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HomeMy WebLinkAbout002-1009-80-000 O y Q v. CD 'a `t1 re"s T CD :M chi Z o a ~ m o~ °o C 0• -4 K) :y 3 r d W Z n W 0) ~ CD CD - o :3 O 0) ~ m w N CL O S O O 1 ~ 3 D C) O _ o 7 VI N O e- rJ m co 17, :3 CD a O W Q N O C O 1 0 S (D CAD ~K 0- r C co co W 0 Q r, (n C (n N N a N C o O O O a O a N a o a. m v v _v N n O G fD N N <D I E. 'a CD r H N ~ t11 1 r o O r D D o - 0 0 7 o ~ a h C I CD O W a 3 m -1 y p O p Z r z H C v o a ,.I cD O- C 7 O -n N . D_ v C r ~ O O C. S C m - 3 r. y m 0 b < n CD m i N ~ N 0 o D .41 o C) CD CL Parcel 002-1009-80-000 12/21/2005 01:43 PM PAGE 1 OF 1 Alt. Parcel 05.29.16.70A 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KANTEN, THOMAS M & MELODY A THOMAS M & MELODY A KANTEN 1187 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1187 220TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 37.500 Plat: N/A-NOT AVAILABLE SEC 5 T29N R1 6W FRL NW NW EXC NSP R/W Block/Condo Bldg: TOWN BALDWIN Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 836/177 2005 SUMMARY Bill Fair Market Value: Assessed with: 86625 Use Value Assessment Valuations: Last Changed: 05/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 9,000 78,400 87,400 NO AGRICULTURAL G4 25.000 3,200 0 3,200 NO UNDEVELOPED G5 2.000 200 0 200 NO AGRICULTURAL FOREST G5M 8.500 1,500 0 1,500 NO Totals for 2005: General Property 37.500 13,900 78,400 92,300 Woodland 0.000 0 0 Totals for 2004: General Property 37.500 15,400 78,400 93,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 510 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 Parcel 002-1009-30-000 12/21/2005 01:43 PM PAGE 1 OF 1 Alt. Parcel 05.29.16.67A 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KANTEN, THOMAS M & MELODY A THOMAS M & MELODY A KANTEN 1187 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 32.580 Plat: N/A-NOT AVAILABLE SEC 5 T29N R16W SW NE EXC COM 464 FT E Block/Condo Bldg: OF SW COR, TH E TO E LN SW NE, N 377 FT MOL TH W TO A PT N 4 DEG. E OF POB, TH S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 4 DEG W TO POB TOWN BALDWIN 05-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/19/2002 673950 1856/463 TD 07/23/1997 993/621 LC 07/23/1997 993/620 QC 07/23/1997 993/620 mor 2005 SUMMARY Bill Fair Market Value: Assessed with: 86620 Use Value Assessment Valuations: Last Changed: 06/25/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 21.000 2,300 0 2,300 NO UNDEVELOPED G5 11.580 4,200 0 4,200 NO Totals for 2005: General Property 32.580 6,500 0 6,500 Woodland 0.000 0 0 Totals for 2004: General Property 32.580 6,500 0 6,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ,RTME,'VT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ,BUR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS f - 011 DIVISION P.O. POX 7969 I, - g~ i 1 I _ Q ' BUREAU OF PLUMBING MADISON, WI 53707 1 ❑CONVENTIONAL ❑ALTERNATIVE state Plan LD. Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure Mound NAME OF PERMIT HOLDER: JA RESS OF PERMIT HOL R: INSPECTION DATE: 11 I; BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. 311.x. s n ) Q(-_ f ll G- I Q (1- ft . ? ~JA r j. Name nt Plumber: No. C ounty: Sanitary Permit Number. SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. J,I C1 DYES ONO OYES ONO BEDDING: VENT CIA.: VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING. VENT TO FRESH -1 ALARM LINE- j AIR INLET : FEET FR DYES NO ` ' DYE ~O_NEARESTOM rac( -7 l DOSING CHAMBER: _ MANUFACTURER BEDDING. I.IQUIO CAPACITY PUMP MODEL IPUMP,SIPHO MA NUFAC RER JWARNING LABEL LOCKING COVER C ) P O IDED P OV DED L(y EYES NO C7-0 SP~I YES ONO YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 1'F2(1PERTV WELL BUILDING VENT To FRESH (DIFFERENCE BETWEEN FEET FROM I IN ~j / AIR INLET 1, 1 PUMP ON AND OFF) OYES NO NEAREST 110 ~6 - f L? 9-7 / / 271- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN r r CONVENTIONAL SYSTEM: WIDTH ILE NG TH NISTR PIPE SPACING. COVER INSIDE DIA. st PITS: LIQUID BED/TRENCH TREN S MATERIAL L IT DEPTH. DIMENSIONS H:. F F TH FILL DEPTH IDISTH. PIPE DISTR. PE IST PI MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH f3F L'J.'. 1111, ABOVE COVER ELEV INLE r ELEV_ ND' PIPES. LINE AIR INLET'. FEET FROM L_ NEAREST --s1 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW LEVA- X the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER. TEXTURE w PERMANENT MARKERS OBSERVATION WELLS. YES ONO DYES ONO I)E PTI1 OVER THEN CHBFD DEPTH OVER TRENCHi BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED CF NTER EDGES. DYES NO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LE N(iTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES 37- t DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE JMANIFOLD MATERIAL: NO. ~TR ISTRPIPE DISTRIBUTION PIPE MATERIAL & MARKING D F~VELEVDIAELPIPDIA ELEVATION AND a DISTRIBUTION U INFC7RMATION HOL SIZ E SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ~y z 1, YES LINO DYES J'J7 NO fJ`v COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF +PROPE RTV WELL BUILDING. FEET FROM L E YES 1:1 NO 1516, ED NO NEAREST S w~ _ Sketch System on Retain in county file for audit. Reverse Side. _ SIGNATURE. TITLE: DILHR SBD 6710 (R. 01/82) ~J~ DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 81/2 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. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner- Mailing Address: Property Location: City, Village o ownshi • County: %/(~,V%S /T,2q N/R X~ III (or ow Lot Number: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: 1$1, 117~ (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms f 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 0 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: w ~ N C_ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New A Replacement ❑ Eximental ❑ Seepage Bed ❑ Seepage Pit 'Zo 3 75' ~ Alternative (specify) 111041,9 Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint El Public I, the undersigned, hereby assume responsibility for inst tion of the private sewage system shown on the attached plans. Name of Plumber: ignature: MP/MPRSW No.: Phone Number: Jeee, off. C/ I IMP 44T2 1 151 - J? Plumb ress: Name of Designer: t;:5 19 C1 W / COUNTY/DEPARTMENT USE ONLY Si n ture of Issuing Age Flee: - Date: ID APPROVED Sanitary Permit Number: l Z- l ❑ 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 & BUILDINGS INDUSTFtY,'► c DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 53709 HU'v1AN RELATIONS (H63.09(1) & Chapter 145.045) LOCATIONN~ SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO. SUBDIVISION NAME: //Y 1/ /T2e?N/R /A(or W ,'f COUNTY: OWNER'S BUYER'S~iNAME: MAILING ADDRESS: / 7- USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMERCIAL DESCRIPTION: PROFILED SCRIPTIONS: PER OLATION TESTS: Residence ❑ New Replaced / c -7 RATING: S= Site suitable for system U= Site unsuitable for system _ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 0 S ®U ®'S ❑U ❑ S 2u ❑ $ Zl1 ❑ S CZU If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /A Jr Floodplain, indicate Floodp lain elevation: too S'S! PROFILE DESCRIPTIONS ~a ~L S Si9b v SAc L BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WIT- THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B . < f U! rp l 5< f l Z f k"r L B- -3 B- _ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 , PERIOD 2 PERT PER INCH P- l19~ l_' d 7 P- - iy 11h 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 ~ Nor-W. ~ P/ Sol ( `f'0 ~ E3 3 + I Fit qo/ To cum r oL I, the undersigned, hereby certify that the soil tests reported on this form were rnade by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: TCERTIFICATION NUMBER: PHONE NUMB Ell (optional): - CS/ URE: DISTRIBUTION: Original and one copy to Local Authority, Prooerrv Owner and Soil Tester DILHR-SBD-6395 J1. 02/82) 0`dtF? O mot - :z VL .1!x..4 y.E p 4 • ~.A V w J z a 1 A'al - - r loci a 41 r .-•e. S-Las..... v._ - ~ ` vi + - IL vi h 4.. f ~ • r ~ 00 V C-4 4+ I V, ~z " • ~ 1. I 4:i,~ ~ i4 n l ~ ~ st l ~ , r + _ - 5~~• ~ h III " qc ' n' g i9r.tf ,R ~ \ des t ' n xc~rk t 9 3 + CCC ft 0 to T f, fA - Qom' ~ w~ ' - q ~ t , 1 Z t N W ~i Vb I C, O 0x -41 tA A ~ + t~` N3 B1SEA ~ r x ! ~ ~ , ~ ~1llll~,l~trrar~ f 41 cL. b t a j 3 ~ a o ~ . At, ~ A 11YY~~'' ~z # ~ZO ~o o ai a(0i 0 0 r_: d 7) Z; C,7 II 11 II !I t t I i J ~~y~x r - l rl H r-1 N pq o Q Q I ~ ~ a~ ~ W + a 0 a-~ IN, L-V cn-E y iF. r W PA N j S1oP~' d 0 •r, ~S N~ j \ O 'd 'd O 0 i r3 CC) U - iI ' 29! 1D7 nytlap °uavdw~g tee u _ - 3 9Zt ';•►17 "PJT 1p•u•0 lq~iN :M~u•J yr ~ ; • gffi" 0140 'puel4sy 'speod AsueS V Woweleto T Zb0£ 69Z/&V 'LZE XO8 80440 tsOd "out 'u!ejAM p uorsIniC H Sduund ~11dW -O-tlO#SH Wdo 05L1 `ajogdS „Z splIAS 'xem' sdwnd aMemsS olq!sjawgnS OOtMS PUB SLMS 109VS :A3!aede3-peaH aLmmn aid sHO11Vfl'sn z 8- O 1- M M OZL OOl 08 09 Ot? Oz 0 v J~ ~ • 8 ` r 'NAM e I ^s 91. ' w 1O10e OZ v l.Aaana S vz `i•. , .ter 10 9z 5!Ar 00 ze t Wda 08LL '70 09'sMOA 91L -saJagdS „ZIL [ VOWS T „b/t l VOWS SPHOS'xeW sdwnd dwnS algls~awgnS VOSdS PUB VObdS :A1!aede3-peaH 3.LnWIW aid SNOIIVJ 09L obt 0ZL oL 09 09 ob oa o Sdflnd 0 et IN-3AIJA az 39VM3S Z bz ~ 3191SHNylons 9Z NEE DNIIONVH 'zH 09'010d b -'saaagdS ,,Z'05MAS V „t/i l 'OAS splloS 'xeWl sdwnd dwnS lequappq alq!sjawgnS 05MAS pue OVAS. •/3!aede3-PE®H sollos 31nmw Had SNOIIVO Zll 96 09 09 917 Z£ 9t 0 I b ~ 9 r v Ob^S 9L ~JV^ OZ bZ Wisconsin Department of Industry, PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection Name o remises Date an No. Street city County Sanitary Permit Master Plumber Firm Name dress Journeyman Plumber Address Owner Address . Discusse-d-with nature ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Site Waste Specialist White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner 70 rrl nQ Wt RKSHEET - MM SYSTEM DESIGN PR06LEM; Design a mounds stem for a red . c--z,- 0/72 The site characteristics are: Depth to groundwater or bedrock -2~ in. Landslope l % Percolation rate min./in. Distance from dose chamber to distribution system g0 ft. Elevation difference between pump and distribution system ..ft. T Step 1. WASTEWATER LOAD gat. j Step 2. SIZE THE ABSORPTION AREA 3 75. sq• ft. A) Aree required = B) Bed or trench length (B) _ 7, ft. C) Bed or trench width (A) _ ft. D) `Trench spacing (C) 1t r lid „ .24 gal/ft2/day B ft. trenc es k Step 3. MOUND HEIGHT A) Fill depth (D) _ O ft. B) Fill depth = D ♦ t slope (A) ft. C) Bed or. trench depth (F) ft. D) Cap and tgpsoil depth (G) _ A0 ft. E) 'Up and topsoil depth (H)5 ft. r S 4. MAN LENGTH A). end slope (K) _ (p_1 + F + H x 3 /0•~ eft. B} Total mound length (L) = B + 2(K) ft. SUp 5. MMD WIDTH I~ Al) Upslope correction factor A2,) Upslope width (J) _ (D + F + G)(3)(factor) _ O_ ft. 81) Downslope correction factor = 1.22 82) Dowhslope width (I) _ (E + F + G)(3)(factor) ft. C1) Total mound width (i1) for bed J'+ A + 1 27-2 ft. C2) Total mound width (W) for trenches = J + + (no. trenches -1)(c) + + I ft. step 6. BASAL AREA A) Infiltrative capacity of natural soil _ /Z gal./ft2/day►- B) Basal area required = wastewater flow natural sail infiltrative capacity.- 375 sq. ft. CO Basal area available for bed for sloping sites = ° .B ,x (A + 1) _ 9 9 sq. ft. C2) Basal area available for trench for sloping sites • B w J + _ . sq. ft. C3) ilasal area available for trench or bed for level sites = 8 x N ¢ sq. ft. f 4 Step 7, DISTRIBUTION SYSTEM a ~ 7A) '"SIZE DISTI2-IBUTION SYSTEM 1) Hole size dole spacing 30 in. ,A 3) Distribution pipe length = ,23 4) Distribution pipe diameter = y in. 5) Spacing uetween distribution pipes = 3,2 in. 6) Distance from sidewal,l to distribution pipe in. 7B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1 Number of holes per pipe 2) Flow pier pipe GPM 7C) SIZE 1ANIFOLD 1) - Manifold is central/_ end 'n: 2) Manifold length M' 3) Number of distribution lines 4) Manifold diameter = 2 in. 7D) SIZE FORCE MAIN 70.20 1) Minimum dosing rate s ;aV GPM 2) Force main diameter = 3 in. ,3)• Friction loss 7ft. 7E) TOTAL DYNAMIC MEAD 1) Vertical lift = 3-J 9 ft. 2) Friction loss = ft. 3) System head 2.5 ft. ft. Total dynamic head a ' ' ' ^ 1.~Z f t. v 7f) PUMP SELECTION 14 Pump selected will discharge -10-20 GPM at 11J.2 ft. total dynamic head. 2) Pump model and manufacturer 5 P y0 y Q ,-~~'c ........~~.~r.rr Ir~~AI~ 1 1 rr~rTl r ■ ! ~!1~~ 7G) DOSE VOLUME 7C t e 1~a11-2 10 times void volume of distribution nines 4 gal./cycle Daily wastewater volume 4 doses ,24 brs. gal./cycle 3) Minfmum dose volume _ A5-3 3 gal./cycle 7H) DOSE CHMBER 1) Minimum capacity required = BOO gal. ST. CROI X COUNTY ,fit<s f, 1- Z t; ~'~y WISC0NSI N ZONING OFFICE 796-2239 HAMMOND, WI 54015 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Thomas Kanten property • located at the NW of the NW Section 5, T2,9N-R16W Baldwin Township In St. Croix. County, revealed suita- ble soils at a depth of 26 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. Yg,u.r-pr-truly, i Jam,.. _ 41 Thomas C. Nelson Assistant Zoning Administrator TCN:wjo SBD6678 (9/81) (Plb 100a) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS BUREAU OF PLUMBING Portion Of This Form With 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: lei, 5, 1(4 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). El 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 before side slope begin). system. ❑ 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. WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of _St. Croix Location NW 1/4 NW 1/4 S 5 _ T 29 N, R 16 lr (or) W Town or Municipality Baldwin Street Address Route 1 Lot No. , Block Subdivision Landowner's Name: Thomas Kanten The application for this site is to serve a: M new construction use. • © replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: part of the 3%/5% limitation. This is number of the applications made through this office. El one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. El 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. Fla lot that meets the site criteria for a conventional private sewage system. If this a REPLACEMENT SYSTEM USE, the mound is replacing: Q 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. I certify that the above information is true and accurate to the best of my knowledge. Thomas C. Nelson Name ~ Signature Title Assistant Zoning Administrator Date Supt ember 29, 1982 0 Nld v C7 C-a aC !)A~ up O ~10 , I f b~r Col V1. nT E' a JZ tl ~ ca I.A iP~ W N H H l-_~ 0 o m ~ D L~~J o a ~ co o Ny (ll ` Q rrr ~yb~ i%3 r OCT - 6 1982 PLUMBING SECTLON r ~ . I LA U] tzi CU '..v H ILA. < I ~ n F1-1--' N ZO `d0 C+ a a c O i'G ! u` o z cam, :31 0 ( b m O OrdJ06 W~ N aC ' I ¢j y JJ a elk ; ~ , ooh J It {0 3' an r +y t I 1 I l 11 II II If o 0 (D (D fib, ~ 1 Q O ((D H ((D ti p Ch !ll P", U) U) ~Q vti. cli 'y 1 4~~~~ia►4►►~`t CLj O C T- 6 1992 t r PLUMBING SECnoN ;V o i i C7 C-a aC I a MC+ 2 cn a Pal in o d 1 a ' 1 U4 oN o 10 m I p~ Ir LA a l J I t 1 I 1 II II ►I If O °Q C L, r OCT - 1982 pLUMENG SEcnom n State of Wisconsin ` Department of Industry, Labor and Human Relations t . ' -oll Please Reply to: {1f~1!/~~~ SAFETY & BUILDINGS DIVISION ®1/ ? 1 Bureau of Plumbing P.O. Box 7969 1. _ Madison, WI 53707 CH ICE Plan Identification Number Re: PRIVATE SEWAGE SYSTEM ONLY- The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative privat sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by 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 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 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 DILHR-SBD-6159 (R. 7/81) mes Sargent, B erector