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HomeMy WebLinkAbout016-1027-30-050 0 O 3 v n d r1 c - 2 3 m ~ T o . m M d (-D _ V1 m c C). CA cu o m z O (n m W p O• IQ A Q C) N p m j Q p ,•y CO (D CD m CL 0 (D co O O CT v C m \ 1 7 + w O 0, N N ~ D O 3 7 y cn O co cc 'A C p CD m cn (D D m 4 A m a -u CD C co 3 p A CD 0 a _ ~ CO - Z (D Co m 0 r fA cn (n !T cr a i v 'a 'a 'a C) rr _Z to to to ~ o D ' Q v v v m y ~ I rn v p 1 v m m = m w cyi N CD OD d w w O Z O D D c O v o CD a ~ I ' CD I C CD c I w (u I ~ 3 Z p Z O w O 3 " to M * w w CL Z 3 ;o O Z H z m I w CD ' a I z 0= Q C5 m wx n :3 m o v c I ? z a m' ~<o ((<D o o a y D m a0 m y I d0~i ! a O 'D a a I ~ m ~ O g m CD a o' a O fp o f EF CD N 3 m o CD a o b m aro c~n o O ti ° I - was DILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 ❑ XGeneral Plumbing Plans Madison, Wl 53707 Private Sewage Plans Telephone: (608)266-3815 Plan idcrgifi(,tirni (;anon,, Per Day PRIORITY PLAN REVIEW ONLY 1 P1,111 Ktwi(->v Fee Ko ei~od Petition I ur Variari((, Fee Re( S Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village ATown of: ( -Z " - Cli~~\/ The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g . This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1) (2 (3a)~ b) (4a) (4b) (6) (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. 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 z-7 /2 If Questions Plans Approved By: Date rov Contact y cc: Private Sewage Consultant ❑ lumbing Consultant ❑ Environmental He County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other e~~ S e. r~ ct t- r S I S C; e, f- e. ~o<rc c- t,,,) 1(1 Sec 13 SOYA i0o ~d h r Res~~ence L; Q ~a•~~ i$ ~c,AQQ`OJ~o T2.4res5 .[3asE coq I o l o' ~ bcr 30 ~o C,v Sl Ski 3o P~ 1 u~ct t''la.~n T7 3 Sy/ £IeJ O 8-2 ~J1AR, loo" f10 S C,4-k i c--t g-o17 ooo RECEIVED, co ` ip NOV 4 1985 ..4_ 5 MRING BUREAU UCEIVED ~BdR d NOV 14 i SAP' ETY g rzLDGS. DIV. Page _ Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ Topsoil G 3 E D % Slope 903's ~ Bed Of 2:2 Force Main Plowed Q~fggregate From Pump Layer ll~~ ~~~~,Zl y S~~S SV Section Of A Mound System Using F 1..5 A Bed For The Absorption Area F 7 S ned. A 9 Ft. H 1.S B Ft. License Numb -2 I 13 Ft. Date: Q J Ft. K Ft. Alternate Position L (p Ft. of Force Main W Ft. L ~y Observation Pipe--,,,, 7-r- - - - It 01 A L---------------------- ----------------------•I W I`-----J--------------- Force Main From Pump Distribution Bed Of 2"- 2 Pipe 2 2 l Aggregate Observation Pipe Permanent Markers 40 E® OCT 21 1985 Plan View Of Mound Using A Bed For The Absorption Ar ~~►MRrnrr; BUREAU v 'SING P4 Page _Of~ tai R `Agar p a } ac~~ , F 1N AFi cj Perforated Pipe Detail End V.I. Perforaled End Cop A PVG Pipe ~e, Moles Loco-led On Bottom, W `e S Are Equally Spaced ,P 7l / s PVC Force Main From Pump i P PVC Manifold Pipe Distribution Alternate Position Of Pipe Force Main From Pump Last Hole Should IDS Neal To End Cap End Cop Distribution Pipe Layout P 2-3 R' S L2 X '.S0 Y Signed: L4 _Ie~"-J Hole Diameter Y-1 Inch Lateral Inch(es) License Nufnbe : Manifold Z Inches Date: Force Main 3" Inches 8507140 RECEIVED OCT 21 1985 p~_t-)MRfn~r BUREAU 1 VAGk: OF PUMP CHAIABEK CK055 SECTIOW ARID SPCCIF ICAI IUKIS - VCIJT CAP 't ••C.1. VLNT PIPC WCATHlK PKOOF APPKOVED L(JCKINI, ~L5• FKGM Ur(jR• JUNCTIOW bOX --MANHOLE CUVEK. WINDOW OK F R L SH I1"MIU. 1 AIK INTAKE GRADE I `I° MIW. Id" MIU. COQDUIT WLI. T PKO.VIDE I AIKTIGHT SEAL I II I pots APPKD`JL IJ JOINT A .¢E~"`S I I I APPROVED JOB .W/ C.'l. PI PL. / w/c.l- PIPE CICTLNUING 3' LPi~j~r~~ I I I EXTEAIDIN(. O►JTU SOLID '.r it_ 1 I I I ALAKM ONTO SOLID S. P+ (}1N~ ~;~P tad C 1 S J~( I oN ~r PUMP OFF ao-1•Ob CONCRETE bLOCK KISEK EXIT PERMITTED GFJLIJ IF TANK MANUFACTURC.K HAS SUCH APPROVAL. PTIC AND 5PECIFICATInKi-r, p ' )A TAWK`., IAANUFACTUKLK: WUMBEK OF DOSES: 4 PEK DAy lA►JK :,IZE : - ROU _ GALLOWS DOSE VOLUME:_. 5ii _ GALLUM5 ALAKIA MANUFACTUKLH: CAPACITIES: A=-_Z-,.5-INCHES OR c3L-ro GALL01 MOUCL WUMbCK:_ B= 2•--INCHES OK .fS GALLON 5WITCH TYPE: tier C= ~ ---INCHES OR; 130 f/ n GALLOA. I'LIMI' MANLII AC. 'I LIKL K: L7 n P_X U= IZ~I INCHES OK ZZ 5 GALLOI i MUD CL WUMbLK. NOTL: PUMP AND ALARM AKC TO BE SWITCH TYPE: SIG INSI-ALL•ED OW SLI'AKATE CIRCUITS PUMP DISLHAK(,L KATE S L~ GPM VEKTICAL. DIFFLKENCE BETWLLN PUMP OFF AND DIS1'KII5UTION PIPL•• ~•O FLCI + MIAII,MUM NETWORK SUPPLY PKES51-11KE • • • • • , 2.5 FEET RECEIVED • t F .3.L?.EET OF FORCE MAIN X i~7 FT. • _ Yr,rLFRICTIOILI FACTOR.. • 20- FEET OCT 21 TOTAL O~AIAMIC HLAD = n.7 D FEET 1 Pl_t.1MR~nlt; VBREAU IIJTEKNAL DIMLWSIONS OF TAWK: ;WIDTH I ~ ILIQU►D DEPTH ubmersible sibs ewage Pum MODEL 3887 ps SIZE WS03-WS10 RPM 1750/3500 RS FEET IMP VARIOUS 60 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 16 50 r yA 14 h's r 2 40 1 oeh' @yp 10 rNp\ K, e 30 : Np Sro@ I'V @F S $ Np S~~@ @ ekes 6 20 \ ws~s@BFSer'es ! Np Senen 4 10 WS038, BF Sees 2 )12B,BF WS101 )328,BF WSt 0 0 1348 BF WS1 0 20 40 60 80 100 120 140 160 180 GPM l yR 0 10 20 I ' 30 40 m'/h TOW CAPACITY gyn. . ,mss 31, w U GOULDS PUMPS, INC. Zli -s_ SBIECA FANS WW tCW 13149 R 8507140 tsCf►ar ~ r 1'x'1 '12 RECEIVED OCT 21 1985 Pi_t_innRING BUREAU ;.5 DE; ARTMENT OF REPORT `ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) L AT SECTION: OUNICIPALITY: LQT :BL~C~fyQ.: SUBDIVISIO NAME: EN 1 IUE'/ 13 /T3o N/R is~ ~/(l/ Y: Err 'S NAME: MA N ADDRESS: USE TES OBSERVATIONS MADE NO. : COMMERCIAL wDESCRIPTION: PROFIL S: P'E~C A ESTS-.Residence /1/ OdNew ❑Replace RATING: S- Site suitable for system U- Site unsuitable for system / 'J ROUNII J ONV ~U • MOU []U IN Ga WU S~ S -IN-F L IHOLDI ~ SG TANK: RECOMMENDED SYSTEM: ptional) I S If Percolation Tests are NOT required DESIGN RATE: [Floodplain, any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UND ATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- aQ ne_. 33 0,C$ . , s I B,~ 0 y 3 n.~. s3 f~ s,l /a 1_ 6 a / 6/7 1 3 t>} 't B3 o7o 5.33 ~one_. J ,o,~B s I / r q 1 9 B - B B- PERCOLATION TESTS PLUMBING SUREAU TEST DEPTH WATER IN HOLE TEST TIME DROP i WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RIO 1 D P I PER INCH P- Q P OZ P- P- P- • PLOT PLAN: Show locations of percolate in t t~§ s, sZ%dVri and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference poi is 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 Cl 9.0 S --a r 1 Q I 4 Z"~ 4U 'R E VE _-t JGV , i 1 44- p3 138-3 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accordlith 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 WARE CO LETED ON: ADDRESS- C r/j/~-~ r d k, - CERTIF___ ICATION NUMBER: PH N UMBER(optiona CST T41RE: 04 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LHRSBD-6395 (R, 10/83) - nvco - Parcel 016-1027-30-050 10/24/2005 04:22 PM PAGE IOF1 Alt. Parcel 13.30.15.206A 016 - TOWN OF GLENWOOD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - RELF, DAVID L DAVID L RELF 1593 RUSTON RD GLENWOOD CITY WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1593 RUTSON RD SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 17.260 Plat: 1583-CSM 06/1583 SEC 13 T30N R15W PT NW NE LOT 1 OF CSM Block/Condo Bldg: LOT 1 6/1583 (17.3AC) FKA 016-1027-30 (206A) EXC PT TO LOT 2 DESC IN QC 1546/363 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 13-30N-15W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 05/12/2005 794799 2801/517 WD 09/28/2000 630772 1546/363 QC 07/23/1997 887/125 07/23/1997 722/274 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 252,800 264,800 NO PRODUCTIVE FORST LANC G6 15.260 30,000 0 30,000 NO Totals for 2005: General Property 17.260 42,000 252,800 294,800 Woodland 0.000 0 0 Totals for 2004: General Property 17.260 42,000 252,800 294,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 111 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 F SANDERS,, JEFF -NW--NE-,, Sec-tiOn--la R. R. 1 T30N-R15W Downing, WI Town of Glenwood San.Permit#75000 11-19-85 L. Myers Mound, New DILHR Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C. Labor and Human Relations 13 E. Spruce Street Safety & Buildings Division REPORT Chippewa Falls, WI 54729 Bureau of Plumbing Inspection Date (715) 723 8786 November 6, 1987 Name of Premises Address or Legal Description City/Township County Sanders - Residence NW, NE, 13, 30N, 15W Glervood St. Croix Master Plumber Name and Address Master Plumber Firm Name and Add Plan I.D. Lyle Myers MP 6219 Lyle 's Plumbing 85/07140 Rt. 2, Box 47A itary Permit No. Bo ceville WI 54725 00 Journeyman Plumber/Soil Taster Ucensed Person's Name(s) an "N s) Owner's Name and Address Jeff Sanders Rt. 2 Glenwood City, WI 54013 j- hi l t- r vx hen signed y the owrer anr plumber i l serve as an em t to co 1 to mound cost cio 1 n ae e 1 civ""~ nisue o" v , 1 insleclior o the momd o SEptEMbEr 6, 197, revealed th* esyt i w --a S-f "s hot Id- ms- WV -tr at- - M g o e o e. p a e -n n 'd i a reorientation of the mcunc' may cause ham than poo~, i i -o _a e a • t may be to h plumber must realize that shcul~ t seerage occur direct result of irn ro r u r o T c n o i i-I Vie- bWf 6 anc th ffi6 unc I a s oes n e s problenm b t;-one y have the o f t' to requect - p --fo - e -S - - e - P Us-. a i- XmevrT Date IV Page 1 of 1 Signature of Responsible Licensed Person (only one needed) Check all Signa u of Plumbing C ns=t/Private Sewage Consultant Original: Copiesto: (thatapply/ sso-staz (R. tvss) District ® DILHR E) Plumber O r my/Local sp. 94er n~ ~a State of Wisconsin ` Department of Industry, Labor and Human Relations 0 V C, mil SAFETY & BUILDINGS DIVISION Ljr` r }=j -47 c Fell, a ' a , t 1 f (mot r?"ectPC tj or 4'; ,f ; y FC `t (I.ffr 1i latis MVI- ti ;"N f T7 , $ f'E_' t z fir, f 9 f. E 1 l,r, L ) of f C k,T, i > fa~~ ~ ~ O ztc )r s 1 C i Sy , + ~ ...y 4 t. ti 0ILHR-SBD-6423 (N. 04/81) State of Wisconsin Department of Industry, Labor and Human Relations 6\ SAFETY & BUILDINGS DIVISION rt ' t .t_ rTr 7, C ax.' p' t 4r- r c t 'r 5.r t~rr ~,crt, 4' . f- ' ? t t ' rrop-t tav. ? E v it ~ crivina l Plan f k. z i + a aIti,,-ryAV,t i t' aC )rr-t{ rf r ) C ft frl~ t'< c rvE t_, i@ M 3 S, t t # t } !~C'rtc ti`. I ar ire ~ o Sp €'Cif i < ~'tCPs r Est! tc I.Mr' nkvict { [i r v4d 1. ' } 1 f ~ t yt ~ €'t± 3• f r t s cif y S r, c,! `C1'~"t '.'`F ~`(t.. 'Os !J r:Q L'iY 4 i.C , t c t"s t V(.+ t } £ P'C°C itt t)^t f` 0...~ { of fl i k, r~ister or c r y r tfStf'# t CCfitac t"r. Jars! at 11F, fJa"ffG`(' eCA ti C C. "°f' A rF , 1 { \ c'c r .,r, s''Y 9 n t+*c f_§?'t3e CC?t;si, t . $S Y 1, C f CV ee q S 1 y f o;, i r, d y*+ y~y Dl LHR-SBO-6423 (N. 04/81) Page _ Of _ Perforated Pipe Defoil 0 End View ~Perforoled End Cop PVC Pipe r'e d Holes Locoled On Bottom, S Are Equally Spaced S * PVC Force Main * From Pump /P PVC Manifold Pipe Alternate Poelllon Of DiatriPbution p~ a Force Main From Pump Lost Hole Should Be Neal To End Cop 'End Cop Distribution Pipe Layout P Z3 R 1 S 30- X Y ~f Signed: Hole Diameter Inch Lateral 11 Inch(es) License Number: Manifold t' 'Z. Inches Date: Force Main 11 3 Inches Page _ Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil G 3 E D b 9L Slope Bed Of 2.-2 :2 Force Main Plowed Aggregate From Pump Layer D ' Cross Section Of A Mound System Using E A Bed For The Absorption Area F G A~Ft. H I~S Signed: B_4_8Ft. License Number: I Ft. Date: J Ft. K Ft. Alternate Position L Ft. of Force Main W Ft. L Observation Pipe +r _ 8 K _ _ A I.---------------------- ------I W Ir ____j--------------- Force Main From Pump Distribution Bed Of %N • Pipe 2 2 2 I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area A., Bulletin CUM July 8, 1983 • For Homes • Farms GOULDS • Trailer courts Model 3885 • Motels (Supersedes Model 3870) • Schools • . • Hospitals Submersible • Industry EnloentPuriV Effluent Pumps • Effluent Systems Pump Specifications anywhere effluent Solids Handling Capability to 3/4". or drainage must be Discharge Size disposed of quickly, 2" NPT. quietly and efficiently. Semi-Open Impeller 3 vane design, threaded on shaft. Three phase units use impeller locknut to prevent accidental back-off. Pump out vanes on backside of impeller for protection of mechanical seal. Casing Volute type for maximum efficiency. Heavy-Duty SOIIdS Handlin Stainless Steel Fasteners 9 Series 300 stainless steel for corrosion Dependable Capability to 3/4" resistance. Mechanical Seal Ceramic vs. Carbon sealing faces, stainless steel i spring and Buna N elastomers. Maximum Temperature '/3,'h H.P. 60 Hz j E 160°F. Single Phase 115, 230 Volt. Capable of Running Dry without damage to components. i Motor Specifications 1/2, 3/4, 1, 11h H.P. 60 Hz ; Motor Fully Submerged Single Phase 230 Volt. Three I in high grade turbine oil for permanent lubrica- l tion of bearings and mechanical seal and Phase 208-230, 460 Volt. ! efficient heat dissipation. Motor sealed from environment by rugged cast iron enclosure. Bearings Heavy-duty all ball bearing construction. Stainless Steel Shaft OPP- Series 300 stainless steel for corrosion resistance. Threaded shaft. Single Phase Units 90 All single phase units have built-in thermal overload protection with automatic reset. 80 Three Phase Units Overload protection in starter unit. 208-230 or F 70 460 volts. Threaded shaft 60 Hz operation. w Power Cord a 60 r• ; Water and oil resistant. Epoxy seal on motor end a r . acts as a secondary moisture barrier in case of ULI 50 O7}i ~damage to outer jacketing. Corrosion resistant X gland nut. a 40 Single Phase Units Z v1 H.P. models equipped with 15' of 16/3 0 30 SJTO with 3-prong grounding plug. 1, 1' H.P. models equipped with 15' of 14/3 STO power ~ cord. 16 4 0 20 10 { SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. 0 0 10 20 30 40 50 60 70 80 90 100 110 120 r^GOULDS PUMPS, INC. GALLONS PER MINUTE u SENECA FALLS NEW YORK 13148 1 L PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS VEWT CAP PE 4" C.I. VENT PI WEATHER PROOF APPROVED LOCKING JUAICTION DOX MANHOLE COVER ~ 25' FROM DOOR, I2'MIIJ. WINDOW OR FRESH AIR INTAKE I GRADE ti"MIN. 18"MILI. CONDUIT-- ~ 11~ PROVIDE I INLE T AIRTIGHT SEAL I I j I I I v APPROVED JOINT A I III APPROVED JOINTS W/C.Z. PIPE I I I i W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING 3' OAITO SOLID SOIL, 9 I II ONTO SOLID SOIL I i oN ~ y c I I CLC% FT. PUMP OFF 0 Q-~3 3 CONCRETE BLOCK . VV' iMAN. 3 Wc►4 RISER EXIT PERMITTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL I X PR,oveD toolN4 SEPTIC E SPEC.IFICATIOUS DOSE TANKS MANUFACTURER: -Qj'4 O 14m ("poa r NUMBER OF DOSES: PER DAU TANK 51ZE: aOn -GALLON DOSE VOLUME 7 1z~s INCLUDIAIG BACK►LOW: GALLONS ALARM MAAJUFACTURCR: MODEL WUMBER: CAPACITIES: A= INCHES OR 2-70 GALLONS SWITCH TSPC: g = Z' INCHES OR 45- GALLONS PUMP MANUFACTURER: C s I Z. 2- INCHES OR 3ALLONS MODEL NUMBER: Li f _ US D= 12. INCHES OR GALLONS SWITCH TYPE: NOTE: PUMP, AND ALARM ARE TO DE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEAI PUMP OFF AND DISTRIBUTION PIPE.. FEET ♦ MZIN~IIALIM NETWORK SUPPLY PRESSURE . . . . . 2.5 FEET ♦ ~t7b FEET OF FORCE MAIN X ' 73 FYofxFRICTIOW FACTOR-L-l A. FEET TOTAL DyWAMIC. HEAD = ZO.3S FEET IMTERWAL. DIMEWSIOWS OF TAWK: LENGTH ;WID H ~;LIQUIG DEPTH 51G, JED: LICEWSE WUMBER: DATE: DEPARTMENT OF INDUSTRY, REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS LABOR AND P.O. BOX 7969 PERCOLATION TESTS 1151 DIVISION HUMAN RELATIONS (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCAT"j~ ION: O HIP MUNICIPALI LOT NO.:BLK. NO.: SUBDIVISION NAME: S IF 1__/T2~ N/RlP E (o I r uer Q CjYNTER' BUYER'S NAME : MAILING ADDRESS: USE NO. BEDRMS : COMMER AL DESCRIPTION: DATES OBSERVATIONS MADE Residence 3 PROFIL D S ONS: A N T ST [On ❑ New ,Replace RATING: S= Site suitable for system U= Site unsuitable for system (O (p CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) os 2u os ou , as Qu os D u ❑s ou If Percolation Tests are NOT required DESIGN RAT under s.H63.09(5)(b), indicate: 1 f Jljl [Flloodplain, any portion of the tested area is in the N • indicate Floodplain elevation: A, PROFILE DESCRIPTIONS BORING TOTAL P H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED -EST. HIG HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / Wpb q~, c7 Dp ~J, ~v 4 g ~s 1 ~'-66 Bn s; r'r~ ~us7 of Ta.s'o 3, So a n Gr. B- ~ ~dD 99, 0 v~ 3 3 . ~o b s r ~.av B n s ~ ~ ~ /`us t Me to to 33 5. ~v~Sh S ~ r, B- 3 PDD 99.0 >~.DD ~~,o~ls;(3.do~,r7se'Cr> Pustn~a7~47`~~5' 3,~OBnS Gr B-6`1 3,00 J3.0 a b D 3 3 .9 h 1 c ~.a G ~f, o a 3 3 B-C~ 3.06 v0 /.33 ~.DO G F'l/ vo B-gb 3-60 S3•(~ 3,oD /.DD .s''o~C~ ~.~U ~ C ~~a~c~~O~© PERCOLA ION TESTS TEST DEPTH WATER IN NUM ER NCH S FTERSWELOLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES P , I,SD PERIOD 1 PERIOD 2 P R PER INCH D 3D 1 ~ ~ P- P- a 7_5 _0 30, A 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 B Slot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION &a vv ya' p Bb r a m f I 1 F - _ , ' e /a Derr" Dori~ I'e'~; fop 'fah C ! s kdvu+4d wcGl Zesxv~ k t re - _ O1 ~o Se1ej - and be E : E ~o P N 0 . 33 1 9y b 4,Z; o o , R) a4;1 g>nA E IeU. Bard R► W sa ra v_ f • 0 F1 e u. Of laa+e r I r1: r P S e E Fro t~ert-_fA41zref: Dell la to kea~i,~ a !3' o%I wr~rr > X70 1, 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): TESTS WE/RE O/MP pETED ON: ADDRESS: Ur O 414 / } Q ~U~~ CERTIFICA ION UMBER: PHONE NUMBER(optional): D .?S-9y CST TUBE: TRTEUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. PETITION FOR VARIANCE WISCONSIN DEPARTMENT OF OFFICE USE ONLY OF A RULE IN THE INDUSTRY, LABOR AND HUMAN RELATIONS Petition No. WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY & BUILDINGS E-Number P.O. BOX 7969, MADISON, WI 53707 I Name of Owner Building Occupancy or Use Agent, Architect or Engineering Firm Company Tenant Name, if any Street & No. Street & No. Building Location, Street & No. City State & Zip City State & Zip City County Phone Phone Plan Numberls) Name of Contact Person IF KNOWN 1. Rule of the Wisconsin Adminstrative code cannot be entirely satisfied because: 2. 1 n lieu of complying exactly with the rule, the following alternative is proposed as a means of providing an equivalent degree of safety: 3. Supporting arguments are: VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED For Fee Information See ILHR 69.15 or Contact The Department at (608)-267-7843 NOTE: Petitioner must be building owner. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless a Power of Attorney is submitted with the Petition. (NAME of PETITIONER Please type/print) being duly sworn, I state as petitioner; that I have read the foregoing petition, that I believe it to be true and I have significant ownership rights in the subject building. OFFICE USE ONLY Signature of Owner Date Received Amount Paid Receipt No. Subscribed and sworn to me this date: County, Wisconsin. Department Action Notary Public Office of The Secretary Date My commission expires: SB-8 (R. 12/84) t s s c~ Q d I o VI) t~ 7 d id o i f 7 ot" 5 } / r c7 f / ~ rJ r 00 ✓1 - i W 2 o ~ ~ u ✓ 15 G C e. r 3 6ectroom \A kv, , Res; ence we'll V fff~~~ Lb g a~AQ~ 7'e- ~Er2 .e3+4s6 ~o ~o• ~r 1 rSwl~ i o n 3p J ~,O C~~c" of J I ~4 AQPia `Q o S~~ ga Q y~ T~ /J 3 t ~1 l0 ~~Q , S~o~ S.~s~tn Cie,) a-2 lop, 11o st.e-Q~, I~ ~ r Li ee n c~t 5 ~ RECEIVED, 0,7 (q Nov 14 1985u_.. h4ptiW%, BUREAU s Sa~ti~ NOV 14 of ~ ()EF~~~~~W p\~` pF~ r J~,p. S~IFrT`~ ~ i3 Lo(.%,s. I)rV. Plb• t-A Wisconsin Department of Indust) DILHR Labor & Human Relations Leroy Jansky P.S.C: Safety & Buildings Division 13 E. Spruce Street Bureau of Plumbing Chippewa Falls, WI 54729 OiS) 723-8786 PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT Name of Premises NW.NE. 13. 30, 1,-sO l~slENwooYj ST CR01)C Location Township County Master Plumber/Se4-T46wr L~1LE McYE2s Address Rt'Z 90-(Cr--VILLV- WT- S4-17-S Owner- .IF-RF SAKz6R-4 Address Sanitary Permit # -7'3 Cjc,)c Plan I.D. No. _ 0-7140 Type of Inspection SYSTEM Persons Present at Site T.-NEL_ ow . L . tAF-ve&c Type of Building: ❑ Public ® Single Family sF-BUPlON BRIEF, FACTUAL COMMENTS AND SKETCH: ► l I i 141 Ijly~ II I! 4- 1-11-P ! I I ~ I { j i Qlr3v i i_._ 1_4ESi 59tQL _ -I- { •I ~ 1 { r I Iota , I it I_7 SEE ATTACHED DISCUSSED WITH PLUMBER/CST SIGNATURE DATE OF INSPECTION Si net re of Inspect Inspector Local Inspector Plumber or Responsible Par DI LH R-SB D-6799 IN. 5/82) L rr wlsconsin APPLICATION FOR SANITARY PERMIT ~ DIL DEPggTMEnT OF HR (PLB 67) COUNTY - InDUSTPy; LRBOR 6 HUMRn RELFITIOnS UNIFORM SANITARY PERMIT # - 15J 9 o ~ -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 OW R _ MAILING ADDRESS PRO RTY L CATION J 1/4,,4/1/4,_S/'3 cITY: ~ C1. N, R '-E (or W G : LOT N~IMBER BLOCK NUMBER SUBDIVISI N NAME TOWN OF: ~ ( ( T ROAD, LAKE OR LAND ARK STATE PLAN I ~fJ /1J .D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 13 ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement El Replacement Soil Absorption System ❑ Repair Alternate System ❑ Revision ❑ Privy ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench System-In-Fill U Seepage Pit El Holding Tank ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Issued Total #of Prefab. Gallons Tanks Site Septic Tank Capacity Concrete Constructed Steel Fiberglass Plastic 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 Septic Tank Capacity Gallons Ta/nks Concrete Constructed Steel Fiberglass Plastic Lift Pump/Siphon Chamber Manufacturer: C/ PERCOLATION RATE ABSORPTION AREA ABSORPTIOEA (Minutes per inch): REQUIRED (Square Feet): PROPOSED qua re Feet): WATER SUPPLY: Feet): r Private ❑ Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of PI tuber (Print): Signature: P PRSW No.: Phone Num/ber: Plumb is Address: (7/ ~C~ 19 R~ Name of Designer: ~:z S v COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: • c~~ ~D~ ❑ Disapproved Reason for Disa 0 Approved El Owner Given Initial s pproval: Adverse Determination Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber i 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. Pi in detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) 14. p 9 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 Snecessary t to of Wiually my 2 to 3 years. If you have questions concerning must be properly maintained. Have a licensed pumper clean your septic tank whenever your system, contact your local code administrator or the Bureau of Plumbing, D'LHR Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑❑r General Plumbing Plans Madison, WI 53707 11 Private Sewage Plans Telephone: (608)266-3815 7 Plan IdcnLifi(,aion No. (D v 1 1 Gaflun, Pei Dal' r , PRIORITY PLAN REVIEW ONLY Klan R(, iIw w rr,e ~c ci~ ecl ' )r Vnriaw e I(,(, k(,( Cam,..,.( Project Name escription ❑ city The plumbing code requirements. This approval is based on Ch; onditionally approved". This approval is continger corrected. All permits required by the city, village or this installation shall keep one set of plans with ciate inspector when inspections can be made. ❑ F enced before the expiration date, new plan /X11 )tained, it will expire the day the initial sanitary 7 uirements only. All other system reviews must be James Sargent Bureau Director If Questions Plans Approved By: f Date Approved: Contact cc: kPrvate iSewage Consultant ❑ PJumL,.. Consultant ❑ Environmental HealkK unty ❑ Local PI ❑ Facilities Need Analysis Section W-SSWMP ❑ Plumber ❑ Department of Agriculture DIIHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other SBD 6678 (R. 08/83) (PIb 100a) (Wis Slats. S. 145.02) 1 4 1 31 Ci Detach And Return STATE OF WISCONSIN DILHR Upper ` DIVISION OF SAFETY & BUILDINGS Portion Of This Form With ` BUREAU OF PLUMBING Any Return Correspondence 201 E. WASHINGTON AVE. RM 141 P.O. BOX 7959 - MADISON, WI 53707 v OW2663815 DATE: 10/21 /85 PROJECT: yo Sanders, Jeff - Residence 3a(b) to Nip NE,13,3Q,15W Lyle Tn Glenwood Myers St. Croix W1 Route 2 T Boycev i 1.1 e, W1 54 PLAN ID. # 85-t1714d - - DETACH HERE PROJECT NAME Sanders, Jeff Residence PLANID. 85-07140 # This is to acknowledge. receipt of your plans and specifications for the above-indicated project: 00 Preliminary review indicates the required fee is $`y Fee Received is $ 80 . Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. Plans being returned. ❑ Overpayment-Refund forthcoming. Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held' in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Sod Tester. (1 copy) specifically noted.. ❑ Petition For Modification signed by county, owner and ❑ .,.Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shalt 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. ❑ 'Condominium declaration. (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 lL Pressure Distribution Systems (Mound or inground Pressure) unit of government (sample enclosed). ❑ Application' for use of 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) ❑ Affidavit for 411-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ,E] Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including. system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil A ❑ Cross section of dosing tank showin data. g pump(s) orsiphon(s). ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be pl9ced prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ -.Construction details • and cross section of ° soil absorption of trench before side slopes• begin.) system. Depth and type of fill Copy of signed onsite report by county or district staff. 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 PPCALTERNATIVE State Plan l.D.Number : ❑ Holding Tank ❑ In-Ground Pressure Mound (If assigned) 507140 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER J, anit4: INSPECTION DATE Jeff Sanders R. R. 1, Downing, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PL ELEV NW NE, Section 13, T30N-R15W, Town of Glenwood Name of Plumber: MP/MPRSW No Cnunty. Sanitary Permit Number: Lyle J. Myers 6219 St. Croix 75000 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: BEDDING: =E:]NO DIA VENTMnTt HIGHWATEq DYES ❑No DYES ❑NO ALARM NUER OF ROADPROPERTY WELUILDING VENT TO FRESH FEFROM LINE AIR INLET: DYES DYES ❑NO NEAREST_ DOSING CHAMBER: MANUFACTURER BEDDING- LIQUID CAPACI TY PUMP MODEL P U M P: S I P H O N M A N OF A C T H I H EH WARNING LABEL LOCKING COVER PROVIDE D . PROVIDED: YES ONO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check thesoilmoistureatthedepth ofplowing iH OIAMF TER MATE HInLANDMARKING; 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 THO OF DISTH PIPE SPACING COVER NSIQE Dln =Firs DIMENSIONS ENCHES NtATEHIAIF PIT DPTIH BER OW nE FILL DEPTH UIST H. PIPE DISTR PIPE DISTR. PIPE -MATERIAL NO DISTH NUMBER OF PROP ERTV WELL. BUILUING. VENT TO FRESH BELOW PIPES ABOVE COVER ELE V. INLF T ELEV END PIPES FEET FROM LINE AIR INLET. NEAREST--s _ 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- D YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rexruRE PEHNtnNI NT MnF{KrHS oHSEFtvnT' LLs DEPTH OVER TRENCH BED DEPTH OVFH TRENCH HED - DYES ❑NO DYES ❑NO CENTER DE PTH OF TOPSOIL SODDFU SEf UFD EDGES MULCHED DYES. ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES FILL DEP TH ABOVE COVER : 7NO LATERAL 77777 DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV CIA ELEV. PIPES DIA: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING CHILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF (PROPERTY WELL. BUILDING: FEET FROM LINE DYES ❑NO DYES ❑NO NE FROM Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710 (R. 01/82) 0 r N x m m N o~n3 =0=0 c oo coww~`<w z " 3 c co co N < o m c s CD •o D fD fD 1a (D 0 N a 0 0 CD F oo~~ ~ -1 w m~co 0 CD r law CD N a N A n ti - tp fD oc3Dn o~°coow - aowocO- rt M , O ~ ~ 3 Z(a co o n w o c w c cr =0 *0- c m c N w N ¢ mN 0 0OM 3' ai = CO Q A m 'CO cD U) C N D tC Q 1 o n Q n / c (0 o n o ~ cx w O O w CO cc N CD m .0 N fD w N. Z N w ='w cn 0 --I ~(a N 0 D o CD CD Z nm 0 3 o CD m N n CA o ? F Co o o Cl. w - 0 Qy a m N 0> a TO ui w n c ° co f CO) ~ -1 p n \m 3CD 0Nww_. C R1 m U) CD CD @' NZ (D to oc o~-(D O= 0 no f 0 Or aw o' R1 w ~ w 0 CD (D a0S oa710m0 , o o co n Q C n C w A ~l6 m a ~°f g 3 0- cD o 0 C L c w acD , N• o a co.~ 0 CD v o -1 O APPLICATION FOR SANITARY PERMIT S T C - 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 Location of Property Section /,2 T_? y N-R Township Mailing Address Address of Site r Subdivision Name Lot Number f L Previous Owner of Property J 1 Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes f/ No Volume and Page Number .02--7,K 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) ceAti6y that aU statements on this 6onm ane true to the best ob my (ouA) knowledge; that I (we) am (ake) the owneA (,s) o6 the p topenty des ch ibed in this .in6o4mation 6onm, by viAtue o6 a waAAanty deed neconded in the 066.ice o6 the County Regi,6ten o6 Deeds as Document No. p _--6 - ; and that I (We) pusentty own the puposed site bon the sewage di~spos :system (on I (we) have obtained an easement, to nun with the above desnibed pnopeAty, bon the construction ob said zystem, and the same has been duty neconded in the 046.ice o6 the County Reg-usten o6 Deeds, a.6 Document No. S' A OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED L H ' z H a STC - 105 r" r a H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d Q~ a OWNER/BUYER o~~/ ~nJF~-7ZS rn ROUTE/BOX NUMBER ~drl)~l~G Fire Number CITY/STATE ~e9u1 nJ„JG LV ~s ZIP:'5- `J PROPERTY LOCATION:A1W 4, 34, Section 13 T 3 N, R /5 W, Town of r oz 00 St. Croix County, Subdivision Lot number. 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. yo 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 Zoning Office within 30 days of the three year expiration date. X SIGNED „ 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. ST. CROIX COUNTY WISCONSIN rA~ ZONING OFFICE 796-2239 (HAMMOND) k 425-8363 (RIVER FALLS) HAMMOND, WI 54015 September 17, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Jeff Sanders property located in the NW&4 of the NEk of Section 13, T30N-R15W, Town of Glenwood, St. Croix County, revealed suitable soils at a depth of 33 inches, be- low which seasonable high ground water was noted. At the time of the onsite, however, there was some concern as to the rate of the perc due to the density of silt loams. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, CJ Thomas C. Nelson Assistant Zoning Administrator mj - WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY I BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53107 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NW 1/4, NE 1/4, Sec. 13 T 3_N, R 15th W Town Glenwood Street Address Lot No. Block Subdivision Landowner's Name: Jeff Sanders The application for this site is for: [anew 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 the first five quota numFers_ssueaT6-you.) I.xione of the applications needing a quota number. The quota number assigned to this application is 59 - 20 - 6 ❑ 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. [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: ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. Ela 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 As an oning Administr^rnr Date September 17, 1985 DILHR-SBD-6158 (R 12/82) 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/ RR NW 141 NE Z S 13 T 30 N/R 15 X WW Glenwood St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Jeff Sanders R. R. 1, Downing, WI 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 DILHR-SBD-6413 (N. 05/81) My Commission Expires: DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION HUMAN NDLATIONS PERCOLATION TESTS (115) P.O. BOX 7969 MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOC(ATIOy]N~: SECTION: ~ OWNSHIP UNICIPALITY: V]B)K.: SUBDIVISIOfy~NAME: IU 1 /V E 3 /T I-3IO H/R I r /j`1~ U~,Y: OWNE 'S/ UY S NAME: MAILING ADDRESS: USE TES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: OFI E DESgRIPTIONS: PE C9LATIO TESTS: Residence L. ew ❑Replace 9/did /p~ j~ RATING: S= Site suitable for system U= Site unsuitable for system O (J CONVENTIONAL: MOUND: IN-GROUNND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RMENDEDSYSTEM:apptional) os~'u Msou osWu oSYU ❑S~u ECOM ~ (/~J If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: AIR PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 5,4 XC 33 DiN~ 1/ 8/2.9d,/6 B > a_0YJ4n sit mdtf 33 .90 B-c2., a Z/. .o~~ s rl /o Sjl/ a th q B-3 5. 33 1L,e- e_ '3 ~ AP A s 1.9 ffinsi .&i ~ B- B- B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P IOD 2 R OD 3 PER INCH P OC 2*7 E 39-4-7 ZZ 74- Q L3 C2 Ir P- P- P- PLOT PLAN: Show locations of percolate in test" "s, sEil"D6ri and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference poi is and show their ocation on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. U SYSTEM ELEVATION • 0 8 . _ l E 3 € E ` a r wLl e_l 0e, O d _ .__9_ car E a } P.3 ~ ►a~r-_ . ~ -m - tea' - _ I t E 3 E r _.3 5----~~ P 1~4 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accordbCith 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)• s TESTS W RE CO LETED ON: ADDRESS: CERTIFICATION NUMBER: JPH N UMBER(optiona CST T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - C ' T CTION FO. , , 4 < ail t4 . 2 T` a whether this is a ae~ or core)"nercial Project; 4, G TAI ONLY IF ALL .1T . 6 P1 F1 7, M. to A d are permanent; 0. a m tent exetnp 10. if L as flood plain, tl -nopriaie box; 11. Sign the fora' A plane your current address and yr r; 12. Make legible copies and distribute as required, ALL _ -1,J ST E FILED WITH THE LOCAL AUTHORITY WITHIN 3 DAYS F COMPL.ETt~, J AT O FOR C' SC and Textures Othi st - (over 10") cob 1 Cl"} gr - 3`°1 _ cs - Co -c Rate med s Me i =d ~I n - *s;l Gilt: Loam Lai s€ Gy J y Loam R si<;` - <y Loam rnot - sl:; Pt Mack x Si r TO THE OWNER: V This sail test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to tt 'ate local authority in order to obtain a permit, The sanitary permit must be obtained and posted p,; to tl,u start of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 P.O. BOX 76 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) SECTIOW- OWNSHI UNICIPALITY: BLJC,IyQJ§UBDIVISIO AME: L % llJ~ % 13 IT 3o tSE ( IE543 T :~"V1K UN Y: NE S UY S NAME: MAI ING ADDRESS: 4 USE TES OBSERVATIONS MADE NO B DRMS : COMM R AL DES TION: s~~~ OF S: A 10 TEST Residence Q ew ❑Replace S: RATING: S= Site suitable for system U- Site unsuitable for system O ON~VENTJUNA MU . L: cos: ❑u IN-GROUND-PRESS' M11 -IANNG TANK: RECOMMENDED SYSTEM: ptional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the AM under s. ILHR 83.0915►(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL-WITH-THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 20 q5 dog xt_ 33 1104-146 09 t If I s 6 I o 33 B,a d y 3 nu, 3 17s;I /0.8 I __g s a 39 g3 5.33 no ,0 8 S/ 1 P77 1 l 9 B- B- B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. I Q1 P 1 D2 PER INCH P- P o2 , Alf P- P- P- • PLOT PLAN: Show locations of percolate in t ts, s i dri and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference poi is and show their ovation on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Cl 0 $ tt _44A 4e_) I 0 C-23 8 I wn i oa2MA'A d- 0 I ' I I r. I r r i I a•a 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord4ith 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 • TES S WARE C ADDR SS: O LETED ON: ~ a; CER I ICATION NUMBER: JPH N UMBER(optiona _75Q6 _ CST TPR E. ' DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nit "A Snn-waom. 112 into,2%