Loading...
HomeMy WebLinkAbout040-1098-60-000 r ~ I.I O y v 7 CD 2 "0 3 M 2. 2. _0 5 A) # CD 1 fD 3 ~ o v o ° rn m n w k O Q 7 3 O_ N N d l pNp C FBI N CD CD n C71 0 j° m C N M W co 5' 0 r') CL M 0 ~7 CD 00 O ^ 0 C,) =3 (D OC) o CD n CO 0 cn r- m o 0 ° 0 y c D 5 CD D a (on m N m o D. m Q m o ° (D N) 0 0- 0) (D 00 N co (D n n p C n ~ d C h • Ev ~-1 ~o <NZ 0 3 cn cn N:3 o D ti CD 07 m m y = A m CD CC D (D m z N z co T j D~~v O ° N o' cn c CD =3 • N DD N n. A (V C A C ° D N W ~ ~ N a 3 0 o a - -A y m p z m n A z O 7 Z N Ut 00 M m co a ~ z 0 3 3 C~ y z < CD ? o E D * XN a N =3 y C - :3 rj M. :3 CD N N = CD ° n z 0 Er m C) x m n o 0 0 ° m Q 0 C ti m 0 n a 77 . C_ F N y d Cil A ° ° m O W A CC ° N N CD y O C) CD -5 a Oo Oo Q Ul ti fD FAQ V 0 L Cl) 69 ° ti W ° ya Parcel 276-1106-40-000 03/31/2006 10:40 AM PAGE 1 OF 1 Alt. Parcel 25.28.19.885 276 - CITY OF RIVER FALLS Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/29/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner CHRIS M KUSILEK O - KUSILEK, CHRIS M MARK B C - SYLLA MARK B SYLLA 186 CTY RD U RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 186 CTY RD U SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 7.260 Plat: 0979-CSM 04/0979 SEC 25 T28N R19W PT NE NW LOT 2 CSM Block/Condo Bldg: LOT 02 4/979 (7.260AC) ALSO TRIANGULAR PARCEL ADJ. TO ELY SIDE OF LOT W AS DESC IN Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 624/8 ANNEXED * 6/5/02 * 1905/055 FKA 25-28N-19W NE NW 040-1098-60-000 (388E) Notes: Parcel History: Date Doc # Vol/Page Type 10/09/2003 743183 2432/465 WD 06/05/2002 860936 1905/055 AX 624/08 2005 SUMMARY Bill Fair Market Value: Assessed with: 133726 1,413,600 Valuations: Last Changed: 05/27/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 7.260 118,600 1,003,200 1,121,800 NO Totals for 2005: General Property 7.260 118,600 1,003,200 1,121,800 Woodland 0.000 0 0 Totals for 2004: General Property 7.260 118,600 1,003,200 1,121,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT t TOWNSHIP 'At } SEC m t. N R/1' ' i~' ADDRESS , _ _ ST. CROIX COUNTY, WISCONSIN. . 3DIVISION Q LOT __._.L.OT• SIZE PLAN VIEW J✓~ j cr 1, J. Distances & dimensions to meet requirements, f H62.20 71~, Y i SHOW EVERYTHING WITHIN 00'FEET OF SYSTEM 10- 77 7~ 7- 'q T'ro Al 3C-Wcti MARK 1 ~ 3 i C'L'URT In,F:~1Sr -T M 4N #C 1z 0-1 "Vz 7 99 •,~y S►~~:.il. - ~ t P i ~ e~. T_R iii t~.. A 7,y f ' 'TIC TANK (S) MFGR. CONCRETE STEEL NO. of rings on corer Depth DRY WELL "`dCHES NO. of width length area no. of lines width length area " - depth to top of pipe ' 1REGATE RATE. AREA REQUIRED AREA AS BUILT ~r claimer: The inspection of this system by St. Croix County does not imply complete ?liance with State Administrative Codes. There are other areas that it is not possible j- nspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted the County will make every effort to ermine cause of failure. ;ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. "INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER :j.' KIPORI Of INSI'[CTION IN'01VIOLIAI SIWAG L SySTLM S ((n ( (-a 'I (p I' c h rri ~ ( ~~Q S(aS(~I~t<i~ 1!A,~ It • Awe _ &40- - --Eownbh4'-p~~ - St. C~1o4x Cuuv(l r1 v( zVe Secxi.uvt a Subd 7vi av( t !'l 1C IANK 1( NumbvA o6 eorr(pa. ;tmevn-t.5 U( %tanco (~l() m: WVC e 6 U4e d.(.Yi(I - 12 0 6 o) H -(g h w a x e n ~ ~,9~ -f.~L~.:,Ca-..u ' l.,c~'~- ~ NIMPING CHAMBER S<=e _ _gaet0n'5 Pump Manuhactu~ie,,( Mode-k Nu-mbv.~( M)I DING TANK Size ga.ePonb Number(. oo Cumpairtrnev(th Plimpe tl Atatirn S(lA tem I~(.~ (t4ilc(~ j~(om: (Ueee H<(1It wafivA. Ali;(~I,'!'l I~~N ;;III tti enchl Ur ti (~(r(~r fj~(um: (Vee.Y Bui.(d.Eny- 92~ 6fope 11i g6(wa-ten USORPTION SITE DIMtNSIONS W(dth( (10 th-eneb( Regt.wrod alcea L e n u t h o f e a c h( k .i vi e -()-t Depth ('6 ~(o c k b e e ow t i e e i v( NumbvIi o0 1'4v(vA ovpth n( 1((rc I? oveh t"iec iw Io(at Vcnuth ei.vtet ~.t Depth( t4ee 1) w (Iti adv <v( 1) (1 tweevi k-inv -s 1j fovc t!cench( cv( - poll 100 ( r(htiohptCoyl at(v(z ~t ((/pv Cuve~(: Pap(n ~~~r 5th~(41 t I' i i I% t '.l r N I oNS + N I I HII) G!(. lI c it it o (1 n (I ~ .t 1 i f l' ~1 YI ( puttiidv diame1 6t Dig-pth( beeow (v(ect ((((e (4I)~0 t(ption ar(c(( ~.t Aoa 11c(o Iced ,t r INSI'I CICD 6v - I- F L f- APPROVED DATE. ' Iyh I JI C f 1"0 VAR-1- A y~ 1;1 SON I 0 R R1 JI CT1ON IDEPARTMENT OF APPLICATION SAFETY & BUILDINGS 4pus ily, FOR SANITARY ' v 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: C 6 Property Location: City, Village o owns i County: IY.,r- '/4 '/aS ~ iT Z N/ R (or Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: i c m` c,r, (If assi ed) 1 TYPE OF BUILDING l- /?yjCf Number of ❑ Public* 1:1 Variance* Other (specify)* O `/GiF &,Da Bedrooms: ❑ 1 or 2 Family *State Approval Required.~%6Yl~lsA j3, -4 ~/lJ7UZ. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 2do E? J HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER Z -V & / MANUFACTURER: (L Frye EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA / (Minutes per inch): PROPOSED (Square feet): 2 New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) (QRjr; ❑ Seepage Trench Water SS'pply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public i5AWc- I, the undersigned, hereby assume responsibility for installation of the private sews a system shown on the attached plans. Name of Plumber: Signature: MP/T0"H4& V-N0-: Phone Number: -G'ilGs~IYE C'zzc, x.56(~ i V17 7 Plumber's Address: Name of Designer: 50 1 Wr--R z l 64L] COUNTY/DEPARTMENT USE ONLY Sign tur of Issuing Age Fee: Date: Sanitary Permit Number: APPROVED Zal C• { f % DISAPPROVED e-~r ea n for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) Y r State of Wisconsin ` Department of Industry.. Labor and Human Relations + SAFETY & BUILDINGS DIVISION Bureau of Plumbing, Platting & Fire Protection P.O. Box 7969 T0: Madison, WI 53707 1 A_~C) r Ong- _t~4 ICS Plan Identification No. Gentlemen: Re: The Bureau of Plumbing, Platting and Fire Protection has reviewed plans, site survey information and installation details for the construction of an alte!Fnative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by 'V1 T_ . and received for approval on S v. _6 5 The soil and site evaluation was conducted by Ar {1~ Cx i k V 0 The site meets the soil an site requirements tspecified in ch. H 'TT, Wis. Adm. Code, for the use -15 The proposed system is for a 4~!_ v1 n e e . r. L e_ U,,~\<7~ Wastes from the building will discharge to a gallon capaci~yseptic tank which will discharge to a ;)H' , gallon capacity pump chamber from which a pump having a capacity of / gallons per minute against a total dynamic head of f 3, R feet will dischar~_ee through a 4 inch diameter pipe to the soil absorption syster. It is of utmost importance that the system ':)e ; s „ a c i n - s eie elc :Ord with the plans and installation details and the conditions of approval con- tained 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 instal- lation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. 1ZP 3'i DILRH-SBD-6259 (N.7/80) In accord with ch. 145, Stats., 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 vepartrent at the construction site. If the installation of this system has not co€-rnenced 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 con- ditions arise Taking 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. Sincerely, Jaf, s Sargent Bureau Director JS:JP:kas enclosures cc, Co U„' V - Tc~~a-. ~►o to 147 f; r C, Lj A-t Gf~ F l o G $ //alzy 70m ~~oye~ x Z o~ z~/d a /-710 C) l-Yoo3a1 x-7.50 = Z15o qai, rx /JaY Z/Sn I79r.Lb`~- Z L(5 ~<~1 X 100 Z, ioo I~oo ~aay _ /►'~~a1` 1I(~(p z 'i' /zoos-~Z AV? ti t. S : , . 4; et k lit' A+c- r I a r vV~ Jay N o f d; n C A 2 G y v v c ) A ►v K S ~ Z L{,5~ Z~ Soa ~a I 'rAN K CAL Li F T- IT Loss la0~ X • 0 o $ S u V- L t, 'ro ?A t_ q rz A ~ 13 .7-l' P71~w aDg~irn x as ~ 191 27 -34 WISCONSIN ADMINISTRATIVE CODE H 63 A W W N N - Distribution Pipe E O Cn O cn O O Length (ft.) -i 0 Q 0 0 to o U1 ° D o a M to a v c 0 0 n N a o Q ~ W n n y ^ (n O 0 1 y ~ ~ - 7 t7 L- A 3 N\ A\ 7 ° O 0) y r- _ Cr W N\-_ N 0 o O =r O W m , ' to 3 N tp A v O W o \W to N\ _ _ .o m ~ O y Q ~J v lD W N\ - N co: = 2 - O O ~ N N N\ - ~ o o v 7 ~ CA m v O ~ o 0 . ~ ? to N N\- W O f/1 O N _ N\ 3 41 1 7 Register, December, 1980, No. 300 e HEALTH AND SOCIAL SERVICES 278-35 H 63 Distribution Pipe Or Manifold Length (ft.) IQ K) UP U 4 U1 N O tW7t O 0 O O O 0 t ~ t Hole Or Distribution Pipe Spacing (ft.) N W A U1 (n 'j J 1 i O N PJ ~ O O Co v O, (;i A W N fD Number Of Holes R tD W V a) Ln p W N N O 00000 O O O m O O Distribution Pipe Discharge ate (gpm at 2.5 ft. head) 1 ~ ~ W m N om. co y A O) W Hole Diameter (In.) Register, December, 1980, No. 300 JL PIoll"A Pu3 • mod! O O O O O ct In V N - J - l0 D1 ID O CD N a Ln - r N 2 ,....1 rrl cf ID O I m It N In ~ O E ,D Z (D c - co ui 0 t a- n L N Q ID j. Cn a O n c a m N a J V ID (V M CD O _ N - O D t0 m a a C O - ~ O ~ ON ~ a ~ N o co a O N c D IN M y ` (D o o • > o a~ r a in A ~ m o - o E in o 4 o LL c ...I U m a W ` t V r N M t U O _0 3 a O N e ~ 3 C QC. _ N lD C O O O - ~ ~e O a) o 0 Cl d m 1+ a d N 10 P d C a o w Y O N J Q c LO - a to D UO O 7 N `a o _ .n _ N F N D O N a ti O CC '0 _ C o _ Q ~D v O D N N D z E Q N, E z m E ~ Q O N 'D '-i• iv in a z .n z N n N _ D v a o N It Z w a o _ cn ~ _ M N It O O _ N a t '_vv a Z F- O co N C? ID C _ - ~M M c• a , W N • N M N1 Y LO N N f O 1n - N PIO;!UDJ4 IOJ$ 8101412 ' C I 278-38 WISCONSIN ADMINISTRATIVE CODE H 63 Distribution Pipe Discharge Rate (gpm) U, + W W N N _ O U O U O U O u O U -i ' D Q_ \ ca Number Of Di ribution Pipes _ N OD O U O I Dosing Rate (gpm) _ N w A U O N L. A L. O O O O O O C O O O O O O O O O O I t i ~o P x 6 19o GP-*" I _ti6 P..B Joe f r e ~ 1 n 10141 Register, December, 1980, No. 300 Ia N HEALTH AND SOCIAL SERVICES 278-39 H 63 Table 9 FRICTION LOSS IN SCHEDULE 40 PLASTIC PIPE (C - 150) Pipe Diameter (in) Flow 1 1-1/4 1-1/2 2 3 4 6 8 10 g-pm ---------------------------•---------------ft/100 ft------------------------------------------ 1 0.07 2 0.28 0.07 3 0.60 0.16 0.07 4 1.01 0.25 0.12 5 1.52 0.39 0.18 6 2.14 0.55 0.25 0.07 7 2.89 0.76 0.36 0.10 8 3.63 0.97 0.46 0.14 9 4.57 1.21 0.58 0.17 10 5.50 1.46 0.70 0.21 11 1.77 0.84 0.25 12 2.09 1.01 0.30 13 2.42 1.17 0.35 14 2.74 1.33 0.39 15 3.06 1.45 0.44 0.07 16 3.49 1.65 0.50 0.08 17 3.93 1.86 0.56 0.09 18 4.37 2.07 0.62 0.10 19 4.81 2.28 0.68 0.11 20 5.23 2.46 0.74 0.12 25 3.75 1.10 0.16 30 5.22 1.54 0.23 35 2.05 0.30 0.07 40 2.62 0.39 0.09 45 3.27 0.48 0.12 50 3.98 0.58 0.16 60 0.81 0.21 70 1.08 0.28 80 1.38 0.37 90 1.73 0.46 1 ?i5 _ 2.09 0.55 0.07 C'' 150 0 A` 0 1 i 175 1.17 0.16 275 1.56 0.21 1 250 0.28 0.07 Velocities in this area 0.41 0.11 300 become too great for the 350 0.58 0.16 various flow rates and 0.78 0.20 0.07 400 pipe diameter. 450 0.99 0.26 0.09 ~ 1.22 0.32 0.11 500 0.38 0.14 700 0.54 0.18 800 0.72 0.24 900 0.32 1000 0.38 0.46 i 810141 2 • t Register. December. 1980, No. 300 278-40 WISCONSIN ADMINISTRATIVE CODE H 63 b. Adjustable weight switch. Adjustable weight switches consist of a control located above the water level and 2 weights attached to a single cable which extends into the liquid. 2. Alarm system. The alarm system shall consist of a bell or light mounted in the structure and shall be located so it can be easily seen or heard. The high water warning device shall be installed 2 inches above the depth set for the on pump control. Alarm systems shall be installed on a separate circuit from the electrical service. 3. Electrical connections. Electrical connections shall be located outside the pumping chamber. All wiring to the pump chamber shall be installed in a conduit. (6) DOSING. The dosing frequency shall be a maximum of 4 t.imec daily. To establish the volume per dose, i ide the daily wastewater flow tthe dosing frequency. In addition, the d95.In~ vo ume shall he At. lent t e capacity of the distribution pipe volume., Table 10 provides the, v i volume for various pie i Table 11 s a e use to determine minimum close vo ume ased on distribution pipe diameter, length and number of distribution pipes. Table 10 VOID VOLUME FOR VARIOUS DIAMETER PIPES r ' Diameter Volume inch gal/ft length 1 .041 1 'A .064 1 'h .092 2 .164 3 .368 4 .655 6 1.47 Da~1y w,,~s+~ A+ c- FI / boo Y G P• ~c S X 50` 3 0 0 ,3 00 ' X , o 7.2 .01 IF-4- x 1 u ~ ~ 4- all . ,QU C s f~ Ai yyl iur►~ 3~O pooft Cj - 0141 Register, December, 1980, No. 300 1 ~ HEALTH AND SOCIAL SERVICES 278-41 H 63 Distribution Pipe Diamet r (in.) J N r \ f Distribution Pipe Lengt (ft.) J f f O yr O ~n O yr O ~n Pipe Vol m (gals.) N , r J f P ~ D r0 O v` O • 0 tT (D Number 0 Distribution Pipes i O ~n O .n f r~ I - f f Dose Volume (gals. O J O O (n P ~n f f O O O O O O O O 0 O C - yr O yr O O 0 0 O O O G O C O 0 0 0 0 O O O v O O t 1 1 1 1 1 1 1 1 i 1 100 i JL• i 8104419 History: Cr. Register, December, 1980, No. 300, eff. 1-1-81. Register, December, 1980, No. 300 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION '•dU 3707 ItUMIE PERCOLATION TESTS (115 ~ P.O. MADISON', WI BOX 53707 7969 MA N I~ELATIONS 1 1 UCATIC7N fiE( 1IZ7N 1UWNSHIP/MUMd IF'ALI I Y lOT NO BLI NU SUBDIVISION NAME: Wr V z c, /TzBN/R Iq W -mo Y ii Z- C s M t!)UNfY OWNIH':S({IIYFFt NAME MAILIN(;/1f)DFi~ei., ~ I _ ST C i o o c 112-. w tvT a w i; V" t r /its O c.. USE DATES OBSERVATIONS MADE NC7 F3EURNtt. COMMFF IAL OFSCRIPTION' - 7ffU TTr S S: ! ~Flncrdatnc•ra x. 7ANew F iReplacp RATING: S= Site suitable for system U= Site unsuitable for system C ONVENTIONAI MOlINO IN GROUND-PRESSURE SYSTEM-IN-FILL HOL DIN(', TANK RECOMMENDED SYSTEM: (optional) a u I . u _ l XS LJ_u [_I s. E ]U f E] S [:]U .7 P iZ Tf u 0L If Peicolation Tests are NOT re uired DESIGN RATE: SYSTEM ELEV. U 1 I If any portion of the lot is in the under s.H6.3.09151(bl, indicate CLASS Z 180.0 Floodplain, indicate Flnorlplain elc+vation: PROFILE DESCHIPTIONS BORiN(_ TOT Ai I II1 ) I1 t') DWAIEH IN{ HF_S 1FI; OI milt Vd1111 IHICKNISS,(;UI011- TEXIIAU, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED_-_. E _4IGIlE,I10 P_EDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 0 ( 8 4- 4i:~6 /V &^V0#9 ? 4- /d " ffl L &'0 " if. As h) • • do 6 IV IB- JL q 0 ' No^'`''_. _ 90 /S" B! L • S'' On _Iir - 31-4X 1s • 34, 8" cs Si z.. f3 B "5 g f /l►oNcx > t z/'' ti • z/8* * is ' r4" 8h S L TO B /1oNL 11" 3/ 7",gn 15 ",Bn Ls._. _ _ r_.--. - _ Bz. _ Z. - - 1 B- s 84 _/1JIau 7 e4 z , » L z7" B-, 15; W B- A.LV- I, C,JNo~~ - - PERCOLATION TESTS fkST DEptH WT TERINHO LF TC I TIMF DRO I VVATTFt LFVE.I IN HF RA"TF MINI) TES NUMHEH INCHE,' AF I I H 1,WE I LING INTFt{VAI_ MIN ~ Frjc~U l PGNIt D F -Ti!(~O.' PER W{ H CAWY p! 7 _ , yyam~,,,3► P. P- P IaLAN VIEW: Show location, of perr-ol,unnr n~•ta, 5r)il hwing." :nul rlm dirnerratons of surhrhlo tirnl arutis. Indi<.nle scale or dist.)nces. Ou-scrtbe what are the horr- 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. SYSTEM ELEVATION tica-rLw Z '1~ M nzr r c.r' r~ tr<aa~ ( t!'jr «zaPee'ry, c ;sW. Ar S 9 rto w n.) a s S ~kl:c'= T n v t o I Na, P ,-i% PjS , L_f,S V ^-rw % K.) '12 ts~e 7 R L nl c, ~ U 'i'.a, r• i a Ti e- lsZ.,rip- V ~ = 1 O b , o fN 5lt~ L;w--' T- C 6C BOILO 110h PL P c.Taakji ~ZZPt T ArV5o i~`ttor.a 1, 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 Admirnistrativr; Codi?, and that the data recorded and 0w location of the tests are cmrec,t to the best of my knowledge and belief. INAMF (prim) l TESTS WERE COMPLETED ONE ! AT)i>I Ec ' CFATIFI(ATION NtiMl{ER PHOW,~ NUMB ,ptlnrAll. !(JD .&C2 PI SAG. X414-^5 K aZ L, ar L "l C",T :I NATIPIE- DISTRIBUTION: Original-Local Authority, 2nd page-Bure.3u of Plun,l,my, 3rd P•rge-Property Owner, pays;-Soil Tester. I"3ll.H0 SBD-6395 (N. 03/81) EH 1.15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH 631 P.O. BOX 309 r MADISON, WISCONSIN 53701 r' REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:-' Se(-tiond_TZSN, R49 E (or W ownship or Municipality Lot No. Block No. t6d -49~ 7755P County ST: Subdivision Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other C_ EFFLUENT DISPOSAL SYSTEM: NEW k1111 ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 8 / PERCOLATION TESTS SOI L MAP SHEET __31! SO! L TYPE ~'/LG =07-7- ~ 'T - PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE iVUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN O IP- j P_ 113- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) i 3- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption at, , needed for building type and occupancy. Indicate scai, or distances. Give horizontal and vertical reference points. Indicate slope. ! E i I t : 45, I t i I ~-;7 1, 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 location or rest holes are correct to the best of my knowledge and belief. Name (print) Certification No. - Address ~`'•~i .L~Oyc 3 / ~ .c' -4 Ayo, r Name of installer if known 46~2 .q - C' CST Sig ''1~- COPY A 3-'° CAL AU! I-"O?iTY ~ , EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS ' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:— Section _,T:;N RAE (or Q, Township or Municipality Lot No. , Block No. r=•~'~ . ~o County fir' c> y Owner's/Buyers Name: 5~ Mailing Address:- Z4Z-'I TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW-REPLACEMENT ALTERNATE SYSTEM OTHER mJ DATES OBSERVATIONS MADE: SOIL BORINGSO ° f3- ~3n PERCOLATION TESTS - L3 SOIL MAP SI?EET® ' ----.--NAME OF SOIL MAP UNIT 4=14 AL-.4 PERCOLATION TESTS _ d -r-,- , oQ N! TEST NUM- DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES BEM INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL RAT::- 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 1P- i P P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- x f=3 B- B_ '~✓GS ct 7 _ i 6 B- B- " _7 -7 _r r 113- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of stable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. o G~ GU~G T~ r _ - - - J v q U 14 45 ~C - , ~ s L 8 I Gt-6 . _7 x I ~ F 3 _ y ~ 1 I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (pant) ='r;• ,~i~ ~ Certification No. - - ~ _ Address .Name of installer if known Copy A -Local Authority CT Signature- a EH 11-5 Rey. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS ' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION!`' Y4'-/a, Sections Tom`-N,R'`` E (or " ~ownshi br Municipality Lot No. , Block No. - County ubdivlslon Name Owner's/Buyers Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL M:AP SHEE NAME OF SOIL MAP UNIT PERCOLATION TESTS DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES NUM- CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL RATE MIN/IN f BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P__ P- P- ! P- P- P- SOIL BORING TESTS F EST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- B- Z7t B- B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. i i f , I i y u i.M t z € ~ E [ I.., S i ~ € i ~ 4_ _ i N r 4_ 4- I f ~ ~ , ~ ~ : 3 1 I I I 3. F , e- ~u I ~ ~ 4 f a a , F ~ t , the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (pant) Certification No._-._ Address - d sue' 3" i c E ✓ c'i~ Name of installer if known ST Signature Copy A -Local Authority f r State of Wisconsin Department of Industry, Labor and Human Relations \ SAFETY & BUILDINGS DIVISION Bureau of Plumbing, Platting & Fire Protection P.O. Box 7969 Madison, WI 53707 T0: Plan Identification No. Gentlemen: Re: The Bureau of Plumbing, Platting and Fire Protection has reviewed plans, details for site survey information and installation installed atethenabovetmentioned an alternative private sewage system aced by location. The plans and specifications were prep on and received for approval The soil and site evaluation was conducted by The site meets the soil an site requirements spec► ied in c N 3, Wis. Adm. 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 ~i gallon capacity capacity of gallons per minute pump chamber from which a pump having a r e through a inch against a total dynamic head of feet will disc a g - diameter pipe to the soil absorption system. andbthenconditaons ofmpapprovalete It is of utmost importance that detailssystem the plans and installation tained in this letter. The licensed plumber responsible for the installation shall notify the county inspector ~o~nshthe allibetablettoninspect thiseinstal- commence so that the county inspec tonal and shall follow lation. The installer shall not deviate fromthis local or state authorities. the directions or orders issued by the appropriate DILRH-SBD-6159 (N.7/80) r liccurd it h. 1 c, Statsws and cry. 63, Ws. €.-s "0 S specifications are Z d, approved contingent upon compliance with the stipula,sa:~F Indicated on the plans. Please review your code for the requirements each code section noted. `the architect, professional engineer, registered desi contractor shall keep one set of plans bearing the stair ei ~4 department at the construction site. l~~ ~ , ~ ' the installation of this system has not commenced witH,,r . tee date of this letter, this a v &ball be made for approval of these plans ab,e before arkomayaco ence : $n granting this approval, the Division of Safety and Buildings does IYAd itself liable for any defects in plans or specifications, plan omiss,'examination oversight, construction or any damage that may result in or aft.. Installation and reserves the right to order changes or additions should ct;: ditions arise making this necessary. This approval is based on ch. H 63, Wis. Aden. Code, requirements. It shat be necessary to obtain and fulfill the permit requirements of the county ~ which this installation is to be constructed, `allege to obtain county permits will autinin t ical l y~ old this a~~~lptar=, Sincerely, is Sargent ',ur°eau i tux_ J °jP a Plb 100f, 1;/78 DFetach And Return Upper State of Wisconsin Portion Of This Form With DIVISON OF HEALTH SECTION OF PLUMBING r AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: 1 IZ3 PLAN ID. # _J 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 plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. 11. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I II. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑Soil boring and percolation test on EH 115 completed bycertifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average fl )w rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Total area filled (fill to extend 20' beyond edge of trench before side sl+; ?e begin). ❑ Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. DEPARTMENT'OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUL/D/NGS LA?Of3 & HUMAN RELATIONS ALTERNATIVE PRIVATE P. a. fox i96,4 SEWAGE SYSTEMS DIVISION MADISON, WI 53707 ❑ Mound ❑ Pressure Distribution BUREAU OF NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PLAN IL, BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: V~ rV 1 REF. PT. ELEV.: CST REF. PT. ELEV.: SEPTIC TANK: [MANUACTURER: ]LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV [N.UM- ;PROPERTY LINE: WELL: BUILDING Eli G3i" A FR : N DOSING CHAMBER: MANUFACTURER: LIOUID CAPACITY: PUMP MODEL: PUMP MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL: ❑ YES ❑ NO ❑ YES 1:1 NO PROPERTY WELL: BUILDING VENT TO FRESH DIFFERENCE BETWEEN NUM PUMP ON AND OFF ❑ YES ❑ NO l+T LINE. AIR INLET CaIIrA~1` SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for and furrows thrown upslope: mound systems to make certain that it PROVIDE A DIAGRAM meets the criteria for medium sand. OF SYSTEM. SHOW ❑ YES ❑ NO ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: II'a`I/TIrN WIDTH: LENGTH: NO. OF SPACING CENTER :LENGTH: DIAMETER: MATERIAL AND MARKING: ©lMENSIgN TRENCHES: TO CENTER. ( Rk1 1 MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING NO. DISTR. DISTR. PIPE DIA.: PIPES: DIA.: DISTRIBUTION PIPE MATERIAL & MARKING: EFJ~TI{~tti! HOLE SIZE: HOLE SPACING: DRILLED CORKECTLV: DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED ❑ YES ❑ NO PLANS. ❑ YES ❑ NO SOIL COVER: TEXTURE: DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED: CENTER: EDGES: SEEDED: MULCHED. ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: TUR E: TITLE DILHR-SBD-6227 (R. 05/81) S