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HomeMy WebLinkAbout034-1091-40-000 n to O d o d o m ~ 'I c 1 1 V, ~ O O n O N O O A (D W w `C W 3 -4 (n CD 7 CD N W N (O l/~1 n. Z n -4 m ~ CD c O 1 CD N N S Q cn CO PO CL 0 0 COI v' 3 N o o' A b N• o c a O m cn H (D G ~ N W ➢ > 'a 0 n p CD m ('Z) w CL v 0 r to w m ~ Co m N o c (n 0 CT Z O O O v, (r71 11 n 3. 3 U1 fn fn v d V C.N N CD N CD !r i (D y 2 pn D1 CD ~ N rn~ a N o 1 m D D o O uo CL FE p C m -j A Z coo 1 p _ Ctj o~c~ Z 1 \ ~z O M N W W CL z A 00 CJ, 3 C N ~ ~ < CD W p~ CD V o D m U)00 -o - 3 m m c m s 3 N W-0 Z Q o N N SCE. j N fC W N S S 3 0 e a CD O ~ O W A w Er A 3 (D fi N po ' A O qz, A CD CD ~ O N O ~ a CL A O b b CD 69 0 O C7 `L C Si 6 (D O L y Parcel 034-1091-40-000 01/04/2006 09:53 AM PAGE 1 OF 2 Alt. Parcel 28.29.15.589 034 - 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 - ERICKSON, MARK A & TAMMY R MARK A & TAMMY R ERICKSON 2949 72ND AVE WILSON WI 54027 Districts: SC = School SP = Special Per pertyAdctress(~s): ' = Primary Type Dist # Description 2949 72ND AVE" SC 2198 GLENWOOD CITY SP 1700 WITC SP 7059 SPRINGFIELD SAN DIST #1 Legal Description: Acres: '9.000 Plat: N/A-NOT AVAILABLE SEC 28 T29N R15W SE SW 9 AC COM E LN Block/Condo Bldg: / SE1/4 SW1/4 AT INTERS. OF NLY LN RR, N ON SD E LN 10 CHAINS 13 LINKS OR 668' TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) NE COR OF SE SW, W 15 CHAINS AND 14 2g-29N-15W LINKS OR 994.24', S 4 CHAINS 86 LINKS OR - - 320.76' TO NLY R/W RR, S 70 DEG E ON NLY i~ more... Notes: - Parcel History: Date Doc # Vol/Page Type 07/23/1997 949/69 07/23/1997 803/545 07/23/1997 749L458- 07/23/1997 " 704/112 G_ a S,'E 2005 SUMMARY Bill M Fair Market Value: Assessed with: 82641 Use Value Assessment Valuations: Last Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 6,450 97,400 103,850 NO AGRICULTURAL G4 8.000 900 0 900 NO Totals for 2005: General Property 9.000 7,350 97,400 104,750 Woodland 0.000 0 0 Totals for 2004: General Property 9.000 7,350 97,400 104,750 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 034-1091-40-000 01/04/2006 09:53 AM PAGE 2OF2 Legal Description: cont. R/W RR 16 CHAINS 3 LINKS OR 1057.98' TO POB EZ-UT-1267/586 I I II AS BUILT SANITARY SYSTEM REPORT OWNER_ j7-pi'1' SI 5 C()WNSH11'/?EC I»i/N-RW ADDRESS, ,7-/_ ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOW LOT S1GL, PLAN VIEW Distances and dimL.nsions to meet requirements of ~H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i U, Ii di at N r h rr< w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: _ Slope at site: SEP'T'IC TANK: Manufacturer: Liquid Capacity: A11141 - Number of rings on cover Tank manhole cover elevation Tank Inlet Elevation: Tank Outlet Elevation: 4'~ J 2_ PUMP CHAMBER Manufacturer: /C -Number of gallons; Total capacity of Number of gal. pump set for a cycle_1,;Z_a_;7 distribution lines _ gallon: size of pump 7~'~~~-- head; gallon per minute horsepower- ;brand name of pump and model number ,`q,~~}~~ C~ S>,j,3 r Type of warning device_,4 4 &2,1A1 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 _ --,,.,.,page pit inl^* pipe-elevation bottom of seepage pit elevation - feet. SEEPAGE BED SIZE: number of lines width -length the depth SEEPAGE TRENCH: width _ length _ PERCOLATION RATE AREA REQUIRED- AREA AS BUILT_____ INSPECTOR DATED PLUMBER ON JOB- LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING E CONVENTIONAL ® ALTERNATIVE State Plan l D N„mbe, ❑ Holding Tank 1:1 In-Ground Pressure X1 Mound n465 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER . INSPECTION DATE: Thomas Hess HeAz ey, wI _1BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN 9 7 REF. PT. ELEV.: CST REF. PT. ELEV. SE SIN, Section 28, T29N-R15W, Town o~ Sptu,ng6ie.P_d Name of Plumber. MP/MPRSW No. County Sanitary Permit Number: Gage Smith 5690 St. C)Loix 43733 SEPTIC TANK/HOLDING TANK: MANUFACTURER 'n+ LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER y /tie ~j -7 C~ 7 PROVIDED: PROVIDED. ~I G/ ! / / 7a YES ENO EYES ENO :ED DIN VENT CIA. VENT MATL HIGH WATER ALARM NUMBER OF ROAD: ` PROPER? WELL. BUILDING: JVENT TO FRESH FEET FROM / LINE' .L AIR INLET`. YES ENO EYES ENO NEAREST 40 T DOS NG CHAMBER: /M'ANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMPS PHON MANUFACTURE WARNING LABEL LOCKING COVER ENO PROVIDED PROVIDED GALLONS PER CY LE: PUMP AND coNTRO s OPERATIONAL u YES ❑ NO YES [:j NO (DIFFERENCE BETWEEN NUMBER OF PROPERT WELL BUILDING, VENrroFRESll, FEET FROM LINE3 IAIRLJFr PUMP ON AND OFF) YES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILEN(,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 5A) a ~/J CONVENTIONAL SYSTEM: 7 BED/TRENCH WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE CIA #PITS LIQUID I E T D DIMENSIONS TRENCHES MATERIAL:_- PIT AIR DEP wTH: GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. PIPES ABOVE COVER ELEV. INI FT ELEV. END. l NO. ISTR NUMBER OF PBE LOW P OPERTY WELL BUILDING. VENT TO FRESH PIP S FEET FROM NE IN 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 ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH 'BED DEPTH OVER TR ENCBED [S~ ES E NO LS*ES ENO CENTER DEPTH OF TOPSOIL SODDED SEEDED MULCHED. EDGES S EYES NO VYEs ENO YES ENO PRESSURIZED DISTRIBUTION SYSTEM: i) . ENCHES: BED/TRENCH WIDTH J FHOLE J~Nl OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS S MANIFOLD NIFOLDDISTIPE MANIFOLD MATERIALNODISTR DSITR. PIPE DISTRIBUTON PPE MATFHIAI MARKING ELEV. A ELEVPIPES s ELEVATION AND "DIA, DISTRIBUTION L FORMATION HOLE SIZE ILLE CORRECT LY COVER MATERIAL VERTICAL LI T CORRESPONDS TO APPROVED PLANS YES ENO 2YES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. LINE: FEET FR )M 1 5J YES E:1 NO D 'ES E:1 NO NEAREST_____~ 20' 7 0 7 QQ.a-cJr ❑`LV r 5 rho &J f ; V I u~~<~,~P Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) Plb. 1-A, 3 Wisconsin Department of Industry, Labor & Human Relations Leroy Jansky O.W.S. `~/gyp Safety & Buildings Division 13 E. Spruce Street Bureau of Plumbing Chippewa Falls, WI 54729 (715) 723-8786 ~ i - PRIVATE SEWAGE SYSTEM INVEST-TI , y Name of Premises- ML>U~t~ SYSTEr~ . Location Township County Master Plumber/Soil Tester GkLZ- SMI-1-1A Address >1 FP' Qr -lot: Owner40 M 00& Address Sanitary Permit # 437 Plan I.D. No. L.~ 07q (ate Type of Inspection Awn iT Persons Present at Site ZL - , NCB r.S _ Type of Building: ❑ Public Single Family of~ BRIEF, FACTUAL COMMENTS AND SKETCH: + ~Tli I f ~ t~ 1,1:1, 1, "1 J-eL~~ i ~Xv LZ I_. Y-!_ l I I 1` ~ ~ S i -11 ! T 464A~k4 '4'0 j , t t 711- -1-1. I~ PAZ - 1 I I , ( t t I t ! III I ❑ SEE ATTACHED DISCUSSED WITH PLUMBER/CST SIGNATURE DATE OF INSPECTION 3- ~8S L i nature off' nspector Inspector Local Inspector Plumber or Responsible Party 0ILHR-SBO-6799 (N. 5/82) 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'/Y 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: A /s c' S' s t~ ldkp Property Location: 4uwyi f4ae~e-er~~iip 'Trj ~hr•/a County: -5 '/4 So '/4S Y iT ' N/R /h"I Wor) W _ 1A 15, LoWq ber: Blk No.: Subdivision Name: Nearest goad, State Plan I.D. Number: - AA ' Iifassay-d/ C+ 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 CHAMBER Q X MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) M p aIVI'l ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Q Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/##P if No.: Phone Number: Plumber's Address: Name of Designer: tr-~ L G~-'r, z° d ? 1` w L-✓ S M / :11-'// COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: 614-1 Date: APPROVED Sanitary Permit Number: ❑ DISAPPROVED Y 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) State of WISCQR*i Department of Industry, Labor and Human Relations F 17 a SAFETY & BUILDINGS DIVISION 712 J, svn scc' F.- "'f Sprin~f ^"i .:-i~ subject Pi.>t Ttiop for < wt j - (if ce Stetrvf"'*V' _z`T is';1 in Z#' C- the t' -e(I fc, PEP. . DILHR-SBD-6423 (N. 04/81) Department of Industry, Labor and Human Relations Division of Safety & Buildings DILHR Bureau of Plumbing - POEPFIRTTTIEnT OF .O. Box 7969 - In0USTRY,LRBOR S MUMRn RELRTIO Madison, WI 53707 Tel. (608) 266-3815 IN ALL CORRESPONDENCE REFER TO PLAN - IDENTIFICATION NO. OF PROJECT, R VA S ALY - ❑ GENERAL PLUMBING PLANS Fee Received: LOCATION Priority Plan Review Only CITY OR TOWN COUNTY Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wner required inspections are to be made. -I-ft, -t*e-•eVefrt--4 aAs rl 1a app. ava.1 -,w.l,.IL-be--v.aidi and new plan appraul shall ha nhtainarl heince work wa beg-in.- In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, p ?2 J' 'vI d!. 1c1 t This approval Is valid Tol two valid Urltli y ears or it will be James SargE6t~~ the expiration daate of the {rlitiaJ sanitary permit. Bureau Dire or PLANS REVIEWED BY: f DATE:/ cc: DPS - OWS Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services County Other DILHR SBD-6099 (R. 05/82) SBD6678 (9/81) (Plb 100a) STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 8 201 E. WASHINGTON AVE. RM 178 Any Return Corresponde P.O. BOX 7969 WI 53707 MADISON, ~608-266-3815 ten! DATE: w,,~l~o PROJECT: PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ r'{ Fee Received is $ ❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. I❑ Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including soil data. size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. v, H y S T C - 105 r y H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d y OWNER/BUYER h S y` I SS ROUTE/BOX NUMBER ~i pK 131, Fire Number CITY/STATE ZIP o i' PROPERTY LOCATION: ~4, Section Y, T N, R W, Town of Sy~T i1 , St. Croix County, cl~ 1 Subdivision_ , Lot number improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- w ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning Office w thin 30 days of the three year expiration date. SIGNED St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 ~j 715-796-2239 or 715-425-8363 Sign, date and return to above address. Fu rill - S T C 100 Owner of Propertyf7~6t/f .Location of Property.._5~e-_ - '!a! ~4, Section__2 J> T r N RW Township-_ GN % Itlin W Mailing Address sc /y Subdivision Name Lot Number Previous Owner of Property Big} fi,Z C' 67 O Total Size of Parcel jr4 /C Date Parcel Was Created Are all corners identifiable?~ Yes No Include with this application one of the following: .Certified Survey Map .Deed 7 Land Contract, or .Other Legal Document which describes he property 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 recorded in the Office of the County Register of Deeds as Document No.: ; 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 Wly recorded in the Office of the County Register of Deeds, as Document 3114-6- Y SIGNATURE Of OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT DUS RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN RELATIONS LOCATION: SECTION: TOW SHIP/MUNISIIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: _S'£1145Wa _aoO A-2,9111/11/61 (or COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERIIAL DESCRIPTION: 171171e3 TONS: ER A ON TESTS: Residence -3 ❑New Replace ~a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRES=SYSTEM-IN-Fl =HOLDING K: RECOMMENDED SYSTEM:(optional) ❑S au M~S U IS ©I e„7c~ If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 17: 2 q 133 95- 3' 7: 'e 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 PERIOD PER INCH P_ i4ik- , a lie '30 P- ~2 /L `Ga 3D -3 3 P- P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION /I' 1, 70 } is's T T tic i !~i"~ L~LCfI, 'fv PI E I "..'76, 95' l~oH10sr. 9j_Q9` ~/f1J fLLl.ve _~1~►__ On; ~ol~ed 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: Go le: (I ryj 1 ~ i 7C ADDRESS: 1"J'1! CERTIF AT N N BER: PHONE NUMBER optional CST SIGNA RE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN'RELATIONS LOCATION: SECTION: TLOT NO.: BILK. NO.: SUBDIVISION NAME: S /4WI /T fN/R 5$or) W l;l COUNTY: OWNER'S BUYER'S NAME: AILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: JCOMMERCIAL DESCRIPTION: ROFILLE T NS: IFERCOLATION TESTS: Residence 3 ❑ New W Replace I 42 -.2- _ F4A S= Site suitable for system U= Site unsuitable for system CONVENTION ~AL: MOUND: IN-GROUND-PRESSURE: SYSTE~`M-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) D U ®S OU El S E ®U ©S EA u a" If Percolation Tests are NOT re ESIGN R ATE: SYSTEM E If any portion of the lot is in the under s.H63.09(5)(b), indicate: ffl 3o2- 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.) B B- B- 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 1 PERIOD 2 PERIOD PER INCH P- 0 O P- :2 /F 2017 j Ile P- P- P- -P PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION /a /o Q~ lVd ve. . i. i i z ' x 66~ Pe/7kz~,eY.' y Poke ,3- yy o8 x , 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: 6= L e A/ S~ i ~f1 .2 - - F ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): G~ e o a d c ' f QCs" _.2 CST SIGNATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION .1). Cox ; c tu, zdi son, : i sconsi , ~WO'17 . t C'r ~ti on fe, Mud-if+catrion of aE`ctll t4 el.`. T ' A t µ p^ t F~.r tt5{i~~ ~ 4'~~.?~~' _.a ~ L~..~~. ~ 4-r.; Y, . 2, ~ ~ _ 5- ~ to .P... §.r. 4 r. •,j,_ - i V.Ff F ~ /ndids of~swiba;)Iae. i?4ttw al rJ'vil. 7?; i tFa' e 3' i,, s•'1e ; eo S P o C i ' C aiti [''C P v. iaC.r ~3 . . r t C } DILHR-SBD-6423 (N. 04/81) Smith Plumbing PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 /~~i e~,; ,:j s , J r' S S J`~' f f L`~• J L .s oy _ ~ g "J~~ 7 ~ ' S ~ 3' t~ I' i~ ~ <<' d IV S-/V/ _P 013 Pc;i.?A4Z-1v zivt MA1;1(~RS A4 if Al d !q'A sys rem el~ a~ I y''levsP~er1c I 5e~~~C i~d I, M /•lo 41Se e~ I I 14m P C i~AM 6 el? xo OI Department of Industry, Labor and Human Relations ~w~sconsin Division of Safety & Buildings Bureau of Plumbing DILHR P.O. Box 7969 ~ oERRRTmenT of In OUSTRV,LRBOR&HumRn RELRTIOns Madison, WI 53707 Tel. (608) 266-3815 IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. 2P NAME-OF PROJECT 'RIVA S A E NLY - ❑ GENERAL PLUMBING PLANS ac~ Fee Received: LO ATION Priority Plan Review Only CITY OR TOWN COUNTY Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wrier required inspections are to be made. pprnval will ha vaidi and new plan ap rnyal zhal l ho Qhtaaqarl bQfQr8 yy®rkF het i 13 In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For Private Sewage Systems Crly' This approval is valid 'ror two, years or it will he valid until 7044 - , ~ the ex;:Jiration date of the initial James SargEkt,- + sanitary permit. Bureau Dire or PLANS REVIEWED BY: DATE V- J cc: DPS - OWS Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services County Other DILHR SBD-6099 (R. 05/82) Page Straw, Marsh May, Or Synthetic Covering ~Distribution Pipe Medium Sand G Topsoil F ~ _ % Slope F Ike d Of 2 % Force Main E lowed z From Pump Layer Aggregate E 7 Ct-;~ ss Section Of A Mound System Using F / 75 A Bed For The Absorption Area Ft. `-Signed' BFt. 1. i Gese Nurnber : Date: dFt. C'h e Alternate Position L7&2.4. Ft. of Force Main W_ Ft. J Observation Pipe---- K O Force Ma n From Purnp Distribution ~Bed Of 2 - 2 2 Pipe Aggregate 1 Observatian Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Smith Plumbing PHONE (715) 265-4838 GLENWOO CITY, WISCONSIN 54013 z r r. S-~, c.czo~x C~o, n,, 1' S ( f ki, 'AI r h 40 1. i ~ Ae- PWA4 2a 8307465 it r , e Ai 4:1.o J?e Ton. Page 2 Of t,io " Perforated Pipe Defoll OIL' n r: Perforated 'I/ Eno Copy PVC Pipe 70^ oe Holes Located On Bottom, Are Equally Spaced PVC Force Main From Pump 8 07 f~ PVC j Manifold Pipe Dittnbution Alternate Position Of pipe Force Main From Pump L WA I'OiO Should Be ~ N-W 7 End Cop t S I } End Cap = Distribution Pipe Layout D R S XZ` Y ' , ft's Signed: Bole Diameter Incr) License Number: a Lateral Incin(es ~ Manifold Inches r Gate: Force Blain Inches PAGE [DUMP t:_IiAMBER CKOSS SECTION AND SPECIE ICAVIOUS _ VEK1-1 CAP 'i"C.I. VENT PIPE APPROVED LUCKIN(a WF AI M K PKOOf j E ~--MAMHOLE COVER { E ?-5' F RCM DUG K, JUMCT-10K) BO'K WINDOW OR FR I, SP, 12°MIU. Afa INTAKE I I - GKADi - IB",MIA. COIJDUIT- ~ - - P R O V I DE ~"Cs T~'{t$ AIRTIGi.7 SEAL I III 'I "act, APPRO` 1,L) JGINT A ~i ~ w " I III I APPROVED C W/C.1.. PIPE ~ 4 ~s s I I I I Vl~C.T_. i iPI , E1<TENUIKIC. s4 Cti I I i ALARM OEXTVTEO tJDI SOLID [b O►JTO SUt.iD l V I I I. O KJ `I I , I _ I II I F Li f'\ V, f> C) F: F OV ~ 6 1933 :.Uh.ICKET'e. BLUCK - ~ X KISER LY,11 PEKMITIED Ci!`IL`-1 it IAIJK MAAJLJrAE'rUFZE-k. HAS ,iULH APPkOVAL. PE C; IFIGATIDIJS LPTIC AND 4 )SE TAhIK` MA0.J1.1FACT"l_; iE K KIUMOEK C f DOSES: DAJ IAFJK I_E (7, AV._t_.C)Ki$ DOSE VOLUME: ALARM MA►IUFACI LiRE.k: CAPACITY.-S: A= ~ J.._INCHES OK ,5L( 6 At- t Ck Mi L E__L 1JUMbF-K: --4 /-ikWHES UK GAL, Cki WITLH T yF E: ---IMCHES OR - GA~t GP. ! - ~ h I'IIMI' MAHMAi I UftE'rt: cf~'0 mI. i,c -_ItJEHE~ CiN Mr l t l K1UNlBt K _ f? _ _ - F10 1 E PWAI' ANU ALARM AIIE VC, bl - IEIStAL.LE_U OQ SE-PARAFE i-IKCUITS J__2 Icc 41 PUMP U 15 H A k v L R A -I L ~ _ - T. CS P M ~ fj~e-vc~ j~ / v VLKTICAt. - Ulf Fr-PLKICE hL-I WLAU PUMi' Of 1- AK)U 01 1 k;f3UTtoti] I'INt_-. FEE-T / 2 i MI l1tMUM. NETWORK SUI'Pt_y PKE: S,~KF FEET 1-?✓` 6 ~!O - / t ~ / tE E I C;I- FvRI_E i''1AIFS jgFKli.t1(-41 FACTOR FEE I i 0I AL_ UJ~jA/'' k- NF_AD FF_LT 1iL.~fi~iV L aV~t141i aC~iAiS Aiuf~ 4., 1~H _ 7~S . ~p,''T }i- 7E? i-T~~►ic1 D~ r~T I+ =37--