HomeMy WebLinkAbout006-1064-80-200
Wisconsin De" -ti, ent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Br n,. Division
INSPECTION REPORT Sanitary Permit No
186
GENERA FORMATION (ATTACH TO PERMIT) State Plan ID No: ~
Personal infoi n you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holde ne: City Village X Township Parcel Tax No:
PACRR i fka Peterson Sisters, Inc. C Ion, Town of 006-1064-80-200
CST BM Elev Insp. BM Elev: BM Description: Section/Town/Range/Map No,
29.31.16.448E _
TANK INf= )fMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SF ;CK INFORMATION
TANK TO 71 WELL BLDG. Vent to Air Intake ROAD Dt Inlet
i
Septic Dt Bottom
Dosing j Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMPIS' )N INFORMATION
Manufact Demand St Cover
GPM
Model Nu;
Ce_,t- - e
TDH Lift Friction Loss System Head TDH Ft
Forcernai- , gth Dia. Dist. to Well
3 '
SOIL Af PTION SYSTEM A 25 4cJ-e ' r
BED/ I REP dth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSI,
SE I L3A STEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFO P ^vi r CHAMBER OR
e Of System: UNIT Model Number
DISTRIE I :,N SYSTEM _
HeadeoMz Distribution x Hole Size x Hole Spacing Vent to Air Intake l
Pipe(s)
Length_ a_ Length Dia Spacing
SOIL CC x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depts uve Depth Over xx Depth of xx Seeded/Sodded xx Mulchea
Bed/~ .rc: Bedrrrench Edges Topsoil
- ~ Yes 0 No ~ ,Yes [ No
COr 11JI ` (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Loca,,or I'ighway 46 New Richmond, WI 54017 (SW 1/4 SW 1/4 29 T31 N R16W) NA Lot 2 Parcel o: 29 31.16 8G n
IVY l e-oc~l Of .6
1.) At E',' ,lion = ~a. d► raCCL, ,a
r
-a.. c. ever l~G~ e, lI P~~ Od
fU4
Plan _vis wired? D Yes ~~No L31 Use r f e additional information. I
Date Insepetor's Si nature Cert . No.
SBD- "O
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner F,uer-
Mailing Address
Property Address
(Verification requir d from Planning & Zoning Department for new construction.)
City/State IQ v/ / cjym o ~j D Parcel Identification Number ®0 6 M& 5L g® - 200 ~W(_)
LEGAL DESCRIPTION
Property Location 5 V~/ '/4 , :!~VV Sec. 'Z , T 31 N R [ C W, Town of Lo
Subdivision Plat: , Lot #
, -5-7 -7
Certified Survey Map # 13 6, /ell" 0 ~ Volume Page #
Warranty Deed # 2 2 (before 2007)Volume Page # d
Spec house ❑ yes no Lot lines identifiable J4 es ❑ no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 0
00 %n
NATURE PLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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County Sanitary Permit App fcatfon ST. CROIX COUNTY WISCONSIN
In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT
information you vide may be used for second es ST. CROIX COUNTY GOVERNMENT CENTER
Personal
[Privacy Law. S15.04(1)(m)] antr 1101 Carmichael Road
y t) Hudson, WI 54016-7710
(715)386-4680 Fax(715 386-4686
A ApI for the system on paper not less 'thadO /2,4 J 1 inches in size.
Coun n ❑ Check if revi 'on to pRi!v~oRs applicat
Application Inoornation - Please Print all Information oration: Q / W ',2 9
Property Owner Name 3 CO 1/4 5k/4, Sec
N, R E or W
Property Owner's Mailing Address Lot Number Z Block Num r
W
City, State 1-1 Zip Code Phone Numer ubdivision Name r CSM Number
e o z s 19,,S-7-73
11 Type of Building! (check one) [)vity ❑ Villa a own of
❑ 1 or 2 Family Dwelling - No. of Bedrooms: C, V
4010-IS
OKPublic/Commercial (describe use): a► ~../r,P S Oct,
❑ State-owned Neare oad
II. Type of Permit: (Check only one box on line A. Check box on line B if applicable)
P I ax Number(s)
A) 11.11EI-Frepair ❑ Reconnection ❑Non-plumbing . ❑ Rejuvenation 00 / _ le? & V _ ~1- 6~/U (7
Sanitation l~
Permit Number Date Issued
B)
tate Sanitary Permit was previously issued 5- ';~D
153S/ J
IV. Type of POWT System: (Check all Owd apply)
❑ Non-pressurized In-ground ❑ Mound k 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A+0
❑-Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line
lsd/Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other
❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating I
1. Dispersal/Treatment Area Information: h
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final 15rade
~ 3 ~ (G~dL d~ /sq.ft.) (Min.lncF~, Elevation ~ 2 40
c/ '276) R lG / ? Proposed
I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab!',(' Site Con- Steel • Fiber- Plastic
New Existing Gallons Tanks Concrete strutted glass
Tanks Tanks
,,0 w T ur- ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
II. Responsibility Statement
I, the undersigned, assume responsibility for repair/reconnenction/rejuvenatioMnstallation of non-plumbing for the POWTS shown on the attached plans. A
icense is not required for terralitt repair or the installation of non-plumbing sanitation system.
Plumber's Name (print) Plu Sign n ps): MP/MPRS No. Business Phone Number
Plumber's Address (Street, , State, p t~pq
o LC..* z~
III. Coun se Only
Disapproved Sanitary Permit Fee ate Issued Issuing gent Sign o stamps)
Approved Owner Given Initial Adverse ,yD 2 ✓ G~/~ /~{,vy~✓
Determination 40
IX. Conditions of Approval/Reasons for Disapproval:
G G~ °
YSTEM OW
1 Septic tank, effluent filter and d
dispersal cell must be;sP_ryiced / maintained
as per management plan provided by plumber. 1160
2. All setback requirements must be maintained
as per applicable code/ordinances.Qith~ vC.~ a~'Wc'f dome-"et
yR~e~v,:8/05 a,,,e Qfi- ~2Qif~rt sy~
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BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
05/31/2011 3:51 PM
ST. CROIX COUNTY CERTIFIED SURVEY MAP EXEMPT
REC FE-E: 30.00
Located in the Southwest Quarter of the Southwest Quarter of COPY FEE: 3.00
Section 29, Township 31 North, Range 16 West, Town of Cylon, PAGES: 2
St. Croix County, Wisconsin.
WEST 1/4 Co" . :
Of~"uC. 29, T31N, I _
'2 NORTH LINE OF LOT 1,
3 I C51`1, VOL. 12, PC. 33q6-----,,
tl1 ~ ~ ~ ,n -+I 115.1 W
n o I S89-0 1'56 530 75 .,E OWNER:
PACRR, LLP, A
O 475.73 WISCONSIN LIMITED
1J N r ` ( LIABILITY PARTNERSHIP
fiO
LOT AREAS
O o oe LOT 1
LOT I
\ 0 60' - o z ~a V TOTAL-215,096 SQ.FT. /
4.94 ACRES
ROADWAY=22,298
SQ.FT. / 0.51 ACRES
t
•.'i :-=i;.i Z` I l / I SB9°01'56°E LOT2
93.75 C\2 ~J
3,230 SQ.FT. /
o Cl) I Z `w ` 365073 A r ` 110.00? °n o a S.O2 ACRES
00
-z 0 E3 I ' p J r`' ROADWAY-56,442
:3 O C* I ~ i N
SQ.FT. / 1.03 ACRES
LOT 2 s '
n o n ~s 8 0
• I I r^J Q M -O ~O
oo HIGHwA', N
C~ SOUTH I
~ SETBACK LINE /4 CCU'.
