HomeMy WebLinkAbout010-1082-60-200
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Form- S T C 104
AS BUILT SANITARY SYSTEM REPORT
<MAS TOWNSHIP iti 684/d SEC. T10 N-RW
OWNER
ADDRESS ST. CROIX COUNTY, WISCONSIN
1 e-,y zoo
SUBDIVISION LOT LOT SIZE 470 ft !i
PLAN VIEW
Distances and dimensions to meet requirements of I.IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
tfi~. A- fr
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a
\ 3 y8AM
HOOS6 N-4
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\ \ 77
Ai ejt
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INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used gL+lyDM UFCogmefi I:O;A
Elevation of vertical reference point : le o r Proposed slope at site: ,Llt~
i:;do aid Roaxe
SEPTIC TANK: Manufacturer: L✓e_e k S Liquid Capacity: /VG t v tW±Zl eZ%
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,Q Side ,O Rear, O 13a feet
From nearest property line Front 10 Side 10Rear, v 13 feet
Number of feet from: well 221, building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity: Lj dO SAL
Pump Model: Pump/Siphon Manufacturer: Zp c~ L!~ Pump Size I3 V
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: S_J'` Aeat~1y Alarm Switch Type: M e-6&i4 X
Number of feet from nearest property line: Front, Side, ORear,4 Ft.i
Number of feet from well: / 7 4
Number of feet from building:_
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed:_ Trench:
Width: Length: Number of Lines 3 Area Built:-75-2-
Fill depth to top of pipe:p
Number of feet from nearest property line: Front, 0 Side, O Rear, Opt . 1W
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE P
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built;
Has either a drop box O o istribution boxO been u on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: ^levatio of bottom of tank:
Elevation of inlet:
Number of feet fro earest property line: Fr t, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated.: Plumber on job:
License Number: Le
3/84:mj
r
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
.MADISON, WI 53707
Nt-&, 1~1rtJ'~,,,S34,T30N-R16W ❑CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
Town of Emerald O Holding Tank ❑ In-Ground Pressure MWound 0093
130th Avenue Zq/I
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER* INSPECTION DATE:
Thaimas Wink 4 1-130th Avenue, Glenwood City, Ta 540 3
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Gale Smith 5690 St. Croix 119507
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO
BEDDING: VENT CIA,: VENT MATL: HIGH WATER NUMBER OF ROAD: 1PINE ROPERTY WELL: BUILDING VENT TO FRESH
ALARM. FEET FROM: AIR INLET:
OYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER. 7ING LI QUID CAPACITYPUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
PROVIDEDPROVIDEDS ONO DYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING. VENTTOFRESH
(DIFFERENCE BETWEEN FEET FRLINE AIR INLET:
PUMP ON AND OFF) DYES ONO INEAREST)M
IL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F'v/, T H DIAMETER MATERIAL AND MARKING
SO
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH : LENGTH NO OF IDISTR PIPE SPACING. COVER INSIUE DIA. #PITS LIQUID
TRENCHES: MATERIAL'. r PIT DEPTH:
DIMENSIONS 9 1? dl I GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: !N sTR. NUMBER OF PR op: WELL. BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER. ELEV. INLET ELEV. END. SFEET FROM LINE: AIR INLET:
I I NEAREST------s-1
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
D meets the criteria for medium sand. TIONS MEASURED.
YES ONO
SOIL COVER TEXTURE IPERMANENT ~-NTMARKERS OBSERVTION WELLS.
DYES ONO 2<E S ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED.
CENTER EDGES:
DYES L/JNO DYES O DYES
NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.. DIA.: ELEV.. PIPES: DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ONO COVER M DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES NO NEAREST
a3, o(P 7 ? ~ 3 y3
Ia
Sketch System on Retain in county file for audit.
Reverse Side.
777 TITLE.
Zoning Administrator
DILHRSBD6710(R.01/82)
SANITARY PERMIT APPLICATION COUNTY
70IL.HR 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 9c~ v
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
C f t/a k!%,Sj~ T9a-,N,R )W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
r// X1,C
o ZIP CODE PHONE NUMBER SUBDIVISION NAME ORE OR C ER
CI, STATE
11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
❑ State Owned VILLAGE •.C/~E ~~Lt~
❑ Public 01 or 2 Fam. Dwelling4 of bedrooms lL PARCELTAXNUMBI
III. BUILDING USE: (If building type is public, check all that apply) x
-Cr. e JC'_ CMG _/C~ -~C
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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) 1.0 New 2. ® Replacement 3. ❑ Replacement of 4. ❑ 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
11 ❑ Seepage Bed 21 X Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
G 1REQUIRED ~7(sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
t E / 6~z - q,'Fl Feet ,42... Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or c
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
G C / 7'
IX. COUNTY/DEPA TMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Is 'ng Agent Signature (No Stamps)
Approved El owner Given initial Surcharge Fee)
Adverse rmin tin 7 q,5' _g91 yzo_~h_
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-MS (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'f 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
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 inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor.,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property ~fIGlC'l/~ S7
Location of Property ---(~c• ~'L, Section ~1 T 3a N - R 1 W
Township - G
Mailing Address r Ale f t, E=
Subdivision Name
Lot Number
Previous Owner of Property .
_
Total Size of Parcel r l' A& A CH,
Date Parcel was Created / 9 SD
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes_ No
Volume and Page Number 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) ce&ti. y that aU .6xatements on th.id 4o&m ate ttcue to the best o~ my (out)
knowledge; that I (we) am (ate) the owneA (.5) o4 the pna peaty de d cAibed in thi.6
tin4onxna by vixtu.e o6 a wattanty deed neconded in the 06 6.i,ce o ~ the
~,i.on ~anm, )
County RegiAten oA Deedb as Document No. ra ' O and that I (we
pne s entt y own the pto pob ed site A o& the b ew g P0.6 yh tem (ox I (we) have
obtained an ea.aement, to nun with the above dactt-i.bed ptopexty, 4ot the
conistttuction o6 said 6ybtem, and the .same has been duty ltecolt.ded in the Oj6ice
) .
ob the County Regiztett o~ Deeds, a-5 Document No. 17 Al
SIGNATURE ~FCO-OWNER (IF APPLICABLE)
SIGNATURE OF OWNER
DATE SIG ED DATE SIGNED
f~
I! FORM 339-WARRANTY DEED-TO JOINT TENANTS. (Section 230.45 Wisconsin Statutes M. C Mwl M we, re.
vo►.
4 Fa~F194
56
4 6
ThisIndenture, Made this........ -day of-- - A. D., 19.77
between.. _-..Merril Wink and Lucille Wink, of St. Croix County, Wisconsin
' ies
I - . - . part.--..._.... of the first part
and._......-.Thomas E. Wink and Judy M. Wink, husband and wife, of St. Croix
- - -
County, Wisconsin, as joint tenants, parties of the second part.
I Witnesseth, That the said part....-1eS...of the first part, for and in consideration of the sum of
I'•
One and 00/100 ($1.00) Dollars
- - - - - -
_d--------- _ - ?tar-°d-~rrd-°errriixable cart
- - -
them in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and
it
1
acknowledged, ha...Ve_..given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by iii
these presents do.. .......-give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of
the aecrmd-part, in joint tenancy, their heirs and assigns forever, the following described real estate, situated in the
our o{ ~I.. Croix ....and State of Wisconsin, to-wit:
nNor' west Quarter o the Northwest Quarter (NW 1/4 of NW 1/4)
in Section 34, Township 30 North, Range 16 West.
I'
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FEB
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I{ Together, with all and singular the hereditaments and appurtenances thereunto belonging or in any wise jl
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appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part .-ies_of the first
part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their
I
hereditaments and appurtenances.
it
To have and to hold the said premises. as above described ith the hereditaments and appurtenances, unto
the said parties of the second part, in joint tenancy, and not as tenants in common, and to their respective heirs and
assigns FOREVER.
I;
Vol 564 ;1rl `XfJ
And the said..-....... Merril Wink and Lucille Wink, husband and wife,
I
for......... their -------_-.-.-,-__--------------_.........heirs, executors and administrators, do............covenant, grant, bargain and
agree to and with the said parties of the second part, and their respective heirs and assigns, that at the time of the
ensealing and delivery of these presents.._-tj'ley---are...... well seized of the premises above described, as of a good,
sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and
clear from all incumbrances whatever,-.except.-such---encumbrances.--as may--havebeen_ placed..-
against said premises by second parties, this deed being given in
.
partial release of the lands described in that certain land contract
datiE Td" ebrizary -"•18-f----1-9.72---and ...f il-ea--ih---Book._.4.8-3 F Page....M';----------------------------
and that the above bargained premises in the quiet and peaceable possession of the said parties of the second part,
as joint tenants, and their respective heirs and assigns, against all and every person or persons lawfully claiming the
they
I whole or any part thereof Will forever WARRANT AND DEFEND.
In Witness Whereof, the said parties.-of the first part ha---ve---- hereunto set__..---- hei-r-............. hand_._s
and seal_S..this...... $th
day of----- NQvember - - - A. D., 19...7.7...
!
• \ (SEAL)
SIGNED AND SEALED IN PRESENCE OF Merril rik
i
(SEAL)
Lucille Wink
on M tink
- -------SEAL)
Shleda Thom on - - ---------------(SEAL)
STATE OF WISCONSIN,
3T . CROIX
- ..County SS.
.
i
II Personally came before me, this 8th - - - day of_... Ngve}nbex A. D., 19.. 7..,
the above named ,1">erril Wink and Lucille Wink, husband and wife,
- -
to, me k~jgavalZ,kp be-.the person .S. who executed the foregoing in rume n ac wledged the sa
TH~S T~ U4JEIn DRAFTED BY :
Gryl. .
on M. Merit'
• Own & Smith ST•CRUIX
Notary Public _..__.___County, Wis.
~ rn Bank Building
3St,t,pfnnesota 55101 November iS
• My Commission expires--------------------------------_.._...----...A. D., 19-79
Or WAS
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STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER' 7&e-m 14 S` 41LL
zyrr
ROUTE/BOX NUMBER 1-Ye i5/ fl L FIRE NO. ~
CITY/STATE ~~ENc~ .~G /7`y Lvj ZIP
PROPERTY LOCATION: A~L_114 N /C 1/4, Section TAN, RAW,
Town of E1V ER ! L cpe St. Croix County,
Subdivision , Lot No.
Improper use and maintenance of your septic system could result in its premature
failure to handle wastes. Proper maintenance consists of pumping out the septic
tank every three years or sooner, if needed,- by a LICENSED SEPTIC TANK PUMPER.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, journeyman plumber,
restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGNED r_i'ry r~: C'. 'f lJ
DATE
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
-40093
5-i C Wo.1 e,, S89
D,q+ IV N g,
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,olq L Sy st-~IV# r=.4 e 99, 9/
otw)
x A/a'f~ ; -2/''o f' SA No( Rey a d
y ~d~ R S-Y .rr-c
>
i
1 r
~r
a
lZi
ONS! T E SEWAGE SYSTEM
c~ / l conailionally
a APPR- OVELD
DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
/ b DIVIS{ON 0 AND BUILDING
SEE CORRESPONDENCE
O / I
10.4 a7`- l''~~N
;,PY
a Page - Of
.
Straw, Marsh Hay, Or 589_40093
Synthetic Covering
Distribution Pipe
Medium Sand
G
Topsoil F
D
ON SITE SEWAGE SYI/fE§AOpe Force Main Plowed
Bed Of ZM- 2 %2
l~'°o From Pump Layer
(f od,&.q It Aggregate
r ms's D 1,z
DEPARTMENT OF INDUSTRY, LABOR AND IiUMAarfWtAT18N3; tion Of A Mound System Using F
DIVISION OF SAFET~. AND BUILDINGS A Bed For The Absorption Area
SEE "PONDENCE 2~" A - Ft. H
Signed: r`~_- L~" , "Z' = " I
B Ft.
i
License Number: N '--5Y Ft o,
Date: O let. Ft.~
KF0"'
Alternate Position L -Ft.t,'4,?-A
of Ft z 4.3
Force Main W .
I
Observation Pipe--,\
-
A
i Force Main
From Pump
.
Distribution Bed Of 2 - 2 2
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
;~G?cfly
Page _ Of
S89-40093
GNSITE SEWAGE SYSTEM 0 0 & ht
a
Perforated Pipe Detail FAPP1 ~ J
DEPARTMENT OF INDUSTt~y
(VISION OF SAFELY OR AND Kl1MAN RELA TIONS
ND BUILDINGS
End View SEE CORRESPONF, t
~Perforoled EWE
End Cap) \e y~ PVC Pipe
I . roe cue
Holes Located On Bottom,
ll' S Are Equally Spaced
p
'x\S
PVC Force Main
From Pump
.7
/P PVC
Manifold Pipe
Distributi Alternate Position Of
on
Pipe Force Main From Pump
Last Hole Should Be
Next To End Gap
End Cop Distribution Pipe Layout P
R
S
X C C/ rN FRc►
Hole Diameter Inch
Signed: l CCU ~,J.~ ~i.
Lateral Inch(es)
License Number: Manifold _ Inches
Date: r Force Main Inches
} 'L l..k F7l 1 . ~ 7 h i. v M i •-1 . Is'i I'•,• ~,~r::'t-i
% t, LeH'~.
L.Y t-
L•'
SEPTIC TANK & _PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHER 09 + 4 0 0 9 3
25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
FINISHED GRADE 4" CI RISER W/ PADLOCK &
6" MIN. ~-WARNING LABEL
ABOVE GRADE - 4--4" MIN.
18 IN. 6" MAX.
INLET
WATER TIGHT SEALS L GAS-
TIGHT
411 BAFFLE A SEAL APPROVED
CI PIPE -i , ALM JOINTS W/ CI
3' ONTO B i PIPE 3' ONTO
SOLID
ON SOLID SOIL
SOIL ON I E SEWAGE SYSTEM C
PUMP F ELEV. FT. OFF 'Q RISER EXIT
(1'O~d•1jt,63R~~ D PERMITTED ONLY
IF TANK
' MANUFACTURER
J 2' v. .adF k•.
A;AAD BEDDING UNDER TANK HAS APPROVAL
DEPART.IMENT OF lNDJSTi Y, LABOR AND HUMAN RELATIONS CONCRETE PAD f
CiVlslGPJ OF "LAHET AND BUILDINGS SPECIFICATIONS
SEPTIC / WSWR€S^i'Dh'CFN£E 22~
TANK MANUFACTURER: & NUMBER DOSES PER DAY
3 •St .n•.,
TANK SIZES: SEPTIC /Ce¢ GEC' GAL. DOSE VOLUME INCLUDING
DOSE GAL. FLOWBACK:GAL.
ALARM MANUFACTURER: ~,7-P 1,~? CAPACITIES: A = 3 ' . INCHES = GAL.
MODEL NUMBER: _/6 / /f t,
SWITCH TYPE: )yf' R~ ~;~At✓ B = 2 INCHES = GAL.
PUMP MANUFACTURER: Zc f /,~~7R~ C = /,jam INCHES = -kGAL.
MODEL NUMBER :
SWITCH TYPE: 1_3-DF0 D = INCHES = ~_GAL.
N►r RoT xy
REQUIRED DISCHARGE RATE 67 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET
+ __3. ~j FEET FORCEMAIN X J ^FT/100 FT. FRICTION FACTOR S-IFEET
TOTAL DYNAMIC HEAD = ,z, FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER rC
LIQUID DEPTH
IGNED : LICENSE NUMBER:
fy~ `C fG DATE: 1/88
• ¢ ."EAD/CAPACITY CURVE 161, 163 AND 165 SERIES
• •w
f• " LL TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE
28 90 EFFLUENT AND DEWATERING
SERIES 161 163 165
24 FT. M. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs.
MO EL 5 1.52 106 401 61 231 61 231
70 10 3.05 100 378 61 231 61 231
20 163 15 4.57 91 344 60 227 60 227
60 20 6.10 82 310 59 223 60 227
16 25 7.62 74 280 57 216 59 223
so
30 9.14 65 246 55 206 58 220
12 4 40 12.19 46 174 46 172 55 206
OD L 50 15.24 21 80 33 125 51 191
30 60 18.29 15 57 43 161
e
70 21.34 30 114
20
80 24.38 14 53
10 - - 90 27.43
100 30.48
o Lock Valve: 56' 66' 87'
GALLONS 10 20 30 40 50 60 70 80 G) 100 110
LITERS 0 80 160 240 320 400 ~
Standard All Models - Weight 77 lbs. - 20 ft. cord - W H.P. 89-4009
Control Selection
Model Volts-Ph Mode Amps Simplex Duplex
M161 115 1 Auto 14.0 1
N161 115 1 Non 14.0 2 or 4a & 2 3 or 5d & 7 SELECTION GUIDE
D161 230 1 Auto 7.0 1 - 1. Integral float operated mechanical switch, no external con-
E161 230 1 Non 7.0 6 or 4a & 6 3 or 5a & 7 trot required.
F161 230 3 Non 3.0 4a & 6 3 & 4a or 5c & 7
•H161 200-2081 Auto 112 1 2. Single piggyback mercury float switch, 10-0034 or double pig-
•1161 200-2081 Non 8.2 2 & 8 or 4a & 6 3 or 5a & 7 gyback mercury float switch 10-0229 (115V).
J161 200-2083 Non 2.2 4a&6 3 & 4a or 5c & 7 3 Mechanical alternator "M-Pak" 10-0072 or 10-0075.
•G161 460 3 Non 1.5 4b & 6 3 & 4b or 5b & 7 4a.Combination starter 10-0162, 115V 1HP-1Ph/200-208/230V
Standard All Models - Weight 77 lbs. - 20 ft. cord - % H.P. 2HPAPh, 230V 3HP-3Ph.
Control Selection 4b.Combination starter 10-0164; 460V-3Ph-5HP.
Model Vohs-Ph Mode Am Simplex Duplex 5a.Electrical alternator, 10-0202 or 10-0214•• 115/200-208/230V
M163 115 1 Auto 14.0 1 1Ph-1HP.
N163 115 1 Non 14.0 2 or 4a & 2 3 or 5d & 7 5b.Electrical alternator, 10-0212 or 10-0213•• 460/575V-3Ph-7SHP.
D163 230 1 Auto 7.0 1 - 5c.Electrical alternator, 10-0207 or 10-0019" 200-208/230V
E163 230 1 Non 7.0 6 or 4a & 6 3 or 5a & 7 3Ph-3HP.
F163 230 3 Non &0 4a & 6 3 & 4a or Sc & 7 5dElectrical alternator, 10-0203 or 10-0205'• 115/200-208/230V
•H163 200-2081 Auto 8.2 1 - 1Ph-2HP.
'1163 200-2081 Non 8.2 2 & 8 or 4a & 6 3 or 5a & 7
V163 200-2083 Non 2.2 4a & 6 3 & 4a or 5c & 7 6. Single piggyback mercury float switch 10-0035 or double pig-
•G163 460 3 Non 1S 4b & 6 3 & 4b or 5b & 7 gyback mercury float switch 10-0230 (230V).
7. Mercury float switch 10-0225 used as a control activator, spec-
Standard All Models - Weight 82 lbs. - 20 ft. cord - 1 H.P. ify duplex (3) or (4) float system (115/230V).
Control Selection 8. Four hole "J-Pak", junction box, for watertight connection or
Model Volts-Ph Mode Am Simplex Duplex wired-in simplex or duplex operation.
D165 230 1 Auto 9.0 1
E165 230 1 Non 9.0 6 or 4a & 2 3 or 5a & 7 NOTE: Two hole 'J-Pak'; junction box, for watertight connection
F165 230 3 Non 6.6 4a & 6 3 & 4a or Sc & 7 or splice.
•H165 200 1 Auto 10.7 1 - *No molded plug.
'1165 200 1 Non 10.7 6 & 8 or 4a & 6 3 or 5a & 7 ••Nema 12 rating.
V165 200-2083 Non 7.0 4a & 6 3 & 4a or 5c & 7
•G165 460 3 Non 3.3 4b & 6 3 & 4b or 5b & 7
For information on additional Zoeller products refer to catalog on Combination All installation of controls, protection devices and wiring should be done by a
Starter, FM-514; Piggyback Mercury Float Switches, FM-477; Electrical Alternator, licensed and qualified electrician. All electrical and safety codes should be followed
FM-486; Mechanical Alternator, FM-495; Alarm Package, FM-513: and Sump/ in addition to the most recent National Electric Code (NEC) and the Occupational
Sewage Basins, FM-487. Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusu l conditions a reserve safety factor is an engineered/design part of every Zoeller pump.
r
3280 ON Miners Lane Manufacturers of...
P0. Box 16347
Kentucky 40216
ZZWZ-M-ff O. Louisville,
(502) 778-2731 1~11&IrY PUMPS SNCE Ji~3P y
-
0 State of Wisconsin \ Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
201 E. Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
Tioi:as r.'ink
4:11 13. th Avenw..,
clewl,yoo(l City, rat
Po: Ti?011,13 S W"i )k - b Csi0C0CC
ons i tr SeO~aue° Systre.
Town of Em r°alo, t.. Croix County, 1+
SeCt.ieI! ;irc; s. ILrIPt', t~.C i~~ (I1;, I-lsconsin
t ,1i, iri1sCGr SIrr Statutes, Ad-i ni strati ve Code, a I mi the ov'rieri.t} Petition the t'epartnent for a variance
to Vic i nstt l l ati on for an o}nsi tee sev.age systev,, to r;--,place an existing onsi to
se%':ace syster, at a site 4:hi e tl i not i n full cor:;pl i artce with- the siting
st.:,ndla r.is in Vic ar.r,i ni strati ve rule. The systew Gesi Qn proposed snout d
protect the vlatF rs of the% skate fror coritar"iiratiar,. If this syst:er! aecories a-
failing syst',er, or` ccrltai,driates the wateT,s of the stet(:, ibis variance stiallibe
resc1nr.e< .
I l r,
Thr, pet'I t i on for" a var1 arxe reat.ie'stod to, s. Z 0 i i 1 oi- the Wis.
Adr i. co( -v;as Consl xjered on !ii y i'.`. , i he p T i t i t:•'i he s i.)Cf_n apr.woveo.
l ie ru'h, ream res e iaC,u i s!ysten, site t(' r:9'iif:i l'' of G-''; i nO-ie i of
suitablo riaturai soli.
loo v,rr'i anc( r ectuL'st,,dA L.:ds .o i ts t:a ! i il, rep I isC l[`EI4 r,ourl syster.1 on 1 site
a t.h 15 incisor of sr~i tat;! c- riaturdl soi l .
t4i{ td1 t' s~`i)i 1 i ?il ;Platt 'rhe aeiitioner were
Al , o ~,i da
cor;sl,:ere,% This var'ianco is specific -o ti,,e sub;,ecs. ~e`tition and cannot be
i!s(?C i(-,Y' ui 'jd Jtional i`.jori1'f1Cat Otis.
y,
Sire ri%ly
A
RJ
,
t iC'~1~?r( e
[Ji rector , ~lfif i Ce o r i)i vi si n
GCiO's a+App I cation )
1
w :KS:16' 13e
cc: Leroy ;ir7slcy, r r'1 vat::' S€ r °,-iqc Consul t;ant Oi stri ct J , h1 z}f}e`ti.'C7 tai 1 s
~i P10ri6S !3PI SC1r'., ZOrl rio Add i rJ s 11rat,,); tC-oi x i,(}llrity
SBD-6928 (R. 10/87)
ST. CROIX COUNTY
WISCONSIN
f;:-~~ ,r••{~• ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
_ 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
May 15, 1989
Division of Safety and Buildings
Bureau of Plumbing
P. O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation of the Thomas Wink property located in
the NW 1/4 of the NW 1/4 of Section 34, T30N-R16W, Town of
Emerald, St. Croix County, revealed suitable soils at a depth of
1.25 feet, below which high groundwater was noted.
This site should be suitable for a mound system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
` hc) IY1" Irs
Thomas C. Nelson
Zoning Administrator
TCN:rms
State of Wisconsin \ Department of Industry, Labor and Human Relations
PRIVATE SEW GE PLAN APPROVAL
Office of Divs on ~oc~e°s an°d~v~ppDTication
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
GALE W. SMITH Owner: THOMAS WINK
3228 HIGHWAY 170 4211 - 130TH AVENUE
GLENWOOD CITY, WI 54013 EMERALD, WI 54013
RE: Plan Number: 889-40093 Date Approved: June 6, 1989
Gallons Per Day: 900 Date Received: June 6, 1989
Project Name: WINK, THOMAS - RESIDENCE Location: NW,NW,34,36,16W
Town of EMERALD County: ST CROIX
Fees Received (Priority Review): 13D.00
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- REPLACEMENT MOUND
NOTE: Petition for variance was approved May 31, 1989.
Inquiries concerning this approval may be made by calling (608) 266-6952.
Sincerely,
4444-40
DENNIS R. SORENSON
Section of Private Sewage
Division of Safety and Buildings
cc: THOMAS WINK X Private Sewage Consultant
SBD-6423 (R. 08/88)
DrEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOP, /\ND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ ]LOT NO.:BLK. NO.: SUBDIVISION NAME:
° /T N/R jtor)W ,9Ld -
OUN~T7Y: OW04 ER'S MAILING ADDRESS: t v LCD -
USE DATES OBSERVATIONS MADE
A N TESTS:
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROF ESCRIPT ONS: Prffun
j R1 FRResidence - ❑ New Replace
-T
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GRO IND•PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
os~u sou ❑s~u ❑s2i u asou
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: //V l Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED ST. I HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 7/ SQL /~a$8 .3
B- ' a`QN eL 01. dj'
Ejj=j B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER t4ef AFTERSWELLING INTERVAL-MIN. P Ri D 1 -PERIOD PERIOD PER INCH
P- Zo
717
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 9q yl ~ ~ 3a 4 ve,
s - ~ + l I ~ ~ I ~ ( 4 E i.
4*
P
I
83
7e- 7 6,
I 1 _tN
f 3 w. f i 7 E 1 (
i
_
' ......t. 1
Qom.. 41~1
I, the undersigned, hereby certify that the soil tests reported on this form were made by q-& ccord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are corre t to t t of my knowledge and belief.
NAME (print): W TESTS WERE COMPLETED ON:
-
.5- la ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
d~~ 83
1-7
woo
CST SIGNATURE:
yo/ 3
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -