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HomeMy WebLinkAbout002-1024-60-000 DEPARTMENT OF INDUSTRY, SAFETY & BUVI ING INSPECTION REPORT FOR LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: SE 4iNE 47 Sec.12 .T29-R16 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Baldwin ❑ Holding Tank El In-Ground Pressure Mound CO ,NA INSPECT10 ATE: HOLDER: ADDRESS OF PERMIT HOLDER: or , •PE IT Il 05 O T Glen Malcein P.O. Box 162. Woodville , WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CS EF. PT. EL o .0, Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale Hudson 6629 St. Croix 128809 SEPTIC TANK/HOLDING TAN ° s r. l~ Csx~= 5 MANUFACTURER: LIQUID CAPACITY: TANK NtElltM TANK OUTL : WARNING LABEL LOCKING COVER ` PROVIDED: PROVIDED: i~c21L ~[ar) G~_j ` 91~, 71~r lO. 1-3 YES ❑ NO ❑ YES NO BEDDING: *12"iFDIA.: VM MATL.: HIGH WATER UMBER OF ROAD: PROPERT WELL: BUILDING: VENT F ESH C, Q, ..0. ALARM: FEET FROM LINE: / W / l AIR INLET: ❑ YES ❑ YES jk'No N C 73 [ P3 DOSING CHAMBER: ./7& - = G~• t!o~ MANUFACTURER: BEDDING: r1JVMTMAPACITY: PUMP MO EL: 7)/66PWQN ANUFACTU ER: WARNING LABEL LOCKING COVER / PROVIDED: R IDED: (0u_ JCS ❑ YES [iN. ~C-0311 L S ~ 5i( YES ❑ NO YES ❑ NO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUIL~fI~ VENT TO FRESH GALLONS PER CYCLE: ( jJ i (DIFFERENCE BETWEEN 1 FEET FROM LINE. 7"' AIR INLETw1 PUMP ON AND OFF I 0 IkYES ❑ NO NEAREST 011- >lG~~ y TY`~' SOIL ABSORPTION SYSTEM. Check the soil oisture at the depth of plowing FORCE LENGTH: / DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until h to continue. MAIN the soil is dry enough ) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NREN HES: DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID REN DIMENSIONS GRAVE TH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: VENT TO FRESH B PIPES: ABOVE COVER: ELEV. INLET ELEV. END: PIPES: FEET FROM LINE: ET: NEAREST 11111" MOUND SYSTE : 7 v d,-'1 z Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furro s thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; bl\ 5; L YES ❑ NO Ft7 S ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: f f I i I - 1~ ❑ YES UP46 Ft S ❑ NO ES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH / TRENCHES: " s DIMENSIONS MANIFOLD PUMP MANI OLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION IPE MATERIAL & MARKING: ELEVATION AND ELEV.: r ELEV.: DIA.: ELEV.: i PIPES:,/ DIA.: ~ ~ m. ~7L~ r%`'~ ~ ~?~~s✓ 1i.,`(' Z7-9 DISTRIBUTION HOLE SIZE: HOLE SPACI G: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPOND TO INFORMATION U APPROVED PLANS p / 3611 U21 ES ❑ NO )a ❑ YES igi~ COMMENTS: PERM NENTMARKERS: OBSERVATION WEL S: NUMBEROF PROPERTY WELL: BUILDIN yy ltr LINE: / 6 FEET FRM 521YES ❑ NO ES ED NO NEAREST----10' >/40 > /CV P. T, 0 =107J_ 37 ,4,64 atb? elm Sketch System on R in in county file for audit. Reverse Side. SIGNA RE: TITLE: SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION 7 DiLHR COUNTY - In accord with ILHR 83.05, Wis. Adm. Code . C,o>/X STATE SANITARY PER -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. 4-Mr.,&Z p evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. SAID - 4Zp.33` PROPERTY OWNER PROPERTY LOCATION 6'/d yl q/ e 5,C Y4 C Y4,S Z T N,R E(or W I PROPERTY OWNER'S MAILING AD RESS / LOT # BLOCK # 141" /V/7 CITY, STAT ZIP CODE ozg PHONE NUMBER SUBDIVISION NAME ORCSM NUMBER NX CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE ZC~/ /~G!>i~ C ❑ Public XJ 1 or 2 Fam. Dwelling- # of bedrooms ~ PARCEL AX NUMBER(b) 0 01~9 ^ III. BUILDING USE: (If building type is public, check all that apply) 171A 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 ❑ Off ice/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. Z Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 0 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 X50 3 75' .3-1 •8y 4? 9`60/1o3Feet 95.53 Feet VII. TANK CAPACITY S one- Steel in allons Total # of Manufacturer's Name Prefab. Fiber- Exp. INFORMATION New istin Gallons Tanks oncret C Fiberglass Plastic Appp Tanks Tanks structed Septic Tank or Holdin Tank D00 DD D t° .r I El El El Lift Pump Tank/Si hon Chamber DO 00 I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsits sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: -Dale -x-, wu,115-04 a"00" Z te Z 9 7~~ 6gy-337~ Plumber's Address (Street, City, State, Zip Code IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued Issuing Age pt Signature tam /J Approved ❑ Owner Given Initial Surcharge Fee) lO Adverse ~(~C` Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name'and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas, and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ST. CROIX COUNTY WISCONSIN .3 . nip s ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 28, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Glen Malcein property, located at the SE. of the NE4 of Section 12, T29N-R16W, Town of Baldwin, St. Croix County, revealed suitable soils at a depth of 13" below which seasonable high ground water was noted. An additional 11" of sand should make this site suitable for a mound. Should you have any questions, feel free to contact this office. Sincerely, qa'wt~- Ames K. Thompson Assistant Zoning Administrator cj G/en . /Y~a/c6 ~y) E AgAIADOP Tm iEx tstta & 5c-prl c, x a3 VM ~-S li-~'R 83bS~L~ r3 ~ + o t I ~ l0~sNltt`i. Are 01 gL ~ THE , b: Z5 F-t, i, It.ov~/ `1'H~ MouN D 1~ M~9~r RGiu1Au.1 _ zy 15 ~F11~tST~RgIS C? f]OP' 5( gi I ExisT~n~ 8 /./oure ~0 5 I , az - 95,2.Z" a3 - 9q~31o' ~I .S2►'1CA rrlQrg lS 60~ jy7 I Q f si'a~,'y1 q Af "/W Conner i I J S9()-,,40 o~ house, 336 i o p~~ a 30q ~ a Nunn a r ~ n P GS t R ~ i 4~,,R p1N ,r ~a B I I.+u t~ GOR~~gpO Il s, f • S ~NeI S91 NE' s I I --rz9N RlGt,~ n ti Sy Scale l = .as mp az9 L Kd? " 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. ---------------------------------,-r----)------------------------------------------ Owner of property n / Y) Location of property 1/4 1/4, Section /Z , T Z q N-R W Township i3 Q /,n. /--i Mailing address r7-, Address of site WX -Subdivision name Lot number T/ Previous owner of property _.L.i/c r. 5-dlq -Y 0Y7 Total size of parcel `40'4Cr'e-sr Date parcel was created - f Z-F-,S- Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes ~Y _No Volume g 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. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(mo) certify that all statements on this form are true to the best of my (-WdTJ knowledge; that I (,we) am (•e..) the owner(-&) 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. L4~_If u_; and that I f4ie-i 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. Signature of Owner Signature of Co-Owner (If Applicable) ~c /sue Yate of Signature Date of Signature DOCUMENT NO. Q STATE BAR OF WISCONSIN-FORM I WQrt ~_,-VPAGE 5U WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE THIS DEED, made between Joan M. Iverson and ST. CROIX CO., WIS. 1 Jean Ann Mentink ROC'd. for Record this 19th - Grantor day of August A.D. 19-B5 and Glen W. Malcein t 1.45 P A& -W rV Grantee, hah1w, of D Wi t n e s s e t h, That the said Grantor, for a valuable consideration . RETUR TO ii conveys to Grantee the following described real estate in St. Croix Menomonie Farmers Credit Unior. I County, State of Wisconsin: Box 126 ~ SE r', of the NE r and the NE r of the NE J and the SW Baldwin WI 54002 j of the NE IF, that lays East of R.R. R/W Sec. 12, T29N, R 16W. Tax Key No. I, • q k kN SFEM FEE This is homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this _ 15th day of __August 1989 JVEA Af _YN. / (SEAL) (SEAL) i * Joan M. Iverson` Jean Ann Mentink (SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN _ 19.- ( ss. Pierce County. Personally came before me, this 4th day of August, 1985 the above named Joan M. TITLE: MEMBER STATE BAR OF WISCONSIN Iverson and Jean Ann Mentink (If not, - authorized by §706.06, Wis. Stats.) 7 $ tM .Yf, This instrument was drafted by B. J. Hammarback to me known to be the e4q*n aK, ,ecut~¢ the. fore- goin instrument and/ kno &eddged+~l~ame.' r' ~lJ (Signatures may be authenticated or acknowledged. Roth * Shirley q. Furugl-. are not necessary.) Notary Public Pierce County. Wis. My Commission is permanent. (It' mf; state expiration date:-^_6/2Q ..1.9 86 'Names of persons signing in any capacity must be typed or printed below their sign UtUre S. WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1-1977 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER T1 ~ FIRE NO. CITY/STATE Ile zip 5YLI)2 PROPERTY LOCATION:.S~ 1/4 /4, Section lZ , TZN, R _Z6 W, Town of 3a /W1'0 n , St. Croix County, Subdivision &G , Lot No. J&/Z . 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. SIGN DATE v-la J_ 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ' DIVISION LABOR AND P.O. BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION N ME:. v~~/~/~,~ ~✓.9 ilk ~ ~r _ 1 S~/a i~ jT_A11111H (AT COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATION MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FlL D I ONS: OLATION TESTS: RC -Z~ _ 9D Residence ? ❑ New Replace I ,C / . 90 JPERC RATING: S= Site suitable for system U= Site unsuitable for system ONVENTI NAL: M D: ~ IN-GR❑OUNDPRESSURE: SYSQTEM-IN-FILLHO~LDINGGK: RECOMMENDED SYSTEM:(op D tional S BU S ~ S U S S o /ylotf/tom Lf . tii NX r ~f o ~~h (?/'.f If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-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.) mot, cc d p/ f' 01 i "(l' /l' 1336nnJ(t / /S. SC / /720 ,4., cc d so '75 ' G 7 B, " si' ,7 S Z • 17 Dente S eo B- S Z 1 0 / , .7 r ° i to / , j,1 " ~O / /S 1P r B- 7.4 N- S. - r p,\ Z, B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I P RIOD 2 P R PER INCH P- o 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 9 -off _ r r-- t ~ L 1 E (ir ~ I IIII ~ t l 1 ~ 1 ~ I I I I i i 1 f I _ j i ITN 1 I I - I t. 3... ~ ~ ~ ` ~ i ~ ~ I I I E I i - - - - I r i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, NAME (print : TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): zl CST GNATURE: /2/ 14 J DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R•02/82) -OVER - r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; ` 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc Percolation Rate coed s - Medium Sand W Well fs Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ with sic - Silty Clay fff few, fine, faint *c - Clay cc: - common, coarse pt - Peat mrn - Many, medium m - Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county orthe Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage yystern and a 1ir,,rmit: application n ust be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit muss: be obtained and posted prior to the start Of any construction. s 1 Cle.n F No, moo, ~oX /~Z E N ap -PAC EX OM 0 6- 5c-P-; C x B3 s p o3 to ~M.iri. ~►re u ~gz TIA, Acv: 25 Ft , 31EiGVa1 `Ta1 MU~)rJU Ar1uSr ~ MA ~ n! zy _ 15 _~i7t:ru~ s3a Aopi r 5~ 81 zJe Q2 - 85.22 I a- 3 , 99 3l~ i BerncA ' r ~ r~'1Q~i S 6o e ff ~ I J /Vlt~ Co,ner L~.~0~ house, 3 (~4 I s~E cEW NOS 3c 1 Q O~pEr1GE Sec. 12, I GO~~ESP . s~'~ ~Na. S, fe SG u / L ~ . y I ~z9N Rrb w n -browh Sy SC a le. 16~6,~Z AS M P eez 9 n' 1 Kd? a State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION I 201 E. Washington Avenue Au us i Lrx , { ~ ?li P.O. Box 7969 Madison, Wisconsin 53707 i I ul~'i1 sa'ICti:'irl s.r3u ~~.1 Dear i';r. , ial cci n: XC l i Crl r al Ceit) - fteS i c enco, snsi to .SLL'Yae S sp l et SL 12 'Z"'i 11 611i; Town of ual(luin, ';)L. Croix l,oun y, iZ Your peLAtion for vari, rnct: to section ILiik ~i.>.c. (1 i, iisconsin J .irlnis.rat;ive i;u(ie, fia +Lsez-i r^E:V°&,r4ec Tree ril i c, is(.1i n, k2:+ r1CgU1 r L!s a oluun( sys 4tt~ Si L~ ' (3 i;aV~ ~ €ir i rri €'lul l of Z4 it)dhes of- suitable 1"at-ural soil. I,ie vari ince requestec l;ts tu inst&J°l a replace.,-rent F:ioulid syste13 u€r a site ,J0 1 > i riches ut suitable "i -"ural soil. € ii ? 4 o i 101, ri €i~ cu 's °ier"r tS wer o i aucle i it t(14 2^' ;l -J ur'r 3 is 1 •r':> 6 `r I . in revi ewi rra 'We petition, i'4 was t,c te( t rlct 4 tttL 'c?C1u :St was Sis:ii l ar -to a ~ . a 'i ° ~t3 is+Gr' i3E~ttitlrlS iICC.:I~.;.tl, s~f '..i`iiS tIEi7cr"ir;~b~:.€"€i:' ilrr:lti.r petition ti ipetition rr~ii;i tUCrS i 2. 1Jdse(J on tiie estaoi isi'i 6 Gn°I pr",:.viuus petitions, 1-As (it,un or variance i5 3Ci l~ iwoGt~ss-eC C).S }0r°'tl",111SCOilS10 Statute :,ection a t Zl SBD-6928 (R. 10/87) w• State of Wisconsin ` Department of Industry, Labor and Human Relations I P- SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue U i i ; !a I CL l! i P.O. Box 7969 Madison, Wisconsin 53707 lc;ari.?i?si"uiif f'1Cii al`l: i'j,+t°UV0ii. 1 K"s i 5 v, j:jproV::;1 15 Y'ut~ sti:t.i l%i .i7l't.lii{ C11 Lill' ji Ll i }t3r Y't S S AC-1 jen'Ls a3iu iliv, colidl Li girls oi aljjt ova i (:1 t+" aa)ov : '.4-1 I i bo C wr7 t~G out. I'reparou ib,V. On .~lt,l, ..i.ev: clj... t::C:1.i43(i N;>J • ILnvironl:l(:Yii:i I f}iJltic'. 'r - :iu. i"vl tJr, 3 z' O12 cpartI~Iento7 ,71,ji, $ "IIr('' A 3: t) Cliar,a ! . r ;'Ii ' Cx_ ?alra'( (OY',i✓a talc tsl ..'1viS1Uil S iI Y YC;d$IOCI I L f I C . ~C6y s ckli..rr, y Y 1 iVt S..ortig., i i?i~iE;i~.S lY..'= $~ifi y (_('iEl I ii ~ f1's;il i1 i LP ~t ~.JY i, Y'`•3 t i~ i.it ii C.;j iludson SBD-6928 (R. 10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations 7 SAFETY & BUILDINGS DIVISION a h W- 411W, t i M& MAiN 10M, Mir ; Wi?Yr3, W, 300, N& _ s ! , 0 t, is RE: Plan Number 110.40341i P'k ~t>z-1. A,,;;:i.r 10, 00 GM ? Ow Of Oil : 4 ,i,i W a - . l4 : i 00 >0 C N.'i(1tm Mi ! zi O My i. sR.iiM09 l~~..,;m .it~(! `i~t+ ~t, i, it Sri. ~,l .f _ i. _ ~r ,..•t't'! ir:1M'z t, t3iy i .ii:£„ WWI ql; t' ifs I :.r6 th a"il-nC t, i 1.napi..'r 145, ,M. ,4, i1f1ta ai "0100% pt,.} ri, W.Wit ion vifl ii> .if _i :tFMw : nnj nM f t; nvy ' li, , pps _ .,i 1' ' s, ';n& !y`_,"s 1m ' hill; . Oil- any , . I Yi1; `.4i .:)1i :SI}.t.o _tii W o t.' #{i'. i i £ i t'itl , 1 'tmi , j i Iw. W 7r fl:: i :.t1 . I , (1. rmj r, , r ."i(u ; -u Qt`s lop W1, , t i..i'- t , ,.tz h r . _ru„ ?1 00 . , Ii. ,.33)3.;2 1 i',. ii Prim £ztC.. it kil, i~3t)rt I ',?o !b £'C °1 ti?t; ._'f .,.,,i, w Ink O-.. iS ;<E{,ilii Mil 00T {4nc V t itt P ;lm with 00 Wr After M A i trthv &I 11£. (t;S`,iYl.iu"t 1oE1 M: ii'f. t, i z lO, .,,n i , ;i. ? .1y .t1£ ;I;i=. t.; ird.. j•' ii t,,ris,ts WIP"Monn can 1W x trr. , ,1(;)9; val Wi it expirp '1~f" yv . t raw 0o novy Bpi, '.3f it Anilari1 g i i " r i ' i i 1 yi % obta } ( u d 0 will p , , top :fay n o WHO n Ci a , .,1i 1 xP i!' t u I J . i t`r."ifit'ttK My. i Thos" p i ,$b b a Y ' ; ? ? ~ ~ f o , ,i. ''~s£~ ~ ~ ~ .=t~. j ;wan a~ ~a,t it ownK ,f.`t. r£.b? th in .,L'1 k. nn i a l k i., q'pn . ji p }"wo `£.`..i 1 t t :s, . :1 v! the 01% approve! K Or ior 10140"q soniova-WK i nmr " s ng 10- ,2ppr rw , my , sip i ,,,op "y w 05 . t NSA M %A ?H J + h s:i i 001, AS WMIVA'' SBX6*3 (R. 0808) C~ ln'o 11~'alee ~Y) Rage L Of - Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand TOPsoil - F ._3.J E ! D ONg1TE v - G ` N (For;f, f 1N 2 Main Plowed rA: Aggregate Frem Pump Layer 10, DL~~~C~11" •K ~fJiS !JC X11, G 0 Dl's ection Of A Mound System Using 2:27 S~CO~RESp~N A Bed For The Absorption Are 6' F -L; G /-O A Ft. H Signed; e 933 Ft. License Numberr.~~~~ Date; G -2 7- 90 a ,7 ` Ft. K /3- o ion L 9- a Ft. of Force Main W Ft.. L. Observation Pipe A W ~o r~--- . - --T--- - V\e Ma' V Fro M Distribution Bed Of 2N-- 2 Pipe AggregQte : 0i WYgtion Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area N ;2 Perforated Pipe Deto(I j En ; Vier.' .i' e Pert orated 'End Cap w PVC Pipe y ' a~~~~44 ~ Hql~~, L.~fFpl~~ ~1~! BpttOm ~ f , PVC Foro' MalR }gnilpJd pipe Qith(butign (1y" r~q a 4t RIPA r0~' 0 Lott k kiol~~~RuIA Q~1 ~ Ns~t T no .49p ! d~ F E~ Gap ©isf~ibution pip ~.QYolt P `L R J~0 ' ` Signed L Hpl(~ Siam ter ;;rich _~traa " Inch(es) l.ieQnse dumber: ll~~ n I Manigl:d y, Inches Date * G = C1~ _ Fo~'ce mAi~ Inches ;4 ONS #:,Of hol est,p pe j l Gc~i~ invent' Elmti.on f 'Lat r►'1 ~1~f~h 'Ft. ~y p ~^.:C b, , r . Tl t.~.w{p~e:. .:r 1:~t 1'}Y F ;a D NCB . ~ ~ , ~RESP co /C°y~f'J ~ ~Ct°l yI PAGE A- OF _L PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS VENT CAP `I~~C.I. VENT PIPE ' WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAIJHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MIN. I AIR INTAKE GRADE ~ 40 MIN. CONDUIT \ 10"A11N. ~ 11~ INLET C?~; PROVIDE -7 P IGHT SEAL APPROVED JOINT IA 4~ prtaR~~~~pt I I I APPROVED PEOINI W/C.m. PI w/c.z. PIPE { S 1@';`~. I EXTENDING 3 EXTENDING 3, 04-11P I I OIJTO 60LID SOIL 6 ~Y~CAU~~v - II ALARM ONTO SOLID $011 L L C V. , 6_I FT. rat? PUMP - OFF D COU CRETE BLOCK 3" APPQo RISER EXIT PERMITTED GNLy IF TANK MANUFACTURER HAS SUCH APPROVAL BEOOINE SEPTIC E SPEGIFICATIOKJS DOSE fee TA1JK MAIJUFACTU0.CR: ` NUMBER OF DOSES: ` ER DA4 TANK SIZE: GALLOWS DOSE AYIL A~~6 IV ALARM MAIUFACTURER: ~P_ P INCLU ~KFLOW: GALLONS MODEL NUMBER: cJ 1600 CAPACITIES: A=zj''31 y3~~78 INCHES OR GALLOIJS SWITCH TYPE: - B = -~n INCHES OR-321"01 4LLOAI5 PUMP MANUFACTURER: u~( C a ` mr-HES OR -/.?0' GALLOWS MODEL NUMBER: 1,t)P__03111--" D- /-Z INCHES OR' Z-2-YGALLON6 SWITCH TYPE: V MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE G(PM INSTALLED ON SEPARATE CIRCUIT$ VERTICAL DIFFERENCE CETWEEN PUMP OF 70*!DISTk BUTION PIPE.. 9 FEET f MINIMUM NETWORK SUPPLY PRESSURE . . . . 2.5 FEET + ffO FEET OF FORCE MAIN X -?'/g F pfTFRIC71o11 FAGYOR.. FEET TOTAL DYNAMIC. HEAD - FEET (2-19-7 rt, (M,",) L~L~•~ INTERNAL DIMLWSIOW~ OF TANK: LENGTH / -;WIDTH r- jLIQUID DEPTH D SIGNED:-014 LICENSE NUMBER: ~Y7 G6G % • DATE. C! Z "6'Ie n o 1' /,ilcel'6 Performance oubmersible Effluent Curves, Rumps y y l I METERS FEET ~.J 90 MODEL 3885 25 80 SIZE 3/4' Solids WE15H 70 S 20 WE10H 60 WE07H 15 50 WE05H 4IN, 0 10 30 WE03M I 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 i i 0 10 20 30 m3/h CAPACITY [gGOULDS PUMPS, INC. ~i SUECA FALLS NEW YOGIC 13148 METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3/4" Solids 30 100 90 4- 25- 80 L) U 70 S 20 J Ia 60 0 F- 50 WEOSHH 15 40 10 30 20 5 t 10 / 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 ST. CROIX COUNTY WISCONSIN Joseph rveyor ZONING OFFICE ST. CROIX COUNTY COURTHOUSE °t 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 March 26, 1991 I fv ~ ~t'i n Glen Malcien y; Rt.1 Woodville WI 54028'} Dear Mr. Malcien: In an effort to upgrade our holding tank files, I have been conducting inspections of all of the holding tanks in St. Croix County. While inspecting a tank which services a property that you own which is located at the SE 1/4 of the SW 1/4 of Section 28, T29N-R15W, Village of Hersey, Township of Springfield, St. Croix Co. WI, I discovered that there was no way to lock the cover of the tank. This could potentially be a very dangerous situation, especially given the fact that there are children living in the house. Methane gases which are created and stored in the tank can be extremely lethal. Should someone accidentally inhale some of this gas it could result in anything from unconsciousness to death. Because this is such a potentially dangerous situation, WI Administrative Code ILHR 83.18(7)(c) requires that all holding tank covers be provided with a locking device. Therefore, I must order you to repair or replace the cover of this tank so that it can be effectively locked. If you agree to do this as quickly as possible and let me know when it has been completed, I will inspect the tank and let the matter end here. If you choose not to have this work done I will be forced to gain compliance through the issusance of citations, violations and/or prosecution through circuit court. I sincerely hope that such drastic steps will not be necessary. Please let me know as soon as the work has been completed so I can inspect it. If I have not heard from you by April 12, 1991, I will assume that stronger measurers are needed. If I can answer any question for you regarding this matter, please contact me at this office. Sincer ly, James K. M son +"►'n Assist Zoning Administrator I cj cc:Bob Rehbock t4 - 1 c F> Z or