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HomeMy WebLinkAbout008-1051-20-000 i 0 y 0 3 0 I O 0 c " = 3 n 3 CD '0 9 ` (A r • 3 y 3 = cn z O -I = M p er[ O n m O m 0 O 4 CD m -I O CD 4 N C•'D -4 q c N 00 a ro z a cn m G7 co 0 `r7 CD CD N a m N ~Et En O W Nbd txrJ C) c C (D CD a , o 0 A+ U) C:13) :3 0 O P r F, Q O O m m a N CD w 7y a b rt G~ m (n W a =r ~ ~ 3 p j o o CD N) l~ Z , C77 W C'D (DD ~.o O m m n r- CA CD co w y O ccr !1 rt O cn cn 06 M l~~ m T "WA v y 3 y y y t- o cr T O D m N CD O d t'"• ~ ^D d 'NO w O I N lu syi GO N - r I n 7 O O N M D D o 01) 0 to Z OL O :3 ry r, rn to m x N ~ n I c ~ G G rr m (n 4'1 O p CD ? 2 A (D o' ~ w T M CD CD (D CL z o m rn y X (D a o CD n CCDD o' - w c z ' p a CD I I zz I ~ I A S A N W O O ti 0 (0 d0 V O N o b Parcel 008-1051-20-000 01/23/2006 03:03 PM PAGE 10F1 Alt. Parcel 17.28.16.264 008 - 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 GLENN W & HERMA L HENSLEY O - HENSLEY, GLENN W & HERMA L 308 230TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 308 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 17 T28N R1 6W 40A SE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/22/2004 757173 2530/479 QC 458/309 2005 SUMMARY Bill M Fair Market Value: Assessed with: 138622 Use Value Assessment Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 33.000 3,400 0 3,400 NO UNDEVELOPED G5 1.500 100 0 100 NO OTHER G7 5.500 27,600 179,200 206,800 NO Totals for 2005: General Property 40.000 31,100 179,200 210,300 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 31,100 179,200 210,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/1712001 Batch 513 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 276.00 Special Assessments Special Charges Delinquent Charges Total 276.00 0.00 0.00 i Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER r~ff TOWNSHIP i~i?/ SEC. T N-R W ADDRESS. l ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ItI LOT SIZE /y PLAN VIEW Distances and dimensions to meet requirements of II.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,35" y5- ou d ND Area 70 Ide Iay- r-, 351 '7, s~~ , ~ o l3 ' Ex~"s7~.~►9 0 1 INDICATE N RTH ARROW BENCHMARK: Describe the vertical reference point used e-') Elevation of vertical reference point: U r '!~0'0 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: /~©627/ Number of rings used: _ yo/1~ Tank manhole cover elevation: 97, 74~ Tank Inlet Elevation: 97, 0 Tank Outlet Elevation: V. Number of feet from nearest Road.: Front 10 Side @ Rear, O feet From neare8t ~ property line Front,OSide,®Rear, O /Oaf feet Number of feet from: well GO , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) 4F.F. RF.UF.RCF. CTnV PUMP CHAMBER Manufacturer: h~ /1S Liquid Capacity: L/ Pump Model: S~~D Pump/ Siphon Manufacturer: Pump Size / '_P Elevation of inlet: 74' 7 Bottom of tank elevation: 96- 7/ / s Pump off switch elevation: 11 1 Gallons per cycle: 7 Alarm Switch Type: /~/~rC Alarm Manufacturer: le? Number of feet from nearest; property line: Front, O Side, Rear, 0 Ft. Number of feet from well: o S5' r Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: L°S Trench: Width: Length: 7 Number of Lines: e~ Area Built: 3 /p Fill depth to top of piper Number of feet from nearest property line: Front, 0 Side, Rear,0 Ft Number of feet from well,: Number of feet from building: / (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Dilameter: Liquid depth: Bottom s page t elevation: Area Built: Has either a drop box O or distrib do ox bee used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation f bottom of tan Elevation of inlet: Number of feet from nearest property 1 F ont, , O Rear, 0Ft. Number of feet from 11: Number of feet from bu ding: Number of-feet from neares road : Alarm Manufacturer: Inspector: Dated: Plumber on job: -DI :71e License Number: ~ q _ 3/84:mj .DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. Box 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL 2ALTERNATIVE State Plan l.D. Number: ❑ Holding Tank ❑ In-Ground Pressure )QI~, of assigned) Round 8505714p NAME OF PERMIT HOLDER: ADDRESS OF PERMIT MOLDER PS qREF. TION DATE Glen Hensle R. R. l Baldwin WI 54002 BENCH MARK (Permanent ref erence omtl DESCRIBE IF DIFFERENT FROM PLAN . ELEV.: CST REF. PT. ELE V.: SE SE Section 17 T28N-R16W wn of Eau Galle Name Plumber. MP/MPRSW NnCounrymit NbDale E. Hudson St. Croix SEPTIC TAK/HOLDING TANK: 979 MANUFACTURER. W LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 1 `'eF (7--f x'74 PROVIDED: PROVIDED. BEDDING: VENT DIA.: VENT MATT HIGH WATER "YES ❑NO ❑ YES NUMBER OF Ron D: O J ALARM N PROPERTY WELL BUILDING. (VENT TO FRESH DYES NO FEET FROM LINE AIR INLET C C DYES O NEAREST__ r--~-illb~ - 1, DOSING CHAMBER: - MANUFACTURER BEDDING- LIQUID CAPACITY PUMP MODEL PUMP : SIPHON Mr 1 ~ q(:TUNER 1-1 w WARNING LABEL LOCKING COVER DYES r r... ` E 5 PROVIDED. PROVIDED: GALLONS PER CYCLE: [N-NO O ~ ` PUMP AND CONTROLS OPERATIONAL UMBER OF F (DIFFERENCE BETWEEN HO ~IYES ONO YES ❑NO ,o LINE Hrv wELL BUILDING VENT TO FRESH PUMP ON AND OFF) FEET FROM NE I AIR I LE ❑ YES ❑ NO____ NEAREST Y Js SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ""Ill or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE WANE rEH MATEHIAE AND MAHKwG the soil is dry enough to continue.) MAIN 3 CONVENTIONAL SYSTEM: Q W IDTH. LENGTH NO. OF DISTR PIPE SPACINC, COVER DIMENSIONS TRENCHES MATERIAL: NSIDE DIA xPlrs LIQUID PIT DEPTH R:1 `d EL Dr PTT' FILL DEPTH UISTH. PIPE DISTH PIPE DISTR. PIPE MATERIAL NO DISTfi BELOW PIPES ABOVE COVER EI EV. INLF I ELEV. END _j NUMBER OF PN OPERTV WELL BUILDING: VENT TO FRESH PIPES FEET FROM LI"E AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- YYES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE ~ PE RM1AANF NT MnHKk HS OHSEH NATION WELLS DEPTH OVER TRENCH RED pEPTH OVER TRENCH BED YES ONO DYES ❑NO CENTER EDGES DEPTH OF TOPSOIL SODUFI7 SEEUFO S ]MULCHED DYES. NO YES ONO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GHAVEL DEPTH BELOW PIPE DIMENSIONS y L' ) TRENCHES G FILL DEPTH ABOVE COVER ` f 14 MANIFOL PUMP MANIFOLD DISTR. PIP MANIFOLD MATERIAL NO WITH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND E EV7 EL ~ f CIA ELIE/ 'P PIPES CIA DISTRIBUTION ! / U L/ INFORMATION HOLE SIZE HOLE CING DRILLED C'11-I LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS COMMENTS: [AYES ONO _ ~ES ❑NO PERMAN ENT MARKERS: OBSERVATION WE LLS: - - NUMBER OF PR PERTV WELL. BUILDING: YES ❑NO FEET FROM LINE YES NO NEAREST IOU Ci S Cv Sketch System on Reverse Side. _ :W =8ta{n in county file for audit. SIGNATURE. yi TITLE. ssI DILHR SBD 6710 (R. 01/82) '~JDILHR w'a`onsl" APPLICATION FOR SANITARY PERMIT (PLB 67) OUNTY T OF 1nOUSTTngV,LRE30 