Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
002-1064-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TC~PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Olson, Thomas Baldwin Townshi CST BM Elev: Insp. BM Elev: BM Description: /~% r~ b a ~ ~ ,. c-~ TAdll! IdICA~11AAT1~1d1 CI C\/ATIAAI 11ATA TYPE MANUFACTURER CAPACITY Septic ~.e.~ %~~ Dosing /f ff 1..~ .'~.b / bsb Ad~trBTl ~~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic i 7 ~oz? ~ ~ t rg l i ~ ~- Dosing ~ ~~ ~ ~~~ e ~ . ~ ~ _ Aeration Holding PUMP/SIPHON INFORMATION .. ~ , Manufacturer ~ Demand ply S GPM Model Number xx '7 TDH Lift 5 ~ Friction L oss System Head TDH t z ~ r . y I G~~ z. zZ. . i Forcemain Length ~ Dia ~ 1 Dist to V~ell ~ ® Z L~ c ~ rJ(~ SOIL ABSORPTION SYSTEM ~~,~ ,fir, jam,,; •_~.~.i,..(~e~ County: St. Cf OIX Sanitary Permit No: 453418 0 State Plan ID No: Parcel Tax No: 002-1064-20-000 Section/Town/Range/Map No: 26.29.16.393 STATION BS HI FS ELEV. Benchmark y ~ `~ /~.` /O6 Alt. BM Bldg. Sewer St/Ht Inlet ,~ • ` SUHt Outlet ~ .~ Dt Inlet .~ Dt Bottom Z~/o ~.~- Header/Man. .~7 ~~. ~S Dist. Pipe Bot. System Final Grade St Cover N ~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ i SETBACK INFORMATION SYSTEM TO '~ P/L BLD WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: Type Of System: ,~ f ~ i" UNIT Model Number: ~ DISTRIBUTION SYSTEM ~ Header/Manifold Distribution ,, x Hole Size Hole Spacing Vent to Air Intake Length Dia L Pipe(s) ~ 1 J~ Length Dia Spac i ~- d t, SOIL COVER x Pressure Systems Only xx Mound Or AtaGrade Systems Only Depth Over Depth Over xx Depth of eded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges ~ Topgoil 1 l,J ~ No i "~; Yes LJ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspe on #1: / / Inspection #2: / / Location: 733 250th St Woodville, WI 54028 (NW 1/4 SW 1/4 26 T29N R16W) NA Lot l ' ~ ~ J ~ ~ ~~~~ Parcel No: 26.29.16.393 ~ 1.) Alt BM Description = '~"' ~ IYe r '`~ ~~ 2.) Bldg sewer length = 'ZG~ / -amount of cover = ,~ i 3.) Contour = _...--- -. _ Plan revision Required? Yes No Use other side for additional information. ~ ~ ~ ~ ~~ ~ ~ 1 r r -- ~~ / __ _- ~ ~ `Y' Date Cert. No. SBD-6710 (R.3/97) St. Croix County Zoning Detail Sanitary Information Tuesday, November 16, 2004 at 11:49:OS AM Page 1 of I Computer #: 002-1064-30-000 ; Sub/Plat: 40 acres Section: 26 Parcel #: 26.29.16.393 Lot: TN/RNG: T29N R16W Municipality: Baldwin Township CSM: 1/4 1/4: NW 1/4 SW 1/4 Owner: Albrighton, David 733 250th St Woodville, WI 54028 State Permit: 299039 Issued: 09/09/1997 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 09/28/1997 POWTS Detail: NA Bedrooms: 3 WI Fund: No POWTS Pretreatment: Unknown Notes Insoector As Built Plumber Other Reouirements Additional Notes Monev Owed Jim Thompson Yes Stang, Joe Stephen Aaby was the plumber on-site, Jim $0.00 Signed Off: No Thompson is listed as inspector at time of installation, but Mary Jenkins' writing is on the inspection report form. Mound bed 5' x 75' with 2 ft. sand fill. 2/5/04 -Survey shots were taken, but not calculated into elevations (will do it to complete form). Current owner came in to get copies prior to remodelling and submitting a reconnection permit application. See permit #453418 Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/27/2000 9/27/2003 04/01 /2004 St. Croix County Zoning Tuesday, November 16, 2004 a! 11:50:29 AM Detail Sanitary Information Page 1 of l Computer #: 002-1064-20-000 Sub/Plat: 40 acres Section: 26 Parcel #: 26.29.16.39 ~ Lot: TN/RNG: T29N R16W Municipality: Baldwin Township CSM: 1l4 1/4: NW 1/4 SW 1/4 Owner: Olson, Thomas 733 250th St Woodville, WI 54028 State Permit: 453418 Issued: 07/28/2004 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 11/10/2004 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Insaector As Built Plumber Other Reouirements Additional Notes Monev Owed Ryan Yarrington NA Stang, Joe permit for replacement of existing septic tank and $0.00 Signed Off: Yes dose chamber per Comm 83.3 a~ n~insTal tank with effluent filter for new 3 bedroom house to nstr[icted-orrsite. See permit #299039 issued to Albrighton, David in 1997 -parcel #002-1064-30-000 - Maintenance ~~y,,~ ~~~~C~LP/Y~/ Scheduled Puma Date Pumped 1st Notification 2nd Notification 3rd Notification 11/10/2007 Parcel #: 002-1064-20-000 11/16/2004 11:51 AM PAGE 1 OF 1 Alt. Parcel #: 26.29.16.392 002 -TOWN OF BALDWIN Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): ' =Current Owner * OLSON, THOMAS L & SANDRA J THOMAS L & SANDRA J OLSON 733 250TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 26 T29N R16W NE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 10/03/1997 566425 1268/312 W D 07/23/1997 444/568 9flfld CI IMMARV Bill #: Fair Market Value: Assessed with: 42,000 Valuations: Description Class PRODUCTIVE FORST LANC G6 Totals for 2004: General Property Woodland Totals for 2003: General Property Woodland Last Changed: 11/02/1999 Acres Land Improve Total State Reason 40.000 28,000 0 28,000 NO 40.000 28,000 0 28,000 0.000 0 0 40.000 28,000 0 28,000 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code 010-GARBAGE Category SPECIAL ASSESSMENT Amount 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 Parcel #: 002-1064-30-000 11/16/2004 11:51 AM PAGE 1 OF 1 Alt. Parcel #: 26.29.16.393 002 - TOWN OF BALDWIN Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner " OLSON, THOMAS L & SANDRA J THOMAS L & SANDRA J OLSON 733 250TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special perty Addr s s): • =Primary Type Dist # Description * 733 250TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 26 T29N R16W NW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 10/03/1997 566425 1268/312 W D 07/23/1997 444/568 7(1(1d CI IMMARV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 29.000 3,300 3,300 NO UNDEVELOPED G5 1.000 100 0 ' 100 NO OTHER G7 10.000 10,400 115,100 125,500 NO Totals for 2004: General Property 40.000 13,800 115,100 128,900 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 14,200 115,100 129,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Safety and Buildings Divisior- Washington Ave., P.O. Box 71 b2 201 W ounty ~.s.~ /p n~ j , J es/~ . ` ~~~~ Madison, ~tY1 53707 - 7162 Sanitary Permit Numb//er (to be filled in by Co.) (608) 266-3151 S3 `1"I De artment of Commerce State Plan I:D. Number Sanitary Permit Application ... ~ ~ S 4 ~ ..Sb 99a rovide n ou ati f l i y p o orm n In accord with Comm 83.21, Wis. Adm. Code, persona be used for secondary purposes; Privacy Law, s15.t14(1 xm) ma (if different than mailing address) Proj Add y ~I~~] I. Application Information - Pleasc Print All Iaf ~. ~~ ~ ~ ~ ~; ~~ `"`1 `~. V ~ ~!' Ht ~ f'mp-er}ty- O/wner's Name Parcel # ,Y / ~Lpt Block M ~~ ~.O - tp) p-a Property Owner's Mailing Address ~ Property Location , ,~. 2~ '~ ~ '73e3 ~ ~ ~ ~ ` .~.. Section ,~ s ~~ City, State h / / / ~ LtJ ~AO C J Zip code c- (~ s~ ~~ ~ N,Y + ~ ;, ~.__. _._ d. ~/ %Q ~ ~ 5^ ~ r ~~r`~ ~ 93 ,(circle one) _ R 1(.,.£~r W T 2~ N . ~ ! I ( !,( . ~ II. Ty of Building (check all that apply) ~ ~ s uti~ ~C ~ Bat„p~r. or 2 Family Dwelling - Number of Bedrooms ~! _ n GtC.y~2 !.X ^ Public/Comtrtercial -Describe Use ` illage ~TJiwnship of ~ ``~ I h ^Ciry ^ State Owned -Describe Use - _ ~ Complete line B if applicable) one -box on line A k l Ch i O~Z ~ ©( . on y ec t: ( 1II. Type of Perm A' ^ New System ^ Replaaxxneat System ~ Treatmertt/Holding Tank Replacement Only ^ Other Modification to Existing System, List Previous Permit Num nd Date Issued 8. ^ Permit Renewal ^ Permit Revisron ^ Change of ^ Permit Transfer to New OQ Before Expiration Plumber Owner ..#'Z ~cfi p 3~ ~( Q IV. T of POWTS S em: Check all that a 1 ^ Noa-Pressurized ln-Ground ^ Mowrd >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized in-Ground r 'Treatment Unit ^ Recirwhuing Sand Filter ^ Recirculating S thetic Media Fil Leachin Chamber ^ D Line ^ Gravel-less Pipe ^ Other V. Dis rseUi'reat Information: (~ Design Flow (gpd) ign Soil App6 1 Area Required (st) Yl. Tank In Ca ity in To n Prefab ~ Steel Fiber Plastic Ga Il of Units Concre nstructed Glass Ntew Existing Septic err Hohtinte Tank Tan ! ~ j~G _ (tiJ • G~ S G/z Aerobic Treatment Unit Dosing Chamber / ( ~ l VII. R aasibil Statement- G the aaderslgaed, a~taae asibllity for htstallatioa of the POWTS ahowa oa the attached s. er s Phone Numb usines B x pQB1MPRS Numbe ' igtaature , Pltunber's Name (Print) Plumber ( ~~j n / , l V v~ ~~~'1'L ~' .ZZi 3Z ~Sr Cj`'/~~~~d r~~/ Phnm s Address {Street, Ci fate, Zip ) , ~`~. a~~ ~~~ ~z ~ ~f ~. c~ : ~--YG2 VIII. Conn /De rtment Use On roved Sanitary Petmit Fee i chides Groundwater Date Isstted Issuing gent Signature No Stamps) v d ^ Disa ' pp ppro e Surcharge Fee) ~f~ J .,Lr ~ ~O ^ Owner Given Reason for Denial IX. Conditionx of Approval/Reasons for Disapproval 3) ~-~~ ~f ~ ~~-(~c~.w~a.~ d~ SYSTEM OWNER: \ ~l (~2C.t9rt ~ 1 Septic tank, effluent filter and ~`5 ST/~ ~"`''"'~ dispersal cell must all be serviced /maintained ~ ~!-~ i .C,a s T rovided b lumber lan ment . y p p p as per manage A' \ Atl setback requirements must be maintained 2 ~ ~ ~~ . ~ . L as Der anDlicable code!ordinances. J ~/ 777"'"`~~~°°° "' P,,~b~ ~ TTG-1 . .. Attach eosplete plans (ts the Caauty ealr) fer tl,e systm oo papa aotlas ttam 81 x 11 hsdras iw alas ~ (n~ r - 398 R. O l /03 ~~~~ VlA s~`~Qa 9 D ~. Sl~~ D ~°~t ~ ~ rGn _p~a ,e-3,rn. W, n~~ i ®~ ,. ~~, ~,o~ ~ ~8, 8' Mok"~ t I ~,~s' , ~-~~ ~' ~,; rf ~R ~ ~, , rn. l QoZ~•cGry~ LAA ~( ~~~ t ,_~ ~~oo ~ Gs~ btd ~ C~~vc/t ~pN ~i c5~2 2~ ~ ~ Nc w 1 s B~~ 1~~kse_ p~~ Hoks~ kC~~ GS ~ .sAnOy ~' ~s®rL !' X33 `~~~'L h N /~ ~ ~vwh D~ !~""'~ V ~ ,~ 5"!~ ~~,~£ ,.rte. r r3~ J~'~ J~~~ I'"~ ~ 2 2 ~N ~s~ ~G~ ~ p IG~ s1~~ D ~o ,~r3.rn. ~- I a~~~ ~,s - ~. ~ /~K O .r-- JOE%Ge9~~~ _ `~ 1 ~'R -~ ~~ ~`~ ~, ~---- ~ q , ! ~° ~~, a s .~ SA hd~ C~(san ~~ X33 ~s'~'~ k. ~-~~v ,ti ~ ~~~~'~' ~ v8~ k' GW - t?~'~ ~; ff cR ~ '' .~ rn, mak~~ ...._y I~oo - Gs~ ~ _ y a~th ~ (~1 No ks~, ptd ~~ t r ~ ~~kac ~? ~u ~ G GJ ~ ~ S "~ ~~ w~ vve t~ ou c Nw/~ sw~~ ~Uw~ O-~" ~4 ~O LcJ ~~~ 25~i~ St- 2 5'~ ~~,~~ u,~. r3~ ~~22~~~~s'' .4a'C~ PUMP CHAMBER CROSS 5EC ~ IOIJ AA:G SPECIF1CA.r10~15 VCIJT CAP ~ _ ti•C.~. vEN7 PIPE' r WE'ATNERPROOF ~ APPROVED LOCKIAIG > JUAlCTIOAI 90X MANHOLE C_OVEF -- 25' FROM DOOR, E wIAJDOw' OR FRESH 12"MIl1. AIR IAITAKE ~ ~ 1 GRAD£ ~ 18 1rCIIJ. colJDUiT ~-- ~_________ ~~1 \ l~l IA1Lt=T PR041DE ~ --..--- `r' AIRTIGHT SCAL ~ i I ( ~ / 1 */ * A ~ (~~ i (I~ ALARM D I it i ~ *APPROYED 1 I ou JOINTS WITH ~ I ~.tirv Ft APPROYED PIPE ~ ~ ONTO PUMIP --~,, ~. j OFF D SOLID SOIL coacRETC DtacK ~- ICISER EX17 PCRMl7TED OASl,~ IF TAtJK MAAIL•FAtTUR£R NAS SUCH APPROVAL SEPTIC f SPECIFIGATIOAIS DOSE TAi,IKS MAUUFACTUR1i.R: "' y ~'1e~ {JUMDER OF 0o5ES: ~ P£R DA.~ TAA)K SIZE : ~ GGG,~L ~~U GALL0IJS DOSE VOLUME ALARH MAULfFACTURER: S~ G'`~ _ ~~~ IN1tLUL1-A!G EACKF~Ow: ~ ~~ GALION'. MODEL -.tUM6ER: - G- ~ G r ~~ CApACIT1E5~ A = ~ ~ ;IJC~lES OR 'j0 C GALLOWS SMfITCH T!P[: Yrl e 2C. 4~ `~ 8 = ~' 1NC-+£s oR 3 ~ ~A-.~ous PUMP MA1.IUFAGTURER: ~"~* 4 ~ C . ~ G tIJtNES OR 1 ? 0 GA1.LO-J- MODEL I.IUMDER: ~^~G' ~ D=~1NCNE54R GAlL01J SWITCH T~3PE: ASQTE: P'JttP AWL` ALARM ARE 70 DE MIAIiMtiM DISCNAR6E RATE ~_GPM NISTAl.LEO OiJ SE PARAT'E CIRCUITS V£RTILAL OIFFEREIIGE OETW14LA1 PU!''~P OFF AAid DlSTR16UTIOAI pIPE.. ~~~ j FE>r•T -i- MIAI jUM All=TWORK SUPPLY PRESSURT,E/.. 2.5 FEET -i- _./`'_:,- FEET OF FORCE MAiM X ~"~ r F/ppftFRtCTto~.f F/+CroR. r~ FEET - TOTAL Dy1A1AMIC HEAD = ~`i ° ~ FEET 111TERAfAI.. 0 E1i15-OAIG AAIK: LE:Al6TH _.__~_.,.;WlDTH ~LlOUiD DEPTH SiGA3ED: LtC£AlSE A111M8ER: ~~°~~ 375 DATE: ~~~~Y _ . 1 L ~~ }~_ ~_ ~~ ~ ~. ~ ~ y~~~. ~~ ~~ ~~~ ~ ,~.~ ~~~~ ~ ~~ O N W • M C~ V ` V 0 ~ ~ f ~f i ~. '" ~, f _ t__,_ 7~ I R s ~ ; , ! ~ ~ _ ~. -~-__~ a ~ ..._ _ .. ~ R ~ ~C .~ yy M ~7 ,. ~ 3 R m ~i~ ~~ ~~ i i! --.9- 3 3 ~~ ~ ~~ '~•J ~ ...i- ~~ ~~ ~~ g S V^ ~~ a~ ~ ST CROlX COYJNTX SEPTIC TANK Mpi1~TENANCB AGREEMSN'r AND OWNERSHIP CERTIFICATION FORM ~ Qwt:ter/8uyer F ~ ~ ~ '`~ Ols~ ~~~ °~s~~ca Way d ; ct ~ ~/~~ 5 ~l0 2~" n Mailing Address Property Address ~ rn (Verification required from Planning Department for new construction) CitylState ~o o _ v ~' ~ ~ e- ~ ' Parcel Identification Number ~ia:GAI. DESCRIPTION ` P>;operty Location ~ ~ yy Sw el., Sec. ~ ~ , T~N R~~. i Subdivision ~-~C+ Tows esf l3 ~ G ~ ~' `i Lot # ~---- CextiCcd Survey Map # _ --~ , 'Volume , _, Page # S 6 (~ ~z S' I Z 6 8' _, Page # 3 ~ ~- VVstrraaty Deed # ,-,.._ .Volume ~~_. Spot house O yes ~o Lot lines identifiable t~es Q no STt~TEM MAYNTENAN [mpreper use and tnaintcaance of yeuu septic system could resui[ is its prematau~e failttte to handle wastes. Props taaintaoance consists of pumping out tlu septic tank every three yesaes or sooner, if ~aeedexi by a licensed pamper. WLat you part into ~ ~°0` cats affee~ the function of the septic tank as a treatment stage is the waste disposal systeart. The property owner agrees to submit to St Croix Zoning Department s ceitifreatiem form. signed by the owner and by a master plvoabu. journeY»»Pl~~• t+estnctedphmn6er ex a Itceasedpttmper vtrtfym8 that (1) the as-site wastewaterdtsposai systorn is is prober operating e;ondition and/or (2} st3er iaspexxion and pumping (if necessary), the scpric tank is less than 113 full of sludge. I/we, the undexligned have read the above mquitusntents and agree to maiaUin the privates sewage disposal cyst°t° ~ the standards set forth, iyersin„ as set by the Department eat Ce>eamerce and the Departme.ut of Natural Resou:rees, Stag of W iscoosin. ~;ertification stating that your septic sysie~ has been Dnaiotaineui must be completed and retttrnesd to the St. Croix County Zoning Oi~ce within 30 eta}^s of the mree year expiration date. ~.2./ d ~~S 02 A'I1iRE OF ~ CA1VT DATE O R CE T ICA ON 1 (we) vcrtifY that all statements on this form ores true to the: best of my (our) Imowle;eige. L (we) am (are) the owner(s) of the property descn'bcd above, by virtue of a warranty deed recorded in Register of Deeds Office. D 7i z2~ o ~` SitiNAT(JRE OLt . PLICA21i' DA'Z'E .:.... pay infixmatiew that is mis-represented xnay result in the sanitary per[sut being revoked by the Zoning Departnueat. •`" s •s '• Inctudc etith tuts appticatiera; a stanspcd warranty decd from the Register of Deeds office a Dopy of the certified survey map if reference is made in the wartaaty deed sTC - ion AS BUILT SANITARY SYSTEM REPORT ' OWNER ' ADDRESS ~ 3 - ~ O ry { ~yo~/y:~,c i. ; S yon g SUBDIVISION / CSM~_~~ ~ SECTION 2 6 ~ LOT ~ T~N-R~_W, Town o f f ~V~~ ru % .~, ST. CROIX COUNTY, WISCONSIN - SHOW EVERYTHING WI~INI~.00 FEET OF SYSTEM ~- ~~ .~~~~ /~ . `~ w ~~~ ~~~ ~ J N~ ,-- ~ ~ ,~`- .,_'~,i; ,,;i e r r,~. QN{~Ei INDICATE NORTH ARROW Provide Setback and elevation information on reverse of thi s form. Provide 2 dimensions to center of septic tank manhole cover. .,:; , .,~ ," .. s~ ~ t-_ . 1 ~~:y:' r-. L~ f ..!`~ ~ ~' `~,/ STC - lOt AS DUILT 6ANITARY 6YSTEM REPORT OWNER_r~A y i ~ ~ 61c.~,~ Soh., ..... ADDRESS ~ 3~- 2 S~ ~ _C!/oaa/v~GG,C ~Ui ~ OdZ Q SUBDIVISION / CSM~'_ /r/ ~ LOT ~~/~~ SECTION ~ 6 T~9'~N-R~_W, Town of1~pL~w I ~1, ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WITHINII00 FEET OF SYSTEM ~- ~~ WALL y~ .~: J bN~ ~~ ~ .~ k' } ~, V E.~ 1 '~ ~,~7 ~_ ^ ,~ ~ ~ e ~' ~ 4 7~tiiv~ ~ -. INDICATE NORTN ARROW-- ~`~~: -• ~ _ ~• Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. IIENCHMARK : ~A_~ ~ ,Tii~' ALTERNATE BM: _~~ p~ n G ~ /~o'tw S lL ~i ~ r i ~/r ~ SEPTIC TANK / PUMP CHAHDER /HOLDING TANK INFORMATION Manufacturer:~j, .~,~•.sr % Liquid Capacity / o00 /~6S'O Setback from: Well / ~~ ~ Other House Pump: Manufacturer Z e k L LE,~ Modell-/=Size Float seperation / ~" Gallons/cycle:?O Alarm Location_ BipS,~ H~ ,~vt ~ SOIL ABSORPTION SYSTEM Width: ~ ~ ~ Length / p ~ ~ Number of trenches O ~ .E. Distance &. Direction to nearest prop, line;x ~ a p G f Setback from: well: / 1, S ~ House Other i '~ ~~ ~ d Y""' e~ ELEVATIONS Building Sewer - 6 ST Inlet: ~. ~~. ~T outlet: PC inlet ~. ~,/ PC bottom/ • ~ ~ ~ p~s~;p Off ,/ ,~ . / Header/Manifold ?d Bottom of system .,5. ~-/' Existing Grade/ O /. S Final grade y ~~ DATE OF INSTALLATION : ~. ~ g -- '~' /q Ala +~ I~~e <~ f-~°T qc ~+~ c _ PLUMBER ON JOQ: S' ~ ph ~~ ~ ~ ~ah`~ LICENSE NUMBER:"' _S f Q ~j/ INSPECTOR: ~j ~ 3/93:jt ' ~ Wisco s . Industry, 'Labor and Hu ons Safety and Buil ion GENERAL INFORMATION Permit Holder's Name: ^ City ^ Village Town o ALBRIGHTON, DAVID BALDWIN CST BM Elev.: ~ %~ CCU Insp. BM Elev.: /Gl~ ~ ~ BM Description: ~ `•~ ~ ~-- Q l TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic - / . S -~~l ~ S ~ G~(~ , Dosing ~ c vn 'n 1~.1y~ GY ~U c Aer ~; Holding TANK SETBACK INFORMATION ~~0 p9 `c '~ ~ 1v• ~~ a °'~k, SOIL COVER v ~ v° ~~~ ~, COMME TS' (Include code discrepancies, persons present, etc.) ~~.`S' LOCATION: BALDWIN 26. 29.16. 393,NW,SW 733 250TH STR ET ~~~a Q~D~~,-~ (~ ~~rn . - ro, os ; S yam---~ ~ .,~-~.~f~~ ~ ~ .e.~ ~ .~. ~ SAC . ~~, ~~ J1 L ~ f' ~•r~ `~w'° ``~ ~- b-tnc~~mGity7~ ~'~~ L~r~v <-~' ~,-,..r` ~.~ P*~ ~- ~~,~Q~' ~~ t~ ~! .J!NrY`~Cl. it u.~ ~" yl L (`~~C1- r y . /'ln ~`' k .k.: ~ ~,.' i ' M.:.' :~ C?1 /~~~ . ! " '~.( /' r t'V1 f~ ~("Q . ~j `Plan revision requir~? ^~es ^ No Use other side for additional information. SBD-6710 (R 05/91) Date inspector's Signature TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic ~~ ' ~ NA Dosing NA Aeration - ' NA Holdin ) PUMP / 5 INFORMATION Manufacturer ~o ~ ~ ~ r Demand Model Number rt ~~~ GPM TDH Lift Lriction Systema SU TDH Ft Forcemain ngth ? Dia. H Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS Benchmark 2,60 ~7.~ ~ 7,G1J r /G'ZI, ~ 3 P~ , ~ ~ os~~6 Bldg. Sewer . ~~-' St/ Inlet 7 ~~ ~ .3 St/ Outlet Dt Inlet ~ Dt Bottom ~/ 3~' I ~, (Q (P +/Man. ,~,~~~' o .3 Dist. Pipe ,~~ '~ ~ ~' 6 3~r Bot. System ~. ~~ / 3 ~3' l %~.(~ Final Grade ,~~,~,, o ~ s. .~ ` ~ ~ BED /TRENCH Width ~ Length , No. Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth DIMEN 1 N S `' DIM 1 SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEA G anu acturer: SETBACK CHAM N INFORMATION Type O ~ um er: a System: ,r1 ,,,,~ !'- Q OR U T DISTRIBUTION SYSTEM _ 4 ~,~„ Header /Manifold Distribution Pipe(s) ~ x Hole Size x ole Sp g Vent To Air Intake Length Dia- Length Dia. Spacing ~ PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) 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 County: ST. CROIX Sanitary Permit No.: 299039 State Plan ID No.: Parcel Tax No.: 002~1~6~-30-000 ~~ ~ ; ~- A97 03 6 ; Cert. No. `~SC~ Department of Commerce SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Safety and Buildings Division 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 i Attach complete plans (to the county copy only) for the system, on paper not less county than 8 v2 x 11 inches in size. ~, }~' • See reverse side for instructions for completing this application state sanitary Permit Number ~q D 3q The information you provide may be used by other government agency programs ^ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number I. APPLICATI N INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Davin Albri htson Property Location N[nh/a SW va, S 26 T 29 , N, R 1 6 E (or)~1/ Property Owner's Mailing Address _ Lot Number Block Number 733 250th. ST City, State Zip Code Phone Number Subdivision Name or CSM Number Woodville wi ( 11. TYPE F B ILDING: (check one) ^ State Owned ~ !t Villa e Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ^ g Town o III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) A '~/ o U ~h~` G ~ 2 -l U G Y - 3 v `~ ~ 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. Checkbox 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 ________ Exlstin~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 21 ®Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ 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. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) {Min./inch) Elevation 450 380 380 1 . 1 8 ~ 1 03, 5 Feet 106 Feet VII. TANK INFORMATION Ca aclt in altos g Total # of Manufacturer s Name Prefab. Site Con- St l Fiber- Plastic Exper. . N E i i Gallons Tanks Concrete ee glass App ew x n st strutted Tanks Tanks Septic Tank or Holding Tank 1 1 0 0 0 1 Midwestern ^x ^ ^ ^ Lift Pump Tank /Siphon Chamber 1 ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility or installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum 's Signatur tamps) MP/MPRSW No.: Business Phone Number. Joe Stang ~ MP6646 1-715-_698-2266. Plumber's Ac dress (Street, City, State, Zip Code): 506 Willow Drive Woodville, WI. 54028 IX. COUNTY /DEPARTMENT USE ONLY Approved ^ Disapproved ^ Owner Given Initial Sanitary Permit Fee (~ndudesGroundwater Surcharge Fee) ate ssue Issuing Agent Signature (NO Stamps) Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: -°.t1/96) - DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary p~+rfYytys~lid far..~,w~o (2) Years. 2. Your sanitary permit ma,~ b~e renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Admir~i3~ra$~Jle~d`e,will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county priorto 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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 1 15 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the 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. ~5 0 0`O SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labo~~nd Human Relations August 21, 1997 2226 Rose Street 6 , ~~~"~~,,~ La Crosse WI 546 -- h REc~i ~D WEGERER SOIL TESTING v 421 N MAIN STREET AEG ~ ~ ~~~~ PO BOX 74 ~, ST CROfX RIVER FALLS WI 54022 Zq~gppilCE C~ Z~` RE: PLAN 597-40990 FEE RECEIVED: 18 . ALBRIGHTSON, DAVID NW,SW,26,29,16W TOWN OF BALDWIN COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. AlI permits required by the city, village, township or county shall be obtained prior to installation. Inquiries sriould be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, d M. Swi Plan Reviewer Section of Private Sewage {608) 785-9348 SBU~ri-t3J iH.01/91) Wisconsin Department of IndusUy, SOIL AND SITE EVALUATION REPORT Page \ of 3 tahor and Human RelaOons ' Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code __„_~. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of sbpe, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O 0 Z - ~~ b ~ - 3 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION; \J~v~Q hl--~D E~.htluf= ALi312-(GtNf-SON eT ivtiJ v4 S Wv4,S Z6 T Z-9 ,N,R l b E (or}(Jw PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ~ 33 Z. so 7r~ sr. - - CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE MOWN NEAREST ROAD wooDv~v.~.~ ,till st~OZ$ (~lS) ~~~-ZSg3 BP<<-~jwlrv Zso'ri+ sT. [ ]New Construction Use [,~, Residential / Number of bedrooms 3 [ ] Addition to existing building j~ Replacement [ ] Public or commeraal desaibe Code derived daily flow DSO gpd Recommended design loading rate - bed, gpd/ft2 • 3 trench, gpd/ft2 Absorption area required 3Z S bed, ft2 3~S trench, ft2 Maximum design loading rate - S bed, gpd/ft2 ' ~ trench, gpd/ft2 Rernmmended infiltration surface elevations} ~ CJ 3 - S ft (as referred to site plan benchmark} Additional design /site considerations t'1oUt~p w / S x'lS' 1~~vef{ . >v1t N . 2 ~ o F S+`r~v~ N t~L Parent material \.o~ S nv~ s l ~~v Flood plain elevation, if applicable N. A • ft S =Suitable for system CONVENTIONAL MWND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for system ^ S ®U ®-S ^ U ^ S C~.U ^ S ®U ^ S ®U ^ S ~'U SOIL DESCRIPTION REPORT Boring # 1 - Ground elev. q8.o ft Depth to limiting factor z. 6 `' Boring # ~- Ground elev. 9 8-oft. Depth to limiting fa`t~ ~~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtdev Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. y Bed Trer>ch ~-9 10yR 313 - Sit z.'Q-sb1T w1~~- a-s av~ •s .t, Z q-2(~ 10 `9R 31L - S11 Z`FSbk vr-'~1- ~S 1v~ -5 .` 3 2-~ -4 0 ~ •S `I R 31 y -ll S `11Z S ~g S I ~ ~ yrt 'FL- - •. 3 ' y Remarks: ~_a 10`1\Z313 s~, Z`FS~1~ ~'Flr- a-S 2,v~ •5 -~ Z 8- t3 LO`12 y! S 1 I Z'~5~1~ wt'~~ e-S lv~ • S ' 6 3 1~3 -3 g 1. S y R. 3J y ; ~ S y ~ S ~$ S I o>~ ~ ~~ - • 3 • ~F Remarks: CST Name:-Please Print Arthur L. Wegerer P~~e~ 715-425-0165 ~ergerer Soil Testing & Design Service-P.O. Box 74 River Fal1s,WI 54022. Signahue: ~ ~,~~~~~ ~~ .~ 3) Date: _~ ` ~ ~ `~ ..7 CST Nwn 0 0 5 7.6 PROPERTY OWNER ~-8R.t6f;}'~'S~t~l SOIL DESCRIPTION REPORT ~ PARCELLD.~ UOZ,._ l0 b~ - 30 Boring # K `c ~o3?r'\'^jw 3 ~,. Ground elev. 102.E ft. Depth to limiting fa 15'' Boring # ~•~;.w,~ i . Ground' -elev. ft. Depth to limiting 'factor Boring # ~..a`~, ~ >`~~ti:a:.2t.~~`, ~2 :Z'~Y ~.i Ground elev. ft. Depth to limiting factor ~. i >~Boring #. ~~~~ .~':~,', ,,t kYCi~''x i `` Ground ' `;.elev. ft. Depth to limiting factor Page ~ of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Try I o-~ ~~~~Z 313 ~ s it Z~s~ w~ `F~- 0..s z~~ . s . ~ Z $-l5 bo `-'t R y 1 ~ S )~ 1 Z'F1s~k x~ 'Ft~ cS t v~ • 5 • ~ 3 tis -~.Z ~ • s ~ fz 3 ~ y ~ ~ ,~ spa s I o ~ -rt ~-.- - ~ "~ • y i i Remarks: Remarks: remarks: Remarks: SBD-8330(8.05/92) . ~ _ ~ PLO P~~ Page 3 ofi 3 ; • SCALE 1 "= y 0 ' ow,vt~.,.l~ ~ ~g 1ZtG trTS opt ~ ` '~ , M ~ x k10..~ 0 ~ •. 3 BUR1~ h}ousF i goo ~ f °~"~" I ~~ I Noi- Zo s ~ _ .J't'= - et'1 - ~~ - lea .u' Q~ o~e4t `A's Spa s ---- s~re -- ~ ~~ O N N LR~-v1.1 ~J Q C`3' ~Qfj~x• $-~ 30~ C~~Ztt3 S __ _ _ - - ~ z s' k 1 5 ~/Z °jo ~x~s~-\,.s G I ~Rr~N P~~.,p ~ I ~ \ N ~1 S j~j2.~i .~ ~ O ~ `'v~T~ S~~C~ I 0 p\SC!\`c~St(~@ ~ J f3-3 I I ez.ioZ, ~ ,I ~o r.~ oz- Co wt P Y!~-T -~I'' oR D~SlvR g `~i~t S g.2 e.D~'tovR ~.L'~t.lOt.S ~~-231 ~ ;3l `~7 (715 ) 47 S-r7~ (400576 CST Signature Oate Signed ~ Telephone tJo. GST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER David Albr; ~ht~c~n MAILING ADDRESS 7 3 3 2 5 0th . St . PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE Woodville, WI. PROPERTY LOCATION _~N nL 1/4, ,~~ 1/4, Section 2 ti T ~ ca N-R ~ ti W TOWN OF Ba 1 dwi n ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEYMRP ,VOLUME ,PAGE ,LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by themeWisconsin DNR. Certification stating that your septic has been maintained must be com et d l L'!'~ to the St. Croix County Zoning Officer within 30 days of the three y e~rcp e SIGNED: DATE: ~/ C '- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property Location of property NW 1/4 SW 1/4, Section 26 ,T~~N-R 16 W Township Baldwin Mailing address 733 250th. St. __ Woodville, WI 54208 Address of site Same Subdivision name Other homes on property? Yes x No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Lot no . x Yes No Is this property being developed for (spec house)? Yes x No Volume ~ ~~ and Page Number S ~Sf as recorded with the Register of Deeds. --------------------------------------------------------------- INCLIIDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER., VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 2133 ~„~ and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the offi of the County Registe of Deeds as Document No. zg332~ -r ~~ ~ ~, ~, griatu~f Applicant ~ ~ ~^ ~~ Date of Signature -Applicant ~~ Date of Signature lUu~rjr~~~ . s ?~ Sa~> UUa - ion ~v .~ St• CrUlx COUnty ZOning Tuesday, May 25, 2004 at 3:53:19 PM Detail Sanitary Information Page 1 ojl Computer #: 002-1064-30-000 Sub/Plat: 40 acres Section: 26 Parcel #: 26.29.16.393 Lot: TN/RNG: T29N R16W Municipality: Baldwin Township CSM: 1/41/4: NW 1/4 SW 1/4 Owner: Albrighton, David 733 250th St Woodville, WI 54028 State Permit: 299039 Issued: 09/09/1997 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: 09/28/1997 POWTS Detail: NA Bedrooms: 3 WI Fund: No POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Jim Thompson Yes Stang, Joe Stephen Aaby was the plumber on-site, Jim $0.00 Signed Off: No Thompson is listed as inspector at time of installation, but Mary Jenkins' writing is on the inspection report form. Mound bed 5' x 75' with 2 ft. sand fill. 2/5/04 -Survey shots were taken, but not calculated into elevations (will do it to complete form). Current owner came in to get copies prior to remodelling and submitting a reconnection permit application. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/27/2000 9/27/2003 04/01 /2004 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF BALDWIN COMPUTER NUMBER 002-1064-30-000 Parcel Number 26.29.16.393 OWNER NAME: First THOMAS L & SANDRA J Last OLSON PROPERTY ADD RESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 733 250TH ST SECTION 26 TOWN 29N RANGE 16W '/4160 '/<40 Line Description Line Description TOTAL ACREA GE 40.000 PLAT LOT BLK 01 SEC 26 T29N R16W NW SW 15 02 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit '~' _ ry nn S. 9 ` ~ ~ ~ ~ ~ V Page ~ of 6 MOUND SYSTEM RECEIVED 3 ~ ~FOx AUG 1 8 1997 A BEDROOM RESIDENCE . SAFETY & BLDGS. DIV. LOCATED IN THE N~'`~l/4 OF THE S1'`~ 1/4 OF SECTION Z6 ,TZ-°l N, R <<o W, TOWN OF eQsL.pWLN , S'C'• C~IX COUNTY, WISCONSIN. INDEX PA GE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION ; PAGE 4 of b DISTRIBUTION PIPE LAYOUT PAGE 5 of b PUMPING CEAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~ O W.'~.S• p~~lt~nally OP~V~D Pr-JO ~LP~l1~J~ 1~L@R~GhIT~4N Co ~~~ X33 ZSO 'frF ST. O ~E~ woopvit_~.~ ,wl 5407-~ ~~~oFCA 0~ DENGE gEE PREPARED BY LJEGE[~EF2 SO = !_ .TESTING ANiD . DES I GfiV S~R~.1 = CE F.a. BUI 74 42i N. iSAltt ST. RIVQ? F*1.LS. YI 54022 715-S~.r-016~ ~~~gCONS'N ~~~~~~ WEGERER o-eis r iILSWORTN. -~~~~w~NN~~ I~SIG1~~ _~ (~v G ~., L `l. a ~ JOB NO _ Q7 - Z-3 I -- - - - PLOT _PLAN _ _ .,~ Page Z of 6 Scale 1 "_ x-10 ' r ~ i ow,~~,,..~{ ~~ _ s f» y fl ~ >~,p ~ pOZ._ Lpbt~_30 1~ ~-e \ZtG L{-TS ow 3 BbR1~ h}ouSE ~ ZOOS f w,- ~o s ~ I N r x ~'V~I.L. Dpi ~ ----~ 1 i _>t-- - - eM - ~.kv. \oo.n' a.~ Eck `A'i- Sl~'PS ~- - S~p'cic lY~L ~ Zu ~ a F y,~` P V C ~AF~,ar~ Dc ~•~ S Z~S' Or Zk PVC F. ~'1, b"1butP~l ~z~ LAwN. 4 4~ ~i ~Z,`` SRc~LI.I'T'C i~~5b1 4 ~. aka` v~~s x.96? ._- ~ - is ~C I 1 I 5 ~ I2, °~o I:X~ST l ~.- G I 1 1 ''v~1'*1 SuQ,~~ ~ 0 p\SC4~t~rRG@ ~ 1 ' II ~I g-~ ti.~oZ.y ~ i I I 1 i J' ~o DoT CA-^~P~-T --~t oR D~SIvR-$ `i1t-iS ~ R •Z ~°l8°- e.D~1vuR ~.~1.101.5~ Bo's'sor~ O~ ``'l2lr~ C'.1} ~v. ~oJ.S' NOTES: ~l. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( z required) 4. -Septic tank to be~ooo/650 gallon capacity manufactured by v~-~~Ow~,s~-~ ~R-~sT , ~rv~- 5. Bench Mark S~ RBo~F 6. llivert surface water around•system to. prevent~.ponding at the uphill side. ,\ Page 3 'Uf b Approved Synthetic Covering 1~3TM C 33 Distribufion Pipe Medium Sand _ _ H_ ~~ _ Topsoil F Elev. l 03. S -J I ~~ p - 3 E , , ~, b 5 ~)Z % Slope Force Main Plowed Trench of 2"-2 Z" -From Pump Layer Aggregate Undisturbed D Z • O Ft. Soil E 2 • Zo Ft. Cross Section Of A Mound System Using F d:8 Ft. Trench For The Absorption Areo G ~ • a Ft. A 5 Ft. H ~• 5 Ft. B ~ 5 Ft. I ~ 5 Ft. Linear Loading Rate= 6-~ GPD/LN FT ~ 10 Ft. Design Loading Rate=a. 3 GPD/SQ FT K ~_ Ft. L 103 Ft. W 3 O Ft. L ~ Force B K Mai~- A ~_-----_- _---,---- - - ~°s- - - -- - --- - - - - - E~~T~s h'E' yy c~~POSt~ Distribution Trench Of 2~ - 2 2Y t;~0 Pipe Aggregate I 'Observation Permanent J pi es Markers (Anchor securely) Mound Using I Trench For Absorption Area Page ~ Of -~ Perforofed Pipe Oefoll End Co. End View 'erforoted 'VC Pipe Install permanent-marker at end of each Iaterai Holes Locoted On Bottom, ~1re Equotty Spaced Lost Mole Next To End Cop ~p Distribution Pipe Loyout P 3y. S Ft. X 3 b Inches Y 3b Inches Hole Diameter ~/Y Inch Lateral ~ Inch(es) Manifold -- Inches Force Main Z Inches ~ ofi holes/pipe \Z Invert Elevation of Lateralst~`I•o Ft. Place lst hole ~~N from tee with succeeding holes at 3 6` intervals.. Last hole to be next to the end cap. ' _ "__ - - Combination Sept~c~ Tank and PLI~"lP CHAM6FR CROSS SEC'f10N>:AAIU SPECIFICATIOAIS_ PAGE S .'QF 6 _: _ 1B~1KlN. y"C.I. VENT PIPE ~ l~' FROM DOOR, '.,JI-JOOW OR FRESH AJK IivTAKE --~ ;. n 6 M n-x . ~v , q8 S f ~~~w'd. !GRI'xDf y"11JS1?t~il~ PIPt II.iLE T APPROVED JOINT W~C.I. P1PEaR 3 4t=>=~~5 VEIJT CAP 4,/EATNER PROOF " ~ .1U.IJCTIOIJ 90X . APPROVED LOCKIIJG MANHOLE COVER wl'~'1 ~ wAR.tJ11JG 1.A6Et... f ~ , cozJDUtT rJ i I L-- \.\~ PROVIDE I AIRTIGHT SEAL I I Is "I r i Tank construction shall comply with ILH~ 1;3.15 and 33.20 C LLEV.°LO.6~ fT. ~TLti- `~O.O 6 PUMP -~ --~ D COAICRETE BLOCK `f~ MIIJ. i ~_- ~ 18'/'UU~ 1 (I 1~ I APPROYED JOIUT: I i w/C.I. ~IPE~~O ~ I ALARM I V i~ oN I OFF ~-- ~ 3" APPRflvFti RISER EXIT PERrSi1fED 01.1LU IF TA1JK MAlJUFACTURER HAS SUGFi APPROVAL~gEQptN(t SPECIFICATIONS SEPTIC f oos>~ ~-1~pw~~.1~J ~Z~ST 3 -3 CTURCR: IJUMESER OF DOSES: PER DAU F A TA-.l~C MAIJU TAIJK :,IZE: 1~0~ ~ 650 GALL 01.15 DOSE VOLUME Z ~-TRA S~Cg~~~S iF.1CLU S •~'• ~ OtA1(s 6AGKFLOW: "O GAttohlS , AI-ARt1 MA/JUFACTUKER: CAPAC , y~ AtODCL AlUMBER: ~~ ITIES: A= ~`~ IuCHCS 0R ~~ b GACLOyS t~, . ~ t~ SWITCH TyFE: ~~"~'V~"~ 8 = Z INCHES OR ~ G~.LLOUS PUMP MA{,1UFACTURCR: 7A~TL"l"~ ~" G= ~ ~ uJCHES OR 11~ CALLOUS MODEL NUMBER: 1 31 D = g INCHES OR l3 b GALLONS E ~ `vim. = b , l SWITCH TYPE: 1'~~'~GV-2.Y IUDTE: PUnP AND ALARM ARE TO 6C Za u~ INSTAlLEO OIJ SEPtiRATE CIRCUITS MtIJiMUM DISCHARGE RATE GPM yERTiCAL DIFFERENCE DETWfE1J PUMP OFF A1JD".DISTRIBUT101J PIPE.. X3'33 FEET + MII.IIMUM NETWORK SUPPi.y PRESSURE .. 2-SO FEET + goo fT.FRIG71orJ FACTOR.. Zts FEET OF FORCE MAIN X `'~, F~ FEET ~ ~~ ~ ~•Z9 FEET TOTAL Oy1JAMIC HEAD = DIAMETER '- Pump chamber 3 g `~ ~ 1{JTER1JAt,. DIMEiJ510tJ~i OF TANK: LE1.I6TH ;WIDTH ;LIQU10 DEPTH BOTTOM AREA - 231'= - GAL/INCH AS PER MANUFACTURER = ~-~`O_ GAL/INCH f. Iw. w HEAD CAPACITY CURVE ~ I4 MODELS 137/139 0 6 20 ~9 • 9 a i 15 0 a ` 137,139 a 10 2.8 08 MODELS 137/139 Ft. Meters Gal. Ltrs. 5 1.52 93 352 10 3.05 79 299 15 4.57 64 242 20 6.10 36 136 25 7.62 8 30 30 9.i4 - -- Lock Valve: 26 ft. o-)-- U.S. GALLONS I 10 20 30 40 50 60 70 80 90 100 110 UTERS 80 160 240 }20 400 0 FLOW PER MINUTE 009921 CONSULT FACTORY FOR SPECIALAPPLICATIONS • Three phase pumps are available in 200/208V, 230V or 460V. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical altemators, for duplex systems, are available with or without alarm switches. • Combination starters are available for 3 phase pumps. • Control alarm systems are available for 1 phase pumps. 137 Series - 47 lbs. 139 Series - 51 Ihs Sin le Seal Control Selection Listin s Model Volts-Ph Mode Amps Simplex Duplex CSA UL M137/139 115 1 Auto 10.7 1 or 1& 8 --- Y Y N137/i39 115 1 Nan 10.7 2or287 3or586 Y Y ' BN137 115 1 Auto 10.7 Y Y D137/139 230 1 Auto 5.8 1 or 1 8 8 --- Y Y E137/139 230 1 Non 5.8 2 or 2 8 7 3 or 5 8 6 Y Y ' H137/139 200-208 1 Auto 62 1 8 8 --- Y N ' 1137/139 200-ZOB 1 Non 6.2 2& 7 3 or 5& 6 Y N ' J137/139 200-208 3 Non 2.6 _ 2 & 4 384 or 5&6 Y Y ' F1371139 230 3 Nan 2.6 2 & 4 384 or 586 Y Y ' G 137 I 460 3 Non 1.4 2 8 4 384 or 586 N N ' G139 _ 460 3 Nan ~ _ 1.4 __ 2 8 4 _ 384 or 586 N ' No melded plug "Single pggyback switch included. Pumps must be operated m upright position. Three phase units require a contrd switch to operate an external magnetic or combination starter. For information an ad6tional Zceper products refer to cataktg on Combination starter, FM051a; PiggybadcVariableLevel FbatSwltGles, FM0477: ElectricalAltemator, FM0486;Mechanical Ahema- tor, FM0495; Alarm Package, FM0732; and Sump!Sewage Basins, FM0487. SK373 • Variable level control switches are available for controlling single and three phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Over 130°F. (54°C.) spet~al quotation required. • Refer to FM0806 for 200° F. applications. 13/16 ~ 7 7/16 ~~~- 6 a'F 6 L-- 6 1 /8 ~~ 4 13/16 - ~°f~~~~ ~ 1 1/2" - 11 1/2 NPi SELECTION GU{DE 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0447. 3. Mechanical alternator M-Pak 10-0072 or 10-0075. Refer to FM0495 4. Combination Starter. Refer to FM0514. 5. See FM0712 for correct model of Electrical Alternator E-Pak. 6. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) fbat system. 7. Four(4)holeJ-Pak,junctionbox,forwatertightconne~Nionforhardwiredsimplex operatiun,10-0002. 8. Two (2) hole J-Pak, for Watertight hardwired Pconnection or splice, 10-0003. CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes sfiould be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. _ MAIL T0: P.O. BOX 16347 ~/~~ ~ t Louisvrlle,KY 40256-0347 Manufacturersof.. Z ' ~ /~~ ~~ SHfP TO: 3649 Cane Run Road qo s ~Ga~ Louisv8le, KY 40211-1961 Q~/q(/TY PUMPS SMCE ~~rJJ I ~~ PUMP !O. (502)778-2731.1(800)928-PUMP FAX(5021774-3624 WiscorlsinDetSartrnentoflndustry, SOIL AND SITE EVALUATION REPORT Labor'and Human Relations Division of Safety & Buildings in ~nnnrrl wi+h 11 LJQ o4 AG \Afin Arlin (~nrle~ Page \ of 3 ... ----~- --....._.... __.__, -...,........- ---- COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include but , not limited to vertical and horizontal reference point (BM), direction and % of sbpe, scale or PARCEL I.D. # ~0 b 4 Z 3 dimensioned, north arrow, and location and distance to nearest road. O -- T ' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERN LOCATION ~D f~V ~ Q h1-->C~ ~l.hl hl ~ AL~3R.(6 ~S O N -691FFt9~ NL.I 1/4 S W1/4,S Z 6 T -2. `I ,N,R ~ b E (or~W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # X 3 3 z s o `rr} s~-. - '- CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ,OWN NEAREST ROAD woo~v~~`,~ wl S~lOL$ hIS) ~~8-ZSg3 Bf~v. Lrv ZSO `h}~ ST. { ]New Construction Use { ~, Residential / Number of bedrooms 3 [) Addition to existing building j~ Replacement [ ] Public or commercial desaibe Code derived daily flow y,SO gpd Recommended design loading rate - bed, gpdJft2 • 3 trench, gpd/ft2 Absorption area required 3Z S bed, ft2 3~S trench, ft2 Mabmum design loading rate - S bed, gpd/ft2 - ~ trench, gpd/fi2 Recommended infiltration surface elevation(s) \ ~ 3 - S ft (as referred to site plan benchmark) Additional design /site considerations f'10 U'r~p W / S ~-1S' ~~.~ve.t} , rat N , 2 ~ o F S~c~ -= t ~L Parent material l.o~ S nv~ s 1 ~vv Flood plain elevation, if applicable N. A . ft S =Suitable for system U =Unsuitable fors stem CONVENTIONAL ^ S ®U MOUND ®~S ^ U IN-GROUND PRESSURE ^ S ~.U AT-GRADE ^ S ®U SYSTEM IN FILL ^ S ®U HOLDING TANK ^ S (~'U SOIL DESCRIPTION REPORT Boring # Ground elev. 98.E ft. Depth to limiting factZo~ ~l Boring # :~<= '>v i>~~ ~ . lV Ground elev. 98-ott. Depth to limiting factor 1~'~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Botx>dar Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. y Bed Trer>ch o- lp~R 3!3 - sit z'4-Sb1~ w1`cf.- a-S av~ •S .tv Z q -z b 10 `1 R 3! ` - S 11 Z `F S b1t vh'~>^ ~S 1 v 'F - 5 3 z~-~o ~•syfZ ~~y ~ts~~slg sl o~- rrt~f~• - •3 ~y Remarks: 1 0-~ 1o`t\z3t3 sil Z`~s~1~ ~'Fv, a-S Zvi •5 ~-~ Z 8-t3 ~o~~y! - stl Z`Fs~~ 1n'~1r ~s lv~ •S -6 3 ~3-3$ ~.s`tR 3Jy ~~sy~ s!$ sl o~ ~'~~- - -3€•`F Remarks: ST Name:-Please Print Arthur L. We~erer Pfrone_ 715-425-0165 ~ergerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 >ignature: Date: CST Number: . PROPERTY OWNER ~-8R.~6!}'t'S~t~ SOIL DESCRIPTION REPORT ~ PARCELLD.~ C~OZ.- lO 6~t- 30 Page ? of 3 Horizon Depth in Dominant Color Munsell Mottles Q l S C C Texture Structure Consistence Boundary Roots GPD/ft . u. z. ont. or o Gr. Sz. Sh. ~ Bed Trends ~ O-~ l0`-tlZ 313 ~ S t~ Z`~' 8b v~- ~~ a.S Zu'~ • S , b Z 8-tS la ~ R yl ~ s ~~1 Z'Ps~k w, ~-~. cg 1 v~ ~ s • ~ 3 tis-4.Z ~•s ~~ 3~y ~Ft R spa s I o~, ,~ ~,,. - . ~ .y i I Remarks: Remarks: Remarks: Remarks: SBD-8330(8.05/92) PLOT PLAN SCALE 1"= y0 ' ow,vt-.,,., f~ Page 3 of 3 ~~.D ~ ooZ_ tbb~,-3O 1'f t- B ~LIG t{-TS o N ~+ r F j ~ ~ (+9 cn ZOO'( 1~C1T \O S e~-~ h~ x ~veu D~vCl~ ~~ ~ - ~•--- - ~~'1 - CTL~Cz,V • X00 .u' OON O~ett 'A'r SIYPS '---- S~P1lC TYp~'~ ~" X O N 6 R"~e~ .z," ~z" 4 ~ ~ sR~'f"CtiTL~I~ ~tsH ~ P~wN Q p Q ~ gfj?x . $-, '30~ is` k I I °~o 5 ~ /2 ~x~s~ 1 ~.i G I , ~Rw~N Ptt'Z..O ~ ~ ~ '~~'cu S ~Q.FPcC~ I 0 , 'p~SC~~-~,G~ I i I B~~ I t*t.toZy .I ~ t» ~rl oT CO wt P'(t~-T -~t' oR D~STvR-0 `nNS ~ g•2 c_puZovR t'L~1. 101.5 B o`~TOt~-~ O~ 1-tZ~ti ~~ ~ ~~G/'l.~-~S r~it , ~ `~ ~ `~ 7 (715 X 4 2 a~-231 5- n 1 F, 5 (400 5 7 6 CST Signature Date Signed Telephone No. CST #