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Home My WebLink About008-1069-70-100 S6. Croix County Planning and Zoning Tuesday, January 31, 2006 at 3:56:33 PM Detail Sanitary Information Page I of I Computer 008-1069.70.100 Sub/Plat: NA Section: 24 Parcel 24.28.16.357C Lot: 1 TNIRNG: T28N R16W Municipality: Eau Galle, Town of CSM: Vol. 06 Pg. 1584 114114: NE 114 NW 114 Owner: Swanson, Wesley 277 County Road B Woodville, WI 54028 State Permit: 69619 Issued: 0713111985 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 0512211986 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Reauirements Additional Notes Money Owed Not determined Yes Aaby, Stephen This parcel was split in 1985 & Swanson built new $0.00 Tom Nelson Signed Off: No house on this lot. He did a replacement mound for original home at 289 Cty. Rd. B in 1986 and sold that lot after CSM 611629. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 512212006 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-Jo a6 ~Sd~ ~Q A-r p H z a S T C - 105 ce^ SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z Vii' ~ ~ t7 OWNER/BUYER L6, 2w IM ROUTE/BOX NUMBER / Fire Number CITY/STATE WOc~ ~(lP W~ZIP 5_V62- PROPERTY LOCATION:/JL4L.~_k, *eAJ 14, Sectiona.To20 N, R~W, Town of 6-'t' cca ff e St. Croix County, Subdivision Lot number Z- . I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- .essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. y 0 E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE .St. Croix County Zoning Office P.O. Box W Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. e APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the"-oanref Us) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractq;,("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 &C, 60-yc,- Location of Property 411,.41 It Section T N - R W Township Gc, ~e Mailing Address e4-. I wO U L`ti~ l CRJ S C~O Lb Subdivision Name Lot Number Z Previous Owner of Property a&a aXD Total Size of Parcel 1j Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION I (We) centiby that aZ.Q, statements on this bonm an.e true to the best ob my (ouIL) knowledge; that I (we) am (ane) the ownen.(s) ob the pnopeeAty described in this inbonmation bonm, by viAtue ob a wannanty deed neconded in the Obbice ob the County Regdstex ob Deeds as Document No. ; and that I (we) pnesentty own the ,proposed site bon the sewage pos system (on I (we) have obtained an easement, to nun with the above desc4ibed pnopehty, bon the constnuctLon ob said system, and the same has been duty neconded in the Obbice ob the County Reg.ib.ten ob Deeds, as Document No. ) . 6 7 1A,~ ,:4 Q1, ao SSIGNATYRE OF WNER SIGNATURE OF CO-OWNER (IF APPLICABLE) --Df DAT SIGNED DATE SIGNED Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ~j a s G TOWNSHIP ) I~~1 L~ SEC. T Xb N-RLLW OWNER 1 S / w A Gc;tf 0 a gq CO. edf. 6 ADDRESS JZ)Z oCal~•l ST. CROIX COUNTY, WISCONSIN 3-66 8 SUBDIVISION LOT LOT SIZE 110 PLAN VIEW Distances and dimensions to meet requirements of 19,10 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM yN ca "o( APO6 v+ SG/~~'c i3 1 0 ww~~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used C J,lw ~i Elevation of vertical reference point: Proposed slope at site: S 4• LP" C T Ma ag %r S /Z S Liquid Capacity: / U y G S umber of rings used:_ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: • Nur of feet from nearest Road.: Front ,(2~Side Q Rear 2 feet i ;.From nearest,pr®perty line Front ,(zSide,O Rear, O all_ feet Number of feet from: well S / building: . (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: _Qe h C'FA's Liquid Capacity: O G.17e _ Pump Model:4 0 S8 /TfPump/Siphon Manufacturer: uL~ Pump Size Elevation of inlet: X Bottom of tank elevation: , Pump off switch elevation: ,7. ! Gallons per cycle: Alarm Manufacturer: i~7h kAlarm Switch Type: Number of feet from nearest property line: Front,(&Side, O Rear, 0 Ft -26 Number of feet from well: S Number of feet from building: go" (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : 299 a ac At ~ Width: Len h: Number of Lines: Area Built:, Fill depth to top of pipe: A . 2 Number of feet from nearest property line: Front, Side, O Rear,O Pt.3 Number of feet from well: f 0 Number of feet from building : ,t. r2 3 0 j' • f 1. ,t (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 O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: fy - .Z - 6 Plumber on job:. License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ALTERNATIVE [State Plan LD). Number. El Holding Tank ❑ In-Ground Pressure Mound (If assigned ItI NAME OF PERMIT HOLDER: AJADDRESSYOF PERMIT HOLDER: INSPECTION DATE.Wesley Swanson ville, WI 54028 Aj_,ZL BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: NW NW, Section 24, T28N-R16W, Town of Eau Galle Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: Stephen Aaby 5184 St. Croix 75036 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIDUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER , NIF y PROVIDEDPROVIDED: AA1Q_ /VT VYES ❑NO ❑YES O BEDDING: VENT DIA.: VENT MATLHIGH WANUMB ROAD: PROPERTY WELL BUILDING: VENT O FRESH C ALARM FEET FROM ~1 LIN J L AIR INLET ❑YES ❑NO ❑YES ENO EAREST Cn f1 7 ~7 I gO r DOSING CHAMBER. MANUFACTURERR BEDDING: L I ID CAPAC Y. PUMP ODEL PUMP/SIPHO;MIIRER: WARNING LABEL LOCKING COVER G PROVIDED: JP OVIDED: WLA4A'*"' ❑YES ❑NCI O YES ❑NO ES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN n C FEET FROM LINE^~ AIR LET PUMP ON AND OFF) YES ❑NO NEAREST f/V~/( SOIL ABSORPTION SYSTEM. Check the soil moisture at th depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until L FORCE " 92 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF DISTR. PIPE SPACING. PV INSIDE DIA #PITS LIQUID TRENCHES: RIAL: PIT. DEPTH: DIMENSIONS "HAVEL UEV I H FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATE A NO. DISTR. NUMBER OF PROPERTY WELL ING: VENT TO FRESH BELOW PIPES: ABOVE COVER. ELEV. INLET ELEV. END PIPES . LINE: AIR INLET: FEET FROM _ NEAREST BUILD s 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- ~yYES ❑NO meets the criteria for medium sand. TIONS MEASURED. L]lI SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS Ia- YES ❑NO YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED: SEEDED. MULCHED: I E. CENTER ES /r S Q 40 ❑YES ❑lo YES ❑NO AYES ED NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH NIDTH LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER /1 TRENCHES: J DIMENSIONS ~-II `VS ? ~ -1 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: IPI,PEOS DIST RJISTR. PIPE RIBUTION PIPE MATERIAL & MARKINGtLEV.: E EVDIA. ELEV.ELEVATION AND IA.: DISTRIBUTION 00S S v INFORMATION HOLE ~IZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED / f YES NO 41 PLANS: 5y ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER of: PROPERTY WELL: BUILDING: FEET FROM YES ❑NO YES ❑NO NEAREST/ w Sketch System on in in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) 77 wisconsin APPLICATION FOR SANITARY PERMIT DILHR (PLB 67) sTCRo~x rOUNTY - DEPgRTTT1EnTOF inousraErITasHumanaeLarions UNIFORM SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Il~ ~i~~ PROPERTY LOCATIO ~y ~I. /40#1 /4, s d, N, R 6 E (or W T,~pl lo~F: LOT NU BER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK S ATE PLAN I.D. NUMBER r crrta Y c. S-o . 3100 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ~JP i c (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total *of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity ! X Lift Pump/Siphon Chamber Manufacturer. S `&q C R PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED ((SS,,quuare Feet): PROPOSED(Sgquare Feet): WATER SUPPLY: ~y. X, g A6' A ® . O'/ d 1 ;K Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Numbers: Plumber's Adds: / Qd a Name of Designer: i~ uroo iGG,t ' S' as a ti~h G ~Ig&! COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved El Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Safety and Buildings Division PLAN APPROVAL Bureau of. ambing . HR P.O Box 7969 :J ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 ~ifirat:N~, - z, S- r it .•!,J ll { w r 5 ` z ism NEENIMM Project Name Project Location - Street No. or Legal Description W- s e S Etee / 40 V 4,/ -.2- 2 4Z > 6 Ltd County ❑ City ❑ Village CO Town of: ~'/''L e S-/-. Gr o i X The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the keep city, village, township or county shall be obtained prior to construction. site. The installer shallunotfy the appropriate hnspe tolrwhenhnspe tons cantbe plans with the departments approval stamp at the construction made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan . approval must be obtained. FOR PRIVATE SEWAGE PLANS: GJ This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director Date Approved: If Questions Plans Approved By: Contact ♦ cc: Ems- OWS ❑ DPS ❑ H&R & Rec. San. Section K County ❑ Local PI ❑ Facilities Need Analysis Section ❑ L)W-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other pct 4dr 6~ C p V r 41, c \ i ' lI 1`` y I°, I D ck c Ire.} t; c~o ~-oJ ~~7t 1- loo f J-~ ~e.t~t1 O T , ` S',, r 1 ~ ~ Car\t~~~~c.-t►rh Woo 1~b IUrtf~ \ SOQ ~C) (~tt \O l:Je\ 1 t ~ J N i 15 CT 1 i a~ n 2- Li 8507938 Ns Tl0 aN ~tELA ItECEIVED, AND MA-1, % ?pRov,jum iS1IND 0NO F SAFESY AND BUILDINGS DEPART NOV 2 5 1985 ~ SpCE 0 R PLIJMRING BUREAU SEE CD Y Page Aof Perforated _ Pipe Detail End Vtew Eno Cop )Poffo(ofed A PVC Pipe o'`OO°oc• Notes Located On Bottom, S Are Equally Spacea • F PVC Force Main From Pump P PVC Manifold Pipe Distribution Alternate Poeltlon of Pipe Force Main From Pump Last Mole Should Be Nest To End Cop 'End Cop Distribution Pipe Layout R S Z-lee X ~n~i y 3~L Signed: Hole Diameter t` Inch License Number: Lateral Inch(es) Manifold Z Inches Date: Force Main 3 Inches PLU1 M"G IfM61-tion44 8507988 VED ApPRO DEPARTMENT VISION OF SAFETY AND BUILDINGS RELATIONS RECEIVED ~cdJ't- SEE CORRESP4NUENcE NOV 2 5 1985 PLIJMRIrqG BUREAU r PUMP C VAI,L of 5 HAMBLK CKQSS SECTION AN[1 _,I'CCIF ICAI I VC WT CAP N C.I. VLAJT PIPE WLAt H(K PKOOF__ _APPROVEU LUCKING 25' FKCM Ut,01C. JUNCTIOAJ BOX MANHOLL COVLK. WIAJ00W UK VKL 5H J2"MIU. JJ AIIR IWAKE GRADE I I 4" MIN. JB'/'11N. COWDUIT - I T MIN. 1 11! - INL-I- ( _ _ vkovlDc f AIKTIGHT SLAL I I I" APPKUYL U JG11uT I I I \ A III .W/C.1. PIPE- i CJCfLNU1KJG 3' III APPROVLD JC. I I I w/C.T. PIP{ ONTO SOLID ;r.It_ I II I EXTEM01w. H ✓ I ALARM I ONTO SOLID I I p. ~ I olu pi.IJM81N~ PUMP 0 l OFF p /S~ I I &CO..NC KE T~ K 1 S L K L X 11 P L R M 17f E REL}~j~0( 1~- I)EPARTMENT 0? [ VAM sQ•, D But ON OF SAFETYI V~ 9o v A t_ 0 4~ -.PTIC AND A f S !7 .'---TA W WM A M U F A L r U K I K: o ~SPONOENCE AJUMBLK OF UUSLS: PLK IAAJK ',ILL ~i) t D^y _ GALLUIJ , _ 1~ di-e. 1 ALAKlh MAAJUFACTUItLk: DOSE VOLUME: 76 - C.ALLUK JS MOUCL ►JUMklCK: CAPACITILS: A=-_ V__1AJCHES UK GAL -11(2! -70) vw Al l 0o SWITCH TYPE: - 8= L. Z"7 - INf_HLS OHGA LU► I'UMI' MAMIJI AC 1 Ukl it: r- C" J IIJCHES ? C GALLO1, M 1 ut,El AJUMBLK: `lt;. ~S'O r cfr({ 1/L}~11 t) `J1JGALlc,r 1"L H E S UK L SWITCH T P J N-OI L f I'LIMP AND ALAKM AKL TO bk: 11~Iy1ALLLD OIJ SLPAKAIE CIRCUITS PUMP DISLHAK(,L KATk - VLKfICAL ~ GPM UIFFcKtW-1. bL'fWLLAJ PUMP OFF AAJD UISTKII~UTIO~1 PIPL__-. + MIAJIjMUM NETWORK SUPPLY PKEbSUkE F"L{:I ~tECEIVED, + °11L_ F L E T OF F U R' F L E. T MAIN X ~u I I FKIC IlOAi FA( tUK..-i F E E , NOV 2 5 1985 TOTAL OUJAMIC HLAD = 11 FLET PLUMRING BUREAU I►JTLKIUAL DIME.WstoA15 OF TAIJK: LLN(,7H . 1 . ;WIDTH v ~ L 14WD O E P T N-=_- Page Of 5 Straw. Marsh Hay, Or Synthetic Covering Medlum Sand Distribution Pipe Topsoil % Slope Bed Of= 2 Force Main Plows d Aggregate From Pump Layer dv S~ LG Vc D / Cross Section Of A Mound System Using E ~_S- • A Bed For The Absorption Area F _47S G / Signed: A Ft. H License Number: l3 -t=`- Ft. I Ft. Date: 0_ Ft. PL K LO Ft. . Alternat~os L Ft. Force ~ w~ Ft. Lp,T10 y LpBOP p ILD %G U pRTMENT IStON OF S E ervation Pipe--,,\ rr ; gRFiE _ K A _ W _ j`-_--___ Force Main From Pump Distribution Bad Of Pipe 2 2 2 Aggregate Observation Pipe Permanent Markers 791 LRECEWED, Plan View Of Mound Using A 4 Bed For The Absorption Ar 8° NOV 2 5 1985 PLUMRING BUREA6 3ub. mersible sewage Pumps MODEL 3887 SIZE WS03- WS 10 ETERS FEET RPM 1750/3500 so IMP VARIOUS 16 - 50 $ , lys+ 14 'yp l0ey 40 +r . r 12 Z eyA U C 10 " r yp \'~res 30 ' Np IVS10Q 1 8 11NA`\ WSO~Q QF S, 6 20 e, QF NP { 1 ~ Sues 4 10 I ; I #wS03Q, QF Sergi 2 t s y , 0 0 0 20 40 60 80 100 120 140 160 180 GPM 0 10 20 30 CAPACITY 40 m3/h GOULDS PUMPS. INC. 511'1A FAIA Wn, CW 13146 1t1` ]RKN13 9' _ Pty Sti1.A~10N5 US 0 8507988 RECEIVED NOV 2 , 1985 p1:tJMFUNG BUREAU 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/contract*Z,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property e! C/,r j:zg y T' Location of Property 14 OV 4/k, Section T ek._°_ N - R 11L W Township E:&C4 ar-GGZ Mailing Address e4 ooze(jei t x 6e,--t e~ a w Subdivision Name Lot Number /V, Previous Owner of Property Z.4zg y S(iti A'TLt S O Total Size of Parcel U G X Date Parcel was Created Are all corners and lot lines identifiable? 2(Yes No Is this property being developed for resale (spec house) ? Yes X No volume and Page Number Jr 44 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3: Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. 1f the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. ---------------------------------------r----- PROPERTV OWNER CERTIFICATION I (We) ceAti.6y that a t statements on this Jonm ahe cue to the best o6 my (our) knowledge; that I (we) am (are) the owner j s) o j the pro pent y des cA ib ed in this .i,n6oAmation Jonm, by viAtue o6 a wama.nty deed Aeconded in the 066.ice of the County RegisteA o6 Deeds as Document No. 33y ; and that 1 (we) pees entty own the . ic.opos ed site JoA the sewage disposat system (oA I (we) have obtained an easement, to Aun with the above desc&ibed pnope ty, 6oA the constnucti.on of said system, and the dame has been duty %ecoAded in the Obb.ice ob the County RegisteA o6 Deeds, as Document No. - SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H z H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER Gt/,ESL Slv I~4 S6i-- y ROUTE/BOX NUMBER JZ Fire Number CITY/ STATE ez JF000i kl4,I' 6<,-* ZIP SyG~~ PROPERTY LOCATION:, k, Section, T *X 9 N, RZ,~_W, Town of C-II" ~,~TCG St. Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, .1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed 'lot and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNE _ ^ DATE f- f'C~ St. Croix County Zoning Office P.O. Box W Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 54 rrrrr;~;~W ST. CROIX COUNTY ABSTRACT COMPANY HUDSON. WISCONSIN CONTINUATION OF ABSTRACT NO. 4381a From the nth day of all 1976 at 9:30 o'clock in the AM. of the land described as: NWt of NWu of Section 24-28-16. 55 Lyle E. Larson and Rosemary Warranty Deed. Larson, formerly husband and Con. $1.00 OVC. wife, Dated Aug. 12, 1976. Auth. Aug. 12, 1976. -to- Rec. Aug. 17, 1976. In 115+1" page 368, #334859. Wesley G. Swanson, and Karen A. Swanson, a/k/a Karen Swanson. NW~ of NW4 Section 24-28-16: ` : Recites : This is b&e`stead -proper~~r,Y ($45.00 Transfer ee,) .,rte a ~ `t Treasurer of St. Croi }County,_, Tai' Receipt No. 12685(No.50) Dater jAu• 17, 1976. -to- \ .C Peterson, Peterson, 14Llte~ & Paym t of Taxes for the Skinner.975 • sC, _ ~sC!D EPARTMENT OF . REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JDUSTRY, DIVISION ABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 UMA.N_RE'fATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) N OCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1/4 /J zlm N' OUNTY: OWNER'S BUYER'S NAME: MAI N ADDRESS: 7l C1¢a )X Guy SwAd4SOIti ljtJ00.ot ►t IA i S G~8 i;E DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R DESCRIPTIZYS-.7RCOLATION ESTS: / _ / g' c Q•~~Q Aeesidence 3 ❑New Replace 1P ATING: S= Site suitable for system U= Site unsuitable for system 0NVENTI0 NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S ILLY xS DU 0 S ZU ❑ S ZU ❑ S NU al s Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the rider s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN. OBSERVED E T. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) .3 •7 /d 1 o' sit, Sff~N.sL z.- tnor 3 ~2 y, o S A/ a At o , , S,( T 3 `~.q a/Y~ / . L•Sr~. J.S~ L G ~90~ 3- 3- 3- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES CUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERI D2 PERIOD PERINCH / . '7. Ala 0 7 I I p 3 0 3 l 3 / _T 1.7 0 30 P_ .OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent land slope. ,YSTEM ELEVATION TN 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 dininistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TAME (print : TESTS WERE COMPLETED ON: STk ti.~~ ~-0 VHONE S . UDRESS: C ERTIFICATION NUMBER: UMBER optional) Z~z y IO46 -FJP- o CST SIGNAT RE: 'ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 11.1111 SBD-6395 (6. 02/82) OVER i i ~ $ 3 j rcc 14oL~ p f{, o' 70' f-oP3 - Na -Q,RLr S.7o .~Co~D/I I I I /a! F I o I i f - ;LGI~ \ f~A Q 9 A A Q / I \ J`L G & R /oa1 ~-?o ;,E~n~l ati s 1 60 KI 4114 oil, /000 Got. SrpT, c Poz f-{. #aZ ~g-~ .50o Gam! Pu.,..p ~GnAax 6. So ~-.CGKN~rh. ~ _UG dl'C N r Yl. 99.7 ~O --0 wJLL 30~~ Ha DnivF Co. / w 13 Uimcar"Mn SANITARY PERMIT (3DILHR coin , GROUNDWATER SURCHARGE 80~111 "MiSTRY..UNMR i-_Wm wT,o„s Sanitary Permit No. 17 5-0 On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground Signature of Issuing Ag l ' oundwater Fee: Dote: WISCOf81n 3 IN S r 1,3 Jj buried treasure DILHR SOD-7289 (N. 05184) <3; PLAN APPROVAL Safety and Buildings Division. D' L H Bureau of Plumbing L1 P.O Box 7%9 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 ~Pl~Ftldel{~ati+,~l~ f~~n, of 3 1 4v 4v r ~ i1 [ Modification Project Name Project Location - Street No. or Legal Description A "v County ❑ City ❑ Village? Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon 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 set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. 111 FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ 1 , cc: 'E] OWS ❑ DPS ❑ H&R & Rec. San. Section )l County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other SBD 6678 (R. 08/83) (PIb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: stvartson, 4a( ) T ft Lana 11 e Qt~' R O Aaby Pluiiibirtg 6 heating SL. mix AI 1 `41 'iui it S41., ree'`1'. alive v i 7 i r,a i r 7t PLAN ID. # ,~ptr"o w DETACH HERE PROJECTNAMF Sv~aj sc)n, v4esley - Lsiciencc: PLANID 5-07:38 . # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ 6" Fee Received is $ • ClU Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local 11. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ° ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon (s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. ST. CROIX COUNTY .rKp4 WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W154015 November 19, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Wesley Swanson property located at the NW14 of the NW114 of Section 24, T28N-R16W, Town of Eau Galle, St. Croix County, revealed suitable soils at a depth of 2.0 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj 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 Alternative Private Sewage System In the County of St. Croix Location Nw 1/4, NW 1/4, Sec. 24 , T 28 N, R 16 V00" W Town ZQI Z*9 Eau Galle Street Address Lot No. Block Subdivision Landowner's Name: Wesley Swanson The application for this site is for: ❑ new construction use. Dreplacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: (..1to have one of the first five approvals guaranteed for this year. This is number - of those applications. (Use one of the first five quota num ers-issued to you.) t. 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. I._]for an application on file prior to February 1, 1980. U 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: ® a failing conventional soil absorption system. a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here .0 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si re (County Official) Title Assistant Zoning Administrator Date November 19, 1985 DILHR-SBO-6158 (R 12/82) 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/muhm" r NW h NW 3Z S 24 T 28 N/R16W Eau Galle Street Address: St. Croix Subdivision: County: Landowners Name: Mailing Address: Wesley Swanson Woodville, WI 54028 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 DILHR-SBD-6413 (N. 05/81) My Commission Expires: 3 EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION dDUSTRY, p P.O. BOX 7969 ABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 UMAN RELATIONS (H63.09(1) & Chapter 145.045) OCATIO SECTION: ~TOW~NSHIP/MUNICIPALITY: JEOT NO.:BLK. NO.: SUBDIVISION NAME: LG /I Gv '/4 R/6 11( OUNTY: OWNER'S BUYER'S NAME: MAI N ADDR SS: p -,Tcizo Gv~ SwA(NSOh, GcJe9dyo! ►~Llt aa`a SE DATES OBSERVATIONS MADE N OLATION STS: n:77& DA DESCRIPTIO I ^ Q ^ 0 New w Replace *esidence ❑ ATING: S= Site suitable for system U= Site unsuitable for system ONVEcNTIONN'A~L: MOUND: IN GROUN~`dPRESSURE: SYSTEcM-IN-FILL OLDIcN GTANj:R EC OMMENDED SYSTEM: (optional) 0 J ILow T~7 El d J J ~U Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the nder s.1-163.0915)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN. ELEVATION OBSERVED E HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 3 •3 .7 111d Al k v2 . .O' siC, . . P' fia, sL • Sr r.. s < z o 41oT Al a IV O .2' 1 3- 3- 3- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES JUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE 10D I PERIOD P FOOD PER INCH 1. 0 30 a l3 P- P- P- _OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent land slope. ;YSTEM ELEVATION 4'• 7 F _f . F , Y TH f i I 7 l r 7 f i f , f 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 dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. LAME (print : TESTS WERE COM LETED ON: CERTIFICATION NUMBER: PHONE NUMBER (optional): ~DDREL~ /s'~~~~ G!_JoOdv~vtL'l.~ f•~( ~~6 ! 0 O p[2+ O CST SIGNAT RE: AISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ,11.HR-SBD-6395 (R. 02/82) OVER -km-Ft --09 • h~r~ ~Sy'o H -7 7 gr e,7 0- 6 -v w- Pent! _ to L-~ b ~~Nx°~'_os~ 1A5 ~'Lb ~►a'Nv~~ 94b Y,yObfw~ jaiyS Oz obi ~ S9b ' ~ ,z° 0,0 ~i o07 o`Cd s o £a SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondenc P.O. BOX 7969 6 MADISON, WI 53707 ' 600-266-3015 DATE: PROJECT: ta, ~y Q J ; Stvanscn, iYI s i ey - kesidence Es =4(i Tr EFILt e..i ~ I l ex Aaby iroix riI ita 'lain Street 600tV1 I vI PLAN ID. DETACH HERE -G7 3v PROJECTNAME Swansoo, 4, 5le: - Resioet`Ic PLAN ID... This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ L r Fee Received is $ 80 .00 ❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ Overpayment-Refund forthcoming. Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section. ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local IL Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ' ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system V Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JDUS DUSTRY, DIVISION ABOR AND CC P.O. BOX 7969 UMAN RELATIONS PERCOLATION TESTS (11J) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) OCATIO SECTION: TOWNSHIPIMUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: 11Grr' Q1,/ / /RMI ( - ,c4 . L-j- /I OUNTY: OWNER'S BUYER'S NAME: MAI N ADDRESS: l C )za 1 y Gu,r .S w AIN S G h. GtJ 4 00! 1 LI L 1~ S D SE DATES OBSERVATIONS MADE FrtRCOLATIONT r ESTS: NO.BEDRMS,: COMMERCIAL DESCRIPTION: ❑New Replace PROFILE DESCRIPTIONS: Q _~iesidence ~ I ~ / '1 ~ g' s j - a t~ S fI~ ATING: S- Site suitable for system Um Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S EM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) E] S mil! RS E]U 0 S 01 D S oU D S NU Mina % a! 5- y 7r r Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the rider s.H63.09(5)(b), indicate: , I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN. ELEVATION OBSERVED IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 3 .3 •7 111d t+k a fir' .o' sic . .p' f3►+. sL s' ,,.sL w ,,~oT IV d Al 3 r2 y, o . S A- o ' Or. 2' i s~[ a• o' /V a rye :P, 3- 3- 3- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES PER INCH PERIOD 3 JUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI D p 0 7 . -A 1.7 Ala 3 d -S 2 Nor 30 ? P_ _OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent land slope. XSTEM ELEVATION 4'. 770 6 49( X,~, i TN 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 dininistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. LAME print : TESTS WERE COMPLETED ON: .DDRE SS: CERTIFICATION NUMBER: PHONE NUMB(optio~ zZ /p~~ ST. ~a~~~~LG.~ Y 7 S OO//77QQ CST SIGNAT RE: 4or 1ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. it H I I SBD-6346 (R-o?/R?) OVER oL F- a . °P3 /vO s'~ R~ rL l I ' Aft F1,001L 4 k,-?o o,-p 61q R ~'0 "Co CO p4 1 ti A t I G h To o Gr+~• ~~pT c. ~ loo _ oo Gkl Pu w'1° i PoL~,cET k~,~~ 90. 6 , r C~tihrK X17.3 go , CaxNia ~ ~ ucaKNr~ 9P.?wIF,CG HO F 3 wR`I C o . -L_C44- 13 - 63 c Q. C~ N o S c~. ~ I v O cue pc rc-j ~ L3f''1 Tor o~' ~~n tao' . 190 ~T q --30 -~98~ bar n ~fl' C0(nbir.e}~ot 1000 54A S-4ft I Rb 5005a1 ?%,Mf Wit 9(~.~O 0 w e11 3d8~ 3 Q I~' X- 3 ~zs c Ca ISSN - - ~~~Mtie^ Wes~e SOC'nso R y nwV, Sec 2~{ $ I~ ((o ~J ~ a oc X3~ ~ Page Of _ Perforated Pipe Detall 0 End View ~Perfofoled End Cop PVC Pipe nee ce ae~~ Holes Located On Bottom, S Are Equally Spaced S PVC Force Main • From Pump .7 Q PVC Manifold Pipe Alternate Poelllon Of Distribution Pipe Force Main From Pump Lost Hole Should of Neat To End Cap End Cap Distribution Pipe Layout P R S_Z X Y 7-1 Signed: Hole Diameter Y Inch. Lateral Inch(es) License Number: Manifold Z Inches Date: Force Main 3 Inches Z?4 ~ I PUMP CHAMbLK CK05S SECTION AkJD SPECIf ICAI IONS VENT CAP 4"C.I. VENT PIPE WCATHER PROOF APPROVED LOCKING JUNCTION BOX' MANHOLE COVER. ~ 25' FROM UvOK, WIKIDUW OK F R L 5H 12°MIU. AIR 1KITAKE I GRADE I `I" MIKJ. I ~ Id" MID. CONDUIT le"MIAI. PKO.VIUE INLE i AIRTIGHT SEAL I 1 I I APPKOVLIj JGINT A I III /1PPROVEO J6 .W/C.L. PIPE: I III W/C.I. PIPE GJCTENUING 3' _ I II ALAKM EXTEUDIUG ONTU SULW "GIL_ B I 11 ONTO 50LID I 1 I 1 ON c I 1 Sl 1 PUMP - OFF D CONCRETE BLOCK K15CK EXIT PERMITTED ONLY IF TAWK MAKIUFACTURCK HAS bUCH APPROVAL 6PECIFICAT10KIS =PTIC AMU )SE: TANKS MAKJUFACTURER: - ~A If- cr C, ►JUMBEK OF DOSES: -PER DA!J IAWK :,IZE : SQ[~ _ GALLONS DOSE VOLUME: "2 _ GALLOMS Q H ALAR_M_ MAIJUFACTUKER: CAPACITIES: A- 1 u__ILICHES OR d~ GALLUP MOUCL NUtAbLK: _ B= _-Z IUCHES OK 27GALLOti SWITCH TSPE: Net C= I'2 INCHES OR~ s11 GALL OK. D= ~Z INCHES OR h•0.7'GALLO► PLIMI' MAMkJFAC.IUKEK: OU , /Lop Mt)t~EL 1JUMBEK: 38 50 F SergJ-FL. PLIMP AND ALARM AKC TO BE IKJSI'ALLED ON SEPAKATE CIKCUITS SWITCH TYPE: inercor% PUMP DISLHAKGL KATE: GPM VEKTICAL DIFFGICEKILE 6V-'rWLEKJ PUMP OFF AUD UISTRIISUTIOKI P11'L:.. FEEI + MINIMUM METWOKK SUPPLY PKQES,SUKE . . . . . . . . . . . L 5 FEET + 40a FEET OF FORCE MAIN X _Ll2_-F~u I FKICIIOIJ FACTOR.. FEET lo. TOTAL DyMAMIC HEAD = FEET L IIJTEKNAL DIMEIJSIONS OF TANK: LENGTH -;WIDTH ;LIQUID DEPTH I t Submersible ~ewa a Pumps MODEL 03- SIZE WS03 WS10 RPM 1750/3500 ETERS FEET IMP VARIOUS 60 16 - 50 yA 14 ' {ys 7 12 40 oeh' Qy,~ U 10 hp W ,e8 r hp S~pQ Q~ 0 tit 77 8 NP \ ~Sp~Q Q~ ~~es 20 +Ti t + wSpgQei; Sues 6 %1P s i hP fit, wSp3e 4- T 10 i { i , BF Series 2 "#I 0 0 it:fftttf+ M i 0 20 40 60 80 100 120 140 160 180 GPM 0 10 20 30 40 m3/h CAPACITY GOULDS PUMPS. INC. SBC-a FALLS WW Y0W 13146 INC. )W Dw6 I J k Page _ Of _ Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil _ G E D 3 % Slope Bed Of -21. Force Main Plowed Aggregate From Pump Layer D ` Cross Section Of A Mound System Using E -L A Bed For The Absorption Area F Q G A S Ft. H ~J Signed: B -r v Ft. License Number: I Ft. Date: J Ft. KJD Ft. Alternate Position L Ft. of Force Main W 30 Ft. -L Observation Pipe +ts 6 K I- - A I•---------------------- Force Main ° From Pump 1 7- Distribution 8ed Of 20- 2 %y . 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area r , EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JDUSTRY, DIVISION ABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 UMAN RELATIONS (H63.0911) & Chapter 145.045) 0ANY OCAT10 • SECTION: TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: OUNTY: OWNER'S BUYER'S NAME: MAI N ADDRESS: 77-C J¢ a I X a/,' S 4, Am -T O h„ lj(J O a o~ Ix i S o I~ B SE DATES OBSERVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: I -PROF LE NS: 1PERCOLATION TESTS: .residence ❑ New Replace ATING: S= Site suitable for system U= Site unsuitable for system LL 1 •7 y J ONVENTtONAL: MOUND: IN_ -GROUNDPRF_SSURE: S STEM-IN-FILL OLDING TANK; RECOMMENDED SYSTEM:loptional) ❑ S AI RS ❑U ❑ S Al Cl S 54U 0 S NU A4,5a h w 5- y 7-r Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the nder s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: A/. . /710 L . PROFILE DESCRIPTIONS ORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN, ELEVATION OBSERVED T. IG-~H±±EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 3- 16 Al k" 02 5U.1,1- 7' fSN. $1) , S I N . S L W r►90 T 3 y, -o S Ale IVA .2 o ' . Sr 41-L, 1 a•o' aK4 S' L G L col' 3- 3- 3- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES JUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT 1 PERI D2 PERIOD PER INCH 1.? 0 0 7 .e;', -A 1.7 /V47 o a l -5 ! . ' . 6 X 1.2 0 50 P- P- _OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent land slope. ;YSTEM ELEVATION 7 f I I i t , . i ~ , I tN F I { i I 1 # i L the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. LAME (print : TESTS WERE COMPLETED ON: S'~k A.~~ 0Z p S ',DDRESS: CERTIFICATION NUMBER; PHONE NUMBER(optional): wa~~~~GG~ yo T s=6~p- o CST SIGNAT RE: 'OF )ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. I L HR-SBD-6395 IA. 02/82) OVER ~n i rY7 o ~p.$ 1.•~Bb -N.rN~pD~ 410 aS E,tlo 9.9.x, ~ V -_9 d~a ~a~ ovs Dorf S 'LZ £'N I UWZFS -70-9 DO 0/ S ti+fll~c/~~'~ obi ,S 9b°~'~l V -d d a Abl/q oed , oG ~ o, a Nd -7-7-0 H -7cJ Sd f ~a 0(n 0j -0 0 d M c ~1. I I' , ~ O +y O O cn RI N O CD O Q O ~ C A' 900 3 A d iv _ z CD 0 CC) G) co N O CD f9 2- C) O d cn O C 0 10 10 = W cD N a N C) I CD 7 CD 5 CD .n•. (D O 0 O O ~3 CL 0 U) 7 N C :3 N O U) O O N OMi C N (D -4 CD 0 nom! U. W a o u' o" 0 3 Q CD K) w (D r• O o co co a 0 r~ rt K 7 rnc°Dn W! 30 c t~l 0 H. r• H 0 w z 0008 ON a) o Cl) Im M rn co C) C CD d a H 00 00 a 9 ~ o Zoo z ti I 0 D CL ~ L=i W v O d H CD • 00 H H Z N c n O N m (h1 N 00 c CD (ND - ~r Z W a 0. I a 3 7 O Z CD co fA I-h a o' A z M L=1 ON a a ? z o m 10 ft r• Z -+N Q' 47 ° W v m CD 00 Sv 3 z N 0 z I-~ ' N 3 ' ~ rn (D y Z C4 o N =r n 3~v; a CD =r o 0 ~CD m 3 ow g o fl a a N_ N a m r. y co ~CDooo A 3 cn OD CD a) a O A 3 (n c w ~ it a cn w o 0 p N o I a o w 7 b CD ao o ~O J N CD a Parcel 008-1069-70-100 01/31/2006 03:32 PM PAGE 1 OF 1 Alt. Parcel 24.28.16.357C 008 - TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SWANSON, WESLEY G & KAREN A WESLEY G & KAREN A SWANSON 277 CTY RD B WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 277 CTY RD B SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 24 T28N R16W 5 AC LOT 1 OF CSM Block/Condo Bldg: 6/1584 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-28N-16W Notes: Parcel History: e Type Date Doc # L722/278 07/23/1997 2005 SUMMARY Bill Fair Market Value: Assessed with: 138764 22,700 Valuations: Last Changed: 10/10/2000 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 3,000 8,300 11,300 NO PRODUCTIVE FORST LANDS G6 4.000 4,700 0 4,700 NO Totals for 2005: General Property 5.000 7,700 8,300 16,000 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 7,700 8,300 16,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 405407 CERTIFIED SURVEY MAP NO. 1584 VOL UME 6 , PAGE 1584 LOCATED IN THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER OF SECT/ON 24., TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OFEAU GALLE,ST. CROIX COUNTY, W/SCONS/N. NORTHWEST CORNER SECTION 24,T.28N,R.16W. ~ 8 9 a. Pit 0 AAft 31985 k UNPLATTED LANDS f~~1 lO.s' N 84 h S 87 °00 X00 "E 334.05 a ti k BEARINGS REFERENCED TO THE WEST LINE OF THE NORTHWEST QUARTER OF SECTION 24,T28N.,R.J6W. ASSUMED AS N000I8 35 "E SCALE- / /001 cn p~ 50 10 20 Z k p i o LOT 11 \ 2/7,80D SOFT. w w LEGEND 5.00 ACRES O Q~ FOUND BERN TSEN ALUMINUM MON. li w , O SET 314 z24 RE-ROD WEIGHING R1 Ip 1502 LBS. /L.F k X-X FENCE y 2 • / 4 fi - r, 0 / i p s i MONIE N a y r ° `C '@ V suR% a I SOUTHWEST CORNER OF THE NWl/4 OF THE NW!/4 S870oo 00 "E /324.65 ' `s 58604214 "E - /325.00 N87°00'00"W 334.05 i SOUTHWEST CORNER OF THE w NEl/4 OF THE NW//4 SOUTH LINE OF THE NE 114 - UNPLATTED LANDS OF THE NW!/4 w N ~k - WEST QUARTER CORNER i, ;CT/ON 24,T.28N.,R.16W, PR- WESLEY SWANSON ROU7E ! WOODVILLE, W! 6RDOLL HAUGFOS, OWNER) SEE REVERSE FOR CERT/F/CA T/ON PAGE OF 2. Volume 6 Pare 1584 O a eo Co A, CD ° fD c • M CD a) CD I ~ ~ O = d O C~l1 O p~ Cf) ( N ? O • N 3 m N c IV 00 0--4 K) c CL CMp z C. to CO N O CD O D? M N CL O Uf CP (D W CO O-0 a = 7 CD < -1 CT O O CD 0 rn n. o 0 -4 (n * O N N = K p r. O I O m~ N 'l a U) CD D (D CD CA v a _0 W o c a c p p 3 3 O ` \ A Z 00 m co zo a) a ~ Or c rn Cr W 0 0 v a • o 0 ~O O n Q col vi co i cD o ' D o ~32~VJ O C o O I = tD vi rn CD N CD d co' ~ CL .3. ? I Z o y co o O O ° a CD (D Ch CD N cc c cc CD W C]. Z CD Cp -4 to co c A Z n .o 0 =1 a CL 0 Z ~ N W M N ? M OD CL z c H Z CD a 7 O s a ~co N• a -5-co ov a o 0 0 m n N N CO d p rn CD ~ N to co co MR CO CD r. S rnna5• m < N m CO A, p O a D C CA 00 R Q° W CD 00 CD a' j o ~3Q N a c° c• N N = ' O O a 7 O Q M CD ON O N O b DQ N CO p ~ ~ A p CZ. y Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER W ~Q N s ~~Y TOWNSHIP SEC. T N-R.L_~ W I ADDRESS Q„ ST. CROIX COUNTY, WISCONSIN ilo 2 C6 SUBDIVISION I} LOT N LOT SIZE L1 U j PLAN VIEW ~y \r Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Gn c9 N~~ se a f % l EF 111 . V INDICATE NORTH ARROW 1-31 J BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 14) / Proposed slope at site: SEPTIC TANK: Manufacturer: W t. "S e')e Liquid Capacity: / 0~ Number of rings used: Tank manhole cover elevation: Tank Inlet.Elevation: '72,5 Tank Outlet Elevation: Number of feet from nearest- Road.: Front &V Side0 Rear, O feet From`"mearest; preperty line ' : . Front Side10Rear, O feet 10 Number of feet from: well , building: W (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE VP1 .t PUMP CHAMBER n Manufacturer: Wf.I'S C. iQ Liquid Capacity: _?6'U Pump Model: ~v4d 5rll Pump/Siphon Manufacturer: l~oa /d Pump Size V,2 . 9 9/ Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per,cycle: 't'o Ala Manufacturer: Alarm Switch Type: lvee C. 4t ✓c? Number of feet from nearest property line: Front, O Side, mar, 0 Ft.) Number of feet from well: NAT Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench Width: ~t Length: a 14 Number of Lines: ` Area Built:5 G Fill depth to top of pipe: ~I Number of feet from nearest property line: Front, Q-Side, O Rear, Opt.40 Number of feet from well: 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 O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING 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: 2 G Inspector: Dated: Plumber on job: %!l License Number : {II 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 ' PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ®CONVENTIONAL ❑ALTERNATIVE StatePlanl.D.Number: r ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE : Wesley Swanson Woodville, WI 54028 a-~6 f BENCH MARK (Permanent reference Dointl DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELE V' CST F. PT. ELEV.: NW4 NW.'-,, Section 24, T28N-R16W, Town of Eau Galle Name of Plumber: MP/MPRSW No.. Cnumy: Sanitary Permit Number Stephen L. Aab 5184 St. Croix 69619 SEPTIC TANK/HOLDING TANK: MANUFACTURER: QQ LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER elt4o- L/ / PROVIDED: PROVIDED. BEDDING: VENTDIA." VENTMA71 gLAHMATER 'D T r YES ❑NO ❑YES ❑NO t NUMBER F ROAD: PROPE T WELL BUILDING VENT TO FRESH FEET FROM LIN BUILDING, LAIR INLET: YES ❑NO ❑YES ❑NO NEAREST y OSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY POMP;0OUEL PUMP/SIPHON MANUF ACTUREH WARNING LABEL LOCKING COVER YES ❑NO / SV PROVIDED: PROVIDED YES ❑NO YES ❑NO GALLONS PER CY PUMP AND CONTROLS OPERATIONAL NUMBER OF (DIFFERENCE BETWEEN PH OPERr ELL BUILDI a VENT FRESH FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES NO NEAREST--Jii. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I , 1 H DIAMF T I MATERIAL AND MARKING or excavation. (If soil can rolled into a wire, construction shall cease until FORCE D 7r \d~CL the soil is dry enough to continue.) MAIN C Y 1✓ ONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF UISTH PIPE SPACING COVER NSIUE UTA s THEN S / r1H1 PI7S LIQUID DIMENSIONS PIT DEPTH. GR.aV EL UEPTH IL DE H DIST iPIPE UISTH PIPE DISTTPF MATERIAL LBELOW IPE BOVE OVER E EV INLF f ELE END NUMBER OF POPERTY WELL jA VENT TO FRESH FEET FROM LINE/ ~ IR INLET: N EAREST---1 03 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PFRMANF NI MAi7KE HS OBSERVATION WELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH FED ❑YES ❑NO ❑YES ❑NO CENTER DEPTH OF TOPSOIL SODDFD SEEDED JMULCHED EDGES ❑YES. . ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH NIOTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES. FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFpLU DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING =LE V., ELEV. DIA. ELEV. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: PERMANENT MARKERSOYES ❑NO ❑YES ❑NO OBSERVATION WELLS: NUMBER OF (PROPERTY WELL BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST J, Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82)