Loading...
HomeMy WebLinkAbout030-1005-60-000 0 N O 3 m o d ~1 O Cl) z o cn ow • n W O N w O CO ~p L N O FBI N z O N N 00 ? N t0 O .7 z EL CC, W W O O O (DD N W N O S N O ►5 N O_ O 0 0 O C) cfl r+ CD 2 -I v o A~ C: CD r. (J7 00 O O 7 N ~ O raj. !r N d O N CD aw o U) N (D v C D ~ N W n O s G 3 0 0 Z3 N U ~r 0 00 C-4 (D O W G O (0 C.0 a m can cwn a 3 a ~d CD ;a o (D x T G iv O p O O (D N• z z `1 O 'p G _4 < OG N D 10 H O ET c N N N F-` n to 9 a m N m w 0 6 O CD - CD cn (D 00 0 ON d 0' 3 m W H rt N W CD O - N z O~y r a z z z D D D N trrl F- ~ O l7 O h• I o N Z I r-t~l 00 O c L-n W m w 5 F-I 10 O N ~ z ~ p? CD 00 o N Z :d v O R h-h p' N D' rt n W A CO rt a z C o cn rt m (D IV CD ? O D w N O (D v O 3 Cl CD O U CL C -00- O T O l1 C z a c, o o = cD :E N co 3 N (D 'i p~ CL O Q A N O_ O C7 A (n j A N O O_ W p CD CJO CL O O N a n A CD b A ti 4Eg 10- QQ O O O ti 01/23/2006 04:49 PM Parcel 030-1005-60-000 PAGE 1 OF 2 Alt. Parcel 02.29.19.26D 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X 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 - BEARDSLEY, MICHELE L MICHELE L BEARDSLEY C - YNGSDAHL JENNIE YNGSDAHL JENNIE 1137 CTY RD I HUDSON WI 54016 SC = School SP = Special Property Address(es): Primary Districts: Type Dist # Description 1137 CTY RD I SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.970 Plat: N/A-NOT AVAILABLE SEC 2 T29N R19W PT NW SW COM NW COR, S Block/Condo Bldg: 533 FT TO N LN HWY I, E ALG N LN 26 RIDS Tract(s): Sec-Twn-Rng 40 1/4 160 1/4) TO POB: ELY 10 RDS, N 16 RIDS, W 10 RDS, S 16 RDS TO POB & EXC HWY PROJ 02-29N-19W 8939-03-00 NKA LOT 2 CSM 13/3593 Notes: Parcel History: Date Doc # Vol/Page Type 04/05/1999 600705 1416/330 PR 02/25/1999 598365 1406/85 QC 07/23/1997 1223/514 WD 07123/1997 733/63 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 83141 123,900 Last Changed: 07/0712004 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.970 50,000 62,700 112,700 NO Totals for 2005: General Property 0.970 50,000 62,700 112,700 Woodland 0.000 0 0 Totals for 2004: General Property 0.970 50,000 62,700 112,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/0412005 Batch 05-26 Specials: Amount User Special Code Category Special Assessments Special Charges Delinquent Charges 00 0.00 0.00 Total Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER oti~ TOWNSHIP S/ / U SEC. T Z( N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT _ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Nu RR., NO E O'NEIG MUMN WIS. 54016 AT8 RootiT ULAICMT ` I~NSI A LL19 4 DESILW, NO, GNER L IC. NO 90 63 N INDICATE NORTH ARROW -iii S.'Oi:JG- BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /p 0.6 Proposed slope at site: O SEPTIC TANK: Manufacturer: Liquid Capacity: J"_ f+ . Number of rings used: ~U_ Tank manhole cover elevation: T 7 r Tank Inlet Elevation: cl Tank Outlet Elevation: R'0 Number of feet from nearest Road: Front ,Q Side,Q Rear, O feet -From nearest property line Front ,O Side,O Rear, O / O feet Number of feet from: well 0 building: 13 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER (N~~~S ~d JG c 1'2 'V'"_ Manufacturer: Liquid Capacity: 2- (a H Pump Model: P Pump/Si.Pu n Manufacturer: 20~~lE/Z Pump Size ~i 1yjA Elevation of inlet: Z r Bottom of tank elevation: Pump off switch elevation: ! Gallons per cycle: Alarm Manufacturer: LEUEl 1411of RM Alarm Switch Type: -7~'/0,7 - r Number of feet from nearest property line: Front, O Side, O Rear , Ft. ~Oa Number of feet from well: ~.Z f+ ~t Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed:K /0')( sv Trench: Width: / R3 Length: Number of Lines, ~O Area Built: Fill depth to top of pipe: 1 f+ Number of feet from nearest property line: Front, Side, O Rear, O Ft. Number of feet from well: (0 { Number of feet from building: 3 41 f (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: - Liquid depth: Bottom of seepage--pit elevation: Area Built: Has either op box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TAN Manufacture_ Capacity: Number of rings used:-`--,_, Elevation of bottom of tank: Elevation of inlet: Num~~f feet from nearest property line: --Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector: Dated: Plumber on job: License Number : NT. J O'NEIL RM, HUMN WI& *16 RT III RRIC14 WAS. MASTER PM.UMBER LIC. NO. 3307 MARS. "A"IL INSiALUR & DESIGNER LIC. N0.80663 3/84:mj iST/~ (f HOMESITE SEPTIC PLUG,BING CO. X RT. 3 O'AIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHT vVIS MASTER PLUMBER LIC. NO. 3307 M-P.R.S. !N rips iN3TAU ER & DESIGNS LIC. NO. 906b3 /5,45C Mftil' Cc 35 L O Igo flip c/G. 4---- q 00 3l -70 3r a ~o y~•~ . o(d~ ~ MA A) r -io r 50 ,")'Vt~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 - MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL ALTERNATIVE SI-MPl- ID Number: (If ass I9 nedI Holding Tank ❑ In-Ground Pressure V1 Mound 85-052l~12 Q NAME OF PERMIT HOLDER / ` / +r ADDRESS OF PERMIT HOLDER: INSPECTION DATE:s Harold Jorgenson R. R. 2, Box 363, Hudson, WI 54016 BENCHMARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT. FLEV NW SW, Section 2, T29N-R19W, Town of St. Joseph Name of Plummer MP,MPRSW Nei Co~,,,iv San,rary Perm, Numher Robert Ulbricht 3307 St. Croix 74978 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INL FT ELEV TANK OUTLFT ~LEV WARNING LABEL LOCKING COVER C PROVIDED: PROVIDED YES ❑NO ❑YES ~JO BEDDING: VENT DIA. VENT MATT 11111,11 WATER NUMBER OF ROAD: PR OPER TV WELL BUILDING VENT TO FRESH ALARM rr , E1T I_ FEET FROM IL Ir A I R P ❑YES ONO f LJYESNO NEAREST ) / a DOSING CHAMBER: MA N U F A C TU HEH BEDDING L IO U II) C A PAC I T V PUMPMont PCl',1P SI{HU ,'1NIjE Ar:iUHELi WARNING LABEL LOCKING COVER /7 PROVIDED PROVIDED ('Jt. ~mJ ❑YES NO U J+~ ( }YES ❑NO YES ❑NO GALLONS PER CYCLE. PUMP AND CONTROL OPERATIONAL - NUMBER OF P""" Y WELL BJILDIN(, vENTTOFHESH (DIFFERENCE BETWEEN FEET FROM NE } ~1R I LET PUMP ON AND OFF) r 9 f ,l 3Y E S i ! NO (NEAREST--~ SOIL ABSORPTION SYSTEM. Check the soil moisture at°the depth of plowing nL,~I rE Ire AT1 HIAL AND MARKING, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN / J` ` CONVENTIONAL SYSTEM: - BED/TRENCH wlDTH LENGTH No or UISTH PIPE Ira('0111, T 77, U, =PITS LIQUID THE N(.IIFE 1f Hl Al' PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH FIVE UISTH PIPE DISTR. PIPE MATERIAL NO DISTH PROPERTY WELL BUILING VENT TO FRESH BELOW PIPFS ABOVE COVER FL EV I N I f I ELW I Nu PIPE S NUMBER OF LINE FEET FROM AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ~`~YES NO meets the criteria for medium sand. TIONS MEASURED. ~I ❑ i. SOIL COVER TEXTURE PI Ei P.1 ANI Nr MAHKIli S I11111 Fi VA 1111N WELLS EYES ❑NO ~JYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER THE NCH BF 11 DEVT~I OF lt)PSf I IL Sf)DUf II EE OF I) MULCHED CENTER EDGES ` ~.JYESINO S OYES [-'NO EJYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH N-0 F LATE HAL SPACINJi~-Av E E-DEPrH B E L Ow P I P I F I L L DE PITH ABOVE COVER TRENCHES / DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATE HIAL NO UISTR UISTR PIPE !)ISTHIBU T ION PIPE MATEHIAL & MARKING FLE.Vi" EL EN CIA v EL V PIPES- I DIA i ELEVATION AND p f ~ ~ 71 DISTRIBUTION INFORMATION HOLESIZE HOLE SPACING DRILLED COHH[ CI LY COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED d' PLANS OYES ❑N0 ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JBSERVATION WELLS NUMBER OF PROPERTY WELL: =L r FEET FROM LINE r~YES I_]NO YES _iNO NEAREST, J Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE ' DILHR SBD 6710 (R. 01/82) --a mw 1~~ mww~ wisconsin APPLICATION FOR SANITARY PERMIT D ILHRIN COUNTY - OEPgRTTT,EnTOF (PLB 67) - InOUSTRV,LRBOR&HUMRnRELRTions UNIFORM SANITARY PERMIT # -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 OWNER O~ MAILING ADDRESS PR PERTY LOCATIO' Ndx 363 N ~~sa~ ,S' S :x. T,~ % N, R I'Cl E (or W 5 V- LOT NUMBER BLOCK NUMBER SUBDIVISION NAME TOWN OF: NEAREST ROAD, I 19%$A44,14 STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 005 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Re air ~Replacement£a+1 A~sO p ~fiSy~em ❑ 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 # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions issued 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 90 Manufacturer: LA.) C&A-)4-t e PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: Y 3? 5 00 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): Si nature: HOMESITE SEPTIC PLUiv 6ING CO. Signature: A+}P/MPRSW No.: Phone Number: N. WIS. 540 6 33 a lqu) ,3~k--P/P Plumber's Address: R06ERT ULBRICHT MS, MASTER PLUMBER LCC. NO, 3307 M.P.R.S. Name of Designer: -MIN H& ING. 906.63 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: ee: Date: 7DDeeterm L~ b eason for Disapproval: Approved Alternate course(s) of Action Available: D ILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 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. DffP4RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION BOX HUMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 539069 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/A4F}Pd+@FFP~F LOT NO.: BLK. NO.Ts UBDIVISION NAME: ti IV '/a '/a 2 /TZ N/R /yE sf• zrosei°ff- /°,~Ix o!= lga~,c„ COUNTY: OWNER'SN44*49'S NAME: MAILING ADDRESS: 51•C~i ~f~teoL1~ _oPL6eN30A) PT• 2 Qox 363 H U DSO 40 1S4461 USE DATES OBSERVATIONS MADE (I~~ NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: I,4(JResidence N ❑New Replace L8--~2 f~~ e RATING: S= Site suitable for system U= Site unsuitable for system yes 3,0 ~ V 110'A6AeP I CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑s u zs ❑u ❑s au ❑s ©u ❑s ou ^00,Vp a~ If Percolation Tests are NOT required DESIGN RAT If an y portion of the tested area is in the 'X under s.H63.09(5)(b), indicate: CL/t ss Floodplain, indicate Floodplain elevation: SE.Pl~~O PROFILE DESCRIPTIONS 'y,4,PE14 CoAJ 7RO/Ed /000 l~igMN BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) . - ~3 - 11A•~ . N. cps- .~,'c s R B- .o ,sue . / sce 'r►ly. f B •y~ 9 3' yam, ' ' d•1 •25 IT. 7'Ap- '5;" -8P, - CSC 6A. w c t~ Not Bj .2. 6 7722 . 6 >,Q.0 ~53 j X6 ,fe o R s"uEV 1 sc-g~ 16-t A T- -2 .6 • 3. O .?.a • 'r /e a""P v; c s .rHa,"e.,► a SL, ) G s B 3. S . b Z Rh o,~ 6-hmI'C 1 o 6eVfP ' ~y. aNPrio-f TO So L ispf t*11 H T R~'k~• PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PE OD 2 PERIOD 3 PER INCH P_ 2- / Z P- i P- 2 . o P- P_ -7-1 Ueo P- S FACE' S PLOT PLAN: S ow locations o 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 tonn~ the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. s/4/V17 ~~~iIS /'~~cF/ell ~E" 19 0 f ~W I L_ ' „f`AA D SYSTEM ELEVATION ~,}7F,~,~t~ JJJ /NvE~T's p~• S f This test site OT APPROVED _ for a conventional septic systerx I x S eVianation. ;30, 1 G' E E E aeov,<.?P JV-fZ0 0AS;f1 E I 3 ~ t.- E j 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. NAME (print): TESTS WERE COMPLETED ON: HOME SITE S09 HIII)S& EPTIC PLUM WIS. 54016 e- 1,3 o ADDRESS: ROBERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMBER (optional): UMBER IC. NO. 3307 MY.R.S. j ~02.lfl~Z_ MINN. INSTALLER & DIESI(AtK ILK,. Nu- 1111vul CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - I-C tit a „¢~E~1ia i1"2 , t' E4v'3U~3 EPF obrY U 17 A (3 ~__~tr "~finr((~Ee d-s£,,i(z;crs !,i ~.c~r,~~sl'-r~,:3g 2#~ p ( t pl «6,KE A (,F_~~=.RL `,ior.fit"i l_c?ss€i€~s .tiLii Et' f .~rE_on,", D avvinil f,r t ~ x Cj, rv~ a £ Hick; C~a A! ay f :.'31 ,tx 'f SE itj-'',. r (3.= t cp u.i,..:.,it ? ifs'o De pa €'t nt iriaI"'(lC eS' -i'd `s it 'i fi;[' 4. E ;r'S ill e? 1,M € , plans for the i aV, ,.e f.,sr.r r.. 1 REPORT ON SOIL aORIN&S, ; PERCOLATION TESTS ►~S PLOT PLAN PROTECT .Z'. D. 11,q,0OL-P DA T-E- _ ~4/ w ~'y 5 10 'y Sic 2 r .z F-13 85 H'C7MESITE TESTING Co. RT, 3, 014M ROAD BOB Ul.l,'1,"c't t 30 PROPOSED HNSE MOST. LiE' 2_;- r-r Q~ MdR£ F~PoM 477-5r PRO POSE D WELL M UST L! E 50 Fr o,~ ,yoRE F,PD.-t AFL TEST ~~PEi9S, • = L3~{C.E'/yoE PiTs O EXIST/~tJ LCIELL 11i4VP R(JgE`PEV o,Q 5-4©dEL ■ _ l/oAK z . 13M V£,pTic~t kE1'rERCA)Cr poi)r w-,VCe-- 4<100,~) ~'uG~S S hotv,v SETS C'oocq.(e 7 6 U QD,tT7'a. ) , /g 7- ' ' . f/o u j'F L E GE N p/EV~~i~.v co,~,v~--P. o r i 'Vy ' ~ 'mil ~/EUATia.c~ c~ cG-r S, pe o f UHF-- \ 19P. 7 79 2 ,y 4 To CE,oT. P Y~, z~ ~ ar ~~ru~• x /3 -1o cc v reW o f ,Pd7. ~ DIL,HR 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. 65 0 57,2-, jot- '2 Gallons Per Da/y PRIORITY PLAN REVIEW ONLY t ( V V 7 Plan Review Fee Received $ 1607 c~c Petition for Variance Fee Rec. Project Name Project Location - Street No. or Legal Description VV 5 W1-2, oZ 9 / 9 W County l City ❑ Village, Town of: ~t~ S I ST O The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approva' based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This appr(; is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set, plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can b(~ made. I 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. K FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4b) (6) (7) This approval will expire two years from the date approved if a sanitary permit is obtained, it will expire the clay 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: i James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ - o 451 ze-f_ 0) CC a Private Sew e Consultant ❑ Plumbing Consultant ❑ Environmental Health X County ❑ Local PI ❑ Facilities Need Analysis Section ,7 UW-SSWMP ❑ Plumber ❑ Department of Agriculture W i IR',BD-6099 iR_ 01 ri, Owner ❑ Other P3 . °?(-L) PROJECT IND'! X SH?ET OWNER: ~rq,PoG P gO,,e&, Ns'o v RT 2 ~8 O x 36 3 ryv~so.u Geis • SS~o/ CP SITE: / ffGt,C A/W% .Sw % SEC. Z /j ~cv 01.o x C o u ,J Ty -f/. .7oSEP tf- T6L.,) O i r PROJECT DESCRIPTION: f 0mE E L^cEHe4T Sy9TE'`~ SMAll l~ P SO L S APE- VF-fey or 0-0 a V F R 1`E 0 /10 Rile- (fom e) B-e- f r• 1 Soi L i9 P p ~~t R o ~Gw WAS o f3 S eR UED A7- 2- .6 (31 ~Po lo,i~//~ cver 10 SEt o,~ SiTe- k~~p°~r ~ ~ LE/ SE~1 I 'Due- To OR9A'' c- ~~N Sk f S. `13uee~t~ of zu~, (3i~ G-) . e NqTu PC of TS. ~N ouE~s~ zcn Mou,00 1 .5 p t~oroS L~ 40p_ (oo j;j_p. DAy , ' 1-4 . L150 fo-p PAGE. 1. PLOT PLAN VIEWS PAGE 2. MOUND CROSS SECTION & SYSTEM PLAN VTEW`3 PAGE 3. PIPE LATERAL LAYOUT .:PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERFORMANCE SPECS oR SIPHON SPECS PLUMBER: SITE EVALUATER or DESIGNER RECEIVED HOMESITE SEPTIC PLUMBING CO. AU G 19 1985 HOMESITE SEPTIC PLUMBING CO. 5 1 i~T. 30'NEIL RD.: HUDSON. WIS 54016 RT. 3 O'NEIL RD.: ROBERT HUDSON: ULBRICHT WIS. ~JMBING BUREAU ROBERT ULBRICHT MS. MASTER PLUMBER LIC. NO. 3301 M.P.R.S. WS. MASTER PLUMBER LIC. NO, 3307 M,P.R.S. MINN. INSTALLER & DESIGNER LIC. NO, 00663 MINN. INSTALLER & DESIGNER LIC. NO. 00663 2y ~~~5 DAT 1]: Aug -ktC, i 3 3 b SIGNITUR; r P1, d r P~-~9~ o f ~f~,poLO ~diP(~.USoN ~/EV,9T/oN, 1 - 2px F S1' ~XjST/NG- f~ PErP fcv T~ j S ter REF Pr Fr New so rE- `~w✓ rP. s • Tip D1 o o .O / oan ~ o Myers ~ le ~ ypADE Ar N4W STATE" A f ~~s f S T° fj~of•E = job. 750 o Um ~Z x'02 ` of ~ , ° ~ o~c D.P; u~ ivy. M st~P • y0 ' • - - - - - - J EA sT s~J~E o f ~PP~°ox • LoT L y~o B3 7o"X3~ " Movvp oya S%Z ~lp) fok 50 /39 i, ~ 1955 PLUMBING BUREAU ' Low /9.P~~` ~ - - - - - - I °F f~o~r G•9~vv 1 ~ ~ ti i...a i occgsov,~ , w~T SCAIE ~ r r RELATIONS Page 2 Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ H - JG Topsoil F _-J 3 I E 11 p e O~r~N pn . % Slope Bed Of 2N Force Main PER lowed Aggregate Layer D Ft. E Ft. Cross Section Of A Mound System Using F - 7S Ft. A Bed For The Absorption Area G / Ft. A 16 Ft. H S Ft. Signed: B .50 Ft. License Number: K /a Ft. Date: L 70 Ft. - J _F Ft. T /.3 Ft. W Ft. d gfObservation Pipe fo,PCE f MAi~✓ A - ----------------------.I Distribution Bed Of z Pipe Aggregate I Observation Pipe Permanent Markers RECEIVED Plan View Of Mound Using A Bed For The Absorption Area AUG 19 1985 PLUMBING BUREAU PL.UM13INC- vH,n E; E Page 3 0f n 2j Perforated Pipe Detail 0 End Vie- End End Cap) PVC Pipe 1 . o~~o`o~ ice Holes Located On Bottom, S Are Equally Spaced S P * c PVC Force Main w w Q PVC Manifold Pipe Distribution Pipe Lost Hole Should Be Next To End Cap End Cop Distribution Pipe Layout P 11~' 5 Ft. R p S !S =X - Inches Y 3 9~ Inches V Signed: Hole Diameter y5~ Inch Lateral / Inch(es) License Number: Manifold Z Inches Date: Force Main 3 Inches # o-f holes/pipe/O Invert Elevation of Lateralsq/ 9.5 Ft. n =Y /hr-~N4 o? •S ~Et9~ Fd,E' Eiq GfJT~,~ Q . Y01:0 7o.P6E- VlY'✓[,t~irrL~~~i 0.A , r WIN 1 l- Fi~~>r1.V~D ..~.._r..._ , _ p,U G 191985 MUMBING BUREAU PAGE f- OF PUMP CHAMBER CROSS SECTIOU AND SPECIFICATIOAIS VENT CAP 'i° C. Z. VENT PIPE WEATHER PROOF APPROVED LOCKING JUUCTION BOX MANHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MIN. - AIR INTAKE GRADE i `i" MIIJ. Jjjjl I 18" MIN. INr ~ COQDUIT ~~EV• D INLET PROVIDE I AIRTIGHT SEAL I III I I I APPROVED JQIIJT A I III APPROVED ,;O`Kr TS W/ C.T. PIPE I III W/C.I. PIPE EXTENDING 3' ( II ALARM EXTI-KIDwG 3' OWTO SOLID SOIL B `/7~~0~ 3 9 a" I I I orJro soup oiL I I I oN I• ~ C ~ I ELEV. FT. IN SiD~nD~ PUMP ~ --J OFF 0 ~ IEV IS /I' CONCRETE BLOCK RISER EXIT PERMI-ITED OAJL`J IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICAT10KJS DOSE 0me5 Cb~yc.G1 z TANKS MANUFACTURER: 47- E.ILIMBER OF DOSES: PER DAy TANK SIZE: goo oO GALLOt~15 DOSE VOLUME 16^d ~ • + Z 7 ALARM : /-At INCLUDING BACKFLOW: GALLONS LEVEL ,4 MANUFACTURER MODEL HUMBER: CAPACITIES: A=2--C IIJCHES OR ~To GALLOWS SWITCH TYPE: CV,0,' ~IDA'T °Z INCHES OR 314/ GALLONS PUMP MANUFACTURER: 20'146-A PU~Alld C= 05 IIJLHES OR 17S GALLONS MODEL NUMBER: ~lofl ~y /{P D= -Sl-INCHES OR ? GALLONS SWITCH TYPE: P"6(1y/3hCK AtOCOA-f f DhTS NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 'GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREAICE BETWEEU PUMP OFF AND D15TRIBUTION PIPE.. 7-7 FEET Nk' SPECS + MIMIMUM NETWORK SUPPLY PRESSURE , . . . . . . . 2.5((33 FEET 72- FEET OF FORCE MAIN X l-/FYoFT.FRICTIC)kl FACTOR.. -00 FEET c ~ 7 0 TOTAL D`,IJAMIC. HEAD = Z FEET o vND '7 1 " 1-17 INTERNAL DIMEWSIO OF TANK: ;WIDTH / -;LIQUID DEPTH A SIGNED: LICILOSE QUMBEP,*. DATE: f467, f , RECEIVED AUG 19 1985 PLUMBING BUREAU T D H H EAD CAPACITY CURVE Ian oc W - w 2 W LUL.; n^, TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE 30 EFFLUENT AND DEWATERING ?.,95 SERIES 53-55-57-59 97 137-139 163 165 FT. M GAL•. LTRS GAL LTRS GAL. LTHS GAL' LTRS GAL' LTRS 28-- 5 152 43$163 65 248 104, 394 61 231 61 231 ~ EFFLUENT AND DEWATERING 10 305 " 34 r 129 57 216 79' 300 sr 231 61, 231 - - - - 15 4 57 19 72 43 163 64 242 60: 227 60 227 26 20` 6 10 - - 27 704 136 59 223 60, 227 SEWAGE AND DEWATERING $ \ \ - - \ 25: 7.62 8 30 57. 216 59: 223 80 \ 30 9 14 - 55 206 58 220 24 p4 11219 46` 172 55 206 \ - 50'. 15.24 33., 12t) 51 191 \ 60 18.29 ^w 15 57 43. 161 30 114 22- ' V X70 21 34 - - \ 2438 ?0 MODEL MODEL Lock Valve 19, 245 26 66 - - 87 20 05 ` 163 1161 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE \ SEWAGE AND DEWATERING 18- IQ - SERIES 267 268 282 284 293 \ ` F M GAL LTRS IGAL LTRS GAL LTRS GA LTHS GAL' LTRS 5 1.52 108 408 102 386 13¢ 492 " 1 681 C C10: -.3.05 60, 227 72- 273 6 95 360 15 598 ` 511 1 y+J`' ` 1S 4 S7 ' 20 76 43 163 238 ' 1 } \ ' 20. 6.10. 30 ":.33f 125 1 401 - 25.. 7.62 - 7 288 \ - - 14 \ 30 914 4 163 J17 29z 45 35 10 67 604 2- : - 46 \ 40 , 12 19 \ _ ,,.45 13.72 28 -106 12 40 \ ,524 45 8 DEL Lock Valve18' 21' 263553 \ 1 <293- 10 35 30` MODELS I 139 137 [25 6MODEL 284 4 MODEL MODEL 10' 268 282 2 MODELS 53, 55, MODEL 57 2M~0DEL , 59 97 267 GALS. Q 20 0 40 50 601,70 80 90 100 110 120 130 140 150 160 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . L' O RO. ZAgZZZZR 01 Looui uisville, Box 1 Keentu ntu cky 40216 /fff (502) 778-2731 UAL/TY PMPS sl NCE 8 Y.. r r~I RECEIVED "G 1 9 1985 PLUMBING BUREAU v. N r m x ~ W wc~~~'30 x v `<o~ g(D(D 44 =r =r c : cn ° o c v H cnm com =01 o z °3~ ~=oC CD ~oN g~ 13 o 03 ~0 m~Mo m0, i_ wwm C`< °cD~ ?g Omm' ° r 0 °3am o~, to ccw O ID c ° w O w C 3° co: 'o c 3 o a o cn ~z c«°~v ww~ W - v ~5 o~oaCD° o (D ° w C, 'Dv CD w~c;c90 < CD m Cn " o D c~ Q j E ° o - w " cQc°' ~3mmo' O ~C w_° w o r.aQ° w C Cl) n^ ohm vCD-00 Z > r v(m ai -i N n <D D v Z m ~ N cl) CD =r te a ~G a°° 3-.Nan > D °N.~n ~I?0WO °_Na CDN=r 0. (a N V u; w a c n* CD C m =rCD ° m M ID M s m mC ElF oam CO em0 CO CD c ClIq N ° °C CO ov N =3 3 0. c CL 0 F w C C a w o Al CD m N v CL CD ^aa~ a v"~G) ° ~w 3 cn N O L7 co m o N CD O ~lr ~ ~ CL o 7 0(a a c -im c a o n . ~cNw"o p~ aS, 3 003 a o # cD co z o ~r . 0 H z HOMESITL SEPTiG PLUOING CO. H RT. 3 O'NEIL RD, HUDSON: WIS. 54016 a S T C - 105 R05ERT ULBRICHT r' WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.& r" a IYIIN 11. INSTALLER & DESIGNER LIC. NO. 00663 y SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z OWNER/B h ok, ROUTE/BOX NUMBER "e7- 13o X 3~P3 Fire Number C , ~f c~~~D•cl wl S S y6~ Z IP S L~CY CITY/STATE PROPERTY LOCATION: it, s 14, Section Z' , T2-~ N, R W, C Town of~ , 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. 'j 0 • E 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- ~d 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. GNED(2~f DATE St. Croix County Zoning Office P.O. Box 9S• 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 Location of Property 4 Section Z , T N-R_ZL W Township 51. josd~a~ v 7-- Mailing Address l Address of Site Subdivision Name Lot Number Previous Owner of Property liQ Total Size of Parcel / Date Parcel was Created Y Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes_ No Volume 1-/OV and Page Number 2_? as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTy OWNER CERTIFICATION I (We) ceAti6y that a t 6tatement/s on this bonm ane true to the best o6 my (outs.) knowtedg e; that I (we) am ( a ke ) the owner (,s) o6 the pro peAt y deg c1 ib ed in this in6otsmation 6mm, by viAtue o6 a waAAanty deed Aecotcded in the 044ice o6 the County Reg-c~steA o4 Deeds a/s Document No. 7 y F? K ; and that I (We) pne~s entty own the propopsed site 4ot the sewage dimespow y em (on I (we) have obtained an easement, to nun with the above dens n bed pnopets ty, 4ot the con.StAuc ti•on o6 said ,syhtem, and the same has been duty seconded in the 046ice o4 the County Regi6teA ob Deeds, as Document No. ) . SIGNATURE F 0 ER SIGNAT E OF CO-0 R (IF APPLICABLE) L DATE SIGNED DATE SIG Ahhftdh~ ®''LHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, Wl 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. i ee i Gallons Per Day _ _ X985 PRIORITY PLAN REVIEW ONLY \ Plan Review Fee Received Petition For Variance Fee Rec. Project Name Project Location - Street No. or Legal Description my ❑ City ❑ Village ❑ Town of The plumbing plans and specifications for this project have been reviewed for compliance wrth-app ica e code requirements. This approval l 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 he 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: I By: i James Sargent7 Bureau Director If Questions Plans Approved By: Date Approved: Contact - CC ❑ Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health ❑ County ❑ Local PI Cl Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture F)11 HR-SBD-6099 (R. 01!85) 1 1 Owner ❑ Other D.I.L.H.R. %R E Leroy Jansky 0.W.8. CTION Wisconsin Department of Industry, 13 E. Spruce Street CRT Labor and Human Relations ~ d Safety & Buildings Division Chippewa Falls, WI 5472q--,-/" G ~ Bureau of Plumbing (715) 723-8786 ? 1~~ Date Plan I.D. No. Name of Premises 12 Sweet/Location Township, County Sanitary Permit # tj aj, 5 W Z 4 (lU T , i~ Si' C PO MAster Plumber & Firm Name Address Journeyman Plumber/Soil Tester Address Own r Address - x,10" ,,I ~ 5 ctM C5 - v t t eartr i ' `t0 ~C 'yr4T"(A KATlu-J 1> > `1 a• T - L t , - I ~ L~ ( ~ U`i I: ~ • j / tai cr. I-/ 0 rvl . T I T 3 t 3- D i~~J (7 ~ Yt 31? l~ Y 6.0 ~liu l12 ~t C. LC Z~t7 - ~"r t~1 GLCv'~C ^"t ? _ a r_. ~ / L~ I ~V' art G.i-✓` -u.'~ l r ' 7 Discussed with Signature ( )See Attached. r )BD-6192 (R. 01/85) Signature of Plumbing Consul a t/Pr ate Se ge Cop ltant