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Home My WebLink About016-1068-10-000~C o ~ °• 3 O t~ a ~.., ~ 0 I M ~ c a ~ i ~~ b ~ 'y N ~~ h N E- I "' o i I ~ r ~ ~ °> ~~ I ~ ~ ~v ~~a h ` w to C t I .S ( C . . . r N ~ C f0 O N Z ~ N aym ~ c ~ N Z I i c O w c ~ I ~ rn w o ~ 3 m °' `° ~~ ~~ I o~ I E Q ULs ~' ~ I a I ~' ~ N ~ W ~ r Z ~ ~ O w ,_ F ~ ' I Zo `_ w C o a m I N M M I- Z I o I oz * ~ r ~ ~ y v N ~ - ~o to ~ ! z ~ , E -o I N M _3 I •~ ~ ~ C o I O ~ ~ Z Z I o N :: Z M I ~ ` ~ N }}yy ~i ~ I W d ~ ~ N S O I D O d I ~° ~ N Z~> ~3~3 °'~ 0 o I I Z~ • O O O N R $ a a a ~ v, a j 3 ~1 ~ ~ 0 0 Q ~~il v N J U ~~ o o N N ~} O ~ ~ ~) N N N Z `'~ N O a, „ ~ m eo Q p O O `-' 0 ~ E N I GO 1 . L 0 m e- C d W I 'O N O :~ ~ 9 d Q A fA (9 b ~ e p s ; ~ 7 a ~ ~ O ~ yy ~ N a C Q '~ ~ O Q d o F°. N ~ ~ N a~i c~ j M 00 c a °o °o V r ~ O ems- O I N t0 ~ C 7 N N y y ~" p •- O C p T ` y y N~ C C N OD O) ~ ~ M~ U ~ `"' o n o s ~ ~ ~ • ~y O M C~ ~~ M O a i Z N Z Y I ~' Cn Q ~ .. I t ^ p ~ ~ € I ~ V ~ ~ -. +~ ~ m n' I .^'~ ., ati a ~ •~ m ::ate • `I~t ~ ++ a E i = m c °: ~ ~ ~ A vat !,ov~ci Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM .~ Safety end Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ lJown of: Jancoski, Mike Glenwood Township CST BM Elev.: Insp. BM Elev.: BM Description: ,~(,~~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~~ Dosing `-` S Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Vent to Air Intake ROAD Septic ySU, ti 33' a(Q ` -- NA ? 50~ >Sbr "` ~-2' > SD r NA Aeration NA Holding ,--~ PUMP /SIPHON INFORMATlO~I , Ii L ~C Manufacturer Model Number TDH lift `riction S stema_ TDH Ft Forcemain Length `Dia. 3 `~ Dist. To well > ~2' SOIL ABSORPTION SYSTEM BE Width r r Len th3 ~ ~ o f PIT No. f Pi Inside Dia. Liquid Depth N I N `~ DIMEN I N SYSTEM TO. P/L BLDG WELL LAKE/STREAM LEACHIN a cturer: SETBACK CH ER M N INFORMATION Type O ~~ ~~ ~~ //~~ ~ ~ ~3s 1 ~ r , ~~ R UNIT um er: o a System: MA~ DISTRIBUTION SYSTEM Header / Mani old it Distribution Pipe(s) u r x Hole Size x Hole Spacing Vent To Air Intake LengtF -'-~, .` Dia. 3 ` Lengtho2`) •}( Dia. 2 Spacing r • ~ f I I/t~ y I 3 ~ r ` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edqes Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Indude code discrepancies, persons present, etc.) '/fi~S C~e;P~J) Inspection :~/ZQ/a'O nspection#2:Oa/3D/~ ~ Location: 2887 130th Avenue, Glenwood City, WI 54013 ~1VE 1/4 NE 1/4 32 T30N R15W) - 3230154,74p ~,ot 1.) Alt BM Description = Fad-~~ 5~ ~~`~ u-'~~ ~-'~ 1 a °t" ~`~-b~ ~ I i _p~~ '~-_ 2.) Bldg sewer length = ~jp - 3 c ~ ~ iL'" ~^~^^~`~ ~ t``( e' ""yam ' -amount of cover = 3.) contour = C.a) `t)s~ ~LP9'`. ~~~ Plan revision required? ^ Yes No Use other side for additional infor ation. o$ ~~ ELEVATION DATA County: St. Croix Sanitary Permit No.: 363906 tate Plan ID No.: p~vs /,~ ~ : 3 z-a~Bo~ reel Tax No.: 016-1068-10-000 STATION BS HI FS ELEV. Benchmark ZZ• 2 cJn .O Alt. BM ~~ a . S~ 119- ~1 ~ Bldg. Sewer Up ~ $ 2S'r ~/+It-inlet 9•b} I12.S8 r St /+It'Outlet~A q', g~ ~ 12.3$ r Dt Inlet ~~,•3S p~.,~p~ Dt Bottom 1~. `4l0 03 ~-~ ` Header /Man. ~ - ~ 02.6 Z Dist. Pipe ((` 3< «' 2 02-6Dr Bot. System 12- o p ~ , .~ r Final Grade ~~ St cover ~ GPM SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~ - ^~.~i-= ~~~~ ~~~~ ~ RY PERMI t; _ ~ ~ - ~~. - a cord with ILHR A j. . ; ~ ~. i r • Attach tom 'f~+~E ~ s ~c, ~,inly) forth than 81x2 x `i t , ' • See reverse sid for I-~st~u~ ioris forreo~yl'ipleting this ap ~ ti The information ou rovide ma /~ y p Eby other government agency p lPrivacy Law, s. 15-04 (1) (m)1- rrSQ ltn r U ~ I APPI 1['OTiI~N IIUFCIRMATI[l1U _ AI FA~F PRIIUT el 1 / .,i :~` ~,fpty a ,y ~1 '4 j~lHa U ! 01 E. W ~ O_ Box , o~~ is (~~ li ildings Division ding Water Systen gton Ave. 53707-7969 I St a Sanitary Pergmit Nt/Ember ~~~ <~tP Check if revision to previous application Plan LD. Number Property Own Na ,_~. c ! ~e tion R ~ E (or~ ~~ii4 N 5 ~Z T C ( L ,~ , ~ , , Property Owner's Mailing Address ~ ~ ~ Lot Number Block Number ~J G~ ~ i~ ~ ~y,St~ate~ /~ "/~- ~ CV Zip Code ~ Phone Number "~ ( ' Subdivision Name or CSM Number ~ ~ t ~i~~ 3l JS ' ~ - (~C ! O ~ ~ .s 4 0 ~~s d~ ~ ~ r~ s II. TYPE OF BUILD NG: (check one) ^ State Owned ^ citfy ~ V a ~ Nearest Road n ~ ~ Public 1 or` 2 Famil Dwellin - No. of bedrooms ~ ow n OF ` !~v ~r ' lII. BUILDING USE: (If building type is public, check all thatapply) Parcel Tax Number(s) 32. 3a./Sy~y~ 1 ^ Apartment /Condo ~ ~ "~ ~ ~ ~- '~V a- J 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 box on line A. Check box on line B, if applicable) A) 1 _ ^ New 2_ ~ Replacement 3_ ^ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an ......System ........System __TankOnly______________ Existing System ________ Exlstln~System B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 Q~Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure , 42 ^ Pit Privy ~ k 3 13 ^ Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fill ~, e O O z ~~ o VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/s . ft.) (Min./inch) Elevation ~ . / r.~ t} t Feet 0 3 3 Feet , , VII. TANK INFORMATION Ca aat in gallons Total # of Manufacturer's Name o~c e site con- l Plastic APPr- N E i ti Gallons Tanks c te stee g ass ew x n s strutted Tanks Tanks S tic Tank nk ~L`1Qa V`f`~~ iD ^ ^ ^ ^ ^ L iphon Chamber ~ 5~ ~ ~ AvG ^ ^ ^ ^ ^ VI11. RESPON ILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Signature: (No Stamps) MP/MPRSW No.: ~V(~ ~ Business Phone Number: ~.d v / ~ ~ ,.2.502 ~ Plu tier's Address (Street, City, tate, Zip{ode IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (In<IudesGroundwater ate Issue Issuin ent Signature (No Stamps) Approved ^ Owner Given Initial s~«nargeree) ~ ~ Adverse Determination 3 Z~ O w X. C.UNU,I I IVNS OF APPKUV/AL// KtAS/UN,1S FUK/DISAPPROlVAL: ~ ' ct '~ (~/ ~f exr5r.:.' SYsfa,., tita51~ qr ~cbq~+~I'6n~~f" ~e~ CoQP, ~ S,PH~ ~ ~< <t.sl'a~l~ per.- /p~~s SHU-639EI (Ft. OS/94) DISTRIBUTION: Original m County, One copy To: Satety & HuilJinga Divr fon, Owner, Plumbxr A sanitary permit is vaKd' ftr- 2. Your sanitary permiti mag'be renew Wisconsin Administrative Code vvtt 3. All revisions to this permit must be a 4. Changesin ownership or plumber county prior to installation ~ ., ~~ ,~ . '~ INSTRUCTIONS ~~ '~~ ~Y ~ fir.. r ~° gars. ._ ~, ~ ~ . "ia b~~ x ~ 'on date, and at a time of renewa riewr-criteria in the applicaBle~ ~ '~ ! s..„ ove~~q .permil.'i. sin~ng authority. ~~, ~ ir''g.Sanitary Permit Transfer/Renewal Form (SBD-6399) to be submitted to the '".~' " / , 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 and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide tf'~e legal description and parcel tax numbers} of where the system is to be installed. II_ Type of building being served- Check only one and corr plete # 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 on tine A. Complete lire 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 aii i~`crrmatio~ requested fc:- cumbers 1 through 1. VII. Tank information. Fill in the capacity of ee~ery r~e~ro/or existing tani~_, iist the total gallons, ;~rsmber of tanks and manufacturer's name, indicate prefab or si instructed and tang. ~;~ =~_nal. Complete rs:;; .al'septic, pump/siphon and i Bolding tanks for this system. Check exper ;~,t:~i approval only if ~a ::<s received exp< n~: nail 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 mus;sin application form. IX. County /Department Use Only. X. County/ Department Use Only. C_ r :)i~tF_ p.`ans and speCfflCilttOns nog _r=i '°r than 8 1,2 x 11 u~c~ ~'", _ , ,~ .. _ ., 1i~_;_E~ A ~c>'' ,~ ;.ounty. The plans must ~~lt!~.id~ t'I~-' It~llOWl~~!,7: /,) f.;iOt plan, l~rci Vb'~1 iL, dale Cr JVt(1 l",OrTl p'_... '_'(l'> C i., :i~L -f'lit' _~` f10iC11ng tdnk(`>), sept:C ,~ (~ ~' _ '(t _,._il _ _. ":S; ~?I iG:. _ ... ~h'E?~i We ~c' 11< ~ '`<.+. _, _ ~.~ _ jc:~':°S, pUnip 7r s!p~?c3(~ '•.c~r ~ ,.'~ ~lJ~_ O _.{? ._ I .v~~Orpfir~~;_. '_ [t'pi~tP-,lEr:i >f~lt .__f5 .,~i:i ~I,FIGCci:;l 'f t}~i21?Utldltlg!erLC'C:; ~ '~s i ._. jnt~ Y:irr ~. , ~ ~'..Jr ~ IC"~. ~ ~ _ _~ _~~. r '~~'1,1R1.~'~a iCl r~C~~'LrC!~, :~i)Sf' .~~Ji" . -.. ~ . , - - c, n 1 ~- i E _ erences, r _r.;c.n oy ~ _ ,~ ... . ,. `.. _ .~`)>uYf>UG"~ ti~!8i~, If t:et~U~ ~ ~_,~ _ ,t~ ._.. _ _~`i .:i Diu `.i~~..~~i~~ ~ GROUNDWATER SURCHARGE 138 V4iscor~sin .pct <1 ; O.ir~icluded 'ne ~sP~t icon c`surcharge<> (fees) `or ~ nurn-,er ~,f r<.:a~~lat.ed pra-tices which cap, effect groundwater. The monies collected througf~ ~:r sc~ ~~:~rcharges are used for monitoring groundwaf . .._ ~ ~~ir:ation. investigations and establishment of sta~~dards ~ ~ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 11, 2000 CUST ID No.227618 TOM GUSTUM N 13450 937TH ST NEW AUBURN WI 54757 RE: CONDITIONAL APPRO PLAN APPROVAL EXPIRES: / ` ~ ~„ ~~ ~ ~/f /11/200 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD Hi1DSON Wi 54016 ~. i J t_~si J ~.~ ...... SITE: ~~~.__t ,-~ ;, ~,"i ~ ~... MIKE JANCOSKI -RESIDENCE "~'-~'a'!` ~~ ~-~ ST CROIX County, Town of GL~NWOb15';I~~$~'7 ~l""~~ AVE ~ NE1/4, NE1/4, S32, T30N, R15W .,, FOR: Description: MOUND SYSTEM ~--. ~.._ Object Type: POWT System Regulated Object ID No.: 668016 Identific ''on Nu be Transaction ID o. 322480 Site ID No. 193977 Please refer'to both' identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of con struction/installation/operation. CAUTION: Wis. Stats. 145.135(2)(b)., indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus, depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otP ential for a lawsuit that may delay the effective date of the code so this status may or may not change. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. ~ d Sincerely„ ';- " ,.~..~- , ~. , ~, ~ j >~~~ L .~ Pl~ E1F E~AGEL , P~ WTS PLAN REVIEWER II Integrated Services i (608)266-2889 , M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE. STATE. W LU S DATE RECEIVED Ob/06/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: MIKE JANCOSKI ~~ ~ ~ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www. commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 11, 2000 OUST ID No.227618 TOM GUSTUM N13450 937TH ST NEW AUBURN WI 54757 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/11/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: MIKE JANCOSKI -RESIDENCE ST CROIX County, Town of GLENWOOD; 2887 130 AVE NE1/4, NE1/4, S32, T30N, R15W FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 668016 Identification Numbers Transaction ID No. 322480 Site iD No. 193977 Please refer to both identification numbers, above, in,all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Deparhnent, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. CAUTION: Wis. Stats. 145.135(2)(b)., indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus, depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otential for a lawsuit that may delay the effective date of the code so this status may or may not change. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. ,; Sincere(}, ,, ~ r'~ 1-= ~~ r,, PETER E PAGEL , POW~'S PLAN REVIEWER II Integrated Services (608)266-2889 , M - F, 0745 - 1630 HRS PEPAGEL@COMMERCE. STATE. WI.US WiSMART code: 7633 cc: MIKE JANCOSKI i .. -- c -4~I~D ~~TE~,#~E JUN - 6 2000 Residential Application INDEX AND TITLE SHEET SAFETY & BLDGS. DlV. Project .3 $edroom.;~ound Owner Mike Jar~coski r Address 2887 130th Ave Glenwood City, WI X15-2s5-also Legal Descriptiop NE NE S32 T30NR15W Township Glenwood Subdivision Name N/A Lot No. N/A Parcel ID,Number Plan Transaction Number ~ ~ Z ~( 5 C~ '~?!~.....~~0~ Index and title sheet Page 1 ~ °°•°., ® Mound calculations Page 2 THOMAS D .~ ~ Mound drawings Page 3 . GUSTUM ~ Pres. c~isX..calcs. andl~rals f~age 4 •` ~-'k 1201 TDH and pump t~rt~C drawing Page 5 ~ Plot Plan- Page 6 c•....,,,, Siphon Detail Page 7 r ~~ - . Designed Thomas Gustum License Number Signature ~ ~~~~ Phone No. Date 6/1 /2000 P.O.W.T.3. Conditionally APAROV~D D1201 715-658-1344 Notice: Tampering with this fife by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Scats. Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. County St Croix SBD-10462-E (R.05/98) Page 1 of 7 L• -- c MOUND SY~TEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design .Inch-pounds .Metric Residential or commercial? r (r or c) (y or n) C~ Replacement system? Crevlced bedrock stte? n (y or n) Slope 13 Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 15 in 38.1 cm In situ soil infiltration rate 0.5 gpd/ft2 20.4 Lpd/m2 Contour line elevation 100.0 ft 30.48 m Use standard fill depths? x OR -Design depth? Din ~cm Place X in box to use standard depths (24 and A+4 inclusive) OR specify design fill depth. Center or end manifold ~(c ore) Hole diameter Lateral spacing 4.00 ft Use 0 lateral spacing for trenches. Estimated hole space Number of .laterals 4 Pump tank elevation Forcemain length - ft Forcemain diameter 0.25 1 n 0.125, 0.156, 0.188, 0.219, 0.25, I 0.281, or 0.313 inch only. 2,50 ft Not a final calculation. -105 ft Outside bottom of tank. 3:0 In 1.5, 2, 3 or 4 inch onty. 3.068 in Actuall.D. SYSTEM SOLUTIONS Inch- ounds Metric Estimated daily flow 450 gpd 1703 Lpd Absorption ~e~tl Design load rate 1~ area 1.2 gpd/frz 375.0 ft2 34.84 m2 Linear loading rate (LLR) 7.14. gpd/ft 88.5 Lpd/m Design width (A) `6.OD ft 1:83 m Cell length (B} `fi3:fl 19:x° Depth of cell {F) 30:D in 25.4 cm meter Upslope fill depth (l3} 21.0 in 53.3 cm Downslope fill depth. (E) 30,4 in 77..2 cm Basal area required (gpd/infiltration rate) 900.0 ft2 83.61 m2 Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 13.43 ft 4.09 m Up slope toe length (J) 7.70 ft 2.35 m Down slope toe length (I) 21.50 ft 6.55 m Total mound length (L) 89:86 ft 27:39 m Total mound wid#h (W) 35.20 ft 10.73 m ~_ Transaction Number: HOLE DIAMETER CONVERSIONS 1 /8 = 0.125 1 /4 = 0.250 5/32 = 0.156 9/32 = 0.281 3/16=0.188 5/16=0.313 7/32 = 0.219 Page 2 of 7 ~. • - ~ t -JVIQI~Q PL-A~[ ~[tEYll 35.2 .ft 10.73 m W I =down slope dimension ~ =absorption cell (AxB) J = up slope dimension ~ =plowed area (LxW) K =end slope dimension MQUI~ ~&~S=SE£~tON- ~ ~ lateral topsoil G H subsoil cap invert 102.25 ft _ _ ~L -- ...._ .............. T elev. 31.17 m _ F D ASTM C33 Sand Fill E sys. 101.75 ft elev. 31.01 m 100..00 ft contour 30:48 m elev. -.~ --ape fID.depth 1~y~' E = downslope_fill depth F = absorption cell depth G = seb~11 + topsoil-depth at cell wall H =subsoil + top~-depth at celFoenter observation pipes (h~Pi~) 13 °10 ~~ slope A = 6.00 ft 1.83 m B = 63.0 ft 19.20 m J= 7.70ft 2.35m I = 21.50 ft 6.55 m K = 13.43 ft 4.09 m typ. obs. pipe (anchored securely) -8•, (152 mm) D = ~ 21. n 53.3 cm E = 30.4 in 77.2 cm F = 10.0 in 25.4 cm G = 12.0 in 30.5 cm H = 18.0 in 45.7 cm Note: Absorption cell media will consist of aggregate and pipe with laterals centered across AxB media. The cell media is covered with geotextile fabric. tlEt llflt#~,4: f ~ _ up.top.lay~er Project: 3 B - Transaction Number: Page 3 of 7 ~ _ 89.86 ft 27.39 m ~- Absorption-cell Inch- oLnds etric .Width (A) 6 " : fit 1.83 m Length {B) &3A ft 19.2 m Lateral speci#ications - Number laterals 4 Holesllateral 12 holes Lateral length (P) 29.71 ft 9.06 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 13.98 gpm 0.88 Us Sys. dis. rate 55.92 gpm 3.53 Us Hole spacing (X) 31 in -78.7 cm Lateral diameter Designer must '~C" one choice from the options provided. IlAanifold diameter Designer must '7C" one choice from the options provided. Pipe diameter Design options Delsian choice 1 in-(25 mm) 1 1!4 in (32 mm) X 1 1!2 in (40 mm) X 2 in (50 mm) X X 3 in (75 mm) X Plpe darrlet6r Design options Design choice 1 in (25 mm) 1 1/4 in (32 mm) 1 1/2 in (40snm) lE 2 in (50-mm) X X 3 in (75 mm) X 4 in (100 mm) x Place X in red box of chosen lameter. Place X in red box of chosen diameter Distribution system contains: 4 Lateral(s) LATERAL DIAGRAM -CENTER CO NECTION Place correct lateral diagram by clicking in one of the drawings at right and draggin the diagram into this area. Force main connection Via tee or cross to manifold at any point. Laterals are identical typical ~e P IEX-~IExt2 I x231 Laterals~Force Last hole drilled next to end cap [per COMAA T Holes drilled on the bottom of the lateral, ~ .permanent end m: equally spaced Inch- ounds Lateral length (P) 29.71 ft Lateral spacing (S) 4,00 ft Hole spacing (X) 31 in Manifold length 4.00 ft Hole diameter -0.250 in Lateral. diameter 2.Ot1 in Forcemain diameter 3a30 in ~ _ ~~_ Transaction Number: er~d cap S ~~ -~ i aF PVC Sch 40 84.30-5) 9.06 m 1.22 m 78.7 cm 1.22 m 6.4 mm 50 mm 75 mm 4 of 7 .. y o <~ 7 t J 11.E ~Of1t0Uf ~ C ~ QCJ C L ~ O ~ U N v N o a> ~ a~ ~ ~ N Q 3 ~ ~ ~ o - _ W ~ ~ ~ a ~ o $y s ~ ~ a ad g~ ~~ ~U ~ W o :~ ~ a i 'g C7 Z ~ ` o o `o ~e ~ ~W - ~ ~2NC7H2 ` a N ~ .U fl. '3 V ~ CL ~ ~ S = o ~ v> o ~ ~ ~ ~ cn ~ a a~ ci ~ o O U w p 0 ~J _ ~ N X ~ W ~ W Q ~ ~ m _ ~ O ~- ~ C~ ~ O _ z o o O ~ ~ ~~ ~ o 0 0 0 o II m w J > w 2 w_ O Cn w W U (n II II II N ~ Z m m CD ~-~ i 7 CC1 ~~ <: ~ ~-~ Pa e;~pf _ .• ~ SIPHON CHAMBER CROSS SECTION AND SPECIFI TIONS .~ APPROVED LOCKING 4" C•I• VENT Plpg MANHOLE OVER „ WITH APQROVED,CAP - 12 MIN. 2S' MIN. FROM DOOR. WINDOW OR FRESH AIR ' INTAK 4" MIN. 18" MIN. ;~ :.• APPROVED JOINTS /o6.y SPECIFICATIONS TANK INNUFACTURER: • c ~ TANK SIZE (GALLONS); o SIPHON SIZE (DISCHARGE DIA.): 3 " DOSE VOIUME (GALLONS: 7 k _ FORCE MAIN DI ~~ ~ 2 ~~"~' AMETER (INCHESj: 3 FORCE MAIN LENGTH (FEETj: s~j " ELEVATION OIFFERENCE.FROM SIPHON INVERT TO DISTRIBUTION PIPE FRICTION LOSS IN FORCE MAIN (FEET ; S (FEET): y /S' ) SIGNED: LICENSE NUMBER: /20/ DATE: 6/~~ao~ ~~ FROM . r ~" --i t !, r ~~ ~. , . ~, . ~` R ~: .~ .1 ~' C; ~, h 3 ~~ ~~ ~~ ~ ~~ w `f-, ~~, ~,. ~J l ~ ti_ (,1 ~ U f~ ~ ~ U 1 L~ U~ r T_ r• n -a _..a = ~. ~ ~M~ o~ ""' ~ p z ~°.: T~ z {P YES L I~F'~... [„ 1'I~P 1 i ~+Ql p L ~ I ~ H ~ ~ O ~ 6 N I~ s r ~ s~ "-''~ r > ~" ~ -~' ~. a~a~ ~^ M p n,n~ ~ N ~ P ~ -i 1" ~ r Z -- - C I ~ s 4'1. ~s, -~- y V ~ - 7...- -- R ~ Y O O U T n n .~ s ` ~dT C , K'' C, V _ ~~ '~ ~ • h ~ ~ 'i ('` M +~ ~ ~ ~ 7 " i~ w ~ s G1 +t P+ d C+ ~ A Y > a~ ^ r- ~ ~ a ~ 1'1 v p~ <~ w ~ -~ ~ ~ ~ (~ ~ C' y ~ U 9 ~ q a. y. M r U ~~ ~ ( ~ ~ ''' ~ w A p i.. i ~ , ` '•'~` ` ti ~ Q't s ~ ~ ~ L' ~ { a 0~ u~ 9 ~ \ • ~ K ~ ~ C ~ ~~ ~ ~ t1 ~ Y ~ 1~x poo ~. ~~~. Y ~ ~ ~ }7 v ~L'GP ~~~~ ~~ ~~~~ { '-1 0 ~ ~ ~ ~ _,1.... ~, ~'~`~ ~. BW GV~ ~~ ~. m ~~ r. ~, y-r~ ~G1~ ~1 ., ~=-i , .__. ~_ . (.~ ~ ~a ° _~ ,~ `r' PM ~ ~ . ~ r ,~ g , w i w ~ .. To _~ D -! y ~- ~~ b ~ n ~ n ~ o D n ~ ~= l ~ ` { ? (~ D V c ~ n• y V ~ L c~ .r ` O ~ ^ ~ ~1 ~ ~ ~ A > ~ ~ `~ ~~ l- ~~ ~ o c ~ ~ ~~, ~, .; `~ J Wisconsin Department of Commerce SOIL AND SITE EVALU~ION, ~^ Div~iori6fSafetyandBuildings in accord with Comm 83.05~11~f~gm. C~ Attach complete site plan on paper not less than 8'/s x 11 inches in size. Plan must ,^, \ .- include, but not limited to: vertical and horizontal reference point (BM), direction a C percent slope, scale or dimemsions, north arrow, and location and distance to n rest road. REC+~-\J `~ Page 1 of 3 Gustum Septic Service APPLICANT INFORMATION - Please print all information. ~ `~ Personal information you provide may be used for secondary purposes (Privacy Law, s. , ---yt 5,tL41(1) (m) ~, ~ ~ 7 i Date Z ~ O Property Owner P Location 5 UVN G ~~~ / t" G GE /` 1/ S 32 T 30 1 R 15 W N Jancoski, Mike ~ n a o 9 ~ , Property Owner's Mailing Address ~~ ;~ Su Lot # ~ am or CSM# 910 1st. Stre Traile et r #35 ~ n/a a ~ ~+ ,: .'~_ N/A _ _ _ __ _ ___ City State Zip Code PhoneNumber _ _ _ _ ~ City Town Nearest Road Emerald WI 54012 715-265-4990 Glenwood ~ 130Th Ave. New Construction ~ Residential / Number of bedrooms 3 ^Additio to existing building Use: Replacement [~ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ftz •6 trench, gpolftz Absorption area required 900 bed, ftz 750 trench, ttz Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpolttz Recommended infiltration surface elevation(s) 100,0' ft (as referred to site plan benchmark) Additional design /site considerations site address is 2887 130th Ave. Part of 40 acres Parent material loess FI lain elevation, if a liable n~a ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Gra a System in Fill Holding Tank U=Unsuitable for system ^ S ®u ^ S ^ U ^ S ^ u ^ S u ^ S ~ u ^ s ® u SOIL DESCRIPTION REPORT ~ Boring# 1 Ground elev 100.0' ft Depth to limiting factor 15" - ~ ~ lI 2 Ground elev 96.8' ft Depth to limiting factor 15" - -~ + ro H ri Depth Dominant Color Mottles T t Structure Co sisten Bounda Roots GPDItI? zon o in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed i Trench 1 0-4 . 10yr2/2 none sil 2mcr mvfr as 3f, lm 0.5 0.6 2 4-7 - 10yr3/2 none sil 2msbk mvfr cw lf,2m 0.5 ~ 0.6 3 7-11 • 10yr4/4 none sil 2msbk mvfr cw lm,lcc 0.5 0.6 4 11-15 ' 10yr4/4 none gr. sii 2msbk mfr cw lm 0.5 0.6 5 15-26 ' 10 r4/6 Y c2-3 10 /2 7.~yr5/g gr. scl 2msbk mfr - - 0.4 i 0.5 Remarks: 1 0-5. 10yr2/2 none sil 2mcr mvfr as 3f, lm 0.5 0.6 2 5-11 • 10yr3/2 none sil 2msbk mvfr cw lf,2m 0.5 0.6 i 3 ` 11-15 • 10yr4/4 none sil 2msbk mvfr cw lm 0.5 0.6 ~ 4 ` 15-26 10yr4/6 y~ 4c27 55/8 /2 sil 2msbk mfr cw lm 0.5 0.6 5 26-35• 7.5 4/6 Yt' m2-3p10vr6/2 7. yrSS/8 scl ~'• 2msbk mfr - - 0.4 ~ 0.5 Remarks: CST Name (Please Print) Signature`.' Tom Gustum Address Gustum Septic Service N13450 937th St., New Auburn, WI 54757 Date 6/1/I Telephone No. 715-658-1344 CST Number 227618 Ref # 1242 PROPERTY OWNER: ]ancoski,Mike SOIL DESCRIPTION REPORT PARCEL LD.# Ground elev 100.0' ft Depth to limiting factor 16' ~~' -1 ~2a2 Page 2 of 3 Gustum Sevtic Seryic~ _ H i Depth lJorrunant Color Mottles xture T Structure nsistence Bounda Roots GPDI!l? or zon in. Munsell Qu. Sz. Cont. Color e Gr. Sz. Sh. ry Bed ~ Trench 1 0-5 ~ 10yr2/2 none sil 2mcr mvfr as 3f, 1 m 0.5 0.6 2 5-8 10yr3/3 none sil 2msbk mvfr cw lf,2m 0.5 0.6 ~ 3 8-12 • 10yr4/4 none sil 2msbk mvfr cw lm 0.5 j 0.6 ~ 4 12-16- 10yr4/6 none sil 2msbk mfr cw - 0.5 0.6 ~ 5 16-25~ 10yr4/6 c2-3p10yr6/2 7.Syr5/8 sil 2msbk mfr - - 0.5 ~ 0.6 Remarks: _, Ground -- -- -~ elev Depth to ----- ------- -- -- ~ limiting factor Remarks: Ground elev Depth to limiting factor 1 li I ~ ~- Remarks: Ground --- - -- __ - - ---- elev Depth to limiting -- --- - ------ - --- - faetor I m ~ ~> I ~ i ~ • c c-> 0 0 m ~J / ~ U/~ • S o o _ g ~ ~ m ~ ~ 6J Ln I'~ ~ Ilz S N _ o K C II II II cn r-.-~ m cn c7 O m rn ~ ~- '_ ~ II ~ 0 0 0 0 ~ ~~2M~JQ 6U1}51X3 ,~ Cn ~ o `~ z ~ ~ C ~ ~ cn o ~~ I I 3 c~ ~ > ~ ~ = O ~ N ~ ~ ~ O Q Q T O ~l ~~ ~ ~ m CD ~ ~ < S ~ o Q Om O O _. ~ .-. " n ~ O n W O .-~ S ~ (D a m a ~ m Cn o ~_ ~ O r-. O ~ D c N TJ C~ ~_ ~ ~ m ~ w ~, ~ 0 ono}uo~ ,0'lOl crl ° _ W ~ W c _ ~ ~ -D ~ N o0 C~J o~ O C ~ ~' ~ ~ N 3 N ~ n mg~m 3 V ~. w g, °-, Q ~`+ z~q` m b' ? o ~3~ ~ y n o ~ m ~ ~_ N ~ W ~ O _ Z D ~ ~.. > ~ ~Y K ST CROIX COUNTY SEPTIC TANK MAINTENANCE A~ AND OWNERSHIP CERTIFICATION OwnerBuyer Mailing Address Property Address ~~~ (Verification required from Planning Department for new City/State ~-''~'^ ) Parcel Identification Number LEGAL DESCRIPTION Property Location L %4, ~ %4, Sec.~~, T3c~ N-R1~W, Subdivision Certified Survey Map # _ ~ S ~~ ~- ,Volume Warranty Deed # ~y~r / ~~`~ ,Volume ~ r~ Spec house ^ yes ~ no Lot lines identifiable 3z. 30, ~S y~~9G4 of Lot # ~~ Page # Page # C ~C- yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature ailure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a lice ed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal syst m. The property owner agrees to submit to St. Croix Zoning Department a certifi tion form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying t (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the privy set forth, herein, as set by the Department of Commerce and the Department of Natural stating that your septic system has been maintained must be completed and returned to t days of the three year expiration date. SIGNATURE O PLICANT OWNER- CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) the property described above, by virtue of a warranty deed recorded in Register of De ~~~ SIGNATURE O PPLICANT ****** Any information that is mis-represented may result in the sanitary permit being sewage disposal system with the standards esources, State of Wisconsin. Certification St. Croix County Zoning Office within 30 /L3/ •-~ DATE iowledge. I (we) am (are) the owner(s) of s Office. b /Z3~~ DATE evoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds ffice a copy of the certified survey map if reference is ma a in the warranty deed ' S,~Ei•~.0;~ ST~iTC °:`.2 OF WISCONSIN FORM 1 - 1932 ~,, R ii'ARRAN'I'Y DEED ,_, _ _ , DOCUMENT r'O ~ ~ ~ t ~ ~~(~ ~~ -_ ~__, r a._ I'R lJ ---_-- ~: _ ii i Thls Deed, made oetwcen .- ARTHUR""_R"JANCOSIrI -- , . _ and "DORIS M J;,NCOSKI~_husband and ,wife, ~! as_ 'oin tenants,---- ;, _ -1-- -~-- - - - --- --- -- and MTC`HAFT -' - - . Grantor~!I ' ~ .I~I.CO.SKL~_3n_ t m a r r le_d_mr3 I1...S2~ ._ - ' --_ le gales 3 et--- - - ----- - - - ~ I -_ ;~ --- - - - FiC~iJ CR~CriY.~_ . ^_ Ii sT c oix cn, ~~~~ R '. hr aatx^7 JUN 2 8 !996 8t 2:45 , P.M I ;i Reg star of t}ea s ~~ -- ____ -------------- .Grantee. 'I: i Witnesseth, That the ;aid Grantor., for a valuable consideration ~~ TNiS SPnCE RE ERVEO FOR RECORDING DATA _ ! -`--- -"-- ------------------ NAME AND PETURN ADDRESS conveys to Grantee the following described real estate in _ St. Croix Thomas O. ulllQdn County, State of Wisconsin: P . 0 . BOX 4 5 7 Lut One (1) of Certified Survey N,ap, Spooner, I 54801 i Document Number 545532, recorded in Volume 11, page 3115, on the 18th day of June, 1996, in the office of the Register -- ---_ __---_ ________ _ _ _' of Ueeds, St. Croix Coun}y, Wisconsin. (Parcel (SEAL) This ~~ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except zoning ordinances, building codes and easements of reco d, if any. and will warrant and defend three sarrle. Dated this ----- °?.~+-~--•-------- daY of ~ J ,~~ 96 -1~~~f~17R R.dy~~ ~~ ~ul ~ J ~ R R • ~T---_ (SEAL) i (SEAL) _ , AUTHENTICATION Signature(s) authenticated this day of lion Number) (SEAL) ACKNOWLE GMENT STATE OF WISCONSIN t s<. Z`''A~t't ~"''"1' County. 19- Personally came before me this o2 g~ day of ` J u,c , 19,.6_ the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ authorized by §706.06, Wis. Slats.) THIS INSTRUMENT WA ~ DRAFTED BY -Thomas _O_ Mulligan, attorney at law P.O. Box 457; Spooner, WI -54801 r ------- -- --------- s may be authenticated or acknowledged. Both are not to me known to be the persons _~~,who executed the fore ((ma~yy instrument/a'~~,d knowled6e tjle'~sar~, M -~-%~-~- Notary Public ~.+ i - L • ~• ~ ~ CoWt~y}W1s. My commission is permanent. (I['4Pt;•,Rta~ ~x~ir,tViptr~date: !1 ,---~ ,, f~: ~~. ~.~ a 545532 CERTIFIED SURVEY MAP BE !NG THE NE I i4 OF THE NE I i4 OF SECT ION 32, T30N, R ISW, TOWN OF GL ENWt)OID, ST. CRO 1 X CO. , W I. PREPARED FOR: ARTHUR JANCOSKI 11LQIE: BEARINGS ARE REFERENCED TO THE NORTH L 1 NE OF THE NE 1 i4. (ASSUHRED BEARING) N /i4 CORNER OF SECT ION 32. (1 " IRON PIPE FOUND ). w °o_ N 90° 00-'-00-` .UNPLATTED LANDS ........................... NORTH LINE OF THE NE1~4 t ~P.TN. A.1!~~ 312. O1' ~ N 89 ° 46' 20" W w g ~' ro * SEE NOTE cn w ~ N ~D 1\ I NE CORNER OF -SECT / ON 32 (SPIKE F~FROM TIES) 33= 1322. B ..11L~0° ' E _~ 10...9,2_ r-'1^ w ! ' 66' WIDE PRIVATE DRIVEWAY EASEA~NT 2 :~ :z :n 'ran v :z aN 66. 00' ~ 844. 92' 1289. 83' w 3T8. 91' 33'~ ` I , ~ HoUSf g ~ O N ~ HOUSE ~ ~ 1 s oo° 24' 40" E~ ~ ~ w LOT 4 ~I~ ~' /-445.28' 10.00 ACRES ~' ~ °f ~ ~ ~ I K 435, 622 SD. FT.) ~ (25T, 5070 SOEFT. ) 8.62 AC. EXC. EASEMENTS ~ 4.31 AC. EXC. R I (375, 472 SO. FT. ) • (18T, 609 S0. FT~ N 90° 00' 00" E 9 10. T3' S 89°46'2O'E 66. 00' ' 844. T3' 4 ! 1. 96' APPROX. L OC.~ y 378.96' 1 EXISTING DRIVE $ ~ 33.00 .~ 0 w_ .ro 0 O MOB 1 L E HOA~E ~ ~'~~® F3 JUN 1 8 1996 ~- KATHLEEN H. WALSH Register of Deeds L~ sl. crow co., wl ~ wN o~LOT 3 ~~ ~;, o °- I O. 00 ACRES ~ ~ o (435, 449 S0. FT; I 4t 9.39 AC. EXC. Ri~V ( 408, 937 S0. FT. II ) LOT 2 15.44 ACRES ( 672, 688 S0. FT. ) 598. 4l' NOTE : APPROVAL OF LOT 3 DOES NOT CONSTITUTE APPROVAL OF A BUILDING S ! TE. (I HL 83. 03 ) Cn~~ --__.W S 00°23' 30' "~ 690.98' N B9°56' 36"W 1322.39' T23.98' ,UNPLATTED„LANDS O = SET I' X 24" IRON PIPE WEIGHING 1. I3L BS PER LINEAR FOOT. ~grE: HIGHWAY SETBACKS ARE ~ 3.3~ Faniu anon /`FNTFOI iNCa :y ~,~'~OVED w co Z ~uN t a ~~ I :r ;~y1' . CROIX COUNTY Ci~prvhw~sive Platufi- :~ Zoning and. a arks Committee :z ;N if not racordod witfiin 30 days of approval dates approval shaft be nth & void 33. 00={-~ ~ I wI I E !i4 CORNER OF N° w ~ SECTION 32. w !" (COUNTY M~ONUA£NT w ~ FOUND ). o. m ,N~1tIraNNq ~~~~~G DNS y~~'; ~ ~ ~ • JAMES M. ~ 3 .... J.H.LARSON COMPANY ~~ ~ ~ ~ ~G iJ~~ ~~ze-) ~-=~~ ~ ~e~. ~~ ~'rt ,~ _ C/, _~ .... C~ ~7 C.~r T. CrF Q~ ~'L~4i~y r ~~ -~ / '.. S 0 ~ i ''T.° ~' / ~~~~ ' ~ ~~ ~~~ terra ,~ c:?~ r 4'~ l~. ~' ~~ STONCO crescent