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HomeMy WebLinkAbout002-1066-70-000 I (D °O Oo o 0 0 °6c~ N O ~ O O 4C O O C p Y C CD U O N N C © O C) L N N O N i 'D w in v O 0 ' ~ O O L Cl) w OED a)o0 w N U co w U w ti w O j 0 O Y O O L 4 O 'D Z N N° O 'O Z N C C C L - O N 3 7 (6 (9 - LL T - N 0CO N a LL r N 3 E ~ "O L E 'O 0-(/) 'O i, O i I Q c 3U~ a ' v 3 Cl) 3 ° z z N N I (O > o Z O O N - III d co a co F N Z 0 o Z I': c w w ' U O CD Z ~ c C: O fn F- N N z C N M ~ 01 N co :3 N a N N 47 N i w L ~ I C N N N • L _ d v 'C O L - O :3 O c`Oi III Al N O 4= O Z F Z Z Z N I Z I N d d y C C N I M - C U) R N N y m N !0 N L C L m CL co C _ 0 0) L Lo U') O C O A d O N_ 2 N O C O O co d L N - d L N 2 0 C U) O III': O d L N LO O G a L 0 f6 N N Z N> I- H f' a cn al S = 0 0 ~i C6 0 0 0 0 0 0 Z o o •nri a a a a a a *a a o 0 0 ~ o 0 0 0 0 0 0) 0) 0 t~ J C1 O O O z O O O z m co c co co o ° ° o o N N ~i Q o o = o o = c Q a E o 00 ~ ar 4 L m N L d O O O O C. w O .3) 'C U) N CT I d CO V Q z if) 'C a >m - J: !6 d - d ~ Q 1E R Ills'.. d. 7 04 7 N H Ul N U) y O ~j O O N C N E O ° co C O 0) o O 00 C) O O O a O d C Q N C C t.! d. O O O L I- O C co N 0 C N N N N N O O W r.r O C w^ •O N w^ Z Z w .O f~ ~ O 04 36 r' E E .E t c°'y m N w f0 O N O w O O € U • O N co : 2It O 2 z = O o H H V) ,I I I v ~ L j'', E d I E d 4) jL rw• C. y .V 4Lr d d y C r A c0 ~a2 oy10 ci 0U)u v Qo xod DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION NIT, MADISON, WI 53707 State Plan I.D. Number: /J~ , :V w , .7 e C . 2 7 , T 2 9 - R16 (It assigned) / Town of Baldwin ❑ CONVENTIONAL ❑ ALTERATIVMoun 8 ❑ Holding Tank ❑ In-Ground Pressure NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: I CT A : .1 Alton Helgeson r6,L~ri Rt. l , Woodville, WI 54028 36 74- -7 -4d aj BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV SO Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Bennie Helgeson 3215 St. Croix 135472 SEPTIC TANK/HOLDING TANK: T. ,..,,It. Lg Court' 71.3 ' MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEY.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVE r / 6 ~ 9 PROVIDED: PROVIDED: (fCY~ f/7 ~C<ry~,, l G~ ` T ❑NO ❑YES O BEDDING: PENT DIA.: 1FE1Li.MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO ESH ~G C d ALARM: FEET FROM LINE: r ( , AIR IN T' ❑ YES NEAREST > /Op) >/CID ❑ YES lr NO CA 5 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P~UMq P MODEL: RiMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER l C J t Q 5,.C ~ ❑YES O I (y[ . W~ PROVIDED: PR~OVID~ED- NO L~'t5 ❑ NO GALLONS PER CYCLE: _ PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: f BUILDING: VENT TO FRESH FFERENCE BETW PDIMP ON AND OFF) EEN.;ol11 FEET FR ~91 DYES ❑ NO NEAREST LIN'/~~. AI r~ SOIL ABSORPTION SYSTEM. Check the `soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN / Q~ I ,Jh. ~C v w~ the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: m*"- OF .,SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: ATERIAL- PIT DEPTH: DIMENSI 7' BUILD FRESH GR DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER O "TY WELL.. _AOEE OW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LIN AIR INLET: NEAREST MOUND SYSTEM: 9,10o o' 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 ES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; 6;tA r r'gfvES ❑ NO YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEP S OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: ri EDGES: ~,Jf Z -~~J (~/X ❑YES %NO 9. ~ YES ❑ NO YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: / NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH / TRENCHES: 01 DIMENSIONS ELEVIFOLD ELEVP: IANNIIFO/~LD DIL VR. PIPE MANIFOLD MATERIAL: NNO.ESISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: 36i ELEVATION AND $ c t 11/f u;(t ~ _ i/v~vC ta, q,D P~C~ T.l7.l~ y, DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: 7 COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION / r to APPR PLANS -21,04,6%;A. re$t rd d t (0 ES ❑ NO `yam - 3S.(~r ES ❑ NO C'"*1 PERMANENT MARKERS: OBSERVATION WELL : NUMBER OF PROPERTY WELL: LDING: 4.1 COMMENTS: FEET FROM LINE: Z YES ❑ NO YES E__1 NO INEAREST Y ~Z ~ `a CCU h ,is4 , r' c[ Sri I (0a 4 v iYV] Ol s r/ G v c ~c c.-r ylirrl-~/) O~ ? Sketch System on R ain in county file for audit. Reverse Side. N URE: TITLE: SBD-6710 (R. 06/88) `3-~ SANITARY PERMIT APPLICATION E:1:9 1LHR 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. ❑ Check Trev sion to :Nab application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S90-40066 PROPERTY OWNER PROPERTY LOCATION Alton Hel eson NW '/a NW S 27 T 29, N, R 16 J /(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Route 1 N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Woodville, WI 54028 715 698-2677 N/A 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE : Baldwin 80th Avenue 4OWN OF: CEL TAX NU BER( ) ❑ Public ❑ 1 or 2 Fam. Dwelling of bedrooms 9 PAR III. BUILDING USE: (If building type is public, check all that apply) ©®L) 1 ❑ Apt/Condo 2 F1 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 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 in line A. Check line B if applicable) A) 1. El New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 300 250 250 1.2 26 98.00 Feet 100.25 Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 1000 Wieser Concrete Lift Pump Tank/Si hon Chamber 6001 600 Combo Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No tamps) MP/MPRSW No.: Business Phone Number: Bennie Helgeson `ter' 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 issued Issuing Agent Signature ( o Stamps) Surcharge Fee) f I Approved ❑ Owner Given Initial _d6-QA Adverse Determination V 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 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 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 semiage 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. III. 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 (R.11/88) APPLICATION FOR SANITARY PERMIT 8TC-100 This application form Is to be completed in full and signed by the ownetts) of the property being developed. Any inadequacies will only result In delays of the permit Issuance. Should this development be intended lot 112414' by ownet/contractoc,tspec 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 Alton H. Hel eson East 1/4~ Section Zi T."--N-R~-Y Location of property _~i'~1/4 .~L_... Township Baldwin Mailing address 2421 80th Ave. Woodville, WI 54028 Address of site 2415 80th Ave. Woodville, WI 54028 Subdivision name Lot number pcevlous owner of property Owned by Alton Helgeson since 1947 Total else of parcel 20 acres Date parcel was created 1958 Ace all corners and lot lines identifiable? =_Yan 0 is this property being developed for resale (spec house)? as =_No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THS FOLLOWING: A WARRANTY DEND which Includes a DOCUMENT NUMBER, VOLUME AND PAGR NVxsn, and the SEAL OF THB R80I8TER OP DERDS. In addition, a certified survey, It available, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a Cestifled Survey Map, the Cattifled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION It'.tWl certify that all statements on this form are true to the best of my (4w&) knowledge; that I ~ am tom) the ownerts) of the property described In this Intormation form, by virtue of a warranty deed recorded In the Office of the County Register of Deeds as Document No. 254803 • ; and that I W.) have obtained an easement, to tun with the above 'described property, tot the construction of said system, and the same has been duly recorded in the Office of the County `Register of Deeds, as Document No. 45703-867 ).Page 491 ,~aJl~ ~a~ . Signature of Owne Signature of Co-owner (If Applicable) Date of Signature Date of Signature ' 457403 867PAGE491 DRAINFIELD EASEMENT Easement made this day of e k;_0 , 1990, between David A. Helgeson and Katherine E. Helgeson, husband and wife, Baldwin, Wisconsin (hereinafter referred to as GRANTORS), and Alton H. Helgeson and Eileen G. Helgeson, / husband+ and wife, Baldwin, Wisconsin (hereinafter referred to as GRANTEES). 1. GRANTORS are the owners and occupants of a tract of land described as: West Half of Northwest Quarter of Northwest Quarter (A of NW4 of NA), Section Twenty-seven (27), Township Twenty-nine (29) North, Range Sixteen (16) West, St. Croix County, Wisconsin. 2. GRANTEES are the owners and occupants of a tract of land described as: East Half of Northwest Quarter of Northwest Quarter (Ez of NW4 of NW4), Section Twenty-seven (27), Township Twenty-nine (29) North, Range Sixteen (16) West, St. Croix County, Wisconsin. 3. GRANTORS desire to convey, and GRANTEES desire to obtain, the right to establish a sewerage absorption unit (mounds system) and sewerage pumping pipe across the above described tract of land of GRANTORS. 4. Therefore, GRANTORS, in consideration of the sum of One and No/100 ($1.00) Dollars, receipt of which is hereby acknowledged, do hereby grant, sell and convey to GRANTEES the right to lay, construct, operate and maintain said unit and pipe in, on, and about the property of the GRANTOR, more particularly described as: commencing at the Northeast (NE) corner of said West Half of Northwest Quarter of Northwest Quarter (Wk of NW4 of NW4); thence south along the east boundary line of the land of GRANTORS for a distance of 185 feet, more or less; thence in a northwesterly (Nally) direction 454 feet, more or less, to a point 96 feet, more or less, due south (S), of the north line of the property of GRANTORS (herein Point "A"); thence continuing south (S) 25 feet; thence West (W) 90 feet; thence North (N) 90 feet, more or less, to the southern right of way of 80th Avenue; thence east (E) along said right of way to a pointwhich is 63 feet North of Point A; thence south to Point A; thence southwesterly (Sally) to a point 2 feet North of the point of beginning. The rights herein granted may be assigned by the GRANTEES in whole or in part. The grant likewise includes the right of ingress and egress on the lands of the GRANTORS for the purpose of exercising the rights herein granted; the right to install a gate or to make a temporary opening in any fence on said . 86 ! PAGE 492 lands at the point where such fence crosses the route of said sewerage pumping pipe or lines. The GRANTORS, for themselves, their heirs, successors and assigns, covenant not to erect any structure or other barriers or to take or allow to be taken any action on said lands that would interfere with the installation, replacement, maintenance or removal of said unit and pipe. To have and to hold such right and easement to GRANTEES, their heirs, successors and assigns, forever, provided, however, that the description contained in this easement shall be replaced and superseded by the description of any sewerage absorption unit and pipe easement on, over and across the lands of GRANTORS which is described in any Certified Survey Map filed by or on behalf of GRANTEES, their heirs, successors and assigns, and which describes a parcel of land in the northwest (NW) corner of GRANTEES above-described property, and further provided that said right and easement shall expire in the event said sewerage absorption unit (mounds system) shall fail. For clarification purposes, "failure" of said system shall be construed to mean the necessity of replacing, rather than making ordinary and necessary maintenance and repairs to, said system. IN WITNESS WHEREOF, GRANTORS have hereunto set their hands on the date first above written. David A. Helgeson K therine E. Helgeson S.ubdtri ii A and sworn to before me yetlii5" day o Ji_ 1990. ?cn Notary Public y$J, ,4ounty, Wisconsin. + ~..~cNmmi-eevon: REGISTER'S OFFICE ST. CROIX CO. WI °~M...,.,....N Rec'd for Record THIS INSTRUMENT DRAFTED BY: APR 31950 Thomas A. McCormack at 11: 0 A. M Attorney at Law 990 Hilicrest Baldwin, WI 54002'Rp4NrofCeeds H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT ~O St. Croix County z 0 a H OWNERIDUVER Alton H. Helgeson ROUTE/BOX NUMBER 2415 80th Ave. Fire Number 2415 CITY/STATE Woodville, WI 'LIP 54028 PROPERTY LtOC2A19 NW 14, NW 14, Section 27 T 29 N, R 16 -W, Town of Baldwin St. Croix County, Subdivision Lot number ' I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, I if needed, by a licensed septic tank pumper. What you put into i 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. 0 E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- "v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offl,pe within 30 days of the three year expiration date. SIGNED 1) ATE 0 St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-223S) or 715-425-8363 Sign, date and return to above address. C099 - _1~ (11 77 PEPAA TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,- DIVISION 'LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: OWNSHIP OT NO.: BLK. NO.: SUBDI VISION NAME: W t~V /Ta9 N/R )b E (r) WT IVY N AiA COUNTY: own-er'. IMAILINGAPDRE S: ~ ` a bce-z e6A UI -e r -a CELN -A USE DATES OBSERVATIONS MADE ~ NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: A E 19esidence TS: d New ❑ Replace I%Z717 j~ 'f if RATING: S= Site suitable fors stem U= Site unsuitable for system PQ 7/ ONVENTIONAL: MOU IN-GROUND-PRESSURE: SYSTEM-IN-FILL OL ING TANK: RECOMMEND D SYSTEM:(optional) []S 20 S ❑U ❑S BU ❑S ❑U Dct s5°`'_ SYS. r I PS H If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the t~ I under s. ILHR 83.09(5)(b), indicate: ) ( Floodplain, indicate Floodplain elevation: 1v PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- I it'61 s~JTS ,6'~hSil /IrFov-t.N1of. /6/ St- I l J /U/t Se f o y l 6 S S g ( e B- tI a B- y'~3( SJ TS L i , S" 3,, SL 0r-- ( Ho~ 3.4 sclTs.g(3h SCI .6 hSL B- f B- 3 y7 r, Q/ o9;el' SilTs ahs~~fo3'~^Sil nFor5,Mo7~ 61 T5 6,x 6,1 L_ PERCOLATION TESTS EST. DEPTH ; WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I P RIOD 2 PERIOD PER INCH P- 1 / r P- P- P_ I r P/ q 7.1 P- r/p, I. AN e r oc P- Q 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. SYSTEM ELEVATION 9(9- ° T 3 .B~glSlt-5 7'P S< fg~ Sd! i i r .8 '81 S, I ?5 Ott 3 . gee _s e i E E / 7 ,clef rtS y .SviS L Mea t .SCE E CNdHrLa~ s 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 p ' t TESTS WERE COMPLE ED ON: 1- N 1~t 6 ADDRESS: CERTIFICAT ON UMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD$395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soll Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand - Greater Than 'sl - Loamy Sand - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sic) - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point 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 must be obtained and posted prior to the start of any construction. i I ~ I i i I I I I l I ooo~ i ~ I I -I yr ~ 1 I ~ ~ z. 1 o t -F- r - ~I', ~ I i b I ~ i li I I - wj I I I ; I ~ ~ I ! I ~ I ~ it 'I i I I ' I ~ i I ~ I I I I I I I ~ I ~ i I I _ I _ i I ~ ~ 1 I I j I I I j ~ i I i I I l i I I i j I I i I I I i I i i It I _ I i cG~ .1~ i I I I I I ~ aP ° I I i j ~ _ i K I ~ I I V -1- j ) -tip----~~~--a-- - - ~ - ' I S ( C1- L 0- L-Ir 1- c d I _ I --F i I i I I j ~i I I , I I j i ~ I TI, - 1 ~ I I ! ( Ii 1. I r , I I I I { I l ~ I ~ ~ I I I I 1 I I ( I I , ~ I I I I I I I I } I t I , Y , I ~ ~ I~ I I I ; I I I I I I I ~ I I I - I I ~ _F ' ~ a I I - , ' I- I I ! I I I I I ~ I I ~ - I I I ( I I t I I t-- f ( ~ I I i ~ f_ I IL ! I L I ( I i ~ I I I 1 I_ i I I I I 1. -I I i 1 I I ~ ' I I ' ~ ~ ! I ~ I I i I I i I I ~ I,~ I~ I 1 I I I I ( I FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER__~ Q es 0 TOWNSHIP C r SECTION T~N-R W ADDRESS, Q ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW /QJ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -r . (42) vt IRI 1y3, a 1r, a nh INDICATE NORTH ARROW BENCHMARK:Elevation and description: C ov Alternate benchmark P, ~-e 40ocOev col 8~~ v 76. SEPTIC TANK:Manufactureer: Liquid Cap. Rings used: Manhole cover elev:7/,,3 ~ Final grade elev: SD Tank inlet elev, o. Tank outlet elev.: C~v`.~e Td No. of feet from nearest road:Front Side , Rear Ft. From nearest prop. line:Front , Side Rear Ft.~r ' 'Dck7zV Building. No. of feet from: Well t'vxs 4(Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: LISfrS Liquid capacity:_ rs-lj Pump Model: t~fC 5 Pump/Siph n Manufact.: o Pump Size tdk~ D fiQ~ Elevation of inlet: ~o~IU Bottom of tank elevation Pump on elev. 0,00 Pump off elev. :~Gallons/cyc 1Q: 0 Alarm: Man.: a U', 'Lo j~5f' w ch Type: e0(~L1, Location a CK t7C4 Distance from nearest prop. line: Front_, Side ` , Rear-Ft. Cj Distance from: Well Building I SOIL ABSORPTION SYSTEM ac 2 2 k , / Bed: r/ Trench: Seepage Pit: i Width: 1f Length Number of Lines:_a_Area Built Exist. Grade Elev. 77,00 Proposed Final Grade Elev. ML-25' Fill depth to top of pipe: ~2,011 No. feet from nearest prop. line:Front Side Rear Ft. No. feat from well: /VO No. feet from building 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: rw. DATE R PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj t State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 BENNIE HELGESON Owner: ALTON HELGESON ROUTE 2 ROUTE 1 SPRING VALLEY, WI 54767 WOODVILLE, WI 54028 i RE: Plan Number: S90-40066 Date Approved: April 19, 1990 j Gallons Per Day: 300 Date Received: April 18, 1990 Project Name: HELGESON, ALTON - RESIDENCE Location: NW,NW,27,29,16W I Town of BALDWIN County: ST CROIX ' The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. j This approval is for the following components only: NEW MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings 4PP039/0009n/26 cc: ALTON HELGESON X Private Sewage Consultant W_ SBD-6423 (R. 08/88) i I 690-40()66 O ~ ~Sl f ~4 ~o --D to J v I ~ k v i I b 41 s oC ~ U •i-I a o W. I 4 b IPR 8 ~I 2 ao -1 I W A z I ~ o a a d a ONSITE SEWAGE SYSTEM O -7? ConditiOnally w .J~ 4 o~ © N w Ap, 'ID IiUMAN tX UILDINGS OR s~ PONDEhCE SEA c co ~ /L7~T 'V) n P cPage Of c~ , ~c~, Lo sg®-40066 Cross Section Of A Mound Using A Trench For The Absorption Area y8•l~ _ Bey, Medium Sand Fill ~I F - 6 Topsoil 3 E D rr~pp~~ ~~,`~S 1re a to Plowed Layer ONSI-T~"'13. 99 9 ow Pip Covered With D Ft. dearsAv or synthetic Fabric ona E 1. Ft. Ft. k h - F 7S Ft. H S Ft. 0.. t!1'11F',N RELATIONS . LA:,zoR Al\ F Ni't~-7r, LOINGS OEPARTMt ISIO~d OF 'A SEE CORR SPONOFWCE Plan View Of ;found Using A Trench For The Absorption Area Force Main T -Distribution Pipe Permanent Markers Observation Pipe - ----------------6 W A I B .T K r Trench Of 2" - 22" Aggregate I r L A t. I 9.0(, Ft. K IQ QD Ft. W Ft. B 5-0 Ft. J Ft. L Ft. ~ License Signed: y % Number:/S- Date: -90 A 4 S 90 0 66 OF r ~G e-11J5T'1~LL ~EtZi••iA1JE~J ~ hR~r,.r-sZ S' AT SUD OF EACH LkTL,RAL T:ti-D CAP Q 1.4v~-ES LUGAT'r'J O1J a17Tph ~ _.~1.f~E R1ap ATt- tmt1RL~Y SPACh'J . pvC FRA1-I Tau P1 P -QV C- LAT"cRS+tS PLP.et LhST ltOl~ 1JEXT ZO EuJ CAP ~J\S-TR -f zQ. P1PE 13~4~U_T_ ONS TE SEWAGE SYSTEM (fo; z t1i'llio 12 a Y f G~~ARTPJictd Ir~~u~r L~~c~r~ aND IS1t)N OF ;/fir UPAAN RELATIUNS _4 1N d i DiNGS CORIJE NDENCE t>JV, Et ~V: of LA%TG% L-.s p~:t'~CE f sT NU►-E f:_RoYI TEE w1?N Sv c.cE2b1A)G HOLD' ffT.w rol~.l lJI U C.S . t_AcST Not-E ~D ~E "ex-r ?D -THE LIUD CJ~P- SEPTIC TANK & PUM_P_ CHAMBER CROSS SECTION AND SPECIFICATIONS Cl 4't t' cat a S n v - S d 66 4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PP00 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE - WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W/ PADLOCK 6 6" MIN+ WARNING LABEL ABOVE 0 V E G AD Er MIN. 18 LIN. 6" MAX. INLET i~ WATER TIGHT SEALS L GAS ' TIGHT i 411 A SEAL 1 ► APPROVED CI PIPE BAFFLE i_ r ; ALM JOINTS W/ CI ONTO B PIPE 3! ONTO Y C ' SITE SEWAGE SYSTEM ON SOLID SOIL SOLID i SOIL® MP 0~ ELEV. &3,c~FT' I OFF :RISER EXIT t fA D PERMITTED ONL s IF*TANK tu. I t MANUFACTURER ElA, 0 a lwll~ O?av it a OCPARIP,^,EN'T ~p HAS APPROVAL 1 I,I J~a,a d P ~ /1i1~D PR6 BEDDING UNDER TANK IS ON OF S E 14 aA,J G~ElATIDP~"~ CONCRETE PAD ' DINGS SPECIFICATIONS SEE CO RES i3GdDENCE SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SIZES: SEPTIC _1000 GAL. DOSE VOLUME. INCLUDING DOSE („fin GAL. FLOWBACK: GAL. ALARM MANUFACTURER: ~.lec~wa~~-~CSPACITIES: A J-7_ INCHES = 'Doo"g?GAL. MODEL NUMBER: to 1 14 uo SWITCH TYPE: B = 2 INCHES = GAL. PUMP MANUFACTURER: C = INCHES = GAL. MODEL NUMBER: WE-0 14 1 SWITCH TYPE: Le ~(L41hy ~ T- D = INCHES = L_j9, g3GAL . REQUIRED DISCHARGE RATE - ~ GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC 7-1,0(- GrM (MtM,) VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 3,57, (o FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . .2.5 FEET + ~T6C> FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR g-, 1,-g- FEET TOTAL DYNAMIC HEAD = 1g-j,~~FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER Please, Sce Tahk e~f~~Ca~roaS LIQUID DEPTH e SIGNED: LICENSE NUMBER: DATE: -qo 1/88 - 90- a~ 40®0 Not. or, vi o ' i W ~ r0h( I ~ *n w I Nit E'S AGE S TE N ~ ~ t7 AP . .m NCO ! ~ u ► /l > N6'-HUMANa TIONSP p ~ x i'R~"iT V1L ` 10 ~ lip IAD t3U~UIS d 'jam y m0 o a CO, o H i t" I OF to .0, cn x +~+v H w fit' NNe• a r x o° t3 t. - x Az " g o y I` x y x 0 to n 'd 30 v c A a 00 N b y rroH )o 0 m , o t~ f " y v,• TO M H eta'' n o ad r~r M r W z o r n i r 0 H ; H H" En b 0 ~ 0. x 0 H Fa z y A v o v r L.: tr+f N x H O Zm ~o max x O p x x 1 a N o . Z (A N ry p p p C HELGESON TRUCKING INC. Spring /alley, W1 54767 April 11, 1990 Mr. Tom Nelson Zoning Administrator St. Croix County Zoning Office 911 Fourth Street Hudson, WI 54016 ~I RE: ON-SITE VERIFICATION ALTON HELGESON NW4f NW4, S 27, T 29 N/R 16 W Dear Tom: Enclosed are the copies of the 115 for the property owned by Alton Helgeson in Baldwin Township. He is anxious that we get these plans to Madison yet this week. Will you please send a letter for on-site verification at your earliest convenience so that we can get the plans to Madison. Thank you. Sincerely, Bonnie Helgeson President Enc. ST. CROIX COUNTY r it : WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 April 13, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Alton Helgeson property, located at the NW4 of the NW4 of Section 27, T29N-R16W, Town of Baldwin, St. Croix County, revealed suitable soils at a depth of 24 inched below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cJ Wisconsin Department of Health and Social Services ` 01b. #67 10/69 Division of Health PERMIT APPLICATION for . PRIVe.TE DC:'tESTIC SEWAGE SYSTz~U" A. 94NER OF PROPEMPY TYPE OR USE BUCK INK Name Address (Street, City, Zip Code) Al VI/1, I lV 4/ County B. LOCATION OF PROPERTY WMIERE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED I/l Check One: CITY VILLAGE LEGAL DESCRIPTION: F TOWNSHIP j~ C. IS LOCAL PERMIT REQUIRED FOR THIS WOiiCY YES NO ^ PEWIT NUMBER ~i D. SEPTIC TANK CAPACITY l ! Gallons NEW INSTALLATION REPLACNT ADDITION MATERIALS: Prefab Conc--ete Poured in Place Ste.,l Other NUMiER OF TANKS TO BE IiISTALLED:~ E. TYPE OF OCCUPANCY Check One: & or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC, Food Waste Grinder ✓YES NO Automatic Clothes Washer z-- YES NO Dishwasher YES NO Automatio Potato Peeler YES NO Other (Specify) - - G. EFFLUENT DISPOSAL SYSTEIM NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin,Feet ~ Trench Width Depth I. Number of Lines Y? Seepage Beds Length Width Depth Tile Size No. Lines Seepage Pits Inside diameter Liquid Depth P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Pinutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted Overnight in Minutes- I Last Period Last Period Poriod One Inch 'Example P- 0 3679 To Soil 1011, Clay 261, 23 es or no 30 1/2 1/2 _112 60 J RECORD DATA FROM MIYIMR-1 OF 3 TEST HOLES ompute size of absorption area in acoord with H 62.20 Wis. Aciinistretive Code. S 0 I L B 0 R I N G S- Minimum 3611 Below Prooos_ed_ Absorption System orin,; Total Depth Depth to Ground Water Depth to Bedrock umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches xample 0 721" 72t1 Black To Soil 121' Clay 18". Sand 16"• Gravel 2491 -1L tj RECORD DATA FROM MINIMUM OF 3 BORE HOLES ' Is the undersignedo hereby certify that the percolation tests reported on this fom were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my kna~;ledg3 and belief. /r NAM t I-~ f TITLE, Type or Print) REGISTRATION NO. or MASTER PLUVOER LICE14SE No. /Z:2 -Z - ADDRESS/ DATE ~0~7 SIGNATUiE~~j' MASTER PLU113ER MAKING . PLICATION -12 Signature: License Number: MP RSW (To be Completed by Issuing Agent) Date of Application Fee Paid $ T Permit Issued (d te) 46 Permit Number Agent (name)'r~ For: Towns Village, City, County, eto. (specify) Notes The application cannot be considered for filing until all of the above questions are an3Wered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY / RETURNED (Initials) (Date) Jf(see Correes. FEE RECEIVED L~ VALID. NO. ~ u PEFWT NO. (Yes or No) REVIE14ED BY APPROVED DATE (Initials) (Yes or No) COMMENTS: