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HomeMy WebLinkAbout004-1080-50-000 rY o a) C) o O or 4) ry a+ ~O w ° I °o I N O O m tl ~ N N j C 00 y C Gr L C N N - C Z ~ y I L ~ LL c N (n O C 4) -0 E ¢ Q~ I U ~ M d O E _N N J o I I Z d M H U) a co O O Z r y Z c z N H N v m w I ° Q z z O 0 N Z V C N `0 ~ N I C o v O o a` cn U) V) E o Y ~aaa Z a ~ m o 7 O (n 0 > 0) a) Q) N J U p) rn CNi C 2z a e- M - 0 O N O C d cn N m 2 'O O Q~ N m C N N r.+ O O N C O E O O CO C CO Cn C c a) O O. C p N O O U~ 3: o ENE ~a~ol U on 40. 00 f- M O O C: O co O y Z L ° N E f~ N F' G N F~ N E 00 i • ~ ri co E N o(n o E ~ ~ I v, - C) M U ~ I V ~ ~ ~ e € II C at a a 4 _1 A vat ',0U)Q r Parcel 004-1080-50-000 02/10/2006 01:38 PM PAGE 1 OF 1 Alt. Parcel 33.28.15.524B 004 - TOWN OF CADY Current X11 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 - CODY REAL ESTATE LLC CODY REAL ESTATE LLC PO BOX 296 SPRING VALLEY WI 54767 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 14.000 Plat: N/A-NOT AVAILABLE SEC 33 T28N R1 5W PT SW SW LYING S OF Block/Condo Bldg: HWYS 29 & 128 EZ-UT-1503/346 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-28N-15W Z-7 Notes: Parcel History: Date Doc # Vol/Page Type 02/07/2003 708765 2134/433 WD 07/23/1997 852/565 07/23/1997 851/611 07/23/1997 487/607 2005 SUMMARY Bill Fair Market Value: Assessed with: 106948 Use Value Assessment Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 14,000 36,000 50,000 NO COMMERCIAL G2 4.000 43,600 107,700 151,300 NO AGRICULTURAL G4 9.000 1,400 0 1,400 NO Totals for 2005: General Property 14.000 59,000 143,700 202,700 Woodland 0.000 0 0 Totals for 2004: General Property 14.000 14,000 103,000 117,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 z.(¢ 90 3( DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING P CATION LRBOR A HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLI P.O. BOX A9 S g117 State Plan L D.Number 'r lryl iii ❑ CONVENTIONAL El ALTERATIVA~Mo If assigned) Town of Cady 2 ❑ Holding Tank ❑ In-Ground Pressure d-7! 9 ( 1-7 S NA E OF PERMIT MIT HOLDER: 7Rt ESS OF PERMIT HOLDER: INSPECTI N DATE: hn Z mmerman .2 S g in Valle WI 54 ,7j S Jo; L V.: , CST REF. PT T BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM LAN: NR o Q Um a i, COQ - SCE. R .7 r: um Name of Plumber: MP/MPRSW No.: County. Sanitary Permit Nbe - 12870 Bennie Helg s - 321 S Croax SEPTIC TANK/ < r, n"r; • . ;`cw'r r*„`,"I S, MANUFACTURER: LIQUID CAPACITY. TANK INLET E T K OUTLET ARNING LABEL LOCKING COVER PR~OV_IDDEED PROVIDED: //ll~lJ2 ~C~~ Ur7Je~c% LONO OYES BEDDING: MATL.: HIGH WATER NUMBER ROAD: PROPERTY WELL: BUILDIPG: VENT TO RESH ALARM: FEET FRO\ LINE: f / AIR IN Ak [ NEAREST ❑ YES O t L❑ YES DOSING CHA l7. i'+?(Q=87P0 'A242' / ,3S v c>j Z)•T n a 2 6~ MANUFACTURER: BQ UID CAPACITY: UMP IAM6N MANUFACTURER: WARNING LABEL LOC PROVIDED: PROVIDED: 0'P~S ❑ NO CUES ❑ NO 10 Kj C ,c' O YES ~~OiL, GALLONS 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 ES ❑ NO NEAREST -111111- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) ~ta v v CONVENTIONAL SYSTEM: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID WIDTH: BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUM PROPERTY WELL: BUILDING: VENT TO-FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM A ET: NEAREST MOUND SYSTEM: G/ ✓ = /O 0 D/. /S Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW Ej~~S ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: ' l Q PERMANENT MARKERS: - OBSERVATION WELLS; I/ r (o I,~t~ ~r ES ❑ NO ES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TiKNGH/B D DEPTHS OF TOPjOIL: SODDED: SEEDED: MULCHED: CENTER: ~I EDGES: tI c 8 Z /i ❑ YES C CAS ❑ NO Z;;-E8 ❑ NO PRESSURIZEDRIBUTION SYSTEM: < f-,~ WIDTH: LENGTH:f NO. OF TERA-t NG: GRAVEL DEPTH BED/TRENCH TREN BELOW PIPE:, FILL DEPTH ABOVE COVE~t~ DIMENSIONS CES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING: ELEV.: I ELEV.: DIA.: ELEV.: . , I , PIPES: DIA.: 4/ P (1 VC, ELEVATION AND OO ct DISTRIBUTION 04 HOLE SIZ~! HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO ! INFORMATION APPROVED YES [ ~'NO f 7' Z C~'Y~S E] NO i PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPER WELL: BUILDING: FEET FROM COMMENTS: 1&6r LINE: t 5;1u NO E;1 II NO NEAREST >1W 8y~! Cove,~GS~, G~9 C, -5 d-9 MA-L :d 'S 6,,1 diAo,&Avd' = 3,75 ~9 191 o SRetc S`y~s m oR n~ In in county file for audit. Reverse Side. SIGNATU TITLE: SBD-6710 (R. 06/88) DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ i'~ Y76 3 8% x 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S90-00700 PROPERTY OWNER PROPERTY LOCATION John Zimmerman SW '/4 SW '/4, S 33 T 28, N, R 15 ¢'Xor) W CK# PROPERTY OWNER'S MAILING ADDRESS LOT # BLO Rt. 2 N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Spring Valley, WI 54767 715 772-3201 N/A ID CITY VILLAGE NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned Cad Hwy 29 ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUM Ill. BUILDING USE: (if building type is public, check all that apply) 004-1080-50 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ® Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. 0 Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑x Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 685 570.83 570.83 1.2 37 101.25 Feet 103.55 Feet CAPACITY Site VII. TANK INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New Existing Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank 2000 D 2 Midwestern Precast Lift Pump Tank/Si hon Chamber 1000 1000 1 Midwestern Precas x Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): P7y~,1 ' Signature: (N7Sta ps) MP/MPRSW No.: Business Phone Number: Bennie Helgeson 3215 715 778-4425 Plumber's Address (Street, City, State, Zip Code): Rt. 2, Spring Valley, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued Issuing Agent Signature (No Stamps) ® Approved ❑ Owner Given Initial 0 0 rcharge Fee) 7 90 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawl to scale or with complete dimensions, location of holding tank(s), septic 'tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) I APPLICATION, FOR SANITARY PERMIT 8TC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any Inadequacies will only result in delays of the permit Issuance, Should this development be Intended Lot resale by ownst/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property JOHN ZIMMERMAN Location of property sW _1/4 [x_.1/4• Section 33T_28__N-Rj_, V Township LADY Nailing address RT. 2 SPRING VALLEY WI 54767 Address of site RT- ~~IT--_1. -q'7 •ubdivlsion name Lot nunbe= Previous owner of property ff_u6- Total size of parcel /`f A Date parcel was created I R6 6 Ate all corners and lot lines Identifiable? Yea X10 Is this property being developed for resale (spec house)? as ~No Volume 15A and Page Number 6415 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the 8EAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(Ye) certify that all statements on this form are true to the best of any (our) knowledge= that I (we) am (are) the owner(s) of the property described in this Information form, by virtue of a warrantyy deed recorded in the Office of the County Register of Deeds as Document No.452052 j and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above -described property, for the construction of sold system, nd the same has been duly recorded in the office th C unty Register of s, as Document No. 1. f n e o Owner Signature of Co-Owner (If Applicable) e'0 Dat of a1g ature Date of Signature - .,,,vemel ncC~R1PtiON AND PRIMARY USE 000MENT NO. STATE BAR OF' WISCONSIN FORM i S9S2 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 452052 565 ~ REGISTER'S This Deed, made between OFFICE ST, CROIX CO., WI I! a sir><g~~..ma~i ; Recd or Record f Grantor, l1V i 0 3 1989 (I and._........ail-m....Z mm-0rman..And_.Debra•R. -Zimmerman--• Ct 8:30 A.M bUsband.,and. wife„as ,survivorship marital.property y, Grantee, Register of Deeds Witnesseth, That the said Grantor, for a valuable consideration...... ~I Oixe.-~?.q-liar.-an~l•other,valuable„consideration conveys to Grantee the following described real estate in .,►~tf,.-- , RETURN To County, State of Wisconsin: it All land lying South of Highways 128 and 29, Tax Parcel No: located in the Southwest Quarter of the Southwest Quarter Mi of SWU of Section Thirty-three (33) ii ~I Township Twenty-eight (28) North Range Fifteen (15) West. j FEB This ....1S..I19t homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all easements, restrictions and rights of way of record. and will warrant and defend the same. i. Dated this .............11th........................... day of September................... 89 19_.. (SEAL) , ..A ....(SEAL) * ughes A. Cardiff (SEAL) .................(SEAL) * I I~ AUTHENTICATION ACKNOWLEDGMENT it Signature (s) i STATE OF WISCONSIN' SS. Q CPe rii me ; authenticated this ........day of 19...... Personally came befd 11 y re me this .....th 11......da of BAsR•- tember : 19.89 the above named Hn hes A Cardiff g............r TITLE: MEMBER STATE BAR OF WISCONSIN " (If not, authorized by § 706 ?06-.06, Wis. Stats,) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY p ROBERT J. RICHARDSON Jv~ 1Vo~rd ..Atto'rney... af_.LaW * l, ........~'.Cr..e..., II Spring Valley, IN1.42.62 Notar,Publr(ic ._.....~...;tl County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission ,iss pe md.ffient. (If not, state expiration I~ are not necessary.) date: a..... ptgmber 9Q..t, I is-90 ) .a t Lf " ' , II y. -Names of persons aigning in any capacity should be typed or printed below their signa0es. r~lsc STC - 105 i SEPTIC TANK MAINTENANCE AGREEMENT ` St. Croix County. OWNER' /BUYER JOHN ZIMMERMAN ROUT /BOX NUMBER RT. 2 Fire. Number CITY /STATE SPRING VALLEY, WT ZIP 54767 PROPERTY LOCATION: SW SW Section 33 T 28 N, R 15, _W. . Town of CADY St. Croix County, Subdivision Lot number Improper use and maintenance of your .septic:system.,could result in its premature failure to handle wastes.:. P.roper maintenance"con- si6ts of pumping out the septic tank every three'. sooner, if needed, by a licensed septic tank um er.'' What,you p.ut into the system can affect the function of the septic tank as a treat-. spent stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a `maximum of 60% of the cost of replacement. of.a failing system, which was in :operation prior to Jul.y.l, 197:8. St. Croix County accepted this program in August of 1980,'wieh the requirement that owners of all new systems agree to keep their systems properly ioantained. The ;property owner agrees to submit to St. Croix` County. Zoning; a certification form, signed by the.own.er and by a. master plumber, journeyman plumber, restricted plumber or a.lic'ensed pumper vert- fying that (1)'the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than l/3 full of sludge and scum. Certification form will be sent approximately 30 days. prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with ..the standards set forth, herein, as set by the.'Wlsconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 clays of the three year expiration date. SIGNED: 1) ATE St. ~ Croix County' Zoning Office P.O. Box 98 Hammond, WI 54015 ti 715-796-2239 or 715-425-8363 Sign; date and return to above address. INbND6^iMENTOF REPORT ON SOIL BORINGS AND SAFETY&BUILDIN IU~Y, DIVISION N LABOR AND P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS 115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNSHILOT NO.:BLK. NO.: SUBDIVISION NAME: SU) %Se4 LQN/RISE ( AT COUNTY: OWNER' BUYER'S NAME- MAILING ADDRESS: sfi c) r hUL" 0,J-C_ rlV1 0- 1~c . S~ 76 USE D ES OBSERVA IONS MADE NO.BEDRMS.: COMMERCIAL DES RIPTION: PROFILE DE CRIPTIONS: ER AT ON TESTS: esidence ~J warm E uyome+v ❑New Replace !b 30 / v 4 7 >Qo~c 9G ~ah RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑sRU NS ❑U , ❑S01 ❑SNU IX(S❑U M L"_k If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the h under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /n~~ []l PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-M eHgS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHi#, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE BBRV. ON BACK.) 18 T B- ` / 910. y 1~ Ovl 7 S. t 3 5: MFD crg-~p1 I.!'~ H~ aly t C O!Qtj, I- G4 o I. . D C Oki t B- 44, .6,161 S;I Tj 3.4' 8" S' I en-i. G7 Hof B-3 7S-(,.9 It (~C~~ , 7'' lls. Ts .3'1. 5/ .7 1,f " S. 6►1. r r i x'7' 81 S. TS , LP ©r~ r Gj • H. B- q '7 B- S , S 8S .71 I I , • 7"131.511 TS . 2' Gy S;1 '~'i,, p ©or~. Ho B- b 671 11 ! .5"Dk6,, Sid Ts 1147 184. i hr4 arvA0 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER1003 PER INCH P -e.. 30 / y j- -3P- 2 Vs " ! 021 P- P-_ P 1 1d P- PLOT PLAN: 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 slope. rn SYSTEM ELEVATION o~►, o~ Rom ~e~ ve. FS H' I t a r I e I i ( E ! { i '7'? .z _ lip - - - - - I [ - ~ I ( 3 a I ~ 1 ~ ~ 3 ~ r _ 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: e c 1"1 7 8 ADDRE : CERTIFICA ON NUMBER: PHONE NUMBER (optional): © 304 7 -,14a~- CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRI - - To be ete and accurate soil test, 4 r:.~=ort must include: I. co i, C_scription; 2. The use ndicate wl- is is 10 or commercial 1 )j(- 3. drooms or eom use, mt system; .rng boxes. A SITE IS SUIT, FOR A HOLDINGS TANK ONLY IF ALL YSTEI'dl. ULED OUT BASED ON SOI'_ 'ITIONS; jrw the is shown here for writing profil 'ascriptions and completing the plot plan; L'71-' accurately ` gating Your test lu,ations. Drawing to scab, is n-r>ferred. A t ("c- fired; and vertu rion l eferer 1 point are clearly rn ~ncnt; C), 'i . > hexes r<. names, ~J food plain data, ; A exernp- ch as floc-' „'-,vation} does m dace N1 A. in the,,ppropr iate box; ~..Ce Your cur 1119 Your r. r numher; dktrit) +1. ALL SOIL TESTS MUST BE FILED WITH THE Y 1THIN Ol1IPLETIOi. AR£ REV"."., . FOR CERTIFI_ `'IL TESa - c As B'do Bir P, - G _ y R rich. - of R P ' t 1 - - I - -i 4-4--j i I ~ 1 I I ~ j 7-- 10 I I T' I I l i l; I; I I ~I i i S ~ i ' Ili ~ i I I Fri I i I I I i i i I I I I i I - - ~ ; ~ I _ I ~ I II i ~ ; it I ~ I ~ i I tp I I I I I I I ' I TFF ~ i ~ I I 7I ~ ~ I I ~I I ~ ~ I i I Y T I I i ' ~ i I i I i~ i ~ I~ ~ I I I t ' i z- i I I L_ ~ I ~ I ~ I ~ i I - - - - t - -a-- - - a - 11-1- fief ~ 1 i 4 - - I, I I ~ I I I I I } - i- - t-- I I I ~ I I - { f I f I - ~ I I I I I ; ~ I ~ ~ I I r , j A i t I I I I 11 i { I i I T I ~ I I ~ i I I i I t I ~ I 1I I i I I I I ' I r ' i I i ~ I~ I I I I C1 ~ I ~ , I ;;;ICI i; I 1_ I I I- I I I ~ I ! I l I I I I t I I I j ~ i~ ' I I i 1 I~ ~ I 11 1 I t f i f ' ~ ~ j I 1 I I I ~ { I I ~ I r ~ I I ~ I I -1 j i I 1 ~ j I H4 AS BUILT SANITARY SYSTEM REPORT OWNERJz>L,, ~rv, irn errnrLr,,-TOWNSHIP SECTION ~Tj~N-R~W ADDRESS ST. CROIX COUNT WISCONSIN Op SUBDIVISION LOT LOT SIZE PLAN V _ SHOW EVERYTHING WITHIN 10 BET OF SYSTEM loco 6,(Ct3~ r-N i Y / bEJ Ck / f7 > 7 INDICATE NORTH AJOW BENCHMARK:Elevation and descriptio 01- ° Alternate benchmark SEPT TANK.Tnufacturer Liquid Cap. 00 Rinq 1%sed:_Z_Man le cover ele "Final ad I .1,.ev~~o jr Y Tank inlet elev. Tank outlet elev.: No. of feet from nearest road:Front , ides, R ar~Ft.33s" t q LFt.~S 13 From nearest prop. line:Front , Side , Rear (A) u' No. of feet from: Well, Building: t L~ R+! , (Include this informat' n/Qin the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: QCs. cc `Tr Liquid Capacity. lCf iC) Pump Model: W3 Pump/Siphon Manufact.: ;cud Pump Size i,;s-A4Elevation of inlet: Bottom of tank elevation • Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side-, Rear Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length_jL, Number of Lines: Area Built~7~ 2 Under "b Exist. Grade Elev. 9./~ Pro sed 'Final Grade Elev.-/63_-?7 Fill depth to top of pipe: f ~ No. feet from nearest prop. line:Front , Side , Rear Ft. V No. feet from well: No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR:, i,,.,. `T U.~.R► - DATE: ,7t/ % PLUMBER ON JOB: LICENSE NUMBER: 6/90:ci Plat SCL I-e s Roowx Shop we loon Gal Se W KITE 14 3 9 0 S~S,LM PIG~ W 1~P P . GDaRES y„POD WeAl L% ,(y e'~e , ~X r Sfr n S 1`~ro~oc iooo G~,1 3 BeeQ_ Sep r c 1•oC a 1 cr o~ < sj p S~wc~ S ~ t. `JIeP< pre(~ose~ OD C,. A- Poc ~orc•c Mow. .3a Q~ h ~ ~ropoS¢cQ , C ~ Sl oP c 9. Mputi.~. / / a'7o 1 DrWe.,~L~ ~ slops. Sc,.1,p I rr~ yD~ / 6 9e '63 s~e~t 8 e 3a'\ ~Y sp~k~ o~ R.bbo~ 3' A.bov-c- Girmul 6 96 -Th NS Power Po It X407 Sfofe 7 cr o L r.• t I j, PROJECT: JOHN ZIMMERMAN ' SYSTEM SIZING 3 Bedroom Home 450 Gal. Daily wastewater"-flow Retail Store - 2560 Sq. Ft. For design purposes will will use 3000 Sq. Ft. 70% of 3000 = 2100 Sq. Ft. 2100 Sq. Ft. / 30 Sq. Ft. per customer = 70 customers 70 customers x 1.5 gal per customer 105 Gal. Wastewater flow 4 employees 4 x 20 gallons 80 Gal. wastewater flow 1 Floor drain 1 x 50 gallons 50 Gal. wastewater flow TOTAL DAILY WASTEWATER FLOW 685 Gallons 685 Total wastewater flow = 570.83 Sq. Ft. of Absorption Area 1.2 Gal. per Sq. Ft ONSrM 'SEWAGE BYSTEA4 A ATMENT OF 11 VI) 0 D EPA DIVISI ` LABOR AND G R TIONS D S AR PO E ~wher : o r -VATS % y - i3-So - i h ~ h ~o~ rr. ~ i w► ~ ~,r Page_ of _ e - Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H 0 0 Topsoil = ___-.mss _ F 1 3 E D b SEND IOU ONSBe 2 %2 Force Main Plowed V Q~ S~ egate From Pump Layer QA~ D .~.0 Ft. QF~Na ection Of A Mound System Using EFt. '~Q~~~~Np\V ~ SAO Bed For The Absorption Area F Ft. p ~~E G 1,C) Ft. Signed: AFt. H _1,~ Ft. '71.5 = e Ft. License Number: K 1'3 Ft. Date:?. 5` = L ~t. 1 J in~5~ Ft. Alternate Position 9q of T 12,_yjFt. Force Main W :31 Ft.' 3'~y Observation Pipe 3g-' B ' K o 17- A W Distribution Bed Of 2 2 /2u Pipe Aggregate Observation Pipe Permanent Markers cam' ' 0 4 h - f ' ~ A ~cr01 S (Op C~. r ' bc~3.7 C99.IS~~ tc- 1.7 ieR~ Plan View Of Mound Using A Bed For The Absorption Area cl~ii~' 11~ ~..Y'' l ) e~ 1A ~ ~ rv~ V~~- P ~ 'wfJt (D i Lq LA. .l wtc, y-13-~~ Perforated Pipe Detall /0 End View )Perforated End Cop Ott ~b PVC Pipe Permanent End Markers Q~6 dot` ,ac` s Holes Located on Bottom are Equally Spaced • ~ P ~ ~ ~e5 T2r~ l~~s f to. P-e ' PVC Force Main r 6c f From Pump ENO PVC /P Manifold Pipe Cpp (Distribution.. Pipe Last Hole Should Be Next To End Cap AG t i e Layout 0 pR aN W s P 33 1Ndu ~ of F A . pEPPR*END,vyS1 R 0 LJ4 G ~ S EE Go~R~Sp~N X Y Signed: L Hole Diameter Inch License Number: / Lateral Inch (es) Date: 4--1 c-~ U Manifold Inches Force Main " Inches S ~ 5`'`,', ,,y f- 5~. A j. r, L.b,S1,1q ~1r'- ~1 t~ V~ v~ .i_wmsAn G-1C U1/~ cx.a•,~ PAGE p F 4 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS -VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER ~ 25' FROM DGOR, WINDOW OR FRESH 12"MIN. AIR INTAKE I GRADE ~ y" MIN. I ~ 18" MIIJ. CONDUIT • 18"MIN. oleo. g9 f~ INLET SO NO ROWDE TIG SEAL I I ~ APPROVED JOINT A V ~~Q1`~+ I I APPROVED JOINT! W/C.Z. PIPE I W/C.I. PIPE EXTENDING 3' O I I OWTO SOLID SOIL Q~i I I I ALARI4 EXTEND IJG 3 g O 1 I II ONTO SOLID SOIL S I 1 c ~pPR~ Dv1~NN ' i oN PUMP, OFF CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER AS SUCH APPROVAL I000 CSI SPECIFICATIOUS G l. Pe SEPTIC AND A~ DOSE TANKS MANUFACTURER' S"1 j l lCPC e is -lJ1-P OQ~f CUMBER OF DOSES: PER DAS GALLOUS DO ,4E VOLUME: _-GALLOAIS ALARM MANUFACTURER: 1 tick Fl out 6S n ~ - S CAPACITIES: A=INCHES OR SS?• •~,ALLOIJS MODEL NUMBER: _ ' B= Q INCHES OR 82 GALLOW5 SWITCH TYPE: 1- _ C=WCHES OR c0110,q , GALLONS PUMP MANUFACTURE R:C~r1~~ i D=jIA1GHE5 OR 1.31.,t2. GALL-O►JS MODEL NUMBER: W~03 P4 NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: /A fY Lk Oct INSTALLED ONp SEPARATE CIRCUITS PUMP DISCHARGE RATE GPM 4s 4)tR w Ac J/ VERTICAL DIFFERENCE BETWEEN PUMP OFF AMID DISTRIBUTION PIPE.. _LL FEET 0 + -I- M,lNIAUM • NETWORK SUPPLY PRESSURE 2.5 FEET _j_ FEET VV~~ ~a OF FORCE MAIN X FYoIFtFRICTION FACTOR.. I FEET 1J TOTAL DJNAMIC HEAD = FEET INTERNAL DIMENSIONS OF TANK: LENGTH . ;WIDTH .S S,r;LIQUID DEPTH SIGI~IED: LICENSE NUMBER: DATE: -!3 ~iU : TO k IV t Vy\ yYl C~_~ m ►1 Submersible Effluent Performance Curves Pumps METERS FEET 90 ' MODEL 3885 25 80 SIZE 3/4" Solids G WE15H = 20 WE10H 60 15 70 WE07H 50 WE05H 40 10 30 WE03 20 WE03L 5 -77 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I i i i 0 10 20 30 m°/h CAPACITY CAD'. GOULDS PUMPS.INC. { j seCEcA FAUS rFw rM GW8 METERS FEET 1-11 120 MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH 100 30 90 25 80 I NI 70 Z 20 60 O H 50 WE_05HH 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i t 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. EfNKIW9 July, 1985 Wisconsin Department of Industry, QNSITE SEWAGE SYSTEMS Office of Division Codes and Application Labor and Human Relations Onsite Sewage Section • Safety and Buildings Division 201 E. Washington Ave., Rm. 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 t (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code,which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave.. P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. Plan Number Previously Assigned 1. PROJECT INFORMATION (Type or print clearly) Name of Submitting Party (plans returned to same) Project Name Bennie Helgeson John Zimmerman Street Address, P.O. Box # or Rural Route Project Address or Legal Description Rt: 1 SW 4, SW4, S 33, T 28 N/R 15 W City or village State Zip Code City ❑ County Spring Valley, WI 54767 Village ❑ of ; -Cady - St. Croix Telephone No. (include area code) 715/778-4425 Town Designer Name of Owner Bennie Helgeosn John Zimmerman Telephone No. (include area code) Telephone No. (include area code) 715/778-4425 715/772 3201 Street Address, P.O. Box # or Rural Route Street Address, P.O. Box # or Rural Route Rt. 1 Rt. 2 City or Village State Zip Code Ci or yillag Zip Code. - S r. in Valle WI 54767 zpring'valley , WI54Sy6k' 2. APPLICATION FOR: ❑ Experimental ® Mound System ❑ Holding Tank ' a ❑ New Construction ❑ Large System ❑ Conventional Gravity System ❑ Groundwater Monitoring ® Replacement ❑ At-Grade ❑ System in Fill IN Petition For Variance El Revision ~l Pressurized System ❑ System in Flood Plain (attach SOD-6698) ❑ Other Alternatives _3_.-FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE , MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. a. 750- 1,500 gallon septic tank $ 50.00 100 r b. 1,501- 2,500 gallon septic tank $ 60.00 3 C. 2,501- 5,000 gallon septic tank $ 80.00 z d. 5,001- 9,000 gallon septic tank $100.00 e. 9,001- 15,000 gallon septic tank $150.00 Over 15,000 gallon septic tank $250.00 g. 500 - 1,000 gallon dose chamber $ 30.00 •30 h. 1,001- 2,000 gallon dose chamber $ 50.00 n i. 2,001- 4,000 gallon dose chamber S 70.00 J. 4,001- 8,000 gallon dose chamber $ 90.00 k. 8,001- 12,000 gallon dose chamber $110.00 I. Over 12,000 gallon dose chamber $150.00 I M. 500- 5,000 gallon holding tank $ 30.00 n. 5,001- 10,000 gallon holding tank $ 55.00 o. Over 10,000 gallon holding tank $100.00 P. Revisions $ 20.00 t q. Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r. Petition For Variance: Setback $ 25.00 Site Evaluation s 50.00 50 Subtotal: 190 s. Priority Plan Review: Enter same amount as Subtotal Total Fee: 180 SBD-6748 (R. 04/88) NOTE:Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER + are subject to change annually. Sa_z Department of Industry, Labor and Human Relations REV. 2/81 Building 1NSPECTIONDATE Inspection Report and Orders FILE NO. I { 2-27-91 E - OWNERSNAME OCCUPANCY INSPECTED MAILING ADDRESS LOCATED AT (STREET ADDRESS) Rt. 2 29 East CITY STATE ZIP CODE CITY COUNTY S rin Valley WI 54767 1 Spring Valle lqf.- Croix An Inspection of the above occupancy discloses violations of orders of the Dept. Of Industry, Labor & Human Relations promulgated under authority of Chapter 101 of the Revised Statutes of Wisconsin. - Plan No. - SEE REVERSE SIDE FOR APPLICABLE WISCONSIN STATUTES NOTE ITEM ORDER REQUIREMENTS: ® Done ® Not Done X' 1. ILHR..... 50.12 (2) Submit general building plans, structural plans a.* III heating and ventilation plans along with calculations, fees and Ts; form SB-118 to this department. These plans shall detail the building being constructed as Valley Enterprises which is located at the above address. a; s 5 s 41 ~ ,KR ' CC: ST. CROIX COUNTY ZONING a° C' 'Co -4 3. ;ycGiNl l (o , R. CHECK ONE OF THE FOLLOWING: BLUE COPY: 1st SB-6 GREEN COPY: 2nd SB-6 ❑ 1. Close File Reinspection Date: 0 2. Abeyance Deputy E3 3. Final Letter Person C c cg0jJh: Luster ❑ 4' Extend To: Title: COMPLIANCE DATE r 7f c M.M State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BENNIE HELGESON Owner: JOHN ZIMMERMAN ROUTE 1 ROUTE 2 SPRING VALLEY, WI 54767 SPRING VALLEY, WI 54767 RE: Plan Number: S90-00700 Date Approved: Apr1 30, 1990 Gallons Per Day: 685 Date Received: Apr 1 16, 1990 Project Name: ZIMMERMAN, JOHN Location: SW,SW,33,28,15W Town of CADY County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 266-2889. Sincer y, 44---E. PAGE Section of Private Sewage Division of Safety and Buildings PPP013/0009n/ 7 cc: JOHN ZIMMERMAN Private Sewage Consultant County UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health SBD-6423 (R. 08/88) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 , 1 J !i t Madison, Wisconsin 53707 AV r i 1 27 I I ff f John ~irl:~ rr:;an route 2 S;) r i r I r `VaIIcy, 4I 7U L,ear Vr. '7'w)errian: ke: Jn a lir:!;;C'rr:9dr1 - ~<<si(ur)cc Gnsi,te Sev.-&cie Syster, Torn oi" Cady$ Wit. Croix County, 4:I Your petition for vari;,,.nLe to st'ctlun ~iscorsin fit,,?inistrativv Co6e, has been r(.iOCV&L. ThE? '1"ul b'(J j'i.4, PE'ti t I C"n roga'i res a ! ;Our(: S;lyste'i'i s i',e i:C, havE: c 137 Y'iii:iual of '4 inches of suitable naturol scf l . the variance Yi(:jue t(`d' ~~s tc install a Y j.;i t .'t«C'.tSt ),=o(!r( syste(: cn a site with 1/2 inches of sui tall o natural soil. The follo3,in cul rserlis tb--,re ;:'ciao it', V: 1'elit.ion arialysis: 1 In reviewinij the pet.itiorl, it wets ncrECl t )ot tnk request was sifniiar to otl t.,r petitions accepteo b t; ,i s c!ei arti.;~:r7t ural-,,,r ~,~e ti ti en nui,lbers l V: l v, df?C" J il)-~ iti=f L . S89-C,3364, 2. L ds!?C` on tt-ti 3;reLi(,.,nt e stciu e i sh,E'(: .)V the j rt vi UI. s petitions, trii s Petition Tor variance is b0tin I rCCCSSC`G i,s l trs'7tteta uy eiisconsin ltl.~;~ ()`C). Statute C:ticr, i i SBD-6926 (R. 10/87) TT State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 c `r.lf ::1 ri Madison, Wisconsin 53707 Pc(; L i its 5 ai;ssr'( Vr~ I 1 s rrar,t~:( of tk ifi(:: l:rlGsa""Sta{~~.i 171: }ia~ al i Of tlrc fa?t7 ti User' S rtat~;,;er;ts ani~ ar,y carati i iur~s ol, apj'rcVal eitC'L abOVC, 011 be carr,ieL out. i'ctNr i. ;'u~.:el Pl ar+ i-xar,•i r)e r Ur)si t/ (ldt r t Scct.i or I 1'' Envi r•onr yen tal Eric ireer, - : upervi saw, Cr+si i;( L~+~ c:( "'l ar pl a i I i~r I jr } i elar,rti;er? al Si4ni.ur(:: Late: rt: i'(" .,r r;r I i t ct I irr ctor, u tiCe, of ! ~Visio uuo"es anL AppliCatiGrr I ' Lnc. cc: t.ercd jar)sCtj, rl-iVaie ('0(i'-tAl <ar)': - i i~tr1c.L is, it)ij 1'C~•c° polls j 7W;,as l elson, onin( r.(i.Joisi.ratcr Gr(»x ..vurty ~ {>~:r:n~ e E'iel (~fsorf, t'l a .slc- r f SBD-6928 (R. 10/87) State of Wisconsin Department of Industry, Labor and Human Relations P: T''Vf~T { ~t r> AU H AN t;f~'+~,~L~~11 E SAFETY & BUILDINGS DIVISION t ih 4.± ; S = a ti ai. i t `~I 11{ 1!,`F 's; `so•. ri; `r h'w ~rIN" _5~, ~ .;~t~ 1•a- A. ~ a 4 ~t y , )may ~t+. rzI~y r,tri l :s f ~S.I1 ~G i i it .~¢i' °.Il i,~i' t,tii . I 1 f'I`; `,a' 1r1 t ~.t:r, ...i 1 ~ ~ 13r' t i;., *f:. ~ ! t 't' ~'E.~i l•r~',i I C a f{I'~T ~ .1;' Y ! ~ .i^a', F;~f 4'1' +,ar i.';~r r ~ 1 i i a ii' !,'li ~ ~ '!I; i f°i~ii`i'3 t.' t . Lill .~i 1, t •f ! i ! a''".3 ,tt ~1r~ i ' iyr si !tF't1"',1 iaitj ,.pail fil SBD-6423 (R. 08/88) State of Wisconsin Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. 1~ ri r i i 'e'7, (t ` Box 7969 " ;Y Madison, Wisconsin 53707 G: t` Jul r( F'.ow to I t Cc,ar ,,r. Zicii:eri,;6 is lut'ifi of l,'a(,,y, '3l.• urcix Lqunty, I:1 f Your i+l'i:i"LiC+Ci for, vorianci tc 4k.lCtitr IL ii~''t.,'.L' I ~~C J, ~'•15(:(3ri:ilCi fi0CiilrliS-r&tiVf Cc,(x, W.S OtEE'Ii -re V1C>ti('t. a}►. . {}iC r"C[iE.' i iot;i,d rtCiL4ir`f' . :1 i"ilurfi; SVS1EG. Si havi: d G1iCiiGrle~;'o of 2; i n(-hes tit sui taol c ria tural soi 1 . i kiC var, i r,'. ues L01, "'Cts to i ris-'a I I r(:!.) S i':(A4r"e7 syst .'ii. ur: a si't . ~ c~rire wi tii 1.'. i ncks of sui t.a i e l,&t.iral soi 1 . 7"1pCzu 1ri t,i;Fi r 1. 1r; reVi6'A1-i(; t1'.u It vr`a`r iiuteu tr)G% tw..' nzzques>~ V~as.5iriilar to t) h(3 r r)etitiCi-is cccCIpti.r tiiiS ntiiw-,rs I 3 L. i•su" on t_ht- rr°~ iUiS p;t1.1LiCris, this pai ti oti for vdri arwc, is t'wi ri(; 1)rucessuc as reriA tteu u'y wi sconsi n SBD-6928 (R. 10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION i 201 E. Washington Avenue P.O. Box 7969 John l i ±r.! r. ,a r➢ Madison, Wisconsin 53707 Ik F, 2 April 2`7, 1~'9(l- a 1)'gp;,rr;r ent.al i.ct.ion: "t,',.~rovec. [his ai,ifwuvc~l is crarlu.,u wi tri the trr;< erstari~_i rub. ti,a t all of the Neti ti oner's st.ater:erits anti any con(AL- ons of approval citeu aLove 01 1 be carr'iec out. i'ctFr L.GJt~ Plarr Exar.Jr&r' Gnsi te:: `aeuage '%ecti on (c~v~ 266-2U5 rli-GCk.w e 7 IE I , t~er P , Cif sJ £nvi ronr:ientaI E n ~ i riceY, - SuPervi sor°, Onsite Cea+u:,e Plar,/Plat f•evics; 1. be : artr.'rePit.aI 5i c,rlaturu: Cate: k• i' rt'.. cyer, r.f :i tt ct Ew a, i irector, Office os E ivisior, i,aces ant Application Eric. cc. Lccroy Jans'rcy, P)-ivaie Cansrsl tart - uistr•±c:t 6`, Chippei,& ~~11 Thori,as I el son, 'Zorii n(j ><;di-A ni strator - A. Croix ;"ounty b6nni e` l;c l r;r tc;rt, ~l ur,: to I SBO-6928 (R. 10/87)