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HomeMy WebLinkAbout231-1047-60-000 (D d # cu rn Z=N z 0w _n N) j 3 y O N n O+ v m CD 7 a o co cn w 00 O d` N O~ O O Q d N v N N O P O N J-4 \ 1 IV C) 0 1 co O 3 (~D O 10 cn C = W O co C O O n O cn_ O O O K 7 N N d O y r n (=D 3 C D C a (D (n N N CL W v c n j O 'TVI I ~ ~ w Z o co OOD N c z 0 0 0 o 0 0 0 l~l r -3T -4 N O' m v o j N m m w ~ O m O ro CD N D D o O v O o- o o ~ w ' I lr. CD I ~ w ~ a ~ 'I z CD z m R l A z O 0 7 cn -1 N) W -0 m w m I (D , m 0 ~ Z o' 3 U C U) m cn N Z CD a I o~ a 2- co o' - m -n - m ~ Z a m m I I fi 4 ti O f I ~ 0 I i N 0 0 I a A a CD oro N o O r v i 0 o m b I o a ~ AS BUILT SANITARY SYS'1'L:M Id:YUK'1' UWNLIt_~'~_Ct°. `vu,rrlb~l~ 1'UWNS11I1'/QCFiooC]~ Sl l:ca~(p l'~IV Idg-(g AUUlt1 S c~ y S'1' . CKU LX COUNTY, w L SCUNS IN 6uliDIVISLUN LOT SIZE-__ PLAN V l L: W UIULariCab and dim4nuiun» LO u1cc:L. L*CL1u1rCUu:11Lt, ul lit)3 ,,.L.YLL"T h I NG WIT 11 I N 1 U U FLEA' OF S Y S'1' L:M i - - - T _ 11 ail a e No th Arrow 1 I 11:NCliMAltk: (Yertu~+nnnt rdt~srbnce Y lt►L) Uuucrlbe. F1evaLiun of vartlcaj.,reternnce puler -_-SIupu v L yILe . SEPTIC TANK Manutacturer: - ~_-=--,r LILIu1U Lap tclLy Wu"ur of rinad on cuvar y_~ Tank Iuaollulu cover ul.,vaL iu11 Tank Inlet ElevaLlun: Ta11k UuLlut 1-1.eyr.1L1u11 PUHP CRAMBUt N tvuu~l,eL „1 t; 1 luii~ MltliufAL Lurer . umber of ga _ l pUulp _atlL-fur -L c y c c 6a1 1 . 1 t k b , L u L A <!apac L t y of did LribuLlUn l inns- _ bu 11011 a 1 LC Cd 1,01111, 11c,1J , gallon par tulr►uLe huruc.puwet bl iAlld mule ul 11uu1p and UWLIal r►uwbmr Typo of w4ruing device _ tUJLUINh TANK: ManuiaCturc r i NLuabcl ul 1;a11u11v ElevaLiun of "[Ikule cuvar l'y je of Warniili duvice r - S1w PALE PIT SIZE:: Nuiubui of I,i L: CCCt aiaulut u1 fct:L liquld dbpch _ ucclia~u p1L 111luL 1,il,u el4vuLtull f)oLLUtu Of eldnpa~u pit C1~avuL Lou I Cel SEEPAGE bEU SIZE, numbur ul l ltlcu wkit li luiky,t li L L I,- .lu1,L 11 width _ _ _ - 1c u6L11 SI::LPAGL: '1'1tL•:NCN PL tCULATIUN, M'1l: ARLA RLQUTRLD__ ARLA A ; ISU'C L'1' aa^~ LNS1'I:t:'1'Ult UA'LLll ~Qo PI.UMlU-A< ON l6h L1l:l~N.;l•~ IVUN111L.1< DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ^ SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. B& 7969 BUREAU OF PLUMBING MADISON, WI 53707 1 y-5J OCONVENTIONAL ❑ALTERNATIVE " State Plan I.D. Number: Ilf aufoned) Holding Tank ❑ In-Ground Pressure ❑ Mound . J j~ J J NAM 1 14 E OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: C INSPECTION DATE: s P C ~,t I I BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: } REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: SEPTIC TAPE /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO BEDDING. VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM LINE: AIR INLET. OYES ONO OYES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL. BUILDING. V (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER 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 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES DISTR. PIPE SPACING MATERIAL: PIT JINSIDE DIA *PITS ILIQUID DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PIPE DISTR. PIPE ISTR PIP MATERIAL . No. DISTR. NUMBER OF R E TY WELL rff7T TO FRESH ELOW PIPESABOVE COVER ELEVNLE I ELEV. END PIPES FEET FROM LINEINLET. NEAREST 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 ELEVA- D YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE RMANENT MARKERS OBSERVATION WELLS PE DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED I CENTER EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING ',HAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE IMANIFOLDMATERIAL NO. DISTH DISTR. PIPE OISTHIBUI ION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA. ELEV. PIPES DA. DISTRIBUTION INFORMATION HOLE SI/F HOLE SPACING CHILLED COHRECILY =ATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO DYES ONO COMMENTS: PERMANENT MA KERS: OBSERVATION WELLS. PROPERTY WELL'. BUILDING. NUMBER OF LINE DYES I_]NO OYES ONO NEARESOM Sketch System on Retain in county file for audit. Reverse Side. TI LE DILHR SBD 6710 (R. 01/82) FNATURU 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 8Yz 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: <_£iiy VillagerorTownship: , County: '/a ='/aS ^ - ~T ` NCR E (or) W r , . Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING r - Number of Public* ❑ Variance* ❑ Other (specify)* Bedroom: Q 1 or 2 Family *State Approval Required. t 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 MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit x { i ❑ Alternative (specify) ❑ Seepage Trench i Water Supply: Owner's Name as Lasted on Soil Test Report (If other than present owner): ❑ Private ❑ Joint ® Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: __JS,g_nature: MP/MPRSW No.: Phone Number: 71, Plumber's Address: lM Name of Designer: ( r COUNTY/ DEPARTMENT USE ONLY Si lure of Issuing ~Age_ Fjee:~lo Date: ® APPROVED San+itary Permit Number: i ❑ DISAPPROVED I 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 Plum*ng, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) D~RArRTMFNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 HLA8 N REDLATIONS PERCOLATION TESTS (115) y~l5~i MADISON W 53707 LOCATION: SECTION: TOWN HIP/MUNICIPALITY LOT NO.: BLK. NO.: SUBDIVISION NAME: ~od /116E (o Ieri aJ C 0 U OWNER'S BUYER'S NAME: MAILING ADDRESS: f t, C /e uu - ~ O 1 USE DATES OBS RVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I R D TONS: PERCOLATION TESTS: [Residence [[New Replace RATING: S= Site suitable for system U= Site unsuitable for system t CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMM NDED SYSTEM: (optional) 0S EU EIS IS OU E:]S ®U ©S ❑U 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- 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 3 PER INCH P- P- P_ P_ l 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. SYSTEM ELEVATION I E i ; . E I . I, 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: I -Z ►r ADDRE S: , CERTIFICATION NUMBER: PHONE NUMBER optional): CST SIGNATURE: t Z DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) f >D r ~ D r y o ~ c r 3 ~ ~ 3 O m Z p < r vi r ro z p N s p U N ~ < O D P Z L L ~ I p O r1 11 r i xr _ N C rte` D S 1 ~q"1 1.-%iva L U- D v G' "11 Z Z 3' n33 mG~ ~ •p p A _ r n " Z 3 mLZ ~ roi Z x N Cn p xi N a O 03 a Z D D < r o A V^ "'o°~^y 7a p O O L 6~ IN, 7~ D -n O W < to p p < U) 0 Drl 1 N-1 C) L: (q to ZL rv o<~ 3 ~r ;o r7' p D oo a'ov o_ x► a r Z m v m L m 0;K O b - p 'n u. A Jo U 77 el c m ~Z: (f A, Paz r y m L tt p m C f -D ' (1 ` c r A 7J ) U u7 m { 3 n Cl A -A s) u J vi D { J I i 3 RECEIVED 6 1982 PLUMBING BUREAU ~ c"Jit"Jil ~*rq ♦ Y ~ 7 t U C HLLA uutL.' b~ 19~ i i Department of Industry, Labor & Human Relations Of r Division of Safety & Bldgs. " SlElle UI, V~ ISCURSiIri Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 i Tel. 608-266-3815 r4 , L O IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. s3lt NAME OF PROJECT / TYPE OF APPR L Z." cm STREET AND NO. CITIY OR TOWN COUNTY STATE ZIP OWNER Gentlemen: Examination of plwribmg 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 of 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 unpiovennents or system has not commenced within two years front this date, this approval shall become void and new application shall be made for approval of these plans before work may continence. In yfanting this approval, the Division of Safety and Buildings does not hold itself liable tot any detects ui plans or specifications, plan omissions, examination and resefves the fight to older changes of adduions should conditions arise innkuxl this necessary. phis approval is based on Wisconsin Admimstiative. Code ierluueuu:nts- It shaft be necessary to obtain and fulfill the permit require- ments of the city, village, township or county ur vvhu;tf this Installation is to be construeled. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, ` ~iJ/fsd r Sargent-Bureau Direc r'IANS REVIEWED HY: DATE: I ttR t^ Pinrnt,,, H !L R i7i ....cow < ::f.