HomeMy WebLinkAbout036-1038-20-100
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT St. Croix
,safety aril Buildings Division Sanitary Permit No.:
(ATTACH T? PERMITS
GENERAL INFORMATIONNEQ,SE%,Sec.16,T3 -R17,1 0th St. 149107
Permit Holder's Name: ❑ City ❑ Village X1 Town o : State Plan ID No.:
Don Morris Stanton S91-40540
6 BM Description: Parcel Tax No.:
CST BM Elev.}: Insp. BM 5Ele
TANK INFORMATION ELEVATION DAT
TYPE MANUFACTURER CAPACITY STATION BS HI ' ELEV.
Septic Benchmark Z,'
`,5U /
Dosing i c~cue~~ ~ .m~ Cf. C~~,~'t ~p
Aeration Bldg. Sewer (A'67-
'
Holding St/Nt Inlet Z 9/10
r
TANK SETBACK INFORMATION St/ W4-Outlet 90-76
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom 0~
Dosing 7b~ 26 r >301. NA 7,
Ae NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand, f . L
99,
Model Number Q7 2~GP
S stem
Friction/
~,SO TDHFt /CO
TDH Lift 3 ,)3 Loss
, (D
ead
Forcemain Length ' Dia. p n Dist. To Well 7
SOIL ABSORPTION SYSTEM = 999'
BED/TRENCH Width Length No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ? DIMENSIONS--
SYSTEM :
SETBACK TO FP /L BLDG WELL LAKE / STREAM LEACHING
CHAMBER
INFORMATION Type O Mode Num er:
y qq
System: OR UNIT
lr~r.
s 4 -
DISTRIBUTION SYSTEM ~y,.,_i','nex ' . , x,
bya#er,CManiiold Distributro Pipe(s) x Hole Size X Hole Spacing vent To Air intake
Length __fL Dia. r~ Length z 4 Dia. Spacing > no
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over r xx Depth Of =xS xx Mulched
Bed /Trene4.Center 14 Edges Topsoil ❑ No L?Ies ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
c4
kcz Lim P ~ ~ ~e `
Plan revision required? ❑ Yes No
Use other side for additional information. c / l
SBD-6710(R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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DILHR SANITARY PERMIT APPLICATION
COUN
E
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ Check i#revision cto rgvious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 5W -,Sld 5V6
PROPERTY OWNER PROPERTY LOCATION
O is N&;C 4 S/ T,3 (,N,R 12E
PROPERTY OWNER'S MAILING ADDRESS LOT # ! BLOCK # /4
S N
C TY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR ?S NUMBER
Ae,kj ,!C ~,4m. lop t
II. TYPE OF BUILDING: (Check one CITY ~ NEAREST ROAD
❑ State Owned ❑ VILLAGE . S 4-11 S O Public 1214 or 2 Fam. Dwelling-# of bedrooms 4/ PARCEL A N B )
III. BUILDING USE: (If building type is public, check all that apply)
Q
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 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.X New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 4Mound 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
3 t7, 7 Feet C~ . 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
Septic Tank or Holding Tank Tt'
Lift Pump Tank/Si hon Chamber " L.
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
94 1
Plumber's Name (Print): Plumber's Signature: (No Stamps) M P~RySW No.: Business Phone Number:
~o(l So?t~
L /e t ~ a- j
Plum is Address (Street, City, State, Zip Cod
r4 z
IX. COUNTY/DEPART11 T USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signatur Stamps)
Approved E] Owner Given initial 4 /c, _ Surcharge Fee) - 1
X _ 7cl
Adve t rmin tion r
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, 605-266-3815.
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.
Ill. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in #1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
i
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 (8.11/88)
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APPLICATION FOR SANITARY PERMIT
. STC-100
his application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property ~Ob ►t-fl C•• I >loV1 2- tS
Location of Property 1J►E' k St✓ k, Section 110 , T 3 1 N-R W
Township _i-►'~ b•~
Mailing Address _ _ b gcr21.1 DS
K;W RAC-44 MOta0, W► X40% 1
Address of Site _ ~ 2 4 5 (O 1-10 `
~~W Pil C-s4 w1.0 N 0, \A1 ► 54-0 n
8ubdi~iiion Hasa _ l~.~P►
Lot Number
`Previous Amer of Property NIjm/e~ Cz'
Total Size of reveal 'LAb
Date Parcel was Created - (a -
Are all corners and lot lines identifiable? ( Yes No
to this property being developed for resale (spec house) ? Yes X No
Volume 0095 and Page Number 'S1 4 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
1 1141 co-WO that at.t s tdtemen,tJS Olt thus Ohm ate tAu . to the but o6 my (om)
hncwtedge; that 1 (we) am (ate) the owneA(s~ 06 .the phopeArty de cAi.bed in thiA
.t"Aonmati.on 6o►tm, by viAtue 06 a waAAa.nty deed kecoAded in the O6 .ice o6 the
County RegiA teA o 6 Deeds a/S Document No , 4 S Z 9 % ; and that I (We ) plied entty
c.un the pupoded 6 to 6oh the 6ewage dAPZi byd em (o)t I (we) have obtained an
t"c-ent, to gun with the above de, ec tbed phopeAty, 6o& the constAuctiOn o6 said
eye.temp and the tame ha.e been duty Aeeoaded .tn the O o !
Veec4, ae Ooement mo. 4SZ.g8 "1 66~ee 6 the Cowtty RegcateA o6
IGNATURC Of OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
SIGNED V. H SIGNED
462k 1
% bow a* Ot UM).
aatufq is iRh Mi die
9pt and lbil Per-
Aber witb'Ibe
ton aobt llr "Pnlsrtrt')~
0t. 9hAs at w'ir ooft: eserwss ro
+ r~ ~ R~111w ~ I ml
'.iuthwest corner of SecticKt fltxteea'. (l6
ML ; 4 th, .4f ;MOO , Sevoateeln W ,'i1N}St e "Om
aiI"- tho tteat ' ilae of said sift, ► g t
llow Of U01.200"t"',
Ilk of wayr, .3
M~rlli►t' ~iuaa:oiTy~'~s~~~ta t#~n. 3"it t ~`+~rts~~► ~
_*b"C a 8ot>Itb. ielst &to>at~q _ saiet Spot line i t
laefi i1~ tg.3ox'~'W -tilt Faf ~rrai ftae of "C. &M t
tom;°~out SO : &UMq Oba>i ion#d right of way 1iue;'
4 erly :.ENO teat aloag Worth right of way line of 'Ar
+•i, R to !e int. of b"inning. Subject to
r~w~iwi~~i►" aIt" ~ 33 eeC
t~o,pw +aee the Properti and tp pa, to Vendor at much -P.1 P..Q a16 0 dAML91X4kt9#,.,
Is tae f0howisiff meaner: ta)
eit%.ab ad et, ~nd .04, 0 4Ys sOx 5-0LAO.................. together with interest iraa**l l
lbw t* two at ft ~nb of..... ItO1. 1911per cent, Per I>rtt°tfi►'il~stafllntents of $160.00, camntncinq
21(. 10$~e
f
R honraPar. 4a sq*fimklift,baleppt shall be paid in full on or before the. _dallrlf
4msait lit iattreat shall accrue at the rate of A.... % per annum on the entire
rim ude. wdt6ant limitati9n. delinquent interest and, upon accele-ation or maturity, the ei:tiptq
%a**" WYeadss ""a, pq seonthiy-to Vendor amounts sufficient to pay reaso"Mt as►iNi► =i
LiaMl:¢~.11re:nld saotdrad isaurance premiums when due. To the extent received by Y
tllrM6-Ah#p$k a,whoa due. Such amounts received by the Vendor for paysaftt OV,
lie ie/oSibii imte as eserow fund of trustee account, but shall not bear 11tia1i~
$ be a *it as bKarea.*a the unpaid balance at the rate specitled and then to prindpW. d~
1OaG...._ t11 '1
W, . ' ea rbtiapal at any tiase after.... C19-$J9..........
