HomeMy WebLinkAbout018-1052-80-000
n cn o n cn o E: m 0
O Ct o m f = o
c ~ c ~ c cs 3
m m ° m CD -0 a
v m -v m m m
r
K
N) 0
r a: IF
3 3 N
_ OCO. O i`; c0 _ < l
O
N Ci a O
(D CL
Z z n O
(r CD O O Cn
7
J N
N
N
~
O
N N~ O
O O C :CD 7 Q -i O O
O D N N O
:
O A
fL' , N N P N N 2 = CD K,
_ _ p *M
L`' d O fl7 N 3
cJ (D p :s Q N
N
CO w
IW ~O O co is - COO COO I CD
O rt: O N
O O. A ~ O O O a
~ O O ~ O O
t7 r cn
ti J V .v m a ? N O C
CO co _
CD _0 _0 -0 Ul
000 Q O C OC C C O o
CO * O 11 * G N z J,,
O
a (n (D cn cn (n 0 o D
Ri (D .O. N O O N A L++C
CD
CD
(D = CD A N N _ N LV
(D
a) a, N O < N
3
N m
°
(D - CD - O
A it Z~ Z Z Z -0
D o
N D D
CD I ' !®y
CD 0
N N ICS ? S I:3" C
cf)
CD S) w CD
T (D ~ -~j Q
(D
a N 7
c O 0
p 0-
- p
(D
1 O
C v Z C7
_ a ,p Z CD
;n OC J' ~ C1
C A Z O
Cn { N
co -0 ca _0 M N W
(D (D (D (D O
O 3 O A .o
O O Cn
3 3 m
Z N 0 A
O (D
a
N W v
CD
(D
p U) as 17' a 3
CO CD W CD (D (D _ (D
p < (o Imo.
n (D C ir.J C Co ~co: C
7 O N 3
~ D) N 3 Iz
[n n ID i:0 a N N Q
4~ ID CD (D i1;
O (D I.n rr.
(P (D' _
CL CD S ! K
N
N N N co
W
m a c (D
v
3 0 (D 7~ o
p U
O (D ? 7
N N
o o 3
a a o
D7 o = p
p (D J
O a
(3D O t
O (D' _v
O0 CS
O
S
10 O ~ ~
SOD CD V~
K
Efl I,r,~- cn O
O } O
Parcel 018-1052-70-110 07/26/2006 10:16 AM
PAGE 1 OF 1
Alt. Parcel 23.29.17.366A10 018 - TOWN OF HAMMOND
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
KENT M & SHELLEY L WYNVEEN O - WYNVEEN, KENT M & SHELLEY L
808 200TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 808 200TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R17W PT SE1/4 SE1/4 LOT 1 Block/Condo Bldg:
C.S.M. 7/2085 5AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
23-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/08/1989 447692 840/193 WL
2006 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/30/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 29,000 129,300 158,300 NO
AGRICULTURAL G4 2.000 300 0 300 NO
Totals for 2006:
General Property 5.000 29,300 129,300 158,600
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 29,300 129,300 158,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 114
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
c
0 O O 0 fn O -u 0 r_
r- 5
(D CD
'U CD lD
D) n
3 (D A
Cl) v O w 0 o O0 w uNi o _ O CO _d w p ~ `C
ro 3 3 a m m 3 0 m? 3
N O 0- N Z a- N C.0 CD Z a N 3 p
N N N
O ? O N 10 `G a Ca "S
N CD- N N
c dd V~ ° n
pC) E Q O (D N(D ,,J O rn p o
(D CD Cn -4 o W o
3 o v o 00 F C)
7 N S 7 N = D O C
N_ N N_ N O lr
(D -4 1
O y m CD O S
N (D N N a Q W G. o N O. a N
O N W (D W
(D O ~ S d
C: c O O N
3 O o cp~n O co co W
_ _ N) b
t -n a
_A m
Co N O CO 1! 0 r- (n
N v v W N W 000
w w 2 N O C
3 P
cri
CD p z 0 C CO CO CC CO OC OC Ao l~+ill
A A O W 'D G< G C 'U T G G G N G 1 Z
0 0 0 N. y~ c vi ccn cn O D
N N ar 0 0 0 O v 0 0 p
O O m
CA (l CD O fn c fD A ~1
rn O < d V N n Ll 'O !r1
CD = N CD - CD (C]
CD y M CO) 3 d 3 o
N m CD
3 5~ c N
z-~z zZ -a o
D m D D m
m O O N
s c h
CD m CD •
CAD ° C w d
O OT. N O 7 ~f
CD
W CD a D
a 3 7 3 c
Z CD CD
O 7 a p Z fD
N C N .a
a A C
I o.
U) N W
0o v W T m
CD o CD co
z
0 3 0 3 A
O O
r. (n
3 3 m C4
M Z N <
N W D)
C
(D
D
7 +n N C D A D D CD
CL a M
DQ_ r
1 O y o 0
o~mc o~i c m c
0 ncnQ oZ a O a
W CD CD
CD cD CD
AN -3 N (n
CO 0)
CO
p CD 00'<
(T M 1h' CD
I
CU <
a n CD
N CD
O CD tl.
CD = = p
7. (D
O N
N O
N
7 a
CL
(D
CD
CD
-o - a
N
.O
Co N O V
D N
3 l o
CD O
O CT
~ A
O 0 W
CD CD DO GOo
en O cfl O
CD :E p `z b
Op a- p0 i-
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BULIDINGS
l 4BOR'& HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION
P.O. ,R -X79 9 SEWAGE SYSTEMS BURS OF PLUMBING
A~ DISX;i, w 53701 F-1 Mound Pressure Distribution
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PLA ID NUMBER:
~ x'01
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: :ft-EV' CST REF. PT. ELEV,
r i l
SEPTIC TANK:
MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: PROPERTY LINE: WELL. [ BUILDING:
DOSING CHAMBER: /
MANUFACTURER: LIQUID CAPACITY: PUMP MODEL PUMP MANUFACTURER. WARNING LABEL LOCKING COVER
/o' P 51DED PROVIDED
YES ❑ NO CgYES ❑ NO
GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL NUMOER Or PROPERTY WELL: BVENT TO FRESH
DIFFERENCE BETWEEN 1~ECT r LINE:_. / r ~ ~ J AIR INLEr.
PUMP ON AND OFF YES El NO NEASt ST»'
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. SHQW-~
❑ YES (gip e s e crltena or medium sand. ELEVATIONS MEASURED.
DISTRIBUTION SYSTEM__:
~y»~y ti WIDTH: LEN H NO.OF SPACING CENTER LENGTH: DIAMETER: MATERIAL AND MARKING:
t r--
TRENCHES: TO CENTE~• 7, ~i
41i411Et~islil IL t>~AI?I
MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING. NO. DISTR, DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
DIA.: i. PIPESDIA.//t
HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY. DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
YES ❑ NO- NYES ❑ NO
SOIL COVER:
TEXTURE.
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF 071 /T"VYES SEEDEDCHEDCENTEREDGES❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
1
COMMENTS:
f i~ C l` {{r %R~~~(~ t 1l lam;
MFXAT~ TITLE:
DI LHR-SBD-6227 (R. 05/81)
Parcel 018-1052-80-000 07/27/2006 02:56 PM
PAGE 1 OF 1
Alt. Parcel 23.29.17.3666 018 - TOWN OF HAMMOND
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 - BAUER, JEFFRY A & IVY M
JEFFRY A & IVY M BAUER
1978 HWY 12
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1978 HWY 12
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 10.360 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R17W PT SE SE PRT OF LOT 1 Block/Condo Bldg:
OF CERT SURVEY MAP IN VOL IV PAGE 905
(ALSO INCLUDES 365C) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
23-29N-17W SE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 845/346
Gov ' 70 (30 2
2006 SUMMA Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 08/24/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 29,000 126,900 155,900 NO
AGRICULTURAL G4 7.360 1,000 0 1,000 NO
Totals for 2006:
General Property 10.360 30,000 126,900 156,900
Woodland 0.000 0 0
Totals for 2005:
General Property 10.360 30,000 126,900 156,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM
Sanitary Permit f
State Septic AME,, C. jV//r TOWNSHI"St. Croix County
UCATION
1-4- 2-2
„S Section Lot # Subdivision
EPTIC TANK
Size gallons Number of compartments
istance from: Well Buildi.n.g_____ 12% slope
Highwater
LIMPING CHAMBER
Size gallons Pump Manufacturer Model Number
!OLDING TANK
Size gallons Number of Compartments
Pumper Alarm System
iistance from: Well Building 12% slope
Highwater
:BSORPTION SITE
Bed Trench
)istance from: Well Building 12% slope
Highwater
.BSORPTION SITE DIMENSIONS
Width of trench ft Required area ft.
Length of each line ft Depth of rock below the in.
Number of lines Depth of rock over the 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:
'LT DIMENSIONS
Number of pits Gravel around pits yes no
Outside diameter ft Depth below inlet ft
Total absorption area _ ft
Area required ft
INSPECTED BY TITLE
APPROVED DATE 198`
'EJECTED DATE 198
'EASON FOR REJECTION
V
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTR1Y,, 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.
1
Prope;KOwner: Mailty.Lg Address: y- 6
L
Property L cation: City, Village /or Township: County:
/T N/R (or) W .4f ;•J
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
(If a si n d)
TYPE OF BUILDING
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_ 4
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER !
MANUFACTURER: t
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New Replacement 0 Experimental] Seepage Bed ❑ Seepage Pit
y~ Alternative (specify);2r j ,,,rte ~ ~.PL ❑ Seepage Trench
f'.3 3
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 pri e sewage system shown on the attached plans.
Nie of Plumber: Siysieare f MP/MPRSW No.: Phone Number:
Plum ~'s Address:' Name? of Designer-
COUNTY/DEPARTMENT USE ONLY
Signa ure of Issuing Fee:: Date: RR APPROVED Sanitary Permit Number:
.ir Ctkxrx":_ : lc 9 ~ Lo v ❑ DISAPPROVED C? 7 9 M
Reaso fo 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)
r _
~>imcilliJ
S /E,o 1 ~0 .scat
4Y1
C aa'
810456'7
0 X V, -.Oki
ditiona y
1.~D D C
on
u/. U rri 1 ~ QrS ~t~'
C1 20ML W% r% " )j E®
f v611,2 LAB R AND HUMAN RELATIONS
ESPONDENCE
...SEE; ,
1231 {
s r~~. ,ng= tTt,'f2'~ J
~ ✓ ~ ~ jy ~ ` r j i ~i ~ fit- . _ : ;
s ,
s y Ck
~0 Ptost►~ ~1 ~ i
ON
ao_
r
v
-a
r
Y
LLynP►rk Ch4vn~~ r ;
C f
n
OMAN RE~p,molls
AND H _
1
<A
n -
o
47
~o
V r-
`
peed /'LT
H
.J
oaf
3 r:,
-DI
YY
r >
~1 W
r V
i ~
Cl-
SEP
\
{ c
rCA_V Y \ Ta 1 \ ~l
C .S G~.~t c
' Crc. C-~
I,.
its
r
I
Conditional
1
r
-rob 4
F 11Z v
>7 Y^^° UST 111LUA 'D) t,'. , RATIONS
E CO R SPONDEN
LINDSAY BROS. CO.
GOULDS SUMPTHING SEWAGE PUMPS
Model 3882 1
Performance Rating
Model 3881 Gallons per minute
Performance Rating WP1012 WPH1012
WP0511 WP1032 WPH1032
Gallons per minute Series No. ► WPO512 WP0712 WP1034 WPH1034
HP m- % 314 1 1
Series No. WPOS WPO51 S2S RPM ► 1750 3450
►
HP 01 1h 5 150 170 180 190
RPM No. 1725 10 126 154 168 170
15 94 125 152 150
0
5 144 =
20 56 90 121 128
_ 10 110 a
E 3 25 17 49 81 107
U p ~ `
E 3 15 75 i 2 30 14 40 86
4. ~ W
2 20 40 Aii 35 10 64
U. 25 6 F 40 43
e
0
F 26 0 45 24 .
Flood and pollution control 50 4
Liquid transfer
1112 " Solids handling capability- Sewage and waste removal 2 " Solids handling capability.
2 " NPT Discharge connection. De-Watering 2 " NPT Discharge connection.
Sump draining 3 " Optional.
Submersible effluent and sewage pumps - Model WP.
Lindsay
Product
Number Model RPM Horse ower Volt Phase Order No. W t.
62372 WP 1750 /z 115 WHObl 1b 60
662143 (3881 /2 2 TO 1 P0512
648949 2 115 1 WP0511 108
651125 '12 208/230 1 WP0512 108
493244 WP 1750 3/4 208/230 1 WP0712 110
656887 (3882) 1 208/230 1 WP1012 114
503533 1 208/230 3 WP1032 112
503541 1 460 3 WP1 4 112
503525 WPH 3450 1 208/230 1 WPH1012 114
(3882) J
GOULDS Model 3870 Submersible Effluent Pumps
SPECIFICATIONS Order No. HP Volts Phase RPM Solids AmMax.
ps wt.
Max.
Order No. HP Volts Phase RPM Solids Amps wt' WPH1012E 1 230 1 3450 3'4" 11.0 70
WP0311E 1/3 115 1 1750 3/4" 9.4 56 WPH1032E 1 208/230 3 3450 3/4" 7 70 !
WPH1034E 1 460 3 3450 3/4" 3.5 70
WP03 ('h HP) TDH GPM WPH10 1 HP TDH GPM 8104567
( Lindsay -
5 100 10 147 Product Model
Number Number Description
Total 10 85 Total 20 124
Dynamic 593540 WP0311E '/a HP 115V
Head 15 62 Dynamic 30 98 550604 WPH1012E 1 HP 230V
Head
Feet to
Water 20 36 Wa er ao 71 *Contact Pump Dept. for 3 Phase Units!
25 3 50 45 Availability.
60 18
W%ZRKSH ELT - PRESSURE DISTRIBUTION NETWORK DESIGN
h~ PROBLEM
f/r;'
Design a pressure distribution network for a . bedroom home. The site
characterisitics are:
Depth of groundwater or bedrock in.
Landslope %
Percolation rate
min./in.
Distance from dose chamber to distribution system ft.
Elevation difference between pump and distribution system ft.
Step 1. ESTIMATE WASTEWATER LOAD
3 ~fa,Qav+~ ~JarF
Step 2. SIZE THE ABSORPTION AREA
A) Area required
I
-~SD;lA1. (>'~CSr•aPtQC f'.frt> .'~y~~.fr/~~ _ ~~o~~~ ~Q~v,4ta
B) Select length 9,3 9
C) Width is
/a' 11
D) I will- use a manifold.
Step 3. SIZE DISTRIBUTION PIPES
A) Hole size I will use is / in.
B) Hole spacing I will use is ~l in.
56 ry
C) Lateral length is ft.
6
D) Lateral size -in.
Step 4. DISTRIBUTION PIPE DISCHARGE RATE
~9~~•n/a?Sh~,D 1. , 1-031
X 9yi°,~ = 7ol
'Vol"
Step 5. SIZE MANIFOLD
A) Manifold length ft.
B) Number of distribution pipes =
C) Manifold diameter in.
~J~
Step 6. SIZE THE FORCE MAIN
A) System discharge rate
B) Force main diameter
C) Friction loss will be ft. /100 ft.
Step 7. TOTAL DYNAMIC HEAD
A) Vertical lift ft. ional '
loss GO ,rondit P IL ff
B Friction ft. 00$1 =
n
P L)
CEPA RTMEN D TRY, LAB - D HUMAN RELATION,
C) T DH = /O. 9_9- ft.
CO ONDFNCE
t,.,
Step H. SELECT A PUMP
/"ur~P S Pic . aS~'r Jlc.~n - 3~ pm
G' ou is F1 J/"40
ttJP03 ( V3N/°) 6"f7t/c.ID - /DO,yPr,
Step 9.. DOSE CHAMBER SIZE
(n /03,94 7;►dkv 1 Qor., /"p~~,~`5 L?Er,t~Jf I~i~°®1/uGTS
3 f344Roo••,s X /O09.~/~a~h~ + Dose /,ri1v~•E /Q~~.f/ . '~19~ga~ wakes
Step 10. DOSE VOLUME
7/ . la o f
00-c-ch 71, oZ. G ~~Es /OA.Y ~S IQA~ P&r/NEo
G O 'o f 3 fo- E a V/-,,,v ,t~ , 3 ~ 8~ ► c~f f = o?~ , b 8,g, 4-
4) elWVLO
7o r, ,1 O 8 q f c P 4..,~oc o
yoDSE Qr~/1n~E,Q - ~O/O~,y~ fCem ~oWc,Ps eE.•~:Nr /~iC'ovu~rJ
ts~"
EY
X
6/~~,t4 $
State of Wisconsin \ Department of Industry, Labor and Human Relations
Please Reply to:
SAFETY & BUILDINGS DIVISION
r Bureau of Plumbing
1 P.O. Box 7969
Madison, WI 53707
Plan Identification Number
L_
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
County By.
Other
Enclosures ~
DILHR-SBD-6159 (R. 7/81) mes Sargent, B erector
•,Plb 100a 12/78
DetaC ,And Return Upper State of Wisconsin
DIV
TCTIIOON N OF HEALTH
Portion Of This Form With SEEC
OF PLUMBING
1 AND FIRE PROTECTION SYSTEMS
Any Return Correspondence MAIL ADDRESS: P.O. BOX 309
MADISON, WISCONSIN 53701
608-266-3815
DATE:
PROJECT:
S~
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.
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 ta~ik.
❑ Holding tank agreement signed .y 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, drawdowr and average flow rate GPM.
Cross section of lift pump tank showing punp(s; or siphon(s).
VI. Systems in Fili (Fi'l must be plaT.ec prior to Subrnissicn)
_i' Total area fillet; (fill to extend 20' beyord edge of trench before side slope begin).
Depth and type of fill.
'J Copy of on.site report by county or distt _t p'umbing supe-viSor.
L.1 Length of time fill has been in place.
Plb. 1-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES
Division of Health
Section of Plumbing & Fire Protection Systems
ON-SITE WASTE DISPOSAL INSPECTION REPORT
Name of Premises
Street City County
Master Plumber Address
Owner Address
❑ County Permits ❑ Appropriate State Permits
Type of Building: ❑ Public ❑ Single Family or Duplex
CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM
❑ Building Sewer ❑ Conventional Soil Absorption System
❑ Septic Tank ❑ Conventional System-in-fill
❑ Holding Tank ❑ Alternate Mound System
❑ Seepage Bed ❑ Holding Tank
❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System
BRIEF, FACTUAL COMMENTS AND SKETCH:
E d
k
' , .f r S <
,
r I •f
c
E s
E 1
F
,
w
_ E _ _
E
e
j
E
E
E ` I
L --j
_ _
,
®m___ w _ __W , ~ta
s ~ ~F
,
I.. -
,
3
- -
E
,
E
s
F
- - - - - - - - - - - - - - - - - - -
3
E
e
E ;
l
- - - - - - - - - - - - - - - - - - - - - - - -
€ s r
E
E ,
. ,
E [ t F F 3
E
G
,
❑SEE ATTACHED
DISCUSSED WITH PLUMBER ( ) Yes ( ► No SIGNATURE (Voluntary)
DATE OF INSPECTION
Signature of Inspector
White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party
INDUSTRY-, OF+ REPORT ON SOIL BORINGS AND `CI TY & B DI VI ON
LABOR
HUMAN REDATIONS PERCOLATION TESTS (115)' IL '
MADISON WI 53707
r
LOCATION: SECTION: TOW SHIP/MUNICIPALITY: L VISION NAME:
64 V41, -/4 3 /T` qN/R/ (or) W
COUNTY: O NER'S BUYER'S NAME: MAILING ADDRES :
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE TONS: E ON TESTS:
Residence ❑New Replace {
s_.
_ ~j-
RATING: S= Site suitable for system U= Site unsuitable for system
7NVENTIONAL: MOUND: I-GROUND-PRESSURE: SYSTEM- N-FILLHO ING TA K: COMMENDED SYtiS ❑U ❑S ❑U S 11U EIS ❑U EIS ❑U
c -:_Z
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the F
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS ~Z p •
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B > -
B-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE IOD 1 PERIOD2 P I D PER INCH
P-
P_ l
_30 J
P
P-
P-
P-
PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slop,
SYSTEM ELEVATION
4 40t,
f~o~r~1
~ ~.c3Pc? z,Esr
svuxx
eN
. s_
3
y :
,l0
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:
AD S S: CERTIFICATION NUMBER: PHON NUMBER optional):
e J _5 _ -9
CST IGNA URE: -
f; r
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DI LHR-SB D-6395 IN. 03/81)
L
Parcel 018-1052-80-000 02/14/2006 04:24 PM
PAGE 1 OF 1
Alt. Parcel 23.29.17.366B 018 - TOWN OF HAMMOND
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
JEFFRY A & IVY M BAUER O - BAUER, JEFFRY A & IVY M
1978 HWY 12
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1978 HWY 12
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 10.360 Plat: N/A-NOT AVAILABLE
SEC 23 T29N R17W PT SE SE PRT OF LOT 1 Block/Condo Bldg:
OF CERT SURVEY MAP IN VOL IV PAGE 905 -
(ALSO INCLUDES 365C) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
23-29N-17W SE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 845/346
2005 SUMMARY Bill Fair Market Value: Assessed with:
90515 Use Value Assessment
Valuations: Last Changed: 08/24/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 29,000 126,900 155,900 NO
AGRICULTURAL G4 7.360 1,000 0 1,000 NO
Totals for 2005:
General Property 10.360 30,000 126,900 156,900
Woodland 0.000 0 0
Totals for 2004:
General Property 10.360 30,000 122,800 152,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 60.00
Special Assessments Special Charges Delinquent Charges
Total 60.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER` 1,L) n/ ✓e C r✓ , TOWNSHIP 49 M ,v SEC. -2:? T 29 N, RZ_Z_W
P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION - LOT LOT SIZE / D 4C w t S
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
15 ~'r4 d m /V . C v_~!t rz.
rZ
OF t4 o u S -e + u G n.i' T'e
o
D RQIn~ NausC
Gad Flfl ~ _
0
)9Y 1ACL
pro C)
SEPTIC TANK(S) 600 MFGR. (,c1 e e KS CONCRETE STEEL
NO. of rings on cover Depth DRY WELL ,Yoo (ziq
TRENCHES NO. of width length area
BED no. of lines widths' length 0; area
depth to to of pipe
AGGREGATE o L~ ,r' ko C' A:
4 r a
PERK RATE o AREA REQUIRED AREA AS BUILT 7-~20 4 42Ri
r
Disclaimer: The inspection of this system by St. Croix County does not imply complete
compliance with State Administrative Codes. There are other areas that it is not possible
to inspect at this point of construction. St. Croix County assumes no liability for
system operation. However, if failure is noted the County will make every effort to
determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
a "INSPECTOR
4
a _ L
DATED ~O y -79r PLUMBER ON JOB
LICENSE NUMBER -
~I
Sanitary Permit
Sta e Septic
TOWNSHIP
mac.-~ ,
t. Crol;~ Ca.
gallons. `umber of Compartment:
!)5.e,4 wince From: We 11 ft. 12% or greate. lop:
Building ' ft. ~!tl. ?,r)~
`Aighwater f
DISPOSAL SYS111,:1 Tile Fie',' From: Well ft. 12% or greater slope f;
Builcin. ft. Wetlands _ f.-.
FIELD itighwater ft
Total length of lines ).Q ft. Number of lines Length of
each line s ft. Distance between lines ft. Width of ti?e
rrench _Z ft. Total absorption area sq. ft. Dept::
of i-ock below tile in. Dp-pth of rock over tile in. Cover
,rs r` 1-0ck t t Depth of tile below grade in. Slope, of
A'
renel in ner 100 ft. Depth to Bedrock ft. Deptb to
o 0n d v ft.
ITS
'lumber of nits Outside diameter ft. Depth below inlet
t. Gravel around, pit: `yes no. Total absorption area
_.._._.__s q f t.
Square feet of seepa c trench bot`oui area required
':>quars feet of seepage nit area required
inspected by: Title:
Approved Date 197
.01 ected Date
197
r~
EH 11 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
LOCATION: Section,' , Tn%, R L1 V (or) W, Township or Nk +ei~aFity - A/>7 /ih a r~ c~
Lot No. , Block No. County Sj~. G f?tY r
Su vision Name
Owner's Name: MA as 14A W
1
Mailing Address: F 1~,4 (u rJ !
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS o7 - a - Z' PERCOLATION TESTS 5- -3 ' 7k
SOIL MAP SHEET 's -:rte 7
SC I L TYPE
PERCOLATION TESTS
TEST DEPTH HOURS WATER I Cri Lc V EL, IN ,i7E6 RA
CHARACTER OF SOIL rvUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
BER Ayr 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/I ;
p Lu. O
P 40 V 1 7 p f' :51 IVO 50
I 3[ rt
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
i NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
r -t 2 Sarc " 5~Lt Am SAN y ,C.rn z~'
L.
4-6
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
,dicate 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. o-=~ d Indicate scale
os distances. Give horizontal and vertical reference points. Indicate slope.
/ + I
- ~-Il~ 1 ~ Ir
I
a "I - a
_;FZ
p r I n
00
F1 P I ~ - ~ - -
Ij l L~5
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)er t In 7 Certification No. y
Address c
Name of installer if known ✓ cy L
CST Signatur b'.c-t r- C c
°'OPY A - LOCAL AUTI-:0RITY
r
I l
PLB67 State and County State Permit #
Permit Application County Permit # _
for Private Domestic Sewage Systems County -571' Ro / ~C
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION:' _ '/n
5 7 C '/4, Section, T;
~3 N, R I $ (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family _X- Duplex No. of Bedrooms 77a -?o No. of Persons
- -
D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder 7( YES NO # of Bathrooms-O-ff C
Automatic Washer X YES NO Other (specify)
SEPTIC TANK CAPACITY /000 Total gallons No. of tanks Q n!
'Holding tank capacity Total gallons No. of tanks
New Installation X Addition Replacement Prefab Concrete
'Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 40 3) Total Absorb Area D sq. ft.
New X Addition Replacement *Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches
C= epage Bed: Length ?'b' Width '1A Depth Tile Depth . if No. of Lines __T4A.~ O
Seepage Pit: Inside diameter 7 Liquid Depth Tile Size
Percent slope of land T Distance from critical slope
the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
"!isconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
11N the Certifiedoil Tester, L
i',~AME + ( d L T C.S.T. # and other information
obtained from r'-/L_ (owner/builder).,
'lumber's Signature l~ MP/MPRSW# ! L-s`~9 Phone # ~i T 79'
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
1 H62.20, including well).
I
P _ p~ N c I r~, 90
yc)' ~rbm Nouns q~
e
o we
155'
PSI}' A
o
13't °pa~°"S~ - ve way - -
I i Q
oil 3W
4--
98
O L
G~1
q' ~2 q3 q7'
Do Not Write in Space _B low - FOR DEPARTMENT USE ONLY
Date of Application ° Fes Paid: State County% i 1 Date ✓ l 7
Permit Issued/Rejected (date) _Issuing Agent Name V/
Inspection Yes ANo 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