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HomeMy WebLinkAbout024-1015-60-000 Q c U o• ~ o rr C d ~ 1 O Y U ~ "O O O d a) O w O O C y 3 a c = C co E o 0) [r) O oM°o~ C M O x m a cl) ° Er) CL 3 0 0 O Y Y N 7 C N=O ma) N a0 y p O M.--a X ~ 4O a) J C f6 3 (CS C 01 LL C O a) O U - O N O O E f0 O C ~ T3 O O. r. (9 E < O a) U N M CL d' N W z p z y y rn 04 d m N a) z ~O ca u :3 (D Z d• cn N ~ C y y ° 00 0 0 0 L C N N N N •~i c Q O O O N Mi1y Q Q Q N N N O "v g ° `0 v C z z z o 0 0 o w ~ C - C 06 .p a) N R m U o - L LO d f6 N ~y LO m ~y y `rl N N v ` n a) D a C h n O V) cn cn _C U 2 J C O N 11 tp U rn 0) !r~ o r r N ..J `00 04 (D 0) : c o N E r- N o 7 cc O ter., O U m O • C o- d z `ro N N y~ O 0 C C cD LO f- O N o m y °w C p - rn °o 00 0 r_ C 16 C O O r. O O N ~w f- I- N O N C m E E U r N rn Ci C', -2 • ira O O O N CD m 0. EL 0 • C~ CL N .V a) r c o L C ® t°7 a o in 0 LO~a~'isT~QTt~partsr'y,VALLEY County: Labor and Human Relations EWA i Safety and Buildings Division INSPECTION REPORT ST. CROIX iSENERAL INFORMATION (ATTACH TO PERMIT) sanitary Permit No-: 186509 Permit Holder's Name: ❑ City ❑ Village [A Town of: State Plan ID No.: T VAL v.: Insp. BM Elev.; BM Description: Parcel Tax No.: 024-1015-60-000 TANK INFORMATION ELEVATION DATA A9200393/0/ 2- cc,~e~i TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (~i C~ e nC / G1; Benchmark i~Jc'1 3 6' , J~~ Dosing d o 109, pia Aeration Bldg. Sewer Holding St/e Inlet /QTANK SETBACK INFORMATION St/~of Outlet Verit TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic WrE qd t o' NA Dt Bot OV,17 Dosing CIO E, 60 'x ' NA -kr / Man. ti 01 Ae NA Dist. Pipe Gb' Holding Bot. System PUMP/ SMU" INFORMATION Final Grade Manufacturer ~eXcl 1~1 'o" 97, d1p Model Number lof /Kea GPM TDH Lifter Lriction~ System ,5d TDH 33 C , oss I- PA E Forcemai n Length--,,)76' ength 375 Dia. a" Dist. To Well I I - I F SOIL ABSORPTION SYSTEM BED/TRENCH Width y Length i No. Of Trenches PIT Inside Dia. Liquid Depth DIMEN I N EN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING facturer: SETBACK ~ INFORMATION Type O r , CHAMBER Mo el Number. System: iyc^,-a OR UNIT DISTRIBUTION SYSTEM his~/ Manifold Distribution Pip'reI ee ,t x Hole Size x Hole Spacing Vent To Air Intake Length _AA__ Dia- -2e/ Length 3't e Dia. Spacing 3/9 " &V I 1> 160 1.4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over r, Depth Over ~s xx Depth Of xx Seeded 19edded'- xx Mulched gr&/Trench Center Bed /Trench Edges f IF Topsoil ❑ No ~r"r ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 27 C) jUC (7/ ~//cry.;. c1-/ H./) PL ' c+ LOCATION: PLEASANT VALLEY 9.2$.17.84B,SE,NE,C4. RD. r 41, Plan revision required? ❑ Yes RroN'o p Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert- No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code ti -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SA IT RY PERMIT 8t% z x 11 inches in size. ~ 4/ ❑ Cheok i ev ion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. . ~QIrO PROP TY OWNER PROPERTY LOCATION S& Y4/~4=/4,S T TN, R E(o PROPERTY OWNER'S MAILING ADDRESS OCK # ~r _ 7 CITt, STATE m 2E[ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR SM NUMBER ~ 0 ' 11. TYPE OF BUILDING: (Check one) ❑ State Owned 0 V CITY ILLAGE + NEAREST ROA ❑ Public 31 or 2 Fam. Dwelling- # of bedrooms a PARCEL AX . UM E l U"00 IIII. BUILDING USE: (If building type is public, check all that apply) 9 10 Apt/Condo 20 Assembly Hall 6 El 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. 91 Replacement 3. ❑ Replacement of 4.E1 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 R Mound 30 ❑ Specify Type 410 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 3?