Loading...
HomeMy WebLinkAbout042-1011-95-000 � o o a o ao 4' (n I to L N c N .'. -9 Y O 2 N � O Z 0) m (1)N L C2 NO M(D o.0 CL N a o c v c c U Imo o OLL 0.O7EE0 C ._ N COL N a 3 3 E'TO ac o —°o a u d co dS u� O e vv yc m aE C z O C C tp 0 0o W N C OD U. O O O Z U C E Y a _ c a E fl- a>i (D Ea0 U O M a a (D iii I rod ' E co C = v !, E lo Z 4) 0) CN a m N LO ! H O Z in fA F- N E L N O O O 00 O m U N N O v - 0 0 N N O Z Z Z Z O O co c M r o v o a a fl U Q p it � N W M j Lo z � > l c333 a5 raaa co 00 o ao 0 .O Z (p f0 O O O O O N O O .-� O N N N N I 0 0 N a N N 0 L co _ On a r �i U) N Q 0 O N O E V m N 'R ^r d OLD co 3 V N c C C 'O N N N N r- FO- m (A VO) 0 C N <p O (D M CO v ` N N o c � yo 4) Z Z CO 00 ++ � E E cp u r \� LO z Me V E CC ik •�' Ili''; � (D I CL � CL #c EL L a. d o 0U) L) Parcel #: 042-1011-95-000 02/26/2014 08:39 AM PAGE 1 OF 1 Alt. Parcel#: 05.29.18.75B 042-TOWN OF WARREN Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-SIMPSON, DAVID A DAVID A SIMPSON C-STUCKY,JULIE ANNE JULIE ANNE STUCKY 1123 100TH ST NEW RICHMOND WI 54017 Property Address(es): *=Primary *1123 100TH ST Districts: SC=School SP = Special Type Dist# Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Notes: Legal Description: Acres: 6.321 SEC 5 T29N R18W PT S1/2 NW SW AND N 1/2 SW SW BEING LOT 4 CSM 11/3087 6.321AC Parcel History: Date Doc# Vol/Page Type 12/03/2013 989874 WD 12/03/2013 989873 EZ-1 Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: *3087-CSM 11-3087 042-96 05-29N-18W LOT 04 2013 SUMMARY Bill#: Fair Market Value: Assessed with: 227760 233,200 Valuations: Last Changed: 09/30/2013 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.321 58,600 175,700 234,300 NO 10 Totals for 2013: General Property 6.321 58,600 175,700 234,3000 Woodland 0.000 0 Totals for 2012: General Property 6.321 57,000 199,400 256,4000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 313 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL CHARGE 39.00 Special Assessments Special Charges Delinquent Charges Total 0.00 39.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A TOWNSHIP t&'9I/Q1L-__A_) SEC. � T N-R /P W ADDRESS So ' ' d& ST. CROIX COUNTY, WISCONSIN up Pi `/s &)1-5 SUBDIVISION LOT LOT SIZE Ay f PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � 0 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used .5a- cV7, of g9l eV- �jCihlE, w�f y Elevation of vertical reference point: /00_0 ' Proposed slope at site: SEPTIC TANK: Manufacturer: �� /�S CQ Liquid Capacity: 2 Number of rings used: `/ Tank manhole cover elevation: /0 2-- �l�o Tank Inlet Elevation: '76•.29 , Tank Outlet Elevation: �7 7 ' Number of feet from nearest -Road: Front,O Side,0 Rear, 0 Qd 2 feet From nearest property line Front,(D Side,0 Rear,O //o 7 feet 4)0-r lt.� - -ID d4 Number of feet from: well f , building: /7 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 0),Ck�S Liquid Capacity: 0 Pump Model: �c� / Pump/Siphon Manufacturer: O // Pump Size �2 Elevation of inlet: /�' 30 ' Bottom of tank elevation: �OZ •�Z Pump off switch elevation: / 3' �.� Gallons per cycle: ' d Alarm Manufacturer: LU�I A� ii 40 Alarm Switch Type: Number of feet from nearest property line: Fro , i nt de, O Rear,0 Ft.y0 7 Number of feet from well: L 1U6 T Y&7— D.Pi// c-D Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM oTrench: Width: Length: /4/9 Number of Lines: Area Built: Fill depth to top of pipe: y Number of feet from nearest property line: Front, ®Side, O Rear,0 Ft> Number of feet from well: ld&li Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of Diameter: Liquid depth: Bottom of seepage pit elevation: Are>Built: Has eith p box O or distribution box O been used on a the above soil absorbtims? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inle . Number of fleet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: / Inspector: Dated: �� Plumber on job: License Number: c�i is 6�PTIC PLUMBING CO. O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT ' MASTER PLUMBER LIC.N0.3307 MR.R.S 3/84•m • U 1.i;,;;TALLER&DESIGNER LIC.NO. 5 cAt'6- : / =2-D I d' ClJf,6;r'S I� w P I1 7 \ iq O i I � i HOMESITE SEPTIC PLUMBING CO. �r 655 O'NEIL RD.,HUDSON,WIS.54016 15 ROBERT ULBRIGHT Iv1S.MASTER PLUMBER LIC.NO.3307 M•P•R•S. f \� 041,INSTALLER&DESIGNER LIC.NO,006W 7�H v Jsc 9c °-L—•-l s`�-9a 2z z pao . t3.8S s �V�1?�D,US 1 -,%' of"r-, To p b -2 M oko)Fo c t7 = /0/,3 y 30�10:�► OF If /0 2 Top OF to X77 9 ' I �le- I f CA q1 � 3 y STFti1 C`/�v Rc)c,e/sI,vv /•v/�,c�j r /oo.70 j Ii I � I Lcv ° w 5-- DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS .+.ABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BLJREAP OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 SW ,SW ,S5,T29N-R18W CONVENTIONAL ❑ALTERNATIVE tatePlan . .Number: (11 assigned) Town of Warren ❑Holding Tank ❑In-Ground Pressure ❑Mound r 100th Street NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE Nancy Parlin 209 South 4th River Falls WI 5 022 "�2 y—gf 3c) BENCH MARK(Permanent reference poml)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber. MP/MPRSW No.. County: Santlary Permit Number: Robert Ulbricht 3307 St. Croix 112655 SEPTIC TANK/HOLDING TANK: MANUFACTURER. JILIOU ID CAPACITY. TANK INLET E LEV.. TANK OUTLET ELEV.. PYES DEDLPROVIDED❑NO — YES ❑UNO BEDDING. VENT DIA. VENT MATL. HIGH WATER NUMBER OF ROAD PROPERTY WELL: BUILDING. IVENTTEVH, SH ALARM LINE. AIR INLT FEET FROM DYES ❑NO [ YES ENO NEAREST DOSING CHAMBER: MANUFACTURER JBIDDING LIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL PROVIDED OVER PROVIDED DYES ❑NO ❑YES ❑NO ❑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) DYES 0 N 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 NOENCHES IDISTR PIPE SPACING ICt COVER N';ILIE UTA -PITS DEPTH PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO DISTR. NUMBER OF PROPE RTV WELL BUILDING V NI TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END'. PIPES FEET FROM LINE AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSEH NATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES LINO 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 UISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKIN(; ELEV.' ELEV.. DIA.. ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE 512E HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PRIOEPE RTY WELL: BUILDING. FEET FROM ❑YES ❑NO ❑YES ❑NO INEAREST- twow Meld gyrd pIft� pe-Y- (soh3 3m g4.0 - 6 -T dew 0 . ►z 3 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator I DILHR SBD 6710(R.01/82) �1 SANITARY PERMIT APPLICATION CO TY _ X T DILHR In accord with ILHR 83.05,Wis.Adm.Code 6Z —�,, ,o� STATE SANITARY-PERMIT# • • 6ks —Attach complete plans(to the county dopy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%2 x 11 inches in size. 5—ho—O P-?3 —See reverse side for instructions for completing this application. PETITION - % 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE YES INO PROPERTY NER P PROPERTY LOCATION �` / (/ 5 W% 5*4;%, S ./ T Z�, N, R `0 E(q/)W PROPERTY OWNER'S AILING ADDRESS LOT UMBER BLO K NUMBBER SUBDIVISION NAME S o d a^ 7T11�' 4c-G .209 ITY,S ATE `/� ��) ZIP CODE PHONE NUMBER CITY NEAREST OAD,L Lo- fl l� (J'�� S to ZZ" �ZS d.SL O VILLAGE: (/ 4 Re/v 1W A TOWN OF: II. TYPE OF BUILDING OR USE SERVED: `f4fz, . d o7- .11411'-pn6vo 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. El New bN 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 Qt.$YST-EM.(Check only one in##1 and only one in##2) 1. a. ❑Conventional b. ❑Alternative c. ❑ Experimental i 2. a. ❑System- b. ❑ Holding c.El Pit Privy d. ❑ Vault Privy e Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.X Seepage Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: /('Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): /QO 7O (P. Z 2 3 / / Feet 0<Private ❑Joint ❑ Public VI. TANK CAPACITY Site in llons Total #of Prefab. Fiber- Exper. a INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass Plastic App Tanks I Tanks I e- Se tic Tank or Holding Tank � " t - ❑ ❑ Lift Pump Tank/Siphon Chamber Od Ael,� R&A n4&✓ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) /MPRSW No.: Business Phone Number: IQ - u�QA 1?14 7—' 33 a �G pl$S Plumber's Address(Street,City,State,Zip S Code);. esigner: 6 !� wAF� L X 4­1 • Guts' �C VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST y yap 655 O'NEIL RD.,HUDSON,WIS.54016 ROB T CST's ADDRESS(Street,City,State,Zip Code) WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. Phone Number: MINN.INSTALLER&DESIGNER LIC.NO.00663 IX. COUNTY/DEPARTMENT USE ONLY �( F-1 Disapproved Sanitary Permit Fee Groundwater ate I uing Agent Signature(No Stamps) I�Approved ❑ Owner Given Initial ,�`) rcharge Fee Adverse Determination ,"`'' X. C MMENTS/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. Ypur 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 tA-y,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-bcjrtstallation; _ r� 5. Private sewage systems must be properly maintained.-The septic fank(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, 608-266-381:1. 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 manufactuter'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.,,,i 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 8Y2,x'11 inches must be submitted to the county. The plans must include the following:-A) plot plan, drawn Wscale or with complete dimensi ts, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; w.efls; 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 forn4. ------------------------------------------------------------------------------------------------------------------Y-------------------------------------- GROUNp.WAGR SlURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed int6Aaw. hTs legislation is more commonly known as the groundwater protection Caw: This chain iti f6Ws was the result of over 2 years of steady negotiation artt)-pubfic'debate. Thos groundwater bill GroundIer included the creation of surcharges (fees) for a number of regulated practices which Wisco W can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r1easuf'Q a is used in your building is returned to the groundwater through your soil absorption u 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 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 N,, ,1 G/ 40,�,/l Location of property `S 1/9 '-5"W 1/4, Section 5 , T N-R �a W Township A),t /P4l., Mailing address Address of site T• ( �a Subdivision name ` Lot number Previous owner of property G-l-�•• /���' G, s Total size of parcel Date parcel was created l / 7 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes No Volume (�S-6 and Page Number 0 7 as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the C unty Register of Deeds, as Document No. ) . �gnature of ner - Sign ure of o-Owner (If Applicable) / /9 of Signa a Dat of ignature to 4 t 3 V, March ,._...,,�.,.. 2nd day rt. NiscOnsin -- =n ttec vW4 at • p Aim aAW► btucs of Glenn B. Fri►tacis _��.._�-=-- I'1Ac1s 1 .4 W.4 WE del Of � , V 4�r 1 4li ' V iscous- Tltle: Memb- State Bai of Authorized unier Sec. 706.06 vis• �9 3 1 L a E'L'ATE OF wIDCOI18[N ss. �t-�� --county. day of Personally came before me, this the above named— —_ — ----- — -- ed the seine• - --— instrument and acknoaled` # to me kaotar►to be the Person-- who executed the foregoing This instrument ass drafted by Notary Public __--- t �; - � 111sconsin �u�b F. Gains Audsons__ 4iic Wa of wttnatsea i<o0tionel LL. _. k1 Ce city eh°nld be typed or Prated below their s�-•'dame$61 Persons signing in any Pa i -- __ ­0 fiat or w0ca"go• r"M No,3 f1t! r S T C - 105 i t-�:•,�•"s. pit SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County OWNER/BUYER ROUTE BO .� / X NUMBER .Fire Number k/s . ZIP S O '2 CITY/STATE -Oe ,j�► ' �+' PROPERTY LOCATION: 14, �, Section , T N, R W � Town of St . Croix County, • y 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 ptit 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 m_ y be eligible to receive a grant for r � 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 I accepted this program in August of 1980, with the requirement that j owners of all new systems agree to keep their systems properly maintained. • .Ih The property owner agrees to submit to St . Croix County Zoning a t 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 i 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. 0 ,c I/WE, the undersigned, have read the above requirements and'" agree Z , . to maintain the private sewage disposal system in accordance with to the standards set forth, herein, as set by the Wisconsin Depart- o ment of Natural Resources. Certification form must be completed ` and returned to the St . Croix County Zoning Off:LVe within 30 days of the three year expiration date . ; ! SIGNED DATE St . Croix County Zoning Office : ' P.O. Box 98: '`l Hammond, WI 54015 j 715-796-2239 or 715-425-8363 Sign, date and return to above address . I ,DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&B ILDINGS INDUSTRY DIVISION , \ `� LABOR AND v PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS \ MADISON,WI 53707 (1-163.090)&Chapter 145.045) LOCATION:s I TOWNSHIP/Mlcl+#21f�AttTY: OT NO.:BLK.NO.: SUBDIVISION NAME: / S /T 19 N/W�E c r) u�0 Rc Lv ya Ads COUNTY: OWN S NAME: MAI L N ADDR SS: e� 54 .CROI� NOW - 44th.) � _5,0. 4� 'Q lug f:t crs � ►s . sVo z USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCtAL DESCRIPTION: R STS: Residence IV.If ❑New ,<]Replace A) �T O-E ISoa ,2vjwa Aoq. RATING:S-Site suitable for system U-Site unsuitable for system ONVENT NAL: MOUND: IN-GROUN :S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM,(optional) ❑S ©U El ©U El U I El 13ll 19 S ❑U MovNi-1— `t' P4*t4s-oo -For, If Percolation Tests are NOT required DESIGN RATE: s If any portion of the tested area is in the under s.H63.09(5)(b),indicate: S-r Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS (0 _J)ECiAjA-L BORING TOTAL P H TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 5,01 12: 7,4ar1> 1,s , 43 ' �r.Qov. S� �0 ' >/'4-V• S1 N/-7k fl'f.A.A 3.o . MOff f / ' .O ' il m i'X Tu E Of- 'R-eek S I a- -a., . M-44 , s . — s j .S B- 4 0-H L E-v f, (e, -z i s T- o e• tiro f.S p�oo/Ev S ' Mfr LIP 'B a. IS 2.3 ' 11k. 2 .3 Zv"1Z S ' . Ic oR Mots -0 1•str,-%c-f- . a . �uuD l r 3 , I ,�3 �r.R� • , , 3,3 a S 33 6V. w,, B-� 3 ,3 �7 �/ Z , S Co W/ f f. R•%:IZ 1140-16-5 .W S B- I w/N. , . I I'S r. TM OQ-Gy. )10 f.S ex— SleaiTiovf PERCOLATION TESTS is IS S-tR,4 'f>'1-S ,u TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERS WELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P. 1 P- P- 2-D 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. .2 fT .54 A.,P/ O1-1C" 4+ 7.0 Ze4e y 70 i SYSTEM ELEVATION ds ,e, tiv Ts f0f. , I i ! I f , E — _ i E u4tw—, . _ �. . a _ - c. i i j IhIs test 83 P PROVECY i H for a z . r � �ca����li�t-►r���l �� i-- trC S Ys te,11. See explanation - 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 ministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. tE(print): TEST WERE COMPLETED ON: 655 O'NEIL RD.,RT UDLB GHTIS.54016 ,(5�� , � � ESS: CERTIFICAT ON NUMBER: P O NUM RI t' Hall: WIS.MASTER PLUMBER LIC. ✓� j�� / INSTALLER&DESIGNER LIC.NO-00663 7 CST S NATURE: 'ION:Original and one copy to Local Authority,Property Owner and Soil Tester. _ 0.6395 (R.02182) —OVER Q --- - 4. • a,Q � � 1 i � o , ,o m Z 3 • I LrU � � � a W O II� If ` V i P � s' . r , 1 s o d � � 1p •S p �' O Pi. c \n Z a► �' �° 14 o n _ m cn %n R` mq mm F7 cq "Zi WS m MO CD oz a y C p IDI > o V rN N H � � El - S88 - 01473 PROJ:rCT IND3X SH BT f, ADDRESS: 20f sa . y - �f 1421'44� S Gtr/S SITE BOCATION: yd s w I1q 5k)- Yy Sac. 5 , 7-1-flxl; lel �re wti PROJECT DESCRIPTION: i T r SO i IS ARE V t pey ' EI2M 0 3 Lam- ?b p.fO i l S) 801- S?A-bf "rat a �Itit.- CFA��(Q ry Gv,4s SE,�UED /� f1- mip' y, r4 Afk p is w �c /�L�.� �'�, a- N-ew 3 O F Lim ��I 'R d X . 2 S AJ O �j tcA'p— #-0m -��+�M �� sue. P/ PAGE 1 . PLOT P_I,AN VTETIS PAGE 2. MOUND CROSS S-20TI01I 3; SYST�M P?,_4N VIEWS PAG 7 3 . PIP LAT R- T; T,AYOUT PAGE 4. DOSING OR SIPHON (-,'H.^s•ZBT,R CROSS S TTIONS PAG-,? 5 . PUMP PER F 0R!'-!ANC SP'E'CS OR ;S IPHMN SPECS PLUMBER: SITS; : V_ILUAT",Rt or DESIGNER HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 HOMESITE SEPTIC PLUMBING CO. ROBERT ULBRIGHT 655 O'NEIL RD.,HUDSON,WIS.54016 WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. ROBERT ULBRIGHT MINN.INSTALLER&DESIGNER LIC.NO.00663 WIS. MASTER PLUMBER LIC.N0.3307 M.P.R.S. v MINN.INSTALLER&DESIGNER LIC.NO.00W DATE S IGNATUR't; P,,?f,444 IW� Af f �S S /-e �Ano-v wN f I�GWel = y o �. S S� l r o 0 V%z z 70 LGGI Q {3 . , j Lt� ,S / to W 0 p ,tao vie y 0 Q� o\ ode c� + -. o Ntb � ► v p 0 � � � � - n z �, ► oa \. o Q M a U fit` �, — --- X J ,. O a Z F ® � ^ 3 �d � m mcn Rim mcrm = m Pi 4-, Jc i S Q g c Q " O1 4 `r�1 Page — Of _ v r Synthetic Covering Distribution Pipe Medium Sond S y STEM H G FtEVATY00 Topsoil F l; D �(/ ye Slope � Bed Of Zr Force Main Plowed PG�y Aggate Layer TO 5 � � Ft. L J. 5 . E 24 Ft. ss on Of A Mound System Using F . �5 Ft. O Absorption Area For The Absor t o d o P G / Ft. �y•Fti � A Ft. H AS Ft. B Ft. K / Ft. O� g� L �'� Ft. • j Ft. T L/ Ft. Force Main W ,? Ft. L Observation Pipe--,,, � 9 K . �—. - -----= --- - ----fit � ---------------------- ----------- --------♦a A ~--- ---------------- ---------------------- W 0 ��Distribution Bed Of z Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area 888 - 01473 page 0f S ,t5f Noy sE �artTION ✓A vim+ a,t O�ArN � Perforated Pipe Detail r 0 1 End View t )Perforated End Cop ode�� PVC Pipe Holes Located On Bottom, ' S Are Equally Spaced 7c' s P +,Z C ,7 w,t�ifold � `�p�5 <1- . 110 �� Alternate Position Of t^\ ®►slri ution ��AP S Force Main Pe u Lost Hole Should Be e Next To Ertd`Cap G End cop Dis FOP y ��� P 23 Ft. 04 , F it 0 0 .90 R ,_v P o�J G0P S 3Z X 30 Inches Y 21 Inches I Signed: Hole Diameter .� Inch Lateral / Inches) License Number: Manifold Z Inches Date: Force Main 3 Inches # of holes/pipe /O Invert Elevation of Laterals/0/2- Ft. I00, 7 FT. yq 1 ,17 10 I/b iD t/o/u.�►.� °R 70 3 P UL f oRc M i-J = z ;,JS . S88 - 014 "73 �L. PAGE OF ' PLiMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT GAP-T'i"C.I. VENT.PIPE APPROVED':LOCKING WEATHER PROOF JUUCTION'BOX MANHOLE .C(3YER-T � 25' FROM DOOR, •• WINDOW OR FRESH 12 0MID. AIR INTAKE of I 0 GRADE IB"Aim. C T- - --- - -- DIP --- I N LE T \�" D�L� � �NG� V �( �y�cj\ON �t� I APPROVED JOINTS APPROVED JOINT A Q\ Pk. ) ,I I W/C.I. PIPE W/C.I. PIPE G 3' ALARM EXTENDIN EXTENDING 3' �� I I I ONTO SOLID SOIL jOWTO SOLID SOIL B rt I I _ I I ON c ELEV. FT. � PUMP OFF t - I �► .Z �I N CONCRETE BLOCK P-0 �. G APPROVAL RISER EXIT PERMI'I1'ED ONLY IF TANK MANUFACTURER HAS SUCH i. SEPTIC E SPECIFfCATIOUS DOSE �NL WMBER OF DOSES: PER DAy TANKS MANUFACTURER: j 0 o LLONS DOSE VOLUME GA ,,// T SIZE: � 70 ANK INCLUDING A KPLOW: GALLONS ALARM MANUFACTURER: MODEL NUMBER CAPACITIES: A= /(,0,5 INCHES OR 36O GALLONS I SWITCH TYPE' g= Z INCHES OR '3( GALLONS PUMP MANUFACTURER: 2-P Ca�,lA1LHESOR ¢�GALL01J5 MODEL NUMBER: (3 7 �Z 1— ' 1, S ' D=/7� INCHES OR 3 GALLONS SWITCH TYPE: 2 11 QAG/� MER 1U� F/ SMOTE: PUMP AIJO ALARM ARE TO BE I MINIMUM DISCHARGE RATE 70 .---GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. � FEET I + MINIMUM NETWORK SUPPLY PRESSURE�. . . . . . . . . . . 