-rrv ) Map. Rs.; Hu .I HG.,In, i-.< _ ST. CROI X COUNTY WI SC O N S I N Px ? ~K~~C4f7`;jjl:';1~' Z O N I N G O F F I C E 796-2239 W Post 066jice Box 227 Hammond, WI 54015 O W N E R P U M P E R A G R E E M E N T PLEASE BE ADVISED, that until you arse again no-t.i6 ied, I Witt contnact with o/ W.i,s eona.in, ( Pumpers) , bon the punpos e o6 nemov.i.ng att waste 6hom the aan.itany system to be .Located on the pnopenty and jutune home site Located in St. Cno.ix County, W is cons.in, Township ob It (I L(7c)c) 4 . bung in the % o>S the G~% o6 Sec.T. N.-R. J J W. (On mope Gutty deaen".ibed as 6ottowa: ) Dated this day o6 19 (OWNER) n State oA Wisconsin) as County o4 St. Cto.ix) Pensonna,Uyappeaned be6on.e me this day o6 19 the above named ;j. r to me nowt' to be the pehson who execute the 6onego,ing xns nument and acFz ow edged the sgme. ota&y u ic, .St. CAOcX C oun.rcl, WT- My Comm. (.is p ea m"= 4`, My Comnuaawou Expuea May 12. IH 5 he4e'nbe6on.e te6evLed to as Pumpers, loin in the above agreement 6 the extent that I have a contnac.t with Owner a3 above stated. (PUMPER) S e ~ E a Page 2 ve a quarterly pumping report submitted to the es to have Owner agre local 3 government and the county which will state the Owners name, location is of the property on which the holding tank is located, the pumper's name, tE the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted to the Departarant of Industry,La145.01 and Human Relations by the governmental unit responsible, p (15), Wisconsin Statutes. 4, We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code. 5. This agreement will remain in affect only until the sanitary permit issuing agent in St. Croix County certifies perty is served by either a public sewer or a septic tank - soil absorption system that complies with ch. H 63, Wis. Adm. Code. aidIn addition, this Agree ment may be cancelled by executing and recording i ference to this Agreement, in the Tract Index indicated above. ! 6. This agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this 12th day of ~~~+~he~r 19 82. TOWN OR MUNICIPALITY OF ENWOOD T-TY 7-7 , OWNERS by by 1 STATE OF WISCONSIN ' Personally came before m this day of 19~ the above named to me known to be the pers s w o executed the oregoing instrument an acknowledged the same. i THIS INSTRUMENT OO A-k PUBLIC DRAFTED BY: My commission expires: 'NOTE: This document is to he recorded in the Tract Index at the office of the Register of Deeds in the county indicated below. HOLDING TANK AGREEMENT This Agreement is made and entered into this 12th day of October _ 19_g~2by and between the IF City of Glenwood Ci hereinafter called Muniei ali and Inter-State Lumber hereinafter called the "Owner. We hereby acknowledge that application has been made for a building permit on the following described property, to wit: Outlot 72 Ward 3 or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. We also acknowledge that said property cannot now be served by a municipal sewer or septic tank - soil absorption system. Therefore, as an inducement to the County of St. Croix to issue a sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code relating to holding tanks. Any time the Town or Municipality of Glenwood City , through its Plumbing Inspector or Health Offi- cer~-t necessary to pump out the subject holding tank, the Owner shall have same pumped out in twenty-four (24) hours, or G lenwo C' will have said work done and charge same back to Owner and p ace same on the tax bill as a special charge. The Owner further agrees that the Town or Municipality of Glenwood city may enter upon the property des- cribed above at any reasonable t me,'to inspect, or pump and haul wastes from the subject holding tank. 2. Owner agrees to pay all charges and costs incurred by the Town or Municipality of Glenwood C' for inspection, pumping, hauling or otherwise servicing an maintaining t e subject holding tank in such a man- ner as to prevent or abate any nuisance or health hazard caused by such holding tank. ~alE~nwood C, it shall notify the Owner of any such cost which shal'~e pa y t e Owner within thirty (30) days from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. DIHIR-AD-6123 (R.3/81) Department of Industry, Labor & Human Relations ~~T Division of Safety & Bldgs. State of Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608-266-3815 INALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT TYPE OF APPROVAL STREET AND NO. CITY OR TOWN e0l~MTY 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 elate, this appro gal 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, pl , 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. Sincerely, 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 SBD 6678 (9/81) (Plb 100a) Detach And Return Upper STATE OF WISCONSIN DILHR DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING Any Return Correspond 201 E. WASHINGTON AVE. RM 178 P.O. BOX 7969 ~g~ MADISON, WI 53707 DATE:' ~V 608-266-3815 i O p c\ - PROJECT: Z Cr x 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 Pr(,file of holding an , showing vent, mar`),:le alarm and II. 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 for ❑ Reason for installing holding tank. Soil test or statement 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 tion system extending 25' on all sides. pump discharge, head and gallons pumped per cycle. Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide soil data. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from 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. VI. Svstems 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. y O -u 0 d f C O eD 0 0 CD ' 3 r, V i n V 0) # 3 = O 0 0 S N Z O W N N CD fl1 O N O m W ~C • ~ n~ 3 l0 NN N C4 J7 N N C 3 N N O 'y N n O O W, CD !.I CD V O 7 M C J CJ7 0 O ° c ro m 3 o W o 3 0 _ O 3 N CD d O r• O ti c o' 'D Z M~ N • N A a 0 N O a D m a v n o ° - 3 9 c o a z 0 o CD N m a 21- O 0 o- I ~ 0 N N O O a I ~ A O b N q O d0 {a o O w C> CD o b 0 a 3 Parcel 231-1047-60-000 10/02/2006 05:00 PM PAGE 1 OF 2 Alt. Parcel 26.30.15.753 231 - CITY OF GLENWOOD CITY 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 - BERENSCHOT LLC BERENSCHOTLLC PO BOX 8 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 118 W OAK ST SC 2198 GLENWOOD CITY SP 1700 WITC SP 0026 TID #3 GLENWOOD CITY Legal Description: Acres: 0.000 Plat: 0058-OUTLOTS/ASSESSORS PLAT GLENWOOD CIT SEC 26 T30N R15W O L 72 WARD 3 & PT O L Block/Condo Bldg: 78 AS DESC IN 1712/237 & AS CORRECTED IN 2269-158 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 06/10/2003 725160 2269/159 WD 06/10/2003 725159 2269/158 QC 06/17/2002 681794 1910/475 WD 05/09/2002 678438 1887/63 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/21/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.000 37,500 185,500 223,000 NO Totals for 2006: General Property 0.000 37,500 185,500 223,000 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 37,500 185,500 223,000 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 I i i i glow, 7) 11 ksol ~ ~ { i i ~l.r..Ic ~d i i we) I' POA0 Pj dV I ~w sE se, l.<~s s Parcel 231-1041-80-100 10/02/2006 04:54 PM PAGE 1 OF 1 Alt. Parcel 26.30.15.712B 231 - CITY OF GLENWOOD CITY 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 - SWEEN, PAUL V & SUSAN J PAUL V & SUSAN J SWEEN C - ADAMS, RIZZI & SWEEN PA ADAMS, RIZZI & SWEEN PA 300 1ST ST N W AUSTIN MN 55912 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 22.000 Plat: 0058-OUTLOTS/ASSESSORS PLAT GLENWOOD CIT SEC 26 T30N R15W SE SE O.L. 46 G.C. Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 09/03/2003 738531 2397/551 WD 12/02/2002 700423 2064/581 QC 06/03/1998 580304 1328/599 QC 06/03/1998 580303 1328/595 ALC more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/21/2005 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 22.000 33,000 0 33,000 NO Totals for 2006: General Property 22.000 33,000 0 33,000 Woodland 0.000 0 0 Totals for 2005: General Property 22.000 33,000 0 33,000 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 Parcel 231-1041-80-000 10/02/2006 04:54 PM PAGE 1 OF 1 Alt. Parcel M 26.30.15.712A 231 - CITY OF GLENWOOD CITY 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 JERRY & CHERYL HOFFMAN O - HOFFMAN, JERRY & CHERYL E862 890TH AVE DOWNING WI 54734 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 14.000 Plat: N/A-NOT AVAILABLE SEC 26 T30N R15W THAT PART OLS 45 Block/Condo Bldg: LOCATED IN SE SE N OF SOO LINE RR Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 917/555 07/23/1997 816/382 07/23/1997 790/274 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/14/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 14.000 600 0 600 NO Totals for 2006: General Property 14.000 600 0 600 Woodland 0.000 0 0 Totals for 2005: General Property 14.000 600 0 600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 k ST. CROI X COUNTY '*lwl . WISCONSI N 92~~~ ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (R I V E R F A L LS) 4 r HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME: RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 tom` r'`.`Z yd HAMMOND, WI 54 015 715-796-2239 or 715-425-8363 TOWNSHIP : PLEASE PROVIDE _THE FOLLOWING INFORMATION ACCOMPANIED BYle-RECEIPTS FROM YOUR PUMPER NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE. 'C USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN(JANUARY 31, 1986. OWNERS SIGNATURE mj:12-83 STA'TFMENT `s. 19 Glenwood Clty, Wis. 54013 with - in Account • nitation Service Cassell, Sa Robert Cassellius Wls. 54013 Glenwood City/ phone 265-4023 _ cr_ k% ss r' f s { minimum charge of 50c, will owith a 30 days. Finance Charge 0 eladded to all accounts over d rT ST. CROI X COUNTY S WI SC 0 N S I N S= z 7 .X F ~'Y'Jy~t} Yt v t r it ! ZONING OFFICE 796-2239 (HAMMOND) 0 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P 0 R T ST. CROIX COUNTY _ ~7 NAME % 9~is.2C%_~ ~;R1 TURN COMPLETED FORM T0: ADDRESS u~ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 «2CC ~'z HAMMOND, WI 54015 715-796-2239 an 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPT -FROM--.Y-OUR PUMP-R: NAME OF PUMPER: EC~z-t t_~ "tom c~ LOCATION OF DISPOSAL SITE: +--L~: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) JULY AUGUST SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED f THIS REPORT MUST BE RETURNED NO LATER TN OCTOBER 15, 198 OWNERS SIGNATURE u STATEMENT Glenwood City, Wis. 54013 ...4 ----`7-------------- In Account With Cassellius Sanitation Service Robert Cassellius Glenwood City, Wi,. 54013 Phone 265-4623 ~ I 1 t ~ 6 E ~ I z? , Finance Charge be la/dded per a month, with over 30 minimum charge of 50c, will : j ST. CROI X COUNTY WI SC O N S I N Ap 1. ;r tel. ZONING OFFICE 796-2239 (HAMMON,D) 425-8363 (RIVER FAX LL.5) HAMMOND W 6401 PUMPING REPORT FFfC6 QUARTERLY------ - hS T. C R 0 I X C O U N T Y NAME IN FR-STATE LLJ,N41;F-T-^e--- RETURN COMPLETED FORM TO: ADDRESS Glenwood City, Wis. 54013 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 o& 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NCE: NUMBER OF PERSONS LIVING IN RESI-DE USE: YEAR ROUND y SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO ATER THAN JULY 30, 1985 OWNERS SIGNATURE ST. C R O I X COUNTY WI SC0 N S I N ,y~tts r} ZONING OFFICE b. fr I = 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME , _ RETURN COMPLETED FORM TO: y -Z, ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. SOX 98 HAMMOND, WI 54015 715-796-2239 on 715-425-8363 f PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: »-z2<<-Z USE: YEAR ROUND C_,, SEASONAL (CHECK ONE) JANUARY FEBRUARY MARCH DATE VOL. PUMPED TE VOL. PUMPED DATE VOL. PUMPED i r~• THIS REPORT MUST BE RETURNED LATER THAN MAY 15, 1985. OWNERS SIGNATURE i, Y J STATEMENT Glenwood City, Wis- 54013 - - - In Account With Cassellius Sanitation Service Robert Cassellius Glenwood City, Wis. 54013 Phone 265-4623 r 4 I v ' r ry i i I 0 i i 9 d I Finance Charge of 11/2% per month, with minimum 30 charge of 50c, will days. o be added to all accounts T. C R 0 1 X COUNTY W1 SC O N S I N ZONING OFFICE 4c w tit 796-2239 (HAMMOND) 4258363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. C R O I X C O U N T Y NAME L U'tij 13` a u0 RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE P. 0. BOX 98 HAMMOND, WI 54015 715-796-2239 or 715-425-8363 TOWNSHIP: PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER : LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: ` L USE: YEAR ROUND t' SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED f I ^7 ' JY gyp.. i % ~ THIS REPORT MUST B~ RETURNED NO LATER THAN JANUARY 31, 1985. OWNERS SIGNATURE c- i mj :12-83 ' ST. CR0I X COUNTY WI SC O N S I N I~1'G ZONING OFFICE rF 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME INTER-STATE LUMBER C~IPrnnnri (;jt~ Wis ~~~a RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 TOWNSHIP 715-796-2239 on 715-425-8363 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: 4 LOCATION OF DISPOSAL SITE: n - _ V - IDFN~: USE: YEAR ROUND SEASONAL (C ECK ONE) J NE JULY AUGUST SEPTEMBE DATE VOL. PUMPED D TE VOL. PUMPED DATE VOL . PU ED ? THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1984. OWNERS SIGNATURE k ' ST. CROI X COUNTY WI SC O N S I N ZONING OFFICE I 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) z HAMMOND, W 1 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. C R 0 1 X COUNTY NAME INTERSTATE LUMBER RETURN COMPLETED FORM TO: &I% 5?>•013 ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 on 715-425-8363 TOWNSHIP ~ u'ac PLEASE PROVIDE THE FOLLOWING INFORMATION A0004PANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER:; LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCZ USE: YEAR ROUND SEASONAL (CHECK ONE) APRIL MAY JUNE ~f DATE ~ VOL. PUMPED: DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JULY 15, 1984 OWNERS SIGNATURE 'S-~ 7-7 ST. CROI X COUNTY WI S C 0 N S I N ZONING OFFICE IpjO~ 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND WI 54015 Q U A R T- ! R L Y, P U M P I N G RE P O R T ST. C R 0 1 X COUNTY NAME RETURN COMPLETED FORM TO: ADORESS ST. CROIX COUNTY ZONING OFFICE - P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 on 715-425-8363 1 OWNS H I I' ~-v- PLL~ASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER:~~ -2 LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: T USE:--- YEAR ROUND SEASONAL (CHECK ONE) DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPLU THIS REPORT flUST BE RETURNED NO LATER THAN APRIL 15, 1984. -7 - GONERS SIGNATURE ~li/ ST.CROIX COUNTY gH~~4/~ _ WI SC0 N S I N s ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R `L' E R L Y P U M P I N G R E P O R. T S T. C R 0 I X C 0 U N `C Y NAME:- G - RE'T'URN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE - P. 0. BOX 98 HAMMOND, WI 54015 715-196-2239 or 715-425-8363 TOWNSHIP: C4 PLEASE PROVTDE 'T'HE FOLEOW NG INFORMATION ACCOMPANIED BY 10 Cl-APTS FROM YOUR PUMPI"R : NAME OF PUM11ER' : ! LOCATION OF DISPOSAL SI'Z'E: NUMBER OF PERSONS LIVING IN RESIDENCE:-~__,~_,y G'y USE: YEAR ROUND L SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBEk DATE VOL. PUMPED DATE VOL. PUMPED DATE VOI.. c.. 13 2~ c~c Is ~f~Rut¢lc'f'' T 111-S R1-'PORT MUST BE RETURNED NO LATER THAN T^,nT= 5 1984. OWNERS SIGNATURE iri j : 1 2-H3 HOLDING TANK PUMPING REPORT S Name o4 Reatidenee yy R~~ Addness r ~1 Tetephone ' /4r Lega.e: % 04 % o6 Section T N-R_W Township ' C r I&C G Date Pumped Amoun-t Pum ed Loea,tlion S tread Rema4ks Pum etc' .-Si natutce - .j Zoning Oj6 ice U~se: Date Inspected Conditions Found The above in6otemat.ion ahatf- be sent to the St. Ctco.ix County Zoning 06jice, Post 066iee Bux 98, Hammond, WI 54015 mon.thty by the Pumpete. The -in4o4ma.t.ion Witt at that time be ,Leviewed by the Zoning 066,iee and placed in a petcmanen-t 4iee. Random inspections Witt atzo be made by the St. Ctco.ix County Zoning 066.ice to inspect the success o6 the system at the above toeat.ion.