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HomeMy WebLinkAbout028-1041-10-000 a o II' ~ o I 1O m c ti 0. ~ I N I I I o I i v ~ I d I I! I I i rz ~ I a ~ I ~ z 0 I Li c p Q ~ I I 3 0 ~ o I Z N I 2i Z = O LO N W d m ch f- Z li g I o z z v = CUi Z ~ c O -o I m I pq ~ .n p m D I O Q Q U z z c N E N N £ L C a n - a 6 IL 0) ° ° H H H = m t- CD o o o ° w u'aaa z m I ~ w I a o 0 to .j u a 0-) ai Aftw, co N N N 0 (D a Q 0 O O CL ' 00 c. d `n O 'D N ~ C77 N p d Q Cn m r o a 0 3 (n r- I O C o o E ° E cN co Lo ~ Fo- o Q 0 d °o °o l 45 o N N C,4 U p' c N E cc L N (4 Z-C a i 'p f- LO 06 L , W co Q> W F- C N C, 00 E 3: 0 U) o Z N ° (n • 0 o M ~ E I V ~ N {p L a is a T • ~ 4 d) tl y N C V C rrww L ~ ~ "~1 A UCL m 0(1)0 `7 DEPARTMENT'OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION N~°, LVVJ; 4W, Spec . 3 5 , T28-R17 State Plan I.D. Number: ❑ CONVENTIONAL El ALTERATIVE (If assigned) Town of Rush River S ❑ Holding Tank ❑ In-Ground Pressure Mound our / NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER:/// C /C, INSPECTION DATE: 3Q ~I~ Tom Weishaar Pinerid-ze Terrace. Ri is. WI ( /0-4-yo BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REP. PT. ELEV.: CST REF. PT. ELEV d/ ~ c,,---,> PC*( PLO, ~ la, 63• Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thomas Wan 3231 St. SEPTIC TANK/ K S/.~b Le,e6,er=/x,83~ S l S MANUFACTURER: LIQUID CAPACITY: TANK INLET ELE NK OUTLET ELEV.: WARNING LABEL LOCKING rt i PROVIDED: PROVIDED: : JT Y}~i ~l ~eS-(~L I / 02)0 13 - 9,3,~~ 9~• 71 YES ❑ NO ❑ YES NO BEDDING: VMT17DIA.: VEi1FT MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WEL~ BUILDING: VENT T F ESH 06 ALARM: FEET FROM V v, LINE: AIR INLET: YES ❑ NO CnS~ ❑ YES ❑ NO NEAREST J DOSING CHAMBER: o 'D a,6 , 7-1v'. SS Cu~~ - _ p0,S8 MANUFACTURER: BEDDI LIQUID CAPACITY: P P MODEL: PU ANUFACTURER: G LABEL LOCKI PROVIDED: PROVIDED: M cc7~` YES ❑ NO 7~ wEb 303 M ~oc~ Ld 16+0~ YES ❑ NO ES ❑ NO GALLONS PER CY LE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDI : VENT TO FRESH (DIFFERENCE BETWEEN r~= FEET FROM LINE: AIR INLET: PUMP ON AND OFF ES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the s I moisture at the depth of plowing FORCE LENGTH: ' DIAMETER: IX1n ERynLAND nnfJRKIIIN or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN C SG the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGT NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N07BER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEE LINE: AIR INLET: NEAREST MOUND SYSTE Z,D 1 ~:,.1 = ,-->,T Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown uns ope: mound systems to make certain that it ON REVERSE SIDE. SHOW Clki ❑ YES NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTU : 5 -I- 4iAj PERMANENT MARKERS: OBSERVATION WELLS; KG PQ IDy~ YES ❑ NO ES ❑ NO DEPTH OVERTAE-NCH/BED DEPTH ER TR&4CH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: ♦ EDGES: ~g /0-- /g ❑ YES ~ [~1ES ❑ NO ES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO OF LATERAL SPA. ING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH i TRENCHES: C DIMENSIONS Q MANIFOLD PUMP o MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRI UTION PIPE MATERIAL & MARKING: EL ' ELEV.: DIA.: ,i ELEV.: PIPES : DIA.: ELEVATION AND SS S SCQ Q Pye, / ~j , 7 L DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TQ (p INFORMATION q t / ! APPROVED PLANS Mfrs -r' G hIK = q6 L~5 ❑ NO N, 7a%,c I~ ❑ YES L~?NO $•g0PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: / COMMENTS: FEET FROM LINE: » > ae L(d'YES ❑ NO P-IrES ❑ NO NEAREST-* 5 S GG/ 02Y-7)'S', 64114-- C~ - I~ 1 ~ (2) Rt vtl 4(ja aJ t2 r,~C>✓ au i cY a r~av~- C.