- SEG. 29, T31N,
58907'56"E R 1
OP S--,
365.73
,11JC)00
7003 70.
03
4207S. T. H. "64 " 2 7 09.71
- S89°01'56"E
530.75
5w COrz. OF SEC, N89°01'56"W
29, T31N, 216W,
FOUND P.K. NAIL I I SOUTH LINE OF THE 5W WITH DISC. 1/4 Or 5ECTICN 29,
T31N, (Z 16~n%
LEGEND
DENOTES 3.25 INCH ALUMINUM ALL LOTS ARE HEREBY RESTRICTED "THE PARCEL(S) SHOWN ON
ST. CROIX CO. MONUMENT UNLESS SO THAT NO OWNER, POSSESSOR, THIS MAP ARE SUBJECT TO
OTHERWISE INDICATED. USER, LICENSEE OR OTHER PERSON STATE, COUNTY AND TOWN
MAY HAVE ANY RIGHT OF DIRECT LAWS, RULES AND
• DENOTES FOUND 1" IRON PIPE VEHICULAR INGRESS FROM OR REGULATIONS (I.E.,
O DENOTES SET 1" X 24" I.P. EGRESS TO ANY HIGHWAY. ANY WETLANDS, MINIMUM LOT
WEIGHING 1.66 LEIS ACCESS ALLOWED BY SPECIAL SIZE, ACCESS TO PARCELS,
PER LINEAR FOOT EXCEPTION SHALL BE CONFIRMED ETC.). BEFORE PURCHASING
e;' AND GRANTED ONLY THROUGH OR DEVELOPING ANY
DENOTES SOIL BORING THE DRIVEWAY PERMITTING PARCEL(S), CONTACT THE
BY A.E.C. SOIL & SITE PROCESS AND ALL PERMITS ARE ST. CROIX COUNTY
EVALUATIONS REVOCABLE. PLANNING & ZONING
B DENOTES EXISTING DEPARTMENT AND THE
SEPTIC SYSTEM TOWN FOR ADVICE."
CLEANOUT
® DENOTES EXISTING WELL
BEAF,INr,L ARE THIS INSTRUMENT WAS DRAFTED
suite stoo REFr-. ' •:D TO THE BY DANIEL L. THURMES '
WEST LINE OF THE SW
LF-h treet
082 1 /4 OF SECTION 29. REVISED 3-23-2011
969 T31 N, R1 6W, '.'VHICH IS
976 ASSUMED TO BEAR c
NOO"35'31"W. NORTH /~'I/
4 DANIEL S Y+
o zoo '
2456
STIL-006;
/ LWAMM
MN i
CORNERSTONE 0*%
t_AN~ SURVEYING, !NC
SHEET 1 CIF- 2 SHEETS
1 of 2
Vol 25 Page 5773
y
ST. CROIX COUNTY CERTIFIED SURVEY MAP
Located in the Southwest Quarter of the Southwest Quarter of
Section 29, Township 31 North, Range 16 West, Town of Cylon,
St. Croix County, Wisconsin.
1, Daniel L. Thurmes, Registered Land Surveyor, hereby certify that I surveyed, divided and mapped Lot 1 of
Certified Survey Map filed on December 17, 1997, in Volume 12, page 3396, Document No. 570018, and part
of the Southwest 1 /4 of the Southwest 1 /4 of Section 29, Township 31 North, Range 16 West, Town of Cylon,
St. Croix County, Wisconsin, described as follows:
BEGINNING at the southwest corner of said Section 29; thence on an assumed bearing of North 00 degrees 35
minutes 51 seconds West along the west line of said Southwest Quarter a distance of 826.17 feet; thence
South 89 degrees 01 minutes 56 seconds East a distance of 530.75 feet; thence South 00 degrees 35 minutes
51 seconds East a distance of 826.17 feet to the south line of said Southwest Quarter; thence North 89
degrees 01 minutes 56 seconds West a distance of 5330.75 feet to the POINT OF BEGINNING. This Parcel
contains 438,326 square feet or 10.06 acres, more or less. Subject to and along with easements of Record.
That I have made this Survey, Land Division and Map at the direction of PACRR, LLP, a Wisconsin Limited
Liability Partnership, owner of said Land. That to the best of my knowledge and belief said map is a correct
representation of the Survey and the Land Subdivision made. That to the best of knowledge and belief I have
complied with the provisions of Chapter 236, Section 236.34 of the Wisconsin Statutes and the Subdivision
Regulations of the Town of Cylon and St. Croix County in surveying, dividing and mapping of the above parcel
of land. FEVISED 3-23-11
Dated this 23rd da of March, 201 1.
+ 11
G o N S\ `11
DANIEL L.
Daniel L. Thurmes, R.L.S. No. 2456--008 THUFRAES o
Licensed Land Surveyor i s ivv i
Cornerstone Land Surveying, inc. rl~ ►+N
200. E. Chestnut Street, Suite 8100 4N=Q=
Stillwater, MN 55082 s u a
CORPORATE OWNER'S CERTIFICATE OF DEDICATION
PACRR, LLP, a Wisconsin Limited Liability Partnership, owner, does hereby certify that said corporation caused
the land described on this Certifiec' E.irvey Map to be surveyed, divided, mapped and dedicated as represented
on this Certified Survey Map.
WITNESS, the said PACRR, LLP, a Wisconsin Limited Liability Partnership, has caused these presents to be
signed by Roxanne M. Rummel, Vice President of PACRR, LLP, a Wis. ' i-1:tnership, this
_,Y- d of _ 201 -i . APPROVED
By; , Vice President MAY 31 2011
State of G{J2 ) 3T. CROIX COUNTY
)ss. PLANNING a ZONING OFFICE
57~ ~llo~~r County)
- Personally came before me this -Z~ _day of 201 1, the above named Roxanne M.
Rummel , Vice Presi nt of PACRR, LLP, a Wisconsin Limited Liability Partnership to me known to be
such psons wh e0cut d the foreLOing instrument and acknowledged the same.
///o !
Notary Public, Count My commission expires
1 hereby certify that this Certified Survey Map was approved i y th Town Board
Zof~ th1s~~ e eT/o~wn of Cylon at a meeting held this _ !!--day of
,oo 1r/'lam J
eet
62 Town Clerk ,N
69,w
LPh
976 s/+~
he duly elected, qualified and
L~CCL1LIclicl,__, being t
usa
.not act'ng treasurer of the L:--iry of St. Croix, State of Wisconsin, do hereby certify
the the records In my office show no unredeemed tax sales and no unpaid
.w -4* tax _s or special asses. ~e....: as of - tl2L l----_-, 201 1 affecting the
lands included in this Certified Survey Map.
