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Parcel 008-1063-60-000 01/23/2006 03:16 PM
PAGE 1 OF 1
Alt. Parcel 22.28.16.324 008 - 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
WILLIAM C JR & CATHERINE GODWIN O - GODWIN, WILLIAM C JR & CATHERINE
260 250TH ST
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 260 250TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 22 T28N R1 6W 40A SE NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-28N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1136/130 WD
2005 SUMMARY Bill M Fair Market Value: Assessed with:
138721 Use Value Assessment
Valuations: Last Changed: 08/04/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 27,000 111,000 138,000 NO
AGRICULTURAL G4 33.000 4,100 0 4,100 NO
UNDEVELOPED G5 1.000 100 0 100 NO
AGRICULTURAL FOREST G5M 3.000 900 0 900 NO
Totals for 2005:
General Property 40.000 32,100 111,000 143,100
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 33,000 111,000 144,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 513
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 138.00
Special Assessments Special Charges Delinquent Charges
Total 138.00 0.00 0.00
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP 4~T Rf ~P _ SEC. T .~d N-R/A~ W
ADDRESS ST. CROIX COUNTY, WISCONSIN
WOO acv: 0 7
SUBDIV /3 Z
ISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
76U S r.
0
m
Lo
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: b U Proposed slope at site:' S
SEPTIC TANK: Manufacturer: ti~'e-A Liquid Capacity: d d
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road.: Front (7%Side O Rear, > > , O feet
From nearest, property line Front,®Side,QRear, O ® 0 feet
Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE STDR
PUMP CHAMBER
Manufacturer: S Liquid Capacity: 7 ~~V
Pump Model: , G 3 L Pump/Siphon Manufacturer: Z att U Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Y Trench•
Width: Leng't'h: Number of Lines:_ Area Built: J
l
Fill depth to top of pipe:
Number of feet from nearest property line: Front, `J Side, O Rear,0 Ft P~y
i
Number of feet from well: Sfg
Number of feet from building: Sr '
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: A
Plumber on Job-
Dated: License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS
DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
❑CONVENTIONAL KNALTERNATIVE State Plan I.D. Number:
❑ Holding Tank ❑ In-Ground Pressure :KN Mound (If91M126
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER:
INSPECTION DATE:
Craig Mohn Woodville, WI 54028 a14S
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV.: IcST REF. PT. ELEV.:
SE NE. Section 22, T28N-R16W, Town of Eau Galle
Name of Plumber MP/MPR SW No.. County: Sanitary Permit Number:
Stephen Aaby 5184 St. Croix 69612
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: CITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
/ / n. it Ate. PROVIDED: PROVIDED:
l/v /`~J 7 YES ❑NO ❑YES GTNO
BEDDING: VENT DIA.: VENEE73 NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
❑ FEET FROM LINE: AIR INLET
Y ES ❑ N O G EST ~~bv { /tJ~of SS Z/
DOSING CHAMBER:
MANUFACTURER, BEDDING. LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL pt
/ Q~j PRO IDED: ❑ h/,q YES [XN O 7 o (~G6 " ""r YYES ❑No GALLONS PER CYCLE: PUMP AN
D CON I HOLS OPERATIONAL: NUMBER OF PROPERTY WELL. BH
(DIFFERENCE BETWEEN FEET FROM LI/- / PUMP ON AND OFF) ES NO NEAREST 6e SOIL ABSORPTION SYSTEMCheck the soil moisture at the depth of plowing
LENGTH uIArER MATERIAL AND M. or excavation. (lf soil can be rolled into a wire, construction shall cease ntil FORCE
the soil is dry enough to continue.) MAIN r yCONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH NO.OF DIST .PIPE SPACING COVER INSIDE DIA #PITS LIQUID
DIMENSIONS TRENCHES TERIALt PIT DEPTH:
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DIS . P MATE IAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER. ELEV. INLET. ELEV. END. PIPES: LINE:
FEET FROM AIR INLET:
NEAREST--- ►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
IY meets the criteria for medium sand. TIONS MEASURED.
DYES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS.
