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HomeMy WebLinkAbout032-2085-70-000 nyo Kvn d ~1 _ C o y = 3 CD n fD "O p7 '9 a01 fD ' ~ ~ ~~011 cu 0 4~ C4 3 D Q y (0 L (D O N r~. _ Q. CD CD (CD- 0) C. CD y o W 00 d d W N 3 CD P O CD 00 N C6 J O 00 m (CD n p (D O O Ul ? d O 3 N Cn CD O O ~ 01 c~D F o O U) z D a m cc~ o y n ~ CD CD p W cD CD 00 00 z a o to co w w= N 0 r, o c v o_ I z 0 0 0 !r~• ° cn (n v - v v g $ 00 CO °o cn O N 3 m N I z z N zz zz -0 O N m 4 O (n N 7. ~1 • :3 CD N N CL 0 ~ ~ II ci 0 a 3 _ p CD D a p Z CD A z O U) w CD " 0 ~ z 0 3 O cn N 3 CO y ;u < CD A ? N n (D CL n = D 3 CD 0 a 3 0' a CL CD T o a~ ° c a~ z a y o 0 3" ~ y -oo T , CD 0 o I CD w Ve fi CL -p y O N ONo N 0 N G O C', O A 3 o b . a ~n D0 A A 0 ti H C) (D O L Parcel 032-2085-70-000 07/28/2006 11:41 AM PAGE 1 OF 1 Alt. Parcel 14.30.20.849 032 - TOWN OF SOMERSET 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 - GILLETTE, RICHARD B & GLORIA J RICHARD B & GLORIA J GILLETTE 1501 TWIN SPRINGS RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1501 TWIN SPRINGS RD SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2566-TWIN SPRINGS LOT 53 TWIN SPRINGS ADD TOWN SOMERSET Block/Condo Bldg: LOT 53 ASSM'T INC LOTS 52/53 (847 & 848)032-2085-50 032-2085-60 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 12/10/1997 569718 1282/66 QC 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 17,500 263,600 281,100 NO Totals for 2006: General Property 0.000 17,500 263,600 281,100 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 17,500 263,600 281,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 515 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2085-95-000 07/28/2006 11:40 AM PAGE 1 OF 1 Alt. Parcel 14.30.20.852 032 - TOWN OF SOMERSET 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 - GILLETTE, RICHARD B & GLORIA J RICHARD B & GLORIA J GILLETTE 1501 TWIN SPRINGS RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2566-TWIN SPRINGS LOT 56 TWIN SPRINGS ADD TOWN SOMERSET Block/Condo Bldg: LOT 56 ASM'T INC 032-2086-10 032-2086-20 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W Notes: Parcel History: Date Doc # Type 07/23/1997 /07/23/1997 819/336 07123/1997 717/620 17 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 17,500 0 17,500 NO Totals for 2006: General Property 0.000 17,500 0 17,500 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 17,500 0 17,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2074-30-000 07/28/2006 11:07 AM PAGE 1 OF 1 Alt. Parcel 14.30.20.785C 032 - TOWN OF SOMERSET 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 - SCRUTON, WILLIAM H & MARILYN R WILLIAM H & MARILYN R SCRUTON 1515 TWIN SPRINGS RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1515 TWIN SPRINGS RD SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 1.720 Plat: N/A-NOT AVAILABLE SEC 14 T30N R20W 1.72A IN GI-2 LOT B OF Block/Condo Bldg: CSM VOL 1/254 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1085/518 WD 07/23/1997 1085/517 QC 07/23/1997 579/431 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.720 27,500 242,400 269,900 NO Totals for 2006: General Property 1.720 27,500 242,400 269,900 Woodland 0.000 0 0 Totals for 2005: General Property 1.720 27,500 242,400 269,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 109 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 v, ~s I 1 21 2 b-T -7 -7 Lory J 3~ -,IOFs~ 7~- , g y5 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION P.O-05JW 7969 SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON, W1 53x707 ❑ Mound K Pressure Distribution NAME PERM:1 HOLDER: ADUH ESS OF PERMIT HOLDEN'. INSPECTION DATE- PLAN ID NUMBER. BENCH MARK (P- -,.w tnrnnc.n 1 0 DESCHIBF IF DIFII III NI FROM PLAN HLF. Pl. LLF V. CSI III 1 PI. E I F.V SEPTIC TANK: MANUFACTURER: ILIQUID CAPACITY: TANK INLET ELEV.: TANK DO TLEL ELEV II{IM~I~IIR+R~." PHUPLH IY LINL1WF LL. BUILDING AR ES Twww DOSING CHAMBER: MANUFACTURER: LIQUID CAPACITY. PUMP MODEL: PUMP MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED. ❑ YES ❑ NO ❑ YES ❑ NO GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET PUMP ON AND OFF ❑ YES ❑ NO NEARE$T 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 E)' EPY'rRENCH.. TRENCHES: TO CENTER: FoRef t]lMEtVS;INS MAIN MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING. NO. DISTR. DISTH. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: DIA.: PIPES: DIA.: ELEVAYitE, 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 1:1 NO ❑ YES ❑ NO ❑ YES El NO COMMENTS: SIGNATURE: 71 I I F DI LHR-SBD-6227 (R. 05/81) REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit/ State Septic NAME TOWNSHIP1s~L•~(.. - St. Croix County L.OCA ON r .4d Section/4/Lot # Subdivision - SEPTIC TANK Size gallons Number of compartments Distance from: Well Building 12% slope Highwater PUMPING CHAMBER Size gallons Pump Manufacturer Model Number HOLDING TANK. Size gallons Number of Compartments Pumper Alarm System Distance from: Well Building 12% slope Highwater ABSORPTION SITE Bed Trench Distance from: Well Building 12% slope Highwater ABSORPTION 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 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 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 ft ` INSPECTED BY TITLE APPROVED DATE 198 REJECTED DATE 198 REASON FOR REJECTION DEPARTMENT OF APPLICATION LDINGS INDUSTRY. FOR SANITARY SAFETY & B DI VISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z 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 O er: Mailing Address: Pro rty ocation: L/ City, Village o ownship:, County: % :5_N~%S J'7 /T ,I) N/R $ (or) W »i Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) 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- OTHEF GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specif, SEPTIC TANK CAPACITY ZC" Vr V__ HOLDING TANK CAPACITY mom,,, LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Z Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit Alternative s ecif (P Y)__jI~O{'rra;,,,razal ~,vrte- _ ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of umber: Signature: M PRS No.: Phone Number: Plumber's Addr ss:q Name of Designer: ' COUNTY/ DEPARTMENT USE ONLY Signatur of Issuing Age Fee: Date: ZI.APPROVED Sanitary Permit Number: ❑ DISAPPROVED as n 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 Di;-HR-SBD-6398 (N.03/81) SIB rYI ~5 r S IV i i l7o J5' PG t1 yam. i M7Y 6 F p• i:k } : ; / F ► ( f Y ~~•Cf. c.. J { t 31 +L"'~ ~"i/...~ ~„1 YV I.'"4 f s ~(r/ ~U' IC ~ r'~..•~ I f y 1 e. ~ I /~'w~'.. .r ✓ s>,( A i ! ,.is ~ w4p i.-9~ %•~y l :s:: ~~r? ^ r ".Mw / ~ ~i' ~7 i" / le 1, Al `t r a Ie "I "VO fL/ v4 i E pd.C POI~ w. _....n.. F..u M _ -10 all JIV)E~s • ~nspcc , © / rr 0 r~ E. I r7d t 0 ~4c. rri 63 f-;r'f r'-~° v"• ? ~ ~•'Y' L loo & v-4 -A-Pr? ~'pvfrr,ng. i ~ /S.Y2 ~LFTI,,N INDUSTRY, LA uR F~1~ KUti'~1~N R~ DRARTME EN CE .Oar 'Pol f n _ -fir t~ r ~'0 . wPcr'►•• ! r r~ _J . nd ~1 a = i f , a ffI~D HUMA ~S - 009 0 r;Z O~ f~f QreuFC -r 0 x Iz'' t 4 1- i~ +0 39j ce- E pop { 1 . 4- ICA C_;✓~ "`.,~„''~y~,a ,R,a'~~y:.r~,,:r"r ~ -rr:.✓~G" --,!~e,y1;1,'~'`F'/ 1 D~Q PR~~t f` GOULDS Model 3870 Submersible Effluent Pumps SPECIFICATIONS Order No HP Volts I Phase RPM Solids Amps Wt. Order No. HP ; Volts Phase I RPM ;Solids Amps Wt. ; WPO311E 1/3 1 115 1 j 1750 i Y4" ' 9.4 j 56 { WPH1012E 1 230 1 3450 1 1 11.01 70 PERFORMANCE RATING (GPM) wPH1034E 1 j 460 3 3450." =3.570 60 ' WP03 (1/3 HP) TDH GPM I 5 100 d i--. I a I i Total 10 85 3 50 t A _ p--- Dynamic III f 1 ' Head o 14 Feet to 15 62 m 40 -1---}-- r ' I Water I 20 36 LL i I i ( I f-- j 25 3 30 0 1 WPH10 (1 HP), TDH GPM I G 20 10 147 1 I Total 20 124 Dynamic 30 98 10 } I Head - 14 i I , Feet to 40 71 T ( Water I 50 45. 0 20 40 60 80 100 120 140 160 ' I Capacity-Gallons Per Minute ! i 60 I 18 Model 3870 Packaged Heaaciti s to 55 GPM Effluent Ejector System 3/4" Solids Handling Capability 2" NPT Discharge Connection Goulds packaged effluent Package Includes: ejector system offers both , ■ Submersible Sewage Pump ease of ordering and instal- (WP0311E)or (WPH1012E) lation. A single ordering number specifies a com- ■ Mercury Level Control Switch plete system designed for (ALS2-5 for 1/3 H.P. package) most residential and (ALS2-7 for 1 H.P. package) commercial sump and ■ Magnetic Contactor effluent pump applications. ! (ALS3-1 with 1 H.P. units only). The ease of installation is enhanced by plug-in power ® Polyethylene e Basin cords for the pump and level control switch which ■ Basin Cover (ALS&1822S) eliminates the need for ■ Check Valve (ALS9-2) additional wiring. (Except , for 1 H.P. units which have Order No. SWP0311E 115 Volts, bare leads for connection to a 95 Lbs. magnetic contactor. Order No. SWPH1012E 230 y Volts, 109 Lbs. MIGOULDS SENECA PULMPS,INC8 Form No. A-478-WS SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. . 2 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN RELATIONS , 707 LOCATION- E TION: TOWNSH P/fflt1#teH1A44-T~y: L T N .:BLK. NO.: SUBDIVISION NAME: I/ l / T3oN/R zvF lot, W > - - COUNTYY: WNER'S UYER'S NAME: MA L N ADD S: 64 ` 01~ 41)( A zz-. USE__ DATES OBSERVATIONS MADE N0. B-~-D9NIS.: ~R~DESCRIPTION: S~L~"f ~~Residence~ ~ CO~-.` ' ❑New A Replace 11Replace RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: iN-GROUN R URE: E -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) Qs❑U 10Sou ❑Sau1DSau ❑S❑u If Percolation Tests are NOT required DESIGN RATE if any portion of the lot is in the under s.H63.U9(5)(b), indicate: ( Floodplain, indicate Floodplain elevation: Ir PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES HARA R F SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.f H T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- Cell ?2 it .311 v~ 7 7 B- 720' 1 loh V) 0 Yl~ ! 00-11-1 B- 0 1 o v) B- 05 ; 14 to" 5""C o~ ~C ~ m~ Sao n ~ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME 0POP IN WATER VE - N HES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PE R 10 PER INCH P- P- i i P- P- P I 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 i F , 4 i § s i 1 l I i i a x ..ems„ f..,. ..T .4 _~••r. ~r1.'.r .-.-.-_..y. ev...w..'»^+1r+..;-..}--.+^'-k--•--•. 'ry-Kll,iti'1 t"'x..lh..:. ",~i i p { j I ~ f ~ ~ f tr F j ~ ~ 1 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. s t NAME (print : TESTS WERE COMPLETED ON: ADDRESS: - _ ✓ CERTIFICATION NUMBER: PHONE NUMB FER optional i I CST SIGNATURE: DISTRIBUTION, Otigin ti-I-oial Aoi, 'r Age B(j,ra[a ~,f Plualt;irrg„3ra3 page-P ,c) perry Owner 4th page-Soil Tester. I L.8 N~k 0 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS } INDUSTRY, DIVISION 707 LABOR AND PERCOLATION TESTS (115) P.O. MADISON, WI BOX 537969 HUMAN RELATIONS t j 3707 ~ LOCATION- SE I N: R TOWNSHIP Ml9N!@#fA{:f;N . BLK. NO.: SUBDIVISION NAME: 1!c 1 4 1 TN/ R tor) W COLIN WNER' UYER'S E: MAILING ADDRESS: `F S' tcI w>r , 5.67a USE DATES OBSERVATIONS MADE N B gRMS : COMMERCIAL DESCRIPT i1 O~~ tB~ F~Resdence ❑New ratteplace !5__ p RATING: S= Site suitable for system U= Site unsuitable for system / J Gr3 J O ONVENTIONtA11L: MOUND: IN-GROUN S E -1 FILL OLDIING(~T"A~'NtK: RECOMMENDED SYSTEM:(o tional) ❑S ®U S ZU I ❑U ❑S -F ~U EIS UIU 111 - -3 0ct_rd r,6-_1 15"-Ir If Percolation Tests are NOT required DESIGN RATE: 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 T R UNDWATER-INCHES CHARACTER 0 SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DE/PTH IN. ELEVATION OBSERVED HIGHEST EST. TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) q,q B- /!y 7#f 42 . 72 27'Cob, 28- B- Z ~Zu `T9 t 40 ' 7Z" 27"C b, 2.5 4C.s B I Qom' 0 It_ !l B- ~-B roc PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DAM IN WATER V HE RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p]ERIOD PER INCH P_ P- tlr e-) t 3 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 JYa #0 rri - is - Is -i-Cs-! , 1 , t l a , °leso 0-3 40 Mu _ _ _ N . :F , OC I~t 1-4, 4q '~Y ✓ , 17 P 2 4-3 lq,WEI.100i 1, 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: H4N NUM optional : CST SIGNA U E: PISTRIUUTION: Original-t -al Authority, :.rni:I paa,7e R(i,(,ju of Picmlbing, 3rt1 Page-Property Owniu, 4th wage Sol pester r , . ~ t STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/ rtP'M:E _ ea.~ 4 S IT N/R 2co --E(or)w m Street Address: Subdivision: County: Landowners Name: Mailing Address: n f~ I (We), the undersigned, hereby make. application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Si ature of Applicant Date STATE OF G:3;SCONSTN Subscribed and sworn to before me SS. COUNTY'.,~QF . 4 This day of 19 131 Not#y Pu lic, t to o-"'W*s!roonsin yMy Com3tci sion Expires: DILHR-SBD-6413 (N. 05/81)[2 6/17/80 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. 14 T 30 N, R 20 EX~a4 W Town or Municipality Somerset Street Address 76 Winthrops St. Paul, MN 55119 Lot No. Block Subdivision Landowner's Name: Jim Ball The application for this site is to serve a: 4 ❑ new construction use. ❑ replacement system use. If this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: ❑ part of the 3%/5% limitation., This is number of the applications made through this office, ❑ 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. LJ a lot that meets the site criteria for a conventional private sewage system. If this a REPLACEMENT SYSTEM USE, the mound is replacing: ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed-and.in use prior to February 1, 1980. 0.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 Thomas C. Nelson Signat Title Assistant Zoning Administrator Date November 10, 1981 1 31 DILRA-SBD- 6158 (11.7/80) F ST. C R 0 1 X COUNTY W I S C O N S I N f ~ yh ZONING OFFICE 796-2239 HAMMOND, WI 54015 November 10, 1981 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Jim Ball property located at the SE4 of SW!4, Section 14, South Part of Somerset Township in St. Croix County,.revealed a limited area of suitable soils to meet setback requirements. This site should be suitable for an in-ground pressure system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C Nelson Assistant Zoning Administrator TCN:sl r ' IN A7 e 4,;/ !d ~ a~1 to j ! k r'd~ '~~~1~~,• Ca` a1~ I i.~'~p,'~.~ E f ff , a 44 i~ ( J / t ell, colt ~ ~ _ f ~ ~ ~ f,~~'~"'° l•~i ~ Vic..} RSME ONp~eNG~ DEY P Rasp "Al 6/17/80 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 14 T 30 N, R 20 B4bt4 W Town or Municipality Somerset Street Address 76 wiathrops St. Paul, MN 55119 Lot No. Block Subdivision Landowner's Name: Jim Ball The application for this site is to serve a: ❑ new construction use. ® replacement system use. If this is a NEW CONSTRUCTION.USE, the alternative private sewage system is to be incladed as: ❑ part of the 3%/5% limitation. This is number of the applications made through this office. ❑ 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: ❑ a 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 Thomas C. Nelson S1gnat,._ Title Assistant Zoning Administrator Date November 10, 1981 DILHR-SBD- 6158 (w.7/80) Plb. t-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- a T $ k 1 0, YI, d r ° a 1 c4 ;U M( J-t t f ° E s s F E E ) - A e E ° , ' ..E_,., W ~.....r._... . _ e E - _ _ _ _ ...W.w_ . _ , , , , :JA ° , " i I t a amp F ~W~...e ~ v A ° E 3 a { k , t , x , i e ~ C e 3 i 3 f 3 ~ _ r F s E E t t f ? A it y x r { € 3 ❑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 Plb 100a 1258 w State of Wisconsin Detach And Return Upper 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: 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. 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 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. ❑ 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.