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HomeMy WebLinkAbout008-1023-10-000 o r m o d 2 c ^ Co \ 1 n o N O N o°o o °C r~yll C\7 C\7 -(D W CD O ? N m N O N N - C1 Ca ~ g O O O 0 oo c: cn CD CD (D A O 3 < 6 a 7 ffl CD 7 D O r. fA N A ° O CD u? z D = a N CD G D O. N A \ s 0 c a c N N ~ p a @ lot CD O ~ O i i r ° oo co 00 ! n r N N m 3 CT .N-. M = K CC CC CC CC • A A O C C G G C C N N ti a (n a o D CD 0 0 u 'U O _O oo 1 I C n CT °7 7 CD N N co CD 7 77 (o j '\^v A \ 7 N z 0 N r D D D O CD c►►~~ I ~ w ~ n z CD p z m ! A ~ ~ 7 z Cb CL z O A ~7 o c y z g I ° ° T D o - v a v d 0 n a CD 'DD v d- m 0 O 'I S CD a. v 3j=1 7 o a CD 0 CD CD 00 R! ~ a Cp0 f7 ) n CD C7 0 c 63 =r ~ , ~ CD ° (n O m CD 0 ti V ~ CL O co' N C CD hQ O 69 O C r O O CD O ~a Parcel 008-1023-10-000 12/01/2005 08:39 AM PAGE 1 OF 1 Alt. Parcel 8.28.16.114A Current X 008 -TOWN OF EAU (~ALLE 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 STEVEN K & TONI J PETERSON O - PETERSON, STEVEN K & TONI J 441 222ND ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 441 222ND ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 4.940 Plat: N/A-NOT AVAILABLE SEC 8 T28N R1 6W 4.94A PT NW SW BEING LOT Block/Condo Bldg: 1 OF CSM 9/2412 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-16W Notes: TDa/te23/1997 rcel History: Doc # Vol/Page type /23/1997 768/350 630/174 2005 SUMMARY Bill Fair Market Value: Assessed with: f 0 Valuations: Last Changed: 10/09/2000 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.940 34,100 137,600 171,700 NO Totals for 2005: General Property 4.940 34,100 137,600 171,700 Woodland 0.000 0 0 Totals for 2004: General Property 4.940 34,100 137,600 171,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513 Specials: - User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 cn O C m o 0 3 S Cy `o1 " 3 CD a CD 0 n ~s o -115' N OZ CX O 0 i. C ~~o ~j..y • N S', G W Q ~s n (n O f~'n. (0 0 C) CD 0 :3 o Co 0 C) CO A CD O D o y a 7 N N j O ~O' d O j C CA D W a N C A ` (D (L7 CD N G G7 W 7 C CJ1 U1 3 N N 0 0 A d U) O O cD cD A O cn CO CO v N p c N N N Q a_ C:) z .N. 0 0 0 = rT !1 • C) O L z !~r O o= iu r,-D N N N o D O o <n O O 0 0 0 O fD N N CO CJ7 (Ji .7 (DD !v A fD N ;7 fD N O z c D D o m O C o h • CD c w m z (D --4 cn O =3 A . n_ co .77 n A z O p 0 7 o, Z ~ Co W * ri Q, - z 0 3 0 U) z (D G~ J W ~ II Cl) 0 D C CD O 21- :3 77 CD 11 u) CL :0 -n . O N z C O O 00 m IF S °o~ <n~N N O N A AMU' a I y CL cn (D cp N O tr O O N Z O O r O ? O N N - O Co O ~ N (D A CD ~ ~ w EA 0 o0 O L p b O CD y 0 a i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL ❑ALTERNATIVE state Plan LD Number. f Ilf assigned) Holding Tank ❑ In-Ground Pressure Mound NAME OF PERMIT HOLDER ADDRESS PERMIT HOLDER: INSPECTION DATE: B CH MARK (Permanent ~ ce pant) gESCR IBE IF DIFFERENT FR M AN. REF. PT. ELEV. CST REF. PL ELEV j 'elf Narn ni ber. MP/MPRSW No.. County. Sanitary Permit Number. I _4 SEPTIC TANK/HOLDIN TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELEV. WARNING LABEL LOCKIN OV t ,I PRO IDED. PROVID I YES ❑NO ❑YE O BEDDING. VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDI G. VENT FRESH ALARM - LINE. AIR L T ❑YES ❑NO i C ( / FEET FROM ❑YO NEAREST DOSING CHAMBER: _ MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER J PRO IDED PRO IDED . YES ❑NO YES ❑NO YES ❑NO GALLONS PER CY LE: PUMP AND CONTROLS OPERATIONAL.NUMBER OF 1'RGPEHrY WELL BUILDING (DIFFERENCE BE WEEN FEET FROM LINE jVENTT11RESH AIRINLET PUMP ON AND OFF) YES ❑NO NEAREST - SOIL ABSORPTION SYSTEM. Check the soil moisture at hedepth of plowing -,r11 nMF TEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE ~ Z the soil is dry enough to continue.) / MAIN J Qx;? , ' r) CONVENTIONAL SYSTEM- WIDTH f . LENS H. O OF DISTR. PIPE SPACING CO V EH BED/TRENCH NsIDE DIA xPlrs LIQUID TReNg MArERIAI. PIT DEPTH_ DIMENSIONS _ GH bFl DE1 IH FILL DEPTH ISTH PIPE DISTR PE DISTR. PIPE MATERIAL. NO. DISTR NUMBBEROF jPHOPERTY WELL. BUILDING. VENT TO FRESH BE L (nv PIPES AHOVE COVER; ELEV. INL ELE . END PIPES. LINE_ AIR INLET. FEET FROM NEAR_EST--p. MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAAG-kAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- r meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVE TEXTURE PERMANENT MARKERS OBSERVATION WELLS _ YES ❑NO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCHi BED DEPTH OF TOPSOIL SODD ED STIDED MULCHED CENTER EDGES C~7I' E ❑YS NO YES ❑NO LL~YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: W rTF / ENGTH NO OF LATERAL SPACING BED/TRENCH GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES . DIMENSIONS - L ' 4 MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING FLEV.. ELEV. DIA. ELEV. '11 ) PIPES DIA.'. ELEVATION AND C DISTRIBUTION _ .R o 0, I ~1 97.071 INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS I 3L~ YES ❑NO ~`"t l IQIYES , O '✓❑NO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS : NUMB ER OF PROPERTY WELL . BUILDING. rryy~ FEET FROM LINE I / /'2 J DYES ❑NO YES ❑NO NEAREST- + 7 cr- Zn 41' 4 '7 It o _a ✓ &0 3,77 13, 7 ~0 1', 17 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. ' OIL-HR SBD 6710 (R. 01/82) - A'; 1SU1L'L' ~.1N1`L'n1tY SYSTEM RJ,"PORT _ S,H - WLW TOWNSHIP u SEC PIERC L COUNTY, WISCONSIN 8 J SU13Ul:V.IS10N LOT____ LOT SI . 7pN/~C T9p? ~ J PLAN VIEW Oil, pis Lances atul (ll.tueut. tuns to uic:c t re,luiren►er►ts of H63 dI' LNC W1-'TICLN 100 FEET OF SYSTEM t 16t J'w - '7- ej -Al - - - - [ .1 e r u - - - - iv I di n e of th Arrow - - S C LQt - r - - - BENCHMARK: (1 c.~-mar~ent reic.retlce 1 o.Lnt) Describe Cor r ~a t~-..c z klevacion of vertical reference point: •0" Slope at site: S1?P'rlC TANK: MclllULi1Ct cn-er;_Lj1:V7~_L_R__.--______ Liquid Capacity: d•, Nurnt,er of rings on cover __114Y1{ --lank manhole cover elevation: i.cnlc lnLet Eleva( iot►: Tatik Outlet Ele 1' vation: PUMP CHAMIQ-At M..►nu t. ai: r:urex : ~S Nwaber of gallons OCR NcYMUer 01: Lai. 1'u+up set oi: a cycle L;alluris; t, -a Capacity of--- di,st ribut_ion lines size of pump -7 --,head; L;al ion per at:Lnut e 4 horse ower- ~ bran name- of pump and model nwubc:r ti i'yl~: of warn tng deva_c4,~ a HOLD .IN( I'TANK: Mal_WfaCturer Nwuber of gallons ir-l vatiun of wartholc cover Type of warwhig device _ ~1' 1'I'1' Sll11: Nu,iler of-pits feet-diaineter J L'('( liyui.d drpt-lc_ scepage pit inret pipe-elevation COCA but''luut of stehuge pl.t elevation feet. 1 ~►.1:!'ncl: LIED' SIZE: number of lines- wl~1t 1~ th tile depth SEEPAGL 1'RENCL1: width length i k 1: (CO1_A'r1ON RA'1'!::________ 11kI'A Ftl: UIRLDT_~ARE~I AS BUILT YLumm-:1( ON JOB t x.10 LICENSE NUMBEK_ s 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 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: 5 Gi4y,,V.illage or Township: County: I LL t~4~(l t~4S /T NiR !r.' (or) W t !lc t C'! 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* ❑ Other (specify)* Bedrooms: Ekll I or 2 Family *State Approval Required. J TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER ycc MANUFACTURER: i_ -(I (_.C EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA ) (Minutes per inch): PROPOSED (Square feet): ❑ New replacement ❑ Experim ntal ❑ Seepage Bed ❑ Seepage Pit i .3 4";,, ❑ Alternative (specify) '1 A ❑ Seepage Trench (f- < E Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public .-i I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Naple of Plumber: Signature: MP/MPRSW No.: Phone Number: J .i Plumber's Address: r Name of Qesigner: 11 COUNTY/DEPARTMENT USE ONLY Signatu of Issuin A eni~ Fee: Date: APPROVED Sanitary Permit Number DISAPPROVED a on or 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 LHR-SBD-6398 (N.03/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N WI 3707 LOCATION: SE CTI N: ITOWN HIP/MUNI XTY: LOT NO.: BLKNO.: SUBDIVISION NAME: /a T NR W ,040_ COU TY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER A ION TESTS: Residence ❑New Replace l~ lee RATING: S= Site suitable for system U= Site unsuitable for system ~s- Cr C' CONVENTIONAL u IN-GROUND PRESS_-IN-FILCH Ps ❑VGTANK:REC MMENDEDSYSTEM: (optional) S ©U S (~~JIU U If Perco lation Tests are NOT required DESIGN RATE: SYSTEM EL V. gIf any portion of the lot is in the under s.H63.09(5)(b), indicate: loodplain, indicate Floodplain elevation: PROFILE DESCRIP ONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- nOA y /0 -d/ sZ r-S B- -2 ( r r sv,, 1'2- B/ SL Ts ~e ..d f SC 1~ ',8,, S;L _51- Dk 9, 54 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 PE 10D2 PERIOD PER INCH P- Oil e /Z;~ i/ t7 P .?O /r P- I P_ PLAN 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 . '7tJ T J _J J'1C;L~l.1l'.,#~~LC.t!:~ e Eke], e n' . t. "Imp 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 WERE CO PLE DON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST SIGNATURE: 'JTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. -6395 (N. 03/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDJSTRY, CC DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: <,1 1/ 1 y /T- N/R E (or) W F -COUNTY:( OWNER'S BLw&R=S NAw MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R F DESCRIPTIONS: PERCOLATION TESTS: LJResidence "j ❑New ❑-Replace . k; RATING: S= Site suitable for system U= Site unsuitable for system a-- CONVENTION MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLD G TANK : RECOMMENDED SYSTEM: (optional) CSC Es DU [:]S DU OSC~U 0S au If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7) if 14ry X> -7 7 B- . ~r 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 PERIOD PER INCH P_ 3 j '1 P- P- P- PLAN 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. 1 SYSTEM ELEVATION a - - z i i d. . e _ . . , . V_ 1 - t , i r j Z) 5 ell E raj t s 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 WERE COMPLETED ON: s ~1Vtr~~ e- sc~. Ile DRESS: - CERTIFICATION NUMBER: PHONE NUMBER optional): ~,t i 1 II<., ,y CST SIGN~/9iTUBE: _21 IN: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. 0395 (N. 03/81) gwul W _ raa y low cm~ T- ~ aj I I ! 41 V Q co m 3t _ _ _ _ 1 ' i j a J cri a ► Pol cli fh. k,ar ~ ~ ~y_ ~ 'T+a Yp ~ v; ~~.1 7yi~ v..~ .~h+• ~Y.+a+9~Y.Y... ~ 'MW~. ~+f r t AL nw a t 1 ~5 ~ ~v, F ~ - , 9..r Y~'1M(►~ r iM:lYlk~w ~'M` c I/+h~k- ~It~... ~ r . w ~ d}. ST. CROI X COUNTY WI SIC O N S I N ZONING OFFICE 796-2239 f t T 3r,~ HAMMOND, WI 54015 October 30, 1981 v U" J D "i I. H R J Division of Safety & Building :Bureau of Plumbing P.O. Box 7969 y~ Madison, W1 53707 Dear Sir: Soils are not suitable for a conventional. system to be located on the Steven Peterson property :Located at NW4 of SW4, Section 8, T28N-R16W, Eau Gal.le town- ship, St. Croix County. There is ground water at a depth of 26 inches as dictated by the presence of mottling. At this time wt~_- are requesting a temporary holding tank be permitted, with the intention of installing a mound system the first part of next spring. Due to a serious health hazard we request that this be quickly processed. If you have any questions, please feel free to con- tact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:sl Val Plb. 108 WISCONSIN DEPARTMffNT OF HEALTH & SOCIAL SEP.VICES DIVISION OF HEAL` 11, BUREAU OF ENVIPONMENTAL ItEALTH P. 0. BOX 309 MADISON, WISCONSIN 53701 APPLICATION FOR THE USE OF AN ALTERNATE SYSTEM lk ilc ~c ~c ~F ~k ~k * ~ ~c ~t ~t * * * * ~ ~E ~Y it ~c ~k 4c :c ~t ~c is is is is ~c ~c ~c 3c is ~ 7t is :c 4c ~c k Location _1/4 Sa/1/4z___T N, R_/& E-ky"r) W Town or Municipality C', C, Street Address Lot No. , Block , Subdivision County <:T ( Landowner's Name : I/ r nn ` c _ Mailing Address; ik ~C ~C 7t 7~ ~C * iF 7k ~c ~C 7k ~t )C ~C * * * * * ~ ~ A iti SC JF iC 7C J< ~ iC ~c ~ * T .'t * iC I (We), the undersigned, hereby make application for permission to install an alternate system on the above-described premises. I recognize that the above premises are not suited for the conventional septic tank-soil absorption field and recognize that the alternate system applied for i:; to be used on my property which fails to meet the soil and site requirements of a conventional system. If permission is granted, I ai ree to have the system installed in conformance with the Division's approved plans and specifications. If the system is improperly installed, I agree to modify, repair or replace it if so ordered. I further understand that the alternate system -is more complex in nature than a con- ventional septic tank system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Division employees or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspecting the construction or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agcut (thy. contractor) to begin the installation of any alternate system. The Division or other authorized representative will perform an onsite inspection of the above-described premises. If the system is approved, the Division will send the applicant a Letter Authorizing the Construction of an Alternate System. I agree to peiTtit Division eml,_uyees or other authorized persons to have access to the premises at any reasonable time for Che ¢urpose of making such an onsite evaluation and I further agree not to begin construction prior to the receipt of such a letter. I understand that this application does not pen:i•it me or any other person to discharge sewage into the alternate system, sought by this application, until 1 receive a Letter Approvirj_the Use of an Alternate, System from tt,c Division. This letter will be sent by the Division after it receives, from the --oper county officials, a checklist and statement certifying; that the alternate system was properly constructed. I agree not to use or permit the use of the .i!teruate system prior to rE:ceiving such a letter. 1 ~ t VOL t -2- I recognize the limitations of the above-described premises and in consider.ition for the use of the alternate system applied for by this application, I agree to repair, modify or replace, at my expense, the alternate system if the county officials or the Division find the :system to be malfunctioning. Further, I understand that the county ' or the Division may require that the alternate system be replaced with a holding tank or with a system of a more suitable design. I understand and agree that if a holding tank is required, I will have to make arrangements satisfactory to the Division for the disposal of the effluent. I agree to give notice to any subsequent buyer that an application for an alternate system has been made and if installed, that the premises are served by an alternate system and further agree to give that buyer a copy of this application. I understand that the Division and the county do not guarantee and do not provide a warranty (either implied or express) that the alternate system sought by this application will properly function. The Division receives this application subject to this understanding and subject to all the conditions and obligations set o~,t in this application. Date Sign ure of Applicant STATE OF VISCONSIN) ss. / COUNTY OF S' C,'P0 ,X) ' L r Subscribed and sworn to before me this `day,of ( 0 C 19 1 Z 4rN6414)ry u5 c, to of Wisconsin My Commission expires: Notes y Public - sha• of VJi,. J.,n. 1~), REGSTERS OFF-ICE ST. CROIX CO., WiS. Rc%'d- for- Rocofd Ibis day ofd A. D. 19 at- M. I<inu's O'Cmilic I I Re9~~~•r of D••di ST. CROI X COUNTY WI S C 0 N S I N ZONING OFFICE 796-2239 ! HAMMOND, WI 54015 1 October 30, 1981 Bennie Helgeson Helgeson Trucking, Inc.. Spring Valley, WI 54767 Dear Bennie: We are returning the paper work that is to be submitted to the State. You have the incorrect fee for plan examination. Make the check payable in the amount of $51.84, not $48.00. I have enclosed a letter and the recorded docu- ment copy that must accompany the request. Please send the request directly to the state. rf you have any further questions, please feel free to contact me. Yours truly, / Thomas C. Nelson Assistant Zoning Administrator sl Enclosure Plb 100a 12/78 Detach And Return Upper ti State of Wisconsin DIVSON I OF HEALTH Portion V This Form With SEECTCTIOON N OF PLUMBING Any Return Correspondence a AND FIRE PROTECTION SYSTEMS MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: ~.ernative .SW,8,28,1 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 plan review fee required is $ ❑ Plan accepted for review. Fee received is $~,^y_' Fee is being returned because of ❑ Overpayment ❑ Underpayment. ~0 Providing one of the two catagories above is checked, remit correct fee in one payment. t No fee has been remitted. Plans submitted with no fees will be held in abeyance. et~ Cn ❑ Plans being returned. Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. II. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I If. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. Cross section of lift pump tank showing pump(s) or siphon(s). `a'?. Systems In Fill (Fill must be placed prior to plan submission ❑ Total area filled (fill to extend 20' beyond edge of trench before: side slope begin). Depth and type of fill. Copy of onsite report by county or distri•r, plumbinci supe vicar. ❑ Length of time fill has been in place. Plb 100a 12/78 Detach And Return Upper State of Wisconsin DIVISON OF HEALTH Portion,Of This Form With SECTION OF PLUMBING 4 AND FIRE PROTECTION SYSTEMS Any Return Correspondence ( MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: . err>:aCatia eye: ,SW,8,28,16W :ring VaLl. 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 plan review fee required is 7 ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. \ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ ' ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2) (a) Wisconsin Administrative Code. ❑ Affidavit enclosed. 11. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I II. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certified soil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Total area filled (fill to extend 20' beyond edge of trench before side slope begin). ❑ Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. 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 . C r o i x Location NW 1/4 SW 1/4 S 8 T 2 N, R W Town or Municipality at~ Cal I P Street Address Rgf2 Lot No. Block Subdivision Baldwin, W1 54002 Landowner's Name: Steven Peterson The application for this site is to serve a: ❑ 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. ❑ one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. 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. ❑ a lot that meets the site criteria for a conventional private sewage ,yJ(v1. If this a REPLACEMENT SYSTEM USE, the mound is replacing: L la 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. Name Thomas C. Nelson Si(Ina tur~ I11.le Autj ~.~j1t-_Lonin~ AdministratorOdte NovEmher IQ, 1981 DILHR-SBD- 6158 (N.7/80) ST. CROI X COUNTY 1 , ~t'±rti~ a W I SC O N S I N r h k1i {r' i F oo a: TONING OFFICE 796-2? 19 HAMMOND, WI 54015 November 10, 1981 STATE ID #81-05969 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, W1 53707 Dear Sir: An on site investigation for the Steven Peterson property located at the NW4of the SW4 Section 8, T28N-Rl6W, Eau Galle Township in St. Croix County, revealed suitable soils at a depth of 26 inches, below which seasonable hi.gh ground water was noted. This aite should be suitable for a mound system. Should you have any gt.iest.ions, please feel free to contact this office. Yours truly, Thomas C. Nelso~ Assistant 'Zoning Administrator TCN:sl l~~' a tE > ~yr.A ya._„ y wJ ; ~ ~ 7~ - ~ ' ' 9 ~J,j, ~ st~.~ { - TV- 77- Y 5 'e < y ':`xyr s ! ~,~G rye'" x } f { < ° , ~ Y ~ y4 ~"k L i~ iY I .7[~ R ~4 :4 3 Py T YY'V a 1 qt~~ 1 43 #(4 A04 t. . • V,5 w t a6 r ~ 7 f rt ~i' r~5 t r 2 5 r t rr ,fir ,F Ka• t r -r- 00 y .s r s, k y, q lie 1v i 1 at i~ ► , ON* t OC ct fit Ji; ) lr~o OWJ