Loading...
HomeMy WebLinkAbout022-1008-80-000 N 0 I Q o� ha) a) °p g g° h ° o I Z. 0) a) I N N Y I �m c N i m o.°c i c 0 o 'o LO E aom N E I o ors I O �c I ; �3)n + N acd � a c(D cC I y ° 3— x ° c- �r m° I E°v 3 i o rnO td cN I m o.. o 3 v N NND C C p) T C M— Co U) O N o C2N O I ;? € $a c I ,C y O a) ca j 7 N O 30 I C Z .D��CO i LL c Y EfA_ ti C j N 0O c ?� a 3Eo °) c 3 ° E� Nr I y N U O O 'O 4 7 w E Q �"' N a N Q w C o O m L I C p l0 CL u O E E z 4.; O 1 v` E co m m i a) d v ►NZ am I am o o I ° z g ) I .- •= w m E I E -o I E co I c� _ D • c (D c v r v g 0 O m U Q M z z o I 2 z z o N Z Z N N Lo - N N : w .. m N c I d :0 c )y) 0 G G a o) 1 O 0 a` -0 o ° °o ` O Cl) N M y N N o E C No N tom : � I No y N to L ; I 3 5 i � a = .� CL z 000 Zgl ►v o � aaa �, I � a. ILCL o r I ° 1 U �o m l 00 00 a o o J U 0 a p 0 0 > i Z v Z N N O Z N N — O C6 O O -O a) 0 0 -O O ml N C CL I (Y m C (1 U) I p of Q Z U) co ° U o U o e7 ° c � o � o N O � N c 3 � N C cl o E E to 0 ci c :1 I m v :3 o l (=) � O C a N IX C 'O l0 W to D N I co ° N 4 ao .y a'. Z M o r o (I> ^ I N Fri N c •O O O Y 1 n 0 Z S 12 � t4 I � � O z c Z � fA )1 — a € L EL m m a • c d '� m m c d a I rr`N� o o c 4 'o 3 ' A00 U) U t L DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ON I LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVISING P.O.BOX 7969 MADISON,WI 53707 NW% NW,,iS4,T28N-R18w 9CONVENTIONALRECONNEC1]ALTERNATIVE IS,,,,Plan 1,11,Number Town Gj Knnickinn�,C ❑Holding Tank ❑In-Ground Pressure El Mound (lf assigned) County Thunk N NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ray Vokwatd Rau e 2. Sax 130-A, Robetct3, W1 54023 BENCH MARK(Permanent reference Poinil DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: JMPIMPRSW No.: County Sanitary Permit Number Date F. Hud6an 6629 St. Ctoix 112708 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV_ IWARNINr�;]LOCKING COVER PROVIDPROVIDED❑Y DYES ❑NO BEDDING. VENT DIA, I VENT MATL: HIGH WATER NUMBER OF ROAD' PROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM LINE AIR INLET DYES ONO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: YES ONO DYES ONO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING IVENTTOFHESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER JINSID DIA SPITS LIQUID BED/TRENCH TRENCHES MATERIAL( PIT DEPT DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: No D ISTR. NUMBER OF P NE RTV WELL. BUILDING'. VENT TO FHESH BELOW PIPES. ABOVE COVER. ELEV.INLET ELEV.END'. PIPES FEET FROM LINE. VENT NEAREST IN L MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER ITEXTURE PERMANENT MARKERS OfiSE HVATION WELLS El YES ❑NO 1:1 YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. DYES ❑NO 1:1 YES ONO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: t WIDTH LENGTH. NO.OF LATERAL SPACING (TRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. DIA. ELEV.. PIPES DI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY 7MATIRIAL VERTICAL LIFT CORRESPONDS TO APPROVED LANS ❑YES 0 N 1:1 YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL'. BUILDING: FEET FROM LINE ❑YES NO ❑YES NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Admt mizt ratan �ILHR SANITARY PERMIT APPLICATION COON In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# D —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION � I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE E]YES 4 NO PROPERTY OWNER PROPERTY LOCATION o l/tol/4 /VW'/4, S Ta,?, N, R #(or)W PROPERTY OW R'S MAILING ADDRESS LOT NUfAB�R BLOCK HUMBER SUBDIVISION NAME Z— BOA 1-3e2 — N// I /" CITY,[STATE ZIP CODE PHONE NUMBE/R� p ! CITY NE REST ROAD,LAKE OR LAN MARK 1 (71—r 7 7'.303) O 5W TOWN OFm VILLAGE: h �d J n�f !R K II. TYPE-OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family "� OR ❑ Public(Specify): 1(q III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. El Replacement c. ❑ Replacement of d.,� Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in#2) 1. a. ❑Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.9 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet El Private El Joint ❑ Public VI. TANK CAPACITY Site in a allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank tom" i Lift Pump Tank/Siphon Chamber r►�� l�tS ✓LEC ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: �ZD Q,'YI Sf ,?klko/' I zle_ S�OlJZ r�� VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name S CST#/ '��� CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stam ) charge Fee Approved Owner Given Initial � �}'� Adverse 12D. jr F-1 X. COMMENTS/REASONS FOR DIIISA�P�PROV(A�L:,, I SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT - APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8%Z 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; dosing or pumping chambers; 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. --------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground eitet included the creation of surcharges (fees) for a number of regulated practices which Wisco iF 'S can effect groundwater. The surcharge took effect on July -I, 1984. All of the water that buried tes"3&�itB a is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. -> o The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LO A N: SECTION: p r TOWNSHIP/MUEI/I PALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: Nw yfi1/ o R/LBUIEC N/R 1tL (or , f MA LI lrf� N -/2- r 4 d L&- I;s 4) " USE _ DATES OBSERVATIONS MADE NO. EDFiM$.: COMMER LA QE§�RIPTION: RQ1.I1 D Rll NES TS: NResidenee RATING:S-Site suitable for system U=Site unsuitable for system 1 ONVENTIONAL: MOUND: IN-GROUNaVRES URE: S STEM-IN-FILL HOLDING TANK: RECO MENDED YSTEM:(optional) DS ®U ®S ❑U CAS ®U OSC�U CISDU 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: P FI E DESCRIPTIONS BORING TOTAL ELEVATION DEPTH R UND ATERS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER fiL-fsF+HAI, B ERV D TO BEDROCK IF OBSERVED(SEE ABBRV,ON BACK.) >4,no I'd hull, 4tIFO .9. dif vi j B cv s d- q h A,,6 fS e- 6,D0 �0 >6. e 0 3,q0 3.3 Ur aIs. 0t3.9.) B- r B731,00 9y S,0 ?' �� 3 B- 0, � & f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAT R LEV INCHES RATE I I D PER INCH INCHES AFTERSWELLING INTERVAL-MIN MINUTES P- P- b �� P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ,ntal 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 land slope. YSTEM ELEVATION 9 !dD 6�ar•►C i I ' •'=�QO a '•Stop- e 1 c/ter 77;Ce ICO 4-r A 10 � � � • � !('a�l�� � ao� � _ red' �- '�l�V, Vj, I Q! Pt B3 1 I Io 3b' I � 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 Istrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. (print): TESTS V EJ E COMPLETED ON: dES : - A A _ 1 CERTIFICATIO NUMBER: PHONE NUMBER(optional): CST ATURE: t�1;RIBU I-IC?N: Ui q}nwl ,n,.l nnu r,.>Iy to l_uc,at A, iJimty, U(firt-SNI)1.:;3' tri U;'lit '1 �VI It a �e , z y ob�F � a Z V'v� r L � � 1 f — -1 F I , �!, �X tST,►,+� CzARA 1 , i G t� Z n Z - �c IAZ a a --- °I N 0 Z A 4 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/contractq]Z, ("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 GI ze5lr 4,5"aZz _ Location of Property w ' 14, Section , T N - R W Township Mailing Address Subdivision Name A Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ?•, Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract - 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. } PROPERTV OWNER CERTIFICATION 1 (We) cent 6y that att .dtatementa on this 4onm cute tltue to the but of my (OUA) knowledge; t'tiat I (we) am (ane) the owneA_(a) o6 the pnopenty deanibed in th 6 in6o4mat on ,Jonm, by viAtue .oj a waA anty deed neconded in the 0�jice o6 the County Reg•i 4 teA 6j, V eed,6 as Document No. ; and that 1 (we) pneb entt y ow the pn.o poa ed .6 to j on the .s ewag e po s ,s ya tem . (on I (we) have obtained an .zabement, to nun with the above descA bed pnopenty, bon the conbttuct o'n of bail .byb.tem, and the •same has. been duty neconded in the 0 j6ice of the County Regi6 ten of Deeda, as Document No. 1 . GD SIGNATURE W OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAry RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 MADISON,WI 53707 ❑CONVENTIONAL BUREAU OF PLUMBING ALTERNATIVE Slff assPlan IIl D .Number ❑Holding Tank ❑ In-Ground Pressure I KiMound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: .INSPECT iON CATS: Ray Vorwald Rt. 1, Roberts, WI 54023 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT,ELEV.: CST REF.PT.=LEV.. NW NW, Section 4, T28N—R18W, Town of Kinnickinnic Name of Plumber: MP/MPRSW No County: Sanitary Permit Number: Tom Wang 3231 St. Croix 75035 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED /d(h o lo7^ SG ° O 6 °1 6 WYES ONO ❑YES D'NO BEDDING: VENT DIA.: VNT MATL. HIGH WATER NUMBER QE" ROAD: PROPERTY WELL BUILDING. JVENTTOFFIFSH ❑YES NO / ( ALARM FEET FROM .�°� LINE �� a AIR INrLET. ❑YES i3NO INEAREST7f DOSING CHAMBER: MANUFACTURER- BEDDING LIOUIb CAPACITY. PUMMP M/ODF.I_ 3 /SIPHON MAN/JUF�q( TURER. WARNING LABEL LOCKING COVER I( ❑NO /*0 0 v✓ DI L /-r Q L.�' ✓` PROVIDED: PROVIDED: YES V I YES NO LE 'ES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I VENT T I FRESH (DIFFERENCE BETWEEN 8%7 F f.,ET FROM LI /{_II AIg1NLET PUMP ON AND OFF) C� ( YES ONO 110AIRIEST' e� � SOIL ABSORPTION SYSTEM.Check the soil moistureat fhe depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until v the soil is dry enough to continue.) A '^ CONVENTIONAL SYSTEM: ICI WIDTH: LENCTH INO.OF IDISTR.PIPE SPACING. COVER ':.INSIDE DIA.-. tPITS'. JLIOUID •' "+' IT#IENCH :. TR ENCHE MATERIAL: P ;:.. DEPTH: JIIMSNIQN;Ce .'i GRAVEL DEPTH �FILL DEPTH IDISTR.PIPE DI _P E DISTR.PIPE MATERIAL: NO.DISTR I'M UMBER PROPERTY WELL ISUILDING- VENTTO FRESH BELOW PIPES. ABOVE COVER ELEV.INLET E ND: PIPES. y�yts+� yyy LINE: AIR INLET: 0 ARW MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER EXTURE PERMANENT MARKERS: OBSERVATION WELLS YES ONO YES 1:1 NO DEPTH OVER TRENCH DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER � / EDGES'. / S `J\ l/ � DYES NO YES ONO CN ES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER t' RaE`I TRENCHES: #'"04 �?-S +;MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: IND DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL& ARKING: ELE V.. ELEV.: DIA. ELE V. /' 'l PIPES. DIA.:/ d � 4V;iE� `(l��1y1 y �(( G/ iIi�f11 HOLE$J�� HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED � I /� / PLANS: :4YES ONO ONO COMMENTS: PERMANENT MARKER OBSERVATION WELLS: PROPERTY WELL: BUILDING: O LINE' YES E NO YES ❑NO ,° Sketch System on etain in county file for audit. Reverse Side. SIGNAT TITLE: DILHR SBD 6710 (R.01/82) Department of Industry, Labor and Human Relations mow " Division of Safety & Buildings DI L H R Bureau of Plumbing OEPRRTTEf1T OF P.O. Box 7969 �11'IOUSTR 1,LR60R 6 mirfmn RELRTICN'M Madison, WI 53707 ` F Tel. (608) 266-3815 ,T� �P f` IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT / n ❑ G E AL PLUMBING PLANS Fee Received: LOCATION Priority Plan R n view y TY 0 OWN OUNT -. . n a c V— �L Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of when required inspections are to be made. yap rnyal will ha vnid And oew pJan approval shall be obtained htaga"e 4 gpk may In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For Private Sewage Systems OW. This approval Is valid for two years or it will be valid until James Sar t the expiration 9 e p :on date of the initial Bureau Dire or sanitary p erinit. kLA REVIE D DATE: cc: DP Owner H & R & Rec. San. Section 4 L PI Plumber Bur. of Health Fac. & Services ount Other t DILHR SBD-6099 (R. 05/82) E conjsln APPLICATION FOR SANITARY PERMIT y D I L H R CQUNTY (PLB 67) UNIFORM SANITARY PERMIT# FiPTTT1ErIT OUSTpV,LFBOR6 HUTWni7ELiiTlOnS__ —Attach complete plans in accord with s. H 63.05,Wis.Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPS TY OW ER MAILING A DRESS Id �_erS PROPERTY QOCATIOrF CITY: �F N, R/ E (or) ow on M!?1 �l�! W 1/4 1/4, S , TI LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. N MBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: � E-1 Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair El Replacemen . a,, ❑ Revision ❑ Privy fN Alternate System C h ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity a Lift Pump/Siphon Chamber L_d" Ova t X Manufacturer: r PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): \ P e; 51 X1 Private ❑ Joint ❑ Public 1,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Sign atu MP/MPRSW No.: Phone Number: � � 3a3i (��s ►r�,s� Plumber's Address: ` ` N e f Designer: COUNTY/DEPARTMENT USE ONLY Sign at re of Issuing Agent: L2;?s'"e: Date: ❑ Disapproved � n / ❑ Owner Given Initial � �� [IVApproved Adverse Determination Reason for Disapproval: I Alternate course(s)of Action Available: DILHR-SBO-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber 1 INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city,village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system,type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,D.ILHR,State of Wisconsin. k L O y O L p �-r- 3 O al L o a= �O O F d " ca 0 O O 7 A:�C? p U k l U : y p r m O O O E � C .n � >3;A ; .o C7 3 W o ((OOV ai 3 ov C7 c° 3 � ob vEc LC v_, yco, = °? � &- Qo = c�O .0u C U NN � m - o ) V) ci m � W m y3 � � v $ L- ea N N cc O t ... cd W o L S H - O w 'Z rn3F- 0 3 cOL c N a IL Z N � y cv CL c0 c -0 •p O OL �y O 3 0 0 0 0 : cO i 9 � .. :. L O D U N = 0 U O= :r- ` r = — to d O (7 R 0 — 7 Q U) O N O `O 7 0 4 -0 N cr C U a CL CO N _ c y C L O p (a M (1) L-cc 3 c .0 O 0 � E co O mz O C D I C C G) O i O 'O U co N U E N O L N .. �. cm u .L. �� +L• U N c J� N UOi N _ e* U N U fO (O Y — U C _ co N w' O 3 O d « O .. N _ c0 C] � C 'O U U, ° 34) CD rncL a• o dC>- >O d O � O L. o c O E c a _ 2E° L O O O O a E O 2 O cO L .0 a i � o 3 N C N 0 O EN a v�i � cc F— (D m .. U1 a = N G 4 14 :I figs 13th duy of June: �1.U. 1964 nt G:30 A M. --------------- James O'Connell A F F I D A V I T bpbt• of D •d� deputy The undersigned, Raymond J. Vorwald and Gloria Tripp Vorwald, as husband and wife, do hereby agree that at no time shall they separate from the original deed, the two (2) residences currently located on the following described parcel of land: The Northwest Quarter of Section Four (4) , Township Twenty—eight (28) North, Range Eighteen (18) West Further described on Farmland Preservation Agreement #003713C, dated July 15, 1980, and expiring July 14, 2006. Dated this twelveth day of June, 1984. * _ze Raymon J. Vorw d .�., 'p e ` State of wisconsi6 Gloria Tripp Vorwa St. Croix pounty This 12thday of June s 19 84 P ay nd J. & Gloria Tripp Vorwald iieesona�l�ca"re before me and is known to be Q' Uie pe ;on(+ho executed the foregoing instrument Ua d nuw(e ged he s ne. Not Public P J �upGissidu Expires Sept. 9, .1 984 As H't r_A' 1. MOUND SYSILM IL If:-GROUND PKESSURE SYSTEM-Conunucd- 1, WASt9water Load,IOIAI Dally flows _L�_ gal. IU. fOICC Main: Use wcuun H 63.15 (3) (0),Wis. Minimum Uosing RAte = gpin. Adnt.Code And PROVIUL A ULTAILLU DIAniot9l° it• LIST Of SIZING ON PLANS. 11. total UVAAMIL HCAd: / L) Lt 1. Depth to Limping fAClor• 2 ft. Syilant HcAd= It. VCrticAl Lill 4, DlllrilLC Irvin Uoso Chamber to fr It. lun Loss DI►tilUuuun System- It. TUil = S. L-IOVAliun UhlOrence 1JOtwoa11 12. Pump SCIeLtlan: Pump And UI►ulbutlun Systonk LL It. Punip w111 it ThArgC At ICA11 72- gpnt b. Ab►oipllon AICA Sltlikr: C, At 3 ft. total dynamic herds n AICA Kcyulrcd . L� �=�' sy. Il. Pulup mudal and mgrtul1'ct�uIt Bed or I(anLh Longth (N) _lP2.3 ft. G✓L Bad of I(91101 Width (A) it. 13. Dosc Vuluirr: 1161101,SpALl11g(C) h 10 Tlmes Vold Volume of ). Mound Height: Ulstrlbutlon Lines= gal. fill Ucput (U) ) ft. DAlly WA►ICWAIer Volume-i f III Depth Uuw11slupO(L) 4 Uusas In 24 hors. r- gal. Ned Of 1161101 UOpth if)- +-75 ft. NACk(low - gal. CAP And 'Iopsull Depth(G)■ •O It. Mlnlnturn Uose= gal. Cap And I UpWil Depth(H)- 5 ft. 14. Dose Chamber: g• Mound Langtik: Volume ° 000 gal. End dupe(K) IulAl Mound Length(L) It. 111. CON VLN IIONAL PRIVAI L SEWAGE SYSI EM 9. Mound Width. 1. WAIWwatei Load,Total UAlly flow= gal. .. Upilupe CoiscWon factor UsO sotllon H 63.15 (J) (c),Wis. Upslupc Width(1) a It. Adm.COLIC And PKOVIUE ULTAILED UuwnslopC CurrCLtlun FAOttU z LIS] Of SILING ON PLANS. 0ow11slope Width(1) )4 It. 2. KOquuod Septic Tank Capacity = gal. IutAl Mound Width(W)o .�i� it. 3. Percolation RA(t IU. NAiAI AicA. 4. Absorpilo11 Area Siting: Inlill(AIIVO Capacity of Relcr to TAbie 2 in chapter H 63 NAtol Al Still= gal.�ay.l L�day and PROVIDE A DE"fAILEU LIS f Of NAsAI Aiea Roqutied= ._ sy. ft. SIZING ON PLANS. Bakal AICA AVrllAWC- sy. 11. Roquiiod A(OA= $y. It. 11. 11 SundAid I Ablei(rain Chaplet Length= ft. H 6 t tit Uwd,IndlLAta 1 able No. Wld{h = It. 12. fill like Ulsltibulloa Network,Use Nunibors 5-14 In Soulon 11. NwnbCr tit Tr9nchos= Tranch Spacing= ft. 11. IN-t k(.)UNU PRLSSURL SYSI EM 5, Dlslribullon Systam: L Uopih to Limiting factor It. Later Al Length° It. 2. L A11dslup0 ye Number of Laterals= J. PaOUTAllun KAIC LAWAI SpaLing= In. 4. Proposed System LlOVrllun= It. Distance Irani Sldowall to Pipe = In. S. WAitcWAtor Lord,IutAl Drily fIUW: L„-O _ gAl. Systam Elova:lofl Uso icctio11 H 6.1.15 (3) (c),WI►. , Adm.Code And PROVIUL A UE I AILLU IV. SYS FLM•IN-f ILL LIS I Of SITING ON PLANS. 1 Fill in Ail Hems front Section III Aclt Re ulicd Sepik lank CA Oo v I 4 V p y - gal. nnk3 b. Absorption ArCA Slling: V. SEPTIC TANK PCiL"WIUl1 Kale o nun./111. 1. CapAOily = gal. AraA Roqui(ed $y. It. 2. Mrnulacluief. Systam Length eD�'S ft. 3. Show Sllc Constructed 1 Ank DatAils on Plan Systam Width ,ZQ_ ft. ). Uuulbuuon Pipe Sizing; t V1. DOSING TANK Hole Slit 1y tit. I. CApaOiry = gal. Hulu SpaLing 3.D 11. 2. ManulaLlutct: LAlu(Al LOnitlh 11. .1, Pump MriIUlaLtu(ef: Lateral Sliu In. 4. Pump Model: 4 \' � I .uni.il`*pa0luµ 11. 5. Opautink Head= Il. Ili.lan0u liom 1iduW.111 ao Pllw 2_ Ilk, 1 6. I low Rdtc- spin. g. ULulbuUuo Plpu Ulsch.uNu Kalil /. ShoW Sill;ContruclOd I Anti D WI,on PIAns Numlwi ill Iluus Ihv flit( I V 1 low Poi Piliu i- tipikl. I ANK 4. M.milold ((�� pQ ��.d�j'�.,c•,,, I. Capacity � gal. lyliu(cunwi u1 end) �St Imo_ 2. MAnulaciurcr: Length ,< It. 3. Show Situ Conslructed Tank DaIAIIs on Pluls UlrmOtur° 3 Ilk, -SHOW ALL INFORMATION ON PLANS- � 7 U14NK SNU•d)61 (R.U3�1,12) � D �`�� �� Bulletin CL2.1A i July 8, 1983 For Homes ,yy ' Farms Trailer courts Model 3885 a Motels (Supersedes Model 3870) GYI Schools Submersible Hospitals Effluent Pump Effluent Pumps Industry Effluent Systems anywhere effluent fn , y�: 'cud or drainage must be « •.'.f .Ir 1,I disposed of quickly, quietly and efficiently. r: Heavy-Duty Solids Handling f t Dependable Capability to 3/4" i 1 I I Ii,l1'I ,- 1/3, 1/2 H.P. 60 Hz it t;,y�r.IUlc i.f ltunntf�y Ijl y' Single Phase 115, 230 Volt. � wIIlnrtil �i.u,l,,, lu(.lifll. ,n , ! 112, 3/4, 1, 11/2 H.P. 60 Hz ' Mirir�i f ally `xUnn,,,;uii Single Phase 230 Volt. Three k:il,il In ,ufll�,.,,ll,l III,LII Phase 208-230, 460 Volt. i i�- ,,ir✓Ilixlll�,�l�l l,y,r,;.l'Jui)�:.i:,l a".,:..,��.I,r.,ii, 1 �� ,,. • .>l Ill d..;. ,Icrl fl ill ' Iusc,I,ur'r I lu,�.,,l,sl::ll;lll Sln,�lc 90 w"M � dill ',III,II , I 111 I II., I I:iil Ili, :aI'd .,t .: i "u g,is.s✓: 4a+ :4 �� ="sa ,<,e''C .'F, ��0..,.,a+��, � �•,�'..� IIi7CC I'I,.,_.r (hilr, 70w >x W Ur 60 W 50 :s y[ 'Ri =. )Caul uul x. S Q 40 �5 Z '� —II, 11, �:II„:I , ,I i' 30 _ � - w : ,J. � ,I I,In.,1 wltli 0 20 . r° SPEGIFICAI'IONS ARE SUBJECT TO CHANGE 10 WITHOUT NOTICE. lq� 0 0 10 20 30 40 50 60 7o 80 90 1.00 110 120 MGOULDS PUMPS, INC. GALLONS PER MINUTE st_NEU,FANS NEW YIN 4K 1 l'W R0.yMona vOQL)Cjj ?cur-,e« ►�,f t I�ob�r Li r1Lj'/4 L-3 KInn"Lki h k•^�pP 1C) o lob+ \ego \ S•Q t �J n63 �J bo r L 1 � k r � 6 o � X 6 3 a 1000 nn L �D qal PrMP 111 LCs_tl(1/l� CcQ�r d U10 ally 0 rl N R� Q loo,3n �;;�r�r1 . r'�, ' r _ of Oc `eJ � y°9 ✓�`� � ef���`'v✓V �+g 4 4t :, v J 3d ? l PUMP CHAMBER 6 1 1 0 9 0 4(K C I 10IN I 1�1\I() T1 C I I I( A 1 1(1&1', vcAjl CAP 4 C.I. VIKYT PIPF WE AT V11 R PKOOF KINI(, > Jumcl-lo►-1 l6ox (jVI. R. WIMI)OW OK 1- R L 5H IZ"MIU. f AIR IllJTAK1 GRADE COUDUlT'--. - ------- 18"MIM. o' VIDE. IMLL-F H co, TI 7 SLAL. �vl 'DTI APVKO'JL Ij JOINT APPROVED -I-. PIPE /C. W/C.l. PIPE rLX'r C N L)I m(' 'i ALARM OkITC) SOLID 51b OKIT'o SOLID c U Om OFF J, PUMP D COOLICRFETL bLOLK- RISCK EXIT PERMITTED O►JLy IF TAUK MAMUFACTURELK I-iAS SUCH APPROVAL --PTIC AWL) 6PC- C- IFICATIDINJS )SL TAWK'a MAkiUFACTUKLP,: We I- QUMBE k OU L)()SLS: P L K DAJ TA"K 41ZE G A t-L.0 IKJ S Dosc VOLUME-: G AL LOKI% ALAKM MAWUFACTUKrk: CAPACITILS. L), -.IKACHISOR�iL GALLOI, MOIJILL KJUfAbF-R: -----j-0N40 B- IKRJILS OK GALLC)i,.j SWITCH T!JFE: wo C H L S OR -.2c)-q— GALLOO I'L I IV\V MA"Ill'ACII LJRL R: MOOL.1- MUMBUK', L KJOIL. PlIMP AMD ALAKM ARE 1-0 BE SWITCH TYPE:* ('c u r 111'31ALLLU OW SLFAKAl-C (-IKCUITS � l PUMP DISCHARGE RATE PtA U-A c VLKTIC&L- I)Il,ltI(EMCc burwLtm Pump oFf AkJD DISI-IZ16LITIC)U PIPL.. ------- � LL I + MI kJIMUM "CTWORK SUPPLY PRESSURE • • • • • . • . . F gc T + FEET OF FC)K(-[ MAIM X 404.11 TOTAL 09MAMIC, HLAD FLU 1- 74 IMTERWAL. DIME.WSIo"S OF TAKJK: LUKIG'rH w ;WIDTH ' LIQUID DEPTH Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil ``s` F G e"t -,p �t f - �`s 2 2 Force � � Main Plowed Aialra ate From Pump Layer �. Cross Section Of A Mound System Using E I.i' ,- A Bed For The Absorption Area F -IS + G 1.0 A (o Ft. H I . 5 Signed: g (02,5 Ft. License Number: �� � I I`i Ft. Date: J �_ Ft. Alternate Position K 10 Ft, 5 Ft. ,•:, of F ���r ,t? Force Main W 32 Ft. I J Observation Pipe--,,, K �►----- --------------- -. --------------------- I Force Main W — --------——---- ----.-_ _ __ From Pump gDislribulion Bed Of – 2 %� Pipe 2 2 I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page — Of _ i Per larated Pipe Detail / Eno View Perlo�uled Eno cop PVC Pipe i,o ��ce a+� Holes Located On bollom, / S Are Equally Spocad + / PVC force Mn a o \ « j from Pump v � PVC / Maralold Pipe Allernole Position Ol O pipe ioulion/�- force Main From Pump pipe Last Hole Should be Next Ya End cop End Cop DistrlDunun Pipe Layout P so R to r S 3' X , Gar Y I.S ' Signed: Hole Diameter Inch �� Lateral 11 �/� Inch(es) License Number: p r Manifold Inches Date: -4 �, l -� u Force Main 3 Inches _ .r M,l•1 I 1-Z H H y ST C - 105 r y H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z r� �f^�w `J y OWNER/BUYER F--�t 14 (1 6lJ �~M ROUTE/BOX NUMBER ft j/ Fire Number CITY/ STATE I.aer S ! ZIP �p7/ PROPERTY LOCATION :_ 34, _ , Section, T 9t N , R _W, Town of ihq 'it /�� n��C St . Croix County , I Subdivision Lot number--- Improper use And maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix . County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County \ accepted this program in August of 1980, with the requirement that `owners of all new systems agree to keep their systems properly ` maintained. The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . Ho I/WE , the undersigned , have read the above requirements and agree U) to maintain the private sewage disposal system in accordance with x H the standards set forth , herein, as set by the Wisconsin Depart- ry ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . �/k-t SIGNE DATE 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 . APPLICATION FOR SANITARY PERMI'i ` 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 Q a m Q © Q^ 0 Location of Property 4 IV4J 14, Section ^, T -Q N - R _ W Township !/j)hl L\/ylji��� Mailing Address I0�(�y ��G✓/ S ���` 3 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ - No Volume` and Page Number �a as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION. I (We) ee4ti6y that att 6tatemeitt,6 on this Dorm aAe tAue to the best oD my (ouA) knowledge; that 1 (we) am (are) the owner(,$) oD the pnope.n ty de cAibed in thii,s inDonmati.on Donor, by vi tue oD a wannanty deed neconded in the ODDiee oD the County. Regi,6ten 04 DF;ects as Document No. �I q V ; and that I (we) pnesentty own the proposed site Don the sewage dtsp .so�a.2 aua.tem (o& I (we) have obtained an easement, to nun with the above descAibed pnopeAty, Don the ows.tAuction o said .6 stem a the same h b n� e as been duty neconded �. 0 �.e � 6 y n the e y 64 the County .Reg-i�sten oD Deeds, as Document No. III 01� ) . DD Al� SIGN URE OF J)/2E SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED s .t Agreement Nn. .003713.p�,... . __._.._.__ ._.:..._ WISCONSIN DEPARTMENT OF AGRICULTURE, TRADE. AND CONSUMER PROTECTION Date of filing appl ication.--_July_11.,—I dfl. FARMLAND PRESERVATION First eligible tax year 1980 801 W. Badger Rd., PO Box 8911 Madison,WI 53708 Expiration Date rz- v 14, 2006 7 ;4r� Parcer No.(s)____T1Sr__4�_P5�►:r,_1 a.3.;__,�'5�,�;_ ' FARMLAND PRESERVATION AGREEMENT p55� except 1 vacant acre w _ THIS FARMLAND PRESERVATION AGREEMENT IS MADE, EXECUTED AND TAKES EFFECT ON THIS 4t _. day of A. D„ 19'_-8j__. , by and between.._—R-LTgnnd J. Vorwald and Gloria Tripp Vorwal ) hereinafter referred to as the "Owner" and the Department of Agriculture, Trade and Consumer Protection hereinafter referred to as the "Department" for and on behalf of the State of Wisconsin, WITNESSETH: WHEREAS, the Owner owns real property in the county of__.___ St�Croix State of Wisconsin, hereinafter referred to as the"Subject Property," which is described as follows: The )Northwest Quarter of Section. Four (4) , Township Twenty-eight (28) forth, Range Eighteen (I.8) West; excepting therefrom those lands described in CSM III, on Pages 646 and 647; also excepting those lands described in Volume 471, Page 511; also excepting a parcel of land approximately one acre in size and described as follows: Commencing at the Southeast corner of CSM III, Page 647, thence North along the East edge of said CSM to the Northeast corner thereof, thence Exist to the driveway, thence South along the driveway to County Highway N, thence West along the highway to the point of beginning; and WHEREAS, the State of Wisconsin desires to preserve agricultural land, to maintain the agricultural economy, to assure a supply of food and fiber, to discourage the premature and unnecessary conversion of agricultural land to other uses;and to accomplistl that, created Wisconsin's Farmland Preservation Law;and WHEREAS, all the conditions required under Wisconsin's Farmland Preservation Law to enter into this Agreement have been satisfied;and WHEREAS, both the Owner and the State of Wisconsin Intend that the terms, conditions and restrictions of this Agreement be consistent with those agreements authorized by Wisconsin's Farmland Preservation Law (s, 71.09(11) and ss. 91.01 to 91,79,Wis. Stats.), as that law exists on the date this Agreement is executed, NOW, THEREFORE, the parties, in consideration of the benefits to each of them accruing by virtue hereof, AGREE that: 1. The term "agricultural use" when used in this Agreement shall have the same meaning as in s. 91.01(1), Wis.Scats. 2. This Agreement is made and entered into pursuant to the provisions of Wisconsin's Farmland Preservation Law (s. 71.09(11) and ss. 91.01 to 91.79,Wis.Slats.); and all of the provisions of said law as they exist on the date this Agreement is executed are incorporated herein by reference and made a part of this Agreement. 3. The Subject Property shall be devoted to agricultural uses. If the use of the Subject Property is changed to other than an agricultural use without first acting under ss. 91,17 and 91,19, Wis.Stats„ the Owner or successor in title can be enjoined from changing the use and is subject to civil penalty under s. 91,21, Wis.Stats. 4. Except as provided under s. 91.75(2), Wis, Slats,, no structure may be built on the Subject Property except for use consistent with agricultural use or with the approval of the local governing body having jurisdiction and the Department. The phrase"local governing body having jurisdiction" shall have the same meaning as in s. 91.01(8), Wis. Stats. A structure made as an incident to a scenic, access or utility easement or license is deemed consistent with agricultural use, 5. Land improvements on the Subject Property shall not be made except for use consistent with agricultural use or with the approval of the local governing body having jurisdiction and the DepartrYient. The phrase "local governing body having jurisdiction" stall have the same meaning as in s. 91.01(8). Wis. Slats. Land Improvements made as an incident to a scenic, access or utility easement or license is deemed consistent with agricultural use, 6. Public access to tare Subject Property shall not be required for the owner to enter into this Agreement and receive tax credits. 7. The following further conditions and restrictions are deemed necessary to preserve the Subject Property or appropriate portions of it for agricultural use: • 8..Warmirissi operations on the Subject Property shall be conducted in substantial accordance with an approved soil and water conservation district canservatidn plan, g, if,-ownerihip`of"the Subject Property or a portion thereof is to be conveyed or transferred by deed or land contract while the terms of this agreement are in effect to a transferee who has not signed this Agreement, the transferor shall notify the Department in writing prior to clps'ng,of the name and address of the transferee and the description of the land to be transferred. It Is specifically agreecl,that if there is army-transfer,of the Subject Property by deed or land contract, the transferee shall sign at or prior to the closing a document drafted by the Department which states that the transferee agrees to honor all the terms, covenants, conditions,and restrictions of this Agreement and the Farmland Preservation Law including responsibility for all payback and penalty provisions under Wisconsin's Farmland Preservation Law. It is further agreed that, transfer of any interest in the Subject Property made subsequent to this Agreement shall be subject to the terms, covenants, conditions,and restrictions of this Agreement and the Farmland Preservation Law n i u t t such time as the Agreement expires or the terms of the Agreement are relinquished as to the transferred interest. The transferring or conveying document shadl contain a state- ment which provides that the transferee's interest is subject to all the applicable terms and reservation of rights of this Farmland Preserva- I ion Agreement. If transfers of any interest in the Subject Property are not done in accordance with the terms of this paragraph a lien may be filed against the subject property under s, 91.19(7),Wis. Stats. and the transfers may be voided by the Department, if it is necessary, for the enforcement of any of the terms, covenants, conditions or restrictions in this Agreement, 10. If the Subject Property is being purchased by land contract, the land contract vendor shall sign this Agreement and shall thereby agree to all of the terms, conditions and restrictions of this Agreement. ,ADPP-a2 11, This Agreement shall commence on the date it is executed and be in effect for a period of _-_- _years from that date. T agreement shall expire on the 14t14 day of 12_ This Agreement shall be relinquished by the Department on behalf of the State of Wisconsin at the expiration of this Agree ment. Upon relinquishment of this Agreement at its expiration, a lien shall be recorded against the Subject Property in accordance wit s. 91,19(8),Wis.Stats, 13. This Agreement may only be relinquished, terminated, or withdrawn from by the owner or successor in title prior to its expiration date according to the procedures established in s. 91.19, Wis. Slats. If this Agreement is relinquished, terminated or withdrawn from by the owner or successor in title prior to the expiration date;a lien shall be recorded against the Subject Property in accordance with s. 91.19(7), Wis. Stats. 14. No lien shall be recorded against the Subject Property when this Agreement is relinquished, terminated or withdrawn from if the Subject Property at the time of relinquishment is zoned for exclusive agricultural use under a zoning ordinance certified under subchapter ) V of Chapter 91, Wis. Stats. If any portion of the subject property is reentered into the Farmland Preservation Agreement under subchapter II of Chapter 91; Wis. Stats.; after the Agreement has been relinquished, the lien on that portion of the subject property reentered shall be discharged. ; 15. This Agreement shall constitute a covenant running with the Subject Property for the period of time specified in paragraph I 1 of this Agreement and shall be binding upon and inures to the benefit of the heirs, executors, administrators, successors, trustees and assigns i of the arties during that period of time. P 9 P 16. Failure to comply with any of the terms, covenants, conditions, or restrictions of this Agreement by the Owner or successor in title while the terms of this Agreement are in effect shall, In addition to any other remedies at law, subject the Owner or successor in title to a civil penalty for actual damages and possible Injunction under s. 91,21, Wis. Stats, 17, The Owner or successor in title shall receive the greater of the credits claimable under s. 71.09(l 1), Wis. Stats., as such section !, exists on the da::; this Agreement takes effect or the credits claimable under s. 71.09(l 1), Wis. Stets., as such section exists at the end of the i year for which a claim for credit is filed, provided all the requirements of s. 71.09)11)_ Wis. Stats., are satisfied each year that credits are claimed under this Agreement, 18. All the covenants, conditions and restrictions of this Agreement shall be in effect regardless of the receipt of tax credits by the Owner or successor in title in any year this Agreement is in effect. IN WITNESS WHEREOF, The parties have executed this Agreement as of the date above written, SIGNATURE OF LAND CONTRACT SELLER(S) (IF ANY) TURE OF N R(S) /� i --- - -- - ------ ( SEAL ) SEAL) (Vendor) Raym J. Vorwald (Owner) i SEAL ) (SEAL) s (Vendor) Gloria Tripp Vorwald (Owner) i -- - - - --- --- ------- (SEAL) i _ (Owner) SEAL) (Owner) STATE OF WISCONSIN DEPARTMENT OF AGRICULTURE, TRADE AN ONSUMER P _C T ION B _. I y (SEAL) Jame Johnson, Director Farmland Preservation Program SIGNATURES TO BE ACKNOWLEDGED BY NOTARY PUBLIC: INDIVIDUAL ACKNOWLEDGMENT (Landowner, Except Corporations) STATE OF ISCONSiN ) County. ) Personally came before me, this ___L_ _ day of It { 19 � __ - the above named Raymond J. Vorwald and Gloria Tripp Vorw 1d TO ME KNOWN TO BE THE PERSON(S) who executed the foregoing instrument and, knowledged the same. p Notary Public, 'r�- �� County, Wisconsin i t' My Commission (Expires CW 7 - CORPORATE ACKNOWLEDGMENT (For Corporations Only) t STATE OF WISCONSIN ) ) ss. I County. ) i Personally came before me this . . ._ _ day of 19 President, and __ ) Secretary of the above named coporation, to me known to be such persons and officers who executed the foregoing instrument and acknow- ledged that they executed the same as such officers as the deed of such corporation, by its authority, _ i s j� Notary Public,__ County, ' Wisconsin My Commission (Expires) (Is) - t DEPARTMENT ACKNOWLEDGMENT (Official Use Only) STATE OF WISCONSIN ) COUNTY OF DANE ��'77 ) + ' On this -/- -_.day of ____./,n2dte:d_.__-- ___.. ___._ __- _-_._ , j' 19 . _�_._. , before me, a Notary public in and for,said County personally appeared James A. Jome known to be the same person who executed the foregoing Agreement,'and who acknowledged the same to be his free a and the free act and deed of the Department vi'sconsin iculture, Trade and Consumer Protection acting m behalf of the State of Wisconsin. . This Instrument was drafted by the Wisconsin Department Votary Public, Dane County, of Agriculture, Trade &Consumer Protection Ay Commission (Expires)yhj'" g s i State of Wisconsin ` Department of Industry, Labor and Human Relations Jr lty 19, 1984 � 8 SAFETY&BUILDINGS DIVISION 1- 1 �� c9 Bureau of Plumbing » �F�'�� 201 East Washington Avenue Z '20 FG r P.O. Box 7969 TgBQ r Madison, WI 53707 Mr. Raymond Vorwa l d " ,} Rotate 1 Roberts, W1 54323 '2 1l Petition No. 54-03572-P Dear Mr. Vorwald: Re: kaymond Vorwald - Residence Private Sewage System RW,N ,4,28,18W Town of Kinnickinnic, St. Croix Coy t.Y, W1 The subject petition, for a variance to section ILHR 83.03 ( 1) of the Wisconsin Administrative Cade was considered on July 5, 1984. It was conditionally approved. The condition for approval is adherence to the signed and recorded affidavit stipulating no partition of property. The rube requires that the private sewage system of each wilding shall be entirely separate from and independent of that of any other building. The variance requested was to place a second home onto a system that serves an original fam home. All of the data and statements submitted on nenalf of the petition were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely; F James Quinlan, Ad t i nq Chief Section of Private Sewage JQ:FD.ks cc: .L,�.roy Jansky, Private Sewage Consultant - District 6, Chippewa Falls '-ilarold C. Barber, Zoning Administrator - St. Croix County Tara W4% 'I I ii I kli&6D-6423 (N.04/81) Department of I=ndustry, Labor and Human Relations ""�°"�'" Division of Safety & Buildings Bureau of Plumbing D'L H R ,f 8 P.O. Box 7969 Madison, WI 53707 �IIIOUSTRV,IiiBOi7 6 MUR1fifI FElFiT 5 10f1 ' Tel. (608) 266-3815 G! cF/yF o IN ALL CORRESPONDENCE 177 Z p��g� REFER TO PLAN Of S IDENTIFICATION NO. E OF PROJECT WA E ONLY - O GEN RAL PLUMBING PLANS 4 � Fee Received: LOCATION Priority Plan Review Only I ITY OR OWN ) {C L '' C ` x Examination of plumbing plans and spec ions for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wner required inspections are to be made. L,e9i In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For Private Sewage Systems Only; This approval is valid for two qyears or it will be valid until s Sar9 t the expiration date of the initial Bureau Dire or sanitary permit. N ; R I E D DATE cc: D Owner H & R & Rec. San. Section Lo PI Plumber Bur. of Health Fac. & Services oun Other DILHR SBD-6099 (R. 05/82) 1401b l000f At�t#' tl�`tiperTq OF ' ► tin':$f,TW f4M tlVith MADIW, 06/ 8f64 - I e� L PROJECT.:. :E ' a�f 9 Vorwald, Raytnortd" ='Res em, e 6 ) NW, NW 4,28,1& To Kir nickinilic, Tate Wang St. Cr oix WI } ' 1009 1 12 Map.16 r River Falls, WI 54022 PLAN ID. 84-03672 p DETACH HERE PROJECT NAME Vorwald, ,Raymond - Residence PLAN>1D.# 84-03672 P Otis no of jptk #our.Plans Amin spmftotjons for th above d eaiecl pry h > Pre}lminary review iddi the rewired fee is$ �'. Fee Received is ,' „4 Uncleayrtitient—Please submit the additionat fee: Overpayment-Refund forthrrtg :Plan accepted for revie"W Plans being returned. pip fee has bin xeirtitted,Bars sUWutted wt#h.no fees wadi 1w.' " Additional information regyrt* held -bejran d _ l y I7 Complete date t r f nal itaf CIO" ton glli be sub�snitlecd to"derplicate un- 120 ples of FL ,81? � fE 1 8lwhow Dead testr action�e quit (1' sa Fgere rwt ca r•,le a ar,parmenent 7 Condaminiuni der araU4n, ( .y Att irtft3rrrlon.submitted shall be signed.."dated;and sealed y� t t or St"-ed;tn acxord earth section H 63.(}>63.08421W Wiscogsin h a ietCattve Afftd rtt errtClttsed. iV,. HoldhIg Tanks. . [ Prctflle of holdir took vtn manafiaciurer tf preca p Pro— Dlst�•'iQfiZyssetns(Mound or In Ground Pressure) site constructed, , f 1001 tsibri for usre'of an alternative system signed by owner (1. x Cl Holding tank?*reement signedf t h " go vernment (sample enc 1 osed) x rya �4 ot�stte t eq' tltgd '; p€ rt. © Design calcut8tions L❑ Reason for instilling: holdttg tankk of"ptessrrze dlstrbtrt Soil,boring$c perrcilation" from"county(t copy) Plpt plan sh owing �n of k r Croce oL "lateral layout. s to any mrudin : + sy�, Pla�dan.. t£ ►., t r rs%lot llrtes; ( V8x0t "of Iy*000 tt Forrrt by County: (1-coPY) F-U4 Provide ber tiirrs(€ a r t i { k n f#f Dtsposal systetrsa V. Llft Porn + d �" rn ept#re*area of slit absorp- f I Galcuiations fir tcttsel`lr� trtstetn axtertdt� 2S�.on alt sides =: pumped l l pert�t iris tutu ioiot{beio6tn n cf le [] Size, ngth&depthzif farce: .+�f` sc tfiable.for.r$pt ►ent;system. provide a Detail 8c ! cif trnp or r �Idrr#ilet8, _ _ . , „ r q } xo :plan'" oweng;lot size ar+d 411,`lateral-diittarrces.from sib¢ sectio o#Ctft ni c ,i dr tee Wiidi, lot lines Welt water �phan(s). � �s� . � m liv'poo jwator service}piping,'Etc;I I 25k F nstruct�o detail of #tc liol#tn or oft pomp tarUc if x t site�* rn Wfac#prer if precast VI" Systems In Fill (Fitt oU*be A oloor", ' loin det! att ' reseed .of Sort n. CD fiQt area frlled�(fitt:tp x k 4 x S B(n # k xs before side slope e rl-b�' rt a test On.' retp#i iced lJrjr-osr C Depth and"[ty �'' t, t{#' t t (t x �r3 d Copy of onsite r #t_ ,{{ Ro � $,` ...���,F� t��¢/ey �t ,.✓ ow 'r ° o t � �°«> '�# q"< �g `� x � tF't. 4 ��`� C3t+S+ �� ��d"°i,r,` de'a -,'+��g55! i x c' p �y 10�6tk .'rJl^ Ek Lv r ro 'kft NJ iY r `'{.i r*� r S � {• ,�-�� r� A .. t � {r = as a,:� ��.. t rd,'a.f�, �, j,°c `�:.,�dt. ast? sue` zf •r i •Y gt :�e�. � "R,. '-Tr ` .?@ .,dam - §.k +:s. n 1:,7a,,,e °.)yti5- p#!`.•.1-n^{}.,'J - �m .sue a� £� � �}_� # =# ;ite;>"'!�F .� e "-�'�:, •.,� F �,' 'r° � i 4. ♦ 's a,�a .� y �";,. •'+'- ""'..+.. .•°,y".' _ ? r _ w ti�Y^� f t. s z aa,w i ,+ i j Fa �� � �<r.i3►.w�`�ay k � � r�� �� � �.�° y sa.�- -r o-,�£"�'4 k,yi .:•..�"".� X"": -sr t'�{ 'tlb'+ 'fJij ', r �i'tF` rsc s' .p '�x.i xfi�'s�' t�'aafi :3j:°Mwi'" -0 f J.'Sai� If.F! J'x'"t, 8 �'�� i L d• '#";"a" t'• i } .j� t�,y $ 3 t a� 1 {R ;}OIL :� 4 +1qr may, „�. J9.�ffi"�r 1,ftwv- x Of'' A 7il n '' `. x ""±$�`r E '�.�,, - y$,-.-, V-;r4 .11'k. 1n Mi ytl ya ' aJ'c t � 6 vu . x.3°. r• ' *'F ys r r^t.. c{ °"t' 3 * # F .� Mkt tca' 'k. k?'rE1sSa € oa .� { W-4 i A". ' r'S' r x'• .'9C�°�Yx'3-s r� '°°x`.3.?'T �,{rit�'r 2 t s''' ' 4r w � hhbb yy a 8"p y s k-^yam rt "SS} ?ff e4a33 t �c yu t 3;. �7YYAf�� � i+�S,�a "C`��},'J�°A �,ar,�Crsw} t" XI�.F� k 3 r h•.r � � ., 1� ',j t !' �r.�i '"�x �` ,� ry. t `fix' �.°u1(�`�• �" -rg�� `�,�'N'g i�' `��$�3> z'a. tCY1k k� L=i'*f�t'b w..-,� .p .rP' '� 'k;+a,� � R. Z� xr q, �'� 3 f wkia xz .. �� .'r�'a r it R °* f ^t �,� 1'�•c°�t, F1( -�{ i` .�r .e is .0 *�+� •h3 rya •y °A 'ro # +".' 3•'j,a �ft"9 to �3�•� "�" o � ty"���,`' �'.�.� �:.� ,,,r�.� t*, '$. �3:�-"-`��� ��?x. �3 '+� �Y �, 6 .,��,r x` `y r i s 4 4 eae a t s'b �.S^ ✓ v s xy a * sea' ,lg, k r� t t-L' . ', ; ` i Tz ra , 3 o s 1 Al alfRK: Y g 'Ail r Asst 4J I-P,.KO`F..tfx4E '� `$ h '�xaa 5 #^ � `*.,f °Y.x k $ ' 'a•cR ,�#.T`�' � # �"�r�.ul'����3a �,#' ¢ �,�� � �x .y ���1'ti �'� s �p �:�. towtc., _ kill ,. sr WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS 111VISIM OF SAFETY & BUILDINGS., BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCQNSIN 53707 Verification of Exception Status fo an Alternative Private Sewage System In the County of �t. CnO.cz Location NFU 1/4, NW 1/4, Sec. 4 T 28 N, R 18 •X4 W Town 6.KXP4MU*UXAj K.innickinnic Street Address Lot No. Block Subdivision Landowner's Name: Raymond VoAwa.fd The application for this site is for: ❑ new construction use. [I replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: Hto have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers i ssue3—to you.) ] one of the applications needing a quota number. The quota number assigned to this application is - - [_] for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. 1 .1for an* individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ( __ for an application on file prior to February 1, 1980. L_I for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: [Ala failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and-the lot meets the criteria fora conventional private sewage system, check here. n I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Net6on Signa ' County Official Title Assi6 tart Zoning Adm.iniz.tAa o,% Date -Tune 18, 1984 DILHR-SBO-6158 (R 12182) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - DUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/ 4 )VAX NW 3 1 NW k I S 4 IT 28 N/R 18 XXJ(UXW Kinnickinnic St. Crtoix Street Address: Subdivision: County: Landowners Name: Mailing Address: Raymond VoAwaX-d R. R. 1, Robehta, W1 54023 I (We) , the undersigned , hereby make application for an alternative system on the above-described premises. I recognize that the above premises, are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for'- the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved , the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. I -,&ignature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19_ Notary Public, State of Wisconsin My Commission Expires: DILHR-SBD-6413 (N. 05/81) ST. CROI X COUNTY W I SC O N S I N ZONING OFFICE 796-2239 (HAMMOND) --- 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 18, 1984 I Division o6 Sa6e ty and Bu tding BuAeau o6 Ptu.mb.ing P. 0. Box 7969 Madison, W1 53707 DeaA Sia: An onzs.rte .investigation bon the Raymond VoAwatd pupenty located in the NG)% oA the NW4 oA Section 4, T28N-R18W, Town o6 Kinnichinnic, St. Cno.ix County, nevea.bed suctabte soitz at a depth oA 3.42 6ee.t, beeow which seasonabte high gnound wa.teA was noted. This site showed be suitable bon a mound system. Showed you have any questions, pteue 6ee.t Anee to contact .this o66ice. S.incenet y, Thomas C. Netson Assistant Zoning Adm.inibtnato& TCN:mj DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, . PERCOLATION TESTS 115 DIVISION LABOR AND ) P.O. BOX 7969 HUMAN RELATIONS J MADISON,WI 53707 (H63.09(1)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUN CIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: NO �/1�/a /TO N/R tli for � ' C UNT : , OW ER'S BUYER'$NAME: MAILI G ARDRESS �e USE [�J4C DATES OBSERVATIONS MADE NO. MS : COMMERC AL DESCRIPTION: rrCCII PRQI E D SCRIPTIONS: PERCOLATION TESTS: ®Residence --� New Replace RATING:S=Site suitable for system U=Site unsuitable for system VVV V TT CTEIS NVENTIONAL: MOOUU}NrD: IN-GROUN=D-PRESSURFEIS STEM-IN-F-FILL HOLDING TA'NIK: RECD MENDED YSTEM:(optional) ®U NS 0� EIS ®U t cy� �S ®u E ercolation Tests are NOT required DESIGN RATE: If an y portion is the tested area is in the er s.H63.09(51(b),indicate: Floodplain,indicate Floodplain elevation: 7' th s TT. P FI Ft DESCRIPTIONS BORING TOTAL ELEVATION D PTH TO GROUNDWATER�MfS CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER OBSERVED EST,HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- J 6,0D a� >4.0 0 .9(2 .g3 B" &_.)/rAs1 v� A46 tr> B- 6.60 ?6. D 3 3,3 o1S. at mid B- r -r vL o Is, B- 3 1,eo 9� s'o P D a 3, �� 3.� B- B u a� fT. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAT RLEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PE IOD2 PE PER INCH P- I( .�U �® If P- P- IQ P-_ P- 2 O!V 3 F .• .. P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9(" 50 16 e Mc J f j � i i�(I ....._._ ... ......m..,.. c , 2 z Pc ± ' I { t� S �,� CI t1 E to , f l i Ol q i r al kA _- E 1 a o I I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRES Ju O) CERTIFICATIO NU BER: PHONE NUMBER(optional): �a e , ueu� s `� �� aF as= s� CST ATURE: Li DISTRIBUTION: Original and Wine ropy to Local Authority, Proper Ly Owner Hnd Soil Tester. I DILWi SPD-5 3�; 02/821 l INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate soil test,yornr report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; , Is this a nevv or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; . MAKE A LEGIBLE diagram accurately locati€7g your test locations. Di:awing to scale is preferred. A separate shier may be used it desired; S. Make Sege your benchmark and vertical elevation reference point are clearly shown,and are permanent; E, Complete all appropriate loxes as to elates,names,addresses, flood plaint data, percolation test exemp- tion,if appropriate; 10, If Mire information (such as flood plains,elevation) does not apply, place Itl.A,in the appropriate box; 11. Sitin the form and place yoUr current address and your certification 11LIMber; 12. Make legible copies and distribute as required= ALL SOIL TESTS MUST BE FILED WITH THE -OCAL AUTHORITY WITHIN 30 DAYS OF C01,0PL.ETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil separates and Textures Other Symbols st _ Stone (owir 10") BR Bedrock cc;h - Cobblo (3- 10") SS — Sandstone gi Gravel ?rider 3") L5 - Limestone s — Sand HG'A{ — High C:notIIId vii ater cs - L o a�se sand €er(, _ Percolation k�itr 5 klod:urtl sai t i sink+ __ t,rr,II s f ,r;s 1<;Errf du ... B3 i dirlg Ih n aI Sandy Loarra _ Lf,ss Thall it S1€t Loam 131 Mack — ,tt (.Iy — Gray Clay Lo1Sni y -_. swidy Clay Loam !1 it:I — `kv Clay I..oa l . n�rit eties 61 v g t if ncl It i_ — ilit;li vv t u i €Cva-rl, Six (7t. f I .6 od Uf Xtu6es Sul fciC L1ate! fr,c I;ai..A vvjs; disfloa al 1 m Vcnch Marl TO THE OWNER, Iil,-� s)€I test 'l)CYi is t?E' fi i t '.;te'p .ill s!#tltr`ri€tLj<1 Sar=eta'sr`y? ,£3C?1 i9;ft. T 1"ir't'(?tlr§1;`g% or tllf', t?'p3ai".CY€t`r3`May tE"Cltr£est veril"c Lion, of this soil te,St ilt °lle ficid pricit" to pee rnit issuarlc @3, A taonlPlete .set of Walls l:",r 9_hg private `5:4'a £ sys9.em and a pel-l"tlit aplplicatiln lrius" i'3£ ,tAi}ti"t.i:ted o the <+pi;iropt i<'alt iocal authority in, Order to {bI ai,1 pi Ctrnit. 11-le Slarlitaly Pt,,,rmit m41st be e;Pbi<ilwil and poFr£3Ll ul",£3r'r=:) ih ?art of anv colist?oction. r. J Am 13th dwy of__ Jun`'.__ A.D. 1S10C' of 6:)j A M. ----__ Jaynes O'Connell A F F I D A V I T SUISttrr of D .Ac deputy The undersigned, Raymond J. Vorwald and Gloria Tripp Vorwald, as husband and wife, do hereby agree that at no time shall they separate from the original deed, the two (2) residences currently located on the following described parcel of land: The Northwest Quarter of Section Four (4) , Township a Twenty-eight (28) North, Range Eighteen (18) West Further described on Farmland Preservation Agreement ))003713C, dated July 15, 1980, and expiring July 14, 2066. gated this twelveth day of June, 1984. Raymon J. Vorw d _-�1 -k Gloria Tripp Vorwa state of wisconsfd St. Cruix county This 12thd4y of June r I9_t.1.1 la�.ys nd�J. & Gloria Tripp Vorwald .. O� �,n,wn.,Ily c�ntn bduro wu aft is known to be Q' Thu p.: ,un G�rw uxucuted the lurugu+rrd insUwoent Qul uuYa a qnd has ut. Q. Noll ublic P�► l u`r�l{sc,uu Expires Sept. 9, 1984 ► 0.y (-10na V OR.(..ja�a �T I ROberi-s S`fo 23 nL /4 , u y i Zs►� P, I K�nn%'ckinn L 19q cW1x �avr� P . Sip s 1 be 1000 t^oUSe n`1 vS �5 r 5k r � C ti. d iZr- SO/ p 00 o 2-40 941 Q,r+P 5L / l ccpI If a� � 1 Qc° Q 100, Iti' �a��ld2e.�Ircc 7o- V! � tWl\/fi. 1�VR7C 1. MOUND SYSTEM e(, II. IN-GROUND PRESSURE SYSTEM-Continued. 1. Wastewater Load,Total Daily Flow= 7 gal. 10. Force Main: Wis. Minimum Dosing Rate= 2Pm- Use section H 63.15 (3) (c), Diameter= n• Adm.Code and PROVIDE A DETAILED �+/. LIST OF SIZING ON PLANS. 11. Total Dynamic Head: /.�� /v o f"1 2. Depth to Limiting Factor 3' ft. System Head= � 1 . 3. Landslope= _ % Vertical Lift= 3` ft. 4. Distance from Dose Chamber to Friction Loss= ft. -I Distribution System= ® ft. TUN = /0 ft. S. Elevation Difference Between 12. Pump Selection: Pump and Distribution System= ft. Pump_willl d�' charge at least 7 2 gpm 6., Absorption Area Shing: at 1�L._ft. total dynamic head Area Required - sy:it. Pump model and m4nuf co 3 Bed or Trench Length(B)_ ' ft. W Bed or Trench Width (A)° ft. 13. Dose Volume: Trench Spacing(C)■ ft. 10 Times Void Volume of 7. Mound Height: ' Distribution Lines= gal. Fill Depth(D)= ft. Dally Wastewater Volume; Fill Depth Downslope(E) ft. 4 Doses In 24 hrs._ - gal. Bed or Trench Depth(F)_ +75 ft. Backflow= gal. Cap and Topsoil Depth(G)_ 100 ft. Minimum Dose= gal. Cap and Topsoil Depth(H) ft. 14. Dose Chamber: S. Mound Length: Volume /000 gal. End Slope(K)_ r�1�0 ft. Total Mound Length(L) ft. Ill. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load,Total Dally Flow= gal. • Upslope Correction Factor= Use section H 63.15 (3) (c),Wis. Upslope Width(1)_ ft. Adm.Code and PROVIDE DETAILED Downslope Correction Factor= LIST OF SIZING ON PLANS. Downslope Width(1)= ft. 2. Required Septic Tank Capacity= gal. Total Mound Width(W)_ ._ _ ft. 3. Percolation Rate= min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in chapter H 63 Natural Soil= gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required= sq.ft. SIZING ON PLANS. Basal Area Available= sq. it. Required Area 11. If Standard Tables from Chapter Length= ft. H 63 are Used,Indicate Table No. Width = ft. 12. For the Distribution Network,Use Numbers 5-14 In Section II. Number of Trenches= Trench Spacing= ft. if. IN-GROUND PRESSURE SYSTEM S. Distribution System; I. Depth to Limiting Factor■ ft. Lateral Length= ft. 2. Landslope= % Number of Laterals= 3. Percolation Rate= min./In. Lateral Spacing= In. 4. Proposed System Elevation= ft. Distance from Sidewall to Pipe= in. S. Wastewater Lo4d,Total Dally Flow: I.."o gal. System Elevatlon= ft. Use section H 63.IS (3) (c),Wis. Adm.Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. Fill in All Items from Section Ill Required Septic Tank Capacity = CZ� 1000 gal 4,a-"k-5 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate a min./in. 1. Capacity= gal. Area Required= i�- sq.ft. 2. Manufacturer: System Length lob•S ft. 3. Show Site Constructed Tank Details on Plan System Width= .� ft. 7. Distribution Pipe Sizing: 1 VI. DOSING TANK Hole Siie= in. 1. Capacity = gal. Hole Spacing= `3,0 ft. 2. Manufacturer: Lalural Lunglh So 11. .1. Pump M.inulaciurer: I..uer.d Sliu I In. 4. Pump Model: 1-110,11 SPaclug I,. S. Operating Head= ft. Disi'mix Irnw hidt1w.dl•lu I'ipc Z" Ill. - 1.. Flow Rate= gpm. g. UlkIrlbullun Pllw Ulsch.ugu Ra1u: 7. Show Site Constructed Tank Details on Plans Nunibur ul I lulus Pet Pipe 10 I Iuw Put Plpu f 2 gp111. VII. HOLUING TANK 9. Manliuld 11111111: 1. Capacity = gal. I ypu(cunlui ur until 0 2. Manufacturer: Length- Cis It. 3. Show Sito Constructed Tank Details on Plans Dlamotor j In. -SHOW ALL INFORMATION ON PLANS- Di4HR SBU-6761 (8.03/1;12) Q Page — Of Straw, Marsh Hay, Or Synthetic Covering I Distribution Pipe Medium Sand Topsoil _ G 3 E D b % Slope Bed Of -12-- 21 Force Main Plowed Aggregate From Pump Layer D 1,0 ` Cross Section Of A Mound System Using E I.Z A Bed For The Absorption Area F -75 G I.o Signed: A 10 Ft. H 1 . 5 B X2,5 Ft. License Number: i IL} Ft. Date: D _3 Ft. K to Ft. Alternate Position L Sj,5 Ft. of Force Main W 32 Ft. Observation Pipe -� ------------ ----- - - - L-----j--------------- ----------------------•I Force Main W — --------- -------__ From Pump Distribution Bed Of ,'2"-2 — 2 2 Pipe ' I Pi Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area i op PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIEICAI10R1S VE1JT CAP Hr C.Z. VENT PIPE WEATHER PROOF APPROVED LOCKING L5' > FROM UUOK, JUWCTIOM BOX MANHOLE COVER — WINDOW OK FRk SH IZ"MILT. AFRO INTAKE GRADE: I -- I I 18"MIN. COIJDUI7 �- - _ _ I6"MIN. \���� - ----- ----- IAILET PROVIDE AIRTIGHT SEAL I III I I I APPKO`JE.0 JOINT A I III APPROVED JOINTS WIC... PIPE. I III W/C.I. PIPE E1rfENU1NG 3' I 1 ) ALAKM EXTENDIFJC, 3' OWTO SOLID SGIL- I 11 ONTO SOLID SOILi I I c ow PUMP-� - - F I O F D n QQJ CONCRETE BLOCK K15EK EXIT PERMITTED GFJLy IF TAUK MANUFACTURER HAS SUCH APPROVAL SPEC.IFICATIOAJS :PTIG AWE) nn )SE TAWKS MANUFACTURER: _f I&Wes- r �rc CaS� WUMBEK OF DOSES: � PER DAy TAMK JIZE : 10 0 0 - GALLOIJS DOSE VOLUME: 127 5 GALLOAIS ALAKN► MANUFACTUREI{: _ St UcJro S,rS CAPACITIES: A= • 2vo_11JCHES OR 2$• GALLO105 MOUCL WUMBEK: __ ION U) 8=_ L INCHES OK 35,70 GALLONS SWITCH TYPE: wO C= I /-I /- INCHES OR 250 GALLOAIS {'LIMI' MAWIIFAC.-TUKk:K: ___ nuli D= 12- IKICHES OR mI ',' 6ALLOW5 MUUEL NUMBER: �J L Q3 L NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: n fle IWSTALLED ON SEPARATE CIRCUITS PUMP DISLHARGL RATE ? `L. GPM I.7, VERTICAL DIFFERENCE BETWEEW PUMP OFF AND DISTRIQIJTION PIPE.. 7-5 FEET ♦ MIAJIMUM NETWORK SUPPLY PRESSURE , , , . , " . 2.5 FEET -H - 10 FEET OF FORCE MAIN X l' I F j ,I Ioofr,FKICTIOIJ FACTOR.. •3`1 FEET TOTAL DYNAMIC HEAD FEET V__ IMTEK.NAL. DIME WS10N8 OF TAWK: LENGTH 6 ;WIDTH �O 'L►GIUID DEPTH S 1 t .1s..Gu. I. Page _ Of Perforated Pipe Detail 0 End View �Psrfo(olad End Cop A# PVC Pipe ore e Holes Located On Bottom, S Are Equally Spaced S X� P PVC Force Main • * From Pump i .7 P PVC Manifold Pipe Alternate Position Of Pipe ibulion Dis Force Main From Pump P Lo61 Hole Should Be Neil To End Cap End Cap Di6lribution Pipe Layout P So R S 3' X Ss Y Signed: Hole Diameter Inch Lateral Inch(es) License Number: Manifold _ Inches Date: Force Main " 3 Inches i