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HomeMy WebLinkAbout006-1049-10-000 o CA O 0 N O n C7 t. :E a) 0 0c A..3 c 3 0' 3 h m a a~ • io (D T at 3 1 3 C CD ` 1 3 =r 3 o O w N O O N O .G N O `C • 0 N 0 CD =r B 0 C0 O CL 0 N W O O j O CD - (D a CL z CL co a 3 O O Q0 ~ m W m W Z ° o a, N m CD 0 m n <a _ 'S . CD CD 0 3 L O 00 7 (~D CD ~ O O o O O C a a 7 , O o r _ B. O N N 7 N O to c? zr iJ: N Q N li Z N CD CCD fD CL~ y CO G O C O co w C Cb \ D O 0 N C) 0 L -4 0\ CD W 0 s Pri V ! 8 O Z N co) CD 00 OD 1 cn cn CN'D O O co N p N a D T MU v s V -o v< Z 0 0 0 0 0 O 0 CD OT ~Ea "I a fp CA -1 Co cn 3 N N N D O o m C7 T 0 0 n Q I ID S) 0 CD ~ m = m I ~ ~ c~D C Ii N 3 3 : Z. CD cn z C) A N A zz~ Z -iZ o =y D D O D m m O 3 O CL :7 S ti O CD CD cn • . CD CD N N C (yam ro C C C N CD w CO a a 3 3 m Z (D CD O O ICI A Z n N n c .a ~ ti Z O 0- 7 G) Z ~ N W CD W ! C (j N CL O Z A ~7 C 0 3 c) CrnC N N Z G OO I CD ? -t, ~ N CD CD O CL C N fD V p CD Q O _ O. :3 :3 Q Q. T d C (O v C N Z CL O N Z G C2 O W N 3 O y x a Q N W < (D _ CD J ~ 7 N O C) 2,3 t3, 3 CD T CCDD = y CD 0 =r N O (p r fD ~ ~ A D1 Ili C~ N N CD V N _ N CD O CD V I I T CD 0 o 0 I o Ii a CD CD 'JG Q O O O O ~ 0 CD O CD O CL O a Wisconsin Department of Health cad Social Services Plb.~#b7 370 Division of Health SEPTIC TANK PERMIT APPLICATION TYP£ or USE BUCK INK ~/lil W J~/L~ A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) Be LOCATION OF PROPERTY Wi'-.RE SYSTEM WILL'BE CONSTRUCTED ALTERED OR EXTENDED COUNTY Check One: CITY VILLAGE LEGAL DESCRIP_TION i TOWNSHIP i'- - L✓' C. IS LOCAL PERMIT REWIRED FOR THIS WORK? /r YES NO PERMIT NUMSE.R D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT _ ADDITION MATERIALS: Prefab Concrete J~ Poured in Place Steel Other NUMBER OF TANKS. 70 BE INSTALLED: ' E. TYPE OF OCCUPANCY r /~I Check One: One or Two Family Residence J Commercial Industrial Other/`/ (Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLUMBER MAKING "INSTALLATION Name: Address: i ` ~`'~~t Y:•`< License Number: Signature of Applioant: ~_J MP RSW Address: ` `1A;i H. (To be Completed by Issuing Agent) Date of Application r f 7-1) Fee Paid Permit Issued (date)' Permit Number Agent (Name) (1? 4 i d, j Fors Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic t8XK and the third copy of the permit (canary) to the Division of Health., Checks and money orders should be made payable to the Division of Hesith. Do not write in space below - FOR DEPARTMENT USE ONLY Ie DATE RECEIVED Q- 0 -ACCEPTED BY RETURNED (Initials) (Date) (See rsc~/. FEE RECEIVED VALID. No. PERMIT N0. es or No REVITWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. R Z P O R T O N S O I L P Z R C O L A T I O N T E S T A N D S O I L B O R I N G S TO DIVISION OF HEALTH • PLUMBING SECTI6N P.O.Boz 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrativs Code P Z R C 0 L A T I 0 N T Z S? Test DeOLU4 Q) adler i So -1-1045 W r k To" Time Drop in or Level Irohes Minutes 11 a I Thiolcsn,3s in InohosT- ince Hole "in 1 'I Into-rW Second to Next to Last To Fall Number Inches 1st Wetted Overni t✓ iri7 inutes Last Period Last Period Period One, Inch Example P - 0 5611 To Soil 10" Clay 2611 25 Yes or No 30 1/2 142 1/? 60 J.2 X~ RECORD DATA FROM MINL1,T- OF 3 TEST HOLES Computs size of absorption arsa in accord with H 62.20 Wis. Administrative Code. S 0 I L B O R I N Gs - Minimum 361* Below Pro osed Abso tion System Boring Total Depth Depth to Ground Mater Depth to Bodroc'-, Number Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches Example B - 0 721* 72" Black To Soil 1211 C1 18111 Sand 1811• Gravel 24" 1 t r. r, RF.IX}RD DATA FROM MINDfUM OF 3 BORE HOLES YPE OF OCCUPANCY: RESIDENCE: Number of Bedrooms ~r OTHER: (Specify) Number of Persons D WASTE GRINDER: Yes No I~ Dlshwashar: Yea No Automatic Clothes Washer: YesNo EFFLUENT DISPOSAL SYSTEM: NEW ~ EXTENSION ADDITION REPLACEMENT li Tile Size No. Lin. Feet T ry " . ranch Width Depth 3~ Number of Linea Seepage Beds Length Width "Depth Tile Size No. Lines Seepage Pit: Inside Diameter Liquid Depth I, the undersi!Vaed, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Cods, and that the data recorded and loba n of test holes are correct to the best of my knowledge and belief. NAME r) r 1 tc_ 7 Y`~ TITLE f J Type or Print REGISTRATION NO. ,or MASTER PLUMBER LICENSE N0. 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PLAT BOOK COM SALES COMMITTEE Cont'dAonTTEE Mr. James Ray page 61 Mrs. Gordon Mueller Mrs. Charles Smith Mr. Jim Ruemmele Mr, and Mrs. Bob Phillips Mrs. Ross Pierson Mrs. Miles Casey Mrs. Guy Wilbur Mr. Robert Harer Mr. Al Franko Mr. and Mrs. Merton Vrieze Mr. Don Matysik Mrs. Judy Ferguson Mrs. Robert Gardner Mrs. Joe Lohmeirer Mrs. Willard Johnson Mrs. Freida F Gardner Mrs. Robert Hanson Mr. and Mrs. John Steele Mr. Leona el Mrs. John Lavelle Mr. Robert Condon Holle Mr. Steve Thompson Mrs. John Glassbrenner Mr. Del Polzin Mrs. Harlan Johnson Mr. LaVerne Karastes 0 ti 0 3-0 0 O " :E r a, O W O N c m N 3 gg 0 0 0) CO 0) 0 =r 3 9) OD m z a C) (Al v N O W ! N O F 0 (D C, r O N 07 cWn O O -w C) cn V U) N) C) O N tj cn G G fD H a d ~ G v (n D A a a rb co y u' CL ro _CO cn Icy W Z 3 ° o°o ° s V y a O o m td 7y rn 00 co m co o C h-I CT N 3 IT a. ~ F CZA 00 ~ OD H `-3 Z-0 x H p p 000 ct Y 0 co e 4 t-4 ~ r o00• ~vv$! d _ N L ~ y m 00 W ° 0 Z `v 0° D D o o. a O W~ p • ~ m co O ~y a ~-fi r N fD N n Cl ! r0F O A Z O 3 H. z --I N W ~ N N a 3 z O M CA D A ~ n O= a CD a CD N O a 9 C - O N Z O a o CD m I ~ a. I i A A N w O O I a ti CD 4 o 0 CL • 'Parcel 006-1049-10-000 01/23/2006 02:52 PM PAGE 1 OF 1 Alt. Parcel 22.31.16.335 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner ROBERT D & JACALYN K STEEPEN O - STEFFEN, ROBERT D & JACALYN K 2311 205TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2311 205TH AVE SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 22 T31 N R1 6W 40A NW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-31 N-1 6W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 400 Use Value Assessment Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 3,700 0 3,700 NO OTHER G7 2.000 8,000 224,000 232,000 NO Totals for 2005: General Property 40.000 11,700 224,000 235,700 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 11,700 224,000 235,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 20.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 9~~~~ TOWNSHIP ~y__~a h SEC. TN-R~-W ADDRESS ST. CROIX COUNTY, WISCONSIN °v .6 -v a &e.,-Z c- SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of BAR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM < G/ ~ Q k ff 1 ~p(~l INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 54) )6~D ~0 Y"? c Y OT~OB/ Elevation of vertical reference point: / Proposed slope at site: ~-J~ SEPTIC TANK: Manufacturer: e Liquid Capacity: ~r3-d-a Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Q Side 10 Rear, 0 /00 feet -From nearest-property line Front,O Side, /71Rear, O r i.afl feet 1 / T Number of feet from: well building: /D (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: ®4 " r~ Pump Model: Pump/Siphon Manufacturer: ~O-e / c r Pump Size,j> 4,/~ Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: a Alarm Manufacturer: OQ zz Alarm Switch Type: C<- Number of feet from nearest property line: Front , Side, Rear Ft` 0 Number of feet from well: Or Number of feet from building: 3 G ~ r (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: idth: Lengf'th:_4,7 / Number of Lines: Area Built: .2 ~✓D. Fill depth to top of pipe:_ Number of feet from nearest property line: Front, ~Side,~ Rear,O Number of feet from well:o o Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: ` `-t- J~r~r,i Dated: 7-7 Plumber on job: • License Number :&1~ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. Box 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan ID. Number: O Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) 8503252 : 7DDRESSSS OF PERMIT HOLDER INSPECTION DATE: _ NAME OF PERMIT HOLDER , Box 158, Deer Park, WI 54007 Robert Steffen R. R. 1 BENCH MARK (Peimanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: / REF. PT. ELEV.: CST REF. PT. ELE V.. NW SW, Section 22, T31N-R16W, Town of Cylon Name of Plumber: MP/MPRSW No. County Sanitary Permit Number: Byron Bird, Jr. 3318 St. Croix 69618 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ~1 LIOUID C PACITV. TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL L ` C LOCKING COVER ttt✓✓TIIYYY ` /~PROVIDED: PROVIDED: -7, 5 BEDDING: VENT DIA.: VENTMATI HIGH WATER OYES ONO OYES ONO ALARM NUMBER OF ROAD: Pq OPER TV WELL. BUILDING: VENT TO FRESH FEET FROM LINE AIR I Er OYES NO DYES NO NE_ARE_ ST 'oo,~Z' f(ov DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMPISIPHON MANUE ACTI1REFt WARNING LABEL LOCKING COVER V/ OYES O V 49J o c2e. P1RvOVrIDED. PROVIDED: GALLONS PER CYCLE: NN7 PUMP AND CONTROLS OPERATIONAL. LEI YES ❑ NO ES ❑ NO (DIFFERENCE BETWEEN t' .fir NUMBER OF PHDPEHrv WELL BUILDING ~VENT TO FRESH FEET FROM LINE AIR INLET: PUMP ON AND OFF) YES ONO _ NEAREST L" f ! I SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE H DInMF TEIf 11ATEHIAL A AgKINI or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN f rf Z CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LE NG 7H NO. OF DISrR PIPE SPACING, COVER - DIMENSIONS HENC iFS MnrEH1AL PIT INSIDE DIn SPITS LIQUID DEPTH GRAVEL DEPTH FILL DEPTH UIST H. PIPF DISTH PIPE DISTR PIPE MATERIAL NO DISTR NUMBER OF WELL. BUILDING. VENT TO ABOVE COVER El EV. INLE I ELEV. ENU PROPERTY BELOW PIPES FRESH PIPES FEET FROM LINE. AIR INLET: --r. MOUND SYSTEM: NEAREST Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upSlope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TExruRE C PFRMnNENrMnHKFIEs GBSEHVATI S WELLS DEPTH OVER TRENCH BED DEPTH OVFR TRENCH BED YES ONO 1~1"ES ONO CENTER UEPTH OF 7OPSUIL SODDED ISFEUFU EDGES / MULCHED 0 1 S DYES. O IeTYES ONO X'YES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH NIDTH LENGTH NO. OF LATERAL SPACING GRAVE L UEP T H BE LOW PIPE TRENCHES. FILL DEPTH ABOVE COVER DIMENSIONS / 't 1-5- MANIFOLD MANIFOLD PUMP MAN MANIFOLD MATERIAL NO DISTR S. PIPE MANIFOLD MATEHIAL NO UISTq DISTR. PIPE UISTHIBUTION PIPE MATERIAL $ MARKI cL/pE V.s,33 EL. ELEV PIPES DIA.: ELEVATION AND NG ON 10LE SIZE H E CIA PIPE %O DISTRIBUTIION ~lF OLE SPACING DRILLED INFORMAT CORRECT LV COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: PERMANENT MARKERS YES NO DYES ONO OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE YES NO YES ONO NEAREST Sketch System on Reverse Side Retain in county file for audit. . SIGNATURE: TITLE: _ DILHR SBD 6710 (R. 01/82) 'MP~ wisronsin APPLICATION FOR SANITARY PERMIT f _ 01 L H R COUNTY - OEPgRTmEnTOF (PLB 67) - InDUSTgV,LRBOg6NUTRnqELRTIOnS UNIFORM SANITARY PERMIT # 94 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY WNER MAILIN ADDRESS PROPE AY ATION CITY: dt1 /45/4) 1 /4, S T N, R E (or ~ VILLAGE: F: C e'cJd L T NUMBER BLOCK NUMBER SUBDI ISION NAME-_ AREST RO D, LAKE OR LANDMARK rSTATE PLAN LD. 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 Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ System-In-Fill ❑ Holding Tank ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: 2t 2t:: PERCOLATION RATE BSORPTION AREA ABSORPTION AREA (Minutes per inch): RE UIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: -,7°? Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): r Signatufe MP/MPRSW No.: Phone Number: Plum 's Address: Name o Designer: r t COUNTY/DEPARTMENT USE ONLY ZAAgent: Fee: Date: ❑ Disapproved ~a0 7-c; ❑ Owner Given Initial Zn Approved Adverse Determi val nation Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber M INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. PLAN APPROVAL Safety and Buildings Division DIL HR Bureau of. drnbing 7 - P.O Box 7%9 El General Plumbing Plans Madison, w1 53707 Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY Plan IIdentification No. Gallons Per Day r PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Name Project Location - Street No. or Legal Description eY-~ S fc4f ~e j, e Alm SC.o 22 31 1 County ❑ City ❑ Village Town of: / O 7~ G 6^p t X The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: 7 This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ cc: ;54L-,OWS ❑ DPS ❑ H&R & Rec. San. Section F3, County ❑ Local PI ❑ Facilities Need Analysis Sectior+ ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other of PROJECT_&ZOCr f 5 -ec ADDRESS_YYZ Aar 114,1V 1 / WOMI/ N/ W 'TOWN 4f COUNTY - G its PLUMBER ISCENSE N0. MPRS3318 DATE 62--2- - s. yruR00'1 CLASS P igZL irCONVENTIONAL_ IN-GROUND PRESSURE,_ CONVENTIONAL LIFT_ MOUND,2~11OLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE D 252 HOLDING TANK SIZE ABSORPTION AREA- Z&.0YRERC RATE ALL ED SIZE hL Bm Ass»me elPw on 100' V.R.P H.R.P .,d J~ torn Location of Benchmark _45e ;Te_~ Q Borehole G woll * Pei c Hole Svstem Elevation e- TYPAR COVERING 2" 2" v 2" 6., NpwPr Ro c i rr. rt 24 O Lam/ '4 VED 2 850325 ~d rLe ' 2 f pLlet ISo w > 3 OPTIONAL WORKSHEET 1. MOUND SYSTEM , 1. Wastewater Load, Total Daily Flow= II. 10.GROUForce ND Main: SYSTEM-Continued- section H 63,15 (3) (c), Wis. ~ gal. 10. n: Adm. Code and PROVIDE A DETAILED Minimum Dosing Rate = y Diameter = gpn'' LIST OF SIZING ON PLANS. --e~_ in. 2. Depth to Limiting Factor = 11. Total Dynamic Head: ~ 3. Landslope = ft, System Head = _ % 2.5 ft. 4. Distance from Dose Chamber to Vertical Lift = Distribution System = Fraction Loss = t. 5. Elevation Difference Between ft, TDH = ft. Pump and Distribution System = 12. Pump Selection: ,L 6. Absorption Area Sizing: ft. Pump will discharge at least . gpm Area Required = at ft. total dynamic head. Bed or Trench Length (B) _ sq. ft. Pump mode and manyfpcturer: ft. Bed or Trench Width (A) _ ft. Trench Spacing (C) _ 13, Dose Volume: 7. Mound Height: ft. 10 Times Void Volume of Fill Depth (D) = Distribution Lines= gal. Fill Depth Downslope (E) = ft. Daily Wastewater Volume; Bed or Trench Depth (F) = J f t. 4 Doses an 24 hrs. _ .-t_~ ft. Backflow = gal. Cap and Topsoil Depth (G) = ~O ft gal Dose = gal Cap and Topsoil Depth (H) = ft 14. Dose m Chamber: 8. Mound Length: 4, Dose Chamber: End Slope (K) _ 3. Volume = gal ft Total Mound Length (L) . 9. Mound Width: ft, III. CONVENTIONAL PRIVATE SEWAGE SYSTEM Upslope Correction Factor = s / 5 1. Wastewater Load, Total Daily Flow = Use section H 63.15 (3) (c), Wis. gal. Upslope Width (1) = ft. Downslope Correction Factor = Adm. Code and PROVIDE DETAILED Downslope Width (1) = LIST OF SIZING ON PLANS. ft. 2. Required Septic Tank Capacity = Total Mound Width (W) _ 52 • Z ft, gal. 10. Basal Area: 3. Percolation Rate = Infiltrative C min./in. Capacity of 4. Absorption Area Sizing: Natural Soil a , Refer to Table 2 in chapter H 63 . Basal Area Required = gal./sq.ft./day and PROVIDE A DETAILED LIST OF 2 sq. ft. SIZING ON PLANS. Basal Area Available = 11. If Standard Tables from Chapter Ahf 0325 2 Required Area = Length = sq, ft, H 63 are Used, Indicate Table No. ft. 12. For the Distribution Network, Use Numbers 5-14 in Section 11. Width = ft. Number of Trenches = II. IN-GROUND PRESSURE SYSTEM Trench Spacing = ft, 1. Depth to Limiting Factor = r-~ 5• Distribution System: ft, L:C,E1VE 1 Lateral Length = 2. Landslope = % ft. 3. Percolation Rate = [ Number of Laterals = .0 4- 4. Proposed System Elevation = min./in. 1 r/ 1~~J Lateral Spacing = ft. 1 Distance from Sidewall to Pipe = in. 5. Wastewater Load, Total Daily Flow: n r~ gal an. U Use section H 63.15 (3) (c), Wis. System Elevation = ft. Adm. Code and PROVIDE A DETAILED LIST OF SIZING ON PLANS. IV. SYSTEM-IN-FILL Required Septic Tank Capacity = Fill in All Items from Section Ill 6. Absorption Area Sizing: r~ gal. Percolation Rate = V. SEPTIC TANK 1Z min./in. 1. Capacity = Q® Area Required =Q sq. ft. gal. System Length = 2• Manufacturer. - ~ St - e / r System Width = ft ft. 3. Show Site Constructed Tank Details on Plan 7. Distribution Pipe Sizing: Hole Size = ~ VI, DOSING TANK in. 1. Capacity = Hole Spacing = fl. gal. Lateral Length • fl 2. Manufacturer: ' Lateral Sane 3. Pump Manufacturer: in. 4. Pump Model: Lateral Spacing It. Dist,urce froru Siilcw,ill ro Pipe ir'' 5 b. S. Flow Ratc= Head= ft. H. Distribution Pipe Discharge Rate: Number of I lutes Per Pape 7, Show Site Constructed Tank Details on Plan gpm 1 low Per t'ipe y,34, 9. Manifold Siting: " VII, 1HOL . Cap c TANK Typc (center or end) e`er 1. Capacity = Length = 2. Manufacturer. gal, I t. Diameter = in 3• Show Site Constructed Tank Details on Plans -SHOW ALL INFORMATION ON PLANS- DILHR SBD-6761 (R.03/82) Z ter- ~ a ro a ~A fD ~ I ?U Ftr i~ ~ i ~ Q CA C1 ~ J \\VVV\ 9~ O G 1 i RECEIVED 85032521 JUN 17 1985 I PLUNR_rING BUREAU I i Page _ Of _ Q r Perforated Pipe Det N~F$Ry 14e F CO Ut~j~gN ~At IpNS End View End Cap )Perforated 1 PVC Pipe D\e OAS, Holes Located On Bottom, S Are Equally Spaced P S PVC Force Main x P PVC Manifold Pipe Distribution Alternate Position Of Pipe Force .Main- Last Hole Should Be Next To End Cap ~GC )It-r14 1S End Cap C ~h ~tr Distribution Pipe Layout P Ft R rte. 8508252 S X Inches i Y Inches Signed: ( Hole Diameter Inch License Num 3 ZZ- Lateral " Inch(es) Manifold Date: Inches Force Main " # of holes/pipd`~ Inches e Invert Elevation of Laterals Ft. Straw, Marsh Hay, Or Synthetic Covering Medium Sand Distribution Pipe • Topsoil G '3 E D d % Slope Of 2 1. qty • ~,pd 2 2 Force Main Plowed MRN Aggregate From Pump Layer • 84N A W~~ 51 ~NOV F S D - ~QSM~ y1SjQN©• ross,Section Of A Mound System Using a.ayE QpF~`+ A Bed For The-Absorption Area •75~F Signed: A Ft. /.5 H - F_t , License Nu er: - - Ft. Date: J 10,30 Ft. K Ft. 2 . Alternate Position 9503205 of L Ft. Force Main Q Z„ Ft. L- J Observation Pipe - • 8 A I-4. _ - _ _ W to - l- Force Main From Pump Distribution I I • Bed Of i 2 i Pipe I Aggregate Observation Pipe Permanent Markers ju!j Plan View Of Mound Using A Bed For The Absorption ArSpgi r PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIOAIS VCQT CAP 4"-L'.T. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUNCTIOR] BOX MANHOLE COVER WINDOW OR FRESH I2"MIu. n~ i"UTAKE I GRADE ( I CONDUIT to"MIAl. IAILET PROVI G I = _ AI 'Z SEA I ( NS APPROVED JOINT A ~Ofv APPROVED JOINTS W/C.l. PIPE W/C.Z. PIPE EXTENDING 3' PNO I M EXTENDING 3' ONTO SOLID SOIL B ~pe0 NOe~ ( ONTO SOLID SOIL OVSA SPF~Z OF c ON o`~\S`~~ ~ SQO~Q~ I ELEV. FT-- ISO? p,R~ ~ OFF D - CONCRETE BLOCK RISER EXIT PERMITTED OML9 IF TANK MANUFACTURER HAS SUCH APP OVAL SEPTIC E P E C. I F I CATION f7~ c47 DOSE 5 0 32 5~-- s TANKS MANUFACTURER: ee MUMBER OF DOSES: PER DA4 r TAWK SIZE: GALLOAIS DOSE VOLUME 1.7 -V' S ALARM MANUFACTURER: INCLUDING BACKFLOW% GALLONS 2 MODEL AIUMBER: CAPACITIES: A= 1%041S OR GALLONS SWITCH TSPE: CrG G /11jr, cs6c%r B = INCHES OR -?4/ GALLO PUMP MANUFACTURER: -GIlL/` 17 It, • C =-~~]IAItHES OR GALLONS MODEL DUMBER: / D=- INCHES OR S GALLONS 5WITCH TYPE: a_-G MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE.,-- GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. - 'T FEET -4- M`IIkIIM,UM NETWORK SUPPLY PRESSURE . • . . " . . . • 2.5 FEET FEET OF FORCE MAIN y IoonFRICTION FACTOR. = FEET °'il >A TOTAL ObWAMIC. HEAD = FEET IMTERNAL. DIMENSIONS OF TANK: LENGTH 'WIDTH l LIQUID DEPTH _ LICEIIlSE AlUMBER: DATE:-.pia-,t--~ Plb. 1-A Wisconsin Department of Industry, D.I.L.H.R. • Labor & Human Relations Leroy Jansky O.W.S. 13 E Safety & Buildings Division E. Spruce Street Chippewa Falls, WI 5472 Bureau of Plumbing (715) 723-8786 PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT Name of Premises N W 2Z. Location Township County Master Plumber/Soil Tester I~tRfl lip Address ~e Owner 1CU p~~ Q~ X ~ • J~{00/ S~ Q'i` 1 FEr.1 AddressX 158 71~c~ ~A(2K bU2 S[,LOU7 Sanitary Permit Plan ....n 11.D. Na. Type 3f inspection '''I:,S Persons Present at Site QU►J B .~b J R M~ S7 E i =•F~n~ Type of Building: ❑ Public Single Family or Brrp}ex 9EPi_ACEµ67 Z %YS . BRIEF, FACTUAL COMMENTS AND SKETCH: W 71 I _4 J2 a- 1iLl~T~►~Cs) II ~ ~ .~L nl N R~-. Irz- Is` _ , 01 (A 1 1, Y N -4 1 2- Ll - 0 _ I P tU s T 3 -V Lu 1 SEE ATTACHED U !DISCUSSED WITH PLUMBER/CST SIGNATURE 'DATE OF INSPECTIONS 22"$5 Inspector Si nature Inspector Local Inspector Plumber or Responsible arty I L H R-S 8 D-6799 (N. 5/82) v N ~ m x , x c N~ ~ m ~ =•'r c'p ~ w 15D 0 (D CD M =r o =r 0) N 0+• ~o c 0 w w v, E (D 0 CDT 11) m a* 'ca N a o ao0 w xm w w mow ' m m m N'aw~ R mom' r M~.>sca "r co CD co o co m oo o3a o..-~(0~w 0 CD 5 (,r- w 0 0 ` C w' N 0 l< c3o 3-•.c o ao ~z cl< Q=*v .=r m w w u, o m n - o ' w CD a D c o 0 CD N 0 D c o cD =r '0 o O O w 0 2) o~ aQ~ w 0 C CL 5CDD CD (con CA " 'o CDCD CD CD ?a A D G$ a coo 3 0 CD o =r g c~ o m a m =r w o QN a co v, Saco C m ui so a c o CD v 3D5 vCDM ==r 0 1m CD oao~cnN n to cD vi c a a Q c co A CA V~~o co o c .'cc° N N S=D 3 Q. go_ app CA c c CL0 0 m S. ao aa~. a0 CD Q~ ,.Ito c~~ N~c <cc 3 g ='n~ -OO 0cA CD M -4 .0ccn-% 3 , FD 0 = 0 O a c -1 D c 0 CL c w ~=r w ~o 0 a c (D o ac3 03 003 • CD 0 ii CD z H z cn H STC - 105 a r r SEPTIC TANK MAINTENANCE AGREEMENT a H St. Croix County z 0 z OWNER/BUYER a RO~er~' i C~~ ~t lTl ROUTE/BOX NUMBER 1 Fire Number-L 2_12 CITY/STATE_ UJT ZIP 54o ).7 PROPERTY LOCATION: _k, -k, Section ~a T. 3 J N., R16 W, Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could reult its premature failure to handle wastes. Proper maintenancescon_in sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pt into the system can affect the function of the septic tank asua treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 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 H and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE- 7z 3 D ~S',j~ v 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. 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 a Location of Property - vhf 3~, Section T a I N _ R ~ W Township Mailing Address G X 0 Subdivision Name Lot Number Previous Owner of Property ro Total Size of Parcel s .re~s _ Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No volume n ?i and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) een ti.6 y that a t 6.tatement6 on .thi4 6onm an.e t.u.e to the beat o6 my know.tedge; that 1 (we) am (are) the owner (6) o6 the pnopen ty deA cA bedinth i6 ) in6onmati,on 6onm, by vi tue o6 a wamanty deed heeonded in the 066ice o6 .the County Reg•i e•teA o j Deed6 a6 Document No. and that 1 (we) p4e6 en tty own the p.4opo6 ed 6.c to bon the 6 ewage po6 6 y6.tem (on I (we) have obtained an ea6ement, to nun with the above de cAi.bed pnopehty, box the con6.tluicti•on o6 6ai,d 6y6.tem, and the Game had been duty tecoAded in the 066ice o6 the County Re9.i6.ten o6 Deed6, a6 Document No. 3 ii& T ) . SIGNATURE OF OWNER GNATU OF 0-OWNER (IF LICABLE) :3a/s DATE SIGNED DATE SIGNED State of Wisconsin Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION July 14, 1985 3 Wreau of P1 ring 201 East Washington Avenue P.O. Box 7969 Medi s on o WI 53707 Mr. Robert Steffen Route 10 Balk 158 Doer Park, WI 54407 s Petition No. 85-=52-P Dear Mr. Steffen: Re: Robert Steffen - Residence Private Sewage System MW,SW022„31,16W Town of Cylao, St Croix County, WI Section 145.24 (1), Wisconsin Statutes, and s. ILHR W..09 (2) (b). Wisconsin `t Administrative Code, allow the owner to petition the department for a variance to the installation for a private sewage system to replace an existing private sewage system at a site which is not in full compliance with the siting standards in the inistrative role. The system design proposed should protect the waters of the state from contmination. If this system becomes a failing system or contaminates the waters of the state, this variance shall be res+citnded The petition for a variance requested to s ILHR 83.23 (1) (d) of the Wis. Adm. Coate was considered on June 29 1985. The petition has been conditionally approved. The condition being that in than event of failure, the mound system shall be replaced with a holding tank or other off-lot system. The rule requires that a sound system have a semi n i n 24 inches of su i tab l e natural soil. The variance requested was to install a replacement mound systems on a site with 12 inches of suitable natural sail, DILHR-SBD-6423 (N. 04/81) J State' Of Wisconsin Department'of Industry, Labor and Human Relations W. Rowrt Steff SAFETY& BUILDINGS DIVISION Page July 1, i All of t1w 4*ta sta# tts s ttod an beh4lf of the potitioew w ca and siftnW. This warm is specific to the sweet Psttties ad cast be faw any additional wilification, i of Private so"" 44M l3ft id C. b DILHR-SBD-6423 (N. 04/81) PLAN APPROVAL BSafety an Buildings ~DILHR Division ureau ofPlumbing P.O Box 7%9 ❑ General Plumbing Plans Madison, WI 53707 [3 Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY Plan Identification No. Callons Per Day r PRIORITY PLAN REVIEW ONLY Plan Review ICI Petition For Modification 5 Project Name Project Location - Street No. or Legal Description . / County ❑ City ❑ Village N Town of: f. 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: 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: This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sar ent 7 g Bureau Director If Questions Plans Approved By: Date Approved: Contact y ---7 cc: Q OWS ❑ DPS ❑ H&R & Rec. San. Section 0~ County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other DEPARTMENT OF INDUSTRY, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS LABOR AND DIVISION HUMAN RELATIONS \ / PERCOLATION TESTS (115) P.O. BOX 7969 (I R 83.09(1) & Chapter 145) MADISON, WI 53707 LOCATION: SECTION: OWNSHI MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: ~.1' 4 50/a /T I N/R 6 E (o G l C.17 OUNTY : 0 N 'S/BUYER'S AME: MAILING ADDRESS:° 6c USE 0 fe NO.BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS WADE O Residence rpF FIRIPTIONS: PEROLATION TESTS: ❑ New Replace - RATING: S= Site suitable for system U= Site unsuitable for system CONV DS ENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLD ING TANK: RECOMMENDED SYSTEM: (optional) Ms Rlu F ercolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the er s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: yJ~ PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WIT E H THICKNESS, COLOR, TEXTUR, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 712 B C/ 5* B- 6/' o fo 1~2 0-10d Gr fflvzs~,' 17:0 fo-tea " y %s, is 74 B- e N i3 B- 5. B ro 10 PERCOLATION TESTS TEST DEPTH WATER NUMBER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 RATE MINUTES PERIOD 2 PER PER INCH P- ~ Q P- P-1-4k Ole 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 a E E E I 3 ~ E PC rG° v<i LOA) A7 J ~ b a- i v ; -lp~ 1 i © Well ~E 0 arca~ p ~H Tr 1, r I" I i lao 5 I, the undersigned, hereby certify that 114 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 t data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (priTO : TESTS WERE COMPLETED ON: :ADD]RESS- CERTIFICATION NUMBER: PHONE NUMBER(optional): ~ c- _ oo f 00 ~ CS S ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - J