Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
034-1005-60-000
n (n p n N Q 'a n d m c o W, 0 3 rel. 3 CD (D 7 O (D p 2 '6 A7 • Z -u n -0 It CD 3 CD i 3 , 3 :1 3 3 O _ z 3 = z O ww ;o (n Ow ow ~y1• O N v (n o 0 0 O C) Ct O N O V a 1 CD M O (D (D CO i N 7 (D A s 7 CNO ."S~ \ a a O N 0) C j a. Z O y N ' O QO O W O N V O CD O N CD Cn O O UT c p a 0 Q O O a 0 7 O PL W O CD CD O O m C W CD - C) , CJi C A , O O 3 O 7 N W N (.J = O 0 w C 4o I d O Po (v co D (D (v (n < D a • CD CD m co a Cn CD (a CD (n W a `C -0 o c CD CD (D cn (D co co co co 0 r- cn kkEE N ~ s N O C N N 7 ~ ~ z O O Oc Q z c0 0 0 a (n G n (n -ro G-1-1 n w 3 3 cl Er 1 (D N L N flt N CD A CD CD (D _ y A (D O O O O C,) N 3 - w cl. z N z z o D m o o z D o O O c O c n O CD S O - CD O O @ lr • Z1 (D CD _ CD CD N C C w (D w m d 3 a E _ z CD O O Z CD --j N D p Z ( i N N ~ ~ f1 n n A Z O a a. (n --I C-3 W M W CD CL , a , - z o o O - O (n 3 3 N N CCD as 'a 0. A V V _ COD C 7 CD O CD j co E; v _S O_ Q CD N CCDD < (n n d C O CD 7c CO Stn O S Q C 7 o Q CD O- O La: G Q W S O O w OC O CD O CU q CD {y a O N T O O T ~Q'cc CD Doi Q 3 Z a co 0-0 o o~ Z a wm o m may o o =,0 N o °o~ o _ m °(D :3:3CD°'Z c o _?3omo m m CD y m F, -O Cpg V Q°o a c (A : a m m C'CQC:L 3 0 3 0 CL o ax o°N N o m XCD CD 0 .ao o :3 LL a CD CL cr :3 (Q 3 0 CD CO a m b o Cn N 7 =r S N 3 j 7 p O Q COD CD O CD N p (a (D C CD N(C =r N O n CD O CD QCD O 7 CD S (Q N N O N N (D O O (D• (n CD X =O cr CD N 7 E O N N O 7 0 CD 0 (o h _ O c 7c M 00 S Cn Q w a n (D a 0 v 0 (D CCDD oa w ° o ,w0 baO CD CL 0 C V -y , M Parcel 034-1005-60-000 03/31/2008 12:55 PM PAGE 1 OF 1 Alt. Parcel 03.29.15.43 034 - TOWN OF SPRINGFIELD Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/14/2008 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner WALDO & DONNA ROTT O - ROTT, WALDO & DONNA 1115 HWY 128 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1115 HWY 128 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 39.930 Plat: N/A-NOT AVAILABLE SEC 3 T29N R1 5W SW SW EXC PT TO HWY PROJ Block/Condo Bldg: 1489/467 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-29N-15W Notes: Parcel History: ROLLED INTO 2009 USING SAME NUMBER. Date Doc # Vol/Page Type 034-1005-60 (43) IS THE REMAINDER. NEW 12/10/2007 865400 COV PARCEL 034-1005-60-100 (43A) IS LOT 3. 02/11/2000 618219 1489/467 WD CSM ALSO CREATED 2 OTHER LOTS IN DIFFERENT SECTION-LOT 1 034-1007-40 (52) more... 2008 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.930 6,450 0 6,450 NO UNDEVELOPED G5 2.000 350 0 350 NO OTHER G7 2.000 9,550 189,450 199,000 NO Totals for 2008: General Property 39.930 16,350 189,450 205,800 Woodland 0.000 0 0 Totals for 2007: General Property 39.930 16,350 189,450 205,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 534 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 N SPRINGFIELD PLAT I W E T -29-N • R-15-W S © Farm & Home Publishers, Ltd. See Pages 115-116 For Additional Names. 0 27 - DD 2900 ODD GLENWOOD PAGE 56 8100 3204 i rt M, N; !A 10 L Brian & J 20 Scorn Johnny Q . M&T Mary BT Annis Lu ind& g M y ;8< ,s & Knsti Butler U Tt L Steven ala 10 & Mona o Gray Ft ng Novomy w gen Lf re;gen ;D &B & --83------- q ° Mark & to Trust ona &Donna 42 $ Inc 20 M , 43~ Lori 43 4 163 40 Scott James - t nak x e Dedric & Kris. KC 99 C 0 topper Haines m Lee rime voeltr I _ a 7 Im & Rayner Seim -d. & 74 82 0°.'. Be gen vor, . 117 120 ° 6 4p rh &n- I vork R is o ' Fouks Leroy ; Enc Franco"n 40 Scott - la 3 I - z5 Bin & Seim Knuth & J drro Brahme t? 60 a„ Hor 31 Scott & {A~: Meliss R 17 & uhe Peroneo M, Trace Ans<~& m'& We a 92 Revelle 78 )er & a0 2 Waldo 97 I y k ' wmlam yer Eliz or &Donna Michael co 37 / Rott m & Glori w Geraltl o; er a eu~ acme a0 TL ~ o c -°~YJkdtfen r79 rinser 159 Gardner & I& Mal N ncy& Marian eMO& Teri y B ° 70 160 lp 9 z o & KathryH Sylvia 191 Finder Walsh Otto 40 Kiesow 95 4. g 40 nl n°m,<r 1 Ot °&e r. oav;a Allan & Robert Gary & I d e T - Eugen Sonie y _ R Richard °a Crockett ~oe & Karhy C=ia 12$ & Phyllis Cher' Jac O v 6o Wt i;. Johnson 37 X79 m 1i0 Krafve 80 Ran 80 69tt I 20~ hall ? 0 j 20 20 /,((l, Glenn „Y„ B- & 2 Steven " cc ¢ Troy & Malcein c;r"" N Leroy & Donn o t Dunn' & Bah, Donald R Sheila Mar aret 75 ao s Seim Haines .a m Hams e Ashley Johnson x s" - 'm`'' Forrest Rath at 60 loa""< 0 240 ilp 40 40 $Q s` 66 Howard d1 N ter n "~~"'M wargc` Fred Robert ~E`rusc G _ I s to 1 Forrest s &raha IN oa NO ,yne i D e 99 0, mss 40 Kreutrfeldt Ke1130a o N ` Tacna & rnnae a& m'Rnr v rt s : & erne" 4 kthicr Hoffinan 0 & Sheri 7err Paul & 05C'- Iam«- Steven 7 Nll 75 H arris 7$ Matthew o_ n ° John& Harold r 'sr Oehlke & Ja et Faeith " Pamela & Be ~r EF a da Aich d / (N GMPSOiy ~h80 > S Larson enendall r (fm 58 yv 40 48 4Qs Brandt GP s 60 mA' ,King M o an E 40 d 40 r - _ ---F - 2J ° Ma ia& Gera 3 KB 11 7 0th AVER, LEV r- Stene n Cline & &K. R&S so & ' u RD t y r Fae t 40 j¢ eev Song Ya 39 McGee valerie u~ L n s Bar,& 40 Her 4o g zo rnao 37 Id3sM &Ajonna ss` ~`y0 2311- r 37 40eWl 40 . Edward & Leon & ' D d Md~O° & RaSusonand Jr Neng Kou lelson $s y Susan t .e co"nal Gessler Donna R,ngstad TM+° Heur <,.<, Her Y5 P James & une 08~ ss 80 Wollack 159 77 ° '40 ol3r, Carol S 5 110 1o Thomas ` mr'-- 224 Steven Shawn Harold Chong Cl ord Jr Carlos & R th 188 y & Betty Her & Vasques eannine & Matthew Frye Brandt o rot Rebecca O Mani 40 116 4 159 t La son 80 Trust S&K 15' Sarah W 60 Bo Nyhus 120 .t' ao warren dt E 2 d - yd 2 Lyons James Chao $tev ( Duane Ba C7 F J-5 „ c f e Fern Her Globes g 120 Ihrke P7 37 on mP & Mary'-. 2& sa°~~a.° . 90th a o ' "r ~Nw 90th AVE 2 00 0 40 80 Trust 73~- a 40 Mahon t , ao AVE 3 d F. c4rles Charles Mahone m sneha Bruce Phog ua t~ s& Karen / 9p - E -SIC & rr°on3 & Laura 1Lo Deeb ! O q D rust 120 y ^tuaa Peterson Yan B,cher / a smith Jeri r&daMhone Evans N H Mahoney ,.S z a Ray 40 Scott _ 40 80 40 'tv6 25 x o y G&G 40 31 48 Z O° & usan Daly gQ (son Smith q - Richard &Nand Oehlk "&eroc<rby20 Thomas / m. <r i... 40 Ma Phyllis I<haI Fo wrt a Oe lke Bloom Y so 85th Arse°< R zo & Louann Nyhus LLP Bakke & am 9aa 1 1 laur 75 AVE e:m& Fber ao '"a`^` IOOm 4 =,'o 75 H H2O eta139 Howard Smith &23 Diana Mitchell w~& xrc"m KBdahl & &a ary s 120 r Brry cM Brunk- ard Alan & it... Ronald David ardwood 'T 12o Anita n ean,ra& ' "6 r Poortu o & Kay 120 teller Mahoney core st en& .11 Rick o~° °a 11 Michelle 1 159 en Larson ,ao Donna ax Hngt, ne Debban Lee & t tar:on no Jay & ceonrey 80 & a~ Leona Meech eo &sna.o" 5 &Mara 160 Mom, B 3 TAE= Darn," CArogocke[6r o Rtdrdy McGee om'. Heath 97 a I k=0,nm 4 80 7a 80th AVE 3 n a nmothr - _ L 40 ~q, 80 80th VE A ' )Uhes ~ .Op l~w,& hale Bonita ark Frank S NM ° I oleos °PPe o ` & Bonnie 10 OMeard Mama „ William Mandehr 12 Z w 0 c-) alters Rohert la(1 E 4( Krueger R & Lyla o'~rtaarro° Y y Leroy 29 $ cnrhe,n Pnnsen na & 80 .thy in o I T Seim I so 9 a". 40 _ 40 ° 60 40 80 a a0 185 Julianne & H Smith Frederick I Implement Risky to v I cm B-ornstad o J yu 6 u lek i Lenet-tr Co 109 qp ng I7o Johnson J u-retie uP HH Y. 127 ~12 ° '2.8- rT 7a 80 l> . son Q"stal a "roov:lrr 26 t E & Piles ~v Y-- 15 C" m.. N 90N IrJorman MV %I tes 40 o Dann Adme 13 72nd AVE ~VleGrane ? !oe nson rr 9 r Robert &D, Nelso" R"°a `r n& a.i .t - 160 <w<a 2 c & Linda Bee I6a cook 11 c. L d,[ SE 10 3 & Date K k ~r`1 US \G r lor"3s >S Darnel 2 4. Kuhn 7s sl Tai 32 Heime o 21 ed a<r don iL5 / i w 3340 tike m & 0 2ff 26 40 70 d urk a Reuben Donald Allen L & Karl Mabel } & d Richard Hermanson Males NN & Joan Thom son EI a for 24 Hagen Gerald & ,J Eugene 7pth VE Jill 7g M Vobeida Trust o Mouse 35 £ Larson , Mink & 40 120 Harold _ M. Michael itch i Trust \ William I"`& JIhiffi, ohn Sh ce& Ovila F s sa li `t 80 Krueger J6 Ali Stan fa edy y nm 6t Ic,°e,a 155 80 BK & Achterhof g 70 All n ' 79 75 1s 80 Trust Lee & { 1O J St e 42 Sl 3 as IR° ` " Mrchbael Mary Stenzel Terce I1nd0 h _ 3 y °t tlandd Keith & N n°e <& iio son 77 Frances Robert &ba°era &Maha el m"a s7 l$rk & s Leaf ~nP'u" Ericksoh R a o" 0 z n & E&T S 13 _ 33 ly Kromrey 91 0. LE 105 00°° 4'- ea trlary R nd & R& xis i&o a Harold Ann tighC°°t 6 + ° 3s a&' H 12 ver d of & mu &Cheryl Ruh' 7y N 168 Debora Todd s Volk Alice 4 $7 zwm<r za +0 K3 SS M o ° 36 rust in 4011 P r.<°<n a Albert >n 43 (Grady an< ,0 67 om 40 40 39 & z buir CADY PAGE 24 I S STOC FARM SUPPLY UNT9ZYSTORE V s. E Wilson, WIy sseo WI WILSON, WI 715-772-3129-:- F 55 ~ 5-5972805 Dry Vans - Reefers - Augers Hoppers - Brokerage Hwy 128 S. - w)€ 10 & I-94 Phone: (715) 698-2442 ii Fax: (715) 698-2962 Redwing Shoes Farm Supply H Hardware 42 Toll Free: 1-800-219-6926 Appliances Groceries Clothing Parcel 034-1005-60-000 12/20/2005 04:58 PM PAGE 1 OF 1 Alt. Parcel 03.29.15.43 034 - TOWN OF SPRINGFIELD 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 WALDO & DONNA ROTT O - ROTT, WALDO & DONNA 1115 HWY 128 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1115 HWY 128 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 39.930 Plat: N/A-NOT AVAILABLE SEC 3 T29N R1 5W SW SW EXC PT TO HWY PROJ Block/Condo Bldg: 1489/467 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 02/11/2000 618219 1489/467 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 81850 Use Value Assessment Valuations: Last Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.930 5,600 0 5,600 NO UNDEVELOPED G5 2.000 100 0 100 NO OTHER G7 2.000 9,550 157,600 167,150 NO Totals for 2005: General Property 39.930 15,250 157,600 172,850 Woodland 0.000 0 0 Totals for 2004: General Property 39.930 15,250 157,600 172,850 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 534 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 SPRINGFIELD R.29 N- . R.15 W 37 o • • • • o SEE PAGE 49 ub C Leonard y usnc C y .Pickard Thom,son ho o/o u dy w{p. Ma y Ev'.1h • • C b Co In fp/ a, Edwin e N ~ 0 4j ~.~onna b C Ci C Ha e~ 4 0 J v John u%/ar F 10 0 Ha/ es r 4sao CCh vtlF u 9 N l 21y N ~a 7/17 9 dyca ivy F \ h 4443 Ql /7f30.9 . 4.35 tlame5 4 0 9v dyy` /73.a ~ ~C¢the/vne 'l~ n0~d~ J~~~ z CCU /oa.bs W ~7P KrnV McC'ce /Io ~A~ /6¢ ¢ n~~ V~J 4o Uw N /e • Bsoe vo cQOi C` tl 0 0 E/d n De rns ~ ` ~ r •zss 0 Lee • E 0 h C ~l~ iTan.ce aixti• \ v go lquW tl 9 r~is a ~ chu/f 499 l 0% Cb o Monr yC Emi/ J~Oy vOQO tl0) vv0 w~ ¢O Wa/do ,p.Ogy ~~F f\ ~~`l t,Ct Lee C C d /2S ? vT0 Ol ad C n0 F Ma g/e /6o v L57A y ayC t^ X00 WW~ >~~'A CSc.m ~o go ~ ~2off Q~°s To/-dheir.-/ JW~ ARK 92 Cl~ • F•pL / 9s • ~V~~ r w , z79 odc 0 /.a Lawr ca Ru n 5~u~/sh V icb o d h. J 966 e f orsen 3 • tl r 0 wh,yy//is Ham/¢n E • k '~nc~s L er . h n.~za Hau9en Le Th to Q 0 fCy¢n cTo hnsoq ~h o.; e/a/ No ar L /zo !/e ne & f 80 /zo /4o d !~/enrs N! ,aeth grin 149 Me/fon • sc zo s~ • 2 Ma/cain ~ ° Nr/son C}y M meson r~cc' amen ~-sfB aia~ a,., Leonard cSfa/ea 6rT¢c S~ 4o z4o C{CC\ /zo 40 5 tl0 ~hnson • /~/on~ ve/ BOS ,qeb/y N°rd 9 drew 1N ~0~ % B° .Cons Comm. o/ 3 Res :N u q a t N n /z 4 s /z o 97 e-a ZI V • w y F far 0 C ? w c~ l U' yi/ f csy/ .Pqy 0 01 ~ y Kerr.,Y 4 d 'b ` ~ d La son C .c. 9nd cw U tl J ha '6 a• f Cudur.¢ C v ~ y\ vC ,oo F C ° C p a~th o f Pe.s l F ee~ 8° ' Bo zo4.74 b~ d C ~tl Q tl v p Q m 4o vx S.B Q~ q 4° • 8° o o` q~ v.'"f~ 4° . 472 \ ~ ~ u ~ aF f R.tF E vti v"3~ t~~ v tlz ~r A r~ r/~ Bey vad`7° 4M Ra.. 0 ~v 3~ H ` b tcne ff= Ea/y ,p ~,j~ Ea / ica a Q ~~y • U// ar; cS. /"a.~ £9 . /mss c'3.F 'F """y d tl h 40 35 5 n 40 9mai, 2.a/ N ~h ' O l y d as ti 9s 2°bcr/ 199 E Al L/orJ~C 'mom KjV,""0 0 7y f 5'h v//ma.~ ' .~C f S y ss ~ ~ Dorw/~ v clones m-' lay s % Zl n 4 C /bo 00 s c.Pr ~ by /vo _ y W ^f /o .ci h Ha o/d po L McCarfhX • a C C 0 h V% ¢st.' p f /.3etty c o- Cass.~,s , U E.P. eon. n Vincent /ba y F O` J 0 ~l n C E ~ Q°d~` F lhvan ~Sandst am n \.tl ` 0 'C C an cStar,/e 79 v 5b~ +v 0 Eva E3~ /Z° €~°°rh n° " m °rsa ah f7a y ny%us ~qQ Al-I.. b 224 Bo Fo f~oan EFH G%ar/as Lyons Fianca~ /zo ~~y C • 4o p, ~ 24o Myers ~ \ jtl eon M Gee nnJF /zo YL ene5 •ga .PM/yahon y 2 to RD. LliQ.S. H n.~ /bo • Chas. Q/i, f. E'//a l C 9/b • • W v E • MANONEYu. U 'C l .a¢/ s p 4o ~/ahor/e tl tl ~ csfoo Me/-win C t v 77 ea t.Z v Dcnn/s tl ~ 0 y W ~ 0 4o M°Ciee, C.O • 2a/Ph Mahoney Orv¢/~ 2 L~ f ~ /z° ~ ~ e/a/ vtl U ~ sem¢rne Bo PBe~e/-yc 7Y j tl Musa v e Fria y tl y vacE ci rd ; C~ o Weber Tho n~ ron Q - o IV O h/ke ~ f3/oom Co/b ~.rn ff 9ia~ fKa/h ly v~ cStrz.~ E e\, Bo • /GO Q/ on • N whousr ~d~ /Bo Ma y'9 /3ak.Ee~ • 2 4 Ba z oo /✓yhrXS • //oQ La ~o E nest- tl b W Y Ph~ert / C/ydc w S M Bo t9 ita o/d s Kennat%,E: d 9427 C'^ ~ s l h tl ~'C cy N p KaGFbrenner C F e p ~~en chore C 0 t ~e/°res r/ah°~ey s r e~so~ C ,,c DoG, /os o ova 0 ` ~ 0 O'Kea e f D tB9fee~~ ~ ~ ~ ns9 CvG~ .0 ~ Oqs v.