-6' 74- /V/J- 0 6,, 2-Feet /0v/Feet VII. TANK CAPACITY in alions Total Prefab. Site INFORMATION Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App structed Septic Tank or Holdin Tank Tanks Tanks ~~>(A U y -ea S-~ Lift Pump Tank/Si hon Chamber I El F1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Sign5ture: (No Stamps) MP/MPRSW No.: Business Phone Number: e.11 i L) 7a- )4g Plumber's A dressy treet, City, State, Code . IX. COUNTY/ EPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issue Iss ' Agent Sign u (No Stamps) Approved ❑ Owner Given initial 4. Surcharge Fee) P) (A 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 sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls:. dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) STC-loo This application form is to be completed in full and signed by the Other(,) Of'the property being developed. An inade9ua will only result in 'delays of the permit issuance Any Should this his development be intended for resale by owner/contractor,(stpec house), then a second form should be retained and completed when the property is sold and submitted to this office with he appropriate deed recording. ..--------r.rw+•----rrra-------------------------------------------------- Owner of property Location of property,: - 1/4 Z ,L'. 4, Section' T N'R~W .Township,. Nailing Y address Address of, site Subdivision name Lot no. ttfi"` other homes on property? yes t' No Previous owner of property Total size „of parcel r ~~c s Date parcel was created 1 01 ,r Are all corners and lot lines identifiable? Yes .H0 In thin property being developed for (apes house) ?,,,,,_Yes ; No volume And Page,, Number ,,~1rs as recorded. with the Register ; M of Deeds. 7`" a r..-----..rrr----- .--wrrr--------r.rrrr-r..•rr-rrr..rrrrrrrrrrr ,f INCLUDE WITH 'TIIIS APPLICATION THE ]FOLLOWINGS fl A WARMUITY DEED which includes a DOCUMENT NUJIDER, VOLUHE AND PAGE HUMBER h THE SEAL "Or 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 eartified'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 ' th best.of ny (our) knowledge that I e the property described in this information am (are) the owner( form, by virtue Hof 4a warranty deed recorded. n }le office of the county Register of Deeds as Document Ile6 own the p and that I (we) presently proposed site for the sewage disposal system 'or'I;(we) obtained an,,,easement to run the above. described pBPerty, fofi the construction iEo r said;_system i; and'"the`"`same, ' I)MA11 been ;1~duly record ad° in wthe~'office 'of county Register of deeds as' Document Signat a of. 'ap 1 cant ' Co-appl cant Date of //S gnat re F bate of Signature fir. ~s 1 • ~r+ r r~ I t. 4, , k i ` < ~,4 k, ~ .qtr , SEPTIC TANK MAINTENANCE AGREEIIENT St. Croix County .r, Now o OWNER/BUYER J ~Cy p ROUTE/BOX NUMBER-_ Fire. dumber d CITY/STATE ZIP PROPERTY LOCATION: '.i Section T N, R~W, 2:7Q Town of St. Croix County, Lot number____ Subdivision Improper use and maintenance of your septic System could result in Rw its premature failure to handle wast e sverPrreemainrenance con- sooner, gists of pumping out the septic t Y th if needed, by a l-idensed• 'se t-ic tank pumper. What you put into the systems can a ect t e' unct on o, t e 'septic .tank as a treat- ment'stage in the waste disposal system. . Croix Count residents'ma'be eligible to£reecieve aggrantefor 5t. a maximum of 60% of the cost.of replacement St.. Croix County wh c was in operation prier to-July accepted this program in August of 1986, with the re quirement properly that owners of all hew s !'hems agree to keep their system maintained.' The property owner agrees to. submit to St.. Croix County Zoning a certification form, signed by the owner and by a mater plumber, veri journeyman plumber, restc wastewaterrdisposalcsystempi~spin proper if rope Eying that (1) the on-site operating condition and •(2)•after inspection and pumping ( esaary)j the septic`.tank is less than 1/3 full of sludge andtscum. Certification form will be sent approximately 30 days •'H three year-expiration. o Ji I/WE, the undersigned have read the above requirements ire entsandcagree to maintain the private sewage disposal sy Wisconsin Depart- the standards-set forth, herein, as..set by the pp meet of Natural Resources. Certification form must be om leteya and returned to the`5t4 Croix County Zoning Office of the three year expiration.date. SIGNED DATE ID'~~ fl St. Croix County Zoning