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HomeMy WebLinkAbout042-1105-30-000 y 0 cn p n cn p n 1 p 9 m n ~ O Gt f O d O m F C" O (D Lo~ 7 CAD CAD = CD A n A D A7 H. 'fl 0 CD A A 3 3 , 3 - ~ I 3 3 3 ~i z z n z Z Z n z N A c (n -I 2 Z O W r < O A • O O rn O A O O O w O N O O n y O N O O OD CD p~ 7 c m (b 7 N O S = 3 c i 7 N N F.y (D ro N - N N CD @ N co N Cb Q. - z Q@ N W (D 7 M oo O CD (D N 3 CD oo ° (n n Cn Q N n p7 (n G7 3 CD S ON n j Q (D O (b O O O N O N O O O ? 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CO ~ z 0 3 0 3 '0 3 A rn ° ° ° z m 3 3 3 to CCD f/1 f/1 D CD CD A :3 -a w m W w CD (D D 3 o D D m x S1 C N O 0- N o co SZ (D C'n 7 Q G N CD d CD CD N(n N O - (D 7L O - fn N CD O' N -n d ~7 CD C L T C N c N j -CDp Cn CD N C CL Z a Z CD o (n O N' Z O a a 3 m 7v o n In NFJ' " m s D --0 = CD CC m cn En C (D Q N cn QdQO N (D G CD 0- CL C:) C~ C: a moco> W CD a CL G d ° m o v w 33'CD c CD Cn F)'nN v v O o a W < c3 co Cno O CD N O lv 3 Sv N (D CD O (1 CD - : O j' C1 CD _ CD O p p ~ b W D CD CD f a 69 Q !A Q Efl 0 ti a O CD O CD O CD O O 0 S. N I Wisconsin Department of Industry, `PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection Name o remises Date an No. Street City County Sanitary Permit 77- Master Plumber Firm Name dress Journeyman umber Address Owner Address , ,scusse with Signature ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Si e Waste pec,a ,s _ _ White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner 0 to O F. -0 o 0 C7 r~ 0 m ~ c ° `r1 3 n ( w ; 3 - (D 3 C 00 O N N N~ N W N 7 PO O 1 Cil 7 Q CD S O N W a O (CD O (D 7 W o O O ~~„~1 ~ C (D O N a O ~ N 7 O W S a 0 Z, Z, o o < CD N Co 0~ CD cn N 3 a v v v ~ o; h O O O > a- C) 3 y N y 0 0- v v o w m N (n N (D N r 0 (D B -0 (D = (D (0D (D _ y 7 3 N D co 0 O CL 7 O 0 N . (D CD N l►1 C D N O 0 CL 7 7 ' Z Z n co p A 7 o_ A Gz,~ O 7 z --i N W M N o CD M O 3 A O z (D A 7 co C N N 0 7 00 D (D (D (D N (D O' 7 N N (n (D v .(D v p~ O7 G 0 0 j (O L T (D N N Z 3 Q 5"o D0-N O I 0 N N Ov O_O C' i C 3 L D: 0 N d O O N } T o C i oc Oa - ~ O (D C0i 0 7 C/) -0 O_ - N 0- 7 7' C ~ Vti T (D l+.i S 0, O ti d a N 7 O O N = a O ti O (D DQ a A O * N a O L N n N O 3 'U n d m f r m o co 3 C- N O N O W N O • 00 CD (D Z Ch o n Cp m O O O O p Cn U) Cn 0 O ~ ~ l 1l n CO 7 p O CD O O O U) c CD C M fl O cn D N W a s CL C p O D O 5D m cn co ~ CD m-4 Q n o c OJD CA CD N Q m O O O 3 cn cn cn W CD 3 vvv N cQ C^D CD 3 N m m m CD U) a Cn CD CU C C CD C 3 7 CD s O O ,A Z CD n c A Z O n a Z N O oov mCD CD m 1 ' Z p 3 ? O r: Z ao 3 m I~ :3 i w CD v (D 1 a CD ID CD CD N ' 0 0 t~ N ~ T O Sv 0=3 (a N C D a m ° 3 a 71 CD m ?C1O - CF) 0) 0 3 `D N a E; 1-:03 CID D 7 O a 7 b O O S 0 n o~m0 m c co-o_ ° $ CL Q I a m C, t ~c w v m 00 oSi5Cp0 CL N a~ N S A CD DQ N O ~ N O ays C) (D 0 L N y T . C ~f r AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC , T .~'1 i N, R` ~W P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM 0 i I I e . 5 ~ r. G s SEPTIC- TANK (S) MFGR. CONCRETE STEEL NO T. rings on cover_ Depth DRY WELL TRENCHES No. of width length area _ BED no, oT lines widt -7 length area ,depth to top of pipe AGGREGATE . PERK RATE AREA REQUIRED AREA AS BUILT DISCLAIMER: The inspection of this system by St, Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. Hcwever, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTE. INSPECTO DATED PLUMBER ON JOB ,y LICENSEr State and County State Permit # PL56T Permit Application County Per # for Private Domestic Sewage Systems County_ , *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Michael Jones Mailing Address: By Horme & Domes Inc Hammond, Wisconsin 54015 B. LOCATION: 1Z 1/4 NZ Section 20, T29, _ N, R 18 E (or) W Lot# _-City Subdivision Name, nearest road, lake or landmark Blk# Village Township Warren C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms 3 No. of Persons 4 D. TYPE OF APPLIANCES: Dishwasher YES X NO Food Waste GrinderYES X NO # of Bathrooms3 Automatic Washer X YES NO Other (specify) F SEPTIC TANK CAPACITY 1.000 Total gallons No. of tanks 1 'Holding tank capacity Total gallons No. of tanks New Installation X Addition Replacement Prefab Concrete X "Poured in Place Steel Other (specify) f EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 3 2)-3 3) 3 Total Absorb Area 60 sq. ft. New Z Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 3b1 Width 1~ Depth 424 Tile Depth 30» No. of Lines -3 Seepage Pit: Inside diam ter Liquid Depth Tile Size 4" Percent slope of land b%g to Distance from critical slope 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 Robert Dietrich C.S.T. # 505 and other information obtained from _ (owner/builder). Plumber's Signature MP/MPRSW# 5184 Phone # 698 -2407 Plumber's Address Oodyi e. Wisconsin PLAN VIEW: Provid- sketch below of system (include direction of slope and all distances in accord with H62.20, including well). ®A /go/ !3 _ gods ~ o j /000 GA4 S,57,0 rye- rA At K t 01 5 e _ I i Do Not Write in Space a fJR DEPARTMENT USE ONLY Date of Application Fees Paid: State cc- C unt Date Permit Issued/BzjE1MKL (date) Y 'f -Issuing Agent Name, Inspection Yes No Valid# Date Recd 1. county ( ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) t, Revised Date 6/1 /76 I. State and County State Permit # PL1367, Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY -0 n-eS Mailing Address: A4 o. )J DO AFT TAf C 146TAZI A" 0 44 C, B. LOCATION: Section , T` j?Zj N, R [k E (or) W Lot# City Subdivision Name, nearest road, la~keq or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family- Duplex No. of Bedrooms ✓T No. of Persons. D. TYPE OF APPLIANCES: Dishwasher YES - NO Food Waste Grinder-YES_X-NO # of Bathrooms Automatic Washer )<_YES NO Other (specify) E. SEPTIC TANK CAPACITY 1aC7,0 Total gallons No. of tanks _ *Holding tank capacity Total gallons No. of tanks New Installation Addition _ Replacement Prefab Concrete X 'Poured in Place Steel Other (specify) F, EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 'T 2) -9 3) Total Absorb Area l sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Li Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length Width Depth ? D Tile Depth 'Q No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size y Percent slope of land c< z T ° Distance from critical slope 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 9 d /Ip T,t't C.S.T. # and other information obtained from (owner/builder). Plumber's Signature f~df ~1 MP/l%R4 &W# ' 57' Phone #~/~_6~1~-„Z~d? Plumber's Address eql, -JVrY L . ,'r-S'~K 01 e PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). vias c X30 /OOa aAC> ;Ls SE j i c TaN K r6,or 36 Do Not Write in Space Below FOR DEPARTMENT USE ONLY D Date of Application Fees Paid: State?/_ Count Date S Permit Issued/,6 (date) -s ssuing Agent Name cJ Inspection Yes Valid# - Date Recd 67 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 I Plb '$7 State and County State Permit # Permit Application County Permit ' for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: AO& Section T~ N, R / Q (or) W Lot# -AC-5-City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~/f,✓j~r~,D C. TYPE OF OCCUPANC,-Commercial Industrial *Other (specify) *Variance Single family ~ Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES I/ NO Food Waste Grinder YES NO # of Bathroom Automatic Washer &'YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks v , c- *Holding tank capacity Total gallons No. of tanks r New Installation l- Addition Replacement Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ~ 2) 3) Total Absorb Area _ sq. ft New L--- Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. o Trenches Seepage Bed: Length `f Width Depth 0 Tile Depth No. of Lines Seepage Pit: Inside diameter ~r- Liquid Depth Tile Size << Percent slope of land T+ Distance from critical slope 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 Certi ied Soil Tester, t~ NAME C.S.T. and other information obtained from , (owner/builder). _ Plumber's Signature MP/MPRSW# Phone #A(+S'-~~'~, PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 1 r C E r 3 a '11) 50, i /Wit r c; F P s f~ r« P I E , i - Do N Write 'in Space rate) w - FOR DEPARTMENT USE ONLY ~r Date of Application Fees Paid: State County 0 bate Permit Issued/~ ? " ( _Issuing Agent Name c~-~ - Inspection Yes No Valid# Date Recd 1. county (w ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 3/1/75 o to O 0 to O' 0 Cl) 0 ~ T n d `i1 m f o m o 0 C = _ O n Q A 10 (D CD m 3 (D 'o I i 3 - 3 3 9 C- Z ~ f(D 0 W W 7 j O N 0 7 n 0 Owo N • C', CD (D m 81 oo CD O N (D O N w a Z ? j M N O D] N CD 0, C) O N a 0 0 C-n `t 1 =r 0 11 N O M (O W O O (D (D W 3 O fy N N O 3 N 7 A p p ~~1 ,Y C O N N O N N w !V d A W Df Q ° ` a a C (0 o N a fl (D W CD 00 m CD cQ CCDD ~ a s CD c W s l v ~ N W D (D IW s C) CD < cD ¢ 3 oo m O m m 0 CD _ cn (D CL N o z O o '4 OZ co 0 47 CD -i CD CD CD (n co co N O C til N O N N W W N 3 C (VV M _0 -0 O O O M O O v v'• z O O O ty Q 3 3 N lJ N m rE --1 N E y y y w O w N) CD v o Q O O N 0 CD CD CD (1) .D ' CD A Z1 i N .Z) v 13 ? lV ~D - CD 0 - (D D (D j d H O M.. d N 3 N N n (D CL N CD CD 0- 3 N z m z z co z ° z co -0 Q O D CL CD 0 Z D n~ o, D a m s v 0 m c o CD m o m m :3. m -0 CD CD m m m a tV v7 CD v 0 .0 N' c m (D C: CD m a a cn 3 3 g n o m CD ca Z D -A N N ~O co l0 O N CL A zZ_ m C N 0 a d N A 7 O 7 cn CD `(DD W 'M W (D m ° CL c z 0 _ o i3 0 3 -P, o Z O Cw 3 3 y TI N ;z N < CD F D a L,) CD w w 0 v (D 0 Q 0 D x D 3 0 ° a m 7. 07 CD d CD N (n Q C ;a CD c I CD -n CD Z 3 O. E 3 Q N X j O d o CL 7 N. Z Q N =r (D N 3 ~D Xk N N 0.O N i N _d Q O C C? 3 d 00 ,I ryO co a "d W o (D' D1 N a o s 3 N a m S I D_ X- 3 a N O 3 (D N O 30 OD N N ~ A N cv DQ O 60 Q o O S9 O CD (D O L O i O 6 (D a. ~ y N ►1 n Cn O 3 v n d _1 0 E; :E _ 3 fD cy, 4t - M) (D 3 n rr O z C- 03 W 7 d N• CD N) m ~~C111 z C) N O N O o n N W 7 ' O~ D = ? W O O CD 6 ) C) (n c co CD W n a w CD W S CL = O o D O < lot m l~ co (a ~ Co C() CD cn n o c iv p 9~, O O O - tT z D o C:) ccn N N N CD n r~ m vvgW (n N H ~ rt ~ ~ (D A N ~ CO A CD C y H n D 7 d r- N r- CD w H N r-- 00 d zco z w O D a CD 0 l 00 m CD co • CD uNi t~l N (D~ ~p7 0 (0 M. c CD N W~ a 7 m -i fn A Z CD I~ y C~ y rn ~ ~ ~ 00 O O N p A z O w E rt ~ ~ Z co (D M N CD o n z o z 00 b t~ o z m 03 rZ CD A CA C, w ~ n I C o Q D m O rt CD CD N .N-. CD Q Y N m m CD O O o CD m ~(a v c ~~CDcr z CL ~o ;L CCDD m m rnD~i a° 3 o3cDT.o S =o $(0 m to O 7 0 CL 7 A 0 0(c (D O 7 Cl) -0 O C m o C T CD CD - O N 7 0- (1 ~ N 00 . N S a CD DQ O o O N 00 O y O 2 N o o y O n y O $ v n d r~ ,2 ' 3 CD CD fD n 3 (D M CD (D 3 y M v 3 m 3 - ~ Z Z Z Z N a 0 N o rn w o m o N o o o Z o w r N o ^s CD (D O CT CD O N O 7 ? ill N O 7 O A ~C • 0 N N CD C 00 N (D 7 3 O tD (D N N FBI O OD C- W Z n N W CD CD N 7 N 0 j (b =r O N 7 O (D to r.C 1 CD N p CD D N O W W O CD O C CD (D W O C CD N N O N N CO O C N O W W O W 00 O ° oo G G cSD (f's ° W O G O I CD N CD CL ID CD c a a c CD 5 :3 rn D < CD a C -v D a IW 0 ° D O m O < 3 m _ w \ Z p w ;a 1 a O N CD o ° o o CD m 00 w 0 o r c N O N N W W Cn : ~ CS cn O O O "It z O O O D • o -1, Q N y N oN Ic N N E m D Ca N N N N RD =r CD -0 0 0 U) CD a 01 'Q N Cn O O CD N N -7 CD Er CD N O R 0 CD (D CD U) 3 v v CD N 3 CD CL _ :3 CD n. N Z W Z CD 0 Z Co Z Z co -0 li D O CL a O D a D a I O m c 5 N ct) 'O (S COD N O= CD N• ~~V • CD 0 (D -0 (n O !V CD Q O U) C CD N C 7 3 D O a w N CD ~3 7 a l0 co Q' 1 D O Z 7 Cl) jco O I O A Z m D a a Z O v 3 o O ' co w M CD (D oo m N) o 0 3 CL 3 CL CD Z 3 °o " o 3 Z - 3 3 m 00 CD y, ~ N W CD W g W ~ ? ET D O 0 a - (p n Nc a CD C a Q. T d o. CD - N C CD 3 T aZ a m Nx c 0 C: ? s N # N a (a I-F C N Q O ! 3S, CD CD n to A N n O ! O ~ N (U Q, 7 ~ 7C• t O O CIO N O O qtl O ~ 0 00 O N M O O (D A da O O 69 O caoc cv Efl O O O Q O N O :E ~ N O a O° a ~ as I N Parcel 042-1105-30-000 12/28/2005 10:29 AM PAGE 1 OF 1 Alt. Parcel 20.29.18.583 042 - TOWN OF WARREN 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 - WILSON, DONALD A & DELORES A DONALD A & DELORES A WILSON 1093 89TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1093 89TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.560 Plat: 2334-PLEASANT ACRES SEC 20 T29N R18W 1.56A PLAT OF PLEASANT Block/Condo Bldg: LOT 11 ACRES LOT 11 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 20-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1071/534 WD 07/23/1997 826/375 07/23/1997 705/202 2005 SUMMARY Bill M Fair Market Value: Assessed with: 79866 174,800 Valuations: Last Changed: 10/23/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.560 32,200 109,000 141,200 NO Totals for 2005: General Property 1.560 32,200 109,000 141,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.560 32,200 109,000 141,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 125 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER 4#Aj&5_ . TOWNSHIP Uj,"C-A) SEC.,:~6T.AIN-R/SW ADDRESS_K S1'. CROIX COUNTY, WISCONSIN. S U B D I V I S I O Np~ ~FSL OLOT SIZE X r[ PLAN VIEW Distances and dimLnsions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYS'T'E°I u it t 6 S tic I ks 1 o• V M i V ~ t 8 3 ~ I di at N r h rr w ; A - F_r BENCHMARK: (Permanent reference Point) Describ5,: TraAot o In H(oLt36 SIAU16 Elevation of vertical reference point:_, 0L -Slope at site: _ _ K: Manufacturer:E-yo 97"/Ai 4& Liquid Capacity: Number of rings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle-"7--gallons; Total capacity of distribution lines gallon: size of pump 7i4 ' bead; gallon per minute j horsepower brand name of pump and model number /Yt~F~-_ •s Type of warning device- 4047 7- A_-4j AL-EA Manufacturer- Number of gallons Elevation of manhole cover ; `t'ype of warning device Number of pits _ feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation _ feet. S PAGE BED SIZE: number of lines-3-7 width length tile'depth H: width _ length PERCOLATION RATE_ AREA REQUIRED AREA AS UIL'T 67 76 INSPECTOR- DATED a PLUMBER ON JOB Q C a LICENSE NUMBER 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 UCONVENTIONAL ®ALTERNATIVE A040,2- lan l.D. Number: gnedl Holding Tank ® In-Ground Pressure ❑ Mound Al NAME OF PERMIT HOLDER: DDRESS OF PERMIT HOLDER: INSPECTION DATE: Greg J. Langer A Route 1 Box 236, Roberts, WI54023 r--7-P'3 BENCH MARK (Permanent reference pomO DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: TREE. PT. ELEV. NE4 NE4, Section 20, T29N-R18W, Warren Township Name of Plumber: IM P o.: County: Sanitary Permit Number: Roger Nelson 6379 St. Croix 1-3 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. E OYES ONO OYES ONO BEDDING: VENT DIA. VENT MATE.: HIGH WATER NUM ER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH RM: j FROM LINE: AIR INLET. OYES ONO ❑ i E EST DOSING CHAMBER: ING LABEL LOCKNG COVER RN MANUFACTURER: BEDDING'. LIQUID CAPACITY PUMPMODEL. PUMP/SIPHON MANUFACTURER'. r r 55 41, OVIDED: PROVIDED: OYES NO,/ L rl ES ONO YES ONO. GALLONS PER CYCLE: PUMP AND CONTROL OPERATIONAL. NUMBER OF PROPERTY WELL jBUfLDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE At 1111 )Tt PUMP ON AND OFF) YES ONO NEAREST -f F"r ID J SOIL ABSORPTION SYSTEM. Check the soil moisture at th depth of plowing LENGTH DIAME TEH 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.) MAIN CONVENTIONAL SYSTEM: WIDTH- LENGTH. NO.OF STR. PIP CING COVER INSIDE CIA It PITS LIQUID BED/TRENCH ! TRENT' S MATERIAL: IT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH 1011T R PIPE DISH I IS .PIPE MA RIAL' NO. DISTR. NUMBER OWELL BUILDINGV NT TO FRESH BELOW PIPESABOVE COVER ELEVINLE 1 ELEV,E PES FEET FROLINE AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the IZI aterial for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound syste to made in that it ON REVERSE SIDE. SHOW ELEVA- NS MEASURED. meets the crit i for 'edi 'd. TIO DYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED JDEPTH F T SOIL. ZODDED SEEDED MULCHED CENTER EDGES P OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING ,HAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS j IL. MANIFOLD PUMP MANIFOLD DISTR. PIPE MNODISTH UISTR. IP DISTHIBUI ION PIPE MATERIAL & MARKING ELEVELEVDIA ELE • PIPES DIA.: / ELEVATION AND 3 c: } 4 ^2ci }v , r 9 _ f/`1 Lw DISTRIBUTION 1 HOLE SIZE HOLE SPACING DRILLED CORHEC I L Y jCOVFR MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS N tl S ONO .,i YES ONO PEHMA ENT MA KER OBSERVATION WELLS. PROPERTY WELL: BUILDING COMMENTS: NUMBER OF LINE FEET FROM j _ ST YES LINO ~E& ES ONO _ INEARE ~~JJ 1 . r 1 ~,~•;,a car-t _~l.c,'c~c:o S b>1 Y c~.KI" +-°(-+1.- t?C:ua~l .1C-LL..c,.:, Ct>'T.l_•-a N ~"'1.~ 1 ll' Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHRSBD6710(R 01/82) lx~~}cCkCtilt r RR ORT OF INSPECTIO . --1,4DIVIDUAL SMM =E DISPOSAL SYSTEM Sanitary Permit = > 1 State Septic TOWNSHIP it. Croix County C1 PTIC TANK n a - r,, - 2 C7 `size 1Q12:L)_ gallons. °Aumber of Compartments Distance From: Tlell ~ 12% or greater slope _ it z -7S ft. Building Wetlands zj ft q ,.,L s.1JzTa~~ter ft. DI,..00tA~~ SYSTEM `~3ile - Field or Seepage Pit(s) Distance From: TiTell /6 m f ft. ( l7 v% or greater slope _ f r p 14- Dui l dingy; Ft. _ r+Jetlanus ft f Iis~hwater ft. 4 - Total length of lines Z!~5 ft. '141mber of lines Bengtri of each line 3L Ft. Distance between lines ft. T.~1idtrz of the trench 2-/ ._ft, Total absorption area sq. ft. BePt'a of rock below, the in, Depth of rock over the z in. Cover over rock Depth of the below grade 2 `~in. Slope of trenc'z in ner 100 ft. Depth to e dzocic ft. De ~t`a to ,,sound water ft. Juzix per of nits t diameter ft, J~ez~t.z below inlet ft. Gravel ar Vn;-.lti,:e yes no. Total absorption area -sq. ft. Square feet of seepage trench bottom area required Square feet of seepa pit ar a required inspected b QQ Title: Approved Bate Z S 19 7J5, ,j ected Date 197 DEPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS LABOR AND PERMIT DIVISION HUMAN RELATIONS (PL13 67) P.O. BOX 7969 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 spdesigned ecified in chaer r H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If by a Mastets 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: ~ 4 Mailing Address: Property Locati n:~d G~ ~S e t y V or Township: Cou a/v N/R/9 E (o W nty: Lot Number: Blk No.: Subdivision Name: CIA/ 01 C A( Nearest Road, Lake or Landmark: 5 /I* State Plan I.D. Number: TYPE OF BUILDING El Public* 1:1 Variance* Z Other (specify)* Number of 1 or 2 Family *State Approval Required. Bedrooms UMB GTOTAL OF TANKS CPREFABE POURED-IN STEEL FIBERGLASS LLONS PLACE NEW REPLACE- OTHER SEPTIC TANK CAPACITY (~C INSTALLATION ME NT (Specify) LIFT PUMP TANK MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental .Seepage Bed ❑ Seepage Pit 5-b 3-o XAlternative (specify ).~Z.~j~ ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Namof Plumber. Signature: D - MP/ No.: Phone Number: Plumber's Address: LZ71~) j/ Let# Name of Designer: p COUNTY/DEPARTMENT USE ONLY Si nat re of Issuing Age t: ee: Date: ~r APPROVED Sani!t~ary Permit Number; Reason for Disapproval: ❑ DISAPPROVED 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) ' LOT P,_j, N S~2 ~ e ltr=3~~ T-L -s O ao' ~c S-n N 3 Ebrr v~ I T~ )o T'D C- 19 T T jI p-.-U C, c 6 rJ G 50 IT ~r_93~ I } F Si PrLti O C-4) L~ v c~ I i ~z L I 6I I i - - -I I i ` I t/ SO, V r 4 535 7l'~iJ i~ J - O I l } ! l ! I ~ I I 3z' g6 ~ E o l on~L E_9 l i°~ - - - ~ c~ 9o~s is N OTES 1. Elevations sbown 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. ( o required) 4. Install 4" observation pipe with approved cap. ( z required) 5. Septic tank to be - ~ooo gallon ca/pacity as manufactured by 1~ \ F C ~"R C:°1>1 C Z r-c P 2 o L~ u CTS (7 K 1 S i hJ G j'ft /J r` ~DO.O --o>J Bpi DH OF S}~}~~ N~USE_- _ b. Bench Nark-E levation - - ;ti}Sti CvZCE Toti R2b SVJ CA2tJ ~2 of r3~~~ =oR ~2AlrJ.~ GF. T - S J S I< C ROSS 51 ET ► D U OF A BED solL FIL ± CI -C-C, REGATE D15 T P1BUT101J ?IP 1 F.- r )V E D S 5 4J I H L T I C : r- F, ===s-~~ cf f ,T L R k t, L O R S r O F c v,' 7 I w [`L i.j` 1 (n0 F/~-21I,11 A.GGRLGATE~' D!STR15UTlOM PIPE TO BC AT LEhST WCHES BELOW DRIGIUAL GRADE F,UD AT L-LAST LO IUC HES BUT IJO MORE THA►J 92 IMCHES BELOW FINAL GRADE ~_oPc =:~,,s':==n •2A i~ ?1D gL'_oW i UCH S~2!`HCE RkD3< DEPTH OF XC.AVi1T10K] PROM ORIGIUAL GRADE WILL E6E .-S INCHF t',IFJIMUP I DEPTH OF EXCAVATIOU FROM DRIGIIJAL GRADE WILL 6E _ INCNE o i 4 ^,~Ll0ES Q 6 O r~pE r _ c, Perforoted Pipe Detoll End Vlew Perloroted N PVC Pipe oles Loceled On Bottom, End Cop I Are Equolly Spoced ~i ~I i Moin PVC Force E r om Pomp P PVC h%..,,nil olC Pipe Dislribulion / \TJS~A 1 QcRT7A}J~1JT Pipe Y Y, ,T E-OS o~ L ACN LA ETLA L- - I i i I i i i ~ I Les' Hole ~heuld 6t N"i io Ene ~cp End Cop Distribution Pipe Loyout © S 0 2,44 g, 01 P z8,S -q- T. OJI PF 3 S Fr F - - - 6 ` h 6 Y 3 Hol e D i a meter SM, Inch <Q~' Lateral 1 >>y inch(es) Manifold 3 Inches Force Main 3 Inches Lrs~r Cif,"A R P, 5c'T!0EJ _JJD SP C(FICA_T )fJS VElJT CAP `iC.I. VCtJT `rIFE WEATHER PROOF AFFROVED LOCKII\JG JUUCTIDU BOX MA~JHOLE COVER ?-5' F RGM DGOR, !!JDDW OP, FRESH 12~MIU. I IR, ILTA KE I GRADE 9 -3. O y M t FJ - ell ----c=~''~~ cot H TO. rjj'v t! fir. . AFFROVED JOINT A y~ r'~~r I I APPROVED J04,115 w/ C. Z. PIPE W/C.Z. PIPE EXTEtJDIIJG 3' 3S• 3U ' v;~ } I II ALARM EXTEUDIIJG 3' 01.1T0 SOLID COIL B' `c~~F T I 11 OIJTC SOLID SOIL pN c~; I I Ors 0 ~C I I PUMPS J I OFF D COQCRETE BLOCK-- - RISER EXIT PERMITTED GULy IF TAUK MAUUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS FTIC AIJD~~, ~S~1ZJC ~~t ~IAU=N IJUMBER OF DOSES: -PER D" TALIKS MA►JUFACTURER: T AFJK SIZE : _ S GALLO►JS DOSE VOLUME: Z' S GALLONS AL APM M,AIJUFACTURER: 5.5. cL~eTRU SL1S; 7 CAPACITIES: h= ~y IUCHES OR GALLC)US MODEL ►JUMbER: _ VW ~W B=- IAICNES OK GALLONS SWITCH TYPE: 8 C= IUCHES OR GALLO►JS PUMP /-,.AIJLJFACTURER: D=IAJEHES OR GALLDUS MODEL UUMBER: _SS Y IJDTE: PUMP APJD ALAFZM ARE TO BE 6~ ` 1 C I1!STALLED D►J SEPARATE CIRCU ITS- 5W ITCH TYPE: PUMP DISCHARGE RATE `f° GPM VERTICAL DIFFEREIJCE BETWELU PUMP OFF AUD DISTR,IBUTt01J PIPE.- FEET + MIUIMUM IJETWDRK SUPPLY PRESSURE 2-5 FEET + FEET OF FORCE MAItJ X O' 69 FjoFT.FKtCTIOU FACTOR__ FEET TOTAL 09UAMIC HEAD = ~•y FEET P,rnE7 lZ 79. S WTEPFJAL DI^^~EI,JSIOFJS OF TAUK: LEFJGTH ;WIDTH LIQUID DEPTH 1>u3 _ Z31= 21.5 GHQ//,~, Or ::"C M, kIll CIV7H ti M Co t-- CD LO Cy) N r- o N 0 O N CD - i N I I CD ,LU co - Lf) Z o - (.6 i DTI C CD 00 FF L~ U) U) -r~-_--- I cy) Q C-r Cc CD LJJ C\J - ► - - I - o - V - CY-) < Co o 0 :D ° - `O (r) N (n U CD X C~ U) 0~ o< cc U < LU CD Lo CD I o CD = CD CD ~ N QO N CD CO CD ~ N CD CO CO N (V N Cam! T T- T T- T-- ~~_Z_l 1 zt 01 m _a 0 ;s.~V~ G nO-j1,D PH W'SSUF~E SYS 'E?: , - F OF. 3 :=-o R - RC~~li -1 Is 1 Tt'D TN T= K)EOF TEF r3 OF SECTION , T ?9 N, R W, - - ~ I~ P► M-: 1 of 7 TITLE S'EET PA GE 2 of 7 wOF.I:S ET P.: GE 3 of 7 PLOT FIAN pk; GE 4 of 7 PL_E N VIEW-CROSS SECTION P!. GE 5 of 7 DISTRIBUTION PIPE 1-k-Y iUT PA GE 6 of 7 DOSE CH k Y3, ER P1,GE 7 of 7 PU?~iP PERFOF ,k.NCE CURVE FREP~ R ,D BY DOZFL, Wa ;GERER I.ND ).SSOClATES L21 NORTH ?~k.IN STREET RI v R F!. L? WI . 54022 .l GTRCiC~ _ rc K V_ , FALLS, a L:2 F i. CII TIo(~AL VfoPKSHEET IL IN GP.OUND PPESSURE SYSTEM{.onnnucd- I. "N' D S YS 7 E M O LI WastcuaIcr Eoad, Total Dally Flow= Z;rl. 10, Force Main: C o F, Usc section H 63,15 (3) (c), Wis. Minimum Dosing Rate = P M ~ in. Adm. Codc and PROVIDE A DETAILED i Diameter = LIST OF SIZING ON PLANS. 11. Total Dynamic Head: S stem Hcad = 2-5 ft. Gertnth to Limiting Factor - / ft. y -?-9 n o~ Vertical Lift = 3. ft sta\ Friction Loss ft. = 4. Dis:a ce from Dose Chamber to ~•4~ ft. Distribution System = ft. TDri = 5- Elevation~Difference Between 12. Pump Selection: Pump will discharge at least - gpm Fump and Distribution System = / ft. at _ 7-L;-- ft. total dynamic head. E 4t•sorption .Area Sizing: / - Purnr •oe! and znu zcture sa. ft Area Required td or Tren,. Length (B) _ - fl. - - - - ft. 13 Dosc Voiume: bed or Trench'14`idth (A) tL 10 Time= Void Voi~~me of i itncr. Sc.acm ✓isuiputron Lines „nd He•ghtL ft ilv 1\ rite, titer Volume T Fill Depth (D) - F ill Depth Downslope\(E) ft. Dotes to 24 nrs 59, Bed or Trench Depth (E' ft. 5ackfiow = - 2- \l! Cap and Topsoil Depth ( ) = ft. f"inimum Dose = - F Cap and Topsoil De th (H ft- 14. Dose Chamber: Fa" 5. GSund Length: Volume o Slope (K) - ft. Total Mound Length (L) = ft. Ill. \ CIQNVENTIONAL PRIVATE SEWAGE SYSTEM j 9. Mound Width: / 1. Wastewater Load, Total Daily Flow = Sal. L'psiope Correction Factor = Use section H 63.15 (3) (c), Wis. Upsiope Width (J) = ft. dm. Code and PROVIDE DETAILED Downsiope Correction Factor = \ LISOF SIZING ON PLANS. Dons,lope Width (1) 2. Require optic Tank Capacity = gal, Mound Width (VI') ft. 3. Percolation ate = min./in. - Total _ ` 1G. hrsa' Area: 4. Absorption Area Sizing: Ir`ihrative Capacity of Refer to Table 2 in chapter H 63 !natural Soil and PROVIDE 'A DETAILED IifST OF Basal Area Reouired ft. SIZING ON PL,4N`Ir~` Basal Area Available sq. ft. Reouired Area = sc, ft ' = - i = f t 1 i 11 Standard Tables from Chapter Length H 63 are Used, Indicate Table No.Width = _ - ft. /2. For the Distribution Network, Use Numbers 5-14 in SectioI1. Number of Trenches = - \ Trench Spacing ft. 11. IN-GROUND PRESSURE SYSTEM S. Distribution Sy~ 'm: - al Le th = \ ft. i. Depth to Limiting Factor= ft. Lai Nume r ber f Laterals = \ 2. Landsiope = in. 3. Percolation Rate = 10 min./in. Later Spacing = 4. Proposed System Elevation = 15~' ft. Distance from Sidewail to Pipe = in. u~ S stem Elevation = ft. c Y.'as;ewater Load, Total Daily Flow: -O gal- ~Y \ L,,- section H 63.15 (3) (e), Wis. fj 11 v f"' Y U -cm. Codc and PROVIDE A DETAILED IV. SYS M-IN-FILL LIST OF SIZING ON PLANS. Fi}, in All Items from Section III S ~ Required Septic Tank Capacity = g 1' Fat. 6. Absorption Area Sizing: V. SEPTIC TANK gal. Percolation Rate = min./in. 1 . Capacity Area Required = sq. ft. 2. Manufacturer System Length = ft. 3. Show Site Constructed Tank Details on Plan System Width = a g ft. ? Distribution Pipe Sizing: VI. DOSING TANK T Sb Hole Sze = 1. Capacity = Fat H 2. Mianufaclurer _ fi. - oic Speciny; 'F L,oeral Length 3. Pump Menulauurer: --T - l )/y in. 4- Pump Modcl SS _.ucral Sizc 2 ' u ft. 6 II, S. Operating Hcad= I iicr.rl Spacin{; - L. Flow Ratc= 5 gnm. I)islanu•. Irnnt tiiJrweli do Pipc ---3- lit. - Di,irihutiun Pipe Disch.ugL, kme: 7- Show Shc Constructed Tank Details on Plans Numhcr of I lines Per I'll)(' O I luw I'ci l'ift' 1$.Z gpin. VI1Y~+ L~1 G I ANK 9. ManilnlJ Sizitt) : 1. Capacity = gal. ~11D 2, Manufacturer: I ype (center of end) Length = \_2 ft. 3. Show S1tC Constructed Tank Details on P n Diameter In. - -SHOW ALL INFORMATION ON PLANS-