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CROIX COUNTY, WISCONSIN nt SUBDIVISION AVA _ LOT LOT SIZE PLAN VIEW 0o 1-1 CS J~/I ~(7 Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lY 1 .V ^ ~3 AJ~~ - P 1 ~j 10 c t Z~r 1 ko (J's \ INDICATE NORTH ARROW l BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ~~.L_~cS Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: ~7 2,G Tank Outlet Elevation: J Number of feet from nearest Road: Front, Side,O Rear, O feet From nearest property line Front,0 Side,) Rear, O c~L~ feet Number of feet from: well building: (Include this information of th above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE J PUMP CHAMBER Manufacturer: i LK Liquid Capacity: © ~ 1• Pump Model: Pump/ Siphon Manufacturer: C~:S lr 1 Pump Size Z ff Elevation of inlet: Bottom of tank elevation: 7 2 Pump off switch elevation: Gallons per cycle:- 2 Alarm Manufacturer4 alAlarm Switch Type:' d Number of feet from nearest property line: Front, O Side, Rear Ft~_ c Number of feet from well: T_0, Number of feet from building:] (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: % Trench: e \ Width: Length: Number of Lines: ~ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,0 F't.~~ Number of feet from well: A Number of feet from building: ~l 6 (Include distances on plot plan). SEEPAGE PIT Size: Number f pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a dro box O or distribution box O been used on any of the above soil absorbtion terns? (Check one). 11 HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of in Number of f t from nearest property line: Front, O Side, Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: r ~ /l Dated: Plumber on fob License 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 1:1 CONVENTIONAL EWALTERNATIVE srfa.1 _nl.D.Number: ~t (Is igned) Holding Tank D In-Ground Pressure ntxMound 8i-08246S NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: ATE: Richard Stout Rt. 2, Hudson, WI 54016 7 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. P V.: JCS T REF. PT. ELEV.: NW, NE, Section 34, T30N-R19W, Town of St. Joseph, Lot 1, Stout Sub. Name of Plumber. MP/MPRSW No.: County: Sanitary Permit Number: Gary L. Steel 3254 St. Croix 88424 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER ROAD: PROPERTY WELL DING: (V : [OIL ENT TO FRESH ALARM FEET FRLINE: AIR INLET DYES ONO DYES ONO NDOSING CHAMBER: MANUFACTURER'. BEDDING: LIQUID C MP MODEL'. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER _ PROVIDED: PROVIDED: DYES NO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF JDISTR. PIPE SPACING COVER JINSIDE DIA 1tpITS LIQUID DIMENSIONS TRENCHES MATERIAL: PIT DEPTH. GRAVEL DEPTH FILL DEPTH OI STR. PIPE DISTR. PIPE DISTR. PIPE- MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING. V NT TO FRESH -BELOW PIPES'. ABOVE COVER. ELEV. INLET. ELEV. END: PIPES: LINE: AIR IN L T E. FEET FROM NEAREST-o-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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED ❑ YES SEEDED NO ❑ YES ❑ NO CENTER: EDGES. MULCHED DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH: W0 OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE pISTHIBU TION PIPE MATERIAL & MARKING ELEV.'. ELEV.: CIA ELEV.: PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO OYES ONO COMMENTS. PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING: FEET FROM LINE: DYES ONO OYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE'. DILHR SBD 6710 (R. 01/82) / v~ ~fQn '~-e.~v ~G~2 r CtJ EZ: ~ SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANNIIT/ARY MIT -Attach complete plans (to the county copy only) for the system, on paper not less than AN 8'/i X 11 Inches in size. STATE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. ~ ON 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETI TION FOR VARIANCE ❑ YES ❑ NO TPROPRTY O(WN~ER'S R PRO•''P,,ERTY LOCATION W '/a 61/4,S3 T N, R l E (or) W MAILING ADDRESS LOTUMBER BLO K UMBER SUB VI ON NAM C/ /fAr" CIT STA E ' ZIP CODE PHON MBER CITY NEARES TX'OAD,L E OR LANDMARK JaI VILLAGE : ..4 T • t 10. TOWN OF;e- II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 1-7 OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. ❑ Conventional b.Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e.X.,Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE '3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED ((SSquare Feet): PROPOSED (Square Feet): - Y-0 3 7_ 7 Feet Private ❑ Joint El Public VI. TANK CAPACITY in allons Total of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins lation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plu r' Signatur : (No Stamps) IJITr/MPRSW No.: Business Phone Number: Plu r' d ss (Street, Citt,Sta ZIP C S r ~V c ~ ~J Name of Designer: Y1 M&AA VIII. SOIL TEST INFORMATION ACed l Test er~T) NamCST ESS treet ty, State, Zip ode) Z Phone Number: f IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signa e ( tamps) ' FApproved ❑ Owner Given Initial Suurrcharge Fee Adverse Determination o CJ 9 p?,S 1 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the, State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment. 30 seat restaurant, etc.). Fill in number of bedrooms it building is a one or two family dwelling; Ill. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the ~ result of over 2 years of steady negotiation, and public debate. Th3 groundwater bill Groundwater - included the creation of surcharges (,tees? for a number of regulated practices which Wiscorisin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Treasure' is used in your building is returned t€. the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies =collected through these sjrc~iarges -,.-e ,_,edited to the grounrtwater fund adrrni ais- tered by the Department of Natural R- sou ce These funds are used for monitoring erou. ,J ~ f water, groundwater contamination in-est gations _i.ncdl establishment of standards Grt jnF ,,•ar~, - it's worth protecting. SBD-(-,398 iR.03/6) Ina 4.d nol 7:Li1S76CAO-7 1v w Y4 A) c -Y id' -71-eooi j2 ig 14 4-o wvti j --4 . a OS E ph, 54. e t4o l A -L v-.4- 14 cid n ~ASES Sys 4e yr ~ iq boo. oh ~E N. S. *4. P/,o 1 8608,246 worK 6hEEf #8, 5 ys ~E,-,-, 6N oss sE c_.,Ll o yl Y dos ~ n' Cp,,.~ r4w► b ~ r c V e.r . BUREAU r1 88 ~A Soh vra oo ppllxa) 4z S-. l D I L STATEN SAF SIN WILMN PRIVATE SEWAGE SYSTEMS OIVISWNOf SAfETYieUIL U1LDING3 PLUMBING M BUREAU OiaMnp on Avenue. Am 141 PLAN APPROVAL APPLICATION P.O. Box M9, Madison, wl 6370? soa-2etas/s .STRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration. Document Sales. 202 South Thornton Ave., P.O. Box 7840. Madison, Wisconsin 53707, Telephone (608) 2664A358. 1. PROJECT INFORMATION (Type or print cie") Revision To Plan Number: Name of Submitting Party (Plans rat mad to same) Project Name ARM ia o wv. Street i No. or R ral Route Project location - rest a No. or Legal Description S r % NE 5,3 -t-,3 K) 19 L 0 City or Village State Zip City County m W' Village OP h G i I ' Town D S Ls To epnone No. (Incuede area code) • 2- 4- - Z, O D Designer Telephone No. (Include area code) Owners me T I No. (include area code) -A r-4 - wolnd Street a KIWA Street a . City or Village State Zip city & illage t7 state ds ~ Z`° 2. APPLICATION FOR: New Mound System (3a) Groundwater Monitorinig (7) Conventional System - Public Building (1) Replacement Mound (4a) Holding Tank (2) Replacement Pressurized System (4b) System in Fi11 (1) Petition For Variance (6) New Pressurized System (3b) System in Flood Fringe (1) Other Alternatives (5) FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank - 50,00 4a. `SO 3b. 1,501. 2.500 gallon septic tank - 60.00 4b. 3c. 2.501- 5.000 gallon septic tank - 80,00 4c. 3d. 5,001 - 9,000 gallon septic tank -100.00 4d. 3e. 9,001 gallon septic tank -150.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 5W- 1,000 gallon dose chamber - 30,00 4g. p 3f " 1,001- 2,000 gallon dose chamber - 50.00 4h. 3i. 2,001- 4,000 gallon dose chamber - 70.00 41. 3j. 4,001- 8,000 gallon dose chamber - 90,00 4j. 3k. 8.001- 12,000 gallon dose chamber -110.00 4k. 31. Over 12,000 gallon dose chamber -150.00 41. 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 -10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank -100.00 4o. 3p. Revisions _ 20.00 4p. 3% Groundwater Monitoring Per Lot - 32,00 (other than a proposed subdivision) Subtotal 8 D - 3r. Priority plan review: walk through 4r. Submittal of plans in person. P4 by appointment, with double fee 3s. Petition for variance Setback - 25.00 4a. " r Site evaluation - 50.00 121 AUL Total Fee An NOTE Fees PNr wd to Wis. Adm. Co". Cha01e► Mid. M San.AT401 IN alas, ow be viblim to own" simaietty 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: TdUffiaffWMunicipality: S T 30 N/R 19 W St. Joseph St. Croix ,,;reet Address: Subdivision: County: Landowners Name: Mailing Address: Richard Stout, Rt. 2 Box 340, Hudson WI .54016 -.-I (We), ahe_ 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. 8608246 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 ands ed'i to all the conditions and obligations set out in this application, q q!`'{l~ ~G 6A OTA V .y Signature of Applicant Date • S d8 STATE OF WISCONSIN; Subscribed and sworn to before me COUNTY OF TF OF This day of 196 ary Public, State of Wisconsin DILBR-SBD-6413 (N. 05/81) My Commission Expires: / ° d ST. CROIX COUNTY k WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8383 (RIVER FALLS) HAMMOND, WI 54015 September 18, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Richard Stout property, located at the NW1/4 of the NE1/4 of Section 34, T30N-R19W, Town of St. Joseph, Lot #1, St. Croix County, revealed suitable soils at a depth of 2.42 feet, below which seasonable high groundwater was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Si erely, "Wadi d►"~ we 2 4 6 Thomas C. Nelson Assistant Zoning Administrator TCN/mj ~ G "y l... yY.. e WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY b 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 Nw1/4, NE 1/4, Sec. 34 T _ 3o N, R 19 Rx(=j W Town 7mQ 11 - tpltW st. Joseph Street Address Lot No. 1 , Block , Subdivision Landowner's Name: Richard Stout The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~..1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers-TssueTfo you. ) 6jone of the applications needing a quota number. The quota number assigned to this application is 59 - 14 - 7 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. lfor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established department. (.for an application on file prior to February 10 1980. LIfor 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. 0 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 4 1`~ conventional private sewage system, check here.0 a I'll s;l1R ~'i► I certify that the above information is true and accurate to the best of my -11!G knowledge. Name Thomas C. Nelson SigrrQtTre (County Official) Title Assistant Zoning Administrator Date September 18. 1986 DILHR•SBO-6158 (R 12/82) DEPARTMENT REPORT ON SOIL BORINM AND SAFETY.&BUILDINGS INDUSTRY DIVISION N LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 3 07 (HS3.090) & Chapter 145.045) TOWNSHIP/tuWBI'QlkAIkI TY; OT N JBLK NO.: UBD 3 jT N R (or)W -40A0Wd2 Ll / 11.11 rp FAMMk14MWWW*"-4 NAME* LINU AUUME35: A~A g ; ATES OBSERVATION ADE OMMERCIAL DESCRIPTION: FILE DESCRIPTIONS: PERCOLATION TESTS ~Mielntce .3 a LsNaW ❑Reploca 2 8 8 to 8~ Z 9. 04- 1 1 1701 RATING: Sr Site suitable for "am U* Site unsuitable for system o s r0S. YSTEM-11, 11L OLDING U TANK: RECOMMENDED 8YSTEMaoptional) If PMooiotioe Tests ire NOT required DESIGN A If any portion of the tasted ores is in the under s.H8300(8)(b►. Indicate: Floodplain, indicate Floodplain elevation: / PROFILE DESCRIPTIONS W)A BO q N ELEVATION =10 CHARACTER OF 301L WI I ri I HICKNEW COLOR. V I, TEXTURE, AN DEPTH B• 3 T ROCK IF OBSERVED E RV. ON BACK.) B- w 8 >v e- z 4,-,?- e 6n L. Z . S • B- B- B- 1 ' PERCOLATION TESTS Nt1MBER AFTER SWELLIN 1 T RVST TIME 8ROP IN WATER LEVEL-INCHES RXTE MNUTES AL-MIN. PER INCH AJ0 17P• p 'ley P• P- LOT PLANS Show locations of percolation tats, soil borings and the dimensions of suitable soil area. Indicate sale or distances. Describe what are the hori- mtal and vertical elevation rafansnce points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent ° ~'ZNA fI -l. Slot o• r 96 "=40' or As m . -6 PE wj n1,w)2F,, A+ loo' Am Y1 '~1,t w, p ~In frw, b e r. , I 8608246 Pt. u~ N SSE pas ~I-., n K T P1S \ ~0~~03`~' JAN% µ 1 i~ r -}vwW, ~E►i K~ BUREA OFTWNAL WORKSHEET L MOUND SYSTEM 11. IN-.ROUND PRESSURE SVSTEMCetttMw& 1. wNwwaw► LAaf. Total oawr rMw • 'SO w• IL Pore Main: Ore t. 11MR 83.15 (3) (e) Mktietuet Deft Raw • Arel.CNW tmr PROVIDE A DETAILED olatnew. LIST OF SIZING•ON PLANS. 2 11. Taal 0V"mk Neer: Paawe • - M V~rtkal lLM~ L Landde" t • 4L' is Frkdes Low 65 ft ONMNwNw yewm .ft TON • Aro f. tlaull ell Oilw "W Ntwaett IL Pump Sdedi t: SIN" 3 PooarONrlooft t Sl"• It 7 MOM" Am MWO aK K ow ryttM" ea AIN Rdlill" • a1. rt, PwM RN w Twed %Io (A)) ELL 13. Dees Vokw M Ttwdt SNtStO (C) • It TIMN VOW VMwm er D~ O 7: MUM WON OitetlkuNatt Lktes• .Li : 9 iM MNM (o! • )*'082 4 OaN1► M►aMawarr VNutua + , FIN Doptlt Oawadepe. (E) • R / OeMa M K Mra • r 8th or Trottdt WPM (r) A.► • ' x CM Gar TOP" ONIM (G) • ~ R MMMwe1 OeM ~ 1+'~LSi. C P ~M~/ TNMM Dspo (M) • A. 14. OEM CMM bMt Roo E. Nester LORI•. Vekeate is . a" Msow Oier (K) L+ieSllt (L) /I. TOW MM • IIL CONVENTIONAL PRIVATE MADE SYSTEM ' • Mttttd WWO 1. Nlapawaiw Leal. Tewl DdW fleet • v uPr.NCet'teilMtt►t>twr• Ote as XZMR 83.13 _t3) (a_ ~j Nit. :22 K Arta. CeN ad PROVIDE Al ` UPtieN W" (q • OewttllePa CnueNae PtWar • LIST Or SIZING ON PLANE. Dewodsps WWO (1) • .LL. h. 3. RegWtM fePde Took Ca/aeRl► • Teal Maud M& • fL >L hrodadm Raw • ...r:.~ ` If. 8twl Am= r. AbwPdm Aw gb" " Alts to Table Z in X&M '93' ~elMlralMa CaPNIq e% Nowd SAN • - 511".h, ft. ad PROVIDE A OETAI Or •aW Ana Reittira l • e1. Ry SIZING ON PLANS. *md Ana Av&W* • N• ft. t ReNtMd Ana • 1 t 'K Shear" Twoo frets ckow 3 ' ! ~~'1 is'4.~C. ..~~sM►Irtlt• I Inacat's TOW 1~. re► So DbW ttdMt Iletwerk, Use Nomben 5-14 In SesNae N. Number of T • Tnttdt S • M. NI~ROUNf1,PRtSfURt;YSTW, • S. O yewelt 1. OaPrt r L2-1.a S rataar • .:t R Leeph • l..'. Laerra~aP*: >r K Lawrak • ' vormok" pow 4. f0mo arSyaMee oboe toe • R DWaea from SmewaN Plfa• LL..~~r``T Daler P1e~ Sritatn Etavaetae nr_ ~ ' - ~ ,i WOW I i" wr PROVIDE A DETAILED SYSTEM•IN•PILL ~ - AM LIROr SIZING ONftANS. PNI M AN IMen beat SactleeJU ! RsNMw Sepik Took Capoft • .h_ r• IL AkeMPdW Aron SIdW V. SEPTIC TANK f ` 1: ' " r C7 U R pwookos Raw • 40 e1k^ 1. CaPaeity • Am moll" • IL Manufacturer: 4 S"IM LutMt • /L L Show Site Ceeeerueter Tw* DewMe em Pke ' Syaete M1NIA • R. T. OMMIMtINtt PEN f VI. DOSING TANK Nab on • ..,LT .lei. 1. Cap"Ity iMY SPadttR i' (1 L Manubduren Ldw d LrW11 • IL S. Puny Matwfmlwon { AWA On. le. 4. PUMP "a** LawdSPA* . n. S. oPNaft m uwatw fists ShMw.tN ~a rlp. h>. V. ; Pttiw Raw*. A ObWN u" "M Db&M a Rate: 7. 'Show SIN Ceegwger Took Doub ee.Plaa Ntttttkee itf Ilulea Mar PNt. 1kiwPetPUta -ra IStte. YII. IWI.DING.1ANK•'. ` !G MaelfeY SNMs 1. CapWAY ■ Tw. (eau or awl - LtteRtit • ft. 3. how Siw CeeNrttdNTaek OegIM ee Pkea OIiAaMI 106 -SHM #!L INFOMATWN ON PLANS- _ tats a1a fa~ea w+aeael : Page _ Of _ Straw, Marsh Noy. Or 62 4 03 Synthetic Covering Distribution Pipe Medium Sand Topsoil F 3 J ~ E p S x ~ ~c ~-~ad Of = 2 Force Main Plowed Aggr to Layer 4 r^ D Ft. a E 43 Ft. r 'Cross Section Ot A Mound System Using A Bed For The Absorption Area 79 Ft. V 7 G Ft. A S Ft. H 5 Ft. S ne d: B -47 Ft. License Number.: ftIO2 Gc~ Z S K fL Ft. Dates 6 Z Ft. J Ft. I Ft. W ~Z 97 Ft. L )bservotion Pipe--.,,, 8 K FA I Force Main Distribution Bed Of ' Zr- 2 %Z Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area ~G tWR!EAU a ` Page Of Pertereted Pipe Detail ~ n 860824,13 End View a PpterNel § RM irM PVC Pip* `i1We L@66led ON sell r ~ j ~ i Are s«~a tdsa PLUjW2jjq ~ . PEPART LA IONS MeM - ee w C" ' oistr*utien Pipe Layout P Ft. S X J Inches Y j Inches Hole Diameter Inch Siples1~ Lateral » Inch(es) FLL weme Number: YYIPQ40 3 Z 5'4 Manifold z Inches Date; Force Main " Inches F of holes/pipe_ Invert Elevation of lateralsm-lt. • ~~lY ► , PAGE: OP PUMP CHAM6ER CROSS SECTION ANO SPECIFICATIOUS VENT CAP ca. VEUT PIPE WCATNC& PROOF APPROVED LOGKIMG JUWCTION boy. MAWNOLE COVER ts' FROM won. WIpIDOW OR FRXSW IC141U. w~ W>4v►rt~rS ►.rlbL( AIR JUTAK9, I W+~'~ ~ GRADE 1 4 MuU. 00 I6' I't11J. COWDUIT L ~ IUILCT s'•~ ~ x, f R,~, PROVIO< 1 },y' RTIbNT SEAL 1 I I ~Ef fl ~ A , ' r a` ~ ` I t I APPRdVtO' J01 i 1~Rdvco 'jaw A 0.2. PIP! I I I t MBE txttNauR ALARM ExTE1J01" a OVl4 ~4-r OitITID >s0U0, 4, LLC~t.L..~.. F'C PUMP-~ Orr 0a ~1 CONCRCTC W=K -RI=CR CUT PCRAIWCD OIJLV' IR TANK m"PAGTURCR HAS SUCH AwvjAa'VA4: IG SURE - unn~ • sPEGIFI'cArtloAls ' oot>c • t,~ F E Ks ~e~~ ~ • zhum P"UFACTURCR: kX M tR OF 00693:- PER DM & _ TAIJK WZC: OAL.LOUG DOSE VOLUME 7 G MA~MIIACTURCK: , ~ 04 1t t4- INCLUOIN(a SACKFI.OMh "Li.0 ° - MODtL UWrIitR: CAPAGITIEtl A:- I=MICgtf OR L"1.. GALLOU SwIT.N "Opt: lm E y ay v IWCNts OR 1 GAEL 0 wl C., 'I 111CIilt OR 3'G GALLON NIAI►IU►ACTURCR• . AoDEL mumacc. S 1 37. O.~IIi1CNES opt 'l G 7~ GALLO 12 SWITCH -rvpc: Mee 11- m' e_~ COTE: PURP AMD ALARM ART TO et MIUIIMUM 01lGMARbC RATE r,►/~ INSTALL90 OU SEPARATE CIRCWTS Y%v"L OIFT91tuKt uTWtEY PUMP OFF AUO DISTRIbUT1OM PIPE.. FECrT Z Z. Z 9 G 7~I~/ln lilLtlllUlrt IJCTWORK Sums PRtSSURC ............~es~... IrLCT AP2 nr ic-r ou MAc.v*R..~_sal. FELT x Q'v D 3 FttT or FORCE pWU X ~2 231 TOTAL DWAMIC HEAD s fLET 3o • 41 rR RMl11,. OIMLiJS<10Nt Of TAIJK: LCA1(iTM~jWlOTH1LIQUID OC►TN .~b:.L~ '"~tV[ ~ LICEIJl~t IJ<IMOERi ~°Z S'~' DA•Tti C Submersible Effluent ~erfomance Curves Pumps MODEL 3885 .o SIZE 3/a" Solid 70 ~o ti yI ~~l A ~ x r N' IN i . Oa 10 90 3D 40 d0 so 70 a0 90 100 110 190 GM 0 10 90 - 30 WAR ~GOULDS PUMPS INC: UWA arks WN to~c O MODE SIZE2 4 6 f ' 110 1iFMr 30 10 ~o so To ~ ~f A. L. fi• Y y" 7~ p10 e ' 01 00 10 30 10 50 so 70 !0 90 100 110 19D am 20 0 10 2D 30111"AI CIMAWII H H y ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d 9 H OWNER/BUYER 8cl?A4op ~L _ ' ROUTE/BOX NUMBER Fire Number CITY/STATE lVgl/)501V PROPERTY LOCATION:jWV k, /Vi5_ k, Section 341 , T3C~) N, RW, Town of , St. Croix County, Subdivision ,,5/cVcii- , Lot number 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 606 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 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 H the standards set forth, herein, as set by the Wisconsin Depart- Fv 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. S I G N ED DATE 30 C96 St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. k ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 I September 18, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Richard Stout property, located at the NW1/4 of the NE1/4 of Section 34, T30N-R19W, Town of St. Joseph, Lot 91, St. Croix County, revealed suitable soils at a depth of 2.42 feet, below which seasonable high groundwater was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sin ere1y, Oyu ~I Thomas C. Nelson Assistant Zoning Administrator TCN/mj 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: 76=WMunicipality: NW 41 NE 14 S 34 T 30 N/R 19 W St. Joseph St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Richard Stout Rt. 2 Box 340, Hudson WI 54016 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 nT7MR-Q11T1_r./ 1'2 rM ns/Q11 My Commission Expires: 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, NE 1/4, Sec. 34 T 30 N, R 19 LAM) W Town ~ tftvx st. Joseph Street Address Lot No. 1 Block Subdivision Landowner's Name: Richard Stout The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers ssuec-to you.) one of the applications needing a quota number. The quota number assigned to this application is 59 - 14 - 7 . for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (....for an application on file prior to February 1, 1980. [_]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. 0 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 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 September 18, 1986 DILHR-SBO-6158 (R 12/82) PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DUSTRY, DIVISION BOR BOX MAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1) & Chapter 145.045) CATION: SECT,IpN: p ]p ITOWNSHIP/-~^UW1 ~o^I-TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1 3`t AgoN/R17I`~(or)W S . f T lrp~ O N Y: ZN'S 134W 41R'S NAME: AILING ADDRESS: If .1 S 1 SE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: t~1 PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 N LIJ New ❑ Replace I Q ~J 8-66 6-2 47 ATING: S= Site suitable for system U= Site unsuitable for system y •C. CJ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑s❑u ❑s ❑s u ❑s ud If Percolation Tests are NOT required DESIGN RATE: ~ If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:} / PROFILE DESCRIPTIONS BORING-TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DZ9I:W IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 36 n?o 0 -s1.1. 54 • S. 1-, .3 60 7, 5'0 00 0 B- B- B- ~~it~4t♦ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ A9 O 1,110 P- Z,°p No 30 / 3 3 ~o P_ 2 3o 145, 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 le, E _ v . E JZy E IE E v e 7 .....e... 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 (print):~ 4/" ~ TESTS WERE COMPLETED ON: _x_57~ ~ ~ 67-2- 1-~* b ADDRESS- CERTIFICATION NUMBER: PHONE NUMBER (optional): 91"'In cJ : *Z ?w 9l & 7S ^ z4,(, -lo Zee, CST SIG RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SBD-6395 (R. 02/82) -OVER - D 1 L 11IN' RU TIONS FOR COMPLETING FORM 115 - SEAL) H To be ` accurate snail test, your report MU: 2. TF y ether this is a residence or a 3. Tcial use planned; 4. _ E „3 SUITABL- , T LY IF ALL L , S. jnd con-, „g the plot plan; 7. I to A Iata, percolation test e)~ J- thc m.~r r, e box; IST BE FIL -D WITH THE _;AL -EVs,'- ? jOlL. T_ als F Is L sE I Bn *SO - SI Gy Y mot wil sic - a Pt (n - t L.. TC r J F APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Pj C P, LD- T Location of Property _&-14 k, Section , T N-R9 W Township Mailing Address Address of Site LSAZ-1 Subdivision Name _CST Lot Number Previous Owner of Property '21g A=©yz /-c Total Size of parcel yo Date Parcel was Created / 9 ze Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No volume T,7 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (we) eeAtiby that att .6tatement6 on this boAm ahe t1Lue to the but ob my (ouh) knowledge; that I (we) am (ah.e) the owneA (.s) o6 the pno pent y de,6 eh ib ed in this .inbonmation boon, by vi tue o6 a wanhlpozat y deed tec ed in the O bb~-ce o6 the County Reg.usteA ob Deed6as Document N'a Z ; and that I (We) ptuentty own the ptopoaed .6 to ban the dewage .ays e (on I (we) have obtained an easement, to nun with the above desc i.bed pnopenty, bon the eon6tnucti.on ob said .syetem, and the .name has been duty teeonded in the Obbtiee ob the County Regi.6teA ob Deedb, as Document No. 21-z SIGNATURE OV OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) . N l 1 r c~lJ , ~ 1GJ DATE SIGNED DATE SIGNED I