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Q o ~ 00 I ~ 00 I M 03 ° p °v) 0 0o Q c c C o 0 ~ I I E 0 w CD N o~ (D d (D co L Q.:3 C c O O E v; I I Z N E c Z O 7 N M L L c ~ Y c d LL c LL O C 2 U ;.r ; C ro O Q N > J Q I N Z ~ w r- UJ _ o w, o o o z d d a~ C:) ui N N a m a m O Z a c 0 N N Cl) (D z H a) III ~ O N O N ~ I N ro N N Il li D- CD CD C) N O o O O O O d L C L N V N N N 0 -O 41) < 0 0 O O O O Z m z Z Z Z Z CD 0 N LO (D (D LO o L L Y U - ~~yy -0 ~ d - a0~-. ~ n N `l 0 y N w V U) N i N c 0 CD O E Y `n O O 0 E O w E ^ L cn cA lA O cn (n m =3 V 1 E Z: _ • ro z a a a 0 a a a CL E 0 cn ' ~ M M N N J U r rn z° 3 m rn } C) ll) 00 C) \ N Z V to 4~ N~ O O O N M Q O N N w 0 N N N 00 1 0 0 'O Q O O -O 7 7` M ~ `r co c .L.. m c d y o O V N N • Q ~f Q Z cn N 'p d7 Q to ro 0 7 a3 00 7 w ~ i U) U) O O O O W s H C 0 c w ro 0 0 6 0 0 l Q o 3 0 a~ c o 0 L ro-e a~ c c n O O O o 0 C N ro E N E C N N N N N L Cl? O 0 m N N O c o o2 E v 3 c~ v 2 s a°i ° o M c aNi (=D c -0 51) Cl) 0 • O N cn -0) O z N 2 Z IL O Z N Z U) v c! ,a`; ~a a a w 0) CL L: CL rr~~• ~ a d m d o d m c 0 N A 0 a m o a U U e STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 1. SUBDIVISION / CSM#4Z LOT # SECTION :22 T_N-RW, Town of a1~~►nJ ao• 3~ . ~"1. 3dg'8 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM , l~ 79 h4L f/use G'~e.~4 1` INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. j BENCHMARK: 4 16J~ ,,Y - ~jz of ALTERNATE BM: SEPTIC TANK / PUMP// CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House c7 Other Pump: Manufacturer Model#~ Size Float seperation~ ~Gallons/cycle: Alarm Location )7Z SOIL ABSORPTION SYSTEM ~oU,iJl] Width: Length Ieo Number of trenches / Distance & Direction to nearest prop. line: - Setback from: well: ;79 House Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom 3,? 2.s - Pump Off Header/Manifold /D/, 4~ Bottom of system Existing Grade 7 Final grade DATE OF INSTALLATION: PLUMBER ON JOB: , - LICENSE NUMBER:q INSPECTOR: 3/93:jt +6~ #S~r'> i1m+~er r~ y 20. 31.17.pjfiftT?FSrWA6%%TEM County: ,Labor'and Hum$n Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary ermitNo.: Permit Holder's Name: ❑ City ❑ Village ❑ 7own of: State Plan o.: TA T. ER 111H ev.: Insp. BM E ev.:rffl BM Description: Parcel Tax No.: 0, Ot TANK INFORMATION ELiVATION DATA A9300138 TYPE MANUFACTURER CAPACITY . STATION BS HI FS ELEV. Septic Benchmark lb .1 /vo. Dosing . ; ` ~p(1 Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Septic G' 7 a' J 7 3 Z7' NA Dt Bottom /.7.5 8 9 3 5 Dosing dD > 7j5 NA Header / Man. l ~ ~f S! Jo/,(~~ Aeration NA Dist. Pipe Holding Bot. System 106" I PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 9916:1? Model Number -7~ GPM Friction Systeml S TDH~,b3 Ft TDH Lift/. /3 I Loss I F_ Forcemain Length,- Dia. F s~ Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S I /00 . / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O ~ Mode Number: -"CL '3~/ 1 ' 71' W4 OR UNIT W-Ltjj System: !Y} DISTRIBUTION SYSTEM Header/Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Length Dia. .14 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over r Depth Over - xx Depth Of xx Seeded /Sadtfed- xx M Iched Red /Trench Center ' Bed /Trench Edges f Topsoil << ef"s ❑ No es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STANTON 20.31.17.308B,SE,SE,200TH , Plan revision required? ❑ Yes Ef No Use other side for additional information. SBD-6710(R 05/91) Date 6Aspector'sSignature Cert No. ADDITIONAL COMMENTS AND SKETCH d SANITARY PERMIT NUMBER: r-7DIHR SANITARY PERMIT APPLICATION COUNTY 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 i 9-5 2I 5~Z5 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. PROPE TY OWNER PROPERTY LOCATION '/4 S T , N, R (or PROPERTY OWNER'S MAILING, ADDRESS LOT # BLOCK 6, 14A, CI STA ZIP CODE PHONE NUMBER SUBDIVISION N FOR M NUMBER yil II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned p VILLAGE : ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms :J-/ PAR AX NUMBER(S) IAJ 111. BUILDING USE: (If building type is public, check all that apply) ~ - ,/d 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility i 3 ❑ campground 7 ❑ merchandise: Sales/Repairs 11 El Restaurant/Bar/Dinin 9 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ~ Replacement 3. El Replacement of. 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - 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 130 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 Feet Feet VII. TANK CAPACITY in alIons Total # of Prefab. Site Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installs 'on of the onsite sewage system shown on the attached plans. Plumb 's Name (Print): Plumbs 's gna re: Np ps) MP/MPRSW No.: Business Phone Number: 'Fill 1 (71 Plumb 's Address (Street, City, State, Zip Code 534.- IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued IssuiS 194.atu (N mp Surcharge Fee) Approved ❑ Owner Given Initial yip Q7 46 Adverse 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 ' r 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: 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 8% 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) 1 rp" ' SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 KO CONSTRUCTION KIM A O'CONNELL RR 1 BOX 105 STAR PRAIRIE WI 54026 RE: Plan Number: S93-40343 Date Approved: June 15, 1993 Gallons Per Day: 600 Date Received: June 15, 1993 Project Name: PLUMMER, JON Location: SE,SE,20,31,17W Town of STANTON 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. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 785-9336. Sincerely, z4lo~- k , 4au+~ DENNIS R. SORENSON Section of Private Sewage Division of Safety and Buildings PPP027/0009n/52 cc: Private Sewage Consultant SHD- 1423 I R. 0"1) ' SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations June 11, 1993 JON PLUMMER 1578 200TH NEW RICHMOND WI 54017 Petition No. S93-40343-P Dear Mr. Plummer: Re: Jon Plummer - Residence Private Sewage System SE,SE,20,31,17W Stanton, St. Croix County, WI Your petition for a variance to section ILHR 83.23 (2)(c), Wisconsin Administrative Code, has been reviewed. The petition has been conditionally approved. The condition is that if the proposed system does create liquid waste problems, corrective action, including abandoning the system if necessary, will be taken. The rule being petitioned requires that mound systems on slowly permeable soils, the effluent shall a distributed in a trench design which cannot exceed 4 feet in width. BE designs require more than one pipe network for effluent distribution. The variance requested was to utilize a narrow bed that is 5 feet wide and to distribute the sewage effluent through a single pipe network. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Wcerely, is a ey , Director, Office of Di i ion Codes and Applicatio (608) 266-3080 RM:DS:2914WPP1 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County 5BD 8828 (R. 01/911 II WORKSHEET • MOUND SYSTEM DESIGN PROBLEM: Design a mound system for a The site characteristics are: 4ZZ Depth to groundwater or bedrock in. Landslope Percolation rate a~~~~.• Distance from dose chamber to distribution system ft. Elevation difference between Dump and distribution system ft. ~ I • Step 1. WASTEWATER LOAD /.S"0yA/e .leAP.4oopIf gat Step 2. SIZE THE ABSORPTION AREA a A) Area required = GOogt-/-' QQ sq. ft. B) Bed or trench length (B) _ ' .LP12_ f't. C) Bed or tr_nch width = D) Trench spicing (C) Wastewater load .24 3cal/ft2 = n /day . B ft. metre ~c'" e►F~"s " Step 3. MOUND HEIGHT A) Fill depth (D)' f t. B) Fill depth (E) ■ D + slope (AJf~~ f t. C) Bed or trench depth (F) _ i't. D) Cap and topsoil depth (G) _ ft. E) Cap and topsoil depth-(H) _ ft. wign: • Ial. cenuo iti'a : ~-~9 usute ' Step 4. MOUND LENGTH A) End slope (K) = D + E + F + H x 3 ft. 8S -A /,S-7,rs 13 B) Total mound leng h (L) B + 2(K) 622,d ft. Step S. MOUND WIDTH Al) Upslope correction factor = A2) Upslope width (J) _ (D + F + G)(3)(factor) _ ft. (/.33t.83f 9•,/)= 8,91/. Bl) Downslope correction factor • 62) DOwnslope width (I) _.(E + F + G)(3)(factor) f t• C1) Total mound width (W) for bed J + A + I ft. 9 f G t ~ 9 Fr C2) Total mound width (W) for trenches • ~F~ g (no. trenches -1)(c) + A + ift. -YA 2 ~ de. _ Step 6. i BASAL AREA r A) Infiltrative capacity of natural soil gal./ft2/4ay r B) Basal area required • wastewater flow natural soil infil ra i e capacity +sq. ft. 3 9 '°J C1) Basal area available for bed for sloping sites • Bx (A+I) _ C2) Bas are wail le for trench for sloping sites = B W ~J + A = sq. ft. C3) Basal area available for trench or bed for level sign: B x W • sq* ft. Lironso r;u:••~__ ~~/.JE,o ,~n'~~~ D at a: .10 Step 7.' DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1 Hole size = ~ in. 2) Hole spacing • ,,2_ in. 3) Distribution pipe length 4) Distribution pipe diameter ■ in. 5) Spacing between distribution pipes = in. 6) Distance from sidewall to distribution pipe • n; 1B) DISTRIBUTION PIPE DISCHARGE RATE 9 ft. 1) Number of holes per pipe ■ .;U- / q 2) Flow per pipe ■ 3 GPM. 7C) SIZE MANIFOLD 1) Manifold is Y,r central/ end 2) Manifold length ■ _ ft. 3) Number of distribution lines ■ 4) Manifold diameter ■ in. 1 7D) SIZE FORCE MAIN 1) Minimum dosing rate ■ ZZ42a GPM 2) Force main diameter -2 in, 3) Friction loss * ~'~g~ ~2 ao . S-_ ft. 7E) TOTAL, DYNAMIC HEAD 1) Vertical lift = ft. 2) Friction loss ■ ft. 3) System head 2.5 ft -!r, ft. 4) Total dynamic heed = ft. Licenee:~? 