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HomeMy WebLinkAbout018-1028-00-000 6 n N O K m n d O m 3 c=• O iS ~ (D (D 3 v - c w °C N CD cD 0- tD z n N O< 3 O M N s O N v° N Q 7 O N N O O (D O A 0 3 7 W 7 W O in U) Of O _ O (D N w U) D a ° (D (p (D (n G N y C W O 3 Q O O O5 -4 ~t S CD N) 4- CL :~z H CID (D co co N C m w ww co .Or. Q CA) 2L (D kj O d (D 2 'D M -0 =3 p W rt z O O O oo p d 3 v v v o i O W m (''D~ ut N CD m v N. ~ y a 3 m N H~ _ A - N a = C~ z W F- o 0 cn D D o 1 O ~ 4-r O CL "A zz • 00 - Z cn n W (D 4--r Ccn CL _ \C1v r-~ w ~D CY F-. (D z = CD -1 cp ~Z(D n : z O w o. W •p m N w o CD CD C " y z V w u 0 , 0 0) O (CD A w a 0 (D CL o - T N C z a 0 (D N fi y A A A O W I N O a I I'I O O b Z) oQ W ' EAO 0 'r Oo (D b O I i ° S' ti Parcel 018-1028-00-000 01/03/2006 03:58 PM PAGE 1 OF 1 Alt. Parcel M 13.29.17.2048 018 - TOWN OF HAMMOND 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 - BERREVOETS, MARLYS MARLYS BERREVOETS 2032 90TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2032 90TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 13 T29N R1 7W 20A W1/2 SE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 08/10/2005 803028 2863/501 TI 2005 SUMMARY Bill M Fair Market Value: Assessed with: 90242 Use Value Assessment Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 23,600 85,900 109,500 NO AGRICULTURAL G4 5.000 700 0 700 NO UNDEVELOPED G5 13.000 11,800 0 11,800 NO Totals for 2005: General Property 20.000 36,100 85,900 122,000 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 36,100 85,900 122,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 116 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 HAMMOND T•29 N.-R.17 W 3 SEE PAGE 45 /10TH I AVE h RK.S a,hlfsP e~c E .vo~ri.~sr fcrs owe~c' _ - s 1s7 k x `c o w e Q 6 • y Lin ode zas. 9e h "Constance v h 0 5~q h KuUnr> % C/in n ZJ. `1CCJ /NE w ley G Geo y>us C N C o °u 9 e ~n ~nd~ ~ ryo F/nde son vwi ~ Y R'~b dh vE " cTune It d Y tl'~"~ pqv C . 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C/°:,r L'oonty ws_ SIEBOLD FEALTY ANDERSON EXCFVHTING FARMS - LAND - HOMES Bulldozing - Grading - Backhoe Work GARY L. SIEBOLD -Broker Dump Truck Service - Snow Removal Estimates Given - Site Work SHELDON O. SIEBOLD - Associate 684-2124 Phone: 796-2391 or 796-5344 s OR CALL 684-2510 HAMMOND, WISCONSIN 54015 HIGHWAY 12 EAST BALDWIN Parcel 018-1028-00-000 06/16/2014 09:28 A PAGE 1 OF 1 1 Alt. Parcel 13.29.17.204B 018 -TOWN OF HAMMOND Current --I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BERREVOETS, MARLYS MARLYS BERREVOETS 2032 90TH AVE BALDWIN WI 54002 Property Address(es): Primary 2032 90TH AVE Districts: SC = School SP = Special Type Dist # Description n 4 SC 0231 SCH D BALDWIN-WDVILLE r V SP 1700 WITC Notes: Legal Description: Acres: 20.000 i SEC 13 T29N R1 7W 20A W1/2 SE SW Parcel History: Date Doc # Vol/Page Type 08/10/2005 803028 2863/501 TI Plat: Primary Tract: (S-T-R 401 /.1601/4) Block/Condo Bldg: * N/A-NOT AVAILABLE 13-29N-17W 2014 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/04/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 36,300 125,400 161,700 NO UNDEVELOPED G5 18.000 37,300 0 37,300 NO Totals for 2014: General Property 20.000 73,600 125,400 199,000 Woodland 0.000 0 0 Totals for 2013: General Property 20.000 73,600 125,400 199,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 116 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REP / OWNER c' ~s TOWNSHIP 11 ~7A r►~ m ~ - ~ , , T N - W ADDRESS_,9,C,gl~ti,,,~ ST. CROIX COUNTY, WISCONSIN. '5-✓ n o SUBDIVISION /V4 LOT LOT SIZE "(4- PLAN VIEW Distances and dimensions to meet requirements of 1-163 W_ EVERYTHING WITHIN 100 FEET OF SYS'1E14 _ j"AP - 44 - - - I d i ate North h A ro7 4 I [ 4 - -I SCAL.f ENCHMARK: (Permanent reference Point) Describe: 7-0,0 d 54• Elevation of vertical reference point:_. Slope at site: 9 SEPTIC TANK: Manufacturer: L~ifE?c3Ks Liquid Capacity: 100 6, Number of rings on cover Tank manhole cover elevation: -L Tank Inlet Elevation: Tank Outlet Elevation: r= - 1L PUMP CHAMBER Manufacturer: Gc%c K s Number of gallons v u Number of gal. pump set or a cycle ~0 69 gallons; total capacity o_F_- distribution lines 9j. S gallon: size of pump head; gallon per minute S'4;~ horsepower ;brand name of pump and model number j 5 P Type of warning device e HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines oZZv width le-figth6,3 the depth SEEPAGE TRENCH: width length PERCOLATION RATE S~ AREA RE'UIRED~7L AREA AS BUILT INSPECTOR DATED 7 - / - S PLUMBER ON JOB i= ✓e e e f 4 1) LICENSE NUMBER yy,~~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL OALTERNATIVE State Plan I.D. Number: O Holding Tank O In-Ground Pressure ❑ Mound (if assigned) 82-02313 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Daniel Barrevoets fZR f`2. Baldwin, WI 54002 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: SEW SW 4 Section 13 T291'.4- 17ta REF. PT. ELEV.: CST REF, PT. ELEV Hammond Name of Plumber: I'M P/MPRSW No.: County: Sanitary Permit Number: Everett Bolin 4489 St. Croix SEPTIC TANK/HOLDING TANK: 3 4 7 u MANUFACTURER: f ,{J y 4 ] LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER t r'~ Ib g~ eROVIDED: PROVIDED: Y BEDDING ~ C IQ,` ~~',IYES ONO AYES . QNO VENT DIA.: 1I VENT MATL.: HIGH WATER , NUMBER OF ROAD: PROPERTY WELL. BUILDING: ENT TO FRESH OYES NO l ALARM: IS FEET FROM LINE IV AIR INLET LU O NEAREST ~I I DOSING CHAMBER: MANUFACTURER: BEDDING. LIQUID CAPACITY PUMP ODEL. PUMP/SIPH N AN FACTURER. / WARNING LABEL LOCKING COVER IN LA I1+3 OYES NO 4' P° ti ( PROVIDED PROVIDED: ITT J 1.fgr..l..•a.«,. GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL WYES ONO ~ L,aL'y,.~ YES ❑NQ. (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH PUMP ON AND OFF) FEET FROM LI"",NN+j5 77 AIR INLET SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NO NLENGTH EAREST OIAME TER t dMATERIAL ARK v y' excavation. (If soil can rolled into a wire, construction shall cease until FORCE th L~ the soil is dry enough to continue.) tam' CONVENTIONAL SYSTEM: 3 BED/TRENCH WIDTH LENGTH NO OF DI IPf SPACING V DIMENSIONS TRENCH MATERIAL' PIT INSIDE DIA PITS LIQUID DEPTH GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR. PIP BELOW PIPES ABOVE COVER ELEV. INLET ELEy,^E TR. P MA ERIAL. NO. DISTR. NUMBER OF LIII J PROP' L BUILDING: V NT TO FRESH PlPfs FEET FROM 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. YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rex7uRE t PERMANENT MARKERS: OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCHiBED YES 1:1 NO U'S'ES ONO CENTER: ) DEPTH OF TOPSOIL . 1-5-' EDGES. 0 SODDED SEEDED MULCHED 11-5- O NO ONO PRESSURIZED DISTRIBUTION SYSTEM: YES ®YES ONO YES BED/TRENCH WIDTH S LENGTH NO .OF LATERAL SPq CING QHAVEL DEPTH BELOW PIPF TI ENCHEB-. FILL DEPTH ABOVE COVER DIMENSIONS G 3 MANIFOLD PUMP MANIFOLD DISTR. PI E MANIFOLD MATERIAL NO UISTH DISTR. PI DISTHIBUIION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV DIA ELEV. PIPES DIA 74 DISTRIBUTION 101-13 P r Iell NFORMATION HOLE SIZF HOLE SPACING DIALLED COHHECItY COVFR MVERTICAL LIFT CORRESPONDS TO APPROVED ® _l PLANS COMMENTS: PERMANEN MARKERS: 44 ES I NO OYES ONO OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING: 5 YES I _ I NO LINE YES LINO NFEET EARESTM 71 7,t ~2 7o Z, Pom of ~ Sketch System on Reverse Side. Retain in county file for audit. SIGNATUNF fi TI LE DILHR SBD 6710 (R. 01/82) cam` - r' DEPAK'I'MENT 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'/2 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: Cor To nship: County: SE t.Sw, %.S /9 iT~9 NiR /7 wor) W W/ M/"0/ -4/ dRo1 x Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (if as TYPE OF BUILDING U Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. i TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY p~ 0Ale- HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER '00 C?nJCr x X MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA ,~camy{ (Minutes per inch): PROPOSED (Square feet): ❑ New Ill Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit a~f ~j / ~j ❑ Alternative (specify) Mo ito c/ ZS TA_ rh ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (if other than present owner): j 0 Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for inst tion of the private sewage system shown on the attached plans. Name ,?umber: umber: ignature: MP/M#i8tltl'f~o.: Phone Number- e~~ff o~~~ ~~~'9 ' Plumber' ress: Name ?~Designer: ~q(w.'~ Cis ~1✓4°RG 74 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: F e: Date: APPROVED Sanitary Permit Number: 14 _ 0/1 ❑ DISAPPROVED / R j 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 (N.03/81) DEPARTMENT OF APPLICATION 3 SAFETY & BUII_ INDUSTRY, FOR SANITARY V LABOR AND PERMIT P.O. BOX HUMAN RELATIONS (PL13 67) MADISON, WI 5. Attach plans for the system on paper not less than 8'/z 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 Owner: Mailing Address: S Property Location: City, Village or Township: C unt Y: .S,4- '/4 S6e)'14S 13 iT269 N/R /7 0 (or) W /yD CI-40/)C111 Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of Public* ❑ Variance* El Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 J TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY .1006 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER QQ X MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit El Alternative (specify) /~}7 o N y/, ❑ 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 instal ion of the private sewage system shown on the attached plans. Name of Plumber: Si nat re: ~r MP/M -No.: Phone Number: Plu Address: _ Name of_Designer: -5 X COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: APPROVED Date: Sanitary Permit Number: /Z.L~ I Gy L C~ Cam' ° ) ❑ DISAPPROVED 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) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & E I N D U ST.R Y, ~eNOs, LABOR AND PERCOLATION TESTS (115) MADISON/oN HUMAN iiELATIONS 69 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: '0'474 /_3 /T~ N/R 17 co W COUNTY: OWNER'S /BUYER'S NAME: MAILING ADDRESS: t- ~rn --ten n "G / G r l/O S USE DATES OBSERVATIONS MADE [A? NO. BEDRMS.: COMMERCIAL DESCRIPTION: I R F D TONS: 1PERCOLATION TL Residence ❑New Replace l RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S5U 1EIS❑U ❑SEA ❑SE]U ❑SEAI If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the under s.H63.09(5)(b), indicate: A Floodplain, indicate Floodplain elevation: A"11 r~ex) N \ fr' 5"0 L PROFILE DESCRIPTIONS :2- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) / ~C? '~'T ~ dN I/ vim' rr -a it" L J~o B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH _Z 0 7 30 _P_ -1z 112 41z,4 e -30 ~r P- P- P- P;AN VIEW: 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 slop. SYSTEM ELEVATION 27a z'z 20 4cres /'~curtGLjll ^ 195 All 'T,* o-F Corner 41 C3 C3 (:a 0 "112 a ~Q Q~ 235' . Q T C'en e Y_ v'~' / < /n~U/~d EQ ~q L TN 41- /oo,o '04 e Q3 <3 -r,4 xle a co au j6 -3 a ~ 3 f;'a~~t Ih 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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 W RE COMPLETED ON: r_N/e, R_ 6 t F, W _ //_1_192 ADDRESS: CERTIFI TION N MBER: PHONE NUMBER optional): 337 URE: T SLGNV DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) ST. CROI X COUNTY W I S C O N S I N ZONING OFFICE 796-2239 NAMMOND, WI 54015 June 3, 1982 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Dan Berrevoets property located at the SE's of the SWk Sectionl3, T29N-R17W, Hammond Township in St. Croix County, revealed suitable soils at a depth of 30 inches, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours Thomas C. Nelson Assistant Zoning Administrator TCN:sl WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location SE 1/4 SE 1/4 S 13 T 29 R 17 EkApRk W Town or Municipality Hammond Street Address R. R. 2 Lot No. , Block Subdivision Baldwin, WI 54002 Landowner's Name: Dan Berrevoets The application for this site is to serve a: ❑ new construction use. D replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: ❑ one of the 25 needing a quota number. This is number of the applications made through this office. ❑ 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. ❑ an application on file prior to February 1, 1980. ❑ a lot that meets the site criteria for a conventional private sewage system. ❑ one of the first five approvals guaranteed for this year. If this is a REPLACEMENT SYSTEM USE, the mound is replacing: © a 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. ❑ a lot that meets the site criteria for a conventional private sewage system. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signatur (County Official) Title Assistant Zoning Administrator Date June 3, 1982 DILHR-SBD-6158 (R 5/82) SB 1) (Plb 100a) -3;x 9 Del 7 And Return Upper STATE OF WISCONSIN DILHR DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING Any Return Correspondence 201 E. WASHINGTON AVE. RM 178 P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: O C' \ ~9-; if-~ err ~ ~ ~ ly /o~ PLAN ID. # d 'e Rte' _ DETACH HERE _ PROJECT NAME PLAN ID. # =-_1i 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. ❑ All information submitted shall be signed, dated and sealee or stamped in accord with Section H 63.08(2) (a) Wisconsir. Administrative Code. ❑ Affidavit inclosed. Profile of holding tank showing vent, manhole alarm and 11. Pressurize Distribution Systems (Mound or In Ground Pressure) manufacturer if precast. Complete construction details if site constructed. ❑ Application for use of an alternative system signed by owner and notarized. (1 copy) El Holding tank agreement signed by owner and local unit of 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 test data. from county (1 copy). ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. El Pipe lateral layout. antes to any building, wells, water service i in water El Plan view of system. El Plot plan, p p 9, course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. Ill. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- tion system extending 25' on all sides. ❑ Calculations for total lift pump discharge, head and gallons ❑ Elevation of permanent reference point (benchmark). pumped per cycle. ❑ Location of area suitable for replacement system -provide ❑ Size, length & depth of force main. soil data. ❑ Detail & model of pump or automatic siphons including ❑ Plot plan showing lot size and all lateral distances from size, pump curves, drawdown and average flow rate GPM. sewage disposal system to buildings, lot lines, well, water ❑ Cross section of lift pump tank showing pump(s) or siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. V1. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. SBD W8 (.S/g.1) (Plb 100a) Detach And Return U ~ pper STATE OF WISCONSIN DILHR Portion Of This Form With DIVISION OF SAFETY & BUILDINGS OF PLUMBING BUREAU Return Corresponde 201 E. WASHINGTON AVE. RM 178 P.O. BOX 7969 MADISON, WI 53707 V 608-266-3815 DATE: PROJECT: o v i` ` i 11 t J~ G 1 Sc l.' 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 $ ❑ Underpayment -Please submit the additional fee. Fee Received is $ El Plan accepted for review. Overpayment - Refund forthcoming. El ❑ No fee has been remitted. Plans submitted with no fees will be El Plans being returned. held in abeyance. El Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in duplicate un- ❑ Complete data relative to anticipated use of bldg. less specifically noted. ❑ 2 copies of PLB 60 enclosed. ❑ Plans not clear, legible or permanent. El Deed restriction required (1 copy). E] All information submitted shall be signed, dated and sealed El Condominium declaration. (1 copy) or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks II. Pressurize Distribution Systems (Mound or In Ground Pressure) ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if ❑ Application for use of an alternative system signed by owner site constructed. and notarized. (1 copy) ❑ Holding tank agreement signed by owner and local unit of El County onsite required (1 copy). ❑ Design calculations government (sample enclosed). for pressurize distribution. ❑ Soil boring & percolation El Reason for installing holding tank. Soil test or statement test data. from county (1 copy). ❑ Cross section of system. ❑plpe lateral layout. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Plan view of system. ❑ Plot plan. ances to any building, wells, water service Verification of Exception Status Form by County. (1 copy) course, lot lines, swimmin p'plvic water Etc. Provide benchmark w gh pools, elevat~olnvreference point road, El III. Private Sewage Disposal Systems El Ground slope with 2' contours in entire area of soil absorp- V. Lift Pump tion system extending 25' on all sides. El Calculations for total lift pump discharge, head and gallons ❑ Elevation of permanent reference point (benchmark). Pumped per cycle. ❑ Location of area suitable for replacement system -provide El Size, length & depth of force main. soil data. ❑ Detail & model of pump or automatic siph incl ❑ Plot plan showing lot size and all lateral distances from C1 Cross section of ra uding drawdown sewage disposal system to buildings, lot lines, well, water size, pump curves, pump to and average flow rate GPM. lift pump tank showing pump(s) or course, swimming pools, water service piping, Etc. siphon(s). ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must ba iflaced prior to plan submksion) ❑ Construction detail and cross-section of soil absorption system. ❑ Total area filled (fill to extend 20' beyond edge of trench El Soil boring and percolation test on 115 completed by cer before side slope begin). tified soil tester (1 Copy), ❑ Depth and type of fill. ❑ Copy of onsite report by county or district staff. 1.2 State of Wisconsin ` Department of Industry, Labor and Human Relations Please Repl, SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Number L Re.~ 6 7 PRIVATE SEWAGE SYSTEM ONLY- 45 _z ~ tC-3~'1 =ice 1~ MG3 rT~ co The Bureau of Plumbing has reviewed plans, site survey information and installation details for the c " ''aE onN of rnative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to agallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a -inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance 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 one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, 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 oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS County By: Other Enclosures 7 DILHR-SBD-6159 (R. 7/81) mes Sargent, B rrector f'ro r7`" A in Z C) « i td i W N .Q td tv slr N Q / 1-j CD !Z m - (D w Al" li•: ~ 0 i I I I # C/j i oog o 'road •waJ slj/a ~ ~ 1~ o A ooo/Tt 0 (A (b 61- - p -'-----gyp ~ R"VED Cb JUN 3 J 19'2 PLUMS114G SKTION Z Stake of Wisconsin 1 Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 x m.. """~^"~°.„.M„° •-M-Plan Identification Number Re: ?,skl PRIVATE SEWAGE SYSTEM ONLY- 4_z C Z ~_O The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by private approval on and received for The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is fora sl l4 a Wastes from the building will discharge to a--'~ - gallon capacity septic tank which will discharge to a gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a_____ __inch diameter pipe to the soil absorption system, It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this by appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance 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 one set of plans bearing the stamp of a the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval become void and new application shall be made forapproval approval of these plans before work may commence. In granting this approval, the shall Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination over construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automaticall void this acceptance. Y cc: OWS County Other By. Enclosures i nit up --0 ~n zmo.,r J`' /h o yW jz~ I ~ h,d w ~ • cn (D Q N -Q 0 td C+ (A (D 1 tool,,~~I µ O Q < N N Q O 00 CP W ► i t Zl~ tD X41 du,nr/ oo$ o P Sol; A Ever ~.J 4 n 3' z'1 ~/~rda S J ooo/ -+Qf~ 0 ~ n 'ff 3 en y .hy e. V is : ~ DYED ~ JUN 3 0 9~2 h PLUMBING coo !,R <Z IL A'm ! z 40, l • EO: 1t.' w° Q3 F I ~ 1- ` • W J N ' 1~ 1 ~ I 1 ~ ice'" may`,, Q"r fit 1 7 I 00 N( r ~S. Q~ v y f11 S6MaN i c~ i 4- Ub i t 1 lz > 1 I ~ w,. N Q I j lk x i IS i % Qj r ' • Q ~i~,l~ +Y' i t f f U: 3 i ,..'fit ~ f . W J 3' • 1 r.~ W m erkj v I -vi 104 t t ttue It' 3 t # i l E k t ~ z v t ° > J J 1° ~t ¢ Z4 `!J i' .a ~ t ; • R ~ ° ~ to d ~ t 1 tr it V*j tr k a Y a O~ ~ ~ ~ c!C v) y yr , Q ( `Y Q V- r ~ jUN 11 1992 Izi- PLUt lF,'#l G SECTS 0 o X p 14 A r L.L tb i~ ~ ~ ~ III ff11 • • 7 r II I;z 1 O• W •H~ =U• a a o h IL Y ve it Q P q a>c 4 ~4 l * ` Qj 0 d 4. 4 v 44 lw it JUN 11 1982 ~ s ~ ~ ~ I no ~ ;o F 1 l~iGi =ION ~ pLU