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` Parcel #: 008-1060-10-100 02/01/2006 10:12 AM
PAGE 1 OF 1
Alt. Parcel#: 21.28.16.305A-20 008-TOWN OF EAU GALLE
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
JEFFREY T&LAURA L KENNETT O-KENNETT,JEFFREY T&LAURA L
286 CTY RD BB
BALDWIN WI 54002
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description *286 CTY RD BB
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 45.558 Plat: 4050-CSM 15/4050 008/01
SEC 21 T28N R16W PT E 1/2 NE 1/4 BEING . Block/Condo Bldg: LOT 4
CSM 15/4050 LOT 4 45.558AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-28N-16W NE
Notes: Parcel History:
Date Doc# Vol/Page Type
03/12/2003 712989 2169/477 TI
06/04/2001 647133 1651/354 AFF
05/09/2001 645064 1636/134 WD
04/17/2001 643019 1620/122 WD
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
138685 Use Value Assessment
Valuations: Last Changed: 07/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 24,800 121,300 146,100 NO
AGRICULTURAL G4 42.558 1,400 0 1,400 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2005:
General Property 45.558 26,300 121,300 147,600
Woodland 0.000 0 0
Totals for 2004:
General Property 45.558 26,300 121,300 147,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 567
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 138.00
Special Assessments Special Charges Delinquent Charges
Total 138.00 0.00 0.00
Form - STC - 104
AS 'BUILT SANITARY SYSTEM REPORT
OWNER �do r-a Zo617�c'I/ TOWNSHIP I_Qz� rVle, SEC. .Z T2,(' N-R�W
ADDRESS / ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE /�✓�
PLAN VIEW
Distances and dimensions to meet requirements of II- HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
RECEIVr-
q F E B 2 3 1988
\ l sT CROI
CJe) B'M X
' COUNTY
?ONINGOFFICE
8�' system
A yocASG /ZOOGa � °).
Sept,'cmP.T
O
I
I
No.
i
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ? oue-r a✓C r r;
Elevation of vertical reference point: _.100, 0 Proposed slope at site: •O�/ `��
SEPTIC 'TANK: Manufacturer: _ Zc-2 Liquid Capacit; : 1200 , q1j,
Number of rings used: 3 Tank manhole cover elevw:ion:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side,O Rear, O Jff / feet
From nearest property line Front,oSide,nRc+:ar,O Ie7oo' feet
Number of feet from: well 5 building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank'
SEE REVERS" S10F
PUMP CHAMBER
Manufacturer: lf���° S Liquid Capacity:
Pump Model: � � Pump/Siphon Manufacturer: G au,1�" l Pump Size Y
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, Rear, Ft./���
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: )/�fS Trench:
// t1
Width: �/ Length: 17' ? /. Number of Lines: C� Area Built:-���
Fill depth to top of pipe: �8
Number of feet from nearest property line: Front,,, O Side, O Rear,
Number of feet from well: / ���✓✓
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number o pits: Diameter:
ottom of see x e it elevation:
Liquid depth: p p
Area Built:
Has either a drop box � distxbution ox been used on any of the above soil
absorbtion sytems? (Check-/one).
HOLDING TANK
Manufacturer: Z Capa ty:
Number of rings used: 7propert vat 'n o ottom of tank:
Elevation of inlet: _Number of feet from neare lid Front, O Side, O Rear, OFt.Number oom ell:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector•
Dated:
- g Plumber on job:
License Number: I'll
3/84:mj
X40 ? 00IL5_4
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
SE'-4,, NE4,S21,T28N-R16W ❑CONVENTIONAL ALTERNATIVE State Plan l.D.Number
Town of Eau Galle ❑Holding Tank ❑In-Ground Pressure 17 Mound (HasOH 7207356-S
Count Q
Road BB / _ - /-_&` D
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
George Lokken Route 1, Baldwin, WI 54002
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV..
Name of Plumber'. MP/MPRSW No.: ]C,"nl Sanitary Permit Number:
Everett Boldt MP 4489 St. Croix 102807
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. jLIO1JjD CAPACITY'. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
2 1 5, P OVIDED: PROVIDED.
BEDDING. VWNT DIA.'. VENTMATL. HIGH WATER YES ❑NQ ❑YES NO
w ALARM. NUMBER OF ROAD: PROPERTY WELL. BUILDING.JVENTTOFRESH
FEET FROM C; J LI"eAIR
❑YES NO f ❑YES NO NEAREST
DOSING CHAMBER:
MANUFACTURER ACTURER �JNG LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUF LIRER f0ARNJNG LABEL LOCKING COVER
�1 j I P DE D.
fl,�1 `��0� YES ONO YES ONO
GALLONS PER CYCLE: / JIUIP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN C �C FEET FROM LINE AIR T LFE7
PUMP ON AND OFF) J ! '� YES 1:1 No NEAREST �'N� �`�S /�J /JJ f
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMErER MArER1AL 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 D 3 ��
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH 1110 G OF PIPE SPACIN COVER INSIDE DIA -PITS LIOUID
TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH IDISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPE RTV WELL BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER
ELEV V.INLE7 ELE V.END. PIPES FEET FROM LINE AIR INLET
NEARESTi
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-
ES NO
meets the criteria for medium sand. TIONS MEASURED.
Y ❑
SOIL COVER EXTURE n PERMANENT MARKERS OHSEHVA TI)N WELLS
YES ❑NO YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER / EDGES. / ,1
U
DYES NO ES ONO YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
ENHES:
DIMENSIONS TR
MANIFOLD P P MANIFOLD DISTR.PIPE MANIFOLD MATERIAL R-0 DISTR DISTR.PIPE UISTHIBUTION PIPE MATEHIA I.&MARKING
ELEVATION AND ELEV EI,Fw� 1� DIA. 2- ELEV � JIIPES DIA: /
DISTRIBUTION x/77 J
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
/ I PLANS
YES ❑NO YES FIND
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF P OPERTV WELL'. BUILDING-
FEET FROM LI NY&
YES NO YES NO NEAREST
Sketch System on R ain in county file r audit.
Reverse Side.
SIG TITLE
Zoning Administrator
DILHR SBD 6710(R.01/82)
InDUSTRV,LRBOR 6 HUFTIRI-I RELRTionsm
did 7
-Attach complete plans in accord with s. H 63.05,Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPE Y OWNER MAILING ADDRESS
z e O r2 L o// ee lo__ / 09�- w;.yj 5,�e-0 a z
PROPERTY LiDeATIONU Y: c
S1/4N1/4, S , T`'1FN, R �(O (or) W Tow±ry o L�L)
LOT NUMBER JBILOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMA K STATE PLAN I.D. NUMBER
A
TYPE OF BUILDING OR USE SERVED - ^�
VQ 1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total *of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concretq Constructed
Septic Tank Capacity Q
Lift Pump/Siphon Chamber O O
Manufacturer: '1
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
4 S 3 '71, X7;6 ( Private ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for insta on of the private sewage system shown on the attached plans.
Name of Plumber (Print): Sig ature: MP/MPRSW No.: Phone Number:
V e Re- 4 f o �� Im P 41q-,?9 11/31) 6? 3
Plumb ' Address: Name of Designer:
w,J0J �i s
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
❑ Owner Given Initial
,0, `�� 54 Approved Adverse Determination
Reason for Disapproval:
Alternate course(s)of Action Available:
DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber
i
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm.Code will be applicable.
10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system,
depth of the system,type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems
must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning
your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin.
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SEPTIC TANK MAINTENANCE AGREEMENT H
St . Croix County z
d
// r> a
OWNER/BUYER e. k 0 R c f-- O K c n/
ROUTE/BOX NUMBE '�, 1 Fire Number
CITY/STATE LA( w / � W / 5 ZIP
PROPERTY LOCATION : SE 'k, fV6 k, Section To`{ Co' N , R -W,
Town of EAu atq Ile- St . Croix County ,
Subdivision A Lot number /YA
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. y
0
E
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- d
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 .
SIGNED
d
DATE /l 3" g7
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 .
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 e_o e o K Kex
Location of Property J - It N C It-, Section T N - R W
Township E40 a A I l e-
bailing Address _ ,.
Subdivision Name
Lot Number 9 V
Previous Owner of Property
Total Size of Parcel . �Q AGReS
Date Parcel was. Created -Dugt""5t c� .
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for resale (spec house) ? Yes _ A No
Volume and Page Number �/S a� as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
I. 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.procese. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) cMtLO that a t 6tatement6 on thi-6 601un ane true to .the best o6 my (ouA)
knowledge; that 1 (we) am (ane) the owneA(6 ) 06 the pnopenty dac i.bed in ttjA
in6onmati,on 6onm, by vcAtue o6 a waAAanty deed neconded in the 066ice o6 the
..County Reg•iAteA o6 Deed6 a6 Document No. d 3 / ; and that 1 (we)
pneaentty own the pnopoaed 6.c to bon the 6ewage po6a6 ystem (an I (we) have
obtained an easement, to nun with the above ducA bed pnopenty, bon the
c0n6t4uctti.on o6 batd 6ystem, and the Game has been duty neconded in .the 066ice
06 the County Reg.c,6ten 06 Deed6, as Document No. /
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
WARRANTY DEED, STATE OR WISCONSIN—FORM No.1
I
Peter J. Stene and wife Beatrice A. 1
NUMBER TO I Received for Record this 31st day of
I
J August A.D.,10 51,at 9 o'clock A.M.
231856' George 11. lokken and wife Grace
David Hope Register of Deeds,
This Indenture,Madethle lath day of August ,A.D.,10 Sl,
between Peter J. Stene and Beatrice A. Stene, husband and wife i
i
part ies of the first
part,and
George !I. Lokken and Grace Lokken, husband and wife, as joint tenants
i
Parties of the second part.
WITNESSETH,That the said part ies of the first part,for and in consideration of the sum of
I I
Five Thousand Dollars
to them In hand paid by the said part ies of the second part,the receipt whereof is hereby confessed and acknowledged,haVe
! I given,granted,bargained,sold,remised,released,alloned,conveyed and confirmed,and by these presents do give,grant,bargain,sell,remise,release,
alien,convoy and confirm unto the said part ies of the second part, their heirs and assigns forever,the following described real
estate,situated In the County of St.Croix and State of Wisconsin,to-wit:
The Southeast quarter of the Northeast quarter and the East half of the Northeast
quarter of the Northeast quarter, all in Section Twenty—one (21) Township Twenty—eight
i
(28) North /
, of Ra ru+e Sixteen (16 West.
($3.30)
( R.S.)
( Can.)
i ' I
I
l
iI I TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging or In any wise appertaining;and all the estate,right,
title,interest,claim or demand whatsoever,of the said parties of the first part,either In law or equity,either In possession or expectancy of,In and to the
above bargained premises,and their hereditaments and appurtenances.
TO HAVE AND TO BOLD the said premises as above described with the hereditaments and appurtenances,unto the said part ies of the second
part,and to their heirs and assigns FOREVER.
i
AND THE SAID Peter J. Stene and Beatrice A. Stene, his wife
I I
1O! their heirs,executors and administrators,do covenant,grant,bargain and agree to and with the said
Parties of the second part, their
heirs and assigns,that at the time of the easeahng and delivery of these presents i
they are well seized of the promises above described,as of a good,sure,perfect,absolute and
Indefeasible estate of inheritance In the law,In fee simple,and that the same are free and clear from all Encumbrances whatever,
Excepting a mortgage of $3500.00 on which there remains unpaid the sum of $2250.00 due and payable to The
Bank of Spring Valley, Spring Valley, Wisconsin., which mort{!aae balance the parties of the second part
assume and agree to pay as a part of the above purchase price
and that the above bargained premises in the quiet and peaceable possession of the said part ies of the second part, their heirs and
assigns,against all and every person or persons lawfully claiming the whole or any part thereof, they will forever WARRANT AND DEFEND.
IN WITNESS WHEREOF,the said parties of the first part have hereunto set their hand S and seal s this lath
day of August ,A.D.,19 51 .
Signed and sealed in Presence of Peter J. Stene (SEAL)
H.M. Waller Peter J. Stene
H.M. Waller Beatrice A. Stene (SEAL)
Minnard Olsen
j Minnard tIlsen Beatrice A. Stene
(SEAL)
STATE OF WISCONSIN,
13^^oge (SEAL)
I
P'e1lt5patx county. f as'
Personally came before me,this lath day of Au(;uSt ,A.D.,19 51,
j the above named Peter d.Stene and Beatrice A.Stene
to me known to be the person S who executed the foregoing Instrument and acknowledged the same.
Helmer h. Waller
(Spy) Helmer M. Waller
Notary Public, Pierce County,Wis.
My Commission expires June 19th A.D.,1955
i
IXEP;OR�ENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
``4•�°>N RE PERCOLATION TESTS (115) P.O. BOX 7969
HJ14.X1i�1 RELATIONS \ / MADISON,WI 53707
(H63.090)& Chapter 145.045)
LOCA I VI--i� E TIO TOWNSHIP/MUNI IPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
SE t 4 T4 / AgA/R/6 (or)W �,n � C�� 11 e_ AU
COUNT�Y1• OWMH R'S NAME: AILING DR SS:
S 6 a0
USE DATES OBSERVATIONS MADE
= SNO.BEDRMS : COMMERCIAL DESCRIPTI PROFILE T N TET
New ��eLpl--ej g esidenc
• RATING:S=Site suitable for system U=Site unsuitable for system
70735
rEls ONVENTIONAL;..MOUND: IN-GROUNDPRESSURE:S STEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
nu ®S ❑U ❑S ®U ❑S DU ❑S DU OunNC/ s �
If Percolation Tests are NOT required DESIGN RATE:
�� [Floodplain,any portion of the tested area is in the' ��
under s.H63.09(5)(b),indicate: indicate Floodplain elevation:
;f PROFILE DESCRIPTIONS
{ BORING TOTAL -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- g�,9 o 61 O • / .11,f /-2 16 'r ge C L
I B 3 � � 93,05 v� � rnor p
B-
B
B-
PERCOLATION TESTS
WNUMWBERI DEPTH,. WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
AFTERSWELLING INTERVAL-MIN. RI D 1 P RI' D2 P R PER INCH
3 a
P-
I 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
f of land slope.
SYSTEM ELEVATION 941 /
_. .. . -------_-
ti r
4.-
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.
NAME(print): kER�7LE7 ON:
✓e,ADDRESS. R: PHONE NUMB R(opti onal):
{
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82)
—OVER—
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INSTRUCTIONS FOR COMPLETING FORM 115- SBD -6395 ,
To be a complete a nd'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;
I 3.-�MAXIMUM number.of.bedrooms or commercial use planned;
4.' k this ainew or re' I'a ce�neht 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 cornpleting,the plot plan
T. MAKE A LEGIBLE �iggram'accur'ately locating your,test,'locations.`Draw g ttl scaleispreferred A .
separate sheet may be used if desired;
i
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,,"pgrcolation''test ekePnp�
i at
tion if a ro fiate,
pP p
10. If the information (such as flood plain,elevation'),does not apply, place N.A.in the appropriate ox;
_.
11- r n;the fprfn and place,your current.ado resaand your certification .number,
x ,g
�Z.-_Make`Legible: ✓pies and' distribute .as-required. ALA SOIL TESTS..MUST'BE FILED'WITH 7HE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
r
__.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
I '
Soil Separates and Textures Other Symbols
I st - Stone (over 10") BR - Bedrock _
cob -- Cobble (3- 10") SS - Sandstone
gr.. Gravel (under 3') . . LS Limestone_ --
f? i'S= a r HGW - High Groundwater
Sand
cs - Coarse Sand Pere -- Percolation Rate
med s - Medium Sand
W - Well
Bldg - Building
-
fs Fine Sand 3 9
_
Is _ Greater Than
_ - Loamy Sand
-- < - Less Than
*sl - Sandy Loam
Loam Bn - Brown
* BI Black
.. -._ .. ._ _.. _ . --
sil - Silt Loam � . - � '••
Av si Sil j. Gy Gray.
*cl Clay Loam Y Yellow
set - Sandy Clay Loam R - Red
sicl - Silty Clay Loam
mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay fff - few,fine,faint
*c - Clay cc - common, coarse
pt - Peat mm - Many, medium
m - Muck d - distinct
p - prominent
HWL - High water level,
* 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 ;
p ring a sanitary permit.The county orahe Department.may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage%systern and a' permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
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Bed Of 2- 2 %2 Force Main Plowed
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D /. O
Cross Section Of A Mound System Using E
A Bed For The Absorption Area F ' 75
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Signed: L/ 7
A �_ Ft. H �� S
B Ft.
License Number: ro �`� � I ' Ft.
Date: /O -;z o - 7 J Ft.
K /0Ft.
AlternateefPosition L `Z Ft.
o
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g K
-----------------
S Force Main
(o_v-� -- ----------------
W -----•
- � From Pump
Of L
Di r' RE�ed Of 211- 2 -2,
N S Ag re ate
l 8pR UAL 9
p Permanent Markers
CT 3 1987
OFFICE OF DIViSION
s CODES AND APPS CAT10
Plan ew Of Mound Using A Bed For The Absorption Area
Page .Z Of 3
Perforated Pipe Detail
l/
End View
End Cap )Perforated /
l �at`ab�o oe PVC Pipe
Holes Located on Bottom,
S Are Equally Spaced
7C s
P
PVC Force Main
From Pump t
1470 7 3
Q .7
/ PVC .:
Manifold Pipe
Distribution, Alternate Position Of
Pipe Force Main From Pump
Last Hole Should Be
Next To End Cap
End Cap Distribution Pie Layout '
P P z3�D
R 5,33
S zz7 ' .
X Z15 ,
Y -/z,
Signed: Hole Diameter Inch
License Number: Lateral / Inch(es)
'Manifold- . ,2 Inches
Date: /d
91 -7 rce Main "
pRtVATE SEWAGE
SYSTEIEP Inches
_
` Cond�tioina`��
OV APto RELATIONS
S LAB!A It DI
DEPARTMENT j t N SAF
ORRESP DENCE
t,
' �eOr�r�'G Lo 1�71�J� pp
PAGE _sL_. OF 3
• PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS
--VENT CAP
4"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
�: 25' FROM DOOR,
JUNCTION BOX MANHOLE COVER
`
WINDOW OR FRESH 12"MIU.
AIR INTAKE I
GRADE I
4"MIN.
I8"MIAI.
CONDUIT -- _---- __
PROVIDE
INLET s�s'f�M AIRTIGHT SEAL
5E
`NPGe (� I I I APPROVED JOIIJ'
APPROVED JOINT A `� rQ
W/C.I. PIPE i.OItpaa I III W/C.=. PIPE
EXTENDING 3' _ ��L� I I ALARM EXTFUDIMG 3'
ONTO SOLID SOIL_ B �/�� j�ONS I I I ONTO SOLID SOI
0 M
i I
�1ENt �F SPF GE PUMP-� --� OF 3
5
GO¢ CONCRETE BLOCK
RISER EXIT PERMI-WED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SPEC.IFICATIOUS
SEPTIC AND ,f/
DOSE TANKS MAMUFACTURER: ���%°��•r NUMBER OF DOSES: PER DAU
I y 5
5. 4
TAAJK ,IZE : POD GALLOMS DOSE VOLUME: �� +� GALLONS
ALARM MANUFACTURER: . S. T. Svsf rY)S CAPACITIES: A= 3'�' Iacm& OPP�GALLO S
MODEL NUMBER: _ 8= 2 INCHES OR 3� GALLOIJS
SWITCH TYPE: _ _r -��r v C=>9;Z II%JCHES OR 9GAL OUS
PUMP MANUFACTURER: D= ZZ INCHES OR
z GALLOIJS
MODEL NUMBER: NOTE: PUMP AND ALARM ARE TO BE
SWITCH TYPE* _^7cf-ale / INSTALLED ON SEPARATE CIRCUITS
`,PUMP DISC.HA.RGE KATE - 70-Z GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE- FEET
+ MI(N�IIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET
FEET OF FORCE MAIN X FyOFTFRICTION FACTOR_.- FEET
TOTAL,DJNAMIC. HEAD Y FEET
INTERNAL. AIM SIONS OF TANK: LENGTH ;WIDTH 7� ;LIQUID DEPTH J_
SIGNED: LICENSE DUMBER: Mt' �Td / 4
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DATE:
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State of Wisconsin ` Department of Industry, Labor and Human Relations
• PRIVATE SEWAGE PLAN APPROVAL SAFETY&BUILDINGS DIVISION
Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
BOL.DT'S PLUMBING Owner: GEORGE LOKKEN
820 MAIN STREET ROUTE 1
BAL_DWIN WI 54002 BAL_DWIN WI 54002
RE: Plan Number: 87--07356-5 Date Approved: October 28, 1987
Gallons Per Day: 450 Date Received: October 23, 1987
Project Name: LOKKEN, GEORGE — RESIDENCE Location: SE,NE,21,28, 16W
Town of EAU GAI._I._E County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved' . This approval is contingent upon compliance with
any stipulations shown on the plans . All items that are noted must be corrected.
All permits required by the city, ,village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department' s approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
— REPL PETITION
— REPL MOUND
Inquiries concerning this approval may be made by calling (608) 266-2889.
Sin ,
P
Section of ewage
D ivision of Safety and Buildings
PPP013/0009n/ 6
cc: GEORGE LOKKEN
Private Sewage Consultant ----County _ _ UInF SSWMP _Plumbing Consultant
_ _Owner —Plumber Environmental Health
0ILHR-SBO-6423(N.04/81)
'State of Wisconsin ` Department of Industry, Labor and Human Relations
uctoter' e.'9, 1 r d'. r SAFETY&BUILDINGS DIVISION
<ann ;ppi lcation
i St 14asI'Iin(itoI) Avenul '.
George Lokken
f oute 1
vdlddin, WAT :4Q0,
i m ti.io t !-I. 13!�zi; .F
Re: George Lolt.,.ken
Private
Town of Lr,ku -ii i Ir-, �;i:. t;a'°o'!.. C;tx4' i'C
D
Se=ction 141.94. ('1 , . . ar. 0.. 4.! S�_'t n�.if
• , t
NC?Conistrative (.(7�"(?, 13E �C? t 'ti.ti;^ til:Itt'^)"J�C 1"_'°e C,7E;.c, ! l4. ,:artf en,, for i3 variance
to the installatit:o tor j r-m"A (if> txiS'l,�ii1(, ¢)riVr3l:e
sev)age systeT.n at a cite U4A'Ic`: iS not.
S'C<#nddrds In the 3(l3 ,1friz f:Y' ;t.lVt:: 4 e?f . coif° ,w� ,i'C r: ,i ;tr �:1 (.�!( 3t��i Si'•Gt,?t�
protect the wat(--r of (r ' Stat4` 1 P`ti:i f Crf!{- i }r, ?.7 C9 . 1? 1;i'',1 , syst. H "'.--cofnes > .
failing System ()1" the f3Lt`r"S t ", . i .;�.� $ , 1,t"riS v)riteJrce slhd? l 'rf:'
rescinded.
Tilt, petition ft,)' F7 var"1[tncv%
Adm. Gore was coil_.,i CA:rc,f
conditional?w : Veflt of i.",ii( r'e., trey.
riound System, sl,,;A? t,,c.
s'lf?r' of i-?tat cyrS t tar,
The rule requires that d 6';ound system, heave a i n1 ?'w% 0 4 inc!,q� of suitable
natural soil.
The variance ref,"jueste(f 1'tc",1s t.c"i nstal 1 :.+V sti3!< ore a sit,
At{' L3 inches of sui tal'. E. ;'r?hturfil 5<,i i ,
A]? of tiiF oia ;, ailf; «i!tc};f,'rts
CC1nS7derf`G• i!"si5 '«iiE"icfr7Cc, is S°�;I:Ctiii� Y'(` ):
Used,` for any i(oit:ion tl r c;i1(?);:
ncf:r'e i ,
--
J lie H.. Peterson,
ection of Private st-w qe
J1iP:PEP:156'V1v
cc• Leroy Ja6s'k , Private to t),vv r111C
?hwas Nel soj-?, -,00i 1�(! r (�i;;i lli Sl:l'G tCJ!` - :, Y(;i X !r t.t?L
. Everett
DILHR-SBD-6423 (N.04/81)
State of Wisconsin ` Department of Industry, Labor and Human Relations
October 29, 1987 SAFETY&BUILDINGS DIVISION
Office of Division Codes
and Application
a� 201 East Washington Avenue
P.O. Box 7969
Madison, WI 53707
George Lokken
Route 1 j
Baldwin, WI 54002 �i ~
etition No. 87-07356-P
Dear Mr. Lokken:
Re: George Lokken - Residence
Private Sewage System
SE,NE,21 ,28,16W
Town of Eau Galle, St. Croix County, WI
Section 145.24 (1 ), Wisconsin Statutes, and s. ILHR 83.09 (2) (b) , Wisconsin
Administrative Code, allow the owner to petition the department for a variance
to the installation for a private sewage system to replace an existing private
sewage system at a site which is not in full compliance with the siting
standards in the administrative rule. The system design proposed should
protect the waters of the state from contamination. If this system becomes a
failing system or contaminates the waters of the state, this variance shall be
rescinded.
The petition for a variance requested to s. ILHR 83.23 (1 ) (d) of the Wis.
Adm. Code was considered on October 25, 1987. The petition has been
conditionally approved. The condition being that in the event of failure, the
mound system shall be replaced with a holding tank or other off-lot system.
The rule requires that a mound system have a minimum of 24 inches of suitable
natural soil .
The variance requested was to install a replacement mound system on a site
with 23 inches of suitable natural soil .
All of the data and statements submitted on behalf of the petitioner were
considered. This variance is specific to the subject petition and cannot be
used for any additional modifications.
Sincerely,
J 6Cie H. Peterson, Chief
tion of Private Sewage
8) 266-0056
JHP:PEP:1563v
cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls
dramas Nelson, Zoning Administrator - St. Croix County
0 ILHR-SRD-9420 (N.04131)
State Of Wisconsin ` Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL SAFETY&BUILDINGS DIVISION
Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
BOLDT'S PLUMBING, C>° �� Owner: GEORGE LOKKEN
820 MAIN STREET ® \� ROUTE 1
BALDWIN W:T, 54002 BALDWIN WI 5400
RE: Plane Number: 87--07356-S Date Approved: October 28, 1.987
Gallons Per Day : 450 Date Received: October- 23, 1387
Project Name: - LOKKEN, GEORGE: - RF.SIDENCE Location: SE,NE,21,28, 16W
Town of EAU GALLS County : ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirenrent3 . This approval is based on Chapter
145, Wisconsin Statutes .arid `the Wisconsin Administrative Code. The 'plaris are
stamped 'conditionally approved' . This approval is contingent upon compliance with
any stip0ations shown on the plans. All items that are noted must be corrected .
All permits required by the city, village, township or .county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer stiall notify the appropriate inspector when
inspecti.bns can be made.
This approval will expire two .years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires .
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILFIR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the fallowing components only:
—•'REPL PETITION
REPL MOUND
Inc{uiries concern' this approval may be made by calling (608) 266-2889.
Sinc -r . J,
P. PA --c
Section of Pr' .ate Sewage
Division of Safety and Building,
PPPO13/0069n/ G
car: GFORGr. L01<KFN
Private Sewage Corlsultrint County UW-SSWMP _ Plumbing Consultant
T Own„r '.: Plumber- Environmental Health
DI1-HR-S613-6423 (N.04/81)
- _.
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY&BUILDINGS DIVISION
October 15, 1987 Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
' GEORGE LOKKEN
BOLDT S PLUMBING
Owner: GEO
820 MAIN STREET ROUTE 1
BALDWIN WI 54002 BALDWIN WI 54002
RE: Plan Number 87-07356—S �.
Project: LOKKEN, GEORGE — RESIDENCE County : CRO:
Location: SE,NE,21,28, 16W Fee Received: 80.00
EAU GALLE Date Received: 10/06/87
This letter is to acknowledge receipt of the Plumbing Plans which you submitted
to the Office of Division Codes and Application, Section of Private Sewage.
We cannot however, process your submittal until we receive:
— A pettion for modification is required for this plan with proper fees. The
county and CST indicate 23 inches to estimated high ground water. Therefore
the site does not meet the minimum standards for a mound system.
Please retain one copy of this letter for reference and return the other with
the materials requested.
Your Plans will be processed within 15 days by the Section of Private Sewage
following receipt of the requested items.
Petitions or plans submitted to this office which require additional information
will be held 90 working days for receipt of the information. If, after 90 days,
response to this letter has not been received, your plans will be returned.
If you find it necessary to contact us regarding your submittal, please call us at
(608) 266-6952 and refer to the plan number as shown above.
Sincerely,
�F 211 --
ALLEN WENDORF
Section of Private Sewage
Division of Safety and Buildings QFh
PPP020/0001n/ 2 COMP: 11 ,
ELEM: 11
cc: GEORGE LOKKEN
County _Plumbing Consultant _Local PI
_Plumber _Environmental Health _Facilities Need Analysis Section
_UW—SSWMP Dept of Agriculture _Private Sewage Consultant
DILHR-SBD-6423 (N.04/81)
k ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
796-2239(HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
October 2, 1987
Division of Safety and Buildings
Bureau of Plumbing
P . 0. Box 7969
Madison, WI 53707
Dear Sir :
An on site investigation for the George Lokken property located
in the SE 1/4 of the NE 1/4 of Section 21, T28N-R16W, Town of Eau
Galle, revealed suitable soils at a depth of 23 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,
Thomas C. Nelson
Zoning Administrator
rc