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HomeMy WebLinkAbout028-1042-30-000 f n to O K v 0 p 1 v y h I ~ v ~ c s m 3 - ~ v Q 0 a~F O N ~ m CD 3 O CO fn , rr 11 cn a z a 4 A o o p L- N co J A 1 CD m - O N N = N N N N 9 -j cn o _ D o 0 7 N O 00 N CD < D o CD (n p 07 Q c C 0 CO (n~ 00 N O w W H a j C co o f. G G H Z N m 5 lnn o c Cf) p a (D N• o 7y 0 0 0 0 rl) ID ~E c vii ccn w O N (DD b rt Z F H N N m V _0 2 N N Sv Li fD y n W O N P d 0 T Q N N rn C W d N o a (p R P CD - c a A N D D O i3 v w•„~ h O0 CD I °rn ° ~ N W CD N I 0. O N [sJ cy~+ w S oo _ -i to G z ~n p _z 0 O 7J a z G7 v ~ td Pd z --i CD 00 G t7 W -u M N) (.x (n rt Q z (D N• o 3 O U) J cn C W a- (D_ j' O (D In G D 3 v O_ m 9" o' N :D T i ~ v c z a p O C) N CD ~ (D N y I 0 a V A I ti O Ell (D O p Q 0 N Parcel 028-1042-30-500 03/11/2008 01:03 PAGE 1 OF 1 F 1 Alt. Parcel 35.28.17.265A-50 028 - TOWN OF RUSH RIVER Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/06/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ERICKSON, DIANNE DIANNE ERICKSON 48 CTY RD Y BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 48 CTY RD Y SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.388 Plat: 5434-CSM 22-5434 028-07 SEC 35 T28N R17W PT NE SW BEING LOT 2 Block/Condo Bldg: LOT 02 CSM 22-5434 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 35-28N-17W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 08/13/2007 857366 WD 08/06/2007 857016 22/5434 CSM 08/06/2007 857015 QC 06/20/2007 853666 WD more... 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/12/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 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 n cn p 3 v 0 d r~ C O 7 I ID n ID 'Q m 3 1 3 ~ O ~s o m p w= c p° `C N 3 frtD CCD cn j• N FBI Q= O O Cl) O z o N 17 O a) U) ? j ~ v ,A O0~ CD < N Q O = _ N N O O n 7 N p O Lnn ro m p D o _ _ 3 C) y ~ 7 O O cn (n d A O O O m cn D CD CD cn a D (n W a O C s Q a O O N CO !\A (D. (D ? _ j d CD 0 !n W 00 CO W !n O 0 000 n i N N C" O N CD o v v v N o SU v Q0 - CD W y y O (D y c N j CD _ n N N z z z 0 o D D o v O o d O CD C W CD Z m VIII s -4 N O O , Z CD N ;u N A a 7 O Z PO W W m m ~ v CL 3 z ~ o - C/) A N O A W ~ CD D 3 Q C CD O _ ~ T O7 C z C 0 CD N y~ ~C 14 'I A A a I ~ 0 N o 0 a A V EA O ~ a O (D CD Parcel 028-1042-30-000 01/04/2006 07:31 AM PAGE 1 OF 1 Alt. Parcel 35.28.17.265A 028 - TOWN OF RUSH RIVER 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 - STINSON, HAZEL B HAZEL B STINSON 48 CTY RD Y BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 3.090 Plat: N/A-NOT AVAILABLE SEC 35 T28N R17W S 325 FT OF THAT PT OF Block/Condo Bldg: NE SW LYING N OF HWY M, W OF HWY Y AND ELY OF RUSH RIVER ALSO N 95' OF S420' AS Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DESC VOL 833/558 35-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 872/318 07/23/1997 833/558 2005 SUMMARY Bill Fair Market Value: Assessed with: 83048 145,200 Valuations: Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.090 35,300 107,800 143,100 NO 05 Totals for 2005: General Property 3.090 35,300 107,800 143,100 Woodland 0.000 0 0 Totals for 2004: General Property 3.090 14,800 63,400 78,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS 1111 1 1 T SANITARY SYSTI,M PF1'ORT 1WNI?R TO WNS1111'-.