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HomeMy WebLinkAbout018-1026-30-000 o 0 r C c 0 I a~ c 3 '*1. i ~ 'D 3 o n O N d W A 0) N W O1 • d~ CD 3 N N N ~d r~ C 1 C N Z O O_ O l^\ Q) CD 7 O 7 J N p N a 7 O D_ m °o -0 ro = o w o 0 n N * C) C p ce CC CO D Co CL CD a CD CD cn D C CD Co O 0 = c = D (n W C C) O 3 CL CD W V CL 03 CD `0 a 0 r CA Cn N N ^ c !r "a -0 T yJ~ O O O O \ W-° 9- E a cr O N CD r M. <D N - Q • a (D z N N `t ° o T O D D o 0 o' ~ a :3 Q e \ C CD (n " `J O = A Z m 1 =i s z .O« 1 a z o. W m w CD (D (o \ a t z a 3 m -4 ~ .D W 0 N_j (OS N10 a amO m ~p CD 2D Ul O C 7 '17 [L,,7 ~ 7 a SV C - CO q OD n O CD (J1 j {p p In .D N oq N X CD 7 CD CD N 7 O Z N (D 0. 61 7 o 3 o m cD CL d C 7 b O O 0_ = O ~ m 3 o N s fn S @ a N 7 O K n 7 N O O O 3 -a tv O O O h p li ~O ~ b CD D Q w m o O a ° CD O i I ti Parcel 018-1026-30-000 12/22/2005 09:03 AM PAGE 1 OF 1 Alt. Parcel 13.29.17.1930 018 - TOWN OF HAMMOND 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 MARY A SUMNER O - SUMNER, MARY A 986 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 986 HWY 63 SC 0231 BALDWIN-WOODVILLE AREA 6of SP 1700 WITC Vk,N Legal Description: Acres: 5.400 Plat: N/A-NOT AVAILABLE SEC 13 T29N R17W NE NE N 258.5' OF Block/Condo Bldg: S628.5'OF W 910 FT OF E 975'OF NE NE 5AA Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 09/29/2005 807933 2898/485 WD 07/16/2001 651219 1680/559 WD 07/23/1997 3 07/23/1997 746/11 /qy' 2005 SUMMARY Bill Fair Market Value: As essed with: 90221 222,100 Valuations: Last Changed: 10/18/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.400 35,800 147,800 183,600 NO Totals for 2005: General Property 5.400 35,800 147,800 183,600 Woodland 0.000 0 0 Totals for 2004: General Property 5.400 35,800 147,800 183,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 Parcel 018-1026-70-000 12/22/2005 09:03 AM PAGE 10F1 Alt. Parcel 13.29.17.196 018 - TOWN OF HAMMOND 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 0 - MELBY, JULE D & PARMA F JULE D & PARMA F MELBY 958 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 958 HWY 63 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 13 T29N R1 7W SE NE 40A Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1116/383 QC 2005 SUMMARY Bill Fair Market Value: Assessed with: 90225 Use Value Assessment Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 27,300 150,400 177,700 NO AGRICULTURAL G4 36.500 4,800 0 4,800 NO UNDEVELOPED G5 1.500 100 0 100 NO j Totals for 2005: General Property 40.000 32,200 150,400 182,600 Woodland 0.000 0 0 j Totals for 2004: General Property 40.000 32,200 150,400 182,600 Woodland 0.000 0 0 Lottery Credit: ~ Claim Count: 1 Certification Date: Batch 111 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 li Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 JtG F'AU& 4J 120TH - - E o.r era L ec eHe n r k - RK-s o~f+s fes /brrr c h y, y e¢n d n 239.92 Q: I s rs7 y h o C C NThor s C/in U. ~v vl/ /NE tiG✓i//i¢m'4' 0' y S' o Kace.> g~ 9 ` "Cons/ance h C o • 9urre yd Flnde on y E m d h ve ° Geo 9ius ~'C ~t b h ~p aAo m . w/ey ~ r9ss R° ere ~ ~v pa ~R ~ a'b^~ .°°sf 9cr~ e ~ ~ 3~ 5V T rss o a ~ 2 q - 4 Lind ~iis/ am ~C/ate 'Y zoo No/¢n~Roth Pau/. Harvey 4 /9d s ~'u 17 0 <To hr7 J r,r. 9nde son Pau/ ~sB s7 \ $ Da~` C 0'q na. Kona/d ` JJa/t n cSam -9S s 40 p 0 Morrow, 6 rmo .C~ l' 1 He/Keno. hyde p n / acofiso/7 rho eta/ a i ya,e/fh _ q. Paui J~ 3 x aso /sa f4a'im 2"9.- ~ 8o USHNELL so<~o° , 30 ~ a~ N ' Cw IL //0TH , • . 0 •io 9 orc2/d f di ~o CTy ati7 rood 3in9ham£ C 9o so. N ~ ra//7C tTu/>e h 5.C K¢ i t - n ~C Cf ` KQfherine yo vo cSrn;rh CL e~Q°r Fink /eo M L/nd~quis/ o F~ U f rt C' 240 A~on¢/d ~ • LTa mesH uss - ',f !Na //ace 7B. of ~ 03 /ea Narray7 'S~ Sc/u/f 40 ~,Bernica 6d rs°-~. Cf ode ¢/d.-ne f Kay ~~y ti E/h Bo Nrgo s ~-ie3e / C~ausman • Fa ms, Inc /~9 Louise /7 sfs /`7ar.e%Cr' ~~h,x ~0`w C'arro// e a /droff Ke •reffi ~ feto/ ~ 8o Fr'e a,oo~q~. C~ Doroffi 23B es.3 bens, rJ%v i p (~eir7 ry ' s reo T s r~9~¢ m .3/s /er> f _r Ku 6ker Wd ~ ~Schr7eJ es Sara rl/e% on ~hn • ogCR e 7~Jora fhy~ 4o ss o . 2e 7.77 for • Curre// S¢tf aA r 6 /oo zz8 6a ' s Bo AVE. 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W W • • , ' L ~-n m s S/v7n9 £ Sara Snc. y ' yo. ~s y ~rarne Fe • E ~.~a re ~g 4o PaU/ e#/ eT~na ~0.D r dTq rs1- • Lorrx2 z C7'/en ie,,.,rs ^~d qh Hoer Bo L~Ro 60 ri7 toroth 7zs y E rnerf /s7 C Lew/s 80 -y b reo ro atr~'~ • ~°QY'f"~ Thom25 0 Sather p 0 Webb ~ i Janet l /s6.a • C C "h 0 • ~~k oi~e /60 /zo o ~,7,~e/r < a /46 /s¢ oy ti ~ v 0. an s°. C aE Wo ch oau/s t~erba t Co~~ dC o Ei~3abefh p CCC~y h d o ~ me/s tl p cTosePh O p p C t E/ma ~ b~ o per/ Do/o es z C/yde T u ~~C ~ V~ ~ti ~ B°m ~v Dohmar7 \ 0 d~ ~ m~~ Frd rvanson ~ ° nhv a`' Pav/6 FJC~ raj z NC ~C° ,CO- ~F~ ~W C V s,E~./ rss a3 ~t^q q~~ cif Do/ores o doh rso.o¢ v~' Cho a eo ~3 F 7-4¢0 -I, pin e /i Fo d rs7 q q' s h~ ~ • ° O °'~o ~ is ~ /2 • s n /fof Kenneth Ma y Tr • P - ~Ernar es C C~0 morlej C,i//is FQ. .7-., us - •Fra ~c,s l C. y T .er ~7m aG ~Cf 1„c ~N aq.d S c. e// Russo// 4o C 0 B ly 0 HA M O 1171 rd ~ i v y9 <,c s 117 4o i 1 'z~ .7yr/o Tr.L /NJsvee¢ C • r7 ~i ii rss \ y ~ 146 .~11 / - iT f nr ferr- ~ CSWd ~-~a e q 3_> -tr /06 3 J rsro 60 ' a a 3 " to e6 se 9 Q- sh,r~ey R. R OKaefe W//ram f C C~ -rie f 7ss Na/maw Farm, 111 . L W/N per. 1-7 e,5 N He//Q 0 79 dsey h Nue C~ e as 1&4 73 / PORT .~y. ,TamesH 6 0~^ i 9 :Evan Chris /%o(I "yr~s W D oo~~ p7///~~ a~Lo y FfRw,E/r/S Q 1, /bo 7747 8o f J e/ Hanson L sfre " F erst~er; qo '~~j~J Bl'1 IN e a 7-9 0TH A v in i roo FJ//.e • G won • - - rz/Gw.3 usse//s~ •T sd~i/ J l~ Ken-Q ch 11 71 ,~oblre y V Bo ~jeO1-ye C7'a d er' J a\ 41 ~Qr-rr/, Snc. Sh Ke ~F 6o do ~ h. ,s.s~ • .T n f ,f9effy l d 0 60 t y C 0 ti Bow Gardner- G/ n s d 0 Cw rBO or.7-/~ De FQ/'m $BBO a ~ C a.> Mohn To/~n ci qw~ IncO . SnC //2 I, /N I>-`~~-zJ e/o rbo 8p ,T°f7nn .?~2-s `l e..76uch . ~ / onnrr~ - cTa.r.as eiJ~ 7t-/ /and oortf /j `C /Lbrr77an C.' L_a w/s F Jana /~ernard /1f L.o y .9 0,0 w J C~uar,Frn.F rVeuendorhe~-y/ /za a sh F-¢ 0 q 0 63 r rss 1319, 7 !lers/err Ly/e Ha w.E%s L/y e 4o T v v~ Lnc. v,C q C /`7ear5 C r~7L. Pe/e~son Ken-iQich /z of ~ n W o ~ n ~ C n v tlN~ /6o Ronr1-/d De/°r s Lua;n G~ed ch rs973 Farn7,Z;7c n /sue R E~ ~q~ • ~4 ¢o saaf Ave• o /rss 9 4 • b • 7760TH ©1985 R c ord Jam 6/s>I c SEE PAGE 19 °"COr~"ty W~~ woo SIEBOLD REALTY fiNDERSON EXQIVOTING FARMS - LAND - HOMES Bulldozing Grading - Backhoe Work Dump Truck Service -Snow Snow Removal GARY L. SIEBOLD - Broker Estimates Given - Site Work - SHELDON O. SIEBOLD - Associate J a- 684-2124 Phone: 796-2391 or 796-5344 OR QRLL 684-2510 HAMMOND, WISCONSIN 54015 HIGHWAY 12 EAST BALDWIN OWNER S'n/I TOWNSHIP , f ! X11 SI:C N-RW ADDRESS do o ST . CRU 1X cUUN'1'Y SIN SUBDIVISION PLAN VIEW & Dietance4 and diu►enbiuns to HILL'I x-u(Iuirenient_~ of 4th /VI) hVLKY`I'H1NG W ['1'ILLN lUU F'1!li'1' OF SYS~I'T'M-"r 1 Lob* J ji di a e o th A ro __j - SC L BENCUMARK. (Permanent reterencu Puint j Describe. Ala;l O/ T m Elevation of vertical retererice puirit . j~~~> Slope at site: ~ to SE PT 1 C TANK. Manufac t ur t~r : ~ _ Liquid Capacity : /;0 i % Nturiber of rin b ort cover -Tank mLinhole cover elevation Tank inlet Elevation: Tank Outlet Elevation: <j PUMP CRAMbER / Mauuf_ac Curer., `7e Nw4)er of gallons (>l~ Nu~urber of gal, pump set for a_ c_ yi 1e 15 gallons; totes c pae i ty -of dtt.tribution lint b s ~;allun. sire ` purup 5 head, r,,,. on per minute 2~=-- hor5epower_-- /I . bran name of pump 'lrnd model number type of warning dev Ce_ I - 1-OLDiNC 'T'ANK. ManutaCturcir Nuutbur of gallons L: uvatiuri of manhole cc ver - Type oY warning device SEEPAGE' PIT SIZE: - - Nun,l~ r or l e t s wee t~iame t r u r l i c a id de--t - set;pa6e pit inle t~1--i -pe-t_ , 1 o- lc.vation lint tuw of seepage -p t tlevat ion feet. SEA]PAGE BED SIZE: number c'f lines depth SEL• TACT; TRENCH. width YERCOLATIUN KATE ~ AREA RI QUIItED ~ l 4'~ ARLA AS BUILT ~ - INSPECTOR DATED _ PLUMBER ON LICENSL: NUMTiEk ✓ 1~_~, ,I.IIAH -rhtNI Ur IN UUbIt+Y. INSPECTION REPORT FOR SAI-L'IYn uuILUINGS AU()H & HUMAN Ht:LAI IuNS PRIVATE SEWAGE SYSTEMS DIVISION 0. BOX 71J6U BUREAU OF PLUMNING AADISON, WI 6.4/U/ I.JCONVENIIONAL L._JALTEHNA I IVE W-lo llIoN.11„1 / III I I Huldlny lank ~ -1 In-Ground Pressure Mound U ~ .nMl ~ f 11 I 111 AI UNLSS UE PkNMII R()L /)k li IPEVL'1IDN OA(E 7 1• I a~- - - - - - lS IP I)1/kLHk N1 EHl.1M PLAN T. ELE V. 1 HLf-PTLLkV 11 11 MAII II'~~~ ~ i Y 111„11 OI .IIIUE HE N r yf~' 11~Ia1y1_.1a- _>rt --1--- - _ _ _l- - - - .I III Ic ANK/liOLUINU LANK: Nfu Uk AL IUIIL II L T IOUIU LAPAI I I Y INNh INLtI k1 tV InNI\ CIUI Lti I. LLV IWn11NINl LABEL LleV[ I' HIV IUEU YES LO U ul ilLimi NIUTA NUHEItOF JHOAI1'IIPLHI VJtLL UUIL INRELI Alr el / n1.nHM II,F.''ErLT FHUM LI' -4 ~YLb_ NO .11yiEF~I~LIti._ JUSINC (:HAMULH LI1(:NINI, LOVER UL EI. ,n r.llllln 1! 1111 11 N -ll lt1111111 n1 n, 1~ - 1'tIM1M l L I'IiMI II II,)IV MnN 11111'.11111 1 W AIININ( AB fl I t v1E P)V O ! iYI INU ~YtS I_~NOI ES GNU I,hI t nN:. III I i y Yll 111110P ANf C1111II'M IH'I HA1111NA1 G. NUMBS I{ OF 11 rl'I 1'. I 1Nk I U Il 11 ( VENT TO F11) .JI -71 Illlil I I I I I N1.1 III t0LI N FEET FROM NI,. f ibl )~Ilun n urn r NI E 1 f i- ~ "".I'll 1 Inh I 11 ,Ulll~lAlibUHPII IUN ,YS It:M. C.hu:k Ihn boll nluulule ~i II ~L Uu )Ilh of dowel y IVU , I I I ".Ill [ FUHCE 1,I 1->.1 Iv ,unl. (II (Ili Lan t)u lullu[1 u11U a wnv, LunSU UCEIOn shall Ul until / ( GJ I_<) MAIN Cr V J l uu. ,ell :,'11 y 1 uyl~ I 11:un Unuu I:ONVI,NII0NAL SYSILM T_.... - I vY I~- II i NCi tll IJ Ik 11 11 VII II V'A 1N1. I (IVI H ~ IN. 1111 .11 l1 ~ LICI lilt Plll tlEU/IHLNCIt + IIM HL:, Hl I I I UI J.NSIDNb I 11 Il _ PIT UL F111 -.II 1111 T11 III UI 1'nl 'IPI-- lu'. 1 I "DIST PIPE-MAILIII/U NIP lnGSIU NUMBI-li OF l1 I ' IH1N1I oily - W1ll UUIL UINL v AIR N I7NL 1O I I 111 ~ 11w 1 ,v nuuvl . I)vl u l l l v INI1 1 ~l L FELT FROM MUUND SY:i7 LM l Muutid ,lu, I)lovilod pelpendu;ulor to dupe Chel;k the texiwc Of the tlll nlatelldl IuI PROVIDE A DIAGRAMOFSYSTEM and iunuws thlown upslope mound syslL:ms to make certdul that 11 ON REVERSE SIDE. SHOW ELEVA- (V meets the C tmia lol mudlum sand. TIONS MEASURED. I ~(~IYk~ ~_~NO SOILCOVE III xlulrl / IIIUMnrvlNlnnnHM[1(I uu~IHVAIU)NwllLs fYtS I lNU _ YES I_INO uL II'I11 fIVf 11111-1 Ni I1 Ill l) 11111 11()V1111HI NI.H.UI 11 61vi"1)1 I(IP'111L .IIl1U - INl1.iI Illtlk _ ~,y' -IYLS NO I YLS i _INO M YES L INU PIt1LSSUHIL1 0 DIST HiBUTION SYSTEM: Of Pirl AHOVE L()Vl It WI )fil I kN1.T11 INl) II I A -ll Ilnl ~1'n( INI l HAVk l i)1.1 11111111)W 1'111 1 I-Il - - BEU/l RENCH Ikit N(ut: DIM~NSIUNb 7r ! Z l 7~ Ml1NIF ot. PUMA MANII 01li L11 .`a IH PIPf M1 111:,11L l v L t I L 1' 1 ELEVAl-IONANQ _ y~ 1:, [DISTRI111,111ION - I v lJl INFOHMATIQIiJ LL SILT - HOLk SI'Al Mill. I I U 1:(11 Ilf ( I v _ UVkll MnI 11A1 nN I l 1 T L,I)N 111 I I N lu AVI1 N - - - - J Y L 5 N U ERS OLISLIiVAI ION WLLLS J - PROPERTY WELL. BUII_UINL1 ~fimkNrMARK I N U COMMEMS NIJMIttH OF uNk FEET FNOM l I 7( tl_YLS I .1NU I`YI'YLS - GNU 's? bkcll I:.,v'=n.:nl elf -F'e'taln in cotrnty_ Isle IoE audit. uIL rui :lull I)/ Iu III ul/82) a~" - DEPARTMENT Of: APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS LABOR AND DIVISION PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'h x I I inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must he shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adrn. 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. A leyible reproduction of the soil test report or the owner's copy must be included. Property O ner: - - M.iifuut tress Property Location: - - / S City, Ville e or Township County: Y. N E%s 1.3_ /T.2 NiR I_ot Number: o.- > i -_9W W L!."n?Man~d ~~T' CRO/ X Blk No.: Subdivisio State Plan I.D. n Name. Nearest Road, Lake or Landmark: Number: - - a/R 6 3 f/C) I I s r, TYPE OF BUILDING Public" ❑ Variance 11 Other (specify)" - Number of Bedrooms: 1 or 2 Family `State Approval Required. 3 TOTAL NUMBER PRFFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION ME NT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY - _X.- X LIFT PUMP LANK/SIPHON CHA ~~j N - MANUFACTUREH: /o - - LFFLUENT DISPOSAL SYSTEM - PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ) New ( Replacernent Experimental ❑ Seepage Bed ❑ Seepage Pit X75- Alternative (specify) Melr~,~ ❑ Seepage Trench Water Supply Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint Public i I, the undersigned, hereby assume responsibility for ins Ilation of the private sewage system shown on the attached plans. Name of Plumber. i ignatur MP~M`PJ~~ F(Vi.: Phone Number: Piuinber"s ss. ('71 Z-13 7? i Name of Designer: COUNTY/ DEPARTMENT USE ONLY gnu a uF Is9uuiy A< m Fee Date. Y APPROVED SanRary Permit Num er: DISAPPROVED (p-- R;as n for Disapproval - - vtnate couise(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 T) to he submittal t, the county linor to it! ~tallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, till_HRSBD-6396 (R.07/8I) NDDUSUS TR'Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INTRY C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N WI 53707 Q LOCATI '/f; SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: Nli / l /T_9 1IIl 11i 7 1 (or COUNTY: OWNE 'S BUYER'S NAME: MAILING ADDRESS: J-1• C.ro'ij e recJ~~~ USE DATES OBSERVATIONS MADE NO. 3_,,, DRMS.: COMMERCIAL DESCRIPTION: R R ONS: ER LA ION TESTS: Residence /I ❑ New ,x Replace RATING: S= Site suitable for system U= Site unsuitable for system rNVENTIONAL: MOUND: IN-GROUNDPRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDEDSYSTEM:(optional) U QS ❑U ❑S [~IU ❑S ®U ❑S 2U 9~~~rt If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: //►r/ PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTF NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) s B SC ,ZSc 72 '20 -Y -7 B- 2 _1?rAZ ~ 2F y~ B- B- 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- P- 12 Vs" P-3 p r v 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 all borings and the direction and percent of land slop. SYSTEM ELEVATION 9 -7Z rcVV E3 .C~ P M 3 x , m Sf~ f" /5 I, the undersigned, hereby certify that the soil tests reported on this form were made b 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 COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST SI QJKATUPt E: G DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) State of Wisconsin ` Department o ,fuss I~b d Human Relations 0 79L,9 4 lease Reply to: y7NIGSAPETY-W UILDINGS DIVISION Bureau/Q lumbing P.O 969 E i n, WI 53707 r` Plan Identification Number L Re: PRIVATE SEWAGE SYSTEM ONLY- The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to agallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of feet will discharge through a -inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS County BY Other Enclosures 7Sargent, DILHR:SBD-6159(8.7/81) meB (rector Detach. And Return Upper STATE OF WISCONSIN DILHR Portion Of This Form With DIVISION OF SAFETY & BUILDINGS BUREAU OF PLUMBING Any Return Correspondence 201 E. WASHINGTON AVE. RM 178 P.O. BOX 7969 MADISON, WI 53707 DATE: 608-266-3815 PROJECT: H aif3tvo n d - PLAN ID. # DETACt PROJECT NAME - -=i - This is to acknowledge receipt of your plans and specifications fL I ID. # Preliminary review indicates the required fee is $ - above-indicated project. ❑ Underpayment - Please submit the additional fee. G - Fee Received is $ ❑ Plan accepted for review. ❑ ierpayment - Refund forthcoming. ❑ No fee has been remitted. Plans submitted with no fees will be ❑ -is being returned. _ rte. held in abeyance. i. SEE BELOW. Plan Submission ❑ Complete data relative to anticipated ust ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. 0 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if II. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. (1 copy) government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service piping, water ❑ Plan view of system. ❑ Plot plan. course, lot lines, swimming pools, all weather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides, pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or automatic siphons including soil data. size, pump curves, drawdown and average flow rate GPM. ❑ Plot plan showing lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if i site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. W 1 CMA : Thomas Hanson Rt. 2 LEGF'~3D Baldwin, Wisconsin '_.i #1 Li Bench Mark is top of xoofin NE 4 4 1 nail in tree (1.6' off grade) Section 13 T-29 N%R 17 W Bore Holes r ~fC7 ~l t s~_ t tea 1` /Coo C - Pere Holes d , f ~1 frtp ~a n '~p J ~ rf , _ 1!6und Area. #1.,& B . M . - .10 !'0" B2- 93.4' o a3 + B 3 = 92.4, /4 3G ; u1e►►r~ o``~~(ZSCM1T' f Vv rr°rrrMr~ 1~ 'pI ••`.T er ERETT A. I t.3 OLDT ° D•0426P • BALDWIN, 54 3.1 16 • WIS. S• 15, IGNE a Pi i1 a ~ 1 90 R`L 0 N t R VOR Are '~it3MA REC.IAP i sY 0 PU' ';7 ° . 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