CORNERSTONE -.5z5LZ.LL---- - ter IAN SURVEYING. ING (Date; (Treasurer
2 of 2 SHEET 2 OF 2 SHEETS
Vol 25 Page 5773
Parcel 006-1064-80-200 05/29/2013 09A4 AM
PAGE 1 OF 1
AP. Parcel 29.31.16.448G 006 - TOWN OF CYLON
Current E ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
J5/31/2011 00 0
Ta x Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - PACRR LLP
Pi,CRR LLP
1°J1 HWY46
NI_W RICHMOND WI 54017
D ,tricts: SC = School SP = Special Property Address(es): Primary
T oe Dist # Description " 1901 HWY 46
S : 3962 SCH DIST NEW RICHMOND
S:' 8020 UPPER WILLOW REHAB DIST
S!' 1700 WITC
Legal Description: Acres: 5.120 Plat: 5773-CSM 25-5773 006/2011
S' C 29 T31 N R1 6W PT SW SW; BEING CSM Block/Condo Bldg: LOT 02
2: 5773 LOT 2 (5.120AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-31N-16W SW SW
N tes: Parcel History:
R TIRED 2011 FOR 2012; TAKES ALL Date Doc # Vol/Page Type
0 3-1064-70-150 (448D) & ALL 05/31/2011 936901 CSM
Oi 3-1064-80-050 (448E) FOR CSM 25-5773 04/04/2011 934472 DRIVE
L( 'F 1 006-1064-80-100 (448F) & LOT 2 08/12/2010 920638 CONY
0! 3-1064-80-200 (448G) 08/06/2010 920294 CONV
_ more...
2 13 SUMMARY Bill Fair Market Value: Assessed with:
0
V Iuati011s: Last Changed: 05/31/2012
D scription Class Acres Land Improve Total State Reason
C i 1MERCIAL G2 5.120 50,000 116,100 166,100 NO
otals for 2013:
General Property 5.120 50,000 116,100 166,100
Woodland 0.000 0 0
otals for 2012:
General Property 5.120 50,000 116,100 166,100
Woodland 0.000 0 0
L )ttery Credit: Claim Count: 0 Certification Date: Batch
S )ecials:
U cr Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 006-1064-80-000 08/02/2006 04:49 PM
PAGE 1 OF 1
Alt. Parcel M 29.31.16.448B 006 - TOWN OF CYLON
Current X_ ST. CROIX COUNTY, WISCONSIN
f Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - GESS, ALLYN L
ALLYN L GESS C - BERENDS, ROXANNE M
ROXANNE M BERENDS,ET AL C - LEIER, CYNTHIA B
1901 HWY 46 C _
NEW RICHMOND WI 54017 - P DEANNA J
- SHATSWE IA A
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1901 HWY 46
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 4.060 Plat: N/A-NOT AVAILABLE
SEC 29 T31N RI 6W 4.06A IN SW SW BEG AT Block/Condo Bldg:
SW COR OF SEC 29 TH E 25 1/2 RDS TH N 25
1/2 RIDS TH W 25 1/2 RIDS TH S 25 1/2 RIDS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TO POB & INC CSM 29-31N-16W
12/3396(006-1064-70-100)448C
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 825/538
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/08/2004
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 4.060 28,000 116,100 144,100 NO
UNDEVELOPED G5 6.000 18,000 0 18,000 NO
Totals for 2006:
General Property 10.060 46,000 116,100 162,100
Woodland 0.000 0 0
Totals for 2005:
General Property 10.060 46,000 116,100 162,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
t ! Form - S T • C - 106 -
AS BUILT SANITARY SYSTEM'REPORT
•OWNEit"'~ 0 SS R64. S , • • TOWNSHIP 1 N--= Ve- A woo h Q SEC. T N-R W
ADDRESSi ~r 3 .••ST. CROIX COUNTY, WISCONSIN
JV e w
. ! SUBDIVISION d - I LOT LOT SIZE e1.4
_ •c... _ PLAN VIEW
Distances aad dimensions to meet requirements of Il,Hli`83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM '
too
.i
1: Al L
• r
cra
. - . ~ . Safi ~•i . •.Lt r.. _ . . • ~ 1
_ INDICATE NORTH ARROW
BENCHMARRs Describe the vertical reference point used t& a H/
•rr . r•It . . r G
Elevation of vertical reference points U Proposed slope at sites 2 7.
' SEPTIC TANKS Manufacturers • M•Q►~ytj•Cgtc"n Liquid Capacitys UPoO
s"Numbef of rings useds
Tank manhole cover elevations
• Tank Inlet Elevations Tank Outlet Elevations
Number of feet from nearest Roads Front, Side o Rear, 0_S Du feet
• From nearest-property line s • Front,OSide, (~ltear,O~ feet
Number of feet fromi Well I building:
(Include this information of•.the above plot plan)(2 reference dimensions to septic tank)
SEE REM"'
ME
PUMP CHAMBER
Menuf ac turer s we d w e-S t7 c.r !1 Liquid Capacity s / S~V
`.Pump Model: 3 Pump/Siphon Manufacturers vL Pump -Size
Elevation of inlet: Bottom of tank elevations
Pump off switch elevations Gallons per cycles
Alarm Manufacturer: Alarm Switch Types
01
•Number of feet from nearest property line f'' Front, OSLdes O Rear, Ft. G s
'Number of feet from well:
Number of feet from building: SrG~
(Include distances on plot plan).
SOIL ABSORPTION -SYSTEM:
Bddr• Trenchs
Width: ~'D~ Z • Lengthi .-Number 'of Lines: Area Built:_ _
Fill depth to to of pipes
i
Number of feet f om nearest property lines Front, O Side, 09 ur,0 Vt. 3a
Number of feet from well: ~ 40 •
_
N Aber of feet from building:
(Include di tances on plot plan).
SEEPAGE PIT t
Size: Number of pits Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
t
Has either a drop box or distribution box O been used on any of the above soil
absorbtion aytems? (C~eck one).
• f .
!HOLDING TANK
i
Manufacturers Capacity:
Number of '.rings used: •Elevation of bottom of tank:
• Elevation of inlet:
Number of feet from.nearest property lines Front, O Side, 0 Rear. OFt.+
Number of feet from wells
Number of feet from building:
Number of feet from.nearest roads
Alarm Manufacturer: '
_.a Inspectors.
Dated: Plumber on jobs
License Number: h~
3/84::0
PUMP CHAMBER
~✓e e-S z c r
Manufacturers t Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: pump •Sise..
Elevatdon of inlet: Bottom of tank elevations
Pump off switch elevations Gallons per cycle:
Alarm Manufacturer: Alarm Switch Types e
• •Number of feet from nearest property linsi.' ' Front► OSLds. Rear,
V Pt. G
G
'Number of feet from well:
Number of feet from buildings 500
(Include diatances.on plot plan).
SOIL ABSORPTION-SYSTEH: t:
Bdds• • Tranchs
Width: % Lengths -.-Number 'of Lines: Area Built: Fill depth to toj of pipes
ar, Vt. 3o"
Number of feet f Iom nearest property lines Front, Side, (age O
Number of feat from wells 40 O (a •
-G
N 'bar of feat from buildings
(Include di Lances on plot plan). "
SEEPAGE PIT t
Size: Number of pits, Diameters
Liquid depth: _ Bottom of seepage pit elevation:
Area Built:
r
Has either a drop box O or dint-ibution box O been used on any of the above soil
absorbtion sytems? (C eck one).
HOLDING TANK
Manufacturers Capacity,
Number of'.rings used:. Elevation of bottom of tanks
Elevation of inlets
Number of fast from.nearest property lines Front. O Side, O Rear, 0Ft._._.
Number of feet from well:
Number of feet from buildings
Number of feet from.neareat roads
Alarm Manufacturer: '
s,A Inspector:.
Dated: Plumber ,on Job: s.~
License Number: h
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
F.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
S_pQA', I9 1, tiVISeC. 29 , T31-R16 State Plan LD. Numbec
C~ ALTERATIVE (If assigned)
t WW~~~ E] CONVENTIONAL,,
Town of Cylon oml~lu
Hw 6 El Holding Tank lw~ In-Ground ressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N DA E; y~ T-3r .
