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Parcel 028-1007-10-000
01/06/2006 04:18 PM
Alt. Parcel 3.28.17.33 PAGE 1 OF 1
Current X 028 - TOWN OF RUSH RIVER
ST. C
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type COUNTY, WISCONSIN
00 0
Tax Address:
Owner(s): O = Current Owner, C = Current Co-Owner
JESSE & CHARLENE L MERRITT O - MERRITT, JESSE & CHARLENE L
1889 60TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1889 60TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 3 T28N R1 7W NE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-28N-17W
Notes:
Parcel History:
Date Doc # Vol/Page Type
07/23/1997 801/352
07/23/1997 561/342
2005 SUMMARY Bill Fair Market Value: Assessed with:
82703 Use Value Assessment
Valuations: Last Changed: 08/30/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 36.000 5,200
UNDEVELOPED G5 2.000 0 5,200 NO 00
OTHER G7 200 0 200 NO
2.000 10,000 154,500 164,500 NO 05
Totals for 2005:
General Property 40.000 15,400 154,500 169,900
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 10,000 106,900 116,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1
Certification Date: Batch 110
Specials:
User Special Code Category Amount
Total Special Assessments Special Charges Delinquent Charges
0.00 0.00 0.00
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Jesse merritt TOWNSHIP
Rush River SEC. 3 T 28 N-R 17 W
ADDRESS ~ST. CROIX COUNTY, WISCONSIN
Baldwin, WI 54002
SUBDIVISION N/A LOT N/A LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used Bottom of house siding
Elevation of vertical reference point:
Proposed slope at site: 3°Jo
SEPTIC TANK: Manufacturer:
Wieser Liquid Capacity: 1000
Number of rings used: 2 , Tank manhole cover elevation: 98-12
Tank Inlet Elevation: 94.85 Tank Outlet Elevation: 94.54
Number of feet from nearest Road: Front,0 Side,OX Rear, O
135 feet
From nearest property line Front,0 Side, (D Rear, O
95 feet
Number of feet from: well 1 0 , building: 12
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity: 750
Pump Model: SS-~ Pump/Siphon Manufacturer: Meyers Pump Size
Bottom of tank elevation:
Elevation of inlet: 94•15
~ Gallons per cycle: 129
Pump off switch elevation:
Alarm Manufacturer: S J Electro Sys. Alarm Switch Type: N . 0.
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
1-60
Number of feet from well:
Number of feet from building: 30
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
87 Number of Lines: 2 Area Built:
Width: 27 Length:
18"
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well: 200
Number of feet from building: 25
(Include distances on plot plan).
SEEPAGE PIT
Number of pits: Diameter:
Size:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Capacity:
Manufacturer:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
line: Front, O Side, O Rear, 0Ft.
Number of feet from nearest property
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
L eR o J anske
Inspector:
Plumber on job: Paul R . Cudd
Dated: 11-30-84
License Number: MPRSW2739
3/84:mj
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 SIM,Pl- ID Number.
El Holding Tank ❑ In-Ground Pressure ❑ Mound of a'94ed8047
NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Jesse Merritt R. R. 2, Baldwin, WI //,.'z 9_YI1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NE NE, Section 3, T28N-R17W, Town of Rush River
Na- of Plumber_ MP/MPRSW No. County. Sanitary Permit Number.
Paul Cudd 2739 St. Croix 58914
SEPTIC TANK/HOLDING TANK: ° f
MANUFACTURER.. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. fARNING LABEL LOCKING COVER
RQVIDED: PH OV IDED.
A 1A YES ❑NO DYES ❑BEDDING. NT DIA.. VENT MATL HIGH WA ER NUMBER OF ROAD PROPERT WELL. BUILDING V
. EN
T FEET FROM LINE YES ❑NO / lJJ~/ DYES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL Mr~:
ZYES..,,,., PROVIDED'. ❑NO ` YES NO GALLONS PER CYCLE: PUMP ANDC NTROLS OPERATIONAL UMBER OF PHOPE RTV WELL BUILDING VENT
TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINT I AIR I"LET
PUMP ON AND OFF) DYES ❑NO NEAREST /~'i' Y
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LE%(;TH DIAMETER MATERIAL AND MARKwG
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER JINSIDE DIA -PITS LIQUID
TRENCHES MATERIAL
DIMENSIONS PIT DEPTH.
GRAVEL DEPTH FILL DEPTH DISTH, PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DS' STH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END PIPEFEET FROM LINE. 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-
D YES NO meets the criteria for medium sand. TIONS MEASURED.
❑
SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS
DYES ❑NO DYES ❑NO
LEE VER TRENCH'BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
EDGES
DYES ❑NO DYES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. JNO DISTR. ID:STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVATION AND ELEVELEVDIAELEVPIPES DA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
DYES ❑NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE'
DYES ❑NO DYES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
S GN T RE TITLE
DILHR SBD 6710 (R. 01/82) ~ft~ 0 ,
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707 ~
❑CONVENTIONAL 19ALTERNATIVE (If assi Plgann ed l).DNumbar:
as
❑ Holding Tank ❑ In-Ground Pressure Ml Mound 8408047
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION DATE'.
Jesse Menkitt R. R. 2, Baedwin, W1 11 L`7-qty P.0A -
REF.
MARK (Permanent reference point) DESCRIBE IF D FFERENT FROM PLAN PT. ELEV.'. CST REF . PT. ELE`
NE NB Sect,ao 3 T28N-R17W, Town aU Rush Riven
7
Ian },M
Sannarv Permit Number
Name of Plumber: IMP/MPRSW No. County ` Paul Cudd 2739 St. Cnvix 58914
SEPTIC TANK/HOLDING TANK:
ACTURER'. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVE
PROVIDED: PROV
OYES YES ONO
PROPS WELL BUILDING VENT TO FRESH
REDOING. VENT DIA.. VENT MATL . HIGH WATER NUMBER OF ROAD: AIR INLET.
ALARM' FEET FROM
❑ YES ❑ NO YES ❑ NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PU PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO EYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. PROPERTY WELL BUILDING VENT LE FRESH
NUMBS E I AIR ur
(DIFFERENC N FEET FROM
PU ND OFF) OYES LINO NEAREST- P
CENG TH UTAMFTER MATERIALA KING
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: Llnulo
BED/TRENCH WIDTH'. LENGTH NO. OF DISTR. PIPE SPACING MO AT COVER INSIDE DIA. #Pirs DEPTH.
TRENCHES PIT
DIMENSIONS
TH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATER" I NO. DISTR. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
GRAVEL OFF PIPES LINE. AIR INLET.
BELOW PIPES ABOVECOVER E~EV INLEr ELEV ENO FEET FROM
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
N~ meets the criteria for medium sand. TIONS MEASURED.
OYES NO
PERMANENT MARKERS. OBSERVATION WELLS
SOIL COVER rexruRE S/c
ES NO
YES ONO
SEEDED MULCHED.
DEPTH OVER PRSPoEM:BED DEPTH OVER TwENt M; BED DEPTH OF TOPSOIL ISOUULD
CENTER EDGES
OYES NO OYES O YES O
PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER
WIDTH. LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE
BF4E TRENCHES ( N1
D~S MANIFOLD PUMP MANIFOLD DISTRPIPE MANIFOLD ATERIALNODISRDITRPIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEVELEVDIAELEV-rt'F' PIPES~ ~ ~ „V`
ELND ~
SL-~r-I 0 VL ~J
DICOVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING ORILIED CORRECT LV PLANS
S/~tc $.5 f YES 10asNO STtZAV.~ ES ONO
PROF ERTV WELL. BUILDI .
PERMANENT MARKERS: ERVATION WELLS:: NUMBER OF NG
COMMENTS:
_
FEET FR
FEET FR
YES ❑ NO .YES 1:1 NO NEARESTOM
7L NATLI~AL CTI A17F TOLD 17L~APt13F.~ T-0 INSTFIlir I,L ADD(T-10"L WF-u..S
~jE ~ W bl,lS i N STt~ l.~,F_~ ♦ 2
2 . 3oTCUM c~>= 7urAtD ~tiPt►~ f~ ;✓LE1~, - `jC'. LAMP £ C~n,T►~o~5 ti~i IIVs~4L r~~
3 1~c~7 T c an C t- ~jl. D Irv M b l i J 9 8 •tc4
• ~G C % Nom}? S 1 OG t-C`i~ SlL-CK~.
Sketch System on Retain in county file for audit.
Reverse Side. SIG A E TITLE' ST-,q DSLHI.
n y
Dll_HR SBD 6710 (R. 01 /82) RRIVATF_ StWAU£- (:0&SUC._1?11J.i
n
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Wisconsin Department of Industry,
INSPECTION REPORT Labor & Human Relations
PLB-1 Safety & Buildings Division
Bureau of Plumbing
a e TT-an-T-.U. o.
ame o remises
oun y Sanitary Permit
as er m e r irm ame ::zla ss
Journeyman um er Address
wnjner ress J
11 'a5t f'/F~~1 t i~f' K.:r::~
•'.J ~ ~......w~'~" ter,..... m-..+~.my.,..,a~
e.
0-1 C 7-,
OUNT>
ri
. r _..y._
,r .
Discussed with
)See Attached..
iR ~s a as p a is
DUHR-M-6192 tR, Signature o um ing u n- l 1, ~3f
I~
PRIVATE SEWAGE SYSTEM GRANT WORKSHEET
Name: County:
Gant Amount
(a) Site evaluation and soil testing. $ 150 (a)
(b) Installation of a replacement or additional septic tank. (b)
Minimum Gallons Required Grant Amount
750 $ 325
975 350
1,200 400
1,425 450
1,650 500
1,875 550
2,100 or more 600
(c) Installation of a pump chamber and lift pump or siphon. (c)
Number of Bedrooms Grant Amount
I or 2 $ 700
3 or 4 750
5 or more 800
(d) Installation of a soil absorption area for a (d)
conventional or in-ground pressure system.
Grant Amount by Number of Bedrooms
Perc For each
Class 1 2 3 4 5 Additional Bedroom
1 1300 $475 S 650 $ 825 $ 925 $100
2 450 700 950 1,150 1,325 175
3 475 725 1,000 1,200 1,400 200
4 500 750 1,100 1,300 1,475 200
(e) Installation of a soil absorption (e)
area for a mound system.
Grant Amount by Number of Bedrooms
Type of Design 1 2 3 4 5 or more
High Groundwater $1,300 $1,500 $1,750 $1,850 $2,150
Creviced Bedrock 1,500 1,700 1,950 2,050 2,250
Slowly Permeable 1,700 1,900 2,050 2,150 2,300
Soil
(f) Installation of a holding tank. (f)
# of Bdr. Gant Anount # of Bdr. Grant Amount
1, 2 or 3 $1,000 9 2,150
4 1,250 10 2,300
5 1,500 11 2,450
6 1,700 12 2,600
7 1,850 13 2,750
8 2,000 14 2,900
TOTAL GRANT AMOUNT
MAXIMLM $3,000
1176D
wlsconsln APPLICATION FOR SANITARY PERMIT
DILHR St- Cr01X COUNTY
- OEPRRTrnEnT OF (PLB 67) UNIFORM SANITARY PERMIT #
In OUSTRV, LABOR 6 HUMRn RELRTIOns /
-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 MAILING ADDRESS
Jesse Merritt Rt. 2, Baldwin, WI 54002
PROPERTY LOCATION XXXX
NE 1/4NE 1/4, s 3 T28, N, R 17 EKTrKW o N OF: Rush River
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, ' 0I4C ^ STATE PLAN I.D. NUMBER
J,r
N/A
N/A N/A Pine Knoll Dr . ~j5/a 8v t/?
TYPE OF BUILDING OR USE SERVED
EX 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
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 1000 1
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
® Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for i ation of the rivate sewage system non the attached plans.
Name of Plumber (Print): gnat IMP/MPRSW No.: Phone Number:
Paul R . CuddMPRSW2739 (?15)425-2049
Plumber's Address: Name of Designer:
Rt. 5, Box 364, River-Falls, WI 540 2 Art Wegerer (576)
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
~{1 ❑ Owner Given Initial
Approved Adverse Determination
Reason for Disapproval
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
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.
KOZEL, WEGERER BOX 74
421 N. MAIN STREET
& ASSOCIATES, Inc. RIVER FALLS, WI 54022
(715) 425-0164
ENGINEERING-SURVEYING-BUILDING DESIGN (715) 425-0165
A TTN : DATE
CC:
f r, d~C Y'~ '11
SUBJECT:
WE ARE ENCLOSING THE TEMS:
NO. OF
COPIES DESCRIPTION
SENT TO YOU FOR THE FOLLOWING REASONS:
❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED ❑ INFORMATION DESIRED
❑/'FOR YOUR USE ❑ APPROVED AS NOTED ❑ RETURN COPIES
❑ NOT APPROVED ❑ FOR REVIEW AND COMMENT L]
KOZEL, WEGERER & ASSOCIATES, INC.
BY• f ~'`y i
I
RR
Mate of WISCQl1$1Cl ` Department of Industry. Labor and Human Relations
SAFETY & BUILDINGS DIVISION
bj1! E::.u of ?li;. 'Ally
e'01 Fast i`- 3; ngto n Avenue
P.C. 0ox 71059
•c3:~isu^, ►Asc:onsin 53707
a • s in ftt
:irate 2
• •~V~ l-+-tJ
J_~-5: Fi'~rr~t4 t>.SiGGiIC.C
s
i:.'•r:n of P, Lsh river, St. Croix County, wi
a~ i=gin iscn;,sirt Statutes end s. IthR 83.09 (2) ;o,, ► aSCC^Sfn
tnisiT'Aiite Cc 'e, allow ti;e a1~--ier to ryOtitiC}~3 'tter ~e~~rt»~!tt fGr ~ ti..c li~R.t'
try t~,_' installation for a private scwage system? to ffeplace an existirg privEte
Sts 3 SVf%': t at a Site 1ft'ic is rot in fUll C:: ?'llct:rE *Ith tt& sitil"',
stzm. :'ar,Os in ne a, 'Anist.rcti` e rule. l iii s i tSit~r3 fir':r:'_ kfGU
J'St~t. post.. 5. le i
protcct the Qaters of f 2 f rc 7 F t t cr c
t ai lifi-v system (sr -itc-r-s of the 5i #.e, VAS variar:ce s%iall ,;e
rc sc i +i:sei~.
I
I
Tito petition for a v ri ;ce ra,ju st.a to W:k &3.c3 (1) (a) c the ids.
r~+atn. Coat was co-isid--re-C o : Nove*- cr 5, Thr petition 3aS ueen I
tri7vEc.. 1•<<t ~wt3{~ititn i, i .rL iti ;sG- cep i ~
conditionally ~ C "L 'is s•r_te~,
ii:115
it shall be corr,.:cteo or its use sisal l be discoatit;3 eL withis Vi-at perioc. of
tin-"e- rerr :iredl by caurty or 6c-ci3rt --.Asl or: er ►.iLtz Lif:'e l i:+it L`= 4i3°
,Yur.
""Equires tfiat ;i iuzd Svst.- areas have et k 7s" Of
soil above i,igf' grounor.'iter os z-i -icai:t?u ty SCiil 17;Xt
f `iis v. r l C : Il. - rL s i.edj •v5 t4 a c' 4• -r.
it-, $t ll C ~St;,;: C7ti c:ri are i?•.,t'1++' f'-t
i
t'!nrs 1t ir;esizS of StiA3 n=_`ite nigrl jrourid::ter.
