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002-1085-30-000
• 7 0 . 2 0 w j k . I • CI . a § , ) 2 1 & =7) C.5 § 0-_ • a 1 tt§2 I E3�] I b f2�� CI ) a) E I % 7/] { al CS ! 0C W ! § G§2 # ® E °5 � ,$ %• , \ �/mac , u. (5 O. I : 0 ( ; a) . 3 E_ C 1 k 7228 ; < �2C= . I •0' I 2 I > w, B m : o I ± E 1 co § \ i a m ; § I C z 4 1 j i . re ,- : k / 1 t « E f I 2 1 4 I• • I ) g -� § y §• k z ILt / i R § ) E c • § ■ I It k 0 CI ) k k o ■ ■ u) E 2 \ E _ - k K K & ° 7 -� t [ a a a M k . � I k \ 1 $ k k ) I tt 2 l 3 § % .- \ � a a o ce E < ° ° 2 7 a _ 2 2 3 e 2 < >- m § § 2 g \ � � � ° 2 § ri a • ) _ C 8 a 8 1 2 $ / ) ® E 2 § 2 / I 2 ) f / ' « ± © = a • m ) , / i 2 $ ] { � 0 8• ) m I ¥ 2 0 ) k k / 2 I fit 2 \ « £ k § , • • $ § a I — , - £ % 7 I E 0 E I k , J o a 2 I o k , Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT f OWNER � p , cGh t v.:% k TOWNSHIP } CCQ lj%f;� SEC. J4 T Gf N-R [4 W ADDRESS Li)ejcv- fd/P (O,' ST. CROIX COUNTY, WISCONSIN •w SUBDIVISION LOT go 4ci. eLOT SIZE e. d89 PLAN VIEW \ K Coin; Distances and dimensions to meet requirements of I•LHR 83 ` SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM rE)Jel 1 IwV OI 4,0p.s a e 115 5t4ck+.o1l Out er • • / INDICATE NORTH ARROW "=So '' BENCHMARK: Describe the vertical reference point used 100,00 1 { i' ) o� ( J, 11 e( ` Elevation of vertical reference point: 00.0 a Proposed slope at site: / �.. f.(CGt9 ^ SEPTIC TANK: Manufacturer: kOWpsfe,� Liquid Capacity: (BOO tea ( Number of rings used: S Tank manhole cover elevation: .6f3 .e.) (n Tank Inlet Elevation: c[/,O& Tank Outlet Elevation: fo, qa Number of feet from nearest Road: Front,®Side,O Rear, O feet From nearest property line : ' Front,OSide,ORear,. 50c6 feet Number of feet from: well r , building: _a (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER t ��jj• fttiquid / Manufacturer:,M WQ,�C ," Capacity: /000 & / Pump Model: WF C* Pum Siphon Manufacturer: C6 US Pump Size 4F /JP G '-7 Elevation of inlet: I? , 5 Bottom of tank elevation: s 7. 0 Pump off switch elevation: 8 g. o 1 Gallons per cycle: ,25"-- Alarm Manufacturer: SsS et•GcFrO 5l{165Alarm Switch Type: / c,r ,7 4o4d- Number of feet from nearest property line: Front, O Side, O Rear, t Ft.Sb o_ Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM / i v Ou sk e Bed: Trench: Width: Length: /i7 9 Number of Lines: // Area Built: O ./ Fill depth to top of pipe: 9,d Number of feet from nearest property line: Front, O Side, (' O ear, Pt 6001 Number of feet from well: v Number of feet from building: v2 OC) (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box() or distribution box O been used on any of the above soil abaorbtion sytems? (Check one). HOLDING TANK Manufacturer: Crpacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of fect from building: Number of feet from nearest road: Alarm Manufacturer: 1 Inspector 7/(LI Dated: 7/''/'/1/c7 Plumber on job: License Number: .3,111---- 3/84:mj t:171-7 h 7= - evi o,r 19(12 - o‘ gs- 0 0, 9 tke;y14.)i • '!_5 , /"/ .- _ /. / 7 7 LOP 7 144 ecA)t- s 89 -. 02 13 9 T1,itr,x6e.)-• c''(-16\, c Ile\ - "3 — art. A- Ni,R f,.. Coo.a o .. 8-8 —89 ' LONtA , LUC i 1 z ....- k :. 0 t e ie •-.2 S a, 1 ■ ) It S• I1J CC: L Gj Sep41`,.. Prefcsck c•-• ‘'ec)c - 1 BAroto% rovc,:z... ------.3 mo,,, S3 A 1 000 -10111111111161 Q2 .• -------1`. i eo LOA\ 1 03Q-s+ -Provxat-A\I 1---0 -Q ! Cs h.fc.k-OX, 3s-b, i U.-- 51}- a& t'L, 1 CYNC1TE STNAGE: SYSTEM .-.,?.?. 'ilAS /t/ ii Nel F 1;14 .( I 17 7.) .-..?s/ t-',:',',',V ':r-• '.,i''-'-ot. :,..:;,,,?-- ....,:i74 ; i,„ .f' ‘..i: '.... C.:: INDUSTR „a ABCR AND HUNIM RELM1ONS ,..->, ____ UIV■GiON Of V TY MD OW GS ,...„.--- „. . SEE CORRESPONDENCE 1 . •T)),-t-u t ' . i ! As Si-lou.)v- , 1..-.__„ectA-,7_. ,z,_ ,.__. ____■ ) .____ .___ _ LA . Ckt.)Irlei-•. k IA. cc I-1 iv.' it \- /...,(-.:.•.>.;-• (....,F v..-jvri- *. ehr 1,-.2‘ , 1-1-ei e....C6b- ... 3c- 0 i _,..) -- ' S 80 4* 02 13 9 s''07 ,.:,,c...w•-,p p.c.:1-m 5..:-TRAw oR 1--ARE,1-1 liFe-f -,C)1S-rp_Isu-r;Wa 7-1Pii. EEL. -x. r-h-q--p P-OVWD Srk -r1C.. C_O\IS---alL)G . "Sj:',-_:=•./-5'...— .41.;--'?•::..'5.■:;..-ST.,` 1.--.E...:`.-31--: Z-51-17:7, ----7. ----------7- -----7-•_._-°"--.:- - s.;.&-r ......:-."`-,__ • TOPSoll_. - .. _- •- :7"z:-' -I ' 0'. -:- i I F •... --:: :-.. BED El-. 1.0$ g, :/1.'__...J i-. -... ' ''. -- . . . • '■- ._.. __72' ...:H D • : • ......--,..:.1---*--=`;---c--- . , :' ..•- • . 3 ' . ... '••-...'...____). . e •' •---1:17.--j—j.:---) .___Z..—).--)----- . I I I _.. .. 7,.. .. . . --•---- .., ,., tc: • .. ,t ----OPE . / 1 • -:_•=-1- or //i"--2.//2,"r>C;d:R.I.E.SFI.TE- -_i ir-4.4-Orl t3J161P E.." P‘•-■_ou1/4) P,PE.- -2.not.) TZ Pi P E r) 205-Fr. r. , e Sy mitip 2 S.:- •W-LC.:__. T2-(5.1■5—, G _L___ FT• . . , • • ONS1TE Sc.%AG . . • er)14,440446/111. JIfr \ A 5 Fi. • '...), tf 114 ,',1+1,1 n:*V t‘. p .,t. '&,; . ' .- . .., S 10 T. , RELATtONS I I t.11 Pr- ot. .%-rmE o Ititl.usrlsoiyal_.ito,t0A`11BOuit.:,...utsni\it, 1 .............„ DIVISION Oc w AN i Zing' T. . 01- , . ,...,_A.,• .• I i' A 40,41, IC 0.11) Fr- - -SE- a CORRESPONDENCE . NI ta2INS--r-r. , V.N C. VOR.C ."1-i P■113— i .F.....,, ,......-,F. • • ..-„. • .., c! •. II A . --WESZH it.4.A;)-1T vi P+RI.c ER- a. AA v....lc -TASTR_WitATIC7io-- . •• N 'PIPE.--\\ 1 . • f 0 „ \hi — - L.1.--- ,, CD'aSERIA*110,0 PJPE --- B / • ,,L__ , ___.. , I _ P,G.GRSGP:CE. . L ,.. ..._:.......„, • ,.. L . • • . , . . • . . • alb i116.0-• e►,nt:� NE eso • 3•-'s K 8—II -89 S 89 " 0213 9 P_ T-oRA ■ Th PtPE b 4.)L PERPOFJSTS-� _....-- ?V� P1PE 7 .f)41:. C.IN I, ....77:7:,..v.:' ., �:-� P�. O-11JSTA,LL Pt_IZMA)JE1.1T HAR.Y�-Q c`S.�( AT BUD OF Eh CN Lr:TL"RJaI. ' UD C.A P. Q l F0 LES W C olaTE O)J 'ctJT'�N or Xdit -F _.BI.Pa PtUD F1R< ec u1w.,/ SPA S , PV C ' t?RAYf Tau r:-►P N—'PV C" LJi'1"E2A L5 P LPN Cfr. LhST MOLE 1JEtCT -To ELZ CAP 71::3\S'SR1HuT7OW. PIPE .13111rOLi1- _. ONSITE SEWAGE SYSTEM . . P { f Pr. e ,C o;aaty \ x 1N, atAi, F n n 1.--1, ? 57 ra„a \d e r Y 3 , N. DEPART ,'NT CC Ni?lJ3T?'', I.A :i AND HUMAN RELATIONS �.i , 'ISBN OF SAFET f ND BUILDING '�,.-- 1�1.:e .INAnc 4 Wit_.-_ . f 1'� ® :... . f!!A•. tai- ! _1:J-�EPJt "1 - 1'4 JC 1 N._ FOR.CE Y)Aui-:i 1),_ '' CORRESPONDENCE .,poF 1wLE_vn,Pe /3 1),3 Ni.ElE).OF .LATE}LS /OS CC 'PT: p r CE 1 — HOL£ ?4" FRo� T� Willi SU CC-EtSD1I1 G HOLES r...?lg •l u-t Uhc:s. ST L AcST '-toy-E It, >JEXT' TD T14 E 67.3D CJA-P- -- Q/la-51- A (TrdflG1 SC 1),Nvt, I 1 _ PAGE OF • , ' PUMP CHAMBER CROSS SECTION AMID SPECIFICATIONS ' 2x39 (--��V E NT CAP ti"C.I. VENT PIPE `— APPROVED LOCKING WEATHER PROOF MANHOLE COVER ` JUNCTION BOX ' 25' FROM DOOR, I2 M11l. 'T"'- WINDOW OR FRESH I AIR INTAKE I _ GRADS: ,/ 1 y MIN. 4 I .* = I 9"MI U. CoIJDUIT t V ------1‘'la"MIN. �,.; PROVIDE, I' I---- --- �NLET AIRTIGHT-SEAL i III /� I I I APPROVED .10Ikg APPROVED JOINT A I I I W/C.I. PIPE W/C.I. PIPE ( III EXTENDING 3' EXTENDING 3' ALARM ONTO SOLID SOIL ONTO SOLID SOIL B i:LATI DEFT , I I ow V. n�.y F T. itii o` ,e GLE a4�i..::n,'.. .! —root �� ► OFF 0 "-� -G LJV,RtY ...,A, VJLi�iCE L ' ' I CONCRETE 6LOCK—+� £ItU. l 4,. 0. 3"APPRot * RISER EXIT PERMITTED OIJLtI IF TANK MANUFACTURER HAS SUCH APPROVAL BEDDING � ( eU C7-.I SPEGIFICATIOMIS SEPTIC E fb 9 DOSE n. �Q ]` rr TAW MANUFACTURER' . _�IriI 0(..Si-Piit ! N' ..as IhQ-IJUMBER OF DOSES: PER. DAy TAIJK SIZE• /(n1 {ter l i)nS-e _GALLONJS DOSE VOLUME ALARM MANUFACTURER: F ,`�: I-c'(f✓n SyC"tFFriS INCLUOIW6 BACK[LOW: - ' R` GALLONS MODEL NUMBER: I 0 I )--I-UJ -(- CAPACITIES: A= (� INCHES OR .�L� GALLONS SWITCH TYPE: J rC- I r� o ` 6= —INCHES OR �d c1GC►LLOAIS PUMP MANUFACTURER: G(I,< t t d c= ID.C2,INCHES OR .•DSO. TrALLOIJS MODEL NUMBER: [..,(.)'En C-C-1.--k 1A D= 11,,c0 INCHES OR cg9•9fALLO1.16 SWITCH TPE: JrccAv'■ 1 ka1 IJOTE: PUMP AND ALARM ARE TO bE MINIMUM DISCHARGE RATE c�0 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AND.DISTRIBUTION PIPE.. 17. 98 FEET + MINIMUM NETWORK SUPPLY PRESSURE 2.5 • FEET ♦ 3/() FEET OF FORCE MAIN X I• y FZou.FRtCTION FACTOR.. q817 FEET TOTAL D1JAMIC. HEAD = .1 .E: FEET IWTERNAL. DIM^EIJStOtJ�► OF TANK: LEKI&TH 7 /o ;WIDTH 6/9 .;LIQUID DEPTH it / , •SIGNED:, Cf Ga--. 1,re f) .- LICENSE NUMBER: - /S DATE: Y r DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SE3 Section 33 El CONVENTIONAL El ALTERNATIVE StatePlan l.D.Number. SW 4 �` 4� (lf assigned) T29N-R16W, Town of Baldwin 0 Holding Tank ❑ In-Ground Pressure EN1clound 60th Avenue y/v-8 `/px _ 9_4--x, NAME OF John TSchmitt 335SSN PERMIT ockwood, Woodville, WI 54028,�_D QQ,:/tr.n�� ���p'��'�� Lockwood, i�'�7 :/tr.g.,_ NCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN REF.PT.ELEV.: CST REF.PT.ELEV. fir- idol _ k, \,\ I •o00 Name of PI ber MP/MPRSW No County: Sanitary Permit Number: SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED PROVIDED. OYES ONO OYES ONO BEDDING VENT DIA.: VENT MATL HIGH WATER `NUMBER OF ROAD PROPERTY WELL BUILDING VENT TO FRESH ALARM. FEET FROM LINE AIR INLET. Ell/ES LINO OYES LINO NEAREST >~ DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED PROVIDED:❑YES ONO OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING.(VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES CI NO NEAREST )11,{ SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH. DIAMETER. MATERIAL AND MARKING or excavation. (lf soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID BED/TRENCH TRENCHES. MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE (DISTR.PIPE (DISTR.PIPE MATERIAL NO.DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. 'ELEV.INLET ELEV.END. PIPES. FEET FROM LINE: AIR INLET I NEAREST. s- , 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 medium sand. TIONS MEASURED. OYES ONO SOIL COVER ITEXTURE PERMANENT MARKERS: OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED: CENTER. EDGES. OYES ONO [DYES ONO Ell/ES ONO PRESSURIZED DISTRIBUTION SYSTEM: H °WIDTH: LENGTH: NO OOFH ES: LATERAL SPACING.'GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: °;PENSIONS- MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. * ELEV.: ELEV: DIA ELEV.. PIPES DIA.: ELEVATION.AND I ISTR MATION ,HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFMAT(OAI PLANS OYES ❑NO OYES ONO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF ' PROPERTY 'WELL: BUILDING:• OYES ONO CI YES ONO NEARESTOM °.J P ;° 1 \pL Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R.01/82) �, DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code �. °....,..,.�.o. St. Croix ' STAT S NITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper ess than 2 �a sp / 0/–� 8%x 11 inches in size. /^ g (PI ❑ Check if revision to previous application -See reverse side for instructions for completing this application. / �j STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. S89-02139 PROPERTY OWNER PROPERTY LOCATION John Schmitt SW '/4 SE '/4,S 33 T �N, R 16 E(or)V)// PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 335 North Lockwood N/A N/A CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Woodville, WI 54028 ( 715 ) 684-4016 N/A II. TYPE OF BUILDING: (Check one) VILLAGE NEAREST ROAD ❑State Owned VILLAGE Baldwin 60th Avenue ❑ Public © 1 or 2 Fam. Dwelling–#t of bedrooms— PAR EL AX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 002-1085-30 002-1085-40 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. © New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit# — 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 600 500 5nn 1.2 32 104.87 Feet 107.07 Feet ■VII. TANK CAPACITY in gallons Total #of Site Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1200 1200 1 Midwestern Precast © ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber 1000 1000 = 1 Midwestern Precast ❑ 0 0 0 1 1 1 1 1 1 VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumb ' ignature:(No Stam MP/MPRSW No.: Business Phone Number: Bennie Helgeson L / 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(No Stamps) Surcharge Fee) ❑Approved D Owner Given Initial 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 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 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete #of bedrooms if 1 or 2 Family Dwelling. 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'f 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 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 (--)■f'lr� LO -a �1 lam\\ . �C�'-`f1, l- �/, ova- ci - orr s C v f Section `3 `oZ T N-R W Location of Property �� � �� �, '?j 4� Township \c` ` N v3 Mailing Address cL») .�c ;" J ,\\ }\37_ c� 1 ( Address of Site Subdivision Name r.....--,r.....--, i Lot Number ----- Previous Owner of Property u r Total Size of Parcel to 0 C gr e_ Date Parcel was Created _,,kC t,k\ r .2._-h - (_.1, C'me^ -� %`^ \C3i l I ,,, Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for resale (spec house) ? Yes 1-7 No z. Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: I A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) cetti.by that att 4.tatemen s on tkiA 4otm ate ttue to the best ob my (out) Finow!edge; that I (we) am (ate) the awnek(4 ) ab the pnapetty ducn,ibed in .hip .inbanmation banm, by virtue ob a wafvianty deed tecatded in the Obb.i.ce ob the County Reg.vs.telc ob Deeds ass Document No. y r \,pkA r ; and that I (We) ptuentey own the ptopas ed 4 to bot the .o ewage d&s poza t .s y.otem (at I (we) have obtained an easement, to tun with the above deseni.bed pnopehty, bon the caws-time-am ab ba,.d system, and the .same hays been duty neconded in th, Lice a, •e Co y Regtistet ob fee ir. Dacwne o. to(c�lo ) . n ■ A„,, r SIGNATURE OF OWNER SIGNATU" OF CO-0 ER IF APPLICABLE) DATE SIGNED DATE SIGNED _I '' DOCUMENT NO. II STAT.E BAR,OF WISCONSIN FORM 1-1982 THIS erACE RESERVED FOR R[CORDINO DATA I M � WARRANTY DEED • ' y �l�3 �- -ll- -1-1- lq?;o `tliur T:"Kost;-'a/k/a _ "`-' n made between _ This Deed, �• Arthur Thomas Kost, single I I 1H-7 p� 6 6- 1 , ll Grantor, and John W. Schmitt and Shelly E. Schmitt , Grantee, \V.tneSSseth Thatgthe said Grantor, of a valuab)e,consideration One o ar and other ood anct val a consideration ___ St. Croix RETURN TO conveys to Grantee the following described real estate in County, State of Wisconsin: II —_ SW 4 of SE 4 and W 15 of SE f of Section 33-29-16. Tax Parcel No: 4, I! • I• �I _ Ii - l I. II - i. I: I II • This is not homestead property. ' (is) (is not) ITogether with all and singular the hereditamente and appurtenances thereunto belonging; II And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrxnles except and will warrant and defend the same. - - rDated this day of June , 19 86 I 1 t. (SEAL) 17 (SEAL) Arthur T. Kost • • 1 (SEAL) I (SEAL) I - • • - I AUTHENTICATION A-CKVLEDGMENT ■ Signature(s) STATE OF WtSCbilStN l; a9. Anoka County. authenticated this day of , 19 Personally came before me t,lye 25th day of June tfbb he abov r. -ned _ Arthur T. Kost, aka ltrialur T'icanas Rortr, vr.vvvr.w+n..wrvAM MMit I • Sugle "nwwtroUNDA.R._MJICt :1: I' -TITLE: MEMBER STATE BAR OF WISCONSIN ••N,WARY NIRUr MINNESOTA I If not, !�:‘ ANOKA COUNTY S • authorized by § 706.06, Wis. Stats.) •Comifiistidl�F�tptracrec;0J299T••7 uted the to me know r • foregoing in rumen ans now edge sa . THIS INSTRUMENT WAS DRAFTED BY c�ey �— • Northwest Title • 2845 Hamlin Avenue, , 551113 . •.•,.. ,) I#eseville iK7.11ile�bta, h vmsenonncvenn.• dwAAAs (.e� r1tj E I_. I- IEr'nY `OUnt1', Wis 1 1:otary Pu2rlt (Signatures may be authenticated or acknowledged. Both My Comrrii%o�`!�is �l2:Wh'ar� !:(WNr�ilkta expiration y R ., AN r-I:(h a i Y 19 ) 1 are not necessary.) date: ., AI ,RrR,.-FyArr•-Avg. ;1991-' i' 1 w M V`�� vvyvw w vvwvvti y, I, •N•me• of persons •lenint In •nY up•rltr should be t)prd or printed belt,. !brit •icmture•. II 37 ST . CROIX COUNTY ABSTRACT COMPANY HUDSON, WISCONSIN CONTINUATION OF ABSTRACT NO. 18,S64 From the 10th day of June , 19 86 at 8:00 o'clock in the A. M. of the land described as: SW'/4 of SE'/4 and WY2 of SEY4 of SE% of Section 33-29-16. 38 Arthur T. Kost, a/k/a Warranty Deed. Arthur Thomas Kost, single, Con. $1.00 OVC. Dated June 25, 1986. -to- Ack. June 25, 1986. Rec. July 22, 1986. John W. Schmitt and Shelly In "747", page 551 , #414730. E. Schmitt. SW'/4 of SE'/4 and W'h of SE'/4 of SE'/4 of Section 33-29-16. Recites: This is not homestead property. (Transfer Fee, $112.00) 39 Treasurer of St. Croix County, Tax Receipt No. 21099 & 21100. (No. 33) -to- Dated July 1 , 1986. N W Title. Redeemed taxes for the year 1982. 40 Treasurer of St. Croix County, Tax Receipt No. 21101 & 21102. (No. 34) -to- Dated July 1 , 1986. N W Title. Redeemed taxes for the year 1983. 41 Treasurer of St. Croix County, Tax Receipt No. 21103 & 21104. (No. 35) -to- Dated July 1 , 1986. N W Title. Redeemed taxes for the year 1984. 42 Treasurer of St. Croix County, Tax Receipt No. 1500 & 1501. (NO. ) Dated July 1 , 1986. -to- Payment of taxes for the year 1985. Arthur Kost. ST . CROIX COUNTY ABSTRACT COMPANY CONTINUATION OF ABSTRACT II . 11 I 6 1 1.1.,-.'''' : .,',-...,. .- ,, .,- . , _ .,,, ''., 'L • v, , ;) '-, • I NUMBER 1 8 5 6 4 % RIVER VALLEY ABSTRACT & TITLE, INC. ti SST. CROIX COUNTY, WISCONSIN ti S ti ti ti ti S ti SW; of SE4 and Wz of SE4 of SE; of Section 33-29- 16 . S S S S S S % \ S S S S S220 LOCUST STREET % P.O. BOX 149 S HUDSON, WI 54016 % \S rYl./l././Y./'./l✓l!./././I ./' I - - _<± j' ././y!./'. !'✓l✓l./' ✓lJ./././ll././'./lllYY./././././✓' ;r_?nt E.,,,..,,,,,r.,....,.;$,...,... ,.. ---,„..-..--rx a •—r,.,...->.. ,— n.xr . .,..x,:.-,„,,,,,T7s!r,,-T., ;:... z U) H 9 STC - 105 r" 9 H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z 9 OWNER/BUYER John Schmitt ry ROUTE/BOX NUMBER 335 N. Lockwood Fire Number CITY/STATE Woodville, WI ZIP 54028 PROPERTY LOCATION : SW /4, SE 14, Section 33 , T 29 N, R 16 W, Town of Baldwin , St . Croix County, Subdivision , Lot number • 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 , if needed , by a licensed septic tank pumper . What you put 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. 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning office wit 30 days of the three year expiration date . S I G N E,_ i_J►v _ i■f../4111,1/ � DATE 4 St . Croix County Zoning Office P. O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND- PERCOLATION TESTS (115) MADISON W 5370i 5370i RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/�: LOT 0.:BLK. SUBDI I ION NAME: _SW '/ '/ 33 /T N/RJ ,E ( r)W l3 1 1)X COUNTY: 1. . -MAILING ADDRESS: • 9 0 . . 33 5 L. . .. I V t • 5 028 USE DATES OBSERVATIONS MADE ��.,,// NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROF LE SCRIPTIONS: PERCOLATION TESTS: I�JResidence 41 N4 ❑New Replace e g y 8/5/ g7 RATING:S=Site suitable for system U=Site unsuitable for system (Pa / O VQ-K t 0.�GC) CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOL HOODING TANK:RECOMMENDED SYSTEM. optional) Mow. ( ❑S a E J'S ❑U ES ( U ES YU ®S LIU .:Dti" ,,:ct oue(r iP(aci)Iw ) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the 1 under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: ✓A`�1 PROFILE DESCRIPTIONS BORING TOTAL JUPTH TO GRQUNDWATER-IBS CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH WO. ELEVATION OBSERVED t EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B' ` �.�1 I��.(J 1 l��'�. /. �/ ;7, SI Sit •J� O�h�101� �,�/ Bhsri! �/C�GI'YI.Mct J . i'(31 St1s .a'6 i •'I'B•. SI FFb ©r B- 6.0 (o;LO) tt /. I .t i ad ► Y. '►s L. - 0 4.6 B- 3 y.Si lD�.l� �( 1.O •117'B( S:113 .3-& &i. .q' 6., ScI �,1MD or -1401" '9. I • ,e-e( s..i rs • -- & Sol %--)2-1P-1) of - )44 ' ' B- `�ict off. .,-f"T B- I€ PERCOLATION TESTS I TEST. DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- I ... `f rt rs n-e 30 , i L.C.--14 3.) 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 hor 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 percen of land slope. i�o..`J..IIZ✓" o OC. (cl SYSTEM ELEVATION N I c I I . S' ,,,,,c.,1-� °c Sa"A °C '� �°t�t" S 1111 _ T l_ _ _T 1 _ b 41,, e r✓ P i -1- i -- LT.. L iL.O.i), (LT .1,. — L ES1:21- ' P3..1 _1 I 110 - 1'° Ii I I , i l _1 E Mu 1 _. _ _. . _ __ ) _ a__ - - -. __ - _1__- ._ _... _ . c I � 1 r _ I 1 , I I I 1 i a 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(pri • [TESTS WERE COMP ETED ON: t eh 1-e __ _ a 8/5-- . .dy ADD= SS: i CERTIFICAATION UMBER: PHONE NUMBER(optional): el �.- �, r,•. �� CA)i . /7‘7 3309 4/ CST SIGNATURE: LCI-'-'-'-' t-(‘ ir--1/1 ---------------- DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. ■ DILHR-SBD-6395(R. 10/83) -OVER - _ 4 ■■ Imp ..em 1111 irapriptif laillirmilmimmit. a y 6 1.......200.■r�r■ :. ■c� u , ■ -a al. 1 WWI! loll II IN 1■■■1111■■■ _ _ I O FAIIL /■1111 11 I■■■■■■■ : • • UIL■ III ii i- ...... 1■■■■■■■■ . 11►%M ■ X11 moil iii fir iiii N.L.-_...ii Illiiiiii ■11 !IU ! R ■ ■■■■■ �■11■ -� 11■■i■ ■mole ■INE ■ lii I!S01111i11r ■ ■■■■i ■■■ Nampo 111111111 11111111111 III iuu u ■p • ■■■■1 ■1111■ 4' 1 A ■■A%-SEEM iIIIUII1IiiiII luau , g{ ilililIlilli 11111111111 I 1111111111111 I■u■■■■■ SIM 111.10111111111111 _ IIII ;1■■■■■■■ • i, _ I: • 11111111E1111111 a-- r 1111 s . ' • IIMIN MPi11 1111111111111111 a_ ..� all 16Mi 111111■111: 'x!■ �!!�.■u mmrai 1u■■■ ■ I■■■■■■■■ 1111111111111•111111111111111111111111111111 1■■■■■■■■ 1111111111111111111111111111111111111111111 _,___ a i_: cT-k,, cc-(,,,Y„ ff- Performance Submersible Effluent Curves r Pumrts >� • r: 1_ 4 �i gel METERS FEET _ '-3O�/ / 8 9 0 213 9 — 90 ��� i �J / 25- 80 /// .MODEL 3885 SIZE /4 Solids WE15H 70 S 20- WE1OH 1..- 6.1.1 ........_ WE07H�,,,',,,',,I,,, 15- 50` `''11��,11',��� 40 WE05H_��•1 !iii!IIIIIL ,IR'`'�S`.�,.0 10- 30 WEO3M 20 WE03L_4 •,1'`,, `,, ,, 5 - - ' -, al 0_ 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I I ' 0 10 20 30 mg/h CAPACITY 0 • M GOULDS PUMPS.INC. SE ECA FAILS PEW'row 13I49 METERS FEET 120 N MODEL 3885 35 110 -WE15HH SIZE 3/4" Solids 30 - 100 90 • 25 80 2 70 X 20,- 4 11 1- I 15- 50 /WEOSHH 40 10- 30 20 5 - 10 0_ 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I I 1 0 10 20 30 m3/h CAPACITY 01985 Goulds Pumps,Inc. Effective July,1985 ST. CRO IX COUNTY ` y WISCONSIN M Cf�r�l G r Y ti e j t ZONING OFFICE 1+,P r ST.CROIX COUNTY COURTHOUSE wd.aim wow , F a :NAM. LOAM 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 August 14, 1989 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the John Schmitt property located in the SW 1/4 of the SE 1/4 of Section 33 , T29N-R16W, Town of Baldwin, St. Croix County, revealed soils to a depth of 1.0 feet, after which high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:sma ST. CROIX COUNTY WISCONSIN ,:',,,,,/,--,,,.,, "'` '`'`""` ZONING OFFICE ...q.:. .4,;:4; Y �� i-,..-. �F' '^s Fyn ' _� .47410, .�: ST.CROIX COUNTY COURTHOUSE .,lr: ► .r �.i�'.. `:,a ir.. e 5 'anli� 1;,,wisq 911 FOURTH STREET • HUDSON,WI 54016 i ;. = 111.1: 11 6. FR (715)386-4680 August 10, 1989 Division of Safety and Buildings Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the John Schmitt property located in the SW 1/4 of the SE 1/4 of Section 33 , T29N-R16W, Town of Baldwin, St. Croix County, revealed soils to a depth of 12 inches, after which high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, 40, Z(..,"*"(0,40.1-4-4 Thomas C. Nelson Zoning Administrator TCN:sma ". WIN State of Wisconsin \ Department of Industry, Labor and Human Relations r �Jr SAFETY&BUILDINGS DIVISION 201 E.Washington Avenue September 12, 1988 P.O.Box 7969 s Madison,Wisconsin 53707 rr4� Helgeson Trucking, inc. Spring Valley, tI 54767 a) , SEA 2 FDircIdenti f-tO :i-cm No. 5 58-01116-P1 Re: John Schmitt Groundwater Monitoring SW,SE,33,25,1OW Town of Baldwin, St. Croix County, WI Monitoring data submitted to this office for approval has been reviewed. Section ILK 83.10 (2), Wisconsin Administrative Code, states that there shall be at least 56 inches of soil above the high groundwater level . Soi l mottling is used as an indicator of the high ground waterlevel . The data submitted confirms high groundwater conditions as indicated by mottling. Approval cannot be granted for this parcel . If you have any further questions regarding this matter, please feel free to contact this office. Sincerely, Douglas A Severson, Plan Examiner Unsite Sewage Section Office of Division Codes and Application (608) 266-5374 . ,.,- DAS:0601g cc: Leroy Jansky, Private Sewage Consultant - • rict t , Chippewa Falls Thomas Nelson, Zoning Administrator St. Croix County John Schmitt, Owner • SBD-6928(R.10/87) HELGESON TRUCKING INC. Spring Valley, WI 54767 October 7, 19$7 Tom Nelson St. Croix County Zoning Office Hammond, WI 54015 Dear Mr. Nelson: This is notification of intent to monitor soil saturation levels at the John and Shelly Schmitt property in Baldwin Township. Property description SE 4 of SE 4 of Sec. 33 , T29, 14` R16w. Sincerely, Bennie He gesa 1g ark/ ?-4 Parcel #: 002-1085-30-000 01/09/2006 10:04 AM PAGE 1 OF 1 Alt. Parcel#: 33.29.16.494 002-TOWN OF BALDWIN Current X ST.CROIX COUNTY,WISCONSIN 1 Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-SCHMITT,JOHN W&SHELLY E JOHN W&SHELLY E SCHMITT 2370 60TH AVE WOODVILLE WI 54028 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *2370 60TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 33 T29N R16W SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 33-29N-16W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 747/551 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 87316 Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 3,100 0 3,100 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 4,000 186,200 190,200 NO Totals for 2005: General Property 40.000 7,200 186,200 193,400 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 7,200 186,200 193,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch#: 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 . I d STATE OF WISCONSIN DILHR DILHR PRIVATE SEWAGE SYSTEMS BURS AU DIVISION PL 1MBING BUILDINGS "`.,•.,•.,••.•-••-••,-• •••� 201 E.Washington Avenue,Rm 178 PLAN APPROVAL APPLICATION P.O.Box 7969,Madison,WI 53707 608-266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales,202 South Thornton Ave., Madison,Wisconsin 53703,Telephone (608)266-3358. l 1. PROJECT INFORMATION Type or print clearly) Revision To Plan Number: , Name of Submitting Party (Plans returned to same) Project Name fiche , pt ht T7- .A'L c7" .7k c ill-Thin Ka sl Street&N or Rural Ro to . Project Location-Street&No.or Legal Description t i0211 rnfii 4 S r .5'!u aF ,'k4- szrf 7477 Nilz. 16'al City or Village State Zip City ❑ County j !� Village ❑ OF: / / �/ �,e,O�1/l L 6Ar Gv ! c a A2 Town la gfite tl/1✓l 5' c►R.obe Telephone No. (Include area code) 775-- (qte- 4ea 7 Designer Telephone No. (Include area code) Owners Nam Telephone No.(Include area code) S7 J b, L )744 ArR�4 K. k sT Street&No. Street&No. / 2 '/ 277/4"4 c 7: t' 0 B4x ,A. S. City or Village _ Zip City or Village State Zip (fa3df tt ) L s-* 'a 0 e GC ''4d '. &L; ezei S�oa.? , 2. APPLICATION FOR: Li Conventional System -Public Building (1) ❑ New Mound System (3a) El Holding Tank (2) ❑ Replacement Pressurized System (4b) El Replacement Mound (4a) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Fill (1) ❑ Other Alternatives (5) ❑ System in Flood Fringe (1) ❑ Groundwater Monitoring (7) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR y p' 3a. 750- 1,500 gallon septic tank -30.00 4a. 3 3b. 1,501 - 2,500 gallon septic tank -40.00 4b. 3c. 2,501 - 4,000 gallon septic tank -55.00 4c. 3d. 4,001 - 8,000 gallon septic tank -70.00 4d. 3e. 8,001 -12,000 gallon septic tank -85.00 4e. 3f. Over 12,000 gallon septic tank - 100.00 4f. 3g. 500- 1,000 gallon dose chamber -30.00 4g. 34.0 Q 3h. 1,001 - 2,000 gallon dose chamber -35.00 4h. 3i. 2,001 - 4,000 gallon dose chamber -50.00 4i. 3j. 4,001 - 8,000 gallon dose chamber -65.00 4j. 3k.1 8,001 -12,000 gallon dose chamber -80.00 4k. 31. Over 12,000 gallon dose chamber -95.00 41. 3m. 500 5,000 gallon holding tank -30.00 4m. 3n. 5,001 - 10,000 gallon holding tank -40.00 4n. • 3o. Over 10,000 gallon holding tank -50.00 4o. 3p. Groundwater Monitoring Per Lot -32.00 4p. - (other than a proposed subdivision) Subtotal 3q. Priority plan review: (walk through) 4q. • Submittal of plans in person, ' by appointment,with double fee 3r. Petition for Modification Setback -20.00 4r. Site evaluation -50.00 Total Fee ,c'.A 0 DILHRSBD-6748(R.02/83) NOTE: Fees subject to change on July 1,annually. -OVER The following information is required for plan review.An index page or each page of the plans must be signed,sealed and dated by the designer. 5. MOUNDS&IN-GROUND PRESSURE DISTRIBUTION SYSTEMS 5e. Application for Use of an Alternative System (DILHR-SBD43413)signed by owner end notarized. 5b.County on-site. 5c. Verification form signed by county)(DILHR-SBD-611581. 5d. 115 photocopy. 5e. Plot plan showing lot size and all lateral distances from the system to buildings,wells,watercourses,etc.Show permanent reference points.Direc- tion and percent of slope or two foot contours must be included. Provide system elevation for in-ground pressure, show area for replacement if for new construction. (TWO COPIES). 5f. Plan view of system with observation pipes and permanent lateral markers(TWO COPIES). 5g. System cross section (TWO COPIES). 5h.Pipe lateral layout (TWO COPIES). 5i. Construction detail of septic tank if site-constructed,or manufacturer if prefabricated(TWO COPIES). 5j. Dosing Chamber cross section with construction details if site-constructed(TWO COPIES). 5k.Purne or siphon model,performance curve,total dynamic head calculations and minimum dose volume(TWO COPIES). 51. If the site is suitable fora conventional private sewage system,items a and b from this section are not required. 6. CONVENTIONAL PRIVATE SEWAGE SYSTEMS 6a. Photocopy of soil test (115)by CST,including data for replacement system,if new construction. 6b.Project Detail Data Sheet providing all sizing information (TWO COPIES). 6c. Plot plan showing location of septic tank, soil absorption system and replacement area. Indicate lateral distances to any buildings,well,water courses, lot lines, etc.The plot plan must also show the location of permanent horizotional and vertical reference points(benchmark).?Also indicate ground slope with 2 foot contours in entire area,extending 25 feet on all sides of initial and replacement systems. (TWO COPIES). 6d.Plan view of soil absorption system showing all dimensions,pipe lengths,spacing,etc. (TWO COPIES). 6e. Cross section of soil absorption system showing system elevation,aggregate,cover material,depths,etc. (TWO COPIES). 6f. Construction detail of septic tank if site-constructed,or manufacturer if prefabricated(TWO COPIES). 6g. Detail of lift pump tank or automatic siphon,tank size,gpm,gallons per cycle,vertical lift,friction loss,etc. ITWO COPIES). 7. HOLDING TANKS 7a. Photocopy of soil test(115)by CST.A full evaluation must be made to eliminate the possibility of any other system being installed. 7b.Agreement document between owner and local unit of government,notarized and recorded in reference to the deed.This agreement must include a statement about the quarterly pumping report. 7c. Plot plan showing location of holding tank with lateral distances to any buildings,well,water service piping,water courses, lot lines,etc.Provide horizontal and vertical reference points.Include all-weather service road within ten feet of the service port. (TWO COPIES). 7d.Holding tank profile showing vent, manhole, alarm and manufacturer if prefabricated.!Complete construction details if isite-constructed. (TWO COPIES). 7e. Project Detail Data Sheet providing all sizing information (TWO COPIES).This is not required for residential installations where the number of bed- rooms is indicated on the plans. 8. SYSTEMS IN FILL 8a. Systems in fill must include an on-site investigation form (DILHR-SBD-6196),as well as all of the appropriate items listed in sections 6. 9. GROUNDWATER MONITORING 9a. 115 photocopy (TWO COPIES). 9b.Groundwater Monitoring Report (DILHR-SBD-6412)(TWO COPIES). 9e. Verification of data and procedures from county (TWO COPIES). 9d.Precipitation data. 10. PETITION FOR MODIFICATION 10a. Private Sewage Petition for Modification Form (DILHR-SBD-6689). DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (11J) MADISON WI 53707 HUMAN RELATIONS C (H63.09(1)&Chapter 145.045) LOCATION. SECTION: TOWNSHIP/MUNICIPALITY: LOT O.:BLK.NO. SUBDIVISION NAME: .rcv /A 14 33 /TxiN/R/`r(a ,?gC.alw l N� /Vfi/ /V//y COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: Sr6A-0 i t 7n7'd,u it, I. e; sT P o ox 2 S' ez/04,-..4 •ecGx ezi; cy''01 g' USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 117P ❑New gReplace —/V - c91/ -i J_ k V RATING:S=Site suitable for system U=Site unsuitable for system S' 0 8 Poi h 7 ' CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) EIS NU MS ❑U ❑S nu ❑S ZU ❑S EU m0ct 44 d If Percolation Tests are NOT required DESIGN RATE: If an ✓ any portion of the tested area the under s.H63.09(5)(b),indicate: � ,, `[ Floodplain, indicate Floodplain elevation: .4/ PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST.HIGHEST 'TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / B- 3.r1 /s . J . g- - i 1-7A s;G^ i- 3'-/.r' , B- /2-I BA sL 3- 4/ S�, w/N.IcN7 bT B-02 Kr X 35 . .7 ' a—. c IiRi, si4, . d=/. 3S''L. ON. s;L. `.35-L- I B- :/ R e., : L. a. /'d a., s c eg,�,,.,1 K�� .T, B- 3' s ®' qc:o '7 . 0 ' .o -,'.'D h/ sib- i•a'-/.g'[. Q.,.L /.(r=Y.O'Sit B- dc/Anti pT 14 4 1 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- / /- S' /!/e la A fa- a. S P-a /- s A/o /O f 1 1 re, 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 9K.. ' 3 __.. �_. - ` P �_ �_._.�.-1- E € i 3 1 : S4 �_._ ( fi S 7 I } 1 I € I _ i 1 .-,...._._ °_a._. .t— __--.�............ ._ j i '" l i .... , ! { 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. 0i7' Pc67 i-I 1-9. 2/-k c %, r z c. NAME(print): TESTS WERE COMPLETED ON: • ST, /240w L l7ra�y ftih-r � .-lS= 247' ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): lvoo��eGLr t ' ,' � ' p / e-, O6 67i -024163 CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — A 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 to scale is preferred. 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 appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, 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 your 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 • Soil Separates and Textures Other Symbols st — Stone (over 10") BR -- Bedrock cob --- Cobble (3- 10") SS — Sandstone gr --- Gravel (under 3") LS -- Limestone s Sand HGW — High Groundwater cs -- Coarse Sand Perc — Percolation Rate reed s — Medium Sand W -- Well fs Fine Sand Bldg -- Building Is -- Loamy Sand > --- Greater Than sl -- Sandy Loam K -- Less Than — Loam En --- Brown 'sit — Silt Loam RI Black si — Silt Gy -- Gray 'cl Clay Loam Y Yellow scl -- Sandy Clay Loam R Red sicl — Silty Clay Loam mot -- Mottles sc --- Sandy Clay wJ --- with sic — Silty Clay fff --- few,fine,faint c ---- Clay cc --- common, coarse pt -- Peat trim -- Many, medium m -- Muck d distinct p -- prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark 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 ntriair, a perm t, The sanitary permit must be obtained and posted prior to the start of any construction. cr I l l �a z /•o I v \/' T Imo' b o 1 :cr cp... G • t% J I e r^ �\13' . T o°p kAl ti I 0 . � i 0 .� �� ull � � 1 l \ I S 1, 0 s Q t. e �� N o o Q A 17 , 1 S T. C R O I X COUNTY s , r� � � WISCONSIN\ , r Ys�;3 .`21.iT.., A : -.,. ..... ,I,'*p 44' Y� ZONING OFFICE 4E' 7 '' ' -►"fr 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 3, 1984 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Arthur Kost property located in the SWk of the SEA of Section 33, T29N-R16W, Town of Baldwin, St. Croix County, revealed suitable soils at a depth of 2.9 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, .iiiiiiallir r Thomas C. Nelson Assistant Zoning Administrator TCN:mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of st. Croix Location Sw 1/4, SE 1/4, Sec. 33 , T 29 N, R 16 IX444 W Town _ _ Baldwin Street Address Lot No. , Block , Subdivision Landowner's Name: Arthur Kost The application for this site is for: new construction use. a_ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: i to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers ssuedtto you.) [ lone of the applications needing a quota number. The quota number assigned to this application is - - C_ilfor one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [_ ifor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. [_._ifor an application on file prior to February 1, 1980. [__]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: X a failing conventional soil absorption system. Da holding tank that was installed and in use prior to February 1, 1980. a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signat (County Official) Title Assistant Zoning Administrator Date July 3, 1984 DILHR-SBD-6158 (R 12/82) A ST. CROI X COUNTY s ,r, ;;+ , WISCONSIN ,Astir ' r"' "'�'' ZONING OFFICE Y ti , • � • _ cal ._' I(* r� 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 1984 July 3, Division of Safety and Building g Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Arthur Kost property located in the SW14 of the SE's of Section 33, T29N-R16W, Town of Baldwin, St. Croix County, revealed suitable soils at a depth of 2.9 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator TCN:mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location sw 1/4, SE 1/4, Sec. 33 , T 29 N, R 16 XX010, W Town go(14419PP4544qx Baldwin Street Address Lot No. , Block , Subdivision Landowner's Name: Arthur Kost The application for this site is for: new construction use. x replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: I lto have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numbers ssued to you.) lone of the applications needing a quota number. The quota number assigned to this application is - - L__lfor one additional homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [ lfor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. I_ _lfor an application on file prior to February 1, 1980. L.._.lfor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: Ma failing conventional soil absorption system. L] a holding tank that was installed and in use prior to February 1, 1980. Fla privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE andsthe lot meets the criteria for a conventional private sewage system, check here. rl I certify that the above information is true and accurate to the best of my knowledge. -- Name Thomas C. Nelson Signat • rr r (County Official) Title Assistant Zoning Administrator Date July 3, 1984 DILH R- SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/ ib M SW 11 SE 1/41s33 IT 29 N/R 16 X414414 Baldwin St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Mr. Arthur Kost P.O. Box 55, Stillwater, MN 55082 • I (We) , the undersigned , hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to . arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application' subject to this understanding and subject to all the conditions and obligations set out in this application. 'r. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn-to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DTLHR-SBD-6413 (N. 05/R1) My Commission Expires: