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HomeMy WebLinkAbout038-1163-60-000 } n y O 0 0 0 v 0 C7 '1 Z (p ((D (p (=D y K _0 m `G u .6• # C F. _0 I a) CD 3 - 3 A: X O Z S Z O W 0 Cn -1 2 N Z O co G) Cl) co O "*A • O N C O v j 3 W O N O J N N O d l0 O N N N p 3 O N J n j (D d ~ Z W (D W N C N CA = N W O C 1 N co 0 N (n m m -1 W 'S 7 (D (p 'D 0 ~ a (D CA O O O ~ O1 O f3/1 (N/1 N Vl ~ :3 co co 0 (n < A 0 R- , ry M Z A CD a DCC) a D N a t CD CD CD C- W 73~ CD < (D co CD co co 0 r r "WA~ O O O CD Z O O O m !mil 3 (n y y 3 v CD cn cA fly 3 m CT 0- I A 1 J D n o. L7 O O n 0) (D (D CD r (D z C 1 -1rc r d Ch r 0 n CD ul (D cn o _ N N z z N e U Ul O ~ Z -I Z ~ Z W Z C) 0- p l z) CD 4 V11 CD o 7 (D _0 ;z (`V (D p ~ (D N 77 Cc N Ql~ CD. C n Cl) ~~"a 3 ? n 3 5 Fes-- .l n V` Cl O O~ O A Z O N G) (rr X XDLN O o j W I_ Z l7 R a l7J a A Z 3 3 c Zl , t C N CD N m r ° 0 o cDi CD n oo n CD o a o z -n N p T C p L C C (ll C ~ m o a (CD O a m ~ m m m O CD (D CD (D Z CD m t 3(c p a 6 (D v n _ N O 2 7 Q' p W t c X A r_ C c v (D W O Z) n O (D ~ a 0 O 0 O b CD (D b 1 b O O H 0 (D CD (D O Cl CD 0- ti I II Parcel 038-1163-60-000 02/0912006 04:43 PM PAGE 1 OF 1 Alt. Parcel 30.31.18.770 038 - TOWN OF STAR PRAIRIE 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 0 - HALL, BRADLEY J BRADLEY J HALL 841 W RIVERVIEW LA SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description " 841 W RIVER VIEW LA SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.633 Plat: 0227-CRESTVIEW ADD SEC 30 T31 N R1 8W LOT 6 OF CRESTVIEW ADD. Block/Condo Bldg: LOT 06 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 966/337 07/23/1997 864/220 2005 SUMMARY Bill Fair Market Value: Assessed with: 120011 170,400 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.633 29,400 138,100 167,500 NO Totals for 2005: General Property 1.633 29,400 138,100 167,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.633 29,400 138,100 167,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER U, _a7~~~ SCE r i TOWNSHIP 57 i^~► i SEC .V' , T.;/ N-P/LW ADDRESS C0,y/<'1 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT CO LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 -EVERYTHING WITHIN 100 F1 ET OF SYSTE'14 --,J -J- - - - - - - - - - I di are North~ A roW SCALE : ,/i -i ► = - BENCHMARK: (Permanent reference Point) Describe: +Or, i~`.G l•;^~{ S'~+K~ = Elevation of vertical reference point: Gam/-' Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity; /Cl~ , f-2a- Number of rings on cover : / Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Nwaber of gal-.'-'pump set or a cycle gallons; total capacity of- distribution lines gallon: size of pump head; gallon.-per minute horsepower brand name of pump and odel number ; T e of warning device HOLDING K: Manufacturer Number of gallons Ele tion of manhole cover pe of wa ning device SEEPAGE P IZE: Number o pits feet diameter fee iquid depth seepage pit inlet pipe-elevation ttom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines widths length-5'-,/-'tile depth--,26' ~ SEEPAGE TRENCH: Width length PERCOLATION RATE_ AREA REQUIRED AREA AS BUI_ INS DATED PLUMBER ON JOB - LICENSE NUMBER y~ r tea? COMMERCIAL TESTING LABORATORY, INC. `.j14 Wain Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 27951/01 PAGE i ST. CROIX COUNTY REPORT DATE: 8/24/92 COURTHOUSE DATE RECEIVED: 8/20/92 HUDSON, WI 54016 ATTNI THOMAS C. NELSON { 3y-7 3 OWNER: Ru~'tun ,.lean Gustafsor, s: LOCATION: 84 ew Lane, Somerset COLLECTOR: Tom Nelson DATE COLLECTED: 8-19-92 TIME COLLECTED: 2:00pm SOURCE OF SAMPLE: Outside tap DATE ANALYZED:8-20-92 TIME ANALYZED:2:0Opm COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 9 g ~0 cp NOynO G~2pO ~ ~ 0 S ~ r r I ~ LAB TECHNICIAN: Pam Gane E FyDEPENpF WI Approved Lab No. 19 0~_° ( Means "LESS THAN" Detectable Level Approved by: b~'6 'AFT ~m o PROFESSIONAL LABORATORY SERVICES SINCE 1952 - - - A FFFFFFFF A X X F A A X X F A A X X F A A XX FFFF A AAA A XX F A A X X F A A X X a F A A X X ST_ CROIX COUNTY COURTHOUSE 911 Foun-th S.t4eet Huda o n, W l 5 4 0 1 6 f DATE: T - T0: FAX NUMBER: NAME: g_( FROM: FAX NUMBER: (715)386-4628 NAME: NUMBER OF PAGES INCLUDING COVER SHEET: ~ - IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: V NAME: TELEPHONE NUMBER: O O Q'~ FROhl EDIHR REALTY HUDSON WISCO11SIH OFFICE 07,29,1992 034.. N11, 1 P ' ST. CROIX COUNTY ZONING OFFICE 911 4th Street ~P Hudson, WI 54016 Telephone - (715)3136-4680 The St. Croix Co. Zoning Office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING FEE : $ 35.00 (For nitrates and coliform bacteria) WATER TESTING------------------------ --------FEE : $ ].85. (VOC'S) SElYPIC SYSTEM INSPEC.'TION----------------------FEE: $ 25.00 t` PROPERTY OWNERS NAME: i ~ IJ ~ ~Cr PROPERTY OWNERS ~ ~~1~t i~~~'~ ~ ~•J < ADDRESS: CITY: 1160- f" r? Legal Description 1/4, 1/4, Sec. _ TN-R__LJ' W, 'T'own of ' Lot No, Subdivision Sn X-7-70 FIRE NO. 0 X-7-70 Atoo LOCK Box NO. Color of houseALLRealty sign? YES Firm:_ L r ti1,'~ PLEASE INCLUDE, IF A POSSIBLE, A MAP, i.e., COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: 't'elephone No. Rlai'011'1' TU BE SENT TO: ✓2 W ao~ S. 0 " a- S~ . V-A ~dsa.~ of J~rc►tisa~ CLOSING DATE:-,- Signature: ' a ST. CROIX COUNTY tai WISCONSIN ,f^ ~ kk ZONING OFFICE } F^ ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET ® HUDSON, WI 54016 - (715) 386-4680 Aug. 18, 1992 Darlene Sorenson First Federal of LaCrosse 201 South 2nd St. Hudson, WI 54016 Dear Ms. Sorenson: An inspection of the septic system on the property of Burton & Jean Gustafson located at 841 W. Riverview, Somerset, WI was conducted on Aug. 12, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Sincerely, Thomas C. Nelson Zoning Administrator cj DEPAATMEA!T OF INDUSTRY, Q V" INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS O PRIVATE SEWAGE SYSTEMS DIVISION P.O. SOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 j (~J XCONVENTIONAL ❑ALTERNATIVE - ( S 1tate Plan I.D. Number. El Holding Tank ❑ In-Ground Pressure su lgned) ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER j ( PECTION DATE! BENCH MARK (Permanent refp ence poie}) DESCRIBE IF DIFFERENT FROM PLAN: . i ) REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber: IMPLAMPRSW No.: Count y: t Sanitary Permit Number: SEPTIC TAN OLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER _ f . _ PROVIDED: PROVIDED: [DYES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WAT R NUMBER OF ROAD: PROPERTY WELL BUILDING: ALARM FEET FROM LINEJVENT'TOFRESH AIR INLET ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANIUFA TURF WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO 'J ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N BER OF PROPERTY WELL. BUILDING. V NT TO FRESH (DIFFERENCE BETWEEN PEItT FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO N9 I AREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing, " (FORCE L GTH IDIAME TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. jNO--0F UISTR. PIPE SPACING V J I INSIDE DIA *PI TS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS ro GRAVEL DEPTH FILL DEPTH DISTR PIPF DISTR. PIPE ISTR. PIP MATERIAL NO. DISTR. NUMBER OF R E TV WELL BUILDING. V NT TO FRESH BELOW PIPES. ABOVE COVER ELEV. INLF 1 ELEV. END PIPES LINE: ! AI I LET FEET FROM ~ 'Er aE /6~ hI . ` NEAREST ~L. . I 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER- EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL I_N0_-D-I S_TR DISTR PIPE DISTRIBUI ION PIPE MATERIAL & MARKING ELEV. ELEV.. DIA ELEV. PIPES DIA: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHE CT L Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO ❑YES ❑NO COMMENTS: PERMANENTMAR KER OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE 61E' OYES I.1N0 OYES NO NEAREST ( I j 4 } to3rg N~ HT t Sketch System on etain in county file for audit. Reverse Side. 147 4 SIGNAT TITLE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, 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'/z 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, sig ture and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. IJ t~k~ ~ . k 4 I Property Owner: Mailing Address:11 ~ S S~y~3 -',Property ocation: City, Village or own5hip. " Coynty: %s Ni R E (or) W 7`- y Lot Number: Blk No.: r ubdivision Name: Nea est Road, Lake or Landmark: State Plan I.D. Number: V r 5~d ►~~c:r (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ©v HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: cJ EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental X Seepage Bed ❑ Seepage Pit a /'p- ❑ Alternative (specify) ❑ Seepage Trench Water Supply: 70w _ ner'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 o lumber: Signature: MP/MPRSW No.: Phone Number: Plumber's Add Ass: ~i, Name of Designer: , COUNTY/DEPARTMENT USE ONLY Signa ure of Issuing Agent: " Fee: Date: -y ❑ gppROVED Sanitary Permit Number: 000 0 a aD __S ❑ DISAPPROVED t 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) Gam- , DEPA''dMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION °.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 )(CONVENTIONAL ❑ALTERNATIVE Sta11 Plann l).D. Number. -~*Holding Tank El In-Ground Pressure El Mound (If assig ed N AE OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: S-S INSPECTION DATE. a BENCH ARK (Permanent reference pm DESCRIBE IF DIFFERENT FROM PL EF. PT. ELEV.: CST REF. PT. ELEV > s 3 T~ LL-) Name of Plumber. MP/MPRSW No.. County. Sanitary Permit Number. SEPTIC TAN HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COV Eft PROVIDED. PROVIDED DYES ❑NO DYES ❑NO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY W LL. BUILDING VENT TO FRESH ALARM. LINE. AIR INLET. FEET FROM DYES ❑NO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER JBEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUF ACTUREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO _ DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL JNUM13ER OF PROPERTY I J WELL BUILDING. ( VENT TO FRESH (DIFFERENCE BETWEEN (FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST-~► SOIL ABSORPTION SYSTEM. Check the soi moistureatthedepthofplowing uvr.n~ ~ v1FTER 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 JNPIPE SPACIN(; CO VER IA uPITS LIQUID BED/TRENCH TMATERAL PIT DIMENSIONS GHAVF I DFII DIPIPIPE MATERIAL. No. DISTH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BF PtPFS ABOVE COVER ELEV. INLF I ELEV. END PIPES. ` t FEET FROM LINE AIR INLET'. NEAREST-i1 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 COVER. TEXTURE PERMANENT MARKERS. JOBSERVATION WELLS I DYES ❑NO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES ❑NO DYES DNO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: _ wIUTH LENGTH. NLATERAL SPACING GRAVEL DEPTH BELOW IP1PF. FILL DEPTH ABOVE COVER BED/TRENCH ' TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. [NORPIPE DISTRIBUTION PIPE MATERIAL & MARKING FLEVELEVDIAELEV. IPES CIA ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY R MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION DYES L1 NO COVE PLANS DYES ❑NO COMMENTS: PERMANENT MARKERS'. JOBSERVATION WELLS. JN UMBER OF PROPERTY j LL. BUILDING. EET FROM LINE DYES ONO DYES ❑NO EA REST- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. [TiE. DILHR SBD 6710 (R. 01/82) 1 w^j r all CA. w M C)E ~ ~ L ra c r DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY 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: Property Location: City, Village or` ownshi y County: n,' ice'/4 '/s iT,,3j NiR 8 E. (or) W 5-1-- Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: r n5 y pf (if assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY Lam' HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New 1:1 Replacement ❑ Experimental ❑ Seepage Bed 1:1 Seepage Pit ❑ Alternative (specify) Seepage Trench 1;29 ZiC27 Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): A 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: Plumber's Addr ss: Name of Designer: COUNTY/DEPARTMENT USE ONLY Sin ture of Issuing Agent: Fee: ~q Date: El APPROVED SanitarylPermit Number: rq a-' 1:1 DISAPPROVED ! L 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) ?try t, DEVARTMENT INDUSTRY, OF REPORT ON SOIL BORINGS: AND SAFETY & BUILDINGS INDNJSTR DIVISION LABQR AND PERCOLATION TESTS (11-5) MADISO , W 63109 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION SEC-T TON:- TOWNSHIP/MUNICIPALITY: LOT NQ..BI-K. NO.: SUBDIVISIONN TWIC h~J '/,SL'/ 30 /T3I N/R 16 (or)W 5~a 7' 1'7 a. r t IL, uq CrL V1 c.0 COUNTY: OWNER'S YER' NAME: MAILING ADDRESS: L(3j. Cro1K 60,1 IU-S vpsoeN 114,80 0-k5+ Apt3 CI-►IS jo CJy MA '5S013 USE DATES OBSERVATIONS MADE NO.BEDRMS,: COMM R A DE R PTIO PROFTL D~`CniPTInNS 15EI '(5 A T STS Residence p New Replace q Za la L 1 O I BL ^_J RATING: S- Site suitable for system U= Site unsuitable for system WV E`NTIONAL' MOUND: IN-GROUNND-PRES'S'URE: SYSTE(~M-IN-FILLHOLDING TANK' RECOMMENDED SYSI FM:(optional) ElU 19 S ❑XJ ❑V OJEU aSN ~ Conuen~pnc, V11 Percolation Tests are NOT re uired DESIGN RATE U If any portion of the tested area is in the O der s.H63.09(5)Ib►, indicate: Floodplain, indicate Floodplain elevation: ~"r~, I PROFILE DESCRIPTIONS . I_ BORING L P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER O f IN, ELEVATION OBSERVED E HE TO BEDROCK IF OBSERVED (SEE ABBFIV. ON BACK.) 0--1' III SI ,gTl.e'(Sn 5111.8 3.(►Dn LS w/~►-~3Z- 1 r, B \02 T 1!0, IG Do fle 0.-176nSlI .7-.z.1 BnSill w/ fir 1.7-4. to ..s~RDnSI B_ 3 101,6 B- 9 (0 5 105.58 7- ~-5 7w 5 0--$ 1-5.1 11 .8- 1.85 4nSit l 11.85-11finSI w/9r1 b•1Is n51.,/gor B 5 4,,9 106.0 . Tw•q 7~0. I 0-.1. lz.l$111.6.1.bonSilw/9rI I.(P -3,91nSISL!I,- 3.6.4 OnS1 a s~ ~ -'t B- (o w-3 103.37 T~O.3 > Lr3 4-.9 bi l:~ ,q -1,35 Bin St) 1.35'S'ybnSl u/1r K9-~.S w8n. r B- 7 lD•~ 1 C'3. T (o1 ~!(o q 0-.831 5t1 v/51 .B-1•(0 pnStl, 2-w-S.s 4nS1 9x5.9-fo.q SI 17rntc el rn` PERCOLATION TESTS TEST DVXI-f WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL-MIN. PERIOD PERT PERIOD 3 PEH INCH P. rion 7 P- 2 no-v, 0 oo ?Z/ G , iv 1 P- 3.7 lilt n e a e- 310 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 100.31 i ~ I I I i I I i 7~ j I i i I TN i 1 I ! i 111.- .-W. \1{i~•l'd hu'vhy ce.'Illy that tile, soil Il'sts reported nn this Im n WI!(e IIINIIf' by 'Tie Ill il(~cold With the procedllres and lrwlh-lS %I,(-, 't-, I .iIlia VV', ,~Jlilnlll,llly, -le, and that the data tecorded anti the location o! Oil! I-At, aw. .nl.rrt to the has! (if my knowledge and belief IIAMI ir,Il ~I l .;f ti WF11F COM111 1 11 ll . 1 I) 10 - 10 - t1 L - ilolll.~.ICIIIIII it 1\ IIIln1.I,In;11,11i 1111 ^vp 5% ~ 140``- C 3 G. i iir> t ~ I q~ i i L t~ , /D D, 3 9 Uv rT Gu s k LA O Ro1c,', VRP ~n lot I,n~ 41~ fro f, G3' bm 7l 7o am 2 S3' gi 3 Q~ BIB r~~~~ /e~~1 ,2 b5 3b P3 '-v J O PA- 5z .,,,u b3 70' 99' i PK na- I Ora'^`j 1 e. 14 6ben\ ZoX atr7r«. ►OO,ool X1'1 Lot Corntr ion ~.P o~ C..,cc p.st ~ot~ ~5+2b LI 105 , 3' `VVl Loi corn,-r (on4opo~"rntr :51^kt) ntLarnr of F,. r-.« S ~t (Sores C55 ,ZIp~J h~ tR.F~~~~ W...