HomeMy WebLinkAbout022-1064-10-000
DEPARill OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
*MAQISON,iLVI 5707 State Plan I.D. Number:
4, - +y4 f ec 22 , T28-R18 ❑ CONVENTIONAL ❑ ALTERATIVE (It assigned)
Town of Kinnickinn,i~~-
IIII Holding Tank ❑ In-Ground Pressure Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO DATFjf
Howard Madsen RRiver Falls, WI 54022 a ~y 7 31//~/
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: EF. PT. ELEV.: C R F. Py
r oq
cD/. 3 col • 60
Name of Plumber: MP/MPR No.. County: anitar rmit Number: ,
6780 St. Croix 128711
p J Steiner
G'
SEPTIC TANK/ S o.S, . I~oC~ Ca - , gs,
MANUFACTURER: LIQUID CAPACITY: TANK IN TANK OUTLET E WARNING LABEL LOCKING COVER
/ PROVIDED: PROVIDED:
YES F-1 NO -1 YES NO
BEDDING: HEF1T DIA.: YE#T MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL BUI NG: VENT T FRESH
C,v, t:..O, ALARM: FEET FROM LINE: AIRINLET.
❑ YES NO ❑ YES NO NEAREST
DOSING CHAMBER: ~.a3 Q, ~
Vr z, MANUFACTURER: BEDDIN LIQUID CAP CITY: PUMP MODEL: PUMPAG aW@SCUANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVI
❑ YES NO q5~ aQ SS 2 /'C ~'t`ES ❑ NO O'YES ❑ NO
PUMP AND CONTROL ERATIONAL: NUM ER OF PROPERTY WELL: BUILDING: VENT TO FRESH
GALLONS PER CYCLE: AIR INLET:
(DIFFERENCE BETWEEN r _ FEET FROM LINE: ~7J
PUMP ON AND OFF) E 43O ' YES ❑ NO NEAREST 'AP a`S
SOIL ABSORPTION SYSTEM. Check the soi moisture 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 MAIN Zj rr p!~ l
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUI
CL-IES:._.. _..MATERI DEPTH:
BED/TRENCH I-TREN D
DIMENSIONS
GRAVEL FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N0. DISTR. NUMBER OF PROPERTY - RESH
BELO IPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
NEAREST
MOUND SYSTEM:
o Mound site plowed perpendicular 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
DYES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
.4~ SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
ar 7~~ G C` Iii ~u ❑NO CE3 ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPT S OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES: / q
❑ YES E~J ~ ES ❑ NO ES ❑ NO
D=Eo /floc
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO. OF LATERAL *MANIFOLD H BELOW PIPE: FILL DEPTH ABOVE COVER:
y BED/TRENCH J TRENCHES: DIMENSIONS
/0 z
MANIFOLD PUMP OV+ MANIFOLD DISTR. PIP: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING:
ELEVATION AND
9
ELEV.: EL DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ATERIAL: VERTICAL LIFT CORRESPryON/DS r ^ I
11NFORMATION L DYES ❑ NO T ~ APPROVEDEl YES LJ IVO
f - ~
a RMANENT MARKERS: OBSERVATION WELLS: i8 ' NUMBER OF PROPERTY WELL: DING:
p OMMErS FEET FROM LINE: ti
ONT ES ❑ NO YES ❑ NO NEAREST-► > ~~d
~R7r l~ S,O
~17 Y71"
L
~.,.t} L ~ f .y...
X ~ trl t t C/ /1 -t,,,._ . ! C~ ~ ~ •
41
Y' /n et - S5
15 13 T '
14 Cl Ly-,C/ i ~J h!
eta' in county file for audit.
Sketch System on
Reverse Side. SIGNAT E: TITLE:
SBD-6710 (R. 06/88)
TDILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COON
STATE SANITARY PERMIT
#
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 /'7
8% x 11 inches in size. n i evision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D./NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
HOWARD MADSEN NW'/4 SW%, S 22 T 281 N, R 18 EX-(or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
RIVER FALLS, WI 54022 715)425-597i
II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE : NEAREST ROAD
;owU : KinnicMdnnic
II~~
❑ Public I~ 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUMBER(b)
III. BUILDING USE: (If building type is public, check all that apply) 022-1064-10
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 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. [1 New 2. -]Replacement 3. ❑ Replacement of 4. E:1 Reconnection of 5. El Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSEDpq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
450 3-1 'J Feet Feet
CAPACITY
VII. TANK 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 k 1000 1000 1 WIESER QOIL~XREl'E
Lift Pump Tan r 750 - 750 1 WIESER CNCRE M
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plum 's Sig ature: o S mps) MP/MPRSW No.: Business Phone Number:
425-5544
MP#6780 715
PAUL CJ STEINER
Plumber's Address (Street City, State Zip Code-
RT. 5 65 E. WOODRIDGE DR. RIVER , WI 54022
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature (No Stamps)
Approved El Owner Given Initial Surcharge Fee)
Adverse Determinationi t7-17-~6
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 ni ai )s/water service;
streams and lakes; pump or siphon tanks; distribution boxes; sail absorption systems; rep?acement 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) cress 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 rnonies coilected through these surcharges arcs used for monitoring grour, dwater, ground-
water contamination investigations and establishment o1 standards.
SBD-6398 (R.11/88)
• APPLICATION FOR SANITARY PERMIT
8TC-100
This application form is to be completed in full and signed by the ovnet(s) of
the property being developed. Any lnadequacles will only result h delays of
the permit Issuance. -Should this development be intended for resale by
owner/contcactog,(spae house), then a second form should be tstalned and
completed when the property to sold and submitted to this elites with the
appropriate deed recording.
-----------------------r-rrr---rrrr---- ------(rrr-rrrrr--rrrrrrr--rr-r+rr--rr-rr
ownet of property HOWARD MADSEN -
Location of property w,NW /4 Sw 1/4r 8ectlon 2T..2$_JL1t.,1&JV
Township Rinninckkinnic
Melling address R.T. 2, RIVER FALLS, WI 54022
Address of alto - Rt. 2, River Falls, WI 54022
•vbdtvtslon name
Lot number
Previous owner of property ADOLF & HAZEL MADSEN
Total six* of pascal
Date parcel was created _ R orded before - 1__0
Are all cornets and lot lines ldentltlablet . Xan 0
Is this pccpetty being developed for seals (apse house)?as x P10
Voldne 521 Page Humber 40123-ft as recorded with the Reglstet of Deeds.
r-- r • - - • - r r •r-•--------•-
INCLUDE WITH THIS APPLICATION THE FOLLOWINCt
A WARRANTY DRIRD which Includes a DOCUNRNT NUNBRR, VOLUXX AND PA09 NU11a9R, and
the BRAL OF THS RROIBTRR OF DRED8. In addition, a certified sucveY, if
available, would be helpful so as to avoid delays of the reviewing process. it
the deed desctlptlon references to a Cestifled 8ugvay Nap, the Cettified sarvey
Nap shall also be required.
PROPSRTY OWNER CERTIFICATION
I(ve) eert{Iy that all statements on this form age true to the best of or (ouc)
Rnovledgel that t (we) am (ace) the ownat(s) of the propscky described In
this {ntocmatlon form, by virtue of a warranty sad secgcded In the attics of
the County Register of Deeds as Document No. 1 and that I Iva)
presently own the proposed site for the sewage isposal system tot I (we) have
obtained an easement, to sun with the above described properly, foe the
construction of sold pystem, and the same has bee
dui recorded In the Office
Of the Count Ra later of Deeds
Y g as
, Document No.
Signature of Owner Slgnatute of Co-Ownst (It Applicabiel
D
Data [ s gnatura
Date 01 signature
MM Y~ 'C *1t 1
f -
I
t i
btlM~rb►,at&ned VOOOW wMr>~tMMtip'*,, '
-46
' ' bst~sL eeliN lapdtgw, stltsCliM t1MN a~;7iliMilyk
ilwt so veedsr it easls"orstios at the Nrs, saw to M s o%
aiflf Mt1~ti '
•!M : tN4 br tits Pw4pse to be parfetimed. as bwoim fir set+taiW;
ttesrs 4" 00'"s to oMver a"libe pmebaser, wpm date prompt MO A41 pw tlp , 6p
th!„ of 14 eotrewti •owd agreissets of Me coetraet to be Ow./M
1 0 1w fallowing deawlMbed reel estate in OtdX r
T
•ellillsat @sarter O of the Saothmest Quarter
* of the seethsaet 400 or,
a if on thie i of tb a US MMM Load
V46.19; 4614 parcel of load beinS described alaf follsivlt~ 1
i'iaR A the M line of the aforesaid Tows load 22 raMllr i.e N
of of Sec. 22-28-13 aforesaid, thence V 31 ruing
the V lift of the aforesaid Torn Load, thence 3 31
•
1iue of the aforesaid Town toad to the place of
ivies w plan. All of slid land being in the Tow of
!iiarthlseat Quarter (Ift) of the Southwest Quarter,
'RMh Seventy (70) acres of the Northeast Quarter ( t
Qloeapt tha Uast'330 feet of the North 182 feet thereof; ?he
Of the Southeast Quarter of Section
Trrea
ty-one (2%
Sad 1 foot thereof; ♦ll in Township Twenty-Eight (28).
.y 4
tMtebr wM all bedLlatss, improvements, ti:twoo and appnrtesances, wwor bereaftar «rt+f7 bMNM.,
dew* sad windows, attached mirrors, fixtures, shades, attached now covering, hot watisrbltbite„ eao ' o,
wbkb shall be a part of the real estate. yam. ?
Thu purcboser, in twsideration of the covenants and attreements hereto nude by J Yldaat 4
deembed }remises; sad to pav therefor to the Vendor at _ tt>,~r rtu
ter sr ar~ Save 9 Tlau48-0 and No 00tl~s$70.s~OO~,QQ)-
MSWAWr faro last 10s000 00 w h,
anal
00 = at the execution Wool, ti~'itteeipt 44""t
together with interest on such poriienu tbareof as obail rtf /ht- ~Irl 11 a
at __~9_. _ per cent per annum, until paid in full, as follows. Said principal and latsviaM Nita .
'
tlaataiitaaats of not less than f __1 . s-000.- 00 - Per--XP~aT a _plus iatereat . be~t1
day of _ 19_-- provided the entire ptrcbaN rsMbq ~ ~
years from the date hereof. ,
In the event of the death of the Purchaser, while one or store at.tB
said Vendors, or either of them, or the survivor, shall have ths>
the real property which is the subject of this Contract, lest r;.
acres of land upon which the house of the Purchaser is located stall=sf►,
' purchase price shall be the am of Seventy Thousand ($70,000.00)
Said y
payments shall be applied fast to ante-rest an the unpaid balance at the rate herein specified sad tba11
amorit may be prepaid w+•h-,,ut premium or fee upext principal at anv time, and interest shall be c
64 balance on the daily rate basis at 1/360 of the annual rate.
Is the event of any prepayinent„ 740, contract shall not be treated as in default with respw {t
balance .f p: incipal• and interest I arolin such rase accruing interest from month to moMb shell be
than the amount that said indebtedue" would have been had the monthly payments been ma/s es fast
monthly payments shall be continued in the event of credit of any proceeds of insurance or CaMdedn
t be:ag thereafter excluded herefrom.
i (x
MUM
tc . n
r0R?he Vc a ! r shall furnish the Purchaser thirty days prior to the date of ultimate-closiog, and the
sufficient ,hAknK of u+le• either A19120"'WO _F_ 10
chantable abate 02 ewing the s tit c
is agreement I an a tr tense , t e arc aser shall notify t ndo , in.writing, of any objeetio" to
tt days after rr c,pr such a t, and the Vendor shall then have t reaagasble time within which to rectifyt~_ s
P { policy as abcr,e described.
s
The Purchaser shall be entitled to taj{e,_passes v
lAi► Cf promises on
pooses-,ivn is h- obtained by the Vendor, tie shslsl fisve s reasonable time after such date in which M
P"Ot
ur,-haser rhali be entitled to remain in posa•ssion as long as be performs all covenants and apsoment. bt~i t his paµ
to be performed and no longer. i ,
f
I d ~ 4'1:- '1 ~0,: +3+ r {fit y
CbItTRACT-ilsO bflAL A1tlt POMOA oil
L a
F.
y a t1w`r1MtR 41w
>IiR!MI~
b.A to
1
tbo
mitt aye irteree! mad . 0 0dw s iil.A1► M .
10 the a>s~her above' spec of tth►
Wiest Warranty Deed, is fee sisole;
anon created b do.a l ff
and "a tsctePt any liess or en"elbr
~t - essence of this contract ea~d R r~ .
UNA qw'shaft be daewad to be at the of pray of tie cam'
~
~ills~w she" %wolow due. or in the performance
~rlrraM continue for a OK~.°f
nu( such default s1►dl this apfee+
is lidtttl
f red. all 041 of eb!s carental tal of said 4s a"
M to~ii on Vendor Property and without notice hiloe the 0011
~aM1eye~at stall farthlwith expressly waived. the whole rst . being 40tsus soot option shall be exercised. the eapaid priweipv
Jol Inwin seahorieed with interest an seep III am
d IW Nor
;
aontract is the some itash tleMe w ' fl" C iirRi tlf isdtbcedness sban embrace, w saw e aw"MI the
mat Mtstir oocorred. ;sad a
_M& Ill air-. 10I
•iereat u:
hat of 1104, a
oft judgment shat) t "lude+ .
' i of icy "-"T ~e sand
inh case
ttt ! ' Ce~e dse as Jacurre the Coo" may spro" t
Ktigrt d foreclosure of this contract. and profs o •
issues.
W of rsy &I receiver to collect the ode cted. to by: hold and apps
OWN M
aw sop" ofits when so
eMr s1reY terlr, Waves. and pr
ePo" •ndd intro W the ltenetk of tiM t7
shall be binding
y spotty +
*a berals he Piro
OYt is IYe n
owd puroYaser: . If not an or anof the pro d agrees to jhe
~aaaIIIIae a" yts in the subject Property
r.,
list day Of - - - j tCh , 100-
this
max.
hoer
Ma$si ~
a/k/a B,usel (:u"UU'
Y'.
~10r
. °r Hoyard Madsen
t r
a .r AUTHENTIC A110%
, .1
dry °f - - - -
Otto- PI
State liar of •iscoaeie or
1 g Tt~ le:yetaber
706.06
Authorurd ue►.!. r Se..
l
a MSk. -
Coun.
an, twi..cy risen a/k/+► Baze 1 Guai lda Z1~►dn; GIs _-uml d Mads;eu
aAd Huwalc d two e.r.e.
nt and scka w r
m rvn
bO rYrcuted the fore(O tnB ~ M • .i
_ r
r b! .0
Notary
My tram
- 4 ` toted irelow then sitanattres.
4
~ 'M @-.- x . ~ iaE.aq esifat'ity should.. ~ AR tK
-,ir'~ar~~ ltfllk t~ . fiT•v~.~lw
ri 'I
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
a
H
OWNER/BUYER HOWARD MADSEN
ROUTE/BOX NUMBER RT. 2 Fire Number
CITY/STATE RIVER FALLS, WI ZIP 54022
PROPERTY LOCATION: NW 14, SW14, Section 22 , T 28 N, RI_W,
Town of Kinnickkinnic $ t. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60/ 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 veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- ro
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED DATE St. Croix County Zoning Office
P. 0. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
I N"~USl~IdP , DIVISION
LA AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
etc-I
1'4\13'/4 _SW z2 /1`z8N/R l8 E Amm__::~x
COUNTY: ZIN ER' UYER'S NAME: MAILING ADDRESS:
o~l Z
ST• GZCl bC ' Ow pmn Y') A{1jS S W S O Z Z
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DESCRIPTIONS: PERCOLATION TESTS:
Residence 3 N New ❑Replace I 6_ 13- 90 6-tS-9y
lt✓! 6-
RATING: S= Site suitable for system U= Site unsuitable for system p1U S1`T- 8`t Zl `9uw ip. S -0~ OKJ I3 -9b
r ONVENTAl MOUND: IN_ -GROUND-PRESSURE: r'' STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑S ES ❑U EIS CCU ❑S ZU ❑S 2 "u~jxj-,-_-, - Q~
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the w,
under s. ILHR 83.09(5) (b), indicate: N•~. Floodplain, indicate Floodplain elevation: ,v' ~1
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 3 Z °l 5, lvorv 7 3 2 S~~- pPt G L Z o F 2
B- S; Z I
B- ? S O
B-4
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 P R D PER INCH
P_ \ 'NQ, 3C3 I.I -Z 1I/-z.. 11/Z 2_c~
s/
P_ 2 18 ND 3 0 1 '"A b \ 9/16 1 a 18
P- 3 ~8 )JO 30 1 Si 1 Sig q!« 1
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. •'a'Z'T • M OF see, 96.7 , ~f-\ GE O su y
SYSTEM ELEVATION C 1'I IVV • Z' of GPwo')I
,
CAF T1tt~_: S E -0'?-- " e* or ?}F~
,
r I ` ~
i
• ~-'t~_lv>N!~ Lam- ~ 7j ~ R~-
92
J
TN
h
,
~`bu S za p~ t
,
,
5~`z: ZZ
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.
WErIEBER SOIL TESTING
NAME (print): AND TESTS WERE COMPLETED ON: 6-1S-4O n_E__SIGN SERVICE ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST O(4u S7Ie -)1S-423-0)65
P.O, BOX 74 421 N~ MAIN ST. RIVER FALLS. WI 54022 CST SIGH NATURE.
715-425-0165 (►x'''"l~
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R, 10/83) - OVER -
=CORM _
4
OF C,' A
z ;s &'~J d t 4_ C 1 & e _ j,
TO THE OWNER:
is soil test repor 3 in s~ uring a sani.. rry I county or'' D,
r r
"ic Ition art 'e to pr priv., e
e sysl~er t _
,i~ order to
t a perr-ni y tion.
r A
f
SOIL DESCRIPTION FORM
Attach Soil Pro tile Location Ma On a Su arate Sheet)
W ~ ~ L NEAR OAOI G T~ 1' a
0
PURPOSE: ~aLV~ SOIL f*~SQ ON S~/S SLOP S
OESCRIPf ON BY: In 71 ' ~R w~ G ASPECT: N ZO O
SUYV E 13 1 R q CURRENT AND U• >~S
DATE.
CWNT STA S - c_vxfNvc VEGETATIVE COVER' G~~S S
LOT DES I TION: W 0P t"> )/V-SW'! SiLCZ-Z,TZ8 ~33 RIgl~J DRAINAGE CLASS'
LOCATION: L-J W 0 F N N 1 C YC I1l J AJ~ C GALLONS' PER S FT. PER DAY: AT O. 39
PARENT MATERIAL(WDEPTT SOIL SERIES:
Q
IKXiIZON DEPTH MATRIX COLORS MOTTLES IEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII 'BOUNDARY REMARKS
in moist G Sz. Sh COATINGS
8A~-)zl 4j 6
L 1 Yn V G S
1 O -g No~tz z [ 2 -
z $_z9 ~o~ttz - ITS lsbtz yn v'f~- ~S
3 Z9-zz1o-1T'x S! LS~R
I
8021 WG Z
1 0 -1 p tort Q- z- t Z. L 1 ~ • ril V c- S ~
Z 1m -z2 It K R z_! Z ! s blz rn U Cn,
3 ZZ.~($ l0 `,t1?3/6 - l Ts ~'T, ~T V 'Fi- C~
q%-52 lo'-t it S/ LS B
u mc> 3 -
w
m
_ to R zl
t b
- s 1 s~k m u c S
,z l4Y2 Zl t
z. y
O-S
3 2V-146 10-IIZ 316 - 1 ~S~k V 'F-
~j ~!b_So 102 sl LS BR
~o Ns
~w
Z $ _ 15 l ~y 1Z ~ [ - ~ '~5 1 S ~lz ~ V `t-►^ cS
3 1S_3Z 1bYR3~~ - ~ S ~ Sblt ~l V ~ CS
32-3 1 o yRsl LsBR -
OTHER SITE FEATURES/NOTES: L//2`Cr
~-Is -9p O0 b576 nn 6e 2• of 2.}'`-.
-LIMITING FACTORS/DEPTH: Signature Date CST M
•
WRIZON OEPIII MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII BOUNDARY REMARKS
jn. 010 1st Gr. St. Shp COATINGS
-
OTHER SITE FEATURES/NOTES;
n/1 GE of
Signature Date CST #
LIMITING FACTORS/DEPTH:
PLOT PLAN ~kA5
Page ?-of
6
Scale 1"=y0 '
5~h
~ s ~-{c~wa rd /Wad
Fn
cr
e v
y
1lV t~FF~~E ]"...1r /r~ ~r P °3 ry+T `70 F30T CDY17~1 cT .C71:
i~dr bI.STvR~ `n-)~S H2L""lA
Y~B+► 94
i~ b Z • 1
N~
3a OF 2puc
B• 1
'I S o
O
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ri J 5
ts:~clShlv6 ~RgPbs~
,Q Ho~S L 1~ ,
AGE
i tint C0,11t
VD
a ~R pt1D N S ~
PF•RtME N •
~ SEE
iR~.S• r..
Z
_ Z Z. ~ p.V~C1J y E
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be 1VOO gallon capacity manufactured by
w \~SER cAtii e. -(2-M pRotlucTs
5. Ber;ch Mark 140,0' otv ctyvc~ J.)T SouTH t~Jn c~F paot~ _
6. Divert surface water around mound to. prevent ponding at the uphill side.
State of Wisconsin \ Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION
Western Regional Office
2226 Rose Street
LaCrosse, Wisconsin 54603
WEGERER SOIL TESTING & DESIGN Owner: HOWARD MADSEN
P.O. BOX 74 ROUTE 2
RIVER FALLS, WI 54022 RIVER FALLS, WI 54022
RE: Plan Number: S90-40299 Date Approved: June 19, 1990
Gallons Per Day: 450 Date Received: June 19, 1990
Project Name: MADSEN, HOWARD - RESIDENCE Location: NW,SW,22,28,18W
Town of KINNICKKINNIC 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:
- NEW MOUND
Inquiries concerning this approval may be made by calling (608) 785-9348.
Sincerely,
GERARD M. SWIM
Section of Private Sewage
Division of Safety and Buildings
4PP039/0009n/45
cc: HOWARD MADSEN X Private Sewage Consultant
SBD-6423 (R. 08/88)
Y
Pa ge 1 of, 6
MOUND SYSTEM
FOR
A 71 BEDROOM RESIDENCE
LOCATED IN THE UW1/Y OF THE SW 1/y OF SECTION ZZ., TZ8 N, R 18 W,
TOWN OF kca 1JU lctz1 N~a ~c , STC,RU l SC COUNTY, WISCONSIN.
INDEX
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER .
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
Corn ~-r~:
PREPARED BY v
scolvs,
titEC3 EFcEtom ''-3 Q I L T"Ec-3 T' I t%.t(D
AND • ARTHUR L.
a WEGERER =
DE.3 I 01%4 E3EFRW I CE o-s15P
6LLSWORTH,
i WIS.
~N•
F.O. BOX 74 421 N. MAIN ST.
RIVER FALLS, NI 54022 I Gl~ j
115-425-0165 h~~NuNo
a
6.48 `le
S 0.40299
Job # 90,110
PLOT PLAN Page Z of
Scale 1"=y0
7CD Q-OT CbNQ~ r-T
Po LE n,Vj'
SLOB i
3t dF 2.•• pvc
rotzcc
Y~Pt~rJ p 66
S ~o
~ JG
~ X
v-~`y a
0
P~JG L'KtST)r~6 pi~oPOS~ - C2
Q~ W VE~` S
H ov S e
IOoP4~VC
W AGE S`l ST EM
ONS~~E SE
= zSs ; O~A
c V
pNS
ONAL
E~ptl
a JD H ~
pR ~ S
i ~6 t
hou
0 coq, 1 `
GQH ~c-,
J~
o.•Z
I7,le ra .299
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be 1000 gallon capacity manufactured by
w t ~ SCR- c~~ ~~1~ pRo~ucTS
5. Bench Mark Ems, m3 p' oN e0►ucCi~T~ ~z)T SoUTN L1Jfl of pooJ2
6. Divert surface water around mound to prevent ponding at the uphill side.
~''7b S~~oF ut~ conP~.c~
Sirow,,ZMarsh Hay, Or
RC~~ROVEQ Synthetic. Covering
Distribution Pipe
Medium Sand I -
Topsoil F EC.erl,
D
3 E
,i` O~S` l •77
"Slo e
JJ:;
'JJ.,,_J' ~tV Plowed
Force Main
d Bed Of z"- 2 Z
From Pump Layer
REIAO g a t e
AND A -
pR , D ~-o rT.
~Ati 1N
u
13EpAR'CMEN~ tNt4 pt: ,,.,.•,,ti~~1'+'t` E Z. S ~r.
Cross Section Of A Mound System Using F p,g FT
car CAE" A Bed For The Absorption Area
G 1- u F~r-
u~ ~ Lp~ptuG = 11.8 r-c~p/L)ha FT A 10 Ft. H 1. s Fr.
/S G) IT. B 3B Ft.
I 2-0 Ft.
~ 1O Ft.
K _)q Ft.
L 66 Ft.
W 19 - 4 0 2 9 J
FoR CE M& I ra
L
Observation Pipe
K
--------------=-------~i
\,-B ed Of - 2 "
Distribution 2 2
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
~E oP
Perforated Pipe Detall'
0
/""_L.d View
)per f orcled
End Cop 1~ PVC Pipe
ode e
~ot~o~o~c Holes Located On Bottom,
~S
Are Equally Spaced
-[To3'TA-Ci. Tit=RMANENT _~'iZ1CER
AT_D CE EAGN LATERAL
Q
P PVC
Manifold Pipe Y.
1
\ O~stributron PVC Force Moir
Pipe ~ F.pR. -imp
Lost Hole Should Be~ N
Next To End Cap u
End Cop Dislribution Pipe Loyout P ~~,.5 FT•
YsTl~.rn S.)0.-40299
A~'aES S 60 Imo,.
~ QQ
x 2, )13
Y 3 6 /N•
(,%j Hole Diameter Inch
goo Lateral 11 I Inch(es)
~D
QOG GS
Of tt4DUSAKY L~ Manifold Z Inches
Dti<~AGTt~~C Of
~i Force Main Z Inches
SSE of NoLES/P/Ps
I t~lP_cir ~.EV h'PON OP LATMA L S 2,0
sF EfD(.~ 1 d PR=01~! . 4 1'TER OF M .A- FUX-D ~•c>1'~ 5L1cc.EED1N G 1tOLES t~T
~3 C~`l TEtZVh~-S. LAST i-1c~ To $E tvEXT 70 THE ~~D CAP.
S
PUMP CHAMBER CROSS SECTION AND SPECIFICATION ' ~E S
VEWT CAP
H'•C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING
7 JUWCTION BOX MANHOLE COVER WITH
25' FROM DOOR, w1~RN1N 6 L+\SEL
WIIJDOW OR FRESH IYMIU.
AIR INTAKE I
W.
~?6 I
Li~~~ GRADE I 4011,
Ib"MIW.
COWDUIT
w L E T dV AGE SYI~~i~TI o f I I
~•ss IC"HT SEAL I III
• ,IStSS ; I I I v
15'~ ` I I (
APPROVED JOIAIT A®awna APPROVED JOINTS
I III W/C.I. PIPEDRPVc
W~C.2. PIPE I I ( i
EXTENDIWI. 3' ALARM
OWTO $0610 SOIL b vko mu"I0A$" I I I
I I
1 01 ANU µu I I ow
1NU
I
LLEV. FT. r"~•IPUMP OFF
0
6 3 g CONCRETE BLOCK
3" APPRovf I
aDDlNQ
• RISER EXIT PERMITTED OWLtJ IF TAIJK MANUFACTURER HAS SUCH APPROVAL I vi
SPECIFICATIOUS
4 (l
005E \ J ES~ QJAJ Z A~~
TANK MANUFACTU0.CR: ~1 UMBER OF DOSES: 3. 6 PER OAy
TANK SIZE: SO GALLOWS DOSE VOLUME
S.J • ~~2'pZQ S YSIIE" S IMCLUDINfa OACKFI.OW: 30 3 GALLONS
ALARM MAIJUFACTURi~R:
MODEL WUMBER'. I lbw CAPACITIES: A= \ S INCHES OR 300'$ GALLONS
SWITCH TtIPIC: 5=-Z INCHES OK LIST G( LLOWS
PUMP MAIJUFACTURCR: Cu' C= 6J/ZIUCHE5OR \1'r'3GALLOWS
MODEL NUMBER: J D INCHES OR '2162 GALLOWS
SWITCH TYPE' ~ZGURy MOTE: PUMP AND ALARM ARE TO OE
MINIMUM DISCHARGE RATE Z$'S'8 GPM INSTALLED ON 5EPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AIJO..DISTRIBUTIOW PIPE.. C' 6S FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . 2.50 FEET
♦ 30 FEET OF FORCE MAIN X `'31 FYo fEFRICTION FACTOR.. 2-2) FEET
TOTAL MWAMIC HEAD = .S FEET
~s a aoT. I
IIJTERWAL DIMEWSIOW~ Of TAWK: LEWCsTH ;WIDTH ;LIQUID DEPTH 3?.
i3o771UpJ /~CL~'A - = z31 = Gtr L / INCH
AS P~---TJL MAIJU FAC1-vrct:v~ = Z.o,OS GRL-/ fJ.,CN
• PhGL~- of
-1-O-v- L ° Or- a D INK FEEE 7
1" -.L - -.1 N N N N
N -POMON.PMMON -P~- O
C) O
Ul N
O
O p
01
° f1"I
O m
N 'u cn
n ° ° oo (n
N 1
.bb p C
O o ~ o r 00
> C.0 O c
z CA)
m ~ ° R1
m C)-
C
o Z -00 ~ cn o ~ ~
C
rn
o II
N 9
CIt o
N
N
O) O
O
NP
O
O --j N W C n M ~1 00 CD
TOTAL HELD IN METERS
ST. CROIX COUNTY
WISCONSIN
'"th :tk'X .t
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- (715) 386-4680
June 18, 1990
Divison of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Howard Mad/en property,
located at the NW4 of the SW4i of Section 2 T28N-R18W,
Town of Kinnickinnic, St. Croix County, revealed suitable
soils to a depth of 29"-43" above lime stone bedrock con-
sisting of 50% very coarse platy lime stone fragments
by volume. Cracks and crevices between limestone platep
qre filled with medium and fine sands to a depth of great-
er than 50".
This site should be suitable for a mound.
Should you have any questions, please feel free to contact
this office.
QsSinc rely,
K. Thompson
Assistant Zoning Administrator
cj