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HomeMy WebLinkAbout040-1118-90-000 n cn O 9 v n m 0 ~1 ? m mm 0 ~ v 3 C v 3 3 O 0) 0 00 Q Z a y m m 1 N_ N (n pWj V=i F O 90 0 ` 1 N Q O_ O O 0 f> > Q N O N O O C m m 77 A 7 0) G) 6 3 W O 7 N W O Q K C O N m N D a a m (D N r 3 m m N V Q O N N Z co j co CD O O !1 N W T N O C !V I z oCCoo~ ~ "wA' o cn l/R C G p G N Z m' ? 3 ai N cn ° D O Q v N O ° C _ M cn N W N z ° z co z 0 > m o v o Q 0 S O O CD CD Z• fA a N C N N. CD W ~ O_ O p Z M c n = A Z O m a ,n 0 (DD ((D c CL Z 3 'a 3 r: Z ~ N Z CD ? W C_ Q - Q G (p O ~ T ~ N C CD Z a (D o O_ ~ y N C A CD CL i m O CD CD c` CL m c 3 m o 0 aa) a 3 a CD o b N < %o N o o O °o Owner: Bock, Jeff Computer 040-1118-90-000 Address: 368 Page Lane Parcel 31.28.19.482G River Falls, WI 54022 Municipality: Troy, Town of Address: 368 Page Lane River Falls, W 1 54022 1211311999 Bock, Jeff Jon Sonnentag Asked for the list of people on the BOA 1212711999 Bock, Jeff Jon Sonnentag He said that he had been trying to get a hold of Kathy Nelson, but she hasn't been in and won't be in until January 3rd - the date Jeff was supposed to have his tree plan in. I told him that we won't hold him to that date for now. I would try to talk to Rod or Steve to see who else we may contact. If nothing could be finished by January 3rd I told him to maybe just put together a list of the people he has called and what he hopes to do. 11/15/2001 Bock, Jeff Jon Sonnentag Jeff called to see what he needs to do for his review. I told him that it won't be a big deal and that we will probably just drive by. I told him that someone would get a hold of him. I M r ' U U I (~`T r ~g INSTALLED 6-22-83 ~~D 1) Li (~~fi 2 fstm glros.3 Parcel 040-1118-90-000 10/18/2006 12:48 PM PAGE 1 OF 1 Alt. Parcel 31.28.19.482G 040 - TOWN OF TROY 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 JEFFREY G BOCK O - BOCK, JEFFREY G 368 PAGE LA RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 368 PAGE LA SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 6.850 Plat: N/A-NOT AVAILABLE SEC 31 T28N R1 9W 6.85 AC LOT 2 OF CSM V Block/Condo Bldg: 4/1083 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1047/585 QC 07/23/1997 908/90 07/23/1997 838/254 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.850 80,000 179,000 259,000 NO Totals for 2006: General Property 6.850 80,000 179,000 259,000 Woodland 0.000 0 0 Totals for 2005: General Property 6.850 80,000 179,000 259,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 `COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 C3:w ii~ f. CROIK COUN-,Y R}FURT DAfL. 6/14/91 COURTHOUSE DATE RECEIVEM 6/13./91 UPSON. WI :x4016 ~ WNERt Peter Ster td Z6 aOURCE OF SAMPLE2 Outs: WOLIFORM. 0 /100 mi NTERPRETATIONS BacteriologicaLLY SAFE ppm - .eve 10 ppm exceeds the recommended Public ',r i nk i ng Water Standard. S 10 (b AB TECHNICIAN: Pam Gane N lc 9 LO >,C 91 A Means "LESS THAN" Detectable Level Approved b, PROFESSIONAL LABORATORY SERVICES SINCE 1952 / ST. CROIX COUNTY ZONING OFFICE 911 4th Street Hudson WI 54016 Telephone - (715)386-4680 ~ r' i[e 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:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.0 0- ti PROPERTY OWNERS NAME : &3 r'` _ , ~r' ✓i r PROPERTY OWNERS ADDRESS : 6ITY: Legal Description _Sd 1/4, I,i 1/4, Sec. , T -?e N-R1LW, Town of Ty. i,, , Lot No. Subdivision FIRE NO. U' LOCK BOX NO. Color of house Realty sign? Firm: 1 k ;.d;g.) PLEASE INCLUDE, IF AT ALL 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: 7)_.~:~E Telephone No. IL '-I - i k J.r i c- X1,3 - 7!5'-17 REPORT TO BE SENT TO: V LLt CLOSING DATE : r _ - y signature: T ACT TROY 28N R.20-I9W 13 T SEE RAGE 25 -a~ \Q 1 cp tP=oe ~`e "~•r <7no'/ewG. atilt ~i e etQ/ c. A~J LAKE 1 • /a¢¢ M.nbaeh ~CTOn~S x~ y~y.c.9. Ise. ye 2 /1/e/srn z A ST CROIX Ma~ue~ite o wf//amJ `"~7 tsf /z Zeta En/oe ~.F., J a • BO' 67 $ e 6i67 W//¢ 4 x V i~ FFF q+Y° o ~ Q ,y MCA •crQrncsf T't~cC. N /49 Wood uff- ° FF u a Sh.~/ee f Roc ~l '7 L9.43 ` 131.7 /ttOr1770-17 ~ ~ ro • y' ? i r 3 •E/Rfon 1 E7'i ck. • /9-t 7925 S9 9 ~Cn ~ s Kon R. t B e~ ~ W n //9s ~a a,~ • 9g s 5 ~ e. ~ 1~ `y° M cS~` / Erdman C$4/mcv7 1 ~ n '27 yJ7 'f~T F.r za 6✓. Oho a s i x /44 r ,s C-7177ms f tfa~ ' beet H Y9 new rancrs ~~O/et may 1. /2 A,G75: 9~ _ /55.2 RD lop Q 29.25 (T 0177e,5 Fj tSch.6o ~e Ae . `L Oa f7/ Th ~uemrre/e y 2 /leiq o ~7a s 7075 7 1Tahri J /.6 LV .6~ow - o`~cih J 5 ^ ~ emrna/e go -Do -z6o r7 Ju .JO ~(~y QCoe • .v.F~ ROLL C 274.7 2744 P qc~ A ~W W / .~Tb e~/~/dye, ~K.s .no~rw,W _ e Edth M ~/sd sum • a25~ .6a~ba~a/ Pe0 san •3 an Kasa . /Nebe.- /BO c'9 5 £ ff0 P q• V 1 ~ee/Q \ } s/L#• S z (}'Wc17if b0 Lo/7¢ F7/v~i,C \ oc y a 3~ o Evs <ye, r E, eta / v 7,673 Co bC 1 _ > v u /ia Ce~nohaus .q(-CI 0 D Sr D. 20 Hffy l /GO U E D L .fi HJ frl_ll. ~ a~is - 1 uC O InNAS sly ci Ch./dt . U C x r uc.r u :ru.,erts y o j 9~ Leo. ASS RO. ss vld tl C L ~9 mb~ust- Funk ~ ~ •?~o/.kC el7o/ . • O.. t ~ ~ e! Cernohaus /58.67 /LO 4o use y J 1 'r W116e.11es e _ q7h q MM 1,97 F7ffo/fa Th f P(`/ /c,~,> e Le o ~N i K ~abuo Bo F I wn ~a-9 Geo y ¢ .Fa ~ tfo6c 9y Ba husma~ vb En/a Piiscs, Ltzz', _ 64 O k. z Cia~san ra C f' 11 B . o%s I od iIWACO C 0 • cif g 7e /s..6 Y v o e ~S Bs3 o.semu/ /sue. s /LWAC . 153 G3 V`~ 4r ~ 0 h 0 0 /:5,3 a a. a Ro/%Q, i C h .r 7s .moo -iTo~ a.3e z F ca.- JdC je \ - ~st CJ~IJ Mo t L9RS ockfoc "a, N b/sue Inc. c PIERCE COUN TY M • Bo R. 20 W.,I,R./9 W, stc /n a~n7y,w,s. NOTICE All maps and other copy in this plat book are protected by the copyright. No item in whole or in part in this plat book may be copied, traced, reprinted nor any photographic reproduction be made. Any such violation will be prosecuted to the limit of the copyright laws. This applies to ALL users of this book, as well as any printer, photocopier or an other person making such copies or reproductions. any ` ROCKFORD MAP PUBLISHERS, Inc. ©Copyright 1985 - Rockford Map Publishers, Inc. Joy P. Dummer, President j ST. CROIX COUNTY m WISCONSIN s ~F~r ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ' 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 13, 1991 Peter Stern Rt.3, 368 Page Lane River Falls, WI 54002 Dear Mr. Stern: An inspection of the septic system on the property of Peter Stern, located at Rt.3, 368 Page Lane, River Falls, WI was conducted on June 12, 1991. 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 from 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. n erely, Mar kins Assistant Zoning Administrator cj AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC-AT_N-R W ST. CROIX COUNTY, WISCONSIN. ADDRESS SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dim rCsioiT I" t y\meet requirements of H63 T RY171H C WITHIIJ 100 FE'E'T OF SYSTEM r_jp I di ate orth~ A ro - - - - -S CA I_ , : BENCHMARK: (Permanent reference Point) Describe: I A2 Elevation of vertical reference point: /0L) Slope at site: SEPTIC TANK: Manufacturer: Ll~ F' Liquid Capacity: 1L;Z_) ) Number of rings on cover : Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Huzaber of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width le-fgth rile depthll~~,,'_j SEEPAGE TRENCH: width f length 5~)w PERCOLATION RATE _C'/ ZTt AREA REQUIRES AREA AS BUILT Vic; INSPECTOR DATED- Z- - 3 PLUMBER ON JOBwB LICENSE NUMBER~'~ > RTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS _ABOR &-riI;MAN~RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.`BOX 7969 , BUREAU OF PLUMBING MAC',$,;ON, WI 53707 ``qCONVENTIONAL ❑ALTERNATIVE (if sPl assigned LD,Number ❑Hol ) ding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. APERMIT HOLDER. INSPECTION DATE. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. IT. ELEV. Narne of Plumber. V71 In AC IMP/MPRtW No County. Sanitary Permit Number: L SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV TANK OUTLET ELEV. WARNING LABEL LOC NG OV Q i PH OVIDED PR D YES ❑NO S NO J PR OPERT`/ WELL BUILDING. VENT TO FRESH BEDDING. VENT DIA. VENT MAIL f.~ WATER NUMBER OF ROAD: { M ?p FEET FROM LINE~~ -7Y AIR LET ❑ YES NO L C lLJ.YLB` NO NEAREST - _ L DOSING CHAMBER: MANUFACTURER BEDU ING. L.I QUID CAPACITY PU P MODEL. IMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP D ONTR9CSOPER N L NUMBER OF JIPERTV IVIELL BUILDING II/ENTTOIRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ' S NO NEAREST yll~ SOIL ABSORPTION SYSTEM. Check thesoil mois real he epth pl vv in -i-r1 - - ER MATERIAL AND MARKIN or excavation. (If soil can be rolled into a wire ' onstr t IT shall cease un II FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR PIP .SPACING; COVER INSIDE CIA -PITS LIQUID BEd/TRENCH _ THE HES 1 4T Mea ~L PIT DEPTH DIMENSIONS (~fiA F I F" T'r FILL DEPTH D 7n. PIPE UI PIPE DISTR PIPE MATERIAL. NO. DI NUMBER OF PROPERTY WELL; BUILDING VENT TO FHESII Bf t Pf ABOVE COV H E l f EL/ PIPES LIN T. C` FEET FROM Q I NEAREST-s►~ v v 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. ❑YES ❑NO SOIL COVER. TEXTURE PERMANENT MARKERS. OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER THENCH;BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO. OF LATERALSPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE ELEVATION AND DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA ELEV. PIPES DIA.'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑ ❑YES ❑NO YES ❑NO COMMENTS:_ PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF 1PROPERTY WELL: BUILDING: FEET FROM LINE q ❑YES ❑NO ❑YES L~JNO NEAREST ---)w _ 1 d.~( A _ Cero a/ll,~ 5 37~ 11 Sketch System on \ l .~(a Retain i my f for audit. Reverse Side. r~ DILHR SBD 6710 (R. 01/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,. . DIVISION LABOIi 7969 HUMAN REDLATIONS' PERCOLATION TESTS (115) P.O. BOX MADISON, WI 53707 3707 6.9 4etA_%_ LLOCATIONJVVI-a SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVIWN NAME: >q '/a 1/ V /T)f N/R/I E (or) W 2- COUNTY: . OWNER'S/BUYER'S NAME: MAI LING ADDRESS: v USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R F DESCRIPTIONS: 1PERCOLATION TESTS: Residence -3 NIL New ❑Replace 7 Z 2 lff~` U= Site unsuitable for system Q()~/711AePr C / v RATING: S= Site suitable for system / CONVENTIONAL: MIN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SS,//YSTEM:(optionalJ) )/33 fj. ❑U ❑U SI$ ❑ U DU I U av~E.uTi~v~L /3~~ l%Cs . If Percolation Tests are NOT required DESIGN RATE: SY V I If any portion of the lot is in the under s.H63.09(5)(b), indicate: I` Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) G „ /a3 i,)O.o~ >103 u. c., ~a' /3 iy „ B / L p /.Q,,. v44 s` 537 0,e CS B l (G Fr, > "Qu• Caj~ st SZ , /2;' aN f 54 , 'y ~y .0 FT > /S 13,,j - o,e • S w. yie C B- 7,? fT > 7S B-:r 79 y7Fj. ~ > 79 S4, y~' ~-aNG y g_ ~O 0 raj ~r c^' 'V._ s & 0,4M ,2 j L • /3ay . S Lr L N - ~jSCL Wr 4w-,,o, 4,I I-i- 'Q -OR -10 A0011) #,ei-A DF /36 ~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH I P 3419 > Z <3 P- llJ~4 'Pg,410"All P- Z O > E s c / L SS < 1 P_ NiT P- > c 3 fi 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, 9fe 7 FT. , A#r /S10 13orra r oF i3FD EXCA(l yj/D,V $~iALL Lim- EXi9crLy SYSTEM ELEVATION K 3 FT /3e~o~ UE~'TiC~tL 1P~f . Poi r A16T_1 t3M lr~r ~ ~(p Voi,~r i-cT- 0 = poc Lvc~rim y 16y57EM &oi// lxV 6eYw,,_E,l1 1 • PY 13,3 --13y -13 5 H~Eh f~ UgiC r9/3fE /9 X56 1I /}LTE~'N1'TEi~E~ 1 -/3-3 (~j3 TN .4,F~ 4u4;1_ 196/ z ~ S~ 'x 5 So' f7jo~'3E luiG L G%E 1 ~5" i~ %O 18 Z$ ~.e WeS r of tZ~ST t3~PF~fs . AtwL_ Mu5r IiE- >_dFj 6) g~~Izo+ gt N LM = R C STEEL fE,(1CE po5 si T N E-I r 7O VERric~L REF f'Qi,~r ;.S 1.~,95E AF AdQ liuCE /~o5f j iT R9o~, ~gt~o~ _ /00, D I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures inethoJs specified in the Wiscui-ji, 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):/h /,C TESTS WERE COMPLETED ON: ADDRESS: CE TIFI ATION NUMBER: PHONE NUMBER optionall: • 3 O 'luFiL_cQ~VSa0 Lrr'iS ~yf/~ SS -nZ1~~ ~CS~T SIGNA IRE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS I'NDUSTRY,. 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 81/2 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 Township: County :C~ X !5W % li-r'/aS /T 2S NCR ~q E (or) W JJ Lot Number: B/lk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: TYPE (If assigned) 2- tP•D l4Gi,~ 'DOV u - TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY I&TV HOLDING TANK CAPACITY N4 LIFT PUMP TANK/SIPHON CHAMBER A MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROP SED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit 4 3 J` p+~~~ ❑ Alternative (specify) El Seepage Trench Water Supply: C`' J 0 Owner's Name as Listed on Soil Test Report (If other than present owner): A Private E] Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na a of Plumber: Signa MP/MPRSW o.: Phone Number: Plumber's Address: Name of Design r: 722 MOAV,0) 6 5T - P K COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ APPROVED Sanitary Permit Number: ❑ DISAPPROVED 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) Wisconsin Department of Industry, Labor & Human Relations PLB-1 INSPECTION REPORT Safety & Buildings Division Bureau of Plumb in , Platting & Fire Protection a e an o. -Name o remises Street y County Sanitary Permit Master um er Firm Name dress Journeyman-Plumber Address wner Address - iscusse with Signature ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o is . um ing up. n- i e as a pecia is l;hite-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner z . w PLB ~7 pc.or and CRO55 o~ w w SEC710 N PJAN5 of v ~ `s d 3 ~~ac ~ I W ~ ~ y~✓v~,J3 v ~0 ~n I V ~ I s ~ 1 I a0p/ M - -1 O ~ O 1 D r' - o0 1- I '1~ Q~L (h\ C-1 qc- o h ti I Noo \v 01\ xv 2 a ~ v ~A~Pk ~E~P.(1E~ - LoT o ~ou~ p T,o.U -02o y T@wk) ti i& AIED L fCEa/SZ h " C , v Fresh Air Inlets And Observation Pipe ~ o v 5 Approved Vent Cap h v Minimum 12" Above J Final Grade 411 Cast Iron `t 2q Above Pipe ~ Vent Pipe To Final Grade v R Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution _ Tee Pipe --40 0 000 ~ILUA)r/OA) OP p- " Aggregate 0 Perforated Pipe Below IF- y0,At) 1100) Beneath Pipe 0 Coupling Terminating At Bottom Of System f WEST Y T. 28 N.- R.20-19 W 13 '.PART T R, 1 SEE PAGE 2S s¢n. 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O Dore 7B /5.L ~ h /S(.S h ~9BS iPay Dusc,F V``l C4. - p a a . t /s9 C~ ~(I{r //~J Toh J IV f/~~/~©~ E /93 Tarns f. 'e, //a ~ d 3 i l ~To f ti ° s~hwC ¢ Co~J 5'v~ T 1 ss -s -7 . /L wAC • RD. FOB ~s~ U Mo f n CCy9~B c.Ef n /%a,, Pub/s I c., Kr~/979P/ERCE COUNTY n R. ZO W- I -R. /9 W, J & J SALES AMERICAN FAMILY UNION STATE - Arctic Cat & Yamaha WEBSTER, INC. Cycles & Snowmobiles AUTO HOME BUS/NESS HEALTH LIFE P.O. Box 846 r John H. Jacobson -Owner STEVE MOORE AGENCY Amery, Wisconsin 54001 732 North Knowles New Richmond 425-8989 715 - 268-7117 246-2488 704 North Main Street Insurance Of All Kinds River Falls, Wisconsin 54022 v' r p - C > zm r~ D Cr = z C C❑ r p m O-J O~ Z co C D C/) co D? 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C o a 0 ? o ~~o- = 3 m 3 D m m I--► m N 3 D3 c m m Da m c ° iA o m 3 0 ° 0 C ° o s m a_ 3 ° o s D CD I • ' , w ~l y~j~ ROHL & TIMM EXCAVATING JOB_ SHEET NO. OF 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY ` DATE 7--y (715) 386-8664 Z CHECKED BY DATES- _ y r~✓ SCALE R v ^l f PRODUCY204-1 Jno., Groton, Mass. 01471. - ~ r JOB /1 (U i~?.~CvJY %LiY ROHL & TIMM EXCAVATING SHEET NO. OF "2- • 310 Arch Street HUDSON, WIS. 54016 CALCULATED BY V ATE r C Z (715) 386-8664 CHECKED BY ~ DATE 2~ ✓ SCALE ,l L Y H 4 ' 41"C oz 4:: ' -du, - t J f PRODUCT 2041 a Inc.. Groton, Mar, 01471, w y E ~ ~ ~ ~ t: