HomeMy WebLinkAbout034-1018-30-000
d
c a m e
C a xt c
2)
CD -
3 - m ^
3 ~r
(n 2 n Z o a CD -0 O O
00 W `C •
CD CD CD -
9 3 m m w 7
c ZZ
0 z :3 CD
CIO (7) ;,o CD
CL O W N = Q N
C rn N N
C:) =3 Cr n n O --I W O
7.1 O
7C cn C O O
7 fA N 7 O 0
rn 3
ro (A (n
r CO
f7'I - fD N
TJ ~ ~ m cn ~ D ~ a
o N W d (7
C7 CD
L-4 a- 0
3 q! CL lot
CD C) (D L
m
Z C
O 8 0
N 00 W N o c
A A Q
z 0 0 0
O n
W 0
A ~f
-a
o m C
< Ch
~O
y -p f, ur y
00 D y C) a
-ta r' 3 m w
N CD
a
N
Z c
° z z ~
O iv ! 0 D D c
Z 0)
Q
i o CD
v (D
aQ
(n (o c
t7y
C> w m
CD co
O` z p Z (DD
CSl 5 n ~a n
Z
~o O
SZ (n -i CO
W - N
O
Q (D
CL z
3 `a
3 Y cn
O A
W ~
n
W an D 3
O N O- (D
O > a C
N O O -
L1l C
O W 7
o a
W z
CD ;a
m
v m an
~ m
o CD
W 3 -
x
O
3(a
S
C 0)
7 a
C (D
(D CD
O
(n b
CD N
N O
T O
C7~`
O A
'(D
ti
ffl 0 W
O S a
O lD y
O 0- ti ~.l
Parcel 034-1018-30-000 01/09/2006 08:33 AM
PAGE 1 OF 1
Alt. Parcel 08.29.15.123 034 - 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
TERRY G & JANET L CARSON O - LARSON, TERRY G & JANET L
2822 CTY RD E
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 2822 CTY RD E
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 8 T29N R15W SW SW 40A Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
08-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 882/545
07/23/1997 418/288
2005 SUMMARY Bill Fair Market Value: Assessed with:
81966 Use Value Assessment
Valuations: Last Changed: 05/26/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 12,950 121,450 134,400 NO
AGRICULTURAL G4 36.000 5,150 0 5,150 NO
UNDEVELOPED G5 2.000 100 0 100 NO
Totals for 2005:
General Property 40.000 18,200 121,450 139,650
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 18,200 121,450 139,650
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 315
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r OC~~~~ p~ Form- S T C - 104
Y w AS BUILT SANITARY SYSTEM REPORT
WNER c~ TOWNSHIP
SEC. T r. N R /s W
ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT j~ LOT SIZE~G/'~ S.
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
300
sv
~i EZoeo
' SeP ~ C.
r
house
P
III
ty INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used 1 /A
Elevation of vertical reference point: /pp '0 P oposecf lope a site: -
~c
SEPTIC TANK: Manufacturer: e~
Liquid Capacity:
Number of rings used: X16 nef Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: ;1a 77e
Number of feet from nearest Road: Front, G) Side 0 Rear, O feet
From nearest property line Front,0 Side, (D Rear, O 3U
~ f feet
Number of feet from: well SQ building: i
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
PUMP CHAMBER
Manufacturer: C7~ S Liquid Capacity:/
pump/Siphon Manufacturer: c>; /e r Pump Size
Pump Model: IS _
~ Elevation of inlet: 7,';~" _S'/ Bottom of tank elevation: /
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: iY7 Alarm Switch Type:
Number of feet from nearest property line: Front, ~Side, ~ Rear, 0 Ft. a? ~
Number of feet from well: 300
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: - Trench:
Number of Lines: Area Built: -
Width: U Length:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, Rear, O Ft
Number of feet from well: 3`fC~
Number of feet from building: d~ ~f
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: f Diameter:
Liquid depth: Bottom o ~sjeepa e pit eleva
i
Area Built:
Has either a drop box O / or distrit~ ion bo 0 been usid on' any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elev ion of/ bottom of tat}'.
i
Elevation of inlet:
Number of feet from nearest proper y ine Front, ide, O Rear, O Ft.
Number of feet from we 1:
Number of feet f. m bui ing:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector
Plumber on job: ~Qle
Dated:
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 F~ ALTERNATIVE IS,,,, Plan 1,11 Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure CJ Mound 8403849
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE.
Jahn. Te kdzen R. R. 1, Gkenwood City, W1
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV
SW SW, Section 8, T29N-R15W, Town o6 SpAing6ietd
Name of Plumber. IMP/MPRSW No.. County Sanitary Permit Number.
Evetett Botdt 4489 St. Cnoix 54931
SEPTIC TANK/HOLDING TANK:
MANUFACTURER . LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL T COVER
PROVIDED. D
~:IJL~ 71 ES EENO
BE DDINGVENT DIAVENT MAT LHIGH WATER NUMBER OF RADJPROP ERTV WELLALARM FEET FROM /S L EYES NO Z4 EYES ENO NEAREST / DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CA PA'I TV PUMP MODEL PP HON MANU FACT UREHWARNING LABEL / PROVIDEDPROVIDEDOYES E/~/3 dC~%Y/1 OYES ENO YES ENO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH
LINP INL T
X9.7
(DIFFERENCE BETWEEN FEET FROM j'70 A I R
PUMP ON AND OFF) YES -1 NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFNTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE J~
the soil is dry enough to continue.) MAIN ~J
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NR EONCH ES 71PE SPACING C1OV ERIAL' NSIDE DIA #PITS LIQUID
PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH 01ST H. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF 1 PROPERTY WELL BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV INLEr ELEV END PIPES FEET FROM LINE AIR INLET
NEAREST=.
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
EYES NO
SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WELLS
EYES ENO EYES NO
DEPTH OVER TRENCH.' BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES.
EYES ENO EYES ENO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVEH
BED/TRENCH L
DIMENSIONS / TRENCHES: j
(o l ~P
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL jiO. DISTR. DISTR. PIPE DIS rH IBUTION PIPE MATE: DIAL & MARKING
ELEV.. ELEV DIA. ELEy PIPES DIA.'.
ELEVATION AND o ? 7S.Jo `ii ' J
DISTRIBUI ION O HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS T APPROVED
INFORMATION , PLANS v
YES NO YES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LR OE ERTV WELL. BUILDING:
FEET FROM
YES ❑ NO YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. [ILL
DILHR SBD 6710 (R. 01/82)
Wisconsin APPLICATION FOR SANITARY PERMIT ,
DILHR (P COUNTY
oEPFIFiTEnT OF LB 67)
m UNIFORM SANITARY PERMIT #
In OUSTRY. LABOR 6 HUMRn RELRTlons
;'y93>
-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
/c°
PROPERTY LOCATION
Su~1 /4. X11 /4, S . T;< N, R 9 (Or)fR TOWN r~ LOT N
UMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE/OR LANDMARK STATE PLAN I.D. NUMBER
X14 /1/1~ 3 IF,/
TYPE OF BUILDING OR USE SERVED
X 1 or 2 Family Number of Bedrooms. ❑ 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 ❑ 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 s Far.'As Soil nditions.
Total # 941 Prefa ' Site
Gallons T k Conc t Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEfJI 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: /o Y
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
3 Private ❑ Joint El Public
I, the undersigned, hereby assume responsibility f in II tion of the private sewage system shown on the attached plans.
Name Plumber (Print): MP/MPRSW No.: Phone Number:
✓e,ee (7.(-) 6,W-33 Plumb dress: c Name of Designer:
w /;V LI S J t, TQQZ.
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
~ ~ ❑ Disapproved
C4 i / ` ❑ Owner Given Initial
((D !P~~ 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.
35 %-4 t
L-.~ ~F-'f'1 - rJ (..Q! f: .,~-+Ls'I'F C. /ey l~/'~~t^/~, F,. LF ~'sr G.... l'r' /~..F
i'
r`
,f •
1=3 i3cl
WEVA-
BS ~ ! !boo $
79;-
I
II I
ry,,o 4 ~ ~9
i
f 1-10
IN Department of Industry, Labor and Human Relations
wlsconsw, Division of Safety & Buildings
Plumbing
H R Bureau of
P.O. Box 7969
PIL T- UIOUSTRV, LROOR 6 Hum nRELRTions Madison, WI 53707
Tel. (608) 266-3815
- - IN ALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
V ;1V NAME OF PROJECT i~
RI ATE SEWA E~ONLY -
❑ GENERAL PLUMBING PLANS L Received:
LOCATION rity Plan Review Only i
CITY 0 TOWN COUNTY
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 wrier required
inspections are to be made.
T 7
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 OniY:
This approval is valid for two
5years or it will be valid until
James Sargthe expiration date of the atitiat
Bureau Dire or sanitary permit.
PLANS REVIEWED BY: DATE: > -
G
cc: DPS - OWS Owner H & R & Rec. San. Section
Local PI Plumber Bur. of Health Fac. & Services
County Other
~?i
8.3
c1 c~ h P7 O o~ ,~1 / .S e 17y1~~ 2,6
- ~ i t
A170,4 1.5-
~o~~~M ;~a t ~,~'«''~~/1 i~ ,C'~~✓. .~G'~; C= goo a_~
r / ~ f ur►~P 7a~= f~
q.
o!
i
U. n -5 Y.5
60
I~
egg
FO, 59
r
/5Q
Daw~ b~
gyp. ~J e re. e, 4-
Page Of
~~~oNN ~~GLsc~,w
~e.v W0,6 C/ Y Straw, Marsh Hay, Or
Synthetic Covering
,t Distribution Pipe
Medium Sand
Topsoil G
- - _ - F s,.
E D
Q~,V1 % Slope a
o~k~U~d Bed Of 22 Force Main Plowed
Aggregate From Pump Layer
D 4
4"
Cross Section Of A Mound System Using Z
,
F 75
cQA4~~~'\ d A Bed For The Absorption Area
O
A Ft. H
signed
6 4
_17- Ft.
License Number: YVI I 10,7 Ft.
Date: J 7_^_l Ft.
K / 3 Ft.
Alternate Position L Ft.
of
Force Main W ,Z( Ft.
Observation Pipe
K
o'
A I•-------___------------ -----•I
W +o ' --j-- Force Main
_ From Pump
Distribution Bed Of %N- 2
Pipe 2 2
l Aggregate
Observation Pipe Permanent Markers
T
Plan View Of Mound Using A Bed For The Absorption Area
: w,ve ot Page _ Df
ke-L .u
Pertoroted Pipe Detoll
Endue Yiaw
~ a Perforated
End Cap `e PVC Pipe
CIO
Holes Located On Bottom,
Are Equally Spaced
m, x
* PVC Force Main
* From Pump
/p PVC
Manifold Pipe
Distribution Alternate Position Of
Pipe Force Main From Pump
lost Hole Should 11e
F Next To End Cap
End Cop Distribution Pipe Layout
P 23
R S 33
x t.5'
Y A 75
Signed: Mole Diameter Inch
Lateral / Inch(es)
License Number: P
Manifold Inches
Date: Force Main Inches
W
Lill"
~r-
`vim
O
. r,r
PAGE OF
PUMP CHAMBER CROSS SECTION AKJD SPECIFICATIOIUS
VENT CAP
4*'C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
JUNCTION BOX MANHOLE COVER
- 2.5' FROM DOOR,
WINDOW OR FRESH I2"MIU.
A.- If,j TAKE
Yt GRADE
4" MIN.
I ~ 18"MIN,
COQDUIT
18"MIN.
INLET PROVIDE I
AIRTIGHT SEAL
I
APPROVED JOINT A I I i I APPROVED .JOINTS
W/C.I. PIPE W/C.I. PIPE
CXTENDIA.IG 3'
ONTO SOLID SOIL ° ; ~n~ < GAP I I I ALARM EXTEIJDIAIG 3'
g b~~, I II ONTO SOLID SOIL
1(9d
C ON
I
I-LEV. - fAAFT. r~ I
ry PUMP
OFF
CONCRETE BLOCK
RISER EXIT PERMITTED QIULy IF TANK MANUFACTURER HAS SUCH APPROVAL
4
SEPTIC E SPECIFICATIOUS '
DOSE Z
TANKS MANUFACTURER: NUMBER OF DOSES: ! PER DAy
TANK SIZE: ~fOC~ GALLOUS DOSE VOLUME ~y
ALARM MANUFACTURER: /~fl . ,w INCLUDING 6ACKFL0`W: .~yz'9/ GALLONS
MODEL KJUMBER: G? 'y CAPACITIES: A= e'A AUCHES OR3 LT 70 ! GALLOAIS
SWITCH TYPE: -41<f c•~-il /o~ f g 'INCHES OR 0141 7- I GALLONS
PUMP MANUFACTURER:}'"o iY1Us C , g
= INCHES OR !~q7. GALLONS
MODEL NUMBER: -.Stl '_Q D= ' 2'IIUCHES 0Raa19.6 GALLONS
5WITCH TYPE: X,a NOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE w GPM INSTALLED OAJ SEPARATE CIRCUITS
VERTICAL. DIFFERENCE BETWEEN PUMP OFF AAJD DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK. SUPPLY PRESSURE . . , 2.5 FEET
+ FEET OF FORCE MAIN X '08 F3,1ooFTFRICTION FACTOR..
FEET
TOTAL OJWAMIC HEAD = l~ FEET
7/0
IMTERNAL DIM IONS OF TANK: -L~T44 ,WDTH .;LIQUID DEPTH
SIGNED: l LICENSE A.JUMBER: M q _q? DATE: lO ~2-4
.~y
24 n
20
16
12 fC 5. , 21 '
t
:y
§ at
i1
i ` d 4
1 -4.
0 16 32 46 64 so 26 112
US. GALLONS PER MINUTE
3
HlAad-CaPacity$V40 i SW,50 Submersible Residential Sump Pumps
All S'% UDS
, r r Max. SOWS SVM0,1 MY' & S%50,2" Spberes; 4 Pole, 9.0 Nz
'HANDUNG
'a SUBMER$JBLE
.
20
SEWALGE
& ~-:-EFFLUENT 13
lit" , r a
M -S
1k, t
~
PU 20 AO 60 , 80 100 120. 140 160
GALLONS PER MINUTE
y ` dead-CapaGil r V40A and SPP50A Submersible Sump Pumps
. Msx.•8 d1► 1'11" &SP011/2" Spheres;
4 .1 WROW, 1750 RPM
~~111N~
~ 2B '
~S ~....SN 24 5
j - ~ + a. RETT A. . a
F
b DT
• t
12
i fr byAALDWIN, t
Wis.. 4
g"~i , ~ w,...• 0 ZO 40 00 80 100 120 110 180
UA k i la. s POR MINIJm
n "W-Capacity: SIG, SK75 and SK180 Submersible Sewage Pumps
I Max. Is 7" Splrem,1750 RPM
a- HYDR-o-mF;Mc
PUMPS
A D vision of. Wylain, Inc.
POO Oft* Box 321. 419/299 3042 W
OanfnohRt 6 pane Roads. Ashland. Ohio 44806
4
[ g 1 J AO CO NOW, W#OWn Goes* Ltd. Lift.. 1211 EmW Or, mu"Oftx. onwic LIFT 102
°N ^AEIVT of REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
siJD(>DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS \ MADISON, W1 53707
(11-163.090) & Chapter 148:045)
LOCATION- SECTION: TOWNSHIP/WA1N+e*"rt--111r: LOT NO.:BLK. NO.: SUBDIVISION NAME:
Sct1 '/s'4/ $ JT YN/R/~I(orl s.0'-". 4;'C /c & r9
COUNTY: OWNER'S/BUYER'S NAME: MAIL ADDRESS: USE DATES OBSERVATIONS DE
NO. BEDRMS.: COMME AL DESCRIPTION: DESCRIPTIONS : ER ION TESTS:
Fe~nce t/ ❑NewReplaca
RATING: S= Site suitable for system U= Site unsuitable for system Co U /
C ONVENTIONAL: MOUND: IN-GROUND-PR SSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
os ®u~s ❑u as ®u e s ou ❑s ®u
If Percolation Tests are NOT 'j re4wired DESIGN RATE:
If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: A ( Floodplain, indicate Floodplain elevation: IyA
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH;R ELEVATION OBSERVED ES . HI H T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
A1011f "Al L7
G
,r ? Y1
B- 3 79, .2. og
-V C A 8,,
B' y`~ t?[1 e^ /Z B' / 1/• ~l.S J R'~'Ii s~r..', „ P
R~
B-
PERCOLATION TESTS
EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P i PER INCH
P- No n
P- / ,r't
P- It 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
i
` TN
r
Is i
,
z ;
.
.
,
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods 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:
-1G` y
ADDRESS! / CERTIFICATION NUMBER: PHONE NUMB R(optional
Lam( ~ yu GJ ~ 'S 55( ~ r. e,
LIT;lG 01 ATU
DISTRIBUTION: Original and one copy to Local Aurlxxity, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
y ` ~83
0 35
-i6 BA
r?✓.RCCltc~'S'rae 1 J%C?rri as^Js'a^ r ,r S" `~b
ff
~~JS_~'Oc~ ~a
z, u
FAI
i
le- V, ?1 7
F 4
to'f !
7 ! ~ f:JO Q~u ~ e I
'Er
a
6 1984
JrL[?a s~~ S pNO J~~;~orr
403849
Nc • Eve- r2 e. 4-
4 14
>rai`; ST. CROI X COUNTY
y a 4{
W1 SC O N S I N
r~~y ZONING OFFICE
'M1 tY f.~r~. 6 d
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
I
June 22, 1984
D.ivizion o6 Satiety and Bu,i tiling
Bureau o6 Ptu.mb.ing
P. 0. Box 7969
Madison, Wl 53707
Dean Si&:
An on Aite .inve6.ti.gation bon the John TeAkeben pnopenty .located in the
SW41 o6 the SUI% o6 Section 8, T29N-R15W, Town o6 Spnings.ietd, St. Cno.ix
Coun.ty,neveated suitable 6oitz at a depth o6 24 .inches, betow which
se"onabte high ground waxen. was noted.
This z to ahoutd be suitable box a mound syz tem.
Should you have any quest,i.on6, pte"e bee. 6nee to contact this o66.ice.
Since te.-y,
~homa.6 C. Ne.P,aon
As4i.6tant Zoning Admin.i.stkaton
TCN: mj
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. C)LOix
Location SW 1/4, SW 1/4, Sec. 8 T 29 N, R 15 [X~U4 W
Town MXl4MKIi 0Jft C Spn~ng~~eed Street Address
Lot No. Block Subdivision
Landowner's Name: John TeAke sen
The application for this site is for:
❑ new construction use.
Y replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
]to have one of the first five approvals guaranteed for this year. This is
numher - - of those applications. (Use one of the first five
quota num ers ssue~to you.)
I -Ione of the applications needing a quota number. The quota number assigned to
this application is - -
C]for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
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.
Ifor an application on file prior to February 1, 1980.
L] 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:
Cxa failing conventional soil absorption system.
❑ a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and'the lot meets the criteria for a
conventional private sewage system, check here. 0
I certify that the above information is true and accurate to the best of my
knowledge.
Name Thomae C. Netbon Signat
County Official)
Title Adziztaw.t Zoninq Admutitzttaton Date June 22, 1984
DILHR-SBD-6158 (R 12182)
Department of Industry, Labor and Human Relations
wmconsin Division of Safety & Buildings
DILHR Bureau of Plumbing
P.O. Box 7969
oEacinT lEnrov Madison, WI 53707
s umc~n aELanons
inousTiav, Lwada r+
Tel. (608) 266-3815
IN ALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
NAME OF PROJECT
, PRIVAlt SEWAGE ONLY -
❑ GENERAL PLUMBING PLANS Fee Received:
LOCATION Priority Plan Review Only
-_CITY 0 TOWN COUNT
Examination of plumbing plans an ~ns 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 whey required
inspections are to be made.
an mnnp--V
,big-tea.
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 Only:
This approval is valid for two
years or it wiH be valid until
James Sarg~ the expiration date of the initial
Bureau D ire or sanitary permit.
1
LANS REVIEWED BY: DATE:
f
7
cc: DPS - OWS Owner H & R & Rec. San. Section
Local PI Plumber Bur. of Health Fac. & Services
County Other
DILHR SBD-6099 (R. 05/82)
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 Cf-014,v. /eQ eg l so i✓
Location of Property SW 4 ~W 4, Section T o~9 N - R W
Township N~ 9. c La/
Mailing Address nj do C/ lji 4~ cj; S
Subdivision Name
Lot Number
Previous Owner of Property
'T'otal Size of Parcel 410 /9c C5
Date Parcel was Created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? Yes X No
Volume and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (we.) eeAti6y that ale. statements on this jokm ahe tAue to ,the. best o4 my (outs)
knowledge; that I (we) am (a)ce) the owneA(s) o6 the pAopenty de/scnibed in this
tn4otcmation 4o", by vi/t ue os a waNAan,ty deed ,Lecmded in the 066.iee ob the
County RegisteA o{ Deeds as Document No. 9 a _ 304 ; and that I (we)
p4ment-ey own the proposed site 6oA the sewage dispo6a system (oA I (we) have
obtained an easement, to nun with the above des cAibed ptc.opehty, 4oA the
cons-tAuction o6 said /system, and the game has been duly tceeotcded in the 06~iee
of the County Regis.tvL o A16 ate Document No. )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
/9 t
DATE SIGNED DATE SIGNED
t~
• y
r
S T C - 105 r
Y
H
~IC 1 l1CItl"1~MLNT
I'VNANCk
IN
"ANK. MA
S11Il'
0
SL . Cro LX Cutlrlt Y
0
OW N ER / 1l LI Y L•: li
ROU`'F:/ BOX NUMIi1:It / ~ ~j~f Pi re NLi Ili bc r g-/
PROPERTY 1.OCAT 1UN : -'W -5W `t„ Sec t i_on 8 `I' N , It W ,
Town of J pR/~/ ~'~L~________• St. Crojx County,
StbdIV t.sit'll /V,4__.____: hot number I`~a
IIll1) ruper use. 'and tltai11Ltlrta11 Ce 0 1 vuur- Sept iC SySteIll c0UId result it
its premature tui urC Lo It r.lndIC wastes. Proper mai,nLcuau('e toil--
SISLs of pumplup, out the Septic tank every Lhrec year:i or suuner,
if it eu:dvd, by a l icen5ed scI)t Lc tank huu11)cr. What YOU I;ut into
Lhe syti tetit Can i1 1 t ecL thc, 1 LI It Ct iurt of LIt e se1) LiC tank it t t rt'it l -
.
Illcitt. stage i.rl the waste di.~7;J)~:):~ul ay.-tteIli
taut Cnr
St. C1-Oix C.Oll11 LI/ IesidCttts ,II I)c efi};ihle to receive it
et III axloluIII of 60Z of the cu:-it of raplacOntenL of a fa ilill}; =;Y_;tcrlu,
which was in operati-ou prior rO July 1, 1978 St. Cruix OLIII
aCCeptud this pl'o ,,vaol In Aul;ust of 19£30, with the rctytuireuic.nL Lltctt
Owners of a.ll. tlc w "j LL,_ms :ai;I C to keep Lhe.ir syst(2 MIS 1)ruJ)erIY
Ilia I lit .ailled .
'I'll L! property owner- rtgl-cc; tv) stebIII iL to St. Cruix C(0 uuLy Gurtiitt, a
certiflCittl0tl fI) rIII, ;iigneCI by the owner and by it toaster ptuutbei,
jc)urit eyma it pluIli l)er, restricted J)luotber or a iiCetlsed pumper vuri--
tyill h that (1) LIIC 011-SiLo wastcwaicr disposal. system it, in proper
upet`aLing COndiLiOn and (2) alLor inspection and puulpi_np, (if nec-
Usaktry) t he s01)L is Lank is 1uSs LIla11 l./3 iull of clLitt +;c and scum.
Certification forth wi.l.l be SeuL ttJ.)pl-oxiutately 30 days prior to
three year expIrat Lou.
1/W1 , tllc undersi_Kued, have I oad LI10 abc)ve re(I It ir0Ill k'IILt; and al;rer v,
t0 Ill al IILai11 the private. suwit dLS1) 05Lt1 :ySLCill iu it CCUrc1<tnce with
I-I
the SLarldr-tray ;ct forth, ht, rein, :as Set by LIle WisCUn.;iu 1) e par L- U
Ill ent L) 1: Natural Rcsuurces. C,ot L i ficatiort f oral olds[ bt, coIll pfeLed
and returned to Lhe SL. Cruix Couit Ly luIiI1 Office wiLIt fn 30 days;
oIF the three year cxplrILiult (1 ate.
C. E 1) CJZ
1) ATE,
St. C r u i x Coit it L.Y Y.oniul; OtfiCU
N. 0. li O x 9 is
IIaIll Ill o Icl, W1 5401
715-7-) 6-2'239 or 715-425--8363
Sign, ditto and r.'IUrn LL) ab )vu address