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HomeMy WebLinkAbout030-2026-95-000 'o C) y ° 3 0 © O c N N ti M y a O C X O a0 N p O C ~ N p p N y w 'D O N Q N E C O Z m p to O w N ~p o C C Z U U O p w n C 47 U. C N 7 - O w p ~j 00 E V 0 cu Q a M Z jry O M E N o w O O Z N m O a m N F- U N C C 0 O Z v c~~a 0 e- 2 Z d w c Z W F- r N N E "O ~ C ~ M I I p z a O 4= ~ Z Z o N Z N C C ~ ~ N V 0 N U) - % O co (D L a M 0 n d' Hd O ai U) D D d a E p FN- FN- IN- 3 w 0 0 0 0 a w z • 5 a a a Z cN 0)~ lq U rn rn ~V rn t!) o o N N O N O O C O o E to o) F- 'O CO N i7J a0 a0 N ~vV 3 +U+ 3 m y c $ E F- I~ L U N p 0 p O O O coo' p C C a O O O (v\ L ( a Z N c E 'D 0 Lo N rn 04 N o c c E aJ Q) 0 p N t[yj' L' N O O O n W a0 m a) 6 c? co :3 Q) (n m • ~V O N U) Z N O U) O ~ ' w I r w w L L a 3#.~ a ~ a • a m m ~ c - m `IV v 'c c E L `O 3 0 A U a~ 0 m U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~/fCIC /~LLSS©/1/ ADDRESS / ~'4W-r'L [I TO At CUB' . s yv8z SUBDIVISION / CSM# LOT # SECTIONA 9__T 30 N-R AW, Town of~ L t r=te ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /y ~V ~e ' 30X?y 1110c./A10 Lf P Y9 81FD /oao c~ goo 6-1- p,G INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r r BENCHMARK: ~ it $ 1 -F / /~L GC> / r/f z*7* A h ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: jVEE/S5 Liquid Capacity: /000 do 8,00 Setback from: Well /00 71- House 6" Other Pump: Manufacturer_ ZO&LL&Model# 137 Size Float seperation Gallons/cycle• Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of t i s.o 1 L/Al Distance & Direction to nearest prop. line: AL6Rry p Setback from: well: go House 30 ° Other ELEVATIONS Building Sewer ST Inlet ST outlet PC inlet 9~,Q 6 PC bottom 6 Pump Off Header/Manifold 4W Bottom of system 100e Existing Grade Final grade ~02`3 DATE OF INSTALLATIO9 y PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt 'g;Q*,ert&cTr,t,of49a ' , H 22.30. %,jATFSE` &Agt SY~I ENP' TRIAN ounty: Labor and Human Relations INSPECTION REPORT S~fety anjBuildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Q-) A Permit Holder's Name: ❑ City 00 Village IR Town of State Plan ID No.: e Parcel Tax No.: Insp. BM Elev.: BM Description: 02 030-2 6-95=DD~~ l) ~ TANK INFORMATION ELEVATION DATA A9400057 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. y Benchmark Septic c}'. pp Dosing Aeration Bldg. Sewer , Holding St/ IyC Inlet v p St/ Outlet 9l ~3 TANK SETBACK INFORMATION ventto ROAD Dt Inlet TANK TO P/ L WEL BLDG. Air Intake NA Dt Bottom ' 3. r gg Septic a S >O!S? 7 Dosing -,:;o 7aS r S ~p NA Header - Aeration A Dist. Pipe Bot. System Holding PUMP / FORMATION Final Grade ManufactureDema Model NumbGPM 0") ~ TDH Lift System TDH Ft PD -r He Forcemain . a " Mist. To weu>SU SOIL ABSORPTION SYSTEM No. Of Pits Inside Dia. Liquid Depth BED Width , Length / No. Of Trenches PIT DIMEN I g N <17 DIMEN I N Manu urer: SYSTEM TO P / L BLDG WEL a LAKE / STREAM LEACHIN SETBACK CHAMBE Model u INFORMATION Type O aIc0 O T System: /11d~cc, r DISTRIBUTION SYSTEM Ma fold n Distribution Pipe(s) , x Hole Size x Hole spacing Vent To Ai~lntake _ 3G Length Dia- a Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over „ xx Depth Of x7x~eded/Sodded xx Mulched r7 Depth Over No Bed / (enter Bed /-4-R Edges,/~Topsoil XeS ❑ No I ~fl COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 22.30 20.439C,NE, SW, LOT D, TRIANGLE DR. 4,7V 6. e3 6 Plan revision required? ❑ Yes 21140 Use other side for additional information. cert No. SBD-6 1~(R 05/91, D Inspedor'sSignat r ©ILHR SANITARY PERMIT APPLICATION couN In accord with ILHR 83.05, Wis. Adm. Code C Cd .e,... ,.,.e,,.,.., ,,...,e. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a d ~ 7 3 T 8% x 11 inches in size. ❑ Check 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. .5 9q vdo r/'7 PROPERTY OWNER PROPERTY LOCATION Ajr 34 ~ e) YL- Y4 0%, S 2 T - , N, R i~ 6 -Et0 W 02 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # &4.57-0-Aff- &I GT. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER G ! b16`• 3 II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned O VILLAGE ; L, NUMBER(S) ❑ Public VN 1 or 2 Fam. Dwelling-# of bedrooms -z- PARCEL TAX a =0 w: 5 Ill. UILDING USE: (If building type is public, check all that apply) 4 L_ Q 30 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. New 2.E] Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E1 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 Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION r Feet C/~• Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plpstic App Tanks Tanks structed Septic Tank or Holding Tank 000 A t C' I 7-H, I LiftPump Tank/Siphon Chamber C. VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu a 's Signature: (No S M W N Business Phone Number: DOA(A !7-7- Plumber's Address (Street, City, State, Zip Code): !E LTA9 IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (Includes Groundwater Date, ssuing Agent Signature (No Surcharge Fee) Approved Owner Given Initial 11sued C~ Adverse Determination (J / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: irmerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber p 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 :n the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approve; ; .w. the permit issuing authority 4. Changes in ownership o plumber requireni a Saoitary Permit Transf(., %Penewal For 3 i 6399) to be subs-.61:uU to the county prior to installation. - C7n5st6 e .tge systems must be properly r ~.w-Oained. The sep! t-tr~(s) must be I" 'r rfs i cy u iicemsed . pumper whenever necessary, usually every 2 do 3 years. 6. If you have questions concerning your onsite sewage system, intact your local code a& lnistrator or the State of Wisconsin, Safety & 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 w.imber(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 welling. Ill. 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, !econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorpficn. system information. Provide all information requ€~str- in ##1-7. VII. Ta i• o or, ration. Fill in the capacity of every new and/or exi- i,: _artk, iisl: Vie r t.i ~umib4ff of tanks ,*nd - 3nufaCtUrer's name. indicate prefab or site conr:ru11t.1 and tank matefial. ` r for all seploc. ou ;%sirahon and holding t: nks lar this system. Check tr< . , I approv, i s received et.r prf,duct approval fr(; n DILH.q Vill. R"spnrssib!wy statement. Installing plumber is to fill in name -,!-nber with i7-.pcropririie p,efix (e.g. MP, sty;.);.girl-,ss and phone number. Plumber must sign applici~;l+an form. IX. County 'X aI),W ment Use Only. X. Countyi,~,-;,Qarirnent Use Only. Goir ;Mans and specification,.. lot smaller than 81/2 x 11 inches n,, r ubrniiti !f' ; c;oi.nty. The Nla is r ~ include tl,e foHowlr,g, plot plan, drawn to scale or vritt t~i ir.io- r : r~ari of septic ~ Cher treatment tanks; building -c- service- si,earnR v,d lakes, pump COY -o jht- tanks: distribution boxes, soli ,U0-0 f 3y"ten s. it ste the location of Fn'<t uF , vm 8- .,aS, ng served, 3) horizontal art: rt;c,,, C) complete specifications for pun-,ps and controls; dose voiurn,, tsva± :J r, ci'ferenc..e 'rlct , o~is; pump performam: e curve; pump model and pump manufacturer; D) c f s sec,ion of the sci; a ::or ,tion 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 suicharles (fees) for ii nurntl=-r r` requ'ated practices -,vhi-h can c fect.5roundwater. <..:..C .azte ~ ~ if t 3 t s i, a!t argE'.~-. of r,r,~~, I water=<.cmtrirYiir-;lion irweF JigahonS•and establishm .21 SBD-6398 (R.11/88) - i p ~Afl o _ Z ~ G 00 338 0 30 1S1h10 42~ Now& (13 o - 16 Z. v,uoll!pu ~y31SX's 3 c P q \ N C~l ~Y Cn G 11`1 1„ cT~ \ \ \ \ m~~fi fir,' oe~R • Z ? L 1v r Fa j _ 9 4 4 0 0 3 Page 1 of 3 V.5sconsin'Departmentoflndbstry, SOIL AND SITE ~VALUATION REPORT LYbor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code F St. C1"O1X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION PR 1/4,S ?2 T 30 N,R ?0 kr)W Nicholas R. Nelson GOVT. LOT NF!, 1/4 c OPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 200 Eastbank Court N. P n/a n/a CITY, STATE zip CODE PHONE NUMBER ❑CITY []VILLAGE kgOWN NEAREST ROAD Iludsort WI. 54016 (115) 386-2231 St. Jose h H . 35-64 ~j New Construction Use [xj Residential / Number of bedrooms 'I [ ] Addition to existing building [ J Replacement [ I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate . 5 bed, gpd/0 .6 trench, gpd/ft2 Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2T_.6 trench, gpd/it2 Recommended infiltration surface elevation(s) 96.85 It (as referred to site plan benchmark) Additional design / site considerations Parent material glacial. till over limeastone -Flood plain elevation, if applicable n/a It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S :BU B6 ❑ U ❑ S Ei k ❑ S :aU ❑ S fRU ❑ S )RUJ SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Baxtdary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. Bed Tienh 1 - 2.-23 10yr4/3 none sil. 2/m/sbk mfr g/w 1/m .5 .6 Ground 3 .3-43 7.5yr 4/4 none sl. 2/m/sbk mvfr g/w 1/f .5 .6 elev. 951.85 ft. 4 3-48 7.5yr5/8 none limestone bedro k Depth to limiting factor Remarks: Boring # 1 0-6 10yr3/2 none sil. 2/m/gr mfr c/s 2/m .5 i.6 2 2 610yr4/2 none sil. 2/m/sbk mvf..r g/w 1/m 1.5 .6 sic 1/m/sbk mvfr g/w 1/m .4 3 11-31 7.5yr4/4 none Ground sl. .5 eev. [r 31-45 7.5yr5/8 none limest e bedroc D 110 - --RECEIVM limiting 4nnLl -J factor MAR 1 7 U71 i 31" Remarks: SAMY & BLDOS. DIV. SST Name:-Please Print - Cary L. Steel Phone: 175-246-6200 1554 2.) h. Ave. , New R' hmond, WI. 54017 Sign~hgn' ! lY Date: 220ft CST Number: ~RROFERTYOWNER Nicholas Nelson SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # _ S94 40097 Depth Dominant Color Mottles Texture Structure Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bourxby Bed ifendt 1 0-8 10 r3/2 none L. ?..mar mfr c /w 2_ m .5 .6 2 8-13 10yr4/2, none sil. 2/m/shk mvfr g/w 1./m .5 .6 Ground 3 13-1£' 7.5yr4/4 none S1. 1/m/sbk mvfr g/w 1/f .4 .5 elev. SL. ~.2_ ft. 4 18-2.9 7.5yr4/4 none Scl. 1/m/shlc mvfr /w 1/f :4 .5 Deptfi to 5 29-40 7.5yr5/8 none li.mest ne bedroc i limiting - factor ' Remarks: Boring # 1 0-7 10yr3/2 none L. 2/m/nr r.Yfr c/s 2/m .5 .6 2 7-14 10yr4/4 none SL. 2/m/shlc mvfr c/w 1/m .5 ' .6 SL. 3 14-25 7.5yr4/4 bone cl. 1//m/shk invf-r 8/w 1/f .4 .5 Ground i elev. 4 25-40 7.5vr5/8 none Limestone bedroc X5.85 ft. - 9~~ i Depth to j . limiting ; factor - j 25„ i. Remarks: Boring # ' Ground 1 elev. ft. Depth to limiting ' factor I i Remarks: Boring # i i i; s Ground elev. ft. - Depth to limiting factor - S94"40097 STEEL'S SOIL SERVICE t554 200th. Ave- Gary L,. Sloe! C.S.T. 2298 Nicholas Nelson New Richmond, WI 54017 MPRSW-3254 PTE%S1d1,, S22-T301I-R2014 (715) 246-6200 town of St. Joseph - tot #T) ~ ~ _ X14 , ` n ir1 r alt a-~~ D ~r ij I ~t, Z Flo ~G ~~ti~ r OrSl 0,0 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations March 25, 1994 2226 Rose Street La Crosse WI 54603 SCHMITT, DONAVIN 586 VALLEY VIEW TRAIL SOMERSET WI 54025 RE: PLAN 594-40097 FEE RECEIVED: 180.00 NELSON, NICHOLAS NE,SW,22,30,20W TOWN OF ST JOSEPH 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, Gerard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 3379R/ 1 SBUwI'L3 tH.01/yl) S94' 40097 MOUND SYSTEM for NICHOLAS NELSON NE1/4 SW 1/4 S 22T 30 R 20W St. Joseph Township St. Croix County Page #1 Plan Approval Application. Page #2 Soil Data Page 3 Plot Plan-Pan View Page #4 Work Sheet Page #5 System Cro9a Section Page #6 Pipe Lateral Layout Page #7 Dosing Chamber Page #8 Pump Curve Donavin L. Schmitt 586 Valley View Trail Somerset, Wisconsin 54025 715-549-6651 MPRS #3205 March 4, _L994 RECEIVED MAR - 7 1994 SAFETY a BMS. ON. 894-40097 Page Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ H _ G 6" Topsoil F i f E D 3 ~ b % Slope Bed Of 2'- 2 Force Main Plowed Aggregate Layer (6" Below Pipe) D Ft. Cross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F Ft. G / Ft. A Ft. H Ft. Signed: B Ft. License Number: ~~1 S ~,~dS K 1,3,5" Ft. Date: L Ft. j 11 Ft. I /3 Ft. W Ft. L 7,- 7 Observatioi Pipe---,,.,, I--- _ of - - I Force Main W - ® ib t' Bed Of 2 2 2" I0~~~~0~s Aggregate ~p~A s se atio rmanent Markers ~ of P Plan Vi Mound Using A Bed For The Absorption Area ~JCfE' ~O .C7 S 9 4 -40097 Perforated Pipe Detail /0 1 End View CPerforotea / End Cap) PVC Pape i bye ce Holes Located On Bottom, ~S Are Equally Spaced P *:1 ON° MAN~F°L0 e % Distribut-o~-~ Pipe Last Hole Should Be Next To End Cop Distribution Pipe Layout P yJ Ft. r-60S MAIN • S X InchPS Y ,3 Inches Hole Diameter Cq_ Inch Signed: jd Lateral Inch(es) License Number: 3-7-65 Manifold Inches Date: cE Vs~ Force Main Inches w s # of holes/pipe p~~v itio~ally Cnrla Invert Elevation of Laterals 9(~.3 Ft. NPI) 14 R~~ of p ~ DOC p1V1S► 0~ S E POVAD E SEE • 4009' S94 PA&EoF~ PUMP CHAMBEFt CROSS SECTION AND SPECIFICATIOSIS VE WT; CAP 4"C.Z. VENT PIPC WEATHER PROOF APPROVED LOCKING JUAICTION BOX MANHOLE COVER ~ 25' FROM DOOR. 12"M11l. ,dINDOW OR FRESH I AIR INTAKE I GRADE I 4"MIW. 10' MIN. -1 COWDUIT - Ib"AIIN. • PROVIDE . IAJLE T AIRTIGHT SEAL APPROVED JOINT A I I I ( APPROVED JOIAII w/C.Z. PIPE I I I( w/C.t. PIPE EXTENDIAIG 3' I I) ALARM "UTENDIN4 AUTO 501.10 SOIL ( I I ONTO SOLID fall o I I i I OW c .I 1 LLCV. `6r' FT PUMP-~ '"'i ~ OFF D CONCRETE BLOCK DEW Ik R15LR EXIT PERMI'ITEO OAJLy IF TAwK MAWUFAGTURCR HAS SUGN APPROVAL 1N SEPTIC SPEC-1171CATIOKIS DOSE NUMBER OF DOSES:..r.L~.~PER OAy TANK MANUFACTURCR: TANK 51ZE : ~d GALLOWS DOSE VOLUME L~2T INCLUDING OACKfLOW: all H" GALLONS ALA AftM MANUFACTURER: 4p/4-~. 35631 MODCL I.IUMBER: -LXG=.- CAPACITIES: A=.~~1►ICHES OR GALLOONS SWITCH T09: C~2 y A= t6`5 r, 5 INCHES OR LL 5 PUMP MANUFACTURER: ZOELL872 - c=.sINCHES OR MODEL MUMBLR: 13 7 0- la - INCHES OR 6ALLOLIJ SWITCH TYPE: ~EncUR(/ l- - MOTE: PUMP AND ALARM ARE TOOL INSTALLED OW SEPARATE CIRCUITS GpjA MIWIMUM DISCHARGE RATE-, VERTICAL DIFFEILEAICE OETWEE)I PUMP OFF AAID.DISTRIbUTION PIPE.. 1_A FEET 2t.7~- t MIAJIIAUM AJETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET + ~ goo fCFRlCT101.1 FACTOR.. ' QD FEET OF FORCE MAIN 'A o F~ ILL FEET TOTAL OtiWAMIL HEAD = T FEET ;WIDTH LIQUID DEPTH IAJT ERWAL, DIMEIJS►OW~i Of TAAJK: _ ~ D: zly -_4,J0_ - LICEAlSE I.IUMBER: l'%~1?S 32oS oATE:.:~_ SIGIJE y r'' gig S 94 r 40 HEAD/CAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 185 should not be subjected to less than 30 feet TDH. TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 53.55 4248 57-59 --28- 137-139 161 163 165 185 19A I FT. M, Gal. Llre ( Gal. Ltn Gal 1 rs Gal. urs Gat Llrs:,. Gal. Ltrs - Gal Urs Gal. Un Gel. ?Llr . Od. ;LCrar ad.:L"U' Cal. 1w, 5 1.52 15 57 23 108 43 163 72 273` 104 394. 106 401 61 .231.. 61 231 58 <$20' 155 d$7:: 155 5871< 10 3.0' 13 49 25 6101 ' 79 30 1Q 8 61 Zal 61 231 48 151 ::m 18 0 19 72 45 320 64 242 91 344 60 Z~Z -U--ZV- a 145 20 610 2 8 7 26 25 95 36 136? 82 310- 59 223 60 227 ?I 58 .290: 138 5013 140 25 _ 7:62 8 30 74 280. 57 216.' 59 223 Sa 128 !W 133 30 9:14 65 246''' S5 20859 220 90 2;g'111:> 58G% 121 127 V) 40 _ 12.19 _ 46 174 46 112 55 206 75 f83.. 58i~j9 105,ti'OQ7,:iti 1 K K LJ 50 15.24 21 80 33 125 51 191 > 58 219 - 58 120:. 90 :$41;2 100 :W:.:. W 60 1929 .15 57.. 43 161 36 138 58 :16 71 1.1 85 >92:.:~ 70 .2134. - - 30 114 10 38 52 :10: 57 :193. 70 12P 11 80 24 38 14 53 45 778: 28 :'1% 54 .2041 90 27A3 32 ::j13#:: 2 ' i$ 37 `140.... 34 100 _*,48 18 .;119::: 21 1e 110 110 32.00 7 5:28: 8 .3a:;;i 105 Lock Vdvs: 21' 22' 19.25' 23' 26' 58' 66' 87' 73' 11S' 01' 112' 32 100 30 95- 28 90 26 85 24 80 75- 22-- 186 70 x _ v 2p a 65 165 0 18 60- 55- 16 163 50 14-- 0 12- 185 35 - 10 30 189 8 25 6 20 161 15 4 188 10 2 98 5 42 41EI 53,55 13 ,139 57,59 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 LITERS 80 160 240 320 400 480 560 640 p FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219. . / , • . 1; . 'v+hscorismDepiln)*Ik%ofindustry, PRIVATE SEWAGE SYSTEMS Private 0*E. n :Labor and.Human Relatims 201.E. Waaching shingtoonn Ave., Rm. 141 ~af~ty and Buildingsbivision PLAN APPROUAL~ UGAT P.O. Box 7969, Madison, WI 53707 Bureau of Building b(~a7ter4yStems w! v 7 . (668) 266-381 S INSTRUCTIONS Please fill-in atl applicable.data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side.okitlt)s #Or': il0Cffibes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, vYhlth;df1e.►i(:I hased'rotrl,theDepartment of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison; WI.5$707 Telephone (608) 266-3358. Plan Review Appointment Date Plan Identification Number 1. PROJECT INFORMATION (Type or print clearly) -3 L -7, Zi OL i Name of Submitting Ajsty (plaris r urned to same) Project Name Street Address; P.0: Box or Rural Route Project Address or Legal Description r '`3G U City or. Village State Zip Code City County T ,n Village ❑ of Te ephone No. (include;area code) 4~ - Town , 5 !^f /2 y Designer 4 1y ,r , Name of Owner Telephone No. (include area code) _ Telephone No. (include area code) Street Address, P.O. Box.# or Rural Route Street Address, P.O. Box i# or Rural Route Citt or Village State Zip Code _ City or Village State Zip Code 2. APPLICATION FOR.: Experiment ti' Mound System ❑ Holding Tank New Construction,❑ Large System (over 8,000 gpd) Conventional System ❑ Groundwater Monitoring :Replacement Q At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ In-Ground Pressure r System in Flood Plain (attach SBD-6698) ❑ Other 3. FEE COMPUTATIQNS, (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. 91 a -756- <1,500 'gallon septic tank $110-00 &4, 6( b. 1,501 2;500 "gallon septic tank $120.00 C., 2,501 5,000 •gallon septic tank $160.00 d. , 5,001- 9,000 gallon septic tank $200.00 e. 1,001 - 1S,000 gallon septic tank $ 300.00 f, Over . 15,000 gallon septic tank $ 500.00 g- 500- 1,000 gallon dose chamber $ 70.00 h 1.,001 2,000 gallon dose chamber $ 80.00 i. 2,001 - 4,000 gallon dose chamber $100.00 j. 4,001 $,000 gallon dose chamber $120.00 k. 8,001- 12,006 gallon dose chamber $140.00 I. Over 12,000 gallon dose chamber $160.00 m: 500 5,000 gallon holding tank g, 60.00 n. 5,001- 10,000 gallon holding tank $11,0000 o: Over 10,000 gallon holding tank S 150.00 p. Revisions $ 50 00 q. Groundwater Monitoring - Per Site $ 60 0i" (other than a proposed subdivision) , Petition Fo~a G 'r.~ WEN Exper+me lipsem (7d ' ee± t. Priority Re®wit as 5ubtotai Fe Total NOTF: Plan reviews s> „Ir k c . :e;; Hward Office LaCrosse Gffur 2619,N 1st Street 2226 ruse S- -Pe kt 8, Bux 8072 LaCrosse, Vvi 54603 C% b u, 7~bQ Hayward, Wi 54843 Phone (608) 765-9334 ;v:adison, W'I 53707 Shawano, W! 54166 Fhuri(, 4fi-8606 Phone (715) 634-4804 Fax (608) 785-9330 Pi iune (608) 267-51 19 Fhc)ne (7151524-36" f, Fax (4 i 4) 5 8614 Fax (715)6$,4-5150,-. ? Fax (608) 267 -0592 Fax (715) 524-3633 + SBD-67.48 (8.05/92). NOTE:Fees aie pursuant to Wis. Adm. Code, Chapter ILHR. 2, and - w _ OVER are subject to change annually. S94`40097 Page fj OPTIONAL, WOkKSH ET I.' AI00 ND 51 I f '•1 II. IN (,k(n;t.:) PH•..`•iU{tF. SYSTEM-Continued- I. Wattcwau 1 t ad, total Daily Flow= y5' gal. t). 1 r;rcP Maur u US(' I is c,3. I5 (3) (C) A';Mtn'Llnt Dosing Rate Rpm. A lm. and PROVIDE A DETAILED Dometer - in. LIti 1 OI tillING ON PLANS, n 1. ?o;.,i liyn,imiL, Head: Depth io L inuting F actor = p~ It. ',vs:L'n, Head = ,h 2.5 ft. 3. Landslopc , % Vrt itcal Lift /A = ft. 4. Distance from Dose Chamber to Friction Loss= j ft. Distribution System ft. I DH = ~ ~•!.3 f[. 5. Elevation Difference Between / 12. Pump Selection: Pump and Distribution System = ft. Pump will discharge at least 3 7, yy gpm 6. Absorption Area Sizing: z [ - at 17, 1-1 ft. total dynamic head. Area Required = ._2. sq. ft. Pump model nd manufacturer: ZdCEL~/1 Bed or Trench Length (B) ft. /~aD. 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+ Fill Depth Downslope (E) _ ft. 4 Doses In 24 hrs. = 413. gal, Bed or Trench Depth (F) _ r 7.5 _ ft. Backflow - gal. Cap and Topsoil Depth (G) _ ft. Minimum Dose = gal. Cap and Topsoil Depth (H) ft. I~-. Dose Chamber: 8. Mound Length: Volume gal End Slope (K) = 1 ft. Total Mound Length (L) _ ft. Ill. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: i. Wastewater Load, Total Daily Flow = I. Upslope Correction Factor= Use s. ILHR 83.15 (3) (c) Wi Upslope Width (1) = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (1) ft. 2. Required Septic Tank Capacity = ial, Total Mound Width (W) n 2 ft. 3. Percolation Rate = min./in. 10. Basal Area: 4, Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 ' eh. ILHR 83 Natural Soil = 16 gal./sq.ft./day and PROVIDE A DE ILED LIST OF Basal Area Required = O(y sq. ft. SIZING ON PLAN . Basal Area Available = 777-9 sq. ft. Required Area = sq. ft. Ill. If Standard Tables from Chapter ILHR 83 Length = ft. are used, Indicate Table # width = ft, 12. For the Distribution Network, Use Numbers 5.14 in Section It. Number Trenches Trench pacing = ft, 11. IN-GROUND PRESSURE SYSTEM S. Distribu on System: 1. Depth to Limiting Factor = 22 ft. Lat rat Length a ft, 2. Landslope = N mber of Laterals= 3. Percolation Rate a rrryy~LtiJrtin./in. ateral Spacing = in. 4. Proposed System Elevation ft. Distance from Sidewall to Pipe = In. 5. Wastewater Load, Total Daily Flow: 1~3-7t' gal. System Elevation = ft, Use s. ILHR 83.15 (3) (c) , Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All items from Section Ill Required Septic Tank Capacity Q ~O gal 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate min./in. 1. Capacity = _ , Q al. Area Required = sq. ft. 2. Manufacturer: _ 1Q[_{i= s , System Length = ft. 3. Show Site Constructed Tank Details on Plan System Width = ft, 7. Distribution Pipe Siting: y'I. DOSING TANK Hole Siic = _ / in. 1. Capacity = --866 gal. Iloic Spacing: ' 3- It. 2. b1.Inufaclurer: g)s L.,tcr.,l Length ll. 4. Pump Manul.1cluret: g j2 1 .,Ir,al Sric in. t. Pump MnJcl: - 137 1 .114-fal sltalilig It, Or:•atmt; Hcad= 17, it. Ih,l.ut,r 11+tn lulew.111 1„ I'qu• m i• I gym. Falt'= 37' gpm. x. Di.I1 11,11114111 Pilu• 1) i%(11.11gC R'lIv: (r_ Show >NC Conurullcd Tank Details on Plans Nunthr, .I I l,tk'. Pt', I`qn• _I `G-•~~ I I„w I'r, I',I,r _~L13iKl+nt. S'li. I` + 11NA Man,lnld 1,ru,y, 1_ l Jra,us = gat. Iyl,l' (,1'11II'1 I1, l'n11) ~ AlJ't:l~.:.llllet: 1V •r i -,,tc i onoru,ted Tank Details on Plans ' I)lanu•tr, ---~II SIJOW At t. INFORM AT ION ON FLANS Dil IIR `ll) f, /W (R Itt'x:l STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County / OWNER/BUYER AIM,#06gS ge, 2 127, MAILING ADDRESS 2 01 A6Kr,4134/C. / ir. Sy~✓ , w/ ~h~v/~ PROPERTY ADDRESS AW (location of septic system) Please obtain from the Planning Dept. CITY/STATE /yt~ZE^J W/ 9 - 2-PROPERTY LOCATION ~14 1/4, Section 22, , T_30 _N-R_Zp W TOWN OF •ST -~~iF~°f1 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 6OWr,3113• x CERTIFIED SURVEY MAP 9 VOLUME PAGE , 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. rn. ~R SIGNED: Lyl DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC-100 This application form is to be completed in full and signed by Ithe owner(s) of the property, being, developed. .Any inadequacies will only result ~n delays of the Pdrmit issuance. , Should this development be intended for resale by owner/contractor,(spec house), thenla 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 - Ali 4Noc-A r ' a,/ ~A~l~/,~s•J hj, ~Jo~ Location of• property 1/4 .-1/4, Section 2-2- , T 3o N-R Zo W Township ~ oS~,o,~/y"~ • Mailing address 209 • ~iflS7~/?~it~ Address of site Subdivision name ~so'o< Gwr/•o~= Lot no. 3 E!« E4sr &73..z other homes on property? yes_ '-No Previous owner of property =~rkfa0 g!MVA6 Total size of parcel 9 G (/-/So 1.k Date parcel-was created !'Are all corners and lot lines identifiable? Yes No is this property Oeing developed for (spec house)? Yes _k_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 & THE SELL 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 t office of the County Registerof Deeds as Document No. , 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 office of county Register of deeds as Document No. ~ C signature of applicant Co-applicant /A Date of Signature Date of Signature- DOCUMENT No. WARRANTY ,DEED-- THIS SPACE RESERVED FOR RECORDING DATA L } 51,1491 STATE BAR OF WISCONSIN FORM 2-1982 VOL' 84 REGISTERS OFFICE ST. CROIX CO WI Joseph Monheim and Leona E. Monheim, Recd for Record husband and wife, JAN 6 1994 - ii 1 10 A: conveys and warrants to Nicholas R, Nelson and Kathryn I at M .M.....Ne~..SQtla- k~us_baz~s3...ax><~..~z~.~e.-•--------------•--- - - er Of Deeds RETURN TO . County, the following described real estate in S_t t Croix it State of Wisconsin: Tax Parcel No:.~.:~ The North One Hundred Fifty (150) feet of Government Lot "3" of Section Twenty-Two (22), Township Thirty (30), Range Twenty (20), EXCEPT the East 373.2 feet thereof. TOGETHER WITH Thirty-Three (33) foot easement East of and adjacent to above parcel and extending South Six Hundred Sixty (660) feet from Northeast corner i of above parcel and then East to public highway. ~I I~ This s.- no homestead property. (is) (is not) Exception to warranties : ~I ii Dated this day of G?~>n (SEAL) ----------•-----------------------•-------..(SEAL) * Joseph Monheim (SEAL) ---..Z-d:y(....... (SEAL) * * Leona E.__Monheim AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WI&GQN91N M°tlY1e 0 ss. authenticated this ________day of 19.... Personally came before me this day of _ 19`1.`-{--- the above named Joseph Mo helm and Leona E. - Monheim, husband anc~ wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not- . authorized by § 706.06, Wis. Stats.) to nieaknown to be the person 5.......... who executed the oregoin instrument a wledge the same. THIS INSTRUMENT WAS DRAFTED BY James F. Lammers 1835 Northwestern Avenue t7 - MN---- 35d$2-------•------------------- Notary Public County, Wis. 1, 1 1! (Signatures may be authenticated or acknowledged. Both My Commission is. of tate ex ration are not necessary.) date: QA4YRJIA,_ 19_. ) ~!OTARY GTOK~ TA *Names 04 persons signing in any capacity should be typed or printed below their signatures. MY Expi 1+, 1998 • . WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc. FORM No. 2- 1982 Aiihvaukec. Wis. r .,,tea.-s+~ean. S 9 4 4 V '♦t i V 7 II THIS PAC RESE~ F~EC 1~~ ORD I 4r DOCUMENT NO. WARRANTY-DEED-- i 51,14.71 STATE BAR OF WISCONSIN FORM 2-1982 1059PAGE' 84 REGISTER'S OFFICE ST. CROIX Co., WI Jose~?h Monheim and Leona E . Monheim, Recd for Record husband an...wife.................................................. - JAN 6 1994 IT - A: : 10 II a ~~C conveys and warrants to -Nicholas... . Nelson and•_ Kathryn at PAgrster of needs RETURN TO the following described real estate in County, the - State of Wisconsin: Tax Parcel No:.L_ The North One Hundred Fifty (150) feet of Government Lot "3" of Section Twenty-Two (22), Township Thirty (30), Range Twenty (20), EXCEPT the East 373.2 feet thereof. III moil, Bill, Nufflf"i I tip, ~ I ~I This s•• nOt........ homestead property. (is) (is not) Exception to warranties: Dated this day c,l !0-4 . . ✓lr~...................................... 19~._l • -.----..(SEAL) (SEAL) •-V w Joseph Monheim ••---•---•-•---•-••-•--••••----•----•----------•---•------•-••••-•-•-(SEAL) -_-_-(SEAL) Leona E. Monheim AUTHENTICATION ACKNOWLEDGMENT Signature(s) : STATE OF I£,6A N (Y~°(tY\e. ,o ss. L~0.~.v✓_ ~ _ _ _ _ County. authenticated this day of___________________________ 19_._.. Personally came before me this day of 19_41.`:1___ the above named _d Leona. F_-_ Joseph Mo eim. an__ h . „ Monheim, husband -anc~ wif----------------- TITLE: MEMBER STATE BAR OF WISCONSIN litho ized.. 706.•- is. St•-•..._..... authorized by § 706.06, Wis. Stats.) to known to be the person !R who executed the oregoin instrument a ~wledge the same. THIS INSTRUMENT WAS DRAFTED BY Tn}48a c.N e s F. Lammers = 999 - 1835 Northwestern Avenue " ..'StT1-1'teTy--+M 55-0.82--------------------------- Notary Public County, Wis. ation (Signatures may be authenticated or acknowledged. Both My Commission is , of tate ewe are not necessary.) date____________________ C , ----DAYUN JIA. RUNS 19 ) NOTARY PUBIIC-MiNNESt)TA ' NGTO~ *Names of persons signing in any capacity should be typed or printed below their signatures. MY Cantu. Expim Jon- 1998 r ~ WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc. FORM No. 2- 1982 Milwaukee. Wis. 1. • 1 1.7 Ala 'S9018 Aj3jVS X1651 C AI EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 S/P,✓ ~~ffII RE ON SOIL BORINGS AND PERCOLATION TESTS _ LOCATION: 'a,Mr-11a, Section 2-7 R`~E (or) W, Township or Municipality ~ sf ~~1Cyi x Lot No. Block No. County Subdivis' n Name Owner's Name~.fpx0VC_i Z 4 / C J_ _'5 X111, Mailing Address: - TYPE OF, OCCUPANCY: Residence X - No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPL E DATES OBSERVATIONS MADE: SOIL BORINGS 54~ - M1 1<f> PERCOLATION T S t / ZONI r~ SOIL MAP SHEET SOIL TYPE A' , c''Tri,cr PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP I Vf~ CHES RATE CHARACTER OF SOIL NUM- INCITES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN BER P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) J G B 2-it - 12 c3//I'rJirc' PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy.NO'/' ,111 ot?P 7__e6AZq - Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 4-o t 0 4-1 x I ~ rl~ i''5' 1115, x w v IT -5 , f 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 location of test holes are correct to the best of my knowledge and belief. ~ J! ~~~►/CSI Certification No. Name (print) Address l^i C%r~~9~~>' h ~'~~7'~/~/ Name of installer if known CST Signature 11? COPY A -LOCAL AUTHORITY