~W 1700 ~Ma y Lechne.-moo Bo of x Bow eta/ ~ 0 lh Tho ~3`on y V 0'7 nho tl • 9~sn M SJOw /~e~e ~ • Vj~ on Lac - /6o K . d nz o_¢ 170 ~.C W;/°/in G✓arne.- b i\ 0~ • K LKBREN ER ' `C • V ~o y . 4o p l b p u P fi% Q T~7 ,~~jC \QC • C' s~v Q~e Char/ ,B T4 B 0~ 39.9 Ba 'l t'•f~ n 13776 O l ~T u~`~'1 • C: 0 Lem f N¢~c . l ry SFO. / N %PG' ~ob CrO' • W • _ C 0~ 0 GAP NALGREN RA S U 0 C~ %0 F S' sari Mandeir et¢/ UC Oa e Bo y`o d d Edmund S `Y g 0 ~ tl ~ l J Se.m ao vo cfo-/ fj Fir risen b C v a (r~ ~.,y • 9 ('combs p Sod u v ~ ~ ca~i /v ` vtlo 4 Q ° d nz° v 7 77 l v Q~ V Q /BB s K-n c cha is s tl 0 /sa zv d t 0 ~w h~ V b~.rn -Dowo d~ v ~ y oFZy Cia~de e f ~ees/f . Ed:/h C Ka / coo 9 Q(0 • ~V~ Me i L e//a 0 Love%~T Bo ~5'weager q y F K°th C. N¢ 2 v .i• Mc~ee go 7 y 5 y !//fern`s 127 _ Chari .s x Lawc sw it _ Bo `F l l B.3 s 0 O/iv /z N/a Daw 0 40~e/ ~C0 ~ O. EP ~ l /'7R in s1a R EY: a .Pobert Borer Q ~ N 0 0C 0 ~ /i-fB/ /so 0 • Fi¢n,E S i l ~y/bert ~ b 9 Ncrm~ ca~NOBwE. s cos ~ O C o 00. C `T vv l 9r/en Mc one 4O • 0 C Car/ 7 ohnson zi ,3' `son WF Ne/soq 7B 4s Ca/ av.cL G J b 0 w 0 0\% f o Bo RD. ~4. . o '.Syde~ s6o tl 3 hW O~QI W Leone 0+~ n(i/so t • /2 n / 77 • z9 p e/so /ao ~"-yo 41~i~ • I~Jj'uJ tl 4o v~ go r/ LBERG ,p eb en Karl P j La . V Herm~n 2 ,son y ¢o ~ y e ,r.s. s ~ nor, ~/c..a e • 7Z i3 4° 4° • O Q~ E/Ba noi- ' e/ o Jh~ E.~ • y n L/o ~ Mo tee/ ~ v aas G'e Q/d i ' o~ ~ b Eo9 ne fCQyoon v9n% 3 ~ cSe/ er z Lawrence 47 ~ -y : f•FJ/i e -D and ~ ~ . o/s <S'rQ~ /yN ~~L rh° Ps°n .s/.v 99 cr/ach Wayne ~h o 9 • b • vb s L son !/anba~ 7s.8 W ~ v as :Ecs 6 s ,9h ~ ~ ~ ~~9= p 32 r L.S N /moo ~p 5 Maynard p ~p 0 C /os /er, ~ ~ C Eit/arid y~ 0 z8o U y n' ~ do/Ph c a o yam./s ~~y hsi e Po6ert Ct 7QrthQ b o G,i WR ~k ate a p b tl . o ~ mest ne'~he~ = Ctlyn Cpptl~ aoro/h vF Wa, Ed a.d Lam on Leaf ll~. /28E,ceson l,y C~W~ k ~ C eo.I { ~Q`f~. eSauer 74 m~ V~ Th a 9 Bo i/6. 4z 4a /9.'.94 •.Prui. f%~effs. , tl~9 f1E'ri y Nei/e • /2 a ~s ``CC SuMMiT . - a W eO 9 Ge°. Me/K4han (y~J GVe~n.Ee h . c,v ~ 0 /'cc• ~Sfu ~t /9L3orden 79 V '~5 / gas '9 \ n ©/96B iP Ck rd Ma ~b/s, Iirc R 4 ~Q ~ h 3B 8s o, f H , ~Pe v. /979 W.k ~ on Re.d ~ SEE PAGE 23 ~StCroy Cb~~ty,ws. STEINER SALES & SERVICE, INC. " We can make your DAIRY EQUIPMENT ;,cows worth WATER SOFTENERS more. SURGE Phone: 684-3261 Baldwin, Wisconsin AS BUILT SANITARY SYSTEM 1U_LVUWI ) 7 `1'OWNS1111' ADDKL:SS ST. CKO IX COUNTY, WISCONSIN /Y/, ze 7Z SUBDIVISIUN LU'1' LOT S1'LL ['LAN V I EW DidtanCee and diwen6ione to tUCcL requireuternt5 of H63 I '1L1;U THING WITHIN 100 F1 E'T OF SYS'11%1 ~ V 41 N =ft ~'A - - - 17, TU F t.- / AN 1 - - - - - j I di a e o th Arrow BENCHMARK: (PoMgnent reference Point) DCbLrlbc : 7-e`/-7 e, /I `/V /vr //C 4 Ye Elevation of vertic~rj, reference point.: Slope at t'lte. SEP'r1C TANK: Manufacturer; G~ L SS:~d S _ L i.y u.i-d C:apaC I L Y . Number of rings on cover Tank ,uaul,ulU cuVer UICVdC iurn Tank Inlet Elevation: TULik Outlet- L1eVaclun. PUMP CH.AM8Eit Manufacturer: Number A gAllu►ts Number of gal pump a-et7-for a Cycle _ bal lane Lot ";1 _ up,l( i t- y 1, distribution linet►_ _ ba 1 lull y i ZC LJ l,uunp head, gallon per tninutei--______ . hurdepuwet brand name ut pinup and model number Type of warning HULDING TANK: Manufacturer Nwubu, of ballunnb Elevation of manhole cover 'Cy e of Warning device SEEPAGE PIT SIZE: Number of p i t Feet d iatiw t L, r feel. liquid d~spth UcciJae,c pit 111 10 pipe -elevatluti bottOtln Of eeepu4e pit elyvat full Lee( SEEPAGE BED SIZE: nunnbtsr ui 1 in,uU with I, l.:t} t I, ~ t I. lpt t~ SLLPAGL TRENCH width i~:t,bLl, PLAC:ULATIUN KA"1~; ARIA EcLi~UlRl D AkL~ A:~ wii.il i v LN Nh~t''Tok DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & rJMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE state Plan LD Number (if assigned) E] Holding Tank ❑ In-Ground Pressure Mound Inc) 9 NAME OF PERMIT HOLD, ADDRESS OF PERMIT HOLDER: INSPECTION DATE. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. IT ELEV. Name of Plumber- MP/MPRSW No Cou my Sanitary Permi[ Number. y SEPTIC TANK/HOLDING TANK: ) r L MANUFACTURER LIQUID CAPACITY: TANK IN ET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER . PROVIDED: PROVDIED DYES LINO DYES LINO BEDDING. VENT CIA VENT MATL. HIGH WATER NUPIIBER-OF ROAD PH OPE RTV WELL. JEIUILDING. JVINTTOFRFII,, ALARM LINE. AIR INLET: FEET FROM DYES LINO DYES LINO NEB\REST i_ DOSING CHAMBER: _ MANUFACTUHFR BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUF AC i UREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES LINO DYES LINO DYES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF I'H OPERTY WELL BUILDING I VENT TO FRESH AINF IR BETWEEN FEET FROM INLET PUMP ON AND OFF) DYES LINO NEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing TII rEH 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: WIDTH LENGTH NO. OF DISTR PIPE SPACING COVER NSI DE DIA #PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS I l'T'I FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR.NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH LINR INLET_ Bf I_'WV flip, S ABOVE COVER ELEV INLF i ELEV. END PIPES. -NEAREST FEET FROM i - .l 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. DYES NO SOIL .`OVER. TEXTURE P E H M A N E N T M A R K E RS. OBSERVATION WE ILLS DYES LINO DYES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: 1111) :rH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES. DYES LINO DYES LINO DYES LINO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LENGTH NLATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO. DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING Ft EV, ELEV. DIA. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION ORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INF PLANS. DYES LINO DYES LINO COMMENTS( PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF 1PROEERTV WELL. BUILDING. FEET FROM V ❑ YES ❑ NO ❑ YES ❑ NO NEAREST---~__, 'Iex Sketch System on Reta_;_,!),county file for audit. Reverse Side. TITLE ISIGNA TURE_„ DILHR SBD 6710 (R. 01/82) PLB 67 State and County State Permit # V D(39 Permit Application County Permi# U --1 Z4 cl for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY y Mailing Address: l ~ e~ 17 C ~ / ~ ~ t /V 6 V B. LOCATION: A/ A /4 c /4, Section Tl_~ N, R /1T V'(or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township "i/ /e Ley C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family __X- Duplex No. of Bedrooms * No. of Persons s-. D. SEPTIC TANK CAPACITY le Total gallons No. of tanks / HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches 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 X 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 Certified Soil Tester, NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signature -(~7 MP/MPRSW# Phone # f /c5 ~',f Plumber's Address 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. ~.<<m. . E 3 z E E E ; .a _ a e e _ _ e z a a } ~ c E E . 3 c Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application ct= Fees Paid: State Count Date, Permit Issued/ (date) ~ . j Issuing Agent Name (4 . ~ 't-`' Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1 /78 ~ r Smith Plumbing & Heating PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 a //r t, f- i ~ '2- ~ VA c prie r NHS' s 1 Nid 0 /NH M f I i ~ C i i AS BUILT SANITARY SYSTEM REPORT OWNER &J, Zg& lqe 7` f TOWNSHIP~pRiN5E FieLdSEC. 3 T21N-R~J Go, ADDRESSfjf'/ ST. CROIX COUNTY, WISCONSIN. AeNwoa d G i fY ~ i SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 OW-Y-IVER.THING WITHIN 100 FEET OF SYSTEM 0 p .01 A14 L e 1`~ .f f( 6- L U 1 di a e o th Arrow I SC L-- - - FT- BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: /0,0Slope at site: SEPTIC TANK: Manufacturer: b j e s* e, RS Liquid Capacity: 0 e, G Number of rings on cover WoA/e Tank manhole cover elevation: Tank Inlet Elevation: t 1+ Tank Outlet Elevation: ' PUMP CHAMBER Manufacturer: L, Number of gallons /pa o 0 Number of gal. pump set or a cycle 2~. gallons; total capacity o distribution lines gallon: size of pump /-7,4/1 head; gallon per minute ; horsepower brand name of pump and model number SW !jo M D o i Type of warning device a R V d HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: um er o pits eet diameter feet liquid dept seepage pit in et pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length tile depth SEEPAGE TRENCH: width U length PERCOLATION RATE AREA REQUIRED RE S BUILT 7 INSPECTOR DATED _2- PLUMBER ON' OB LICENSE NUMBER--:!