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HomeMy WebLinkAbout018-1073-50-100 St- Croy County Planning and Zoning Detail Sanitary Information Thursday, January 26, 2006 at 10:95:19 AM Computer 018-1073.50.100 Sub/Plat: NA Page 1 of I Parcel 33,2817 51213 Lot: Lot 1 Seaton: 33 Municipality: Hammond, Town of TN/RNG: T29N R17W CSM: Vol. 06 Pg. 1730 114114: NE 1/4 SE 1/4 Owner: Cunningham, Robert 640 County TdRoa Hammond, W l 54015 State Permit: 79202 Issued: 06/1811986 POWTS Dispersal: Mound County Permit: 0 Installed: 10/21/1986 POWTS Detail: NA Permit Replacement POWTS Pretreatment: NA 13edrooms: 3 WI Fund: yes Notes issuedinsoector As Built Plumber Mary Jenldns Yes Other Reo _ u_ ire Ad Hudson, Dale diti Notes Tom Nelson Signed off.- yes This was original house on 40 acres, with CSM Mowed completed in 1986. f/034 house built sometime $0.00 Maintenance later for remaining 35 acre parcel. Schedu_ led pump Dat 2712005 1st Notion 04/01/2005 and Nomcati 10/21/1989 on 3rd Notification ficegon 4/27/2008 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CUNNINGHAM, ROBERT NE SE, Section 33 Rt. 1 T29N-R17W Hammond, WI 54015 Town of ammond j San.Permit#79202 6- -86 D, Hudson Mound, Replaceme111's -~cdl- _ /16-,)/- Re i Form- STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 7pobe.'- TOWNSHIP SEC. 2,3 T Z/ N-R2-W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM boel/ Ilouse AW4 Ike -&I s z~' .o p r S$~ iaa 6'0/ s~ , c 7ar~ ~ou~d too a/ Pump ~ir/r INDICATE NORTH ARROW /f 06f '704 Scat BENCHMARK: Describe the vertical reference point used / Cep ~g~6af~ of Cer~7`er~.S7~ ~efi,~e~rl 94ra9e p,/~> Elevation of vertical reference point: /QQ ~Q Proposed lope at site: °2a SEPTIC TANK: Manufacturer: zl ez_- e5- Liquid Capacity: ~D6V Number of rings used: -<a Tank manhole cover elevation: 99' ~ i Tank Inlet Elevation: Tank Outlet Elevation: to -3 / Number of feet from nearest Road: Front, Side,O Rear, O feet From nearest property line Front 10 Side 0Rear, 0 feet Number of feet from: well ~Dbuilding: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: G%[/C~x J Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size / Elevation of inlet: Bottom of tank elevation: a0 ' Pump off switch elevation: I9•.35~ Gallons per cycle: Alarm Manufacturer: e6z~- Alarm Switch Type: z~/^ Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft ✓SQ ' Number of feet from well: S Number of feet from building: SJr (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: y~ Trench: pi Width: Leng1th: 7 Number of Lines: Area Built:-3 Fill depth to top of pipe: i Number of feet from nearest property line: Front,/ O Side, Rear,O Pt Number of feet from well: 9Q Number of feet from building: ~.2 (Include distances on plot plan). SEEPAGE PIT Size: Number of pit/oleepa D ter: Liquid depth: Bottom i a vation: Area Built: -ax/-~ Has either a drop box 0 or distri tion b O en u ed on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevat of b tom tank: Elevation of inlet: Number of feet from nearest prop/buill ne: Fro , Side, O Rear, 0Ft. Number of feet ell Number of fet fro i g: Number of feet from nearest road: Alarm Manufacturer: p Inspector: ~YUG~'34~ Dated: AQ Plumber on job: Zcll Z. C License Number : 2 q°1• St 2c,2 2G ~'1•SL 3/84:mj Parcel 018-1073-50-100 01/26/2006 10:34 AM . PAGE 1 OF 1 Alt. Parcel 33.29.17.512B 018 - TOWN OF HAMMOND 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 - KAUTZ, JAMES M JAMES M KAUTZ PO BOX 162 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 640 CTY RD T SC 2422 ST CROIX CENTRAL ~/Y u SP 1700 WITC Legal Description: Acres: 5.000 Plat: 1730-CSM 06/1730 '98 SEC 33 T29N R17W PT NE SE BEING CSM Block/Condo Bldg: LOT 1 6/1730 LOT 1 5.OOAC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-17W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 07/20/2004 769324 2620/325 EZ 06/25/1997 1247/527 l / WD 575/41 2005 SUMMARY Bill Fair Market Value: Assessed with: 90732 197,600 Valuations: Last Changed: 08/24/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 35,000 128,300 163,300 NO Totals for 2005: General Property 5.000 35,000 128,300 163,300 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 35,000 128,900 163,900 Woodland 0.000 0 0 Lottery/ Credit: Claim Count: 1 Certification Date: Batch 213 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Chargees s Delinquent Charges Total 60.00 U U this instrument was drafted by Douglas Zahler job no. 86-32 0 0 o n E n (11 m O = Co A rt o fD rv o r _ TI o 7 r{ _ I--+ unplatted lands owned by platter r* x e~T1 0 ~ f~'.ry1 t0 r n ro r•. > > V m to r_ Z d rt C) - d 0 (n 7 0 3 rt r.• ~ K N01°39'54"W rt a ; T 330.00' N m to v c o a m o < m x 4-1- _ 3 ~ E n 0 v to o "~O 3 C rt d en• 7 K to v 7• rt 7" D. N r N u rv c to N 0 7 E 84- + N O N C:) W Co (A O+ r+ O ' d O W O N Cr Co O n O 0 O r9 = '7 O N Vf fD N M N r rt C lS • tD (D N 7 f1 . N N d ^ S N O 7 d -h fi E O K rt m tD 7 • F-t vl o ~ rn -e w m w x z d c r- n v o = N r- r '-3 7 t9 -1 I~ Oo c c I C -3 rt d ro I co O O 1= o to t0 < of z t0 -n rlyr r-0 z z (v I rt O C) O I N CL M O IM o O z Irt O' rt O+ \ \ c v 00 - IC S Co i s Z d f O 1 rt 0 to . 1 7 N 1 S O N I d O I d t D N rt I N 1 7 N ' I t7 I O_ V1 N I o O+ T I N Y - 1 O 1 7 O Or m 1 0 = Ito IE G") 1 d O O 1 7 7 t I O I fD O < O IO_ I o+ I Cr D rn O+ I~< n = I I--. M O I O ~G I d O I V C Irt O 1~ 7 to 1 rt O 1 I r o o Irt ~ I'f I APPROVED I N I ~ 7- 0 N Q O C l 2 4 1986 0 rt ,c. 4 AND ZONING CO'n~.+r{IkF n - N m = s N O rl+ ~ to n N Z K f+ 7 O r O O '7 7 7 7 'D W t.. ~ W N01°39'54"W 330.00' v 'o Ln o 0 0 C.T.H. 'IT" 525.22' S01°39'54"E 330.00' east line of the SE _ o ..r In cn o N m m - ? L ~D O O a,_ = unplatted lands owned by others OCT271986 " m o C/) W ,MM v b o o 1l of rt o The 3 ' • . j ..r . 'rot.: j r. ~ ~ (7t n • Z: x O W d t~ 1 N T G / O 7 Ln C) bearings referenced to the east cn = line of the SE} assumed to bear 6 ' Sol 3915411E. n % o Volume 6 Pave 1730 o SEE PAGE 45 ~p - iz,es ~rar3.w..~. E I AyE /r M s rs k x ~.rs ~s ewe c/ of / kWi//iom't' h h ~0 C C Tio~ s o/e// eas.5e ~i i Ij~rri` Cons/arice h LO y h 5 0~ r~ I Geor ius h ~aU~ C/in ~J " Y~ C /NE av %ry y~ /9 s y C 0\ °^0 9 a /7nde son v v I P st Qo9ere oaQ ® k F'ey do o CTune /~G /57 ? F l0 oqv I Lirid~~iisf ~ ~ T q y~y q h 4 ~ Jsarve 772 /98. s - L~r7 ~ 0` J hn zoo No/ars ~Rufh eLrr~a O.r' S C/ate I K. C160- 9s f72!/ 9 j He/kemn Hjy ed Jean `l 17aifor7 cSa.r, /Ve/son ~~3`~ I y orw a-CO&1on Morrow, s 40 /se s V Ol K 4so. G/ /9d o'/• I~v . ° r6o ern/ a o'6O Haro/d, vi- ob'i. C. z.se.s 8o I % w E .Puth .q. Pau tl~ • • • so (/S//NELL • Johnson R iTufnc y 9 Ka d airr rar7~ I.A j:: f a Ge/¢/bI/Ac Lind[xnst ~1C Kotherr'e 6in9hame'fr °C 1-0 4o RH. 7v or ~oy F~ ° Ufrrts h ;o vo cS.n.S ~@ ~ Frank /eo 0 rso.ar tl4 `e tl /ao • -.0-a /y a- C' 2fo Roma/d e M 1, Nan Cjena/d,Ne Tf f! y H c/xr/f -Wga//ace 5 I~`l E/hgoo n Flank Bo Ave— l/ira3e Gczusma 6J Jsa / 2 3%rf Ken.•rffi U/ a ts, Mamie/G ~~j~ y^~ e • Fa ms,2 /i39 • f ~Tohnson • //errso .Pobe fs, r/a/ Fr, Q J CQ C¢//o// • A/e/ o /eo Ti. r Bo Do/otAy ead 'r tZohn /79~t 0.9/s /en Kue6Fcer- \D 0 zs8 Cu/r'e// • ° D .othy 4o V e D SC'/inCJ C/acc~cCC BO ~athe~D /d5" 0 P67.77 aye!/dforf- S. Bo A rc • Lbna/d P u/~ E loo V Fe r-n rohn E E/ a6Cth .Poye Evan ri • n /,y ~h'Q . s E • Fosfrr 309 Ch isria o .r ,g9 0 .d l~ Card • f Joe/ 70s" rrn- 0 Q- Z ow.trirs f V-~-° L e onrco. Li d ur;st 7 Fars K si/a 17, Z /bo /G 73¢ niron o q a 7s. b.r 7-L4 q Is /ss Lawrer cr Find - Be/curd ~7u/e s V °f • R • /.9-/- Haw.Er:,s E/ha.~ 40 A r~i • WJkkGrJnk Pa ma f~ 7IIa.z7 `i Mc/by q • G'R / Toirn Gorna 17e 4' s 8o wd , go • N ? ~Poyer R vard .Duane Lorrxl y u Kooimarr • ~ ~ .9e/'nard i// /zo Lewis awls R /to Wa//ace W F roc s7 .tx C y 53'0.-+, Snc. Wikkerink He ~e s V i//is, a 5Gr9 Lind~uisf ~C IN. , /O9 /e/76 to 10 /P -~.vo/ia S.x. Farm.~Srx. gs 4 • .Qo~er tTune FF - iO f auanr Srvin Koo:m°n fe1rn Lri~a'~qulst Lor/u Gewr r d 4- `9 Ho/ er fSor,, rrx. PaL/ eta% yos W E ett /57 b Lewis go Dorothy ~2.s 3 Bo DeR ao y O~ e% l ~ /s6.~ S'atse.- C d Y~~ D reo • ro ,~'f°~rr' ~~v'_ Thors»Q,g !V • 3 \ q /sd /54 - cO,, ~y1 Wl~`0 ~~nk ~~e /ao rrt'? /ao ebb ~ r Pa h 0177°e'ri R2u/ f ,ryerb rr-t e 4'~ V y,o li a o Do/ores F E/.na E(?~ rtl 0 E/.jcebet \C n t,~, y,C~ a Clyde Tu ne.- tl G3 ot" 70 ~r mme.(s tl tTose~oh C 4 K Pa / 6 Ford Hanson a. Bo Doh ~i h v ti " ~Ff Do/ores C 0 S `y /s7 e iiv $t` 1i[ € .nr::::: c E v 0 i o "x07 l u o e, e~%/ Ford. rs/ q y, .so.a4 C q a `c1`r W. C f/os.Eur% j~~ ~h: Q1`• O N r.TS. da3 7 in Nar /P (ji//is F2r-rrs, ass- Fra.vm's ,fo l C. l d' ~'"~Ner c R rnG e// Russo// 6f::`:: a 117 q-o C v N K' ifp Tu nrr B6 C C~~ Doan-Hof, ~C'er//xh/7 /ss #]FI 1.0 b 3C. r4 d P.c%.a d 4 Iiic A/~¢erd 8o n tlytl 1Y ~Qhn-Te L. /r✓yrr✓een ~VM// ~y~. • F::FE ' Sbr ~/By S I / A/i//o/n f g ~e R R• ~e a /s7. es y .:1°//a C C 7ss ,Borne// R cf a. 4, h rr ~ 0 //ix9 Ch~ ~ ~ c'y [tt ifi/mars Fars., rnc. WIN James ff f Bs ` or /eo 7747va~ c . rs a L syr~ s...' s✓ a 23473 /PORT s`~a I B BOf Joe/ Harnson [t Lrst~udr For star; 40 7/ 9410 a 7-1-13 r7'a loo Arm ¢ -(jariT,'°r) • • ✓ SfirrE~ .y V Bo ~a d er -T uesdri/ .i 00 t~ 0 ~y f ,aeffy g0 ob f ' '7~ q'~ F4rrnr2nc. • 154. 7e I[: 9 h B Bo tl~ BO Gad rr- Cr /en s tl d~ BO Q v y .ASCis J n /iz l rr arm rao Mohr .Tohn§ ~f10. CI~u r2o o n-Nor DeF2rm • • /N ~e/ores V V Inc. Sne - einbueh Bo .Toh'nr7 r3err~ard o es q onni ry .9¢cs Karsten Hf Gor~ Euyarse -L'he~ u 31j ~ "i • LS d Ha w E. s Neuenobr /z ° ~i/ a • y F¢r Abrm¢n C. • Gew/s F cTu e Pefrr^sor~ /.aG. z -f om 7 r/ q U Crurr-,E/ C ri/L. • • /zO so T C rr~c: t, q u ~ C Mears rss 03 iedr-ich /s9./s Farr„ 1. /sb DeLs ~WO °p n C N nd N .PonQ/d4 . .c. o .77eorw 9 Y `o ¢ - R Eq • 3qV 9 /!eo 4.0ucrnndaer • • N O ,--as ~Po ord Ma A f+ /°ub/sr Irsc. SEE PAGE /9 . Croix G'ounty {try, SIEBOLD REALTY IVNDERSON EXCR tVITING ~ FARMS - LAND - HOMES Bulldozing - Grading - Backhoe Work GARY L. SIEBOLD - Broker Dump Truck Service - Snow Removal ' SHELDON O. SIEBOLD - Associate Estimates Given - Site Work Phone: 796-2391 or 796-5344 684-2124 OR CALL 684-2510 HAMMOND, WISCONSIN 54015 HIGHWAY 12 EAST BALDWIN ~ H Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /Qp,6~ y fp~i/Jl~h~/I7 TOWNSHIP SEC. 33 T ARF9 N-R /7 W ADDRESS ST. CROIX COUNTY, WISCONSIN J SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -FOO 50 Pomp G'aroge Ai z /~ourrc~ ,Exisf; n9 Ai /000 0 <--3D' ~yslc got, //0USe E--- C~ , I 112 SOS INDICATE NORTH ARROW No. ~fy -7✓ BENCHMARK: Describe the vertical reference point used p o ~ e e~P/~ ~ use Elevation of vertical reference point: -0 CCrlfer' be&een 9°r09e- P X00-D Proposed slop at site: SEPTIC TANK: Manufacturer: ~ee5 Liquid Capacity: /QQD 4'Cl~S Number of rings used: p, Tank manhole cover elevation: Tank Inlet Elevation: W23 ~ Tank Outlet Elevation: 9Co'~3 Number of feet from nearest Road: Front,® Side,o Rear, O feet From nearest property line Front.0 Side 0 Rear, O 120 ~ feet Number of feet from: well 7S'. building: 30 ' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE. REVERSE STDF. PUMP CHAMBER Manufacturer: S Liquid Capacity: /J ODgrz~ Pump Model: &15039 Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: /~~•9 Alarm Manufacturer: 141a r/}9 - Alarm Switch Type: /%C,-'CG/"-y Number of feet from nearest property line: Front? Side, O Rear,. Ft Number of feet from well: 531 Number of feet from building: 59 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ye -5 Trench: 0 Width: Length:_ 47 Number of Lines: Area Built:-3- Fill depth to top of 'pipe: Number of feet from nearest property line: Front, O Side, O Rear, Ft . -116 Number of feet from well: 90 Number of feet from building: $5 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: ameter: Liquid depth: Bottom see age it elevation: Area Built: Has either a drop box O or distri tion ox been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: E vation of Otto f tank: Elevation of inlet: Number of feet from nearest pr pert line: F t, Side, O Rear, 0Ft. Number of f et fr m wel Number of fee from bu ldi g: Number of feet from nearest road: Alarm Manufacturer: pO~/ Inspector: Dated: -ZZ- 6l~ Plumber on Job: License Number: W/&/1 ~l Z9 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑ CONVENTIONAL ALTERNATIVE State Plan I.D. Number: (11 assigned) ❑ Holding Tank ❑ In-Ground Pressure XX Mound 1860213-0 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION E: Robert Cunningham Rt. 1, Hammond, WI 54015 'a l ~ ~ ✓ft/ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. NE SE, Section 33, T29N-R17W, Town of Hammond Name of Plumber JMPIMPRSW No.. Counry. Sanitary Permit Number: Dale Hudson 6629 St. Croix 79202 SEPTIC TANK/HOLDING TANK: MANUFACTURER. + 1_1011~13 CAPACITY: TANK INLET E EV.. TANK OUTLET ELEV.. WARNING LABEL LOCROVIKING COVER W q IDED PDED S Q ~I ~p 2 I~p 05 PROV YES ONO OYES 560 BEDDING: IV ENT DIA. VENT MATL JHIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH d`O ~D L ALARM FEET FROM I I uN~ AIR INLET DYES NO C.1 OYES NO NEAREST DOSING CHAMBER: WARNING LABEL LOCK INGCOVER MANUFACTURER . JBEDDING. 1_101113 CAPACITY PUMP MODEL PUMPrSIPNA At 6 PROVIDED PROVIDED: V O 503 W~ YES ONO YES ONO YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL PH OPE HTV WEL BUILDI C; VENT TO FRESH LINE` S AIR (DIFFERENCE BETWEEN o PUMP ON AND OFF) U 'C -1 YES ONO D MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE ~ or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN AMf3TEN MATE HIAL AN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LloulD BED/TRENCH WIDTH LENGTH NO OF CMOVER PIT NSIUE UTA -PITS DEPTH. THENCHFS UISTH PIPE SP INF4 ATERIAL: DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH. PIPE DI T IPE DISTR. PIPE MATERIAL NO DISTH NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH PIPES FEET FROM LINE. AIR INLET. BELOW PIPES ABOVE COVER EL EV. INLF F EL V. END NEAREST------v- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ONO -71 PANI NT MAHKF HS OBSERVATION WELLS SOIL COVER TEXTURE DYES ONO OYES ONO SEE UFD MULCHED DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BED 7OF SFIUUF U CENTER EDGES OYES. ONO OYES ONO OYES NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER WIOTH_. LENGTH. NO.OF LATEHAL SPACING GRAVEL DEPTH BELOW PIPE BED/TRENCH ^ TRENCHES / I s ( I s DIMENSIONS ` I 1/~ ` MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL N11 UISTH DISTR. PIPE DISTHIBUTION PIPE MA ERIAL & MARKING ELEV E tSiV IA. ELEy. ~I PIPES DIA.: I 1 4.,1[) ELEVATION AND C) DISTRIBUTION / / COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DHILLEU CONNECT LV PLANS 1 a I YES ONO DYES ONO PERMANENT MARKER : OBSERVATION WELLS: NUMBER OF PROPERTY WE BUILDING: COMMENTS: FEET FROM LI" V~ C DYES DNO YES ONO NEAREST___~ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) ~M~ _ wIscot- in APPLICATION FOR SANITARY PERMIT ILHR .2LIC-n I E:= PRRY7nFnT CW (PLB 6]) .GC..000NTY rc~uSTa,.c~Oi61~y'i°T'Or's 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 PROPERTY L CA ION -eFFY 1 /4 5F1 /4, S T , N VIiintAel!". _7K (Or W WN OF: LjQ LOT NUM'SER BLOCK NU BER SUBDIVISION AME TOWN f~ NEAREST ROAD, LAKE III4 LANDMARK ST TE PLAN I.D. NUMBER " -f- ~eoa ~d TYPE OF BUILDING OR USE SERVED _ it i or 2 Family Number of Bedrooms; l ❑ Public Specify): THIS PERMIT IS A: AI ❑ New System ❑ Tank Replacement LV Replacement ❑ Repair ❑ Revision ❑ P _rivy Alternate System , ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench System-In-Fill ❑ epage Pit ❑ Holding Tank ❑ In-Ground Pressure aunt Privy ❑ Pit. Privy ❑ Existing, For Which A Previous Permit Is On File, Permit ❑ An Existing System That Has Been Ins issued pected And Is C iant Far As Soil and ions. Total #o Pref Site Gallons Tan s Con onstructed Steel Fiberglass Plastic Septic Tank Capacity, Lift Pump Tank Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Off Mound In-Ground Pressure Total *of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity rQ Lift Pump/Siphon Chamber Manufacturer; itr PERCOLATION RATE ABSORPTION AREA (Minutes per inch): ABSORPTION AREA WATER SUPPLY: REQUIRED (Square Feet): PROPOSED (Square Feet): 30 _f75 76 ❑ X Private Joint Q Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: NIPlMPflSY1f'NO,: Phone Number: Plumber's Address: 7 Name of Designer. J CQUNTV/ MDARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: - ~ p / ❑ Disappravecl Approved ❑ Owner Given Initial Reaso for Di' ppr Adverse Determination Alternate course(s) of Action Available: )ILHR-SSD-6398 (R, 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber , ~ ~ OCR ~ p~~ : ~ ~ e(J 4 r e~ ~ a r ie nc.e. I Obd ~e 4t. Ilk cry NDUST ANT OF REPORT ON S LABOR AfJD HUMAN . PERCOLATION OIL TBORINGS AND SAFETY & BUILDINGS IVISION X OX 79669 RELATIONS TESTS (115) P.O. BO ` . (H63.090) & Chapter 145.045) MADISON, WI 53707 LOCA ION: 1/4 N. TOWNSHIP/MUNICIPALITY: OT NO :BLK. N SUBDIVISION N ME: COUNTY: 3l T.24AI for OW ER's BU ER'S NAME, 611< 0 MAILING AD RE S: 611< USE C , EDR COMM R DESCRIPTION: DATE OBSERVATIONS MADE Residence R New ~RePlace ~ / _ & 1 NS: A NpT/ESTS: RATING: S= Site suitable for system U. Site unsuitable for system ONV 10NAL" M UND• IN-G DS ~V ~c~(-JN 111. • Sa~ -I LJY' N FILL HOLDIcNG(t~A}!N'K: RECOMMENDED5YSTEM:(optiq al) v ~ 0 CIS Y_JU If Percolation Tests are NQT required DESIGN RATE: under s H6309(5)(b), indicate: N// W If any portion of the tested area is in the Floodplain, indicate FloodPlain elevation: PROFILE DESCRIPTIONS BORING TAL PTH T R NUMBS DEPTIt1iM ELEVATION NDWATER-INCHES CHARACT R OF SOIL WITH THICKN SS, COLOR, TEXTURE, AND DEPTH' OBS RV D 1 5T TO BEDROCK IF O SERVED (SEE ABBRV. QN BACKJ Ile- B- g- Q- RECEIVED ~mE0 e- JUi1 0 1986 p 19(96 PERCOLATION TESTS NUMBER DEPTH WATER IN HOLD TES TIME ' RING BUREAU BUR~A ++E@ WATER IN HOLE INTERVAL-MIN. D OP 11\1 WA LEV 1N H S P_ Z'0 PE ~ P I RA E INUT S f~ PER INCH P i P- P- P LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe )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 f land slope, what are the cent percent iYSTEM ELEVATION 8602130 i l T- .t • j 18 4- yy, N-a 31! A"'w• RECEIVED JUi4 041986 PLUMBING BUREAU ±Cr, ono .o`(i qy , ~~0 9G Zl- d 6l~ ~s ZOO /Ooo Sept C, Pow Iz a DNS, pip a tj L3 Ilk 53 c a J1 Page / Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil's r 1- 41 4 L pro s s ~ N J~L ? Of = 2 .2 (Force Main Plowed . U Aggfe a From Pump 0 ~~p Layer 0 O N q ross Section Of A Mound System Using ~Eq G A Bed For The Absorption Area F a ti Sig/ A Ft, B 1,7 Ft. License Number: I YEZ Ft. Date: J Z Ft. K Alternate Position of 7 Ft. Force Main W _ Ft, 2 13 0 L J I. ' Observation Pipe W - _ _ - Main From Pump ~~Distrlbution Pipe eed Of i 2 2 I Aggregate Observation` Pipe REMSnt Markers R€CEI D PLUMBING BUREAU MAY 1 3 1986 Plan View of Mound Using A Bed For The Absorption Are ~UMBINQ BUREAU Page, 2 Of Per orote4 Pipe Detail MP+ ELAj10NS P ~A RY ; LA~ N 1 DEPPRIMEN i F SA iw CE CAI cop Perforoted l \ ~a PVC Pipe ~E a e5~'~.*t` ►+~sr t•r+6eted f1t+ ~ettAm, S 40 Etuolly SM41 R P S PVC Foecir main * From Pump ,•t_4 PVC Manif e1q Pipe . Distribution Ait*rttore Position Of Pips 1,46t Hale Should Be FW6e titeM From Puptp ~ Next To End Cap End Cap Distribution Pipe La Yput R~ S 7' 2,0 Signed: __,Z Z42 Hole Diameter Inch License Number: ~g Lateral //Inch(es) Date: S_ Manifold " C~ Inches Force Main It Inches RECEIVED RE`CEIy~Ep Jury o~ rJAM?ING UUHrAL) MAY 1 31986 P~~MSIIVG BUREAU i PAGE OF ..3 PUMP CHAMBER CROSS sEcrloti A SPA C( (A IUS .-VEUT CAP l~ 4."C.I. VENT PIPE WEAT14EK PROOF ?.5. FRCM Doolk, • JUAJCTICIAJ BOXY MAtJNQW4, OL AED LOCKING W1AJDow OR FRESH 12»Mlll. CO~/&R AIR IkITAKE GRAD I Aim. I8"MIAI. COIJOUIT INLET , l PROVI E T(CoN ; AIRTt(sY $EAL ~ f t A,NhROVE u .JOInIT A P ~ . ~ ~ ~ W/C.I. PIPE E)I,TLNDIMG 3" APPROVE I3 JOINTS ONTO SOLID W PIPE L3 O uM HEM-A(iO~S ALARM EXTENDIAIG 3' ® 8~~ ~~D I ONTO SOLID SOIL. G OF . ( ~ oAl GEPp;R~ME~~®~ S CE I ( D PutAp OFF RECEIVE© COUCR£Tf BLOCK J LIN d 4 1986 P ""PING BUR&n RISER EXIT PERMITt'Ep GI,)L WU y IF TAUK MANUFACTURE-Ft HAS SUCH- APPROVAL, :PTIC AND ~P~CIFItyATI0A~5 S TAIJKS M,AtJUFACTU FZ E R: TANK AC : WMBER OF DOSES: ~2n GALLONS p RAL ON ALARM MAUUFACTURER; _ 0 DOSE VOLUME: - - T r, /~J - .i~ ~'i4 - CY1L1 1.0IU S MODEL ►JUMeER: CAPACITIES: 11a Z3 IALCHES OR GALLOWS SWITCH T.4PE: /27_ B= IMCNES OR 21 GALLOAJS fIllMt MANUFACTURER: UG// C ,xIMCHES OR -4Z<2- rALLOAJS MODEL UUMBER: -3,qS fcJS~3.3 4~-- --:IWGNES OR GALL01,16' SWITCH TypE; pT PUMP ARID ALALJtM ARE TO se: IIv5TALLED PUMP DISCHARGE, RATE O. 41I SEPARATE GIFICIJITS b G PIN VERTICAL DIFFERENCE BETWEEN PUMP OFF AIID DISTRIBUTIOM WIPE.. '1' MINIMUM NETWORK SUPPIy PRESSURE * FEET RECEIVED + -~--~L~ FEET OF FORCE . FT. . 1:~.~~ Mqy 2 MAIN X _ ooFr,FRICTION FACrolq.. 1986 ---Y.._. FEET pL01181NG TOTAL OyWAMIC. HEAD) Ft;.ET BUREAU IIJTERIUAL• DIME►,JSIOhtS O ~ F TANK: LENCaTH ,;Witte LIQUID. DEPTH SIGA]ED: DATIEr: 5-5- LfE1JSE WUr"ILEf3(: Performance ;F~-k-d Submerob Curve. Sewage Pumps METERS FEET 16 50 MODEL 3887 SIZE 2" SOLIDS 14 7 40 { 12 10 q , = 30 J rp t _ F- - 1. 6 20 #r 4 # 10 2 H7 0 0 y 0 20 40 60 80 100` 120 140 160 180 GPM 0 10 20 30. 40 ma/hr CAPACITY LJG(XJLRS PUMPS, INC. r3a8 86021,90 RECEIVED JUN 0 4 1986 PLUMBING BUREAU RECEIVED MAY 13 1986 PLUMBING SUREAU 01985 Gouida Pumps. Inc. Effecb" - July, 1985 WORKSHEET - MOUND SYSTEM 'DESIGN PROBLEM: Design a mound system for a The site characteristics are: 0006 to groundwater or bedr ock in. Landslope % Percolation rate Distance from dose chamber to distribution system ft. Elevation difference between pump and distribution system ft. Step I. WASTEWATER LOAD gal. Step 2. SIZE THE ABSORPTION AREA A) Area required = ~O 1,2 l 37 ~ sq. , ft. B) Bed or trench length (B) _ ft. C) Bed or trench width (A) _ p ft, D) Trench spacing (C) t M ter io d = `.24 gal/ft2/day B = ft. renc es Step 3. MOUND HEIGHT 8v4 2 1 O A) Fill depth (D) _ /...'p ft, B) Fill depth (E) = D + % slope (A) ft. ~~•03XF - /-2 C) Bed or trench depth (F) _ RECEDED.,.? ft. D) Cap and topsoil depth (G) = JUN 0 h 1996 R.UM-PING BUREAU 'j.,- ft. E) Cap and topsoil depth (H) _ /r ft. w RECEIVED MAY 13 1926 PLUM-1N BUREAU, -Step 4. MWKD LENGTH A) End Slope (K) _ D+E +F+M x3 ft. e) Total mound length (L) = B + 2(K) . ft. Step 5. MOUND WIDTH Al) Upslope correction factor A2) Upslope width (J) _ (D + F + / 6)(3)(fact6r)- 81) Do nslope correction factor = 82) Downslope Width (1) _ (E + F + 6 )(3)(factor) * 9. 7 ft; CO Total mound width (W) for bed J + A + i • ft. C2) Total mound width (W) for trenches • J + ~ + (no. trenches •1}(c + , ft. Step 6. BASAL AREA 213 0 A) Infiltrative capacity of natural soil = f gal./ftNay B) Basal area required = Wa stewater flow = natural soil infiltrative capacity = 59. ft CO Basal area available for bed for sloping sites = 8x (A+1) 8sq • ft. C2) Basal area available for trench for sloping sites 8 W; 1+ NOW"" sq. ft. C3) Basal area available for trench or bed for leve sites =BxW=' 1 RECEIVES sQ* ft, J U Cj 0 4 1986 RECEIVED pt.iiMBING BUREAU MAY 1> 3 1936 s . PLUMSING' BUREAU ,Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size 2) Hole spacing 3) Distribution pipe length 23 f 4) Distribution pipe diameter in. 5) Spacing between distribution pipes = 2 in. 6) Distance from sidewall to distribution pip¢ n .14 78) DISTRIBUTION PIPE DISCHARGE RATE R ft. 1) Number of holes per pipe • 2) Flow per pipe 7C) SIZE MANIFOLD 1) Manifold is central/ send 2) Manifold length ft. 3) Number of distribution lines 4) Manifold diameter in, 71)) SIZE FORCE MAIN 1) Minimum dosing 2 1 3 0 rate XGPM 2) Force mein diameter in. 3) Friction loss ft//G0~f. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift ft. 2) Friction loss RECEIVED 3) System head 2.5 ft. JUN 04 1986 ? ft. 4) Total dynamic head PLUMBING BUREAU ~ ft. RECEIVED, MAY 13 1980 PLUMBING BUREAU 7F) PUMP SELECTit 1) Pump selected will discharge ?022NPM at ft. total dynamic bead. 2) Pump model and manufacturer 7G) DOSE VOLUME: 1) 10 times void volume of distribution lines go)./cycle 2) daily wastewater volume 4:4 doses,/2+4 hrs. gal./cycle 3) Minimum dose volume ; "IMP 7H) DOSE CHAMBER 1) Minimum capacity required gal. UW2 0 MAy A 1986 UgEq~ ~ RECEIVED JUN 04 1586 PLUMBING BUREAU 4W.PARTMENT OF INDUSTRY, REPORT, ON -SOIL BORINGS AND SAFETY & BUILDINGS LABOR AND p DIVISION HUMAN RELATIONS PERCOLATION TESTS (115 P.O. BOX 7969 O 41463.09(1) & Chapter 145.045) MADISON, WI 53707 ~I ~L TOWNSHIP/MUNICIPALITY: OT NO ;gLK NO' SUBDIVISION N M COUNTY: 1AtNE S UYE NAME: i"[}irX [Q ^ j L MA LIN AD RESS: U E BResidence Cp RI T 0 DATE OBSERVATIONS MADE ' ❑ New Replace ~ ~ O T S RATINt3: S= Site suitable O for system Uw Site unsuitable for system s N L: M UND: I; GROUN UR T IN-FILL ULDING TANK: RE COMM EN DED SYS M:( TEo ti al ou rs Qu osu os~u FEIS .emu If Percolation Tests are NOT rQquibESIGN RATE: under s,H63.09(51(bl, indicate: If any Portion of the tested area is in the /y Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL "1 ~T NUMBER DEPTH *W ELEVATION P 08 H T V R UNDWATER-INCHES CHARAC ER"OF SOIL WITH T1111 CK SS 13- .1e H ST TO BEDROCK IF O SERVED (SE ABBRV: ON BACK EXTURE. AND DEPTH B- z -~(10, 97169 l3 SCA 4l/~ir► r~ RECEIVE B- B MAY 1 3 ; PLUM3ING PERCOLATION TESTS NUMBER DEPTH WATER IN HOL TEST TIME @ AFTER SWELLING INTERVAL-MIN. DRO I WATER L V 1 P- Z'0 P t RI HES RAT MINUTE PER INCH P- i / Z3 r~ P- P- P- OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate Ital land slope. YST scale or distances. Describe what are the hori- la 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 EM ELEUATIOIV %0213o }3 t Y. 4171 e~ 770 J 1z~N R 40 9-'5r07 v 4 ~I►l. i CJ ~ r',s a -05 aocA 75 (XI B3` 4LL Fcnti~ , wec,run DSANITARY PERMIT Coun ILHRGROUNDWATER SURCHARGE Sanitary Permit No. /ar 1 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 ih 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 3s Sign lure of lesul Age M» Groundwater Fee: Date: WISCO'~ DILNR SBD- 89 ( . D5/ bused Yrh 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/contractgr,("spec 4ouse"), 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 6 Lo4a'tion of Property 'r 'k StC Section _F3 T Z9 N It /7 W Township Mailing Address - %1 ! o Ha m m o 5. S"yo A5. Subdivision Name ' Lot Number1114 Previous Owner of Property Total Size of Parcel Date Parcel was Created 170 Are all corners and lot lines identifiable? Yea No Is this property being developed for resale (spec house).? Yes Na Xolume ff 75 and Page Number 141/ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.. Other recordiii .go filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful sous 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 OWAIER CERTIFICATION - I (We) eekU6y that a t e.ta.temen to on .th" foAm a4e -true to the best o m know£.e.dge; that I (we) am (are) the owner (a 06 the o 6 y (owl ) 4n6o4mation 6ohm, by v oktue o6 a`wama de ply a 066ibed in he thiA my deed neco~ded in the 066ice o6 the ,.,,County Reg-e a#en o j Deeds ae Document No . and that I (we ) pn.eaentty own the proposed 4-c to bon the sewage po4at4y4.tem (on I (we) have obtained an easement, to Aun with the above deacn.ibed pnopeUy, 6on the conatn,rrWon o6 Amid eyb.tem, and the same has been duty neeoh.ded in the 066.ice o6 the County Reg.,a.teA o6 peed, as Document No. w SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (I ePPLICABIE) DATE SIGNED RATE SIGNED`