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HomeMy WebLinkAbout231-1040-95-100 abgr sidDepartme dustry, L PRIVATE SEWAGE SYSTEM County: SaetyHumanRelations INSPECTION REPORT ST. CROIX Safety and~6uildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299017 Permit Holder's Name: City Village j Town o : State Plan ID No.: 32 DRAXLER, JOSEPH GLENWOOD CITY 7 CST BM Elev.: Insp. BM Elev.: BM Description: l Parcel Tax No.: q011 231-1040-95-000 TANK INFORMATION ELEVATION DATA A9700335 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe [Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model 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 ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD CITY 26.30.15,NE,NE 1225 320TH STREET Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau a Building Water Systems .O E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O.E. 201 P.O. Box 7969 • Attach complete plans (to the county co Madison, WI 53707-7969 y py only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application state S.tary. P=Number The information you provide may be used by other government agency programs / [Privacy Law, s. 15.04 (1) (m)]. ❑ Check if revision to previous application 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION State Plan I.D. Number Property Owner Name Property Location 1/4 14E 1/4, S 'Z6 T 3 o , N, R `S- E-(ter) W Property Owner's Mauling AdLi 5 Lot Number Block Number dress , State Zip Code Phone Number Subdivision Name or CSM Number G'fltc„W CCTV w; ( 17 is)7 4 -Z -t7-., - I1. TYPE F BUILDING: (check one) ❑ State Owned Ity Nearest Road Public E!rl- or 2 Family Dwelling - No- of bedrooms Village Town OF C'( AbG ~`r 111. BUILDING USE: (If building type is public, check all that`apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 31 o J/ 4, - 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Re Repairs 4 E] Church/School p 11 ❑ Restaurant/Bar/Dining 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OFF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. lew 2. ❑ Replacement 3 Replacement of System_ System E3 Tank Onl 4. E] Reconnectionof 5. E] Repair of an yExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 F,,Specif Type 12 E] Seepage Trench 22 E] In-Ground Pressure y 41 E] Holding Tank 13 ❑ Seepage Pit 42 ❑ Pit Privy 14 E) System-In-Fill Al e QAclc_ 43 ❑ Vault Privy 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 d 0 l ot~o [?oo .6 Feet I o3. Z Feet VII. TANK - Capacity INFORMATION in gallons Total # of Prefab. Site New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel gFiber- lass plastic APp- Tanks Tanks strutted Septic Tank or Holding Tank I - F2c~o tn1 2- ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I pv 1 t0cr 1 _:L M t ID ❑ 10 VIIL 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 r PRSW No.: Business Phone Number: _ *1Z1 Plumber' Address (Street, City, State, ZipCode): t s - Z2 Ik COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sa itary permit Fee (includes Groundwater ate slue Issuing gent Signature (No S m Approved I ❑ Owner Given Initial p& ~ Surcharge Fee) '7t Adverse Determination, ~O0 /°27 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6396 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1 A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be-renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years- 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 'T VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r yi• i , S97m408 17 Safety and Buildings Division SANITARY PERMIT APPLICATION BureauofBuildingWater Systems 201 E. Washington Ave. In accord with ILFIR 8105, Wis. Adm. Lode P.O. Box 7969 Madison, WI 53707-7969 0 Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. N • See reverse side for instructions for completing this application State Sanitary emit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)I. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S97-408-17 Property Owner Name Property Location 14 t, 1/4 146 1/4, S ZG T 3 0 , N, R (,S E-(or) W Property Owner's Mailing Address Lot Number Block Number 14-53 s" - _ City, State Zip Code Phone Number Subdivision Name or CSM Number le-hWe0a C %T-t Lit (71~)Z6S-760 . TYPE OF BUILDING: (check one) ❑ State Owned a City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms W Rvillage Town OF C.1~ AI.G S 11_e_tiT- III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OFF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. lew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an B) Existing System Existing System System --System Tank Only-------------------------------------- ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 110 Seepage Bed 21 ❑ Mound 30 g,5pecify Type 41 ❑ Holding Tank 12E] Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit G tzAIlt-. 