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Parcel 29.29.18.458A 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - TRIEBOLD, LEONARD L & DIANE P LEONARD L & DIANE P TRIEBOLD 701 107TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 721 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 16.300 Plat: N/A-NOT AVAILABLE SEC 29 T29N R18W & PT SEC 32 PT OF GL 1 Block/Condo Bldg: LYING ELY OF CL HWY & PT COM NE 1/4 SEC 32; S 89'E 739.76 FT TO POB; TH CONT S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 89'E ALNG SD N LN 578.22 FT;TH S 00'W 29-29N-18W 85.OOFT TH N 89'W 578.22 FT; TH N 00' E ALNG E LN OF PARC DESC IN 497/59 85.00 more Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1155/258 TD 07/2311997 683/600 2005 SUMMARY Bill M Fair Market Value: Assessed with: 79629 117,100 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,500 39,200 51,700 NO PRODUCTIVE FORST LANDS G6 14.300 42,900 0 42,900 NO Totals for 2005: General Property 16.300 55,400 39,200 94,600 Woodland 0.000 0 0 Totals for 2004: General Property 16.300 55,400 39,200 94,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 09/2912005 Batch 05-25 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 LOCATION: WARREN 29.29.18.458A,SW,SE,170TH ST. wiscor<sin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT { Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149332 Permit Holder's Name: ❑ City ❑ Village] Town of: State Plan ID No.: TRIEBOLD LEONARD & DIANE WARREN CST BM Elev.: Insp. BM Elev.: BM pcription: Parcel Tax No.: f A 042108095000 TANK INFORMATION ELEVATION DATA A9200179 /2 ,a? . TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ Benchmark S 4' Dosing n 1l /dam ~c ' i '9. Aeration Bldg. Sewer 6 p~, err/ Holding St/~ Inlet 93 TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 6" Zo Septic 1 ~l7 NA Dt Bottom y~ 95.6 Dosing NA Header. Aeratio NA Dist. Pipe b.d3 G y , l /of, Holding Bot. System 1 PUMP /SFIVFORMATION Final Grade Manufacturer errand 7-,00 6 s.7. Xl S d / 3/ Model Number GPM 67~r, ~ 3 /d/. 57 TDH Lift 19 Friction Systema gyp' HH TDH Ft Forcemain Length Dia. Dist.ToWell SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length i 7 No. Of TJenches PIT- No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING INFORMATION Type Of /jpr Moe Num e . System: OR UNIT DISTRIBUTION SYSTEM WFeerde'N Manifold' Distribution Pipe(s) x Hole Size „ x Hole Spacing Vent To Air Intake Length Gd r' Dia. Length _4/z Dia. Spacing Xv v 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 discrepa oegs, persons present, etc.) / ~C~K ~r?hcrP~1 ff~ tC_.?_^, c-.