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HomeMy WebLinkAbout002-1038-60-100 AS BUILT SANITARY SYSTEM REPORT OWNER - RORe-r Lo K ~,Pr TOWNSHIP U~1C©W~y1 SECTION T~N-R ~iW ADDRESS R70 Frgrk 0YV-el-ST. CROIX COUNTY, WISCONSIN bqldnli)l t~ c oP7 5T0,21 SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f 710 10 11' n S Ca N ~ L h 9~ cc' 0 \ Y 2 ,f y ell b ~r INDICATE NORTH ARROW BENCHMARK: Elevation and description: 5~ffI eyolai- by nower bdc de- /0I Alternate benchmar& m s J►K 4A 0p 00c l 1 SEPTIC TANK: Manufacturer: MW Nertr Liquid Cap. 100gL, Rings used: Manhole cover elev: J'/ Final grade elev: Tank inlet elev.:~Ol Tank outlet elev.: No. of feet from nearest roadii:Front, Side , Rear Ft. From nearest prop. line:FronjSy , SideJ2-5', Real Ft. No. of feet from: Well co , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer : J0,11e3krk, iquid Capacity : __q~ _ Pump Model) Pump/Siphon Manuf act T~ 0 -e/I e4,- Pump S i z e Elevation of inlet: IF/ 6~ Bottom of tank elevation g ~-64, 7 Pump on elev.:019 Pump off elev.:~Gallons/cycle: f 9 2 Alarm: Man.: NCI bw) Switch Type: //II I~WCVYV Location- Distance from nearest prop. line: FrontLDU, Sid/e/60 Rear Ft. Distance from: Well l 7 Building SOIL ABSORPTION SYSTEM Bed: Trench: / Seepage Pit: Width:__Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. X ~ l I/ Fill depth to top of pipe: 1`~" No. feet from nearest prop. 1ine:Frontk, Sidedo ,~Re`az~ Ft. No. feet from well 4d No. feet from building ✓ J HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR: I/ e DATE: PLUMBER ON JOB • rdc LICENSE NUMBER: / I U V 7 6/90:cj T-i'MT f-AT x. %r' Cl '147 M'lk T r)TOT TT 1 -7 T r_'7 s`T .re°Irn =1 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Hur*an Relations * Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 1 A n9 if' A Permit Holder's Name: [I City ❑ Village ,,E] Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: g~ , x r, rr TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -,rv Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 0S- TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom /9/23 Dosing !Gp` 3o' NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System y8 10a PUMP/ SIPHON INFORMATION Final Grade a,N ~03,1~ Manufacturer ~J Demand Model Number 0 a~,16GPM TDH Lift Friction Syste TDH Ft Forcemain Lengthag0 Dia. 0 Dist. To Well > 56 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS y (oa/, i' DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK _ INFORMATION Type O CHAMBER Model Number: System: 69 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. a' Length JO'_75'Dia. Spacing ~y SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over +C~tX Depth Over Q U xx Depth Of xx See d /Sedded xx M Iched Bed /Trench Center ! v Bed /Trench Edg~s Topsoil es ❑ Noes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 0S 6 . 10. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: p e r ~b U s -OOYff SANITARY PERMIT APPLICATION 4` 0 ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than I , 8% x 11 inches in size. 1:1 c eck f re onto evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - PROTIIOC/6V TY OWNER PROPERTY LOCATION . iCY45ttlY4,S 1'7 / T2q /,N,R ~i~ ( )W PR PER OWNER' MAILING ADDRESS LOT # BLOCK # TATE CU~r Sr ZIP~ PHONE NU BER , SUBDIVICS'IOC SAME OR C NUMBER 11. TYPE OF BUILDING' (Check one) ❑ State Owned ❑ VILLAGE/ I LL AG✓✓E~ NEAREST Rt Cr FN QF~ :2 4911 RCH J S' ve -e❑ Public ~~r 2 Fam. Dwelling-# of bedrooms PA A N M R( ) 111. BUILDING USE: (If building type is public, check all that apply) J 1 El Apt/Condo Pt V'c C_ 1 25gG 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) X-System New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an 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 P7;5~ound sed Distribution Experimental Other 11 ❑ Seepage Bed 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ~O REQUIRED (sq. ft.) PROPOSED (so. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVt4TION F t1l 1 -L Feet L`J beet 5,3 VII. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank g"rf /-F] F1 I I Lift Pump Tank/Si hon Chamber Ji l ! rP VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Name (Print): Plumber's Signature: (No Stamp MP/MPRSW No.: Business Phone Number: Plumber's Addr s (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY 9f ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' g Agent Signature (No Stamps) Approved ❑ Owner Given Initial q5- Surcharge Fee) 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 s Buildings Division, Owner, Plumber INSTRUCTIONS . 1. A sanitary permit is valid for two (2) years. 2. Your•sahitary 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 approvai 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. a SBD-6398 (R.11/88) AfG'(i ~yl `2 S T C - loo This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - Owner of property kqev- Location of property S k 1/4 St` 1/4, Section L7r T 2?N-R 16 W Township G Mailing address . f~q y/A UAS call I-T of site A / 9a_5 aaO"A\ TA - Subdivision name Lot no. Other homes on property? yes No Previous owner of property Total size of parcel S 2-- Date parcel was created y - Are all corners and lot lines identifiable? =Yes No Is this property being developed for (spec house)? Yes YNO c Volume and Page Number ! as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE 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 .n 05 5 I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Mice of the County Register of Deeds as Document No. and that I (we) presently own the proposed site fo the sewage disposal system or I obtained an easement, to run the above described (we) the construction of said system, and the same haso been duly recorde' the office of County Register of deeds as Document No . 1 ~ Signa u e of applicant Co-applicant °9 Date of Signature Date of Signature f D0CVMIV4T No. STAT! MR OF WIBWNNM FORK i-!M• ~ awses Fee aasaassw rlsaw WARRANTY DOD a 49093 VOL _941 wa476 t_ Paul- A. Lokker and REGISTER'S OFFICE '1 b" made between . (~jQU( fps ~ C~>Gal~ine--J.•-Lokker-,--husband and wife_as--joint ST. tenants . Reed for Record ; . - - . Grantor. MAR 2 51992 sad. - Roger D.•.Lokker -and.-Brenda J. Lokker-t _ - survivorship marital property . 2:20 P. M - " 4 & - - _ Grantee. "sw of Deeds Witnesseth, That the Said Grantor, for a valuable consideration RETURN TO Y conveys to Grantee the following described real estate in - St. Croix r 6 p~ j Ex County, State of Wisconsin : 0 3' o I l'~~~Pls i Tax Parcel No: Part of the Southwest Quarter of the Southwest Quarter (SW, of SW,) of r Section Seventeen (17), Township Twenty-Nine (29) North, Range Sixteen I. (16) West, Baldwin Township, described as Lot 3 of Certified Survey Map, #2440 recorded January 15, 1992 in Volume Nine (9) page 2440 of St. Croix County Register of Deeds. SALAL F_% This is homestead prupecty. (is) AX") Together with all and singular the herrdrtanwnts and c,pj-tien.,nrr: th.•r.unto I,"In,t+:u,ti; And %va rant< that the title is good, u,dei,:,sibl.- to tee :niplc and 't:ui ,•h':ar ,r: , n :,n,hramv, except and N,ll Haan:u,t and defend if,.. a me March ly 92 s 11:ated thi: p2 0 ,lu} r I~t:.\L. (SEAL) Paul A. Lokker (SEALl S Ci-raIdinc .1. Lokker y i tt I. AIJ'I'llKN 1':, \ VI0N t'h VUP 1•E1)GMP.NT Signature l < t K • uuth.•ntici~trd th:: i , O i;,% of 1 ~ ta.k y L ! • iun~.•d I':utl :1. I„kl<, r inr! t',tl~lin, I. ~ lo , is I , t' s 'PITLF.: \1 11 IiI?It rl \'1'i: t. \I: „I '.1'I Ill nrrt, ? ourir:•,i.,•r3 i,•. At ec.,t--d the . C. nom. ,..~~~Ql+h~lia: ILA,- Sh rley A: ~ademjke B:tldt.•in. lJistuntiin :,.1~? not. ~V to e -A rSt r4,•, n!'1 rr. , ~ tarY rt t 5 tl 1 ~f My r v"rn-_K + kn*if• Jea b3f •d' $Aj arar►: a or >lru+cotvwH ~~•s u , SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ Pole-v L 0 ADDRESS:. 090 Mica yL N ;s FIRE NO: LOCATION: S kJ 1/4, S 1/4,,SEC. / T .2q N-R_E_W,_ TOWN OF: &0 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 to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the 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 from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. A SIGNED: f. DATE: 3 -03.9o'L St. Croix County Zoning Office 911 4th St. - Hudson, WI 54016 t~ `t0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ,INDUSTRY,. DIVISION 69 LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) /P44PT of 30 ,9c%f5 LOCATION: SECTION: TOWNSHIPMtJM eh0l- FY: OT NO.:BLK. NO.: SUBDIVISION NAME: 5&j 1/ sicJ 1/ 7 /Tz q N/R E (o SA L 0 w1A3 cs,Y pis-AJDI.43 COUNTY: MAILING ADDRESS: 5rao%X ~ 'R Lo k k,FR 1-1-70 FRAO k L rnl ST BA L.oww,J , Cv r' S . USE Co P{ -33/( DATES OBSERVATIONS MADE NO. BEDRR& : COMM R AL DES RIPTION: Residence 3 4e 4- New ❑Replace TO&iE -Z y _ l If JUtiI^ 2 S SC -5 v 2 ~Ev6v~f ~R C ~t o.v ~So/ 1.5 RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S DU EN S ❑U ❑S BU ❑S EJU ❑S ©U MouNI-) aAjLY If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the Junder s. ILHR 83.09(5)(b), indicate: C~i4 SS Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) PVPD1e,P IT- o y 3 ,51J R oc.vEp /U eoa7~ c w ~ 9 /2 " B- y 2- 100.6S 3 S Z 5 /o yil° Y74 5 f 5 b K A- ~R 1 u,A Ro c T-S e%o ; 12 yZ" 7.5 YR `//G 61, (,%j9bk, 41A R~ cc,~) eu/dii~ B- + 2 f S Y R 318 h0 7-5 2- 2 100,(a8' Puoo/EO fir 2- o"6 ' IOX4 'Y13 5P16 " /0 Y•e //f- B- 3 8 Sll 2,w 5 to k, . f )2 14-- -2-5 " 7.5 YR IF/e, S1y Icgk nmv P i5"- 14 1" 7S YR'//4- Sly (C5k,/W B- w,dt, c i S- 1,5' yn 5/y HoT-S sb~ q A<r/uE- t%-w yl-'~_ s, Pew,<o ; e-11" 7.5 Y 116 F/, B. 3 ~Z f~,Zo 3,0,~ Z~ Mtn;, -7- ye y s~ 2fs~k nHfi lu 110otS C"cv I,0•- y2" 7•5 Yk. S/G S~ 1, 5!h& B- 5,4-rURPt 'r &--D wi' C2-2 7.5- 61JO ho7- PERCOLATION TESTS } EST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES* AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ 1 2-0 p_ 2- 20 3 O 1~ J (p to P- O Cv / 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. SAA.3D/p0 eK 1A3 reR FA cc Cto X14, 12- 7, AjD SYSTEM ELEVATION. I , V t _._~..L /l) ' T rk' ~f C+ltrt✓ t ~4~'r~ a"fl _ S M.-I- l 1r J 1` I'S her J i S a i L._ . _ _ j. - i 17 Oc I I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and met ods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: HOMESITE SEP11C PLUMBING CO. Z 7 _ I q~ l --650 'NEIL RD.~HUDSON, WIS. 54016__ 444414 ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 2 `/P2_ 3 G 00/10 MINN. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATURE: 1 C DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. Il 1`111 I-In onn ~~na /G 1nIC41 - MICR ( o gutoU 5 koo AIA P k r AP~>?oX..►"o . DoT L, i f i i IRS f PoIE (3M SET. I r` STEEL Co.upv~~ ~jrk rhEkED wr L~- ~ Q- VA V o,~ = /O 0' o ' C P3 3y ~ 8p 3 4f s IopE ~Pt P7 t3 t i PAi? r O1 ex('ST1acr 3 0 ORES PLOT" pLA&.~ 0 CORUl ya.0 To DA-re = Bi44k iiOb4ESITE SEPTIC PLUMBING CO. ~E f TS 665 O'NEIL RD., HUDSON, WIS. 54016 a E RC l o G1 ri o -o $ ROBERT UL3RIGHT c-S t F-- 1 Y ~z- oi& MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MANN. INSTALLER & DESIGNER LIC. NO. 00663 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BRUCE WEBSTER Owner: ROGER LOKKER RT 3 BOX 231 1270 FRANKLIN ST ELLSWORTH WI 54011 BALDWIN WI 54028 RE: Plan Number: S92-00545 Date Approved: March 27, 1992 Gallons Per Day: 600 Date Received: March 25, 1992 Project Name: LOKKER, BRUCE - RESIDENCE Location: SW,SW,17,29,16W Town of BALDWIN 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: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 266-2889. sBO 6423 1 R. 01/911 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations BRUCE WEBSTER Page 2 Sincer , OTE.' PAGEL Section of Private Sewage Division of Safety and Buildings PPP013/0009n/ 6 cc: ROGER LOKKER -Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant Owner Plumber Environmental Health SBD 6423 iR. 111/911 A MOB 'J PI CO): Logy Ro3er ~okkl-r J -OU V57 r')ov x ; ~-'4 :jry-f- hrPmv C's Q_ ewr- t jdvvi~ 70WA5 ~fp ~t Cro Cove rr EH II~~ b~ r~G~p~~ Urr~ 4 V :oat a .1 1 J +y" (a iv) v Of { Tt.. 1 4/,1 R-g 0- 1Q P~o P lQn co - p lo 17 P s r- ft P r ~cTrvn, e T Cvo5, sectlo1) or ~c(,M, C+~v ss -Sc 7LAO ~ac 2 Za e~le"- pt£ of Cuirvtr ~'eao cu1cv6v/"-s qt 7 f ~ 2 I o 13 Sel,~' ~ T-' 2,- o4~ctrr f J rpae ,T) IvH CYG•i ~ ovk # TC - ~0 0 ~Q~ . ~5- 5 4 \EV fw r e Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEMS Private Sewage Section . Labor and Human Relations 201 E. Washington Ave., Rm. 141 'Safety and Buildings Division PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 0608_) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Adminis io D ument Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. Plan vie A of Date Plan Identification Number 1. PROJECT INFORMATION (Type or print clearly) (tii C," L. )1 y 11 57) -CC .5 y 57 Name of Submitting Party (plans returned to same) Project Name % S tv d B -oc'e ,8l/Y I, ujr✓ V 5 ~ ~O u:41114,- Street Address, P.O. Box # or Rural Route Pr jest Address or Legal Description 1 L, D 3 / l r s I 'I SCC 17 1ILA Q 16 Lt./ City or Village State Zip Code city ❑ County Z 44; co hi L161 Village ❑ of Olvi Telephone No. (includ rea code) Town POcl l,' ~J r C1/0 / DQsigner Nam of Owner i. - L a fi, i 1> 'U. /r. r ~ tw Sh`r C Z-7 P Telephone No. (include area code) Teleph a No. t nclude area code) Street Address, P.O. Box # or Rural Route Street Address, P.O. Box # or Rural Route ' t" -3 6,L '2- 3 ) V Fv h 1, hLh ~T" City or Village State Zip Code City r Village State Zip Code P Isl.,,, 1,~.~ , ~ 6,)) q c U~ i'`-, 2. APPLICATION FOR: ❑ Experimental ~~Mound System C] Holding Tank m Conventional Gravity System Groundwater Monitoring ❑ Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ Pressurized System ❑ System in Flood Plain (attach SBD-6698) ❑ Other Alternatives 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. a a. 750- 1,500 gallon septic tank $ 50.00 b. 1,501- 2,500 gallon septic tank $ 60.00 C. 2,501- 5,000 gallon septic tank $ 80.00 d. 5,001- 9,000 gallon septic tank $100.00 e. 9,001- 15,000 gallon septic tank $150.00 f. Over 15,000 gallon septic tank $250.00 g. 500- 1,000 gallon dose chamber $ 30.00 Z G, h. 1,001- 2,000 gallon dose chamber $ 50.00 i. 2,001- 4,000 gallon dose chamber $ 70.00 j. 4,001- 8,000 gallon dose chamber $ 90.00 gn k. 8,001- 12,000 gallon dose chamber $110.00 1. Over 12,000 gallon dose chamber $150.00 m. 500- 5,000 gallon holding tank $ 30.00 n. 5,001- 10,000 gallon holding tank $ 55.00"`> 0. Over 10,000 gallon holding tank $100.00 _4/2 p. Revisions $ 20.00 q. Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r. Petition For Variance: Setback $ 25.00 Site Evaluation $ 50.00 Subtotal: S. Priority Plan Review: Enter same amount as Subtotal 1 Total Fee: G~ NOTE: Appointments for plan review should be made prior to submittal. You may contact one of the offices listed below. Hayward Office LaCrosse Office Madison Office Shawano Office Waukesha Office P. O. Box 754 2226 rose Street P.O. Box 7969 P.O. Box 434 401 Pilot Court, Suite C 209 West First Street LaCrosse, WI 54603 201 E. Washington Ave. 1053A E. Green Bay Street Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8605 Phone (715) 634-4870 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 SBD 6748(R 07/91) NOTE:Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER . are subject to change annually. TIONAL WORKSHEET Page Of MOUND SYS I EM -Continued- 1. It. IN-GROUND PRESSURE SYSTEM Wastewater Lord, Total Daily Flow= gal, 10. Force Main: Use S. ILIiR 83. 15 (3) (c) Minimum Dosing Rate = l Adm. Code and PROVIDE A DETAILED Diameter = in LIST' OF SIZING ON PLANS. S.0 11. Tnta► Dynamic Head: _ 2: Depth to Limiting Factor = It. System Head = 2.4 h 3. Landslope = % Vertical Lift = I 4. 'Distance from Dose Chamber to 2,15- Friction Loss Distribution System = ft, TD11 = , S. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = ft. Pump will discharge at least 6. Absorption Area Sizing: ern j at ft, total dynamic head. Area Required = 5-00 sq. ft. Pump model and manufacturer: Bed or Trench Length (B) = r ft. Bed or Trench Width (A) _ ft. 13. Dose Volume: Trench Spacing (C) 10 Times Void Volume of 7. Mound Height: 17 Distribution Lines = Fill Depth (D) _ gal Daily Wastewater Volume Fill Depth Downslope (E) = n r fL 4 Doses In 24 hrs. _ Bed or Trench Depth.(F) _ ft. Backflow = gal Cap and Topsoil Depth (G) _ O gal ft. Minimum Dose Cap and Topsoil Depth (H) ft, 14. Dose Chamber: gat 8. Mound Length: s0.23 Volume = gal End Slope (K) = fc. Total Mound Length (L) _ ft. 111, CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: .119 1. Wastewater Load, Total Daily Flow = gal Upslope Correction Factor Use s. ILHR 83.15 (3) (c) , Wis. Upslope Width = r• Ss ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor= 1.14 LIST OF SIZING ON PLANS. Downslope Width (1) _ t0 • ft, 2. Required Septic Tank Capacity = Total Mound Width (W = 2 b.0 gall ) r iL 3. Percolation Rate = mi 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83 Natural Soil = gal./sq,ft./day and PROVIDE A DETAILED LIST OF Basal Area Required - 81 sq, ft. SIZING ON PLANS. Basal Area Available = 11_ 5 sq, it, Required Area = sq. 11. If Standard Tables from Chapter = . ILHR 83 Length ft tt are used, Indicate Table # width = ft 12. For the Distribution Network, Use Numbers 5-14 in Section II. Number of Trenches = Trench Spacing = ft. It. IN-GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor ft. Lateral Length = ft. l 2. Landslope Number of Laterals = 3. Percolation Rate = min./tn. Lateral Spacing = in. 4. Proposed System Elevation = ft, Distance from Sidewall to Pipe = In. S. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use s. ILHR 83. 15 (3) (c) , Wis. Adm. Code and PROVIDE 'A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All Ite 19A It1 Ch Required Septic Tank Capacity s gal, *CV2 3 , a al 6. Absorption Area ' Sizing: V. SEPTIC TANK Ch(es) Percolation Rate = min./in. 1. Capacity = gal. CheS Area Required = sq. ft. 2. Manufacturer: System Length = ft. 3. Show Site Constructed Tank Details on Plan CheS System Width= ft. 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Sife = in. 1. Capacity ° gal. Hole Spicing _ ft. 2. Manufacturer: L.dcr.d Length • ft. 3. Pump Manufacturer: Lalcr.d Siic in. 4, Punrp Moidel• I.ale•ral Spaci ig It. S. Operatinit Head= It. Ui%wticr ln+or Sidew.dl to Pipe in. to. How Rate= gpm. R. Distrihution Pipc Di%ch.ulte Raw: 7. Show Site Constructed Tank Details on Plans Number ul I lulu Per Pipe I luw Per Pipe : Kpm. VII, IIOI.UIN(; I ANK Manilold Sizing: 1. Capacity : gal. I ypc (center tar end) 2. Martulacturer: Length It. 3. Show Site Con aructed Tank Details on Plans ' Olameter = in. -SHOW ALL INFORMATION ON PLANS- 1ILHR S13D-6761 (R.0V,3'~/8t2}+) ~c: ~ p Sele ~1~0~ • ~ddhp~ ~Y g}'Fw► ! y ts' o~. adsl c to ► ~ qaa-,n • tsO 7 0 ` - ~ ~ IS off, !c ..t'_'" 7v~►c j44f v S+"~- 2 "E ~orae y+,alh a^J • ~ , k © E Ut~ ~1 / M iy~a j(~e ld Ftnec., lat~(t q of .g° C-' ej p i f 3 ~~er Ili t ev : lY►rtr~.A~ ~1`10`f r s x x _ 'd,.er~ er toQl a F © ( (vp c..` { x '~'~..vC'tlvPc ~ (H~gd loss ~ r~. # } z~G Age,{+~ ;oho ope Urve MG~i° M ~a.1E C2.0 r~vr[OQ o ~ , ~,1~ ~'~~~t ~ ~ ~~~K6 s '~t ~ y~ j ~a ~ ~'+•~k ~~~xtsr t. ~ - ors . ~ t9ae~.TF,1B~.`M Y 7~ - tT "k. a e w.~Y r - C;1k yt, ftie ! tfl/[ 1 ~~`fKy~ F yi R ~4k`trw• (f t r ',Y VIP" ::11 11% 1 VI! ) mu5 d a(r1, 'o del;,.w («+evak ar to C. etevqhcv r e vvw 6 tope( aF b«ce►rtwr'46A feet- P`t t~ i3,qJ_ al fte+- of- ~~ad. dmrh $i' 'f Pu_ Y:o goz[tc% P JP ~~a►'_rc{J, f 64 v~ ,p-f INNh , 2 "ar %a"P,~- F~o+ Y.3 ve IS t 6 3 0+^ C6~ ~xa .y r. . p r / a~ rOrR Darfi Li . qr- b i"- 3 P'"r' p `,r/a17G•1 k Q I / dr 137 Or 96,0- CG'.o f~: o f~.s) ,'$7.6 P tr= ae( t 63 t4ferat 2levaNvn Will 3-991tn t•,1Kir►ic~ ~ $9.5' pump QtetnNv9 a, 1 a~ 163 e ~ $I t= be E 3. Cd P a- a Yak'`` _ `~"~bWr~~tex" ~}ee~t';~eP~v~eo4 si^~ h P" r 17 «sla64o att T tf P1 1^~V Fr x x ~ /u15 tCtl+K to ii y S S' - ~ ~ 500 F~-z _ e~,4ls 'el~evan~~►~•,~~~;o~ ~ a= tip, T ? 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O ~ 1 r rho i ,.•p ~ N n L 2 i , r 7rl - ? 'z ?L^JQO~ _:<1 PVT T^i'ih cs Y a, 1 1 s 3 ~ _ o . CC. i~ 1 s O a i I 4 0 I i 5... G -95 i 3b~ JI~ C~ cr~tfi~j'% -A -4 Page - Cf ' l Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand 6" Topsoil - " G W F 3 E D Eg~~PG Slope 6 ONS~'C C Cd Of 2 - 2 2 Force Main Plowed Aggregate (6" 13 low Pipe) Layer ~ v 0 D Ft. } r ss Section Of A Mound System Using E 1.32 Ft. \j, < A Bed For The Absorption Area F 0.7$ Ft. G~ C Ft. S' ed: ve*-- A C Ft. H Ft. B Ft. License Number: K /4.23 Ft . Date: L g3.0o Ft. Alternate Position J 6 Ft. of I r7. Ft. Force Main W 26.1 Ft. L fl Observation Pipe 11. K W ~o - d 4or i Distribution Be» Of Pipe z 2 2 I Aggregate Observation Pipe Permanent Markers 1 i Plan View Of Mound Using A Bed For The Absorption Area i } n t f", os. i Page Of Distribution Pipe Detail For A Four Lateral Network will vSe alrprnP►- Po•:i710" Ft~i"CZ Mal End Cap Alternate Position Of Force Main P N ~3' r. c, a • PVC Distribution Pipe P l Equally Manifold Pipe O~Q~c~~ Gj On.BottomSpaced ~X S JZX X 2 * Last Hole Should Be Next To End Cap * Y P30+ 1~'Ft. S O Ft. X`-T 7 Inches 66 .1f---~I nches ..Signed: License Number: /7 Hole Diameter Inch Lateral Diameter Inch(es) Date: Manifold Diameter Inches Force Main Diameter 2 Inches I Holes Per Pipe 6 Invert Elivation Of Laterals 1 d 'y Ft. PUf'iP CHAMBER CROSS S PAr-i _L2_CF-~ ECTIOIJ AUD SPECIFICATIOU5 VEUT CAP 4"C.I. VENT PIPE 7 WEATHERPROOF APPROVED LOCKING 25' FROM DOOR. JUNCTIOM BOX MANHOLE COVER WINDOW OR FRESH 12"M►U. AIR INTAKE GRADE I } ~ `I" MIIJ. 510618U IT IB"/"flu. C WAIN. N tn€" fxj di~~) wl~. \ rt INLET PROVI " I AIRTij4 Li I * C. VV rt~,L`E ~ I ~ ~ d C~i~R~S p I ALARM SEE ~ I C *APPROVED ELEV. JOINTS WITH I ON FT. APPROVED PIPE I 3 ONTO PUMP D SOLID SOIL OFF of phi y sit ~ 6 COWCKETE BLOCK lcvlZs 50 6. RISER EXIT PERMITTED ONLY IF TAUK MAWUFACTURCR, HAS SUCH APPROVAL` cr Qft~ t- Mel ?I*b' SEPTIC E Xe ~ ri~S~eet' SPECIFI•CATIOAIS DOSE TAWKS MAWUFACTURER: t~rdu-ffl- Pl ecccrr- TAI►IK SIZE: WMBER OF OOSES6 GALLONS DOSE VOLUME t ALARM MAUUFACTUP K;t: ~Q h INCLUDING BACKFLOW: 165- MOO[L NUMBER: GALLON: SWITCH TYPE M p~rv CAPACITIES: A=~IAICNES OR cJ ~ ' CALLOW: PUMP MANUFACTURER: L'tPV_ B - ~ INCHES OR it'~ GALLOWS MODEL AJUMDER: t63 C ---INCHES OR GALLOW! lu.'og SWITCH TYPE: D" INCHES OR GALLOIJ4 1 13I U il'v IJOTE: MINIMUM DISCHARGE RATE 7 9~ GP/h INSTAL ED ON SEPARATE CI C t VERTICAL DIFFEKEMCF BETWEE►I PUMP OFF AWD OISTRIBUTIOW PIPE..' r R U TS FEET + MINIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET Tti~s rs DIQNN~ + FEET OF FORCE MAIN X 2 OS F~0 FLFRICTIOW FACTOR. , f- FEET P cF ,j,., _r6' M~ belavert~, Io IaVIG D T6►e ~,wrtc hey a TOTAL OtIWAMIC HEAD dif- FEET +4,e Ax"pP I~ v~ ~s sip ` ` MITERIUAL DIMEWSIOIJC OF TANK: LENGTH e- V ,WIDTH C' spe IJdt•a ~--;LIQUID DEPTH 43 qZ LICEKJSE HUMBER : a 3I13'I i° 13 ~ TDH H EAD CAPACITY C;U RV E - ~ Mo>✓~v sE-li.d",p s ysr~~~ LU p, Co. y 30 TOTAL DYNAMIC HEADICAPACITY PER MINUTE EFFLUENT AND DEWATERING SERIES 53 SS•57-59 97 137.139 163 165 M_ LTRS LTRS LTRS LTRS LTRS 28 _ 152 16f 248 394 231 231 EFFLUENT AND DEWATERING 305 129' _ 216 300 231 231 45F 72 16J 242 227 227 26 \ - 6 10 t W 136 223 zz7 - SEWAGE AND DEWATERING - r 7 62 30 216 223 ♦ 91-9 206 220 ..1219 24 172 206 I S_24 - - ' 125 191 ♦ lfiZ!) 57 161 22 ♦ r~ 213-1 114 t 53 2431 MODEL MODEL Iwk VaNe 1y 24S 26 6b87 .20. 163 -\4 - 165 TOTAL DYNAMIC HEAMCAPACITY PER MINUTE \ SEWAGE AND DEWATERING \ SERIES 267 266 782 284 293 18 M LTRS LTRS LTRS LTRS LTRS \ 152 408 386 492 681 3 05 227 273 360 598 7 78 163 238 Str 16' t s 5 10 _ - 30 125 401 6 7 62 288 14 \ 1 914 _ 163 292 10 67 227 \ 12_1~i 174 - \ t3 7:2 12 152•1 \ MODEL L1 .k Valve 16 21 26 Js s3 10 \ 1 293 MO ELS ' I 8 137 139 \ - - 6 ~ - ~ MODEL 284 4 MODIEL MODEL 282 i 268 > _ - - - - - 2 MODEL 1 , 3 5' MODEL MODEL - 57, 59 97 267 ' r 1 ,k ~tl 1 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 7 3280 Old Millers Lane Manufacturers of ZZ71Z riff O~ P.O. Box Kentucky , Louisville. Kentucky 40216 (502) 778-2731 Qua[[~r Putws Svc[ • ST,. CROIX COUNTY ~s • WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Mar. 20, 1992 Division of Safety and Building s Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To Whom It May Concern: An onsite investigation of the Roger Lokker property, located in the SW 1/4 of the SW 1/4 of Sec. 17, T29N-R16W, Town of Baldwin, St. Croix County. This onsite revealed suitable soils at a depth of 24" requiring 12" of fill beneath the mound septic system. Should you have any questions, please feel free to contact this office. in erely, ames K. Thompson Assistant Zoning Administrator cj ST. CROIX COUNTY r , a WISCONSIN 'l ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 i Mar. 20, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To Whom It May Concern: An onsite investigation of the Roger Lokker property, located in the SW 1/4 of the SW 1/4 of Sec. 17, T29N-R16W, Town of Baldwin, St. Croix County. This onsite revealed suitable soils at a depth of 24" requiring 12" of fill beneath the mound septic system. Should you have any questions, please feel free to contact this office. In erely, ames K. Thompson Assistant Zoning Administrator cj I ST. CROIX COUNTY ZONING PAGE 1 (92,13:56 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/25/92 AREA: MJ Activity: A9200139 6/25/92 Type: MOUND Status: PENDING Constr: Address: 925 BRIDGE ROAD TBAL Location: 17.29.16.BALDWIN 258C, 17, SW,SW, 220TH ST., LOT 3 Parcel: 002-1038-60-100 Occ: Use: Description: 149294 Applicant: LOKKER, ROGER Phone: Owner: LOKKER, ROGER Phone: Contractor: WEBSTER, BRUCE Phone: 594-3080 Inspection Request Information..... Requestor: BRUCE WEBSTER Phone: Req Time: 09:06 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION