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HomeMy WebLinkAbout038-1126-40-000 H cn U) 7d hd 47 / ~ y ''d , d n o y o C7 (D Lo~ (D " 3 (D 3 (D (D 7y vm #(D b rt rrJ d CD - F ~1 H 0 tyy ~ ~ # O n O r 5' 2 Z O v l0 Ui o1 y 0) O 0 y Q A CDD WO N• fD oo P O m 3 0 m ~ O N a m o oo m rt 'J F-{ N co N W 7 _ W Lfl N N N Q y 67 y O O ^ F-~ A O O O C (D n D 3 0 ~ ° r O 0 o O t y N ° tr1 p d 3 0 D m a C7 CD C/) Z C r-~ cn can m ~ ° y d co O ~ W N W c n c (JJ7 N ~ O O O 3 O ' n Irv 00 O (D N C~ V ! dp C A 00 Oo 7 cD co 0 r fR In y H y ccn co v w :F,~ v 3 'U 'D by rh co c) 00 c n° can ai N 3 3 cn 3 !D cn td rt W CC) m v m y d a go c~ I-d y O C 7 W 7 0 N N r~ O Z Z Fl- A O Z O fD o 3 D m N N d O ^ N O ^ 7 COIL J 0 CD • (D O a m c C 7 CL 7 (D ~ O 3 m 0 cD y c 7 y 7 c n ~a Z n N A Z O CD -V CD m G C Z 0 3 i+ ~ O w m C CD ? a i A N O v m c om a 3 O O y ° CD ID p~ N C T n - ID v a o m co iD N y fD CD 7 O y _F O O O O S n -.(O 2 sl x y \ p, v c n ~ a _v ` m 7 ~ S F m' m ~ °1 fl- 7 0 fgZa w ° n o ci) 4 y n -L, (D V 2 0 O ` a ~ y DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISbN, WI 53707 ❑CONVENTIONAL `~"°,'A LTERNATIVE BUREAU OF PLUMBING state Plan LD Number of a~~ned( E] Holding Tank XN In-Ground Pressure ED Mound 50147442 NAME OF PERMIT HOLDER . ADDRESS OF PERMIT HOLDER. INSPECTION DATE Tom Petherbrid e R. R. 1, Box 164B, Somerset, WI 11-1/-S BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. P7. ELEV. NW NE, Section 31, T31N-R18W, Town of Star Prairie Nam E. of Plumber. MPiMPR SW Pernil Nmber B Ton R. Bird 130Croix 74998 SEPTIC TANK/HOLDING TANK: MANUFACTURER. _ LIQUID CAPACITY TANK INLET ELEV TANK GUTLET. ELEV WARNING LABEL LOCKING COVER PROVIDED. PROVIDE D BEDDING VENT CIA VENT MA u HIGHwnrEH ❑YES `ENO ❑YES LINO ALARM NUMBER OF TROAD PROPERTY WELL BUILDING T OFRESH FEET FROM NE IVENT AIR INLET ❑ YES ❑ NO ❑ YES ❑ NO NEAREST - DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAFn<ATV PUMP M()()EI PUr.iP SI01UN VANUf A(: TUNE H WARN ING LA B EL LOCKINGCOVER PROV DED. PROVIDED ❑YES LINO YES ~N0 L YES LINO GALLO S PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHUPEHTV JWELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN _ FEET FROM LINF I AIR INLET PUMP ON AND OFF) ❑YES L_ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IInr,+E TE H [IATt HIA; AND MAHKINI, or excavation. (If soil can be rolled into a wire, construction shall cease until L FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH NGTH NO OT uISIH PIP( sPncltijNO tiii;E n In PIIS THE NCHES DIMENSIONS PIT GRAVEL DEPTH FILL DEPTH DISTIL PIPE DISTH PIPE DISTRPIPE MATERIAL DIHSTH NUMBER TV WELE BUILDING VENT TO FRESH BELOwPILLS ABOVE COVER EIEV INIII ELFV IND ES FEET FROM LINE AIRINLET NEAREST► MOUND SYSTEM: _ Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEMM~ and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES LINO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PIHMANiFIT VAh2KfHS OWAl VATON wELLS ❑YES LINO _❑YES NO [1PTH OVER TRENCH BED DEPTH OVf H THE NCH HF fJ =--7l)Df 1) OF DFII MULCHED ENTER EDGES ❑YES 01 N 0 ❑YES NO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATERAL SPACING <;HAVEL DEPTH BE Low PI P, FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTH PIPE IMA1111OLD MAT EHIAL NO DISTH DISTH PIPF DISTHIBOTION PIPE MATERIAL & MARKING ELEV. ELEV. DIA ELEV PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILL ED COHHFCT L V COVER MATERIAL - VERTICAL LIFT COHHESPONDS TO APPROVED PLANS r~~ ❑YES LINO _ L"IYES NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF PR QPERTV WELL BUILDING FEET FROM LINE ❑ YES f LINO ! Yl LINO , NEAREST- a J U Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBU 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT ~ DILHR (PLB 67) ~)t - LL-i-11-COUNTY UNIFORM SANITARY PERMIT # OEPRRTTT1EnT OF InOUSTRV, LRBOR 6 HUMAn RELRTIonS 1;7y 0/ ~I --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 OWNEf3..~ MAILING ADDRESS C lh, 618 ~ 5~ ~L Y" ) ' (t-'-L 5 q6 PROPERTY LOCATION CITY: VILLAGE: W 1/4N E 1/4, S , T:31, N, R E (or) W,, TOwN oF: r ' LOT NUMBER JBLOCK NUMBER JSUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED X 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair j. Replacement ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity l ( 1 Lift Pump/Siphon Chamber ) , C Manufacturer: U C L -Cu 1 Lttr PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): F~4Z 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): Signatur"2 MP/MPRSW No.: Phone Number: Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: F/ee: Date: ❑ Disapproved nt ❑ Owner Given Initial LLL/`I cam ~i? Approved Adverse Determination &,~i A~ 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 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. u 20 y nN 6 y rn m 6. i I ILI C -31 8507 f •-~.I RECEIVED C7,q L G BURFAU PAGE OF r CROSS SECTION] OF A BED SYSTEM RTN,l, .iVf tiji F\!r r 31 i i rw~t -1111si 5 L~r TY L d{ia SOIL FILL 2" OF AGGREGATE DIS I KIIiUTI0A1 PIPE 7F,4 R APPROVED 5tiM HETIC COVE / MATERIAL R. 9 OF STRAW OR MARSH HAS a ogP OF AGGREGATE ELEV. OFI12, FEET DISTRIBUTIOM PIPE TO BE AT LEAST IAICHES BELOW ORIGIMAL GRADE AkJD AT LEASTLD IIJCHES BUT NO MOR HAJ.J 42 INCHES BELOW F{I~JAL GRADE < t MAXIMUM DEPTH OF EXCAVATION FROM ORIGIiJAL GRADE WILL BEN ..IAICHES MINIMUM DEPTH OF EXCAVAI'IOU FROM OKIGII.IAL GRADE WILL 5E f-",n-zg INCHES F G IVEP SIG1.lED: ' LIGEMSE AJUMBER: Page _ Of _ r Perforated Pipe Detail %a4 y' 00 '1,U End View t Perforated k~ ~~~y P End Cap) \e, PVC Pipe . ,max^< Holes Located On Bottom, S Are Equally Spaced \ S ~^t PVC Force Main X From Pump w . Q / PVC Manifold Pipe `C Alternate Position of Distribution Pipe Force Main From Pump Last Hole Should Be Next To End Cap End Cap Distribution Pipe Layout 2 O P to - R w- 5' = S X M Y .2 ,i Hole Diameter Inch Signed: Lateral ~`-t- Inch(es) License Number: a~ Manifold 3 Inches Date: / Force Main Inches 85,07442 x RECEIVED 19005 t _ ._4{ 1 v r L~ 240 WISCONSIN ADMINISTRATIVE CODE 11,11111 82 ' //V A /c A-82.34 (5) (b) - c 71e /V cevex (~.FIJc( E Z -4 ,Z INLET z+ OUTLET j7 is y/se i ~ t ~ ~ J~ ~ c~ y L l~-~ Le`•~~ ~i{6,1~t r KIT ~ U~' vv L d/ Register, February, 1985. No. 350 r RECEIVED 0.1 ?F ~v PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 1 VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FRCM DCOR, WINDOW OR FRESH 12°MIU. AIR INTAKE I GRADE `1" MIN. i. IB" Mlu. CONDUIT PROVIDE I INLET F'. AIRTIGHT SEAL. I III I I I I J011J t. APPROVED JOINT A I I APPROVED W /ca. PIPE W/C.I. PIPE I I I k l EXTENDING 3' I I I ALARM EXTENDING 3 ONTO SOLID SOIL B s'A f7 I I I ONTO SOLID SO' , y~ c " I I " I OW jJ7 Y i y:'Y U, N MP OFF y1y~ iy~i C rr lL•~.,... CONCRETE BLOCK RISER EXIT PF- MITPED GIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL ..SPECIFIGATIOK1S~xa " SEPTIC AND WMBER OF DOSES: PER DA-4 DOSE TANKS MANUFACTURER: e4:,4,$7- 3. • TANK L, ov GALLONS DOSE VOLUME: 160 GALLONS ALARM_ MANUFACTURER: L6 -I k CAPACITIES: A= MIQCHES OR "160 GALLOM'' MODEL .IJUMBER.`/ lk " ICl B= - INCHES OR GALLON5 SWITCH TYPE: wl (c)l Q C= INCHES OR 11 ( MALLOWS I'I.IMP MAHUFACTURFR: OLJTA/V D= INCHES OR GALLONS MODEL NUMBER: C?XZ_ NOTE: PUMP AND ALARM ARE TO BE SwI~CFI T`JPE: C7u~ .9~DCLT SW'J INSTALLED ON SEPARATE CIRCUITS PUMP DISCIIARC,E. RATE GIIM VERTICAL DIIFERENCE BE1-WEEK I'l1MP OFF AND DISTRIBUTION PIPE.. r? FEET + MIMIIMUM NETWORK SUPPLY PRESSURE . , , . . . , 2.q5 FEET P I V D + _ L FEET OF FORCE MAIN X F ooFtFRICTIOM FACTOR.. FEET • TOTAL DJNAMIC. HEAD FEET v )URP INTERNAL. DIMENSIONS OF TAUK: LF-KIGTH _L-;WIDTH ;LIQUID DEPTH SIGUE D: '`19 LICENSE HUMBER: 1 0 DATE: 10" 7 T D H HEAD CAPACITY CURVE w wL W W. 30 00 TOTAL DYNAMIC HEADICAPACITY PER MINUTE EFFLUENT AND DEWATERING .9 JS.E RIES 53-55-57-59 97 137-139 163 185 i M LTRS LTRS LTRS LTRS LTRS 28- 1 52 163 6 246 - `1 394 6 231 "•6 . 231- 9Q EFFLUENT AND DEWATERING 305 129 216 79 300 B 231 ei 231 4.57 .'1 72 163 242 227 6d 227 26 \ 6.10 ; 104 ~"3 136 -tf 223 ;6 227 5 SEWAGE AND DEWATERING - - - \ 7.62 30 216 223 9.14 206 220 24 0 12119 172 15' 206_ 1524 125 191 5 ' 18.29 57 A161 21'.34 114 22 - 24.38 53 -MODEL\\ MODEL Valve: 19' 24.5' 26' 66 87 20- 65 163 165 TOTAL DYNAMIC HEADICAPACITY PER MINUTE t. \ SEWAGE AND DEWATERING SERIES 267 268 262 284 293 M LTRS LTRS LTRS LTRS LTRS 1 J ` 1.52 i 408 7 D 386 492 -681 5G' - 3.05 227 273 '38 360 598 J \ 4.57 76 ` 163 238 .~3 511 16 \ 70 6.10 30 125 'j 401 _ 50 \ x $ 7.62 298 \ '3Q 914-u:', d 163 - 292 14 45- \ 35, 10 67 1d_• w 227 i 4tf 12.19 '4 174 \ \ ".49 13.72106 - 12 .40' \ 15 24 - - -45 ,,-1 \ 1 MODEL Lock Valve: 18' 21' 26' 35' 53' 10 35' \ I 293 - t y 30, MODELS I 8 25, 137 139 \ 6 .20$ MODEL 284 4 MODEL MODEL 268 282 2 MODELS I♦ 5r 53, 55, MODEL MODEL 57, 59 97 267 S GA xS> X1;0 20 3q 40 5,0 0: 0 80 ; :x.90, 1:00.0 0. 1 U QO "150 '16QA 180 9 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTk RECEIVED r_. i-'. i I 3280 Old Millers Lane Manufacturers of . P.O. Box 16347 Z OELLE.~4' O~ Louisville, Kentucky 40216 502 778-2731 UAC/TY /9!/MP8 SNCE lgSq 8 OPTIONAL WORKSHEET r t 1. MOUND SYSTEM 11. IN-GROUND PRESSURE SYSTEM-Con tinued- 1. Wastewater Load, Total Daily Flow= gal. 10. Force Main: Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate = lo c) gpm, Adm. Code and PROVIDE A DETAILED Diameter= 3 in. LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor = ft. System Head = 2.5 ft. 3. Landslope = % Vertical Lift - ft. 4. Distance from Dose Chamber to Friction Loss = ft. Distribution System = ft. TDH = l 41 ft. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = ft. Pump will discharge at least 16 n gpm 6. Absorption Area Sizing: at 10 _ ft. total dynamic head. Area Required = sq. ft. Pump model and manufacturer: _glulft Bed or Trench Length (B) = ft. _ ~R Bed or Trench Width (A) = ft. 13. Dose Volume: Trench Spacing (C) = ft. 10 Times Void Volume of"/ 7. Mound Height: Distribution Lines= gal. Fill Depth (D) = ft. Dally Wastewater Volume Fill Depth Downslope (E) = ft. 4 Doses in 24 hrs. _ X00 gal. Bed or Trench Depth (F) = ft. Backflow = gal. Cap and Topsoil Depth (G) = ft. Minimum Dose gal. Cap and Topsoil Depth (H) = ft. 14. Dose Chamber: 8. Mound Length: Volume = I CiU ~1 gal. End Slope (K) = ft Total Mound Length (L) = ft. III. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Dally Flow = gal. Upslope Correction Factor = Use section H 63.15 (3) (c), Wis. Upslope Width = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (1) = ft. 2. Required Septic Tank Capacity = gal. Total Mound Width (W) = ft. 3. Percolation Rate = min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in chapter H 63 Natural Soil = gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required = sq. ft. SIZING ON PLANS. Basal Area Available = sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter Length = ft. H 63 are Used, Indicate Table No. Width = ft. 12. For the Distribution Network, Use Numbers 5.14 In Section 11. Number of Trenches = Trench Spacing = ft. 11. IN-GROUND PRESSURE SY51EM 5. Distribution System: 1. Depth to Limiting Factor = 7 y ft, Lateral Length = ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = 3~) min./in. Lateral Spacing = In. 4. Proposed System Elevation ft. Distance from Sidewall to Pipe = in. 5. Wastewater Load, Total Daily Flow: > > gal. System Elevation = ft. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL ' r LIST OF SIZING ON PLANS. Fill in All Items from Sect' nP Required Septic Tank Capacity = 1 a 00 gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = 317 min./in. 1. Capacity = n 160 0 gal. Area Required = U c sq. ft. 2. Manufacturer: ~vuS~U {f~ " Rc Ga&-t System Length = 160 ft. 3. Show Site Constructed Tank Details on Plan System Width = I ft. 7. Distribution Pipe Sizing: t VI. DOSING TANK Hole Sire = in. 1. Capacity = loo _ gal. Hole Spacing; fl. 2. Manufacturer: C'L(stoIn 9A.-Co-, I Lalcral Length - ll. 3. Pump Manufacturer: - zGtJ ae-R Lalcral Si/e i 17 In. 4. Puntp Model: Later•il spacing; it. 5. Operating Head= ft. Distance Iron) sidew•ill•lu Pipe in. 6. Flow Rate= (QQ gpm. 8. Dist Ilbulion I'Ipe Dischalg;e Rnle: 7. Show Site Constructed Tank Details on Plans Number of 11oles Pet Pipe Jr I low l'cr l'Ipn ' KPnt. r I ll".,;°HOL )ING 'I AN K Manilold Siiingt: „4 r 1. Capacity = gal. ype (Centel or end) CC"tit~ Manufacturer: Length f.:;,~. Diameter = s i .•a! Show Site Constructed Tank Details on Plans -SHOW ALL INFORMATION ON PLANS- /.3G DILHR SBD-6761 (R.03/82) ~ DILHR PLAN APPROVAL Safety and Buildings Division APPROVAL Bureau of Plumbing P.O Box 7969 General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. L4 `1 Q Gallons Per Day t s ray PRIORITY PLAN REVIEW ONLY Plan Review Fee Received Petition For Variance Fee Rec. Project Name Project Location - Street No. or Legal Description VD F-- Tz- County ❑ City ❑ Village Town of: C RIC, ! 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) (3b) (4a) (4b)9 6) (7) This approval will expire two years from the date approved below or i 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: 71 James Sargent Bureau Director If Questions Plans Approved By: Date pp ved: Contact ♦ cc: Private Sewage Consultant El umbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section UW-SSWMP ❑ Plumber ❑ Department of Agriculture uII i ih 1,M) 6091) 'h 01 is ,i ❑ Owner ❑ Other + STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 3969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/5NUD&dMPUQWW, NW ~4 NE4 S 31 T 31 N/R 18 X)" W Star Prairie St. Croix Street Address: Subdivision: County: r Landowners Name: E Mailing Address: Tom Petherbridge R. R. 1, Box 164B, Somerset, WI 54025 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. 4 da, r' agree to give notice to any subsequent buyer that an application for an I 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. R~C~.Mi~kC~ Signature of Applicant Date n T3 STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF ` This a day of 19"L - Notary Public, Stat K of Wisconsin My Commission Expires: /,;1 - `7-5f DILHR-SBD-6413 (N. 05/81) WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NW 1/4, NE 1/4, Sec. 31 T 31 N, R 18 ~EXob) W Town RrxNRnigARvL1ktTx Star Prairie Street Address Lot No. Block Subdivision Landowner's Name: Tom Petherbridge The application for this site is for: ❑ new construction use. replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ersissueTto 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. [.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. r4 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. RECEIVED If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. y;,.1 1~. I certify that the above information is true and acc~rate to the best knowledge. - Thomas C. Nelson Name Si Wiat ure (County Official Title Assistant Zoning Administrator Date October 22, 1985 DILHR-SBD-6158 (R 12/82) DEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 769 HABs': tCN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 pACroP . (H63.09(11 & Chapter 145.045) as IL N UNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: //P/ ISECT 3/ /T3/ N/R/,,E to S f ' i No ,r~" s JCOUNT JOWNER'S R'S NAME: M cR,/p t+w USE DATES OBSERVA ONS MADE NO. BEDRhS.: COMM D R TIO~syL' STS: ~qRssldanca ❑New yyPeplaca zL/ (••/tT +JJ^ ZS O~ RATING: S- Site suitable for system U- Site unsuitable for system .74-7- 5-9 Af ONVENT NAL: MOUND: IN-GROUND-PRESSt TE-IN-FIL L OLDINGT NK: RECOM ENDEDSYSTEM:(op[ tonal) DS DU ®S DU ®S ❑U DS ®U D ElS ®U Al eS 4600 b If Percolation Tests are NOT required DESIGN RATE: If any portion of a tested area is in the under s.H63.09(SIIbI, indicate: Floodplain, indicate Floodplain elevation: A PROF ESCRIPTIONS BORING TOTAL P H T R UNOWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. H HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) O 98 6 7 uwE_ l By,/l All Bs<Ts O, yz' 7S'B,NCs B- ,1 t M Ec oe"C -94 E !9, Y 92' r1N3 / 92' / Te,r D 7' B Z Sv / 94 7' N~Nt, 0q,6 ' Bset a, s,L i jpe z b8' &z, e O 3' r8-'s 4 B e F~ e D Ca F eA~ .bs' ih.'s a V S8" e SO' qEb7' aw', 9y v9' BwscF/~/e, ~QsCts p 'B,oslw / 'Bw Dec Fr PERCOLATION TESTS TEST nro WATER IN HO LE TEST TIME DROP WATER V L-INCHES RATE MI NUT S Nl1MBER ISFSfitS AFTERSWELLING INTERVAL-MIN. RI D PER INCH P- I /V O 3 7 -37 P P. co 7- N o Z P-. P- / 7 O P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suit d -JM,,c~I to o distances. Describe what are the hori- zontal and vertical aleystion reference points and show their location on the plot plan. S he surf4e j at orings and the direction and percent of land slope. SYSTEM ELEVATION 9 Sd r °,9°~y`~o~'~ 1_7 1 - 1 e 5 s - ill -TN S rN 71! Roll- 45 Fall ~e p J~ I~ bQa41 t~ _ _ - IQL- - - - - - A Illy 1- - ~J KNE, p 1s C - A_ I, the undersigned, hereby certify that the soil tests reportenk) fhq /oAEswere nW 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 ben of my knowledge and belief. NAME print /r TESTS WERE COMPLETED ON: v,w / 2SS'f S ADDRESS: / CERTIFICATION N BER: PHONE NUMBER IoDtionall: T ~oQS CST SIG A E I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Taster. DILHR-SBD-6395 (R. 02/82) - OVER - 77- fitA 'I REIVI*r OCT ! t s J, F a aY r k ST. CROIX COUNTY • r WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 October 22, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Tom Petherbridge property, located at the NW4 of the NE4 of Section 31, T31N-R18W, Town of Star Prairie, St. Croix County, revealed suitable soils at a depth of 93.42 inches, below which seasonable high ground water was noted. This site should be suitable for an in-ground pressure system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj R-ECEIVED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION BOX 7969 HUMANUMAN'RE LATIONS \ / PERCOLATION TESTS (115) MADI P.O. SON, WI HA 53707 ►°&kr;-, ' ; (H63.09(1) & Chapter 145.045) LOC ION: , SECTION: /L UNkI ALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: / 7'/a .3/ /T 3/ N/R If E (o IV f ' M.4, s e to COUNT': OWNER'S/BUYER'S NAME: MAILING A DRESS: 1 x f I. i ) s Jt,t~ ' C. ~ idc AEr~J ~w Ce'l ju k USE ' LF DATES OBSERVAT/ ONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: ~Ftesidence ❑New ReplaceL~~, RATING: S= Site suitable for system U= Site unsuitable for system st CONVENTIONAL: MFX S 2U IN-G®NDPR❑ESSURESYI®ILLHOLDING®NK:REcOMf~ENDED SYSTEM: e( tional) ~ STEM- s S U S U ❑ S 00'r t If Percolation Tests are NOT required DESIGN RATE: If an If I y portion of e tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 1,11A rrr.; PROF E DESCRIPTIONS !BORING, TOTAL ELEVATION DEPTH TO GROUNDWATERd S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH OBSERVED EST• HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) l - ~ ~~r ~ / ~ 'r ~ 1 Qir✓~ ,CJ.+.~'3 c Bs ~S L~ ~ 7' L ~ '7~ B ~i'`s~ I r5 i~ ~G e'&"c "'c'''am y/ ! B- 1 , t `3. 1eiY4 s t 7IV I C o ` 7` AG ` f / d C Q , ( 1 B' r~ l+'~G~~✓/`~,r / Gl t 3 r 6Ilr s4 i.' / 2`~ n h) t. st- CJt~ r l PERCOLATION TESTS TEST T}i WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1~t~11fS AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH P- N() c ? 7 7 i P- P- Z / /V © Z. P- -T. 37 P l = i PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suits e i area I to o \,distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. S uv_,4he surf e y i at i 1~orings and the direction and percent of land slope. I 1' SYSTEM ELEVATION 7 5 c a'~ia► ~f I E I I i~1aA rsi,~+~✓.. P.pF. T.2 frc4 Vic 3 c° 4ttTA !'r igN S EP6~~lpQiP.rc.M,/! Q -q- 1 _UM `Po 't piN~s I, the undersigned, hereby certify that the soil tests reporte V his orm were m 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: ADDRESS: I41~S l rH CERTIFICATION NUMBER: PHONE NUMBER (optional): '00, I ss CST SIG A E DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SRD-6395 (R. 02/82) -OVER, 4 ..,1. n n d , _ _ >:.P. Md a~,cur aw z;oil test, Yw r$wv Silt.tf,5 i', USt C lea' MA)CPOUN! rlt.rrn rr of h€ d o, r€. 4Er c +r ~t~ia1 use =char -il --D 0 _r °S t..-M ah -`w vt_.+i, « ~f~Cl e fs~ b=d ,a (f £ _c-P'p-.~'nns ati MIA _ , ~..'t. a. 'ir_€. c, €_~jrarn acc,€,t.ael hvca'iz3-€", 1rCSii1` test l£?(lc€,sr?i`€ vi ~.~t`i ttt. _ " .€-e 1 f you,- and ve , 'c++ i ievaisr r tenle?a cu poit,z a7f1-- `t. D w i3plE'.1.£: +,h c; .7 r:' t.}~ x~l"£, 3t1Y,`.;> a5 to dates'. narr`v: s, a~:3c9s?'s'ses, i ..t"r:', Pda?r1 dac - , to i 1, i i,`1, r}JC)£, t.atr-., £.£'vcEz,f ;1 F (b'i, e3 , not . w .1 £3 pti3 =1 zC;gt cl'<, cw)d Jii7_i" € .r."?icai,on ,tun, . , S.,' . and t?t,:~+ta,£.,€: Al p R - B e-, ter. k LG«b a3fl£' e its "t ~"S - 'sliRCil9lE3r3~ - G ravel (under` 3-) - ,t , s cst~ San g;G~ € t~a~Y: a"su'rid.~ V` 1 vi = c. _ - J 131 it -c _ - Ss}t Loam Lid sill t - + ~ a3, t i_ 'tom -3 + . - & , _ vigil L liF_t"v"t ncO - tip°'". t{ `srt a, ;rr s .a.$ Clay 3 £p o e, mii -1 he- county ,q3 j,, L,i .~JFl p =€r2~F , ~=Sr_ }a~' a~ c~€ p, Q, I u the -:.;l .,TC' ,rla~ v Y 3,tt OC£1_' M DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION 7969 LABOR-AND PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 53707 HUMAN'RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 4/14 /T N/R p" E (or) W , COUNTY: OWNER'S/BUYER=.S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE 7rDRMS NO..: COMMERCIALDESCRIPTION: PROFILE DESCRIPTIONS.: PERCOLATION TESTS: ❑Residence ❑New ❑Replace J :3Yy i RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: CTN-GROUND PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMM ENDED SYSTEM: (optional) ❑s❑u ❑s❑u ❑s❑u ❑s❑u ❑s❑u V Pe colation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the der s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- ° . B- , t s ,r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERS WELLING INTERVAL-MIN. PER O 1 PERIOD 2 PERIOD 3 PER INCH P- P- P c:. P_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soi A\. IndicateAale or'dislances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show t face eobatiprf"at a ri s and the direction and percent of land slope. f a SYSTEM ELEVATION S 1 0~`o~yn~lo F. , E j r e„ 1 f r - °t t_ _ f.. _ . . rr . !,le _ E { r , i# a~ f I• _r +-e . y - lip jr- ~ S w._ w I, the undersigned, hereby certify that the soil tests reportedon'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): );yg TESTS WERE COMPLETEp ON: . t`=- fig' r.r Oay~T 9f _ - . ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: _t DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER