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HomeMy WebLinkAbout034-1081-50-000 0 ol, > 0 0 o (D 0 0 m (D CL 0 E O)F- o c CD 0) 0 U) co 0 U) CL LL w 0 0 0 0) CL c) zt E Lo 0 z / { a co C14 a) Lu CL co In 0 z .!t (D E :3 CD :3 0 0 z z 0 .0 0 CL (D Q (L E Z k U) co 0 0 IL IL 9L m CY) 0 B [ LO co co 0 ce) cD C) C, 0 CL r- t-- E , moo CD 'o m a) LO 0 0) 2 I C-4 U) W U) c C) LO 0 0 m 6 m L? CN a) Lo Ce) / ) a 0 0 j U) En U) M r- 0 z z Lo 0) 4 E E ce C) Ce) ("D c- : I C> c) U) (D 0 U) o o 0) C) z E 4—i M CL L: (L CL 0) E 2 0 m U) U 0 u 0 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 ttiblime of renew'at any new criteria in the Wisconsin Administrative Code will be applicable; 3. Alf 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 an 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'/2 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 bones; soil absorption systems; replacement, system areas; and the location of the building served, B) horizontal and vertical elevation reference'points; v) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; puAlp` 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. On f0 ay 4 1y;, 8"' 1/1riSC0! !r. 4c, Was sig] 7,0 t,7)f 4i result 1.i� Jv:'� ea s'i.- ��, .,. _ ,.0 JYGwr ., !! a f�: - I fl anafE „ ,Pt is used System -fhe :.i SANITARY PERMIT APPLICATION COUNTY DILHR _ In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# � -Attach complete plans(t0 the county copy only)for the system,On paper not less than STA 9,10 TE PLAN I.D.0 4/NUMBER 8%x 11 inches in size. o �O /� ,� -See reverse side for instructions for completing this application. D PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ No PROPERTY OWNER PROPERTY LOCATION D 1� c�LC '/a�(�(/%a,S T�i� , N, R /r E (or PRO ERTYO , �'S MAIL G A D�,RESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE +� 9f7c4l IP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK r O VILLAGE: P /7 ►`e/� s �., to �. II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family ' 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. 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. CRAIternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e.N1 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 0 seepage Bed b. ❑See a e Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes er inch): REQUIRED(Square Feet): PROPOSED(Square Feet): // 3 75 3 I �� Feet .Private ❑Joint El Public VI. TANK CAPACITY Site in alions Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank X 1000 M-4weST 4i 9S� Lift Pump Tank/Siphon Chamber y I 75v << FF:. F; VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): tier's Signal re:(No Stamps) P/ PRSW No.: Business Phone Number: 'so e, Ake*j rt r ��� c�� 7 .15 935- 7d 1/ Plumber's Add ress(Street City,Wile,Zip C e): Na of Designer: c! _Q, VIII. SOIL TEST INFORMATION Cer•• d Soil Tester(CST)Name CST# - — cgk/ r-—try b L e— 'C.._.. c71° 02,, csr ADDRESS(Street-City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTME USE ONLY ❑ Disapproved S itary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) S char a Fee `� Approved ❑ Owner Given Initial Z/00, D� g / "/�"8/ I Adverse Determination s�, Qc / rV 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 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR&H`UMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.6. BOX 7969 BUREAU OF PLUMBING MIA, 1 S�nJ`i,�35Ig7, 29N-R15W �q SE a, a, CONVENTIONAL K?�?ALTERNATIVE State PlanLD.Numben Town of Springfield ❑Holding Tank ❑ In Ground Pressure R7Mound State Highway 12 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Don Wik Route 1, Knapp, WI 54749 J °7 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber-. MP/MPRSW No County Sanitary Permit Number: Joe Menter I 5658 St. Croix 96049 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUT ET ELEV.. WARNING LABEL LOCKING COV R PROVIDED PROVIDED" •' lD•79 A3.�1 _7''Y A3,12 OYES ONO DYES ❑NO BEDDING: VENT DIA.. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: JBUILDING. VENT TO FRESH A LARM. FEET FROM LINE: AIR INLET: ❑YES ❑NO DYES ❑NO INEAREST p P DOSING CHAMBER: 'Q �^�'�/ >{ / -� Al 97 q ,3 Z, //-6(/ S0'& MANUFACTURER BEDDING: I_IOUID�:APACITV P MP MODE(_ JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED lG�irjt/tQ.{T ❑YES ❑NO �so ❑YES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PR OPERTV WELL. BUILDING.I H (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) CJ YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing JLINGT� DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN '� CONVENTIONAL SYSTEM: WIDTH. LENGTH NO OF DISTR PIPE SPACING COVER JINSIDE DIA #PITS: LIQUID BEOITRENCH TRENCHES MATERIAL: I,IT- DEPTH DIMENSIONS I GRAVEL DEPTH FILL DEPTH JUISTH PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV.INLET ELEV.END PIPES LINE: AIR INLET. FEET FROM NEAREST' MOUND SYSTEM• e 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. ❑YES NO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES NO El YES ONO DEPTH OVER TR ENCH/BED DEPTH OVER TRENCH;BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED. CENTER ❑YES 1:1 NO I EYES 0 N ❑YES NO 4ESSURIZED DISTRIBUTION SYSTEM: WIDTH: L NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER , TRENCHES. 0111 TENSIONS MANIFOLD' PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.. ELEV.. PIPES. DIA.: °ELEVATION AND 11ST IR-TION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED tiORMTION PLANS 1-1 YES ONO F-1 YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PR OPERTV WELL: BUILDING: FEET FROM LINE: DYES 1:1 NO ❑YES ❑NO NEAREST IBM - o� 3d / 100- 36 a sue, (�, 3 L/ 9 C� 3,7 0,ve Sketch System on L etain in counity f` ile for audit. *fy)i Reverse Side. SIGNATURE. TITLE: DILHR SBD 6710(R.01/82) Zoning Administrator PUMP CHAMBER - Manufacturer: / \+�di�u�ST ?rl- °9-S h Liquid Capacity: / 6 0 Pump Model: VM1<�90 Pump/Siphon Manufacturer: ro-J0+f"( Pump Size Elevation of inlet: 72 • Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: G, �. Alarm Manufacturer:-,q,( L-,ZeC_.r'ru Alarm Switch Type: /Q Number of feet from nearest property line: Front, O Side, (\A Rear, Ft./ Number of feet from well: Vf Number of feet from building: / (Include distances on plot plan). SOIL ABSORPTION SYSTEM P00A 'D Bed: x Trench: Width: "Length: Z Number of Lines: 3 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, Rear,0 Ft Number of feet from well: / 7�) _ Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box 0 been used on any of the above soil absorbtion sytems? (Check one) . N h5"g TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: - �J7''i� Dated: Plumber on job: e. License Number: 3/84:mj I Form - S T C - 104 I AS BUILT SANITARY SYSTEM REPORT L L e., o Air w I'' OWNER.Je•Aj A) CS UJ e_I Jo Le_ TOWNSHIP , /�j/'�u9,A e SEC. T N-R W ADDRESS 4 A)19-P p ST. CROIX COUNTY, WISCONSIN 74/? SUBDIVISION LOT LOT SIZE U C . PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I L1 1 S P11r_ C Le-u T ';Ok)S •� q3• D-13 q 3 3 d � 5 q \A,S of V1 4 V11, INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used „T„ Te L Po 5-r Elevation of vertical reference point: r010—,6_.Z -/Qp Proposed slope at site: p SEPTIC TANK: Manufacturer: �"l►�mGveS'T" f�/'e-�N57Liquid Capacity: /000 Sp-e- , Number of rings used: © Tank manhole cover elevation: �7 �O SRS" _FVYS n �J l 2 ►� ►eadrLrS r Tank Inlet Elevation: "( 3. `� t Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Rear, O feet From nearest property line Front,0 Side,10'�Rear,0 feet Number of feet from: well building: �$ f (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: `"\+ fvt-S�'' ��-CSC Liquid Capacity: Pump Model: ' Pump/Siphon Manufacturer: f ++� '�%'�r�C Pump Size Elevation of inlet: % 32' Bottom of tank elevation: �� 7 Pump off switch elevation: Gallons per cycle: l cl" �. Alarm Manufacturer:,;() QT L�:Z- PC41-11-') Alarm Switch Type: /O Number of feet from nearest property line: Front, O Side Rear, Ft.,1 Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM pooiU L7 Bed: n Trench: Width: ` Lenjth: df f Number of Lines: Area Built: / i r Fill depth to top of pipe: 21 -/ Number of feet from nearest property line: Front, Side, Rear,O Fts° _ Number of feet from well: 7 ) Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box 0 been used on any of the above soil absorbtion sytems? (Check one) . NObDtM TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, Q Side, O Rear, O Ft. 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:-,- 3/84:m,j DEPARTMENT OF REPORT _ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY', — — _ —__.___._ _ _ DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 'HUMAN RELATIONS (ILHR 83.09(1) &Chapter 145) LOCATION: SECTION: TO N HI / L T O.:BL O.: SUBDIVISI ME: (�1/a . /TRgN/R OE (o W NT OW R'S/BUYER'S NAME: MA G ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: �!� PROFIL E PTIONS: E O TIO ESTS: esidence 1� ❑New IJi�eplace /,r 8� / � l V f Cl' -f[ RATING:S=Site suitable for system U=Site unsuitable for system 'CONaVENTION MOUfyB: IN-G {}PRESS(}RE: SYSTEM-IN-FI HOaLDING TA ' . RECOMMENDED SYSTEM- optional) L�� u DESIGN RRATJE: If Percolation Tests are NOT required I I If any portion of the tested area is in the ��\�// n under s. ILHR 83.09(5)(b),indicate: A// Floodplain,indicate Floodplain elevation: iq PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-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- I I q q.5,,'3 3 I B- .0 0 n i 3 Aksik B- q,5. 33 6 d3 5 'k Q i si B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD1 ERIOD2 1P ER OD3 PER NCH P C 36 � P-a 0 P 36 919- 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- ontal and vertical elevation reference points an show thei cation on the plot plan. Show the surface elevation at all borings and the direction and percent ;f land slope. SYSTEM ELEVATION 16. 91 " wr ti -- P- qo JUR 1 x-19 , � I i _....._ -ZONING- a T 4 i l I y ({ 1 I 1 41 I 4 r I ir I � the undersigned, hereby c ify th the soil tes s reported on thisorm were made by me in accord with the procedures and methods specified in the Wisconsin administrative Code,and that th ata r orded an I the location of the tests ire correct to the best of my knowledge and belief. VAME(print): TESTS WERE OMP TED ON: d ADDRESS: CERTIFICATION NUMBER: 1,?NE NUMBER optional CST SI TURE DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. )ILHR-SBD-6395(R. 10/83) —OVER — M�dri4���•t? R $,� Ate: ..�- �,a�"7'�•+1.ar`�'��T" '' ''•}�. t L t�l�'.4�'r..:.Jam' ..... ... t X4,1 •1 F 51 m e UMBING U-, 2 � Ap DEP VET Ir Y LkBOR AND 4UMAN RELATIONS 1 D I SION SA CTY AND B ILDINGS i A Ad f C M PO I i lJ's 3 i n -MA XA& G � o b - r � z�I lip� � b � I o I t> .i r � Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand �.. G Topsoil -- F 3 E b %. •ti. PLUMBING `8` Of 2N- 2 %2 Force Main Plowed ti ConjdWona&y Aggregate From Pump Layer Qo7��.� of lid ��s7',B£,C�i✓E,L p OVED—""A TID S E ,/ A�. AN HUMA RE.LA �J �1 DEP OF IND TRY, LA80R �ross Section Of A Mound System Using U VISIG F SAFETY AND UILDIN6 , F * `7 d. ed For The Absorption Area G 1.0 OFIR P1 NDFNCF ���- A g Ft. H1�_ Signed: B � Ft. Lice a umber: �'[ 1� 566-8 I &A Ft. Date: � � -`�J Je�Ft.9�7 K 14,61 Ft. Alternate Position L UO-1-Ft. of Force Main W Ft. 9�3 L Observation Pipe - - --- - =-- --------- __ 0I ----------------------- Force Main o----T--------------- ------- From Pump Distribution, Bed Of 2 2 2" Pipe Aggregate I Observation Pipe Permanent Markers `165 0 Plan View Of Mound Using A Bed For The Absorption Area Plan t.fl X70 ,s� =i•+ i �4a _ Y t ��?. �'f ��.a �' ar �� 7Y,.. '41 s �+ .y.atl° ., r ,� i .._.,.w._.. .,.,wr... .. Perforated Pipe Detail 0 End View )Perforated End Cop � PVC Pipe '0\e Holes Located On Bottom, S Are Equally Spaced *-2 PVC Force Main r: * From Pump .7 Q PVC Manifold Pipe Alternate Position Of Distribution Force Main From Pump Pipe Last Hole Should Be Next To End Cap End Cap") Distribution Pipe Layout P R to S � X SO-- Signed: Hole Diameter Inch License IV\ �C Lateral � Inch(es) /umr: �' Manifold d2 Inches Date: (D Force Main Inches PLUMINNfl l.v►rdtljoau ��' • APP ROES= o DE OF MIO't TRY, LAGOR AS DI ISIO F SAFET AND Plan - CO R SPONOENC Z i r oct ru `t CU G' C a � � � P PLUMBING oRdi�`Iona� 0. GF OVED Info �ti. L A ., VI810 F SAFETY AND N�1 D NGS RELATIONS CORR P tVDE:NCE ,1, tip, e• PUMP CHAMBER CROSS SECTION AKJD SPECIFICATIONS k VEIJ7 CAP 4"C.=. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FRCM DOOR, WINDOW OR FRESH AIR INTAKE GRADE I 4"MIN. Jt 1 B"MI 1J. CONDUIT `-- --------- 18"MIN_ ���\\\ ----------- PROVIDE I ----- INLET T AIRTIGHT SEAL i4 II APPROVED JOINT A I III APPROVED JOINTS W/C.z. PIPE PLUMBING I I I ( W/C.=. PIPE EXTENDING 3' Ill ALARM EXTENDIUG 3' ONTO SOLID SOIL BaE� �l� I II ONTO SOLID SOIL ow Ap 'OVED I 1 DE P OFIND RY, LABOR AN HUMAN RELATIONS I 01 ISIO F SAFE AND IL%q4 --i � � OFF D , c as S 0NDEi'cicE CONCRETE 9LO&K- GRISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL- S PC C-1 F I CATI DUS ;EPTIC AND mI ALuesT f re, cwt' c )OSE TAN M E KS ANUFACTURR W : MBER OF DOSES: PEyR DAH • /ya L rn Aj. TANK 51ZE: 780 GALLONS DOSE VOLUME: GA LOKIS�/,� ALARM MANUFACTURER: �`�eGM CAPACITIES: A= fL1CHES OR �AL d S MODEL IJUMBER: I01 Blf-X—INCHES OR .95 -� GALLON SWITCH T.9PE• `e �u 40( �CbJ C= INCHES OR���`LO S d PUMP MANUFACTURER: D=-1 ALHES OR 1020S &ALLOWS MODEL NUMBER: g ",A© NOTE.: PUMP AND ALARM ARE TO BE SWITCH TYPE: !r\G r �'� �'� INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE G VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..PM / It��FEET �/ + MIMIMUM NETWORK SUPPLY PRESSu �g . _ 2.5 F 9 + FEET OF FORCE MAIN X 1 F�oFTFKICTION FACTOR__ FEET TOTAL DYNAMIC_ HEAD = ^FL/E fo IKITERMAL DIMEMSIONS OF TAIJK: LENGTH ;WIDTH —6 ,LIQUID DEPTH �4�(' 7 SIGNED: LICEIJSE 1JUMBER: `� J DATE: r- - r PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FRCM DOOR, _T JUNCTION BOX MANHOLE COVER � WINDOW OR FRESH AIR INTAKE I GRADE I y„MIN. CONDUIT---// ---------- 11� INLET PROVIDE I ----_ AIRTIGHT SEAL II APPROVED JOIN7 A I III APPROVED .JOINTS W/C.=. PIPE I III W/C.S. PIPE EXTENDING 3' I II ALARM EXTEAIDIAIG 3' OUTO SOLID SOIL 8 I I I ONTO SOLID SOIL I C ON I PUMP � �•. OFF D CONCRETE BLOCK RISER EXIT PERMITTED GI JLy IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC-IFICATIOMS ' PTIC AND '>SE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TANK :SIZE: I,b GALLONS DOSE VOLUME: � '� �"� GALLONS ALARM MANUFACTURER: LeG " 1^4 CAPACITIES: A= 2 S INCHES OR 457'``GALLONS MODEL NUMBER:- 10 B= 2- INCHES OR Ju" GALLOUS SWITCH TYPE: Q re-Li f C= INCHES OR V-K'r d?tALLONS PUMP MANUFACTURER: j rO �'i���l'�" D b� INCHES OR AO YALLONS MODEL NUMBER: Y` 70 NOTE: PUMP AND ALARM ARE TO BE SWnCH TJPE: te rt-Ll INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTIOM PIPE.. J /'3" FEET + MINIMUM NETWORK SUPPLY PRESSURE . . 2.5 FEET -� 7 FEET OF FORCE MAIN X '05 F31/ FRICTION FACTOR_. ��� FEET 0 FL f� TOTAL DYNAMIC HEAD = lyf`" FEET IMTERMAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH ST. CROIX COUNTY WISCONSIN ZONING OFFICE X . =wY 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 16, 1987 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir : An on site investigation for the Don Wik property located in the SE 1/4 of the SW 1/4 of Section 36,T29N-R15W, Town of Springfield, revealed suitable soils at a depth of 16 inches, below which seasonable high ground water was noted . This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office . Sincerely, Thomas C. Nelson Zoning Administrator rc STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/7N=X%VM%M= SE 14 SW 141S 36 T 29 N/R 15 X04W Springfield Street Address: Subdivision: County: Knapp, WI 54749 N/a St. Croix Landowners Name: Mailing Address: Don Wik Knapp, WI 54749 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. Signature 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) WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Arotgrnative Private Sewage System In the County of Location SE 1/4, SW 1/4, Sec. 36 T 29 N, R 15 IXW) W Town or t*iXi03P"ftF Springfield Street Address Knapp, WI 54749 Lot No. N/A Block N/A Subdivision N/A Landowner's Name: Don Wik The application for this site is for: ❑ new construction use. © replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numuers sued to you.) 1 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. for 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. ❑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: Fla failing conventionalxsoil 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 for a conventional private sewage system, check here. I certify that the above information is true and accurate to the bast df my knowledge. Name Thomas C. Nelson Signature County Official) Title St. Croix County Zoning Administrator Date June 16, 1987 DILHR-SBD-6158 (R 12/82) 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 e s Q i Z Y/,/A) �� l•�j y q Location of Property ' 1 ��i ' , Section N-R W Township f I� IrrJ�� -,' LA Hailing Address f� . Address of Site S N1 Subdivision Name : Lot Number Previous Owner of Property _Dcm) tl- d A , 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 ?C, No Volume and Page Number 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) eeAtiN that a t 6tatementA on th..s 6otm ahe true to the best o 6 my (oun) hnow.tedge; that I (we) am (aloe) the owneh(6) 06 the pnopenty duni,bed in thi,6 .in6o4mat.ion 6oAm, by viAtue o6 a waAAanty deed neeonded in the 066.iee 06 the County RegisteA o6 Deed-6a,6 Document No. ; and that I (We) pAuentfy own the pn.opo6 ed 6d to bon the sewage digs pod 6 y6 em (o,% I (we) have obtained an eab ement, to nun with the above dens cAibed pnopen trl, ban the con.6tnuc ti.on o6 baid system, and the same ha6 been duty neeonded in the 066ice o6 the County Re9.c.6ten o6 Veedb, Voaument No. �9214/_Vx� C� SIGNATURE OFD ER SIGNATURE OF CO-OWNER (IF APPLICABLE) 3 19e7 DAT I DATE SIGNED 'DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED This Deed, made between _Donald_Wlk__ 17C]----------------------------- Janet-_A._Wik,- his_ wife------------------------------------------- ---------------------- - --- ---- ------------------ ------------------ -- ----- -------- -------- --------, Grantor, and_-.Dennis-_A._Weibel_and Lynne_C,__Krueger,..husband-and -_ wife, aS -survivorship_marital_.property_ _ _ -------- -------------- Grantee, Witnesseth, That the said Grantor, for a valuable consideration. . .. - - - ' RETURN TO conveys to Grantee the following described real estate in _.S t_.- Cr0_iX----------- County, State of Wisconsin- Tax Parcel No- ................................... Part of the SE 1/4 of the SW 1/4 of Section 36, Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin, described as follows: Commencing at the intersection of the West line of the SE 1/4 of the SW1/4 of Section 36, Township 29 North, Range 15 West with the Southerly right-of-way line of State Trunk Highway 12 for the point of beginning of the parcel herein described; thence South 49D 46' 32" East along said Southerly right-of-way line, 268.64 feet; thence South 691 19' 58" East along said right-of-way line 99.44 feet; thence South 641.19 feet; thence West 298.16 feet to the West line of said SE1/4 of the SWl/4; thence North 849.78 feet to the point of beginning. The bearings used in this description are based on the assumption that the West line of the SE 1/4 of the SW 1/4 of Section 36, Township 29 North, Range 15 West, bears North-South. This --------.iS- ------------ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And... Donald Wik and Janet_ A._ Wik. his -wife ------------ --- - - ---------------- ------------- --- - - - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I easements, restrictions and roadways of record; and will warrant and defend the same. Dated this ----- ----------- ------------- -- day of --------- ----------My --- 19_8 _. (SEAL) -------------------------------------(SEAL) * ----------------------------- ---------------------------- ---Donald..Wik. ------------------ ------- (SEAL) 1 ----(SEAL) * ------------------------------ ----------------------------------- net--A�--Wik - - AUTHENTICATION ACKNOWLEDGMENT Signature(s) ....Donald Wik STATE OF WISCONSIN ss. -------------------------------------------------------------------------------- -----------DUI1-------- ........County authenticated this --------day of.-July---------------- 19-AZ Personally came before me this ----- -------day of ------- July---- ........................ 1987... the above named ---- -------------------------------------------------------------------------------- William H. Thedin a -----Jane-t--A*--Wik--------- ------------------------------------ * g TITLE: MEMBER STATE BAR OF WISCONSIN �_ ---------------------------- -------------------- ­_ -- (If not- -------------------------- 11 -------------- --- ------ ------P-------------- - ---------------/ -------- authorized by § 706.06, Wis. Stats.) to me known b the person . . ..... who exe ted the ? foregoing in r ack W I d _the sam THIS INSTRUMENT WAS DRAFTED BY c �! i THEDINGA LAW FIRM =-• ----- ----- -- _e e___ - 24T1 Sfout Koad� --- .---- ----------------- -Menomonie,--WI-.54751--------------------------------------- Notary Public -----------Dunn County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration j are not necessary.) date: r ------------ -� g 1951 ) i *Names of persons signing in any capacity should be typed or printed below their signatures. '! STATE BAR OF WISCONSIN H.GMi1.erComparyEO FORM No. 1-1982 Stock NO. 13001 ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239(HAMMOND) 425-8383(RIVER FALLS) HAMMOND, WI 54015 July 10, 1987 Mr. Joseph Menter Red Cedar Plumbing & Heating 1120 Broadway North Menomonie, WI 54751 RE: DON WIK MOUND SYSTEM Dear Mr. Menter: This office has received confirmation that the State has approved the plans. Once we have received the plans, this office will issue a sanitary permit. After which time, the system can be installed and will be inspected for code compliancy by this office. If you should have any additional questions, feel free to call this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:rc