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HomeMy WebLinkAbout028-1001-40-000 n cn o g-0 0 d o w c o cD \ - ' m 7 v ~ nl co ~ C A, 3 3 p ~a Cr' o z o ON T o o d- of N o m iv ~o L rn ro ro io ca Q =r oo CD :-4 N) CL CD .0, 3 C) ' O) C O d O O O l'`-. W O O to cn C v O fl1 N CD cn O N CL W 0 _ rn O co L V O\ OD ill ~1 z C-) r- cn O co co N O+ C 3 ~ Q 0 0 0 .dr• G OZ 0 0 0 07 A o' 3 w N N N i ro ~f O O ~I v G -0 O O CD ~l O (D ro (D O SD vi = CD ' d L !V (D SD Q O S U) O T N U) N a o D D o ° • o CD C I ro O Cl) m a CD -i fn O0 O A Z M N ~ n A Z O_ o ~ ~ W m (D 03 EL c 3 A ~ o m 3 N e` 'CD A `r ro V r~~ = Q SD ~~ll ~ C µ S (D ro 00 T o o a m O ro ff SD C m ~ ~O ~ O N O A 0 N • :3 o CD Up b a 0 O ~ O r Parcel 028-1001-40-100 12/19/2005 02:56 PM PAGE 1 OF 1 Alt. Parcel 1.28.17.4D-10 028 - TOWN OF RUSH RIVER 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 - LARSON, JEFFRY L & TAMELA A JEFFRY L & TAMELA A LARSON 572 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 572 HWY 63 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 0.710 Plat: N/A-NOT AVAILABLE SEC 1 T28N R17W PARCEL IN SE NE COM ON W Block/Condo Bldg: LN HWY 63,12 RIDS & 15 FT S OF N LN, TH W 17 RDS, S 7 RDS, TH E 17 RIDS TO W LN Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) HWY 63, N TO POB; EXC PT TO HWY PROJECT 01-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 02/13/2004 754183 2509/242 EZ-U 03/17/2003 701567 2074/063 WD 10/08/1999 611814 1462/167 WD C 2 2005 SUMMARY Bill Fair Market Value: Assessed with: 82652 176,400 Valuations: Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.710 16,300 157,500 173,800 NO 05 Totals for 2005: General Property 0.710 16,300 157,500 173,800 Woodland 0.000 0 0 Totals for 2004: General Property 0.710 6,000 80,900 86,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. t'OX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Num"' (lf assigned) ❑ Holding Tank ❑ In-Ground Pressure ®,Mound L NAME OF PERMIT HOLDER . ADDRESS OF PERMIT HOLDER: INSPECTION ~agDATE BENCH MARK (Permanent reference pointl,DESCRd E IF DIFFERENT FROM PLAN REF. PT. ELVE V.: CST REF. PT. ELEV. j T y I 1 Namt" tit Plumber MP/MPRSW No.. County Sanitary Permit Number. C7 (",CI SEPTIC TANK/HOLDING t4NK: MANUFACTURER. LIOUID CAPACITY. TANK INLET ELEV. 1ANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED ,g YES LINO ❑YE6" ,E] NO BEDDING. VENT DIA. VENT MAIL HI(;H WATER NUMBER OF ROAD * 1PR OPERTV WELL. BUILDING. VENT TO FR•1SH 9 ALARM LINE - AIR INLET,/ I ` ❑ FEET YE6 NO NEAREST--._ •rZ_-+a ~U ❑YES ONO DOSING CHAMBER: M ANUS ACTURFH BEDDING 1I OUIO(.APACITY JPUMP MODEL P UMPi SIPHON MANUF WARNING LABEL LOCK TTfREH COVER T PROVIDED PROVDED. ❑YES LINO YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF I 'IPFRTY wFLL jB11111N (VENT TO FRESH 01 (DIFFERENCE BETWEEN FEET FROM A AIR INLET PUMP ON AND OFF) YES L N NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at t d pth of plowing LFNCTTI TrH MATERIAL AND MARKWc, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN (j/ CONVENTIONAL SYSTEM: VIDTH LENGTH N) OF I DIS R P ;IN( COVET INSIOE Oln PI7S LIOUID BED/TRENCH N, S MATFHIA1 PIT DEPTH DIMENSIONS -I I),_ T7 1'. DEPTH I)ISIH PIPE H IPE IST PIPE MATERIAL. NO. DICTH INUMBER PH OPERTY WELL BUILDING. VENT TO FRESH I' P FOVE covEll EI Fv INLI I END PIPES FEET FROM LINE AIR INLET NEAR EST--~~ 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. ES LINO SOIL COVER " F)FTORF PERMANENT MAHKFRS OBSERVATION WFLLS YES LINO ES LINO DFPTHOVEH TRENf:H H111 UEPTH OVER THE NCH BED TT(rl OF TOPSOIL„, SODDED ISEEDED MULCHED C:FNTER a E""ES ter " ' ✓ , I ❑YES NO YES LINO ES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH I FNTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COV_ Ii BED/TRENCH ~a TRENCHES DIMENSIONS A "IAN PUMP MANYOI U DISTR. PIPE MANIFOLD MATERIAL ! Nn -DISTH DISTR. PIPE DISTRIBUTION PIPE MA TLHIAI & ^.tAHKIM1(; FI FV. EL - DIA E r, PIPES ELEVATION AND DISTRIBUTION INFORMATION HOLE SITE HOLE SPACING DHILLLDCOHHECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS , G ES LINO J41YES LINO COMMENTS: PERMANENT MARKERS.,. OBSERVATION WEL LS_ [NUMBER OF PBUIIILDINGFE ET FR YES LINOJYES LINO EARESTOM d Sketch System on Retain in county filer audit. Reverse Side. SIGNATURE IT)ILE -yam DILHR SBD 6710 (R. 01/82) DEPARTMENT GF ` APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LAB6R AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 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: Willard Kimberly RR 1, Baldwin, Wi 51002 Property Location: City, Village or Township: County: SA '/4 NE '/4S 1 iT 28 N/R 17 E (or)WQ Rush River St. Croix Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: u. s. HIWAY 63 (if assigned)8204 90 TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: Q 1 or 2 Family *State Approval Required. 4 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 1250 1 x X HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER 1000 1 I A MANUFACTURER: Weiser Concrete Products EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New 0 Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit 30 504 ❑ Alternative (specify) Mound ❑ 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. Name of Plumber: Signatur MP/MPRSW No.: Phone Number: Stephen L. Aaby MP 5184 (698)2407 Plumber's Address: OF Z-" I Name of Designer: Box 254, Woodville, Wi Stephen L. Aaby COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent:- , Fee: r Date: Sanitary Permit Number: ti APPROVED ❑ DISAPPROVED 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 DLHR-SBD-6398 (N.03/81) IND DEPARTA5'04T-O~F O ' REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IND;~TRAND y, DIVISION -i PERCOLATION TESTS (115 P.O. BOX 7969 HUMUMAN RELATIONS \ ) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) U LO N: E TION: TOWNSHIP/MUNICIPALITY: OBILK. DIVISION NAME: S F, % Nk4 i /T 2tfl/R 1°]E (.,(W austh River .COUNTY: OWNS NAME: MAILING ADDRESS: 3t. Croix Willard Kimberly fiR 1, Baldwin, Wi 54002 JSE ( DATES OBSERVATIONS MADE NO. BEDRMS : COMM AL DES RIPT ON: PROFI D RI IONS: CATION ESTS ®Residence 4A ❑ New ®Replace 6/16/62 61 16162 -1 1 GATING: S- Site suitable for system U- Site unsuitable for system :0!ff!Nj T NAL: MOUND: IN-GROUND~RESSUR S S EM-IFILL HOLDING TANK: RECOMMENDED SYSTEM(optional) S ~U ~C~S ~UC~S ®U ~U ®S ❑U Mound. 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: N/A Floodplain, indicate Floodplain elevation: Iy/w PROFILE DESCRIPTIONS 4UMBER TOTAL P R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH VIJMBER DEPTH IN, ELEVATION BSER H TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) B l ~g 921 74 None 364 74 BL.s11, j5n x. 91, 64 c 1 'B- 2 39 94' 34 None) 264 94 Bl.sil, 2/~4 A. el, 64 C 37 ' None 244 94 Bl.sil, 224 H. el, 6" c k B- i PERCOLATION TESTS Pere Hole ~levati~ns TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES DUMBER INCHES AFTERSWELLING INTERVAL-MIN. I p __PRIOD2 P PER INCH 1 n 4 4 P- 1 2 NO 30 2 24 No tt -----i 1 0 u 2 a_ 0 l 1 la 30 a_ 2 No 0_ 1 N-- 1 n--- - 1 n 20 r j N v i a OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon ital 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 ,'land slope. y STEM EL F. EVATION 95} 9 P ~ftk 1►+ 10 -;Atai~ N*Lt N mnR~ OF of- LP CeA$ 7'ArJk` IOA I 1 'i 11~' BPR~, N4~1 ( K i ♦-t SIPW- 4 rl*K; •~W~u. x~I S~~P►~- .j ' ter' i 40 ~ Na~c s~ ~ I I - 1 11 2f A i ;x 1716 ; -t T (x I P I iX i ~ 5~ ~~oF ~ ~ 5• r-~~K.,n I IT he undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified m the Wiscons n ministrative Code, and that the data recorded and the location of the tests are correct to the bust of my knowledge-and laaliet. ME print : TESTS WERE COMPLETED ON: Stephen L. Aaby 6/16/62 ,DRES : CERTIFICATION NUMBER PHONE NUMBER(_tptionall Box 254, Woodville, Wi 1406 696_2407 cST SIGN~A T _ E - _Z '4 TRIBLITION: Original and one copy to _ocal Authority, Property Owner and Soil Tester. _HR-SB"395 (R. 02/82) OVER w ~ ct . ,'LAN APPROVAL DIVISION OF SAFETY & BUILDINGS BUREAU OF PLUMBING APPLICATION PRIVATE SEWAGE SYSTEMS 201 E. Washington Avenue, Rm 178 P.O. Box 7969 Madison, WI 53707 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are receive,'. 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) Name of Submitting Party (Plans returned to same) Project Name W tHa- 4 Kirnkc-dy 11 Street & No. Project Location - Street & No. or Legal Description t 1 boa-),- 5 City ( n State Zip Code City County UwIO~IJ~n ~Ll 0 02 Village of -0 t Town Designer Telephone No. (Include Area Code) 2. THIS APPLICATION IS FOR A: ❑ New Mound System (3) ❑ Holding Tank (2) ❑ New Pressurized System on site not suitable ❑ Petition For Modification (6) for conventional (3) Replacement Mound (4) ❑ Replacement Pressurized System on site not ❑ System in Fill (1) • suitable for conventional (4) ❑ System in Flood Fringe (1 ) ❑ Pressurized System on site suitable for ❑ Groundwater Monitoring (7) conventional (1) ❑ Conventional System - Public Building (1) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE 3a. 750- 1,500 gallon septic tank 25.92 4a. 2 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. _ 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 3j. 4,001 8,000 gallon pump chamber - 58.32 4j. 3k. 8,001 12,000 gallon pump chamber - 71.28 4k. 31. 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 Mollification 27.00 4q. Subtotal 3r. Walk-through plan rt!vicw: 41i. Submittal of plans in person, by appointment, with double tee CY Total Fee ~~f J ON COMMENTS: Q~V~~~1i• DILRR SBD-6748 (N. 03/82) --OVER ilsceru••rc+N,, , A OPTIONAL WORKSHEET y/'vl 6. MOUND SYSTEM 11. IN ROUND PRESSURE SYSTEM-Continued- 1. Wastewater Load, TUlal Dally Flow p C) gal. to. Force Main: Use wcIton it 6.1.1.5 (3) (c), Wis. Minimum Dosing Rate = lo)<) tipm Adm. Code and PROVIDE A DkTA1LED Diameter = III LIST OF SIZING ON PLANS, ' r 11. Total Dynamic Head: 1" I = 2. Depth to Limiting Factor System Head 2.5 it. 3. Landslope I % Vertical Lift = - II. 4. Distance from Dose Chamber to Friction Loss = 1 ft. Distribution System = ll U ft. f0iI - 1191 It. 5. Elevation Difference between 12, Pump Selection: Pump and Dlatrlbutlon System ■ ft. Pump will discharge at least gpm 6. Absorption Area Sizing: at 11. 4Z ft. total dynamic head. Area Required = S sq. ft. Pump model and manufacturer: L Bed or Trench Length (B) ■ ft. 2 ° * 1l_ Bed or Trench Width (A) ■ r~ ft. 13. Dose Volume: Trench Spacing (C) ft. 10 Times Void Volume of 7. Mound Height: ` Distribution Lines gel. Fill Depth (0) _ ft. Daily Wastewater Volume + Fill Depth Downslope (E) = 5 ft. I a{ S 4 Doses In 24 hrs. _ gal. Bed or Trench Depth (F) _ .75 ft. Backflow - gel. Cap and Topsoil Depth (G) _ ft. Minimum Dose = 4b~_)L-l gal. Cap and Topsoil Depth (H) ft. 14. Dose Chamber: g. Mound Length: Volume ty[~ gal. End Slope (K) _ tt, lo. S Total Mound Length (L) it. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Dally Flow = gal. 10 Upslopo Correction Factor Use section H 63.15 (3) (c), Wis. Upslope Width (1) ■ _ 1t. -12'L Adm. Code and PROVIDE DETAILED Downslope Correction Factor ■I LIST OF SIZING ON PLANS. Downslope Width (1) ft. I 1 , S 1 2. Required Septic Tank Capacity gal. Total Mound Width (W) 1 A~5 ft. 3. Percolation Rate min./in. 10. Basal Area: 4. Absorption Aroa 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. ~4rt (r::~ Required Area = sq. ft. 11. If Standard Tables from Chapter Length = --r- ft. H 63 are Used, Indicate Table No. Width = it. 12. For the Distribution Network, Use Numbers S-14 In Section 11. Number of Trenches Trench Spacing = ft. 11. IN-GROUND PRESSURE SYSTEM S. Distribution System: I. Depth to Limiting Factor - ft. Lateral Length - ft. 2. Landslope = ed Number of Laterals 3. Percolation Rate = min./In. Lateral Spacing = in. 4. Proposed System Elevation = "'q 1..5 ft. Dlstanco from Sidowall to Pipe = In. 5. Wastewater Load, Total Daily Flow: GVUQ_ gal. System Elevation = fl, 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 Iterns from Section III Required Septic Tank Capacity ■ 0 D gal. t3204590 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = -sL _ min./in, 1. Capacity = gal. Area Required = 100 sq. ft. 2. Manufacturer: 1{~ System Length = ft. 3. Show Site Constructed Tank Detaa~T System Width - ft. 1 C, 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Slie = In. 1. Capacity = J gym Hole Spacing it. 2. M.Inulaclurer: Lalcrai Length It. I. Pump Manufacturer: Lalcl.d Siic In. 4. Pump Model: 1 afer,ll Spacing II. S. Operating Head= ft. Di.lanLt. Ilmu hidewall 141 1,11)v 6. I low RaIC- gpm. X. DlstiibuIlml Pipc DkOhelge Rale: _ l 7. Show SIIC Constructed Tank Details on Plans Numhct ul Iluics 1'cl Pipe I low 1't'I I'Iiic glott. ~I 7 VII. HOLDING I ANK 'I. Mamitild Sliulg: { 1. Capacity Kal. 1 ypC (LCnICI 01 011(l) r l~ 1 CJ 2. Manulacturcl: Lntgth It. 3. Show SIto Constructed T ank DeUlls /)`I Plans Diameter -SHOW ALL INFORMATION ON PLANS l t" P~.:r~( 2 ~ cc G'T e C ~ y I [ y i r o c P' y ~o v 0 r ~ _1 J d ` T J 1+ cr - 8204590 ~ ' lON ! t ~ P~ tZV4,~,~e% Page 3 Of Perforated Pipe Detail ~l r End View PerfOrUlBtl End Cop- PVC Pipe oae.~ C e Holes Located On Bottom, ~s Are Equally Spoced to l,b ~ s ~PVC Force Main / From Pump PVC \ .7 - Munlfola Pipe U.tr oution Alternate Posltlon Ut ~i Pipe For;• Main From Pump L U61 Hole Should Be 15 Next to End Cop End Cup Oihtnbutlon Pipe Layout P R 7' S J S ! rr y o~ Y ~.S Hole Diameter I~ Inch Signed: X., Lateral I~y in( h(es) License Number:% Manifold it 3 Inches Date: Force Main Inches $204590 ~Q SEA N t4olo ~ Mr,(Jv ;)i4 l 01 pa8 V 6111sr) I?l,noyy 10 MOIA Un{,4 S1aNJI)A IURUDwJad edld UOIiDAJORgo I alo6aJb6y ed!d Z 06 S 0 .?Iz z1 JO Pag uolinglJlsia dwnd woJd - Q M I ---edid UOIIDnJasgp "li M _ 10 UolJlsod @IPU.JRIld ` I d N IA 0 :.JaqumN 9sua311 :p9U6LS 0 r~ S DaJd uolldlosgd 94.L Jod peg d S L ° d 3 6uisn welsAS punoyy d ;o uoiloeS ssoJ:) 5'I r a r Jarto-1 dwnd woJd e1060Jb6d POmOld UIDyV 0OJO-4 J0 Peg •dolS % Ilosdol H puDS wnlpoiN add uoiinquist4 ~6uiJenoO OlleUluAS Jo IADH LISJDV4 'MDJiS 40 T abed PAGE OF r PUMP CHAMBER CR055 SECTION AND SPECIFICATIONS -VENT CAP 4"C..L. VENT PIPE WEATHER PKOOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MIU. I AIR INTAKE GRADE I y" MIN COIJDUIT INLET PROVIDE I A.IRTI>;.HT SEAL I III i I APPROVED JOINT A I III APPROVED JOINTS W/C.2. PIPE I I I W/GI. PIPE EXTENDING 3' ' I, I I I ALARM EXTENDING 3° O►ITC) DEPA ONTO SOLID SOIL SOLID ~Gi l_ g ON gWSVED C ;,Y c~, _ tR a1,5D PUMP C91FF P - 192 D PL t NG SECTION CONCRETE BLOCK RISER EXIT PERMITTED G"Ly IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC.IFIGATID AIS 8204590 =PTIC AND )SE TANKS MANUFACTURER: Wt' S of NUMBER OF DOSES: PER DAy TANK IZE . 1000) GALLOEJS DOSE VOLUME: f 89' S-7 GALLONS ALARM MANUFACTURER: _ Tan CAPACITIES: A= INCHES Io GALLONS MODEL IJUMBER: _ B=2- UI CNES OR -.11.3 GALLDMS SWITCH TYPE: C= 10% INCHES OR 129-9 -9 GALLOiU5 PUM11 MANIIFAC.TLIRE R: Zp~' leAl D=_IkWCHES OR 1 1• E GAt-LQUS MODEL NUMBER: 2~ -7 -7 NOTE: PUMP AND ALARM ARE TO BE SWITCH TJPE: efir L,( r'4 INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE s -7 7 G PM ~lArc. • c~ = 3~. 1 `t ``k VERTICAL DIFFERENCE 5LTWL6N PUMP OFF AND DISTRIBUTION PIPE.. " FEET + MINIMUM NETWORK SUPPLY PRESSURE , . 2 5 FEET 100 FEET OF FORCE MAIN X A-7 F ',FT_FKICTIOU FACTOR.. A7 FEET ,y TOTAL DyNAMIL HLAD I I FELT sr f p4 Q, , ' INTERNAL DIMEIJSIoNS OF TANK: LENGTH-TR , I "UMBER ; I i A I E S-. .00, 4 1 STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN KL LA'li0NS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM j 7ation: Township/Municipality: ? 1 NE S 1 T 28 N/R 17 i(or)W Rush River Beet Address: Subdivision: County: iral Route 1 .Idowners Name: Mailing Address: Lllard Kimberly R.R. 1 Baldwin, WI 54002 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. 8204590 / Z-2 f V-41 1-2 •r....Y.1 Signature o Applican Date TE OF WISCONSIN Subscribed and sworn to before me SS'. NTY OF _St . Croix This day „i August 195-. C3 V-y %0 Notary Public, State of Wisconsin My Co ; B p i r ( N G ST. CROI X COUNTY W I SC O N S I N 1 yi. w" Sao-.• 1, '~«b ZONING OFFICE 7 9 6 - 2 2 3 9 D k~. s HAMMOND, WI 54015 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, W1 53707 Dear Sir: An on site investigation for the Willard Kimberly property located at the SE of the NE , Section 1 T T28N-R17W Rush River Township in St. Croix County, revealed suita- ble soils at a depth of 29 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. YQur~p- truly, Thomas C. Nelson Assistant Zoning Administrator TCN:wjo .8204590 REWVED PLUTA61iia 3EC'[t0rv` I 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 SE 1/4 NE 1/4 S_ I T 28 N, R 17 9- (or) W Town or Municipality Rush River Street Address R.R. 1, Baldwin, Wl Lot No. , Block Subdivision Landowner's Name: Willard Kimberly The application for this site is to serve a: ® new construction use. x❑ replacement system use. • If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: ❑ part of the 3%/5% limitation. This is number of the applications made through this office. ❑ one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑ an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ❑ a 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. 8 2 0 4 5 9 0 ❑ a holding tank that was installed and in use prior to February 1, 1980. Da 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 knowled Name T^~~-s h ~i> Title Assistant Zoning Administrator Date August 23, 1982 ri1 Ut;►~~►~(3 SEC110N FtPARM%t' r• NT-OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ?IDU~TRY DIVISION .ABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) vl MADISON W1 3709 (H63.09(1) & Chapter 145.045) OC N: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: S9 14 NY4 ! /T 2JI/R 17E (or(W Rush River ;OUNTY: OWNE NAME: MAILIN ADDRESS 3t. Croix Willard Kimberly Rid 1, Baldwin, Wi 54002 ISE DATES OBSERVATIONS MADE d NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE D RI IONS: tPCOLATION TESTS: 1 I-SResidenca ❑ New [L] Replace 4/16/i32 6/1S/d2 IATING: S- Site suitable for system U- Site unsuitable for system :ONVENTI NAL: MOUND: IN-GRO17N~~V` OLDING MENDED SYSTEM:loptional) O S lu ® S ,U ® S ❑U Mound _ DESIGN RATE: Percolation Tests are NOT require If any portion of the tested area is in the * / - rider e.H63.09(6)(b), indicate: N/A Floodplam, indicate Floodplain elevation: +Y A PROFILE DESCRIPTIONS `ORING TOTAL ELEVATION DEPTH R UNDWATER-I CHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN, BS R TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) a3- 1 .48 920 70 None 360 7" BL.sil, 35" R. sl, 6e c 3- 2• 39 94' 3e None 26" 9" Bl.sil, `I)." R. al, 6" c 3- j 37 94r e None 24a 9" Bl.sil, 22" K. cl, 6" c - 3- !3- PERCOLATION TESTS Perc Hole :levati~:ins TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L VEL-INCHES RATE MINUTES LUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PER10D2--- _ PER INCH 1 2 No 0 In l" 1" 0 2' 2 24 No 30 1" 1" _ 1" 0 ' 6" 2 No 0 lip 1 " Jim 20 94"J" OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon ital 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 land slope. YSTEM ELEVATION 95' 90 -IRR'r- N! $ ` f /►1n~K rot' 0P LP GWAS-rAtJk`IOO'1 ~ 1!r BwR~; NQL~s a I ~ I i i ~ ~ • w~u. I n x 40 Naus& x A --A op X* t~ k P-1 I J5~ o Nrr t 1 N n I SBD 6678 (9/811.0ty1009) 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: :,NE,1,28, , Rusty R i wa Avij' 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 $ 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 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. ❑ 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. Ill. 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. I ~ y • r 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 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 T Other C~Jiy/ YE~1ti(_/ Enclosures mes Sargent, B erector DILHR-SBD-6159 (R- 7/81) 12-81 ST. CROI X COUNTY y i WI SC0 N S I N ZONING OFFICE 796-2239 HAMMOND, WI 54015 April 19, 1982 Dear Sir: I am enclosing the forms for application for a grant from the Department of Natural Resources for failing sewer systems. You may be eligible for a refund of up to 60% or a maximum of. $3,000 for the replacement of your fail- ling system. Please fill out the enclosed pamphlet. Give the single bid sheet to the plumber you have chosen to install your system. Return both papers to us as soon as possible, with a check, made payable to St. Croix County Zoning, for-$150, which will cover administration expenses. Permits must be taken out by the plumber before we can sub- mit your application. However, your system does not have to be installed prior to application for the grant. When we receive the approved grant request from the DNR, we must submit a copy of both sides your cancelled check or money order, for payment of your system and soil test, plus the itemized billing from the plumber, oii his invoice. Should you have any questions, please feel free to contact this office. Your truly, l ` Harold C. Barber s l Enclosure