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Home My WebLink About020-1013-10-000 Q N O N O ~..I ~CD o ate • CD m A A CD 3 ` 1 Z 2 m z O A CD 2 Z a A Z C, a 0 N C(D N CD N 3 O C M A( a N Q N a N Cn CD (n p, Z d N p CD NO CD CD W e O w e W ~D W e co O (v N O N Q 7 O O N O --1 CT _W "Y (D CD C) CD = CD CD O O O a g o cn 3 o o O o N N v 7 N V p Z C Ni N fll n (q b co D y a s CD ka CD N a a j Q H CD W C O N W CD (D C CD K Z c- = r c a c o o r v rn 0 o= 3 O N\ m_ L j N O "*ARM1 a a ol N CO 00 ca n r C/) co 00 U) V) o 0 In G a Z o cn 4~ 3 ai vii ai C) 3 E oA o N zz o + f 3 a v v m 3 rn o c~i v a co M 7- m t~ j y N y y (c !r n CD :3 CD PO N a a N Z W Z z co z 0 a, w D CD 0 c D a a c -tom v ~ ~ ~ m O N N• VN`1 ~ Z , N O CD N ('7~ N N O W N N 'a N (D Z Cn m m C:. m m rye \ RI C CCD N (c N (D a W CD C (D CD a Z3 S' O o CD O Z m co N TJ Qom' ` a ' v a A ~ ~ • o W CD W m a 3 a z r o c Z Z cD H M O N CD CD A W ~ W a c CD a D 3 o a o m - _ c N Z CL Z = a O O a CD c CD N O y N CD `0 :3 A co C CD _ o- N O N Z C N O V CL N oN CD O Q ~ A O c j Z7 O CD A '+C cti o O O Q O O C> 0(D 6 - O CL b V Parcel 020-1013-10-000 09/27/2006 10:56 AM PAGE 1 OF 1 Alt. Parcel 11.29.19.57D 020 - TOWN OF HUDSON 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 GARY L SCOBEY O - SCOBEY, GARY L 1037 TANNEY LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1037 TANNEY LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.210 Plat: N/A-NOT AVAILABLE SEC 11 T29N R19W NE SE LOT 2 CSM 3/722 Block/Condo Bldg: ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/03/2003 748045 2466/284 SC AF 04/21/2003 717826 2210/442 QC 06/03/1998 580232 1328/373 WD 03/12/1998 574917 1305/091 QC Lo d 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.210 79,800 146,000 225,800 NO Totals for 2006: General Property 3.210 79,800 146,000 225,800 Woodland 0.000 0 0 Totals for 2005: General Property 3.210 79,800 146,000 225,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 223 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 L COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 C3:w gio O i + CRGrX %t)i1tiT; REPORT DATES 10/24/: COURTHOUSE DATE EIiS 10/23' H!lDS13N, WI 54016 `f Robin Dickman ATION! 1037 Tanne- I trva, i} rCTOR2 M. Jenki w- 'OURCE OF SAMPLES Outs,, '9LIFORM: INTERPRETATION 4 PPm ~ve 10 PPm exceeds the =r ommestred ~i i i c zL : ia, ; - LAB TECHNICIANS Pam Gane OC`~ WI Approved Lab No. 19 zQ Pk co Z OG n9 c~ C 2 O O~~ ~~.1MDfVf S ~Of~f 'm O _ Means "LESS THAN" Detectable Level Approved by: bm~ ~.T 4 m PROFESSIONAL LABORATORY SERVICES SINCE 1952 i S"1. ROIN COUNTY ZONING OFFICE 1-1 D 5Oi` , W J 5 016 i-PHONE - (7151) 386-46~? !'_,r,nty Zoning Office offer-. is and water inspections to Lend zlt.y Firms, and private individuals. ~npletion of this form is essential be locate(_l. e--a.se provide the foll-owint'• i.nfr ~.pi:)r•opriate fee made pavable to -ice, a nd mail, along' with form to the .ti.ng will be m are receive ER I'ES`['ING-- 25.00 (For nitrates anti col. f or•m bacteria.) TER -TESTING FE'E: S12 7 . 1For VOC'S TIC SYSTEM T~SPt•(-,rI<< F: 25.00 Determines - inspection! opert.y Owner Tom & Robin Dickman roper. ty 1037 Tanney Lane- -;al I:{ NE { u SE Sect l of 11 , 29 19 - 2 FIRE NUMBER 1037 - - - LOCK BOX NUMBER SUK Yellow/Beige Yes so, Coldwell Banker - - - - PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e, COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND .A COPY OF THE LISTING SHEET. _LS ~acaat, and has been so for s time , the water line must be purged by runnin:; t for several hours before the test can be conductr. WINTER TESTING: luny times water lines are turn: sill cocks are turned off, making access to the ho.; necessary. If this is the case, please make propel arran •ements with this office to et'-.!!r- t i_mf, t;t~<>; may he -~a ined . Firm or indi is Coldwell Banker/Evett Westphal Tel_ephorre Nu.m},. 386-3942 RE'POR'T TO BF Co dwell B ker/E Westphal - (`losirrg Dal Octob 30 COMMERCIAL TESTING LABORATORY, INC. ~c Mafn Street, P.O. Box 526 • ~fax,,Wisconsin 54730 (:I:Aw t,, 715-962-3121 800 - 962 - 8378 (WI) 800 - 962 - 5227 c C~ L / N r/ -7 RE~ M• i r~l , ; 31 X75, u1 PAGE 1 037 TANNY LA REPORT DATE; 7/24/69 DATE RECEI~!EI~: 7/20189 !IUDSONd WI 54016 g-16 ?Q4ER! Don r'ingei. CCATION' Hudson, WI COLLECTOR: ~~JRCE OF SAMPLE. .'OLIFORM+l V /100 m[ i4TERPRETATION'Pacter i o ioa i! a t LW SAFE isI T R.A Tr pPR, Col it'orm ;ar.teria/00 ml I li LAB TECHNICIAN: Pam Gane ~ Q[0~~ , WI Approved Lab No. 19 ,e .OF.NDEPENpE,Y P VZ D MeaTi = Lr :;lit".4 E'icC tab le Levc l Abp 'owed by t PROFESSIONAL LABORATORY SERVICES SINCE 1952 - ST. CROIX COUNTY ~ ~Y ~ r r sd~ WISCONSIN a x` ~'.,x ZONING OFFICE Y~ ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 July 20, 1989 Don Pingel 1037 Tanny Lane Hudson, WI 54016 Dear Mr. Pingel, An on site investigation of the septic system on your property located at 1037 Tanny Lane, Hudson, WI was inspected July 19, 1989. water sample and submitted the sample to the laboratory for testing. The results of that testing will be sent to you after we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. 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 is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Yenkins Assistant Zoning Administrator MJJ/sa ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 &-n (For VOC'S) { SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 S C%'J (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's address Legal Descripti n 1/4 of the 1/4 of/Section T N-R Town of Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house. If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number, - o REPORT TO BE SENT TO: - / Closing date I X41 7 Signa ture %t y~,- w - ,r ~ , _ _"jl R,~N'y ~ ~y a A~ 5 R SERCO Laboratories 1931 West County Road C2 St Paul M,nnesota 551 13 16121 636 71 73 LA3J3'>1'0.tY AJALY313 ;~~PJ,lf :1J: 1JTJ 'A 1 03/03 C0 n:a300ial r`_. 3tia~ Lab, 1 -1 51'1 Lain 1t. 3•o;; ~?o D,li t: i'JJJ: JT/'j/ ;olfa , 1I 5473J C;JL~,J i~J 3f: Lls;Ii Is. pa ncla ",any P:i ..dJ JP 31: LIJ:Ii La`t)oratory aupervi3o.^ St. Croix Zoning 3a,11C-J A IPL~ IJ: '1JT23 D )A Pi-IJ L A'INT,Y,3I 3: - - - - - - - - - - - - - - - - - - - - - - - - "3ro•nolic'iloron-~t;za•_z~, u~/I. <0.1 3ro-nometha:za, u/L <1.J a'+~on tet,ac'.alori l>, z~/L N. 1 <1 . J _ ^,'c1oro-3t'1yIvj.ny1 u-r/L <J. .h.loroforn, u,3r/L <J.3 `;hLoranetnanc, u;;!L <1.J :;7. 1,2 Dic`alorobenzen~~, u./L <1.J 1,3 Dic`nLorab~nzen°, z~/L <1.J ~ichloroocnzez°, u~/L <1.0 1,4 )ic'zLowo li£luoro.,zot'i~in~, u~/L <1 .0 1, 1 Jic'zloroetzane, u,_;/!, <J.1 1 , ? Dic'Zloro=t%za~ae, u~!L <J. 1 1, 1 Dichloroota;~le~ic, u~/L <0. 1 co ,fig 1,? Dicnloroatrlylen~, trans, .1~/L <J.1 ti, , 1,? Dic'lloroprop3ac, <0. Z. 1, ,3 Oic'iloro-l-propylen3, c:i:,,, ock 1,3 Dic~z10ro-1 -pr'3pylen>>, tr1z3, u,/L <0. ? Sample taken by Mary Jenkins of the St. Croix Zoning Office App-'ove-l by: < n~a zs "nog datcete,a at t:li:; lc•re"i". 1 .n~ = 1 JJJ u;. c~ it i,ia 3 1 Member J SERCO Laboratories 1931 West County Road C2 St Paul M,n,esola 551 13 16121 636-7173 "A.)`)-?ATJ:1i A1ALY•3I:" it, ?;)H _1): 1 j0 ?.'li 03/03/3) St. Croix Zoning 33CJ 3A I?L" dJ: it l~') i J1;~ A' UM13: _ :1'ethylen° n'llOr1~?, ,aa/( ) 1, 1,2,2 Tetrichloroet'I-Ine, u,/~ <0. Tetrachloroet'lyleae, u,P, <0. 1 , 1 , 1 Trichloroetll -..i u7/1, <0. 1, 1,2 Trictll oroethan e, u,/L <0.1 Trichtoroethylene, u'/L Tric7lorofluorom'~t~la.z>, u~/L <1.J Vinyl ^_'Ilor_i 1e, i~/L <1 .J T3 nzene, u3/11 <1.J Ethylben ene, u/L <1.0 Toluene, u3/L ; 1 . J ,All anatyse3 '7:r per or'a,9A x51:1 -'PA OC Jt.1.3;' I X91 t?.j ,II' ~aO~J1J 3 J.~il~i' 3 ~rli~ may be of an enviroza:._ltaliy 'iaz,ir.iou3 tiatur:e .aill b:3 r~-Itarnal L-o jia. J~,I~r 3a.np1~3 aiii oe 3torel for 30 diy3 fro?o t,lc date of tzic report, then 'lispo;;a1 of -)y Laboratorio,3. ?lease contact a3 If ot`13: Al' I:r,-,'--1P3At tleea,~,i. 3 are port 3u':j:•n.itt l oy, Ql~ co ti ~ -,;~y~)Nn FtG~ < neln3 "aot ietect°1 at t,li3 i~:v3i". 1 :a 1JJJ a J J Member ST. CROIX COUNTY WISCONSIN s y.;~ 2,r rk t ji . ; ZONING OFFICE ~s ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Oct. 23, 1991 Evett Westphal Coldwell Banker 126 2nd St. Hudson, WI 54016 Dear Ms. Westphal: An inspection of the septic system on the property Tom & Robin Dickman, located at 1037 Tanney Lane, Hudson, WI, was conducted on Oct. 221 1991. At the time of the inspection, a water sample was obtained for testing. The results of that test will be sent to you as soon as we receive them back 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. Si erely, Ma Jenkins Assistant Zoning Administrator cj AS BUILT SANITARY SYSTEM REPORT OWNER •rz~ f TOWNSHIP SEC ?*-R > W ADD it ESS ST. CROIX COUNTY, WISCONSIN. 5 U B ll I V 1 S IO N -LO'T - LOT SIZE ~ PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i _ - 1 - r r r w t7 7!-- BENCHMARK: (Permanent reference Point) Describe: r r.<u~i~vi Elevation of vertical reference point: 11e-) Slope at site: `'Zo SEPTIC TANK: Manufacturer: )/11/4e, r'S Liquid Capacity fad: ank manhole cover elevation:-- Number of rings on cover : _ - Tank Inlet Elevation- Tank Outlet Elevation: PUMP CHAMBER 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 f►orsepower- brand name of pump r ' 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- - _ _ _ t' "'page pit inlet pipe-elevation bottom of seepage pit elevation - feet. SEEPAGE BED SIZE: number of lines 3 width f length 3C-~ the depti ii --E SEEPAGE TRENCH: width- l e n g t h PERCOLATION RATE AREA REQUIRED- AREA AS BUILT INSPECTOR PLUMBER ON JOB LICENSE NUMBER-- ~?,%_7 - DE ARTMEN;T of INDUSTRY, INSPECTION REPORT FOR V LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53X07 BUREAU OF PLUMBING &1 CONVENTIONAL ❑ALTERNATIVE StatePlanlD.Numben ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound ufas9neai ADDRESS OF PERMIT HOLDER: INSPECTION DATE: g et R. R. 1, Hud6on, WT L _ 3L ffPJ,mbee, LDER: nent efe enee pomt DDESCRIBE IF DIFFERENT FROM ~~44'°~~ectcan 1 1, T29N-R 19W, Lot # 2, Town o HuW1.J(fin RF. PT EEV. CST REF PT ELEV MP/MPFiSW Nc)Sanitary Permit Number m 3224 St. Cnaix 430 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ETEF GAPACIT)'TANK INLET ELEVTANK OUTLET ELEVARNING LABEL LOCKING COVER PROVIDEDPROVIDEDYES ❑NO ❑YES ❑NO BEDDINGVENDI VENT MTLHIGH WALARM NUMBER OF ROAD: RTY WELLBUILDINGVENTTOFRESH ❑YES ❑NO FEET FROM LINE (E❑NO ❑Y NEAREST / V 77 r-wf~~ DOSING CHAMBER: MANUFACTURER BEDDING! LIQUID CAPACITY a PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER [:]YES ❑NO PROVIDED PROVIDED GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL ❑YES [:]NO ❑YES ❑NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH PUMP ON AND OFF) FEET FROM NE AIR INLET. SOIL ABSORPTION SYSTEM. Check the soil moisture at the❑d depth of plowing LE%(~TH NEAREST DIAMETER MATERIAL AND MARKING, 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: WIDTH LENGTH NO. OF BED/TRENCH ~l DISTR PIPE sPgaNG CDVER zPlrs INSIDE DIA DIMENSIONS TRENCHES MgEHI A C PIT DEPTH GRAVEL DEP H °'f - BELOVµ'PIPE$X FILL DE H DISTR PI DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. fy A OVEV ELEV INLET ELEV. END. r r f p ETBFROM PROPERTY WELL. BUILDING: VENT TO FRESH PIPES , - AINLE T' NEAREST-i.• 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rexruRE PERMANENT MARK S. JOBSERVATION WELLS f DEPTH OVER TRENCH BE. ❑ Y 'S ❑ NO ❑ YES ❑ NO CENTER DEPTH OVER TRENCH'BED DEPTH OF TOPSOIL' EDGESODDED SEEDED JMULCHED ❑YES "DN ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH. NO.OF CAT AL SPACING.. RAVEL DEPT BELOW. P TRENCHES. FILL DEPTH ABOVE COVER. DIMENSIONS A / E EV M-ANIFOLD EPUMP LEV MANIFOLD CIA ISTR. PIPE ANIFOLQ ATERIAL. NO. ISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEVATION AND ' r` FLEV PIPES DIA [DISTRIBU1ION INFORMATION HOLE SIZE HOLE SPACING DRILLEDICORRECTLv COVER MATERIAL: VERTICAL LIFT CORRE$PON DS TO APPROVED Y PLANS COMMENTS: ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: / NUMBER OF PROPERTY WELL. BUILDING. ❑ YES ❑ NO FEET FROM LINE 111000 ❑YES ❑NO NEAREST >3 i~ UI~•` 'T ///!JJ V P e- I S t ' I Sketch System on ' Reverse Side. Retain in county file for audit. si NAT"RE.. TITLE: DILHR SBD 6710 (R. 01/82) { MEMM~wisconsin APPLICATION FOR SANITARY PERMIT D ! L H R COUNTY oERRRTmEnT F (PLB 67) O - InPUSTRy,LROOR&HUMRnRELRTIOns UNIFORM '7SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING A~RESS ~i T1~h , PROPERTY LOCA I IO CITY: Aft 1/4G.1/4, S 11 , T.-':), N, R / E o VI 9 ( T WN OF: 11 V DSO A/ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ~M LAKE OR LANDMARK STATE PL,~N I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedroums: 3 ❑ Public (Specify): I THISERMIT IS FOR A. New System ❑ Tank Replacement ❑ Re air Replacement Soil Absorption System p ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF F IS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ See a e Pit System-In-Fill p g El Holding Tank El In Ground Pressure ❑ Vault Privy E:1 Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions, issued Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity /000 Lift Pump Tank/Siphon Chamber Holding Tank capacity ¢J;~ Manufacturer: i U t IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #,f Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name o umber (Print):. Signa e: MP/MPPBS.IN..No.: Phone Number: Plumber' A resss z p i Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ^ ) ❑ Disapproved v eK 1,2- ❑ Owner Given Initial Reason for Disa Approved Adverse Determination pproval Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To, Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. • JOB y;.-;7.). ROHL & TIMM EXCAVATING 310 Arch Street SHEET NO. OF- HUDSON, WIS. 54016 6 X (715) 386-8664 CALCULATED BY DATE_ - ~l ` CHECKED BY c DAT-E_ SCALE , (o 4 93 i i Ile PRODUCT 2041 ~M es~ Inc., Gmton, Mass. 01471 JOB ROHL & TIMM EXCAVATING _ • ~ 310 Arch Street SHEET NO. Z OF a HUDSON, WIS. 54016 CALCULATED BY fr - _t;; (71G5) 386-8664 DATE CHECKED BY OAF£ _ l SCALE YHOOM 2041 /VE'9s Inc., Gr01M, Mass 01471. LC) v - L v v W o o ~ E - ~ °i Y CV - c ~m3 ~n n of m 0 CY) o Q C6 a a T>~ - Q E m m N cn m E`ro _ mE E w m ~ N v N v c _ c o CL Ir n!mw f c E o r° o > o E Ql Q oa iv ° - ° =00 m N z c ° ° c c w o, Wry- u N n ° L a U E° L1_ nw E E E n L: c > u.. ° c o E V ~w w ~v E 3 o vo W Lri Y 3 v c_ =8 c U co -C Ecm c N~ EY vv ro o N v T EE E 9 m v v ~ c Q O n 3 n o w I"- w w N T d .O 7 c O L cp a o c Et c m ~y w n m S LJ V na-i m c my 3 v tp E O vL c c w~ W L ~Fc H v ~c o _a F- vv9 U W ° U Q Z 'J U v E > - °a ~o u ov vo T =E °a ~I~ ~J z 4 z z Z cn 0 J o o w z~ v) z Z r l1• - H OC x U) r Lij O p N tJ) Z U Cr U I W IF z J ~ C) 00 J 1 ~ ~ m w ~ J co CO ~ Lij U) X COOD J ~ W Ir -1-0 Lij y~ w m .V 0) .0 Lij r) ID C) VJ O z _ 2 O n t- Q t- DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LA80B & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7Z)69 ' BUREAU OF PLUMBING M'4DISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE sraePlanLO N mbar: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Don Pinget RR#2, Hudson, WT LE BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN REF. IT EV.: CST REF . PT . ELEV NE% SE%, Section 11, Lot #2,T29N-R19W, Town o~ Huct6on Name of Plumber MP/MPRSW No. County Sanitary Permit Number. 224 St. Cteoix 43725 Rogers Timm 3224' SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. EYES ENO EYES ENO BEDDING: VENT CIA. VENT MAT L' HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING: JALARM FE LINE. AIR INLET. ET FROM EYES ENO EYES ENO NEAREST DOSING CHAMBER: OC KING MANUFACTURER BEDDING: JLIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANU FACTO RER WARNIDNG LROVI DED OVER EYES ENO EYES ENO EYES ENO TO FRESH GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PLROPERTY WELL BUILDING VENT INE AIR INLET. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) EYES ENO NEAREST--> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nc.TH DIAMETER MATERIAL AND MARKING 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: BED/TRENCH WIDTH. LENGTH TRE NICHES DISTR. PIPE SPACING MATERIAL: JINSIDE CIA #PITS oEQPTHC. PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PR OP ER TV WELL. B . VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLFT ELEV.END PIPES FEET FROM LINE. AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. EYES NO PERMANENT MARKERS. OBSERVATION WELLS SOIL COVER TExruHE EYES NO EYES NO DEPTH OVER TRENCH :BED DEPTH OVER TRENCHBE D DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES NO EYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES. DIMENSIONS EV. O. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. N ELELEV.. DIA. ELEV.' PIPES CIA.. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED COVER MATERIAL PLANS INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY EYES NO EYES ENO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING: COMMENTS: FEET FROM LINE: EYES ENO EYES ENO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) .DEPARTMENT OF 46 APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR-AND PERMIT P.O. BOX 7969 HUMAN RELATIQNS (PL13 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. Property caner: Mailing Address: Property Location: City, Vill ge or Townsh'p: County: t/aS P ~T Z NCR (0r4-0 TiC~-ice Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. umber: Z / Y✓/ 72 7 (if assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: ❑ 1 or 2 Family *State Approval Required. 3 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 CHAMBEFj MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit / L~1 ❑ Alternative (specify) ❑ Seepage Trench -71 Water Supply: O Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signatu Mp LULERSW.N0.: Phone Number: Plumber Address- _ Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signat re of Issuing A ent: Fee: Date: APPROVED Sanitary Permit Number: .ry o ❑ DISAPPROVED 113 o~ 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 (R.07/81) Forty - 5 T C 100 Owner of Property .Location of Property J Section IT N R j W Township Mailing Address C Subdivision Name 3 ) 7-:?2 Lot Number -2- Previous Owner of Property G-~ yr c~ Total Size of Parcel i 2- Date Parcel Was Created- Z7j,' Are all corners id°::tifiahl^? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other legal Document which describes the prulicrty PROPERTY OWNER CERTIFICATION (We) certify that all statements on this form are true to the best of my (our). knowledge; that 1 (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed regarded in the Office of the County Register of Deeds as Document No. Z~L--" ; 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. l sla U of Jawftf-ff j~ ~ , ~ r ; ~}ri~` SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED x~ _ Nov 97 3 5 '14 v pli CERTIFIED SURVEY MAP N E 1/4 CO. . M ON. NE 1/4 - SE 1/4, SEC. 11 7 T-29 - N I R- 19-W SEC. I I 11,92' p 4PN~S' TCER - BEARINGS ARE EAST LINE OF THE WEST REFERENCED ALONG WO RODS OF THE NE 1/4 VNp1"A~ THE EAST UNE OF THE T m 1 I~ OF THE SE 1/4 pWNE~ SE I/4 OF SEC. i I z "'1 501 (ASSUMED y S00°-43~ 05"E) o N89°-30'-00° E 560.80' o r ' 38.081 / 522.72' A m X00 I N W _ I p 01 O N .4 50j °O O m L 0 T 1 _O z N I ro 3.22 ACRES w o 0 3.0 ACRES EXCLUDING R/W g of o 0 ' °o I o 0- w ~ ~ N c m CL 3~I2' 1 I 559.60' m D 36.8 I 522.72 1 rn ' --i z cn r _ z o I o S 89°- 30'-00" W m m cr-j c ZO LOT 2 722.70' -n 3.21 ACRES N co Ln Ln M. r-l o I w o 3.0 ACRES EXCLUDING R/W o r O O O co N m S Z o ANA - 'rm ~o I ° ~tEC _ ` A 35.681 522.72' 432 I 558. 40' m = ~ I I ~ . N I cN Z I LOT 3 0 0 N I N 3.20 ACRES N o I ° 3.0 ACRES EXCLUDING R/W o c it I °o_ - e 0 I h~ o, n o ( o m 34.481 522.72' N- _ I S 89°- 30'-00" W 557.20' I~ UNPL?' " THE .1~=,t•. 15.52' LEGEND 100' 0 25 5d 75' 100' • GENE C. 0----I"x 24" IRON PIPE SET, SHAFF WT. 1.68 LBS./LIN. FT. HUS -"T5 SCALE IN FEET v DSON pQ ~~---90° R/W WIDTH W) I~ < •~O od VOL. 3 PAGE 722 THIS INSTRUMENT WAS ~a~~4o~°°~` I -,_,.GLRTIFL~ SURVEY cJli'S DRAFTED BY GCS ST. CRQIX COJ.JIY, 'ICI. JOB NO.78=55 SE CQR n , rn kinN h4` EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES 6 P.O. BOX 309, MADISON, WISCONSIN 53701 d o y~ LOCATION:IE'/4,P t '/o,SectionTN,R`(or) ownship rfllFaa>+ty v y `9 Lot No. Z- Block No. AA V-2 `7ZZ_ County S { F ~ Su IvlslonlQa e QW1419f' /Buyers ame: d V1 vi ck i B Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW ✓ REPLACEMENT -ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS/ PERCOLATION TESTS SOIL MAP SHEET SCE NAME OF SOIL MAP UNIT PERCOLATION TESTS 'Sot C-1 TEST HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL RATE BER INCHES THICKNESS IN INCHES ii 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- i a toN'T~. 1251 5.1. P Z L4 "r. G3'tG Cam. ® d Z . q P-- , Z P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES u 13- 13- Z- -7 9 Z- B- Z it I 7 7 6' 10"S 1 C•~ B- rf 113- It P PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. \\ti 5zz.~~ p I ► a c~® Su1-Eae- tU 17~ $~a i4 o a SaiG s _ W Lei aC "1 A°` L Z 0._ \~j S:l 91 y < ' !Q A 4 z 1C~7. 5U - Z. Z 7 Z S t5b. 14 C> 1, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. Name (print) A vi (o-, Certification No. Address 106 WAY 6d+ S f'. `1 o d c,,i , uJ 1 5 q 61 fo Name of installer if known Copy A - Local Authority CST Signature JOB G ✓7~ I f ~i'4 ROHL & TIMM EXCAVATING SHEET NO. OF -2- 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY DATE I z (715) 386-8664` Z Z~ CHECKED BY -DATE- SCALE 119& w - 13 b 32- Y 14, f~ PRODUCT 2041 nrees Inc., Groton, Mass. 01471. > JOB ROHL &TIMM EXCAVATING SHEET NO Z OF ~ 310 Arch Street / a HUDSON, WIS. 54016 CALCULATED BY DATE / -j (715) 386-8664 , CHECKED BY DA~E_ ~ Z SCALE Z _ n PRODUCT 291 / s Inc., Groton, Mass. 01471.