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Parcel #: 032-1062-90-000 03/31/2014 09:59 AM
PAGE 1 OF 1
Alt. Parcel M 23.31.19.315E 032-TOWN OF SOMERSET
Current EX
ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O- BACON, DELAINA L
DELAINA L BACON
693 205TH AVE
SOMERSET WI 54025
Property Address(es): *=Primary
*693 205TH AVE
Districts: SC=School SP=Special
Type Dist# Description
SC 5432 SCH DIST OF SOMERSET
SP 1700 WITC Notes:
Legal Description: Acres: 3.030
SEC 23 T31 N R1 9W(3.03 AC) PT NE SE LOT
1 CSM VOL 3/765 Parcel History:
Date Doc# Vol/Page Type
05/04/2009 894019 WD
03/11/2009 890670 SD
05/22/1996 544023 1179/240 WD
06/01/1989 448346 842/146 WD
more...
Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg:
*0765-CSM 03-0765 032-79 23-31N-19W NE SE LOT 01
2014 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/12/2010
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.030 25,100 130,600 155,700 NO
Totals for 2014:
General Property 3.030 25,100 130,600 155,700
Woodland 0.000 0 0
Totals for 2013:
General Property 3.030 25,100 130,600 155,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 306
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUMAN RELa NS DIVISION
P.O.BOX 7969 1 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707 State Plan I.D.Number:
NE,SE , 2 3 , 31, 19W xn CONVENTIONAL ❑ ALTERATIVE (If assigned)
wyn3p�f&S�>6Srset ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Kenneth O' Patik RR Somerset , WI 54025
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 119553
SEPTIC TANKMOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: T7;27 PROVIDED:ABEL LOCKING COVER
❑NO ❑YES ❑NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: : BUILDING: VENT LE FRESH
ALARM: FEET FROM AIR INLET:
❑YES ❑NO ❑YES ❑NO NEAREST—♦
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQU7PUMP P MODEL: PUMP/SIPHON MANUFACTURER: PROVIDED:WARNING pROVIDED:OVER
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: ONTROLS OPERATIO NAL: NUMBER OF PROPERTY WELL: BUILDING: AIR NLOT RESH
(DIFFERENCE BETWEEN FEET FROM LINE:
PUMP ON AND OFF ❑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: TRENCHES: DISTR.PIPE SPACING: MATERIAL: INSIDE DIA.: #PITS: DEPTH:
PIT
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----1110'
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: TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO [--]YES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS: [FEUE MBEROF PROPERTY WELL:COMMENTS: T FROM L❑YES ❑NO ❑YES ❑NO AREST♦
Retain in county file for audit.
Sketch System on
Reverse Side. SIGNATURE: TITLE:
Zoning Administrator
SBD-6710(R.06/88)
=1!LL, SANITARY PERMIT APPLICATION COUNT In accord with ILHR 83.05,Wis.Adm.Code _
STATE S 7TjY PERMIT
–Attach complete plans(to the county copy only)for the system,on paper not less than II ((JJ((
8%x 11 inches in size. ❑ Check if revision to previous application
–See reverse side for instructions for completing this application. STATE PLA JI.D.NUMBER
1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. O g r
PROP RTY OWNER 1/ PROPERTY LOCATION q
I� /�� '/4 �'/4,S T3 , N, R J/ E(or)W
PROPERTY OWNER' MAILING ADDRE LOT# BLOCK#AIA
CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME O SM NUMBER
CITY NEAREST ROAD
11. TYPE OF BUILDING: (Check one) ❑State Owned VILLAGE:
❑ Public ®1 or 2 Fam.Dwelling-#of bedrooms- -PARCEL TAX UM E
ill. BUILDING USE: (If building type is public,check all that apply) ,31-5 1%
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ 12 ❑ Service Station/Car Wash Mobile Home Park 13 ❑ Other: Specify
5 ❑ Hotel/Motel 9 ❑ Office/Factory
IV. TYPPEf OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. Lbl New 2. ❑ Replacement 3. ❑ Replacement of 4' ❑ Existing System
B) 5 ❑ Existing System
System System Tank Only 9 Y
B) ❑ A Sanitary Permit was previously issued. Permit# —
Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
30 ® Specify Type 41 ❑ Holding Tank
11 Seepage Bed 21 ❑ Mound 42 ❑ pit Privy
12 El Seepage Trench 22 ❑ In-Ground 43 ❑ Vault Privy
13 El Seepage Pit Pressure
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. M(Min./inch)RAE 6. SYSTEM ELEV. 7•gFINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) ( � 93 Feet /S Feet
7S0 56
VII. TANK CAPACITY Site Fiber- Exper.
in allons Total #of Prefab.
INFORMATION New Win Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
structed
Tanks Tanks
Septic Tank or Holdina Tank N< f.
Lift Pump Tank/Siphon Chamber +3� �j°'Q"" FIRE.
VIII. RESPONSIBILITY STATEMENT
1,the undersigned,assume responsibility for installation o the onsite sewage system shown on the attached plans.
Plumber's Name(P Plu is Signa re: o S mps)
MP/MPRSW No.: Business Phone Number.
Plumber's Address(Street,City,State,zip Code): S Yb/
6�xaY - - d
IX. COUNTY/DEPARTMENT USE ONLY Iss i g Agent Signature o S mps)
❑ Disapproved nary Permit Fee(Includes Groundwater a e Issued
Surcharge Fee)
?�Aproroved ❑ Owner Given Initial
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 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:
I. 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
application form is to be completed in full and signed by the owners)
of the
This app result in delays of the permit
property being developed. 'Any inadequacies will only
ssua ce. Should this -development be intended for resale by o ee the t rope ty`,ispec
i n
house' ) , then a second `form should be retained and completed wh •
sold and submitted to this office with the appropriate deed recording. - - - - - -
- - - - - - - -. - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Al
Owner of Property
Location of Property '
SE'�'
Section o?.`.._+ T �� N - R _Z_,4 W
f9 nship .►:. :i�:,. S S C
Mailing Address
........ y
Subdivision Name
Lot ,Number
Previous Owner of Property
!/AN%e se
Total Size of Parcel d 3 C s
Date Parcel was Created /7
Yes No
� Are all corners and lot lines identifiable? No
(spec house) ? Yes __._
Is this property being developed for resale (sp —
I as recorded with the Register of Deeds
+ Volume and Page Number
1
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
�. Other recordings filed with the Register of Deeds Office
ion a certified survey, if available, would be helpful so as to avoid delays
In addit ,
of the reviewing process. If the deed descripteion refedences to a Certified Survey
Map, the the Certified Survey Map shall als o b _ - - _ - _ - - - -
- - - - - - - - - - - - -- - - - - - - - -- CERTIFICATION -• -
) PROPERTY OWNER m (our) .
I (we) cvttiby that aP,e 6tatement.& on thin OAM cute true to the be6� o� y
I (weedge; that I (we) am (axe) the owner(6) of the pnop�y de cA bed in thiA
a wcvvcan ty ice 06 the
by vixtue o6 eed neeanded .cna de�1� �1 (we)
'a .injoAmati.on 4on.m, Na. _ '
County RegjAtex ob Veed6 ab Document a o6 6y6#em (on I (we) have
{ pneaent2y own the pnopo6ed 6•c to 6oh the 6 9 p ion th.e.
obtained an easement, to xun with the above deaeJr-i-bed p' e� Qd in the Mice
eon6tnucti-on of 6a.id 6y,&tem, and the Game has been duty )
a6 the County Re o6 d6, as Document No.
SIGNATURE 0 R SIGNATURE OF CO- ER (I PLICABLE)
3/
DATE SIGNED
DATE SIGNED
P1
10 5
SEPT LC 'PANIC MAINTENANCE AGREEMENT
tit . Croix County
OWNER/BUYER---- A., __
RbUTE/BOX NUMBER 2
Fire Number
CITY/STATE �r _r ZIP .5W�/�'
i
PROPERTY LOCATION : !Z , -SC_Z , Section T- T/ N , R !9 W,
i
Town of So^ e,- re of St . Croix County ,
Subdivision_ -- V, Lot number,
i
Improper use and maintenance of your septic system could result in
its premature failure,, to handle wastes . Proper maintenance con-
sists of pumping out he septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper . What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system .
St . Croix . County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980 , with the requirement that
owners of all new systems agree to keep their systems properly
maintained
The property owner agrees to submit to St . Crb.ix County Zoning a
certification form, signed by the owner and by a master plumber ,
Journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2 ) after inspection and pumping (.if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration .
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 Depart-
ment of Natural Resources . Certification form must be completed
and returned to the St . c: I_0ix County Zoning Office within 30 d-ays
of the three year expiration date .
SIGNED
1)ATE
St . Croix County Zoning Office
P.O. Box 98
Hammond , WI 54015
715-796-2239 or 715-425-8363
Sign , date and return to above address .
DEPARTME$JTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G BOX 7969
LABOR AND • PERCOLATION TESTS (115) MADISON WI 530
HUMAN RELATIONS
(H63.09(1)&Chapter 145.045)
LOCATI / SECTION: u/D �1or TO N!P/ NICIPALITY: LOT O.:BLK. SUBDI ISION NAME:
M��_ NFR'S BUYER'S NA E: /C �7 MAI ADDRE S:
J/
7,n,,*
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: C DESCRIPTION: ICI FILE DESCRIPTIONS: ER AT O TESTS:
Residence MNew OReplace �f
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL:aLOU M0�.Q� IN G 1 S PEOU RE: SY❑S 1®u L HO0L S TANK:R�M ENDED SYSTEM:
If Percolation Tests are NOT require DESIGN RA If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: �� Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
C
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF IL TH HICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-
1 is-3
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER INCH
PERI0Q_1 PE RjQQ 2.P.
P-
P-
P-
P-
P- _
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil ar s. icate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot pl n. Shovy�t a su face el ion at all borings d rceenn
of land slope. ✓ �,baas
SYSTEM ELEVATION
40 _.-
o, -
I
I - - TN
10 f
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.
NAM pri TESTS WERE COMPLETED ON:
AD CERTIFICATION NUMBER: PHONE NUMBER(optional):
i
CS I A URA:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
Office of Division Codes and Application
Wisconsin Department of Industry, QNSITE SEWAGE SYSTEMS Onsite Sewage Section
Labor and Human Relations 201 E.Washington Ave.,Rm.141
ST.#@ty ind Buildings Division P.O.Box 7969,Madison,WI 53707
PLAN APPROVAL APPLICATION (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 c this form describes fromthe Department o f Administration, requirements
and Distribution,202 South Thornton Ave.PP O Plumbing
Code,which can be purchased
7840,Madison,WI 53707,Telephone(608)266-3358.
Plan Number Previously Assigned
1. PROJECT INFORMATION(Type or print clearly)
Project Name /r ( ��-v Ae
Na a of Submitting Part tans returned to same) v
Streeet Project Address or Legal Description Address,P.O.Box#or Rural Route
County
City or ViII ( State City
c Zip Code y ❑
Sya I� Village ❑ of s .G
Town
Telephone No.(include area code)
Name of owner
Designer I ' P � I,I�
Telephone No.(include area code)
Telephone No.(include a a code) - /5 _ r� j
Street Address,P.O.Box#or Rural Route
Street Address,P.O.Box#or Rural Route R R'
State Zip Code City or Village States Zip Code
City or Village z'-' 1
System [] Holding Tank
2. APPLICATION FOR: ❑ Experimental ❑ Mound y Groundwater Monitoring
Conventional Gravity System ❑
New Construction ❑ Large System ❑ ❑ Petition For Variance
❑ Replacement �At-Grade System in Fill
Revision Pressurized System
System in Flood Plain(attach SBD-6698) [3 Other Alternatives
❑ ❑ ❑ Y
3. FEE COMPUTATIONS (include existing tanks)
FEE SUBMITTED FOR OFFICE USE
MAKE ALL CHECKS PAYABLE TO SAFETY&BUILDINGS DIVISION. V;-p
a. 750- 1,500 gallon septic tank $ 50.00
b. 1,501- 2,500 gallon septic tank $ 60.00
c. 2,501- 5,000 gallon septic tank $ 80.00
d. 5,001- 9,000 gallon septic tank $100.00
e. 9,001- 15,000 gallon septic tank $150.00
f. i Over 15,000 gallon septic tank $250.00
/
9- 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
j. 4,001- 8,000 gallon dose chamber $ 90.00
k. 8,001- 12,000 gallon dose chamber $110.00
I. Over 12,000 gallon dose chamber $150.00
M. 500- 5,000 gallon holding tank $ 30.00 O
n. 5,001- 10,000 gallon holding tank $ 55.00
°. Over 10,000 gallon holding tank $100.00
p. Revisions S 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
Subtotal:
S. Priority Plan Review: Enter same amount as Subtotal J
Total Fee: / Q
SBD-6748(R.04/88) NOTE:Fees are pursuant to Wis.Adm.Code,Chapter Ind.69,and
OVER
,.are subject to change annually.
If fl ,
rar +.a
State of Wisconsin ` Department of Industry, Labor and Human Relations
s i•�,; . SAFETY r1 BUILDINGS PIVISION
APPLICATION FOR THE USE OF AN AT-GRADE SYSTEM 201 E.WashingtonAwnua
P.O.Box 7969
Madison,Wisconsin 59707•
Location: Township/Municipality:
C 1145EI14 Section 3T3/N R 5 `se
Street Address : ubdivision: Count/y:
Landowners Name: Mailing Address: `
I (We) , the undersigned, make application for an at-grade system on the above. ,..
described premises. If approval is granted, I Agree to have the system
constructed in conformance with the plans and specifications approved by the
Department of Industry, Labor and Human Relations (DILHR).
I further understand that an at-grade system is somewhat different that a
conventional onsite sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to pe nnit both county officials charged with administering
county sanitary ordinances and DILHR employes or other authorized persons such
as the system designer, to have access to the above described premises. at any.
reasonable time for the purpose of inspecting the construction, or of
monitoring the system. I agree to either personally or by my agent contact
DILHR or county officials to arrange the time and date to begin construction
of the system, after obtaining a sanitary pe nnit. I agree to pay the cost of
any monitoring wells required by DILHR for the purpose of measuring the
wastewater treatment performance .of this at-grade system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin construction. (If the system is approved,
DILHR will' send the applicant a letter of approval which authorizes
construction of the system after all necessary permits have been obtained.)
I agree to give notice to any subsequent buyer that an application for an
at-grade system has been made and if installed, that the premises are served
by an at-grade system, and further agree to give the buyer a copy, f this
application.
I ilz'�4 A� _"
�Jgnature p scan Da e
alid onl if otarized)
STATE OF WISCONSIN Subscribed ands rn. before me this
COUNTY OF Q (date:) 4_
�Jo Ayt nlic, t e o �sconsin
My Commission Expires: 4X/hs,
OILHR•SBO.5524
M 25 a ro n °> om v 0
A- H z o m 0 $ i
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9 /
8
r
r
7 1.
0 1 1/4
C a
evo
CCL s
w /
` 3
- / 3'
a 2
,
1 4'
0
0 10 20 30 40 50 80 70 80 90 100 110 120 130 140 150
Lateral Length (ft.)
Minimum Lateral diameter for Plastic Pipe (C= 150) Versus Perforaticn
Spacing and Lateral Length for 1/4" Diameter Perforation (Otis,
1981) .
10 Perforation Diameter:
/ 3/le-In. ( 7.9 mm.)
9 j
C 1 1 1/4• /
C
i 8 1 1/2•
CL
vs 5 2
C 4 /
3•
0 3
ti 2
4
1
8
0
0 10 20 30 40 50 60 70 60 tt0 100 110 120 130 144 130
Laterst Lw4th (ft.)
Minimum Lateral Diameter for Plastic Pipe (C=150) Versus Perforation
Spacing and Lateral Length for 5/16" Diameter Perforations (Otis,
1981)
• t
AT-GRADE SYSTEM CALCULATION WORKSHEET
Owner's Name: rt�v, h Parcel Tax Number:
Legal Description: _�x, �i, 513 , TN, R��E or 1
Lot Number: , Block Number _, Subdivision/CSM Name:
Town of: _!oey• rs-ft r Sfi CY' O 1 X County, Wisconsin
At-grade Structure
1. inches. Limiting Factor Depth
2. $ percent. Land Slope
' so
3 gal/day. Daily Design Flow Rate (DDFR) 3 9-&) )( /-So
y
4. gal/ft 2/day. . .Design Loading Rate (DLR)
50
5. 7.5 U feet Effective Effective Absorption Area (EAA) = QLRR - A x B /�
6. -7 fwl�' feet. Effective Absorption Width (EAW) = A
7. 0 7- feet. Effective Absorption Length (EAL) = B = EAA
EAW 7
8. _7 DDFR gal/ft. Design Linear Loading Rate (DLLR) = EAL /o)
9. 9_ feet. Total'. Aggregate Width = A + C * 7+a
10. feet. Finished Width (W) = A + C* + D + E** •7-f 1- 5 ►-5
11. /17 feet. Finished Length (L) = 2(I) + B 4- 007 ;,
12. feet. Finished height (11) = F + G 140
13. /7, feet. 1/6 B )
Observation Well Locations
14. .�3.�j feet. 1/2 B )
15. Texture of Soil Cap Material.
Notes: * C is 0 if the slope is j %, otherwise C is 2 ft.
**. On 1 el sites, substitute another D for E.
Plumber/designer Signature:
License Number: /5.63 Date: 7 — %2 — d,
Page of f�i
At-grade System
Pressurized Distribution Network Design
16. Distribution Lateral Sizing. .
inch. Hole Size
feet. Hole Spacing
$3 feet. Lateral Length
inch(es) . Lateral Diameter
feet. Lateral Spacing
93S feet. Lateral Invert Elevation
17. Distribution Pipe Discharge Rate.
a Number of Holes per Lateral
gpm. , Flow Rate per Lateral
_. , Total Number of Laterals
71 gpm. Total System Flow Rate
18. Manifold Sizing.
Manifold Type (center or end)
feet. Manifold Length * S ~T_ * If only a tee fitting is used
as the manifold, the manifold
3�
inch(es) . Manifold Diameter * length and diameter may be
reported as not applicable (NA) .
19. Forcemain.
- inch(es) . Forcemain Diameter
_35 feet. Forcemain Length
0y yr
gpm. Minimum Dosing Rate (system flow rate) 06W O akLl^�
a a� gallons. Forcemain Liquid Capacity.
20. Total Dynamic Head. (TDH) Calculation
System Head = 2.50 feet
Vertical Lift = feet
Friction Loss = 0 C feet
TDH = a,7,5 feet
s-ed Page of
J // X"9
Owner's Name: .OM'n +
Plumber/designer Signature: Date: c�
License Number: S
L
> 5,
y 5' B
z
I I
E .L..._. —_— — — — —�
W A I
. .._.._.. -°—._.
1/6 B
�_ ft E - 5 ft I = S ft 1/2B = 53,5
A = -- -� ,� ft
B = 107 ft F = __L0 min Lq_► ft 1/6B / 7
C = •
�, ft G = /a ft W = / / ft
• D = S ft H = *1h
Fabric Distribution Lateral
Observation-----_,, Soil Cover
Well
12 _
, H
i \
Note: H is
measured from
I directly below
51 } the lateral to
D
A I C E finished grade.
Plan View and Cross Section of Wisconsin At-grade Unit with a
Single Absorption Area on a Sloping Site
+�6 �D /
Page (v of /02..
PERFORATED PIPE DETAIL
and
DISTRIBUTION PIPE LAYOUT
Perforated Schedule 40
PVC Pipe
End •/Cap
9 e %
t ya oe \ 4
aO / /� Holes Located On
5 w Bottom Are Equally
\. Spaced
End
Cap � �•'. 4
Schedule 40 �
PVC Force Main
Last Hole \
Should Be
Next To
End Cap
Owner's Names ���� q //� p 53 feet
Plumber design 's Sig nat e: x A- _ inches
y inches
Date: 7—l7—N License No. : 1.5 Z7-5 Hole Diameter �� inch
ONSI` a S6w%V QS SYSTEM " ` Lateral Diameter 2, inch(es)
Force Main Diameter 7 inches
oc/ !toles per Lateral APPROVED DFFARThOEP OF INDUSTRY, LA JOH AW MUM �€ hTJONI 9 3� 5 feet. Invert Elevation
IVIS(GN Of WiTY BY11�®�W6$ of Laterals
40
SE9 COA0tQ61 NbIiNQE
AS f
Page of /-4
7F) PUMP SELEC ION
1) �=tpd will dischargQ,22Y GPM at �� ft.
total dynamic head,
7) Pare and manufacturer
7G) DOSE VOLUME }
1) 10 times void volume of distribution lines gal./cycle`
2) Daily was ate�r v 1 4 doses/24 hrs. ,jI�„ gal./cycle
3) Minimum dose volu • gal./cycle
711) DOSE CHAMBER
1) Minimum capacity required gal.
Sirn:
!Aci;11;3C ::U
Date:— . y-
M F
S C R CW T YP P CAP
OR SLIP CA
4�� p V C PIPE
(LENGTH VARIC5 )
I
i 4 - %4" x 4 LONG
51-OT5 @ 9o° AIPA13T
-- TOILET AING.
4
I 1/4" 5 L 0 T
9 0'* �`�--- 4 - �/4" S L O TS @ 90 °
i, END VIEW ( [30TTOM )
I' 4 - 1/,z" Ho1-65 FOR RE13AR5
4 - %4" x 4" LONG
SLOTS @ 90 ° APART
--�•.�E-s— I/4" SLOT
�� Two Methods of Stablizing Observation Tunes
�SI'a'y'r
4 s�
I
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY&BUILDINGS DIVISION
201 E.Washington Avenue
P.O. Box 7969
Madison,Wisconsin 53707
DILHR Plan Identification No.
CERTIFICATE OF COMPLETION OF CONSTRUCTION
I hereby certify with my signature below that construction of the at-grade
system identified by the above number has been completed in conformance with
the plans and specifications approved by the Department of Industry, Labor and
Human Relations (DILHR). .
E
Signature license
OILHn•S00-5524 d �r �• '' s ,
A,ye
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k, s
AW xg;
3n A
$ `
r i � '
qp 1 � rr
d, x € fie
a ." t5sk
' AT 4
� z
t g
jr v
i vv, TANK SPECIFICATIONS,;
I �p g
CONCRETE STRENGTH: 5000 PSI
ii REINFORCEMENT:
COVER #4 REBAR
STANK •6x6/10 GA. WIRE MESH
._.. DIMENSIONS
Tl z
WALL 2
A 1/2" LENGTH: 104"
� � 1
' BOTTOM: 21/2 BELOW INLET 51" /
E
a
COVER 4" MANHOLE: « ''
11,114
.. HEIGHT: _67"
VENT: 4", CAST IRON HUB
b INLET: 4" CAST IRON HUB
,^ DISCHARGE PIPE: 4" CAST IRON HUB
MILLER 3" AUTOMATIC SIPHON
AVAILABLE COVERS:
CONCRETE/CHAIN LOCKDOWN
STEEL LOCKDOWN
GALLONS PER DISCHARGE: 279
GALLONS PER INCH: 23.81
WEIGHT 8,230 POUNDS
x
- � rQ. Ap s
1 ' fs
tl N
MODEL WST-1000
1000 Gallon Siphon Tank coneRETE J
Rt.2(Hy 10)Maiden Rock,WI 54750-(715)647-2311
ma b
+K +(v
Y .0
3i
:f
.v . ..
st Croi:_
WA
Raba
Taol��Miis
v—"t° � tbeast quarter of the Southeast qust
%46L►> 9 ahi 31 North, Range 19 West,
r described as follows: Lot. 1 Of ' t
l*mod ,February 220 1979 in Vol "3 0, paw, Tai+
7�-
a a :
�0�- • ��,
s5 a�
+x
R
F
4
�4�t P�
V!
toe*w0Ms recorded easements and rights of vay.
,....,.. .....,, .�'..-rw
4
3 • Dar e J.
17L
St Croix
s
STATE OF WMCONM
:x
rem `
. r 77
4
IM�!N! *V jf
6
4
4
355156 �.
SURVE OR'S RECORD
CERTIFIED SURVEY MAP
I un_platted land 100' 115' ; unplatted
WI/4 Corner I I land
EI/4 Corner
Section 23 I 1 Section 23
T31N,R19W ; E-W 1 /4 Section Line - -_ - -r-31N,R19W ''--------
- -0- - - - - - - - - -- - - - - - - -- - - -
EXISTING g87°36'35"E 230.07'
centerline FD 200'
(DI TOWN R
------ S87°45'38"E 26s °
Southwesty � ���F ° c
line o'no °
M N
ly right-
2 line
1 Ln
NE
� -
N
'n V) 70'
co 3.03 acres including town road c _
N right-of-way ;� MI
2. 82 acres excluding town road o = I
M right-of-way ; — r,
O N N =I
V) f0 M
c W Ln F-
`�'
N°E
I CAI
ASSUMED N87°36'351iW 374.53'
BEARING 49.08'
587°0 4 E
00, N87° '35
"W
I
gn� att
eq
unplatted land land 52°10'16 W
43.34 X
"
o" i 60' 60'
Po
SCALE IN FEET Beginning
SE Corner, Section 23
0 100 200 300 T31N, R19W
TABLE OF INTERIOR ANGLES
A=90 0131091' E=2700
B=89 046151" F=90°
C=135°11'05" G=89°46'51"
D=135°02'04"
LEGEND
COUNTY SECTION CORNER MONUMENT, FOUND. APPROVAL OF THIS MINOR
SUgpI
0 1"x24" IRON PIPE, WEIGHING 1.68#/LINEAL FOOT, SET. HOES NC,� ML'AN APPROVAL BUILDING :, ; =�j� ROVAL FOR
SEr'TIC SYSTEM.
0 EXISTING 1" IRON PIPE WER TO hoZ20,
$ S
FILED APPROVED
FM -22 1979 FE8 21 1979
Drafted by Robert K. Krisak V) AAAW Of mNk�� W
4
�C°M°h tai
ST. C2QiX Cud°
COMPdEHENSIVE PARKS
�► ,� AND ZONING COMMIT-mi
ter^
GOlume 3 Page 765
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