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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. ksOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
M.AD.SIUN'W I 53707
®CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number
Holding Tank ❑ In-Ground Pressure E] Mound 1 11 assigned)
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
James McNamara RR#I, Emerald, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV
SE SE, Section 2, T30N-R16W, Town of Emerald
Name of Plumber. MP/MPRSW No.. County: Sanitary Per Number:
Gale Smith 5690 St. Croix 34832
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET EE LL EE V.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.. VENTMATL. HIGH WATEH NUMBER OF ROAD. PROPERTY WELL: BUILDING. VENT TO FRESH
ALARM FEET FROM LINE' AIR IN LET.
❑YES ❑NO ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING. I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET'
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE 1EN(;TH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH +D1111I H NO OF DISTR PIPE SPACING COVER JINSIDE CIA =PITS LIQUID
DIMENSIONS TRENCHES MATERIAL PIT DEPTH
GRAVEL DEPTH FILL DEPTIPE DISRPIPE DIS TR. PIPE MATERIALP NIODISTR NUMBER OF
PE PROPERTY WELLBUILDINGVENT TS
BFL(7W PIPES ABOVECOLET ELEV END AIR INLET.
FEET FROM LINE.
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.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES 1-1 NO
1111TH OVER TRENCH .'BED DEPTH OVER TRENCHi BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED
CENTER EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM-
WIDTH WIDTH LENGTH NO.OF EDISTR. ERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD PIPE MANIFOLD MATERIALNO. DISTRPIPE
ELEVATION AND ELEVELEVDIA PIPES DIA.:
,DISTRIBUTION
INFORMATION ROLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑ND ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE'
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
S
TITLE.
DILHR SBD 6710 IR. 01/821
r
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing Address:
M e .s" N i I V1,4 L cf 4,' S G' c
Property Location: City, Village o ownship: County:
t/a %S ,Z, /T " N/ R / E (or) / L cL !1
Lot Nu ber: Blk No • is ubdivision Na e: Nearest Road, Lake or Landmark: State Plan I.D. Number:
14 ~h 2 9Og / (If assigned)
TYPE OF BUILDING T Q
Number of
❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:
I 1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY L' f>
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New 0 Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
Z Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
❑ Private W Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: P MPRSW No.. Phone Number:
G/~ ltd ~M / Z_~
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Si at a of Issuing Age Fee: Cc~ Date: j y APPROVED Sanitary Permit Number:
❑ DISAPPROVED
9
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/81) AM
. .~~~l~L' U! ~~ISIUIiSIII f Vj6-11 TT/1 iI ~~I In~u~,lry L~Ibor Lill(] I-IUIII(Ill RclallOns
I~I,rr'c11 1 ytl.i l ,
Q-) ~~~~~:w r/ ~/~I L I Y tS IJUII UIIVC._; IIVI51UIv
lSurudu of F'luinbiny
u~ I~N7/y IJU~ 291 Last WaShinyton AVer1U,
box 7969
1~Icllsoil, Wisconsin 53%01
U : ALL COUIV I Y COUL I1UI~1 1(V I SI RA~ I
St)bACI I Lary I'l'.1 ul I t 1., ~uul~:l_ I'ru~:).IJure
SuyyeSted prucudure pr•lur• to sanltary pur-11111- ISSualicu whuru a SepLlc tank must
be replaced (Jur ing w Inter wuathr.r' ur othur pea I th euler,yency and Sui 1
uvdludtlun or ether' SyStelu evaluut iun cannot be CutiduCLed.
1. ObLdIN assurance that the propurly uwnur Is dwaru of further reyuirealents
fur a systuill evaluation.
2. Obtain assurance LIt dL owner aI;,u Is aware that 11- SyAcm 1s found to be
failiny it will he their respurnsibiIity to replace it wiLli a code
cumplyiny system.
~uyyeSLed at ficlavIL to bu sIynud by pur5un rucluesCIt y the sat ltar'y purm it.
1
~~!!~the under`Slyncd du hert:by acknowledge that 1 ant
racelvifig d sanitary permit to y r.
wi thuut
a soil dnd System evaluatiun due to Inclument weather ur health emeryuricy.
lurthur, 1 acknuwledye that a soil dnd systelu evaiuatiuii will be conducted ds
weather permits and that il- the system is Chun found to be fai l my a5 defined
in Sectlun li 63.02 (18), Wiscuii~,ln AdwlnlAr.aLive Code, it will bu replaced
with one that coulLilles w1Lh chapter li 63 of the Wiscunsin Adnlinistr'~tive Code.
IUAIL: ~ ~ 1
A Cupy of an all IdavlL In I icu of LIi 115 aluny with Lhu K-b-G7 Must be
Submitted to the Plulubiny Bureau for purposes of fue reinlburseulunt.
Sincerely,
antes Sdry~rl - /
Director
JS:ED:Jh
I IH,L, 13 IJ i141J (N. U41U 1)
r
Me Al 4 Iv) 4,~C,4
jes
y . , . _ Sep r _7,
a
d
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Ho
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wlsconsln Department of Industry, Labor and Human Relations
DILHR ~ Division of Safety & Buildings
Bureau of Plumbing
oecRRTmenT OF P .O. Box 7969
- InOUSTRY. LRBOR 6 HumRn R6LRTIOns Madison, WI 53707
Tel. (608) 266-3815
l S, IN ALL CORRESPONDENCE
7 REFER TO PLAN
IDENTIFICATION NO.
NAME OF PROJECT
R ATE SEWAGE ONLY -
❑ GENERAL PLUMBING PLANS W< Fee Received:,
LOS LION , Priority Plan Review my
CITY OR TOWN COUNTY
e
Examination of plumbing plans and specifications for this project has been
completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations shown on the plans. Please
review your code for the requirements of each code section noted.
The licensed plumber responsible for this installation shall keep at the
construction site one set of plans bearing the department's stamp of approval.
The installer shall also notify the appropriate inspector of wrier required
inspections are to be made.
.inn vin ..-.l 1l ~•EL-VA 1(~ lnF1 nf.>V1~ - ~ I.. ..l t 4. tea. t-. r
In granting this approval, the Division of Safety and Buildings does not hold
itself liable for any defects in plans or specifications, plan omissions or
examination oversight, and reserves the right to order changes or additions if
necessary.
This approval is based on Wisconsin Administrative Code requirements. It
shall be necessary to obtain and fulfill the permit requirements of the city,
village, township or county in which this installation is to be made. Failure
to obtain local permits will automatically void this approval.
Sincerely, For Private Sewage Systems Only:
This approval is valid for two
years o► it will be valid until
`
s Sargiti the expiration date of the initial
q
Bureau Dire or sanitary permit.
PLANS REVIEWED BY: DATEc
cc: DPS - OWS Owner H & R & Rec. San. S lion
Local PI Plumber Bur. of Health Fac. & Services
County Other
')Tf'4Q C.Rf?_~ngo 'Q_ 05/8-0?
IT~(IENT OF SAFETY & BUILDINGS
INDUSTRY,
REPORT ON SOU BORINGS AND
LABOR AND PERCOLATION TESTS (115) DIVISION
HUMAN RELATIONS P.O. BOX 7969
MADISON, WI 53707
LOCATION: SECTIO?!
TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
'/a '/a N/R E (or) W
COUNTY: OWNER'UYER'S NAME: MAILING ADDRESS:
USE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
❑R ,:;Aence R D R TONS: ER LA ION TESTS:
❑ New ❑ Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
osou osEUI osou osau osau _
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V.
If any portion of the lot is in the
under s.H63.09(51(b), indicate: Floodplain, , indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B
13-
B- 6 J.
f"V9..:'
B-
FB -
1
PERCOLATION TESTS
NUM ER INCHES AFTER SWELOLING INTERVALPMIN. DROP IN WATER LEVEL-INCHES
PERIOD 1 PERIOD 2 RATE MINUTES
PERIOD 3 PER INCH
P-
P-
P
P-
P-
P-
PLAN VIEW: 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 slop.
SYSTEM ELEVATION
-
P
2 5-
jf .2
Ole;
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisc
Admimistrative 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:
CERTIFICATION NUMBER: PHONE NUMBER optio
CST SIGNATURE: i
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
HY®R® "TIC SECTION 100
PUMPS DIMENSIONAL DRAWINGS
& PERFORMANCE DATA
MODEL: OSP33 SUBMERSIBLE SUMP PUMP -MAX. SOLIDS 5/8" SPHERE -1750 RPM
TOTAL Lit. No. 113.5 348
i* HEAD - - - -t-- - - - -
IN FT. _3/,o HP MOTOR -
~ - I i I - -
24
I I
22
20 C
Ty
16
14 - - I
i
12
10
8 - t - r- -
LOAD
- t - - FULL 6
4 AMPS AT 115 V.^
6.5
2
I Y -r--
_i 1 I. ~ i -I f
0
10 20 30 40 50 60
U.S. GALLONS PER MINUTE 84 03852
MODEL: OSP33 319
4 7
43/s
_ ® ® 51/4
9
4
Q
1'/a STD.
25/16 PIPE THD.
Ilk, u uw 43/8
NOTE: CASTING DIM. MAY VARY ± 1/8
PA.G E O F
I'l-IMf' Ct~AMf3EK (-!+.05.5 ~~_~_t (jiJ Akin) SPEClHCA-il0 S
- Vc tJ? CAP
4" C. :J_. VENT PIPE
WEAi H L R PKOOF I APPROVED LOCKIM(,
'Au"C TION BOX MAPJHOLI CC)VE:K
.15' FRGM. 1) (1CGK,
WINDOW OK F RE S H ( 12 MIU.
AtK INTAKE I
C>KAD - I -
/ I
i' MiN.
41
_ 18"MIA;,
' COPJDUIT-- -
PROVIDE
AIRTIGHT SEAL I ! I
APPKU'JE.U Jc)lto A I I I APPRCVE11
Vj/C'.-.L. PIPk: ,51t4c' I I I W/C.T.
f.JC'TENDINV .S' y(~ I I I ALARM EXTEUDi.J.'
QNT0 UA Ir "r.1 t b ypC~, t I 111, ONTO 501,
P~`O,VS I i oN i
1 ? P P 1934
tr
NLI
'i NC REI- E BI`,,C-A
r ~ -
KlSELK EXIT PEKMIIIED GIJL.`J IF TAtuK MAtJLJFAC7-UREK HP's SUL-H APPkOVAL
PIFICArIONS 8403852
-PTIC AIJD
)SL TARJK`- MAILJUFAC VUKLK: AIUMBEK C)F DOSES. °EK DA J
l A f J K L E V----___-- - A I_ . L f 1 1 1 S D O S E V O L fJ M E:----/ ~---J l, A L L U IN i
AI_.ARM f1AIJUFAC rUKEI<. _ ~ G,`✓~,'-._..------ CAPACI T tES: A- S~WCHES CK GAL I C !
--IAlCNES UK GALL. t:
WITCH l JPE:
iAAnJIJI Ac I IJkF t'. t]11 1 / J=-~IIJCHES Ul.
tJOl E: F'LIMP A"[) ALAKM ARE TG BF-
ti15TALLk D G'tJ SEPARATE (-IRC U i T :i
VI_KI I C A L Url F r t~ L FJCE Bc t WL T Q PuMr OI 1- t\uLi O15 ~ k'tE'U1lGtJ f'II'L.. 1-EE- I
♦ MIA11MlIM. N.JE(WOKK
_ - = F LL T
C: F FZ:4Lr E It-FKtC f ioAt FAc_70R_ FEE 1
in1A!_. UJ1JA 1!U HLAU 9tE?
Zrv 7t~21~I+~ ;~fr~c w.~aNS 4'y= 'TNrC'f*ttt T itil.loi~~
31
Page_ Of .
hi L `al i0NS)
/ End View /
Eric Cap) (Perforates f~
PVC Pipe
Holes Located On Bottcm,
Are F Quolly Spsi:ed
rr~ \
F
P Force Main
From Pump
PVC
Manifold Pipe
e\folslribulion \-~_Alternote Position of
1 pipe Force Main From Pump
Last Hole So BeVJ 666YYY//// 8403852
Next t To End Cap
End t:ap Distribution Pi
_Pa Layout P
R
S ~2.
X y, ~7
signed: Hole Diametery Inch
License Number: Lateral _i Inches!
MPs 90
Manifold
_ Inches
Date: Force Main Inches
r_
r-
Page Of
Straw, Marsh Hay, O
Synthetic Covering
Distribution Pipe
Medium Sand ~ -
J ` G
Topsoil
F
D
% S l o p.e
2 ' Ford Main Pio',Aieit
Bed Of 2 %
2
R.Ar~ Aq~g$ egate From Pump L_eyer
0vu
Crg.45 Section Of A Mound System Using
A Bed For The Absorption Arec F
Ft.
S i gned. ' J
B Ft.
License Number: I ~ ''Ft.
Date: - --~y J L6_'Ft.
K~1. Ft.
Alternate Position F jf Ft. 8 4 0 3 8 5 2
of - , r
Farce Main W~'_,I,5~.' Ft.
r_
I Obser-vatio+i Pipe--_.~ '
-A K
I J
t
i~ ~l
A I.---_-_-_. --01
_ Force Blain
W From Pump
D'estribution Bed Of
_ 2 2
Pipe Aggregate f
I S
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
Smith Plumbing & 1~atzng PHONE (715) 265-4838
r
' ~ - GLENWOOD CITY, WISCONSIN 54013
V yf F yl
pECEIVIL)
8403852
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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,(1tspec
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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1
Owner of Property / ✓ ' i
Location of Property 14, Section , T N - R W
Township
Mailing Address ~t~ lU C 1 /
Subdivision Name
Lot Number
Previous Owner of Property Z✓ ~¢/,l A1,4 Al A
Total Size of Parcel J~~ I~G iQ
Date Parcel was Created b
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:
1. Warranty Deed
(Z.~ 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.
PROPFRTy OWNER CERTIFICATION
I (We) een tC'b y that xe-t statements on this bonm cute tAue to the best o b my ( our )
knowledge; that I (we) am (are) the owner(s) ob the pnLopeAty dac4ibed in this
inborLmat<.on bonm, by viAt:ue ob a waAAanty deed neeo4ded in the 06bice ob the
County Regi,6,teh o6 Deeds as Document No. :317,f";2 ; and that 1 (we)
pn.a entt y own the pro pots ed site bon the Sewage poi alf-,syes tem ( on I (we) have
obtained an easement, to nun with the above de/scAibed pnopeAty, bon the
con,stAuction ob .chid system, and the same has been duty neeotded in the Obbice
ob the County Regizten ob Deeds, as Document No. 3/1, 2 7 )
--8a"
SIGNATURE OF OWNER SIGN URE OF CO-OWNER (IF APPLICABLE)
a 8-
DATE SIGNED DATE IGNED
IDUSTM , OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INNDUSTRY, DIVISION
UMAN AND RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707969 P.O. BOX 7
rfUMAAl ION SECTION TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME:
`~t_ 1/4S(' a 2 /T W N/R 1 b I_~r_W ,
FYI - OWNLR'S/HUYER'S NA ME MAILING ADDRESS:
~t'_l ~t ,x .Ts`!~r►~1 1~1 I ~q"Y r" J4f -
L DATES OBSERVATIONS MADE
NO BEDRMS.. COMMERMAR AL DESCRIPTION:___ PROFILE DESO-RTPTIbNS: ER A ON TESTS:
~~Hesufence ❑New
XRepiace -
JtATING: S= Site suitable for system U= Site unsuitable for system
uNVf"N IIONAI MOUND IN-GROUND.PRESSURE SYSTEM IN-F(I_L HOLDING TANK: RECOMMENDED SYSTEM: (optional)
~ s u osou as au 1E:]SNU s❑u
i, I ercol,iiun T, sts are NOT ieyuired DESIGN RATE SYSTEM EL If any portion of the lot is in the
,Wrier s.H63.09(5)(b), indicate: ( c
Floodplain, indicate Floodplain elevation: I
PROFILE DESCRIPTIONS j
,(RING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
UMBEH DEPTHAN. ELEVATION OBSERVED 77. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
/ J i
B- 0 Ro 02
V' 7 10
13-
[B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
(NUMBER tfal11111111111ft AFTEH-SWELLING INTERVAL-MIN. p-RIOD1 PER1 D PERT PERINCH
P L; /V0
-31 X144
P-
P-
'LAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon
)ntal and vertical elevation reference points and show their location rrn the riot ;,law Sl,w: I,e ,uri.#re r~levatir,n ,
~f land slop. -
SYSTEM ELEVATION C:, /
i
f 1r' V f ` /
'n ! - - "7 ---tl~i
1
-71
I
Y
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
„hnnnistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
A M E (print): TESTS WERE COMPLETED ON:
/4 Z
-'~DORESS
CERTIFICATION NUMBER: HONE NUMBER optional):
r Z Cie /,_7
CST SIGNATURE:
tISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
i)ILHR-SBD-6395 (N. 03/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, CC DIVISION BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707
LOCATION: ' SECTION: , / TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME:
S aS 4 2 /T N R l e 4*W
o e_1 01 /C
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
Sf_~"'re t .T+4rni f~1~~ rf
USE DATES OBSERVATIONS MADE
NO. BEDRMM ERCIAL DESCRIPTION: PROFILE D TONS: PERCOLATION TESTS:
®Residence 1-3 MS.: CO ❑New Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: JRECOMMENDED SYSTEM: (optional)
❑S ~U ~S ❑U ❑S 9U ❑S 1 ®S ❑U f-Hafo.rA 11
[under Percolation Tests are NOT re uired DESIGN RATE: SYSTEM EL V.
q , If any portion of the lot is in the
s.H63.09(511b►, indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEP'
NUMBER DEPTHS, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
0 -
17' ~i 7`7,,1 -5 `R c
B~~
B-
B-
FB__j
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER f AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
6 IS- _1Z
P -
P-
P-
P-
PLAN VIEW: 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 slop.
SYSTEM ELEVATION 5
l
He-
i
e
Q
Sec q
x
i
wn t~oi+ri .75 cu N o d
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative 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:
14,4 e- k) 5^M
ADDRESS: rr CERTIFICATION NUMBER: [HONE NUMBER optional):
<5~'Z e IV Q(
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-639. (N. 03/Pi)
r -
x
ST. CROI X COUNTY
r
WI SC O N S I N
r r-m ZONING OFFICE
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
June 21, 1984
Division ob Satiety and Bu td.ing
Bureau o6 Ptumbing
P. 0. Box 7969
Mad%6on, Wl 53707
Dean Si&:
An on .6 to inve6tigati.on ban the Jamey Mc Namara pupenty tocated in
the SE% ob the SE% ob Section 2, T30N-R16W, Town ob Emeha.8d, St. Croix
County, neveated 6u.itabte 6oit6 at a depth ob 2.7 beet, beeow which
6eabonabte high ground wateA wcus noted.
Thin site 6houf-d be.6uita.b•-e bon a mound 6y6.tem.
Shou.td you have any quati.on6, ptease beee bnee to contact this obb.ice.
Sincenety,
Thom C. Ne zon
A66i.6tant Zoning AdministiLaton
TCN:mJ
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 SE 1/4, SE 1/4, Sec. 2 T 30 N, R 16 *X(bW W
Town ~ ld$otg EmeAaid Street Address
Lot No. Block Subdivision
Landowner's Name: Jame-6 Mc Namara
The application for this site is for:
new construction use.
0 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 numbers ssue~too-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.
❑ 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.
❑ 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:
EX]a 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 lot meets the criteria for a
conventional private sewage system, check here
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Neb on Sign
County Official)
Title Abziztant Zoning Admjnj,6tAa,to& Date June 21, 1984
DILHR-SBD-6158 (R 12/82)
STATE bF WISCONSIN-btPXK 1gT OP INDU9T" , tABOR 6 HUMAN RELATIONS
DIVISION OF SAFETY 6 BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Township/MMXXX E X
SE ~4 SE ;4 S 2 T 30 N/R 16 XJk0(X) W Emena,ed
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Ja.mez McNamo a R. R. 1, EmeAaed, W1 54012
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:
i
lui PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, 1 1 C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969
HUMAN RELATIONS 53707
II 6 A`I ION SECTOOfV TOWNSHIP ~
LOT NO.:BLK. NO.: SUBDIVISION NAME:
- L SE_'/ 2 /T3cI N/R Ib m WWWWWW~f;y /d
cc>UNrTY: 6W`N~ER'_S_7BUYER{7S /I ME MAILING ADDRESS:
~~,C__'rc't~( ~JI`EiYlP1 1~t~ (~Fjrr~1'otr A"I C
J - /Yf r'zt ! r G /
USE DATES OBSERVATIONS MADE
X Residence iMS.: COMMER IAA L DESCRIPTION: NS: PERCOLATION TESTS:
XResldence ❑New ®Replace
RATING: S= Site suitable for system U= Site unsuitable for system
Ir 0 VENT IONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
DSUS DU DS auks Chu ®s ❑u r}~ ~~~~a
It Percul anon Tests ire NOT required DESIGN RATE: ~S-TEM EL If any portion of the lot is in the
under s.H63.09(5)(b), indicate. `
Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
UMBER TOTAL
wHING
N PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHrw. ELEVATION OBSERVED EST, HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- / 0
r 7 ~/Y~: p 11 I
113- pr/,
13-
0 80 Z
13-
B-
~ B-
PERCOLATION TESTS
TEST DE PI It WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
INUMBE~ It+l~ AFTER SWELLING INTERVAL -MIN. P RIODt PERI D2 P R PER INCH
_P_
'LAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
nntal 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
,f land slop.
SYSTEM ELEVATION W. C, U 1
n 1 ~ t5 ~0 •
I y!r 'y- ,fit
TN
t
Tn A7
)
r
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
~tfinimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
JAME (print TESTS WERE COMPLETED ON:
Lt ! fylr 1 ,
ADDRESS. CERTIFICATION NUMBER: HONE NUMBER optional)
t r
CST SIGNATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
UILHR-SBD-6395 (N. 03/811
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Parcel 010-1006-70-000 01/06/2006 09:43 AM
PAGE 1 OF 1
Alt. Parcel 2.30.16.34 010 - TOWN OF EMERALD
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 - MCNAMARA, JAMES H & JANET
JAMES H & JANET MCNAMARA
2580 170TH AVE
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description *2580 170TH AVE
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 2 T30N R1 6W 40A SE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
79908 Use Value Assessment
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 35.000 4,200 0 4,200 NO
UNDEVELOPED G5 2.000 200 0 200 NO
OTHER G7 3.000 13,500 190,200 203,700 NO
Totals for 2005:
General Property 40.000 17,900 190,200 208,100
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 17,900 190,200 208,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 60.00
Special Assessments Special Charges Delinquent Charges
Total 60.00 0.00 0.00
Parcel 010-1006-40-000 01/06/2006 09:43 AM
PAGE 1 OF 1
Alt. Parcel 2.30.16.31 010 - TOWN OF EMERALD
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 - MCNAMARA, JAMES H & JANET
JAMES H & JANET MCNAMARA
2580 170TH AVE
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 2 T30N R16W 40A NE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
79905 Use Value Assessment
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 39.000 5,900 0 5,900 NO
UNDEVELOPED G5 1.000 100 0 1()0 NO
Totals for 2005:
General Property 40.000 6,000 0 6,000
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 6,000 0 6,000
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
Parcel 010-1006-50-000 01/06/2006 09:43 AM
PAGE 1 OF 1
Alt. Parcel 2.30.16.32 010 - TOWN OF EMERALD
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 - MCNAMARA, JAMES H & JANET
JAMES H & JANET MCNAMARA
2580 170TH AVE
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 2 T30N R16W 40A NW SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
79906 Use Value Assessment
Valuations: Last Changed: 07/29/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 5,600 0 5,600 NO
AGRICULTURAL FOREST G5M 3.000 2,300 0 2,300 NO
Totals for 2005:
General Property 40.000 7,900 0 7,900
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 10,100 0 10,100
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
Parcel 010-1006-60-000 01/06/2006 09:43 AM
PAGE 1 OF 1
Alt. Parcel 2.30.16.33 010 - TOWN OF EMERALD
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 - MCNAMARA, JAMES H & JANET
JAMES H & JANET MCNAMARA
2580 170TH AVE
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 2 T30N R1 6W 40A SW SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill Fair Market Value: Assessed with:
79907 Use Value Assessment
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 39.000 :5,600 0 5,600 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2005:
General Property 40.000 5,700 0 5,700
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 :5,700 0 5,700
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
Form- S T C - 104
J AS BUILT SANITARY SYSTEM REPORT
OWNER SEC. T 2 ~ N-R W
ADDRESS ,1,2-7-1 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
i^C TAN 4"
c'sc.
He
ih rH Al r
\~J
Mr uNd
INDICATE ORTH ARROW
BENCHMARK: Describe the vertical reference point used
.40
Elevation of vertical reference point: Ar-I Proposed slope at site: ,Z
SEPTIC TANK: Manufacturer: Liquid Capacity: / e .
Number of rings used: Tank manhole cover elevation: ~2 xl't'
Tank Inlet Elevation: ',Tank Outlet Elevation: f 1f~
Number of feet from nearest Road: Front, (D Side,o Rear, 0 ;2 C' E% feet
From nearest property line Front,tr\~/ Side,O Rear, 0 ,/2 e- feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
1