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HomeMy WebLinkAbout014-1074-95-000 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 M ftS §g'I I~~}}07 1 15W State Plan I.D. Number iS J Town of Forest El CONVENTIONAL El ALTERATIVE (If assigned) CTY 'S' ❑ Holding Tank ❑ In-Ground Pressure I!Nxmound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D E: im Hurst Route 2 Glenwood Cit WI 54013 7-347 f v'N NCH 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: Lyle Myers 6219 ~t. Croix 119551 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 20 q PROVIDED: PROVIDED: U 6 ❑ YES ❑ NO ❑ YES YNO BEDDING: VENT DI VENT A L.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LIN AIR IN, FT ❑ YES NO ❑ YES ❑ NO NEAREST ~ s S S DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: JPUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) I ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN 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: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS 3 ~ 3 TRENCS: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: 07):,5 0 DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS INFORMATION ❑ YES ❑ NO COV ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: strator SBD-6710 (R. 06/88) Zoning Admini Thomas C. Nelson ILHR, SANITARY PERMIT APPLICATION ~o~N 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 1:1 I 2evZZLIous 8% x 11 inches in size. Ch k if application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 9 2 PROPER OWNER PROPERTY OCATION / _1j I jn,= 6L se-6. I i~ Y. %a, S3 T3 N, R /5-E (or W PROP,,f_RTY WNER'S MAILING ADDRESS LOT # BLOCK # _ X)/yl I -,j /,a STATE ZIP CODE PHONE NUMBER SUBDIVISION AME OR CSM NUMBER II. TYPE OF BUILDIN Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE i d L /"f__-7S ❑ Public 1 or 2 Fam. Dwelling4 of bedrooms PARCEL TAX NUM ON- 1C7 / ` S O 111. BUILDING USE: (If building type is public, check all that apply) T 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3.E1 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 g 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 (s . ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ^ 4 - S'Z • ~ • Z Feet S Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Prefab. Fiber- Exper. New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank l V U/ti . c 7 Lift Pump Tank/Siphon Chamber 7 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu ber's Name (Print): Plumber' Signs re: (No Stamps) PRSW No.: Business Phone Number: 1 _57) I- I Plum 's Address (S et, City State, Zip C d IX. COUNTY/DEPARTMENT USE ONLY NJ ~ ❑ Disapproved Sary Permit Fee (includes groundwater a e Issued Issu g Agent Signature (No Stamps) pproved ❑ Owner Given Initial Surcharge Fee) yn~ Q Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber v INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. r 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) + APPLICATION FOR SANITARY PERMIT 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 - i rn 4 70 7-2, Location of property 5KSC1/4 SC- 1/4, Section , T~_N-R~_W Township 25 Mailing address Z~j UJ, S <Iel-? Address of site 5Ay"6 Subdivision name Lot number Previous owner of property ?"o., .4,af Total size of parcel 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 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said syste , and the same has been duly recorded in the Office of County Register,- Deeds, as Document No. S ature of Owne Sigiatur of Co-Owner (If Applicable) 7-/7-89 Date of Signature Date of Signature v H Y. o* am goo" Se Mr. yi;•$,~r~ ,Sk t lhk o-"pow gilt > +~►:..w OL awl, It l9w l Una Wain 00 M MY M M ar idiN the k~.. dw 4c, ~ IL• 12 t Mle~lf at !M raa of ...........1~ Nf a mon tUR ot'owmaisooh a± i= awL itMtraR •fM soetlwaNta.ar aNlgtelfr. t#ii ` ~ Nnodwas wia *aL To tr AMM . W r. 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M'M•fl.~!gli{.N.wNMrw.. r..wM.•..w...rN.r..r..v.__•.-.-•.....__r.M.M.w.M.wwNrMw ">'~('f to at /rs jI mn end (e1 is the Where Id a ~afti t Y N , i;; 001 *1 d ..Mt-deli Odhourbs the ~ des 1~1.k rlt~l~ hnbmw Ub" e $i toe a d f....0 ' 111b~ nodded Good" man). then t~iattef ` r II/1M r ie14 at Va WW% aptisi end wibt so"" s 4tlpr MINI IM liNraYt eidYts need remedies (aeM it to Syr MI er Y aOdy: (i) Viudee seqs at his option, fouls sto MM S 'S t jgere of tine rwY is atbet an wd dateaMNbara~aestsdeeMrwei~e~`LL it t ` ` aselalMd as ligaidded dSnnsgae tee foam a fdf0 IYS zs' * `t yes !Ws to release); or (it) Vendor euy gap for specific pertornaaa* et Muds . irM ptipnsst d the eat oitstawiing badsan. with interest thereon at the Babe Y a des Mrwader, in which Went the Property shall be auctioned et Is ! MOW_ delieisne~• or (IN) Vender may sae at law for the entire us"M pore - ere (de) Vender am deeSar+s Me Contract at an end and renoee this CaaRrastaasiw n. if Min agaltai~ istsnst of Penhner is irignifiawtp and (v) Vender any bow Pwrhits* TttOer and have a naives to ealiset any coats, inn" or ts darius r ( K' (der abaeo. ittg say and or written stet mooft or action st ahap only M rpea Vendor it and when perswi ~'trSawWo olylrtMys too at Veadtr t0 a it, 0 any hrrw~r (w1~Wlr R. , ~ MA-0 o _bV _ _ e espouses of title evidema d" be de peiseipal aM'pdd htr # tes~sees •4 j•de•UL forsdomrs al a rseeivsr+ a hsaeitesdd lawnst. to eedliastthe Y? d~ariet et web aetioad rents. isswe, and pnAts when as eAiM~ as pert s1 iirect. " Pwdmssr ahaii net transfer. Sail or eoaway any legal or ePilabls interest in the r' f at Iwo under Ab Contract or by Option. b~tera Nose or in all etbr way n;. Mioss either the ootdaag baleen pgabN eerier this Contrast ie first paid i. a K anismmw t of Purabsoves'-forest ender this Contract ashy as sourly ter es ,mot . b the awet of any such treader. ale or sea without Vendor's written mo a % aM ruder thin Contract Shall because iSnaadisi ydne and payaNe to tuN. at Vasier's aptMa AM Snake d[ payasta when due soda any ;engage awwandhig WIN* the hap Mlir ` !!k-aonbaot (saieepI for any Save tgago graated by Purchases) or ands any neM second , 903 - et the somata then due under this Ce ntract. PuTeho er way ado any it Vender to% to do se and all payments so wade by Purchaser shall be rda Mite~eMe asade R Vender all wdw any default without waiving nay other Subsequent or prier defauk at lMehasst.. AS term of this Centnet stall he binding ;pea and inure is the bomft of the bier I I o- ° and K Vander and Parebmw. (It as! as owner of Ma Fr"WIN the opaeae a[ Vilt hr, eMie~~isY Ito MwLh) -aestaad rights is the subject ft"aty and arses is Job is 00 ` 3rd d: Doled this day of August- 1l... O.S.. (113911A Frs@-= (MA Richard Banda;l Ja>tee V. Hurst Fri, Patricia Ana Wolff J R. Burst ta.5 r AVTUXKTICATION AC=NOWLBDOKXUT Nwitsra(N 4aia11 Richard treemn Sad STAT2 OF WISCONSIN k . Pa(riele AMWolff Fr+a St. Croix a& this 3rd ef. A~nat lb._. y cams Yfera Ise this , .,w. Ara a" t tt. ~ Mtn ahf~s Jaes_,n•.Hgrst..~_Jon~[...:.,:' - trio J. 11 TnW- M1 M92, STATE BAR OF WISCONSIN y, (if Mot. owthorind by ; 906A6. Wis. State) to we known to be the Parana , r. forgoing and Mkfa 5 THIS iNsmu"aw WAS o/tAIT[D BY -1 • ~ •tic J. Lundell. 1" 157 , ~ ~ Visevttsia 54017 St. C ba...................... Notsri Public , ' Mmes ant be modwatiesked 4w aeksowledged. Both YS Coetrainisn is 1 are vvA necessary.) '!11ry'rs.0 tu.wr,tlewpt w Ms .WWier : #.nM be tsr+ a' rrEnt.! ` . = lalrK ice. ~ vr: - ~•.aj rxir, ❑ - 'AS.T;~ ~,~5'F"as ~ - Tama a~Ma to }lw man Wa sw pCkfam *New 63 se m dak a arri arim"M lam. ~ stroll be laataUed as at balm July 319 as app# tw a peat tumqft do 3a. Cs+oLi! ~a to amt alga p fsarf for aal~i a aload" ddU: M is do aMt of +3, . wst of said alsa+as, ubldwvar aws" is fall be us& r at belt "t Iprll 30, low. I is X71 r " r gat and4we PWA~ shall landLetw aat~R a0 1! `sasaiws !`ts~ sali R 2w 4sat "aw to ve"fiw sa¢+! + ' r frmt I RIP tas jai tailiss tsrop 4aa OI ~S. Andn ales svmt Irm M.. Pwahm so*" do tins se arttataetias at atria Iasi SOMM09 M iaO. " alli " to SU at do ava of the salt awed a3atss, U "'t a~ovt at $3,000.00. s r :e ~t a yg 6 4 State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION NovemteY 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 P J i m ?-c u r s t ;cute Box 266 Forest, 1.1 54013 Petition No. S8£ -045, 2-P i#urst: i' : Jive i urst - Residence or)si to Sewage System Town of Forest, St. Croix County, WI Section 145.24 (1), Wisconsin Statutes, and s. ILlik 83.09 (2) (b), Wisconsin dw.i ni strati ve Code, allow the oyiner to petition the department for a variance to the installation for a onsito set' :age system to replace an existing onsito sewage systen at a site which is not in full compliance with the siting stahda nds in the adn i ni strati ve rule. The system design proposed shoul o protect tr)e caters of the state from contar,l i nation. If this system becomes a failing system or contaminates the waters of the state, this variance shall be rescinded. Toe petition for, a variance requester to s. ILM,1, t :s.23 i) of the Wis. Adri. Code was considere:6 on Noveriber 21, 11,16L. The petition has been conditionally approved. Tie condition being that in tije event of failure, the mound systeht shall be replaced with a holding tank or other off-lot system. The rule requires that a r..iourid system have a mi nir,.,,um of L'4 inches of suitable natural soil. The variance requested was to install a replacement mount system: on a site itrr 1I inches of suitable natural soil. All of the data and statecents submitted on behalf of the petitioner were ;;onsi dered. This variance is specific to 46 Sub; ect peti ti on and cannot be used for any additional modifications. Sincerely, f f y~A, icVi ieyer, l~ ' hi tecti Director, Office: of Di vi/sior, Codes and Application (606) 266-3060 Rf.i:KS:1006g cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Toomias INelson, Zoning Adr-Anistrator - St. Croix County Lyle's Plumbing & Repair SBO-6928 (R. 10/87) Sate of Wisconsin \ Department of Industry, Labor and Human Relations E'{7;1f1i fik:.Gi/Cd, ('I.11f1 t'sPi'A',iUtlt. SAFETY & BUILDINGS DIVISION r RE Plan NixwtbPr:' S88 04992 114 f"' i i,•- :rlt`4~ r li;t` I I SBD-6423 (R. 08/88) - - JI State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 4 I I SBD-6423 (R. 08/88) k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 19.R. r9'19 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 October 28, 1988 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Jim Hurst property located in the S 1/2 of the SE 1/4 of the SE 1/4 of Section 34, T31N- R15W, Town of Forest, St. Croix County, revealed suitable soils at a depth of 13 inches, 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, Thomas C. Nelson Zoning Administrator TCN:rms STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 2S ; a!~ 7.? ROUTE/BOX NUMBER 12447 FIRE NO. M~ /fir t 5~ D CITY/STATE (_~~--xJtUd~~ y G if Z I P ~ , , R1-:;- W, PROPERTY LOCATION: S'1 G~/9 ff 1/4 Section T N Town of 4210e_ T , St. Croix County, Subdivision r----- , 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. SIGNE C DAT 7 / SI7 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 EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IDUSTRY, DIVISION 4BOR AND PERCOLATION TESTS (115) MADISON W 7969 UMAN RELATIONS (H63.09(1) & Chapter 145.045) OCATION: SECTION: TOWNSHIP/k~: LOT NO.:BLK. NO.: SUBDIVISION NAME: 'X'SE'14S'64 3 9 MY N1R1dY(.r) W11 fo Z's OUNTY: OWNER'S E: MAILING ADDRESS: -7 D/,t' - oo,o ie~7 7` I-ve ;E DATES OBSERVATIONS MADE W Residence COMMERCIAL DESCRIPTION: -q,~, PROFILEDESCRIPTIONS: 1PERCOLATION TESTS: 61Residence ❑New EoAeplace ' Lly ATING: S= Site suitable for system U= Site unsuitable for system :)NVENTI NAL: MOUND: IN-GRn-S ND-PR RE: SYSTEM- N-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 0Szu l~-s~u 2u❑S&u OSLR Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the nder s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: f PROFILE DESCRIPTIONS DRING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN. ELEVATION OBSERVED EST. HE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) •i D4 i3wsz L' 7-1dyoer. /of 36 170,1 Of -111,440rj J6 11,02 o = 33 S s vL %W l3y.NO7' 30 /0 " 5 ii r` L isrl i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES JMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD P R D P I PER INCH a v 7• i/ 3~ 11 9 i ti :)T PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe'•.vhat are the horn tal 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 'and slope, YSTEM ELEVATION X39. 2 I ) : . L7 r~3oR 1a4C - - U D/h, i;OPoF 04 AC~MDAT/t7.V r0 ~ 1 ! _ t / j-- 1003 No , u5~ _ I /Co. . i ~ qy y p RIVE - l~.r 42 10 - "oi. -J L J_ he un ersig7A T Pa ned, . ereby certify :that the soil tests reported on this form were made by mtAacord with the prot:edures and methods SP.,22d in the^WUon ninistrative Code, and that thtt.` ti 4ibrded and the location of the tests are correct to the best of my knowledge: and belief. y Xt `t7a► .ME (print : TESTS WERE• COMPLETED ON: ~D E C TIFICq I N NUMBER: PHONE NUMSER(optional): "fr o ? lob' s-T = ~ a 5- 716. a T GNA'TURE: ~4' ;TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. .HR-SBO.6395 (R. 02/82) --OVER - 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 LYLES PLUMBING & REPAIR Owner: JIM HURST RT. 2, BOX 47A RT. 2 BOYCEVILLE, WI 54725 GLENWOOD CITY, WI 54013 RE: Plan Number: S88-04992 Date Approved: November 28, 1988 Gallons Per Day: 260 Date Received: November 17, 1988 Project Name: HURST, JIM Location: SE,SE,34,31,15W Town of F'OREST County: ST CROIX Fees Received (Priority Review): 260.00 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 PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 266-•-8230. i i i SBD-6423 (R. 08/88) State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION L_YL_ES PLUMBING & REPAIR Page 2 II Sin erely, O KEN ETH STIEMKE Section of Private Sewage f Division of Safety and Buildings PPP016/0009n/ 4 cc: JIM HURST _-Private Sewage Consultant ---County UW--SSWMP .-....Plumbing Consultant Owner Plumber Environmental Health I SBD-6423 (R. 08/88) ' State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION November 28, 1988 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 Jim Hurst Route 2, Box 256 Forest, WI 54013 Petition No. S88-04992-P Dear Mr. Hurst: Re: Jim Hurst - Residence Onsite Sewage System SE,SE,34,31,15W Town of 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 November 21, 1988. The petition has been conditionally approved. The condition being that in the event of failure, the mound system shall be replaced with a holding tank or other off-lot system. The rule requires that a mound system have a minimum of 24 inches of suitable natural soil. The variance requested was to install a replacement mound system on a site with 13 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. S1 ,-brely, i ichard Meyer, A chitect Director, Office of Divisi n Codes and Application (608) 266-3080 RM:KS:1088g cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Lyle's Plumbing & Repair SBO.6928 (R. 10/87) Straw, Marsh Hay, Or Synthetic Covering • ; Distribution Pipe Medium Sand H ~G Topsoti F E li D 1 3 ~a % Slope Trench Of Force Main Plowed 2 2 From Pump Layer Aggregate Undisturbed Sgg0 4 9 9 2 D 2 Soil E Cross Section Of A Mound System Using F s 3 Trenches For The Absorption Area G A 3 Ft. H B Ft. Signed: I Ft. Lic~2e Number: J 11 Ft. I K 1J.,5 Ft. Date: L q O Ft. Alternate Position of Force Main W Ft. L J ~ g K A - - - ..J C - _ Force OL Main From yy Observation Permanent Pump Pipes Markers l _ » `Distribution Trench Of 2 2 2 I Pipe Aggregate SA S c Ica o~ r tir~A ti~51? sin Dena ~b,.,, sorpt n r f % R r> , i J ..p4992 Page _Of S 88 Perforated Pipe Delall t. End View Perforated End Cop PVC Pipe oo~~ `e Holes Located On Bottom, S Are Equally Spaced PVC Force Main • From Pump 7 Q PVC Manifold Pipe Alternate Position Of ~O,ttribulion Force Main From Pump Pipe Lott Hole Should Be Neat To End Cap 1 End Gap /J Distribution Pipe Layout P 3 r R X Yc21 Signed: "-XU/P Hole Diameter -L`- Inch Lateral I/L Inch(es) License Numbe : EM Manifold _ Inches Date: ( ~~E Force Main Inches S PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS •v VENT CAP 8 88 W 049 9•2 'i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIRIG JUNCTION BOX MANHOLE COVER ~ 25~ FROM DOOR, 12"MID. WINDOW OR FRESH I AIR INTAKE I GRADE I 4" MIN. i IB" miU. CONDUIT 11~ INLET PROVIDE I AIRTIGHT 'SEAL I II v APPROVED JOINT A cj I III APPROVED JOINTS G~S~ I I I W/C.S. PIPE W/C.I. PIPE ~A,A I III ALARM EXTENDING 31 EXTENDING 3 `O``s I i I ONTO SOLID SOIL ONTO SOLID SOIL I j s n ~ I I ON C flu ~ ELEV. FT. > r ` ~Vlc+°~~y P J OFF ONCRETE BLOCK RISER X T R ~1 ED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFICATIOUS DOSE TANKS , MANUFACTURER: fr11c+~LJe Pro9-cot- WMBER OF DOSES: PER DAy TANK SIZE: 750 GALLONS DOSE VOLUME ~,I t150 15q, I GALLONS ALARM MANUFACTURER: n K A12r't INCLUDING BAGKF~~LOQQW: 91 MODEL NUMBER: 1 ~A CAPACITIES: A=~ INCHES OP. 315GALLONS SWITCH TYPE' ' La B = 2' INCHES OR n3~3g GALLONS 2 PUMP MANUFACTURER: 0 t I, `r r C= Ill INCHES OR -72210 GALLOWS MODEL NUMBER: '3 - D= l O INCHES OR 177 ' GALLONS SWITCH TYPE: H 9~1 NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE- 16 --GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 5.0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2.5 FEET + 2, 5 FEET OF FORCE MAIN X 3'yg FYoFtFRICTIOII FACTOR.. 'v FEET TOTAL DYNAMIC. HEAD = FEET IMTERPJAL DIMENSIONS OF TANK: LENGTH ! ;WIDTH ~=--;LIQUID DEPTH SIGNED: LICENSE DUMBER: DATE: 8 CURVE and DEWATERING E TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE ' i EFFLUENT AND DEWATERING 53.55 SERIES 57.59 97 137.139 151 163 165 16s 766 169 r 16 r, FT. M Gel. L1rs. Gel. Urs. Gal. lira. Gal. Urs. Gal.'.* LUS. Gal.: Lira. G♦1. Llrs. Caii. Llrs. (311.. Lira. 34 I 1 10 S 1.52 43 163 57 216 104 394 106 ; 401 61. 231 61' 231 A 85 322 10 3.05 34 129 X51. 193 79 300 100 378 '61. 231 61; 231 65:; 322 .,;.15';. 4.57 19 72 43 163 64; 242 :91.' 344 '80; 227 `60! 227 X85.` 322 i 32 1105 20 6,10 27 104 36 136 82 310 59 223 6b' 227 85 322 1 - - - - - 25 7.62 8 30 74 280 57 ? 216 59 223 85' 322 30 9.14 65 246 65 ; 20866 220 -90 340 ,.'t b6 322 301100- - 40 12.19 46 174 46 172 '55' 206 75: 283 <69:; 337 83 314 50 15.24 21 80 33 125 .51' 191 58 219 73` 276 •77 292 ! 955 60 18.29 15 57 43( 161 36 136.57'- 216 •:67 253 70 21.34 30'- 114 10, 38 37: 140 •:,S7.fi 216 28 80 24.38 .14. 53 .t3`: 49 -:411Y 178 90 90 27.43 4361 138 100 3048 80 i 26 -j 85 Lock valve t9' 24.5' 26' 56' 66' 87' 1 73 85, 110, i 24 80 75 189 88-04992 22 - 1 70 20 - 65 18 60_ 55 16 50 14 163 188 ~ V 45 12 40- r ~t HIV - 35 - 10 M DE 30 - - i Us 8 25 6 20- 1 1 j`I2 ~EL 15 4 15":, E-t 2 55, 7 0 3ALLONS 10 20 30 401 50 601 70 80 190 100 110 LITERS 0 80 .160 240 320 400 /7-31 A)/72 ! S` Uj G ~ c"~J c..c) V (1.7 l.. I ~.S ~ ~cc) 2 S 88-04992 . I ~ ~ rtJ C'--; 1 U - - - - - - ISM~ LO ~ rU C S /U A y ~~~70 7O 6C04n tLpilf/J I:T 2 v A ~~7' ~ SCEs I B , r~-• U-1111% Arc 51'r 07 o • v Col., 5 C_ Ap4s ' cx~ e ri GYl~ 2 ~ v/ 4 0 t2 6S 20 O.Q ~►'~p l ~ ~ - ~ ~ t ~ C ~ - ~~3~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION N LABOR P.O. BOX 769 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOC C E,/4SW sE3 q /T3 I H/R 16)(or) w TOV~(N6) IP'JE.5LOT NO.: BLK. NO.: SUBDIVISION NAME: SAS COUNTY: OWNER'S !CAl " 1fm H0,1sr 74V $T. OIX USE DATES OBSERVATI NS MADE NO. BEDRMS.: COMME IAL DESCRIPTION: 2~r P FI LE S R PTION9 E LATION TESTS: Residence ❑New IQReplace I~ RATING: S= Site suitable for system U= Site unsuitable for system CCCJJJ J U V G~ ❑ CONVENTIONAL: MOUND: IN-GROUND-® URE: S~EM-I ~ LHO~LDING L/,JTANj :RECOMMENDED SYSTEM: (optionaq If PercolatioUUn Tests are NOT re uired DESIG RATE: ` Q ( If any portion of the tested area is in the , A under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: z--VLTl PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i / ~ ~ 1 3 6• RD,vg , B- 7 3 D 3 B- 3 S. O 13 SA ME A S 30 ac a+o'f B- q 1 '7 2- / A- 0 tmo, 4- Or B- ~5 30 /O - lo" 0-1bh4yjt12-Jd1.,rBA0 c G I' B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH P-ME 20 111A q - P_ At E 30 P t '1 P-. P- i 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. w , SYSTEM ELEVATION 91 V t 100. k I ; PEAL ho[E . D • Ci vRE Mmt O I ©=.(3M Top of 01D;fiwnro4Tj0f4 &i t too. - - P_ 7 f t A i a ~I 1 S { T 1.4 1 ~ C I, the undersigrtl~drhefe y c F t7f'yhat the soil tests reported on this form were made by me in accord with the procedur and tho8speLiflErd'Tf isconsin 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: ADD SS _ C RTIFLCATION NUMB R: PHONE NUMBER (optional): el wis -CST 3696 /2 C IGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. II DILHR-SBD-6395 (R. 02/82) -OVER - INST U TIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a cornpf urat yocnF report must include: 1. Comp! :e I ~>tion; 2. The use s(~ ust clearly indic 'tether this is.sidence or commercial project; 3. "-4AXIf" f " Iro+ is -or nercial u ~I; SITE IS SUITABLE FC HOLDING TANK; ONLY IF ALL. f BASED ON SOIL. CO S, S. PI_ use t' ,.e~ e for vvritirm, scri.ptions and completing the plot plan; 1. 1 LFP : 1-:-Sting your t Locations. Dravying to scab I:-° r red. A 'io, referen< t clearly ho'Xes as to date', names, act;;. plain ,xernp- elevation} do s "t 'iate =pox; 1 , ~I 9ress and yo it, '.)n W as requifer.l, ALL TESTS I ILED VVITH THE '10 DAYS OF COMPL.L JIATIONS FOR CERTIFIE Tr- Suit rnd :Is t J Is - y Sand `sI Loam < z B n - SrGy Y y L Clay f, " Clay 01.0 Iota 5f,► I_ . a t m t Ix, ~4.41so ~7l { y~r.►.o~ CaaQ No DoT R t HWL - High wat ~r I 0 surf ,r ; IJ * Six ger-'al e; t°ue 11 \ tot Iiclrr"d f BM - Bench N X00 V RP - Vertical R ~;1~ A i % r. -r' may request r The private -filer to i _.J V 1(500 ' 0.3s In 141- 4-1a Z .z ~ _ /G