HomeMy WebLinkAbout004-1086-90-110 (2)OHNER
ADDRESS
SUBDIVISION LO',l
DisEances. and dimensions !o ueef,
SHOW EVIiRYTHING
OI.,iNSHIP
CROIX COUNTY , I^IISCONSIN.
LOT SIZE
PLAN V I EI,I
regulremenE s of H63
WITHIN lOO FEET OF SYSTEM
\
I-...-l l)q L q ql ,/a
7s
r )v
I
r,0 T Z
(a )4
I 7 1n l at(N trrl h rr
BENCHMARK: (Pernanent reference
reference
Point)
point;
Describe;
ElevaEion of vertical /,q o
ffict@@pu"ttt,
Sl-ope at site: /
SEPTIC TANK; Manufacturer:
Number of rings on cover :
Tank lnlec ElevatLon:
gaIlon per ninuEe
and model nunber
Type of wa rn tn g de
/ ULt r
Tan manholc cover elevaElolt:
tank Ouulet Elevation:
PUMP CHAMB ER----;.;;;;;,.".,
r'',1 ) lr"t",lr- 8[",,? Number ot eal-Lor.s lD t) (\
Numler of gal
dlatributlon lines galIon'. ALze'of
t horsepower
galI
pumP
/^-_; brand naue of pump
ons To aI capacity of
head;
HOLDING 'tANK: Ma
77tr'.?"nutac'du rer
O..(
Nunber of ga
/ta/g
EI eva ! 10n of manhole cove r
Type of warning devlce
SEEPACE PIT SIZE;
bot.tom of seepage p1t elevat j-on
SEEPACE BED SlzE: nquber of lines
feer Ilguid depEh_ seepage pi
Number of plts_ feet dianeter-
t inIeE pipe-elevatlot=---
f eet.
widEh_length_E11e dePEh
widthSEEPACE TRENCE:
PERCOLAT ION RAl E AREA REQUIRED- AREA AS BUILT
I PLUMBER ON JOB
LICENSE NUMBER
length-
j l/
INSPECTORA*7DATEDa7
AS BUILT SANITARY SYSTEM REPORT
SEC
.lL I
1 LlA{n!*
DEPARTMENi OF INDUSTRY,
LABOR & HUMAN RELATIONS
P.O. BOX 7969
MADISON, Wr 53707
SAFETY & BUILDINGS
otvtstoN
BUREAU OF PLUMEING
8303623
INSPECTION REPORT FOR
PRIVATE SEWAGE SYSTEMS
D coruvelrrronnr- E aLTEBNATIvE
n Holding Tank D tn-Ground Pressure E Mound
NAM€ O'
'ERMIT
AOLOEF
Genald llamnond
AOOFESS OF PCAMIT IIOLDER
RW2-Box l82,Spring VaLLeq, Ul / '1-Y- ra
OENCH MARK IP.'h.MNI GI"'C' @I'I' OESCFISE IF DIFFCAENI FROM PIAN
AJE SE Section 35 T2EN-R\ 5W ,Town of, Cadq tbr,'
Ho)Lace Huzlb uttt 5650 St. C)Luix 38512
SEPTIC TAN OLOING TANK
DOSING CHAMBER:
/1/)'riu es f YEs Eruo E ves ! r'ro/000
Rves !ruo I4',Tooe J3nvNOJ
ves !ruo Eves Druo7tz{P,/o-r7
*'iJtffih.
Fves ! ruo
L oNs
(DIF FEB ENCE BETWEEN
UMP ON AND OFF )./).t t^nves !r.r rFhl
3lfo'lcE.*tflt.
W
SOIL ABSOBPTION SYSTEM. C heck the soil morstu re at the deprh of plowing
or excavation, {lf soil can b€ rolled into a wire, construction rhatt cease unlil
the soil is dry enough to continue.)
ENTIONAL SYSTEM:
:fliGmtred-.:!.Ertil,lriL-,
ENGTH
Prr
FfiOIfELEV ENDLEV
L
D 7
Mound site plowed perpendicular to slope
and lurrows thrown upslope:
/h.r.. Er'ro
PROVIDE A DIAGRAM OFSYSTEM
ON REVERSE SIDE. SHOW ELEVA.
TIONS MEASURED.
Check the texture of the fill material for
mound systems to make certain that it
meets the criteria Jor medium sand.
d(t=r - Er.:o N".r E ruo
DEPIH OVIF IRENCHIAEO OEPIH OV€E TFENCH;€ED
EOGES lves ' Er'rE ves I r'roEves !ruo
Klirrlil;nElil
r-tu-oc'ta1!9Y! 911€j _ENCHES
GRAVEL oEPrH sELow PrPF
DISIFIAUTION PIPE MATEEIAL & MAE(IN6
t',^
I
.LCV
MAXIfOLO MATCFIAL
HOLC SrZr
t
ESPOIJOS IO APPROVTO
Er'roDves
OBSEFVATIOI,I YIELLs 5oE ves E r'ro Dves ! r.ro
o
OF
F F
EANII
PRESSURIZED DISTFIBUTION SYSTEM
COTIIMENTS
toq.t{
p.q q ?.-6 ol'{-1$.ta,)\.s{
It.4( L,$,^--
*
q.Bz
ql.sL
qy
q 3''{
\-"o\
u-t lip+ s.G6
Sketch System on
Feverse Side,
IIT LE
Dr LHR SBD 57101R.01/82)
q
4-",(
Retain in county file Jor audit
DEPARTMENT OF
INOUSTRY,
LABOR AND
HUMAN RELATIONS
APPLICAT!Ot{
FOR SAillTARY
PERMIT' (PLB'67)
SAFEry & BUILDINGS
DlvlsloN
P.O. BOX 7969
MADTSON, Wl 53707
Maili
tCiry,illage
NrR )W
rty Location
Sta t.o. N mberNeaLek6 or LandmarkLdt filumber
(^-
Blk No:: -S'ubdiiision Nam-e
TYPE OF BUILDING
E Puutic* E Variance' E Other (specify)*
D 1 or 2 Family *State Approval Required.
Number of
BEdrooms:
3
NUMBER
OF TAN KS
PREFAB
CONCBETE
POUR E D,IN
PLACE STEE L F IBERG LASS NEW
INSTALLATION
REPLACE.
MENT
OTHER(sp€cify)TOTAL
GALLONS
./, ^n vSEPTIC TANK CAPACITY r
HOLDING TANK CAPACITY
LrFT PUr\4P TA N K/St+nor{-er+fi43€B 2{6
MANUFACTURER
EF F LUENT DISPOSAL SYSTEM
PERCOLATION RATE
iMinut6 per inch):L€
ABSORPTION AREA
PROPOSED iSquare leetl:,tsn New E Replacement E Experi t ! See page Bed E Seepage Pit
Alternative (specify)E &epage Trench
W.ter Supply:
F Private fl Joint E Pubtic
Owner's Name as Lisled on Soil Test Report (lf other than present owner)
l, the undersigned, hereby assume responsibility for installation of the private sewage systy shown on the aftached plans
7::W'{,2,2 NumberName of Plumber M P / MPRSU/-|i..Ph
of Oosigneri
COUNTY/DEPARTMENT USE ONLY
"ih7;::5iZ)4a/tild Yiaa Y Date0-p-rs ETppnovro
E otslppnovso
Sanitsry Permit Number
Zp.s,, z',
Reason for Disapproval
Alt€rnate 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 o{ Plumbing, Pink'Owner, Goldenrod'Plumber
DrLHB-SBO€39a (N-O3/81 )
Attach plans for the system on paper not less than 8% x I I inches in size. lnclude a plot plan that ii dimsnsioned or drawn to scale. Horizontal
and venical elevation rererence points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H€3, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. lf designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of ths soiltest report must be
included.
./Yl' r a
<.L(A
REPORT ON SOIL BORINGS AND
PERCOLATTON TESTS (11s)
(H63.09(1) & Chapter 145.045 )
S NGS
N
USE
RATING: S= Site suirable for syn€m U= Sirs unsuiiable for systam
DATES OBSERV TIONS M
fr^*,o.^* 1i4 S1)
NO. BEDRIUS,
3
COMM ERCIA L DESCR IPTION
NK 7ffilt"* En"pr"""
SUBDLK. NO,LOCATION
tle t/seVt SECTIONj* /ltg[/Rtsir*rW
OT NOIOWNSHIPiM{'fiEFAE#TY
C-KDY
^)*
t
COUNTY:
3T cPn,\
-zo -3 6-a-
R ECOMMENDED SYST EM i (optional)
rr4ouND
NVENTI NAL
U strut\,10 u D IL
trs tru
HOLDING TAN Ktrs trll
IN GROUN
trS U
lf any porrion of the tested area is in the
Floodplain, indic.te Floodplain elevation
PRO F ILE DESCRIPTIONS
PE RCOLATION TESTS
s
tion Tests are NOT required
63.09(5) (b), indicate:
DESIGN RATE
E LEVATIONEPTH IN,
L IL WI THICKNESS. COLOR. TEXTUBE. AND DEPTHCHABACTER
TO BEDROCK IF OASERVED (SEE ABBRV, ON BACK.)
B-l {+Q s,z o ,t'o BL slLrs31 tdN't-o fi3N stt- )-"qmN
sia rD/ YR. th-or;: Ry LS l Gt/ C,t- B.
e-3l s4 4'l.q 3q nrTi-377u d lBl -7Tro stc-t- 34j
/eu rt rtrl c'f c-L AfufB rtl s i,u/ YA fi ot
B. S
B
.7: oettiE Et aleP
rLtt s A.
YR Fs *uTGANaflNa t<)/
a-5 5r/q'/,1 0 JS BL 5tL Ts 3;a: Ail iz r's\tl
&rBN StL a/ YR. fi-oa|'"tofsll A3: 18rJ s c.t tD,/ l/Ri' /o,/'LY 3 D.sslLoB.
B.
TEST
NUMBER
DEPTH
INC H ES
WATER IN HOLE
AFTER SWE L L ING
IME --5FOP lN ' ATER LE\/EL-tNCHESTEST T
INTERVAL MIN
RATE MIN UTES
PER INCH
p-I z4 ilo a 5-5 t
p-J 2-o
^Jo
3o 3t*Va {/n 49
p-3 JO ilo 4o I )za I I 30
No,? i P-n e t . -- q6.o',
SYSTEM ELEVATION
_-=. O._ <. ><
tllou ttt
cZA
Z'$q'd{rnF -l'J I
q
\\\$I
\t-,
\q
\
lv,
s$tq{.c \A
$lp u/U.,
x;$sr L\'_l_Ar(\[r\o
aA
,$t
-t
\*\rr ltt
Cco
ots
l, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods speciried in the Wisconsin
Administrarive Code, and that the data recorded and the location of the tests are correct to the best of my knovi,ledge and belief.
aJ-
TESTS WER E COMPLETED ON-Lt -3NAIM
IEnl
PHON E NUMB ER (op!ional)
L'|2-O s4')
ESSD
e J 5 5?CERTIFICATION N UMBER
NATUR E
oepeiruelrt or
'rru ouf, nv.
LABOR AND
HUIVIAN RELATIONS
0
DEPTH TO GROUNDWATER INCHES--sTli6IEsT-
5'
=
I
PLOTPLAN: Show locations ol percolation tests, soil borings and the dimensions of suitable soil areas. lndicate scale or distances, Describe what are the hori
zontat and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direcrion and perc€n!
$q-
DISTRIAUTION: Orisinal and one copy to Local Authority, PropertY Owner and Soil Tester.
DTLHR.SBDS3gs {R.02la2} - oVER
1
2
3
4
5
6
7
8
I
INSTRUCTIONS FOR COMPLETING FOFM 115 , SB} ,6395
To be a complete and accurate soil test, your report rnust.include
Co mplete legdl de(cription,
The.,use section must clearly indicate whether lhas is a residence or commercial proiect;
XnAX IIVUM number of bcdrooms or commercial use planned;
ls This d n4w or ref,lacement syster;
Comptetd the suitability ratinq boxes. A SITE lS SU ITABLE FO R A HOLD ING TAN K ON LY lF ALL
OTHER SYSTEMS ABE RULED OUT BASED ON SOIL CONDITIONS;
PLEASE use the abbreviations shown her.e ,or writinq frrofile descriptions and completing the piot plan;
[rAKE A LEGIELE diagram accurately locating your lest locations. Drawing to scale is preterrcd. A
[4ake sure your benchmark and vertical elevation refetence poiat are clearly sholvn, ar'td are permanent;
Complete all appropriale boxes as to dates, names, addlcsses, flood plain data, percolalion test exemp.
1ion. il appropriale;
lf the irrrormatiot: lsuch as tlood plain, elevation)does not appiy. pl.rco N.A. in the approt),iate box;
Sigll the {orm and place your current address and your certificat]on number;
l\fake.legiblc copies arrd distfltrute as required. ALL SOIL TESTS I\,IUST BE FILED WITH THE
LOCAL AUTHIRITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FQR CEBTIFIED SOIL TESTERS
Soil Separates and T€x11rres Other Symbols
t0
11
12
st
col)
gr
s
cs
rned s
fs
l5
-sl
's il
si
'cl
scl
sicl
sic
pt
m
BR
LS
HGW
Perc
.l ql(lq
"(
Brr
BI
Gy
R
f11
cc
.l
p
H\,VL
B IV]
VRP
Srx qen..al soil lextirrcs
1or,1!qu id waste dispo.al
- Stonc (over 10"I
- Cobblc (3. 10")
- Gravel (under'3"1
- Sand
Coarse Sdnd
- Metliunr Saod
- Finl Sand
- Loamy San.j '
Sarr]y Loatn
- Loanr
Silt Loarr'l
. Srll
- Clay Loarlt
- Sandv Clay Loam
- Srlty ClaV Loam
- Saidv Clay
- Silly Clay ':
Clay
," Peat
-- L4U(k
- Betlrock
- Sandslone
- Limestone
- High G ro(ndwate.
- Percolaitron Rate
Building
-- Grelter Thon
:- Less -ihart'
- Brov,,n
B lack
'Yeliorv
* Rerl
- Motths
\1itlr
- few, l tne, taint
- cofilmon, (Daisa
- Mary, mud iunl
- distiicl
- P.ominent
- Hlgh |iater level,
sur{aco water
- Bench Mark
-- Veraical Reference Point
TO THE OWNER
This soi, test ret)ort is the lirst slep in securil]!l a saoitary pcrmit- The cou'rtv or the Deparlnlent Inay rarJUest
virrificatisrr of this soil test in the fiel.l prior to peflni1 issuaflce. A cornl)lete s9t of plans tor the pli!ate
sor'naqe svsi,]]'r1 anal a permit aDplicaticn rnust he su5mitte(l to the appr{)priat.. local aL"rllror;ty in order io
ol)l3i. a permil. Thd,sdtitarfper it must be oblained and posted prior 1() the start oi.any const.uctlon.
ot Propcrcy &ta
e I uL)
at 1on ot rropattvy'f__\.<f \,S"ctior', 35 ,1,
Tounshlp
HalllnB Addrecs 7)/tt 5
/subdlvre ron N a.e
,4,oc Nuobcr
6tuuLouo ouner o! !ropercy do
To t...I Slze oa Parcel J.ft
Dece PurceI rlau Creared 17/ 3
Are al} cornera ldenclflable? X yes--No
Lncl ude r..,Lth thls dpDIle iit]'o n one of tlic f olIoL/irrg:
tled Survey Map
. Deed
, Land Concrac!.. or
.0rhcr L-egal DoculuenE uhlch descrlbes the properry
PROPERTY OWNER CESTIFICATION
| (Wo) c8rtify lhat all statemont5 on
knowloclgo; thct I {w!} am (aro}
inlorrnation fo.m, by vlrtu6
thas lorm aru trus to lhc b€sl of rny (our)
orty describ€d in rhis'
Off icc ol rhotr
Counry flogistor ol Otrodr as D that I (wo)pro$ntly own the proposod slto ,o,or | (ws) havaobrainsd an 0assmont, to run yralh ths abovo dorcribod proporty, for rhocon ruclion of &id ryttsm, and tho sam!hss b00n duly rocordad in rho Otficcof tho Counry Rogirtor ol Doodr. al D ocumcnt No..- ).
NATU a€ of otrltca SIoNATURE OF COOWNEA ltF Appl-tCAaLEl
OATE 5IONt OATE 5IGNLO
(
I No.
ty
I
4
331s92 v0L 53Ctr:r620
i\)\TR.v'T br F. r(rr,'.r -... EAfl J. Iayno rrr(l Al],la Y.YaJmE, Lurbgnil and wlfe aa Jolnt tenantg
t $TATE AAn OF 3rsaon3tlr - ?OaI rrlio Cotltlcl . ldrrrrsa rt C..rra.
T.
. \ .!i \r ,... Gerald L. Hanoond. :md l4arjorie A. iiantrond,i;lisband and wj,.te aB Jo.Lnt tenants
i i) ,,
AL so_the- fo-1lou1a6-deacribed real estate ln plerce County, StateThe trorth Half of the Southeaet erElter, Sectlon tt, fouiefrfp ZiRange 1! Ieet.
ha(bt r.'l1r Fd .8r.er !o rdvc, rdtre rh! Fs{r..d, (a!.r tlE }r,r{,r }rsl ,!l! iN.rl.,.r aalt,at tO
.n<. It tL! Pircirsr}t ga lii .ol!a6lr r.rl ar.co.nts ./( rhtr ..6rrB.:t to t* try th(
Pn rh.6 F {rrd. t|. ,6umi4.t <<'rr'.d rt.l "r(.r! - St. CfOif
C.,6!r, S!.ir cl l!..6itrr
The rorrtb Hslf ot t&c soltlrest qu.rtor, sectton ro; ::] *'j^F:w-t 77'2?Ql
nr. tror.th rtr:'i oi trra Sonah;;;a eG"t;;; a;;ir;; ir: *'. '' aoa h'ft'!("dF,xnv
except a parcel of land located 1! th6 liortheast Quarter of th3 SoutheaotQuarter deacrlbod ag folloys: Co@enclng at the SB corzrer of salat forby;thence Xorth -aIolg th6 E]"y lfae of eald forty, vhich le a].so Torn iloail,-,24 teet to- thc plgc€ ot beghalDA; th€nce at'right angtee i{eat, 725 teerithenc€ lIorth on a Ii-ac-paraiIsl vith the Ealt I1ie, vhlch 1e Tovn Road,,8O teet; thsnce 8erat 725 fo.t to the Saet U.ne of ' sald forty, whlch iiIoun Boad-; th€oca Soutb s16ng the East Ilno and Torl Boaa, :b6 feet to theplace-o! b€gr"llag; Th€ yegt Ha1f of the Southeagt er.rart6r of the Soutb-eeat Querter, Soctlon 15; A.LL 'n Totmehlp 28 trorth, tiange 15 Ueet.
of Ylaconglllllorth,
td..rh.t *rth .ll haild!lrt3, ltrrro!.E nt., lixl'ftr oad iPtt!r.1.trxn(,.{, nuB ,, h. !t.rr.r rr..r.d rhFton. dclu,l.na .ll s..c. ..d rrd.
do€r .ad -t r(lotr. .rl..l-a r! ta.. firrnt., rtr&r" .rt..h.d rlry colar! hdr urt hr.r4' timn.., oll tsnt .nd lirhl l[ru.r.
rh,.lr ri.n b . pGr o, tt "!.1 ..t.rt
aIYe Purchasgrl' s r!fiht of first I'efusal. for a period-ior the -ourchase of the res j.dence Dolr occupied by
yendor hereby alao convoya a 14' x ?.1 ' nobile hooe, including stove'
".ir:-gerator" davenpori r- chair arld drapsa lnw locatr-'d ln tire mobile
;;;;.--il; vifue of'tfro aobile hone shal1 be *5,OOo.Oo a-nd the value
cf the above real ostate shall be S1?5'o00'0'l'
and for the(10) years at
1{lscons in water
tlBber on theCounty. Vendor
the above excepted
closing to reBove
YenCor reaerves the right to ^fear-:lt and rcnsve tt'e
iiE+ of sE*, sectj.on 1r; T. 2s N. ' R. -15 ',j', st' (jrcix
*iif "oi i"t an"v trees near the residence locatcd cn
ii"i"f.- i.naoi ahs1l have one yee'' fron the date of
sa! al t ittber.
?trPE.trr<.bcd!.1&'.ll6o'lh.'!.Enlii.d{Er.!h..l$irr'?ln6.d.bvlh.v.nd..,rr5f..topu.hr*.thi..b.v.
d..(.thcd p,.i,..r. .a.l ro P., rh.Ftq rD rhe t''ttl{ 'r thelf ,feeidenCe;*;;;t'oae ltuaoiea Bkhty Tboueard and no/loo ----------- D'tr'r'
,"-^-*, ",i"*"",
r 40r 0OO . O0 .t rh,. cre. ur,* hr ,.o,, th( rr(( '!r (h( ...r , { h.'tr)! r( l^ n',q l' drtd, sdd thc b'r'h'e
"i i 14O"OOO.OO . roa.rh.t n.!lh ,ot.,ri, ,!n ru.h r.rt1.,ns rhr.r!{.\ rh!!t ','r.,,, (r,,n r,{' ii' t's' oprkr' rt rhe r't!
"t 'll , ptr(.'hrP.t.nnur.unlttF3kl!tlull sJ r"llnr'\: sxrl rrln' rp": nnrl rnr"r't <h"ll ltr r';\!r'1 rn afUeUaL
::...';;",. .' I' ,*.,i-' tiooo.o0 - - ' ,',,vear + interest r' r'|-nrr"D rh' i?tl-
;;1.;;*-
- lGrch , t" 77 -{''-.r'ro{!!"'*!..rl't$r'Y'r'**{ vxrvrr'r'xl' ..f, trrxr rrY}.rl(rir'''r(
YI-rrl:...v*esr6tctr see below+**
P!'cl'..r,t,the'.eF.l.onler..r.6.dbr1cn.,,d'lUp,ft,dlhlrp.}dnlr\ul,!.l.nt.i,.rone',ltl,'1.''.IFJIFlh.p.thl'.\ofrd.r. rFc,.r esi.ir*.!!. ri.. ."a .',. '.i'l'"' -i;;; ;;;';;' "; -*r. "tr"' l'i'' "i':" ''tmrqfr\
d' \'' n'; ' -dt r('Lruft' ra'r Pur
ch.s .grce. r. k. iq:h F,y*r.,,, ,;;;';.;;", "lo i...r\ .riho?!z.s vrHlor r. .oply rh. r.h. u tl.linrn' .'r -u' h r''h{
**r fqs the flret flve yeare, thereafter annual payBents of f2OOo'OO plus
i"t.ilitti ?I-;;.-;;f pir-."n'u, for the next five learg:- The entire
i'J"ii"-a"i aia'payatre ien (lo) veare after uarch 15' 1976'
y0t tr3{ na@?
Tt PtIch.*r hctcbv rtrtc6 lh.l h. i. s.lrEtt d *rth thF
hill fo. lt.Gtmti4ti ilr Vcnao. .r... lo &Irvrt rhe .bsr"'l
br.|l6d.t.hrll llvc b.Bn P.id The Prrchrrcr r*rer to pgr
l,r the .bir.! t.rrllr rniulrn.. , ohi(h.nt +uht
pohcy 16 lh? Pur.h.rd rhe. lh. lull our ''ol .birr.( I lrrl. Insdtsr ' '
r sh.ll .(crPl .! .
r sotn ot rhe 9l,(h.r.rhe Veodoa. t(1. ii
)hdilro^ crllcd fd bv
d !itl. errhrn l.D (lO,
rrlle o. fsnlsh . titlc
nt. I.hr
ha
th
p,76
n th!.h lo t '!olc ,n, o..{9-
l.'..ftcrts ha.r, o.ntlr.crl o.
""*-c-ffi..',-.,. Ed
'>->ir
531 nn62E|ei -
I r
"'1u,..ful1 j.re'ira bi. c,/ ' -'
6r
the Clty of Dursrd, Wleconsln I.1ar ch
-t r' \t'a,J.-_2j (y/2
. Wan neEa.z I
I
I
4.a#\j
GeraL0 !.
t
-1(lj1.lr.r-
Marjcrie
HaroondI)a/"
A. HaE&onal
\t r'|ll Vr' \ 1 .,\
Srslrrt d( i ol
rrrhautic'lL, r his
l- .t Irlayn.:.at krld
t*
r ' .L.lo'?a,i(Ml(r
t{rtlrc e-Dc.xrrr>J6oo:r,
STAIE (!IJ TIS('ONSIN
IlePin (.a:,, I
Pe^inarrr (.h, rr r,{. n ,!,.. 15th
rh. .t,,,t. tr,'..! Barl J. i{a;rne, furna v
_ MarJorie A. Hanmou,]
lo D( tno*., l" r. 1t, r.,.. ,, S
r.... ,,r ilarch
iiayne, Gerald Lr. llanrnorul enrr
76
Attorney KarI J.
Durand, lliscons
?h. u.,r.,;t *rlrr
Goetheln 54736
3
F.
;
a\?J
*
?epln
15tr
1e
IF{1
:'.
Srot" of Wi="or,.ir,
Department oJ lndustry, Labor & H
Division of S.
Bureau of Plumbing Plattinq & Fire
P.O. E
Madison Wl. :
Tel.608-266'3c
IN ALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
NAA,4E OF PR OJECT
TYPE OF APPFOVAL
STRE ET AND NO.
CITY OR TOWN ztP
OWNER
Gentlemen
Examination of plumbing plans and specifications for the above-mentioned project has been completed. ln 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 oJ the department.
sm-nas.arotlofilrr lel.d-yiitlril?,.trve.'.eal?f+e,m.+his.dstqtlilefpr€{€l
e.
ln granting this approval, the Division of Safety and Buildings does not hold itsel, liable for any delects 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. lt 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
)
STATE
)
U NTY
cc: DPS-OWS
Local Pl
CountY
DrLH A 580-6099 {N. O6/aO)
ownet(.'
Plumber
Mlg. Rep
DILHR
H&R(2)
Bur. of Health Fac. & Services
Rec. & Env. Servic€s
€t\u t-\F\l-r h'--\ A
Q. o. Bo:r / 63
4s:6g1Nxes
6<.3 6Z\ CRC l €r6a\
\
Ll bo
A.c\cl ()\E-
<T -J R
(
ifft tJ;'r1t"*:yas e sv sten s on rvi
years or it rvill I:.- ,,r,;r , ,-i;i -
9?'ili',il;"J,,1'1" o-i'i r [' in it;"r
.a
DATE:PLANS REVIEWED AY:f ffizix
/t.
a
d,r:
:|ri .
,4.:
I
,{
sT. cR0rx c0ut{IY
l{tsc0r{stt{
ZONING OFFICE
796-2239 (HAMMONDI
425,8363 (RIVER FALLS)
HAMMOND, WI 54015
AuBus t I8, 1983
Mr. Ge rald Hammond
R. R. 2, Box 182
Sprlng ValIey, WI 54767
Dear Mr. Hammond,
[.] e have received
1s necessary f or
1n thls office the form STC - 100 uhlch
ls6uance of a sanlEary permit.
I am returning the form to you' as in order to comPlete
our records on the system, the areas noted in red [0ust be
conpleEed. A coPy of the deed ls requested. This can be
obEalned fron the Register of Deeds Offlce in Hudson. The
number on Ehis deed is Ehe number to be placed in the blank
for DocumenE NuEber.
Your cooperaElon 1s appreclated on this matter'
Should you have any questlons reBarding this subject' Please
feel free to contact thls offlce,
Slncerely,
91,r "- o -
Thonas C.
As6lstanE
)<TNelson
Zonlng AdEinistraEor
TCN : mJ
Enc.
'{
ir-
;2
ANO OESC R IPTTON
pi T2 -35
8A
Gerald L & l{arJr.rrle Iamrnc,nrl
J L IOL)
t,
I
I
I
6
T
5
I
Sec 3! 12919 p159
NE SE EXCot E 325,
37 ,l l6AN 380' of S 22 c IJ
t.v/r-\,.<f \,/j-5scttuu JJ
ddrr:cc ,?)L
0
af raTull6 o, owltrrl
./)
UATE brortt
/subrt rvr c roo Nsuc
-'f,o c Nurulror
6rovLuut onrrcr oi !roperry
'foc6I !i1zB ot P6rccL :'{1
Dcco Purc.rI yuu Croored J
lnclude
/,-) l' ':'
,, 1..; )
Arc UII cor ..rd lddllr. ltlaUIc? X ycu No
eltll rltlb c
!
,u0 tO the bosr of rrr y luur)
rl,ty dcrcnbcd llr thlr
Olrtco ol ttto
rhat I (wdl
or I (wo) have
bod paopoary, lor tlto
dsly rlcordod ln rhd Otticc
Lle .rtlon one of tltc Io.tlerurrrr
:Jar tlsd Survsy M.rp
. DosC
. L.. tr d ConCr.rcL. or
.OCh.rf t.rgs.I Docull..luc rlllch dcacrlbl:a clte pr(Jp!:rcy
PROI.|ERTY OWNE R CE ITTIF ICATION
| (Wo) cnntly thdt dll {ats ll,ntr on tl|lt lorllt ,rro r
knovulodgd; thsl I lwol {rn (dr6l
tnroflrrItion lorm, by yifluo
C{)unty Hoetrl0, ol Otndt dr Oocprd$ntly own rlld ProPoed rlto ,o,
obtainod !n Clrornont, to run wtth tho obovo dorcrt
Conrtf ucllon ol r.td rvrbm, {nd lh! umo hlt boono, tlto County Hqltrrcr ol Doo{.tt. u Oocunrorrl No.!).
lroNATUnC (.)f CO<)WNG,r. lt, Aptr-lcA|,Lt,)
o
;dt
d 0 ud oco
rlt No
L
P
ST. GN()IX G()Ul{IY
tulsc0l{sr1{
ZONING OFFICE
796-2235 (HAMMOND)
425-8363 (R rVER FALLS)
HAMMOND, WI 54015
June 24, 1983
Oivition oI Sa(etg and Bultding
Buzeau o( PtunbingP. 0. Box 7959
Maditon, Ul 53707
Oean tirt:
Thit aite ahould be
Should you have angthia o[{ice,
An on tite inveatiga,tion (on the Genald Hanmond pnopulttt
Located at the NEh oi the SE\ o( Section 35, TztN-R.l 5W,
Town of, Cadg, St. Cnoix Countg, nevealed t wltab Le toiltat a depth o( 2.E (eet, beLow uthich teatonable high gnound
wa.tetl uua.6 noted.
Lu.Ltable {ott a nound Aqtten.
queAtion|, pleate (eel 6nee to contact
uLtrtY o urtA u,
Thonat C.
Att it tant
T CN: nj
NeLt on
Zoning Adninirtnaton
?
'- -\-- t'
r# liii
ti:
t
}IISCONSIN DEPARTMENT OF INDUSTRY, LAIJOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BURE^U OF PLUMBING
P.0. B0x 7969, MADISoN. hltSC0NSIN {i3/0i
Verification of Exceptlon Status for an Alternative Private Sewage Systern
In the County of St. Cnoix
Location iJE l/4, SE l/4, Sec. 35 , |JJ_N, Rl 5 E (or) w
Torn or llfr(rc{|lfftryx Cad,q Street Adrtress
Lot [o. Block _, Subdivision
Landoyner' s fldne:Genald, H o.mno nd
The appl.ication for thls site is for:
fr-l new construct ion use.
! rep I acanent system use.
lf this is ilEU CONSTRUCTlOil USE. tht alternative private sewage system is:
klto n.ra one of the first five approvals guar,rnteed for this yedr. This is
nurnlrer 59 - 04 - 4 of thosr. applicatir.rrrs. (Uscr onr] of the first flvequota nffiEis-TGfeif-t o you. )
rlI lone of the appl ications needing a quota numl)rtr. The quota numher assigned tothis application is _-_-_.
L -l fo" one adrlitional homesite on ,r fann to b(l occupicd by a pdrent, child,
grdndchi ld, sibl ing. niece, ncpheh,, or first cousin.
[-l fo" an individua'l lot for which ,r sanitary p(]nliL was issued but was later
ruled unsuitable due to new or changed soi'l criteria established by thedepartmnt.
llfo..n application on file prior to February I, 1980.
[.-..] fo..lot that neets the criteria for a convcntiondl private sewage system.
lf this is a REPLACEiIEIIT SYSTE}I USt, the alternarive privare sevrage system is
repl ac i ng:
na fatling conventional soil absorption systern.
[Ja holding tank that sas instal led and in use prior to February l, 1980.
Ea p"lvy that nas installed and in use prior to February 'l . 1980.
If this is a REPLACEI,IENT SYSTEM USE a
conventlonal private sewdge system, c
I certify that the above information
kmwledge.
slrn Thonat C. NeLt oi
nd the lo
heck here
is t rue a
S i gnature
t rneet s the crirr't l
nd accurate to
.,,
teria for a
the best *_y
?( Countv0f icial )
1i 11. Aaaiatant Zoning Adninittttaton
f
DrLHR-S8t)-6t 58 (R 12/821
3ate lune 24, 19t3
S TATE OF WIS CONS I N- DEPAXI}{ENT OF INDUSTNY, LABOR & HUUAN REI.ATIONS
DIVISION OF SAFEIA & BUILDINGS - BUREAU OF PLT'MBING
P.O. BOX 7969 - r,rADrSOli, Wr, 53707
APPLICATIOI{ FOR THE USE OF AN ALTERIIATIVE SYSTEI'I
.ocat10n:
,4.,1 S t N/R
rou,wnql{tHfidfilH**.
Cad.
Su vlslon:
Ha ng Address:
t{
I reet resa:
,rndowners Nane:
;a naLd Hannond
|TATE OF WISCONSIN
unty:
St. Cnoix
I (Ue). thc urd.rllg,n.d. h.rGby t IG appllcatlon for an .ltQrnatlYc tyltc! on
the abovc-dcacrlbd prc.l!a!. I rccognl ze thlt thc aboY€ Pra.lre! lrt not
sult.d for a oonvantlonal plvatc laye8a !y!tGn. If epproval 1r grrntcd. I
-re to hsva tha lyltao lnlt.llad ln confomrnce Ylth thc htreaurg .pProval
of plan! and lpacl ftoatlon!.
I further rxdGrltlnd that an alt.rnetlvc !yst.! l! Dore cooplcr ln naturc then
a conyGntlonsl prlveto larlga !y!ta end as tuoh r11l rcqulrc d.tlllcd
lnlp.otlon drln! oonltructlon rild lonltorlng lftcr thc !y!tc! lr put lnto
u!.. I lgrGc to p.r'!lt both county offlolal! oharg.d rlth e(ilnlltarlns oounty
srnltery ordlnanc$ and Efaru rploye! or othcr authorlz.d perlon! to h!v.
lccGls to tha abov. d.lcrlbad pril!€r at eny r..loneblc t1!. for th. purpo!.
of lnrpGctlon tha oonrtructloa of or Donltorlng of thG !y!tcr. I nrrthcr agrac
to elthcr p.rlonally or by !y r8ant contect th. proper county offlclal to
arrangG thc tlaa and dlta to bG81o constructlon of the syltao.
I und.rlt.nd thrt thl! applloetlon doe! not p.mlt Dc (the appllcent) or ly
aScnt (thc contrlctor) to b.gln lnltellatlon. If thc lyrt6n h .pprovGd r thc
Burcau ylll !.nd th. .ppltolnt a lctter of rpproval drlch cuthorlz.!
conltruotlon of thG altcrnatlyG lyrt.D aftcr all necclsary pcrDlts havc bccn
obgalncd.
I egrcG to glva notlcc to any rublrquent buycr that en eppllcatlon for !n
altcrnltlve !y!to h.! b.cn red. .nd lf ln3Eellcd. that thc preEllG! erc lcrvd
by an altcrnattva syltGn rnd l'lrrth.r agrcc to Blve thc buyer a copy of thlrrppllc.tlqr.
Thc h.lr.au.eccapt! thl! appllcatlon rubJcct to thls understandlng end lubJcctto aU th. oondltlon! ! oblltat,lons s€i uu: ln thl! appllcatlcn.
Slgnature of Applicant
Subscrlbed and sworn to before me
ss.
Thls day ofouNTloF
Notary Publ1c, State of Wlscon8ln
DrLHR-SBIF5413 (N. 05/81)My Comlselon Explrea:
l9
Da te
sI. cR0rx c0u1{rY
lItsc0l{st1{
ZONING OFFICE
796-2239 (HAMMOND)
425-8363 (R rVER FALLS)
HAMMOND, WI 54015
June 24, 19E3
M,L. ll otLace Hunlbett
Eau GaLLe Ptunbing
?.?.tl , Box 103 A
Eau Galle, Ul 54737
9eat Mn. Huttlbent,
Encloted ane the cottnected f,onnt on the GenaLd Ho.nnond
p,Lope,Ltg. I would Lihe to apoLogize (oz anq inconvenience
the nittahe in nanet nag have caut ed qou.
Pleate deatzog the [intnotice the nunben aatig
appnovalt guananteed. f,o(non youn nane to that
have bezn connected to
t
ne
n
tet thel I no.iLed to qou, at qou wiLl
d to have one o[ the liut 6ivethil q ean wat t implq t,Ldna 6erL,Led
Genald Hannond. 0un necondt
ow thit .
0 6
h6
Should you have dnu queationd on thit pleate f,eel (nee to
contdct thit o ( {ice.
Sincenelg ,
Manq J.enbint
Secrletdhq to lltL. NeLt o n
Enclot unei
?
f
,!,-. r.
f-i. , .
sr. Gt0rx c0uilrY
utsc0l{stil
ZONING OFFICE
796-2239 (HAMMOND)
425.8363 (R IVER FALLS)
HAMMOND, WI 54015
June 22, 1983
Dlvlslon of Safety and Bulld1ng
Bureau of Plunblng
P. 0. Box 7959
l,!ed1Bon, WI 537 07
Dear slr:
An on slte lnvestlSatlon for the Horace Hurlbert property
locared er the NEt, of the SEL of sectlon 35, T28N-Rl5l{,
Towo of Cady, St. Crolx County, revealed sultable solls
at a depth of 2.8 feet'beIow lrhlch seaaonable hlgh ground
veter uaa uoted.
Th 1s slte should be sultable for a mound syatem.
questlons, Please feel free Eo conEactShould you have any
thle of f 1ce.
Youra t ruly,
ThoDas C.
Aas 1a tant
Nelson
Zonlng Admlnistrator
TCN3EJ
I{ISCONSII{ DEPARTIITTiT OF INOUSTRY. LAIJOR
^ND
HUHAN RTLATIONS
DIVISION OF SAFETY & UUILDINGS, I]URE^t-J OF PLUI.TBING
P.0. B0X 7969, TYADISoN, UISC0NSIN l;3/0i
Verification of Exceptlon Status for an Alternative Private Sewage Systetn
ln the County of SE. croix
Location NE .ll4, sE l/4,Sec, 35 T__:!_N, R 15 txtdr8 r{
Town ot!{iltdtPllgx Cady Street Address
Lot No. _, Block
--,
Subdivision
L andorner's - l{ane:Horace Hurlburr
Ihe appl ication for thls site is for:
new construction use.
rep I acernent system use.
If this 1s t{EU CoNSTRUCTioN USE, the alternative pr'ivaLe sewaqe system is:
l-l to n"r" one of the first five approvals guaranteed for this year. This is
numher 59 - 04 - 4 of those applicattorls. (Use one of the first five
quota n[66EFs-Tii[eiFT6-you. )
I lone of the applications needing a quota nurtber. The quota numher assigned to
thi s appl ication is
[-]fo. one additional homesite on a farm to he occupied by a parent, child,
grandchild, sibling, niece, nepheur, or first cousih.
[-lfo" an individual lot for which a sanitary pennit was lssued but was ]ater
ruled unsuitable due to new or changed soil criteria established by the
departnEnt.
I lfo" .n application on flle prior to Februa
[-..1 fo. " lot that meets the cni teria for a co
If this is a REPLACEIEt{T SYSTEI,I USI, thc alter
replacing:
Ea fai ling conventional soil dbsorption sys
L) a holding tank that v{ds installod and in u
Ea privy that uas installed an<l in use prio
If this is a REPLACEI,IEIT SYSTEII USI and the lo
conventional private seuage systenr, check here
I certlfy that the above information is true a
kmwledge.
am Thonas C. Ne 1s on Signature
ry I, 1 980.
nvent iond I priva
ndt i ve pri vate s
tofl -
se pr ior to Febr
r to February l,
t mects the crit.t l
nd accurate to t
.,/
te sewage system.
elrage sys tern is
uary l, 1 980.
1980.
eri a for a
he best o ,)
'- /'-
icial )
Title Asslstant zonlng Adnlnlstrator D,rte June 2I, I983
feo,
DILHR-SBtr-6158 (R l?/82)
a STATE OF UISCONS IN-DEPARII.{ENT OF INDUSTKY, LABOR & H1JUAN RELATIONS
DIVISION OF SAFEIY & BUILDINGS - BUREAU OF PLI'MBING
P.0. BOX 7969 -. MADTSON, Wr, 53707
APPLICATIOI{ FOR THE USE OF AN ALTERIIATIVE SYSTEM
Locatlon:
NE K sEt s 35 T 28 N/R 15 [(nd!,I cad
S Ereet dress :Su lvls
ro i.':rsh ldxirrYi..! FILX!g]YX
n
Ha1
County:
St. Crolx
Landowners Naoe:
Horace Hur 1b e rt
reas :
RR# I, Box lO3A,Eau Ga11e, WI 54737
I (IG), thc udGrtltncd r hcraby Dake sppllcstlon for an sltcrnetlYc !y!t.E on
thc abovFdalorlbcd pr61!a!. I rccognl ze that thc abovG prallc. arc not
rultcd for a oonvcntlonel FlvltG rGr.agG !y!tcn. If approvel 1! 8r!ntcd. I
ag,rGG to have thc lyltGo lnltalI.d ln conforDanca Ytth the hrreaut! lPProval
of plen! end rp.cl flortlon!.
I further utdcrltrnd thrt an altarnatlvc ryster 1! Dore coopler ln nature than
a conycotlon.I prlvrtc !ave8€ lylteo atld as luch u1ll requlre detslled
lnrprctlon drlng conttrrrctlon rnd ionltorlnt aftcr the lystco 1! put lnto
uE. I str.c to p.rrtt both county offlolal! cber8cd Hlth a(blnlrtcrlng county
lanltary ordln.nc.! lnd Hr.au .rployc! or othGr tuthorlzed p.r!on! to have
eocGlr to tha abovc d.rcrlbd pralser rt lny rG.ronablc tlDC for th. PurPolcof lnlp€ctlon thc oonltructlon of or lonltorlnS of the syltan. I furthcr !8rcc
to clthGr p.rlon.lly or by !y .g.nt controt th. proper county offlolll to
rrr.ngG th. t1!. .nd d.t. to bagln conltruotlon of thc !y!tco.
I underltrnd thlt thl! .ppllc.tton doGS not p.rult DG (thc apgllcant) or ay
agant (Ur. oontrlctor) to bcgln lnltell.tlon. If th. lyltGD l! approv.d ' thc
Burcau vlll lcrd thc rppllc.nt a letter of approval uhlch authorlz.r
conltruotlon of th6 .ltarnatlvc lyltetr rftar all ncc.alary pcrDlt! have been
obtsln.d .
I egree to gtvc notlc. to any sublequent buyer that an eppllcatlon for an
alternatlvo !y!ta ha! been oadc and lf lnstallcd, that th€ pre lsGs are served
by en altGrnltlvG !y!tc[ and Itrthcr egree to glve the buyer a copy of thls
appllcetlon.
The Brreau acccpt! thl! sppllcatlon lubJcct to thls understandlng and subJect
to el1 thc oondltlon! .nd obllg.tlons rct out ln thl! sppllcatlon.
1ng
Slgnature of Appl lceqc
Subscrlbed and arrorn to before De
Thls day of
Da te
S TATE OF WISCONSIN
ss.
COUNTY OF
Nocary Publlc, State of Wisconsln
DrtnR-sBrF54l3 (N. 05/8r)l,ly Colmlsslon Explrea:
l9