-X 9D I:l PORT 01 INSI'l CTION IN DIV ILM AI_ tiIWAGL SVSTIM San-~ ta~ttl I'crttni t aat.Scp1Ic v AM f 4`01O I!S[ A144 _ ti t. C r u t x C u u vi (i l G,DD_ X77~ I war, (,vt _ Scc t(nkiJ lot " Sitbd< <,a t tYt ';l I'I 1C (ANK S c tit, avih Nurnhv>t I curnparr trnv!vi to - - - I!~ ti ttnr' c (It(Itit: (Uv:f V ~-.3- 12 ! Y ~'7 1; «,t < d( n o o if < <Ihwa tc ~t i'JImr I N(; CI(AM81 R +zc t/ 1'0 yaPYtnA I'urnp Mttrtu(ctclrrit crt ,w 1Mc1 Num1tcrt51~ l?I"DING TANK ~ yaI'o vtA Nitm1) It ( Co rnpati trm ki t' , rtil,c t Aeanrn Sys tvrn Atance, um: GleBU4fdiYI 120 s~u_>e H i.ghwa tc tt 1h"~'ORPTION SITV li c rl 1't c n i' it ftttcc (It t,rn: (Ucee 8(11 Cdi vtl IY`,tiP~I-,c HI ghwa -tc,( ~W:0WI'IION SITL 1) 1 ML NS IONS (u c d I6t tjjtJt All It j) h t IZ c r~ tt < rt c t1 rt h Icet,ltIt nca_ch f4'Y1 {.t 0cptIt o~ hock 1)f, 1 ev tvt Nurnbcrt o (-i nCA Dvpfit (I 7ach t'vc~t tI v 1vt fog ((e l'cn(I.th oS P-inv-A-- ~ - At Dcp-tit r( Nec I)viow g~( ade 1) A.tavtec by twv.vn ki nv6 ~t Mope a tn_e_nch 71 i. vi . pv,t 100 61 Iuttf' ab5u~tp-tLuvn ane(t Type u(~ CuvvAt : I'aL~crr n', 5t~taw i 1 1) IMINti10 N$ Numbv i t, i_tA G~tavcf anuund itA r CA n„ OUtoido d-(' am(,teit - - - - t Dcpt11 bveow IPI Pct I utak abAC 1f)t4*(i rt ahea i I A'tca ncclu<rted-- - (~.t N 1' I C I 1 1) 1i y C l% LIT 1_ t GEC/ I I,' c? V 1 I) D A T L'~. _ 1 rl x t II ClI D DATC I~Ih I (~I: RI It CTION - Al A 8100 06 1 * State and County State Permit # o OLB'67 iC y Permit Application County Per # - for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required -~-i/ State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: _ Ay _'/4 5-4-a '/4, Section -3 , T„~ZYN, R _Zj:'j&(or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms 7 No. of Persons 7 D. SEPTIC TANK CAPACITY 4,2, 0, %t;-Of I etal gallons No. of tanks o21 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concreted Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Od O Total gallons Prefab concrete A _ Poured-in-Place Other (Specify) E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate- Total Absorb Area sq. ft. New Replacement-A Alternate (Specify) ZVO1WNO( S" sreim Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches 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 X 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 Certified Soil Tester, NAME C.S.T. # Z24y and other information obtained from (owner/builder). 04 Plumber's Signature MP/MPRSW# y0-- Phone #a4l& : PP, ',p Plumber's Address Gci 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. , i , F i - P_ ~ .gym.. ~ w f , i i E , o u m _r 3 o Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY to of Application ep Fees Paid: State/l. 0-0 C unty d G Date rmit Issued/Re}ee~eci (date) Issuing Agent Name ection Yes_X___No State Valid# Date Recd ounty (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 tate (pink copy) 4. plumber (canary copy) Ii Revised Date 7/1 /78 State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & B L SDI 4 7 Bureau of It4 bing, Plattq JEF?. PC , -te ion P.O. Box ,O O C'7 TO: Madison, 3707.= GO co C ~q Plan Identification No. Gentlemen: Re: J The Bureau of Plumbing, Platting and Fire Protection 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 an site requirements specs ied in c H 3, Wis. Adm. 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 disc'Targe 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 con- tained 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 instal- lation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. I / / DILRH-SBD-6159 (N.7/80) in accord with ch. 145, tats., and ch. H 63, Wis. kum, l odl , 'h specifications are approved contingent upon compliance with the ~ ~ Indicated can the plans. f")f use rev7e y °a-$b cKlz each code section noted1. The architect, professional engineer, contractor shall keep one set of plan e a l r T` th, .,e department at the construction site If the installation o this system has not w it h n t ) ear- gore- the date of this letter, this approval shall become gold and new application stall be made for -approval of these plans before work may commence. this approval. the Division of Safety are Buildings clues- not h 1 itse~f liable for any defects in plans or specifications, playa omissions, examination oversight, construction or any da °ale that may result in or after installation and reserves the right to carder changes or additions should con- ditions arise king this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the court; which this installation is to be constructed. 1 ~ . r ~.x$r old F MI;® t permits Sincerely., r~ ms arge:at a £.F''C 0 Oute 2 ('t !t' flan Identification No. 80-05697-V <<_: Waldo Roth - Residence "Iternative System and Variance 1/4, SW 1/4,Sec. 3, T29N, R15W ,pringfiela', WI - St. Croix Co~inty Apr?pi Val: Variancey&,sed' a in Sections H 62.24 ar~d H t;'~.!1l Wisconsin Appl icatioti: H Q'3.03 1 j accord with section r , ( j r:oy gran ?_a r sidences. , . i A 1 S a~'3prtaV= is ` , i 41f ~YI of C. iwat 4i„l= i 5.. ~'.;.,Y ,i• a.. iri l.. i at ' F. the design e.nd s i z-- of system. -r its variance is subject to the follow it: E :i .i i. nat any lrc4ll r crnc:erned authorities having t f r >P 6 i~ i l enforcement of local ordinances permit the installation as prop--se d4. It stall 'Ce tie es ary to oulfill all p r,mit. rerauirenents of Cir village, township or county. Failure to -A'tain suco pormits automatically void this app.;-, i. In 'he event that this var,_.ncr cr°~ ~.i'~; ii~l;<fr' : ievel or ~~ny f,tker operate a ;.:1 r pro lelms occur, ttle" provisions necessary to resolve these pro,ler;ls s!;all be comil-le Iced, p,"A A. We Smitk Page 2 Nly ?G, ' I I I In gy'ming Lois approval, We #.l1WIMP of Swaety ans dui ivingS UUeS NOt i?iiid 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 rigit to order t:;#san,s or aNitiaos s:"ould conditions arise making this necessary. in the event construction has not coFm'iiced dl'COP two years l'i'{om this date, this approval sha ll becone void and n , application shall a e ?;ludo for *':ppYoval A Anse plans Moro worK May COMMV~C~. raft James Sargent, : wredu of P l umo i ng v . Lero,y jansky, OWS - District nij"Jp?wa Fa Q5 . darw , _ G. Ornir, J - „i',,. 0, ix Count,--, ~ i D11.1111-Si3D-6227 (R.9/80) (PLB.106) Plan Identification No.- X7(7 Construction Inspection of Alternate Design Sewage Disposal Systems Wisconsin Department of Industry, Labor and Human Relations Bureau of Plumbing. Platting and Fire Protection Owner's Name Mailing Address-_R1 _ CG~C}G~ A. Site Investigation at onset of construction 1. Name of Installer- 2. ~S-~~1 - County, ijeC,(-'Inspector),O~,b~ r~Date 3. Package 4. Preliminary onsite made by~(),~ _Date____ 5. Depth to limiting factor (50o unconsolidated rock or estimated ground water level) 6. Percolation rate 7. County installation permit number 8. Are percolation and soil boring holes evident? Yes _No _ 9. Is system located in area of soil tests? Yes X\ No 10. Is system located in area shown on state approved plans? Yes No 11. Ground slope in area of system - - 12. Site data is correct as presented by C.S.T. and system designer? Yes--A tJ o B. Inspection of Construction 1: Disposal site plowed and properly prepared? Yes No 2. Disposal site conditions wet or damp? Wet Damp Dry 3• Type of fill material_ 4. Depth of fill (1' Minimum) J r 5• Is a crawler type tractor used? Yes- No a. Blade Bucket - --1( - 6. Has site been driven on by any vehicles? Yes No If yes, explain 7. Trench width as indicated on approved f l ans7 Yes No 8. Trench spacing as indicated on approved plans? Yes 1K rJo 9. Have 'trench bottoms been properly leveled? Ycs ~ No 10. Trench length and number as shown on approved plans? Yes No- 1 1. 0istr[but ion piping proper diameter? Yes No 12. Holes in distribution piping properly sized? Yes -----X No 13. Boles in distribution piping properly spaced? Yes ~j No 14. Holes in distribution piping in a straight line? Yes No 15. Distribution holes drilled straight into piping? Yes l` 'Jo 16. Depth of gravel below distribution piping_____ - - 17. Depth of gravel above distribution piping ir 18. Thickness of marsh hay covering 19. Permanent marker at end of each trench 2 0 . Depth of f i l l over center of system 21. Depth of fill over outer trenches-- 22. Side slopes 23. Type of fill used above trenches 24. Depth of top soil 25. Seeded? Yes -A No_ If no, has mulch been placed over mound? C. Pumping Chamber 1' e s No--- 1. Diameter of inlet 2. Diameter of outlet 3. Head 4. Size of pump tank gal ions 5. Draw down or gallons pumped per cycle 6. Manufacturer and type of pump same as that indicated on approved plans? Yes "Jo If no, indicate Mfg. and.Model r of p5 p used. 7. Quick disconnect provided? Yes No 8. Diameter of ma nho I 9. Height of manhole above finished c,radc 10 Diameter of vent I1. Height of vent above finished grade 12. Pwnp tank located as shown on approved plans? Yes Fro D. Septic Tank 1. Properly installed? Yes No COMMENTS I, the undersigned, hereby certify that the questions were answered on the basis of my personal inspection or knowledge of the construction of this alternate system and further that all data and answers recorded on this form are correct and to the best of my knowledge and belief. Fame: Signature: Title: WE NAVE INCLUDED TWO COPIES OF THIS FORM FOR COMPLETION BY YOUR OFFICE. WHEN INSPECTION OF CONSTRUCTION IS COMPLETE, ONE COMPLETED FORM SKALL BE RETURNED TO THIS OFFICE W1 THIN TEN (10) DAYS AFTER YOUR FINAL INSPECTION OF THIS ALTERNATE SYSTEM. Date received by Bureau of Plumbing, Platting and Fire Protection 1 Plb 100a 12/78 Detach And Return Upper State of Wisconsin DIVISON OF HEALTH Portion Of This Form With SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMr' Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: i i Stily~ Sec.. PLAN ID. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. 1 Preliminary review indicates the plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. No fee has been remitted. Plans submitted with no fees will be held in abeyance. El Plans being returned. ~ O jO~ ❑ i.., Additional information required. SEE BELOW. ~C . 1. Plan Submission r ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. 11. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. 111. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test dat: . ❑ Plot plan showing lot size and all lateral distances from sewage disposa ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certified soil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Total area filled (fill to extend 20' beyond edge of trench before side slope begin). Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. Plb 10Ua 12/78 State of Wisconsin Detach And Return Upper DIVISON OF HEALTH Portion Of This Form With ~P SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: I . Sp'a' $Qr y nrar~ r+l 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 plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Co: ❑ Affidavit enclosed. H. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of analternate svstem). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. I11. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. i ❑Soil boring and percolation test on EH 115 completed bycertifiedsoil tester (1 copy).- rz\~s,~~ ,ran ❑ Complete data relativo to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. i❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) Total area filled (fill to extend 20' beyond edge of trench before side slope begin). Depth and type of fill. Copy of onsite report by county or district plumbing supervisor. engw of tim- JI has :peen in puce. Smith Plumbing PHONE (715) 20-48301 j,,./ •R G 7 1" _ Y 7 - V GLENWOOD CITY, WISCONSIN 54013 Q~ A,p'~`'Q' rN e duiraAlt~• a ig i tK $vu i ~ t ~ ~ a8 ~ lj c-rKC I _ !1 h!/~v r l pf j-,v a a r,4 N J 1 ~T Ac If I { r i -ecll ~J F H t P/3 d 7 P rr;} e r,; ry , % 4~ r; ~ - 'Fk