office 911 .4thSt. Hudson, WI 54016 386-4680 r Sign, date and,return to the above address. , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS WDUSTRY,14" DIVISION LABOR „ND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMARI RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWN UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SI ~ i - 1/ K) f'-; C I/TIS N/R V, E (a - COUNTY: ES : 14 60 (Z-,Tw S'T'. CNLQ'1V JDAIL >€hi A1E131J Yltl-L h~OtuD W) s~~)5 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: rr~~rr I ROFIL DESCR IONS: PERCOLATION TESTS: Residence 3 N A ❑ New rxReplace l S- ZO - 9) 6-))-91 RATING: S= Site suitable for system U= Site unsuitable for system CAJ.S 1T-'Z'- 81-/ S1" -T*6"~ OA' 5_-4)-9) ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) L U 0S ❑U EIS ZU ❑S (~U "S ❑U suBJt'r-l- '`O V P%NLI RNCtl P11-1PROUn L If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the NA. under s. ILHR 83.09(5)(b), indicate: N-A. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 4 3 1©S.V Z3 zz s P~~E 3 0t= 3 t, B- Z y I 103. q l q \ -S B- 3 O 103. l 8 1 S I, B- Ll ~t l o S-Z l 9 ) 6 B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ ZQ0 ►~0 30 5/g sis 5~6 8 P_ 2 ZZ 1 10 3 C~ 5/s 9/!E, 9/!6 S 3 P- Z.4 N O O `I~! 6 y~ "lt 6 4/ 1/ P_ 20 N O 30 ~/g 3/y 3/ Li v 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 rltiN• zy"oF s►o 8 19 T 7-11111- r_-_11.__T___ t f 3 } r l T 'L C~,r" fn t to i 1 _ _~~~~5 _ L40 _ Il L10~ sT - - r I I ( r C_ oM_ { . 1. LOS `t101J S L1 I i t I I I 4 s~ . 9 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. wPG_E_R__E_R__ S_ 011 TESTING NAME pr n AND TESTS WERE COMPLETED ON: DESIGN RERVICE ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ^Sr01)bS--) 16 7JS-L4ZS-0/6S F? 0. BOX 74 A21 N. MAIN eT, RIVER FALLS. W154022 CST SIGNA URE: 715-425-0165 91-sy DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - 1 t?d► s INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly 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; 5. 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 scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; It. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols at - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. , SLOT ~L~?~I -77 ^Z o • y Vn L'tom c-T-H tz!~ Lo mu Q~ Zsa ~ ~ i r d i x v oars f ~ •TP~1z a IL C~RR1~5e 3 ~8DRw1 ~ 2 V x ~ WELL Q o ~D ON TDP OF COAJC.R.@--TE ~tbRCH, 13'N~Z- `,L. ~0°l•O' W ~M Q OF I/Z'l ~.R.01J C~4D~ Zo X1614 %T' BU1l0~~G 5?-" ER. L P~wN pz t _ ~ ~ oR DlSN29 F) LL t) ° 1 T►FIS R2t9A 1 310 ~ 1' 1 ` 1 1 1 PROI~S~ NO~~ 37 -z_ (!AAjyb\jiz LL. lOy.2 ~~GL Z ot= ~ SOIL DESCRIPTION FORM Attach Sold Pro Ile Location Me On a Su areto Shoot) c~ E RATJD~~,~ 1'111tC~Al ~AtIJ M I LL ER LINEAR LOADING RATE: Z~,Z,S IQQ PST b . o PURPOSE SLOPE' DESCRIPTION BY A FZTl-}UR L • I~ ~G ~Z ASPECT' S d U••Tliffl L t,., / - F~1 k` ( -Lt, , q R GATT CURRENT LAND USE: - COUNTY/STATE ST cZ% \ 4 C uij - -t ► Ly VEGETATIVE COVER: G 211 S S LOT DESCRIPTION'"I'T 6FTI}2 SE11V NEB/fc SLC.gtTZSk), R11kJ DRAINAGE CLASS: MoD~2~1TE~Y 1^1 X-L LOCATION -7~,I.~JN O(= RUSH RI Uem GALLONS- PER SQ. FT. PER DAYt -Z~,E~s LG►J mrr a • ZS PARENT MATERTAL(s)/DEPTH - SOIL SERIESt ~R~~-dam S - . HORIZON DEP111 MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS P11 .BOUNDARY REMARKS in. 010 1st Gr Ss. Shp COATINGS Sofizt ~ I O-$ Z~yR 3/3 S1•1 Z+ns0r_ NY\ ~r cs z $ - ZZ 1Z m y 1 y - s ) I Z, m Ib1z M. 42-5 C S 7.S`7R S~6 "n0T 3 Zz-z3 lu`tr~ 4t/y c 2.0~ Si ~ ZM s~k ►n Z3 -(I3 c Z~ s I Z c sNb yv% SoT l . Z 1 O-b 1r,-)LI tL 313 - S1 I Z1nS~1c vv~ Fv CS _ 2 ~3 t opt y 1 Y s 11) Zm s'bh Y►1 a. s _3 13- 19 loLIR Vl c z~ s 1 I 2m s~k yn sv p- 5/8 *07- 19-W ~.5 yR 3 /y G Z~ s I 1 Sbk )y1 i -7.1; Litz S/G 1n OT 1 O_9 tD`iR 3)3 - 51 1 ZmSl~lz Z 1-\s I bti R y/y - n s i t Zh1 s ~k ►^n a, S 3 IS-18 v%,IR VIV GZOC S l~ 2m s bYx M1 `E'H L` S 7.S`!12 518 ►»oT L.l lg-yD ~,s ~R 3 J~ c ZcQ s 1 1 soh YY, ; SVP- 3l6 RIOT ~o -L)c O-S 1ZHR 313 - s1~ 2ri►S?,12 n1`FT~ eS Z $-1b Lo'cP_ Y v - S i I em 3Mt >"L ~h ors 3 lb-Nq Ic"tz y/ CZ k s i I Z - S'bk Yq1' , 0-s ~;S`ti~ sls Mor 19-y -).SLIP 3)y Q--?-dl S~ 1 %,bk ~n~i -s~Ie 516 r„oT. Srssu L . ~1 lr~ •S11'71 SO! OTHER SITE FEATURES/NOTES: 000,526 nn 3 of 3 LIMITING FACTORS/DEPTH: Signature Date CST M REPT131 PLEASANT VAL ST. CROIX COUNTY ZONING PAGE 1 10/26/92 15:48 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/27/92 AREA: JT Activity: A9200393 10/27/92 Type: MOUND Status: PENDING Constr: Address: PLEASANT VALLEY 9.28.17.84B,SE,NE,CO. RD. T Parcel: 024-1015-60-000 Occ: Use: Description: 186509 Applicant: MILLER, RANDALL S & MIKEALEEN J Phone: Owner: MILLER, RANDALL S & MIKEALEEN J Phone: Contractor: LICKNESS, CHRIS Phone: 684-3730 Inspection Request Information..... Requestor: LICKNESS, CHRIS Phone: Req Time: 09:10 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION i 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 WEGERER SOIL TESTING & DESIGN Owner: RANDALL MILLER PO BOX 74 460 CTH T RIVER FALLS WI 54022 HAMMOND WI 54015 RE: Plan Number: 891-40509 Date Approved: July 8, 1991 Gallons Per Day: 450 Date Received: June 24, 1991 Project Name: MILLER, RANDALL Location: SE,NE,9,28,17W RESIDENCE Town of RUSH RIVER 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 I Inquiries concerning this approval may be made by calling (608) 785 9 G c s N 3 v E Z S HD-6423 1H. 01 /911 v . SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING & DESIGN Page 2 SiAGERARD rely, M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/26 cc: RANDALL MILLER X Private Sewage Consultant I SUD 9423 (N. 01/91) s ~ »w»«► I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Boa 7969 Madison, Wisconsin 53707 " State of Wisconsin Department of Industry, Labor and Human Relations July 2, 1991 RANDALL MILLER 460 CTN T NA1*10ND WI 54015 Plan I.D. No. S91-40509-P Dear War. Miller: 6 Re: Randall Miller - Residence Private Sewage System SE,NE,9,2.8',17W Town of Rush River, St. Croix County, WI Your petition for a variance to section IUR 83.23 (1)(d), Wisconsin Administrative Code, ha& been reviewed. The rule being petitioned requires a mound system site to have a minimum of 24 inches of suitable natural soil. The variance requested was to install a replacement imound system on a site with 13 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 similar to other petitions accepted by this department under petition numbers S89-03304, S89-03318, and S90-00072. 2. Based on the,..preeedent establisb.ed by the,.,pr vious petitions, this petition for variance is being processed,as ermitted by Wisconsin Statute Section 101.02 (6)(g).' Departmental Action: Approved. I S RD 6928 i R. 0 119 LU i SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations RANDALL MILLER Page 2 July 2, 1991 This approval is granted with the understanding that an of the petitioner's statements and any conditions of approval cited above will be carried out. µ Prepared by: l.} . Gerard wim c - Plan Examiner Private Sewage $ tion (60) 785-933 Departmental Signature: Date: 72-1 c ar ey , rc n c Director, Office of Divisi n {lodes and Application GMW:182WPP3 Enc. cc: Leroy Jansky, Private Sewage Consultant - District f, Chippewa Palls Thomas Nelson, Zoning Administrator - St, Croix County Arthur L. Wegerer, 0-915 P a SBD 6928 (R. 01191k , Page 1 of MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE 891-40509F LOCATED IN THE SE 1/4 OF THE U 6i 1/4 OF SECTION cl , T Z$ N, R 1-1 W, TOWN OF ~~s~y C2~y~a , ST. C~~ZX COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PA GE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~►~~vo T~ r-~ t LL Ak-1 lei p~..~'D ~ W } 5 ~ 0 l 5 PREPARED BY WECEI~EF? SQ I L TEE3T I P4(=- AND C~~ I7E~ I C~t~1SEF=cV I CE -S s/ q P.O. SOX 74 421 N. MAIN ST. AMUA WeDEM RIVER FALLS. MI 54022 = d,44~RTH• 715-425-0165 s wis JOB NO. - S O . y YYt -'C o cTl•1 z " O . Jn I p C.`[TI N " ° 40 5) 0 i I r a P w ~ y PbC-~ ~,iST. 1 No'T~: ~\S'1~►~G ~•'POJle3' 1'0 v f7.icS S GG, .R~►~oU~ c6t J ~YCtsT. f4tBAIJDMIM AS PAR. Chbe 3 ONSIFT SEW ZO' OF GE gYS $M" ~ Q • ~,1~L C~ARA6t 3 ~~Rw1 SU ctio tI Co I 0'a Iff VwD PPIR V TI NS 2. 0 MON REI_A v F tNDUSjRy LABOR UILDING& ~ ~TI`J1%S~i~ 0• A OEpA, SION x ~ OEI~CE o V) SEE COR ~ 3ss~ DF z PUC. aM 1 - S- I00. 0' oN `IvP of co+j cw~:M ;POR.CH, I~ 'li11#L- ti0°I.O~ CuJ 7Ufl OF I~Z" ~.R.Q1.l ~OD~ zo ~ISH,~r Bv~l.o)x1G cau,.►~z. i I - t~w1J i " I ~ P 71 B.I \ 1 ,I\ ~i 'DO ►JOT td"fPlt~-T 3 L O 6 . _ \ ~ oR a ISTv28 T>•}•IS RQV°A LLD ° ~ ~ 1 ~ 3zZ'c.en,'to V R ei., lo4•L NOTES: .1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be t0o0 gallon capacity manufactured by V YCLS~-zR CtyUC~krTE PC`ZlJ~~C'TS 5. Bench Mark S 1~Z6vt~ PLhN 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of 6 ; Approved Synthetic Covering 1, -zr 14 i Distribution Pipe Medium Sand _ _ H_ -~G Topsoil F Elev. I O 6 .Z ~i 3 E o b 3 % Slope ONS E SEWAGE SYSTWed Of 2"-'2 %2 (Force Main Plowed Aggregate From Pump Layer ~t?Y2~tr~t0~ ~ ighad Vm~mw&., D Z_ o Ft. A C E Z• ~5 Ft. IyLl ~ e lY, iti ~~R s~tJNWtflblvATVNSA Mound System Using F g q Ft. DEPAR t MC F A Ft. ISION 1 VR h- For The Absorption Area G N. o A S Ft. H 1• S Ft. SEE CO DENCE B -1S Ft. I 16 Ft. Linear Loading Rate= 6.0 GPD/LN FT 11 Ft. Design Loading Rate= O.Z'iGPD/SQ FT K Ft. L 1~1 Ft. Alternate Position of Force Main W 3 Z. Ft. L Force g K Main~- A - - W Trench Of 2~ - 2 2M Distribution Pipe Aggregate Permanent J Observation Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Page Of Perforated Pipe Detail 0 S91-405 9 End Co End Vi.- PVC )Perforated PVC Pipe Jo~~o o~°c Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop PVC Force Main Distribution Pipe Last Hole Should Be Next To End Cap `~,,AG SYSTEM ' CJ`~yv ist ' ution Pipe. Layout P 3q-(S7 Ft. ® ria ~ x 6`f Inches Y 6 Inches ~ r RELp71nNB 3/0 Inch AFAR Hole Diameter t.~BDB pti10 1NRS~ Lateral Z Inch(es) p~PF~R~~ S10e10 Manifold - Inches SEA OpRR Force Main Z Inches # of holes/pipe -7 Invert Elevation of Laterals Ft. N " Place lst hole 3'L from tee with succeeding holes at 6 y intervals. Last hole to be next to the end cap. ' PUMP CHAMBER CROSS SECTION AAJD SPECIFICATIOMS ' PAGE S OF 9 VENT CAP ~ 0 4'C.I. VEIJT PIPE .40 WEATHER PROOF APPROVED LOCKING MANHOLE ? 25' FROM DOOR, JUNJCTION bOX COVER WITH WARNING LABEL wINDOW OR FRESH IZ~MIU. I AIR WTAKE I GRADE `I" MIIJ. WAIN. COQDUIT !8"MIN. EN1 SE I IAILET co jilivaAJOVIDE I I APPROVED JOINT A Alp oy AN RE~p~tONS i I i I APPROVED JOINTS A1301~1 AND aJi CGS I i F INDLi`.1 I I I ALARM ~PAR~MENT I I CE i I ON CE GppR~ I LLEV. $'l" "l FT I PUMP-~, OFF left. 0 L ~TL 86.0 O' COAICRETE BLOCK 3" APPRwe' RISER EXIT PERMITTED OWLy IF TAWK MAMUFAGTURE:R HAS SUCH APPROVAL. BEDDING SPEC.IFICATIOMS 005E ""E-3ER cots ~'1Z? .PRoDuaTS - 3-mil TANK MAAIUFACTU0.ER' . NUMBER OF DOSES: PER OAy TAWK SIZE: GALLOWS DOSE VOLUME ALARM MAUUFACTURPrR' S"S' 'EiLN~~CN7-J3 S`t3T'R-MS INCLUDING OACK►LOW: 1~Z'3 GALLONS MOOCL WUMBER: CAPACITIES: A= Jl- lZiNCHE509 6 ALLON3 SWITCH TSPC: 8 = Z INCHES OR 22'' G~l.LO1J5 PUMP MAIJUFACTURCR' cbmy. r tj-f C = 6 INCHES OR L "Z-- 3GALLOMS MODEL DUMBER: 3 D= 1y INCHES OR US l • q GALLONS SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE MIWIMUM DISCHARGE RATE 36.68 GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AUO..DISTRIBUTIOM PIPE.. 19'53 FEET MIWIMUM NETWORK SUPPLY PRESSURTE/.. . . . . , 2.50 FEET + 3 S S FEET OF FORCE MAIN X .2'Z'L/ FY0 Ft.FKICTIOW FACTOR. 2-95 FEET + = TOTAL OtiIJAMIC HEAD = 2-9-98 FEET DIAMETER 4 IUTERLIAL DIMENSIOW~ OF TANK: LENGTH c1q TeP ;WIDTH T0';LIQUID DEPTH 36-=_ BOTTOM AREA - 231= GAL/INCH z AS PER MANUFACTURER = Z8:"7) GAL/INCH HEAD/CAPACITY CURVE 161,163 AND 165 SERIES W TOTAL D HEAD/FLOW PER MINUTE EFFLUENT ANDDEWATERING ~a so SERIES 161 163 165 FT. M. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. 24 so 5 1.52 106 401 61 231 61 231 MO EL 10 3.05 100 378 61 231 61 231 70- ODE a zo 15 4.57 91 344 60 227 60 227 W 163 20 6.10 82 310 59 223 60 227 = so V 1s 25 7.62 74 280 57 216 59-223 a 50 30 9.14 65 246 55 206 58 220 } 40 12.19 46 174 46 172 55 206 p 12 ' 50 15.24 21 80 33 125 51 191 J o OD L 60 18.29 15 57 43 161 0 s 70 21.34 30 114 20 80 24.38 14 53 4 90 27.43 10 100 30.48 Lock Valve: 56' 66' 87' 0 GALLONS 10 30 46 50 60 7; ao 90 100 110 ~vr r.~ i LITERS 0 so 160 240 320 FLOW PER MINUTE *441 St andard all models - Weight 77 lbs. - 20 I'L cord - % H.P. 161 MODELS 1x-11%NPT ConMolSelection :11xNPT(On) Model Volts-Ph Mode Am Sim lex Du x ' NpT M161 115 1 Auto 14.0 1 or 1 & 9 N161 115 1 Non 14.0 2or2&8 3or5&6 D161 230 1 Auto 7.0 1 or 1 &9 E161 230 1 Non 7.0 2 or 2& 8 3 or 5& 6 F161 230 3 Non 3.0 2&4 3& 4 or 5& 6 T-A 'H161 200 208 1 Auto 8.2 1&9 - '1161 200208 1 Non 8.2 2&8 3or5&6 'J161 200 208 3 Non 2.2 2 & 4 3 & 4 or 5 & 6 /ex `G161 460 3 Non 1.5 2&4 3&4or5&6 i Standard all models - Weight 77 lbs. - 20 M cord - % H.P. 163 MODELS Control Selection Model Volts-Ph Mode Am s Simplex Duplex M163 115 1 Auto 14.0 1 or l &9 - ° N163 115 1 on 14.0 2or2&8 3or5&6 J D 163 230 1 Auto 7.0 1 or l &9 - E163 230 . 1 Non 7.0 2or2&8 3or5&6 F163 230 3 Non 3.0 2&4 3 & 4 or 5 & 6 SELECTION GUIDE `H163 200-208 1 Auto 8.2 1 & 9 - ''1163 200-208 1 Non 8.2 2&8 3 or 5 & 6 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback mercury float switch or double piggyback mercury float `J 163 200 208 3 Non 2.2 2 & 4 3 & 4 or 5 & 6 switch. Refer to FM0477. 'G163 460 3 Non 1.5 2&4 3 & 4 or 5 & 6 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075- Standard all models -Weight 821bs. - 20 ft. cord - 1 H.P. 4• Combination starter. Refer to FM0514. 5- See FM0712; for correct model of Electrical Alternator, "E-Pak". 165 MODELS Control Selection 6. Mercury sensor float switch 10-0225 used as a control activator, with "E-Pak" M Model Volts-Ph Mode Am s Sim lez Duplex alternator, 3 or 4 float system. Mod 2V 1 Auto 9.0 1 or 1 & 9 le 7. SIMPLEX CONTROL BOX 10-0050, 115/230V, 1 Ph. max. 2HP use one (1) E165 230 1 Non 9.0 2 or 2 & 8 3 or 5 & 6 single piggyback wide angle mercury float switch OR two (2) 10-0225 mercury F165 230 3 Non 6.6 2 & 4 3 & 4 or 5 & 6 sensor floats for level control. 8. Four (4) hole "J-Pak"; junction box, for watertight connection or wired-in 'H165 200-208 1 Auto 10.7 1 or 1 -&s - simplex or duplex operation. `1165 200-208 1 Non 10.7 2&8 3 or 5 & 6 9. Two (2) hole "J-Pak", junction box, for watertight connection or splice. `J165 200 208 3 Non 7.0 2&4 3 & 4 or 5 & 6 `No Molded Plug `G165 460 3 Non 3.3 2&4 3&4or5&6 For information on additional Zoeller products refer to catalog on Combination Starter. CAUTION FM0514; Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0406; Mechanical An bldaparon of oaM al a. protection devices and a dng should be done by a icwlad qusNBed Alternator, FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex decblden. All elecblwl and ad* coda should be f &mW 1g In mad we National Control Box, FM0732. Elacbfc Code (NEC) and In ooayatlp,al Sd* and Halve Ad (OSH4 RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 280 old Millers Lane Manufacturers of... P.O. BaK 16347 ZZ7ZZ-ZZff ZZ7. 3 ® ILoulsvift Kentucky 40216 (502) 778-2731 QUALITY Al"AS 15wr 931 ~4 SAFETY & BUILDINGS DIVISION 8 c) C_ `9 State of Wisconsin 4>, U c, Department of Industry, Labor and Human Rel so C? I PRIVATE SEWAGE PLAN APPROVAL Western Regional Of 1 7 2226 Rose Street LaCrosse, Wisconsin 3 i WEGERER SOIL TESTING & DESIGN Owner: RANDALL MILLER PO BOX 74 460 CTH T RIVER FALLS WI 54022 HAMMOND WI 54015 RE: Plan Number: 591-40509 Date Approved: July 8, 1991 Gallons Per Day: 450 Date Received: June 24, 1991 Project Name: MILLER, RANDALL Location: SE,NE,9,28,17W RESIDENCE Town of RUSH RIVER County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 785-9348.- Siff) "23 1 K. 0 1/91 i SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING & DESIGN Page 2 Sincerely, GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/26 cc: RANDALL MILLER X Private Sewage Consultant SIID 6423 iK. 011911 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations July 2, 1991 RANDALL MILLER 450 CTH T HA IP40ND WI 54015 Plan I.D. No. S91-40509-P Dear Mr. Ili 11 er: Re: Randall Miller - Residence Private Sewage System SE,NE,9,28,17W Town of Rush River, St. Croix County, WI Your petition for a variance to section ILHR 83.23 (1)(d), Wisconsin Administrative Code, has been reviewed. The rule being petitioned requires a mound system, site to have a minimum of 24 inches of suitable natural soil. The variance requested was to install a replacement round system on a site with 13 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 similar to other petitions accepted by this department under petition numbers S89-03304, S89-03318, and S90-00072. 2. Based on the precedent established by the previous petitions, this petition fbr~vartance j s treing processed a-srpbtmitted by Wisconsin Statute Section 101.0 (6)(g). Departmental Action: Approved. i SBD6928iR.01/91i i ,fir SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations RANDALL MILLER Page 2 July 2, 1991 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; ►,1~-~a~~ Gerard w m Plan Examiner Private Sewage Section (608) 785-9334 1 Departmental Signature: Date: Z I c a ever, ec Director, Office of Division Codes and Application J GMW:182WPP3 Enc. cc: Leroy Jansky, Private Sealage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator -jt. Croix County Arthur L. Wegerer, D-915 P i r SBD 0028 (R. 01/91) y ST. CROIX COUNTY WISCONSIN th rkl} ,.1. t X' ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 4 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 18, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Randall Miller property, located in the SE 1/4 of the NE 1/4 of Section 9, T28N-R17W, Town Rush River, St. Croix County, revealed suitable soils at a depth of 13" which meets the A+4 rule. This site will require a minimum of 23" of sand fill beneath the mound. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerel`, James K. T pson Assistant Zoning Administrator cj i COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 .1:AL-w Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 12687/01 PAGE ST. CR'OIX COUNTY REPORT DATES 11/14/90 COURTHOUSE DATE RECEIVEDS 11/13/90 ii1DSON, WI 54016 _ ATTNS THOMAS C. NELSON IK2 Md&_1Z_ 0z I/ I- OWNER: Ctarnece Dolezal. LOCATION*4 460 Ciy. Rd T, Hammond COLLECTORS M. Jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 mt INTERPRETATIONS Bacteriologicatty SAFF NITRATE-NS 4 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Dane WI Approved Lab No. 19 .O`'NOEYEWOE~l o ~ss V > t Means "LESS THAN" Detec+abte Level Approved byS PROFESSIONAL LABORATORY SERVICES SINCE 1952 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 CcoIfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 4:1:lk ST. CROIX ZONING REPORT NO.** 11945/01 PAGE 1 ST. CROIX COUNTY REPORT DATES 10/26/90 COURTHOUSE DATE RECEIVEDS 10/25/90 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNER: Clarence Dolezol LOCATIONS 460 Hwy T, Hammond COLLECTOR: M. Jenkins SOURCE OF SAMPLES Kitchen faucet NITRATE-NS 4 ppm Under 10 ppm is safe for human consumption. LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 C?° or~ /C G> OF.\N0EDEAj0 O V 1 Zg A { Means "LESS THAN" Detectable Level Approved by*. o PROFESSIONAL LABORATORY SERVICES SINCE 1952 :COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 . x, Wisconsin 54730 15962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.+ 11945/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 10/26/9Q COURTHOUSE DATE. RECEIVED: 10/25/90 .l HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Clarence Doleiol. LOCATION: 460 Hwy T, Hammond COLLECTOR: M. ,lent; i ns SOURCE OF SAMPLE: Kitchen faucet NITRATE-N+ 4 ppm Under 10 ppe is safe for human consumption. LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 .0&At4VEDEAj0. T, Z4 hA C Means "LESS THAN" Detectable Level Approved by: o PROFESSIONAL LABORATORY SERVICES SINCE 1952 7 0 ,d 7 U a° ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. CPjWQ_LeJt of the form is ones tiai so that the-Vroflerty can be_ 122w i • Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, address. Testing received will be done as along with soon as possible WATER TESTING----------------------------FEE: $ 25.00 &0- (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC'S) SEPTIC SYSTEM INSPECTION----------------- FEE: $25.00 •0C (Determines if system is properly functioning at time of inspection) Property owner's name Ga.i'' c- n Property owner's address - . 440 C/ Legal D rapt n S 2- 1/4 of the 1/4 of Section , T N R i Town of Lot Number -.Subdivision Name IQ Color of house-A7, j Realty sign by house? If so, list firm: GO PLEASE X C*"UDE, iF AT ALL POSSIBLE, A. MAP,, S jCOPY OF PLAT 8003(, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. I WINTER TESTING: Many times water lines are turned oft, or sill cocks are turned off, making access to the home necessary. If this is the case, please make'proper arrangements with this office to ensure time when entry may be gained. Coat; `.cr Firm or individual requestin services: tTelephone Number - s-z3 REPORT TO BE SENT TO: Closing d t Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE 'Mn ST. CROIX COUNTY COURTHOUSE mmw 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Oct. 24, 1990 Jim Claycomb Century 21 894 Dayton Rd. River Falls, WI 54022 Dear Mr. Claycomb: An inspection of the septic system on the property of Clarence & Lynn Dolezol, 460 Hwy. T, Hammond, WI was conducted on Oct. 24, 1990. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This not not in any way warrant or guarantee the continued proper functioning or operations of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact me. sincerely, Mary Jenkins Assistant Zoning Administrator cj 11/14/90 10.50 '715.962 4030 COMM. TEST LAB S.C. CO CRTHOUSE 2002 i COMMEJICIAE TESTING LABORATORY, INC. v 514 Main Street, P.O. Box 526 ! Colfax, Wisconsin 54730 715-962.3121 800.962 - 5227 ST. CROIX ZONINu KMT 12687/01 RAGE ST. il]IX CDUKT1f REPORT DATE:; 11/14/90 DATE RPIXIVDI*; 11/13/90 C"THOUSE H1lDSi Nv wI 54016 ATiN: THOW C+ NL P4 OWNER: CLarnece Doleaal LOCATION*- 460 C#y. Rd Ti Harrand CMLECTOR: Ho Jerkins SUM OF. SAMPLES Kiithen faucet COLIFORM*o /100 at INTERPRF-TATION:'SaeteriotopIcatty NITRATE--NS 4 ppm Under 10 ppe is safe for haman consumptian. Nitrate-i~itrayen, mg/L LAB TEC MICIANt Pam Game WI Approved Lab No. 19 \.\N~PENpd, ~p h pg means 'USS THAN" Detectable Level Approval by! PROFESSIONAL LABORATORY SERVICES SINCE 1952 'CO4ERtIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.S 12230/01 PAGE 1 ST. CROIX COUNTY REPORT DATES 11/01/90 COURTHOUSE DATE RECEIVED* 10/31/90 HUDSON, WI 54016 ATTN*# THOMAS C. NELSON OWNERS Clarence 6 Lynn DolezaL LOCATIONS 460 Hwy T, Hammond COLLECTORt M. Jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORMS 0 /100 ml INTERPRETATION: Bacteriologically SAFE Co Iiform Bacteria/100 ml LAB TECHNICIANS Pam Gave WI Approved Lab No. 19 O&AtkDEVEN,F 5 0 < Means "LESS THAN" Detectable Level Approved byt o PROFESSIONAL LABORATORY SERVICES SINCE 1952 d ~ • ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. CoviQ ati°n or this form is essential no that the proper -v can be _ l,oc ated . Please provide the following information, enclose appropriate fee made payable to St. Croix county Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 f.90 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOV S) FEE: $25.00 SEPTIC SYSTEM INSPECTION----------------- (Determines if system is properly functioning at-time of inspection) Property owner • s name l.1 ctl" / b" Property owner's address tom` ript n SL 1/4-of the 1/4 of Section STN-R~ Town lof Lt Number -Subdivision Name FTE13 KIrNmyu 4160r, r, ER Color of house Realty sign by house? If so, list firm: Go PLE SS INCLUDE, IF AT ALL POSSIBLE, A HAP, .e,COPY OF PLAT BOOK, WITH LOCATION SHOWHe AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. MINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make'proper arrangements with this office to ensure time when entry may be gained., Firm or individual requesting services: Telephone Number -1,96 - S- REPORT TO BE SENT TO: i~ i z - a 6,G~ Closing date Signature