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HomeMy WebLinkAbout176-1025-60-001 0 O L C ~ ~ c m 0 d Er 05 Z o v 3 m rn ^ CO N J • Cam] ' O w N O O co 3 C tD S d N m ICI w n Z 3a H w O C° o Co W CD 5' o co 3 N Q N N N 3 A m -u D (D o O ~ o ~OI C.P C: CD CD 0- 3 0 CD co 6 cD N O U) U) C5 (n D G . m o a, CD a 0 3 < 3 O N N o CD FP o m =1 cn c 7y a a A 3» c o tv a 0 x 0 0 0 CD fT !mil • p (D J a o z * * * ;t N ~ 0) r-3 . . . HH 0 SD CD 0 d CD m m 'a Cl 00 CD !r r 70-. = CD N W (O N 3 m i A LFI (`(DD W l0 Z CD C °U Z D a ~ N I _ D D o O H O CIO D F-3 (D (D t7l 0 ry N c d m ON w I n 3 rt I w co Z CD -q N rt 41 N n N n A Z O R CO b H. N Cy o. I Z ro C;o N W m N M CD 00 ° z x o V 3 x Io rn O Z :5~ (D co Ul (D O rt N 70 Cl n N• (D p (D 0 o m N. rr C Da 3 H U N CL, D N ( O T 3 N C 0 o n. CD a I 0 a I O n 0 a n z ti N a O ti O r O W < V Efl O ti C) N a O i Parcel 176-1025-60-001 10/02/2006 10:08 AM PAGE 1 OF 1 Alt. Parcel 22.29.18.167B 176 - VILLAGE OF ROBERTS 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 SSG CORPORATION O -SSG CORPORATION PO BOX 1000 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 900 N DIVISION ST SC 2422 ST CROIX CENTRAL y SP 1700 WITC Legal Description: Acres: 0.920 Plat: N/A-NOT AVAILABLE SEC 22 T29N R18W NE NW.918 ACRES LOT 1 Block/Condo Bldg: OF CSM 5/1495 EXC HWY PROJ 8949-03-22 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1085/600 LC 07/23/1997 1054/477 QC 07/23/1997 701/172 07/23/1997 701/171 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/02/2006 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.920 104,000 281,000 385,000 NO Totals for 2006: General Property 0.920 104,000 281,000 385,000 Woodland 0.000 0 0 Totals for 2005: General Property 0.920 65,000 234,200 299,200 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 3 . ' ST. CROI X COUNTY " W l SC O N S I N z:'„r ! f t 3 py g ~r ZONING OFFICE 196-2239 (HAMMOND) .425-8363 (RIVER FALLS) r HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME : (mil / A 'f/ &'y) RETURN COMPLETED FORM TO: ADDRESS: ~ ST. CROIX COUNTY ZONING OFFICE . P. 0. BOX 98 ~,9-v>^ w, HAMMOND, WI 54015 715-796-2239 or 715-425-8363 TOWNSHIP : PLEASE PROVIDE FOLLOWING INFORMATION ACCOMPANIED BY CEIPTS FROM YOUR PUMPER NAME OF PUMPER: L tc /c N S LOCATION OF DISPOSAL SITE: Vi q NUMBER OF PERSONS LIVING IN RESIDENCE: c Ili USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED ® DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1986_. OWNERS SIGNATURE G ~L mj : 12-83 r t I 6 3 4 V Central st,,.ti-; rt. 1 Roberts, I 1.4023 i_ DETAILS CHARGES CREDITS BALANCE Lic'Z=5e .s Cesspool ServiceU An,(-'[_ Fw:<F1 ,000 gallons ~ 30.C0 ?,CCO a.llons ( 3.), .00 50.00 , 2, OOO gallons 30.0v 1?0. C~0 2,000 gallons 30.00 120.C?C ?,G00 K-allons 3o,o t✓i_lazre of `?obert.> C)ct. 1-Der. 31, i'J,000 € l- is. at .,._.00 Tier PAY LAST AMOUNT IN BALANCE COLUMN 02878 DUP SPEEDIPL1 PAT D mc- P'm CROI X COUNTY T R(/'WI SC0 N S I N r a ZONING OFFICE Oy7;~~ v r I 796-2239 (HAMMOND) OFF f 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME RETURN COMPLETED FORM TO: A'D'DRESS y~C J`" ~ ~~~G X l S ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 on 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR 99MR: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND L/ SEASONAL (CHECK ONE) JULY AUGUST SEPTEMBER DATE VOL.PU,MPED DATE VOL. PUMPED DATE VOL.PUMPED THIS REPORT M -BE RETURNED NO LATER THAN OCT BER 15,_.1985. OWNERS SIGNATURE / 1k , DATE DETAILS CHARGES CREDITS BALANCE BALANCE FORWARD, c Hess Cesspoo_ )ervice ' ?000 gallons 30 .,0 S 2000 g!-l lons 30. ~~0 30„ %20/85 2000 9P.llons /85 2000. 30.00 gallons /l 4/85 2000 gallons 30.00 120."', /,4/93 2000 gallons 30.00 1500 iii 30.00 loo. 2000 gallons 30.00 , Villas e of Roberts July 1-Sept-30, 1985 1,000 gals. at X2.00 f per thousand 28.00 238.00 PAY LAST AMOUNT IN BALANCE COLUMN AEOFO~ 02878 DUP SPEEDIPLY' PAT D MCP PAT D zvn ST. CROI X COUNTY W I S C O N S I N ZONING OFFICE 796-2239 (HAMMOND) v~r ` h 425-8363 (RIVER FALLS) HAMMOND, W1 54015 I\~ 2 U A R T E R L V P U M P I N G R E P O R T ST. CROIX COUNTY NAME C~ c,4 f j~q U)") RETURN COMPLETED FORM TO: to U TYz c vin ADDRESS c>c / j ST. CROIX COUNTY ZONING OFFICE --P.O. BOX 98 ~}ry, yv, S HAMMOND, WI 54015 715-796-2239 on 715-425-8363 TOWNSHIP m C' Y1 d - PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: L/~~<.v~_-~ S ~t'j I LOCATION OF DISPOSAL SITE: / \ 6, f NUMBER OF PERSONS LIVING IN RESIDENC <'N et- c //q L USE: YEAR ROUND SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED VL 20v y S L THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985 OWNERS SIGNATURE i~~ J STATEMENT LICKNESS CESSPOOL SERVICE Liquid Waste Pumped DATE % f Rt. 1 Box 178A BALDWIN, WISCONSIN 54002 (715) 684-3730 . _ _ TERMS: PLEASE DETACH AND RETURN WITI; YOUR REMITTANCE $ DATE I INVOICE NUMBER / DESCRIPTION I CHARGES l CREDITS ) BALANCE BALANCE FORWARD ~r _ _ . _ PAY LAST AMOUNT IN THIS COLUMN LICKNESS CESSPOOL SERVICE d ST. CROI X COUNTY z" X fi u9~~ ; axe WI SC O N S I N A ? * ' ,leo ZONING OFFICE 796-2239 (HAMMOND) A a 425-8363 (RIVER FALLS) F HAMMOND, W 154015 Q U A R T E R L Y P U M P I N G R E P O R T ST. C R 0 1 X COUNTY NAME i` RETURN COMPLETED FORM TO: ST. CROIX COUNTY ZONING OFFICE ADDRESS P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 bh 715-425-8363 TOWNSHIP 1 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE-,-/ NUMBER OF PERSONS LIVING IN RESIDENCE:` USE: YEAR ROUND SEASONAL (CHECK ONE) JANUARY FEBRUARY MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN MAY 15, 1985. OWNERS SIGNATURE DATE DETAILS CHARGES CREDITS BALANCE BALANCE FORWARD' Lickness Cesspool service J),000 gallons O 1.5¢ 30,00 30,00 x/175/°r 2,000 gallons C-~ 1, 5¢ 30.00 60 0 ,,-~0 Villa, e of Roberts January 1 - March 31, 1985 Mininum Charge for k-,tr. 16.:~'~0 -76. no f PAY LAST AMOUNT IN BALANCE COLUMN A ,REDIFORM ® 02$7$ ST LICKNESS CESSPOOL SERVICE Liquid `,haste Pumped ~J. Rt. 1 Box 178A DATE BALDWIN, WISCONSIN 54002 (715) 684.3730 . TERMS: PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ DATE INVOICE NUMBER / DESCRIPTION' ds r r+ CHARD g _ EDIT a. a BALANCE FORWARD Zf 71 _ ........a 3/i -3 ~ . y/ _ ~-._~.~..q . . a>-- . . . . . . . . . . . CS . _ .7.._....... . C . - . 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 ❑CONVENTIONAL IjALTERNATIVE IS"' te PI, D.Numbe IN Holding Tank ❑ In-Ground Pressure ❑ Mound Uas:',eI, NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Don Dahlstrom R. R. 1, Box 159, Hammond, WI 54015 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN • PT ~ 'I` REF. PT. ELEV.: CST REF. PL ELEV.- NE NW, Section 22, T29N-R18W, Village of Roberts Name of Plumber. MP/MPRSW No.. Count y Sanitary Permit Number. Henry Nechville 3258 St. Croix 58923 SEPTIC TANK/HOLDING TANK: MANUFACTURER. - LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. WARV LOCKING COVER PROP OV DED. NNO YES ❑NO BEDDING. VENT DIA.: VENT MAIL. HIGH WATER NUMBER OF ROAD: PROPERTY BOIL ING: VENT TO FRESH ^ ~ / ALARFEET FROM LINEAIR ~1 LfyT ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER EBEDDING LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDED❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYPUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERLINGVENT TO FRESH (DIFFERENCE BETFEET FROM NE AIR"LETPUMP ON AND OF❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH 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 NO. OF DISTR. PIPE SPACING COVER INSIDE DIA. -PITS LIQUID DIMENSIONS TRENCHES MATERIAL: PIT DEPTH GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END. PIPES. LINE. FEET FROM AIR INLET NEAR EST~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVFRrRFNCHeFHTRENCH ;BED YES NO ❑YES ❑NO CENTER UEPTH OF TOPSOIL SODDED SEEDEDMULCHED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES 0 _F LATERAL SPACING JGRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER . DIMENSIONS MANIFOLD PUMP MANIFOLD =ELEV. ANIFOLD MATE R I AL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV ELEV CIA PIPES DIA: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ::7[N UMBER OPROPERTY WELLBUILDINGEET FROM LINE ❑YES ❑NO ❑YES ❑NO EAREST c_5 `LG c it'e jc Sketch System on my file for audit. Reverse Side. ORE. TITLE. DILHR SBD 6710 (R. 01/82) / Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. ADDRESS F; e ST. CROIX COUNTY, WISCONSIN SUBDIVISION y,~,rf LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM b 44, INDICATE NORTH ARROW r BENCHMARK: Describe the vertical reference point used .;>y r, Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: ufactur r: Liquid Capacity: Number of i gs u d: )Tank manhole cover elevation: Tank Inl t E ev ion: ank Outlet Elevation: Number f fe t from n rest ad: Front,O Side,o Rear, O feet rom ne rest property line Front,0 Side,0 Rear, O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pu" Size Elevation of in *,t: Bottom of tank elevation: f Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: 5 Number of feet from nearest property line: Front, Side, O R-eFLr, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Ares Built: i Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rar, O Ft. Number of feet from well: r Y Number of feet from building: (Ificlude distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liqui depth: Bottom of seepage pit elevation: Area uilt: Has eith a drop box o or distribution box 1 been used on any of the above soil absorbti n sytems? (Check one); 4 i HOLDING TANK Manufacturer: { f Capacity Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, Fear, Oft. , Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: r License Number: - 3/84:mj ~ wlscOnsln APPLICATION FOR SANITARY PERMIT COUNTY DILHR (PLB 67) OEPggT TEnT OF UNIFORM SANITARY PERMIT # In OUSTPV, LRBOR 6 HUmgn gELRTIOnS -3 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT P PERTY OWNER MAILING ADDRESS a PROPERTY LOCATION CTTT- VILLAGE: ? 1 /4 it L11 /4, S 1 , T- , N, R j j E (o W..:. eroara-ems: A U C 1'3 LOT NUMB,E~R BLOCK NUMBER SUBDIVISI0N NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED Public ❑ 1 or 2 Family Number of Bedrooms: ; (Specify):, /2' THIS PERMIT IS FOR A: ~~d r rU c>, ~1 J LJ flew System ❑ Tank Replacement ❑ Repair Replacement ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit E4 oldiny Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Construct Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity 0- } Manufacturer: , u 4-G IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic i' Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (IV T I utes ya r inch): REQUIRED 1$q re Feet): PROPOSED fSqu re Feet): f r ~ ~J Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam of Plumber (Print): Signature: MP , ERSW No.: Phone Number: Plumber's Addre s: Name of D signer. -COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved i ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: 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. _11k * DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY', . DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969 ON WI 53707 HUMAN RELATIONS Aiu) (H63.090) & Chapter 145.045) LOCATION: SECTION: Z 3f-F?f MUNICIPALITY: LOT 7T71!7I~ NAME: Ns; -2- /T 7 N/R 1 A (or) W (R 05 E lens w i s . COUNTY: OWNER'S+b} ~S NAME: MAILING ADDRESS: 5-{.Ca,oiK x l5~ IV4,4+,Af wiS. S_17 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑Residence ('a(1VEN~t'U«- ❑New Replace ~CY/, 2 - ~5l i1JOT QUvf 11, . Z- 20 ",c vie` 60 D+r'c y c v So u ED'S , RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) OS DU ❑S EU ❑S DU ❑S ❑xU ❑X S ❑U IXOZ,01106- %ANW O,c'Ly- y EgJo.J : 6ACk Of S01'r j41 - SO,gcE - SC.I^f0NND/A.) l- 56,9Sa~~►Z_ o.vDS If Percolation Tests are NOT required DESIGN RATE: I If an ~ r any portion of the tested area 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) eT. - - i0" D,e. -Qa S1 1a" L1• (3N. wi OAR- B-/ 7,;)- 9(p.2 0 /d 1404S 1T- 10" 1 0" L-1' /3a - OR. Si I C-3 ids. op•Gy A40 ~s). 10" oR f~.,,.e S SI ►-tiA40RI~- ()404gLao)~ s7" Ltl 2.3. CI-A'/ /0A B- tv iH- Di s T1Mc T `'E19,~e. D- 114 o S B B- for a c nventional eptic systerfl. 1v eexp a ~fi_on. 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 3 PER INCH P- ZT S /V07- /KC ~E~d tiME l%oN °f %f' Si Tom' 1f1-V F7ER To 5-0 J~F EST P- Ifu 6 4`4 5 OV ,2 E"R Fv t So.'L 19 ,ei vlrs ON N 16Y iP t v G- P- 7f0 e,45T- So odd Si' CE" vE ~P~ U L L ESN P D S~5 0&v I L vr~ yEA-,X I E=GG ail/e-- 7o g e- PohD,-o w J P- Al !F-I- OFF S /P S CE' Of P"CA.)OS-L3 SbAP CE WIt7`E _D1s VA iES FV QOOPE ES dAt p_ iv ~i?iN 6- 1 oA, /,J C n1T beopet 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 '~D ~~'E~T.~rE~vT syST~M 4mlvoveL - ""y f!- Ikz-% E E i E E . 3 3 3 TN I Iro - sir TErAr~ srrNO co APPROVED ST T r-A ; tr y (PERC Ails S ~ b3 ©'NEI. AD, 55-02482 ; , HUDSON 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: HOMESITE SEPTIC PLUMBING CO. 661.2 y- /y ADDRESS: ROBERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMBER optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. S S o 2- y,p z---- 3 P MINN. INSTALLER & DESIGNER LIC. NO. 00553 CST SIGNATUR : DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI LHR-SBD-6395 (R. 02/82) - OVER - ice am! aaa ! W&I tent, yon mpm d rovat Won i h a 4+:' , { r,u pie kb ind h .t' Vi'n + ,t V, .ti.P,C,e a4 ;:o;` ro r;,.a3 project; Cow Nor owy.&TW"mmo No A SITE 0:0111 TABLE IQ R it fiOLD11401 TANK ONLY IF ALL PLEASE too Me WE `;-36 v Am " ha Or w 7, .g pi€ fHe des.n iotin uni co mW ng the Not plan; WWE P'? I.E=,H>r_E Ci_czWa aox =tdy locahiq yvei` ion Irma. ons. Dv-avvino, €fa s,zPk is :bt flE,C:ed. /A ``fag , Eiei E =!'rc ji kE a ! k<al aak „=liGn tuoi 3t w t, doarly- sh,-",vn' -'and riv.'(s 7rop"'p,.; Woe , ,a$g3 ,r pis a to than, n<_z7" n, ajohooes, 10"I Plat War, L i:..aii: a test E`Y,.C;(? p- ,f ann , as 1500 n , elna m ) OWE ro c ,agTi'. , of;oo, J{ A, ii= .hr, ap,, a',,jn i at; l cr,<; tai raLini .z!, y.,o, aoo ~:'Jtj ;ill's grout Von R 4 r SS So T 0 icy; ~f . h C3 W Ind v- Ix y Awdy Low,,; <_£"o Ron I n..a.., H; f, :a y f Sol, Coy Low, !i RI f `V C _ SAN r Cky f`f f0s t 3V 0C - (;k,} t , 'IG " , s, K f, ~An vi c t 3 e,, Two,wraf saw Mum,, nurimr, v.' v'! -1 t_,` f,r0"sa! S M F =3 i ch Mark l? - .I _z:a k .r is =k✓ ~k'k as . .sue .r . REPORT ON SOIL BORINGS ; PERCOLATIoN TESTS IIS C~NTiQrfL ST/FT%04J Cp.cJ vE.V~E.~►cF Sfpp~ PLor PLAA1 PROTECT' 17.0. DATE NE iy /V S, r if A) R/,,P eo S~ - Cxol•X couov w is . BOB ULI;R. A, ~~G csT SS- a2 Yo f I STATE Ap HOMESITE TES'T'ING OVED SITE EVALUATIONS (pERC TESTS SSA/E 36 MINNESOTA LICENSE NO. 00663 WISCONSIN LICENSE NO. S ~F3`l s-o2as2 PROPOSED HOUSE MUST Cie Z~ Fr. o~ jetr FOR OOL 54016 pRo Pose o WELL M V5T LIE 5Sp Fr O,e ttD~PE` FPoti ALL TEST ,4,PE • = 6,4c~/~gE Pfr3 O = 47/54/w 6- wELt- X s Ante_ 10CAT12,bUf AfAvP RvJ ,CkE0 aw 54,owEL /.34enf ` /doe%Z . BP's VtRr1-CAL ~QE~E,Qt.tIL'F poi:JT 4010 ~ LE GE N p/EV~~oN of var. ~E~ Pr io 0 0 " S•%p S/bN ST,! TF //W/ / Z llewr• REF Pr Fxrsi~~4 y` So,' ; U ' Y3 S oL sy,.,; . Fr~,,T r . S9 y~. 2 f o 0 3 9 19`o f~S AREA lS y ~ sPR►'~cr \ a I • Acj r~°"' 'This test site NOT PPROVED S I~ F , fora. gonventional se tic system. ► WAt 0 • ~ . Ste explanation. ~ P oN 1 ~~oW MCLT ^~tR~oSEfD W n C //o 1,01V Tj ~K ~'/~Ur►T%DN = /l) GRDP I L A►JD S 0LuoED 110 soffit, got c.,•,,t ~ 0 D~ILHR PLAN APPROVAL Bureau ofPlu bangs Division P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 ❑ Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY Plan Identification No. 771 Gallons Per Day DE(' 10 zt;~ PRIORITY PLAN REVIEW ONLY Plan Review Petition For Modification Project Name Project Location - Street No. or Legal Description ounty ❑ City ❑ Village ❑ Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This appro,, 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 Secticr: ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other H01 01V (r 1i9ti~ PL v r l o -r4 SCiq/~- / = Z p SON ~NifLfT.POM p.Po J6c T G~~,vr~~L ST~TioN Cavv~-viE,vcF STo,PF ~ Ro/~~,~~ wis , 84-08560 Hwy. 12- 331 37' VjA r. 5 to? It 6- Solt' F s r~f/f /~s HEO iQ~GJ0 - foe E u,4SiON /00.0 El 90 r ~ ~ \ \ CIS, Jyrk ~~FA 10 \ \ M ~ ` 1 1 / y ~ yy 1 / ~ % PRgnosEO ~ COM of ui6,ucF fe-r.. 14 \ l ~'i ST~F ,lll v ~C vATIoa \ \ 1000 ~Q . Comcltl(c 540-tt \~o \ : u~;ESEP ro~c~e J ? ~ \ c ocarEV /v" fito,H R,4 vFO 11t CIM Sw nor \ . \ /O D " ~ Lo7r \ oaewE,e arc y~~//// 1 \ 84 HOMESITE SEPTIC PLUMBING CO. ~s J r /~E RT. 30'NEIL RD„ HUDSON, WIS. 54016 ROBERT ULBRICHT « WIS. MASTER PLUMBER. LIC. N0. 3307 MARS WNN: INSTALLER & DESK UC by WA3 C y a ~ o 'gip t.~ ~d 11 ~ I ~ ~ k4 S 3 O LIN h a .o ~ g O r0 ~ ~ h n C O O O H C) 91 41 cp cra z~ CD, m a~ N ~ n cm H N LA r T C~ ~ 1 1984 STATE OF WISCONSIN DILHR DILHR PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING BUILDINGS 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608-2663815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The bark side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. 1. R JECT INFORMATION Type or print clearly) Revision To Plan Number: Name of Submitting Party (Plans returned to same) Project Name Street & No. or Rur} }E SEPTIC PLUMBING CO. Project Location - Street & No. or Legal Description RT. 3 VNEIL RD., HUDSON, WIS. 54016 NE % NW % StZ'• Z Z 7--) yN X /PW City or Village Zip City ❑ County WS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S p MINN. INSTALLER & DESIGNER LIC. NO. D0663 Village ® OF: Town ❑ Telephone No. (Include area code) 7/S~- 3 AIL /SP03 Designer Telephone No. (Include area code) Owners Name Telephone No. (Include area code) HOMESITE SEPTIC PLUMBING CO. -1 0 'D f4AL- D Street & No. R1. 3 O'NEIL RD., HUDSON, WIS. 54016 Street & No. ROBERT ULBRICHT 'Pi - ( 3 0 ~ S Zip City or Village State Zip City or Village ug" 'J MINN. INSTALLER & D SIGNER LIC. NO. 006663 H AM M O A W I S• Sy 01_5 2. APPLICATION FOR: ❑ New Mound System (3a) ❑ Groundwater Monitoring (7) ❑ Conventional System - Public Building (1) ❑ Replacement Mound (4a) Holding Tank (2) ❑ Replacement Pressurized System (4b) ❑ System in Fill (1) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Flood Fringe (1) ❑ Other Alternatives (5) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750- 1,500 gallon septic tank - 50.00 4a. 3b. 1,501 - 2,500 gallon septic tank - 60.00 4b. 3c. 2,501 - 5,000 gallon septic tank - 80.00 4c. 3d. 5,001- 9,000 gallon septic tank - 100.00 4d. 3e. 9,001 - 15,000 gallon septic tank - 150.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. 3g. 500- 1,000 gallon dose chamber - 30.00 4g. 3h. 1,001 • 2,000 gallon dose chamber - 50.00 4h. 3i. 2,001 4,000 gallon dose chamber - 70.00 4i. 3j, 4,001 8,000 gallon dose chamber - 90.00 4j. 3k. 8,001 12,000 gallon dose chamber - 110.00 4k. 31. Over 12, 000 gallon dose chamber - 150.00 41. X 3m. 500 - 5,000 gallon holding tank - 30.00 4m. 30 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank - 100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal 3r. Priority plan review: walk through) 4r. 30 Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee. Ze 40 0 Note: Fees pursuant to Wis. Adm. Code, Chapter Ind. 69 may be subject to change annually DILHR-SBD6748 (R. 03184) Effective July 1, 1984 -OVER 84-08560 CA, l % 1984 PROJECT INDEX SHEET OWNER: TD►V ~DHAL Sr ROM 84-08560 Rf•1 ~o7t isy HAhMONp wl'S. 5yolS SITE: NE's WW" 9pc,Z2 T-11o y j~jqo - :pNTERstc7'ioN ~s.t. cc~eat,Q) OF sTAre Nwy Ii, -D►uiSfau S4. Ra~E~erS w is) . PROJECT DESCRIPTION: 4.r,411 to r loo' X 170 ' Gov f6tiNFO ocv #Izfb oAydE// sysfE,r . THE" f/ovSr, w ois seeoh/;1 A,4 s /3Eev Rf2,_V 00.2'7-8l' THE VI'W dkJpER I(!T£.vOs f o /DES%,~ CovS f,~vcfio v p STORE (rAerAli SE///vf .y~'/,~, ~,c'F,4d q,PocEXiFf w S f ~9 2~1 yy C'AVU£.ui£ti c`c-- cosromtoQS % S D~ t ' P ShSo (iaE ' ~S-I I HATFL~ ~h1~~ o c ' y o2 ~''`f n~~ fiE E s /t~E ~LA,vv Eli . f} SOlL /3qR%itl y /0C1~• 1 ~ 1 / ` ~ 9p~ /1 E'E~ } iE0 SE~}So.u~//y s~f Tu.C~r~-o So/t S (-iYGw) 7e w / o " d s v~F4cE . SEE- kE/~or~t F°~ fu~~f Sorg //tip r~ rio,us . SrTE IlAoE'~4,ps Su i r i¢,B/E- o,v c y a~Q ,q f/aL0/:t/' ' 5EE /SEt 0 w 1 PAGE 1. PLOT PLAN VIEWS 11 PAGE 2. CROSS SECTION & SYSTE'lvl PTjAN VT) W' • PTPP, J _.J PAG7 . Pump P (7 , n PLUMBTE' : HbvAy _ SITE EVATiUATM or DESIGNER, ~f I 65 tl /pQ/3E~Prs G(7%S . HOMESITE SEPTIC PLUMBING CO. IT. 3 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRICHT 332-2- NIS MASTER PLUMBER LIC. NO. 3307 M.P F `t,'y~=E: MINN. 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