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HomeMy WebLinkAbout016-1054-50-000 _~l Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER, V -W TOWNSHIP o/X SEC. T,30 N-RI ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT - LOT SIZE O C' ,Q PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /D (f 4- l,~ EGG ~r~d lAL Se~r`~~ t.4 N r . PNMP 1'HN~,' j 3.t V deus ~ h~ 0 ~Y ~e oN PoedH > OCT j S 1yc3 0.14 1 r . ST CPO X INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used tqv 12 gj_ dqY ely Pogyl,i Elevation of vertical reference point: lee Proposed slope at site: L SEPTIC TANK: Manufacturer: Liquid Capacity: le d 1 jr-A Y_ Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Q Side, Rear, O l feet From nearest property line Front .0 Side 10 Rear, 0 feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic r SEE REVERSE SIL'E PUMP CHAMBER Manufacturer: ~v• e r S Liquid Capacity: eG" G 6 /1 L .~}P Pump Model: y Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Sf'r-l-eel%64 DAlarm Switch Type: L'ti/S~v Number of feet from nearest property line: Front, (D Side, ® Rear, 0 Ft.~ _ Number of feet from well: Number of feet from building: v2 J (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Q Rear,0 Pt. ;2- Number of feet from well: Number of feet from building: 71-l' (Include distances on plot plan). SEEPAGE PIT Size. Number of pits: Diameter: Liquid dept Bottom of seepage pit elevation: Area Built: Has either a drop box O o istribution box O been used on a of the above soil absorbtion sytems? (Check one). HOLDING TANK / Manufacturer: Cnpacity: Number of rings used: Elevartion n. bottom of tank: i - Elevation of inlet: Number of feet from nea -est property line: Front, Side, O Rear, 0Ft. umber of feet from well: umber of feet from building: 'dumber of feet from nearest road: Alarm Manufacturer: _ Inspector: Dated: f e l if Plumber on job: License Number: ,i .1 State of Wisconsin \ Department of Industry, Labor and Human Relations i SAFETY & BUILDINGS DIVISION f`f 201 E. Washington Avenue P.O. Box 7969 NIIQU St L«, 1 Jts Madison, Wisconsin 53707 1i . Sn1 rl e y Jasr7f rson Ci enwooo (A tv, r!' l -.~~~Neti t i or, Ego. Si✓' - 1 1 ._p near :•:s. Jasclerson. 4_; y ~ ( f' i ~ e 11 t" . V ii irI -v vdCi D E.'. ;`'.on - I[[~si `tc Sf. wdofx ~vste. aIC~,S^~, r 7 lr)~tr of ' lermow,, Si. (.ro1x, lr~(IG.~'. 1. ` r w ~ Sl.l.~,ti L~ Iltl SECT 'n l ~l~.i:4 f 1 1 , 1, scor'si `utxitutect cow, s b)! Wisconsin nt for d Von inCe ~,(i(T;i rri strati v Cone, a I i ow the uovner to C E :"1 tli3n t le arc'>crtrJe to tope 1 nsti l l ati il(r tor i',n CYISI tt_ c,: )..<zU(' YStt.i;s to Y'r Ul oLE' an NX1 sti rio UYISIte sP;Id(4e SVSter~i at a site t:iiic n is not > ti= I 1 ~i;iCl ; 3nCf' vvi toc' sl tl na Stan6aY•r4s in f~cirreinistra*ivP r•ult. T iA svs r.eri desicn crouaseti should Drtitect the. waters k i tilt-, state tror;l c ,n ::i~r;ii sari ofi, it ;his svstem ecories a fai l i no svstef o) contar-ii hates t; ,'caters of vie state, t0 s var•i anc"e sha 11 be resci ni1eC. Tl.e ueti ti on for variance recuestec; w s. ELhiii ('I) td! of inie ;pis. A,r% -oo7 `lids c'ita5lr'k r+=4 on Aucust the petition has ueeo auDroved. lt)e riI lP r':.aulres ':ourl i svsl•.eua s't' to i,ave. 3 r?onlcwi.; iJ t'G inches of St.itdble natural sail. ThE, variance r e~rjk ~e~a was to install a reD l dct,5lent i,..ouok. s,vstelr, on a site with 13 inches of suitable natural so-! 