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HomeMy WebLinkAbout030-2028-30-000 0 mvo C r~ c m f c a 3 M 0 c m CD 3 n a O v r p can j N OW °C• 'J' 17 O O- Z d V~ Cp O O N Oo C O co 7 CD CD O N n ° co C N N O h 1 d `S 0 0 v 3 $ s o p C:) 0 o (1) U) CD p v c o ° ~ (n Z cn Cp O CD ~ o cn a c c 3 ° ° rn I~ V O Q C) CD N N C o CO `O n r ti N O~ cn c 2 ~ 'Y a °7 h Z O O O W • ° C/) m c -i -I -I 2 3 m 3 ti cn y o m a v o q m 0 Ch 0 V fk M ami (n (D cr o 3 0) c cn Q m 4 C1 N N Z N O O D D O twl ~ cn h m N. • CD ~ m C 3 n 3 0 Z m c :0 - -I fn O = a A Z n~i A Z O o. O W O W N (D (D < CD a 0 3 r- O N 0 CD a o m CO CL a) > m N Q m 4 ;Z g CD o T CD a 'COD m c CD oo _ z 4 0 0 CD 0 CD (D v 3a' CD a0m cn n 070 c: N -O v CD CD S ' O ~ N O C O = N CD CQ S 1 CD N Cn O O 3 ON CD CD ~ A O p m fA O f O z • V O M a ti Parcel 030-2028-30-000 07/27/2006 09:18 AM Alt. Parcel 22.30.20.440D PAGE 1 OF 1 Current X 030 -TOWN OF SAINT JOSEPH Creation Date Historical Date ST. CROIX COUNTY, WISCONSIN Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: T-G O = Current Owner, C = Current Co-Owner FREDRICK & STEVE,MICHAEL MEYERS , FREDRICK & STEVE,MICHAEL GOLDEN CORRINE M CORRINE M 1472 50TH ST SOMERSET WI 54025 Districts: SC = School SP - Special Property Address(es): ' =Primary Type Dist # Description ' 1400 HWY 64 SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.240 Plat: N/A-NOT AVAILABLE SEC 22 T30N R20W PT GL 4 COM 190 FT W OF SE COR GL 4, TH W 517 FT, N 250 FT, E Block/Condo Bldg: 613.8 FT TO W LN HWY 64 TH SLY ALG W LN TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 22-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 11/24/2003 747435 2462/101 PR 11/24/2003 747434 2462/098 PR 07/23/1997 07/23/1997 732/244 2006 SUMMARY Bill Fair Market Value: s Asse`sse with: Valuations: Last Changed: 07/09/2004 Description Class COMMERCIAL Acres Land Improve Total State Reason G2 3.240 143,700 422,000 565,700 NO Totals for 2006: General Property 3.240 143,700 422,000 565,700 Woodland 0.000 p 0 Totals for 2005: General Property 3.240 143,700 422,000 Woodland 0.000 0 565,700 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 030-2028-90-300 07/27/2006 09:19 AM Alt. Parcel 22.30.20.4401 PAGE 1 OF 1 Current X 030 - TOWN OF SAINT JOSEPH Creation Date Historical Date ST. CROIX COUNTY, WISCONSIN Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C =Current Co-Owner GERALDINE R MEYERS O - MEYERS, GERALDINE R 1472 50TH ST SOMERSET WI 54025 Districts: SC =School SP =Special Type Dist # Description Property Address(es): ' PrimarSC 2611 y 1410 HWY 35/64 rY ON SID 1700 WIJTDC Legal Description: SEC 22 T30N R20W PT GL 4 BEING LOTr11 OF Block/Condo Bld 5 970 Plat: N/A-NOT BldAVAILABLE CSM 9/2556 5.966 ACRES g; Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-30N-20W Notes: Parcel History: Date Doc # Vol/Page T 02/13/1998 572988 1296/157 ype 11/04/1997 567964 1274/471 WD QC 2006 SUMMARY Bill Fair Market Value: Assessed with.0 Valuations: Description Last Changed: 07/09/2004 Class Acres Land COMMERCIAL G2 i Improve Total State Reason 5.970 204,200 j 3,700 207,900 NO b Totals for 2006: General Property 5.970 204,200 Woodland 0.000 3,700 207,900 0 0 Totals for 2005: General Property 5.970 204,200 Woodland 0.000 3,700 207,900 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Char es Total 0.00 g Delinquent Charges 0.00 0.00 CERTIFIED SURVEY MAP CENTER OF SECTION 22 UNPLATTED LAND S I/4 CORNER SECTION 22 NO°35'20"E - _ - - - _ _ _ T30N,R20W S.T.H. "64"a"35" EAST LINE GOVT LOT 4 580 743.60' - - - NE CORNER OF No°10'20' " 0_''-~eENTE GOVERNMENT - R /NE 64LOT 4 136.47' - - i 1 POINT OF 1 - - BEGINNING r'° WESTERLY 9 1 ~ h a l 90 ° RIGHT-OF-1 , J 30 O., LNE 2 O O r \ Fw°_I ~ _ t r) HOLCOMB' S I N QI N SUPPER_CLUB al a3 UN PLATTED z w0 - - ) t- L A I O 00-(j) PART o I cw w m cD ~5 z OF CD 5 0' 10 200' 3 o m 0 3- 400' _ ~ I Scale in Feet N --L- I Z a- co o w Q DI/ M oa6 a :z ¢ - o/ 130' 00 N9 O°2 E I 0 ~ - - ~ OJ/ N0040'2 'E 250.00 (D W 3 90. NOTE : Driveway encroaches ° a I _ 69 Z 2- 0( 244°3050 _ a_ I rn~ 7 J 0,6 ~N 8022 w QI _ J Z 121.0 6A 161030" o ~ LL I R 165° It I S105 0 "E o R=80 3 W a w°I i M I U HI I M I I (D 158.70' QI N 4 S7°04'W ZI I N I I 2751q, - Cl- It Z) I I i I ROA DWAy I c~ EA - E I I I I _ - I PA RT I - I (TRUE BEARING) I _ 4_ I ~ _ I I DOTE : I - i - M 3 CONTAINS 17.0 ACRES, MORL I S E E DR LESS, AND INCLUDES 2 PARTS. I S HE ET 2 OFI I 1 2 QI I I I JI APPROVED I I ~q I I ~ Lu1 JUN 2 8 1979 TF~S i I I I Q I J ST. C!?Olx C~)u rr EDGE I zl COMPREHENSIVE PARKS Plan. !NG I I =I AND ZONING COMMITrU I I APPROVAL OF THIS MINOR I E SUBDIVISION WATERS EDG DOtS iv M_AN APP.\CVAL FOR BUILDING a,T OR SEPTIC SYzoTE6t. REFER TO H62.20. Dram by Julie Kraemer. LAKE ST. CROIX Z Vol 3 ?'nCe 822 Shcot 1 of 2 Section of Plumbing & Fire Protection Syste ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises SE, swS2 ~iW zot.'j 2 f` VII L OF-guILT203 ~i'•C120r COUni Street City County 5.101-7 Master Plumber ~ Address Vr6 L,;z5t Vk._, A)TtAJ R1C1b"0 0..W = Owner E t t ' A ~i.1e~1C? Address 'STILL TF S SDe Z LJ County Permits Appropriate State Permits PLAN r.b. a 2 -OiS4 t t T: APT- WE 6 - z A), M itj Rt v FALL wr eC) 27-_ Type of building; XPublic Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION 'T'YPE OF TREATMENT SYSTEM Building Sewer Cunventional Soil Absorption System L Septic Tank SOi LSD Conventional System-in-fill L Holding Tank Alternate Mound System L_ l Seepage Bed L~ Holding Tank i.._~ Seepage Trench Seepage Pit Experimental System BRIEF, FACTUAL COMMENTS AND SkE_rCH W~ TU*A tJEL.3c tJ' CU- R--S; • 6A . c"" L' `;~..+.~'~f. ^t.~'r C'~'3~1.,+Zt:•~LL+-G t-G''►'7 L~t~.~`-~' 1~2~►a.~-e~~' ~ J /~1~. ~~r~C1~ ~ d.,~/j .~r lac / 9,/~~ t..."' .+'4r 1_4 eh 7-1 , y.8►~,~Uy~.-/z) L °r-~ 0-Y" V. b. 6yP4KA,Y:,) L b a zLOwis~+~3►J~ayRy,~) J/- 2-3 " AYF'JJeW19403A)(1o1-j RYfu) L 44VI S1 w1 e'&MWWrj 23- 73 a, NELL~u;iS 609(2--'7~1~) Cs 73 -a5 " LS f?>~' ? 5 ,9 c-~ rus XtA:M4e,4* C q1,24 F-L UP &MIlk-Ak T'o T-•14 t EXCEPi- LS RPI I.S T Z F,' ok oiz- -ro 3(- "C A"E ~ b A`- &6 „ l~E~r 7f <;,,kP_ FACF U, 8m, (7S`11_3A) ~16AVJ S R ocK ~'►cf' Cchf,~, ~c.~-, ~ N is ~!~%d`~(~ t~'c~ t~r~' ~ T~ T~ d~. #~D~I~'~? j.S Pa.~CVNttrJiACu~ ~--fit ~c411.€E:a~,~ 1 S ~~7".' C`~,vc3fl~Ek'E~ r `r tl -T---- q LS Sp- 15 7-3 0_(7 " L'.;).41 Bt,) 6oiP-i) Et_, OF 7 1_5 175 -7, S-,j R Mg t 1--~ $ 041u-owis ir:?~to4~~2 4 ~ L<> 64 D,q L1ZW'G4 ' 60L1P-`fir ~ r~~. c 7r+ IcT+.~x c;f)- Vr-R-t W Isr .E}(( AvATI0a.) i 9C_TWgC",0 >s?ln. 40I LISEL ATTACHED TFM f7iSC'r'~i F[3~N.ITiI PlUM€fEii t 1 Yeti ) No SIGNATURE (Voluntary) T)ATE F IN: PC!;T;C,N ~ -Z f ~sr~ i m.pecror 'While rr.,y~..rCtcn ~'c •i::~,,~I.oc.;J1 1!11.'f, -r-ttrr Pin!. Plr.rrnber OF Re,q- r ,tilt: 1.1 s Section of Plumbing & Fire Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises R-STAI ArR A01' n VILIL'"F OF" -Tr. CAe)C)( COu.UT-L Street City County Master Plumber Address Owner Address County Permits ❑ Appropriate State Permits Type of Building. Put)iic D Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM [._i Building Sewer a Conventional Soil Absorption System Septic Tank LJ Conventional System-in-fill _J Holding Tank ❑ Alternate Mound System Seepage Bed Holding Tank i Seepage Trench Seepage Pit Experimental Systgm BRIEF, FACTUAL COMMENTS AND SKETCH- .et-` 7- 7 ate, 4 I ~t ice" its - A-4 t ~ et.Z-zz-k 17 ~-c~-°-L~~ .,~rc.L`C-'~-^~ ~.-~c~., ~c_-~1 Gs''"-~C,{~~ C.~-C L r. --~---4y..~.~t ~"Y~.:~-c~-A-e~ ~ C ,/1.~-1 ~~.''~e'~~-RL ~-t'''~~ .-alt{'' e"'~t•~..tZ .s.crt -=mar-~ fL-C'Z'-f^-L.,. ~ ~~i--9 ..~t'~~Z. ~"~1~s y'-E=2.~•~~~~ r+l.,_ ..~•-C f .,.~yt..t''.~. l~-•~i[ z"'LL ~/-~t.l.,~''~-t. t "L. ~,.eE'1rLe~'x . _~c•'-c~yc~c'*~ - G~.r/C -s r''ZLc_•t~. y^,YYIr f ~ Z. C-ti C.t/,'r L t..t. L? ~_,/C ~ , ~ L L ,~r~,Z r- =r C ,•~,,,•~y+u,,r,,~t'... y~ o /f1,.--'L~-i-c.7'~ ~,/~.C..L-hLL~L ` tvi„~~t. r~t,0,-~•L.~...~. / ,fit ,(t'`"i Lt Z.,r:: i ~//r~l~{~y l/""~ ~'L'i „/.Lj. /r' • 4 i i G~("'t Lct_ /{j/•J(`y/~IV-_ /e 70C C-t „~"G~`n ,ip" .Q:9L'7C.-~t^s2. '-s.1.---~ ~G~.<.~:~~-c..c+c-'C-Q--~~ ,•~`x~ +~1 ~~~~~'"'G'~1 '3V C C~ s2 ",it' L LcL lt'41 . , SEE ATTA'; ALLF) hlSCl);f;sfi W{?"H PLI.iP.rlFSkri Ye; ) N rlf,Ps,~T1)FiE. t°Jolr,rxi~ry) h- 7 t: tc+ 8l Ir'. r^r r k 1'iunrl; Eif3 It: Z__._ c~ F A IN N ;ty. x 7'-....-..,_.- _....~...~...:..~..~r..._ may, ~ 4t "+.r+~n+r. ~l y -1 -n 2 to rT ! ~ f ~ ~ ( ~ .S ^1 ? o ~ Y '~1M---x7 r rt- ~y ALA C .S~ 40 J ` I a- e1 2 Oct Q.,, go so o.. 1t~~ to } t y. +t m 00 ~lM r f 0 f t wS ~.,a t +f . V) I, 2 it o~ aN r> WIM r, x r _ tt Y ct < ' a - Aw- p°, r ..t LCS w Vrr-1 . - 1 f - ••--"I~ 1 r .._„1•V r ~~rrl rV/V ..:i A~'/ Plb. 1-A -Z:~) -T IV~F L~Y/f/7 Section of Plumbing & Fire Protection Syste ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises N)~+~~-AN r`~IRAf. SF, Sw S Z? 3vN ZO uJ ST pis V IL 1Ez- OF4Qc?v,,) Si ,CRO1 CoQ N Street City County S~fQ1-1 Master Plumber ~AR`1 '-':Z,7~- IF- Address NFtQ RIWNANWE Owner_L~EIT~ ~t ll~lra Address R-tI ST ILLI,~,iAa-FR t~'1►~ 55b~Z County Permits ,Appropriate State Permits ~ZAnI S r~. 8 2 -015{ cs7-,. APIA WE 6E2,C(z - 517_1 A,,, MAnJ sr. Rl y,Ep FALLs wr '002--L- i ype of Building: Public - R1=-,T4HR-A►JI ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM 3uildinp Sewer ) F-1 Conventional Soil Absorption System Septic Tank Soi LS U Conventional System-in-fill Holding Tank ❑ Alternate Mound System Seepage Bed ❑ Holding Tank Seepage Trench I. J Seepage Pit Experimental System BRIEF, FACTUAL COMMENTS AND SIkl TtCH W/ TUUtA Co. ~ssT. ~q T,.4 - 7-1 0 -Lo V, D.. 6yr 8N,Ljt2Az) L TA L 19-41ot~ D. *I-LOW154 RQ )04p4/q) 1/- 2-3 rl D, y C y~t~rwrs~-~~~1(to~R l~~ L 4-94VI sI~ W f cu4MOIJ 23-73" CS 4L, L S RR ELF` ? s-df WE 11) - ,N -PL4tE, der ~«ua ~ q1,24' z- EL vF- Bf~ T-S SiMILA~k To T-q , E XCE-f i LS R'I~ !S T -Z ~ oM o~ t hoc ~ A:r &o " BELOvJ -t"-F SuP FACE . ,i3N, ~7.s`1R3i) ASAVI sl T 15-Ai-so A 44"i sg ROCK 3b Z11 OLIlVZ /3) S%C,/ W/ THAT- t s i CdA;T16000C(5 j~,~~Tff 775~r_ McP 10'1(2. I% P, err. TNts 0A;bt~Q L`fI,uG, LS Bd~ TT4131 , T 15 t16)P_jZe,J IS j ~SCOi-nIJi/A.Cu5 L4PAF FP46rs oT- coA.)s~1 E?~ A -W KJD T *E PIT t3 ~ . EL OF 8P_ CiC,ZS = EL o~ QED Rc~rrcJ~ T--(~+ SiMt~A-(ZT~ T-~( ~X«-f'~' Ls ~3~? 1~ T 3 -q 4y P>N 6oii2-Y,) s,`/ EL. L F AQP,,C, .311- 51 ELLC,.J tS14 c (U Ll -r-7 LS BP ( S AnPx , ~ / u`-/ CC1, /0~(2'~i 1RL Z MUT 5?-E I n ~f~LLUl~~sr+ ~rJ (~o~tR yN~ ~S L5 J)~_ 15 APPX 14 Ptcx~ . VEP~j Mal,;;; - WiFiop Sr~T, C I -7 t 1 D ELL.owlst.~ BUJ ~I~~(R-yly') CS rJIaV~: E. _ oP- BSR t 5 T#E Wn C 7~ K 6L~_N VE'R~ Mo IST x .EXCAVAT'IC3,J IS RE WE4~7rJ 8(0.401 C. ]SEt ATTACHED TM 1s f,F cs7's o~ PLAN 82-olS'r / DiS("I'StiED WITH PLUMBER 1, ) Yes ( ) No SIGNATURE (Voluntary) ;)ATE ')F II`JSPEC'~TiO;J Siynatrl nspeclutAlh'Ite ctoi yhlIoo" Local lrtsprctoj Pink. Plumber or Refit. e"';Ilhju P;,-,y fAF>E. l o~ 2 11 DE{A1i7MF.P;T OF INDUSTRY, \ INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS l PRIVATE SEWAGE SYSTEM DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 \ ❑ CONVENTIONAL ❑ ALTERNATIVE sl<<asvgn~io Number ❑ Holding Tank [1 In-Ground Pressure ❑ Mound NAMED PERMIT H LDER: ADDRESS OF PERMIT HOLDER. INSPECTION DATE. ENCH MA l (Permanent referent-pod DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.- CST REF. PT. ELEV. Name of PI ber_ MP/MPRSW No Com"y Sanitary Permit Number SEPTIC TANK/HOLDING TANK: MANUFACTURER LCAPACITY, TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ONO DYES ONO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD' PROPERTY WELL. BUILDING. I VENT TO FRESH ALARM LINE'. AIR INLET. FEET FROM DYES NO DYES ONO NEAREST.------ DOSING CHAMBER: _ MANUFACTURFH BED DING. LIQUID CAPACITY PUMP MODEL PUMPiSIPHON MANUFACTURER W RNI DLABEL LOCKING OVER YES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP ANDcoNTROLSOPERATIONAL NUMBER OF LINE PROPERTY WELL BUILDING (VENT FRESH . LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) EYES 1:1 NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1F TER 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: D WIDTH TLE GTH NO. OF DISTR. PI E SPACING COV FH INSIDE DIA. PITS LI E QUIH FPI BED/TRENCH TRENCHES MATRIII DPT DIMENSIONS 7777,77 > f `II F IL L E I'1H PIPE DISTR PIPE DISTR. IPE MATERIAL NODISTR NUMBER OF R OPERTV ELLVENT LE FH ESH BFL , 4II EH)VE COVE INLETELE VEND. PIPES'. FEET FROM LINE. AIR wLET. NEAREST MOUND SYSTEM: 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. DYES ONO SOIL .`OVER. TEXTURE PERMANENT MARKERS. OBSER VATIONWELLS 'g_~ 'L6'-p j' 5 DYES ONO EYES ONO DEPTH OVER TRENCH BED DEPTH OVE RENCH; BED DEPTH OF TOPS L. SODDED SEEDED MULCHED CENTER EDGES DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: _ V,I';TH LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS ` 1 \ 100 M11ANIF _ PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. JN0 DISTR. In IH. PIPE DISTR IBUTIO.N PIPE MATERIAL & MARKING EI.FV. Q LEV.87 GZ. DIA. ELEV. PIPES. DIA. I ELEVATION AND ~ c ~ r< DISTRIBUTION LE, HO E - DRILLED CORRECTLY o COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 19 1 PLANS INFORMATION _ DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ,;NUMBER OF PROPERTY WELL. BUILDING. FEET FROM uNE. YES NO YES ONO NEAREST- t~1~:i~`I 7 7 f 7 /00 tot .z19 14-02 Sketch System on ~~yy 0ja2n Ot I county file for audit. Reverse Side. `Z - ` SIGNATURES. TITLE DILHR SBD 6710 (R.01/8G- APPLICATION SAFETY & BUILDINGS DEPARTMENT OF FOR SANITARY INbUSTRY, DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 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. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: ~f r Property Location: City, Village or r nship: County:/ / '/45l~'/aS A iT 3C, NiR,;? F,- (or) W -ter Lot Number: Blk No.: Subdivision Name: arest Road, Lake or Landmark: State Plan I.D. Number: (If assignedl- TYPE OF BUILDING Number of ;&Lpublic* ❑ Variance* ❑ Other (specify)* Bedrooms: LJ 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE STEEL FIBERGLASS PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY / [l HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER (r. MANUFACTURER: , EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA ~c (Minutes per inch): PROPOSED (Square feet): ❑ New I! `replacement ❑ Experimental ❑ Seepage Bed Seepage Pit Alternative (specify) j)? _41, y~~~~,r~r,~ YrI~~SL~~r~ ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): rivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of PI ber: ff Signature: /MPRSW Ph ne Number: JJ Plumber's Address: t ` Name of Designer: 0, /0 Wj 42 COUNTY/DEPARTMENT USE ONLY g Fee: Date: Sanitary Permit Number: natu e of Issuing Agent r _ 2 APPROVED c9~J tt7 - El DISAPPROVED d Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted 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 (R.07/81) State of Wisconsin Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION i E. r,idsniii9toc Rvts);.- box 791") 75OM"s, lSC~rnSiC) ;:3/;.i. rt i :.X i ua % „CttitwttfitTC7itd~ Fri~ssur Distriuuti€ n i~ Y .1r, U."j ct Petitlutl fur moujf icdti,,, of i ~Or~;iti HomuyisvracivL~ Cl(t! twas Cttsi icrr<i t.rl i°av it Is,e ruie requires triat ~ i f j1drl switch v l of t si- i dtc aito=i 5Lateteie_pt5 S~1t` rii tu!) ifi f= if of trr~= ittiL):: Tnisi ippr,;vd1 is specific to the SuGurCt jJ~jVitii It i Pt'Iv;at: Y. DILHR-SBD-6423 (N. 04/81) State of Wisconsin ` Department of Industry, Labor and H PII pI Reply t : " i SAFETY & Bju4~1311\! Wt~4Sl* Bureau of PI bJng ~ P.O. Box 796 Madison W1 5 G " Plan Identification Number L J Re: r 1c C\ 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 a -gallon 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 3 ci!iry~G~/ - ~E ILHR-SBD-6159 (R. 7/81) mes Sargent, B erector SBD 6678(9/81) (Plb 100a) STATE OF WISCONSIN DILHR betach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 608-266-3815 DATE: PROJECT: PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ 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. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. E] Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and manufacturer if precast. Complete construction details if 11. 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 tion system extending 25' on all sides. ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main. ❑ Location of area suitable for replacement system - provide soil data. ❑ Detail & model of pump or automatic siphons including 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 course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank ! site constructed or tank manufacturer if precast. ❑ 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. i I i o i - - - o OOQPO~M ~ GO~R~s SSE RECEIVED MAY 13 1982 PLUMBING BUREAU DRAWN BY SATE REVISIONS DATE CHECKED BY 421 N. MAIN STREET RIVER FALLS, WI 54022 APPROVED BY S CALL, (715) 425-9381 (715) 425-6,18 TITLL DRAWING NUMBER 8 8201541 ~'~-G3 SN~r_7 ty =='F ll~ - i 0 \~0~ OR ©EQP~,~M~N 0 X54 0 S~ GO RECEIVED MAY 13 1982 "IUMB4G BUREAU DRAWN BY _ DATE REVISIONS DATE CHECKED BY 421 N. MAIN STREET APPROVED BY RIVER FALLS, WI 54022 $CALL: (715) 425-9381 TITLE DRAWING NUMBER (715) 425-6118 8201541 -o ~r 7 = .y i ~ i `x1S-iti~~ ~g~NG - ~\ONS FcE>✓, , r. ~D' 'o AA \NGS OF FES OF O'~PARTM~N ~ ~ ~ dNpENG~ C0 TCS? ~L~Li. ` (Z RECEIVED MAY 13 1982 E- _ PLUMSING BUREAU DPAWN By DATE REVISIONS DATE CHECKED By, 42~ t4 MAIN STREET _ RIVER FALLS. W! `4022 APFRC,vso 8t' _ SCALD - 7151 425-9381 'I IT-LE '1'+t A?5-E•tg 82015 41---j DHAV.ING N:1M6ER TZ7, Tic 1_AT'E N. /Y,• , 'r~> = CIF L •L ar- 1_ ,4 S ty ck, N PL~~g`NG QQ ~ btt~ o s RE ~~N+ S ~~M~~ \ of NGE RECEIVED MAY 13 1982 PLUME3EfliG BLI(r=U DRAWN BY DATE i - REVISIONS DATE 421 N. MAIN STREET CHECKED BY , RIVER FALLS, WI 54022 APPROVED By^ SCALE; (715) 425-9381 - S o~ (715) 425-6118 TITLE DRAWING NUMBER 8 2 015 41 a -03 5~ ~T \ZT ,V T Plb. t-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber Address Owner Address ❑ County Permits ❑ Appropriate State Permits Type of Building: ❑ Public ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorp*` ❑ Septic Tank ❑ Conventional System ❑ Holding Tank ❑ Alternate Mound ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental Sys. BRIEF, FACTUAL COMMENTS AND SKETCH: a 3 5 4 , , , t c g , ~ x e £ r F 3 x f € ~ c V 3 r ~ , 3 t E a e , . 3m. a , _ m v ~ y 1 - - - - - - - - - - - - _ f d.n . _ A _ - --._4 - - 1 ~ s s i , r E j 1 3 a t ° , , E E ° f t , € 3 i r~ € f- e E y r ~ ~ z ? 3 b A A ~ ' ( F = € i 3 v ~ E d j € r ~ yy I J ~ ~ o- r , € r `~g E 3 E 3 3 € 0 s _a d . , r , r € S t w 4 € r i , i i s i i m~ e ❑SEE ATTACHED DISCUSSED WITH PLUMBER ( ) Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow- Local Inspector Pink - Plumber or Responsible Party