HomeMy WebLinkAbout020-1125-80-000
C o as °o
°
m
O ~ I
-o x
°o ~oo 0o
N (D
E O
M O y Y
c
C -0
o a y
c N m I
i a o
3
O
r .E °o '
o-
a n~ m
o n m
o z m a)
c 0 o r
o
LL c
c 3m -o
o m
4 ng'(n-oLO
I
M
V (D
> z H
CD Cl) 0
V C
z
N am
o I
o z a
L) Z o
m ~ z
o co
N :3
0 0
N (D
o
O
a of m
0 o aa)i Q
z co z C
N rn z
o) cz
o
0 0 CL L 6
co (D U) U) U)
U) 0
0 0 0 a z
m a a a
a
~l = O N N N y
cn J 0 u) rn rn
rV o o
2 N N -
a) CD O E
c O O a
m z)
J+ N a)
Q ~ U)
ca
O O Y N c
CD
0 o c n L
l o co 3 m o uCI- o
V N ~ E a N
cu O N C U) O ED C = ~
O - co to L -O a
r~.r O' N N M .0. OL C N
• N ~ W O a) v
N y, o 0= N O z c2 Cn
cO
N N (L
7 O' L: d
• ~ CL d u a) d C
E i c 7
r A u a O in v `r
00'0 00'0 00'LZ lelol
sa6ae4a;uenbu!laa sa6ae4a leloedS s;uawssessy leloedS
001Z 1N3WSS3SS`d IVIO3dS JNMAO3iJ-8 L0
;unowd AJOBa;eO epoa leloadS jasn
:slelaadS
OL£ 433 es :a;ea uol;eol poo L :;unoa wield :IIpaao Aiallol
0 0 000'0 PuelpooM
O0E'98L 009'Lt, OOL'LE OZ8'L A:podoJd IeaauBD
:EOOZ Jo; slelol
0 0 000'0 PUelpooM
O0E'98 L 009'Lb4 OOL'LE OZ8' L AtjadoJd IeJauaE)
:170OZ J03 Slel01
ON 00E'98L 009'LbL OOL'LE OZ8'L L0 IVUN3aIS321
uoseaa a;e}s le;ol anoidwl pue-1 sajov ssela uo!;dl.iosea
LOOZ/9Z/OL :Pa6ue4a;se3 :suoilenlen
009'6EZ 8998t7
:4l!m Pessassv :onlen;aNJew JIed II!8 Audwwn$ v00Z
99Z/999 L66 L/EZ/LO
(IM 9094LO L L66 L/EZ/LO
odAl a6ed/10n # 30a a;ea
:AJOISIH !aoJed :sa;oN
M6 L-N6Z-LO
(t7/L 09L t'n Ot, 6u2]-UMl-oaS) :(s);oeil
6t, iM :6PIEI opuoa/ Ola 6t, iM DE)CM] 319VE1 M6L2l N6Z1 LO 03S
3DGI2l ElOV3-9ML :;eld OZ8'L :soiod :uo!ldljosaa le6a-I
OlIM OOLL dS
NOSar1H 30 a HOS L M OS
`d-1 Al IliiVl JN ZLE uo!lduosea #;sla adAl
jewud :(sa)ssaippy A7jjad0ad IeloadS = dS IoouoS = OS :s;ol.i;s!a
9L0t,9 IM NOSanH
V~ AElii`d JN ZL£
1M3MTiS A VIINV IR 8 N3Hd31S
A `dllNV 12 9 N3Hd31S '1-13M-IUS .
jaumo 1uaiinO = :(s)jaumo :ssa.ippV xel
0 00
edAl }!woad # a!wJad # uol;eo!iddd eeid soleS # deW a;ea IeolJo;slH a;ea uoljewo
NISNOOSIM 'J.1Nnoo XI0210 '1S X ;uaiina
NOSanH 30 NMOl - OZO 8L9'6 L'6Z'LO lowed IIV
L 30 L 3JHd
Wd 9Vb0 50oZ/LE/E0 000-0Z-9Z W0Z0 laaaed
ti
Q o -0 °o I
3 0
N O
H ~ v
c
p m N
N v>0
O >
N O ~ ~
s o
m
0 nO
o
o
c ~r
w o
C~~ N
w O
y n
0)
L 'C N
C N ~
j Z) a) (D
cn O OU (0
a
L U
V
ns
v o m 0- LO
c Z o E x
3 ooo~o
LL c c d
'O w y O
p C 3o Y
N .~t
Q N h !n
Cl)
z y \
W
rn
o G
Z '00
N a m,
'f1
c C7 r `
o z
v
fn H r l o Z
11'/ a) j
(0 a) `
In a(
U) c
r
0 1.'
m z
-
U) r)
N
0
i6 " c a
__0
m u o ` I
0 IL
cn cn co E o v ( ._r
n 65
'aaa z '
R
a ~ i
~y a ~ -
'i , .6 N C N N y
to J U °i rn rn a ~
w.v _ F o _
Q O
c o o - E
co o
fn a)
J m N c a
O O Y N vJ
CD w 04 =
o E
o c rl- t a) LO
O(N - 00 3o CO a) s-0 U a :3 C,
O
E ca N 'E N
(D L co
„0 N U) C Q) co C? O
C\j
O 00 N" 'O -p m
FBI N "NO a) M 4? p C O
• ~a CNO f-- D = co O 0 U O m U
IV N
0 0 2 . ~ N= Z
I
O it z 2 ~ CO
C l*t.
E m
v~ d R a
Xk a ` a r
• a 'y 2 a) y c
`Iv E ` c c
A 0 IL O in 0
i
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
W fl u II 0 11 ■ MINt
ST. CROIX COUNTY GOVERNMENT CENTER I
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
March 7, 1994 71f
Ms. Jenny Olson
rL y / f
Century 21
706 19th Street South /
Hudson, Wisconsin 54016
RE: Water Inspection for Tom and Kathy Lally
Address: 372 Krattley Lane, Hudson, WI
Dear Ms. Olson:
Enclosed is the original test results from Commercial Testing
Laboratory, Inc. for water inspection of the above property. If
you have any questions with regard to said report, please let me
know.
Sincerely,
Mary J. Jenkins
Assistant Zoning Administrator
mz
Enclosure
.COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800- 962- 5227 CiEw
FAX - 715 - 962 - 4030 c
` CROIX CTY ti'W.CTR REPORT DATE; 3/04-
t CARMICHAEL ROAD
A 3N, WI
ATIOW 372 Krat
.-ECTORS M, Jenkie;:
COLLECTED1 3-02-."'
r COLLECTED t 31 Cri f
RCE OF SAt i
_ ANALYZED'-,.
'L ANALYZEDtZW po
.IFGRM,WCC: D `:~tti,c, ta<
"'RPRETATION* SacterialogicaLLY 4
ppm
14 ppo exceeds the recoismerued r trb r_
fC"
OF,NOEPENpEHl,
it
o
d A
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY
WISCONSIN
L y. Jay
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
- 911 FOURTH STREET • HUDSON, WI 54016
- - r (715) 386-4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
1~iU
Specify desired test(s) & remit appropriate fee with application.
Outside water lines are often turned off during winter months,
~J making access to the home necessary. Please make arrangements with
this office to insure a time when entry can be gained.
5c.cr~ 1
❑ Water (VOC's) $185.00 ❑ Septic
❑ Water (Nitrate & Bacteria) $0 (Visual inspection)
iLA~S.CI.
Owner: ..Te r, r K v)] Ht_1 1. Ii L s! Requested by:
Address: =-1,12- KC441 Itlca L Address: `>CCity & State: (,cAse~, City & St. ftc.~~._r~•; l.
Zip Code: Ljd-IL-,ie Zip Code: ~KTelephone N°: ( ) Telephone N°: O Ir,) - F = <<
Property address (Fire N° & Street) : is
Location: Sec. , TN, R W, Town of
St. Croix Co., WI. Tax ID N°~c_. I lh< 7c Parcel ID N°
House color: Realty firm: (.c, o (-t .4 4z Lock Box Combo: _E)F o .
Water sample tap location:
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Is the dwelling currently occupied? Yes ❑ No
If vacant, date last occupied:
Septic system installed by: `p, r,,; rlilt_1 k r < r~_'lE'c! Year:
Septic tank last serviced by:Aj_ _1A) ~s4pv-'-L Date: 31r _
Previous Owner's Name(s):
Have any of the following been observed?
❑Y MN Slow drainage from house. A~'~'
❑Y ON Sewage Back-up into dwelling.
❑Y 4N Sewage discharge to ground surface,
road ditch or body of water. f-X t _
❑Y NN Slow drainage from the dwelling..
❑Y AN Foul odors.
g
Other comments relative to system operation:
I certify that the above information is complete and true to the
best of my knowledge.
'
OWNERS SIGNATURE: DATE:
`z
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
4
IN `aT
Z: \
I ^ T
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? []Yes ET9-o
Soil series per SCS Soil Survey: sheet #
Type _of soil absorption system: below grd ❑At-Grd []Mound
Approx. size 'X []Gravity []Dose []Pressurized
Ft.2 []Bed []Trench []Dry Well
[]Holding Tank []Outfall pipe
OBSERVED DEFICIENCIES []Other []Unknown
Septic tank
Setbacks: []House G []Well ` []Prop. line []Other
Dose tank
Setbacks: []House []Well []Prop. line []Other
[]Locking cover []Warning label []Pump/Floats
[]Alarm []Elec. wiring
Soil Absorption System
Setbacks: []House []Well []Prop. line []Other
[]Ponding: ` ,7;. r~ []Discharge:
Gencral comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector G' ?.z >
Title
ST. CROIX COUNTY
WISCONSIN
- ZONING OFFICE
n u u n n u x n n n,■„~ ST. CROIX COUNTY GOVERNMENT CENTER
_ 1101 Carmichael Road
- - Hudson, WI 54016-7710
(715) 386-4680
March 2, 1994`
~Jf
Jenny Olson
706 19th Street South
Hudson, WI 54016
Dear Jenney:
An inspection of the septic system on the property of Tom & Kathy
Lally, located at 372 Krattley Lane, Hudson, WI was conducted on
March 2, 1994. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon as
we receive them from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
~cerely,
I%{Fi'U 2 a. 1 .yrhZr.
Mary Jenkins
Assistant Zoning Administrator
js
1
AS BUILT SANITARY SYSTEM REPORT
OWNER_ TOWNSHIP ec a, r U~` SEC. '}'.Z IV-RI W
ADDRESS f' ST. CROIX COUNTY, WISCONSIN.
- ~ ~ 7 S IZF:
SUBDIVISION -r LOT LOT
PLAN VIEW
Distances and dimensions to meet requirements of H63
a Q>aL_E-VERYTHING WITHIN 100 FEET OF SYSTEM
I di a e VotthjArrnw
.S L ' I
BENCHMARK: (Permanent refere Sg Point) Describe:1~0 Z` / 5
Elevation o vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: I 0 PU
Number of rings on cover Tank manhole cover elcvat_ion.~ ~~f zl'
Tank Inlet Elevation: ) Z ' Tank Outlet Elevation: PUMP CHAMBER
Manufacturer: _ Number of gallons
ihatiber of gal. pump set or a cycle _ gallons, tot.a capa~ i t y c~
distribution lines gallon: size pump Bead;
gallon per minute horsepower _ brand name of pump
and model number
'T'ype of warning device _
HOLDING TANK: Manufacturer _ _ Number of gal Loris
Elevation of manhole cover
Type of warning device -
SEEPAGE PIT SIZE: --Nuin er o pits- Feet Camel er-
feet liquid dept seepage pit inert pipe-elevation _
bottom of seepage pit e evation___ feet r
SEEPAGE BED SIZE: number of lines_ widthLe,,gth le dept Ii.?
SEEPAGE TRENCH: width length _
PERCOLATION RATE #AREA REQUIRED7,.; ARE -AS BUILT U1
INSPECTOR
DATED PLUMBER ON JOB
- y }LICENSE NUMBER - ~j -7
0
P
1
IJf
J r
r I ~ ~ e , ! l7 J r~, cf 1
~ r
i
V~hT
r
DEPAR :MENT OF INDUSTRY, INSPECTION REPORT FOR c~11 SAFETY & BUILDINGS
LABOR & HiMAN RELATIONS PRIVATE SEWAGE SYSTEMS '1_4WDIVISION
P.O. BOX'79t)9 BUREAU OF PLUMBING
MA61SON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number
(If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NA E OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER . INSPECTION OAT
jl_~>r~-'r„ D Z-
BENCH MARK (Permanent ref. P,- point) DESCHIB IF DIFFERENT FROM PLAN: REFF.. PT. EL ]CST RE F~IT1. ELEV.
Name of Plumber MP/MPRSW N,, oumy. Sanitary Permit Number:
SOTIC TANK OLDING TANK:
UM~NCTURER. LIQUID CAPACITY. TE LE V.TANK OUTLET ELEVWARNING LABEL LOCKING COVER
PROVIDEDPROVIDED
~ I U O YES LINO ❑YES LINO
BEDDING: VENT CIA VENT MAT L. HIGH WATER NUMBER OF ROAD: PR OP WELL. BUILDING. JVENT TO FRESH
ALARM. LIN AIR INLET.
ES LINO /nJ FEET FROM - OP
V, ❑YES LINO NEAREST
DOSING CHAMBER:
MANUFACTURER JBEDDING. JLIOUID CAPACI Iy JPUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: TMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL JBUILDING V(DIFFERENCE BETWEEN FEET FROM t INE AIR INLET
PUMP ON AND OFF) ❑YES LINO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F I ~1_mi TEH MATERIAL AND MARKING
FORCE
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LENGTH JNOOFSTR r . PIPE SPACING COVFH INSIDE DIA -PITS LIQUID
BEG/TRENCH / TRENCHES / M H LAW PIT DEPTH:
DIMENSIONS /t44/ _ _
C;RAVF I..>I 1 i~ FILL DEPTH DI STR I'IPF DISTR. PIPE DISTR_ PIPE MATERIAL'. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING. JVENT TO FRESH
BE PI4'f ''77 ABf)VF OVER ELEV. I 'q' ELEV END. PIPES LINE AIR)INLET
. FEET FROM /t ~ I/0 /O j ,p~~ NEAREST-P- 1o
l D
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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
SOIL COVER. T XTURE PEHMANENT MARKERS. OBSERVATION WELLS
1 ❑YES LINO ❑YES LINO
UFPTU OVER TRENCH RED JDEPTH OVER TRENCH. BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTEH EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE JMANIFOLD MATERIAL'. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MAHKING.
ELEV. ELEV. DIA. ELEV. PIPES DIA.'.
ELEVATION AND
DHOLC SIZE HO LE SPACING DRILLED CORRECTLY MAT ERIALVERTICAL LIFT CORRESPONDS TO APPROVED
ON PEA NIS
_ ❑YES NO ❑YES LINO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PR OPERTV WELL:- BUILDING.
FEET FROM LINE
❑ YES L] NO ❑YES ❑ NO NEAREST-
Sketch System on R ain in county file for audit.
Reverse Side. DIL-HR SBD 6710 (R. 01/82) VE
,
State and County State Permit
PLB 67
~ Permit Application County Permit #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
s a M t1/,* 7-r o f roo~! A tjUJ54, h W,5
B. LOCATION: % ) If Section , T N, R 4 (or) W Lot# It!f City
Subdivision Name, nearest road, lake or landmark Blk# Village
y j~ r Township / .C SO/7
/ /C Ir r
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family &I" Duplex No. of Bedrooms No. of Persons
D. SEPTIC TANK CAPACITY p Qd~J Total gallons No. of tanks If
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete oured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
f/ -
E. EFFLUEN>j ISPOSAL SYSTEM: Percolation Rate - Total Absorb Area -sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of in aI Ft. Width Dgth Tile depth (top) No. of Trenches
Seepage Bed: -~_Length. Width Depth L` Tile depth (top)~No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- 2- 4" ~o Distance from critical slope
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil T ster, 66
NAME Di e I S ~ A i J 5 !7 , r°~t C.S.T. # I ~ ~ and other information
obtained from cr ; (i^ (owner/hm1dPr4-
Plumber's Signature /MPR# / - Phone #21;!
3 3 /
Plumber's Address - `
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
E
3
E ~ E
,
I
E ,
i ~
3 _
i {
r
. ii a,.+-4e m w...., _ e ~ m . m . ~ . .....w a.. ,m, e m... -lm
j
.a ~ t ~ . e q .m. ~ a, e e ~ . AP,.m , a , > . n:. , . m ,e-. m.-_ . -
G i
F
{
E
E
a
i
Do Not Write in Space Below OR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application ( 17 Fees Paid: State County Date
Permit Issued/Rejected (date) Issuing Agent Name
Inspection Yes No State Valid# _,D~ate c'd
1. county (white copy) 3. owner (green- Zapjr~ DIVISIC)N1]~ ++taT~H, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. Plumber (canary copy) Revised Date 7/1/78
DEPAE THE ,QF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
.NDUSTi i~` DIVISION
P.O. BOX 76
`LABOR` `N `7 PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATI
LOCA I ; : EC IQ," TOWNSHIP/ d 18 1 PA I!: LOFT NNO.:BLK. NO.: SUBDIVISION NAME:
S /Yf~I7F" NW Rl9®(or so,~•~ % / tWC11 G
COUNTY: QQV NER'S BUY S NAME: MAILING ADDRESS:
USE • DATES OBSERVAT ONS MADE
NQ_. Ms.: COMMERCIA DESCRIPTION: R DESCRIPTIONS: 1PERCOLATION TESTS:
Asesidence -3 New ❑Replace fe72,
soa'//C?,y s4ee-g~ X40 09 Q 44
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLINGTANK:REC MMENDEDSYSTEM:(optional)
~~S ❑U ® S ❑U xS ❑U ❑ S zu ❑ S ®U 0~~ ads
If Percolation Tests are NOT required DESIGN ATE: SYSTEM EL V. I If any portion of the lot 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 THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13- /L/a Al e-- gy
B 3 K'' /7 All 0m 17"' 94 9A l -Q n S
PERCOLATION TESTS
i. TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
CUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERT D PER INCH I
n
P- 0 s Y v a
Q
1 P- .3 3 ~
CP O 4 /ry
P
P-
PLAN VIEW: 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 slop.
SYSTEM ELEVATION /D/
UrrQ,,.S
$des r,
,go f-A SY s /,e,,.,_ 4r*4s l/8 LSY -t) z
r5`1ftArrr_
Pra~.~A~y S9t-1 Gs~rA G C~a~
17 -1
R C-4 r1co,
Toto .1L to' Iw-
svee l . elac « 00~&f i9r.r~r~a ~ OrAvG .
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin
Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (prin TESTS WERE COMPLETED ON:
4;,.3 o i
ADDRESS: CERTIFICATION NUMBER: PHONE NU ER optional):
C _fir
CST S RE: p
f
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
7
a ~ ~i
A
v 6..
x
~ ~
r
_ -n .
J
E
~
Y,, ~ s
' a i
~ _
i a
{ " .
i 11 ~
r
~ ` .a,. i+ Y
i
- ~
t _ 1 _ 'tv ~ Y
. ,y
~l
. a„ ro
i7
INI.
f.
I
o 0 o 0cn0 g -on
0
11 C 3
O (D O (D n (D 'O
Z n v o
3
0 ---4 C/) 2 0 0 Y ~
n m w 0 O N O N o cn p c: N O -4 rQ
CD o 0 o m 3 0 n o m w m
C a to v 0
Z o- _ y v O 1
C: U)
3 W W N
O W ? c°
N Q v v n 3 1 p v a Cf) p -1 cn
C) -4 CO
° o 0
CD @ m m n w ° m n v P
3 CL C)
7 u 7 V w - p
CD O co C3
v u> D a to D a
m N cn a A N N a
(D CD
r- O. W ' O Q co
3 a -
0 N O
(D CD CD w
a) w CL
a 1 11 2
N 000 W? o oho co 0- N o c ~l
N N m cn N a
o
"hit
z o o o A O O O
o cn v_ cn n m
0 cn y cn ? ti cn ti° L" W
0
Q cr v O Q cr v v m m
O (D ~11 hD O N O (D A O N
CD C1 'C i D1 'O D_ ~y
CD CD CD
(n CD
N 3 0 3
o _
(D ~ cm 77
o
N
z co z z co z
O D CD D n
O
a S
CD CD CD CD
~J -CDO cn TJ o eJ
m m & m w M~
cc F, 'a c (DD CD ° c oo (D
w m n O.
z (D CD -a N
O O O p Z (D
co o _ n
Q D A Z j
a
I O ~ ~ v
W m 03 -u N)
CL A a i Z
3 ' 3
O - O -
3 3 m
N z Z7
O O
w w
61
O
_ O
Ow (_nQc w° (o O_ O O O > 3 CD CL CD
CD CD :3 Ln-
(D N O6 O (D O O (D O. _ n n D O
5 O O
m T
_ O 5. m T
m C
m Z m m 0 0 m z a
s v z a
3
CD a) cn 6 (D < 70 (D
3= N C. `G Np N N N
CD O O 3
C) 0
CD » m - a
~0 CD
a m l a
N = N N (~D TI
3 N 7 Q N
y
O .+(D 7-6 0) (n a
Nc 00° ='a co t
D3 ACS
C9 :3
ID C-
0
0. 0.
o m
-o v.~moo a
(D ?tes A
o
° N
o o o
m CD a o
m CD
ft e
O O . ~
o * p C y~
V Oo (D. Oo (D
' y
ti
a
0
b
kJ
x to
r- w
0 Q)
° h}
J-J Ei bD 0 ` r
v
W I ~ q
~ z
rn 4-J
a I Lf~;~7
can Ca 0
N
00 10
M 1 ,r
I
a
-J
v H ~--r1
P4
o o CD
z o
~4 4J
P4 V~
O C~ > )
14 >
F-I ca ca 0 1 1
r
~ LYi x CJ] U . r ~
i
0 0. 0 ic v 0 Cz
v c
v 3 m
3
r. ~
v v vN o ° rnN o o ~
oa
m o o m m j m aN) o ~
m a d O_ N v O' ~h `A\
C 7 W W U) 7 O N C 1
N d a) N N 3 j
O v
°O
<OD CD CD w -r, C.Ti
O 7
3 N ° ° C
O (D
m (n D fl
CD CD 0
N W O. 0
c a
TD O o o c t`+
~ j a
N 03 00 0 (n 0 c
A
z o o o M •
0 0 0 0 U) O ~N)
~ W rn
J N C/) N
3 -0 v v CD
° m q - m m
cQ
(D d
m M
a
_ cc
0
O 3
N
CD _
z N
N
z co z
D m o
n 0
o. ~ h •
N
(D v N
C (D N
W d
n 3
O O O A z (D
n C A z O
v C)
U) -4
W 'o
CL " z
3
°O cn
3 m
N z
(D A
O~ (n c W z Q 9 CD
7 N w0 ~ Q C
O N O N O O (D T
'O 0
:1 O `O N N 7
O
s0j L ID ID o a
FD' CD v N - m
7 0 NN~O N O N
N O
zr O
,ID
O
fi
CD ,
CD CL 3
7 'D Q
O (D O 41 ~p ,a
D 7 v N
N 5 d
O - - 7c Q N
:3
m a
N p
co :3 n n
Q 3 N _g
c,
coax-CD
O W W ET - 7
CJ O) p' N N
N = 7 A
CD O
"~6 '00 (D O C7 CN
(D 0 p' a
N
O
oaQ °
(D
o p
CD CCDD
O CL
Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing
Name o remises Date / an No.
Street County Sanitary Permit
master um er Firm ame dress
EW li't4~ t-nil W?
Address
JE rt« ! ir~~%la'~`>>/=N l?I!~ ~fk?r C . ~c%>c~nJ T s'/c i(o
, )er AdTreSS
Own
r
"S n ti1K
APR4.
./-714
5. V hi,,
4-11 zt
,:..~..Ae..... E.M.: ...S.F . .....«....~y... T.. _ ,.......W........ ..<...~~.M. 2. wC -.n,...~r,vC..oe...'dt~✓.«~~~i .1r e... .w. ~~vl :.,r
`A
1
V 1 i Y py
Vt, it l '.NJ "z~ a_.
bit ! ' ! ih. t Aj V no
. f ;
: li4.,, trxta -)F AT Vt. r I
r _
1
Discussed with Signature
( )See Attached.
ri
DILHR-SBD-6192 (R J i /83) Signature of Dist. um i ng u . n- l 2 " as a peci a i s - - - I'
• Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing
Name o remises Date ESanitary No.
t county Permit #
1t~3 ? r ~V tea 4tj
-7 j as er Plumber irm ame d ess 1
7 Address
i_-Y rj ~ . '1 ' ► >t',- (i l - l- /AL4 P- Auk? b 1v? S CaI
Owner ress
~5~c , . j':2i7 ;4 /l 7 f~l s e,.. ..,r2-
/40
cat- pe A~Nl=lbit`~
1'I
y
l
y i ,pp
1 cusse , Signature
{ )See Attached. -
DIMR-M-6192 (R. 1 1 /83) Signature of Dist. Plumbing' ` up. (in-site waste ` 5 M
Wisconsin Department of Industry,
PLB-1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing
Name o remises Date an No.
Street i y oun y Sanitary Permit
5w Ste. 7 1 +aSC, J s; -(P0/y ai
as er Plumber it ame d ess
{
2,_ T ress
_ owner ress
. n_... .,..,w., -r~-~`-t,,,1 ~ c,-~ ~~~~`'SC1.....✓~'U-r_~ 1~.... _ _ ;.~~E1 ~~tQ_ d b.®_aM~ _ .
J
-we~
m _ .
co
. MAY C..EIVEC~
Y 1985
_ _ . , ....~e_"ZONXI . , ,
w, e,.. ri..... m.z... e,..,. Of~1
_ro,.. m .
Discussed with igna ure
( )See Attached.
DILHR-SBD-6192(R.11/83) Signature o is um ing' u n-- a as e, pecia i