HomeMy WebLinkAbout040-1129-90-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village Township
Tim Wilson I TOWN OF TROY
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
W
1
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
\�
7T
Demand
GPM
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
Forcentaln
Length
Dia.
Dist. to Well
SOIL ABSORPTION SYSTEM
vif- tiAOUSC
ELEVATION DATA
■
I"Alk
�
�
f
LOTM
■
mmm�
---_
---_
---_
---_
BED/TRENCH
DIMENSIONS
Width t
`�
Length I
3
No. Of Trenches
1
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
Type Of System:
P/L
�tACLC�
BLDG
IWELL
5
LAKE/STREAM
LEACHING
CHAMBER OR
Manufacturer:
a
Model Number. pi, ve-
DISTRIBUTION SYSTEM
Header/Mani{old
1 I /
Distribution
Pipets)
x Hole Size
x Hale Spacing
Vent to Air Intake
Length Dia C+
Length Dia Spacing
SOIL COVER r Prnssurn Rvsfams nnly yr Mn.,.,! Or At -Grade Rv%tems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed7Trench Center
Bed/Trench
Edges
Topsoil
Yes
0 No
�w Yes
0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:
Location: 672 CTY RD M
1.) Alt BM Description =q,Y �A
2.) Bldg sewer length = W
- amount of cover =
Plan revision Required? 0 Yes No M
Use other side for additional inform Ion. U
e
Inspection #2:
' r{ bl 0.L tviA 1K r
Or3'1fl:�� oix County Plan/Zon'ing 715.386.4686
1/3
JUL 31 2019
pi
.,•a'
ounty Sanitary Permit ApplIcation
- Tn accord with Choli 12 Sr. Groh County BanlWy Ordinance
ET. CROIX COUNTY WISCONSIN
PLANNING k ZONING DEPARTMENT
�
46'ar
Personal kdannatlon you INovioe may be used for secondary purposes
ST. MIX COUNTY GOVERNMENT CENTER
(Privacy Law. S. 15.04(1)(m))
1101 Carmkrluel Road
Hudson, WI 5401ri7710
16)3B6490 Fax(715)3864888
Attach COMPIGIS plans for the system on paper not lose than 8.1/2 x 11 inches in size.
COY
8anl Parma a ❑ Check k rsvlslon iD prevl0Y9 Bppliodi0n
t7 ZZ
'
LApplication Information • Planes Print di Information
Location:
Proparl�9wnsr Name
11 m
,!�
! v G%1 Jf
A
1/4 V BK 4
b ✓O �1�0 1�— s-L�
N. R If E (oA
any Own!ero Matling Address
Wcoo
Lol Number
_.. �...
Block Number
6laro
W
21p Code
sonzv
Phone Nurser
9)5 4a1��8Iq
3UMMOOM N a
AlaM Number ��
,VCV d�1}
Ii Type of Building: (arvWX am
/ . U _ ^ [7„ly ❑vina0s own of
.+�, ., ....7 ,v - , .., o.,.,.,,n,.
❑ PubiciCammarael (describe ueo):
C) Sim"ornad
. Type of Permit: (Chock only ono box on lin
a Reconmollon
le)
, ' T
❑ Rs)uvana0on 7, A o - 1 .
SAD-1 aa-30 -(w
rMA Number Dato Issued
7 - C�> 5 9 -9 -15
IV. Type of POWT System: (Check oil that apply)
! G V / 7"j 01
w-
❑ Nonpressurtsed In -ground
❑
Mound a 241n, suitable soli ❑ M[oxund 5 24 In. sukable all
❑ Mound M0
❑ Sand Filter
❑
Constructed Wetland ❑ Pool prior
❑ Dip Line
❑ Prossudud In -ground
❑
Hokfing Tank ❑ Singlo Pass
❑ Other
❑ Al -grade
❑
Aeraac Treatment Unit ❑ Rsokculaling
V. �IwewrnlRwownnam AIWI:M.amn:
1. Design Flow (gird)
if Dlepered Area
$. I pereal All
4. Sol( Application Rate
Percolation Rate
5. System Elevation
7. Final Grade
fiaqulred
�>r:
Proposed
(Gd6JdaylacIA)
18.