`~'7'l ~ c =l`:~C'", t [:s"~" I 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: • DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 / t a 8% x 11 inches in size. Check Irev7slonAp3revious 1101511cation -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION i 51.1 '/4,S T-? ,N,R 8! E( W PROPERTY OWNER'S MAILI A DRESS LOT # BLOCK # o/ <o7 9-/- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 36 0 A.4 CITYLAGE : NEAREST R D Ill. TYPE OF BUILDING: (Check one) ❑ State Owned Q r, fo < 4OWN OF. ❑ Public IJ 1 or 2 Fam. Dwelling-# of bedrooms a- AR EL Ax MB 0 4 ;k - tD T9 I~ 4~s 3 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 130 Other: Specify IV. TYrNew PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 L"1 Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ 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 O REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION O SA Feet i 9)7--qr Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank h9eiQ Lift Pump Tank/Si hon Chamber 149001 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pri ty Plumber's Signature: (No Stamps) M SW No.: Business Phone Number: lumber's ddress (Str et, City, State, Zip Code : 7 w !S- I- IX. C LINTY/DEPAR ENT USE ONLY ❑ Disapproved Sa ry Permit Fee (Includes Groundwater Date Issued Issuing gent wi ature (No m Approved ❑ Owner Given Initial urcharge Fee) Adverse Determination ~ ~g XCONDITIONS OF A PROV ,AL/REASONS FOR DI PPRO AL: 0, & /&Z& Ile SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber MENOMINEE 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 tf,is 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 mast'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. If. 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 all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlff. 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, ocation 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, replac,emert system areas; and the location of the building served; B) horizontal and vertical elevation rt:f;'renre 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) alas z(ng information. GROUNDWATER SURCHARGE 1983 Wisconsin; Act 410 included the creation of surcharges (frier;) for a numb r of regulated practices which can effect groundwater. 'The ii;onies ted through, these surcharges arc rr;,-r7 for p'konitnrinq grown ;(Epvater, ;round water contamination investigations air d establishthent of standards. I SBD-6398 (R.11/88) S92-01058 PROJECT INDEX SH-!:ET -7/5- 7y~ - 3531 p o- U~JIVFR: GENO%D T~E'1 EJ3oLD , ADDRESS: 70/ /07 ST SITE LOCATION: -4G0 % .5E-' % -.P, c Z 7"Z f10 sT C eo l)e Co v-~ T y PROJECT DESCRIPTION: "off 32 • Nt W CO,U S7 k U C % /a,tiJ - fj 2- p jep p oSe p . 130T S s re -,-l w 4-e 3 T3 ~ ~ kM s Vie. Y ~ S A-7 U Rh TC u T' 1 ~f " ~1 o v,v p S y S BEM I S P~.o po s~-D PAGE 1. PLOT PLAN Z rI ,WS ORIGINAL . PAGE 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERFORMANC SPECS OR SIPHON SPECS i t ' VALUATEt/ DESIGNER SITE E PLUMBER: i / 3;:z~g tiOMESITE SEPTIC PLUMBING CO. 655, O'NEIL RD., HUDSON, WIS. 5 4016 ROBERT ULDRIGHT Q !j IS, g', ;;!'R Pt. UMBER LIC. NO. 3307 M.P.R.S. / / / / !!t►d;1. W-ri l t7ESIGNL•R LIC.140. 00683 DATE: f SIGNATURE: V eu y enA~ a ~gg2 UREp,U O S STEMS G B W AT~R o PARCEL A I c v-4 N~ N00 SO'33E 230.00 ° e A S,92 --0010 5 g N00050'55E 262.79' co 230.00 f 24.59'W o O O IENTERLIN 107 TH STREET D xl A. W m ~ w O - w t0 CD 0 N o N p a m t1i u p 0071_ ~ m rn N _ N V O ~y q to - - co co • O I- w 5• M N m a N W Q~ i-I- W. ft 0 O n O N• w w rt ry 'w O~~nm p OHO 7 N rp•1 O W C O b W N11 C w 1231 r•O W W 0 'T ro ` - M, aq W m m m 0 R 0 o O 0 10 'A U' aq p p w o w a ~ /Jr CL m N ~t,O (D hb w O fD O 1 'Or , w 00 m r tv .:•t w F+ m j 1"4 1-.'14 M R K :3 0) _0 3c W J w N N 1 p G O 165.00' V aw~h0n 85.00' S 00° 50'55"W 262.79' S~V`P m O~S ~Oto mr OD Y N OW 0 1,1 w N n Q o y rn a o r a_-T nAi R p y c 'o W D 14' (1 n L11 nti Qy~ ~ 1~ 7 1 n ni_ ~ a ~ ~ ~ b ~ Z fin! Q ao W A - C L 1oc h'r 2, +'C 2 'Wp m eta m \ \ z qs N ~ n 'Id o ~ o ~ O ~Ct, I m \ rn ago g m Vl N lh o Q S00050'55"W y 0 ? 85.00' S92 01058 i0 5 O f GEV4rl'on03 T- Op i;oC1C _ P Page 5- ro P OF 7t P /0S- ~o Synthetic Covering Distribution Pipe Medium Sand s y STEM H Topsoil N _ F 10-570 E ; p _ 3 u 6/~v.` /O`/° 57Gd % Slope S~ySE ~r~E Bed Of i~ Force Main Plowed JA110 r. Aggregate Layer t D /10 Ft. <o Ft. Cross Section Of A Mound System Using E / A Bed For The Absorption Area F • 75 Ft. y5~ G /.o Ft. A g Ft. H 1-5 Ft. ~ y 6 Ft. K Ft. L G q Ft. ~A® 7 Ft. `SP 1 Ft. 'p a Main W Ft. O Observation Pipe El K I" Distribution Bed Of -;-2 Pipe Aggregate Observation Pipe Permanent Markers L/'~ f~l~G C/j~PEla S~E~L ,PODS i Plan View Of Mound Using A Bed For The Absorption Area ii I r 592=01058 r Page 3 Of S • Vold U 01VM 6- 160 Fr of '40Rce __T ~f~i•cJ Z ~ 5`~Ps . ~~i4rF /AS Perforated Pipe Delall zc~J,ei'Gti r" Fok 1/~C vfrE End View )Perforoled End Cqp) PVC Pipe i . Jo~~o once Holes Located On Bottom, Are Equally Spaced t R 44s r hlo% Is + NEXT To E,Np cy}~ Q PVC Manifold Pipe \h Distribution Pipe Distribution Pipe Layout P 7y Ft. $ys~~M R S D G~ ZFORCE Mhi .J ~CEw MAN ~~s X ~0 I nchPs s NR~~ Y !U_ Inches V P - I Signed: Hole Diameter Inch Lateral SAY Inch(es) License Number: \NOVS S Manifold " 2- Inches Date: ~~~\V\s ONO~N Force Main " '2- Inches a. 2 of hol es/pi pe S Invert Elevation of Laterals /0S'S Ft. d / S r~ v ~'"/o.~J !~i 5 c~ ~,P~ E P~9 TE ~l,.E' E~ c ~f? TE/~' ~t / ~j~, O 'PAYL o-r 5 2-7) • To 'a i S T i /3 U Tip„ l7 i'S G~ A,c' GE !P~ iE` Fo,~ L 8 . 0 /gun. T~ l ~ IvO~PIC ~/E~p i , I .0- PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P~ 1 ~F 5 i VENT CAP 4"C,I. VENT PIrE WEATHER PROOF APPROVED LOCKING MANHOLE COVER 25' FROM DOOR, JUAICTION BOX- IAISe/ WINDOW OR FRESH 12"MIU. AIR INTAKE ~ ?~On/ GRADE v IB"MIA1. /0 CONDUIT - y~ NN;\ r IEYin oil. 4:_ PROVIDE I - INLET G._-+- AIRTIGHT SEAL I III y~'S ,DEJ I ICI r APPROVED JOINT A ti r I I I APPROVED JOINTS w/G.I. PIPE ' IN lad UM I I I( W/C.I. PIPE CXTENDING 3' ~0~~ I II ALARM EXTEWDIWG 3' OVJTO SOLID SOIL B I i I ONTO SOLID SOIL 2 II ELEV. FT __J PUMP OFF D y k ~ BLOCK A t4 VA r,o d I RISER EXIT PERMITTED OQLU IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E 5PCC.IFICATIQKJS DOSE w~ ~S Go.~G~PET~ p,PODUCTS TAWKS tA4kI IFACTURER: (DUMBER F DOSES: 3 PER DAB TAN SIZE : go 0 GALLONS DOSE VOLUME INCL'UDING BACKFLOW: 17C~ GALLONS ALA M MANUFACTURER: 1G MODAL NUMBER: L V CAPACITIES: A= INCHES OR x306 GALLONS .~i~,r2 c v R "104 T 2- 5W11rCH TYPE: aY B = -INCHES OR GALLOWS PUMP MANUFACTURER: C= 'p INCHES OR GALLOWS M09, EL NUMBER: 97 11S V p= IS. a INCHES OR Z 8" GALLONS G SWITCH TJPE: ?I5SY%ACk ME-ProFY r/,94 r NOTE: PUMP AND ALARM ARE TO BE MINI . MUM DISCHARGE RATE -~0 GPM / INSTALLED 0W SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTIOW PIPE..FEET "rAA)k STECs ~ + MIMIMUM NETWORK SUPPLY PRESSURE , , , , , , , . , 2 5 FEET EAG(I. I ~~0 FEET OF FORCE MAIN X sy Forr.FR►CTIO►J FACTOR..L''L FEET Y 2-' TOTAL 0y3WAMIC. HEAD FEET ~o.vD ,7 IAITEKWAL DIMENSIONS OF TAUK: LE►J~.YCT ;WIDTH ;LIQUID DEPTH wAaE SY~ otAsin SE e nom D N~MAN 1NDUSTp'y, rlSdR alit NGS DAP ~~N Vts10~ pF SAS . 1 g~ C~ a Z' ~ r.~ 1 'J u 11 N I cc W + FA H DI . II Jf 115 34 110 PA CI'Y 32 105 30 X__ 85 P URVE 28 90 26 85 EFFLUENT 24 69 I I MODEL and Q 75 MODEL 189 DEWATERING = 70 165 V 20 B5-SN ti, ;j Q Z 18 60 55 18 50 ODEL 163 14 MODEL ~ O ~ O ~ l- 45 188 9 ~J /2 40 35 ,0 MODEL 1-3 139 MODEL SEMfAGE and 6 25 fb i DE 6 20 MODEL 15 MODEL 161 efi 4 7 ,lti_ h 2 MODEL 5 53, 55, 57,59 i, 0 GALLONS 10 20 30 40 50 BO 70 60 90 100 110 tlE i ~ LITERS 0 80 160 " 240 320 400 it tl FLOW PER MINUTE i, ' MODEL 295 d MODEL z 284 - I J MODEL 4 293 1 MODEL 284 It- - - 3 MODEL ?0 - 282 4, 77 ot 1~ I 1I I -74PDEL - OfLLE/P O 0 3280 Old Mlllm Lane r! 4ALL N0 101,21: 30 10 50 60170, 80. 90 100 110 120 130 140 15 80 P P p 1 170 ,60 190 O. Box 16347 Lou(SVlNe, Kenluclry 40216' ~LITERS 0 : 160 240 .320 100 460 560 640 720 (5M) ,778-2?1 ' ' FLOW PER MINUTE 't t HEAD CAPACITY UNITS/MIN • Automatic or Non-Automatic. Feet Meters Gat. Llrs. I • 'i H.P., 1 Ph., 115V or 230V. 5 1.52 57 216 10 3.05 51 193 • Non-clogging vortex impeller design. 15 4.57 43 163 • Passes solids (sphere). za 6.10 27 104 • 1 S1" NPT discharge. Lock valve: 24.5' j • Float operated, submersible (NEMA 6) 2 pole mechanical switch. U~ listed 97 Series • Automatic reset thermal overload protection. sc2225 O • Stainless steel screws, guard, handle and arm and ~a~aaF. seal assembly. • Watertight neoprene •`D" ring between motor and pump housing. Canadian Standards SP Assoc Approval M97, non-automatic, available packaged with a piggyback mercury available float switch. I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N W1 3707 HUMAN, RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MbNtCtPAt+TY: OT NO.: BLK NO.: SUBDIVISION NAME: sw ;e_ 1/ -2'? /T29 N/R I eE (o al 9m PF-v COUNTY: 0WA16,d': L~AV TklEd36LQ S,e MAILIN ADDRESS: s/• CAOM( 701 16 7 -r& Sr 21 oRERrs is . Svo2- GF,u TiPiEv3 d c ~ 2 . ~ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER IAL DESCRIPTION: TESTS: PROFILE DESCRIPTIONS: PERCOLATION Residence Z oP_ 3 ti 7• xNew ❑Replace O '7', 15 1 q ~o OCl'• !CQ I ( Q 110 RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) [i s ©u ©s DUUO s A EIS ou EIS ©u Mo U- 2 S sTE~ If Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the To gE under s. ILHR 83.09(5)(b), indicate: Cli1~ S S S Floodplain, indicate Floodplain elevation: r PROFILE DESCRIPTIONS Zo"i'`~~ BORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.H E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 4 it De. 6, S /0 s B- 7Z'. /0 5"30 32- SA-P tv/',~,~' "',ois 36 'r*ti Mof,~o s 1314-. e,, vR'&e S ok- T,- 7S 3Z " Gf ~3a 1 r, ~r B- Z /dS. 0 yy /s /Co ~i l3a .c,:e S . w n~.aA, s., if a/2 - 5 . B- 3 ~ ~ a /~1 • / S " C~.o . /S ' a.