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HomeMy WebLinkAbout012-1075-20-000 ' o 10 ~ m o d r~ to `r1 Er 05 I m 3 I Z 0 o) m o o • 0 to 3 CD trtD CO CCDD p IV j~ lA\ N` Cp v N z y O v O O 1 O ? N y CA 7 M. Q. _ CD O OOD O O OOD N O C _ co -I W co 3 ° O 7 N a = CD c r) O N co CD ID I d' K ) CD V) Q7 O 7d ° ° o o rn o ^AI W phi 3 a O O N O l~r a a b ~til C) 3 P, ° z co cc n r (D N• m ' i- ° rn cn 00 m (D Fl- H d 000- ED 01% t4 o o- v° vs N N ° OIQ t_n N N w a T v e y F O O° CD N N 90 N _ a U) O a• N d p_ rn o 00 10 o CD a h • ON ° 00 I H H `cn CD W c W z° c p I a CD CD N z 7 p Z CD G1 N A (Z 3 'Fl O ' cn 1 w ~ I W ~ ~ w0 cn 'LS ri CD Z N W W ° 3 Fj_ v, °o C CJ D• y z m C m w 0 Cl) 'o a m z a CL o y 0) S C~'1 t CD A m b N O O• D) m N k_j O n kA ~ A O ~v 0 N m cC A CD c W ti Parcel 012-1075-20-000 12/02/2005 12:05 PM ~ PAGE 10F1 Alt. Parcel 35.30.17.542 012 - TOWN OF ERIN PRAIRIE Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ANDERSON, DAVID L & GLENDA M DAVID L & GLENDA M ANDERSON 1200 200TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1200 200TH ST SC 0231 BALDWIN-WOODVILLE AREA r l SP 1700 WITC t q ~ q T g - 14;~ Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 35 T30N R1 7W SW SE EXCEPT THE W 1/2 Block/Condo Bldg: (EZ-1-1121/207) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 866/428 07/23/1997 734/33 07/23/1997 722/201 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/21/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 15,000 201,600 216,600 NO ENTERED BEFORE 2005 OPE W7 19.000 60,800 0 60,800 NO Totals for 2005: General Property 1.000 15,000 201,600 216,600 Woodland 19.000 60,800 60,800 Totals for 2004: General Property 1.000 7,000 147,800 154,800 Woodland 19.000 20,900 20,900 Lottery Credit: Claim Count: 1 Certification Date: Batch M 313 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ssinLD.Number: El CONVENTIONAL MLTERNATIVE StfateaPla (Igned) ❑ Holding Tank O In-Ground Pressure XX Mound 185-06492- NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION OAMTE q Dave Anderson R. R, 1, Baldwin, WZ 54002 - ~ /~cJ BENCH MARK (Permanent reference pomO DESCRIBE IF DIFFERENT FROM PLAN'. REF.~T..ELEy,: qT REF. Pj LA SW SE, Section 35, T30N-R17W, Town of Erin Prairie II//ff// OO(O) {W~7/ Name of Plumber: MP/MPRSW No Cnunty Sanitary Permit Number: Gary Zappa 3300 St. Croix 69685 SEPTIC TANK/HOLDING TANK: MANUFACTURER: JLIQUID CAPACITY. TANK INLET ELEV_ TANK OUTLET ELEV.. PRO OVID MO DLABEL PROVIDED OVER ( ) 0 YES ❑NO DYES No EDDING'. C IVENT DIA.'. VENT MATT HIGH WATER NUMBER OF ROAD PROPERTY WELL. BUILDING: ~VAER N OTRESH /y ALARM FEET FROM ,l LINE p q YES DNO ,a C e59- DYES DNO NEAR EST V~ ~I^uJ DOSING CHAMBER: V MANUFACTURER. BEDDING'. LIQUID CAPACITY PUMP MODEL PU MP; SIPHON MANUE A'T IHER WARNING LABEL LOCKING COVER `i + PRO IDES: PROVIDED: YES ;:E NO 0 YES ❑No YES ONO GALLONS PER CYCLE: PUMP AND CONT HOLS OPERATIONAL NUMBER OF PH I OPEHTV WELL BUILDING VENTTOFRESH N'. (DIFFERENCE BETWEEN FEET FROM L E , I 5_ S AIR INLET PUMP ON AND OFF) r~ YES ONO NEAREST=. /V /9 1, -7 z SOIL ABSORPTION SYSTEM. C eck the soil moisture at the depth of plowing „I,,MF TER MATE HIAL AND MARKING RCE or excavation, (If soil can be rolled into a wire, construction shall cease until FMOAIN v the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH IDTH LENGTH NO. OF UISPACIN(I COV EH INSIUL DIA PITS LIQUID MATERIAL.. DEPTH'. W TRENCHES I DIMENSIONS _ EL ULI'I II FILL DEPTH DIST R. PIPE UISTH PIPE DISTR. PNO DIS MB OF PHOPERTV WELL BUILDING'. VENT TO FRESH BE LOW PIPES ABOVE COVER EIEV. INLET ELEV END PIPES FEET ROM LINE AIR INLET'. NEAREST- 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- ,,ma~yy meets the criteria for medium sand. TIONS MEASURED. IpJYES ❑NO PE 13 M A N I NT MAHKI RS 013 S EH V A T ION WELLS SOIL COVER rexruRE ( f lIYES ❑NO /J YES ❑NO DEPTH OVER TRENCH BED f~EPTH EFUFD ®YES MULC DYES L HED CENTER N`'O S YYES ❑NO . INNO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE- FILL DEPTH ABOV OVE BED/TRENCH TRENClES h DIMENSIONS CO "j Z s / MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND EL ~ 0%ELEV DIA. ELEV ZI PIPF~6 DIA w-1/ O CV, DISTRIBUTION JHOLE SIZE HOLE SPACING DRILLED COHRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION n _y _ PLANS 10 u YES ❑NO _ L3YES ❑NO y COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF PROPERTY WELL: BUILDING: M YES FROM LINE/~ 7S YES ❑NO IBS YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) ~wisconsin APPLICATION FOR SANITARY PERMIT D I LHR COUNTY f (PLB 67) UNIFORM SANITARY PERMIT # - O EPRRTTEnT OF A ~ ~nOU5TR4, LRBOR 6 NUTLin RELriTlOns j / / ~ R 1:M -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING _ ~/te a/ ~ 4 i 5 ~¢U~" AA-1P,-_X S 10A-) (Q 3 PROPERTY LOCATION CITY 1/4 E1/4, S 3 S, T 3o N, R / 7 E (or W TOVOW OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME "'Z^R .Q,AD,~LAKE OR bk4QMABK STATE PLAN I.D. NUMBER ,R,t T ` 0 "f v 000, it - C,qS~~ Lif-K ~ ooS- 6 G TYPE OF BUILDING OR USE SERVED 4 1 or 2 Family Number of Bedrooms: ~ ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity / ie t.., o / Lift Pump/Siphon Chamber Ive-4 J E0 / X Manufacturer: - &L52e D.rI G~ 744- PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED _(Square Feet): :Za 375 2.2 ] Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibilit y or installation of the private sewage system shown on the attached plans. V I Name of Plumber (Print): igAature:/MPRSW No.: one Number: 23 0 0 (7i )3~G Plumber's Address: Name of esigner: OoOo' 7LZ i'-c ac>~0~ s~ /f/ , ADS ~ COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: fee: Date: ❑ Disapproved /7 ❑ Owner Given Initial r ~1 6?,; Gr15 Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 , To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; I 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. • APPLICATION FOR SANITARY PERMIT S T C - 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 for resale by owner/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 , WX0 4 14I ,t- .5o/-/ Location of Property 50 k S5 14, Section _5,!5-, T d N - R 7 W Township /fkl J Mailing Address f1~Dt,v~ t,UIS Subdivision Name Lot Number Previous Owner of Property ~JOI/ ~L ~C-,j V. htjn 0 Total Size of Parcel 7~. ACRD'S Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume and Page Number 1 `1- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION I (we) eeAti.Sy that a,Q.Q. statements on this 4oAm cute true to the best a6 my (outs) knowledge; that I (we) am (aAe) the owneA(s) o~ the pnopWy descAibed in this in6oAmation 6oAm, by viAtue o6 a waAAanty deed Aonded in the 066ice of the County Reg.csteA o6 Deeds as Document No. 3S'03`7 / ; and that I (we) pnezentey own the puposed site 6oA the sewage pozal system (oA I (we) have obtained an easement, to Aun with the above de,6eAibed pupwy, 6oA the eo►vstAuction o6 said system, and the same has been duty Aeeo&ded in the 066ice o6 the County RegtisteA o6 Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H H a ST C- 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT r~-+ St. Croix County z d a OWNER/BUYER Dfi~!//D -C ~fNDE~3'd~ ROUTE/BOX NUMBER Fire Number CITY/ STATE AV /A-2 Z IP 6-yyc~ PROPERTY LOCATIONza5- ~C 14, Section Y,:!5-, T3,D_N, R)_W, Town of iPjN' St Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment 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 July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if n.ec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning 0 ice within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. f1 DDf v U•'-t % o ~i ~-i%vq / TES T /P~/~ a.P T a~ I P f P5 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME: 5W 1/4 1/4 3S /T3o N/R 17 E (o W 1014107- 10/a '4' 0 4ae_ .PceSZ COUNTY: OWNER'SY-13 ER'S NAME: MAILING ADDRESS: 5r. r u E ~vERsoN F I • Rq1-0 to USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence New ❑ Replace P5 SepT- 1,9- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S DU E S E U ❑S CCU ❑S CCU ❑S RA MovvP 0.01- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNE , COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE AB V.ON BACK.) B- 3. Fr. B- ~VolE ov SiTE' .PE'-Ex>7~►:,V~ro,J av/d 5 i ,X. S ? S ST ,Vl O.Ari ll.f7*f7E-,r, OM B- To B- SE'l¢ dN~/fir S47V'elt7 D co vD Tio~IJS i00 7- dEC~ Mo B- B- $ % T 500AC•E" e1,6W7i6VS o'- 10W 51 PERCOLATION TESTS O V'v fh• TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING NTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- l /o O ~-Ive, /S_ P- P- Z /1- O r _P_ - P- J 'y O 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 1161A at all borings and the direction and percent of land slope. Si}ND//Pock bo cwt f atCE- C ZA&- RD t161A 1 / dL S FT SYSTEM ELEVATION GgTEoeA-L IN VERrS 9~• Fr , E qST/m , I , TN E } , I I , - - a.. I 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: HOMESITE SEPTIC PLUMBING CO. n RT. 3 O'NEIL RD.: HUDSON, WIS. 54016 •5407- /0-P - / ~7 d s ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 MARS. S-_r 6 2-yPL 3F CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester,- DILHR-SBD-6395 (R. 02/82) - OVER - l Z INSTRUCTIONS FOR CO IV ~ "'IG FORM 115 - SRI - 6395 1 ti To ht, a co end accurate soil test, your rep it include,: 2. _ u} s _ ' 3, rn. nne( 4. A rs €-r BLE7 r-nQ i AKIK ONLY IF ALL w I ti p 10. riate box; t EL WITH THE _ -V TINS -1 ! 301L TESTERS HWL VRP TO THE OWNER: the first str irr sec y permit. The cc e ,)artment may request n is soil test mil: issuance. A carof A< for the private t _,ste _nd a permit q. pitted to the apt ?p I ,,y in order to permit. The sanitary per i ' e ncd pe>sted prior to start cif y construction. REPORT ON SOIL 13ORiN&S PERCOLATION TESTS IIS Paor PLAN PROTECT r D. DATE rl- ► $S HOMESITE TESTING Co. FAT-3, VNEIL ROAD BOB UUSON, WIS.-- 514016 cs7- SS aZYf2- PROPOSED MovsE Mosr Li z.~ Fr. oR Mo~fr "a-4,f ALL TEST f~,PEAS, PRO POSE D W E a M vsr we 50 Fr Cf 110-fC Ffem ALL TEST ~iPE~9S, • = L3AtelleE Plr3 O = ,Cr/ST/.U G- wELl- x PE-QG 10Cj#r1'dVf = 11,4,vp 409Ekev ©,Q SleIJEL /34,45 4? ° yo,~iz . B M ki-AsAc cE- Top /EV~triov o~ var. ~E~ fir. o. o. LEGEND w ooD~ ft uoL.T pate 5i ly Nib Powfp vOc T- Sf#€~ pE ~ EN~~A Got. VA' pRi'mTV- /EV ,or y~ G-RAvE~ 5h~ of _ 1b I ~7. yG oeDs ~Z iv` y v w SV STE"l ~3 Y yo' y ST. CROIX COUNTY WISCONSIN 'y Y' i 't2/. ' 1 a 4 ° ZONING OFFICE 796-2239 HAMMOND ,Q. 425-8363 (RIVER FALLS) HAMMOND, WI 54015 i August 13,. 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An onsite investigation for the Dave Anderson property located in the S04 of the SE14 of Section 35, T30N-R17W, Town of Erin Prairie, St. Croix County, revealed suitable soils at a depth of 3.16 feet, after which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mi _ STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM cation: Township W 34SE 14 S 35 T 30 N/R 17 XKW Erin Prairie St. Croix reet Address: Subdivision: County: ndowners Name: Mailing Address: ave Anderson R. R. 1, Baldwin, WI 54002 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date I TATE OF WISCONSIN Subscribed and sworn to before me SS. [ILHR-SBD-6413 OF This day of 19 Notary Public, State of Wisconsin My Commission Expires: (N. 05/81) WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location sw 1/4, SE 1/4, Sec. 35 T 30 N, R 17 XPW W Town ~W Erin Prairie Street Address Lot No. Block Subdivision Landowner's Name: Dave Anderson The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~..1to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num-5ersissuea_f6-you.) 61 one of the applications needing a quota number. The quota number assigned to this application is 59 - 16 - 6 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [.1for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. L'J for an application on file prior to February 1, 1980. (Jfor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here .0 I certify that the above information is true and accurate to the best of my knowledge. Name -Ihomas C. Nelson Si re (County Official) Title Assistant Zoning Administrator Date August 13, 1985 DILHR-SBD-6158 (R 12/82) Sw- g f14allm - S^.vr4so - VL,4sAty s.YT Lo,}~ So~GS ~A el s DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 4 ABO~DUSTRY AND DIVISION PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIV SION NAME: 'w MAOp , f3jg of Ora,P14 / oto 1/ 1/ 35 /T330 N/R 17E (o 401 COUNTY: OWNER'S R'S NAME: MAIL,IN(DDRESS: S . A WX N O,EIeS oA) USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMM CIAL DESCRIPTION: PROFILE DESCRIPTIONS- PERCOLATION TESTS: Residence ? . XNew ❑ Replace 12_ / Mr / RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: YSTEM-IN-FILLHOLD INGTANK:RECOMMENDED SYSTEM: (optional) MOVAJP I &U ❑ $ ❑ $ [NU RECdHME'~uDEt~, Our- MrA,?4-W - Ms ❑U K7 $ ❑ 0 $ ❑ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: G/' SS r~s' Floodplain, indicate Floodplain elevation: *f4- ?