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W CL d 3 7 z N (o N O p Z m a A Z G7 O z W 00 M M N (D CD 00 o z o * I W M 3 cn N C A W D CL CL ~ i o - m c z a o (N I A. n O D• t I 0 N a A ~ w O CD ~Q N I CD ' 69 O O S~ i Do O `1 O ti f AS BUILT SANITARY SYSTEM REPORT OWNER 4;1euc4. TOWNSHIP SEC. 3 ~~-R ADDRESS ST. CROIX COUN Y, WISCONSIN. ?GCy~ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meeC requirements of 1163 A r- Hfl.W- EVERYTHING WITHIN 100 FIli1?T OF SYSTE'14 ve n F i 35- - P ~ ell r c. a n t l - - - - - - ~Qt 1't. ~}.G Lr5 I di_ ate orth A )w SCALE' . = i BENCHMARK: (Permanent reference Point) Describe: J Elevation of vertical reference point: /00. 00 Slope at site: o SEPTIC TANK: Manufacturer: (/~Q Liquid Capacity: /©p C~ Number of rings on cover : Tank manhole cover elevation: Tank Inlet Elevation: E Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o 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 o pits feet diameter feet liquid dept seepage pit in eipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines--3_width~leagth~tile depth?7 SEEPAGE TRENCH: width length .0 PERCOLATION RATE Z AREA REQUIRED 6_15`7 "AREA AS BUILT ° INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER„ i_~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 pf-I BUREAU OF PLUMBING MADISON, WI 53707 ~I o CONVENTIONAL ❑ ALTERNATIVE 1I • aO state Plan I D Narnber (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. BENCH MARK (P---1 reference p-0 DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. CST REF. PT. ELEV N,t,ne nl PIr M ct Cou niy. Sand ary Permit Number'. i 1~ SEPTIC TANK/HOLDI TANK: MANUFACTURER LRIID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV WARNING LABEL LRY OVER,IDED. P0100 YES ❑NO ❑NO BEDDING VENIA.. VENTM ~TL HIGH WATER NUMBE ROF RO PROPERTY, WELL BUILDING IAIER NLOET RESH ALLIN ARn FEET FROM ❑YES ❑NO NO _ NEAREST DOSING CHAMBER: C1ANUFAC71JHFR BEDOI L 104 l 1(: APA(, I T Y PUMP- ODEL PUMP;SP'HON MA NUFACIHHFH WARN ING LABEL LOCKING COVER '`t PROVIDED' PROVIDED. ❑Y ,J ❑NO ❑YES ❑NO ❑YES ❑NO ro rR LSH IEFIT AIR UILDING AR INO GALLONS PER CYCLE: r PUMP AND CONTROLS OPERATIONAL NUMBER OF PFHI Y WELL B (DIFFERENCE BETWE FEET FROM PUMP ON AND OFF) ❑YES ❑NO _ NEAREST 10, - A". f TEH IMATIRIA1 AND MAHKING SOIL ABSORPTIONS STEM Ch ck the soil mo lure at the depth of plowing or excavation. (If soil can be Ed into a wire, onstruction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: 7 ID AVHLE NGTH NO OF DIS7O"~Iut OIn Plrs uou BED/TRENCH THECHFS T DEPT" ".1 E{21 1DIMENSIONS li PIPF DI$TH PIPE DISTR PIPE MATERIAL NO STOOPEHTV WELL BUILDING VENT TO FRESH INLF ( ELFV. L N D el PIP FEET FROM uN AIR INLET ~rtrt ry- NEAREST_ Q MOUND SYSTEM: • Z I V 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER FEXTUHE PERMANENT MARKE RS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO UFPTH OVER IRf NI 11 f1E D :jE)D1P,IIIT ()VE H 7HENCH BEU Uf PTH ()F 7()PSC)IL SODDED SEEDED MULCHFD (:F N7 EH S ❑ YES ❑ NO ❑ YES O NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: VaIDTH LENGTH O. OF LA T FHA L SPACIN G. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVE H BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR-PIPE MANIFOLD MATERIAL NO DISTR CISTR. PIPF DISTRIBUTION PIPE ~!ATERIAI & MAHKIt`(, El FV ELEV DIA ELEV. PIPES DIA._ ELEVATION ANDI DISTRIBUTION I_ VERT I CAL LIFT CO RR FSPUN OS TO APPROVFD INFORMATION ]"OLES"E HOLE SPACING D-D'LLEDCORRFCTLV covFRMATEHIAL ❑YES ❑NO PI Ani_S ❑YES ❑NO Y3 S: OBSERVATION WELLS'. NUMBER OF PROPERTY r COMMENTS: P ERM A NEN T M A R1< FEET ELLFROM LINE ❑YES ❑NO ❑YES ❑NO NEAREST= 'r Retancount file for audi Sketch System on y Reverse Side. SIGN - TITLE DILHR SBD 6710 (R. 01/82) ~ DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDVBTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: 1eue Me5C ~ Ile ~ 5C, w~a Property Location: Gity, Village-ef.Township: County: i '/a ~E%s 3 /T ,~g N / R €-Fer) W < d C Lot Number: Blk No.: Subdivision Name: Nearest Road, ake or Landmark: State Plan I.D. Number: (If assigned) I TYPE OF BUILDING Number of ' ❑ Public* ❑ Variance* ❑ Other (specify)* Bedroom or 2 Family *State Approval Required. I I TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) i SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): E New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit is x7 ❑ Alternative (specify) ❑ Seepage Trench Water Su ply: J 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: lCS0 e,\ I f NO '5,Z'P Plumber' Address: Name of Designer: ` COUNTY/ DEPARTMENT USE ONLY Signature of Issu' g Agent: Fee: 0 Date v : - Sanitary Permit Number: Iic B rvt y ❑ APPROVED _ 0~ ❑ to to DISAPPROVED Reason for Disapproval: ~'lnl )x~l Alternate course(s) of Action Available: W/ r i1 P~•` L~~~~~. 1~ti iT Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T /t4 it bt_ t to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) DEPARTMENT OF NW SAFE Y & BUILDINGS INDhTSTRY, REPORT ON SOIL BORINGS: DIVISION LABOR AND PERCOLATION TESTS r1 P.O. BOX 7969 HUMAN RELATIONS \ \ O~~~L DISON, WI 53707 LOCATION: SECTION: TOWNSHIP MUNICIPALITY: LOT NO.: SUB NAME: /T:22. N/116 W C s r COUNTY: BUYER'S NAME: AILING ADDRESS: A l~ all, USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLA 10 TESTS: I sidence R- ew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system V /(CS ec CON NTIO~NAL: MO❑U J: [A J 2S IN-GROUND PRESSURE: SYSTEM-IN-FI L Y ING TAN : R C 0P ✓e h J` 6A-0'1 (optional) If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot 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.) B- .z n 0/2 < / 7 f K ~E 54 It's %Ei B- 7) B-3 6:1 5 L R". _5 ~3 9(q d B , 3 0,k An 54. Is -,D k y~ Gi. C S B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P 36 47 - j / P P- i/^ P- P- P- PLAN VIEW: 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 qI borings and the direction and percent of land slop. SYSTEM ELEVATION r`J ~~~r@~ yc' B. 1 i I . a ;1/I e a . 1 183 ✓R, ` I ar iQ t Sir,p r- .M I A ht r , >tas .P. F~GJ V'R 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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 )PLETED ON: (°-11n1 Cc!S06-% A RESS• CERTIFICATIO NUMBER: PHONE NUMBER optional): S' J q.L, 7X" t✓ i t i q 1! 7~ 3 c- CST SIGNATURE- _U of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. BMW ~y~ JJ - u- o et- / STP U C/"O-'c-~ Imo; i A ~ LL'ja t ~ ~ ~ yf ~l 8 r U A. a n 1k o~ m g fia t S tooo Gwl. Sep F~c ~~r-t7~ G S r cQ ~ Sr~rmnl Pr- 0 sf~4~ u e__ y ~Jor C° y ~ ~ f Parcel 004-1006-80-000 10/02/2006 11:10 AM PAGE 1 OF 1 Alt. Parcel M 3.28.15.45B 004 - TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - FROESCHLE, STEVEN L & GAY A STEVEN L & GAY A FROESCHLE 544 310TH ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 544 310TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 3 T28N R15W PT OF NE SE N OF Block/Condo Bldg: INTERSTATE HWY LOT 1 CSM VOL 4/1192 V 651/328 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 651/328 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 35,000 167,900 202,900 NO Totals for 2006: General Property 3.000 35,000 167,900 202,900 Woodland 0.000 0 0 Totals for 2005: General Property 3.000 35,000 167,900 202,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00