Loading...
HomeMy WebLinkAbout038-1088-50-000 0 y 0 m v 0 d O N ~2 r IM O fD 7 CD m COD 'o _ r. lot cn CD "I 0 d W d 2 O Z N eC ,~1 • 3 O w N cp 7 d i (b ~.y ryl OO CD 7 O CD N N :3. j `r1 p- Z a N C d CD LU 00 N 00 ` 1\ n j 0) cn O fD N 'I p n O K CZ) 7 N O 7 O Q~1 fA a cn !r C N O (n D fl' CD m fn a ° `C 7 fn co O j CD C 3 O o a lot C) N) CD 4 N (n O l(~•~f N O O .r Q CD O O O !1• Z lr a o v_ 3 41 j m fn fn fA o 0 N ro n cn O C N Q n 1 d O lV p N N 7 m N d CL 3 N Z 'Y N O Z co Z 0 _ D m p v p ° 7 m I m d N I c CD CD w d CD -1 cp z 7 0 A Z m O N c .'0 n 7 A Z O o. 7 CL j Z I c 3 I ~ ~ CD C,) ~ n CD 0- CD -0 > 3 w CD X CD C1 CD (D n' 21- C/) 7 r 0' - fD N > O'f0N T Q _ C - CD ~ cD '0 -o fil o OZ G O 0 v cD ~ N "p N 7" 7 N N 3 7 7 p n fn 4 I = 7J 7 N d co b N a 7 CD OC_ O n CND Z N N CD v x C N N O Q O _S T S 7' CD O O 7 C N CD Q'Q EA to O ti n CD (D ti Parcel 038-1088-50-000 12/08/2006 01:01 PM PAGE 1 OF 1 Alt. Parcel 21.31.18.363C 038 - TOWN OF STAR PRAIRIE 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 - BYDZOVSKY JR, MARTHA A & VLADIMIR V MARTHA A & VLADIMIR V BYDZOVSKY JR 2052 COOK DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 2052 COOK DR SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 21 T31N R18W 1 A IN SW NW N 200 FT Block/Condo Bldg: OF S 233 FT OF W 217.8 FT OF SW NW EXC PT TO TN RD AS DESC IN 927/161 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 12/30/2003 750365 2483/026 QC 07/23/1997 927/161 07/23/1997 913/381 07/23/1997 913/380 2006 SUMMARY Bill Fair Market Value: Assessed with: 175397 177,800 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 132,100 157,100 NO Totals for 2006: General Property 1.000 25,000 132,100 157,100 Woodland 0.000 0 0 Totals for 2005: General Property 1.000 25,000 132,100 157,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT YVkc✓J4Vt 61--eevcQ. OWNER TOWNSHIP SEC, T _N, R W ADDRESS l• ST. CROIX COUNTY SUBDIVISION LOT LOT SIZE Distance- & dimensions to meet requirem VIEW irements of H62.20 SNOW EVERYTHING WITHIN 100 FEET OF SYSTEM 77777 77:= r y 1 J I I d-i-~ ate oath Arrow SCALE: ( i SEPTIC TANK(S) / MFGR. CONCRETE STEEL No. o7 rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR, M WL NO. GALLONS Per Cycle TRENCHES NO. of wicj length area RED NO. of lines width length area depth to top o pipe NUMBER OF SEEPAGE PITS Outsi e iameter total pit area AGGREGATE PERK RATE AREA-RED AREA AS BUILT Disclaimer: The inspection of this system by St. Croix Cdvnty does not imply complete compliance with State Administrative Codes. There are other areas thn' it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of fAi_1ure_-_-_ GREASES AND OILS SHOULD NOT BE DISPOSED THROUGIL-Tt j2t SYTEM. I CTOR mT DATED-4z - PLUMBER ON JOB LICENSE NUMBER r 00•0MMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ,F. CROIX COUNT f'Unf +AIt; $l15iti.: COURTHOUSE DATE kECP'7TJr-T1t J' , iUDSON, WI 34^..l6 /aJJ ;.iai~Y icunr, ng 7CAT I ON 4# d ;2 C o r+~ t :!ELECTOR: M. tiers!. at CE OF SAWLE 2 1\ UFORMS 0 /100 mi "IONS Bacter+oIogica11 34 4 put ,)Dove 1;.; Dr i Rim: OF.\NDEVENpfH O n V y Z O PROFESSIONAL LABORATORY SERVICES SINCE 1952 4 ( 0/) V i5(z f'i C L, )C ivc ~ti: w 1=~7 ! ! > etc, ✓ An- IST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street It C 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 '(y private individuals. Completion of this form is essential so that the property can be located. lease provide the following information, enclose appropriate ee 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. I / ) -WATER TESTING----------------------------FEE: $ 25.00 /X\ (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 „ 1V (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 _ (Determines if system is properly functioning at time of inspection) Property owner's name ? )S;Z ccxlk !<Property owner's address i J, T Legal Description 1/4 of the 1/4 of Section , T N- Town of qtr?~: >>"x', , , Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER /j, Color of house Realty sign by house? r 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: Manv t.ir„es ..ater 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 indiv i (i,lal requesting services: Telephone Nu,T~ber 7/_S-yl-1GC REPORT TO BE SEtlT "FO: i"~n+>✓~t.+c /C_~ i1JN, !'~°K S" C1osin-4 d ltr. _ . ?U - / - r STAR PRAIRIE T:31 N-R.18W. 55 II POLKI COUNTY RQJ JIPO K 57 CRO/X - _ - _ srt -I scriie U [u 9 N TR ~c y w o ese 65 ti s Z y L yQ CEDAR Po w h C ~ooyfas H a s vJ w'° ° e crs o W c 0 69 24 0CC Randal/J Pvar'd y P r ~~im e~~ c~ DTr w C~ q Far o hca o fMaryE. v~ N CEDAR L. ~F~ M F H y~ ; v,o~N BO dVv Ubb DeAi//i zvr % r Q~3 M Xr n ti Fo > b a 5 q ~5~ v~ , 6. B q ~ 202 ~ ~ 2 y C ~r"'r . = V- N T Grego A. ~ ~ s cn y~ ~ 0 a h 0 fnk h7 f0 ~b o ~o C H cn<s "9y e d~° r, b n 5 s of Ne so Quss. p ZB d C h ~a s v s a o 5 ti N o 3u3 F V p W . c5't ohb een ~ tl v C ~ " 'k ~k . are . v:~ c ~ ~ v C v Rodn® •S ~t 0 a \ R v h~ v Po e1 a bF~ b o ST i A 8.7 77 atl 2c Ca r wbn p ® IS vnn Qi✓ard ~Cl J b.iCo pt `Z0 C0 .is° c tl~, !✓/son .R en . 9s Q oJ"b2 Moe(E) g 9o.B7 ~ 7ho5 H N • ~ m, 5RS H ti • ¢ sc. 9 S'usai% a eve /z se T > - , e 9/" ur 'i: p ru • La ✓aurl i ~ ~ C ~ 396/ wo r< Kathe ;!i~ Te/s/ad ad y HUN 1 M 0 Ne/son - v Z w'k " 4u iF n GO o eeds z ~ ~ y~ ed _I . E H1510C N H RAIRI Z79 zs `~~n • CF h John /Vormar/ `9 l i ~A e n C /x 5 5 ~c ? oh'~ -.J hnt/ i-/e •R~ Ctl3H mrcB wick v L.NB/sga~n J m3 : 0 a/ C l r`J~~ r rson, r s rs >v sc So°y s`r;•r 345 C v • s t I o o//gyeL%fi' ym s M r5 J'ti~ Ferri 77io R Dnnie/ K a ter! ✓ C 0 1 cLaS p 4~ y eas ,v unson r; 0 ~Sfa~. et¢l' ar eon ~ ~ o Gq w /E. day b C nc .9h/ness t~,son \ r3 ',er ^ p , ~ e ~ re 4D 40 9 e P" c v a s c C C oo Ga y n 40 ! ~F_ cc aV o Teo uesscr /17 b race b~N_ /e/✓nr 7r e a K ;rt. o Q1 ti N r/led rWVre,/ k=y s a C a L v. GoweJ/ ' B¢z5 V~ ~~y, r >c. .5 ✓36.> T~: ' c • eK c~37 LN ~r%c~ Nom` W 43.9/ E49 ~ni~ uavk O 0TH t~ G ar/'eKn fson 36 S7 iai e o • r aufe "KJ 4p ' r N 1 darn s 6 v •S h 75 f-,atd r.~ N SQUAW L. c RP ntss< s ~ ss- ~ x, e n ~~n s o o ~erd7 c s u° Cr/sd U., i ~n <P/ch a.-d rL y. dne ~ 9 v Nemeth 0 ~ 9ndc°rs • ~ Home etux® ry NFv v eA fia.rse~ Fia /oe F ai F~ a W R /,.7 774 F~ W v'i v ov rza nrR _ o a > 3~~ 67 ' 9 Fa_MS 409TH r' Ceerc/e L.B. 96 M rTo.> o vE a Norman F~ y L >e~7 Mdr,on 2nC, cTarneshJ nr sv fG et/`a r ,,,n,n r3 ara Joy~/ee .n ~•v b coos Sc oltJ' Wow Ma jOnc ® ✓e Kerf R s e ManYe by C ` 5 .fo Coun/e/' R h L7e 'ccle/ •NrrKhoj 1579 S 8e// ve 9an V e/ 40 ug ra a 'vvti~v Bo JE ^ 1 7 zo ,N r/zr / e,Toite"~ s° ,T Thomas (Na//er f Firm rn Keit \ 732.98 KE•ndz a:• berF /`%/7ons.F'~t /o - \ Otfe+ronj omas, ~.w / tiv OfPats H .ei TerrJ /C ra eraser eta/ `o h 59 ~.R o M r25 PetrrcFc H omh O Larso7 elln hrrs on 80 h fire 76 B,r /zO 46 S ~rrl ro Ri✓ar ata/ row a 6p aNer= ,35 T rc . 0 ice Dennrs 4 y 1Janie s lu a~/Mg Luc/%% C/a rcnce v. so my r y J) Emsc `Uh 8eN D. Casey osemai' fJai//ar- Do.-.s P Lcona 71 "Ie ass- C m ti0 rrsfine ( ,(/eme r y 13 7 eon mN oden r'✓e~m¢nn t eo o h`~ Gr J e5 ucL b • C4 Son Trnrt) a ,~,ei 575 a O Q / N 40 /oo SM Rw. M 't a ~~n~ nary ~ G4 ~ 40 • SBP9 C' • 44 .S S P 99 99 ¢boi ~.0 ; • \4 TFS / AV y`~ W N W / a>`rrc y~xyy eva 6 0 ro p berY- e ~f ip F//,-ce " • v Nam .Bruce ✓ C C1l 0 W W Y cyse M¢1`b erne Everetr ~F "1 a yy Pa is,y r x s 7a/m 9e \ v F 0 e way Emerson 0 h 41 / / Y / C/oufie.- t ~ ~n 4 rH S . C 0 ~ ~ ~ 41 0 0 h °'yb d. y.o rlreb yy o - sari 6ro3 .,p 60. Bo l p~C V ~ • ~ or3`t 77 ~ tiQ q5 ba ' ve 97 S O E a ti • v v Col/een narrc// 7 C n oe rH rN w y • ® 29 `sC sfy K5 ~q D, e/is/e hard a - f C yFnofnhe /2 Uban v $ ,.:e eyi C ~ ;a }ek fh /d H~oA/VriE nde c j u ~ ~V v o~a~+ Q 0 re e. •P'rke'J/~aus Z Si ¢o s ^ Germain v ~ - 7as Bo 49 x, ? '7H 07 7 A wVb ~ S /2775 Fti 4' O //s7(a c / ~`•N L z Dater Laur: e has o a nes ~amesvE. e9 Gera/d • Ql `Tames,•L McvyS yc/ci c C baGk, Neumann . 6er'nd, r2o6 er/" oY%een K/emesruc~= C/ouher' pM~y ,Pa/ph h4ando sK re C'Cp JT 9z 5 0 c7 FMaxi BO ne !i J i✓ai'¢'; Kosene, o//n a /d /a B !/o/~Eerf 4o e 7d.ma „o ~ 10177 40 ,7 a 79 4 Ander/iK Rona/d E/mere i s. seoh Lerroyrre, s, ~o fie- \~n fls - ~PaJphs Mar c~ £Roberti a6 r,`~w/r`;~ /Noh/e/S • F Lo'fY /5769 O p N Av C vaa`yd h'a/tee r-.son masse A537 C! a~' rsba bo QLE Martlor 3~y: NP/ct~ r sn:_ sNf r-trs 3 C BS Bo ti ~ l ` BO W>L'~ Bo 7-RS_ -.-rc 77c~2 (V i rCt.hu.ESy~ras ' Cjera /cLP `vy5 Crenevre✓e. Tho tai R,; Bor tom u, fMarce//¢`ti Fro ncors Dame/ B7G rPober/ E.Do is N/G HAw DR rv fJackcs s Thomas L. 776 /7037 •6- . rB row 9o Ma/dre son zsz.9/ • CCLS 2/RI `HM 363 RED W rb 20 /df 1 I PND ~5T.4YFS Backes y zoo /oo Mrc 2_337sm TR5 410y %e9 sK •r3 ha is OS 7H AVE 0 9 9y on ~ ~ ° K ,x bar Yy v an,C/ ~ ~ ,(g2 72 ~ ` _ F o 259 7 ° m u n F i ~s New- y `C r p uo n z°~ CC F7 r" h_ Case d~° CC .h 4ll a 3 ~ Z~ ¢ ~ e~ i ~$~~tl0 sn. rd ~o b°~ ~ dQ w T 7B ¢ L• V M cr K d 5 A n r by ~O .Garen hose/, Q1.. C C a car L 2 s N o N\7 c7arnes AV Base/, ° T 1/~`,. Ilk ers q ~ izo s cranet ti~ 0 w wa yy ~ Victor M \ r uXton ,y F ~ n ~ 0 8o Equrkc -fa/ , A ~ ~r i tl w~ /mm u•B-S 3B.o7.~e1' .0.v9 /O24B ~~W~~ Moo t`a 7y / 0TH 6Cc<-E) C _ c obert - crane ® I e_ 79 a/ L• # . H ,7ges t, C + roe - Fca/y - R/ex C)reer C 6t Crbix 6d r q n>arc C v °oqtivo ~er .Pay f cra j 0 /:;o \ rde ""``C tl-Cl4 Fa9na r~ ~ 39 p'C Russe// L L• v;"- /en E a y x o • 29/d-4 Tos ePh .SM c J 0 d n/e ti F r/a y ~i o d` F/andsrck, /s7 ~%cner y Z KK o Rvard p~~ etux ~C ti /aI` ao J 3 n o ~/esr /6B - - red e. L ro M. cNrr EYY RI C oh S Neurn¢ 0.9 ber-f Uoh/JSa/l,e 182ND Ce co /a. zr h~ as st.o'o y F/ Bd9 S. ~`E VE y k . n, ®ti tl sfo w~ V' ~T A 9769 91 7,T I J _s ~~"~l 4 i1e bert f zc.63 °Cc~~o !y 64 ¢R/rce S/)c Cg m ss~Ai ,eobcrt rs3 el'Vayne 3 W ej& 's?s; R bha¢ K w rU9~ < 65 o 0o c0 ~ © m: r a f Caro/ ill Straub ~~o ~ .r'~ - ry on etr~ O ` y!.. ai Da. Bo - (Id • 9243 :rrts 4~ - ©/99/ R cE o d %Q° 6Ls nc. 64 Bo 7H n.oo. SEE PAGE 43 AvE St Cro/ C fy, w SEE PAGE 53 800 900 1000 100 200 1300 400 UTGAARD'S HATCHERY Year Round Poultry Service RUSSELL'S SPORT'N BIKE POULTRY FEED - EQUIPMENT - REMEDIES Live Bait Wholesale & Retail POULTRY BUSINESS Raleigh and Ross Bicycle Sales - Repair of All Make Bicycles - Indoor Archery Range SINCE 1901 Complete Line of Archery Supplies - Featuring Golden Eagle & Browning Bows New & Used Guns and Wide Range of Ammunition Phone: 248-3200 or 248-3209 Fishing Tackle and Trophies STAR PRAIRIE, WISCONSIN ■ 248-3644 STAR PRAIRIE, WISCONSIN 54026 GARRY & GLORIA RUSSELL, Owners a Hot property... 2052 Cook Rd., Somerset, WI $57,900 PRESENTED BY: DONNA SATTERLUND i.. Stillwater office I 2020 Washington Ave. ~W (612) 430-2100 MN i ; °X 1111 1, _ E _ (715) 246-3633 WI - r - (715) 248-7156 Res. ~ Highlights: This quality Rambler features spacious rooms, Andersen windows, a Patio door off the dining room and a convenient main floor laundry - a very clean home! If you're feeling cramped and want country living