/p Nut Jr PROFILE DESCRIPTIONS j4 SX-CNA4 -Pf-. N 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.) J B- / 7 ! 71 ' , 'GX . s4 " P • at • iy 3. ~ . s~ . ,IV cam, s w s"4T oc.tdr. 4k. Z ~ wit, 0.-'a r %.9j-1rMG r1 :o; • v►~. s~~ f'•fi f. ae. J?ooT r~oTt Ar r B-2- 7 97 f L ~Zo'` 74 of B-..3 a "07 ? 3• ICu 4..4Nr ff. GIQ HOrS ~Rd/N a•s~~ 3.44'hcy/.+K 717 r tub r P." 01 Tat, y. I. .Y1 B- 7p. ya' ? 3.50 .f. Mois mr 3.S' y Z RAA -V w fnw I r 0,0-of "V614. Sr' , . ya •4; x • o Gy s;/ 0,4►. S , 7 s "~~,+pe o • 37 A) • &y. If C g , B-,, 2s' / yY ? 3 d o Ll f. od-6 Poq - Rocr ~1$ A r- 3.d N~1 • ales, e•q . 'Df ST- A&V is /9r S. B- ROOT ROOT MO T's PERCOLATION TESTS ~ A&W y fJf/~S I -pr► TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PER D PER INCH A/2 " P- d 1 5h ea z Y/1__ 2 c~ P 0 P- Y p P 2 Zt5i P- z C PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon-V.O 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 percentZ of land slope. /J nd M f Ti~L~„A~ s ofy 0 V1 SYSTEM ELEVATION _ _ _ ' - - - r- ~ 3 F 3 S ~ I ~ 4 n f co`I I r I E 3 3 _ _ Z 3 1 • _ rv ~t I r I 1 { I 4 3 R 3 F for p L- nvbntiQr Sep l 3 i_d O 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 N Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 15 X NAME (print): TESTS WERE COMPLETED ON: NOMESITE SEPTIC PLUMBING CO. h4 ADDRESS: CERTIFICATION NUMBER: P NUMBER (optional): ROBERT ULBRICHT SS D-z ` 'Yea MASTER PLUMBER LIC, NO, 33a7 M,P.R~ 57 MINN. INSTALLER & DESIGNER LIC. NO, 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r '~"RU TONS FOR C"MPL.FTING FORM 11 - SB - 6395 Tc rarate soil to ;sort must include: i. . TI is is ,oi,.n 'tsject, 3. M,` I 4. ' 5. _F FOR A H CNLV IF ALL. 0-., i-ONDITI IN 0. PL-' plat 7. 1 [A t: l~W r t" MUST D Wt THE L, I ITHIN 30 DAY ' ' =VIATIt I., i -d ®ig TE- a~ Lures 3' 0. y R Y L mot Clay wi sic _ ly 1f$ IX r cc j? a. rss tr, t~ d p - X VRP 3 a TO THE NEE: ii t- ;`report is the first step in securing a Ksr Ti-- or the Department may request this soil test its the field pr A f set of plans for the private I and a permit application mus o-riate local authority it) order to obtain ~rrnh. The sanitary permit rvrust be c td ste ' prior to't'he start of arfylg;nstruction. REPORT. ON SOIL C3oRIN&S ir PERCOLATION TESTS 115~ PLo r P L. AM PROTEc -I r. D. Ac. DA rE rl-- t c HOMESITE TESTING Co. F PT. 3, O'NEIL ROAD BOB ULb'Rlt:..s 1 riU"OTi, WIS..- 54416 02- 31,02- t PROPOSED HOUSE MUsr t, i 2j; Fr oR MORE "dAf ~ 1u. TEST "e. PRO POSE D WELL M U5r m r 50 Fr. a,~ tioRE Fit'o y ,gcc TEsr ~,P,E-,¢5. • = 13gt.('fj/oE I°iTs Q = EXist~.~J tvELL X : ~E~G /DC~yT/DNf ~ ~ f1AN~ f}d9E~PEO o,Q S~OdEt ~4,~ES f1o,~iz BM VtRrl Al- CPC,-rrR wcA- Poi~T ~ To P LEGEND L~/~v~triow o~ Vhf, APE` PT. /G o . o cDe tifgk voc.TP att` 7-,q~ SZ lye WAGE O~ woOAS 13 si' Nt /30ce)~R !lpLT S-M&4 o Eu~~ . PT ALSO. ~.?fjveG.- e Rte. 3~ Y f a~,~RRtt) y4 wa° s~~~r} « B firE hip e 3 ~D F 7`his ~~,rx sip` .n~,nfo tai nalAPpj? spAtic ~ ------r d~ 1~6 0-0 system, 1$ • s Y o. k e. ys 114L,Ob' - S/IvT,~fsO S,/_T /e4ly X0,-5 J-- ; . I-NDUS < DE~ARTMLENT OF REPORT ON SOIL. BORI US AND SAF¢ TY & BUILDINGS ,VDUSTRY,. 4 DIVISION LABOR ANY PERCOLATION TENS (115) P.O. BOX 7969 V MADISON, WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP tfi'Y: LOT NO.: BLK, NO.: SUBDIVISION NAME: :5u) 1/ 1/ 3.5 /T30 N/R 17 E (o .ERi,v i,~'IE ~ ors cpa 4 e"o- P-Z" COUNTY: OWNER'S Q4LCLR'S NAME: MAILING ADDRESS: t sf . ~rX ~q uE- N offgs oa ~T• .~~'G.r~tvi cJ 4,y-/l-r USE DATES OBSERVATIONS MADE I;N,Residence NO. BEDRMS.: COMM CIAL DESCRIPTION: ~r PROFILE DESCRIPTIONS: PER LATION TESTS: ? ~ LgNew ❑Replace /_P~ If& aaw ry C( _ RATING: S= Site suitable for system U= Site unsuitable for system ONVIONAL: MOUND: IN-GROUND-PRESSURE: fEIS&UMS YSTEM-IN-FILL ING TANK: RECD MENDED SYSTEM:(optional) M OU,t.ly VENTDU gj S au a S Du Qu R ecvMM -,voE~a 00r- 71?eveArs _3' If Percolation Tests are NOT required DESIGN RATE: [Fl..dplin, f any portion of the tested area is in the ~j under s.H63.09(5)(b), indicate: indicate Floodplain elevation: V ,r4- 7jpt tJCf mss' PROFILE DESCRIPTIONS 1'4 DECIMAL' . 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- 7 J ~0*0 7ta- 71 txu~ a4. s/ w~ s; r- por.~r rrr..3, oJ"' IPZ-R s/ . r r ? • - + B- Z 17/ ?7 ~2 9to-- 7.0 ~ P,-A sJ w/ f•f. f. DR. Powr mb-rs A-r B-3 I•d 90P 07 /v- 3. 16 wits.. HA~y f f, o,P Ho'tS f'0 or 3.3", 3-64'Abjl le2 51 . C_4 M1 B- '51P ya r0 > 3. f. M01 Ar 3,S' Z. Ro.2 C) 'i fa., 15. OR-of "'ws' r Q &Y. yd, . JA 't;x. o Gr s;/ - oa. s , ~!7S o • B-,S' zs y , yY ? 3 ~0 41 w +.f, og, is Rocir- Roo-r ~o'IS q T- 'IN B- v ROOT MO t.5 PERCOLATION TESTS DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES TE MINUTES n NUM HES AFTERSWELLING INTERVAL-MIN. pERI D t PERT o 2 PER PER INCH P- O .2 P ry~ P- 2, 1-7 0 ~ v P t ` 4 Z L P- \.3 ISO P- C PLOT PLAN: Show locations of a ation tests, soil borings and the dimensions of suitable soil areas. I awem sca distances. Describe what are the hojrV. zontal and vertical eleva ' e erence point show their location on the plot plan. Show r ace elevation at all bon d the direction and percentZ of land slope. /j_r7 M S YSft_k ELEVATION d3~ y'S L I f filr -7-- , 1--- r I -1 - ' - _-1-_ r r L----- L------ L c -I I fir--} ) - -1 - - - ! fnnf ` t~st i 61 O I i_-- ► 'OCanveniona!_.eptic' l 1, 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- NOMESITE SEPTIC PLUMBING C0.. ADDRESS: ;A 3 9*16 RD., HUDSW WIS. 54016 CERTIFICATION NUMBER: PH NUMBER(optional): MASTER ROBERT LBRICNT SS^0 d' j t MINN. INSTALLER & DESIGNER LIC, NO, 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nu wQ_CRrLR'IQr M nl),n,)t n..oo T.L.. N.R. 3.0 g(i) r PROJECT Ii?T)7~ SHEET OWNER : ~9U~ tg,~D~,pSo.(J ADDRESS: RT SITE LOCATION: 00 l¢cLc ~rtiPc~G - 7-E57- S%TE 10047- v i,-) 7K 5~ jy 5E'%/ 5~~.'~S T 3oN kl~ ~ Toga of ~.~1r~ ~~,~rra~E PROJECT DESCRIPTION: CLO i x coo 0 T/ Soil TES 1`S p L v S A0 a k)S i TE" 3'o i L 1 rJ S p C c 'r i DrJ 13 S T', G d r X eo ~T 2o►~I~q ~t p T .k~~thf~-v ~v.~- ~r I sc~sa,~J,t~/y StTVXIreD AT 3.167 iS NEW cOVS7iVVe,7 'io,v 3 /~E~•p~S . SST/~f1-TAD O~%~'/ Wks °~9 ~S ReOM9 S y5-,7;FI-7 PAGE 1. PI,OT PT,AN VIEW,-) 2. MOUND CROSS SE('T1-011 & SYSTM P,,All ~TII;WS PAG 7 3. PIPE LATERAL T, 1.Y0TT'i' PAGE 4. DOSING OR SIPHt?:I'T Cis /\MBT',R CROSS PT0TIS PAGE 5 PUMP PER F ORI•-IAN(I , r? SPECS OR ":i%:1TT`-1TT S :PLUMBER : SIT U ^,.T:': l: or DES -rGNE:R HOMESITE SEPTIC PLUMBING CO- RT. 3 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P R.S. MINN. IN31ALLER & DESIGNER LIC. NO. J0663 DATE: ~J o. S, T - 5'i - oz SIGNATURE 850649 2 ~ECENE® SEP 1985 pLUMBING BUREAU DI C) 7- o 000~~{ry h VOLT po (E Y2- 41V y 2, STEEL f1/5fl PdWER/,PD~~ a 04,0 oiL p P~~ s 4to Qi• da (C pI f n S T EEL/~~ T%o~ 7 2-(p P q De[ACO)a ~4r C PTE VA gQL 51K- 9 3y t5(~, :o , -65 ~Roros~o ~ Hollar (3y Q5 $7'i?TEr 00 U64) /000 G.4 ST C-o,u Cup 1.c- W ie se e ~a G-l~c C o U 5-~~ ~`.~'c 7 9•vk • . 7'j'!~f %D~,v <t°o ~ ~ ~ i S , lv;--jr p eavcq I-e- ed- r /0 8506492 ~g1NG RECEIVED 0 198i PLUMBING BUREAU p HpMA GS T ~ pF E~;p,JST ~ti , . t .Y oP p U11.D1~ of SA ptiPARjMENp1V1S SPON~~NCE EE C~RRE x Page 2 Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H - - LG Topsoil F. `J D " 3 E b % Slope Bed Of ZM Force Main Plowed Aggregate Layer D / Ft. E 1.3 Ft. Cross Section Of A Mound System Using F -75 Ft. A Bed For The Absorption Area G / Ft. A Ft. H /5- Ft. Signed: B Ft. License Number: K /0 Ft. Date: L 7 Ft. d Ft. Alternate Position T /L Ft. of Force Main W 28 Ft. L Observation Pipe---,\ Io ----T-------------- W 2 Distribution Bed Of J,?"-2 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area 8506492 P`VMg~N /~,►~G RECEIVED SEP 3 0 ,r R~~ttoNS 985 t PLUMBING B ~s - r~~~~ Reap UREAU 1lE~D~t'9Gs pEPPRZME D'►`t FENCE ,~,P®N GOP, Page-3 of~ Perforated Plpe Detoll L,~s T No/E S err- 7- foR 0 A,'R PUAc vATio.u End View )Perforated End Cop)) PVC Pipe I. oe~Q e Holes Located on Bottom, • Q s S Are Equally Spaced P 7C S .7 P PVC Monifold Pipe Alternate Position Of Distribution Force Main fT. Pipe 30 ~UC Lost Hole Should Be SC ~i,eL Next To End Cap End Cap Distribution Pipe Layout P 23 Ft. 0 R 3 Z S X 30 Inches y -2-J Inches I Hole Diameter ~y Inch Signed: / Lateral Inch(es) License Number: Manifold Z- Inches Date: Force Main \3 Inches # of holes/pipe /0 Invert Elevation of Laterals yg•9 Ft. x/57, i13 uTio,v f i~E DiSGL,,~iP ~'a7~e = /oZ S/~ ~•s hlE~a !v i d ~e ~i4TE.f? ~S T° r/&4 72-- 3 0 fr, 3 /'vc f.~c~- 11 • ids 6492 50 t ;~1AN RE~,ZIONS PND HD RECEIVED ~`ISY1.Y, LDOR tLD1NGS N AND IND DF SV pEPAR1ME~p1°; S-EP 3 0 1985 E CoRRESP~NDENCE. E PLUMBING BUREAU 1 • PAGE ~ OF PUMP CHAMBER CROSS SECTION AAlD SPECIFICATIONS r~ipADE G`'lE-vtrio n~ y9 o Fr VENT CAP 'i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAMHOLE COVER ~ 25' FROM DOOR, WINDOW OR FRESH 12"Mill. AIR INTAKE GRADE y" MIN. I6" MIN. Re d/rT,'a cO~I DUIT- - 4-X- T of 16"MIN. IN Ler 9a•s INLET PROVIDE I ~'---1 ~ AIRTIGHT SEAL I I i I APPROVED JOIN-l/ A I III APPROVED 30INTS W/C.I. PIPE I III EXTENOPNG 3' LARK ONTO SOLID SOIL OEXTNTEO NDI SOLIJIGD 3' SOI L B A i C i.I 1 I II I NY I _ I I ON ~~.5 IN t ELEV. FT. FlG~ VpJ PUMP _-j OFF ~ ti D g9.o CONCRETE BLOCK RISER EXIT PERMITTED DULY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E /5PECIFICAT10US DOSE TANKS MANUFACTURER: IJUMBER OF DOSES: -PER DA-9 TANK SIZE: 7S"0 GALLONS DOSE VOLUME INCLUDING BACKFLOW: GALLONS ALARM MANUFACTURER; rl MODEL I.IUMBER~y~' L' V / CAPACITIES: A= 2✓ -IIJCNES OR 7S/~ GALLOIJ5 SWITCH TYPE: hax!j flelf7_ B= Z9- IMCHES OR 3a GALLONS PUMP MANUFACTURER: ~o .t' lQr-HES OR GALLONS MODEL NUMBER: ~p /03- D= INCHES OR GALLONS SWITCH TYPE: /ed LVA'/! F/(047-5 (2) MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET ~/fitJ~ TptcS + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2 5 FEET 30 FE ET OF FORCE MAIN X IO F jO FT.FRICTION FACTOR.. `33 FEET S TOTAL Dy:IMAMIG HEAD = 1.3'2- FEET INTERNAL DIME.I'JSIONS OF TANK: LEI67~1 ;WIDTH 05~/ ;LIQUID DEPTH A SIGNE D: LICENSE WUMBER: DATE: 8-506492 SEP q 0 oesDDSi, v , ~ tiD 985. o~ sg~ PPR~MEN %l IS10 PLUMBI/VG B DE N w URBq U S PA&E T D H HEAD/ CAPACITY CURVE w w TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE 30 EFFLUENT AND DEWATERING SERIES 53-55-57-59 87 137-139 163 165 M 'T AS LTRS LTRS LTRS LTRS 28 1.52 163 248 394 231 231 EFFLUENT AND DEWATERING o 3.05 129 216 300 231 231 5 4.57 72 163 242 227 227 26 ` SEWAGE AND DEWATERING 0 6.10 104 ,3s z23 2z7 \ 7.62 30 216 223 9.14 206 220 24 12.19 172 206 ` 15.24 125 191 0 18.29 57 161 22 0 21.34 114 \ 24.38 53 MODEL MODEL Lock Valve: 19' 24.5' 26' 66' 87' 20 163 ` 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING \ SERIES 267 268 282 284 293 18 M LTRS LTRS LTRS LTRS LTRS 1.52 408 386 492 681 3.05 227 273 360 598 - 16 , 4.57 76 163 238 511 \ 6.10 30 125 401 7.62 288 _ 14 9.14 163 292 10.67 2' \ \ .fJ 12.19 i 1 yr.' \ 13.72 106 12 15.24 45 ` MODEL \ Lock Valve: 18' 21' 26' 35' S3' 10 293 MODELS 8 137 139 6 MODEL 284 4 MODEL I MODEL 282 268 \ 2 MODELS 53, 55, MODEL MODEL 57, 59 97 267 Q 0 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of... F P.O. Box 16347 OL fR O~ Louisville, Kentucky 40216 P 1~93~9 (502) 778-2731 Quatirr UMPS /NCE s L `tj, "5®6492 ~EN~ OF ! 1 E S(~FE~ P~9 !-D!N RT /~S r . pEPA p1VIS ~NpENCE, 0 1985 SEE CDRRESP PLUMBING BUREAU iw..riwiY~Yr~1~Y~Y~Y~WIWIr _.~_r_ . p N i n m ;w (~D ¢1 5 2 N "3 ~D 7 O (D 7C C= N 0-3 ~co =r 3 ca co = o a ~m -0 a~D N o A o c CD to CD v, COED$°vo 0Daw0 co ► ~ ? ID o ' m a`DO A 3 Q O - -%(D (o Oa) O-,~ >>s (a =r :3 Fo* c C- a 3~~ o~3oa00 ei R w ~ 0 N Co. N CD ~vv D (D ID < N N AtG cQ o A mO _ D_c_ ac m ° A W A C fQ ~ ~ O g CCDL O ~ Q w(D O D Q N C (a -9 e~ U 3 CA p, fD G D w °s a N O fD m cD ? a CD 0 3 D w° co w y ° ~~atc vi W a a C A CD C m (D c '00 0 N O r. G, 7 O W U1 (A c c fp O 6 N a CD J A N ~1 caO~* nt O a y j W O w O C. C ~ ~ o a a Ck. a0 Q~ f =r v; G) co 0 CD n C G)0 a N W A Oi O C m s Qo a r`° w -4 m acv cv O p fl. S W A ~ C o C 0= O a 3 ° O ° 3 Chi, O a cD O d O < • c fD N f0 O O " D' R Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing PI s~ Madison WI 53707 Private Sewage., Telephone: (608)266-3815 Pfaii Identific.,mon No. `fit 10, %A Callons Per Day A PRIORITY PLAN REVIEW ONLY . Plan Review Free Received Petition for Variince Fee Rec. Project Name Project Location - Street No. or Legal Description : t • t r v > Cou ❑ City ❑ Village 5 Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable co e requiremen s. 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. ❑ 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. Q._ FOR PRIVATE SEWAGE PLANS: (1) (2) ``(3a) j,(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: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: A Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health 0\ County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other