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HomeMy WebLinkAbout040-1081-50-000 o 0 C m 0 d ° F ° ° m m ° a 3 ^r m CD -0 CD ° 3 m 1 a~ o w to o 't C v a N o CO < < • o rn N m m rn m < CL z N Co _ l^\ O O N N 0 O i"ti 1 N Q O O = w O -0 n 7 Ln p O O C CD Ln N 6 K 7 N ~ O O .y+ CD ? O !V CD D 3° g (9 fl O N x 3 n c rn rn °r' p D CD rn OD C) CD Z1 I i N Lo w N o r w w ~ 3 a z O O O Y n' R fn o D r3 C' o O (D •CD► N N 3 y - (D (n N Ol N (DD _ Co p' M z z co z 0 Q 7 ~i N O "i• (D (D CD N N 0 O N (D co ~ O N G (D (D w a z ZZ (D c A Z O v p O 3 I o. z -I N W * N) CD (D 00 Z G r: z O y m ' O CD a N 2(~~-i D 3 < N O O N =T CD n cn _a m c) 7 O 7 CD CJ -0 `G p O N N a) n G z 7 co < O. `G CT CU :E ZD' O fl. Cn _ N m m N N 6 o N N o m c CD (n p ;2 cn Cr v 2 5 (D0=3 3 - 3 'o m °vr N wcwov C)a- 4 =r x s CD (D 3 0 6--04 ° m m b (OD- VC) 8 ff v ~a CD Co =3 CO CD a m N 0 CD 7 N N O O O a O n m Q O CD V O C(D a O L v Parcel 040-1081-50-000 04/18/2005 07:53 AM PAGE 1 OF 1 °Alt. Parcel 21.28.19.321 C 040 - TOWN OF TROY 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 HARRISON, ROGER D,& ELIZABETH HUIE ROGER ELIZABETH HUIE HA RISON 562 CHIN K LA RIVER FALLS 022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 562 CHINNOCK LA SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 19.390 Plat: N/A-NOT AVAILABLE SEC 21 T28N R19W 19.39 AC NW NE THAT Block/Condo Bldg: PART OF LOT 1 CSM 5/1296 INCLUDES P324F L I 7i 'I V4 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1110/448 WD 07/23/1997 799/02 07/23/1997-a9f 5 07/23/1997 733/211 2004 SUMMARY Bill Fair Market Value: Assesse with: 26772 396,900 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 20.580 108,900 288,800 397,700 NO Totals for 2004: General Property 20.580 108,900 288,800 397,700 Woodland 0.000 0 0 Totals for 2003: General Property 20.580 99,000 277,200 376,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 117 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 L s hor ar,,#,Human Relations Division of Safety & Buildings in acc f 3.05, Wis. Adm. Code ,1 I COUNTY Attach complete site plan on paper not less th x 11 inch sin n must include, but not limited to vertical and horizontal referenc (BM), dire d pe, scale or PARCEL I.D. # dimensioned, north arrow, and location and ce to F Wiest Y REVIEWED BY DATE APPLICANT INFO RMATION-PLEASE)PS NT AI~t I ON PROPERTY OWNER: PERTY LOCATION VT. LOT/,~,.,/,,/ 1/41I4,S / T N,R / E PROPERTY OWNER':S MAILING ADDRESS / r OT # BLOCK # SUBD. NAME OR CSM # 5-r " i e or l 2'.." / CITY, STATE ZIP CODE PHO ❑CITY ❑VILLAGE MOWN NEAREST ROAD X yrr a (s ( ) y1S->~'r1, f(J s'` r VI New Construction Use Residential/ Number of bedrooms ,3 [ ] Addition to existing building [ I Replacement Public or commercial describe 4~ Code derived daily flow /y'If~ gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surfa elevation(s) Ao , 6 t P~~ ft (as referred to si e plan benchmark) Additional design /site consideration o ~f.~,ti {<r * a Parent material Flood plain elevation, if applicable - It Fu = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK =Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S plU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend - 3 2 S/ n k h S G i r Ground _ elev. - i ft. Z - - 3 SC 3177 b'K r Z :,3 /7 Depth to limiting ~ factor Remarks: 1e+~o ~+~sGrf ~os~ S 7-*' "v, z t.7/ 63 Boring # Z. / Ground elev. t. c S 6K vt, / v l^ S` Depth to limiting_ r Z S- n r t c~ - - factor a y~ Remarks: CST Name:-Please Print Phone: Address: rte w~ r.