Peterson Sister's Crossroads Rt. 3 New Richmond WI 54 171/i®-ttJ o.`s- 9 '8S'
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. E ~
Name of Plumber: MP PRSW No!: County: Sanitary Permit Number:
Joe Stang A 6646 S Croix 135517
SEPTIC TANK/
MANUFACTURER: LIQUID CAPACI T NK INLET LEV.: TANK OUTL T ELEV.: WARNING LABEL LOCKING COVER
1~ 2C~ 1 / PROV ED: PROVIDED:
1?1x 11R] 'd YES ❑ NO ❑ YES NO
BEDDING: V~ DIA.. VCHdT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING' VENT FRESH
C ; ALARM: FEET FROM LINE: / AIR IN T:
❑ YES NOS - YES NO NEAREST D 95 S
o
DOSING HAMBEFtk_,_- .z, IIA r~ e;„ g.
MANUFACTURER: BEDDING. LIQUID CAPACITY- PUMP MODEL: PUMP/ NUFACTURER:' WARNING LABEL LOCKING COVER
~}-PRO IDED: PROVIDED:
❑YES NO QL(e-r- YES ❑NO YES ❑NO
14'y GALLONS PER CYCLE: `PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: / AIR INL ,Ty:~ /
PUMP ON AND OFF ❑ YES ❑ NO NEAREST 01 '~L~ J V
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAME' ER MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
C / TRENCHES: MAT IAL: DEPTH:
DIMENSIONS + o )(66 ~ a,.°--
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTfj. PIPE Mf>,TERIAL: N D STR. NUMBER OF PROPERTY WELL: NT TO FRESH
BELOW PIPES: ABOVE ELEV. INLE ELEV. END: PIP S: LINE: A
7y 1- . ~ ^ FEET FROM
41?t _0 9d F0, 2,1, C.{t NEAREST
MOUND SYST M: ,33' k^° iv,cr
Mound site erpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO r medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PE MARKERS: OBSERVATION WELLS;
❑ YES N ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO E] YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEMt~D
BED/TRENCH WIDTH: LENGTH: NO. OF LATERALSPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS cc (a
Zp - C
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE Dl TRISUTION PIPE MATERIA & MARKING-
ELEVATION AND ELEV.: ELEV. \ DIA.: ELEV.: i PIPES: DIA.: 1 it 3 1I Atfe ✓5 410 h-
DISTRIBUTION 9a
HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION /f APPROVED PL S
1
YES ❑ NO : , ?L, ' YES ❑ NO
TV WELL: / BUILDING:
PERMANENT MARKERS: OBSERVATION WELLS: LINE
NUMBER OF :
C MM TS: FEET FROM LINE: /
-K ❑ YES NO YES ❑ NO NEAREST
.e>".'"r.✓ D ~Ll~ ~ it . ~
T 1zv ( C
Q Two(, ~-Lrz K . ~jL 1~ 4
Sketch System on tain in county file for audit.
Reverse Side. SIGN URE: TITLE:
SBD-6710 (R. 06/88)
R
h 77 7
.~,r~ ~ w Ir y -.r 7.3 r~
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, -41
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4. 44X
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A 4 j ~K
S ~ V Z~
I -a SANITARY PERMIT APPLICATION T
TDILHR In accord with ILHR 83.05, Wis. Adm. Code COUN
• s STATE SANITARY PERMIT #
Attach complete plans (to the county copy only) for the system, on paper not less than El -7
8% x 11 inches in size. Ch re si to pr sous application
-See reverse side for instructions for completing this application. STATE /PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 7 Q
PROPERTY OWNER PROPERTY LOCATION
[fete otSG tSt e,tS -ANC. CRc Roc ~ s 5t'✓'/4 S ~ T N, R E (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
l~r 3
CITY, STATE ZIP CODE PHONE NUMBER SUBDI I ION NAME OR CSM NUMBER
~tw fir #K e, m e( s 1 t 2vt:-~ N~
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE C ` 16 (1lvv~
IAPublic ❑ 1 or 2 Fam. Dwelling-# of bedrooms - A WN O NUM R( )
III. BUILDING USE: (If building type is public, check Z11 that apply) 3,
-16
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
Home Park 12 Service Station/Car Wash
8 11 Mobile
4 Church/School
❑
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. ~ry ~ New 2. ❑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 M Seepage Bed 21 El Mound 30 El Specify Type 41 El 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.) (Mip./inch) p QELEVATION
3 7~ v 631? 4 3 CF-0 , 5-l G G Feet l Feet
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 Holdin Tank L/ 0 rJ m ed A/ t G
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumb 's Signature: No Stamps) AWNPRSW No.: Business Phone Number:
Plumber's Address (Street, ty, State, Zip Code)
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination O(7 !v C,
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
r
INSTRUCTIONS -
1 .
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.
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; (Jose 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)
Y
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o WEGERER SOIL TESTING
AND
DESIGN SERVICE
(A P,Oo BOX 74 421 N. MAIN ST.
RIVER FALLS; WI 54022
715-425-0165
Ol-T'~ / ~ 0 5 r d® o s-) 6 Z 0 F 3
State of Wisconsin ` Department of Industry, Labor and Human Relations
t
PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION
Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
WEGERER SOIL TESTING & DESIGN SERV. Owner: DEANNA PERSON
ARTHUR L WEGERER
P.O. BOX 74 ROUTE 3
RIVER FALLS, WI 54022 NEW RICHMOND, WI 54017
RE: Plan Number: S90-00448 Date Approved: May 9, 1990
Gallons Per Day: 3,790 Date Received: April 30, 1990
Project Name: CROSSROADS AT THE CORNERS Location: SW,SW,29,31,16W
Town of CYLON County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- REPLACEMENT PETITION
- REPLACEMENT IN-GROUND PRESSURE SYSTEM
Inquiries concerning this approval may be made by calling (608) 266-2889.
Sinc ely,
PETER E. P L
Section of Private Sewage
Division of Safety and Buildings
PPP013/0009n/ 4
cc: DEANNA PERSON
Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant
SBD-6423 (R. 08/88) -Owner -Plumber -Environmental Health
3
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
May 10 , 1990 201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
i
Deanna Person
Route 3
New Richmond, WI 54017
Petition No. S90-00448-P
i
Dear Ms. Person:
Re: Crossroads at the Corner - Bar & Restaurant
Onsite Sewage System
SW,SW,29,31,16W
Town of Cylon, St. Croix County, WI
The petition for a variance requested to section ILHR 83.15 (5)(b) of the
Wisconsin Administrative Code was considered on May 7, 1990. The petition has
been conditionally approved. The condition being that an alarm system be
incorporated into the duplex alternating controls which would be activated in
the event of pump failure, simultaneously switching the remaining pump to
dosing on each cycle.
The rule requires that there be a one-day holding capacity above the high
water alarm switch in pump tanks.
The variance requested was to use duplex alternating pumps in lieu of the
one-day holding capacity.
All of the data and statements submitted on behalf of the petitioner were
considered. This variance is specific to the subject petition and cannot be
used for any additional modifications.
4 Sin erely,
Ric rd a er, i ct
Director, Office of vision
Codes and Application
(608) 266-3080
RM:0378e
cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls
Thomas Nelson, Zoning Administrator - St. Croix County
Arthur L. Wegerer, Designer
SBD-6928 (R. 10/87)
IN-GROUND PRESSURE SYSTEM Page I of -7
FOR
A BAR AND RESTAURANT
LOCATED IN THE SW1/4 OF THE SW1/4 OF SECTION 29, T31N, R16W,
TOWN OF CYLON, ST.CROIX COUNTY, WISCONSIN.
INDEX
Page 1 of 7 TITLE SHEET
Page 2 of 7 CALCULATIONS
Page 3 of 7 PLOT PLAN
Page 4 of 7 PLAN VIEW - CROSS SECTION
Page 5 of 7 DISTRIBUTION PIPE LAYOUT
Page 6 of 7 PUMP CHAMBER
Page 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
CROSSROADS AT THE CORNERS
ROUTE 3 yt~t4~imMqvw
NEW RICHMOND, WI 54017
R' ti
.y ; ARTHUR L.
li WEGERER =
s 0.915 P
c M=ORTH.
4w 1. Wis.
PREPARED BY ~ 1 .0
%
s I G, tA
~Nttp
l E--2'REIF 1E; C3 = L_ TEST I RIG
AND
DES:I GRI ~E~u' I CE
P.Q. BOX 74 421 N. FAIN ST.
RIVER FANS, VI 54622 "QU c/
715-425-0165 pGE SYgTEM
ONS~'~E sew JOB NO. qD - I F6
)r Ita
APR 3 0 1990
R _~p0
OFFICE ()F CFd'27~!Of
m e A W rl ;1 ,'i `~w
CALCULATIONS Page Z of
The soils at this site are Onamia Loam - class 2 perc rate.
The design loading rate used is .8 gal/sq.ft./day.
This bar and restaurant contains 2 floor drains, a maximum of
100 restaurant seating spaces,a dishwasher for the restaurant,
30 bar patron spaces and 6 employees.
SEPTIC TANK
2 floor drains at 50 'gal/day 100 gal/day
100 seats restaurant (kitchen and toilet)----=3000 gal/day(30X100)
100 seats restaurant (dishwasher)------------= 300 gal/day(3X100)
30 bar patron spaces at 9 qal/day 270 gal/day
6 employees at 20 gal/day--------------------= 120 gal/day
TOTAL WASTEWATER ----------=3790 gal/day
3790 + 750= 4540 gal minimum required septic tank capacity.
2 - 2400 gallon precast concrete septic tanks will be
installed in series to provide 4800 gallon capacity.
ABSORPTION AREA
. ~ 631`1
3790 gal/day divided by 44E-3~=$ sq.ft.minimum required.
30 106
2 identical beds each ZV by will be used to provide
sq. ft. of absorption area.
G3$p
PUMP CHAMBER
A 750 gallon precast concrete pump chamber will be used with
dual pumps. Each pump will discharge to it's own bed 3.9 times
-per day. Duplex alternating controls will be installed with
the alarm system being incorporated into the duplex controls
which will be activated in the event of pump failure,
simultaneously switching the remaining pump to dosing on each
cycle.
0- 00
AGE S14S5sM
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PLOT 'F~IUNN ~f1GL 3 of `7
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,
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This approval does not include review of
any plumbing upstream of the septic/holding
tank. See section ILHR 82.20, Wis. Admin. - F 7- 11 f `F
Code to determine whether plan submittal and
approval Is required for that plumbing, A' R 3 0 1990
OF-RCE
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Z. TA~-SkLS 1b Be t~~Ow~sTt'RU 5~~:t~~ST ))vC -~REchST CoUCR~'TL' TMjks
.'}'1` lN`Trcl►J t✓111J. S OF BUILQlK16 sew*l2 Tb S(~P77C T'ftKJtZS,
L(, l { S1tt~l CMT 19-443 1- L Pe 3 ' C1 TD L )AO STUt2i3L-6 SOIL '80TH S/0(373 OF
s
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pia O~S1iZ1 B~iTton~ pith ~~za to Z~/ZY F1 6G RE6hlt - 6 ~~$~Uw PIPES
Pv~.n 2" l~3ovE P~P~s
ONSITE SEW
AGE SYSTEM
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Page S Of
ONSITE SMAGE SYSTE
A
DEPARTME,WT OF IN P , 9
Perforated Pipe Detail DIVES T f U ~nltf
AFt) ING .1 TIoNS
91
SEE CORRESP
O
End View EIVCE
)Perforated
End Cap) ~\e~e PVC Pipe
Holes Located On Bottom,
lY S Are Equally Spaced
I1JST~`~ C~'E-R"1-'1AtJE1~T ~ ,
K\^V.It. PCT ENO rz>F S
PVC Force Main
s
PVC P
Manifold Pipe
DistriI bution
Pipe
Last Hole Should Be'
Next To End Cap
End Cap I P SO Ft.
t
R ?A FT -
S
Distribution Pipe. ayout X 80 Inches
Y gO Inches
Hole Diameter I/Y Inch
-T, C"f L Lateral '1Y Inch(es)
Manifold S- Inches
Force Main 3 Inches
# of holes/pipe 1B r
z 0).
Invert Elevation of Laterals~L OFt.
(?o -oc) vs-
N-_:1LkCEi l Sr HULC 14 O'r 1=RZM'1 CGOOM:E'R OF ~~N 1 FOLO I,j 111-1 S V C ~ ~ S
V' T 20" 1).1 Tt'RV A L S , L N S T 1-}0 LL TU $t NAT 7n . T}fC L=KatD C &p
ga r' R 30 1990
OFFICE OF ~W LION
'~.°i" r• `tea ,'~`,t
~r '411y
S
PUMP CHAMBER CROSS SECTION AND SPECIFICATION t~E OF
VENT CAP
4*C.T. VENT PIPC
WCATHEK PROOF APPROVED LOCKiAI6
25' FROM DOOR, JUWCTIOAI BOX MANHOLE COVER WITH
? w RRN 1N 6 L+\8EL
WINDOW OR FRESH ItaMIU. I
AIR INTAKE
GRADE
EL 96.°_ * H' MIN.
10' MI IJ. .
INLET PROVIDE I
. ~ AIRTIGHT SEAL
APPROVED JOINT A WP' PEOINT$
W/W. PIPE 1 uplex alternating controls with the alarms I III EXTENDING 3'
EXTENDING 3' V ns ng i porated into a duple: controls ALARM
ONTO 50WD $OIL aced in ant of pwp failure, " I ( ONTO iom som.
Its 1 s bin emaining pump to I I
ON do I i ON
' J I
CLEV. 53.~ FT.
uP~ E}C PUMPS OFF
COUCKETE BLOCK
O~QPQ~ ~
RISER IRMITfED OIJLy IF TA1JK MAAIUFACTURCR HAS SUCH APPROVAL 3" APPRoWED
"DOING
5PCC- IFICATIOKJS oe y r / G
DOSE MIS TANKS l. 'STtQ~y ptzt`C~ST. JA, e _ 3 i 'I 4
MAAIUFACTURCR: NUMBER OF DOSES: -9 PER DAy
TANK 51ZE: 150 GALLOWS DOSE VOLUME S1g ~
ALARM MANUFACTURER' S-S. Ec CTRL S`iS l`U~t 5 INCLUDING O'ACKFCOW: GALLONS
MODEL NUMBER: HW CAPACITIES: A= 0 INCN[S OR - GALLOWS
SWITCH TSPC: -"e'eAjQy g = lI' INCHES OK 3O' S G~ LLOIJS
~►Tt1 PUMPS MANUFACTURER: G°U L t) S r t P 3 , I ru C. r- INCHES OR SI GALLONS
MODEL NUMBER: 388-7 WS O'7 8 D= b INCHES OR ~qq"~- GALLONS
SWITCH TSIPE:' "eacUtty DOTE: PUMASAND ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED OU SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF ANO-013TRIBUTION PIPE.. IC"3 FEET ~ ME ~
+ MINIMUM NETWORK SUPPLY PRESSURE . 2.52 FCET
+ S FEET OF FORCE MAIN X ,'$6 F y fEFRICTIOU FACTOR.- OS FEET APR 3 0 1990
TOTAL OtMAMIC. HEAD = 1'3 'OS FEET OFFICE O D1*V j!0N
INTERNAL WMLWSIOW, OF TANK: LENGTH ;WIDTH ~;LIQUID DEPTH
t3oTTol-1 AtZ A 3 SZ I, i31 = S .Z b GML_ / 1AJC.N
AS PER 1~ A !J U Faa C~ ~J 1t X12 = - G Pr I- / I U C -H
4
F
` -Performance
Submers'NP7
Curve Sewage Pumps
METERS FEET
MODEL 3887
16 50 SIZE 2" SOLIDS
-i- -
14
40
12 N
10
= 30
J
0 8
{ t
6 20
13.08>
-
4
10
4- 7~1
2-
0- -
0
0 20 40 60 80 100 120 140 160 180 GPM
C3.6~
0 10 20 30 40 m3/hr
CAPACITY
(q GOULDS PUMPS, INC.
SE ECA FAILS NEW YORK 0148
RECF
APR 3 0 1990
OFFICE y 0
0 1985 Goulds Pumps. Inc. Effective July, 1985
•en~}
State of Wisconsin ` Department of Industry, Labor and Human Relations
GENERAL PLUMBING PLAN APPROVAL SAFETY & BUILDINGS DIVISION
Bureau of Plumbing
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
~I
WEGERER SOIL TESTING & DESIGN SERV. Owner: CROSSROADS AT THE CORNERS
DEANNA PERSON
P. 0. BOX 74 ROUTE 3
RIVER FALLS, WI 54022 NEW RICHMOND, WI 54017
RE: Plan Number G90-00591
Date Approved: April 3, 1990 Date Received: March 21, 1990
Project Name: CROSSROADS AT THE CORNERS Location:
Town of CYLON 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 Bureau of Plumbing has reviewed these plans for plumbing code requirements
only.
This approval is for the following elements only:
- GREASE INTERCEPTOR
NOTE: This approval includes installation of Grease Interceptor Only.
Inquiries concerning this approval may be made by calling (608) 267-9548.
S' a ely,
JAMES WEHINGER, S~
Bureau of Plumbing
Safety and Buildings Division
PGPO04/0011w/13
cc: CROSSROADS AT THE CORNERS
_ DONALD A. KAY /""Environmental Health _ Local PI
Dept. of Agriculture _ Facilities Needs _ P.S. Consultant
SBD-6423 (R. 08/88)
1
GREASE INTERCEPTOR Page of
for a 100 seat restaurant
Located in the SW1/4 of the SW1/4 of Section 29, T31N, R16W,
Town of Cylon, St. Croix County, Wisconsin.
INDEX
Page 1 of 4 Title Sheet
Page 2 of 4 Calculations
Page 3 of 4 Plot Plan
Page 4 of 4 Plan view.- Cross section
Prepared for
Crossroads at the Corners
Route 3
New Richmond, WI 54017
E•a A.7T}iUA L
.15p
Prepared by
.00
GIAS
WEGEFZEF t Ep I L_ TEST I Mcs
AND
DES~I G[V SL~RV I CE
PA MI 74 421 H. H&IN ST.
RIVER FALLS, YI 54022
71.`x425-0165 ~ ~ ~ O ~ Q
G
Job No. q 6
CALCULATIONS Page Z of
This 100 seat restaurant will be open as much as 11 hours
per day and contains a dishwasher. A food waste grinder
may be installed, therefor sizing of the tank includes
the waste grinder.
As per ILHR 82.34 (5) (b) 2a
C= S X H X A S= 100
C= 100 X 11 X 1.25 H= 11
C= 1375 A= 1.25
A 1450 gallon Midwestern Precast, Inc. precast concrete
tank will be installed.
.059
- r - ~~Gl= 3 OF 4
' Sc~l t"-So'
L
C)N L.v
GRG)SE
woooo~
r.
?
i 70 oww" IN ttifi F*d um
all tMgQ pAee Wage treatment
` a• ~ ~ A46 ~ .
IS Prw to the suit Of eay Cook a
4feview Of that system ia, 14
it co;as a o` b \ i
th'a o~& ced to ddwWW
grid that it wiq
WgW OWN- by Me PW
gftclsd
016
io \ GS
J
I T Ory~ \ ~ o• j ~ 1
. eSof 3N PvC
! !
N SO f~ftllON I ~ S ~_~'7SO GAC.. PU~+P CtMHB
? 0~10 4
lo~
LEI i Gtie'ASL g
1 r~T~~1ce9TOR Z - Z4Q0 6a~ won.,
II ( S Ls-W~ C TR"N is S
o
V C-)T
- ~ COR`TW~L~ I
C-X S 1-IN G S e~ C T is la It ,
ff ~~Z•tw~L.l T~ 8E RSANOUa+ev
'PLUMBING AS PtM •
j (..or~ialC
~ I
APPKOVED
DEPARTMENT Of ttMTRY LABOR AND HUMAN RELATIONS
WY110 BUILD • ~ v
Notts .
8~:1t~ 1M1~1:tz_ L=L IOO.Ob oav -miz% 01= wL"1.1, N~kD,
Z. 71,' .ohs lb BE }-~~OwESTt`SZ~a T~~:~c ~S7 >>v C -~(2EC+~ ST Cola CRk'TL ~h1Uk s
I 3 . 'S'1 W N`Tki N . S 'Dew Sekilzr Tb SL-pr c 'M pjJ r s .
T~-1 O~ ~u~t~~K►~
4. 1. 3S`Tk -l CP,S ~ ~Rs~1J P~PC 3 or~Tp v►~~l ~Tt,t2B~ SOIL SON S t OF- `C~-1E C~tZEAS~ 1~ C~PltlfZ . _
S • N 6 - - -
r
• 5.. l
'7~8y
lri
c
41 OF
1a_ Q~ l y SO 6r~1.. ~RL^ SST cO~veR.E.T~-'T`A?~}z
_ '~ANV'~~~v~~D 8Y x-111~w~"S'Y't~1V I~LCf~ST,~NC,
- '~~B~. ~1►J`i'~fL C~~-BUR"
UMSING
t tonally k
OVOED /
4 PAATMENT Of DUST LABOR AND HUMAN RELATIONS
OF A BUILDINGS
Qx - NI Q. I G H T .~ii~ ► 214 bi : F%t~f3TiO CE I'TN
-lb' Sl►\ZFP4C-(_ . :
77- INLwr
~Z~ 'aR~FL~S OF t'IPPR~~"D
SECURI:.L~( Q 0()0
a
81I
. C,i~w3 S_ S LC`170N
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
,c e.r)r'= F'«1rr,ori
Y
!~C7'rC tlr.
f"C:'. t:_. , t.
T'~,
7l:-? £.wti'tiol r?r d
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t:lE ('Vt^"j of }~l?.i1 ftiiltir-C, $i!:?ld7i.~~llt'('.rc~_'j t"t^~''etirtir!< ,`t:f.iC> iO
f'i.5 i 1l,' f~l C
rL:ti (.":(,~itti', .•i ~,'r C;'vc
4,'ttEar' r iar£: JL' i t C it; n
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1.., (ii1.,~ C:_.. fi:t;ic :.L.,•i.t ry;f,.:ii,~G~'1" s:)r! is^;`t.~{C~Eiii'%Y' l.~:Y'%~
rrrisiC'cr a. This VrC GY.:£' is sl:t:'ci it, t.L1 at'(r C?r'nct C'
~lfirr;..i
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Git'C'Ctcrr, 'ffiri' '0fi
(t,i~' 't w,
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lh{,res "0sorl, Z(r?ir1( ~'scr.ir,iskr~:t^r 4. Lrcix t.£
v~
)-6928 (R. 10/87)
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
D-6423 (R. 08/88) r r
W C3 I=- E 1FC "EiCa I I_ T IE= D T I h9 C
AND
DE~,~- I G;" E3 EFc4" I C:E
F.O. BOX 74 421 N. MAIN ST.
41IvER FALLS, WI 54022
715-425-0165
ATTN: Z ~ c A-) C_ DATE 6 - ~ - °10
CC:
SUBJECT:
WE ARE ENCLOSING THE FOLLOWING ITEMS:
NO. OF
COPIES DESCRIPTION
~t S1 Ck) S (S z
SENT TO YOU FOR THE FOLLOWING REASONS:
❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED ❑ INFORMATION DESIRED
Q-FOR YOUR USE ❑ APPROVED AS NOTED ❑ RETURN COPIES
❑ NOT APPROVED ❑ FOR REVIEW AND COMMENT ❑
WEGERER SOIL TESTING
AND
DESIGN SERVICE
State of Wisconsin ` Department of Industry, Labor and Human Relations
M PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION
Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
WEGERER SOIL TESTING & DESIGN SERV. Owner: DEANNA PERSON
ARTHUR L WEGERER
P.O. BOX 74 ROUTE 3
RIVER FALLS, WI 54022 NEW RICHMOND, WI 54017
RE: Plan Number: S90-00448 R Date Approved: June 4, 1990
Gallons Per Day: 3,790 Date Received: April 30, 1990
Project Name: CROSSROADS AT THE CORNERS Location: SW,SW,29,31,16W
Town of CYLON County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- REPLACEMENT PETITION
- REPLACEMENT IN-GROUND PRESSURE SYSTEM
- REVISED IN-GROUND PRESSURE SYSTEM
Inquiries concerning this approval may be made by calling (608) 266-2889.
SBD-6423 (R. 08/88)
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
WEGERER SOIL TESTING & DESIGN SERV.
Page 2
i
Sincer y,
PETE PAGEL
Section of Pri to Sewage
Division of Safety and Buildings
PPPO13/0009n/ 3
cc: DEANNA PERSON
-Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant
Owner Plumber Environmental Health
SBD-6423 (R. 08/88)
-
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' ~E b OF
VENT CAP
APPROVED LOCKING
'i"C.I. VENT PIPE WEATHER PROOF
,
JUUCTION BOX IKROLE COVER WITH
25' FROM DOOR, (tmM1U. Vv1~RNIN6 >r~+BEL.
WINDOW OR FRESH
All
AIR WTAKE I
GRAD
E i M' MIN.
0 (Z
9 6 l
COWDUIT
WAIN. %0
PROVIDE I
IMLET AIRTIGHT SEAL I I i I
. ~ i III v
APPROVED JOINT A 111 duplex alternating controls vith the alara I I APPROVED JOINTS
~s being incorporated into the duplex controls I II W/C.I. PIPE ORPvc
W~C.I. PIPE ORPU vh 11 be ctivatRd in event of pump failure, I I'I I
EXTENDIIJla 3' itching cuing pump to ALARM
OUTO $0610 &OIL Ln a le.
ow
C P~ I I
LLCV. g3'~OFT. ~•$~~O __J
I LL DQk-EX PUMP-s-%, OFF
Q CONCRETE 9LOCK
3" APPRoVRD
RISE ERMITfED OAILd IF TAUV. MANUFACTURER HAS SUCH APPROVAL BEDDING
5PEC,IFICATIOk1S
DOSE ~R ST. 3.
TA K MA1JUFACTU0.ER: "1bA ~!J INC. NUMDER OF DOSES: PER
TANK 51ZE: -t SO GALLONS DOSE VOLUME Sl8• $
ALARM MANUFACTURER' S.J. EI. Ttz4 SVSS~1 S INCLUDING 6ACKFI,.OW: 6Al1.ONS
MODEL NUMDER: CAPACITIES: A= O
INCHES OR GALLOWS
SWITCH TyPC: O Y g = ~Z~ INCHES OR 30' S 6~1LL0►IS
$An} PUMPS MAIJUFACTURCR: Z'~~I'L'L3~ Cm -ly INCHES OR Slit CALLOUS
MODEL WUMDEK* D w IL INCHES OR Z"4 Z GALLONS
SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE 4 L (GPM GPM INSTALLED Oki SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AWD..DISTRIDUTIOLI PIPC.. So FEET
+ MINIMUM NETWORK SUPPLY PRESSURE 2 5~' FLET
+ FEET OF FORCE MAIN X L'$~° FYoFtFRICTIOU FACTOR.. FEET
TOTAL 01MAMIC HEAD = FEET 0
of Slwt ETER
IAITERIJAL DVALWSIOLIi OF TANK: LENGTH ~ ;WIDTH 1 ;LIQUID DEPTH
~3oTtoh AtttsA 3S 2.6 _ z3! . ~5.2io GRID /1juCN
AS ~'R M q K3 U FA C`5 l~ iL ts•C' = G R / 1.~ C I-I
ti
~ r
• ~
i ~
~
s;'
.c ~
~}'~x . ; }
~1
a 1
T o H HEAD CAPACITY CURVE
W
lu
i
3O TOTAL DYNAMIC NEAW"PACITY PER LWAM
EFFLUENT AND OENMTErAM
SERIES 53-55-57-s9 97 137.179 1p 165
28 M LTRS LTRS LTRS LTRS LTRS
V 1.52 163 249 394 271 231
EFFLUENT AND DEWATERING 3.05 129 16 300 231 231
26 ♦ 4.57 72 183 242 227 227
\ SEWAGE AND DEWATERING 6.10 104 136 223 227
\ 7.62 30 216 223
9.14 206 220
24 12.19 172 206
\ 15.24 125 191
16.29 57 161
22 21.34 114
♦ 24.38 53
MODEL\\ MODEL Va*e 19 24.5• z6• s6 97
20 163 \ 165 TOTAL DYNAMIC HEAD/CAPACRY PER MINUTE
♦ SEWAGE AND DEWUMNO
~ ~ SERIES 267 266 712 264 293
18 M LTas LTRS LTRS LTRS LTRS
♦ ` 1.52 408 386 492 681
3.05 227 273 380 598
6 ; 4.57 76 163 238 511
\ 6.10 30 125 401
\ 7.62 288
14 \ 9.14 163 292
\ 10.67
227
12.19 174
\ 13.72 106
12 , 15.24 45
` MODEL Lock valve: ,e 2r 26' 1 35• 53•
10 1 293
MODELS 1
8 137 139
6
MODEL
284
4 MODEL ♦ ti I DE
268 282
2 MODELS
53, 5 MODEL MODEL
57, 59 9 97 267
LITERS 80 160 240 320 400 480 560 640 650
FLOW PER MINUTE
L- 3280 Oki Mitten; Lane Manufacturers of...
P0. BOX ISMS, K~ucky 40216 pM
zffzz-zzj-ff O~ LOU
(502) 778-2731 A411,rY PUMp9 SNCE
8
"N. DILHR
Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C;
Labor and Human Relations REPORT 13 E. Spruce Street
Safety & Buildings Division
Burequ of Plumbing Chippewa Falls, Wl 54729
Inspection l9ate (715) 72.3-8786
I l., 11 1 D
Name of Premises A Ithwasw Legal Description Oft/Township County
L ~SSt~c R+7Sn A- 7t; GYL..c,t j ST. CP-61)r
~r`t - Sw - Z If - 3 I t l~ ~.l
L G R iJ Ea cl - K.ic-SrAq R AJT-
Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No.
5,?o ° C"o L/ v
Sanitary Permit No.
/Soil Tester Lic, ~nsed Person's Name(s) and License Number(s)
W E-G EPER cS-r S-7G, F~l r AP --t WEGE-k
Owner's Name and Address
Ul IiZoA-C~s AT- Trl - C nP-wER-> D 0 F k-"- PA Z
~'t 3
NF~W ~1C~Y-~►U W'~ S4-C't
Aj-
-4 t` • v C`R~ < L' p rfC2J t:.,; (i i ~'-?L /~1 _
csr 9-2 O-3 4.8t,_ ~I .~R3) I ' f 's6~ PA vi P 1,).
3- D• V.~3~1 ~,14yR.y~l~~ S , ~ Sit ~ i .
It, -,qo w.AtiJ uyFc Vii) S 1 f G Sb ,eat v~f`+ w~ SOS 3-S
TN t c to 4- ) 0" RWTO l'- 80 (I b`u2 911) 1 S t m -i-o 1 c fA , r,4 n , c w .
101E <..6 US1 <-rV44c.,j 0r -I-,4,-_ AS A~r1
tNtRrsast~,
FsT imAjT-{) iAIC-~tk=ST LFVt-L OF SFA~~N4(- Suet - 'SRiURA11CrN t S `~O
csT 8-~} G- " v 19 r4 -1R- 4 `,6 ! MtrYr\,
16 --a9 TZ:1 11-t V41- , ~s .
a6 - 3s'` ,r 8rJ (IUyx.' t CO. S , si X 1 5- .
LOO 61-j 6 0
' _ -2 ice? ARE MI
e r / td 13 A S, l o 117 ` - f.). D A/d 7- /W l< !'r 7- i
I
r."S r.~t,~ Il :IJ" ar'1 i t c = Sra/~Ac_Cr;477~.v / ?
Page of Z Signature of Responsible Licensed Person (only one needed)
Si natu of Plumbing o ult Private Sewage Consu an
Check alll
Original: Copiesto: (thatapply/
SBD-6192 (R. 11/85) District DDILHR O Plumber 0 o4i f er my/Local sp. Ot~er GST- A1~ 5S
71
Wisconsin Department of Industry, DILHF~
Labor and Human Relations INSPECTION Leroy Jartsky P.S.C.
Safety & buildings Division REPORT 13 E. Spruce Street
Bureu,.ifPlu mbiwg Chippewa Falls, WI 54729
nspr4&iondate (715) 72.3-8786 'i
Name of Premises AddFosea~ Legal Description Gity/Township County
Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No
I/ Ye
Sanitary Permit No.
Soil Tester Licensed Person's Name(s) and License Number(s)
Owner's Name and Address
s ;
r 1 r ,i r l r! t I. - ~ r ! 3 '-7 d L..wf .~_f
r
r ~ - ' 4 r~-;+ .e + ,a r''L,- ' ' • ' f n ° .:ice ~>y2-t f
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' r. . , '_F l o ,,J.L e,J .-r, ~ .x~ f, ~ 6/7J~ ~ ! + •rf,r~~`f
Page Z of Signature of Responsible Licensed Person (only one needed)
i
` I Check all \ Signature of Plumbing Consultant/Private Sewage Consultant
Original: Copies to: `that apply/
I ~_~5
S13D-6192(R.11/85) District 0DILHR Plumber Owner Q-'County/Local Insp. Q Other.
DEPIARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
+LNBOR AND PERCOLATION TESTS (115 P.O. BOX 7969
HUMAN RELATIONS 1 MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATIONt SECTION: OWNSHI UNICIPALITY: JOT NO.:BLK NO.: SUBDIVISION NAME:
svw 1/ sw 1/ 2.q /T3) N/R J6 E (o C LI LOK)
COUNTY: MAILING ADDRESS: !Zwurm
SI-T C IX ZI~SSR~IApS RT -Pte c() 4S !JS,,Q V1 1:~D LV 1 S4/017
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: 1707,U DESCRIPTION A TS:
❑ Residence ❑ New Replace Z
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
®S❑U ®S❑U ®S❑U OS❑U ❑SI 16P23~--bSE.~NZV>e,uof
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: e,.~.PCS S Z Floodplain, indicate Floodplain elevation: N '
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 1 YO q. 6,-) lvoyv '7 1I D Sri ~ G~ 3 of 3
B- Z °I Z g S. 9 it > 9-Z
B- 3 a6 qy-y It ? 9b
B- y C- :1 °I ► tr > 9
B-
B-
PERCOLATION TESTS
TEST - DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES
4
f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH
P_ fv
P-
P-
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. %Q-n} llet~ S 1~::> ~ C Z -Z v NYN lI-t 1 Lo
SYSTEM ELEVATION 9 3
E T i
P
I f
c _
3
L u1~ ~S '
i E
N
E
i
E
r
.
E
x?
7 i ( ~ I
1"6'4 1 s 9
~ I t
6
V1 -
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME print TESTS WERE COMPLETED ON:
AND Z -9-40
ADDRESS: DESIGN SERVICE CERTIFICATION NUMBER: PHONE NUMBER (optional):
CSTOQOS'7.6
P.O. BOX 74 421 N6 MAIN ST, CST SIGNATURE:
RIVER FALLS; WI 5+4022
715-.425-0165
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER - ~~GE
.r
INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 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 scale is prefered. A separate sheet
may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soll Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
fs - Fine Sand Bldg - Building
Is- Loamy Sand > - Greater Than
'sl - Loamy Sand < - Less Than
'1 - Loam Bn - Brown
'sil - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay fff - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER ~l z 3 FIRE NO.
CITY/STATE Y/.fv .ccl~• -'e ZIP yU
1/4, Section T 31 N, Rl_~__W,
PROPERTY LOCATION: S V114
Town of ( ~Z 1Gh , St. Croix County,
Subdivision N 14 , Lot No. 0 4-.
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. Ce ification
form must be completed and returned to the St.Croix County Zoning Of`fi~e within
30 days of the three year expiration date.
SIGNE
DATE
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
' APPLICATION FOR SANITARY PERMIT
STC-100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
-
Owner of property
Location of property 1/4 S 1/9, Section T 3 / N-R_J_~ W
Township
Mailing address Tl7 ,1~'L~-~ y lc
Address of site
Subdivision name
Lot number
y
Previous owner of property
i
Total size of parcel G~ ,z2Rtft a
Date parcel was created
Are all corners and lot lines identifiable? Yes ~_No
Is this property being developed for resale (spec house)? Yes _No
Volume S~ and Page Number V as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (ate) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
constfuction of.,saidystem, and the same has been duly recorded in the Office
of to County Register) of Deeds, as Document No.
_14L
31,gnature of/Owner Signature of Co-Owner (If Applicable)
Date of Signature Date of Signature
' \ l
i/