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Parcel 006-1045-90-000 12/28/2005 03:41 PM
PAGE 1 OF 1
Alt. Parcel 21.31.16.317A 006 - TOWN OF CYLON
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 - JOHNSON, MICHAEL
MICHAEL JOHNSON C - JOHNSON, GARY W
GARY W JOHNSON
2232 205TH AVE
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 2232 205TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 21.000 Plat: N/A-NOT AVAILABLE
SEC 21 T31 N RI 6W SE NW THE WEST 693' OF Block/Condo Bldg:
SE 1/4 NW 1/4 SEC 21
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-31N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
03/31/2005 790944 2774/4y4A- WD
07/23/1997 1977/,19(1 WD
07/23/1997 33/194 v i LC
2005 SUMMARY Bill Fair Market Value: Asses
384 277,300
Valuations: Last Changed: 09/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 15,000 175,600 190,600 NO
UNDEVELOPED G5 4.000 6,000 0 6,000 NO
PRODUCTIVE FORST LANDS G6 15.000 45,000 0 45,000 NO
Totals for 2005:
General Property 21.000 66,000 175,600 241,600
Woodland 0.000 0 0
Totals for 2004:
General Property 21.000 66,000 175,600 241,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/1712001 Batch 512
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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 C ALTERNATIVE lad)
in _,gne n D NN-1,11,
If assi
❑ Holding Tank ❑ In-Ground Pressure [XI Mound 830 388 1
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Douglas Thompson RR#I, Star Prairie, I
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.' CST REF. PT. ELEV..
SE NW, Sec. 21, T31N-R16W, Town If Cylon
Na- of Plumber MP/MPRSW No.. Co_ unty Sanitary Permit Number.
Gary Steel 3254 St. Croix 38519
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. n LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
W ~+'..I 7 0 PROVIDED: PROVIDED.
7A/ )(YES ❑NO ❑YES ~WNO
BEDDING: IVENTDIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. JVENITOFRESH
ALARM. FEET FROM O LINE: A/ O AIR"4E
❑YES NOr er ❑YES ❑NO NEAREST ~d ~(10~ flf
DOSING CHAMBER:
MANUFACTURER. BEDDING LJPUMP MODEL. JPUMP/SIPHON MANUF TUREH WARNING LABEL LOCKING COVER
M~ P ARMING PROVIDED.
DYES NO 0`" ~~/'a (.¢'f'f YES ❑NO XYES ❑NO
GALLONS PER CYCLE: f PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL JIUILDING. VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) ES ❑NO NEAREST-~ / ao f .00", r i/
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ENGTH 1111AM11111 MATERIAL AND MARKING;
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH ILENGTH NO. OF DISTR. PIPE SPACING. COVER [INSIDE DIA 'PITS LIQUID
BED/TRENCH TRENCHES MATERIAL PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR,rp~E ER NO. DISTH. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV.INLEr ELEV. END. .rY PIPES FEET 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-
meets the criteria for medium sand. TIONS MEASURED.
YES ❑NO
SOIL COVE TEXTURE PERMANENT MARKERS OBSERVATION WELLS
X YES -]NO L~K ES ❑NO
DEPTH OVER TRENCH.'BED DEPTH OVER TRENCH;BED = 1 TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES / _
/ J ❑YES O YES ❑NO ES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
DS J
BED/TRENCH
IMENSIONS TRENCHES S
MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. JNO DISTR. JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEVATION AND E/ 0O 7el EL67 DIA ~E
-7/ PIPES Dn
rd ( V J
DISTRIBUTION
INFORMATION HOLE SIZ€ HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
lk~ PLANS ~
ES ❑NO E4' ES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. JIIJILDINI.
FEET FROM uNE /sp7/
ES El NO YES El NO NEAREST--
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE
7
DILHR SBD 6710 (R. 01/82) ~ - If 'lilt I
DEPARTMENT OF APPLICATION
SAFETY & BUILDINGS
INDUSTfiY, FOR SANITARY / DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/2 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:
s m so R. ►21 r , U) . - Z
Pire,
roperty Location: -64y;.Vi1Mge-wTownship: County:
% A)V) /aS o;2 ,T 31 N/R I (o E (or) W
,SO Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: 41
A~. (lf si ned~e /
TYPE OF BUILDING
Number of
Public* ❑ Variance* ❑ Other (specify) Bedrooms:
1 or 2 Family *State Approval Required. Z.
TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
ESip- Ks 0-44 12 4- 9 j2d 4-s
FFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): K New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
5-0 Alternative (specify) rrl p U_,YlCj El Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint El Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name pIll Signature: MP/MPRSW No.: Phone Number:
Plum s Ad re~ss1: Name of Designer:
y
aq A~;I'n&
COUNTY/DEPARTMENT USE ONLY
Sign ure of Issuing Agent: F Date: Sanitary Permit Number:
N ~ 0~o ~~3 APPROVED
.4 SO 7- IMA .1,0 /7"
a( ❑ DISAPPROVED S~
eason for Dis pproval:
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.07/87)
Department of Industry, Labor & Human Relations
Division of Safety & Bldgs.
State of Wisconsin, Bureau of Plumbing Platting & Fire Protection
ei ~ A P.O. Box7969
Madison WI. 53707
Tel. 608-266-3815
aL?,
IN ALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
NAME OF PROJECT
TYPE OF APPROVAL
STREET AND NO.
CITY OR TOWN TY STATE ZIP
OWNER
Gentlemen:
Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145,
Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com-
pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted.
The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of
plans bearing the stamp of approval of the department.
In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval
shall become void and new application shall be made for approval of these plans before work may commence.
In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan
omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary.
This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require-
rnents of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto-
matically void this acceptance, c
7~r1•JG l? v~Y1:~a~Q SyJt~ri l.:) O^IJ.
Sincerely, apprOval is va'id for tv v
s ``r i, c!id un,.
cT/ljttl3~ = ";r 1J,0n date of the i7Lt'al
sanitary ;,)en-nit.
l , ..w
James Sargent-Bureau Director
PLANS REVIEWED BY: DATE:
cc: DPS-OWS Owner DI LHR
Local FI Plumber H & R (2)
County Mfg. Rep. Bur. of Health Fac. & Services
)ILHR SBD-6099 (N. 06/80) Rec. & Env. Services
Form - S `1' C 100
Owner of Property
Location of Property -S 1.. Section / T N R r-W
Township
Do
Mailing Address
q i
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel f _i -z~
Date Parcel Was Created 4
rr
Are all corners identifiable? Yes No
Include with this application one of the following:
.Certified Survey Map
.Deed
.Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION I
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I !we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No. !i ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
SIGNATURE OF OWNE SIGNATURE OF CO-OWNER (IF APP CAULE)
D E SIG D `DATE SIGNED
Department of Industry, Labor & Human Relations
State of `~j Division of Safety & Bldgs.
State of Wisconsin Bureau of Plumbing Platting & Fire Protection
P.O. Box7969
Madison WI. 53707
Tel. 608-266-3815
INALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
Zoo
NAME OF PROJECT
TYPE OF APPROVAL
C5. C9.
STREET AND NO.
CITY OR TOWN 'COUNTY' STATE ZIP
C
OWNER
Gentlemen:
Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145,
Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com-
pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted.
The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of
plans bearing the stamp of approval of the department.
I
In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan
omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary.
This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require-
ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto-
matically void this acceptance.
FOr Private SES'vage c\rS¢ GIs Orty:
Sincerely, This ap p;';,v` al is v-, 1:C! if"
yol'.m Ot it YAll
flhEl c!_J0 OI "t?lG iilii u
James Sargent-Bureau Director
PLANS REVIEWED BY: DATE: f~
I ZZ& % / -
cc: DPS-OWS Ow DI LHR
Local PI Plumber H & R (2)
County Mfg. Rep. Bur. of Health Fac. & Services
DI LHR SBD-6099 (N. 06/80) Rec. & Env. Services
I
tt~l ~ 04~~
ti
r4 ~ F
881
M
1903
L11LHR STATE OF WISCONSIN DILHR
w w, PRIMATE SEWAGE SYSTEMS BURS U"OOF PLSAF UMBING BUILDINGS
201 E. Washington Avenue, Rm 178
PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707
608-2663815
INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received.
The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration,
Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266.3358.
1. PROJECT INFORMATION (Type or print clearly)
Name of S44mitting Party (Plans returned to same) Project Name
Street & No. Project Location - Street & No. or Legal Description
/AO c t ! 4 ) S
City State Zip Code ❑ City County
/ U Village
T
~'//l7 Town ~ ~ i•~ e-`I 1 r
Designer Telephone No. (include Area Code)
__-~_-ter -
2. THIS APPLICATION IS FOR A:
New Mound System (3) 1 j Holding Tank (2)
❑ New Pressurized System on site not suitable U Petition For Mods w,ition (G)
for conventional (3) (0 Replacement Mound (4)
❑ Replacement Pressurized System on site not U System in Fill (1)
suitable for conventional (4) ❑ System in Flood Fringe (1 )
❑ Pressurized System on site suitable for ❑ Groundwater Monitoring (7)
conventional (1)
❑ Conventional System - Public Building (1)
3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE
3a. 750- 1,500 gallon septic tank - 30.00 4a.
3b. 1,501 - 2,500 gallon septic tank - 40.00 4b.
3c. 2,501 4,000 gallon septic tank - 55.00 4c.
3d. 4,001 8,000 gallon septic tank - 70.00 4d.
3e. 8,001 12,000.gallon septic tank - 85.00 4e.
3f. Over 12,000 gallon septic tank - 100.00 4f.
3g. 500- 1,000 gallon pump chamber - 30.00 4g.
3h. 1,001 - 2,000 gallon pump chamber - 35.00 4h.
3i. 2,001 4,000 gallon pump chamber - 50.00 4i.
3j. 4,001 8,000 gallon pump chamber - 65.00 4j.
3k. 8,001 - 12,000 gallon pump chamber - 80.00 4k.
31. Over 12,000 gallon pump chamber - 95.00 41.
3m. 500 - 5,000 gallon holding tank - 30.00 4m.
3n. 5,001 - 10,000 gallon holding tank - 40.00 4n.
3o. Over 10,000 gallon holding tank - 50.00 4o.
3p. Groundwater Monitoring - 32.00 4p.
Subtotal ""2 1?
3q. Priority plan review: (walk through) 4q, r; Cj - Dc7
Submittal of plans in person,
by appointment, with double fee
3r. Petition for Modification t'.
Setback - 20.00 4r.
Site evaluation - 50.00
- c? c.
Total Fee -)'12
COMMENTS:
DILHR SBD6748 (R. 5!82)_- - -OVER--
STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Township/M.KJ #.tXy,
SE 141 NW ~41S 21 T 31 N/R 16 )MVX) C lon St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Douglas Thompson RR#l, Star Prairie, WI 54026
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.
ABC
Signatu.e of ApplicLut/ _ Iate
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF~_ ,r This day of _ 19Z
41 ✓
Notary Publi , State of Wisconsin
My Commission Expires: J
- ~
DILHR-SBD-6413 (N. 05/81)
ST. CROI X COUNTY
s
Wy WI SC O N S I N
4 MPL fr S S^~ 5?~F?f
r,r zr rx ZONING OFFICE
~.M 796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
July 11, 1,983
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear sir:
An on site investigation for the Douglas Thompson property
located at the SF14 of the NWT of Section 21, T3].N-R16W,
Town of Cylon'in ST. Croix County, revealed suitable soils
at a depth of 37 inches, below which seasonable high
grotind writer was noted.
This site should be suitable for a mound system.
Should you have any question, please feel free to contact
this office.
Sincerely,
Thomas C. Nelson
Assistant Zoning Administrator
TCN:mj
Ti l
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY 6 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, NW 1/4, Sec. 21 , T 31 N, R 16 )EXt0A W
Town or I IaWlicjKX Cylon Street Address
Lot No. Block Subdivision
Landowner's Name: Douglas Thompson
The application for this site is for:
new construction use.
[.-Ireplacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
1X1to have one of the first five approvals guaranteed for this year. This is
numher 59 - 05 - 4 of those applications. (Use one of the first five
quota nurn ers i ssuec-to you.)
]one of the applications needing a quota number. The quota number assigned to
this application is - -
L__]for one additional homesite on it farm to he occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
Ifor an individual lot for which a sanitary po rrnit was issued but was later
ruled unsuitable due to new or c.han(jed soil criteria established by the
department.
]for-an application on file prior to February 1, 1980.
L_.1for 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:
Lea failing conventional soil absorption system.
L_1a 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 nieets the criteria for a
conventional private sewage system, check here.
I certify that the above information is true and accurate to the best of i~y
knowledge.
Name Thomas C. Nelson
_ Signature
County OfFicial
TitleAssistant Zoning Administrator DaLe July 11, 1983
DILHR-SBA)-6158 (R 12182)
SAFETY & BUILDINGS
DEPARTMENT OF, REPORT ON SOIL BORINGS AND
INDUSTRY, DIVISION
LABOR AND ` PERCOLATION TESTS (115) P.O. HUMAN RELATIONS MADISON, WI WI 53707
37Q7 ;
L 1 3MTION:, T WNSHIP Mt1NYCtPA-LtTY: ZS O.JBLK. NO.: SUBDIVISION NAME:
or)
1/4
COUNT`S OWNER'S /BUYER'S NAME: MAI LING ADDRESS:
p~ ! y r tt l
k a• L'S !1 f.:,i.''..''*`' A,r" r'A C'. T. T`, v % ' Y
USE 4 DATES OBSERVATIONS MADE -
NO. BE[ MS.: COMMERCIAL DESCRIPTION: I 'I E9
Residence n KNew uRepEace {
fs
RATING: S= Site suitable for system U- Site unsuitable for system
ONVENTIONAL MOUND: IN-GROUND- URE: SYS E • N=FILL HOLpiNG TANK: RECOMMENDED SYSTEM: optional)
0S LU IRS ❑U _a S U Q S U❑ S ff. U
SYSTEM ELEV.1
rcol
ation Tests are NOT required DESIGN RATE: If any portion of the lot is in the
r s H63.Q9(5)(b), indicate Fioodplain, indicate Floodpiain elevation:
P''
l PROFILE DESCRIPTIONS
Yb'A BORING A H R DWATER-INC ES A A ~bF~SrOIL wE THI SS, OLOR, TE TORE, AND D PTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED fSE:E ASBRV. ON BACK.)
4 B- a~W' L ,r"4 .r 3. k..,.3 .F. xP, a +yr K..' a.Tleh. '^FS'~, rh ..a. i✓? !`."S. e~•„ %}Yl. n,;?1r r! r,~*v C
ark 4 .
g,yi
-Y 13 G
„ a
L..Jl R t.tv~
'
y. ~4 ...i %C. , Rl' I R F SAI ~ , 7 F ! is','
B- - -'s•,a
, I~ iY~; ~ dd 7 aF la ~ ~ t' , t ..3 .•r
u
p.
PERCOLATION TESTS
EL- S RATE MINU -MCHE
DEPTH WATER IN HOLE TEST TIME - WATER V
f NUMBER INCHES AFT ER$WELLING INTERVAL-MIN, P91 PER INCH `
.,C, , 7/.,
r.r F
p_
~v, 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 hors-
. ;zontaf and vertical elevation reference points and stow, their, location on the plot plan. Show the surface elevation at all borings and the direction and pwoent
of land slop.
4
` SYSTEM ELEVATION
a w
a
1~
...3,.. q/.,_ l1
,
s
J'
I H ~ ""1 ) ~ I
51,
f
lk~
17
w
k
i ,
1
» . t .,.ym::wnmr+w"mmn«lmmmx,+el ~.v--=#'+' , r..r..,r : I µ.1.~':c+au*,a. F=+.x. ma'..w...•u•.m, rani.+nnett~es b': '~'dk*d~tx '~``Yi : 4 y _'!...1..,,
....m
a.'.
the -undersigned, hereby .certify that the soil tests reported, on this.,form were made by me In accord with the procedures methods,rredfied in the Wiscoeiit0'
p Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and iwiief .
NA pant : r" TESTS WERE COMPLETED ON:
ADORE SS M5ATION NUMBER: PHONE NUMBER optional :
, ~yJ. 4.y 5 S.. ffiy { + a/. 9! a+<#Flt n.J C~~ ( 4 J'e~4` ~l `w.• ~ i`:_ ~3. e.~,. Z.,J ~1+
_ q
n D CST SIGNATURE:
b19 BUTION: Original-Local Authority; 2nd page-Bureau of Plumbing„ 3rd page-Property Owner, 4th page-Soil Testy:
DILHR-SBD-6395 IN. 031611 '
OPTIONAL WORKSHEET
1. MOUND,SYSTEM Sy r" t II. IN-GROUND PRESSURE SYSTEM-
Continued-1. Wastewater Load Total Daily Flow G~ gal. 10. Force Main:
Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate = 1 gpm.
Adm, Code and PROVIDE A DETAILED Diameter=_ in.
LIST OF SIZING ON PLANS. ? -Q-& 11. Total Dynamic Head:
2. Depth to Limiting Factor = ~ ft. System Head = 2.5 ft.
3. Landslope = Z 3 % Vertical Lift = 7 ft.
4. Distance from Dose Chamber to ft.
Friction Loss ~
Distribution System = 10 C ft. TDH = tiL ft.
5. Elevation Difference Between 12. Pump Selection:
Pump and Distribution System = _91-31- ft, Pum wHI discharge at least 4 7'~ gpm
6. Absorption Area Sizing: r~ at~ ft, total dynamic head.
Area Required sq. ft. Pum o el and a fagyrer: ✓
Bed or Trench Length (B) ft. fa
Bed or Trench Width (A) to ft. 13. Dose Volurne:
Trench Spacing (C) = ft. 10 Times Void Volume of
7. Mound Height: Distribution Lines= 0gal.
Fill Depth (D) ft. Daily Wastewater Volume
Fill Depth Downslope (E) = A ft. 4 Doses in 24 hrs. _ 5 - gal.
Bed or French Depth (I ) . y It. Back(low gal.
Cap and Topsoil Depth (G) = ft. Minimum Dose = gal.
Cap and Topsoil Depth (H) = ft. 14. Dose Chamber:
8. Mound Length: y
Volume gal.
End Slope (K) _ ft.
Total Mound Length (L) ft. III. ONVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. Wastewater Load, Total Daily Flow = I.
Upslope Correction Factor = 94, Use section H'63.15 (3) (c), Wis.
Upslope Width (J) = ft. din, Code and PROVIDE DETAILED
Downslope Correction Factor = le LI 'OF SIZING ON PLANS.
Downslope Width (1) ft. 2. Require eptic Tank Capacity = gal.
Total Mound Width (W) _ ft. 3. Percolation to = min./in.
10. Basal Area: 4. Absorption Ar Sizing:
Infiltrative Capacity of Refer to Table in chapter H 63
Natural Soil = 7~ gal./sq.ft,/day and PROVIDE A TAILED T OF
Basal Area Required = 2// sq, ft. SIZING ON PLANS.
Basal Area Available = p Z. sq. ft. Required Area = sq. ft.
11, If Standard Tables from Chapter Length = ft.
H 63 are Used, Indicate Table No. a~ Width = f ft.
12. For the Distribution Network, Use Numbers 5.14 in Section IL Number of Trenc s = w
Trench Sp * ft.
II. I -G~ ROUND PRESSURE SYSTEM 5. Distribution y
Sy m:
1.~De-Plittcl imfting'Factor = ft. Lateral L gth = ft.
2. Landslope - Numbe of Laterals
3. Percolation Rate min./in. Later Spacing = in,
4. Pro em Elevation - -v ft. D' ance from Sidewall to Pipe in.
Wastewater Load, Total Daily Flow: gal, stem Elevation = ~t
Use section H 63.15 (3) (c), Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTFM-IN-FILL
LIST Of SIZING ON PLANS. Fill in All Items from Section III
Required Septic Tank Capacity = gal.
6. Absorption Area Sizing: V. SEPTIC TAN K
Percolation Rate = min./in. 1. Capacity = gal.
Area Required ~r v" T-:7-
2. sq. it. Manufacturer:
System Length = f z, ft. 3. Show Site Constructed Tank Details on Plan
System Width ft.
7. Distribution Pipe Sizing: VI, DOSING TANK
Hole Size - yl; + in. I. Capacity = 1 _ gal.
Hole Spacing = _ C = ft. 2. Manufacturer: ~ C
Lateral Length 20 Il. 3. Pump Manulacturer: to _
Lalcral Si,,c in. 4. Pump Model:
I.alcr,rl Spicing It. S, Operating Head= -.1-57's '7 ft.
Disl,u)cc Iron) Sidcw.ill to I'll)(' in. 0. Flow Ralc , a 4 gpm,
K. Distribution Pipc Discharge Rile: 7. Show Site C.onsLucled lank Details on Plans
Number of Iloles I'ef Pipe _
low Per Pipc glom. VII. I A N K
9. ManiloldSiiing' I. C.lpacily"
c
YPe (center ui end) 2. Manulacturer..
Length = ft. 3.
4,iciw-.Stte f;tSnstructcd Tank Details on Plan
Diameter = in.
-SHOW ALL INFORMATION ON PLANS-
DILHR SBD-6761 (R.03/82) -123- ~4-
mGu.vNr-A two 5
y
1
,
5 A
eJ a t' w E
~
9~71f
1
i
tom` ' ~r
Page Of
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
_ H G
Topsoil F
-J I E
3 D
Jib
b
% Slope
Bed Of 2y- 2 2 Force Main Plowed
Aggregate From Pump Layer
D Ft.
E Ft.
Cross Section Of A Mound System Using
F , X75 Ft.
A Bed For The Absorption Area
GFt.
A Ft. H Ft.
Signed:J
I B Z Ft.
License Number: Z'6 ,L K In Ft.
Date: I? LZL Ft.
J 9 Ft.
Alternate Position Ft.
of W ~..c; Ft.
Force Main
L
71-
Observation Pipe
g K
A I~----------------------
----------------------•I Force Main
Distribution Bed Of 2 2 2~
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
-114-
• Page , Of _
0f~
Perforated Pipe Detail
End View r '
Z erforated
End Cap) VC Pipe
1 . • Holes Located On Bottom,
Are Equally Spaced
r
PVC Force Main
r~
i
/P PVC
Manifold Pipe
Distribution Alternate Position Of
Pipe Force Main
Last Hole Should Be
Next To End Cap
End Cap Distribution Pipe Layout P 2 O Ft.
R
S
X ?p Inches
Y Inches
Signed: Hole Diameter i~ Inch
Lateral / Inch(es)
License Number: . Manifold_ Inches
Date: f" z, ,dry,; Force Main Inches
# of holes/pipe
Invert Elevation of Laterals- Ft.
-116-
( r,
. PAGE 0 OF I
PUMP CHAMBER CROSS SECTION AND SPECIFICATIOUS '
VENT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
MANHOLE COVER
JUNCTION BOX
25 FROM DOOR, „ t
12"MIU.
WINDOW OR FRESH
AIR INTAKE
GRADE
4" MIN.
Alk
I ,
I 18° M I ~1.
COQDU1T
18"MIN.
PROVIDE I - -
INLET AIRTIGHT SEAL i II
I I I ~ ~4 a.4..
APPROVED JOINT A APPROVED JOINTS
W/
~C.I. PIPE k I III C.I. PIPE
W
EXTENDING 3' ALARM EXTENDING 3
OV.1T0 SOLID SOIL I I I UNTO SOLID SOIL
B I
I ON
C
ELEV.1__ FT. -_J
PU MP OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPEC.IFICATIOUS
DOSE
TANKS MANUFACTURER NUMBER OF DOSES: `3 PER DA-4
TANK SIZE: GALLONS DOSE VOLUME
INCLUDING BACKFLOW: A y~ GALLONS
ALARM MANUFACTURER:
MODEL IJUMBER: CAPACITIES: A= 0 INCHES OR GALLONS
B= !8`r
INCHES OR GALLONS
SWITCH TYPE:
PLIMP MANUFACTURER: =~-INCHES ORS//' :"H GALt_OU5
MODEL NUMBER' D=_l z- IMCHES ORg6 S'"°tALLONS
SWITCH T`JPE: `r DOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM c~ IN15T~ALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 9"l `FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET Z Z . Z ~l aN' /1 r1
+ FEET OF FORCE MAIN Y, J7'' 0 F oFT.FRICTION FACTOR._ 3~ p FEET '7J~x RZx D
13
TOTAL OJNAMIC HEAD FEET I v
Imo"'; i
INTERNAL. DIMENSIONS OF TANK: 6-Efd&+H " ;WIDTH ;LIQUID DEPTH
f
LICEOSE NUMBER: DATE ~ n
S I G N E D Cam...-=~. -
" Gallons Per Minute Model
WP-3881 WP0511S
s
Series No. ' WP0512S
W PO532S
WP0534S Submersible
"p ► Sewage
RPM ► 11 10
Pumps
V j 5 160
{
i
Z d 10 133
E 3 P 15 90
O 20 - 50 41,
H LL 25 20
30
Liquid passages provide true full diameter solids handling capabilities as ,
advertised. Epoxy seal on power cable acts as secondary barrier to liquid
intrusion if cable jacketing is damaged. Rugged cast iron construction. F'
High efficiency full volute casing.
WP3881 y Max.
Series HIP Volts Phase RPM Solids Amps Wt.
WP051 1 S 116 1 1750 1 !!13 60
1
WP0512S 230 1 1750 1'. 6 5 GO ~ a
93M
WP0532S /2 230 3 1750 1112 2.2 60
WP0534S 460 3 1750 1 1 60 '
!
'CSA Listing Pending f
x.
.
e "
PERFORMANCE CURVE
30
,
W I
r
t ~M
U.
A
I I 173/4'
10
r I t i i i .F.T
i ~ 1914 q Discharge
I` t
~ WPH
y
0 20 4d 60 80 100 120 140
Capacity
- Gallons Per Minute "
43/40 ta:
f yt.~'. Y
2
H
w
1 l ^r S
SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE
ell
DEPARTMENT OF REPORT ON SOIL BORINGS AN A BUILDINGS
INDUSTRY, RFf' DIVISION
LABOR AN 7969
HUMAN REDLATIONS PERCOLATION TESTS (115) F(VE~ BOX
APR 30 IDI WI 53707
3707
cs~ ZONI
LOCATION: SECTION: TOWNSHIP/M17MTCTPAt-rrY: LOT NO.:BL . : SUB~I 0N NA i;,
/TJI N/Rix(or) W 10
COUN& OWNER'S BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: CL DESCRIPTION: PROF!LE DESCRIPTIONS: ER OLA ION TESTS:
.Residence 3 i KNew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system - T C7
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
aS Zu XS OU ❑S Zu ❑S kU E1SXj
f Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the
under s.H63.09(5) 1b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS ?l
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, C OR, TEXT E, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
i
B C) IF3 , S'.5 1_ U7t~` n:S, A., 'AA
B- f7
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
6 P_ C_') yp, do
P- Z ft?_ S
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 I:-~-
4
hh
J7m '
Pi PL 13 -1
co L` +
\J~fj y- "
®o het S/015
Inspectort Tc
1, 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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): 60, / /L'~c~~,l C.r ✓ ~L~%~' • VI Vl.l f ~~Ir~'f`Y - Z ~ ' r'/~-.,.~~`f-~1
CST SIGN AT
E:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing„ 3rd page-Property Owner, 4th page-Soil Tester.
1
ST. CROI X COUNTY
WI S C 0 N S I N
ZONING OFFICE
786-2238 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
July 11, 1983
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, Wl 53707
Dear sir:
An on site investigation. for the Douglas Thompson property
located at the SEA of the NW4 of Section 21, T31N-R16W,
Town of Cylon in ST. Croix County, revealed suitable soils
at a depth of 37 inches, below which seasonable high
ground water was noted.
This site should be suitable for a mound system.
Should you have any question, please feel free to contact
this office.
Sincerely,
Thomas C. Nelson
Assistant Zoning Administrator
TCN:mj
r-