2.5 FEET - +- 0 FEET OF FORCE MAIN 'A �' F/oo FKICTIOW FACTOR.. '-7S FEET TOTAL 0y1JAMIC HEAD = a' (? FEET R�v,Al P 7G 1. q INTERNAL DIMENSION!: OF TANK: L.E�11> \ ;WIDTH - �/ ;LIQUID DEPTH � o�D. 51GNE D: LICEMSE DUMBER: DATE: { f! G s 5 Nk � p Y al HEADI W W 115 C,"PACITY 119 32 105 8 _ O 1 4 7 3 95 CURVE 100 _ 28 90 26 85 I I EFFLUENT 24 80 MODEL and Q 75 MODEL 189 DEWATER/NG i 22 70 185 333' 29 � 85" Q Z 18 60 � 55 C 18 .50 ODEL 163 MODEL H 14 45 188 12 00 I 35 10 MODEL 30 137,139!. MODEL SEWAGE and 9 25 165 DEWATER/N_ G 6 IN MODEL 15 MODEL _ 161 4 7 10 C �ie MODEL 2 a LL 5 53,55, W 57,59 0 GALLONS 10 20 30 40 50 601 70 80 90 100 110 24 LITERS 0 oo 160 240 320 400 75 22 FLOW PER MINUTE 7o i zo � 18 60_ Q 295 S 16 55 V 50 i Q14 45 MODEL_ Z 294 C 14 40_ — J MODEL Q 35 293 h- 10 MODEL 0 30 284 a MODEL 6 20- 282 15 4 ZZ71, M W T�7- 10 MODEL 2 5 267,268 t M 0 3280 Old Mules Lane GALLONS 10 201 30 40 50 60 70 80 90 100 110 120 130 140 150 180 170 180 190 P.O.Box 1637 11 4 Loulsvift Kentucky 40216 LITERS 0 8o 160 240 320 400 480 580 640 720 (W2) 776-2731 ' FLOW PER MINUTE r O.yr.nun-auiomanc,avauaole packaged with a piggyback mercury float switch. I i "137" Cast Iron Series CAPACITIf "In" Bronze Series*, HEAD UNITS/M N r Feet Meters Gal. Lira. • Automatic or Non-Automatic. 5 1.52 104 394 0 1112 H.P., 1 Ph., 115V,200-208V or 230V. to 3.04 79 300 15 4.57 81 242 1 • 'h H.P.,3 Ph.,200-208V or 230V. 20 6.10 36 136 • Non-clogging vortex impeller design. 25 7.62 a 30 • Passes'is inch solids(sphe;e). Lock vane: 26' • 1'f2"NPT discharge. • Float operated, submersible (Nema 6) mech- listed Canadian Standards APP ran anlcal Switch. available 4, Automatic reset thermal overload protection. • Stainless steel screws, bolts, guard, handle and 139 Bid"a s6.111s arm and seal assembly. ....,. Bronze motor and pump housing,switch NOTE'No UL listing for 200.208V/1 Ph. case,base and impeller. pumps. Mercury float switches are available for non-automatic models. L State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION 201 E.Washington Avenue P.O.Box 7969 lop G`, Madison,Wisconsin 53707 i')(icy riir l 1Ii ICA ,, f 7 r V Ll :`> e!��J E,' :)3` 1 irJ=alt Ci: uY'1'+.: 3lC s`i ! .t ( f , iSC%Io�lrl S,,,3tCat£'S, t?ria S. li.li;. t..s•'i t• (� ) , �Ii5COliSlrl 01,4iC. E.ci r,' ."ii:`ion th {;::')iit`"ti;iO(1"i, for cl, variance ; k t•i aCL art t-xi Sii ri� private to tiie l rsu i l ti orl a r r vat", se � iE' S' c l 1s iL a )3 E IttC9; ES t'iJw l,`.1 itiil + r,j je� ti� +� 6l + %t 'Ci'U SiLiri' sl litiuri:S i11 the au in-IL''r .ati c rul i t jsto+:; tar ` [ !I'c3i3C75L� `aI;OU�Ct p i o i,(-L L 'ZiiL.' 'v t1 LC r" Ui tiii2 `_to i.C; i Y uu; r`.izi ijI:i i`ra Gl t r Al i' L'i1 5 S y Ski ei," beco i'?es a g'c i ll';ti. Sw3'St1:> G1"' C Ci;fiz =;;'lliutl i Ci,i:_' i;tJ±`i'YS q' Vi(' :;4c :t v 1ris1 s variance l Shdli aJC' r"I==SC"t 13i �t [( tt 'file �.._ � ? yi n. .1 f ;.. r.$f 1L1 3C .: el•t..,' I A (mot} o�1 tt1C: 1�i s. i1e 'Y✓C +y� lit t ..11 a YiAt d Ul3 1, llt ot...:!it 4d J , Ii��.I':k. d.'i:1: S �C rl l t,:1'l t� Utl tv , i t. . i ioC l.tU uT L 1ri9i c+S a3C l rl CGrlu1 t1 11a i 1y a,ppr'jve6. Thc C )r'i i`L1Ci`! 177rSC, i!<x§ iii itiry{t`twlt '1�" t6iJ re, t.iie F.:Ourd SyST:�lli; Jii(a I I i.l L: i`' r�i t,Lrr:l: I✓',i l.si U t1C�I C, I li,� �.0 ill- .).r' Ctti,t'r 't.)l "� —i.i'i, SJ,�'Ji.t,:'t'F• �a � = 1itc r lc' t .`LEA Ii"£ S ut::°i aj 1,0Lrta aG(k:i Rix:4C' a i;-'tti'ili.'t:ti;= iJi' t" tt;itES ttT St,i lift"{,.u1 J iii(; vcti'iollckt 7'f'Lih S�r�U =+ � s to '{iiJt6'1 1(:�) tr.y4i`.;uIit. :'lii;l!t;' Sj y�tiei t)ll J site vii ii it ritiU Lil: S1ui id r1S ll r 1L4i'..' Cl's t,iiit t tbE y1LLit;,ori C011F, r't�'r"t• ica{S V'; -tct?tc 3S SNE'C: i1;C %l ite Sti !_.1. ,, }+E l Jt7 uric ; .tr3rlC3t %C' p' Uf:lSi 'tC%lt^ l iatst„l'l 3( t,�1(i'r1a• itii(.t li''., aa01'01 y i'1rciJt"�CCt. 4,Ucta;� �i;1fi i1i.'r)i lCta a,1'�+#i 9 , .•, l.ti j:, Z1,a t ai i S - cc: - I_f'i”l,iu` U 4 1 i s icf, t`i'"i 1�\s'�.,(: :7 i,,• al NY L li i i y'x� „l�i+':. ii t a 1.t"`l{.i. 'xiscm' +..i)'7it di �t.111i1a'ir' 'C 1J 1" - j'L, LiLtlX lCUIiL SBD-8928(R,10187) .ti State of Wisconsin Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION Office of nivilion WOO, id Application P It t3'� + MGMESITF SEP f,{, i1C.lEa1,t LNVG' �..17f�1f'rlitit i �:-:+.•Jfi,,, 1`1,1t1 + i<I 655 O'NETL ROAD 1 1101 IiGII-it Opt, dal: 5401f., C `fl . r'+.�t1 ; 4 ,Nt�r, ?7 •.A RE: Plan Number: 588--01473 Project 4_),+:^r" 4, N.=4t,3e;v , , lIR1.,.ISi, =l.i ( �. ,? >i<_ *•). _ ;tl�_ lown of Kf 71011 ;' F003 pEat,,. t,tt..'.i_ (Priority R J.1 t?w) ; 'i7C UP plumbing plans and I) `. I 1 4�, <r':. r d for , .: 1.t i ..e'7;.)I: for (;�' )r'i ;' ;It" S.` 1. l � L:ompl i Anco 1aJith appliCA10 rodn Thi Pppnvsl V,d on Waat,%1f"- 145, Intls( unX7.1} Stata,.l1'os aiO the WA, i '1win Mii+.>.r1inl , .'l , . (;f? UP I`IFJns uYP stamped `Crrd 1 t c_na. i 1 a 1 .; ;:C + Thin� 4^ � i41 rl i alit , jfC tl s aB ,. a. KIM.; �; any stipulations :ii'i:)inlil on 'i•;lls- })- ,:'fiti All 0 =5 lai<d4 ar;°' no-IPA mtt: 1: be CoP'i^ACItE'if All }'3k'!r1111 (:9 1't_?ql,1)r'M by 1 ,'sr'9 city, :) I ', i.,l({=':, i.,.w4soi'l, a c,r muntj WIT ' obtained prior to Ct7if "lCtl-Cl. 11' + {C C ' i -i )1} h r{ ! s r , 51att for 4.1..1;.`: iitn'1y7.I-ut1all shall k<>L. p one set of pLani with tho ao ,11"t:7,1•rl ._ II.pc 1"1 34_p .0 Wt' construction site. f hr instiller .;Ir_I f n,,, i h;, 1_Ew s,,i+i,.Ixr.ato Jn, p._::tor whorl inspectiono can be made . This appY"oval. will k-xpiro two your-.; from t°ho dat�p Rolwovod or ] Y' a ,;4:3111 t:<: r prdti"lil'Et: 1.'. <sIi<-b11.{7o(`i, it will 4ax1 k�t:: 1ho :I;ty 140 _ 'li I, 1- i �000 rY rtir411ii: o%Gp'Si"4'" Thp Section d .. Le 4xa-sgp d'Ii,AE, { t'v.ls'lJs"CI @.Iipi.Fl plan` I <ii'` 1pivato sowago nutow r,"irompnts only . fhp5n plani howv not Ono v "'"7 .s L,:;r, rov 4 ,}o d- r`, 111.1"P,t1+.t lt:.'i i 1': i,I1111.1I �..�i ",�0 64 of tho r Section.. .. - ,':�4 Ilc,r- .I I;l laii;l.l;i"'I GI t,r, ;. s���l:. fc)1�-t:�i i.ri ,:t � 4.acn�1 _11..1{!�; �2 for 1. i:;roo31,)h Administration + oloi l I r approval ;21 r" . . t +(? Q_ l irta3:1.0q � :,i111E;(�i �tT 'li 1.l t 12!":VI_z'1(.vmi. Ni r PE f:I i t'tN 10PPLACKFIN17 MOW) TiCt t i 1hs roncPrOnq this a)l '44 = rFj : c. t { _ y < a .i t3 [60h) ,°r;C A/30. SBD1423(41057) State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION P"acio 2 j 11l !.7"1 l .1 1,fi'l.,E c , - l(V S i � ;� Diuisior, c,f G f1 : , zwd 1111J Id,i.11is PPP0l6/0 ,0 rt!31. t c: : lUrlll( Y 11(1f<f._I'i'11 ,00n Cr-llyr`'i' SBD-6423(8.10/87) ST. CROIX COUNTY WISCONSIN ,,< F ZONING OFFICE 'r r? 796-2239 (HAMMOND) 425-8363(RIVER FALLS) _ HAMMOND, W154015 May 4, 1988 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir : An on site investigation for the Nancy Parlin property located in the SW 1/4 of the SW 1/4 of Section 5, T29N-R18W, Town of Warren, revealed suitable soils at a depth of 1 . 3 feet, below which high groundwater was noted . This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office . Sincerely, n J Thomas C. Nelson Zoning Administrator rc Y