Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
002-1019-50-000
7 0 & 0 2 � \ � � ; § � K � ƒ � t ' � ) ] 2 _2 co 2 k a 3 A ID ; n c % E CD § $ a ca q § B \ \ « n 1 $ � f 7 § E � ] � � � o � � 6 � L � j P Q ) kk } � ( , k � a 7 C14 CX) 6 ' CD 2 Cl) 7 $ � § g k \ \ Q . $ 0 0 0 k ° a a a # IL M j j m§ § to r.- § j 2 _ 0 ) § 3 « ) £ k § k \ ƒ ƒ § ■ g § § ° _ \ = a / f 5 E g E Q § § § \ 8 c c J o o 2 w 0 S a § e k \ j $ k n k z z 2 \ § , a\ \ z § c \/ /\ ) W o c 2 £ E M IL — \ © EL . g CL 2 (Daf & \ a 0 k 0 � . Parcel #: 002-1019-50-000 01/31/2006 02:46 PM PAGE 1 OF 1 Alt. Parcel#: 09.29.16.131 B 002-TOWN OF BALDWIN Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner LEROY R&KAREN I ESANBOCK O-ESANBOCK, LEROY R&KAREN I 2338 CTY RD E BALDWIN WI 54002 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description 2338 CTY RD E SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC i I Legal Description: Acres: 9.540 Plat: N/A-NOT AVAILABLE SEC 9 T29N R16W IN SE SW LOT 1 CSM VOL Block/Condo Bldg: 3/841 ORD(EZ-U-1117/150) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-29N-16W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 944/395 07/23/1997 770/603 07/23/1997 717/244 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 86718 Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 7.040 800 0 800 NO UNDEVELOPED G5 0.500 100 0 100 NO OTHER G7 2.000 4,000 128,500 132,500 NO Totals for 2005: General Property 9.540 4,900 128,500 133,400 Woodland 0.000 0 0 Totals for 2004: General Property 9.540 4,900 128,500 133,400 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 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ZCr'0 /�(JG TOWNSHIP SEC. T N-R �� W ADDRESSf, ST. CROIX COUNTY, WISCONSIN 20 l��{>,'r� 1��,'> --z SUBDIVISION /v� LOT /�/' LOT SIZE A/9 PLAN VIEW Wei) Distances and dimensions to meet requirements of H 63 i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 120 FX�t1n4 .r iv 2 g0 d got O O� /HO 6004 pJ 5 Pump 4'1-K o� -�'ysf�r� • 1�/0 No. INDICATE NORTH ARROW cty BENCHMARK: Describe the vertical reference point used- Elevation of vertical reference point: /DD / Proposed slope at�site: SEPTIC TANK: Manufacturer: Liquid Capacity: /lX>G7 Number of rings s used. ONG` Tank manhole cover elevation: Tank Inlet Elevation Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,o Rear n `,�-_ l 00 feet From nearest property line Front,0 Side,nRear, O L' feet Number of feet from-: well building: (Include this information of the above plot. plan) ( 2 reference dimensions to septic tank) SEE REVERSE STnr PUMP CHAMBER Manufacturer: Liquid Capacity: gO0 " Pump Model: � �� Purpp/Siphon Manufacturer: Cdu/W Pump Size, .5 N� Elevation of inlet: ��j'� /� Bottom of tank elevation: 90• /.� Pump off switch elevation: 9/ %� / Gallons per cycle: �3 Alarm Manufacturer: sc� /G �/ Alarm Switch Type: Ale,rGZ.l'r V Number of feet from nearest property line: Front, O Side, O Rear,. Number of feet from well: Z Number of feet from building: O (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: yf S Trench: / C Width: � � Length: ^ Number of Lines: !::;, Area Built: _7� Fill depth to top of pipe: �8 Number of feet from nearest property line: Front,/ Side, O Rear,Ft . 70 Number of feet from well: 230 Number of feet from building: ' F0 / (Include distances on plot plan). SEEPAGE PIT , i Size: Number of pii / ameter: _ r Liquid depth: Bott J of se page p t levation: Area Built: Has either a drop box O or dist uti�n b een u ed on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: E1 ation of bo m of tank: Elevation of inlet: f Number of feet from nearest pro"/ ro /rr y lin: hron , Side, O Rear, Ft. � / O O Number of fe t f om ell: Number .of feet rom uil ing: Number of feet fro nearest road: Alarm Manufacturer: Inspector: / Dated• 51 - Z7 Plumber on job: License Number: 3/84:mj 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 SE14, SW1,4, S9,T29N—R16W 1:1 CONVENTIONAL KNALTERNATIVE Sltate Pla I.D.Number Town of Baldwin ❑Holding Tank ❑ In-Ground Pressure JiMound 87Q4091 CTY Trunk E NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HO D R: INSPEC 1 N DATE: LeRoy Esanbock Route 1, Baldwin, WI 54002 3.30— 0' BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County- Sanitary Permit Number: Dale E. Hudson 6629 St. Croix 99053 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER [.� P OV DIED: PROVIDED: 9 7-7 �J 7 ! J PWYES ❑NO YES ❑NO BEDDING: VENT DIA.: VENT MATL. I H W�TEg. NUMBER�IF ROAD: PROPERTY r;� BUILDING: VENT TO FRESH ALARM. LINE AIR INLET. FEET EST / / 7a o _ ❑YES NO 1:1 YES NO NE'4REST la DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY. PUM MODEL. PUMP/SIPHON MANUF ACmIRER WARNING LABEL LOCKING COVER n C P OVI ED: PROV ED: YES ❑NO r_L✓/�J( ES ONO WYES ONO GALLONS PER CY PUMP AND CONTROL OPERATIONAL. NUMBER OF PROPERTY - 1111-1-if. BUILDING: V (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) /j YES 1:1 NO NEAREST ��� SOIL ABSORPTION SYSTEM.Check the soil moisture at to depth of plowing LENGTH DIaMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE / ? / the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: fTRF..NCI'I WIDTH: LENGTH. TRENCHES. DISTR.PIPE SPACING. MATERIAL: PIT JINIIDE DIA.: #PITS. ILIDEOU T D Df AAEN�u1ONS GRAVEL DEPTH FILL DEPTH DISTR.PIPF 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: NEAREST 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. YES ❑NO SOIL COVER ITEXTURE ANENT MARKERS: OBSERVATION WELLS "_ - F'"L!(YES ONO YES NO DEPTH OVER TRENCH/BED JIDIPTH OVER TRENCH/BED 11111TH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER. EDGES. / IX YES�- A � c � ❑YES N40 YES ❑NO YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BEPITR Cm . 0 TRENCHES: i 01MErNStOW o 3 ' MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL � . NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV: DIA ELEV.: PIPES DIA.: lake R# T ILlhS trf HOLE SIZ HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED ,dry MAT / ES PLANS: ,,ma�yy ( O YES E1 NO I YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: IN UMBER.OF LINE: R WELL: BUILDING: XYES ❑NO EXES 1:1 NO NE ,F S < 0 L3 0 1 9z' Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. Zoning Administrator DILHR SBD 6710 (R.01/82) I {� SANITARY PERMIT APPLICATION COUNTY U 5�LN� In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT# 3 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. P 7v vv —See reverse side for instructions for completing this application. PETITION �y 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES l.�NO PROPERTY OWNER _ // PROPERTY LOCATION Ze Y-0 G�S�i/�OpC '/aS� '/a, S T29, N, R /� (or W PROPERTY OWNER' MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,ISS`'T1ATE!/ ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAK OR LANDMARK Q/J1Lt�✓/I LC/ S /-j' �o��" VILLAGE:3Q/olu,/�) Cf TOWN II. TYPE OF BUILDING OR USE SERVED: oZ— `�/g— Number of Bedrooms if 1 or 2 Family —� OR ❑ Public(Specify): X III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.,0 Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ❑Conventional b.JX Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.,X Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): /719r 37� -3�Co 97'21 Feet RPrivate ❑Joint ❑ Public CAPACITY VI. TANK Site in allons Total #of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank /000 /,00,0 / Lift Pump Tank/Siphon Chamber DO '— Poo !/ 1 ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Oat� 9 71S ell 00 —X37 Plumber's Address(Street,City,State,Zip Code): Name of Designer: .?V0 a 5 > Zld /, VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# - ? e , CST's ADDRESS(Street,City,State,Zip Code) Phone Number: i?Y: 36Jl AX - i'. _5:�'0 Z_ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial cRR Fee r' /'7-97 Adverse Determination Vl� o I(^�C�JI o� X. CO MENTS/REASONS FOR DISAPPROVAL: `a, ` d sta'L. SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained.The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 210 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-381.5. To be complete and accurate this sanitary permit application must include: ! Property owner`s name and mailing address. Provide the legal description where the system is to be installed; li. Type of building or use served: If public is checked, ndicate type of use (i.e. 10 un t apartment,30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; II!. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. ------------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the ..............:......: result of over 2 years of steady negotiation and public debate The groundwater bill uro nd ateC — included the creation of surcharges (tees) for a number cf regulated practices which wlsco Er1`S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure is used in your building Is 6eturned to the groundwate= through your soil absorption p I� system or- the disposal site used by your holding tank pumper. a The monies collected through these surcharges are cred ted to the groundwater fund adminis- ° 9 ., 9 tere by the iepartment of Natural Rasources These funds are used for monitoring ground- t water grour dwaier contamination investigations and est,i51ishf n€ant of standards. Uroundvvat�r, i-'s worfll. pr0ecting. Il Q Page / Of c� � L, 7040 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H _ G Topsoil -- -- F —_1 E �I p 3 % Slope p�• , �, fi;-, �. M� °'� Beni Of 2M— 2 z Force Main Plowed •^✓ t� �Z �, t * ' ,. ` 99regate From Pump Layer D .2.0 Ft. r ss Section Of A Mound z ou d System Using Ft. A Bed For The Absorption Area F �� Ft. G /,0 Ft. A Ft. H Ft. Si az- B `1Z Ft. License Number: K /.?,,3 Ft. Date: —3 7 L 73,E Ft. J /O Ft. Alternate Position x IzI Ft. of Force Main —�� W 3 Z Ft. L Observation Pipe Ai----------------------- ----------------------�� W •-----T--------------- -----------------------I Force Main o Distribution 7:Bed Of % — 2 2 2 Pipe I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area 2 r �s oc page Of.= Al Perforated Pipe Detail ; / lew a Perforated / `.,", •" ti End Cop PVC Pipe ' Ail Holes located On Bottom, S Are.Equolly Spaced, Q S 8;0,a PVC Force Main f * From Pump / PVC / Manifold Pipe Qistribution '� Alternate Position Of ......-.--.� Ripe `� �. Force Main From Pump `i' lQ6t ►sole Should Be" J� Npxt To End, Cop nd Co p Distribution Pipe Layout P Z3 ' R s'.33 S 3 3o.. Signed: ca,�. Hole Diameter �l� Inch Lateral Inch(es) License Number: M to Manifold ,2 Inches Date: Force Main 3 Inches N7t'R A L ';Lego,/ n/��nG PAGE 3 OF -3 PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS —VENT CAP 8� . 4"C.I. VENT PIPE APPROVED LOCKIONG O WEATHER PROOF 9 JUNCTION BOX MANHOLE COVER s-T 25' FROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE. I I GRADE I F 4"MIN.---41 18"MIU. -x CONDUIT INLET t, PROVIDE I —--- i' t+'�ARTIIkHT SEAL AG.l,J' II APPROVED JOINT A a APPROVED J01A1 W/C.I. PIPE III W/C.=. PIPE 1=XTI-NDING 3' ARM EXTENDIUG 3' AL ONTO SOLID SOIL B xs,� `�� ,A I ONTO SOLID S01; fh ON W PUMP---_ — OFF D CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS �' DGZAIN'3{�G SEPTIC AND DOSE TANKS MANUFACTURER: L���� �' ' �JUMBER OF DOSES: —PER DA-9 TAMK :,IZE : ��� GALLONS DOSE VOLUME:- 11FIlY I GALLOKIS Z ALARM MANUFACTURED: . f��(7�'%?1 '/��7� CAPACITIES: A9�NU-I ES OR GALLOUS MODEL NUMBER: _ 20��—� B= —2 INCHES OR GALLOUS SWITCH TYPE: i"GLl,—V �` JC I �y. � C= INCH 5 0 GALLON PUMP MANUFACTURER: ��U D=�IUCHES OR,��� ' �I � ) GALLOS MODEL NUMBER: NOTE: PUMP AND ALARM ARE TO BE SWITCH TJPE: INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE 70'L GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE , . . • • , . 2.5 FEET +*�� FEET OF FORCE MAIN X �'OP F j FRICTIOFI FACTOR.. � FEET 100 FL TOTAL DJNAMIC, HEAD FEET INTERNAL DIMEMSIONS OF TANK: LENGTH 2 / ;WIDTH _ 7"' LIQUID DEPTH / /l SIGNED:- X<"2z /7'Z - Vl/- LICENSE MUMBER:_� Z DATE.• e/,- J Performanc e Submersible Effluent Curves METERS FEET 90 MODEL ,885 25 80 SIZE 3/4' �I 0 WE15H log 9 Z 20 - -WE10H a WE07H 15 50 40 WE05H 10 30 WE03M 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L 1 1 0 10 20 30 m'/h CAPACITY �GOULDS PUMPS. INC. SeCECA FALLS NEW YC>a1C 13148 METERS FEET 120 11 MODEL 3885 35 110 WE75HH SIZE 3/4° Solids 30 100 90 25 80 70 X 20 Q 0 15 50 WE05HH 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 1 0 10 20 30 m'/h 01985 Goulds Pumps,Inc. CAPACITY Effective July,1985 i I APPLICATION FOR SANITARY PERMIT STC - 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 L y r7 Location of Property SE 1z SLt] , Section `� , T N - R W Township Rile "7 Nailing Address . Subdivision Name _ Lot Number Previous Owner of Property ���✓9 Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No _Is this property being„doves oped.,for zeea7. .__spec house) 7 . . Yes A . No Volume _ 7d2 and Page Number GAO as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING; 1. Warranty Deed 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 Nap, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) eent16y that att a.tatementA on tJU.6 6onm cute tAue to .the but o6 my (owe) knowledge; that I (we) am (ane) the owneh(6) 06 the pnopeA ty des c t bed in .th i a .i.n6onmatton 60nm, by vchtue 06 a wakanty deed neconded in the 066ice 06 the ..County Reg.iAterc o6 Deeds as Document No. yzso Z ; and that I (we) phesV!t y 0(lin the rhnrosed 4ite 6ax the zeivage 6poLaZ sy4teii, (Oie I (wei have obtained an easement, to nun with the above deb.�u..b_ed pnop�-ty, 6on the conStkucti,on o6 6aid system, and the flame nab been duty neconded in the 066iee 06 the County Reg.caten 06 Deeda, 0 Document No. ) , 1 47 9k) SIGNATU OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r , State Of Wisconsin ` Department of Industry, Labor and Human Relations � _±USt , SAFETY&BUILDINGS DIVISION ,,f C:fvi si can Codes r'CI C.; st i,asi i jwtu ) Avenile I r'7707 Leroy, EsaW,-t:sc: Route 'I Dr-:ar s,r. Esa n'Dock: ke: Lerc y F.. /Esdrrt:,ccL Fes,derice SE S . l ,. Trwr. of i ia'i u ,ti r Sec ti or 1 14E.21- (l iscfnsiI, StatE;f.::s WC s. I L i I +IWAsconsin ,,(1mi ni s€:rati ve C.wi :, 6 i l oo the owner to the C.4';?i C'iC'f:'ftt for a variance to ti:c i ns tal l a ti ofl for d private itte sewakite sy sttr!? tc, repl;i,..e cars exi st:i nci private 5E8�i3 r: sys1:t Cry It e site Adci'r is nQt ill full ccf;q l i lance i'"e i '; tine siting s.tiin;."Ards ii the a('TA, i strati ve ruil e. 'noe sy teu, d si-i: -ropose s€tot+1 c, r,wotect thc- ,•!caters c;i.' ti c: sta tc. tror, cwitar,,i tiat,i c,rt. If fl,i s: s.yrstert beccff7es a failiry.;, syst,�,r- of, contarlindt(-.s tijr %Biter.5 of the stat£,, tPlis v'i:iriance shall lS+? re�sci ndec- Thc, i;Aitic i for 2 ':rarlt;ilCN rt,qu'stct`. to s. IUM c .i::,. ( 1 } W) of the WiS. cciisitae e- 017 #'k gVSf, 1 , 1SCt-/. Ti itit-1 Pigs been cur€ditioise,i ],�,' approved. i ;e c,oildtiori Leiw' tWit, in t0i L-vent of failure, the 3:iolln"I 5vstul scl oI I l''t rep'! scEi witi• a i oi( ini t,injl- or otll.er .fitf-1 of s4rstert. Tbe: r'ulle rt;-cuirc'S Ljjdt � ffwtt+' systepi :Clvc. a iK'+'i3"'#(!Csl; { i lrcct3es of stitaHe ,*i-A ;ra l soil . Ti':t: valiance reqtiestedl v:as tc, iiisti�ll r'E`i l,.it F3'e.'( nt C cri r°c' itCaC't 0?1 rr• Sit(! vii-tt, .lj 3 i nchos of s 0 tab i e natural sofi . "',i l cF t i;L' ciaL :irlc= `atc3tCCl^Ebl i a fill C:i t.tl?''i i t';ri r of tic ric:'tl i:i(:C)f'r k'E.'re consi cierc,6. This vdr"i arlce is Specific to t..(',C sly li(Ct i'rwl Cannot i e ised for ianlw �d(AtioIlA modifications. >i ncerel PfCEIVEQ G� AUG 12 J 1 it � . Peterson, k,;AC,' 7 ZONING i r:p.f' {1 e �. ecLion of I:•riv°atc d.,e OfFXj cc: Lr=:r td'a' r'i W2tc: L.orivsultent ,w a r _,�9err as �'el sor , �or)i rye; Ac li rli stri?tor - :at. iroi x Cc,i Dial' E. Fkjosr-,n, t''i t,;A-c-'r' / C LHRSBO-6423(N.04/81) f';._ t t° "' y' Stag Of Wisconsin ` Department of Industry, Labor and Human Relations 6 PRTVA T f:. Sf.WA(-)t' P1..Ali APPROVAL SAFETY&BUILDINGS DIVISION J{ 1 ili:) ,., i;�:i ?;cit Clfl t'It;nt'iitr• I °g'. s t+, f'il;y.,{;�3ift: � 1 y,,:,; t •'�+. 3 s`;41_i�;l�;l< ls: ' . ,. .. . , ?i ,'t „1;�tritc' i ;(lf,l; .r<. i3 i {.111;.1 iTt°fF - ).i.L, it{, !,r.:l iti. ii :t1,C'f -j.)4'-'. , I..i .,:I i;'vt!,+ v ,.l... i.1'ii � 1: P. ilit?'. �iC•. rl k?C1 it } { ) 1.:7f tlrilr; :�1:,,4: ti�'P itt '.f 'I"fir 1i,vl ii ,,ti111 Ii.IH,li� l 'ilr �•+(: it1Fa ^l d:+ (�'ir' (71 ,1i1`� .:d6"(! !';f'; '� !,'( �L;' t ;l It ;�,r,)` ;�c,'�:i ir,� �;,i•'L, t';,f,al i ;fV� !;� .ii� r.i1lCtil r +IC)(�?I �t 1i' rlfi 1 t it,;t !r:i c,:1` }1:Ifw r:t'} i'iu., I'1.-arts i. i't l l IrY = v t.r?'?( '.� I'ii:a { 1 f,., C',1aI ri;>f:1 , i { ;.}I "i'i.l t'„+ ! to'I * i?j ifi ,.I,t,; 11'-6 11 '(Ii ,.�'1r ItA.1 ,�%{'tl rie�.:(.{ ,},._ I ,.. t41'I f�y.f r .1 7 1" C.} 'I t f l ? PL:.. i ..f y:' !vii I:.. . rl!"i 1 1,,.,"'�.I pG+t,..iti f t' r.;;:p 1.: -(,.� {'tc_ 1 _`:,1 JEs['.i LIr :;ti' {,i, iii c. t.. (:11•._11Lid 1 t lurt(1(' a tit /°oN oip'l i -i�ic-1t1 - it t},-iu=r,t ' }) . 1;1,Ltai'ict ! ttt r,t1,1:,;;+h" pd'�v- 1+3a t�t 4"1': t, i1�,i 11t,i,�, :.1 1 11:'%iJ+ -C;t.I'• 1I' •Pi.('} t , ! I 1''rr' I'..j U-'. 1�'t ?;:.,..J,t1'j fY�i7,:, t!t `7°,{ 10! i fii<-a 1'i t t6� r7}a,�t� i`v�( t ,-�v l � ;,iL:1 ! } {-,. ;)i �� i:it)ij1 •"1, `.uf'�++��: i ::ti,:I I'f1.?I l�tivl`':1'? +"p.ir A�i!`,I'l l t ':r't` V _•tt'!fp'? l,;ij'(k` �l�t ii,ilil� Lllij l,,)i}..:i{ `. 'til DILHR-SBD-6423 (N.04/81) 1 .sy aw by driMrApsoodw bated t�t1 r i �i� �ii��111►'!t. a ON*Ro gemnam IV WPWIR 4811006 Aft N 'M do@ Aft ban +r r e1fM hamM it be do aw pqft iii, 1� . itae[ftaammeatdbO n & � p, araadwo 66 em aaaaddi began* ilIndnew itsad boom"wgaaaabaaad ism aiib Poison W PWPM , do beeft dis Guam W do unit War wbid mv bwe been�� d at - IF IAA,r and maids a me dWmW is do �a � .;� r Roreaaoana sniff. �� Ewa r admiss fiaf>ar miss lwwad r iMyaliaa d afi aid w4won.iadadiS,naaadii `. a w aaiws MW mm*bwsoWar is dw NAM as paoI N fay.and eapaaan of 1Yr a idsn iaa lMI }rfd by lradaaar.as lnanaaed.ad daft he incMW is sW ,'SW*r apbea to renew this land contract at the end of five years at an � •. Le exceed the conventional loan rate i effect at that time i by the WFMV SRI, the purchaser has said all the taxes, rinciple and interest called !br' �. U"'COntraCt in a timely manner. There wil not be a prepayment penalty. anus to maintain complete and acc to financial books and records It Dr"UR RMWd financial information !balance sheet, operating statement or '£ 00 0 h form prescribed by, or acceptable to seller. cNl! ' ' `", 6omUealcelent or during the pendency of any action of foreclosure of ` =�t�to Pam chaser consents to the appointment of a receiver of tM ftlldiif� ho�estead interest, to collect the rents, issues, and profits of p M ► dW iq� the pendency of such action, and such rents, issues, and pe�od'!te iW h lft*ted shall be held and applied as the court aha11 direct. a } 4s AV iadW"fne"hanift w/um 160madMaa b be of#A Pm"hmee apaoest"Mukaa In be aafaflag oa�saadgea 1016air aimins i.Y ins ad aft a. The! omen ad Wo"aaai bads en"we arias IN MW macOn and ainplar.U,iowerer, R fta►aaanaiaa ha mo n Oft ar l�adaaar.ar GMw P"be d to ft&jm an or a aaoaar dos eaa awns join V aaYas is*ad.INK%iae w Wismar. 1-19 old d).Do="@@aaa basin a1a8 bird ebe ��am*aai afnii M nai as i! teaRaoafMn taalir •� .aaooaaeam and anus of is i 'r T.« r: E j t � M' • . a .. OL lift mawaft Ol. Poo Ift ohm ; 'J r, y d' «,...... ,�,., eon { now -e Mobd t a' H a STC 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT CD St . Croix County d ,✓ a OWNER/BUYER �G'�o�f �Iln -AoC7! ROUTE/BOX NUMBER �f, Fire Number .CITY/STATE �a�P�'rcJ�i'I, Lf/�. ZIP "�f�Q2 PROPERTY LOCATION : , �, Section , T ,Z N , R W, / I Town of /��7�LNu,�I�? 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 ve.ri- 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 . H 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein , as set by the Wisconsin Depart- u ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SICNE DATE S 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 . D DUS TiJITRY ENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS • INDUS , DIVISION LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.090)& Chapter 145.045) LOCATIONS SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: SE /a' /a /TVN/R/�1(or w. /4 COUNTY: OWNER'S/BUYER'S NAMEE: MAILING ADDRESS: USE DATES OBSERVATIONS MADE Residence NO.BED MCOMMERCIAL D SCRIPTION: ❑New eplace PROFILE DESCRIPTIONS: PERCOLATION TESTS: .3 I /_/_ P J _ _ RATING:S=Site suitable for system U=Site unsuitable for system !O Co CONVENTIONAL: MOUND: IN-GROUND-PR SYSTEM-IN-FILL HOLDIcNG TANK:RECOMMENDED SYSTE :( do ) S �U �v �U J U EIS EIS ®U If Percolation Tests are NOT required IDESIGN RATE: I If any portion of the tested area is in the under s.H63.09(51(b),indicate: PROFILE DESCRIPTIONS Floodplain,indicate Floodplain elevation: ��`/// BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IM, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- f 5.5- tl71V ,I• 11 10 d B-3 B- B- B- PERCOLATION TESTS TEST DEPTH•, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER -6W"IEB AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- -2 30 2ZI P- J 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 9V, 2 . I ( i r i tN i { i { { I i i i f 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(print): TESTS WERE COMPLETED ON: _Dlo e 6�-- 2- 7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): s era _3 3 7� CST SIGNATURE: e—. TY DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate sou t�st, , ;ui i nit, t include: 1. Complete legal description; 2. The use section must clearly indicate, whether thi 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 boxy;... A SI 11- IS SU°TABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED 01-11 BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations show:i hkfi(� to; vvritiimi orufile descriptions and completingthe plot plan;< 7: MAKE A LEGIBLE diagram accurately locating yrAur tryst locations. Drawing to scale is preferred. A separate sheat maybe used if desired; 8. Make sure your benchmark and vertical r levatiwn point are clearly shown,and are permanent; 9.,,,-Cnmplete all appropriate boxes as to dates, nanw.s, addresses, flood plain data, percolation test exemp- _ t'jon",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 anti your certification number; _ 12._Make- legible copies and distritrutt: :-;s .,ui+ec. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 Dr`'a t �4" C }R1r'i-r Tit3iv. AB13REVIAT10%!~, F ',' r �T 1 i1FD SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") B R Bedrock cob Cobble (3- 10") 7S Sandstone gr — Gravel (under 3"j LS - Limestone *s - Sand f GVV -- High Grourrdvvater cs Coarse Sand Pei Percolation Rate med s, — Medium Sand v`d — Well fs - Fine Sand B!,k) - Building Is — Loamy Sand -- Greater Than *s1 — Sandy Loam Less Than }. _. *I — Loam R,n Brown *sil — Silt Loam 131 Black si - Silt Gy - Gray *cl — Clay Loam Y Yellow scl — Sandy Clay Loarn R - Red sicl — Silty Clay Loam mot — Mottles sc - Sandy Clay with sic — Silty Clay fft fevv, fine,faint *c Clay ck{ common, coarse pt - Peat ?nn; - Many, medium m Muck - distinct — prominent flit-]h water Icvel, Six general soil texture surface water for liquid waste dig>r,crsal "A Clench Mark Vertical Reference Point TO THE OWNER: This soil test report is the first step ill W:, MM, v r.-. 7rit. i he county or the Department may request verification of this soil test in the heid c: ;+� ;r i= �:�e. A complete set of plans for the private sewage system and a permit applicahm) nit �� irr, s. a _ ;�3 'the appropriate local authority in order to obtain a,permit. The sanitary perrnit muse ';le �.,arl prior to the start of any construction. Owner; iz 0, .Leroy E.sanboc7� Rt, � • � 13Q1a✓u�i n� r,J,: E�;Sf,rr syd'o Z /ooa o� '"f 5 800 cc. 73 Sec. q PumPTan< 30 , 30" pai �G B2 rj IS-0 C--v TK E 3z PrOp, /Y)ou Y)o� Y3 SE /� Sul j 3/- 97,5 f f,J t 1, \1 I`• az- B3 — 96.05 No. a o - !7. enofes A-le s Paz Foam S o RECEIVED P#o - ��nofes r��c 1-fo/es �oQOI JUG 2 � 197 1�enr- Ma,--r !s �oP of eerr/e SAFETY & BUILDINGS RECEIVED — or, ' _ ``/Q .t dl yt 1 yi. ,-awn By; ��.I j U T.1,UMBING BUREA U ��- �• �� /wp��z9 Csr 3-y13 CIO,y E- 4whery -_/zo. { .Leroy E.san6oc7� � Rt. J 5'yO0 Z I /OOU �a 0. p > AusL { a B.M. r�- I'� i t goo 73 '! .Sec. Q Pump-ton 41 3O i 30 B2 o P/ ------- G =45- SI C�� TK E 3z ,f3' S� o 83 5,• pLl�1P+u� 0 7:�r B.M. - /oo•o £/e v � � x . • ELAlIO;tis 3/- 97,5 az- 97. 1 B3 - 96-05 No. Q 8'M' -Denofe5 Bencti Mari• � 1 it � O -17eno leS �o,-e. /�a�e S �a� � F,�am .$3 to RECEIVED P#o - .DehofeS Pe,c. /e y JUN 2 2 197 SAFETY & BUILDINGS RECEIVED 41,n 117 1--l-UMBING BUREAU g., . /�7P�6z9 CST" 311/3 d ST. CROIX COUNTY WISCONSIN ZONING OFFICE -y 796-2239(HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W154015 June 8, 1987 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the LeRoy Esanbock property located In the SE 1/4 of the SW 1/4 of Section 9, T29N-R16W, Town of Baldwin, revealed suitable soils at a depth of 13 inches, below which seasonable 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, twq Thomas C. Nelson Zoning Administrator rc 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 SE 1/4, SW 1/4, Sec. 9 T 29 N, R 16 MW W Town Ya*X4ff� �� Baldwin Street Address Route 1, Baldwin, WI 54002 Lot No. , Block Subdivision Landowner's Name: LeRoy Esanbock The application for this site is for: ❑ new construction use. FE replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ 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 num ers i s ea to you.) . one of the applications needing a quota number. The quota number assigned to this application is - - ❑for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑for 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. ❑for 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: Fla failing conventional, soil absorption system. ❑a 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.E] I certify that the above information is true and accurate to the,,b t df my knowledge. Name Thomas C. Nelson Signature 1 County Official Title St. Croix County Zoning Administrator Date June 8, 1987 DILHR-SBD-6158 (R 12/82) y Page Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H __ G Topsoil - — _ —� D -------ii E b % Slope Bed Of 12,"- 2 2 Force Main Plowed Aggregate From Pump Layer D ,2.0 Ft. Cross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F , '/7 5 Ft. G /.p Ft. Signed: A Ft. H Ft. B Y_ Ft. License Number: K 13,3 Ft. Date: E 17-?,-,5-' Ft. J /0 Ft. Alternate Position of x IzI Ft. Force Main W 3 Z Ft. L J Observation Pipe-� B K A •---------------------- - --------------------•� ��----- --------------------------------------•� Force Main W o Distribution Bed Of % — 2 Pipe 2 2 I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption p n Area M �so�hoc Page 2 Of ,* r ` 4y r Perforated Pipe Detail End View f )Perforated / End Cap PVC Pipe # l \ �4 Holes Located.On Bottom, S Aie.E4uolly Spaced. e S PVC Force Main * From Pump PVC w�,� Manifold Pipe Distribution, Alternate Position Of Pipe �.'. Force Main From Pump l axt Hole Should.@'e N�pxt .T6 End Cop End Cap Distribution Pipe Layout P- Z3 R s'•33 S 32'' X 30'' Y Si gredd �, L.. Hole Diameter Inch Lateral / Inch(es) , License Number: M Fa <5�� 9_ f Manifold 2 Inches Date: -3 - ''7 Force Main 3` Inches • ;�e�oy' �lJ/�/JOG PAGE OF PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS —VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUUCTION BOX MAIJHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE. I GRADE I 4"MIN. 18"MIU. CONDUIT -- _------___ ---------- INLET PROVIDE I –--- -T AIRTIGHT SEAL I I APPROVED JOINT A I III APPROVED JoM i W/C.Z. PIPE I III W/C.=. PIPE EXTENDIMC, 3' _ I II ALARM EXTEUDIAJG 3' O►JTO SOLID SCAL B I I I OIJTO SOLID SOI� I I I I ON C PUMP----_ --� �.. OFF D CONCRETE BLOCK RISER EXIT PERMITFED GNL9 IF TAUK MAIJUFACTURER HAS SUCH APPROVAL SPECIFICATIOMS SEPTIC AND DOSE TANKS MAMUFACTURER: �E� �'1 J LWMBER OF DOSES: —PER DAU TAWK :,IZE : ADD GALLDJJS DOSE VOLUME: ���'�'f GALLOAIS ALARM MAAIUFACTURER: . /0 12a 1-2 CAPACITIES' A= 'D�INCNES ORS 2'27GALLOUS MODEL IJUMBER: _ ma�yy-772000-1 B= Z ,✓ IMCHES OR 3 '0 GALLO�J5 SWITCH TYPE: 1.266 GC�r� V C= �' a IRICHES OR&EW GALLCtJS PUMP MANLIFACTURER: //�))�U�G� _ D= ZZ 10CHES ORZ2 ' GALLOIJ5 MODEL NUMBER: Cz/G-��22G- NOTE. PUMP AND ALARM ARE TO BE SWITCH TYPE: INSTALLED OW SEPARATE CIRCUITS ,PUMP DISCHARGE RATE GPM VERTICAL DIFFERENCE BETWEEAI PUMP OFF AIJD DISTRIBUTIOU PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . , 2.�5�- FEET -F GD FEET OF FORCE MAIN X D�s� Fo Fr.FRICTIOJJ FACTOR.. FEET TOTAL OJIJAMIC HEAD = Z��� FEET IAITERNAL DIMEIJSIONS OF TANK: LENC,7H � ;WIDTH. r LIQUID DEPTH 7` SIGIJED: LICENSE MUMBER:- <!;gWz2 DATE:-!!L-F-97 y '6�anzocX'Performance Submersible Effluent Cu rves s METERS FEET 90 MODEL 3885 25 80 SIZE 3/4" Solids 0 WE15H 0 70 2 20 — —WE10H J H 60 WE07H 15 50 40 W E05H 10 30 WE03M 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 0 80 90 100 110 120 GPM L L 0 10 20 30 m'/h CAPACITY RGOULDS PUMPS. INC. i SB`ECA FALLS WW)10W 13148 METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3/4" Solids 30 100 90 25 80 70 X 20 J Ia- 60 0 15 50 WE051 40 10 30 20 5 10 oL 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 0 10 20 30 m°/h 01985 Goulds Pumps,Inc. CAPACITY Effective July,1985 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION:S SECTION: OWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: -516--516- '/a /a /T29N/RA/ (or T fl COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: l e ra ,E q ct GTuJ�� 5W100 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL D SCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ❑New Repl:C1 -2 _ RATING:Sm Site suitable for system Us Site unsuitable for system o CONVENTIONAL:: MOUND: IN-GROUND-PRESSURE:r STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:( tional) If Percolation Tests are NOT required DESIGN RATE: I 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH A. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) a J 7"B- 1141, ter, 10 d Iq , B- x•08 97, 01 "13 �� a�;-/1' 5 s-. • z 7"'eZ/ ,---7/"dle B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 'Arr#EB' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P- I -2 30 78' 8" ' 2- P- Z /-Jr/ P- 2-0 " , 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. cvcTI:M FI FVATION 99, 2 L�DIlOn.l�suaa hue j0 lack ayx of lol.kti 04 aa(>J0 ul A11a0tllne Iea01 a:iel�do.ldde ail; a: 11ui.rad kipliues @Hi 'klul�ac�e ulel o a1eAl.ld a ieulldde T.lwied e pue waISAS afiemas 4z ao� sueld �o .10S alaldwo;) 031wns r ili�.�su cal .ac, )d aLi1 Ln I,91 IOS si isanba,l Aew 1uauJ1JPdaU )q a0 f.lunoo at I. 4� ;0 uOlteOl}l.laA i 1 °Itt.tit�t9 t,rir�,ry I>iitll nar)S ul c�rlls ISAI ayl Si 00daa JsaJ.IIOS slut :83NMO 3HJ.. Ol INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 'To be a complete and accurate sail tesr, Yom report must include: 1. Complete legal description; 2. The use section rnust.clearly indicate whether this is a residence or commercial project; 3._.MAXiMUM number-of bedrooms or use planned; A.,is this a new or replacement system; -5. Complete the suitability rating boxes. A ` I t I.� l w SUITPBLE FOR A"HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations sholra hr) ;or v,-iting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram acccn-at,ly lcacating y(:)ur test locations. Drawing to scale is preferred. A separate sh.ept maybe used if desired; 8. Make sure your benchmark and vertical r levatic e erence point are clearly shown,and are permanent; 9...Complete all appropriate boxes as to dates, narrn�.s,addresses, flood plain data, percolation test exemp- nLjf appropriate; 10. If the information (such as flood plain,elevation) does riot apply, place N.A.in the appropriate box; 11. Sign the.form and place your current address and yorrr certification number; 12.. Make Legible copies and distribut(s as required'. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPi_ETION. — ABBREVIATIONS FPR Cf RTIrIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cot) - Cobble (3- 10") SS - Sandstone gr — Gravel (under 3") LS — Limestone *s — Sand HGW - High Groundwater; cs - Coarse Sand Pf? c, Percolation Rate med s — Medium Sand '04 -- Well fs - Fine Sand Bldg Building - Is — Loamy Sand - Greater Than *sl - Sandy Loam < Less Than *1 — Loarn Bn Brown *sil - Silt Loarn ul -- Black si — Silt Gy Gray *cl — Clay Loam Y -- Yellow scl — Sandy Clay Loarn R Red sicl — Silty Clay Loam root — Mottles sc -- Sandy Clay with sic — Silty Clay i; _ few, fine, faint *c Clay C common, coarse pt — Peat rr T, �- Many, medium m — Muck d -- distinct I> .- prominent iH%,"I High water level, Six general soil textures, surface water for ligrric#waste Ciis(>t7z>al Bench Mark ;E:p - Vortical Reference Point Own e.r; 120. .Leroy �`sanbocl� Rt, . SyOO Z BM, 7S� goo '73 GG .Sec. 9 Pump Tn< 30 82 d ✓ .0` o vi ------- �, 2 Cf-v ?rK E 3z P/'o/?, /Y)ou SE ' Sup/y I `—- 73.5'_ , 7291`l �!!o W O P3_ 83 az- 97, l B3 - 96.05 No, A 8'M. -Denofes Tench Afar 1 ,i 0 -Denofes Bo.-e /tole S �dz � AeOM B3 to pro - .17 nofes pe,C. /lo/e5 ROOa/ �enc� y Marl JS �oY 07` cemei7r l csT' 3Y/3 ctv.