Loading...
HomeMy WebLinkAbout038-1087-30-000 C . CD , F 2. E. •v n .a it c CD CD (D d ^ a~ co rg 1: :1 F z r) 0 Co "A. C7 y N D7 N O W W &T 0 N N O O N fD W ~ Q_ J Q :z~ N '[J j p O co 7 fl'. co 01 O N O W -s \ 1 N D- N N cn W O O CD (D (D -D 0 B- E3 O N (D 'p O 3 ° r D ° y~ w N Po ° O y Z o O CD W CD Cn D ip fl (D (O N Q (D W y 3 Q C 0 0 C) V O (O (O m O CD O al _n !I: lz t0 N O co O O O O 3 c~i~ can ~Zml m ~1 Q N N Fn' m 12. K v CD 77 CD cr N < 61 O O 0) ~ O (D N N `r, z 07 Z O D CD O O ~ 0 CD O (D N CD N N C fD (D CD n 7 N --i cn 3 p Z CD A z O (n -1 N W -D C j fD O Z CL A 0 O Z 60' 3 m u, z CD A N 7 S O O Q ~ CD O C =r CD O O O0 T = N C O N - z a N O O_ O- N ~Q < !D s- NJ rn N 4t b N N A O 0 A O ~ a v CD 131 O q CD Isk S Parcel 038-1087-30-000 06/02/2009 04:47 PM PAGE 1 OF 1 Alt. Parcel 21.31.18.359A 38 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - OLSON, ROGER L & NANCY P ROGER L & NANCY P OLSON 2061 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 38.450 Plat: N/A-NOT AVAILABLE SEC 21 T31 N R1 8W SW NE EXC P 359B BUT Block/Condo Bldg: INCLUDING ABANDONED HWY IN VOL 541 P 292 EXC CSM 11/3227 Tract(s): (Sec-Twn-Rn 40 1/4 160 1/4) 21-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 08/16/1976 334803 541/292 QC 07/10/1969 297053 452/249 WD 2009 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/12/2008 Description Class Acres Land r--CO e Total State Reason RESIDENTIAL G1 4.000 64,00 0 166,900 NO AGRICULTURAL G4 13.650 2,300 0, - 2,300 NO UNDEVELOPED G5 17.000 30,500 30,500 NO COUNTY X3 3.800 0 0 0 NO Totals for 2009: General Property 34.650 96,800 102,900 199,700 Woodland 0.000 0 0 Totals for 2008: General Property 34.650 96,800 102,900 199,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Ch rges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT !DER.. } , TOWNSHIP ~ ~ SEC. r N R W ? 1 1,, j _j/ 0. ADDRESS , ST. CROIX COUNTY, WISCONSIN. ~ ~ ?DIVZSION LOT- S l Yn awl LOT LOT SIZE PLAN VIEW -Distances dimensions to meet requirements of H62.20 C'~y, - SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM # I # i ^ P' ~ I i i Inldicate Northi Arrota SCALE: ,PTIC TANK(S)_ _ MFGR. CONCRETE STEEL N0. or rings on cover / Depth DRY WELL .ENCHES NO. of width length area no. of lines - width jj t lengthj.~-_ areaE:i` - depth "to top of pipe ,d *a6?ZEGATE /i~ `'RY RATE,,.,. AREA REQUIRED I _y AREA AS BUILT` itsciaimer: The inspection of this system by St. Croix County does not imply complete .opliance with State Administrative Codes. There are other areas that it is not possible ,o inspect at this point of construction. St. Croix County assumes no liability for yStem operation. However, if failure is noted the County will make every effort to ,jtermine cause of failure. ,,EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST 'INSPECTOR DATED - - PLUINMER ON JOBS LICENSE NUMBER S ff SOIL EVALUATION REPORT #2115 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service Attach complete site plan on paper not less than 8'/z x 11 inches in an u County include, but not limited to: vertical and horizontal reference po. (B d i St. Croix percent slope, scale or dimensions, north arrow, and locatio o nearest road. Parcel I.D.p3f /Op 0 30"-- . Please print a'REOVIVE - Revi Date Personal information you be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~1, 9 b Property Owner 13 1 2009 Property Location V/ Mark & Julie Ball Govt. Lot na SW1/4, NE1/4, S21, T31N, R18W Property Owner's Ma ress 5i W Mjl^.,Qu - - Block 8. ZONING OFFICE Lot 1 bd. Na or C M#~ 2q66Cty Rd C PLANNING na .Q t . CSM /UG~tJ - - - - - - - City State Zip Code Phone Number city Village ~I Town Nearest Road Somerset WI 54025 715-760-0636 Star Prairie Cty Rd C New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: na ji~j, • - A 10, a~ft Parent material outvvash r~dd plain elevation, if appli69ble (~J na ft. General comments Conventional System, system elevation 95.25ft. Trenches spaced and depth to code 3.00ft below grade and recommendations: ❑ Boring # Boring Pit Ground surface elev. 98.25 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/4 none sl 2msbk dfr cs if 0.6 1.0 2 10-21 10yr4/4 none sl 2msbk dfr cs na 0.6 1.0 3 21-34 7_5yr4/4 none grms osg ml cs na .7 1.6 - - 4 34-120 7.5yr4/6 none cos osg ml cs na .7 1.6 - T~i~ ~ 3 0 ~ ~i4 s ~ i Boring ❑ Boring # Pit Ground surface elev. _ 98.25 ft. Depth to limiting factor 120 in. Soil Application Rate Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft' Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 1 0-10 10yr3/2 none sl 2msbk dfr cs if 0.6 1.0 2 10-32 7.5yr4/4 none grms osg ml cs ~na .7 1.6 3 32-120 7.5yr4/6 none cos osg ml na na .7 1.6 Effluent #1 = BODS> 30 < 220 nab/ d TSS >30 < 150 g/L Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L - - CST Name (Please Print) ~Sign tufe:"y CST Number David - Steel `u - _ ~ ! 248956 - - - Address Steel's Soil Serbrc.e Date Evaluation Conducted Telephone Number 1699 150th St New Richmond, WI 5401111 5/29/2009 715-760-0347 SI3D-8 330 (R.07,00) Property Owner Mark & Julie Ball Parcel ID # Page 2 of 3! • - Boring # Boring Pit 98.25 ft. Depth to limiting factor Ground surface elev. 9 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence, Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i 'Eff#l 'Eff#2 1 0-20 10yr3/2 none sl 2msbk dfr gw if 0.6 1.0 2 20-46 7.5yr4/4 none ms osg ml gw na 7 1.6 3 46-120 7.5yr4/6 none Cos os ml 9 na na .7 1.6 Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t 'Eff#2 I Boring ft. Depth to limiting factor in. F-1 Boring # Pit Ground surface elev. -----ft - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence) Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 I " Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If }you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or T"pY 608-264-8777. SBD-83;() (R 07 ;00) Steel's Soil Service f North Country Surveying, Inc. Douglas R. Crane, P.L.S. 7875 Big Doctor Lake Road Siren, Wisconsin 54872-8405 (715) 349-5957 A Parcel of Land Located in the Southwest 14 of the D Northeast 14, Section 21, Township 31 North, 1:: Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin 09 North 14 Corner NTY E Section 21 Northeast Corner P. O.B. B Section 21 . Z w ° NW Corner ° GRAPHIC SCALE ° SW%-NE~4 Unplatted Small Parcels ; cn cn 1" = 160' o a 160' m / (R. S89'44'10"E) N89'22'45 "E 400.00' N89'22'45"E 2248.29' 0' 100' 160' 320' 98 6. See Note j / See Note on Fence o on Fence AAA* ~ ~ / N ~0 a)_ N N 'rea A N o East V4 Corner Q I'~ I~ / ~Ae Mobile Home N J cn Section 21 iD 1 o Svnall Parcel A,/ W I R / J V. 1188 P. 570 ryo f*7 Sure Dated 3-29-02 5~•ha p 3 b iR I off./,/~,~51' „nl0b Fence - (D m (D Ic)) to N89'22'34"E 332.65' to 0 0 I D ;M Lot I o o~ / (R. S89'44'10"E, 332.63') C) Cn o 0~S ° 130,680 sq. ft. - o I N N j 3.00 acres o o O N O 3 369.85' M ((D 589'22'45"W 6O• 0 (D D O O / Z (D N rt 2 1 I p a 3 C(D o f p ~7 I z Q) / , g o o ~I o / yd n \ V ~I Q IN Lot 2 Oc' o o P I I n ¢ I 3 I 256,371 sq. ft. 1< (D o o ° (D 5.88 acres o fy> ~R/' 3 m I~ `Q DSO LEGEND 33' 33' 01 / O 1" x 24",1.68 lbs./ft. Iron Pipe Set (1.315" O.D.) * 1" Iron Pipe Found (1.315" O.D.) I,0) p Q 3/4" Iron Pipe Found (1.050" O.D.) / I_ I~ I OO 3/4" Rebar Found Ib,~ k Survey Mark Nail Found 0:) I~ 1130 County Aluminum Monument Found V10. Soil Boring (RJ Recorded As GX~ c# Curve Identifier -See Curve Data Table °~e CURVE DATA TABLE ~ U4 ( Curve Lot No. Length Radius Delta C. Bearing Chord T. Bearin T. Bearing ~q' N 01 C#1 Lot 2 75.09' 894.98' 4'48'24" S44 '25'27"W 75.06 546'49'39"W S42'01'1 5"W C#2 Lot 1 181.85' 238.79' 43'38'00" N21 '38'18"E 177.49 N43'27'18"E N00'10'42"W C#3 Easement 101.13' 121.21' 47'48'02" S24'04'43"E 98.22 800'10'42"E S47'58'44"E N v ( ~~~\\\\IUIIIIIUUp/U~~~' l~ I o i co DOUGLAS R. 00 CRANE S-1511 SIREN i WISC. South Y4 Corner June 1, 2009 Section 21 Page 1 of 3 '~g~~,~,//1111111111111 1 i 1 7 ~1 °7 ~ / ~iI f yy(( l 150A • "U IT 000 = bg IJ SS £6 = £g~ IJ SZ'86 = Zg TJ SZ'86 = to suoIJT?nal- ~4utzog si~uljos odid and ,tlc o do l3 SZ'OOI l3 xHwLiouag JId = • ; f adid and «p/£.Io doZ li 00,001 "ai3 x.zLu.TT.Iouag = V = I ICI puata7 -p impuoa sem Isar Dios aqT aanl aqT w, paysijqujsa Tou aaaM sauil job luauawad se `umoys se aq Tou ~Crw ao Cuw is3i sigl jo uoiluaol ayZ •asn ano/C aoj alqujins aq aou ~Cuui ao /~uw p `Tuawaaunba.i Quiuoz e /~Jsllus of palonpuoa suns uoqunlena J!OS siq~ 81 £0-9tZ-S IL X134 1101 INSJ Lp£0-09L-SIL Ioa.Tia XTO]D 'IS `;)IJIBJd CIS JO UMOJ, 9S68t7Z# .o?Z LIOtSIM`PUOW-qoT'd maN M812J' Ii£.L`IZS't/IJN`17/IMS INS.IMO&ISD ~S 410O 1 6691 Iiug oiln f puL, jjpN IaajS -f PTnP(1 C JO c :EIAWAS ZIOS SAMUS REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sani tatty Petcmit State Septtic ,k X? 3 2 NAME Towns hip_St. Ctcoix County Location Section,2lLot # Subdivi6ion SEPTIC TANK Size 1--t gattan,5 Numbeh oA c,!mpanLtment6 r Vi6tanee. 