~ SEC .3S71a-RI 7 W A1)1)K1?S'~> ST. CROIX COUNTY, WISCONSIN. ro ~ I ;lllil)LV IIt)N LOT LOT SIZE _ PLAN VIEW 4- jG SH V1?RYTII INC W1TIIIN 100 FEET OF SYSTEM T - Y I, II I-" Q~ I l fl v 7 Indic at N r h rr1 w - - IIJNCRMAkK: (Perm~nent reference Point) Describe: c © pc~S~ 1,.levation of vertical reference point: Slope at site: I-J"FIC '.TANK: Man.uLae_turer: Liquid Capacity Nuirlber of rings on cover : / Tank manhole cover elevation: Tank 1.111 cf- I levat -Loll : 6. Tank Out I et F.luvatiun: ~ - PUMP CHAMlilslt Manul<tcturer_ iv5Number of ga1.lo N1-lmber of gal. pump set 1-or a cycle__.a' ; gallons; Total capacity of di-rtribution siZeOf purttp ~0 1-1 head; };a L1o11 per mfI I I I t Horsepower ;brand name of pump and model number T ype o1- warn-111g de 7_ce k 1IOLD I NC 'T'ANK: Manufacturer Number of gallons___ _ ELevation of manhole cover _ Type. of wit rn _1tg device SIEI'A(_7L; P I:'[ S L'l.l;; Number of pit feet diameter Feet I_ i_quid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. f `_;I I?I I ACI," 1i HD SI/_1?: number of Lines f~ width ~ length4-tile depth 01~- - SEEPA(~T; 'I'RI,N( I:I: width -Lengih- - - - - - - -----r 1'I?RC0LAT 1:0N LATE---- + - AREA RhQU1RED aq./_T7'_ AREA AS BUILT INSPI CT oR 1)A'1'1?I) - PLUMBER ON IOB_ L1. C.I;NS!; NUMlikll- " ~ - DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL 1-ALTERNATIVE State Plan 1. D. Number. 11! as El Holding Tank ❑ In-Ground Pressure CXI Mound 8 3s)n6edl3 9 0 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Hazel Stinson RR#2, Baldwin, WI f'• BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.. CST REF. PL ELEV. NE SE, Section 35, T28N-R17W, Town of Rush River Na- W Plumber_ MP/MPRSW No. County Sanitary Permit Number: Bennie Hel eson 3215 St. Croix 43694 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PR VIDED PROVIDED Q,u1"E ' to U c~ y. S o L~' Y ES ❑ NO ❑YES N O BEDDING: VENT DIA.. VENT^MA TL. HIGH WATER NUMBER OF ROAD: < PROPERTY WELL: BUILDING: VENT TO FRESH G l i1 ALARM FEET FROM LINE AIR INLET ❑YES NO v ❑YES ❑NO NEAREST ~6r01 J ~ DOSING CHAMBER: MANUFACTURER BEDDING . LIQUID CAPACITY PUMP MODE L PUMP/SI7ANUFACTURER WARNING LABEL LOCKING COVER PROVIDED PROVIDED: W>i~S ❑YES ❑NO OYES ❑NO N~IES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PH OPERTV WELL JBUILDING v(DIFFERENCE BETWEEN 9 Z FEET FROM LINE S AIR INLET PUMP ON AND OFF) v ES ❑NO NEAREST S~ 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 o< 3 7 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER NSIUE CIA 1tpITS LIQUID TRENCHES MATEHI DEPTH _JT D___jI I DEPTH FILL DEPTH UISTH. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. IST J;f ' NUM R OF PR OPERTV WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER Et.EV. INLET ELEV. END. IP S/ FEE FROM LINE. AIR INLET (1 NE EST---► 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. YES ❑ NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS sIt YES ❑NO ❑tts ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES.," v ❑YES O G ES ❑NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES. ( ~ J - MANIFOLD `~~j MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. ID:1TRPIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEV. ELEVDIAELEV PIPESDA.: ELEVATION AND / DISTRIBUTION / 16 ) fl L~J ~O 7v INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. I,~' ( r ES ❑NO ` 5q ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: JBUILDING: FEET FROM LINE~~/^ r YES ❑NO YES ❑NO NEAREST vim' f ~GJ y Sketch System on Retain in county file for audit. Reverse Side. _ SIGNATURE ,..0 - TITLE. DILHR SBD 6710 (R. 01/82) / PARTMENT OF PLICATION SAFETY & BUILDINGS DUSTRY, NITARY DIVISION ABOR AND E,a MIT P.O. BOX 7969 UMAN RELATIONS Q4 £CF/~~~(P 67) MADISON, WI 53707 I~Z& 1983 1 Attach plans for the system on paper not eas,than E~~g inches i, e. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points mus hown. P111 appropf~ separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An i e or ead must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number beln n~ he owners copy or a legible reproduction of the soil test report must be included. FProperty Owner. / Mailing Addres n _ 12- Property Location: or Towns ip: County: J" '/aS ~T~ NCR I" E (o W Ut Lot Nu er: Blk No : Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: tt /i N o (If assigned ):3 qe) 63 Vol TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHO AMBER MANUFACTURER: 7 EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New X Replacement ❑ Experimental [V Seepage Bed ❑ Seepage Pit Y Alternative (specify) ❑ Seepage Trench Water Supply: 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: Signature: MP/MPRSW No.: Phone Number: c / -e r t CLr Plum is Address: Name of Design r: 4 /7 COUNTY/ DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number: Z4 c} o /0-d3~-9 3 ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: L Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- sta,ll tion. 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) Department of Industry, Labor and Human Relations '7DILHR `~'.s`°ns'n Division of Safety & Buildings Bureau of Plumbing P.O. Box 7969 oePRRTmenT a i InOUSTRV,LFM &HUR1RnRELRTI nS Madison, WI 53707 Tel. (608) 266-3815 IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT [=PRIVATE SEWAGE ONLY - ❑ GENERAL PLUMBING PLANS Fee Received: / LO ATION Priority Plan Review Only CITY OR TOWL 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 wher required inspections are to be made. Y ,beck 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, or twu :rs or it vv, 'l be v-~ iu Until c L t e r' p','rion c';v to of the init a! James SargEit-/ Bureau Dire or REV~kf~dED_ BY~L, DATE j cc: DPS'-c0#s Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services i nth Other DILHR SBD-6099 (R. 05/82) r s- "i:,"l; v1 ¢w y +x.13 a1 y: g Y -AZT- OCT - 5 1983 f s. Ll/ y t ~ ~ FM, 7 L 1 A z:, r~Q.L.SQ _ r i q Wei e t / Page Straw, Marsh Hay, Or Synthetic Covering ' Distribution Pipe { Medium Sand Topsoil H G F 3 E D % Slope to Bed Of 2"- 2 :2 Force Main Plowed Aggregate From Pump Layer D Cross Section Of A Mound System Using E - A Bed For The Absorption Area F G S-irgned; 1-711 A _ Ft. H license Number: es, 6 Ft. o s I_ Ft. Date: OCT - 5 1983 i ,7_ Ft. T Alternate Position K Ft. of D _ (=_7 Ft. Force Main W Ft. T._ Observation Pipe--,,, K A I-------------- - - W ---------------------orce Main E JT' 76ed From Pump Distribution i M Of 2 - 2 2 2 Pipe I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area a f t~ PerfOrOted Pipe Detoll Perforated End View / End Cop). PVC Pipe F . ~~`o` o ce Holes Located On Bottom, S\ Are Equally Spaced * PVC Force Main From Pump P :7 / PVC \ Manifold Pipe D;str;bution A. ternate Position Of Pipe ~j Force Main From Pump Lost Hole Should Be i Next To End Cop . End Cop ~ y Distribution Pipe Layout P a3 R S X JC„ y t if Signed: Hole Diameter Inch License Number: Lateral Inch!) Manifold 3 InchE Date: OCT - 51983 Force Main " . I ncht 6s ~ i ' N .,n ~j1 Rw t ~ PAGE ; Al~ PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENJT CAP 4",4,1, VEMT lIPE APPROVED LOCKING WEATHER PROOF JUUCTIOU BOX MANHOLE COVER ZE' FRGM DC.Ol., NIIJu:_,W OK FRL SH 12"MIU. Alit ?JTAKE GRADE I 4" MIM. I 18" MIIJ_ COQDUIT 18"MINI. ~ \ PROVIDE AIRTIGHT SEAL I I i I V f I I ,7E Ii JGIIuT~ A ( III APPROVED JOIKITS PIPE I III W/C.I. PIPE L. t ; L JDIIJ - S' I I I ALARM EXTENDIIJG 3' ONTO SOLID SOIL J~I11. SULI[.i ',r,1'._ B I ~ I _ I I ONJ C I I i PUMP OFF D cOUCRETE B1_OCK SER EXIT PER1`11TTED GL1L9 IF TAtJK MA!JUFACTURE.R HASQSUCH APPROVAL SPC CIFICATICWS brCkfl/\ t JP J IKS MAKILFACT URER' r</"~PSer-S WUMBER OF DOSES:- -PER DAy 00 - 1 AIJK _ _ GALLOIJS DOSE VOLUME: , - Q ~G'/ALLS K_M MAIJUFACTURER: _ J L1--<<r~U 5 y5 % t:v1a5 LOv'QAPAGITIES: A=1L.-`1111CNES dR C AlLOA15 MODEL NJUMBEK: _ 16)1/q iA1 _ B=INCHES OR ~II~~~y]13 G,ALLON5 SWITCH TYPE: C= L INCHES OR ~LLO S t ~P MAUJIIf AC.TURER: D= INCHES OR GALCOiJS MODEL MUMBER: NJOTE: PUMP AND ALARM ARE TO BE 5WITC. i TYPE: IUSTALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE GPM { srICAL. DIFFi:R.EAICE BETWEEAI PUMP OFF AUD DISTRIBUTIO►J PIPE.. _ 51 FEET " J.'AlIJIMUM IJETWORK SUPPLY PRESSURE . . . . . . . . 2~.5?~ FEET ~ FEET OF FORCE MAIN) X 1L a_FYoFTFRICTIOU FACTOR. FEET s TOTAL Dy1JAMIC HEAD = .30 i& FEET :Rl►lAL. ©►MIJSIOAIS OF TA►JK: LEtJ&TH -;WIDTH .~L-~;LIQUID DEPTH : 41 OCT • 51983 L_ICEMSE HUMBER: ~O~` S DATE: :iI jr0: zezs~2~_ o w n09b 09- V- N O a O Q M ~ n O ~Z Id N cD O c 0 r "Z ,2S cv CD Q O N i co oc W h i 0 IL OI q C)QImo vl ( O J NN;W - Z*. 0 J Cn _ I rQ Cnx j r WOSQ _ V cn N j 0 i co Z I ~ i ~ ~ C j ~ i ~ C• ac ~ Cl iu i ' - - I - ca CC) Q Cni 0 `g.. j N I 7f O ' OF • 0 j 0 0 0 0 O L c y~ (D to th to N N 15 z a _ Form - S T C 100 Owner of Property- Location of Property_ VF SSW Section 3S- T o2e N R 17 W Township Ae-el J Mailing Address Subdivision Name Lot Number Previous Owner of Proper/ty + Total Size of Parcel Date Parcel Was Created Are all corners identifiable? Yes !i No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (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. SYS --2 /7 ; and that I (we) j Z 3 (o ~ 1 3 presently own the proposed site for the sewage disposal system (or I (we) hav~__ - ` / 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.,LV! ' mt/~ ) SIGN TORE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE GNED DATE SIGNED NGS DEPARTMENT OF REPORT ON SOIL BORINGS At y? S & BUDIIVLDIISI pt jr ON INDLIISTRY~ LABOR AN'J CC \0~. . BOX 7969 HLYAN R: LATIONS PERCOLATION TESTS (11J) jAAD WI 53707 er 145.045) o o. LOCATION: SECTION: TOWNSHIP/ LOT NO.: S S AMt~j rs~ F 1/4 ~/T,~N/1117 Nz+Wl COUNTY: OWNER'S/R"Ie F MAILING DDR SS: USE DATES OBSERVATI DE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCZY3 IONS: PERCOLATION TESTS: Residence 1-3 ❑New Replace I Z4 -K 3 RATING: S= Site suitable for system U= Site unsuitable for system A- G C/ 8 Ls CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: 'SYSTEM-IN-FILLHOLDG TANK:RECOMMENJDEDSYSTEM:(optional) ~S ®U Ix S EU ]S ®Y OS U OS U !d If Percolation Tests are NOT required DESIGN RATE: It any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 4 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 ISEE ABBRV. ON BACK.) Of 3 B- 4l 0 nonce / -1191 11:'s ^j,0 6,i T: A C ~-I S, -c',,,6 f 6' jC::-_5 B-~ Id 7q n cv) 9-- .3 T a B-. T,s 8'.9,151 6) n 1 3 4? &A S-IC IL OE-'- t5 ' % No Q.;) t . Y Q l S i / r5 ~ l' B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1Oi6WeS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P ` 6 y P- 00 C P ! S P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _113- 7 13^0 aw. ~3~~.! j`JE7l / , Qt K O r bOQVee h ] I , , i 3 i t - 3 A- I r u t , m i a „ . d ~ ' _ _ _ e. t r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 r t I S._ I : l F + I a ( ] 1 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: & 2 C ADD C CERTIFICATION NUMBER: HONE UMBER(optional): rth e ~9 - o CST SIGNATU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - To s) a c,a,rr ar ,I ae ;fzr<. _E- sod },-,3z you" E" @ { -I) +wis"tit jd. aira r r<<i: M;u t },ic~vC IndiCA A"ll ,TIam- "I'lls is a resi& .rf "A ;_ira'tP, tr of IAAdr< om t , ciai u,E p am"w. i I~x OTHFf~ cg ARE MIL; D' IOU"! ASE CJN .s..i~... CO E` I)i . 0 NS; .~.;,3 c,N7r ftl t ,fY.) d-,, Sf.7"tp( ions and a:.f_l`7 P it':'ti 1g ~ta~:~ f?f Of Ella, . 3~r . aP _ use t A ,€t'r„ ~"si}" c,, att v. jr'_sf; io€w~ .t:7p1S, D[iivfiCig$.(➢ scale is pr,,fion-c ~l a, s BR B Gtaw~l K)" LS Unnwstciz Sand HGW H~~mh pe! AnI sand" b p1q) _ llf tit 3° a L; <rta Y lr1 (Ay C 3f~ C ;Iw C Mgr ( i' fps; ff;f, . - I, „E 1-4 i v%, I L; VL P 2 8 1983 T't¢~peY ~...th~2 EI •z ~ . ~ day ~ s, e Z-6 7b °F' o Sto p~ Pei f ~ iii-~~► z i ~F~.Nt M. i©o,co tQ~~om Wow%s ~ 5il j ouSv t-c ~ 1-1 a v.,Y ~ 93, s Department of Industry, Labor and Human Relations ui~ unecOnsi" ion of Safety & Buildings D I L H R' co ~l ~Bureau of Plumbing P.O. Box 7969 ~ DEPiiRTR1Ef1T OF -If"IOII5TpV,LRB0i7GMUTRf1RELFiTI0fI5 J~.O Fc Madison, WI 53707 ~S ~T Tel. (608) 266-3815 r F P n SQ o, Ntp 983 ~ ALL CORREESPPONNDENCE REFER TO r ff IDENTIFICATION NO. NAME OF PROJECT RIVATE SEWAGE ONLY - ❑ GENERAL PLUMBING PLANS Fee Received: /Z. o" LOCATION Priority Plan Review Only CITY 0 COUNTY clS ~i^ 'x Examination of plumbing plans an specs lcations 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. apor-oval will ha vgirl aAd AQ;As plap appr-Qual shall bia 8646-444@d 64812e y r 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. s Orly: / Sincerely, .rte ` h- - ap,prova1 i Jr J r -ars or it ,uiii be val;il un~~~1 C ~fi;-•.~i . ' f~ emir tiort date of the initial James ,/1 f~ Bureau Dire or REV BY~ DATE- cc: DPS - ej 4k r'7 Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services Other DILHR SBD-6099 (R. 05/82) ST. CROI X COUNTY WISC0NSI N } s ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W 1 54015 October 5, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, Wl 53707 Dear sir: An on site investigation for the Hazel Stinson property located at the NE-4 of the SW`4 of Section 35, T28N-R17W, Township of Rush River in St. Croix County, revealed suit- able soils at a depth of 2.1 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, ~"1'►'uC. eJ Thomas C. Nelson Assistant Zoning Administrator TCN:mj WISCONSIN DL=PAkTMLN1 OF iNDUSMY, MbOk AND HUMAN kLI-Al IONS DIVISION OF SAFEiY & BUILDINGS, BUREAU Of-- PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53/07 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NR 1/4, SW 1/4. Sec. 35 T 28 N, R 17 ~4X W Town g~txr~{i Rush River Street Address Lot No. Block Subdivision Landowner's Name. Hazel Stinson The application for this site is for: [_]new construction use. 11replacement system use. If this is NEW CONSTRUCTION USE, thr, alternative private sewage system is: to have one of the first five approvals guaranteed for this year. This is number _ - - of those applications. (Use one of the first five quota nwiibers t ssuec to you. ) l Zone of the applications needing a quota number. The quota number assigned to this application is - - -]for one additional homesite on a farm to he occupied by a parent, child, yrandchild, sibling, niece, nephew, or first cousin. I Ifor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ]for an application on file prior- to February 1, 1980. 1_--Ifor a lot that meets the criteria for a conventional private sewage system. If this is d REPLACEMENT SYSiLM USI, Lite alternative private sewage system is replacing: 'Pd failing conventional soil ah,,orptiun system. Lla holding tank that was installed dnd in use prior' to February 1, 1980. U a privy that was installed and in use prior Lo 1~ebruary I, 1980. If this is a REPLACLMLNI SYSILM UPI- and the lot meets the criteria for a conventional private sewaye systeiii, check here•I -I I certify that the above infOrmdt ion is true and lCCurate to tilt' bast Of u~y knowledge. Name Thomas C. Nelson Signature County Official Title Assistant Zoning Administrator [)Ae October S, 1983 DILHR-SBD-6158 (R 12182) STATE OF WISCONSIN-DEPARTMENT Or INDUSTRY, LABOR. & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township /XadkKJUXYkXU~A S ~ IT 28 N/R 17 iK fA4W Rush River ~t . Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Hazel Stinson RR#2, Baldwin, WI 54002 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the-above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. 4 Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19~ Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: