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018-1053-00-000
~~bl County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016-7710 (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previo a tion 0/ 3? ` - - 1. Application Information - Please Print all Information Location: q n Property Owner ame Y , ~~1/4 ~ 1/4, Sec L. 5 LtC o ~ar,C a r c Z 9 N, R I a(o Property Owner's Mailing Address / Lot Number Block Number City, State zip code Phone Nungtp 2 5 Subdivision Name or CSM Number 1 II Type of Building: (chec one) laity ❑ Village gown of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: > Nry Mp/f X Public/Commercial (describe use): ./G1 1 Qi c ~0 n ~ /yQ On ❑ State-owned Nearest Road II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) K3 Parcel Tax Number s 11.11 Repair 12/1'Reconnection 3.❑Non-plumbing 4. ❑Rejuvenation A) Sanitation 0 f $ -10-5.5 - o 0 - 00 0 B) Permit Number Date Issued c~ State Sanitary Permit was previously issued o 1/3 Z I,6 IV. T e f POWT System: (Check all that apply) ❑ Non-pressurized In-ground ❑ Mound z 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed ' (Gals./day/sq.ft.) (Min./inch) J Elevation 41174 /690 ~I ©0 0.s.l IM 95. 0 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks r-; l k, I 30tgi C(J { t: C ❑ ❑ ❑ ❑ 5O0 2500 `S~,I° ® ❑ ❑ ❑ ❑ I /"J VII. Responsibility Statement I the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A I, license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (nnt) Plumber's 'nature (no stamps): MP/MPRS No. Business Phone Number ~c i1 . ow 33'76 Plumber's Address (Street, City, State, Zip Code) III. County Use Only Disa Sanitary Permit Fee Datte Issu d Issuin nt Sig4nJ Approved caner Given ' I Adver 2Z S D a q/1 ~,3 Deter ion IX. Conditions of Approval/Reasons for Disapproval: 3 ~j✓~( I.A be-, J 1. Septio'tank,effluantflfter-Md p('6kt.4_d~ f:~O.n dispersal Fell must all be services f maintained as Par management plan provided by plumber. d" 2; _ Aft s4a4k requirements must be maintained LI) as per applicable code, ordinances. L~ G1~ a fJ'~-- 1 L) ce, Rev: 8/05 , ~ ~ ~ ! s POWTS Reconnection Index & Title Sheet Non-Residential reconnection Project Name: Instruction Society for Christians (Baldwin Christian School) Contact Name: Sue Nelson - School Board President Project address: 896 Hwy. 63, Baldwin, WI. 54002 Site address: Same Project Location: Subdivision: Na Legal Description: NE1/4 NEI/4, Sec. 24, T.29N., R. 17W., Town of Hammond, St. Croix Co., Wl. Parcel ID 018-1053-00-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Project overview and calculations Page 4 POWTS Maintenance Agreement Page 5 Certification Statement for Utilization of Existing Septic tank Page 6 Dose Conventional Mgm't Plan Page 7 Waranty Deed Attachments: Soil verification report Mater Plumber Restricted Service: Dale Hudson Dept of Safety & Professional Services Credential #220853 ZY Oe;- Date: / Signature: Page 1 Of 7 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01-, R. 10/12) ♦ Ex~ s 9,v de elegy \ :%.;.s uc ;01 SO ~or'C~(fi Suc a~.S PIGy ~~ov 32/a~ov/n, cJ/. s- 1,•c p e naslE o f1a,r inond Q ,P/7uJ., Tn. , ~ . ~/~i)C Coy cc~, V 3 cov s . es e.- (?4m. o~nla.r Ade ~ 9clk C.o er=!"fit!' Proposl,c~ y/" i~ST~N 30 3 5/ VV "fin 5 u /S eQ J , A) 5 ni S~ d, ocrsa/ cc//a G 5~/ X/Od. ■ ~ t1 e ~ 5 e.~eo 1 r'oo~ (cc l i ~y C, Ca d f, aE: b KI 1 d ~ nq Scw~~ y8 /D ~s Instruction Society for Christians Non-Residential POWTS Reconnection In accordance with In-ground POWTS Component Manual, Version 2.0, SBD-10705-P (N.01/01) JOB DESCRIPTION: Expansion of existing private school facility. The facility is open 8:00 AM - 3:00 PM, Monday - Friday. Maximum daily attendance after addition of new facility will be 51 students and 5 staff members per Sue Hanson, School Board President. There are no kitchen facilities on site, no meals prepared or served, no showers taken. The Soil & Site evaluation report indicates soils that will accept effluent at a rate of 0.4 gpd/sq.ft./day. Existing dosed (non-pressurized) in-ground dispersal cell provides 4,100 sq. ft. of absorption area. PROPOSAL: Connect building sewer of new facility to inlet of existing Wieser 3,000 gal. septic tank/dose chamber. Install SimTech STF 100-A effluent filter at dose pump discharge located in existing 2,500 gal, pump tank. Demand dose to be reset as per design calculations. Wastewater Flow: 672.00 gallons per day (56 occupants/25 occupants per classroom)(300 gpd per classroom) = 672 gpd. total wastewater flow after new facility is completed and occupied. Septic Tank Capacity Calculations: Existing Septic Tank Manufacturer & Capacity:.__ Wieser 3,000 gallon septic tank Minimum required capacity: 1,403.14 gallons (672.00) + (11.61 x 3* x 8.96) + (46.77 x 8.96) = 1,403.14 *(Requires a three year maintenance cycle) 672.00 gpd / 75 gpd = 8.96gpd person equivalency Dose Chamber Capacity & Dose Volume Calculations: Manufacturer & Capacity: Wieser Concrete W2500-MR (50.00" @ 49.46 gal./inch = 2,473.00 gal. actual) 1. Pump Chamber Calculations: A) 24 Hr. holding capacity: 33.25" = 1,644.56 gal. B) Alarm setting: 2.00" = 98.92 gal. C) Dose volume + flow back: 2.75" = 136.02 al. (672.00 gal./5 doses per day) + (0.163x40') = 140.92 gal. max. dose volume D) Reserve storage: 12.00" = 593.52 gal. TOTAL: 50.00" = 2,473.00 gal. Dispersal Cell Calculations: Minimum required dispersal area required: 1,680.00 sq.ft. 1. Design Wastewater Flow: = 672.00 gpd Design Flow 2. Infiltrative capacity of natural soil = 0.4 gpd/sq. ft. 3. Absorption area required: 1.680.00 sq. ft. 4. Existing Absorption area: 4,100.00 sq. ft, (4 P x 100') 5. Dispersal cell infiltrative surface elevation: 95.50 Pg. 3 of 7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Instruction Society for Christians, Sue Hanson, School Board President Mailing Address 896 Hwy. 63, Baldwin, WI 54002 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 0 1 8-1053-00-000 LEGAL DESCRIPTION Property Location NE NE '/4 , Sec. 24 , T 19 N R 17 W, Town of Hammond Subdivision Plat: Na , Lot # Na Certified Survey Map # Volume Na , Page # Na Warranty Deed # d (before 2007)Volume 421 , Page # 179 Spec house DyesElno Lot lines identifiable Oyesono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are tfue to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed r corded in Register of Deeds Office. Na Number oft, dlr0j s j/ (J r Fj. l I l~//L~ 616NATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) J jD ~c,,- 7 f ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 896 Hwy. 63, Baldwin, Wl 54002 located at: NE ''/4, NE 1/4, Section 24_____., "Town 29 N, Range 17 W, Town of Hammond , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: /v/, gallons 1 minutes Tank Capacity: 3,000 & 2,500 gal. Construction: Prefab Concrete X _ Steel Other Manufacturer (if known): Wieser Concrete Age of "hank (if known): 29 years Permit number (if known) -L ~'Mle- C150,v'~ (Licensed Plumber Signature) (Print Name) ';~Zox 5- (Title) (License Number) MP/MPRS ~13 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 In-Ground Dosed Conventional Dispersal Cell Management Plan Pursuant to Dep't. of Safety & Professional Services 383.54, Wis. Adm. Code General The In-Ground septic system shall be operated in accordance with Dep't. of Safety & Professional Services 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10706-P (N.01/0I). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Septic or pump tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Set3tic Tank I'he operating condition of the septic tank and outlet Filter shall be assessed at least once every year by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The septic tank contents shall be removed when the sludge and scum in the tank exceed 113 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 28 1.48, Stats. If the contents of the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scurn and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Dep't. of Safety & Professional Services, Safety and Buildings Division. Purnp Tank The pump (dosing) tank shall be inspected at least once each year. All switches, alarms, and pumps shall be tested to verify proper operation. Dispersal Cell and Pressure Distribution System 1 raflrc (other than for vegetative maintenance) on the dispersal cell is not recommended. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Management Recommendations I . Monitor wastewater flow from facility as needed. 2. Monitor existing trenches annually to determine condition of bio-mat and potential hydraulic failure. 3. Clean effluent filter annually. 4. Pump out contents of septic tanks on a two year rotation. Continaeney Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the pump tank, pump, pump controls, alarm or related wiring become defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the dispersal cell component fails to accept wastewater or begins to discharge wastewater to the ground surface, effluent flow will be diverted to the resting cell. Questions on the operation or maintenance of the system should be directed to the installing plumber, Dale Hudson of Boldt's Plumbing. & Heating at (715) 684-3378 or your County Zoning Inspector at (715) 386-4680. Pig. 6 of? 375h'~ Wisconsin De rtment of C SOIL EVALUATION REPOATPage t of 3 Division of Safe ty~p~ in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations ~v Attach to site not less than 8% x 11 inches In size. Plan must County St. Croix indude, but not` Imo and horizontal reference point (BM), direction and Parcel i.D. percent aimemsioas rth arrow, and bcation and distance to nearest road. Rp' talllnlarmat9on. 018-1053-00-000 ~C RDate Personal incarnation you provide may be used for secondarY WPM (Privacy Law, s.15.04 (1) (m)). D~ Property Owner Property Location Instruction Society For Christians Govt. Lot NE 1/4 NE 1/4 S 24 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 896 Hwy 63 na na Na City State Zip Code Phone Number -J City _ I village e Town Nearest Road Baldwin WI 54002 Hammond US Hwy. 63 & 90Th Ave. J New Gong= Use: I Residential / Number of bedrooms Code derived design flow rate 672 GPD 1 Replacement W1 Public or commercial - Describe:Priv pol rent mate ' acial Outwash Flood plain elevation, if applicable na General comments and recommendations: Evaluation completed to determine suitability o existing dispersal cell to accomodate proposed addition to existing school facility. See Memo page for system details. Boring # J Boring 16 Pit Ground Surface elev. 97.47 ft. Depth to limiting factor 69" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Ply in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 1Oyr3/3 none sil 2fgr mvfr cis 2vf,f 0.6 0.8 2 12-30 1Oyr4/4 none scl 2fsbk mfrf gs 2vf,f 0.4 0.6 3 30-49 7.5yr4/6 none Ifs Osg ml cw 1vf,f 0.5 1.0 4 49-69 7.5yr4/6 none Ifs WI$ Osg mi aw - 0.5 1.0 5 69-86 7.5yr4/6 f2d 7.5yr5/8 fsl/lfs 1 csbk/Osg mfr/ml - - 0.2 0.8 H #3 contains 10yr8i2 sii incusions 6" x 1 ' in diameter, irregularly shaped, oriented vertically, Comprising 10% o horizon with redox. concentrations at outer edges due to tension saturation and are not indicative of groundwater saturation. Boring # I Boring 0 Pit Ground Surface elev. 98.40 ft. Depth to limiting factor >88" in. Sort Apprrcation Rate Horizon Depth Dw*iant Color Redox Description Texture Structure Consistence Boundary Rocs G in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. *Eff#1 `Eff#2 1 0-11 1Oyr3/3 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 11.29 10yr4/4 none scl 2fsbk mfrf 93 2vf,f 0.4 0.6 3 29-46 7.5yr4/6 none tfsAs Osg ml cw 1vf,f 0.5 1.0 4 46-55 10yr5/4 no sil 2fsbk mvfr aw, - 0.5 1.0 5 55-88 7.5yr4/6 f2 .5yr5/8 s Osg ml - 0.7 1.6 CI' * Effluent #1 = BODS> 30 < 220 mg/L and T >30 < 150 g/L uent #2 = BOD <_30 mg/L and TSS 1.30 mgA. CST Name (Please Print) Si ture: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Rate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, W154020 6/25/2013 715-248-7767 t _,2- of 3 PROPERTY OWNER: Instruction Society For Christians SOIL AND SITE EVALUATION 2335 Page PARCEL. LD.0 _018-1053-00-000 A.C.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed to determine suitability of soils and existing dispersal cell to accept anticipated waste water flow increase generated by proposed addition to existing structure. School does not serve meals, no kitchen or shower facilities present per Sue Hanson, School Board. President. Existing dispersal cell area, 41'x 100': 4,100.00 sq.ft. Existing dispersal cell infiltrative surface elevation: 95.50' Infiltrative capacity of soil at or within 36" of infiltrative surface elevation: 0.40 gpd sq.ft. Total anticipated wastewater flow after addition completed and occupied: 672.00 gpd 51 students + 5 staff per Sue Hanson (56 occupants/25 occupants per classroom)(300 gpd per classroom) Minimum required dispersal area required: 1,680.00 sq.ft. Maximum dail flow capacity: 1,640.00 gpd (136 students and staff) y ' yp a ~P4c';Z33s E~cis ~U2 P e ♦ 5-p3 &T pie ¢ i",. Per- \ ` \ Play~rowd cJ"3S5W-2- ` e~w~Oenc /!ES'~'rlE See ~T..2 U O Q.17W, Tn, o f/a.►v~nond, N 0,• la¢%~1~9 Z.7/acres. it M ~JCiSEil7G GJ Y Sew ~'py~.(. T iu ~p aX 44/C C~ r 4 In ■ _ _ - - _ - ~ off' age /C4 4D -v Aso kW (,b d.~ve /.wK,n~ 5 ~ E.~iS~id,;~,ocrs4/ cc//a ~ s✓i;ri~; go,. ~;vP.5cu.e a%v = 94/, 41 30'3 -0 0 a' ° I 3 o I y O 6% 0 ~ I o I H Y I a „moo„ 0 Q .U r~ I y D oy, x a o 0 C CO N w N ~ d Z - E C V 7 LL c o O m O O) r- C) 00 E 3 Q (n In o CL O r M rn O ~ I W E 500 Z o o a U) O 'D Z U 4) 4) W d m m CL N F- Z ~ ~ I O z c I tin 0 0 o Z (n F- N m (n c I m c:r N_ N N O N O 13 7 a O T) N y C w N ~ N N E d O O d L 7 m N m N O N Q O N N ZoOZ OZO r z E E O 41 - c 0 CL U) LO W d N W m O D a a (D 0) t2 U) E = o X333 FL co 3 0 0 0 IL IL CL ' m a m Ilmv ~l (A U 0 o00i oirn } CO 0) 0) C) OD t- N - 0 0 0 0 0 co = N 0 0 0 p C. O N N N N N N N N v rn o ~ CID m C W h m M lf') M O p~ r Qr~n U O b 0 (n ~j o c c w c O ~ 0 a) O m .y U d O O O N_ N_ N_ v v l_n LO T O O L d- C U a O O O O O O O O O V C C U C co y r O N C W N N N N N c p E!; N w v N o N rn M N -r co N E a ~ a; o Z c d o a M 0 L CID N ' o N 2 M o o Z F- S' (n V 7 a L: (L ° c c }t c rw a~ r A ti ` a2 I0U)u VOL 423 eaLEI7- 8 WARRANTY DEED THIS INDENTURE, Made this 18th day of February, A. D., 196E, between Leon A. Holle and Eleanor L. Holle, husband and wife, and the said Eleanor L. Holle in her own individual right, parties of the first part, and Society for Christian Instruction, a Corporation duly organize and existing under and by virtue of the laws of the State of Wisconsin, located at Baldwin, Wisconsin, party of the second part. WITNESSETH, That the said parties of the first part, for and in consideration of the sum of Seven Hundred Dollars ($700.00) to them in hand paid by the said party of the second part, the receipt whereof is hereby confessed and acknowledged, have given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien,,convey and confirm unto the said party of the second part, its successors and assigns for- ever, the following described real estate, situated in the County of St. Croix and State of Wisconsin, to-wits Commencing 160 feet West of Northeast corner of North Half of Northeast Quarter '(N2 of NA) of Section Twenty-four (24), Township Twenty-nine (29) North, of Range Seventeen { (17) West; thence South along the West line of the real es- tate owned by the said Society for Christian Instruction, a corporation, a distance of 465 feet to the Southwest cor- ner of the real estate owned by the said Society for Christian Instruction, a corporation; thence West 94 feet; thence North 465 feet; thence East 94 feet to the place of beginning. The parties of the first part agree to pay all real estate taxes for the year 1965 and all prior years. RaG.ISTEIRS OFFICE £l-r. CROIX CO.. W10. Rec'd for Record this_?S day of. hftM= AD-1966 Re r Wds 1. ' L TOGETHER with all and singular the.heredtaments and appurten- e5 X 9- ances thereunto belonging or in anywise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said parties of the first part, either in law or equity, either in possession or ex- pectancy of, in and to the above bargained premises, and their heredi- taments and appurtenances. TO HAVE AND TO HOLD the said premises as above described with the hereditaments and appurtenances, unto the said party of the second part, and to its successors and assigns FOREVER. AND THE SAID Leon A. Holle and Eleanor L. Holle, husband and wife, for their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said party of the second part, its successors and assigns, that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheri- tance in the law, in fee simple, and that the same are free and clear from all encumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said party of the second part, its successors and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, they will foxever War- rant and Defend. IN WITNESS WHEREOF, the said parties of the first part have here- unto set their hands and seals this 18th day of February, A. D.; 1966. Signed and Sealed in Pr Bence of X"yL l/. (SEAL Wesley rie Leon A. Holle (SEAL) earl rotennhuis Eleanor L. Holle STATE OF WISCONSIN ) ss St. Croix County ) Personally came before me, this 18th day of February, A. D. 196E the above named Leon A. Holle and Eleanor L. Holle, husband and wife, and the said Eleanor L. Holle in her own individual right, to me known to be the persons who executed the foregoing instrument and ac- knowledged the same. Peanl. -Groteribuis Rotary Public, St. Croix Co., Wis. My commission expireseFeb. 25, 1968. vo '1R1, C ;tom%~ ' c t V 421 PASUA irnnq; ui:+ O O M ~ Q 69 d a~ I Op O v tl M O p N i Y w y ~ y y a~ I .n I N p I 0 0 M ~ ! N W T Q C ZO 'V 7 ca CL LL - w O C m OI c ~ O (D '0 U C> E Q L N o M U y O 0' y c o c O Z _ O v v E o 0 0L C%j ' w a m a °Z N I- Z E C CL rn 0' r a0i Z ° w Z fA F- r R' N m fA E .2 cl~ N N O O O. N T y N c N N N N N N r O O 00 •(y d L 7 (0 N M f6 N 11a Q 0 U b 0 -L) N O N O Z co z Z Z o N I C d O L ~o m 04 ca > a m o o a` a w E H H a m 3 O O O P'Q, 4i CL m iCo~ 7 O N ! (MO c+p N J ~1 rn rn D v = N N 0 0 0 0 0 0 0 0 0 0 'i O O O 0 N N N N N N N N O) r 'C W r r r co c~ co C N d co N ti 0 m~ N 0 co N N a CO L •O Q U) f0 U) m U Cdr O m N N C O = O O N_ N N_ v v _0 _O V q O L N c U a o o 0 o o o o 0 0 1 m N C-0 N N N N N N N N N W In r O c ` co N c N N r\ 00 O N M y o Z C co n m M In M • ~ O N 2 CO LaOo C) Z N 2 F- (n r a s # a L: a E c °.3 S r A c°~a~ 0Uo .-T C - 104 AS BUILT SANITARY SYSTEM REPORT , !;^4 OWNER ~o/ayi/I TOWNSHIP y d tSECO~` -RZ-W Sc~i04~ ~ . t ADDRESS A~ ST. CROIX COUNTY WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM awn ©G~ m V Chr;d;oy1 35 Duy~, ✓sn~' D 0 H bra ; y~ Do" INDICATE NORTH ARROW Gee// Is de/'oss /1iu0a 63 ,y- Vey Is' BENCHMARK: Describe the vertical reference po-n*_ used (~'raore 4 Cp~'rler' p sr-A00/ B/a'9- Elevation of vertical reference point: ,1610. D Proposed slope at site: / o SEPTIC TANK: Manufacturer: _lJeAse rs -Liquid Capacity: 30C0e?41• Number of rings used: &e Tank manhole cover elevation: 90• Tank Inlet Elevation: 97,5 Tank Outlet Elevation: 97. 30 Number of feet from nearest Road: Front ,Q Side 0 Rear, O feet ..From nearest property line Front,OSide10Rear,O ig~Q feet Number of feet from: well 306- building: .3::5rl (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER Manufacturer: Liquid Capacity: / T ~ Pump Model: 3 Pump/Siphon Manufacturer: <'oev~~/ Pump Size y'P i Elevation of inlet: 9~• q3 Bottom of tank elevation: • Pump off switch elevation: Gallons per cycle: x50 Alarm Manufacturer: A/~~[22 Alarm Switch Type: 245Z'0-/ Number of feet from nearest property line: Front, O Side, ® Rear Ft.-0/49 Number of feet from well: 300 -t- i Number of feet from building: 35 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: YeS Trench: Width: 211 ' Length: /pD " Number of Lines: Z_ Area Built:±~IQ, Fill depth to top of pipe: ,2 y Number of feet from nearest property line: Front, O Side, © Rear,0 Vt. Number of feet from well: a 00 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number *ofeep Dia t r: Liquid depth: it ev tion: Area Built: Ha s either a drop box O or disen us d on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: on of bottom of a k: Number of rings used: Elev 7 1 Elevation of inlet: Fron Side, O Rear, 0Ft. Number of feet from nearest Pre Viing: Number of fee fr : Number of feet om b Number of feet fro. neares : Alarm Manufacturer: Inspector: .~4~e f~ccelsPl't Dated : A52 _ Plumber on job: License Number : 9Jr(f 3 3/84:mj PUMP CHAMBER Manufacturer: Liquid Capacity: -5- / - 00e, Pump Model: X8,1 Pum /Si hon Manufacturer: / P P Pump Size ~ h'•~ Elevation of inlet: 9° 93 / Bottom of tank elevation: Pump off switch elevation: y~ Gallons per cycle: 7 0 Alarm Manufacturer: Alarm Switch Type: ~YJ-/ /~JE.^Cur(/ Number of feet from nearest property line: Front, O Side , Rear Ft.~d Number of feet from well: 300-~- Number of feet from building: -35i (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: yes Trench: Width: L} / Length: Number of Lines:Z-Area Built: 6 Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, © Rear, 01?t. /L9 Number of feet from well: QQ~~ Number of feet from building: (Include distances on plot plan). SEEPAGE PIT s Liquid depth: f eep ge pit ev tion: Size: Num4distr'ution Dia t r: Area Built: Has either a drop box O or Vbxo b en us d on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of a k: 1 Elevation of inlet: Number of feet from nearest /om lin Fron Side, O Rear, O Ft. Number of m w 11: Number of feei ing: Number of feet froroad: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT O'F INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ti LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MAbISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: El Holding Tank E:1 In-Ground Pressure E] Mound (If assigned ) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE Batdwin Chni ti.an SChoot BaedVin, W1 0 'o1d 49 3=,0 0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NB NE, Section 24, T29N-R17W, Town of Hammond Name of Plumber: MP/MPRSW No.: Coumy: Sanitary Permit Number: EveAett Botdt 44 9 St. Cnoix 588 3 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER O o o ^ A' / PRD YES Q (NO PR❑IYES NO BEDDING: VENTDIA.: VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: 1VEN TOFRESH ALARM FEET FROM LINES J l AIR INLET OYES NO OYES ONO NEAREST lg f ~f 7 J DOSING AMBER: MANUFACTURER. B : LIQUID CAPACITY. PMP MODEL. PUMP/SIPHON MANUFA Tl R. JWARNING LABEL LOCKING COVER ,wit/ PROVIDED: P V DED: vJ~ OYES O YES ONO YES ONO 1 W' GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL. 11111-111\11: VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE L > AIR INLET PUMP ON AND OFF) OYES ONO NEAREST v ( .i S 3 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing n, uIAM rFR MATERIAL AND MARKING FORCE or excavation. (if soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH IND.OF DISTR. PIPE SPACING COVER JINSIDE DIA #PITS LIQUID THE HES. MATE.8IAL: PIT PTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. D R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PI t ABOVE C ER. ELEV. INLET ELEV END 2 PIPE FEET FROM LINl qIR INLET: ([ff!!,I _n J NEAREST-s' 41 • /`/S7L MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for mediu sand. TIONS MEASURED. DYES NO SOIL COVER TEXTURE PERMANENT MA' ERS: JOBSERVATION WELLS DYES NO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SAT SEEDEDMULCHEDCENTEREDGESYES1DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH TRENCHES LATERAL SPACI IGRAVIL DEPT BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOL M TERIAL. NO. DI TR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.. ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: OYES ANO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: OYES ONO OYES ONO NEAREST Sketch System on Ret • n county file for audit. Reverse Side. SIGNATURE. TITLE: DILHR SBD 6710 (R.01/82) Wisconsn APPLICATION FOR SANITARY PERMIT OUNTY s O- D I L H R (PLB 67) f' e'kO 1I r 1000 oEwararrnrnTOF UNIFORM SANITARY PERMIT # int)USTgV.LOri6r+umran gELSaTKN'13. -&-goo 00,3 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT MAILI 3ADDRESS PRO TY OWNER p~qA ~I7R15 rAa 5C90 PROPERTY LOCATION CITY: NE 1/4Nf'1/4, S -24 , TA;Z~ N, R /7 E (or) oWN OE~ AMmow~l• LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 7REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER /VA Na v. s . . ~A 6 T o 6 /4 4.11 1 TYPE OF BUILDING OR USE SERVED Public (Specify)1 or 2 Family Number of Bedrooms. : ~~e o L THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair { Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 9 Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank J System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy U Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total *of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity QD d OAIG X Lift Pump Tank/Siphon Chamber 40 O 4K Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound C~ In-Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 41 o a A.~l 00 ® Private ❑ Joint ❑ Public the undersigned, hereby assume responsibility for ins ation of the private sewage system shown on the attached plans. Name of lumber (Print): S MP/MPRSW No.: Phone Number: ~e i2.~e f' f ~O,(, q/ rt- o Q MP (7/Y)6 p,1-337 Plumbe ' ddress: Name of Designer: f4 L cjw ..a t.~ r S SA e - COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: /J Fee: Date: ❑ Disapproved ld~~„ _Y~ ~r ❑ Owner Given Initial T Iivrz ~d~ r~ Approved Adverse Determination Reason for Disapproval Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County; One Copy To; Bureau of Plumbing, Owner, Plumber /ha + IL + nr v jj P ~ ~ - 'may. ~p7 ~".•0 a Rey , ~Nk '.A ~ Rl}~ ' Tt 14 e4a~' r Z +C bl ~I 44 04 ~ ~y. ~ nom, r. ~y ~ `1:,:, e = f~~l,ft 1904 0 tA 'A 41 L*A w' k o 00 e AL -e - - r %F te a " .D#?v14 i, A*Y 71, Zr(~ + 2 x ' 4-- 1 i 43 L~j 7k ell:~ J) od C, J i 4JI" , ti j~ crz ~oi h , ~bE t r If J4 OZ. lip, + % As z 10 ~ ,il" 6~ tom. ~ ~ ~ a ' a 1~ C _vt i 1 t'n s `aCj \ r~~e~ \ ~t tom,' `A ~Vq m T; :p Z F . ri COT 111984 0 - P . r ^M PAGE OF PUtE CRAM R C 03§ SecTloN ~qq SPEC ON .q V 'IJT CAS 4"C.Z. VENT PIPP11 WEATHER PROOF APE+RCVEQ LQsrKI44 JtJIJCTIOLI BOX MANHQ.LE COVER. Z5' FROM DOOR, ~ WIIJQQW OR rRCSH IR II+#11I. i API IIv TAKE I , GRADC I y" Al IN. I CONDUIT 18" ht t AJ. . FROVIpE I INI.ET A►RTlr*H'T $CAL. I 1 ~ APPROVED JOINT A ye^:~ I i I APPROVED JOINTS ~1/c.z. PIPS C ~ i fi I [II wfc.l. PIPE 9X,TENDWf* 3' cs~,„ I I ALARM Ta9lTE1JD11Af. 3 ONTO SOLID $pl CATIONS I ONTO SOLID $OIL c a ~s = I f-L E v. FT cLIMP QFF Gp141CR,E~ TE FLOCK RISER EXIT PERMI'1TEp OQLy If TANK MAMUFACTUREIR HAS SUCH APPROVAL. gC I IGATIOI)S DOSE TAIJKS MAMUFAC'TLIKE-R, s" sQ r ~401JO#C +P- QUMBER OF 0050 -----.,,-.PER DAy TANK 51ZE : of s 4 0 GALLOWS DOSE YOWME 4/,6c) o u tr INCLUDINIG OACKFLOW: _4 SO-- a GALLONS ALARIA MAWUFACTURE.R: I Ga MODEL k4QA59K: CAPACITIES: A-TO- IkICHES QR ALLOWS SWITCH TSP911 /'a1ei2r 8m INCHES OR ~AI. ONS i PUMP MAWUFACTUR61Pt. r. ~ IIJCHES OR 6I©WS MODEL IJUMBICR: D= 6 : INCHES OR O''sGALLOIJE 5WITCH TWPE: T PUMP AMD ALARM ARE TO SE INSTALLED ON MINIMUM pl$CN'AFtCpF RATEGPM SEPARATE CCIRCUIT$ VERTICAL. DIfFLRENGE UTWER14 PUMP OFF AJJD DISTRIbUTIOM PIrE.. FEET + MINIMUM NETWORK S,UppL'A PREM.IKE~. ~ , , , . ...,A•„S,..,- FCET 017J 11~~4 - FEET OF FORCE MAIN X 00 F7~1CTtQla FAtroR.,~.,.:,~... FEET TOTAL DbUAMIL HEAD aaas FLIT p (o ell t141TERMAL Di EA15tdtLIS OF TAsIK 1.EMC9T4 iQ ~.;WrI1~TH / -..-+;`I.,IQUIR DEP M' C.~..-.-- IGtjEp1 LICEf43S~ WMBERt,cn`o td9 IDA'TE: 777 k yf` "IT, Hy MM EN ROCK, wl 54~ 23t t4 ~ ~n ,4,,r i j~Y .fJRP►.~tL~ {~{11Y1~' v' t :y,,,~ yNk - r L , ~3 t $ W 1~ ~ I~hl L~t, ~r F { ~ .el t ,1 ¢t ,i La' a 77 tt$toeV~ 1 L LQ 68"' } air ~ ~4 i~ q~• l 1 ,I Lf. ~If t qy r ( 2t4 i K 3a- --r ti - - - - 6 - 5 IM 1 1 4IF~ .L~~~ ddd VF L" y Ei Y.-7915" 311984 ~ ~ r i } fi ~ ~"r~ R', k ~ sit C~~.~ #~ti ~ z ~ 4 y F. t r I . ~ 7"q. :5~ ~~4 ~ c+~{~~1 ~1 I i~:da'~~4;,~ r; •tt• n~M„ Model 3s$s Sewage Pump Bulletin C L2.2A " July 8, 1983 • For Homes - MOULDS • Farms Model 3886 • Trailer courts • Motels (Supersedes Model 3881) • Schools Sewage PUMP Submersible • Sewage systems • Hospitals' Se'wage Pump • Industry anywhere waste or drainage - must be disposed of quickly, Pump Specifications quietly and efficiently. Discharge Size 2" NPT. Impeller Non-clog, semi ope,' cast iron threaded to shaft with ejector v:ane:e> on back side t,-;r :;eal protection. PERFORMANCE RATING Casing Cast iron volute typ:a for maxirnurn e;fti: ~ncy. 4-Bolt construction 1/2 HP Series No. . Series 300 Stainless Steel Fasteners WS051fA for corrosion rr 5i !ara,c 1750 RPM WS0512A Mechanical Seal WS0532A Ceramic vs. Carbon >ealing faces, s(a:nlc~ss WS0534A steel spring and B(jr i IN elastomers TOTAL DYNAMIC GALLONS Maximum Temperature HEAD-FEET 160` F. PER MINUTE OF WATER Capable of Running try 5 143 without damage to ..cltnljonents. 10 109 a 15 75 Motor Specifications 20 41 f I Motor Fully Submerged 25 7 in high grade turbint' oil for permanent L;b- 26 0 ' rication of bearings aj-,d mechanical and efficient heat dissipal on Motor sc !edf 1r fn Liquid passages provide true full environment by rugyc.d c st iion er.._irs rr. diameter solids handling capabili- - Bearings ties as advertised. Rugged cast Heavy-duty all ball bearng construction iron construction. High efficiency Stainless Steel Shaft full volute casing: Series 300 stainless steel for corrosion: d resistance. PERFORMANCE CURVE ' .'ii' c.. L e' Single Phase Units All single phase units h e guilt-in the rrral 30 y overload protection mi ataomatic reset. Threaded shaft. Three Phase Units w 25 Overload protection in .:farter unit 2ii~, III LL or 460 Volts. Threaded s°;n`t 60 I 1r o rc I Power Cord C1 20 Water and oil resstan Fpor:y sea' orr :~~icr Z end acts as a seco idary n;nisture ba'! r in case of damage to ~,,:tor jacketing U 15 resistant gland nil Z Single phase units 15' of 16 SL~ t 3-prong groundinn pw( 10 Three phase units 5' u 4/41TJ), ended leads s~ ~ 5 1 'rillr Yrs. , SPECIFICATIONS ARE SUBJECT TO CHANGE ~0 20 40 60 80 100 120 140 WITHOUT NOTICE. GALLONS PER MINUTE Form-STC- 103 f PUBLIC BUILDING The existing system must be inspected for compliance to bedrock and high groundwater requirements of the code. This, in many instances, will require a soil test to be conducted by a Certified Soil Tester or an on site by this office. If the existing system does meet requirements for groundwater and bedrock depths, additions to public- buuilding,, ,st he considered on-an individual basis before determining what must be done to the private sewage system. Restaurant additions, service buildings, or other building additions that will serve additional people will require private sewage systems that will treat all sewage from the structure. Additions to storage areas or work areas that will not result in additional employees or customers could be completed without updating the existing system, but a replacement area should be identified for the future. Al f5 N E w. f~AMM6Nd 1/4 1/4 (Subdivision & Lot 0 Section Township - ~ALq~w~.v Rural Routtee# Address Post Office Zip Code (I) (We) ~FgL4."*V CMV15iAn/ plan to add to the above building and are adding only to work or storage area and will not be creating additional sewage discharge. The present private sewage system appears to be working satisfactorily. If the present private sewage system do s .fail, it will be replaced with one that is code complyin . (1) - V (Owner's Signature) G Date Subscribed and sworn to before me this '6 day of 19 Notary Public • C--0-y~. County, Wisconsin My Commission Expires ST. CROIX COUNTY (County Authority) Plot plan attached (show location of building addition to drainfield and septic tank). Include soil testers report form. DEP'ARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, . DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS (H63.090) & Chapter 145.045) ECTION: L 95CATION: F/4 I s~ /TA 9N/R(or) W TOWNSFy~Merrr: L /O.: BLK. O.: SUBDIVISION ON NAME: 1/ N COUN S7 -T~RQ/X OWNi9,LdctJ/A/Sad. 6G~Oe L MAILI A~c~cu/.✓ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ERCOLATION ❑Residence .5 / ❑New ❑Replace TESTS: RATING: S= Site suitable for system U= Site unsuitable for system v O 7 CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL MS DING TANK: RECOMMENDED SYSTEM:(optional) NS❑u ❑SS❑u ❑S❑U ❑U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH 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.) r B- 02 ~ • I / / /eZ I✓sc Z 94/ WLS B- Ca,~ ~~`gLSiC. ~~-NQNScL O~~j~jNLS q'~JJn1n'I B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 P PER INCH P_ A /V Ai: r P_ O W , Q / P-_ P_ P_ 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 I ~ E ~ e 04-44- E I ( { E I ( 1 S E ~ x 7 - 7 I ~ i __J T _.E.....,.., ...............q....,........, i ................-,-gym-.. _ e..,.ee _ 1.. f _ - - - E _ F r ) 7 3 ~ m 1, 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 (print : TESTS WERE COMPLETED ON: 6 - /~t - fell ADDRESS: CERTIFI TION NUMBER: PHONE NUMBER (optional): L c~wi:✓ GJ~ S 5Y /.5'- 6 ~~-378 ST URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 1,' Ilk o a` 0 r LL) N o ~ N It o~P ~ x 4i N 7zs L f 10 C) o LU r w n fit. ~~-way 63 Rid P, I AFTRYNT OF REPORT ON Salk. BORINGS AND SAFETY & BUILDINGS INDUSTRY,, DIVISION LABOR AND HUMAN RELATIONS PERCOLATION TESTS (15) P.O, BOX 7989 , / (H63,09(1) & Chapter 145.046) MADISON, WI 53707 LOCATION: 7TIII-N-p TOWN/Sji~71'Y: O/0.. LK.. NO.: SUBDIIVIS16N NAME: 6 ~ 41 ITAIR fLoWN !/AI► M40AJ t' )v COUNT OWNER'S/BUYER'S AM: JMAILIADDRESS:~', R p i x A,Lq~wJ~✓ ~ /t, c'`jc~o e L AL~wi •k► , DATES OBSERVATIONS MADE NO. BEDRMS.: O R AL S PTIO R DESCRIPTIONS: PER LATI N TESTS, t C)Residence ❑New QReplace cam/ RATING: S= Site suitable for system U- Site unsuitable for system NV IONAL: MOUND: tN-Q IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional)` s ou as ❑u a au os ou ❑s u c,l, If Percolation Tests are NOT required OESIGN RATE: If any partionbf the tested area is in the Under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P R U D T R-I CHES CHARACTER OF SOIL WITH THICKNESS, DOLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. i4f-GR TO BEDROCK IF OBSERVED (SEE ABBR . ON BACK.) 62 hW-r, X7 q~s ids -3`;qL s; C.. 14" 8 ScL a'&4s q`f3~vlt~ s- PERCOLATION TESTS DEPTH WATER IN HOLE TES TIME DROP IN R LEVE I NCHES RA MINUTES NUMBER INCH@ AFTER SWELLING INT RVAL-MIN. 1 PER INCH P < P+ F_ 3 %a ow ljo Q y P, 01 Q41 ~t_100)011 JeWl, x & s P 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 ) ~ r I 3 I l r.._ - I - , { I ( ~ i ~ 1, 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, AM (print):~ TE TS WERE COMPLETED ON: e, AD R $S: CERTIFI TION NUMBER: PHONE NUM13ER(optional); ST URE: DISTRIBUTION:' Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-S6D-6395 (R. 02/82) OVER 3 bt O F p ra Q y~• 'v- r. ' V 44 y, d'~'~' . l~+-c+»9 y e6 3 ;a U) 171 STC - 105 r y ti SIsPTIC `1'ANK. MAINTENANCE AGREEMENT ~o St. Croix County d Sc~00 ~ H OWNlIt/BUYER ALc/w~•J I,{ KOUTE/,HOX NUMBJ`R__ 1?6.*LFi.re NuIli ber I C I T Y / ST ATE _ A (r c1 L j L j; PROPERTY LOCATION: IV E `4. Section °Z T- > •I A9 N, Town - St. Croix County, n u ut b u r _.!4 S u h d i v :i s i. o n _ ' P► _ _ + L o t I I►uprupe:r use •and' Ilaintonance of ve)ur septic system Could result in its premature failure to hatidiv wasLos. roper maintenatiee con- sl.sts of pumping out the septic tank every three years or sooner, i,rneuded, by a 1_te e~nsed s )L it tank lrutttLer. What you 1)ut into the sytitem can aft'UCL the function of the septic tank as a treat- ment stage in tiro waste disposal system. St. Croix County resident's mi-y be eligible to receive it i;r.anL Cor a maximum of 607. ut the cost_ of replacement of a failing sy:;teirt, which was in uperaLlun priur to July 1, 1978. St. C:ruix Count v ace.Upted this program in August of 1980, with the requirement that owners ut all new systems agree to keep their systems properly ma in La itred. 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, reestricc.ed plumber or a licensed pumper veri-- lying that (l) the on- site wastewaterrdispusal sy,•Lem is in proper uper.atlitg cuudiLiun and (2) after insoection and pumping (if nec- essary), the 8ept.ic 'tank is loss than!' 1,/3 full of slud,gee and scum. Certi.ticatioa term will be -jerrt approximately 30 days prior to throe year expiration. o I/WL:, the undersigned, have read the above requiremei►cs and agree u, to malnLain the private sewage disposal system in a000rdanCe with M Lhe standards :yet forth, here: in, as set by the Wiscons.iu IleparL- k-U moot of Natural Resources. Ccrtilication form must be completed and returned Lu the St. Croix County Zuuing Office wiLhin 30 day: of tine three year expiraL ion date. S tCNEU / c-S - 1) ATL 5t . Croix County Zo ting 01. t ice 1'.0. Box 98 llammo iid , WI 51101.5 11 5-7 )6-223 1 or 715-425-8363 Sign, date and return to abuvc address. APPLICATION FOR SANITARY PERMIT S 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 A Lc' w /,,J e- R 1 S T I R rj c o L- Location of Property /VIE 14 NE~ ~4, Section o2 T N - R 17 W -s------ Township rye M 40 C/ Mailing Address W14 L- cl w ^LI) I' S ^ - Subdivision Name Lot Number IYA-• Previous Owner of Property L e p~,) A/0I/ I( e Total Size of Parcel C. S Date Parcel was Created o2 - Are all cornets and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes X No Volume 2 and Page Number /79 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Dee 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) cehti.6y that aP.e 6tatement6 on this 6oam are true to the beat o6 my (our) knowledge; that I (we) am (are) the owner (s) o6 the pro peaty de a cAi.bed in thi,6 injoamation 6onm, by vi4tue o6 a wa4Aanty deed neconded in the 066ice o6 the County Regi6teh o6 Deeda ab Document No. 2 p ; and that 1 (we) pne,sentty own the pnopoaed a.ite bon the .sewage aystem (on I (we) have obtained an easement, to nun with the above descAibed pnopenty, bon the cona.tAu.cti.on o6 said system, and the tame has been duty neconded in the 066ice o6 the County Reg.ustea o6 Deeda, a5 Document No. ~ ► . SI ATURE OF OWN R SIGNATURE OF CO-OWNER (IF APPLICABLE) /0 -as Vdl DATE SIGNED DATE SIGNED 5a Gi 6gll -Fero- sr1.9,~ //,Js ~ 61G-77 e 14,-) BALDWIN-CHRISTIAN SCH00L NB NB, Section 24 Ba.2dwin, DUI T29N-R 17w Town o4 Hammond Sani-taty Penmit#588,83 10-23-84 E. Botdt Conventionat, Reacement (Commenciat) INSTALLED - 10-26-84 1 • v r LA m _ (D 0 Q ° Olt" s ?c c ^'3 O 0 3 Q w w _ ~o~2 3S o n G= M p a m m p A N y ~ O m y m y y 0 aDG 'Np p co 30 ~ m _ y pD [ _ 7 m y m CL (D r.. m~~ A = A 3 aW p o 0 m m .pp..Oy. ? fp 0 W O - 1' 3 ° cc ~G c vi E3 C A 2 C j.f 0 G S y=- y 0 _y y 0 .a pD C 0 21 CD ~ ~ •p < M Co Q CD Q O .A-► 0 Ca C CA W A O •G *0 0 IV 0, =-,m 0 o O ym co m » Al C _y ca N S W y f o :1 to z O O D D»- -1 -i7 Z = a0 A 3 mm m a m -w "1 y fA MCCD a w 0 w - s p 1t1 C ~ - au Q U) m A > 0 A = CL to = w a m pv b a G A* m~ Co m ycoM0 C f11 0 CL CD (D to 0 LV p a ~ at Q fit = "i °ij O c O •A• =cm w (D 3 a c v0 c A' w=w M~.=maymp f11 c ac a_aaa..._v 00 c +n ~p 7 MM m-, 3 a 0 C ca a O y A m 0; a c-4 w c c0 "4 Q cx a 'c ~~A 2 ~z3 0, p00 v 3 s y (D a < N SEED $8784(R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) STATE'Oif. DIhHR L LAP Qetacn.And Return. Upper DIVISION OF 8AFM A. UILD ; Por#ion Of This Form Wit BUREAU c~= v~.uMelly~ yr$ 18, ZAt E. WASHINGTON AVE. R M -J44 Any Return Correspond 9 ~ A P.O. BOX 79i* m FCF~ MADkSON, %18; 7 H DATE 09417 1%i4 V%.' l9 . w PROJECT: Badin Chriszwian School NE,►VE,24,29,17w, ` i Tn Haimond Everett aoldt _St. i oix WI 820 Main Street Baldwin,;: W1 5400E PLAN ID. # 84-0661 6 DETACH HERE _ Baldwin Christian School $4-06616 PROJECT NAME PLAN ID. This is to aclknowledge receiptof your plans and.specifications for the above-indk { % irof, Preliminary review. indicates the required fee is Fee Received is $ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans w&be held in abeyance. Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance.. 1. Plan Submission ❑ Soil boring and percolation test data on.115compieted ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and Plans not clear, legible or permanent. notarized. (1 copy)' ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use ofbutlding. stamped in -accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required_ (1-co . Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration.: (1 copy)° ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, ' well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state=approved; Cbmplete vice road, etc. Show benchmark with permanent elevation.. construction details if site constructed. ❑ Holding tank agreement signed by owner and local li. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample encloses.. ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank.' Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that as0lfabsorption system . ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel... Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head,and gallons . pumped per cycle. 111. Private Sewage` Systems ❑ Size, length and depth of force Main. ❑ - Ground slope with 2' contours in entire area of soil absorption Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing. pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20'beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or:district "ff.