RBOq6HUAlg1'1RElgTIC7n5 UNIFORM SANITARY PERMIT # ~ IrlOUST .7y 9175 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x ii inches in size. See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILIN ADDRESS PROPERTY LOCATION S 1/451/4, S , T , N, R (Dr W T41" OWN OF: 14:5-044, 4 ;a 1A _j Z LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.O. NUMBER /11Y//r1rJ~ frrJ ,/1/jSf o TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 L] Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair lr Replacement Se" *bSV1PtiUIrSy.M-M ❑ Revision ❑ Privy X Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vaulf Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ssued L~ An Existing System That Has Been Inspected And Is Compliant As Far As S03 -Condition Total #of Pre b. Gallons Tanks Co rete it str cted Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: X Mound L] In-Ground Pressure Total #of Prefab: Site Gallons Tanks Concrete Constructad Steel Fiberglass Plastic Septic Tank Capacity - - - - - - - - - - - - - - - - Lift Pump/Siphon Chamber 8o<0 X Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 ~ / Private ❑ Joint ❑ Public the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP/MPRSUV NQ.: one Number: Plumber's Address: Name of Designer: a COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 0 5- ~ /0 ❑ Owner Given Initial 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 ~ DILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing s P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 I'Lin Ideritificati(w No. E PRIORITY PLAN REVIEW ONLY f Ertiti~~n } ~~r ~'~~rl~nc~• I t•~• Rec. h Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village Town of: G \1V S T. C~, 1 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. ❑ 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) (3 (4ab( b) (6) (7) 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 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 Bureau Director If Questions Plans Approved By: Date Ap ov Contact ♦ ~f cc: Private Sewage Consultant 11 Plumbi g Consultant 11 Environmental Hea h County [I Local PI 11 Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other ` r State of Wisconsin ` Department of Industry,. Labor-and Human Relations SAFETY & BUILDINGS DIVISION September 25, 1985 Bureau of Plumbing 201 East Washington Avenue P.O. Box 7969 Madison, WI 53707 Mr. Glen Hensley Route i Baldwin, WI 54002 Petition No. 8505714-P Dear Mr. Hensley: Res Glen Hensley - Residence Private Swage System SE,SE*17,28,I6H Town of Eau Galle, St. Croix County, Hi 7 Section 145.24 (l), hisconsin 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 sting 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 September 21, 1985. The petition has been conditionally approved. The condition being that in the event of failure, the sound system shall be replaced with a holding tank or other off-lot system. The rule requires that a mound system have a minim of 24 inches of suitable natural soil. The variance requested was to install a replacement mound system on a site with IS inches of suitable natural soil. DILHR-SBD-6423 (N. 04/81) 4 ~ > ~ is a~ ~ s, `s" I r.... '4. ~ - _ i l r. ~ _ - _ I' i i State of Wisconsin ` Department of Industry, Labor and Human Relations Mr. Glen sl SAFETY & BUILDINGS DIVISION Hensley ~ tem16,, 25* 1985 Page All of the data and stet is submitted can behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for my additional modifications. Sincerely, Jams Quinlan* Chief Section of Private Sewage (608) 266-3937 JQPEPzl937v cc: Leroy Jansky* Private Sewage Consultant - District 6. Chippma Falls Harold C. barber., Zoning Administrator - St. Croix County boldts Plumbing, Plumber DILHR-SBD-6423 (N. 04/81) Y ,3' _ a i ~ ~ i...., ` r 4l ~ t1~ a C N W V T o a c,a 111 Z mom! r4j) xo 0- y Ito Zli w Lo 8505714 r~ -19, A3 -SEP 0 3 1985. P, MRING BUR A 'RECEIVED 03 c~ SEP 19 1985 *UMRInt0 13UFZEAA 1 t r ` ~ ' i 2",~ ~ ~ 4 t ~ : J x ..r' ~ : x ~ ~ ; - Yx~: y .1* 4 t '"tl~ ~ h x Ve' 1-~Iefis ~e Page I of _3 ✓ 131 Straw, Marsh Hay, Or Synthetic Covering 1 LZ { Distribution Pips Medium Sand Topsoil G 3 p % slope N Bed 0f 2"- 2 :z Force Main Plowed.. 00 • P~~ Aggregate From Pump' Layer D PF y'A~ Q. /GNG~ Cross Section Of A Mound System Using E ca / r. A. Bed For Th F F a Absorption Area ~u Signe Z°1uo-r A S Ft. M B q7 ft, icense Number: I 15,31 Ft. Date;-~-5! +t. K / Ft.IA.69 Alternate Position ' i • 7z-3 of 8 Force Main W Aotg Ft. 3fl tO571 4 L 14 Observation Pipe-,,' A'--------- W ~o - - - - Force Main - From Pump f.. Distribution ~u Bed Of 2 2 Pipe Aggregate Observation Pipe 4//1 Permanent Markers RECEIVED S E P 1 RECEIVE,) Pion View Of Mound Using A 8k*lPdt1 11T+ReBi Lion Area SEP 0 3 1985 PLUMBING SURE .r A U h d ` y As, as TI ~ ~11 R f of. M W Y` Page Of 3 CIO o~ Pert_oroted Pie Detail P N ~ ~PtiSP . ~ nd low )P@rfOfOf*dc End Cop) .1N PVC Pipe i . \0 ice NoNs Located On Bottom, S Are Equolly Spaced * PVC Foresrmain from Pump PVC Monifold Pipe "f n Qislripution- - Aitgrttgt• Position Of pipe Force M41i1 From pyfnp, . Lost Hole Should Be Next To End Cop End Cop Distrit>u►ion Plpe Layout P 23 f; R -5-338 S505,7 14 xz y Signed: Q- Hole Diameter Inch License Number;cJ Lateral, Inch(es) Manifold 2 Inches Date: .2 4:1;-~ Force Fain _ Inches RECEIVED RECEIVED SEP-1 190J SEP 0 3 1985 BUREAU PLUMBING BUREAU c ~ j 4 ~ r t ~ l ~ ;w 'y ~~t-Ai.<i ~I Olen nn lei PAGE 3 OF -J PUMP CHAMBER CROSS SECTION AA,ID SPECIFICATIOMS ' •---VEWT CAP 'I" C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING ? L3' FROM DOOR, JUIUCTIQN 8OX MANHOLE COVER WIIJCOW OR FRESH 12"MID. ..AIR INTAKE I GRADE I ( ( y,. MIN. C4IJOUIT IB"MILJ. PROVI DE AIRTIGHT SEAL, APPW/CAPPROVED 7011JT5 4N~ 6XTEtJDLNC• 3' h^ (\~N I L I W/C.I. PIPE EXIMG OIJTO SOI.IO Sr'',. 8 U'" ALARM O NTTO 0SOLi LI 3' D SOIL N~ G5 ( II c ~~P 0 Q~~~ ( I onJ F LNG - 0 PUMP -j OFF CONCRETE BLOCK RISER EXIT ERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIONS SEPTIC AND 8 505 7 1 DOSE TAIJKS MANUFACTURER: f'i71 S p DUMBER OF POSES; PER DAB TANK SIZE G L_LOAIS DOSE VOLUME ALARM MANUFACTURER: _ iCL r^I!7 - f (I INCLUDING SACKIFLOW: _4f- ' 7 RECEIVED -GALLONS MODEL AIUMBEK: CAPACITIES: AaINCHES OR j oGhi SWITCH TtIP[: Gt.~r S I J 1 - f _~01J5 LUMP MANUFACTURER*. MANUFACTURER*. ! Vci^ ~fY7t"d~ r~i EP 1 f9 C 2 INCHES OR/~t~_ GALLONS INCHES OR Aj?___~_ GALLONS MODEL MUMBEK' SP-104 pl_II l71'0'l' 18U~E INCHES OR _ZQY__ GALLONS SWITCH TYPE' Y' r^' / MOTE: PUMP AND ALARM ARE TO BE. PUMP DISCHA.itC.E RATE _ 701- 2O GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE at roI PUMP OFF ARID DISTRIBUTION PIPE.. FEET + MIAJIMUM AIETWD'RK SUPPLY PRESSURE , , , , . . . . . 2.5 FEET ;RECEIVED, + FEET OF FORCE MAIN X ' FYo fT.FKICTIOII FACTOR.. /113, FEET _ SEP 0 3 ]985 TOTAL Dyk,IAMiC HEAD FEE kUMBING BUREAU , IIJTERMAL DIMENISIOpUC OF TAUK: LEMC,TH ---WIDTH 7 sLIQLID DEPTH 3' 51GUED: ~r_4 LICE p ~t MSE LIUMBER: DATE: -117- f rr 16 I DEPARTMENT OF REPORT .ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ~ DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) Chapter 145.045)' LOCATION: s , SECTION: OWNSHIP LOT NO.: BLK. NO,: SUBDIVISION NAME: c__ 1 SE /£A i /TON/R/lCo W ,~`vu Q/ COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ~ ele • ~7~ 1 USE DATES OBS RVATIONS MADE NU.BEDRMS.: COMMERCIAL DESCRIPTION: rr-tte~ PRO OIL .D RI TONS: R O AT ON TESTS: ~Resldence 2 ❑New Replace p 19 ~ I " d ~y Y-11170--S-5, RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED $YSTEM;(optional) I EIS ®u 0s [:]U os ~u ❑s ~u as Quin If Percolation Tests are NOT requiredl DESIGN RATE: [Floodplain, n y portion of the tested area is in the under s.H63.09(5)(b), indicate: indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING ' TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF OIL WITH THICKNESS, C)LOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-/ q,(? goo WO-71.11 1 / Ct1 n947` B17 C eJ Ir e .32 Sn B-3 DO B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIO 1 PER D2 P R D PER INCH / P_ z C) i 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 _99.0 r r ,i t . i - i 57114 ~P E; EWED J_ . TN RECEIVED' l ~ C 1 ry i I SEW 0:3 19 8 Q AU PLUMBING i z r 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): TESTS WERE COMPLETED ON: J_DaltL ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - -1-. ui a Pte. a 10 L44 -C) Sp Z a If ~.R1 CS vl RECEIVED n P l 'v~ I fi EA0 v'f fob ~#J ~ QL, Q3 ej q ' irk 4c t too T ti 0.;M 5 t a c, i ty) 04 Cb► o O W O N W? S C C N 3 O N N a n A cD S S m m m C 0- 0 c O w ran c o o S~ ~n°vamo°oA N a C)o O •0)► ° CD = Oho n CD m CD d p~ A -00) CD Cn (n 3 CD ~ 0 0 m S cp n CD: °3ri ow~ o co h ~ co oo omo o 3 ° c rC-C: ni o 3 o a LA. m m co Z-0 -D C) oNC oDc~ o n _ 'pi n p c c S v a n ° ° a cD 0 CD cp ° S m CO) C o CD (A CD 0) (j) OM 5D * a- M CD CD o°'o=r- (D Z aCCD0 3Q ~oNa n D w as ?A*?c° QN a (D to ?ac'c m ?(Ds °N0)m0~ CO) m ~ m CD C ~ 0 CL =r 0 (D (D (A FA 0 CD Eft rr (a CD (D 60 N ° to a (D (A ao a, r ° c f CL a =r (D c 3 m A C a O N n CD o a° a C m CD CD CD C aoc a Sc a~ oo ° m CD 0 CD CD v_~Y APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property //17 Location of Property sz Section Z, T ,ZP N - R W Township 6/ //Z-- Mailing Address "17 -5~00 2- Subdivision Name Lot Number Previous Owner of P: Total Size of Parcel Date Parcel was Created i7a-17, /2 Are all corners and lot lines identifiable? X - Yes No Is this property being developed for resale (spec house) ? Yes No Volume ~45P and Page Number 30!F10/D as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: X_ 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 Mal), the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRT'✓ OWNER CERTIFICATION I (ale) ce4ti6y that aU, statementA on ,this 6onm ake tkue to the but o6 my (ouA) hnowtedge; that I (we) am (aAe) the owne4(4) o6 the pnopeAty dani,bed in -this in4onmati.on 6o4m, by vi&tue o4 a waAAanty deed ecoAded in the 066i.ee o6 the County Reg.csteA o6 Deeds " Document No. ; and that I (we) pAae.ntty own the pnoposed site 6oA the aewage c~,oda,2: aylstem (on I (we) have obtained an easement, to nun with the above descAibed pnopeAty, ion the eon,5tAuction;o6 .,aid by~s,tem, and the same hals been duty Aeeonded in the O{6ice o6 the County Reg,i s,teA o4 Deeds, o-6 Document No. ) SIGNATURE Oi' OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ' H ST C- 105 r r 9 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ° z d OWNER/BUYER ROUTE/BOX NUMBER. Fire Number CITY/STATE ZIP__54'00 Z_ PROPERTY LOCATION:5:~- Section 17 T Z? N, R W, 7 Town of St. Croix County, Subdivision /V Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-gite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v 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 X y~ DATE 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. State of Wisconsin ` Department of Industry, Labor and Human Relations -SAFETY & BUILDINGS DIVISION Septemb*r 25, 1985 Bureau of Plumbing 201 East, Washington Avenue P.Q._ Box 79619 Madison, WI 53707 Mr. Glen Hensley v Route 1 a Baldwin, W1 54002 Petition No. 854)571 y Dear Mr. Hensley: Re: Glen Hensley - Residence Private Sewage Systems SE SE,17028,1 fi111 Town of eau Salle, St. Croix County, WI Section 145.24 (l), hi ,.~a+asin Statutes, ark 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 sell system at a site which is not is full 'cempliam a 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 _statt, this variance shall be' rescinded. The petition for a variance requested to s. I t 83.23 (1) (d) of the Otis, Adm6 Code was 'considered on September 21, 1985. The petition has ban conditionally approved. The condition being that in the evert of failure, the mowW system shall be replaced with a holding tank or other off-lot system. The rule requires that a sound system have a minion of 24 inches of suitable natural so>i l . The variance requested was to install a replacea~errt mound system on a site with 18 inches of suitable natural soil. DILHR-SBD-6423 (N. 04/81) State of Wisconsin Department of Industry, Labor and Human Relations W. also ft"sifty SAFETY & BUILDINGS DIVISION I S"tWAW 2SO 1 Fags t All of the data and statements SuWtted an behalf -of the petitigner, Nor consi . This varian" is specific to the sect petition ad carat be ised for any additional modification, S *1Y* Quinlan. Chief Section of Priveft Sew 2637 JQspEPt1937rr cc: LWOY StY# P~ril#ate S*MP 3taet y- District 6, Chippwa Falls Ntrold C. tamer. Zoeing Ad"Distrator St* Croix county 801dts plw6ia% P1 DILHR-SBD-6423 (N. 04/81) U D' L H R Safety and Buildings Division P p a PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. $S c S l 1i t=~ r C;aNc ns Per Day PRIORITY PLAN REVIEW ONLY Plan Review Fee Received $ Petition I or Vari,w((, I ee R(~c. Project Name Project Location - Street No. ory Legal Description j County El City 11 Village Town of:~~~ v T. 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. ❑ 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) (3 (4a) )b) (6) (7) This approval will expire two years from the date approved b 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 Bureau Director ? If Questions Plans Approved By: Date Ap ov Contact y ~ !/y ~ .1 cc: Private Sewage Consultant ❑ Plumbiffg Consultant ❑ Environmental Hea h County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other