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032-2017-20-100
~ o -0 ° I ate' ° I o " p fH p 60 ~r o°'o o I o I o 0 1 p o E y 1 t w _ U ~ i a1 u, LL I cco - a~ I fV O N ° I ~ N ~ r`1 m in c m . 6 O O E x z N CL N a) 0- E Uw Imo' E It i' m m ~c `y p° m N 3 c a p O LO L C-4 M.2 N (D c E a) ao~ y E N E E y N Z.' N N C) W >1 CL O O C O N N C z p p~ d C Z C L w C a) + C . N LL c C m N LL O 'C CN cc O O C U 3 3 ° E m o Q nm33 E Q vOic°CL CL n U O O CL 0) (D z w E rn z o = o € v € a ma m a4) (D ~z m II I I o Z a ij U a- p N p N a) Z C C W H r O N O a) C C E _ E N hi Q ~w N cm a N VN o cm a o N C N C- C • N O O O r- LO m C14 N Z m z Z co z O Z D N _ o Z !U.) d (D E o~ m - E m - c m y y d N c m p N `y J. 0 oca >'oca ~m Q p o N U) N ~ 0 1> y N N ~ v Z> > 0 0 0 a ° 0 0 0 4 m •N a a a a a a ~1 a f6 o ~ 0 7 tl1 J U c cco, coo) } U 0) } (D 00 'a 0 C5 0 LO N co N 25 o O O r U O co U E N N n O O N O LO CO C f0 co C CL N m 'O N N 0 N N Mm LO CO Q 1- cn atS 'p Q Cn N OI ID d Q C~ 0 N N N to y 1/! C 1V o U 3 as N c o m o E v rn O o o y o d ~ rn O C%l ch N a> a> c c U rn o o 0 n a) J C m N U C N u1 m N N O V 4. O n - a) l0 LZ a) 01 C 6 N 41 p N N a) '2 C'4 ` Ly cv o y (D C o z 0 o y z z d Co ~ co 0.0 c) E :cG 00 7 U 7 • O O O !n N Z N 2 H US O Z N H f- fn v1 r j I'I € a € a • a d ;u m a m a ` c c c 3 A cia~jll0UiL) I0NU I J FORM - STC - 104 o r G •n AS BUILT SANITARY SYSTEM REPORT V , - 77- r W l 5-e OWNER A. r p/77 .e /a TOWNSHIP IP Grn SECTION T-70_N-R_,Z-Z W ADDRESS CROIX COUNTY, WISCONSIN ~`fa SUBDIVISION LOT -LOT SIZFr PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET JF SYSTEM 3 Z4 ~ w a n ( 5 ~:1 0 u 5! I VJ 0~ INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. Rings used:7LManhole cover elev: Final grade elev: d- Tank inlet elev.: X02 Tank outlet elev.: No. of feet from nearest road:Front)(, Side , Rear Ft. From nearest prop. line:Front , Side, Rear Ft. No. of feet from: Well Building: ,2 ~ 5~: age (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 4 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed:_ X Trench: Seepage Pit: Width: ,/.f,,Z_Length ~Number of Lines: '7 Area Builty~ Exist. Grade Elev. Proposed Final Grade Elev. --e- Fill depth to top of pipe: No. feet from nearest prop. line:Front Side, Rear Ft. ./--1o~ No. feet from well: ,,7 No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feett from nearest prop. line:Front , Side , Rear Ft. No. fet:t from: Well building , nearest road Alarm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER.: 6/90 : cj A G~ 1 0 0 d-1 l DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &41UMANIAELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOAC 7969 BUREAU OF PLUMBING MADISON, WI 53707 SE,,NF.4,Sec .5,T30-R19 ❑CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: Town of Somerset, Lot 1❑HoldingTank ❑In•GroundPressure ❑Mound (11 ssslgnedl 65 & 35 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: George Sinc.lear 500 Hwys. 35 & 64, Somerset, WI BENCH MARK (Permanent reference point! DESCRIBE IF DIFFERENT FROM PLAN, REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber: MPIMPRSW No. County. Sanitary Permit Number- Byron Bird Jr. 3318 St. Croix 149059 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LA EL LOCKING COVER / PFtPVJDED. PROVIDED- „'r! / c.~ t ? i s1 LYYES ❑NO ❑YES LVNO BEDDING: VENT DIA.: VENT MAT I HIGH WATER NUMBER OF ROAD: PROPERTY IWE4:. BUILDING. VENT TO FRESH ALARM J LIN c ~ FEET FROM AR A LeT YES ❑ NO ❑ YES NO NEAREST v DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI IV PUMP A1ODEL 1PUMP.SIPHON MANUI ACIUHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING JVINT TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST --0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I i a(,I11 IIIIA1,11 TE 11 110AIIIIIA1 AND MAHKIN(i or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH III (7F UISiN PIPE $f'A(.I NI, COVEN JINSIDE 11IA IPIT$ LIOUID BED/TRENCH fir i) r THENCHFS r MAt1RIAL: PIT DEPTH DIMENSIONS ? G ►l ` r GRAVEL DEPTH FILL DEPTH 'IS 114 PIPE UISTH PIPE DISTR. PIPE MATERIAL NO O 111 NUMBER OF. PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER EI IV INLf I E V END PIPES LINFi AIR INLET EETFR t s' 44 , S 91:.3 T . G NEARESTO-► !f12 L.~ ~ ' 7. s ^ 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE [111110ANINIMAHK1/i5 O❑YES ❑NO DYES 1:1 NO DEPTH OVER TRENCH BED IDE PTH OVER TRENCH HEU 1111 PTH IF TOPSOIL jSlID01U ISEFDFO MULCHED CENTER EDGES [DYES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING (iHAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MIF OLD MATERIAL jNO UISTH IDI STR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV. DIA ELEV. PIPES DIA: ELEVATION AND DISTRIBUTION INFORMATION< HOLE SIZE HOLE SPACING DRILLED COHRECI L V COVER MATERIAL VERTICAL LIF T CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER PROPERTY WELL. BUILDING. FEET 'FROLINE: ❑YES ❑NO ❑YES ❑NO INEAREQT5=~ Sketch System on Re ' 'm county file for audit. Reverse Side. SIGNATURE: - TITLE DILHR SBD6710 (R. 01/82) 4- SANITARY PERMIT APPLICATION _~ILI-IR In accord with ILHR 83.05, Wis. Adm. Code couNTV / 6 STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than n~ 8% x 11 inches in size. ❑ Check if revision to previous a II aNO -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ?o ~ PROPERTY OWNER t PROPERTY LOCATION j!2,ewl-cle u w► ~rK , S c~ T O, N, R PROPERTY OWNER'S MAILII ADDR SS LOT # BLOCK # 3 STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUNJBER CI II. TYPE OF BUILDING: (Check one) CITY AREST ROAD ❑ State Owned VILLAGE TOWN 3, $Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms --PARCEL TAX N MB ( ) III. BUILDING USE: (If building type is public, check all that apply) 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 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/NC r Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13)0 Other: Speci IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 511 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 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet 00 6 D 6s~ C/ jF 14:::~ VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 4r t M_ El 1:1 1 Ll 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): Plumber' ature: (No Stamps) MP/MPRSW No.: Business one Number: r r 1 / Plumb s ddress Stree , City, State, Zip Code): ,e14 14, IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g gent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) ? Adverse Determination / X. cJ C~J 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 APPLICATION FOR GAU TART PERHIT • 9TC-100 This application form is to be completed in full and signed by the ovntr(s) of the ptop!cty being developed. Any inadequacies will only result In delays of the pzrnlt Issuance. -Should this development be intended for teaale by owner/contractoc,(spec house), then a second Satin should be retained and completed when the property Is mold and submitted to this office with the ■ppropclatt deed recording. Oynir of propetty DYCO 4 jz' S 1 e -?-A Location of propetty 1/4,1/le Bectlon T_ ~y M-R~V T o wn s h i p_ so-y't.e ['falling address ~~'X tiyrie~Saf Addr*ss of site j2t Subdivision naw* Lot number previous owner of propetty jZi J v^ 4_ ,V Total slit of parcelt v~ Date parcel was created Are all cornets and lot lines ldsntlflablet Yes _ No Is this pro, petty being developed fog regale (spec house)?_ as N0 YoIU)" " -and page Humber -17 6 as recorded with the Register of Deeds. . INCLUD9 VIVI THIS XMI CATION T112 FOLLOWING[ A VkARANTr DVID which Includes a DOCUHtHT HUMIR, Vot,"t AND PAOt NLrxlzSt, and the BRAL or THE RROIBTKR OF DHED©. In addition, a certified survey, it available, would be helpful so as to avoid delays of the tevlewinq process. it the deed dteerlptlon references to a Cettifled Survey Hap, the Cettlflsd Survey, Hap shall also be required, PROPERTY OWNER CERTiFICATIOH live) cettlty,t•hat all statements on this form are true to the best of any (out) lnovltdgel that I (we) am (Ace) the ownst(s) of the property desctlbed In thIa InttltMatIon term, by vlrtu■ of ft warranty dead tac ded in the otllce of the County Rtglstet of Deeds es Document ){o. &0-5-. o pttstntlY own the proposed alto for the newage disposal s'yaten (or I (we) have obtalntd an easement, to tun with the above deaccibed property, for 1.he conettuctlon of sold nyatem, and the same has been duly recorded In the Ottlce of a Coynt Regl !er Deeds, as Document Ho. J. 00 4-tr signature of owner eignatuta oL co-owner (If Applicable) Date of slgnetuts Date of Signature I DOCUMENT NO STATE BAR OF WISCONSIN - FORM 2 - e WARRANTY DEED II i' BOOK ~j THIS SPACE RESERVED FOR RECORDING DATA F 4200543 / I12PA6f 310 I 1~S OMCE Lowell P. Rivard and Virginia L. Rivard, husband REGISi $'i', CROiX op,, W~; and wife Rleed. for R rd this 5th ' dray of ec. A.D. 19 86 conveys and warrants to George W i ncl ear and Marian J 1 1: 0 A _Sinclear M. DN61W N Owi• II RETURN TO I the following described real estate in St. Croix County, State of Wisconsin: I Lot 1, Certified Survey Map filed October 1, 1986 in the office of the Register of Deeds of St. Croix County, Wisconsin as Document No. 417657, Vol. 6, Page 1716 in Tax Key No. the NE-4 of the NEi and in the SEk of the Na Sec. 5, T30N, Rge 19W. Excepting and reserving to the grantors their heirs and assigns an easement for ingress and egress over and across the West 66 feet of the South 66' of the portion of said lot lying north of the northerly right-of-way line of State Trunk Highway '35-64" "E i This iS not homestead property. M (is not) Exception to warranties: Dated this 3rd day of November 1g 86 I (SEAL) '11I (SEAL) * well P. Rivard (SEAL) to .~~c t -~~cJ (SEAL) l • Virginia L. Rivard i AUTHENTICATION ACKNOWLEDGEMENT Signatures authenticated this day of STATE OF EMI MINNES A Walsi n County. Personally came before me, this 3rd day of November 19 86 , TITLE: MEMBER STATE BAR OF WISCONSIN not, the above named (If authorized by § 706.06, Wis. Stats.) Lowell P. Rivard and Virginia L. Rivard, husband and wife This instrument was drafted by John E. Walsh, Attorney at Law 106 South Main Street P.O. BOX 142 tome known to be the person S who executed the foregoing In- strument and acknowledged t sam tillwater MN 55082 '~q '4 4 Sign t61es m4%1 -4 a tKenticated or acknowledged. Both are not iecessary.) Otary Public Washington County, names of persons signing in any capa t e lyped~6TJ~(ir+-66W AIAgnalure #e NOTARY PUBLIC -MINNESOTA My COmmiSSiOn iS permanent. (If not, Stat@ piration date: ~I WASHINGTON COUNTY , 19 i; MY commission expires July 31, 1991 SEPTIC TANK MAINTENANCE AGREEMENT w St. Croix County • F~ F'- 01MER/BUYER D v Nc o ROUTE/BOX NUMBER 06 C Fire Number a 0 a i ZIP ~t CITY/,.. TATE ~d' +W PROPERTY LOCATION:'.'~J', section T '36 N. R-4-W. Town of of 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 con- sists of pumping out the septic tank every three years or sooner, if needed, by a licens'ed' 's'e t'ic tank pumper. What you put into the system can a ect the .unction o. the-septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents'-may be eligible to recieve a grant for a maximum of 604 of the cost.o£ replacement of a failing system, whic 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 'st'ems agree to keep their system properly maintained. The property owner agrees to.submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- 30fdayssludge apthan 1/3 proximatelyfull priordtoc~• essary the sfoormcwiillkbe ssentless Certification three year-expiration. 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.seC by the Wisconsin Depart- ment Natural the Certification and returned d of the three year expiration.date. SIGNED -7~V W DATE 9 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. : 1, ' 1' u - 1 .L W4. .luL.. M.L.-FLar,., « s.:.u.....,.4:Y:'~ifNp!Ji+M.liM;41'i(kvW,.Wlii%i'h. M4. _ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 I-ABOR AND PERCOLATION TESTS 115) MADISON, W153707 HUMAN RELATIONS ~ / ILHR 83.09(11 & Chapter 145) ` LOCA,/ N: SECTION: T N/ ~ IO W NICIPA'Lj1~TC./' ,ems B•_"` BOyVISIO0A1N~1/" `~LG COUNTY: MAILING ADDRESS' <Gre vac n .1f~•rT = USE S OBSERVATIONS MADE NO.BEDRMa: COMME LDESCRIPTION: PROFILEDESCR!PTIONS.IPFF . gResidence ❑New Replace RATING: S- Site suitable for system U- Site unsuitable for system 0+^~.~C- ` ` ONVESNTIONAL: MOUND: IN-GROUND PRESSURE S STEcM-IN-FILL OLDIQNG TANK: RECQMM~§NDID SY EM:~pptio U Iss ou 0S I ou 11:1 ou 0 tou If Percolation Tests are NOT required DESIGN RATE: If any portion of the tasted area is in the :-l under s. ILHR 83.0915)(b), indicate: G T Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION gSERVED TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) 4 ._LQ XwA Imo 7" B-3 B- 13- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER 1 116 AFTr"WELLING INTERVAL-MIN. PERIOD I--- PERIOD;_ P. P a P P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sale 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 r I 44 Apis cc- I I i 7- F, is* #P I ~ 114 I lot { T f I F i. 1 fir/ F 7 a r.. I i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and m*thods "fisid in the Wl"onsin 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: IPHONE NUMBER (optional): 3 T SIGNATURE: (V,~ 0 ~ 11 O 'P OJECT •l ~s~ ~i~a~S~r~yADD~ESS91o° 3 S`~~y s-0~ r .S-,e as~ -4 11/4/S_- /T~a N/R i~ W TOWN COUNTY ; MPRS Byron Bird 'Jr. 3318 DATE - - BEDROOM CLASS PERC CONV NTIONAL,k IN-GROU PRESSURE CONVENTIONAL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE . BED SIZE l,.z 1116 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. C3 Borehole Q Well Scale = Feet 0 Perc Hole System Elevation y 5^ Vent This pprovg does not include ptens for the private 12 ■ sewagr system that is required far INs protect. Those Grade plans awat be sub aaBd and approved before coostnr-fiw :Project r ctartf. TYPAR COVERING 2' , JI'rOBtt F, 12" 3' 4 6 4 3• lab / AIDIDI R 0 ~Jr E!, [F. OEF'ARTMENT OF IWDUSTRY, LA.60rR A,,,D H;'Af,,' r l_A i:`.iPdS , I DIVISION QF SAF Y A 'U WILDAG5 EE ORFi iJtv~:~tkCE= Alt f r y f, it ~c~► ~a f . prP~ ~o ~ .~L / h L P,, A&- ell s y 7 'reel p / y y L G9120061 SAFETY & BUILDINGS DIVISION Tommy G. Thompson Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Northwest Regional Office 209 West First Street P.O. Box 754 Hayward, Wisconsin 54843 BYRON BIRD, JR. Owner: GEORGE SINCLEAR ROUTE 4 BOX 6 500TH - 35-64 AMERY WI 54001 SOMERSET WI 54025 RE: Plan Number: S91-20170 Date Approved: May 17, 1991 Gallons Per Day: 200 Date Received: May 7, 1991 Project Name: SOMERSET TRANSPORTATION Location: NE,NE,SE,NE,5,30,19W Town of SOMERSET 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 CONVENTIONAL Inquiries concerning this approval may be made by calling (715) 634-4804. Sincerely, 14~ JOE MCGAVER Section of Private Sewage Division of Safety and Buildings cc: GEORGE SINCLEAR X Private Sewage Consultant SIM 6 23 i K. 07/901 . Wisconsin Department of Industry, ONSITE SEWAGE SYSTEMS Office of Division Codes and Application `Labor and Human Relations Onsite Sewage Section Safety and Buildings Division 201 E. Washington Ave., Rm. 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements maybe contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. Plan Number Previously Assigned 1. PROJECT INFORMATION (Type or print clearly) Name of Submitting Party (plans returned to same) project Name Street Address, P.O. Box # or Rural Route Project Address or Legal Description City or Village State Zip Code City ❑ County Village ❑ of Telephone No. (include area code) Town ❑ Designer Name of Owner Telephone No. (include area code) Telephone No. (include area code) Street Address, P.O. Box # or Rural Route Street Address, P.O. Box # or Rural Route City or Village State Zip Code City or Village State Zip Code 2. APPLICATION FOR: ❑ Experimental ❑ Mound System ❑ Holding Tank ❑ New Construction ❑ Large System ❑ Conventional Gravity System ❑ Groundwater Monitoring ❑ Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ Pressurized System ❑ System in Flood Plain (attach SBD-6698) ❑ Other Alternatives 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. i a. 750- 1,500 gallon septic tank $ 50.00 b. 1,501- 2,500 gallon septic tank $ 60.00 C. 2,501- 5,000 gallon septic tank $ 80.00 d. 5,001- 9,000 gallon septic tank $100.00 e. 9,001- 15,000 gallon septic tank $150.00 f. Over 15,000 gallon septic tank $250.00 g. 500- 1,000 gallon dose chamber $ 30.00 h. 1,001- 2,000 gallon dose chamber $ 50.00 i. 2,001- 4,000 gallon dose chamber $ 70.00 j. 4,001- 8,000 gallon dose chamber $ 90.00 k. 8,001- 12,000 gallon dose chamber $110.00 1. Over 12,000 gallon dose chamber $150.00 M. 500- 5,000 gallon holding tank $ 30.00 n. 5,001- 10,000 gallon holding tank $ 55.00 o. Over 10,000 gallon holding tank $100.00 p. Revisions $ 20.00 q. Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r. Petition For Variance: Setback $ 25.00 Site Evaluation $ 50.00 Subtotal: S. Priority Plan Review: Enter same amount as Subtotal Total Fee: SBD-6748 (R. 04/88) NOTE:Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER + are subject to change annually. The following information is required for plan review. An index page or each page of the plans must be signed, sealed and dated by the designer. 4. MOUNDS & IN-GROUND PRESSURE DISTRIBUTION SYSTEMS a. County verification of soil conditions. b. Soil data (115) photocopy by CST, including data for replacement system, if for new construction that will be served by an in- ground pressure system. C. Plot plans drawn to scale showing lot size and all lateral distances from the system to buildings, wells, watercourses, etc. Show permanent reference points (benchmark). Direction and percent of slope or two foot contours must be included if drawn to scale. For in-ground pressure, show area for replacement if for new construction (TWO COPIES). d. Plan view of system with observation pipes and permanent lateral markers (TWO COPIES). e. System cross section - provide system elevation (TWO COPIES). f. Pipe lateral layout (TWO COPIES). g. Construction detail of septic and dose tanks if site-constructed, or State approved manufacturer and size if prefabricated (TWO COPIES). h. Dosing Chamber cross section - show manufacturer and size or construction details if site-constructed (TWO COPIES). i. Pump or siphon model, performance curve, total dynamic head calculations and dose volume. (TWO COPIES). j. If the site is suitable for a conventional onsite sewage system, item a. from this section is not generally required. k. Provide all sizing information (TWO COPIES). This is not required for residential installations where the number of bedrooms is indicated on the plans. 5. CONVENTIONAL ONSITE SEWAGE SYSTEMS a. Photocopy of soil data (115) by CST, including data for replacement system, if new construction. b. Plot plan showing location of septic tank, soil absorption system and replacement area. Indicate lateral distances to any buildings, well, watercourses, lot lines, etc. The plot plan must also show the location of permanent horizontal and vertical reference points (benchmark). Also indicate ground slope with 2 foot contours in entire area if drawn to scale, extending 25 feet on all sides of initial and replacement systems. C. Plan view of soil absorption system showing all dimensions, pipe lengths, spacing, etc. (TWO COPIES). d. Cross section of soil absorption system showing system elevation, aggregate,cover material, depths, etc. (TWO COPIES) e. Construction detail of septic tank if site-constructed, or State approved manufacturer and size if prefabricated (TWO COPIES). f. Detail of lift pump tank or automatic siphon, tank size, manufacturer, gpm, gallons per cycle, vertical lift, friction loss, etc. (TWO COPIES). g. Provide all sizing information (TWO COPIES). This is not required for residential installations where the number of bedrooms is indicated on the plans. 6. HOLDING TANKS a. Photocopy of soil data (115) by CST. A full evaluation must be made to eliminate the possibility of any other system being installed. b. Photocopy of agreement document between owner and local unit of government, properly notarized and recorded in reference to the deed. This agreement must include a statement about the semi - annual pumping report and pumping contract. C. Plot plan showing location of holding tank with lateral distances to any buildings, well, water service piping, watercourses, lot lines, etc. Provide horizontal and vertical reference points. Include all-weather service road within ten feet of the service manhole (TWO COPIES). d. Holding tank profile showing vent, manhole, alarm and State approved manufacturer and size if prefabricated. Provide complete construction details if site-constructed (TWO COPIES). e. Provide all sizing information (TWO COPIES). This is not required for residential installations where the number of bedrooms is indicated on the plans. 7. SYSTEMS IN FILL a. Systems in fill must include an onsite investigation form (SBD-6196), as well as all the appropriate items listed in section 5. 8. GROUNDWATER MONITORING a. Soil data (115) photocopy. b. Groundwater Monitoring Report (SBD-6412). C. Verification of data and procedures from county (ONE COPY); copy of Notification of Intent to Monitor which was sent to county. d. Precipitation data. 9. PETITION FOR VARIANCE a. Petition For Variance form (SB-8), signed and properly notarized. If anyportion of an onsite sewage system is in a floodplain, form SBD-6698 is required. ~L I P O ECT6~~ oN~~A'DDAESS,2004 3 522'51 4/4 1/4/S /T v N/R 1 W TOWN CO NTY j ; MPRS Byron Bird Jr. J3318 DATE BEDROOM CLASS PERC CONV NTIONAI k IN-GROUND PRESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE- gae6FT TANK SIZE DOSE TANK SIZE 101, HOLDING TANK SIZE ABSORPTION AREA PERC RATE 3 BED SIZE ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. D Borehole Q Well Scale Feet 0 Perc Hole System Elevation s t~ rswAGE SYSTEM Uent 12" Grade a ,ILLATIONS TYPAR COVERING 12" 3' 4 61 Q 3 S E CORK PONDENCE Rock _ 6 " Sewer ga 1 b 1. 2' a ws ` nnn e • r r - /f l i1~~ ~3`~~ 10, 17 .ci i ®6yyf~~ y S91-201'70 SAFETY & BUILDINGS DIVISION Tommy G. Thompson Governor Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations GENERAL PLUMBING PLAN APPROVAL 209 West First Street P.O. Box 754 Hayward, Wisconsin 54843 BYRON BIRD, JR. Owner: GEORGE SINCLEAR ROUTE 4 BOX 6 500TH 35-64 AMERY WI 54001 SOMERSET WI 54025 RE: Plan Number G91-20061 Date Approved: May 13, 1991 Date Received: May 7, 1991 Project Name: SOMERSET TRANSPORTATION Location: 500TH 35-64 Town of SOMERSET 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 items 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. If construction has not commenced before the expiration date, new plan approval must be obtained. The Section of General Plumbing has reviewed these plans for plumbing code requirements only. This approval is for the following elements only: - PRIVATE INTERCEPTOR MAIN SEWER - SANITARY NOTE: This approval includes installation of Sanitary Private Interceptor Main Sewer Only. NOTE: This approval does not include plans for the private sewage system that is required for this project. These plans must be submitted and approved before construction of the project is started. Inquiries concerning this approval may be made by calling (715) 634-4804. Since ely, s(,~M~Q"" VL KENNETH J. PERTZBORN Section of General Plumbing Safety and Buildings Division SBD-6423 (H. 07/80) cc: GEORGE SINCLEAR X Plumbing Consultant •~.*-.k. :-Ira . ~ ww r I Indicate whether the following facilities are present. i Floor drain yes no Number of drains Food waste grinder yes no Dishwasher ....yes no Automatic clothes washer yes no Number of clothes washers 3. Septic tank capacity Holding tank capacity Septic or holding tank manufacturer width of trenches 4. SEEPAGE TRENCHES: total square feet length of.trenches depth number of trenches ! If SEEPAGE BEDS: total square feet o2 width Ja` length of bed. depth l j - SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit FOR DEPARTMENTAL USE ONLY Signature of erson completing. form:'. Address -2. a- -2$_ Telephone Numb Date x 0 60 59.-•201'70 P1 b 60 'I 176 ,x..,•. i ~ , t PROy)ECT. DETAIL DATA SHEET NAME OF BUSINESS LEGAL DESCRIPITION OWNER G- eo P' e- hS./e °'crn~ MAILING ADDRESS - ARCHITECT, ENGINEER, ADDRESS ,Op4y , PLUMBER OR DESIGNED ......TELEPHONE NUMBER'Z' 1. Check appropriate building usage(s)- and fill in'the information requested opposite each usage listed. Please consult Section,H 62.20. Existing building- - - --New building Addition ( ) Apartments-and•condominiums Number of bedrooms ( ) Assembly hall Seating capacity ( ) Bar ;:...r:.. Seating capaci.ty• # of meals served O Bowling-al•1ey Number of lanes OWith bar' O Campground and camping resorts . . . Number of;sewereT sites, ..Number -of:unsewered sites :•T tal number. of sites Camps ( ) Day use only Number of persons O Day and night Number of persons ( ) Catchbasin . . . . . . . : . . Number hr . :R r ~ s.•.,, ( No kitchen ;.,Number. of, ..persons . • • . , ( With kitchen Number of person; ( ) Dance hall . . . . . . . . . . . . Number of persons ( ) Dining hall . . . . . Number of meals serve- daily ( ) Dog kennels . . . Number of enclosures ( ) Drive-in restaurant . . . . . Inside seating capacity kT Car-service --,:Number of car spaces ( ) Dump station . . . Number of dump stations- lo (p~ Employees ( total of all shifts) Number of employees ( ) Hotel O Motel O Cottages . . . Number of units with 2-persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors,-nurses,.medical staff Number of office personnel Number of patients O Mobile home parks . . . : . . Number of sites ( ) Nursing homes . . . . . . . , . Number of beds O Parks . . . . . . . . . . Number of persons O Toilets O Showers O Restaurant • . . . Seating capacity ( ) Dishwasher and or disposal? O 24-Hour service O Retail store . . , . . . . Total number ofcustomers O Schools . . , . . . . . . . Number of classrooms 77 Meals O Showers ( ) Self service laundry . . . . . . . Total number of machines ( ) Service station . . . . . . . Number of cars served daily ( ) Swimming pool bathhouse . Number of persons O OTHER . . . (Specify) . . . . . . COMPLETE OTHER SIDE • S g 1 -20 1 7 0 PLOT PLAN P JECT ~ e~scT a~S~N~1"DD ESSe3-01'4 3 ~y ~ e~s~/ 3 boa s- ~E 414 1 /4/SS /T~q N/Rim W TOWN CO NTY S xMPRS Byron Bird 'Jr. 3318 DATE _ BEDROOM CLASS PERC CONV NTIONAL.,,~C IN-GROi1i;K PRESSURE CONVENTIONAL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE /~~IFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE l.~ s ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark A - * H.R.P.__~~ M Borehole (2) Well Scale Feet O Perc Hole System Elevation Uent . J ,I 12" Grade TYPAR COVERING 2" fem. F 4 4 S E C,--iFE FDNDE NCE 12" 3 6 O 3 o.b ) 60 Sewer Rode la 1.2' _ owe - ~o 6~Lfy ,bGr oL / ' /h U M-i v I ~ rch; ; ° LAO PI b. - 60 1/78 • M l PROOfCT.,DETAIL DATA SHEET NAME OF BUSIRESS ~e fr,,~ S ST T•c~S/,JO r- 75 o~z LEGAL DESCRIPTION OWNER G-eoKh le v,._.~ MAILING ADDRESS, ARCHITECT, ENGINEER, ADDRESS PLUMBER OR DESIGNER :,;~-e ZIP da ` ....TELEPHONE NUMBER' 1. Check appropriate building usage(s), and fill in*the information requested opposite each usage listed. Please consult Section,H 62.20. ..Exi-sting -bui-lding°-.- - New building Addition ( ) Apartments and condominiums Number of bedrooms ( ) Assembly hall . . . . . . . . Seating capacity ( ) Bar . . Seating capdci.ty. . of meals. served., ( T Bowl ing-al ley 'Number of lanes, O With bar ( ) Campground and camping resorts Number of sewered-sjt~s,; Number of unsewered,sites • ptal number. of sites Camps • . . ODay use only Number of persons O Day and night Number of persons ( ) Catchbasin . . . . . . . . . . . Number ( ) Church No kitchen ,.,Number., of ,persons. _ ( With kitchen Number of''persons ` O Dance hall . , . . . . . . . Number of persons j ( ) Dining hall . . . . . . . Number of meals served daily.: O Dog kennels . . . . . . . . Number of enclosures ( ) Drive-in restaurant Inside seating capacity Car-service --..;Number of car spaces ( Dump station Number of dump stations- /0 Employees ( total of all shifts) Number of employees/1 ( ) Hotel ( ) Motel ( ) Cottage$ . . . Number of units with persons per unit Number of units with 4 persons per unit O Medical and dental office bldgs. Number of doctors-nurses medic4l staff Number of office personnel Number of patients O Mobile home parks . . . . . . Number of sites ( ) Nursing homes Number of beds ( ) Parks . . . . . . . . . Number of persons O Toilets ( ) Showers O Restaurant . . . . . . . . . . Seating capacity ( ) Dishwasher and or disposal? O 24-Hour service O Retail store . . . . . . . . . . Total number of customers O Schools . . . . . . . Number of classrooms 77 Meals O Showers ( ) Self service laundry . . . . . . . Total'numbe'r of machines ( ) Service station . . . : . . . . . . Number of cars served dairy _ ( ) Swimming pool bathhouse Number of persons O OTHER . . . (Specify) . . . . . . COMPLETE OTHER SIDE $ 1 2 0 170 T ~ off/ gwnN auo4d901. 00 ..UL L Of"II-77rssa,APPV 1 :"w,~o} 6u ~a Ldwoa uos.aa }o aan~eu6}S 1~1N0 3Sf1 '1b1N3W1btld30 M i s BEd }a WoZloq ol doz . wou}41daP M01 IaLUL mOLaq 4zdap aajawejP OPtSZno laa} aaenbs Lel0l .,':Slld 39`dd33S / 43dap 'pag }0 416ua L 44W 20 laal ajenbs le404 :5039 39Vd33S . saOuaal }o aagwnu S943uail }0 446ual 41daP sa43uaJ4 10 44W 4aa} ajenbs Ielol ~SNOM 39Vd33S 'b aaanlae}nuew fuel 6U LP LO4 ao 3 pdaS 44pedea 4uel 6uPLOH C ~Z pedea jue4 a L4daS • £ sa84svm s844OLD ;o aagwnN ou sat a84seM s84ZOL3 opewo4ny ou SOX aa4seM4sL0 ou sax japu.w6 a4seM poo3 SULeap }o.oagwnN ou. - SOX u}e.Ap , 0013 -juasaid aae saLlMoe} 6ULmOLLO} a43 ua4la4M ajeaLpul I . . nL+E 17657 ftoww of mob CERTIFIED SURVEY MAID ,apP Located in the NE 1 /4 of the NE 1 /4 and in the SE 1 /4 of the NE1 /4 of Section 5, T30N, R 19W , Town of Somerset, St. Croix County, Wisconsin OCT 01 1986 Owned by: Lowell Rivard Rt. 2 Si. CROtX COUI-tT'f COMP.;'.-HENSIVE PARKS PLANNING Somerset, WI 54025 AND ZONING COMMITTEE NE CORNER SECTION 5 _CEFLTLF1FD_$_ULV_EY.. MLP ML. 4- _ 2 A-G-F_I02-9- in o 500.01' 0 0 LEGEND 6174.44' _ 47.42' 278.15' 5.57 S88024 28 W PAINT OF SECTION CORNER MONUMENT BEGINNING 3/4" STEEL REINFORCING BAR FOUND 0 I"X 24" ROUND IRON PIPE WEIGHING 1.68 LOS./LIN. FT. SET LOT I 277,163 SQUARE FEET OR 6.363 AC. INCLUDING RIGHT- OF- WAY 253,782 SQUARE FEET OR 5.826 AC. EXCLUDING 3 W RIGHT-OF-WAY' W 20 I=- ku r__ NI of ai O W al CWi a I - Z Z JI m W CI W W \ q - I Wz m CO 500 N a p :41 ti =3 I ti W dl o ~ a 4!' Z ZI 10 _j W ~ 1.- W N W J Y d N W i I ~ 0 O (SCALE IN FEET) I ° = 180' 0 7s' Iso' 300' aso' /SOUTH ° LINE OUNE- N88 22 07 0 154.59 ZO 3 Z 4 ~5 u; 3 N 6g/ 1 h 9 g 02 I - N69 o I ~ _ ~p~~E ~PNO/ SECTION SNER C T 30N, R 19W 1 ,p I /'~ygYtiYSy3~1~~-- E ofl~ pPs~ y9y,', I ~ 486-1001 Vol. 6 Page 1716 n D W o u O ~ C 9), o n Jo s e~h Henne ~ ~0 2 :Cy~+r: ~ ~ o~aF N o T~ ~ C~ 1 x •..'Zi G W • 0 .Po .Fc, ~ f. ~ vB eta/ ~ o~ ob ti ¢o ~a O to '"x a w _ ft, ri 14 n1 . > v`wirn ei • • W A \ ~C \ tw Q .ta ° 7-r m 7-z b o o e ~ ~ ~ (p Oa XN L4::OA... D K'ha/~f • i. IV ri cc rq. JS. is . SI A: . B RQ h S 3SS ~ > • •2 R.G. io ::yA>: • b ~ , (min rr o ti~ onOAO 3.o~.y opr bj ~o \00 om Ill `n~• a~ 0 kR~ ohv It om' l dom. n Oq~ ~~nA Edwai J~ AA tin \ M~p • ~C° BRAHr l~A. • 60 ¢0 Oan ~\A • C, N~ bC ~ • ,p ye~i-,y x ~ Q~ 0 ,a ~A03 ~ ~A j P 0 ~a nA H rf • 8O raic o • . o5x o oc ~o OAS o a ~F~ j 0 (o ~ \ A o ~ ~ ~O (o~..v, a c ~ ~ A O, AGE stn tip • sN 4, 0 A • p a E nnaf ~ ~ ~e ~ Gy,A ~ y ~q G • i°~'#'i~° .f° a 0j ain v m ~l, ~1 c~ `0 y • ~fE::-`I`::•:: . ^ 60 fR >Y ca urcxe S cw .l ^ os D ~{e/ - 0 n ~D m G A r V nseri 0 ARt bec.E cscv, ~ a . ~ y' E Richard o , ~ A ~ ~ ~ tD > o ~ ° ~ `~,~1 ,iIII t~l . - BO 2 n. 0 N ~ ~ /ou • V ~t o AA 7 pc,~ ~p~ obz o, 6 ~ ~0 C C~ O ~ n ~ A ~ ~1 . :a:r.::Q 0~ AS BUILT SANITARY SYSTEM REPORT OWNER, TOWNSHIi~' - SEC__T IeN-Ro ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 UW--EVERYTHING WITHIN 100 FEET OF SYSTEM i I di a e o th Arrow} SCALE: BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: 77A4 Liquid Capacity: Number of rings on cover Tan manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ~fT - I PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyycle+ gallons; totes capacity o distribution lines --gallon: size of pump head; gallon per minute horsepower ran name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover- _ Type of warning device SEEPAGE PIT SIZE: um Fer-of-pits eet iameter feet liquid d''pth seepage pit in et pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines wi th 9 , lerggth,'1 file depth C~ SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED AREA AS BUILT , INSPECTOR ` DATED PLUMBER UN JOB `T'ED ~ j LICENSE NUMBER- _ /p,v a REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit_ w214 State Septic Z0?7 NAME, TOWNSHIP St. Croix County LOCATION _ZP~6-_-_- Sections Lot # Subdivision - SEPTIC TANK Size gallons Number of compart ents- Distance from: Well Building 12% slope Highwater r PUMPING CHAMBER Size gallons Pu 1a,du acturer Model Number HOLDING TANK l Size gallons Num. r of QApar ments Pumper :alarm tS` stem Distance from: Well Buildk`ng 12% slope _ i e Highw4terV ABSORPTION SITE Bed Trench / Distance from: Well Building / 12% slope Highwater ~.r ABSORPTION SITE DIMENSIONS C7, Width of trench t cl ft Required area-_ ft. Length of each line ft Depth of rock below tile__ in. Number of lines Depth of rock over tile ~_..in. Total length of lines v ft Depth of tile below grade_-?o in. Distance between lines Cs ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover: J PIT DIMENSIONS r' Number of pits Gravel around pits yes no Outside diameter," ft Depth below inlet ft Total absarpti'on Va_ ft Area req~i.r'ed ft A INSPECTED BY TITLE APPROVED DATE ].98 REJECTED DATE 198 REASON FOR REJECTION State and County State Permit # PL-867 Permit Application County Perm' # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Q Date Approval.%Received from State if Required State Plan I.D. # v A. OWNER OF PROPERTY Mailing Address: /Vi /V 'e, - /f 4 n c> 42 -71 G r g B. LOCATION: A'- % & Section , T-32 N, R f (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# 3S: OVillage Township SL a ee--S ¢ C. TYPE OF OCCUPANCY: Commercial r-~ *Industrial *Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 49-0 -Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Z--- Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New L/ Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)es-No. of Trenches Seepage Bed:_ lZ 3 Length. 6 73 / Width L9 / Depth 5/ " Tile depth (top) D No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land 61 - Zd Distance from critical slope WATER SUPPLY: Private 9 Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, 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 Test r, , NAME / e- 4 cy h 2 W/ C.S.T. # 1 LI / 3 and other information obtained from (owner/builder). ¢ Plumber's Signature MP/MPRSW# ,~rl S Phone #7/S - .2-Y4 -.5 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. 3 3 { Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ON4Y Date of Application Fees Paid: Stately County to Permit Issued/Rp}eetled (date) Issuing Agent Name Inspection Yes__4__No State 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 7/1/78 EH 1 15Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:''/4, /4, Section ,TiLN,R_JE (or) W, Township or Municipality :fe Lot No. , Block No. County u igion ame~// /J / /9 4 d 13 Owner's/Buyers Name: T- AF- a A c t1_1 Mailing Address: Rd S®~ e.r S ~/S TYPE OF OCCUPANCY: Residence dN . of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW v REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS -ZZ-2 - S l SOIL MAP SHEET r NAME OF SOIL MAP UNIT 62_", o~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P_ 1 6" P- 2, , l 6 6 6 , P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 7) 7z f S B- 7 7A /_1 Al If B- ' S S 7 72_ :5: B_ 7 72 -5- A) n -5.1 VP , 2 7 r ~ a- f 72 7 74 S-. I S 3 5,z 9 B- 7 .2 _ 7 S Ze PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. o~~X yd r-- p d /pi e 4 F,v" f ~ - ~ ray A F t all FL N t a s t: I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. f ) J Name (print) Certification No. e_ h, n ~~1 YI/ I S 11 Address L/. 4 Name of installer if known CST Signatu Copy A -Local Authority Department of Industry, Labor & Human Relations Division of Safety & Bldgs. State of Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison Wt. 53707 Tel. 608-266-3815 IN ALL CORRESPONDENCE REFER TO PLAN ~i IDENTIFICATION NO. Gcl L NM OF P.ROJECT Ac /ett~ TYPE OF APPROVAL f STREET AND NO. /OOF 4C TY OR TOWN CO `i j STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance 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 at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, 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 and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed- Failure to obtain local permits will auto- matically void this acceptance. Sincerely, James Sargent-Bureau Director PLANS REVIEWED BY: DATE: O Q CJX cc: DP9 Owner DI LHR Lo I Plumber H & R (2) unty Mfg. Rep. Bur, of Health Fac. & Services Rec DI LH R S D-6099 (N. 06/80) . & Env. Services 8105028 -2 Ln O~ T n I 1-9 P of O „ ~Q 4 o f a ~ N r c Q- o I _ 3 r ❑ d c ~ a ± O w w ~ driac %Jdy BECBVW PLUMBING 0 b V~r I . ~:e l;i t L, per < ti sitar n rc~ , ~ ~ a ca - 4 ~~1{O 2 Y& (~ga rciaic Twc- Cros5 Sto'~~on Ertd UnecJ _ Department of Industry, Labor & Human Relations Division of Safety & Bldgs. State of Wisconsin rr~ ~ Bureau of Plumbing Platting & Fire Protection P.O. Box7969 - j Madison WI. 53707 ACT Tel. 608-266-3815 ~ IONjN~ ~~BJ ~ ~,cF7~F Ai IN ALL CORRESPONDENCE ~ REFER TO PLAN 4- + 4~ c~-~~ r ..ray • IDENTIFICATION NO. NAME OF PROJECT TYPE OF APPROVAL t sn-.a!':.. s.._C.... 5:,.j"-Le::~~+G.R_t+~-,.N7 ..+y.j K>...q,yE_. `'`~~'-~~1 STREET AND NO. r' STATE ZIP CITY OR TOWN , C r17 OWNER (A 7 l a -F Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance 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 at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, 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 and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed.. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, vl►ts~ James Sargent-Bureau Director PLANS REVIEWED BY: DATE: cc: DPSc00_E _ Owner DI LHR Local PI Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DILHR SSD-6099 (N. 06/80) Rec. & Env. Services ? AN" t I L a } f Off. {r .4. c-t. ,i. lye fI 4 ,Ott sa ` DI f Rvt~t =$1 to t ref 5 rhse r: f y a r4~ lk3L]f JET; 1, i, not 4*4 sir s ~ , ; **w pun r S r~ o~ r i y. ` r lr ~ lF~ fr~t~. 44P w r t•" 1'F ~ ~ wok i~-!'' % k . x i WA_ aT .7Af;t 1o4rftY000 ' ~ i~4 srgr~cf, f)C Jed in ao;g 114 cfe I©n 'LF.a~~.+•~r{gyR,. y~t',~T,pYyM~Va!?Ng~,}p~''}~' " +ItK { :JIFF ',~'F.~' 1',„n t. 3 t :i l•1~~ '~~+`~c5~sstte r~;6lPrecti~~ 'Y~: ~ ~IeEi~at' pri ~~tattrortY ~ '~~A' ~ ~ t~ a ~ efl Grr septitlxrof C ripe k7W iaj •~fan view b ##exar2ta: " a fi•r3 iP !t e + + .xssndi#tg 25`'on all sides. x3 ; r= t fIrta t = i a;and k# h calraA. q 600v Or holdE g a 't# rictg5 a Ql~ sr =j `1'ct,ctft~ ctseil tstlb,.#kca sr t$ff' site cartr #9 ,k maru#i± xfca,~~ 6 t, {f' 1 ai d Cross 4 xi of sor# ptian system. ~j rA ''mot** vl'•'f~ Y7~~, F ~y,w(~ Y~ Iyl~'zS 4'~tC&`F~r P of 7z 77 " C~ NOW8410 s+' by Omer > i ~#.~►eix4'af goverr#a~ js~sple enci600 000000- faf w±ss tilirtgtiriltlifw." t tea ga,a tvr1i cvurTw i topy), to is-for tot tptitt tf harge, hb ad: q tloste PtarstPpd, cy cte. ~ Sze, #er+gtttJ~t'~"~dep~b rtf forcr ajein. ' x: zl Qe# Owdet-Of P 8r iRitoNt8ti40syptap =t Ctt1d~3iTe, p►idtp~ s, drawdouun arrtd ~ S8C 111 •Q '.#4f i"t , Q Y+ iOit~ S~ . n" t tit e s ~ ~ f l~ S f riR M -in, (FM mustbe placed prior, tto Sut `Q'Totarfmvifiifetf (fi# to;exern'iF.2k9"h~;+ond { 'cr 'before side' pope, tm*,). ~ ~ r ~ .r r f % ~S Y v s> x . Y r.y z t.,~,1.rs 9l'~'rr { ! y 1r 3 r } ~ ' 9 1 5 ~ 1 [ -,.n. -a. 7 a_-.i J ~ [ L x ~ ~ I-W tt C :l 11 In- T 1 h S f 1µ t i S fr It, - r.r Y _ ~tt- r y i ~ R re, rFD 1986 0 cm 0q 84 ski Of D D"ck ,app 4V CERTIFIED SURVEY MAV Located in the NE 1 /4 of the NE 1 /4 and in the SE 1 /4 of the NE1/4 of Section 5, T30N, R19W, Town of OCT O1 1986 Somerset, St. Croix County, Wisconsin Owned by: Lowell Rivard ST. COIX COUNTY Rt. 2 COMP.*EHENSIVE PARKS PLANNING Somerset, WI 54025 AND ZONING COMMITTEE NE CORNER SECTION 5 ►.Q2- L _CF_PJ F.1F D_ 5_UJ1•V_EY LOAF!- 500.01' _ QgG~_1029 n o 0 o_ 01 174.44 47.42' 278.15, LEGEND 5.57 see° z4 2s w o NT of BEGINNING SECTION CORNER MONUMENT 3/4" STEEL REINFORCING BAR FOUND 0 I"X 24" ROUND IRON PIPE WEIGHING 1.68 LBS./LIN. FT. SET LOT I 277,163 SQUARE FEET OR 6.363 AC. INCLUDING RIGHT- OF- WAY 253,782 SQUARE FEET OR F 5.826 AC. EXCLUDING a RIGHT-OF-WAY N W ~ ZI ° y O W Q1 W Q _ Z Z JI v I !D 0) W 01 Z VN N - z W1 rc W Z O O W Z 0) co v O J1 I h t- W 0_1 ~ i 3 OI Z Z1. ~ o ~ N lal' J ~I U. a (K W a i W Q aM m.J2 0. { W 0 O (SCALE IN FEET) I " = 150' /SOUTH LINE OF E NE- NE 0 75' 150' 300' 450' N88°2Q'Q7E o.z 53 E t1 N O 04 m 154.59' 4 of I L` 344 5 3 E / g° Zg 1 m ~ 0 Ego 2g c o ~PNO' SECTION SNER T 3 0 N, R 19 W I ' I / ygYti~'y~~- qt.~f 154 P P3~' 486-1001 Vol. 6 Page 1716 4L DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS ILHR 83.0911) & Chapter 145) LOCATION: SECTION: WN NICIPALITY: LOT, NQ, BLK. NO.: BDIVISIOIy NAM 5 COUNTY: MA LING ADDRESS: e~Yb ✓ C .e d~ D S OBSERVATIONS MADE USE NO. BEDRMS.: ICOMMERCL DESCRIPTION: Lg PROFILE DESCRIPTIONSPERCOLATION T STS: ce ❑ New ~rseplace L „3 .G ~ O26r- - RATING: S= Site suitable for system U= Site unsuitable for system rONVENTIONAOUL: IM[NOUND: OU IN-GRZS POU RE: SYSTEM-IZILLHO~LDING TANK: RECOMMF,?JDE©YSTEM:loptio al 4:::~` v If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 0 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- 9 B-3 ':~r B- B- 'PIC TESTS t TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFT2t~-SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P f G P_ a G 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 ~aD~ t `G , r ~ l~~ ~ 4r o ~e H c 044<' e/ i d rya 41, E al ~Yh I, the undersigned, hereby certify that the soil tests reported on this form were T I ord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests c(%Re~t iq_ e t q y knowledge and belief. NAME (print): iI WERE COMPLETED ON: ADDRESS: CE ICATION NUMBER: PH E NUMBER (optional): S CS ATU E: ~ ~C~,Jti FF1GE ZO;.~;NOn . ~v DISTRIBUTION: Original and one copy to Local Authority, Property Owner d S I fester, DILHR-SBD-6395 (R. 10/83) - OVER -