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HomeMy WebLinkAbout042-1013-70-100 n SO Q 3 0 d C ( (D Cf 3 (D (D C CD w (ID C/) o m o CD (n c°n `G • m~ 3 o c m -P~-~ N N I'i a ro Z a(D y m q 3~ o = *ft C (D W L CU O O Al U) N N O W 00 O a 7 6 ° O J o CD ro n m o fy 3 o _ n1 3 N O O C l~a1 (n cn 0 N O U) D a F' ~ CD cn CD U C) m (D W c 3 O C) C) D CD * CD L n A Z co cc o n r cn ° CO CO CAD o C !V rT 0, -zi Z O O O - tr 0 c y n I n' fin (n N o o w D H d CD 3 N CA) 21, O O w o h V O (D N CT CD 3 Cs m \ N CD - Ul 3 Z N Zco z H =;4 o Sll 0 D Q (D 0 ° = c m !r• N !1 CD N I~AV aD ` d I C CD C. a, w m a V n 3 7 Z CD C6 N CD O n c ;o CX Q N (Ti d. d li; ? Z j z rn C/) CP G W ~ m z CL zt cz. C, 3 m N w Q'I C- 60 D 7 N CD 0 f1 ( (D Si 3 N a o - I Sao m v c o CD M Z a o ao ° CD a N 0 o :3 33m.n ~ o m o g 3 @ z 0 0 i O O N o A d d d O O 7 N O 7 O N CTS= O N CT CD A 0 W O_ CD D0 Oo N O A p 0 0- r 1 s Form - S T C - 104 ..r f AS BUILT SANITARY SYSTEM REPORT OWNER l TOWNSHIP _eSEC. T ..cYN-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEE`i ur' SYSTEM r o ~ ME— lri1j4j~ lj7fXc!r- vex e~ ` 1vw a~ I 7 ~ ~i~ac~*A t~cswa~~ 4e /4) Y i.U %0 r t t~ i L i~zc ~ S. J a- r i rr tr 7~ ~ / t-~ T. -7 1V W e 7 1 i u~ e,/ Y~ S/ j rt) INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used P Elevation of vertical reference point: rf"~~Y Proposed slope at site: SEPTIC TANK: Manufacturer: ' Liquid Capacity: Number Df rings used: Tank manhole cover elevation: A/7`'-Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side, Rear, O feet From nearest property line Front, 0Side, (D Rear, 0 feet Number of feet from: well 2 `7 building: 7 (include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE RI~VF16E SIDF t PUMP CHAMBER Manufacturer: L Liquid Capacity: ,106 Pump Model: Pump/Siphon Manufacturer: ✓~=~'L Pump Size e- Elevation of inlet: _ Fr;e Bottom of tank elevation: Pump off switch elevation:.- Gallons per cycle: Alarm Manufacturer:?t,t, Alarm Switch Type: Number of feet from nearest property line: Front, ( Side, O Rear, Ft•~_ Number of feet from well:% A Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: i/ 'french: Width: Length: sl/ Number of Liners: „S Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, 10Side, O Rear, O Ft. Number of feet from well: (tf~ t Number of feet from building: (Include distances on plot plan). ~t,~/ ~h SEEPAGE PIT ~~ek Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK . Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet From nearest property line: Front, 0 Side,,0 Rear, O Ft. Number of feet from well: \ i Number of feet from building: Number of feet from nearest road: Alarm ranufacturer: Inspector: _r L Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAI#OR & HUMAN RELA?,IONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON,,V.(l,537(, UCONVENTIONAL ❑ALTERNATIVE State Pla nned) lD.Number. (If assig ❑ Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE. JeAAy AggvL R. R. 1, Box 106, Hammond, WT BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SE% SF%, SEction 5, T29N-R18G1, Town vj WaC tAen Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number. Dave Fogerty 3289 St. Ctoix 49479 SEPTIC TANK/HOLDING TANK: MANUFACTURER. . LIQUI CAPACITY TANK INLET ELEV JTELEVARN.ING LABEL JLOCKING OVER XVIDEDPROVID ~ YES LINO ❑ E ~:N. BEDDING. VEA3r D,f VENTMA L_ HIGH WATER NUMBER OF ROAD. PROPERTY WELL: JBUILDINAI,: E SH tALARFEET FROM LINe IVENTTO nIR INL ❑YES LINO ❑YES LINO NEAREST DOSING CHAMBER: MANUFACT ER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MAN"UFtiAC C1R WARNING LABEL LOCKING COVER L V r/ ❑YES N O YES LINO YES LINO GALLONS PER CYCLE: PUMP AND CON T HOES OPERATIONAL NUMBER OF PROPE TV III, W LL BUI ING_ VENT TO FRESH (DIFFERENCE BETWEEN - FEET FROM LINE IAEr PUMP ON AND OFF) YES LINO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the epth of plowing LENGTH / JDIAMITIR MATERIAL AND MAR LNG or excavation. (If soil can be rolled into a wire, construction shall cease until MAINE Lf 3 , the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO. OF IDISTR PIPE SP LING C V JINSIDE DIA. -PITS LIQUID TRENCHES f~f AL' PIT DEPTH DIMENSIONS . GRAVEL. DEPTH FILL DEPTH DISTR. PIPE pISTR. PIPE DISTR. PIPE MATERIAL : O. D rR. NUMBER OF PROPERTY LL. BUILDING : VEN TO FRE H BELOW PIPES AHOVE/COVER ELEV. INt.F f ELEEVr. END. PIPE LINE., AIF NLET: FEET FROM NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill Taterial for PROVIDE DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVSE SIDE. SHOW ELEVA- ❑YES LINO meets the criteria for medium sand. TIONS~ EASURED. SOIL COVER TEXTURE PMARKERS BSERVATION WELLS >t10 DEPTH OVER TRENCH:BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED YESr` SEEDE ❑YES MULCHED LINO CENTER EDGES. ❑YES LINO ' ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. d' DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA ELEV.. PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES NO ❑YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES LINO ES LINO NEAREST ~v 41 Sketch System on }et tr1 county file for audit. Reverse Side. f V SIGNATURE - TI TEE. D I L H R S B D 6710 (R. 01/82) LABOR AND PERCOLATION,. TESTS (11,5) MADISP.O. BOX 7969 ON W1 3707 HUMAN RELATIONS M63.0901'& Chapter 145.045) LOCATION: SECTION: WNSHIP/MUNICIPALI'T LOT NO.: BLK. NO.: SUBDIVISION NAME: V 1/4, -,7 /T~ N/Rig E ( « _ C'0 NTY: ' . OWNER'S BUYER'S NAME: MAILING ADDRESS: ` O/ USE DATES OBSERVATI NS MADE NO.BEDRMS.: 1COMMERCIAL DESCRIPTION: (PROFILE DE RIPTIONS: ER LATION TESTS: [ErResidence 3 New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUNDPRESSORE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) c~s❑U 2SElUos❑uIosau EIS BU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: - I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS -Z nrr _ c ORING TOTAL ELEVATION -.OEP-rH TOG UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND Df-PTH NUMBER DEPTH IN, OBSERVED EST. 1 HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) off f w '7 z 3 .7 B- lei 71-- 1-1 7 r A rr I M ' , B- 7 B' f', s w G .0 91.r, -7 r ,7. PERCO A ION T STS 15, TEST DEPTH WATER IN HOLE TEST TIME DROP N WATER LEVEL-INC S RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P__RI PER INCH P- /D s z- P- P- O P- P- 2 0 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~ o t t j f. 1 -r , , ! i I I O I I IN V s' ~I l i I I h. ~ o >a I NL. n' ; t 1 i ~ r I j y , ; I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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, E (print : TESTS WERE COMPLETED ON: S; CERTIFICATION NUMBER: PNONE UMBER (optional): II - DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIOCJS (PLB 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 Owner: Mailing Address: Prope y Locati n: l City, Village Townshi' • C unty: t/a Ste" t/aS /T NCRi E (or'~~ e- !r . Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 5"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 y HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): 11 New ❑ Replacement ❑ Experimental Q Seepage Bed ❑ Seepage Pit 1:1 Alternative (specify) El Seepage Trench 7 Z c Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): ED' Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the priv to sewage system shown on the attached plans. Na a of Plumber: Si re. M PRSW Phone Number: PlumFer's Addr ss: I' Nan7-1Desi9ner:_ COUNTY/DEPARTMENT USE ONLY iof Issuing oApt: 0,~a Date: APPROVED Sanitary JPermit ~Number: v ' Ja ❑ DISAPPROVED! / 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) _Z - APPLICATION FOR SANITARY PERMIT S `1 C - 100 This application form-is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractez,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 4!! Location of Property <-v~, ~4, Section g , T ? N W Township Mailing Address 4 ( ~ lG( !1 ~y9~t~ 3~a w ye /S Sub-division i.risi°Jn Na:M;: Lot Number •r a f Previous Owner of Property r_e .~zpi `LG~ ~G Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes y/ No Volume -59 and Page Numbers-- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - pROPERT V /)FINN CERTIFICATION I (We) eeAt. 6y that aU statements on this bow ane -tAue to the beat o6 my (ouic.) k.nowtedge; '.that I (W~~) am (a)101 ttin n04100/( (h) o6 the pnope&tU de6c4 bed in 'this in6onmat%on 6oun, by vi4tue o6, a waAAanty deed in -the 066ice o6 the County Regizten o6 Deeds as Document No.? 2 S y ; and that I (we) pnesenay oan the paopoaed site bon the sewage poa system (o& I (we) have obtained an easement, to 4aw with .the above desuubed pnopeaty, bon the eonstAucti.ori. 06 said a y.6 tem, and the same has been duly -tu'.canded -i.n the 066ice o6 .the County Regis-ten o6 Deeds, as Document No. IGNA URE OF ER SIGNATURE OF CO-OWNER (IF APPLICABLE) ~r G E SI NED DATE SIGNED 7 t';•a~'I'11•'I I':I~ III~Vt~:'r I~'Irll' Part of the Southeast 1/4 of the Southeast 1/1 of Section Township 29 North, Range 18 West., Town of Warren, St. Croix County, Wisconsin. o Indicates I" x 24" iron pipe stake weit;:liu~ 1.15 lhs/1't. set.. • Indicates 1' pi pe found. n W~Q S G •9 G E / c CD 0 1~ / .4GG '~.Q//V ~ S RED' TO T~'E EAST ~ rn~~ G /N E 0~1-lT~yE ~/E_ " O ~ E C. S T Z ~3 /V ~ VI \ .5 ZD(D c) 0 0 0 N W m N mi ~i W o r7:- CJ .0 I. N~ a 0 0 m NN 0~4 N m T/O. g'7' r J 600. OO" N Ln -voo'Od oo"F ~--E3 /o. 8-7 m Q N~ A o¢.~. 0 N /0 a 3O O Aq, 0' (0 I ` \ G' //CD- c C )c) ~10 sl Qo 0 APPROVED \ O U ~ 0 ~ I oil ~~~a~~nunl'lu►unu~~~~~ G c I P 19 1979 .!L o { JA MIS L. - I ~ S1. CdOIX COUNTY CO,n►.tEMENSrVE PARKS PLANNING r`V ~I'I 4 J ' f MURPHY •1f AND ZONING COMMIME O\ c S 4 2 ooh u = t klVLtt FALLS, r~0 APPROVAI OF THIS MINOR SUBDIVISION 'l v' J J'J WISC. 44v DOLS NOT MLAN APPJtOVAL FO i J FiQ ' va f~ S BUILDING SATE OR SEPTIC SYSTEM; LAND REFER TO H62.20. Vol. J'r,f~r (:vrt.ifi•td .;ur\\.~ > ; ;I , I / )rrfnrrn I.. a f,t,y .:1 . f,('f)f X i;•ilul"t~,r'•, t..rr~~.r•,,,I:,I r~ , i .•~.I:IIn•!'r•~1 I .Ifni .;ilf'V,':/tif' CZ7 =--j 1 s..~y 1 I,r •Ir I•I I.1 Ir.n „r I1r yr r •Ir i PAl>E OF ` PLIMP fIihMt~lK CHL)_~ `1CTI0IJ AFIU '~VLCIFICAl-101 " r.r.r+rtiiataatdtil.a~uaw.r++■~aolml~+~*~+i~'~'~rl~rns ~ - - 1 C 1 vLfJl" PIPC WLATHLI( YKOOF APPROvEO LOCKING. JUWCTIOIJ 00)( MANH(1LC COVLK ` ,n FNOr\ UUUR. wiIJL,0W UK FRCSH 12 MID. AIR I&I FAKL GKADC I 18'M I U. COIJDU17-- PROVIDE I IAII 4 I ~ AIKTI(.HT SEAL I I i I I i APPN.O'!k0 JOINT A I III APPROVED JDIWTS W/LI. VI PG. I III W/C.TL. PIPE LIITENDIMG 3' I (I ALARM EYTEWOINL 3' OWTO b0l 10 SC;: I I ONTO 501-ID COIL d I I I I oN G I 1 I PUMP OFF 0 - COkICRETL CLOCK K15r I EXIT PERMI?IrED ONLY IF TA1JK MAWUFACTURLR HAS SUCH APPROVAL ~PCC.IFICAT10KAS bLPTIC AND pp5 MAWUFACTUQEIZ: WUMbLK Of OOSES: PLK DA.y TAWK ~IIC:. GALLONS an ~y DOSE VOLUME 1/-5d LAK MAUUFACTURFRR: OACKfLOW Y/ GALLONS MODEL. WUMbLK'. CAPACITIES: A = f INCHES OR ~~Yf GALLONS SWITCH TUPL: I'D = ' u INCHES OR GALLOWS 1'uMN /'\AWUFACTURER: INLHES OR GALLOWS iV MODEL WUMEER: ,l~'1 D~ INLHESOR r'eee/ALLOW6 SWITCH TbpE: MOTE: PUMP AND ALARM ARC TO oL PUMP DISGHAkf g: RATC PM IN5TALLED ON %EPARATE CIRCUITS VLKTICAL DIFFE LLMGS GtOWLLIJ PUMP Off AWD PISTftibUTIL)w PIPC.. FEET + MIWIMUM NETWORK SUPPLY PRf66uKc . . . . . . . . . . • 2.5 FLET + Lug Q _ FEET OF FORCE MAIN X f/Ip01I[FRICTIOW FALTOK__-k1~ FEET l I~~ TOTAL ~JWAMIC HEAD 17 FLET r L~~u r~ ~ < < y IWTLKLIAL. plf-lLW i0W'fi Of TAWK: L_LK46,TH iWdDTH Q i LIQUID OLPT H(" ~IGIJEG: " L IZE.WSE NUMIALKI. s 2 4 UATL -111- I rwk~ c,;~~e• o~ PAGE OF PUMP CHAMBER CRO55 SECTION AND `;PCC.IFICA"T"IONS VCWT CAP 'i°C.I. VENT PIPE WEATHER PROOF APPROI/ED LOCKING JUNCTION BOX MANHOLE COVER :5' FROM DOOR, WINCOW OR FRESH 112 MIU. I AIR INTAKE (:BADE I 'i° MIN. 118" MIU. CONDUIT 16"MIN, IN11..1_ T PROVIDE I - 'T AIRTIGHT E I I V I I APFR.OVEC JOIN A- III APPROVED JOINTS W/C.I. PIPE. I III W/C.I. PIPE EXTENDING. 3' I II ALARM EXTENDING 3' ONTO 501.110 SC B I ONTO SOLID SOIL I I C ON I I I OFF b~ U O CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC.IFICATIOMS SEPTIC AND ss DOSE TANKS MANUFACTURER: NUMBER OF DOSES: _-PER DAy TAIJK LIZE GALLONS (4t DOSE VOLUME ALARM MANUFACTURER: r1r BACKFLOW. _f= GALLONS fr / ~It s~ vo/, yu/. MODEL DUMBER: CAPACITIES: A=INCHES OR GALLONS SWITCH TYPE: /l~•'' Z INCHES OR r _ B = 6ALLOAJS PUMP MANUFACTURER: l c+ Ff c C - lie WLHES OR GALLOWS MODEL NUMBER: D= e INCHES OR ALLONS SWITCH TYPE: _h~ar~s~ ~Z.. NOTE: PUMP AN ALARM ARE TO DE PUMP DISCHAR(.E KATC GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BTi;7 IGCAJ PUMP OFF AUD 0I5TRIBUTIOM PIPE.. 17 FEET + MyIAJI~MUM NETWORK SUPPLY PRE55URE . . , , • . , , • , 2•5 FEET J 7.?L~ FEET OF FORCE MAIN X FT. ~I Ja o Fr.FRICTIO►J FACTOR.. FEET TOTALfO tJQAMIL MEAD = FEET IMTERILIAL. DIMILI ISIOMi OF TAWK: LENGTH ;w4DTH ;LIQUID DE TH 91GNE4: C ~z" LICEIJSE AJUMBER: DATE: -11]- imam r BM ~ r I VIn~ (]o Oil 117 I l"---7 7 h <93 f % r UYJ i F•// ~ I ~ /z ~r _ ;d4 z~L l~ JJ i I i~ I~ ~ i ~rrr~ /~ff~r 3572 i I IE ~ ~ fc.~ Yo / I ~ S'-I-gy i i ~is-t - r'6o, O - 5 r - pp ~ ~G a ' Oore 3 C ~vt lil nlXwrf' I..f '+~u✓/` ~Gc{ 7'~ "_4.~f"Nsca-sQ- ~ /'("f .LAS[ f r ~ /~^f /~nJC / (ii r/! H SGIGy / ~G,.fif/ LH4lT jJiv / r AI ! D.1-1-H.R. Leroy Jansky O.W.S.wisconsin Department of industry, PLB-1 INSPECTION REPORT ' ~'f- `W1154729 Sa fetyb&rBui 1 diingsRDi vi s i on 1 ` 15) 723-8786 Bureau of Plumbing Name o remises Dl~1~ P I an T>7--No: t County Sanitary Permit # as er, um er Firm Name A-ddress `.csT Address Owner- Address ~Ah l r" t>1..*b esl= o, T- D. Y.i FU 01 r- Y.etN~luy ~~r slc:(w cc_ - swn F 2 D 3r~~lU`t. -2,2 1~ ~'~'f~~_ S r g%,r,n~ c U,i3rJ (1cR`!/35_.._ Y__.... _ .._.2 2.7 n.Y 1Aa-rt1h AT 1`i rt_:.P'.T..~~ ~4`tl`►s1 J P. C 3n, 6ra ~k lto TNk ,C'_~, AEI C 1711'x, 7r i F~ ~Fhi 9 ~t wFv~ r" aan~F~ TAE ~s tic>,r~~, (21 ~,~f.~~rs31+E Wv=si cry. L n' X) i~ Discussed with Signature ( )See Attached. 4L. " 5 Ve~ a pec is DILHR-SBD-6192 (R,10/82) Signature o i a Inspector Local Inspector Plumber or Responsib e Party" ~,0 ner ZA MAY 7 1984 ..JA`f Si ZONING. l ~(~~Ui`► OFFICE 1 -~1,.~7 f7.i.:~ ~_.f`-{r-i'f'7J ,.n:c'C--~L---C2...t'.lc-t.... /G~~ ".~r' j.l.(_.~f..2•~•.s`-~/~ Ce _ ('-c°,•v[•,t.'-d.q-L__`"T~ /~.yt?Y~',,~'~~~~a.7~ ~'-~'`UT-c1-2- /~'`-f'v(-t <~-~..,.V./~,'~'-c.~,.i.~.2 ~ •,(?,~~w--n~v.~~~,~-.~l XsZ,,r-2.-t~.-a-cj("iY..~Cv.+-G^-~~-~ ct1-f r ~Y 2 7 etZ -Fr12 4R(+C'4(./L i t ~Q1t'~i"~LZ-j~,1T{ /Ytl. r"-"(./~~E.L L,Y:! C /c`~+lJ a % v 41 /i1~'..Z"-•I'^-C C-~''?~.1Y~'Li..-~-G. 1'ti ".,r..}Frr r:l. i,-1 71fL1'(..f,!,c,y -r_.-~...c.G ..~~•.C~-:~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 JOHN J AGGER O - AGGER, JOHN J 1090 110TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.550 Plat: 0865-CSM 03/0865 SEC 5 T29N R18W PT SE SE BEING CSM 3/865 Block/Condo Bldg: LOT 3 LOT 3 2.55AC ASM'T INC 042-1013-50 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-18W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 09/15/2003 739917 2409/64 QC 07/23/1997 605/226 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/19/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.910 36,400 131,600 168,000 NO Totals for 2006: General Property 4.910 36,400 131,600 168,000 Woodland 0.000 0 0 Totals for 2005: General Property 4.910 36,400 131,600 168,000 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