64om: weft Buifding / _1.20 5f-ape Highwatetc PUMPING CHAMBER Size gafZon5 _ Pump Manufaetuken Mode. Numbetc HOLDING TANK Size gaefonb Number o6 Compatctmentis Pumpetc A.Qat m System Di,5 tanee Atcom: WeU Building 120 tstope Hig hw atetc ABSORPTION SITE Bed 3' 5- Ttceneh Dti.stanee 6tcam: Weft Building _Y20 stope Highwatetc ABSORPTION SITE DIMENSIONS Width oA Vcench Ail Requ,Ltced atcea At Length o6 each tine At Depth o6 noch below ti. e in Number oA ~ive,5 Depth o4 hack, ovek tile. 2 in Tota~ length ob finet5 At Depth a4 ttiEe betow gtcade tin ~Di/stance between Ines At Shope oA ttcench ~ in. pen 100 At v Totak. ab6otcption anea At Type_ o6 Cove-,t,.: Papetr 6 thaw F' PIT DIMENSIONS Numb etc o o pits Gnavef ateound pith yes Out,slide diametetc t Depth Wow 4ntet At Total abts otcption atcea At Ateea kcquitc.e At `v INSPECTED BY {~~Ct.~ TITLE APPROVED DATE / _ 198_ i REJECTED DATE 198 REASON FOR REJECTION I~ REPORT ON INSPECTION OF SANITARY PERMIT #5'_3 (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection f'd3ulb 6't~~ ' ~ ~A_v - i, :Zo - 1-40 - e, ress, icense NO. o ns a ing Plumber Time of Inspection ~~--~t.~.~ a--rc-t~.frzJ c~~ . Gz.c~~~ nom, C~-~` • 3 INSTALLATIO CONSISTS OF:Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit Seepage Bed ❑ Holding Tank ❑ Fill System BEN (Permanent reference Point) escri e: A vation of vertical reference point: g ~ Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: j Tank Inlet Elevation: 1C Tank Outlet Elev: ~/r/ `/1~ # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; _ ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ N0; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE:/ ft width; A ft length; of tile depth; a V lineal feet tile; 1kag7 ft to residence; 3 2) ft to well l~ ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed j p o ft. (11) SEEPAGE TRENCH: Total length of seepage trench eft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes. water courses or d...._-'--' _1_ trench (12) Has system been L'4iL3 ~J,vv (13) Has system been installed in floodway? ❑ YES NO Floodplain? ❑ YES fr NO DILHR-SBD-6095 N.05/80 Signature of Inspector: Veut-IL& xj~ktlj s RAIRIE -I- . 3 I N.-R.18W. 55 II POLKI COUNTY / RD • z \ C J °/'E~i a r ~ o C /a t o" Line man Gasde~ Dona/d _L7ouy/as f s L~ sr .-rr25 w tl He y iese 7~ Q 52. B2 T CT5 ~ 63 ` h Lars orz G9 65 CEDAR C. z ~ d.CJ Q7 ~ o C h ~ 0 /3z O vi%/e j TR. \ ~Qtl 'Saea l :.0 tl r 0~ vC • 0 , a ma Luec /c tl~ Cv~ y N a C Pads 2 ti y ~l ~ee~ v ~ ~ 3 s 4 N7, S v ar ~ N 3 Zi \ l \ UJJ /6 0 ~ ~ l ~ • ~ rPo b art- • ~ ~ ~ i Mu//en ~Cjy~\ 2~0 ~,Cci tl~y o~~ NbaZ~~~Pose/fQ dJ ~bo ~ v~ ~,;y~\• I • ~~FN~~~ `t'wo 40~~/~Q~ w~~on jf O'ho' b~S"t"A ~o ~ec/r Q n ~ S fD zo .T ry. T /z h .40 ¢o era/ Lies ~ /vprTJQ/l o ,pddd- n s/a ' ~9 Ha re. ~ :,QT/sz ¢o cSu//ivan rc ✓ HUN /0 5r \ \ ti9 © r m e LorrQ,r7B ~9 famed / -I 4 $hwan , *~h Normcz~ : ook O § f//iCC • ~1, h R w. o sM: d~e~ Ne/s°/ mm ~N Larson c x 1 H '7~IRIE 40 i-RS r °9 Bp /-4s. oz C ~,as oBo Cia .v Qrth. • v- OLD M/LL • J ~~L O Cf~ ^J"N1 a. d !-uszo 1775 2 Fe e QS- Iar/ clna 16 2.9/ z2(o.7B 0 9 of9e hor l Fuchs Effie/ r72r ij1/"Jr' O v t$tz~r 4o etQ/ L 1 9 et i1a/v e/-saw C C 40 p - • v c v Pia:r e -,to \y 0 Naw- /3/ .was.. ~ s Koch ber9•£ ~ CQ'r/s n C a ~ !/i9iY James Rsue eQS- • 4o arson o '~rO V Eme% FMarg e 'urSOq c36.s7 rz/ver'~;_ • •ner n, BELL/ R Son (TOf~OSOn 20 °o 40 `C X34 e@ rr WILD LIFE RD, -¢-o BO SQUAW L. •h v se 0 9 sa/7q /n i//a c~ s~ M /20.2/a~~- E Para I f JRrIeY St ,oaf o vv ~ 2 J s%yar/ ~Qe - I Q Ne o effl 0 ~ N fJnde~s o¢ • ~'eorye 7~CZ v/d Norm27 tl 40 40 • p O 8 uJ U 9 .3 8o e tM¢ or/ ~jiese 7011 r Ho es cToyCC -1a /Q • as tJrcico f~3ii'r~ho/,3 s \ Mate n 03 '>9an ¢o won ita%so • /bo d ~ ~ E h ~ /sz R 1 78 ¢o y Te. n 15 all a ~ Inc. a v~ S¢ r-¢ 0 E'or M//or/~,Pu/ C ~s ~ fZobert • !~✓Q//er 4 F>rmirl c%if q , ~/ane .eobe,-/- O)'00 ,.3es er- O atf ~Toh~som a•s" h et¢x d C f'oa /r o 0 Dosede/ FCr4emer /r/C17 ice ~tE~ ~N GOPN£ R.gO /un ~3,~- B ry °Q 60 79 /zo ¢o ed moons- ~lC y/fM Zj o~ Dav/ Ne/s rJ tl . V/~rq Drsnis W 20 eo on ec.F- 5 C'hiis/ine £ \ al f /1/%Ce f"orr,ee C Es/her f/ V (o /O Qae v •~h ^/rare ~reen 0~1"\~ Het won tl a] ,Q Emer- ~5 oy Or'fon Q /o R.M a/ \d • G6~ o. -r ~ Y P ~s'on a \ ?o - (J ¢o . a 40 . B 7£ ~h• 78.5• 12 RD. f- LS `kr` 0 o C rPob arf Norri ~~Car • G rSfiQ /GL~ f y • Gl Ma9 f vi9i/ y~\~ l11 yPatsy so/ d NeT- ~Cd 0 U Z Larsor~ GB9B sHansc T¢/rn 9e 0 E 0 enwa • Y•9/ice 'l i.0 to ,.2 Q i 4~ 3w a OH NN SB RG' 70 v y E_ ~7 o o ~o . Bo ~ `h~ct Ur6Q ~ :rC06f C ¢ ~y. Don¢/c~ a 8or 07 ~ie/ma.~g cooE Aso/u c~ y f/ahn ,iv O ttJ:4-. 4/./6 "aV 0~1~^v 7 /z77S TR D Tfe-.i v.~`~tl • 8 p 4 /d /z6 l v He/~~ ~ a~ r- tTohrr L or-r~ y • P E/e2 ire mob e/-t- • er` /~O ~Mo• oMizr~C ~de C P L r/d¢ L- r go h achf E e-.9 ~e ~d f rlax ne fK c. ~9ou/for? ~ ~ `6 tce/ Bo !ib/.Eer1- M's. Pau//me C~2 /e rri Qt/o EL eR i~3 C u 3 190 i o/9s1r-or~7 `"Co /2o e/n_ F'Ro 6Ei-f W \ F~y Larson • F LU~i z37 PLE ~J~ 4oe ~s~o rzd4 W~ • = e~~8 uF •865 ,s aid cos B° ~jera/a 6. Ke/fh ~..s. LU£B/RO OR. ~F soyco MLZrce//a DGk[)~ _ cToe Thomas, `I //K/e,~7rsru 45Qek.es Yr-fie O a O 0• Thomas L ~i-tz rzco/s B7 e- /00 40 \~\'~1 ~q,3urow zs.Z.9/ • Br-/7Qr'd 65 k~s f9 ~ CS ~ Ra zoo /o o Fizrm \ ° P amo j evf Co. y N i//• za/,j haifs .y ~ UARRY• RD. • //8.25 p ~ y; NorY-/7 4o r~~~il 9K obei- fyo ~0 ~9 ~ Sfa1~s I \ ~ W ~ C J rO \ Ft~s New q ~ 5 Power Cy Iwo Oda ru ch- 8o CC 3 C.l SS Co. Qo tl1 0~ 0 80 ~Q, W~ ~ lQ~ UR, ~ UARRY qj 0 ` • c~arnes La VO i»GZ h \ RD- • .yy ~ ~ 80 /`7cLeocL 0 0 8p /zo m Oa \ ~ 260 Q.~ r tiN s . T w ffA7rF/E~ e E, A rCaro- yo go - (L >I ` N 54 C ~ ~ rPay ~ Cra 9 ~ cSi. CEO/X ~ • FAQ U/ rte -,10 ~ ~ b • ~a r/a ~ 0 /do h'ea /f-h Ce/»`~r- t^ n/arn. ~SSe/r 1 y y ~ ~ ~ ~io• ~ • .nan /Ve- 6 4 S. UA RD. O W OOL AND OM i • ~'t e K ,i d ~ o Cod ~ ~ ~ ,cn ,Pv6E'i-f Q, h'o/rr,QUis L7f • C~ W ors/ RI '~1y~e ysi (1000 o g/ C INE ~ozlo ~Q ACrs ~~¢r<% s,v QcStict~.b `C0 yL~~~cz~ £ ~.Tpoa/; O~~'yy-, tle \ 64 I 64 ~e cos a •r•~ e as a i State and County State Permit # PLB 67 Permit Application County Permit # for Private Domestic Sewage Systems County -Q-C' *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: R Q C- - p- C .6 B. LbCATIOX: Section, T N, R E (or) V11 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 Z No. of Persons _ D. SEPTIC TANK CAPACITY / 00 -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:A LengtR" Width 12~ Depth 1/ Tile depth (top) 3 22 " No. of Lines M- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land I Distance from critical slope 1!VATER 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 Ce fied Soil Tester, C it, NAME lr. " C.S.T. #~53/ and other information obtained from Cvcz?' (.owrLe ,LLbuilder). XPlumber's Signature - MP/MPFiSW# / ~116 Phone Plumber's Address ~IZL 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. 7 S E E 7 j i _ ~ [ a @ i 3 ~ t i Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Fees Paid: StatejS-. County Date -c - Permit Issued/Rejected (date) `~C~ 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 X20 ~-6 Z`5 ` J- w Z ~oo \ 6 s ~ _ v~ oOC r J o T1111141115FIev. 9/78 • REPORT (3N'SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL_ SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:, %,AZL%, Section T,?LN,R I II,E (or) township or Municipality sJA•A i0R,9-jIQl County Lot No. , Block ' Subdivision Name Owner's/Buyers Name: O - AMailing Address: c, TYPE OF OCCUPANCY: Residence a-No. of Bedrooms 2- COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 12-9 -g 1) PERCOLATION TESTS _2J kC2 SOIL MAP SHEET I I NAME OF SOIL MAP UNIT_13r6 -,3 uic In a z PERCOLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES NUM- DEPTH CHARACTER SOIL SINCE HOLE HOLE AFTE INTERVAL RATE MIN/IN BER INCHES THICKNESS IN I NCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- S On - S" IF ri P-2. Yf? I ► ► ,h fs P- 1 r r ~ P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- - 4 Z 2. A- 2 S CeL B- -.Wq J4- 4&C B- M y -L-^ 3 J L- J " 0- 5 B- L/ B- 2,0 1-5 t :L, U 4. 5 ~i Y ST- <v B- (0 0 10 15 ~L - _A2 `141 -S Li 0 PX 5 PLAN VIEW (Loc to percolation tests, 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 ~l0 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. I ~c- ~L I it a Soll, 0091% i 1~odV, A Pe- 1- 4- T- L.c +fiCrN L~~ tx Jp ~N 3 Q F ~ a e I, the undersi9end, hereby certiL 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 roles are correct to the best of my knowledge and belief. Name (print) v Certification No. Address .Name of installer if known Copy A -Local Authority CST Signature i