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HomeMy WebLinkAbout042-1102-40-120 N 0 0 0 d 1 m 3 0 ~ 3 .r v c CD (W) (n w w C:) S N m Oi 00 j N, 3 CD z H C° 3 0 0 ?0, o O N) CL 0 cn C) =3 CD 0 o 0 c°n 3 0 Co 7 N W O O O (D D C a P m a m CD En a W O O -a m v' W 0 Z CL C, cn (D 3 p C) CD lot rt co co 0 cn w t-I CD co co a- N Cn W w m (n 0 c n "a M -0 t H 0 0 0 0. 00 N v a Z Co =r 0 - CD Vi co 1 ' m o ~ 2 m = CD c0 T CD A T" (DD z z 7 o N D D o N v 0 !r • I CD 00 w H O w CD CD N -I F-h N O N A Z n x 'z 'z p z 7 W I 0 Z rt 7~ (D n Z * NO N rn C7 (D 00 ul .l m (1) (D a Z a E 3 n o O C/) 00 (D ca A m N co C a CL CD 0 al c- oo v o N N. p 3 N C CD 7 Z ID a ~ o 3 -4 m CL p CD 0 m '0 CD N 7 CD S 0) CD y S Z N a m 0 0 N O O A ~ N S X07, O C Q U) =r O CJ 00 O O O 7 c a ~ A O b Ci O JQ W 0 m o ~ 'r yO p O_ ti Parcel 042-1102-40-120 01/03/2006 04:07 PM PAGE 1 OF 2 Alt. Parcel 36.29.18 566B-20 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/21/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CONWELL, JERRY D & JANICE M LE JERRY D & JANICE M LE CONWELL C - CONWELL, JEFFERY D JEFFERY D CONWELL,ET AL C - SIMON, JODIE M 633 140TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 633 140TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.767 Plat: 4791-CSM 18-4791 042-04 SEC 36 T29N R18W PT NW SW LOT 2 CSM Block/Condo Bldg: LOT 05 8/2258 2.49 AC NKA CSM 18-4791 LOT 5 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-29N-18W Notes: Parcel History: WRONG LEGAL. CALLED BESKER ATTORNEY ON Date Doc # Vol/Page Type 08/22/05. THEY ASKED TO MAIL DEED BACK 08/30/2005 804933 2877/490 AFF AND THEY WILL FIX. 08/12/2005 803293 2865/566 QC 08/18/2004 772033 2640/237 QC 07/21/2004 769410 18/4791 CSM more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 79848 186,200 Valuations: Last Changed: 06/22/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.767 41,000 109,400 150,400 NO Totals for 2005: General Property 2.767 41,000 109,400 150,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/14/2005 Batch 05-33 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 Parcel 042-1102-40-120 01/03/2006 04:07 PM PAGE 2 OF 2 Parcel History: cont. 07/23/1997 879/170 07/23/1997 874/54 Parcel 042-1102-40-110 01/03/2006 04:08 PM PAGE 1 OF 1 Alt. Parcel 36.29.18 56613-10 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/21/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CONWELL, RETIRED RETIRED CONWELL Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.490 Plat: N/A-NOT AVAILABLE SEC 36 T29N R1 8W PT NW SW LOT 2 CSM Block/Condo Bldg: 8/2258 2.49 AC INCLUDES PARCEL 567 A-10 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 879/170 07/23/1997 874/54 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/08/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT 7,-_jzAA4j C a_"L~ _ TOWNSHIP ti SEC .3T;;~?N-R /g ~W J - ADDRESS`1'. CROIX COUNTY, WISCONSIN. SUBDIVISION LO'C LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 1163 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r (,l / i r. 74 1 1 1 1 I 1 1 1 - 1 I 1 1 ~ - I di at N r h rr w Z) TL L I; BENCHMARK: (PeJrmanent reference Point) Describe: 41 A _44 o"..'-sF•.ru Ai- Elevation of vertical reference point: % "4 Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number. of rings on cover __Tank manhole cover elevation: .3r,::Z6) 'l'ank Inlet Elevation: 'L'ank Outlet Elevation: t, ZS~ PUMP CHAMBER Manufacturer: (,(Jp~ _ Number of gallons 7S` a4i Number of gal. pump set for, a cycle_1~~.-~~ gallons; Total ca acity of distribution lines 72 Oallon: size of pump_ ead; gallon per iuinute __7$ horsepower_ ;brand name of pump and model number -.~G o~~~ - jP0 ; 't'ype of warning device lJ._,i.4". HOLDING TANK: Manu acturer Number of gallons Elevation of man Ole cov r_ 't'ype of warning evice SEEPAGE PIT SIZE; _ Num er of pits feet diameter feet liquid dep h _ seep ge- pit inlet pipe-elevation bottom of seepa>e p't levation feet. SEEPAGE BED SIZE: num er of lines width length tile depth SEEPAGE TRENCH: idth length PERCOLATION RA'1'Ed_•"'y AREA REQUIRED REA AS BUILT ~37 r INSPECTOR DA'TEll g ?3 PLUMBER ON JOB C ~~/y ~c_/cY• <4 LICENSE NUMBER 3,-?:.~ APPLICATION SAFETY & BUILDINGS DEPARTMENT OF FOR SANITARY DIVISION INDUSTRY, PERMIT P.O. BOX 7969 LABOR AND (PLB 67) MADISON, WI 53707 HUMAN RELATIONS that ori Attach plans for the system on paper not less than 8% x 11 inches in size. Include lot plan and pis dsical sio ed eri d a n spec fie. Hn chapter and vertical elevation reference points must be shown. All appropriate separating distances 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. ~64 Mailing Address: Property Owner: Village o ownshi Locatio City, county: Property ~ ~ r / N b r: State Plan I.D. 5 ~j '/4 ^ W'14S /T;ZQ N/R / E (Of)® Nearest Road„Lake or[ Landmark: (If assigned) Lot Number: Blk N SubdivisionfN e: LI (J-~ TYPE OF BUILDING /[~j J_ Number of lrn _(1i5~, Bedrooms: ❑ Public* ❑ Variances ❑ Other (specify) 7C/ [?11 or 2 Family State Approval Required. TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OT STEEL FIBERGLASS INSTALLATION MENT (Specify) OF TANKS CONCRETE PLACE SEPTIC TANK CAPACITY coo HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER 7 1 ~s j. E.c MANUFACTURER: S E "y e-_ EFFLUENT DISPOSAL SYSTEM (Minutes per inch): PROPOSED (Square feet): 1:1 New Replacement ❑ Experimental ❑ Seepage Bed Seepage Pit PERCOLATION RATE ABSORPTION AREA ❑ Seepage Trench Alternative (specify ) 3 7$- %Nater S ply: Owner's Name as Listed on Soil Test Report (lf other than present owner): Private ❑ Joint ❑ Public Pundersigned, reby assume responsibility for installation of t he private sewage system shown on the aPttta hedoplans. Number: M RS hone Signature: r Name of Designer: 6 COUNTY/DEPARTMENT USE ONLY Date: APPROVED Sanitary Permit Number: Fee: Signature of Issuing Age ~fa Agent: Q f1 3 El DISAPPROVED V j / [9 V Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) DEPARTN,4ENT 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 K:1 ALTERNATIVE IS,,,, Plan I D. Number. (If assigned) ❑ Holding Tank ❑ In-Ground Pressure Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Jerry Conwell Roberts, Wi BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELF V. SW NW, Section 36, T29N-R18W, Town of Warren Name of Plummer. MP/MPRSW Nn.. County Sam tary Permit Number. Henry Nechville 3558 St. Croix 38491 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PR VI YES ❑NO S ❑NO BEDDING: VENT DIA.:* VENT MEAT L.. HIGH WATE r , NUMBER OF ROAD: 1 PROPERTY WELL: BUILDING: VENT TO FRESH ALARM T FEET FROM LINE LAIR INLET. ❑YES ❑NO ` ❑YES/ ❑NO NEAREST 1 ✓ d c DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/ SIPHO MANUFA Tll R WARNING LABEL LOCKING COVER PROVIDED PROVIDED. / 6~~` ..,v ❑YES } N0 -7 ~U ES ❑NO XYES ❑NO GALLONS PER CYCLE: PUMP A NO CONTROLS OPERATIONAL. NUMBER OF PROPERTY WE LL 1111 LDI NC; VENT TO FRESH (DIFFERENCE BETWEEN / FEET FROM LINe/ AIR INLET PUMP ON AND OFF) YES ❑NO NEAREST /®af SS SOIL ABSORPTION SYSTEM. Check the soil moisture at the de th of plowing It EN(,TII DIAMETER MATERIAL AND MARKI or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE /D the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: 10 WIDTH. LENGTH NO. F DISTR. PIPE SPACING; !NODISTR OVER INSIDE DIA -PI LIDO BED/TRENCH THE Es ATEHIAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DSTRPIPF DIST PIE JITR. PIPE MATERIALNUMBER OF PR OPERTV E BUILDINGVENT TO FRESH BELOW FVES ABOVE COVER EEVINLET ELE EU IPES 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 OF SYSTEM 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 COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑ ES ❑NO S ❑NO DEPTH OVER TRENCH: BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL SODDED SEEDED JMCENTER EDGES. v S ❑YES NO YES ❑NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH n el TRENCH DIMENSIONS 2- MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD M E AL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. / CIA ELEV ELEV CIA PIPES ELEVATION AND ➢ y' , Z f~ 4 - D 6 FT CORRESPONDS TO APPROVED DISTRIBUTION VERTICAL 1_1 INFORMATION HOLE SIZ HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS 3') YES ❑NO ES ❑NO 11111-11NI. L ROPERTY WELL COMME PERMANENT MARKERS: OBSERVATION WELLS: FEET FROM OROM F PI NTS: NE: ^ v EVES ❑ NO YES ❑ NO NEAREST } Q Sketch System on Reta n county file for audit. Reverse Side. SIGNATURE. TITLE'. / DILHR SBD 6710 (R. 01/82) c Form - S `1' C 100 Owner of Property Location of Property, S(1(J ~~4 a(U Section,`l'_N R~ Township DJ A /It /lJ Ma iIinL Address % j X Subdivision Name Lot Number Previous Owner of Property < lL"'-4 Total Size of Parcel--,-:2' arcel , -:2' A r Date Parcel Was Created Are all corners identifiable?_Yes -No Include with this application one of the Iollowin- .Certified Survey Map .Deed .Land Contract, or Other hegal Document which describes the property PROPERTY OWNER CERTIFICATION 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., _ 7 -x 2, ; 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. SI NAT f ROOF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) i'7 j DA E SIGNER DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, r DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 3707 HUMAN RELATIONS ~ (H63.090) & Chapter 145.045) LOCATION: SECTION: p r, TOWNSHIP/MIJNII CIPALITY: LOT NO.: BLK. NCO.: SUBDIVISION NAME: ..3 C _ S~v /4 D /T 1 29 N/R/d E (or Lv,4/~PL~,✓ ST 40~x OWNER'S ERE N CqjVYJVZ-LL M~T A ~6, i` O/J~iQ~s W~S . USE V DATES OBSERVATIONS MADE NO. J COMMERCIAL DESCRIPTION: PROFILED SCRIPTiONS: PER OLATION TESTS: Residence /~I,L~- ❑New Replaced RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS C7 U INS ❑ u EIS ®u CIS u CIS ©U 11-1eWP If Percolation Tests are NOT required DESIGN RATE: ( If any portion of the tested area is in the under s.H63.09(5)(b), indicate: I Floodplain, indicate Fllooddplain eievation: r- FT. PROFILE DESCRIPTIONS SC- 57 SHOWS ~I S ~WET%" SiGT BORING TOTAL D PTH TO GROUNDWATER-thF6+1ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHNy. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) yL a ~y s<<, / A), slL, • ~.3' ~~r'B~v, s;L, d.~7 . sc w "e M 00- . ~o75 ' JH Y/ 40 B- l 17,0 9l~ /l~ xa' 3.3 1314) X41 9CL B- q C 33'13/ • /7' -PA) 67 f /R-Rd -r1w /7 B-2- U / d• 7 1,4Nv S~'~- w ,PD o,P 6 fro 7- 51 G 7 &Y.,. 5-C w~ P oM. oQ-6y ,~,or"s . B- B-3 (v . (1 9~i / J' 0 'R SL 4j/ -FOA •6 .~r. ~s , , 6 ` ?AAI s'C. i-cWd-A 7f"vq~ b,A-0. hd 73r . B- Sv,P Aft E/EL! of ~E,QC'f PERCOLATION TESTS TEST DEPTH WATE N HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I 3 AFTE WELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD 3 PER INCH P „ -3 33 S7/ z - z a. Q . L P P- P_ D P- _ PLOT PLAN. Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, tvk2x hAv/1✓rQ iv ST~9TE i4~P~OdFo S,q.V 1~ Fi%/ Ai.-enr %uTE-iP /=.}ems=S SYSTEM ELEVATION eatk /Ev-griov i s ~7 F9 /n;~ I L9 Fr. l , E I i i , i ! I r I t t I : I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief- NAME (print): TESTS WERE COMPLETED ON: /Qol APT' Zt/,b c'i'GtiT~" 1yt 3 ~-,3 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 tR. 02/82) - OVER - r 'REPORT ON SOIL 80RsNUS "t, PERCOLATION TESTS IIS ,4obt~r~ Pao r PLAN P R co-' E(::i r. D. 3al~/ CA'awE-z1L Buis DArE- 3/ -i9P-3 HOMEISITE TESTING CC). [IT-3, O'%NEIL ROAD BOB III1;h'a L. AUUSON, WIS• 540I6 C57_ 02 yr2 PROPOSED HoVSE moor LIE 2s- r-rr o,f MORE FROM 81,1- rEsr ft~PEgs. PROPOSED WELL MVSr or Q Fr o ✓C R tioRF Fit'oH c~ T£sT ~Ei9S A ~9 o = ,OAU 1f AoF P;rs D = zxiST/,v e,- wELG 1( = &te_ 10C4rIOAlf ' 11AVP ~}v9E~PED ote S~aDPlft /3prES 1/0, e; . 13 M Vtifrl , l_ ,PEFERt.vc~ Poia r- AFB Doi OA/ s~ J~f ~ao,P Old .540 7-1;05 Q 414NW,c Ll_ L/0,,SE", - = LE ,E IN D/EV~rc~~ o~ llE~r iPE` p1" /bD- OCR f deg. If P~ i 7 C p ~ d P i ~ ~ ~ X ys I ~ ti m ___At i v _ f ~o, ~ 3 Department of Industry, Labor & Human Relations Division of Safety & Bldgs. State o Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608-266-3815 IN ALL CORRESPONDENCE 1 REFER TO PLAN C3 6 1 IDENTIFICATION NO. I C NAME OF PROJECT T P O APPROV L ( - STREET AND NO. C,// STATE ZIP CITY TOWN CO TY~ OWNER Gentlemen: eted. In Examination of plumbing plans and specifications for the above-mentioned project 9e thupte co 5, and specifications as been coalre approved rd with Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans 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 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. Or P'ivai -e So" Sincerely, i hi5 approval is Vif; d for L`,' 0 years or it `dviii Ice vadid the expiration a+ ir. ttd sanitary perrxt': James Sargent-Bureau Director DATE: PLA EVIEW D BYE DILHR cc: D ~ Plumber H & R (2) Local al PI PI Mfg. Rep. Bur. of Health Fac. & Services Rec. & Env. Services D I L H R SBD-6099 (N. 06/80) tFM VT I ~ U~_ tc 1 C/ /V w y " 36-:/ / „1 y/Vr foc~v or ~A~s',Pt 1/ S ~ ~o ~c~ ~ G ~ /~1i,9•~/ /`~/~~/~'w/~ L r ///9 ~ ~ ...fit ~E ~ : . - , - UPT/vv~tL ST.9TC- ~l'~iPKS~/~~ T ` f i /p.2 Lfl T,~rPA,L. L~~C1u ~ 5 - / Po S S St < T 'o Ao,'-I/~ rte/ tIAi!G),vS S~~< - P4 o i f z o/ - 116 r 2 /l 6,J All 7z 7- l J So y L- Tt S / 190,' T ~s\1 YL, Ot SOX 4 M C~ DIVISION OF SAFETY & BUILDINGS r,LA,N APPROVAL BUREAU OF PLUMBING APPLtCATION PRIVATE SEWAGE SYSTEMS 111 201 E. Washington Avenue, Rm 178 P.O. Box 7969 PAadison, WI 53707 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Pans 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) Project. Name Name of Submitting Party (Plans returned to same) f C~C~ V T Fl~til2 t EGh U~/~C lA04- /,04/ Street No. ✓ Project Location - Street & No, or Legal Descilption - COUnty City State Zip Code City n Village of CJ Town - - Telephone No. (Include Area Code) Designer 'R ) ! 3 2- -2~~ 2. THIS APPLICATION IS FOR A ❑ New Mound System (3) ) Holding Tank (2) Petition For Modification (6) ❑ New Pressurized System on site not suitable for conventional (3) Replacement Mound (4) [ I System in Fill (1) ❑ Replacement Pressurized System on site not suitable for conventional (4) (_l System in Flood Fringe (1) [«1 Groundwater Monitoring (7) ❑ Pressurized System on site suitable for conventional (1) ❑ Conventional System Public Building (1) 4. FEE SUBMITTED FOR OFFICE USE 3. FEE COMPUTATIONS (Include existing tanks) 3a. 750 - 1,500 gallon septic tank - 25.92 4a. 3b. 1,501- 2,500 gallon septic tank - 32.40 4b. 3c. 2,501- 4,000 gallon septic tank - 45.36 4c• 3d. 4,001 - 8,000 gallon septic tank - 58.32 4d. 3e. 8,001 - 12,000 gallon septic tank - 71.28 4e. - `A 3f. Over 12,000 gallon septic tank - 84.24 4f. 3g. 500 - 1,000 gallon pump chamber - 25.92 4g. 3h. 1,001 - 2,000 gallon pump chamber - 32.40 4h. 3i. 2,001 - 4,000 gallon pump chamber 45.36 4i. - s~-x 3j. 4,001 - 8,000 gallon pump chamber - 58.32 4j. 3k. 8,001 - 12,000 gallon pump chamber - 71.28 4k. 3L Over 12,000 gallon pump chamber - 84.24 41. 3m. 500 5,000 gallon holding tank - 25.92 4m.. 3n. 5,001 - 10,000 gallon holding tank - 32.40 4n• 3o. Over 10,000 gallon holding tank - 38.88 4o. 3p. Groundwater Monitoring - 27.00 4p• - 3q. Petition for Modification - 27.00 4q. Subtotal 3r. Walk-through place review: 4r• Submittal of plans in person, by appointment, with double tee Total Fee COMMENTS: R-- • -avE DILHR SBD-6748 (N. 03/82) O TiOINAL WORKSHEET Y It. IN-GROUND PRESSURE SYSEM-Continued. L . MCUNi3 SYSTEM -11-6'0 0. Force Main: 1. Wastewater Load, Total Daily Flow = gal' 1 Minimum DoV'~ gpm' n H 63.15 (3) (c), Wis in. Use sectio Adm. Code and PROVIDE A DETAILED 1)lamettr LIST OF SIZING ON PLANS. 11. Total Dyna H02.s- System He 2.5 ft. 2. Depth to Limiting Factor = ft. ft. Vertical Lift 3. Landslope Friction Loss ft. 4. Distance from Dose Chamber to J. J•S ft TGiI = ft. Distribution System = 7 12. Pump Selection: 5. Elevation Difference Between Pump and Distribution System = ft. Pump will dischafge>,at least tipm at ftltotaI'dynamic head. 6. Absorption Area Sizing: 76, Area Required = sq. ft. Pump m4eu manufacturer1, 1 Bed or Trench Length (B) ft. Bed or Trench Width (A) ft. 13. DosVmft 10 TiniCv old Volume of Trench Spacing (C) Distrilit?tion Lines gal. '71 Mound Height: ft Dally/Wastevrater VOIUme 4• Fill Depth (D) _ 4 Doses In 24 hrs. gala Fill Depth Downstope (E) _ r 3- ft. 7 ft. Da~kfiow _ gal. Bed or Trench Depth (F) _ 6'Uninium Dose gal,. Cap and Topsoil Depth (G) _ ft Cap and Topsoil Depth (H) _ ~L.~- ft• 14. Dose amber. w ._r> _ Val \c = gal. 8. Mound Length: End Slope (K) = ft. Total Mound Length (L) _ ___(e:Lr• ft. III. CONVENTIONAL PRIVATE SEWAGE`SYSTEM 9. Mound Width. 1. Wastewatcr\Load, Total Daily Flow r gal. Upslope Correction Factor= / Use section H 63.15 (3) (c), Wls. Upslope Width (J) _ fe. k.etni. Cod\and FI:OVIDEjDC"FAILED Downslope Correction Factor= I"-EST OF SIZIING ON PUNS. ft. 2. Regttlrcd Septic nk Capacity = gal. Downslope Width (1) Total Mound Width (W) ft. 3. Percolation Rate = Basal Area: 4. Absorption /trea Siz:ng~! 10. Refer to Table 2 e I chapter H 63 Infiltrative Capacity of Natural Soil gal./sq.fe./day and PROVIDE A/D~TAILED LIST OF Basal Area Required = sq• ft. SIZING ON PUNS Required Are i= Basal Area Available = sq. ft. ft 11. If Standard Tables from Chapter 2-7 Length Width = ~ it. H 63 are Used, Indicate Table No. Plumber of'Trenches' _ 12. For the Distribution Network, Use Numbers 5-14 in Section It. j esncti Spacing = ft, 1 S. Distribution System: It. IN-GROUND PRESSURE SYSTEM Lateral Length ft. 1. Depth to Limiting Factor = ft. 2. Lands~opc = % Nunibar of Laterals r j Lateral Spacing in. 3. Percolation Rate = - min./in. D ft. Dlstance from Sldewall to Ptcn .~.t in. 4. Proposcd\Sysicm Elevation a Systuni Elevation ft. 5. , Wastewater Load, Total Daily Flow: - gal. Use secti~G H 63.15 (3) (c), Wis. ' Adm.Code\and PROVIDE A DETAILED IV°. SYSTEM-IN-FILL LIST OF Slip G ON PLANS. Fill In ME Items from Section lit s` Required SeptTank Capacity = gal. E PT IC=T A N K 6. Absorption Area Siz ng: V. S f e gal. Percolation Rate= min./in. 1• Capacity &A'SIS4w r"- Area Required = sq. ft. 2. Manufacturer'. _ System Length Length = ft. 3. Show Site Constructed Tank Details on Plan System Width = ft. 7. Distribution Pipe Sizing: V11. DOSING TANK Hole Sete o- in. 1. Capacity u w1~ jl:' 2 Hole Spaci Spacing = ft. 2. ARanuFact rce: ft. 3. Pump Manufacturer. GOUG ' Lateral Length Lateral Siae in. 4, Pump Model: 5. Operating, Head= _ ft. L.elcra{tip.evittkf fl. ham. 6. Flow Rate gpni, f)isi,uece frrnee/tiiilc+waU -let Pipe in. 8. Distribution Pipet Discharge Raw 7, Show Site Constructed Tank Details on Plans Number of Flutes Ile$ Pipe i low Per Ripe' F4Pnt, VII. HOLUING TANK 1. Capacity = - gal. 'D. Manifold Siifnµ: - i ype (s:ontet or end) - r, 2. Manufacturer: Length = ft. '3, Show Site Constructed Tank Details on Plans Diameter= In. ~~'DN( 1A ~~~/'srkibul7o~c1 -SHOW ALL INFORMATION ON PLANS-- ~ 2 • IA%x~ DILHR SBD•6761 (R.03/82) (J~ ~I e S v `~f Page 3 Of Straw, Marsh Hay, Or Synthetic Covering `s ! Distribution Pipe Medium Sand- G 97 y Topsoil F _Jt D % Slope Bed Of (Force Moin PIowed Aggregate From Pump L.oyer D F ~SFr Cross Section Of A Mound System Using F 7.5 ~T A Bed For The Absorption Area G k o Q 4 Ft. H f~ Signed: Ft. f License Number: Ft. rt. Date: I /Cy Ft. Alternate Position i- Ft< of - Force Main W Ft. Observation Pipe---,,\ t 01 A _n ..f Force Main W _ From Purnp Distribution Bed Of -1-2"- i Pipe /aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page Y Of • 3 70f~L 175c~ ~ t Perforated Pipe Detail )Pefforaled _W . End Cop \e ~A PVC Pipe Jot`~o~° Halos Located On Bottorr+, Are [quolly Spaced { +,y PVC Force Main * From Pump PVC Manifold Pipe Distribution Pipe Last Hole Should Be v~ t+ r Next To End Cop ` fT End Cop Distribution Pipe Layout P 23 30 Y w. Hole Diameter ,/Y/I/w_ Inch Signed: Lateral Inch(es) License Number: Manifold `a- Inches r~ Date: Force Main c3 Inches w 10 L~ f PAGE OF • PUMP CHAMBER CROSS SECTIOM AKJD SPECIFICATIONS &)RtER HI-fiRM 130X COQ T-P0L. S 1rt o U uTEt, 1 ,v --VENT CAP COA.) SPicUVUS/)3 Ho05F- `f"C.I. VENT PIPE ~ _ WEATHER PROOF APPROVED LOCKING JUAICTIOAJ BOX MA lMHOLE COVER - 25' FRCM DGOR. WIAIDOW OK FRESH I2"Mlll. AIR IAITAKE . GRADE I 4" MIIJ. 16 1 Ohl P~ pr. C.0UDUIT• \ U7~~ ~ 18"MIAI. ~&8 Sole \ - _ INLET PROVIDE AIRYI6Wr SEAL. I III Wi EP - APPROVED JOINT A ° I I I APPROVED JOIKI'1.5 W/C.T. PIPE ( III v.//C.T. rlrr_ XTL KI I) G 3' EXTEND I AG 3' ALARM OtJTO SOLID SG! Le e ~G1Qf ,l~If~co I I I t OI ITO Sgl_II> SOIL- V l 1> Gi FT • ~ r, I 12 c 5 t4,xw:.. I i> Oti PLIMP _j OFF J)omp l iu LE Q H T C0KICRV_T'E BLOCK 1 E&IJ41-10.J 0,4-- -f4,U/t /.SASE = FT - E RISER EXIT PERMI-TE:D GFJLy IF TANK MAAIUFACTURER HAS SUCH APPROVAL SPCC/_IFIIC_ATIOUS SEPTIC AND GIjcl f cl? (y1yctt 1 e DOSE TANKS MAIJUFACTURER: e IJUMBCR OF DOSES: PE K DR.`S TAWK :,IZE : j5-0 GALLOMS DOSE VOLUMC: 1! ' / GAt_LOIJS ALARM MAMUFACTURER: CToUL.v CAPACITIES: A- / -,I►.1CNE5 OR 300 - G AL. I MOUEL IJUMBER:e~~`~ r I r_ .Z -_IMCNESOR L GAL~OUS SWITCH TYPE: 1~jCRCURY lC 6a9T✓` I/> C INCHES OR GALLOIJS r. ~t(~q PUMP MAMI-IFAC_TURER: ~DULy D ~lAlf.liES OR t!24_ 6At_L()1J;~ MODEL NUMBER: lvPo 3 A HP NOTE: PUMP AND P,1-ARM ARE TO BF_ SWITCH TYPE: F1DAT- 5 IA.ISTALLE) OU SLPAK/:TE CIRCUITS PUMP DISCHARGE RATE _ Ze GPM Na S~Ecs VERTICAL DIFFEREAICE 5E.TWEEM PUMP OFF AAJD 0I5TRIBUTIOM VIPE.. a - - FEE T + MIAIIMUM NETWORK SUPPLY PRESSURE , , . Zr,S FEET f ~r ~~Y o Q~ ` -f- -5(0'5FEET OF FORCE MAIN X FYOFYFRICTIOM FACTQR.._' FEET TOTAL DYNAMIC. HEAD = FEET IMTERRIAL DIMEMSIONS OF TA►JK: L'ElgGfi~ ~iJl6T H f7EPT H SIGNED: LICEMSE kJUMBER: DATE: cs v ' r\j I M ~ ° a v - t i .A o V ~ ~ 00 y V s I Nj h 1 V 1 i