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HomeMy WebLinkAbout028-1004-30-100 0 o c c °7 0 (D (=D 0 (D v A+ c ^ ~ i hi ' N Nn o O co M C7 o p i; C: c O o w CO' o D (o m m s N °D 00 p, tb Z Q = N N N (D Z1 Qw 0 WN = ~ ON (~j 7 Q (D - _ W o O (D ((D 0 D 3 :E CD 0 7 y = O C a (n D a m m N a N QJ O n CO N (D L O ` i a O m (a co n r U) CD 00 N co cn C11 o o Q tO Q b a r D h~ z O O O < Oi ~d N n Q N N 0 a D rt 9 v m 3 v v _v a O (D ? ~ CD (D lp 6~ N = ~ N o ? H rt N N D D o O H n~i O ~ o n h • CrJ ~ 11; d 1O CD Vy I c V w m -I to I In o N A Z n H H cn _ O tv w A z 01) 00 z z s I r~ U) ~ N O ~ t-h F- W - No d v Cn CL Z (A O O Z rt A v H. N m O N O W N C N m CL n CD O - v C oZ O (D cn O A ~ v I A R A i N I N O O a A 0 b W O_ (D 0Q N 0 0 O (D C) n 'v Parcel 028-1004-30-100 01/23/2006 03:43 PM PAGE 1 OF 1 Alt. Parcel 2.28.17.19A-10 028 - TOWN OF RUSH RIVER 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 - J S K FAMILY TRUST J S K FAMILY TRUST 1945 60TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1980 55TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 4.322 Plat: 4234-CSM 15/4234 028/02 SEC 2 T28N R17W PT SW NE BEING CSM Block/Condo Bldg: LOT 01 15/4234 LOT 1 4.322AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-28N-17W SW NE Notes: Parcel History: Date Doc # Vol/Page Type 10/07/2002 692987 2002/27 WD / 01/08/2002 667584 15/4234 CSM 4) D ~ VINI'L- _~v V_r, 2005 SUMMARY Bill Fair Market Value: Assessed with: 82676 190,500 Valuations: Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason OTHER G7 4.322 18,100 169,600 187,700 NO 05 I I I I Totals for 2005: i General Property 4.322 18,100 169,600 187,700 Woodland 0.000 0 0 Ii Totals for 2004: General Property 4.322 9,000 95,500 104,500 Woodland 0.000 0 0 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 PLEASAN I VALLLY _ MvZ)n F-N, v L1. . 160TH I I - SEE PAGE 31 ~i o v/ 9 AVE. 1~ • 0 BQ/d • ~ . ~ ~ na°/a J sse/c nc F vy~~O F///en D h h/qU.~s/ k vYb c: .r C///. 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T L N-R- W ADDRESS 7f" l ST. CROIX COUNTY, WISCONSIN SUBDIVISION x`✓ LOT LOT SIZE , PLAN VIEW Distances and dimensions to meet requirements of ILUR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -y "a:~y Ipy `9~0 t G1Jc l/ , C i 7 Y 4-X 1,5 30 o /o c //0ase- ND~CATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,7) 0 !'G i~ ii'G Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side ,0 Rear, © feet .From nearest property line Front, 0Side, 0Rear, Q 200 feet Number of feet from: well y 7 building: 3f~~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER 7_5~ 9 Manufacturer: Liquid Capacity: 01 Pump Model: Pump/Siphon Manufacturer: fr Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: ~jl)riri - ~JC Alarm Switch Type: el,.V Q Number of feet from nearest property line: Front, O Side, ® Rear, Ft. Number of feet from well: h' Number of feet from building: y (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: f Width: Length: Number of Lines: 61~ Area Built: ~~C} Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,0 Vt Number of feet from well: ~o Number of feet from building: Iz r) (Include distances on plot plan). SEEPAGE PIT Size: Number of pits 'Diameter: r; Liquid depth: Bottom o se pag ~ Pit elevation: ~ . Area Built. e Has either a drop box O or distruti box b en used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capa ity: Number of rings used: Elevation o b t om of tank: Elevation of inlet: Number of feet from nearest proper in nrontt O Side, O Rear, O Ft. Number of feet/from ell: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: `J Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL XXALTERNATIVE State Plan IDNumber (it assqnedt ❑ Holding Tank ❑ In-Ground Pressure XXMound 18505715 ~(I NAME OF PERMIT HOLDER. - 1 JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Arlo Holman f-A , "JI'A`._I R. R. 2, Baldwin, WI 54002 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REE PT. ELEV. SW NE, Section 2, T28N-R17W, Town of Rush River Name of Plumber. MM PRSW NiSanitary PermumberDale E. Hudson 6629 Croix 69662 SEPTIC TANK/HOLDING TANK: MANUFACTUR ER. LIQUID CAPACITY. JTANK INLET ELEV.. TANK OUTLET E LEV.. WARNING LABEL LOCKING COVER 930 PROVIDED PROVIDED < e t. E ►NJ Y ES O NO OYES bi]N O BEDDING. VENT DIA.. VENT MATL.. M HIGH WATER NUBER OF ROAD: PROPERTY WELL. BUILDING: ALARM LINE I JVENTTOFRESH AIR INLET. OYES NO OYES NO NEAR ES OM 61 J0 * DOSING CHAMBER: I MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL IPIIMI/SIPHON MANUFACTURE{? ARNING LABEL LOCKING COVER {7 n k jP`FCVIDED .PROVIDED. -'~W,2.-C~1 ®YES ONO r 7j1 f TL ~l ` i YES ONO YES ONO tR~ GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPE RT W E LL' BUILDING FRESH (DIFFERENCE BETWEEN FEET FROM uN w.- IAVIERNITNTLOET h PUMP ON AND OFF) YES NO NEAREST ,i ~V C ~ - 1 ~ t SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLLNG111 DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE y the soil is dry enough to continue.) MAIN ~1:2 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH JLENGTH NO OF DISTR E SPACINU COVER INSIDE DIA 1 PITS LIQUID TRENCHES MATERIAL' PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTH PIPE DISTR. PIPE DIS R PIP MA RIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPFS ABOVE COVER ELEV. IN-11 ELEV. END PIPES FEET FROM , LINE. AIR INLET. NEAREST----y-1 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- ~~yIJYES O meets the criteria for medium sand. TIONS MEASURED. YY~" NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS YES ONO YES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH, BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER , EDGES , OYES f10 YES ONO EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH y TRENCHES 7 f DIMENSIONS ~J 1 r MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELE,V ELEV.'. DIA ELEV PIPES DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. 215 ©YES ONO a, DYES ONO COMMENTS: PERMANENT MARKERS- OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING: FEET FROM LINE5 9) 1? 7 EYES ONO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE4 ~.,,r•-°" - TITLE: DILHR S B D 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY ~ (PLB67) PERMIT # oe►RRTiT1EnT ov UNIFORM SANITARY UST qY. LR60q 6 HumRn RELRTIOnS 4 2 /(7 / ) , -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY O NER MAILING ADDRESS X/11- /0 A/0- 112-2 62 17 )qf 2 PROPERTY LOCATION --effy- 11/4 X1/4, S T N, R (or W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION N ME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER " PJ 18,50 5 7 /5 TYP eN-T E OF BUILDING OR USE SERVED / 1 or 2 Family Number of Bedroom,: ❑ Public (Specify): I THIS PERMIT IS FOR A: ~J New System ❑ Tank Replacement ❑ Repair Replacements-h PTf m-S7"rm ❑ Revision ❑ Privy .k-Y Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. D-1 Seepage Bed ❑ Seepage Trench J Seepage Pit ❑ Holding Tank System-In-Fill In-Ground Pressure U Vault Privy ❑ Pit Privy Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is CompI t As Far As Soil Co ions. Total of Prefab. Site Gallons nks Concret Constructed Steel Fiberglass Plastic i Septic Tank Capacity Zj_ _Z Lift Pump Tank/Siphon Chamber i Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: IR Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: F? PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /3 2 75' ? ~ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature:/! MPP/MPRSW No.: Phone Number: 1 )~-?!t'? s ~ll,''> `r --f`.c.._ C.1~ jL Y~~ G.~ C-, ~ ~,l ru Plumber's Address: I Name of Designer:^ COUNTY/ DEPARTMENT USE ONLY Si natur 'of Issuing Agent:I/ Fee: Date: ❑ Disapproved ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber v v s .o m mg~-~ ~~cncnn~3O v vi w ~ v m~ o v g ao N c O C2G 7 =r 3 0 -=r FD' -0 C, CD ccnD N to 4 _0 c m N 'o - CL C) 0 o CD CD CD CD ol W Co ~wa~ mcn.aC" Er C=D*: =3 i8 o 3 a o ° w w =3 m E; "S :3 0 O o ~ c to 3'~ Co z z o-= 0 w c (D w - w C) 0 w~D ojoc:3 CD 5 l D CD cx) - -v 7pw w ,.@ c o+ < cD ~ ~ c0 Q O cD o Dc CD Q c ' - o 6lc to w O 6 o : Q ~a - cD (p ° :3 Err ° v cn C N Lim : N 0 0 (D w to Z D 1~ (n ? w < ow C 2 woCD CD Jr gym vas 3 m CD M N A a D n CD C 0 Ica ow~o?0 m w r+ =r ro-w0 u,,- a cD = o. co lA V w a c O cD C m =r 0 ~m CD ~ CL CD =r I m m (D cn 3 CD n CL cD - m = v °-o (n o~_~~ a CAD A W a fl 1 W o. w (D C= C 0 0 CL Lot a0 CCD 0,:3 g a=r cn =r (D 0 0 c a O N n 0 7 CL 0 = O to c c CC"D m cow =w o m -.0 0 v 1 a 3 way o X03 cc) •"h N• 7 a O < w ~ 1 O O1~ 0 0 1~)®ILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. Gallons Per Day F PRIORITY PLAN REVIEW ONLY t Plan Review Fee Received F etition For Variance Fee Rec. P Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village ❑,Town of: 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. L1 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 pl,< approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date 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 Plans Approved By: Date Approved: Contact so cc: ❑ Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section UW-SSWMP ❑ Plumber ❑ Department of Agriculture oi~ 1 iK-MM-6099 (R. 0 1, 85) 1 Owner 1-1 Oth,,r SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 _ MADISON, WI 53707 608-266-3815 DATE: PROJECT: 7~~~9FO ,NE.2,28, i 4.1 Kush Rive. .0 ee, PLAN ID. # - _ _ - DETACH HERE - - - - - - - _ - PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated proje _ Preliminary review indicates the required fee is $ Fee Received ❑ 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 Soil 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 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. ❑ 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 II. 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 all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ 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 ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed 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. I 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 4~,/-'~/' Location of Property 5a) 14 Section 1 , T N - R. / W Township i `✓e Ic _ Mailing Address A)7' Subdivision Name Lot Number , Previous Owner of Property 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 No Volume _ and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: h. 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) eexa6y that att statements on this 6ohm ace tku.e to the bat o6 my (ouA) knowledge; that 1 (we) am (ane) the owneA (s) o6 the pnopeA ty da n i.bed in this injo,cmati on (ohm, by vi tue o6 a waAAanty deed ne.eonded in the 04 6 i ce o6 the County Regiz teh o6 Deeds as Document No. -3 6 ; and that I (we) phesentty own the p.iLoposed site Got the bewapoba ays-tem lon 1 (we) have obtained an easement, to h.un with the above desehi.bed ptopehty, 6o/t the con6t u.ction o6 said system, and the same has been duty hecotded in the 066ice o6 the County eg t/en_o6 Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H V] y S T C - 105 r y ti SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d OWNER/BUYER rA ca ROUTE/BOX NUMBER Fire Number CITY/STATE 'LIP ~~7DCI--- PROPERTY LOCATION : _S'L(_) Section ~ P N ~ , R 7 W, Town of ✓Zc~S~ X"/may' St. Croix County, Subdivision- /y Lot number N~ • i~ Improper use and maintenance of your septic system could result in i 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 z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- w 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. Jam} ~~~~G~~. pQw`~ 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. bILHR PLAN APPROVAL Safety and umbi Bureau of Plumbi P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-381:, Plan Identification No. , 3C-~ S71 Gallons Per Day -4-- c) Q ' l -1 PRIORITY PLAN REVIEW ONLY Plan Review Fee Received Petition For Variance Fee Rec. Project Name 1 ( Project Location - Street No. or Legal Description v ( G 4 L: 1 yb~ A OJ ~ 2 v l ~ ~N C c? -7 (rl d r-~ County ❑ City 1-1 Village Town of: kS l V e_q- _I C c t X The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval i~ based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b (4a)) (4b) (6) (7) This approval will expire two years from the date 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: -y~- ~l~-7JZl.:y r -l~z.Z James Sargent Bureau Director te Approved: Da If Questions Plans Approved By: L Contact * cc: X Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section I)Ir ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture Al 11R 'BD-0099 R. 01 8,? Owner ❑ Other ,,Qi°~ ~✓o~r~C/,ri' Page Of _3 Straw, Marsh Hay, Or / Synthetic Coverinq~ f/ Distribution Pipe Medium Sand y H G Topsoil F D 3 E r 4-% Slope Bed Of 2 Force Main Plowed Aggregate From Pump Layer r✓ t3'S'~~~' C)V ` D d " E S to°o` °N, 4 t Cross Section Of A Mound System Using IDIf~~USTRY....: MD g4~iL~ F , 75 • ` 16o or Aged For The Absorption Area Ft. H Signed: B 7 Ft. License Number: i zl iz Ft.., Date: F--,2 7-- F- 73 Ft . K /o,2.3 Ft. Alternate Position L Ft. of W Ft. Force Main L 140bservation Pipe-•-," FA 3 Force Main W - --._..------T----r._ From Pump ~~CDistribution Bed Of i - 2 2 Pipe Aggregate Observation Pipe Permanent Markers U S E P 0 3 198,5 Plan View Of Mound Using A Bed For The Absorption Arta ~o ~✓~/~ar~ Page L Of 3 ~f r Perforated Pipe Detail 111101k tam aft 0 INDUSTRY, LAAOR. ANN HUWA RE End View ~Perfofotedn- \6 End Cop PVC Pipe ce Holes Located On Bottom, Are Equally Spaced S P X S PVC Forcer Main ' From Pump _ .7 PVC Manifold Pipe \"-.Alternate Position Of Distribution . Pipe Force Main From Pump Lost Hole Should Be Next To End Cop End Cap Distribution Pipe Layout P Z3 r r R 5,33 . ~ 5 2- 7 X '2"5 Y X75 Mole Diameter Inch Signed: z2,,e,,,.- Lateral / Inch(es) License Number: Manifold .2 Inches Date: 2 7- g75 Force Main _ Inches RECEIVED P n 3 1995 M R Kt"'U 1 PAGE 3 OF 3 PUMP CHAMBER CROSS SECTION AMP SPECIFICATIONS --VENT CAP `i C. i. VENT PIPE WEATHER PROOF APPROVED LOCKIKIG JUNCTION BOX MANHOLE COVER 25' FROM DCGOR, WINDOW OR F"RE 5H 12"Mlll. I w n--~w AIR INTAKE I GRADE y" MIt`.J. IB"MIN. CONDUIT PROVIDE I INLET AIRTIGHT SEAL i I I APPIKOVET) JGINT A ( I APPROVED JOINTS W/C.Z. PIPE ,j1Vft31 III W/C.I. PIPE EXTENDING 3' I ALARM EXTEAIDIAIG 3' SOLID Sr.,il. ✓~~~~~~~iL/ ~ II ONTO SOLID SOIL ONTO B tt, f. ; I ON c V E LABOR RfD HUB 11'? F! r, T OF II,IDUSTRY, ND BSI DI~I S --1 DPlISION OF SAFET' ,PUMP OFF D L L~`Q CONCRETE BLOCK RISER EXIT PERMITTED GNLtJ IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC IF SEPTIC AWL) DOSE TANKS MANUFACTURER: 4~e eNUMBER OF DOSES: ZI PER DAY TAPJK IZE: w_ GA[L~LOAIS DOSE VOLUME:-L~f`~~ GALLUn1S ALARM MANUFACTUKERC: - jL 6,- 12--,- - P~/1 CAPACITIES: A=2IWCNES OR a3'q GALLOWS MODEL ►JUMBER: _ /J'000 -Z B= Z )MCHE5 OR --3q GALLONS SWITCH TyP£.: al-'V C= 9'`3 INCHES OR ~-5 GALLOU5 PIIMI, MANI.IFACTLIRER: D= 1,2- - INCHES OR 2Q-'/ GALLONS MUT)EL NUMBER: PNOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: _ I AJSTAL.LED ON SEPARATE CIRCUITS ~I PUMP DISCHARGE RATE 70"z GPM p d FEET ` ECEIVE t: ; VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. + MINIMUM METWORK SUPPL.y PRESSURE . , , . . . . . . . . 2•~S~ FEET LP 03 1985 + //0 FEET OF FORCE MAIN X L. p~_F 100FT.FRICTIOM FACTOR..FEET TOTAL_ DyJMAMIC HEAD = L----- FEET IMTEKNAL_ DIMEWSioKIS OF TANK: LEAJGTH -,WIDTH -;LIQUID DEPTH ~7 r SIGNED: L_ICEMSE NUMBER: DATE: 17 ~ ;r, iJ (,ta 00 > k-/ Z r. V, n {~rt rl. z. t: v P SEP 0 Ti CJ k` 3 79? Q_ © N 10 10 1 71 iA i 24 ,4 / /V Ao °w 20 - - VK LL 1b Z S~40 12 W Z i 8 O ~ 4 I LIE 0 16 32 48 64 80 96 112 _ U.S. GALLONS PER MINUTE SOLID~11 Head-Capacity: SV40 and SVK50 Submersible Residential Sump Pumps Max. Solids SV40,11/2" & SVK50, 2" Spheres; 4 Pole, 60 Hz. HANDLINU 32 SUBMERSIBLE 28 24 S EWAut: z2o ,6 s p4pq 0 8 &'EFFLUENT 0 12 PUMPS 4 0 20 40 60 8o 100 120 140 160 U.S. GALLONS PER MINUTE Head-Capacity: SP40A and SP50A Submersible Sump Pumps Max. Solids SP40A,11/a " & SPSU,11/2" Spheres; 115 Volts, 60 Hz., 1750 RPM ao 3s 28 3 24 K$ 20 16 12 . 8 4 0 20 40 w e0 100 120 140 180 U.S. GALLONS P" MNA M Head-Capacity: SK60, SK75 &W $K1* S~laapl lk Serrate PmW Max. Solids 2" S*m,1"~'S~ ~ HYDR-C lififM c PUMPS A Division of Wyloin, Inc. Post Office Box 327, 40/20192 _ _ n 3 q8l~ Claremont a Sa ey Roads, A6Wwia 10 44806 FI-82 V in amow: "Wa cs w.ua. use., ISO ~r WW., waft t f to . 'BURL' DEPA•RTNPEN F OF REPORT ON SOIL BORINGS AND, SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR,AND PERCOLATION TESTS (115) MADISOP.O. BOX N W153969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: ~j v TOWNSHIP/1-11-11 -+1 LO~Tf~NO.:BLK. NO.: SUBDIVISION NAME: 1/ 6,/4 Z /T2d N/R/7R (or) /!Gx COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ` f USE DATES OBSE VATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence ❑ New Replace Y _'Z3 4Jr.. RATING: S= Site suitable for system U= Site unsuitable for system d " CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(op Tonal) oS[2u ©S❑u ❑S2u aS®u ❑SiXu If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH4ft,, ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ell B- /D "y e7t,7 B- - ..Z5 93,79 32 3 B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1PdOlF_8 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH Zo /140 P- ,2, l> 11 ~i Al IZ9 /40 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 Sol- I/ i ~EC~7G'ED,'` N 8EP tl 3.1985 I t. I hUMS UREA , I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLETED ON. NAME (print): ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (oplional): I -4 7. Z _3 CST SIG TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - ti t I~ © txs c q ~ i ^"~1 1 l' ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 19.14-1119,19 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 27, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An onsite investigation for the Arlo Holman property located in the SA of the NE14 of Section 2, T28N-R17W Town of Rush River, St. Croix County, revealed suitable soils at a depth of 24 inches, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, k-.V04 M4,& o. 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)Mhh ~ #X SW ;L NE ;L S 2 T 28 N/R 17 E(or)W Rush River St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Arlo Holman R. R. 2, Baldwin, WI 54002 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: 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 ski 1/4, NH 1/4, Sec. 2 T 28 N, R 17 V-"A W Town or KWildi Uty Rush River Street Address Lot No. Block Subdivision Landowner's Name: Arlo Holman 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 the first five quota num ers ssueTo 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. F ]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (._.]for an application on file prior to February 1, 1980. LJ 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: E la failing conventional soil absorption system. ❑ 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. R I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson $j re (County Official Title Assistant Zoning Administrator Date August 27, 1985 DILHR-SBD-6158 (R 12/82) WORKSHEET - MOUND SYSTEM DESIGN PROBLEM: ss Design a mound system for a _ 3 2-- a~ Vo The site characteristics are: Depth to groundwater or bedrock ter' in. Landslope % Percolation rate min./in. Distance from dose chamber to distribution system / ft. Elevation difference between pump and distribution system ft. Step 1. WASTEWATER LOAD `150, gal. Step 2. SIZE THE ABSORPTION AREA A) Area required 37~ sq. ft. B Bed or trench length B / ft. C) Bed or trench width (A) = 8 ft. D) Trench spacing (C) Wastewater load .24 gal/f /day B = ft. trenc ees Step 3. MOUND HEIGHT A) Fill depth (D) = A0 ft. B) Fill depth (E) = D + % slope (A) _ /•3,? ft. C) Bed or trench depth (F) _ •76 ft. D) Cap and topsoil depth (G) = , /,C), ft. E) Cap and topsoil depth (H) = ft. Step 4. MOUND LENGTH A) End slope (K) _ (D E1+ F + H x 3 10,23 ft. B) Total mound length (L) B + 2(K) ft. Step 5. MOUND WIDTH Al) Upslope correction factor = 'g9 A2) Upslope width (J) _ (D + F + G)(3)(factor) 7-3 ft. B1) Downslope correction factor = B2) Downslope width (I) _ (E + F + G)(3)(factor) ft. Cl) Total mound width (W) for bed = J + A + I ft. C2) Total mound width (W) for trenches a j + 2 + (no. trenches -1)(c) + A + I ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil / gal./ft2/day B) Basal area reuired = wastewater flow natural soil infiltrative capacity = 37 sq. ft. C1) Basal area available for bed for sloping sites = B x (A + I) sq. ft. C2) Basal area available for trench for sloping sites = B W= J+ _ A sq. ft. C3) Basal area available for trench or bed for level sites B x W = sq. ft. . Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing 0 in. 3) Distribution pipe length 23 fib( 4) Distribution pipe diameter in. 5) Spacing between distribution pipes 32 in. 6) Distance from sidewall to distribution pipe in. 1B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes per pipe = /0 2) Flow per pipe 11,70 GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length = 5,33 ft. 3) Number of distribution lines = 6 4) Manifold diameter = Z in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = 70,20 GPM 2) Force main diameter = 3 in. 3) Friction loss = 1,08 ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = S ft. 2) Friction loss = 1,19 ft. 3) System head 2.5 ft. _ .cft. 4) Total dynamic head = G~ ft.