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HomeMy WebLinkAbout040-1103-40-000 n ln 0 m-0 n d _1 0 CD (D (D v A r I >v 0 3 `C • n [CD O 00 =3 m A w n r- W ° ° m Z N NO O O° ° n N d V) 7 W •'ti CL 0 O- n 7 K O N O O cpn c fD to o 3 N O C N A r~7 CD CD C D o a CD CP CL w C M~ 3 p 0 c `D c s V o o°o 0 o W 7~ Z CD o c0 0 °;u ~r N .<_<J n 0 G G T d p p c G w N m W N o c r! r (D TI o Z z T y rD r a a v, 3 I/ V rf o fi w w rn 9 o• x~ v o v, N a n 00 = rn d 'yo A Q (D Ul w C H o (D 00 41 Z w _ n ~J CD rr r aD Z Z ' D D o I t 0 0 r o m n h• J C w CD \ H ~ 3. N :E~ a 3 Z ' Z N O N A Z n b7 I~ t7 p z x O= o' W c~ O N) m ri F W CD I,, x H z n r. n N 0 3 A A O ON O z rt co 3 (D A A N N CN a 3 N a a - CD N x -n a~ m v c N-o(o o a N = o m N O m' 3 0 U) c y C,) CD CD CL N N ~ A O - 7 O 0 T t 0 A X ~ C2 CD CD O O V Cl) ul i N O C) a A b (D SAO W [y9 O O i 'i 6 CD ti Parcel 040-1103-40-000 01/03/2006 03:47 PM PAGE 1 OF 1 Alt. Parcel 26.28.19.402B 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 O - KILKARNEY HILLS, MANAGEMENT COMPANY INC MANAGEMENT COMPANY INC KILKARNEY HILLS 163 RADIO RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 151 RADIO RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 26 T28N R19W PT SW NE 5 AC S 250 FT Block/Condo Bldg: OFW871.2FT Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 702/201 07M/1997 1251/434 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 102814 227,800 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 71,500 147,800 219,300 NO Totals for 2005: General Property 5.000 71,500 147,800 219,300 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 71,500 147,800 219,300 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 Parcel 040-1103-30-000 01/03/2006 03:45 PAGE 1 OF 1 F 1 Alt. Parcel 26.28.19.402A 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 O - KILKARNEY HILLS GOLF INC KILKARNEY HILLS GOLF INC 163 RADIO RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 35.000 Plat: N/A-NOT AVAILABLE SEC 26 T28N R19W 35 AC SW NE EXC P402B Block/Condo Bldg: ASSESSED W/040-1103-10 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1065/508 QC 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/10/1997 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: 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 1 ' w AS BUILT SANITARY SYSTEM REPORT OWNERW (bl ` ti s7 i N Ert~ 0y'--,TOWNSHIP SEC ADDRESS (L ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE '-AN VIEW Distances and dimensions to meet requirements of 1463 SHOW- EVERYTHING WITHIN 100 FEEIT OF SYSTEM d ILI C ~ a I di. ate or,th~A rc~w SCALe BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: l Z,G C~v~l,, Number of rings on cover : - Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: '~~~~a`c:~er?( Number of gallons, Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size pump 7).-Z 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 o pits feet diameter - feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width leirgth tile depth SEEPAGE TRENCH: vridth length PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER LICENSE NUMBER w~ , , ~~t L Cc DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAB"vR &'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL CXALTERNATIVE State Plan I.D. Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure Mound 8302954 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER' INSPECTION DATE Marvin "Bill" Anderson RR#3, Box 26, River Falls, WI BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV.. SW4 of NE4, Section 26, T28N-R19W, Town of Troy Na- of Plumber. IMP/MPRSW No. County Sanitary Permit Number: Michael L. Hawkins 5926 St. Croix 38538 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ` LIQUID CAPACITY: TANK INLET ELEV. T/~NK OUTLET E V WARNING LABEL LOCKING COVER J > IIPROVIDEQ~r PROVIDED ~L -7 ES LINO DYES LINO BEDDING. VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF A: ]PROPERTY WELL BUILD ING: JVENTTOFRESH 14- LINE: AIR INLET. ALARM. FEET. FROM DYES LINO ( DYES LINO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI TV PUMP MODEL PUMP/SIPHON MANUFACTUREH WARNING LABEL LOCKING COVER PR- VI OVIDED DYES NO Z l_. -t Y~ ES LINO ES LINO _14 GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PH QPERTV WELL BUILDIN I VENT TO FRESH (DIFFERENCE BETWEEN ✓ FEET FROM LINE , AIR INLET Q 1 C PUMP ON AND OFF) ES LINO NEAREST 30 SOIL ABSORPTION SYSTEM. C t esoil moisture at th d pth of plowing LENGTH DIAM TEH MATERIAL AN MA"KING 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: WIDTH. LENGTH _ITT OF DISTR. PIPE SPACING. COVER INSIDE DIA. I#PITS LIQUID BED/TRENCH NCH ES. MATERIAL. PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH JDISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BF LOW PI PES ABOVE COVER EE EV. INLET ELEV. END PIPES. FEET FROM '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- meets the criteria for medium sand. TIONS MEASURED. YES D NO SOIL COVER TE TURE. PERMANENT MARKERS: OBSERVATION WELLS. J r YES LINO ES LINO DEPTH OVER TRENCH TED DEPTH OVER ,.E BE DEPTH OF TOPSOIL. SODDED SEEDED T HED CENTER EDGES f DYES NO YES LINO YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING. JGRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: / DIMENSIONS , ( l I MANIF{61 ! ELEV.'. DI gNIFOLD DIS PIPE MANIFOLD MATERIAL. INC). DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. PI PES. DIA.: ELEVATION AND r S ` ~/C DISTRIBUTION INFORMATION HO E SIZE HOLE! SPACING DRILLED CORRECT V COVER MATERIG VERTICAL LIFT CORRESPONDS TO APPROVED .i PLANS DYES, LINO QYES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF LROPE RTY WELL. IBUILDING: FEET I YES LI NO YES LI NO NEARESTOM' ~L"/ J r Sketch System on Retain in county,file for audit. Reverse Side. l SIGNATURE ...7 TITLE. DILHR SBD 6710 (R. 01/82) f t State Permit # ob PLB 6 7 State and County Permit Application County Permit # for Private Domestic Sewage Systems County G r~ ~X -DENOTES STATE APPROVAL REQUIRED ~ 19~ ~ Date Approval Received from State if Required 'i State Plan I.D. # al A. (~OAWNER OF PROPERTY Mailing Addr B. LOCATION: "73_ 4, Section Z,4, T_Z,_BN, R-) _4M. (or) W Lot# City Subdivision Name, Aearest road, lake or landmark Blk# Village v O 0-1Z) 4~_ Z~ Township C. TYPE OF OC U NCY: `Commercial Industrial `Other (specify) "Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon ChamberTotal gallons Prefab concrete _X_ Poured-in-Place Other (Specify) - E. EFFLUENT DISPOSAL SYSTE Percolation Rate Total AbsorJ~Are sq. ft. New Replacement Alternate (Specify) V VA c3~ N3 6 ~ ~ ,-u~A Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenche Seepage Bed: Length Width Depth Tile depth (top) No. of Lines - Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the ertiffiiedd Soil Tester, NAME 1C.~ l (-t J7- C.S.T. #and other information obtained from © (owner/builder). Plumber's Signature P/ ?I U Phone = Plumber's Address 4) Q't t, ~7t t~ k PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. t f i 3 t g .ns .y ..am. e Ye- s e_m. awe.. m. ~ ,.a-: .<m e ...n.. .=~ws P m x®,... ,...e..a ..e .-0a a .e?.m F ~F u i e. ~.ws a ~a w e.. ..m, m re..._ . e ,or m . 9. t i F E t 3 r a. y.._ d..,fa.. e e .e ems.. e~m -S .n q......,_ 1 i i r Do Not Write in Space ~elovv FOR COUNTY AND STATE DEPARTMENT USE ONLY ~y ~j Date of Application... Fees Paid: State 14>46 - County Date if - f,O ,3 Permit IssuedkAet@@4od (date) Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DI ON OF HEALTH, P.O. BOX 309, MADISON, WI 53701 7 etata Ininkt rnnvl d n I I IM hPI Iran ar , -n% Form - S T C 100 Owner of Property '16.~. Location of P-r-opertyf VJ 4 ~ G, Section /i_:~~ T ? N R_ la_W Township `ICJ Y Mailing Address Subdivision Nanie Lot Number Previous Owner of Property Total Size of Parcel t 2 Date Parcel Was Created a Are all corners identifiable? Yes No Include with this application one of thu followin .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 re or ad in the Office of the County Register of Deeds as Document No. 3 /J0 ; 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. ) SIGNATURE OF OWNE SIGNATURE OF CO-OWNER (IF APPLICABLE) - 2- Z DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INQSTR~f, DIVISION LABOR AND PERCOLATION TESTS (115) Zr RELATIONS ~ I*DI 3707 (H63.09(1) & Chapter 145.045) '/`~J LOCATION: SECTION: TOWNSHIP/>NICIPALITY: LOT NO.: BLK. NO SU IS' Su' '/a '4 .26 /TL=4' N/R l9 E COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVAT16 DE Ae/ r O. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTI OL TS: ,{{Residence N+ ❑New Replace / 1- 2-2- O., RATING: S= Site suitable for system U= Site unsuitable for system gee 141*19//~0Cf~ JCL/ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ s ®u ©s ❑u o s ou o s Ku a s T] MoUti12 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the /JA under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: Fr. PROF LE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER- ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHff*4 OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9y~2 13',!3,',5,4, ,5-'lAV 5, - .7' TAN sL/ .y 4 H07) <3 G o. . B Z 5, .1 ~6,7 ` rev r) 1, C7 •7'Iii,t•5,~, A~;5,~ i0'r,4,v,s~L -P IV-6y I, TS B- " fA ( 45 r. . 5 ' SiL ~~aff~dl B Z, 47'&. w/ff.MOr5/ 16"OW-T1,v 3- 6/_ 6jot L ' ed Q B- ~~1DSTc?c1~ 13R B- S0,4MCr6lambdS DF PEifYS /'o fe PERCOLATION TESTS "TEST DEPTH WATER IN HOLE EST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING TERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 9 P- P- 2- , 612- 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 F ~04 i _ .F. d /~c.¢-l'S 4a/~.- 5'tsr~ /P~~raCTS ~/!✓d~lr ?yam Sts r -e4v,, SO U 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. !d r NAME (print): TESTS WERE COMPLETED ON: z_ F,3 ADDRESS: "OMPSiTS TEING C)CERTIFICATIIONvNUMBER: PHONE NUMBER (optional): r-1 ~ F-a &r3 n + ~ 6)_/IO 0 CST SIGNATUR Ar !S- Z, DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. C i .4.a.. y rating ho6.. l^i Ed! E IS SS r. 0 'j7L 4y r asir Y 2" =1,, Lu, _U. BASED ON SO! } .AR)1aI&,; ass: WY , 11 d! j> cyp VA. a a Ej. ~o ,°??fi s) (call .a 000 p EEi. fN `M ? M YS iF (r3N 3 1,! A ,`1 97 _ N£;k`i.1B}, late E}` t .(.1 t .e ~ i.nU~.`- `Y' O. (a' 1 on ..F.eJ F v W ac " ,n t l mines } ,.i 1 e:,('*. ALL. S~( SS svv M y F 3 , 1 - M) SO& V ti; a B Q m, y Low, ` s La n R to ;Wdy d i r sd' , 3 s _ ; . . { , F k°,. ion ~ l 1. , i n o may .;1uns! r am! o ! - REP RT ON SOIL. QORIN&S ~ PERCOLKTION TEST5 11S ROT EC i _ = d - F,~ s1 w, SD y /302 z~ PL© r P L AM PROTECT' i9 w DAT'~ sw tiE y s~~;. z 6 7- X/0, 1-2 y-z9- HOMESITE TESTING CO, AT. 0'I4EM R 0 A BOB Ul,Bji I (,-I; L AUL)SONt WIS..__ 54016 e57- S - 02 YJC'Z PROPOSED moose MUST 1.4E Z-;' o,~ MD~PE F~'OM ALA TEST f3,PE`~S, ,Ole MVS-r ME, go o = ~At.('ft'o~ STS e EX/Sr/,v 6- LlJEGL. 1140 iC}O~ "C© o,Q SIOfIEL 134eE5 Mow; < 13 11° a " Wf%tAc ,ESE B E.vEr ®AJT T°P cf cvtl/ C'as~;~'1,. LEGEND e/EV,4; /Ow 0A I/"r 'PEF Pr. /o o, o Fr. Rli,Dl o is FAi IEV SYSTEM- _ A I (__SE Up 13e~ - = ~ 1, , s 50 3 fFNpEk'Sd✓ ~ ~ + ~ / ycrt~ ~ Hcaz• I, ~ 501 60 l..J • r~ N X s ~ ~JE~'71GR ~ r ~ 4) X pf. r, F i .v o JHrc i r « TOF REPORT' ON SOIL BORINGS, AND DIVISION PR P.O. BOX 7969 STRY' IOR AND r PERCOLA • i ~II,J i' (115) MADISON, WI 53707 I '1r 1 LAi.I~' AN HU,viAN RELATIONS (K63.09(1) & Chapter 145.045) TO! NSHIp/MSJNOCIPALITY: LOT NO.:BLK NO.: SUBDIVISION NAME: LOCATION: SECTION: p '.'e V /PC~L $Ct1 Ii~4 .26 fld N/R /9 E (o _ COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: DATES OBSERVATIONS MADE r;:R.DES IPTION: CRIPTTIIN S: P/E~R ATI ZNTEST .DE New Repl2'2-0 VV ~ 1~._- sidence RATING: S= Site suitable for system U= Site unsuitable for system ~ ota 7 ~IRT CONVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILL HOLDING TANK: 111 ECOMMENDED SYSTEM: (optional) ::ES GN RATE: If any portion of the tested area is in the I1 If Percolation Tests are NOT requ°red _ IILLLL~~~~~~loodplain, indicate Floodplain elevation: under s.H63.09(5) (b), indicate oad n: M PROLE DESCRIPTIONS _SS, COLO V ON BACK jEXTURE, AND DEPTH Fr. iiBORING TOTAL NATION PTH TO EDOUND ESTEHIGHESTS TO BEDROCK tOF OBSIERE ABBR IF}UM~BERDE°TH_T~TE FOBSERV TS SL .S'?.+.~• G KoT 94/ 7, B- 17~,62 /3/~• S~~ , ' ,v Sri, 7$ 7 f T WtT 2, 0 f ,4 A.) A SQL _ C w_ 13- B F I, 7!>'P } ,~'l~1 S,'ta7 f~ DoTx1. f~ °_Tr~, B- 001 2, A~PSTof.Io- 13R B- S- , PERCOLATION TESTS T E MINUTES oe p X~ /,J Foz DROP IN WAT PFRI RATMB DEPTH WATER IN HOLE ERVAL-M R ER LEVEL-INCHES y PER INCH NUMBER INCHES AFTERSWELLING TERVALIN. PER310D1 PE IOD 2 of , Q_~ - P- Z- _ s_&2- - P- / P- dista sca L~_= ndicate areas. I soil s, Descr AN: Show locations of percolation tests, show the their location h ont hen plots plan. Show the surface ellevatio alt all bo ingseand the'dirctionaandrpercent PLOT PL zontal and vertical elevation reference points and nd of land slope. SYSTEM ELEVATION -77-1 IT e F -T- 3 - ' ~I 5r, 7~ S 1~--~-t 'S{04.S7~.r'`"`' - 1 1 I accord proce t the undersigned, hereby certify that the soil tests reported on this form were co arectby me best of with tweedge and belied methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are to the my OD ULBR,tcm, TESTS WE/RE COMPLETED ON: NAME (Print): ~pQ/ v / P CERTIFICATII~O`NPNUMBER: PHONE NUMBER ADDRESS: CST SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester - OVER - DILHR-SBD-6395 (R. 02/82) REPORT ON SOIL C30RINGS P COLATIo I TES-r-5 lid R ~ ,Pw~oo. /3oX Zw PLO -r- PLAM PROTECT -r- C)- j ArE- Sup Y tiE S4ci z Tz~N, /9 HOiMESiTE TESTING Co. N Rs < 3, O'NEIL ROAD BOB ULI,RjC-.a A r ULSON, WIS.-- 5,4016 C57- SY-02YeZ PROPoSED moosE mosr pie 2l r ' ®,c M®R~ ~P©~ ~tL r~sT ~,P~'g~. PROPOSED WELL M u5T or .5-Q r-r X = peve- /oc*nowf HgN~ i4~9E~E® o,Q S~adEL Bowr5 z . 13 ~j R, - ~i p~ SeT / ''5T p®/;JT yl t',Pal NL" ~-,p o)- Yo,,rE - LE GE N D e/EVArow o~ var tfEF Pr. /O o, D Fr. i5 - fAi~EV SySTEr n~ erp 13tP i 29'; s ~p 3 4 ~z3 l ycn~ \ ~Ic~2 i , I (3t'r r 50.30 __..7 X iY SO, z 'Y . /-3Z S { a Pf• t X ~w V q Department of Industry, Labor & Human Relations Division of Safety & Bldgs. >f>te OI Wisconsin Bureau of Plumbing Platting & Fire Protection r y V jO~ P.O. Box7969 Madison W1. 53707 Tel. 608 266 3815 lI INALL CORRESPONDENCE d~/j /^C^ REFER TO PLAN _ IDENTIFICATION NO. NAME OF PROJECT TY rOF APPROV e Z._ COUNTY _ CIT'i OK '(Ov1l5J ' (51°~FtTE iZIP OWNER>. Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, pro"ff ssrrrna? engiriecr, registers,", deSignar. C:Clir:?t or ; rw1 .ra'Aot' "hall kfl,ep a, ti v" n`.'ArUction site onr aka: plans bearing the start::,p, of :approval of the deismtr1fient. il,`'nn ,aF fr,,, nl~rr~hinn~,-;m nrnlLyyGlltS~L]C.~~(_St~.n~ h;~e rtcit r~mmanra ~ rSfr m thicdata Chic r `?~-sal f~ ~{afarov ad.af Thy: srJ,araf-ieftxe.rawr.k®mz;~ ~n . „A ,ce. 'n granting this approval, thr Division of Safi t; dnd Buildings does n ,%t ho' itse?f liable for any defects in p'.ans or specificatio plan omissions, examination and reserves the right to order changes or additions should. ~unditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, For Priva10 years ears O it, ~A1I:1 t..° Va. ! the eXjoi u'for, r! Sanitr erre: ,lames Sargent-Bureau Director PLAN , EVIE EY( DATE: / _ ro cc: DA wz_- i ivvner DI 1_F R Local Pi !mbar & F (2i Ra Bur, cof rt~z tht F v_- & Service;. DILHR SSO-6099 (N. 06/80) Re.,, & f2i,v, Scl,jices r y .St C . / 57, '17 'A~l 1014 57 pL~ 14 t "7"~ /f 1. ~ 1 ~ ° ~ ..t . ' ~ ~ ~ ! , , ~ ~ L ~O • • PPP / -t..~,~r~~ .'I,AN APPROVAL DIVISION OF SAFETY & BUILDINGS A'rPl_lCAt ION BUREAU OF PLUMBING PRIVATE SEWAGE SYSTEMS 201 E. Washington Avenue, Rm 178 P.O. Box 7969 Madison, WI 53707 i .IS fflUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back 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. PROJECT INFORMATION (Type or print clearly) Name of Submitting Party (Plans returned to same) Project Name rJ ~/V(r ~1t3,Pt/IaJ Street & No. Project Location Street & No or Legal Description X y CC" P~ 1~i0 City ` State Zip Code City County Village of /t 57' - Town Designer Telephone No. (Include Area Code) Ract>~//VS-Gh~,~T ~J ) 71~-?~~~~i.x J 2. THIS APPLICATION IS FOR A. ❑ New Mound Systern (3) ❑ Holding Tank (2) ❑ New Pressurized Systems on site not suitable ® Petition For Modification (6) for conventional (3) ° Replacement Mound (4) ❑ Replacement Pressurized System on site not, L_J System in Fill (1) suitable for conventional (4) 0 System in Fla(A Fringe (1) ❑ Pressurized Systeri on site suitable for t ( Groundwater Monitoring (7) conventional (1) ❑ Conventional System - Public Building (1) - " .w 3- FEE COMPUTATIONS (Irsclude existing tanks) 4, FEE SUBMITTED FOR OFFXE USE 3a. 750- 1,500 gallor; septic tank - 25.9 4a, 3b. 1,501 - 2,500 gallon septic tank - 32.4 4b. 3c. 2,501 4,000 gallon septic tank 45.3 4c. 3d. 4,001 8,000 gallon septic: tank - 58.3 4d. 3- 8,001 - 12,000 gallon septic tank 7 1. 3' 4e, If. Over 12,000 gallon septic tank - 84. 4 4f. _ _ .-.w._~ 3g. 500- 1,000 gallon pump chamber J72 2 4g. 3h. 1,001 - 2,000 gallon pump chamber - 0 4h. 3i. 2,001 4,000 gallor, pump chamber - i 4i. 3j. 4,001 8,000 gallon pump chamber e 4j. 'k. 8,001 - 12,000 gallon pump chamber - 8 4k31. Over 12,000 gallon pump chamber - 4 41. 3m. 500 - 5,000 gallon holding tank - 3.92 4m..~ 3n. 5,001 - 10,000 gallon holding tank 32.40 4n._ 3c. Over 10,000 gallon holding tank - 38.88 4o. 3p.. Groundwater Monitoring - 27.00 4p. _ 3q. Petition for Modification - 27.OC 4q. Subtotal 1 3r. Walk-through plan ratview: 4r Submittal of plans in person, by appointment, with double fee Total E`'ea COMMENTS:-_._-_- -._M._ DILMRSBD•674 N. 03/82) -C1VEiR-- °l t ~}Y,