'!l Gi t +i c.i rat. (ii3i y~wtt•: ~i'Ft5 S=;.. :iTte. Gy Qit r, t4ii %.'i L:1:.- Z,_~itit. .:r
cf: i .'T tis `,ariartce is specific to tt 5 eL"'J'-ct p c ti atiC.'; Cs C. t. E'.
f,~r 4:its t, nal Aficetions.
ri: 1., 1r
'f
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cc: Lcr-,jj v I1. _ i~ii l1c
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. ! Safety and Buildings Dki<ion
t` `r ~L
H R- PLAN AFT.RV VAL Bureau of Plumbing
P.O Box 7969
❑ General Plumbing Plans Madison, WI 53707
❑ Private Sewage Plans Telephone: (608)266-3815
OFFICE USE ONLY
j Plan Identification No.
l
C_ Gallons Per Day
PRIORITY PLAN REVIEW ONLY
Plan Review C, i
Petition For Modification
$ V~J
Project Name Project Location - Street No. or Legal Description
Cj!
❑ City 11 Village own of: County(-,.,
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:
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.
,L FOR PRIVATE SEWAGE PLANS: ~r
This approval will expire two years from the date Jproved below or if a sanitary permit is obtained, it will expire the day the initial sanitary
permit expires.
Comments:
By.
James Sargent
Bureau Director
If Questions Plans Approved By: Date Approved:
Contact ♦ ~
cc: OWS ❑ DPS ❑ H&R & Rec. San. Section
County ❑ Local PI ❑ facilities Need Analysis Sect~,.n
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
rr.Itk ~,,,,C k09 (h o; 84) Owner ❑ Other
FOUND SYS`! E:,!
FOR
FOR
~SZtZlTT
LOCATED IN T~_r OF THE )'JET/VOF SECTION T_z~'N, F~ » W,
OWN OF COUNTI ~SCONSI?~.
INDEY
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE- CURVE,
REPA RED FOR
Pr tuL ~~oQ 8' SDr~, S , ? c -
~v7-t. S
SL/o~ z -
PREPARE
D BY
KCZE•L, WEEGER4 R AN.D ASSOCIATES
BOX 74 21 PvORT M4IIV STREET oo~~~\? C, 0 /v
RIVER FALLS, WI. 54022 •o
CHAPLES -
K07EL o
E-09415
RIVER FALLS, c°
WIS
0e C , h~ ~ X00
cn s::a:asz~e
' I
Job -So
Scale
t
r._
1J ST
No ;c: CUT T'2- -1-p C, R_UV jr, I II~
~ E! 96.5
sz * 11 . ;
17 SI
a/n EL%.o' I D ~x~sT~N6 ~~z r`l _ CTS
II cAV~ 1~ tt~o F~~~~-o~
~ ~ t 2~ws ~F
i2..
~15' pct 9i.o ~I ~c tST1r~G j-tom , F
Pts 4 15' x I~ / (oc C~~ T2 No7E :it j
Ova" 4"Pvc ~o=.T
0 33
1 t .98.0 - ao~S~ ~o,T--' t.v-zL ~S
• F-I,-d _
i O~ I'^~U fJ C]
N OTES -
l. Elevations shown are existing ground elevations unless otherwise noted.
2. Install cast iron pipe 3' onto undisturbed soil both sides of each tank.
3. Install permanent markers at end of each lateral. ( Ll required)
)
4. Install 4" observation pipe with approved ca e . required)
5. Septic tank to be Novo gallon capacity as manufactured by
~=T_~ C-~k t ~nr.~ ~ `T'U1-~ ?D ~c `r►~7 o v~_ _
6. Bench Mar'_~- Elevation Bt'1'~►_ ~ ~`~t-" Cr Hc) stL>
-all '4 Z EL 100.`7 ' C/V 80-r- U" OF= L S ! C 1 ~,3 r- .
Sirov,, ~forsh Hod Or
Synthetic Covering
Dislribulion Pipe
Medium Sond
- -----i-- JG
Topsoil F
7- TD
SFd O` 2 gFor ce ts;oin riDw°_c
2
From Pump Loy
~ppre Dal e
D
E 1 • ~ -~T.
_ Cross Section Of A Mound System Using
F -~T
A Bed For The Absorption Areo
G 1 0 ~T
A 6 Ft. H
6 G3_ Ft_
D`` t; l Z_ F t.
i S-7 F t
W Z-7 Ft.
i
y Observation Pipe--,\
- `I ! n - - - K
Distribution g5ed Of 2 2 `
Pipe Aggregate
1 _
Observation Pipe Permanent Morkers
Plan View Of tvSound Using A Sed For The Absorption Areo
i
E
-Per for oied Pipe Detoi!
EnC
L=erio+cle[
~nC ECG-. -7 PVC P,pt
Hopes ~occied On Bottom,
0
Are E cuellV -poc ed
K 2
I/-i>iSTAtL ~`Rt~ANEr--R A L
AT t=~D of EACH L-P%
Q c
PVC
F wS i
ih O~~JOld FIp[
~Dstrieut of t~ =VC Force Vair
\ ripe - F-prr
Lcst >,oit Sr,ould Be~ ~J\y ti^v. "
H
hezt 10 EnC CCC
End Cop Distribution Pipe Loyout P -s 3 ~T.
S y ~cT
X ~b ~h-
Y bb
ole Diameter Inch
y cieral 1 / Inch(es)
anirold Inches
Force Main Z Inches
of t ~LES/PJP=
P`_P.CE i tES T 33~, 99~t~ 1b5~, 23\tu 29'1u 3~3~' r fR0;i-1 ~~}ll`=ply. -
PUMP CHAMBER CROSS SECTIO!J AUD SPECIFICATIONS
VENT CAP
,I C. i. VENT PIPE
WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
25' FROM DOOR,
'~JINDOW OR FRESH WMill.
AfI INTAKE I _
GRADE I -T
.ELEV. gat i I 4~ MIIJ. 1~'
COQDUIT `
18"MIN. ~
' PROVIDE I -
IMLET cZEV. ~~f.~ I - -
- - - AIRTIGHT SEAL
I I
APPROVED JOINT A I I I APPROVED JOINTS
W/C.Z. PIPE I I I W/C.T__ PIPE
F' I III EXTENDILIG 3'
EXTENDING 3' ~ LARM
A
ONTO SOLID SOIL B I II ONTO SOLID SOIL
i
ON
c
9z Ib i
ELEV_ - • FT---
Pump-__ OFF
D , gg0.
ELEV. SO.83 , CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MAIJUFACTURER HAS SUCH APPROVA,C''
sjE~T 5PEGIFI'CATI0US
DOSE
TAIJKS MA►JUFACTURER P~2-Db Cn NUMBER OF DOSES: -PER DA-'J
TAMK SIZE: SC)GALLONS DOSE VOLUME
ALARM MAAIUFACTURER: S.S,ELC-LT1Z(~ SYS18;$ INCLUDIAIG BACKFLOW: GAELOt1S
MODEL QUMBER: lDl 1-1 w CAPACITIES: A= _14-INCHES OR GALLONS
SWITCH TYPE: o B = Z INCHES OR GALLONS
PUMP MANUFACTURER: C. G INCHES OR `Z9 GALLONS
MLIDEL MUMBER. _ SS y _ D=-16 INCHES OR GALLDUS
SWITCH TYPE: ~`1RG►J~~C DOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE 7 G P M INSTALL--
VERTICAL DIFFERENCE BETWEEN PUMP OFF AMD 015TR16UTIOM PIPE._ 6-- FE;.
MIMIMUM NETWORK SUPPLY PRESSURE . . , , _ , , , , . , 2.5 FEET
+ \00 FEET OF FORCE MAIN X 3.10 F/
- iooFr.FRICTIO►J FACTOR._ FEET
TOTAL 01 1MAMIC. HEAD FEET
• IIJTERNAL DIME►JSIO►.15 OF TA►JK: LENGTH - ;WIDTH -;LIQUID DEPTH
N L~C)-) CC) ON 0)wCND N) N) K)
)N O
- - - - O
O
O - - - - - - - - = _ _
O
-
o 0-1
O 0 :u
N) > cf)
O 0 CO
o
> w o r
o N ru
CO - O
cn - - - - cn C
o~
in o O f
a
o C
-
C: I
rn CD CD C-
I N
O 10
cn - - O
N
~ N
- O
N
- O
_L__L L
O N w -p. Ut m y CO m
N~~ TOTAL HEAD PI Pwlr fF-lr S
r ARTMENT OF
i,JuUSTRY' REPORT ON SOIL BORINGS AND SAFETI' & BUI!.;5
!-,,BOR.'ANG PERCOLATION TESTS OX DIVISION RELATIONS 9
(115) P.O. BOX 7g
(H63.09(1) & Chapter 145.045) MADISON, WI 53707
1 r_iCATIONV SECTION:------_
- TOl'JNSHIP;fd{t pt7 y.
