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HomeMy WebLinkAbout024-1006-40-000 0 Ci) 0 C -V 0 C7 ~w `o1 o y F 7 0) o c 3 3 C o n1. CD CD1 n U) M a=i vNi O' O' o 3 N OD m N N ? H N X- N .~3 d. N ,(D (D C-D co Z d n 00 C~l N a 7 NO D) N G W "S C:, CD CD 0) r (D CD n ° rn 3 0 ) sp o to c n 0 0 CD o m CD * u> < D a tD (a N co a I o I~ Cil CD o 3 a °i ' 3 V (D -4 -4 C CD CO ~ n K Cl) cl) C- Q cor "W Z 0 0 0 (D • n a N N N o D `may o 7 m (D a v N W (p fD IQ M N z zco z o D a o ::r N y i aQ D N C (D CD W O. a 3 S Z (D -4 N O O ? Z N c , ~ n A Z O w a G7 F! o. Z -i W N) CD (D 00 CL Z p _ ? 0 V 3 Z m m ' w f =r N 0) N > N O O,a~ a N !A CD O- °-.j as o N m m D -n ~C-)ono). z 3 6 o C). F o m-o m N 0) (D m o v m m jt o O c 3 N x 00 O A O (D Cp V O O O a CD PO tv v O A 0 w CD DO V tv 0 0 o O ` ►l ti 01/08/2007 03:19 PM Parcel 024-1006-40-000 PAGE 1 OF 1 Alt. Parcel 6.28.17.34C 024 - TOWN OF PLEASANT VALLEY 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 - STEPHANI, PAUL H & LIZABETH J PAUL H & LIZABETH J STEPHANI 585 CTY RD J ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 585 CTY RD J SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.580 Plat: N/A-NOT AVAILABLE SEC 6 T28N R17W NW1/4 NE1/4 DESC AS LOT Block/Condo Bldg: 1 CSM 4/1106 TOWNSHIP PLEASANT VALLEY Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 10/08/2003 742954 2431/173 WD 07/23/1997 912/324 07/23/1997 875/11 07/23/1997 771/197 2006 SUMMARY Bill M Fair Market Value: Assessed with: 156417 249,000 Valuations: Last Changed: 06/03/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.580 25,500 146,400 171,900 NO Totals for 2006: General Property 1.580 25,500 146,400 171,900 Woodland 0.000 0 0 Totals for 2005: General Property 1.580 25,500 146,400 171,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 206 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 1:A: 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.. 06312/01 PAGE i ST. CROIX COUNTY REPORT DATE. 6/18/90 COURTHOUSE IIATF RECEIVED. 6/15/90 HUDSON, WI Z 3~tG OWNER: R i ci'J:: u <,th,- t t I TIP SOURCE OF SAI'fF'LE. K i tche , r COLIFORM. 0 /100 m. INTERPRETATION. Bacterioi- , NITRATE-N. 4 ppw Cotiform Bacteria/10( i2 T'n. OF•\NDEVFIy~fHl t` elm rygD ...Lw_ J` ~t.1 i. t~c ham' 7 o PROFESSIONAL LABORATORY SERVICES SINCE 1952 F` ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Nr 'L X Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following infcrmation, enclose appropriate fee made payable to St. Croix County Zoning Office, 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: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name r_.c A ~ Property owner's address Legal Description 1/4 of the L- 1/4f of Section T N-R Town of LLL Lot Number l Subdivision Name L s r`, FIRE NUMBER LOCK BOX NUMBER Color of house > -,iRealty sign by house?,k.,_ If so, list firm: 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: Telephone Number REPORT TO BE SENT TO: Closing date Signatures ST. CROIX COUNTY WISCONSIN ZONING OFFICE - M ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 June 15, 1990 Steve Miller Hammond State Bank 915 Davis St. Hammond, WI 54015 Dear Mr. Miller: An inspection of the septic system on the Richard Graf property, located at the NW 1/4 of the NE 1/4 of Sec. 6, Town of Pleasant Valley, was inspected on June 14, 1990. At the same time I also obtained a water sample 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 o chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspections. 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 is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj Cr i7' I F'1'r,D StJLiVEY i.L; P iiA"Ry iiANSUN Part al' the Northwest 1/4 of the Northeast, 1/4 of ;3e e t,i_ori 6, `I`ownshi l) ?fs or-t,}i, West, Town of Pleasant Valley, St. Croix Coimty, vJ.isconsirl. • Indicates 1" diameter iron pihc, f'nund UJ I/4 CDR. SEC. 6, T 28 N, R 17 W, o Indicates 1" x ~'?t" i.ron pi pe we i p,;r1_infr 1 . 1 j 1 bs./lin. f't,. (COUNTY SUR V EYOR'S MONUMENT) i S 00° 00' 00"E 660.00' UNPLATTED LANDS S 89. 49' 55"W 218.30 W 3.3 9 8 00 0 0 O. Sg M W o ~0. a p'9 -0 66 Ot -1 0 33 ' i` 't o ~ o o C o -z v► 1o z f $ ~ o o I M a1 a z w Z _ LOT 1 J W2 a1 = M w 1.579 ACRES of xo W NET = 1.340ACRES _ w 1-N in 68,764 SQ. FT. 0 o Q W S NET=58,275 SQ.FT._ a 0 o J I ; I °o o wr a Iz o z o Z I W O 190. a O z (n O = I b O OZ o l e ao; 0* 'n Z_ CO W 00 N Q ~ W z 33.3' 1 8 5.00' ~ Z89.49' 55"E 218.30' o as R(N90e0O'OOE 185.00') _j J W 4 U) C. S. M. LOT I SCALE I" = 100' S1/4 CDR. SEC 6, VOL. 3, PAGE 643 T28N,R17W, (COUNTY SURVEYOR'S MONUMENT) DESCRI P I'IUN That certain parcel of land located in the Northwest 1/4 of they i:ort,h~ sat 1~~1 nt~~ct,i<1r. i,, Township 28 North, range 17 West, Town of Pleasant, Valley, ' 't. Croix Co>.mty, 'iii co- ,,in, ;core fully descr.ibod as follows; Commencing at the North 1/14 corner of :iairi lection 6, thence S 00° 00' 00" (r, ,,iznie~i b( on the North/South 1/4 Line of said ~ecti_on 6) a d:ist_uice of 660.00' to the ('F' of thE-; parcel to be herein desc ril)od ; hence onri t;i nu, on sa.-id ] in(, S 00' 00' 00" 51 x.00' ; thence N 89° 49' 55" E 33.50' to a I" diiametev iron kilo= fouled; thence cone u~ r fv „~o ;}cJ' I (recorded as N 0° 00' 00" a distance of 18'_.00' can tho North line of that Cr,rtific,ei -)uivr:: Map recorded in Volume 3, Page 643, of ate Croix. Ccn.Lnty !,('cords to a 1" d-i.~.unetFr Lron p(l)c found; thence N 001 00' 00" E 315-00'; ttlence :i W 30I to uI lf uF' BEGINvING, containing 1.`>79 acres, more ()r less, bean!, siib,joct to easement over the m,,,it( 33' thereof for C.T.H. "J" purposes. Mate, of 'v.iscorisin) Courity of Pierce) ~~a~p(tmnnmHU~~~~ 1, Jarens i_,. ~~'Lurphy, Hepjotl're,i Land >ur'vey'or, du ~]E r'ft~V 0,r t l 1' !1'it_ 1,:x Harry tiarison, I have surveyed and eiivided ;,rie (maid he ,-e,on i n c ~lr 'i ~ records, Chapter 236 of 'wisconrain -tatutles and the Urdlii~inces o;' CA JAW,') , - the above reap and description are a truce and correct. r~1,resent,~ ~.i r,n tIr-4df'. Da ted. 11 Aup ust 1981 S 2 Vol . ~1~age 1 tob ' Certi F'i.ed Survey Maps James i.. ~•Iurphy isconin t{F'frl ,t,r,i l,;ltl(1 nJY'V~ Ll1NU C~ Croix COlLTlty, W s ~ ~i (11111111`".' i lb ' ' AS BUILT SANITARY SYSTEM REPORT ADDRESS /t:iC" TOWNSHIP", I~ .1'SEC.~ T NR - ST. CROIX COUNTY WISCONSIN. -.DIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 f`, SHOD' EVERYTHING WITHIN 100 FEET OF SYSM ,~v~ - 1 - - - - _ -r- 4-F ! I I ~ I I ' I ~ j z I ~ "a Gtr ' P I A 4,Q FT J. i ---t-- 7 ~5S-10 11, .1 7F TIC TANK(S)/" 1'1-t'MFGR. , I vtd i cafe Notch Atcnvw CO.*CRETE STEEL Scale i N0_-o f rings on cover_ -,i_ Depth DRY WELL ':CHES NO. of widtIn length area no. of lines ,3 widths length area ..depth to top of piped 3=,EGATE R.~TE /c' AREA REQUIRED 1a AREA AS BUILT c -claimer: The inspection of this system by St. Croix County does not imply complete _raliance with State Administrative Codes. There are other areas that it is not possible - inspect at this point of construction. St. Croix County assumes no liability for stem operation. However, if failure is noted the County will make every effort to --ermine cause of failure. ZiSES A;vTD OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTE-11. 'INSPECTOR DATED PLL2IBER ON JOB - ~ • LICENSE NiJ MER - - I 'REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitary Permit "Pez State Septic /~oSQ __r(e TOWNSHIP-L(~ _ St. Croix TCounty NAMF. Lr I,0 CA'1'ION Section Lot Subdivision SCPTIC TANK Size gallons Number of compartments Distance from: Well Buil.ding~~ _ 127 slope- Highwater PUMY7 NG -CHAMBER Y~1,r;~~ ti r t ~j' r✓' ~I S Size gallons Pump Manuf..acturer L ti[)C5 Model Number ~t I10L1) TNC TANK Size gallons Number of Compartments c-A Pumper Alarm System Distance from: Well Building 1.2% slope Highwater ___J ~.1 ABSORPTION SITE Bed Trench Distance from: Well Building 12% s]_ope Highwater t ABSORPTION SITE DIMENSIONS ~ t C _ v. t j > Width of trench % Z ft Required area ft Length of each 1_ine~~ ~ i ft Depth of rock below tile___4"= in. Number of lines Depth of rock over tile Total length of lines c^' ft Depth of tile below grade _ in. Distance between lines ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover: I'IT DIMENSIONS Number of pits Gr;2vel around pits- yes no Outside diameter ft/ Deptl~beIow inlet ft 't'otal absorption area ft Aresi required ft X~ ? r s I NSPEC'I'ED BY`- 7_% TI`I'LI APPROVED DATE 1 ~ 1.98 REJECTED DATE 198 REASON FOR REJECTION _ t~A "DEPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & B DI VI ON 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. The owners copy or a legible reproduction of the soil test report must be included. 47, Property O ner: Mailing Address: Property Location: City, Village o owns i County: 1Y0'/4 I'll 4S /T 2 ' N/R / E (or W - :5 0,17t Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Lan mark: State Plan I. D. Number: Vnd Y -Rip 'e " (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* 1:1 Other (specify)* Bedrooms: L!1~1 or 2 Family *State Approval Required. 5 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY C ILO HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: Cgtn~f 46A ;14, EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ✓~New ❑ Replacement ❑ Experimental 5J Seepage Bed ❑ Seepage Pit ':Z TG' - ❑ Alternative (specify) ❑ Seepage Trench Water Supply: T Owner's Name as Listed on Soil Test Report (If other than present owner): _7 LYJ Private El Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/MPR6W{ No.: Phone Number: Plumber's Address: 61 Name of Designer: h~ COUNTY/DEPARTMENT USE ONLY Signature of I uing Agent: j Fee: Date: APPROVED Sanitary Permit Number: DISAPPROVED' Reason ar Disapproval: y 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 (N.03/81) 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% 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: City, Village or Township: County: /VW1i/4111£ '/aS E /T2e5 NCR / E (or a Cc Avr i 1.,z. 5r, c er' Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: •T~ ' j3" - •r (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 10 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB P RED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE P ACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY j~ v y HOLDING TANK CAPACITY t,- LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: ( s!' EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): LJ New Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specifyY ❑ Seepage Trench Water Supply: Owner'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 sewa system shown on the attached plans. Name of Plumber: Signature: MPhVPRSW No.: Phone Number: .8, A~Z_) 1 ( Plumber's Address: ( 17 Name of Designer: COUNTY/DEPARTMENT USE ONLY Sign t e of Issuing Age t: Fee: 1 Date: Sanitary Permit Number: 6^ APPROVED U El 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 (N.03/81) c NDOSTNI , OF REPORT ON SOIL BORING \ AFETY&BUILDINGS DIVISION I NDUSTRY, LABOR AND PERCOLATION TESTS 5 Z j y P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: L O.: BL . NO.: S DI ~yl N NAME: lY ►V 114wLY4 6 /T 2g N/R 17E (or) W P) V it,_- COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRE S: _S r Pete USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL DESCRIPTION: ROFILE DESCRIPTIONS: 1PERCOLATION TESTS: [AResidence 3 ®,New ❑Replace s/,_-'A RATING: S= Site suitable for system U= Site unsuitable for system S. M , S IV ('f V CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) QS ❑U [~S ❑U ®S ❑U ©S ❑U ❑S ❑U -_-j If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. , If any portion of the lot is in the (under s.H63.09(5)(b), indicate: In -'~1-- I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGH-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- .4 % ' /0 1) j AAl d 0 "'4,412 A 13- 2 0 /tT" h1 "C' s w I dr dr B 3 C & 29 13 1 13, y 3' s Of 13- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 5y ev~ r , ^ P- , ..Z ~r►F P ; G < 3-1 , P- ~P- - PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dist Q sgribe,-7 at are the hori- points and show their location on the plot plan. Show the surface elevation at all boring' s~etra t e'dit~cti and percent zontal and vertical elevation reference n . of land slop. SYSTEM ELEVATION(, IVEO T -5 7 , A1.►~ 1 1981 Bo r e hGlF$ zomm; X Pert A4e5 A 1 r DF OFFICE LN ! f1e1r4fion/00` P/an FcdJ._ PfCp X r` a ' TW_ or in C e ~ ~ tlcas ~ 1 _ ' Sm411'Lr~ IIA job Ln Qt~cn~ Jar-1f t3usv.f aret center of (!~oktftf4j otae' I, the undersigned, hereby certify that the soil tests reported on this 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: C' ADDRES ,c CERTIFICATION NUMBER: PHONE NUMBER (optional): CST ATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tes er. DI LHR-SB D-6395 (N. 03/81) INDUS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN RELATIONS LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: N tv /a /T. N/Ni E (or) W VQ COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ST C i G i ~ l ~c 1 I( ~C Ii R ( j.) r T USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE TONS: PERCOLATION TESTS: Residence New ❑Replace I P? RATING: S= Site suitable for system U= Site unsuitable for system 7~ IV ew j CONVE/`\`~N~TIONAL: MOUND: IN-GROUND-PRESIIS''URE: SYSTEM-IN-FIILLHOLDII/`\NN~~--G TANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the 0 1. under s.H63.09(5)(b), indicate: 7 c. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) L , E J_ ~~yp F /G - % f3 ? c/a log 7y r 7C j r~ rz / In S 13- _73 _Z 3. 3., r e 13 B-- 7 ?A M e .c n / a n k :F a 77 ii h 13. i /,c -5 ' no yt b.4 '.3 C. B- ® 9::Z n i nvne /C" n Z"13n1 "G 20" 13- ----r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NQ-ATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- ff,, P W~ 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 7'7" .tom brL.,k G / Pro ^ Fe.7d a... QP ilc'i i4C1Ek ' a ~Ittih ~s~r*~FcA} s ~ haacx~ '~`P` ° ~ _ h Pr I i~U a v z_ . ~ .41 r AreQ i, the undersigned, hereby certify that the soil tests reported on this 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 int): TESTS WERE COMPLETED ON: t C S e r1 2t if ; 11 ADDR S: CERTIF CATI N NUMBER: PHONE NUMBER optional): lei .5 G^ J_XV -_3t,.3 2 -7 1 CST SIG AT RE: f~ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 IN. 03/81) ASAN ~1~~ •1 1 N~ h~. Neu Alt- r s p & t' -1u fit IZ ~ l /1 8~UD CrK~ ~ Lip 1 k Al z i. i r4 F ' xis -hofCO ►o t ,4.CT,~Xn~et rG~ A 2-_ iC[t W1G~ ~ / • 1 i 4 N i" 1 ~p~ie "If You Like Our Service, Tell Your Friends" BIRCHWOOD PLUMBING AND HEATING E. F. GROVE, OWNER PHONE 425-5824 ROUTE THREE RIVER FALLS, WISCONSIN 54022 i 7` g hl GCCIC' E'r y LLk GL d All i if 3 -/d w ' # i C/1-41 w~ g y~ _y DEPAR EMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS 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'/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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: City, Village or Township: County: '/a '/aS /T NCR E (or) W Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: Tof tate Plan I.D. Number: 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 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner'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. l Name of Plumber: Signature: MP/MPRSW No.: Phone Number: 1 ) Plumber's Address: Name of Designer: 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 DIL;AF1-SBD-6398 (N.03/81) J 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% 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: City, Village or Township: County: t/4 t/4S /T N/R E (or) W Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: 7tfate Plan I. D. Number: 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 HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): El Private E] 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 Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ APPROVED Sanitary Permit Number: CI 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 ir- stailation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81)