HomeMy WebLinkAbout018-1075-30-000
St. Croix County Planning and Zoning
Wednesday, January 25, 2006 of 3:16.21 PM
Detail Sanitary Information Page 1 'of 1
Computer 018.1075-30-000 Sub/Plat: metes & bounds Section: 34
Parcel 3429.17.5276 Lot: TNIRNG: T29N R17W
Municipality: Hammond, Town of CSM: 114114: SE 114 SW 114
Owner: Pepi, Peter 1850 60th Ave. Hammond, WI 54015
State Permit: 75033 Issued: 0312711986 POWTS Dispersal: Mound Permit: Replacement
County Permit: 0 Installed: 0810711986 POWTS Detail: NA Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
issuer/Inspector As Built Plumber Other Reauirements Additional Notes
Harold Barber Yes Bird, Byron Jr. Money Owed
Tom Nelson Signed Off: Yes $0
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
81712006
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
-
PPEPI51 PETER SE SW, Section 34
Rt. 1, Box 251 T29N-RI-N. _
Hammond, WI 54015 ,,-Town of Hammond
PETER PEPr -
MOt1ND -
SE SW 19 San.Permit4175033 3-27-86 B. Bird, Jr.
3, Section 34, T29N -
Town ofr`Ra~nd 11W Mound, Replacement
i
Installed 8-7-86
I
I
'Parcel 018-1075-30-000 01/25/2006 03:09 PM
PAGE 1 OF 1
Alt. Parcel 34.29.17.527B 018 - TOWN OF HAMMOND
Current 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 - NIEMEYER, ERNEST R & DEBRA J
ERNEST R & DEBRA J NIEMEYER
1850 60TH AVE
HAMMOND WI 54015
Districts: SC = School SP =Special Property Address(es): Primary
Type Dist # Description ' 1850 60TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 5.430 Plat: N/A-NOT AVAILABLE
SEC 34 T29N R17W 5.43A IN SE SW E 195 FT Block/Condo Bldg:
OF S 1214 FT OF SE SW 518/221 695/130
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
34-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 975109
07/23/1997 695/130
07/23/1997 5181221
2005 SUMMARY Bill Fair Market Value: Assessed with:
90754 143,100
Valuations: Last Changed: 08/24/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.430 28,700 89,600 118,300 NO
Totals for 2005:
General Property 5.430 28,700 89,600 118,300
Woodland 0.000 0 0
Totals for 2004:
General Property 5.430 28,700 88,100 116,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 138
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 60.00
Special Assessments Special ChaTOO es Delinquent Charges
Total 60.00 UU
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 KNALTERNATIVE State Plan I.D. Number:
lf st ned
❑ Holding Tank ❑ In-Ground Pressure MMound g 9•g6 I85asx8132
Y"
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA
Peter Pe pi Rt. 1, Box 251, Hammond, WI 54015
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF, PT. ELEV.:
SE SW, Section 34, T29N-R17W, Town of Hammond
Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number:
Byron Bird, Jr. I3318 St. Cro x 75033
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
~ ^ PROVIDED: PROVIDED:
l//" /I/v/Z OL/ O~J YES ❑NO YES ❑NO
BEDDING: VENT DIA.' VENT MATL. HIGH WATER NUMBER OF R AD: PROPERTY WELL: BUILDING: VENT TO FRESH
s ALARM. FEET FROM 'z LIN AIR INLET:
DYES NO DYES NO NEAREST '7 OZ~~ w
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MAN FA TUBER. IWARNING LABEL JILOCKING COVER
30 PRO PR VI C
DYES O~ YES ❑NO YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL BER OF PROPERTY WBUILDINGVENT TO FRESH
(DIFFERENCE BETWEEN IAREST---o-I ET FROM L160 ^ AIR~lL~
PUMP ON AND OFF) 116'. YES ❑NO 6 S
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE Z yJ
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH IND OF DISTR PIPE SPACING COVER JINSIDE DIA *PITS LIQUID
TRENCHES. MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL UEPIH FILL DEPTH ITR. PIP' DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR_ N MBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER. JE'LEV . I NLET ELEV. END. PIPES: F ET FROM LINE. AIR INLET:
N AREST--►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill ma real 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.
YES ❑NO
SOIL COVER E TURF PERM NENT MARKERS: OBSERVATION WELLS
ES ❑NO DYES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED
CENTER: < EDGES: D
/ n
✓ `7 YES O YES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH- LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES: 11
DIMENSIONS J_
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
E V ,8 / E - DI PIPE DIA.:/ _3 .2 ELEVATION AND J` yv
DISTRIBUTION J
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
7 YES ❑NO YES ❑NO
COMMENTS: - PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF ILRnOPF~TY WELh~ BUILDING:
FEET FROM EE//VV~~)) TTY//
ES ❑ NO ES ❑NO NEAREST
Sketch System on tain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
710 IR. 01/82)
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ff r eT! TOWNSHIP j4aAjjM d?tg SEC. 5_5;S4a TN-R/ / W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IrLHP 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3,Qey ~r
l7oq S s ~
or
6AJ
INDICAT NORTH ARROW
BENCHMARK: Describe the vertical reference point used '1z O'Y.-o)
N
Elevation of vertical reference point: As'p ( Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: 1
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,@ Side 0 Rear, O _
~ feet
-From nearest-property line Front 10 Side,O Rear, O feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: f s Liquid Capacity:
Pump Model: . Pump/Siphon Manufacturer: P ~tJ" Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
~s
Alarm Manufacturer: ~2)4 Alarm Switch Type: 4
Number of feet from nearest property line: Front, O Side, Rear
Ft..J
0
Number of feet from well:
g
Number of feet from building:
(Include distances on plot plan).
f r
SOIL ABSORPTION SYSTEM 191 04CA.-~/ 72 t, 4c//`1
Bed: Trench:
Width: i02 Lendth: Number of Lines:-L,/ Area Built : "0
Fill depth to top of pipe:
Number of feet from nearest property line: Front, `O Side, ® Rear,0 Pt.
,a Number of feet from well: Lf-
Number of feet from building : `7 7
(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: "J v•
r
Dated: g Plumber on job:
License Number : 1
3/84:mj
UIISCDnsi:: APPLICATION FOR SANITARY PERMIT
~~yd ~X COUNTY
D(PLB 67) UNIFORM SANITARY PERMIT #
OEPRRTT
InDUSTRVMRn RELRTIOnS
EZ2y►~ j~
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPE Yjq~WNER r MAILI G ADDRESS
PROPERTY LOCATI N CITY:
1 / lr~ 1 /4, S , To; , N, R/ E (or O N GI rn
LOT NUMBER ]BLOCR NUMBER SUBDIVISION NAME NEAREST OAD, E OR LA MARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: ❑ Public (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.
❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ` ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy `17994," ❑ 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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber -Sllyla + __<1
Manufacturer: .142 -7
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
oc pZo2 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 Number:
1~5~~GY7
3i f.>/ I
Plumber' ddress: Name of Designer: r
Ao~
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
^ ~-o ~l ❑ Owner Given Initial
~(p( v 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 peribit. 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.
r
State of Wisconsin \ Department of Industry, Labor and Human Relations
t 30 1"6 SAFETY & BUILDINGS DIVISION
Sw*w of Plif
201 Wit 116MMAft" ISOm
1 tiso% MI $370'
Mr. Peter >pepi
A.+e 1. Box, 251
"W"do al 5401S
Petits fib. 36-0133-P
ftw Xr. Sri;
ket Pater frsi cle
Privota systel r
3E*5W*34*29- * 170
Tom Of OWNWA,St.Croix covetysIII
Section 45.24 (1)* St is SUtaums and s. MIA 83.09 (2) (6). Vi sts
Adstaistratiee Qm*, allow the a r to petition the departnot for a twime
to the isstallatiee for a private sewn" system to replace an existing prime
SWAfp SYSUM at a Site nth IS not 14 fUll CQWli4MC# WfU tie sitiab
staa4 s ie the inistr'ative rule. T system desi uM sbould
pivtsct tit waters of to state from +contariaati+ . If th#s sst w becomes. a
tailing system or c taeiaates the oaten of the state, this variance still be
rei r
Th# petitUm for a variance requested to s. IL $3.23 (1) (d) of the Wis.
+oe was Considered on Decedwr 26, IM. The petition has boo
CO"MODAlly approved. The conditivin being that is the aeon of fallore* the
mound system shall he r rlacaid with a holding to* or other off-let system.
The rule rapires that a mvvW system We a minimia of tb iwAes of suitable
natural sei1.
Thu rariame nupest to lastall a replacement system so a site
With 16 IllwAft of suitable sate &I sail.
D I L H R-S B D-6423 IN. 04/81)
State of Wisconsin \ Department of Industry, Labor and Human Relations
W. ft' ftP1 SAFETY & BUILDINGS DIVISION
JOINAWY 30 t
ft" Y
All Of U* UU AMA stets t tt" vo waif of tM petitioner
toast Inks wartance is specific to UM subject Petition Cagmt 60
" for any a tional 81104ifiratiol".
Quinlan* Chief
soctiew of Primate Saw"
t
ecs a~577r
L"y Joa ky, Private 34vage sultant - District b, Ckippwa palls
14 C. awtor'v Zuni Adwicistrstor - St. Croix County
L Bird, Jr*
i,
DILHR-SBD-6423 (N. 04/81)
u 21
6 14
PROJECT
4/ `r ADDRESS
A w TOWN C
4/ OUNTY
BEDROOM y ~
SS PERC
CONVENTIONAL CONVENTIONAL LIFT
- UND~C HOLDING TANK
IN-GROUND PRESSURE Mp
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION A P CRATE
BED SIZE = x y7 i
PLUMBER LRTSC
A7ENSE VN
1► BM Assume eleva on 100' DATE Location of Benchmark, '5"
17r-e L
Borehole 0 Weii - . Corp er -5-- : /Yd
k5.~
• Perc Hole
System Elevation 4 ~'/t
TYPAR COVERING 4"' Y,.
2" 2" 2" 2"
6" Sewer Rock
Wft.
18 ft. 24 ft. i
i
Cr`7~~~ c I^ -c ~s t
r c. ~ a
3r8~ ' ,
O , o { ~
10
CZ
~1za IG
8508132
DEPART"Jt;ST {°dDC!STRY, LADOR AND r!U?v1Ai! RELATIONS
Di'JI OF SJ~ AN l;iL~l'i`dCS
SEE CORRESPONDEN-E
DEC 1 ~ 19~
r p lri BURSIS!
Page Of
Perforated Pipe Detail '
1
End View
End Cap ct r Perforated
j D - Pvc pipe
Hot*$ Located On Bottom,
Are EQuotty Spaced
R
PVC Force Main
P PVC
Manifold Pipe
Distribution Alternate P
Pipe osition Of
Lost Hole Should Be Force Main
Next To End Cop
End Cop / 5 0 8 x 3 2
Distribution Pipe Layout
P3 Ft
~Rri
X Inches
Y
Signed: / _Inches
Hole Diameter Inch
License N tuber: ':~7/-of, Lateral "
Inch(es)
Date; Manifold "
----r---- _ Force Main Inches
"
Inches
Pa uMe3ItvG -
# of holes/pipe__4g~,~
ncd' ~ Invert Elevation
of Laterals
Ft.
4a ~ RELATIONS i. t~rl Y, zOR A JT) HUMAN R'-''CEIVED
DEPARThi"E':T U" 0~ Sr,r p;dD i Dl;1GS
C31Vf~{ II~~
SEC I C) 1 q
y Straw, `Marsh Hay, Or
Synthetic Covering
Medium sand Distribution Pipe
- Topsoil G
1
3 E .i
6
FLUMBIN % Slope
aHad Of ~ - 2 1
2 Force Main
Rlowed
t,; F Aggregate From Pump Layer
D AND HUMAN ElATIdNS
714EE 1~!D;JSTRY, LA.Sr, R
0~ SAAND 'ILDINGS~7 Cron ion Of A Mound System Using
CORRESPONDENCE A Bed For The Absorption Area F
G'
Signed: A Ft, j~
- - - B
,,~.-_F
License Number:
r.z .1- Ft. r
Date:
Ft.
1z,,fs_-K Ft. 30'
Alternate Position
of 7i.9=L Ft.
Force Main 30,9' W Ft.
L 4
~ f u
J observation Pipe
Force Main
From.. pu
Distribution Bad Of 2"
Pipe
Aggregate
Observation Pipe Permanent Markers
RI CEIV D
DLEC T 2
Plan View of Mound Using A Bed For The Absorption Ari~b~ ter.: y
r
Q
f
4,,
4 t O ~ l
v
2
r
'DEC 1~
# PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
f VEMT CAP
'I"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
` Z5' FROM DOOR, JUNCTION BOX MANHOLE COVER-
W#NDOW OR FRESH 12"MIU.
Af;} INTAKE
GRADE I
4" MIN.
18" P111J.
COtJDUIT
18"MIN. \a\~ -
11~ -
IA1LET PROVIt'~'''V I
AIRTIGHT SEAL
PLUMBING
APPROVED JOINT A ~r~ma4 I I I APPROVED JOINTS
1n! C.I. PIPE { I W/C.I. PIPE
EXTENDI UG 3' {
71' T\ ALARM EXTEIJOIUG'
OIJTO SOLID SOIL
8 k y., r; { i IONTO SOLID SOIL
~ o.t 63 EW I
C DEPARTMENT 0' iNDUSTRY, LP V0 RELATIOPIS ~
GI`IISIO` CI= S.~L A.lD iLD,k ,S I ON
bL
E L E V.FT-
OFF
v D
CONCRETE BLOCK
132
RISER EXIT PERMITTED GULJ IF TANK MAIUUFACTURio.R HAS SUCH APPROVAL
SEPTIC E SPEC. IFI'CATIC)t~15 le r -4; c-,417
DOSS_ /'J
TANKS MANUFACTURER; ze) NUMBER OF DOSES: PER DA,i'
TAAJK SIZE:
GALL0MS DOSE VOLUME
ALARM. MANUFACTURER: h -4e /s ,crtry~ INCLUDING BACKF 0 _L o
GALLONS
MODEL QLIMBER: ~ CAPACITIES: A INCHES OR 6 GALLONS
SWITCH TyPE: Gkr~
8 =INCHES OR GALLONS
PUMP MANUFACTURER: ;?-INCHES OR GALLOWS
MODEL NUMBER: D=INCHES OR GALLONS
SWITCH TyPE: -MQrE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE INSTALLED Oti' SEPARATE CIRCUITS
VERTICAL DIFFERENCE BE,TWCEU PUMP OFF AND DISTRIBUTION PIPE.. -_,,7 FEET
+ MIAJIMUM NETWORK SUPPLY PRESSURE . , , . . . 2.5 RECEIVED,
FE ET
+ FEET OF FORCE MAINIX' /iooF'CFRICTIOLI FACTOR. . EET DEC 12,N05
TOTAL OJWAMIC. HEAD = FEET PI I III9r?IN , RURFAIJ
INTERNAL. DIMEMSIONL OF TAIUK: LENGTH Sf~;WIDTH .r;LIQUID DEPTH
StC,tJED: LICENSE NUMBER:.3•~' DATE42
OPTIONAL'WORKSHEET
1. MOUND SYSTEM
1• Wastewater Load, Total Daily Flow= G If. .GROUNDP I RESSURE SYSTEM Continued•
Use section H
. 63.15 gal' 1 100. Force Mdin:
(3) (c), Wis. „r?$
Adm, Code and PROVIDE A DETAILED Minimum Dosing Rate=
LIST OF SIZING ON PLANS. Diameter = gpm•
2. Depth to Limiting Factor=
11. Total Dynamic Head: in.
B actor =
3.` landslope System Head =
4. Distance from Dose Chamber to % Vertical Lift = 3.5 ft.
Distribution System = - Friction Loss= ft.
5. Elevation Difference Between ft. TDH = ,--ft'
Pump and Distribution System = 12. Pump Selection: T y ft•
6. Absorption Area Sizing: ,Z1- ft Pump will dis harge at least O
Area Required = at ` ft, total dynamic hattd, ~1~m 11 Bed or Trench Length (B) = ~1 54' ft` Pump model and manufacturer- .,.,2Q=1
Bed or Trench Width (q) =
Trench Spacing (C) 13, Dose Volume:
7• Mound Height: ft. 10 Times Void Volume of
Fill Depth (D) = Distribution Lines Fill Depth Downslope (E) _ ft' Daily Wastewater Volume + Leal.
Bed or Trench Depth (F) _ ftw 4 Doses in 24 hrs.
Cap and Topsoil Depth (G) = r BackNow
Cap and Topsoil Depth (H) _ ft. Minimum Dose = '---~+-t gal
8. Mound Length: ft. 14. Dose Chamber. 8a1.
End Slope (K) _ Volume =
Total Mound Length (L) _ -•~i~~~tt. gal.
9. Mound Width: ft. Ill. CONVENTIONAL PRIVATE SEWAGE SYSTEM
Upslope Correction Factor = 1. Wastewater Load, Total Daily Flow
Upslope Width (1) _ Use section H 63.15 (3) (e), Wis. Hai.
Downslope Correction Factor a ~f L Adm. Code and PROVIDE DETAILED
Downslope Width (1) ft. LIST OF SIZING ON PLANS.
Total Mound Width (W) . 2. Required Septic Tank Capacity =
10• Basal Area: ft' 3. Percolation Rata = gal.
Infiltrative Capacity of 4. Absorption Area Sizing: min./in:
Natural Soil = Refer to Table 2 in chapter H 63
Basal Area Required = >1 /sq.ft./day and PROVIDE A DETAILED LIST OF
Basal Area Available ft' SIZING ON PLANS.
I I. If Standard Tables from Chapter sq ft Required Area
H 63 are Used, Indicate Table No. Length = sq. ft.
12. For the Distribution Network, Use Numbers 5-14 in Section if. Width ft,
Number of Trenches ft.
If. iN-GROUND PRESSURE SYSTEM Trench Spacing=
1. Depth to Limiting Factor = d 5. Distribution System: ft•
2. Landsfope = ft' Lateral Length
3. Percolation Rate = % Number of Laterals ft.
4, Proposed System Elevation Lateral Spacing =
5. Wastewater Load, Total Daily Flow: ft. Distance from Sidewall to Pipe = Ins
Use section H 63.15 (3) (c), Wis. gal, System Elevation = In.
Adm. Code and PROVIDE A DETAILED ft.
LIST OF SIZING ON PLANS. !V. SYSTEM-IN-FILLO
Required Septic Tank Capacity • Fill In All Items from Se 32
6• Absorption Area Sizing: gal.
Percolation Rate = V. SEPTIC TANK
Area Required = min.11n. 1. Capacity
System Len g s sq. ft. f ~ gai
H ft 2. Manufacturer: -
System Width = ft. 3. Show Site Constructed Tank betalls on Plan
7. Dirtributionpip@ Sl~lnp:
Hole Sire a _ , VI. DOSING TANK
Hole Spicing = '-'-eJ4 In. 1. Capacity =
Lateral Length • ft. 2. Manulacturer: Hai.
Lateral Siie ft. 3. Pump Manulactumn
La1t r tl tils.rcing In. 4. Pump Mudcl:
~\j S9
Ui+t iuu lrnru SiJrwall lu 1'Ipu It. iEr'S
5. Operating Head=
R. Distribution Pipe Uiycltarge Rafts: in. 0. I low Rates ft.
Number of I lulu Per pilrr 1 7. Show Site Constructed Tank Details on Plans 9131".
I low per pipe = ~1
N. Manifold Sizing: Kpt^ V!~,r,~!WUING TANK
(ype (ccn(cr ur end) I. Capacity =
Length
~ 2. Manulecturcr. gal,
Diameter 3. Show Site Constructed T
in, ank Details on Plans
DILHR SBD-6761 (R.03/$2) -SHOW ALL INFORMATION ON PLANS-
HEAD CAPACITY CURVE
V TDti
W
.90
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efslt~wTANOOEWATEMNO
26--85 sus s>ws~.55 n in-m 157 us
EFFLUENT AND DEWATERING T. oAl G& : GAL "L tiAl
• 3 SEWAGE AND DEWATERING 10
1 1% 24 ` 75 s, 5,
% % Is 43 04 to
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20 ~ ` f ~ 51
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cg s ,OS .108 130 452' 150
♦ i 10 so n 95 107
20 43 57
143
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- MODEL
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MODELS ;
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LITERS 80 160 240 320 400 480 560
0
FLOW PER MINUTE 8508132
MW
it" OM Affairs Lane M&Wacturas of...
ZA9ZZl1lRrZ7, coe~v#* Kw*iicky 40215
(502) 778-2731
Qu.►~/rr puwas SSMC! ✓.~3.~ a
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969
N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSHI /MUNICIPALITY OT NO.:BLK. NO, [S-UBDIVISION NAME:
I / N/R -7 E (or) i 4 14 COUNTY: OW R'S BUYER'S A E: MAIM MG ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BED MS.: COMMERCIAL DESCRIPTION: PR FIL D T NS: 1PERCOLATION TESTS:
1wesidence ---1-~ ❑ New Replace I /D !T
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDE SYSTEM: (optional)
C
®U $ ❑U U U $ ❑U h eA&
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: xoa I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS ff/
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 37 Y 7 e:./
" -
Mpg
5"117 /(v fir. C/16 - G fin" / /y►(rw
B- e2
0_foC%.4ii 5r' /ty ! G/ 6 7 Ir bwoId~
B-
C;Z r4
A4t A:'/
B-
- o
B- 4& B-
PERCOLATION TESTS r
TEST DEPTH WATER IN HOLE TEST TIME DRO I WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P- /
P-
P
;400'h,17 A/
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope
SYSTEM ELEVATION 4eher)y fi1CC~ Du~,~~r
IT-
i ~ E V ` ~ Gt ap
E i € i I I 1
y
i ~
01
F
i
Il [J
s
yf
j
5 '
t/
f 3
= I t
:
Qr`~
/Ve
i
f
i
I
i
t- ..1 l _ _
1'_ _
i1~6 c ,
I, the undersigned, hereby certify that the soil tests reported on this form Were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief,
NAME (pri TESTS WERE COMPLETED ON:
rc~ - O
g'00'A'n "46
ADD E CERT (CATION NUMBER: PHONE NUMBER (optional):
e ~ c Ooh O .r'S'o
CST SIGNATURE:
-or 4~ - loop,
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
FOI t I't ETj. FORM 1 O .
To 6,:; xa coa, soA :,t ;clcde-
1. ComPlete legal descriptio€ ,
2. 1 he use-section must cIew iy irndicate whe' ° ns a, r--si(:lence or commercial project;
3. MAXIMUM rare-nber of bedrooms or cornmer ._El use, p aned;
, Is this a nev,, osreplacement system;
5, Complete t ho suit< 'iity raging box(,s, A SITE IS SUITABLE. FOR A H0f..DING "I-Ai,K ONLY IF ALL
01-HER SYSTEf° RULED OUT BASED ON SOIL CONDITIONS;
6, PLEASE us§> i:~R a~l,.t €:rras shown here for writing profile descriptions and con,;, he plot plan;
1. (MAKE A I1. diaararn accuraveIy locating your test locations. Drawing # is preferred. A
separa. be used if df.=sired
8, Make sw , mcnmark and ve:tic~rl elevation reference point are c':. Ia~:naaraent;
. Conapl:.'l o--tal:e boxes as to dates, narnes, addresses, flood plain - a ~.st exernp-
ticrra, it a~
10, If the inf, - €h as flood Alain, elevation) does not apply, place N.A. in the ar)nropriat€, box,-
11. the fro; n cc your current address and your certification nurnber;
12. Make legit, and distribute as required. ALL SOIL TESTS MUST B FILED WITH THE
LOCAL A,._ .,:OR: , Y WITHIN 30 DRYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Sail Separates and Te; Other Symbols
ct Stone (over 10") BR Bedrock
cot) Cc'-Ne (3.. 10") SS Sandstone
€Ir ,rtel (under 3"i LS Limestone
"s HGW High Ground valer
Barad Pear: Prreola:i± I
St O rd VV - Vvel l
rr€ Bl€?r Building
Sand ~ (31 'eater That=
s? ? a dy Loam L°.ss Than
Loam, 3r1 E3ra A` 11
siI SO L€~arn Si - Black
si Silt Gy Gamy
scl ±rra
sic' r§ nlc~t
sr-
iC few, " re, far'rtt
r,
'C Clay cc common, coarse
In Pexa rnm - Many, medium
m Muck d distinct
p - prominent
HWL - High water level,
SA g,>.ra§:`-al soil xtu°r:S surface wafer"
for llctuid waste disposal BM Bench Mark
VRP - Vertical Reference Point
TO THE OWNER.
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage systern and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must be. obtained and posted prior to the start of any construction.
DILHR
a• PLAN APPROVAL Safety and Buildings Division
~ Bureau of Plumbing
P.O Box 7%9
General Plumbing Plans Madison, WI 53707
Private Sewage Plans Telephone: (608)266-3815
i
7` o x ~O
I
l a'
Plarl
Project Na~j Project Location - Street No. or Legal Description
I" 7~ ~e e s. 6,6101 SW 3!K az- 9 /7-4/
County
El 4 7~
City ❑ Village K Town of: M ~8~1 ~7 - d/
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: 3a 3b 3c 3d 3e 3f 3g
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: (1) (2) (3a) (3b (4a 4b) (6) (7)
This approval will expire two years from the date approve or if a sanitary permit is obtained, it will expire the day the initial sanitary
permit expires.
The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be
submitted to the Bureau of Buildings and Structures.
Comments:
By:
James Sargent
Bureau Director
If Questions Plans Approved By: Date Approved:
Contact ♦ j;~) 1 /3- F 10
cc: Private age Consultant ❑ Plumbing Consultant ❑ Environmental Health
County ❑ Local PI ❑ Facilities Need Analysis Section
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RE
IONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Se
In the County of St. Croix Wage System
Location S___ 1/4, sw 1/49 Sec. 34
Town mxmxi T 2 9 N, R 17 W
k Hammond Street Address
Lot No.
Block Subdivision ~K
Landowner's Name: s
Peter. A. Pe
i
The application for this site is for;
O new construction use,
]replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private
11 to have one of the first five approval sewage system is:
number _ s guaranteed for this year. This is
of those applications. (Use one of the first five
quota num ers-rsSUe-you. )
t, one of the applications needing a quota numb
this application is er• The quota number assigned to
rte. •
Elfor one additi
onal homeslte on
grandchild, sibling, a farm to he occupied by a parent, child,
nniece, nephew, or first cousin.
F-Ifor an individual lot for which a s
ruled unsuitable due to new or changedtsoilpcriteriasestabldishbut ed was later
department. the
by
l.~ for an application on file prior to February 1 Q
1 1980. 850 8 1 3
U for a lot that meets the criteria for a convents
If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is
Oa failing conventional soil absorption system.
Eja holding tank that was installed and in use
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM prior to February 1s, 1980.
Conventional USE and the lot meets the criteria fora RECEIVED
private sewage system, check here.
I certify that the above information is t DEG ~ 2 1~~
knowledge. rue and accurate to the best
qb m1f«Ll~U
Name' Thomas C. Nelson
ounty c a Si 9++at'rre
Title Assistant Zoning Administrator
Date prober 21, 1985
DILHR-SBD-6158 (R 12/82)
t
ST. CROIX COUNTY
k, WISCONSIN
ZONING OFFICE
798-2239 (HAMMOND)
_ 425-8383 (RIVER FALLS)
HAMMOND, VW 54015
October 21, 1985.
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Peter A. Pepi property located
at the SEk of the SW's of Section 34, T29N-R17W, Town of Hammond,
` St. Croix County, revealed suitable soils at a depth of 16 inches,
below which seasonable high ground water was noted.
This site should be suitable for a mound system.
Should you have any questions, please feel free to contact this office.
Sincerely,
LJ L ,
U ~I,L~YrGIla~
Thomas C. Nelson
Assistant Zoning Administrator
mi
85081 3
2
RECEIVED
DEC 1; 2 1925
pl_11~ARINIG BUREAU
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/Amom"
SE
kJ ]%I
SW 5 34 T 29 N/R 17
Street Address: $W Hammond
Subdivision: County:
Landowners Name: .4 St. Croix
Mailing Address:
Peter A. Pepi R. R. 1, Hammond, WI 54015
I (We), the undersigned,, hereby make ,applicatioq fr.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 then
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
me (the or
agent (the contractor) to begin installation. If permit
system pisiapprov d myth
Bureau will send the applicant a letter of approval e e
construction of the alternative system afterallnecessar aobtained, y permits have been
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 understands 8 3 RECEIVE
to all the conditions and obligations act out in ing and_subeot D,
this application.
DEG 12 1985
URFA-
gnature of A licant
Da e
STATE OF WISCONSIN
Subscribed and sworn to before me
SS.
COUNTY O
ThisZZ day of
•.',Notar}T Public, State of Wisconsin
DILHR-SBD-6413 (N. 05/81) My Commission Expires:
D
Petition for Modification of an
Administrative Rule WISCONSIN DEPARTMENT OF OFFICE USE ONLY
INDUSTRY, LABOR AND MUMAN RELATIONS Petition No
* PRIVATE SEWAGE DIVISION OF SAFETY & BUILDINGS
P.O. BOX 7969, MADISON, WI 53707
ID-No.
Name of Owner Building Occupancy or Use
Agent, Architect or Engineering Firm or
Master Plumber
Company Tenant Name, it any
~t / BaX ds ~
Street & No. Q /T ~i H
BuUding Location, Street & No. Street & No.
Cit State & ziP of
City County ikY ate & Zip
S~f al S
done Piln Numbers (1f Known)
hone
Type of Petition
Set Backs (Soil Absorption Experimental and
Fee
m T ❑ and Septic Systems) ❑ Loading Rates ❑ Site Evaluations
L
LEGAL DESCRIPTION
%,s5-",L Section A .
TN, R -Z_Z,_ E (or Township '0:P7
`;Subdivision Name '
County-- sd' 9,
WISCONSIN ADMINISTRATIVE RULE BEING PETITIONED
Rule
bf t e'Wiscon in'Adrrtirx9sttative code cannot be entire! satisfied
y due to the following reasons:
A9
c~
xw - - E ov-e3 ;
lrl.,aieu of.complyingexactly with the rule, thc,fnUq~ngAlteinatiye is proposed as a means of providing an equivalent degree of
safety or health: /
rte/
. -
- tea.- - - a ~ -
- - - - - - - - - - - - - - - - - - - - - - - - -
- L.r^ 77
I, - ~'n ,
3. Supporting arguments (For site evaluations, include Form 115-"Report on Soil Boring and Percolation Tests" -
-