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. P,,,FPORT OF INSPECTION--l-NDIVIDUAL SONAGE DISPOSA.. SYSTEM
Sanitary Permit
State Septic/jC.x
7A'=1E TOWNSHIP
9T. C ~,,A County
SEPTIC TA?K
Size C C t gallons. "lumber of Compartments
Distance From: TJell -
ft. 12% or greater slope f~.
L/PLIO Building C ft. Wetlands f•
17ighwater ft.
DISP SAL SYSTL.:1 Tile Field or Seepage Pit(s)
Distance From: TTe11 ft. 12% or greater slope ft
Built;ink- ft. Wetlands f:
r
FIELD £~t
1bihwater i
Total length of lines ft. Number of lines Length of
each line ft. Distan e between lines ft. Width of the
trench _ft. Total abs ! ption area sq. ft. Dept'.z
of rock below tile 'n.1 Depth of rock/over tile in. Cover
over rock Depth of tile below grade in. Slope of
trench in ner 100 ft. Depth to Bedrock ft. Depth to
ground water ft.
PITS
'Number of nits Ou sic:e diameter, ft. Dept'1 below inlet
ft. Gravel a-roun i _yes no. Total absorption area
sq, ft.
Square feet of seepage trench bottom area required / / ell
r
`square feet Of s epage/ nit are* required
Inspected -by t,°~ 2!i i ~t!r, Title
Approved, Date 197•
Rejected Date 197
Male e1K5 LGullly
Permit Application t #
f for Private Domestic Sewage Syste:
:aUIRED
if Required State Plan I.D. #
_ - I
"JER OF PROPERTY Mailing Address:
ATI,mj- ~t I Cr cin °1. T ~l R ul I n. r +y
l
Ae-~
,)Ship
Variance
Single family _ Duplex No. of Bedrooms ~j No. of Persons ,~111R'f G'R,~
YPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES XNO # of . Bathroc
automatic Washer _-YES ENO Other (specify)
:,EPTIC TANK CAPACITY Total gallons No. of tanks
Holding tank capacity WD0Total , gallons No. of tanks C__ _
-Addition Replacement Prefab Concrete
Installation
X
.gyred in Place Steel Other (specify) _
LUENT DISPOSAL SYSTEM: Percolation Rate t) - 2) 3) _ Total Absorb Area
,ew Addition Replacement -'Fill System
Seepage Trench: No. Lin. Feet _ Width Depth Tile Depth No. of Trench
Seepage Bed: Length Width _-Depth Tile Depth No. of Lines
-,eepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land--- Distance from critical slope
,ne undersigned, do hereby certify that the information I have reported i,~ in accord ~,V;th ,e, ^r H("° .
isconsin Administrative Code, and that I have sized the effluent disposal sy
the Certified Soil Tester,
I,ME n 1N)77'4Q7,i407 C.S.T. rained from G(owner/builder)`~7 ,
-
ember's Signature p~'MPRSW# _ ----Phone' VIEW: ;Provide sketch below
H62.20, including wei
.__1,_,.__ w_
,e r.,
Vj"
- Y r
1,
CRI
le OrR
Do Not Write in Space Below FOR DEPARTMENT USE ONLY
Date of Application -Fees Paid: State .--County Permit Issued/Rejected '(date) Issuing' Agent Name.
f
nspection Yep-' No Valid# _ - Date Rec'd_
county (white copy) 3. owner (green copy! DIVISION OF HEAL Vh ,,):2~ci 5 X 309, MADISON, ih',
2. state (pink copy) 4. plt:mb,
• IVISION OF HEAL.:-
- ,',IL ADORLSS: P. J BOX
MADISON, W15C;ON' IN 5J:
UDR£SS: 1 W(=£T WILSON: ST R4
MADISON, WISCONSIN 53
PLY PL EASE REFER T
TI OIJ O° 'LUMi-I.r
`-~t ; i tr pus I ayes:; CorpordL ion A
E C Route 1
wl 54
drence Sr.h I I I i nger, Bar and 6rii1
l,4, SW 114,_ Sect"gzn 28, T29, Ri
` Springfield, W:'sccrsin
a x County
=f p1%Amib'ng p'
I5j Z. _wen complete
accord with LhapL'er 14.',, J`Jt;i aZeSy eat t.!iapte
;mInistrativ- Gad., the plumbing plans and specifications are, approyed
,:,r.tincgent upon compliance with the stipulations Indicated on the plans
e fol lowlog code sectlor
each code section notes.
Our rev i e+i of tree hol d
4ructural stability, only for compliance to desi,
,alter H 62 of the Wisconsin Administrative Code.,
The ioiding tanks shall he maintained and the
~qulred un4er Section H 62.20 (7), Wisconsin Administs.
H 62.20 (9) (b) 6. Septic tank conversion fo:- hc~
H 62.20 (9) (b) 4. Hoid+
H 62.20 (9) (b)'3. Hold,
Butid!ng se4ers.. Dpmt'
1
aye
rt; rtact, pr~G' essionai engineer, registered dusigner, Ownes° or
olumbing contractor shall keep at the construction site one set of plans
xaring the stamp of approval of the department.
8. In the event installation of the plumbing Improvements or system has
;lot commenced within two years from this date, this approval shall become
void and new application shall be made for approval of these plans before
work may commence.
In granting this approval, the Division of ftelth does not hold itself
ilable for any defects in plans or specifications, plan omissions,
~!xaminatlon oversight, construction or any damage that may result in
:ar after installation and reserves the right to order changes or additions
should conditions arise making this necessary.
This approval is based on Chapter.H 62, Wisconsin Administrative Cede,
requirements. It shall be necessary to obtain and fulfill the permit
-equiremnts of the city, village, township or county in which this
installation is to be constructed. F"allure to obtain local permits -.gill
3itomatically void this acceptance.
icy order of Raiph L Ar, °
i rely,
hlef
,r. Harald C. Barber,
_AU OF ENVIR0 W-Al-TH
N.O. BOX 309
.
IADISON, WISCONSIN 537
_01L BORINGS AND PERCH, "
nr , N, R 1_f'E (or) W, Township or Municipality
• 4,, ~ County
ion
s me1~e/lwr
s Name:
Address: - ---~.t~+ as's.J
t /`/tJ' ^ f `
JF OCCUPANCY: Residence No. of Bedrooms Oher
>ENTDISPOSAL SYSTEM: NEW - ADDITION- REPLACEMENT
OBSERVATIONS MADE: SOIL BORINGS. -PERCOLATION TESTS -A-, ~k
_1_,~-'!G/
_ SOI L TYPE _
PERCOLATION TESTS
- HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE RATE
061"
` CHARACTER OF SOIL
THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MINIIN
INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
Lay-1 V
.30
1,6 3AMD
5AAAD L3 _2 I
J
SOIL BORING TESTS
ST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
t'R INCHES (DEPTH TO BEDROCK IF OBSERVED)
OBSERVED ESTIMATED HIGHEST
6 'Vic
J* OF 40 AP
a
040,
I! AN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.)
ndicate on the plan the location and square feet of suitable areas. Indicate number of square feet of albsorpttio scale
Needed for building type and occupancy.
or distances. Give reference point. Indicate slope.
a
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6 -
I the
proc 1. the undersigned, hereby certify that the soil tests reported on this farm were made by me in ccorn with t ho es arse co:
that the data recorded and
and methods specified in the Wisconsin Administrative Code, and
to the best of my knowledge and belief.
~Ai / 7~~V~~~ Signature
Name {print)
Certitication No.
Name of installer if known
Copy A - Property
17- 13
1 ~
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elty:
('r lJorin
I / ~T
ITT
I-
(v ^
l'
X - Is dic-netc:r of T
rowed tn_I`,'.' or lenC u11
of rec•t:anniLt r tarilco
Y - Ts lild'uh of" u
.l
tt l tall?i Z t111::X'V~t~ t,• f
ir~clic~.Lo top and bottor,: it
/
-AGREEPdiE1,~i
This agreement, made and entered on this ~20 dwy of , N 19 17, by
a,nd between the Township of ~ lddress &.1,6617
Ljec c j- J
s EERE.P S: n application has been made for a sanitation system on the
following described property:
46 t- ( 131 d K I4 'o
FE RE! S: Septic tank drainage does not meet the minimum standards of the
ordinance of St. ::roix County and state codes.
V 1-EI-, E, P. S: The owner agrees to install a. holding tank for septic tank purposes
purposes.
NC v' , TEEREF Ol?E: For and in consideration of the issuance by the Town-
ship of ,j of a permit for the above premises, the parties
do hereby nd bind themselves as follows:
1. Owner agrees that they will conform to all the rules and regulations
pertaining to a holding tank system. They agree that anytime said
township deems it necessary to pump out said tank, the owners shall
have same pumped out in 24 hours, or township will have said work
doneand charged to owners and place same on their tax bill as a
special charge.
2. The Township reserves the right to assess a bond if they desire to
cover any possible pumping charge in the sum of $ e0 & .
IT ih UNDEi,STGOD that this agreement shall be binding on the owners,
their heirs and assigns.
IN V_ ITNESS WEEREOF, the parties have hereunto set their hands and seals
the day and year first above written.
s ownship of
by.
L~..~
Developer
or owner
STATE OF V ISCONSIN)
SS:
COUNTY CF ST. CRS)
Subscribed and sworn to before me this day of _SLr2 h 19 77.
. Croix ounty °~~'~~7
t
Indenture made this l day of June, 1977, between James
Schillinger and Melba Schillinger, husband and wife, hereinafter referred
to as the grantors, and Clarence Schillinger and Dorothy Schillinger, hus-
band and wife, hereinafter referred to as the grantees.
Whereas, the grantors are the owners in fee simple of Lot 3,
Block 19, Village of Hersey, St. Croix County, Wisconsin.
Whereas, the grantees are desirous of obtaining the right to
use the grantors' lot for sanitatiom purposes; and
Whereas, the grantors have agreed „iri consideration of One
Dollar ($1.00) and other'good and valuable consideration paid by the
grantees, the receipt of which by the grantors is hereby acknowledged, to
grant to the grantees an easement for fifty (50) years.
Now this indenture witnesseth:
That in consideration of good and valuable consideration paid
by the grantees to the grantors, the grantors hereby grant to the grantees,
their heirs and"assigns, full and free right and authority to have an ease-
ment to use said Lot 3, Block 19, for sanitation purposes, that is, instal-
lation of any tanks and piping to and from the tanks to meet all code
requirements as to completion of the grantees' sanitation system and the
means of ingress and egress to said lot for access and maintenance pur-
poses.
In witness whereof the grantors have hereunto set their hands
and seals the day and year first above written. "
UN 2 1 W1_7
S' ned and Sealed in Presence of L t (SEtiL)
/ mes Schil finger
1714 ohn G. N stingen
(SEAL)
J "ckie Langer Melba Schillinger
STATE OF WISCONSIN)
) ss. 1
COUNTY OF ST.CROIX) Personally came before me, this
day of June, 1977, the above named James Schillinger and Melba Schillinger, to
me known to be the persons who executed the foregoing instrument and acknowledged
the same.
Drafted by John G. Nestingen John G. Nestn'gen, Notar Public
Attorney Pierce County, Wisconsin
Baldwin, Wisconsin My Commission is permanent.
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TREASURER'S „e„~.,,_.,,p.,o,,.~,,...,..~„p„p~
GENERAL RECEIPT Town of Springfield
84 ST. CROIX COUNTY, WISCONSIN
1
Wilson WiseopIsin 54027
RECEIVED ?
{ - - DOLLARS 0
1
- Cro s out one` i
~.--Original
Treasurer's Copy - Treasurer 4
- ~-Clerk's Copy
R Y~IV,-
JUN 2 _1 1977
r
Plb. # 60
3/70. PROJECT DETAIL DATA SHEET -
NAME OF BUSINESS LOCAT I ONe-~~ LY1 ~ 1~ ~LYLT
street or highway city or township county
LEGAL DESCRIPTION S_1 -7L~f-__~
OWNER 6,~Zl) Mailing address
ZIP
ARCHITECT OR ENGINEER Address
ZIP
PLUMBER t Address
.7 ZIP
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed:
Existing building New building Addition
If addition to existing building attach detailed memo for each.
( ) Drive in restaurant Car spaces
( ) Restaurant Seating capacity (10 sq. ft./person)
( ) Dining hall Per meal served Toilet waste Yes No
( ) Motel ( ) Hotel ( ) Cottages Number of units: 2 persons/unit
4 persons/unit TOTAL NUMBER OF UNITS
( ) Churches Number of persons Kitchen Yes _ No
(jQ Bar or cocktail lounge Seating capacity (10 sq. ft./person)
( ) Nursing or rest home Number of beds
( ) Mobile home park Number of units-- dependent (camper trailer) _
- nondependent (mobile home) _
( ) Retail store Number of employees
Number of customers T10 s_q. ft./person)
( ) Service station Number of cars served (daily)
( ) School Number of classrooms Meals served Yes
No
Showers provided Yes No
( ) Factory or office building Number of persons (total all shifts
( ) Apartments Number of bedrooms
( ) Other Specify
2. Indicate whether or not the following facilities are connected:
Food waste grinder Yes No _X__ Dishwasher Yes No l~
Automatic clothes washer Yes No _ Automatic potato peeler Yes _
Other (Specify)
No X
3. Fill in the appropriate information for the following as indicated:
H/ Iw/it•
Sic tank capacity planned 6 -A/1,,
Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET
COMPLETE OTHER SIDE _
Seepage trench bottom area planned width
linear feet depth
Seepage bed area planned wi dth
linear feet depth
Seepage pit planned zwzr?? ~ outside diameter
depth below inlet depth _
4. See approved plan for specifications and details.
Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION
P. 0. Box 309, Madison, Wisconsin 53701
Approved:
Address: Date: _
2a;7'z Zi ZIP THIS APPROVAL IS BASED ON STATE PLUMBING
CODE REQUIREMENTS AND DOES NOT EXEMPT THE
Date: INSTALLATION FROM CITY, VILLAGE, TOWNSHIP
OR COUNTY PERMIT REQUIREMENTS AND SHALL BE
VOID IF REVISED WITHOUT THE WRITTEN APPROVAL
OF THE DIVISION OF HEALTH.
DEPARTMENTAL USE ONLY
1 EXAA-UNCED and reported upon by the Section of
lurnbing and fire Protection Systems, Bureau
of Environmental Health, Division of Health,
DePGrtment of Health and Social Services.
JAMES A. SARGENT, Chief
Section of Plumbing & Fire Protection
APPROVED by the Division of Health, Dept. of
Health and Social Services, subject to conditions
set forth in the letter of approval.
RALPH L. ANDREANOlPh..
Adminis for
Verification
H o MM 1
• Ability Business Corp. , Q rn 3 n
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® Se" acv m n D 3 rn
G Complete Sewer vs~• ° o m °
a s T 0 Ci' , cn .Dy, 0,3 Q.
KNAPP, WISCONSIN 54749 ° > Q• nq- D• Q5m2l 1
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State, of Wisconsin \ DEP $~It EALTH AND SOCIAL SERVICES
\~y DIVISION OF HEALTH
RE~E MAIL ADDRESS: P. O. BOX 309
y IVE
C lF MADISON. WISCONSIN 53701
I 1 JUL 5 1977 IN REPLY PLEASE REFER T0:
l r^` ZONING SECTION OF PLUMBING
OFFICE AND FIRE PROTECTION SYSTEMS
Plan Identification No.
Dear Sir:
Re.
j nv' r
This is to acknowledge receipt of your plans and specifications for the above-
indicated project. When referring to this plan in the future, it will be absolutely
necessary to utilize the plan identification number assigned to the project. The
spaces below indicate if proper fees have been submitted or if more information is
required. Providing plan review is not completed within thirty (30) days, a permit
to start construction may be issued if requested. See Section H 62.25, Wisconsin
Administrative Code, for limitations in reference to permits to start construction.
Preliminary plan review for determination of fees does not hold the department
liable in the event additional fees may be required upon complete plan review.
Preliminary review indicates the plan review
Fee required is $ /
Fee received is $ 1 C F71 Plan accepted for review.
Fee is being returned because of II Overpayment F1 underpayment.
Providing one of the two categories above is checked, please remit correct
total fee in one payment. Indicate plan identification number on remittance.
No fee has been remitted. Plans submitted with no fees will be held in
abeyance until remittance is received. Indicate plan identification
number on remittance.
Q Additional information required. See attached Plb. 100, The permit to
start construction will not be issued until 30 days after requested
information is received and accepted.
Plans being returned. See attached Plb. 100.
Sincerely,
Z ames A. Sarg
Chief
JAS:fjs