Loading...
HomeMy WebLinkAbout002-1046-10-000 � o o °• I a Ui ao � ^n c c 4 0 o � I m I N E c N O Y CD rn E I U t ( o O y L L N } (D = o o c Z a' m > rn LL O 16L� C N co C 5) m C E ¢ O U m M O. d' y Z = O Z d d rn O N w a m I N C o I O Z v o d 2 c Z N E M O C • N L O 0 Z Z O O N E Z O N C G a o f N Z 'Co �U �w z C aaa CL a) 0) c U) a) rn rn m v } r O I i O Co N N .- ''C O O E c U) m c d o L v u, o m z In m l�l N 7 a� �j I o o j �m H e A O a0 U O d j N c0 O N N m V d $ p 7 O N H a N c tm m O (D N N W OO 1, W p C V V1 y O N iC 0-4 N N W Y .4 :3 w C F C N O O `V 'O > L O , O N m j J M U) C� v � `m € a �# a ` a E ` 'c c A ciao !,0U)0 SANITARY PERMIT S'7 COUNTY 1 DILHR TRANSFER /RENEWAL UNIFORM.PEf3MIT # , PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: to zz a PROPERTY LOCATION: ITY: VILLAGE: S '/a ' /a,Sa ,� ,T.1' N,R/ E (o TOWN OF: LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: NEAREST ROAD, LAKE OR LANDMARK: PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME: PHONE NUMBER: ADDRESS: PHONE NUMBER: ADDRESS: 1 71f gtJ l 7 5wil I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLUMBER'S SIGNAT E: PREVIOUS PLUMBER'S NAME (IF CHANGED): x L )le PLUMBER'S ADDRESS: / PREVIO S PLUMBER'S ADDRESS: p l'lr Sc o �Gl� of sG /,�/ / x nd� Lo) C MP /MPRSW NUMBER: PHONE NUMBER: MP/ PRSW NUMBER: PHONE NUMBER: SIGN TORE OF ISSUING AGENT: DATE APPROVED: DISTRIBUTION: Original - County C Copy - Bureau of Plumbing 1 Copy - Owner DILHR -SBD -6399 (R. 5/82) Copy - Plumber t Vyisconsirl Department ofCommerce Sa1�ty and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix G ENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344574 Permit Holder's Name: ❑ City ❑ Village ❑ of: IState Plan ID No.: Town of Baldwin � FRAAS A- CST BM E ev- Insp. BM Elev.: BM Description: Parcel Tax No.: la3• /o3.s CSt" z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic M.4- h Benchma k"*? Dosi ng � Alt. BM 3-0 O 0 / Aeration Bldg. Sewer g•e 96, Holding St/ Ht Inlet g. 5 !ri �$ TAN SETBACK INFORMATION StM it Outlet — TANK TO P/ L WELL BLDG. Air i to ntake ROAD Air Septic 3 7'� ' NA Dt Bottom R. Dosing ''` µ a ' NA Header /Man. �•Sc{ (gj(, 7 - fi- Aeration NA Dist. Pipe ' � ©�. --3 Holding t. S ystem Bo 9 Y PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number �� ft0GPM TDH Lift q Friction� System �S� DH ���� Ft oss Forcemai n Length) D Dia. 2 " Dist. To well > Bo SOIL ABSORPTION SYSTEM �,`,, ,�; B SI ENCH Width Len th o Of PIT No. Of Pits Inside Dia. Liquid Depth DIMENS NS o� DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACF nufacturer: INFORMATION Type Of n 8 IF O — CH UNIT R o el Number. System: M9� DISTRIBUTION SYSTEM Header /Manifold u Distribution Pipe(s) \ / it x Ho}e ize x Hole Spacing Vent To Air Intake Length Dia. Length �0.c� -Dia. Spacing�q- �� ,z G SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:0 /z� /`I Inspection #2: Location: 853 210th Street, Baldwin, WI (SEl /4, NWl /4, Section 20 T29N -R16W) - 20.29.16.295 �Pruw n i-e-eko nn I n vv l cs ° Plan revision required? ❑ Yes No oz Use other side for additional information. �/, SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH R " SANITARY PERMIT NUMBER: �.�� �....... �. �.aM. .,.. _ € e n o 3 ..�.�. -mm ...� ------ _ --- i m mm � 9 .,' .__ _. .. '_._._... _..,_ �..._ .�. ...._.... o- _. .._ �.__ _. _ �_. _. .,_. _...� ..................j s J mm. : a � = s _ € € .. 3 m e d m �a... ... „ .. .... .........w. m .m..e .. Ee . e ��,.. N.N me, m vase 3..:.,�e.... e .} ®m. W 9 i ....... ..... _.�,. e S 4 . . �w.. .. ..» .. J # i i t ; t E e d e � i i p t � a t � S s � e � i ..a....... .me.a .m��m. ..._. ......,P.,. u�` 5_... .. �. mm�.,., »..... .. .. �.s �e .._ . r P € t € .P „_�.. .,.,. �..... J. ..... p ,,.. ,... 1 . . .<»io. ..,.. i � E 4 E r r Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue y In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302 Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches In size. CNo) • See reverse side for instructions for completing this application State Sa PPerrmmiitt�Nuummber Personal information you provide may be used for secondary purposes E] Check if revision t previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 1 75 71 rp 231196 Property caner Name Propert y ocation 6, Lak�C.�u 59 1/4 �k/1/4, S T 2 q , N, R16 (or) Property Owner's Mailing Address Lot Number Block Number _ sue 0 , Sta Zip Code Phone Number Subdivision Name or CSM Number wM S 402, c > 0o2._= lo4b lU —•cxi� II. TYPE OF BUILDING: (check one) ❑ State Owned it n Neare Road Public ' 1 or 2 Family Dwelling - No. of bedrooms o filil:j Vown of 13 r) • 2� t(�• 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs 11 ❑ Restaurant / Bar / Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box online B, if applicable) A) 1. ❑ New 2. & Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________System __ ___ _ _____ __Tank Only _________ - - _ Existing System ___ -____ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 2 Mound 30 ❑Specify Type 410 Holding Tank 12 ❑ Seepage Trench 2Z❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro os d sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 1 Elevation 175 � 61 3 Feet V Feet VII. TANK Capacit in allons Total # of Prefab. Site Fiber- Exper INFORMATION New Exist' Gallons Tanks Manufacturer's Name Concrete strutted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank X El El 1:1 11 1:1 Lift Pump Tank /Siphon Chamberl X 6)V rnrn W AII'll ❑ 1 ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (P int) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber' Add ess Street, ty, State, Zip Code)• g IX. UNTY / DEPART NT USE ONLY ❑ Disapproved 5 nitary Permit Fee (Includes Groundwater D ate Issued Issuin ge Signature (No Stamps) Approved C] Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumbef requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement_ Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if.required by the county; E) Soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included Vie creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 '\Ifisconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary July 07, 1999 CUST ID No.220499 ATTN.• POWTS INSPECTOR ZONING OFFICE w BRUCE ALLEN WEBSTER ST CROIX COUNTY SPIA N3659 CTY RD C 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Id ID 1 i c 2 ers APPROVAL EXPIRES: 07/07/2001 Transaction ID N .2341 SITE: Site ID No. 17570 Site ID: 175703 Please refer to both identification numbers, St. Croix County, Town of Baldwin above, in aH correspondence with the agency. SE1 /4, NW1 /4, S20, T29N, R16W Facility: Paul Locker Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 477521 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing septic system must be properly abandoned. Note. The changes made to this plan on 7/7/99 by this reviewer were acknowledge and approved by the plumber in charge of the project. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the DATE RECEIVED 06/24/1999 telephone number listed below, or at the address on this letterhead. FEE REQUIRED $ 180.00 6erard erely, FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 M. Swim POWTS Plan Reviewer - Integrated Services WiSMART!code: 7633 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us P au Loc <er Dada au ' ma4j 4 Mound P� t �s� 5 � r 6 SE 1/4 of NW 1/4 �':',f. ; .............� c� of section h o l e.4 20 T 29 N R 16 W 6y5jrm rP � � r e5 i T" 1 b , q& I TO 2 " I1 er M oC+ 0 � +) 1 nis IO°l� F T ) � 8 v -er i k a3' vGr - ride I'F + QYPAIrr IYQh )Ve5 , Baldwin Township �/ Pur"P 04 l o WV r 140" $3 5'elYV4i61�7 St. Croix County Th�h L t jfr Puof rec6�red SPi ��►�P Curve OW Pare. 7 Page 1 Title Page ((�� y )fe ► $izea rr t�r base) Area. rep y(Pf+h ?nfi OT �.2�A�InNS ��fi � Page 2 Plot Joe •}. Hor(20h f vr1', horf2oj l5 near ve G(o,Y Icaw� Ca�,c?11�0••�S Page 3 plot Il r�ded ok� c�iS <I G�f on �ecer�� Page 4 cross section and plan view p�owin3� f D P Page 5 pipe detail Page 6 pump tank Page 7 Pump Curve Flo `!99 PA6F- Z o i N j � Q i N 3 Of j O In 07 O` IN S n o ci `--6 C C) i LA N d C C f; C a U b O �. O O O' O H Li Q' Okr +� LLj a, y d d Or EC,- 3 r m ] S i W W W I 4' b ~ p tl I.4 cu CY) IT O r u +- x ^ d+ W M m m O O Q p N 2 C 0 a n o o �a oa t- eua i a e) is tl Z 0 4 - 4- O O L V Z i Oi \ LOAN i U2r w4-C3 ° v1 O N i $� Fi Oe O J 0 q OO t 3 O ' ' o aAl ACI I � I a a a I t O a Z o n a X Q d • p� C L n I I x W I d k I i I S T0'd 6T : T2 666T -90 -inn PA GE OF Lo as Cys C) I i I �cs d U Q O 4, Q O _O P O N W ( i' f-' 4-' c d (4 - Qj W � o *N, ° +3 a 4J ;aa w w a4 O O a o u C>-Jo io 0 0 o a4 F-- u 3 0, z th 4- 4- O 0 r L 'T 0) U Z F" i pq o+ W 4- o ° ,+ 0 O cu f e 2 4t a 5�0 �5`oPo F a y da w W 00 � 2 0 o any Cl lu a I i � E I � Q i s i N I 1 . z0•d 6T:ZZ 6661- 90 --inr t Page Of / Cross Section Of A Mound Using A Trench For The Absorption Area _ H ... _ Medium Sand Fill � ° 1 F 6" Topsoil 3 E D Trench Of " - 2�" Aggregate, Plowed Layer 6" Below Pipe, Covered With D 1.33 Ft. Straw, Marsh Hay Or Synthetic Fabric I E 1' 5 3 Ft. O • © Ft. 5 C O "( v� F Q, $ Ft. H Ft. ;/* BRUCE ALLEN - WEBSTER. D -1195 _ s ELLSWO t =` � W N I r SIG . rmrpgW Plan View Of Mound Us ng A Trench For The Absorption Area _ I Force Main Distribution Pipe Permanent Markers Observation Pipe W L B K I \Trench Of - 2- Aggregate L Il.l�j r A t. I o2 Ft. K Ft. W 3� • S Ft. t B ' 75 7 Ft. J. 8i Ft. 5 L Ft. License - l� � Signed: Number: t Date: ' '•�rsre�r<z: au :r}rr ^�'riF.$wt?}�ja`.�ay!y'f s .. '.z::� -:1.- r ...:.e. Page _E of Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap 7 Y _._ P X X PVC Distribution Pipe P * Last Hole Should Be Next To End Cap PV( P Ft. Hole Diameter X r? Inches 1 // Inch Lateral Diameter �� Inch(es) Y �a� Inches Force Main Diameter 2 r Inches # Of Holes /Pipe Invert Elevation Of Laterals l ot, W Ft. C'antov- at - 100' 14 fo 33 B. fiM am Pr'P a az t- 101 +V3 Top Signed: G License Number: i; Date: t A� BRUCEALLENj� WEDSM ? D -1195 a ELLSWORTH ; j . �;• K'ISCONSIN L COMB'INA SEPTIC TANK /PUMP. CHAMBER AfC 7 (No Scale) 4 " Pft- Vent Pipe w' ,Approved Locking Manhole Cover Approved Cap, +25: 1 4m With- Warning Label Attached From Buildings ' Warning Labe e l - Weatherproof Approved ' — Junction Box . Vent Cap , :12" Mini, Final Grade -� 6" Minimum i 4" Minimum _.._.., 6 11, Maiim � 18" Minimum 4 11 Pic Quick - Insp. Pipe Disconnect ' 1/4" Wee , 8a.f f.l es ' Hole I BRUCE ALLEN'':. A D • V��9STER _ � Alarm ' ELLS' /OATH i':;SCONSIN , On 6 J )k G PPR'OD JOINTS WITH Off 6e APPROVED PIPE •� 3' ONTO Conc. Bloc SOLID SOIL 3" of Beddinq Under Tank -� Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day 1 ` Gallons Per Day/ of Doses: )13 Gallons Tank Manufacturer: �Id Volume of Backflow:........1 ,� Gallons Tank Size-Septic/rump 0 6 s1 Total Dose Volume:........ - G 3 Gallons Alarm Manufacturer: LCVel rw, C a lops Model ..Number: p v Capacities: A___�_i nches or 3 G allons Pump Manufacturer. Switch .Type : I''►ERCvRY + B j o inches or t al Ions _ zc�i1�R Model Number: q$ + C �.: inches or Minimum Discharge . ate: 1 51. + D L7 — inches or goo GPM Gallons Total ..... _ _ 32 inches or Crp Gallons Vertical.Difference Between Pump Off and Distribution Pipe: f Feet Minimum Required Supply Pressure:............ /� - 6S /lhc� 00 Feet of Force Main x .I Friction .Factor /100•Feet:•.+ Inch Diameter Force.Main Total Dynamic Head:... Feet Internal Tank Dimensions: 'Length I r Width 6 � ; Liquid Depth 37 1/ q I _..__ S ... gnature License Number Date 0 WAR. AM N 4 V 2) 14 9 : 2 cg, Jt fA (D ... .... ... .... Xa:m A .... .. .... .. ........ U) S oi % .. .... .... — — — - - — — CN 04 ♦ ull tom. .... .... .... . .... ... . ..... ... . A j �f j .. - 0 LL z 75 0 4) U) 'I N a V V LU CL - 1 0 .... ... ...... .... ... .... .... .... .... ... .... .... .... ... .... ........ A . .. ... . .... 0 co CL 2 CL C) T11- m CL . o W 2s Y. 4) U) y . 0 W .. .... .... .... 0 4 b N N N W) ft CD ............... 0 x Z a LL 0 .... ... .... .... .... ... .... .... % .4 z U RX, J z ( . ... .... ... ........ . . .... .... .. .... .... . J.A: .... .... ... . 'a _j 44 V In ... ... .... .... .. .... .... ... ......... a. A V. ACR _j of CL & ... .... .... ... .... .... ....... . .... . .. .... ... .... .... ..... ......... ..... .... .... 0 9 ... ... .... .. .. . . . . . . . . ..... ....... C- : 1 00 C4 ! -j 4c lo Vlof. Al : i W. :i4: T 0 0e, ...... oe uj N 0 U. ooe C4 4n 10001 001, OD ooe 0 00 r 0 6 o - 0 10< '00orT '100 ID co a zo 0 In SO -.00 o ll 1.0 111 1- t 0 00 � '000 0 ' , o ui -00, 00" A A O o 0or 0 O 3 A ootl A� p CA Ig 6 .... g n I Z a O .......... 9 . ............ . earcs Pau Lock<er Soil Evaluation SE 1/4 of NW 1/4 of section 20 T 29 N R 16 W JIJ } sr2 ,? f99y _ cgp Baldwin Township ti St, Croix County 953 220th Street i Wisconsin Department of Indus ,lI rand Human Relations try' SOIL AND SITE EVALUATION REPORT Page o of 1 5 ion of Safety & Buildings �` in accord with ILHR 83.05, Wis. Adm. Code j COUNTY Attach complete site plan on paper not less than 8 1%2 x 11 inches in size. Plan must include, but Sf Cr"o► not limited to vertical and horizontal reference point (BM), di and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance tc gttroad. APPLICANT INFORMATION- PLEASE PRIN FORRNATION� REV / A N TE k� i PROPERTYO�v G n RTY OT L ION4 .N t /4,S 2 O T oZ / N,R / ' (' to PROPERTY OWNER':S MAILING ADDRESS S - tM 19 L BLOCK # I SUBD. NAME OR CSM # CITY, STATE ZIP CODE `,p HONE NUMBER ONTY ❑VILLAGE RTOWN NEAREST ROAD I 8 con 001 �, ; -) ' Y NG OFFICE j6q Id T h /e 1 ( ] New Construction Use [XJ Residential / Number.pf bedroo � [ ]Addition to existing building Replacement (] Public or commercial descrlbe Code derived daily flow 4S0 gpd Recommended design loading rate Ot y bed, gpd /ft �,S trench, gpd /ft2 5, z 3� e. ase Absorption area required 3W bed, ft trench, ft Maximum design loading rate C , — 4 bed, gpd /ft 0 /3 trench, gpd/ft 8".5c t Recommended infiltration surface elevation(s) 1 00 s 33 ft (as referred to site plan benchmark) "t D• #1-. Additional design/ site considerations RFOUSRSOLI -01r M 2; nearer fac-M 64sr1 area,s,'nj af0,�416icojkrt- Parent material t o e55eS Flood plain elevation, if applicable A/ A ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT-GRA E SYSTEM IN FILL HOLDIN ANK U= Unsuitable fors stem ❑ S �' S O U ❑ S U ❑ S U ❑ S v'U ❑ S A U SOIL DESCRIPTION REPORT ke.vr -,^,) Dey Plvw,'nj C644 C.,� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmrdary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh �. '> y % ! a f abk >r s ':ter --L._ ,. 0 0'(9 a Ground jq 2, Y►� 6 --�— 2 ajk rk 4L i'oo. 2S Yk 3A 515 SJ 2 Alk Depth to limiting fact„ s % C A (I Remarks: Boring # F 6-7 10YR 4/ 1 05 0,` Ground 3 ° YQ t' - r i 0.5 0 19 loi ft '3 A 12 316ff sw s/ s I Depth to limiting facto a Remarks: CST Name: — Please Print rU CSC. A I t ►� W*- b Phone: 7 5 9 ?08,b Ad dress: � 36�Q CnvN Raad C Signature: D : CST Number: h 19 CSTri ss WL PROPERTYOWNER Pa Lckkefr SOIL DESCRIPTION REPORT Page _off PARCEL I.D. S r x Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trpnch 1 0 0 -6 10 4 / I �. 1 , s o b 2 6 - R 4A --- ;c I a Fr 5 1 , 4 0,5 Ground 3 - fl �•5YR 3l� 6 2 b tM �r ► �`' �'� 0.6 q 15 YR Depth to limiting facto Remarks: Boring # r n z J Y E 9/4 s � I s 1 a.s of� .:...v:: IDYQ 4 ic� 2 N, S 0,y :OAS Ground 0,5 O•d el gl . ,2' 30 2 .S 3 /6 �� SYR 51$ 2 ,� F r r 0, S ; 0,4 Depth to limiting factor Remarks: rN � ro ►� a x ('5f/r v WC) Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD- 8330(R.05/92) no O C+ S C+ 5 rD m V P X A N ' c h � ] A PC X .� a fi � o v m N 7 D laara, (, D D D Drive 0 k 0 0 3 a o o o m m � N mpr MOM tv Lot brie- %a O Z 0 Z W P N �+ n C3 C3 X 1 h n 7 . f N (gyp p S p a RR C .NF 7 4 0 3 m I^1 rq K + O < < < p 3 P P P to rF rF eF rF O c N 3 3 3 3 a N m or 3 to O ° O io � � A t 6' c b ►- s c ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer T Gt,J L o 4 � e r � Mailing Address )- .' & , ) 0d n ' s Sy Property Address > :2 2d /A � � A (Verification required from Planning Department for new construction) I City /State w c Parcel Identification Number ' a - `� �- C? ..t LEGAL DESCRIPTION p � � Property A Pro p a Location ' /., !V %., Sec. , T Town of Subdivision V A . Lot # Certified Survey Map # P , Volume �^ . Page # Warranty Deed # o , Volume b Page # Z 2 Spec house ❑ yes 1 1 no Lot lines identifiable 1, yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three ex ' on date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro d scri ed a , by virtue of a warranty deed recorded in Register of Deeds Office. 3'�Iv A f SIGNATURE OF APPLICANT A * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed a ro ff ff � t � ,f 7 t� pr 7 x. 1 /- 4 •y }1. __ •. .. t. 114.4).... y, S• 4m r 7 A r ._ _ ......._ _ . ,1.. x _ _ ' Y'•..,. — . 9 77 Of t', 1t.£t t tt,.f3S '2 e'_" Q- ""; i tt`.0 { , '' -i 1/4 A. .?.. 7.. +� C•'-,v .: 1.C!1{ `] s. TI b : Ct.s ?i y,:�tI ^`, t 9 (1 o- tti€? i "t � a 1 C.3'rt. Y7 off 'd 1,'7, ?. .?'i 'i »'1. 3 "(lv . ".lt Lid S1 - 7 7C V .- _..3 `t t„ .t �s tt+ Yry11( ' _ l 172 r: OL tC? - - a± - _ 1 t_lt..0 e.a I i i 1 � A i i 1 6. }� FLr : %sd 7 Y , 1'• ,... t ,. P +j- ' , V;A C: P sy' to _ , -: �. 5 a � t ✓_11: 'a4 � , G 7..t.'rt C $ : , t C i p.,,, y cl l- r:' On l � �/ K ? , J. ,: S t S; ;.''11 t'ry P r O r Q (}df Al -G` 02 �t:.�Y L 3`i�i r i ?'.t e # }.-- _ C p✓ , pi �`vir _.d ht. .�v� x, t'2�.t t. ?e p inC' -� 1 and *JL. ,3 s,,, li be a- tn.e » 3 }f: � " . p_ - > _ y � q ate s s -,x t ; i ;�1 /�_ 3 F�� _ 4._.1"x:' J -. +t, 1 ,';.n f0� d'j't".f �ti4.t'ii }. -7.�_ if u':: C Y S3,t? p._1'L. _t. .-'.tV t dL ' "i, £' cl(a]il;; C - .i Ch 3 .3r1 i an 1 Af - 0 3t .S Or tll, . - Put, `".: a ... , }4 V>n ff. .'<�'' i= "` _.. _.�_ _.is_'3,'� r s - `� ,�:_sYt: -3 . 3. _- rt. , +� dJ )Y,_ - _n - ?... � 3 - q._•�.eP', =.,� +_,rah :� •^- . `s r 7 �l J�S'•s3 i f3 t+ (e a <''" _ i 7i v v 8 f r t: .A ,tr ..t` B . -' --qN - .� R. - ";tr ,:mss,' fif a,e.�..r 3_� „� _. }'_ }, ;i,:� t, }1;_ i,aef l r 4, ....: _, _ - i .a�._ .7i .. .___ _, r ;_� i�•Y }.__- ng`� _S -� �k ' 6 tl:r ?�a� T _ ,.� .. -s:Pc ::b u. °. ti.F l • } >� �s, +,l:,c n ° %3" aj_ - l:�_d:r i ;7 s : s; t,r,n_ .�;Yy ft,.,?,i tai i'7ktf be rrKr u'� �.t,,r�. -.Ft ate °*?reAtt3ra o. x p fit; 5 {tr .) y `L *TMit dt' °, _J:x � ' -`1 I.__ 1!3 _ 8 3'�'s� C Xr�:� ° - rte - ,f ,''- �.`�r:, -t •.. ,:.; ...'. -� c v.,� ,.n but 3 y�1� `.) �} nv per �Tl, l?, a , i�- Ili.'7�; rr�Yt! t.iS:'; ()fi (� "k r: <i r_ as x"Eb tk2'. - ,t Si'.: =s? , ti l_'i +.: )-F . tit shil ,_..:U be a 4 i e l Jt ?iir }t t i :?t'i, i 1 �..: _ !7{ ;Y iFit U;Ittc i� ^ u ' FC ., c :j'- . 3 "i Pi:. BGiL f;3 �i in ..,.;: }x _ ; °v a'; . _. .v •r•:. SF: { 1. .1 A',Cr;• } ., 7;i x 'iis� ..... _ .. : h' +.f� �,)'.ItN r ?f1) ?.•t Sj; i�a, �f '.,. _}.y �.1 ,e - ' � .,;`�• 1 __: _1 $ :.J�J ,: ISe: ) f'_�YL � k� ., •)�'' � .' � ? �.J� 'Y_ �.?"SC p ��tl �• ? :'� P, t , .ty .= x., _ _ .- _a •_�.u., �`d.Y. the ,_ "ssN, b title .,'ider, -t- 3- r_ it :i;att.i3.. v a3ci >.c�Ct {,hi-3 _ 1.,,?. ,..,- ,. ta'� - � ' y i � 1r a 1nr � 2 a 4i7 , 3 b9 "'33. ve x",. . - ,*•,£' «t, : �i �t it -;f 6'r4t in it $;;A "o t.J � Y`' . c � p. ° a. P ,.a r ' ;: L �''+' 1$ w �' , ! -. E .•?rd ti`J f 7Pt?, a t :_ ('FJ sr.. >y�r. r. by V4 - r 4)� _ Vc3 i ii but `J t art # c c as �iF s �^w x [` t t : ) 11`, _• � , ir. '� t :. � t ttr .� �^ _ t v ., ro � - 'tom i •s C3 a '�'sd i" � -. �tL t,B° Y''e ti� - r Y' iA r' • t it F3 of , r a t . t A. 1 \- f � k�a sw x ti �. �.. r t� G 1 � 'S �C., :..yr t s ty.x•Y �.. t - y i ".: a ^b 'tat Yr= rt e �t. f it >.3!� t 'l _ r+n e er :' .s*�d ti +•?. L x.aA C .b t 2+ ' 11'�'" • w ' „ -.,3 �,_ rj' d of th pivgiCtj a r ' tt er iY o + iY t "C Ia t f :3 tT 1 jf ! in ,y' t4c, t.:nt of+ l • !f. - J ' ,{ y'+ d to s i ' =i ' 1 ef: °ti F� 3 _ fii 4' ,; r ;n t17 �f_r:? t a t' n , t . r- -� (� S La xi �T' a't.2t tl ;.' 1F 3tyS a i-n i:,: inn r., tof „r- • >'* �_.. -,Y. f, _� . i C.. r ,f ! , t u r` tf r' _t ?" _.. r _i�t C f, i.,. . �, (� �:.,.. _.- ..... -. h th. f .,. _ of an of tF,:. to .. _ . +. t._, ct. :: n'.-. t r }a :,. r x ',tt< .5, ' yy h�� r l tr ,:rat ,1� for a . c , ! Cn } t t - t ..�.T !, "�_ ° C ,. �. *_ .S_Cr;lt a -tJ C 4 :, t �r 'wt 1 f 3 1 t e Cf _ , =1 a.: 't i '.':i7. - -3 .� ,'•:x.tL( �..,'' r'; fiat to F 1 } ft• ht+ t , N d nL }� .� S y tt, .art a , v 7 Silt Ltt :•t t ! .4 f4 a + t ?Iiii �t}1i7ist n ! = t arc! .I.t' c _,-� 3t :l.0 i e 1. t th ' i t £ f -:! li 'i ca 0;'W% n;a 1. 1 ,e Sln �e =a r _•y t ' Jr a 4 2.t ? .. le tf a c t at 1_:, r t t t 'r Jf L� ,t'FZCt !ii J if to -wh r.' i_: i =:t r ha' x: at t, t ,: v 1 a ! u '. a,d rue in- Li }(,yl .S; �� _9. d•+'ti Wi`L 1'1 uT'i it!1 c _ t u'' lot +, Sh its 4v��1ir Lt ? 1 '3 _ t rit+' at i mi' C+7'±F of to �'itf , 9 4 1 t . ' tY 't t tr ab +4 Ci fi At C of y up- t r • - 'Lri" „.. [._taitr' -'.t or do Iilg ��.; +:�E i._y of an 4 tii�tt of foi_•c,. :.h Ui d,� I a l.ita�eC Cam. �i'nt :.q C�,t iir of .3 ce.eiv(tr of ih it �, !iA. ;'iN' a t' to La: 't 'urn. and profit” of tf: Pr'H � ty. d tom,. pp s c� t t'? °' c , i.;r� ti ;>•,a, ency of ac , :< -. i tL�, t�� h , an ? ;f orits w' t - r , r4 . AU r e ,; of Cc:. Bract S t,e bia+' -;g „ p _A, 'an - d ins,-- ,c+ t�:� ��rn -.,�. of t1l, het. Rwcbe er. then of rtt thf' ;p ,p of a alli,lbIC Lu si.' zf }Dins h - :- itt to r}?.s? -e t ,- ::ter. l ngl:k5 it th._ I "r ) ' 'y and a , .`e t+, join in the et L U * " * ., ,, `e +'� in fi:lfiilr.le tt 1 0°) '. day of FAT . r t,f.l '.t22 B. i is .i . • • G� al.c' f r2E' Tc� : i' s I3CiT3 i t.ti L ^I1�,�1• 1rt,�, t 1 ' -Itf'. ot. -tt.+.f 1.17 ti .�.T A I t' l # ►9 of the above fi( ss. St - -- C day D Ya?r'� i Reyl. .���z t h,s,, , -.:r, +r'_ _._ _•Z�f �. - -- _ . v 1 n T> S °} 1 t 7. - to n3e t >_ V � 1) .t,�tJf'' it sf3 t'', jif not, C {; e 1 Jr t ,4 }(' i !. 1 it Y. L' i_ " St 1v i;V:i1fY ,1(' 1 _ — _ a.v VIA 1.'I':'K 9 __ P �__ .1 _: , n,t :, .c.� -�ryA e .\:a L, ii '!lfd �. F,,ts •., ;t Ct s i:. - '1116,4 be I of -F:11il,'! -1_ _ ST. CROIX COUNTY �� WISCONSIN . �`�'� . ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER N r r r N �, �, ■....6 1101 Carmichael Road '" • ' in Hudson, WI 54016 -7710 (715) 386 -4680 NOTICE OF VIOLATION July 2, 1999 Paul Lokker 857 2W' St. Baldwin, WI 54002 RE: Failing septic system at 853 220'' St. LOCATION: SE' /., NW 1 /4, Sec.20, T29N -R16W, TOWN of Baldwin, SAINT CROIX COUNTY, WI Dear Mr. Lokker: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category b). This violation was first noted on May 19, 1999 and on June 19, 1999 (see soil report). The violation noted is discharging sewage to the surface of the ground and into zones of saturation. The soil and site evaluation report submitted by Bruce Webster revealed that the existing system is located in non - compliant soil conditions. An on -site on May 19, 1999 did reveal septic effluent discharging to the road ditch. Based on the soil and site evaluation report dated June 19, 1999 by Bruce Webster, ID # 5501902, this system failure meets the definition for a category I failure (see boring # 4 of soil report). If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of March 19, 1999, in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: The location on the replacement has been determined by the soil and site evaluation done by Bruce Webster. The next step is to have a system designed and approved by the Department of Commerce. Once approval is granted, then a licensed plumber secures a sanitary permit at the Zoning Office. The septic system shall be installed no later than May 19, 2000. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Since ly, /�� Rod Eslinger Zoning Specialist cc: Ken Klanderman, Town Clerk file i