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HomeMy WebLinkAbout014-1046-60-000 ~ I Q o ~o c a ~ I I o = I o N a I i E OR d I € ~ I c a ~ ' I U I O N V C aNi y w I z Q N C y 1i c E y o °v E ¢ v rn c) v~ a I fl! ~ Z I c I d d N P Z a m 1 o I O Z V d z~ ~ ~ z I fA F- N E ~ c •N o O Q ~zz wN = z I CC ~T N M C d L N O W ` ' C U') LO 'ccCL N N f~ w p ~ N fA N a~ w O O V~ V Fy? 2 Q Q V Z O O •N Eaaa y IL w N G) O) U) J U a~ci rn rn_ A ~V Qmc~ rn o (D CD L~ co ~ E N I O O O ~ = O 00 C14 U) LO m N ~1 N U C > U) c U) C O O Q p N E O O U rr 1 N m C C 4 0 0 0 1 1 in M O V) N N tC0 N N N (V co (D 0) v~ N C Z Z n a; ol in c n Y `y c co c~ i-+ m c° E E L • Q O N lL fn O Z y H H g (n o € a a~ 2 da E c c 1 A C0 Form S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER i t TOWNSHIP E- 6,tg f SEC. T LN-RAW ADDRESS i` / ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE /(T a lv_ L PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C~ 4. z - d • w r o w, ham ~ ~ i GOO, INDICATE NORTH ARROW t BENCHMARK: Describe the vertical reference point used AIC Cbrate 8 zC% Elevation of vertical reference point: ~G Z) roposed slope -fit site: SEPTIC TANK: Manufacturer: Liquid Capacity: ``l Number of rings used: Tank manhole cover elevation: 9!8 Al Tank Inlet Elevation: /fez` H" Tank Outlet Elevation: 4Z~ ~aI o Number of feet from nearest Road: Front, Side,o Rear, O ? t)f feet .From nearest, property line Front,~Side,ORear,O y feet Number of feet from: well 8_6 , building: aQ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) E SIDE PUMP CHAMBER Manufacturer: .S;Aaj.4 Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: _ Pump Size ex) Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: 0ACofi--r'1per cycle: Alarm Manufacturer: arm Switch Type: LkQC~ Number r of feet from nearest property line: Front, Side, 0 Rear, © Ft. Number of feet from well: a 6 Number of feet from building: I (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: T Length: Number of Lines:_ Area Built: t/ Fill depth to top of piper Number of feet from nearest property line: Front, 0 Side, O Rear,O Pt Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT / Size: Number of pits: Diameter: s, Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: %umber of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job License Numbers 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NW,-,NG ,S22,T31N-R15W kZ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Forest ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound A P700 I L ER: ADDRESS OF PERMIT HOLDER: INSPECTION-DATE: David Swanepoel Route 1, Emerald, WI 54012 ( 19- 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: John P. Sykora III 3212 St. Croix 119472 SEPTIC TANK/HOLDING TANK: MANUF T FIER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROV D: P~RO~ED: D 2. ! D YES ❑ NO OYES ❑ NO VIES NG: VENT DI VENT M HIGH WAT R NUMBER OF OAD: PROPERTY WELL: BUILDING: VENT TO FRESH gjl...~ ALARM: FEET FROM / LINE: AIR INLET: O ❑YES NO NEAREST L v O _~D / SING CHAMBER: UFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PU P/ IPHON MANUFACTURER: WARNING LABEL LOCKIN COVER / ~c p P OV D: PROV D: re'v YES E] NO ~A d .~3 YES ❑ NO YES ❑ NO GALLONS PER C. LE: PUMP AND CONTROLS OPERATION NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM c / AIR INLET: PUMP ON AND OFF I L/ YES ❑ NO NEAREST ~Jo -2-11 .L SOIL ABSORPTION SYSTEM. CheqVhA soil moisture at t depth of plowing FORCE LENGTH: DIAr~METER: MA'T/E~R`I/A,LnAND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN 13~ Z/> TO l/ the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: 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: r PERMANENT MARKERS: OBSERVATION WELLS; / -51 W~' ~ ES ❑ NO YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: / z j /-f7 E__1 YES NO E] YES O ❑ YE NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIF LD PUMP MANIFOLD ~DISTyR,. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND EL E V.: D DIA.wk:- PIPE DIA.: DISTRIBUTION HOLE SIZE: H LE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS YES ❑ NO ES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINT; Q YES ❑ NO ES ❑ NO NEAREST- Sketch System on n in county file for audit. Reverse Side. SIGNATURE: TITLE SBD-6710 (R. 06/88) ~ Zon' Administrator ~i =:7E01jLtHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than //9G/y Z 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. PR ERTY OWNER PROPERTY LOCATION /a '/a, S a2 T3/ , N, R /S E (o W PR ERTY OWNER'S MAILING ADDRESS LOT # Y ol) /k BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 7~ ~ Z °7i5 3-,~I29 II. TYPE OF B LDING: Check one CITY Fa NEAREST ROAD ( ) State Owned VILLA =N QF: GE %t e.S J e_,, ❑Public 0 1or2Fam.Dwelling-# ofbedrooms,_3 PAR GEL TAX NU ER( ) 111. BUILDING USE: (If building type is public, check all that apply) IA~ . /04 6- (06 Z 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. 0 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] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 375': ~G Co q`}" Z feet feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks `.460 Concrete glass App. Tanks Tanks (Astructed Septic Tank or Holding Tank b fdlA- 04 F] F1 I [I Lift Pump Tank/Si hon Chamber 6601 10//-* r9 0 1 0 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu a ignature: (No Stamps) /M SW Business Phone Number: Plu bar's Address ( tr et, City, State, Zip Code): Z~z4/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (N2Zh_%_.j _00C/ P"I-) Approved ❑ Owner Given Initial IAIZ~ `IV 1 Surcharge Fee) 46 Adverse Deter ination W 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 P4mped by ar 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. If. 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, fist the total ga(lons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction foss; 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) aa 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) 5 APPLICATION FOR SANITARY PERMIT ST 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/contractpr,("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 4 ~ 0 r~(E~ l•~cL~~ e e., e Location of Property .14) Section T N - R W Township V o r^ ,e S + Mailing Address ~i yd~ - Subdivision Name Lot Number n V- ~f Previous Owner of Property,' Id r,- C, U _T Total Size of Parcel [ 0 aG~, Date Parcel was Created Are all corners and lot lines identifiable?- Yes No Is this property being developed for resale (spec house) ? Yes No Volume a 1 and Page Number T 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-) 3 g v v~~ I (We) eehti.6y that att'etatementb on thiA 6oLuco e tnu. to the but o6 my (ouA) knowledge; that I (we) am (are) the owner(6) peaty desc, i.bed in th" in6onmation 6o4m, by viAtue o6 a wauanty deeed in the 066ice o6 .the County Re9i.6teA o6 Deedb as Document No.,, ; and that I (we) pnebentty own the p4oposed ad to bon the sewage di6posat 6y6tem (o/t I (we) have obtained an easement, to A.un with the above de cAibed ptopeAty, bon the constn.uctlon o6 6ai.d system, and the same has been duty tecohded in the 066ice o6 the County Regtbteh o6 Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 2 C/ DATE SIGNED / DATE SIGNED " pocu"RNT NO. STAT2 BAtt O# NlSOONWl1 7030 2 YM Pulse 8"ca noonvee FIRS n"Same it wM~ WAMANTY OM ; .394658 , v-' 681 , 308 r~z oFF,~.~ or. CROIX Co,, vot , s Deeds st+awMl fntww4 1.RsR...i+1..Kh~aw.......'. Ibse'd for R+atrd life . I I 't'his day . @A Is 20 M,, t: ams O'Connell aa+6............AAA/3d.....~11pId.Iti..L..p0ue1....... slow~ ".._Laaltasid:alad adsa..s...jalias t+~oaata . Witneesetb. That the said arvo r. toe a vain" coviomwetka ma..................................... fr +s i~l rtsi. is •:St~-:..Croix asruau ro aasttasyo C4404. Sit"* of wbaselat Tlts Vest Half (W 1/2), of the North pest Quarter Tax Pared No: (tit i/4) Of Section 22, and the North East Quarter '(a 1/4) of the north last quarter (NE 1/4) of Section 21, Tovw&4 31 North, Range 15 West. the East Half (E 1/2) of a jj= the Nort>t Vast Quarter (NW 1/4) of Section 22, Township 31 mwtb, Image 15 Mast. FL This Dena is given for the purpose of satisfying a Land Contract between' 11dd A. Sebultg and Hilda 8cbult8 and David Svanepoel and Lorelei Swanepoel, k: Rated January 3, 1973 and Recorded January S, 1973 as Document Number 314139. Seek 493, Page 363; and Addendum to Land Contract Dated November 29, 1982 and Recorded December 3. 1982 as Document Number 381463, Volume 656. Page 179. s. Thi.' t rA.... a~ U.w.awd S"WW. `is6. (V eat) '1906o r with all oW singder dw hauls and appurts"aw Ummute bdouging; warrants Nat do We W @*A laiafias" in In simple and free sad clear of encumbrances except t. I) and Will warraat and 426aad the aerie. Dated this ...,........a7-:.............. day of ~ .JE.rMIfRh~- If is-` j ...(SEAL) (SEAM.) . . ~ Hilda Schults .................(SEAL) _ .(SEAL) I AUTUNDITIOAT=ON ACKNOWLlIAOYSNT } t Sigasto»(s)(4L►A......... SGbj~SrxZr STATE OF WISCONSIN } %(If County. > a. ttd this f I91ta Ptrwnally came before me this day of ...................lfl... the about named A Q REUSE STATE BAR OF WISCONSIN not... xmhorhTed by (S 708.08. Wis. Stets.) to me known to be the pr r. o who executed the foregoing instrument and .t.i uowledge the name. THIS INSTRUMENT WAS DRAFTED SV i . Francis.. X- L. Rivard..... GltttwQUd..C1.tY....Wi... 544.1.3. Noturv Public ("milt%. Wis. ! /Sianaturea may he authenticated or acknowledged. Rath lity Commission is pernum,nt (If not, ,t;a, e>,i,lration are not necessary.) date; !9 .1 •Nanm of Pomns Sitning in .ny uuncir.y should be typed or t.rmtwl het- th.tr .inr.t:,rr.. .a I STATE, SAM OF WISCONSIN MCYrle. tontt+r7® VORM Ns. 1 - us: Stock No. 13001 z En H . y ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St... Croix County z ty 9 H OWNER/BUYER 0-,t, cL a 0 red r t wCi ✓l ~ o nn ~ ROUTE/BOX NUMBER 10 '4- 1 u) Fire Number. .CITY/STATE rme-rQ ZIP '15 yy~a PROPERTY LOCATION:_,N k) k,Section, T N, R _J_5 W, Town of -Fore.5+ , St. Croix County, a Subdivision n/y„e Lot number lVail.10-. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior-to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE c77 7 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. D. D LXOR YE, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B DI VLDINGS ISION LABOR AND P (115) P.O. BOX 7969 HUMA ~Ij PERCOLATION TESTS HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNSHIP fJIUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 141, ty -E N/R COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS: C7 - St, Croy c._ ii k!ct► / O USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence ❑New 54Replace RATING: S= Site suitable for system U= Site unsuitable for system Cry CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) EIS IZU ®S DU O S [&U D S ®U DS ill 016,-" If any portion of the tested area is in the kA If Percolation Tests are NOT re tt~17A IGN RATE: under s.H63.09(5)(b), indicate: ~A_ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HI HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- o"q''P,,, s:l T-, ci"-~ 7G r• r ~ci v~► p `l t, S • ~'~s , 9 20" G•,j c_ ~s ti h I 0,6 C' -j (I. B- PC 9 s c, B- C. te; B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- / '3 0 2_6t. G, P- ` / UtcE? a~ /7~i / v P- P-- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96' 9" go,,,ek Et j 98'$'' sn~tcl d I F { eo" t~ 1 jo 1Jt'% p V .iI - p,L/ a~ ---Got tN E t P-l r11_.z _5Y t -T it . l~ 3 • i Ott Ir`t7 1 . 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: R/.:;oa 5 -C ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): C-7 L t' T4 _2 -71 CST SIGNATURE: DISTRIBUTION; Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 65355 To be a comp rate soil test, your report must 1. Complete legal 'on; 2. The use sectic- :Arly indicate whe-' is is a re-ic" r cornmercial project; 3, MAXIMUM numl-F )f bedrooms or comm, use planned; 4. Is this a new r pent system; 5. Complete -f rating boxes. A .1' IS SUITABLE FOR A HOL TANK ONLY IF ALL OTHER SYS" RULED OUT 'D ON SOIL CONDITIONS; 6PLEASE u t eons shown ' v~-r iting profile descriptions and completing the plot plan; T. A.KE A ' accurately v,.g your test loc,-Dns. Drawing to scale is preferred. A d sired; nd verticals reference I' clearly shown, and are permanent; 9. '0' Date boxes as to dat nes, addresses, f, 1 plain data, percolation test exernp- ~ , n ch as flood plain, does not apply, place N.A. in the appropriate box; 3 1 . rt p' ce your current ad+ d your certification number; gible I distribute as I. ALL SOIL TESTS MUST BE FILED WITH THE I THIN 30 DAY. 'PLFTION. ABBREVIATIONS FOR ITIFIED SOIL TESTERS s tares Other " mbols - ) BR - ock cols - ')f (3 - 10") SS gr (under 3") LS - L ;estone s HGW - H r Gror iter cs a Sand Perc _ F )latic.... i rs2ed s - F "Id W V, 'I fs- ' nd Bldg - Eurl Is - Loamy Sane! > sl dy Loam I - LE . m Bn sil - I i :rm Bl Si - Silt Gy - "cl - Clay Loam Y scl - S:, dy Clay Loam R Biel - >Wy Clay Loam mot - Z'.tttles sc - Clay w' i vv ith sic - fff few, fine r ~c. t y ce - comn ;~i pt t mm Many, m n'i - Eck d - distin p - prorr HWL - i-'i -`t hire's I osal M P VRP TO TH7 <,a3t t f State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE -PLAN APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 i SYKORA EXCAVATING Owner: DAVID SWAN[=PQEL ROUTE 2 BOX 75 ROUTE 1 BLOOMER, WI 54724 EMERALD, WI 54012 RE: Plan Number: S88-04315 Date Approved: March 10, 1989 Gallons Per Day: 450 Date Received: March 1, 1989 Project Name: SWANEPOEL, DAVID - RESIDENCE Location: NW,NW,22,31,15W Town of FOREST County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PET11 ION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 266-8230. in rely, KENN::TH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/ 2 cc: DAVID SWANEPOEL ----..Private Sewage Consultant County _UW--SSWMP Plumbing Consultant .-Owner Plumber Environmental Health SBD-6423 (R. 08/88) - M, !~M state of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue a Y'C tl 7 , 1989 F.O. Box 7969 Madison, Wisconsin 53707 Cavid 5wanepoel Route 1 El;,erald, 4!I 54012 Petition No. S88-04315-P ~ bear h r. Sv.,anepoel : 11e: David Swanepoel - Residence Onsite Sewage System 1.114, NW, 22, 31 , 1514 Forest, St. Croix County, WI Section 145.24 (1), Wisconsin Statutes, and s. ILI1k 83.0cJ (2) (b), Wisconsin Administrative Code, allow the owner to petition the department for a variance to the installation for a onsite sewage syster,i to replace an existing onsite sewage system at a site which is not in full compliance with the siting standards in the administrative rule. The system design proposed should protect the waters of the state from contamination. If this system becomes a failing system or contaminates the waters of the state, this variance shall be rescinded. The petition for a variance requested to s. ILhk V3.23 (1) (d) of the Wis. Adm. Code was considered on lurch 2, The petition has been approved. The rule requires a mound system site to have a minimum of 24 inches of suitable natural soil. R The variance requested was to install a replacement mound system on a site with 16 inoies of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifical-rpn _,Si/ cerely, i "s I ; I /her c and t,e €Yr, 'A 4 tec birector, Office of Uivision ".:odes and Application ((i08) 266-306,0 Rtt:KS:21501 SBD-6928 (R. 10/87) - - - - ON W G V r ,"~\.rd r"y 7' 3 "Ad-l- Wl + y For p ?it'd D a w~IA r "10 ~i K G\ G1 0- ej G &%p 4061 - uiF 40 00 o" 87 RECEA; fig`'° 1989 MAR A 10N R 0F' AND AWI.!`,A i ION o ~y mss., rr a . ~ • C --7- to 6 (-7 bed{ :7.x "x k WA/ Sec. Z2o -r ti, R 15 Straw, Marsh may, or `+-&l4 Synthetic Covering istribution Pipe Medium Sand Topsoil F a s ~z*s 3, E o Sl • 2 h~,~ Bed ~f , • force Main ~Plowed From Pump Layer °,y b gregate h < DD , ~hG s -Section Of A Mound System Using E` 023 Ft D - A Bed For The Absorption Area F Ft. E G G Ft. S' A Ft. H ft. S ed: _ B LDp , Ft. License Number:'', K Ft, ELEVATION O L ~ Ft. BOTTOM OF B Date: 9 J 9f~3~ Ft . ofPosition Ft. w0 7ED Force Main W ZS -t. MAR 0 7- UFF el! 19 41;1 fSION Observation Pipe -.ODES 7ANDAP LICANO A I--------- - _ -----------~_.1 1 w o - - - -----.J Distribution Bed Of Pipe 2 2 l Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Sad For The Absorption Area r'aJe~ o f4ttid cuee A)u~ y~ NW 6W (A ©S Fo re-s.fi S7' Cro x Cap s,,~ _Porforoted Piptt Cotoli n View Ptrforato End Cop d + PVC Pipe Cob ""W1146 To *AMK Holes Located An Bottom, Are Equally Spaced PVC Force Main \ * From Pump tNQ CAP MW Z7 P ~ 01AS11 4 , . > MAR 01 1989 pr~ ~Y Vale OFFICE OF DIVISION Last CODES M. APPI t- x~tnd' cap a out X otiu P D A114 GoRRE SEE X -S(C) Y Signed: _ Hole Diameter Inch Lateral Z Inch(es) License Number: IS# iZ Manifold " Inches Dater/2 /Sg Force Main ~Inches # Holes/Pipe ! Lateral Invert Elevation Feet 2Da ~4, raa R o 4~o r zof zbf r ~q 3 c?~ ~o,~zd, -,r~o~ ~0~~ Sal c? , 3`8 7 . x..s3~s~ > . ` .?sue ~~~•.r~'- ~ ' + { .'~~E...'~_ F' IV, EPTTC TANK PUMP CHAMBER CROSS SECTION ANl SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE ~ 2S' FROM DOOR, WINDOW OR WEATHER PROOF FRESH AIR INTAKE JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVE FINISHED GRADE 4" CI RISER W/ PADLOCK & 6" MIN. WARNING LABE t. . AB OY AD E 4 " MIN. 18" IN. 6" INLET - r* W ~I~HT 5 GAS TIGHT 411 l' A 0~. A SEAL CI PIPE(;\5~~~~fr ~I F i ; APPROVED R. GE ALM JOINTS W/ CI 3' ONTO ~~S~aDEN B ! SOLID ON PIPE 3' ONTO SOLID SOIL SOIL C M> F ELEV. FT. t OFF' RISER EXI D PERMITTED ON IF TANK MANUFACTURER 3" APPROVED BEDDING UNDER TANK to IF Ir ' CONCRETE PAD D posh ~f,~a• (c~ u^ SPECIFICATIONS [VAR 0 1 1989 SEPTIC / DOSE OFFICE OF DIVISIO TANK MANUFACTURER: S (6 ~ _ST a, NUMBER DOSES PER DAY : DES AND AI''PI-I A i TANK SIZES: SEPTIC 1000 GAL. DOSE VOLUME INCLUDING DOSE _,Cja GAL. FLOWBACK: 161 GAL. ALARM MANUFACTURER: CAPACITIES: A = 22.5 :INCHES = 364) MODEL NUMBER: GAL SWITCH' TYPE: B= 2 INCHES = ~~o,bCo GAL PUMP MANUFACTURER: y y"c) C lZnb INCHES GAL MODEL NUMBER- SWITCH TYPE: rn~~w~_o lfi D = INCHES GAL REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER I LHR 16. 23 WA VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 8 FEET + MINIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET /Zf' FEET FORCEMAIN X 2,/Gl/FT/100 FT. FRICTION FACTOR 7 FEET TOTAL DYNAMIC HEAD = 13 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTHS I SIGNED: LICENSE NUMBER:>~aZ/Z. DATE: Z~ FY )Y3 F OSP33 113 HP - MAX. SOLIDS 5/8" SPHERE -1750 RPM . Available in automatic or 24 ..manual. .1 J • Completely submersible. Non-clog bronze impeller. 20 • No suction screens to clean. • Oil-filled, double ball bearing W:.16"A motor with built-in overload protection. Reliable diaphragm switch with piggyback plug-in. 5 • ' Rugged cast iron construction. s Completely field serviceable. { FULLLOAD . 1 1/2" NPT discharge. AMPS AT 14 115V. 6a AT 2WV. 36 :.H 0 0 10 20 30 40 50 60 U.S. GALLONS PER MINUTE SPD50H/SPD100H %9 O DIVISION ' ~DDIVISION 112and1 HP-MAX. SOLIDS 3/4"SPHERE-3450 RPM 0CE OF ~1 • Available in manual or E 6 automatic. • Dual seals standard. Seal 50 FuuLAlD failure sensor capability AMPS Al 1e.a1 a'. 20 "w available (to be wired to an W '/YA AMPS ATA3~.. - 40ti ;rV alarm device) on manual pumps. Open two-vane sewage type 30 sN impeller. y Pump shaft and all fasteners are SPU50AH ~ c .t FULL65RT LOAD stainless steel. 20 MZ I~1 5V. ° • 1 /2 HP (SPD504 and 1 HP p (SPD 100H) motors. Ball bearing i construction and oil-filled. M, • _ 2" NPT discharge (W flange 0 ° 20 40 80. BU 100 120 140 U.S. GALLONS PER MINUTE optional). SKHD 150 A)(.SOLIDS 3/4"SPHERE -3450RPM 1/2 HP-M ,eo Semi-open thermoplastic - - - - - - - impeller. s a~ W 720. 1 1/2 HP, oil-filled motor. Pump shaft and all fasteners are t stainless steel. 1 1/2" NPT discharge. FULL LOAD A~M AT 10, - y--- PULLLDAD Spring loaded mechanical seal 5~x. with carbon and ceramic faces. Pump-out vanes on rear shroud of impeller. 1U zo 30 40 50 eo 70 • Dual seals. Seal failure sensor` U.S. GALLONS PER MINUTE. capability available (to be wired to an alarm device). S V31 State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue March 7, 1989 P.O. Box 7969 Madison, Wisconsin 53707 David Swanepoel Route 1 Emerald, WI 54012 Petition No. S88-04315-P Dear Mr. Swanepoel: Re: David Swanepoel - Residence Onsite Sewage System NW, NW, 22, 31, 15W Forest, St. Croix County, WI Section 145.24 (1), Wisconsin Statutes, and s. ILHR 83.09 (2) (b), Wisconsin Administrative Code, allow the owner to petition the department for a variance to the installation for a onsite sewage system to replace an existing onsite sewage system at a site which is not in full compliance with the siting standards in the administrative rule. The system design proposed should protect the waters of the state from contamination. If this system becomes a failing system or contaminates the waters of the state, this variance shall be rescinded. The petition for a variance requested to s. ILHR 83.23 (1) (d) of the Wis. Adm. Code was considered on March 2, 1989. The petition has been approved. The rule requires a mound system site to have a minimum of 24 inches of suitable natural soil. The variance requested was to install a replacement mound system on a site with 16 inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. i cerely, r Ric rd a r, A ' r c Director, Office of ivision Codes and Applicati n (608) 266-3080 RM:KS:2150i SBD-6928 (R. 10/87) f State of Wisconsin ` Department of Industry, Labor and Human Relations PRTVATl= S WAGE:. Pt_AN AIPP OVAL SAFETY & BUILDINGS DIVISION ;Y i~s7E-~1:, ,_?it l'!ti~!1 1 di4'~ s,nr}ti:!!~ 11" ~dr'1{ tl !'!11:1. ROME l 11OX I lhil f:'9 I''ll h'rl fl, Uii ,Ili)! RE: Plan Number: S88-'04315 I Y h I1 ;8 .,,1 [l,a; IVII.1 I,I i. !+!l:i+' I;c! c~i,-u'.":; :t?' l t r •:~-l ir:`•!'~~ f - ~ !l~l ia. ~ ,c I tlr-t.,i~ !•~r~i:'f~ r r~,r.i;,t,li~,•~ f~r)Y t I )I Chit )ter a .i1111r..i l,t!')1 S.L LPI ~c)I~>1 rr.<ai:) I.. _.I11.~1 j'.t ~ ,~Ip) ~td.!d.l I 1 - i)C;I G.! r, (4 ' ! I 1 i. I.. ti i , ~ 1 ,1 IF; it ?!flf• ;I"':;:11.1. i'ik? t>M:)Yidi.tlFC.I !!'..A n' ril_. 1,!+.1: 1. {')(.v 11 1. 1s.1'fllh; i.. I..r;i"!-iz; I, IJY I. ~'1'I ii .i .a1 Lc't 1. C`-t•1 i I r<,~:1:~ :)ril.~ i" i,arls wt++l t.hn ~~•:=i ' ')I. ~ ~1r? 1 ;i.~ i~,j; rat; (I!<-' ;.•;!):i. !'+.f:?. i.)Iijl„ It'i- ;al.i. `..`t I.,'ai ii , !i"':... Y!i:: ,_i..hr'l,J It .'i P"iHl I. Z'7(I"11- • :i ~'f l.t' 1r! 1 it_,ri .k.f !I > t, I'•,: C)F rn,~r,, f'!ii;?,Tic! it ,:h:?1>Ct r )t) :i tP I"1 I. ;v1;tC)Y'.ii/r~.l. 1 i <,1 ;"t1;-~ i-t:1 LI`in}l.l•Y'.'I .;!h~?` r~ 1. - P 0 "11~ 1\I I Nit )I II'Vo ..:":'.j I ! Y 1 r, r;r E`1 i" r_Y i1-i i'1'~: ,1 (i•17 ~ -.i l:i i.)Y-. re: el 1, ill 'y ;,;t~ rt. V'j f.,,, _ ! 1 , ~ i K f t\1111 1 I-1 ! 1 L: i"it; F I i -1,.17 i S?.':I•t a)? .c I.`-i.ii I!.'1 :.~!1 1;'I IT". ' l' I' 4,11!iL't!'`~-1 .f,tl : 1 i 11 W j; b 1-7 1111i`1 SBD-6423 (R. 08/88) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION January 25, 1.989 Office.of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 SYKORA EXCAVATING Owner: DAVID SWANEPOEL ROUTE 2 BOX 75 ROUTE 1 BLOOMER, WI 54724 EMERALD, WI 54012 RE: Plan Number S88-04315 Project Name: SWANEPOEL, DAVID - RESIDENCE County: ST CROIX Location: NW,NW,22,31,15W Date Received: 09/27/88 FOREST Date of Request: 10/27/88 On October 27, 1988 we sent you a letter regarding your submittal for the above--mentioned project, stating that this office could not process your submittal until we received the requested additional information. It also mentioned that plans submitted to this office which require additional information will be held 90 business days for the receipt of the information, and if after 90 business days a response had not been received, your submittal would be returned. The purpose of this letter is to inform you that 60 of the allotted 90 business days have gone by and we have not received the requested additional information for the submittal. If we do not receive a response from you within 30 business days from the date of this letter, your submittal will be returned. If you have any questions concerning this matter, please contact this office. Sincerely, Ann E. Addis Plan Entry (608) 267_-5119 ¢ cc: DAVID SWANEPOEL LEROY JANSKY COUNT Y : ST (SBD-6423 (R. 08/88) k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 SeptembeA 14, 1988 Diviz ion of Safety and Buitding BuAeau o6 Ptumb.ing P.O. Box 7969 Mad,tzon, Wl 53707 Dean. Sit: An on site investigation boA the David Swanepoet pAopenty, .eocated in the NW 114 o6 the NW 114 of Section 22, T31N-R15W, Town ob Fotat, St. Cuix County, Aeveae.ed .suita.bZe 6o.iU at a depth ob 16 .inches, below which ae"onabZe high ground wateA was noted. Thi6 site ahoutd be suitable 6oA a mound dyztem. Shoutd you have any quebtion6, pZease jeet 6Aee to contact thi.d oj6ice. S.inceAety, Tho"ct) C. Mx~ I r rys Thomas C. Ne Uon Zoning Adm.inistJcatoA TCN:Am3 ST. CROIX COUNTY TMs.. WISCONSIN =a X31 2. ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 A; (715) 386-4680 September 9, 1988 Divizion o6 Sa6ety and Bu,itddng Bureau o6 Pteumbing P.O. Box 7969 Madizon, Wl 53707 Dean Sit: An on site inve6t i.gati.on bon the David Swanepoet,..located at the NU!% o6 the NW14 o6 Section 22, T31N-R15W, Town ob Pone6z, St. Croix County, nevea.Ced 6u.itabte bo.ca at a depth ob 16 ikche6, betow which seazonabte high ground waxen wa6 noted. This site .6hou.2d be bud table bon a mound sy6tem. Shoutd you have any que6ti.on6, ptea6e beet 6nee to contact th.ivs o66ice. Sincenet y, Thoma6 C. Netzon Zoning Admmin i stAaton TCN/ju t