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~47i~con~iTi L3~" : rt AMR f In us 19k& ry, LE 35.28 .1 PRIVATE SEIIVA~'iE SYSTEMNE RD. County:
S
Labor and
ar Human Relations INSPECTION REPORT
Safety fety ar,d Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 171516
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
HUMPHREY, MICHAEL J & KAREN M EAU GALLE
CST BM Elev.: Insp. BM Elev.: BM Description: ! Parcel Tax No.: n /~a?
<1,$- 008-10'99-70-000
TANK INFORMATION ELEVATION DATA A o2s0 282N ~ 7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 6-F .~t %C ~GL Benchmark 3 /d,
' 10
Dosing 2 /
Aecatierr- Bldg. Sewer ' 3 °
Holding St/,,It Inlet 9-7 '
TANK SETBACK INFORMATION St/of outlet q7, Z7
Ventto
TANKTO P/L WELL BLDG. Airlntake ROAD Dt Inlet
Septic NA Dt Bottom ? ID' pei s 1"'
Dosing d~ > NA _6km4%/ Man.
r
Aera NA Dist. Pipe
gy,
Holding Bot. System
PUMP/ SWNiOtd°'tNFORMATION Final Grade
Manufacturer Demand / e. `Y ° ° -9.30P
~rGPM
Model Number
:V /6y, 3 fir
TDH TLiftq, / Lriction 14e-ad TDH/Z.4Ft
H G I
Forcemain Length ° Dia. " Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width i Length i No. Of Trenches p Inside Dia. Liquid Depth
DIMENSIONS IMEN I N
SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING anufacturer.
SETBACK CHAMBER po el ber:
System: Typestem: of 10 >/,p OR UNIT
DISTRIBUTION SYSTEM
1.1"Ad r / Man' old Distribution Pipe(s) / ,e x Hole size ,t x Hole Spa sing Vent To Air Intake
Length a. Length Dia. J& Spacing / O
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over „ Depth Over I/ , xx Depth Of xx Seeded/ Sodded xx Mulched
god/ Trench Center - ed-/Trench Edges ` Topsoil Fes ❑ No des ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 16oPO/Q3E01~-
/ 3~S
/
Pan revision trqir d? ❑ s o
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector' Signature Cert. No.
f
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER: n
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code couNTY
STATE SANIT PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than (~J^
8% x 11 inches in size. ❑ C~ec7revisi'on o evious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER :Z0 .1 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. va`/vet
PROPERTY OWNER PROPERTY LOCATION
e/P "L k24,0A. 00A ~'/a, SS-5- T.-; F,_ N, R 1,l;~' E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE :
h
El Public & or 2 Fam. Dwelling of bedroom PARCEL AX NUMBER(5)
III. BUILDING USE: (If building type is public, check all that apply) Ud 00
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 K Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
V1. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
L ~Q ~Qt / ~ Feet f
Feet
VII. TANK CAPACITY Site
in alIons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holdin Tank 02LI
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.:, s Business Phone Number:
4,'/ fto- ~ 61/sr ~-3rA/
Plumber's Address (Street, City, State, Zip Code):
D d ozr` Kd AG
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue I w Agent Signature ( tamps)
1
Approved ❑ Owner Given Initial Surcharge Feel ~j JUt
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. -Your-sanitaryNpermit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will, be applicable.
a AJI revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation. -
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped'by-a licensed
pumper whenever necessary, usually every 2 to :3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if--
required by the county; E) soil test data on a 1].5fprm; and F) all sizing information. , .
GROUNDWAT99 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 sWharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
S T C - 100
This application form is to be completed in full and signed by
the owner(s ) of the property being developed
Any inadequacies
will only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor,(spec
house), then~a second form should be retained and completed when
the property` is sold and submitted to this office with the
appropriate deed recording.
Owner of property l G 1-i9EL A/up Kily&d H um6#94:5- '
Location of property 1/4 1/4, Section , T N-R W
Township ZR L) C~.R
Mailing address
b w (3A C o L c v~ 06~
1 Xele' E
Address of site 2S 9'0 PIER Ctc- L_5714_*
Subdivision name Lot no.
Other homes on property? yes No
Previous owner of property G L[~ Otd h (t
Total size of parcel L-10 C_ R 4_s
Date parcel-was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes XNO
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
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of
the property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
No.
~ I
Signature of applicant Co a plicant
Z7-q2-
Date ~of Signature Date of Signature
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
486373 11 V,O REGISTER'S OFFI
(:E
This Deed, made between Eldpn F . Hill- _,___a~k/a.__ ST. CROIX CO., W~
Eldon__Fred Hill, a&/`a E.F. g-------ill
sin .1....... Rec'dforR@COrd f
-•ill a g
- •_.a.-
.per-son -------------------JUL 281992
Grantor,
and----------- ic.hael-.J-._-_Iiumphre-y--.ax1d_.Raxexl-.M._..Humphrey, , at 8:40 A. M
hushand---and---wit.e__as.. jo_int.-_t-enants._as--W aconsl
mar.ital..-preperty.,------
- Grantee, R092 of Deeds
Witnesseth, That the said Grantor, for a valuable consideration..----
.
conveys to Grantee the following described real estate in st_._..CY:o1X.-_ RETURN TO
County, State of Wisconsin:
The East One-half of Southeast One-quarter
of Southeast One-quarter of Section 35, Tax Parcel No-
Township 28 North, Range 16 West.
And,
West One-half of Southeast One-quarter of
Southeast One-quarter of Section 35, Township 28
North, Range 16 West. it
r;
This Deed is given in consumation of a Land Contract between
the parties hereto dated
tj. 0
This -__.____.._iS---not-- homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And---------. Eldon.--F-..Hi 1 I.......
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant a defe d the same. 92
Dated this - day of ------------July.---•---------_..------------------., 19
- (SEAL) (SEAL)
Eldon F. Hill
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Of__Eldon__F. _H .ill STATE OF WISCONSIN
ss.
County.
uth . ted th' .l.~?day of.......... July 19 9 2 Personally came before me this
y day of
19........ the above named
.
Robert-- R. Gavic
-
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not- - - - -
authorized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Robert R. Gavic
---------------------Attbrri~~y- at---Law--------------
Spring.._i7al.ay WI Notary Public ---------Count Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date:
•Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN
.
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 1q eu0 ~A06-,AJ ~Vmto Ll
ADDRESS W FIRE NUMBER
CITY/STATE l.As/.mot , C/-JZ ZIP 5 ~o ~o
PROPERTY LOCATION: 1/4, 1/4, SECTION , T N-R W
TOWN OF ne , St. Croix County,
SUBDIVISION , LOT NUMBER
Improper use and maintenance of your septic system could
result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three
years or sooner, if needed by a licensed septic tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant
for a maximum of 60% of the cost of replacement of a failing
system, which was in operation prior to July 1, 1978. St. Croix
County accepted this program in August of 1980, with the
requirement that owners of all new systems agree to keep their
system properly maintained.
The property owner agrees to submit to St. Croix Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper
verifying that (1) the on-site wastewater disposal system is in
proper operating condition and (2) after inspection and pumping (if
necessary), the septic tank is less than 1/3 full of sludge and
scum.
I/We, the undersigned have read the above requirements and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning officer within
30 days of the three year expiration da e.
SIGNED: LA'_~
I DATE: 7- 2 7- 9'a?_
St. Croix co. Zoning Office
911 4th St.