at an affordable price, this is it! Location: Dimensions: Mechanics: (APPROX.) Corner of Cty. Rd. C LR 21.2 x 12.5 Lot Size - 1 acre and Cook Rd DR 11.9 x 12.5 Kit 10 x 12.5 Foundation - 26 x 52 (S21T31NR18W) MBR 13.6 x 12.5 Heat - FA/Oil 2BR 12.5 x 9.6 Annual cost- $750 3BR 13.6 x 12.5 Age - 18 yrs. LAU 5 x 7.10 DEN 11.9 x 12.4 We 11 New S TU V Septic - 9 yrs. old r "Color Lock" Siding uo T✓C~~f- Schools - New Richmond Burnet Passion. Burnet Fire. ((fr Q® ST. CROIX COUNTY j~ V WISCONSIN j 1, f - Y * s ,.J~ ~ 4 f.4 G ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ITI 911 FOURTH STREET • HUDSON, WI 54016 ' l - 715 386-4680 Aug. 13, 1991 David Bracht Re/Max Tean 1 Realty 103 Main St., Box 68 Somerset, WI 54025 Dear Mr. Bracht: An inspection of the septic system on the property of Gary Running located at 2052 Cook Rd., Somerset, WI was conducted on Aug. 12, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. NOTE: This house has not been lived in for an undetermined amount of time. n erely, Mar P Jenkins Assistant Zoning Administrator cj j REPORT OF INSPECTION - INDIVIDUAL SELVAGE SYSTEM SavutvLy PE nm.i.t 2 • State Sept.i:e. NAMI Town,6h.i.p St. CAoix County t t can s _Section~Lot # Subdivision I I'1 IC TANK gaUons Numb en o6 eompantments Mince morn: LVett Buieding 12% 6- ope Highwaten I'(IMPING CHAM6ER at.Eans Pum u actun~ -9 p~ M o d e. k. N u m b e n_ 1l UINv, 1ANN `i ze gaUon,6 .Numb n o6 Gompa4tments Purnpen - At h S /s tem ti(nTunce (Atom: Wetf Building 12% .62ope Highwaten AIisORF'l"ION SITE lied T~Lene ,I)(.-.'1 lance ~n.om: LVetf Buitding~ Z 0 r2% ~s 2ope Highwa en At, ORPIION SITE DIMENSIONS wi dth n{~ to-ench 1L 6t RequiA.ed anea 1cn<ith aA each bane __At Depth o6 noek be-ow tt..Ee 1-12 ~n Numbers (,A k_I4les, _ Z_ Depth o6 noek oven tite Z' ~n I o to f te.n gth. o 6 Une/s 7 6t Depth o6 .t,i to below grade n Ui~,tance between tine_.s At Stope o6 tneneh in. pen 100 At 1 ota.(' ab,5onptt.on an.e.a S~ At Type o6 Coven: Papvc oA 6tnaw F DIMENSIONS I Numb e n 06 p.I-ts GAav/~ aaound pit/syea no Out,.i.de d%amete.n. '~bt "th below inte,t lotae ab6onption ane.a___ 6t i neu ncqu10red _ t l N ; F' [ C T I D ~~:G-•'- TITLE - AITR,OVED G~ DATE / 198 I.I JI CTED DATE 1 I:I ASON FOR REJECTION i 2 ~ v k4 n ~ State and County State Permit # PLB 67 Permit Application County Perm, # for Private Domestic Sewage Systems County v' *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATI -57 '/i Section , T LN, R (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 3 No. of Persons_ _ D. SEPTIC TANK CAPACITY 1(00 Total gallons No. of tanks HOLDING TANK C CITY Total gallons No. of tanks Prefab concret 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 Raten1 / L-ALTotal Absorb Area sq. ft. New ReplacementX Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (t p) No. of Trenches Seepage Bed: J( Length- 0' idth-4~2 ❑Depth O Tile depth (top) z No. of Lines = Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private W 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 Cer ified Soil ester, NAME ~ i - C.S.T. # and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone 3S 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. ) 3 3 i . 3 Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY ~l Date of Application Fees Paid: State „ County, Olt, Date - ~5 d Permit Issued/Fl*eeeeted (date) Issuing Agent Name Inspection Yes_-)~--No State Valid# Date Recd T-V 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 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: Section -'~LT. LN,RL (or) W, Township or Municipality ~lhi~,'~1 Lot No. , Block No. Count.- dt -Subdivision Name Owner's/Buyers Name: ~ 'y K ~ t Mailing Address: R 1_ .t i-*i .rs„-s'_k~ ~kA I;: C_ TYPE OF OCCUPANCY: Residence-X' No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW -REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS - Z PERCOLATION TESTS %0 SOIL MAP SHEET- -----NAME OF SOIL MAP UNIT- 131S acx t-k' hu rrc~~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 iR 1~ P- I YZ- P- 41V 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 OBSERVEp ESTIMATED HIGHEST IF OBSERVED IN INCHES -t- B- 7 f) b B- 2 S 1~ I,& A B ,2 ~ - G 5 S/ ~4 r 5 , B- - B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the pl,9n 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 horizontal and vertical reference points. Indicate slope. r i ~ 3 r ! E n • .v` N Al- psi C ~a s ~ 9 ; o F ' t ° = 1 I, the undersigend, 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)Certification No. ~i Address` .Name of installer if known Copy A - Local Authority CST Signatur~ 4A • I ? 'd .y r. p t~' D u~ t 1y E t F REPORT ON INSPECTION OF SANITARY PERMIT # -1' (1) Name and Address of Permit Holder Person/Persons at Site 2 Date of Inspection Time of r , Inspection ase, Add s License NO. ns a T ng Plumber (3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill Sys em BEN ermanent reference Point) escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # 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 ❑ NO; 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; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot 0ir 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 ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; 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 la es, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ No ~r DILHR-SBD-6095 N.05/80 Signature of Inspector: