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41 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 o.
Street city County Sanitary Permit
as er um er irm a m e -Adaress
Journeyman VIUMDer Address
Owner ress
-
iscusse with igna ure
( )See Attached.
DILHR-SBD-6192(N.09/80) Signature o is um ing up. n- i e Waste Specialist
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner
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PAGE 40 210th ST `
Parcel 018-1004-50-000 12/21/2005 12:08 PM
PAGE 1 OF 1
Alt. Parcel 02.29.17.27A 018 - TOWN OF HAMMOND
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 - PEARSON, MICHAEL J & KATHLEEN
MICHAEL J & KATHLEEN PEARSON
2805 LISBON AVE N
LAKE ELMO MN 55042
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 513 PRAIRIE DR N
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
j
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 02 T29N R1 7W SW COR OF SW SW W 15 Block/Condo Bldg:
RDS OF S 53 1/3 RIDS OF SW SW 5 AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
02-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/19/2000 621546 1504/90 QC
10/19/1999 612334 1464/293 TD
07/23/1997 834/70
07/23/1997 829/409
2005 SUMMARY Bill M Fair Market Value: Assessed with:
89982 2,500
Valuations: Last Changed: 07/13/2004
Description Class Acres Land Improve Total State Reason
UNDEVELOPED G5 4.000 100 0 100 NO
PRODUCTIVE FORST LANDS G6 1.000 2,000 0 2,000 NO
Totals for 2005:
General Property 5.000 2,100 0 2,100
Woodland 0.000 0 0
Totals for 2004:
General Property 5.000 2,100 0 2,100
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
DEPAR ~_MENT 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 ❑ALTERNATIVE IS,,,.,, Plan I D. Numbe__
(If assigned)
❑ Holding Tank In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
r
~ItJi ILI, (~eC' ".:~X?.
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. BEE. PT. ELEV.: CST REF. PT. ELEV.
l f,.
Name ,f Plu be, IMPWPRSW No. Cy Sanitary Permit Number_
SEPTIC T K/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
❑YES LINO ❑YES LINO
BEDDING. VENT DIA.. VENT MATL HIGH WATER NUMBER OFD: JPROPERTY WELL JILDINC. VENT TO FRESH
ALARM LINE AIR INLET
FEET FROM
❑YES LINO.' ❑YES LINO NEAREST
DOSING CHAMBER:
M1AANl1F ACTl1REH BEDDING jL11IL 1 I I) C APA(: I IV Pl1MP MODEL P N MANUFACTURER IVIARNING ELABEL LOCKING COVER
PgOVI D ED
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF 1'1+(IE'FHTV 11111-L BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN _ FEET FROM IL NF AIR INLET
PUMP ON AND OFF) ❑YES L_1N_O_ NEAREST 110
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing N I I. j ,','I T r H 11CATI HIAL 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 DPIPE SPA( '.IN, COVE E2 INSIDE DIA =P1 IS JLIQUID
BED/TRENCH THFNCHes MATERIAL PIT DEPTH
DIMENSIONS_
I II'i DEPTH l) PIPE DISTR PIPE DISTR PIPE MATERIAL. NO DISIH NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
1: I'li'I AH()VE COVER 1FISTI?
E V INLF I EI LE V. END - PIPFS LINF FEET FROM AIR INLET.
NEAREST
--s►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑ meets the criteria for medium sand. TIONS MEASURED.
YES LINO
SOILCOVER rExruHE PEFE NI AN FNIMAHKERS OHS EEE VA T10NIN ELLS
❑YES LINO ❑YES LINO
DFP T11(IVE IF T HE NLII RFD DEPTH OVER IRE NCH BE1J P7H OF T(IPSCIIL S()DDFD SEEDFD MULCHED
CF NTFH EDGES DE ❑YES LINO ❑YES NO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
'vVIIITH LEN1;111 NO. OF LATEHAL SPACING. RAVEL DEPTH BF _L0 W PIPE FILL DEPTH ABOVE COVE H
BED/TRENCH TTRENCHES
DIMENSIONS IG
'.9ANIFOLD PUMP MANIE GI Il DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATT HIAI FL
E1 EV. Et EV. DIA ELEV. PIPES DIA
ELEVATION AND f.1,1HKIN(;
DISTRIBUTION _
INFORMATION ~I'OLESIZE HOLE SPACING, PRILLL D C 01111ECTL V FIR MATE R IAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES LINO _ _❑YES LINO
COMMENTS: PERMANENT MARKERS JOBSERVATION WELLS NUMBER OF PRIOPERTY WELL BUILDING
FEET FROM L NE
❑YES LINO ❑YES LINO NEAREST-
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITLE- -
DILHR SBD6710 (R. 01/82)
State and County State Permit # t 0Lj r`
PLB 67 of Permit Application County Per it # r
rJ X
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF P/R~OPERTY Mailing Address:
5 -"V,4`1 13r e qC1 114 92 a i 1 i r u P/'~v(, H u Soh W; 5
B. LOCATION: 51k/'/a '/a, Section 2- , T~N, R ONW) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# (p u j A M1! f -14 lage
Township 14 6, /M a4
C. TYPE OF OCCUPANCY: *Commercial *Industrial "Other (specify) *Variance
Single family Le"' Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY 1 000 Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New. [Z Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:✓ Length.! -Width Depth Tile depth (top) No. of Lines
Seepage Pit: Inside diamete Liquid Depth No. of Seepage Pits
Percent slope of land-_ 7 ` 7y 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 J a M^ 5 L° R L4- S G C.S.T. # ~O(G and other information
obtained from n e y P-1 a t A_
(owner/builder).~^^ ,q~ 2
Plumber's Signature +R MP/MPRSW# 1'1 F/ / Zhone #217- -3;
Plumber's Address n w ~v ~ t S c d I/1
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.
a _
{
gea I-~
t ~ t
2 i t t
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I
Do Not Write in Space Below FOR COUNTY AND STATE Q)~PARTMENT USE ONLY
Date of Application Fees Paid: State County Date
Permit Issued/It~ (date) 1 ] Issuing Agent Name
Inspection Yes No State Valid# yt"1 Date Recd
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 7/1/78
State of Wisconsin \ Deqait e f Industry, Labor and Human Relations
_ Please Reply to:
SAFETY & BUILDINGS DIVISION
-1 Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Plan Identification Number
Re:
PRIVATE SEWAGE SYSTEM ONLY-
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 By:
County
Other
Enclosures ~
mes Sargent, B erector
DI LHR-SBD-6159 (R. 7/81)
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
POST OFFICE BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of SL . Croix
Location SW 1/4 SW 1/4 S 2 T 29 R 17 R (or) W
down or Municipality Hammond Street Address 401 Mallalieu Drive, Hudson
Lot No. Block , Subdivision
Landowner's Name: St eve BF(-eu t t
The application for this site is to serve a:
`!J new construction use.
replacement system use.
If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to
be included as:
11 .]one of the 25 needing a quota number. This is number 1 0 - of the
applications made through this office.
(__]for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
for 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.
Ll an application on file prior to February 1, 1980.
U a lot that meets the site criteria for a conventional private sewage
system.
Hone of the first five approvals guaranteed for this year.
ro~end-~~ress re
It this is a REPLACEMENT SYSTEM USE, the tKi6MYtF1 is rep acing:
I Id failing conventional soil absorption system.
la holding tank that was installed and in use prior to February 1, 1980.
ka privy that was installed and in use prior to February 1, 1980.
~a lot that meets the site criteria for a conventional private sewage
I e'l t ity Inat. Lilt' abuvt' inturiiiation is true and accurate to the best of nay
k n ow l e d g e. y-,-, _
Siynature'-
-
z,,inty ~1!~f ~cIdl
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/Municipality:
SW ;41 SW ~41S 2 IT 29 N/R 17 X(or)W Hammond St. Croix County
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Steve Breault 401 Mallalieu Drive, Hudson, WI 54016
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
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
DILHR-SBD-6413 (N. 05/81) My Commission Expires:
ST- CROI X COUNTY
WISC0NSI N
ZONING OFFICE 796-2239
rr!f~ HAMMOND, W1 54015
Division of Safety and Buildings
Bureau of Plwiibing
,P.O. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Steve Breault
located at the SW of the SW Section 2, T29N-R17W
Hammond Township , in St. Croix County, revealed
suitable soils at a depth of52 inches, below which
seasonable high ground water was noted.
This site should be suitable for an in-ground pressure
system.
Should you have any questions, please feel free to
contaQt this office.
Yours truly,
Thomas C. Nelson
Assistant Zoning Administrator
TCN:sl
Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing, Platting & Fire Protection
Name ot,Premises a e an No.
17--/3- 5, Z_
Street County Sanitary Permit -47 F Mt b as er um er irm Name Address
yilia It ress
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( )See Attached. 00)
t, 'DILHR-SBD-6192(N.09/80)
n- as e; cia
2 White=Inspector Yellow-Local Inspector Pink-Plumber or Responsible '~arty- reen-0 r
r L"
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDVS"~ RY, G DIVISION
"LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
HUMAN RELATIONS
N, WI 3707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK, NO.: SUBDIVISION NAME:
/ 1/4svV z /Tz9 N/R a r r) W 4 >"M NA a
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
~_J i)( ST BSI ~ hf ,~f}' j~ - I +
USE Z,. DATES OBSERVATIONS MADE
NO.BEDRMS,: COMMER~ ALAL DESCRIPTION: / PROFILE b~SI ONS: A N' ESTS
Residence 1 IIJNew ❑Replace ~71"!
_r ! T
RATING: S= Site suitable for system U= Site unsuitable for system w
r ONVENTIONAL: MOUND. 1 u N-GRO ND-❑U RE: SY~S~TEM-IN-FILL HOLDING~NK: RECOMMENDED SYSTEM: (optional)
'r EI,i IN - C~
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: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST, IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
! •~1 2j ~3n 1 u; / C,
`"V
B-
B-2-
6,
6y ,no t'
r
B
-,P Y vr• ryi m i i'r1 p'~' 4- 11)) C~
B Y IZ ,r of 2 61 Si Zj Gy C
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t -_PERIOj P-R PER INCH
P- a t~i_ S i ~/~/ice 1 Y
z
P- 1 { t` A,I t -r'
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.
SYSTEM ELEVATION moo
P. I 1 or'.
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I ~!o field,
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210
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a- 11 6,9
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:
ADDRESS: CERTIFICATION NUMBER: [PHONE NUMBER (optional):
^ CST SIGNATURE:
~ A
DISTR!St.'TtON- ~`enu.?I .~nr+ n.),, -nPy t,, I o .tv n
' t
W Der .wr{ .i
L
INSTf,UGTIONS FOR ( OIAP~,ETING FORM 115 SBD 639n
Fia tlt' .;i '`t)a T1 Ftl Fltt'. ,n'~F C::' ->.tl t~}5t, + lti r;.'}r.7 ~t ;all! ~ 7t;li
I. t;ulalpiet%? Ir r,i i#e antic,+',;
rl. I"h F' (j4$5!'~;7ti"1!) tl"lt a$t i,I OS,iI A' i:iu i, .t .l~l :+;nS't ili~.I~~r to ,u k_:3C<N-Ef ~;€'1€~ la~?r Chi ji(<7pd C`t;
3. NIAXINIUTA rlwnber u1 tWdloorn" of c«arara~erci~ll ust' phoned
4. I, this a nety «r ieat,Idcenient systeavt;
5 , Wnailteta We sa.iiAaf Toy r,atinq boxes. A `AT-L I S SUITAHLE 1 o h A 1114 DIM! TANK ONLY IF ALI_
01-FIFR SYSTEMS ARE RULED OUT HPA -4-'J) ON Soil- CONDII 1,C)NS;
i. WASE me they abbremiamms shown hop 110 Wsiting POW d" iptiuns aaxl cumplrW6 the pilot Ilan;
7. MAKE A LEGAIL.E dactram accurately I«rating ymm test iu::idons. Diativing to scalar is pleferred. A
;epic Tv WW W a7t,7y 1W Wwl if desired;
j We sire YOW hum rovirk mad vo hod illevtatum lu1{>aremw point are ui'.taly shovvn, and aff- [?F'.I"ml Iwla;
9 Golrq&tea ad app: ropsriate boxes as to dmes, names, adr iums, HmA plain data, peic(, ration test exemp-
1!'wr it <apprOhrlizte;
10 It AW intotl7a IN01 N 11 an tl vi rlWL elevatlon) do,',s not ii} t-lv, il!,wf ;V.A. IIY tha -t,' clop iT atE, i4 x;
I 1 . Skin the; farm and jwt(:~' yon: r:urrent eddi($ and Your cerrlhcatic~;a Mmlber;
1 Make li,yihtr~. copies and distrituate as 01rlulr0d. ALL SOIL TES-IS NIUST BE F i _ED WITH -'rFiE
I_aii AL. ! l111-1 .)(ill Y A HNN 3i) DAYS OF CUIVIFI-L HOW
Al._it111EV1;!`1IOCo'S FOR CERI IFIE_D SOIL I ESTERS
Soil Setsw,sm and Terxtram (tth(m Symsys
Over 1C1 ) ilt - is"lra l r,
i3 10"1 S,,, t al t:.
U l'ci iland"i 3''; Lei - L.iriit's"i„
smid H6Vp - Flil.)h l.i; irill KlVda Cr 1'
t rdrSE Flal,t.l Prtc l'
Fs hnu ;~lrf;l E3{ci,p t ihh!ly
i}ii)il
1 hoo
Gy - Grr
goon (AV Lca v: H Is" t
iiity' Gl., I lTt la7at - 1lrc>t.,.:.
S. dy Clay
p:> p'ra.aTt:ar~: ;
,W tot vVateal
'I itttiu I i~ ,lasprt7sial BPs' 1:41 tsiW3
10 'T 11 E R
~}C'lt lw"' *:pol'i is the first shspa in securi ul a sanitary tstet mn. Lhn Ulm' f rip tha De:pza, .rienl may re"guest
thi ..:.1) ,a of ;ht' nCir_l [Alai Io prior! „'1a 16 ,t (>t p.N„ , IY,-' itw pli'vatl'
a;re: sy,tet i ano a n,,t rnit n!uo he sutmliltfa_i to th" ,,I.pmp n or l wnd arsEhmAy "i ca Aq to
I lphl 1,... ,-:t nor, ip .i;iAW t~ Wk :.ti ,.i aq a wlr.;dl.
N urn:, l~% ~50►L
State of Wisconsin ` Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
r- -1 Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
Plan Identification Number
Q- C
vzc - cd p T
Re:
PRIVATE SEWAGE SYSTEM ONLY-
~ , Q!~t i 7 tom;
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
0' and received for
approval on !:Z, /31, `9
The soil and site evaluation was conducted byZ
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 a /CAS`) gallon capacity septic tank which will discharge to a 752 gallon capacity
pump chamber from which a pump having a capacity of_4.2. L gallons per minute against a total dynamic head of feet will
discharge through a 2 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.
OWS
By:
County
Other
losures d'
mes Sargent, B erector
9-SBD-6159 (R. 7/81)
Tom:
f II. IN `ROUND PRk',"L kk ',T k Ml
s
• gaI 10. f oice Mam
Wk Minimum Dosing Rate gpm.
Z in.
m (nde and PROVIDf A OE IAII ED Diameter =
LIS 1 OI SIZING ON PLANS. 11. Total Dynamic Head'.
System Head = 2.S ft.
2. Depth to Ltmlung Factor {t ft.
3. Landslope = % Vertical Lift =
= L. ft.
4. Distance from Dose Chamber to Friction Loss !3, lo ft,
Distribution System = ft. TDri =
5. Elevation Difference Between 12, Pump Selection:
Pump and Distribution System = ft. Pump will discharge at least '4 D gpm
6. Absorption Area Sizing: at .11_, - -ft. total dynamic head.
N YIJR.OMItrC.
Area Required = sq. ft. Pump~Qdel~d manufacturer'.
Bed or Trench Length (B) = ft. Q MM
Bed or Trench Width (A) = ft. 13, Dose Volume:
Trench Spacing (C) = ft. 10 Times Void Volume of 49
7. Mound Height: Distribution Lines= gal.
Fill Depth (D) ft Daily Wastewater Volume T
_ 7• J gal,
Fill Depth Downslope (E) = ft. 4 Doses in 24 hrs. = Z ' S gal'
Bed or Trench Depth (F) ft. Backflow = J _ `tea" gal
Cap and Topsoil Depth (G) = ft. Minimum Dose =
Cap and Topsoil Depth (H) - ft. 14. Dose Chamber: 75'O
Volume = gal'
g. Mound Length:
End Slope (K) = ft.
Total Mound Length (L) = ft. Ill. CONVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. Wastewater Load, Total Dally Flow = gal.
Upslope Correction Factor = Use section H 63.15 (3) (c), Wis.
Upslope Width = ft. Adm. Code and PROVIDE DETAILED
Downslope Correction Factor = LIST OF SIZING ON PLANS.
e
Oownslope Width (1) = ft. 2. Required Septic Tank Capacity = gal.
Total Mound Width (W) = ft. 3. Percolation Rate = min./in.
10. Basal Area: 4. Absorption Area Sizing:
Infiltrative Capacity of Refer to Table 2 In chapter H 63
Natural Soil - gal./sq.ft./day and PROVIDE A DETAILED LIST OF
Basal Area Required = sq. ft. SIZING ON PLANS.
=
Basal Area Available = sq. ft. Required Area RECEIVED sq. ft.
ft.
11. If Standard Tables from Chapter Length =
H 63 are Used, Indicate Table No. Width = ft.
12. For the-Distribution Network, Use Numbers 5-14 in Section It. Number of TrenchesAUG 3 1 1982
Trench Spacing = ft.
11. IN-GROUND PRESSURE SYSTEM 5. Distribution System PLUMBING BUREAU
,C VL( 7-1 S ft. Lateral Length = ft.
1. Depth to Limiting Factor = N
2. Landslope = TIC NO =--rH -1 Z- % Number of Laterals=
O min./in. Lateral Spacing = in.
3. Percolation Rate =
loo, 5
4. Proposed System Elevation ft. Distance from Sidewall to Pipe = in.
=
5. Wastewater Load, Total Daily Flow: TO gal System Elevation = ft.
Use section H 63.15 (3) (c), Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL
LIST OF SIZING ON PLANS. Fill in All Items from Section III
Required Septic Tank Capacity = D gal
6• Absorption Area Sizing: V. SEPTIC TANK
Percolation Rate = / D min./in. 1. Capacity = gal.
Area Required = C,040 PG S~ ZJ 3~ / 7, S sq. ft. 2• Manufacturer:
System Length = ft. 3. Show Site Constructed Tank Details on Plan
System Width = ft, ~3 2 044 6 0
7. Distribution Pipe Sizing: ✓ VI. DOSING TANK
Hole Si,,e = In. 1. Capacity = gal'
Hole Spacing = r_ ft. 2. Manufaelurer.
Lateral LonRlh It. 3. Pump Manufacturer:
Lateral Site in. 4. Pump Model:
I.ArIal tipacinµ L • S It. 5. Operating Head= ft.
6. Flow Rate= gPm
Di%Llncc tunas 1idh will In Pipe
M. Ulslrlhwinn Pllw Dlschaipe Rale: 7. Show Site Constructed Tank Details on Plan Ate.
Numhcr ill I loic% Pri Pier
1 low Prl Pilw _..10 ppm. V11. HOI.UING 1 ANK
y. Manilold SiAna. 1. Capacity : % NI•~`
ypc (u+nlcl of cnrl) GEhX1~„L~L- 2. Manulacturer
Lengili = s ' It. 3. Show Site Constructed Tank allfon Plata
Diameter - 2 In.
-SHOW ALL INFORMATION ON PLANS- 1
DILHR SBD-6761 (R.03/92) p
-ell
7rCl C-'4
ALTE~h'F~Tt_
30 {
J N C- L N U S O IJ~ E. ; ti's
F
aye o~
E
~Are-5
o5S - T 10 1 Ia s~ o P , a
B~
/ pi P/p icL~rV, loo, pi br'` r-rw ,.;L
JGw
OL ~ ROO N ~ . CJrrb ~ tQ ~
% 7,
- ~ ~ Ofd ~LJGL
n
777 ::7.
E , . RECEIVED
r _ A U G 31 1982
PLUMBING BUREAU e v 5cD g;
8204460
'C~v till 1 rla~ •~i ~
Perforoted Pip* Detall
n
Eno Cop ~Perforated
PVC Pipe p~
ae~ Holes Located On Bottom,
S Are Equally Spaced
a x P s
' PVC Force Main
From Pump
1
C
Manifold Pipe Distnbulion 'I-, Alternate Position Of
Pipe Force Main From Pump
Lost Hole Should Be
Nest To End Cop - 1
End Cop
Distribution Pipe Layou P 30
k t~I OT L, ' • Y1& -t Ivy V" I LJS E. 3o sp~►f.i~, R -
~cr I fa-D2 4
pipes 15~'k=lBurl on S
i EA Ua Pi t~Qr 1v 6Gc' _1cvM JX 3,s'
N c W wa
Y
Signed: Hole Diameter '14- Inch
License Number: //I- Lateral I Inch(es)
Manifold z Inches
Date: Force Main _ Z Inches
4
820446
-3 X
RECEIVED ' o~ CRT A.
I
C: J
AUG 31 198(.
PLUMBING BUREAU t1
I
6
loom
,Mh
ENS 0` P SPA
E
p~PP~-~M N,` u
E O
CROSS SECTICAJ OF A BED SYSTEM
RECEIVED
A U G 31 1982
PLUMBING BUREAU
N O P>~a Pc~ c iv STS n Vv ' I_
SOIL FILL 2" OF A&(,Rt .GATE.
DISTRIBUTIOII PIPE-,
APPROVED S~:ILITHCTIC COVER
MATERIAL OR 9" OF STRAW
GR MARSH NAy
o OF %2 - ~'/2 AG&RCGATE
ELEV. DFA0Q,!jFEF-T_,,
DISTRIbLITIOU PIPE TQ BE AT LEAST 62 'UCHE5 BELOW ORILIAIAL GRADE
AQD AT LEASTkO I►JCHES BUT WO MORE THA.J 42. INCHES BELOW FIAIAL GRADE
MA'01AUN, ULP; II C.)t 6KCAVATIOIJ FROM ORIGIQAL GRADE WILL BE IIUCHES
MINIMUM DCP1 H OF EXCAVATIOIJ FROM DRIGIUAL GRADE WIL ' INCHES
C
A
ROB R T
SIGQED: I CU-17i
r~~Z ter' ,~iL~`'
LIC L Q 5E UUMBE R:
UA I
82o4 ff--