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Parcel 002-1010-40-120 01/06/2006 09:07 AM
PAGE 1 OF 1
Alt. Parcel 05.29.16.74A-20 002 - TOWN OF BALDWIN
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
ROBBY & AMY MILLER O - MILLER, ROBBY & AMY
1127 220TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1127 220TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: 4461-CSM 17-4461 002-03
SEC 5 T29N R16W PT NW SW CSM 17-4461 LOT Block/Condo Bldg: LOT 01
1 (10.AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-29N-16W NW SW
Notes: Parcel History:
Date Doc # Vol/Page Type
03/10/2003 712612 2165/509 WD
02/12/2003 709372 17/4461 CSM
12/31/2002 704165 2096/424 WD
12/31/2002 704164 2096/420 TI
2005 SUMMARY Bill Fair Market Value: Assessed with:
86630 Use Value Assessment
Valuations: Last Changed: 06/25/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 7.500 200 0 200 NO
UNDEVELOPED G5 0.500 100 0 100 NO
OTHER G7 2.000 4,000 106,400 110,400 NO
Totals for 2005:
General Property 10.000 4,300 106,400 110,700
Woodland 0.000 0 0
Totals for 2004:
General Property 10.000 4,300 106,400 110,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 45.00
Special Assessments Special Charges Delinquent Charges
Total 45.00 0.00 0.00
Parcel 002-1010-30-100 01/06/2006 09:05 AM
, PAGE 1 OF 1
Alt. Parcel 05.29.16.73A 002 - TOWN OF BALDWIN
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 - VAN SOMEREN, ALLEN J & BARBARA J
ALLEN J & BARBARA J VAN SOMEREN
2143 110TH AVE
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 51.570 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R16W NE SW NW SW NE SW ALSO Block/Condo Bldg:
PT OF THE NW SW DESC AS COM W1/4 SEC 5;
TH S 02 DEG E 660';TH S 89 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
667.04'POB;TH S 89 DEG E 496.96';TH N 00 05-29N-16W SW
DEGW 648';TH S 89 DEG E 116.36';TH S 02
DEG E 1306.74';TH N 89 DEG W 640.41';TH
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
12/31/2002 704165 2096/424 WD
09/04/2001 655559 1712/161 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
86629 Use Value Assessment
Valuations: Last Changed: 06/25/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 41.570 4,300 0 4,300 NO
UNDEVELOPED G5 10.000 1,900 0 1,900 NO
Totals for 2005:
General Property 51.570 6,200 0 6,200
Woodland 0.000 0 0
Totals for 2004:
General Property 51.570 6,200 0 6,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM
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
r /
OWNER A .4TOWNSHIP r y:/f SEC. T W
ADDRESSf . ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOTS LOT SIZE
PLAN VIEW - ~ ~0
Distances and dimensions to meet requirements of H 63 r/rF
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
f
7 T
301
301
113, fil
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point:
/DrjProposed slope at site: S j
SEPTIC TANK;: Manufacturer: Liquid Capacity:
Number of rings used: wc> Tank manhole cover elevation:
Tank Ir„let Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side, Rear, O SOD feet
Prom nearest property line Front, ~Side, ~Rear,
feet
Number of feet from: well 1ZL)" buiic-Lj8:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: fi- Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle: d
Alarm Manufacturer: ZX"". > - P' Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, Rear, 0 Ft.
Number of feet from well: 12
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORBTION SYSTEM
-
Bed; Trench:
Width: Length: Sly Number of Lines: Area Built: ~JV
Fill depth to top of pipe:
Number of feet from nearest property line: Front,/ O Side, O Rear, O ht .
Number of feet from well: 1-5U
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits:t lliametex:
`-t
Liquid depth: Bottom f s epage it e:1 t"on:
Area Built:
Etas either a drop box or distrib tion 46 been sed.n any of the above soil
absorbtion.sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Ff bot[ m, of tank:
Elevation of inlet: Number of feet from neare: t, O Side, O Rear, Ft.
Number llNumber of Number of feet from nearest road:
Alarm r.anufacturer:
Inspector:
Y--
Dated: 7-- Plumber on job: __Dll~~' 57n/2
License Number: 3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR & H-MA{V RELATIONS SAFETY & BUILDINGS
P.O. BO): 749 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
❑ CONVENTIONAL LXX\LTERNATIVE Slate Plan I ,D Number,
❑ Holding Tank El In Ground Pressure Ofg4 ,fined)
1Mound 02906
NAME OF PERMIT HOLDE H. ADDRESS OF PERMIT HOLDER:
I NSPECTION DATE. '1/ Anthvn Ila
Bcred in, WT uC(o BENCH MARK reference ponnR DESCRIBE IF DIFFERENT FROM PLAN
REF. ELEV.CST REF:7E NW SW Section 5, T29N-R1GCU, Tvwn v4 Baedwin
Name of Plumber.
MP/MPRSW No. County. Samlary Perm, Number:
Evened BaEcCt 449 S Ctcaix 54919
SEPTIC TANK/HOLDING TANK:
MANUFACTURER:
LIQUID CAPACITY. TANK INLET ELEV_ TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED-
BEDDINC. VENT DIA.: VENT MATL.. HIGH WATER ❑YES ❑NO ❑YES ❑NO
ALARM. NUMBER OF ROAD: PROPERTY WELL. BUILDING: VENT TO FRESH
❑YES ❑NO FEET FROM IAIRwLEr
❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL P
UMPi SIPHON MAN U FAc T U HER WARNING LABEL LOCKING COVER
❑YES ❑NO PROVIDED PROVIDED
GALLONS PER CYCLE: PUMPANOCONTROLSOPERAT ANAL ❑YES ❑NO ❑YES ❑NO
(DIFFERENCE BETWEEN NUMBER OF PROPERrv wELL BUILDING IvENTTOFRESH
FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLENGTH DIAMETER MATERIAL AND. MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENT10NALSYSTEM:
BED/TRENCH N1DTH LENGTH NDISrR PIPE sPAC ING MATER
DIMENSIONS MATERIAL INSIDE DI -PITS LIQUPIT DEPTGRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTRPIPE R. PIPE MATERIAL'. =NODISTR BELOW
PIPES ABOVE COVER ELEV. INLET ELEVEND NUMEPR OPERTV WELLBUILDINGFEET FROM uNE AIR INLET.
NEAREST- ►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED.
DIL COVER TEXTURE
PERMANENT MARK E
OBSERVATION WELLS
rHOVER rRENCHBED DEPTH OVERTRENCH;BEO ❑YES ❑NO ❑YES ❑NO
'TER DEPTH OF TOPSOIL SODDED SEEDED MULCHED
EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
:SSURIZED DISTRIBUTION SYSTEM:
OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE
MENSIONS ENCHES: FILL DEPTH ABOVE COVER
ED/TRENCH WIDTH TELEVV 7~:TDA
MANIFOLD MP ANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
VATION AND ELEV ELEV PIPES
DIA.
rRIBU1ION
)RMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL
VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
TENTS: PERMANENTMARKERSEYES ❑NO ❑YES ❑NO
OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑YES ❑NO ❑YES ❑NO _ NEARES_
tem on Retain in county file for aut'
le.
SIGNATURE. TITLE:
6710 (R. 01/82)
b5cons"' APPLICATION FOR SANITARY PERMIT
ILHR ~06' COUNTY
lEnT
In OUSTTRY, LR OF
(PLB 67) UNIFORM SANITARY PERMIT #
n OUSBOR 6 MUTRn RELRTIOnS
3'y9/9
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
r/ _S-0 In ee-~
PROPERTY LOCATION
Eye,
vl
x%1/4 ~4A/4,S T.,29 N, R
If (or W TOWN oF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
X 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): 141111
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
2d Replacement Soil Absorption System ❑ Revision ❑ Privy
X Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Per ml # issued
An Existing System That Has Been Inspected And Is Co pl/int As Far,, s Soil Conditions.
Total # of efab. Site Steel Fiberglass Plastic
Gallons Tanks oncrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Z Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber }
Manufacturer: 5-
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
51~1) 'Z 5'c_) [X Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for in ation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Ignatur MP/MPRSW No.: Phone Number:
✓e Rif"f
Plum e ' ss: Name of Designer:
r4 L ~ ~ 1 ~ ~`~a G ~
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
/ c~ ❑ Owner Given Initial
Y Approved Adverse Determination
Reason for Disapproval:
Alternate courses) 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.
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APPLICATION FOR SANITARY PERMIT
5 T C - 100
This application luau is to be cumpletad in lull and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor,("spec
house"), then a second form should be retained and completed when the property is
Auld and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - -
Owner ol- Property 'j /-/0
Location of Property a Section
Township, RLJt.~J~ .J
Ma L I..Lng Address Fy t Uzi i.n_? r. n_7 / r"~ r" r 1 r Al e Aj
Subdivision Name
brit Number Al Pr cviuus Owner of Property /►~pq/-C..
Total Size of Parcel 35- !T G0 S
Date Parcel was Created
Are all corners and lot lanes identifiable? Yes No
Is this property being developed for resale (spec house) ? Yas x Nu
Vu Lome, - and Page Number as recorded with the Red Lstcr o t Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
A. Other record:i_ngn f i i sad with the Register o l Oooo:s OI Dice
In addition, a carEfl iud survey, if available, would be he_ipful no ar, to av"16 .1s lays
ut the reviewing process. if the deed description referz HL t , uo a Urr i f i wo sHvvev
Map, the the Certified Survey Map shall also be requi-real.
PROPERTY OWNER CERTIFICATION
I ((AiK ce?t06y that act 5ta-tame-n-tS Ott thLS ~onm atce- tkue to the bc,s,t uqj my (uun)
rnuwfedge; that 1 (we) am (cute.) the owner(s) Q tie paopeaty de. cAibed in th-A
(Quamation 6oam, by v.tih.tue o6 a. wahlian.ty deed aecott.ded in the 066ice o6 the
county Regisfen oA Veedts ab Document Nv. and that I (we)
wtehe_ri ty own the paopo-sed sate 6m the sewage- dUpdat lys-tem (on 1 (we) hav(~
obtained an eazeme.nt, to mun With the above de6cuubed pnope&ty, 6oh- the
eon s.ttcuc tioOo6 ha.id s ynem, and the -)curie ha6 been My tie-goaded in the Mice
o6 the County Reg.i tm of Vee(L, ab vocumetttNo. ) .
L
SIGNATURE 0:' OWNER SLGNATURE OF CO-OWNER (IF APPLICABLE)
2t
DATE SIGNED DATE SIGNED
0HIAfffWNT , OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
~i~UMANs
_AB N ;RELATIONS PERCOLATION TESTS (115) MADISON, WI 3707
(146109(1) & Chapter 145.045)
OC.A ION SE fV - p / rOWNSF(IP/N41J"- fhPM 1TY------. t_O/T~NO. BI K. NO SUBDI VI IO/N~ NAME
'/4 or n7 _ 19~r7~L✓/ w l N_~~- rl
)LINTY OWNEBUTE 'S NAME MAILING ADDRE
't es)
iSE DATES OBSERVATIONS MADE
NO. BEDRMS.. COMM~R~IAL DESCRIPTION PROFILE DES(`.RIPTIONS PEIa( OLATInN TESTS:
i19 Residence New Replace
\ of I O
ATING: S= Site suitable for system U= Site unsuitable for system
()NVENTIONAI- MOUND: IN-GROUND PRESSURE' SYSTEM-IN FILLHOLDING TANK: RECOMMENDED SYSTFM:(opfion,,l)
S ®u®s ❑Z o s r~ s ®ula s_(ul_ ovX) C1.
It Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s_H63.09(51(b), indicate: Floodplain, indicate Floodplain elevation:
Ff PROFILE DESCRIPTIONS A~ S9
tOHING TOTAL P H T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
VUMBER DEPTH*. ELEVATION OBSERVED ES I HES TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.)
B 9 c 1- --:2 ~t h;' ,5~ 4- &
/t t(
B- 3 6.3_ a /4 f 9 " /d s/ L "/Q~ C► L 3E e .s e, L & K" _ L
B- w
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN . P' IQD _ pLRI_QD R _ - PER INCH
P-
f C3 V~D -
Q
P
P-
P -
LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
nial 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
land slope,
SYSTEM ELEVATION 7, '
de d
TN
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
,tiministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
AME (print TESTS WERE COMPLETED ON
- ✓Frte'..cy Ate- / y-/ ADDRESS: , CERTIFICATION NUMBER PHONE NUMBER(opuonal)
(
)ISTRIBUTION: Original and one copy io Local Authority, Property Owner rind Soil Tester.
tILHR-SBD-6395 (H. 02/82) OVER
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Pertvorot~ t e b6t~tty fy
- 4 3 ~t ~y 9,r. h
En View
)Perforated
End Cop PVC Ptpe
Holes Loud On iottom,
Are Epually Spaced
yo
PVC Force Main
` C
Manifold Pipe
Alternate Position Of
LMsfribution
pine Force Main
' Lost Hot* Should Be~
Next To End Cop
End Cop tribution Pipe Layout 3,7.5
P Ft.
~EPARTMESdT~~~S101A Ur R (Q'~
-
77. S
t. X - Inch _
n hes~`, r
Si9ned: Hole DiameZr In
Lateral Inch(es)
License Number: /'Y) P '~`Qg
T Manifold 02 Inches
Date: rS a Force Main Inches
# of holes/pipe
Invert Elevation of Laterals/U7,9Ft.
fw N e 2 0% Pa g _
l a Of
N , I o y V )4r 10 So nn e. eN
c.•., Straw, Marsh Hay, Or
(,J ~ S Synthetic Covering
Distribution Pipe
Medium Sand
Topsoil - H_ G
__II E 1 D
3
b
yo Slope
Bed Of 2"- 2 2 Force Main Plowed
Aggregate From Pump Layer
D o
Cross Section Of A Mound System Using E
A Bed For The Absorption Area F
G /.D
A Jr Ft. H 5
Signed: ~,,-e - B 56 Ft.
s
License Number:~ 44 509 I '
/a Ft.
Date: S- .2,Z - J 7,aa Ft.
K 0./Zft.
Alternate Position L Z,aS~FI
of
Force Main W~PS~Ft•,- -r~
Observation Pipe--~
(o ----j-------= Force Main
W
From Pump
Distribution 7's Of 2 2 Pipe Aggregate
3,1 OY's'ervation Pipe Permanent Markers
z
Plan View Of Mound Using A Bed For The Absorption Area
A tJ SO mtRe~ PAGE of
,tIvNY PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
ALwr~,
L,), S
---VENT CAP
y,C.I. VENT PIPE
WEATHER PROOF APPRpVED LOCKIAJG
- M
JUNCTION BOX T ANHOLE COVER
- 25' FROM D(,OR,
q4 WINDOW OR FRESH 12°MIU.
AIR INTAKE
GRADE -
y' MI A.
.
k
IB"MIlJ
COIJDUIT `
18"MIN. \
~ 11~
INLET PROVIDE I
AIRTIGHT SEAL I II I
I I
APPRO`JET) ,,JOINT A I APPROVED JOIN
WlC.T. PIPE I I I W/C.I. PIPE
EXTENDING 3' I II ALARM ExTENDIIJG 3'
ONTO SOLIDGIt. _ B I (I ONTO SOLID S01
I
I ( ON
C I I
I
PUMP---- OFF
CONCRETE BLOCK
r RISER EXI ERMITFED GNLU IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECIFIGAT10MS
SEPTIC AND
DgW TAN! V`;11 UFACT URER: ~i✓G~SG~2 I.O.VGr2e7~~ KIUMBER OF DOSES: -PER DA!J
TAMK :,IZE : Poo _ GALLOIJS DOSE VOLUME: //7 GALLO"S
ALARM MAMUFACTURER: _ CAPACITIES: A= 10.5IIJCHES OR `O J0 GALLOUS
MODEL IJUMBER: _ B= ~33-3INCHES OR GALLONS
SWITCH TYPE: e- et to C= 6 INCHES OR L_7 GALLOAIS
f'IIMT' . MANI.IFACT URER: oep M 1'441 C~ D=M-0 OR A GALLONS
MCUI',EL NUMBER: SP 4 D NOTE.: PUMP AND ALARM ARE TO BE
SWITCH TYPE: F.4- IUSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE RATE 0 GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION! PIPE.. 9 FEET
-I- MIIUIIMUM METWORK SUPPLE PRESSURTE/. . . . . . . 2.5 FEET
+,_24 .r FEET OF FORCE MAIN X~~FypFT.FKICTION FACTOR-_"- FEET
TOTAL
•~D~J JAMIC. HEAD = FEET
IMTERNAL DI NSIONS OF NK: L /E-1 Al.2-
• ;LIQUID DEPTH
51GKJED: LICENSE AJUMBER: DATE: 15'-'ZZ-
24
I
20
w
W
LL 16
c SV40
W 12
S
t_1 yF` FJa- 8
O
4
0 16 32 48 64 80 96 112
U.S. GALLONS PER MINUTE
and SVK50 Submersible Residential Sump Pumps
SOLIDS Head-Capacity: SV40 a
Max. Solids SV40,11/2" & SVK50, 2" Spheres; 4 Pole, 60 Hz.
HANDLING
32
SUBMERSIBLE 28
}i 24 Spy
Z 20 - - q
SEWAGE W Sp4
s 044
& EFFLUENT ~12
8
PUMPS 4
0 20 40 60 80 100 120 140 160
U.S. GALLONS PER MINUTE
Head-Capacity: SP40A and SP50A Submersible Sump Pumps
Max. Solids SP40A,11/4" & SP50A,11/2" Spheres;
115 Volts, 60 Hz., 1750 RPM
40
3s
+~,,-po -1C u 1 \i 32
SKy00
,w,~ 1 V 28
w
BVERETT A. Z 24 K~5
BOLDT f.
20
v
a il ~ 2
1 x 16 SK6
-oar "60.. X Q
Z H 12
;
AL S;N,
, , i 8
4
rrS a s f e r is. 0 20 40 60 80 100 120 140 160
jD NIP Q04489 US. GALLONS PER MINUTE
Head-Capacity: SK60, SK75 and SK100 Submersible Sewage Pumps
Max. Solids 2" Sphere, 1750 RPM
HYDR-O-MRTIC
PUMPS
A Division of Wylain, Inc.
Post Office Box 327, 419/289 3042
_ Claremont & Baney Roads, Ashland, Ohio 44805
H-82 In Canada: wylain Canada Ltd. Lt".. 126 East Dr., Brampton, Onhno LBT 1C2
Department of Industry, Labor and Human-Relations
~wls~onsln Division of Safety & Buildings
DILHR Bureau of Plumbing
oEwaRTmEnT of P.O. Box 7969
InousTRV,LRBOR 6NUMRn RELRTIOns Madison, WI 53707
Tel. (608) 266-3815
s IN ALL CORRESPONDENCE
REFER TO PLAN
DENTIFICATION NO.
J ~~~GF
NAME OF PROJECT ~I $
PRIVATE SEWAGE ONLY -
❑ GENERAL PLUMBING PLANS Fee Received:
LOCATION _ Priority Plan Review Only
CITY OR TOWN C01 INTY
F
Examination of plumbing plans and specifications for this project has been
completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations shown on the plans. Please
review your code for the requirements of each code section noted.
The licensed plumber responsible for this installation shall keep at the
construction site one set of plans bearing the department's stamp of approval.
The installer shall also notify the appropriate inspector of wnen required
inspections are to be made.
4N@641 4- -4-- yeaps fpem thi6 date,
approval ;A411 bQ void a.Ad AQW.As pl&A approval shal
.bej4+a.
In granting this approval, the Division of Safety and Buildings does not hold
itself liable for any defects in plans or specifications, plan omissions or
examination oversight, and reserves the right to order changes or additions if
necessary.
This approval is based on Wisconsin Administrative Code requirements. It
shall be necessary to obtain and fulfill the permit requirements of the city,
village, township or county in which this installation is to be made. Failure
to obtain local permits will automatically void this approval.
Sincerely, / For Private Sewage Systems Onty:
This approval is valid for two
years or it will be valid until
` ~L the expiration date of the initial
James Sarg~it~
sanitary permit.
Bureau Dire or
PLANS REVIEWED BY: DATE:
cc: DPS - QWS'' Owner H & R & Rec. San. Section
Local PI Plumber Bur. of Health Fac. & Services
-County Other
DILHR SBD-6099 (R. 05/82)
a
i ST. CROI X COUNTY
WISC0NSI N
u1uL i
ZONING OFFICE
~ ~ ~~►'d'1 ~ ~ ~ ~ 1 raw rr~r~ ~ > >
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
May 24, 1984
Division of Safety and Building
Bureau of Plumbing
P. 0. Box 7969
Madison, W1 53707
Dear Sir:
An on site investigation for the Anthony Van Someren property located
in the NWT of the SW4 of Section 5, T29N-R16W, Town of Baldwin, St. Croix
County, revealed suitable soils at a depth of 28 inches, below which
seasonable high ground water was noted.
This site should be suitable for a mound system.
Should you have any questions, please feel free to contact this office.
~S~-i~n-c~erely ,
` Iiomas C. Nelson
Assistant Zoning Administrator
TCN:mj
H
y
ST C- 105 r
y
ti
SEPTIC TANK MAINTENANCE AGREEMENT
0
St. Croix County
d
9
OWNER/BUYER 14 r? O/7
ROUTE/BOX NUMBER _Jy f T~ Fire Number
CITY/STATE p/G~'C.c~i'►~ ZIP „$"y4DZ
PROPERTY LOCATION:/', S~ Section S TN, R ~b W,
Town of St. Croix County,
Subdivision NA Lot number.
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank Lnper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. ti
0
F
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- ro
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date. I
S I C N E D L
DA'Z'E (0// t
St. Croix County Zoning Office
P. 0. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
WISCONSIN DEPARTMENT OF INUUSIRY, LABOR AND HUMAN RELI\IIONS
DIVISION OF SAFFIY & 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 . Cr_o Lx
Location NW 1/4, SW 1/4. Sec. 5 T 29 N, R 16 ZXWY,W
'town oXX .KkAW44* Baidwin Street Address
Lot No. Block Subdivision
Landowner's Name: Anthony Van Someren
the application for this site is for:
El new construction use.
h1replacenent system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
Ito have one of the first five approvals guaranteed for this year. This is
number - of those applications. (Use one of the first five
quota numbers ssuQ to you.)
lone of the applications needing a quota number. The quota number assigned to
this application is - -
_Ifor one additional homesite on a farm to he occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
I
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.
U 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:
[XIA failing conventional soil absorption system.
Lj a holding tank that was installed and in use prior to February 1, 19HO.
L_1 a privy that was installed and in use prior to February 1, 19HO.
If this is a REPLACEMENT SYSTEM USE and the lot 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 n~
knowledye. /
Name Thomas C. Nelson Signature
~runl.y Official)
Title Assistant Zoning Administrator Date May 24, 1984
DILHR-SBU-615f.1 (1l 1l./HZ) i
STATE OF WISCONSIN-DtPXA*RNT OF INDU8TRY, LABOR & HUMAN RELATIONS
DLVLSION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location. Township/NhAAk`7L?hA AXY/A
NW ~4 SW~4 1 S 5 T2.9 N/R 16 XIKC8,)W Baldwin St. Croix
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Anthony Van Someren R. R. 1, Baldwin, WI 54002
I (We), the undersigned, hereby snake 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
a ree to have the system installed in conformance with the Bureau's approval
o}` 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 und(;standing 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
DT_LHR-SBD-6413 (N. 05/81) My Commission Expires:
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUST`riY, DIVISION
707
LABOR AND PERCOLATION TESTS (115) MADI P.O. SON, WI BOX 537969
HUMAN RELATIONS \ 1
3707
(H63.09(1) & Chapter 145.045)
LOCATION: SE[C✓TION: TOWNSHLP/JM~tfiY: LOST/NO.:BLK./NfO.: BDIV/I~S/IO4NNAME:
/I~/~ (Or) ■1, /'7 NL-~~.I~J/ r.: / I /.1 / 1l
~4 ~.J /T /
COUNTY OWNER'S/BUYER'S NAME: MAILING ADDRESS-
/
,4 Ill() rLl`j-U'~ V~'Ml'Sf_>Y1) -Yt.4`f'~ r LC_.%rS
USE _ DATES OBSERVATIONS MADE
~s NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS
:
>71 -
L~9Residence '1 ❑New Replace
l J J
RATING: S= Site suitable for system U= Site unsuitable for system
-
CONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑S DU ZS ❑U ❑S U ❑S DU ❑S❑ Mu
SIGN Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(h), indicate: Floodplain, indicate Floodplain elevation: -
PROFILE DESCRIPTIONS ~i
3ORi OTr,L DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH Ni, ELEVATION _O_BSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- /0
L Z_
B-3 33 `f K C~. go,
3` r
' 6'
I
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER_ INCHES AFTERSWELLING INTERVAL-MIN. PERIOD _ -PERIOD 2 PERIOD 3 _ PER INCH
P- eel)
P- v -f T e,
C1
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 hon
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 / T
4y\c ~j ~4
TH
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print):
~ TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
- CSTStG_NAT RE:r
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester,
DILHR-SBD-6395 (R. 02/82) OVER -
4
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SBD6678 (9/81) (Plb 100a) 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 178
Any Return Corresponded , P.O. BOX 7969
` Y J MADISON, WI 53707
~n 608-266-3815
DATE:
III PROJECT:
4
Ipa~NG 1984
Ce ;
,SW,5,2:.
L 1.i
M n,
i r
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 $
❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming.
❑ Plan accepted for review. ❑ Plans being returned.
❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW.
held in abeyance.
1. Plan Submission ❑ Complete data relative to anticipated use of bldg.
❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed.
less specifically noted. ❑ Deed restriction required (1 copy).
❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy)
❑ All information submitted shall be signed, dated and sealed
or stamped in accord with Section H 63.08(2) (a) Wisconsin
Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks
❑ Profile of holding tank showing vent, manhole alarm and
manufacturer if precast. Complete construction details if
11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed.
❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of
and notarized. (1 copy) government (sample enclosed).
❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement
for pressurize distribution. ❑ Soil boring & percolation from county (1 copy).
test data. ❑ Plot plan showing location of holding tank with lateral dist-
❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water
❑ Plan view of system. ❑ Plot plan.
course, lot lines, swimming pools, all weather service road,
❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point.
111. Private Sewage Disposal Systems V. Lift Pump
❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons
tion system extending 25' on all sides. pumped per cycle.
❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main.
❑ Location of area suitable for replacement system - provide
soil data. ❑ Detail & model of pump or automatic siphons including
size, pump curves, drawdown and average flow rate GPM.
❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or
sewage disposal system to buildings, lot lines, well, water siphon(s).
course, swimming pools, water service piping, Etc.
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast. V1. Systems In Fill (Fill must be placed prior to plan submission)
❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench
system. before side slope begin).
❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill.
tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff.
SBD 6678 (9/81) (Plb 100a)
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 178
Any Return Correspondence P.O. BOX 7969
MADISON, WI 53707
608-266-3815
DATE: PROJECT:
12s 0 i ,5w
4n
'2' 1
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 $
❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming.
❑ Plan accepted for review. ❑ Plans being returned.
❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW.
held in abeyance.
1. Plan Submission ❑ Complete data relative to anticipated use of bldg.
❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed.
less specifically noted. ❑ Deed restriction required (1 copy).
❑ Plans not clear, legible or permanent. ❑ Condominium declaration. 0 copy)
❑ All information submitted shall be signed, dated and sealed
or stamped in accord with Section H 63.08(2)(a) Wisconsin
Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks
❑ Profile of holding tank showing vent, manhole alarm and
manufacturer if precast. Complete construction details if
II. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed.
❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of
and notarized. (1 copy)
government (sample enclosed).
❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement
for pressurize distribution. ❑ Soil boring & percolation from county (1 copy).
test data.
❑ Plot plan showing location of holding tank with lateral dist-
❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water
❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road,
❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point.
Ill. Private Sewage Disposal Systems V. Lift Pump
❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons
tion system extending 25' on all sides. pumped per cycle.
❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main.
❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including
soil data. size, pump curves, drawdown and average flow rate GPM.
❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or
sewage disposal system to buildings, lot lines, well, water siphon(s).
course, swimming pools, water service piping, Etc.
❑ Construction detail of septic, holding or lift pump tank if
site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission)
❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench
system. before side slope begin).
❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill.
tified soil tester 0 Copy). ❑ Copy of onsite report by county or district staff.