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HomeMy WebLinkAbout008-1002-50-000 n Ul 0 9 v n o o d ~1 M a # c_ :r n o N N o ~ co = m o 00 `C . m Oo c co CI0.0 m p• D 3 0 CD 0 0 _ (P G) n a o 0 0° CD oo J o rn N o `Al W O CO n J CD -1 O l o w er m S o D b y cn a O o 3 ° - o p N Z J N N O O .•r C 0. ! d u> D F P. a' CD cc N N G. N J W I m c N I ~ ~ ~ 0 0 0 (D W N (~C) (0 ~ ` fzfz eQ44 N otD~o N o caN N O O O a o v v If -n~ v I~ OJ D A (D !V O N N U) N N W I Z Z Z -0 c D D O N Err O CD N N • J CD a c _ C J I w ~ O O 3 C: s Z d A Z m O N n ~ Z O a J Z N v o m co o z a zt 3 a o o m rn CD w w O (D CD Q ry N o v J TI v c m - ~ a o 0 m 0 J N o~ a x CD I fi O 4 CD `C cn cn Q N V N N N Q O C O~ p 0 N ~ A N a ,6,9 0 o * c ,q O CL ti Cl/ r AS BUILT SANITARY STSTEV REPORT 1 ; c ~t 1'U43i~J;;tl7_i' "u ✓ ; EC I - 10 : X COUNTY, W T:,CONS IN . 0 I SUKIJIVTSION LOT LOT SIZE PLAN VIEW 'Distances and dimensions to meet requirements of H63 -n-h H-OW_ LVEI YTA 1=NG WITHIN tOO FEET OF SYSTEM . I I 1„t.l 1 r< f : i ! I } -t - t-- - t-- - - - ! I ditattp nzthi Axrnw j- ISC Q. BKNGHMARK (Permanent reference Pu.i nt) Describe: i,:levat ion of vertical reference print: - - -----Slope at: site. EPTIC TANK_ Manufacturer: '^,c- is Liquid Capacity: l =t'} 'Jumber of rings on cover _Tank manhole cover elevaion: a, 1 I' a n k Inlet Elevation L /')O` 1 Tank Outlet Elev tion: li~} < P C}t11MBER of r Manufac Curer : Number o gallons - _ _ -L--.. ---a-- r gallons totalcapac ity o - lumber of dal pump se,-)FA)r ~ - pump head. a dist ribut ion 1 ines l l on. ~ -AN-ST ga'power J~; brandname of pump 11an per minute-"' _ Isc se a _r and model number_.__:_ 'T'yne of warning device _ HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Tvpe of warning devLce - ~c e t c~iamc t t'r S EPAGE PIT SIZE: Numlj>er a~ pits - feet. Liquid depth - seepa. 2'e pit i_n1et pipe-elevat ion bot t om of seepage pit e1 evat run feet. `;EEPAGE 13CD SIZE: number p l i tae's w_i dt h Length - 'I'R1,,NCk1: wilt 11 AREA L1:(?j l e~n)"I }I AREA L {Z 0;1 RATt~: F t i ZEA AS RL}IL,T ~ ~t t 7ell 1 }ttM}il. {~TJ '101'i S~ Pl-e I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION P.O. BOX-7969 - SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON, WI 53707 ❑ Mound ❑ Pressure Distribution NAME OF PERM HOLDER At) RFSS OF PE LIMIT HOLDER.. INSPECT ION DATE PLAN ID NUMBER _ /z o i'te- BENCH MARK (Pnrrnumm f ruN,-rn po,, 1 DES 'HI. E I IJI It 111 NI FII6-,PLAN IILf PI. 11.1 V CST HI I . PI. L I F.V SEPTIC TANK: {r FACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET LLEV (11 jVMJ$F* i ©F PHOPL'HfY LINL Wf LL JIIUILDIN(~ DOSING CHAMBER: OVI~N K DEED OVER MANUFACTURER. LIQUID CAPACITY: PUMP MODEL: IPUMPMA NUFACTURER: WARNING LABEL LOC PROVIDED ❑ YES ❑ NO ❑ YES ❑ NO GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL F JPROPERTY WELL BUILDING IVLNF TO FRESH DIFFERENCE BETWEEN FEET ER{~AA LINE: PUMP ON AND OFF ❑ YES ❑ NO INEARE$T----&- SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW F-1 YES 1:1 NO meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: {TRIVrL, WIDTH: LENGTH: NO.OF SPACING CENTER ty LENGTH: DIAMETEH MAT F. VITAL AND MARKING GI`D . f - TRENCHES: TO CENTER. j iD Co [?fiVl~~tS.lc7 S MAIN MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: DIA.: PIPES. DIA.. ELVA CEt)i, VERTICAL LIFT CORRESPONDS TO APPROVED HOLE SIZE: HOLE SPACING. DRILLED CORRECTLY: DEPTH OF GRAVEL OVER PIPES: PLANS. ❑ YES ❑ NO ❑ YES ❑ NO SOIL COVER: TEXTURE: DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODUE D: SEEDED. fIULCHEI1. CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: NATURE'. l i I I. t DI LHR-SBD-6227 (R. 05/81 SIG RE:1101x'1` Oh' INSPECTION - INDIVIDUAL SEWAGP; SYS'T'EM Sanitary Perini t ow State Sept i NAME '1'OWNS II1P St. Croix Cuurit v 1. 0 CAT10NJAJ- SectLon Lot Subdivisiun ~I PT IC TANK Sizegallons Number of compartments Distance from: W e I I Building_ 127, slope }ii_ghwater 1't1MP I NC (IIAM1iF.R - Size E/ ga.1Ions Pump ManufacLurer Model Numbt~r HOLD I NG TANK Size gallons Number of Compartments P u m p e. r A .I 1 r m System_ Distance from: Well- Building 12% slope Ifighwater ABSORP'T'ION SITE Bed french Distance from: Well ~ Building 12% slope Nighwater ABSORPT10N SITE DIMENSIONS Width of trench ft Required area ft f..ength of eac}i line ft Depth of rock below tile, in Number of Line Depth of rock over tile, Cot~r.l length o ~.nes✓ t. Depth of til~e below Yad i n Distance between tines 1-t tr c It i1) per I U(! i t . A114)" 41&;I I Total absort1) tion area fL Ty pe of Cover: 1111' DIMENSIONS Number of pits Gravel around 1) Its yes no outside diameter ft Depth below inlet ft Total absorption area ft Area required ---ft I N S l h T 1 11' L E APPROVED D ATE t 98 REJECTED DATE 198 REASON FOR REJECTION State Permit # PL8'67 State and County Permit Application County Per it # u ication 1 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required 1 ' State Plan I.D. # 01 A. OWNER OF PROPERTY Mailing Address: Thorvold Halderson Rri 1 Woodville, A B. LOCATION: ICE % SE Section 1 T 2d N, R 1 E (or) Y(V) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township i~BU Galle C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms j No. of Persons 2 D. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 1 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement X Lift Pump Tank or Siphon Chamber 750 Total gallons Prefab concrete x Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 40Mill- Total Absorb Area X40 sq. ft. New Replacement X Alternate (Specify) Seepage Trench: X No. of Lineal Ft. 160 Width 4 n Depth Tile depth (top) 16 * No. of Trenches 4 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 21. Distance from critical slope N I/ WATER SUPPLY: Private ® 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 Stephen L. Aaby C.S.T. # 1406 and other information obtained from owner (owner/builder). Plumber's Signature MP/MPRSW# 5164 Phone # 6g~ - 2807 Plumber's Address box .)4 ,goo y e, 4Z 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. 1 s , I F r j r . i_e . .,a ,e tee, b_..... e «d„~.........„,_ Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application /Gf Fees Paid: State /y 0-0 Co my t 6-10 Date cy- -49 Yl Permit Issued/ set (date) /0 -..7 9-- J'/ Issuing Agent Name Inspection Yes 4_No State Valid# Date Ree'd 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 k r YY+ti~i~I _ to ~J ,rn -ta I;i d a n ( 1 1t s (V. Iti I ~ 1 rte, 41 1 ro r. II 1 t .fl I r~ 1 I t r I i l: , f~ 7< M'1N 1 I ) r 1` r ~l ' 11 1 -1..._ v. ~,J--1 ni b ~ ~ c a vi t1. 