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Home My WebLink About040-1163-70-000 "CO) O C-u0 t7 Lo 1 3 CD 0 ° CD c w 1 o o N N O N) Ca < 0 ~ A `C • N O c fD ? K N 'O ICI CO - Z~ n. 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ADDRESS : -Fierce Courtg, • ' sconsin Subdivision Lot , Lot size PUN V. I Distances & dimensions to neet requirements of Sec. N62.20 vo. cc i 1 ~ P LL P Septic tank(s) f~ - Yo xings^ Dept to cover ed zo1t~~--,E- ~ C ver Dry tirell size Type of Aggregate &,et ~Ccc Depth of seepage System__ Vent caps in place , number used - DISCIAE'D•.R: The inspection of this systen by Pierce County does not i.nplf co;-,plete co:rnliance with State Adrrinistrati.ve Codes. There are other areas that it is im-possible ,o inspect at this point of construction. Pierce County assumes no liability for system operation. PLIDMEI R ON JO • r 6 DATED: LICENSE I;UT-MER: /l1 - ~ ` z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itatty Pehmit-'.~.' State Septic ' NAME Township _ St. CtLo-Lx County Location' % o6 Section T-Z~N,R W SEPTIC TANK Size gattons. Numbest o6 Compartments Di.6tance Fttom: Wett 120 ott gtteaten zZope," bt f f.. Buitding it. Wettand6 bt. H,Lghwaten it. DISPOSAL SYSTEM Di,6tance Fnom: Wett it. 120 m gteatet 6tope Bu.itd.ing it. W ettand/s Ft. Highwatett it. FIELD DIMENSIONS: WidTth o6 tttench it. Depth o6 tock below tite .in. Length o4 each tine it. Depth o6 stock overt Cite in. Number ob tines Depth o4 tite below gttade in. totat .length o6 t.ines - - it. Sto pe o6 tttench .in pets 100 it. Distance between tine/s fit. Depth to bedttock it. Total absottbt.ion attea 1'%4t2 Depth to gtcoundwatetc it. Requi&ed attea it 2 . Jl PIT DIMENSIONS: Numbest o6 pitz Gttavet a-tound pitz yes no Out~5ide diametett ,.6t.1 Depth betow .inlet it. Totat ab~s ottbtion attea. it2. z 17 Area ttequ i t e d it2 rn INSPECTED BY , TITLE APPROVED DATE 197 . REJECTED DATE 197 L4' a State and County State Permit # PLB67- 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: 6) L B. LOCATION: / _YQ ,C Y4, Section ;Z-) , TP-9 N, Ra Sig1k) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township !1z'Q Y C~,LkF /VA//e v r d 7l Y F C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms y No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES ,'NO Food Waste Grinder YES >-NO # of Bathroom Automatic Washer -YES NO Other (specify) E. SEPTIC TANK CAPACITY /2&c Total gallons No. of tanks rte"' *Holding tank capacity Total gallons No. of tanks New Installation A--'~- Addition- Replacement Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)_-5~_12) 5,:3 3),V• Total Absorb Area sq. ft. New ✓ Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length-7,0 Width /5!_ Depth "f Tile Depth IX, No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope /YE1jy,~ 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code nd that I have sized the effluent disposal system from the EH-115 prepared by the Certified oil to NAME C.S.T. # and other information obtained from 3 vver ,l 3 ~'(a Z 5 d Plumber's Signature RSW# - Phone # Plumber's Address - 6e c . 01 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20,- including well). 'a V . _ ^ _ a k.._ t `I n i v e t E ; 1 1 1 Do Not Write in Space Bel_gw FOR DEPARTMENT USE ONLY lee C Date of Application,/- Fees Paid: State Count Date Permit Issued/Rejeeted- (date) -Issuing Agent Name r t:eL (t/~~~ ~ r Inspection Yes No Valid# Date Recd 1. county (w ~te 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 6/1 /76 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 IL BORINGS AND PERCOLATION TESTS LOCATION:., ~/4, ~'/4, Section ~N, RL,~ W, Township or Municipality tt~ ~~Count ST~C'/v Lot No. , Block No. kb I Y P - 1 , 9 i O division Name Owner's Name: le T ~-~J /J Q Mailing Address: ~ Jj &>_~kf~9G'V~ 2'/ U5- i Ei!q&t) 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 z ~ Ll ~e 9RDT 'L PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NU INCHES THCHIARCKNESS IACTERN IOF . NCHES SINCE HOLE HOLE AFTER INTERVAL M- BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN rI_ ~v A~w P_ 6 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) 21 73 r __T6" .d IL /('i :SC' G 3 5G l Gr ' dory 7'!<t . B-3 1 .0-o 7Z _-s i B-- 7 _ _ LAG 4 C~ ' ri ` L' b? :rd rr , 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 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. c-, I I i _ I I i I ~ I 4 t N I 11 111 ~ t , r I 3 11' ! t I i ~ ! r I I A Ci~y'j' 0 7 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. ~ n Name (print) Certification No. Address Name of installer if known 24 - -L< CST Signature 4 x AUTHORM' TRANSFER FORM PL 13 6 T ~ T SANITARY PERMIT State Permit # Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: '/a, 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'~oert . If well has not been drillgp i t _ i 6 i I s i W E E n 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 PLB 67- T SANITARY PERMIT ,rte State Permit # 1 Sanitary Permit ~7e,~ I - 11 C u t Sanitary Permit Transfer Date Original Pei^frr~t Tss A. Property Location: '/4, Section , T N, R E (or) W Lot # -City Subdivision Name, Nearest Road, Lake or Landmark BILK # Village Township B. TYPE of Occupancy: Commercial Industrial Other (Specify)- &Ir Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY _~d0 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 DISP SAL SYSTEM: Percolation Rate ,Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth ~_Tile Depth(top) No. Trenches f p Seepage Bed: Length Width Z Depth_1 Tile Depth(top) ~~.No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal Present Sani ry Permit Holder Phone No. Sanitary Transferred T Phone No. ~Y 8 A. r / N ~ Er `T - N 6 f Address C Address 41 ZiP Zipt 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 ;T 2ra d/or any addition oil is that m have been required. may. ? e~ Plumber's Signature A~FP/MPRSW # \7 / Phone # - - c 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, n the property or neigh- bor's prop ert . If well has of been drilled cate - - e i 3 4 i _4 i 3 Q ~ ~ s 1 If wa~ i I i 3 f 1 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 ST. CLOT.:; COUNTY FOR:Bldg. Permit O SubDivision of Land Approval Date ( ) Non-Conforming Permit Appl. No. Variance Permit Permit No, ( ) Reclassification of Zoning Dist..Date_ Other Comments APPLICANT'S NAME --tome Address Phone Business Address Phone Agent's Name Agent'-s Address Phone TYPE OF BUILDING PERMIT REQUESTED: ( Home Farm O-atbuilding ( ) Commercial Building O Accessory Building ( ) Industrial Building Trailer Home - C ; Seasonal Dwelling Basement Home Remodeling O None OC 1' I1 OF ND Section Township Range Block Quarter Lot #---T Road Abutting Street Comments DISTP.ICT CLASSIF CATIOi~1 UNDER PRESENT ZONING ORDIIT,A!ICE AS A.I~TrID~D: Residential ( ) Industrial Agricultural ( ) Lal;e-Strc= C ) Commercial ( ) Comments A ove is a triAe presentation o the -acts. Initials Oi,-ner f Agent ~ Zoning Administrator Exception Note: ( ) None ' LOT AND BUILDING LOCATION DRAW DIAGRAM of Lot, Building, Accessory Building, Roads and, Parking Area. Show Highway Set-Back and identify Highway. i DIMENSION OF LOT Front Ft., Rear Ft. Left Side Ft. Right Side Ft. (Facing Lot From Front) Approved ( ) Non-Conforming ( ) Approximate Area Sq. Ft. Comments J LOCATION OF BUILDING ON LOT Yard around home or main building Front Ft. Rear Ft. Left Side Ft. Right Side Ft. Approved ( Non-Conforming Comments Yard Distance of Accessory Building From Main Building Ft. From Side Lot Line Ft. 'From Rear Lot Line Ft. Approved ( ) Non-Conforming Comments " Above is a true presentation of the facts: Initials Owner Agent Zoning Administrator Exceptions Noted: ( ) None