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HomeMy WebLinkAbout042-1017-10-050 Parcel #: 042 - 1017 -10 -050 10/18/2006 03:08 PM PAGE 1 OF 1 Alt. Parcel #: 07.29.18.101 D -10 042 - TOWN OF WARREN Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/29/2005 05/26/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - MOEGENBURG, LOUIS A & JULIE A BEST LOUIS A & JULIE A BEST MOEGENBURG 950 107TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 950 107TH AVE SC 2422 ST CROIX CENTRAL SP 1700 W ITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 7 T29N R18W PT NE NW LOT 1 OF CSM V Block/Condo Bldg: LOT 01 5/1214 ASSESS WITH P98B EXC PT TO 107TH AVE Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -18W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 11/29/2005 813148 2935/514 QC 07/23/1997 1196/087 WD 07/23/1997 989/254 QC 07/23/1997 904/165 more 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.130 39,000 195,100 234,100 NO Totals for 2006: General Property 2.130 39,000 195,100 234,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/03/2006 Batch #: 06 -15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i 3 82624 i. VOL 21 PAGE 5213 KATHLTfiA H. WALSH REGISTER OF DEEDS CERTIFIE10 SVRVEV MAP ST. C VED CO.. MI RECEIVED FOR RECORD LOCATED IN PART OF THE NE1 /4 OF THE NW1 /4 05/26/2006 11:00AM AND PART OF THE NW1 /4 OF THE NE1 /4 OF CERTIFIED SURVEY MAP REC FEE: 13.00 SECTION 7, T20N, R1 8W, TOWN OF WARREN, COPY FEE: 3.00 ST. CROIX COUNTY, WISCONSIN; BEING PART PAGES: 2 OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 5, PAGE 1214. NE CORNER OWNER SECTION 7 LOUIS & JULIE EGENBURG N1/4 CORNER NS 8 °55'31" 950 107TH AVENUNU E NOTE: SECTION 7 An ROBERTS. WI 54023 THIS CERTIFIED SURVEY MAP DOES CREATE 2523.32' SURVEYOR ANY NEW BUILDABLE LOTS. THIS MAP S NORTH LINE OF THE NEI /4 EDWIN C FLANUM REFLECTS THE REVISED BOUNDARY OF AN NORTHLAND SURVEYING, INC. EXISTING LOT AFTER THE DEEDING OF P.O. BOX 14 PROPERTY TO THE TOWN OF WARREN FOR ROBERTS, WI 54023 A TOWN ROAD N I n c" --------------- o� 1" IRON PIPE FOUND I z D (�\ S02 "55'49 "E 1.07' FROM ITS I = m I \ 1 \ COMPUTED POSITION + �;, I c� m I m m IW3613 02 �, 58 ��E 3'17.52' N ? ° M 1 83 � m m I N� m I 0 a a -13 Q q m m cn p Z SEPTIC f1 f1 b W I v v MUT `L L- ' i.�B. . OH VENTS � W I � � m 1 � f7 ° o ° w N =O m o 4� pC�o ���'� �3 ` �! j ?5 t7 o p I o O \ q - - - -- - - - - -- \p N y I o s� o SEPTIC o m 1 y VENTS p w / LOT 1 WELL 17 .... ............. 24 ACRES "2 97.574 SO. FT. 11-05 � OJ I 1 1 I 1 � - ------- --- �� S69 4 254.07' i '107th AVENUE � EXISTIN C ' i V ' 4 RIgBLE R -�a do - c — (L c CURVE DATA TABLE' I(r I NUMBER NUMBER I I� I RADIUS 30.00' CENTRAL ANGLE 76 °48'21" w CHORD BEARING N52'1 5'35.5W ��N��\p CHORD LENGTH 37.27' y �� S !s / %�� ARC LENGTH 40.22' S8 9 "20'14 "W S1/4 CORNER TANGENT IN SECTION 7 / EDWIN C TANGENT OUT N13°51'25 "W �j s FLANuM ?~ LEGEND �i RY 4 .-/ = wIS a ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND 0s; , "�yv iyi� /iigpuHuK`I1�`�t�N������ OlI � 1 5/16" 0 . IRON PIPE FOUND ■ 3/4" 0 IRON REBAR FOUND SCALE IN FEET 1" = 100` 100' BUILDING SETBACK LINE THIS INSTRUMENT DRAFTED BY SAM ADAMS SHEET 7 OF 2 SHEETS 100 O 100 JOB NO. 05 -60 DATE 11 -14 -05 1of2 Vol 21 Page 5213 9 WisconsinDepartmentofCommerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal informat you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363846 Permit Holder's Name: ❑ City ❑ Village ❑ TXwn of: State Plan ID No.: Moe enbur , Lou Warren Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: c3 0 • c7 O . c7 o �c iG C,cstn� -r CSC �t3►� ,- 042 - 101~6 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic N N _ ts Benchmark co, ID ' Dosing Alt. BM I v fP JCV4 ' Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 3. �� �2 " 13.G1 TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic OL NA Dt Bottom Dosing S NA Header / Man. Aeration NA Dist. Pipe y, zy �, 3/ 9s . s.7 Holding Bot. System s �' " / 9/. 3Z PUMP / IPHON INFORMATION Final Grade ti 3 35 Manufact n St cover a6 Y Model Number GPM TDH Lift n System TDH Ft oss m ead Force Length DI Dist. To Well SOIL ABSORPTION SYSTEM 8fe& TRENCH Width r Length i No. f Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIME �� � DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER I D 1 0 t INFORMATION Type O I o / e Numb System: Co" . > I Zo OR UNIT &u ZZ DISTRIBUTION SYSTEM Header/Manifold y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Lengt Q�d Dia. Length Dia. Spacing 5 ' SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nch Center Bed /Trench Edges Topsoil I E] Yes E] No [] Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: oS /oS/ o° Ins ection #2: -4-- -f Location: 950 107th Av u , Roberts W1 4023 (NE 1/ NW 1/4 7 T29N R1 8W) - 07.29.18.98B 1.) Alt BM Description =U of. '" sP ti N � I " K 2.) Bldg sewer length = - 53 ,� ( 1 �( ,gL - amount of cover = +I? �^� f s 3 6" Z 3 Lo 6t- 1 S" e , m i 110 s P Plan revision required? []Yes No Use other side for additional inform tion. 05 0 (� °v ( Z SBD -6710 (R.3/97) Date Inspector's Signaturig, Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _m n p - �.��..em f � a ? t uM. V T - . E e f l - � fl Safety and Buildings Division A sconsin SANITARY PER 2 01 W. Washington Avenue *. P O Box 7302 Department of Commerce In accord with Co , WispAd e Madison, WI 53707 - 7302 KEMD Ian complete � • Attach P Y) fort n f e3 stem on paper n I unt s ( to the county c opy onl of es�: Y � than 81/2 x 11 inches in size. n )--S s O f 2000 • See reverse side for instructions for completing this akpX]gation ST ate Sanitary Permit Number Z ? ,, Personal information y ou p rovide may be used for , J� ( Jl� Y P Y secon purposes £�� Zy�.: � � Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ,-; State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL Property Owner Name y Location G n l6 u r & 1/4 Al W1 /4,S 7 TZ9 ,N,R /$ )((or Pro erty Owner's Mailing Add ( ess Lot Number Block Number i tate Zi Code P C hone Number Subdivision Name or CSM Number (.v oa (71$ )N9-299 I)_A . IL PE OF BUILDING: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Tow of via j d 7 L A ve - III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number s) 4 6 yVy 1 E] Apartment/ Condo .W/ 2A —/0/ J -8. ' 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ SYrstem ________System _____________ Tank Only______________ Existing System _________Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trenc a 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit bt x 886 43 ❑ Vault Privy 14 E] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 600 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 8 57 O.G 7 /- 6 Feet . 9 Feet Capacity VII TANK in Ca gallo s Total # of N Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass App. New Existing structed Tanks I Tanks Septic Tank � A00 app k/10 ® ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install ion of the onsite sewage system shown on the attached plans. Plu tier's Name: (Print) Plumbe ' igna (No Stamps) P .. Business Phone Number: /2 �w>�a� _87s '7 X35— S/63 y Plumber's Address (Street, City, State, Zip , IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) %A roved Surcharge Fee) pp ❑ Owner Given Initial aa �Z Adverse Determination Aq X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable: 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. 'The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or, the State of Wisconsin, Safety and Buildings Division 608 - 266 -3151. - • - - -• To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. ` VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete - dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction1oss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; €) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SITE PLAN Page 1 of 1 man Plumbing, Inc. Lou Moegenburg Master Plumber No. 5875 NE,NW,7,29,18,W Warren township 2819 Knapp treet St. Croix county pp Menomonie, WI 54751 -4634 FAX (715) 235 -3650 y� Jack A. Bowman MP 5875 LEGEND �1 4 BM: 100.' top of ood�° 0 . deck 0- borings No ILHR 83.10 pr blems 1 S Scald 1 0 -40 1 exc pt where indicate 6 System elev. 91.5' d SO Ca � 6' w// f 0 Wiscorisin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of - Division of safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 4A - to 1(o -3a APPLICANT INFORMATION - Please print all information. R wed by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location eo A At r Govt. Lot N Z 1/4 N Vv 1 /4,S "7 T ?9 ,N,R (a X (or W Property Owner's Mailing Addre Lot # I Block# I Subd. Name or CSM# At A City State Zip Code Phone Number Nearest Road 5510 ( ` i.5 ) 70? El city ❑ A ag r 6 ®Town /67 '"4 116 . ❑ New Constriction Use: ® Residential / Number of bedrooms Ya ter Addition to existing building A. A ® Replacement ❑ Public or commercial - Describe: AI . Code derived daily flow 6 M gpd Recommended design loading rate bed, gpd1W j. - - 2 — trench, gpdtW Absorption area required /� bed, ft 3_5 7 trench, ft Maximum design loading rate _ bed, gpd/W 7— trench, gpd/it Recommended Infiltration surface elevation(s) Lae�"� 1 per- , 9/. _ ft (as referred to site plan benchmark) Additional desig Parent material a -- Flood plain elevation, if applicable it/f�. ft S = Suitable for system I Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ®S ❑ u ®S ❑ u ®s ❑ u ® s El u CIS ®u D s ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color { Gr. Sz. Sh. / Bed , Trench ? r z.3 /C 5� 5/ a6k rr S '0.6 elev. 3.33 7. 5 " Vb s r n Tr c S Q�Lft. �. 33 5 Y ` m�� 7 Depth to 5- 1 �' , limiting / .- Z" factor , Remarks: Boring # z. a- 6 - z 6 / 9 T S K - im 1. 6 -53 7 L Yk 4 / S M r C, S -- G Ground A aj, 10% slew. 1 ,r Ylb 9 — ft m S m y d c Depth to limiting L JaLae. ;�hjl_u� Z- '/5� ---------- i factor , 65 In. Remarks: CST Name (Please Print) Signature Telephone No. T ess : Ms. Loretta A. larra (715)235 Address Business: Date CST Number Bowman Plumbing Inc., 2819 Menomon'e 54751 2 /,} c CSTM 3719 SOIL DESCRIPTION REPORT PROPERTY OWN Page �' of -� PARCEL I.D.N Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Geptft2 in. Munsell Qu. Sz. Cont. Color �1Gr. Sz. Sh. P Bed , Trench o?• O2/ 7. Q �� c, Yn. o r 5�o Ground i - a 6 _5 Yo (v elq 6 - 75 yr? /r m ,n � Depth to 1V LUJ / Z // Z177 limiting actor $ 6 in Remarks: Boring # 13 Ground elev. n. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roofs in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; E3 Ground elev. n. Depth to limiting factor i Remarks: Boring # E3 Ground elev. ft. , Depth to limiting factor in. Remarks: ' SBDW -8330 (R. 08/95) Page 3 of 3 SOIL AND SITE EVALUATION REPORT Lou Moegenburg NE,NW 7,29,18,W Warren township 1 St. Croix county \� loret a larrabee CS 3719 LEGEND `ABM; 100.' top of de k 0- borings borings dug with �\o back hoe = r l NO ILHR 83.10 problems 'Scale 1 -40' exce where indicated `4J I C5 •J� ST CROEK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mr • Louis A. Moegenburg Mailing Address 950th 107th Ave. Property Address Roberts, WI 54023 _ (verification required from Planning Department for new construction) NO A6444 City/State Roberts, wi Parcel Identification Number 42- 101x6 -30 LEGAL DESCRIPilON Property Location NE y., NW 1 /,, Sec. 7 . T 29 N -R 18 W, Town of warren Subdivision N.A. Lot # 1 Certified Survey Map # 379826 . Volume 5 , Page # 1214 Warranty Deed # _ 548417 . Volume 1196 . Page # 087 Spec house O yes I) no Lot lines identifiable !g1 yes O no SYSTEM HAR.UERANCE Improper use and maintenai}ceof your septic system could result in its premature &&hire to handle wastes. Proper maintenance consists of Pte$ art: die septic taah every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the fad on of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterph mA e4 joutneymmpinmber, tesbictedplumber or a license dpumper verifying that (1) the an -site wadmmterdisposal system is is proper operating oondit%oa and/or (2) after inspection and lumping (if necessary), the septic tank,is less than 1/3 full of sludge. Uwe, the undecaigno 'have read the above requirements and agree to maintain die private sewage disposal system with the standards set forth, hmin, as set by the Department of .Commerce and die Department of Natural Resources, State of Wisconsin. Cectificxtion stating drat your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year iration date 4 TtJRB OF APPLI DATE OWNER GERM DCAUM I (we) oertlfy that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the ppperty described ve, by ;iof a warranty deed recorded in Register of Deeds Office. IGNATURE OF APPLI DATE * ** * ** Any informati on drat is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Mr. Loe Moegenburg residence located at: NE 1/4, NW 1/4, Sec. 7 , T R __Ig_ W, Town of Warren Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Fall of 1999 Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: 1,000 gal concrete tank Construction: Prefab Concrete X Steel Other Manufacurer ( if known) : unknown Age of Tank (if G nown) : 1989 Jack A. Bowman nature) (Name) Please Print Owner /Bowman Plumbing Inc. MP 5875 (Title) (License Number) `/- /'/— v 0 (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Jack A. Bowman Signature MP 5875 5/88 ., 5t��i (�'�� ` STATE BAR OF WISCONSIN FORM 2 — 1982 ri4 II WARRANTY DEED DOCUMENT NO. �I VOL PAC iOS7 - - - -- - - -- - �L - — : -__ . - - -- _- — - - -- ._ -- REGISTER'S OFFICE li St CROIX CC., M William G. Joha nnsen and Charlene A. Johannsen, ' �l ` �Fius5en� a - fie, AUG 2 0 1996 conveys and warrants to LOu ° enbur?� and Jul ie sIt > 2.00 p husband and wife, as survivorship marital `K.�4t.. 4 " property: lMpU��tt�i>� i `. THIS SPACE RESERVED FOR RECORDING OATA NAME AND RETURN ADDRESS = . the following descrihed real estate in Crai x County, State of Wisconsin: TRANS R 3 42- 1016 -30 -.46441 PARCEL IOENTNFICATgN NUMBER � FEE Lot One (1) of Certified Survey Map in Volume Five (5) of Certified Survev .` •J- Haps, :+Fge 1214, as Document Number 379826, filed in St. Croix County Register of Deeds office on September 21,1982, being part of the East Half of the Northwest Quarter (E1 /2 of NW1 /4) and the West Half of the Northeast Quarter Section Seven 7 Township Twenty -nine (2` > '.North, Range 4 of .,ectao ( ) p (W1 /2 of PIE1 /) � Eighteen (18) West, Town of Warren. s Together with and subject to easements as shown on said Certified Survey Map. •T . �1L +I5 ' • j �• s This is homestead property. t (is) Mom Exception to warranties: Easements, restrictions and rights -of -way of record, if any. t Dated this �t day of Aticrust A.D., 19 9b . • William G. J nnsen Charlene A. Johanns� �a• t�= 6 S EP 2_1 L ED :198 2 w 3' 9626 ,� N 1/4 COR. SEC. 7, T29N, RIO W, CERTIFIED SURVEY MAP (COUNTY SURVEYOR'S MON.) GLENN FRANCIS Part of the East 1/2 of the Northwest 1/4 and the West 1/2 N 88° 48'40"E 2697.88' of the Northeast 1/4 of Section 7, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. N. LINE N W I /4 • Indicates 1" iron pipe found NW COR. SEC.7,T29N, o Indicates 1" x 24" iron pipe weighing 1.13 lbs. /lin. ft. set R18W,(COUNTY S18 0 59'38 "W 1039.06' SURVEYORS MON.) 0 50 100 200 300 W E- LANDS 4 3 N 78 0 28'49•'E 66.00' UNP -� E� gym_ N 8-3-14'34 " E 317.52' W z / 6`yA Og Z N CID .a 0 W I 133• �0 S z 1 001 �WW of O N1 eO LL Wd it W 1W- K O m _ UNPLATTED N =� 1 LOT I 2.564 ACRES LA NDS t� –m 1� 111,686 SQ.FT. ?Nz NET : 2.1087 ACRES W ZWp c� 1 91,855 SO. FT. 4 3W 1 N to M mF 1 �p M J O N 0 %% a Q 2 Q UNPLATTED R�OO M \ SCALE I" =100' LANDS �� p0• S 00 °'50' II "E 33.00' !7 l • 1p'4p 89° 09' 49 " E 2 76.80' S 89 49 "W 34 3 ' 1 • b — — — _ . ' 90 00 00" c 1 _ – S89 °09' 49 "W _ 304.15' I 0 - 0 0 � t0 • — N89 °09'49 E 675.8 J i z 66' ROADWAY EASEMENT UNPL ATTED LANDS / (EXISTING) THIS INS TRUMEN T DRAFTE BY LAURE W. MUR PHY 66'TOWN ROAD APPROVED SEP 141982 $T. C&01l4• COts114jY State of Wisconsin) "A P101#0" rARKS ruNKING AM Z.ONa43 COM VINE County of Pierce) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Glenn Francis, I have surveyed and divided the lands shown hereon in accordance with official records, Cahpter 236 of Wisconsin Statutes and the Ordinances of St. Croix County; and that the above map and description are a true and correct represen>lFdlonlnpp���� NN thereof . G G O iV s ����,,� i //% Dated: 24 August 1982 ••••• • • ,. •• •� /' .JAMES L. = MURPHY - j S • 1 0 4 2�_ Vol. 5 Page 1 14 James L. Murphy �. RIVER FALLS :moo Pied Survey Maps Registered Land Surveyor wlsC. -oix County, Wisconsin (DESCRIPTION ON REVERSE) r C "M1 T }} i i' . 1 � `�`� a� t l 11/111 1 111 1 1► I// j / //' g ONVT oslnn • v`� ��: u •k�uno0 xTOaO ' �'� SP ZP n d S 3. � 0 .� � ,zo�an..m tre a,z sTBa s � anan a T t ,za SIIV� �3nia Agd.lrw 'Z saurer VTZI aBUd 5 'TOA Zti0T �kHd?jf1W I V. l S3Wdf (� ..Oft ,gtt 0 88 N Paumssv 'q.saM 8L a8 'q'4..aON 6 e dTUsumoy ' L uoTq-DDS 3o t7 /L samq' aON aq'� JO auTT M-aON aq:� 04. paoua.zaJ@J a,xe G&uTJv9q TTs uoT stq jo sasodand JOd) �ONINNIOdg d0 ,I,NIOd dui:+ u+ L' 4eC tai ., L L L , L L N aouaq:. : ,'7 L 'ttu�'L' M „617 1 60 o68 S aouag4 :,00' a „LL X 000 S aouagq- l, 5C ' ttK M ..6tt 160 068 S aouaq� , 00099 M .. 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C lr 000 Z a 000 �• gg < z ($ 3 co ca CA o I f (1) (A � o D O CD a T v v" N C d N d d CD 3 d I 0 3 01 N N � D m o I -; D m o O O° O > > T I (�D m m � m m • c 1 X Cl) e O N I m 'a N �f CD CD CL 3 a 3 m N °~ CL I w n A �? I I 1 m N v W I W T CL m I a m z �� � $ $ » Z co N Z y CD I v a w C. I I �.m o o FL m y c I c a F CL m m CD N f (D 'T1 m d 3 n N CCD ° CD 60 d + �=r .Z1 P 1 10 G I A .. �° O O ,+ c x N 7 I A ° I A o o CD m am N O rs+ O o f I o g v I o a I o o Parcel #: 042 - 1016 -30 -000 02/0212007 03:41 PM PAGE 1 OF 1 -Alt. Parcel #: 07.29.18.98B 042 - TOWN OF WARREN Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/26/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner LOUIS A & JULIE A BEST MOEGENBURG O - MOEGENBURG, LOUIS A & JULIE A BEST 950 107TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 7 T29N R18W PT NW NE THAT PART OF NW Block/Condo Bldg: NE TO LOT 1 OF CSM V 5/1214 ASSESSED WITH P101D Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 07- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1196/087 WD 07/23/1997 989/254 QC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 042 - 1017 -10 -000 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 /$ g 2 a 7 2 k T ° 2 E @ « s z c # -n # o 2 E § \ g k \ i > - ¢ z E ® 0 � o E § 0 § § o ƒ CD ' CD 0 $ § �g ( c:�o0 ■ S . c if ° k @ ± ■ 4 m $ A " e' I \ $ E � ® \ k ; "WIN, 0 CD § M g E c z 0 0 0 Q n E . 0 2 0 0 o f .. / \ § CO) (A § / § E 77 �0 @ 7 / 7 (D E - § & § # � 7 � ! \ o 0 cn cc � E \ i I } ) / ��■ � o � o � k � ■ - � ■ � / z R ƒ w ® m L o 1 z 2 ' CD CA) 2gk � }/� § A £ c U E ` � E k � / k C f CD $ � ® \ � { 2 J \ _ o % & C. 2 : � AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 4V'44e.,m, – SEC . -V ? -RXW ADDRESS lflw� z CROIX COUNTY, WISCONSIN. SUBDIVISION LOT - LOT SIZE PLAN VIEW Distances and dimensions tb meet requirements of H63 THING WITHIN 100 FEET OF SYSTEM S 41 7D' All 2 t , �x t SCk di a e o th Arrow L' i ,t 't BENCHMARK: (Permanent reference Point) Describe: Y 6alr�rl��r 7 /e C®rhrY Elevation of vertical reference point: /67A,p Slope at site: / 2 SEPTIC TANK: Manufacturer: eVe AS Liquid Capacity: /, ' eB,p Number of rings on cover Alow Tan manhole cover elevation: / Tank Inl2 Slevation: z&g j Tank Outlet Elevation: , 2 " {� u rc a u 'r ° a� aPr- Manufacturer: Number of gallons Number of gal. pump set for a cyc a gallons; total capacity o distribution lines gallon: size - of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device Manufacturer Number of gallons Elevation of manhole cover Type of warning device —fir e 9 DTT 9149._ Number ot pits feet diameter feet liquid depth' seepage pit in et pipe- elevation bottom of seepage pit c evat1 feet. SEEPAGE BED SIZE: dumber 6f lines width " length tile defh width len th 7, PERCOLATION RATE IRE AREA AS BUILT , INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER �lC C' o !w c-L 1 uc DEPARI'MENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON 53707 • 15� CONVENTIONAL ,; ❑ALTERNATIVE State Plan I.D. Number: 11f assigned) ❑ Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INS P TON DATE: Gene Ftcancis RR# 1 , Box 26 1 , Robetts , All - .0y r, e. 0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: tow p REF. PT. ELEV.: CST REF. PT. ELEV.: NF% Nw% Section 7, T29N -R18W, Gtenn Fnanciz Sub. Watten Name of Plumber: MP /MPRSW No.: 1 77� 7ctoix Sanitary Permit Number: Richa&d Hop kins I 11 059 43641 SEPTIC TANK /HOLDING TANK: MANUFACTURER: L OUID)PAC TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCK G C - ` 44 77��•°M1M1���°M1M1�������''" p P OV I PRO E ES 1:1 No YES ONO BEDDING: VENT IA.: VENT MATL HICH WATER NUMBER OF ROAD: PROPERTY - WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM LINE, 1 AIR INLET: DYES NO ❑YES ❑NO NEARE ' 7 (70 DOSING CHAMBER: 4 1 MANUFACTURER [ 71 LIQUID CAPACITY J PUMP MODEL. J PUMP/SIPHON MANUFACTURER. ARNING LABEL LOCKING COVER OVIDED: PROVIDED: ❑NO YES ❑NO I ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER': 'PRO RTV WELL: BUILDING. VENT LE FRESH (DIFFERENCE BETWEEN FEET FR LI AIR INLET. PUMP ON AND OFF) ❑YES ONO NEARES SOIL ABSORPTION SYSTEM. Check the soil moisture at the dep of plowing FORCE LENGTH YMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wi P P il re, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: �.y WIDTH LENGTH. DISTR. PIPE SPACING. COV INSIDE CIA.y #PITS. LIQUID TRENCH TRNCHES. M AL: PIT DEPTH fMgI 14illiS 1 I NO I OF Y GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI R NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BE LOW � PE 4 S ABO E CO ER. ELE V. IN / L - ET. ELEV p E � N c;; PIPES: FEET FRAM LINE' AIR INLET: It q U - � 7 l NEAREST- --^i► �� a{ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA meets the criteria for medium sand. TIONS MEASURED. OYES N SOIL COVER I TEXTURE 1 7 E YES ENT MARKERS OBSERVATION WELLS ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MU LCHED. CENTER. EDGES. /Al ❑ /ES NO DYES ONO ❑YES El I� PRESSURIZED DISTRIBUTION SYSTEM: BEt31TFEl+tCFl WIDTH LENGTH TRENCHES: LATERAL SPACI GR VELD TH BELOW IPF FILL DEPTH ABOVE COVER: ` if1IMENSICINS MANIFOLD PUMP MANIFOLD DISTR. PIPE ANIFOL M ERIAL: j NO ` %CjSTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: DIA.. ELEV.. PIP DIA.: ELEEVATlON Alai OJO ' 1 " '. HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED tNFi71141AT10N PLANS: DYES E] NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBE CtF'. PROPERTY WELL: BUILDING: FEET FROM LINE: ,p Oil ❑YES ❑NO [:]YES ❑NO I NEAREST � • T-,� r .3 , 7 a Sketch System on ain in county file for a itI[, Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) . � mmmmmi� WISCOnsln APPLICATION FOR SANITARY PERMIT DILHR Yd' � r OUNTY O�PRRTmEI"IT OF (PLB 67) UNIFORM SANITARY PERMIT # InDUSTRV,LRBOR&HUMRn RELRTIOns t /i� — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS e L Sa PROPERTY LOCATION IV F 1 /411V /4, S , Ta , N, IRLN It (or) W TOWN OF: wa? LOT N / UM A BER BLOCK UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED ©y,1 — /Q /( jr6-- �) 'K 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank El System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA. ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): G/ S7_ I G.9 KPrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Sign ure: AW /MPRSW No.: Phone Number: Plumber's Address: Name of Designer: S y b COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved j� ❑ Owner Given Initial P,2 7 C 3 X Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, lease circle the appropriate n' ' e p y p g p , p municipal government unit, (whether this Is In a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Form - S T C 100 Owner of Property 44 is S .Lo of Property /flw Section T N R4t_W Township a Mailing Address , Subdivision Name Lot Number Previous Owner of Property ��e ,� 7�rq e /S Total Size of Parcel oZ /d Ir A 5 Date Parcel Was Created S � / y — / y 9' �2- Are all corners identifiable? L----Y No Incl with this application one of the following e— .Certified Survey Map .Deed .Land Contract, or .Other Vagal ]Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty dead recorded in the Office of the County Register of Deeds as Document No. 3 ? `?' 3!,;z 4 ;and that I (we) presently own the proposed sits for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds,, as Document No. ), , 4Aie j r SIGNATURs` Of OWman SIGNATURE OF CO-OWNER (IF APPLICABLE) CJ QATIVSIGN 0 DATE SIGNED 37 9826 �' . ry , C �\7 �. yJ S URVEY (COUNTY SURVEYOR'S N! /4 COR. SEC.7, T R: 1 . 12 Or the N E8` 48' 40 "E N. LINE NWI /4 -" A' COR. SEC.7, T 2SN, _ T. a w , (c Oul 1 JRVEYORS MO � O 50 C N 78 °2849 "E 66.0:' �4 - C. T_ �- irn ;PI-AI TED AN D S ^ 1 1 °i0 'f , ' 1 - CO' `: r ;.� !i;STRUMEENT 1 - f: C. _ DESCRI P' ='ION : GL, ... ,:'. �:n v certain pBrC -C;.. �:' .. �'.: t,�iC !�r C'i; 1/2 Of the 1':::r i,Si i�' :5� .`.'!;: she .rc�St 1/2 Of v_.@ � 1 j _ _ _r 2 .:firth, R an : 1C CSt, _`C';::: Gf I.arren, St. Croix CO'i i t ',�'.. aS fOi -C:: > CC's u E G pit t<,e t11enC� S 1 0 . �'' n i_.: __,G1?i:�h :- -o CC C t1CrC_.. ' LhCnce i+ t :,hn-nC8' $ Ona _ _ �'� C' _,;eject, tc:a�;s�.. thence ls" .- C .� 1`�° �/ .' � • -' _ 'J �.�- ._.�..'J l y " E' =T ;x 1 , A 1 A 1 _ \'1_.J i _ ... -'E"_ n' _ ,t �7/�j ) ice" � ` y. ,.. Pa - ;r - c- t _, 1 7DEPAFITMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION ` LABOR AND' C P.O. BOX 7969 'HUMAN F�EtATIONS PERCOLATION TESTS (115) MADISON, WI 53707 -- S- LQ,CATI ,/ SECTION: (or) TOWNSHIP /M LITY: a-:jBLKNQjSUBDI i I�ON NAME: LOQA CO OWNER'S/BUYER'S NAME: MAILI GAD RESS: Sl ( 2. d ± r r i 5 USE DATES OBE VATIONS MADE NO.BEDRMS : COMMER.IAL AE SCR PTION: NS: R A TESTS: Residence A ` KNew ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system C ENTIO . U;: aU IN- R ' S a URE: SYSTEM - ILLHO TANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGIy RATE: S S . 9 / /�/ f� �/ *. I If any portion of the lot is in the under s.H63.09(5) (b), indicate: / 7 I indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 7� 77 ' B - 7g 10 a B - 3 7� ��� 3 /si �/'s ^ors/ / /fir sL B- 7 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PE R105 3 PER PER INCH P- 9 y'Z 12ZV 2 S S P- .Z 30' 4. 3 3 Z P P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM EVATION _. _ .__.. 1 ' /Oty # i # { „_. „. x, . ....., y . >........ _. ........ ........ ._... a i• .. ... ....._ .. .«. ...., ._ ....... # i .. E TN # � k r f a. I g 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME ( rind: TESTS WERE COMPLETED ON: ADD SS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST SIG TURE- DISTRIBUTION: Original -Local Authority, 2nd page - Bureau of Plumbing, 3rd page - Property Owner, 4th page-Soil Tester. DILHR -SBD -6395 (N. 03/81) /Y �6 , 3 3 Lo ,r N A ,, o k T �a ♦415 ' w bY� "s C ,T 33 f - .�:' ,� , .� -, t -.r I i '� _ _� -� I � I) �� 1 A i I I � � �`\ �`` � `� fi � �� f ` �� �: �.