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HomeMy WebLinkAbout042-1101-50-001 "7 s el ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - 715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 Septic $25.00 Water (Nitrate & Bacteria) $35.00 Visual inspection) II ~rlaw ~o ~los . Cen)" C/uB °`"LJ +?do Owner: reLRObe+m Requested by e~~4 Address: Address: City & State: 023 City & St. , Zip Code: Zip Code: Telephone N°: O ~f , - S2342 Telephone N4: ( ) Property address (Fire N2 & Street) : ~~`1 -?dam Location: Sec. T ZQ N, R_Lf~_W, Town of jAjy -r.2~ St. Croix Co., WI. Tax ID Ns Parcel ID N4 ~QA Q. aka-- j[61-Sb House color: A Realty firm: (Pvt 2 961 Lock Box CAP- Water Water sample tap location: owr--Q S rvw5f- 6~ fir. T BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied?l Yes ❑ No If vacant, date last occupied: \ Septic system installed by: Year: Septic tank last serviced by::-T- 1-- Date: Previous Owner's Name(s): Have any of the following been observed? Ijq ❑Y Slow drainage from house. ❑Y Sewage Back-up into dwelling. ` ❑Y Sewage discharge to ground surface, road ditch or body of water. ❑Y Slow drainage from the dwelling. ❑Y 1 Foul odors. Other comments relative to system operation: I certify that the above informatio is co lete and true to the best of my knowledge. _ OWNERS SIGNATURE: 6 DATE: a3 4/93 kl 4 OWNERS DRAWING OF ROUSE & SEPTIC-=SYSTEM LOCATION t A` IN C 1 TO BE COMPLETED BY INS~PEfN AGENCY 1;/ System design &/or permit on file? 9K s ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: a ow grd ❑At-Grd OMound Approx. size /a2' X(0,2' Q vity ❑Dose OPressurized - ~Ft.2 L9~ed OTrench ODry Well OHolding Tank ❑Outfall pipe ---OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse OWell_dDProp. line OOther Dose tank tbacks: ❑House OWell OProp. line 00ther 0 gcking cover OWarning label OPump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OIiouse OWell~Prop. line other ❑Ponding: 65 - " A.41) t u~C]Discharge: General c mmen s• p~ INSPECTORS SRETC OF SYSTEM LOCATION N -t~ rp Inspector O" Title r ST. CROIX COUNTY WISCONSIN PLANNING & DEVELOPMENT PLANNING SOLID WASTE REAL PROPERTY ZONING 715-386-4674 715-386-4623 715-386-4677 715-386-4680 August 31, 1993 Brent Robertson 1427 70th Ave. Roberts, WI 54023 Dear Mr. Robertson: An inspection of the septic system serving your home located at the above address was conducted on August 30, 1993. This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly there may be hidden defects in the system not discoverable by this inspection. It is very difficult to estimate the useful life remaining in any septic system. Their failure is a progressive decrease in the systems ability to allow sewage effluent to seep away from it. This results in the disposal of less and less effluent until a point is reached where the system fails completely. At the time of inspection, this system appeared to be functioning, but not at full capacity. I noted that there was sewage effluent ponded within the septic system, indicating that the system is fairly far along in the progression of failure. I cannot predict however, how long this system will continue to properly dispose of sewage effluent nor how soon the system will reach complete failure. As a result, I cannot guarantee or warrant that this system will continue to function properly in the future. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow from the house which enters the system. For example, repair any leaking water fixtures and/or replace them with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there is a full load, use a washing machine with a suds saver feature, etc. I would also recommend that you have the septic tank pumped at a minimum of once every three years. Should have any questions or concerns that I can clarify, can be reached at this office between 8:00 am.- 5:00 pm., Monday - Friday. 2Since ly, Thomp on Assistant Zoning Administrator ST. CROIX COUNTY GOVERNMENT CENTER • 1 101 CARMICHAEL ROAD • HUDSON, WI 54016 8t ' REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS OyO t,. DIVISION P.O. BOX 7969 7.. PERCOLATION TESTS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) M TOWNS HIP/M 4irFW: LOT NO.:BLK. NO.: SUBDIVISION NAME: CD 9H/R/ (or y K c BUYER'S NAME: MAILIN ADDRESS: B Gv s DATES OBSERVATIONS ADE O.BEDRMS.: COMMERCIAL DESCRIPTION: PR F L DESCRIPTIONS: A NTESTS: 3 0:1f6ew ❑Replace r fe suitable for system U- Site unsuitable for system A' MOUND: IN-GROUND-PRESSURE: rigs STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optio al) U EIS ❑U CAS ❑U ❑U ClS ❑U sZ o ation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the pr s,H63.09(5)(6), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SO WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERV D EST. HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B h f 7 2- ~7 + v / 97 B-3 .9 '.R ~e 9Z 2? eo B-. A-7 ' y > 86. s f/. w r c 1-2- ~a, w,l, 00 44< ;'4 /A P-16.411 B-10x re 14~& e -e 4, S'r PERCOLATION TESTS _ TEST DEPTH' WATER IN HOLE TEST TIME DROP I WATER LEV L N HES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p l PER INCH P. S 24'o~ S, P- P-V,7 e P-- P- / Z P_. L - asc 7' rZ PLOT PLAN: 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 slope. SYSTEM ELEVATION 6- _1 17 TN I I _ - i t. t i 10 ! 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 the location of the tests are correct to the best of my knowledge and belief. N_ A Mint : TESTS WERE COMPLETED ON: ADWES : CERTIFICATION NUMBER: PHONE NUMBER (optional): T SIGNATURE: i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r 7 Form-STC- 104 AS BUILT SANIT SST OWNER 644 ~ -3/)1k TOWN ~ P SEC. J~, T .8 2N-R if W ~s ADDRESS /ZT ST. C COUNTY, W ` NSIN ITiti~r 'Yo A3 SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILIIR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM well D r i PLC Gv ~T L,. of ~o -1= j 7P r~ et J~NC c~ ( Bin T 7/1 v - s7 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used r c il Y ~rC S ,~Y /ca . v Elevation of vertical reference point: I®0. ,y Proposed slope at site: SEPTIC TANK: Manufacturer: Ale e ks- Liquid Capacity: Number of rings used: p Tank manhole cover elevation: ~o e Tank Inlet Elevation: zf,6 Tank Outlet Elevation: ~R.3X Number of feet from nearest, Road.: Front Io Side,1&Rearl o > _eV ' feet From nearest property line Front, OSide, &ear,0 > S'y~ feet Number of feet from: well building: ,77~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE j MMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 i - i ST. CROIX COUNTY GOVERNMENT REPORT NO.: 48016/01 PAGE 1 i CENTER REPORT DATE: 9/01/93 f 1101 CARMICHAEL ROAD DATE RECEIVED: 8/31/93 p HUDSON, WI 54416 ATTN: THOMAS C. NELSON a OWNER: Brent Robertson LOCATION: 1427 70th Ave... Roberts COLLECTOR: Jim Thompson DATE COLLECTED: 8-34-93 TIME COLLECTED: 2:00pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED:8-31-93 TIME ANALYZED:2:00pm COLIFORM,MFCC: 0 /104 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: 13 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. + Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN: Pam Gane OF.WDEOFNpFNr 1 WI Approved Lab No. 19 o ; Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~Q ADDRESS SUBDIVISION / CSM#~~ J l LOT # SECTION_ __2 T N-R_ZLW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q ~.N1 tbv •b ) Igo' a~" ~ast INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 BENCHMARK : Q y t C[ C S !/1 ' i%` f'( `l l1 ALTERNATE BM: SEPTIC TANK' PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: L 4.(GL Liquid Capacity: Setback from: Well f House Other Pump: Manufacturer C~~ I Mode l#C,~~~C Size ~3l rr Float seperation Gallons/cycle: /1 Alarm Location r, SOIL ABSORPTION SYSTEM Width: Length (J Y Number of trenches 4,) d 6)C6~ Distance & Direction to nearest prop. line:J~ Setback from: well: ~OL1t' House %/5D Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATI PLUMBER ON JOB: r~<<~ LICENSE NUMBER: INSPECTOR: 3/93:jt • r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ST. CROIX Sabot aa„ 1 Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 224671 Pe AUr~cni 91ti fts NaftAN ❑ City ❑ Village [Town of: State Plan ID No.: i WARREN 042-1101-50-001 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A9400298 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark '3, Z 3 _0 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. (p. Z~ Aeration NA Dist. Pipe 7.3~ 7 3 Holding Bot. System 9G '7~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~QQ,U Model Number GPM TDH Lift TF-ri System TDH Ft NO j,Q2~ G~'YL Loss Forcemain Length PDi H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) \ p p .j LOCATION: WARREN 23.29.18.560B,NW,NW,70TH AVE. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code cos~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a a 8% x 11 inches in size. ❑ Check if revision o prelous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP OWNER c PROPERTY LOCATION r)-ekYl fibn(,l % Njj%,S Tt2 ,N,R/'P E(orQ PROPE OWNER'S MAIL~JG, DDjiES LOT # BLOCK # CITY. TATE t /ll~/ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER p 'E S Ij ; 3 ` 0 576 E NEAREST II. TYPE OF BUILDING: (Check One) El State Owned VILLAG N OF: : ~Ye E ]Public 1Q1or 2Fam.Dwelling-#of bedrooms PARCEL TAX NUMBER(S) ,f'~ III. BUILDING USE: (If building type is public, check all that apply) 0/YoG Ncj/ 50 DO / 1 ❑ Apt/Condo ( v 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 in line A. Check line B if applicable) A) 1. ❑ New 2. 0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ 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 REQUIRED sq. ft.) PROPOSED (sq. tt.) (Gals/day/sq ft.) (Min./inch) ~E}LEVATION /v} up Q Feet 7 5-6 Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank K Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i ation of the onsite sewage system shown on ttached plans. Plumber' Name (Print): Plu %er',Signature: (No S ) MP/ RS Business Phone Number: Plumber's Addr ss ($treet, City, Stat Code tl l~~ (J~ ?/YJ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee ~GO (les Groundwater ate Issued Issuing Agent Signature (No S arge Fee) Approved ❑ Owner Given Initial Adverse Determination o ' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL; , r Ci SBD-6398(R.08/93) 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 the 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// 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% 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; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE I 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations July 26, 1994 2226 Rose Street La Crosse WI 54603 WANG EXCAVATING THOMAS WANG W9672 770 AVE RIVER FALLS WI 54022 RE: PLAN S94-40720 FEE RECEIVED: 180.00 AUSTIN, DEAN NW,NW,36,29,18W TOWN OF WARREN COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Note: The existing septic tank must be inspected for structure, soundness, size, and baffles and be replaced if needed for conformance with ch. ILHR 83, Wis. Adm. Code. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. S' cer y, i -4 - i erard Swim Plan Review Section of Private Sewage (608) 785-9348 SBD-6423 M. O1l91) LA~W. ui S94-40720 -rzql,l 8 w -MUJA ~p 0 a gcd rc~m ~a s. nn ,o ~ 25K~Snn iooo 0 ~ 5ephc Tank ~ zO i HrpJVLscr: C.etlaM+~iri 8y WGT tkt5rtNL SCf it rnNV. Mils t,L IWWvC C0 Fes% Stizkx Vsp,E , Scat d CS5 StZX iij iv Ft.ar %W-> EL }'v~~~D tE 4EL-D t) F: ctwi~ ci:a7A/IrJ~C Cit+ ca , lVt1F 8yi ~N ts, AD:~t o i AK rl l °U , `~r' ~ ~ 1 SON q SEE O ~iy8 X99, eI~GS 491k ` 5 9 4. 4 0 7 0 Page _ Of Straw, Marsh Hoy, Or, Synthetic Covering Distribution Pipe ~ i' Na Medium Sand ' As Ke. ILL IG 6" Topsoil==_- = F o 3 E 1 p~1V ATE ditlo . Slope E Cott ED Bed 'Of 12.- 2 12 (Force 46'iit Plowed ateLayer egg 9 re g o .~so K11~a (611 13e 1 ow Pipe ) ~ ~ tl►t ► eu~►.°~~ s 0 1.0_ Ft. 00q. ts~oN 21 E I ,Z Ft. ss Section Of A Mound System U3inq yD070W F . $0 Ft . A Bed For The Absorption Area SE G 1-D Ft. A Ft-.~ H 1,5 Ft. I ~ i Signed: B Ft. License Number: K /p Ft. I Date: / L gy Ft. i 0 Ft. Alternate Position I Ic/ Ft. of W ~g Ft. Force Main L Observation Pipe A I~ - - - - - - - - - Force Main W ° - M • Distribution Bed Of 2 '2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Sy4 4q,12 0 r.{ Air C: 4 L.asl We Sho~l~ 6G hcx~ 110 enA tap --~_F X.. ~nchc~ ~Z. te%el.cs GE 5~5~~M h-$~~ ~l~.~. ~ ~ n c~ • djt1~~~ Mo,no~Vick, 1h (el ' Oft. 0 p Ng piPe. 1 ~ 1 h tier ~ ~f ~ w S ON y SEA GO r PUMP CHAMBER CROSS S94m4U720 5 rAC,I c;r ECTIOI,1 Akio SPECIFICA'rI0k15 VC NT CAP 4 C.I. VE!JT PIPE WEATHERPROOF APFROVED LOCKIMG 2: 25' PROM DOOR, JUAJCTIOW BOX MANHOLE COVER WINDOW OR FRESH J,I MILI, AIR INTAKE Y" MIN. S t, pF{Z~"~ .t'oCONDUIT l - 18" /rCI1J. 110 \ P 1 IAl LET ~~p(t B \ 5 ` PROVIDE I 11 _ _ - • P TIGHT SEAL t I III*~ u+ N ~a I III DES I II ~ I III ALARM I I) I I , C, *APPROVED ( I OAJ . I ELEV. ~ b'SFT JOINTS WITH - APPROVED PIPE 3' ONTO PUMPS OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED O&JLy, IF TANK MAAJUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC"IFfCATIOAIS DOSE MEMO= TAMKS MANUFACTURER:-zAW S+ IJLUrIBER OF DOSES: PER DA`J TANK SIZE' GALLOWS DOSE VOLUME ' ALARM MAIJUFACTURER• ro IMCLUDIWG 6ACKFLOW: I ~O • (o GALLONS MODEL WUMDEK: _ Q Lb 114 CAPACITIES: A- 18IUCHES OR SWITCH TYPE: GALLOAIS PUMP MAAJUFACTURER: INCHES OR 27,5 GALLONS C= p _.0._INCHES OR 0 GALLONS MODEL NUMBER: SWITCH TYPE: I-1a D'INCHES ORS. GALLONS ,y NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATC INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE OETWi,,iW PUMP OFFlAND D TR 4UTIo&j PIPE.. 7' FEET + MINIMUM NETWORK SUPpLL PILESSUKE 2-5 FEET FEET OF FORCE MAIN aC 1, S FT✓00 r%FRIC4IOU FACTOR. FEET * QTAL DYNAMIC, HEAD FEET INTERWAL DIMEWSIOW6 OF TANK: LEWGTH 1 y p ;WIDTH ;LIQUID DEPTH ~ ~ - X13 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION:SECTJO%~~~N/R1'~E (or N MUNINI'ITY: LOS T NO.:BLK. NO-: SUBDIVISION NAME: Al, N 36 COUNTY IM ILING DDR SS: .Cro 0e f~eY7S (i USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FILED S RIP TION ESTS: Residence ❑ New C eplace 9 , 6 - C,,.Tr yq-3E7!' 5 RATING: S= Site suitable for system U= Site suitable for system 'r ONVENTIONAL: MOUND: IN-GROUNDPRESSU RE: SYSTEM-IN-FILLHOLDING TANK: REC MENDE Y EM:(optionl) y ❑s~u MU ❑sau as u asau If Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is h under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain ele`' tSm Y~tNz; PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, C E ND DEPTH NUMBER DEPTH IN, ELEVATION. OBSERVED EST. HIGH EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BA B- 600 76 16 fan o Is; j 9- C/~' ` 41, Anse s B- rrt ~JAPU S t o7`S 47~a6'36,do,r SGT s'~" s B- ` boll I fJ 'I"13I~c ~~^3al~B~~~~~ 3va"~~ la^ a 4ers B- 3 jolt A3,~ B- S a ti W 'bi S r a P!"~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERS ELLING INTERVAL-MIN. p OD 1 P OD2 P PER INCH P- V P- 3 / 3 P 37 P- P- P- PLOT PLAN: 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 slope. SYSTEM ELEVATION t77~ D S She ~ --I-j- ~ - t 1 I ~ 1 ~ t i i %___A C , IN a , , , 1- 3 , i E E 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 the location of the tests are correct to the best of my knowledge and belief. NAME (pri TESTS WERE COMPLETED ON: 14 A 9 ADDRESS• CERTIFICATIO NUMBER: PHONE NUMBE optional): CST TUBE: S DISTRIBUTION: Original and one copy to Lq al Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbol* at - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water ' Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point 1 TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 11~_JA FILED 390513 JAN 111984 JAMES O' CONNELL Elf R"Istor of Dadrt Sb Croix County, CERTIFIED SURVEY MAP LOCATED IN THE NEI/4 OF THE NW 1/4 OF SECTION 36, T 29N , R 18 W, TOWN OF WARREN, ST. CROIX CO., WIS. OWNED BY: DORWES FARMS INC., RT. I , ROBERTS, WI. 54023 I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Dorwes Farms Inc., owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the NE4 of the NW4, Section 36, T29N, R18W, Town of Warren, St. Croix County, Wisconsin, to-wit: Commencing at the NW corner of Sec. 36; thence East along the North line of the NW4 of Sec. 36 a distance of 1319.171; thence South 517.341 to the point of beginning-, thence East 274.831; thence South 317.001; thence West 274.831; thence North 317.001 to the point of beginning. Contains 2.00 acres subject to a roadway easement for ingress and egress purposes located in the NE' of the NW4 and the NW14 of the NW4 of Section 36, T29N, R18W, being further described as follows: (Continued on Reverse Side) NORTH LINE OF THE NW 1/4, SEC. 36 EAST 2638.34' `W 1319.1 W 1319.17 w ~N 1/4 CORNER _ _EAST 8 EAST TOWN ROAD (5TH ST. W SEC. 36,T29N,RISW NW CORNER 033.00 33.OOi r'~ - X1.5"IRON PIPE FD.) SEC.36,T29N,RISW (CO. SURVEY. MON. FD.) o c -I v1 x o APPROVED 1:~ROADWAY 66' WIDE a EASEMENT tb z~ w JAN 41984 O V ~ .p c =I U N P L A T T E D ST. ~;ROIX COUNTY Z w L'A'N D S CO`AP.:EHENSIVE PARKS PLANNING I? . • • . . . . AND ZONING COMMITTEE 'D . -i EAST 2 74.83' 3300'1 241.83' m z n z In A LOT I ° = I= 00 m t• 2.00 ACRES = D w (87,121 SO.FT.) . Z AI 1.76 AC. TO EASEMENT i„ IW (76,660 SO. FT.) SCALE I" = 100, • I V °o ~0 o D 0' 50' 100 200' •v cn NOTE: BEARINGS ARE REFERENCED n I TO THE NORTH LINE Of THE NW I/4 T OF SEC. 36, T29N, R18W (ASSUMED EAST) 0 x D (~3.00' 33,00' 241.83' - WEST 274.83' M o= SET I "X 24" IRON PIPE WEIGHING $ U N P L A TTED • L A N D S 1.13 LBS. PER LINEAL FOOT. r---- . . . . . . . 83 - 170 m Vol. 5 Page 1386 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~G l 1 cY S ~1 ij MAILING ADDRESS A/07 PROPERTY ADDRESS L"? / (location of septic system) Please obtain from the Planning Dept. I CITY/STATE ~_eO3 , PROPERTY LOCATION 1/4, 1/4, Section , TZ L_N-R~W TOWN OF ~l ~`(G G 2°/'1 ST. CROIX COUNTY, WI r- SUBDIVISION C / LOT NUMBER CERTIFIED SURVEY MAP VOLUME J , PAGE l LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three y expiration d e. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property 4 l1 A S 11,11 Location of propertyl/44J 1/4, Sections , TN-RW Township rv)4 Mailing address F"' Zj -e 15 It Address of site n Subdivision name ✓~j ; Lot no. Other homes on property. Yes No Previous owner of property ~l nT 1° o Total size of property C9 Total size of parcel P Date parcel was created e10 Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? Yes __No Volume _/(J> b and Page Number Yb/ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 deed recorded the office of the County Register of Deeds as Document No. ?0~'J~2 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the of icce f the County Register of Deeds as Document No. v Signature of Applicant Co-Applicant ~ 7 Date of ignature Date of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RLCORDING DATA STATE BAR OF(~WISCONSIN~~??FORM 2-1982 50G04'7 VOL 103GPAGE 364 r• - Brent D. Robertson and Patti Cowles 'obertsol:, a/k/a Patti C: ttoberteorl, . a Coirles fotme E~usband_ rl y Patti -Ccrirles, f SEP 2 4 1993 - . Patti Aiui.- and "wife, - 905 coAnusveys and warrants to Dean J. Austin arie3 ~:iiitla S`. ta tin, husband and w fe. as surv3 7rsQ niari I Rr`Istar A rxw~w • rt Proms RETURN TO . . l~ the following described real estate in ..._.._..X-----------........ County, - - State of Wisconsin: Tax Parcel No-.............................. Part of NE 1/4 of NW 1/4 of Section 36-29-1P described as follows: Lot 1 of Certified Survey Map filed January 11, 1984 in Volume "S", Page 1386; TOGE'THE'R WITH a roadway easement as shown on said Certified Survey Map. 1~-4 j' p0 This i8------------------ homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. 17th Dated this - - day of - September - 199.3.. ---------(SEAL) ` ---D'- - (SEAL) kl(SEAL) PATTI COWLES ROBE, a/k/a "Patti C. I2o?~ertsori- - AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix aa. of anthentic-`ed this day of--------------------------- 19...... Personally came before me this 17th September 199-3.... the above named Brent D. Robertson and Patti- Cowles " _ R°bertson---------------"---------------•--"----------"-------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by $ 706.06, Wis. Stats.) -moo -mom wn to be the person who executed the < fb tng " st ent an ackno edge .yam THIS INSTRUMENT WAS DRAFTED BY 1. STEPHEN J. DUNL.AP ~ - Rt '`J ce.S~LZ r~ Hudson, Wisconsin Notary Public St. Croix ----..County, Wis. c y (Signatures may be suthentica` A or acknowledg4 -Beth 1!Ky "Commission is permanent. I~(_ n tate expiration are not necessary.) Notary's tdx date: - - ~IssiorTfMW.b._1q%4.., 19- - awning in any capacity abould be typed or printed below their signatures. STATE BAR OF WLSCON SIN Wisconsin Legal Blank Co, Inc. FnRM K. 2.-- 14" Milwaukee, Wisconsin Orr) X2.57 ~s S ~ S 6`3~a ~ 1 o ~ ° I ~ ° I a~i °o I OOCn 0~~ I 0°~ I ° ~ I d y .r c e I E P o N I a I I o I N t I I E I I I ° I r m I I m I = m w ' I a~ Its m Q CL O n c I tt= ~ ° U) g N N 0 T > y _ 0 '5 -5 Z v Z Vl z li o~ c ti o li 0 a a ?L Q a co m N M z z E a0 Z 00 00 = 00 v co am am am w Hz ~ I I I o I Z j = 7 Y to FZ- C O C C Z v v 91 4) 1 0 20 M d d N y d o p z°mz z°mz 2zz N Y Z co m d d N ~ % ~ ' o c }}yy Ili m o a ~i o N O G G m Cl) G M 1 2! .0 G a G c a 01 O N Q O N N N j p O~ N N N M N N N E Z - o a.l LL N "~N O 30 30 0 30 Soo Z o •N a a a a a a a a a _ y IL ai L LO LO H a L v co co z tiJV ~ z 4) O 1~~ Q N N Q p M CM 'fl p0 ^I ~n z ai OD O E L_ O O :3 •p L 0 0 7 N :3 (D O fa C O co c Q co N C d r n o m QI z Q r in m 04 (((~yyy C"• 04 H 111 N n O N 04 O r V- fl! C C H C y C O O C O N 0 O C E Lo ~ N C m N C m N g~g~~ c N C a C a N N 1, U, Q O 5 M N 00 ao r~ 4) r 4. - t of r O v z y y y c y CD - to 2 o f m o c Z` L N N t6 d a 7 d a+ O ~ to f0 E t0 U I • M O rA fd O O O t~ t0 0 7 N O Z N 2 H Q' O Z = z Q N O Z -f fA O go jl € € € V d R €a €n. 0a rz L: IL U CL r`iv 0 A 3~3 3 00 3 0 3 9 o r A 0IL !OU) 0U)Q ONV H Form - S T C - 104 AS BUILT SANIT' SYST6+,~t\, OWNER TOWNSP t" SEC. T N-R f~ W 6~' ADDRESS ST. ckc~x COUNTY, WT NSIN V0.43 d-' SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM well p ~ s-o D r VC W L Q d- /70 r~ ~et l / fln 74 1 a Nw ~2rll'~'t- X s7 01 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: "Veeks. Liquid Capacity: , Number of rings used: p Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,OSideRear, O > S' ` feet .From nearest property line Front,OSide,©Rear, 0 > '5_V ` feet Number of feet from: well > 3-a building: 27/ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER r' Manufacturer: Liquid Capacity: Ar Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: - 4W Trench: Width: Length: Number of Lines: Area Built: 7 ye Fill depth to top of pipe: 3.i " Number of feet from nearest property line: Front, O Side, Rear, 0 Pt Number of feet from well: Number of feet from building: /6J (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: V Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPAF3TMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI. 53707 ~ U'4I~stONVENTIONAL ❑ALTE RNATI VE State Plan I.D. Number; % El Holding Tank El In-Ground Pressure El Mound I (It assigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: ROBERTSON, BRENT 201 WI Street N.#306, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NE NW, Section 36, T29N-R18W, Town of Warren Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: David B. Fogerty 3289 St. Croix 64900 SEPTIC TANK/HOLDING TANK: MANUFACTURER . ( LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PRO DE ES NO Y ❑ /❑NO BEDDING: VENT DIA.: VENT TL.. HIGH WATER NUMBER OFD ROAD: PROPERT WELL: BUILDING: VJE~N'T T F ESH /Mr ALAR ;'FEET FROM S! ) _ LINZ DYES NO L:YYES ❑NO NEAR EST DOSING & AMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. ) PU /SI HON NUFACTURER: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: DYES ❑NO DYES ENO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLSOP AT.NA : NUMBER F PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN 4d NO FROM LINE: AIR INLET: PUMP ON AND OFF) DYES 4'JNO NS OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing N1,TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH: NO.OF 17E,SPACING CO VER IDE DIA#PITS: LIQUID BED/TRENCH TRENCHES DEPTH. DIMENSIONS i GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL J BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV.,END. PI FEET FROM LINE. Sz. AIR INLET. NEAREST 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. DYES ❑NO SOIL .`OVER TEXTURE: PERMANENT MARKERS. OBSERVATION WELLS. DYES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED 7EPTH OVER TRENCH/BED :E1 TOPSOIL SO DED SEEDED. MULCHED. CENTER: DGES. DYES ❑NO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIALr NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND . DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL P VERTICAL LIFT CORRESPONDS TO APPROVED : DYES ❑NO LANS DYES DNO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ❑NO DYES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD6710 (R. 01/82) unsconsin APPLICATION FOR SANITARY PERMIT DJ L H R (PLB 67) COUNTY UNIFORM SANITARY PERMIT # - OEPRRTTEnT OF - InOUSTRV,LRBOR&HUMRnRELRTionS y 9 0 0 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT P PERTY WNE MAILING ADDRESS PROPERTY LOCATI N 64:FY: 1/4 ,W1/4, S , T , N, R S E (or TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAAAD,4_AK-lm-// off" STATE PLAN I.D. NUMBER T'. TYPE OF BUILDING OR USE SERVED 21"1 or 2 Family Number of Bedrooms: 2 ❑ Public (Specify): THIS PERMIT IS FOR A: Ltd' 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 ❑ 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 TERNATIVE 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): -5- 6is_ rivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. a of Plumber (Print): n t rP/MPRSW No.: Phone Number: ( f, Y-1 C A isa;;~ 1~1, ;L Plumber's Addr ss: Name of esigner: 2nC e-y- 176 !4 'Z COUNTY/DEPARTMENT USE ONLY gnat re of Issuing Agent: F e: Date: ❑ Disapproved W/1 h ❑ Owner Given Initial P - > tG1V 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, please circle the appropriate 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS' (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/Mb1Nfe+PAtrffY: r OT NO.: BLK. NO.: SUBDIVISION NAME: At11 /T,29 N/RIPE for COUNTY: JJ_~ OW R'S BUYER'S NAME: MAAILING ADDRESS: Lpfr /if/ USE F DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: esidence 3 ~t6ew ❑Replace I s- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK : RECOMMENDED SYSTEM: (optional) CTS ❑U ❑IS ❑U CAS ❑U CAS ❑U Ea S ❑U 2 )r sZ 7Q1'Z14Z If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 3 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SO WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 97 /b/ 45- t > 2- B- s s. L w<o6 ~-iC s y ewl j!.r J's B- > p. .ff I1 ceb 9~ 25- B- > ~,A Sr . 3 3 Sf. / sue f "!r 17& r r cag, p I 60, f v44 Gv t 011 ;e4 4_1/ LB- < < c PERCOLATION TESTS _ ~AV = W t TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL- NCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH P- S J P- P- 3 P-_ P- e 4D 2 1 2 S P- - s PLOT PLAN: 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 slope. SYSTEM ELEVATION d- Z i i ~ t t ~ t s V I , s t i ; sE___. fir? -s Er f N i t E i I ICA, 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 the location of the tests are correct to the best of my knowledge and belief. NA Tint : TESTS WERE COMPLETED ON: E ,S _y- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ~o Y, cQ Z JR ,2 2 ? T SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - J J 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Comple legal description; 2. Tf- t on must clearly indicate whether this is a residence or commercial project; 3. MAXI` 1UM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANG ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Dravving to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If file information (such as flood plain, elevation) does not apply, place N.A. in the 'e box; 1 1 . Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as re<luired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock col: - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate reed s - Medium Sand W - Well fs- Fine Sand Bldg- Building Is - Loamy ' > - Greater Than sl Sandy Lc,. n < - Less Than ~l Loan: Bn - Brown #sil - Silt Loam BI - Black si - Silt Gy Gray 'cl - Clay Loam Y Yellow scl- Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Motties se - Sandy Clay w/ with C - Silly Clay fff - few, fine, faint x c - Clay cc - common, coarse pt - Peat mm - Many, rrledium rn - Muck d - distinct p - prominent HWL - High water level; Six general soil textures surface water for liquid waste disposal BM Bench Mark VRP - Vertical Reference Point TO TF W7 R: Th" 'I r : eport is the f i. oi the Del, Ilc=nt may request - tF ;c sc - n so, of for }i° ; rivate a n W sr for ;l y, in o ier to It. The s: lrerrnit must be obtained at r), pa ' ~1 t~sr i I ~ w o + r - - F _ s I I I , " 0 v I H4, F4 1 " I _ - I I I FT. ILE _ y - - - - - - - 3 - - - - o_ till- V - ~ k i I ST. CROI X COUNTY K y z'~ 011 W I S C O N S I N J T 41 'L } ZONING OFFICE A+ f _ 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 28, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carolyn Haag Dear Carolyn: Permit #64841 has been rescinded by St. Croix County as the system was placed in a different location as shown on plans. Permit 464900, issued on May 24, 1985 replaces the rescinded one. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins, Secretary St. Croix County Zoning Office mj Cc w w N b ~ V M C QO c QE c ° Q CCD w _ c $E w A W « N FA _ Q = °E E r W , Tm E ~c $ c O c •E O CZ -a c o 3 of ` Ea,N ° OW ° TQ y Tow N /O ;0 ~ ~ ~ c Z E Nn$ 2 A y~ %q ° w O n H oAL wv do E'o ° nm `E" r E E 0 3 _a•No, a ` a « e 1O r- LL r c$ « N 7 c w ° ui ' a erg -c01 $T0 Ed `a°, co cN EPEE °To m d« F a O t Q° S7 T .r Z! a (y«~ p7J C O t ~0 Q Q d l0 V.. ~1 G N r. N C w J CL c Er V V ° w~ Nc cEi ~a Ee w c tg c L« t~ UJ do d « ° wa F- w f-~ Ho ~uy« C1« ~Aa H-D Q d c „ _ E Z z w aC Z Z D • Z 9 U) O O p o w z U 3 U) (.D J °Z) Lai 40 > j z LL CC x ♦ m ~ p U 5 o Q Z cmm ~ ~ p Z ~ ~ O ~w-- 0 w O J a Y D = Z O U a ~ cr y` J l 00 m ° cr J Mac w V) m v w w '46) F- 0 F- OD cr L J C= OD Co CC O O w a CO Z Z 19 m m p 2 m 0 Z O y F- Q O • O_ N r m 30 CD .4 0 D N w (D 7C A A M N o~a.3 ~OwwN w :cn- ccoco p y+ ? c ~N o~ SD 0 0~o°- NINA Rr Q:N D M CD (D oo con 3 a 0 ((D w oo. coowOO~ ===wc w 'Y o C- c cn 3: c o c 3 o o.o Zco c• <v= f = 3 a !m %D 9 v, a~ M o.mooa% CD M CDr CID -0 CCAD :ph. < 0 (n ID CD Ul , o D w o C c= o c~D O C w a w o r►aQ= N tf~ cl) CA 5D :E o 3cn 3~(DCD- a to cn s a CD A 0 171 Nc °w ono = a ? c w QN M (D v+ ='aco f N CL o.c0~CD C RI moo vo=c~ ' d CD N N N a M rt W = i Ei E! ID CL to M N Lo. 0 N w ~ M m aO wcco.N0 RI M = n.aaar« CD :E ao Q= cr G) p M. lc cc a? m 3 r o c*-% =c CD -±o co L7= 0N~AW s a m~_ ' c A C p co o. c --I N c a c o o° 3 %Q, :y = 3 a O • 1. i FILED \9®a~. j JAN 11 T984 5AaC1E5 O' GOPIWELL f ItegIder of Vacd1 Any 751. ! rolx Connfy, l~ CERTIFIED SURVEY MAP C~ LOCATED IN THE NEI/4 OF THE NW 1/4 OF SECTION 36, T 29N , R 18 W, TOWN OF WARREN, ST. CROIX CO., WIS. OWNED BY: DORWES FARMS INC., RT. I , ROBERTS, WI. 54023 I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Dorwes Farms Inc., owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the NE4_ of the NWT, Section 36, T29N, R18W, Town of Warren, St. Croix County, Wisconsin, to-wit: Commencing at the NW corner of Sec. 36; thence East along the North line of the NW4 of Sec. 36 a distance of 1319.17'; thence South 517.34' to the point of beginni.n~; thence East 274.831; thence South 317.001; thence West 274.831; thence North 317.00' to the point of beginning. Contains 2.00 acres subject to a roadway easement for ingress and egress purposes located in the NE-1 of the NA and the NWT. of the NWT of Section 36, T29N, R18W, being further described as follows: (Continued on Reverse Side) NORTH LINE OF THE NW 1/4 , SEC. 36 EAST 2636.34' - 6)- - - - - OIL 1319.1 w 1319.17w ' w ~N 1/4 CORNER _ _ eASr °o_ T TOWN ROAD (5TH ST. W SEC. 36,T29N,R18W NW CORNER ' 13300 3 •~_i 4 u --(1.5"IRON PIPE FD.) SEC. 36,T29N R18W (CO. SURVEY. MON. FD.) o C x o 66' WIDE APPROVED a ROADWAY EASEMENT co z~ A JAN 41984 ~ A C it . ? 00, U N PL A T TED ST. '-ROIX COUNTY Z CA L AND $ CO'AP..EHENSIVE PARKS PLANNING IA AND ZONING COMMITTEE •r EAST 274.83' 33.00 241. 83' •n z 2 A LOT I :m z I= -•1 r ° 2.00 ACRES = w (87,121 SQ.FT.) 0 1.76 AC. TO EASEMENT (76,660 SQ. FT.) SCALE 1" = 100' oo IQ oO 0 50' 100' 200' 2 U) NOTE: BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NW 114 ,I I OF SEC. 36,T29N, R18W A (ASSUMED EAST ) 0 X 3 13A0' 33.00' 241.83' 1 - - WEST 274.83' M o= SET I "X24" IRON PIPE WEIGHING o U N P L A TIED L A N D S 1.13 LBS. PER LINEAL FOOT. 83 - 170 m Vol. 5 Page 1386 THIS INSTRUMFNT nRAFTFn AY /Ldtrt~~~" DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BO'X 7969 BUREAU OF PLUMBING MADISON, W.I 53707 ` t~CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: 1f assigned) ❑ Holding Tank El In-Ground Pressure El Mound 1 I NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Brent Robertson 206 WI St. N.#306, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: EV.: NE NW, Section 36, T29N-R18W, Town of Warren Name or Plumber. r/MPRSW No.: Countyt. nitary Permit Numb David Fogerty 3289 S Croix 64841 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL ILOCKING COVER PROVIDED: PROVIDED: OYES ONO DYES ONO BEDDING: VENT DIA.. VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: 1V ENT TO FRESH ALARM FEET FROM LINE: HAIR INLET: OYES ONO OYES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: NO CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. JV(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) r70YES ONO NEAREST 10 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILIN1,111 DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: E CIA#PITSLIQUID WIDTH. LENGTH: NO. OF JDISTR. PIPE SPACING. COVER SID DEPTH: BED/TRENCH TRENCHESMATERIAL: :HT DIMENSIONS GRAVEL DEPT H FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH BELOW PIPES- ABOVE COVER. ELEV. INLET. ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 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 ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS I DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED. CENTER EDGES. OYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEVATION AND ELEV.: ELEV.. CIA. ELEV.. PIPES: DI A.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER PROPERTY WELL: BUILDING: FEET FRLINE: D YES ❑ NO ❑ YES ❑ NO NSket ch System on Retain in county file for audit. Reverse Side. SIGNATURE: ITITLE: DILHR SBD 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT ` D I L H R (PLB 67) .COUNTY UNIFORM SANITARY PERMIT # - OEgFRT.T1EnT OF - InOl35TRV,LRBOR 6MUTRn RELRTIOns /'o Al PJ_/ - -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 PR RTY OWNER MAILING ADDRESS 01 o 20 411. o O ERTY LOCATION C-K-V- ~E 1/4 /4, S .3 , T 'PN, R E (or) TOWN OF: LOT NUMBER BLOCK NUMBER JSUBDIVISION NAME NEAR ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 11 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS P RMIT 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. 'J✓Seepaye Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank ❑ 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): s- " Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. ame f Plumber (Pr' re: MP/MP RSW No.: Phone Number: i89 (7 3 r 1% ki s Ad r s: Nam f Desi er. 25 4;v4& Rk 6 © Z COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved CI ❑ Owner Given Initial 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, please circle the appropriate 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. I 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. 491, ple '4W 710 ~~a/ ~ W ~'K Gv~1. ~4ut Sa~,,~r',~ fyu~' mss''''°~' 3~''`'l°~ ~G "`a/ 7~ ~d 3 _r~A~PLI TION FOR SANITARY PERMIT STC - 100 I This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgr,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property _ /r/~✓ 14, Section T R W Township Mailing Address .2W4 6w2- s .s~fol6 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Zp Date Parcel was Created ~~J? Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes x No Volume lk' 1 and Page Number 0 71, corded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) een ti.6 y that a t e.tatementa on .th iA 6oAm cute tAu.e to the beb-t o j my (ou-0 knowee.dge; that I (we) am (ate) the owneA.(d) o6 the ptopeh ty deb chibed in xh i,a in6oAmati,on 6oAm, by viA tue o6 a wcvvLanty deed Aeeonded in the 066ice o6 the County Reg-i.b,teA o6 Deed6 ae Document No l and that I (we) p4e6 enemy own the pnopoa ed 4 to 6oA .theewage` d4ApoAat 4 ya.tem (oA I (we) have obtained an easement, to Aun with the above de c i.bed pAopeA.ty, 6oA the cond.tAu.ction o6 eai,d 6y,6tem, and the Game had been du ' Aeconded in the 066iee o6 the County Reg.i.d.teA o6 Deed6, a6 Document N 1. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ''DATE IGNED DATE SIG ED DOCUMENT NO. nnnnnn.. ra.rr-r, YY.pme.- g STATE OF WISCONSIN-FORM 2 VOL 6 1 PA ,E"7 THIS SPACE RESERVED FOR RECORDING DATA 103J R IyZS OFFICE 1 THIS INDENTURE, Made this...-... day of...... .February » ST. Gi"m CO., W;6. A. D.,19...84., between DUKE.$....FA .,....I C Rec'd, for tzcord thus-fi b- day of Feb A. D. 1984 - a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, located at 11:15 A-# M: at Roberts,,,,..,,,,,,,,.,Wisconsin, party of the first part and Patti...An ...QPK1.pm Rpbler of Dews _ _ part y..... of the second part, RETURN TO OL~C+N W I t n e s s e t h, That the said party of the first part, for and in consideration HAROLD. D. of the sum of.... Cine-J)DIlar...(.$1_010).... all-d...athEr..•g.Oad..and.... valcable...... ATTORNEY .EY A AT LAW LAW W1 54002 ....coslsideratian to it paid by the said part. y.......of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ...y..... of the second part,. Lqr heirs and assigns forever, the following described real estate situated in the County of....... $t-.--•GG®3,x .........and State of Wisconsin, to-wit: Part of Northeast Quarter of Northwest Quarter(NE14 of NW14) of Section Thirty-six (36), Township Twenty-nine (29) North, of Range Eighteen (18) West, Town of Warren, St. Croix County, Wisconsin, described as follows: Lot One (1) of Certified Survey Map filed January 11, 1984 in Volume 5 of Certified Survey Maps, Page 1386, Document No. 390513, in the office of the Register of Deeds for St. Croix County, Wisconsin, to- gether with a roadway easement for ingress and egress purposes located in the North- east Quarter of the Northwest Quarter (NEk of NX1k) and the Northwest Quarter of the Northwest Quarter (NW4 of NW4) of Section Thirty-six (36), Township Twenty-nine (29) North, of Range Eighteen (18) West, St. Croix County, Wisconsin, being further de- scribed as follows: (See reverse side for remainder of description) (IF NECESSARY. CONTINUE DESCRIPTION ON REVERSE SIDE) ' 1 Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said part.. y...... of the second part, and to....... her..... heirs and assigns FOREVER. And the said DO.$WES...EARMS .I V.... party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said part..y........ of the second part ha-r.... heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all encumbrances whatever . and that the above bargained premises in the quiet and peaceable possession of the said part-.Y....... of the second part,Xiet...heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. FARMS .s.... W In Witness Whereof, the said....... party of the first part, has caused these presents to be signed by es.le'y... .....~Q.W.~e.S................................, its President, and countersigned by Doris A. Cowles its Secretary, at .......................Baldwin........... Wisconsin, and its corporate seal to be hereunto affixed, this !At....... ..day of........ Yebruary A. D., 19.....84... SIGNED AND SEALED IN PRESENCE OF DORWES FARMS, INC. urVUrate ame by real rut Wesley G. Cowles GNED: if`~-t1l ate QJ by Seuetary Doris A. Cowles - • STATE OF WISCONSIN, ss. ....................5 t .....cxplx........................ County. Personally came before me this lst......day of....... Fahmaxy A. D., 19...$4., President, and ................Daris••-A.-•-CawLes.............................. Secretary of the above wf:.s.ley..... ......lvowles.............................. named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such ........................President and ........................................Secretary of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as the deed of said Corporation, by its authority. ``blot' ieY' ''L Harold D Olson _ __........»County, Wis. 4 F Notary Public . S t.._. Croix This instrument drafted by Harold D : Olson? . Atty : = ~1 My Commission (6,tpiea (Is) nermanent» _ _ w =u 59.51 (1) o the Wisconsin sStatues IIoarda /i~,e1 , migti to b reoordd s6.11 hays plainly printed or tPPewrlttw thereon the wm WARRANTY DEED-STATE OF WISCONSIN, FORM NO. 2 K. C. r,LUR co.. WILWAUK91 r VOL Remainder of description: _ Commencing at the Northwest. corner of Section Thirty-six (36); thence East along the North line of the Northwest Quarter (NW1,4) of Section Thirty-six (36) a dis- tance of 1319.17 feet; thence South 33.00 feet to a point on the Southerly right- of-way line of 5th Street also being the point of beginning; thence East along said right-of-way line 33.00 feet; thence South 801.34 feet; thence West 66.00 feet; thence North 801.34 feet to a point on the Southerly right-of-way line of 5th Street; thence East along said right-of-way line 33.00 feet to the point of be- ginning. This is not homestead property. All of the above described real estate is subject to municipal and zoning ordinances, easements of record and highway. Z 03 J J OQ y W `7 0 00 ~ cc t- • H . z r H y ST C- 105 r r _ a • H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z t7 a OWNER/BUYER er,~1 d rGyt,T''l~` c~ ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION:,/ 4, ,*~J 14, Section T-.2f _N, RIgf W, Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a.-grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►u ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoni g Office within 30 days of the three year expiration date. SIGNED ` DATE St. Croix County Zoning Office P. 0. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. LA + = n m aNO ` ^ *=r w (D c N 3 00 ' c v►wcDm ~mm~ v g cc o - g a s w o- o o w w u, c v 3 co'COD o ~ A ~ID •o acD o o m N n CCD g O apo Mom w ' 0 v w m m o comwm ~~omNOIO ~ • c, 3 a o --moo w > > cc om w ° o =r 7 w c c OC3OCL zoo c~ Qo w c s ooo o 7. ~o N -r. w CD w A as ~0. ~D C Q A O V1 o CY A L CD N C N D C • CD a w ° 2o ~c~ ~o,cw"DCD O ~w o 7 w o N CD ' m° - w v, Z N CO) S (A CD g a =r 2) CA (D CD CD C) =r =r CO) CD s a(D0 3~CA 0 . S w w ° ??c o a 0 > > w QN a m w Saco g V~ =r CD w$ aNwww a m -q m d C N= N nw 1 ~ Sao w ~ (D (D y o c .-:co w S c a p N C 0 a(A O 1t1 w so aaaCL cD 0.0 cD , r 0O tom to oNO > apj ooCL c~~c~ocID s Z c w m CL ID 0 o = C*L cm 3- 0 -3 0 C) CD to M loll O O i awe BUILDINGS OF REPORT ON SOIL BORINGS A INDUSTRY, 410 DIVISION LABOR AN C~. BOX 76 PERCOLATION TESTS (115) ov3o,9~ D! N W53707 Ht~1MAN RELATIONS` (H63.09(1) & Chapter 145.045)', Alli LOCA ION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.: B SUB ISION N A/t /4 .34P IT-21 N/RIVE (1 ~U~iP,~°E.v ~,PT F ca iv CO NTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 5 . "OIX vES Cd wL s ,2 / d~ S r lpm"7 s USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence gNew ❑Replace /V f / aC~-. Ly-~3 ~dv L~-~ RATING: S= Site suitable for system U= Site unsuitable for system t0 O / " /G'' l ;u _5_1L7- ' CO©ENTIO❑NAL: M©ND: IN-G®NDP URE: SYSTEM-INFLHOLDING©NK: RECOMMENDED SYSToptio QR S U S S U S a ❑S U ~i(/ ' Y•PQViU f~ i'U oUU .fJ L3~.L~ ~ a. If Percolation Tests are NOT re uired DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ;p f7-. PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) xo- ' ' •yz-o,~av.s:~, I.ya'aa.s:~, x,17' 61f - re-1 4U.S*- Zs, B- IF.D /0O. 63/ p .•S ' G,P....~2 oR L S [o /,,jjr /6d B-y YO 7e00' - 90 ' •ya',,F40•s,G, 6',6N.Si/a.7,s O.P.edu~oLS ,RkG.e.,, e-5:5 oq~, ~rlt° . ?.O '&J k~ 40-00 'Fi:r.e 5. i p 4, -67'0,'e rdLL. LS, I /7 TA,tJ 'x L .3 97 B- c/l ",,Q, /s 'TaN sc 3 GR 3. tvf S.R G,e . /CO , > 7 i .7f,", Bo. Sid, 4l' ON, 5-i4-, /,/7' 0,?. LS, .67' B- S 2410 //7'A,X-OF A-CER- LS e.~t SL a.3'{woo w . / i .g2' -dO-Si4, • yy'Q1v: SL, /•/G'O,P. eiz"R GS, /.l7' mf B- f 9f 93 Ao- 7 s s U &R go 7' rw L9 ' 1-4m N .B4 -LS I.(o7'f 71 fl UW h;7-F SAAJP yE.PS /N L3, R,, 6AMjUAT,-v R y 6~4r"3* of /3.U . LS . 15 a4 B- A" 7-1 s 4),45 L0,0'r .v/ vE PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTER SWELLING INTERVAL-MIN. PERIOD 1 PER 02 PERIOD PER INCH P- Z 0 3 P- P- 1 3., o P-_ P- /O % G P- PLOT PLAN: 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 slope. 13-07/0,4 of 13_&v e-WgdgT/O.V SA&&_ ZIS- ctY,,,etZy 3,,r(o fr . SYSTEM ELEVATION !3e /ow Par RED pr 1 ? i E f e Im (I! 3 TI- i mm , fi This test site APP 40 E. ~tj sy5 dr cgnven~iopal ;s I -I-- . 3 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: RT. 1, O' EIL ROAD N411.2-4? Hf> RESS: CERTIFICATION NUMBER: PHONE NUMBER optional): BOB UERR[CUT ail®50N, WIS. 54016 ~5 =a Zy~2- (v - / .S- CST SIGNATURE: 64- Original and one copy to Local Authority, Property Owner and Soil Tester. (R. 02/82) - OVER - v • v r INSTRUCTIONS FOR COMPLETING FORM 115 S€3C} 5395 tpr To be a complete and accurate soil test, your report must include: 1- Complete legal 'description; 2. Thy 036'section must clearly indicate whethr +ris isa residence or commercial project; 1 MAXIMUM number of bedrooms or comme use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE is SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make Sure your benchmark and vertical elevation reference point are clearly shown, and are )errnanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10..1f the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your. certification number; 12. Make legible copies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st Stone (over 10") BR - Bedrock cola - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc - Percolation Rate rued s - Medium Sand W - Well fs Fine Sand Bldg - Building Is - Loarny sand > - Greater Than ti sl Sandy Loam < - Less Than 'j ~l Loarn Bit - Brown .sil - Silt Loam BI - Black si - Silt Gy - Gray cl - Clay Loant Y - Yellow scl - Sandy Cl y Loam R - Red sicl Silt- CI r Loam mot - Mottles sc - Sal ( , r w' - with sic - Silty C, fff - fetii, fine, fE r, -Clay cc - mmorr, pt - Peat corn - ny, mew T) m - MUCk ri - inct p - pro rn'rnent HWL - High water level; Six general soil textures Arface water for liquid waste disposal BM -ch Mark VRP tical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Dep, merit may request verification of this soil test in the field prior to permit. issuance. A complete se` c ` 'is for the private sewage system and a permit application must be submitted to the appropriate Icr al )rity in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of construction. O NA 9 O ~ $'w REPORT ON SOIL SORiNGS ~ PERCOLATION TESTS 115 ' Poor PL.AM PRoTEcr r. D. A" .e. DA rE' Npa. 7-F -f-3 'l~ % SEA 3~ T19N ~p/~'~ HOMESITE TESTING CO. GUg ppE;~ TDcvvSry~ "T. 3, O'NEIL ROAD BOB UII;1 lG U USO I, WIS.,_. 54016 e s 7- 02 YeZ PROPOSED tiovsE Masr LIE 2j' FT opt MORE FiPOM ,qL,c TEST ^ee.45• PRO POSED WELL M vsr or 50 FT G4 /MORE' Fi om ALL TEST 11,P4,4Sr • = e,4&e OF P/TS O E,1'/fT/~t! I.C~ELL X ~ ~E~QG /o~Cq''/OA/f ~ = ~/A~V~ f}v9ERE0 o,~Q S~iDNEL Ij~ES 13M (/ER1"%C~L ~'EiERr'wcE- Pour"° O 6,r 40 o / sE.c op Pipes s~ T f~ To Th,~c1,e&T ,Qaw 6 ~A,Atl,- 6Y e S77 LEGEN p /EV~rO~t! ©f ~/~iP1 DEF. Pl.~ /60,0 F r, w 43 frr . /VA Y. bib 6 I V ~ y f y xP z / 0 x i 3 y 5 TE/'J S %TE ;a It\ a y yv 3g~ f3 Z a / / S O ~ A~7fQN~►tx HR~R ~Z- 3- 5 s X30~ WA"LN T29N-18W. 2' SEE PAGE 4 E / ~ / ~ ~ f/r.G !JU 1 eHRE - d i / _ ` % • fn Wm.f / crr.,/ F/ao < • Xc ' v Al4'ES nr,sc• 77 • ,lJ/•r/ /`/.•,('r/so/r U. Da.< Md 4 F l /,v 7 0 x<- z ,•o°- N t ~ v n y o ~w ! 3 e / • W 'e f .f / • r, s x / v xii/ ~ ~ S !o.<.,~; 0 v N 7,:;<S !~e'~no<~ M ~ ' ♦C/ .:1 Q ~ v Grs / w V 6tiar.s. ~ /z /Vc%c./ v `p0 / /'CC1Pr', c,L l4 C' N ✓ y\o L.S//4JN~ /i/f q /Q /o ~e \ lCf 2 (V > 4'~ v • ay ~l~ 4° s.m 3°693 W~ n//C/lCe/SC/ b /Sr r • ~ ru/y s ✓oh~/ • • zJaG. c ti . :~r.a Rr ~ ~ de s f/rrv.<kf .de .<•,E• c/ard f/ \ ~ an J f 4 '/rJC ~~h0 ^C e rrr ® ~ tzr/7/c/' Lti f/ .1 n ~3 c .c 'A U 7 w /1~~. ~Cl T .•:nr r/u/~ - / r Ae nc•,e /e t r Uo~leJ ye.. ./rl Kr.,./e•ri U<S~Fl kx•f <//d - Ef./../ Y C • ~ _ ,G4' E< -r !Ne/s;: 2 Sne f-i ev~'er.c/: A DO.rs ® _&J, An e e A-, •xt /6 0 / r 2 NO. AG J11 • ^ A ~ ^•C Leo .D C l' W<s./tc/ -///a S. s v ~k av cCe.,nQ ~ /Vechv.Y/e W~ ~ ~ ~ • 6° \ h db 78:4. C/¢;,o ~7/ c.. / V /1~ ~ wC~a d' ~L ~ /6n tlvy n • . ' /ao ,Ba ~ .y N OC~'h f~C.ofr / u a / tt..~ ~ ~h fle./>r. ,w I Z 16 h, 4G / o u,n///F - J d v Fc / c5cfvu/tr, !u~ v. k 0 i aHc/en U? V 40/cK „ L 9 0 d ~~T«o c ! / 9 Tc/<c o oy h i8s 0 1, 7a /Y7, ~V\vh hU / a _~e4o ~i e.YLN .cs lV^ U7 tia .'n.ctir .h hP eb Q ^ .o y,r~ ` h~ rru/ ~ ~ ~c".aes ~/UN/> icy ~D ~ •w N` \ ~ a t'<. f c/.a/d lv.Y' ttlcC~Q 0 U ~.Wj. N lye we/ /<c erode Oho a~ 7b~y f!/ac,// /Gn qqC~Q XC\~ V wi fre / v u v u y'a/ d /rr l C 47 A W A w w f' / Jr< t - /n l v C w r ! i //r's ` LL Rp~ ROBE TS s Ne/.. /°o/en 74 ,co 'hcr y ~\u M M h ~i~ : `v u ~y l c7 ..s eo k+ l~~jd N y ~ d ~ ~ a `C~ 0 M.//cam :✓.um ~/!'c..<nc// Joan to ~ ~ zta.,a9 Jce /%s ~ ud~;^ ~I'~I1N "'`c r"~ Q1 ,n~,~ <.,,o <.~y oe'orrr.e// tl,(4~~ ~i cTo se h cry. ~'l: / <o. r t/u h ll: qp /¢/e/^ Tha, ¢S s-: Sc we.// r / 9! - r. -9 tlW a ~ sa i./ nF•~ el'/ O Co,rne// Pi NvW 0~ ? m' '.W! ~KEJ II i ~ 65 ' ,kV 4 z , ,or G/~ I //ux.,Fc. /c ,c /to wC MO`l' 0 . t9. ~ \ \ i V 4 1 cSJ.,.-✓.5 ~echuman W. //.a ,q 1):~1 y~ ~ i GGOn y r s !CON. ~cf<,/73 tloi~J} _so i~ ,D/anC / d.% /v-o /ss~s- /~O Q 0~ 1 7-1 C opR } {e 3 'N. \1 Y kF6 w R f/ 3 • • - $ La ></f Leo <z rd E ~ c lo/ 6 s f!°.ahoid K~~i<~<"/' ,~i'.-«3 ye/,'. ~ ~ 3'94.1 c %o.µ W • ~ Lt • / ~ ~Ne -../T Jx F~GCiuq/</..r h , fY: bf Y, 9I r'fQ/ > /~E S.F/I ~ ~ C w/c`.4 c`N.'f. .bt",K! a  4A yO ~rV ~l Say/C'y 7lL.`3BS.Euu~ . / tTR ,Q la ado rf~ BO o/ ux °E t:, t / to~^ AA'o ~ ~ PIc~9a6 .Poc,E• d~tapa /a, r,~c, ~E'e~.<,r'9 SEE PAGE 17 o V W Hammond RUNE PUMP Dependable Hybrids Golf Course WELL SERVICE From Dependable People -111,11 Dail Green Fees Food & Bar SALES Richard H. Kamm INSTALLATION SERVICE Rhone: 796-3266 C;6 `A 796.2294 No ........Roberts, Wisconsin- Ht Edge,c~f rn Hammond HAMMOND CALL: 749-3332 I WISCONSIN r ~ i i .u~~ s ~ ~ ~ , .r v  a r- v A n ^ \ L rS r. 0 O \ a M 4 if ~I 4 ~ I v P ! y' ~o a L O L 1-4 4a n a I c 'Ne