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REPORT OF INSPECTION - INDIVIDUAL StWAGL SV-MM CCC~~~
' San.i ta~rrl I'v,rrn< ( ~Q~
S to try
NAME _ e,,4 Town.5 hip-St. Cleo(x Couv► l y
Lr cation Sectian Lot N Subdivi.54-on
s'i-'~-
SI PT I C TANK
S< e ! gatton.6 Numb en ob eampaAtmentA
D<Aficrneo Alum: wett Buitdin.g 120 Atope.
HtighwateA_
f'IIMPING CHAMBER (?1 1.
Si .°e < ga tov►h Pump ManuAaetui►en } Model, Numbe.tr
HOLDING TANK
Size. gattons Numbe.A o6 CompaAtme.ntA
Pump eiL Atanm S ys tem -
0i.s Lance, k: °baktdi n y 12 o s o
s p e
H.i:ghwaten
Ar.~S0KVf ION SITE
8c(I Taench
Di taree. 6,gom: Weet $ui.td~ ng --__----t 2 o Atope,
Flighwa.te4
AhSORPTION SITE DIMENSIONS
Width /
o6 tAench 6 t R e ci a4 it e d a A e a
Len
q th o each. Depth c,A it( ef2 beeow t.i
c -_-<n
tine Numbers a6- iine.6 Depth o6 icoeh oveit t~ev t !%n
Totae Length o6 Une.A ' fx Depth o6 tiee bellow gnade _i.n
V4,6 Lance between tine.A 6t Skase o6 tAe.neh (n. pe it 100 bt
Fntae abAOAption an-,.u. -----At Type_ cif Coveh: Tappet utitaw
I
l'i I DlMl•NSIONS
Numbeir of p,t,b G.avvv ahoitv►Tl ;>"t5 r eA no 'Ift
Ou tAl r v di ameten De_pt6► bekow l_neet -
Totaf absokpt-Lon aAVa t
AhPa h c u.i.Aed , r r x ~ I.
1 N ti I' t r 1 TITLE A-r I' K v 1 1) DATE 19
RJ 1I ► I U DATE 19 x
RIASON FOR REILCT10N
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State and County State Permit # 4; 2 2
PLB 6 7 Permit Application County Permi #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. # of /<Qr)_
A. OWNER OF PROPERTY Mailing Address:
G e-- d!jR Y~ V-0 Ns G L c° N 1/t/ 0 0 0/7'Y'
B. LOCATION: /a$ ytJ Section , T 30 N, R E (or) W Lot* City
Subdivision Name, nearest road, lake or landmark Blk# Village
O I Township L L° Vi-P;d-WC1
TYPE OF OCCUPANCY Commercial Industrial *Other (specify) *Variance
Single family ✓ Duplex No. of Bedrooms .3 No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder-YES-NO of Bathrooms
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY-/0490 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation ✓ -Addition- Replacement _ Prefab Concrete
*Poured in Place Steel Other (specify) 90 A GAS., PO /tit
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft.
New,Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width 4 Depth D Tile Depth o2 " No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land __~G* Distance from critical slope
1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil ester, ,
NAME 1714Z A A L e~_ C.S.T. # and other information
obtained from (owner/builder).
Plumber's Signature MP/MPRSW# 16 Z Phone
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application Fees sy Paid: State , / County a Date
Permit Issued/ft"ne (date) 7 - -Issuing Agent Name
Inspection Yesk--jNo Valid* Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2, state (pink copy) 4. plumber (canary copy)
Revised Date 6/1 /76
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RL'~ SEE C :€~Ei'~N3cNCE
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RECEIVED
JOIN 301981
P? U":r NG SECTION
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WORKSHEET - PRESSURE DISTRIBUTION NETWORK DESIGN
81029tj
PROBLEM
Design a pressure distribution network for a bedroom home. The site.
characterisitics ife
Depth of groundwater de bedrock in.
Landslape ld %
Percolatidn rate min:/in.
Di stafttd fr®m dose chamber to di sari bution sy tem Ap 6~9 ft .
Elevation difference betwd6h pump and distribution system 34 ft.
Step 1. EStzmATE WASTEWATER LOAD
Step 2. SIZE THE ABSORPTION AREA
RECEIVED.
A) Area required 3 75
JUfa 3 U 1981
q)' Select length (Q tll " iVG StCT1071
C) Width is
I Will use a e N. p adh i fol d .
Step 3 SIZE DISTRIBUTION PIPES
A 1,161 66 02-e I wi l 1 use it f h.
R') 4616 spacing I w'i11 use is j(9 . in.
c) Ut#fal length' is _ ft.
D) L-at#ral size J in.
Step 4-. D`ISTRIBttfTON PIPE DrSE4NAME Olt
Step 5. SIZE INAgfFG.L-D'
A) Main'i fo 1 d 1 etPgt Fi' ft .
B)' NutabY'r, of distribution pipes
C) Meri'folct diamote'r _ fem.
7is - 9 9~
Step 6. SIZE THE FORCE MAIN
A) System discharge rate
4.
B) Force main diameter
r
C) Friction loss will be ft./100 ft.
c
Step 7. TOTAL DYNAMIC HEAD 4
A) Vertical lift 30 ft.
B) Friction loss . (o to ft.
C) TDH ft.
Step R. SELECT A PUMP
Step 9. DOSE CHAMBER SIZE.
Step 10. DOSE VOLUM. ,
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_ a ~ ~ 6~ ~^3 E',Lt1i',Id RELATIGNS
( l h.
L)ENCE
RECEIVED.
JUN 3 u 1981
F'_U7E iqG SECTIO l
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RECEIVED
juiv 3 G- 1981
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M 0~ L r iL SCR tv' HU RELATIONS
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State of Wisconsin ` Department of Industry, Labor and n Vati
//''eA
SA F B U I LCS(N ~O
Burea Pluml~44, otl l ► Fir tection
P.O. B 69
TO: y Madiso 3707
Plan Identification No.
Gentlemen:
Re:
r
rr.~rrrir..~~.~.~i~.i.~~r~~.r.•~ ~ ~ . ~ .ter.. '-The Bureau of Plumbing, Platting and Fire Protection has reviewed plans,
site survey information and installation details for the construction of
an-, lxer=na* a private sewage system to be installed at the above-mentioned
location.. The..plans and specifications were prepared by -'7
and received for approval on
• l .
The soil and site evaluation was conducted by
The site meets the soil
an site requirements specified in c.. , Wis. Adm. Code, for the,use
of
The proposed system is fora
I A,
Wastes from the building will discharge to a
gallon capacity septic tank which will discharge to a gallon capacity
pump chamber from which a pump having a capacity of gallons per minute
against a total dynamic head of feet will dish rge through a inch
diameter pipe to the soil absorption system.
It is of utmost importance that the system be installed in complete accord
with the plans and installation details and the conditions of approval con-
tained in this letter. The licensed plumber responsible for the installation
shall notify the county inspector when the installation of the system will
commence so that the county inspector shall be able to inspect this instal-
lation. The installer shall not deviate from this approval and shall follow
the directions or orders issued by the appropriate local or state authorities.
DILRH-SBD-6159 (N.7/80)
a`
In accord with ch. 145, Stats., and ch. H 63, Wis. Adm. Code, the plans and
specifications are approved contingent upon compliance with the stipulations
indicated on the plans. Please review your code for the requirements of
each code section noted.
The architect, professional engineer, registered designer, owner or plumbing
contractor shall keep one set of plans bearing the stamp of approval of this
department at the construction site.
If the installation of this system has not commenced within two years from
the date of this letter, this approval shall become void and new application
shall be made for approval of these plans before work may commence.
In granting this approval, the Division of Safety and Buildings does not
hold itself liable for any defects in plans or specifications, plan omissions,
examination oversight, construction or any damage that may result in or after
installation and reserves the right to order changes or additions should con-
ditions arise making this necessary.
This approval is based on ch. H 63, Wis. Adm..Code, requi-cements. It shall
be necessary to obtain and fulfill the permit requirements of the county in
which this installation is to be constructed. Failure to obtain county
permits will automatically void this acceptance.
Sincerely,
Ja s Sargent
Bureau Director
JS:JPtkas
enclosures
cc: OWS
County
sta~
~,y Qlvl~s0~
~rI1471 - SJ~CTICY I
NQ DIRE F-14
alp Al - ~ t
MAE)I
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' 4,- sow ~;~,:R r~ :~~a
4401
'DATE PRPJECT:
b 11,571
'7,~cQ d~
PLAN ID.k
r ,
DETACH HERE a y'
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2ai)b ,
ep
, 11 JECT NARIIE, PLAN, ID..#
_ Ti is to aeknovAec* receipt of your, plans and specific aions for the ve-indicated pew:
Preliminary review indicates the plan review fee required is $ ,E
Eyplan accepted far._review. Fee received is
- bee returned because of LJ ,Overpa Underpayment
,,A- >ee is
Providing OM of the two categories above is, checked, remit correct fee in one payment.
rl.
Nxrfge has been remitted. Plans submitted with no fees will be held in abeyance. r f
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w T '
Plift-,beit g returned.
dd'itional information required. SEE BELOW. >
q. ~
c.'_.::. .i ~.o-: v^~ Fri .
I. Plan'$ubmission
Additional information shall be submitted"in triplicate unless specafacall noted.
#sl a~ allt
❑ Plal s not clear, legible or permanent. a
❑All i0ormatiorrsubmitted shall be signed; sealed or stamped in accord with Section H 62.25(2)( a) Wisconssn. '
Affidavit enclosed. 71 3};#
rl r
i o Systems 1 Mound Systems)
11, Alternate sewa> D sp sal
C~IPLB 108 (ARplication for use of analternate system).
1.4
❑ County onsi required (1 copy). El Design calculations for pressurized distribution
❑ Cross section ofmound: ❑.Pipe lateral layout. ❑ Plan view of alternate.
i .-Private Sewage Disposal, ystems v 3 t}(
0 Ground slope with 2`,contours in entire area of soil absorption system extending 25' on all sides.
❑ Elevation of permanent reference point (benchmark).
_ 9
❑ Location of area suitabi& f or- replacement system - provide soil test data. N rt s
Plot plan showing lot sizeVmd all lateral distances from sewage disposal system or holding tank to bldgs, lot lirti
❑ Construction detail of septic, holding, or lift pump tank it site constructed or tank manufacturer if precast.' + *4 t
0 Construction detail and cross--motion of soil absorption system. - -i
: oil boring and percolation test on EH 115 completed by certified soi[tester (t pY).
Q Complete data relative to anticipated use of bldg. 3 copies of PLB 60•enclosed. G " l
❑ Deed restriction required (1 copy):.,, ICI
IV. Holding Tanks ~,r.• ti 1 r 3 " p'
El Profile of holding tank. t^ f
i❑ Holding tank agI'eentent sorted by ownei;and local unit. of government (sample -enclosed)..{ `
Mi k
Reason for installing holding tank soil testor statement from.county (1 copy).
$'"ds a? c.
-i(.° Lift Pump .
Calculations for total lift pump,dscharge, head and gallons pumped per cycle. (f }
AL.
Size, length & depth of force main.
❑ Detail & model of pump or automatic siphons•inoluding ifte., pump curves, drawdown.and' average f
QCSOSS tivn of lift pump tank showing; pump(s) or siphon(s):
Vl. Systems in Fill (Pill must beplaced prior to:plan submissiorrl
~.tu
❑Total area filled (fill to extend ,20'beyond edV of'trerich beforerside`sloperbggin)•
OQepth and type of fill. y.x
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~C4pY of onsite report by county or district pt4mbing supervisor,
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of tame fall has been m place,
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ANIA
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Wisconsin Department-of Industry,
'INSPECTION REPORT Labor & Human Relations .
Safety & Buildings Division
Bureau of Plumbing,. Platting & Fire Protection-
'Name o remises Date an, No.
OUT
11 71?b
Street _ i y.. e-
y ermi
arty a
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as: er um er irm ame ress.
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M~ti~~ 1 i S Sf
Journeyman PIUMDer Address
Owner 'Address 14
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, FIE: - C 5' A iZ E E I t~ 6 TAE 1 c4
° 7A
.nee
f Discussea with signature
ts:
( )See Attached.
DILHR-SRD-6192(N.09/80) Signa`ure o Dist. um ing. n- e s pecia s
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green ner; ~
SAINT CRO IX COUNTY CERTIFIED SURVEY MAP
RECORDED IN VOLUME OF CERTIFIED SURVEY MAP BEARINGS ARE
MAPS ON PAGE LOCATED IN THE SOUTH- REFERENCED TO THE
WEST QUARTER OF THE SOUTHEAST QUARTER OF NORTH - SOUTH 4
SECTION 11, TOWNSHIP 30 NORTH, RANGE 15 LINE OF SECTION 11,
WEST, TOWN OF GLENWOOD, ST. CROIX COUNTY, T-30-N, R-15-W.
WISCONSIN. ASSUMED TO BEAR
PREPARED FOR: Joseph Lyons N-000 00' 00"-E.
R.A. 2, Glenwood City, Wt- 54013
PREPARED BYV Lee Villeneuve, R.L.S.
SCALE IN FEET-1 • t20
R.R. 6, Box 150,
Menomonie, Wt. 54751
LEG END 120 0 6d 120
P.OoB. = POINT OF BEGINNING
= 14" x 35" ROUND STEEL AXEL SHAFT SET.
14" IRON BAR FOUND INPLACE.
+ = 2" IRON PIPE FOUND
1" x 27" IRON PIPE WEIGHING 1.68 POUNDS PER LINEAL FOOT SET.
I
RTH 1/4 CORNER OF
SECTION II, T-30-N, R-15-W
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so Olt. A_ co 1[,_ N-89°3558"-W 2494.10'
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RFrFi~r~J~E BUILDINGS
[?EPARTMEN of REPORT ON SOIL BORINGS A DIVISION
INDUSTiY11j co Jul- 7. 19$1 BOX 7969
LABOR AND, PERCOLATION TESTS (115) ZONING MAD N, WI 53707
HUMAN RELATIONS
OFFICE
N
LOCATION: SECTION: TOWNS IP/MUNICIPALITY OT O. B UBDIVISION
S E %LJ /13tH/R/SE (o r \ k
C UNT 6 O R'S BUYER'S NA rMA L ADD SS:
1040
USE DATES OBSERVATIONS MADE
NO. COM R AL DES R PTION: I
Residence V❑Replaca
RATING: S= Site suitable for system U= Site unsuitable for system
ICEIS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: R COMMENDED SYSTEM:Io ,ion
au a s au sou o s au ❑ s au - -
If Percolation Tests are NOT required DESIGN RATE: SYSTEM ' ELEV. If any portion of the lot is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- ~ g8`~ so Q An s/, Y-6 6n _S, I/ Gil.
B g8 'b > to 6 /P Ox On s I n 6 YA to SO r
B 00'7" 7 6 C~ S~ s a s/ r
B y qG , it > B S 3
/02 6 a_ -5 1) 9 s, 3 #3 1 S 1-- 24 VAVI s g
g- 5 2 6
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RI 1 PERT D2 R
P- 3
P~
P-
P
P-
P- _
PLAN VIEW: 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 slop.
SYSTEM ELEVATION ZOO
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NA (print : TESTS W 7E CO LETED ON:
CERTIFICATION NYMBER PHONE NUMBER optio at):
ADD ES
41C %-x
CST A,TUR pL
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHRSBD-6395 (N. 03/81) J
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
IIABOR &'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
SW4, -41~ .11.T30-R15 (]CONVENTIONAL ❑ALTERNATIVE III asslgnedI.D
Town of Glenwood, Lot 1 SI„ePined) .Number:
l
Holding Tank El In-Ground Pressure O Mound
Town 1:1 Ave.
160th
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Joseph Jerry Lyons Rt.2, Glenwood City, WI
BENCH MARK IPermanenl reference Pornll DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
Name nl Plumber. 17219 PRSW No. CnumV. sanrlary Permrl Number:
,Lyle J. Myers St. Croix 149063
SEPTIC TANK/HOLDING TANK:
MANUFACTURER- LIOUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LA L IOCKING COVER
PROVIDED: PROVIDED
OYES ONO OYES ONO
BEDDING: VENT DIA.. VENT MATI HIGH WATER NUMBER OF aono: PROPERTY WELL BUILDING VENT TO FRESH
ALARM FEET FROM LINE AIR INLET
DYES ONO OYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING JLIOUII) (:APA(;l TV 1pumv MoDtt. IPUMP.SIPRON MANUI ACIUHEH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO DYES ONO OYES ONO
GALLONS PER CYCLE: P AND CONTROLS OPERATIONAL NUMBER .OF.; PH )PEHTY WELL BUILDING IV NT TO FRE H
(DIFFERENCE BETWEEN FEET FROIN LINE AIR INLET.
PUMP ON AND OFF) PUM OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I N611i JOIAMF Tilt IMATINIAt ANU MAHKIN(i
or excavation. III soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) ```MAIN
CONVENTIONAL SYSTEM:
WIDTH JLENGTH NO O 6M5; PIPE SPAI;INI. COV H UTA -PITS LIOUID
BED/TRENCH HENC/TFS MATLIIIAL: DEPTH
DIMENSIONS
G AVEL OE H f ILL DEPTj ISIPI UISiR PIPE DISTR. PIPF. MATERIAL NO NPROPERTY WELL BUILDING VENT TO FRESH
BE LOW PIPES ABOVE COI FV INL1. ELEV LNU °'Pts iFEET FROM LINE AIR INLET
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
OYES ONO
SOIL COVER TEXTURE VI IIMANI NI MAHKI ITS OBSERVATION WF LLS
OYES ONO DYES ONO
DEPTH OVER THENCH BED DEPTH OVF H TRENCH 111 UE VTH OI TOPSOIL ISCII)DED SE FLOT 1) MULCHED
CENTER EDGES
OYES. ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTI/ NO.OF LATEHAL SPACING (iHAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISIH DIS R. I UI TRIBUI ION PIPE MATERIAL & MARKING
ELEV. ELEV. DIA ELEV. PIPES OIA.
ELEVATION AND
DISTRIBUTION
INFORMATION ROLE SIZE HOLE SPACING DRILLED COHHELII Y OVER MATERIAL PLANS VERTICAL LIFT CORRESPONDS TO APPROVED
DYES ONO C OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM,,; ~ LINE:
OYES ONO DYES ONO INEAR ST
Sketch System on !tai in county file for audit.
Reverse Side.
STITLE
DILHR SBD 6710 (R. 01/82)
17 DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code CouN
S ATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑,/710 ~ 3
8% x 11 inches in size. Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
RTY LOCATION
PROPERTY OWNER RPROT/
W
- /a S N R
C ' - ' T E O
PRO ERTYPWNNER'S MAILING ADDR S LOT # BLOCK #
CIV, PTATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
//vv~' eo,D d / 3
11. TYPE OF BUILDING: (Check one CITY On) NEAREST ROAD
❑ State Owned VILLAGE \n) C-O&Wnjkb , -o V- r~
❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms Z PARCEL TAX NUMB
III. BUILDING USE: (If building type is public, check all that apply) 7/4 -16
1 El 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. 0 Replacement 3. ❑ Replacement of 4. DRfReconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 129,ln-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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New F-xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plu ber' Signa e: (No tamps) P PRSW No.: Business Phone Number:
Za
v-4 )2~& 7Z
4 vrw S
Plu er'g Address (Street, City, State, Zip Co e
I la /l d c_ e- r
7 2-
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanity Permit Fe (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) ^
❑ Approved ❑ Owner Given Initial A, - !Quiz
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
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SAINT CRO IX COUNTY CFRT I FI ED SURVEY MA' _ _
RECORDED IN VOLUME OF CERTIFIED SURVEY MAP BEARINGS ARE
MAPS ON PAGE LOCATED IN THE SOUTH- REFERENCED TO THE
WEST QUARTER OF THE SOUTHEAST QUARTER OF NORTH SOUTH 4
SECTION 11, TOWNSHIP 30 NORTH, RANGE 15 LINE OF SECTION 11,
WEST, TOWN OF GLENWOOD, ST. CROIX COUNTY, T-30-N, R-15-W.
WISCONSIN. ASSUMED TO BEAR
PREPARED FOR: Joseph Lyons, N-000 00' 00"-E.
R.R. 2, Glenwood City, Wi. 54013
PREPARED BY! Lee Villeneuve, R.L.S.
R.R. 6, BOX 150, SCALE IN FEET-1 = 12®
Menomonie, Wi. 54751 1K ar-mm-m6iii
LEG END 120' ® 6d 120'
P.O.B. POINT OF BEGINNING
= 14" x 35" ROUND STEEL AXEL-SHAFT SET.
1 = 14" IRON BAR FOUND INPLACE.
+ = 2" IRON PIPE FOUND
= 1" x 27" IRON PIPE WEIGHING 1.68 POUNDS PER LINEAL FOOT SET.
ORTH 1/4 CORNER OF
SECTION 11, T-30-N, R-15-W
W
8
U N P L A T T E D L A N D
8 ~ at~aa~~
z 3-8903558" E .tom 3Ga.
/42.00'
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A FEET EXC.
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L SQUARE a
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ID ° 2.41 AC I - - - - Z 1AMES p CO tim-LL
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ST Cpax ~C , is'J fY
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ow 142.01' SOUTHEAST CORNER OF
~N N-890 04'57"-w SOUTH LINE-S.E. I/4 SECTION 11,T-30-N, R- 15-W
A
_ V N-89°35'58"-W 2494.10'
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Vol. 8 Page 2182
SURVEYOR'S CERTIFICATE
STATE OF WISOONSIN ) SS
COUNTY OF DUNN
I, LEE F. VILLENEUVE, REGISTERED LAND SURVEYOR, Route #6 Box 150, Menomonie, Wisconsin
54751 hereby certify that I have surveyed, divided and mapped part of the Southwest One
Quarter (SW -41) of the Southeast One Quarter (SE-41) of Section Eleven (11), Township
Thirty (30) North, Range Fifteen (15) West, Town of Glenwood, St. Croix County,
Wisconsin described as follows:
Commencing at the South 1/4 corner of Section Eleven (11), Township Thirty (30) North,
Range Fifteen (15) West, Town of Glenwood, St. Croix County, Wisconsin for the point
of beginning of the parcel herein described;
thence on an assumed bearing of North, along the North-South 1/4 line of said
Section Eleven (11), a distance-of 739.00 feet to an iron pipe;
thence South 890 35' 58" East, 142.00 feet to an iron pipe;
thence South, 739.00 feet to the South line of the Southeast One Quarter (SE4)
of said Section Eleven (11);
thence North 890 35' 58" West, along said South line, 142.00 feet to the
point of beginning.
Said survey subject to roads and easements of record.
The bearings used in this description are referenced to the North-South 1/4 line which
is assumed to bear North.
I certify that I have made such survey and map at the direction of Joseph Lyons, Route
#2, Glenwood City, Wisconsin 54013, and that such map is a correct representatinn to
scale of the boundaries of the land surveyed. I have fully complied with the provisions
of Chapter 236.34 of the Wisconsin Statutes and all provisions of the St. Croix County
Sub-division Ordinance in surveying, dividing and mapping the same.
AtrN~011a~yh~
aa" \5G 0 ~~>G
LEE F. VILLENEUVE RLS #0984 : ~L`',.+"'•
LEE F. Z
November 1, 1989 VILLE~IEUVE
Certified Survey No. ~ i S-0984 *9
St. Croix County, Wisconsin. t MENOMONIE, j
% ~
t WIS. O
Ito,
s U fk%J
Page 2 of 1 sheet
Vol. 8 Page 2182
0
o
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TO NSHIP/MUNICIPALITY: LOT NO.: BI K. NO.: SUBDIVISION NAME:
14
W14 s '/4 ! /T"/R/s E (o
oon lls
L w
11,11- 4 1
CO Y: OWNER'S/BUYER'S NAME: M ILING ADDRESS:
all
USE DATES OBSERVA IONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS:
❑Residence ❑New ❑Replace A/Q
RATING: S= Site suitable for system U= Site unsuitable for system ,J
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
[IS OU E -Is OU O S OU [IS OU 0S OU
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- D 0:-"P p A, 4- A"lc B- ✓
B-
B-
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 PERIOD 2 PERIOD PER INCH
P-
P-
P-
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION <3 2*/ Dgow Akov ✓o I-Aile
3 ,
F '>rC7 ~ ~4R~ ~ f~~ ;
i
0 5"rx,_V4~-~ % P
T
3 >
a
,
3 ~ E
_E;
I, the undersigned, hereby certify that the soil t s r rted FW~i ?mwm a e y~meinccor wit a 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.
NA (print): TEST . S
WERE COMPLETED ON:
L
A FI~SS: ~ CERTIFI I~~UMBR: PHON~ UM~R~(o~tionall:
1J ~ 6 s
T S NATURE: <
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
.J C'!L~ C=oo 11
OWNER/BUYER ( I K 41 DscJS
ROUTE/BOX NUMBER Z FIRE NO.
CITY/STATE ZIP 'SYd 3
PROPERTY LOCATION: 101/4 T 1/4, Section T 30 N, R f'L W,
Town of L^±/£-xJat'W-0'^~ , St. Croix County,
Subdivision ,~~~4 , Lot No. .
Improper use and maintenance of your septic system could result in its premature
failure to handle wastes. Proper maintenance consists of pumping out the septic
tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, journeyman plumber,
restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
+ APPLICATION FOR SANITARY PERMIT
STC-100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
d s 6-;n2
Owner of property
Location of property ~J 1/4 C 1/9, Section 1 , T N-R -W
Township el 'n.
Mailing address (n.ll=x~ Ct)C)6n \ c'`~I L cS
Address of site 72 '~'Z. ,-c eJde ®13
Subdivision name /tJ
Lot number
Previous owner of property ~Zep 1f- A'ea fy:"C-e, /-Yetis
Total size of parcel 4 C !e-e=
Date parcel was created 12 ~a ffi~ 9
Are all corners and lot lines identifiable? _X Yes No
Is this property being developed for resale (spec house)? Yes No
Volume 846 and Page Number- as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the 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
1(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. 4-5-:B5'3 ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No. S/S q ;o
~ rv -a
Signature of Owner 'Signature of Co-Own (If Applicable)
Date of Signature Date of Signature
DOCUMENT NO. ~j WARRANTY DEED ii THIS SPACE RESERVED FOR RECORDING DATA II
STATE BAR OF WISCONSIN FORM 2 -1~8~ j
is
REGISTERiS OFFICE
r I ST. CROIX CO. WI
i for Record II`
Beatrice L. Lyons a/k/a Beatrice Lyons. Reed f
atJsN 09i~ . M
-
conveys and warrants to oseph•-G. -Lyons_•and--Kathy__L.-•LyQa~-,-_. 'rWR99 Of D"husband..4nd. -w1f e..af j..AurvixQxehip_.roaxital_.pxopQxty...........
i!
I
1i
Rivard Law. Office i RETURN TO P. 0. Box 9
I Glenwood City, WI 54J1,3
the following described real estate in St.._ Croix ..............County, i
State of Wisconsin:
Tax Parcel No:
Part of the Southwest one quarter (SW 1/4) of the j
Southeast one quarter (SE 1/4) described as follows:
Commencing at the South 1/4 corner of Section Eleven (11), Township Thirty (30) North,
Range Fifteen (15) West, Town of Glenwood, St. Croix County, Wisconsin for the point
of beginning of the parcel herein described; thence on an assumed bearing of North,
along the North-South 1/4 line of said Section Eleven (11), a distance of 739.00 feet
to an iron pipe; thence South 890 351 5811 East, 142.00 feet to an iron pipe; thence
South, 739.00 feet to the South line of the Southeast one quarter (SE 1/4) of said
Section Eleven (11); thence North 890 351 5811 West, along said South line, 142.00
feet to the point of beginning. j
VMTT
This is-not ..........'homestead property.
(is not)
Exception to warranties: Subject to municipal zoning, rights of way and easements of I
record, if any, and mineralrights reserved to Federal
Land Bank of St. Paul.
Dated this 28tH day of •--•--December----....--• . 19.89....
be i
(SEAL) ~1C..G4./LL- C!C✓•-) SEAL)
i Beatrice _L. __Lyorl; a. iaice Lyons
(SEAL) (SEAL)
s
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Beatrice L. Lyons STATE OF WISCONSIN
• - - -
i! $S. (I
..............................•.......County. I
r}uf1'ie icated is t ~of.AElrzubpaS--------- , 19$9.. Personally came before me this ................day of
, 19........ the above named
j~
• rancis.- . - and
T T E: MEM ER STATE BAR OF WISCONSIN 'I
(If not, (l
authorized by § 706.06, Wis. Stata.) to me known to be the person who executed the ~j
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Francis X. Rivard II'
Glenwood Cit~ WI 01
• . x Notary Public -•.-•••-•County, Wis.
i' (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration I~
j are not necessary.) date: 19.••--•--•) ~I
i
'Names of persona signing in any capacity should be typed or printed below their signatures.
STATE i OF WISCONSIN Stock NO. I300Z
~0mw 1 No. 2 - 1882