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HomeMy WebLinkAbout032-1011-40-100 Ulf FORM - STC - 1 AS BUILT SANITARY SYSTEM REPORT OWNER- ✓3 .fe-1 TOWNSHIP-&. ` SECTION _T_Z2_N_R_ Z, W ADDRESST. CROIX COUNTI, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN I p0 FEET OF SYSTEM i a 14 3 3 4? 01 j, ~--5 r I I V0 INDICATE [NORTH ARROW BENCHMARK:Elevation and description:- ~ j' /c ~SW. ~c•~+ ~ - 6 ✓e, Alternate benchmark- ZLz CJ "'Y ,r SEPTIC TANK:Manufacturer:- lLQ-eS Liquid cap. oa-a Rings used:~Manhole cover elev: -4/ inal grade elev: Tank inlet elev.: 1-/)5_Tank outlet elev.:- No. of feet from nearest road:Front Side( ~ , Rear Ft. 7S' From nearest prop. line:Front side, Rear Ft. >s No. of feet from: Well , 4)el/ , Building: -;719 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I f pump CHAMBER Manufacturer: Liquid Capacity:y " Pump Model: Pump/Siphon Manufact.:20* e"'' Pump sized-. • _ Elevation of inlet: Bottom of tank elevation V,.V7 7-7'- Gallons/cycle: Pump on elev.:A~umP off elev.: Alarm: Man.: LSwitch Type:,3/' q/,. Location Distance from nearest prop. line: Front_, Side, Rear-Ft. Distance from: Well I/ ~ / Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: ~ ~a`l Width: Length J 3 Number of Lines.-Area Built 7 Exist. Grade Elev. l Proposed Final Grade Elev.-,f2 Fill depth to top of pipe: No. feet from nearest prop.. line:Front , Side, Rear Ft. . o No. feet from building No. feet from well. HOLDING TANK Manufacturer: Capacity: No. of rings used: -Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building------, nearest road Alarm Manufacturer: INSPECTOR: PLUMBER ON JOB: DATE: 7-a7 LICENSE NUMBER: 6/90:cj J DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR /T I SAFETY & B11ILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 2969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION ~ MADISON, WI 53707 e iVWy,NE,,Sec.5,T31-R19 Ox'- (ifsigned D. Number: Town of N. 5 Hers t CONVENTIONAL El ALTERATIVE p _ Hol ?ing Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: I x 99 G. 0cpoln, WT 5409n BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL T REF. PT. ELEV.: Name of Plumber: MP/MPRSW County: Sanitary Permit Number: SEPTIC TANK/HOLDING TAN !'A , q' MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ARNING LABEL LOCKING COVER Q i P VIDED: PROVIDED: S V 8 45, 95.66' YES ❑ NO ❑ YES N BEDDING: *EMT IA.: *ENT MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WE L: BUILDING VENTT RESH ALARM: FEET FROM LINE: AIR 171T: ❑ YES NO ❑ YES NO NEAR a / DOSIN CHAMBER PT. - z. b ;,e, = S MANUFACTURER: BEDDIN : LIQUID CAPACITY: PUMP ODEL: MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: P 1 VIDED: ❑ YES NO Y60 6s 4_-t' YES ❑ NO YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUIL G: VENT TO FRESH (DIFFERENCE BETWEEN 1( FEET FROM LINE: t e_ AIR INLET: / PUMP ON AND OFF I~ , YES ❑ NO NEAREST -s - / SOIL ABSORPTION SYSTEM. Check the Soil m isture 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 his --55 6C the soil is dry enough to continue.) SC - O 3 CONVENTIONAL SYSTEM: 7 3 C c,, _ BED/TRENCH WIDTH: _ERGTT+ NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: DEPTH: DIMENSIONS T C/ GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NOD TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH G I , AIR INLET: BELOW PIPES: ABOVE COVER' ELEV. INLET EL V. END;r '~Q /f YC. PI ES: FEET FROM LINE: /t % d 9_< 74 NEAREST - > ~S MOUND SYSTEM ( .c5) 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 ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES [__1 NO ❑ YES ❑ NO DEPTH OVER TRENCH/ BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: E] SODDED: SEEDED: MULCHED: CENTER: EDGES: YES E] NO ❑ YES E] NO ❑ YES El NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES NO❑ YES ❑ NO-f NEAREST-♦ UU Sketch System on in county file for audit. Reverse Side. SIGNA URE: TITLE: SBD-6710 (R. 06/88) G1~ SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm: Code COUNTY ,t71LHR STATE ANI RYPERMIT# Attach complete plans (to the county copy only) for the system, on paper not less than El n 8%x 11 inches in size. eck if revision to p us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION e '/4 11/2 '/4,S T N,R E( PROPERTY O R'S MAILING ADDRESS LOT # BLOCK O CITY, STATE Z ODE PHONE NUMBER SUBDIVISION NAME OR CSM N~~ R ~E,AARESTT ROAD ~ II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE . g q r X ❑ Public 1 or 2 Fam. Dwelling-# of bedroom LAN B R( 10 I _ / /0. r QU 111. BUILDING USE: (if building type is public, check all that apply) `tt 1 ❑ Apt/Condo 20 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) 1.9New 2.E1 Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.E] 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 4.20 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. EFINAL LEVATION GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) l,;T L Feet Feet /V I ,r ;7 . TANK CAPACITY Prefab. Site VII - . in gallons Total # of Manufacturer's Name Prefabe Con- Steel Fiberglass Plastic ExperApp INFORMATION New dating Gallons Tanks structed Tanks Tanks Septic Tank or Holding Tank Ga Lift Pump Tank/Siphon Chamber d0 44r 0 F1 1 0- 1 Ll VIII. RESPONSIBILITY STA MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): l Plumber's Signature, (No Stamps) MP/MPRSW No.: Business Phone Number: o Plu is Ad as (Street, Ci , State, Zip Code). r-~ IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issui gent Signature (No Stamps) ❑ Surcharge Fee) lo A-& Approved ❑ Owner Given Initial Adverse Determination ` X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. , Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. -Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. 111. 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 ,ewers, sells, 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 corlected thrt~t;gh these surcharges are used 'or monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequaoies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgr,("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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ` n Owner of Property 1,J r T Location of Property +_k Nr 1&, Section 5 , T N - R I W Township C~ r% mom: ; L Mailing Address U 5c~ol~, Subdivision Name Lot Number Previous Owner of Property L- ~~<\+v,5 \ Total Size of Parcel 3. I 0 C~(- -,e Date Parcel was Created 7lay~ 'A U Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes x No Volume and Page Number a.~~15 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ceAti.6y that att statements on th.i,a 6oAm are true to the beau o6 my (our) knowledge; that I (we) am (ahe) the owner (s) o6 the pnopen t y de cA i,bed in thiA in6o4mati,on 6onm, by viAtue o6 a wahAanty deed xeeonded in the 066ice o6 the County RegiAteA o6 Deed6 as Document No. H(p)3L7') ; and that I (we) pneaent.ey own the pnopoaed A to bon the sewage dlApo.6af- aydtem (on I (we) have obtained an eabement, to kun with the above deacA bed pnopenty, bon the eonbthucti,on o6 aaid dyatem, and the dame hab been duty xecokded in the 066ice o6 the County Reg-ie.ten o6 Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED G DATE SIGNED THIS SPACE RESERVED FOR RECORDING DATA _'CUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 WARRANTY DEED `461367 IV% 81 9PA'A REGISTER'S OFFICE lit - ST. CROIX CO., WI This Deed, made between Lyle Palmsteen_ and Beverly___ RBC~CI for Record -_Palmsteen,-- his wife------ IM Grantor, 1 1:30 A*, and------..inlb,l•l_y.seerl, CSC { husba>i?a ana w e-_as__s>~ x ~4x b E--max a~..Progerty " Reghterofnel~d' Grantee, II Witnesseth, That the said Grantor, for a valuable consideration ...of i ..one--dollar-.and.-Qther-.gQQd-_and_- valuable. considex t-iQA$.... RETURN TO I,I conveys to Grantee the following described real estate in ...St-Croix GUY T. LUDVIGSON,S.C. County, State of Wisconsin: P. 0. Box 337 II n^^^^1 P f.iT %40-7G Lot 1 of Certified Survey Map recorded in Volume 8, page 2245, on July 24, 1990, as Document #460727, Tax Parcel No- being located in the Northwest Quarter of the North- east Quarter (NWI of NEJ) of Section 5, T31N, R19W; I I F c,X Ei'J[PT I~ II (I II I I{ This is__ not_____-__. homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; {i And--------- grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record i and will warrant and defend the same. Dated this l5t...................... day of All$.l1St........................... , 1990..... <J~~ (SEAL) ---------------------•------------------•-•------------------------.-(SEAL) r yle Palmsteen * - nn (SEAL) X`, f fA txC (SEAL) Beverly almsteen i * I i ACHNOWLEDQMENT AUTHENTICATION Signature(s) STATE OF WISCONSIN j I ss. I POLK County. i { authenticated this day of-------------------------, 19 Personally came before me this lst day of August 19..90-. the above named i Lyle__ Palmsteen_ and_ Beverl_y__Palmstezn------ J { * l TITLE: MEMBER STATE BAR OF WISCONSIN i (If not, - p' a authorized by § 706.06, Wis. Stats.) to me known to be the erson who executed the foregoing instrulr,etlbiEivv4,peknowle lge the san'/-PY I{ THIS INSTRUMENT WAS DRAFTED BY ~ ` ~ - !j ? ~ GUX _'T, _1 UI)yI~SoN, S_: C_._, Attorneys _ at _ Law____ Ma~e~11a~L: ard Wis. C : ` aunty, Notary F.Il1►` ie Polk Qsceo_1?..-_Wi consin__ (Signatures may be authenticated or acknowledged. Both MY Comia ts(on is pe'rmanent._TIf not, state expiration are not necessary.) date: f~-1~PrY1?-- ••---25-----•• 19._93-..) ' 01 - ---------ter- -~z~-- •Names of persons signing in any capacity should be typed or printed below their signatures. r 1 L STATE BAR OF WISCONSIN keonsin Leval Blank Co. Inc. WARRANTY DEED FORM No. 1 198'.1 Mil"ank". Wis. . i 460'727 C ER T I F-I ED SURVEY MAP Located in the NW 1/4 of the NE 1 /4 of Section 5, T 31N, R 19W, Town of Somerset, St. Croix County, Wisconsin. Surveyed for: Bruce and Kim Palmsteen Owned by: Lyle Palmsteen Note: Found iron is-,S 5°01' 18"W Rt. 1 8.62' of corner. Osceola, Wi. 54020 North line of the NE I /4 L K= STCROIX ROAD CO M • _ 4.0_4.0.,,F -2 r~0 n\ _ _M M N F----- 24.37' rn 1306.58' 1056.57~'m 11 30.14' - NE Corner N 87'2i'47E 250.50' Section 5 N1/4 Corner T31N R19 W Section 5 Bearings referenced to the North line of the NE 1 /4 of L ® IT 1 Section 5, previously recorded as N88°40'40"E 137,648 Sq. Ft. (3.160 Ac.) r+ Including ROW CU I CU 130, 854 Sq. Ft. to Z1 zl to (3.004 Ac.) Lr) J1 al Excluding ROW 3 I I LLJ to n 0 rn o I WI 01 N in East line of the NW 1 /4 of ~I J the NE 1 P4. N al ~I N ..J 10 0 Di _ v z POND s. CVOlx G;U1H S'~ ilc 1~ ►1~Q51V♦J `r>`~i~~i TEL IN, ~ZONI(J~ ' Jo - 'u I _~a4tif~fi:N S 88'40'40-W 250.00' `1 1 1 .plc I UNPLATTED LANDS 0101 JOHNSON 1 ' - - - - - L-1 61 s-189 LEGEND I a al HUDS T W 1 2 1 ~•i VY1S f+ - Section corner, Berntsen cap I "1 R 0 1"X24" Iron pipe weighing 1.68 lb s /lin. ft , set ~Itr1B R • 1" Iron pipe found (R) Previously recorded information, if different.. ~ JUL2 41990► JAI ASS ~~f",pNNEII SCALE IN FEET I'= 100, V Regdef01De s I P===q C4, VWA1 o St Goy 0 This instrument drafted by: 4901764 VLUME 8 1 2245 DESCRIPTION A parcel of land located in the Northwest quarter of the Northeast quarter of Section 5, T3 1N, R 19W, Town of Somerset, St. Croix County, Wisconsin, described as follows: Commencing at the North quarter corner of Section 5; thence N88040'40"E (bearings referenced to the North line of the Northeast quarter, previously recorded as N88°40'40"E) 1056.57' to the Point of Beginning; thence continuing N88040'40"E 250.00'; thence S 257110"W 552. 131; thence S88°40'40"W 250.00'; thence N 257'10"E 552. 13' to the Point of Beginning, containing 137,648 square feet (3.160 acres) more or less, and being subject to all easements, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of Somerset Subdivision Ordinance to the best of my professional knowledge, understanding and belief. 7~7 ,``~~ftflgNb Harvey G. Johnson S-1899 Jo fjNsY G. Johnson Surveying, Inc. $_1g99N 407 Second Street V Hur)'So 1 Hudson, Wi. 54016 WAS N ri a e1 ' VOLUME 8 PAGE 2245 z ' H r ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a H M OWNER /BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE STATE__.Q, L0 -I,- ZIP PROPERTY LOCATION: N -1k, IV, 5k, ~ T~_N, R~W , U 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 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 nec- operating condition and (2) after inspection and pumping essary), the septic tank is less than 1/3 full of sludgeandtscum. Certification form will be sent approximately 30 days p H three year expiration. ° E I/WE, the undersigned, have read the above requirements and agree; to maintain the private sewage disposal system in accordance with r, ro the standards set forth, her/ein, 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 DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. .::U- ..-L1WWfi/YYf11WIM~awYNM1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 3707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: -SECTION: SHI !MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: J , OUNT E ~ MAILING ADDRESS DATES OBSERVATIONS MADE TOM DESCRIPTIONS. NO. BEDRMS : COMMERCIAL DESCRIPTION: / Residence XNew ❑Replace ,mac RATING: S- Site suitable for system U° Site unsuitable for system S K: RECOMMENDED SYSTEM: (optional) ONVENTIONAL: MIN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TAN Bu ~ 1 -1 DU S DU DU ❑ S ~i! ❑ S'Bu 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: Q Floodplain, indicate Floodplain elevation: ~Q PROFILE DESCRIPTIONS BORING TOTAL P H T GR UN WATER-INCH S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSE V D H T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ) o ? B- 10 B-3 /oo ° Ao_ B- 5 /3/ _ tea 'Oi~.. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES NUMBER IVINICf3 AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD PER INCH P. d .2 [O rP G q- A v1 G P- O G P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suita Wiraf dicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Sh n at all borings and the direction and percent of land slope. SYSTEM ELEVATION. 1 i e 6 j I i 1 1 1 i 1 1, th undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): _ TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ev r - 7 CST SIGNATURE: DISTRIBUTION: Original a coov to Local Authority. Property Owner and Soil Tect®r. PLOT PLAN PROJECT_r . ct ADDRESS-4~14/ r f/4/S~ j'/T,V N/R/ W TOWN -Pr COUNTY MPRS, Byron Bird Jr. 3318 DATE BEDROOM CLASS PERCCONVENTIONAL 'IN-GRO PRESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA GQ PERC RATE ~BED SIZE T~ 16 Benchmark V.R.P. Assu a Elevation 100' Location of Benchmark ` * H.R.P.^ C] Borehole Q Well Scale = Feet 0 Perc Hole System Elevation J/ Uent 120 Grndp- TYPAR COVERING 2- 12" 3' 4 6' 3' 1 6 » Sewer Rock 12' G 5 0~ R-q A- Q PAGE PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS s VENT CAP 'i°C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER ? 25' FROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE I GRADE I 4AMIN. i ~ ~ IB"MIA1. j CONDUIT t8"MIN. ''Qk 11~ INLET PROVIDE I - AIRTIGHT SEAL I I i ( / -T III v APPROVED JOINT A I I (I APPROVED JOINTS W/C.I. PIPE I III W/C.I. PIPE EXTENDING 3' ( II ALARM EXTENDING 3' ONTO SOLID SOIL B I i I ONTO SOLID SOIL I I oN ELEV. FT. PUMP--- ~ OFF . D H CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF -TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIONS DOSE TANKS MANUFACTURER: IJUMBER OF DOSES: 0*2 PER DAS TANK SIZE: GALLONS DOSE VOLUME ALARM MANUFACTURER:INCLUDING BACKFLOW: O7l ~ GALLONS MODEL HUMBER: CAPACITIES: A,Zcd INCRES OR ...GALLONS SWITCH TYPE: 5= INCHES OR VLo GALLOWS PUMP MANUFACTURER: -Zge~-,1< r- INCHES OR ~ GALLOWS MODEL NUMBER: ~cz D= INCHES OR lCi2 GALLOWS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO DE MINIMUM DISCHARGE E ~dP GPM INSTALLED OAI SEPARATE CIRCWT$ VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. Zd• FEET + MINIMUM NETWORK SUPPLY PRESSURT7EE . AA FEET + ~ FEET OF FORCE MAIN X ~F/opFtFRICTIOM FACTOR. L C FEET TOTAL DtJUAMIC HEAD = FEET --,,_INTEKNAL DIMENSIONS OF TANK: LENGTH ,WIDTH ;LIQUID DEPTH SIGNED: LICEMSE 'NUMBER: 2Z1 DATE: i HEAD CAPACITY CURVE TDH cc W ' ilr . W.W: -90 U J TOTAL 0VkAh%C "EADVAPAC1rr NA MIN!! 2 i _,w--- EK►11ENt AM 09WATENNe• 26 •EInE• S34T.se n 9ar.ue 193 tee b EFFLUENT AND DEWATERING GAL oa GAL r.. S -~3 eb /0• 61 61 SEWAGE AND DEWATERIN(i 34 s~ et of 24 % ;e 1e a « •e so 20 27 N e• e0 a • st s. 2 % ss N --1-- 40 N ss a> i I I _6_ 1s a 20 70 Y ` 163 MODEL o: " . i 6e a - 165 % toTAt ID"" Nc ""DICAfto" No won 1 I ~ sEtawwoEw.rc~o I, ` c►e. c~. OA. GAL a. 16 ' I s toe ta• tao . teo 1 - 1 10 so n is lit 14 i1 I ,s 20 a st /a --T_ 20 • a tta r 70 >•>"w. % 12 1 's e N MODEL - --r- - so 1: 10 l i loci- thbs U ?t 26 34 e' 3J Ii 8 MODELS M DEL 6 ' .t ODE 264 I 2821 4 MO EL 2108 ,I M DEL's 2 ~ v 53 57 M DE MO EL 59 ' 97 207 - 1■T/lt7TY AM 1 LITERS so 160 240 320 400 48o s ~o o FLOW PER MINUTE N G BUREAU r 3 P.O. Box 2W Old M/Mas Lww ~~NIYIdCAlI~IY of . Lours x«ni~ ky 40210 (SO2) 775-2791 a4ilrr ~uuos S~~F Mg i t I g_q I I ~,7nr ~o 1 J 1MORTGAGE LOAN RURAL PROPERTY SEPTIC INSPECTI S I HAVE INSPECTED THE SEPTIC SYSTEM ON THE PROPERTY LOCATED AT: THE PROPERTY IS OWNED BY f 'in fa AND BEING SOLD. THE PURCHASER IS: ADDRESS: S r SEPTIC SYSTEM APPEARS TO BE IN WORKINC ORDER ( YE ( NU). DATEf JS-6 SEPTIC SYSTEM APPEARS TO ISE' MALI-NNCTIONING AND MAY NE'El) 'IY) BE. RE'PALRED OR REPLACED. REMARKS: << r 1,A) can e THIS INSPECTION IN NO WAY IMPLIES, WARRANIS OR GUARANTEES THE FUTURE OPERATION OF THIS SYSTEM AND IS MEANT ONLY TO PORTRAY THE EX1•STINC CONDITION OF THE SYSTEM ON THE DATE OF THIS INSPECTION. Inspector 913 License No. 1 Applicable) Date Inspected ru 24/~ _ Inspected For I.T.P. 05/07/01 MON 06:23 FAX 715 483 1623 10001 f 2001` S I s.~ IN of m e on•~ ~j u ce Per oyr 5 ©o n arr as r~4 ~ a u o -F o %A- etc us e aid odd ~ o r` . r rnork-~ Q r\ ova' ~vor\ e •s 7rS~ aqy- 3a3~t IYo u Po, lo,141,, [A 002 05/07/01 MON 06:23 FAX 715 483 1623 I.T.P. 18'-0" z N - f d ~ w p ~ ~ b 2'-b" - I r i ~ r E r 1 r 17 r I I ~ r w I r b0 r N I ~ ~ b I I ~ 21-011 18'-O" 05/07/01 MON 06:24 FAX 715 483 1623 I.T.P. Q003 I 1 1 _ of - 4 ' 11 1 ' 1111 I t„------- ' loll - 1 , ' 1111 1 1 ' 1111 1 1 ' 1111 1 1 ' 1111 1 1 ' Me l t ' lilt I 1 ' Me r t ' loot 1 t ' toll r 1 ' tilt 1 1 ' rill t 1 ' nn + 1 ' 1111 ~ 1 tell i t loll t 1 - Ill r 1 2x10 FLOOR JOISTS ~ ~ l 4 i ~6" O.C, t 1 - I rill 1 1 ~ ~ 1 , Inl ~ 1 _ nu 1 r 1 nit ~ 1 , Iru ~ 1 ' 1111 r 1 1 ne l r i lnl ~ 1 1 uu 1 r ~ nn r 1 nn ~ I r tits t r loll l 1 Ittl s t 1 1111 ~ + t 1 1 ltlt l r ~ Ilrl t 1 loll 1 1 Ex- 1 leur~g cveu 2b'-O" LOUDER FLOOR PLAN SCALE: 114" = 1'-0" - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - + - - - - - - - - - - - - - - - - - - - - - - { 05/07/01 MON 06:24 FAX 715 483 1623 I.T.P. 004 . s ( : ( i I ' oo I a a 0 7 05/07/01 MON 06:25 FAX 715 483 1623 I.T.P. Ij005 I kip JrT ILI T `T j ~ t ~ - ~ fff•'f--} i i IT ~ a I ~ -1 F7o4'Ym' ~ N fb ST. CROIX COUNTY WISCONSIN ZONING OFFICE M u M rrrrr ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4684 May 22, 2001 Bruce Palmsteen Box 369 Polk St. Croix Rd. Osceola, WI 54020 RE: House addition, Town of Somerset, St. Croix County Dear Mr. Palmsteen: You have requested the Zoning Office to review your remodeling/addition project for compliance with the state sanitary code (COMM 83)• When remodeling or adding onto a dwelling you are required to examine whether or not the construction involves an increase of wastewater. I have reviewed your project plans and It is my understanding that you plan to construct an addition onto the existing residence. The existing dwelling was constructed with two bedrooms. This project will add one additional bedroom to bring the total number of bedrooms to three. The septic system was sized for a three- bedroom structure and installed by Byron Bird Jr.(ID#220527) in 1990. This project will not add additional wastewater load to the septic system. The current septic system was evaluated by William Pfannes and found to have no effluent in the inspection tee. To prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum combined, which may occur in less than three years. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. The property owner has met all the requirements of COMM 83.055 and can proceed to obtain a building permit for the proposed house addition. Should you have any questions, please contact this office. Sincerely, ~ ~ kk) Kevin Grabau Zoning technician