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Home My WebLink About002-1066-80-000 ncao 3vn O y f c 1 O \ c 3 3 h~ ~ 3 A n fD L A ~ 1 ~ 3 r: x~ 111 7 3 C) N fD Un (D E N o" o C) (D =3 (Ji 0 V Y V N Uri C < 7 W O e~T O CL 0 V C y -4 O C W A Q d CD w m cn CD (f' a a eiN^f (D C C D C a N ~ N W O \ S CD =r CD F~ W SD CD CD L 'L O lz lz (D OO D 00 0 gL co n 0 C _ ! V7 N N Q oC oC oC 1 o o m -i cn z ~f ~ cn to cn a ~ D m 0 0 U) a o0 0 ! O O O CD .~-r Vl N ? CD cn 51, o- CD m N V~`T ~y 7 O Z Z Q Z D D o h m n ^ CD w m Z p - (DD C) J `Q O V CZ N V r-j W < O CL z 3 a 3 Z 0) 1 N CD A "t w g CL C Q G O N C z a o R t N O A A tv ~ ti b N o b ~ oCD- ~a E AS BUILT SANITARY SYSTEM REPORT OWNER , e e, /4 e:. TOWNSHIPSEC . T `r -R%~ W ADDRESS f SX PIERCE COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE U ,yr PLAN VIEW Distances and dimensions to meet requirements of H63 YTHING WITHIN 100 FEET OF SYSTEM LEE- I - 1r I a I EL 00 s1 I di a e otthl Arrow f.t 1. -i- _ - - C / BENCHMARK: (Permanent reference Point) Describe: ' Ct c~ n Elevation of vertical reference point:_ Slope at site: SEPTIC TANK: Manufacturer: (.."{r.<- Liquid Capacity: -r:e Number of rings on cover C, Tank manhole cover elevation:-,!~K,r Tank Inlet Elevation: Tank Outlet Elevation: -o2.:> PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity distribution lines gallon: size o T- pump'"r-/') fj ; l head; gallon per minute horsepower gran name of pump and model number- Type of warning device_ TJ~ HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover `type of warning device SFE'11AGE PIT SIZE: _ um er of pits eet diameter feet liquid depth seepage pit in et pipe-elevation bottom of seepage pit e evation feet. SI' I'AGE BED SIZE: number cf lines width length tile depth Si`EPAGE TRENCH: width length I'E?RCOLATION RATE REA REQUIRED AREA AS BUILT DT 1" 1) PI.,UMI3ER ON J013 _ _ 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 ❑ ALTERNAT VE srarePlan LD.N mbe, (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure Mound NAME P RM IT HOLDER.,! A L R. INSPECTION DATE: BENCH MARK IPermanen reference poin ESCRIBE IF DI FERENT FROM PLAN. REF. PT. ELEV. . CST REF. PT. ELEV. /U 1 N ,f,,,, of P umber. IMPJK~PRSW N,, County Sanitary Permit Number. SEPTIC TANK/HOLDIN ANK: MANUFACTURER . LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: _ DYES ONO DYES ONO BEDDING. VENT DIA.. VENT MATL fLGAHRM WATER UMBER OF ROD PROPERTY WELLBUILDINGJVENT TO FRESH LINE, - AIR INLET. FEETFROM 1 r. ~ f ,s OYES ONO DYES ONO NEAREST- DOSING CHAMBER: _ MANUFACTURER REDOING LIQUID CAPACITY PUMP MODEL PUMP SIPHON MANUFACT URER'" WARNING LABEL LOCKING COVER PROVIDED: PROy1 DED: DYES ONO I J~/r "YES ONO YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 11H (iPERTV,~ WELL B LDINC I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE ' AIR INLET PUMP ON AND OFF) DYES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing f v1,11, 1111AMITER 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 C ? > CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DIS PIPE SPACIN(, COVER INSIDE CIA SPIT _ JLIQUID BED/TRENCH TRENCHES - MATERIAL: PIT DEPTH'. ""0'000~~" DIMENSIONS ° Hl1v(I II I DEPTH DISTR. PIPE DISTR. PIPE D!S .PIPE M TERIAL. NO. DISTH NUMBER OF PROPERTY W got L'. ILDING VENT TO FRESH eF LCV hIPES ABOVE COVER ELEV. INLE r ELEV- END. PIPES. FEET FROM ' L1N L'. AIR INLET- MOUND SYSTEM: NEAREST-_! 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. Ky_ ONO SOIL OVER. TEXTURE PERMANENT MARKERS. OBSERVATION WELLS E5 YES ONO YES NO DEPTH OVER TRENCH RFD DEPTH OVER TRENCH BED =TOPSOIL ISODDED SEEDED MULCHED CENTER EDGES f~ DYES C NO YES ONO F2 YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NLATERAL SPACINGJGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRNCHES DIMENSIONS 3 r - "N FOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING FLFV ELEV CIA ELEV. PIPES DIA.. f( t~I ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED _ PLANS DYES ONO YES ONO OP RTY WELL, BUILDING, COMMENTS:~ PERMANENT MARKERS JOBSERVATION WELLS. NUMBER OF PR FEET FROM P ! YES ONO DYES NO NEAREST- I o 11. ~'~nl 7 5 . S I.LS 0 Sketch System on Retain in county file for audA.., Reverse Side. p TITLE ATURE. DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS IN•DCJSTR,Y, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: 7 / ) ^(D Q iv t c ( e-s o 7(0 F/vv •~c C # f r~ /mot (eft/s Property Location: o n hip: Count 4/w '/a ✓W %S /T~ N/R /6 Or) W Q70710"r .,7 Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If a ' nevi TYPE OF BUILDING l Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: Q-1 or 2 Family Mate Approval Required TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY x"000 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER S OC MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): NEW ❑ Replacement ❑ Experime tal ❑ Seepage Bed ❑ Seepage Pit Alternative (specify) ,/~Ozi ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (if other than present owner): CJ Private ❑ Joint ❑Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N me of Plumber: - Si nature: I 9 MP/MPRSW No.: Phone Number: Plum is Address: * Name of Des' er: COUNTY/DEPARTMENT USE ONLY nitary Permit Number: gason e of Issuing Agen Fee: j ~ Date: APPROVED /f 7--,7 DISAPPROVED or Disa 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 (N.03/81) DEPARTMENT OF ` Y FE jtp U I L D I N G S INDUSTRY, REPORT ON SOIL BORINGS AN DIVISION t~ rr LABOR R HUMAN RELATIONS PERCOLATION TESTS (115) F',CIABOX 7969 IS ' WI 53707 i LOCATION: SECTION: 71)w O%SHIP/W4G R*tf'FY; LOT NO.: BLK. Q* SUB ISIO M ' ' /11 / /T' i NRM#d/f~ c~ f~. 17 COUNTrY: /OWNER'S BUYER'S N ME. MAILING ADDRESS: z~` oaf `CJ//` uE ! c` 3 G s. f~ C.~ ~'fc ~'rl t S 4le ~ct~ Lc. USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER~iAL DESCRIPTION: ence PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: New ❑Replace I f<;/ j~ ~7f t RATING: S= Site suitable for system U= Site unsuitable for system CONaVENTIONAL: MO: IN-GROUND-PRESS~IRE: SYSTEM-ILHOLDING TANK; RECOMME DED SYSTEM: (optional) ~ SS ~u' SS (u~{u' S OS 1J u F ercolation Tests are NOT required DESIGN RATE: SYSTEM EL V. [Floodplain, f any portion of the lot is in the er s.H63.09(5)(b), indicate: 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. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r O 7C r ~ s1~3 J ~ ✓~L ~~~ii Jy~ CC~ ~'li.l J.f! M l'•~`~ ~ ~ B 3 SL Sc 1- .-7 ~7 B- 3 B- ] t ur r ii 04 S. T3 a NOW o 2 i v,,y' z B- 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 P RIOD PER INCH P- / n c vt t u 5' / gr a/ P- A :z 1. " _ r ~I l jl y 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. q,5 SYSTEM ELEVATION s { v iZ.e orUKy~ Rabb,,, cak st4kC_ a 3Sao Ccirsz~~~^' ~ f ele C_ 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 ( t): TESTS WERE COMPLETED ON:~ 14 1-1 e. C C., ADD ESS: CERTIFICATION UMBER: PHONE NUMBER optional): CST SIGNATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DII_HR-SBD-6395 (N-03/8,1) b TOTAL HEAD IN FEET. i N cn w I WO a ~s C ~ • 100 ' I 2 oc m I I O p n rn p Q rz i <=WU)N Q o ( m o c @ iOrn0 0~ W rn m : v+ -4 -n o m 4 2E 01 ol o (n State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 a c Plan Identification Number 7 LL Re: L ~ Gql-I PRIVATE SEWAGE SYSTEM ONLY- L 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 Q_ J1 lt-l L 5Q -c7 and received for approval on i /Z y O The soil and site evaluation was conducted by Tlic A S A' STS Z4 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 Wastes from the building will discharge to a11200 gallon capacity septic tank which will discharge to a- 3n-gallon capacity feet will pump chamber from which a pump having a capacity of per minute against a total dynamic head of discharge through winch 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 conditions 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 By: County Other ' ~ Enclosures mes Sargent, B erector DILHR-SBD-6159 (R. 7/81) . ONS ti ~t3~~a t~.l l i Y { ~.S t 5µ _ c ~ L ~«c eC C 1 1-4 x i ~ 7 ~ ~pM C °CE I~iti Sd ' :'`f?lrl ~ J loc I JAN uLGESON TRUCKING, INC. 7,zan9 ,alley, Wisconsin 54767 ;.a= 77 RaT Q E\ <o ID co { \ A ~r.► + Q ZJ .a•~ JQ ,pQ t7 3i~~o dJ ~ - tin s s o LL o' o w co • Vii;; ''I ~ _a n=.. Cd S Ii En % + 1 s- I-- ~ N.2J r+ ' . 1~ • W• ~~~1 ~ cV(7 Cd LL W ' Ucf) Q +'t~ w0 ,h _ to U Q J , ~ a0 0 IUL J a J Ch p o ci N o ~ Vn h• U \ a 41 All 9 {a a Q/ 7r 'dTSLIOOS thk ` . Y I11 y s; s4.t 7~~~~yy r is ~ ~ ~%¢,.~4 f R y~~~LJr"wU.Li 1~ fi}'1np J ' Cl v 1., r* leg 101 nt s ✓."'['ap ._A / 'fir ryt{ `.r~ ~p j ` o 4 a a w o o I Q W t s C] a W w } a E- 1 d V° IL 44 de ..~J1 s. H t ~ 'Y~ 'i.~ tk Fn t ~t 1 .3 w T Y R .{C f Cr'5~ d n x I UJI C x u , W L LLJ k. 1 > d V~ t M t Q w s. rt . , N ~~..yy M -j -1z 00 w w cnQ _ :3 v Cl -j e '111 / Ji #I i r ~ r -7 ~ V r [+r~ ~ x .L 13-rLS.7EoOyyy) .F1." 'Sp Wr _ MODEL lkjUmt;l S' gin. A ~ nR C ~ MAtkj "?vQ O►J AND PUMP V - VAU (~za 1'e y' z 'tl t ~ `t _ , .7U P Dc EA, F C, C71 4, (r ~ s 1 +..GESON "TRG-i i, 3. . yy Y p~ Vmw 4 0 , t rat kw, #w t >~r t « r ~t * -ice t ht ~aasr# or i~ to a w~ it>b ttix 1 lid k lAiff. YB dwoom, w t i ~Y. i it, ii# ~s irldQ~t pfa~L► or a 00 lW mot be w, wbe w w o1j*w. it jw,* ►tn # l sib **AowW w4mW mA* bt Aaw". ' The 0ows per. fi!' s !I►t+ a~-+for+~ 44 C tT kiR t cad, Lake or Lem*~ k: area P'fatr f. ~:"y "IF Of BUILOOM 6ff aa#~+e4! K,,> i 7 Pul ie L 3 Varier at' Other Upwf +f" ; i or 2 Felrlify 5 A,L - UM►gE PP►!! PQUiIBQ-IN GALL t~ TAMi G' "i PLACE STEEL FIBERGLASS INSTALLATION WENT . 0-04 SEPTIC TANK CJ4pA NEW REPLACE } GlT\►' 14"E MG TAW CAPACITY Li FT PUMP TANKISIPHON GtfsA BER t~aANUFACTURER: t t FLUENT D1 AL 4 ";TEM I, A 'Mmum pet ku*4. Pft( SEf f r® tow).! ❑ r ~ApyE~ir+arlt ❑ EXpen tal ❑ Seepage Bad ❑ Serp~ ~t i j- ae +r ❑ SlopMp TIM M& 1+Na er s Y: Owner`: Name a [ aW Tat R+wport tit OMr tfian Peftem owner): l 'Nivote ❑ joint Pubhas I, the Undersigned, hereby aawr" respoonsibghy f~W ` live of the private sa i~ wspe system shown on the attached plans. Nmw f l1AP/#APR3W No.: Ph ms kwvb w , ~ eMw: r Nam! of Dec er. T flOWr~/DOMTMff USE ONLY : awl +rt s}# i+wE ew1: ~►V T 4 lfternatt #'Apst Auailq; *Aft r1,J/ ,77 n a YRIF or t..'Abw Rr77* f f9FRhi 40 b"0 unty IS / to be 4u M. to Vw pia. t ifPl.; 4i tmw* wif Vwd to m*wv t• Y ky "MS y µ ~ ~ - -ES _m y ST. CROI X COUNTY ' WI SC0 N S I N ZONING OFFICE 796-2239 HAMMOND, WI 54015 January 27, 1982 PLAN I.D. #82-00077 COUNTY #59-02-3 Division of Safety and Buildings Bureau of Plumbing P.0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Alton Helgeson property located at the NW of the NW Section 27, T29N-R16W Baldwin township in St. Croix County, revealed suitable soils at a depth of 25 inches, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:sl MEMO WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of st. Croix Location Nw _ 1/4 NW 1/4 S 27 T 2; N, R 16 E W Town or -Baldwin Street Address R.R. 1 t_ot No. Block Subdivision Woodville, WI 54028 Landowner's Name: Alton Helgeson The application for this site is to serve a: new construction use. ❑ replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: x❑ part of the 3%/5% limitation. This is number 1 of the applications made through this office. D-one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Q 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. I_Ja lot that meets the site criteria for a conventional private sewage system. If this a REPLACEMENT SYSTEM USE, the mound is replacing: ❑ a failing conventional soil absorption system. ❑ a 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. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signatuik~e Title -Assistant Zoning Administrator Date December 9, 1981 DILHR-SBD- 6158 (11.7/80) 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/Md*RA~ A ' S T 29 N/R 16 )W Baldwin Street Address: Subdivision: County: R.R. 1 Landowners Name: Mailing Address: St. Croix R. R. 1 'Alfon Hpjge~ion Woodville. W1 54028 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 pystem. 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. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin My Commission Expires: SBD 6678 (9/81) (Plb 100a) Detach And Return Upper STATE OF WISCONSIN DILHR DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O.BOX7969 9 MADISON, WI 53707 ( h 608-266-3815 DATE: r RFr~I)/F~~ PROJECT: i IAN 25 1982 ZONING OFFICE ) 27,20,1+ `it~r1 V11~;, 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 required fee is $ f Fee Received is $ ❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2) (a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if Il. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. 0 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. L❑ Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including soil data. size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Number L_ J ; i Re: CC PRIVATE SEWAGE SYSTEM ONLY- -9 5 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 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 for a Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to a -gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a -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 (33, 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 conditions 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, B erector SBD 6678 (9/81) (Plb 100a) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: 8 9 8 1982 r i rcq V~) ► ~ ION/N6 PLAN ID. # o DETACH HERE ~~'f! u+ fx - PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be Additional information required. SEE BELOW. held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement `or pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. III. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide soil data. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. V1. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester 0 Copy). ❑ Copy of onsite report by county or district staff. State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 ~p bm~ mPlan Identification Number i Re: PRIVATE SEWAGE SYSTEM ONLY- A) r ~ Opf" ' i. 1. 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 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 for a Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to a -gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a.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 conditions 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 7~/ T- DILHR-SBD-6159 (R. 7/81) mes Sargent, B erector