7F) PUMP SELECTION 1) Pump selected will discharge GPM at =V,- total dynamic head. ft. 2) Pump model and manufacturer 440 7G) DOSE VOLUME 1) 10 times void volume of distribution lines s - X .,,.L . 9 al./cycle ~~yX~~o - i y LG 2) Daily wastewater voTume4 1 z doses/24 hrs. ~Q gal./cycle 00 ~ _ 3) Minimum dose volume gal./cycle Aso 7 13,Y-'r ~a3, oJ8 a73,a8 7H) DOSE CHAMBER i) Minimum capacity required • SOO- 7so ~Q~ gal . 800 dAJi s t a; Sign; Licanso ::u:-~..-.- Date: _90 Wisconsin Human n elatio ndustry, tabor and Hu PRIVATE SEWAGE SYSTEM Safety and Buildings Division Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt-8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188 Phone (715) 634-4804 Fax (608) 785-9330 34 hone (608)1267-5119 Phone (71 5) S24-3626 Fax (41(414 41 ) 1( 548-8861846 06 Fax(715)634-51 S0 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 inform ti submit. PLEASE P a n t RINT VERY CLEARLY. A sample of a completed form 1 ' s on the reverse side for your reference. 7 APPOINTMENT INFORMATION If ou have scheduled an appointment, fill in the information requested b low to save Appointment ave time: Date Reviewer Name Plan Identification Number 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: rolect N me ❑ City Village ® Town Of: County Project location GOVT. LOT 1/4 114 T N R or 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type 1 (include new and existing tanks) A ❑ At-Grade Up To 1,500 gallon septic tank $110.00 1,501-2,500 gallon septic tank $120.00 _ 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 sep ' $300-00 P ❑ PressurizedIn-Ground Over 15,000gallon sep ~C ...~D $500.00 O ❑ Other: Up To 1,000gallon dos b$r 1'1893 $ 70.00 ,1 93 1,001 - 2,000gallondos ber $ 80.00 ......,V Building Type (check one): 2,001 - 4,000 gallon dose chamber $100-00 4,001- 8,000 gallon I lir85! .~V. , , ;120.00 . D ❑ wDwelling, 1 or 2 Family • • 8,001 -12,000 gallon dose osechamber ;140.00 ....%A: ' P ❑ Public Building Over 12,000 gallon dose chamber , , • ;160.00 S ❑ State-Owned Building ' Up To 5,000 gallon holding tank S 60.00 Code Derived Daily Flow. 5,001 -10,000 gallon holding tank ;100.00 gpd Over 10,000 gallon holding tank - $150.00 ❑ Check If Replacing Existing System Experimental System (additional onetime fee) $300-00 Revisions To Approved Plan 2 $ 60.00 Petition For Variance: Setback $100-00 ® Petition For Variance Site Evaluation $225.00 r~ Plumbing $225.00 Revision S 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 Subtotal: - PriorityReview: Enter same amount as Subtotal: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 5. SUBMITTING PARTY INFORMATION c- Telephone No. (include area code & extension) Comp y Na ~ Cont Per n (r n No. & treet Address Or P.O. Box City, Town or Village, State, Zip Code 1 Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 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. ` SBD-6748 (R. 03/93) OVER N 319 'oa rt , 4-0 0 C; car N 4~ C + c i rrs~a 4-+ c o~ ua+~ Rs c a) 4- 4v I- to 4) DWI .0 E OL 4J 0 CL c Go I- ov 4J 'D CL 4-0 'v c C EN C# a~ IV r-~~i~' E O O d a E p N C c E t 4.+ p0 fd CL >v E 41 V) w W 4. r- 0 4J 4J (0 4J N ea fO r- V 4J CL 4J 4J a L a .r N w N 4- N Lon N 7 to 41 rd CL c x 4- > c ~ N i+ i.+ ear- =4000 NBC 1- p _*07 'D E 41 4j Go t E c nO~.t c a c a C~+ E.r cp M 0>_ Rf ar N C gr r- w EE++, c Ad Oa o a 00 J a~~ I- =41 aaa N .o = 4D 64-0 'o +1 w V- car 4- N v O t O 4J;C O=Earl ar c m aCw c N d~w-~ c oar nOs_C L Os. ararv►v o V1 a) to 4- c C N a c 4- N~ >0 0 0 4-P 39 39 4-0 4.0 u p a E QP in v~ ~0-► d o 4-J 4.0 YOQ- 'd ~ 41 p L I' 4J ar N= O w s. n- L 0 4-0 G. _ o a1 d 4-0 E 4-P - 4 •0 N ar s t W -V 0.+ CL ar CJC U. c • E 4J > aEr Or-4D #0 O L °a E L ~ ns ar u4- O ar ar c d ~ n> c a, a+ c E L s' c a to to O c r 'd L N E 4J O E ar Q s. t ~ CT 1n v~ E CiC N V w CL z aZ IX c >1 ~ O ~ U ~ W 0 0 0 0 •x I IM 3 [1cc a 3 8 3 0 . . . . . . . . . . . 1n s 3 888$8$ 888888 ago 88 sass a s _ A x sus ~ss~~$ Is sxn~ s s „a sN g~~ ~~47 MNMNMM MNNNNM MMM MN MMMN N M ~ ~'^S s~~ Ss ~ : r• ,,~3 Mz $1 13 z a~ 111 lilt It III III f 3 a 0 o ~Q - I: V) K f a~ b a mfl•r 11Js N s: O 74i{its t 19 4y 1 d i ^ r j F S W 1L ~T S 3 C in = n ~ o = s t- o rim 141 s ` oootRoo b00 )it O O x 0 oil _J1 bi - o ~ - o PETITION FOR VARIANCE APPLICATION Wisconsin Department of Industry, Labor and Human Relations OFFICE USE Amount Paid ONLY Safety and Buildings Division';' Petition No. ONLY 201 East Washington Avenue, P.O. Box 7969 Receipt No. Madison, Wisconsin 53707 E-Number 608/266-3151 Name o Owner Petitioner Building or Project gent Architect or ngineering Firm Company Tenant Name, if any Street & Number Street & Number Location, Street & Number City State Zip Code rI/ City St at Zip Code City.. County Telephone Number Telephone Number Plan Number, if known Name of Contact Person 1. The rule being petitioned reads as follows: (cite i fic rule number and language) s 7~ 2. The rule being' petitioned cannot be entirely satisfied because: / c1 3. The following alternative(s) and supporting information are propo ed as a means of providing an equivalent degree of health,,safety or welfare as addressed by the rule: .~~s_.Ji~! n.~e✓f -ffi! win...) r.C ~Q11S ~/J vft~ Gd-~~(? / ~ _ ~uN o s. DIV. Note: Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for complete fee information Note: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys, etc. Jon not sign petition unless a Power of Attorney is submitted with the Petition for Variance Application. _ .Jon "PIU.M01W , being duly sworn, I state as petitioner that I have read the foregoino (NAME OF PETITIONER, Please type/print) P, petition, that I believe it to be true and I have significant ow ~~F"•in the subject building or pr/oject. So z ~d swd before me this date: J( 8 I Si ture o P t' t UNARY I o p o y w COl mi j~51~O0 Lit'p a r VubRi 1i SB-8(R.09/88) Of Wei; i ST. CROIX COUNTY ' WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 April 22, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 ..To whom it may concern: An onsite soil investigation of the Jon Plummer property, located in the SE1/4 of the SE1/4, Sec'.20, T31N, R17W, Town of Stanton, St. Croix County, WI., has been conducted with the assistance of .Kim O'Connell, CST# 2344. This onsite revealed suitable soil for onsite sewage disposal'to a depth of 20" while meeting the requirements of the A + 4" rule. This site should be suitable for a replacment mound septic system having 1611 of sand fill.' Should you have any questions, please feel free to contact me at this office. Since ly, mes Thom~sson Assistant Zoning Administrator cc: file Wis:oniin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labo; anb Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 La Crosse, WI 54603 P.O. Box 7969 P.O. Box 434 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) 267-5119 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 info ation to subm it. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your refegn 3 4 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 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Project Name ❑ City ❑ Village [Z Town Of: County All) An#ae Project ocation GOVT. LOT 1/4 1/4 T N ,R E or 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 116 A ❑ At-Grade 1,501 - 2,500 gallon septic tank $120.00 H ❑ Holding Tank 2,501 - 5,000 gallon septic tank $160-00 . M IM Mound 5,001 - 9,000 gallon septic tank $200.00 N r3 Non-Pressurized in-Ground (convenuonal) 9,001-15,000 gallon septic tank $300.00 P ❑ Pressurized In-Ground Over 15,000 gallon septic tank 4500.00 0 ❑ Other: Up To 1,000 gallon dose chamber $ 70.00 Z16 - 1,001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber $100-00 4,001- 8,000gallon dose chamber $120.00 D ® Dwelling, 1 or2 Family 8,001 -12,000 gallon dose chamber $140.00 P ❑ Public Building Over 12,000 gallon dose chamber $160.00 S ❑ State-Owned Building Up To 5,000 gallon holding tank S 60.00 5,001 -10,000 gallon holding tank $100.00 Code Derived Daily Flow 1A196 gpd Over 10,000 gallon holding tank $150-00 Check If Replacing Existing System Experimental System (additional one time fee) S X00.00 . Revisions To Approved Plan 2 S 60.00 Petition For Variance: Setback $100.00 Site Evaluation $225.00 ❑ Petition For Variance Plumbing $225.00 Revision S 75.00 Groundwater Monitoring - Per Site $ 60.00 ❑ Groundwater Monitoring (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring . $ 60.00• Subtotal: Priority Review: Enter same amount as Subtotal: )S6- MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: / R© S. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Comp ny Nam Conta Person ( > / No. & Street Address Or P.O. Box City, Town or illage, State, ip Code I Aerobic or prepackaged treatment system fees are calculated based on equ/valent size septic tanks and dose chambers. 2 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. SBD-6748 (R. 03/93) OVER I ' r ~ I r 41L --A) fa i Al / s F7U D) E US, , Li "Al C i "PAX- BE h F $ 40 i 0 I • Oesigner~ Rate" Non-Woven Filter Fabric 4" Observation Pipe Distribution Pipe ASTM- C 33 Sond H Alter, Poe, of Topsoil _ Force Main E % o? Slope Bed Of ;"S*- 2 Force Mo in Plow e Drain Rock From Pump ONSITE SEV AGE SYSTEM D E 3 Cross Section Of A Mound System Using' A Bed For The Absorption Areo F -1-~ A P G 0EPA Ti T CF 4'tit}.; 7;,_I,', L,~.L`'J3 A!410 " U',AiAil RELA"i iO1!S A .r F t. H B ,LQlL_ Ft Ft. K Ft. 6,00 C•r"N , 0.3 r n~/ 4i b-AI = Zoc) tZ. Alternate Position L zZ2,4 Ft. of t.GCO ` to.. L = 20 w Force Main W .39 Ft, -L FIT 14NObservation Pipe r_ K CL A o i _ ~ ~ Force Main W o t From Pump 3 ° Distribution Bed Of 0 Pipe(C_"TekZ?N) . Drain RocK 1 N 4 Observation Pipe Permanent Marker r~t3c ze ~zT N Pipe or Rods, Plan View Of Mound Using A Bed For The Absorption Area PAGE-LOF_,,j- PERFORATED PIPE DETAIL an DISTRIBUTION PIPE LAYOUT Perforated Schedule 40 PVC Pipe j End r ~ 'aeti'~ssr°e 4 Holes Located On Bottom Are Equally .~c Spaced End ONSiTE SE1I AGE SYSTEM Cap 4 / Schedule 40 \ C Force Main • Last Hole ~'..t'1 n~~~. i Gt= I°ali~;,TF,' ' r ~i~F ~ +P„J :';L , S ,J Should Be C~" Next To y.rr+rtis ~*K End Cap CCU+t~~ ,.;~+•;:v t..sL Owner's Name: _ P 49 feet Plumber/d igneroe Signature: x inches Y S_ inches Date: S f9-~~ License No.: Hole Diameter //-4,/ inch Lateral Diameter inch(es) Force Main Diameter R_ inches Holes per Lateral feet. Invert Elevation of Laterals I q x z . 343 ~~~Es C 1165 C::P.n = 44.3 CP,n \A 2..5~ hQ~,( Page ~7 of ) • b. z U) v `a -ol l,,jaf 7 I t 4 W,A Y ` LIP OJ 1.~. f I't'4yTRW ~J'J - • J ~ ~ifii'x. . 4.1 \ {A~ 19 w I F1 1'(~ $40 9: J i ~ w t m 44 a~ W o 8 o 0 i •r 93 U, z a 0 a U W ~ V' R ~ QJ d1 tT V i► b d1 a a , PAGE _L. OF Zv PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS 'JoA . VENT CAP . `'C.I. VENT PIPE 7T f WEATHER PROOF APPROVED LOCKING f r__ f - JUNCTION BOX MANHOLE COVER 25' FR¢M DOOR, WIIJDOW OR FRESH 12"MIU. AIR INTAKE GRADE 18' MIN. CONDUIT l~,.`'Lt .PROVIDE I INLET. G`1 AIRTIGHT SEAL ( III eT ` r ilk I I I v APPROVED J 7 p ,?14 •gR+a ( I I APPROVED JOINTS M. ( I I W/C.I. PIPE W/C.I. PIPE • E ' 1G' I II EXTENDING 3 EXTENDIN(S 3 ALARM OWTO SOLID. SOIL f r. I 1 I ONTO SOLID SOIL' t~~" GN C 34C % 1 y t __j ~;,4.` d;• r,,,v PUMP ~rA 1 OFF CONCRETE BLOc* • RISER EXIT PERMITTED ONLY IF `TAWK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS EFfIC AND _ )OSE TANKS MANUFACTURER: „~.~.alS WMBER OF DOSES: PER DAS TAIJK GIZE: e C1 GALLONS DOSE VOLUME: GALLOMS ALARM MAWUFACTURER: CAPACITIES: A=c~Z,r IUCHES OR . MCALLOUS MODEL HUMBER: B= -.INCHES OR -3_ GALLONS 27 .SWITCH TYPE: t % C= INCHES OR _ GALLOU5 PUMP MANUFACTURER: D:INCHES OR ZZ GALLOWS MOREL NUMBER:.- NOTE.'. PUMP AND ALARM ARE TO BE DW17C•H TYPE: I WSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE. RATE 79 GPIAlk VERTICAL. DIFFERENCE bETWEEW PUMP OFF AND DISTRIBwTIOM PIPE..FEET + MINIMUM NETWORK SUPPLY P~RE~S~SURE/ . . . 2.5 FEET 3t FEET OF FORCE MAIN Y, kZs F/ FRICT IOU FACTOR..FEET f 1.7 r{V ytk goo Fx TOTAL OtJ JAMIC. HEAD = , ~ L3 FEET c %7,q -,k tAg-'l UNI-) At 4.~"Ale IAITERNAL DIMEWSIOWS OF TAIJK: LENGTH ;WIDTH (LIQUID OEPTH ~ SIGNED: LICENSE WUMBER: S"9 DATE: rAGe X /of iv " Effl et 'Performanc zwfrsb" Curves Pumps MMRS FEET MODEL 3885 25 SIZE 3/4' Solids WE15H - 70 20 WE10H 6p OF -WE07H 15 50 WE05H 40 10 30 WE L E3 20 WE 'M 5 10 0 0 0 10 20 30 40 50 60 70. w 90 100 110 120 GPM 0 10 20 30 rWlh CAPACITY ~GOULDS PUMPS, INC. SB`ECA FALLS NEW YM 13148 METERS FEET 120 MODEL 3885 35 SIZE 3/4 Solids 110 WE15HH 30 100 90 25- w 70 20 60 O 50 WEOSHH 15 . 40 10 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I 1 1 1 0 10 20 30 nP/h CAPACITY 91986 Goulds Pumps, Inc. Ensc" Juiy.1985 C3885 +isi~+lsin Department of In ustry, SOIL AND SITE EVALUATION REPORT Page _ of • Labor and Human Relations Division of Safety & Building in accord with ILHR 83.05, Wis. Adm. Code COUNTY 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 IBM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORM TION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE TY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S T AR !{(or PROPERTY OWNER':S MAI IN ADDRESS LOT # BLO K # SUBD. NAME OR CSM # Ay ' CI STATE ZIP CODE PHONE NUM ER ❑CITY VILLAGE ®fOWN NEAREST ROAD LLLL_~_1Z-Z1Z;L I ~ -;2eo } 'L=je7 ZJ~F [ ] New Construction Use Residential / Number of bedrooms -!W~Alf [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration urface elevation(s) 16f, n ft (as referred to site plan benchmark) Additional design / site considerations Parent material S Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ® U ® S ❑ U ❑ S N U ❑ S ®U ❑ S [0 U ❑ S [Ell SOIL DESCRIPTION REPORT Boring # Horizon Dept Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench /40w 64? Ground s s _77- 'f ze -941 elev. ft. /o yr st, Depth to limiting factor „ Remarks: Boring # _ > -31 ` jay. Ground s ev. ft. Depth to limiting factor Remarks: CST Name _Please Print Phone: Address: Signature: Date: CST Nub : PROPERTY OWNER SOIL DESCRIPTION REPORT Page.V PARCEL I.D. # , Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground - n, c- 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: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 1 I I ! ~ I I I I , I I I I 414a-~ I I I ~ , I I , I` I I i ' ~ I I I I I ; ' i _ leg - - ! j i , I I I I I I! I I l I I ~ I i ~ ) I I ~ Q I I I I I ~ % % 1 I ~ ~ I I i I i I i I -I I T I I I I I I C I . I ; -71 I I I I I I I I , I I ' 1 I I - - -L, - 4L, I I I , j ;~8 ~ i I I I I r i ~ _ . -r-- t r - - - - fir-- - ---t-~ I ~ ~ I ~ I ~ ~ I I ~ I. I I i I , , i --_--r--. r-r---'--r- 'I,-. - -t- ~ it - _-j ._-r , I 1 - I ~ i j ' ~ ~ ~ 1 ~ I j I I~-• I , i , , I ~ I I I i ~ ~ •T I r. ~ I I I I ~ j ! I ~ ~ °I I I 1 I - I I I I I ' r I j I , : ' Wisconsin Department ti Industry, Labor and Human Human Relations SOIL AND SITE EVALUATION REPORT Page L of 3 Division ofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code R COUNTY Attain 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 PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP7~y OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S T N,R (ors PROPERTY OWN R':S MAIL IKG ADDRESS LOT BLOC # SUED. N ME OR CSM # s CI STATE I ZIP CODE PHONE NUMBER [:]CITY VI LAGE [MOWN NEAREST RD ) ' 7 New Construction Use p(] Residential / Number of bedrooms Addition to s ' hum, n (1 pQ Replacement [ ] Public or commercial describe Code derived daily flow "4 _ 9pd Recommended design loading rate __,_bed, gpd/ft 2 trench, gpd/ft2 Absorption area required -rw4 bed, ft2 S-pb_ trench, 11:2 Maximum design loading rate _ =~9__bed, gpd/ft2 . trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) RECEIV Additional design / site considerations Parent material V' Flood plain elevation, if applicable N 3 S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL G . DIVV. U = Unsuitable fors stem E3 S O U 6d S ❑ U 1:1 S ® U ❑ S (U ❑ S ®U pSOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft a : in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh Ground ~ elev. icy~'G a ft. i Depth to i°y« limiting factor 7 Remarks: Boring # /oyl G ~ Ground elev. iog4-Ma ft. Depth to limiting fact_or~ 1 y Remarks: CST Name:-Please Print J Phone: Address: ~2 '4 Signature: Date: \ ~ CST Number: 1 wN REPORT Paged Boring # Horizon Depth Dominant Color 13 in. Munsell Ou. Mottles G Sz. Color Texture Structure Sz. Sh. Consistence Botrckvy Roots G P D 1 Bed Ground elev. Depth to ` limiting factor Remarks: Boring # 13 Ground elev. Depth to limiting facipr_ Remarks: j' Boring # E3 Ground elev. ft. " Depth to limiting factor Remarks: Boring # Ground elev. Depth to limiting factor se Remarks: D-8330(R.05/92) t T I ~ r r _ .I _ I - l- t ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certif that I have inspected the septic tank presently serving the - residence located at: / 1/4, S`.z- 1/4, Sec,:; ~,,9Z, T~fZ_N, R_Z7W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced },iceZ& Did flow back occur from absorption system? Yes_No (if no, skip next line) Approximate volume or length of time: gallons ~S minutes Capacity: Construction: Prefab Concrete Steel Other a/ Manufacurer (if known): Age of ank ( i f. k wn ) (Signat re) (Name) Please Print --Z;2 S (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform t the requirements of ILHR-83, i m. Code (except for inspecti o n' g~er outlet baffle). Name Signature - MP/MPRS 5/88 II S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER--Jon A. 1'IGtiNIM1 of ADDRESS ISIS 2001= AyGY►bt,[ FIRE NUMBER_ !S7$ CITY/STATE n,P" aAYVCMd W~SC(MSir1 ZIP_ S~f(11~I PROPERTY LOCATION: 1/4, S G 1/4, SECTION 20 , T_3 N-R I- W TOWN OF .y[un+Qn , St. Croix County, SUBDIVISION , 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 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 60% of the cost of replacement of a failing sYstem which was in operation prior to July 1, 19'78. 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/lle, 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 Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: olw6yml DATE : S ZI ,3 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 01 y 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), thenta 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 Jan A. A)umrw Location of property 1/4 SC 1/4, Section_ W . Township aayr M Mailing address K-1 't` Address of site subdivision name ,v LA Lot no. other homes on property? yes x No Previous owner of property ShfeyjDodi Vdhl'1$7~~1 ~ yrV~~ Total size of parcel /.24 QCrt Date parcel -was created Are all corners and lot lines identifiable? __Yes NO is this property being developed for (spec house)? Yes „L_No UxiWl Volumeand.Page Number c7~ as recorded with the Register of Deeds. dog :fL X410 INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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 n the office of the County Register of Deeds as Document No.- S~F141 , 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._ ~K4/L7 sick to of applicant Co-applicant Dat o Signature Date of Signature - - • DOCUMENT NO. THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED STATE PROF WISCONSIN FORM 2 - 1982 45^ 1V7 woo 0757 PASE rjo REGISTER'S OFFICE ST. CROIX CO., WI Rec'd for Record r- Sherwood A Johnston and Sylvia T. Johnston, r husband and wi fP at D' 1') 1989 conveys and warrants toJ on A. Plummer and 11:15 A. M Cynthia L. Plummer, husband and ftW V wife as survivorship marital Register of Deeds property RETURN TO Century 21 the following described real estate in St Croix County, New Richmond, Wi State of Wisconsin: Tax Parcel No: The South 241.7 feet of the West 208.7 feet of the Southeast Quarter of the Southeast Quarter of Section 20, T 31 N - R 17 W. i 1•K j~l`1~~ This is homestead property. (is) (is not) Exception to warranties: recorded easements and rights of way. Dated this ~ day of D £ C F- m 49 ~ ,19 (SEAL) (SEAL) * S wood A. John ton * Sylvia L. Johnston i (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGEMENT Signature(s) STATE OF WISCONSIN ss. St Croix County. o -Tif Personally came before me this o day of authenticated this day of , 19 b 4C F=: /n [B E A, , 19 the above named qbp-rwnod A. Johnston and Sylvia L. Johnston * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the persons who executed the authorized by § 706.06, Wis. Stats.) foregoin instr ment and acknowled the me. THIS INSTRUMENT WAS DRAFTED BY John D. Walsh * John D. Notary Public St ~ dbty Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permar4t. ""'m 0 (yyof, tb4e expiration are not necessary.) date: Decembbr 46' T}g09 ) M % *Names of persons signing in any capacity should be typed or printed below their signatures. f rj WARRANTY DEED STATE BAR OF WISCONSIN i ~1SIN EAL'F * Stb SSOCIATION FORM No. 2 - 1982 ayeRtlail~ IVWisconsin 53704 ~f1rtA~1~h wisoonsin Department of Health and Social Services Plb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) B. LOCATION OF PROPERTY Wfir.:tE SYSTEM WILL BE CONSTRUCTED ALTERED J1 EXTENDED COUNTY Check Ones CITY VILLAGE LEGAL DESCRIPTION !!TOWNS HIPS, ell, C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? DYES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSs Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: 9. TYPE OF OCCUPANCY Check Ones One or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms 3 F. APPLIANCES, ETC: Food Waste Grinder YES ~Q. Automatic Clothas Washer ~L~Yks NO . Dishwasher YES =0 Automatic Potato Peeler YLS----NO Other (Specify) G. MASTER PLUMBER MAKING INSTALLATION , Name: ! ~•cxct.~c~ G z ~v7 Address: t// ~iGLLcr h 'aense Number: MP Signature of Applicants MP RSW ~C 2,7 Addrosss H. (To be Completed by Issuing Agent) Date of Application 'R- 2 / Fee Paid ; 1.. U Permit Issued (date) ~71 _ Permit Number c/ 7 7 Agent (Name)~t,tiL" Fors Town, Y llage, City, County, etc. v (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tank and the.tnird copy of the permit (canary) to the Division of Health. Cheeks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED - d- ACCEPTED BY RETURNED (Initials) 5a (Date) See C- ras~ FEE RECEIVED VALID. No. PERMIT NO. es or No REVIEWED BY APPROVED DATE (Initials) Yes or go) r COMPLETE OTHER SIDE S&PTIC TANK PERMIT NO, R Z P O R T ON S O I L P Z R C O L A ? I O N ?ZS? AND 301L BORINGS TO DIVISION OF HEALTH • PLUMBING SECT16H P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P 9 R C 0 L A T 1 0 N TIS? Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall let Wetted Overnight in Minutes Last Period Last Period Period One'Ineh Example • 0 3611 To Soil 10" Cla 26" 25 Yes or No 30 1 2 I L2 1 2 60 ic/ -3 r' ILI -3 RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 1 L B O R I N G S- Minimum 36" Below o posed Abso tion stem Boring Total Depth Depth to Ground Water De th to Bedrock Number Inches Observed kstimated Observed Estimated Charaoter of Soil with Thickness in Inches 1:xample B - 0 72" 72" Black To Soil 12" C 18" Sand 18" Gravel 2410 0? 711 RECORD DATA FROM MINIPlLAI OF 3 BORE HOLES PE OF OCCUPANCYs RESIDENCEs Number of Bedrooms OTHERS (Specify) Number of Persons - rOOD WASTE GRINDERS Yes No ' Dishwashers Yes No Automatio Clothes Washers Yes 1`10 M~ FFWENT DISPOSAL SYSTEM: NEW ZXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length *zl C (Width -?-~Depth Tile Size . If No. Lines , Seepage Pits Inside Diameter Liquid Depth Ii the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method speoified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME L a cl o - A-) TITLE zo ` D S Type or Print REGISTRATION NO, ~C> or MASTER PLUMBER LICENSE NO. ADDRESS --4: '-r t IGNATURE - i .2c "Z~ DATE SIGNATURE-- f LAL X0111 `4 ~02TJf 3 553 Zd S uW 1i9v~ 2 y/. -7 x Z Gef, 7 _ SAFETY & BUILDINGS DIVISION ! I I State of Wisconsin Department of Industry, Labor and Human Relations May 26, 1993 2226 Rose Street LaCrosse, Wisconsin 54603 9 10 KO CONSTRUCTION cb ~ KIM A O'CONNELL RR 1 BOX 105 s~~d' G~0 S 7 8 a}b STAR PRAIRIE WI r .4026 00 C' J~ tico + ©,3(0- /bq J-z1O-co6 RE: Plan Number S93-40343 Project: PLUMMER, JON S ti County: ST CROIX Location: SE,SE,20,31,17W Fee Received: 180100 STANTON Date Received: 5/24/93 This letter is to acknowledge receipt. of the Plumbing Plans which you submitted to the Office of Division Codes and Application, Section of Private Sewage. We cannot however, process your submittal until we receive: A revised soil report.;mot.t.les reported at 14"-32" in B1, at 7"-25" in B2, and the limiting factor is listed at 28" & 24" respectively when the depth to a limitine factor is actually a new horizon. Load rate is not correct for Hor. #2 in B2. Load rates for surface horizons in B1 B2 does not match structure nor is structure reported correctly there. A revised plot plan which clearly orients the proposed mound perpendicular to the slope; as depicted, the slope has a SW aspect on the soil report plot plan, and the mound is directly N-S. .A revised plan utilizing the trench design. Your soil report indicates that the natural soil load should be 0.3GPD/sq ft.. but the width of 5 ft.. does not meet the requirement of ILHR 83.23(2)(c) which limits the width of mounds on slowly permeable soils to 4 ft.. As we discussed in our phone conversation this morning, if you lack the room to build a 4 ft wide mound,'then we will consider a petition for variance to use a 5 ft wide dimension. Please feel free to contact me or Jerry Swim if you have any questions about this plan. Please retain one copy of this letter for reference and return the other with the materials requested. Your Plans will be processed within 15 days by the Section of Private Sewage following receipt of the requested items. Petitions or plans submitted to this office which require additional information will be held 90 working days for receipt of the information. If, after 90 days, response to this letter has not been received, your plans will be returned. SHn•saas M. 01/91) - - SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations KO CONSTRUCTION Page 2 I If you find it. necessary to contact, us regarding your submittal, please call us at (608) 785-9336 and refer to the plan number as shown above. Sincerely, I S R. SOR NSON _ Section of Private Sewage Division of Safety and Buildings 4PP027/0001n/13 COMP: 11 + ELEM: 12 cc: Private Sewage Consultant. SRD•6423 4 R. 01/91) - - - - ST. CROIX COUNTY y:.k WISCONSIN cg: ZONING OFFICE rF`"1 ST. CROIX COUNTY COURTHOUSE f P 911 FOURTH STREET • HUDSON, WI 54016 RAILW - - (715) 386-4680 April 22, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Jon Plummer property, located in the SE1/4 of the SE1/4, Sec'.20, T31N, R17W, Town of Stanton, St. Croix County, WI., has been conducted with the assistance of .Kim O'Connell, CST# 2344. This onsite revealed suitable soil for onsite sewage disposal to a depth of 20" while meeting the requirements of the A + 4" rule. This site should be suitable for a replacment mound septic system having 16" of sand fill. Should you have any questions, please feel free to contact me at this office. Sincerely, mes Thompson Assistant Zoning Administrator cc: file