~ :2 3 S ~s j 3 Signature: Da e: CST Number: PROPERTY OWNER'`- SOIL DESCRIPTION REPORT Page 2 of .3 PARCEL I.D.# Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell ()u. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trench I -iS io 3 5 i k s S , s" Ground elev. ~oz.5dit. 2 5 t( O r 3 3 ti,t r° 1 V 3 Depth to limiting factor , 3 c _ 7 a L Remarks: Ile y7 Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 F Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) DAVE FOGERTY PLUNONG / III Licensed pork Tester & Plumber c #3233 #32.89 FoortY Heights Road ROSE' ph , " co 36l 6 54023 Y ~rnrte i L- - - - 'l F t -Ltr.e f r .~BS'T ~ ~~UI~I C ~Qd • Q ~ / rG'/ i` v i l ~ ~ ~a ate? 641-kklpel~ Z0. f Parcel 040-1082-30-000 04/18/2005 08:13 AM PAGE 1 OF 1 Alt. Parcel 21.28.19.324F 040 - TOWN OF TROY 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 * HARRISON, ROGER D,& ELIZABETH HUIE ROGER D,& ELIZABETH HUIE HARRISON 562 CHINNOCK LA RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.200 Plat: N/A-NOT AVAILABLE SEC 21 T28N R19W 1.20 AC NE NW THAT PART Block/Condo Bldg: OF LOT 1 OF CSM 5/1296 ASSESS WITH P321C Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1110/448 WD 07/23/1997 799/02 5,v 07/23/1997 749/545 ~N 07/23/1997 667/321 L- 2004 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: 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 FORM NO. 985-A , HGM:INr Conpany® Stock No. 26273 CERTIFIED SURVEY MAP LOCATED IN THE NE 1/4 OF THE NW 1/4 AND THE NW 1/4 OF THE NE 1/4 OF SECTION 21, T28N,R19W,TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. N 89-17'30"W 2637.86' N 1/4 CORNER 31NORTH LINE OF THE NW 1/4 OF THE NE 1/4 SECTION 21 ° /(b* NE CORNER T28N,R19W r /rL POINT OF UN_PL_A_T_TE_D_ LANDS SECTION 21 BEGINNING T28N,R19W 644.83 421.701 S 89° 1713011E 1066.531 00 cfl ~I 0 0 I r` z I In <1 00 JI ti 0.59 ACRES± , EING 897,106 In w S IN ING TOWN ROAD r-- ~i w i 0 20.10 ACRES BEING 875)576 01 (-1 - S0. FT. EXCLUDING TOWN ROAD rn ZI aI QI Q N JI JI ° 0 zI Z O ZI f~ - = N 89°02'3011 W pl 515.001 wl O N 1 M z 01 F_ I o UNPLATTED LANDS ZI a a JI O I al O I N - zI O I to - (n O I w I O In ~ W u? HI N ~ = O 6 Q i co r- 0 J Q V -to 1 a- Z d I I o to 0 - In N In z NORITH RIGHT-OF-WAY LINE OD 0 M N 88°5914511W 5 1.451 - - PINE--- M - i2_ LANE SOUTH LINE OF THE NW 1/4 OF THE NE 1/4 UNPLATTED LANDS LEGEND. 0 111X241 IRON PIPE WEIGHING 1.68#/ LINEAL FOOT, SET. ST. CROIX COUNTY MONUMENT, FOUND • 111 IRON PIPE, FOUND FILED SCALE IN FEET JUN .151983 JAAU o+ WNNaL 1 gsubkw et bead, O) 01 2001 4001 14 CAU b, nr• g j Folume 5 Page 1296 THIS INSTRUMENT DRAFTED BY JAMES T. SWANSON Parcel 040-1082-50-000 04/18/2005 08:02 AM PAGE 1 OF 1 Alt. Parcel 21.28.19.325B 040 - TOWN OF TROY 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 PAUL M & PATRICIA TR SYLLA ` SYLLA, PAUL M & PATRICIA TR 600 CHINNOCK LA RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH 'Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 21 T28N R19W NE COR NW NW COM NE COR Block/Condo Bldg: NW NW OF SEC 21, TH W ALG N LN 18 RDS TO HWY, SELY ALG HWY TO INT PT OF E LN NW Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) NW, TH N TO POB: EXC N 365 FT 21-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/02/2000 622216 1507/80 QC 05/02/2000 622215 1507/78 QC 2004 SUMMARY Bill Fair Market Value: Assessed with: 26778 5,300 Valuations: Last Changed: 07/20/2004 Description Class Acres Land I tprove Total State Reason PRODUCTIVE FORST LANC G6 1.000 5,300 5,300 NO Totals for 2004: General Property 1.000 5,300 0 5,300 Woodland 0.000 0 0 Totals for 2003: General Property 1.000 3,500 0 3,500 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 'Parcel 040-1081-30-000 04/15/2005 05:15 PM PAGE 1 OF 1 Alt. Parcel 21.28.19.321A 040 - TOWN OF TROY Current X 3 f) ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner PAUL M & PATRICIA TR SYLLA SYLLA, PAUL M & PATRICIA TR 600 CHINNOCK LA RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS V SP 0100 CHIP VALLEY VOTECH G v~(/l14,c Legal Description: Acres: 15.500 at: N/A-NOT AVAILABLE SEC 21 T28N R19W 15.50 AC NW NE EXC P ock/Condo Bldg: 321 B & EXC THAT PART TO CSM 5/12a~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/02/2000 622216 1507/80 QC 05/02/2000 622215 1507/78 QC 2004 SUMMARY Bill Fair Market Value: Assessed with: 26771 Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land + Improve Total State Reason AGRICULTURAL G4 15.000 2,300 0 2,300 NO UNDEVELOPED G5 0.500 100 0 100 NO Totals for 2004: General Property 15.500 2,400 0 2,400 Woodland 0.000 0 0 Totals for 2003: General Property 15.500 2,600 0 2,600 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 Parcel 040-1081-90-000 04/18/2005 07:58 AM PAGE 1 OF 1 Alt. Parcel 21.28.19.324B 040 - TOWN OF TROY 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 * PAUL M & PATRICIA TR SYLLA SYLLA, PAUL M & PATRICIA TR 600 CHINNOCK LA RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 32.200 Plat: N/A-NOT AVAILABLE SEC 21 T28N R1 9W 32.2 AC NE NW EXC Block/Condo Bldg: P324A, C & D & E & EXC 1.20 AC TO CSM 5/1296 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/02/2000 622216 1507/80 QC 05/02/2000 622215 1507/78 QC 2004 SUMMARY Bill Fair Market Value: Assessed with: 26776 Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land I prove Total State Reason AGRICULTURAL G4 21.000 4,000 0 4,000 NO UNDEVELOPED G5 1.200 100 0 100 NO PRODUCTIVE FORST LANC G6 10.000 52,500 0 52,500 NO Totals for 2004: General Property 32.200 56,600 0 56,600 Woodland 0.000 0 0 Totals for 2003: General Property 32.200 39,300 0 39,300 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 PART PARTT R OY T. 28 N:- R.1 9 W 15 SEE PAGE 27 Hobert ~ y°y ~ N ~Q ~ J~RD zean r i7o 7933 /96.77 7 RP ~ z. dcc¢~ • / avid a o hwa/ h'a~d - Gordo 4iooy etuK de/6 f e~JF.Barne ~or"don ~ a Is C ~ • N s go/ woof B LS- e,hoase Knofl" 'SH/l:l..l .ts ::6B.S7 X39.6 9 0 n~ • DoV/d. £ ;?'RHC TS': :.i 270 /S9 \V \ B~ M¢y c5%bc • F arr s Ma soq V qo Leon¢nd J" y 7~enn/S h' rr9 q-3z BO -DES Lau/y ers Wp Noo /ey.,et¢/ 4° FF L e,~X o /r9/S Charles S T .9/beet wi e~ zta ~ c 0 p wdy e~ o ¢n.sen -D¢v~d z4 s F M¢r/on 0 ~u~ c g %r/ene / Moe 7/,/ /i2.7 ,Qoe.Eer" .Pob 7`~4a~bar¢ •RD.6. • Wtl~ ■ R /ss67 d 9 Cjacbe s 'p p cudd r y e • saz.s9 d° Hecbe tf IJa /d Ilac a .Oarba~cz /'7a a~ i`>a!-tha ~h, REALTORS y° 5 9 RS S K/emme /B¢ 4o etuX zoo • -r Fy~ A 9 ~ ~~/h 9 ayf• RIVER FALLS asen Ly/e c NY/s Ca.o/ /zo qv John ev>: I c. 9rno F Macb./ ,g.r Senn e/r 435-7911 or 425-8101 Ra1ah/ /zszz ~zo • W.'//.¢,r, Tess p 253 </uoPert,eto./ : 102 North Main Street - River Falls _ iTro ,yc 64 ahone f l? eefly ~5~°berr L V&'? HUDSON - 386-5555 °h y s sh/~/ y Highway 94 o ~5'hi~/e 70. z ona/d Owe 0 7 ' ` K~zv7 PRESCOTT - 262-5555 0 Lb ¢G Fa a E Botvx Q 144 Broad Street North W .s :t Pa £ iof r 'e n e~f~7' 1~eori s • s yi "th Ph s 7@ 6,7 o .Do a tu 'Z7,M, 6 /d f z 4 .Dona/a'f h '+7 eTea~ette lu ¢ -P/NE LN. Bo 7706 3 L¢wrcnCc J sen H ~Pect h ~ nsch.i> .Ei f J //B /3i.-chc Bo - go ~ ~ 7 • 2/B / MEADOW R. d v ~~i/adys ° 79¢ ~,p G 9 thony /be/-t ehaP.no.k v p -!'ice / Duc/o,? Tim an IJoncc/d W % 9 nn r.' F rows `T E¢ / •ef¢/ /BS o/ 'c. AB /6a -67 s n 24a c.W.3B l 0: 6 192 • 9 CSna- ~ • /3l -Doyr'e ~ Thomas DaVic~' cco. F Ruth g o grade son F cS eYray ~Quth U //nn f ~ a O%`lrz/ley e/ ib/.z Ts R"ch¢r 7 .a/ • Bo Ho GSB2 ey- lJOwiV:: 7 W : P¢tr/ck D ¢ EwinsiEi, 227 Lain/ne 3iig h of x ,Pe9enf S Pau/son f 3 B9 ~w 2 o TARGET-4-H AIMS T0: Charles F V oy State mt,~ .zo6. B6 65 fDonn0. 6. o,tia,ley .9 < ~ Facns Inc. /men/-son ~ o //s •z4o. s Orin E. ,s w &"TME~FEEL /s9 4 2 19B. 7i ° V hnson ,20//.' 9 szB 171 W a a 147 WWTED o Kenna th ° . orr" • o • • 9s7/ ~e~.,- / 6¢ on wanted by--- .Fasirxrss- e nohous tl q 0 Ly r' 6 ---family p ~ ~ J nE 5/ ,si F ara~.san, 'R vGE a -v lba yon 107 B5 /57UX • e N Z,,((~CC':- ~~10 JV ---friends GLENMO T \p t°. OCW Q p~ ~~uene of .5 ---adult leaders H~C C/arise l • .a_ 2 L¢wr"encE IId~.~ y~ y' ~ y/ander b //a 7Z~/ e noh°us Vp a s;. ~N ---community Ci ate/ C7ea e nie/S'Dois Nh '69 ta/ 0 35 RIVE F ~ ---society /y r/e 7Ve/ • n, of NE/son G~rn ac/s ALL; so es /B9 ¢o 0/968 >Pockfo dMaP/~u6 nc"Qev/979 PIERCE co LINTY v"tC oix C ty ss RIVER FALLS River Falls Dental RIVER FALLS REALTY CO., INC. MEDICAL Associates, Ltd. DENNIS R. SCHULTZ CLINIC, LTD. Stephen Schwalbach, D.D.S. REALTOR 4Z5-670 Robert W. Hasel, D.D.S. David A. Page, D.D.S. 113 Phone: 715 - 425-9701 113 650 South Main Street REALTOR' REALTOR' River Falls, Wisconsin River Falls, Wisconsin 220 SOUTH MAIN STREET 54022 54022 RIVER FALLS, WISCONSIN 54022 425-6732 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 1/'o SEC . a~ T 2hN-R_/? W ADDRESS fi'~e~3 ST. CROIX CO 'IY,_WIS~ONSIN. red' 1l13 4~ ~G~< t y,~,l-~' SUBDIVISION LOT e-4q V LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t r.. t' I di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point:- Slope at site:` SEPTIC TANK: Manufacturer: egLw Liquid Capacity: Number of rings on cover Tank manhole cover elevation: 6 Tank Inlet Elevation: rQ~jj" Tank Outlet Elevation: -Tcp PUMT~ CHAMBE Manufacturer: Number of gallons Number of gal. pump set for a cycle __gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower __----;brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons_ Elevation of manhole cover- ; Type of warning device SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SE P4GE BED SIZE: number of lines- width_j length,"',* ' the depth SEEPAGE TRENCH: width- l~ngth_ PERCOLATION RATE "s AREA REQUIRED- AREA AS BUILT. _ _ INSPECTOR DATED PLUMBER ON JOB-- p m LICENSE NUMBER _r'ARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR Bc HUMAN RELATIONS SAFETY & BUILDINGS "P.O. BOY 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON. WI 53707 BUREAU OF PLUMBING lD.Number IN CONVENTIONAL E] ALTERNATIVE ZDATE ❑ Holding Tank ❑ In-Ground Pressure D Mound d) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPE TI . Paul Sylla RR# 3, Rive r Falls, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT.ELEV NW NE, Sec. 21, T28N-R19W, Town of Troy Name of Plumber_ MP/MPRSW No. County: Sanitary Permit Number: Thomas A. Wang 3231 St. Croix 38469 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK ]INLETELEV T ANK UTLET ELEVWARNING LABEL LOCKING COVER PROVIDEDPROVIDED ' DYES ENO DYES DNO BEDDINGVENT DIA.VEN MATLHIGH WATER ALARM NUMBER ROAD PROPERTY WELL BUILDING NT TO FRESH FEET FRO.LI AI. r DYES NO DYES NO NEAREST l~' Val GZ~ ~~J T DOSING C A BER: MANUFACTURER BEDDING'. LIQ/1 ITV PUMP MO PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: DYES ENO GALLONS PER CYCLE: YES ENO DYES ENO : PU AN ON OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET' PUMP ON AND OFF) YE ENO NEAREST SOIL ABSORPTION SYSTEM. Chec the soil tur at the dep of plowing ENGrH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolle into a w con9truction s all cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR. PIPE SPACING. COVER - BED/TRENCH a INSIDE CIA ttPlrs LIQUID DIMENSIONS ( 7 L` TRENCHES M AL / PIT D EPTFI" GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO, TR BELOW PIPES ABOVE COVER ELE V.INLEi ELEV. END. - NUMBER OF PR OPERTV WELL. BUILDING. VENT TO FRESH C PIS S FEET FROM LIN AIR IyL; NEAREST ~ Z MOUND SYSTEM: Mound site plowed perpendicular to slope CXeck the/ exture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: ound st to make certain that it ON REVERSE SIDE. SHOW ELEVA- eets tl~'e tri DYES ENO te a for. medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS /f DEPTH OVER TRENCH.' BED DEPTH OVER TRENCH'BED DYES ENO DYES ENO CENTER E H FTOPSOI SODDED SEEDED MULCHED 111 EDGES DYES DNO DYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DIST PIPE MA IFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE -MATERIAL & MARKING. ELEVATION AND ELEV ELEV CIA ELE V, PIPES DIA [DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRE 4` y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. EYES r'd ❑ O DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: INUEMBIERROOF PERTV WELLT M LDYES ❑ O/ DYES ENO EAREST ct /,A4"U z y 8 z; q Sketch System on R Reverse Side. eta 'n n county le for audit. , SIGNATURE ' TITLE'. DILHR SBD 6710 (R. 01/82) / r f, i,cPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS DIVISION LABOR,AND PERMIT P.O. BOX 7969 iUMAN.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. The owners copy or a legible reproduction of the soil test report must be included. Prope ty Owner: ail' g Ad ress: Par; ll ~te`3 iotr fil~s CJ`S. Property Location: City, Village or ownship• County: NO 1/4 F'/aS Oil /T o20N/R If E (o W l 13 5`t. ~ ro (1C Lot Number: Blk No.: Subdivision Name: NeO rest Road, Lake or Landmark: State Plan I.D. Number: 1"i oe (If assigned) TYPE OF BUILDING ❑ Public* El Variance* ❑ Other (specify)* Number of Q - - Bedrooms: 1 or 2 Family *State Approval Required. G v , OD a _3 d10 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ov I--, HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: A -7,f EFFLUENT DISPOSAL SYSTEM `iQ T Sal ~'Za G - G PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPO D (Square feet): ❑ New Replacemen ❑ Experimental Seepage Bed ❑ Seepage Pit ive < 30 El Alternat /~XQ ❑ Seepage Trench Water Supply: O prier '7ame as Listed n Soil Test Report (If of er than present owner): Prvate ❑ Joint Public &1 I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name f Plumber: Signature L-10M M MPRSW o.: Phone Number: Ala S L)A n ~a3 1(7.,s Plumber's Address: Name of De igner: COUNTY/DEPARTMENT USE ONLY Sig a re of Issuing A e it: e: Date: ~ APPROVED San~itaaryy~Perm(jtjNumber: c C' G C'. ❑ DISAPPROVED J~ Tv / Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber 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 DILHR-SBD-6398 (N.03/81) Form - S T C 100 Owner of Property Lk 0- Location n of Property_d L4/ Section _ T ' N Rj _~_W Township ~ Mailing Address_ Subdivision Name R 19 f -1 'C ~ Lot Number A Previous Owner of Property J f) ~(f Total Size of Parcel_ Z e / A ---S Date Parcel Was Created 4 a R// r y` 3 Are all corners identifiable? X Yes No Include with this application one of the following: .Certified Survey Map Deed .Land Contract, or .Other I;egal Document which describes the property PROPERTY OWNER CERTIFICATION R 1 (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ~i / 73 and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWN (IF APPLICABLE V/ 2- 1 /V DATE SIGNED IF DATE IGNE DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS LNDUST-RFiY, DIVISION -AN BOX HUMAN PEDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SECTION: OWNSH MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1/ 914 1 /T,9g N/R/~' E (*Q re) COUNT ` OW ER' /BUYER'S NAME: r r f AILING ADDRESS: r xQU p ~'r►cia S • lla ~e_t ~e r F USE DATES OBSERVATIONS MADE NO. BE JCDESCRIPTION: PROF LE ONS: PER A ON TESTS: Residence ❑ New Replace RATING: S= Site suitable for system U= Site unsuitable for system Q CONVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMME DED SYSTEM: (optional) U t3ec Awl xES lu xis Eu ES ❑U ES ©U ES xi . /Of 46 /1) 19 IV If Percolation Tests are NOT re uired DESIGN RATE: SYSTEM E V. 4 ) If any portion of the lot is in the under s.H63.09(5)(b),indicate: lU< 3f~ c ~ ~~~0 51 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." IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r B- l I ~ r'z yQ ~ !r 1J '/UlS'1 ~/`r (jb~ Sir/ ~t~'hF-~Y~ !✓►~C~ B ~ qy. ~7a l~ S s Its ~s 6P s~ -FL 14 fAed s B meUS B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH P ONE 3D 3 / - 179 P- 311f ely E 30 ;?1 1.5 P- e Al t `.0 b 2 , 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 7/566 Steed x rvl gain 1V Bore l~l~s in=.' !35 I ~m _ Hor. krl t $5= a P3 rd 6 n c~ znt +,steel lgsf . tN a 5"ewer ~ Pe ~ I C`___ SurfacC'S v rr`esz►tiT Pr eS en's x J°ln e_. ~ Pi hit la e Gncy~e ti Sec: a 1 ~d~t PiRe Lane i, the undersigned, hereby certify that the soil tests repo ed 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. NAMZjnt): TESTS WER COMPETED ON: o~t t~Rn ~~d see) ADDRESS: r , CERTI I A I N NUMBE : PHONE,NUMBER optional): l0e' d LA-! ;5a A t%~Y Fqr! s Li 3 S~sF r zo 9is' s-~'s~1 CST S TUBE: Q `l G'I1 4 DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. I I t DILHR-SBD-6395 (N. 03/81) Owner's name San. Permit No. H63.05 PLOT PLAN Show: R~J Location of building served Q Dosing chamber L^_t Septic tank Vertical reference point M Building sewer Horizontal reference point Effluent system f ic] Well Replacement system area Property lines w/in 50' of system Distribution boxes Scale or dimensioned Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal, per Min. Gal, per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: VICkouer pipe Covere too t~04~^ I'"= ;d''r k Strz I ~e~.e vit Bas e ~ . I bit I, fe'4~ mark Ske~ XS 3 04 ZC►mett r i Barn I Srep ( P~5 t l35 ' 8 its' I as a ~9 Inv ~~z9a, bpd r q. a a ~ Present i5 art B , f se pTtiZ tiara ~ 4 e vy~e 0. Pit' By the granting or approving of the 'bbove plan, or upon the event of a subsequent permit being issued, Pierce County and the Pierce County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. Plumber's signature 1/II2