/T~P~/R E (o LOT NO.:BLK. fJO: SUBDIVISION NAME:
~v S !y_ 1
COUNTY: OVyNER'S/B iYE~S NAME-- - - - -
MAILING ADDRESS:
5~ • CZO l~C J t. S .S ~ }~1 E - .
S
USE -----------J 1 y oo Z
NO. BEDR MS. : COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
Residence
3 ❑New Lq~3eplace PROFILE DESSCRIPTIONS~PERCOLATION TESTS:
- -
RATING: S= Site suitable for system U= Site unsuitable for system
-
CONVENTIONAL MOUND IN-GROUND PRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDEDSYSTEM:(optional)
M
If Percolation Tests are NOT required DESIGN RATE: o~°-
- _
unc err s H63.09(5)(b), indicate: LF portion of the tested area is in the
plain, indicate Floodplain eievauon: A
_ PROFILE DESCRIPTIONS
B O R I N G TOTAL
rVUfdIBER DEPTH+4 ELEVATION DEPTH TO GROUNDWATER f't~, S CHARACTER OF SOIL WITH THICKNESS COLOR, TEXTURE, AIVD DEPTH
- _ BSERVED EST_ HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B_1 S• U~ 96.0 ~wrnoT J '6 G' gn s i ) l-s ; 1.3 l3 in s j~ -
B-Z S.O S~,S •Nd1JL• m\?S' ~ p ~ k -.3 sjl7'SJ 1•ZY~~r 8~ s _
Z.S ) ~
t I SSA 6~ RT Wt o p . 8 ~ DrC 6 I ~ Gv G
0. 7 Q ~ s
B- 3 S, z 9~ .o ~5 y T'~
z. a I l s Gyn sl)
_ y_91
PERCOLATION TESTS } V
TEST ,~tt`~_ -
DEPTH WATER IN HOLE TEST TIME
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES "
PERIOD i PE 2 RATE MINUTES
RIOD
P Z Z 3 p 11/! 3 _ _ PERIOD 3PER INCH
P_ -2 Z
P- Z Z tv o 3 0 -2 AE,
_-P 1 1'71b i 1j16 zg
P_
_P-
LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
intal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borin s and the direction and
( land slope. g
pA6E Percent
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IN'GUSTRY,' DIVISION
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 53969
HUMAN RELATIONS , 707
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/~ LOT NO.:B7KNO,:ISUBDI VISI ON NAME:
/Tz,N/R `,1 E -
COUNTY: OWNER'S/B-G - S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ? ❑ New [Rkeplace Il 4 G '
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROU\D-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑ S ®U ElS ❑U ❑ S DU ❑ S zU ❑ S CCU
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the A \ /1`
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 1V ~l
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-If'd6H#ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH +.a. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
Y`n oT
:3y sin,- v,n o • Utz Gyp, a i J T~ • 1 ' vy l si i ;
t
B z y.J
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P ~J 1111 (o I, - - D
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. ~~`Z--y`ls~ 0 ~
SYSTEM ELEVATION
i
~cY o p OFM
tr sr a Qtr 1C Fk 1. _ 1-i ftTz tic 2 - p%O .
'Bo -T-1'~x~ c'~ r= F'~ L~ 1. S t C:~ 1►.~ ~ .
V SIT L- IS _C.OGt _ ESQ)
_ . . a v'i ff-~L E -1
O )7 S L-C'E~ is UN TL
w o~° .,,'`$E, rtioc~t p~ }1 y- try
1c
o - .
f 5►,~
f1l
t y
E
E
P
S 42^ 0
I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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:
v12 L vo-
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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