~ . /aoS a :jV'f' kQ eo ves-e /s ,N~,u~/ S,y . Di S T 0,0-6--y f0 is . A-0-P . B- w Am f ti L t' S T G o" S yy f~ s"- B- Voi /jc°,?!E~f or Hy- Ze -j sui7nR~ sr . op. teats, ZY" PERCOLATION TESTS /,V I no y'/V'1i_v. p ~S DEPTH . WATER IN HOLE TEST TIME D 1 WA R V H RATE MINUTES TEST NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PFRIPQ2___ PER PER INCH S P_i zy A,- 2 7 17 2- ~PiIK P_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicates ~ dicta S. scribe a the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevati 411 borirtQ€ ~e irecti percent of land slope. 12 SYSTEM ELEVA_TION_ _ c~ ' r q(i i 1 I i 4 ,flit 1 i t ~.J FIC, y f } - - ! l [ I i ( I 97.1 ;toA., o0e Lo 41~ 7 ~ I I I >e: IT 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: HOMESITE SEPTIC PLUMBING CO. 0 C ~ 14? (r / Q ADDRESS: S0N,_II JL5_4.~ ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): PLUMBER LIC. NO. 3307 M.P.R.S. 1 Z 3 Fog - / S INaTALLER & DESIGNER LIC. NO. 00663 CST SIG~NAAT~U~R~E:~ ^n DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - 1,,4 rr3 Z J ~a N ~ o ~ O I Q . Cl 1 c~ o o'er ~ C 01 7 w A w * 8 9fl ~ z P ~ CW y A • o m Cl Q~ w P QL d or Y m =ocr z w "z J a W tA= LAJ U ad w~p=iw LJCCO,J {{b W F h IA r? o ~ o SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations Pk1VAlt:.,_SEWAGE PLAN_ APPROVAL. Litt Kle ut ll iv I iurl Cucle, and ApF1 hi-,it lull :UI k41~1 Wd,hin9Llln Aveimt,- l',u. mails ~c,r, Wisi~ttrt. to 5arUi b013 UI.bRICHT J►awner : L.t.N lkiLbUL_U, Jk. 655 0'NE It. RU ;ill IOi 1H :;l HODSON WI 54016 RUbLkl ~ WI a4U2:j RE: Plan Number 592-01058 Udte Appruved. May 4, 1992 Gallons Per pay: _ 300 _ Data ReLelved: May 4, 1944'.' PruleLt Name. IRtEBULD JR., LEN t.uc:dt iurr: SW,St.29'~9, ldw fo,wn ut WARktN county: ."1 Ckiliil They plumbing plans drtd specitic.dtiuns fur till,, prulect have been reviewed tar e;ua►Plidnte with appliCtit) Ie trade requifumenh,, ltiis dppruvdi is bds,Pd ut► Chdptcar 145, Wiscunsin Stdtutes end the Wl:,cuw in Administrative Cudr--. 1'lte plaits are ;,td►iiped 'c:unditiurrdily dppruved`. ihi, ippiuvai is LunLingvnL upun cuwplydrlte with ally stipulations shown ur1 the plans. All iteav, that art' noted n1u.,t be Lurrectrd. All peumit5 required by the tity, vi f ldyr, tuwresllip ur cuurlty shall be ubtdinrd priur to cunstructiu►i, lhr, l ic.rrised Nlur►rber ve:,purlsibie fur this irrsl.ai rat ion shd l l keep une Set ut p (ern; w) t,h tt►+- depth Lntr-r, t ' dppruva I : L<irrrp a t the I:unk.trut,tiun site. the instdtlear ~hdil rrutit,y the dpprupriate '1113pec.Lur wht--n 01 I,ectiuns rdn bt,~ nidde. Ibis approval wi i l t.xPO" t.wu ye-ar'. Frun► tilt- ddte nppruved ur it a san'rtdr y permit is obtained, it will expire- tile day the irtitidl sd►eltdry permit expirr.a. Then Svctiaun ut Pr ivitea aewaye lids reviewed ttie,e pidr►, for pr ivdte stwdye :ystear Lutlr reiquire►iient:4 unly, i-ht-le plans have- r►ut bt.rn reviewed far the rude require~tnr.r►ts ;.r,t rurth io Section ILHk 82 tur, yl,iwi ,i plurilbmq ur in Clwpl.ers 50-04 Lit the Wiscunsin Administrative Lode, lhis dPpr0Vaf 1 i-ur the f-ulluwinta cu►►Ipunc:nt" only: _ NEW MOUND Inquiries Luncerniri9 this dpprovai wd,y be mitele by calling fb08) 26b-823U. a. l SBO N93 i R. U1 /Y1 i rte...... .~~..»..~~_.~..__..r«..~_~.~_.. SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations BOB ULBRICHT Page 2 i i ince ely, i KENNET I SUNKE 'section ut Pr-ivdte Sewdge Division of Safety and builuings PPPOIb/0009n/ b (cc: LEN TRIEBULD, JR. _--_Prrivdte Sewaye ConsulLont _Cuunty _.__--Uw-SSwHP _-,Bumming Cunsuitdrlt j Uwner P I U111ber Env i ronmrrnta I Hea i Lh I I I I i ~ l 88D 9473 R. 011011 ST. CROIX COUNTY ~ Zsty N ~y ' WISCONSIN ;~~7~•.,.,: ~~:.~:r~s K ~ ZONING OFFICE ST. CROIX COUNTY COURTHOUSE mmw Willi 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 IW April 29, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Len Triebold, Sr. & Len Triebold, Jr. property, located in the SW 1/4 of the SE 1/4 of Sec. 29, T29N-R18W, Town of Warren, St. Croix County. This onsite revealed suitable soils at a depth of 24" requiring 12" of sand fill beneath the mound. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator Js i APPLICATION FOR SANITARY PERMIT STC-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 l e~7!?IlYY~' f 1~iGbd~G~ Location of property 0,_W_114 5 E 1/4, Section T-,-N-R ~ Township 9-& Mailing address 201 7 Q~ er Address of site `tg f l\~hn~^15 Subdivision name Lot number { Previous owner of property Total size of parcel 17 S Date parcel was created d Z Are all corners and lot lines identifiable? -Z-Yes No Is this property being developed for resale (spec house)? Yes _ No 3 d !o Volume .98 © and Page Number Y27 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 rec ded i~ the Office of the County Register of Deeds as Document No. 391 " Y 6~~r, and that I (We) presently own the proposed site for the sewage disposal- ystem (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 th County gister o Deeds, s Document No. ignature 0 ner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER eon 8kd -t 7).;,&12&- ~~.e_Lo ROUTE/BOX NUMBER 7,0 / /0 7z h` S7c • FIRE NO. CITY/STATE /?a h er f.s GC,/zip S'Yo-a.' PROPERTY LOCATION: X1/9 X1/9, Section __J_, TN, R1_ cw,,1 Town of &JaPreh , St. Croix County, Subdivision , Lot No. 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 a 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 $3000 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 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE /9~ St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-9680 Sign, Date, and Return to above address yy , t r ~ ~Ifi~" N....... d"UNINd c baud MIS in tt[, iiat~sh: ' r t xa1: ~y~, ~.~ir.~•e~ ,.,cam- .Cc s~ .•(c..Gce-L.rseQ ./~-sc.~ c J 66 s. '7 This 5...110 homestead property. (is) (is not) # Ya Exception to warranties: r}: ~i.rt 'r. Dated this day of 19 O A'. 1 ~.l~cG- f ISEAL ) A? 4 i?'0-( S E A I,)1\ pfd -Anita 'A.Bc!rtQl_duF...._ . •4 (SEAL) (SEAL) i tm •.q AUTHENTICATION ACKNO%% LBDGURNT 1 Signature(s) rt! I STATE OF WISCONSIN Ix aieJc L County. _da of 7. authenticated this -day of r✓-~~.'^! 19 Personal) came before me this S 19; 6~4 the above named rr~ t o Di e I l r - - TITLE. MEMBER STATE BAR OF WISCONSIN (If not. ( authorized by § 506.06 Wis. Stats.) to nip known to be the person who exetute*:thp forei oing instrument and acknowledge the same. r THIS INSTRUMENT WAS DRAFTED BY , Anita L!. rare..':]:; \„t Pohl ,ir County, Wis• (Signatures may he authenticated or arknoWedwed. froth I'l -I n'" t 4~' not, state expiration 19 ) are not necessary.) dut!• -NAM" of Prno- !igninA '.n s~. S' ® STATE HAM WISCONSIN Stock No. 13002 MCIMN•Corrory POMM No. . I- I'+kY r. •~i'~ It P~ ~j p< ....a. w7• . .A.. w 1. Amor" Wool aftib In.. at Croix c Slwt f~t>w K. Nisestnls: aws~ss . ,;:~fi part of the NM} of this N1t and Oswetwnt Lot 1 Smat on 32, 1winship 29 -North, <assgs is W"16. won at 1orrap, at. Croix Ot+lwtys Meoat3as 01%40A ltas IM #!t Nutt wly of the Nocthrrly righli•of-wig it" of 1kowetafte Noway "9101 V=VT that pactiM of the MIt :aL the M■i r EaliaMti !Cowienc ing at a point an tits NWM l it e at satA Mlk* f intaraeation with the Cast r19ht-d-wy line `d the lain Mad tlmR. . ft tb-Soot' thraph said NMt at the M*; theme Vast, along O ti thence South, parallel with the West line of said NIA of the Mme. 250 _ :nets parallel with said North line, 312 feet; thence North, pardlel MtN~~ ; line, 2SO feet to said north line; thence Mast, along said North line, the point of beginning. i 1. f p 5 This vItat hwwstead prepaty. ' ~ (N) (N met) Wised this 4.0 day of [2Q1 . 19..x., `I R. V CIItiD FIDSLIi'Y CGIIP f .................................................(SSAL) HY.' . N3......... R. V. 111•xand• , ar..t.zvotll vim • . • ...Twin..8...~lv3ebold,..Caca1•-N...MOS• Leonard L. Triebold, Todd is.. (SEAL) .....loll k TrYa»Id';"]calYtb"T1"iN #a !P • . Brian Triebold,..Chad t Evenson, Bradley _ MVe Tiiibold J1` y !l' AflTt21111CATION ACKNO W L>ZO6>ItiM!'' V. Al STATE OF WISCONSIN i, . . lay af..ftptvW:0W...... 19AD - Personally cams bef w m tkb .AM id . .119 thm a"w sacra! , i ..l~t..~locA - TiTLi: INAT9 BAR OF WISCONSIN y, (Ia tMirind by 17NA6. Wis. Stats.) to me known to be the ps:.aa wbe enelaini tOW y foregoing instruwent and i eksowleiye the mms& TNts mvrviuMlNT wAs amAFTeo my Stl...~tl..S+#Y ).._MACA Y e i $iY.er . F41 W.... 4022...... Notary Public . Wis. ($ignatum way be authenticated or acknowledged. Both My Commission is permnnenL(If met. start su ors met necessary.) date .......*39 . •L6M of r+exa•• signing is any capacity Auuld be typed of ProntN Wow "t efe•atWre+. - aTAT►: BAN OF wisp OKSIN A.Ma. 11 FORM Ka r - ►!ar Ir i iFt'~ i* F { ,t