2. 'r o ~ O 9 C, IVY NLlrfvi~ I Y i ^l" f { v j ; 1 Ck' CL : V I i \A VAW l,J ~ ' ray ~~t:.^~w~j~ C,_~„'~" ~ ~ ~ ~ ~ ~ ~ ( ,1 aN + 1 ej tl lF f ~ i a Rr_Gr_wt_.n y I~181 f'f UMAING Gf~_cIION O r'vt '?,pr r.uli,~ y 1 C 41 ~ a. t. fl-l CI I~ t c n ~ f. r B q ~ r171 '^n Ut4. 4w4'v4vti I ~ 911 l! I .:;ry'~~rrvr 1'.tfv f ' ~.w,~~ ,x,,0,..1,.. ,1'• e fi w `r 1,e1 1~or s I9'Yt^1~y ! r~' ~jfY11u0 T ~ r~..,,C,lrl «i 1 m ~A~ 11 ~ I hW 1 1 y~ ~yy ~r>, os ~"s 41 fit << T n f p' ~ "~llf yEf 1 Q d A ; r 1M r ,t t h , }I r )i1ap ~,adrr'a.) f v pt r a prw`fl ~F'~1n'ryl~trq arfi M''1~+,. 1 r, c 7 , r t! I I~~_ " 00 t p~, I r .Ink1 "I ~ 4'PJ ~C, i b tra^ca1gly+t~~"""! rafiwr~*+r .1 baQronm home. The Site ~ ~`y "~1U1rs 1~l'! pwlhMr IA~+droc!k In. I, % . r! i~ S'~dYk tl U ~'"l91 '+Yr' ^-~-(J--- min./in 6%fof 0 from dOON OMrnWe r to d ifgat a~4 but i on system a"~wlt iii 'o'4'Pf'aroot# , twO#itn pu" An4 (1I0-0huf,lnn system -~--~5 ft.. RECEIVED ! AIJI 1 1981 5 wo n AbOtOrr AMPM AP PA PLUMBING SECTION ,~I~t+:k;~tjM+ + ~q!N4'I1A'~'►"~l .c~ ~ , ~ ..v r. Want anoth 1A 01 POW use a mnarold. Atom 11 1 j . wK''"gip"IiN +~Ma1 ''Y' 'a! 1 Ulm is in ov" P L h. l "fiI~ II`'f X11 N I "Mfg µ l; Y. 5rMA nF m. TF I ,iu~~Cl~°PI'r+;:;~ ~a ~!►pMb~w+'~ I ~1 ,gip ~ , ~ ip POPU MAIN A) CIRchArge raw s (t) Farce MA In Frictinn Inns ~rS't I 17a~ I. fa, l arl~ l . TINAL I)VNAMI C JIk.AI) A) SAW& lilt RECEIVED /IUD:; 1 g 1981 IN, \10, !Imf State of Wisconsin ` Departmen of 'lndyatreL~or._ nd Human Relations ~ Please Reply to: AF~ & BUILDINGS DIVISION r elr By e' of Plumbing 1 ox 7969 adison, WI 53707 z Plan Identification Number Re: PRIVATE SEWAGE SYSTEM ONLY- The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The plans and specifications were prepared by and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a Wastes from the building will discharge to a -gallon capacity septic tank which will discharge to 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 By: Count Other Enclosures mes Sargent, B erector DI LHR-SBD-6159 (R. 7/81) Plb-Na.12/78 State of VV isconsin .Detach And Return Upper DIV Portion Of This Form With - SEECTCTIIOON N OF HEALTH OF PLUMBING ^//E AND FIRE PROTECTION SYSTEMS Any Return Correspondencq MAIL ADDRESS: P.O. BOX 309 / MADISON, WISCONSIN 53701 608-266-3815 DATE: _I IO~r _ PROJECT: O~c c/`Ir SE-4, Jed.. 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 Code. ❑ Affidavit enclosed. ll. 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. III. 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. ❑ Soil boring and percolation test on EH 115 completed by certifiedsoil 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. ~ 5 s ►nd Return Upper ti ate of Wisconsin ;DIVISON OF HEALTH Of This Form With a q ! Y0 SECTION OF PLUMBING I rr ~.A,NDIRE PROTECTION SYSTEMS urn Correspondence IL ADDRESS: P.O. BOX 309 ADI SON, WISCONSIN 53701 608-266-3815 PROJECT: SE'k, Sec. 1, T' PLAN ID. # DETACH HERE E PLAN ID. # mledge receipt of your plans and specifications for the above-indicated project. indicates the plan review fee required is $ 1ccepted for review. Fee received is $ ned because of ❑ Overpayment ❑ Underpayment. he two catagories above is checked, remit correct fee in one payment. emitted. Plans submitted with no fees will be held in abeyance. A. lion required. SEE BELOW. ation shall be submitted in triplicate unless specifically note, . ;ble or permanent. mitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. +d. Systems (Mound Systems) for use of an alternate system). (1 copy). ❑ Design calculations for pressurized distribution ❑ Pipe lateral layout. ❑ Plan view of alternate. ms tours in entire area of soil absorption system extending 25' on all sides. ference point (benchmark). )r replacement system - provide soil test data. -id all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. holding or lift pump tank if site constructed or tank manufacturer if precast. -section of soil absorption system. st on EH 115 completed by certified soil tester (1 copy). ,,ipated use of bldg. ❑ 3 copies of PLB 60 enclosed. 0y). owner and local unit of government (sample enclosed). ;oil test or statement from county (1 copy). arge, head and gallons pumped per cycle. siphons including size, pump Curves, dravvdown and average flow rate GPM. 1 pump(s) or siphon(s). Sian submission) J edge of trench before side slope begin). plumbing supervisor. DEF'AR 1 N-;rNT OF REPORT ON SOIL BORINGS AND TY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (1151 P.O. OX 7969 HUMAN RELATIONS \ / fp /QrML ISON, ' 153707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. N BDIVI ION:NA N r / sA/4 1 /T 28 N/R 16 E (or)I &u Galle IO 108 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: F,y~F r St. Croix Thorvald Halderson tiii 1, Woodville, A USE DATES OBSERVA ONS;M DE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ROFILE DESCRIPT L ON TESTS: ®Residence 7 ❑New ❑x Replace 6/25/61 /G] RATING: S= Site suitable for system system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 1:1 S ❑U 1:1 S ❑U ❑x S 1:1U 70S ❑U ❑ S In-Ground-Pressure If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. I If any portion of the lot is in the under s.H63.09(5)(b), indicate: 93;' 8" Floodplain, indicate Floodplain elevation: N/A PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 77" 97' None N/A 7" t.s. 10" gy sil 60" sl °(mot at 64") B- 2 68" 97' None N/A 14" t.s. 6" gy sil 46" sl (mlbt at 64n) B- 3 66" 96' 6, None N/A 12" t.s. 48" gl sil 36" sl (mot at 56") B-4 71" 96' 2" None N/A 7" t.s. 10" gy sil 54" sl (mot at 56") B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 P RI D PER INCH P- 1 No o 3/4 / 3/4 40 P- 2 34 No 0 3/4 374 40 P- 2411 NQ 30 1 1 1 30 P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION ,.l E Z / f . . _ ._B_.... c~ q ~r er /k.nC E / ! t3,r r~- - -7 03 T C14 D IL I t'~ c.J.' S G'H ' w+N f~~, jp,° F~~~t a j= C17it1< ~{~s~~~ ;At 'I, Ile 0 "K ►t F4 n rq R C? P a vu 12 All I, the undersigned, hereby certify that the soil tests reported on thig form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Stephen L. Asby 6/26/81 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): Box 254, Woodville, Wi CST 1406 698-2407 CST SIGNATURE: _ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) r WISCONSIN DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING, PLATTING & I-IRE PROTECTION POST OFFICE BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of 1I; I- o c a ti on NE 1/4 - SE 1/4 S --1----- T '418 N---, R 16-----V ~ 6 rO W town or Municipality V.ate GaLlc___-_ _ Street Address R R. I GTo~icTv Te- LET- 54 0-7 R !ut: No. T Block _ Subdivision I_ indowner's Name: Thorvo_ld Hal_der-son the application for this site is to serve a: I~ new construction use. replacement system use. It this is a NEW CONSTRUCTION USE, the alternative private sewage system is to be included as: ❑ part of the 3%/5% limitation. This i, number of the applications made through this office. one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil ,r;rAr;a }:hlished h,. the department. I__Ja lot that meets the site criteria for a conventional private sewage system. !I '.hip, as REPLACEMENT SYSTEM USE, the mound is replacing: U a failing conventional soil absorption system. L1a holding tank that was installed and in use prior to February l,' 1980. ❑ a privy that was installed and in use prior to February 1, 1980. I certify that the above information is true and accurate to the best qf-n4L--bww.jedge. 1 Name - - 1 U. r a S e ~c S C"-) Sign - 11t,le Date Au ust 1.7, 198-1. n1Uix-S8D- 6158 (N.7/80) ST. CROI X COUNTY WI SC O N S I N ZONING OFFICE 796-223) HAMMOND, WI 54015 _August 17, 1981 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Thorvold Halderson located at the NE4 of the SE-4 Section 1, T28N-R16W Eau Galle township , in St. Croix County, revealed suitable soils at a depth of 56inches, below which seasonable high ground water was noted. This site should be suitable for an in-ground pressure system Should 1 I1,1v tt7,Y yiic:itIis g?Lc i:,E ctrl i rt e to contact. t` -iis office. Yours truly, 1 Thomas C. Nelson Assistant Zoning Administrator TCN:sl n N O 9-0 n d ~1 o c z v M c _ v `3 v ~ m 3 0 0 o o • c CL a D CL 00 y 1° n m m p N 7 O i ~ s o D° O (D (D !~1 CL s o o f CD ? Z3 ° Z O m c a (n Z D a cn d N D W D CD o (D O zt Z, o o o "%N.A ~ O z (0 C C/) O W CO CLOD N r p a 0 0 n •°*:2 Z . O O O ~ e~~1 I~ 77c CA cn fC/) W ~f cn N fD N n 7 LI •O A CD M _ A ° N 00 3 m O N D D O N O O (n ~ c !r m c. • CD m a c ~ 0 N ~ -4 fn O. p Z W A Z O Z N W _0 m m m z o i' O Cl) 3 m 0) y ~ < CD A W N n (D co a 3 00 a CD N o - v c m - ~ 0 o a :D ~ m N N O n a CD 0 S7 ` m fi N ~ a N (p O O O b O m a C) CD Parcel 008-1002-50-000 07/26/2006 10:59 AM PAGE 1 OF 1 Alt. Parcel 1.28.16.13A 008 - TOWN OF EAU GALLE 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 O - HALDERSON, HARVEY HARVEY HALDERSON 542 270TH ST WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 542 270TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 28.000 Plat: N/A-NOT AVAILABLE SEC 1 T28N R16W 28A NE SE N OF INT HWY Block/Condo Bldg: 94 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1253/094 PR 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/03/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 26.000 2,800 0 2,800 NO AGRICULTURAL FOREST G5M 0.500 100 0 100 NO OTHER G7 1.500 5,800 52,400 58,200 NO Totals for 2006: General Property 28.000 8,700 52,400 61,100 Woodland 0.000 0 0 Totals for 2005: General Property 28.000 8,700 52,400 61,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/200'1 Batch 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00