Loading...
HomeMy WebLinkAbout030-1073-30-000 0 to 0 0 cn O 3-u 0 C ~ 1 m 3 m (D 2. ID -o # -0 m W CD 3 - O Can O W (b N ~n ?.N ~ -I Z O N 00 (n N O N Co (n O O !r O W N (n W • 3 D b CO n C_ CJ O O co (n ( CD nD N rn m a Z 0 P1 ~ N o o O rn U) -a - W (n It A CD O O O N cn CD 0 (a C 1 N 0- O O ? N W 00 C) 7 W O o cn J m a O D o ,t 3 N 7 N j O C N N N N C W C W O CD -P, n Z A a n CD IA m a n D14 a m N a y m m O v 1 o m ` ~ C J N (O C CD ~ j CD (D NO A CD O fl CD O co CL CD co co N (n 0 C N = N N - ~ Q O O O O z O O O O "IVA~ 7 1T C) "O fn C (D CU O N iS O Cn CD M N b GI "O d a QO N _ ~1 (D C7 77 CD •2 d cn Q1 ,2 d N 0 O !V CD CD _ a Ia N N z D W o y co o O o a 7 y a= CD CD (n (D CD o m ~ c ti n CD CD CD CL a Cn z Z m 0 E3 U OC :r A n D D. A Z O CL Q~ G) N G7 w m W A CD f~D ° O CL a Z e 30 3 °r c,J CO f/! ~ N ~ 3 0 0 o f IA CD CJ p CO D A N . w O 12 - 7 - fns =3 ,Q I 0 W S (CCDD N -°o o N c z v * - ° ,0 O CD -n Cn ~.~m~ I° -n a CD O C -O C O N '>J C 3.3 v m m z ° s3 ~ v 3 a o• -o z a O^ CD 0- y' O CD CD N N O CD En °<noa CD u ao~ o m'3~ ~=1 0 p N C (p a 7 7r O C'L n~ = O CD CCD, SO r O a -0 Ed c- w O 3 7 S C CL 'O 7 0- O' 3 CD :E cc) CD O O c 7 S O" (D X F1, O 3 S O (D W 4 a m Om Ul En U 0- W W N ti O .N-. (D CD 'U 0 CD (b N C Cn O p_ < < W N v 3 (n rn O S N =3 U) j (D S O O 7 O O ti O W CD (D (D '.1 n O O O <n v Cn O O Cn ~ ° a v m ~ to O rfl ;O t j O p IcD p D a O IQ O C1 ~ 1 ~ II 1 G 4, V 6q ~ O :n L IV O N J C C n~ 7 'C r- o N E 0 C/) -r - i o y -0 o ZF) N m;o C D L O y It N Oy_ 2 Y _ Cl y N 0 L E O OO 3 a N Y O r C D O y~ N O C a N r E . C U ,N, N 7 co 2Y £ 05 U 3 C ch (9 N O _ U D C (9 c N EL O c C-N 7 N p 7 G A O LL 3 LL = CC p Q co N L (T9 CO M C N i C~ S ti d. O fb O < T C7 f9 F- 3 N ~ M 3 M a~ a ~ Z N Z N rn ~ E E z E E D ° o a m d H 0 o z d T c - T, C ~ D C N y L y - •C 01 n N O c0 tU O Z [O Z Z co z N U ` s I o a a 10 _ C7 K y d d ~ N ~ `1 a `n D❑ d n = , D O a o w crn frn tro - N = FN- H H •ti a a a a a a rV a = T - m 04 C,J = C14 1\ 7 O N 00 00 d t~6 M O cn ~ U ~ rn rn } Z 7 a, N C 6 O co yI i 3 L:j Q Q v < S } 1 Z ~ O r VOi N N N C O C C N C _ C N C ~ 3 M~~ co O co N L O C t N ti a v y N AV N a y a> C) ao L; E c a M (,l y M L O N CO N 0 Z H 2 m w Z -i Z O 'S E m E d # y y .E .E • 2 y O d O C CD y C 0 aL 2 0 Ch U 0 <n U Parcel 030-1073-30-000 03;02,,2005 04:00 PM PAGE 1 OF 1 All. Parcel 26.30 19.256A 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner BARSNESS, W E & DIANA W E & DIANA BARSNESS 1341 AWATUKEE TRL ,r - HUDSON W15401fi Districts: SC = School SP = Specia, Property Address(es): Primary Type Dist # Description ' 1341 AWATUKEE TRL SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST j 5/~-{/j'L` !J I T~ SP 1700 VVITC / _ y- , / - Z2 I'" O~ CGiX/z~ Legal Description: Acres: 124.710 lat: NIA-NOT AVAILABLE SEC 26 T30N R19W GL 6&7 EXC BEG 1109 FT 1 Alock/Condo Bldg: E& 33 FTNOFSWCOR;THN10DEGE300 ~FT TO LK: SWLY ON LK TO PT E OF POB: W Tract(s): (Sec-Twn-Rng 40 114 160 114) T TO POB EXC CSM 3738 36.5 AC AS DESC IN 26-30N-19W AV.'A Notes: Parcel History: Date Doc # Vol/Page Type 07' L1997 --1078,1180 RD 07123!1997 8611631 07i23!1997 7694316- 07i2311997 5961308 r !t-/~ 2004 SUMMARY Bill Fair Market Value: Assessed- + 5350 530,200 Valuations: Last Changed: 09107/2004 Description Class Acres Land itimprove Total State Reason RESIDENTIAL G1 4.130 290.700 f 222,700 513,400 NO PRODUCTIVE FORST LANC G6 1.580 8.200 0 8.200 NO MANAGED FOREST LAND-( W8 19.000 98.800 S 0 98.800 NO Totals for 2004: General Property 5.710 298.900 222,700 521,600 Woodland 19.000 98,800 98,800 Totals for 2003: General Property 24.710 242,800 166,900 409,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 519 Specials: User Special Code Category Amount 040-OTHER ASSMA_ SPECIAL ASSESSMENT 721,91 Special Assessments Special Charges Delinquent Charges Total 721.91 0.00 0.00 ,.Ott 7!' _ S 52°-52'-32" E 69 .35' 24 49 c S 380 36' 55' E J~~J \ \223.90, r T. L 0 T ~6 ~ 38 37 R S 65.,_ 46'.42'• E 84 ;,---143 a7 5 2 ' - 1 2 / S 46'- 33 W 14.07 N 2 - S 300-39'-41" E p n `n s UL' S 1 5° 5 4'- 3 9 E ` 2 1 1~ t4, i' O ~J J / tg1 1~ 3'9clm 29'- 57"' w t , °o, S 43°- 36, - 56 F 3 2 9 2 8 U! ~J 4k, 47 ~ 15 I r'•i~ t `t\ 12 32.. 36'-2 5 o' Ita9^c^ ~S 870..22'-28" W ~ t T6 22` et t PEC. AS EAST, N 90 - 51 - 2 7 PEC. 4S N 10° E i 1.93. 3i' S 10 "-08'-33 " W, 1 300.00' j v. sEr 1 , . _ ! I ENLARGEMENT -;r? ~fln + 1  ~fr _ - - , PIT- - 4 RFC AS ;1 C R 1' 7 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP j f, SEC.2-6 TJ-0N-RIQW ADDRESS 2 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION, LOT LOT SIZE PLAN VIEW ` Distances and dimensions to meet requirements of H63 ~;;~c<ax VERYTHING WITHIN 100 FEET OF SYSTEM Vz I - - Cf, k I di a4 No, th A ro SCALD : i ~ :f~ F LEH BENCHMARK: (Permanent reference Point) Describe: Sr-f~~ i Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: `yfiS _5 Liquid Capacity: Inez) Number of rings on cover Tan manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons____ Number of gal. pump set or a cyc e gallons; tota capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAZ;h: PIT SIZE: _ Number o pits feet diameter feet liquid dept seepage pit in e-t pipe-elevation-_ bottom of seepage pit elevation feet. SEEPAGE' RED SIZE: number of lineswi th jX, I-erigth2 tile dept h_-_ SEF.PACF; TRENCH: width length 1'1,'R~ c ►I.,AT [ ON RATE ~j AREA REQUIRED G /.5 AREA BUILT___ OC,, 6- INSPECTOR PLUMBER ON JOB - T LTCENSE NUMhER' I  gPPjcv0-1-j -k C~ P~CY~1I g ~ ~Pcoo,o r r r- M 4 y ~ c. ~ `Y F~L . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN(~USTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 7969 HUMAN RELATIONS 53707 (H63.090) & Chapter 145.045) LOCATI,N : , SECTION. TOWNSHIPr'MUNIG IV1~ / /4 2& IT36N RIVE (or) p IPALITY LOT NO.:BLK. VO. S' 6DIVISION NAME: S7/ rJOSEPI~ _ Vj~~.~ STovT COUNtI Y OWNERVBOYER'S NAME: MAI LIN ' ADDR SS ~o,P~N Stir c o d~' Laws T -/P/ . USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPI ION- PROFILE DESCRIPTIONS: PER CIO! Al ION TESTS: Residence A New ❑ Replace I Q_ 1 _y ~ I~~ RATING: S= Site suitable for system U,= Site unsuitable for system D,2_ C!/~1iN E~T CONVENTI NAL MOUND IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING, TANK: HECOMMENDED SYSTEM (optional) i J S ❑U ~ S ❑UI S ❑U S ~U - ❑ S_ k]U_ ~'d wwrlo'd4L 134P If Percolation Tests are NOT required DESIGN RATE: 05 , If any portion of the tested arra is in the -1 - under s.H63.09(5)(b), indicate: f ''S •fT I - Flnndp'am, indicate Flnndplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED T, HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) u 7-1/30 Y776 s/fib . 6s ~so,S°4Y .a S46u,,v Gs, r7., ~f- aV B 9 ~ ~ ~u. mss, Yo- P~-a~, sL., .3.3 a,e . e-5-. a. 1 B- s- PERCOLATION TESTS TEST DEPTH WATER IN HOI F TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVALAIIN. Ntfiiou i PE I o2 PER _ PER INCA P_ - Sc -PLO-I/ -,4T412- -5611 P- P u . 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 Iv.rcent r r Land ;lope. /3c -,roAl DF -SeV TD t ~E RT '?f ; FT. I- - - - - - SYSTEM ELEVATION AEf, pr ; A~7>~RNl+re ; M /~v s qN~ ST,PATr1- ~ y' Y ~n I O of f JAM L l IBS T wqoe Cu'L . aP?. /3tit l!" 7 3y 40 ck,tZ-)'is7-141 f v191'1Ew43 t N T V ) PEVA rl" aF 445E / s /00, 0:' f r 13- 1-13'444*E Pars o Qlzl~ 2- ( SiAkFv -os ur" ~ ~ YY I Jfovs~ ~ - - - - - SS - - 0'3 v orEa f P,Po~os ~D C M vs w~ Aso ~j' F~Pa.M 1430 r(- 1-E57-I, the undersi Ined, 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 AtImwistr;alive Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ON: NAME (print): hod T l~`C TESTS - ERE 2 C 7-2- ADDRESS: 0 CE 191 ICAIION NUMBER: PHON= NUMBER (optional): C_F',;P,~G N AT IJR E- : f o ~ 6T ~ Tod s c/ ~ ! ~XG~ llA-T/.V (r ~U o T~ /j A  DISTRIRUTION: Orinin.i::- , 1 feD _ 4- Ps-K+k Po t74Z-l ,ate and acc -1pietR ;(,gal descrip'if use Section must ale o l,AXil.'IUM number of budU L)CIt.., iJi G:=!liilYCl: lo: t+yC (Ua!417::. Al a new or replacement sys-e!t: r. Wme the su rlYlity rating boxes. A SITE iS SM FAM f z !IFR SYSTEIMS ARE RULED QUT EASED ON SOJ_ CONDITION'_ASE use, the anbrrviattons: shown hi-,e for writing ,no file descli{ri~..: 1KE A LEGIBLE diagam accnately Imatinig Vnm test locatfnns: D r,%,in•g t,-; scabs _ pn fclf~u- , atars shoe; IldV 6 isse:,f it Jcsire,l; . ke sun you, ae11Chmwk MA vertic:a; C!84cttf Ofi I'efere;`Cr' I>LNfli~d LE', 'e;,`('dflV ShnVJll, a!7d al'f-po[IY ne!pl; replete all apmupt4 re luxes as to dates, warm yd esseV Hnod slain data, nerr.Omk- ' i. if appropriate, he inform i-ictn (;urh as flood It A"q elevation) dmi not illlpiy, plac;e N.A. in the apj) nl "c form, and IMP your ru "mt address and yndr F,ertrf16tion !lumber: ^•tih'r r!:: - -wd rik; iih-ite ri t'rnlf re,. \L.I_ S(~II T'FCTS 'klllcT RE F'.I_Fr? VVIT-1 lI -Btrdroi k . HGV'a' - Wp, Groundv.atcr j!' Sand Putc R-!rc.olation Rite l!f1l S:lfU;~ VV - WW ~oil!ICf Misr-7 ,t•~ CC;t~(: ) - GicotCl iIldrl . Lr.:;r ; ttc n Loans R - iickl I. u_. ,:I,_-..{ a r:•;••;~'',tea! „r,.t t~ > ALr4 PNATE" fq,(JA `1<n X -1y of 1~Ay 70 y00 z r Cut. V~4 SRG Soil T~S%) ~h~ ~ /5 k / y 5><E£L P~E 33fo CW& aic m5;9 -7 of ~~P~ . D,P~vE Q p~ /oo, o F~. 10 I$ f~ t;s 760 y~Q~ ~f sP z 1 y ,~oOED S~,~t~ APP x 6' ND",-` ' rp ~ ; II II; oo sort f X 3 ~f. s,Dew~f,~f I z fr. I 3 ~iPO SGT ~/,Pav ~r,~ti~ESS t',~u•~. sT~U% ~D~~tio~ ,C~~9Ss G~~f L P10'r C=NtD cross Secotloh 1 h S r~ Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade Axi 00 Mi~/IMdM o 4" Cast iron Above Pipe Vent Pipe r'1"C r i o Final Grade Morsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 Aggregate o Perforated Pipe Below Beneath Pipe Cnunlinn TPrrninnf inn At  TE~7- Bottom Of System J 8 D1I JST(V OF REPORT ON SOIL BOR E SAFETY & BUILDINGS I,F,`,'r~ 1STfdY, ~ DIVISION LRIOR AND PERCOLATION TES (1 P.O. BOX 7969 HUMAN RELATIONS 10 t ~y MADISON, WI 53707 y I UCAI ION C SECTION TOWNSHIP!%JUNICIPALITY: B O.: (VISION NAME: NCI 1/ 1/4 L /T 30 N/11/1 E (or) W 5 t dose-,o - 1s F lea. 2 S7ot17-- 'DUNTY: OWNER'S.BUYER'S NAME: MAILING ADDRESS: (toy X y 0 /.3A W,4!7 f USE _ DA OBSERVATIONS MADE I fVD. k3EDHhgS. = COMMERCIAL DESCRIPTIO 7110 F I LE D TONS: I PE R A N TESTS: _ I New [:]R=eplace ~t7 f~/Dj_ ~~~v~D .Residence `3 A/ RATING: S= Site suitable for system U= Site unsuitable for system a .JS ❑U 0S ❑U ®S ❑U ❑S ®U ❑S ©U ovt~t~i~ay.j i3=D JNVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOVINIENDED SYSTEM: (optional) NVn G~y^ S p `T Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. l~•S '50 - cr { IC If any portion of the lot is in the rder s.H63.0915)(b), indicate: y~j,✓ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS rj yZ -~'li' Cie 30RINC TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH ICKNESS, COLOR, TEXTURE, AND DEPTH UMBER DEPTH IN, ELEVATION OBSERVED EST HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) oR. ~ - S~31. ~,~.4~Sc. oc rre#S Fr 33 /3~, . S, Ylf' W r~/u, B Z yp /0-0.0 0-/3,j A-Ad . S 30~I C s ~;o % ate S /a 9 B..3 fr )1,U- -6y. Z-s, QAJ mss, 7'1 " AV .6y `s LY--G/ sL, 30"°,0 -„'J a S. > 96 it . ~e sL B 13-A PERCOLATION TESTS TEST DEPTH WATERINHOLE TEST TIME DROP IN WATER LV L-INHS RATE MINUTES 'NUMBER INCHES AFTERSWEI LING INTERVAL-MIN. PER1001 PER1002 PERIOD PER INCH , 3 _1 - 56 S M►4T So r S1P.t ~ C i P_ a 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. 1%7 0M /3t~ EXCAdAT/011 A) LiE EXAC r4y y FT- le,- 13f + SYSTEM ELEVATION F 1:yArfo -j or 7r oR P. f" rT /3c how V l~ r`. - 40- .L~r_ LiVE 9,54 2. aM = RJ'd' S --,d 1au¢ %6 3~ I Q j + t I "APPROVED I2y Date: InsPe ' ctor. (3 y I~ Il J ~a ' R~JEA o 1 S I >~Po/~oscv 11 s'aPEs FkoM 1 A~l 710 /Ufei, • 1E~~~ I 5'j~ l~~//BUST 6iF >4-0 I s%+kE~ o~~~ l ~ Not£ jr/~o.~t tfsi A~~'~-- ~ 1 I, tl ~ 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 d-nimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ME (Print):~OhrRT 7f X6,el' ' I_ TEST/ Jq `OMP /~?L :DDRESS: C TIFICATION NUMBER: PHONE NUMBER optional): Pf 3 C uFi~ c~ ~'vr~soti% Cc~~s Syoi , ,r'_Da y~12- 3 -,9- - - - - C. SIG-NAT`VRE:  TRIBUTION: Original-Local Authority, ?rd p:+ge B.ne:iu :A Plumhi•ig, 3•d p:jge Properry pvarer, 4th p, ge Soil Tester. HR-SBD$395 (N. 031811 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR 1 t-SAFETY & HUI WINGS LABOR & HUMAN RELATIONS DIVISION P O, BOX 7969 PRIVATE SEWAGE SYSTEMS 1 BUREAU OF PLUMBING MADISON*,NI 53707 50CONVENTIONAL CJALTERNATIVE starrvlanLD Nu~er, C Holding Tank 7 In-Ground Pressure ❑ Mound MANE -_F PERMIT HOLDER ADJR ESS OF PERMIT HOLDER INSPECTION DATE R=NCHi ARK (P.-a-m •et•- arc o.-It OFSCRIRF IF DIFFERENT FROM FLAN HLF. P7. Li CST REF PT E_EV P,~H•i. `.1F. \APR^>V.' N,I •.Hh" y f•.•rn:r 4•. rnt>er I I r J I c -i >s - SEPTIC TA /HOLDING TANK: _ r.1tiN Ili AC T L H EH IL IOU ID CAPACIT TANK 1`.1 IF L 'fit., K OU T L E' L L_V Y'oARNINv L1 BLL LOC NC; COV 1. O•IDED FHr iUL~ L 6G -'e- II, 7.~ /DYES ~]Nn ES/I lr~o BEDDING vT of , L", +A71 n I n:• 'r NUMBER OF IHI,AF! =R :'FNT'r wEL_ J.ul I r;i ENT I cI>F,r * le FJ YES NO i NEARESTOM_ C1 ~~G~ f U(5 S4 J DOSING_ AMBER: _ ...I I+I n FF UUIN'.; I IaiUl 7 +I •,11'r.: L F , t .;y„ r n.l- i \AFNING LABEL LOCKING CCVLH PROVIDED PROVIDED _ UYE_S_L_I_NO CIYES LUNG DYES L1N0 1 -o GALLONS PER CYCLE ur n>I_I lr. Inisc fill NUMBER OF vu;;htHr, ['11'1 R'.l I rnr,;, FNT TO FE S~ " R IVEr DFFEHENCF RFTINEEN FEET FROM PUMP Oh AND OFFI IYE dG NEAREST_ SOIL ABSORPTION SYSTEM. C'Teck the Eot -I t )F a ede h of plo•. 9 FORCE rj,,. a iHIA_ AM: ; Ir,r. II Nxcavxtcn I If soil can i tolled into a wir • construction shall ceas, until MAIN I'e- Sidi r; Illy rr»nugh ti, .:-11111110'.) _ CONVENTIONAL SYSTEM: cll. LFr r.rf. rr. r,I U_,'f. ~I~ `f:•~ .FI: -is-.1- T. - nx,c BED/TRENCH r•u' J`PTf' DIMENSIONS PIT I.I•I 'I- OI :TR IPF A1AT_•i Al ,:7 7,11 NUMBER OF I ;iPFF /~F BJ ~Dir.G 'DENT TC FRESH FEET FROM AIL1T~ --►I fir( YV( c, 7 2'I L_ - NEAREST MOUND SYSTEM: _ Mound site plowed perpendicula• to slope heck the tex ire of t fill rridteridl for PROVIDE A DIAGRAM OFSYSTEM and furrow,, thrown upsl: nd syste is Lu IT ak cn_rtalI that it ON REVERSE SIDE. SHOW ELEVA- erla =or ed UM sand. TIONS MEASURED. e (51 /c6 _YES C NO SOILCOVER IYFS ~NO ❑YES NO L ILI .F DYES ❑NO --1- - - l YES NO OYES C NO PRESSURIZED DISTRIBUTION SYSTEM: - '~lF N:: I. 'i%LI' ..I~ 1. :'I .-.II'~f1~ISI IH.,1'1 f•IF' 1111-I I:I ('I II F.-~':_, BED!TRENCH ~raev'-III DIMENSIONS - - I .IFIjLfi I-Jh1P r,l ::N 11 ".I Ic1H FIPL r,l{ - )r,n;.TEril%•L t'JI H ) $Tt L:I;:II• FIPF I';PF fk HI.L S t - r..; il',,. al Fv 'InA L L:., •1 FIFF6 ~rn:. ELEVATION AND' DISTRIBUTION I uAI IIFTUGHHESF;vDSroAPPR I--LC i IF rlplE SPAl:I Mir L`I tILI r '.III I - - ..-.VAR ^.1ATFi AL INFORMATION 4r s N - TS: - LYE NI ❑ C OMME YES NO 0E RN1 LENT MAR[FRS OBS R•:AT IO N ELLS NUMBEROF PROPERTY %VLLL I'I is !nt.',I ` (FEET FROM LiNL YES NEAREST- - ll t_.: ~l rZ.caC c~tHcM,~w<<~• ~ ~'1 ~ L G b cG~ d y sr:: rl rl ti )'•,I l!5 .,I, etain co le for audit. I`I HF `;fill F,7'-,I IR. ~1l821 _ hovs~ SirE- NiovE~ - ~fJ H~P~~}' T.ESr~p c~osE~ ~o t~'a use ~,v~-w ,~GS~-us 'DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/Z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing A dr ss: I3YAP0Av ,44WSNt/ is Property Location: City, "Village or Townshi County: Al 0,1,5"c- /oS ~P ~T-50NiR / E (or) W S1• fE 51.cl0i Lot Number: Blk No.: Subdivision N me: Ne st Road, Lake or Landmark: ~9 JS State Plan I.D. Number: --N r jTo0;e-- (If assigned) A/ TYPE OF BUILDING v Number of L7 Public' ❑ Variance` [1 Other (specify)" Bedrooms: 1 or 2 Family State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: / EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement L~ Experimental Seepage Bed ❑ Seepage Pit 3 6/- D y?3- Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present o"uner): 91 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sign re: MP/MPRSW No.: Phone Number: I I 4A -7,-7,',- - i &15~~ 211 Plumber's Address: Name of Designer: ~ 2 ~lo~Ro~ 5T /UD,~ d~ /~vv.SD /S COUNTY/ DEPARTMENT USE ONLY 51g ature of Issuing Agen Fee: Date: Sanitary Permit Number: ~7 7 ❑ APPROVED r t . , jI. "l I - ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumher requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DI LHR-SBD-6398 (R.07!81) .,''IPTAIEN•7 of INDUSTRY, INSPECTION REPORT FOR SAf-EJY' & BUILDINGS LAj*R 1 I;.Uh1AN RELATIONS PRIVATE SEWAGE SYSTEMS h O DIVISION P.O. BOX 7969 - BUREAU OF PLUMBING MADISON,'l 53707 ~ i .ONVENTIONAL ❑ALTERNATIVE `1 ? Seca PI., ID. Nun Holding Tank ❑ In-Ground Pressure Mound F, atdF r)- F`EHM1^IT H,: LDER JADDRESS OF PERM 10-DER INSPECTION DATE FT NC ri - II'--,..~-~+ ~I=r..... yo„.A DESCRIBE 1F :;IF 'F LHENT FROM PLAN REF PT EIEV CST REF PT, EIEV N MI•: MPI Ow., N-: r ^ s.ln Ivy Pcr T'I -be, S'EPiIC TAN OL G A K: M1t::•, I, F a.; T I. R F R LIQUID CAP.;C 17' 'ANF; INLET E LEV -ANK OUTIET ELEV :ARNI CUVI II ~1 PIf11'.Ir:EO • PR ;VIF'F~, I v° t+'.~C OYES LINO DYES -JNO BELLING. VF `1T .IA `:ENT 1.1 ATI HI':;H V:AT IF UMBER OF HC'A!1 I'11::PFRTV WFl _ 1 BJIL [VENT 70 PRF.H I ILAHM1~ LINE L, AIR INLET EET FR OM t 5, L-YES ONO LJYES LINOEAREST- is T DOSING CHAMBER: N.: 1l I•qC T. utRF TIUING UU li to rA V aC I Tv PL1L'='I'LEl WARNING LAtlEL LUC K ING COVl PRCVIOLD PHUVIDED YES LINO E. YES NO DYES NO U. BLALDIN(; NT To FR ,H G! LLONS PER CYCLE: Pun+r ANR CavrROlsc~FRAnuN ' NUMBER OF rFRT A,: IDIFFERENCE BETWEEN FEET FROM F S` AIR INLFr PUMP ON AND OFFI .YES LINO NEAREST-Vill SOIL ABSORPTION SYSTEM. Check the soil moisture at the depthof plowing ' 1'-II ATIIUAI ANIIAIIk1Nl er 1?xcavatio i Ilf soil can be rolled into a wire, c onslluctii shall cease .1111, FORCE MAIN tic svill is dry r' iri L.gFl to comirui CONVENTIONAL SYSTEM: DI%• s~I TS L10LI ID i`:II. 11' LEtJ. TII NC:' OF L) li It I'IPI `:1'AI'.1 N~. l.'1: FH ['""r - ~ DBEIMEDITRNSIONSENCH -HENCHES ;:,TER I:•I =PIT DEPTH C P ~EP71 11I iH FIP= DISTR PIPE DISTR PIPE MATERIAL 10 DISTR NUMBER OF PROPERTY WELL BUILDING VENT To FRF<--1 F\EfTCIV ER LLEy 1`1LtI ELE1, END PIPES FEET FROM LINL AIR IvLLT NEAREST" MOUND SYSTEM: I Mound site plowed perpendicular to slope Check the tP.XILJrP. 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- O meets the criteria for medium sand. TIONS MEASURED. YES -INO SOIL COVER U: AN *41 tiA1:KI lc. r, .:.r I l YES LINO UYES DNO 'NI,LCULC_-~.-- C-IYES UNO DYES ENO DYES NO PRESSURIZED DISTRIBUTION SYSTEM_ : I i-l I NI II ^lU. n~ 1 ;V 1 r.'•I '.I•A U.'. I~.'.I 1 I'I l ul : n 'n - :ILL DEPTH ASO'vE COVE:. BED/TRENCH TRF^1CHE$ DIMENSIONS f, ,I ..II PUIJP I'i :.11=0LD LII$1•'. 1.1'1 MA`.IF;; L[ '.1,}T F-i !}l r•,I IiIS'-'. 11:~114 PiPF DIS'HlBll rlriNPVL \1 :7:HIA_(y r,1AHKl`1 E: EIEV D I A LLI.V PIFFS CIa ELEVATION AND DISTRIBUTION DI T R TIO Irh,.l I 1~:I I SP:,L1Nr, DRILLFO;.l ~t l: I l v =ATt MAI VF R- r7AL Lli C^RRESPONOS To APPRCl -till c L : •..I OYES LINO O YES ONO COMMENTS. VLRMANENT MAFtKLHS OBSERV'AT ON WELLS. NUMBER OF -FRTY 'WELL. 18JILD NG. FEET FROM uv' 2 CJYFS _ NU OYES I JNO NEAREST J I t 1 - y _7,7~ l l J 1 i~ . ~ r It.y`~ S• 11•~I~ Sketch System on Retain in county file for audit. Reverse Side. $F:iN ATURE f rill - DILHR SBD 6710 101,182) I f • DEPARrTMENT OF APPLICATION SAFETY & BUI LDINGS IU44J&TRY, FOR SANITARY DIVISION LABOR AND PERMIT r P.O. BOX 7969 HUMAN RELATIONS (PLEI 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Prn erty Owner Mailing Addre s: 'y,~oN lov7 ESS pia Lowe ,~f y ~P; .yo,vv was Property Location: City, wage or Township: County: /UGC1 '/4 SE /4S -Z6 T 36 Ni R 9 E (or) W 5V- TOSepr/- l)( Lot Number: Bilk No.: Subdivision Name: - Nearest Road, Lake or Landmark: State Plan I.D. Number: 51~107 If assigned) u4_ TYPE OF BUILDING Number of ❑ Public" ❑ Variance" ❑ Other (specify)` Bedrooms: 1 or 2 Family 'State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 6vv BOLDING TANK CAPACITY N LIFT PUMP TANK!SIPHON CHAMBER "ANOFACTURER: & E EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement 0 Experimental ~ Seepage Bed ❑ Seepage Pit 3 ~}r l j S~ ~T ❑ Alternative (specify) [,J Seepage Trench / X 35- Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owne6: Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sig ure: MP!MPRSW No.: Phone Number: T ~~PI 161 Plumber's Address: Name of Designer: ZZ N10,U,P0~ ST iUO,C'~ UO.sa~ CU/S COUNTY/DEPARTMENT USE ONLY Sigrature of Issuing Agent: Fee: Dace: APPROVED Sanitary Perm t NLmher 6 DISAPPROVED I~> t eason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Forrn (67-T) to he suhmittPr_, to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau Of Plumbing, Pink-Owner, Go!denrnd-Plumber DILHR-SHU 6398 IRA7l81)