HomeMy WebLinkAbout016-1023-70-000
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ST. CROI X COUNTY
h WI SC0 N S I N
si`' r OF F I CE OF DISTRICT ATTORNEY
11 1 r 1t_i x ` .
L f °i 386-5581 Ex. 41 & 51
C O U R T H O U S E H U D S O N 54016
March 3, 1982
Mr. Harold Barber
St. Croix County Zoning Administrator
Hammond, Wisconsin
Re: St. Croix County vs Paul Anderson
Dear Harold:
Would you please check out the Anderson residence to ascertain
whether or not they have obtained proper sanitation permits.
If not, we are ready to re-commence litigation against him.
Yours truly,
7
ERIC J. LUNDELL
District Attorney
St. Croix County
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Parcel 016-1023-70-000
10/02/2006 05:09 PM
Alt. Parcel 11.30.15.185A PAGE 1 OF 1
Current X 016 - TOWN OF GLENWOOD
ST. C
CROIX Date Historical Date Map # Sales Area Application # Permit # Permit Type COUNTY, WISCONSIN
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
BRENT E & SALLY M STANDAERT O - STANDAERT, BRENT E & SALLY M
1650 320TH ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1650 320TH ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: t20.000 Pat: N/A-NOT AVAILABLE
SEC 11 T30N R1 5W N 1/2 OF NE SE 20AC lock/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
11-30N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/16/2005 814380 2944/477 WD
04/27/2005 793253 2790/618 WD
05/18/2004 762885 2574/118 SD
07/29/1998 583883 WD
more...
006 SUMMARY Bill Fair Market Value: Assess d with:
0
Valuations: Last Chana4oz avi
ged: 0/0 20 3
Description Class Acres Land Improve Total State o
RESIDENTIAL G1 2.000 12,000 259,000 271,000 NO
PRODUCTIVE FORST LANDS G6 18.000 31,500 0 31,500 NO
Totals for 2006:
General Property 20.000 43,500 259,000 302,500
Woodland 0.000 0 0
Totals for 2005:
General Property 20.000 43,500 259,000 302,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 135
Specials:
User Special Code Category Amount
Total Special Assessments Special Charges Delinquent Charges
0.00 0.00 0.00
U
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Jansky, Leroy, 07:09 AM 9/30/98 , RE: Leslie Berg
X-From ljansky@commerce.state.wi.us Wed Sep 30 07:09:58 1998
Envelope-to: resling@pressenter.com
From: "Jansky, Leroy" <ljansky@commerce.state.wi.us>
To: "'tgustum@bucky.win.bright.net <tgustum@bucky.win.bright.net>
Cc: "Rod Eslinger (E-mail)" <resling@pressenter.com>
Subject: RE: Leslie Berg
Date: Wed, 30 Sep 1998 07:09:51 -0500
X-Mailer: Internet Mail Service (5.5.1960.3)
NE, SE, 11, 30, 15W, Town of Glenwood, St. Crcix County
Holding Tank Plan 81-05968
I had a long talk with Leslie Berg and she does not want to live on a
holding tank system any longer. It seemed appropriate to see if the
site might qualify for a sand filter installation with as little a 6
inches of suitable soil. Of course, the problem is identifying the 6
inches we need. Try to give me a call on Friday to discuss a date/time
for an onsite visit.
> -----Original Message-----
> From: Tom Gustum [SMTP:tgustum@buck
> Sent: Monday, September 28, 1998 9:20wPM'bright.ne[
> To: Leroy
> Subject: Leslie Berg
> Hi Leroy
> Just heard from Lyle Myers, he said I should set up a time with you to
> meet out to the Bergs place. He said something about paper work from
> Me.
> I didn't write anything up when I was out there. What would you like
> wrote up? It looks as if it is mottled directly below the top soil.
> There is possibly a soil test on file from the 70s' when the Holding
> tanks were installed. Let me know what will work out for you as far as
> a
> day and time is concerned. Also let me know if you would like a
> backhoe
> there. Thanks
> Tom Gustum
FAX
ST. CROIX COUNTY ZONING OFFICE
1101 Carmichael Road
Hudson, WI 54016
(715) 386-4680
DATE: 1 ? y
TO: Fax Number:
Name: ,
FROM: Fax Number:
386-4686
Name:
Number of Pages Including Cover Sheep
IF COMPLETE- AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE
CONTACT:
NAME:
TELEPHONE NUMBER: t
'v
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit p?7"O2
State Septic
/~C~ I li+9n ~1 -
A M E- '0 T O W N S H I P _L!l~
St. Croix County
i.OCATIONO&A-F _ _Section-//- Lot # Subdivision
`;EPTIC TANK
Size gallons Numb (r of comp tments r
r
i)istance from: Well ui din ! l
12% s l p,
Highwater
PUMPING CHAMBER
size _ gallons Pump Manufacturer Model. Number
HOLDING TANK
Size lgallons Number of Compartments
Pumper -J Alarm System
Distance from: Well 5-~_ Building 12% slope
Highwater
ABSORPTION SITE
Bed Trench
Distance from: Well Building 1.2% slope
Highwater
ABSORPTION SITE DIMENSIONS
Width of trench ft Required area _f t.
Length of each'line ft Depth of rock below the in.
h ui-,_ r of lines Depth of rock over the
i n .
Total. n of lines- ft Depth of tile below grade in.
Distance between lines ft Slope of trench- _in. per .100 ft.
Total absortptfon 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
INSP
- - ~E
APPROVED DATE
-198
REJECTED DATE 198
REASON FOR REJECTION
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY c DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
LOCATION: SECTION: TOWN /MUNICIPALITY: ]LOT NO.:BLK. NO.: SUBDIVISION NAME:
'/4f'/4 fl-b N/R p>-E (o ;-l L--/V Cc's: ~ l Z&
C UNTY: OW ER'S BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFII D TONS: ER OLA ON TESTS:
Residence - New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system '
CONVENTIONAL: nE U ND: IN-GRESURE: SYSTEM-IN-FILHOLECOMMENDED SYSTEM:(optional)
❑S ❑U S ❑U ❑S ❑U [-]S ❑U I-N S ❑U oL
Ieation Tests are NOT required DE=SIGN RATE: SYSTEM EL V. If any portion of the lot is in the
indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13-
B- 61 = Lei.:.:
B-
4-1
f
C r/
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P-
P_ W)
P-
P_
P_ it l C~ ` fl y y l
VW)
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the ho, -
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation 3t all horir.gs arc] the direction and pp,-
of land slop.
SYSTEM ELEVATION',
_ /CL CXl51 !NC-
/
100
a
L7 We` E,~IS~T/NC=
♦ Cis
c'
A93 .
A 7i N
p
A ell
NL' ri
•
D11) 14N ~7/Y 517-Z-- L1 30 ?r
F ~fCr E /N.SPZ- c, TIel)l _ 3Y . S/ - CAQ) ,,r U, 1/Y SP~~TL l ' a 0 r c? K
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:
r
t 'Z
ADDRESS: CERT T1 N NUMBER: PHONE NUMBER optional):
CST SIGNA~IJRE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY; FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% 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:
7
~ ~'4 A Sty
4/ R
Property Location: City, Village or Township: County:
c
/T ? N/R E for o ei IBC
Lot Number: Blk No.: Subdivi
FA A- sion Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(lf ,signed),
TYPE OF BUILDING /
Number of
Public* 1:1 Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required.
TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify)
7'- 777-
SEPTIC TANK CAPACITY
6T-c G y, yv
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
)L /P ❑ Alternative (specify) /J ~
_71-4111ze ❑ Seepage Trench
Water Supply: T wner's Name as Listed on Soil Test Report (If other than present owner):
Private ❑ Joint ❑ Public ~L -AN
-DR
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:
lumber's Ad
dress: Name of Designer:
Tl>
COUNTY/DEPARTMENT USE ONLY
Signatu of Issuing Agent: Fee: ~ Date: 1.2 APPROVED Sanitary Permit Number:
G~~,fC~f~ % ❑ 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, Goldenrod-Plumber
DiLHR-SBD-6398 (N.03/81)
Ability Business Co. 81 - 0 5 9' 68
A 9 B *
C Complete
Sewer Services
KNAPP, WISCONSIN 547.49 N 1,, L/Nt Phone- 665-2112
EX IS FMc- n
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~T ► -059 6~3 ST. CROI X COUNTY
W I SC O N S I N
ZONING OFF 1 C E 196-2239
Poet 0666-ce. Box 221
tl " ) Hammond, WI 54015
RECEIVED
O W N E R
F U M P E R "M 6 198A
A G R E E M E N T SECTION
P1.UMBINO
PLEASE BE ADVISED, chat unto t you arse again no.t.i6.ied, I w.i.U'...C
contact with c'; ) e
I--~L~ o ~ ("1,
NiAcona.in, (Pumpex), bon the purpose o6 temov•ing a.t.L waste 6nom the
ean.i.-tany system to be .Cocate d on the pAopen-ty and 6u,tune /home site
Located in St. Croix County, Wisconsin, Township o6 L~),"( r().
being in the o6 the S Lf- % 06 Sec- T- (1 N. -R. /s 01.
(0,t moAt 6u.t.ty des cn.ibed as 6ottow4: )
Dated .th.i".s ~ day o6 19
• ~
(OWNER)
State o6 W.ib conA in )
- bb
County o6 St. Cno.ix)
PetAonnat yappealed) be on me__,thk,4 day o6 19
the above named~~ . to me known to b the
pennon who executed t e 6o4e'gox.ng ins tnume;it and acknow.Eedged the same.
o any u tic,~ t~no x County, Wl
My Comm. (is p.eicman-t) (Exp.ines )
I A ~D heneinbe6o4e n e6erred to as Pumpen
llj s
join in the above agneemen•t to t e extent that I have a con•tnac.t with
Owners as above s"ta"ted,
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373908 ~
Vol.
NOTE,: This document is to he recorded In the Tract: Index n( the (4 1 ho
"S OFFIC Fof the Register of Deeds in the county indicated below.
...,..)I:K CO., WIS.
i E;1:Gt. iUc 12,,-c:ord this i 5th _ 0 5 R68
Jay nt cL .,_A.D. 19~ 8 WEIVW
dt 2:00 i, _*I& HOLDING TANK AGREEMENT
James O' Connell NUV 6 IAI
This Agreement is made and entered into this WPgINO SECTION
- 19 by and between the J.,-
hereinafter called
and wner. hereinafter ca e t e
We hereby acknowledge that application has been made for a building
permit On the following described property, to wit:
North Half (N11~) of North Ea,,A Qu inter (NE'„) of South E i t
Quarter (SE's) Section 11, Township 30 North, Flange 15 West.
or that continued use of the existing premises requires that a holdinq
tank be installed on the property for the purpose,of proper containment
of sewage. We also acknowledge that said property cannot now be served
by a municipal sewer or septic tank - soil absorption system.
Therefore, as an inducement to the County of 24 C-,-,- to
issue a sanitary permit for the above described frem ses- >te e-Fy-agree
and bind ourselves as follows.
1. Owner agrees to conform to all applicable requirements of the
Plumbing C relating to holding tanks. Any time the Town or Municipality
of through its Plumbing Inspector or Health Offi-
cer, necessary pump out the subject holding tank, the ()caner
shall have same pumped out in twenty-four (24) hours, or
will have said work done and charge same back to
the tax bill as a s Owner an~pTace same on
pedal charge. The Owner further agrees that the Town
or Municipality of J,-. C<J YY ll L may enter upon the property des-
cribed above at any reas able tome, to-Tnspect, or pump and haul wastes
from the subject holding tank.
2. Owner agrees to payy 11 charges and costs incurred by the Town or
Municipality of J, ff o for inspection, pumping, hauling or
otherwise servic ng an ma nta n ng a subject holding tank in such a man-
ner as to prevent or a to pny nuisance or health hazard caused by such
holding tank. c shall notify the Owner of any such
cost vAich shall be pa y t e er w thin thirty (30) days from the date
of notice and in the event that the Owner does not pay said cost within
thirty (30) days, Owner hereby specifically agrees that all of said costs
and charges may be placed on the tax roll as a special assessment for the
abatement of nuisance, and said tax shall be collected as provided by
Wisconsin Statute.
DILHR-SBD-6123 (R.3/81)
Vol. 636 PA E 533
Page 2
3. Owner agrees to have a quarterly pumping report submitted to the
local government and the county which will state the Owner's name, location
of the property on which the holding tank is located, the pumper's name,
the dates, volumes pumped and the disposal site. An annual pumping report
or the fourth quarter report including a summary of the pumping history of
the previous year shall be submitted to the Department of Industry, Labor
and Hunan Relations by the governmental unit responsible, per section 145.01
(15). Wisconsin Statutes.
4. We guarantee that the holding tank contents will be disposed of at
a site meeting the requirements of chapter NR 113, Wisconsin Administrative
Code.
5. This agree will remain in affect only until the sanitary permit
issuing agent in c -L, ~ _ County certifies that the subject pro-
perty is served by e r a p0bllc sewer or a septic tank - soil absorption
system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree-
ment may be cancelled by executing and recording said certification with re-
ference to this Agreement, in the Tract Index indicated above.
6. This agreement shall be binding upon the indicated governmental
unlit and the Owner or heirs and assignees and shall run with the deed.
WITNESS our hands and seals this / s day of C(-)-e ,
19~.
TOWN OR MUNICIPALITY OF
ti
OWNERS
by
by~l~ ee :L
STATE OF WISCONSIN
Personally came befprf me thi ~ day of
19' the above named " X '
to me known to be the persons w o execute t e orego ng instrument an
acknowledged the same.
THIS INSTRUMENT
DRAFTED BY:
My commission expires:
' Department of Industry, Labor & Human Relations
of Division of Safety & Bldgs.
State Ot Wisconsin Bureau of Plumbing Platting & Fire Protection
P.O. Box7969
Madison WI. 53707
Tel. 608-266-3815
i
- I
INALL CORRESPONDENCE
b L 4 y (J ( 'j r is j L C>- REFER TO PLAN
( IDENTIFICATION NO.
NAME OF PROJECT
TYPE OF APPROVAL
STREET AND NO. rAi
\ 'CITY OR TOWN
COUNTY STATE ZIP OWNER V0
O
Gentlemen: j
Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145,
Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com-
pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted.
The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of
plans bearing the stamp of approval of the department.
In the event installation of the plumbing improvements or system has rWt commenced within two years from this date, 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 and reserves the right to order changes or additions should conditions arise making this necessary.
This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require-
ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto-
matically void this acceptance.
Sincerely,
James Sargent-Bureau Director
PLANS REVIEWED BY: DATE:
cc: DPS-OWS Owner DI LHR
Plumber H & R (2)
County Mfg. Rep. Bur. of Health Fac. & Services
OIL BD- 99 IN. 06/80) Rec. & Env. Services
PLb Ma 12/78
State And Return Upper of Wisconsin
DIVISON OF HEALTH
Portion Of This 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:
3o /_5
M c.,vc 0
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.
II. 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.
I 11. 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.
z
REPORT OF ~NSPECTION_INDIVIDUAL SEWAGE SYSTEM
San.itany Penm.i%
State Sep-t.ic
NA 4E L~~ _S.t. C&oix County
Location Section
SEPTIC TANK
Size _ga ton6. Numb en o6 Compa.,ttmentz
Di-stance Fnom: We.tt 6t. 120 on gneateh zZope 61
Buitd.ing 6.t. Wettands ~.t.
• ~
DISPOSAL SYSTEM Highwate`c 6t.
D.i6ta.nce F&or7: WeU 6t. 120 on g,%eaten 6Zope 6.t.
Bu.itding it, Wettands Ft.
Highwaten ~ .
FIELD DIMENSIONS:
Width o6 ,then ch 6.t. Depth o6 no c k b ekaw A---'it e in.
Length as each tine 6,t. Depth o6 rLock oven tiZe in.
Numbe,t oS Zi.ne4 Depth o6 ,t.ite below gtLade .in.
TotaZ 2engtih o6 °.ine3 6t. Stope o6 tnench in neA 100 Distance betty+een Une.s_ 5,t. Depth to bedAock
Total. absoAbt-ion a,-,ea- tit Depth to gioundcua,te-'L ~.t.
Requited area 6t2 Type o~ Coven: Papeh of Stinaw
PIT DIMENSIONS:
Numbers o6 pigs Gnavet anound pits ye/s no
Outside diameters 6.t. Depth b etow in.Let Ot.
Tota.° abz anbtion anea 6t2 , z
A,tea nequiAed 6t2 rn
INSPECTED BY TITLE
APPROVED ,DATE 197
REJECTED DATE 197
F
I~ EH 1.15
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
LOCATION: Section T.1LN, RhC~ M W, Township or q ~ ~'N D ~
Lot No. , Block No. County X
~j Subdivision Name
Owner's Name: A L/ A_ 6~JU2~G R,S D l
= 'P J1-.~~ Ci.-c%
Mailing Address: 881
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS ,S - - 2 7 PERCOLATION TESTS 5-10 "75r
SOIL MAP SHEET SOIL TYPE lqti ,A8~~
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN
NO 411 :2-
P-3 :7
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)
es
JJ rr
B- j /
_70- ye- 10
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. _ c ,L Ile Indicate scale
or distances. Give horizontal and vertical reference point. Indicate slope.
j t t
- ? + - I a i - I$
{ yy /j ;
E f ~ ~ I ~ ~ ~ 5 ~ S_. ~ I 1
1 f
4
f
' ,i S ,I 5 I I i i ~ ! j i
II il. I
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_JL
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i
i
t,. i., ._.~.._..r..
t f t I ( I I ~ I ~'/Y~,f ~ t
i{ I ynf ~ ~
t t ; IA ~V i
I ~ I ~ ~ I 1
I ,J 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. ~j
Name (print) C_ 4,4 e- S M / r Certification No. 1F/ 71o
Address 9 R/ 6--~ N 1,e 0 e d d, I Y ✓
Name of installer if known A.4 e- 5-M CST Signature
..-LOCAL AUTH~:tMTV
I
State and County State Permit #/3
PLB67 Permit Application County rn2qV # 4
/
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED 1( eel l
q
Date Approval Received from State if Required State Plan I.D. #
A.OWNER OF PROPERTY Mailing Address:
B. ~`ON
OC
ATI: _YQ '/4, Section 11 T ? N, R /!5 ~,',>lw) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township CLn/~c~ od
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons S
D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder A YES NO # of Bathrooms
Automatic Washer _,(_YES NO Other (specify)
SEPTIC TANK CAPACITY Total gallons No. of tanks
folding tank capacity ~j ,Z, L11 Total gallons No. of tanks
'dew Installation Addition Replacement Prefab Concrete
'Poured in Place Steel Other (specify)
-FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) * 2)V4 3) jX.a Total Absorb Area sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of lands Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
^iisconsin Administrative Code, and that I have sized the effluent disposal system ftom the EH 115 prepared
'ay the Certified Soil Tester,
IN,AME ~'z4 L S /Tfj~ C.S.T. # /L and other information
obtained from klz , A-At . "7 (owner/builder).
-yam-3Y
"lumber's Signature ~ MP/MPRSW# ?z' Phone #2d5
Plumber's Address - - -,.t%
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
JiNf-
A /.v' ~.r a4 y
tr'0:F5e I,
y,/17.,
P''",
Do Not Write in Space Below CFOR DEPARTMENT ~~,,,SE ONLY
Date of Application Fees Paid: Statelee I-~Cou 'e
Permit Issuec~fReiected at Issuing Agent Nam 1 e
Inspection YesJ I - No 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 6/1 /76
L
Smith Plumbing PHONE (715) 265-4838
GLENWOOD CITY, WISCONSIN 54013
.
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RECEIVED
f
( JUid 0 5 1979
PLUMBING SECTION
J6.c
F
v
{~1 Lys//,
r;
it -
~ AGREEPd~iEh:ri
Y
' This agreement, made and entered on this dray of 192e by
and between the Township of F ddress'~ 1...,
V'hIEREA S: In application has been made for a sanitation system on the
following described property:
V EEREY`,S: Septic tank drainage does not meet the minimum standards of the
ordinance of St. Croix County and state codes.
V` hERE.L,,S: The owner agrees Lu 1li::Lall & Loo iii: ice:"i r_ _ N j t- - N
ai: t L
purposes.
NGV, TEEREFORE: For and in consideration of the issuance by the Town-
ship of 7f` of a permit for the above premises, the parties
do hereby agree and bind themselves as follows:
1. Owner agrees that they will conform to all the rules and regulations
pertaining to a holding tank system. They agree that anytime said
township deems it necessary to pump out said tank, the owners shall
have same pumped out in 24 hours, or township will have said work
doneand charged to owners and place same on their tax bill as a
special charge.
2. The Township reserves the right to assess a bond if they desire to
cover any possible pumping charge in the sum of
IT IS UNDEE.STGOD that this agreement shall be binding on the owners,
their heirs and assigns.
IN VITNESS WEEREOF, the parties have hereunto set their hands and seals
the day and year first above written.
Township of j
Developer
or owner
RECEIVED
STATE CE V,ISCONSIN) j;j,✓
COUN': Y Ch ST. CRQX) PLUMBING SECTIO."i
Subscribed and sworn to before me this day of 19
Notary Public, St. roix County
.
June 14, 17?
nti
Glenwood ~wi ty, k~I ~4k) 13
Plan Identification No. 79--0?211;
Gentlemen;
Re: Site constructed holding tank - 3,241 gallons
Paul Anderson - Residence
NE 1/4, SE 1/4, Section 11, T30N, R154
Town of Glenwood, St. Croix County, Wisconsin
Examination of plumbing plans and specifications for the above-mentioned
project has been completed.
In accord with Chapter 145, Wisconsin Statutes, and Chapter H 62, Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations indicated on the plans ant'
the following codes section. Please review your code for the requirements
of the code section noted.
1. Our review of the holding tank plan has not been evaluated for
structural stability, only for compliance to design requirements of
Chapter H 62 of the Wisconsin Administrative Code.
2. The holding tank shall be maintained and the contents disposed of as
required under Section H 62.20 (7) of the Wisconsin Administrative
Code.
3. This approval is not a blanket approval; this approval Is for the one
tank to be constructed for the above-mentioned installation only. Design
of the tank shall conform with the conditions specified and be constructed
as shown on the approved design plans.
4. This tank shall be clearly marked to show liquid capacity and the
manufacturer's name and address. The markings shall be inscribed into or
embossed on the outside wall of the tank iannediately above the inlet opening.
F
;lot
:`t'':,F w 1 , s; , F O s " ;,y: -
1 ~ E is ~ S
is
Am
.Z VIN ; 1'9^Cl oil no o.'J de a
S be:,,nOM Hah t dAl A .Cabl:: _ Of arm _ t~1r~?.a~tsas2rtrf~
p : vz -7 r! , , f 4 1
SuAth Plunking i, heating
Pa go 2 . .
June 14, 157)
5. H 62.19 (2)(a) 16.c. Water stop.
6. The architect, professional engineer, registered designer, owner or
plumbing contractor shall keep at the construction site one set of plans
;-~t>aring the stamp of approval of the department.
7• in the event installation of the plumbing improvements or system has
not commenced within two years from this date, 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 Health 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 Chapter H 62, Wisconsin Administrative Code,
requirements. It shall be necessary to obtain and fulfill the permit
requirements of the city, village, township or county in which this
installation is to be constructed. Failure to obtain local permits will
void this acceptance.
By order of Robert Durkin, Administrator, nivision of Health.
Sincerely,
James A. Sar ent
Chief
JAS:KS:bah
Enclosures
cc: Mr. Dennis Sorenson, oWS - nistrict - La Crosse
I*r. "'arc37t.l C. .+(3rf;vs 'tai:~~ i'.d-An?st.-7ter, St. Croix County