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HomeMy WebLinkAbout042-1064-80-050 o y n cn O r~ 0° 3 fu 3 d r1 CD > > yy (D x~ ty O N CD A W Z N W N O p CD z 0 Cn CD 7 1 CD CD w c IV MCI 0 CD z C) 0 m .7 CD (O ° CD v o w 1 .7 N co a co O N 0 CO 7 UI co o- O d C W N fA co O O C° D W a s _o (o ti m o CD o ~A 3 CL I O O CD cW T O w A a I o o m _ i j N m o i, CD CODA Co co o m cD co f7 r !n ~O1 N N COD N 0 0 0- CA O C !V ~u N CD a Cn O O O O O O z o s r s 3 N N y O CD ~ < Z N O fA N (R O O D l,/R m OF w o la O O w o m -0 ? v w :r CD (D CD d W ~1 Co C0 =3 3 m 0 m =r 00 3 (3D N a ~ N Z z O D D Q O D D a O 5 S' CD (a • Q m CD 7 c ~c- c 3m CD CD 3 (n ~ -i N U) A _Z m A z o N D A CD 1 a 3 a 3 z 3 3 ° ZZ 0000 t/1 CD N z C C O A p '"M w n N CD d_aN C a CD M. CD I O D CD 2~ O O p O T N O O O _G CD X N C .a) C CD m O X, 0 CD o j ° OZ d in ~ cc) _ a aw N ov m t_ V O O JO N O S p O p`~l C 7 O CO (~JD N fi CL s CAD Q 0 5 a . 0) 0 ;R 2 < CD > 0 O N O a CD O * p _ CD b CD-0 co 1 V ~ n0 0- N O p O a oCL (C) 0 I CD o Na z 0 (n II c n N Lll CD CD V 0 3a 'a CD O p O _ H C CD : N f f3 Q o CD o o a O° b Parcel 042-1064-80-000 12/27/2005 02:06 PM Att. Parcel 23.29.18.356B PAGE 1 OF 1 Current X 042 -TOWN OF WARREN ST. C Creation Date Historical Date Map # Sates Area Application # Permit # Permit Type COUNTY, WISCONSIN 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner RICHARD M BRAUN O -BRAUN, RICHARD M PO BOX 352 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): " =Primary Type Dist # Description 893 130TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.670 Plat: N/A-NOT AVAILABLE SEC 23 T29N R18W PT NW NW LOT 1 CSM 3/892 EZ-HWY-1185/338 EZ-U-1419/138 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: 79438 Assessed with: 171,900 Valuations: Last Changed: 10/22/2001 Description Class Acres RESIDENTIAL Land Improve Total State Reason G1 10.670 65,500 73,400 138,900 NO Totals for 2005: General Property 10.670 65,500 73,400 138,900 Woodland 0.000 0 0 Totals for 2004: General Property 10.670 65,500 73,400 138,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: Certification Date: Batch 507 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I X 60 ee .I I( ~I I f f i 1 C..V`A1'Yh y 9 w - - o? ' 1~ - v C ~ ~ i%G J ~ L• ._.:-ice..-, rf c . G ~.a ,-('i ' } 1I I 4 I I I j< Ll i i I f} i ~ i , i i _ SK SOP <ed #orm J cs 03 O ~ mZ v 0 CD D ZOD n cn Q 177 z .o o;6 OZ 0 i mm v O tri Q n v V 4 ~O v C 1 CA 4 State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: r- SAFETY & BUILDINGS DIVISION -l Bureau of Plumbing P.O. Box 7969 IECV~~~.~ Madison, WI 53707 ~ Plan Identification Number ERA_ 7S y(~O J Re:~C~r~2 PRIVATE SEWAGE SYSTEM ONLY 4 _Clcn'~X C, The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by and received for anproval on f'~~~V,_r l 1 The soil and site evaluation was conducted by _ 1 l ,t yam,, The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a `CJ V~ Wastes from the building will discharge to a~ gallon capacity septic tank which will dischar a to a 9 Yex"-~ gallon capacity pump chamber from which a pump having a capacity of_ 7 '-5 gallons per minute against a total dynamic head of1_feet will discharge through a-_ 3 inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance 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 one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, 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 oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should condition, arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS County By: Other Enclosures DILHR-SBD-6159 (R. 7/81) mes Sargent, erector L --BR INDUSTRY, LABOR & & HUMAN RELATIONS INSPECTION REPORT FOR SAFETY & BUILDINGS P.O. BOX 7969 41 PRIVATE SEWAGE SYSTEMS ~a- MADISONaWI 53707 DIVISION BUREAU OF PLUMBING CONVENTIONAL NALTERNATIVE stee Plan L D. Numbe,. ❑ Holding Tank O In-Ground Pressure _'gned Mound /U D NA PEgM1T HOLDE ADDRE OF PERMIT HO DER: INSPEC I N DATE. B NCH A (Permanent reference Pmm) DESCRIBE IF DIFFERENT FROM P AN. ~3 REF. PT. ELEV.: CST REF. PT. ELEV. Nm. of P tuber ' MP/MPRSW No.. counry Sanitary Permit.Number: 17 $,;Ti SEPTIC TAN OLDING TANK: D~D MANUFACTUR LIQUID CAPAC T TANK INLET ELE V.. T UTLET E E WARNING LABEL LOCKING COVER . PROVIDED: PROVIDED BEDDING : VENT DIA. VENT MATE OYES ONO lvH p! TER UMBER OF aOA OYES ONO O YES / IIaRIFn + PROPERTY WELL BUILDING ONO FEET FRO LINE : VENT TO FRESH ES ON NEAREST°____ AIR INLET DOSING CHAMBER: MANUFACTURED BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER d WARNING LABEL LOCKING COVER YES ❑Np l7`-J{.✓% ~ PROVIDED PROVIDED GALLONS PER CYCL : I 0., PUMP AND CONrgoLSOPERATIONAL YES ON YES O NO (DIFFERENCE BETWEEN NUMBER OF PHOPEHTY BUILDING vENrroF PUMP ON AND OFF) FEET FROM v~pp AIR INLETT NO _ NEAREST-~ / ~ „~00 SOIL ABSORPTION SYSTEM. Check the soil moisture at t hIVYES e depth of plowing FORCE or ' excavation. (If soil can be rolled into a wire, construction shall cease until )IAr: rr TER MATEHII AND MARKING the soil is dry enough to continue.) LENGTH NO OF CONVENTIONAL SYSTEM: MAIN i BED/TRENCH WIDTH DISTR PIPE P CIN COVE I- DIMENSIONS TRENCHES -Y , MAT iAl_ DE -PITS TN IT I LIQUID DEPTH. VE I.I. E)E II"!I E ILL DEPTH UISTH. PIPF DISTR. PIPE DISTR. PIP AT IAL. nvPIPFS ABOVE COVER ELEV INLET ELEI/ END DI IT NUMBER OF I IPES. PROP L. BUILDING. VENTTOFRESH FEET FROM E' LET, NEAREST-----,, MOUND SYSTEM: Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YES NO meets the criteria for medium sand. TIONS MEASURED. O SOIL COVER TEXTU E / PERMAN ENT MARKERS. OBSERVATION WELLS DFPTH OVER THE CH BED DEPTH OVER THENCH BEO JELI YESNO YES ❑Np CFNTER H OF TOPSOIL. 1 /r EDC;ES. I SODDED SEEDED ~ I MULCHED PRESSURIZED DISTRIBUTION SYSTEM: OYES NO YES ONO YES ONO i BED/TRENCH v IDTH LENGT" NOOF TRENCHES LATERAL SPACING. GRAVEL DEPTH BELOW PIPF DIMENSfpNS y 4 FILL DEPTH ABOVE COVER MANIC LD PUMP MANIFOLD DISTR PIPE MANIFO~,MATERJAL NO. DISTR DISTRIPE ELEVATN AND ELEV. ELEVDIA ISTRIBU 710N PIPE MATERIAL & MAh7KINCj1 ELEPIPES DISTRIBTION f ','i INFORMATION HOI E I$ / I?E HoLE sPAC ING DRILLED COHRECTLY I , / COVER MATERIAL VERTICAL LIF CO SPONDS TO PPROVED PLANS COMMENTS: PERMANENT MARKER YES ONO 1 E . o : YES NO PROEP RTY, WELL. ' NUMBER OF LIN + BuILOINC FEET : t~l K YES ONO AYES ONO NEARESTOM n 77. oj) O i 2 . Sketch System on a t ~ '2_ r ~ Reverse Side. Retain in county file for audit. .,.~I@I.LLBEe.,.+ TITLE. a . . R SBD 6710 (R. 01/82) State Permit # ~D` B .67 State and County j w Permit Application County Permit ~ # j County for Private Domestic Sewage Systems ` / o -DENOTES STATE APPROVAL REQUIRED _ t 1f - State Plan I.D. # Date Approval Received from State if Required Mailing Address: A. OWNER OF PROPERTY i' cr, u ' g. LOCATION: /a /4, -23, T N, R_1Y E (or) W Lot# City nearest road, lake or landmark Blk# Village _ Subdivision Name, Township i L r h 7= l~ 'Other (specify) -Variance C. /TYPE OF OCCUPANCY: -Commercial *Industrial No. of Persons Single family Duplex No. of Bedrooms D. SEPTIC TANK CAPACITY ~At1in Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Poured-in-Place St el Fiberglass Other (specify) Prefab concrete New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete v Poured-in-Place Other (Specify) - - - E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate.f5~--=e-11-&d.-w-Total Absorb Area sq. ft. New Replacement Alternate (Specify) No. of Trenches Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Lines Seepage Bed: Length Width Depth Tile depth (top) Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land y.- S7;7, Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME 1,6 C.S.T. # and other information obtained from wne builder). ~33~Z MP/MPRSW 3 ~ > ~ Phone # Plumber's Signature Plumber's F.ddress S`o 3 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. I . . E E , e e g n Space Below FOR COUNTY AND STAT DEPARTMENT USE ONLY 1 .n .y Fees Paid: State A Tr Date - (date) , - Issuing Agent Name State Valid# Date Recd ay) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 4. plumber (canary copy) Revised Date 7/1/78 ' E a, Tn~7it`!JT OF REPORT ON SOIL BORINGS AN ~k ~NDU~T,RY, D BUILDINGS LABOR AND P C4' ~ DIVISION HUMAN RELATIONS 3707 7969 PERCOLATION TESTS (115) e- *ISON, /I X 53707 II~f p p sO LOCA7T~Y:- Gy SECTION: TOWNSHI /MUNICIPALITY: LOT NO.: NGtI ~ 23 /T N/11~d E (or) W BLK. Ug I -f COUNOWL NERS BUYER'S MENG ADDRESS: /rr'MAILI USE "{:•j~<:• NO. BEDRMS.: ILulvll\nER IAL DESCRIPTION: DATES OBSERVATI M 1n't` ;lx Residence y R F D T ONS: LA ION TESTS: ❑New Replace If S11 ZQ lfPj RATING: S= Site suitable for system U= Site unsuitable for system W/O 7 ~ U~?JJ41r/ CLAY 40-4,'l CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: S OLDING TANK: RECOMMEND D SYSTEM: (optional) sub STiP.llrt- ❑ S ©U 0 S ❑ U ❑ S ©U ❑ S U ❑ S ❑ U /41#( ~V/' TO A)01,4« ETi.vf fifo~0i If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. under s.H63.09(5)(b), indicate: [Floodplain, f any portion of the lot is in the indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, NUMBER DEPTH IN COLOR, TEXTURE, AND DEPTH IN, ELEVATION OBSERVED EST. f GI_ EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) rr B- 60 y® 32 Z y 7'WN. s/Lr u,/,oo~ .[rro ft h,G B 6La w e "CA(,* r 31 „ 9t' 4r J"? - 7Z& 60 B U ,I D" 3o p r' iV.s/`Lr y"t/'11V.siLo ~7"Bu-ar-54, 6~•L~,B 67tL OO av, . d~Q-Gy. Aro7-S~ A4 -6y. H.07: B- .3 60 y"/3u-6y. S,tr Zo c~ o o,- SL Z " /3Lvr - CL . Dace, cy~o..ti.4 B z~ ti 2 y y. Q tl Tf ~UERy ay~.u~,t~rr) EA/ST PaC bles 5 vE//e-D 2_11 mil PERCOLATION TESTS , TEST DEPTH WATER IN HOLE TEST TIME !NUMBER INCHES AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES PERIOD 1 PERIOD 2 RATE MI N /Q Z ,l I PERIOD 3 PER Iw o i P 2 Z 3ep Z' P- ~ P Z 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. Me ov o S j~S fE.~'! - pPESS~i~ i' ZEU xy5,x ~ n `iE A/3oUc SYSTEM ELEVATION tii~rurrw- _ /,~wy r z- TrffB FE.l1CE /SOS j ~ 5111 1( ' /~EiPc 5'/IEf ~ ol IJA_ ~rsr/Ny /3M ~osj xP - - , B~Au u m4,l 04 d _ • j✓E7PT ~E~ f'T. yiu V k ysrFM 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): oluaor 4G/4el'Ch7' TES S WERE COMPLETED ON : : ADDRESS: f ~ L 0 1 Y?/ y(JD~~,(f CERTIFICATION NUMBER: JPHONE NUMBER optional): CST SIGNAT RE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 41h page-Soil Tester. DILHR-SBD-6395 (N. 03/81) T LABOR F~ HUMAN RELATIONS WISCONSIN DEPARTMENT OF INDUSTRY, Y & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION U(Vl`AON OF SAFET POST OFFICE BOX 7969, MADISON, WISCONSIN Verification of Exception Status for an Aj te`rnative Private Sewage System In the County of L 0cati0n NW 1/4 __Iqk 1/4 S - town or Municipality Street Address fit, Subdivision lot No. Block i-andown er's Name: Ric_hard__Braun the application for this site is to serve a: new construction use. replacement system use. be t y~is is a NEW CONSTRUCTION USE, the alternative private sewage <System i- to included as: applications part of the 3%/5% limitation. This is number of the app D made through this office. one additional homesite on a farm to be occupied by a parent, child, D grandchild, sibling, niece, nephew, or first cousin. 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. lot that meets the site criteria for a conventional private sewage system. a it this a REPLACEMENT SYSTEM USE, the mound is replacing: ❑ a failing conventional soil absorption system. 1; 1980. a holding tank that was installed and in use prior to February ❑ a privy that was installed and in use prior to February 1, 1980. ~ know edge. . I certify that the above information is true and accurate to the best ` - - - - - -i o S i gnAt~r . --1-,_ - - Name e Date August 1981 litl DILHR-sBD-- 6156 (M.7/80) i ST_ CR0I X COUNTY W I S C O N S I N ! ~ dl y4i ~~~~1 ~rVl c ~4,to,,. a IC)NING OFFICE 796 2?3) tt1 HAMMOND, WI 54015 August 11, 1981 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, Wl 53707 Dear Sir: An on atte investiKat l"n for the Richard Braun property located at the NW`4 oI the NW's: Section 23, 'l'29N-R18W Warren township in tit. Croix Co"nty, ievealed suitable molls at a depth "1 27 inches, helow which seasonable high ground water was noted. This site should he sultahle for a mound mvntcm. Should you have any Bluest Ions, pl cone I ee I I i vv t contact this office. Yours truly, 'T'homas C. Nelson Assistant Zoning Administrator TCN:aI Pk-100a 12/78 ' '6e-ta-*-h And Return Upper State of Wisconsin DIVISON OF HEALTH Portion Of This Form With SECTION OF PLUMBING / AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: c~ 1~... ternative Syst ;4wi, Sec. PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. ll. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I11. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certified soil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Total area filled (fill to extend 20' beyond edge of trench before side slope begin). ❑ Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. PI.b 100. 12/78 , Detach' And Return Upper State of Wiseonsin O N OF HE=ACTH DIV SECT: ON OF PLUMBING Portion Of This Form With - AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: ~rnar zve Sy 6 F PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. II. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I11. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. FA 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flew rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Total area filled (fill to extend 20' beyond edge of trench before side dope begin'. ❑ Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. Depart >arft of r'y abor and Human Relations State of Wisconsin O Please Reply to: r FETY & BUILDINGS DIVISION ureau of Plumbing .0. Box 7969 Madison, WI 53707 Plan Identification Number L_ Re: PRIVATE SEWAGE SYSTEM ONLY- for the eau of Plumbing has reviewed plans, site survey information an i s allaf adonis Iwere prepared construction of an alternative private and speci by The Bur sewage system to be installed at the above mentioned location. The plans and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is fora gallon capacity Wastes from the building will discharge to a-gallon capacity septic tank which will discharge to a_~ feet will allons per minute against a total dynamic head of_~- pump chamber from which a pump having a capacity of_-erg discharge through a -inch diameter pipe to the soil absorption system. of shalplans and installation details and the conditiions hs on the l notify the county inspector when the installation allwith of utmost importance that the system be installed in complete accord It is approval contained in this letter. The licensed plumber responsible for the of the system will commence so that the county inspector shall be able t loc spe sthis autholation The installer shall not deviate approval and shall follow the directions or orders issued by t appropriate with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with eac professional In accord department at section he sti ulations indicated on the plans. Please review your code fork keep rogelse of plans beahingahe stamp of tappTheroyal a of this architect, ed. t p royal shall engineer, registered designer, owner or plumbing contractor shall P royal, the the construction site. If the installation of this system has not t commenced within two years from the date of this letter, this app become void and new application shall made for approval of these plans before may commence. I ons, additions examination oversight, the or right work specifications, chplaannges omissi conditions Division of Safety and Buildings does not t hold itself liable for any defects in n plans the construction or any damage that may result in or after installation perary to olbtain and ful y void arise making this necessary. This approval is based on ch. H 63, Wis. A dm. Cod edeFuire ments. Ita nail b necess permit requirements of the county in which this installation is to be this acceptance. By: cc: OWS T County / Other Enclosures mes Sargent, B rector DI LHR-SBD-6159 (R. 7/81) DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION P.O. BOX 7969 SEWAGE SYSTEMS BUREAU OF PLUMBING MADIS( v, Wl 53707 ❑ Mound ❑ Pressure Distribution NAME OF PERMIT HOLDER: AUDHESS OF Pk'RMIT HOLDER: INSPECTION DATE Pt ID 6'j110 BENCH MARK IPxrrnnnnnt rot-,,- point) UESCHIHt IF DIr II RENT FROM PLAN HLI P1. LI.ty CSI lil I . PI. LI EV SEPTIC TANK: PHUPtH rV L.INI: WF LL. Rl11LOIN, MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLEI ELEV NUMBER OF FEETFRO NEAT EST » DOSING CHAMBER: MANUFACTURER: LIQUID CAPACITY: PUMP MODEL: PUMP MANUFACTURER: PRWARNING OVID DLABEL LOCKING COVER PROVIDED ❑YES ❑ NO ❑ YES ❑ NO GALLON PER CYCLE UMP AND CONTROLS OPERATIONAL PROPERTY WELL BUILDING VENT TOPRESH AIR INLET. NUM E R M - LINE: DIFFERENCE BETWEEN YES ❑NO NEAREST---,--P PUMP ON AND OFF P ❑ SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW El YES El NO meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF SPACING CENTER LENGTH. OIAMETEH. MATFHIAI_ AND MAH KI N(3. Qi TRENCHES: TO CENTER. FtIC~;: DIMENSIONS 1~1A1N `.MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL&MARKING. DIA.: PIPES. DIA.: ELEVA'rtQtSE' HOLE SIZE: HOLE SPACING: 1DRILLED CORRECTLY DEPTH OF GRAVEL OVER PIPES: VERTICAL SIFT CORRESPONDS TO APPROVED PLANS El YES ❑ NO El YES El NO SOIL COVER: TEXTURE. DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED JDEPTH OF TOPSOIL: SODDED. FS EDED. MULCHED. CENTER: EDGES'. ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES NO COMMENTS: - - . . TIME NATURE SIG DI LHR-SBD-6227 (R. 05181) BOB ULBRICHT HOMESITE SEWER AND SEPTIC CLEANING 715-386-8185 R.t. 3 O'Neil Rd., Hudson, Wisc. 54016 CERTIFIED SOIL BORINGS ELECTRIC ROOTER & PERCOLATION TESTING SEWER UNCLOGGING SEPTIC TANK PUMPING STEAM THAWING FROZEN SEWER LINES STEAM CLEANING Client ~7 ~.4 Address Date Charges/Cr via4lts jtlaqn, ue J/ % 1At. -k) r Unless otherwise arranged, payments are due in full within 30 days. A $1.00 billing fee or 1.5% interest on unpaid balance applied monthly. NDUSTRY, RMY, OF NDUS SAFETY & BUILDING=!~ I REPORT ON SOIL BORINGS AND / , 3 LABOR AND PERCOLATION TESTS (115) P.O. BOX OX 7 79 HUMAN- RELATIONS MADISON, WI 537. LOCATION: SECTION: ~X^/T 1'I SI//tr~ /~,N - CSE1~ TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 1f?Grl.'it N/Rd'E (or) W COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:4 USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE Residence Z ❑New Replace 15 R TONS: ER OLA ION TESTS: X [A ~Jp/ RATING: S= Site suitable for system U= Site unsuitable for system CONVEcNTIONAL: MOnUND: IN-GROUNcDPRESSURE:SYSTEM-IN-FILLHOLDINGTANK:R jCOMMENDEDSYSTEM:(optional) D~7 I `'S EIS MU EIS c 11U EIS cJ ~U If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL under s.H63.09(5)(b), indicate: [Floodplain, f any portion of the lot is in the indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) o - eve; ~ Al -7e B- 4 r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME NUMBER INCHES AFTERSWELLING INTERVAL-MIN. DROP IN WAT LEVEL-INCHES RATE MINUTES PERIOD 1 P RIOD 2 PERIOD 3 PER INCH P- P P- P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. • rf, ~ ~ , C C4 Tf7~~$~~ ~ f 2 f7 rye ~'~q ~?L ~~E1~ SYSTEM ELEVATION - ~~r . y~ Fr• s.~.~n-,~~~K ~~a<<,e~.~C~ / ~rs=~~l> ~rs~r,. iPb g 3 L3 . ~~p3 f TN i n SG r;` Q CI'S G~~I y~l7jl' l - 81 IS Y i V= r~ co, AJAR I' f/2ert fti'r! I, the undersigned, hereby certify that the soil tests reported on this for re by n accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the locatio the test ~'rect to th ~ t of my knowledge and belief, ®ffICE NAME (print): 1 Gd >~~IPI ~~'C6✓~~ j' ~ TESTS WERE G9{b4P1 £T'Ep ADDRESS: ~ ~ ~ I ( ~ CERT_IFICATION 3: PHONE NUpMBER optionall: CST SIGNATURE.-~f DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) F{ OV n op 00 rD C ' ~ E ® L ~ III I I' ~ IhI , I~ ~ i 0 0 1 n 0 0 II Ij r I ~ I ~ A. i a I 1 I u I I! ° ri M O ►y I H i~ jrl! I ~ ~ 1'~ r'► ~ I 1 1 I b ,i ! I G rD i III ° I m w III III Ij l I I Li l y ~-r cr (D (h o Ii ,ti 1; I ry I, i I i n ~I II ~1I J I i n w O ~ ~ I I,ii II I ° ! n W A- VJ O III '•f' I r 1 II Ii II~j ~ m I;~ III , , I I 7~ J~ ~ ,y t! 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