43E] 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 U i7 100c;, 1 000 6 161.30 Feet (p 3 , Z Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per. ANe Existin GallOnS Tanks Concrete Con- Steeglass Plastic App Tanks strutted Septic Tank or Holding Tank 9- ❑ ❑ ❑ ❑ ❑ l ifi Pump Tank /Siphon Chamb- I W~ Y~1 T ❑ ❑ ❑ ❑ ❑ 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) PRSW No.: Business Phone Number: lt/►a~t h a MP/M 13,1 7 f - 22 _tp"Lt 00 IOU, W1 Plumber's Address (Street, City, State, Zip Cade): 15 .34 (o S - Pow( 0a 13 r~~c ev IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ❑ Approved ❑ Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: ' R O' 3 OI ~ 'U 4' O II s f e A w 3 l- al xl al J - 4f ~I S a w U iV' ~ III - W L > W 1 _ C9 O ch 1 ~ N x O w `1i V - w 00 N n ~ d G; N a c r 1 ~ I I -I ' y w l y e(I ~ ~ M i s _ o ~ a W of a -n I ~ I n ~I n I Z661ZZlnr 43AI3,03a Ct: w rp vwici J lV Qlllc : ,,,gyp )`pµ \,f'\LW'1G 'I GJL. Plumber/designer Signature: Date : 7/21 /q7 License Number: If -3 Li I i L t >5 ~ B >_5 I ' I >5E C ---=----1------ I iW A I I > 51 D 1/6 B 1/6 B 1/2 B A = Ip ft E ft I ft 1/2B =.50 ft B = (rjo ft F = I ft L = _]lo ft 1/6B = X6.66 ft C = 2, ft G = ( ft W = 2-7- ft D= S ft H=_fttiy~ra Fabric Distribute. } Observation----,,, Cov Nc ~ Jz NoE Well i2 G IV. o -F FzFz H Note: H is measured from 5> 5~ directly below the lateral to D A C E finished grade. Plan View and Cross Section of Wisconsin At-grade Unit with a Single Absorption Area on a Sloping Site Page of AT-GRADE SYSTEM CALCULATION WORKSHEET Owner's Name: so nQa kl w Parcel Tax Number: - Legal Description: -jA k ► .-ILE_4, - S 2 t. . , _ T _3D N, _R .F-- F, er- W Lot Number: - , Block Number Subdivision/CSM Name: =f-of: CAe-Y\ Wood CITY . 4-cSt'. CRLo\-c County, Wisconsin I At-grade Structure 1. y 2 inches. Limiting Factor Depth e• 2. • 5 percent. Land Slope 3. Loo gal/day. Daily Design Flow Rate (DDFR) 4. . 6 gal/ft 2/day. Design Loading Rate (DLR) 5. dpo feet2. Effective Absorption Area (EAA) = DDRR = A x B 6. 10 feet. Effective Absorption Width'(EAW) = A 7. loo feet. Effective Absorption Length (EAL) = B = E`er EAW 8. 6 gal/ft. Design Linear Loading Rate (DLLR) = DDFR EAL 9. Z. _ feet. Total Aggregate Width = A + C * 10. 7-t feet. Finished Width (W) = A + C* + D + E** 11. 110 feet. Finished Length (L) = 2 (I) i+ B 12. Z. feet. Finished Height (H) = F + G 13. W IL feet. 1/6 B ) Observation Well Locations 14. 0 feet, 1/2 B ) 15. Texture of Soil Cap Material. Notes: * C is 0 if the slope is 0%, otherwise C is 2 ft. On level sites, substitute another D for E. Plumber/designer Signature: / 1 License Number: g3LI Date: 7/21/97 Page of At-grade System Pressurized Distribution. Network Design 16. Distribution Lateral Sizing. 1 inch. Hole Size 3.5 feet. (43..) Hole Spacing 11(3.4~ feet. Lateral Length inch(es). Lateral Diameter feet. Lateral Spacing feet. Lateral Invert Elevation 17. Distribution Pipe Discharge Rate. L Number of Holes per Lateral gpm.. Flow Rate per Lateral Total Number of Laterals 31 9PM. Total System Flow Rate 18. Manifold Sizing. Ce_ATcz1Z Manifold Type (center or end) feet. Manifold Length * * If only a tee fitting is used as the manifold, the manifold Z inch(es). Manifold Diameter * length and diameter may be 19. Forcemain reported as not applicable (NA). . 7- inch(es). Forcemai.n Diameter o feet. Forcemain Length 32-• 6 gpm. Minimum Dosing Rate (system flow rate) ~3•~t gallons. Forcemain Liquid Capacity 20. Total Dynamic Head (TDH) Calculation Vertical Lift = 4 So feet Friction Loss = N;S feet TDH = C/. ZO feet Page of . ~ N •r1 ^ i ro 4, L a g a m 0 6 t H -0 0 L O W `N a ° CJ w .*4 - W .n Z Q, O N 0 (1) 0 d. w a CO x •-4 ro 41 • r-1 (D .1 • U ~ W ~ c N I N a ; a w -\J 1 H o 14 tf) l 4) 11 y U U 0) E Q .a)1 N Q~ W .,~.1 Cy O W 44 ~ ~G 7 M a. b £ p tr ~p T. ) S r uIN a x >ti 0 a ~0 N cr- x < O CL a Q cn Z co U W O o J (7 W Q„ LL, c x M C- d n- Q = pOj Z 3 J v ~ a• F•- O WCn W CL -j U) z° V [r _ W I -i p = Cn O V• J c)• (n F-- 1 b N G co Cn WCJ •.i U L }.1 N Aa a a A~ 3~ t 014 m Cd R En 04 - - - - N 14 . o a a [ 0 .H b pAC.C OF j PUt %P CHAMP,-:R CRG-15 SEC"1-101J AAJG SPECIF'ICt.'rlu"!`. 'VEMT CAP I ! 4'.C.I. \•E\!T PIPE WEATHERPROOF APPROVED LO(-A*-'.I(.• > 1G' FRO^1 GOOK. JUIJCTIOM BOX MA►1HOLE COVEF. i - _ WINDOW OR FRESH 12 MIU. AIR INTAKE GRADE I I Y" MIN. I cououlT 18"M rN. IIJLET PROVIDE 19-T AIRTIGHT SEAL APPROVED J01m T A I III APPROVED JOIAITS W/C.2. PIPE I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTEIJDI►1G 3' 'ONTO SOLID SOIL B I 1 I ALTO SOLID SOIL I I S6 C I I 1' ELEV.. 7? Z57 FT. ' n0 7 • PUMP OFF 0 5 COUCKETE BLOCK OE } oNO~N~E SEPTIC E SPECIFICATIOMS S~~GO DOSE. TANKS MAWUFACTUREP,: -n'1%AIJecTpo PQ'yd 1 IJUMBER OF DOSES: `I PER DAy TAWK SIZE: Lwoo GALLOAIS DOSE VOLUME ALARM MAIJUFACTURER: 7s S~(~.-m „ INCLUDIMG BACKFLOW: 14.3. rl GALLONS MODEL LIUMBER: 1~l K,-) CAPACITIES: A= le- 2. I)JCHES OR ?Z. ( GALLONS SWITCH TYPE: I"I B= Z IUCHES OR SZ. GALLOWS PUMP MAAJUFACTURCR: kti~~rvtaTlc. C=IUCHES OR L3. 't CALLOUS MODEL WUMBEK* sI-\_ 3:l D= 12- INCHES OR 3tZ GALLOWS i , SWITCH TYPE: Mco . u MOTE: PUMP AMD ALARM ARE TO BE MI►JIMUM DISCHARGE RATE 36A. GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEW PUMP OFF AWD DISTRIBUTIOW PIPE.. Li-so FEET + 111AJIMUM NETWORK SUPPLY PRESSURE 3•2-,5 FEET' T,/ .2 1, G -I- ~0 FEET OF FORCE MAIM X F/pprT.FRICTIOIJ FACTOR-.l '15 FEET+' ~✓ICN TOTAL OyJUAMIC- HEAD 2 ZO FEET`I-3 IUTERNAL DIMEW5*101JS OF TAIJK: LE~.j&TH 0 2-" ;WIDTH ;LIQUID DEPTH 7/ SIG~JEO:~ LICEMSE' DUMBER: .L~DATE: 21/97 sump LUPJN Pa, ,a . , WS/DS25 WS25A1 • Completely submersible DSIWS25 - 114 HP - MAX. SOLIDS 11/2" - 3300 RPM automatic sump/effluent pump. 20 • Avallable with wicle-angle - - - "piggyback" float switch 24 (WS25A1) or diaphragm type '.plgaback" switch (DS25A1). • Cast Iron conStucliorl with non- w 20 corroding ADS volute/base. I - - • 1 /4 HP. 115V oil-filled motor z 16 with thermal overload o _ protection. w - - • Anti-clog thermoplastic = 12 _j L - AM SLO AD Impeller. F • Can be used without switch for o 0 16I 115V. DS25A1 portable dewatering pump. 8.5 • 1 1 /4" NPT discharge with adaptor Included for 1 1/2" Nl'1' 4 discharge. - • 10' replaceable power cord. o 0 Weighs 14 lbs. 5 10 15 20 25 30 35 • UL listed sump pump. U.S. GALLONS PER MINUTE e SW/SD►25 & 33 For sump and effluent use. 2e SWIS02S - 114 HP - MAX. SOLIDS 112". 1SSO RPM SW25/33 Automatic models available - - with wide-angle "plggybaclC 24 float switch (SW models) or AFULLMPS AT LOAo diaphragm type switch (SD ~20 1•.nsv. models). Also available In LL - - e.o manual models. 018 _ • 1 /4 HP (SW/SD25) or 1 /3 HP l -F 12 (SW/SD33). heavy-duty. 115V < _ _ _ oil-fllled motor with thermal 8 - overload protection. - - -I - - • Rugged cast Iron construction. 4 • Non-clog vortex Impeller. - - - - - • Long life lower ball bearing. ° s to is 20 25 30 35 40 s so Sintered top sleeve bearing. U.S. GALLONS PER MINUTE • Carbon and ceramic mechanical shaft seal. SWIS033 - 113 HP - MAX. SOLIDS IR'• - ISSO RPM a 1 1/2" NPT discharge. 2e SD25/33 W 10' replaceable power cord. (20' optional). T • UL listed sump pump. 20 LL Z 16 - - - - 0. 12 FULL LOAD AMPS AT 10. I15V. _ O 10.0 S 4 0 5 10 15 _202S 30 35 40 45 s0 Wisconpin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Page of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and D N percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ` O t Parcel I. D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location q 0. Govt. Lot I\t C- 1/4 WE 1/4,S 2 4 T 3 a N,R IS E-*) W Property Owner's Mailing Address Lot If Block# Subd. Name or CSM# I 1'k city State Zip Code Phone Number Nearest Road C n cccd C l 1 (rj 15-) _ 7o 2-3 ❑ City Village ❑ Town Ora k 1 - LJ' New Construction Use: U?Residential / Number of bedrooms 1'1 Addition to existing building •i ❑ Replacement ❑ Public or commercial - Describe: a Code derived daily flow b d D gpd Recommended design to 4te ed, 9Pd/ft2 • _(.trench, gpd/ft2 Absorption area required J-L0,2 _bed, ft2 1 QD o trench, ft 2 Maximum design loa ng rate bed, gpd/ft2 • 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 10(.30 C C)►iTD:-Qt- ft (as referred to site plan benchmark) Additional design/site considerations aT - G-RAJO- Parent material !Sla hd S-h Il Flood plain elevation, if applicable 14. A , ft S Suitable for system Conventional Mound In-Ground Pres ure AT9G ade System in Fill Holding Tank U = Unsuitable for system ❑ S E UU El S U ❑ S ✓ U L_,~ S❑ U ❑ S U El S © U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 In. Munseli Qu. Sz. Cont. Color Texture Consistence Boundary Roots Gr. Sz. Sh. Bed , Trench 10 `r lZ ~t ' Sk 1 rrl 510K mfr tA S 3 rh • J .6 2- - i 1 10 It `1/Z St t 2 w► r►, f t- A w 2 rh • S;• C Ground 11-16 y R `S~ elev. - 5 6 k frl i C- W 2 o i. i ft. 1 g _yZ `lv~. s/ - 5 ( I 5 6 ►c f'~ F r C e,.~ - • `t ' . S Depth to s YZ -Su S 't t 15 1 t 51, k n1 V F t- - , limiting factor `1 Z In. Remarks: Boring # 1 0-'1 to `tK 3"L S► Z k M i,- h s 3 ► 6 5 6 Q. 2 ~f • (2 7.5 li _ 2 r S6 f ►1 E h C Z !+'1 S . L 3 12- rl• S `tR S 1 l /`n S b✓ F h C ~..3 . S round 4 119-58 1.5 1~t G t P to `m ~ Is 1 4 4 In V f H - ~ $ G elev. 101.3 ft. Depth to limiting factor P~t_In. Remarks: CST Name (Please Print) Signatur Telephone No. R! e_ 7/21/97 91 -3 Z2 Address - Date CST Number ne C~ZAxIw SOIL DESCRIPTION REPORT Page. " of PROPERTY OWNER PARCEL I.D.# 2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 - S( Z b rc t^1 r t~ C 0-L 10 01 ---5 2 01 ttZ`~y 51 Z~F S~ K M C►- +h Ground tR S l S6K th r G~ zth • `i -5- elev. Icl•3 n. y ri7 1t' lo't IS F s6►: My r ; Depth to ; limiting factor rs j j In. Remarks: Boring # Ground elev. Depth to limiting factor 3.5' in. Remarks: S aVL A~ 3 s'~ ~ ~eS S Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/flP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench Boring # Y , Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground elev. n. Depth to limiting factor in' Remarks: SBDW-8330 (R. 08/95) °I ' o I s) x , I Al) 1 ~ ~I N w ~ ~ vl s 3 JI XI ; ~ S L i T o r u c 3 d f , ~ sl to J ~ o CV Jll ~ ^ ~ I 'rl 1~"'- ~ T f' I o ! J o ~ d ~ ,I o ~ I E r r S v Q yyc W ° ,y I S i i Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location -To H p xt c. 0. Govt. Lot JA E 1/4 {CIE 1/4,S 26 T 3o N,R I_T E-*) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# I Lt _T3 320 1h City State Zip Code Phone Number Nearest Road 1a n Ooc4 C v t l ('7 15) ❑ City Village ❑ Town ~?ra be 1 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement / ❑ Public or commercial - Describe: Code derived daily flow 400 gpd Recommended design loading rate S bed, gpd/ft2 • -6 trench, gpd/ft2 Absorption area required !Zoo bed, ft2 1 Db0 trench, ft2 Maximum design loading rate - S bed, gpd/ft2 • 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) (O - 3c) J ►rrb"_,a_ ft (as referred to site plan benchmark) Additional design/site considerations 13CT - C-K"ala_ Parent material S A r,..A 5-M 'I er Flood plain elevation, if applicable IIJ • A . ft S = Suitable for system Conventional Mound 2,-,- In-Ground Pres~re AT-Gade System in Fill Holding Tank U = Unsuitable for system El S 2 U ❑ S 2 u ❑ S Z U C]'S ❑ u ❑ S 2`6 ❑ S © u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 10 `1 LZ 2 ~ii Ib tt`may - S 1 2M Mf1•- Aw 2rh Ground 3 c. 51, K Pl C W 2 . S 6 elev. led i ft. 1S-yz `lvzS/ S ( 1 ►Lt 56K fn Fr L t_') - • `1 .S Depth to S K2- t, I.5 `t 1 S I } 51, k P1 V V .7 . E' limiting factor Remarks: Boring # I b-'1 l O `~K lz. S~ ~ 2. rh ~ M k 1^ S 3 6 Z a '7 - 12 1.5 tt 2-4- 5.6 M 3 IZ- 1• S `tit SI km 5.6K k- c.' Y S Ground y k9-58 I.5 'uL L 1 P to u. 1 5 1 H V~ 1^ elev. lof.3 ft. , Depth to limiting factor Amain. Remarks: CST Name (Please Print) Signature Telephone No. 4L e. p i -3 7-2-3 Address ate CST Number L I z RQAtA- No v (L Lj Page of PROPERTY OWNER '~n~ D~-Akl 56, SOIL DESCRIPTION REPORT PARCEL I.D.# Horizon Depth Dominant Color Mottles Structure 2 Boring # Texture Consistence Boundary Roots G~Dtft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -3 0'4 S' 2r. bK I•t _r 2 6-I , Ground „f `J i S K r G~ -2M • 4 S • a 'I elev. . ~ , 101.3 n. y % e tn'c I s 5 6~ ►n y Depth to limiting factor W41 in. Remarks: Boring # Ground elev. Depth to limiting factor U_in. Remarks: 0&& S S i3 iz Av 3-5 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) State of Wisconsin ` Department of Industry, Labor and Hum an Relations - - APPLICATION FAR THE ~f j~ SAFETY & BUILDINGS DIVISION c- OF AN AT-GRADE SYSTEM - 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 Location: Tewv,64-~p/Municipality: 1/4NG1/4 Section, T NI iet Address: sRr)W enw CAEIA 1 9 Su0division: County: Landowners Name: A 3ZoT'i Mailing i ng Address: I (We), the undersigned, make application for an at-grade system on the above described premises. If approval is granted, I A ree to have the system constructed in conformance with the plans and specifications approved b Department of Industry, Labor and Human Relations (DILHR), Y the I further understand that an at-grade system is somewhat different that a conventional onsite sewage system and as such will require detailed inspection during construction and monitoring after the system is use. I agree to permit both county officials charged with administering county sanitary ordinances and DILHR Put into ch as the system designer, to have accessmtoothe abovvehdescribedipremiisesoat an reasonable time for the purpose of inspecting the construction, or of y monitoring the system. I agree to either personally orb m DILHR or county officials to arrange the time and date to begin construction of the system, after obtaining a sanitary by y agent contact permit. monitoring wells required by DILHR for the purposegof measuringhtheost of wastewater treatment performance of this at-grade system. I understand that this application does not permit me (the applicant or agent (the contractor) to begin construction. ) my DILHR will send the applicant a letter of a (If the system i approved, construction of the system after all necessary permits have been obtained.) I agree to give notice to any subsequent buyer that an application for an at-grade system has been made and if installed, that the'pses by an at-grade system, and further agree to give the buyerrramcopy aofre served application. this gna re of ppI'cant (valid only if notarized) Dat STATE OF WISCONSIN Subscribed and sworn to before me this COUNTY OF (date : ) r] JOHN E. U~pN %a of Wb=wb Jotary uo ic, ate o Wisconsin I DILHR•SBD-5524 ofn fission Expires: ~Q FILED 8 AUG 1 8 1997 ► r j~ KATHLEEN H. WALSH 4O6 2 L Register of Deeds St. Croix Co.. WI C ER T L F-I ED S UR V E Y- 1\11A Located in the Northeast quarter of the Northeast quarter of Section 26, Township 30 North, Range 15 West, City of Glenwood City, St. Croix County, Wisconsin. Owned by: Joe Draxler 1453 320th St. Glenwood City, Wi. 54013 • - Indicates 1"X24" Iron pipe weighing NE Corner 1.68 pounds per lin. foot set. Section 26 (County monument I found). I I 6 s' Ep LANDSS_ M U_NPLATT RpJ ~ / h ( t L~-~S 140 TH AV E: J' 3025 - - - - - -'m- N X546 80. - ~ 1 LU 109.52' 01 Z W I ai zi !L®7r 1 o .oa-j QI I III , w Ji 110,771 Square feet 00 . (2.543 acres) a o o M pi FW- I I of o ~ NI F-I Qi r~~l Z Q I mil LL I Z 488.40 ' S 88'22'37°W I UNPLATTED LANDS w- I I ~ i r N Curve Information Curve #1 Curve #2 E1/4 Corner Radius - 863.00' Radius - 1046.00' Section 26 Central angle - 13024110 Central angle = 1°53'04" (County monument Arc length 201.88' Arc length - 34.40' found). Chord - N82°12'30"E Chord - N76°26'57"E 201.42' 34.40' Tangents - N88054'35"E' Tangents - N75°30'25"E N750 30125"E N77°23'29"E _~~rlntrn~hN,,_ , r Description A parcel of land located in the Northeast quarter of the Northeast quarter of Section 26, Township 30 North, Range 15 West, City of Glenwood City, St. Croix County, Wisconsin, described as follows: Commencing at. the Northeast corner of Section 26; thence South 00 degrees 14 minutes 20 seconds East 55.32 feet along the East line of the Northeast quarter of Section 26 to the Point of Beginning; thence continuing along said East line South 00 degrees 14 minutes 20 seconds East 271.08 feet; thence South 88 degrees 22 minutes 37 seconds West 488.40 feet to the Easterly right-of-way line of 320th Street; thence North 00 degrees 39 minutes 48 seconds East 210.73 feet along said right-of-way line; thence North 88 degrees 54 minutes 35 seconds East 109.52 feet; thence Northeasterly 201.88 feet along the arc. of a 863.00 foot radius curve concave to the North whose chord bears North 82 degrees 12 minutes 30 seconds East 201.42 feet; thence North 75 degrees 30 minutes 25 sec- onds East 146.80 feet; thence Northeasterly 34.40 feet along the are of a 1046.00 foot radius curve concave to the South whose chord bears North 76 degrees 26.minutes 57 seconds East 34.40 feet to the East line of the Northeast quarter of said Section 26 and the Point of Beginning, containing 110,771 square feet (2.543 acres) more. or less, and being subject to all easements, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that-under direction of Joseph Draxler, owner, I have surveyed and mapped the above described property; that such plat is a true and correct rep- resentation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes and the City of Glenwood City Subdivision Ordinance to the best of my professional knowledge, understanding and belief. 7 Harvey G. on S-1899 HARVEY G. i Johnson Surveying, Inc. r 216 Meadow Drive North JOHNSON = Hudson, Wisconsin 54016 HUDSON • W1S rj A, 40 '140.o, 4) SURIJS %10 4W$lost So This map is hereby approved by the City Council of the City of Glenwood City. F 117 Date 7w STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER CSC; ~j /L' / lzo MAILING ADDRESS ys~ s~,>2C`'' S~. C ~Py~ Ctiol3 / Ci 0 SfsO PROPERTY ADDRESS ~'le~c~~Qc C s-y0,1_2 (location of septic system) Please obtain from the Plan ing Dept. CITY/STATE L'1 ~P.~i tU 0OG~ U4 PROPERTY LOCATION N 1/4, /I/,C 1/4, Section TO, N_R W TOWN OF G' le- 4,2 w 00 c~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ` G yoyCVOLUME PAGE33--?'7, LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can.affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum 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 systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - loo .-This application forts is to be completed in full and signed by the owner(s) of the property being developed. An inadequacies only result in delays of the permit issuance. ould this development be intended for resale by owner/contractor, (spec house), then 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 66x 4~ and CAQrlbie, ( ray le P-? Location of prop ty~~l/4*01/4, Section Township 3c~ N-R w - ~ I iucbMailingaddress /yS3 3aOt`' S~ al; . ~~►a C ~ - yol3 Address of site 3 S~ Subdivision name n © n e Lot no. - no-47e-Other homes on property? Yes __,2~_No Previous owner of property 3_0s" QomJ cl'a"Ie.~e O Total size of property C'© Acre . Total size of parcel Date parcel was created Are all corners and lot lines identifiable? K Yes Is this property being developed for (spec house) ? Yes No Volume ~ No 86Q -12- and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPbICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No. /_/y/ z?r~ own the and that I (we) presently site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Xnat/ree of Applicant Co-Applicant Date of Signature J_Iy- ~ 7 Date of Signature °DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 REGISTERS ONCE 441466 - r~ p I ----I 6~OK PQ~E 6~0 ST. CROIX CO.; Wt& Read. for Record this.16tth- i H. Robert Luepke day Of_ W1.,. _A. D. '19L8 and Ruby C. Luepke, a/k/a -Rufiy ~;uepke;' TiiisSanc~...and"wife- as""jo rit".."."". 1:00 Pr M. t e . n... t a...n s James O'Connell conveys and warrants to .J Q~_eph_.D rax~..e x...&nd.. C_k~~. r l e n e-- •~1 . l.J Drax-le-rT.--hu..sband-•.an d--.wif e-,..-a-s-- sur.vivnx.shi p---- ma r -tal- pr"o-pe-rty............................................................... Deputy - . Rivard Lsw Office RETURN TO -P._0. Box 7 Gleruaocd City, WI 54013 the following described real estate in S t • r o 1 x --R .................County, State of Wisconsin: Tax Parcel No: The North one-half (NJ) of the Northwest one-quarter (NW J), Sectial Twenty-five (25, Township Thirty (30) N Range Fifteen (15) W; ' AND Outlot Forty-three (43), City of Glenwood; S AND Outlot Forty-four (44), EXCEPT those parts conveyed to the City of Glenwood in Volume 320, pag I 391, as Document No. 244604, and EXCEPT that part described in Deed recorded in Volume 797, page 116, a Document No. 432278, and !i EXCEPT that part described in a Deed in Volume 816, page 183 as Document No. 439253, and corrected by a deed in Volume 822, page 150, as'Document"No. 441208. I This s_..no_t homestead property. Cb* (is not) i' Exception to warranties: Subject to mirdci pal zoning, easements and rights-of-way, of record. I' /S ; Dated this day of ...................•--"-•--•--•._._...••-•••--•-•--••-•.••••-•(SEAL) ......--(SEAL) R H-, obe-rt.._Lue ke .•••.(SEAL) (SEAL) ~i AUTHENTICATION ACKNOWLEDGEMENT Signature (s) H R o b e r't Luepke _ STATE OF WISCONSIN ~j Ruby C. Lue ke ss / a _ -•••••-••-•---••.•-•--.....County. hen ted this l`da~f.~7X 19__..._ Personally came before me this ate=, ..e 4#h Department of Industry, SOIL AND SITE EVALUATION Page of Ad Human Relations of Safety and Buildings in accordance with s. ILHR 83.09, Wis. County dch complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ST. CRO I X klude, but not limited to: vertical and horizontal reference point (BM), direction and ~ercent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. If 26.30.15.15-707 Date APPLICANT INFORMATION - Please print all information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot JA C- 1/4 Or- 1/4,S 26 T 3c7 N,R (J• - -W)w A 0. Property Owner's Mailing Address Lot # Bloctc# Subd. Name or CSM# Nearest Road City State Zip Code Phone Number ❑ City Village ❑ Town _ Cie-n I L%/ ('1 1 S) - Ora co.( C t~ t w stru ction Use: l-" Residential / Number of bedrooms Addition to existing building ❑ Rcement ❑ Public or commercial - Describe: Code derived daily flow QQ gpd Recommended design loading rate • 5 bed, gpd/ft2 • b trench, gpdiii'- Absorptlon area required JL°r, bed, ft2 i Oo( trench, ft2 Maximum design loading rate • _5 bed, gpd/fl2 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.3o ft (as referred to site plan benchmark) Additional design/site considerations 4t4_ A , It 4 Flood plain elevation, if applicable Parent material ~ Conventional Mound In Ground Prep ure ATG ace System~in_,F/ill Holds g Tank S Suitable for system / ❑ S ❑ S U LYJ 5 ❑ U ❑ S LrI U U = Unsuitable for system ❑ S L7 U SOIL DESCRIPTION REPORT GPD/ft2 Texture Consistence Boundary Roots Bed 1 Trench Boring # Horizon Depth Dominant Color Mottles Structure In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Ground .3 1L - (g 7,R - • y . S elev. i• i ft. 2. om 51 1 wt 5 K M F V- C 0 1.51 % % %S 1 4 S I, k rti v F i- - - .7 .0 Depth to limiting factor In. Remarks: Boring # I v-'1 t o ~tK % 5 Z. r, r" E r la s 3 6 . Z _rr Sb M F t w 2 r~) .5 3 7 S t►h Sb✓ 'rH O S. - SI Ground t•i Lt9-5f; 11.5 7a L 1 P 10 `tts G --I -s 14 f-i V~ i" ^ f elev. C iof.3 ft. Depth to CWT limiting factor 71AI-In. Remarks: e~ p CST Name (Please Print) Signatur - t t'C e- Date CST Number Address Li i S ~ r) /A-7 PROPERTY OWNER _100 DILAxl..A, SOIL DESCRIPTION REPORT PAga of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure 2 In. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 0 _-L -10 S. 2 r•. b K M r fa . ~ I_ -11 ~54 _ 51 7.1 S6 K M Ct- ' . r; Ground S _ elev. - KR S t S6K n~ h Gi,j Z/N • y S IQL,~ft. y 'i7- e to 'M s/ i S s 6 r My r - Depth to limiting factor In. Remarks: Boring # Ground elev. Depth to limiting factor 3.5' in. Remarks: n, Pt1~~%1 l7cSe_e_S pr,h S S 3tt Rr 35 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. Depth to limiting factor in' Remarks: Boring # t. Ground elev. ft. Depth to limiting factor (n. Remarks: SBDW-8330 (R. 08/95) D S EP 101997 FILED ~ s sz cROlz couN A U G 1 8 1997 ► SURVtYOR'S RECORD KATHLEEN H. WALSH 2 564046 L Registu of Deea SL Croix Co., M C ER T I F I ES SURVEY 14A Located in the Northeast quarter of the Northeast quarter of Section 26, Township 30 North, Range 15 West, City of Glenwood City, St. Croix Owned by: Joe Draxler County, Wisconsin. 1453 320th St. Glenwood City, Wi. 54013 • - Indicates 1"X24" Iron pipe weighing NE Corner 1.68 pounds per lin. foot set. Section 26 (County monument I I found). I s s' Lq_NDS M UNPLATTED J I I l40 TH AVE. rGILLf'i 30'25 4 I - - - - - - - ----~J- N a6 g0 - O N88°5,.4;'35"E I WI 109.52' Q 21 Z LL l W Q I QI I III IL0T 1 m a° Qi JI W 110,771 Square feet ? m (2.543 acres) o it =I mn N° I ~I • O to p IW- I I O I N cl roll z w Q J~ JI ~I ~i 488.40' S 88'22'37"W I UNPLATTED LANDS r N Curve Information Curve #1 Curve #2 El/4 Corner Radius - 863.00' Radius - 1046.00' Section 26 Central angle - 13°24' 10" Central angle - 1°53'04" (County monument Arc length - 201.88' Arc length - 34.40' found). Chord - N82°12'30"E Chord - N76°26'57"E 201.42' 34.40' Tangents - N88°54'35"E Tangents - N750 30'25"E N750 30125"E N77°23'29"E ' r Safety and Buildings Division t~iLrliln' SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adra, Code P.O. Box 7969 ~ AWS, o Madison, WI 53707-7969 • Attach complete plans (to the county cA y nl forp per not less county than 8 112 x 11 inches in size. ST C at • See reverse side for instructions for completing this application State San ary rmit Number The information you provide may be used by other gove e,e g nn q jr ms (Privacy Law, s. 15.04 (1) (m)l. [I Check iI revision to previous application 'L State Plan I.D. Number 1. APPLICATION INFORMATION - E SE P N&ALI. F RMATION S97-408-17 Property Owner Name ~l Property Location yrU S 4(g 114 (IE 114, S Zb T 3 a , N, R lS Hor) W le> se- D_ 11kZ - 41 Property Owner's Mailing Address P t Number Block Number f° City, State Zip Code %0 P ber 4'\' ubdivision Name or CSM Number _ e_hw v Ct,T`f tit !4 7o%3 i II. TYPE OF BUILDING: (check one) t a t e w i ❑ City Nearest Road Public 1 or 2 Family Dwelling- / avillage Town OF C %T`f Alt t2~+rrT III. BUILDING USE: (If building type is public, check _ y) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash S ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OFF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. lew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 g15pecify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit J~krt - G tt-AItt.. 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 lU d 100C> i Uav je)j. 3,o Feet ( o 3 , 2- Feet VII. TANK Capacity INFORMATION in gallons Total # of 's Name Prefab. Site Fiber- Ex per New Existin Gallons Tanks Manufacturer Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank I (2 0o pm w%,, a- E 0 El El lift Pump Tank /Siphon Chamber j - I W~ T 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: (Nq Stamps) IMP/vPRSWNo.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (IncludeSGroundwater Date Issue Issuing Agent Signature (No Stamps) ❑ Approved I ❑ Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: • o f ~ ~ -dy 3 3I ~ QI a NJ s~ QI L4 1 f ~ ° o I ~ Lu z I } W ~ V11 cem 1 3 CL W z ~ M al 2 1 ~ N 0 J r i I 1 I A I w ' ~ ~ O ~ 0 1 I 1 ~ 1661 -7 1 y~~~• MAiJ ja Y r a ~ ~i vdM may. t.~ omi" iTJ ' rte.. ~ 1'r Owner's. Name : ~'U Sc:PN ~RJaX (L,. Plumber/designer Signature: vU al ~L~ Date: 7121197 j License Number: C13Li L 5' B ' 5 I ~ I >SE ---------L----------- S97 1 0 c~ W A I L -0 - 0....-.. ...J > 5~ D 1/6 B 1/6 B 1/2 B A = I U ft E = 57 ft I = _ ft 1/2B = 50 ft B = ~b0 ft F = 1 ft L = _J10 ft 1/6B = ~6•b` ft C= 2. ft G= ( ft W =aft D = S ft H = 7 ft ~SAS avo Fabric io Observation f2„ , Ov W e l l o- 2 H Note: H is measured from 5>5 • directly below the lateral to D A C E finished grade. Plan View and Cross Section of Wisconsin At-grade Unit with a single Absorption Area on a Sloping Site Page of i i ~Y', a'~ A.. b,. ~t` L , S m " r. w •o o W Z D, C)b w ca 04 :4 i ® ® O N y a W W ~-w~ v v4 ~ ~ U U y U • G N I • ~ sroi W ~ • 41 W N a ; w a ~r 1 H O ° N N 0) I 41 4! U U 0 f 43 ) E Q .-i 041 N C. V td O 4 c N 44 E Q w ON l r 7 T w m U l N 1--1 JJ >1 44 r x v U W O Q Lu a. LL, Ej CL < CL M CL a- W X n't cr- t- o t D co W o w (n ~ Z J (/J 41 Cn O ct J d. to CO p► WV U L 14 N ►a CN mx ~ E N •N w pal a z ~ l - - ~ U O W q AT-GRADE SYSTEM CALCULATION WORKSHEET Owner's Name: parcel Tax Number: ---Legal Description: ~S, S_y T - N -R . - Lot Number: - , Block Number Subdivision/CSM Name: ~em4z o f: _st st_ o C; t 'T , R a - County, Wisconsin At-grade Structure 1• inches. Limiting Factor Depth 2• percent. Land Slope 08 3- 6OO gal/day. Daily Design Flow Rate (DDFR) 4• -1-_ gal/ft 2/day. Design Loading Rate (DLR) 5• 00o feet 2. Effective Absorption Area (EAA) = DDFR DLR A x B 6• ~D feet. Effective Absorption Width .(EAW) = A 7. 10,0 _ feet. Effective Absorption Length (EAL) = B = EAA 8. 6 EAW gal/ft. Design Linear Loading Rate (DEER) = DDFR 9• Z _ feet. EAL Total Aggregate Width = A + C 10. Z Z. feet. Finished Width (W) = A + C* + D + E** 11. 110 feet. Finished Length (L) = 2 (I) B 12• z feet. Finished Height (H) F + G 13. j6,66 feet. 1/6 B ) ) Observation Well Locations 14.- feet. 1/2 B ) 15. Texture of Soil Cap Material. Notes: * C is .0 if the slope is .0%, otherwise C is 2 ft. On level sites, substitute another D for E. Plumber/designer Signature: License Number: Date: 7/21/97 Page o f Pressurized Distribution. Network Design 16. Distribution Lateral Sizing. inch. Hole Size 3.S feet. 4 3" Hole Spacing feet. Lateral Length inch(es). Lateral Diameter feet. Lateral Spacing lot.e feet. Lateral Invert Elevation 17. Distribution Pipe Discharge Rate. I L Number of Holes per Lateral 14.3 gpm.. Flow Rate per Lateral - Total Number of Laterals 3Z.6 gpm. Total System Flow Rate 18. Manifold Sizing. C~jiManifold Type (center or end) feet. Manifold Length * * If only a tee fitting is used as the manifold, the manifold inch(es). Manifold Diameter * length and diameter may be reported as not applicable (NA). 19. Forcemain.. 7- inch(es). Forcemain Diameter o feet. Forcemain Length _(Z gpm. Minimum Dosing Rate (system flow rate) 13-q gallons. Forcemain Liquid Capacity 20. Total Dynamic Head (TDH) Calculation System Head = 3•L~ 2-.-&0 feet Vertical Lift = Lt .50 feet Friction Loss = ~.-1S feet TDH = It • ZO feet Page of VAGC OF - I j PUt`%P CHAt,%F ER CROSS SEC-10IJ AUD SPECIF'ICA•rlul!.`. VEA:T CAP 4'C.I. \•EAlT PIPE WEATHERPROOF to GOOK, 4PFR0`/ED LOC•~.s'.. > JUUCTIOU BOX MAI,JHOLE COVER WINDOW OR FRESH 12 MIU. r. AIR INTAKE I (`j GRADE • i i. I 4" MIM. cououlT IB°Mlu. ~ IMLET PROVIDE I AIRTIGHT SEAL I I i I ` / i \vf APPROVED JO11<IT A III W~C.Z. PIPE I I I APPROVED JOIIJTS I I (I W/C.I. PIPE EXTENDING 3' I I I ALARM EXTE1' MUG 3' ' C)NTO SOLID SOIL B I 1 I ONTO SOLID SOIL I 1 C I I O 10IJ I I 0- E.LEV..17. 225 FT. s t,~y 'Nap • PUMP COWCRI:TE BLOCK 10 dW NHS ~~Gy• 46. b REgP SEPTIC E SPEGIFI•GATIOAJS DOSE. SEEGOR TAWKS /`1AWL)FACTURER: NUMBER OF DOSES: LI PER DA-4 TAMK SIZE: (b(OD GALLOWS DOSE VOLUME ALARM MAIJUFACTURER: S -S I~~m INCLUDING BACKFLOW: 3. rf GALLONS MODEL WUtAbEK: l l K~_J CAPACITIES: A-10. 2._IuCHESOlt Rz.l CALLOUS SWITCH TiIFE: B = l INCHES OR 52- GALLOWS PUMP MAMUFACTURER: '-1kj_V,,o A4Xc. G = INCHES OR . ~I _l( GALLOWS MODEL UUMBER: S1-) ~-C D= ~Z- INCHES OR tL GALLOWS SWITCH T`.IPE: I„Icys.ny MOTE: PUMP AMD ALARM ARE TO BE MIWIMUM DISCHARGE RATE GPM ~INcS,T,ALLED Old SEPARATE CIRCUITS VERTICAL DIFFEKEMCE BETWECIJ PUMP OFF AND OISTRIBUTIOI~:I PIPE.. '1.50 FEET + MIUIMUM WETWORK SUPPLY PRESSURE . . . . . . . 3•2-5 FEET 26 6n~ ~yICN + 10 FEET OF FORCE MAIN X FTC /oorLFRICTIOAI FACTOR..• `157 FEETi,S2 TOTAL DyWAMIC. HEAD = LG FEET.`?) IMTERWAL DIMEIJSIOWt OF TAWK: LEt-jGTH 2.~ ;WIDTH ;LIQUID DEPTH SIGIJEO: LICEWSE DUMBER: 13 Li DATE: 7~ 2W97 UMP/ErVLt9r'4,T.,,,P Features UMP . WS/DS25 WS25A1 i ~ l 1f • Completely submersible DSIW - 4 N1• SOLIDS 1/2" - 3300 RPM aW0111atlc Sump/effluent purnp. 2 • Available with wide-angle - - - - "piggyback" float switch 24 (WS25A1) or diaphragm type "plgVback" switch (DS25A1). • Cast Iron conduction with non- w 20 corroding ADS volute/base. LL • 1 /4 HP, 1 15V oil-filled motor z is with thermal overload o protection. w - - • An1.1-clog thermoplastic = 12 Impeller. a FULL LOAD - AT • Can be used without switch for o e tm P115V. DS25A1 portable dewatering pump. (1.5' • 1 1/4" NI,, discharge with adaptor Included for 1 1/2" N17T 4 discharge. - • 10' replaceable power cord. 0 • Weighs 14 lbs. 5 10 15 20 25 30 35 • UL listed sump pump. U.S. GALLONS PER MINUTE SW/SD►25 & 33 ror sump and effluent use. 2e SWIS025 - 114 IIP - MAX. SOLIDS In". ISSO RPM SW25/33 Automatic models available - - with wide-angle "piggyback" 24 float switch (SW models) or - - - FULLLOAG diaphragm type switch SD ~20 AMPS AT ( 14, 11SV. models). Also available In LL - 8.0 manual models. o1e _ _ _ • 1 /4 HP (SW/SD25) or 1 /3 HP 12 (SW/SD33). heavy-duty, 115V - - oil-filled motor with thermal, e _ overload protection. • Rugged cast Iron construction. • Non-clog vortex Impeller. - - - - - - • 1,ong life lower ball bearing. ° 1 s 10 15 20 25 30 35 . .s so Sintered top sleeve bearing. U.S. GALLONS PEn MWUTe • Carbon and ceramic mechanical shaft seal. r. SWISO33 - 113 HP - MAX. SOLIDS in" . ISSe RPM 1 1/2" NPT discharge. 28 SD25/33 10' replaceable power cord. (20' optional). 2, • UL listed sump pump. tz 20 W Z1e- - - - 0 12 FULLLOAo AMPS AT 10. IISV. 0 10.0 0 S 10 1s 20 25 30 35 40 .S so Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Page of Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. N Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location q cL Govt. Lot i\l E 1/4 ~k- 1/4,S24 T30 N,R (S' E-(er) W Property Owner's Mailing Address !~g l ock# Subd. Name or CSM# City State Zip Code Phone Number G i e, n cc,4 C Cm i 1(715') 21.5- 2_31 ❑ City Village ❑ Town Nearest Road t New Construction Use: Residential / Number of bedrooms ' Addition to Isi~ b ding g ❑ Replacement ❑ Public or commercial -Describe: Code derived daily flow 600 gpd Recommended design loading rate S bed, d/ft2 • 6 Absorption area required 2 2 9P trench, gpd/ft2 q~_bed, ft Ob o trench, ft Maximum design loading rate bed, gpd/ft2 • 6 trench, /ft2 Recommended infiltration surface elevations gPd lot-_3') r o To ft (as referred to site plan benchmark) Additional design/site considerations ITT- G- CLtc~ Parent material JA hd S-M ►1 Flood plain elevation, if applicable A • ft S = Suitable for system Conventional Mound In-Ground wPres ure ATT-9 ade System in Fill Holding Tank U = Unsuitable for system ❑ S L7 U ❑ S L~'I U El L~J S ❑ U ❑ S U ❑ S © U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture a Structure GPD/ft2 in. Munsell Ou. Sz. Cont. Color Consistence Boundary Roots kid 0-'B Gr. Sz. Sh. Bed Trench 10`+11 VK m fr Tw22 • J .6 2 13- it lo tZ `YZ 5t 1 2. m M 1: 1- . ;elev. ~ 3 n& Grou 2 c- 5 b k N1 . S. 6 )q-1. i ft, (g _yZ `ivy s% - 5 i 1 ^1 51, K M F r C t„~ - • `1 ' . S Depth to S YZ - S Y 1 S 1 t b k n1 V limiting factor Z In. Remarks: Boring # I v-'] to-(K ~L S► 7- i,_- MEv AS 3'VA Z Z '1- i2 '1. S it - 2 f S6 M F H c.w 2 rh S . L 3 I2- Lfq '1 S 'it? % S1 km Sb✓_ •Y .S Ground `-i Ltv-.7v '1- S YgL L 1 P to `(it 1-5 1 4 I, H V H elev. ft. Depth to limiting factor 'Di_in. Remarks: CST Name (Please Print) Signature Telephone No. Ar-t e_ 7/21/97 ! Lt -3 Z2 Address Date CST Number (o ra m( U c LJ i Page of SOIL DESCRIPTION REPORT PROPERTY OWNER ` PARCEL I.D.# 2 Structure Consistence Boundary Roots Bed , Trench Mottles Texture Gr. Sz. Sh. Horizon Depth Dominant ()u Sz. Cont. Color . ` Boring # in. p _ S~~ Z M 6 K 1"•~ . b O,b O`t ~z _ 51 Z~r 51~ K M Ct- . . / S 1 %14 Ground s/ (S s 6 r MU Y- elev. cc> Depth to limiting factor r~ in. Remarks: Boring # Ground elev. by. i ft. Depth to limiting factor ;1 S 3 Rr 35 veS in. Remarks: Dl Structure Consistence Boundary Roots Bed , Trench Mottles Texture Gr. Sz. Sh. Horizon Depth Dominant Color Munsell Qu. Sz. Cont. Color in. Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor ___in. Remarks: SBDW-8330 (R. 08195) i I3 I ~ (o I rn ~ c z 3 Ilk 7 I J ~ I~~ I V. I N ~ I~ I~ I tc lQ I~ ~ U s x ~ 1 p r la ~ Irn I~ F w '4F p I ~ IR EA w N I I I ~ W ~ s s n E ~ r ~3 ~ n I~' ►n ~ m F 1 IL I d^ ~ X N b W Y t is t L ! Y1 i .rr 1 t r r1R r "Y ~rY~ Ft 14 jr ~ 4..~~ r MR L+vF•rf + 1 ~ V r! !a k .yY ff~~a~f~E~'ytr rn Yi~rY~+~Y eTT I r { . R / ~ •r~lV {T, "SfF u j r lz a ',w r pF . j I ~ ~ f„ r ra* err ~ ~ f r f 1 6F;` I 4 v f1 L!e PTY G Yf Td ! r it r~ O R I { i* 4 ~ ifs ~4 k 1 - -'a t dF'r+t~t1 r r - ~ (K Q r r " f (S I I ~'~SI. . JC( L C1YR ".p-~ ~ye!Y~ ' t < y .Y t GUSTOr LCF~ PORE .le DESIGN w _ TITLE t1,cvRTtia ~y0,yp r111r 1rl 7 K Y AT - VISwo WG 0 t D rW IGIIAPfafoflYlon yp coon +Ma t%% 147TH STREET 034I NAt[. NID Walr a 1411 YL R PARK. V! y~Ti V. T -97 at,. NpTICEM „s r,n, •smH~wY (ns)1a-~10 ''~h~ Imp volYr~ ,W r r i'ce' ~ ~ IY qp". It - n r ik i6l i`f tit •F r ~ l~ llw yam,:- ' 'if A s ~ a lu~ t 41 " # t~ 3 ft ff tf a .j. alp ! S< - Z 30, t I I z r y s I~A t r~ M4 1~ r C ~ 7 1{et ~ 14 ax e A ' we w W. 3 N~4 ~i ♦ 4 lC 1Vt li ~ - ae1a1A6~01s •1At IAIIM71i7 tNMfLNf M1M wi i CUStOM OEsmm FOIe JOE \ CWQ ORAKLER 1I Cd ;y' 6 OWM.[7 n w. rro tang olearm uo mall `n.at DESIGN 11YN11 //16! AIWS dl t01M1RM U~ 011 IU11.1o1 /0 vegv /etgtn6 6X7 rllosa. r xar sWaR r srnm m 1ww ae• K 147IM ITREEt 1/4' - 11 eEER ER f G t•' F!+ wAr autos. ~ ~ n11v7 _ CL /eM ^~Is. n1t rlrorwA moc swu eow71 ; ►AItK VI 77007 BY. Kff DATE I- MAN l[v .L j Sao. ouMrlo. re auwllo a ri .oes _ ()1e)2~6•]Ot0 v MrE vISIOA... Ova NO ,j e. t ~ ai f ~ f ~ ~ a ` Itt r cv r,~ ' e t a; a xi ~ k S y Y ~ t k.. a, ,r Y^ 3 t t i 1 1 N i11' Ilk 9. i.. I G r.~, , Iz, t pp e , ,.bete ~ fI , ~ Iq d qr - , { 4 K Fil dg $ FIl N I N . r LEA ctuicte DESKM Fort, .A[ t pMF nun" ea aewn+e,ete „uer rreret ve,ne.,a vnw •c ESIGN - MDTiCfe tmest. snq. /Iq ,am. a,owwco ,uR~ coeu .qx f' , m W,wls an aWlr~ar uao Iq M 1~7T 7 STRCET iriE COLINDATIOt RMI ~E MFLICI! v V[FAr ML MOM~F • M IICI[Ct °H a. /Iel 40 Ielr !t[ti,l>Ylr RlOm a H/N att 1 _ we Wutgw ,ws Iwv w geofowK,R „K YMpfwE roof fwLL OtnglK EEEF ►~RY. W 54007 V ViS OVB XO weN, N Ieet¢~ ca aFwmfa ,w ow,n a ~u eow. 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