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HomeMy WebLinkAbout002-1073-40-000 n N p 3-D n y d O 0 c CD F). (D = ~1. 0 (D l^\ I 1 z Pi N O 3 N C 0 o W (0 O ` CD -N "'o W \ O O_ O Z p_ N 0) N 3. p .^S. LS Z3 O W (D {11 N W N ? W W O N N N N CL O_ O O_ 00 n 7 N 0 * AO O O W N O (n O 3 p N 7 7 N E ~ N O CA (n _j ' 0 OJ ~ W ~ !V w to CD D ° W t \ N cL'] ccnn N a cN C W O C C N c O m 3 Q. O O O' ' N N N !~I 0 0 0 C:) 0 (D O co W CO ~I (D (D so ( W N 0 C ty y N Q (V O O 0- o N~~1 C v n 3 to cn L-n Lnn v 0 g p m y F. N) N cD d ccn N N T N Z 0 O D N s c h• m I G~ N. O C _ O n - ~1 C = O Q i - (O cD O (D N 7 ~ (n =5 w n p Z (D V) C A Z ;G !Z O Z N (0 co T CD z 3 O A 0 U) M I 3 y ~ < A (D A I a W ~ O CD ZCD a 3 CD _n <Z v 0 < N o O 7 T A z a O o N (D W (D 77 cr (D s ~ 3 < O C C A a ~ v ~ ~ a -a o h, ~ o o ~ o (D m on w en O o i 0 a a y 0 0 I 7 O a- Parcel 002-1073-40-000 07/26/2006 10:24 AM PAGE 1 OF 1 Alt. Parcel 29.29.16.440 1/2 002 - 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 - BERKSETH INC BERKSETH INC 733 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 733 220TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 39.000 Plat: N/A-NOT AVAILABLE SEC 29 T29N R16W NW SW EXC TO STATE IN Block/Condo Bldg: 603/73 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 01/23/2006 816999 EZ-U 07/23/1997 603/73 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 25.000 2,900 0 2,900 NO UNDEVELOPED G5 12.000 2,300 0 2,300 NO OTHER G7 2.000 4,000 140,100 144,100 NO Totals for 2006: General Property 39.000 9,200 140,100 149,300 Woodland 0.000 0 0 Totals for 2005: General Property 39.000 9,200 140,100 149,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 o 0" m 0M m 7 m _ o ^ O w - S m z nNi ao go W cN, °o `C • CD 7 3 O C N N (D N CO W CL A Z C1 2: a) CD O .y ~ A - 3 W 7 m J 0 0 0 v N N N -I A A `C CL O A `r. 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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 - BERKSETH INC BERKSETHINC 733 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 733 220TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 39.000 Plat: N/A-NOT AVAILABLE SEC 29 T29N R16W NW SW EXC TO STATE IN Block/Condo Bldg: 603/73 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 01/23/2006 816999 EZ-U 07/23/1997 603/73 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 25.000 2,900 0 2,900 NO UNDEVELOPED G5 12.000 2,300 0 2,300 NO OTHER G7 2.000 4,000 140,100 144,100 NO Totals for 2006: General Property 39.000 9,200 140,100 149,300 Woodland 0.000 0 0 Totals for 2005: General Property 39.000 9,200 140,100 149,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • AS BUILT SANITARY SYSTEM REPORT TOWNSHIP SEC . I' ~N-RW OWNER ADDRESS pia ST. CROIX COUNTY, WISCONSIN. SUBDIVISIONS LOT LOT SIZE PLAN VIEW Distances and dimensions t0 meet requirements of H63 yE$yTHING WITHIN 100 FEET OF SYSTEM F1 i i v' ~a I di a e o th Arrow SC - 4-:-- - i - I BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: / SEPTIC TANK: Manufacturer: Liquid Capacity: X/IJ0c) Number of rings on cover Tan manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: ' Number of gallons 2r ~C Number of gal. pump set or a cyc e 7 gallons; total capacity- of distribution lines gallon: size o pump /21 -head; gallon per minute _ horsepower brand name of pump and model number Type of warning deviceZ/,- HOLDING TANK: Manufacturer Number of gallons _ Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: um er o pits --et,~~ameter feet liquid dept- h seepage pit in e~ t pipe-elevation_ bottom of seepage pit eI-eva on feet. SEEPAGE BED SIZE: number of lines width 15, leTtgth .5,W the depth SEEPAGE TRE14CH: width ---RED length PERCOLATION RATE KREA TIRED > -EA BUILT a INSPECTOR _ DATED - PLUMBER ON LICENSE NUMBER- DEPARTMENT. OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR& 111JMANRELATIONS ALTERNATIVE PRIVATE DIVIS P.O.''60X 7969 ' WW SYSTEMS BUREAU OF PLUMBING MADISON, WI 53707 El Mound Pressure Distribution NAMEj')F PERMITI~IOLDER: ADDRESS OF PERMIT H DER. INSPFCTIO I)ATI PLAN IU NUMBER- / '51 '5o - - BENCH MARK IPnrmunnnl rufar- ,n puinl) DESCRIBE If OR II HFNI FIiOM PLAN IIC.F I'I LI F V CSI HI T- P I LEV SEPTIC TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OU TLEi ELEV ~1.~:PHOPIL HTY LINL. WP. LL_ HIJILDINi FIMT FA( DOSING CHAMBER: MANUFACTURER: LIQUID CAPACITY: PUMP MODEL: PUMP MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: P VIDED. YES 1:1 NO YES ❑ NO GALLON PER CYCLE P UMP AND CONTROLS OPERATIONAL $(L :PROPERTY WELL BUILDING VENT TO FRESH DIFFERENCE BETWEEN 1^ET PR1i4R uNE: fi _ -AIR INLET PUMP ON AND OFF M YES El NO EARES'1'»~«-tl► 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 El YES El NO meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF SPACING CENTER > LENGTH: DIAMETk R. MATERIAL AND MARKING. EDTRENCH. TRENCHES: TO CENTER: , FORE I MANIFOLD: PUMP: MANIFOLD PIPE MATERI~jL AND MARKING/ NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. DIA.. f%/ i' f l PIPES../ DIA./ ELI~iXA (#Qt, HOLE SIZE HOLE SPACING. DRILLED CORRECTLY DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS i YES ❑ NO ❑ YES ❑ NO SOIL COVER: TEXTURE: DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. ----tS EDE D. MULCHED. CENTER: EDGES. ❑ YES ❑ N\O, ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS' J C. l`A-A L ~ l -J) 0 SIGNAT j- I I I I F: r. DILHR-SBD-6227 (R. 05/81) F/ State and County State Permit # PLB 6 7 w Permit Application County Permit # for Private Domestic Sewage Systems County 5 *DENOTES STATE APPROVAL REQUIRED G C Date Approval Received from State if Required 1~ -lo 4/ State Plan I.D. # 6 A. OWNER OF PROPERTY Mailing Address: L~JJl2SE''~(~/~~-~ tom,..) L~r S B. LOCATION: f,--~ '/a ~✓'/4, Section, T N, R / (k (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ,41,W" C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X_ Duplex No. of Bedrooms No. of Persons `T D. SEPTIC TANK CAPACITY Total gallons No. of tanks OnJe- HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement X Lift Pump Tank or Siphon Chamber 00 Total gallons Prefab concrete _X Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate --c Total Absorb Area sq. ft. New Replacement X~ Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width--3 Depth Tile depth (top) No. of Trenches Seepage Bed: X Length-;Fa~~Width 1-5 Depth-L-77-0 epth 7-`'0 Tile depth (top)---419L--No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land / 171' Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil - Tester, NAME 7` O 4- C.S.T. # ~s and other information obtained from (owner/buiIde0. p Plumber's Signature MP/MPRSW# MP ~~Yy Phone #71 ~ -E9 17 Plumber's Address C,t): w C"L) S PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. PL . f r. w.._-- i F i .m y, R ..a e. ..A e ...y. -,u.m .•G.m 1 } t E a .s y r m i i F . 5~~-. ~y...-,,.... A ~ y ~ m,. ..,,..m s e .i....._ a _ Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT SE ONLY Date of Application 10 -9i"X/ Fees cG Paid: State County 7 90--0 ate Permit Issued/Refeeted (date) /L> -di-OZ Issuing Agent Name Inspection Yes 2 No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2_ state (pink copy) 4. Plumber (canary copy) Revised Date 7/1/78 ••y ,raj ~ _ R►,. • W J N Q N • ~ O• lilt eta 7.1 vi o. d- I d ~ Qcn e f 4y, r Ir) ! DECEIVED _L SL--P 2 8 1981 - , ON t I N CZ ~ I e wda OSVE ' •ZH O RIGA 5l t 'sojogdS ,-bra '0GLHHS I HOOtdS'HOSdS spiIoS •xew sdwnd lUanI93 PBaH 411H OSIHNS PUB HOOtdS 'H09dS Apedoo-peaH WWI Had SNOT WO Ott 017t OOt 09 09 Ob oz Q Hods ~ Ca SdNnd HOp~dg °bi 09 iN3AlJJ3 09 00 t;q OV3H H91H Ozt 0% Wd8 OSLI "ZH 09'goA St1 !sa,agdS „v/t 'GUS s „ 1e 'EEdS SPHOS •xew sdwnd dwnS algisjawgnS GUS PUB EUS lpedeO-peaH imilll wad SNO'nVo '8'n r 09 05 06 oe oz Ot p doss + a b + C/] ~ a LL ~ R O F° fi p m • d 9 ' =U Wp o $i N~ p) Z > m o m v 111 fit X f • w 9t ~ IiII L"~a.•.•~• ♦ti~ oz A bZ 9Z SdNnd 'ZH 09 '810d ti'UJagdS „bits splloS 'yew sdwnd du",sIq!sJawgnS EEAS PUB SZAS :Omdeo-peaH dNns ainNin wad sNOiivo 's•n sb ob se oe 9z oz % of 9 0 3191SHNyons a CEiVEn e SEP 2 g 398 Zt m st^S st Z PLUMBING , SECTIOpj EIS °Z nin loft bZ 9Z sdtunci Z9-H sOnt:f r%H ry) r1 v' ~/1 a • F m z i z _o: w o a- s a t :U; m® o a 3 J ~ d 7 ♦ ~ S s t ti J St r J'\ F r ` t`~r at ~ ~ `Vi`i --tr r OC St y a ~ ' ~ ` `.t a I£ 1 Q ~lu~ VEp 281981 3~ i ' bf n jC E T/ -16 ~jl ra- Q I a 'J 41 Q 10 o Q vi NM i/ ter, ~ 161 h } 0515 2 o • i.,~ 120 00 Of ts" alsoo* RECEIVED SEP2 8198" 1ZL 1 i 01 CL cG !t h ( ..-v- P'll 7 -.I f ..,e.n+. ,`,`1/ 1111 f t f *10 'te f(g r a a _z ''l w m a e~` 77 =cI1 • > o m • Cry , r ~ F ~ ~ ,,off/fl tl►l►tl/11,,, ~ J.y S~ Q? - R~f 7 0 .40 RECEIVED SEP 2 8 1981 PLUMBING SECTION Ot,p ~ j o , cn t ~d _ ~ ~ --f i e ~ - - J `til ~ T CIO -vu lie 1 -i ~~i i lie- ~ + k f ! ~ t ' ~~~~nnun~N ~ , q a RECEIVED •-z i 2 8 1981 LUMh e~T~n . R r i x x t ..3 State of Wisconsin \ Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Plan Identification Nu .L----.1 , 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 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: ;y Enclosures mes Sargent, B erector DI LHR-SBD-6159 (R. 7/81) P*b 100a 1 :t/%? z, State o Wisconsin DIVISON OF HEALTH Detach And Return Upper Portion Of This r form With SECTION OF PLUMBING g J AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 "7' MADISON, WISCONSIN 53701 608-266-3815 DATE: QCT~~/~F ROJECT: 1 G 2~ IpN~NG 7~8j .-4, SW&4, Sec. 29, -r- v W: 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. 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 certifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. F_1 Holding tank agreement signed by owner and local unit of government (sample enclosed). El 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. J Size, length & depth of force main. Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. _.i Cross section of lift pump tank showing ,u .^r siphon(s). > 1r = i... ,st be placed prior to , . r::urrmss;cni 'i otal 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. r i' has n in place. add r 'QEPARZMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDWRY, c DIVISION LAB AND PERCOLATION TESTS (115) MADISOP.O. BOX N W1 7969 HUMAN RELATIONS LOCATION: SECTION:TV TOWNSHIP/MUNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: , 53707 COUNTY: ~J OWNER'S BUYER'S NA MDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R F D R TONS: ER LA ION TESTS-71 .Residence ❑New Replace RATING: S= Site suitable for system U= Site unsuitable for system Ail/ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1 N-F I L LIHOLDI NG TANK: RECOMMENDED EM: n ❑ $ ❑U El $ IS [:]U ❑ $ ❑U ❑ $ ❑A If Percolation Tests are NOT required DESIGN RATE: SYSTEM L If any portion of the lot is in the i„ under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevaa t rf.' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, RE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEES ABBRV. ON BACCK_.) B / 4- L ct S' PL-'- 17ey2n- l - B- 3 -7 72- B- if B- 2 r t( /r C -1 !2 V (J 4 Y r C rr rr CL~ z 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 PER INCH P- 1/2- ' e? P- r' a 4 9 9 c, P_ C n j a / r P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dist es. 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 SIR w,~~ Da A! .,3` p J60 R j ~d ~r S 35 d / /~©/a rr RRr~G C9 13- - 6' 3 ! . 10, i~ 1'10 f-" 'mil cf! C CI `'C! 3-I iLi t7 e 4el 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: 9 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): 0L - ct~ Ctir S S'/ /5-- 6,?-1- 337 ' CS TARE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) I _ J