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HomeMy WebLinkAbout040-1201-80-000 n N O m •v n d ~1 O A 3 m E' " 3p A~ i`' CD c Q o v v o W O 0 o o N 3 o C D w m OC) F•-i CD CL fD Z CL N O L~ N "h E-. CD N O O 1 N a 7 O W N N W O O 'C9 Q n C ° CO C> >v C o 3 -4 ° (n C) O W G N) U> D CD c ~j p R. (D m cn m N a C U1 U7 -D N W v (D b O rF C (D C O O C ~J "J 3 r. (D W (D rt O r; H CD rl) -41 a rt o F• :r:4 < cD co p n r N p rt H d N co W C (n o c W ~ I ri H ! ~ 3 r• ~ C' ` • 41 H Z W fD O O O o = p ~L ° C t °o ai ai ai o $ v 3 a cy - CD N 00 °t ' N N d m (n 41 a a N I O N rt O 00 W - Z W O w ao v O D n . m o h H Z H a7 (D O O N m (D ^Z rt r~ c N N. R Z W m Q 7~ 7y N• I Cn a O n C7 Z CD --j Cl) O A` rh r\ o ~6 - I~ O H (D :E~ C) CL A Q t7 rt N. o ri T O OQ ~1 C=] a t Z r oo-0 m00 (n m V a -t z rr rn o 3 c A o m N z (D A W N N D CD n CD CD N CL En m c Z a d W C) m~ N n 'o 9. N W (CD X p' c -0 A CL N 4 O ~ O O a A ~ A O C oQ b cfl O r °w O b O T ~'RCIAL TESTING LABORATORY, INC. n Street, P.O. Box 526 Wisconsin 54730 a2 - 3121 62 - 5227 c:cw CROIX COUNTY REPORT DATE: 3/06/9.. ,OLIRTHOUSE vJDSON, WI JTNI THfIMAS C, NEi.70": ;'ION* 547 Nord ,_JLLECTORI M. Jenk; DATE COLLECTED'* 3-04 `IME COLLECTEDI 2IOOP OURCE OF SAMPLEI Ail .,ATE ANALYZEDI3-05-' IME ANALYZED21230p,;;, FORM I 0 >:RPRETATIONI Bacter' 3 pr Above I .'Liform Bacteria/:100 9 1© N ~ Q C Z p ~ 0" iECHNICIA%iI Para vane OF.~NDEPENDEtif Wl Appraved Lab N~, I9 o p V 1 zs Means ""Li SS THtaN!'' ~it'Tt„ 3tii@ ._£''df i Approved by' ' 6Wti'b a o PROFESSIONAL LABORATORY SERVICES SINCE 1952 T. NX COUNTY ZONING OFFICE 911 4th Street Hudson, WI 54016 • J J~ 1 Telephone - (715)386-4680 h Croix Co. Zoning office offers the service of septic and U w er inspection to Lending Institution, Realty Firms, and rivate individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. `t'E ST1Ni _25 E ~ WA TEK . 00 r; r n~tra yes and colyFo--m oacter a. ~ ATt. EST.LNG--------•---------------- ~ -------FL' E:$~ .,1~ x.00 0 P S) SEP:'._ SYSTEM INSPECTION--------------------- ,Y..,.$ 25.00 PROr._ TY OWNERS N470 'AE: PROP£ 'TY OWNERS ADDRESS : S,-1 CITY: Legal Descr lon 1/4, 1/4, ec.T c~) _N-R_J~) W, 40- Town of „Lot: NO. subdivision FIRE NO. LOCK BOX NO. S\` Color of house Realty sign? `S Firm: PLEA ;E INCLUDE, IF AT ALL POSSIBLE, A 71AP, i.e., COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the t.ome is vacant, and has been so for some time, the water line must De purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting service s~~.,.; J n~av.►.,~ -.C~,'\~,~z~_\~<~r Telephone No. "'13 y~ REPORT TO BE SENT TO: LOSING DATE: Signature:, . I MEMBER OF THE SEARS FINANCIAL M1EiWORK 1ST CHOICE ,262ND STREET REALTY, INC. HUDSON, wi 54916 BUS.(715)386-3942 FAX (7'5) 386-6741 #790 547 NORDIC LANE HUDSON, WI 54016 PRICE: $114,900 LARGE 1952 SQ. FT. RANCH ALL ON 1ST FLOOR. SUN-ROOM BEAUTIFUL LANDSCAPING, a .i: FLOWERS ETC.. .AC x t, r i s r t .y, Y11 x: ~s....t."s.•..~.....W._.v..,a..;:i ,,.,>.:...,w.a,fkx'.*4...tacw,:....:... s.=wa..:::, DIRECTIONS: DIMENSIONS: FEATURES: E. ON TOWER RD. TO NORDIC LANE, TURN LR:17 X 22 TOTAL SQ. FT:1.936 RIGHT, 1ST HOUSE ON DR:10.6 X 10 HEAT:GAS F/A LEFT KIT:16 X 11 TAXES:$3001"-1990 MBR:15 X 14 LOT:2.01 FINANCING: BR:13.6 X 12.6 SIDING: BR:11.6 X 12 APPLIANCES:RANGE, DRAPES SUBMIT BR:12 X 12 & DISHWASHER. FR: AIR:CENTRAL PRESENTED BY: BATHS: 2 SCHOOL DIST:HUDSON SUN-R:12 X 12 GARAGE: 2 CAR, DON SUKOWATEY ILT:1983 COLDWELL BANKER YEAR EAR BU BU BROKER OFFICE: (715) 386-3942 Information is considered accurate, but we METRO: (612) 436-5515 accept no liability for error. Listing may HOME: (715) 386-6790 be changed or withdrawn without notice. An Independently Owned and Operated Member of Coldwell Banker Residential Affiliates, Inc. MLS ST. CROIX COUNTY WISCONSIN ` ZONING OFFICE ST. CROIX COUNTY COURTHOUSE r 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Mar. 4, 1992 Don Sukowatey Coldwell Banker 126 2nd St. Hudson, WI 54016 Dear Mr. Sukowatey: An inspection of the septic system on the property of Croixland Properties, located at 547 Nordic Lane, Hudson, WI was conducted on Mar. 4, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Singerely, w S~,G,rr-• } Ltd' '+..F~~,l'1R, Mar-.3. enkins Assistant Zoning Administrator cj *NOTE: The house has been empty for an unknown amount of time. Parcel 040-1201-80-000 01/13/2006 03:32 PM z PAGE 1 OF 1 Alt. Parcel 6.28.19.929 040 - TOWN OF TROY 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 MICHAEL ROE O - ROE, MICHAEL C - VANSOMEREN DIANN R VANSOMEREN DIANN R 547 NORDIC LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 547 NORDIC LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.010 Plat: 2204-NORDIC HEIGHTS ADD SEC 6 T28N R1 9W 2.01A LOT 8 NORDIC Block/Condo Bldg: LOT 08 HEIGHTS ADD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/01/2000 627328 1530/430 WD 06/02/1998 580136 1328/99 WD 07/23/1997 1131/147 QC 07/23/1997 940/120 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 103614 237,200 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 55,700 172,600 228,300 NO Totals for 2005: General Property 2.000 55,700 172,600 228,300 Woodland 0.000 0 0 Totals for 2004: General Property 2.000 55,700 172,600 228,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 215 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 f Fl y ST. C OIX COUNTY WISCONSIN 11 ZONING OFFICE GROG STJ ~ IX COUNTY GOVERNMENT CENTER 0F c€ 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185.00 L/ Septic $50.00 P 0 Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria 0 Water (Lead Concentration) 21.00 retest $15.00 Owner: A2ot\i S A au,- ~.i Requested by: SCo:i QArrle 01u 14 -1 Address: I o N Address: ?ZZ 3rZ S,7, TF2,) 1 Ws PS~L - Telephone . ( ZIP 5 y0g, ld) Telephone 10: (4) 3Sb2_ Property address (Fire W & Street Location• ) Sec., T N, R W, Town of Realty firm: iNA Lock Box Combo: Closing Date: TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: 1~ Is the dwelling currently occup'ed? Yes 0 No If vacant, date last occupi d: Age of septic system: toiW7> 1NSW4 Septic tank last pumped by: Date: -)y-~~ Previous Owner's Name(s): eT i Have any of the following been observed? 3bedr'oorn $y+cwx ❑Y ON Slow drainage from house. 