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Home My WebLink About034-1089-90-100 C 2L (D A I'I Q fpD_ •30 A~ 3 ~ o y 3 m n O C) A D o m o Q. 3 Z p_ 0 co r (o ~ O O ^ CD 3 co W~ m cn 00 CD a) cn a) (D N O- O N N v \ 1 O, CD 7 `0 ~ O n o y o 3 q s- 0 :E O W S 7 O O ID E3 v C D (e m G. 7 0 a 73 7- m o W CD C11 -i 3 :E N N N F N 7~ O D O o m a, Ul U] L j N A O H QQ• O O O "o 0 r- (1) m CC) a) 0 _ N _ a z 0 0 0 N CD E ~ o o v a d v o 05 O (D CO N C) O" O =01 w -_j cn (D CD (p (D d 'o N 2 H ~ ~ A CD O CD M (D x N 3 d l 0 H d a 9 p l~ z o a d IQ v _ D D N ~-h O O I N• o CD (n h • :3 CD N W ~r C) (D U r~-r o Z ~ n o rt ~u C; z m j Z c hh M rr O = ? p x i"' N A Z O (D ~ n m G) cn ri N rt m - H F,• \ a y w E oo v N) W W I G Z Q N G 3 U N W O p~ ((DD m a (D C O O C cut O O= 3 v c i p o (D p N m a z A O. m N b N O O ON ~ A I p CD II 7Q o0 b9 ~ ti pp O L ti Parcel 034-1089-90-100 09/29/2006 05:15 PM PAGE 1 OF 1 Alt. Parcel 28.29.15.575C-10 034 - TOWN OF SPRINGFIELD 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 O - MCFARLAND, RANDALL L RANDALL L MCFARLAND 2926 HWY 12 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2926 HWY 12 SC 2198 GLENWOOD CITY SP 1700 WITC SP 7059 SPRINGFIELD SAN DIST #1 Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 28 T29N R15W LOTS 1,2,3 BLK 29 VIL Block/Condo Bldg: HERSEY ALSO THAT PT OF ABANDONED HAZEL STREET Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/12/2000 626293 1526/78 MIS 09/13/1999 610233 1456/36 WD 07/23/1997 1121/198 WD 07/23/1997 913/122 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/25/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 2,700 84,450 87,150 NO Totals for 2006: General Property 0.000 2,700 84,450 87,150 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 2,700 84,450 87,150 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 529 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT Sr 7 OWNER i, 4arc_6 TOWNSHIP eeer! SEC. T N-R W u ADDRESS ^T~ -A5 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE ale PLAN VIEW ' Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y f l e t2° e ~ I f I I gr 9 -~30/ X tom= .__f' INDICATE NORTH. ARROW BENCHMARK: Describe the vertical reference point used Told' 71 er E', Elevation of vertical reference point: Proposed slope at site: SEPTIC T#NQ Mq.nufacturer: ______---Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Enlet Ilevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,oSide 10 Rear, C) - feet From i carust property l.i.nc : Front, 0Sidc,0Rear, 0 feet Numbe: of feet from: well building: (Include this information of the above plot plank 2 reference dimensions to septic tank) SEE REVERSE SIDE. PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: 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, ./Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL. ABSORBTION SYSTEM Bed: Trench: Width: Length:_____Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, O Ft Number of feet from well: Number of feet from building: (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:e uc ~i Capacity: 9, Number of rings used: __I Elevation of bottom of tank: /L t Elevation of inlet.' Number of feet from nearest property line: Front, O Side, O Rear, O Ft./f Number of feet from well: 1 Number of feet from building: :Z Number of feet from nearest road: 2 U Alarm Manufacturer: Inspector: Dated: Plumber on job: 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 slate Plan LD Number. 111 assign edl ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 8506900 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE First Lutheran Church Wilson, WI 54027 ^.5- ' 1*,3D BENCH MARK (Permanent reference p.,PIL DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT. ELEV SW SW, Section 28, T29N-R15W, Town of Springfield, Lot 1,2,3,Blk.29 M Plwnber MPLMPHSw N,, c(.„nw a O-f--Herse n~r,Y "er,~, N~mher. Stephen Aaby 5184 St. Croix 75008 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUID CAPACITY TANK INLET ELEV TANK OUT LE?ELEV WARNING LABEL LOCKING COVER I l PROVIDED. P OVIDED ~.7.i,'L „LC`: Lj ~4 RYES LINO YES LINO BEDDING. VENT DIA.. VENT MATT HIGH WA TER NUMBER OF ROAD: PROPERTY T E"LL BUILDING JVENTTOFRESH ALARM FEET FROM INE AIR IIINLET ❑YES E, NO YES CINO NEAREST4~o '+2' DOSING CHAMBER: MANUFACTURER JBEDDING LIQUID CAPACI TY PUMP '011,11 L Pt. P 511'11()1 `.,AN1_,I At:1"HL H WARNING LABEL LOCKING COVER PROVIDED PROVIDED. ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND COfTROLS OPERATIO AL NUMBER OF P11nPEHTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR INLET PUMP ON AND OFF) ES I J NO INEAREST--?• SOIL ABSORPTION SYSTEM. Check the soil moisture at the d th of plowi AMI rE 11 IMATEHIAL AND MAHKINr, or excavation. (If soil can be rolled into a wire, construction Pall cease until FORCE ` MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH NO F 11111111 PIPE SPA(,IN- I-CI `ItH III.', =PITS LIQUID BEDITRENCH TR I'PN 1,1AIEHIA' PITT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTH PIPE DISTH PIPE DISTR. PIPE MATERIAL Nc IJI~I" NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BF LOW PIPES ABOVE COVER ELEV INLI f ELEV END PIPFti AIR INLET FEET FROM JLIN1 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. L I TIONS MEASURED. ❑YES NO SOIL COVER rEXTURF PE II In NEUIMAHKERS o1ssFHVannNwLLLs _ -]YES LINO _DYES LINO DEPTH OVF H TRENCH BFU S()DI)F D JMULCHED EDGES ❑YE LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LAIEHALS ACIN(; 6fAV1 L DEPT HE LO) PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD ! D I S T R P I P MANI FOLD MA E R 1 A L NO DISTH 1111111 PIPE DISTHIBUT ION PIPE MATERIAL &MARKING EL FV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION IIOLE SIZE HOLE SPACIN(, DRILLED 771, ECII Y OVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED / PLnnls . ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS JOBSERVATION WELLS NMBER OF PROPERTY WELL BUILDING FEET FROM LINE ❑ YES LINO ❑ ES NO ___________]NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) .gyp F1nDU77 consln A PPLICATION FOR SANITARY PERMIT JI/ ~ . DiLHR B6 COUNTY (r ~7) UNIFORM SANITARY PERMIT # STRY,LR9OR&HUn1Rn RELRTI015 -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. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS TZ 6Z /I PROPERTY LOCATION MME : W1 145611 /4, S TOO N, R E (or) W TOWN OOF: s R K LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST FIAD, LAKIi! OR LANDMARK STATE PLAN I.D. NUMBER ;L, 3 A I Ptoro ,~s~ r w S D6 ao TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): C,4 o it c A- THIS PERMIT IS FOR A: nrvm ❑ New System ❑ Tank Replacement ❑ Repair X Replacement ❑ Revision ❑ Privy L_l Alternate System Ll Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Q Q ' 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 Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Ada Iq IKPrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name~f PI umber (Print): Signature, MP/MPRSW No.: Phone Number: Plumber's A dress: Name of Designer: C ad. T ,tA- COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved /cy /if U U '1 _G ❑ Owner Given Initial o GihdV 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 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 clearly 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. DEPXRTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 S (H63.09(1) & Chapter 145.045) iJ LOCATION: SECTION- r(~ TOWNSHIP/MUNICIPALITY- LOT NOLAK. NO.: SUBDIVISION NAME: W d /T TN/RJ-],lor) P/2 h- L - 1-N s COUNTY: OWN S BUYER'S NAME: MAILING ADDRESS: it'a S LkT~~wti ckHn~l, GviG a,.. Gvi S'yDa17 c USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: ❑ PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑Residenc y n G/ New Replace 11"1.. J S' 1 C i h 1/ ( b RATING: S= Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-11LLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ SLa EIS ~U ] S [ZU 0 S .®,U Ns [:IU .zd f k 1-90 K 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: A//q PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B' aNr- . 6 L• B-4-1Z ';k4 J. 'T'%EeE1VEE) If B- a 5 ' . S' L. c L. 'G ' i 2 .09 B-~ c~ 'ktoT PERCOLAT ON 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 P R PER INCH P- P- P- P-. P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori. zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION - - _ N I , I f _ I 907 It C 11 Z4 A0 K ON I I I ' a I , I ( 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 'T'ESTS WERE COMPLETED ON: 73 P ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): y 1 N S T• u~o~.~~ L Gv► S"y,,, I-V'a 6 F -rya CS SIGNAT RE: ' DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - 1-- - - 10 0 _ - ----t r Lt 7- LG4 N S 7 ~ r1;£ J Ulf 00 (i) tic) gyp' B tt Q / VVVmil 1 ,a b r~ a '5069 00 ) _ CrC'r+e~ni n OCT 1 0 1-9'85 ec,. -.......a...., " ~'Flis,ahr •iY.seuv...~.. .........~-.ah. ..-v.. - D r Z r ~ A o y D i~ Z M n~ N s fn S 3 0 Zr < N ~ v l v M Y, C~ O A~ n C O , o a`vx rn _ ~r a~ ~D fib S' rA m D P , 7Y Y jy° L O `1 0 ~ A p o ~c ry~p~ s`n Z Z rt C: L A N P1 O p L < 0< rn0 n L s ;a rn O O D ro ri rri CC, LOO N < Z < ~ - x ac Z u D ~ w < = n Z oo 1~ Dip 0 C) - 0 O v r OW In 45 9( U~+ O -1 O N '1 y D i = - -4 - > C: ;pp 20 LC 1 oev 41 r D m q _n O -LI ly D 0 p O i \ r 4 In o ~LN in A J~O C ~c 'i OO D m Z A Y r• lG u+ 4 r c \ / n L r m " C'VED 0 A L ' m = o v 3( Q p nt, r 1935 ~ r rt Plh. = 60 1/13 . F PROJECT DETAIL DATA SHEET NAME OF BUSINESS r, 0111C L, LEGAL DESCRIPTION 4' 26 1 Z-9 IS OWNER l_u7,~`~,~ C!, stn c f MAILING ADDRESS ZIP 5,4161 ~ ARCHITECT, ENGINEER, ADDRESS PLUMBER OR DESIGNER _1 Do cl L) -1 I't , ZIP 0L6 TELEPHONE NUMBER C / - Z7 1. Check appropriate building usage(s) and fill in'the information requested opposite each usage listed. Please consult Section H 62.20. Existing building New building T Addition ( ) Apartments and condominiums Number of bedrooms ( ) Assembly hall . . . . , . . . . . . Seating capacity ( ) Bar Seating capacity of meals. served ( ) Bowling alley. Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Numher of•sewered sites Number of unsewered sites Total number of,sites ( ) Camps ( )Day use only 'Number of persons ( ) Day and night Number of persons ( ) Catchbasin Number Church No kitchen Number of persons. ( ) Dance hall t 1 With kitchen Number of persons • • • . . . . . Number of persons ( ) Dining hall . . , . . , • . . . . . Number of meals served daily ( ) Doa kennels , . . . . Number of enclosures ( ) Drive-in restaurant . . , • , . . . Inside seating capacity Car-service Number of car spaces ( ) Dump station . . . Number of dump stations ( ) Employees ( total of all shifts) . . Number of employees ( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit Number of units with 4 persons per unit ( ) Medical and dental office bldgs. Number of doctors, nurses, dical staff Number of office personnel mmok Number of patients ( ) Mobile home parks • . . . . . . Number of sites ( ) Nursing homes . . . . . . , . Number of beds ( } Restaurant . , , , . • • • • • • • • Number of persons ( ) Toilets ( )Showers • • • • • . . . Seating capacity ( ) Dishwasher and/or disposal? ( ) 24-Hour service ( ) Retail store , . . . Total number of customers • • • . . Number of classrooms - O Mea Showers ( ) Self service laundry Total number of machines-. J ( ) Service station . Number of cars served daily,, / 0 ( ) Swimming pool bathhouse ( ) OTHER Number of persons (Specify) . . . . . . COMPLETE OTHER SIDE t , 2. Indicate whether the following facilities are present. Floor drain yes no Number of drains Food waste grinder yes no Dishwasher yes no x Automatic clothes washer yes no _ CX Number of clothes washers 3. Septic tank capacity Holding tank capacity &o0 Septic or holding tank manufacturer 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches depth number of trenches SEEPAGE BEDS: total square feet width length of bed _ depth SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signature of person completing form: FOR DEPARTMENTAL USE ONLY Address Z2 el 7- ~~t/a Z i p j -,d o~d Telephone Number 7Z - 7 Date , v N i m C, O w ° m = ° 3 =r 110 N O O C C w p1 N G ~Ca E. ol 3 c co co 2 =r - - -0 CD CD o O C CD =r CD to CD O N :E s N a 00 w" (D D W A i_ ' 0 w I N S $ co~D~O ~°o~c?DO~o fl 03~Da ~W a o CD Y c: po ~w c0 = = =r> > ° p~ c Z (o C `G CJ O O =r o O OL f~ 7 7 W CD 0. n CD W < A ca CS 0 CD C D C CD L, c cow? ~omCD o~ O a w CD : Fay= C o N CD CD ° w N Z :3 U) 'elm vU Z ) N~~~ - U2, CD CD ) ~~mm~a aU in' D CD 0 u, co 3' °~cD o~* -4 c,- Ri ~ p d w? C w o N n CD Cn o n CC] W* N 'fl N' w Q C 0 CD C R1 ~~o n~ww~~ m m C~ o° CD ~N C7 (n CD cn W o CL to n =cam a O O N' 0 O - CD ° c to m CD -q 0 ao f N Qc aw o' ffl m =3 w N rM CD cn 7 w ter. Q CL QUO CD 0 2.- <'o BCD Ch n 3 o N O O CD ~ U. (D (D m 0 C - CD c a o Cl) a p p C C° w CC: (D O C O s to Q ° a =r -C :CD w 0 O pd ac 3 0 o 3 m.., CC) p~j d~• aCp 7 ° O 3 t oo ~ O 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.BOX7969 MADISON, WI 53707 ? " i t 608-266-3815 DATE: PROJECT: w ~Oki _ ,S1~,2fs,2 , I Main St PLAN ID. DETACH HERE 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. SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR y 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 f MADISON, W153707 ~ t.)~' Fis our eept 608-266-3815 DATE: OWE I i PROJECT: r 7 'A JV OCT 2 g 195 Spri3 tai r Si r~ PLAN ID. DETACH HERE PROJECT NAME PLAN ID. This is to acknowledge receipt of your pli ated project. Preliminary review indicates the required fee is ❑ Plan accepted for review. e. Plans will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. n abeyance. 1. Plan Submission Dn test data on 115 completed ❑ Additional information shall be submitted in c copy) specifically noted. signed by county, owner and ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, date, anticipated use of building. stamped in accord with Section ILHR 83.08 (2 (1 copy) Administrative Code. ❑ Affidavit enclosed. -1. (1 copy) ❑ Plot plan showing location of land parcel nearest road intersection, etc.), lot size and all private sewage system to buildings, lot line ing vent, manhole, alarm, course, swimming pools, water service piping, au 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. DIL'H`R Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, W1 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. Gallons Per Day 0, 40 PRIORITY PLAN REVIEW ONLY Plan 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 appli 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. 17 FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. r] FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the 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: By//, ~ James Sargent Bureau Director I If Questions Plans Approved By: Date Approved: j Contact cc: Private Sewage Consultant F1 Plumbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ] Department of Agriculture Du HR-SBD-6099 (R. 01/85) 1 Owner Oth"I "U> ST. CROI X COUNTY } R .~vxr W I S C O N S I N rr ~O N 19 6 I N G O F F I C E 2 - oet 0666ice Box 22 il' `G1 1 Hammond, WI 54015 -J O - { O W N E R P U M P S R` A G R E E M E N T PLEASE 8E ADVISED, rha.turn.tit you are again no.ti Aced, I w.itt contract with t-tle4 r1ll or* r 06 k e r,' S r,ar, NiAconA ia, (Pumpers) , bon the punpoae o6 nemov.ing a t waete 64om the ean-i,tany eyetem to be Located on the pnopenty and 6utune home site Located in St. Cno.ix County, W i_a consin, Townah.ip o6 S A,',nN F.'tf l Lers 1-3 ,!~/a AY being in the ------z o6 the !A o6 See. ;2Y , T. .11 N.-R, j;" W_ (O)t mom. Gutty deecn..ibed ae 6ottowd: ) Dated thLA day o6 u< 1 ,,U: 19 (OWNER) State o6 Wieeon.6in) bb County 06 St. Cno.ix) Peneonnattyappeaned be6one me th.i-6 ~ day o6 the above named tr0 be -t ry penbon who exeeu e the- onego.cng indtnument and ack.nowte'ged•",•th;e o any u cc, t. nazx ozn~ My Comm. (.id pv ant) (f;xpah I, 7 - 1Z 7A, t? , heAe.inbeAote ne6enned to a um pen, join in the above agreement to the extent that I ave a contract with Ownex ae above &tated. -~la~ ,j'ig' ~~(PUMPER) H H _ y ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d 9 OWNER/BUYER << Gc ROUTE/BOX NUMBER Z/ „S'cc.t Fire Numbe i CITY/ STATE Sc+-~ 7.IP j~ PROPERTY LOCATION:5-W 4, S~ 4, Section,~,S, Tot N, R W, / I Town of SOS I-'j ~rec' , St. Croix County, Subdivision-wk-'Is Lot numberX 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 stems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning :i 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. 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ~ 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,(' ~a~~rc -tom _ 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. 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/contractoz,("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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a Owner of Property S L Gt Tl~ Lo,-ation of Property 564-1 ~4 Sw '4, Section , T ,~q N - R/_5 W Township ~P9 17 1 k Mailing Address l aZ y I Subdivision Name it 1 .a J Lot Number nj / 1221f Previous Owner of Property ~S L Gc Total Size of Parcel j57j~~2 D }C / G ILZ Date Parcel was Created H/ 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number GJ~~ as recorded with the Register of Deeds INCLUDE WITU THTS APPLTCATTON ONE OF THE FOI,LOWTNG: 1. Warr m 2. Land- 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. PROPERTV OWNER CERTIFICATION I (We) eeAti6y that aU statement6 on this 4ote.m ahe thue to the best of my (ou.,) knowledge; that I (we) am (oAe) the owneA(,s) ob the pn.opetety dacAibed in thib in6otcmation dot m, by viAtue ob a wvfta.nty deed tteconded in the 066ice o4 the County RegisteA o A Deeds as Document No. /,)'D' and that 1 (we) ptA"entty own the.puposed site ~o,c the sewage pob system (ote I (we) have obtained an easement, to nun with the above de6cA bed ptc.opeAty, ~otc the conAtituct%on o6 said by.5tem, and the same has been duty heeottded in the O~6i.ce o6 the County Register, o4 Deedb, " Document No. ) . J SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ST. CROIX COUNTY kxA~. WISCONSIN -2 , N 3' 51 ZONING OFFICE ~r rte' 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) r HAMMOND, WI 54015 January 12, 1987 Mr. Hugh H. Gwinn Attorney at Law 430 Second Street Hudson, WI 54016 Dear Mr. Gwinn: In regard to your correspondence of January 7, 1987 concerning the Cross Lutheran Church property, located at the SE 1/4 of the SW 1/4 of Section 22, T29N-R18W, Town of Warren, this property is not in the flood plain as defined by the Flood Hazard Boundary Map for St. Croix County. Tre community number of this map is 5555578B. Should you have any further questions regarding this subject, please feel free to contact this office. Sincerely, /LL Thomas C. Nelson Assistant Zoning Administrator TCN/mj G`'VIN & GWIN ro\ 17 ATTORNEYS AT LAW f-rbe Cgwin .`BuiDiny z;. V.~,~~~ \ i HUGH F. GWIN z'30 SECOND STREET HUGH H. GWIN P.O. BOX 106 ?5-386 9510 4% A HUCSON, WISCONSIN 54016 li' V A- ,7anuary 7, 1987 i.~ Thomas C. Nelson St. Croix County Zoning Office P.U. Box 98 Hammond, Wisconsin 54015 RE: Cross Lutheran Church Dear Tom: Per our phone conversation several months ago and my conversation this morning with your secretary, I am enclosing a copy of the most recent survey of the Cross Lutheran Church property just east of Roberts in the Town of Warren. I would appreciate it if you would check your zoning maps and send me a letter indicating that the property is not in the flood plain as defined by your maps. If you have any questions on this or the wording necessary, please give ine a call before you write the letter. Very tr ly yours, Gwin G Hugh Gwin HHG/11 Enc. -OF-THE SE 1/4 OF THE SW 1/4 N 00° 58' 25" E i O • X ;o r T N O Z I A 0 m o m m z 0 ~ o ~ c m 00 N m l 73 58' 25" E 526.01' 461.01' rn I m C. i' . j I J O N O J N r 1 m - -n .4i 0 rn a, O N m C)I ~i m i S BRUNING 40-21 WEST LINE 0 cn U) m m m 0 n ao i 1 0 z m 0 z -n M N T N N (n _ m ~ A OD o U) n - 0 n m D r 2> m o D fA N M n co co ~1 w n 2 ~ y - x T O r Go ca 2 0 n - c _ y v 3 m 2 N f 1 z ~ a ~ o I~ 0 r N 00° 65.00' i I 0 I' aD (D ' ° o o 65 N O N ml: z i \ o I N I O V1 \ N (n I \ y N ~ V I = Z Im \ CD m (.0 I N I Z O ~'I < D N Io N A ~l I u) rn m Im O CD O I in 4 1.25' A . ol F ~ 41.25 C O Soo° m O ZI: y O ko Tt 2 U O rtl D ~ O rt, m N D T N 2 y O I ltj ~ I'j x x ~ r cl r- i3 = O rD rt pj 0 (D N at M l< CD to 0 N rr x tp ` "r rn N O a a m :7 0 fN (Dano _ A m h a m A rt El N O 0' 0'0m Cm P) F( N 0 (D N 0 O m 5 t C ::1 as + + -mr* M0 Z + m x 0 m a rt N . n m O' n r c i > e uu)i r+• O fi H. K z i r m > UI o n ~►rt a~ o m r O M 0 N :+m A►£ o u N a:3 F-- 0 o :r a 0 a N m m !-•0084' rn ~mTro m O ~KOa~3a m rn m £ Kaa H- ct ? r+ 7r U Lr n ::r m%D N m > m F'- O f D ~ n It ncnrn u: 0W(Dm 2 z bC 0 a z IV " .fi ft c Z~ z A m a F'•'C r* r O- a a N A _ z ° o cz to a 3 Z n G m h > o N Z ::s N 0 0 0 m C z N m tea" 0 n `.s ry~ = UI C i 7D rl a " a OD m o m~ N 7tQ ~ z I > -4 OD U r F- D O < z F 1. a o ~ o m m I-- It ol D ~ Z N _ J r_ -p lT~ D 'V C -7) rTl a rv 4 8 4. 76' 58' 25" W 526 01' m ~ cn y --r O :yC 1 O c_ T C- m c T D m 3 N 0 Z A m n 0 0 A n x