Sr
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED YES ❑ NO nES ❑NO
CENTEREDGESSEEDEDMULCHED:S ❑N
❑YES NO XkYE❑EO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL ?t ELOW PIPE. FILL DEPTH ABOVE COVER:
DIMENSIONS C/v TRENCHES: ~
MANIFOLD PUMP MANIFOLD DISTR. PIPNODISTR. DISTRPIPE DISTRIBUTION PIPE MATERIAL & MARKING:
E~~ELEV DIA ELEV. PIPES DIA
ELEVATION AND ~C
DISTRIBUTION
INFORMATION HOLES fZ /j HOLE SPACING DRILLED CORRECTLY ATERIA_ L PLANS
TI CAL LIFT CORRESPONDS TO APPROVED
L /~y
J
YES _ ❑YES ❑NO
COMMENTS: PERMANENT MARKERS NUMBER OF PROPERTY WELL: ITr
F
EET FROM LINYES ❑NO ❑NO NEAREST Sketch System on in in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD 6710 (R. 01/82)
ooww~ unsconsin APPLICATION FOR SANITARY PERMIT ,
CO DILH(PLB 67) COUNTY
mousraV,cweonsHUman~ UNIFO M SANITARY PERMIT #
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/:x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRE S /
C 12-;41 h /oa !/I G.-4 ,r 6& / l
PROPERTY LOCATION
.C*W
f.E 1/4 1/4, S _ N. R (or) To e: frG{ 94.~
LOT NUMBER BLOCK NUMBER SUBDIV SION NAME NEAREST ROAD, E OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): 111
THIS PERMIT IS FOR A:
X Newogy&te m ❑ Tank Replacement ❑ Re air
El Replacement Soil Absorption System p
Revision ❑ Privy
IN Alternate System ❑ Reconnection
❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed
❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
J System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit #
issued
An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: X" 5 ,1' S Co tt A -f
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound
❑ In-Ground Pressure
Total *of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity ~Qd
Lift Pump/Siphon Chamber
Manufacturer: /,r _r.A 1 ilf"C ot e
V ZZZ12 RPTION AREA ABSORPTION AREA
ED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY:
~ a Private ❑ Joint ❑ Public
I, the undersig
ned, he reby assume responsibility for installation of the private sewage system shown on Mthe attached plans.
Name of Plumber E(Print): Signature:
10
P/MPRSW No.: Phone NumberSig Plumber' AddresName of Designer:
GAG' ~LC~' /Gb
COUNTY/DEPARTMENT USE ONLY
Signatu of Issuing Agent: Fee:
Date:
~~7j ❑ Disapproved
10 Owner Given Initial
Reason for Disapproval: APProved Adverse Determination
Alternate coursels) of Action Available:
DILHR SBD 6398 (R. 5/82) DISTRIBUTION:. Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
PLAN APPROVAL Safety and Buildings Division
D 1 L H R Bureau of Plumbing
P.O Box 7%9
❑ General Plumbing Plans Madison, WI 53707
El Private Sewage Plans 7 Telephone: (608)266-3815
OEFlCE USE ONLY
Plan Identification No.
r
119
Callous Per Uav
a
E
PRIORITY PLAN REVIEW ONLY
Plan Review
Petition For Modification
Project Name Project Location - Street No. or Legal Description
County
❑ City ❑ Village Q--Town of:
The plumbing plans and specifications for this project have been reviewed for compliance with~jle Eae}e'Fequirements. 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:
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.
El FOR PRIVATE SEWAGE PLANS:
This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary
permit expires.
Comments:
By:
James Sargent
Bureau Director
If Questions Plans Approved By: Date Approved:
Contact
i
cc: SJWS ❑ DPS ❑ H&R & Rec. San. Section
' County ❑ Local PI ❑ Facilities Need Analysis Section
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other
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8504126,
copjitioS1
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+ L
t1S:. Ialjjs{`e i-Pi$L`R AND SEA CQRr(i:I-PONOENCE
f.
Page _ Of
Perforated Pipe DetalI
0
End View
Perforotea
End Cop A PVC Pipe
Holes Located On Bottom,
s Are Equally Spaced
S
* PVC Force Main
From Pump
48 504x26
PVC
Manifold Pipe
Distribution Alternate Position of
Pipe Force Main from pump
Last hole Should Be
Neal To End Cop
End Cop 4i
Distribution Pipe Layout P •7 `~+~'gt'` '
r~
R 1d2 -1
rr ~ ( ~l3
X°'
Y
Signed: Hollef-Diameter /y Inch
G
License Number: J* Lateral Inch(es)
Manifold "
Inches
Date: 60s Force Main 3 Inches
PLUMBINQ
(fo n Il r, z
1.4
6iy~~l~~ v~ ~ f rit _.;''s
VVV
SEE CORRESPONDENCE
1 ✓
Bulletin CL21A
July 8, 1983
For Homes -
Farms G 0 o 1. _.,y
Trailer courts Model 3885
Motels (Supersedes Model 3670)
Schools •
Hospitals Submersible
Industry E"'"411^'Pul" Effluent Pumps
• Effluent Systems F'un?L, •`II ublic.-bons
anywhere effluent •:uluh liun.:!uly t::,,,..Inllly lu
or drainage must be 1 ulat:h.ll,l' -,11.,
disposed of quickly,
quietly and efficiently.""'
4 ~.uu 0, u,ll 11.1, b ll uu',h.dl I hl,•,•,d41~.,
Moll . Is " uul,• 11. 1 h,, mull lu,ncvl ul .u t.uh:nl.,l
h.n t oil Piny, „t11 v.uu•:. un h.n.h-d,h: ul ulgn•Ih•1
IIn ,nuL'1 U.nl„ 1 rill
t.h.uut..d .I:.d
' C.uu1lJ
~~1IIUIc 111"" 1•,1 n1.1•.Illlllln t•IIII N'IICy
Heavy-Duty Solids Handling
' x,'11.", .il 111 '.I. Ill dl:'.:. '.1, Illl 1.11111 /'.I, 111
Dependable Capability to'/."
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~•,,'lln,l.Il:•1luubl ld 11, 1'.~IUlllt•1
. M.Illllllulll 1 t:uyx:l:uwL!
'h, 'h H.P. 60 Hz ~I ; 11,11
Single Phase 115, 230 Volt. (:"'''''''l; l'' llL""ull Dry
W11111 1111 tIJ111J,,,1 lu to IIII,,UIIt.'111L.
Motor S'pecitications
'h,'/4, 1, 1'h H. P. 60 Hz j M11101 I-Lilly ;lulnul:lycLI
nl lul)h 1,1.1+11 lullnrn: I,11 ICn ,,Innl,lnl•nl lulml a
Single Phase 230 Volt. Three
~ luul ul I„~.uunp. ,Intl nurt.14uu1::11 r,c.d ,uul
Phase 208-230, 460 Volt. nil 1, nl I11 •d ,Ir.,.1,,.111tiI1. (vlulnl LI.11,:1, hl,nl
{ rnuuunll•nl toy n,.pp ll+:.l l Mull unt.lu:,wl
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11::.1:.1:1111 1111,•, 1111 •,I :,11.111
04-12
C F• ' ` 8 Sit-suit: 1'll.lav Ulm.
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1` uvullu.ul,,l,dl•, hl ,u vr1111.udunl,llu, n:;.cl
80 7h1eL 1'h.l:a lhnla
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~.1a s, ' + +s C 12 •1611 VoW. I Ill,
70 MODE.4 3"
•,ulull ,Il,dl Inl l l: u,ntl.lhun
W W tOH: ( - WL; RP1 - ,1740 f 4~Q r a i Power 00041
W.Ilcl .ll"I „1) n•'.I'.1ald I ,,u.y .11 .'u lnulnl I:u,l
so
y IIIUL dIU I' 1411 n1r1 111 c,v.t: ul
W ,alt ~w0 M hl: t1.111LU1r 1„,nllrl ,.u brill l,, (,Ullu:.lull llr.,l`:1.1111
U so - 71
1,1•n1,l llul
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O 30 WEO3MV FU J t + lll,rvlll, t,n„ny pulln,hlnll'luy I. 1' I11'
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t•
SPECIFICATIONS ARE SUBJECT TO CHANGE
10
WI IHOUT NOTICE
0 10 20 30 40 50 60 70 80 90 1.00 110 120 GOU LDS PU M PS, I N C.
GALLONS PER MINUTE SEW-CA FALLS WW mK 13140 C7 I
( 011,
•
PACE Gr
PUMP CHAMbk ( C.KOSS SECTION AMU SPCCIf ICAI 10kh
- VC MT CAP
4"C.1,. VLMT PIPE
WCA FHI K PKOOF AVPKOVE U LOCKING
25' FKCM ULUR, I JUNG rION bOX MANHOLL COVEK.
WINDOW OK F-KL 5H IZ"MIU.
AM IAITAKE I
GRADE I
I y. MIAJ.
L IES" MIm.
COUDUI7
16"MIN. - _ -
INLI.
AIKTIGH'f SEAL I I i I -
I i
APPKUYL U JGINT A I
WIC.I. PIPE I I APPROVED .1G.
_ I I W/c.i. rlPk
4CflNUlAG 3' II OWTU SULIU ,r.It- ALARM EXT"
B I I I ONTO O 50LI SOl1U
I
L''
' PUMP ~t,~A ,
If Qov
U
r~
CJJ, I ~ 1iJCKETk bL0CJl i t
<~-itd e -i'STL 'f
KISLK EXI1 PLKMITI'ED UNLy IF T{
K VAL
SPECIFICATI0K1s V '
_VTIC ANU
jLL TANK`.. MAMUFACTUKEK: _ I' f I lni~CfPl C
f\IUMBk=K VF UUSES: ._PEK DA-'J
1AMK :AZL :
1 _ 6ALL0IJS DOSE VOLUME: f ALlU1US
ALAKM MAAJUFACTUKG-FC; C
L_ t }
- CAPACITIES: A=_ 5-1KILHES OK 33 i GALLU-
MUUE.L 1JUMbEK:
LAW - B= L INCHL5 UK - X13 GALLOki
SWITCH TYPE: O
C=T, IMCNES OK - ( ~ GALLO4
I'IJMP MAN111 AC. 1 UKL K: ~S
IMCHES OK GALL01
M011L L NUMbLK:
( NUrL: PUMP AND ALAKM AKL TO fiL
SWITCH TYPE: _ 'I IL W51ALLLD ON SLPAW-E CIKCUITS
PUMP DISLHARGL KATE: GPM
VEKTICAL. DIFFLKENLL bLTWLLN PUMP OFF A S
AIU DISTKIkSUTION PIPk:.. i-1, FLCI
+ MINIMUM WETWOKK SUPPLY PKESSUKE .
J 2•S FEET
tC7-` FEET OF FORCE MAIN X Z ti V -
u>ut~.FKICi'1011 FACTOR.. LJ_ FEET
TOTAL Dy1JAMIC HLAD c I~ 11 cp
IWTLKNAL DIMLWSIONS OF TANK: LLMC,'FH 7~ ,I
-----..--;WIDTH ;L14LIID OEPTFi
Page _ Of _
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
Topsoil
F
3 E p
% Slope
Bed Of 1-2 2 J~12' Force Main Plowed
Aggregate From Pump Layer
Cross Section Of A Mound System Using F '4
A Bed For The Absorption Area F 7S
Signed: A 8 Ft. H I .5
B 5 Ft.
License Number: 0* S/
I 1 ~ Ft.
Date: -7-/~ J cg Ft.
Kl~ Ft.) '
Alternate Position L F "O-~'I
Force Main W I C? Ft.
L
} Observation Pipe
W lo ----j--------------- Force Force Main
- - From Pump
Distribution Bed A.
01 2. 2 2
Pipe - i"
'
'Aggregate
Observation Pipe Pery}honent Markers
Plan View Of Mound Using A Bed F`or` T'heAbsorption Ar~e;g4 ~ y lJ'
r
DEPARTMENT Or REPORT ON S IL ORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(H63.090) & Chapter 145.045) i
LO A ION: SECTION. S (or TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME:
J- /T g!/R/6
VIN I Loa G L /V N
COUNTY: WNER'S BUYER'S NAME: MAILING DR SS:
Gxoi c A►' oAh R T ooQr. ,LG.~ w; S'yd
USE DATES OBSERVATIONS MADE
NO.BEDRMS,: COMM R AL DES RIPTION:
Residence 'E New [TffMEE DESCRIPTIO IPERCOLAT ON NS: STS:
❑Replace / 0
RATING: S- Site suitable for system U- Site unsuitable for system G, 3 d
ONVENTI NA L: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM-1 ptional)
DS I.U ZS ou DS Ell DS ~U _ DS gu 2,ouH:
Percolation DESGN RATE: If any portion of the tested area is in the
If Tests are NOT required I A~11:7
under s.H63.09(5)(b), indicate: ~Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS T
BORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED ES I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-/ y. S' .3 oNk. a./' /.5' r~flsza
;t~•T
B- 2 6 o N k • ' . 9'131t1. / • O' 67 s t R sit.
I Ll. B-,~' 5 7• D ►v E 3• g aIL • S G S L . a [ S. ' SfC. ,+v,GT
B-
B- ? E C E 1'V Fa
B- J L
PERCOLATION TESTS
I ~ DU"
, ~ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t I PER INCH
P_ 299
P- S o / y
P- 7S • S' Alo
d /
P-
P-
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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 borinait4hgdryign percent
of land slope. 8 ifr)1
SYSTEM ELEVATION • G
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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:
STS 1,xh is- _
ADDRESS: CERTIFICATIOON Nl,(MBER: PHONE NUMBER optional):
CST SIGNATURE:
00
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
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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/contractQx,("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 C Jc A12 At
Location of Property 14 ~X Section, T N- R 16
W
Township
Mailing Address-/Z/7,4 Subdivision Name
Lot Number ZZIA
--r
Previous Owner of Property
Total Size of Parcel Ac ,fix
Date Parcel was Created 6~ L7 - 9
Are all corners and lot lines identifiable?- Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number S 3 / 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) centiby that att statement6 on thi,d bonm cute tAue to the best ob my (oulc)
knowledge; that 1 (we) am (one) the ownen.(s) o6 the pupeh ty des ch i.bed in thi.6
inbonmati.on bonm, by v.i4tu.e ob a waA&a.nty deed &ecotded in the Obbice ob the
County RegisteA ob Deeds ad Document No. ---rt /A .S ; and that I (we)
pnesentQ.y own the proposed .a.ite bon the sewage pod system (on I (we) have
obtained an easement, to hu.n with the above dedeJ[,ibed ptopeA-ty, bon the
condtAuction ob sald system, and the same had been duty teco)Lded in the 066ice
ob the County Regizten o Deeds, ad Document No. T 0 jd,9S- ) .
I A"A-- 4. /g A~ffl
/I a-9~1
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
i
7 -S 7/Q(e jF
DATE SIGNED DATE SIGNED
H
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ST C- 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
OWNER/ BUYER
ROUTE/BOX NUMBER ~ ..L Fire Number f~
CITY/STATE 611o,VWJ1 Z L.* z/j ZIP S"L,1-d
PROPERTY LOCATION : SjC 14, Section o' TN , R 6 4 W,
Town of 'E/44t. 6.J1LLz St. Croix County,
Subdivision Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into II
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. H
0
E
I/WE, the undersigned, have read the above requirements and agree EA
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
DATE 7/a 6
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.
SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) {[x`
STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILDINGS
Portion Of This Form With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 141
Any Return Correspond e ; P.O.BOX7969
MADISON, WI 53707
" 606-266-3815
DATE: 07/12/85 PROJECT:
s Mohn Craig - Residence
3a(b
SE,NE,22,28,16W
Tn Eau Galle
Stephen Aaby t St. Croix WI
124 Main Street
Woodville, WI 54028 PLAN ID.
85-04126
DETACH HERE
PROJECT NAME Mohn Craig Residence PLAN ID. 85-04126
#
This is to acknowledge receipt of your plans and specifications for the above-indicated•project.
.80.00. .
Preliminary review indicates the required fee is $ gd d~ Fee Received is $
/1011 $ Plan accepted for review. El Underpayment Please submit additional fee. Plats will be held in abeyance.
Plans being returned.'~ Overpayment-Refund forthcoming.
❑ Additional information requiJ9 ISELOW. ❑ No fee has been remitted. Plans will beheld in abeyance.
1. Plan Submission ❑ Soil boring and percolation test data on 115 completed
Y ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy)
specifically noted- ❑ Petition For Modification signed by county, owner and
❑ Plans not clear, legible or permanent. notarized. (1 copy)
❑ 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
II. Pressure Distribution Systems (Mound or Inground Pressure) 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 i
❑ Soil boring and percolation test data on 115.completed by cannot be installed on the land parcel.
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 ❑ Detait 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 V1. 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.
State of Wisconsin ` Department of Industry, Labor and Human Relations
July 19s 19M SAFETY & BUILDINGS DIVISION
Bureau of Plumbing
241 E. Washington Avenue
P.O. Box 7969
Madison, WI 53707
Mr. Stephen Aaby
124 Main Street
Woodville. W1 54028
Plan Identification No. 85-04126
Dear Mr. Aaby
We have received your plans for an alternative private sewage system. The
purpose of this letter is to inform you that approval for said system cannot
bear anted until such time as the disposition of the State of Wisconsin budget
is finalized.
t
Authority to approve alternative private sewage system was as per section
145.022 Wisconsin Statutes which sunset Jim 309, 1985. Sew enabling
legislation for this @epartowt to provide alternative private sewage system
approvals is a part of the above referenced .budget, bill. Up" final
disposition of the above we will take appropriate action on your plans.
Sincerely,
James Quialafts, Chief
Section of Private Sewage
JQt 13'1Ar
DILHR-SBO-6423 (N. 04/81)
ST. CROIX COUNTY
WISCONSIN
dar ZONING OFFICE
{
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
Mir
- .w
July 10, 1985
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir:
An on site investigation for the Craig Mohn property located in
the SE14 of the NE14 of Section 22, T28N-R16W, Town of Eau Galle, St.
Croix County, revealed suitable soils at a depth of 2.1 feet, below
which seasonable high ground water was noted.
This site should be suitable for a mound system.
If you have any questions, please feel free to contact this office.
Sincerely,
Thomas C. Nelson
Assistant Zoning Administrator
mj
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. Croix
'Location SE 1/4, NE 1/4, Sec. 22 , T 28 N, R 16 XVJ W
Town X HK* jUy Eau Galle Street Address
Lot No. Block Subdivision
Landowner's Name: Craig Mohn
The application for this site is for:
19new construction use.
❑ replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
to have one of the first five approvals guaranteed for this year. This is
number - - of those applications. (Use one of the first five
quota num ers ssuea to you.)
M one of the applications needing a quota number. The quota number assigned to
this application is 59 - 11 - 6
❑ for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
(Ifor an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by the
department.
[._.]for an application,on file prior to February 1, 1980.
Ll for a lot that meets the criteria for a conventional private sewage system.
If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is
replacing:
❑ a failing conventional soil absorption system.
C] a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a
conventional private sewage system, check here .0
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomas C. Nelson Si9ft ure
County Official
Title Assistant Zoning Administrator Date July 10, 1985
DILHR-SBD-6158 (R 12/82)
STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR
THE USE OF AN ALTERNATIVE V
N LTERNATI E SYSTEM
Location: Township/ ~j~tp 1 f~
SE 31' NE S 22 T 28 N/R 16 NW)W Eau Galle St. Cnoix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Craig Mohn R. R. 1, Woodville, WI 54028
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises.are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for 'the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
94.gnature of Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF This day of 19
Notary Public, State of Wisconsin
DILHR-SBD-6413 (N. 05/81) My Commission Expires:
DEPARTMENT OF REPORT ON S01 BORINGS AND SAFETY & BUILDINGS
INDUSTRY, I DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
AIF.
LOCATION: SECTION: OWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO. : SUBDIVISION NAME:
S /T g 11116 (c,4 T,Etta L /V I /v W&
COUNTY: OWNER'S /BUYER'S NAME: IN ADDRESS:
C)eof c A,' ~'loti x RE T oovl, iLL- Gv; a 9
USE DATES OBSERVATIONS MADE
Residence NO. BED BMS : COMMER AL DESCRIPTION:
New ❑Replace ROFILE NS: I TESTS:
G~ o d g".ls
RATING: S- Site suitable for system U= Site unsuitable for system
ONVE TTIONAL: MOUND: IN-GROUND-PRESSURE: ISEIS YSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:1 ptional)
0SZU I ZSau aSEu ~ .u IHEISC,u ;!!f o44 14Ql
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS •~~r
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- / 141 S' . 3 a N k a / ' . 3 ' a - I . / . 5' S z e , , )..q 9s; c ~.1
13-d2 cS 6 aNk o'~ & Sit. B-~ ,g5 a►v~ 3- 4 ~l32 2.5G SC. 5 n Cs. ' s►t, 6T
B-
B-
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PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- l S O d a I l i r
P- a2
P-
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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
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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:
SA h - Ado 61- / 7_<
ADDRESS: CERTIFICATION N MBER: PHONE NUMBER (optional):
owl, it- 71 -d. L/41 7
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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P S
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Mani old Pipe
Distribution Alternate Poaltlon of
Pipe Force Main From Pump
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Signed: Hole Diameter /y Inch
Lateral Inch(es)
License Number:
Manifold 2 Inches
Date: Force Main S Inches
\ Bulletin CL2.1A
l July 8, 1983
For Homes Ear
y Farms G4 y
Trailer courts Model 3885
Motels ?t co (Supersedes Model 3870)
Schools k •
Hospitals Submersible
E"luenlPump Effluent Pumps
Industry
Effluent Systems PL1101.; `specificatioll
anywhere effluent Sollds H"ll':4fi,l C,t1,.11,lllly to v,',
or drainage must be Dlhat,tty„ SIzt:
disposed of quickly,
quietly and efficiently.
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10 ` .i SPECIFICATIONS ARE SUBJECT TO CHANGE
WITHOUT NOTICE.
0 e;
0 10 20 30 40 50 60 70 80 90 1.00 110 120 ' [ GOU LDS PUMPS. INC.
GALLONS PER MINUTE SEIdKA FALL`. M_w YOIIK IJ148