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AS BUILT SANITARY SYSTEM REPORT
C_
OWNER -4'0 W N S H I P /Y f
---SEC TN- R i W
ADDRESS- ST. CROIX COUNTY, WISCONSIN.
fA ~
SUBD IV CSION LOT LOT SIZE
PLAN VIEW
Distances and dimt~nsions to meet requirements of 1463
SHOW EVERYTHING WITHIN 100 EEE`1' OF SYSTEM
f
I di at N r h rr w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at-
.,ztc:
SEPTIC TANK: Manufacturer:iquid Capacity:-®~"
Number of rings on cover Tank manhole cover elevation
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set for a cycle -gallons; Total capacity of
distribution lines gallon: size of pump _ head;
gallon per minute , horsepower ;brand name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer____ Number of gallons
Elevation of manhole cover ;
Type of warning device _
SEEPAGE PIT SIZE; Number of pits feet diameter
feet liquid depth- seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines widthlength_tile depth
S2`RPAGE TRENCH: width length
PERCOLATION RATE- - - AREA REQUIRED !n AREA AS BUILT
INSPECTOR
DATED PLUMBER ON JOB
-
LICENSE NUMBER
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 1)3707
E~ CONVENTIONAL ❑ALTERNATIVE S,a,ePlanl.D.Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPEEC ION DAATE.
Anthony Gartman RR~~ 1, Woodville, Wi '`^O43
BENCH MARK (Perman-1 reference ppinL) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT_ ELEV.
SE SE, Section12, T29N-R16W, Town of Baldwin
Name of Plumber. MP/MPRSW No County. Sanitary Permit Number_
Byron Bird 1309 St. Croix 132-16147 T
SEPTIC TANK/HOLDING TANK:
MANUFACTUf~ER. ILIQUID CAPACITY. TANK INLET ELEV.. y/ TANK CUUTLE)T ELE : PWAORNIIINGDLABEL PLOC GC
RO DED
YES El NO NO
J")_
BEDDING. VENT D A.. VEN ATL•. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: IVEN TO FRESH
LIN AIR INLET
< ,/~?1
DYES NO ALARM O N FEET EAR FROM 0 NEAP
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CITY P M MODEL PUMP/SIPHON MANUFACTURER WARNING EL OCKIN COV
PR OVIDEQ. PROVI
DYES ONO OYEA O ES ONO
GALLONS PER CYCLE: P ND CO ROLS OPERATIONAL NUMBER OF PROPERTY EL d B LD G VENT TO FRESH
LINE r 7!j ~AIRINLET.
(DIFFERENCE BETWEEN FEET FROM r
PUMP ON AND OFF) ❑ ES NO NEAREST
SOIL ABSORPTION SYSTEM. Check t soil sture at the pth of lowin LENGTH DIAMETER ATERIAL AND~nAKING
ORCE
P g LFAIN
or excavation. (If soil can be rolled into a wir , construct io shall cease until the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO OF DISTR. PIPE SPACING; COVER.:..' INSIDE DIA -PITS LIQUID
_7 I
BED/TRENCH r 1; TR,"X-U.ES _ MA HIAU PIT OEPTH
DIMENSIONS 4-
GRAVEL DF PTH FILL DEPTH DISTR. EWE DISTR. PIPE DISTR. PIPE MATERIAL. NO. D NUMBER OF PROPERTY WELL T~1 DING. VENT TOTF SH
BELOW - E COVER ELI INLF T ELE PIPES /9 _ AIR LE
PE ABOV
FEET FROM L I
NEAREST>
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check td e ,,texture o e fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems ake certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the crit 0-for edium sand. TIONS MEASURED.
DYES ONO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
t / O
DYES ONO DYES NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCBED ]TIEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES.
DYES NO DYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM: f
WIDTH LENGTH No.OF LATERAL SPACIN RAVEL DEPT ELOW IPF FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS 41
MANIFOLD PUMP MANIFOLD DISTR. PIPE _ M NIFOLPMATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV.. DIA.. ELEV.. / PIPES DIA..
ELEVATION AND /
DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING GRILLED CORRECTLY COVER ATERIAL PLANS
DYES NO DYES ONO
O
COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS NUMBER OF PROPERTY WELL. BUILDING:
FEET FROM LINE.
L1 YES ❑ NO DYES ❑ NO NEAREST
10
r? _.j ~-jam.. y; ~
1G
L
Sketch System on C' A. ain in county file for aud+
Reverse Side. (j~ T
~J ' F i 1
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF SANITARY PERMIT
INDUSTRY, SAFTY & BUILDING
LABOR AND TRANSFER FORM DIVISION
HUMAN RELATIONS
(PLB 67-T) P.O. BOX 7969
N: I PERMIJ NUMBER: PERMIT TRANSFER DATE: MADISON, WI 53707
-1614117 7- If rya ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER:
PROPERTY LOCATION: /
J Y4 Y4 S .T N R / E O CITY, VILLAGEr-O TOWNSHIP]
COUNTY:
LOT ~UMgER: BLOCK NU BER: S BDIVISIO NAME:
VA ` NEAREST ROA~, ~
7'r ~ AKE OR LANDMARK:
PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED):
NAME: SANITARY PERMIT TRANSFERRED TO:
SIGNATURE:
NAME:
PHONE UM ER;
ADDRESS:
PHONE NUMBER: ADD ES
BUILDING USE (IF CHANGED):
I
❑ Public* ❑ Variance ❑ Other (specify)*
1 or 2 Family *State Approval Required NUMBER OF
BEDROOMS:
I, the undersigned, hereby assume responsibility for installation of the private sewage system that has either previously been approved
for this property, or that is shown o e attached revised plans.
P ER'S SIGNATUR
PREVIOUS PLUMBER'S NAME (IF CHANGED): 01 P RS ADDRESS: 4
~a
PREVIOUS LUMBER'S ADDRESS.
SSG.
MP/MPR W NUMBER:
P NE NUMBER: MP/MPRSW NUMBER:
PHONE NUMBER:
SIGNATURE OF ISSUI J ( 1
GE T: DATE APPROVED:
DISTRIBUTION: Canary -County
1 to ~ White - Bureau of Plumbing
DILHR-SBD-6399 (N fl t/$i) Pink -Owner
Goldenrod -Plumber
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E 1 1 5
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
I OCATION:S_~ Section R /'1' • (or) B, Iownshlp uI Mmm ilmilty
I of No. - Block No. County
ryry SUbIVISIUn Name ~
Owners Name: _ !'rp, Tlt •1 1y
Mailing Address:
I YPE OF OCCUPANCY: Residence No. of Bedrooms Other
I FFLUENT DISPOSAL SYSTEM. NEW _A1 ADDI IION REPLACEMENT
HATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
,OIL MAP SHEET
SOIL TYf F ~ - N ~ ~ / f7rj' c1
PERCOI ATION TESTS
TEST DEPTH l HOURS W:+?Cf' ;N TESL TIME mil IN WATER LEVEL, INCHES RAI E
CHARACTER OF SOIL
i NUM- INCEIES THICKNESS IN INCHES SINCE HOLE ROLL AE I EH IN1 EHVAt MIN/IN
HER tST WE 1-1 ED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
T I ;L. fill
'Z mo
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
r s 41 e,
H ✓ , ` , t tI ~i- rt s L
PLAN VIEW (Locate percolationtests,soll bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. 'r Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
Olt T
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I, the undersigned, hereby certify that the soil tests reported on this form wet e made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief. n
Name (print) ~FAE Certification No.-
Addl
Name of installer it known__~QA~?~~~ 7 7`'_---
CST
r'rl('Y A -LOCAL AUTHORITY S(Inatuie.,,.,.'_/ _ = ~ ~%r
t ~
1 ~ ~l Q1 ~ x
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1
71,
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App"p,
REPORT 01 INSPLC7 TON INO IV IVUAt- Sl luACt SVS II M
Savl.i ta~~r{ V I, 'ti fit,(
*,ta.te. Sepxi,c -7-/
uk1,5ki 1Id l,1LU ( k l VI 4 it
S e 0 4 oyl o f N Sabdivis4',on
1(( CCokIA NnrnbeIt (I cornpait ,tfn c.vt
i'Ir~rn: (Uekk Buy fd4"Yl 12 % Ak.opc,..-
it w a. gte.n
i'iIMI'ING ('HAMIM-R
~V gak.kgvt~5 _ Pump Manul~ai'.tull.ell Mur'(ek' Nurnberl
,(p 1 U I NG TANK
gafe(In6 Number ot5 CotripalI fn nits
Akat(m SyA tern
f(~ yllulrl t~''I
'I (I ki ch
(voff 6 LI4 ~.d-<,ny t2o A'o pe
iI < git wa-te It
'N 1II UIMLNSIONS
thench Reyu,iIi ed area
~ it .~~11 oh ea-ch f,ne (t Depth oA back be.&)w tike
E'tnvDepth. (I n-uch ovot
i'I'vl.(lth o~ f ne.A Uepth ot -i.ke b veow c{Ila,lc
IcI~~,~ II ui(I VI neA {t Scope u(~ #n.v_neli trl. I „I 100 f~1
III)t.,ovi alrea At Type o(, Covet: Papelt o,I III thaw
hI to Gh-« ve C around p4 to IIeA rIO
I~~Irnl'tt"I ~jt Depth be'61w .I_nke=t Al
TITLE
19
- A T t z - _
1 l r ll DATE 19 x
~I~' I'I 11 ('T10 N
DEPARTMENT 6F APPLICATION
SAFET .LDINGS
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'/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:
Anthony Gartman rift 1, Woodville, 'Wi
Property Location: City, Village or Township: County:
33 '/a SE %S 12 /T 29 N/R 16 E (or) ^ Baldwin Township St. Croix
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
Cty Rd "D11 (If assigned)
TYPE OF BUILDING
Number
Bedrooms:
❑ Variance* ❑ Other (specify)* ~r'j. of
❑
Q 1 or 2 Family *State Approval Required. 4
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY 1250 1 x x
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: Weiser concretes products
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ® New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
2 Min 666 ❑ 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 installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: MP/MPRSW No.: Phone Number:
Stephen L. Aaby r l MP- "ld (6 8) 2407
Plumber's Address: ame of Designer:
Box 254, Woodville,; Wi ,S'
COUNTY/DEPARTMENT USE ONLY
ign to of Issuing Age t: Fee: Date: APPROVED Sanitary Permit Numb r:
CPL' iJ~ ❑ DISAPPROVED
e son for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309` -1
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION: t'/v, Section 1, , T2qN, R L69 (or) W,, Township or Municipality ~p <<~ y
Lot No. ,Block No. County c tLc
sr
n 9jL7 ;4, Subdivision Name b
Owner's Name: A ~~y~
Mailing Address: l~ .l2. 1 ly d/`i /i. 'J
TYPE OF OCCUPANCY: Residence _ X No. of Bedrooms A Other
EFFLUENT DISPOSAL SYSTEM: NEW A ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS
~T
SOIL MAP SHEET
SOI L TYPE /qze> 13 IT
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHEST RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P_ 77
P_ T
x ):I
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B- f ? .11-/ 71 S- / C C- 762Z L-
y '
All, T. 6-;1- W VAF 4-
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy. },7 FT 7R IF H 1'Z Ws' Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
01. .0
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
to the best of my knowledge and belief.
Name (print) S /L^~ 44, Certification No.
Address r 3n tr; t• ~5 I -
Name of installer if known _Nt G2-' )34 hit, l- L > T 7'2 <
CST
M CAL Signature,
p
Parcel 002-1025-90-200 09/22/2006 04:26 PM
PAGE 1 OF 1
Alt. Parcel 12.29.16.1836 002 - TOWN OF BALDWIN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
12/28/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - GARTMANN, CHRISTINE L
CHRISTINE L GARTMANN
1020 CTY RD D
WOODVILLE WI 54028
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1020 CTY RD D
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: " Acres: ___-45,030 Plat: 4900-CSM 19-4900 002-04
SEC 12 T29N R16 SE SE CSM 19-4900 LOT Block/Condo Bldg: LOT 01
1(5.03 AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
" Tt S~ 12-29N-16W SE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
12/28/2004 783614 19/4900 CSM
09/22/1997 565717 1265/346 TI
07/23/1997 488/609
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/19/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 9,000 143,900 152,900 NO
PRODUCTIVE FORST LANDS G6 3.030 2,700 0 2,700 NO
Totals for 2006:
General Property 5.030 11,700 143,900 155,600
Woodland 0.000 0 0
Totals for 2005:
General Property 5.030 11,700 143,900 155,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 09/27/2005 Batch 05-20
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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SEE PAGE 21 v Ca Per
AVE.
F
We'll eover it all." for you. NELSON'S
SUPER VALU
South Highway 63 & Cedar Street
))))))REALTY WORLD Baldwin, Wisconsin 54002
Countryview Realty YOUR COMPLETE SUPERMARKET
Route 1 - Woodville, Wisconsin 54028 Full Line of Groceries, Meat, Produce,
(715) 684-3871 Dairy, Frozen Food and In-Store Bakery.
S!ta1
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Wisconsin
State of
ss
County of St. Croix u'
THE ST. CROIX COUNTY ABSTRACT COMPANY hereby certifies that the foregoing abstract consisting
of entries No. 100 to 108 both inclusive, is a correct abstract of title since 11
-April 10, 1974 11:00 A. at _ o'clock in the M. of lands described in
the Caption at No. 100 hereof, to-wit:
S? of SE4 of Section 12-29-16.
That, for the period covered by this certificate, said abstract correctly shows all matters affecting
or relating to the said title which are recorded or filed for record in the office of the Register of Deeds
of said County, including Federal Tax Liens and Old Age Assistance Liens filed therein against the parties
listed below.
For the period covered by this certificate, except as shown by this abstract, there are no unsatis-
fied mechanic or material liens affecting title to such lands docketed in the office of the Clerk of Courts
in said county for the past two years.
That, except as shown in this abstract, there are no unsatisfied judgments, including delinquent In-
come Taxes, docketed in the office of the Clerk of Courts in said County within the past ten years, as and
against the following named persons which affects the title to the real estate above described to-wit:
Anthony J. Gartmann
or
Chr1. s tine Gartmann.
That for the period covered by this certificate, all instruments appearing in this abstract contain the
necessary number of witnesses and acknowledgments unless otherwise noted.
We further certify that for the period covered by this certificate that we have carefully examined
the records in the office of the County Treasurer for St. Croix County, Wisconsin, and find no record of un-
paid taxes or assessments standing as a lien on the real estate described in this abstract, except as shown
herein. Such examination covers up to and including the taxes for the year 19
That this certificate and annexed abstract and also any prior certificates, if any, made by the un-
dersigned, covering the some land, are furnished for the use and benefit of any and all owners of the land'
described in said caption and their successors in title, including mortgagees and guarantors of title.
Dated at Hudson, Wisconsin, this 22nd day of May A.D.
19 81 at 8:00 o'clock in the A • M.
ST. CROIX COUNTY ABSTRACT COMPANY
By ~~141&e-f
A s s t t. Secretary
,VILE,
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SEAL
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sr. i o° 'F9i'. w~"Y►YOYED NCMBCP
Form 3 - 1956
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