&)`~+- T, [fir / a e,~~y vs, a z"` 1,c1~.,,,o~ ecm~~~-e-~~a~ ~ ~,az~a,~~.~~~.-, , cr•,~~1%R,,~r~c~~c✓v,-, ~'-c~-~ U Retain in county file for audit. Sketch System on Reverse Side. SIGNATU TITLE: 1 SBD-6710 (R. 06/88) DILHR SANITARY PERMIT APPLICATION couN In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. c v I sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRORER.W OWN PRO RTY LOCATION 1/a S .F T N, R E (or W 16A4 j ~ ~p PROPERTY F NE 'F(MAILING ADDRESS LOT # BLOCK # All 7 (de'C ( ~1 STATE Lt ZIFCODE PHONE NUMBER SUBDIVISION NAME O C M NUMBER e I I ~d 11. TYPE OF BUILDING: (Check one CITY NEAREST O D ❑ State Owned ❑ VILLAGE ❑ Public 2 1 or 2 Fam. Dwelling-# of bedrooms PAR L AX. NUMBER(b) III. BUILDING USE: (If building type is public, check all that apply) c~:5 7 D 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. TY PEI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. E New 2. El Replacement 3.E1 Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other F-1 Holdin Tank 11 ❑ Seepage Bed 21 R Mound 30 El Specify Type 41 42 ❑ pit Privy 12 ❑ Seepage Trench 22 In-Ground 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION n6 Feet d `;GFeet VII. TANK CAPACITY Site in aeons 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 Lb Lift Pump Tank/Si hon Chamber C Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe s Name (Print): Plumb ignature: (No Sta ps) MP/MPRSW No.: Business Phone Number: Plumber' A~Fress (Str et, City, Stat , Zip Cod): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e ssue Issui g Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse D r int n v X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS • . ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. - 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 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 patmlt Issuance. Should this development be intended lot tessle by owner/contractoc,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office vith the appropriate deed recording. Owner of property l Jel IQIac r Location of property If _i/4 /4, Section T_1.J''R-~•-~-w Township Melling address I , C Address of site , Subdivision name Lot number Previous owner of property Total slse of parcel ! Date parcel was created At* all cotners and lot lines identifiable? on 0 is this property being developed tot resale (spec house)? as 0 Volume fT/sand Page Number Y4L ss recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWIMCI A WARRANTY DEED which Includes a DOCUMENT NVMBRR, VOLUME AND PAGE NUMatR, and the SfIAL OF THE REGISTER OF DEEDS. In addition, a certilled survey, it avallable, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a CeitiEled Survey Map, the Cattitled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(VO) certlty 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 fntocmatlon torn, by virtue of a warranty ad tecoc ed In the OLtlce of the County Register of Deeds as Document No. and that t tVel presently own the proposed site for the sewage d eposal system (or i (we) have obtained an easement to tun with the above described property, Lot the construction of said system, and the same has be dul ded In the office of th oynty Register of Deeds, as Document No. 1. Signature oL owner Signature of Co-owner (11 Applicable) Data of Signature Date of Signature DOCUMENT NO. THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 463538 i STATE BAR OF WISCONSIN FORM 2-1982 . LL REGISTER'S OFFICE i ST. CROIX Co. , WI i { Recd for Record ii __Single---Pexs-Qn.,----------•----• at Ut,1 2 G 1990 8:40 A. M conveys and warrants to I~,° P.eX SQxI...•--••--•-••-• RegtsferofDeeds i ( I RETURN TO the following described real estate in St...._~Q l X.......... County, State of Wisconsin: Tax Parcel No_ NEk of NEk, Section 35-28-17. i II~ I~ This j,.9..XIQ.t.... homestead property. (is) (is not) Exception to warranties: Dated this 24... day of ---_-------------------QQtQb r.-•---•---..---........-_., 199.0.... --•••------.._..----••-------••(SEAL) -•-•--•-••-------•----•-------...•••-------••----••••----...........(SEAL) i * .erx.,_..Sakzby.••--••--•-......_................... (SEAL) .--•------......._.............._--......................•--........(SEAL) " A TBENTICAT NW----- ACKNOWLEDGMENT ALABAMA Signature (a) •-----_STATE OF ss. . County. authenticated this __day of___ ' , 19_t:Q Personally came before me this ..a day of Gt4J? QX . the above named TITLE: MEMBER STATE BAR OF WISCONSIN (1 not, authorized by $ 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED. BY ; .Jvhzl _.G..._Mstxn enf-A-t .ty ..Xi ..W. abama~ 0~~ . . CAX1S.].ri ....5.40-0.2 Notary Public County, . (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date:.... MY C4mmis~inal:xn.r~sFeb. lAy3 19._._._._.) i 'Names of persons signing in any capacity should be typed or printed below their signatures. ~l STATE BAR OF WISCONSIN ~wcmna► FORM No. 2 - 1982 Stock No. 13002 Cn SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County Fa P3 OWNER/ BUYER ( J w I 0 ROUTE/BOX NUMBER fire Number d CITY/ STATE Cl ZIP 0 PROPERTY LOCATION: Section ?s • T~%, N, R ~W, _ Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed"se t'ic tank pum ear. What you put into the system can affect the .unctio o the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-may_ be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, whit 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 'sys*t'ems agree to keep their system properly maintained. The property owner agrees to submit to St.. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- 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. H I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with N the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. , SIGNED 01-1 hI /'/V DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS -'INDUSTRY,' CC DIVISION LABOR AN BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: OWNSH UNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: lV~/ eN/R/ E i2v5 COUNT MAILING ADDRESS: `I, e9~ Y' kk r L 1 _ Stab b 4R I 10 USE DATES OBSERVATIONS MADE NO. BEDRMS.: r MMER IAL DESCRIPTION: TESTS: esidence 1 -.3 New ❑Replace 17-/7-17o 7 - l 8-c70 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) os ©u Esau OU os au os ©u IflaatV -sr« If Percolation Tests are NOT required DESIGN RAT . If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- l to y9, 71 iUo 2~f" gyp' ae T" S, to,=/Z'B2 L 12~_ zv d 1-411A-10- 4e,%,k B- 2 Vo 2~ ~r27,SC=-12_"3e~'.L, =24'Aals.[_2y~~~,ti~~•, , r cu1.u OS d-f rA--- r- 4, e- 72" x, B- o 2y 13Q TES, e 4, /Z B- 241 -Z'11A1C LoF+nn Sgt 5 ' 4, JT4v5 B- ~L, 5 - trcrY 6-^wL4v, L I G ~ tti>`t ~ S T h~c~ t-v t•L.. rB- TESTS N TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 _____P _9_R PER INCH P_ 20 Np 3a f,'f3 7 3/~f 5% P- 2 20 Ne 30 //g 7/ s O P- 20 ,tJ D 3 v / : 3 yb P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ?au 20 ee C r_ ~ i E , E , , I E -I , I~ E , ~P--Is I"aa (rt e 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: ADDR SS: CERTIFICAT_LON NUMBER: PHONE NUMBER (optional): C IGNATU7 : L DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester, i DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing 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 Soil 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 Is - Fine Sand Bldg - Building Is- Loamy Sand - Greater Than 's1 - 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. lJ~e c 5 4 Qa rr nEsc~ 35 T~.6N R ~1 THE +AM& 25 Ft. B15: W TF+E _ Ell. MOVNp NiVSr I~ AvJ 9 vW--,eD / Al SI• r, f f" 15~ 7s' r acre aaf~e l D ~ e ~I 4,44 L) Bn (A scre in yoo' 2 " < (p `~cSStJOo T~cG I ~ s 5 ~ ~Y c~~,~~{ P . II gLbra DEC `4^ l Page - Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil F D E st-"j ~ ONgl~ ~ r a, (Force % Slope S 40 4 Bad Of 2- 2 %2 Main Plowed -F1d g~egate Layer D 1.0 Ft. nr~F E 1.3 Ft. Cross Section Of A Mound System Using sue= A Bed For The Absorption Area F --75 Ft. L G 1.0 Ft. A ~ Ft. H I.5 Ft. Signed: B y Z Ft. - License Number: 2 K (D Ft. Date: 112 y`Q L Ft. _ Ft. Alternate Position T I~L Ft. of Force Main W ~.8 Ft. L 7 F I Observation Pipe J B K A ~•-----T--------------- ----------------------•I Force Main M M Distribution Bed Of i - 2 Pipe Aggregate To1&9- u F 4 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page 4 ;4~allt)+w~ Parforole 5®-~ 0594. End View r.` Perloroled End Cop A PVC Pipe de~O~ Holes Located On Bottom. S Are EQuolly Spaced 9 s • ~ , _ * PVC Force Mom i From Pump Q PVC Monllold Pipe D-slritoulion Alternate Position Of Pipe Force Main From Pump Lost Hole Should Be Neel To End Cop End Cop Distribution Pipe Layout P 2 1.7 R vp i~ S -_LS1 X 1-I U „ v L 0rt Signed: Hole Diameter y Inch 19 Lateral i Inch(es) License Number: a 3 1 Manifold _ Inches Date: !D l~~ i~d Force Main RL Inches 7 holes l Pl pc • PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEIJT CAP-If r-T 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIIJG P-5' FROM DOOR JUNCTIOM BOX MANHOLE COVER , WINDOW OR FRESH IP"MIN. ~ ~ AIR INTAKE uw L . GRADE I PI I yr MIIJ. COWDUIT PROVIDE !!D LE T}+t `etC~4, 4 9 f AIRTIGHT SEAL I I i 1 1` APPROVED JOINT A I I I APPROVED JOINTS W/C.I. PIPE I I I ( W/C.I. PIPE EXTENDING 3' I 11 ALARM EXTENDING 3' ONTO SOLID SOIL r 61-tti~l~~s i II ONTO SOLID SOIL I 0!J A# f.~a ELEV. FT OFF PUMP CONCRETE BLOCK RISER EXIT PERMITTED OUL4 IF TANK MANUFACTURER HAS SUCH APPROVAL S EPTIC F Sj~PEC,IFII'CATIOUS C~ DOSE TANKS , MANUFACTURER: ~ Id( ~P 1 r~ r a S f {DUMBER OF DOSES: ` PER DAy TAWK SIZE: O CALLOUS DOSE VOLUME MS1 GS-(p ALARM MANUFACTUPIER: ~ G n K `,P ~ INCLUDIAIG BACKS FpLOW: 1-78, 1 GALLONS MODEL HUMBER: CAPACITIES: A=! IS INCHES OR 11 -9I~e GALLOWS SWITCH TYPE: a B = Z INCHES OR 3y 05 GALLONS PUMP MANUFACTURER: ~T n L'~ Irk C -INCHES OR Zz(l .r CALLOUS MODEL NUMBER: lI I~ - 3 D- 10 INCHES OR 1~~GALLONS SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE ~ MIWIMUM DISCHARGE RATE 32.7(0 GPM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 13 FEET ( -j - Ll LI + MIAIIMUM METWORK SUPPLY PRESSURE ~2.5 FEET t ♦ YbO FEET Of FORCE MAIM X I'8a' F/pOmFRICTIOU FACTOR..J_"=gQ FEET TOTAL DtIUAMIC HEAD = 2 ? FEET 1UTERUAL I SIOWG OF T IJK: LEM&TH 7 , ;WIDTH.- -;LIQUID DEPTH 51GtjED: LICEMSE IJUMBER: DATE: 4 pI7-Y, I State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WANG EXCAVATING Owner: TOM WEISHAAR ROUTE 4 BOX 342 B 628 PINERIDGE TERRACE RIVERFALLS, WI 54022 RIVERFALLS, WI 54022 RE: Plan Number: 390-40594 Date Approved: October 17, 1990 Gallons Per Day: 450 Date Received: October 16, 1990 Project Name: WEISHAAR, TOM - RESIDENCE Location: NE,NE,35,28,17W Town of RUSHRIVER 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/54 cc: TOM WEISHAAR X Private Sewage Consultant SBD-6423 (R. 08/88) - -G"2 T4csmrr:. ..sl`: Si 130 I P - ST. CROIX COUNTY r ~ } h WISCONSIN A'' 4 ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 FRA" ` - 715 386-4680 !W Oct. 11, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Ferris Sabby property located at the NE 1/4 of the NE 1/4 of Section 35, T28N-R17W, Town of Rush River, St. Croix County revealed suitable soils at a depth of 24" below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, Barnes K. Thompson Assistant Zoning Administrator cj DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 79069 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: 0- '/4 3s/T~~N/RI~E(r)W ush wee Al COUNTY: OWNER'S UYER'S NAM W MAILING ADDRESS: ~51Co It l Co '5O-1 USE DATES OBSERVATIONS MADE NO. M L DESCRIPTION- _J_ E DESCRIPTIONS: PER OLATI N TESTS: Residence 7 . I ~1, New ❑Replace / 8 F v ~J o ' / RATING: S= Site suitable for system U= Site unsuitable for system Ila' Qi r 3 _5f)) Sr4i VIR C~ CONVENTIONALA.MOUND: W -GROUNDPR: SYSTEM-IN-FILJ_ HOLDING TANK: REC MEND D SYSTE :(optional) If Percolation Tests are NOT required DESIGN RATE- If If any portion of the tested area is in the A f under s. ILHR 83.09(5)(b), indicate: 4 Floodplain, indicate Floodplain elevation: / V A 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.) 6`0 SL TS f'' 4~- S~_ l o'L D ri scL Y~~ CO 6" Bl S,l rs v~' S; i IOyR AHD a B- 0 T~s" ~y s~yo M~ r~o T Mal B- D O-C? Val `e- C i ! c o I', W B- 4 l r q-,61 S,'( TS cV'6-7 S;1 SBn ~5 ( F©p r l y c a " F~S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P- P-M/T P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /U A ii-hc ~o N~ 3 y E { ©`T' o'C= E.. _r Qs al ~ 3 ar-~ P o~ 'v -r r - o d E 3 p 4 3 E E 3 2 F ~Fd ~/tr q LL1ti'e. 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME rint): TESTS WE COMPLETED ON P I{ Ue eg t3 AD ESS: V CERTIFICATION NUMBER: PHONE NUMBER (optional): r ~e I "170 729 CST SI URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD_6395 (R. 10/83) - OVER - l I 'STRl1 TI rOR "Y ETIN r -n 115 - SRS! w To tie a coma ' ` and accurate s it test, your rep art 1. Complete lpga -~.'scription; 2. The use section must clearly ; to whether i oi- commercial project; 3. MAXIivlt. N1 number of bi > or c£3mmercial 4. Is his :t new or renlac rrn' r; 5. Complete the suitahiL' . A SITES IS S` ll'T _ FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE F .1LED OUT BASED ON SOIL. CONDITIONS; 6. PLEASE use the abbreviations shoLpvn here for Vvi-itir g profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE dia€.ram accurately loca:tirg your test locations, Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevai:i€sa reference from: are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresse food }Main data, percolation test exemp- tion, if appropriat 10, If the irf<rrrrratior 3d plain, elevation} does r' a in ihe appropsiat.e box; 11. Sign the form current addiess and your c - n nut 12. Make legible - t d tribute, as required. ALL SC; _ TESTS ;SST E FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIA'i I,- R CERTIFIED SOIL TESTERS Soil Separates and Te; r - Vmbols s[ Stolle (over 10") 3edroc#€ cob - Cobble {3 _ 10") _ `sandstone gr -Gr<<vel {utader 3' } Limiatorae High Croundvvater s - Sand cs Coarse sand - Pe-colation Rate med s Medium Sand Well I<; - F=ne Sand iq Loamy Sand j G •.,ri1 sl Sandy Loam L s 1 ? Pro :-i g,; ?la.r.,k G~ay st1 ` eli0v", cot y Loam Peet sic Loarr, - Mottles so y with sic - Sil few, fine, faint £;omn7C1r1, C£)arse pt n1m "My, Medium fn d - 'ini- p orTain'r1t i§t^ti eigh water IevE.l, ,;()j: 4~ surface water Bench Mark Vl_ Vertical 1`30erence, Point TO THE OWNER: This soil test report is the first step in securing a san=a :ry permit. The county or the Department may request verification of this soil test in the field prior to i 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. ST. CROIX COUNTY WISCONSIN ZONING OFFICE M M N r ■ ■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 27, 1994 Gene Nelson 59 C. T. H. "Y" Baldwin, WI 54002 Dear Mr. Nelson: In response to your telephone call yesterday regarding the septic system on the Tom Weishaar property, Section 35, Town of Rush River, the mound was sized for three bedrooms at the time of installation. It was installed on 10-30-94. It is believed that the house may not have had three bedrooms, but was sized larger due to marginal soil conditions. Now Mr. Weishaar wishes to add two bedrooms. If, by your determination, the house consists of no more than three bedrooms at the present time, the system should accommodate the addition, and nothing more needs to be done. The building permit may be issued. However, if the number of bedrooms exceeds three, an affidavit must be signed by the property owner, and recorded with the Register of Deeds, stating that the addition may cause the existing septic system to become undersized for a dwelling of the resulting size. This should be done prior g g to issuance of the building permit. I am enclosing a copy of the affidavit that should be used in that situation. Please note that it also requires county approval. Should you have any questions, please contact me. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cc: Township Clerk File t'k ST. CROIX COUNTY WISCONSIN V.e 3"q ZONING OFFICE ST. CROIX COUNTY COURTHOUSE v 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 EXISTING SEPTIC SYSTEM AFFIDAVIT I The existing septic system which serves the dwelling being added on to must be inspected by a licensed soil tester for compliance with high ground water and/or bedrock seperation requirements as set forth in s. ILHR Chapter 83.10(2) WI. ADM. CODE. The results of that inspection must be made available to this office. If the existing septic system meets these minimum requirements, and is ,properly functioning, an addition may be added to the dwelling without updating that system. This addition must not, however, encroach upon the required septic system setbacks as setforth in s. ILHR Chapter 83.10(1). Property Owner(s) Property Mailing Address: Property Legal Description: LotCSM/Subdivision 1/4 1/4, Sec. , T. N., R. W., Tn. of I, as the owner of the above described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that this addition may cause the existing septic system to become undersized for a dwelling of the resulting size, and I will make this information available to any future parties interested in purchasing this property. Notary Public Subscribed and sworn to before me on this date: Signed- Date- My commission expires: County Approval- A Date: