Loading...
HomeMy WebLinkAbout018-1011-00-000 C) o c O M ~ ~ I ~i a o I w ~ I b O O N b O ~ I 3 •O I O y Q7 ° ° Z I C I ' o I E U a3 V N II ~ ~ ~ y I ti Z C O am cD H Z I o oz `t z r ll z E co C O Z Z d w N z I N C a7 U ~ O. y y C A d ry. a) y O CD O a ~n rn to v> > Q _ z o 0 o a s Z •rv ~aaa y E 7 ° N ° N J U 00 CO Z ti D ID 0 zoom E W o o 'd m Q rn > Q z co co U ° R 16 O C M y y ~ M y c I Di O a) Q o m H a> d c u o r I,y OJ "m N c N 16 N 0 co E y C Z N d _ 'tJ N N E E cD :3 E ° • y~' o o= Y N o Z y H Z v ~ as '~a ~ a L a E C C +d+ t A cia~,l,0C)0 Parcel 018-1011-00-000 02/06/2006 02:11 PM PAGE 1 OF 7 Alt. Parcel 06.29.17.85B 018 - TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type III 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KELM, ROGER ROGER KELM 1533 CTY RD E NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1533 CTY RD E SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.300 Plat: N/A-NOT AVAILABLE SEC 06 T29N R17W NE NW COM NW COR SEC 6 Block/Condo Bldg: TH E 1501.76' TO POB CONT E 339.76' TH S 679.3'W 339.76 FT TH N 679.3' TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 06-29N-17W NE NW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 504/251 2005 SUMMARY Bill Fair Market Value: Assessed with: 90053 241,100 Valuations: Last Changed: 10/18/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.300 39,200 160,100 199,300 NO Totals for 2005: General Property 5.300 39,200 160,100 199,300 Woodland 0.000 0 0 Totals for 2004: General Property 5.300 39,200 160,100 199,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 212 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 I Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 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 , State Number: NEE, M DI ~ Ej ON, , W~ ~3701 7W Town o f Hammond ❑ CONVENTIONAL ❑ ALTERATIVE f assigned) Cnt Rd E ❑ Holding Tank ❑ In-Ground Pressure Mound Re lacement NAME F PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: PE N J_~ . Roger Kelm Route 1 New Richmond, WI r-- - 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: Calvin Powers 1563 St. Croix 128618 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF PU ❑ YES ❑ NO NEAREST 1111~ 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: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES E:1 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: Zoning Administrator SBD-6710 (R. 06/88) Thomas C. Nelson D~LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ swrn~rv ~ a~rwu.~v~.~nw„~w.v~ STATE ANITA PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Z~D 8% X 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PL I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 1 7 9 PROP OWNER PROPERTY LOCATION '/a '/4,S N,R or PR E TY OWNER'S MAILING ADDRESS LOT # BLOCK # I STAT ZIP CODE PHONE NUMBER SUBDI ~[SllO NAME OR CSM NUMBER NEAREST R AD II. TYPE OF BUILDING: (Check one) ❑ State Owned CITY ❑ Public ~ 1 or 2 Fam. Dwelling-# of bedrooms EL =W QF* TAX NUM ER(S) l ff / U~ _OQ Viii. BUILDING USE: (If building type is public, check all that apply) ~l 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 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. X Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E1 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 X Mound 30 El Specify Type 41 El 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 ,y Feet Feet VII. TANK CAPACITY Site INFORMATION in gallons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's ame (Print): Plu is Sign atu : (No tam MP/MPRSW No.: Business Phone Number: Z, rit Plumbe 's Address S reet, City tats, Zip Code . SZ444 -12 IX. OUN /DEPART ENT USE ONLY ❑ Disapproved itary Per It Fee (include Group water rAte ssue Iss g ant Signature (No tam s) 5 Surcharge Approved ❑ owner Given Initial r 21 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 & 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 systemsmust be properly maintained. The septic tank(s) must be pumpedby-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. ~ bmplete 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 1,t5 form; and F) al(sizing_information. . GROUNDWATER`SURPHARGE 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 investigatl'ons and establishment of standards. SBD-6398 (R.11/88) A + APPLICATION FOR SANITARY PERMIT STC-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 40 9 r- A'e zryu Location of property IVE 1/9' W 1/4, Section T N-R W Township f7f~i7'1/j'lOl'IC] Mailing address New ,e~h mr~n Uj Sao Address of site (fpm Subdivision name Lot number / Previous owner of property ARC✓~ /u C ild ~CtZCc~/1Cc fit. f7IG ~ rn~ Total size of parcel ~/(o Ct Cry Date parcel was created Obl6b6of- Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes x No Volume Sy 7 and Page Number Cps I 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. 13 / dO15• ; 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 system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 74~ , Z_e~ S ure of Owner Signature of Co-Owner (If Applicable) 8" /Fl Date o Signature Date of Signature L ~i DOCUMENT NO, STATE BAR OF WISCONSIN-FORM 2 l WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA 1.0015 i BY THIS DEL D, F.iarvey N-_ _ H,ielkema and_5uzanna REGISTERS OFFICE ST. CROIX CO., WIS. e Hie]kma,_ husband and wife Recd for Record this_ 1Jth - - - - - - day of__2ctober__A.D.1973 Grantor conveys and warrants to Roger Kelm A M. Register of Deeds Grantee- fore valuable consideration RETURN To CHARLES E. WHITE Attorney At Law the following described real estate in S-t • Croix County, State of Wisconsin: River Falls, Wisconsin 54022 - - - Tax Key N- This is not homestead property. A parcel of land located in the Northeast Quarter of the Northwest Quarter (NE~NW~,) of Section 6, Township 29 North, Range 17 West described as follows: Commencing at the Northwest corner of Section 6; thence East along the North line of said Section 6 a distance of 1501.76 feet to the point of beginning; thence continuing East along the Nort line of said Section 6 a distance of 339.76 feet; thence South 01 37' East 4 distance of 679.30 feet; thence West a distance of 339.76 feet; thence North 01037' West a distance of 679.30 feet to the point pf beginning, said parcel being subject to the CTH "AA" right-of- way over the northerly 33 feet thereof. TRANSFER • 00 Exception to warranties: FEF~ , Executed at New Richmond, Wisconsin _-this-- l0th___ day of_ October 19 73 , SIGNED AND SEALED IN PRESENCE OF (SEAL) i Harv N. Hielkem_a _ Suzanna_H. Hie-lkema _ ` (SEAL) - (SEAL) Signatures of_ HarveY N. Hielkema and uZ_an_na H. Hiel e a _ _ authenticated this 10th day of~C~Ober 19.2.3_. it G. E. Norman I Title: Member State Bar of Wisconsin ax.10)tpcXRtp= X~tbi4lWddd}Qit3i1~XR8#'XROb}iI@}41$. ' I STATE OF WISCONSIN ss. County. Personally came before me, this day of 19-, the above named j to me known to be the person- who executed the foregoing Instrument and acknowledged the same. t DOAR,trDRILL,drNORAN & BAKKE New Richmond, Wisconsin 54017 Notary Public County, Wis. The'use of witnesses is optional. My Commission (Expires) (Is) . Nsii li of pewgntl gienln in any capacity tihould be Wiped of printed ,beloti thsi♦r•si }is -may, • I1589- Vd - irmtio~o e, ♦ 1 1 1 N OC r01 NMr~oN O o NMV ~1 O 0 0 CO LA OD Z s V ^ m LAO+V {UO% O+ O+ co Z ODLAOLA%D LA LA N I"1M CU., v LA ~ z ~ ~ v a ' z o C a Mr r r v U v rc 01 a ~ NO via' 3r"- x ~ tL Y co ~ Z O O M f- PO' Z U of W v n % LA OD p w oe r yQ. W W OC Q . M < Q Z N a K OX Uw OD C ^ c LL e < r b 'z- cu z MOD << a~ O W U W was 9orc ONN a LL~ Q 7~ JOD <W1=Wo W IoH cg<"sum ~o 12 W W°Co>, 0 2 °o HO2O< Q ~O i~ V7 0 ,j .J OC W d K Q* K R" O W LL Q ¢ m y Ed O SZ< O o W o h J . V OD O O W {A u W ~ O 1< z LL O. q y a Q W a V W W W `w O I1QD Z X Q Q Q~ N h o y a to f O EK C gC~ < OF'=WOC F'• 0? 3~ ❑V 2~ mO V• J HNN Linz CL r m ?O I i 7O et~OrV O+.-aDN N v WN ° V•ODOV'~- ODV•V•O ~ X ¢ ° rNMLAM Ll1Q NOIr f- N r< ALn o CUOD-O% NQLn%a u M1 W in p LL W< rlro ~o•- V o W~ W Z W t ° O LL„ a O V < ^ r r N h S jz x~ 3lA 4c 0 ~r 40 1 1 1 1 1 Z M LA o LA M _ W p p o LL. ~ LA%DV't- m tax 3 H F8 < NM^M U1 x" aO o z v, < OW O h m O ~1 ^e; Z W>EW O O ^ r < (3 -1 3 h Vo O OWr-W W =cIzZ W gy M h F 7 ~'qr O+WDV•O'` N Q °8V MWODOD N C Q N ° ~NW-MNNV' Ln r W rLn °O+NMN N Ln 1- M Ln O ~D W W °C N V1-3O h LA N p W W z- a ^ ° h u Ir in O M Cl z o Vaa u •O amaw Ooh LLI 6: W LA ~ hL~ O AVh F o ONOLnN f!l Z o Z Z H u o 1`- tY IL M OOh-3 °N 4 OX CZ a - P U) U.SV• 5 S"O u o = N ZZO O+ W=xz o =UO u J N a IN-•o- 00 W < Ll h = O w ° O+ aD V'D " Z - J NouD N'O lA Z3 S 7 )-OtI 0 U) Ul O t~=N oo•-a IW-ZZ1 Q u v < r Zr 4-N, ~7hd'Z W W f- 0 DOJO oO+ 4a/-OOV/yO1 O < < W a OUW/~WWMF-O F~WQ{n~~WK tAVhtt)> h N t; Z u)o-(DZ^MLLLA STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 16cfer C~ Lelryt_111 ROUTE/BOX NUMBER T ,SOX FIRE NO. CITY/STATE r Y e.L `e.h Monig (N 1- ZIP 7 / PROPERTY LOCATION: NA 1/4 A VV 1/4, Section _ , T_aLN, R Z y W, Town of f7/~/Y)~Ylt1✓1 e! , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failbre 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. _Y~Zj SIGNED DATE //SY St. Croix County Zoning Office St Croix County Courthouse 911 4th Street Nude , WI 54016 `86-4680 `.e, and Return to above address •.WiscortsinDepartmenfof industry, QNSITE SEWAGE SYSTEMS Office of Division Codes and Application Labor and Human Relations Onsite Sewage Section < 1~~' ~A.i °iJ rt1 tw+$4 l° I' } •~""•~~q t~• 'q; ~,.5'~..: r~ k h 4 C<~, 's'.91 201 E. Washington Ave., Rm'.•141' Safety and Buildings Division PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, wl 53707 (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements maybe contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. „ Plan Number Previously Assigned 1. PROJECT INFORMATION (Type or print clearly) Na of ubmitt i Party (plans returned to same) Pro* Name Stree ddress, P. . Box # or Rural Route Project Address or Legal Description .,t.. t,r; : A6E& l City r Village St to Zip Code city County , •9 Village ❑ of a elephone No. (include area code) Town IL Designer,, Nam of Owner a + Telephone No. (include area code) Telephone No. (include area code) Street Address, P.O. Box # or Rural Route Street dress, P.O. Box # or Rural Route City or Village State Zip Code Ci or Villa St at Zip C de >c', r{ 2. APPLICATION FOR: ❑ Experimental Mound system r. ❑ Holding Tank ❑ New Construction ❑ Large System r ❑ Conventional Gravity System ❑ Groundwater Monitoring Replacement ❑ At-Grade ❑ System in Fill /-Petition For Variance ❑ Revision ❑ Pressurized System, ❑ System in Flood Plain (attach SBD-6698) ❑ Other Alternatives 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. r i a. 750- 1,500 gallon septic tank $ 50.00 b. 1,501- 2,500 gallon septic tank S 60.00 C. 2,501- 5,000 gallon septic tank $ 80.00 ! d.' 5,001- 9,000 gallon septic tank, gr,j .$100.00 14i ,`Y~ e. 9,001- 15,000 gallon septic tank S 150.00 f. Over ' 15,000 gallon septic tank 1 it ",$250.00 lair "r g. 500 1,000 gallon dose chamber $ 30.00 h. 1,001 2,000 gallon dose chamber ' 50.00 i. 2,001- 4,000 gallon dose chamber $ 70.00 ` i j. 4,001 - 8,000 gallon dose chamber $ 90.00 k. 8,001- 12,000 gallon dose chamber $110.00 1. Over . 12,000 gallon dose chamber S 150.00 m. 500- 5,000 gallon holding tank $ 30.00 n. 5,001- 10,000 gallon holding tank $ 55.00 - o. Over 10,000 gallon holding tank t : 5100.00 ; t p. Revisions $ 20.00 q. Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r., Petition For Variance:. Setback - $ 25.00 Site Evaluation $ 50.00 5 Subtotal: s. Priority Plan Review: Enter same amount as Subtotal Total Fee. SBD-6748 (R. 04188) NOTE:Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER . are subject to change annually. PETITION FOR VARIANCE WISCONSIN DEPARTMENT OF OFFICE USE ONLY OF A RULE IN THE ` INDUSTRY, LABOR AND HUMAN RELATIONS Petition No. WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY & BUILDINGS E-Number P.O. BOX 7969, MADISON, WI 53707 - Name f Owner Building Occupancy or Use Agent, Architect or pneering Firm Company Tenant Name, if any Street & No. N 1V "rl.-- , P-3 P Y 9 Street~p& No. Buildin Location, Street & No. City State & Zip ' / City State & Zip 014y p County Phone and I,J~S~~c 7 /VW rckmt and S C d 71 s _ J (o S/3 Phone Plan Number(s) Name of Contact erson 7~ S zk S3 O 3 IF KNOWN Ca / C vJ e r5 1. Rule G 3• ~302(d) of the Wisconsin Adminstrative code cannot be entirely satisfied because: l e 1 r S a n ~y d O r J tt Aa wo t _g b~?e t, h" o~l n+ S1 ----------/--~L `---r _L/LS `~cI --Q a'-°--- Q5 Ne a---------------------------------- 2. In lieu of complying exactly with the rule, the following alternative is proposed as a means of providing an equivalent degree of safety: r--us P-!- ° S - 5411 d!-~ s ad f~ d 4 _f~ - L ~ _ 1^e 3. Supporting arguments are: 0. C"'~ -t h rs N5 01 .E iale -ar--------------c-ssw------ Ynore. VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED For Fee Information See ILHR 69.15 or Contact The Department at (608).267-7843 NOTE: Petitioner must be building owner. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless a Power of Attorne is submitted with the Petition. er ee-Im being duly sworn, I state as petitioner; that I have read (NAME of PETITIONER Please type/print) the foregoing petition, that I believe it to be true and I have significant ownership rights in the subject building. OFFICE USE ONLY [`may \\Hy~~h' Signature of owner Date Received Amount Paid Receipt No7 a~riar to me this date: 9~ 9 l C OON r County, Wisconsin. ' Department Action GEU Notary Public Office of The Secretary Date ISO E,~. 14-91 -Tiss (y. S!3'r.f12K~, r'~ ST. CROIX COUNTY 1. WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 July 28, 1989 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Roger Keim property located in the NE 1/4 of the NW 1/4, Section 3, T29N-R17W, Town of Hammond realed soils to a depth of 1.2 feet after which high ground water 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, 4109 Slot% Thomas C. Nelson Zoning Administrator TCN:sma $9®019'73 . _.....r~rYUYYIt~tWOW~r+rrnsrtattrc!~+trcW., . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (1-163.09(1) & Chapter 145.045) LOC ; , SECTJON: e TOWN IP/MUNXIRAtlTY: LOT .:BLK. SUBDIV ION NAME: /4 / N/n )Z ~ (or N Y. OW S U ER A E: Al ADDRESS: U E DATES OBSERVATIONS MADE STS: NO. B DRMS.: 1COMMERCIAL S R T O : =LOReplce ❑New RATING: S- Site suitable for system U- Site unsuitable for system ICONVEN ION MOUND: IN-GROU D PRESSURE _ : S S -I -FILL HOLDI(N~G TANK: RECOMMENDED SYSTEM: (optional) LOU DS COO S C]U 0s U EIS OU EIS U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: 4* PROFILE DESCRIPTIONS ; EXTU E, AND DEPTH ,L7 BORING DEPTUTAL DEPTH TO THU4. ELEVATION OBSERVED- EST. HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Nt B- ,3 - B• B- - p,~G 41 113- PERCOLATION TESTS ~r^•;r r•, DEPTH WATER IN HOLE TEST TIME DRO IN WATER LEVEL-INCHES RATE MINUTES NUMBER WGUES AFTER SWELLING INTERVAL-MIN. I P RI PERINCH P. 7 P- P• AhOr P-- P- LEE PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable s it areas. Indica • scale or distances. Describe what are the,hori- zontal and vertical elevation reference points and show their location on the plot plan. Show t e urface ele 'on adetItboyi gs and the direction and percent of land slope. SYSTEM ELEVATION ea, 41 WIN S'A _ X Ilo ' A, lwdilee r I ' I ;V_ 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 pr in TESTS WERE COMPLETED ON: ),eo CERTIFICATION NUMBER: PHONE NUMBER (optional): DDR : CST S AT RE a DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 1R. 02/82) - OVER - G 4 SI S N `B YSTE M E a L DS c N MU 0 ~ 7 ✓ WORKSHEET'- hl iC ~ PROBLEM: Design a mound system for a The site characteristics are: groundwater or bedrock in. Depth to ' Landslope Percolation rate (o min./in. ,t Distance from dose chamber to distribution system .3= fto; Elevation difference between aump and distribution system 'Step 1. WASTEWATER LOAD ■ /3'~.gt~,c' X. gal Step 2. SIZE THE ABSOqPtION AREA.• f T fit. A) Area required ■ ',f/y 3~'S75q to 4 r B) Bead or trench length (B) _ /~t• A 1~d9 ft. F; C) Bed or tr inch width O a D) Trench spacing (C) _ C•or Waste ter load .24 ga,l/ft2/day B tre°ic eies Step 3 MOUND HEIGHT S8 9 Q 7' ' A) Fill depth (D) _ ft. ti B) Fill depth (E) D + slope (Aft. 93 (6~(,/)) 1,9'9 C) Bed or trench depth F) _ - •~3 fit. U) Cap. and topsoil depth (G) ft. E)' Cap topsoil depth (H) 3.iicc~nc~e x't iN~_ a -77 0i. t. V.• ,•.iL.«.i.•• :.t4 Y Step 4. MOUND LENGTH t A) End slope.O ft.'. B) Total mound le tha(L) _ B + 2(K) ti ` Step 5. MOUND WIDTH 0 Al) Upslope correction factor • f t,: r r i ..z Or A2) Upslope, width (J) (D + F + G)(3)(factor) B1) Downslope.correction factor = Y 82) Downslope width (E.+ F + G)(3)(factor) 18.' (,2 Cl) Total mound width (W) for ,bed J + A I * ft. 4 C2) Total mound width (W) for trenches / a;r+ + (no. trenches ••1)(c) + A + Y' (6) 4.:.~ 1y /._7 ~W i / e r 9t I c?._ Step 6. BASAL, AREA, 0197 `A) Infiltrative capacity of natural soil t ~ 'fi .199 ~ ~ s.•; ~ 8) Basal area required • wastewater flow natural soil infniltrat/i~je c acity C yr,~~ ^t'~;. f' wr C1) Basal area available for bed for sloping,,sites B x (A + I) * sq, ft.~;►,5.. C2) Basal, are avail le for trench for sloping sites A B W ~j +,A t., 5 . r , 76 Y C3) Basal area available for trench or,bed for level ' s to * B x W sq j ft. 1 S,40 x-d~7z Data~ pp t F Stip•7. DISTRIBUTION SYSTEM 7A) SIZE-,DISTRIBUTION SYSTEM 1) Hole size in, 2) Hole spacing = in 3) Distribution` pipe length,,,, s 4) Distribution pipe diameter ■ in " 5) Spacing between distribution pipes in. ,6) Distance from sidewall to distribution pipe in. 76) j DISTRIBUTION PIPE DISCIIARGE .RATEft. 1) Number of holes per pipe _ m- 2) Fiow per pipe GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length R 3) 'Number of distribution lines 4) Manifold diameter = s: ins l 7D) SIZ& FORCE MAIN q''< 1) Minimum dos,ng rate =Q_ GPM c'•. 2) Force main diameter = in. 3,) Friction loss 7E) TOTAL DYNAMIC HEAD S, 8 19 13 1) ,Vertical lift * L f•. , * a''~s 2) Friction loss ft. 1 } 3) System head 2.5 ft. ft. 4) Tota l dynami c head ft • . Qrr1'~C.Sfl nJ : f , r SA17 7F) PUMP SELECTION 1) Pump selected will discharge -GPM at ft. total dynamic head. 2.) pump model and manufacturer. 7G) 005E VOLUME 1 a.' 1) 10 times vo d v lu 7j.? Hk(e of d stribut on lines x gal,./cycle 2) Daily wast ater vglume - 4 doses/24 hrs. gaY./cycle,k~'h z 3) Minimum dose . vo~l ume..~. 9a 1{/cyc • 1:r V .yH) DOSE CHAMBER ;t 1) Minimum capacity, required 40 y.S?1 .~~,ti. /~IAD gal+?•~ FS,~1 Licunu" ;u_,~~~ 4 t s va to : fY C,r,.y b r' , 1 ~tv~ ~r C ra1~ , R {zF tl 1 ~Q r; lit i t '.A ~ y Lq t y: t I -LW I - XiS - - zwo I --dl r OIT4 I~. 4. 711 ~ s I ' - - I i 1 • i a { iik f r ~7i. t r t~~+l~~~,i' i..,~ r ~ tt v i ~ ' ' r. t" ~ 4w' tint ~f''~~r~. l..: r~[ ~..C NIra 0 4w.'~' r ~ rSh HO , ~ S draw, ~6 Y. S n Cav~ert'n thetIc . 9 l Dis ributbn Pile Medium. Sancl--~ , t Topsoll K r' { r M. f _ ..a-•------7'~ ~q Yi~ it ~ 'y~,'~ , .7 71, 1 s.4 V \ l _ k y ~~y+~ ' , y'~' [{.'Y:l~ • 1t~~~ +r!., V 1'S 4 e L~. 4 t...fKl i~~1 2 Force Main Plow A xt r(.SS] j~Qj t j '~i xkq 1 ¢ J•M: ' (//yy~~`~, h~~/~~~P i ,,F ~ . ''R1. ' ~ ~ t l r i f { S ~ y k * i l y, 4 l~ T R`"~ 4 T Y. Pl t ;dyer 'l S1 t ~qt r~iM'J c. ,1•. . W , "4' L A ASR S: {F I [ Ft-ri~ tt{r P' .s e v y 7 3t t i l~Cf+r ! ':-i'''4 ~.Ft V Z r f * •~~lr S stem Using' t , 9 eation,OfA: Mou Rd. Y rp q ti#d Far.r'The Abso tiort Area ' rt Ft y tlJ . i~ A, HrF x $19ned. B ;Ft. AYR i r , r?'n'1p J~ I{ ,t l~ ~~~'t ~ t S:'. G ~y.,7 tai , t i !1r•,~ - K';,,. Ft. : z license Number • t~~}te i ,~r+r~' .ry.~...~w~_,.~,w-- F} Y f r4 4 = 'i n Alternate Pos ti on . Ft~ rK.of J Ft.. , ,tOr•C{~'iEkT+~• - ti /t''dV t Forte Man' ' ~ ~"~r.`~".~"r.~! ir5 ,ill ~A ~ r~ `I4.t~n Jlg► ~Obser.v~ation Pipe 4 t r 1 r. i~ r. rx 4Y~\~M,rJ Y ` 4r J+t 't~. P .r 1.Y.,, ~ ~ ~ ~ +r-.....~+.yr1!;, i( S t I S . !c o-r For+t:s. Main t ;1,, r4 t ~.i 1 Jr ~ M I A t ti Distribution. f Bed O.f Ypipe Aggregati~ y. Observation, Pipe Permanent' Markers qq{{ 4 W f5l'`. Sit `t k i`- ~ ~ a ~ ~S ~t'•~ t Won View Of.Mound Using A Bed For The Absorption Area ~ ,4, rr r . J F . 7R7* t ) ~ J ~ ~ y 4 1+ ~ f. y } 4 iy • f y PdgQ „Z4?.~ B~ Perforated Pipe Dololl ) Y", End Vi Petforated End Cop. PVC Pipe o~FPR , , oleo Located On Bottom, : Are Equonr Spaced Q%.C ~r~, DDS ribs 661) Lott Hole Should So Noatle End Cop Distribution Pipe Layout P Ft. auk ,S 1 sy f~~ ,t'•„ nnsl , y R r AIIA X Inches -es Signed: ( Note Diameter Inch Lateral " Inch(es) License Number: Manifold " Inches pate: Force Main Inches ,22 # of holes/pipe,, l Invert Elevation of LateralsA!Q,f Ft. S,89 0193 N ~ 14 ~y 6 8 b .04 t~ q 00n444 _ 0 Ad rr••r--r W a . rl r4 rrrrI ..i' a. 04 '„rrr•-- Al t 4 • rrr - r r 41 rrr r rrr- N 41 C1 W N W 9d0 O' $4 s ' V N U AA ~ 0 'A Z re ,w OC m t L9 ~ . ~ W.• , • :.r • ...,.kur.w., n~a.r. rpwJ..euun.r,..:~..5., .....r. - _'.r{~"'"a`~.......i1w1~M1iawMd PAGE OF AD PUMP CHAMBER CROSS SECTION AAJD SPECIFICATIONSGkK VENT CAP /j~Ea/ J! Cil~~p lar 4"C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER N 2.5' FROM DOOR, 12"MIU. ' WINDOW OR FRESH I AIR INTAKE GRADE I `I"MIN. 19"MIN. CONDUIT WAIN. \ ~PROVIDE G SEAL ( I / _T Ji(q~`~`m I III V APPROVED JOINT A Q~ jjr~N" rF~ \O I III APPROVED.JOINTS W/C.I. PIPE. C(~' Ir f T.. I III W/C.I. PIPE EXTENDINIC• 3' `O I (I ALARM EXTENDING 3' ONTO SOLID SG:;• ONTO SOLID SOIL 4z ON c AGE 1 F'~ ~~~`OQO` PUMP OFF O CONCRETE BLOCK RISER EXIT PERMIITED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIONS S89-0,1973 SEPTIC AND JDOSE TANKS MAIJUFACTURER:A/9Al & IJUMBER OF DOSES: PER PAa TANK 51ZE : held a / GALLOWS DOSE VOLUME q ALARM MANUFACTURER: INCLUD!!:C ZACOFLOW: c s! GALLONS MODEL NUMBER: CAPACITIES: A=r INCHES OR .alL GALLONS SWITCH TYPE: B= INCHES OR 7 GALLONS PUMP MANUFACTURER: C=__12__.INGHES OR ////pD GALLOWS MODEL NUMBER: 1 DINCHES OR I:a GALLONS SWITCH TYPE: jL NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE Bi WEEN PUMP OFF AND DISTRIBUTION PIPE. L3 . FEET ~ ~EwE© + MJIUIIMUM NETWORK SUPPLY PKESSURT,E~.. . . . . . . 2.5 FEET ~g69 ♦ -?JQO FEET OF FORCE MAIN X _tQtl_F/ ~ QUG ►ooFrFRICTION FACTOR. e FEET p~,ti~S10N TOTAL DYNAMIC. HEAD = LA 49 FEET CdhF'~ A~'~ lee INTERNAL, QIMENSIO OF TANK: - i}-- H ;LIQUID DEPTH SIGNED: LICENSE NUMBER: DATE' . -11~- GOULDS SUBMERSIBLE/ SEWAGE AND EFFLUENT PUMPS r~ EP0311 y x,' ! LIST DISC. t• t i . n 1. 4 1/2 solids 256.80 172.10 ODUPFY0311 142 PSY0311 1/3 HP 115 V Effluent Pub , ~th~1~~ ~ E~► ~ ~ Submersible Effluent - Pump ; MODEL EP0311 t pi,; V~Yt ' i SIZE W SOLIDS 4 pia}, , METERS FEET , ,,y~ k,o~ ~ r r 15 • C . 4 s 10 1 ~9Y r~ r i4 2 Ell 0 00 , 0 12 1• 20 24 26 92 38 40 GPM r 0 2.6 5.0 7.5 m'/h h.. CAPACITY - • • rllj lip Performance n 38,85. s Curve fiy t' r ; . , ' oo MODEL 3885 25 SIZE 3/4" Solid Ir f ~rfx y? 14 ' p ` ' 40 A { 10 1 S 20 . 10 FfR,, _ - - 19 s L.: 0 0 wo 110 • 120 orw 4 r , KN x ~ 0 to 20 30 10 QO AO 70 . EO . 00 - ^11 Lj o io p - aowM Nv ~`~IISION qty S CAPOAM ~rnT!(1N ~ LIST tiD~"n 1 3/4' solids 491.55 329.35 1~n:t"r k' (10UPWE0311L 142 WE0311L 1/3 HP 115 V law H OX WE0311M 142 WE0311M 1/3 HP 115 V Mod H 3/4" solids 491.55 329.35 3/4" solids 704.25 471.85 " G3UPW%0511H 142 WE0511H 1/2 HP 115 V High H X414.}• r K 3/4" solids 843.65 565.25 1 Ns GOUPWE0712H 142 WE0712H 3/4 HP 230 V High lid. + , : r *****SEE FL UDWIN3 PAGE FOR PIIOUNAItM AND SPECIFICATIONS. PAGE Vu DEPT 30 i... , DATE 10/88 State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 i ko(ier Kelr,P Rural Koute 1 1tl;l New kichrr;ond, +'.l (:e: koaer Kelm, - kesioence Onslte ;,ewaae Svsteri i:Ei ,5, 21,17W Town of liaifciono, St. Croix Courit~' :fi Section 145.24 (1), i sconsi n Statute;, anc, . ILiiI< v~ (2) (o), wo sconsi n Aoriinistrative Code, allow tl,& omier tO r~r ci ior~ the ~~+~r~artrer~t for a variance to the installation for an onsite SE-1;,1-11Q(4 SysLEll„ ti.' rc,r~=lace or" existing onslte serfage systegr at a site w,'o ch is riot iii fu l 1 cour-ci 1 i o-ri(.~ kai tr1 the siting , standaros in Vie ad~Ani strati ve rule. I ne. _:ysteci oesi on aro~,i ,sea shout r1 protect the waters, of the state from cr)nto,tIn,idO.on. It this ,yscear becor4es a fai i i na systeo or contaminates the r",aters of tilt staz,, this variance shall be resci n(eci. The petition for a varianc:, requester" zo s. ILifl, (1) (d) of tiie ;Wis. h,m% Code was considered on August 4, 1 ~-1. T!"ie aetiiiori has been aDDroved. The rule requires a mor:nn syster, site tc' i'3vn 3 rill r!1!''t:sa' of 2[i inches of suitable natural soil. The variance requested was to inst«-i l systemi on a site -ith 14 inches of suitable natural soil. All of the uaLa aoc state;3ents suk)o"oi4:(. t,ti Je:,~lf of t„r- aetltioner were consinererl. This Variance is specific to the su,1-ject petition and cannot be. usee for, any aooitional inooifications. S A 4C,t ct . Cirector, ;ffic:e of Division Q L1 Codes anc ApDlicatiorl ! '~;oj ; ry RM : PL11: ~tC54e cc: Leroy Jarishy, Private SewiGe Corisk41-;:ant - C1 str-6. z 6, Cri ppewa 1=a1 i s Thomas Idol son, -"oni nq. Acirni ni strator - S c. Croix , ourty Calvin Powers Jr,, iylurTrter SBD6928 (R. 10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION CALYIM PGWEit~~ jR. Page 2 Since eiy kA .Z' PAVE Section of pr 1Gate sewage 1►lvi~ion of Safety arr(l bul idinrls r PPP0l Y000gn/21 cc: Private Sewaye Corsultant t:0unty - -UW-S WMP Plumbing Consultant ~_I_rwrifr I`Iumber ~ Environrriental Healttr 4 I I OS A~~/9 ~J ~-/S- ~ o . ~ 5 I'~~--~ 1 o l ~i.os 1 I - _ _ S~5 ~ ~ ~1 ~~4 ~ ' ~ ~ f L/ r _ k,