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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 - STATE OF WI CONS COMM STATE OF WI CONS COMM X MADISON WI 53707 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ~r Gv 1~"~ SC 2611 HUDSON 111 SP 1700 WITC i Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 08 T29N R19W SE NE OTHERWISE Block/Condo Bldg: ASSESSED Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/23/1995 Description Class Acres Land Improve Total State Reason STATE X2 40.000 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 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 O ~y U; ICI i t> ~ J ~D T` W lj) t ~w Y ~.J G 1,u ~t CO n DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR A HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISrRN, WI 55707 NE 5E g,Z~, l9WCONVENTIONAL DALTERNATIVE crate Plan l.D. Number: -g n D Holding Tank D In-Ground Pressure ❑ Mound -02zs Tow o c r NyD,So,J NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE STAKE D N R Pt -1- W ILL01 FJ RLvii;k St` "11-= t~K , I "osu N, wZ ~j-ZZ-~(o BENCH MARK (Permanent reference patntl DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. "MP OF Et.f~. TRf~f fL2N~~' BCOL 100.6 , Nanu! nl Plumber. JIIIIIILMPHSW Nn Cnwnv Sanitary Permit Number. -r U~aRICN~ 330 s.cRo~ 8? SEPTIC TANK/ MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV NIYES NING LABEL LOCKING COVER W~~ r c VIDED PROVIDED ~J (~0 VA,L. 91.3oj w7-IS ENO ES ENO BEDDING. MINT DIA.`,.~ vt-w MnI I HI(lH WATER ROAD. PROPERTY IWELL BUIL ING. VENT TET 1 J FRESH INSP 124SGJZ W , Qls ALA . RM . -TIP EET FUMBERROO T YES DNO " G= F ]YES Ci ~1f! NO NEARESTMF NtQ LINE Z- NF4 I3 AIR INNLWA DOSING CHAMBER: MANUFACTURER ~71 IOUII I CAPnCl I V PI IMP MI ID1 l PUMP, SIIIHON MANUI AI:I OH1 H WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDENO DYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL [NEAREST UMBER OF 1l,HoPfHTY WELL BUILDING VENTTO FRESH (DIFFERENCE BETWEEN EET FROM LINE AIR INLET PUMP ON AND OFF) DYES ENO --0. SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NI.TI I 11AAMI if R JMA 11 FHAL AND MAHKIN(, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH INO OF UISIH PIPE SPAI:IN(. COVER JINSIDE DIA =PITS LIQUID BED/TRENCH E F T11111:1111 E MATERIAL DEPTH DIMENSIONS I0 NPt (0 5yNTNETkC PIT WA- NJ A- Ph GIIA L )H FILL DEPTH ,Sill PIPI UISTH PIPf DISTR PIPF~ M^A ERIAL NO DISIE1 NUMBER OF 'ROPE Y WELL BUILDING VIRNT TO FRESH BE, DW PIPES ABOVE COVER f V IN11 I tLL V 1, U I ~wI^1~1T PIPES LINE A IT ABOVE E FEET FROM r L _ Cf3.S3 ~i3,1,48 I~STNa_)] PUC_ Z NEAREST-----m- NA 40 S(vrt MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE [1111MANIN' MAHKI IIS OlISE HVATION WELLS DYES ENO _D YES ENO DEPTH OVER TRENCH BED DEPTH OVER THENCII HE 1) DI POI of TOPSOIL S(n1Uf U SFF UTU MULCHED CENTER EDGES DYES. ENO EYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATERAL SPACING [HAVEL DEPTH HE LOW PIPI FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANITOLOMATLHIAL N(1 UIS H ID ISTH PIPE DISTHIBUTIONPIPL MATERIAL a MARKING ELEV. ELEV DIA ELEV PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACIN6 DMI-1.I O COHH! CII Y COVER MATERIAL VEFITICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ENO EYES ENO COMMENTS: PERMANENT MARKERS JOBSERVATION WELLS NUMBER OF...' PROPERTY WELL. BUILDING: FEET FROM LINE DYES ONO EYES ENO NEAREST--- I . to j_octC REQ , Ell SEPTIC TRrJIC wcKLai coV P: F p T. z . PI.-A0n ra t'Rov IliQC I N s u L,P,T. k) ov 841 co sewer 1 3. uo WEI..'I,_ AT 'TI}IS S►TF DILHR Leroy Jansky P.S.C: 13 E. Spruce Street Chippewa Falls, WI 54729 (715) 723-8786 Sketch System on w"" Retain in county file for audit. Reverse Side. SIGNA HE TITLE DILHR SBD 6710 (R. 01/82) flR%V E -$eyuA4F_ CONSIALTAWT W1Ll )N.J RkVt,14. TAT ~'A~K N ~-~R~ ct-~rtT:R 4" cT VENT 5`1S. E 42.l.5 4b.13 ltb,l g 9S.1,i ' 1' PVC y4L ~ 1 ~ n s-looo c~At, ~n+6bICS nSt ~ 13'-14 CL csr NoR~. / 9-I. ta, 1 V kF-r. PT', uAT~nR'` ct-.N?~ SCALE 1 No = NOKt.IeTz, P t x IJOT6 ALL 6L.. ARE. -top of P,f} cof:t4f-A OF Bu~lP~n~4 BcT, SioiN~ . 9y,gz' COUNTY SANITARY PERMIT,000 TIO'N i1,..HR In accord with ILJAR 83 *Ydis. A '~"c&de ~T lcr K STAT MIT # -Attach complete plans (to the county copy only) for the system, on . th r 1STATE PLAN I.D. NUMBER. Sh x 11 inches in size. ~ i~ er -See reverse side for instructions for completing this application. > PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. r. iTVO FO R VARIANCE YES NO PROPERTY OWNER ~ " PROPERTY ~ Q l1/S . /1,/S o-~ T R E (o W PR PERTY OW ER'S MAILING ADDRE S LOT NUMBER BLOCK NUMBER SUBDIVISION AME CITY, STAtT ,~qq ZIP CODE PHONE NUMBER CITY NZ4A&6~QAD, LAKE 0rr!!71VDttARK 1f ~SV~~ T ~Gj~ u✓ VILLAGE : {Jv JD C1 ` 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR P is (Specify):~,l s III. PURP F APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) Ae;kf57/k)G- /i~G 13x-!,4; ( - 1, a. New b. ❑ Replacement c. Replacement of d. E1 Reconnection of e. ❑ Repair of an em System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPEYSTEM: (Check only one in ##1 and only one in ##2) 1. a, Conventional b. ❑ Alternative C. ❑ Experimental i ~ 2. a. ❑ System- b. ❑ Holdi n,@~ c.0 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan V. ABSORPTION SYST ATION: (Check one) 1. a. See a e^'edL b. ❑ See a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPO ED (Square Feet): -`~J5 /J0 ~Zr 7 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total of Prefab. Fiber- ! Exper INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App- Ta ks Tanks structed Septic Tank or Holding Tank V_ ❑ i~ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ L1. 1 U E VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): 7008ERTber.ttkLSt iNG Cf/ MP/MPRSW No.: Business Phor.e Number: ~GL~- ✓ W. 3u 'NEItL[RD., HUDSON WIS. Wj$ 3367 Plumber's Address (Street, City,G,M& ate, Zip Code):IN3. MASTER PLUMBER LIC. NO. 3307 M"PR.S. Na e pf Oes'ign~er n t/ ` I 9 (.07 G MMIN IN TALI R & DESIGNER Hi C, VIII. SOIL YIEST INFORMATION Certified Soil Tester (CST) Name CST # rC T's ADDRESS (Street, City, State, Zip Code) Phone Number: 1,2 IX. COUNTY/DEPARTMENT USE ONLY - ]Disapproved Sanitary Permit Fee Grcundwater Date Issuin Ayent Signature (No Stamps. A oved Sur c~e'F pp L~ Owner Given Initial /J v CJ Q Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: AUG 2 01986 SAFE FY & aLUGS. D!V SANITARY PERMIT APPLICATION COUNTY I~/h 7 DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # 'y 3 -Attach complete plans (to the county copy only) for the system, on not less than 79 9 paper STATE PLAN I.D. NUMBER 8'Y2 x 11 inches in size. 6Z~ 7 -See reverse side for instructions for completing this application. d PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES Al NO PROPERTY OWNER PROPERTY LOCATION S%~i Lt/r-j Nc'a j~, S T , N, R E (o W~ PROPERTY OWNER'S LIN/~ ES5 1~~ } LOT N~ T BLOCK NUMBER ) BDIVIS19N NAME qjTY, STATE /i[ 6), r. ~P CODE ~1~` PHONE US~<3~ O VCITY z(11te_ ILLAGE 761 fte).t/~d -R j~lllfE O4--.f II. TYPE OF BUILDING OR USE SERVED: EXj'STi0 -fill /fir! Number of Bedrooms if 1 or 2 Family OR K Public (Specify): l LO ELC' III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2, 3 or 4, if applicable 1. a. New b. ❑ Replacement c. L Replacement of d. ❑ Reconnection of e. El Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. E1 Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a._XSee a e Bed b. ❑ See a e Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (M~ i/nutes per inch): REQUIRED (Square Feet): PROPOS (Square Feet): ~ I 4g5, ! 7/ a /d Feet ~ Private ❑ Joint 1:1 Public CAPACITY VI. TANK Site in gallons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank aV ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): lumb gi nature: (No Stamps) •fOiP/MPRSW No.: Business Phone Number: ffdi ku SEPTIC PLUMBING CO. RT. 3 O'NEIL RD.; HUDSON, WIS. 54016 330 7 713- 3 A06 4/11 Plumber's Address (Street, City, State, Zip Code): Name of Designer: 1 Y WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 5 1,'rL !2 L~~, VIII. SOIL EST INFORMATION Certified Soil Tester (CST) Name HOMESITE SEPTIC PLUMBING CO. CST # 5;414 ~ RT. 3 O'NEIL RD., HUDSON. WIS. 54016 2 C CST's ADDRESS (Street, City, State, Zip Code) Phone Number: WIS. MASTER PLUMBER LIC. NO. 3307 MARS. `f' A/ IX. COUNTY/DEPARTMENT USE ONLY lv ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination //j v 0 9,5X9_;- X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DSTr"6UTION: Original to County, One Copy To: Bureau Of Pi: robing, Owner, Plumber 1. This sanitary p. 2. Your sanitary permit may be renewed bef, criteria in the Wisconsin Administrative Coy;-_ ..i...., 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may t, if there is a change in your building plans, system location, estimated wastewater flow (number c rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a pumper whenever necessary, usually every 2 to 6. If you have questions concerning your private se State of Wisconsin, Bureau of Plumbing, 608-266- To be complete and accurate this sanitary permit app . 1. Property owner's name and mailing address. Provide the legal der installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwell; III. Purpose of application: Check only one in ##1. Complete #2 if permit is for tank reply repair; IV. Type of system: check all appropriate boxes depending on system typ is in conjunction with University of Wisconsin; V Absorption system information: Provide all information requested in # lank information: Fill in the capacity of every new and/or existing tani lumber of tanks and manufacturer's name. Indicate prefab or site constructea and tank material. Cor for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval on!. tanks received experimental product approval from DILHR; Responsibility statement: Installing plumber is to fill in name, license number with appropriate pr' NIP, etc.), address and phone number. Plumber must sign application form. Fill in designer name applicable; !il. Soil test information: Certified soil tester's name, certification number, addre< County/Department Use Only; Comment area for use by county or resaon given when application is disapp ,omplete plans and specifications not smaller than 8'h X 11 inches must be sub lans must include the following: A) plot plan, drawn to scale or with complete di i er, oE: , i~atr a olding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water ser, treams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement ystem areas; and the location of the building served; B) horizontal and vertical elevation reference points; complete specifications for pumps and controls; dose volume;'elev'ation differences; friction loss; pump rmance curve; pump model and pump manufaGfijrer; D) crib-&s section of the soil absorption system if GROUNDWATER SURCHARGE y 0; was signed into law. TY ,ton is more c, non y kr own as :lie gro-,ndvvaie protection taw. This chant es was the ?sult of over 2 years of steady negotiation land public debate.j, ,rater bill Ground : ~18C cluded the creation of surcharges (fees) for a number of regula~eo.pracuces which Wisc® imt.s -an effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur c '.a used in your building is returned to the groundwater through your soil absorption . o -ystem-or the disposal site used by your holding tank pumper. ,,e monies collected through these surcharges are credited to the groundwater fund adminis- red by the Department of Natural Resources. These funds are used for monitoring ground- T t zter, groundwater contamination investigations and establishment of standards. Groundwater, ® SANITARY PERMIT APPLICATION COUNTY f :EILHR In accord with ILHR 83.05, Wis. Adm. Code 5; C,C4% x =11 1 -YP -Attach complete plans (to the county copy only) for the system, on paper not less than z X 11 inches in size. STATE PLAN I.D~N3UMBER -See reverse side for instructions for completing this application. ,~~Q 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES NO PROPERTY OWNER I A PROPERTY LOCATION GfJJ-~ . oC...J /~J•/~ S T , R E (O W PR PERTY OWNER'S MAILING ADDRE5S LOT NUMBER BLOCK NUMBER SUBDIVISION NAME -L ~j/fot~ CITY, STAT ZIP CODE PHONE NUMBER y CITY NZAR D, LAKE OR"CAM 31vFAeRK 51 0 / 30~ ! 3/ 1 C7 VILLAGE : U~L R1 II. TYPE OF BUILDING OR USE SERVED: 414-711,6E 1r` Number of Bedrooms if 1 or 2 Family OR L Pu is (Specify): , III. PURP F APPLICATION: (Check only one in #1. Check 2, 3 or 4, if applicable) ice'A ---X1577A)6- /;WG- 1. a. New b. ❑ Replacement c. Replacement of d. ❑ Reconnection of e. ❑ Repair of an em System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. ~C~ I 7 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agre A to Co,~nt mil" y IV. TYPE OF YSTEM: (Check only one in #1 and only one in #2) r, 1. aonventional b. ❑ Alternative c. ❑ Experimental D~~yy6, !0 V f o 2. a. ❑ System- b. ❑ Holdin c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound s I P ~ In-Fill Tanw~✓ V. ABSORPTION SYS7'b. ATION: (Check one) ; [ 1. a. See a e ❑ See a e rench c. ❑ See Pit 2. PERCOLATION RARPTION AREA 4. ABSORPTION REA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inchED (Square Feet): PROPO ED (Square Feet): 1Private Feet ❑ Joint ❑ Public VI. TANK CAPACITY in allons Total of Site INFORMATION #O Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New xisting Gallons Tanks Concrete glass App. Ta ks Tanks structed Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon ChamberL❑T ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber'' MP/MPRSW No.: Business Phone Number. NT. 30'NEIL RD., HUDSON. 54016 33c, 7 °-7 ~k10-1 Plumber's Address (Street, City, Mate, Zip Code): OK Name of Designer: - WIS. MASTER PLUMBER LIC. NO. 3307 M.PR.S. G MINN. IN iA1lER & DESIGNER LiC. NO, U4 VIII. SOIL YIEST INFORMATIO Certified Soil Tester (CST) Name CST C T's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater Date Issuinc Agent Signature (No Stamps) IY Approved ❑ Owner Given Initial Surchar e Fee Adverse Determination ~ X. COMMENTS/REASONS FOR DISAPPROVAL: AUG 2 01986 SAFETY a DLDGS. DIV. 'REMRT ON SOIL 80RIN&S ~ PERCOLATION TESTS 115- PLO r PLAN PRoTEc i I)ArE- 41Wi gep" MOMESITE TESTING CO. VT-3, O'NEIL ROAD BOB Ujj-,, , jC,-r ri J 63 t7 bd, WIS.- 54016 e 5 7- '57y° 02 Yew. PROPp5ED HNSE moss I-ir g'~ -OPOSED WELL M V5r LIE 50 Fr PIP ps EticP~,c l~oX sS' f~o.~e J~,~i~ r4~. ,IGda C~~ - l 1,,V 6- 40 7- //0Vse- 30 j U~ai' , 97 YO A This test siie APP aO ED ~ ae for a conventional septic system. e G 740 A PPO POSE 9 y a, z 'a' n r IF•~ A;r $3 x t s YsT~ P - - - - - 0 3 - - 1 + M1 State of Wisconsin ` Department of Industry, Labor and Human Relations DATE: SAFETY & BUILDINGS DIVISION i Bureau of Plumbing 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 TO : N L f-C L-7 r Plan Identification No. Re: 19 ~4 c vo x C-0- The Bureau of Plumbing has received a request to review some minor changes to the above-mentioned plans. Those changes have been approved as indicated below. The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. ems, Sincerely, ox" la Approvals Section of Private Sewage and Platting r r cc: On-Site Waste Specialise: County D I L H R Safety and PLAN APPRO Buildings Division Bureau of Plumbing P.O Box 7969 1 General Plurnbi ansv <Madison, WI 53707 ❑ Private Sewage Telephone: (608)266-3815 Plan Identification No. i Gallons Per Day 9 _ -7'"` PRIORITY PLAN REVIEW ONLY Plan Review Fee Received Petition For Variance Fee Rec. Project Name Project Location - Street No. or Legal Description ounty ❑ City ❑ Village ❑ Town ot: The plumbing plans and specifications for this project have been reviewed for compliance wi .applicable code requirements. This roval based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are sta afl ve ".This approv is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by t' city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can made. F -1 FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: 1 James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: -LJ' Private Sage Consultant ❑ Plumbing Consultant f i Environmental Health County I.i Local PI ❑ Facilities Need Analysis Se, IJVI/-SSWMP ❑ Plumber "en,rtment T)f FlnriculturcR i.', of wna' illr>r SBD 6678 (R. 08/85) (PIb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion bf This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 Private Sewage System Only - Does Not Include General Plumbing or MADISON, WI 53707 reviews that must be submitted to the Bureau of Buildings & Structures. 608-266-3815 DATE: PROJECT: IpH/ r PLAN ID. # 194 OFF/C;G 1 - - _ - - - 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 required fee is $ Fee Received is $ ❑ Plan accepted for review. ❑ Underpayment-Please submit additional fee. Plans will be held in abeyance. ❑ Additional information required-SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. ❑ Overpayment-Refund forthcoming. ❑ Plans being returned. I. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Variance signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Common ownership Plumbing System Easement. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local ll. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Cross section of system. ❑ Pipe lateral layout. V. Dosing Information ❑ Plan view of system. ❑ Calculations for total dynamic head and gallons ❑ Verification of Exception Status Form by county. (1 copy) pumped per cycle. ❑ Size, length and depth of force main. III. Private Sewage Systems ❑ Detail and model of pump or automatic siphon, including ❑ Ground slope with 2' contours in entire area of soil absorption size, pump curves, drawdown, and average flow rate (GPM). system extending 25' minimum on all sides. ❑ Cross section of dosing tank showing pump(s) or siphon(s). ❑ Location of area suitable for replacement system - provide soil data. VI. Systems in Fill (Fill must be placed prior to plan submission.) ❑ Construction details of septic, holding or dose tank if site ❑ Total area filled (fill to extend 20' beyond edge constructed, or tank manufacturer if state approved. of trench before side slopes begin.) ❑ Construction details and cross section of soil absorption ❑ Depth and type of fill. system. ❑ Copy of signed onsite report by county or district staff. =77 LHR Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7%9 ❑ General Plumbing Plans Madison, cal 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. JUN 2 310 Gallons Per Day LA-"<~- ENGINI":01NG L a 3 f PRIORITY PLAN REVIEW ONLY r > Plan Review Fee Received Petition For Variance Fee Rec. Project Name Project Location - Street No. or Legal Description Town of: ounty 11 City ❑ Village ^X C) S-7-. The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval 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. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLAN cf-rom (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years e date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent / Bureau Director If Questions Plans Approved By: Date oved: Contact cc: Private S wage Consultant El Plumbing Consultant 11 Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section ❑ I -SSWMP Plumber Department of Agriculture %1I I fR-SRI)-6099 rR n1 B,~ Ocaner ( 4her x ~ i t~K~ } ^St# ~ ~ -s E , .PORT ON SOIL 130RW.&S PERCOLATION TESTS IIS ' Gv%S• ~ (,~ji//D~u ~ili~ STtlF Pao r PLAN PROTECT .ti eFr vG 16t pArf- HIV// ~o it 8~ HOMESITE TESTING CO. AT. 3, O'NEIL ROAD BOB ULBh'I aUuSON, WIS..._ 54016 c57- S.S- 02 y402- PROPOSED HovSE mosr LIE 2~ FT o,t MO~f F~PoM ALA TEST 191,PEA5, Pao poSE o WEu M vsr LIE 50 FT a~ MO~PF F,PoH ALL T£sr ~,PE'~fs, • = eACe*X- pir, f 0 = E rl$,rl A! (r W ELL A ~ y-P,~OE ~ lE Ur}Tio,us X ~ ~EQG /OCsy1/ONf ~ = /~,4,v~ fjtl9E~PED o,Q S~iDdEL ljg~ES 114;z . BM ser V£Rr1-cA4 ,QEFE,pt~vcE- Pol:07' #IiA !/'0// d. , I it sTeci pip" eleC7jel'c 13ox ss 'fle0-4 M*;N ~4kg ~,F,4d^, 4oV4~0- LE GE N D ~lEV~ro~v o~ t/E.Pr. ~PE~ PT goo • o " ~A uE1> P~,~'x'i vG- L oT 97•° ' ~/o vSE sC riIE 30 155 rn ~EeT• ,PEA 9 7.25 / ♦ j .yo ♦ Ties tt site 6► a~,> E et conventional septic s; rit0"I le 76 • jo A 7640 A, RoPis D~ ~y /so 8, ZX5 r ~ SRO OSED Si?E ~ 20 '~E~RC Ei1 fNT x f; (5 ySTEN) a i P OF I O prQErF 3 r , ~/A7vPE 1/4//~ ; /03-6" 1 S HE'c f r k~ 004e.D) i9 Pry y v • = 16 0- S ' NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS r, DIVISION ,A r1ND PERCOLATION TESTS (115) MADISON, WI 7969 HUMAN •RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SEC ION: TOWNSHIP/f*b*+ *Pf~-V- LOT NO.:BLK. NO.: SUBDIVISION NAME: NE M- J N/R /1 E (a y uDso v fl r 61 CG~Y/D ~'0,0t1, s T,tr~- f W-t COUNTY: OWNER'S 13tT'v'ER'S NAME: MAILING ADDRESS: 1/ ~rZ s7•0/~ wi5 . . ~uil~OW v . sr4T_'C- ~i~• ~Twy. #I/pse i ~v%s . USE DATES OBSERVATIONS MADE M6:•BF91~fro1S.: COMMERCIAL DESCRIPTION: l~ PROFILE DES,CCRIPTIIOONN~S/: PER OLATIIOON TESTS: /U/~ viPL q/~/ /pSSE/N~dL j t4 New ❑ Replace I ~~O'r/ ~U~ O to ~~ie// / We pd/3i/'c 3,9, 15 • SEf 3E/047 jCs ~ ~U/J/~~/~~ /S RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ®s oU KS ❑U ~S ❑U ❑S n❑U ❑S au l'OuvE-y/~ay/9~ If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ~J,~ under s.H63.09(5)(b), indicate: C'G,~SS T Floodplain, indicate Floodptain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN• ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 3 . 0 . a 9 70 moo- > ~Q 0 ' 7,,l, v cs ~o 1y y~ Zoo ? ~0 ' . 3 " 4( . c s, z•33 , 3 33 %w B- , / " /J ~O~ ,U- > 3 3 /L3~ L' aa~PLe s / 33 " ~v , ~o del2 s~ B- ' d Rl S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ / 3.9 , Z fPCQ~ET v.~ES ~'T /.v P- UE.« r -s vp T, ,t7 S. P- L P- w T /;vEZ~ i PsS P- .7- Z vTf 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. SYSTEM ELEVATION 9d " 'O°°'" D'`~'~/'' ~'E`~ T~°E~ s ' see ~TT~~~ . ~~D~OJED /1 /~Q~ • ZISF•~- - / ~ ~r1,C~ ~1/~TV,P~¢./sr~ ~i ~7vQfS C M,~i.✓ ,c~,Y~ ~o i,~ ~.e,~ l~S yzi q~v~y) . /N SVA.A4e s~-efSo.~ 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): HOMESITE SEPTIC PLUNi8ING CO. TESTS WERE COMPLETED ON:/~ KT. 3 O'NEIL RD., HUDSON. WIS. 54016 41'ell 1O~ d ~ ADDRESS: ROBERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMBER(optional): WS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. S~ OL ~1~2_ .3~~~ ~(~0 /PS • CST S I G~ ""~-CJ I, c~t/~ ~,U,,f? ~,Pd afES ?o ~iDV~-iN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 7-~ 9uT' /N j/~F- DILHR-SBD-6395 (R. 02/82) - OVER - 3 - R~ /~ME~ / /.~EV•Ppoy S ~ tvil//S .