(MIn.Mch)
�a
Eovdlon
VI. Tank Informadon
idy M Gallons
I Tot
a d
Manufacturer
reon•
tee
Fiber,
c
New Edoung
Gdlons
Tanks
Conaete structed
glns9
Tanks I Tanks
C6dr'
ES. Cl
❑
❑
❑
❑
❑
❑
❑
VII. RBBPonelblllty statement
I, the underolgnod, assume map .aw1bniy for ropalrhooemonotloNrep+venerloMnsldletion of non -plumbing for the POWTS shawn on the atladrod piano. A
r
Alwrevad Owma dal Adv�e ae `/,s Z L.i
IX CondiS''o//��raa off ApprovalrAamins for Disapproval: `eT •JC7
i� (ca, r �t\?< ,I�p✓V�fw.+�A` c4.r•.Oa ONE
II
30
Sce (Pa f-r r- o o p n J (b. �( ST.I�t yell
l� n
PLOT PLAN
-z tr 6
9)
2
Q
Scale 111=201
cola.
G>4'�hGF sv.3
W ELA.
P1. D{Nv m
a
e,a DIN
j
3 c-
J SHIMi` 32 of 4" 1 ,` � � 4a LvhP OF Snh"
1 �S G I iC 7Rg5 - d.+T hT
/ GRs�wo l6VE�
SEWeR - PLUc
o - _ i Sl+ts OF PIPE-
i� "'- - -- Do NOT REnpUE
q6 P)pe
`RRL� 5'
kr
$ cap+P1�C�F�_B+�SE o EfcisT. T111ntKs-
SIEPl:11C.E 2 d•'n _45 pVY1P TN h S
I
P ' � � ` sRFrtc ecTTonr,
�� p ILL W/SN.Ifl
e-bS of
7O5 LoT t-Iu 5 �EZLFuw p1e]
-- -- - ell
k
{ome. r,o��� is %r�1i-�h amaA;ielj
rlp P` P r� �t pia ►'oG�
aqx' --� wl.trz ���0yeP +rf�+%t=abri E�
S1J COR1.7�R of
SE Icy - SE �/y SEC.34,7-ZBII, RNA- a��c NOTES l oPy
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install cast iron pipe 3' onto undisturbed soil both sides of each tank.
3. Install permanent markers at end of each lateral. (14 required)
4. Install 4" observation pipe with approved cap. (� required) ? 'oowus�oPE
5. Septic tank to be \Oo0 gallon capacity as manufactured by
1ti1 NS�R G'.OUC�El�• �p�1jucTS
6. Bench Mark- Elevation loo.o'ou BoTToi.1 of SID)NG AT SoUTHeAST
CAR>`1� OF 1a ,, SF_
7, D1V�T SuRFAcE'-.wh7rR ARuviaD 11b ib TD PREv9UT.=PoADIIUG_9T_vP137tL-5].D�
DEPARTMENT OF INDUSTRY,
LABOR & HUMAN RELATIONS
P.O. BOX 7969
MnAp�ISON4yv1 53707
SPTI„ S1?i�I S34,T28N—R19W
Town of Troy
CTY M
INSPECTION REPORT FOR
PRIVATE SEWAGE SYSTEMS
❑CONVENTIONAL ALTERNATIVE
❑ Holding Tank ❑ In -Ground Pressure XK1 Mound
SAFETY & BUILDINGS
DIVISION
BUREAU OF PLUMBING
MRF Rfn I.O. NMNer:
""97-*5554
NAME OF PERMIT HOLDER ADORESB OF PERMIT HOLDER. INSPECTION
WI 54022
DATE. ��
a ` 't Y-
Robert & Carol King Route 5, River Falls,
N
ENCHMARKPvm rX,IN,OPCf...,I DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV.:
TRFF T. ELEV
NImIAI P'...
MPIMPRSONo
Cron,, $IniMry
AVM. NumM,'.
Thomas A. Wang
3231
St. Croix
99078
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY TANKINLETELEV_ TANK OUTLET ELEV.- ARNINGU LOCKING LOVER
OVIDED: MOVIDED-
W LL til OZi� YES ONO DYES NO
BEDDING
VENT CIA.
VENT MATE
HIGH WA R
ALARM
NUMBER OF
POwD:
ROPERTv
Lj/F
ELL
1
UILDING
I
V TOFFIN
AIR INLET
FEETFROM
`J a
�,
N1
DYES 14
❑YES NO
NEAREST
DOSING CHAMBER:
MANUFACTURED BEDDING.
LIQUID CAPACITY PUMP MODEL PUMPISIPNONMANUFAC IRER WARNING LABEL
PROVIDED:
LDCKING COVER
IDED
W �l ❑YES []No
S J YES ❑NO
❑YES ONO
GALLONS PER CYCLE: PUMP
wxpcDNTR LnPEAATIMAAL
NUMBER OF
PROPERTY
LINE
ELL eU1LDING:
v NTT
AIR INLET:
(DIFFERENCE BETWEEN
rr�!�
FEET FROM
PUMP ON AND OFF)
DYES
NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moistureat thedepth of plowing
FORCE
LENGTH
DIAMETER
MATERIAL ANDMARKING
or excavation. (if soil can he rolled into a wire, construction shall cease until
F—
the soil is dry enough to continue.):MAIN
LIeV C1Y 1 IVnnl. a. Rf cm.
WIDTH: LEND H
p15TR PIPE SPACING
_
C V -
INSIUF DIA.
IIPETB LIUUI
TRENCHES
BED/TRENCH TflENCNES
MATERIAL: PR
DEPTR
DIMENSIONS
-
AVELDEPiH FILL LEVI N
DISTR. PIP OIBTP PIPF IS PII A DIAL
NO. DIBTR.
ER OF -
R Y
LINE
WELL
WRDING
VNTTOfREBN
AIR INLET;
BELDW PIPES BOVE COVER
ELEV INLET ELEV END
PIPES
FEET FROM
-BAREST-
_
M&UND SYSTEM:
Mound site plowed perpendicular to slope
Check the texture of the fill material for
PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope:
mound systems to make certain that it
ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand.
TIONS MEASURED.
ES ❑NO
SOIL OVER TEXTURE
PERMANENT MAP%ER . OBBFRVA71UN
WELLS
\
❑NO
VES ONO
YES
DEPTHOVER TRENCH:BED
DEPTH UVER TRf NCHIBEO
OFPTH OF TOPSOIL
SODDED
SEEDED'
ULCHED
CENTER
1. S
EDGES
1 V
c
❑VES I�NO
YES ONO
YES ❑N
I
J
PRESSURIZED DISTRIBUTION
BED/TRENCH
DIMENSIONS
WIDTH
q
1 V
SYSTEM:
LENGTH.
p
1'
O.Of
TRENCHES.
LATER AL SPACING. GRAVEL DEPTH BELOWPIPE-
f
FILL EPTNA V COVER
1 1
MANIFOLD
PUM
MANIFOLD
DISTR. PIPE
MANIFOLOMA7MATERIAL
ISTR
DI PI
DI TRIBUTI N I MATERIAL&MARKING
El EV
ELEV
DIP.
ELEV.
A O
`t
DIA
O
ELEVATION AND
DISTRIBUTION
IIOLE 512E
HOLE SPACING
ILLFp CORRECTLY
C
VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION
om.
PLANS.
YES ❑NO
YE
❑NO
O
COMMENTS:
PERSIAN NTMARKE _
OBS RVATIONWELLS:
P 96FERTY WEL4 BUILDIN
NUMBER LINE:
)06FM
FEET FROM
YES ❑NO
YES ❑NO
NEAREST
Sketch System on
Reverse Side.
Retain in county file for audit.
ZonU Administrator
DILHR SBO 67101R. 01/82)
SANITARY PERMIT APPLICATION
COUNTY
(�
UILHA
/ ' 0 X
U In accord with ILHR 83.05, Wis. Adm. Code
STAT SANITARY PERMIT#
I iy
—Attach complete plans (to the county copy only) for the system, on paper not less than
STATE PLAN I.D. NUMBER
8'% x 11 inches in size.
—See reverse side for instructions for completing this application.
PETITION �I
❑ YES NO
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION.
FOR VARIANCE
PFPEBTY OWNER 1 1
h
PROPERTY LOCATION
-,f ''/ Ya, S Tp�i, N, R E (or
P ,EpTy OWNER'S MAILING ADDRESS
VK?NAME
LOT NUM
BLOCK NUMBER SUBDIVISION
C . STAT `.
S% J
21PC
IP A
PHONE NUMBER
CITY �� NEA♦i ST ROAD LAKE OR LANDMARK
VILLAGE. �O C
Fe TOWN OF
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. ❑ New b. N Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
a.
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. P?konventlonal b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e.,R Mound E ❑ IGP
In -Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ® See e e Bed b. ❑ See a e Trench C. ❑ Seepage Pit
2. PERCOLATION RATE
3. ABSORPTION AREA
14. ABSORPTION AREA
5. SYSTEM ELEVATION
6. WATER SUPPLY:
(Minutes per Inch):
`i
REQUIRED (Square Feel):
PROPOSED (Square Feet):
❑ Private ❑ Joint ❑ Public
o
Feel
VI. TANK
INFORMATION
CAPACITY
in gallons
Total
Gallons
#of
Tanks
Prefab.
Manufacturer's Name ncret
site
Con-
Steel
Fiber-
gla
Plastic
Exper.
App.
New
xistin
Tanks
Tanks
strutted
Septic Tank or Holding Tank
A 0w
Iy
n"fGt
Lift Pump Tank/Siphon Chamber
4
SO
I r r r
VIL RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for Installation of the private sewage system shown on the attached plans.
Plumber's Name (Print):
Plum ignature: (No Stem s) MPJMPRSW No.:
Business Phone Number:
,f "'
3a3 1
as 9f'fP
Plumbers Address ;Street. City State Zip Code): Name of migner.
Vlll. SOIL TEST INFORMATION
Certified Soil Teeter (CST) Name CST #
Ave
rT eyes-
CST's ADDRESSsStreet Ity, State, Zi de) / Phone Number:
4ox 7< eeyep- ��LS �/r•
IX. COUNTYIDEPARTMENT USE ONLY
91 Approved
Lj Disapproved
❑ Owner Given Initial
I
I Spnitary Permit Fee
.� rl�Q
Groundwater
urcharge Fee
Date
/'� ,p �-7
Issuing Agent Signature (No Stamps)
///���
l_ 7y��'i
-X
'7� r (
Adverse Determination
0I��
A
X. 7MMENTSIREASONSFOR DISAPPROVAL: %i-e 136;1,
/Cc,n CVy a,,rl by 'iho"rA
SBD-63913 (formerly Plb-67) (A. 03/06) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
Pa ge 1 of 6
,
MOUND SYSTEM
FOP.
A 3 BEDROOM RESIDENCE
P21
LOCATED IN THE OF THE SE//uOF SECTION 3Y , T ZbN, R l9W,
TOWN OF 'r%2z_Ll ST• CRu1X COUNTY, WISCONSIN.
INDEX
PAGE
1
of
6
TITLE SHEET
PAGE
2
of
6
PLOT PLAN
PAGE
3
of
6
PLAN VIEW -CROSS SECTION
PAGE
4
of
6
DISTRIBUTION PIPE LAYOUT
PAGE
5
of
6
PUMPING CHAMBER
PAGE
6
of
6
PUMP PERFORMANCE CURVE
PREPARED FOR
itpaE�.i 8 GARO t �c.1 u G
R o u'rt. S
jZ1U�c_FR��S,w1 SUo=Z
PREPARED BY
WEGERER, WEBER AND ASSOCIATES
BOX 74 421 N. MAIN STREET
RIVER FAE.IS, WISCONSIN 54022
PW�,18iNG {�
C��iiionn'•"r - -
8 O5564
p#1 C0N `I
r}
.mHun L .i
W 15EP
D915 V
-?;-7
Job
PLOT P LA N
Scale 1"=201
co>,c.
C>�P-hGE sLn$
N
m
A
?
oe
23
7 �
ZS
H ov SE
Dt?r'?JN1
w
P:,G - Z 6 -
N
P)
p`��ptNG U
4b
=9-, is
r r-1 LL 1l'AJkY �f B /
a
OF 5n
- 0T iaT
� LEVEL
EMSPAiG BLpG.
SEWet - Pill(
ENb% of Pipe -
Do uOT RFMOVE
'q6 P)PE
? \;-�scisT.T"AUT—
R�
��� @ conialcZED BASH _ 0 J h °�3 _ VM"Ovt COJExs;
21 PI CE 11W 11T1 9S Pbs-lP T/tiNkS ,
J P BxFr �c BoTTonr ,
2 'Q �OvEAFw�w SPi*�FEJ
2 1 O S' L°T L)ME 5
--- -- — -- — qI
k ss
{oKe M b.�ti 16 1�%Ch a*YyIG�n`Ta��
n 0. P ry tt VOGN
d�t5oye; re�%cry abri V
S�J COFtJJC-R. OF
SE ply- SE I/y SEC.3y,T-Is"R19w
NOTES
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install cast iron pipe 3' onto undisturbed soil both sides of each tank.
3. Install permanent markers at end of each lateral. (—'�L required)
4. Install 4" observation pipe with approved cap. (L4- required) z 1olamt aE
5. Septic tank to be IOOO gallon capacity as manufactured by
6. Bench Mark- Elevation l60,dpV 80TTur4 Or- 5jbAlG Fh' SouTHeAST
CoR�1� OF 1Ao%,Se
7, p1 V 0Z'r SORPA c WATER. ARovrab "ouub TO i�REv0�7=Po►�AuuG_ AT. UPHILL Sl DE
L 5if�F U" WVIIPACTt-D
Sirow, Morsh Hoy, Or
.PPPR.oVE.Q SynihefiC Govering�
Medium Sond To 180�" OF
s rrno
Topsoil
I
VRRIES"/o Slope
Bed Of i — 2'2
Agpreooie —
r
PAGE S O- 6
Disiribuiion Pipe
1D
Force AAoin
From Fump
Gross Seciion Of A Mound System Using
A Bed For The Absorplion Areo
p1.limaIAG 4
Cn�iti4ilL+ �
`o175!0�5
Z-7 ' /N
H
3q'
- ��n�SiRlBbilda PrPE
G
so
Plowed
Layer
D 1, o Fi-
E Z. 4 �T•
F o•-)S FT•
G
H 1• S PT.
- 0asmQ um pipe
— PC'Rn ". u FI.fT r'1ARkHQ, S
8M OF //L 7p Zr/z"N6GRE6ATB
Co
DI
�— 14
r4
T o 9SERWTOU -1
PrPtS
ry' ly'
N 60'
Atta>J v tEw
L.oT uNe-S
PAGE y OF 6
1.
wEm"TED DIM DETAIL
O
ICRF9RI,LED
WC PEc
yr.O UPJ �
>'F%AMNFNT
HI. {LKIC '
IWLE A ee NCLi A pm el.P
a1S 19yOIAI DIPS %AVDIIT
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ppr%RIMH•V"1 � CE
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8705554
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a,LT. RenHsl G Fr.
LATELILLx s
3la IN. x
36 IN. V Z.�IAL
UV IN M.Y /
VT
NIINIPoLD 2 lu.
21N.
M OF Me1E3
— PEII. PnC 6
f LnT6RA L3
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m400I FCii-A ICjMIY. yu[TIOU e0% II.II
R::::4' OR 0, %FSM I I,
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INLCT
T _fl%TILMT SEAL I
I( Olw�
I
11
v
APPROVED JOIT
w/c_x.me
A
C �I
o
I
I
I
WWII. Ts
WC.I. I.Pt
EONFO 35dL
%T NdN4 3'
aElt'\'O I
I ALMM
SLL ,
ONTD fOIN SOIL
O
L
8'7.1'I FT
LLCN
EIEV. 06.OD1 LDNCRCTL IXOC%
s �
5 IJ i1
* RISC% SLIT PERMNFCD WLU I11- MWOIM:T40.CR MAL — ""OVAL
SEPFf-! SPECIFICATIOAIS
mst
TlIkWKS MANDFACTVCCR:"42M 0OWD.M CAFOVLLS SNOF DOC%DOSES: �, PER D%b
TAUS Slzc �i 50 &ALLOWy BOSE VOLunC
ALARM nAW1F1ETuau: S3•eLcent Sym./S IUCLudNe MCCnow LAuous
MODEL UWAeER: \OI "I LYACm1:1. XS SRIRSORIN-1 LrLLOus
SWITCH TD,.: NEtCA'" ee IdMESOR yD_1 WLO.S
p4Mp MANIIFACTLIRER: F E InLists CO. - C. II1 IVLXLS M.n!'U''s 4LL045
MODEL NUMBER: SS LI D..1LL dGXESOHY1L OALLD.1
SWITCH TVPC: HlRdsN/ LIOFC' FWAPANDALARMARET--
NUIMYN DICLNAIIDC RATCGPM LB O INSTALLED OU SEPARATE CIRCUITS
_
VERTICAL DIFFERENCE DETWCCN POIM OFI . dvm,mr.. NIC_%7 fj% FEET
} NI41nUM URWORN Sums PRCLSOfRfE�........... CySO FEET
} %TS FEET OF COXCC .M—M % \•D\ liernlRlCIIW IILAo%. o_q"I FEET
TOTAL OYUAMIC NC9AIS —P 15' D FEET
O'PrIG SSt
IUTCRUAL DIMEUSIOUS 01 T%UX: LEU4TH�MIDTH ILIG.ID DEPTH rSL_
WS 4EP. hrO.IL3Fq'C%Lq@L
IIA P, AD" = j.IV AST"= In x : z31 � 20.05 CnL�1 n.
MYERS SS SUBMERSIBLE SUMP PUMP
CAPACITY LITERS PER MINUTE
0 20 40 60 80 100 120 140 160 180 200 220 240
0 5 10 15 20 25 30 35 40 45 50 55 60
CAPACITY GALLONS PER MINUTE
0
8
cn
7 w
F-
6
5 z
4
3 �
2 p
1
0
T1
I�
WEGERER, WEBER & ASSOCIA
ATTN:
Lend Surveying a Civil En
Percolation Tests
DE
SUBJECT: �T--lA-1G
WE ARE ENCLOSING THE FOLLOWING ITEMS:
421 N. MAIN STREET
RIVER FALLS, WI 54022
PHONE (715) 425-0164
TE g — 2q
CC:
NO. OF
COPIES
*''DESCRIPTION
SENT TO YOU FOR THE FOLLOWING REASONS:
❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED ❑ INFORMATION DESIRED
FOR YOUR USE ❑ APPROVED AS NOTED ❑ RETURN COPIES
❑ NOT APPROVED ❑ FOR REVIEW AND COMMENT ❑
Le_
WEGERER, WEBER & ASSOCIATES
r .State of Wisconsin
i
,iuly 31 , 4L'1
Nwert K' i nq
%51:ty i,
F.ivrr Frills. taI u4C2?.
Lear .;r, P'irr:
;:e
Department of Industry, Labor and Human Relations
!:i:Lert T. Kinp - Residence
Private Seuage Syster.
T;rm et Troy, St. Crcix Gn,nrtu A
SAFETY & BUILDINGS DIVISION
-r
Cftice of Division Cones
anC Application
"Li East I:asnington Avenue
P.D. box 79t9
:;iwi son, GI F3707
Petition i:o. E7-05f ��1-P
T1.e pet;i tior for a variance requestea C tiolplui' F3.lI. (11, ILFR 83.23
(1} (a), ILPih': ,2s 0) (c-) 1, Milk 83.4.. (2) (c) I, an(' iLhS fi3.s"3 (4) (l))
of tire. Wisconsin Aeninistratiya Ccae teas considerecs on uuly 2-5, 1987. The
petition !ms sc;en clinditirmaily appruvm(i. Ti7c• cc-nsiti(;n s,ving ti,at surface
:rater 4c perr,anently diver•tee aruune Vic r,eune systr•r:.
i •
.,
:1
2
The rules require: that a .,ell a)sor•ptioi: system to locator, no closer than 25
ftet to the ;elow grade foundation cf d I?ahitable S.afldirlg; a motm- syster,•
shall riot be installed over till; a rsourd systew shall nat ;2 installed in a
caapac):mn area; a round systerl stsali not to installed over a failed
conventional systen; the vaxirnn+: slope f€.r a r?ouna system is 12, if
the percolation rate is L. to less titan 3G !.;inutes per ir:cia; for Slowly
perTlea,.le soils t"e etfluert s;wll be dstriNutea in t!se rium".0 by a trench
system; and the arNa Othin 25 fet=t. of Ve r;4ur:r's crnrnslope toe shall remain
undi sturi en. r
The vdrianct regoestee was to install d replace:sent !.:ou,Ic with the upslope toe
being lU trrt rrcra an existing ttu.re; zI:e T,Onnd'S absorption syster will Ce
ever till; a (portion of the dor+nslcpe fill will to over an a;.andoned driveimy;
a portion of the noui:d's eneslope rail F--e cvr?r a failinn conventional systen;
the 11 011 to installf.,C in an area witi, slept, varying a to 1f,.7r%
dno a percolation rate of Mi ripi in the filiec area a atvral
soil, Vie i::uune i:III use it 12 foot 0ce afsorp Li Or U ; .Id a&U a ditch
is found i feet tr4f. tirf f:OtinCl'S ClUrinSl4ie tie. , j(Fj1CnA'n _±
DI LHRSBD•8433 (N. 04/81)
„State of Wisconsin \ Department of Industry. Labor and Human Relations
SAFETY & BUILDINGS DIVISION
July Xi, 1^87
Page Z
All of UW data anc State)-ents'sutnitted or. bei;alf of the petitioner •olere
consiaered. IM s variance is specific to the staject petition and cannot be
` used for an; additional c+o+iificatitins.
sincerf•ly, ,
.. — J iie -i. Fetersen,,,T�"i;ief:
d•. Section of FriYdte Sewage
k-lbm) �1t)-1Ju+t
JHP:pCP:074fiv
cc: Leroy Jans).y, Private Sewage Cots ant cistrict b., Chippca+a Falls
1irilas Nelson, Znning AfIninistrat -'' troix Lounty
Artr:+r L. kegerer, Designer
-I /
DI LMR-BBDA423 IN. 04/01)
r,.. .
,
/
.State of Wisconsin \ Department of Industry, Labor and Human Relations
.,•,,:...v..:.:...... ....+,-,:.._.•,,...,..pg�ySpT6•S6WpGfe:.:li)kAN APPROVAL SAFETY St BUILDINGS. DIVISION
N
,.:.. ofFic" of Div)sitij.Cemir'i at id AppIic,-,tlon
01 k.,ti: k.,ashingtun Avanue
le-tr Dr.x /969
14.3td.i son,-I•lis"na n `,'i 107
..... .,.
WFL,I.14.0, WSOV11
ownar, •I"C'M PI RING
11.0. ROX 14
1,101) [1 .
- ....
RTViat I AIL-; ..
Wl- S4O22
.... R.I.UfR. LA1.1:L..:..,.,. W1 54072
S!^"1';3^. •.;
RS: Flan. Numba4':
11JXA'6f4 •a•
- LIwtN A protkntl: Au_tt .t. 4, i198%
Ga.11nrv. Per' Day.4
'SU }, -
LLa.I'.e Received. duly 16, 1907
..
Proj"t Nama: I'MC, R=R'T RI`>.IDIIII' a
it.v;it)on: :.5,;;1,34,28,19W
Town of TROY
Gount:yt 5T.GN91A
The Plumbing plans arxi specific., QWA' r thisprrt'jts;t have baps roviea'ed for
compliance with appll.r«tisl.r rudr• rir 1::4.- ;{Yi:•: .,ppe-uval is b'isod an..•Chaptor
14F1, Wisconsin Statutes ,end 1.har 'on Imfniat.r�.a.ive Cticl 's?. Ittp ra p(Rnr re
:stamped 'tondit:ionelly approved' Tbc utral 'i: ,ont.trttlenl. iiprtn cumplianrn wits;
any stipulaCion. shown on the plan. ems rhiO ara r-:nt:eci.tnust. bn cor•rectva
Al l.pormit.- reryuired :iy HP, ir,ty,- iluc•=,nLvl:hsp or- ::.natty :;hall be obtained
pr'inr to cons truc.t.i.un Iho lif.eur.rd )'lumhvr-rwat+on•nblr• for this installation
•shall kavp nru) set: of plfi8'l .: w.it.i, i.h•• d+!tr,arr uteant' :''_Jj)p'r)'r'•t- slaxip at 1-tte
r.onstruction.sito th« rnstaltor ,h,01 .not'ifv thin approprieto in:«pt:t,tr.r when
inswec.Htn. cart be made.
Thi.s.approval will exps.rr two yeat'> I-t•r>m th•' ri:.tt• ul,Tt.t,Ye:i at- if. a :anit'ary
pet'mi.ta': obt'aiti Rd. it will estpiro i'hi• gray the ttltk:, td. -Aritt,hty peniti43.-expires.
:,.Tha HUr'eau of P11/rnb3ng tiaa teviowarl tlrer.c plan; 1'(jt pr viwlo setVagp yaem cadp
r BQuii^a-mrents unly. Tho'3. piians havo itat. in?en r'i'y1ntJ.-ri for t:ha rodQ'-CegUir:ement•i
sat. forth in :Sect.ir4'i.11IiK it2 fist- tyF•nc'tisl piumbinea nrr in Cttapt.ers F40 64 of the
- Wisconsin.Adminiatratuyie c.odci.+q
-. This appr.ovifl is'fof' Lhi, rr.11owirtq ,.,�nprnu:.nt•a :v:lY' -
RI Pt f4)UND
.,,......,•..., inquiries. concernin-1 this apprnval m.tv by mar:, by. t.itlIirtq (602) 766t"89.
ere •ly.� r
pr a.. ['I T . PAOF-I
SftoGior- .+.f
Division of Snfet v ant-% llui ldinq,
NPNQi3/Uf?O9n! .3
cc: XOM?T WING
;., ...m....,. ,., ..Prival.p Sawage Cxmvull. nt V Coos,] ...114 :-:. W"Ill _... Plumbing Cnnsult«ni
._-. .. Owr.ctr PItur.her- 1.nvirorwieni:a:l:.lice.
'.iY:
DI LN R40 D-6423 1N. 04/81)
DEPARTMENT OF REPORT ON SOIL BORINGS AND
INDUSTRY, PERCOLATION TESTS // CC��\\
HUVAIN RELATIONS (115)
• (1-163.090) & Chapter 145.045)
SAFETY & BUILDINGS
DIVISION
P.O. BOX 7969
MADISON, WI 53707
E--S12/ 1/
3 zs3N/A19Ei
OWNSHIP UNICIPALITY:
-q
T NO. NO:
—
SUBDIVISION NAM :
`
COUNTY:
W U ER'S A
M DD
ST.C-R1,l+x
Pn 'ZCARnL 1cIf.,G
ZX_ 5 21U>EW- PrtI_-s wI S4'JZZ '
! DATES OBSENVATIONS MADE
bnce R PTI
®flairOMMERCIAL IMF
•3 � N ❑New �Imlme Ie_z.-7_86 :
U- Sit, uauirbla for
If Paruletion Tan are NOT r Intl DESIGN RATE:
e0Y If any porti[In of the Ortetl aru I{ In IM
antler s•H83.WIS11M, inr8este: 1\l • A - Flootlplain, Intllula Floptlplain sImeticn:
PROFILE DESCRIPTIONS
BORING
NUMBER
TOTAL
DEN
ELEVATION
DEPTH TO GROUNDWATER-1
OBSERVED
N A ER WITH THICKNESS, COLOR. TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED BEE ABBflV.ON BACK.1
B- �
S•3�
°i S,Oe
3.5 t
1� 2.3
o•$'OIz GYsI•I �s v sl I l•5'Bnsi l;
B. 2
a
-1
1
98•S
�oNe
mar'@ ,
"I.o
o.�' D�Gysi ITs; \•8'3n GI-scl r I_t_ w/
VINP 1pVAGT4, s •I • ZZ, IS n IS 7
B•
O.2'ah-8n F12t-f1�-� memeloTm S1; 03'
3
4.4Pi1
96.Ot
A]aoita
hTQ 2.'l'
vqzB-
Sot w!r_ 6F St 1 yt blc 6Y51 I`,Z 3Y 1
B.
H t'f UL'W7 UC'rJSN. C1
B-
PERCOLATION TESTS
r
PLOT PLAN: Show lootiI of percolation taab, it borings entl the dimensions of suitable mil area, hMiur sole or distances. Deecribe what are the horn
tonal erM wMioal ebwtion refenw. point, entl chow their loan.. on the plot plan. Shaw the rvrftu eMw,tion at all botlna entl the dbachon and Peroh.,
of land slow. ^, ^ PPCz5e 90 Tl �OV A
SYSTEM ELEVATION v L1
r
f
L
f
—' fat! 7
411
LA
0
Q
OF
,
4
I
I i
i
TN
snhLS \tl = So' SEC -As,
1, the uMatgMd, hanbV mortify that the sal arts repose l on, this form were nettle by ma in accord with the procedures and mahpb spedfied In the Wipvnsin
AdminisVaiw Cab, entl the the iota remrdM and Ma lomtion of Ihe teal, are mrrnt m [he bast of mY kwwletlpa aM helief.
f�2iNL R ,L W�G�57��Tt
X.
DISTRIBUTION: Original and one cop, to Local Authority, Prowny Owner and Soil Teerer.
DILHR-SBD4395 (R. W/87) - OVER -
Oct-19-2010 0159 PM St. Crcix County Plan/ton ng 715-386-4696
K
OwnerlBuyer __,,✓rnim _
Mailing Address W ��
Property Address (�
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
re? f2l LJtK CA
an & Zoning Deoartntcni for new
a22
City/State - R V1=1'L 2 C W f Parcel Identification Number 670 J1243 - 90 - 600
LEGAL DESCRIPTION
Property Location 6)-7- '/, . '/, . Sec. 3L, T 2-KN R-4�-W. Town of �y.,r,
Subdivision Plat: Lot #
Certified Survey Map # 3 3 a 6,6 , Volume 6M—, Page # -J-. 2- 7,
Warranty Deed # (before 2007)Vofunte , Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists ofpumping out the septic tank every three years or sooner, if needed, by it licensed pumper. What you put into
the systein can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities arc specified in §Comm. 83.52(I) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification tbrm, signed by the
owner and by a master plumber, journcynhan plumber. restricted plumber or a licensed pumper verifying that (1) the on -sic
wastewater disposal system is In proper operating condition and/or (2) after Inspoction and pumping (if nemasury). the septic lank is
less than 1,3 Ibli of sludge.
I/wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
Standards sot forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisoonsfo.
Certification stating that your septic system has been maintained must be eompk tad and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on t forth are hue to the bat of mylour knowledge. l/we aware the owners) of the
property described above, by virtue or w my dad recorded in Register of Deeds Offim
Number of b droom9 3_
�S IGN� TURF APPLICANT(S) -DATI-
***Any information that is misrepresented may result in the Sanitary permit being revoked by the Planning & Zoning Department e"
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if
reference is made in the warranty deed,
Suo22
(REV. 08/05)
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TA_NK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following re
(Street address) (o-7 2 C
M
located
at: '/4, 1/<, Section 34 Town L.N, Range J'i W,
Town of LMN St. Croix County Wisconsin.
Upon inspection, certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Aid ,n5(Kc-1461",
Most recent date of inspection or service MQy ao1c1 ' Sean 6irU.
Did flow back occur from absorption system? Yes_ No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: / Or9O
Construction: Prefab Concrete ti Steel Other
Manufacturer (if known): l ,.9 ��afi/ l"V 1) n C—
Age of Tank (if known): 1 kj ?
Permit number (if Im
Gtb O
(Licensed Plumber Signature) (Print Name)
M Y" U
(Title)
8-1-11
(Date)
�W o s;�]
(License Number) MP/MPRS
1 F� ri5tr ad�ec� �v
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012