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HomeMy WebLinkAbout002-1018-70-001 n N O 3-0 0 Cj o d ~ c o 3 a 3 r M 1 N # M ~3~ Co 0 C) 0 0 o v v z co o w CDD C) `C O• (D 3 3 O_ C tD CO d N N 00 (D SD j Q W L C1 E fn 7 CD CD Q O d O N 44 0 co (D C) co 0 O CD O 5 O1 co 0 --4 0 td ~C G l7 F- to C D a w in. d '~d ° y W a O (D Fl C Q C a V rt 4~ 3 O (D ~~I H L N `(D rlt 7* cn W v, H d I CD A0 r, ~ m rrT Q C) OD (D 1,0 H CD 'D M -a (D O O O Y "NA~ o l~~l rr n ° c ai ai W o o D E ° ~ v v v O CD H Q' m CD » (D N cD :.r (D cc (D A) ~ N ~1 rn m rr IV d w i z rt co 0 O I N D D o d O P3 CL Ici F-3 F-3 0 CD I O N z~ 0 CD V O I c 00 r p rn w 00 ON cn a td (D Z CD -j fn CrJ w n O A Z CD O I r7 ~6 5+ W O. H. 0 A z 0 Oo L O m O U, O N• o O F-I Z cD (D (D a 3 z G A 11 0 Z 3 ~ CD _ -O A w w C m 7 O d-4 y 3 3 m ° aN a (D -o Co .J < O "n -v r v c O N 000 n O CD A 0 < O N o OwT a) N C 00 CD 7 O" CD M C1 N =r CD 7c .1y" a0-:-~ CD i N (D N A N :5- E "a 3 F d 3.~ Q a CD a ~`n O CD d CD A d Z A _ (D O `C S 7 O W60 < 7 3 M O j~ C N CD O 0. C., W S ~ I A ~ W • Oq N O t-j ts> O 0 ( o CD Parcel 002-1018-60-001 01/05/2006 02:57 PM PAGE 1 OF 1 Alt. Parcel 09.29.16.124B 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 DAVID W HOVDE O - HOVDE, DAVID W 1083 230TH ST 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: 0.480 Plat: N/A-NOT AVAILABLE SEC 9 T29N R16W .48A NE NW THAT PART OF Block/Condo Bldg: CSM 5/1463 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 02/26/2001 639156 1591/164 QC 07/23/1997 933/225 07/23/1997 699/438 2005 SUMMARY Bill Fair Market Value: Assessed with: 86708 600 Valuations: Last Changed: 11/02/1999 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.480 400 0 400 NO Totals for 2005: General Property 0.480 400 0 400 Woodland 0.000 0 0 Totals for 2004: General Property 0.480 400 0 400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/1712001 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 J AS BUILT SANITARY SYSTEM REPORT OWNER -7 x 4~ TOWNSHIP SEC. T j N-RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE / /,:1:,- PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I ~ us sF pfr~ _3 I -75 y i ~ -f- C Ii - INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used, f=fJ nom' ' Elevation of vertical reference oint: P Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation::` Tank Outlet Elevation: 1 J Number of feet from nearest Road: Front,0 Side, Rear, O feet From nearest property line Front, 0Side, ORear,O feet Number of feet from: well / f building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model:, Pump/Siphon Manufacturer: Pump Size Elevation of inlet: `-1~2 Bottom of tank elevation:- Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side Rear, 0 Ft. 6 J Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench:--- Width: 3 Length: Number of Lines: Area Built: Fill depth to top of pipe: 'r Number of feet from nearest property line: Fronts O Side, O Rear, 0 vt.-7-'~ Number of feet from well: :5~ 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 distriution box O bee' used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest prrperty,'line: - Frog t, O Side, O Rear, O Ft. Number of feet fr A well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: f Dated: Plumber on job: License Number : ,J G-' 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISON, WI 53707 X ❑CONVENTIONAL -C 7ALTERNATIVE State PlanLD N„mbe,. ~c (If assigned) Holding Tank ❑ In-Ground Pressure Id1 Mound 84 03850 NAME OF PERMIT HOLDE H. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gerald T. Rose R. R. 1, Baldwin, WI -~S_.1~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF PT. ELEV NW NW, Section 9, T29N-R16W, Town of Baldwin Nair- of PI-bar MP/MPRSW No.. Coun[y Sanitary Permit Number_ Everett Boldt 4489 St. Croix 58901 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER q q PROVIDED PROVIDED f / ~ /`x`3'7 YES ❑NO ❑YES O BEDDING: VENT DIA.: VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING. VENT TO FRESH ALARM FEET FROM LI"EO AIR r ❑YES ❑NO ❑YES ❑NO NEAREST w~J DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER Q PROV DEG: PROVIDED ❑YES NO fyI YES ❑NO ES ❑NO GALLONS PER CYCLE: PUMP AN~CONTR OLS OPERATIONAL NUMBER OF PROPERT WELL BUIIG VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE AIR"LErPUMP ON AND OFF) ' - 7YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENCrH 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 y10 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH. LENGTH. NO. OF DISTR PIPE SPACING. COVER INSIDE DIA 'PITS ILI QUID TRENCHES MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIPES 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 OF SYSTEM 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. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS YES ❑NO Z~' ES ❑NO DEPTH OVER TRENCH;BED JEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER DGES. r "KINO YES ❑NO -YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER 80 7 TRENCHES DIMENSIONS /S MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL. NO. DISTR. DISTR PIPE DISTRIBUTION PIPE MMMATERIAL & MARKING E LE V.. ELEV. DIA. ELEV. . PIPES. DIA.. I i7 ELEVATION AND / /!f L/ DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 5 PLANS. ISZYES ❑NO f ❑YES ❑NO COMMENTS: PERMANENT MARKEH . OBSERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING. LINE YES ❑ NO YES ❑ NO NEARESTOM J % Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE-. TITLE. DILHR SBD 6710 (R. 01/82) `i O 40 A4 Ac~ p .tit U . r oji V) Lot t v h 0 45 1J Q ~ i t, ,t ~ is ~ r elk k p~ / Le ° ' 1 y raw, f " VA (T i 1V 4,03 jSe7 _ ~ Y 1 s X C~ Qom. ` ¢tj . . ~Wwe`R Page / Of" ~ Straw, Marsh Hay, { r Synthetic Covering Distribution Pipe Medium Sand Po 4 Topsoil o - F d 3 Slope a Bed Of 2 % Force Main Plowed From From Pump Layer f , ; DL E ,2. /5 Grass Section Of A Mound System Using , a P • 75 A Bed For The Absorption Area F , G A A St0 Ft. H 5 S i gned ; -°-~-M--- B Y 7,DFt. License Number!::: M 9 I /11,3 Ft. J S~ Ft. Date; K /Z5 Ft. i' Alternate Position L 72,0 Ft. of Force Main W 31.0'Ft. Observation Pipe--.,~ B K- - A W fa - - _ _ _.....Force Main _ _ From Pump Distribution Bed Of z 2 Pipe' Aggregate 1 Observation Pipe Permanent Markers Pion Yiew Of Mound Using A Bed For The Absorption Area Page Of. fi, ~Q v t ' (,e L twi.J is r Perlar*ted Pipe Dietafl s nd View } End Cap )Per forated ? 1 PVC Pipe 1. ,Do Holes Located On bottom, r' S Are Equally Spocad PVC Force Main „r r From Pump f PVC Mgnitoitl Pipe w Distribution Alternate Position Of Pie Fore Mein From Pl anp 1~ 4at 14010 Should ba Nest To End Cqp End Cap Distribution Pipe La out 06 Y 75 51gned: ' Hole Diameter Inch Lateral l Inch(es) License Number : 1'>7 P Manifold Z Inches Date: Force Main 3 Inches p,, '0Z L5 -6, PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOUS VEMT CAP H°C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING a. JUWLTIOA! BOX MANHOLE COVER r 25' FROM DOOR, WAIDOW OR FRESH 12"MIU. I A- !t,~TAKE GRADE 4" MIN. I 18" M I Al. COQDUIT INLET PROVIDE I AIRTIGHT SEAL I (i I V I APPROVED JOINT A APPROVED JOINTS W/C.I. PIPE ,1~ I I W/C.I. PIPE EXTENDING 3' EXTENDIUG 3' OMTO SOLID SOIL B y y `1. ,`S I I I ALARM ONTO SOLID SOIL I ON ELEV. FT. PUMP nE - OFF CONCRETE BLOCK RISER EXIT PERMITTED OAJLy IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIONS DOSE TAWKS MANUFACTURER:-S NUMBER OF DOSES: -PER DA!;I TALK SIZE: FOO GALLOUS DOSE VOLUME If ALARM MANUFACTURER: /e/o,-rn)INCLUDIAIG BAC~KFL~OW: I~~• I GALLONS MODEL DUMBER: 0(90 CAPACITIES: A=LL ' -INCHES OR 4 1, ~GAALLOUS SWITCH TSPE: B:; 446INCHES OR GALLONS PUMP MANUFACTURER: si~v~.~-a n7ca ~G G = L 5 INCHES OR /6 3 GALLONS MODEL WUMBER'-Sp'yQ D= IAICHES OFZ° ALLONS SWITCH TUPE: /V&r 42zW 1/ ,~~UCr NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE - 7~ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEAI PUMP OFF AWD DISTRIBUTION PIPE.. FEET + MIAIIMUM NETWORK SUPPLY PRESSURT.E/. . . . . . 2.5 FEET + 35 FEET OF FORCE MAIN X 000 FTFRICTION FAC,TOR.. '-5 0 FEET TOTAL OyIMAMIC HEAD FEET ~D,ldmdfe"_ 7,0 11ITERNAL. M:: S OF TAUK: -1=E d-OrT- l ;1r,lQT-H LIQUID DEPTH SIGUED: c3" LICE.QSF k1UMBER. 4(489 DATE: i,. 24 n' 20 V ' t2 5 8 k x'' 4 0 18 32 48 64 80 96 112 A. ""ONS PER MINUTE So"LIDS Head-Capacity: SV40 and SVW Submersible Residential Sump Pumps ' v`f l " s Max. Spuds SV40911/V &,SVK50, 2" Spheres; 4 Pole, 0011z. HANDLING 0 A " 28 SURMER$iBLE 24 i 20 16 S E W1, G E EFFLUENT 0 - Y ! 4 k PU M'ps." x , _ a, 1 l 20 at! , 60 . '80 100 120 140 160 U.S. GALLONS PER MINUTE Mead-Cap SOY: SP40A and SP50A Submersible Sump Pumps Max. SW $P4K 11/4" & S 11/2" Spheres; t r., s. 415 *fts,,60 Hi. 1750 RPM s 40 t!►1un►►r1~~~ SI 28 % 20 #WORETT A. A .y. , 4~>`3~ • -Mob., • t A j , 1 + 12 6-0426P e A' fy, s VpBALDWIN. L ~',Y r WIS. 4.. r ,'0 1 i ♦ 7 ,IGN~~ 0 20 4e a0 e0 100 120>,o Aso ii11~1►u►`"' U.1j.1SiA1,1"IN$ PEi1 AAMrIlm RearCapacity: V00, X15 # nd SK100 Submersible Sewage Pumps Mal Sphe gr. re,' 1150 RPM { 1 ► ,k H DR-o-mRT'IC • 1 , . PUMPS A Division of Wylain, Inc. PW 0160 Box 327, 419/296 3042 Cla►arnort 3 6aney Roads. Ashland. Ohio 44806 W 1, 1n QNwftr WVaWa po* ltd. Uk., 120 Fflr Dr. errrpbn, 0~0 Lff 1C2 w,sconsin APPLICATION FOR SANITARY PERMIT C ~c ® I LHR C~~'uiX COUNTY (PLB 67) UNIFORM SANITARY PERMIT # OEPRRTT T OF Ir'IOUSTRY, LRSOR 6 HUMRn RELRT1ons ` r VD~ -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 ~eRAG-7' i, cr5c/ PROPERTY LOCATION CITY: Hw1/4NGA)1/4,S ,1~~N R/4~t (a W TbVVNOF. LOT NUMBER BLOCK NUMBER SUBDIVISION NAME R ST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER n/ : 42 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. L7 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny 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 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 0 Q 6 Q ,A.J(Z, X Lift Pump/Siphon Chamber Q U rU n Manufacturer: e E'- k-5 PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): C) 7~ X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for instal ail n of the private sewage system shown on the attached plans. Name of Plumber (Print): <-D MPRSW No.: Phone Number: Sig ature Ma 7i.5)E;85~-7~~ ✓G.2~ ff ~aa~f 'J ( Plumber' ddress: Name of Designer: 19 Cj CnJ i vtJ ! S § J M (.171- 1 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved l~ / (yam L-1 Owner Given Initial OR q) Approved Adverse Determination Reaso 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 L a 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. . t F' h ` y. yr ~ s x 1 vt6 n to Y ~ M s { ~ ~J 1r K3.. + M r - 6 y }rw kFA 63 v y ilN, r r 1 + d l1rw , , Yl~ k F t aI ^ c - a, vi, P t, 7 Iq (4 k { t1 4 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 76 ON WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: Nj1 SECTION: ~ / TOWNSHIP/ LO~TJNO.:BLK. NO.: SUBDIVISIO/N NAME: 9 /T.C79N/R/le 1 (or 230 OI L.cJ,'Y7 /!r NA N /4 4 il I COUNTY: OWNER'S/BUYER'S NAME: L MAILING ADDRESS: Sr ra USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system J O C~ 0 7 CONVENTIONAL: MOUND: IN-GR)UND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S Lai DS ❑U ❑S ®U ❑S 2U ❑S ©U /10 u"O/ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the A under s.H63.09(5)(b), indicate: 11114 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTALF" DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ft. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE A/BBRV. ON BACK.) / B- O -2, 3 i / u~/%f'Orf/ • 00 ~r s (D "/~SG/ B- Z ~ "O ~~'Cvco 1~ 9 ".13 Ix, " n sl" w~„~y`f- • /S •.C s/• ,29 iPs B- 3 ~'Q 9`f•~`1 i/ 5~~8/s,' l~' sit 20 I3 w o '3yl~sc B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERT D PER INCH P- P- 2 / z' ,1 p P-3 7' it 3y" 5 5 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 s i r 1 I ~ ~ ~ t 1 i t I ( I i / . I et j 1 f ! I { t t . i ~ k 1 I i I, the undersigned, hereby certify that the soil tests reported on this form were made bfine 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: ✓G2e~~ / o L q/' -/G -F, I ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ] t'S W i4 L ~ w ~ •v P q 7/ to 33 SI URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - i o 0 >o ac cn \J m o cc c c~ co r a 6 .2 E p c M cwt c a O= m F- L- co O c e o U) U m A V o p 10 V i C CM L- U a) l a) N ? . c 00 v1 c~Q W _v c N (D 'a :9 'a oca~c•-(D -ca ca 0 3 0-0 0 m v o v E c f~ c 0> j ~ c ca CD 0 tj= c 0)-0 Lt c c m o o y c m c -0 -C CD ca cu a) CL - o a) c a 3 ~ -0 -C c`a c W gt 0:c cao Q ~wo` L-- (D vs a) Q) U m 10 Z c H w c m O .0) U cn ro s u V) ca 0 v,- cv ac c p vi o O ca c ~ 'D 0 _ CD 3 0 a c ~ c~ o V O= N ` er - O Q 0 h = (D (7 O 0) (D Q dQ a)040 ~ O~.C ~ - M - c p C 0 'O L- 0 y co RtN ~~•O 0 3 0 n rZ ca _c cn 0 m 0' 0 0 O c c c i c~U J ~ C-CoCo 0 (1) 0 10 r- 0 [ U _ Y A3U cC p ar -0 2 r O c cm w, co co O~ c o w O c W V O- N p'0 Q U) L 5 a Q o C O 0) C a~ O c cri Y L- cV (LJ O m p C)) w 0 Z catt i CL a O 0- c p U c O p 3 C ~J O cj cn ai w 3 m o ~ m m c a = N D APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property QeRe41-_4 7-~ k e)) SG Location of Property A1 0J 4 ~GLJ , Section / T N - R t W Township Mailing Address 0 f L c4 Subdivision Name Lot Number Previous Owner of Property V / A/ Total Size of Parcel,( 6,0"" mss, , 0"" ~C P- Date Parcel was Created ? Are all corners and lot lines identifiable?_- Yes No Is this property being developed for resale (spec house) ? Yes X, No ~ po ~ Volume and Page Number,0? as recorded with the Register of Deeds - INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 1`{1 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eeAti6y that a.U 5tatementIS on th,i5 6ohm oAe tAue to the b"t o6 my (oufe.) know edge; that I (we) am (one) the owneA(,s) oA the phopenty de/seAibed in thi6 tin4onmat%,on 6o&m, by v.iA.tue ob a waA anty deed heconded in the 066ice of the County RegizteA o6 Deeds as Document No. n_ ;~2 ; and that 1 (we) pnesenUy own the pnopo6ed bite bon the sewagedizposat ay~s-tem (oA I (we) have obtained an ear, emen.t, to nAun with the above deg eAibed pnopeAty, boh the conbtAuction o5 said .6ydtem, and the same hay been dut neeonded in the 066ice of the County RegizteA ob Deeds, Document No. ~971~6 )..j ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H C!~ y S T C - 105 y SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County OWNER/BUYER We, Sc- rn f 4,,q Me P_ ROUTE/BOX NUMBER 111. ~ Fire Number L ' CITY/STATE /,D nLC~~~.~ v, -ZIPc'e, Z PROPERTY LOCATION: ✓VLv' ~ IV(,J ~4, Section 7 T N, R W, Town of ,9,q w"St. Croix County, Subdivision Y►A Lot number N/~ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-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 the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ;K 7 6b ' CL-a' D ATE St. Croix County Zoning Office P.O. Box 9$• Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. SBD 6678 (9/81) (Plb 100a) STATE OF WISCONSIN DIL-HR DetacK And Return Upper DIVISION OF SAFETY & BUILDINv BUREAU OF PLUMBING Portion Of This Form With 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 608-2663815 DATE:- PROJECT: '9 y ~9 PLAN ID. # DETACH HERE PLAN ID. # PROJECT NAME 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 IV. Holding Tanks Administrative Code. ❑ Affidavit enclosed. ❑ Profile of holding tank showing vent, manhole alarm an manufacturer if precast. Complete construction details if IL 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. III. 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. 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 before side slope begin). system. ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and t pe report fill district staff. tified soil tester (1 Copy). ❑ Copy P by county or MA Parcel 002-1018-70-001 01/05/2006 02:56 PM PAGE 1 OF 1 Alt. Parcel 09.29.16.125B 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 - HOVDE, DAVID W DAVID W HOVDE 1083 230TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1083 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 6.160 Plat: N/A-NOT AVAILABLE SEC 9 T29N R1 6W 6.64A NW NW THAT PART OF Block/Condo Bldg: LOT 1 CSM 5/ 1463 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 02/26/2001 639156 1591/164 QC 07/23/1997 933/225 07/23/1997 699/438 2005 SUMMARY Bill M Fair Market Value: Assessed with: 86710 158,900 Valuations: Last Changed: 11/02/1999 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.160 13,400 88,600 102,000 NO Totals for 2005: General Property 6.160 13,400 88,600 102,000 Woodland 0.000 0 0 Totals for 2004: General Property 6.160 13,400 88,600 102,000 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 00 0.00 State of Wisconsin Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 7 7 vG~~~A► P.t-. oox 7961 r - -A 1:171 --vi i Ie ti r is - I-W of ~3aldvon' St. p t a t C Petition for a ~Q 1,144 ce vu 3,e l,i: AL at- - - . t i~ SaJ vi Y.`-s oistrative Cooe: ryas . ovsmier ei4 ~'0y Ij, i 84. It :~a,- '~ultiit3t !is r~+ t" v The condition being that ill the event of fall a ttl 5-issttN4 shall 3e replac-a(i 4eivi a tio)OA in;( or 0Lter off-10 S i.ie rule: requires that a rziourv sySt Shall have a ;sir=t s 124 :,Jtacilb natural so! I. v4 ri a,w-r questea was ---a 3st- ! 1 3 1 inches , 1. _ife s id ere°.v Tnq,q 'FCertaqct S,x.da ','~joo of Privdt Sewage ftP.J ~ . ^ it+la 4♦ io3t 1.'nf 'Z o P,tri A,Iiiy jx tbbr~ S f.,r t 1i J Private p:,wa, C' DILHR-SBD-6423 (N. 04/81)