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Parcel 032-2056-50-000 01/31/2006 04:32 PM
PAGE 1 OF 1
Alt. Parcel 16.30.19.718B 032 - TOWN OF SOMERSET
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
PAUL E & CLEO R WENZEL O - WENZEL, PAUL E & CLEO R
500 150TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 500 150TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 16 T30N R1 9W 5A IN SW SW S 660' OF W Block/Condo Bldg:
330' OF SW SW
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1196/14 QC
07/23/1997 592/33
2005 SUMMARY Bill Fair Market Value: Assessed with:
77971 220,800
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 58,000 119,700 177,700 NO
Totals for 2005:
General Property 5.000 58,000 119,700 177,700
Woodland 0.000 0 0
Totals for 2004:
General Property 5.000 58,000 119,700 177,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 209
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 032-2056-40-000 01/31/2006 04:32 PM
PAGE 1 OF 1
Alt. Parcel M 16.30.19.718A 032 - TOWN OF SOMERSET
Current XST. 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
PAUL E & CLEO R WENZEL O - WENZEL, PAUL E & CLEO R
500 150TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 35.000 Plat: N/A-NOT AVAILABLE
SEC 16 T30N R19W 35A SW SW EXC S 660' OF Block/Condo Bldg:
W 330'
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1196/14 QC
07/23/1997 736/414
07/23/1997 699/586
2005 SUMMARY Bill M Fair Market Value: Assessed with:
77970 Use Value Assessment
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 6.000 700 0 700 NO
AGRICULTURAL FOREST G5M 3.000 6,000 0 6,000 NO
ENTERED BEFORE'05 CLOSE W8 26.000 52,000 0 52,000 NO
Totals for 2005:
General Property 9.000 6,700 0 6,700
Woodland 26.000 52,000 52,000
Totals for 2004:
General Property 9.000 12,900 0 12,900
Woodland 26.000 104,000 104,000
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
_S SEC. I ~D T 36 N-RI i W
OWNER ~AvVI h Z , TOWNSHIP cS p~-n g.
ADDRESS ' ST. CROIX COUNTY, WISCONSIN
LOT j # LOT SIZE
SUBDIVISION
PLAN VIEW
Distances and dimensions to meet requirements of I•ZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r~~ z
loo?
10,
IRL m tr4~nn b
i
i
log
5
INDICATE NORTH ARROW
~D
BENCHMARK: Describe the vertical reference point used ~ Z t~~ E~ la, gf.
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: c,..-'!> Liquid Capacity: cam,I
Number of rings used: ' Tank manhole cover elevation: /
Tank Inlet Elevation: Tank Outlet Elevation: 16) 10
Number of feet from nearest Road: Front 10 Side 0 Rear, O feet
From nearest property line Front 10 Side,® Rear, O / 3 T feet
Number of feet from: well ~S'd f`f , building: /
(Include this information of the above plot plan)( 2 reference dimensions to septic,ta
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: (.L~1616 5 Liquid Capacity:
-z
Pump Model: Pump/Siphon Manufacturer: Pump Size )dA6-0-
Elevation of inlet: Bottom of tank elevation: 7.9
Pump off switch elevation: Z rO
9 ~ Gallons per cycle:
Alarm Manufacturer: A ~w Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, Rear, Ft AS' ~
Number of feet from well: 4w 7/-
Number of feet from building: (Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: f Trench:
Width: 7 2 Length: Number of Lines:_ _ 7~
Area Built3
~
Fill depth to top of pipe: 552
Number of feet from nearest property line: Front, O Side, 0 Rear,0 Ft.~
Number of feet from well: Zoo,+ ICY
Number of feet from building: 8 f
(Include distances on plot plan).
SEEPAGE PIT'
Size: Number of pits: iameter:
Liquid depth: Bottom of seepag pit elevation:
Area Built:
Has either a drop box O or distribution ox 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 rom 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:
Al rm Manufacturer:
Inspector:
Dated: l Co Plumber on job
License Number:
k) '84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 UREA OF PLUMBING
_ 0 60 -
❑CONVENTIONAL MALTERNATIVE O Stale Plan Ito. Number
111 ass~pnnl
❑ Holding Tank ❑ In-Ground Pressure Mound 8603125
NAME OF PERMIT HOLDER.
ADDRESS OF PERMIT HOLDER. INSPECTInN DATE.
Paul Wenzel Rt. 1, Somerset, WI 54025
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: C~ I REF. PT. ELEV
SW SW, Section 16, T30N-R19W, Town of Somerset
Nam) nl Plumber MP/MPRSW No.:
COU nty- $an,lry Peimn Number:
Gary Steel 3254 St. Croix 83814
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQU I~ CAPACITY. TANK INLET EV. T K TLET ELEV J WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
BEDDING OYES ONO OYES ONO
VENT DIA. VENT ji1 'H WATEH N IF ROA PROPERTY WELL BUILDING NT TO FRESH
LARM17 ET FRO
O M LINE IAVIER IN LET
YES OYES YES ❑ AREST
DOSING CHAMBER:
n1nNU/P nCTUREN BEDDING LIQUID Cnf nCl7v P179 M F CTUHEH WARNING LABEL LOCKING COVER
PROVIDED . PRO~VID~ED-
('!J YES ONO v v v JYES UNO 1(~YES ONO
GALLONS PER CYCLE: PUMP ANOC ROLS OPERATIONA L NUMBER OF PHOPf Hlv WF LL HUILI)INIV IVINOIN11,1THIS11
(DIFFERENCE BETWEEN /~2 FEET FROM LINIt aS PUMP ON AND OFF) YES NO NEAREST-3w. 3oS~
SOIL ABSORPTION SYSTEM. Check the soil moisture at a depth of plowing FORCE LENGnI nlnMf n II 11TI RIAI nND ataIKIN"
or excavation. (If soil can be rolled into a wire, construction shall cease until Z T v
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH 1Y1 DTH JO NGTH NO OF DISTR PIPE SPACING COVEN INSID! DIA SPITS DUIU
TRENCHES MATEHIAL: PIT UFP111
DIMENSIONS
(Vf' n VEL UEPLH .FILL UEP 1""I UISTR PIPE DISTR. PIPE MATERIAL ND UISTR NUMBER OF
ABOVE CPROPER 1v WELL BUILDING VFN1 TOE T
LOW PIPES INI F ! ELEV END PIPES
fHl 91
FEET FROM LINE AIH INL
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
YES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PE HM11 AN( NT MnIIK! RS I)11SI IIVATH)N WI t i S
YES ONO LYYES NI
DEPTH OVEH THENCII BED DEPTI!OVf If THENCH BEU UEP TH OF TOPSOIL .S()I)UFU JSEE OF II
CENTEH c EDGES S MULCF1f D
J / OYES O YES ONO IVYES NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF LATERAL $PACIN(i ,HAVEL DEPTH BE LOW PIPI- 111 L OFP111 ABOVE COVE H
7 TRENCHES
DIMENSIONS \
MANIF OLU PUM MANIFOLD DISTR. PIPE MANIF OLOMATEIIIAL NO UISiN UIS1R PIPE I) IS T)iitI III IU N PI I' 1 M TIIH AI &MA I IKINt,
ELEVATION AND ELE Y, E DIA ELEV PIPES DIA 'l
DISTRIBUTION _/Z' V
INFORMATION HOLE SILF 1OL`SPACING UHILLEU COHlIEC11v COVFR MATERIAL
vEHnc I L u r coflHf svlmus ru nPPRUVI u
3(/- .1 PLANS
YES t?:] DYES ONO
COMMENTS: PERMANENT MARKERS: LC N
UMBER OF PROPERTY WELL BUILDINGES ❑ NO ❑ NO NEARESTOM LSEIo 2 O
FEET I
Sketch System on Re i n count file for audit.
Reverse Side. Y
SIGNATURE I/ TITLE
DILHR SBD 6710 (R. 01182)
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than I. /
8% X 11 inches in size. STATE PLAN I.D. NUMBER
-See reverse side for instructions for completing this application. t 2S
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION
FOR VARIANCE ❑YES ❑ NO
PR OWNER PROPERTY LOCATION
T3 C), N, R V<or) W
PRO- ARTY QWNE S MAILING ADDRESS LOT NU BER BLOCK NUMBER LNE~REST VISION NAME 14
C Y, STATE ZIP CODE PHONE NUMBER CITY ROAD, LAKE OR LANDMARK
Q yr%(!
U) `f-tJZ
TOWN VILLAGE S30 -6,4 At/
11. TYPE OF BUILDING OR USE SERVED: XA.-~6
Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): T~
III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable)
1. a. ❑ New b. Nn~ 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. E:1 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. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA q4, ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square FeeROPOSED (Square Feet): 8 7
VI. TANK ft Feet Private ❑ Joint ❑ Public
I # of Prefab. Site
INFORMATION Tanks Manufacturer's Name Con- Steel Fiber- plastic Exper.
Concrete structed glass qpp,
Se tic Tank or Holdin Tank ❑ ❑ ❑ ❑ Lift Pum Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT 'SCI
I, the undersigned, assume responsibility for inst lion of the private sewage system shown on the attached plans.
Plumber's Name (Print): Plum r' ignature: ( S
AAP/MPRSW No.: Business Phone Number:
k. & & 13--?-:5-
-5 A?w
Plu ber's Ad ress (Street, City, State, Zi e):
Name of Designer:
N • 1
VIII. SOIL TEST INFORMATION .
Cgee d Soil Tester (CST) Na e
CST #
CDDRE S (Street, City, State Zip Code Z Z
14
4!9 ^ Phone Number:
-7 M h"- - 1 " ` -6
I . COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee
Adverse Determination yO 2~ ! (p
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) 'o 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, usualby'every 2 to 3:years;
6. If you have questions concerning your privates: sewage syste contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's nar;-ie and maiiing address. Provide the legal description where the system is tc be
installed;
ll. Type of building or use served: I public `s checked, indicate type of use (i.e. 10 unit apartment, K seat
restaurant, etc.). Fill in number of bedrooms if 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'/Z 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. The groundwater bill uroundr:ater -
included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's '
can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried jr.a ,ure
is used in your building is returned tc the groundwater through your soil absorption i!
-system or the disposal site used by ysur holding tank pumper.
The monies collected through these Surcharges are credilted to the groundwater fund adminis-
tered by the Department of Natural R sources. These funds are used for monitoring ground- t
v,A,°ater, groundwater contamination in,,esti,gati,-?ns and establishment of standards. 'groundwater,
it's worth protecting.
SBD-6398 (R.03/86)
H
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a
ST C- 105 r
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a
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
ry
/J a
OWNER/BUYER j~i~G/L Cam' =AIZ L ! ~
ROUTE/BOX NUMBER_ L~ ,c Fire Number
.CITY/STATE C/!'`/L-
l) S L= T Z IP
PROPERTY LOCATION:, Z& k, ,'het) k, Section , T 3GJ N, R _W,
Town ofJ/'"I~/c~S~% , St. Croix County,
Subdivision Lot number-"V4
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
0
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- b
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Z=ffige in 30 days
of the three year expiration date.
SIGNED ,mar
DATE
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.
d~
RECEIVED
we n z AN 1
t/ / l o 1 Dept. of ~j,,y, a' KJ t0lotionF~ ~frlah►~y
86031;25
P~ ~o17
7~~
PRIVATE SEWAGE SYSTEMS STATE Of WISCONSIN DILHR
[73 D I L H R BUREAU OF PLUMBING
PLAN APPROVAL APPLICATION P 201 Box 7969, Maalson wi 53io71
608-266-sells
INSTRUCTIONS: 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) 266-3358. C11 da C& CA 4 6% Pd
1. PROJECT INFORMATION (Type or print clearly) Revision To Plan Number:
Name ubmitting Part (Plans to ed to same) Project Name
r 7- / pG1~
Stree QNo. o ural RouteProject Location Street & No. or Legal Description 41
fL -,''k t,/, ~kd t~ i ~i • i ' /~i yC' K~JI
City or Village State Zip City ❑ County
L \ f Village OF:
! / f f 1 j ; ! L ! Town
Telephone No. (Include area code)
1121.s z 6...e ~ v
Designer Telephone No. (Include area code) Owners N e Telephone No. (Incl de area code)
Street & No. Street & No.
Inr
City or Villag State Zip City or Village ate Zip
'50 /Y1,6 V L r . ~ Zs
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 Fill (1) ❑ Petition For Variance (6)
❑ New Pressurized System (3b) ❑ System in Flood Fringe (1) ❑ Other Alternatives (5)
3. 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. .SJD
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 - 15,000 gallon septic tank -150.00 4e.
3f. Over 15,000 gallon septic tank -250.00 4f.
3g. 500- 1,000 gallon dose chamber - 30.00 4g. • _
3h. 1,001 - 2,000 gallon dose chamber - 50.00 4h.
3i. 2,001- 4,000 gallon dose chamber - 70.00 4i. ,t
3j. 4,001- 8,000 gallon dose chamber - 90.00 4j. +f Flj~ 1 gam' _
3k. 8,001 - 12,000 gallon dose chamber -110.00 4k.
31. Over 12,000 gallon dose chamber -150.00 41. per yot Inn uSt r
3m. 500- 5,000 gallon holding tank - 30.00 4m. f°4 rr~ktl►
3n. 5,001 - 10,000 gallon holding tank - 55.00 4n.
3o. Over 10,000 gallon holding tank -100.00 4o. _Eli-
3p. Revisions - 20.00 4p. ' Nom,\~
3q. Groundwater Monitoring Per Lot - 32.00 4q. ~
(other than a proposed subdivision) Subtotal o • O c? n
3r. Priority plan review: walk through 4r. .a \1
Submittal of plans in person,
by appointment, with double fee
3s. Petition for variance
Setback - 25.00 4s.
Site evaluation - 50.00
Total Fee C. (")C)
NOTE: Fees pursuant to Vile. Adm. Code, Chapter Ind. 69
S60-6748 .R. 8/85) may be subject to change annually
Ef ectlve July 1, 1984 rn --OVER
STATE OF WISCONSIN-DT'- -IENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF c;-AY & BUILDINGS - BUREAU OF PLUMBING
P.U. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Township/X0MEXKJ3[Ltt X:
SW 14 SW 14S 16 T 30 N/R 19 XRWW W Somerset St. Croix
Street Address: Subdivision: County:
Landowners Name:
Mailing Address:
Paul Wenzel R. R., Somerset, WI 54025
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. 86 Q 3 1 2 5
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 alternatile 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 serve
dd,, O
by an alternative system and further agree to give the buyer a copy of thiq~oE1V~
application. fir"' q ~1ty.r';J
L tJ
N\`\ ' P
The Bureau accepts this application subject to this understanding and subje~t \G ~~~RE
to all the conditions and obligations set out in this application.
Signature of Appl nt Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS. COUNTY OF This day of 19 .
Notary u io; State of Wisconsin
DILHR-SBD-6413 (N. 05/81) My Commission Expires: O
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
~ 15
796-2239 (HAMMOND)
j 425-8363 (RIVER FALLS)
HAMMOND, WI 54015
May 29, 1986
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, K 53707
Dear Sir:
An on site investigation for the Paul Wenzel property located
at the SW-4 of the SW14 of Section 16, T30N-R19W, Town of Somerset,
St. Croix County, revealed suitable soils at a depth of 2.25 ft.,
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 C
office. J
Sincerely,
Vj I` _ Ors .
Thomas C. Nelson
Assistant Zoning Administrator
m3
4~ '`.J J
nc,
L
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 Sw 1/49 Sw 1/4, Sec. 16 T 3_N, R 19 XU W
Town oQfftMJCJp$cx Somerset Street Address
Lot No. Block Subdivision
Landowner's Name: Paul Wenzel
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:
[..1to have one of the first five approvals guaranteed for this year. This is
number - - of those applications. (Use one of 48631 tf `5
4T
quota num ers~ssueUyou. ) one of the applications needing a quota number. The quota number assigned to
this application is - -
❑ for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
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.
[jfor 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:
Da failing conventional soil absorption system.
❑a holding tank that was installed and in use prior to February 1, 199
❑ a privy that was installed and in use prior to February 1, 1980. 3,N, ~~R~CPU
If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a~U~~lG4
conventional private sewage system, check here .0
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Nelson Si re
(County OfficiaTj
Title Assistant Coning Administrator Date May 29, 1986
DILHR-SBD-6158 (R 12/82)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR P.O. BOX 7969
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
1Q~ (H63.09(1) & Chapter 145.045)
n~ S Y: OT NO.: BLI~. NO.: SUBDI VISION NAME:
LOCATION. SECTION: VJ %T~oN/R/ / or) W TOWNSHIP/
~
COUNT WNER YER'S NA MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
DESCRIPTION] NO. BEDRMS.: PROFILE DESCRIPTIONS: OLATION TES
neesidence ❑ New Pk-place
RATING: S- Site suitable for system U- Site unsuitable for system ~r
ONVENT AL: MOUND: IN-GROUND-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
O S U ES oU . E] S Cpl EIS ®•U EIS ISU
If Percolation Tests are NOT required DESIGN RAT : If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
109 s, m PROFILE DESCRIPTIO1860 3 2
BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- Cow
917 8: ,7% d'' 6.
B- z o z An s.. z L . I ~.s. , - f L
B-to I
B- RE
B- 1r'a - Pu
fS~ PERCOLATION TESTS ~~8~•
TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES
NUMBER hN@MES AFTER SWELLING INTERVAL-MIN. p p R PER INCH
P O
P. z J90 'O o? y 7
P- G 7 /
P-
P
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. Ai1r7
l_
,00 w~.e
4603125 ~5' ~303~#
800 ,
' ► Bm ~o
o
76
i
uMghG 8U
PLUMBING
LY~S. v r~ econaililona
DEPART APPROVE
L
y,~ PLLA~;~N~
DIVISIO OF SAFETY AND BUILDINGS
- - ------T Z1.2
SEE CORRESPCNDENCE
OPTIONAL WORKSHEET -
1. MOUND SYSTEM II. IN-GROUND PRESSURE SYSTEM-Continued-
1. Wastewater Load, Total Daily Flow gal. 10. Force Main: ,
Use s. ILHR 83.15 (3) (C) Minimum Dosing Rate = r~gpm
Adm. Code and PROVIDE A DETAILED Diameter = in.
LIST OF SIZING ON PLANS. Jr 11. Total Dynamic He> ^
2. Depth to Limiting Factor = ft. System Head = ~`G)r► 2.5 ft.
3. Landslope = 2, Vertical Lift = 3btL~L. ft
4. Distance from Dose Chamber to Friction Lou = i,jft.
Distribution System = ~ 0 ft TDH ■ Z ft
S. Elevation Difference Between 12. Pump Selection:
and Distribution System ■ ; .Y1.. R. Pump wIU discharge at isast SptnV601-
Pump 6. Absorption Area Sizing: at Left total dynamic head.
Area Required ■ 7"5-
94. ft Pump n ~I and ratan t tier O u 1 a
Bed or Trench Length (B) ■ ft 1N+dr Og~ S
Bed or Trench Width (A) ■ ft 13. Dose Volume:
Trench Spacing (C) ■ ft. 10 Times Void Volume of X.Q
7. Mound Height: Distribution Lines ■ _L_L_ gal.
Fill Depth (D) Daily Wastewatef Volume
Fill Depth Downslope (E) ■ 0 Z ft 4 Doses M 24 hrs. ■ gal.
Bed or Trench Depth (F) = ' ft Backflow = gal.
Cap and Topsoil Depth (G) = ft Minimum Dose = + gal.
Cap and Topsoil Depth (H) _ ' ft 14. Dose Chamber: ^ -
S. Mound Length: Volume i
= rOiti
End Slope (K) _ ft
Total Mound Length (L) = ft 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. Wastewater Load, Total Daily Flow ■ . gal.
UpslopeCorrection Factor = + Use s. ILHR 83.15 (3) (e), Wis.
Upslope Width (1) = ft Adm. Code and PROVIDE DETAILED
Oownslope Correction Factor = O LIST OF SIZING ON PLANS.
Downslope Width (1) = ft 2. Required Septic Tank Capacity ■ gal.
Total Mound Width (W) _ ft 3. Percolation Rate = min./in.
10. Basal Area: 4. Absorption Area Sizing:
Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83
Natural Soil = ' galjsq.ftjday and PROVIDE A DETAILED LIST OF
Basal Area Required = sq. ft. • SIZING ON PLANS.
Basal Area Available = sq. ft. Required Area = sq. ft.
11. If Standard Tables from Chapter ILHR 83 Length = ft.
are ''used, Indicate Table # Width = tt.
12. For the Distribution Network, Use Numbers S-14 in Section 11. Number of Trenches =
Trench Spacing = ft,
11. IN-GROUND PRESSURE SYSTEM ~ 5 S. Distribution System:
1. Depth to Limiting Factor = Z ft. Lateral Length = ft
2. Landsiope = % Number of Laterals =
3. Percolation Rate = min./in. Lateral Spacing = In,
4. Proposed System Elevation = ft. Distance from Sidewall to Pipe
S. Wastewater Load, Total Daily Flow: V ro gal. System Elevation = ft.
Use s. ILHR 83.15 (3) (c) , Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEMdN-FILL . t.
UST OF SIZING ON *PLANS. Fill in All Items from Section III J .
Required Sepik Tank Capacity = in co, gal. 1 I g1~R ~u
6. Absorption Area Sizing: q~ V. SEPTIC TANK
Percolation Rate = _'~s="7 min./in. 1. Capacity = (Er(S CDC/),- - L A gal,
Area Required = 317S sq, it. 2. Manufacturer: S
System Length = s5 ft. 3. Show Site Constructed Tank Details on Plan
System Width = ft.
7. Distribution Pipe Sizing: VI. DOSING TANK
Hole Size ■ in. 1. Capacity = 0.V gal.
Hole Spacing = ft. 2. Manufacturer:
Lateral Lenalh - A. Pump Manufacturer: 41g 56
Lateral Site in. 4. Pump Model: Idd O
1.4ter41 SP40119 ft. S. Operating Head■ ft.
Uislaoa+ from Sidewall •141 1111x 2_ ice. 6. Flow Rate= BBD gpm.
K. Distribution Pill Discharge Rain: 7. Show Site Constructed Tank Details on Plans
Number of I loks Per Pipe
I low Per Pipe r 1tpm. VII. IIOLDING TANK
y. Manifold Siting: 1. Capacity = gal.
'type (center or und) ,_.tr YN d~ 2. Manufacturer:
Length = 1't. 3. Show Situ Constructed Tank Details on Plans
Diameter in.
-SHOW ALL INFORMATION ON PLANS-
L DILHR SBD4761 (R.03182)
Page Of _
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
G
Topsoil. F
3 1i E u p .
% Slope
PLUMBING Bed Of 2 %2 Force Main Plowed
CO~Jiliona1 Aggregate Layer
APPROV D Ft.
DEPARTMENT OF WDLIST RY LABOR AND HUh<<Ad r,~AlpggSSection Of A Mound System Using E ' L Ft.
DIVISION OF SAFETY AND BUILDINGS F 7.5 Ft..
A Bed For The Absorption Area
G Ft.
SEE CORRE DENC -
A ~ Ft. H 5' Ft.
Signed: B S5 Ft.
License Number: 32 5~/rr,P,n.S.tJ. K Ft.
Date: -9 - 8~ L.~~ Ft. J 9 Ft. 8603125
Alternate Position r Ft.
of
Force Main W a 7 Ft.
L
Observation Pipe
B - K
A i•----------------------
------~i Force Main
W T
Distribution Bed Of %M- 2 %N
Pipe 2 2
I Aggregate
Observation Pipe Permanent Markers
, :JJ
J
P~
v~B`hG g!1
Plan View Of Mound Using A Bed For The Absorption Area
Page _ Of _
PLUMBING
conwilio"11,
Perforated Pipe Detail DEPART A PON
MEN
T OF INDUSTRY LABOR 0VVwLJ
A;°dD H~i~,~;a;~
D IVISION OF SAFETY ND BUILOI~JGS J r'~LATION
n
End view SEE CORRESPONDENCE
Pertaoted
End Cop y' PVC Pipe
a~`Ob\~ce
Holes Located On Bottom,
S Are Equally Spaced
S
Q
PVC Force Main
i ~
PVC
Manifold Pipe
,n
Distribution ~ Alternate Position of
G Pipe Force Main
Lost Mole Should Be
Next To End Cap
l End Cop
Distribution Pipe Layout P S3 Ft.
'"03 12 5
R 3
S -
X J Gs Inches
Y , Inches
Signed: Hole Diameter VL1 Inch
• Lateral / e V2. Inch(es)
License Number: 1. Z 5 ~ Manifold 2- Inches
Date: lo!-Q 8~ Force Main 2 Inches
# of: holes/pipe
Invert Elevation of Laterals-?Ft.
Izi I Ski ~Ll'L4, zn"Ic; 33 "'S '4 48, Sl, S3 ® 1
r v
Alk.
`~Rp U
Z LI "s = u2.~ t c,Pin ~3S r wnQ1~G .
l~
rrPAGE L OF ~Z
' PUMP CHAMBER CROSS SECT°IOW ARID SPECIFICATIONS
VC WT GAP
4'C.Z. VENT PIPE
WCATNCK PROOF APPROVED LOCKING
JUUCTIOW OOx PIANHOLE COVER
?',LS' FROM DOOR.
WINDOW OR FRESH It MIL!. I q~ S 0
AIR INTAKE I V
GRADE
4L 16 ~ 'I' MIN.
~ i0"MI►J.
COWDI 'IT
INLET "PROVIDE I
~ AIRTIGHT SEAL I I i lJf P
1 v
APPROVED Jolki T A I I i I h p APPROVED .1011JTS
W/C.I. PIPE I I I W/C.X. PIPE
EXTENDING 3' I II ALARM EXTEUDIUG 3'
ONTO 601.10 SOIL 4 I ; I ONTO SOLID 601E
`VMllXNG o i ON
~6! P {
I RtrCE1VED
CLEV. ! F'E UMP --J
-
O►i I~tit!
D
~A1JCRETE DLO gUF
PL~IM~
-4 #s APPOW
' Kiser. ,~1~.~J'~PEp1 °I~,MyiKIUFACTURER HAS SUCH APPROVAL. 3gE00SO
`SPEGIFIGATIOAIS 2 5
SEPTIC 6Q31
DOSE Wee S ~ of) t' N
T_aNK~ MAIJUFACTURCR: t~ NUMBER OF DOSES: I _PER oAa
TAWK 51ZC: 80d GALLOWS DOSE VOLUME as
" ~ GALLONS
ALARM MANUFACTURER: INCLUDING OACKIFLOW: g
MODCL AIUMOCK: CAPACITIES: A$ LL_WC14ES OR 59-1*~~ GALLONS
SWITCH TyPL: G r^ yz,-/ D -.INCHES OR AwPi'Lol
PUMP MANUFACTURER: INCNES ORMODEL WUMDCR: G233 885 D-...LZ_INCHES OR 247 GALLON,:
SWITCH TYPE: NOTE* PUMP AND ALARM ARE TO OC
MINIMUM DISCHARGE RATE d 6PM - INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND .013T DUTION PIPE.. = FEET
t MINIMUM NETWORK SUPPLY PRESSURE ~ -2.5 1FL5T 2 2. 24,, $n /--r),
♦c FEET OF FORCE MAIN X SA~f/oofLFRIC7IO►1 FACTOR.,o~.2~ FEET ✓r,JX 2)e
= TOTAL. Dy1JAMIC HEAD = A112Z FEET 2.3)
a~aJ
IWTERNAL. 004L W610146 Of TAWK: LEWGTH ;WIDTH ;LIQUID DEPTH
010
9I0iJED. LICEIJSE WUMBER: 3Z.SSL DATE.
Submersible Effluent
Performance . curves Pumps
METERS FEET
- 90 MODEL 3885
25 SIZE 3/4" Solids
wE1SH
70
20 WE10H
60-
15- E~H
50- 4-j I I
WE
40
10
5 2Q
Qu 1M P 10
0 0
o 10 20 30 40 50 60 70 60 90 100 110 120 GPM
L
0 10 20 30 rWlh
ITY
~GOULDS PUMM INC.
S84SCA FALLS PEW NOW GW8
METERS FEET
120 MODEL 3885
35 110 wE,sHH SIZE 3/4 Solids
100
25
rr
70 , J J
20 ~ t r
c tiG gvaEPV
1-
cop-
so WEO6HH
15
40
10 30
20
5
10
0 0
0 10 20 30 40 50 60 70 60 90 100 110 120 GPM
0 10 20 30 ml/b
CAPACITY
01OW Goulds Pumps, IM Elb*A July Im
L
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON W1 53707 P.O. BOX 76
HUMAN RELATIONS
(H63.090) & Chapter 145.045)
LOCAjTION: SECTION: TOWNSHIP/ Y: LOT NO.: BLK. NO.: SUBDI ISION NAME:
S 1 k~/a /T9oN/R /ft(or) W -S Tn s
[COUNT WNER' BUYER'S NAM MAILINU ADDRESS:
i. A
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER L DESCRIPTION: 177
LE DESCRIPTIONS: PER OLATION TESTS:
Nesidence 3 / ❑New eplace
7 RATING: S= Site suitable for system U= Site unsuitable for system C~ 7` CCU
CONVI=NI1ONAL: MOUND: IN-GROUND•PRESSUR_E:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
OS U IsS ❑U ❑S ill OS gU E]Sf3o
If Percolation Tests are NOT required DESIGN RAT I If an
y portion of the tested area is in the ,61
under s.H63.09(5►(b), indicate: Floodplain, indicate Floodplain elevation:
a i PROFILE DESCRIPTIONS
&S
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
87
z _
B-
51119 9 1`7 -0 2 3.q~ 147-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I'PdGlES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIO 3 PER INCH
P- / ca ?
P- z r ~o o a 6? a 13
P- (m 7
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 ~ S15''1y1
e
S~` pro ~ ,a► ~ ~ '
E
E
I
_71" J
E
I
3
E
3
.
E r78/
{ . _ . _ T ._.q 7 .
E E
E- E
i
-
F
1, the ndersigned, 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) TESTS WERE COMPLETED ON:
ADDRES CERTIFICATION NUMBER: PHONE NUMBER (optional►:
.the r~ t d 17 z 71s-z~
CST SIGNA
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER -
INSTRUCTIONS FOR COMPLFT.ff", r-~n 115 - 36 - 6395
a y
To be a complete and accurate sail test, your red
3. coy-P' l ciescrir rr;
2, T~ rnL I ~.:a' - whether this is or corns, ject;
, M, r commercial use
4.
A SITE IS St IT _E FOR A TANK ONLY IF ALL
6 e 6 .,scrlptic s -1 the plot plan;
? ns. ` e preferr- A
p-
q q - appiupriate box;
l.. iLED WITH THE
L; Y
`ITII FOR s F3.
col.
s[t'
4
fin st in )u .y it may r,.,.u-t
r ti it
t ~
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ / MADISON, WI 53707
(H63.090) & Chapter 145,045)
LOCATION: SECTION: TOT NO.: BLK. NO.: SUBSION NAME:
'/0/ /TS0N/R/ t(or)W x9 ~J
COUNT WNER' BUYER'S NAM IMAILING
ADDRESS:
(2-
USE DATES OBSERVATIONS MADE
JNOBEDRMS,: 160-m-ME-1 L DESCRIPTION: PROFILE D RI TIONS: R ATION TESTS:
esidence / ❑ New eplace z -
RATING: S= Site suitable for system U= Site unsuitable for system .j' _ rj (~J CO
ONVEN I IONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
EIS U M EJU ❑S a [IS ®.U DS~II ~
If Percolation Tests are NOT required DESIGN RAT : If any portion the tested area is in the
under s.H63.09(5)(b), indicate: Floodptain, indicate Floodplain elevation:
Q& Mn I PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER ELEVATION OBSERVED EST. H GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
-5 7
B- I ~o ~Z
3 I 11 1
MO A) ,
"s I i
'Z 75 4 7- A
B- 'Li m mdsi.M-6s, /11-61?
B- 3 g 917 o
B-
B-
B-
ESr' PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER itde'I S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH
P- 0 7114 -
7 JV4 P_ z 6 r 00 o o? o? Y 73
P- Z&7 &TC-) -3e) Rik
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. ~17 , /
- 9 "4,, 1191
SYSTEM ELEVATION
i"Q
E ( i
l
L I
,
. t
134
N,
I
f
I
,
- jj
,
• t
Su I9-Y+4_ S I' 0 A' M Rr 1t fey'
1, the ndersigned, 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) TESTS WERE COMPLETED ON:
ADDRES • CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST S I G N A
.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
I` DILHR-SBD-6395 (R. 02/82) - OVER -
(:~DILHR PLAN APPROVAL Safety and Buildings Division
Bureau of Plumbing
P.O Box 7969
❑ General Plumbing Plans Madison, WI 53707
~l Private Sewage Pla Telephone: (608)266-3815
Plan Id~nLihcati~~n "'o
G
et' ,~J~y Gallons Pcr 1)<1y
PRIORITY PLAN REVIEW ONLY
Plan REvit'V, 1 00 R(~ ci~~ <1
P(^ti6on i Or ~`tirit~naFec KE c
Project Name Project Location - Street No. or Legal Description
n ` ~t t.~ ~t.,J 1 tr -
ounty
❑ City ❑ Village ® Town of: 5 O,Q-q -70-A- - ~ ~ FO%Y,.
The plumbing plans and specifications for this project have been reviewed for compliance wit app ica e co e 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.
~I FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) Q4a (4b) (6) (7) (04 j
This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary
permit expires.
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 Plan~pproved By: Date Approved:
Contact Zc
rte. ~4.r.t^
cc: K Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health
A County ❑ Local PI ❑ Facilities Need Analysis Section
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other
SBD 6678 (R. 08/85) (Plb 100a) (Wis Stats. S. 145.02)
STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILDINGS
kL BUREAU OF PLUMBING
Portion Of This Form With 201 E. WASHINGTON AVE. RM 141
Any Return Correspondence P.O. BOX 7969
Private Sewage System Only - Does Not Include General Plumbing or MADISON, WI 53707
reviews that must be submitted to the Bureau of Buildings & Structures. 608-266-3815
DATE: ? PROJECT:
~e Paul Re iu~ ice
l•
Ip
88, NGrtti &-wre Drivt
f~~5+ R1cti iron, W1 40,1- PLAN ID.#
Aso-~1t
DETACH HERE
X
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $ C_ 'C, ' < Fee Received is $ 8Q.0,0
Plan accepted for review. ❑ Underpayment-Please submit additional-fee. Plans will be held in abeyance.
Additional information required-SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance.
Overpayment-Refund forthcoming. ❑ Plans being returned.
1. Plan Submission ❑ Soil boring and percolation test data on 115 completed
❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy)
specifically noted. ❑ Petition For Variance signed by county, owner and
❑ Plans not clear, legible or permanent. notarized. (1 copy)
❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building,
stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy)
Administrative Code. ❑ Affidavit enclosed. ❑ Common Ownership Plumbing System Easement. (1 copy)
❑ Plot plan showing location of land parcel (distance from
nearest road intersection; etc.); lot size and all distances from IV. Holding Tanks
private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile.showing vent, manhole, alarm;
course, swimming pools, water service piping, all weather ser and manufacturer if state approved. Complete
vice road, etc. Show benchmark with permanent elevation. construction details if site constructed.
❑ Holding tank agreement signed by owner and local
Il. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed).
Application for Useof an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from
and notarized. (1 copy) county or soil boring and percolation test data on
County onsite required. (1 copy) ❑ Design calculations. " 115 completed by CST, showing that a soil absorption system
Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel.
Certified Soil Tester. (1 copy)
❑ Cross section of system. ❑ Pipe lateral layout. V. Dosing Information
❑ Plan view of system. ❑ Calculations for total dynamic head and gallons
Verification of Exception Status Form by county. (1 copy) pumped per cycle:
❑ Size, length and depth of force main.
lli. Private Sewage Systems Detail and model of pump or automatic siphon, including
❑ Ground slope with 2' contours in entire area of soil absorption size, pump curves; drawdown, and average flow rate (GPM).
system extending 25' minimum on all sides. ❑ Cross section of dosing tank showing pump(s) or siphon(s).
Location of area suitable for replacement system - provide soil
data. VI. Systems in Fill (Fill must be placed prior to plan submission.)
❑ Construction details of septic, holding or dose tank if site ❑ Total area filled (fill to extend 20' beyond edge
constructed, or tank manufacturer if state approved of trench before side slopes begin.)
Construction details and cross section of soil absorption ❑ Depth and type of fill.
system: ❑ Copy of signed onsite report by county or district staff.
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ARV;
Y y, 0 fi q{ `vr~?
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
May 29, 1986
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Paul Wenzel property located
at the SW`-4 of the SW-4 of Section 16, T30N-R19W, Town of Somerset,
St. Croix County, revealed suitable soils at a depth of 2.25 ft.,
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,
07 -v
Thomas C. Nelson
Assistant Zoning Administrator
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: Township/IJ=MKCW:
SW i SW ;41S 16 T 30 N/R 19 9t9020 W Somerset St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Paul Wenzel R. R., Somerset, WI 54025
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
Signature of Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF This day of 19~
Notary Public, State of Wisconsin
My Commission Expires:
DILHR-SBD-6413 (N. 05/81)
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. Croix
Location Sw 1/4, Sw 1/4, Sec. 16 T 30 N, R 19 xfx W
Town orAftk4W14 Somerset Street Address
Lot No. , Block , Subdivision
Landowner's Name: Paul Wenzel
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
numher - of those applications. (Use one of the first five
quota num ersissueT to you.)
[ ]one of the applications needing a quota number. The quota number assigned to
this application is - -
❑ for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
[-]for an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by the
department.
[._J 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:
[la failing conventional soil absorption system.
v a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a
conventional private sewage system, check here .0
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Nelson
SigFmt
re
County Official
Title Assistant Zoning Administrator Date May 29, 1986
DILHR-SBD-6158 (R 12/82)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property 1,J C_ L_
Location of Property _y ;4
14 Section , T N-R
~ W
_30
Township
Mailing Address 2 1, 2
a
Address of Site 5,4/"rG
Subdivision Name AA
Lot Number
Previous Owner of property /,F
Total Size of Parcel J
Date Parcel was Created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? Yes_ No
Volume and Page Number 2_ 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) cexti jy that a P-t .6 tatement6 on th.i,a 6 oxm atce txue to the best o6 my (out)
hnowtedge; that I (we) am (axe) the owneA(z) ob the pxopexty denscAibed in this
inboxmation joxm, by vi tue o4 a wat arty deed xecoxded in the 046ice ob the
County Reg.usteA ob Deedsas Document No. y and that I (We) pies en 2y
own the pxopo.s ed site Sox the .sewage di s pots Sy6tem (ox I (we) have obtained an
easement, to nun with the above deschibed pnopeAty, jot the coast ucti.on of said
.system, and the same has been duty xecoxded in the 046tice o6 the County Registet ob
Deeds, as Document Nab.;C7G
✓,r~ .fir,/`
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED