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HomeMy WebLinkAbout014-1032-10-000 t 4, 3: C) o 0 0 0 M r C 0 O O O t\ W N U N 3 ~ -O N ' O N p I a .yp O N E S M O ofl c E0 N Vii O N N y N c c Y 9 0 N E O L n +U+ C z ` O j 7 (6 7 H U I LL c a O 7 I O N 65 w _ Q) ~M m E Q Z in tT 8 CU a Z C O Z ~ y d ~ a CO F- z l o I c O a~ o z L d' i n w d Z o O (A F- n Z N d o E M E ~ o ~ c io U O o z z w ~ o N ~ z I ►y,~ vi E 3 ~.T N • m a y m o m Y O O O LL z~ • ►~,i co a a a of ro a g N z o N U rn rn o U, rn rn i~ -0 M (0 W _ N N O M N U O C) = W T _T 3 U ` d s~ N c •d rn ac'i << 'I. p U m = Q O O N C O N c c N° rn N O N a d ~i O O O m H LL E E cc) U-) C O O 5 n C w a~ ~i FL- F ro .r M ° NI E E -In • y'~•,' O Il 2 N O O ~ r~ `D m m a y 5 dt a a CL (D `iv L 3 r - E A 0 N V a a 0 104 '/3,01 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER c~ L c° _JO 2'2 :JAS . ADDRESS 7~7 ST G(i(:~ i A ~l Q ~G`~t'tY ILI SUBDIVISION / CSMV N11- LOOT SECTION-) 6 UNT 1 N-R J~ W, Town of ST. CROIXX COUNTY,, ~W-I-SCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y N o ~ JIN ICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. off' g~Gnf~~l~ous~ ~ • ' ~o~qC'1 dl icy BENCHMARK: ALTERNATE BM: SEPTIC T7Z,7,C P CHAMBER / HOLDING TANK INFORMATION Manufacturer: a 7r Liquid Capacity: 12C)17,0 / i Setback from: Well r0 House P Other r t Pump: Manufacturer ~o fn/-Z Model# 8 Size - Float seperation Gallons/cycle: Alarm Location- ABSORPTION SYSTEM Width: Length Number of tr6ni--k l Distance & Direction to nearest prop. line: W0flr#rf?d.4,() . Setback from: well: ~a House ffp Other ELEVATIONS Building Sewer ST Inlet: ST outlet , PC inlet PC bottom f! pump Off I&I L9 Header/Manifold r / Bottom of system Existing Grade 7~ Final grade d&, 1pe*. /U/ DATE OF INSTALLATION: PLUMBER ON JOB: fc~y. LICENSE NUMBER: 1124Ll -3122 INSPECTOR: 737/-( 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: ~rKGENERAL INFORMATION 268555 F rmit Holder's Name: j e , rs/ ❑ City ❑ Village Town of: State Plan ID No.: ISEL, FRANK o• FOREST T BM Elev.: i Insp. BM lev.: BM D scription: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -~I~C u_i4 (.y; Benchmark Dosing M. Aeration Bldg. Sewer zo S, a3 Holding St/ Inlet p/~ 9 91 NK SETBACK INFORMATION St/ Outlet Verit ir Ito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Air Septic C_ NA Dt Bottom 96,yp Dosing NA i tJ Man. aj.1(7 Aeratio NA Dist. Pipe 3,d /w. Sa In 9 Bot. System 99 8'0 PUMP / $ INFORMATION Final Grade Manufacturer C~a-/ Demand ,e2S 996 7~ Model Number GPM TDH LiftFriction System TDH Ft Loss 'd ~ ti Forcemain Lengthgs i Dia. " Dist. To Well F-1 SOIL ABSORPTION SYSTEM BED /TRENCH Width I Lengtly r No. Of Trenches PIT No. Of Pits Inside Dia. 9~pth DIMENSIONS t DIMEN I N M acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA INFORMATION TYpeO • Y,(" >ZD O AM T Mod I Number: System: M AA d DISTRIBUTION SYSTEM E : [Heaider / Manifold Distribution Pipe(s) r „ x Hole Size x Hole Spacing Vent To Air Intake / r ~ •r a enth y3 (D / Dia- Length Dia. Spacing S 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 / Center Bed Jfti;W Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: Forest.15 31.15W NE NE County Road 0 L2r l { I / lhi... Iv a1 f Vii: 1, r._ if r Via" llfd, !-7 • , } Plan revision required? ❑ Yes 3/No Use other side for additional information. 'J SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less re'er than 8 12 x 11 inches in size. el~v • See reverse side for instructions for completing this application State Sanitary Perml Number The information you provide may be used by other government agency programs I] Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION ~'aD~zs Property Owner Na a ropert Location 1i4,Sf T 3/ N,R E490)W Lot Number Block jNumber Property Owne"r's Mailing dress -117 ~3_ ~r 4Q,9 ~Z 7 '0 e/i __1 Ci tate zip Coe Phone N tuber Subdivision Na a or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned City ~G Nearest Roa village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) D/~f -lo,~L ~2d 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 2." Replacement 3. ❑ Replacement of 4. Reconnection of 5. E] Repair of an *ew ystem System_____________TankOnly______________ 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 21XMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ~O Required ropose (sq. ft.) (Gals/day/sq. ft.) (Minn/inch) Elevation Feet -Z V1 Feet VII_ TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks T nks Septic Tank or Holding Tank ! r-P~ ! ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber V ^d ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit or installat' o he onsite sewage system shown on the attached plans. Plu is Name.: (Print Plum e s Signatur . (No Sta ps) PRSW No.: mess a Number: /77 Plumber's Addr ss Street, City tie, Z p ode) e_ 5,~ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved sapitary Permit Fee (1n`1udesG,oundwater ate Issued Issuing Age t Signature (No S ` Surcharge fee) Approved ❑ Owner Given Initial Q'hG7~~ d Q s1 Adverse Determination CJV X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SOD-639.8 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS - I , 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. Onsitesewage 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: I_ Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII: Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction 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) fora number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations May 15, 1996 209 West First Street Route 8, Box 8072 Hayward WI 54843 FANSLER EXC 794 172 AVE BALSAM LAKE WI 54810 RE: PLAN S96-20125 FEE RECEIVED: 180.00 HEIBEL, FRANK NE,NE,15,31,15W TOWN OF FOREST COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, j4w~ V / Thomas L. Braun Plan Reviewer (715) 634-3026 7:45 - 4:30 5056R/ 1 SHUA-6928 (x.16/94) Mound system for i~i 4K pages #1-------plan approval application #2-------soil data (EH 115 or Morphological Evaluation) #3-------plot plan-plan view #4-------work sheet #5-------system cross section #6-------pipe lateral layout #7-------dosing chamber #8--- ----pump curve PRIVATE SEWAGE SYSTEM Conditionally Duane D. Fansler s AlIPPROVED DEPT. nF IpnUSTRY, LABOR a HUMAN RELATIONS - " ~ Z~ 1 ION OF SAFETY AND BUILDINGS 794 172n'd Avenue Balsam Lake, WI 54810 MPRSW 3177 SEE ~PRRESPONDENCE Date: S96-20x25 RECEIVED MAY 14 1996 SAWY & WIGS. DIV. WiscoansinDepartment ofIndustry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Yd~ / Labor arid Human Relations REVIEW APPLICATION Bureau of Building Water Systems ( l l Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C Rt B. Box 8072 LaCrosse, WI 54603 P O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-51 19 Phone (715) 524-3626 Fax (414) 548-8614 Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewer Name Plan Identification Number rSi~ -lei? l 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identlilication number, provide that number here: Project Name ffPJ l City Village rV_1 Town Of: County Project Location GOVT LOT 1/4 Z-_ 1/4 S T N,R ' W 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type 1 (include new and existing tanks) Up To 1,500 gallon septic tank $ 110 00 $120.00 A At-Grade 1,501 - 2,500 gallon septic tank H Holding Tank 2,501 - 5,000 gallon septic tank $160.00 M ® Mound 5,001 - 9,000 gallon septic tank $ 200.00 . N Non-Pressurized In-Ground (conventional) 9.001 -15,000 gallon septic tank $ 300 00 P El Pressurized In-Ground Over 15,000 gallon septic tank $ 500.00 O 11 Other: Up To 1,000 gallon dose chamber $ 70.00 ~r - 1,001 - 2,000 gallon dose chamber $ 80.00 . Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00 4,001 - 8,000 gallon dose chamber $120.00 _ D ® Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $ 140.00 P El Public Budding Over 12,000 gallon dose chamber . . $160.00 . S ❑ State-Owned Building Up To 5,000 gallon holding tank $ 60.00 5,001 -10,000 gallon holding tank $100.00 Code Derived Daily Flow ~~C~ gpd Over 10,000 gallon holding tank $750.00 Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00 Revisions To Approved Plan $ 60.00 Petition For Variance: Setback $100.00 0 Petition For Variance Site Evaluation $ 225 00 . Plumbing $22500 Revision $ 75.00 Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00 (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 . d5e Subtotal: Zlfi! Priority Review: Enter same amount as Subtotal: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: S. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Company Name Con ct Person No. & Street Address Or P.O. Box City, own or Village, State, Zip Code , I Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. z Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis Adm. Code, Chapter ILHR 2, and are subject to change annually. The information you provide may be used by other government agency programs [Privacy I - t 4 (r j , 0 1 2 SBDW-6748 (R. 09194) 1+ !V §iVER DEWEY FANSLER EXCAVATIN~r-~~ 9 CST 507 MPRS-3177 I i ' - - . ' 1 I i I I ~ ~ I I~ . i 1 I i I rz I ! i ~ i I ~ I Py) ~ ~ ~ ~ I I I i ! O c , kr\ CD I 1 1 _ I -All t I ~ a 6 I I I I i I y I 1 ~ I ' I - I I 1 I 1 ~ , i I i 1 j I i I ~ i I I I e 4~ j I p C-t • r per/ I ' 9 r RREEEE" 1 I - - OPTIONAL WORKSHEET 1. MOUND SYSTEM II PACCLArd PRESSURE SYSTEM -Continued- 1. Wastewater Load, Total Daily Flow= gal. 10. Force Main: = Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate gpm. in. Adm. Code and PROVIDE A DETAILED Diameter = LIST OF SIZING ON PLANS. / 11. Total Dynamic Head: 2. Depth to Limiting Factor = .I l ft. System Head = 2.5 ft. 3. Landslope = _(0 % Vertical Lift = A ft. 4. Distance from Dose Chamber to Friction Loss = ~yJ it. Distribution System = ft. TDH = --L-1 L ft. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = ft. Pump will discharge at least gpm 6. Absorption Area Sizing: at 16-ft. total dynamic head. Area Required = Soo sq. ft. Pump model a lid manufacturer: Z•©e_l Bed or Trench Length (B) _ ft. - r Bed or Trench Width (A) ft. 13. Dose Volume: Trench Spacing (C) ft. 10 Times Void Volume of 7. Mound Height: Distribution Lines= gal. Fill Depth (D) = ft. Daily Wastewater Volume T Fill Depth Downslope (E) = ft. 4 Doses In 24 hrs. _ gal. Bed or Trench Depth (F) = t33 ft. Backflow = l~ y gal. Cap and Topsoil Depth (G) _ ft. Minimum Dose =`YJ_ gal. Cap and Topsoil Depth (H) = ft. 14, Dose Chamber: 8. Mound Length: Volume gal. End Slope (K) = ~y ft. Total Mound Length (L) ft. 9, Mound Width: y O P Upslope Correction Factor = o Upslope Width (J) = ft. Downslope Correction Factor Downslope Width (1) _ ft. Total Mound Width (W) ft. 10. Basal Area: Infiltrative Capacity of Natural Soil = gal./sq.ft./day Basal Area Required = sq. ft. Basal Area Available = [o[_- sq. ft. 11. If Standard Tables from Chapter Z H 63 are Used, Indicate Table No. Z 12. For the Distribution Network, Use Numbers 5-14 In Section II. 11. MDgA d PRESSURE SYSTEM 1. Depth to Limiting Factor = 7,~ ft. 2. Landslope = % 3. L,oad/aJ Rate = _ 9yls/Spl7' 4. Proposed System Elevation = ft. 5. Wastewater Load, Total Daily Flow: gal. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED LIST OF SIZING ON PLANS. Required Septic Tank Capacity = 7-00 gal. 6. Absorption Area Sizing: V. SEPTIC TANK 4 oad4vi Rate= _JA,s/sP FT 1. Capacity= CU 1c_ OD gal. Area Required = sq. ft. 2. Manufacturer: -4612- System Length = ft. 3. Show Site Constructed Tank Details on P;an System Width = ft. 7. Distribution Pipe Sizing: VI, DOSING TANK Holc Sirc = t in. 1. Capacity = 1 gal. N Hole Spacing fl, 2. Manufacturer: / Lateral Length • It. 3, Pump Manufacturer L° Laleral SLe In. 4. Pump Model: crating Head Lalt•:,il Spacing it. S. Op ft. Dishml.v Irom Sidvw.dl to Pipe _!3D_ in. (i. Flow Rate= -Y~ 91) M. H. Uisulhutinn Pipe Uicch.uge R.ilt: 7. Show Site Constructed Tank Details on Pans s: Number of I lolcs Pei I'Ipt• 7 r I low Per Plitt' gpin. f, 4. M.utllold Siting: eN~ I ype (cutlet or end) G Length = ft. Dlamcicr In. S96-20125 -SHOW ALL INFORMATION ON PLANS- DILHR SBD•6761 (R.03/82) page,!' Ofg Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ H _ _-~G Topsoil _ F D 3 E . b % Slope Bed Of z.- 2 %2 Force Main Plowed Aggregate Layer D Ft. E ~ Ft. Cross Section Of A Mound System Using F Ft. A Bed For The Absorption Area G / Ft. A Ft. II Ft. Signed: B G~ Ft. License Number: - K ~Q,35Ft. L F+ Da t e : 0 Ft. T 1~ Ft. W Ft. 7- L J Observation Pipe--," A (Force Main w - Distribution Bed Of 2 - 2 z Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page Qf6 Perforated Pipe Detail n nd View Perforoie0 End Cop PVC Pipe a` Nolee LoCOted On Bottorn, S Are Equally Uoced t YLI~Cc IsT 1-~c~~ Nrxr' TL, i°I1 AN i S=c i7 Loll Hole Should Be Neat To End Cap Dielribulion Pipe Layout P Ft. 60 S X _K InchPS 45- y . Inches45 j Signed: Hole Diameter 44 Inch Lateral 7i Inch(es) License Number: Manifold Inches Date: Force Main Inches # of holes/pipe i Invert Elevation of Laterals .~~Ft, 2 0 2 :06e7we SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 9 WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE C FINISHED GRADE 4" CI RISER W/ PADLOC 6" MIN WARNING L . ABOVE GRADE 4" MIN 18" IN. 6" MAX. INLET I ~WATER TIGHT SEALS GAS- 'FIGHT, 4" BAFFLE A SEAL APPROVED CI PIPE , ALM JOINTS W/ 3' ONTO B ON PIPE 3' 01 SOLID SOLID SOIL SOIL C ' PUMP OFF ELEV . O,O FT. 1- I OFF RISER D PERMITTED IF TANK MANU FAC TUR. HAS APPROV 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE 'T'ANK MANUFACTURER: __!_s~_ C c NUMBER DOSES PER DAY: 'T'ANK SIZES: SEPTIC _c ? GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: aa~ GAL. ALARM MANUFACTURER: ~ifGfLcr~t~ CAPACITIES: A = 04"1' INCHES = y g G: MODEL NUMBER: SWITCH TYPE: B = 2 INCHES = 3y G" C = INCHES = PUMP MANUFACTURER: 7- MODEL NUMBER: SWITCH TYPE: ~ke v~y D = INCHES = /oz GE- REQUIRED DISCHARGE RATE 39~~ GPM PUMP E ALARM WIRING AS PER ILHR 16. 23 4 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /0,0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2.5 FEET + FEET FORCEMAIN X 3, l FT/ 100 FT. FRICTION FACTOR 2- FEET TOTAL DYNAMIC HEAD = 7 FEET TNTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH (og DIAMETER S=20125 LIQUID DEPTH ':SIGNED: LICENSE NUMBER: DATE: Y ~ cn 3 7/8- HEAD CAPACITY CURVE MODEL "98" 30 8 25 m 6 20 15 4 10 2 5 0 S. GALLONS 10 20 30 40 50 60 70 80 RS 80 160 240 0 FLOW PER MINUTE .t TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING 12 CAPACITY HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 } Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT ' of Laba7 and HuMan Relations J Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code jj]] F11D.4K I~UrO1X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ' q6 dimensioned, north arrow, and location and distance to nearest road. 14 0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ZOe UP;-}. UNFY PROPERTY OWNER: PROPERTY LOCATION } _ Frank Heibel GOVT. LOT NE 1/4 NE 1/4,S ,1 wlW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2977 Co. Rd. #Q na na na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Clear Lake, WI. 54005 (715 263-2342 Forest Co. Rd. #Q [ ] New Construction Use [ Residential / Number of bedrooms 4 [ ] Addition to existing building Fc] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 4 bed, gpd/ft2 •5 trench, gpd/ft2 Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate .4 bed, gpd/ft2 •5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 99.45 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on ocntour line of el . 98.45' Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ®U CRS ❑ U ❑ S ®U ❑ S ®U ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.Bed Trench 1 0-11 10yr3/3 none 1 2msbk mfr 9w 2f .5 .6 2 11-28 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 28-42 5yr4/4 c2p5yr5/6 sicl 2msbk mfr gw if .4 .5 elev. 4 42-75 7.5yr4/6 c2p 7.5ry5/8 is Osg mvfr na na .7 .8 99.15 ft. Depth to w/b nds o 10yr5/6 cld 7.5ry5/6 sicl M na na na np .2 limiting factor 28" Remarks: Boring # 1 0-13 10yr3/3 none 1 2msbk mfr gw 2f 1.5 .6 M1.......2< 2 13-22 10yr4/3 none sicl 2msbk mfr 9w if .4 .5 3 22-26 5yr4/4 none sicl 2msbk mfr gw na .4 .5 Ground elev 4 26-48 5yr4/4 c2p 5yr5/6 scl lcsbk mfr na na .2 ' .3 . 98.95 ft. Depth to limiting factor 26" Remarks: CST Name: Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200;01. Ave., Newy~gichmpnd, WT_ 54017 Signature: Date: CST Number: ~YA~ 4-4-96 cstm 02298 PROPERTY OWNER Frank Heibel SOIL DESCRIPTION REPORT Page _2_ of.&__ PARCEL I.D. # 014-1032-20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 3 2 10-17 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 17-25 10yr5/6 none is Osg mvfr gw na .7 .8 951e65ft 4 25-48 10yr5/6 none sandstone resi um na na np ;np . Depth to limiting factor 25" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Frank Heibel 1554 200th Ave. CSTM2298 NE4NE4 S15-T31N-R15w New Richmond, WI 54017 MPRSW 3254 town of Forest (715) 246-6200 N 1"=40' EM.= bottom of siding of smoke house @ el. 100' o 0. j 1,7~ 23' .1 \A r, G 40 do, Gary' L. Steel 4-4-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER --FC- R,RY A N p D F r38 i f- N► L 6,~ S MAILING ADDRESS cm, p PROPERTY ADDRESS 5 PAW (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1-f- AIR L R K C- W::~' `J ti 005 PROPERTY LOCATION N 1/4, N E 1/4, Section T_a_J_N-R_Lf)_W TOWN OF ~b A~ ST. CROIX COUNTY, WI SUBDIVISION _t\j I~ LOT NUMBER CERTIFIED SURVEY MAP, VOLUME LA, PAGE N 1 , 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) afier 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. SIG c1 DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. r- Owner of property M A N ae>/E Location of property_,4/C- 1/4 We 1/4, Section T ; -R~W Township Foltor" Mailing address 27 Al Address of site cS;¢ t' Subdivision name _1()IX Lot no. Other homes on property? Yes No Previous owner of property Total size of property A9e),4ei= Total size of parcel X, .oft, Date parcel was created &f Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volumel and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION 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 the ffice of the County Register of Deeds as Document No. -Z ~7'/? , and that I (we) presently own the proposed 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 offic of the County Register of Deeds as Document No. Signature Appli a Co-Applicant Date of Signature Date of Siqnature • 1 4 5` 9 W %KRAN UN DEIE:D R'so~F~cE {j..,FNI NO n Mina 242 F GW.. wi H. Heibel, a single man 1 1996 Frank at 4:00 P-M ,:on%ecs and tsarrants to Terry E. Nilges and Deborah L. Rsd6 dD~Yr~ Nilges, husband and wife, as survivorship, marital property 1 - x the tollo-Aing described real estate in St. Croix r ouw,, State of Wisconsin. N}ivE}, Section ls, Township 31 North, Range 014-1032-10 and 01- -1032-_0 Pircel IdentifiLanra, Nun bO i 15 West. Subject to existing highways, easements and rights a: way of record. The above described premises contain 80 acres, more 3r less. i. o s~~R S This is homotcad prorcrt% (is) (is not) Exception toaarrani s: Subject to all easements, restrictions and covenants of record. w~v i,t 96 31st dad ,`t Dated this i ~2Q ~ ~s/tC.71 J~~•~/ lY I S F 11 1 Frank H. Heibel .SI V t (SE \1.) AUTHENTICATION ACKNOH LEDGMENT S f s 'ON~IN t Signature(s) \Tk ,.T N IS( . Croix ( ,unto - 31st !.v, of Bat, of 19 P.' -111% -en( NCtorc ntc the, ❑uthcnU~ated the, 11) 96 Cr ar• .i nal led e May Franc H. Heibel 1! TYFLL \II MBER STATE BAR OE WISCONSiN (if not. .n h, f III" n ~ Y• auth~iritetl h} §70P06. \\"is Stats.t thc the { rr n n,nnnt ,rn 6n,,. 1, )hr .imc Connie M. (,ullixsor). f rrr(((((( Notary Public. t11'y•J`-~.L 4 r.,c iPIIMF N' `rVAS [)RAF TED BY