Hudson, WI 54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
MDUSTRY, c DIVISION
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWN50IP/MUNICIPA/LITY: LOT~N/O.:BLK../NO.: SUBDIVISIIO NAME:
S
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
%J
USE DATES OBSERVATION MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER 0 A I N TESTS:
Residence 14/4 ZNew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GRQUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(opti nal)
❑S1~U ,Z]S❑U ❑S~U ❑S®U ❑Srll ,~~2
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
F PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ft ELEVATION OBSERVED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- :3,DQ
Soll 1/1 , ` rr e af1G 5' d'/s".' ° ' ~.~rs~" ° yZ 1F'13r, s~'
B- IS, O 1 ~Qi'1 •5~ mss; o 0 1s, / •.5'3 eel, s 7 S r
B- 2,91 9:5-,07 161
z 6/ 5 Y3 'k, "9
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTE SWELLING INTERVAL-MIN. PERIOD 1 PERIO 2 PER1003 PER INCH
P- 37
P- S S
P- 30
P-_
P-
T
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 9 7 .
r
I
1
1
j _-F
....m.-__,__j.« -m----.~-1-- _
#j ~ 3 T l
i i l ~ i ( 7 - ~ 3 ~ 1 s I ~ r
t
_ I I 1
. i
I _ T
j_.._
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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 7,7 CST SIGNATURE:
7 r~
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal descriptii 1;
2. The use section must, irly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
S, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
0. Complete all s _ opriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if api
10. If the informa (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form a.._' place your current address and your certification number;
12, Make legible copies and distribute as re<luired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Sail Separates and Textures Other Symbols
st - Stone (over 10'") BR - Bedrock
cob Cobble (3 - 10") SS - Sandstone
gr - Gravel (under 3") LS - Limestone
- Sand HGW High Groundwater
- Coarse Sand Pere - Percolation Rate
Medium Sand W - Well
- Fine Sand Bldg - Building
Is - Loamy Sand > - Greater Than
sl - Sandy Loam < - Less Than
*1 - Loam Bn _ Brown
sil Silt Loam BI - Black
si - Silt Gy - Gray
*cl Clay Loam Y - Yellow
scl Sandy Clay Loam R - Red
sic - Silty Clay Loam mot - Mottles
sc - Sandy Clay wi with
sic ry Clay fff few, fine, faint
*c - r cc. - common, coarse
pt - t mm - Many, medium
m - ick d - distinct
p - prominent
HWL - High water level,
Six general soil textures surface water
for liquid waste disposal BM - Bench Mark
VRP - Vertical Reference Point
TO THE. OWNER:
l r ° is i may request
r r n private
}i c ler to
and pos :d prior to the f cCion.
J
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
ROBERT ULBRICHT Owner: MIKE HUMPHRIES
655 O'NEIL RD 550 HWY 63
HUDSON WI 54016 BALDWIN WI 54002
RE: Plan Number: S92-02050 Date Approved: July 22, 1992
Gallons Per Day: 450 Date Received: July 8, 1992
Project Name: HUMPHRIES, MIKE - RESIDENCE Location: SE,SE,35,28,16W
Town of EAU GALLE 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) 266-6952.
G11~
SBD 64231R. W/OI I
1
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
ROBERT ULBRICHT
Page 2
Sincerely,
"Q.S.
ALLEN WENDORF
Section of Private Sewage
Division of Safety and Buildings
PPP020/0009n/ 4
cc: MIKE HUMPHRIES
-Private Sewage Consultant _County UW-SSWMP -Plumbing Consultant
Owner Plumber Environmental Health
I
I
SsD 64231R. 0l/9U
4
SAFETY & BUILDINGS DI' ISION
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
ROBERT ULBRICHT Owner: MIKE HUMPHRIES
655 O'NEIL RD 550 HWY 63
HUDSON WI 54016 BALDWIN WI 54002
RE: Plan Number: S92-02050 Date Approved: July 22, 1992
Gallons Per Day: 450 Date Received: July 8, 1992
Project Name: HUMPHRIES, MIKE - RESIDENCE Location: SE,SE,35,28,16W
Town of EAU GALLE 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) 266-6952.
C(DFY
SBO 64231R. u1NU
III
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
ROBERT ULBRICHT
Page 2
Sincerely,
ALLEN WENDORF
Section of Private Sewage
Division of Safety and Buildings
PPP020/0009n/ 4
cc: MIKE HUMPHRIES
-Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant
-Owner Plumber -Environmental Health
I
I
S80 61214R.0141I
t
1
I..L.H.R. 83.08(2)
PROJECT INDEX SHEET
Owner: X~&E l/ llvlt j~i1P ~E S 71
Address:
5VO o 2--
Site Location:
5~ S~ SC• 35'x, r1(~ 66) , Td &.)ti u
ry
57' 4401 `X Co
Project Description:
14 'lift 020
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Page 1. PLOT PLAN VIEWS
Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS
Page 3. PIPE LATERAL LAYOUT
y; Page 4. DOSING _CHAMBER CROSS SECTION
{ Page 5. PUMP PERFROMANCF SPECS
PLUMBER:
~P Y2
DATE: 9~-- SITE EVALUATER/ DESIGMER
's
SIGNATURE
fit/ r
ORIGINAL
• W
yam,
O
Prior To Plowing- Installer will
carefully
3 y shift or orient mound position ( toe line
E and area under bed agaregare) so growrd
elevations across slope are as uniform as
possible. Suggested elevations (staked on
3 B,ElI.PiH site with lathe markers) are shown herein
`i and on pg. 2.
/GOO ~a~• e.,~o3y 1`
v _
Pkke r is r
SiC-~Or/'C 1fJ~rr M /1~LvES'Tt,Pnl \ ~ ~ - _ _
---_r
1
~ o r ~ r
t' r r
$ i ~~U XL I rr ~ i
a j
00
r
E ` I f i t
~ r
i r
13,4 ceA oe r) r..,5" 13H -4
J ~t t>hTPo v = /O o' O
c
To~,u o~ %f17E
ATC P 0S 7.5, 7'
r x '
27
C7-1. ` rive i ~7 ~ Elfl/,¢r;oya
96, /d
o Z
z ?3,
133 7
i;
:
1lf~
-47 t/ftrio u 'e" 7-00/' rt j~ ,Nr F ? / 2 Q
0 L11
ly 2-
Pagel Of
o~ Straw, Marsh Hay, Or
ppp~ P r r Synthetic Covering
P1
93' Medium Sand Distribution Pipe
H..
G
•
Topsoil
3 E
(p-% Slope Trench Of 2 - 2 z Force Main Plowed y2-
Aggregate - / Layer
Undisturbed 77, yZ / D 2-'o Ft.
Soil E 2-3 Ft.
t5~
'rocs Section Of A Mound System Using F Ft.
Cad ~
~P rench For The Absorption Area G AO Ft.
co, j
C,
.0 .01' A f Ft. H 5 Ft.
QP ~ ~ B y~ Ft.
3
Ft.
OAS 0~'i ~L /2 Q Ft.
'
J /0 Ft. i'
Al terna I ' f Force Ma i n I 17 Ft.
c~E W J,/ Ft. J
L ~ k
1
7rI- ~
i
W Observation Pt rMo,nan j
Pipes Morkers
`f
P
Trench Of 2 ~ - 2 ' N f
I Aggregate
Mound Using Trench For Absorption Area
il' P Y
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Page 3 Of
VOIL)
I
~vlwc /4s r ~io~ I
Perforated Pipe Dctoll
Z,(,4R1*6A7- V/111416
r 1
i End 'Jiyw
)Perlurottd
End Cap
~ ~o``~\o PVC Pipe
1 0 0 .
Holes Located On Bottom,
Are Equally Spaced
oria
= ' Q dw Q
to
e OS.~~~I.SpFE~`l
ENO OF E
t o~ \S~oN ~ ~ ~~NG
o~eow P
tx
Dislribulion ~O~` ~S
Pipe
Last Hole Should Be
Next To End Cop
End Cop Distribution Pipe Luyoul- P
Ft.
X 70 Inches
y 3 6o Inches
Signed: Hole Diameter Inch
Lateral / Y2- Inch(es)
License Number:
Manifold 2 Inches
Date: Force Main Z Inches
# o-f holes/pipe 12
Invert Elevation of Laterals Ft.
PkL OT i C,
~J7 /5 7 i13Urlo j U~S« r1~'6z. ~ q?
j
- j
I
t r
I
- i
a PUMP CHAMBER CROSS SECTIOIJ AND SPECIFICATIONS Pf} E Y of 5
-VENT CAP
`"C.I. VENT PIPE
f r- WEATHER PKOOF APPROVED LOCKING
JWJCTIOKl BOX MANHOLE COVER
25' FROM DOOR, ill41,j U),0(l1i913-rl
WINDOW OR FRESH 12 MI►J.
AIR INTAKE
~4-047~On/ GKADE I y'MIhJ.
I
G I 16"MIm
COIJDUIT
r l1~ v~r1. cal. `
S
l INLET - _ _ . J '~~Ci • G H E - ~~~p~~ III
I~G QP` Qa CGS I III APPROVED JOINTS
APPROVED JOINT A
1J / INyi~a~ O~ O b~Ve~~L oo~ I W/E:I. PIPE
~C.I. PIPE ° III ALARM EXTENDING 3'
EXTCNDING 3' 11V0 P1 Q
ONTO SOLID SOIL ONTO SOLID SOIL
/7 , ~p~ ~ I I ON
g y g C_--
ELEV. FT.
/ i ~•~G PUMP----
OFF
5
D I,1 f
4ANKVA f o,1 I _ _ d~OCK
16 RISER EXIT PERmlirE:D ONL`i IF TAWX MANUFACTURER HAS SUCH APPROVAL
sEPrlc E S_PI: CiFIC'jiQMS
DOSE MiDGysTE/c'n> ~i~'~r~9~ 3
T IJUMBER OF DOSES: P E R DAB
TANKS MA►JUFACTUREk:
TAMK SIZE: GALLOIJS DOSE VOLUME 2-
ALARM MANUFACTURER: LtU .L '1,11y'l 4' IIJCLUDING BACKFLOW GALLONS
(J. CAPACITIES: A= INCHES OR GALLOWS
MODEL IJUMBER: -D.
SWITCH TYPE: Ni~,Plu -,e10 A T- 8 = 2 INCHES OR 39 GALLONS
PUMP MANUFACTUREK: q~OE//14 ~j C= INCHES OR 2- GALLONS
MODEL NUMBER: L~ {ok.,~~,)l f D= ~3. INCHES OR 2-.50 GALLONS
SWITCH TYPE: ~IyyYQ~~K `f~~/ 7- NOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE -30 C P,~ INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD DISTRIBUTIOIJ PIPE..~~ Z FEET TAA~k S~fGS
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EAC11,
FEET OF FORCE MAIM X Z'S FYorr.FKtCTION FACTOR.-4 Z FEET t-4OA 75
TOTAL. nytJP,MlC NEAP - _ FEET
INTERNAL DIMEIJSIONS OF I-ANK: LEL.IVTH ;WIDTH / iLIQUID DEPTH 7 „
I
I
i
i
1
i
l
f
i
f
' ' • U) W
HEADI LL
v
' 115
110
CAPACITY 34
32 105-
VURVWJIb=m 30 100 -
85
2e -
90
26 85
EFFLUENT 24 80
MODEL
_ and Q 75 MODEL 189
22
70 165
DEWATERING =
V 20
N
~ 65-
Q
} 18 60 -
55
16 50 MODEL
l 0 14 163 MODEL
r
li- 45 188 - r 11~ 12 40-
35
10 MODEL -
itw, 137, 139 =MODEL
I ~ i 0 '-A " ~ 30
SEWAGE and `l 6 25
DgWATgFRING 6 29-
MODEL
15 MODEL 161
4 7 1
10 -
MODEL
1 2 5 53.55, -
i 57, 59
0
GALLONS 10 20 30 40 50 60 70 80 80 100 110
21,
75 LITERS 0 80 160 240 320 400
22
79 FLOW PER MINUTE
2Q
14, 60 / MODEL
D 295
W 55
x /8 -
C3 50 - _
t Z 14 46 MODEL
-j-
1 p. 12 4b-
s 35 MODEL
F- 10 293 ~-t -
f O 30 MODEL
I 284
9 25 l
MODEL - - -
6 20- 282 -
15
10 MODEL -
4 vE«E~ a.
2 5 267, 268
0 8280 Ofd Milers Lane
GALLONS 10 120 30 4) 50 60 70 80 90 100 110 120 '130 140 15P 160 170 180 190 P.O. Box 1047
Loulsvllk Kentucky 40216:
LITE JS 0 80 160 240 320 400 480 560 640 720 (502) 776 2MI
FLOW PER MINUTE
itltt~c -
'97„ Cast Iron Seder CAPACITY
HEAD UNITS/MIN
j~ \ • Automatic or Non-Autornatic. Feel Meters Gal. Las.
5 1.52 5 216
• H.P., 1 Ph., 115V or 230V. 10 3.05 51 1 193
• Non-clogging vortex impeller design. 15 4.57 43 163
j} • Passes Sz" solids (sphere). 20 6.10 27 104
• 1', NP T discharge. Lock Valve: 24.5'
• Float operated submersible (Noma 6) mech-
arlical switch. 97 Seder
• Automatic resat thermal overload protection. JI listed SC-2225
• Stainless steel screws, guard, handle and arm and N~Na
sea] assembly.
• Watertight neopren, t:l'• ring between motor and
1~ Canadwn Standards
pump hOllSlllg. Assoc. Approval
v
Ii avadaUle
N97, nwl-auton4atie, available paceagad with a piggyback mareury
lloal switch.
h
Tommy G. Thompson SAFETY & BUILDINGS DIVISION
Governor
Gerald Wbitburn
Secretary
State of Wisconsin
Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL, Western Regional Office
2226 Rose Street
LaCrosse, Wisconsin 54603
BOLDT'S PLBG &-HTG. Owner: MIKE HUMPHREY
820 MAIN STREET 550 HIGHWAY 63
BALDWIN WI 54002 BALDWIN WI 54002
RE: Plan Number: S91-40056 Date Approved: April 1, 1991
Gallons Per Day: 450 Date Received: March 25, 1991
Project Name: HUMPHREY, MIKE Location: SE,SE,35,28,16W
RESIDENCE
Town of EAU GALLS County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- REPLACEMENT PETITION
- REPLACEMENT MOUND
Inquiries concerning this approval may be made by calling (608) 78' -c^ ~ 4 Z$
7
V-r7
C=3 co
m
C)
O
00 t" 1
h
rT, C W Co
4
sUD-6123 i rt. u7fti
Tommy G. Thompson SAFETY !E BUILDINGS DIVISION
~
Governor
s
Gerald Whitburn
Secretary
State of Wisconsin
Department of Industry, Labor and Human Relations
BOLDT'S PLBG & HTG.
Page 2
Sin rely,
ERARD M. SWI
Section of Private Sewage
Division of Safety and Buildings
PPP039/0009n/15
cc: MIKE HUMPHREY X Private Sewage Consultant
i~
N
i1
;a
!Y
SRD-6428 K.Offloi
1
. x _ _
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
I
201 E. Washington Avenue
'lar'ch 28, 1991 P.O. Box 7969
Madison, Wisconsin 53707
i
•9IKE IIUMNIREY
550 H IOHilAY 63
3ALDWIN WI 54002
Plan 1.1). ido, S91-40056-P
Gear Iir. Humphrey:
r~e: iltike Huriphrey - Residence
Onsi to Sewage System
SE,SE,35,23,1614
Town of Eau Galle, St. Croix County, 1
Your petition for variance to section ILHt 33.23 (1 )(d), ttisconsin
Administrative Code, has been reviewed,
The rule being petitioned requires sa mound syster: site to have a r iniinum of
24 inches of suitable natural soil,
The variance requested was to install a replaces=lent mound system on a site
with 12 inches of suitable natural soil,
The following comments were made in the petition analysis:
1. In reviewing the petition, it was noted that the request was si:ni 1 ar to
other petitions accepted by this department under petition numbers
S89-03304, S39-03318, and M90-00072,
2. Based on the precedent establisheu by the previous petitions, this
petition for variance is being processed as permitted by Wisconsin
Statute Section 101 .02 (6) (g).
SBD-6928 (R. 10/87)
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
Nike Humphrey
Page 2
March 28, 1901
Departmental Action: Approval.
This approval is granted with the understanding that all of the petitioner's
statements and any conditions of approval cited above will be carried out.
Prepared by:
Gerard Swim Plan Examiner
Onsi to Sewage Sec ti on
(608) 735-9334
Reviewed by:
San we er, PE, CPSS
Environmental Engineer - Supervisor,
Onsi to Sewage Plan Review
f,
Departmental Signature: Date: 7
iii enard ; leyer, 'rc i ect
Director, Office of Division Codes and Application
GIaIS:2404e
Enc.
cc: Leroy Jansky, Private Sewage Consultant - District 5, Chippewa Falls
Thomas Nelson, Zoning Adrr;inistrator - St. Croix County
Dale E, Hudson, IMP 7#6629
SBD-6928 (R. 10/87)
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
11arch ? , 19:31 P.O. Box 7969
Madison, Wisconsin 53707
MIKE illUMPHREY
550 111GHtiAY
1t",LD1 II14 WI 540012
i
I
Plan I.D. No. S91-40056-P
i
I
Dear olr. Hunphrey:
i
Re: iliIce Humphrey - Residence
Onsi to Sewage System
SE, SE, 35,28,1 6W
Town of Eau Galle, St. Croix County, W!
Your petition for variance n IL+i ,'i. X33 23 (1)(d), Wisconsin
e to section
Adninistrative Corse, has been reviewed.
The rule beii g petitioned requires a round system site to have a r1inimum of
24 inches of suitable natural soil.
The variance requeste i was to install a replacement mound system on a site
with 12 inches of suitable natural soil.
The following comments :ere made in the petition analysis:
1. In revie.wino1 the petition, it was noted that the request was similar to
otaier petitions ac -,epted by this Department under petition numbers
S69-03304, S89-0331-1, and S90-0(1072-
2. Based on the precedent establ isi'ied uy the previous petitions, this
petition for variance is heint; processed as perriitted by Wisconsin
Statute Section 101.02 (5)(9). 5 6
Cc~ r .7 ~
tti (O
Z " 0
l
SBD-6928 (R. 10/87)
- - - - - -
r State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
Mike ',urnphrey
Page
1 to rch 28, 19'3l
Departmental Action: Approval
This approval is granted with the understanding that all of the petitioner's
stateiAents and any conditions of approval cited above will be carried out.
Prepared by : l" L r` 1r~.` 1 , a LA
Gerard win
Plan Examiner
Onsi to Se,fage Section
iCG 785-9334
Reviewed by:
7T Rock Ne 1 ! er , Pt , l,S -
Environmental Engineer - Supervisor,
Onsi to Sewage Plan Review
Departmental Si gn<a Lure: .4~ / ~ ! a~, t ~ Date:
i r ///r
Tai cnardL_.-f'feyer, rc l be -
Director, Office of Division Cotes and Application
GMS: 2404e
Enc,
cc: Leroy Janslky, Private Sewage Consultant - District 6, Chippewa Falls
Thomas Nelson, Zoning Administrator - St. Croix County
Dale E. litidson, F;? -46629
I
SBD-6928 (R. 10/87)
- - -