HomeMy WebLinkAbout032-338-27-5403-LUP-1980-217Appltcatlon for Iand Use PerDlt
Courty of 8trycr
fhe undeltlgncd hercby EtkoE rDp11catlon for a Ianrd UBo Pcmlt and
agreeE thrt aU rork rhru. be tlone ln accordance rlth the requtre-nents of the Sarycr Cormty Zonlng Oritlnance rnal tho Lara and reg-u].atlon8 of thc gtcte of Uleconeln.
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winter Wlscongln 54896
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Frb 67
State of Wisconsin and County
Uniform Pormit Application
for Private Domestic Sewage Systems
41
A. LOCATION OF PREMISE WHERE SYSTEM WILL BE CONSTBUCTED, ALTERED OR EXTENDED
LEGAL DESCRIPTION
(Sec., Lot, Block)
d-/ 3t'r.l \tU _ (tt / rr1*tbrowrusHrp
B. OWNEB OF PROPEBTY MAILING ADDRESS
(Street, City, Zip Code)
B (_
MATER IALS: Prefab Concrete
D. TYPE OF OCCUPANCY
One or Two Family Residence
County
Number
t"'lt rJ67
Name One:
---- CITY
me
VI LLAGE
5
C. SEPTIC TANK CAPACffY 2IC.-GAIIONS NEW INSTALLATION REPLACEMENT
-
ADDITION
ured in Place
---
Steel ( O,ner ==-__-; No. of Tanks
No. of Bedrooms
Commercial lndustrial Other --- No. of Persons to be Accommodated
(sPecifY)
E. APPLIANCES, ETC.: Food Waste Grinder - - - YES -{-ruO Automatic Clothes Washer
-YES
t fuO
D ishwasher - - -YES X ruO Other (Specify)
F. EFFLUENT DISPOSAL SYSTEM t NEW
-L
EXTENSION ADDITIoN
--REPLACEMENTSeepage Trenches: No. Lin. Feet Trench Width -- - - - Depth _.-____, Number of Lines
Seepage Bed: Length &tt'width a Deprh 2' Tite Size {"No. Lines
Seepage Pit: lnside diameter Liquid Depth
G. Percent of slope of land R o)/o --dl!t hti- direction
H. lndicate Slope of Land & direction of slope on sketch l. Tile Depth
PERCOLATION TEST
lndicate Soil map number And Soil Type
Water
in Hole
Overnight
RECORD DATA FROM MINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED
(COMPLETE OTHEB SIDE)
Test
umber
Test Time
I nterva I
in Minutes
Depth
I nches
Character of Soil
Thickness in lnches
Hours
Since Hole
i st Wetted
Drop in Water Level lnches
Second to
Last Period
Next to
Last Period
Last
Period
Minutes
To Fall
One lnch
7u Ts, ttnluJ J"x6 Zc>2 -)2 ./{
D
Depth to Ground Water
Lt
Total Depth
lnches Observed Estimated
(
RECORD DA]'A FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED
B O R I N G S - Minimum 36" Below Proposed AbsorptionSystem
)'/ _
Character of Soil with Thickness in lnches
fs 2
1!_C)d *a-2--
il e
_s
Z
,y/
t
l o
0N
I
SOIL
Boring
umber
il
I I1
Depth to Bedrock
a.
Observed Estimated
State Permit
Number
ft
Yorl .
t
2_
Al Dk ,,1/cqlc
n lm,l ,t )ol4L_
l"'ll,nl-J t)
I
Name oI Owner Colrnty +/cttttt-ytv
PEBCOLATION TESTS
l, the undersigned, hereby certiry that the Percolation Tesls reported on this form were made by me or under mY tupervision
in accord with the procodures snd morhod specilisd in Section H 62.20 {3), Wisconsin Adnrinistrativc Cod€, and th.t th. data
my kno\^/ledge and belief.
i ...:,. , r'.1\ i{ ''
recorded snd loca_tion, of l8rt no*:
11" "o:l"o to the be!1 ot
NAML TITLE
A-r I :lr=.-/,,
SIGNATUREDATE OF TEST
MASTER PLU IVIBE R MAKING APPLICATION
Signaturs:
For:
(employer)
MP
License Number: MP RSW
Provide sketch below ot systcm
(lnclude direction and percent ot slopo and all applicable distances)
l
LA
Lr
(i
P EWl,Pe
Ti
20'
'15'
'10'
5',
0
10'
15',
20'
25',
qcste
1-,
L lati
I
i
r col o0 est & Soil aore,l o les
J / ,L/ . \
ir
l
-t-,7 \I t,/,4
fl
L't:.ftI
-4
PROFILE (lndicate Groundwater or bedrock wherelapplica h"rl Iti I
I
I:l
I
1
7Tv
it,1',
z',
3
4'.
5',
6',
7'.
8',
10
t 1'
I
I
i;
++_+--r-1
+t t'
"t /$" t i'v1,./tt.-
Noto: Tho app licstion c€nnot bo considsrod lor filing unlil rll ol,lhe above questions are answersd and lho lee psid
Dare o, Applicarion
Permir I ssued/RriEia (date)
lssuing Agent Name
Do not write in space below - FOR DEPARTI\4ENT USE ONLY
Fees Paid Stare l.e(\
ocT El Y3 lnspection Yes
Valid No
County lO .C(J
No b [l-jra+
DrvrsroN oF HEALTH, P.O. BOX 309, MADISON, Wl 53701 h,173
Date Rec'd
ADDRESS
i
eernrlNo-41b41
(Type or Print) _1 >/ 7
REGISTRATION NO.
-
or MASTER PLUMBER LICENSE No. >
t ,J
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Thls Indenturg lltc thlt 5th . dry ot May ,1. o., tc 72.
Dctwa.a WILLIAM BUTLER and LOIS BUTLER, hls vdfe, and each ln thelr. o1{l rlght ,husband and Wlfe;rtl 69l thc fittt put, and '
. PAUL E. WHOEFER and IOIS A. lrliIHOEFER,/each an iurdlvlded One-half. lL/2) lnterest as tenants ln common, and not as Jolnt tenants'
Xr ]1. t..trrl, Ho.Eor htr, &. lll.ll f,L SlrtrB (3T lt o, trSotoNarxl harb.a t Lr crh r{ a a.{--r ol
Prrti g Sol tic sc cond Patt
oa tntrdt$: T[at alc ser'd prn i 63 ol thc fitst part, lot rzd ia coas.r'dcratioz oI the suE of
' 0ne and no/tootls ($I.00) DoLlar and other valuable consideration
to them ia hand paid Dytiasaidpanies ol thc sccood p!tt, aie receipt whcreof is hcrcby
confcssed anil acknowlcilgcrl, haygivca, greatcd, bergalned, sold, rcan'scd, tclcascil, aliencd, coaveyed
and confirmcil, aad Dy tllesc preseats do &ivc, grant, bargain, scll,lcartc, rclcasc, alicn, convcy and
confirm unto thc saiil part ies of the sccond part, their ieirs and assigzs
forever, the following described rea, estaac, sr'luated ia thc county of Sauyer
and State of Wisconsin, to-wit:
Corunencing at the meander corner between Secs. 27 & 28-, town-
ship thirty-eight, north, of range three west on the south shore
of Connort s Ia[e, thence northeasterly along said lake shore
350 feet to a point, thence southeast to tovrnroad, thence north-
easterly along t or,rn road 200 feet to a point, this being the place
of beginning; -thence northwest to shore of said Connor:s lake,
+,hence northeasterly along said Iake shore a distance of -100 feet-,
'-hence southeasterly to townroad to a point that is 100 feet north-
:asterly along said tounroad from place of beginning, thence south-
westerly to place of beginning, being a parcel of land in lot four,
se.tion twenty-seven, tounship thirty-eight, north, range three
Parties of the first part agree at their expense-to have a
Sllrvey rnade of the above- described property and to furnish same
to part-j-es of the second Part.
.TRANSFER
s H
FEE
@ogct!/Cc witb a aait sizgutrr thc hcreditaaents al,il apDurteDa cct thercunto betoagiag or ia aay*isc
appertaining; and all the estate, right, titb, lntercst, claia, ot dcmaad whetsocver, of thc said Pan ies
of the first pad, cithcr in lav or equity, eithct in posscssr'on or c rp"ctarrcy of, in aad to lhe ebove bargained
premises and their hcreditameats aad apputtcnadccs.
@o q8tt OnU to eolD, tbc saiil premises as above ilesctibed with th. hereditamcnts and aPPurtenanccs,
unto the saiit pafties ol the sccond Paft, arril to theidet'rs and assrins FOREYER-
.rltlDtlt$ol! Williarn Butler and Lois Butler, his wife ' and each in their orrrt*6?"Cn"rn=a1ves. thei r hcirs, erecutors anit adainiiratots, do convenaat, graat, batgah and-
,er""" ii";;Z7r1ii hL "iii"frrt ies of tlre second part, 1,hsip ,rcr'rc and assrgas, that at thc tir,e ot
ttre ensealing anil delivery of tiese prescrts they arewe/l seized of the preaises above ilescribed,
as of a gooi, sare, perfict, absoluti antl inileteasibie cstatc of inheritaacc ia the law,in fec siaplc, azd
that the same are |rce and clear lrom all incumbrances whatever,
anil that the abovc baryaaicil prc',,lscs tn thc qula tail pcaccahlc poscsdoa of thc rplil nart les of tic
pg 216 ?|L
'9'
Peisoaally ceac beforc me, tbis 5th ilay of
the abovc named William Butler and Lois Butler,
fi: 2 16 tc.
'91
\wr<,
i'Ji1 l_am Butler -{Scal)
J.;-, B,-;d.*-
-(
SeaI )Loi s B ut 1er
eel )
Itlay , A. D., 19 ,72,
and each ir, /.
Wo od Coin t?,Wigcgnst!,
'J. : -:
*",1+
s.cond part, 1,hgir ,rairs anil assigns, agaiast ell and every person ot persons, lewtully claiming the
wholc or any part thercof , they will lotcvcr WARRANT anil DEFEND.
ln ollltntgd oultllot, the salil patt Les ol tr? /lrst pett hlbcrcunto sct their hen! s anil
seals trrs 5th day of MaY , A. D., 19 72 .
4ig:)C toa s""tcd in Prcscacc of
L h ? ra)r\"
CarI L. Mei ssner
--{Seal)Lois C. Mercer
$rlt ot afnidtonrln,
Vr/o od
ss.t
Iounty,
s wife,. their owl risht.
to me Lnown to be the pcrso"D gtiho crccatcil thc foregoing in and acknowledged the same.
Ca r1
aMy commission
't D.:
D|altcd by Carl L. Me 1S snp r A tto rn e -a f w
/r'.r 1
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