~l~telbiaEelrel►tT~sa~isrr
,y a+yr° t.,".ess}4too thdi not be treated as is default with respect to payment so
4 h **Mt jA" in "A case accruing interest from month to month shall be
is ,0*3Yat► 00 s!> AW bdel:bduess wuuid base keen had the monthly ptymes+ts
# piih►i:jst tbau vuOtif - partners A" ho. continued in the event i credit of any
9r. 1la~1 nsa btu thereafter- e::ekaded berefrom.
i Asa thaal '!'nte>.aser Is eathOod with tbo title as shown by the • title evidenes submfned to PtifCC> '
That lien to the Wisconsin -Department ft
J~mt~a»y .5, 11114 In 'Valuate 680at paq` 132, Ve
I"se of tho lien at or before.: final
e a a A
bud fatter ado Ormence. *f *k & dri*e is -hs tly► f* ft af, n~
let"the'Pip C Q$ 4n~ ~'s
~ porty cu
< IIIIAM~• ~i~~~~~~MrIM~ +S~~MI~• Pr►?
>~~ie~or otbec+iso ~t~s
the isoaes _:I
Vendor
vlded
IN, 11wiad 10 lerarat#on ae repair of the I" r6iWrtY WAN4pro
Purchsser covenants not to couuutt waste not allow waste to be cumniitted on t? a Pro(kity~ to ii)sip
in pod taanantablt condition and repair, to keep the Property free frond lien superior to the flea lit Wtis
e.Iapty'with sU lave ordinances and regtdations adbating the Property.
Vdbdor agrees that to can the purchase price writh. Merest sad other moneys shall be ft ppd.+M11 ei
00 U.toy performed at the tiutas &W in the manner dwve specified, Vendor win an demand, tsse i1~ _
Warranty Deed, in tea simple, of the Property, free and clear of all )idol dad ml"
A*.gins or encumbrances created by the set or default of Purchaser, and excepc TIA~-
s.,, easeme>te and--rear ions-..of recCord,-................................
~s . _ - - -
,yJyf ♦ffwW
.e.. ..rr .
Psrehsaer agrees that time is of the e9rence and (a) in the event of a default in the payment 4 iOW
which rAntitrues for a period of ..60.. days following the specified due date or (b) in this event 44
otrosnoe of any other obligation of Purchaser which continues for a period of ..60--- days 7tw`
tWili
~eot'bir VwAor (delivered personall_• or marled by certified mail), then the entire outstanding balance following
shalliliitrpoaitt imtttediately due and payable in fulr., at Vendor's option and w.thout native. (which, ftrghsse '
hr#mtsR; acid Vendor&hall also have the followmK rights and retneciies. lsubjec*, to arty limitatiorus provided
r hurgtie those provided b)- law or in equ;ty: (i) Vendor may, at Lis option, terminate this Contreet'-sw
and interent in the Propert) and n•cuaer the Property bacn ttrough strict foreclosure with #My
Wbe conditioned upon Purchaser's full pa)-ment of the entire ( rL-tandit - balance, Ranh i4terestda Wtatthe rate in effectun such date and other amounts due hersunder(in%thicheaantallanOiYrtsp
le .
~lyq ! r0b#w shall be fore''eited. as liquidated dama(ws for failure to fulitll thre Contract and ss tent laat°
ti#~ fails W redeem): or (ii) Vendor may sue for zlxcrfl nerfurn,ance of this Cian~
A WOW of the entire outstanding balance, with inter r.gt t t, reon at tt.e rate in effect ew thli
undo,.in which event the Property sliail l,e auctioned 'at judicial sale afl , .
a}
1bsllaDfb'1wanydeficiency-or (iii). Vendor may sue at law for ti:e entire unpaid purehase'priice oe,,a
'Vs1►do>< may decrlare. this Cortract at au end and remov- th:~ (_a;ntractasacloud on Gt to
,,r• ; oz (itr)
Y 'if the agtrita6le interest of Purchaser is in,• gnificant: and (v) Vendor may have Purchaser ejected
Vt the, and have a receiver appointed to collect any rents, ttruvs or },rut its during the prndenty
eiiietl
t render. 1). (it , or (iv)>above.Notwithstanding an), oral or written a:atements or actions of Vendor, an
Irif fdYi,ersgvinX remedies shall only be binding upon ;'eudnr if ay id wiu pursued in liticatien and all coet(1-
fatIudis+y[ - Ie attorneys fees of Vendor incurred to enforce an. termed), iitmunder (whether abated ed
nigtp•proh flat. by l and a pe,jm of title evidence shall . be add.d t0 principal and paid by • irl lint
t;,iabdrbt l is any judgment.
ap+kn tin osINraeaeenlait or daring: the pesdeney of any action of foreclosure of this Gotttr
a Ms the ititrr It dl.a »ceiver of the property, innccLluding homestead interest. to collect the rQPte
)POKY 4iwiurAht pendency of such action, and such rents. isaues, and profits when so collected
d applied as the court aliall dirrdt
r i Paver shalt not transfer, sell or convey any legal or ey-uitabie interest in the Propert, My,sasigrre+
tpt IPatelkieWs, Ae thutider.,thib• C intract or by option, long-term icace or in any other v ray) w.thout, tits )1wRl4e,
ti eatsent of Wrplot-tlttkss;titherUe outstanding balance parable under t`.is Contract is first pate! in fa11 c4;
omweyed ill a pledsn} prassignmeRt of Purchaser's interest under this Contract sole)) as security, for art'
r A velia ta'. ln,the event of iitt• such transfer, sale or conveyance withnut Vendor's written cor. ent, the'en
bali$riime payable andei,this Contract shall he'wme immediately due and payable in full. at Vendor's option
Ve*%In -lids Isms ke: all payments -when due under any mortgage cutstandin}z acainst the Prop}i y*
" "..'Vontraet (113cept it±r am' gturktage xranted by Purchaser) or under ar-• note secured thereby, .
MAINS C01W7,111113itbent of the amounts then due under this-Contract. Purchaser may make an)' such
the Motltstagee li, VBndcr fails to do so and all payments so made b) Purchaser shall be conside psi
endormms, waive any default without waiving any gther subz-quent u- pri•.r def:t;:lt of Pureltssvf `1
111T terms of lino E)ot+4rfMlG`:eMlf be,:bWbw tom and inure to the benefits of the heirs,
successors and assigea of Vendor and Purchaser. (If not an owner of the Property the spotase af'
elplsideration John twrein to release homestead rights is the subject Property and agrees to join in tit! 4:
deed to -e made in tnlflthntatt hermf )
1Jnted this 02(0_ day of October
tSFAU
• Donald C. Morris, '-Jr..
Stei+•en tai. fleyer
i at~t Kathleen K. Morris
J~, , ~►l. ; Il~r . < 4 .
^UTIARNTICATION AC ]KNOW LBDGK2U!;
Steven W an Jean M. 3TATI' QF WlSC(_PNS1N
tllre(Si :bw. lid C ,I c Kathleen
county.
r
fjrt+iC.dsy:ot,..ftt:r>......, 19...89 Personully came before aie• .tbrle •
iyIHEiI -S'pTf: BAR 0F ti'i sC O\.511
4.
( if dot
a au%horrred Ito 7hE .tlfa ePrs Alata J' . to the rssp
to me :knee to . lre ~
foregoing ir:atratnrnt and "ac~ct~DeslildliMt.t
F 1 r. : txrs ,NsTkt:r s ~t WAS Cxcarreo.r-y t -
n Oh
les !I►vewe. Aux., i2-7
- ~ S +en ~ per7M r r
=ibtai~Ef3.- y t h .
SEPTIC 'ANK MAINTENANCE AGREEMENT
Sr.. Croix Cuuncy
i
OWNER/BUYER ~p►4--O G~~t5.
ROUTE/BOY NUMBER ~toq ~~S /-WE Fire Number
CITY/ STATE WSW PVC44MO "Q f V41 Z IP 5 40 t1
P^OPERTY LOCATION: Re '-4, 436 1c, Section t(PJ , T "51 N, R W,
Town of 3-2w $ t. Croix Councy,
/A W A
Subdivision Lot number
Improper use Xnd 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 licensed septic tank pumper. 'ghat you put into
the system can atfect the Eunctiun of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents.mav be eligible to receive a grant for
a maximum of 607 of the cost of replacement of a failing system,
which was in operaci.on 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 veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) af'cer inspection and pumping (if nec-
essary), 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 maincain.the private sewage disposal system in accordance with
the standards set forth; herein, as sec by the Wisconsin Depart-
ment 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 A"
DATE r2-14
St. Croix County Zoning Office
P.U. 3ox ?'?7
Hammond, W1 54015
7.15-796-2239
tii..~n, Oar,- and r,rvtr.n "n ahuve address.
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LAJBOR AND PERCOLATION TESTS (115) P.O. BOX 7969
AUMAN RELATIONS MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOTNO.:BLK.NO.:SUBDIVIS1 NNAME:
1/ /b / N/Rl :A (o C ie%
COUNTY: O NER'S/BUYER'S NAME: MAILING ADDRESS:
V-5 C41_4&2
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERC AL DESCRIPTION: X New DESCRIPTIONS: 1PERCOLATION TESTS:
Residence yolNew ❑Replace <2 9
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑ s Au YS EA ❑ S 0S ou [--Is YU
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:A~J
/T
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH
TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMB1ER DEPTH IN, ELEVATION OBSERVED EST_ HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13- LI 177 7
B~ q S' 76,3 ~q Is / -ilOlrdys' N ~J` t79.v1lcvL.Oy~A~ r 013 ` 111Q-, 1,6 -6 4,126+ t yr o~G
/
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 PERIOD2 PERIOD PER INCH
P- I f"? ! n_ t s V le
P- I Is- / -aC44444 I
P- , j iY
4Z ME P-
P-
P-
i_tvl LIWI--
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. I ate 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 elvevation at all borings and the direction and percent
of land slope. %~C'~/jG SII Ls
SYSTEM ELEVATION 7 sue'
w _
10 0
Wool C ~p 3 / s
O ca...
~R ~lC
3
V~` 1"'c
1C 144F
1G
•
N
7 -
7X
E
• /
• . - r
6
E
H
i -
3
Lori, 111l /•307F.
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the es an t4ds sp-4ied 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
NAME (print): TESTS WEk~f Y ETED ~N
'1
A
b'ORESS: CERTIFICATION NUMBER: PHONE UMBER (optional):
6 r C57- 6
C NATURE:
Z
-RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILi
9D-6395 (R. 10/83) - OVER -
i
I STR TIO S FO ' vv I, :._ETIN( -RM 115 - S IB -
TO 1)e. test, y
1, Compl :e ips n;
2, TI east clearly = ate whether this is a resitience of cornmercial project;
3, Pvt. ;h _ of hedre c,r commercial use planned;
4, is --ii- ~emen+ s°~ >'em;
5. C= i , ty rating boxes, A SITE 13 SUITAf _ A Y, d- T ONLY IF ALL.
OT H' ' . 3 'kRE RULED 031,..T BASED ON SC': ..TIC, s ;
d, PLEA. 11 ',caviations shown for v=rritir,g p _jetiptions wind completing the plot plan;
7, M, _E diagram accurately 1c,catirrg your . ~ locations. Drawing to scale is preferred. A
{ used if desired;
F, irk and vertical elevatir it are clearly shown, and are permanent;
qs, C ,r- riatr,, boxes as to dates,'nannes, a& Mood plain data, percolation test exemp-
tion, if of
10, If the inf, n l rch as flood plain, elevation) does place N,A, in the appropriate box;
11, Sign the form - „d place yorar Current address and yor r atidrn number;
12. Make legible comes and distribute as required. ALL )!L TEST'S MUST B FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLE = i'ON.
REVIA~.TI NS OR CERTIFIED SOIL TESTERS
Soil Separates and Textures I Symbols
st Stir 10"? "r
cob Cobble -1011)
gr ..~ra1 alder 3") La _
S HGI ocu?dv~~ater
Perr- ='ation bate
r m =and
"and Bldg - La. r. ,
oars < 1. s Than
B r
sic S'.''y le,
~c Clay cc
111 -Pet min -
r i i Muck ci
P
1-1WL
VRf' Paint
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
selvage 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.
4 I
SCL
L) Sfic- n~o~ T~anS~,~~
~I
apt
ril V,
505
ONSITE SEWAGE SYSTEM
I ~
yuliEionu>~ 04V
Co a ILI,
U v ED
AaftPR" &
DEPARTMENT Of INDUSTRY. LABOR AND MAN RELATION '
VISION Of AFETY A D B INGS R °
g F1 S~Q la.,
t , 1100
SEE WRRE , Z . p C L.... f
c1,
ss ~ Cl I i -
~o
a
13L
0
THE 2S ~t g~Law"CND ~ ~
~n°`'''D (3 p
Vot0,4 Si.Ere >cDc,E^ oF Z *+G
VAUST r-CmA u 0E>lSTV k"C>
I bT (1l1~. ,
I
Page _ Of
-54
V
t Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
y Medium Sand
_ H -
6" Topsoil
_ _1 „ D
3 E
b
L~ Slope
Bed Of 2'- 2 %2 (Force Main Plowed
Aggregate Layer
(6" Below Pipe)
0 ~ Ft.
Cross Section Of A Mound System Using E . _ Ft.
A Bed For The Absorption Area F .75 Ft.
G 1.0 Ft.
A 10 Ft. H 1,5 Ft.
Signed:
B SO Ft.
License Number: K 10 Ft.
Date: Z /3b/ L 70 Ft.
1 8 . Ft.
Alternate Position I 13 Ft.
of
Force Main WFt.
L
7- r
Observation Pipe
6 K
A ( Force Main
w
ONtUnSO
Distri ion 1, a Bed Of P onatttOna Aggregate
'I
Ob
0 v anent Markers
A TM F !NDUS ~'RY. LABOR AfVD HU RELATIONS /
SEE CORRESPO
Plan View Of Mound Using A Be For The Absorption Area
i
Page Of
Distribution Pipe Detail For A Four Lateral Network
b40
End Cap /
Alternate Position Of
Force Main
P
PVC Distribution Pipe PVC Force Main
P
ONSITE GE SYSTEM
Ho 1 e 11 qua y Spaced
PVC Manifold Pipe O iEo A ym
,PPROVEED
S TIMi 'OF INDUSTRY, LABOR AND H RELATIONS
1 X SiGi OF F BU GS
X 2
SEE CORRES
* last Hole Should Be Next To End Cap
*
y P_AL F to
S~Ft.
X y a Inches
Y ,2 Inches
Signed:
Hole Diameter Inch
License Number: t,
Lateral Diameter Inch(es)
Date:
Manifold Diameter Inches
Force Main Diameter Inches
N Holes Per Pipe
Invert Elevation Of Laterals Ft.
i
1 I
' I
i~
PAGt (;F
PUMP CHAMBER CROSS SECTIOU AUD SPECIFICATIOkJS
d
VEIJT CAP S91-40540
4 .Z. EMT PIPE WEATHERPROOF APPROVED LOCKIKIG
5' ROM DOOR, JUMCTIOAI BOX MANHOLE COVER
WI ` OR FRESH 12^MIU.
AIR INTAKE
L 1, GRADE I
1
I H" MIM.
ON SITE SEWAGE SYST
COKJDU IB"Mlu.
