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HomeMy WebLinkAbout040-1185-80-000 7 L L - ,10) 0 1 1 TLS y t TLr. ok 5 r i 1 O N O er O e9 d N I ty 0. O I 2 h O O C'• 3 ti I C y >r O_M CL CO O C_ OQ 0 O C r w O L N 3 C III, m O y' C m 0)O— cq 0.0 f0 y 7 o 3 °L, CL 'O Z Y C C N 1L C 3 N LL O L w O C O �6 Eya:y; E Q o S o Cc � a rn z c') H z III a m � o I E Z v N H E N Cl) I 0) Q z z O w NZ N N cN Q O �1p0 E i r+ R OD m H c ' � o 3 G G G. -C 0) FyFy ~y~y � 7 Q f0 w LL a o > Z •N .; aaa CL y N V c 00 00 Z 00 00 rn 00 CO ti� Q) ��l o z N co Op Q O O � T7 2 8 00 a N O O W •p — Q Z Qj cl O o j w c Q } eC O 0 N v O O i.I n 3 C N N O 00 O O Y O G — 0 0 • �' O� NcM 0 Hp• � C N ' N th C O 2 N " O Z U L U ao O _ Z cn C/1 0 is y a cc C V p I C a to E °' c r� r Q V a N V DEPARTMENT OF INDUSTRY, INSPECTION REPORT SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISMADISON,WI 53707 ON,WI 3707 -R19w CONVENTIONAL ❑ALTERNATIVE srarePlanl.D.Number: (If assigned) Town Oj TAoy El Holding Tank ❑In-Ground Pressure El Mound _ GJood)tid a INSPECTION DA ER NAME OF PERMIT HOLD ADDRESS OF PERMIT HOLDER: Doug StAeumke 142 GloodAid e DA, RiveA FaM, W1 540012 BENCH MARK(Permanent reference Foml)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber MP/MPRSW No.'. County'. Sanitary Permit Number: Thoma.3 A. Ulan i323" St. CAoix 1 112747 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED'. ❑YES ONO DYES ONO BEDDING VENT DIA.. VENT MATE.'. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING. (VENT TO FRESH ALARM FEET FROM LINE AIR INLET ❑YES ❑NO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ❑NO ❑YES ONO ❑YES —]NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ONO 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 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH IN HE OCHE$ DISTR PIPE SPACING COVE ERIAL' NSIDE DIA xPIT$ LIQUID PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL BUILDING VENT TOFRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END'. PIPES FEET FROM LINE. AIR INLET NEAREST go MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1:1 NO SOIL COVER ITEXTURE PERMANE—MARKERS RS OBSERVATION WE LLS ❑YES ❑NO 1:1 YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL ISODDID IMULCHID 16'EU'U:1YES CENTER EDGES. DYES ❑NO ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH No.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTE DISTRIBUTION PIPE MATERIAL&MAHKIN6 ELEV. ELEV.: DIA.. ELEV. PIPES DIA..R.PIP ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLAN SCAL LIFT CORRESPONDS TO APPROVED DYES ❑NO ]YES ONO COMMENTS: PERMANENT MARKERS: 08SERVATION WELLS. NUMBER OF LR0 ER TV WELL: BUILDING. FEET FROM ❑YES ❑NO DYES El NO NEAREST Sketch System on Retain in county file for audit. Reverse Side, TITLE SIGNATURE. Zoning AdmivLfE6tAatoA � DILHR SBD 6710(R.01/82) i SANITARY PERMIT APPLICATION C T DILHR In accord with ILHR 83.05,Wis.Adm.Code `-) ' C U/ �'� �°• ^�^� STATE$AANITARY PE�iMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I�I..iD.ANY/UM`✓B�ER 8%x 11 inches in size. 5 ?? —0Z 93 —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OW R PROPERTY LOCATION �t e, R F'/4 '/a, S 3 T %-, N, R E(or)W PROPERTY OWNE 'S MAIL G ADD SS OT NUMBER BLOCK NUMBER_ SUBDIVISION NAME D r' ITY,ST E . Z C D PHONE UMBER CITY KE OR L NDMARK ' O VILLAGE: II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.N 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/IR Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 5Q Seepage Bed b. ❑Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 3 16 Z'o to k5c b Feet Private ❑Joint ❑ Public CAPACITY VI. TANK #of Prefab. Site Fiber- in gallons Total Manufacturer's Name Con- Steel Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks I Tanks Septic Tank or Holding Tank X El 0 El Lift Pump Tank/Siphon Chamber DD fv� /�C4�f ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumb is Name(Print): Plu s Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: w a g9s6' Plum er's Address($treet,City,S to Zip C e): Na esigner: 1,069 .4�- VIII. SOIL TEST INFORMATION Certified Soil Tester (CS a pe , CST# D �C T's A RESStre /City,S � Phone Number: r. i 6 7�— � L � IX. COUNTY/DEPARTMENT U E ONLY ❑ Disapproved San't Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) pproved ❑ Owner Given Initial �) charge Fee Adverse Determination "�""CU as is-`/P—wx ' l X. COMMENTS/REASONS FOR DISAPPROVAL: 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.lThe septic tanks) 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 owners 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 ter included the creation of surcharges (fees) for a number of regulated practices which disco in`a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 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) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property DA —S fr M CL Lf, Location of property SEJ1/4 NU 1/4, Section �O , T ° N-R21W Townshiph d Mailing address / 7 CA- I/JOp e ri- /T 6--�i Address of site Subdivision name Lot number Previous owner of property /�A� �o Total size of parcel _ I A c re Date parcel was created /D— 7- ?5- Are all corners and lot lines identifiable? 1k Yes No Is this property being developed for resale (spec house)? Yes 1C No Volume �0 Jand Page Number s as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed re or d in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been XYNT rded i n the Office of the County Register of Deeds, as Document No. ) . nA �s , S g SZr,nn, nature of Owner Signature of Co-Owner (If Applicable) DDaae of Ifignature Date of Signature ° ST. CROIX COUNTY ; .. WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8383(RIVER FALLS) HAMMOND, WI 54015 June 6, 1988 Division of Safety and Buildings Bureau of Plumbing P.0'r Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Doug Struemke property located in the NE 1/4 of the NW 1/4 of Section 36, .T28N-R19W, Town of Troy, revealed suitable soils at a depth of 3.50 feet, below which bedrock was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN/rc Y i III DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION 76,LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1)& Chapter 145.045) LOCATION: SECTION: NS MUNICIPALITY: LOT NO.:BLK.NO.: SUBD1%'IS ON NA E: N,F '/ G>'/ /T2�N/ E ( � CN �D,1 WNE BUYER'S ME AI LI ALyDR ES: USE \J' QI/ DATES)OBSERVATIONS MADE NO.BE R : COMMERCIAL DESCRIPTION: PR FI LD�FOP IONS: ER �ON TESTS: Residence �S ❑New Replace. .., (/I-' RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND•PRESSURE:SYSTEM-IN-FILLHOLDING TANK:RE OMMEND D SYSTEM:(optional) ❑S ©U ©S ❑U ❑S COU ❑S �A ❑$ ®U � ".,n If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- r o e S d B- DD. Do , r Gv o fraC?` IWA5, 95, B- B- B- 1 .eD �? G� �nC 4` o PERCOLATION TESTS Q)� TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PE E1100 2 PERJQD 3 PER INCH P- " D P- 1/95 P-- P- 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 ,��• a I E _ -_ - _ -•J a I 0 i - - _ _. T— _ � _ Ilk 3 I 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME( nt): S ^ hQ TESTS WERE C{�P ETE ON: ADD ESS: / CERTIFIC 10 NU BER: PHONE NUM ER(optional): Vey' l �� S' 4 2 2' ebbids'V'T Cr, NATURE: b , LJCJ7 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 Tc Drnplete and accurate soil test, your report must inr:lucle: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or co nmeiciai use planned; 4. Is this a new 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 th e plot plan; , MAKE A LEGIBLE diagram accurately locating yOur test locations. Drawing to scale is preferred. A srxpmate sheet ntay be, used it desired; S. ktake scare your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9 Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion= if appropriate; 10. If the information (such as flood plains, elevation) does not aEaply, place N A. in the appropriate box; 11. Sign the forma and place your current address and your certification number; 12,. Make legilflea copies and distribute as required. ALL SOIL TESTS MUST BE FILED VVIT14 THE LOCAL AUTHORITY 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIES SOIL TESTERS Soil Separates grad Textures Other Symbols rt — st. n"! (ovar 10") RR Bedrock c otaEa(€' (3- 10' ) S __ &I n c7stone: av 1 ( rider 3") I S Li ncs tone x Sail ( l`i{.7l•``V -_ Hogh Gi"C)1.E sovvatt f sand pert: P'rcolatmn Rate S'md Fin- 1 _. > - s.-.nos ��£3t5t3 <; Say d�' Ltsam l _ Las,; [hG},r Silt4 a, z a e €ty C!ij L r3 im i1'! _.... M.3tt CS tF I nj J - °_' a [.-v a t.;`�r High A'a O zi.JPl, gexu ' soli 'r:xtrrrus 'urface r, t+ iw lic{md ,,rust= (J;spo:aal )r11 - Bench MaIk `v`'RP - `, z r,ic..zi R 9f<relnUt t ;t,r�t TO THE OWNER: This soil test roport. is the first stop in securing a sanitary permit. The county or the Departmont may request verification of this soil test in the field prior lra rt-unit issurancr, A comple te set of plans for ttae private sewage systen. and a p rrnat application rnulo be submitted to tf,e appropriate local aul.hovity in order to a }e: nit. The sanitary permit must be obtained and posted Prim to the start of et"y�(atl�trts'Ctrf3rl. "MID go"low 4 '4 Jim .......... 67.CMMX C 06 This D66C mi& b0"'m Aoe&for ftw* ............. ................................. ....................... ........................................... .9 .............. ............................ ......... ....................................................... ................ oil ................. ..............A"'aw"JL*D*­`�� .............................. ................. . ............. Grant@*, ...................................................................... mid Grantor,far a"hwbk 00"derut'o"...... WitneS99th. ................................. ..... FAITUMI TO .. . ...... .. . ............ ............. .. .. . ...............Gn-at'".tb.*-Ionowm-dneribod-n-o-mtstg auto of Wisconsin: T"Parcel NO: --—----—--- the ToWn Of Lot is, Oak Ridge Acres in Troy. al property. This is not rent This .....is,.. ............ .. horbuts" propSAY- (is) (to not) the hereditaments and appurtenanum themntO belonging; TogetbaI, with all and singular pt And....qX&ntor..her-eiA, nd clear of Itneumbrau""' ible in ee gingple and ftee a warrants tbat tb* title is good, indefe" if any# restrictions of recorde easements and and will warrant and defend the same. September ])ntad this .. ... ....... . .... day of EAL) ....... .... A Amdahl ................. .. ....... . . ...... ...... It (81ML (SEAL) :j AMdahl 'j ........ .... .... XT ACKNOwLBDGUZ TION AUTRUNTICA STATZ OF WISCONSIN .............................. 90. .......................... .......... ... ...county. ....................... PIE1991P.......... .... ......... ..................... .......................................... personally came before Me this ........ thenticat"tMS ........day of......... . . . ....... . Sul pt embar................... 19...45- tbs sbe"�'*A" -Se - Amdahl...And-JAnit... ............. .............. ... ............................... ...... .... ........ ................... .................................. ........ it STATE BAR OF wiscONSIN ...... .... ............. ---- ......... TITLZ: MZXBZ .. .... .. ..11.............. ..................... A ................. ....... who execid" (if to me known to be the person .......... Wis. Stats. by 17 t and t1W milmraf!. foraggoing inst 41. WAS DRA"90 By THIS 1?4vMUM&"T joaleptj,.JD�... ...W; .....S.4022NOtary Nmie ....... My Consmiss"R is 2,19-11—MAin, or &*now*dged. Both astbeaticSt" date: .... .. ;A- J, A.-Am 1W wood 4W Pria"d%A&W tb@4r STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER �D ROUTE/BOX NUMBER o` f l' FIRE NO. CITY/STATE_ �( r JV �(S' ( ZIP PROPERTY LOCATION: AIC114 1/4, Section �b , T M N, R 9 W, Town of /4 , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED Qtc92_um �=V-��, DATE , St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address � , ' ^ . ' �� State N� Wisconsin Department OfIMdUStry. Labor and ��U��aO ��el8�OO9 � SAFETY&BUILDINGS DIVISION PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7960 Madison, Wisconsin 58787 THOMAS WANG Owner: DOUG STRU|.HKE 1009 1/2 WEST MAPLE DRID�E DRIVE ] -- '- RIVER FALLS, WI S4O2� Kl� �� `�xrp�ER FALLS, WI � O��i[) V6, 988 7X ~1~� . .- ��'��; ��� Date Ap�ruve�� June Gallons Per OaW� ��� Date Received: June 6^ 1988 Project Name: STRUEMNE, DOUG - RESIDENCE Louation: NE,NW~38,28, 1?W Town of TROY County: ST CQOIX The plumbing plans and specifications for this project have been� reviewed for compliance with applicable code requirements. This approval sed on Chapter n�� 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval in contingent up(>n compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one met of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary l permit is obtained, it will expire the day the initial sanitary permit expires. � The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the oode requirements met forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative node. This approval is for the following components only: - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 266-0056. Sincerely' JOEL W. BECK � Section of Private Sewage � Division of Safety and Buildings PPP031/0000n/10 co: DOUG STRUEMNE --Private Sewage Consultant County ___UW-SSWMP -_-Plumbing Consultant __--Owner ___Plumber ___Environmental Health � nau'6423 m.10/87) | r DoUG i rJ 2r`^ C n L nom C- C- 3 (� ^, S88 194 200 ' ONStTE SEWAM 8r3 EM M PPROVED �>P AATMENT OF olfoR AND HUMAN REUTt ?r e S Q- T DIVISION PF SMFE D � _ �'AN DINGS b. ft 4 SEE C'C;!;T`:FONDENCE 0 30' i N 67' 'etc) _ - 0 Z \ i I �� f 30��eje �8 �1 r 1 kct. 7`v 'Lot �r�P�nanP ,)Jlc �-► F\\S3bS � ^J P Page _ Of _ Straw, Marsh Hay, Or _" ,, 4 � 3 Synthetic Covering Distribution Pipe Medium Sand G Topsoil _ F ONSME 3 b Slope Bed Of Zr— 2 %Z Force Main Plowed AP ROVED Aggregate From Pump Layer DEPARTMENT OF INDUSTRY LABOR AND HUMAN RELATIONS _DWISION OF SAFETY'llp. ILDINGS D 1 ! >' Cross Section Of A Mound System Using —1' of SEE CQRRE DENCE For The Absorption Area F °i S G 110 A Ft. H 1, S Signed: B — Ft. L i cense Number: 3 r I Ft. Date: , . Ft. K Ft. L Ft. W Ft. L 0 Observation Pipe • 6 K A ��----- -- ------------------------------------ Force Main W — ------- — ----_ From Pump Distribution Bed Of 2 . Pipe 2 2 I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area � `fUt c— I, off, Page _ Of_ Perforated Pipe Detoll 0 End View Perforated End Cap o`e ys PVC Pipe Holes Located On Bottom, S Are Equally Spaced ONWE SEWAGE SYSTEM APPROVED ¢ DEPARTMENT OF INOUSTR`•, LABOR AND NUMAN RUM" _ DIVISION QF WETY ILDMIGS Distribution Pipe Last Hole Should Be f �� a� Next To End Cop / SEE C0�ESP �E Distribution Pipe Layout P -/1'0 Ft. R i`A S J roil X Inches JY Inches Signed: Hole Diameter ! Inch Lateral Pb- Inches) License Number: _�� `� Manifold 2 Inches Date: /Wer Force Main i Inches # of holes/pipe i a Invert Elevation of Laterals103i5 Ft. f , PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS �• VENT CAP �4 9 3 4 4*C.I. VENT PIPE WEATHER PROOF _T APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR. WINDOW OR FRESH I2'MIU. I AIR INTAKE I GRADE I `I MIN. COIJDUIT . IIJLE T IONSIM SEWAGE q 16HTESEAL -- ' II V APPROVED JOINT A I III APPROVED JOINTS W/C.'r. PIPE I III W/C.I. PIPE EXTENDING 3' �E� I I ALARM EXTENDIUG 3' ONTO SOLID SOIL I I( . ONTO SOLID SOIL e APPRO S AA1MN1 Of tN011STRV U�BOR AND HUMAN REL/►TfQN I I SION SAWYANO�1LaNGS I I oN -��5 C CLEIC�_ FT. � J � 8EE CORRESPONDENCEPUMP'� orF 0 _7 S ( 1 CONCRETE BLOLK—+ • . 3���w iNCw • RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL J �►PPRavtLbb ���3=eOtNy SEPTIC E SPECIFICATIONS OOSE TANKS MANUFACTURER: rrl NUMBER OF DOSES: PER DAU TAWK SIZE: ' GALLONS DOSE VOLUME r� ALARM MANUFACTURER: n k (=I e.,T INCLUDING 6ACKFLOW: �- OC- GALLONS MODEL NUMBER: i1 CAPACITIES: A= =� INCHES OR 3 SI" GALLONS SWITCH TYPE: 15=_ 'l INCHES OR -7L488_GALLOWS PUMP MANUFACTURER: C= 7 INCHES OR 11`a GALLONS MODEL NUMBER: D- 12' INCHES OR Zg GALLOL16 , SWITCH TYPE: c-, NOTE: PUMP. AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 3� ` GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEREUCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. 1110 FEET ♦ MIIJIMUM NETWORK SUPPL`i PRESSURE . . . . . . . . . . . 2.5 FEET ♦ FEET OF FORCE MAIN X i 1 FiooixFRICTIOU FACTOR.. i FEET �'j�' r l' r�✓` TOTAL DYNAMIC HEAD = 9' IDIO FEET INTERNAL SIONS OF TANK: LENGTH ;WIDTH °I -;LIQUID OEPTH �' ED , LICENSE NUMBER: DATE. �j r v i F� T I i i i I i Li Oil? t 2 02- 9$ 1c v` 1 pp p 9 Jt.J n 0'.-t t - Bulletin_CL2.1A July 8, 1983 –_—_— -- • For Homes G O U LD • Fauns - • Trailer'courts Model 3885 • Motels (Supersedes Model 3870) 0 • Schools • ' Submersible • Hospitals Pump Efflugnt Pumps EHluenl • Industry --a(C --V JL 0 i • Effluent Systems Purnp Specifications anywhere effluent Solids Handling Capability to Discharge Size or drainage must be `. NP 1, disposed of quickly, Semi-Open Impeller quietly and efficiently. s design. ira,„a,iod on s1 aft. f i ­ units use inlpibilcr IGCkriul lu pieeciit a—do I'd back-Off. Pump Out vanes on backside of rrrpciicr for protection of mechanical seal. Casing Volute type for maximum efficiency. Stainless Steel Fasteners Heavy-Duty Solids Handling Series 300 stainless steel for corrosion Dependable Capability to 3/4” —� resistance. Mechanical Seal Ceramic vs.Carbon sealing faces.stainless steel spring and fauna N elastomers. — - Maximum Temperature 1/3, 1/2 H.P. 60 Hz �_ 160°F. Capable of Running Dry Single Phase 115, 230 Volt. without damage to components. Motor Specifications 3 /1 H /z, /4, 1, 1 � .P. 60 H z Motor Fully Submerged in high grade turbine oil for permanent lubrica- Single Phase 230 Volt. Three tion of bearings and mechanical seal and Phase 208-230, 460 Volt. efficient heat dissipation.Motor sealed from environment oy rugged cast iron enclosure. Bearings Heavy-duty ail ball bearing construction Stainless Steel Shaft Series 300 stainless steel for corrosion resistance. Threaded shaft. Single Phase Units All single phase units have built-in thermal 90 overload protection with automatic reset. 80 Three Phase Units Overload prote ution in starter unit.�06-_"30 o. 360 volts.Ttiireacied shaft 60 Hz operatiurl Lu 70 Power Cord ^Dater and o11 raslstarit. EpoAy seal on inui:,i -rid Q80 acts as a seconuary moisture t,airi r in ca r *' damage to outer IacKeuny.l.urfOSldn rasr tu;.t Z 50 '" gland nut. a Single Phase Units Q40 H P ri.. Jels cgwpped vviln I of to J Z "J Y - r �. 10 itn S i n n,3 r�ruunJir,y ply 3 _ I 1 r i } 0 30 r .« ti s iro,h.ls e(I"li;i".d r.nri 16' ref 14 101 i,;,"'i Cold O0 20 rYY {, SPECIFICATIONS ARE SUBJECT TO CHANGE 10 { WITHOUT NOTICE. 3:. 0 0 , 10 21) 30 40 50 60 70 80 90 100 110 120 u GOU LDS PUMPS. INC. GALLONS PER MINUTE u SENECA FALLS NEW YORK 13148 A S B U I L T S A N I T A R Y R E P O R T Se ,�Tnd R 01.1. TER• T sh�,p > > P.O. ADDRESS: ounty, asconsin bdivision 1'°t size Su • PLM VMI Distances & dimensions to meet reg4irements of Sec. H62.20 - 1 P Septic tanks) �,ffgr. Vo rings Dept to cover �r ��vered Dry well size Type of Aggregate i Depth of seepage syster.►— o! L t Vent caps in place 4—, number used DISCIAII-EER: The inspection of this system by Pierce County does not imp7,y complete co :reliance with State Administrative Codes. There are other areas that it is ir►possible to inspect at this point of co ►struction. Pierce County assumes no liability for system operation. PLUMBER ON JOB• LICENSE I.'GI•BER: S DATED• l _ _ z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Penm.it-111-2- State Septic 7.3/�?­ /i f NAME . � ., �� ' x c - �- Townbh.ip t."° `" St. Cno.ix County Locatiorvl/6% ojAV4. Sec s 0►�,.3( T^N, R W SEPTIC TANK j Size ® gattons . Numbers ob Compantmentz j Diztance Fnom: Wett �� ` r 6t. 12% on greaten ztope 'w°' .� fit!, Bu.itd.ing it. Wettands - 6t. H.ighwateh - it. DISPOSAL SYSTEM D.iztance Fnom: Wett 12% on gneateA ztope' Bu.itd.ing it. Wettands Ft. H.ighwa.ten it. FIELD DIMENSIONS: Width o6 trench it. Depth ob Aock below Cite �.in. Length o6 each tine it. Depth of Aock oven Cite Z .in. Numbers, of tines (�, Depth of Cite below gnadey-?l_in. Totat .length of tine.6 } it. S.bope of attcench in pen 100 it. D.id tanee between tines it. Depth to b edno ck Totat abdonbtion area jt2 Depth to groundwater-'° it. Requned area it2 i PIT DIMENSIONS: Number of pit-6 Gnavet around p.it.6 ye6 no Outside d.ia.meten it. ,, D, h be.2ow in.Cet it. r Totat abzoabtion area t2 . z A Area nequ.inesi . _ it rn i INSPECTED By TITLE APPROVED � " ���°` ,DATE 197 REJECTED ,DATE 197 T w �_EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON,WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATIOO %,AN.,Section -,TZgN, R!i i W,Township or-M r& pafitq % Foy Lot No. g Block No. ®�Y__ P II-Z-(,- County ILL!117 A t q®A u`b'division Name Owner's Name: Mailing Address: 1-3 Z4 S SQl7�C Cr 11L Part�t­STW11S 54,0ZZ TYPE OF OCCUPANCY: Residence X No.of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT ,I DATES OBSERVATIONS MADE: SOIL BORINGS -7' 1 — -79 PERCOLATION TESTS '73•- 5 �+ (,=, -_79 SOIL MAP SHEET 1 - 4-S SO L TYPE 9022 � %2"*eIZZS1 114 St L-e I-D p'uCl PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P P a� 3�0 S' �'o«. 3ve��C. �� Z( 0 30 ��8 � '��� S�i� Z3 P- 3 3G� -mss; 13" s► Z3'` Z N o 3a 5/$ 3 3/4- 14-o SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B_ 1 77_ 001- ,7 7Z" 'C's 1►" Sj l Zs'' 5111 C Z ­73 N0 A i r- 7 -73" T s 13" s► I 'ZD " _f s-I 40" B_ -7 3 113 ouc y '7"3 T S 1L" s k i Zd-" {'�1 33" -7 -3 I`)0 lu 9 7 -7111 W. l I s 1 4w I trr►�f+�t 1 B- '73 3 No�J� > `7. Ts 14" s I z3" (o -7 Z. F30IUt > "77-" Ts 1S`t s r l 3o" J51 U7 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) +I Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area 1 needed for building type and occupancy. f�a(-"r Bds ) 31C 37S Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. Co Y3 �v K fo I i Z° J SL t N J SG Si_ Pl' It 11 PI R T . IN S pA E ey ; oo av L • PI lr LN w Po e 2 ,O1 P3 - 1bZ� �N 41 ~� ned,herEby certify that the soil tests reported on this form were made by me in accord with the procedures 41vd� pecifiWd n the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to t15� t �n'y kouJledge and belief. tw>g5 l �. . ��a,?r��rin t�a� Certification No. A I r �e�. ►2wts2 �A+�-S W t s SZZ Name of installer if known xI CST Signatur COPY A—LOCAL AUTHORITY r Pl867- State and County State Permit # Permit Application County Per ' # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mail' g Address: B. LOCATION: '/4 4, Section T N, R E (or) W Lot# ZY City_ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCU-PANNCCY: Co ercial *Industrial *Other (specify) *Variance Single family y Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: ishwasher YES NO Food Waste Grinder YES_ O # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement_ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New j/Addition Replacement *Fill ystem Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Distance from critical slope Percent slope of land I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifie Soi! Tester, NAME C.S.T. # and other information obtained from (owner/builder). �� Plumbers Signature ! MP/MPR .,#a Phone Plumbers Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). y' Do Not Write in Space elo OR DEPARTMENT PS�E ONLY 0 D Date of Application Fees P i State/�_C u ty Date Permit Issue��jeet6d date) Issuing Agent N Inspection Yes-No Valid# Date Recd 1. county (whi a copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76