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Home My WebLink About006-1081-80-000 0 3 v o D o ~ F c 0 o c 3 H' o m m CD n c CD m m A ~ m C 1 Dpi 3 v u o w rn o LT, 0 C • c f o w v Q Z (D Z d N O (D 'O = (D lm N co _ N 0 ~ w O N O N N ° U1 ° o S(D ° A O O c O CD O 77 N O 3 0 o co 0 7 N p CO O y (D (D cn Z D a A • l~I, m ca' o N a o `fir N v m W s co 3 Cl ~ o o iv O co co m C) (D 3 w ' M (D ~ o o v n r' (n ((n O° a N o c C 3 a- su ^1 • o o o p ° o c 3 c to to u) (D N s v o v N fD a Q° CD CD cr 3 N O d (D N 3 N Dom( O S N "ft1 lD CD • ID o a c _ c > Q m m co 3 ° y --I cp N C O- A Z CD m X A Z o 0 C/) W Lo W O CL 3 - z 'O _ A 3 " z 3 (D "O A A p~ 0 (D coo c 07:3 o- n 3 cD 3oCo . xa n O S O S _ '0 cf) CO La :3 -n 0 o Za CD (D < Z a 0 O O- O ° co m S cn O ((DD - Or O c o°° Q 7 3 0 = O O- ° O (D (D 3 O p Xk N Co O (p N Oo OS (D O ° (a ? (j C CL (D [D S (D N O O c OS N SU M (D N b ~:3 3 0_ (n A v N 6 O 0 C:) ° O A 0 3 v°o m o O v C J ~ ~MTll $ wVX2 k, ' l) 3 i s 00 .gym < ay.` w s ~s m ~ d m m e < n 1 M< cn It Ak" ~ q#. yam" i ~ CD x t# rya' < 21 { „Vy ~ as n R~~ ~ t ~ 4 1£' u ~ nt Al, s4 ~ ~ 3 < d ~ 4n t a Parcel 006-1081-80-000 05/06/2011 04:45 PM PAGE 1 OF 1 Alt. Parcel 35.3 .16.5428 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner LATON N & RANAE J HENDERSON O - HENDERSON, LATON N & RANAE J SAMUEL C ERICKSON C - ERICKSON, SAMUEL C 1790 220TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special P Address es - = rims -7 Type Dist # Description 1 3 0TH ST ( ry SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: - ACFW- 2.060 Plat: N/A-NOT AVAILABLE SEC 35 T31N R16W P OF SW1/4 NW1/4 CO Block/Condo Bldg: NW COR OF SW1/4 OF LN TOWN RD, 561' TO POB; TH E 495' TH S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 181.5' TH W 495' TO CEN LN TN RD TH NLY 35-31N-16W TO POB Notes: Parcel History: Date Doc # Vol/Page Type 03/03/1998 574222 1302/044 WD 07/23/1997 1191/160 WD 07/23/1997 863/304 LC 07/23/1997 748/436 more... 2011 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2007 Description Class Acres Land prove Total State Reason 1`U RESIDENTIAL G1 2.060 30,000 196,50 26,500 NO 'JL I fvU 'Ali Totals for 2011: General Property 2.060 30,000 196,500 226,500 Woodland 0.000 0 0 Totals for 2010: General Property 2.060 30,000 196,500 226,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 509.49 l' CSM VOL 20, PG 5142 N 541 B LOT 1 co N (D N rn O a N ' //4 I _ SW-NW ig1,-6 f~ 495 i~ 542B 2 A - - , W A COR . SEC. 35 Parcel 006-1081-70-000 05/06/2011 04:44 PM PAGE 1 OF 1 Alt. Parcel M 35.31.16.542A 006 - TOWN OF CYLON Current I( ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner LATON N & RANAE J HENDERSON O - HENDERSON, LATON N & RANAE J SAMUEL C ERICKSON C - ERICKSON, SAMUEL C 1790 220TH ST NEW RICHMOND WI 54017 Districts: SC =School SP =Special perry ss es): ` - Prima Type Dist # Description " 1790 220TH S d SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 7.94 Plat: N/A-NOT AVAILABLE SEC 35 T31 N R1 6W 37.94 AC SW NW EXC Block/Condo Bldg: P542B Z . 0 (O Tract(s): (Sec-Twn-Rng 40 1/4 1601/4) 35-31N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/03/1998 574222 1302/044 WD 07/23/1997 1191/160 WD 07/23/1997 863/304 LC 07/23/1997 748/436 2011 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/10/2010 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 33.940 6,800 j ! 