The URL can be used to link to this page

Home My WebLink About002-1014-90-000 tv n sto. p 3 0 d O c N O 3 A A p (D •O ~ - Z Z Z o = 1, CO O o v `C • ~ o o v, o o (D (D > > (m 3 3 1 ~ D ~ O (D f (D CD a p CL N O O O r. U) cn CO (A z D a D W a O CD c O o o ~ z CD CD c N O c O OD 00 CL :T v I f. ~ O O O Y cn _ N ai o m v v v ° m N CD CD 7 CD al 'O 9o O N N 61 C 7 CL II N N z z Q O D D w N N M. • N m a - cn I ~ a n A Z (DD p Z O 0 Z N J W -V CL " - z 3 A 3 z U) z CD Cl) CD c0 a 20 a U7 f/ O F :3 C (D - 3 o z a N m ~ a. m a a ? A O ~ N N a M ' N (D O O ON ~ A O~• :3 n ti O hQ O ti ea O o O CD 0 y~ I ~ !Parcel 002-1014-90-000 07/26/2006 11:03 AM PAGE 1 OF 1 Alt. Parcel 07.29.16.96A 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 DIOGENES A PEREZ O - PEREZ, DIOGENES A 1095 210TH ST vl- BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Pri ry Type Dist # Description ' 1095 210TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 7.047 Plat: N/A-NOT AVAILABLE SEC 7 T29N R1 6W THAT PART OF NW FRL 1/4 Block/Condo Bldg: LYING WLY OF HWY 63 TOWN BALDWIN Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 09/15/2004 774427 2656/563 WD 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/03/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.047 14,100 119,400 133,500 NO Totals for 2006: General Property 7.047 14,100 119,400 133,500 Woodland 0.000 0 0 Totals for 2005: General Property 7.047 14,100 119,400 133,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 08/22/2005 Batch M 05-1 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ R }r 0 (n O ~ -0 n d O O O. :E od O M (D -0 7! rr o v # (o A 1 A7 'S C) O N En o O O N W~ O °C • a N N i--i N 3 3 O C LD 0) 00 r-- z E-L C) CD N Q N W H O A p CD 8) cr cn A C (D C) ? D O p -0 Q 7 ~ (D CD O O O ~ O 3 O 7 N O O Q (D ~ Q C D C Q CD O ~ N d p 7 3 a W a- lot (D r. CD l~ m m cn 00 o r to N W p Q N O C 0 03 0 dO N (n cn a 3 _ ~1 3 p (D Q' v v v C I CD N < a Q° m m _ (D O m c N 3 I 7 CD • • a z N o z D 0 m v O N O C c D N ZJ (D !V CD CL C 7 W (7 d z (D 7 -1 cn 7 d Z (D v A C a 7 z -I v W CD I n• 3 z O 0 A O r! z Cp C W p~ N D 3 W a CD N p - - CD -o oZ a 7 N v Q y A N i V N O O a Q 0 N d0 0 Q y ~ y l t1%. ,=f > , TOWN SH1,(jWNEk ADDRE-YS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT /0// LOT SIZE-,/tq PLAN VIEW Distances and dimensions to meet requirements of H63 LV,$YTHING WITHIN 100 FEET OF SYSTEM Ns e?y - ti _ 1.- - - -4 ~iralce } t_hl Arnow BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point ---Slope at site: SEI)TI-C 'LANK.: Maiiufac:t:urer Liquid Capacity: Number of rings on cover Tan~C. manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PIMP CHAMBER Manufac t:urer : Number of gallons S?00 _ Ntwiber of gal. -pump set or a cyc3e %--3,.2 gallons; total capacity o~- d i 5 t.riUution lines / ga 1 ion : size a pump`s head; p,aLlon per minute horsepower, - ~ bran name of pump _ and model number Type of warning c e . ice HOLDLNG TANK: Manufacturer Number of gallons 1levation of zuatlhole cover~___! _ ry ),c ()t waxn.Ing device teet ciiame~.c r SEEPA_,E PL'L' SIZ1:. -Number. o~pits feel tiduid depth-_--~ seepage pit inY t pipe-elevation hoe t o-ii of seepage p t e I eva.tion feet . SE:1?PAG1` M,A) S I ZEL rwiuber c,f lines width 5~ ~_le~tgtt~ 7`~ t i 1e ~ie}~t h CR~i:NCH wi.dt-h - - length - _ Ph1~C!.)1 AT 1(A RATE ' AREA REQUIRED ' AREA-AS BUILT ' 7- INS} CCTOR DA'1't~i) PLUMBER ON JOB LICENSE NUMBER I I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING; s ALTERNATIVE PRIVATE DIVISIOP LABOR &HUMAN RELATIONS P. 0 B0., 7969, SEWAIgE SYSTEMS BUREAU O~UMBIN( MADISON; bY1 53707 ❑ Mound Pressure Distribution NAM F HMI- HOLD R ADDRESS OF PERMIT HOLDEH. INSPI CV ION DATI PLAN ID NUMBI II BENCH MARK IP.nrwo~ 1 rd~r a IHdn11 ULSC111 IEIE IIFNI FROM PLAN- V ( HI I PI 1 I v . 'r SEPTIC TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUILLT LLCV ~~~Ch"p~ Pf1OP1-f1IV 1.INL Wf U. H11IN11 DOSING CHAMBER: MANUFACTURER.' LIQUID CAPACITY. PUMP MODEL PUMP MANUFACTUR WARNING LABEL LOCKID/Ep OVER „ PROVIDED. PROVI ❑ YES F-1 NO L-1 YES I -I NC HFS ER pF PROPERTY WELL HULLOING VINI II I. PUMP AND CONTRO LS OPERATIONA NUM4 n GALLON PER CYCLE LINE ) -r Il T DIFFERENCE BETWEEN YES El NO FF NEET ~ M M► PUMP ON AND OFF SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or_sxcavation. (If soil can be rolled into a wire, constructic shall cease until the soil is dry enough to continue.) ~J - Mound site plowed perpendicular to slope Check thext e t flit aterial for PROVIDE A DIAGRAM and furrows thrown upslope: mound Ste o ake c tain that it OF SYSTEM. SHOW ❑ YES El NO me`ja a ria fo med ufxf sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: i-~+ u WIDTH- LENGTH. NO. OF SPACING CENTER ; LENGTH. OIAMLTEH MATFHIAL ANU MARKING SEI.E7/ ~ fR~'.I C"- TRENC TO CENJ~R / µ ,PZ s i t?IMEttSIgA!$, ~ f ~ IN / i1 MANIFOLD. PUMP. MANI OLD PIPE MATERIAL AND MARKING NO. DISTR DISTR. PIPE DISTRIBUTION PIP MATE HIAL & MAHKING a L ` DIA. PIPES DIA. / >hE..^.aI,ATIQI HOLE SIZE' - HOLE SPACING. DRILLED CORRECTLY. EPTH OF GRAVEL OV R PIPES. VERTICAL OF T CORRESPONDS TO APPROVE D l PLANS YES E:1 NO ❑ YES L~ NO SOIL COVER: ' TEXTURE pEPT--OV EHTR E NCH/BED ID EPTH OVER TRENCH/BED DEPTH T PSOEL. SODDED SEEDED MULCHED CENTER EDGES. i ❑ YES ❑ NO 0 YES ❑ NO L_1 YES l I NO Y A COMMENTS: SIGNATUAE- I I l I f r DILHR-SBD-8227 (R. 06/81) REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit 0 ~ State Septic p NAME TOWNSHIP St. Croix County LOCATION Section Lot # _ Subdivision SEPTIC TANK Size gallons Number of compartments Distance from: Well Building 12% slope Highwater I'UMPING CHAMBER Size gallons Pump Manufacturer Model Number HOLDING TANK Size gallons Number of Compartments_ Pumper Alarm System Distance from: Well Building 12% slope Highwater ABSORPTION SITE Bed Trench Distance from: Well Building 12% slope Highwater ABSORPTION SITE DIMENSIONS Width of trench ft Required area ft. Length of each line ft Depth of rock below tile in. Number of lines Depth of rock over tile _in. Total length of lines ft Depth of tile below grade__ in. Distance between lines ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover:_-_ _ PIT DIMENSIONS Number of pits Gravel around pits yes no Outside diameter ft Depth below inlet ____ft Total absorption area ft Area required ft INSPECTED BY TITLE APPROVED DATE 198 REJECTED DATE - 198__ N~ REASON FOR REJECTION _ R DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY,' FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/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: PC I e- re- /44 w ,L. e It 2- Ca L.~+~t rJ ~ $ Property Location: City, Village or Township: County: IVUJt/atv'")1/aS /T Ae1 N/R 8(or) W SAL-rclL-j '.J Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: /~ic✓ A - (If a j) p h Gy TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: ( 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 0 06 D /V e- X HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: 61, n-7a ae_: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New 9 Replacement ❑ Experimental ® Seepage Bed ❑ Seepage Pit Q t~Q ❑ Alternative (specify) ❑ 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 inst tion of the private sewage system shown on the attached plans. a Name of Plumber: S nature. MP/MPRSW No.: Phone Number: v C,aZe ;3, Ldf > rnP X89 (7i~) 6$'f-33 79 Plumb ddress: Name~esigner: ALdw~~ ~S /-ve-a-e- /3'4- + COUNTY/DEPARTMENT USE ONLY Sjgnatu of Issuing A t: Fee: Date: APPROVED Sanitary Permit Number: F' tf`R~-~ « ! l" / ❑ DISAPPROVED eason 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, Goidenrod- Plumber DILHR-SBD-6398 (N.03/81) l+ ~ Q _ I m I P~ I~ ~ ate, Cy cr) 4L M ° I AD r (b r, cn T~.y ii it k,-~~, O r I 14 I 1 V~ V I d 46 i 1 M c 'C _ E la) mA Poo i -00 1 13 Vs p ~y d ro any n haN t: a b n a,. o I cc-a , tno 0o4 ` I . ~ o ooe, ~ . I C I cu A ° ` 04 N 7'x'00 ~A j dF ~ p 01" kA C) cl jwq G f~ o °Z P n1 c ~Ll oo (b "ham V o ~ Q ~ ~fp Of. 4+ L1, IS k ( C>G) W,' m Cjx Lij fL~lTs_ ~ ~ w -A CA Or) A w' w ; ~ x 1 xl e~ C 91 r A * n - ~(A ~ TT) fL nzP -o A - t" cr CP c io Ul CIO (b 4,.; - i x 3 ~t t 1 .4L 1 a Z 10 2 11G i , 10 r ~aZ b Zoo -is .t, a IF " c- f' F-A a 'Rr-----~ f P A 14 c t~41 4- r. NO OGK "ZHO9 'SIIoA SI I sdwn •sojogdS "►,i 'OSIHIIS I HOOIdS'HOSdS SP!IoS -xnw d luanl113 PION 411H OSW)IS Pug HOOWS 'HOSdS :A3l=dv3-Pg9H l M Odl31nN1 ~ 3d sN T v0 •s•(1 • olp -09 o► oz .a ds °V SdAnd o► ~S 09 rn lN3mJJ3 004z OV3H H.91H On Ott NIdt10SL l ''=N 09 's31oA Si t •sa~aydS'„ 'SUS'8 „►/c 'Ends solloS -xgW Sdwnd dwnS elglsjawgnS SUS Pug EUS :A3!aede3-Pl#aH mm Hold sNO nvo 's'1 09 09 ov 1 oc oz of o b i r Lt H~E 9t OL ►L 9L Sdvynd 'xH 09 'clod t 'auaydS ,i* sppoS -men sdwnd,dwnS olq!sjawgnS EEAS Pug SZAS'Av3rd"-peeH dvyns axnNiw dad sNO~wo • n 9i► 0► 9¢ oc SZ oz 9t of S o I ~ s~~wens ► e~ r S zt m w" ~s o 9t 1S oz ►a ez s sdwnd La-H ~LI.t~LL! -O• bJCl^H Rib 10Ua 12/78. 1 ~oaue Detach And Return Upper Late of Wisconsin DIVISON OF HEALTH Portion Of This Form With SECTION OF PLUMBING r AND FIRE PROTECTION SYSTEMS Any Return Correspondence+ MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: 44 N' 41'4P Sec PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated proje Preliminary review indicates the plan review fee required is $ i-rl co o z G rr'*+ C~ r'f1 ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. 4 Vy1 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. III. 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. J.L.H.R. Plb. i-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES ' oy Jansky O.W.S - Division of Health 3 E. Spruce Street Section of Plumbing & Fire Protection Systems Chippewa Falls, WI 54729 (715) 723-8786 ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber M - Address i r Owner Address ❑ County Permits 1-4 Appropriate State Permits fail IpN~ 198 ~ Type of Building: ❑ Public 4~ ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION a TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH- ~ 4 i } ter- - E~ t n E ; m__ 1 8 3 E , t t r t u . E I , s ~ E i E t i ~ ~ ~ ` t g 4- _A =J,_ { I , ° r z _ a .d j v , a ~ .g L = r., 1 e • e = i « e f , f r ~ • t ~ t t A ; xr .1,.... ..,.,.mom ° . _ ° 3 - - ° I ~ F , e r ~ E ~ L 3 9 E i , , , 3 I ° E ° , i ® 1 a _ - E 3 E I ~ a 3 ° = d ' 3 E i 1 , 3 t E ~ I m 4 € a ; e 7- 6 F_ e = a I ° i r , a f g W pT i , t ❑SEE ATTACHED DISCUSSED WITH PLUMBER ( ► Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector `'ol!ovi - I ncal Inspector Pink - Plumber os- Responsible Party PIb 1,00a 127$ Detach And Return Upper State of Wisconsin DIVISON OF HEALTH Portion Of 1 1 This C 1 orm With n SECTION OF PLUMBING C AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: cV l~%`>If . `CC. 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 $ 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. ll. 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. III. 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. P,Ib 1a0e12/78 Detach And Return Upper State of Wisconsin DIVISON OF HEALTH Portion Of I This C Form With y SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: NW4, Sec. 7. r. of Raj. T 6 TIN 'p 10"T PLAN ID. # p y ~~Gn y co 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 $ 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. 111. 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. L_1 Detail & nodel of pump or automatic siphons including size, pump Curves, drawdown and average flow rate GPM. Foss section of lift pu€,ip tank Fowirg f ~ ir3Ip(sot siphon(s). i Vi In C.11 iF, sr `)e placed i--tior to _:an ;i~bmission) caa ale,; filled (fill to extend 20' bey: nd edge of trench before side slope begin). Depth and type of fill. L.J Copq of onsi e report by county or dish i~A plumbing supervisor. Lcngg.h o, ?'me fill has been in place. y ~ r State of Wisconsin ` Department of Industry, Labor and Human Relations x=.. ''r-1 cSy b; SAFETY & BUILDINGS DIVISION r(il kdst teas AngtL,i - .U. fox 7969 . ~ ter it 1tY ~ J t +l i. .-ar native System St. o f. naule cc app 'ovt t~t} z;i1V£ feat t ' 3. Code requires the ti;+u'twiv of the syst:?ta ?3e insta i leu 36" 11bove t i i,zsit og fzictor tno t,,0niat:gym (f 13" i)0o.i original gran,. With a Jq' i " to liaattinrq f actor a ::ite wticiul{l have to c,e perfectly lev,-l to confurr is r-q>.,iir~eiwe, t. Tits sitte ty: s a slope o LN ar4u re 0%wiogs -.h:;'wn inai( :'lati+3n F ifferenc:es of up Lo 10" vinich would resb{lt isi the system heinc t'ie ground if txte ~~;t rAri was installe6 levc an at the proper eIeva:. suq st ttt t u e ither lucate another site for ati i• - gr"t3und r 'i DILHR-SBD-6423 (N. 04/81) Plb 1 COa 1' /W? Detach And Return Upper State of Wisconsin DIVISON OF HEALTH Portion, Of T 1 his r form With SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: ivy-, Seca 7, 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 $ 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 ❑ 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. I11. 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 averaie Flew r r 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. State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 East Washing~~~--~ P.O. Box 7j69 ~ ~ C`,~ r ~;u(1ZSi3tr, ~!ZC>cOfl:?Zii '?.:i~+._E/ i ~r~ Ev~r`tt v~ 1 0 ~11? is !()l"jtls PIUtTfi3Z,l. ri t:, C. : a]dwin err :lr. 1w: ~~r Z _'ticv or ,rayf~: Vari,x,lc~: ~.1 1 / c.~-, W.i 1/-4, &--!c. 7, I F~J~.•~, cl ! JYS own of Baldwin, St. Croix County, WI V,'-;rianc: Based oa Sections H 63.01 and H t''1 isconsin Administrative Cade H 63.14 ( 1) accord wito s ctions I,i 61j'.0l at3u H 3.09 (u), Wisconsin Aurionistrat-, Code, a variance is hereby t•' ! p?>, ~;'a. i~' E X11 ;ilri t7f Gn C'r";i)t: , prC-ssuri distr'ittuti n systoiti '13 incnes from original grad',., Ills approval is for the var m". of the design and size of systel,I. Ti-As variance is suuject to 1. T!1at any locally concerned authorities having thkk r -spon! ioi lit-s- U fiforcement of local ordinances perailit the instal (atim as propose. . L shall be necessary to fulfill all perr{it requirements of the ci , °i 1 lage, township or county. Failure to odtain suct, pcrmit€ wi 1 ,uto atically void this approval. 'a the r".veilt drat tins variance creatt°.s liquic waste pru!ter::s aL gr'otj o R(-yvel or any other operational or maintenance probleMs occur, the Y ::pv isions necessary to resolve these, prOulcrris shall be cc?!„mrnced upoa) t°t3r.€ipt of approval by this d:~p?rtrrent. DILHR-SBD-6423 (N. 04/81) M State of Wisconsin ` Department of Industry, Labor and Human Relations ;tj I d t SAFETY & BUILDINGS DIVISION Page 2 ,',uvwmuer 4, in rrar)tirzG =;r)is ;rfr°) v 1, tr)L ivisios of Safety and 13si lciings does not hold itself liable for any ief Lcts in plans or specifications, plans oiiiissions, I :carrii )atia ~ oversigr;t, coristrucLiuo or arty ar)iaq~. that may result in or after, installation; and reserves the right to order changes or additions should conditions arise rroalcilol this necessary. rn the event construction ras not commenced within two years from this date, tois approval shall becume void and new application s )a i i 1;<< ril:lk.U 1:r'.)r approval of these plans before work may cuimnence. B Enclosure cry Jansky, OWS, District 6, Chippewa Falls 1/ arold barber, 7P% - st.. C"r~; ix ('cunt' i I I i I DILHR-SBD-6423 (N. 04/81) State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION 1 Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Number T L _j Re: PRIVATE SEWAGE SYSTEM ONLY- The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private 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 capacit, 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 By: County Other Enclosures 7Yyll..~/ DILHR-SBD-6159 (R. 7/81) mes Sargent, B erector ,f1FPARTIVICIVT OF SAFETY & BUILDINGS REPORT ON SOIL BORINGS AND `JDUSTRY, DIVISION ABOR.AND PERCOLATION TESTS (115) MADISOP.O. BOX 769 IUMAN RELATIONS 07 N W1537 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: j%/L.4,1/4 114_17 /L~61/R/61(orlj COUNTY/: OWNER'S BUYER'S NAME- MAILING ADDRESS: J'~.CRoiX Z iJ~Lc~LJ~w USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROF[ DESCRIPTIONS: IPERCOLATION TESTS: Residence ❑ New Replace RATING: S= Site suitable for system U= Site unsuitable for system rOff:f::[ ONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) u as ❑u MS D U DS ❑U 0s ❑U If Percolation Tests are NOT required DESIGN RATE: S STEM ELEV. If any portion of the lot is in the .09(5) under s.H631(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.) o,-/& Sd . ~ ~:1v c~•f-tL~~ 7A /0 ~ei~ 15 " ti S, I S t =2 7-' S~ C i `,7 2-i ` B- 7a -2, C 3d B- C' r LL)44e~ - 5o rV (G Nd . Sei Ls u 13-5 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. RI OD 1 PERT D2 PERT D 3 PER INCH P- / /y ! p P- o a P- 3 y 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. SYSTEM ELEVATION 91 01 _ tC ° e, 3 Jt~~o cue-GL7'cP~rX_ ~131 7, 13,a_ ,10 ~ - - - - - - - ' ~ IM 85 r j Fj 3 jL s2 . ~ L % d P3 gq x 83 - 13 5- 0 A s 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): C SIGN Z RE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81)