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HomeMy WebLinkAbout040-1100-30-000 ° O °o 3: c; av I p o O N 0~ N ° g ~ I a~ a I o o w c E ti a°i m I ~ I h N N E O N aUi ° I Y ° m O O pL o 2 'i z c 3 v Z m o {L c LL w Q~ i.' ° E v m c o (D -0 c Q w N E Q C co J N O co C >ON) U ; O = C L.L (n O Cc L L Ln co GO. m a m N W O Z c m Z I' v) H ~ c ~ I E w N CL V~ O O C) i+ •MV d (n L 0 v 0 O O N Q Q O Z co z Z Z ° Z o N ~ I z I ~,i, c y I d I E m £ 40) co 0 CL m CL T 10) 0) 1 ~i o a a ai a I a` rn Q ° I; co N H H U) 2 a § H Fy- H 2 m z~> 333 c9 LO a a a o 0a a s N a i co M y N 3 O (n O `n `n Q) O r- r- 0 Lo V1 J U v T_ T Z to 0) m } v LO am 2 CD °i j o o ° °o °o F4 N ~l I; T M O = LO LO O E w o 0 0 0 - U M O O 3 'C7 7 N m C W 00 m y L , 2) cc M 'C N QI Z U) U 'O d Q Y C!J O ~ y y U) U) O O L U) c M c N O O c E OOW C U U O w d a co N O O' O O', C O N N ° N N C tl 0 0 0 ce) O I, N V y C -p N N a .0 -0 O oo 0)° Y M Co v C L 0 d ~ N too CD U, 1: -0 -0 0 w 00 T £ O 2 j O O v_°, A 7~ Z c N H N try,' O O 0 N t6 to 0) Z U) I E V d ~a I €a r%1 fat a', `a4, cam a v 'c :3 3 c v~ U `1 A U a j 0 N U 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERSko ft &156 ~ll Fre eN k ADDRESS C- )lW ~j <la SUBDIVISION / CSM# LOT # SECTION aLT _N-R W, Town of- LA ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l,o~oga~ Se~~C Qwr~ P s' Sa' s 16 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. t BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:&4we,St #,ie,oaSI Liquid Capacity: Setback from: Well-,D~~ House p Other Pump: Manufacturer C-~ 8LA~d Model# b3 L, Size-b)365 I1~ Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width: Length Number of trenches e Distance & Direction to nearest prop. line: Setback from: well: J 0 House Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATIO 3 PLUMBER ON JOB: LICENSE NUMBER: 3 a3~ INSPECTOR: 3/93:jt ~'i~i~ artrr` Inetrs~try28.19. 396FRIV/a-ff SEWACit SYSTEM County: Labor and"Human Relations INSPECTION REPORT Safety and Buildings Division r"DQTV (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID o.: T. P ERFDRRICK1 TROY C T BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: _ r TANK INFORMATION ELEVATION DATA A9300063 /Mo TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Mldtl e f' Prr- 1sf p 6 Benchmark Dosing /1;C116-/5 /1CC o Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet ~-35 SS TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet 3S q/(-!S Air Intake Septic 77S 3 S / ' NA Dt Bottom ga• 7°~ Dosing Tom' NA Header/Man. Aeration NA Dist. Pipe cx, , /p '2- L Holding Bot. System 32, _ /0()-1~? PUMP/ SIPHON INFORMATION Final Grade Demand 5 Manufacturer 1 __1 %i r y /Qo1 `73- /oV Model Number p GPM nn Friction TDH Lift 4,< S stem L a TDH Ft Forcemain Length 1401 Dia. µ Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: L4 4 SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Model Number: System: 15v 1740 + >-71 11_q OR UNIT DISTRIBUTION SYSTEM Header/manifold I Y Distribution Pipe(s) ln,, eSize x Hoe Spacing Vent To Air IntaLength Dia. Length ~ Dia. Spacing of 3C - SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over i Depth Over > xx Depth Of y xx^S/eededt~add~fi- xxylched Bed /Trench Center 1 Bed /Trench Edges Topsoil r [Yes ❑ No L~ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 19.396E,NE,SE,HWY 65 t", oat,_- _ 2cl , 5--~ - l~ LOCATION: boo TROY - ao JY/ 71 ~ ~ Q ~ , q ~i ('4 - J 1&_ s ( ~ Plan revision required? ❑ Yes No Use other side for additional information. k3] Q1,,, c~ SBD-6710 (R 05/91) Date Inspe or's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH . SANITARY PERMIT NUMBER: 5T UXLC~ 4 r _ fv v STC - 104 9 AS BUILT SANITARY SYSTEM REPORT OWNER hdsD 416 RECEIVE EC 1 135 ADDRESS 5-3 SUBDIVISION CSM J p 6 P " ~ Lod r-^' SECTIONT A N-R/9 W, Town of N ST. CROIX COUNTY, WInC0 NSN~ 0 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~it,rAaiSF O , SO S e~~'►c 63 Puy ~ INDICATE NORTH ARROG~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: X~~Fs7 S~ Liquid Capacity: 60 t Setback from: Well 30 House 35' Other Pump: Manufacturer_ ("G4 Model# EO3~ Size Float seperation Gallons/cycle:-/517 Alarm Location t~ ~ n e of SOIL ABSORPTION SYSTEM Q Width: Length C~ Number of trenches U e~ Distance & Direction to nearest prop. line: / U , Setback from: well: 541 House l01 Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt 01L R SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY 24~~, STATE SANITARY PEFMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check 0 revision to pr sous application -See reverse side for instructions for completing this application. Tt STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER, f PROPER LOCATION f~ o 16 36 , /(j AW 4 /a S ol- T ocv, N, R E (or 6 PROPERTY OW ER'S 4A )LING AD Q LOT # BLOCK # W CITY, STATE * ZIP CODE PHONE NUMBER SUBDIVISION NAM NUMBE U q 3r . } 11. TYPE OF BUILDING: (Check one) El AD El State Owned 103 VI CILLAGETY S LC Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms - PARCEL AX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) Q ~Z>-?140-30 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 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. k 'Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.0 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 El Specify Type 41 ❑ Holding Tank 12 El 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 YD REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION o P6 P 7d t Z1 6 Feet eP S' Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New )Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 1C 6 S r rrL- N, 1C F] F1 Lift Pump Tank/Si hon Chamber J 1 ' / VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on he attached plans. Plum er'a Name (Print): Plu=Signature: (No Sta ps) M RSW Business Phone Number: Plumber's Address (Street, City, St e, Zip Cody): IX. C UN DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (Includes Groundwater Date Issued Issuing ent signatu tamps Approved El Owner Given Initial QF9/ Surcharge Fee) Adverse Determinati n 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 f 1. Asanitary 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 installati 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 rode administrator or the State of Wisconsin,. Safety.i& Buildings Division, 608-266-3815. To be complete and accurate thin r;- *"it application must include: 1. Property owner's name,and,mailin address. Provide the legal description and parcel tax number(s}-of where the system is to be installe'T- 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; waiver 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.11188) Lr 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 WANG EXCAVATING Owner: SCOTT NELSON & PHYLLIS FREDERICK W9672 770TH AVE 883 HWY 65 RIVER FALLS WI 54022 RIVER FALLS WI 54022 RE: Plan Number: S92-40845 Date Approved: September 18, 1992 Gallons Per Day: 318 Date Received: September 18, 1992 Project Name: NELSON & FREDERICK-SCOTT & PHYLLIS Location: NE,SE,35,28,19W Town of TROY 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 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 PPP039/0009n/27 cc: SCOTT NELSON & PHYLLIS FREDERICK X Private Sewage Consultant SBD-6423 (R. 01/91) e . AbewibcN THE EX lST~1J St:. P7~ C vevIT sys ► r~s FER t~ t tc- s c2) x Y `~aYiiStl Nccrser ~ l~ Sked f6l k f,radNe . 7"b b~ 5 FrM Poo ,f l 5' , 3 ~ lood gQ .Sep~-i ~ s - w P C' lt~ ~,'b er --q0 E14 o1S~ q~O Th , reef 1i:'08i'ttra-dc~resiWfum H' Soii'~1~1iso`iptlon.System wst remain. Una, turgid.,,. - f~ 4~ ~e lea e I 5 co7'- Xe `soar ~h Ilis Freder c See PRIVATE SEWAGE SYSTEI,-r9F-N j 9 - Condition ~J~o own APPROVED • *OUSTIIYI Laos i HU B `y avlsio OF ""No gEP 1 ~ 1952 SEE co W ENCE ~a Vhri, , E SEV1 AOE M Page _ Of ~'on Wndt' • - q . Straw, Marsh Hay, Or PPROve; Synthetic. Covering WT. OF NIOUSTRY, LABOR & NOMAN RELATIONS Distribution Pipe az? SAFETY AND BUI d' H _ G SEE CORK D CE F 3 E D u % Slope Bed Of -'2-*- 2 %2 Force Main Plowed Aggregate Layer (6" Below Pipe) D I_ Ft. Cross Section Of A Mound System Using E 1•I Ft. A Bed For The Absorption Area F .75 Ft. G I Ft. A Ft. H 1.5 Ft. Signed: B 4!5 Ft. License Number: 30 S t K ~p Ft. Date: 7 L yS Ft. Ft. Alternate Position I io Ft. of Force Main W '25 It. Observation Pipe-- (00 JT 6 K i _ A I W ° --T------------------ ♦I Force Main Distribution Bed Of 2 %M 2 2 'I Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area JL a~ vc man, P It.' AL e, man,C.IJ. L`Q ► 1 Makupoid 1,5 I PT-PoAf cab LoVlkA- pv0 -Y Las hole shovlk bG hcx~ ~o tMA CAP PFtI ATE SbVA'GE m "F i- Condid-ohW ~ x I e% ckt 3 y_ _ Inckes APPROVED. , lhole cQ~a. '/41 I r-1 ON Kff. OF INDUSTRY, LABOR & HUMAN RELATIONS I a4[r..I CI1G • n c (cS) M MION OF SAFETY AND 8U1 fY1 w n F o la tI 10.. ~2 1 r~ C k ( e S po trc. Ina; n tJ 1 ca . ~ 1 ~1 c k e -s SEE CORK D CE 'nol't per piper 1$. 101 3a3t PAGE LF PUMP CHAMBER CROSS SECT 101,1 AA1G SPECIFICATIOKJS VENT CAP `I 1. EUT PIPE WEATHERPROOF APPROVED LOCKING S' ROM DOOR. JUNCTION BOX MANHOLE COVER WI ` OR FRESH 12"MIU. AIR INTAKE I LL ¢RADE P"TE Stft13E Jtt M j y"MIN. :11i~ _T AILK Oki N CondithpnW • CONDUIT - IB"MIN. APPROVES. I 'CL INLET OW. OF NIDUSTRY, LABOR i HUMAN RELATIONS PROVIDE I _ 0IYISI011 OF SAFETY AND BUI AIRTIGHT SEAL I i I I ~ III * SEE CORK D CE I I I I ALARM B I I I I C *APPROVED I I ON JOINTS WITH I I ELEV.FT. APPROVED PIPE -f I ~ ' ONTO PUMP 3 OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC,IFI•CATIOAIS DOSE TA MAUUFACTURER: 'y I~t5~'?(eeayr uUMBER OF DOSES: _ PER DAv TANK SIZE: 150 GALLONS DOSE VOLUME (p,549* I So. ALARM MANUFACTUREIt: ~a-JC aAlkl- INCLUDING OACKFLOW: 11540. 54P -GALL MODEL WUMDER: -A1A CAPACITIES: A=12L._INCHES OR 31010 GALL( SWITCH TSPL: - / 146 8 = I INCHES OR -3 5 GALL( PUMP MANUFACTURER: dowel Ca I INCHES OR 151 GALL( MODEL NUMBER: W F n l L on /0 INCHES OR 11Y GALL SWITCH TJPE: MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE (p_G►M1 INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEILI PUMP OFF ANO DISTRIBUTION PIPE.. LQFEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . 2.5 FEET 17•yyI='N + FEET OF FORCE MAIN Z_"7.Ff pp FLFRICTIOIJ FACTOR. FEET TOTAL DidWAMIC, HEAD = FEET NTERNAL. DIM IJ61OWS OF TANK: LEW&TH --;WIDTH-; LIQUID DEPTH IG►JED: / ~VL~✓L LICEMSE NUMBER: DATE: ° Bulletin CLZ1A July 8, 1983 • For Homes • Farms GOULDS • Trailer courts Model 3885 • Motels (Supersedes Model 3870) • Schools • • • Hospitals Submersible EMuw"Pa1iP Effluent Pumps • Industry • Effluent Systems Pump Specifications anywhere effluent Solids Handling Capability to 3/4". or drainage must be Discharge Size 2" NPT. disposed of quickly, Semi-Open Impeller quietly and efficiently. 3 vane design, threaded on shaft Three phase units use impeller locknut to prevent accidental back-off. Pump out vanes on backside of impeller for protection of mechanical seal. Casing Volute type for maximum efficiency. Heavy-Duty $OIidS Handlin Stainless Steel Fasteners 9 Series 300 stainless steel for corrosion Dependable Capability t0 3/4" resistance. T Mechanical Seal Ceramic vs. Carbon sealing laces, stainless steel spring and Buna N elastomers. Maximum Temperature 'h, 'h H.P. 60 Hz 160° F. w~► Capable of Running Dry Single Phase 115,230 Volt. without damage to components. Motor Specifications 'h, 3/4, 1, 11/2 HA '60 Hz Motor Fully Submerged in high grade turbine oil for permanent lubrica- Single Phase 230 Volt. Three ' tion of bearings and mechanical seal and Phase 208-230, 460 Volt. efficient heat dissipation. Motor sealed from environment by rugged cast iron enclosure. _ Bearings . A Heavy-duty all ball bearing construction. Stainless Steel Shaft Series 300 stainless steel for corrosion resistance. Threaded shaft. Single Phase Units 90 All single phase units have built-in thermal overload protection with automatic reset 80 c! Three Phase Units if Overload protection in starter unit 208-230 or 70 460 volts. Threaded shaft 60 Hr operation. Power Cord h Water and oil resistant Epoxy seal on motor end 60 R ; ` w' ? acts as a secondary moisture barrier in case of it damage to outer jacketing. Corrosion resistant 50 ti gland nut. "y cr Single Phase Units C 40 H.P. models eyu pped with 15 of 16 3 A S :k ti ' ` SJTO with 3-prong grounding plug 1. 1'. H.P 30 models equipped with 15' of 14'3 STO power 1? : 3: 1 sk. cord. 20 t w tai r1. t0 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. D 0 . 10 20 , .30 40 so 60 70 so 110 106 110 120 i' GOULDS PUMPS. INC. GALLONS PER MINUTE tU SENKA FALLS NEW YORK 13148 DEPART,I'+pFNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN WS7I~Y, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 53707 (I 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSH U ICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: F1/a S,E~/a s' /T)YN/R E (o ro vI o~'e s t' ~1 COUNTY OWNER'S/BUYlR'S NAME:r AI_LI ~G ADDRESS: ` Sco°t~ ~lesoh P/i 1lis F a a to USE DATES OBSERVATIONS MADE AA NO. BED ICOMMERCI QL DESCRIPTION: PROFILED SCR TIONS: ER OLATION TESTS: ❑Residge• ❑New Replace~2 C~ ! pv ~a iii ~~f 6 ( (U J l J S Es"ple es jflair0ns &I bo'X1~f?',~'et~; lg RATING: S= Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED W STEM:(optional) osou Esau as u os u os©uko 14 V If Percolation Tests are NOT required DESIGN RATE: I If an L any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B ONE ~~ov .o Ort l s~/,-hA B @~ S a o .-a,,~61L -4.6 6,h f'te S B- a 6 0 0 9r g' ^ oo ' e 'o A c e 6 ld loo 3,00,8 Js ~ B- (~,pp ~ ~ b ,50~ •s ~ ~4s'o ~ ~,od ~.ao -6.ov n S~6r B- .PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P- 3 D A 1W P- a`/ 3o p C4/ P- 01/ 0 3 P- P- P- 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. SYSTEM ELEVATION b S?, 65 e 3 r E G _SLr_ 3 3 t 3 a~adis>n E 7", AZ ~ N e (d.. f~,eol tgld ~ :A ~ 7 'A _a i va' 9a€ _ a F 1 3 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: w AD CERTIFICATION JV MB R: ONENUMBER(o tional): to fr S 4 5' D a o7 6 d S CST SIG A RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - DILHR-SBD-6395 (R. 10/83) - OVER - QIMPL 115 - Sid - 6; To ALL a. i,, THE g i TO THE OWNER: This soil test report is the first step in securing a sanitary permit, The county ehw Department may request v ification ` this >il Est in the field prior to perry ; :suance. A cc r s"t of plans for the private s a _ it application must be subm °-,d t- the appr_!, I., ,,-al authrarity in order to _ >f permit must be otrt,, d prior to ti :art of any construction, . Y ` DE,~ARTMENTOF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS (~IDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N, WI 53707 11 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSH U ICIPALITY: LOT NO.: BLK. NO.wewa6 ME: Lf'/ Sj ° s' /TWN/R E (o S 1° ~1 COUNTY OWNER'SBUY R'S NAME: AILI G ADDRESS: a" 5~co-H Ne~soh PA 11is Frlr USE NO. BED COMMERCI L DESCRIPTION: DATES OBSERVATIONS MADE PROFIL D S 10 S: E A ION TESTS: Resid a y(„ ❑New Replace ❑ e 4 S e 2 Q / ~v ^a l [Q v 7/ dn b f/ 5 Fmrk es flayrOr."al da Xgel et4l ~QRATING: S= Site suitable for system U=Site unsuitable for system d CONVEccN~glONA~L: MUND:, cc N-GROUNDPRESSURE: M- S STEccIN -FILLHOLDI(cN~G TANK: RECO MENDED YSTEM:(optional) ~V M J DU CIS EIJ ~J ©U Ykb r4 F0 I If Percolation Tests are NOT required [DESIGN RATE: [Floodplain, an under s. ILHR 83.0915)(b1, indicate: any portion of the tested area is in the indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 3 A16NE ;2 /B- j a o g 6 V' B- a 6 B- - p,~D 3 6 ~f 6 s IS'o ' ~,ad 8~ a,oo -6,0o S~6r BPERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD1 PERIOD2 P PERINCH P_ a 30 ~4a P- 01 so , P- J 3 P- P- P- 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. SYSTEM ELEVATION d ST. N, b~ x~erlt ~e~ C• I*hk gysT. ar4a~s~ . _ ~ ~ _ ~ T N Pens ! e id, lobe - . el 5C e a Q p atiel a F. N rs t~ p~ ~ d 36' , 1, 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 COMPLET DON: AD RES ~!r`a r[ 3v p/ CERTIFICATION MB R: ONE NUMBER(o tional): VV ~u~Pr S 5' Dad ~ .~S CST SIG A RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - SOIL DESCRIPTION REPORT Bori%'# Horizon Depth Dominant Color Mottles Structure GPD%ft~ in. Munsell Texture Consistence Boundary Roots Qu. Sz. Cont. Color Gr. Sz. Sh. Bed :Trent( Ground elev. Depth to _ I limiting factor U"T Remark's: f ✓1 Boring # ?z t>< t z- ) 3 Ground 3 "-3 L v3 _ /C 5 elev. Depth to c limiting ? factor - ra Remark's: Boring # 0-19 .A Grounder ~GS$ w S-/d o c'~ b~ elev. 6 Depth to limiting factor Remarks. Boring # 7 ply Ground elev. , S r ft. Depth to limiting rt factor F-T Remarks: ST. CROIX COUNTY WISCONSIN ZONING OFFICE y` ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 Aug. 24, 1992 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 Scott Nelson / Phyllis Frederick property, located in the NE1/4 of the SE1/4, Sec. 35, T28N, R19W, Town of Troy, St. Croix County, WI., has been conducted with the assistance of Tom Wang, CST# 2860. This onsite revealed suitable soil for onsite sewage disposal to a depth of 36" while meeting the requirements of the A + 4" rule. This site, should be suitable for a replacement septic system serving a commercial business using either an At-Grade or a mound system having 12" of sand fill. Should you have any questions, please feel free to contact this office. Sinc ely, mes K. Thompson Assistant Zoning Administrator cc: file CERTIFIED SURVEY MAP Part of the E 1/2 of the SE 1/4 of Section 25, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin 4 o Scale; 1" 2001 oKy 4jj v Sly eo.W.. s r~ 66 key F 1 L E D U~ o p F FEB 251975 ~,-'ii JAMES Ci' CONNELL rw(I~ ~i 0 ep Register of Deod! Lb 1Y p(~ ~o C St, Croix County, Wisconsin 1O 117- 90° F o 40. 40° 0. Q Fro ah ~tp Indicates 30" iron pipe R o~ stake weighing 1,'13 #/ft. Description: That certain parcel of land or tract of real estate located in the E 1/2 of the SE 1/4 of Section 25, T 28 No R 19 W. Town of Troy, St. Croix County, Wisconsin, more fully described as follows; Beginning at a point on the southerly right-of-way line of S.T.H. 65 S 340 45, 30" W and 927.36 feet distance from the East quarter corner of said Section 25; thence continue along said southerly right-of-way line S 420 33' 00" W a distance of 450.00 feet; thence S'470 27' 00" E a distance of 400.00 feet; thence N 420 331 00" E a distance of 450.00 feet; thence N 470 27# 00" W a distance of 400.00 feet to the Point-of-Beginning. Cerf ification : I, James L. Murphy, Registered Land Surveyor, hereby certify that by direction of the Owner, Kenneth Sumner, I have surveyed and divided the lands shown hereon and that the map and description hereon are a true and correct representation of and description for the lands as divided; and that I have complied with all the provisions of Chapter 236.34 of Wisconsin Statutes in surveying, dividing, mapping and describing said lands. `,~~+++,++unnnrnr,,,~~ Dated. 25 February 1975 `Jms L ' Mtrpha RegosN4 reclIAnd•.• 4sa" eyor Vol. 1 Page 81 Certified Survey Maps, St. Croix County, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County PI/ J svz ' ll `S t k_ OWNER/BUYER o ROUTE/BOX NUMBER c,.GJ FIRE NO. e ~ 7 CITY/STATE jL f YPV- F4 A; ZIP PROPERTY LOCATION: ~1/9 /9, Section , T a " N, R G W, L1 ~ Town of P/1izz b I il) St. Croix County, Subdivision - , Lot No. . 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 ~2j DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address i ' 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. --------------------Cc---------------- Ownet of property ~'1 Location of property _,!~IE114 1/4, Section ,2 , T c;-U- N-R_.w Township Mailing address 7 Address of site Q Subdivision name t ` 1V( If~ (~j'' Qljpc~ Lot number Previous owner of property hie Total size of parcel Date parcel was created 0 Are all corners and lot 11 es identifiable? _.L.-Yes _ No Is this property being developed for resale (spec house)? Yes k=No Volume 3 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 SBAL 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 re orded 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 rded in the Office of the Cou ty gist r of Deeds, as Document No. Signature of owner Signature of Co-Owner (If Applicable) u 3/~y Date of Signature Date of Signature ~~-r.;,c Win' +6r I _ ~I 5 ( I @001( 813 ?40 DOCUMENT- No. WARRANTY DEED ~ THIS SVA:E RESERVED FOR RECORDING DATA . i~ STATE BAR OF WISCONSIN FORy1 2-19821 43.8196 r - - _ l REGISTER'S OFFICE li a Wisconsin Corporation ST. CR41X CO., W) Paradise Pools, Inc , . . . . . . - . . Recd for Record _ M.k JUN 8198$ conveys and warrants to . phylhs . Q?_ Frederick aT1d Scott L, at 11:30 A (111 ~tel on,.. as. joint .tec,aX;ts ~ d1 ~ I - ibgist« of a.a>' . . . ! I RETURN TO - - . . . . . 1 County, the following described real estate in St. Croix. I State of Wisconsin;, Tax Parcel No filed February 25, 1975 in Volume 1 of Certified Survey Maps, Certified survey map Page 81, as Docurnent Ntmlber 325802, being a part of the East Half of Southeast Quarter (E of SEk) of Section Twenty Five (25), Township Twenty Eight (28) North. Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin. FEE This is'-TIQt----- homestead property. I Imc (is nut) Exception to warranties-, Subject to easements, restrictions and rights of way of record, if any. Dated this . . day of ._..._June 19.85. PARADISE POLLS, INC. (SEAL) -BY:_.. ....(SEAL) Attest: .(SEAL) ..................(SEAL) _ ' ~ _ - AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. I - ' ------County. authenticated this day of 19 ersonall came before me this 9.%A.._day of 19_$$. the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 1 706.06, Wis. Stats.) to me known to be the person 5_ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Keith RDdli, Attorney At Law - Sa':------------- - -C- ..219--N=- D4ain•-Stre@tr-.B 3ler--Falls.,_.Wl..5 022 Qota-y Public ..QGth -----County, Wis. (Signatures may be authenticated or acknowiedged. Both My Commission is permanent.(If riot, state expiration are not necessary.) date: °Z-.q..---...__..., 19.Q~....) o MM,MMi.ar n~a r. • ,fin y n n,\^,^~1~~ba 'Names of persons signino in any capacity should be type,+ or printed be1nw their siRnar:ros. i. J .i. WARRANTY DEED STATE BAR OF WISCONSIN i n . i. _ N'braialu'i Labtad 1t1arT I'~•. !nr FORM No. 2- It,a2 t 3 CERTIFIED SURVEY MAP Part of the E 1/2 of the SE 1/4 of Section 25, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin L~ LOrr~Qr 6Z5 729AI~ IF19W h o Scale; 1" 200' M1D S%y R.o.W s 65 tH FEB , p f'b. ,B ° • h1~ o0 %bP i_ o- Q o p0 M 6° 90 t -f 13 9crms 410 a Rya °a tp Indicates 30" iron pipe o stake weighing 11013 #/ft. •gj. Description: That certain parcel of land or tract of real estate located in the E 1/2 of the SE 1/4 of Section 25, T 28 N, R 19 W, Town of ':troy, St. Croix County, Wisconsin, more fully described as follows; Beginning at a point on the southerly right-of-way line of S.T.H. 65 S 340 45' 30" W and 927.36 feet distance from the East quarter corner of said Section 25; thence continue along said southerly rigght-of-way line S 420 33' 00" W a distance of 450.00 feet; thence S'470 27' 00" E a distance of 400.00 feet; thence N 420 33' 00" E a distance of 450.00 feet; thence N 470 27' 00" W a distance of 400.00 feet to the Point-of-Beginning. Cerf ificati on : I, James L. Murphy, Registered Land Surveyor, hereby certify that by direction of the Owner, Kenneth Sumner, I have surveyed and divided the lands shown hereon and that the map and description hereon are a true and correct representation of and description for the lands as divided; and that I have complied with all the provisions of Chapter 236.34 of Wisconsin Statutes in surveying, dividing, mapping and describing said lands. g G O Dated: 25 February 1975 (11, m s '-L AMUrpha ' Beg' s" ~,,erecVlland..•~4~r4eyor v Vol. 1 Page 81 Certified Survey Maps, St. Croix County, Wis. 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Highwater Mark ft. 12% or slope fla etla 1 Cistern ft nd_ No. compartments_1-. Liquid capacity/Q D ) gal. EFFLUENT DISPOSAL SYSTEM consists of Tile field Seepage Pit Seepage i- it or Tile Field: Distance from: VY e 1 ft. Building ft. Lot Line ft. Ci stern ft. Highwater Mark..,.of water course ft. Slope 127o or greater it. Vs. etl and ft. Total 4 ngth of t it e 1 i nes~ 0 ft. Number of lines Length of e c line ft. Distance between lines ft. V idth of trench Total effective absorption area of trench bottom • 5 feet. -Kq Depth of filter material below tile in. B of f' e f~_ material. over tile~Z- ln. Cover over filter material Depth of tile below finished grade in. Slope # trenc bottom Z-i per 100 ft. Depth of bedrock n. ~ft. Depth to ground water 15 -ft. Number of Pits O sid iameter ft. Depth below inlet ft. Lining material - Gravel around pit: yes. No. Total absor ti area sq. feet. ae trh barea required Square feet of see=V- Square feet oed Inspected by: Title: 1 pproved D ate 197 . 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't'.~ ~~k 'a ~.S.,v x ur;:u.~~ ~ . h r 3.tb~xt4p r 1rx'Y _ ~„'}l, ~ a ; s ';~r rib 67 State of Wisconsin and County Uniform Permit Application AIAR for Private Domestic Sewage Systems State Permit /Mimty g ha 13 Number / a 50 Number A. LOCATION OF PREMISE WHERE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED LEGAL DESCRIPTION: 6*57 I' 0+ F Y41 Name One: (Sec., Lot, Block) 1'51 d.T1P* A CITY VILLAGE T W / TOWNSHIP B. OWNER OF PROPERTY MAILING ADDRESS )er#, Name (Street, City, Zip Code) 111))? 4 log e C. SEPTIC TANK CAPACITY /4000 Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other ; No. of Tanks D. TYPE OF OCCUPANCY One or Two Family Residence A'TEt No. of Bedrooms di Commercial Industrial Other No. of Persons to be Accommodated (specify) E. APPLIANCES, ETC.: Food Waste Grinder YES __AP<'NO Automatic Clothes Washer YES ENO Dishwasher YES j' NO Other (Specify) B' F. EFFLUENT DISPOSAL SYSTEM NEW J*' EXTENSION ADDITION REPLACEMENT Seepage Trenches: No. Lin. Feet t+l'. Tr ch Width Depth Number of Lines Seepage Bed: Length ' Width + Depth Tile Size No. Lines Seepage Pit: Inside diameter 1~.~✓.•. Liquid Depth G. Percent of slope of land . % 4I_, direction H. Indicate Slope of Land & direction of slope on sketch I. Tile Depth PERCOLATION TEST Indicate Soil map number And Soil Type Hours Water Test Time Drop in Water Level Inches Minutes Test Depth Character of Soil Since Hole in Hole Interval Second to Next to Last To Fall Number Inches Thickness in Inches 1st Wetted Overnight in Minutes Last Period Last Period Period One Inch TICE Local nandlor count), -nstallri permit regw T RECORD DATA FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED S 0 1 L B O R I N G S- Minimum 36" Below Proposed Absorption System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches RECORD DATA FROM MINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED (COMPLETE OTHER SIDE) Name of Owner County Permit No. PERCOLATION TESTS I, the undersigned, hereby certify that the Percolation Tests reported on this form were made by me or under my supervi~on in accord with the procedures and method specified in Section H 62.20 (3), Wisconsin Administrative Code, and that Rhe data recorded and location of test holes are correct to the best of my knowledge and belief. NAME sit • rr, , - r TITLE :SDI, _(Type or Print).., ►►/q REGISTRATION NO. or MASTER PLUMBER LICENSE No. ADDRESS DATE OF TEST - SIGNATURE MASTER PLUMBER KING APPL 1'O MP Signature: License Number: MP RSW For: Provide sketch below of system (employer) (Include direction and percent of slope and all applicable distances) 20)r _ -PLAN VItW ( oc to Percolatiwn.Tes_& Soil Borg Holes E 3 5, E a_ 3 5 E 2E)' - - - E ~ i F t 2$ Al P FAO Fl Ll_ (I ndicate- 6ro4ndwater or bedrock where ~appllicable) E = F x 3 3 [ 4 3 2 3 e ~ F 3 ~ F 1 E i i t % 5` "TA 93 I E E _ - E -1 cy Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid Do not write in space below - FOR DEPARTMENT USE ONLY Date of Application 721"" 14 7!!r Fees Paid State County Permit Issued/Aeeimeted (d te) V6 Inspection Yes No 11 Issuing Agent Name Valid No. Date Recd DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI. 53701 - Revised 4-1-73 lev.; 906' - ~ o i x ~ a ,b pl/ ~e ~ ~Se o sysTF~ ~0 K£~,1 .Sy ~j yFi~ Rita PE,QTY o Aj 0 A/~~ re &'Cd - vs,,le D ~ i a~ a~ 1 i (~o I X40 iSeo sy6- TE-l t t i t L j O O ~ i I a "If You Like Our Service, Tell Your Friends" %O W 1449C 04 Is Y 7T BIRCHWOOD PLUMBING AND HEATING SN,6:z'T' 2- aE 7- E. F. GROVE, OWNER PHONE 425-5824 ROUTE THREE RIVER FALLS, WISCONSIN 34022 r. R4P a /01 301 -Tr - r A v/V } ira/i « Jl."~ C.tIe A4V ~J~~:1T .e-~LtS T/L t"a7 N! 1e1~c9NN,D U11',~}~' . CL a Ak,!-,% Aar.1 *1 Ti J J; 3,4",4t, q,! s u R ~i44 ,P14 k. rya (L R#9 D C Appro , DATE MAR 0 6 1975 PLUMBING S WIS. DEPT. OF HEATH & SOCIAL SERVICES THIS APPROVAL SHALL BE VOID IF NOT INSTALLED WITHIN TWO YEARS FROM THE DATE OF.APP.ROY&L This approval is based on stet! r plumbing code requirements as shall be void if revised without the Written approval of the Department and does notexemS* am the Installation from city, vill villager 1 township or county permit requireme^, /~e!t~ .~Gfsc. NOTICE Local and/or county installation permits required State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES j►4~r(+h 3~ 197 DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 709 MADISON, WISCONSIN 53701 IN REPLY PLEASE REFER TO: Bureau of Environmental Health Mr. Eugene F. Grave Route 3 River Falls, Wisconsin 54022 This is regarding the soil +test data sheet for Ken Sumner„ Sec. 25, _T28N, R 9W, Town of Troy. St. Croix County ®4e are accepting this data but have the following checked comments or suggestions for future soil tests and reports. ❑ Please find the soil test data sheet enclosed. We cannot accept this data and are returning it for completion or correction as indicated by the item (s) checked below. Following completion please return to this office. Please provide: n ❑ Name of property owner. Address of property owner. r lp~ `s, ❑ Legal land description. ❑ Direction and percent of slope. F /,ta ❑ Soil textures (as in Soil Tester Manual) [Water level drop (all three are required). ~ ❑ Data for bore holes constructed to at least 3 feet below the depth of percolation test. ❑ Estimated high groundwater level for all bore holes. ❑ Depth to bedrock. Signature. Soil tester certificate number. p Date tests were conducted. Plan view sketch made to scale or showing all distances. ❑ Locations of all soil test holes. ❑ Locations of existing well, buildings, etc. ❑ Sketch showing critical slope, high groundwater, shallow bedrock and floodplain or extent of suitable area. L~ Other, Percolation tests should not be conducted closer than 3 feet above the high groundwater level. Test P-3 makes no sense if bore holes were constructed first as they should be. (OVER) Please correct or explain: Q Large change in water level drop indicates the percolation test was not conducted for the full 4 hour period. Q Percolation rates are extremely fast when compared to soil textures. Q The data indicates percolation test holes should be presoaked and permitted to swell. O The data indicates percolation test holes were not properly presoaked (4 hours) and permitted to swell (16 to 30 hours). Q Percolation tests were incorrectly conducted because of more than 6 inches of water in test hole. Q The data indicates measurement of water drop was not made to nearest 116th inch. Q Other, It is essential that all work be accomplished in a complete and exact manner. Continuation of your submitting incomplete or incorrect data will result in Examining Council and Department action to suspend or revoke your certification. Data is being compared with soil map information and field investigations will be conducted. Sincerely, dzk Ro rt C. Hill, Secretary Soil Tester Examining Council clc cc: District 6.- Eau Claire mold C. Barber, ZA 1-75 P l b . 6o 3/70• PROJECT DETAIL DATA SHEET NAME OF BUSINESS Pto LOCAT ION ~:`~b1J11' tr et or highway 64- or townsh p county LEGAL DESCRIPTION` Y OWNER Z:EW Mailing address ARCHITECT OR ENGINEER 11~ Address _ ZIP PLUMBER - - Address A'+6 19A X I 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition If addition to existing building attach detailed memo for each. ( ) Drive in restaurant Car spaces ( ) Restaurant Seating capacity (10 sq. ft./person) ( ) Dining hall Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( ) Cottages Number of units: 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS ( ) Churches Number of persons Kitchen Yes No ( ) Bar or cocktail lounge Seating capacity (10 sq. ft./person) ( ) Nursing or rest home Number of beds ( ) Mobile home park Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store Number of employees Number of customers Z10_sq. ft./person) ( ) Service station Number of cars served (daily) ( ) School Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building Number of persons (total all shifts ( ) Apartments Number of bedrooms (`.Other Specify - 2. Indicate whether or not the following facilities are connected: Food waste grinder Yes No Dishwasher Yes No Automatic clothes washer Yes No Automatic potato peeler Yes _ Other . . . (Specify) r-' No 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned &40 " , Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET COMPLETE OTHER SIDE Seepage trench bottom area planned l3''p'NS"o width f linear feet depth Seepage bed area planned l9f width , A, -J- / linear feet to depth 4C1 Le r Seepage pit planned p/a outside diameter depth below inlet depth 4. See approved plan for specifications and details. Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madison, Wisconsin 53701 t ! rf,' Approved: A dress:x Date: ZIP~j•• THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: INSTALLATION FROM CITY, VILLAGE, TOWNSHIP OR COUNTY PERMIT REQUIREMENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY Y.. w y S PAAWX 36 rti~ !j Fne cot d" ~er~rGc+s tither- f ADDIT19% amt T HOURS WATf.R IN :zTEST > 6 How HOLE AFT IN ~ 'i':W4TFED SWt'Ltj m - '04_. SORING TIES ^ r IA C {DEPTH TO' r' 1.4. • H 1 ~ r .,ran r • Q , f 71 c $"e t nr r } s and suitable soil yteas.} ~r}c# sou&r~ ~r~at t~#.#u&~~bl~ , ,-17kdi~ umlast caws F +r 'Alm r. 6. T R 2 7- 77 -Tir, f . Nn _ '11- 7 _ .Y • ~ k+ fib. ' h ~ inv- ' I -ere- u 4 t i x I t;q 1 r • h tom} ~ 1 z' I ~ T .T'P'R~,~ k •'r l yy HJ ~ t~ , { Fah.'. Al; t''•'•s r t 6 ~i r~'n ( ' _ e 1 3 ~ -fir y'r 1 J f F €4 R r t+,. t' N - i' if . Aar It ,~1 { ~ X I L u p' S -r i i ty 1 ; 5 s X ~ j ;I ~ r r ! ~ J t I £ F t •~G 15 C3- :ftte .sue N 1 led 906' o ~ a\ a PS-0 d de u / /d /it o o a j ~o .x 60 / S e o S sTFn~ /h PE T 11-11-10 AY " e KE,v "If You Like Our Service, Tell Your Friends" BIRCHWOOD PLUMBING AND HEATING f r E. F. GROVE, OWNER PHONE 425-5824 ROUTE THREE A- 7 RIVER FALLS, WISCONSIN 54022 a . ..r.. M _ , .._..wa 1 MAP -1 197 { i"ce"', ni ` f I S 3 r DATA,pR75r- + PLUMBING S ION 77 WIS. DEPT. OF HEALTH & SOCIAL SERW, NOTICE r A Local and/or county installation permits required Y This approval is based on $totsi plumbing code requiremontt ank shall be vo d ;f revised withbuf the written approval of tht Department and does not exernot the installation from city, villoger a township or county permit requirement 1 THIS APPROVAL SHALL BE VOID IF NOT INSTALLED WITHIN TWO lu-^K: FROM THE DATE OF APPROVAL -1 4 '6 i' 7 n. t ~r r • St ~ t a 1 "If You Like Our Service, Tell Your Friends" 15 M 0 7 BIRCHWOOD PLUMBING AND HEATING { E. F. GROVE, OWNER PHONE 428-8824 ROUTE THREE RIVER FALLS, WISCONSIN 84022 G f"- W1AR Jd !tt6s <1 s. _ _ - r r V u u N ^V d Ths op;"ra•. 1 s bser. i;' plumbing code requirements and vial; be vo d f rev sed without the written approval of the o~ Department and does not exempt Appr the installation from city, village, township or county permit requirements. DATE MAR 0 6 1975 PLUMBING SECTI THIS APPROVAL SHALL BE VOID IF NOT INSTALLED WITHIN TWO YEA.Rv 'NIS. DEPT. OF HEALTH & SOCIAL SERVICES FROM THE DATE OF APPROVAL NOTICE Local and/or county installation pern*s requiW Pib. 60 3/70 PROJECT DETAIL DATA SHEET NAME OF BUSINFQS 1'g•O+'Ri •~/~G~ 6~•N~j.~W,III ~ , LOCAT I ON W GrlfRA/ T*rvy street or _W1ghway ci y or-~township ~ g county t~/ ( elt LEGAL DESCRIPTION 4 h ra' OWNER r+ ` Mailing address-- ~z vex N ad, Z I P%f roll, 01-100* ARCHITECT OR ENGINEER'S Address ZIP PLUMBER Address o mot VA-001 I Z I PW F, 1.' Check approp,r.iate building usage(s) and fill in the information requested opposite each usage listed: . Existing building New building Addition ti If addition to existing building attach detailed memo for each. Q ( ) Drive in restaurant Car spaces ~ ( ) Restaurant Seating capacity (10 sq. ft./person) w, ( ) Dining hall Per meal served Toilet waste Yes No ( ) Motel ( ) Hotel ( ) Cottages Number of units: 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS ( ) Churches er of persons Kitchen Yes No ( ) Bar or cocktail lounge KiLi-ating capacity (10 sq. ft./person) ( ) Nursing or ru_h~gm~,~,y.(= ,coh~tr of beds. ( ) Mobile home 1 f1Va~, Nmr,,~gf„~,i - dependent (camper trailer) tO~~Qt10fl nondependent (mobile home) ( ) Retail store Number of employees Number of customers T10 s_q. ft./person) ( ) Service station Number of cars served (daily) ( ) School Number of classrooms Meals served Yes No Showers provided Yes No ( ) Factory or office building Number of persons (total all shifts ( Apartments Number f ) Other Specify XFMI1A.,~J' biv 2. Indicate whether or not the following filities are connected: Food waste grinder Yes No _ shwasher Yes No Automatic clothes washer Yes No _ Automatic potato peeler Yes Other . . . (Specify) No 3. Fill in the appropriate information for the following as indicated: Septic tank capacity planned /ftV 441. Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET COMPLETE OTHER SIDE Seepage trench bottom area planned . width linear feet depth Seepage bed area planned -Sao width ~ a linear feet 30 depth w 36 Seepage pit planned IYONIr outside diameter depth below inlet depth 4. See approved plan for specifications and details. Si ature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 30 adison, Wiscons n 3701 Approved: Date: AR 0 6 1975 A dress: ZIP6~.Z:t- 'THIS APPROVAL IS BASED'ON'STATE PLUMBING r~► CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: 15 INSTALLATION FROM CITY, VILLAGE, TOWNSHIP -Fab- OR COUNTY PERMIT REQUIREMENTS AND SHALL BE VOID IF REVISED WITHOUT THE WRITTEN APPROVAL OF THE DIVISION OF HEALTH. THIS APPROVAL SHALL BE VOID If NOT INSTALLED WITHIN TWO YEARS DEPARTMENTAL USE ONLY FROM THE DATE OF APPROVAL J State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADDRESS: P. O. SOX 309 MADISON, WISCONSIN 53701 March 6, 1975 IN REPLY PLEASE REFER T0: SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS plan Identification No. 75-00284 Milton D. Hovde Highway 35 North River Falls, WI 54022 RE: Ken Sumner E 1/210 SE 1/4, Sec. 25, T28N, R19W Troy, Wis. - St. Croix Co. Dear Sir: Examination of the plumbing plans and specifications submitted for the above- indicated project has been completed. The plans and specifications may have been given only a preliminary examination because of staff limitations. The type of plan examination provided is indicated by the examiner checking the appropriate box in red. xx Complete plan review [D Preliminary plan review In accord with Chapter 145 as. and Section H 62.25, Wisconsin Administrative Code, the plumbing plans and specifications will be approved contingent on compliance with the stipulations listed below and indicated on the plans. DETAILED STIPULATIONS H 62.20(5)(d)l.g. Cast iron vent at least 4" in diameter shall be installed. This vent shall extend at least 12" above ground level. H 62.20(5)(d)l.h. A minimum of 12" of aggregate shall be laid into bed below distribution line. In granting this approval, the Division of Health does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction, or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. By order of George H. Hanry, M.D., State Health Officer. Sin rely, am es A. S44tr- Chief JAS:fjs cc: District Plumbing Supervisor State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 309 'MADISON, WISCONSIN 53701 R* 11915 IN REPLY PLEASE REFER TO: SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS "3,1 111141, 73m" Maw is jr Plan Identification No. after Taus* wx 341122 Dear Sir: Re : to* Sir - *fthbWey UOV r 4 D (*x hi1►gr"t. ftsda * Uwe) A % $25 T249 9IW, !may y lp St. MU Owwgy Swap g01 This is to acknowledge receipt of your plans and specifications for the above- indicated project. When referring to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the project. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ IS-0b Fee received is $ L,- X Plan accepted for review. Fee is being returned because of II Overpayment n underpayment. Providing one of the two catagories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance, Q Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. Plans being returned. See attached Plb. 100. N~~' Sincerely, a~rtica~ 0®N/;~0 9~S3 FF/if ames A. Sarg A, Chief JAS:fjs State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADDRESS: P. O. BOX 309 MADISON. WISCONSIN 53701 Febr"ry 21', 1973 IN REPLY PLEASE REFER T0: '"J J~ SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS 1ton A. NOW* Highway 33 North Plan Identification No. 7S0#iZ84 River Palls, W1 S4022 Dear Sir: Re : KOO Sumer - Machimry Warehouse b Display 93% SZ, S25 T28K R19W, Troy Township, St, Croix County Sewage Disposal This is to acknowledge receipt of your plans and specifications for the above- indicated project. When referring to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the project. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ J,5'b 0 Fee received is $ n Plan accepted for review. Fee is being returned because of II Overpayment ❑ underpayment. Providing one of the two categories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. to Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. Q Plans being returned. See attached Plb. 100. Sincerely, S a awes A. Sar Chief JAS:fjs f "If You Like Our Service, Tell Your Friends" 91 19 7,-r BIRCHWOOD PLUMBING AND HEATING n#E,>=T I OF " E. F. GROVE, OWNER PHONE 425-5824 ROUTE THREE peya 6 yo RIVER FALLS, WISCONSIN 54022 ,ty ~,rr.o r.n....+:--m w!w+.+.r-» r++.» ...-...w......«..~.n.» . ...._,...-.........A..,-.,......,,r.....~ ,[j]~ ~~a NOTICE t4RA1 A1,N-.04r-9j Local and/or county Iinstallotion permits requ' d 'Ap r AvaLd - MAR 0 619'M `DATE PLUMBING I _ 67 WIS. DEPT. OF HEA1T- M & SOCIL'At SERUM' ~a 1 i' lRaP rwa lgew useT41 5 A41,-;? fJ AFr- _ This approval Is based an state 4 ! plumbing code requirements'apwt T shall be void if revised without 6o written approval of the TANK popartmartt and does netexetapt _ Nue ina91lation from city, viliager townshtip or county permit requirements. f a THIS APPROVAL SHALL BE VOID IF NOT INSTALLED WITHIN TWO YEARS _,.„.1 t3 ol2Pti~rsn 36ip ~T FROM THE DATE OF APPROVAL 3 3 /ARC + BvR~ 061 " VIEW r 41 F ` i ~ld~ PAP~~ a ~ G" aQ a~ ~ > v la r 7soD ,361 ~ooD Id - tWisconsin Heumn ReltofIn ustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 n of Safety ~ Buk6ns. in accord with ILHR 83.05, Wis. Adm. Code COUNTY Sr: Q-k 4 X Attach complete site plan on paper not less 8, f!2'Ix±11 inchets p size. Plan must include, but not limited to vertical and horizontal refer ~,poin3°JBM), direction ah % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and locatio n64ista to1 est road \ 0 Ho - 110 0 - 30 ^fil REVIEWED BY DATE APPLICANT INFORMATION-PL 'S PRIN y4L~ 1ORMATa N 12-31 R~ PROPERTY OWNER: L t f~ PROPERTY LOCATION T~ -GOW-.E65 NE 1/4 SE 1/4,SZS T Z8 N,R V~ E(a~ SCA 1V~,SpN e w aT Q PROPERTY OWNER':S MAILING ADDRE COUN rY LOT # BLOCK # SUBD. NAME OR CSM # 531 lk16R.lfl6F. (1? NINGOF-FICE CITY, STATE ZIP C /-,-PHONE NUMBEEi []CITY []VILLAGE MOWN INEAREST ROAD RIU~R 2L;% IAJt 0 `f TRo`f s~+ b5 [ J New Construction Use [ ] Residential / Number of bedrooms [ ] AddiWn to existing building jam} Replacement [>q Public or commercial describe-DF`t CPnt.C ~ Z 4 t Sf ~ LLs .CseF Rj 1~ # Code derived daily flow V3 S S gpd Recommended design loading rate • `I bed, gpd/ft2 - trench, gpd/ft2 Absorption area required ~ \ 3o bed, ft2 13 trend}, ft2 Ma)dmum design loading rate, • s bed, gpd/ft2 • trench, gpd/[t2 Recommended infiltration surface elevation(s) a c Z • G It (as referred to site plan benchmark) Additional design / site considerations I`'10 '8'>'- L14-Z' i3 m , I ' oy= S AAjb FI L L Parent material s~~t~c S~p1h ewr ova S 't GV Flood plain elevation, if applicable 8 9 - 3 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 O U ❑ S ®U ❑ S (RU ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. g~ rertd~ ~,tvmv-~'MYv'-Gyp 3 ~ A 1 k ham' ~ `t' :4 ] a-i1 Zb~2z1 z - S~1 2'F at- Y✓t`F~ Z it c' -I 2 313 - Sil ZmSbk Yn~i- cs •5 .b Ground 3 30 Lo Iz 31 - S O S 9 Yrti S - • 1 elev. clot .14 ft y 48 -)Z totitZ y/6 S-t S/f S 0s) \'i Depth to limiting factor M Remarks: Boring # I o- 2 3 ~lw-i z Z- L Z S 1 ~ Z `F 5 h wt'~H c►ti, 1 u • S Z 'Z 40_ Z O`-l %z Z . SL y - s i ] Z s b~ w► ~S . S • 6 3 ~o-its 1.S`12.3ty - Se6~ l7 S9 t-nl eS ~ Ground elev. y LIS_&o S-/(t VV -S -I S)B S a61- k3 %9 j •1 .8 °IOo .Y ft Depth to limiting factor flemarks: GiZovh~jt SL-~r°tG~ PrT 5~.'I TName:-Please Print Arthur L. We erer Pine 715-425-0165 Ad: egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnaque: _ 3 9 Date: _Z y .7 CST Number- 9 0 0 5 7 6 PROPERTY OWNER Nql -SON) SOIL DESCRIPTION REPORT Page? Of 3• PARCEL I.D.# ~~LO - \10 0 - 30 Boring # Horizon Depth Dominant Color Mottles Texture Structure . Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 3 o -Z-7 IDS-! lZ Z l z L Z `F g r M-P , cw J u l . S • b Ground 3 34,S~i ID`f2 ~~6 ~-~i•S %lR s J~3 S ~Sr.~ bk M elev ov .b °t ft. Depth to limiting factor T-I Remarks: Boring # 0-►9 ~oti2 Zt z si I Z ~9~ 1v~ •S 13v 2 1q-3I Lo`iR 31y ZrnSbk yn~1. eS - S 3 31-bb -~.S'ttZ 31 f-1•SyR GIB elev. Ground b RDo •9 ft. Depth to i limiting factor Remarks: ~'R~~~Ow~'T~-1Z S~ IgGrr' r)l Sb Boring # 1 O-Z3 1O`lR ZlZ - 5L1 Z~91, m~h C,tu ~U`~ S'••~ S Z i3 -u S l O `'l tZ 3! - S I 1 Z,r,., S h12 ~ `fit- c S - . S.~ 3 uS -5S I O`i LZ VI V 71 s l rz S 1(6 S O Sg C S i Ground elev. y SS -610 e) ►ti, 1 - •1 $ °tot.6 ft. I Depth to limiting factor yS Remarks: G~k-A'n~Z SGT AT SS'- Boring # t~~: ~ - bo ~i S S ~P 1 Fw 1Z 01 Its 4 R Z L P 1 gun do o i Ground S elev. ft. Depth to limiting factor Remarks: cr- 7 i ,arvm ~1zlclvnz~d Asa Z1 ~~11 z1a o- X ' 2 91 ' _ o ! ~1 , 9 z olo -to ir IV a 0 1 ,i91 'J N i Ov I V s 7•; 40 P d ~54~ vvvc~Q ~Q r I II r- F- w o u i o Lrl cl~ ~0 Z a, c n 0 r ~ ~ ! v i J • D s~ 9 /v 0 3 N /1 'o ^0 Gl 2 o°- 10 a a J r N ay) rn o 2 m V 3