Loading...
HomeMy WebLinkAbout002-1061-95-000 ti ~ -o o I a o I 3 0 ~ m I N tt p C O. 0 N y O w LO O 0 Boa CL i N - N (y C m a o a rn N cR N :p R 'O T N = (n O C O p ca 3 O O! (D O LL 00 0 O E 0 O O c o m M N ,III Q N co Q N d. ~N N (O ~ 00 CL M Z y d m w a m N H U) C C7 I O Z ~ ~ N I m Z c !n 1- a ca ~ o 0 o I I- O w O O N O Q Q S Z Z Z 0 p 0 o C) Z N iLO I N a) 7 N is Qy o od 'a 0) N m 0 0 a o a~ m cn m N EI v ~w 3 WJ E a S 0a.0 0 a cn o 7 O iO N 8 co co a) "V ~v N ti~ (D C) c'o ) a L_ 0] N tm a) O N O N N d Q} Cn Q O "a O N C O E c a CO LO co o f a) r \ M I N l6 y lC N _ Vx, (O C ` m N O O N 40. Z O O I oc (D O_ O E C L O ~ N N fD U O N l1f o i (o 0 0) N O N M J 0 O Z N S F- 1c4 y y m a V 3 a' L a - CL m .2 III a) `1v o m 3 o A 0CL2 0 N0 C RO IXCOUNTY PLANNING & ZONING June 12, 2009 Joe Gillett 17024152 nd Street North Code Administration Maine, MN 55047 715-386-4680 Land Information & RE: POWTS Installation Inspection, Sanitary Permit #69663 Planning 715-386-4674 Location of Property: St. Croix County, Wisconsin Municipality: Baldwin Township Real 715-3~~~86-4G777 Subdivision or Plat: Metes and Bounds SE 1/4 of SE % of Section 25, T29N, R16W Rec.vvhng Lot Number: 715-386-4675 Address: 706 270th Street Dear Mr. Gillett: An inspection by county staff of the POWTS servicing the above referenced property was conducted on September 24, 1985 (inspection report included). At the time of the installation inspection, this Private On-site Wastewater Treatment System (POWTS) was found to be code compliant for a three (3) bedroom home (sanitary permit included). The system consists of two (2) 1000 gallon holding tanks. If you have any question regarding this wastewater treatment system, please contact our office at 715.386.4680. r Sincerely, Rya rriAgton, POWTS Inspector #683475 ST,CROIX COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, WI 54016 715-386-4686 FAx PZ000. SAINT-CROIX. W1. US wWW. C O. SAI NT-C R O IX. W I . U S DEPORTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ,LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P,'O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑ CONVENTIONAL ALTER NATIVE State Plan I.D. Number: KXHolding Tank 1:1 In-Ground Pressure E:1 Mound 8505155 I NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dennis Larson R. R. 1, Woodville, WI 54028 -a945' BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SEA SE%, Section 25, T29N-R16W, Town of Baldwin Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale E. Hudson 6629 St. Croix 69663 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUI CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER U) 1 J• I Do 0 G'~ 7 5 q 77, PROVIDED: PROVIDED: G 7., / / / BEDDING: YES ❑NO ❑YES [:]NO VENT DIA.: VENT MATLL. HIGH WATER NUMBER O ROAD: ILIN RO PER Y BUILDING: VENT TO FRESH ALARM FEET FRO`O E AIR INLET. ❑YES ❑NO ❑YES ❑NO NEAREST J DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: 7ND CONTROLS OPERATIONAL. NUMBER OF ROPERTY WELL. BUILDING. JV(DIFFERENCE BETWEEN FEET FROM INE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NSO IL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLErJ',TH JLAAMETER 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: WIDTH. LENGTH. NO. OF JDISTR. PIPE SPACING. COVER JINSIDE DIA.. #PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENTTO 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- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/RED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED: SEEDED. MULCHED: CENTER. EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: .ELEV.. ELEV.: DIA.. ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION FORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. _ ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES 1:1 NO -]YES 1:1 NO NEAREST Sketch System on Retain in ounty file for audit. Reverse Side. - SIGNAT ti TITLE: DILHR SBD 6710 (R. 01/82) - . wmmnsvr APPLICATION FOR SANITARY PERMIT COUNTY DILHR Nf-Z2 (PLB 67) UNIFORM SANITARY PERMIT oepRRtment ov m pustRU,LRBORSwumRnRELRTions ! (D pj -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION G4-T-Y: / _5 114-$ 1/4, S .,95, T21, N, R 10 11 (or W TOWN N OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I. D. NUMBER NA _s I A14 //W X /2 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair X Replacement ❑ Revision ❑ Privy I 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 U Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity ©60 Manufacturer. IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ M and In-Ground Pressure Total *of P fab. to Steel Fiberglass Plastic Gallons Tanks cret C ructed Septic Tank Capacity 4- 4 Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): N Private Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: (71 ) L -ZY 7 F Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date`. ❑ Disapproved ® ~z q / F ❑ Owner Given Initial ,LA,S ) ~ - 7 t7 S 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 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. 2 T2/ N-R 2 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION / LOT /f✓ LOT SIZE ~j PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i q7~ I CJe II C , Aaus~ 01 /00o Ve 16 ~111 1 - r C>U INDICATE NORTH ARR W z t BENCHMARK: Describe the vertical reference point used A& Elevation of vertical reference point: Proposed aslope at ite:~ 1 SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: /aFr anhoie o"er elevation: Tank Inlet Elevation: ut t e ation: Number of feet from nearest Ront, S' e,0 Rear,feet From nearest property linron ,O Side,O Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE STOF. p . . f PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Sip Manuf 'ctr Pump Size t Elevation of inlet: Botto oflt nk elevation: Pump off switch elevation: Gale s pr cycle: Alarm Manufacturer: Al ch Type: Number of feet from nearest /ropert ine: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM n Bed: Trench: Width: Length mter of Lines: Area Built: Fill depth to top of pipe: Number of feet from neares pro rty li Front, O Side, O Rear, 0 Ft Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pi Diameter. . Liquid depth: Bot om f seep e 'it elevation: Area Built: Has either a drop box 0 or distribution b x O Zen used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK (2- 000 ~00' J Manufacturer: z~~ Capacity: ~}9 des`, Number of rings used: A0t>r/e, Elevation of bottom of tank: 7 Elevation of inlet: Number of feet from nearest property line: Front O Side, Rear, O Ft./e~~ Number of feet from well: Number of feet from building: ~d Number of feet from nearest road: 220 Alarm Manufacturer : 41,9 Y-12) _ pa Inspector: 671~t~YY°-•f,~ '~-~Ce Dated: Plumber on job: License Number : 3/84:mj _ ItVWVW11\ 1., ` I 7 r ten DIV ISI Oi._. fi- LABOR AND PERCOLATION TENS xr115 P.O. BOX 7969 HU,IVIAN RELATIONS l" MADISON, WI 53707 I IW63.09(1) & Chapter 145.045 1 L C' T ON: SECTION: /D TOWNSHIP OT NO,:BLK: NO,: SUBDIVISION NAME: /T~n1~, (or C?IOW~Y?: QWNER'S/80YER'SINA111 MAILING A DRESS: Ze ; . USE DATES OBSERVATIONS MADE. NO.BEDRMSCOfV) mERCI ALDESCRIP fON: P I NTEST Residence New Replace IONS: ATI RATING: S= Site suitable for system U= Site lupssu.itable for system l`I a VENTEl I IMQUND S. [2U IN-GROUND P® URE: SYSTEM -I©ILLH® GTANK: RECOMMENDED Si STEM:(optional) DE IGN RATE: $ If Percolation Tests are NOT required [Floodplain, f any portion of the tested area is in the under s.1-163.09(5)(b), indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEP ROUNDWATE -1 CHES CHARACTER OF SOIL' WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER lei, 013SE VED ES EST' TO BEDROCK IF OBSERVED SEE ABBFIV. ON BACK,) Met Grp B- •o` g8t35,~~ At q /1/. 0 .13/ ~ Y 7.05 1 i ~ ' J/ B. .V. 94.35 r y' • ° 0 N a) imor -ilk a" ONE.) Ax i'w 'k 67 PERCOLATION TESTS T DEPTH . WATER IN HOLE T [ST TIME DR WATER EV -I H UMBER INCHES AFTERSWELLING NT RVAL-MIN. R D 1 RATE MINUTES E I D PER INCH P,- 4Z P- h- . P- PLOT PLAN: Show locations of percolation teats, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zphtal 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- SY$TEM ELEVATION 1. , r i I _ E . T. t - ~ i H i-(, I , JJ. I I I _ P1, U RI TG 13UiREA1'U i a ; ' i 1 I p~ - , i i I ' I I r k I, the undersigned, hereby certify that the soil tests reported on this fprm were made by me in accord with the procedures and methods specified in the Wisconsin Admipistrative 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: le 141;4 ADDRESS: , CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SI TURE: DISTRIBUTION: Original and one copy to,Lcip 'Authority, Property Owner and Soil Tester. IQILHR-SBD-6395 (R. 02/82) - OVER - pry r ~1 Ki r 6r3~ I ~ f '~Krr9 't t 1l r x. .14 . Q_ a r I • ~ L F - c YdF ys kn L F_ . CA, r~ ~ , ca 1 /''`era Cj ~ ~ c~~ q 1,31 ``I r 1 1 c~a 4S r'1i~ r r~?yam Py ,7t1~ ST. CROIX COUNTY IoZONING OFFICE )t4- W I S C O N S I N vy~yC 796-2239 (HAMMOND) ~8' 425-8363 (RIVER FALLS) HAMMOND, WI 54015 U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME : S G V-\ RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE. f> a~ yt~~~ ( P. 0. BOX 98 HAMMOND, WI 54015 TOWNSHIP: ~cj w 715-796-2239 or 715-425-8363 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY ECEIPTS FROM YOUR PUMPER•> NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING I#SIDENC.E: U SE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1986. OWNERS SIGNATURE mj :12-83 Ability Business Co, AeB*C Complete Sewer Services a Telephone 665-2112 Route 1 KNAPP, WISCONSIN 54t7~49 ate Work Per, or TOTAL COST Signature i 'f 190 I 0 ~i IN za ~l 4 n S -1... , v 1 u ` Q ~ 'PAY Yfp!j 9z F3 t ~ 0 c v ? ci^ e. ST. CROIX COUNTY x WISCONSIN r,~~5yn ZONING OFFICE 798-2239 (HAMMOND) 425-8383 (RIVER FALLS) - HAMMOND, WI 54015 August 12, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An onsite investigation of the soils was conducted on the Dennis Larson property located in the SEA of the SEk of Section 25, T29N- R16W, Town of Baldwin, St. Croix County. The inspection verified that the soils were suitable to a depth of four inches. This site should be suitable for a holding tank. Should you have any questions, please feel free to contact this office. Sincerely, .P - Thomas C. Nelson Assistant Zoning Administrator mi DEP*RTMENT OF - REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND 1 G P.O. BOX 7969 `HUMAN RELATIONS PERCOLATION TESTS (15) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.T- NO,: SUBDIVISION NAME: W, " 11 COUNTY: OWNER'S/BUYER'S NAME MAILING ADDRESS: G3~ lam/ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DES RIPTION: PRO!!;,. I.S IPTIONS: IMPI CATION TESTS: Residence A/ ❑New 1~ ratReplace T 14 RATING: S= Site suitable for system U= Site unsuitable for system - r ONVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑Sau EIS12U oS®u [IS Yu Dasou If Percolation Tests are NOT required DESIGN RA TE I If any portion of the tested area is the I under s.H63.09(5)(b), indicate:// Floodplain indicate Floodplain elevation: /~V/ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER BEE F. ELEVATION OBSERVED EST. I EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) /f'10-f f> 'f /1'1' 0 B-.2 41' 97.05 o B- 3 Al-O' '71o 1 3 5' 11 1) BI B_ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP LRI WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P I o 1 1 P A100 2 PER INCH P- P- P P- P_ P-_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan, Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION + + 3 E s t { , y~lt i f { E 3 c . . . ..-b. IN + t t t + I s ( t 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optionalT CST SI TUBE: & lea _S-~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - QIQ sh Rd. n..~ cn r f t,: o i 32a. .ter I~ ~ p- 45 a C)ILHR Safet and Buildings Division u. PLAN APPROVAL y . Bureau of Plumbing P.O Box 7969 11 General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Iduitification No. C.~ll<NYS Per [)0" z. _ ud Ll 00 j PBfOA'lY MILAN t i'tE'4N ONLY 211 _ e PlanFb vlew.toe ~~YE~IV d P #itit i5 $ot tfari~ n. e Rec. Project Name Project Location - Street No, or Legal Description 'S 1-: 4,5 2-S V11 Count F J city L l Village Town of: 73,4zJ The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This , pproval is based on Chapter 115, 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 he 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 he made: 0 FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1 (2) 3a) (3b) (4a) (4b) (6) (7) This approval will expire two years:from the ate approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By l James Sargent Bureau Director If Questions Plans Approved By: Date pprov I: Contact y a cc; rivate Se age Consultant ❑ Plumbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Sec, ion 11 W-SSW\4P ❑ Plumber C) Department of Agriculture DILNHR-S8t)-6099 (R. 01/8.5 1 : Owner ❑ Other i r nn A d r CA 'D A a r n IN. lt+ r ~ril~►11~(A1d 0 pil YR 'Awl H r' loZZ 4* AL ' ! ~33 4p n! V! R n C - f -1 d p" r -n Q 0 o~ O co )a in 0 on (P in X Uk 201 f,, C n . °9 o v , N T . D 4 m 0 . x D a ,gyp 3~Yd p Ilk o lop. N `d3une JN[m- n s~n,ht 1~ i and CI3nI3,03 O x n`'' z t o o,~ Q v p 0 <Q~ L~ ntid < rt ~o r U~~ p ~ O'1 1 Wpb 4 z o C ~o p vfn Z s w l Lc 0~ to f'I fc C A 4 -77 Ql a cz) r ~4i,' Via.. 1 f t` { \ RECEIVED' 1.f `J „a. ry` .1 j r•J AUG 14 1985 1.~ © t 4MRING BUREAU b F ,4s i ' (~)DILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, Wl 53707 Private Sewage Plans Telephone: (608)266-3815 r0 j S; Plan IdentilKalion No. C~allun5 Per Day, PRIORITY PLAN REVIEW ONLY Plan Review fee Kcc.ei eri $ Petition I or Variance Fee ftec. $ Project Name Project Location - Street No. or Legal Description L XTown my ❑ City ❑ Village of: / The plumbing plans and specifications for this project have been reviewed for compli ce with applicable code reqyrap emen s. Th' proval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans on itiona pro ved". 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. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. r FOR PRIVATE SEWAGE PLANS: (1 (2) 3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the ate approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent l Bureau Director f If Questions Plans Approved By: F. Date prov Contact ♦ / j F cc: rivate Se age Consultant ❑ Plumbing Consultant ❑ Environmental Health ❑ SSW ounty 11 Local PI ❑ Facilities Need Analysis Section MP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other SBQW8 (R'08/83):(Plb 100a) (Wis Stats. S. 145.02) 9~ ? I Dea,And Return Upper STATE OF WISCONSIN DILHR #F60t n Of This form With D1V1S1O1'r OF SAFETY & BUILDINGS BUREAU OF PLUMBING Any Return "Correspondence 201 E. WASHINGTON AVE. RM 141 P.O. BOX 7969 MADISON, W153707 608-266-3815 DATE: 08/14/85 PROJECT: Larson, Dennis - Resid 6 7 2( ) SE, SE ,25,29,1 6W Tn baldwin G C~ 'I vale Hudson St. Croix WI ®cG~ 820 Main Street co a [Baldwin, WI 54002 s PLAN ID. # CS 85-05155 r , - - - DETACH HERE Larson, Dennis -Residence - - - PROJECT NAME- PLAN ID. # 85-05155 This is to acknowledge receipt of your plans and Specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is$ 30.00 ❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑Overpayment- Refund forthcoming., Additional information required. SEE BELOW. ❑ Not fee has been remitted. Plans will be held in abeyance. I. PI n Submission . Additional information shall be submitted in duplicate unless' ❑ Soil boring and percolation test data on 195 completed specifically noted. by Certified Soil Testes (1 copy) ❑ Petition For Modification signed by county, owner and ❑ Plans not.cledr, legible or permanent. All information submitted shall be signed, dated and sealed or notarized. (1 copy) stamped in accord with Section ILHR 83.08 (2) (a)'Wisconsin ❑ Complete data relative to anticipated use of building. " El Deed restriction. required: (1 copy) ' Administr9tlve Code. El Affidavit enclosed. El Condominium declaration. (1 copy) Plot plan showing n locating of land parcel, (distance from nearest road intersection, etc.), lot size and aU distances from IV. Holding Tanks priv ate, sewage-. system to buildings, lot lines, welt; water- El Holding tank profile showing vent; .manhole,jgjarm; course swimming pools, water service piping, a_,,fi weath~w.rr cw.,_ and manufacturer if state approved: Complete vicerroad, etc. Show benchmark with permanent elevation. ;construction details if site constructed. II. Pressure Distribution Systems (Mound or inground Pressure El Holding tank agreement signed by owner and local ) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner and notarized. (1 copy) ❑ Reasonfor installing holding. tank. Statement from. county or soil boring and percolation test data on ❑ Countyonsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorptions stem El Soil boring and po=Iation test data on 115 completed by cannot be installed on the land parcel , Y Certified Soil Tester. (1 copy) ❑ Affidavit for atl-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V.. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy)' ❑ Calculations for total dynamiohead and gallons III. Private Sewage Systems pumped per cycle- ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Size, length and depth of forte main_ ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all. sides. Location of area suitable for replacement system- provide soil Size, pump curves, drawdown, and average flow rate (GPM): data. El Cross section of dosing tank showing pump(s) or siphon(s). ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to lan submissi constructed, or tank manufacturer if-state- approved. P on.) E] Construction details and cross section of soil absorption of trench befor El Total area before side ide slopes begin.) System. Depth and type of fill. Copy of signed onsite report by county or district staff. SB1 78 (R. 08/83)(PIb 100a) (Wis $tats. S. 145.02) A STATE OF WISCONSIN DILHR @ And Return' Upper DIVISION OF SAFETY & BUILDINGS " , Of Thl P~~ 4 This BUREAU OF PLUMBING Rio Form With 201 E. WASHINGTON AVE. AM 141 Any Return Correspondence P.O. BOX 7969 i MADISON, WI 53707 eoa- =S- lot PROJECT: DATE: 0$/23/85, cS Larson, Dennis - Residence 119. 2 SE,SE,25,29,16W Ta Baldwin Dale Hudson St. Croix W1 4 820 Main Street Baldwin, WI 540U2 PLAN ID. # 8a-05155 tDETACH HERE - - Larson, Dennis - Residence PLANID.# 85-05155 PROJECT NAME This is :to acknowledge receipt of your plans and specifications for he above-indicated project. Preliminary review indicates the required fee is $ 40*00 Fee Received is $ 30`00 Plan accepted for review. ❑ Underpayment-Please submit additional fee. Plans will be held in abeyance. /ft Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. No fee has been remitted. Plans will-be held in abeyance L Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (l copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarb!ed. (1 copy) I ❑ . All information submitted shall be signed; dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section'ILHR 83:08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑Affidavit enclosed. ❑ Condominium declaration. (1 copy) Plot plan showing location of land, .parcel (distance.from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed 'by owner and local Il. Pressure Distribution Systems (Mound or inground-Pressurep, unit of government (sample. enclosed). ❑ Application for Use of an Alternative, System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County, onsite required. (1 copy) Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. A', Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main.. Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. 'Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state-approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and . cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. v N 'r x ~ s p ~ (~D ~ Al ? fA Ul N 3 O V O A A 0 A A (D C:r a o °'3 'c: o w w w`~ w z ' =o ~3 3 am m °'o? o vc°cn m*oN~g~ N n ° avA o m 00 m ° W su A 8 CD :E cD ~ 0 0) , CD 3 CD -1 0 ~ ~ = CC n c~ f0 A O Cp N w O m ° °c „-.c°c° w omo-,~ w ~ 5 > > = o 3'ZS cZ Qm f w , r N ~ fD 7 ID d 0 'o CD OD -a 'a n c Ul ID Q N N ° D C . m p N° A A A CD s; w c ° aQ~ w O CL cn :3 Er'.0 Z 71 (D w (D A = ~D a a~ 3 M CD Q. D 0 co (D (A m No?:e 0a oc 1=0 Q 0 A 7 7 W cD°=aco~ vi D) a L n: A i m C Ri CD N= ° a CD cA n N V ~ C N 0 _ 'p Noc mc~oz(A lu 3a aQoc* m ° ~ y w (D M. w cx a° Q :r0 CD :1 mAc a O AN° °`-4 w C (D -~((D a cp s' c Z k 3D 3 ° c l. E r A (D O a 3 0 o° o fem. s~ <; • Via' m cc 0 - CNAI X COUNTY T . ; ~ i , k t ! ` t . ~a 2 o a 1 N G o F F i c E 796-2239 t P04t 044bice Box $21 Hampond, A 5401 Q M M ,E R p u m P E R A Q R F E M E M T PLEASE. BE AA4 isty, rhat untiiz, you axe, again not 'Cie d' 'I Witt, cQKuae.t With M.i.4ca 441 , (P"Apc-t), box the pu4poee 06 xemovins,, 44t w44,te J40" the aanits.ey Aotem to be Loea,ttd on the p40peAty and 6u.tu"a hoipe &ite toca.tgi$ in S.t. C4441 coaxtV, Wit cond-in, ToWmAh `.p o6 being tK the ob► the 4 06 sec., t.N.-1t.W. Wit 004a 6 ut4j( d o.4 cUb ed a4 j O to ow4 : ) Qa#ad tkiA d4y a cc~, (OWNER') State, bb M(.t~eQ+~4~~ i ~t 4 couat!/ 06 St c4 oi xa P44.40 *natty a ~ - pPew~.ed be.,6axt we th.i.e day 06 1 th'e above nap+al6 fM0, rrti~s L, ~ 5~ to ve` .o wn .to` e pit Aox whe exitdutIE4 the, Jot y MbZicp' $to 46ix County . My rop~m. (~.e pe.xmant) (E xp.tne4) 11--z$- , i, G~ ✓ he 4inbe6oa.e u6vtud to as Pi pen, jn A'44 the a# v a94-ce.0en to the e4toln,t that z ~ a contnac.t with Owed a4 4bove. Atated. At PER H r ST C- 105 r H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d y OWNER/BUYER ROUTE/BOX NUM~BER~ o Fire Number CITY/STATE ~~C/~p~tlE~~~~i~• ZIP PROPERTY LOCATION:.3-"" k, S)e Section.4?~~ , T ,C'5~2 N, R1~ W, Town of , St. Croix County, Subdivision , Lot number I 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. ti 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro 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. S I G N E D DATE -7/30 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 Location of Property It 5-r It, Section T -:2 N - R W Township Raldz,-~o!2 fl? 1~ Mailing Address IY7 zx,)OOCj-jZ/ & C.l~s~~ Jr D,C~ V Subdivision Name AIX Lot Number - Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes X_ No Volume e~ and Page Number 291 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 Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eetti.6y that aU statements on this 6oAm ate tAue. to the but o6 my (out) know•te.dge; that 1 (we) am (ate) the owner(s) o6 the pnopehty dese i.bed in this in6on.mati.on 6oAm, by viAtue o6 a wahAanty deed teeonded in the 06jice o6 the County Reg-isteA o6 Deeds as Document No. 7'~':5'3 , and that I (we) pAeeentey own the pn.oposed site bon the sewage diApoe system (oA I (we) have obtained an easement, to nun with the above dac4i.bed pnopehty, bon the constAucti.on o6 said system, and the same has been duty )teconded in the 066ice o6 the County Reg,is.ten o6 Deeds, as document No. ) . 1A SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) cz~ ea- 17 -ISI DATE SIGNED DATE SIGNED n co O i 3-0 n d ° c to O f5 c n 3 V m 3 3 r+ O n O m U) O ° co on eWi cNii O • co m 9' 3 o m y W o cNO C C ° 3 :D 00 x cn 7y a cLn O CD ° Cl) co 10. 0 C) cn 0) .'3 N N• vim-. ~ m ~p N a4 ~ ~ ~ I m cn ~ ~ ~ a ° H N• 1 -0 CD W O s ~D taxi W rt Z c a 0 _ o o h pql ON H H m . -4 ON L N N H a\ m co co n or m 00 co (D w CL T -0 -0 H O n oD OOO~' d (D a f~A m rt N O ISM ' C G N m _ 0 0 'v 00 m 3 m p Oo N so - a 1 v' o N ' co ` ~I Z cn ° zzzzo O I ytrJ o7 n ~ ~ m O D d a*1 M ° m ° td N w n ro x a o w m ED FJ' 2L 3 Fly N Z A Z u, (n v Z O A O ~ 0 N _I N pp T m cn z c A M 0) I y ~ W N Q 3 O T 3 N C p OZ C. fD N N A. n rC N b II m t N I yo N qO O~ I A O dQ qb N ffl at ° CL ti Parcel 002-1061-95-000 09/29/2006 05:06 PM PAGE 1 OF 1 Alt. Parcel M 25.29.16.383A 002 - TOWN OF BALDWIN Current IX 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 O - LARSON, DENNIS L DENNIS L LARSON 706 270TH ST WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 706 270TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 11.000 Plat: N/A-NOT AVAILABLE SEC 25 T29N R16W SE SE EXC PT NLY OF RR Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 06/08/2005 796988 2817/500 AFF 03/09/2005 789163 2761/549 LC 02/17/2005 787674 2751/347 AFF 09/13/2004 774200 2655/124 WD more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/02/1999 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 11.000 17,200 140,100 157,300 NO Totals for 2006: General Property 11.000 17,200 140,100 157,300 Woodland 0.000 0 0 Totals for 2005: General Property 11.000 17,200 140,100 157,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/16/2005 Batch 05-15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n(1)O3-u n d ~1 o c o v o to m i. v 3 0 o) r- C/) A~f N Q N .J~ • Sr 3 152 m O a N_ [ 1 tD a z a `::1. 0 W I O :3 a) N y N N w CL 0 0 CD 10 00 CD W 7 H v O O 0 C) o N 6 o. o CL m c N m s T a o o C4 3 O " ED c2 o ? N a o o 00 o li nr O c ~y y cn u, 3 3 6 !N N o o o N N OIQ CL CO j (n m 7 D O O M fu a Rp Z COD o 0 M - CD y n A N N O O A ° D D o r°v o O ° 2; "WA CD j ; Z (D x 3 ~ 7 C I N 3 ' N A Z I a C C N oov mom"' a z ~ 3 I A ~ o m ~ t3/I ~ A (D V W ~ ~D~ N D 3 m nm a m o- 3 a o N O 7 T *2 ~O w c m fl? z O s m ° • o acn o ai m a o v, a 'r p a 4 00 C" N0 °o a CD b o, y o cn g ti m c _ v v 7 0 m a e i p 0 cv 46, N oo O N ti to 00 0 F O b 00 Q ~