inches Date: // —� ^� 3 Force Main "_ Inches •r, e O .. O z > E o c m • c °: {:<: co Cv C m N F— .. C O 0 m f C O m m N >` 7 C a { m r C ` �L- N I 0 0cd W 0 W "o : 3 vs ; O ' oa� C E.c�. cc �_ O m O O N (p C Q .O .�+ = U >- N (M'O O �? N�Lm�c 4� cc CC H c� c m N ° m f W m3��w �c`�N Occo• m � IC LU °0 ° & 3 0 - 0 ' O y-- N C N V 0 -0 Q Q m:Er 0�� o Q Z 0m�mN 0N0 • CL r c tm 0 c° o° �v� O 3 . - w .. O a r 3-- _ 1 cc pv —� `ova O �m_�Q0 ��> -- ° cC c °° m _ •- Qa mc�oo cmcL -N .N c� m c3cm>%m �Zc c OBE N cZ - 00 y« - �.cc� tcc o - ��o�cdoo �4) Gommo�� m c w. 0 •- � { $ rny���� �a0'6 g Co C cc U 0 0 a rnc co �� a � - 0— N N O- .-� O 2 c °. E. F a cd co 0 O C U U �Y C O5% > t t m O EN m (A.•.. a Q C = J ° i S T C - 105 r Y H SEPTIC TANK MAINTENANCE AGREEMENT r+ St. Croix County o d y OWNER /BUYER �J x H �pe �, Cl,'.u°�vr+/U� >iC� .5'r�/o �l �i� lam✓ � ROUTE /BOX NUMBER� /� /63 ` Fire Number CITY /STATE �i�IL�i� ZIP - PROPERTY LOCATION: /I/ '�;, � %4 Section T� N, R J W, Town O &J*1 �I �_, St. Croix County, Subdivisio /q Lot number. Improper use `and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a lice septic tank pu What you put into the system can affect the function of the septic tank as a treat- ment stage In the waste disposal system. St. Croix. County residents may be eligible to receive a grant for a m of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in. August of 1980, with the requirement that owners of all new syst agree to keep their systems properly maintained. The property owner agrees to submit to'St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pu:uping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. ti 0 I /WE, the undersigned, have read the above: requirements and agree v to maintain the private sewage disposal system in accordance with � the standards set forth, herein, as set by the Wisconsin Depart- o ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zuni'ag Office within 30 days of the three year expiration date. S I(3 NE1) D A'I' E� St. Croix (county Zoning Office P.O. Box 911 Hammo W1 54015 715 -7 46 -2239 or 715- 425 -8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,( "spec house "), than a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property _L���,L,q� /�i� �9i►/!?1�/lld�� Location of Property 4_ Section /ZV — , T el 4 N - R W Township s p )t, l h y pr k L'd Mailing Address &K / -V Subdivision Name Lot Number Previous Owner of Property V j ,4, zvISQ Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? � x Yes No Is this property being developed for resale (spec house) ? Yes T No Volume La and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. --- ----------------------------------------- PROPERTY OWNER CERTIFICATION I (cue) ee&ti y that aU btatements on thin 4oam ahe tue to the best o6 my (ouA) knowledge; t4at I (we) am (ane) the owneA(4) ob the pnopeuty de6n bed i . thtis in�onmation 4onm, by v.uctue 06 .z wakAa.nty deed , LecoAded in the 06jice ob the County Regis ten o j Deeds a6 Do e,unent No. and that I (we) Stock K 13001 M.GMiILrcomp 17 r n ' DOCUMENT NO. STATE BAR OF WISCONSIN —FORM 1 j Vol. „, (� WARRANTY DEED 82� O rlt'L'� THIS SPACE RESERVED FOR RECORDING DATA i THIS DEED, made between Virgil C Larson OT' $j Cv; C(, 'I. Sylvia A Larson husband and wife Recd. for Y 25th Grantor day of Jan ,�,.1.:. 19 83 and Pamela J Carlson and Gary A at 2:00 Petrano a.q Joint Tenants James_ O'Connell Grantee, Real,t of D d, Wi t n e s s e t h, That the said Grantor, for a valuable consideration One uty dollar and other valuable consideration-- - -- -- L RETURN TO conveys to Grantee the following described real estate in qt CrOi x County, State of Wisconsin: A part of the Northeast Quarter (NE 1 /4) of the Southeast Quarter (SE 1/4) of Section 10, Township 29 North, Range 15 West, Town of Springfield, County of St • Croix, State of Wi scon- Tax Key No. sin, more particularly described as follov Commencin at the Last 1/4 corner of said Section 10; Thence N. 87° 53'�?3�r W 948.3 feet; . Thence S. 00 07 E. 459.31 feet; thence S 870 53'43 E. 948.38 feet, Thence N. 00 07'26" W, 459.31 feet, to the point of beginning. Said parcel contains 435,600 square feet, plus or minus (10 acres, more or less). GSt 1 ! This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors j� warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except r and will warrant and defend the same. �! Dated this 214th day of Jan 19 2 3 Is 1 I i. (SEAL) / (SEAL) mil C Larson (SEAL) c` l tc t (SEAL) *_ �l_ A. T irrnn AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN I 19 _— ` SS. ( st, • _ C1'Oix County. Personally came before me, this 211t day of l the above named- µ s ST. CROI X COUNTY WI SC O N S I N � doh .. ZONING OFFICE 796 -2239 (HAMMOND) -- 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 November 11, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear sir: An on site investigation for the Gary Petranovich property located at the NE4 of the SE's of Section 10, T29N -R15W, Town of Springfield, St. Croix County, revealed suitable soils at a depth of 54 inches, below which seasonable high ground water was noted. This site should be suitable for an in- ground pressure system. Should you have any questions, please feel free to contact this office. Yours truly, / Thomas C. Nelson Assistant Zoning Administrator mj WISCONSIN DEPARTMENT OF INDUSIRY, j-,"J )1 AND 11UMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BURL_AU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 1 )3M Verification of Exception Status Ior an Alternative Private Sewage System In the County of St. Croix Location NE 1 /4, SE 1/4, Sec. 10 T 29 N, R 15 )d iX( W Town Springfield Street Address Lot No. Block Subdivision Landowner's Nalne: Gary Petranovich The application for this site is for: ❑ new construction use. 1]replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ( to have one of the first five approvals guaranteed for this year. This is number - - of those applicatiuns. (Use one of the first five quota nuilers ue to you.) ]one of the applications needing a quota number. The quota number assigned to this application is - _- L.__lfor one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. I . 1for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department.. [_]for an application on file prior to February 1, 1980. L_Ifor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USL_, the alternative private sewage system is replacing: EX ]a failing conventional soil absorption system. L a holding tank that was installed and in use prior to February 1, 1980. Da privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here.[ 1 I certify that the above information is true and accurate to the best of m knowledge. Name Th omas C. Nels Signature _ County Official) Title As sistant , Zoning Administrator Date November 11, 1983 DILHR -SB D -6158 (R 12182) a .te ��' x �, y • ST. CROI X COUNTY � t � •y _ �a �S'� i�y„ :h�,��"S:{��� �, W I V C 0 N S I N ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 November 5, 1984 To Whom It May Concern: In regard to the installation of the replacement system on the Gary Petranovich and Pamela Carlson property located in the NE4 of the SEk of Section 10, T29N -R15W, Town of Springfield, the system was installed on October 31, 1984. The system does meet all code requirements as required by ILHR 83, Wisconsin State Statutes. Should you have any further questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator TCN:mj 1 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner ClaLjr s tZ Property Address I I O City /State Legal Description: Lot Block Subdivision/CS # � '/a . , 7L ' /a, Sec. a, T N -R 16 W Town of rim PIN # () � - r'0�- -� - 67) SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: fi Tank manufacturer (/V� Size ST/PC 1 oDG� Setback from: House 3L Well � P/I Pump manufacturer Gi yy eU Model Ls>221 if 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 Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS _ �J Description of benchmark �NA I�csa �l' I�Q.S(� Elevation 1 C) Description of alternate benchmark Elevation Building Sewer 7 STAW Inlet S to , / ST Outlet Y X77 PC Inlet C Top of ST/PC Manhole Cover / PC Bottom d I- Header/Manifold Distribution Lines O O ( ) Bottom of System Final Grade () () () Date of installation /N8 6Permit number 31s"�O �:) State plan number Plumber's signature D(A 4U4 License number o'c-�-O g Date Inspector PM (Mj \ + �i �j� Complete plot plan Or NJ, �WWI P111" 44 4AIn ,A1� R Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety-and Buildings Division Count bT. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarvPltcrni�.: Personal "information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)), 3 y PETRANOVICH , GARY & PAM u Town of: State Plan ID No.: CST BMElev.: C � O Insp. BMElev.: r BMDecri n: Parcel �Q�Q.:1022-70-000 TANK INFORMATION (( ^^cc�j��J� ELEVATION DATA A9800291 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. -cs Septic er 100-0 Benc �,r� $ Z. Ge> ! 02• (oc� Dosing - 7�j AU Aeration Bldg. Sewer Holding St /Ht Inlet 76:57 YC -/f TANK SETBACK INFORMATION St/ Ht Outlet �_ q- r TANK TO P/ L WELL BLDG. Aeintake ROAD Dt Inlet 17 R; Z S ' J-o/ a 3 P f� r✓ NA Dt Bottom Dosing Z� D O NA Header/Man. �S��,k 7' 7 ` 7 ' • Aeration NA Dist. Pipe Hold in Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer � Dem 7 and �j{ -zj g�S• 3 Model Number Q, APM TDH Lift 6ALrictionZ3 System TD Q•q9t Head oss Forcemain Length 17D Dia. 3 " Dist. To Well \`\' SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Typeof mo Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes allo COMMENTS (Include code discrepancies, persons present, etc.) 39 5, z c�, d 3 LOCATION: SPRINGFIELD 10.29.15.157B,NE,SE 1050 ROAD #3 Y 33 Plan revision required? []Yes 0 No Use other side for additional information. ( l i � �qq F 7 SBD -6710 (R.3/97) Date Inspectors Signature e S ANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY DILHR STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than : j �- 8% x 11 inches in size. svw} & ❑ c hock If It t previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER � PROPERTY LOCATION p,. rPa Cl�+ 4: i C' /aS� %a,S /0 T2 ,N,R1:5 11 (o W PROPERTY WNER'S MAILING ADDRESS LOT # 992 6 V OL BLOCK # 14 Rol 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ale- .•. w000/ (,f�, ' , 1 (715 w6-` ,?f�A Io Xc y-e Park e l BUILDING (Check one) CITY NEAREST RC II. TYPE OF AD IIC�II ❑State Owned ❑ VILLAGE ^,1 ❑ Public 0 1 or 2 Fam. Dwelling -#� of bedrooms -3 AR Ax N NUMBER(S) 7 III. BUILDING USE: (If building type is public, check all that apply) a y ! D Z Z — 7 0 1 E Apt/Condo IG ' °? /5. F5 5 7 49 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 in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. X Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) A Sanitary Permit was previously issued. Permit## S Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 _Q Mound 30 El Specify Type 41 El Holding Tank 12 El seepage Trench 22 In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION Y 5 o 1 /4 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding T Tan ank / 1900 ZDal SG Lift Pump Tank/Si amber 7501 17 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 Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: a (c . /-4t 4 oY/50 off.. e. /v 22 0 (71-5 ) 6F#-3.3 79 Plumber's Address (Street, City, State, Zip Code): Z a Oil 'Y.. l0/" 0,0 IX. COUNTY /DEPARTMENT USE ONLY p Disapproved San#ary Permit Fee (Includes Groundwater Date )ssued tamps) �J Approved ❑Owner Given Initial Surcharge Fee) Adverse Determination i, X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber P CIO -�- 4L a ? O o w 2. o ro o .o ro �� z •o fl� pl►, _ LD ol V= A a j � o o � P o � 0 N � � rb 3 � � k rnr0 -- - -" PUPW CHAMP,- Ch655 SEC`IOtJ A1JG SPECIFIC! t "10�!.`_• VEAJT CAP `i" C.I. \ E "!T PIPE WEATHERPROOF APPROVED LJC /'' ;/- JUNCTIOIJ BOX MANHOLE COVE( > 25' = R0.^1 DOOR, WINDOW OR FRESH 12 "MIU. AIR INTAKE I GRADE I IB "MIIJ. COIJDUIT -- - _______ 18 "MIAI. \ ---- - - - - -- �1 PROVIDE I - - - -- IAILET AIRTIGHT SEAL I APPROVED JOI A l APPROVED JOINTS I I ALARM EXTEUDIUG 3' I II ONTO SOLID SOIL D ( I I I ON G I I ELEV. 8z' 6y FT. I Pump- -'� OFF o CONCRETE BLOCK RISER EXIT PERMITTED OIJLH IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E _ LP ECIFI DOSE- TA1JK5 MANUFACTURER: v" IJUMBER OF DOSES: PER DAy TAWK SIZE: GALLOWS DOSE VOLUME p ALARM MANUFACTURER: S 'y' le C fro INCLUDING BACKFLO W: /' & -5 U Q GALLONS MODEL UUMBER: ' 4-9 CAPACITIES: A= N- , ACRES OR4 /y GALLONS SWITCH TYPE: /�rCu�'V B = Z+ IIJCHES OR-3 'r 7 Z [ GALLOAIS PUMP /AANUFACTURER. �N ^ {/ G= � D , ' 9 y 5 1AlLHES ORI11(�Z/1 'S V CALLOUS MODEL IJUMBEK' I !' !'` D- 1� INCHES OR 7 GALLONS SWITCH TYPE: z NOTE: PUMP AUD ALARM ARE TO BE MIIJIMUM DISCHARGE RATE o'ZO GpM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEREAICE BETWEEAI PUMP OFF AND DISTRIBUTION PIPE.. /3/ 76 FEET + MIIJIMUM NETWORK SUPPLY PRESSUR . , , , , " , , 2.5 FEET - / FEET OF FORCE MAID XJ / f 38 F /ppiTFRICTIOU FACTOR.. FEET TOTAL DyWAMIC. HEAD = FEET IIJTEKMAL DIMEWSIONS OF TAUK: LE* ..IC -TH ;WIDTH - ;LIQUID DEPTH SIGUE0� f 1l4 %� LICF-USF DUMBER: 22095 DATE:!5 -%S 06/22/98 MON 09:50 FAX 713 386 4686 5T CRX CO ZONING W1 002 ST. CROIX COUNTY .� _WISCONSIN ZONING OFFICE r r'r I r�`` ... ST. CAM OOLPM QOVERNMEhf C CENTER 1101 Cw dduW Road �- r- Huds n, Mn 5018 -nio (715) 386 -4680 AFFIDAVIT OF RE- CONNECTION Property Owner ' P a w © CI • Address : 1't'P50 Pa:51 "C R ot N©- - l2!e, n400O� C1 y � C�1 Day time. phone: (715 S — 79 '10 - pareal I.D.# 0 3- /oZZ -'70 Legal Description of property: AIZ SL -" i(, Sec. /0 , T.214-11 R. W., Tn. of .5 1'i e./ , St. Croix County, W1 As owner of the above described property, I acknowledge that the aseptic system serving this proposed 3 bedroom residence is undersized by current code standards, but otherwise meets all requirements of State Statutes, Wisconsin Administrative Code and St. Croix County Zoning Ordinances. I understand that the issuance of a sanitary permit to allow the ;re- connection of the existing system does not imply that the system will function properly after it is placed in service. I also ,acknowledge that I will inform any future parties interested in .purchasing this property that this permit was issued for the re- connection of an exists septic system and Mgt for the installation of a new system. Signature: Date: r Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of 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 less than 8 1/2 x 11 inches in size. Plan must County �_,c. include, but not limited to: vertical and horizontal reference point (BM), direction and . � / r^o i percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal infonnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location GC?22 -° Ro&) 1 ^ Q >tipV r �G �j Govt. Lot ', 1/4 !S;Fl /4,S 16> T 2 ,N,R 15 16 (o e Property ner's Mailing Address Lot # Block# Subd. Name or CSM# 16) NS l i C. � � -3 AW I N4 City State Zip Code Phone Number ❑ City El Village a Town Nearest Road p� W , ` I 5 (7/5 ),7615-7Z40 New Construction Use: ,� Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow y:5 D gpd Recommended design loading rate bed, gpd/fi trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpdfil trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations ' e- C-o, inc _} Parent material ` v —7C 0/1 Y 1 e ,�) ! Flood plain elevation, if applicable A / ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 0 U 0 S El X s ❑ u I MS ❑ U ❑ S ®U EIS U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ME L .. / 9 14Y,< `'� Z �(/o-y e, s•' _54 �-? - Fr• a-5 -3 Z Z -18 / Zm� / )l n��r cfa 2 ' •� Ground -.3L r7,SyR `i S/ v r ,2m shY. /7J t/ G • S ; • �o Depth to S' G' 7 G S" /� r C l J • Z; 3 limiting /_ /<}r\✓P, / 7, Y IC �/0 S c n1 — , Z, ..3 factor 5 f in. Remarks: Boring # .. .......... . 3 z -7-7 7, 5 p `Y / c c v Z -� • 5 •� Ground Z7 31 �' S `1' , / 7 mv) c W ' 3 ' - y elev. ft. S 381 s YR � s r'� f I c <, .7 - YZ Al Depth to • Y) YR 5 G t S r") f G LO limiting _ 17 factor in. Remarks: C'Pry — t i YN a CST Name (Please Print) Signature Telephone No. - �)al (�' Z �uo�so>ti �7'��'" 7/5 '6?4 ".3 37$ Address Date CST Number 'EZ a JY �'.- to w; �. !,� ►' r 5�'�oz ��s -�� 7-7--0953 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 1 ©5eg — Property Address 6 n w cool (Verification required from Planning Department for new constmctioa) City/State G' /ems +- .�aadr Parcel Identification Number 0 10 ' LEGAL DESCRIPTION Property Location N E % 5F %4, Sec. / 0 . T z 9 N R /5 W, Town of ,�.'� -�►' c /O! Subdivision Lot # Certified Survey Map # 31 Volume , Page # Warranty Deed # 3 g Z 3 I l Volume 6� 5�8 . Page # Z 7 Spec house ❑ yes,0 no Lot lines identifiable,,' yes ❑ no WSTEM MAINTENANCE bgmperuse and maintcuaaxofyoursepticsysrezncould result iaitspremamr 1kilureto handle wast =Propermaiateaanoe consists of pumping out One septic tank every three years or sooner; if needed by a licensed pumper. What you put into the system can affect dye function of the septic tank as. a treatment stage is the wastc&Vosal system. The. pmperty� owner agrees to submit to St. (keels Zoning Deparbmeat a certification, foram. signed by the owner and by a p lomwYmnPI resUctedplumbcror a licxasedptmipervedfying that(1) One on -site wastewaterdisposal system IS in POPCE %=tmg condition and/or (2) after inspection and pmq*.(if necessary), the septic -tank is less than 1/3 full of sludge. i/xe,. dye Undersignod have read the above rcquh=cnts and agree to maintain the private sewage disposal system with the standards set forth, herein. as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.. Certification stating dart }roar septic system has been maintained must be Completed and rmuaed to the St. Croix County Zoning Office within 30 days of the Ogee 3 7 A# � tion date. aw SiGru o APPLtcAMT o 43/ DATE OWNER. CER MCATTON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described e. by virtue of a warranty decd n riled in Register of Deeds Office. SIGMA F PLICAMT DATE Any information dint is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *�� «•• Include with this application: a stamped warranty deed from the Register of Deeds office a Copy of the certified survey map if reference is made in the warranty deed me. 1 300 1 aRataa 'f �" rrAT7t *M Otr �ONW 7 -- 011 7 710. VOL •`A f ! c THIS PACE is AKi DATA f; r► REGISTW5 OFFICE T DEED, sjada batty -es � L�C 'f' n _ Qn or ST. Cl�OIX CO., Wfs. TM t yje A L�r u� nd et2d_>�ge Recd for eRewrd this 25th Grantor day of Jut A.D. 19.83 m pA,� " yMMT A � at 2 tIY ' ' Patransl as Jo3Ai�1'ezla - Junes O Grantee. MME► .1 r W i t s e s s e t b. Tbm the said Grantor. for a valuable cemsideestion Depu y d a anc� 0th r aluable consilerAtton--- - - - - -- u" To C"Ve s to Grantee the following described real astate In x covoly, state of Wisconsin: y b, part Of the Northeast Quarter (NE 1/4) of the Southeast Quarter (SE 1/ ) of Section 10, Township 29 North, Range 15 West, Town o*_" _ Tax Key No. 3,rIngfield, County of St. Croix, State of Wiscon sin more particularly described as follows: Commencing at the East 1/4 m corner of said Section 10• Thence N. 870 53tt}3" W 948-35 Peet; Thence S. �w u0 07 E., 459.31 feet; thence S 870 53'43' 94 •38 Peet; Thence N. 00 07126" W, 1 459.31 feet, to the point of beginning. Said parcel contain 435 600 square feet, plus or minus (10 acres, more or less). This_ is !lot homestead property. ` (is) (is not) Together with all and singular the hereditaments and appurtenances the belonging; And Grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except t and will warrant and defend the same. a Dated this day of Jo .19 83 ii ( - (SEAL) (SEAL) i it C. Lgrson e (SEAL) (SEAL) AUTNEN'f (CATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN , 1 i• ss. 9 = S Croix County. 1 Personally came before me, this _ 9 day of * 1 ,1�?83 the above named _ TITLE: MEMBER STATE BAR OF WISCONSIN Virgil C Larson and Sylv A. (If not, rson_ authorized by §706-06, Wis. Slats.) Lis ", � l This instrument was drafted by �•'� N ' R O � + G . Walter to me known to be the person a w V,, ' t `the `lore - going rent a d k ovule d t C. , �� , ti FORM NO. 985-A v►'� • ' NGMiI,.r CanpMry� M319 Stock No. 26273 CERTIFIED SURVEY MAP NUMBER 1249 Part of`the NE 1/4 of the SE 1/4 of Section 10, T29N, R15W, Town of Springfield, County of St. Croix, State of Wisconsin, described in Volume __ _ of Certified Survey Maps, page 121x9 as Certified Survey Number 12119 BEARINGS REFER TO 11/4 OF SEC IO,T29N 07 26 2 R �W 'Owa3 ASSUMED BRC% N00 ��W. J0 Co ) UNPL. AT TED LANDS 6 I NORTH LINE OF THE SE 1 /4,SEC. 10, T29N, R 15W N87 43 ° W I , 948.38 P.O. I EAST 1/4 CORNER OF 915.38 SECT IQjd 10, T29N, R15W 33.03 M I SET 2 IRON PIPE & CAP of QHOUSE BARN to Q: It z Q n DS SHEDS o: 4 . W LOT I N 435,600 SO. FT 1 3 3; 0 10.00 ACRES = io o (INCLUDING ROAD R.O.W.) N 0 420,442 SO.FT.= 0 0 EAST LINE OF THE SE 9 65 ACRESt ° °0 1/4 OF SEC. 10,T29N,R15W (NOT INCLUDING ROAD ROCK) S 0 z 915.38 z 33.03' R S87 43"E 948.38 V; UNPL A T?ED LANDS I N SCALE'- 1 O O SET 3/4 "X30" ROUND $ IRON ROD WEIGHING z SE CORNER OF SECTION 1.502 LB. /L.F. 200 100 50 0 100 200 IQ,T29N,R15W,REPLAPED I PIPE SURVEYOR'S CERTIFICATE 6 e IRON St CAP WIT 2 I, THOMAS G. KUESTER, Registered Land Surveyor, hereby certify t at have surveyed, divided and mapped a part of the Northeast"1 /4 of the Southeast 1/4 of Section 10, Town 29 North, Range 15 West, Town of Springfield, County of St. Croix, State of Wisconsin, more particularly described as follows: Commencing at the East 1/4 corner of said Section 10; Thence N. 8� 53' 948.38 feet; Thence S. 00 07' 16" E., 459.31 feet; Thence S. 87 53' 43" E., 948.38 feet; Thence N. 00 07' 26" W., 459.31 feet, to the point of beginning. Said parcel contains 435,600 square feet, plus or minus (10 acres, more or less). That I have made such survey, land division and plat by the direction of Virgil and Sylvia Larson, Route 1, Glenwood City, Wisconsin 54013, owner of said land. That said plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutes and the subdivision regulations of the County of • 1 i Form- S T C - 104 i AS BUILT SAN SYSTEM REPORT OWNER �q/jr Atra r)& I TOWNSHIP � � SEC. 1 L2 T N -R j S' W i ADDRESS l�. g rl Lj/,j Ud _ STt CROIX COUNTY, WISCONSIN I SUBDIVISION LOT LOT SIZE 1 LAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHINGIWITHIN 100 FEET OF SYSTEM i sL _ b t. I w � i w • i , , 3 IND ATE NORTH ARRbW rV W N IT o A 0 BENCHMARK: nPCrrih,- t},A .��•, - ri�ol �F __� .. _a 1�_ _ C i_ /l ""SC°r'SIn APPLICATION FOR SANITARY PERMIT , DILHR �TC Z10 / C OUNTY - t>E�ggTrr,EnTOF (PLB 67) UNIFORM SANITARY PERMIT # � M10USTQV,IgBOi•16 PIUlTIgn gElgTqnS — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than $', 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS p PROPERTY LOCATION 9 =: 114 1/4, S I , , N, R I,S'll (or) TO WN OF: LOT NUM ER JBLOCKNUMBER SUBDIVISIOP NAME NEAREST AOAD, LAKE OR L ANDMARK STATE PLAN I.D. NUMBER Gtt 5-T "V / TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System CJ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepaye Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank E System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1'a'14 Lift Pump / Siphon Chamber S . 40 Manufacturer: x srx, <. If PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA _ WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Q a X Private ___J Joint El Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP /MPRSW No.: Phone Number: 'lumber' Address: Name of Designer: COUNTY/ DEPARTMENT USE ONLY i ure of Issuing Agent: Fee: Date: ❑ Disapproved LA Owner Given Initial Appr Adverse Determina rr Disapproval: , 00 of Action Available: ,R 5!82± DISTRIBUTION 0, to County. One Copy To. Buieau o} Plumhinrl, Ovvnei Plumber • r � l - s ��•�r ndU C - s c /-, �e- r.�i I 0 �eY 15 LJ Dr T ,p '�� ,� bl 9 25' 5q sk.,D 90 c' J� can N �Z1 1000 750 Yur]� ChtM�Cr �V\ 1 I r,cD IO acrc ;Cn5C- 6 'R403847 '� INDUS T TR Y, OF REPORT ON SOIL B ORINGS AND SAFETY &BUILDINGS INDUSY, DIVISION LABOR -ANO PERCOLATION TESTS ( 115 P.O. BOX 370 HUMAN RELATIONS \ � MADISON, WI 53707 L CAT17N SECTION TOWNSHIP /MUNICIPALITY: LOT N0.:8LK. NO.: SUBDIVISION NAME: N u '/4 s� to A29 NI R 15 E lotl( WWWWW� 3�pr ld COUNTY: OWN I.- W -W UYER'S NAME: — MAILING ADDRESS: St. Croix Vir Larson USE — — _ DATES OBSERVATIONS MADE Rasidence NO,BEDRfv�.: COMMEI�rIi1LDES�FIIPTION: 1'S�iZSFI L�CSE�CI�T{s"IT S: E f3�C - A ESTS: UrrIeOAC N/A l ❑New R eplace FLLJ I 9 /lj /tS2 9 /1�)/d2 RATING: S- Site suitable for system_ U= Site unsuitable for systarn -- CO�VENTIONAI- M OUND. ❑ � IN-GROUND-PRE RE SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) L - - . —__` � S _� J� 5 U S � in Ground rrassura If PetcolatiOn Tests are NOT le uired DESIGN RATE: SYS t EM ELEV. If any portion of ilia lot is in the under 0-163 .09(5)(b) indicate: 10 1 4 Floodplain, indicate Floodplain elevation: PROFILE ,� DESCRI - 2 (Arnary) Sdtil map sheet #56 BORING — TOTAL P H TO GROUNDW IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBEI=1 DEPTH IN, ELEVATION OBS E ' TO BEDRO IF OBSERV (SEE ABBRV. ON BACK.) B-1 60 104'- �3 4'_ 54" 10" tit sl 36" bn al 14" al B -2 72" 105' 4" 5d" y" bl 31 41 bn al 22 cl B -3 7 211 105* 10S v 5d " 9" blal J 6 11 bn sl 27" cl B- \ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TI ; T TIME DROP IN W ATER LEVEL- INCHES RATE MINUTES NUMBER INCHES AF I LH SWELLING INTL1-iVAl -MIN. — -- - - -- -- -- - - - -- �! ----- -_- --- P� PER I N C H P- 1 1� " _ X1 /�3 _ _, U -- 1 } — 1 1 20 P- 2 20 ° /�J No_ ; _�- - -- - -- 1} - -- 4 4 7� P P- P- ?LAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- , ontal 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 slop. SYSTEM ELEVATION o y �� /0 3.3 3 � ' f"f cE LlN6 pta ►� »« B -3 ' �` 1' 16*4 b 4l Ao 4r— too tN y { ,► b + � 'sac i a 7- Y5 Q �S4J i 1 �p 3� 1 I