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Home My WebLink About032-2071-80-000 0 to O 'I 3 v 0 r_ 0 Er 0 'o 3 v1 3 m v ~mi I d m 1 ~ ` 1\ S o ra o m 0 o CD ow m o w w °C • s 3 o c: 9 o n 3 w -r CD m w m o N) c- A z a- N N N N O m in p O (D v ch co N cu d O CD CD m r,j O CD O O O O A7 :E 6 cn 3 0 _ _ v o e 7 N ~~77 O N C .p III ~i Di CD ? Sv (n < D m Fr w CD co N N a a :3 ul - _ 3 w CD n+r CD _ 0 m co -4 N C y 0 C z 0 0 0 m • Z O < w z n 1 c cn ch~ N O D D v v v o p O N m N co '6 !r O C _ (D t) N d N 00 (D cn C a N Z c p z ca z D a CD 0 0 Z fn h • p CD CD ~D v CD N - ~1 I (p N• C CD CD W CD n' CD (n Z p :3 A Cm! N n A z 0 CL O 0 7 00 - fZ o w (D M z I 0 3 ~ C/) O O 3 m g z CD w :E 1.11 on n C 6- CD = I N tl G C PK N CD n R C CL m z a CL a o CL W CD m ~ w O U) X y~ Q S v O C A CD CD (D CL ( D N a O 3 Cn S d0 fi O N. O ti O O ~ W CD ~i CL p~ lv O C O d a a A O.. 0 = CD D p O rfl O cc O p- Parcel 032-2071-80-000 08/14/2006 10:54 AM PAGE 1 OF 1 Alt. Parcel 13.30.20.777D 032 - TOWN OF SOMERSET 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 - HOWARD, JOHN A & LANA J JOHN A & LANA J HOWARD 1544 23RD ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 1544 23RD ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.010 Plat: N/A-NOT AVAILABLE SEC 13 T30N R20W 3.01A IN NE SW LOT 3 Block/Condo Bldg: CSM VOL 1/285 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 840/500 07/23/1997 758/21 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.010 48,000 155,500 203,500 NO Totals for 2006: General Property 3.010 48,000 155,500 203,500 Woodland 0.000 0 0 Totals for 2005: General Property 3.010 48,000 155,500 203,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 105 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2071-90-000 08/14/2006 10:55 AM PAGE 1 OF 1 Alt. Parcel 13.30.20.777E 032 - TOWN OF SOMERSET 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 - HOWARD, JOHN A & LANA J JOHN A & LANA J HOWARD 1544 23RD ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.170 Plat: N/A-NOT AVAILABLE SEC 13 T30N R20W 3.17A IN NE SW LOT 4 Block/Condo Bldg: CSM VOL 1/285 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 840/500 07/23/1997 758/21 07/23/1997 755/481 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.170 48,800 0 48,800 NO i Totals for 2006: General Property 3.170 48,800 0 48,800 Woodland 0.000 0 0 Totals for 2005: General Property 3.170 48,800 0 48,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: Cate o Amount User Special Code g ry 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 C Aw 715-962-3121 800 - 962 - 5227 cT. i:hOIX iCUN'rY 4.'POR-1 OWE' x/07191 COURTHOUSE LATE RECEIi ~Ob/91 HUDSON, WI 54016 ohn h Lars, H oward 1 3 3D. Z•v- 7 1RCE OF SAWLE2 Kitchen faucet IFORMt 0 1140 ml ERPRETATIONS Bacteriologically SAFE 17 . 3 ppm ,)ove 10 ppm exceeds the recommended Public rinking Water Standard. LAD TECHNICIAN'# ►'am Gane W1 :Approved Lab No. 19 O~,,NDEDENpE~! O` Yp v D =J t heans "LESS THAN" Detectable Level Approved by: o PROFESSIONAL LABORATORY SERVICES SINCE 1952 f i. ~s- gi - ► 3 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 ~a Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic 4iand 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 information, 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: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 L~ J (Determines if system is properly functioning at time of inspection) Property owner's name J o !4 /j c L A M A 1-~~ (.Ja Y Property owner's address 1,5(49 2 3 d ~t ~-ior, 1p1~J Legal Description 1/4 of the ~JJ 1/4 of Section Tao N-R22-A) Town of Sos" C rS,eT Lot Number 3ff~ Subdivision Name FIRE NUMBER S LOCK BOX NUMBER Color of house e Y Realty sign by house?NQIf 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: Q N % i-U 5 T W1oi t9 a ~ e C,-)AP, Telephone Number t 29?- REPORT TO BE SENT TO: d TA'4A s -r PM 0 kc a ¢ - os N r x, ,yG T~in~ y et Su ; e/ 50 r A k d O-iu bl l /s 4~2N s s i z~o M14 y ~t e Is ra Closing date S 9 9 Signature _ VV\ ~ L 3 ~.~r-tz H wy 0 4 0 5 8 O UI) N O M O y✓ F SOMERSET TWN Q-Q - - - - °p J - - --a 150TH AVE. - - - - - - - I J W F K y~0 WW (V• < Q aF a v 14STH P~ ~ ~P~~ . Q 35 64 23 24 144TH AVE. a o F= 21 % 22 a 1142ND AVE. 19 a o 20 F tl/ a F o a W HILLTOP ? a a w VI TRAIL o HILLTOP (A v 3 Z .4 -4 ~ g1( CHURCH ST. v o p co 28 PETERSON ST. 136 = 25 29 ' t o\ W AV E. 30 0 o \ a ~ 26 f jDr-S W O Or LAKE F ~i\ 2aQ ~ h 130TH AVE. F~ WEST 4 PE CH 3 ~ r d 35 F EAST E 125TH \%y 35 125TH AVE. x 126TH AVE WHITE 86 31 0 9 32 33 OAK 4 RIVERVIEW z 9 LA. 41°d RC ES RED PINE °r ~jq~ ~9C,y 6• ° A TR. o x iy C4 LF `~OS~ 0 B q CREST Z Q W BLU IRD DR. p 14 IZ DR. A V Z m 0!,- "e -i a o~ .rd, pq4 r, 4 A SA v z Z o z 04 f CORRVER ROAD ~ vii RIVER S n rc 5 4 I Wz at h F BR Y W 1 mg z m = ppND 3c cc A Y ~ ~S /r yF/ ~8 p9~i4 *1 UTTL£ fp Q I 12 T 8 9 1 Anderson Scout Camp Trail A2 Cedar Drive D3 Haggerty Street B1 Nelson Farm Road Appalousa Court D3 Cedar Drive West D3 Heron Lane A5 North Bay Road Appalousa Trail D3 Church Street B1 Hidden Oak Trail A8 Arrowood Trail C6 Crestview Trail D8 Hilltop Drive B1 Old E East Aushe9un Trail B8 Hilltop Lane B1 Old E West Awatukee Trail 88 East Oaks Trait A5 Hilltop Ridge 61 Old Huy 35 Egard Street B1 Hilltop Road 81 Old Mill Road Bass Lake Road C8 Homestead Trail B6 Bass Lake Trail B8 Fox Ridge Trail B5 Howard Road B8 Perch Lake Ridge Beatrice Circle C7 Frog Pond Lane B8 Perch Lake Road Birch Lane C6 Lemar Lane C8 Peterson Street Bluebird Drive D5 Golden Oaks Lane E4 Pine Tree Lane Broken Arrow Road D4 Golden Oaks Road E4 Main Street Al Pine Valley Trail Brown's Lane B4 McKinley Drive D4 Pine View Trail Burr Oak Lane C6 Mound Drive D8 1 ST. CROIX COUNTY Sr~x~ WISCONSIN f4x ZONING OFFICE = ST. CROIX COUNTY COURTHOUSE 19 PUWFVII~~ 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Mar. 6, 1991 Mary Melstrom Centrust Mortgage Corp. 4105 N Lexington Ave., Suite 150 Arden Hills, MN 55126 Dear Ms. Melstrom: An inspection of the septic system on the property of John & Lana Howard, located at 1544 23rd St. Houlton, WI was conducted on Mar. 5, 1991. At the same time a water sample was obtained for testing. The results of the 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 operations 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, feel free to contact me at this office. incerel M- J. Jenkins Assistant Zoning Administrator cj • AS BUILT SANITARY SYSTEM REPORT] ',DER a.• T01INSHIP SEC. T N, R W 0. ADDRESS , ST. '1-R0f C5U'NTY, WISCON' _ ?DIVISION _ LOT LOT SIZE e PL 4.N VI 1 -Distances & dimensions to meet requirements of 11462.20 SHOSd EVEF,Y'Iilliti'G WITHIN I00 FEET OF SYSTEM I I i I t I I ( i 5 r- I f r I i t i r y yt I _ i A _41 1 i ( I r I - Inds cafe North A woY., - i SCALE r"TIC TANK(S) MFGR. _CONCRETE STEEL NO. of rings on cover Depth DRY WELL tl.NCIIES N0. of width length area no. of lines Y width length area depth to top of pipe aG~ ,EGATE . RATE AREA REQUIRED AREA AS BUILT t,r,riai.mer: The inspection of this system by St. Croix County does not imply complete o'pliance with State Administrative Codes. There are other areas that it is not possibly: o 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 €_ormine cause of failure. TEASES AND OILS SHOULD NOT FEE DISPOSED THROUGH THIS SYSTMI. ' '-INSPECTOR DATED _ PLUAfBER ON JOB LICENSE NUMBER y • RFPOI;T Or UISI'?;CTI0:1--I74DIVIDUAL SE;•IAGE DISPOSIU, SYSTEH Sanitary Permit o_ ' ate Septic TOtII1SIiIP County SEPTIC TI~'?1: :iJ1.2e h . . gallons. `lumber of Compartments Distance Front: T1ell ~~J ( ft. 12% or greater slope f1. Building ~ft• We ft Highwater ft. DISPOSAL SYSTL:4 Tile Field or Seepage Pit(s) Distance From: Well ft. 12% or greater slope 1. ft Building' L- ft. Wetlands f:. 'H • 1'IT:LD iFhwater ft. . Total length of lines ft. Number of lines rem Length of each line - %ft• Distance between lines ' ft, Width of the r r trench `ft. Total absorption area h L sq. ft. Dept. of rock below the in. Dp-pth of rock over the ~ in. Cover aver .rock,, 7,;.. Depth of tile below grade Z in. Slope of trench in per 100 ft. Depth to Bedrock ft. Depth to ground water ft• PITS Number of pits Outside diameter ft. Depth below inlet ft. Gravel around pit: ___yes no. Total absorption area sq. ft. Square feet of seepage .Drench bottom area required Square feet of seepage nit a a required Inspected by~_ Title. --r Approved Date 197. Rejected Date 197. EH 115 (11-74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ' P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Section TN, R E (or) W, Township or Municipality Lot No. , Block No. County Subdivision Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION -REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- B- B- PLAN VIEW (Locate percolationtests;soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give reference point. Indicate slope. t IN I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Signature Certification No. Name of installer if known Copy C - Local Authority PL13 67 State and County State Permit # Permit Application County Perm~i3 # ~ for Private Domestic Sewage Systems County ~1 t t/` *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. -}O'WNERR OF PROPERTY Mailing Address: B. LOCATION: )VE % .5Zi% Section _L-7, T ,7 7N, R-2ZE (or) W Lot# _City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial Other (specify) *Variance Single family X_ Duplex No. of Bedrooms No. of Persons .J D. SEPTIC TANK CAPACITY /000 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete d Poured-in-Place Steel Fiberglass Other (specify) New Installation „A Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-PlaceOther (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rates'-:%Total Absorb Area sq. ft. New, 1( Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed:- X Length 0 Width ® Depth Tile depth (top) No. of Lines Y Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land. Z1 Distance from critical slope WATER SUPPLY: Private A Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME C.S.T. # "g w' and other information obtained from (owner/builder). Plumber's Signature MP PRSW# ezs_x Phone #71f laaedhQ~rl Plumber's Address J 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~, fQ aK 1 . i e E s ~ _ f , i ~ Do Not Write in Space 'Below FOR COUNTY AND STATE DEPARTMENT USI~DNLY Date of Application Fees Paid: State County, Date =21 Permit Issued/Rajected (date) - Issuing Agent Name Inspection YesXNo State Valid# Date Recd 1, county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1 /78 TRANSFER FORM PLB 67 ~ ~ SANITARY PERMIT State Permit # Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: " % Section T 4 N, R E (or) W Lot # 7" City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township x B. TYPE of Occupancy: Commercial Industrial _ Other (Specify) Single Family X Duplex No. of Bedrooms } Variance C. SEPTIC TANK CAPACITY It L ' Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete A Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Z/l 'Total Absorb Area sq. ft. New X Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: X4-*_Length fir' Width f.'s' Depth 6i '2 Tile Depth(top)4.No. of Lines 2 Seepage Pit: Inside d ameter Liquid Depth No. Seepage Pits Percent slope of land - r' Distance from critical slope E. WATER SUPPLY: 5k Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name fx Sm%V Name ! /~l /i/rf+ S Address I L Zt 11 5tf Z Z ' Address -2' A ~ Zip Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared by the Certified Soil Tesler and/or any additional soil tests that may have been required. Plumber's Signatures yr - 1y' MP/MPRSW # Phone #2~_'i 1`> Plumber's Address Information obtained from ) t /v- owne or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor s_pro ert . If well has of been drilled,p a jr>dica e ~r tfh C 4 - - i- i 7 t r Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green (copy) P.O. BOX 309, MADISON WI 53701 TRANSFER FORM SANITARY PERMIT PT LB 67 _ State Permit # Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: '/4 Section T N, R E (or) W Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township B. TYPE of Occupancy:. Commercial Industrial _ Other (Specify) Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete Poured-in-place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines Seepage Pit: Inside o ameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name Name Address Address Zip Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20., Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prepared by the Certified Soil Tester and/or any additional soil tests that may have been required. Plumber's Signature MP/MPRSW # Phone # - Plumber's Address Information obtained from (owner or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's ro ert .If well has cat been drilled_JeaS l I n ~ ~ a g tea. ~ 4 a ! g t I v . . . . . . - Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green (copy) P.O. BOX 309, MADISON WI 53701 PLB 6 7 State and County State Permit # Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: -0114,tFY4 Section , T _A4 N, R ZP-, E (or) Lot# 3,4- 4e City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: C mmercial Industrial r *Other (specify) *Variance Single family x- Duplex No. of Bedrooms j No. of Persons-_ D. SEPTIC TANK CAPACITY 060Pe~) Total gallons No. of tanks 0 HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete---4 Poured-in-Place Steel Fiberglass Other (specify) New Installation ~l Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E . EFFLUENT DISPOSAL SYSTEM: Percolation Rate `,CCU ' otal Absorb Area .49T sq. ft. New. X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: 'A Length7-0 _Width a Depth Tile depth (top) No. of Lines- 3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land G-1 ---I 1,;fb Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: 1, 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 j{j-o46C-Z,~e C.S.T. # and other information obtained from (44 ner uilder). Plumber's Signature 1. MP/MPRSW#.i2G `ice Phone # a/~~j'y CGS y Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. , r e- Rt J /Ot'clzr eL 13 _ '//SIG , K .V , Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State County Date Permit Issued/Rejected (date) Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Section 1-3, T3PIV, R 15 (or W~Township or Municipality G~ s Lot No. 2! ,Block No. C'e, i° F~~~ ~u.u~ Subdlor~N e/~~~S County S1~ etD~`X Owner's Name:gg ~y ~~}cL /~t.-s / Mailing Address: ~~d/0" CAI 41'0-,3 ADX 3.3 if lloll4e l C4.), TYPE OF OCCUPANCY: Residence X No. of Bedrooms -3 Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS F PERCOLATION TESTS SOILMAPSHEET _ SOI!_TYPE~ r / /V4/-N PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 t 3 F- - 2- -4 PA 1,4 S~e v, i- .16 n_3 P_ -3 Se- -114 Y16 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) j B- 3 t/(t1`C,aCL 7P6•' (f ILS, 3E " /Yv Y/4 f-5, 3 rc,lAe~l S1 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate nu ber of square feet of absorption area needed for building type and occupancy. ^2 w o1 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. AF7`~- S~r~tFe~, z I aj+~ 9j- f ¢ I ~ Pty r ell I i w. I Y ° 0 o Aj- i 34~ I 1 I ~7tw~ Ia. I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief Name (print) 3 Certification No. ~Sr rj yy Address Name of installer if known l✓ CST Signatur - nCAL A-UTHORI-TY - c - - 67 State and County State Permit # PLB Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: '/4 '/4, Section T_ N, R_ E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private ❑ Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone # Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. s 4 i e E f ~r E E j yy. M Z e a e ~ s was e._. ..m_ i 3 1 E , E E a E I R A E t 1 E F 3 F , ~ 1 3 r E 1 1 4 s ~ 3 i~ E e Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: State County Date Permit Issued/Rejected (date) Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 S EH 1t5 (11-74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVIt,,_.. DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 308 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TEST'S LOCATION: RE% lvl` '/4 ,Section 1 T3.CN, R rOX(or) W, Township or Municipality... ,4s Lot No. ~5. Block No.h.~ix (FACE ZF' "'Couniy r 1ZG X Suk clivision Name Owner's Name: ._._iJ C) 1`411 A, 1r,-A, -T i c nl Mailing Address: _~t t vet. v 1 y~ t K F Z 1 7- e, ►a~ tn.~ I. c SIMC.i~ TYPE OF OCCUPANCY: Residence T--A.N-t„__y No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW _--__ADDITION - REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS-1 C_ PERCOLATION TESTS _ti N TiA.r~'_ S~ T I t3 n N1- - - SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST I DEPTH CHARACTER SOI L HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE - NUM- INCHES THICKNESS IN INCHES Si~~CE HvLcnuLC AF T En iw i-En'vAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD PERIOD 3 MIN/IN P- , I C _ P L 3 1! 1( 1 1 ! I Q~ iu 3 S .7' I i / I I~' t~ P SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 1 7 z 7 z>V s z~- 5 B- 7 7 7z. " L, Ts B- 7 7 Z_ L" LTs 4 Ste. 47--sJL PLAN VIEW (Locate percolationtestssoil bore holes and suitable soil areas.) i Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area i necueu for building type and occupancy. ri ~T. J11,11 K-'- f-,r..,"C •indicate scale or distances. Give reference point. Indicate slope. X'-C 7a.t h ~y ST C ra derr*k o 1 _ i .r ~-~-{f--- S 1 rk _i z I - - - I CtN S I I v u~ t_i~{- - E - - - - j f' f= AlzEA IN I n L I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. ' Name (print) - Signature_-____. Certification No. zC) Name of installer if known Copy A J • n ~ -5-,2 3 77D 3 so 6sl r G/ j V a