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002-1056-30-100
Oo 4i - 00 d ((DD 7 O n ^r Z -u v CD 1 ~ 1 V~ 3 .r ~ O Q O N 0 O c" AO * co W C) C - M n N ~~C 111 CD O O CD O Q - - ".3 d Z d y _ O cy) N (D O W 7 m ? c C 1 (a Lj 0 T3 0 0 n m m m o r~ O C, CD n COp c (D CD Z5 A7 o r ~r O N' °O O Ca to Ln Oo N N N a) cn < D fl m CD ca y d o ol W (D rev c n ° D O O N N 3 ^~I O 0o W C O ` C W CO O O n (A ((n Oo W Q N Q C 0 0 0• O O O ~ 'lV Q 3 N N N o o D V y Q -0 v a m _ m co < r~i v '6 N CD _ (D I , (D + CD O N D D o O 6 N O c C O .G O S d "WA • /D (b (D O O (D (D CD C CD O 3 Co y CD ~ Cn A Z CD t%1 ~a O (D C1 O p Z O CD O o o s o CCDD Si * N W CD CD CD Q Z ❑ Q :r f0 v O a 3 m o CD ~D 3 (n "O Xko o N m D 3 (D D 7 v O?~ (O-. ~ m m NCD ~3W03 o: O 'Q (01 y O O c O T j (D N CO O N SOD 7 N 'o (/i O Q_ O OD (OD N y0 U O O O OZ Cl -0 =r o (n an li N 3 Q ~ ~ N ID cD N :3 Al a (D y_ (O CD -O .y-. O `G O CD O O (D O Q w p 0 CD fD ,y.F N _Q G y f f1 N Q. 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CD D 3 o (D N m c 4 CL C d co O A O 3 ] C b 0C n CD tr N v c v A' CD a I O co N ooN7 O X CA j Q o b CD aro O H (D :E °o (D ti Parcel 002-1056-30-100 12/21/2005 01:57 PM PAGE 1 OF 1 Alt. Parcel 23.29.16.346C 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BRADFORD, DANIEL C & TAMRIN S DANIEL C & TAMRIN S BRADFORD 2528 80TH AVE WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Prim Type Dist # Description * 2528 80TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC ~ d vd Legal Description: Acres: 0.760 Plat: 3290-CSM 12/3290 SEC 23 T 29N R16W PT SW SW BEING LOT 4 Block/Condo Bldg: LOT 4 CSM 12/3290 848/590 850/552 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 12/18/2001 665604 1793/622 WD 12/09/1997 569645 1281/495 WD 07/23/1997 850/552 07/23/1997 848/590 2005 SUMMARY Bill Fair Market Value: Assessed with: 87068 162,600 Valuations: Last Changed: 11/02/1999 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.760 5,500 98,900 104,400 NO Totals for 2005: General Property 0.760 5,500 98,900 104,400 Woodland 0.000 0 0 Totals for 2004: General Property 0.760 5,500 98,900 104,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 Parcel 002-1056-50-000 12i21i2005 01:57 PAGE 1 OF 1 F 1 Alt. Parcel 23.29.16.347B 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WEISS, JOHN A JOHN A WEISS 2532 80TH AVE WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 2532 80TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 12.900 Plat: N/A-NOT AVAILABLE SEC 23 T29N R16W PT SE SW LOT 1 CSM Block/Condo Bldg: 4/1186, EXC THAT PORTION INCLUDED IN LOT 1 CSM 8/2133, ALSO INCLUDES LOT 2 CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 7/2097 & LOT 2 CSM 8/2133 23-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/12/2003 712977 2169/376 QC 01/22/2001 637193 1577/551 WD 07/23/1997 1094/486 LC 07/23/1997 848/589 2005 SUMMARY Bill M Fair Market Value: Assessed with: 87070 Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 9,000 63,800 72,800 NO AGRICULTURAL G4 10.400 1,100 0 1,100 NO UNDEVELOPED G5 0.500 100 0 100 NO Totals for 2005: General Property 12.900 10,200 63,800 74,000 Woodland 0.000 0 0 Totals for 2004: General Property 12.900 10,200 63,800 74,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/1712001 Batch 510 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 AS BUILT SANITARY SYSTEM k1:PUkT UWNEK 6"ene TOWNSHIP AllDK1:SS A, ST. CKU 1X COUNTY , WISCONSIN . SUBDIVISIUN LOT LOT S 1ZE PLAN V I CW Diatancee and dimenaiona to maet reyuireu►er►Lb 01 B63 '1lEIJ THING WITHIN 100 1~EE'1' OF SYSTL'M ,1 Z 214 - - - - 4- c n a I di a e o th Arrow sc ~i✓~ : - r off' BENCHMARK: (Pertuanent reference Point) Dederibe: / C f" a A Elevation of vertical ,reterance poir►t . ~~n~~~--~S1oPe at ~iLe : /b SEPTIC TANK; Manufacturer:__~%1/~~°S - Liquid CapaclLy Number of ringa on cover ~ Q Tank watihole cover eluVaLlut► Tank Inlet Elevation; hank OuL1eL ElevaLlun l PUMP CHAMBER ~ Miinufacturer: ~Af-1 Nuu►ber of ballu[[5 _ Number of gal. pump sor a c Y( 7_ b-al 1011b, to} a1 c:aNa,' i t y of dia tribution lined ba l lur[ b i z.e of' puu►p ~~u~lU . gallon per minute horsepower brd[[d name of pun►p and model number ~rYJ -(C:__- Type of warning e ce_A/~ HOLDING TANK: Manufacturer /1//~ _ Nu[uber of ~;allun5 Elevation of manhole cover-/! 'rype of Warning device ~ *teSEEPA E PIT SIZE:_ Number-u1 1)1 L fet feet li uid d~ t - 8e~:pd P1t inlet pike-elevaLlon J bottom of seapaS,e p ~vaLlC 4 feel ~i SEEPAGE BED SIZE: number of liners width 1.eii8Lh`YFL1Lu dupL1►2- SEEPAGE TRENCH: width _ - leubtl► - RCULATIUN. RATK_, AREA REQUIRED a _ &~A AS BUILT DATED _ PLUMBER ON .10B ~ ~f.-/_. ao~<_ LICENSE NUMBER t REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit '200 State Sep t AMI: Ct J TOWNSHIP l~C St. Croix Count CAT 1.0 `s r~ Sect Lou a Lot # JQ, Subdivision EPTIC; 'T'ANK Size. / ()0() gallons Number of compartments istance from: We II ~ V - BU ildi_n1_-- 1 - 12% slope-_~!/ - Highwater X ,g UMPINC CHAMBER Size vivo gallons Pump Manufacturer Model Number !OLDINC TANK Size gallons Number of Compartments Pumps, Alarm System istance from: Well Building 12% slope Highwater BSORPTLON SITE Bed Trench listance from: Well Building 12% slope Highwater BSORPTION SITE DIMENSIONS Width of trench it Required area ft Length of each line ft Depth of rock below rile 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: ' I'T DIMENSIONS Number of pits Gravel around pigs yes no - Outside diameter IL Depth below inlet ft Total absorption area ft Area required ft NSPECTED BY TLTLF.. \PPR0VED DATE .198 :EJECTED DATE 198 REASON FOR REJECTION AS IiULIA` SANITARY SYS'T'EM REPORT OWNER TOWNSHIP SEC, T,' 'N-R -W ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT i LOT SIZE Pi,AN VIEW Distances and dimensions to meet requirements of H63 $.1.IOW. EVERYTHING WITHIN 100 FEET OF SYSTEM of rr Irr i'. T - - - - f s - - - - I di a e oath Arrow C LF~` i BENCHMARK: (Permanent reference Point) Describe: E Le,va.t i.on of vertical reference /point_ Slope at site: SEPTIC 'T'ANK: Manufacturer: X Liquid Capacity: Number of rings on cover TA manhole cover elevation Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: , Number of gallons _ Number of gal. pump Set or a ('yCIE' -Ya110T1S; total capacity o distribution lines _7-~ .-ga I ton size of pump----- AS head; gal Lon per minute /a horsepower ~ brand name of pump (.and model number Type of warning device HOLDING TANK.: Manufacturer Number of gallons _ Elevation of manhole cover Type of warning device----.-- SEEPAGE NIT SIZE: 1QizmF~ez= c~ pits - ---met. iameter feet liquid dept- seepage pit: inT-et p=ipe-elevation _ bottom of seepage pit-elevation feet. SEEPAGE. BED SIZE: number of lines width length tile depth SEEPAGE 'F'RENCH: width ---length a PI?RCOL.ATION RATE REQUIRED AREA S BUILT~~JJ INSPECTORLog~_/ DATED j l PLUMBER ON JOB LICENSE NUMBER -f'TARTMFNT OF INDUSTRY, INSPECTION REPORT FOR ! SAFETY & BUILDINGS IiUH & HUMAI! RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION f. BOX 7969 BUREAU OF PLUMBING ,~OISON, WI 53707 CONVENTIONAL It ALTERNATIVE IS,,,, P1,, I D 11-00,, (1 ass~9~,ri11 Cl Holding Tank In-Ground Pressure Mound. .11 (ll PE HMIT HOLDER SS OF PERMIT HOLDEN INSPECT ION DAI E I 1 G 122, ERE NT FROM PLAN _ V HEN. PT. ELEV. fit I PT ELI V 11 MAR - IPr~ . , ,rl, e 7'e Pn II UE SCHIBI: 11 S" C_ 12- -3 .,I Plu„~1 JIVIPIMPHSW N,, C<lumy Sanitary P-,,1 Numt- PT IC TANK/HOLDING TANK: _ „I ACTU11E if LIOUID CAPALI_ IY TANK INLII k-LP V TANK OUT 1_I.1 LLtV WARNING LABEL LOCKIN(E,DCOVEH PROVIDED PROVID~w© L_ L_~YES L.]NO DYES L_.INO - II~INE VENT UTA. VENT MA 111tH WATCR --------]NUMBER OF ROAD. PHOP- EN TY WE LL BUILDING VENT Tf FFi~$YI / (r At `7' _ FEET FROM uNE AIR IN T ~Y S ~_~NO L_- YES LJNO N A EST 11(2 L)SING CHAMBER: _ _ _ 1I nr l Unf n I IOUID CAP ACI T Y PUMP MODLL PLI Mf /SIPHON MANUI AC U HEH WARNINLABEL LOCKING COVER 51 PROVIDEDPROVIDED YES _~NOJj_ •~~d ❑YES ❑NO ❑YES ❑NO ,11_LONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N BER OF P1i1/PEHTV JWELL BU II DING, VENT TO FRESH LIN / _ AIR INLET IIF LRENCEBETWEEN / FEET FROM TMI ON AND OFF) S NO NEAR S 1 ;v )IL ABSORPTION SYSTEM. Check the soil moisture at the deptI'D I plowing Nr, lu JWAMI It If IMAILHIAL AND MA14KIN(, cxCavation. (it soil can be roiled into a wire, construction shall Cease until FORCE soil is dry enough to continue.) MAIN )_N_V_E_ NTIONAL SYSTEM: _ r WIDTH LENGTH NO OF rSTH.^'PIPL, ACING COVER INSIDE DIA UPITS LIQUID BED/TRENCH TRENCHES MATERIAL. PIT DEPTH DIMENSIONS fH l' II I11t UE PiH 1715TH PIPE DI$TII PII'. 1 R. PI M ERIAL NO DISTH NUMBER OF PROPERTY E,LL BUILDING VENT TO FRESH , /I ABUVL COVER f P IV WLk I El_EV ENb PIPES FEET FROM LINE AIR INLET 11 NEAREST-----i► OUNDSYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- % the criteria for medium sand. TIONS MEASURED. YES C7N0 OIL COVER II xlllHh PEHMANE TMAHKFHS OBStHVATION WI 1 LS JODDIO NNO YES NO ''I1111VFH IHIN(II till) IIEP111oviti THENCH;BED SEEDED MULCHED "1111 j EOGkS I _J I/ ❑YES NO YES DNO YES ❑NO RESSURIZED DISTRIBUTION SYSTEM: WIDTH LENUTFI NO OF LATERAL SPA JNJ GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH J p TRENCHES / DIMENSIONS MA N IF ULD PUMP MANIFOLD DISTH PIPE M A N I F O L D MA TE R I A L NO UIS7H DISTH PIPE DISTHItlUIION PIPE MATEHIAI lL MARKING t Ex ELEV UTA ELEV PIPES UTA rLEVATIONAND t;, L~ I1 ~ r J / DISTRIBUTION - HOI.C SIL HOLE SPACING DRILLED COHREC ILV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS YE NO t-, 2 ({may-JJ/Y_ES EINO OMMENTS: PERMANENT MARK ER OBSERVATION WELLS. NUMBER PROPERTY WELL BUILDING FEET FLINE 2 S T 1 ~•L YES L_~NO YES ❑NO RE JJ/ I C . 1 l UUU nQ r. c Ketch system on Retain in county file for audit. vurse Side. SIGNA TITLE } 1 iL.. I IIH SBD 6710 (R. 01/82) ~~~_~C-td.4-!~ APPLICATION SAFETY & BUILDINGS 13EOARTMEN.T JDF INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 /\ttach plans for the system on paper not less than 8'/s x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal +i id 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 i'lumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be ncluded. Property Owner: Mailing Address: I'iuperty Lo ion: City, Villa Air Township: County: S6 '/4 ~t~J'4S a 3 /T oZ 9 N/ R Irv ®(or) W A L W ,J Rp i x Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.O. Number: ,red 1) 16 i If S!ig TYPE OF BUILDING J Number of ❑ Public" ❑ Variance" ❑ Other (specify)" Bedrooms: 1 or 2 Family "State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY QQQ Q X X HOLDING TANK CAPACITY Qn/e LIFT PUMP TANK/SIPHON CHAMBER] 0401 MANUFACTURER: _ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New [Y-Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit QS( ❑ Alternative (specify) /1no LJH4 ❑ 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 ins lation of the private sewage system shown on the attached plans. Name of Plumber: gnatur MP/MPRSW No.: Phone Number: ✓C~,e~f t- oL4/7- C' p 44 1?9 Plumb Address: Name of Designer: r~ A uJi-) GJI s S~~oo Z oe e- -h f lo~aL~/ t COUNTY/ DEPARTMENT USE ONLY SignTur of Issu g gent Fee: Date: APPROVED Sanitary Permit Number: 0 4AA Q ^ZDISAPPROVED 7L 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 ,tallation. Failure to comply will void the sanitary permit. C)ISTRIBUTION- White-County, Canary-Bureau of Plumbmg, Pink-Ownef, Goldenrod-Plumber -4i :Ml) it 08 (N.03/81) , o ka State of Wisemin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION -1 Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 t Plan Identification Number L J Re: PRIVATE EWAGE SYSTEM ONLY- $ The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system 2~-6112 installed at the above-mentioned location. The plans and specifications were prepared by - /on/.Zc~ and received for approval on O&W The soil and site evaluation was conducted by z The site meets the s •I and site requirements spe •fied in chapter H 63, Wisconsin Administrative Code, for the use of ~t F The proposed system is fora Wastes from the building will discharge to a gallon capacity septic tank which will discharge to a gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a 4?_ 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 plan:; or specifications, plan omissions, examination oversight, construction or any damage that may resuit 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 ^ ^ Sargent, B erector f. Win' 'hy d fi { s t i [Tai i ~ . -4"T ~-j } U~Cope ,Ilk a Ma, Oct ma 41 14, ON ilo h Z f C!r (a [ S.►,,, t-- - -111 'l~" t~ r b P% J 16 1 Z. 1 0 3 A-m t O . ~ A tk ~ + G Z p a s j s p t0 n p i f - SL c ~ C b y CA -its ca ; b w z t cH ..~►i0N . r COO Qo L I I!m - Tj 'Aim rn Y I I 'n^~N~ ~ it -TI J i 1 A ~ I a T ; t y, ; s? t ►s _ 1j leA s McfElgilu"M "Id ~rl wry 1 ~ I ~ ~ ~ IuV j~~~~.i~t ..3 ~'Y~~~~►✓~ I I r .r._ i tit i7 z -AD o° c P p 11 L r0 -01 CA y C' -a '~~r 1 a C1 b ti Z O o+ r` -rc ny 70 w o 1 10 L a Q PE~ r Imo` e I M P ; I~ pm D ~N 1L, y F N 41 H4DRw0m RTIC H-62 r PUMP 28 z4 r4- SUBMERSIB LE 0 5 10 t8' 10 85 30 40 45 U.S. GALLONS PIM MINUTE Head-Capacity: SW5 and U33 Subirnertible SUMP Max. elids S ~/4 Sphere:4 Pete, 60 H:. Pum, P 28 24 114 48 0 10 2or 40 50 60 h.: U.S. GALLONS Pat Movi E Head-Capacity. SP33 aid P25 Submersible Sump Pgnips - t. M4 Solids SP33, 3/4 & SM. 1/4Spheres; 1.15 Volts, 6o Hz, 1750 RPM It:S _ ' 140 V 4 :HIGH HEAD ~ 0 1 30- r EFFLUENT ~ sin PU M?PS '°~oyr - ~D. _ _ • 20 40 ft0 . 140 -1 20 440 U.S. GALLONS a1tKUNuTE Head-Capacity; SP50H, SP100H and SKM50 High Held, ps Max. Solids SP500, SP100H & SKH150, ~✓a" 6 b " i 1t5Voh, 601k, 3450 RPM 5 J INDFAARTMENT 'DU OF REPORT ON SOIL BORINGS AN & BUILDINGS INDUSTRTRYY,, , DIVISION LABOR AND BOX 7969 PERCOLATION TESTS (115) o~T c.Fi®D WI 53707 HUMAN RELATIONS ~ L~a~, SECTION: ~Tod `~H/I~~~illor)W TOWNSH~~ Y. LOT NO .:B K.'O.: SUB~FlC~I AMij COUNTY::~ OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVA DRMS.: 1COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: PERCOLATION TESTS: ~Residence NO. BE ❑New ~RAplace Il !O J!"._ ~ _ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: JITANK: RECOMMENDED SYSTEM: (optional) VxL s [:]U ❑ s ❑u ❑ s ❑u ❑ s ❑u ❑ s ❑u If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. I 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.) t~ r if 1 r/ B- 0 B B OpQQi jC « S'4 b SAC. sr'( S - l PERCOLATION TESTS e 3 5n,4 4-TE DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER IINCH 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 I of land slop. SYSTEM ELEVATION r . /C30rpr/ t~ ~c25 j / 4- 6:,964e- t3z _ n i f / ~z+ q 64.1 `644 I ( P3 rv _ p / Qvvj I i' /c~a'9 " + C. 1 + QCI @ . ( I I ~ I c1 cva.l 15- W, 44 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): z7Y CSTs3tG E: ~VR DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) Wisconsin Department of Industry, PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection Name o remises a e an o. Street City oun y Sanitary Permit Master Plumber Firm Name dress Journeyman Plumber Address Owner Address Discussed with ignature ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Site Waste Specialist White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LA BOR & HUMAN RELATIONS ALTERNATIVE PRIVATE - DIVISION P,Ot BOX 7369, SEWAGE SYSTEMS olriMB/NG MADISON, wl 53707 Mound ❑ Pressure Distribution NA OF PERMIT HOLPOF PERMIT HOLDEN: JIEPLAN IU NUMHEIi BENCFI HK IPnrointIP UIFFI 1JADU%SS FROM PLAN HL IF PL Lt C;T HI I. PI. CLEV SEPTIC TANK: _ MANUFACTURER LIQUID CAPACITY: TANK INLET ELEVt: `E TANK OUTLET ELEV NUMBER OF PROPER (Y LINE: 'VF LL HUII DIN E It FEET FROM 1 NE 1,067 / 11) DOSING CHAMBER: MANUFACTURER. LIQUID CAPACITY: PUMP MODEL' PUMP ANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: (o'! ✓)N/ YES ❑ NO YES ❑ NO GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL OMSER OF PROPERTY WEL BUILDING VENTTOFRESH .y~ AIR INj DIFFERENCE BETWEEN EETFROM LINE: / If( Jy PUMP ON AND OFF YES ❑ NO htEARE$'I'---► I v / ~D SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW ❑ YES El NO meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO.OF SPACING CENTER LENGTH: DIAMETER. MATERIAL AND MARKING (EDITF3ECUGH TRENCHES: TO CENTER QI DIMEIdS;ItNS. ARAIhI MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. DIA.: PIPES: DIA.: >E LEVAT3t HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO SOIL COVER: TEXTURE. DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED: SEEDED MULCHED: CENTER EDGES. ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO - - - COMMENTS: SIGNATURE: 11II T. r DI LHR SBD-6227 (R. 05/81) WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & FIRE PROTECTION POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St Croix Location SE 1/4 SW 1/4 S 23 T 29 N, R 16 FX ~ W Town or Municipality Baldwin _ Street Address R.R. I Woodville, WI 54029 Lot No. Block Subdivision Landowner's Name : _,~g~_~d------- - The application for this site is to serve a: ❑ new construction use. 0 replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: ❑ part of the 3X/5% limitation. This is number of the applications made through this office. 0 -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 system. If this a REPLACEMENT SYSTEM USE, the mound is replacing: 121a 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 Thama_~__..~IP~ Si gnat - - Title Assistant Zoning Administrator Date October 14, 1981 DILHR-SBD- 6158 (N.7/80) ST. CROI X COUNTY s. - r aw1e ti y~f]y`'~uu'' ; W I S C O N S I N r , b : 7 S '+M ZONING OFFICE 796-2239 HAMMOND, WI 54015 October 14, 1981 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison. WI 53707 Dear Sir: An on site investigation for the Eugene Zwald property located at the SEk4 of the SW4 Section 23, T29N-R16W, Baldwin township in St. Croix County, revealed suitable soils at a depth of 28 inches, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, Thomaa C. Nelson Assistant Zoning Administrator TCN:sl State of Wisconsin ` D rtmeIn stry, Labor and Human Relations E " -s1 ? Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Number Re: PRIVATE SEWAGE SYSTEM ONLY- The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative 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 capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a -inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions c approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installatic, of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from th 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: `Count er enclosures AR-SBD-6159 (R- 7/81) mes Sargent, B erector Plb 100a 12/78 T ,State of Vviseonsin Deta cn And Return Upper DIVISON OF HEALTH Portion Of This Form With SECTION OF PLUMBING ANb FIRE PROTECTION SYSTEMS Any Return Correspondence ;~1VIAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 CZ7 DATE: PROJECT: I terr*. 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. Il. 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) I ❑ Total area filled (fill to extend 20' beyond edge of trench before side slope begin). ❑ Depth and type of fill. I ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. ST. CROI X COUNTY. W I S C O N S I N i . v 17 sfti ryR~c. ZONING OFFICE 796-2239 HAMMOND, WI 54015 March 14, 1983 Mr. Everett Boldt 780 Curtis Baldwin, WI 54002 Dear Everett, We have been holding the Sanitary Inspection Sheet for the following system(s): Fugene Zwald - Mound System SE SW, Section 23 Baldwin Township Please turn the As-Built into this office as soon as possible, so that we may complete our file. If you have any questions, please feel free to contact this office. Yours truly Thomas C. Nelson Aasistant Zoning Administrator s1.