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HomeMy WebLinkAbout022-1002-70-100 Q o 3 0 3 0 i eo a~ o -4 k1l, c c 0. O t" w (D N w C °c LID o' 9) co :3 y .O O O Y N D N U N O co cc-M a) m v ~*kME ° N l4 o 0 p C. > N mQ a~. O p N N ~ c aN~o 0 0 co M c s N O N O 0 0. CL Z y co a C_ 'D Z O C Li c o'amdEE ~i c p O L C V a y C C Q CL U) ~ (n Q z I' c 1 co O M 7 L) z E co O Z ° w p E cOI as m Cam. m I N F- Z W O o z zt Z v v m Z d ° c Z c Z N F N ° ~ 72 E '2 O 2 M N M hh,~ E =5 ^a c ~ c • N -o O -p O c m C ~i p O 2 Z Z ® 2 Z Z p N z E z f0 0 r_ -o I M r_ V N 1C ? N N (~i O~ y N `y N~ d N Pl\ 4. 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BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 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. Airl to ntake ROAD Dt Inlet irl 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 i Loss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIM I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of 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. Sparing 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/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Kinnickinnic.2.28.18W, NE, NW, Kinnickinnic Drive Plan revision required? ❑ Yes ❑ No Use other side for additional information. L I SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH 1 , SANITARY PERMIT NUMBER: • ~ ; SANITARY PERMIT APPLICATION Bureau oand f Build Safety Build i nWater System, g Water 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 County C than 8 112 x 11 inches in size. 51 • e-66-1Z • See reverse side for instructions for completing this application State Sanitary P rmit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATIO Propert Owner Name Prope tlon 6;-1/4 1/4, S Tt , N, R if E (orto Property Owner's Mailing Address S - 4otc 1 IJ N I Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number e At) Q V _'T ( ) i II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Vilage ❑ Public 1 or 2 Family Dwelling No. of bedrooms Town III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0 IQ 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10E] Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3_ ❑ Replacement of 4. M. 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 11E] Seepage Bed 21 OLMound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22 ❑ In-Ground Pressure 42E] Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] 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 37G 31 G l ! 0 O Feet l0 _5 Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks r Septic Tank or Holding Tank [ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber t ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stam ps) /MPRSWNo.: Business Phone Number: 17 Plumber's Address (Street, City, Stat , Z C e): go ,3'c st/ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agen igna ure No Sta s) CApp roved urcharge Fee) 60 F1 Owner Given Initial 11/ Adverse Determination ~P X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit: issuing authority. 4. Changes in ownership 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 systern, 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 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 >eptic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks receives 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 10 x 11 inches must be suh!ritted t,D 0ie -(I!nty. The plans must inoude the following: A) plot plan, drawn to scale or with complete dir enssor.>, locaLi or n cc,dinc tank(s), septic ,k(s'i o< ;the- t r eairnent tanks; braiding sewers; wells; wa.er mains/v iD1__- se; a ce, s1.e~,. lakes- pump or siphon t inks di s;- ~oution boxes; so,! absorption systems; replacement system arte,j, o; thle I:-,,- `the building served; F1 hor!ZOr'tal ; ve tir-l el ,on refere^Ce Oin'S; CI complete spec; i(alioii. or purlp, ,.l o it'"OiS; dose VOIUme; elev tlon olifferE 1c-5 1 ,ctio , plump _ ,-nano- -urve; purrpT`_ on, 'Um(`, in - r -rc'r; D,1 crosssection o' lrleSt,.` 3LSOrptlOilSyst2n If'cflullEd l~~ •_V 't.. l-) soil i.estday." 1 M, all: i ;Ring information- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (°ees) for a number of re,.. fated prat ic:e<. Which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater z,ontamination investigations and establishment of standards. HOMESITE SEPTIC PLUMBING CO. I+ L U r 1 L AW 6% OVEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. N0.3307 M.P.R.S. • = ~AC e0O E 73oRtiu(~ MINN. INPTALLER & DESIGNER LIC. NO.00883 = RG $ P T S ♦ = 6KrSrsAJCr- ,z SUR FACE ElevATio..)c i` 1* 4- 30 SET !3 , /oyez RGf' PT' pA) f.. T ,,Xr ~N l~f'1 Neer To s-+Et:L f~cE 4o $ T- ti ~ ~ MINA ~,uS'~ y P~& pi p W ~yo.'o ~1 ,V ~ 15 A~ c16'vAV CEO y Nth ' oq. 15 G~~ Q bo G (s /H IZ~. Gti A/~^ D PUMP AaEk t . 0 ' I ,u~-w ~ooo p R~~•~s r SEpT~c T,~,~,r" ~ ~ ` ~u iE'S EiQ Cova.Cr`-2. CD ~N A t p Ea R V Gam, Lc! 1 S. 4 SA~~6 E ~.V~ PRdQos~~ Q goal l V~~, WAY v~` . DFAn FNn ~QIVr1?~- 2 n rr"R~u ~L .1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION 7~TM1~AD ISO~,TTN,,TTWI 53+707 NE 4, i TJk, Sec. 2, T29-R19 (Ifa si Number: assigned) El CONVENTIONAL El ALTERATIVE Town of Kinnickinn Holding Tank ❑ In-Ground Pressure Mound /qJ NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jean Hanson ;1 &4ZP RRoberts, WI 54023 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: F.. PA. ELEV.: CST 17. PT. ELE. D Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: GTm. Scb.umak,er 6332 St. Croix 135441 SEPTIC TANK/HOLDING TANK:-Er, c.'Ur. '/112"W4 / G1 MANUFACTURER: LIQUID C TANK IN TANK OUT ET ECt V.: WARNING LABEL LOCKING CO;; PROVIDED: PROVIDED: zlc) ms's L GMC• ? -00 /O$ /S YES ❑ NO ❑ YES BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY r WELL: BUILDING: VENT TO MESH ! t ALARM: FEET FROM LI : / r AIR INLE ❑ YES O C? ❑ YES ~04 NEAREST ~ DOSING CHAMBER ,j m,, c,- =i&--i' 02/ MANUFACTURER: BEDDI LIQUID CAPACITY: PUMP MODEL: P/ - ANUFACTURE : WARNING LABEL LOCKING COVER NO PROVIDED: ^ vCC ❑ NO W ~ ' (Qf. PROVIDED: ❑ YES E~i 0 ) p-c cs i E u Fes! r GALLONS PER CYCLE: UMP AND CQ ROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: y / 1A AIR INLET'PUMP ON AND OFF) Flei ES ❑ NO NEAREST 70 - >/'/O SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING,:) or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN q0 j ~V C the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: BED/TRENCH NO. OF DISTR. PIPE SPACING: COVER ITS: LIQUID TRENCHES: F~I AL: DEPTH DIMENSIONS O 619 MATE / GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDI VENT TO FRESH BELOW PIPES: ABOVEPOVGEpi ELEV. INLET: ELEV. END: PIPE : FEET FROM LINE: I AIR INLET: 11110- G . 1 ' ' r ( Y =f o r' l ; , MOUND SYSTEM:i,I, bo >,a ,~LC = U 3, a' o/'6"'4 Mound site plowed perpendicular to Check the texture of the fill m terial for PROVIDE A DIAGRAM OF SYSTEM /01/U slope and furrows -hrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: ` PERMANENT MARKERS: OBSERVATION WELLS; L)_ Ett ES ❑ NO k;AfZ-1:J NO DEPTH OVER TRENCH/BED DEPTH OVER TR946@"IBED r.. DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: ,r EDGES: ! t Z ' Z~ CG ED YES '~'1VS--~ ~5 [__1 NO FEES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH I If TRENCHES: If ,I DIMENSIONS 13 C/ ? I (10 Z - /8 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: i ELEV3 r DIA : If ELEV.: / PIPES: DIA.: DISTRIBUTION r Z D 3'% q6 /V l !I D HOLE SIZE: HOLE SPA2IftG: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRES ONDS TO INFORMATION APPROVED Y~ 7U [e ES El NO PLAN ES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: - - FEET FROM LINE: / / EE? ❑ NO I~=E3 ❑ NO NEAREST 7140 -C - j~ v ~T 6-c 0 3, 0! -,s~.~s . Sketch System on Ale-tai county file for audit. Reverse Side. SIGNAT E TITLE: I , i~ SBD-6710 (R. 06/88) ' MMMM" SANITARY PERMIT APPLICATION cou A 20 06 I.El TDILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ <lq 8% x 11 inches in size. Ch if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 9q 16 Z/ PROPERTY OWNER PROPERTY LOCATION j ,,f FY4 1VY4,S T ,N,R E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) ❑ State Owned ❑ VILLAGE `N r-- ❑ Public 0 1 or 2 Fam. Dwelling-~# of bedrooms ~ PARCEL TAX NUMBE ( ) III. BUILDING USE: (If building type is public, check all that apply) C 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash 50 Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pres-srp~urized Distribution Experimental Other 11 ❑ Seepage Bed 21 [9 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 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 e,5 a Feet f5Feet 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 Holdin Tank d(~d El I El El- Lift Pump Tank/Si hon Chamber X G Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system sho n on the attached plans. Plumber's Name (Print): Plumber's Signature: (No S mps) P MPRSW No.: Business Phone Number: ,p VM 2 lal Plumber's Address (Street, City, State, Zip Code): IX. COU TY/DEPARTM NT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing Agent Signature (No Stamps) Surcharge Fee) A~ 1 Approved ❑ Owner Given initial C1 A verse Determination 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 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 e% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) + I.L.H.R. 83.08(2) I PROJECT INDEX SKEET X 89-4U496 Owner; ~EtrN~luSe~ ~~S 7f~- 3Co0Z Address: Rr. I (208ac'RT5 tofS S 4 0 ;L-3 Site Location: PAR T` 0 F 3 b D /4 Ct,l R to . %y IVu 2, T Z,? W To w~•a o F k' I'AJ N CC k Iwtit IC Project Description: 5 T•. CRD(x C'ou o ry New ~'oa $ vcTi'o~ }1 o v,3 D SYST,Eel • So o~ ~G-S >+4S U~ R~ i.ED Z y 6t3- S fTC EXA AA (3 y COU4-ry 20 A,3 eA5 /4ST~A~o~~ te-1L SOi1S A Pe ~EA.M1"tai-ir i laUT Se-ASOAJA LLY S *T-u R-~ Tle7D a ~ t}' - e ~ RM . M O 3 t h o,K E- ~ ~ t ( ,N► ova D 0Aa+0 'C'Ropt- T y. 4-6wecvt•*° 0VA.)D Ro (SOS E La - t t ( O Vt- P S 1*2t= ~ DBE $ i ~J -0 Fp k 3 11CPRbO-q5 A u •+-2ffG-E' 1r S Ti AI , 7 E p l A i L/ I,Ur4 S T l t~' 1~ F- 4s 0 S10+6 Page 1. PLOT PLAN VIEWS Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS Rage 3. PIPE LATERAL LAYOUT Page 4. DOSING CHAMBER CROSS SECTION Page 5. PUMP PERFROMANCE SPECS PLUMBER: WA 4. SC 44,t .*I Ate ie M~oao ~3 82- RATE:-4g SITE EVALUATER/ DESIGNER 4IGNATURE HOMESITE SEPTIC PLUMBING CO. i' 665O'NEIL RD., HUDSON, WIS. 54016 J ROBERT ULBRIGHT WIS. MASTER PLUMBER UC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 i i P HOMESITE SEPTIC PLUMBING CO. Pi-Or 655 A'{ it RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. • = l$A~K~7FDE ~OR~u~ f MINN. IN$T LI R a DESIGNER LIC• NO.00883 PeRC $ TES 'I ~ ♦ = ~tC fS TIa G~ SUP FACE S(evAM"S ( 4 " pvc- ..O1 p4-5. 30 SET, I { PT Qc f• TI-pA) ?T - ~,ow'- T WtV Tjkc 014- To S'1 EEL {tA+tE QOST- ~''o auS-~ R~ IrW" pu`'pipf, ClaUATioa RONNA /DO•D roe yR' _ _ _ ~t0* v/REf 74Y 'BCD B3 z5 -t uf''l °f Z4 Oe Mbd vD • yam,. 40 ,a ~G RCC ~,~11 ?S p G~t~ ? ~ Go Aack of p0m o~ /ooo f..(, p a~~.~s r SEpTfc ~U /G-sev CD•v~.tf4. `O ~I NAIDE~ 12L~u', ~tJi$ . WRH . HoRiIE 11n►,F 5AA'n6-E PROPOSED S f TE WK PO PRbPOSb-O 9 O ~RoPoS+w - OVA /33 F 5 ~,~evj 3 0 s~ SEA CA~~~S~ Col c L. TeAp fN p IPRIVATF R D 6-OxA ut l _ A , i Page Z Of S Synthetic Covering Distribution Pipe Medium Sand s y tTEr1 - H - D EI&v*TIoN Topsoil F i 0 3- yU E „ D 3 , QW, % Slope Bed Of it Force Main Plowed Aggregate Layer AG ?BYSlP-14 D Ft . rJNS~~~ Cross Section Of A Mound System Using Ft. • ' • ®t~ s " A Bed For The Absorption Area F 7 Ft. ' G Ft. A Ft. H Ft. B Y7 Ft. nY' low of S~... ~~iap~itCv~~R'~T K Ft. CA~NES~NO~NC L 9 Ft. 7 Ft. T /S Ft. Force Main w 3 V Ft. L Observation Pipe K B i A ~----I--------------- w o •I - - M ~.Distribution Bed Of I Pipe Aggregate 6tcuREL'I/ AUCc D,ety Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area X Of Page • 010 V o /VM E ~R -Z s Fs' o` Z BUG ORCF` fl4c,r /A6 r ({0/E Perforated Pipe Detoll ZcpRiGtiT Foe V AIM-Ale E le-WA- iOA), TOPS OF VAC V.47 %oN 0 I I A TEeri IS /01/,0 End View Perforated End Cop PVC Pipe Holes Located On Bottom, j Are Equally Spaced R Q i PVC Manifold Pipe • Alternate Positlon Of Distribution Force Main Pipe i Lost Hole Should Be r[' STS Nest"-fji J' EWA i En eP istribution Pipe Layout P 2,2- Ft. j r; R 5 PRO ED AP CI~7 4~dCmUSif Y, LACER u T ~ RELAD X Inches G~CPAF~TM Y y8' i 51 N OF SAF Y Inches y SPDND CE Hole Diameter Inch Sign SEE CORRE / Lateral Inch(es) " License Number: Manifold 2- Inches Date: Force Main" Inches # of holes/pipe Invert Elevation of Laterals1034 Ft. DI S fA%l3ur1oA) lPiSektgo e- *,f117E CD,,2 r4 c4 IA7',rR,+1 7-02- ~d- aA" Z • fo r4l ~~'ST~~/3Utipa aiS ARSE" D k ~E~tQ t 1 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEWT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 1 BOX MANHOLE COVER ?-!S' FROM DOOR, JUWCT101. W14V WA)Ia6, /i9;S---/ WINDOW OR FRESH 12"MIU. AIR INTAKE I y pAD~ ~~EV~7/O n! GRADE I y"MIIJ. /`l/" ~ ~ ~ Ib" MIDI. • 'Q S , CONDUIT 9 j, ► PROVIDE ( 0j,0 IMLET AIRTIGHT SEAL I APPROVED JOINTS APPROVED JOINT A O~1 C, Q ~ I ~ W/C.I. PIPE W/C.I. PIPE EXTENDIWG 3' ALARM EXTENDING 3' ONTO SOLID SOIL OWTO SOLID SOIL B Oil flop 1 I q;- ow 19.7 LLEV. FT. ( PUMP OFF D Z - - K p~p01a I IC I q yy CokICRETE BLOCK i ~~IEV~ rlo~l 0'1.25 ~ RISER EXIT PERMITTED ONLY IF TAIJK MANUFACTURER HAS SUCH APPROVAL SEPTIC E 8PECIFICAT10MS DOSE G[~/ESt~° CD~JGc(f Q WMBER OF DOSES: PER DAB TAWKS MANUFACTURER: TAWK SIZE. 1750 GALLOKIS DOSE VOLUME Lx- OI L INCLUDIWG BACKFLOW: `s GALLONS ALARM MAWUFACTURER: MODEL NUMBER: D' L), L CAPACITIES: A= 7 INCHES OR 3 d b GALLONS SWITCH TYPE: M R~ L)'(.'- Y F Ic^T` B= L INCHES OR 34o GALLOWS PUMP MAWUFACTURER: ZD C I R S C = INCHES OR ~ GALLOWS MODEL WUMBER: 7 \~i << s vl D=/"* INCHES OR 2(0 0 GALLOWS SWITCH TVPE:3ACK uRy rle475 NOTE: PUMP AND ALARM ARE TO BE ` MI INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE Z ~ GPM S. "rAA~k S~>F~S VERTICAL DIFFEREWCE BETWEEN PUMP OFF ARID DISTRIBUTIOW PIPE.. 3 FEET ' I + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EA~n. Of" ✓ ~ ltv 25 FEET OF FORCE MAIN X ~F 100 FT FRICTIOU FACTOR.= FEET t-40A I C TOTAL DYNAMIC. HEAD Z FEET. J N D ~r L,/ r. INTERNAL DIMEWSIONS OF~TA K: LEKI& ;WIDTH O y ;.LIQUID DEPTH / Z E SYSTEM SIGNED: (~NS~j~ SIB LLICEWS MUMBER: ' DATE: v Coda - J, E D ;R A, OHS, D)yS•TRY, LAgO R AND t NM ~ v tNO~S t4F~Y~ SEE COFt1~ESPONDENCE 9 ~fl G--~ a i 5 HEADI a LL 115 34 105 - CAPACITY z CURVE 3° 195 95 28 90 26 85 i I EFFLUENT 24 MODEL MODEL 189 and a 22 75 165 DEWATER/NG = 70 V 20 65- Q 60 55 _ 16 50 ODELI 163 MODEL t•- 14 45 188 12 40- 35 - 10 MODEL MODEL 30 137,139 185 SEWAGE and 6 25 DEWATER/NG 6 20 MODEL j 161 15 MODEL ! 4 97 Ij 10-- MC DEL IC uWi 5 53, 55, r U. 57, 59 0 GALLONS 10 20 30 40, 50 60 70 80. 90 100 110 80 24 LITERS 0 80 160 240 320 400 75 FLOW PER MINUTE 22 70 20 85 MODEL-I- --I - ~ 285 W 55 - = 18 V 50 14 46 Ih10D_L I' Z 294 p 12 40- t MODEL 35 293 - - F~ 10 MODEL - - 284 f 8 25 MODEL 8 20- 282 - II j F 4 15 MODEL j 1 2 5 267, 268 - I 3280 Old We7s Lane P.O. Box 18347 1 GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 180 1 LoulsvlNe, Kentucky 40218 LITERS 0 80 160 240 320 400 480 560 640 720 (502) 778-2731 FLOW PER MINUTE ;I ".97" Cast Iron Series HEAD CAPACITY UNITS/MIN Feet Meters Gal. Ltrs. is Automatic or Non-Automatic. 5 1.52 57 216 • 'i H.P., 1 Ph., 115V or 230V. to 3.05 51 193 if \ • Non-clogging vortex impeller design. 15 4.57 43 163 20 6.10 27 104 e Passes`"?, - sphere). Lock Valve: 1 Vi" NPT dischargValve: 24.5 • Float operated submersible (Nema 6) mech- anical switch. 97 Series UL • Automatic reset thermal overload protection. listed SC-2225 is Stainless steel screws, guard, handle and arm and M.w. seal assembly. • Watertight neoprene -0" ring between motor and Canadwn Standards pump housing. SP Assoc. Approval availaDla N97, non-automatic, available packaged with a piggyback mercury float switch. yf y R" ~ W-71 X ~ 1 y 2 1 he'y' ~ a' ~ ~ F rt T-- 1 a ~t ~ i K G s. s x. z C - 4 4' 9 e _ k s~ ~ ~ • X19# Rim a .~.r7 ,+*w-5.. 'two-:Mnrrw r. •+,.vr~.ie ~ . ^ +41e Arv Pi { L-Z r. j a IWO a W-4 -31 ~Mits ,Iy7~~' ~~t 2 ~r•, il,~ tftmftt Ito opt or. 0 F rook k + -'4~~. 9~. gar. Y z t State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 HOMESITE SEPTIC PLUMBING COMPANY Owner: DEAN HANSON 655 O'NEIL ROAD ROUTE 1 HUDSON, WI 54016 ROBERTS, WI 54023 RE: Plan Number: S89-40496 Date Approved: December 14, 1989 Gallons Per Day: 300 Date Received: December 13, 1989 Project Name: HANSON, DEAN - RESIDENCE Location: NE,NW,2,28,18W II' Town of KINNICKINNIC County: ST CROIX 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. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. i This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings cc: DEAN HANSON X Private Sewage Consultant SBD-6423 (R. 08/88) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JND,US,TRY, DIVISION 4ABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 •HUMAN'RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/n4 N+6}PA -6 LOT NO.:BLK. NO.: SUBDIVISION NAME: AIF 1/ NW 1/ z /T29 N/R I$ E (or) W k 1. 10 A-) ( c Ic /A.'AJ I- C- M,4e of 3 60 /4c. FA" COUNTY: OWNER'S &bYER'S NAME: MAILING ADDRESS: Si,cRolr\ 'ZFtti N,,~AjSe,,j I Ro j3Ep-r s, ci k'S, 5q 0.13 USE U ER Jef: F 5 74 3315 DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 2 14New ❑Replace ND0 • Z0 /700, 2 / V 5c S 76 OAS ry 5"1 . RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN_ -GROUND-PRESSU7E]szul[--]s2ulm6L),.,JL) YSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) CCU as ❑U ❑S ©U Sys rc""-I If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ~L - under s. ILHR 83.09(5)(b), indicate: G`i} $ $ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS IN tbECI'MhL f ttr BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ` (07' i3~otKr 8.+-5y /,o` G+ . 131ocfy. B- l ,o oo.~yi 3,a 3.33• OR.f:k oo~ S 3 per. P . ,WI 13huDS of ,ly, c A-y o-tM ho LEO 1.6 ` y,Pfif' Y / f ors r . oQ.,4p't s l,o' 'Rlocky 1r.13N, sl) l.o •'1310 cky 13,J.S% , S• o/r.&,. B-2- 4 S /o/. V2- 7~0 31 o , • y .13a. Sd w fF~ OR. A.d+S I. S' Gy. pt;" el.rST. oR. NrotS B' "Trf,J wCh kC ~F`rEUrE[~ T3,F.,~EO S~ v0 S 1 o alE B- 3 Co, D• /03. 18" F3 5 .TG, .(,-7' 73,0. g(oeky 51) 1.17 ore I.3 oli've Vor- kS~/ W sMt, B f~,Vr o~p-Sy. to I's .2, U' f/ el4y /o µt w/ P2oH . o . Mot PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- I zH -Arr D I'%G I "/iG I1~ l7 p- 2 2 36 / 5/4 P- 2 % I ( 2 P- P- p /n) Diyrt Sr4aD ' off/ STie°~ T PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. I W U C P r S O F I I G/ -t E AA / S ' /03. YO ~ 103. ~D , SYSTEM, ELEVATION T o `~rap, 10 I~ V. 1 LO 7- P-C.- 7 'sAOL uP_ yes 6 :S "P 3 , N , F r 0 E "Ole 3 i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. 11,6 V Z cj ) q g 9 01 ADDRESS: ROBEWTULBQN'W CERTIFICATION NUMBER: PHONE NUMBER (optional): I . N0.3307 M.P.R.S. Z y 10 1- 71S- 3 006 ' ela ':`!NN. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATUR : I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - I j n j HOMESITE SEPTIC PLUMBING CO. P L0 T l L►.° ` Iy 655 O'NEIL RD., HUDSON, WIS. 540186 . , = ~ACk~~DE T3O~pw( J VIS. MASTER PLUMBER LIC. O. 7M• S TI )-63 !N. I r`'TALLER 8 GE$IGNER LIC. NO. 00663 J ( TES "2e a° soil to i, .;port 3Yi Min fie: Il. ~ Pe . A - 6x (S r1AJ G- 2 _ ly indicate v& this is a resi of orni-nerciai project; SUP FACE EIEIIATieaS a rooms or cc_ _ use piann system; I " Pie P► (?mss boxes. A SUITABLE FJ7F HJ; TA O L)' 19 ALL W w ' >T M, LED OUT BAS 35csmeC.C)~1L7i f SST { 3 u ~6n_ use tilt a¢ c~ town here fu, wrp Rat r ; i{ E A LEGIBLE 'ia, i accurately locating your test locations. s A <ite sheet tray be us+ desired; i sa your benchmark and vertical elevation reference= point at- clI to - all a r,opt iatetq r ~s to dates, names, addresses, flood plater t.. p- app opiate; o 7 ~ ~ rr)a r sue as food ~alain, elevation) does not apply, plac€: i.A, in the alai rsx; , hel~eMA and place got€r CUr'rent address and your certification number; 2, ke6ecgible copies and distribute as required. ALL SOIL TESTS MUST RNE~ p r. ~ LOCAL AUTHORITY WITHIN 30 MAYS OF COMPLETION. SET Icy„ Pue plpf Clet,-ok, Tlna ioo~0 I p ~ m J3 ~ l 5 ' ABBREVIATION FOR , IFfMO TESTERS 1,q jq • ✓ Sor separates and Textures Other yrnbols a st Stone (over 1()) tiBeds 7 e cob Cobble {3 - 10" SSl-'Sz 11, tVAT.O i~ gt- gavel (under 3LS - ri; - m" " Q/R y i~' ~dsz'y ncl • HGW High Groundvvat:er UvAFX lq&1VAlD BED ! z ;s - Coarse San(~b Perc Percolation Rate need s Medium Sand W Well I's Pine Sand GO Bldg B I -g Is Loarny Sand I I :er Than I sl - &indy Loam < Than o Pv H P c ~AA4 'I - Loam Rn 3rpk,Q4k f sll Silt Loam L31 Black I si - Silt ' Gy Gray cl Clay Loam Y - Yellow i sc1 Sanely Clay Loam R _._Red s cl - Silty Clay Loam mot - Mottles sc - Sandy Clay w' wi th sic Silty Clay fff few, fine, faint c Clay cc common, coarse; pt Peat - - - - - mite - Many, i-n diunt m MLiek I I i d- distinct p - prominent 3 BeoRH . Hodi(C fD►1E- S111pA~E HWL. High water I , PROPDSe 0,ue.J&(aT'4Vi1 tr3kt ~ PRopoS~D suifac V or Itcl:W, Haste disposal - UM - Bench Mark VRP Vertical Reference Point ! O ~ ~ PRopos~v ~ well ~I s T /33 _ TO THE OWNER: 3 D D A Ci2. ('t p-ce-L This soil test report is the first step in securing a sanitary permit. The county or the Department may reouest verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit, The sanitary permit must be obtained and posted prior to the start of any i i ~~.~vRE L C STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County i OWNER/BUYER qCC 1/✓ -S®s✓ ROUTE/BOX NUMBER R - FIRE NO. CITY/STATE Pbfi&~ F-5-, ZIP -ze PROPERTY LOCATION: IV , 1/4 1/4, Section Z , T N, R `V W, Town of St. Croix County, Subdivision - , o o. 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 a 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 $3000 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 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 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED (/~G DATE g St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT STC-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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ Owner of property 3) &-4,1 Location of property E114 A'&) 1/4, Section , T 2P N-R W Township )<f /',ow/ G ° Mailing address i Address of site Subdivision name__ Lot number Previous owner of property 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 X No Volume 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 in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with 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. Signature of Owner Signat of Co-Own If Applicable) Date of Signature Dat of Signature 'k, SEND VIOLATION TO: DATE VIOLATION -~y~rZ2S NOTED~S'd PROPERTY LOCATION: 7-n. o:P NATURE OF VIOLATION: T nffOU 57 P -iAp) _zv SITE NOTES: e STATEMENT OF VIOLATION AND REQUIRED ACTION