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Home My WebLink About028-1041-20-000 G a E -V G td 0 y O c o a, cL I o m d b tr c m~ ~ 0 tD N, N I ~C n 3 # ~V (D (D CD £ ~t 3 = >v C/) Cn S' S cn W O I W 3 S17 O 0) V1 O O? N C U, N TWA • CO 0- In O cn c\ n 3 o N m (n h••i ~~ll w O a 3 Z n v 01 N N y y W tOn T v G 1 N ! m N C ro = n a m p R O Z CIO y 3 o cD o o 'D c y m CY) 7 O H O C D a (D CD U) Ln CL it a cc CD N IW o v, of i 3 CD ~z O cn \ - CD W V I ( co H o 00 CD `o f n r cn j N CO ce'n 3 K oc, ON o r r v v Ln N• I'd o O O O a (D JE (D n 1 0 co 3 u N ti o (n T ID I - C-) m O (D o CD - (n ~3 ~ ? 1 D N G C W W y 3 m In C D D m r i Oz N zZ c ~ I 0' D D o m O ~ I o a I c~ I ~ w cn a G F-' A Z W 0 (D i O , FD' G N O (D Fl- Z -1 w rt a) -o v H o Q m co u ~0 r. m v, 3 C) w w ~ C) CD N I w CL a ° T r- c I z o a In CD W N H y o N a, `z z I • V A x G Z~ N I :3 cn N r t I~ O Cl) O C' a W (D ~ ~ A A CCDD D O cfl O O O d LO b 1•''~- 61- 1 A3 t2 19 o--,ems ~r~---- ~i'~T 1 ~ y to ~3 ~ I I ~ to Qj N. N. N. 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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 - SPIEKER, MICHAEL JOHN MICHAEL JOHN SPIEKER 1961 10TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1961 10TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 35 T28N R17W NW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 09/13/2004 774185 2655/001 WD 03/22/2002 674324 1859/215 QC 08/21/2001 654348 1703/266 WD 07/23/1997 952/26 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 83034 Use Value Assessment Valuations: Last Changed: 09/02/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 29.000 4,700 0 4,700 NO 05 UNDEVELOPED G5 3.000 3,600 0 3,600 NO 05 AGRICULTURAL FOREST G5M 7.000 12,300 0 12,300 NO 05 OTHER G7 1.000 6,500 166,200 172,700 NO 05 Totals for 2005: General Property 40.000 27,100 166,200 193,300 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 12,900 95,800 108,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 567 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 f Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Fe TOWNSHIP SEC. ~S T '2~ _N-RW S4 ADDRESS Dtbc~`~2°:^ ST. CROIX COUNTY, WISCONSIN f Cc SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4F Z "Ire 119 1600 I~.S 1 !U 37 INDICATE NORTH ARROW _ r~0-.1 n~ (/o~ BENCHMARK: Describe the vertical reference point used Arid ,LL0 ~y~ 1114,132_ Pde- Elevation of vertical reference point: /Coo Proposed slope at site: SEPTIC TANK: Manufacturer: rjl~ Ipr_kLz~iquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet elevation: Tank Outlet Elevation: Q g Numb4:r of f ;et from nearest Road: Front,0 Side,Q Rear, O /00 feet From dearest property line Front, (aSide,nRear, 0 /nD feet Numbs r of feet froip: well 4 0 building: N / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE kip PUMP CHAMBER Manufacturer: 1-LENUk Liquid Capacity: Pump Model: 3 3 Pump/Siphon Manufacturer: Pump Size Elevation of inlet: (Sq Q~ Bottom of tank elevation: 7% w Pump off switch elevation: ---c~~ Gallons per cycle: 3 Z Alarm Manufacturer: Sr~ , /(f G~Vp ~5l PA'~rm Switch Type: a i Number of feet from nearest property line: Front, 7 Side, O Rear, Ft.a~ Number of feet from well: Number of feet from building: r / (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: pp ktlr'ec., Width: /0 Length:___, Number of Lines: Area Built : 16 Fill depth to top of pipe: r) 0 Number of feet from nearest property line: Front, Side, O Rear, O Ft Number of feet from well: Number of feet from building: /C/ (Include distances on plot plan). SEEPAGE PIT /"6 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 NA Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, 0 Side, O Rear, O Ft. Number of feet Lrom well: ~J Number of feet from building: Number of feet from nearest road: Alarm ranufacturer: / Inspector: _ y/i /L'(SO- _ Dated : / Plumber on job: / • ~Sa "`ww`777"""' License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ALTERNATIVE State Plan LD N mbar [ (If assigned) El Holding Tank ❑ In-Ground Pressure Mound 8506845 ADD PERMIT HOLDER. INSPECTION DA Ferris Sabby R. R. 2, Box 143, Baldwin, WI 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN R . PT. EL V.. CST REF. PT. ELEV NW NE, Section 35, T28N-R17W, Town of Rush River Name of Plum ba r. MP/MPRSW N,, . Cnuirrv ~•,itary Permit N-ber Bennie Helgeson 3215 St. Croix 74995 - - SEPTIC TANK/HOLDING TANK: MANUFACTURER. J ( LIQUID CAPACITY ANK IN I EI FV ANK OUTLFT E EV WARNING LABEL LOCKING COVER PROVIDED PROVIDED' ❑YES -'No ❑YES []NO BEDDING: VENT DIA.. VENT MAT( HIGH WATER ALAHM1? NUMBER OF ~RonD PROP TV WELL BUILDING VENT TO FRESH [FEET NE_AR_ESTOM-- j X ~(f 1 LAIR INLET ❑ YES ❑ NO _ YES NO DOSING CHAMBER: MANUFACTURER BEDUIN(. E(QUID CAPACI Tv EIHOL-S T"IMP SIPIVI)N\iAN)f A(. i'rfRE H WARNING LABEL LOCKING COVER ' 9 ! PROVIDED PROVIDED. ❑YES ❑NO 1 ❑YES ❑N0 ❑YES NO GALLONS PER CYCLE : PUMPATONAL NUMBER OF ;,PEHrv wELBUILDING vENTroFRESH (DIFFERENCE BETWEEN FEET FROM IaIRI"LET PUMP ON AND OFF) ;-__INO_ NEAREST 10. / SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of pl0vving : T rI 1In~ I E I. %1ATI HIAL AND MAHKIN(, 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: - W BED/TRENCH IDTH ESEI TH NQ OF )ISrH PIf TAt In,; 'T UL IIn =PITS LIQUID THtccHE` t,rtHlnl'. PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH PIPE DISTH PIPf DISTR. PIPE -MATERIAL NO DIS1I7 NUMBER CIF PH OPE RTY *ELL BUILDING VENT TO FRESH BF LOW PIPES ABOVE COVER NIfI ELEV END I P IPED LINE AIR INLET FEET FROM 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 meets the criteria for medium sand. TIONS MEASURED. YES ❑NO n SOILCOVER TEXTURE T MNINTrnnHKEl+s oBSEHVauurvwELLs ❑YES ❑ N0 _DYES ❑NO DEPTH OVER THFNCH BED DEPTH OVER THENCH HE f) Df PTH OF TI)P',OIL S<)OI)E SFF UFU MULCHED CENTER EDGES ❑YES ❑N0 ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LA TEIi AL SPACING HAVEL DEPTH BFLOW PIP[ FILL DEPTH ABOVE COVER I BED/TRENCH TRENCHES DIMENSIONS + MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO I)ISTH DISTR PIPE DISIHIBUTION PIPE MATEHIAL & MARKI ELEV ELEV DIA ELEV. PIPES D,A ELEVATION AND NG DISTRIBUTION 1 7 ( 7~ l1 INFORMATION HOLESIZE HOLE SPACJN6 DRILLFDCOHHl CTtV COVER MAIEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLnnls ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PE RMANENT MARKERS. OBSERVATIO N WE L LS NUMBER OF FROPERTV WELL. BUILDING'. FEET FROM LINE DYES ❑ NO ❑ YES NO NEAREST- _I T Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) S - wisconsin APPLICATION FOR SANITARY PERMIT ' L~kt~~_ COUNTY D(PLB 67) UNIFORM SANITARY PERMIT # - oEPRRTTTT - InoUSTR4, LRBOR 6 HumRn RELRT Ions -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. [PROP Se reverse side for instructions for completing this application. PLEASE PRINT OPERTY OWNER yx NG ADDRESS Ferris Sabby 143 Route 2 Baldwin WI 54002 TT~ ERTY LOCATION 'fE: N I.D. NUMBER 1/4 NE 1/4, S 35 T28 N, R 171 (or) W OF: Rush River T NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK S8A~TOE68'WW A 10th Avenue 18506845 NA NA =EO LDING OR USE SERVED amily Numb er of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: New TankO Repair ® New System El Revision ❑ Privy Replacement Soil Absorption System ❑ Reconnection ®Petition for Modification Alternate System IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Holding Tank r ❑ Seepage Trench El Seepage Pit ❑ Vault Privy ❑ Pit Privy System-In-Fill ❑ In-Ground Pressure issued ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ® Mound ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed X Septic Tank Capacity X Lift Pump/Siphon Chamber Manufacturer: WATER SUPPLY: ABSORPTION AREA ABSORPTION AREA PERCOLATION RATE (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ❑ 53 1 026 ® Private E] Joint Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on he attach Nod:pl Phone Number: Name of Plumber (Print): Signatur ` 3215 (715 778-442 Bennie Helgeson Name of Designer: Plumber's Address: Bennie Helgeson Spring Valley, Wisconsin 54767 COUNTY/ DEPARTMENT USE ONLY El Disapproved Signature of Issuing Agent: Fee: Date: Owner Given Initial ylC~L~~ / / Approved Adverse Determination eason 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 e INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and cleaHy shown, 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) 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 Correspondence P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: RuskI ni vet co ®CT 16 t- a,~.. I~gIN6 PLAN ID. ~r DETACH HERE 0 Y - - - - - - - - - - - - - - - - - - - - - - - - PROJECT NAME PLAN ID. 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 $ ❑ 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. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ 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 ❑ 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 ❑ 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. ST. CROIX COUNTY WISCONSIN ` ` r~ y ~,i~ ~'S.5ir4 f ; r ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 October 3, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7967 Madison, WI 53707 Dear Sir: An onsite investigation for the Ferris Sabby property, located in the NWT of the NEh of Section 35, T28N-R17W, Town of Rush River, St. Croix County, revealed suitable soils at a depth of 1.8 feet. The 1.8 feet is the limiting factor, along with a bedrock prob- lem at 2.2 feet, making the recommendation that a mound system be utilized in the area, with a fill depth of 2.0 feet. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISO?;, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: TownshipMiMU;Y% NW Z NE k IS 3 T 28 N/R 17 NIRR)W Rush River St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: ,Ferris Sabby RR#2, Box 143, Baldwin, WI 54002 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. Signature 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: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 79699 MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location Nw 1/4, NE 1/4, Sec. 35 T 28 N, R 17 jf ~ W Town ]o~xf~tt~X Rush River Street Address Lot No. Block Subdivision Landowner's Name: Ferris Sabby The application for this site is for: ❑ new construction use. ® replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~.1 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 n~rs ssued_T_oyou.) ]one of the applications needing a quota number. The quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F] for 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. (_]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: B~i failing conventional soil absorption system. ❑ 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 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si re County Official Title Assistant Zoning Administrator Date October 3, 1985 DILHR-SBD-6158 (R 12/82) U L H R & Safety and Buildings Division rt,.....,. " „5 PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans--- Madison, WI 53707 ' Telephone: (608)266-3815 ❑ Private Sewage Pla ~Y /~a~~ 6 t Plan Identification No. !V Z Gallons Per Day 3 } M ( FPRIO RITYPLAN REVIEW ONLY Review Fee Received Petition For Variance Fee Rec. Project Name Project Location Street No. or Legal Description County ❑ City ❑ Village ❑ Town of: 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) (3b) (4a) (4b) (6) (7) 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. 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: James Sargent Bureau Director Date Approved: If Questions Plans Approved By: Contact cc: ❑ Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health County El Local PI ❑ Facilities Need Analysis Section UW-SSWMP ❑ Plumber ❑ Department of Agriculture 1 Owner ❑ Other Dli FIR-SBD-6099 (R. 01/85) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION ,".'ureau of ,Ul East Washingtc i vi= 1.U. Box 7969 ~tJ 53707 r•. a~~~"rig )Ox 1143 Route A1~ } ~e: Ferris 5auoy - si r:c t'rivate Sewage 5ystetr Ai,NE, v5, 28,17" ;own of ush River, 3t. Croix County, V. Section 145.24 (l), Wisconsin Statutes, and s. ILhK'- bs.u~ (z) kw): i"iscGr Administrative Code, allow the owner to petition the departrient for a var to the installation for a private sewage systeo to replace an existing pr ,V,0,: ;Ravage syst i at a site which is not in full compliance with the siting standaru-s in tie administrative rule. The systwa (design proposed shoU14 protect the waters of trte state f r,mi contamination. If this system- becomes failin(j s st =:i or worr~~~,all~~cs tte ,,4,3ters of the state, this variance shall T C` p'C't lti(1Sd 'C'llr k1 vCiraZal,cC: revues ~t~(.: F..u J• IC,.H' C)...t. ,y .,M. Code was considered on November 5, 1985. The petitiofi has been c;orttjitionally approved. The condition being that in the event of failure, V)e unti system small he replaced with a holding tank or other cuff-lot system. rule requires that a mouse systeri gave a ridnirumn of 24 inches of suitable I aural sail.. variance requested was to install a replac nt and system on a site 21 inches of st itatle nat.kr l soil. DILHR-SBD-6423 (N.04/81) State of Wisconsin ` Department of Industry, Labor and Duman Relations s.,. SAFETY & BUILDINGS DIVISION i-4ove >vr ,tip Path 1 i i ! f j. {s:_. f iiitE ►.~t s;. .,ir i.+ s s fu i ii= e or .:ei, If of the petit 'lover Eder,: used for c;t '606) 266-3,9 wdge cunsult4flt District f" ivate se i,irclta L. ZJjr erg Zorn i r'."nini!trator St. Croix LLxunt etinii .11elgeson, Plui;T';c.r' { DILHR-SBD-6423 (N. 04/81) rJ; S T C - 105 r r y SEPTIC TA*dK MAIN'I'BNANCE AGREEMENT 0 t. C;r~r i X County OWNER/BUYER ROUTE/BOX NUMBER 3 Fire Number J~ CITY/ STATE Z IP PROPERTY LOCATION: I~✓ Z, -o, 1 Section T N, R f 7 _W, Town of (c5~ St. Croix County, Subdivt Lot number I Improper use and maintenance u~ 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 St. Croix.County resident lc to 1L~ ('IV" A graIIt. 1 1 a maximum of 60% of the cost ui: 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 maintains The prope 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. N 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- 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 expirn, :NED~ St. Croix County Zoning cr P.0. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to Form- S T C 100 Owner of Property .Location of Property Section ;,S ,T~_N R-I) W Township Mailing Address Subdivision Name Lot Number Previous Owner of Property__ 44" Total Size of Parcel /rr t+ :y Date Parcel was Created 1'73-?j Are all corners identifiable? \ Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded the Office of the County Register of Deeds as Document No./ and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office o°f` the County Register of Deeds, as Document No. c J-.E%2iud ~I/ s-~ SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) P-t DATE SIGNED DATE SIGNED i6 con. WHEREFORE, IT IS ORDERED AND ADJUDGED, That the account of said Oscar Larson and Anton Larson, as executors, as stated aforesaid, be and the same is hereby allowed. That the residue of said personal estate consistin? of money, goods, chattels, etc., aforesaid be and the same is hereby assigned to said sons and dau-hters, to each 1/5 thereof. IT IS FTT!,TTj R ORDERED AND ADJUDGED, That the sale of the real estate to Lh-ma Uabby, under the terms of the will of said deceased, be and the same is hereby confirmed. 17 Oscar Larson and Anton Executor's Larson, as executors of Con. 000 Deed. ..the will of Ole Larson Con. w55000. I also known as Ole Larson Dated July 7, 1933. Gonsholt, deceased Ack. July 10 & 170 1933. ~ Rec. Oct. 9, 1933. In 1'22611 page 1740 Ale ,4zy It Recites; Ole Larson, also kno~iYi - EJm,.?a Sago,,. as Ole Larson Gonsholt, died tes- tate on Dec. 12, 1931, and the will of said deceased was thereafter admitted to rrobate in the County Court for St. Croix County, and whereas the will of said deceased provided as construed by the County Court of St. Croix County that the farm of said deceased as hereinafter described should be sold to Emma Sabby, for the sum of 5000., she to have six years within which to pay for same and to pay the taxes thereon and that such conveyance was to be made by the executors of the will of said deceased. Now, therefore, We, Oscar Larson and ~ Anton Larson, ac executors of the will of Ole Larson, also known f as Ole Larson Gonsholt, in consideration of a mortga7e on the pre- mises hereinafter described liven to secure the -ayment of 5 rro- rrissory notes of :;x.1000. each, payable according to the terms of said will, do sell and convey unto Emma Sabby, the following described real estate, to-wit: N1 2 4 of NE--L and SW4 of NEB of Section 35-28-17, and other lands. ~r;_n-7e stamr cancelle~_.). ~ E~iria Sabby, I Mortgage. -to- Con. X5000. Dated Au r. 11, 19;3. Ack Oscar Larson and Anton . Aur,* 11, 1933. Rec. Oct. 13, 1933, at 9:30 A.DTO Larson, as executors of the In "222" will of Ole Larson Gonsholt, page 262o i deceased. N-1 of NE' and SW-1- of NE's of Section 35-2 It is further provided that said first party 8ay7cutnsuchhtimbearnds. and trees on said premises as are deemed necessary for fuel fence posts,to preserve the timber and thereof, and for use in constructin-vbuildings a r in value same, but no other. ~ „ and d ep ai rin the (Satisfied see No. 21). (Satisfied,, see No. 22). . JJ J 1 ► J J J t~ Y J J J J / J J J J . . JJ J J J J t J J i t r,1ofi 4-) 1a~ 1_~rly ? .S IL C ct T I OLA.S ~ l U,'• w I va k~c~us e S« P,~, r /ooo G4I Srp f~ ~ / 1 S. M, l bD. U O c c, e = y y PLUtABjt4G 01" ~rcc 7S0 6r,l awe F,, ~ 845 6o 44 o d ~ or Q r ]RECEIVED OCT 0 9 1985 r' A IRA01"P, RUREAU Page _ Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand L Topsoil N I 3 E all, 0 11 % slope. Bed Of 2'2 , Force Main Plowed VgAlITAg g r a g a t a From Pump Layer D_ Ft. - Cross Section Of A Mound System Usin E Ft. 9 A Bed For The Absorption Area F o ;'S Ft . G Ft. i A Ft, Signed: B~ Ft, License Number: 3o K Ft Date: L Ft. J /D Ft. Alternate Position I / d Ft. Force Main of W Ft. 9506845 L Observation Pipe 13 K 01 A W ~o ----------------------•I ~Distribution Bed Of %M- 2 %N Pipe 2 2 Aggregate Observation Pipe Permanent Markers EIIEC! Plan View Of Mound Using A Bed For The Absorption Area OCT 0 9 WE rIi I M411ii"P, RUREAU Ilk PAGE of PUMP CHAMBER CROSS SECTION AkJD SPECIFICATIOAJS ---VEIJT CAP `i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FRCM DOOR, JUNCTION BOX MAUIIOLE COVER WINDOW OR FRESH 12•MIU. AIR INTAKE I GRADE I I ~ 'i"MIND. L-_ 18"MINJ. COf\1DUIT 11~ INLET PLUM I - PL~aP.r " AIRjHT SEAL I I I (✓1i~~~~/~~~yl~A~~r-%"' 4S I III APPRO`✓ET) JOINT _T A APPROVED W/C.I. PIPE = I; ( I I W/C.I. PIPE EXTENDING 3' cl MATINS I III EXTEUDINIG ONTO SOLID SOIL_ ALARM B I I I ONTO SOLID ~ ( 1 DEPARTtv"Edd" s lop C: I I Om FF PUMPg D CO NCRETE BLOCK iI RISER EXIT PERMITTED OIJL9 IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC.IFICATIOUS EPTIC AND f;,506 8 4 9 _ LL S p v OSE TANKS MANUFACTURER'_ L7P47~rh jl f P~~~f WMBER OF DOSES:_ j~ SU PER DAU TANK LIZE : . o,~/ _ GALL6- 5 DOSE VOLUME: 3 y, lc ALARM MANUFACTURER: EIc, Fri l itii S CAPACITIES: A II,ICHES OR -GALLOGALLO^JS MODEL DUMBER: _ /ri / "IA1 B- C) INCHES OR CALLOUS SWITCH TYPE: ~-7 C= INCHES OR -'--~y. l'GALLOUS PUMP MANUFACTURER: - C 0= INILHES OR ? INV. GALLOU5 MUUEL NUMBER:%S NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: INSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE GPM VERTICAL DIFFEREMCE BETWEEN PUMP OFF AND DISTRIBUTION! PIPE., - FEET + MINIMUM • NETWORK SUPPLY PRESSURE . 2,5 • . FEET + FEET OF FORCE MAIN X ~ F 00FT.FRICTIOIL) FACTOR.. FEET = RECEIVED TOTAL DUNAMIC. HEAD = FEET RECEIVED OCT O IIJTERDAL DIMENSIONS of TANK: LENGTH ra` 1985 --4--;WIDTH -LE ;LIQUID DEPTH I IJR4PIr"r4 BUREAU SIGNED' .1, LICENSE DUMBER: /n c DATE: dc" t v, Perforated MM Oetot! ' n vl Eno Cop )P4001Gled PVC Plot Hdee Lacehd On Bottom, Are tqvoly Spaced -7 Q PVC Fares Mr From Purne FND /Q PVC CA P ►Marwfoti Poe 0111trlbut,on Pipe Lott Hot* Should 8, Next To End Cop Distribution Pipe Loyout P S 850684b X ' Signed: Hometer Inch License Number: '>V 5 - Lateral _ Inch(es ) Date: PLU 0 ' Manifold Inches /n y- 4-t 07 Force Main " Inches r` tIO~~S D RTC ~~~rt~ 04---0 . RECEIVED A H OCT 0 9 1985 PUREAU DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .INDU~TfY, DIVISION H LABOR HUMAN RANEDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMA N WI 53707 (11-1163.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVI ION NAME. '14NN1 /T_? N/Rr kr) W , e V- I V'+ COUNTY: OWNER'S Bt3YEP,4-h"E: MAILING ADDRESS: Fern/ SSG bb / ~e- j u)lvl . -5 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI DE R PTIONS: R ATION TESTS: Residence ❑New ~Reptace ~1/ RATING: S= Site suitable for system U= Site unsuitable for system T 0. < ~3 r 1 Q h CONEIVENTI(AL: MOUND:❑U 1. S IN-GR❑OUNDPR u EIS 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 BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE,; Nf) DI NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) s61 1 6/ S I i TS B fio' 85.E /)one. 1.6/ aC '*70 t B' 7. 1 f J✓_ f~ e~ ' 6n FS B S Or • 8, f3/S1f Ts , 7,911 SC M B- B $ ~C~ 7~ C. C~1 f se. L S / r Q<j 'h Pn ' ~ ! t!?'s^crCL' B- RECEIVED PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES ATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH P- 1 /i r>!_~ nARtn~r EAU P- P-_3 2 -b P-I l( P- er _ (l Gt P- h Lt 4 4c, r u 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 9--6 C4CkAtS .7 5L t1% ell 66- 3:3 w / i . __1Z -2-10t i UV 5~_ 1 o , ,51 R S4)1 i f z I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods siwofied n th,, VJ,i ,v 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 - - - n TESTS WERE COMPLETED D ON: ON: l / PSd C" ~S, y ADD ESS:/ CERTIFICATI NUM R: PHONE NUMBER (optional): CS I NATU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tetiter. DILHR-SBD-6395 (R. 02/82) OVER