1 . All of the t,ut« an,0 statelreents SCLIrlittea on Denalt of Lhe, c,er.itioner were ccn0 n'ererl. This era ri anc,a is SUPCi f i c Lo tile SUb.iect DE:ti ti on and cannot be used. +'ai° anv ai(liticn;iI ~:wlitic a.tion.7. ~i itCer""f'l' , rliC.r!arci never, FrC.iriteCt. -i rec tor, Ott i ce of A v-"-si on t'00es ar=-r Avr'licatior, cc : Leroy sansnv, °ri vrzte ' C-k4 QC- UhLUl t.a,,r - Li strict Chl uoewa Falls C. of :K :.(;uoty ~tlof~-ias rvr i ~Un, ?Oril nQ Adr'i Cll Str'dT.t?r - S'~. Gale SI;IiVi, Aannt SBD-8928 (R. 10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION NkzvAl ss w,4 A~~'~OM trti if ;it '..1IvP,iun foot" and Appi ic.iation ~ rl . n;t tea°hlnElt+art l~ur:riUk' t~'... "P it bux i~.Jtl °f' l ♦ r' 4 .ter taAL_F W. ;)M iH 1228 111'WIWAY I Ili ftb`t.NUI 1:I4tiI t gY L~:.~ s a1 t. (:lnilt;l.i t J I'y ~ iF! i.ii OLt`:iVW{100 t l 1 Y , WI 1-9 _ RE, Flan Number: ~89_01819 ;U,3U"i G~ ~~~r?'a C,a 0115 Per, 6ay": 40 OatI, Wt",Ivod itllgust 1Y 4Ei4 Ptoject Nawi'. JA`>KIJkk'SON, ,11IN i Y i h::at ioti: own Of 61-E.PdW000 * it lC~f.irtnS tt ttl~i , Ur plumbing pia n'> and S1*( compliance wittl a ,lc.abl4 t°rfdc reluirr~rcicnt-_ i~je( I #0v i7E?eri tse on tar ~ pp t ' I - ttt't , <lp,Ii~ cia! i ~ based based on C. tiot+ter -145, Wisconsin Statutes and the disc owl n Adrrtlnistr,it vFr !:,ude. the plans are stamped 'tr0rlcl1t100dlly a{~hroved' Ih!- al.ilitov'Il coni'Inyent: Upon c-Ciwpllanf_e with arty ,tipulatiuns shown on trig 9:~~larlr>. l'.i i itpi . tt'cat tire noted rnu~J bk, c orrec led. All permits reclu'ir~ed by the city, vi l laitt-, towri hs p (it cliunly Jiai i be obtained prior to cons4:iuc:tlon. ilie 1i(_onr'od plumbef r+stx~ns'Itilc~ for th"IS 'n5taliatitjrl Old l l keep one Set tit plai'is whit t.la(;, 01-F dI trleVII al)',1T 0 'dl ~ tat ,9 at t:hc" construction Site. Ilie 'Iw,tr~' I If r sE?a I i not; ~il.y tho aiti?r0,l,r 11,10. ins>liec for wt;Wrl inspet,0011s can be made. Ithis apNtnva i wi l i expire two year- it ~wl t1 iti' de't- Ipl't"wry ' i <~I ii0+ ~atlttar~y per'nlit 1S 13tit6,1nf'(I, it wilt If ri1t~ day l, irr Itif+.li i ,z.triitclt'„ Ihra 1 Jorl of Pt ''ivdt,' ~ ewayf' lids rr^vIf'>Ned tits-``-f' f~ian`.~ 'o N~f iv tr cw,dq Syla (1-t1il-1rerrent.s only. Ihi-'e p'lan`t have rr+)I bi-'f'n ' `~~It41^.i ti3t IrPe' f'otJk r'f~',1tlltH1100" , Ff4 tcirtri In `)ei t'tltn li_iiR iy~ flit ;i>`r;t>ra I i)Ifftiii.t lIJ'j o, i(i ltrti ir...r}4 it the Wisr_::rnsin Adsrri Ostrativcl code. t his appt6va i i 4 I Cs i ite t" 1f 1 1 cjw I (itj Wil? )f f?r'it ?ri 1 kt VLA(,EM£N t 1'l. 1 1 i ION - RE PLACI:M[N I MOUNtl Inaiuir'I es cc irli.}'.rtlin(j t h i dpprc.cuaI may be midis, Ity + al VIt riil {60"), !Ut,-39 1 ."Onc ere l y, JAMES QUINLAN Sec t:iarl of P1,ivatc .,ewatj tlivisiari cit `>atety and lu<Icilrig: , HIP012/0009nf 1 t.c SHIRLEI` JA)11tk1,yON Fr1vate `,atewaye t1'0`6 UItar# ChW~tiitant SBD-6423 (R. 08/88) - (IWtit: r __..._I, 1 k1r11ho r t n V l r c:,rnlleri t a i Nl' a l l 11 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 SE 4SW4, S24,T30-R15W ❑CONVENTIONAL ❑ALTERNATIVE Slate Plan I.D. Number: Town of Glenwood El Holding Tank El In-Ground Pressure ❑ Mound 140th Ave. NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D TE. ~Q' Shirley Jas person 3234 140th Av. Glenwood City, WI 4013 4 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: I(IST-RET:. PT. ELEV.. Name of Plumber: JMP/MPRSW No.. County: Sanitary Permit Number: Gale W. Smith 5690 St. Croix 123645 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET &NL ABEL LOCKING COVER PROVIDED: g7 C~3 6, ❑NO ❑YES EVNO BEDDING: VENT DIA.: vENT MATL.: HIGH WATER NUMBER OF ROAD: : BUILDING: IV ENT TO FRESH ALARM . AIR INLET FEET FROM ❑YES NO r ❑YES YNO NEAREST DOSING CHAMBER: 1RER. WARNING LABEL LOCKING COVER ~y PROVIDED: PROVIDED: MANUFACTURER. BEDDING: LIQUID PACITV. PUMP MODEL. 7MAIN Av& a r~i DYES ❑NO 0 ( 7 ~ YES ❑NO ❑YES C1KO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIOER OF PROPERTY WELL. BUILDING: IV ENT TO FRESH 7 AIRNLET : ~J FROM /s ly. (DIFFERENCE BETWEEN L I N E PUMP ON AND OFF) v YES ❑EST 7 SOIL ABSORPTION SYSTEM. Check the soil moisture at t e depth of lowin DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until Fthe soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH NO, ONCHES: IDISTR PIPE SPACING COVER INSIDE DIA #PITS LD EQTIH MATERIAL' PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES ABOVE COVER: ELEV. INLET ELEV.END . PIPES FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM anal furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑N• SOIL COVER TEXTURE 7ALNT MARKERS: OBSERVATION WELLS. ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED: 1111ULU111,11. CENTER. EDGES. ❑YES ❑NO ❑YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: BED/TRENCH / TRENCH: DIMENSIONS 1Y li~' /I S MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV. - EL 'J DIA.. ELEV.: PIPES- DIA. ELEVATION AND e al- ~o~rJ~I ~V p~ DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLES HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS. YES ❑NO ES ❑NO COMME S: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LI 3y~ ~,7 LYES ❑NO YES ❑NO NEAREST .rL Sketch System on R tain in county file for audit. Reverse Side. SIGNATURE TITLE: DILHR SBD 6710 (R. 01/82) DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COON STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El a d3 8% X 11 inches in size. eck 1f 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. Q PROPERTY OWNER PROPERTY LOCATION T,4s,0e1?s-&1V 57,F % .Si~1'/a, S T , N, R / or) W PROPERTY OWNER' MAILING ADDRESS LOT # BLOCK # I a A Ile -72 36~ CITY, STA ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER G~.e wod ~Cr ~ 3 0%~ :~6s' 6~ II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE G4 eHw O Cam/ /4/0 ❑ Public IN 1 or 2 Fam. Dwelling~# of bedrooms PARCEL AX NU BER( ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 7 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. El New 2. © Replacement 3. El Replacement of 4. El Reconnection of 5.0 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.) PROP(SED`(sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION J~ _1/~ .3 ;l3 , F7,,577 _I al- 957,- p / Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank h0® Ge/1~.~' Lift Pump Tank/Si hon Chamber Xd-, d0 Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (N Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTYIDEPARTM T USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) XApproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination el 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 L 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 subr'tted 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) DEPARTMENT OF 671REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RUATIONS (ILHR 83.0911) & Chapter 145) : LOT IBLK. NO.: SUBDIVISION NAME: LOCATION: SECTION: TOWNSHIP/73GI~WRESS'/, '/a '/a /T.~D N/R f(or) W C r COUNTY: OW R'S/ NAME: : L~ 1 vim. e/~rc, ead a C DATES OBSERVATIONS MADE USE : PER OLATION TESTS: NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS Residence ❑ New Replace RATING: S= Site suitable for system U= Site unsuitable for system EESYSTEM: (optional) r ONVENTIONAL: MEWSi IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOM;NID ❑ S ®U ❑U ❑ S ®U ❑ S YU ®S ❑U 1/ Al d DESIGN RATE: If Percolation Tests are NOT required I If any portion of the tested area is in the under s. I L H R 83.09(5)(b), indicate: ` f Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH 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.) B X97' 13- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 XR, PERIOD P_ 1 d. P 2 0 D Z° I F / / PL 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 99~ 9/ / ©F SANd Xey ~r;,~d _~Nd~t SyS1R"erv~, P/ - q 71.17 9" P.? 477. 6' Pia rRc ~ S R3 q~, /K.4PIe 3h'RM twee lvl' to 4tse. 310 A e, i? e- 4, t TN 4 cZeS tepe B3 r y 1. 578` a P.tIh7 Pv.RL"W daife, i, the undersigned, hereby c tify 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 tha the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATI N NUMBER: PHONE NUMBER (optional): 01 ~elvtvdod C ' 4.1 3 CST SIGN TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - DILHR-SBD-6395 (R. 10/83) OVER f:. MOM9 INSTRU TIO, _ i 1 - T ,yoiii- rep( I. cc Jett: 3_ m h li 4_ is v 5. xes. A S FABL'~ 'A.D1NG " !FALL OUT al d cc) P1_ . C s staewF Iaef;Ur"atE [ "Our + ing to i5 A desired; and vertical elevation refe€-enc ,hovvn, and are permanent; - -te boxes as to dates, names, acv-, ~ ta, percoh, ion test exemp- 10, tl~ in _3r n r , (such as flood plain v. Jon) dons no ply, pla~ ate box; 11. Sign the foram and place your cur rd your certification number; 13, Make legible copies and ~ as ired. ALL. SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAY~_ COMPLETION. AE_ TIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st ;tone (over- 10") S Bedrock. cot) CoPl le (3 - 10") SS - Sandstone gr Gr% l (under 3") LS Limestone `s HGW - High Grocmdwate} r;s C, Percolation Rate need s Medium 1 y,+ttell fs Fine S,-n . I L~i€ig - Building is - Loamy & > Greater Than sl Sandy Loan) < Liss 'Than Loam Fan Brown sil Silt. Loam, BI Black si Silt Cry - Gray x.t Clay Loans y fellow ,cl ; y Loam R - Red sis;,' mot lalissttles a y vv/ with tff few, finN f, c y - common, pt: iJl~ar y, i distinct HWL High water level, S l t~x:€sr~.xs su face, Via ter or ,_u r Waste disposal Ben fi F. TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. i 1 State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 GALE W. SMITH Owner: SHIRLEY JASPERSON 3228 HIGHWAY 170 3234 140TH AVENUE GLENWOOD CITY, WI 54013 GLENWOOD CITY, WI 54013 RE: Plan Number: S89-01819 Date Approved: August 28, 1989 Gallons Per Day: 450 Date Received: August 21, 1989 Project Name: JASKPERSON, SHIRLEY Location: SE,SW,24,30,15W Town of GLENWOOD 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 PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 266-3937. Sincerely, C JAMES QUINLAN Section of Private Sewage Division of Safety and Buildings PPP012/0009n/ 2 cc: SHIRLEY JASPERSON -Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant SBD-6423 (R. 08/88) -Owner -Plumber -Environmental Health State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue August 28, 1989 P.O.Box7969 Madison, Wisconsin 53707 Shirley Jasperson 3234 140th Avenue Glenwood City, WI 54013 Petition No. S89-01819-P Dear Ms. Jasperson: Re: Shirley Jasperson - Residence Onsite Sewage System SE,SW,24,30,15W Town of Glenwood, 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 an 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 August 22, 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 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. Sincerely, Richard Meyer, Architect Director, Office of Division Codes and Application (608) 266-3080 RM:JQ:2961h cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Gale Smith, Agent SBD-6928 (R. 10/87) 1 S is u i-m ge, - N u, ~~2L ?r J fin e .,e e ~,t L S e o tHti/~ l~ ~ G~ PIN& v'o C, 6 h Pei M P r,4 IN 133 ` N 0 ~'~~-N "SraM P 3 ,8R M F Q/-/ c a 6 / to F' o Ilk , 67M /0'0 p / ,230 ~c+I~IC~ ~'JQ~CfI ,Lc?d,% e aAl 57 M,4//v I'G~efl~ Zi t 51sreM o I ONSITE SEWAGE SYSTEM 9 t cc,gc6. ccW4 waft ram, V;~% m DEPARTP ENS Or INOUSTR.Y, LAB-,.!R AND I UPS AN RELATIONS DIVISIOf4 OF SAS E ~NL' i3UILUiP', , IV/ SEE CORRESPONDENCE Page / Of .3 Straw, Marsh Hay, Or 89 AG 21 AN 948 Synthetic CoverincJ Dis rMution Pipe Medium Sand G Topsoil F 3 E " ~ b r%--S I io p e - Bed Of -2"-2 1? (Force Main Plowed Aggregate From Pump Layer .Q Do, 9a Cr 11L (ninon Of A Mound System Using C2'0~!f A Bed For The Absorption Area F A, G c~ `NCE A Ft. H L~ SiA C" I~ Q Ft. f t. License Number: I fl~f~✓5"t~~0 UYF J Z ,o Ft. Date: O-~__:.. K /S Ft. W.2Zff Ft. iv L Observation Pipe B -K - - A 177 Force Main W From Pump istribution Bed Of 2~- 2 2 Pipe Aggregate E;` Observation Pipe Permanent Markers AU G 2 989 0e PlC 0-F F)IV1Ce *r Plan View Of Mound Using A Bed For The Absorption Area Page ~7, Of 3 A 9: 46 Perforated Pipe Detall kA 4;1v 0 00 End View Perforated / End Cop)) PVC Pipe 1. apce I e% Hole ocated On Bottom, S re Equally Spaced A s r Distribution Pipe Lost Hole Should Be Next To End Cop End Cop Distribution Pipe Layout P q / S X u y . .2 L Signed: Hole Diameter Inch Lateral_ Inch(es) License Number: Manifold Inches Date: Force Main " ~ Inches ONSITE SEWAGE SYSTEM soft wolp. AUG 2 1 1989 AP "'1v 11 DEPARTMENT OF INDUSTRY, LABOR AA!D HUMAN RELATIONS OFFICE OF DiVIS1;0°N, DIVISION OF SAF AND 6UILQIN S 1 SEE CORRESPONDENCE PAGE OF PUMP CHAMBER CROSS SECTION AMID SPECIFICATIONS VENT CAP `i"C.I. VEPJT PIPE WEATHER PROOF APPROVED LOCKIMG JUNCTION BOX MANHOLE COVER 25 FROM DOOR, '.IINCOW OR FRESH 12"Mlll. AIR INTAKE GRADE I y'MIN. 18"MIN. COUDUIT 18"MIN. 11~ INLET PROVIDE I I _ r , r •A}RflT SEAL I I I APPROVED JOINT`','. A I APPROVED JOINTS C. -I. PIPE ( F i III W/GI. PIPE EXTENDING 3' I II ALARM EXTEUDIIJG 3' OUTO SOLID SOIL 'U B f I I I ONTO SOLID SOIL T- 4~ I ON ELEV. FT. OFF CONCRETE BLOCK RISER EXIT PERMI-ITED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC 5PECIFICAT IOKIS D051- ` . TANKS MANUFACTURER: It/-,a P. ~S NUMBER OF DOSES: PER DA-'J TANK SIZE: /!%UO ¢ d?CEO GALLONS DOSE VOLUME ALARM MANUFACTURER: Se'ot f)? .0 INCLUDING BACKFLOW: GALLONS MODEL IJUMBER: LO/ 1142 CAPACITIES: A=ZIMC14ES OR GALLONS SWITCH TYPE: e~ R l~ B INCHES OR l GALLONS PUMP MANUFACTURER: Zee L G °X? C= ~ INCHES OR23 q ~ GALLONS MODEL NUMBER: 9 y / D= !q INCHES OR ~ GALLONS SWITCH TYPE: FLE'~ RO I MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE2GP~y I~K INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE HETWF.€N PUMP OFF AND DISTRIBUTION PIPE.. 3'0 FEET S 89 + MINIMUM NETWOI?„ SUPPLY PRESSURE . , • • • , , • • • • 2.5 FEET Vey + 230 FEET OF FORCE MAIN X LCYoFLFRICTION FACTOR..1/ FEET TOTAL DYNAMIC. HEAD = Ls ,4 FEET INTERNAL DIMENSIONS OF TAA1K: LENGTH ;WIDTH ;LIQUID DEPTH ` 51GNED:~`~"'~`' ~~~%rrv~ d LICEPISE IJUMBER: ✓ 7v`~ U DAT E: L~! 5 N ETERSYNAMIC HEAD FEET/ ~ W HEAD/CAPACITY CURVE MTOTAL w U. MODEL 97 2 CAPACITY GALLONS/LITERS 30 CAPACITY HEAD UNITS/MIN 8 FEET METERS GAL LTRS 25' 5 1.52 57 216 10 3.05 51 193 0 15 4.57 43 163 6 20020 6.10 27 104 X - -t Lock Valve 24.5' U Q 15' C J 4 Fa- 0 10' 2 5' 0 US 10, 20 30 40 50 60 70 80 90 100 11,0 GALLONS LITERS 0 80 160 240 320 400 CONSULT FACTORY FOR SPECIAL APPLICATIONS • High water alarms available. • Electrical alternators for duplex systems available with mercury float switches. • Long cords available. • Mechanical alternators available for duplex systems. • Over 1300F. - 540C. special quotation required. • Variable level long cycle systems available. Zoeller Co. can provide complete packaged systems or combination of components including controls, pumps, polyethylene and fiberglass basins. SINGLE PHASE UNITS Cast Iron M97Au omaodel 1Ph S.P. 1Volts 2 6pS W33 tlbs. 41 1 D97 Automatic 1 .5 230 6.3 33 1 bs. N97 Non-Automatic 1 .5 115 12.6 33 1 bs. E97 Non-Automatic 1 .5 230 6.3 33 lbs. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is an engineered/design part of every Zoeller pump. 3280 ON Millers Lane Manufacturers of . PO. Box isville, Kentucky 40216 ZZY-1,lb-7 TZ7. Lou (502) 778-2731 QUAL/TY 14MMP9 SNCE lffi9 DEPARTMENT OF REPORT _ ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION HUBMOAN REDLATIONS PERCOLATION TESTS (115 P.O. BOX 7969 ` ~ MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/A4 L T NO.: BLK. NO.: D N/R 111(or) W COUNTY: OW R'S NAME: MA L A DR SS: 3W/ USE NO. BEDRMS.: COMMER IAL DESCRIPTIfON: DATES OBSERVATIONS MADE ITIPTIZEIr. LXResidence ❑New Replace A STS: 7 f~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUNp: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:''optional) os ®u s ou _ os IKu as u ®s ou u d If Percoleticn Tests are NOT required DESIGN RATE: under s. ILHR 83.0915)(b), indicate: If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING) TOTAL DECHARACTER OF SOIL WITH THICKNESSCOLRE, AND DEPTH NUMBER DEPTH IN, ELEVATION E I ,HEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- v~ NO F v L a_ LU 9.18 m B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME D OP IN WATER L V ES -NUMBER INCHES AFTER SWELLING INTERVAL-MIN. RATE MINUTES / PERI D 1 ERI D PER INCH P / V r P- P- L 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. ffoIle SYSTEM ELEVATION a13oFSAtya( Re yiRed' GrNcleg pet? tr fiG Cr V Y sysY`-eM, ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 July 14, 1989 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Shirley Jasperson property located in the SE 1/4 of the SW 1/4, Section 24, T30N-R15W, Town of Glenwood revealed suitable soils to a depth of 1.17 feet, after which seasonal 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 : sna • I ~ Y.~11MJ 80 iWWYfYAlwi.•..MMN'M:MMNI1r.MNVAMWlY, Y1q• • ~ ~ ~i ST. CROIX COUNTY ABSTRACT COMPANY HUDSON, WISCONSIN CONTINUATION OF ABSTRACT NO. Februg-r' 196 at 8:30 o'clock in the A•M. From the 9th day of of the land described as: . - Part of SEA of SWo follows: Same Section described as fo in the Caption at No. 73. . 81 Francis W. Jasperson; and Release of Financing Statemen Shirley I. Jasperson, Filed Aug. 3, 1970 @ 8:30 AM. ) -and- United States of America acting through Farmers Home Releases Financing Statement Administration. filed in Doc. No. 233870. q'. 82...•..M.......~,~....AITVQ'f..r,.m-r•n„:w.r.':•a:. -.rna.-r rM••r•.rt ri Shirley I. Jasperson, Mortgage. Con. $10,000. -to Dated Jan. 12, 1977• Ack. Jan. 12, 1977• First National Bank of Rec. '1Jan. 13, 1977 @ 8:30 AM Glenwood, a corporation. In "5`'x'7" page 520, #337633• Part of SEw of SW4 of Section 24-30-15, described as follows : II rner mencing 398 feet E of SW corner of SE4 of SW1 of said Section 24; nce N to the N .line of SEA of SW►,, thence E'approximately 363 feet; nce S-SEly x+25 feet to marking post situated 175 feet E of SE cor-{ of the existing ba rn; thence S parallel with E line of said sW4 roximately 535 feet to marking post; thence E-NEly approximately feet to existing marking post; thence S along the E line of said; SW4 of said Section 24 to the SE corner of said SW1 of Section 24; thence W along S line of Section 24 to Place of Beginning. Recites: This Property is the homestead of Mortgagor. II .•rwww.....w+.r+wrt+ 83 ry,,.,....s.rwww•rn•w sri n,,..:..w. v. c. .c s.... v, c .r, !I Satisfaction of Delinquent State of Wisconsin, Income Tax(Ito. C) Dated May 11, 197 . i -to- Francis. Jasperson• Satisfied in full on margin Mme. a of docket.. 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Ui F{IJ'I )0 1,)c11 YuJmolloj aya PaPA-rX •d pezP140T~j .r ..r Ol Na1 f113tl ~~wwj~'Y'„i'Y'Y ~Y IYWW Wer too obb 9Z~3...s'~UQTIou pu,~ ~uP"snat~y...x-~s.~h~~am~ - ~0 bu jo wns a1{t .)oj vuuo.)srx ' (auno~ _ "1 N jo as;uzt9 XTD.Z V- 6c:- ---lp 1Q41 '!y1 Pjooa){ IOj p,acaH 'ursuoasrAX 'dtuno aS 01 sluv.Ilrm plnl s~(anuo.) 6gaaaq ...............?cTt9cfi.,..$ 5......_.....jo loauw$ , 51M "off xI SVET ......OUT OLIT 'p Cr `.....,{9 aPr14 `:F2Ill.l:NffQNI SIF3.L VIVO oNIONOD3JJ JJOA 03AN393Y 33Vd9 BINi e WN0A-NlaN0J81M a10 31V18 - n L1 s' `e' if Q;aHQ A LXV'HHV a 4 BOOB 'ON LN3Wn00(3 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ >li~/~Q~e S/ v7-i¢S~E.~ S 4/S/ i ROUTE/BOX NUMBER /-I/O V ~ FIRE NO. CITY/STATE 6Le-Al 4.10d d 6;2*Y Z/^ ZIP ~'yo/3 PROPERTY LOCATION: X1/4 Gc~ 1/4, Section, T„71N, R__zl-5- W, Town of elyk) 0 n d , 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. ~J .;b SIGNE 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 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 Location of Property 1c) Section , T -3o N - R W Township E4 eiv to e v Mailing Address O 7~~ U Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel D C / S^ Date Parcel was Created b No Are all corners and lot lines identifiable? Yes Is this property being developed for resale (spec house) ? Yes No Volume and Page Numbers, `as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 1. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be erhelpful so as to avoid delays of the reviewing process. If the deed also be required. Map, the the Certified Survey Map PROPERTY OWNER CERTIFICATION I (We) eeht%by that ate. statements on this bonm ane tAue to the best ob my (ouh) knowXedge; that 1 (we) am (ane) the ownen(b) ob the pnopehty de,6ctibed in this inbonmati.on bonm, by virtue ob a waAAanty deed nee ed in the Obbice ob the County Register ob Deeds as Document No. and that 1 (we) pnebentty own the proposed site bon the Sewage pos system (on I (we) have obtained an easement, to nun with the above descA.bed pnopeAty, bon the conatnuat%on ob said system, and the same has been duty x nd)d in the Obbiee Z/ 7 ob the County Regiz tet ob Deeds, as Document No. c3Qc SI NATUR OF ER SIGNATURE OF CO-OWNER (IF APPLICABLE) mss, /9•~ DATE S NED DATE SIGNED 8,703 K 4.77 TLS C k 1