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HomeMy WebLinkAbout002-1006-95-000 1 0 ~ p °c~ I a c CD c ~Y o I N ~ ts C I b o I N a I o I M ~ I 't i s I I N I z° c U. o c 3 ~ ¢ I L _ o fO z = o I z a m o I o Z v w o I U) Z c tn I-- r E z a I ~ I 3 N c • c I 1 0 Z Z O N z (D 'D V c N N I d m Q « : C c 0 y d y O G a N N N Q o f/J fA fA EI Lo CL m '6 4 2 0 0 0 z° CL IL m a _ ►'`i ' ° 3 fA J V rn rn z ivy Lo m N N N p Cl 04 T3 t co c a u~ tq Q Q Z 05 w Z6 I N m R „V O~ o O : co I~ C O N N 7 N CO cq: LO m c y ,c c u a C) CD Q 0 C, r c N N C o c p c L"i 3 'O W QNU N 'O 'O C (D Ili ~ N N O~ O N O O t6 U • 0 o DO CD Z N Z z g <n V d ~a a ~ . mat c ` IL • c3 a d V d C ~1 A 0 (L2 0U-)U Parcel 002-1006-95-000 02/09/2006 02:46 PM PAGE 1 OF 1 Alt. Parcel 04.29.16.54A 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner SARAH M KREFT O - KREFT, SARAH M 1189 230TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1189 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 37.500 Plat: N/A-NOT AVAILABLE SEC 4 T29N R16W FRL NW NW EXC NSP R/W Block/Condo Bldg: ~ TOWN BALDWIN Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 08/04/2003 733624 2346/244 WD 07/23/1997 817/174 2005 SUMMARY Bill Fair Market Value: Assessed with: 86601 130,800 Valuations: Last Changed: 06/25/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 9,000 59,500 68,500 NO UNDEVELOPED G5 20.000 7,400 0 7,400 NO PRODUCTIVE FORST LANDS G6 15.500 8,100 0 8,100 NO Totals for 2005: General Property 37.500 24,500 59,500 84,000 Woodland 0.000 0 0 Totals for 2004: General Property 37.500 24,500 59,500 84,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 510 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT 1 OWNER Law, J'AlIr TOWNSHIP SECTION ADDRESS. c~c fltt ,~(20 ST. CROIX COUNTY, WISCONSIN w SUBDIVISION LOT LOT SIZE Q XC/ r'S PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ 9 10 p p 8 cam- ~ >a 04 w e cs C, O~ N Ir f ~ , f vu~~d ~S h -P \c~ 6C i c, e z Jr c Ex c eip~- As oc c76-- a -1 1 INDICATE NORTH ARROW BENCHMARK: Elevation and description: -77,5-Y 60 0wt ®cY Se J! Alternate benchmark 79,03 1 ,o "cos _ SEPTIC TANK:I•ianufacturer: Liquid Cap. Coo ?s Rings used:- D.-Manhole cover elev:Final grade elev: 376 Tank inlet elev.: Tank outlet elev.: '73. ~So No. of feet from nearest road:Front , Side L-, Rear Ft._ From nearest prop. line:Front Side Rear Ft. No. of feet from: Well Z15- , Building: /V (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER i Manufacturer:` frec,,,,4 Liquid Capacity: knc) 634- Pump Model:wE67~ Pump/Siphon Manufact.: ~Aj 5- Pump Size --~4, Elevation of inlet: Bottom of to elevation -70• Pump on elev.: Pump off elev.:-;7/)g Gallons/cyc e: '2P MZ ~(°y % r/ L Alarm. Man.. Switch Type, . Location Sk r` I Distance from nearest prop. line: Front_, Sidev Rear-Ft. Distance from: Well (03 Building ~2 y SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length 7 5 Number of Lines: Area Built Exist. Grade Elev._ Proposed Final Grade Elev. a.). Fill depth to top of pipe: 1:9 " No. feet from nearest prop. line:Front , Side V, Rear pt. 4f , No. feet from well: No. feet from building_ 775 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE: - PLUMBER ON JOB: ► a LICENSE NUMBER: i 6 0:c' /9 7 - DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY NG LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number. NW4,NE4jSec.4,T29-R16 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Baldwin Holding Tank El In Ground Pressure lu'J Mound Intl, qt ❑ NAME-OF P T HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dan Mondor Box 1189 230th St, Baldwin, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST REF. PT. EV , W, Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Bennie Helaeson 3215 St. Croix 128820 ' '7.~ I• V VI--,e I' C , SEPTIC TANK/HOLDING TANK: 6, t&t"1)Qd o ' G S ! <`7141 MANUFACTURER: LIQUID CAPACITY: TANK INLET EL TANK TLET WARNING LABEL LOCKING COV R PROVIDED: PROVIDED: .L.l~ ~ 7Y/l NO ❑ YES 0 BEDDING: MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL, BUILDING: VENT TO FRESH VE* C . (J.. b4'~ , , ALARM: FEET FROM LIN : \ < AIR INL E NO ❑YES O EST -1111" " DOSING CHAMBER: i~ ' J of l = D. y o 2' 6 pu«. = MANUFACTURER: BEDDING: 3.fN IQUID CAPACITY: PUMP MODEL: PUMP/SM"O"ANUFACTURER: WARNING LABEL LO ING COVER P,RRO,VW: PROVIDED: Ei- ES ❑ O ) d~ 0 L (CY w 0 7 2 -YES E:1 No d'P~❑ No 1/1 uAID GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN I FEET FROM LINE: , I _0 • AIR INLET_ PUMP ON AND OFF 35 ! YES ❑ NO NEAREST ~ >,;2 Y 9 FORCE LENGTH: ! DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the aPth of Plowin or excavation. (If soil can be rolled into a wire, construction shall cease until( the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: L NO nF DISTR. PIPE SPACING: COVER PIT INSIDE DIA.: # PITS: DLIQU EPTID TRENCHES: MATERIAL: DIMENSI GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW 141-E ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; OYES ❑ NO YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: r , 12 ❑ YES NO 00YES ❑ NO YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE rF: TRENCHES: (/k DIMENSIONS 160" , IMANIFOL DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: MANIFOLD PUMP 6,51C:7- ELEV.: ! ELEV.: DIA.: ELEV.: PIPES: DA.: ELEVATION AND Z/a DISTRIBUTION HOLE SIZE: H LE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION " I APPROVED PLAN ;r, d sc.L. GOn. 3~ YES ❑ NO / zf z9,yl! 01ES'E:1NO;,,sLWtd@ ?.D,#. PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: , BUILDING: COMMENTS:, ' y FEET FROM LINE: M ' -~I 73O • YES ❑ NO YES ❑ NO NEAREST --111- > )_0 CL -0 $,_,J 4,V ~f the q, 4416.e .3-5-- //7/ 1.~ 2 U Sketch System on in in county file for audit. Reverse Side. SIGNAT RE: TITLE: i SBD-6710 (R. 06/88) rOILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. n k if revs on previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S90-02911 PROPERTY OWNER PROPERTY LOCATION Dan Mondor NW '/4 NE %4, S 4 T 29, N, R 16 V(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Box 1189, 230th St CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Baldwin, WI 54002 715 684-3253 CITY NEAREST ROAD E:l II. TYPE OF BUILDING: (Check one ❑ State Owned VILLAGE ; Baldwin 230th Street TQWNQF: ❑ Public 01 or 2 Fam. Dwelling-## of bedrooms 3 PARCEL TAX NUMBER(S) 111. BUILDING USE: (if building type is public, check all that apply) :H2-1006-90 & 002-1006-95 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. X❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 5 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 3 y 100.1 Feet /0-2, Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank 1000 M000 1 Midwestern Precas x LiftPump Tank/Siphon Chamber 1000 1000 1 Midwestern recas VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumbe ' Signature: (No Stam ) MP/MPRSW No.: Business Phone Number: Bennie Helgeson 3215 715 778-4425 Plumber's Address (Street, City, State, Zip Code): Rt. 2, Spring Valley, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date ssue I suing Agent Signature (No Stamps) Surcharge Fee) Approved I ❑ Owner Given Initial v Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by 1:he permit issuing authority. 4. Changes in ownership or plumber 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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'/ 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 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, ground- water contamination investigations and establishment of standards. SBD-6398 (8:11/88) APPLICATION FOR SANITARY PERMIT • 8TC-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/conttactot,(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 ~a-u": YA °'1' a n, Location of property IVk).-1/4, Section TEL-P-R-L--w ~ Township r--->3 C' LQ Nailing address 15 Address of site 5a,wt.~ subdivision name Lot number Previous owner of property Total also of parcel Date parcel was created - ' q Ate all cornets and lot lines Identifiable? as 0 is this property being developed for resale (spec house)? as 0 Volume '91,7 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWINGt A WARRANTY DEED which Includes a DOCUMENT NUMBERt VOLUME AND PAGE NUMBER, and the sRAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if avallable, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Cestlfled Survey Map, the Cattlfled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(Wo) cettify that all statements on this form are true to the best of my (ouc) knowledge; that I (we) am (are) the owner(s) of the property described In this 1ntotmation form, by virtue of a warranty deed r corded In the Office of the County Register of Deeds as Document No. V S7b ~ ; and that 1 (We) Presently own the proposed site for the sewage disposal system (or I two) have obtained an easement, to tun with the above 'described property, for the construction of sold system, and the same has been ,Q 1 e orded In the office of th~~`~ Sgsinly Re later of Deeds, as Document No. `r ) • JLJ- slgnatuce of Owner Signature of Co u wnet III Applicable) ?-//-V - 9 a 1- 15'-J,) Date of Blgnatute Date of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 43G19 BOOK 817 PAvE 1.7 REGISTER'S OFFICE ST. CROIX CO., WI Helen Sletten, a/k/a Helen M. Sletten, Recd for Record a sincrle Derson J U L 2 0 1988 conveys and warrants to ..-...Daniel L. Mondor and Sarah at 8:50 A M M...Mondor,--.husl~aBd..And---W .fe,--.holding-_as•______.._. Ur survivorsh.j:p..marJ,tal propert'y------ . Register of Deeds - _ RETURN TO I I d the following described real estate in St,.._.c. Xo.ix ....................County, State of W* sconsin: Tax Parcel No: North Half of the Northwest Quarter (N~ of NW4) of Section Four (4), Township Twenty-nine North (T29N), Range Sixteen West (R16W), except a strip of land Fifty (50,) feet in width off the North side of above described real estate heretofore deeded to the Wisconsin-Minnesota Light and Power Co., all in Section Four (4), Township Twenty-nine North (T29N), Range Sixteen West (R16W), St. Croix County, Wisconsin. TRANSFE11 F i This 1S not homestead property. XpX) (is not) !I Exception to warranties: Easements and restrictions of record. I I i~ I Dated this 1$... day of _July 19.88... (SEAL) v .......(SEAL) * Helen M..•-S] etten SEAL v ♦ t . S r AUTHENTICATION ACKNOWLEDG I,TT"Q Q../ ~ .l Signature (s) STATE OF WISCONSIN 41~••P ]~L • . Y 8 1 Stroix - - C----------•--•----------County. authenticated this day of 19 Personally came before me this 1.8........ day of ------•---July-----------------•••. 19.88._ the above named ' Helen Sletten, a k a Helen M. * ..Sletten - TITLE: MEMBER STATE BAR OF WISCONSIN rA. (If not, ^ authorized b y § 706.06, Wis. Stats.) to me known to be the person who executed the foregoi nstrumen~t d acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY (/,V Cht7 V Thomas A. McCormack Baldwin, WI 54002 '---Re_u_be_R_.D-np.rnink Notary Public ..St . County, Wis. . (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 8-27- 1989....) 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc. FORM No. 2 - 1982 Mil:rsukec. Wis. v H a ST C- 105 a H SEPTIC TANK MAINTENANCE AGREEMENT p St. Croix County z` d a H -o,.,n.;C~ OWNER/BUYER ROUTE/BOX NUMBER X30{I" . Fire Number 11~6~1 CITY/STATE ~ dCw ~ W~ zip 51400-2- PROPERTY LOCATION: Section , T '7•q N, R__16_-W+ Town of I 'Jj'W;'YL St. Croix County, Subdivision Lot number _ • I Improper use and maintenance of your septic system could result in I its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pest into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho E I/WE, the undersigned, have read the above requirements and agree N ac to maintain the private sewage disposal system in accordance with r. the standards set forth, herein, as set by the Wisconsin Depart- w ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkpe within 30 days of the three year expiration date. SIGNED_ D ATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2235) or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ faiCiP7kttd=`P: LOT NO.: BLK. NO.: SUED VISION NAME: ~ 1a 4A14 /LqN/R/6E,.)Wt F, COUNT : OWNER'S/ MAILING ADDRESS: , S 0 a O r 1I `~3 Sd,,f f3~~c LJ( i USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCI AL ESCRIPTION: PROFILE DESCRIPTIO S: PE OLATION TE S: [~Ries~iclence ❑New EK-Place y g~ RATING: S= Site suitable for system U= Site unsuitable for system I V''~~ r CONVENTION MOU IN-GR❑OUNDPRE: SYSTEM-IN-FI OLDI SV : RECOMMENDED S STEM:(optional) ❑S ❑U S S U $X7 S, ~ec If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: 4 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ,1 ?",94 8, SS~ S n B- ' 'J 7 ri ~Z.Z non -e_ 17 30" 8, &x SC O Mo B- t 9 C) t 1 l S 8 5'/ Ts S' "41 &v 51.1 " CCL 0</ A SCL B- 0 ~o''k,t3ti Scp N,p B- S,,U~~.' <o'Un H. ~Fv O ~ Hot' 1 ( r, 7~'rJt Si TS 1 `y B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH P- f /113-1-11 3 P_ < ( I r / r y P_ L( Lj 6- ar- P_ P_ g.3s PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. M (n. ©i % CV, e ~ sa'a lav A'o- L ff""- CA,,- SYSTEM ELEVATION /00, &140M 0~ ROCK- lgeck- . E I E ` . 3 I E E F i . i 3 . , E f E 3 . E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pr' . TESTS WERE COMPLETED ON: ~Phnt ~I e d o TRESS: A CERTIFICATIO NU BER: PHONE NUMBER (optional): C"_'f <Sv r I 'V" C)CXI LC~74 oil , _S I CST SIG TU E: L.DISTRIBLITION: Original and one copy to Local Authority, Property 'Owner and Soil Tester. -I1-HR-SBD-6395 (R. 10/83) -OVER - INSTRUCTIONS R tUMPt_.. , FORM 115 - ~ 61395 To be >rnpiete and ac ire /OLU, include: 1, cor- aI de 2. The w ~at1 must c whothe, sidence or corn} project; 3. MAX] " ^t number v' b(- commercial pianned; 4. Is v of ret)r- 1 h. C< r the sui! al :1 . A SITE I' .aJITABLE FOR, III AG TARN ONLY IF ALL i '-'['E N" p RULE[: -LJT BAS r SOIL. CONDITION, 6. PLEASE u, the abbr . Fr t:icaars shown here f( r :`ofile descriptio ; on-pleting the plot plan; 7. MAKE A 3IBLE di --__n accurately loi )ur test locations. Di w, t to scale is preferred. A separa-, sl~ r„=:y be c if desired; €3, Make sure .:gar bxnchrrark and vertical elr:vz "r :re point are r;learly shown, and are permanent; 9. Complete all appropriate boxes as to dales, nan , , 'J- :as, Mood }slain data, pereolatior-r test exemp- tion, if appropriate; 10} If the information (~,;h esievatio~a} drags r A. in the appropriate box; 11. Sign the form anc ct. Iress and your c r 12. Make legible copies I distriE required. ALL SC TESTS IST BE FILED WITH THE LOCAL AUTHORITY WITHIN : 'SG- C L TION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil S and Textures Othe- Sy; l als st - we (over lUl BR cob Cobbie (3 - 10") VS >t ne nt;- gi C <=.vel (urider3") ;c sf? a'ldP ,r,'i Sand Well 4 Sol BarYt _ Loam snot tles sc - Sandy Clay vv/ v",itn sic - Silty Clay fff - few, kC Clay cc - corrtrsto. ~e pt teat narrt rViany, rn.. , M muck d distinct: p prominent WAN- High wate;• levvi, Six tier. tl soil te~ surface vuater tot - Bench rt° Vol ti r" rt TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit roust be obtained and posted prior to the start of any construction. - - I ~ ~ r I -kA w I I i ~ ~ i I i I' I : I I I el( I ! I I I I I ' ~ ~ i I I i ~ I I I I I, ~ I ,:Z5- f l l l) ~ j 'I r 3° I~ I ~ I~ i I j I I i I I --r-t - f-- --i - -f i TI II I m 0, F- --1--- I ~---~--~--tom-F ~ : I i I I I I I i I i I Wit-- I ~ i --1 -t i - I ~i C I I I I 9. X # w i 1I 03 44 I I N I I I I I I ~ i~-~- I I B3 - - - { I Jf 042+1THc0 . I I I . I I ~ I I ~ 1 -T ~ j ~ I, ~ I I I I I ' ~ I I i I I T-7-- I a- - - - - - - -r-- -1 I I I I I I j I ~ I I I j l I - - - - - F----- - - - -1-- t - - - - -L - 1 ~ t f I ~ I I I I _ I t I ~ I ~ I I I j I I I 1 I I I ~ I I ~ i j I I ' I I I I ~ i l l~ l I , I ~ I I I C I ~ I I I I ~ I l i j , I i I 1 I 1 y I' I I I I i ~ j~ I I , I , I , ~ I I I I i I I I - I I 1 r I I ' I ~ I I I I I I I f 1 f i I I I I ~ j i I I I ~ I i i , i- l - i r I j I I I I I I I I- I_ _ J 1 i i I I L;Luy\ cy-, Uc7.v~ r4l 1n d c5r- 1 JI d - j o _vv '7 4s ~per- i g3.o3 ~s Ott m -r 16 R I k~ous~ S,~,hS (p bt~e11 Pray os-k 1000 G~~.rSe~~~C 1 ~I ~ ,M(~ 1~.ti~ ('U Ol7 CTa~. Q oS L ~a~,v~,~ I ~ r^ Th l3c+rh I a3o ~h cC ~ III 5 A '~urca ..c,', FW f + LA T,'C,)-j.3 c i I o, j qo~' ( n gb i I SL rJ.o ~ - Exc•e ff As w I jJ,.a~c,sPc{ I ~ Aroma Ike V'\ v\ I ~v fity uwc~is}~.rbed' 4 1 i-IJ-1 es4 4 I- ('e- s awn 63 / (ri~ic~ ?aCO~ ~tc t g -qv J I c- T4 :r pz_ B. M # t t oc~, 00 I TOO4 siasR- i M n U o lr Page Of Cross Section Of A Mound Using A Trench For The Absorption Area - E1-c.v . X00,'? Medium Sand Fill ~I F - opsoi r-pe,. jCV, I 3 D E Trench Of 2~" Aggregate, Plowed Layer 6" Below Pipe, Covered With D s Ft. Straw, Marsh Hay Or Synthetic Fabric E L'71 Ft. G Ft. F `77 Ft. H /,.S" Ft. P1 anLUevt :Of, Mound Using A Trench Foir-The Absorption Area orce Main Distribution Pipe Permanent Markers Observation Pipe A o W II B K \'Trench Of 1-2" - 2z" Aggregate I L ft-s A Ft. K 11. g~ Ft. W (o. t 8t2 B 75- Ft., J g, 1 Ft. L Ft. 2.~~~ License Signed: Number: Date: u.~. n ~n c QY' vi ux L -V J ~ ~•~.•S.'"=~iJSTN,~~ QE2r~A/JE~.1-' 1~AR1-~"'TZ O\ ' `S AT GUZ) OF 6~71\ CH LkTL'WaL "~uD CAP. Q ` 1-Fo L.ES LC~:~iT"~'J OlJ ' ~tJT"~ H ~ +/\j~ -.~Lt~B iilJtj J~R~ ~'C>Jt~RL1.y SPAC.h~ . t +v ~ ;C ~ pVC ~-"FpRGE Y~ A 11J _ / FRAr'I Tau E'1 P P~hcE LJtS'S' !t-OLt 1JE)C'T ZC FuD C.RP I ~J\S'TR.1BuT]DIJ. PIPE 1Ay~U_T_-_. P FT. _ x ~(41, _ OF Y1tlLE$/T~1 PE - I , C, 11JV. El£V. OF LS f b ~T- V ~l p~r'~ C E t sT NU ~ ~ ~=Ror-l T~ w J TH S v cc~E~"D1 ~ G tt~ L E~_ . /`~T_- ~ ~v 1 lll'~U~C-S . -THE T Ta E E~1 D Cf~ P- L ASST HO I-E TO l _ PArI, ;r • 1 PUMP CHAMFER CROSS SEC'!Cfj AAJO 'PCCIFICATIO'!S I VCQT CAP 4"C.I. VENT PIPC WEATHERPROOF APPROVED LOCK1I4G JUIJCTIOW BOX MAWHOLE COVER 25' FROM GOOK, ` WIMCOW OR FRESH 12"MIU. AIR INTAKE GRADE I y" MIW. ' COIJDUIT L-- _ 18"MIN. \ _ \ X11 IAILET PROVIDE AIRTIGHT SEAL, I i l I III V APPROVED JOINT A dr I III APPROVED JCI W / C.I. PIPE Fes'' ) III W/C.I. PIPE EXTENDING • 3 3 II ALARM EXTEUDIUG I i_ ONTO SOLID SOIL ONTO SOLID Sc I a I I I 1 y~ oW I I ELEV. 77/,X FT. OFF COUCKETE BLOCK' ~i v S RISER EXIT PERMITTED OIJLy IF TAWK MAUUFACTURE:R HAS SUCH APPROVAL 'SEPTIC E SPECIFI'CATIOUS TAUKS MAUUFACTURER:AI (3:)e-s Tee-*PN + 1JUMBER OF DOSES: PER DAB TAWK SIZE : 10 0 n GALLOWS DOSE VOLUME ALARM MAMUFACTUR,ER: S.T- Fle ty IAICLUDIIJG 6ACKFLOW: ~55 GALLOK MODEL WI-114EK: f-C i 1 I CAPACITIES: A= t~ IUCHES OR _ GALLOu SWITCH TyPf: __Nl!E r CC ~ _~'I r_i+ B= IUCNES OR GALLC'J' PUMP MAMUFACTURI:.R: - 1CuL + :YID C rote C,: ILXNES OR 3s.1 GALLOL NP 0 V MODEL IJUMBER: 7 N D- IMCHES, OR 389.3 GALLON -WED 5WITCH TYPE: Do,'11,C :[Ic-,J e SL--f j NOTE: . PUMP AMD ALARM ARE TO BE MIAIIMUM DISCHARGE RATE GPM INSTALLEO OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AND D15TRIBUTIOLI PIPE.. FEET + MIWIMUM METWORK SUPPLY PRESSURES. , , , 2.5 FEET ; + _79•y FEET OF FORCE MAIM X 9- F/IOO FLFRICTIOU FACTOR. FEE T" ~ 2t6x 1 (All - TOTAL OyWAMIC. HEAD = Y 3 FEET' IIJTERWAL DIMEustOWt OF TAIJK: LF-KIGTH ~ ~l ors s' fi ;wtoTH ;L1qu10 DEPTH SIGNEO:` Q .~C~ ~=-T- LICEUSE WUMBER, DATE: j i ~ ST. CROIX COUNTY WISCONSIN r 1' `}Y 3ZONING OFFICE ,.~3 ST. CROIX COUNTY COURTHOUSE lqyq911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Aug. 17, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Dan Mondor property, located at the NW 1/4 of the NW 1/4 of Sec. 4, T29N-R16W, Town of Baldwin, St. Croix County, revealed suitable soils at a depth of 17 inches below which seasonable high ground water was noted. An additional 19" of sand fill is required. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, ames K. Thompson (T►/ Assistant Zoning Administrator cj I 1 State of Wisconsin ` Department of Industry, Labor and Human Relations 4C , SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 UC t(jg)E_r 'y' 1t) t Madison, Wisconsin 53707 00 I /I. 02020/ ci f'lan 1.[). o. S - td-t Z19 'Zo: iV~ls`fl7r d':t'ai t.~?Clr; 3 jai;" fir3 i`ownshi pX ::>t. ('X0iX GOLItlty, 'I Your petition for varianc;a to sectiL'i"6 ;Ad',ii Cai s tra ti vo t. odo, E'ws )e.en revi owcl(j. 1 iio rule pet i ti un(-,~. C oqui res r: systei:i si to 'iava a !'i i til,:tili 3 o r •i rlc its of siai ; aA e natural soil. The variance ri'.C ueste i was to install a r pl aceL ,iop s ri(s I. nc! sys :e;:i on t? site w`I ii) 17 i nchcs of sui -,.1e?i o , aturai so'i l . Tf`io tAJC}'/iC+" br~... .~cno i,Cud<: in 't-tic jscti%l ylti alla y'Si S: I . 1n revie,,irig khe p)e-F'iti on , ii; -ray (:otoa't' ti i~, request- .:~s SiiAiar t0 ot'h'r potions c'cccl)tou by ti;Js l1'i ~:uk tt:i; iit un(:' ' xtti t,ioo i1Ul; 5erss 2. ;:iris on the pr+'cocru'Ct est aljl i sllit t y the :)r i'jLis ~ict'i Li c~n5, this petition for variance is ;,)t ng proct~,s,--, as g;E!C t 'by 14i sconsi n .d}- q I I i SBD-6928 (R. 10/87) i, J ,r State of Wisconsin ` Department of Industry, Labor and Human Relations I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 )iii? .if)nd1or" Madison, Wisconsin 53707 Pu TAi; ?l:)roval 1c, 'wi-+.l ilt' Ule.::C"S~cl1<3iI1„F iiie pc-,titiC)ncr'.rs ai- )ow,? ail l 51`i2 C 'S mild any corridi -;1ons of ,ap/pJrova l ci i-£~ j unisi 4 1'~`:i? f Siyc 'i f I 607 1 nvi r"C n;,, orta. f Ejj nc,,?rA - S!11)t~r"~J1 ri )r", on.,'tC''e=7 'ai l'x P»ac.,f i3 L~ r 1:~ L J r(~`,.1 f G r`~- tc ~ ti~Tf•5r=fir ~.si:.rr.`i"~ ~7r"•:'ct=~T'", le l 3~o J1 i..%'iV3S{Oil ~C)t.:'i ail I,-, ic; ti on l31i c Env. L° Jatnsky, r" V ciA(f? ( s1'')') aJtr t'A1 CC: Lero i + ::ras 'io7 son, ni r; ,r,oi x fC011;lty -),fm i o ?12`1 .J,'son' Pi C, . r I I SBD-6928 (R. 10/87) TY ~BUILDIN(,SDNISI~N SAFE -A G ThomP'on nsir ~elatlOnS O Human 1 t- a } 1; 3tt " Tommy of wise d Governor State Or an trttl Wb'tburn ~t4tt dustry, Lab Cant. . Gerald in `y tlSr ` { t1r1 1\vt'-r1i3e` t11 tYl Of . ~t t Cttj . Secre cy ent ° nepartm ,r l~ > ti 1" . a ~ t Nt n F1.~N ~~~P~``•~J_ e+3t`d• •tac,r `_F ; ttin'"•'tt~ uitN huh{)UK ;t ,Ctk ;~iRf~-{ UG a„•.t. C,tdi1J , Apps tlve ept rb ft{~ti1i Cott I k.'r , tdWR~I, Sgt ~2g~1 ~nuttty 'j ed Of Number : , : aIC)f N{~E , ro`~t~w ' G ri Qa`! Ca~N kt. have be'e•ri baSt± o r d on R~ n ti'or{~tytlCaP, , fic t ;lk wit-h Ot t Narrra: ~ yar- tk1i5 Thi~, epPr°v a~ , he plarilte~ s t:mt,0t adF, t.(►tt~p Ct,d. uari r Prod g~k_ivJ1 if tt'rarl`' live t, t btu co ~ r a Tcwr1 4311C k3cv t t,tktalr ' ~ttlmlrr t.ont'►c1g'ri > rfitk5 1 be ah~ srt c r t,va , -XpV 1 LAOS til'tcat} t a rtt.odt" < c oil`;iri natt.d t'ta1 4 al1 t utr P 1 umt?irly 4 , A t.ht> W t Tk1 t app that a r t. rtt.y i s ri Jhaylc.F. with r t at UA 111 i ~h1p ar t. -ou fur. .k,h'1s ~t , W' r 10(111) t aC ltw etl the 1 tit iit>c.o°s 1~tnally 011 r p'1ixj9e, ttawo~,C,t~n~ii'~c `il ~katup at 1 145, tcaritr't ih crap I) of Fd r =rtlawrt c..i t `1 , app t , by ltatin~]f r r av i ,,t.arrtp r~alat ionc, i'tk the t.rr">t>.t P t~G t~ir n 1it - rarttl't?r1t a1~F t~ am t.rmits r eQ flan • 1h watt, tht., iitaE ttat.i{ y 'tie 1i p~t.ta earl'>t.ruc.t a1 pi: n'.tailt;,r `:ha~1 tC, a `>ai1t., klr.titlrl ua ont b C 'rns d t1 ~.ha tr.jtt" ttak~r av~ (lit ar per 1111 c ticlt:. f.t`4i1 he rill F i {t t r j k 71. rtrriS F~+ t'tar1~> t;ari k 1 tlin t t twt, .~1w~rr`'~ttr. <i'tJ t.h" ~trv,rt ttt-• `r i t1r 1 t tr~jt t lie. irtsp cav~tl wi i 1 ~4t wilt F.~.1r'r t'. t , all k1t t r1 k t d t or k = ti 1s ,jpp airltr.ti , r.t>v it;vteil t , tr,vt ? 'hoi r;t t. ktc.t ar k~i~rnlit. 1 t, >ti~waq ha have. 110 11,4 v~,{ pr ~t, V1 1ity trrt;r,'A {,k I'll, i tlrl or C{rt ° { t1r y tsi r tinti:n i='1 t,E r 1.iart ~ vtik rte ~ on1Y~ f;yrt.h r.it c.izrilptrt7erit~ st t~ t~ }'~tlrni r11 > 'r r1~ ,~i.,t~~.~s1`•'ir1 i,kit' ktrllaw apClt.ova .Chi .C 1 ~t1 I ~1EN~ Ptiii 1 M{ii4NC} ~ EN C CP i I suo.saas kit. u~re0` milli h ~ I I y - "If Ay & BUILDINGS DIVISION ~'mtiy G. Thompson T Governor ''Gerald Whitburn Secretary State of Wisconsin Department of Industry, Labor and Human Relations HENNIE HELGESON Payt~ 2 fr7quir-i(--y concerning t.hlS appr-vvai rnayr owde by E:a1lint t6O8) 266 9314. Sincerely, 1'r( wct:'i orl of Pr' i vat.e Sewage Mvisi-ori of Safety arid Buiidirig~ PPP045/6OCi9n/' 5 cc: BAN MONDOR __-Private Sewage t:nmir tarnt --count.y_-bili S.,li-IMP P11,11111-1 Illy i'Ioosuti.lift _ ::rwn~.~ r i'° 1 uirii~t~ r ~F n v i r t~ntrrr~n t a i tit:ti i tit . j r SUD-64231 a.07ft i