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Home My WebLink About014-1052-30-000 t 0 !n O ~ -V n 3 on 3 ty, CD '0 CD m # 3 3 - >v m o v uN of o W o cNn ° ~C CD CD O C fD CD A FBI Oo Lp ~(D Z E N V C :J 01 N a O Cn o w N R C) o (D s cn w O = Q D o O C CD CD C7 7 m CD li7 cn 3 E7 0 H U] C p. CL G m fD r n co w U) a v O G d CD W o (D 3 C) 0 j O Lz] O r- ~-l CD ~j CD r a (D co" n rt c'] r O z b Cl) w° 3 (n ° Z Cn t Oa rt y D -11 ~d 9 ~ O o O O O o ~y~~• cn cn (A CD t7l rt d (D ra o m3 CT voN D CD < 90 o ~ CD _ y a h-N N 3 7 (D C :3 (D W I d 7 0O V) 00 Z o N 0. 1 F- D w D O O cn of ° m :3. h W (D H F--3 CD CL O W z~ F-+ w N p Z 0 3 0 I LTJ z (D > -i fn O o a Z (D ~ n A Z O In cn 6) 7 o ~ N a' <7 O N N W Lnn (D M z C1 Cn N a rr ft Ln 0' 3 o 3 m y z CD ? N N W d O3 0 T 0o Q - CD m Z a s o 3 N am o N _ (D s E A A ;-z* X Z CD h O T i 0 l O W (o_ [vo O ON ~ A A CD aAO W O yN O L Parcel 014-1052-30-000 09/13/2006 04:19 PM PAGE 1 OF 1 Alt. Parcel 25.31.15.386A 014 - TOWN OF FOREST 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 JOHN M STROM O - STROM, JOHN M 2185 ELDRIDGE AVE NORTH ST PAUL MN 55109 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description " 3159 200TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 25.000 Plat: N/A-NOT AVAILABLE SEC 25 T31N R1 5W NW NE EXC LAND ON N Block/Condo Bldg: SIDE OF OLD 64 HWY Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-31N-15W Notes: Parcel History: Date Doc # Vol/Page Type 12/31/1997 570608 1285/431 JD 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 75,500 90,500 NO UNDEVELOPED G5 9.000 9,000 0 9,000 NO PRODUCTIVE FORST LANDS G6 14.000 25,200 0 25,200 NO Totals for 2006: General Property 25.000 49,200 75,500 124,700 Woodland 0.000 0 0 Totals for 2005: General Property 25.000 49,200 75,500 124,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 60FOREST T.31W- R.15 W Nocrran 11 POLK~I COUNrK IL AVE 1 ad`s` ~ ca fJe/~a~ ~ ' /6 zz6 y ~ds.> r / `s R/ hri w f .vaom; y C ~ C P c be Y ~s f h.~.so.-r Lesf .-t..s 1. a F s,Se~ 0 63 bz.,~~ ~O & etat U^ ,Pole.-f ~a/ 7 Y Cirue e ,o a Nonni. ° v\ .P ye.- 9 9 Q/ ec c P £ R~/h y 5 V~ LMan Y F n/an y E.~ast 1~Pase Q sen W s ~ p v /78- e6 /Pec d ~ Jill ~ lq P :ebe ~ GRE ~Q y~ /ve.-man l v o~ f \F0. ~ ~ /BS z ~L S 96.6/c ~ JAS <o~Ba~ z.sy eG 4i~ i3z7(o4 n C/anence I Y C Met✓/ E Donorhy Q GIs Lo an Lastn ~ C % 9 s. c be -Be ¢ arena 6s CLtl\ 9 and P /ee C p ~ zoo F- ,E p Laura/ E ge.~e tl i ~ /6 0 /2o a ~ ~ Bo /aa C Pao/s o./ tea/ cc C r ort l a Mei ~ C a • ~t p /7z. o/ yr~a~ma~ 0..0 tl Na~~ P iebe • F/an_ Q•y F eon C y l a .Y .38.3/ _ ho/ldof 0 Dad E /60 'O^~0 A/vecma~~ Q • ' JSOTN /zo e,s fereQ Q .B/o.rbe~ O`4J ao /sB ~7~sk `Y ~ b ~'P Ne/- ~ eben .B C. Rob t • J 40 1 v . V a C e/sor/ son. - 6R~ / E yes y V w C C l o so crux G2eye v n.E a /an_ Fl/ ec- F d ~ W. //.a m 0 > 0 \ \ C tl 0 W,~~O Le n 4o Bo Bo fo ~o ~ man c.5'hin/ee C a %e/`e c a~ 0 v ~ 0 sir /i M ,s G ~ o cra O l '0 ~ ~%rh ~a/, r ac 4o h` N~ v~ `q~ ~°,W~ He~eson ~ Pa/men fzx./ ,C3na o.Qs .~lhV 40 hq W ~ ~ W, /90.5 40 N : Zo ~f/v zOmaQ /2° /60 /60 ~~~JV Lawc_ - Y. 0 Ernes F an,E C o0 21 • Bo ~ C 01 Ko e ~ ia.o9 '9 ~y E.~~ st v ono CR Loon f Q C n Laste Ne!/ 4 LeRoy 4 ~Po own 4 0'4 Fia.>/c amt Judith a ~ u^r. F an,E GV¢/ar/¢ G /c Pc ~ ..DennssKa~y Lena ' V v n zg-o - y enson v~ U/ri ~ °.J~eindah/ b !k E99a t Maroen l ~ rnfE „i 60 o H C/a - ~hn ~ L ~ Fed o 9s 6 B V a 100 0 /zo Dmid R,cS~ fJe ~am:n c > • vE. ' • 40 @ ~9 4 en L,ef'Ba f 2 cSt' .:~be 9on `al p 10..0 ~ 'Le Qi-/alt n ¢o /9s 74 \ 6 /7a Olen F an,e•f Do oth a s. Wes/ey tfe.be/ He -'e f Q L,/a 6 0 n` F/hce 80 40 p, ~5'fan. 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Cjondan f2 n 0 ~ w °o/ ~ /'7c Conf .3207H 40 40 765 C i-/o1~fE' y b Edwa/zzz £ RO ci Tc Cahn ~ cSwan%'oe 2 ~ Tohn Gl/rich C.Q ff Meyvn • I /s7 s Man /o. w,n_ .Qusse// L/°// y 4oy f7/con De Ooe~he/6o bn, Onv 1/e 7z ss 4o f 9/ica games w 40 ' • ~a a U e/r3 40 o BO La whence 46 < ° f Jeanert 'B yd 1'f7/.- e Ki y s f on f// cd £ ~ V 0 • C fTerr, fen /io E/ason 8a do /zo H Luc% K 9 0 /zo woe/re ;/i-'° ,e C M s. n/am-a °E F/o/-ence ~2~chc o Onv/// 's`O 4o Zoo /20 0 ' ~ 7\I g ~ ~ Backe%n /ba f sha_ n /•6.67 /`lay uhf b l' /'~'/ha"'f - Nano td /tam-~na./ .2o an 2J i wu 6 5 ides ~ she./a 9 F an,F ~ v ~ • u v@ \ W Paul ' wcn.Fa /3onmPf f Susan anePoe/ a d b y 63 77a o r/i//e P jyk \y /do a r~ua y~ one,/i pp /zo C a a C C a e v h K /n 6d.1 o` C~ C J~ L¢wnel,ce ~ro.s.b /zo dye /zo lCy, p1~0 F f d.lfi C0 zs.z V3 N/eyensi a.,dc /anc /zs '~'yw 4 ~\Ol N7/ l~lOO Oi)tla 64 ~ ~ .BO ° ¢os ybu h `3.s 0.~ o . ~ ZQ' v 0 \a'00 ,~\a ~w /bo tltla aF~, q _7JO/Ja/d v • R ES • • \ • • L2 , • 64 V w FDio,>ne mW~ 8° \ DaU9/OS C Lauc nca u l °0 0 - oy/a v WJ~ y °0 Nan a.> f 9/., ,Peichst dt Cl Cn M \v a~ A//e`ne re fen a C ~ e H/ D w oXp va M/ton ,2.6a 40 ~n McN aa. Qy3 vv /ss °O '74 ~4~ ~J0 a~ /ZB Ibtl zao C/anence D ~ l 0 y~[[tl. cTac,Fc%.> zoo CShC/d • h \ C C 200 m R t~ vd F7. 0 h y0 .Bennh¢nd ` 3 C a W c5 mo., on Fl//rn C ~ 00 v o Mo/.,:.7 C/ e%.- E/dare 3 \~C \ ~ G ~ David e ce C G✓eb step - wQi etux ti'l'l v o Lac. a /oo f L,nda v l y \ h ,F De Sm:t/i ac.rr tl G m z6 z.4s 3~~ W,CO S.mon~son Lind¢ h~isfe~sen ~a00 Bo 160 •e%n CEO Ub0 H /G • a~ F /60 ~PO1 2/S • /60 • ev~ 'c /rQno/d /ZO - a 0 C > Q O 9Gd oc.Ef red M¢P /s Inc ,Pe,. /979 $ - SEE PAGE 47 SE, -,PAGE qg FOREST GLENW000 ~tCno:~- C ~~ty p HENNE,SSY'S ' Forest, Wisconsin oil SAND Corner of 64 & County D t Dining 11:30 in the morning till 12:15 evenings RD[K Sunday 12:00 12:00 Noon till 12:15 evenings FOOD TO GO "Radio Dispatched" Phone: 265-4698 Turtle Lake: 986-4442 Baldwin: 684-3376 Osceola: 755-2906 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP w SECL N-Ri~- W DRESS ST. CROIX COUNTY, WISCONSIN. S U B D IV IS ION ---L_ L 0 '1- - LOT SIZE / PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y i 44 _ Ii di ±tNN h rrIt w LIT BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: _ Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings on cover - _✓~r Tank manhole cover elevation: _ -'l'ank InIet Elevation: Tank Outlet Elevation - PUMP CHAMBER Manufacturer: Number of gallonsi Number of gal. pump set for a cycle /`Z~ gallons; Total capacity of distribution lines /~i gaIIon: size of pump 2~ head; gallon per minute horsepower % ;brand ' and model number --L-- name of pump Type of warning device HOLDING TANK: Manufacturer Number of gallons f~ Elevation of manhole cover Type of warning device ' SEEPAGE PIT SIZE;- umber of its feet liquid depth - p eet diameter seepage it inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines/ width length the depth SEEPAGE TRENCH: width length PERCOLATION RA`1'EAREA REQUIRED j' - AREA AS BUILT INSPECTOR__ - - - llA'1'ED ~r PLUMBER ON 1OB LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN ~RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WY!. 53707 BUREAU OF PLUMBING ❑CONVENTIONAL1 ALTERNATIVE State Plan I.D. Number ❑ Holding Tank [ In-Ground Pressure ❑ Mound (If 30edl 8303638 NAEFER OLDER JADDRESS OF PERMIT HOLDER: Sridges NSPECTION DATE BENDESCRI BE IF DIFFERENT FGRO e nwo o d C 1 t yf W j Nec. 25, T31N-R15 W, Town of Forest REF. PT. ELEV. CST REF PT ELEV NamN of Plumt~er. MP/MPRSW No Everett B O l d t County Sanitary Permit Number 4489 St. Croix 38547 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET T ELEV.: TANK OUTLET ELEV.: WARNING LABEL ' PROVIDED. LOCKING COVER ✓ GI Z,, ~r / ~ E G/ ` PROVIDED: BEDDING: VENTDIA.. VENTMATL. HIGHWATER / YES NO ❑YESNO ALARM. ; NUMBER OF ROAD. '"U"E: T WEL BUILDING: VENT TO FR ES, ❑YES NO L FEET FROM NE IAIR INLET ❑Y 0NO NEAREST - R ti N DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPA4' ; PUMP M(76EL ; PUMP /SIPHO M UFACTU R / WARNING LABEL NO LOCKING ES COVER O ~di fr V DED: ID: GALLONS PER CYCLE: PRO YES PRO ED ❑ N ❑NO (DIFFERENCE BETWEEN ❑ Y YES P CONTROLS OPERATIONAL. NUMBER OF PROPERTY W E L L BUILDING VENT TO FRESH PUMP ON AND OFF) FEET FROM yE f U - 11IR INLET SOIL ABSORPTION SYSTEM. Check the soil moisture at th YES h of plowi n❑ NO NEAREST 0-0 or excavation. (If soil can be rolled into a wire, const rU Ctl n hall cease Untlgl FORCE DI METE" MATERIAL AND MARKING the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH wlDr LENGTH No of DISTR PIPE SPA AN C Al o DIMENSIONS e7[ TRENCHES INSIDE DI s. LIQUID PIT DEPTH. "F GRAVEL DEPTH B F LOW P IP E FILL DEPTH DISTH. PIPE DISTR PIPE DISTR. PIPE MATERIAL'. ABOVECOVER ELEV. INLET ELEV. END. IS R UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH 22 -J P E ~I FEET FROM LINE: AIR INLET (f L _ MOUND SYSTEM: NEAREST-u. Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM 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 P RMANENT MARKERS OBSERVATION WEL LS DEPTH OVER TRENCH. BED DEPTH OVER TRENCHBED ❑YES ❑NO ❑YES ❑IVQ CENTER EDGES DEPTH OF PSOIL SO E MULCHED ❑ N O SEEDED ❑ PRESSURIZED DISTRIBUTION SYSTEM: YES YES ❑NO ❑YES ❑NO BED/TRENCH WIDTH LENGTH NO OF LATE L S LING GRA L DEPTH BELOW PIPE DIMENSIONS TR.ENCEiBS r J/ FILL DEPTH ABOVE COVER: I ~ r MANIFOLD PUMP MANI LD D S ELEV eye R. IPE r MAN] OLD MATERIAL. O. DIST ELEVATION AND 'DIA L DISTR. PIPE DISTRIBUTION PIPE MATE AL & MARKING sjy L1 . J [DISTRIBUTION 1 ) PIPELL?i D I A C J INFORMATION HOLE sI E oLE sAC PuG RiLLED I ' cORR rLv OVER MATERIAL. VERTICAL LIFT L'ORRESPON DS TO APPROVED PLANS [)IV FnICES N J ES ❑NO COMMENTS: PERMANENT MARKERS: OB& RVATION WELLS: - l NUMBER OF PROPERTY WELL BUI DING. FEET FROM L ES ❑NO YES ❑NO NEAREST AG Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE TITLE: DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Ow er: Mailing Address: S ARDw &q "C/ e s ~a cwae) Cr4 , LJr S Property Location: City, Village or Town county: A/W %N6%S 615,T NiR i(or) W e es- - Sf Y,- Lot Number: Blk No.: Subdivision Name: Road, Lake or Landmark: State Plan I.D. Number: /VA Cmtc4 r (If~' ~36 39 TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* mot)( le Bedrooms: 1 or 2 Family *State Approval Required. A TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW- REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY /Qdp 0/1 e- X HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER p p p N e.. X X MANUFACTURER: ,JG~2 + EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ® New ❑ Replacement ❑ Experimental ® Seepage Bed ❑ Seepage Pit 37 ❑ Alternative (specify) 2n, a,p ovPQe.55 o pc ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for insta tion of the private sewage system shown on the attached plans. MP/MPRSW No. Phone Number: M,0 44S_ (71r Si na Name o Plumber: - 1 )6 Plumb ddress: Name o Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: F~ ~ Date: APPROVED SanitaryPermit Number: F~ DISAPPROVED 34J5Y / Y~ZU~111 lc~ Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) a ~ P ~ w r I r't d . l fc'.y • .y J ry r Nif J _ y - c ra I KiP 5° ,P /v' t i, L OR f'/ e 'e a '7 0 q) OJ 17, ~~S( 17 ;5~-'--- u c s cQ°5" 5~ q~1 ' of I 40/- k; l~/ C.-~ Rv d {v c-~,« .5 c, t a X / f , L 4)~P fvJ a ~y F ` 01 j ~d o Flo c . 0 170' e R N e ~/S-~e r^ o j _ T ro F 2 Ra S-/k e. ~Vu~~ ~~En Ili Sey 4 1 APP . NK ~y l0e~se ~t f r /00, ICON c je e_ -c J r 6, w,'s. Ato. 6y we rS e ALX 03,7 iJ 0A 93 j-~t,~ _ "Olf o ro Iz w ® f+` ~ ~ p e s C. I;z (b ndo a LA, p b arc , y., A c (A ~qp n .`a' n a ~ ~ ~ ~ { A + . fs- Oro J cs ~ V l c 41 r to tow oc, i, ~ ~ Atlo- ~ ~ f l' ~ X14 ~ +:~4' y ro 14. , 4 C+' 1, Q. -t 4e C) tD . , - PAGE OF I ' - PUtR CHAMBER CROSS SECT_ i^ON ARID SP~CIFIG TIONS m VE KIT CAP 4I C.i. VEAIT PIPE WEATHER PROOF APPROVED LOCKING 14 1 25' FROM DOOR, JLJUCTIOA.1 BOX MANHOLE COVER WINDOW OR FRL'SH 12"MIU. JJJ AIR INTAKE 5 GRADE 4- M11-11 wk I COUDUIT IB"/wIA1. IN L I- T PROVIDE: I { 1 AIRTIGHT SEAL I I AI'PKOVE.F) JOINT A I III PIPE APPROVED .IOIUTS 6KT ENUTAJG 3' I W/GT. PIPE 4)MTU SOLID rit.t. I I ALARM EXTENQIAIG ' I I ONTO SOLID S1,'>'yIL I OAJ PUMP----- ¢ DOFF cOAIcRETE BLOCK - e RISER EXIT PERMITTED AA1Ly IF TAUK MAWUFACTURER HAS SUCH APPROVAL 51983 SPECIFIGATIOMS §1;fTIr- AND TALKS %`N APUFACTURER' IJIIMBER OF DOSES:- ___PER DAy TAA1K tZE: G t LOOS DOSE VOLUME: X49• Lq R M► G A L L UAJS /M1A#IUFACTuftER: A~A ~'rr, ~9c,~ IMCHES OR CALLOUS MODEL ►JUMBEFk: U U CAPACITIES: Aa,__LZ g=--~Z- IAJCHE5 OR 6 CALLOUS SWITCH T4Pr,: 0,q f 4ILIM1' C=-'A'CHES OR GALLCNUS MAIJl1FAGl U{;E"q: / / k" ,.y~A ! c, • --Fe-mg D=--Z` : IUCHES OR J _ CALLOUS MOOEL - ` ~ a NUMBfi~.: C,~~ > C)T PUMP AND ALARM ARE TO BE SWITCH 7 ypE: F_ r,L pH * IUSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE. RATE 5 GPM VERTICAL DIFFERENCE BETWLEU PUMP OFF A /CL'J~.J~ fc' c AJQ DISTRIf3UTI0m PIPE.. _ FEET + MIAJIMUM NETWORK SUPPL9 PRESSURE . 2.5 FEET /fk'UI~J Z}n ~~~rrS FEET OF FORGE MAIN x F7/ TOOFT.FKICTIOAI FACTOR_._ FEET d . TOTALL Dy1JAMIC. HLAD ~ I FEET I S IAITEKAJAL DIM M IOAlS Of TAAIK: lAmv, +t f?- a 1 . LIQUID DEPTH T'vZ 3 I(,IVEI t_ICEMSE WUMBER: rn~ ` ~ DATE: HYDR=0w MRTIC H_82 PUMPS 28 24 LL 20 SV33 Z 16 ` O > = 12 SV?S J F 8 . O SUBMERSIBLE 4 0 5 10 15 20 25 30 35 U.S. GALLONS PER MINUTE 40 45 SUMP Head-Capacity: SV25 and SV33 Submersible Sump Pumps Max. Solids 3/4" Sphere; 4 Pole, 60 Hz. PUMPS 28 24 L 20 Sys z c 16 _ ,2 J IS 8 - I- 4 I I l \ 0 10 20 30 40 50 60 U.S. GALLONS PER MINUTE rn p c~ c~ Head-Capacity: SP33 and SP25 Submersible Sump Pumps Max. Solids SP33, 3/4" & SP25,1/4" Spheres; 115 Volts, 60 Hz., 1750 RPM v _j 1ao 120 j~ - HIGH HEIAD i100 y C 80 EFFLUENT S60 15 40 S~ DOH PUMPS 0 20 sP SOH Q 20 40 60 80 100 U.S. GALLONS PER MINUTE 120 140 Head-Capacity: SP50H, SP100H and SKR150 High Head Effluent Pumps Max. Solids SP50H, SP100H & SKH150, 3/4" Spheres; 115 Volts, 60 Hz., 3450 RPM SBD6678 (9/81) (Plb 100a) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Porti(in 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: ,NE,25,31, F-nrrFS+ ii 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 0 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 and manufacturer if precast. Complete construction details if ll. 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. 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. WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY 6 BUILDINGS, BUREAU OF PLUMBING P.O. BOX 1969, MADISON, WISCONSIN 1>3/0/ Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NW 1/4, NE 1/4, Sec. 25 T 31 N, R 15 IC X W Town 2S~tl4>~tt Forest Street Address Lot No. Block Subdivision Landowner's Name: Sharon Bridges The application for this site is for: new construction use. ❑ replacement system use. If this is NEW CONSI-RUCTION USE, the alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number 59 - 09 - 4 of those applications. (Use one of the first five quota num ersu Ss uer7 to you.) I lone of the applications needing a quota number. The quota number assigned to this application is Hfor one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Ifor an individual, lot for which <i sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. _1for an application on file prior- to February 1, 1980. 1_.1for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USL, the alternative private sewage system is replacing: E la failing conventional soil absorption system. L )a holding tank that was installed and in use prior to February 1, 1980. Ala privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM US[ and the lot meets the criteria for a conventional private sewage system, check here.1 I I certify that the above info nnation is true and accurate to the best of ►u knowledge. /Y Name Thomas C. Nelson Signature _UCounty Official Title Assistant Zoning Administrator Bate August 4, 1983 DILIIR-SBD-6158 (R 12182) 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 Correspon+e P.O. BOX 7969 MADISON, WI 53707 n 608-266-3815 DATE: PROJECT: 1 C 1 ~ pIF'f'/.YC YF 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 IV. Holding Tanks Administrative Code. ❑ Affidavit enclosed. ❑ 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 ❑ Detail 81 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. SBD6678 (9/81) (Plb 100a) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portidn 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: F ,idE,25,31, i For,rest 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. I11. 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 (1 Copy). ❑ Copy of onsite report by county or district staff. ~o ~ r WORKSHEET - PRESSURE DISTRIBUTION NETWORK DESIGN PROBLEM Design a pressure distribution network for a bedroom home. The site characterisitics are: t Depth of groundwater or bedroc`< 7 Landslope Percolation rate / g m,n./in. Distance from dose chamber to distribution system fs0 fi. Elevation difference between pump and distribution system _ fi Step 1. ESTIMATE WASTEWATER LOAD C. o Step 2. SIZE THE ABSORPTION AREA r A) Area required 3 a R) Select length 9 C) Width is D) I will use a ~ Fes- manifold. Step 3. SIZE DISTRIBUTION PIPES A) Hole size I will use is in. B) Hole spacing I will use is in. C) Lateral length is ft. D) Lateral size in. Step 4. DISTRIBUTION PIPE DISCHARGE RATE 45-pj9 c c S Q L A-'-e e A • ? Step 5. SIZE MANIFOLD A) Manifold length ft B) Number of distribution pipes C) Manifold diameter in. t, Step b. SIZE THE FORCE MAIN 7 A) System discharge rate ~ ' ~ ~ ' B) Force main diameter x C) Friction loss will be ft./100 ft. Step 7. TOTAL DYNAMIC HEAD A) Vertical lift G' ft. B) Friction loss • ft. G~ C) TDH = c• ft. Step H. SELECT A PUMP Step 9. DOSE CHAMBER SIZE Step 10. DOSE VOLUME v Department of Industry, Labor & Human Relations 'State, r Division of Safety & Bldgs. of Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 60 7 Tel. 608-266-3815 l0 1s F ;-I~ ~aOO r INALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. WN, NAME OF PROJECT TYPE OF APPROVAL STREET AND NO. CITY OR TOWN COUNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. For Private Sewage Systems Only: Sincerely, This approval is valid for two years or it will be valid until the expiration dale of the initial rl-nit. r' James Sargent-Bureau Director PLANS REVIEWED BY: DATE: cc: DPS-OWS Owner DI LHR Local Pi Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DILHR SBD-6099 (N. 06/80) Rec. & Env. Services ST. CROI X COUNTY e 1~ x t^ a r, 7, WI SCO NSI N i ~ ZONING OFFICE pr # 796-2239 (HAMMOND) i 425-8363 (RIVER FALLS) HAMMOND, W 1 54015 July 1, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, W1 53707 Dear sir: An on site investigation for the Sharon Bridges property located at the NWT of the NEB of Section 25, T31N-R15W, Town of Forest in St. Croix County, revealed suitable soils at a depth of 56 inches, below which seasonable high ground water was noted. This site should be suitable for an in-ground pressure system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:mj i ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,' DIVISION LABOR AND PERCOLATION TESTS (115) MADISON BOI 53969 HUMAN,RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: r//4 OT NO.:BLK. NO.: SUBDIVISION NAME: 'ON .25 /T 3 N1 /R /5r I~ 1Vfj - COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: 2i USE DATES OBSERVATIONS MADE _ ' N~O.BEED~ffi COMMER~CJIIAeL DESCRIPTION: r~ PRO/FILE DESCRIPTIONS rE_RCOLATION TESTS: ce IatReside / 18JNew ❑Re place ~ RATING: S= Site suitable for system U= Site unsuitable for system n COIrNVENTIONAL: MOUND: IN-GROUND-PRESSURET11 YSTECM-INFILLHOLDIINGTAANK: RECOMMENDED SYSTEM:(optional) -j S ®U z A\V FII' Y ® SV ❑u V ®U ❑V ouN If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: A Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Imo, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 5 I (p. i' /A/, i r v.. , I,~ f~L C. ~ a~ • :~''~~al..y ; _C._ i U O .S`",' r v'11, B- 6, 75 r t ;r~ , J , 'r d Q;.. - f ` L S o v e, G B- '7 3 ' L... ~;✓.j ,1 .:r p/~ ~a f { fI i5p Y I r rr ~~~T .1 ~..~h7 A10 ra.e 61 J. L / l B- 0 Al _y, PERCOLATION TESTS Ff~ TEST DEPTH WATER IN HOLE PEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1006 AFTERSWELUNG INTERVAL-MIN. PERIOD1 _PERIOD2 PE RIO PERINCH P- 2 P- S-7' Ale/7 e- /0 P !a'..z 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 J _ - ~ plc.,;' ; • ~H i I, the undersigned, hereby certify that the soil tE sts 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 UN ADDRESS. (CERTIFICATION NUMBER: PHONE NUMBER optional): T~~ CST SIGNATURE DISTRIBUTION: Original and one copy to Local Aothority, Proper y Ovvner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER l r= ~ !r✓ G-t.J CJ O ~ ~ r ~ "F M / ~ ~ ~ ev7i ~ ~ ~ j R'~~ 1 J) ~,trOdlr~ r I r ~ W,4 ,1 e y'' r✓ - i'~ 1 .cJ 12 ey g ~ 02 J.J ciP,G 5 c~ E~ ~ yC /`d G-l.% , F/. e ~ U i j _7 ' '7h r :r r Cr* i.tM2. b K, ell ~EtiJ U N.) f3 Es' Form - S T C 100 Owner of Property ~R_t) f Location of Property /Vile ~4 Nr =4, Section T3/ N RW Township '70 cu Aj Mailing Address l L. r= N w -C~ 3 - Subdivision Name Al n~ Lot Number Al Previous Owner of Property Total Size Of Parcel Date Parcel Was Created Are all corners identifiable'; x Yes No X include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty dead r ed in the Office of the County Register of Deeds as Document No. ; and that I (we) ~39L presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. 1. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) OATL,WGI DATE SIGNED