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HomeMy WebLinkAbout034-1037-80-100 nwp mvn r_ ~o CID v `~1 =~3 T 7 .a * c v A m CID n 3 ~ m 0 2 v Z O o oW C H~ D~ 3 v n O ~ O (Op ~ ~ 7N A ~ _ W O OD Q(D O Z Q Vi W? (2 O N N Q j O O N N Q (NIi 60 •~J• O O O T O Q CD Ln. .i O O tD n C 0 W O m 3 o N CO O 7 N O 7 O C (n (A w - c O O ,`3 v cn z (n tom. 0 (n CL o ro W a- c) N 3 O ..p co W N do O O co i Z f (D O co N p N 0 r- (n 5 C O_ O O O I ~r fa aQ CID 3 v v _v c p1 (D rOi N O O d (D (D W (p N ~ N y N (p A N DWO z O a CID C CD (D O O (D N ° ° i .0 (a O O O CD (D S ~ N (P N P 3 ET 7 (D (16 .a N M o A Z 5 (n a a) U) cm ;o p Z O 0 o Q 3 ~Q p z N m v (D Cal W M a (D m a 3 z a ~o 0 0 3 m C-n (CD A N p~ n (D j w = D 3 Q 0 Q (D pOj 0 N O. j Q Q 7 T (p ~ ~ N C O z O ,-a N O W Q N ( N Q. N N_ SS O fD N (OC ~ ~ F N S Q Q O O i 00 N U1 O O CID cn 3 O. N 4 (D 6- ti D - -L 'v O CD 3 w A • (D 2 O O 0 O i i O ~ ti n N O K m n 0 11 o d _ 0. a (D c O N co UJ O n Ali O N VN O Oo O -O m W ~C • (D 3 3 O (D m 7 N A ~ Ct) Z CL N W? 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KLATT, WENDY I WENDY I KLATT 930 HWY 128 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 930 HWY 128 SC 2198 GLENWOOD CITY SP 1700 WITC .-Legal Description: Acres: 1,320 Plat: N/A-NOT AVAILABLE SEC 16 T29N R15W PT NE SE BEING LT 1 CSM Block/Condo Bldg: i 10/2941 1.32A EZ-UT-1348/278 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 1 16-29N-15W Notes. S Parcel History: V Date Doc # Vol/Page Type 03/13/2003 713092 2170/294 TI 09/15/1995 533857 1140/207 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 82142 296,400 Valuations: \ Last Changed: 06/23/2003 Description Class Acres Land Improve \ Total State Reason RESIDENTIAL G1 1.320 8,500 247,500 256,000 NO Totals for 2005: General Property 1.320 8,500 247,500 256,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.320 8,500 247,500 256,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 314 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 034-1037-80-000 01/11/2006 12:09 PM PAGE 1 OF 1 Alt. Parcel 16.29.15.253A 034 - TOWN OF SPRINGFIELD 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 - HER, CHONG TOU CHONG TOU HER 4310 MCDONALD DR STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 38.680 Plat: N/A-NOT AVAILABLE SEC 16 T29N R15W NE SE EXC PT TO CSM Block/Condo Bldg: 10/2941 EZ-UT-1348/280 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 04/08/2004 759026 2544/241 QC 10/28/1999 612868 1466/443 WD 10/28/1999 612865 1466/438 WD 1129/590 LC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 82141 Use Value Assessment Valuations: Last Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.650 3,300 0 3,300 NO UNDEVELOPED G5 1.000 50 0 50 NO Totals for 2005: General Property 38.650 3,350 0 3,350 Woodland 0.000 0 0 Totals for 2004: General Property 38.650 3,350 0 3,350 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 0 cn O E v n C7 Lo1 T (D v `D d N \ 1 z C) r) Co U) 0 N = O_ iD O O N? ICI x Q- CD z CL zzS- = M- a c0 m na W y n m cn O ^ N N CL 3 O N O_ N \ 1 cn O O N C O 7 (D N W c CD c' 3 i (n CO O w ca o p O N c CD o p d v cn z D P. _ (D (f1 O N C W O C O C: (D A c. C) C) 0 N lot O co (o Oo ~p O ! \ to co Z O N N O w o r- cn !V a a O O O E can can u~i ~ Z N ~3 > 0 D O O A I N fD - N O O O y A N D CO Oz O Z O CL Z m U CD (D (D n O (D N CD . Si O (O .0 F, j ~ S S. (D N D N N 3 _ N N 3 7 7 lD -i cn O O A Z CD N N cn C M v' _O A z o o - n O ° FD' CL o o z N rn nm m 00 _0 m m fn a z A o O m cn CD N N O (D 0. F m F), 0 N D) O. Q Q 7 T o z a CD m o O_ N N 0 47 N I 0 Q se I N N A c y d ~ O 'c a O i L, :3 O CFO 3 2 y fD O M CD ti _ - N O t-j N O CD Cti A O (D A W Hi O O O CD ya CD CD 0 O_ r V f r DFPP.P f~MENT OF INDUSTRY, INSPECTION REPORT FOR f t AFETY & BUILDINGS ',ABOR & H,JMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O- BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 X1 CONVENTIONAL ❑ALTERNATIVE State Plan LD.Number ` Ilf assigned) ❑ Holding Tank El In-Ground Pressure [11 Mound NAME OF PERMIT HOLDER.. JADDRESS OF PERMIT HOLDER: INSPECTION DATE'. S i c^ I T C~11 o BENCH MARK (Permanent ref- ce point) DESCRIBE IF DIFFERENT FROM PLAN. REF. :PT.ELEV.. CST RE F.,PT . ~EV% 97 .9 c, 5S Ml~ Naini• of Pl uint-. MP/MPRSW No) County_ Sanitary Per-~i Number'. d(~I $ I(~ i31 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIOUID CAPACITY. TANK INLET LE V.'. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED tZC EYES ENO EYES ENO BEDDING. VENT DIA.. VENT MATL HIGH WA EH NUMBER OF _TF AD. PROPER TV WELL BUILDING VENT TO FRESH 1rvL(T, ALAR FEET FROM LINE AIRZZ ~ S NO NEARESTT YES NO DOSING CHAMBER: _ MANUF ACT URFR BEDDING LI DID .A ACITV PUMP MODEL PU MP; SI P4{ON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ES NO EYES ENO EYES ENO GALLONS PER CY PUMP AND CONTROLS OPERATIONAL NUMBER OF TPHOPERTY WELL BUILDING; VENT TO FRESH (DIFFERENCE B EE FEET FROM INF a1R INLET PUMP ON AND 04 F) DYES ENO NEAREST---~ SOIL ABSORPTION SYSTEM. Check t soil moisture at the depth of plowing nr, l TE R %1ATEHIAT AND MAHKIN(S or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: 'vDIH LENGTH NO. OF DISTR PIPE SPA('.11(-, INS1oEDDIA = S LJO UID BED/TRENCH TRENCHES r l 1Ar H(AI PIT DEPTH DIMENSIONS ~ ~ ~O `L4~ _ 1 - - - I I 1I' 1,I DEPTH UISTH PIPI DISTH PIPE DISTR PIPE MATERIAL NO DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH ~yI ET. 10 l )V. I II^ _5 JOVE C.OvER I I V INLI I ELEV END PIPES FEET FROM , LINE 1 4 A,IF &f Zt[ 1 r NEAREST_ ~ (00 1 MOUNDS EM: G , 2 ~Q Z Mound site plowed perpe cular to slope Ch k th e ture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upsl e: Ft sys ms to make certain that it ON REVERSE SIDE. SHOW ELEVA- he rite medium sand. TIONS MEASURED. EYES NO SOIL COVER rEXT013E P E H M A N E N T M A R K F R S O H S E H V A T I ON w E L LS EYES ENO EYES ENO UFPTH 0V ER T11F N: 1113E EP1R R IHENCH HE I) I)E PT OF 1OPSOIL SOD_DED SFFDEO ]M~LEJLC H ED E NT F 1t -S ENO EYES ENO YES ENO PRESSURIZED -DISTRIBUTION SYSTEM: I;)TH LEN(; iH NO. OF LATERAL SP ING. G VEL EPTH BE IPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS 1A NIFOLD PUM M NIEOLD DISTR. P I P E N I LD MATEHIAL NO DISTR DISTR. PIPE OISTHIBUTION PIPE MATEHIAL& MARKING LFV EL A ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION ~~'1OLE SIZE ?E PACI F U C;O HHFC I LV HMATERIAL PLANS CAL LIFT CORRESPONDS TO APPNOV ED ❑ YES ❑ N O - ❑ YES ❑ N O ETROROMF PROPERTY WELL BUILDING'. COMMENTS: R N TMARKERS' JOBSERVATION WELLS- NUMBEF FE uNE EYES ENO EYES ENO CEAREST--~►~ Iv 2.~6 fe±Sl'"i 2.2 0 VN\ 0- -(e kkxf S"~A U, r 4-`~ • 7~ SS ,,asl~ ll li-rt-c- Sketch System on Retain in county file for audit. 4,J -7 Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS I~`4DUSTRY; , DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 'HUMAN RELATIONS N WI 53707 LOCATION: SECTION: gTOWNS H I P/M U N I C IPA LI TY: r5f1q5]BLK. NO.: SUBDIVISION NAME: NS_ '14VI4 16 / N/R6-E (or Spey&G A -~a,a FA) ?m COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ` ST- C a m CASSION 3 U)11_S6N USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R DESCRIPTIONS: 1PERCOLATION TESTS: XResidence ❑ New Replace 1 J ~ RATING: S= Site suitable for system U= Site unsuitable for system loms : IN- ND-PRESSURE: SYSTEM LL HOLDING T K: RECOMMENDED SYSTEM: (optional) A❑u s ❑u ❑s u EIS u IfPercolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the d7n under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: _Z 0(a PROFILE DESCRIPTIONS BORING TOTAL ELEVATION PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) n, 0 rt ft 13-a !3 7,00 Of B-3 59 let J, I etl B- .30~~LMAII/ SAID q,~ 244M B- Af Ile B- r A PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERT D PER INCH P- 0", Q P- 0" /41 P- _ P_ o /I Q P_ & .30 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 ELE"TION ~L 0.1 of FA,5T/Y6.;- U.lO c r ell 5 ELFOArlOly /00.00 b Jw G IV y► C + 11 10 v A,' L %V0 13 {1roe..~~ ~a, ~ /ri r. I1~as ' ~ v \ Z./`C ~O ~ p, I, 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 (print): TESTS WERE COMPLETED ON: v ~ I ,G t 74 D77 .112, ADD ESS: v CERTIFICATION NUMBER: PHONE NUMBER optional): PIP CST SIGNATURE: L 'IBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. SBD-6395 (N. 03/81) APPLICATION SAFETY & BUILDINGS DEPARTMENT OF INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% 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. Property Owner: Mailing Address: ~yy G / ' V Property Location: City, Village or Township: County: C '/a-SE s ~T NCR E (or. W Sl"c O M Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: F P. or s t" `•tIr N (If assigned) TYPE OF BUILDING r '7 /-f - Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: I 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 i (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental ASeepage Bed ❑ Seepage Pit i ❑ Alternative (specify) ❑ Seepage Trench C r Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public i I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N me of Plumber: Signature: MP/MPRSW No.: Phone Number: T A, FS 7A DI )Q3.2 : Nam o Deigner: Plumber'ffAdd ss COUNTY/DEPARTMENT USE ONLY Si ture of Issuing Agent: Fee: Do Date: t ❑ APPROVED Sanitary Permit Number: ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: ._J Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to ir. 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) Ability Business Co. A* Bo C Complete Sewer Services KNAPP, WISCONSIN 54749 Phone: 665-2112 S ySTEM To 8b /NSTA,U D Fa R CASSIVs BED W111. LIE 13o'xlpnn~ $OOTH -#_r-1 o>= S,Ey 01SUNb LJE'L[. SFG, )G TowN a 9 /PA,vGE /S LJ, TowRSN1 p Olt S,00Y4 F/6LC GOUN7y EXl ST/Nb L~6// Top F/RvaT/o,y ct ST, cfbl.Y tdIscoasw O PRA1d 1NlrS y6T To SG9LE• EXISTING: A MEP AooM Mo811F NoMF 744 of 7S-o SQ. FT. 11v REp /o' By ~S' j3FA GoNSItTs of Zt..b LINES - 3 aAST L+E^►TS A FLo 0#06 -URV TRAP D)rQ T AIliR W17H ,Z "~lFNT f TRw "jt oDNNbrr "AIL E SEF AEMIL Df40/N6j6.r RS,0 W17H 6:ft), S ' A yNcAST pJPE To MealtE HA,~,E At' 13oAaM of PAGE 0 - 1009) bAL. PRECAST SEPTiG -%y/. w/tN 00 -10* RISIf /NEAREST LOT LINE 1)9)• EAS1 os SYSTEM "4" AI MANNDLl~ L "vN06R c/M/S/IiriO SURFArs, tJr7N 9••CAS7 a jER /'AB.vF REPLACEMENT S ySTFrM - PERK RA-15 yy 0/7N STATE APPRoVr,,D SEALED CAp CAST (y/"') STATE APPROOE'D SEALS T _ _ rys~ I SFG, y0 PLASTX (yy.~ /UEO ;ro uv7S A9ySo ♦ 9S,oo Y" sFc. Yo rtASric /he,y,fola LI/VF GLvfb 70INTs CAST OEW S y" PFRFoRATFA PLASTIC p/ pf PRAOIN6 S BY: HewARp 4j17TlFS7ADT MpRSW a4/ y - STATE APPR601: a vf~r CAP Top OF VENT (;--f'ADF 47,/.,00, 11N1S NEb &RA)3, 9S DD Y'CASr t1ENr MAO Gott ER/NG; 9)N BE • p GR DE ~bN PER J- pocs eoi poeoo • o/ s t,olo~e sA r' A g3.0~ be °c $ D p c o °o °v°e°a s ° 12 e GRADE 9 ,50 WA SHE YTANA' AGGREGATE SIDE 01 ELJ OF BED SySTE A END UJE&J OF ;QED S ySTFM Safety and Buildings Division DILHR PLAN APPROVAL Bureau of Plumbing P.O Box 7969 F-1 General Plumbing Plans Madison, WI 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY Plan Identification No. 8 Gallons Per Day PRIORITY PLAN REVIEW ONLY Plan Review I Petition For Modification Project Name Project Location - Street No. or Legal Description Count ❑ City ❑ Village O Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. 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: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. ❑ FOR PRIVATE SEWAGE PLANS: 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. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section ❑ County ❑ Local PI ❑ Facilities Need Analysis Section UW-SSWMP ❑ Plumber ❑ Department of Agriculture DIMR-SM-0099 (R. 01/84) ❑ Owner ❑ Other ST. CROIX COUNTY WISCONSIN l ZONING OFFICE -IN 796-2239 (HAMMOND) 7 [ 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 30, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An onsite investigation for the Cassius Booth property located in the NE4 of the SE4 of Section 16, T29N-R15W, Town of Springfield, St. Croix County, revealed suitable soils at a depth of 2.2 feet, below 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 mj 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 NE 1/4, SE 1/4, Sec. 16 T 29 N, R 15 vm W Town otl4x.yc Springfield Street Address Lot No. Block Subdivision Landowner's Name: Cassius Booth 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: lto 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 ers-issued to you. ) Ix`Ione of the applications needing a quota number. The quota number assigned to this application is 59 - 14 - 6 D for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. (.for 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. [..for an application on file prior to February 1, 1980. (__]for 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. L]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 I certify that the above information is true and accurate to the best of my knowledge. Thomas C. Nelson Name Si ure County Official Title Assistant Zoning Administrator Date July 30, 1985 DILHR-SBD-6158 (R 12/82) I 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 Location: Township ~XXI]:IX NE ~4 SE ;L S 161T 29 N/R 15 E;I$WW Springfield St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Cassius Booth R. R. 1, Glenwood City, WI 54013 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 STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19~ Notary Public, State of Wisconsin ' My Commission Expires: DILHR-SBD-6413 (N. 05/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, cc DIVISION AND HUMAN RELATIONS PERCOLATION TESTS (11J) MADP.O.ISONBOX WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: ~ SECTTION:u p TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: Ne 1/4,134/4 /(p /W? N/R/S (or)WI COUNTY: OWNER'S/BUYER'S NAME: AILING ADDRESS: ra r x G' o of"'y0/3 USE DATES OBSERVATI S MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIDNS: PERCOLATION TESTS: I)CResidence Q „t New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: 'I IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYST M:(optional) OS ©U S ❑U OS ®U EIsWU NSElu F ercolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the er 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.) / , 9Y .2 d ~Q// -14 -5 C_ 3.60 `G ~ J. -,~-7 L_ 93.9 q rV6 B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD2 PERIOD3 PER INCH P- 3a ` 3 3 , . ~U P- a 3a y 'N6 " P- P_ P_ PLOT P- PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 7 -rt p: 94.2 _ . P b f I I c 3 t F ~ E r P3 31* Jonjo 624L 14 , • E ~G11~ r~ wr !lxa. ep . Ale- , ' T•~►~ TQ~ a lR•+c,6w P- 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: L°/ ADDRESS: CERTIFIC ION UMBER: PHONE NUMBER (optional): At 1 t 17,69 - CST SIG AT,rU/ E: j DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 3 ,sw3 6:$1 rT 4., `s8 ,t'4„) i;$Eg E.. 1 HE! FORM 1 3- MiA 1is 1N1 ntirnber of iii ear d _ r , Arta rtr i , I (a€t€,r"r+: 1, i',o a kie . t v.F?<.k diry wt ; knees. SITE U.At,.d3T>t B A:s ,.rNk'a ="r P'~~ 64. L AS to die i idFit s=t Ok ,~w n his" =tr+t ntb }=t+`, ile Asc EjTo m wul con-inkling the plot Ph, ? ".iAd$KE i. E 4_ ML .35g r 5 mu risel t f„77"r' g ;t€. w tat ,:}C,,'aio e, Dt ?fvi i{g !tT scal pt [f ;r;ed- _ . . Leis . u if approl=tP w ho T!c?slt)" ,an aw b m .i i n _ r , - - ryrgi,tr:? ALL SOP- <d' ri i Fon i B i Av t wn ° - L Own of - un h GV -Gy CoyLoarn Y Cwt~ Law- t- a ~ 1% 4i s sawy Clay w Ay y Co y1 I t f k- tir7 i Mumc! t?3Ii€, i_, is ' -face t`.`. arc = i ♦ l r•. ~ a E ~ r s `a7t a c P i'It F tCO' .,Ox, . hn . M DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDJJS'i'RY,. DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: ~k /4 /6 /V? N/R/_f1(or) W lc_tt COUNTY: OWNER'S BUYER'S NAME: AILING ADDRESS: USE DATES OBSERVATI S MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: New PROFILE DES RRIPTIONS: PERCOLATION TESTS: (Residence ! ❑Replace ? aa' yS ~ z3 8S RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYST M: option ❑S®U S❑U ❑S®U OS~U ®S❑U :1~ If Percolation Tests are NOT requifl! GN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: !!t 1" 1 1 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.) 0 If 911-s? 100 N//, C2.0 jc_ B-.5 4/p• 93.9`1 I'd. `f 8'O ~,B l/ l- 9 sc- 3, 7 ' w B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PE RI D PER INCH 0 OF P- A-7 /1/10 30 P_ .2 1.41 jys 45( #0 'Y46 P- ' OV ~ P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 4~ ~7 I I i t j i I N - - - I ( . ~ I ~,p 10 f I ? V'' I j ~ I I L 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: ADDRESS: CERTIFI ION UMBER: PHONE NUMBER (optional): 57,,& I / gg QO (/flit CST SIG ~ATUURE: / DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - z o 1 ~11N0 L15CJd3d yU~ ru~l'-, i ~ r ~Its t~L i f r t o.:,w .r v, L / f7 0 vo 6 7rq I LA cd rn O - v V < O ~ J T (vim O O0 O fA O • O 1 Ir cc Z Z N rn O cc an 0 m Q Z Z O J Q 3 U w t ~Q 3 ~ U Z ? rC 0 , O cC o N y 3 1 z .a y tU ~ _I~ O Q V •IN ra = u .l.. ~ - Ir o o O do e -