0Y eN Sewage Back-up into dwelling.. ❑Y ErN Sewage discharge to ground surfacvor rid ditch. ❑Y I Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: II~~ 1/x)4 OWNERS DRAWING OF HOUSE & EPT~C SYSTEM LOCATION IN i~ 3 e q5~ ~ Q , ~ dal Wu,Gs o >~10V r < (r Tj0 BE COMPLETED BY INSP/ECTION AG Cy l System design &/or permit on file? WYes ❑No re,eVM 4 Sao Soil series per SCS Soil Survey: sheet # Type of soil absor t. n system: elow grd 0At-Grd OMound Approx. size Xw Wed ❑Dose ❑Pressurized - Ft • : IdBed OTrench ODry Well Molding Tank 00utfall pipe OB E VED DEFICIENCIES Bother OUnknown e tic tan] Setbacks: L 6,01 use Zjr(o1(0We11 OProp. line Bother Dose tank Setbacks: OHouse OWe11. ❑Prop. line Bother OLocking cover BWarning label OPump/Floats ❑Alarm ❑Elec. wiring -e f oil Absorption S stem e ac s: Ouse OWell ❑Prop. line Bother OPonding: BDischarg General comments: qr jS e )~j t a4 INSPECTORS SKETCH OF SYSTEM LOCAT ON N Ins ec or p l Title Ott_ ;1~ qb T. CROIX COUNTY ~ \ ~ r R~-~~t'`'`~~ . WISCONSIN ZONING OFFICE `A s~ cR~ ST IX COUNTY GOVERNMENT CENTER _ _ co oFF~Gti 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 Septic $50.00 4- L1 Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria 0 Water (Lead Concentration) 21.00 retest $15.00 Owner: 20 i 121 5.0-111ki Requested by : SCo 1► C?Avqe~a►~1 Address: DV- I- N Address: ?ZZ "5a 1.J1 ZIP 0~,j w~ ZIP 5yo/6 Telephone Telephone 10: QL 153~~2 Property address (Fire W & St eet) : ~~}7 1~O2u►L Location: Sec. , T_2_N, R 1c W, Town of Toosi Realty firm: VNA Lock Box Combo: I\A/A Closing Date: ~ag- \ TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* J Water sample tap location: Is the dwelling currently occup'ed? 51 Yes ❑ No If vacant, date last occupi d: Age of septic system: iy Septic tank last pumped by: ~trnTiL Date: y-~y~q~1 Previous Owner's Name(s): e Have any of the following been observed? ❑Y PN Slow drainage from house. ❑Y Sewage Back-up into dwelling. ❑Y ECN Sewage discharge to ground surface or road ditch. ❑Y M Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. c DjI, OWNERS SIGNATURE: DATE: O 1/04 f, S & N LAND SURVEYING HUDSON, Wi. 386-2007 NAME River Valley Abstract & Title Inc. ADDRESS P.O. Box 149 Hudson, WI 54016 DESCRIPTION Lot 8, Nordic Heights Addition to the Town of Troy, St. Croix County, Wisconsin. 91-2575 Alderman P-LAT DRAWING N This is not a complete Land Survey ' TOWER ROAD N89 0- 14'-59"E N89 0- 541-57"E 0 222'16 Wis. Bell easement Vol. 781-Page 79 119.83' 16.5' O cn W O, I O C.) I I 1 N I CURVE DATA V ~ do ` 4"-(2'! R=200.00' d^ d CL=177.34' r-- c?70nl, I 1 Ritc P 0 0~~\Pddd z ♦ Q \ `?d SSo . 9no 2 G as ` P~PO B6, o 110 ~ \ c ~ 1 o w fhe Location of improvements on this drawing are approximate and are based on a visual inspection of the premises, the 16t-dimensidns are taken from plats and deeds of county records. This drawing is' for informational purposes only and should NOT be used as a complete Land Survey. River Valle Abstract E Title Inc. has agreed to waive these.requi.rements of A-E7.02, A-E7.03, A-E7.04, A-E7.05 (1)-(5), AE7.06 (1)-(5) , and A-E7.07. The purpose of this paragraph is to comply with A'-E7.01 (2). clap No. 92-01-95 Drawn By S.N. Date 5-7-92 Scale 1"=60' 'i AS BUILT SANITARY SYSTEM REPORT r t_ OWNER ~QSQ2 cZ TOWNSHIP- SEC. T~A-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION rGI,C_ 0T LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM All I I ,n t t Ii di at N r h rr w BENCHMARK: ' (Iermanent reference Point) Describe: oy e- 25 40 Elevation of vertical reference point: X57 Slope at site: C7 SEPTIC TANK: Manufacturer:- 6t'c- ly-S _ Liquid Capacity Number of rings on cover i Tank manhole cover elevation: 'l'ank Inlet Elevation: Tank-Outlet Elevation: - ~ r PUMP CHAMBER Manufacturer:- _ Number of gallons Number of gal pump set for a cycle --gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer---- _ Number of gallons Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE; _ Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation _ feet. i SEEPAGE BE SIZE: number of lines ~ width ~_length_ S tile depth --3 I" 4 I qwP o SEEPAGE TRENCH: widt_h_ lngth PERCOLATION RATE AREA REQUIREll <I- AREA AS BUILT (v 3u ~j INSPECTOR PLUMBER ON JOB / LICENSE NUMBER, ~C-I l , >:J ST. CROIX COUNTY , WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER prauraraN ~ 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 18, 1998 t+ s Aaron Alderman S. erman 4 t. 3<. -tv x. P 5 47 Nordic Lane ; Y , , Y , Hudson WI 54016 RE: Existing septic system serving Lot 8 Nordic Heights Addition % Legal: NE '/a, SE Y4,.Sec. 6 T28N-R19W, Town of Troy, St. Croix County Dear Mr Alderman On May 12, 1998,1 conducted a surface inspection of your septic system. At the time of the inspection ..k ,the septic system appeared to be functioning properly, however there was approximately 5-6 inches of ' ~`ponded effluent.in the drainfield,vent. Ponding of effluent (liquid) in the soil absorption system (SAS) F could indicate that the SAS is .reaching its life expectancy; but riot system failure. E- t~ x The se tic s stem serving Lot 8 in the Nordic Hei hts Addition was installed on September 2 1983 and z was sized ~~#or a':three"bedroom house. k Weeks' 1000 gallon septic tank discharges to a bed type s s~dra ntield `(8 ft by 37Hft The system was inspected by staff from this office on September 2;j1983 and }'$s . :,,was, installed as `a code compliant system_ Pondmg results when microscopic bacteria and `sludge plug the soil pores forming a clogging mat. This { cloggg ing mat decreases the soil's 'ability to dispose of the sewage effluent. Over time this clog9 mg mat , becomes thicker, causing less liquid to percolate through the system. As this mat becomes progressively ahicker rt;leads to failure of the system. To prolong the life of the system, remember to have the septic 'tank pumped once every, three years or when the tank becomes 1A full of sludge and scum. Other efforts ".1 prolong"the life of.the system could be as simple`as fixing or replacing plumbing fixtures with water conserving fixtures,, reducing shower time, washing dishes when the dish washer is full, avoid using a s_ ,;'garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of 'this system' i'may -bedependent upon proper maintenance of the system. `This inspection'of thissewage disposal system'wasFbased on a surface inspection of said system, and did y not involve any:excavation or chemical analysis. Accordingly, there is the possibility of hidden defects the system not:discoverable by this inspection. This does not in any way warrant or guarantee the =continued `proper; functioning or, operation of,this system. It is recommended that the system should be pumped once every three years. 3 .Y Y; Should you have any questions, please contact this office. 4 cer ~ ~ odd 'nger, :Assistant Zoning'Administrator 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 y E~CONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number E] Holding Tank ❑ In-Ground Pressure ❑ Mound (I1 assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE. Art Hoseid Chestnut Drive, Hudson, WI 9--~3 //04 BENCH MARK (Permanent reference poim) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: IcST REF. PT. ELEV.. NE-'4 SE4, Sec.6,T28N-R19W, Lot 8 Nordic Hts.Town of Troy Name of PI-me, MP/MPRSW No.. County Samtary Permit Number: Richard Hopkins 1059 St. Croix 38530 SEPTIC TANK/HOLDING TANK: /10 , -3 MANUFACTURER. {LIQUID CAPACITY: TANK INLET ELEV.. JTANI~OUTI-q ELEV.. WARNING LABEL LOCKING COVER P OVIDED: PROVIDED: "r`/ /VI ✓ S ✓ YES ❑ NO ❑ YES ❑ NO BEDDING. VENT DIA.. VENT MAT L. HIGH WA TIER NUMBER OF ROAD: ff PROPERTY WELL IBUILDING, V ENT TO FRESH ALARM LINE~AIR INLET'. FEET FRO M EYES ENO DYES ENO INEAREST 1 A-/ rDOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL L=IVENTTOF JPRCVIDED: PEYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING RESH (DIFFERENCE BETWEEN FEETFROM NE AIR INLET PUMP ON AND OFF) EYES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENC,rH 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 DISTR. PIPE SPACING G-VT INSIDE DIA -PITS LIQUID HES. MA RIAL: - DIMENSIONS -37 G ~ - PIT DEPT GRAVEL DEPT FILL DEPTH DISTR. PIPF ;ECISTR TRPIPE PIPENO RNUMBER OF PROPERTY WELLBUILDING VENT TO FRESH BF LOW ABOVE COVER EL EVINLET V. END.((__ C. PI O (LINE AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- EYES ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE 4DDNO ANENT MARKERS OBSERVATION WELLS EYES EOYES ENO DEPTH OVER TRENCH BED DEPTH OVFR THENCHr BEU =DEPTH OPSOIL SEEDED MULCHED CENTER EDGES ENO EYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL -MARKING ELEVATION AND ELEV_ ELEV.. CIA ELEV.' PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ENO EYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE: 1 DYES ENO OYES ENO NEAREST d / C'-G' 4 --'kA C _ C ' IZ. I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE. / DILHR SBD 6710 (R. 01/82) 1 /J mml~ wisconsin APPLICATION FOR SANITARY PERMIT L D I L H R (PLB 67) L COUNTY OEPRgTTTIEnT of UNIFORM SANITARY PERMIT # InOUSTq 1, LRBOR & HUMAn RELRTIOns ? "y 57 -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 PROPERTY. WNE MAILING ADDRESS f PROPERTY LOCATION C`ITIT- `✓~:1/4j~/4, S 4, T)-,-?N, R V(or) W TOWN OF: 3 c~ a LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LA )(E OR LANDMARK STATE PI[AN I.D. NUMBER f1/ / r TYPE OF BUILDING OR USE SERVED y;<1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): IV A THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding 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 Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: e- e s IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): L -3 L~ S ✓:r' 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): Signatur *F1/MPRSW No.: Phone Number: is (71S~ ;)IX Plumb 's Address: Name of esigner: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: - Date: ❑ Disapproved 7 Gt, ❑ Owner Given Initial Approved Adverse Determination 'fr 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. f 1 4- /0 _ ti Ilk r~ 0 63 y 4 T-A -17 ?N DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRRYY DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 NUI~AN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO. jBLK. NO.: SUBDIVISION NAME: ~N4_ '/a '/a b /Tl N/Rf9 E (o %46 ~l/a,Pf~ic~G/>TS COUNTY: OW+ NDWS/BUYER'S NAME: MAILING ADDRESS: 511 . %S USE DATES OBSERVATIONS MADE rNO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERC CATION TESTS: Residence New ❑Replace ~,~1' Z S --fJ3 l /V J v RATING: S= Site suitable for system U= Site unsuitable for system S ICY 73 ~imneli wr S1__ rCOfNVENTIONNI~~ nf=j N-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM:(optS ❑U ®S ❑U EIS®U ❑S ©U ~o Ulvi~),vAz- 134v / . If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B r-, .1'f -"6,v. , 11.. , ifll'/ ~ C' S B Z ~41"~SY L: 7' T~fiU L'S ~cr. , B- 3 ~I•~` 9/`Y~ 'yz'Ov-6ySL/ 167`Z 10 .cS w ~ Pt.4 t-k -1~ , 74,v hw' ( s~, s , /3AJ 6 , B-3 1.2-6) 103, 22, 175-' u es ~ 6 v.~, e 57~2 ~ '74N 4~ y ~ c ~ c B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN : AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH SeT P- P- L o P- P- < 2- 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 percents, 1 of land slope. /60 /7dM of V EX~-4vAT~o v ~-e &,r*' 7_-11Y 3 OF?- /,e-4,,- SYSTEM ELEVATION 90,0 7-9- a- / .e . - - E E , E 4 T1 f E i . i r ~ I I E f , i , E 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: NOMEM TES"Ne co, Z 3 ADDRESS: RT. , O'NEIL ROAD CERTIFICATIO NUMBER: PHONE NUMBER (optional): '0- 62 2- CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LHR-SBD-6395 (R. 02/82) - OVER - ,,te anfl d(.-(; rat° soil test. t, x _~`arly Indic E , ya~~ I [ lyl .~rar 0'er o~ A)f., : r .g m , ei l N rs " r m a ns t ;y5>r : tp; [xi S' IS SI(J 'I E ? U, E B63.St:i' R kR E' ,ft L.., i?'~ '3{3kH T;r iiJ °R,'t±a €ofik, Nester ;sans and E:C,litpirlien}ti p3lot ~"t~r` s=?( s-%i`: C°" A 1 f t=:jk -kn"1 ctiFt°, vf:9?.t f' ,5: Di iivvi q ,o scat is ijrk -,f6,F?' d, ,_v LEGIBLE' v edi m k t f _ a E n R3, ie; s ...E r: :SS tea: e*' b ` Sass; r1€ V"', sFrt C. S . 3k axe..=*r=k- 5- y L c.r`}"3 Loam C Ff s g PC,-, M,11 cFily, .Ets l! i et}',_. F . i c 1 C / J i ~ PLOT PLAM PROTECT 17. D. Ih OMA-:-,iTE TESTING CO. P'l-, '31 VNEIL ROAD BOB "UfvSONI WIS.,.._ 514016 CST. 02 yd~Z PROPOSED House musr LIE ~r. oA+ Mo~PE F~'oM .gtL TEST ol,eE.45. pzo Posf O WEij- M vsr Li E- S0 7T 64 X = 0ee6 of S ®t~~L 134Pe5 11r.e;Z . 8 M SAM VCR r% AL eC l-r ?ZA)e,r POi,3T T° ~ b 3'1y 'ly l /q- 5 UrR r" 5 7 V. 9iP4v,~JU !C>~ r T y-~ 130e,F- T LEGEND Ik - 4 o y ~ O pp r z s 36 /070 Cj~ ~ 9S 3 ~ v~ v° 5S OhO~'~ i By ~ ~ 3Gd 8s" y ~~g g p r'o rm - S T C 100 Owner of Property Location i - of Prope rty~~~~ Section ,'1' ,Zf N R 1 W Township Mailing Address c~ /jC~/~ Sa f~_ 44z e:7 Subdivision Name -42 ,G~S~ Lot Number Previous Owner of Property_ Total Size of Parcel Date Parcel Was Created Are all corners identifiable? des No Include with this application one of the following: t--`C rtified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that ail 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 duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATU 4.yl, RE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 21 DATE IGN60 DATE SIGNED i - W / W JOLy\ f t j _ i. ~u c~ A p x r V/ ~ ~ ` •rf 5 OWN CD C xI e' F ww~~ / 41` - Q ? n - _ _ z >~s V'l ~17 I AR 't, w, - 17. out L: 1