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HomeMy WebLinkAbout008-1061-30-000 n cn p g m n v o Lo1 d ~ W CD m _ \ IU7 z S ~m O ;r, m rj O h1 ~0 O W m W O W co ( O _ CU C O W C N ' z r ~Xl G- N d A O r~i. A (D m W N Q W N m W p C W N p p w 3 a Q _ N p (tee ° p 7 N p p !i 'n cn 1 Q Q D fD C 0 o D a P. s T W D 7 p OA W 71 5~! (D 0 N) w a Q o c~JO cfJO n r cn ~ a c 0 !y U o o o A v• z o o o o C p Q' W m CA fn U) N Q C) O n O O D i ! V N m - N t►i z A C. it z co z Q r D co Q CD- • CD (D (D (D (D a C W Mri p CD V C (p (D W ~ Q Q ~ 3 z CD cd 1 cn O a aa p Z CD Cl) C ~a a A Z (<<n N N W C < co CL z O A Z7 O (n N z O A W Q (D C CL C N Q X 7 T7 W C 41 z Q Q O O O W N W ~ F ~V IV b a c 7C J 0 Wisoonuin De;Art_ant of Health rs_d Social So-vicoJ Plb. #67 3/70 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK 111K C/V~~l ~w / 3Q ~EYL~ F.A R OF PROP 0!IrIEERTY Namo Address (Street, City, Zip Coco) B. LOCATION OF PROPERTY Wf_.t1E SYST_T1 WILL BE CONSTRUCTED ALTERED OR EXTENDED j ~ Check One: COUNTY _ CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP / C. IS LOCAL PM1IT REQUIRED FOR THIS WORK? { YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS PO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence ~ Coroorcial Industrial Other (Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES NO Automatic Cloths Washer ' YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. MASTER PLU113ER MAKING INSTALLATION r Nerve: ,-e r= t r Address= i License Number: Signature of Applicant: MP RSW J ~ Address: /n, H. (To be Completed by Issuing Agent) Date of Application Fee Paid Permit Issued (date) Permit Humber Agent (Name) For= Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will°or.,:ard application, the fee of $1.00 fcr each septic tanx and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. De not write in space below - FOR DEPARTMENT USE ONLY 1. DATE RECEIVED / - -~l ACCEPTED BY RETUP14TD (Initials) (Date) See Corres.) FEE RECEIVED VALID. Nc. PERMIT NO. es or N-oT- - REVIE'.fED BY APPROVED DATE (Initials) Yes or N -7 COMPLETE OTHER SIDE . SEPTIC Tiiii' PER'IIi NO. RYPORT ON S OIL PEP,C 0 L A TI01I ?EST A H D S O I L B O R I N G S y TO DIYISIG:F OF H::AL"t'F: 4 PLUMIDLr:;r SLCTItTd ; ~ J P.O.Box 309, Madison, Wis. 53701 "Aslor Pursuant to H 62.20, Wis. Pct--inistrativo Codo L•"' G EA. F'7 P E R C O L A T I O N T E S? Test Depth Character o' Soil Hour:j Hater at, Time Urop in T?stor Level Inches 93nutos Nu ben InOhOS ?hio'rnoss in Inc:3os Since Hole in Holo Interval Second to Next to Last Example To Fall 1st Wotte3 Ovor°nl.ght in Minutes Last Poriod Last Period Period C?^. Inch P - 0 3611 ?o Soil 10" CI-1.Y 261' 25 Yes or No 30 1 2 112 1/2 60 J _7 RECORD DATA FROM MINEI M OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Aeministrative Code. S O I L B O R I N G S- Minimum 36" Beier Pro osed Abso tion S,yst,:n BorinZ Total Dopth De th to Ground Water Depth to Bodroc'_t Number Inches Example Cbsorvod --sti-Ited Observed Estic_a,tod Character of Soil with Thickness in Inches B - 0 721, 72" Blaok To Soil 12" Cla 18" Sand 1811• Gravel 241, RECORD DATA FROM MINIMUM 07 3 BORE HOLE TYPE OF OCCUPANCY: RESIDENCE: Number of Bodrooms OTHER: S ecif (p Y) Number of Persons FOOD WASTE GRINDER: Yes No Dish:aasher: Yes No Automatic Clothes Washers Yes No EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT Tile Size NO.Lin.Feet - Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Dianeter Liquid Depth Is the undersigned, hereby eertlry that the percolation tests reported ar, this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62,20 (13), Wisconsin Adr.dnistrative Code, and that the data recorded and location of test holey are correct to the best of my knowledge and belief. NAME TITLE Typo or Print REGISTRATION NO. or MASTER PLUMHER LICEPlSs NO. ADDRESS DATE - SIGNATURE Parcel 008-1061-30-000 05/29/2007 02:43 PM PAGE 1 OF 1 Alt. Parcel 21.28.16.315 008 - TOWN OF EAU GALLE 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 JOSHUA M & AMY B SHAFER O SHAPER, JOSHUA M & AMY B 2320 20TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2320 20TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 21 T28N R1 6W 40A SW SW EZ-U-1284/228 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 06/29/2006 828466 WD 07/06/1999 606225 1439/363 WD 10/09/1998 588785 1364/381 WD 10/08/1998 588709 1364/178 WD more... 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.250 2,300 0 2,300 NO UNDEVELOPED G5 1.750 100 0 100 NO OTHER G7 2.000 21,600 133,300 154,900 NO Totals for 2007: General Property 40.000 24,000 133,300 157,300 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 24,000 133,300 157,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t n N p v 0 v u con 0 3 m <D 0 q -0 a' C ~ m m r Z 2- O f m rlJ O ^o+. IZ7 C: 7 O co G) OG C N W in Q O O w - co a 41. C) 1, CD co m A A i0 {y IIC7 m O N N r.J m W O O -J O 'n N -I O (D O) O ~ O- '.Oz N ~ 00 N. N O O O "dal C N py O Q N O O~ O N 47 "^~i p I;y A Co Q rn z Q0 co r cn cn O C . y o O O A°o ti Cl) 1 -0 N A cn N C CD ~ o v n N •aa d N U ~ Z CO Z D oC ~ (D ~ " (D l0 (O N' CD (D I~ d tD an -1 (A D_ O A Z N C {a z O n C) a n N N W C O a A z O - ~ O n O N z O A W Q > N O (D fl a A , i (D X C A Z Q ~ ~ 10 C O O 'D :ZF (D O O O e A cn O O~ O O_ cO v r: O (h (v 7 'D 4 (D (D C N (o CD- (D -O V O O v ~J ~V .J Ir Cif Q O O v t ST. CROIX COUNTY WISCONSIN ZONING OFFICE IpNppNppll - w~wwb' ST. CROIX COUNTY GOVERNMENT CENTER w' - 1101 Carmichael Road Hudson, WI 540 1 6-771 0 (715) 386-4680 June 9, 1994 Jon F. Johnson 2262 23rd Ave. So. Baldwin, WI 54002 Dear Mr. Johnson: An inspection of the septic system serving the Robert & Rosemary Phelps home, located at 2320 20th Ave., Baldwin, was conducted on June 8, 1994. This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly there may be hidden defects in the system not discoverable by this inspection. Most septic systems consist of a septic tank which traps the solids and greases from the sewage stream and then allows the remaining sewage effluent (liquid) to drain into a subsurface drainage area. Once the liquid reaches this point it seeps away by percolating through the soil surrounding the system. Failure results when the soil surrounding the system becomes plugged with microscopic bacteria and sludge, which form a clogging mat. As time goes on, this clogging mat becomes progressively thicker, allowing less and less liquid to seep away from the system. When this clogging becomes severe enough, liquid sewage is trapped in the drainage area, a condition known as ponding, and results in backup of sewage into the structure or the discharge of sewage to the ground surface. At the time of inspection, this system appeared to be functioning, but not at full capacity. I noted that there was approximately 40" of sewage effluent ponded within the drywell. This indicates that the lower 40" of the system is plugged and will no longer allow sewage effluent to drain away from the system. Because the failure of a septic system is a progressive process, I cannot predict how long this system will continue to dispose of sewage effluent nor how soon the system will fail completely. I believe that the system may be nearing complete failure. With proper care, however, it could conceivably last a few more years. Again, I want to stress that I cannot guarantee or warrant that this system will continue to function properly in the future. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow from the house which enters the system. For example, repair any leaking water fixtures and/or replace them with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there is a full load, use a washing machine with a suds saver feature, direct sump pump discharge away from the septic system, etc. I would also recommend that the septic tank be pumped at a minimum of once every three years. Please feel free to share this report with anyone who may have an interest in its findings. Should there be any questions or concerns that I can clarify I can be reached at this office between 8:00 am.- 5:00 pm., Monday - Friday. Sincerely, 5_ ames K. Thompsdn Assistant Zoning Administrator cc: file ff~►~ ST. CROIX COUNTY WISCONSIN _ ZONING OFFICE r r r r N u a■ ~r,C Muni ST. CROIX COUNTY GOVERNMENT CENTER 0~ 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 Septic $50.00 ❑ Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria retest $15.00 Owner: o~oe HT d-RQS, Pti Requested by • i crriJ F © Cto Address: ,g3,4o 2 e 7d . F~ Address: ~5 _z3 ~ lzb • Ig r'1 Z I P Q 1 . ff r- «J c.tiC t;~ J-~" Z I P__ ',Z_ Telephone N°: (Oils-)_(dgy_ 37 Telephone N4: Property address (Fire N2 & Street) : vt 3,W6 9r_> l4y C~ Location:_~At., Sec._' I , T_22_N, RA W, Town of [ptf CA 11 Realty firm: N Lock Box Combo: N/A Closing Date: L f 0 ~/CYJ 06 -log 3v--dz111 ~ i S- TO BE COMPLETED BY PROPERTY OWNER ' PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Nip Age of septic system: A6cL! T 2S, >y Septic tank last pumped by: Licy.Nr,&~E e~ Qw_c=,Date: g Previous Owner's Name(s): T-115-R(Z Y R100/V Have any of the following been observed? ❑Y P< Slow drainage from house. ❑Y PTf Sewage Back-up into dwelling. ❑Y Pff Sewage discharge to ground surface or road ditch. ❑Y R Foul odors. Other comments relative to system operation: _ I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE:4~16y 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN T ~ 50 TO BE COMPLETED BY INSPECTION A C1 System design &/or permit on file? []Yes ZW'65~ Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd ❑At-Grd []Mound Approx. size 'X []Gravity []Dose []Pressurized Ft.' []Bed []Trench []Dry Well ❑Holdinq Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: ❑House []Well ❑Prop. line []Other Dose tank Setbacks: ❑House []Well ❑Prop. line ❑Other_ []Locking cover ❑Warninglabel []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: ❑House []Well ❑Prop. line ❑Other_ " ❑Dischar e: ❑Ponding: ~14eS, 4Z General comments: A. qZ INSPECTORS SKETCH OF SYSTEM LOCATION t~ Inspector _ Title