Is^MrAI.
a 41 am
.w,. 111
UJLET P IQ
I
0 PARTMENT ~ I;vDUSTRY. LABOR /~NUT`G I&TIONS
* A t ION OfiAFjj~~]] BU I I
III
SEE CORRE .,x.,,;•,; t?.'' I III ALARM
d I II
'4~
c *APPROVED I i ow
JOINTS WITH I I
ELEV. FT. APPROVED PIPE I
3' ONTO PUMP OFF
D SOLID SOIL ~
COIJCRETE BLOCK
RISER EXIT PERMITTED OAJLy IF TAUK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E _5 P E C I F~ItAt I OU
DOSE - /
TAWKS MAAIUFACTURER:6ouie:~T",(.47 'e-n"' "T- "UUMBrik OF DOSES:
PER DAy
TAAJK SIZE: --T r TO GALLOMS DOSE VOLUME 4 / 2-
ALARM
ALARM MAIJUFACTURER: %Qn~ qA~ INCLUDING BACKFLOW:- 72-
MODEL IJUMB'ER: oh /Z
CAPACITIES: A. 2 3 INCHES OR GALLOAIS
SWITCH T`.IP[: i B =_INCHES OR 515
GALLONS
PUMP MAMUFACTUR[R: O ! tom'
C = lr2S~ INCHES OR 17T • ~GALLOUS
Z
MODEL MUMBER: _ D= v INCHES OR
GALLONS
SWITCH TYPE: G'. MOTE: PUMP ARID ALARM ARE TO DE
MINIMUM DISCH6►RGE RATEGpMK INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEAI PUMP OFF AMD DISTRIBUTION PIPE.. FEET
-I- MII~~AIl~I~MUM NETWORK SUPPLY PRE UKE , . . . . . . 2.50 FEET
-I- FEET OF FORCE MAIN X ~F~ 57
Ioo FxFRlCT1OA! FACTOR. 1.57 FEET
TOTAL DyWAMIC. HEAD = FEET
IUTERMAL DIMEIJSIONS OF TAAJK: LEAIGTH I~;WIDTH ;LIQUID DEPTH -
1
SIGUED: LICEAISE IJUMBER:
t DATE:
J 1"
r- W
W W
s LL
TOTAL DYNAMIC HEAD/FLOW PER MINUTE
HEAD CAPACITY CURVE SEWAGE AND DEWATERING
"26611 - "267" - "268" MODELS
25 • 266 - 267 - 268 Series
HEAD CAPACITY
UNITS/MIN.
20 FEET METERS GAL. LTRS.
6
v 5 I 1.52 128 484
`o
C2 10 I 3.05 89 337
p
Ed 15 15 4.57 50 189
I
4 20 6.10 10 38
o
F-
10 Lockvalve: 21.5'
2 4:0540.-
5-
0
U.S. GALLONS 20 40 60 80 100 120
LITERS 80 - 160 240 320 400 480
0
Flow Per Minute
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators for duplex systems • High water alarms available.
available with mercury float switches. • Mechanical alternators available for
• Minimum recommended basin size duplex systems.
Simplex-18" x 30". Caution: Maximum temperature of sewage or
Duplex-30" x 30". dewatering must be limited to
• For over 130°F. (54°C.) special quotation required. 130°F. (54°C.).
Standard All Models -
266 - Weight 44 lbs. %2 H.P. 5ELec7!0N GUIDE
267 8t 268 - Weight 51 IbS. 'fz H.P. I. integral float operatec c od:e >_`an ca! switch, no external control
required.
2. Single piggyback wide angle me..,cury float switch 10-0034 or double
" piggyback mercury float switch 10-0229.
3. Mecnanicai alternator 10-CG72 or 10-0075.
266/2671268 Models Control Selection 4. See FM-712 for correct mocei of Electrical Alternator "E-Pak".
5. Mercury sensor float s-:cn 10-:225 used as a control activator, specify
Model Volts-Ph Mode Amps Simplex Duplex duplex (3) or (4) float sys:em.
M266.1267!268 115 1 Auto 10.4 1 or 1 d 8 - 6. Simplex control box i0-X-_3. 11:230V. 1 Ph, max. 2 HP• use:
one (1) single piggyback wide angle mercury float switch OR
N266/26i/266 115 1 Non s0.a 2 or 2 d 7 or 6 3 or 4 d 5 two (2) 10-0225 mercury sensor floats for level control.
7. Four (4) hole -J-Pak junction tbox,for watertight connection or wired-in
D266/267/268 230 1 Auto 5.2 1 or 1 ii 8 - simplex or 2 pump operation. 107002.
E266/267/268 230 1 Non 5.2 9 or 9 d 7 3 or 4 b 5 8. Two (2) hole -J-Pak-. !or watertight connection or splice. 10.0003.
9. Single piggyback mercury float switch 10-0035 or double piggyback
mercury float switch 10-CM (230V).
CAUTION 4
For information on additional Zoeller products refer to catalog on Piggyback Mercury All installation of controls, protection devices and wiring should be done by a qualified
P
Float Switches. FM-477: Electrical Alternator, FM-486: Mechanical Alternator, FM-495: licensed electrician. All electrical and safety codes should be followed Including the
Alarm Package. FM0513: Sump/Sewage Basins. FM-487: and Simplex Control Box, most recent National Electric Code (NEC) and the Occupational Safety and Health Act - P
FM-732. (OSHA).
i
RESERVE POWERED DESIGN ?
For unusual conditions a reserve safety factor is an engineered/design part of every Zoeller pump.
3280 Old Millen, Lane Manufacturers of
P.O. Box 16347
OfLLE~ O~ Louisville, Kentucky 40216 p
(502) 778-2731 Q[is[irr PaMVS SNCE ~~~x!
!
FM0390
_ 0188
ffZzO Supersedes
`QU.4L/T1/ PUMPS SNCE 19,79 0787
Product information presented here
reflects conditions at time of 3280 Old Millers Lane
publication. Consult factory regarding
discrepancies or inconsistencies. P. 0. BOX 16347 • Louisville, Kentucky 40216
(502) 778-2731 • FAX (502) 774-3624
91 405 10
COMPARE THESE FEATURES
• Non-clogging Vortex Impeller Design. "266"* - "267" - "268" Series
• Float operated, submersible (NEMA 6)
2 pole mechanical switch.
• Durable cast construction. Cast iron WASTE MATE"
switch case, motor and pump
housing, base and impeller. No sheet
metal parts to rust or corrode. SUBMERSIBLE
• Stainless steel screws, bolts, handle, SEWAGE PU M P
guard, and arm and seal assembly.
• UL-listed 3-wire neoprene cord OR DEWATERING PUMP
and plug.
10 ft. cord standard for automatic. 2" NPT DISCHARGE
15 ft. cord standard for non-automatic.
. Thermal overload protected.
• Oil filled motor-hermetically sealed.
• 60 cycle, 1725 RPM.
• Carbon and ceramic shaft seal.
• Bearing running in bath* of oil.
• Passes 2-inch solids (sphere). LISTED
• 2" NPT Discharge.
• On point-11". Canadian
SA Standards
• Off point-5". Association
• Major width 121/2". approval raraa.
• Height-14". available
Sump 8 Sewage Pump
• Engineered plastic base on all Mfg. Assoc.
266 models. ssPMNupbet'tuflort
• Model 268 (shown below). SC-222`5
Combination 2" and 3" discharge.
2" N.P.T. Female discharge.
3" N.P.T. Male discharge.
SIMPLEX AND DUPLEX SYSTEMS
AVAILABLE
PACKAGED SYSTEMS AVAILABLE
MODELS AVAILABLE
• Automatic or Non-Automatic
is 2" NPT Discharge (2" & 3" Model 268)
. 1/2 H.P., 1 Ph, 115V or 230V
. Passes 2" Solids (sphere)
Automatic Automatic • N267 available packaged with
"268" "266" Piggyback Mercury Float Switch
"NOTE: No UL listing for Extra Duty (ED) pumps and 266 Models.
ST. CROIX COUNTY
4J)Je .w•...
WISCONSIN
r{rvr 'Y y~'~~p i l l4•
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, W154016
(715) 386-4680
July 2, 1991
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation of the Donald Morris property, located
in the NE 1/4 of the SE 1/4 of Section 16, T31N-R17W, Town of
Stanton, St. Croix County, revealed 24" of suitable soil for an
onsite sewage disposal making this site suitable for a mound
septic system.
Should you have any questions, please feel free to contact this
office.
Sincere y,
James K. mpson ? • rye
Assistan Zoning Administrator
cj
I.