0~ 6,800 NO OTHER G7 4.000 16,000 462,100 78,100 NO Totals for 2011: General Property 37.940 22,800 62,100 84,900 Woodland 0.000 0 0 Totals for 2010: General Property 37.940 22,800 62,100 84,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch M PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 006-1082-10-000 05/06/2011 04:53 PM PAGE 1 OF 1 Alt. Parcel 35.31.16.545 006 - TOWN OF CYLON Current j XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner LATON N & RANAE J HENDERSON O - HENDERSON, LATON N & RANAE J SAMUEL C ERICKSON C - ERICKSON, SAMUEL C 1790 220TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1853 240TH ST SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 35 T31N R1 6W 40A NW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-31N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/03/1998 574222 1302/044 WD 07/23/1997 1191/160 WD 07/23/1997 863/304 LC 07/23/1997 748/436 2011 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/10/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 15,000 24,900 39,900 NO AGRICULTURAL G4 38.000 7,800 0 7,800 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2011: General Property 40.000 22,900 24,900 47,800 Woodland 0.000 0 0 Totals for 2010: General Property 40.000 22,900 24,900 47,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUL/DINGS FOP eUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION P.O. '60A 7961? SEWAPE SYSTEMS BUREAU OF PLUMBING MAb/SGN, W;53707 ' ❑ Mound CSI Pressure Distribution NAWt)OF PERM( HOLD~f ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PLAN ID NUMBER: 81-02 BEN7 MARK (Permanent refer oe point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV,: CST REF. PT. ELEV. if SEPTIC TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET LF,V.: TANK OUTLET ELEV I PROPERTY LINE: WELL BUILDING JL- I _ I DOSING CHAMBER: MANUFACTURER: LIQUID CAPACITY: PUMP MODEL: PUMP MIANUFACTUF PR. WARNING LABEL LOCKING COVER Ic a:• / PROVIDED. PRFO~V7-IDED: RYES ❑ NO L~ YES ❑ NO GALLON PER CYCLE AND CONTROLS OPERATIONAL NUMBER gp PROPERTY WELL: BUILDING: VENT TO FRESH DIFFERENCE BETWEEN I„EE7 P}tO3Vl LINE: AIR INLET PUMP ON AND OFF r UMP 0 YES El NO NFAREST W...,-Am ( C i I c> f . SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM_: LL3~ WIDTH_ LENGTH: NO. OF SPACING CENTER - :LENGTH: DIAMETER: MATERIAL AND MARKING: EIN+3•- - TRENCHES: TO CENTER: 01MENS7'IO -t:) ` ;S it C A0 MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKI VG- NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: r`~S ryy, \ PIPES. DIA.: j DIA.:~,/y HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY DEPTH OF GRAVEL OVER PIPES. VERTICAL LIFT CORRESPONDS TO APPROVED YES 1:1 NO PLANS: YES ❑ NO SOIL COVER: TEXTURE: DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED PTH f TOP !j SODDLD SEEDED: MULCHED. CENTER. EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO 4 COMMENTS: (1 SIGMATUR E. / TITLE DI LHR-SBD-6227 (R. 05/81) (A Yl 4 1 (A /I If 1114 , SX S t - A, r , 4 x 1 1 tJ 5 .L. , c 4 U K 1. U U YI 4 1.) SW ~S e c tiu n o f NS ub di vi.6 o n yakkane Nurnben 06 cornr,a~r tmen to h'I(Irn; Wek4_ Bu4.kdin9_ ._-12o Atope H.tghwaten w~- CHAMBER a~~ona Pump Manu6ac.tu4e4__ --Model Nurnben TANK --,q C4 ,e le Number 1,4 Cirrnpa4 rneYl.te A-e a4tri SIf e.te.m r,1: W e e t bU.~~.d(.Yl H4 yhwaten ;•'N ti1~It Tnench AIt (Ilit: We.Lk Bu-i.t.diny - r2~ e~nrrrr Ht ~Ihwa"t el i If OIWNS10Nti n fnl,ylc it - - - Re,Iu.r fled aILea h cash x4ne hfi Uel:,~ l u(~ noch be~'uw r<~ ~'ll t'irte.e Uk.1d 01 uA A-ock 0 k,v t~ l'r (~r1}I.tll U.IS nee ~.t U['t.)th u(~ tk, c be vuw Nnadc ri I,~~ fiweerl f~ nee 6.t `.Pu1~e a(~ tn.e.ncit cr1. i~,,,, 100 t 4 un a11(1a 6t INC~e u~ co„e.~: Vape~~ nor e t~1,n11 r~r ~e (;nrzue!' ahuunrl r.,, to ,r~~`~ it 11,rrrleterl Uer~tll be~uw inl'e~t ~ C T1 TLL D A 11 OA 7t 19 I0N L. r. 6 7 i State and County State Permit # PLB Permit Application County Permit # ZZ~ for Private Domestic Sewage Systems County "DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # ~ _ 9 A. OWNER OF PROPERTY Mailing Address: B. LOCATION: ~t Y'Section T N, R (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: "Commercial "Industrial "Other (specify) 'Variance Single family -4_ Duplex No. of Bedrooms- % No. of Persons D. SEPTIC TANK CAPACITY L( (-Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber' i Total gallons Prefab concrete x Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate q. ft. Total Absorb Area L S s New Replacement X Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed:_,X -Length- •S Width , L.; ' Depth- 4L ' Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- Distance from critical slope WATER SUPPLY: Private 5Q Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME f C.S.T. # , S 5 f and other information obtained from (owner/builder). Plumber's Signature - e 1~ 7 MP/I~IPRSW# Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. I e P. s d ~ i i e. e m a i r E 3 E F ~ j e 3 Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT U E ONLY ` Date of Application a' Fees Paid: State ~ O Co t cr'L~ Da 'o Permit IssuedMT7tF Ted (date) - Issuing Agent Name inspection YesNo State Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 L. -tate (pink copy) 4. plumber (canary copy) Revised Date / /COL 31tr L-.'OA),4,CS F~~c~.aid ~,1r Sw% ~ ~~y4~ S~.c 3s y T3/ N ~ ~'Q u.7 Za n 57- CV- oiX ~~p r ~~jj I, ~a ► ~(A rS L7~~Fr~ YG t~~euNd NAI~re~-gprrc,~6 d Slar'E 3 g ) ,ee' /56. 3 ,~~s r~,t~ fD S ~ r~i/ ~ 1i ~ fofi~t i:.t ✓ ~ vIZ~ a t J`,1t35oX~r/:J.tl ~r"~A qC ' Y 0 2 9 7,J r~ Conditi®naFy 3 /71 ANDPRF'l VE D ZOO CEPf',RTh$' OF 1 u L ~ R AND HUNAN RELATIJNS / lai...::a ONIDENCE ' 11D G 1-7. , 7-z),41 C)o CJV. 7-0 714 J-C➢4JFJCS <M/C~lr I~ e l7j0~~GT'$ `~D BEi.~ ourr,E r SD 000 = ~d fit/f~~Cln / Pu,- ~ s4r ro p4"• p T ~ 1S° Sh/%, NdY1,5EC3~, T3l N, 7~/~ k/ ,din ~~Pa.c o k~~ G~~C a✓ ~ S-t C r o~ X ,,n,®~ O'V E ;f R AhJ~ HU%IAN RELi;TICoNS LA . r. o r D,ENCE e `1 Lt %9• Q f~ /D0.`0 s 1~JE c 7~zN~ q 4 5 e ~'~1J. - J/Art V/ /DD• tlous~ 73 i E i tom` ~ ~V L I ' I ` ~ ; .1 -.a•e ('p ~ . i I I ~ V w j ~ ~ T"U P /~if'E -for„ r~:• ,J3 ~:;~w,~Et ti. VEL n , c rc) C~ -5 1 1 0 r ~ l'~ / l ~ 1 FLA- v ~ ► 1 ~~J. s ~ J f°v 17.~' V ~ Cr t l \ \ l~ \ 1 a r ~ Pa U n i 1 P Po541 1 F -load ~ $ 0 2 9 r ,W IC)%4 ED h S I op lp ~{~}h1pN RElA11 _ - Lr. GR ACID .~3 Ali NNI o, I A 3r 1 h Nrr r l fl f ?C it a M t6 ! . t~ P V 1 p 2 O •l I Al / ` i nally uondittok t o i i Pli~ .00a 12; 78; State of Wisconsin De~pich And Return Upper N F HEALTH SON OF Portion Of T 1 his Form With DNIO SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: PLAN ID. # x DETACH HERE z PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. ll. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I11. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank Holding tank agreement signed by ovvrler and local unlit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for totai lift pump discharcle, head and gallons pumped per cycle. ❑ Size, length & depth of force main. ❑ Detail & model of pump or automatic siphons including size, pump curves, d-awdown and average flow rate GPM. Cross section of lift pump tank c_hovviog ouinp(s! or sirhon(s). Vi. Systems In Fill (Fil to i ,;n suhrniss:on) i_JTotal area filed (f! To extend 20' bey, nd edqe of trench before side slope D-pth ?r,d "vpe of fill. Copy of ^n's!te retort by county or o in ~"lace. F State of Wisconsin ` Department of Industry, Labor and Human Relations <~_j ,P5 , FETY &e Ut y SDIVISION l ~ `J ~Bur i g, %jtCng & Fire Protection TO : :.J P.9(/~ 0sb~ U I Ma Non,'VV~I ~ l - Z0N1 G offICE % v Plan Identification No. Gentlemen: Re: The Bureau of Plumbing, Platting and Fire Protection has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by and received for approval on The soil and site evaluation was conducted by . The site meets the soil -f -ho an site requirements specs led in c H 3, Wis. Adm. Code, for the use of The proposed system is for a . Wastes from the building will discharge to a gallon capacity septic tank which will discharge to a gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will disci's arge through a inch diameter pipe to the soil absorptjo~` system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval con- tained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this instal- lation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. F~ / / I DILRH-SBD-5159 (N.7/80) In accord with Stats, and ch. H 63, W's. »im- ch. ~ ~ specifications are approved contingent capon compliance with the stipuietx.:' Indicated can the plans, Please review your <,ode for tl-e. r u r ev s t- each code section noted, The architect, professional engineer, reg i s :re : es i gncr, owner of g um b s rer contractor shall keep one set of plans bearing the stamp of approval of this department at the constructions site, If the installation of this system has not corgi ence within t years from the date: of this letter, this approval shall became void and new application she be v1~;s.--4 for approval of these plans before work may commence. In :r nt'inc- thl s approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan lasso examination oversight, constructions or any damage that may result in or aft Installation and reserves the nigh. s ti ditions arise making this necessary. This approval Is based on ch. H 63, ff be necessary to obtain and fulfill the permit requirements of the ur.,which this installation is to be constructed. ~b to ,pe rmits bl r a r. l thlss ac e to rofi: Sincerely, a s Sargent la r au, a s JS.~J pleas e closurc-<- I Wisconsin Department of Industry PLB-I y INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection Name o remises Date an No. Street City County Sanitary Permit Master Plumber Firm Name dress Journeyman Plumber Address Owner Address Discussed With Signature ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Si e Waste Specialist ldhite-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner r EH 11 5 Rev. 9/78 _ REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:=^Y4, Section ,T_LN,R.L~E (or) W, Township or Municipality Lot No. , Block No. County - l Subdivision Name Owner's/Buyers Name: •;i , ;•T Mailing Address:__~_~ J Z.4 _ TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS' xi SOIL MAP SHEET; NAME OF SOIL MAP UNIT ,,rsa«L PERCOLATION TESTS TEST DEPTH CHARACTER HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES NUM- SOIL SINCE HOLE HOLE AFTER INTERVAL RATE BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- n f /7 i P \ P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B / - ^ SA L' A ILI. B- B- ii PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. . s . e _ 5 e , x , ,y F , "'~1~- yea N i • Via,,.. e...,.,. b _ " 5 a_~C 4 e Eve ~t. t ~ ~ ~ ~ ~ ~~.z~ 3Y E r F _41_1- A _ f I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (print) f~ Certification No. Address Name of installer if known n_ A Copy A -Local Authority CST Signature / r C Y LO N T 31 N7-R. 16 W. POLK COUNTY Jahn N/ ThosQ '/a~ f/o o% • ~ Pao c- ~ `C~ p ~fe~so~ iefsc ~ose~/ e son s°o~ o F /Q~d 30 °f'a ~ ~ee~~ \`C ~ • 86 ~7 • 9z • • 47 ab~ /Zy 9U9o~ K d4.0/v ~eo~e `C Oscor f ~r' ~ C¢/-/ ~ E~w~ ~ he ~ ~ U V A ~s/oGT ,`tlw Kfo h, Cho ~Q ,Y¢sh. ~iP~h¢~f macho/s ~ell F B~ /~D a 0 172 _ ore`s • 2 33 4, w U ~ ~ 9.~'e so /66 C¢-/c VAL b Cfl `7 rde o v /moo TT5 0~' 94 ~Tu,Q//uoms bc /deri Doco~YtFi y /C3/ah~a,E eff ~U~ U tl ~ tl F . (~vU~J~ 46 Tf~i7oammf e~s soEw. m~oom er /feJi--/o 74 o/J 7 s• '~C o sif"4 ■ /o~ia. <7 63 170 • /zo ` c?e rs Ce 'e W ~7/e.r Lo etf¢ ' Ca.a Le/'7o 0 o/d . h m on : • f0 • K(loh/ .y Kats ~ ~a ems- P Fishes h 4✓~~so/7 U n w-i-s friio// .Y Ox~~ h /o/ 9 /4g fJ%V.n ~ 2s7 met ~ C ~ ~ 8o E99ert~o v y ARK ZIhman e y <J o% h; /4 Goo b l f/c~be f `ioeno - QO ::~~1 . A ardor-7Ja (~L . iede~ic',~ anx ° ~y~ U Fours ettr ~o ell /a c~ .die C.BN ie//e m a✓a . v V of H 5 0~ leila Boc w \ d `4, 'L' y E oc m¢r'- 39 n 0 L D .,.,1 ■ ,96~a~ . ~T..P. 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N T 7 C N C <n CD z a Z N CD O o y 0 (D i pp fi O O N C) N ~ a A N a A ea O „ o0 b (D o a St. Croix County Planning and Zoning Friday, February 17, 2006 at 2:02:30 PM Detail Sanitary Information Page 1 of 1 Computer 006.1081-80.000 Sub/Plat: NA Section: 35 Parcel 35.31.16.5428 Lot: TNIRNG: T31N R16W Municipality: Cylon, Town of CSM: 114114: SW 114 NW 114 _ - - Owner: Cowles, Jack 1853 240th St Deer Park, WI 54007 State Permit: 10725 Issued: 0312211978 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 0412811978 POWTS Detail: Trench - Rock Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Harold Barber Yes Powers, Calvin $0.00 Tom Nelson Signed Off: Yes Maintenance C Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification (e' 19 OP/ 4/28/1981 - - - - - - - - - - - - - - - - - - - - - - - - - - - DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADIS11 WI 63707 LZCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: 111 afignetl) D Holding Tank D In-Ground Pressure D Mound RECONNECTION NAME OF PERMIT HOLDER: ADORESS OF PERMIT HOLDER INSPECTION DATE. Doris Weeks Rt. 1 Box 128 New Richmond, WI 54017 BENCH MARK (Permanent relerenee point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV NW SW Section 32, T31N-R16W, Town of Cylon Name of Plumber: MPIMPRSW Nu. County Sanitary Permit Number: Ga Steel 3254 St. Croix 79212 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ILIOUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATI HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO RE N ALARM FEET FROM LINE AIR INLET: OYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER jflEDDINGLIQUID CAPACI TV PUMP MOUEL PUMPrSIPHON MNUI ACTUREIi WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDYES ONO 0 I 1 ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING V N TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ONO NEAREST ' SOIL ABSORPTION SYSTEM. Check thesoilmoistureatthedepthof plowing IIN('T14 UTAMFTEH MATIHIALANUMAHKIN(i 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: WIDTH LENGTH NO OF UISTR PIPE SPA(:IN(. COVER JINSII)L DIA =PITS LIQUID BEDITRENCH THE NCH FS MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IUISill PIPE UISTR PIPE DISTR. PIPE MA RIAL NO DISTR NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ASOVECOVER ELEV 1NLF1 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- DYES NO meets the criteria for medium sand. TIONS MEASURED. O OIL COVER TEXTURE 1,11 /IMAN1 NT MARKI IIS UIiSEHVAT ION WELLS DYES ONO DYES ONO DEPTH OVER TREND/ BED DEPTH OVER TRENCH HEU =OF TOPSOIL Isol)DID SFF OFD MULCHED CENTER EDGES DYES. ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH FITLOW PIP[ FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUM MANIFOLD DISTR. PIPE IMAN11010MATIR.Al. JK45ISTH l)UISTN PIPE OISTHIBUI ION PIPE MATERIAL & MARKING ELEVATION AN ELEV. ELEV DIA ELEV PIPES UTA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHF C It Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED vLANs DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE DYES ONO DYES ONO _ NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710 (R. 01/82) DLHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'/s x 11 inches in size. wee reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO P ' WNER PROPERTY LOCATION 011 %501/4, S 3; T 3 N, R / (or) W PROOPE TY OWN R'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 121 '1 15.X 1~ 0; 1 A) 14 Y, STAT ZIP CODE PHONE NUMBER CITY NEARES ROA , LAKE OR LANDMARK 1 L' 6 j. VILLAGE TOWN OR C1,11&pi acv 3 II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. ❑ 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. [&onventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. E1 Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ See a e Bed b. ❑ seepage Trench c. seepage 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): Feet Private ❑Joint El Public VI. TANK CAPACITY in -lions Total # of Site Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. p Tanks Tanks structed - -::ffj _j_j Septic Tank or Holdin Tank S Lift Pump Tank/Si hon Chamber '0 !X I ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb gnature: (No Sta ) tNP/MPRSW No.: Business Phone Number: Plum er's Ad ress (Street, City, Sta~B, Zip C Name of Designer: tAT VIII. SOIL TEST INFORMATION Certified-Soil Tester (CST) Name CST# Qj CSNAAM. DRES:jCityT's t, , Sta Zip Cod - Phone NumbZ,er C~ ~ G t d 0 t 7e5 "-6z00 IX. COUNTY/DEPARTMENT USE ONLY X❑ Disapproved Sanitary Permit Fee Groundwater Date I uin gent Sig -lure (No Stamps Approved ❑ Owner Given Initial Surch% Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: 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. Anew 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 2 to 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, 608-266-3815. To be complete and accurate this sanitary permit application must include. 1. Property owner`s name and mailing address. Provide the legal description where the system is to be installed; H. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. 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 81/2 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 1 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 Ground#at6e included the creation of surcharges (fees) for a number of regulated practices which Wisco in`--s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in. your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The n-ionies collected through these surcharges are credited to the groundwater fund ,idminis- terec' by the Department of Natural Resources. These funds are used for monitoring g ound- 1 water, groundwater contamination investigations and establishment of standa-ds. Groindwater, it's worth protecting. SBD-6398 (8.03/86)