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HomeMy WebLinkAbout032-1018-40-000 (2) O C) , M > d g o m c O 0 m - a Mo at-a y rnv y$U aE`)��� _ �N._ 0 aZ 2 E oy c c-a � o Zt m mC m.. pN'OO LU L Y N O C OY a w >m` O a 0 0 N L O L E w„ N L TU > > U)aS m w�a Luoi �:a yca� CL o Z E > o. ..4 p� 7 m 0 yZ ofn m NL p p N O LL V C d�H C V N m 3 p = v N• a N in L 0 0 0 O O L c m Q U U$ c ELL J U o d l I 0 / (D Z o m 0 Z � d � o LU y a in F- Q- V m 0 O z II; in N o 0 '++ N .N. C-4 w d z z , c tNi� N C m N F- a� E y�co d N cc i N � ° 5 O m I r`•J L N D •A� W :3 V L O j �1 O O a Q O as N � z v a �3 a� � N m c E z ca ! N Q 1 ate+ J MH d NI G G d E N E CO •� •• I y a a d a m N d z m 0 0 ` fA J C1 i m O) 01 Z rv! O m Q N N N V O O E ° ° :3 m 3 M c LO O m CD O N r U Q Z in U = ° W O C L N C r.+ O 3 � U � N d j � O N M O O a C N C C C •O N N N N G � N m c N C e- N M }� N d N V C N O iA O ~ N M E p N m o 0 • ' O O U) LL 0 z N Z E CC ak a 1 L: IL IL • 0 Q d 4) c E �1 A tia 0U) LO) • 08/01/2006 05:19 PM Parcel #: 032-1018-40-000 PAGE 1 OF 1 Alt.Parcel M 7.31.19.91A 032-TOWN OF SOMERSET Current X: 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-BAPTIST CHURCH,TRUSTEES OF FOURTH TRUSTEES OF FOURTH BAPTIST CHURCH C-CHURCH CAMP LODGE CHURCH CAMP LODGE 900 FORESTVIEW LA PLYMOUTH MN 55441-5934 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *300 221 ST ST SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: 31.960 Plat: N/A-NOT AVAILABLE SEC 7 T31 N R1 9W SE SE EXC PARCEL 91 B Block/Condo Bldg: CHURCH CAMP LODGE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-31N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 721/41 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2003 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 1.960 7,800 0 7,800 NO OTHER X4 30.000 0 0 0 NO Totals for 2006: General Property 1.960 7,800 0 7,800 Woodland 0.000 0 0 Totals for 2005: General Property 1.960 7,800 0 7,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 NORTH PART SOMERSET T 31 N:--R. 19 WIL 51 POL K COUNTY ��l f Fifc .yy cr m.-4 %yM [ 4 Cotfvnwc John c/ s�, k,�non 389 y: s� cSwarsor/ �+ ,be y0 =E/- M°creri PeC�- oid h Land fo. 17 az son �O crk n '•O pp���b 77 164 7 9 �� :>a��ee • MPrtn® °5'ahic�e% l� oe°a Eds✓ p o ��� �. /^1¢ rice /%a:/� ,Tsfu di 7o /6r� � ^' L¢✓e�7U C v ` � �� ^12 /so !70 o h o gs�/ /in ®ffdFaem.ie 7 s /mo �f'ca ho¢c/if- \h ��D\ �Op F 379 er /.s7 S ia�' � �Q W.F. 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Edmvi p Pent En 90 �9ssn }Q"e Tohn£saris® Luedtke y Iona Vie•//e�X FM ® SS �. t1 e" 7y yo meister s ° 80 ao / V /ao 2chaid o C 0 7p ef_ �Tos.t beef v N¢ro/d f r�2�n 11\ !o W o_ Thos. ,Qobk .Pob� /v. ude/iQ G \ V o Coo.¢ e G • h X l 01 as oo a//¢r- eibe ann /40.is 'u C'arufe7R s ® • do �a�' y 2 4 `C °v 79 erma,7 G' re¢u/ y Dona/d mo ? v5N ]3 ,3N �oberf ,Penee 69 Q 90 to ❑ 6ero/ 3C, ^ o �U,� /mo /60 80 .Df�rs/7 Ue Miier o ,� C,.n�h 4 ./o Bo �. 7 • mo V � � v o o c Ot/b .Si/htt �: i f`s we.- E/�.� fiub .BQi%/ 9BOi7 5 h a ,� ' 303.ci7 a G7 x%247 fwd.-✓� ux ,ro 7�.5 /-Fs- ff rc tl i t /zo 7s o. v e es Louis �U` A v'� h man s9 1 nR / F U -bs eic son/ �'' -/ - V,y� • ewman\r� Bo- •G/en Be/is/e Honsen U b p Ge°ryc T YDrci�C/an 'Ea/L./✓er n¢rl fi a,wc l eor¢ �p�n �l en a� Jahn.Fe `l � Pennock Parcn V �Y �'Z"c 2 Z nie Ghd 71— Jas. U w o 2 Alah,Lo�sf¢�i G/e,7 d ece/i ndr dr /vnds •� z­- 0 �Q 1Jernofi� Vc.4 ,d O/C a • L.{.t/.Brown g S tice o:3a.4 s/'q �� 49 ,z 781 /'7on B O�or b o gO /aiYC a G/rn rccq d`d ��0 a Lawson :::::Moe L�z/-f/f �8ae q \ U O� • i?7P �` S3.Z e •.i:::::::::76.iS :::"Y-' fy�`aAI - efzt/ A loe Aw • i n,7a SerYi% 4G5 .Twp.• ljtl • "i_::::=[:i::: ,�: ® 7 �c,Eyord rJ¢P P i; 'qv✓ i -0 P GE 9 BANK OF MOULTON MONTGOMERY WARD SOMERSET IRRIGATION CO. at Baldwin Save With Us - Help PUMPS AND PIPE FOR SAVE ENERGY - SHOP BY PHONE Build Your Community EFFICIENT HANDLING LARRY AND BARB ANDERSON MEMBER FDIC OF LIQUID MANURE PHONE: 2a�-3a2� .PHONE: 684-3291 PHONE: 2 1 SOMERSET,WISCONSIN BALDWIN, WISCONSIN 54002 SOMERSET, WISCONSIN 'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING DIVISION LABOR&HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION P.O.BOX 7969 �a DIS§l WI�,7Q7,31-19W State Plan I.D.Number: 1 (I�a sgn. ) Town of Sty-.rset CONVENTIONAL ❑ ALTERATIVE ,0109 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: C Clearwater to 1, Somerset, �JI 5�l•025 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Lyle J. Myers 16219 St. Croix 119493 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL pROVIDED:OVER ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST—► DOSING CHAMBER: WARNING MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: ROVIDEDLABEL LOCKING ROVIDED:OVER ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GALLONS PER CYCLE: FEET FROM LINE: AIR INLET: (DIFFERENCE BETWEEN ED YES [I NO NEAREST�� PUMP ON AND OFF LENGTH: DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST�� MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO [:]YES ❑NO DEPTH OVER TRENCH/BED�EDGES:OVER TRENCH/BED D SODDED: SEEDED: MULCHED: CENTER: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE 1 MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV: ELEV.: DIA.: ELEV: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: TFEET BER OF PROPERTY WELL: BUILDING: COMMENTS: FROM LINE: ❑YES ❑NO ❑YES ❑NO REST Retain in county file for audit. Sketch System on TITLE: Reverse Side. SIGNATURE: Zoning Administrator SBD-6710(R.06/88) Thomas C. Nelson 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 ��! Y P F13 834 x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE J j P �O N I.D.NUMBER �r I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. ? IO 7 PRPfERTY OWNE%ex PROPERTY LOCATION a a, S T-?/, N, R E(o W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Sd Jr7d 2-5- II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD Chk ( ) State Owned 0 VILLAGE ❑ Public Ill or 2 Fam.Dwelling–#of bedrooms— PARCEL TAX. UMBE III. BUILDING USE: (If building type is public,check all that apply) 9 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 EgCampground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 El 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. K New 2. ❑ 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 Rr In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 12.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Mien../inc ELEVATION / 3( -229 d oC . c3 C� �` 3 , Feet S Feet VII. TANK CAPACITY Site in aallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New AStin Gallons Tanks oncrete stCon- glass App. Tanks Tanks Septic Tank or Holdina Tank AtK ( Lift Pump Tank/Siphon Chamber (o f}O 2 1 Vlll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber' Signature:(No Stamps) M MPRSW No.: Business Phone Number: >• �e o2.) / g' �o ZSZc> um is Address(Street,Ci ,State,Zip Co IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater Date Issued Issuing Agent Signature(No tamps) Approved ❑ Owner Given Initial Surcharge Fee)C!!S'� Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: A 9 11VG` SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber e 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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 all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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 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) DILHR SANITARY PERMIT APPLICATION COU TY r, In accord wittriLHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for tHO system,on paper not less than 8%x 11 inches in size. /-,/:? 4 Z ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE 7J N I.D.NUMBS 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. <y// PROPERTY OWNER PROPERTY LOCATION PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD El Owned VILLAGE: f Public 1:11 or 2 Fam.Dwelling-#of bedrooms— PARCEL TAX NUMBER(S) 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 3 0 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. ❑ 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 0 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 REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION Feet Feet Vil. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks I Tanks structed Septic Tank or Holdina Tank , Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. B umber: Plumber's Name(Print): Plumber's Signature:(No Stamps) M /MPRSW No.: usiness Phone N t r Plum "is Address(St rest,lCity,State,Zip Code): IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee(Includes groundwater Date issued Issuing Agent Signature(No/Stamps) Approved ❑ Owner Given Initial surcharge Fee) Adverse Det rmin tin X. CONDITIONS OF APPROVAUREASONS FOR DISAPPROVAL: i i f 'j t' C SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber ;N 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 now 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 Xegnires;a SaPtt>3ty 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 bepumped 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 bivision,*608-266-3815. To be complete and accurate this sanitary permit.application must include: R. I. Property owner's name and mailing address. Provide khe 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.pppropriate•boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, oh repair. „ V.- Type of system. Check appropriate box depending on system type: Vi:' Absorption system information:Provide all information requested'in##1-i. w° ,;<z , VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total'gallons, numb er°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 approvai.only if tanks received experimental product approval from DILHR. y Vtfi. Responsibility statement Installing plumber is to fill in name, license number with appropriatffprp7x(e MP, etc.), address and phone number. Plumber must sign application form. t. IX. County/Dep4rrtment Use Only. X. Coun ty!Department Use Only. - .tea? '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, locatiori'of ':' holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water4ervi* - streams and lakes;pump or,siphon tanks; distribution boxes; soihabsorpt+on systems; replacemen"ystem areas; and the location of the building served; B) horizontal and vertical elevation reference points; :v ; 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. P* GROUNDWATER SURCHARGE- 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect.groundwater.' The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and-establishment of standards. SBD-6398(R.11/88) 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 propertyrJ2T Location of property 1/91/9, Section Township _5�wE SST Mailing address /'i'/ Address of site sls Subdivision name —T Lot number Previous owner of property Total size of parcel 7 :5— Date parcel was created Are all corners and lot lines identifiable? _Yes No Is this property being developed for resale (spec house)? Yes /�c_No Volume _ 7/and Page Number._ 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 in the Office of the County Register of Deeds as Document No. and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ) . '4 6'c'y "O� Signitureof Owner Signature of Co-Owner (If Applicable) C�2 Date of Signature Date of Signature t i .; �. w'e }sue IF and r+�sii!`MdLtIRSMNi1 . mad as follows pao of G ovog s att Lot 1 and the Southeast %Actor 'U"Whin 31 llxth, a gs 19 Matt lying 8otttb and Mrwrt or , gagiming, at a point on the south line r er a it l 3S1t scluth ego 2()# 34 asst of the southaat anyjer of , f; " w, am ■oca or 3s"t I* point ssr Me �t-Lat,lr` sated point"being 600 feet. or Owner of said Lot l:and there girding. fwrthar, and quitclaim all right, title.and into .4, kz �, `�" strips ac 9cxes abutting or adjoining said! ' ehpMe described lands are being acquired for administration by pis of the Interior through the National park Servic#. ; SID 10 i M MM# "other with all the hersdit� I lo a i nW belonging or in a rpi appst KK . ., . .., _ , to fibs ' forever. m d the said four itself II-ittss sic C I I with the G and its assigns that Me s� o[ the Us" and premises aforesaid, and has gad right to sell anal is the mames and form aforesaid, and that the see are free fs+aew } . woes, escept for existing easements for public roals and highwei s, railroads and pipelines. 4 %arrant, and defend:Gitl�N'1LE and its assigAs the quiet aa� { W"smion of the above bargained and granted lands and premtsas 10, t6wftlly,claiming cc to:clain the whole or any pert _ !4- viopow, the GiMNMI has caused its corporate nane-antow t`EiyMd b7t its.duly authised representatives the day and yaeac or ASS ORCE Rwrth ist Church of Mews is �^ u . %W , Wf5• �,y 16th � '= Zi30 P lee Pratt, i of tdb*e E. (10 vie, Secre y of .litstonsirt tv, St. Croix 1u � this 16th day of . October 1985, before me, a Notary- -to y lee Pratt mown to tm be the Chairman" of .the.' 8. ligtivie '``iutowe#-to se to be the Secretary of the TrustQes G&t << anAlescribed in' and who executed the within instrument pursuant o oc -a resolutuion of its board of directors. -d ' r _ Qmiesia3n Expo � r� �-•I 3� # GIs � t lnta1 1Mec'st# � :.'Qc Z en iF` sr state** � F '> x STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 041y1z C .Cc�4s2�1�. rz=�2 4&jL1 7-75_T ROUTE/BOX NUMBER Z FIRE NO. CITY/STATE Ses�r,�t �' G'T, L� S ZIP PROPERTY LOCATION: S1/4 Sx 1/4, Section _, T _37 N, R_z_f_W, Town of _�6_n,rn eJ_0s,L1 , 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 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDIN INDUST�i DIVISIO Y, LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.09(l)&Chapter 145.045) LOCATION— TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: SE '/45t /T3 N/R/9E (o o �T 1-.111141 - 1i9 1 i4 COUNTY: O ER'S M (LING ADDRESS: ST of a L w.�7'E S '� .S sFT fjox�o 0 USE DATES OBSERVATIONS MADE NO.BEDRMS.:1COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: E AT ON TESTS: ❑Residence XNew 7 RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) r0s ®U DS DU DS DU ®S DU DS ©U I - Q 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: 1 I Floodplain,indicate Floodplain elevation: e-- A/ � PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED I EST.HIGP—E—ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) - S B_ 6 6; B-3 71, `18. 1 >72 B- 6 0 7 7Q B- / �!o Y G?�/ -/6 �o- c3�f-�I'f c F PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD P PER INCH P_ 1 13 4ZO N P_ �ot 13 .t/ D qe P- 3 E 3 1 9 P ! © 3 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_ 98 612 Z _ q0 ! ! �dP ►.v NCR i o[E �} _ _ -° _ _ 3 E I � � E _ P /'i L V l - �N i ' E � 3 s , RA F' i*! TMRH I t4 -' E - ` - _ l t . ._ ' e 1,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 (print): TESTS WERE COMPLETED ON: � Z o ' Ycl A DRESS: C T,IFICATION NUMBER: PHONE NUMBER(optionalCsr36V ): -- ?m2 CS S NATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — N ' INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 w 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 re0acernent system; 5. Complete the auitaahility rating boxes_ A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; c F'LE-ASE use the abbreviations shcovrt here for writing profile descriptions and completing the plot plan; 1. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A „� p arat'shiaet may be used if desired; 3. "0010 sure your benchniark and vertical elevation reference point are clearly shown,and are permanent; Lt. Coiriple-te all apps olariate boxes as to dates, names,addresses, flood plain data, percolation test.exemp- t ipjlropriate; 10, 0 "ile infort»aI.Jon (soda as flood plain,elevation)does not apply, Place N: A, in the apprcl�ariate, box; ?1, SiLln ah� form and place your, current address aril yocn certification nranaber; 12_ Make legible copies ;mad distribute as required. ALL SOIL TESTS MUST BE FILED VVITH THE LOCAL Ate.-_HORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other,Symbols st _- Stoma (ovr r 10") BR I3=-1drock o,ih — Cobble (3- 10") SS -- Sandstone yr __ Gaavel (under 3") LS — Limestone s — Sand HGVJ - High Groundvitater I's - Coarse arst Sand Pew Percol<atiot- Rats: xac<i ::; M."?,diurn Sand VV - "v,II11 F IP"! Sand Bldg .._ Building Is — Loamy Sand > Greater Than `sl -- Sandy Loarn — Less Than "i — Loam Bra ._- Brovvn 'sil Silt Loara HI ..... Black s Sift Gy Gray cl Clav Loam Y _ Yellow scl - Sandy Clay Loam R _ Red sicl -- Silty Clay Loam root -- Movies scs Sandy Clay vv( _- with sic — Silty Clay fff few, fit=s.,faint Clay cc — cornn o n,coarse pt - R"-'-at tram — Mail,,,, medium In — ((duck d — distinct. p — prominutit HWL — High v`iFatm level, Six gerreral soil textures surfacra water for liquid waste disposal SM — Bench Meatk VRP _- Vertical Reference Point TO THE OWNER: k •y soil test report k [lae first step in sc;currng a sanitary pei tnit. The county or the Department may request Vol ficalinn of this soil lc, 'i in (tae fiold prior tO Pt-arts=.( issuanr:r,. A r.<smplet- Set of plans `or tfae private ;e System and a peernit must be -'uharirted to t1at, applopMatra local aut:hol;t;r i., order to lr.malt n i lae r,.as,air, .§;arld po,ar d prior to 1'Ir_ start€;f any e,c>aa s taction. DEPARTMtNT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS i0IT PRY, D IVISION AND P.O. BOX 7969 RELATIONS ERCOLATION TESTS (115) MADISON,WI 53707 (ILHR $31.09(1) &Chapter 145) LOION: W-CTION: TOWNSHIP/MUNICIPAL TY- LOT NO. CAT :BLK.NO.: SUBDIVISION NAME: 452'/4' /13I COUNTY: OWNER'S/BUYER'S NAME: M�jILING ADDRESS: E TE 7T 1 ,8 D Sp E W USE DATES OBSERVATIONS MADE NO.BEDRMS:: COMMERCIAL DESCRIPTION: rr��- PROFILE DESCRIPTI NS: PILHUOLATION TESTS: ❑Residence S�4N�T I,zS�New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GRO D-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ros uu ❑s Zu s au ❑s,Uu ❑s ®v... DESIGN RATE: If Percolation Tests are NOT required D If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ( ,� D o�/E 53 B- G 9 E s.3 O'9-!JYQ,v 9- a S - o,ate w� ,•� B- -7 f / --5-3 d F J3-6 0 s w ,± oT B- 0-/0 ,D ,C9 -5 4/o- o- / Y B- > sus f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD 2 P R PERINCH P- P 13 0 s P_ 30 3 '114 l P- 0 0 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 E E , iy- 3�s .o 'To,w_ Ropes ID w. E1. 3 _ d _ E SL F 3 T . e I _ E Vt. 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. NAM rint : TESTS WERE COMPLETED ON: A1.4 I ry 4'1 A Rj S: a/ C FIQATION N UM BE ONE NUMBER(ptional):� T [ y / 61 1 CS TU DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SRC} - 6395 Tc I.ac e(.e)m plet@ an£:l ia£C 83 i'nt£: SU€I f'.St:,yf3fr rel3v. i3"il( 1GI .'.';: 1. Complete legal description,, , The use section must clearly indicate whether this is a re-�sirten(;e:or Cary)niercia I f i0ject; 3, NIAX IM UM number of bedrooms car commercial use planned; 4, Is this a new or replacement systern; 5, Complete the s uitability rating boxes, A SITE IS SUITABLE. FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEIMS ARE RULED OUT BASED ON SOIL CONDITIONS; B, PLEASE use the abbie iations she m here= for vvritirig profile descriptions and completing the plor plan; y, MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A £se p a`o,,sheet, =,n ay be us,,,d if dt sifed; B, k4ake scare your opnohrran( and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes its to dates, names,addresses,flood plain data, percolation test ex€:nip- 6on, if approf.)riate; 10, if the inforrnation (such as flood plain,elevation) does not apply, place, N.A. in the ap+)i opr-iat:e box; 11, Sign the Porn;and place your current address and your certification number; 12. Make legible conies and distribute as required, ALL SOIL TEST; MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Slone (over 10") BR Bedrock cob Cobble (3- 10-) SS Sandstone gr — Gravel (sander 3") LS Limestone , wand 1-1GVV High Groundwater Coarse Sand Perc Pe,,rcolationRate mead s Medium Sand W — Well Fine Sand Bldg Building Loany Sand > Greater Than sI -- Sandy L_oarn < ._ Less Than 11 -- Loam Bn Brown Si Loam So ;jilt <ay cl .._ Day Loam y — Yellow sci SIaWidy Clay Loam R M,�d sici _... Salty clay Loam mot I I,ot.r1es sic — Silty Clay fff few, fine,faint X"r ...... Clay Cr ..... corny,ion, roars(; Pt — Peat min _ Many, nieOhurn r"i ._._ Mucl d — distinct p __. prc)rninent FIWL. - High water levesi, Six qe oi- Soil t`.>'t:i.ai,es ,,t i'faf.'a'. wa t£?`' e:} 1=quid vvast disl°osal BI)d — Bench Mark VRP _ V!,rtical Reference Point 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADI P.O. BOX SON,WI 533707 707 HUMAN RELATIONS (1-163.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: IOT NO.:BLK.NO.: SUBDIVISION NAME: 1/ 1/ /T N/R E (or)W COUNTY: .' OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE INO.BEDRMS.:ICOMMERCIAL DESCRIPTION: (PROFILED SCRIPTIONS: R A N TESTS: ❑Residence ❑New Replace Il RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑u ❑s ❑u ❑s ❑u ❑s ❑u ❑s ❑u If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P- P- 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 nd show their location on the plot plraq. Show the surface 7-elevation at all borings and the Tdirection�and percent of land slope. a9 r- �'9M� ls✓✓Lt� ��/ I1 5 �C1'Vl�RS�I W/JC SYSTEM ELEVATION ' L s { t t 1 . i 7 f - E^ 1 _ _ I I I I t t t t t t °- _ a.._ t _-t -- d e � E t t € ( t € � �� _ l J___c __. 1,the undersigned,hereby certify that the soil ests reported is form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded d the lion of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPL T D ON: S 3 - F7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): -S' ?6 �6 1-1164 CSt SI ATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 A INSTRUCTIONS FOR COMPLETING FORM 115 - SRI -6395 To be a complete and accurate soil test,your report must include: it 1. Complete legal descriptions; „ 2. The use section must clearly indicate whether this is a residence or corramercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a now 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 RASED ON SOIL CONDITIONS: S;. 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 to scale is preferred. A se;paraw sheet may be used if desired; S, iAWkE'sczr'e your he hrnark and vertical elevation reference point are clearly shovvn,and are permanent; 9, Complete all appiopiitate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion. if appropriate; 1 0, If me infornnatican (such as flood plain,elevation)does not apply, place N.A. in the appropriate box; t I Ssc.n the form and place your current address and your certification nunrtaer,. 12. fvl e Iec;ible copies and distribute as required, ALL SOIL TESTS !MUST BE FILED kAJITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Str m (over 10") BR - Bedrock Coll Cobble (3- '0") SS -- sandstone gr Gravel (u )der 3"1 LS — Limestone s - Sand H G W -- High Groundwater s,s Coal Sand Pe;rrc - Percoiatinn Rwe rried s rVV drum Salid VV ?; F 1 n'o Sand 13;c1ci - Building is Loamy Sand - Grealer Than sl Sandy Loam < -- Less ThaF, — L..,,)am Bn -- Bt-n i sil Silt Loan) BI - Black si — Sill Gy -- gray cl - Clay Loarn Y -- yeIIrl scl - Sandy Clay Loran R — Red sisal — Silty Clay Loam mot — Mott3es sc SaI,dy Clay wi' - ? vith sic - Silty Clay fit - fevv,fine, faint C - Clay ca: — crarrrrrsor€ co=arse I,t ._ Peat rfirn -- Many, nlediun7 nr — Mtack d — distinct p — prominent I-WL — High vvatcr level, Six general soil textures Surface water for liquid waste disposal BM Bench Mark VtRP -- Verlical Reference Point I' TO THE OWNER, s soil lest a epc rt is tl e first statr in sraccrl inn a 7anitary taermit. The county orthe Department may request +ic,ation (if this soil test ill the field pi'iol issuancs;. A complete sat or plans for the private sgc= system ar'd a permil ar)plicatitsr, must be scatsnritte€I to the appropriate local aulhority in order to E)W9 a� -"� pc rtnEt, E lle satWai y frertnit roust. be ohtak i;tl and T)osted pi iof to the start of any construction, II I I , 9 4010 �r -r,u ENT OF � SAFETY&B , ?r D: k DIVISION tRY, P.O. BOX 7969 UR AND I ) HUMAN.REI.ATIONS �� ` " v •� MADISON,WI 53707 N� . r MLI t A ; O'�NK O IViS10N NAME:UCA ,-!— %'f _ a COUNTY: E d?�`OE! !e ` i r conic:; t`€RMI:nT!9TTI T S Is: ^� *e r NO.BEMMS.° ❑Residence P110,F,CgIVENT Rl+-.JG.S-Site suibbld fof system U-Sit, if I L: UN D: h l:; 'lul.. •. ; ! (ILL. nJli IIEU(J^�tV1ENUEDSYSiEM:loptionali S .0 U ®uT U,� [_u w_�_ -_ X s if Percolation Tests are NOT/squired DESIGN RATE: It any rticn of the tested area is in the s under s.H63 M5)(bl,indicab: Fiao i'ttah,,indicate Floodptain elevation: (/ uexil'3?> �, BORING TWAL 12EPTH TQ 'R UNDWATER-INLIJES CHA ACTGR OF SOIL WITH THICKN SS,COLOR,'TEXTURE,AND DEPTH x NUMBER DEPTH IK EEEVATION OBSERVED + TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 53 0 Ph 014e P/S ,. 66-2-2 AvCs O -/�~ io- -5►y PERCOLATION TESTS D H WATER IN HOLE TEST TIM A HES RATE MINUTES H AFTER SWELLING INTERVAL-MIN. PER INCH ME :30 A'Al to 1 Q.10 Cl 9 K J 0 3 M'LAN 0 1111 toationa of percolation tests, soil borinps and 0t;44liltal»lons of suitable soil acft I lo.l(Aluniistances.Describe what are the hors" 'q.; ends .:�N�t{sltiq�!t lWerenee points and show their location oh the,plot plan. Show the elevation at II borings;and the direction and percent ->� MAY 2 3 � y� t: - ._ ! } ! _ r { '`.:l �1�•. j% Iw: , , rte,f �+ � C I _ q 'A r Y I ate undsrsipned 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 *IWtihe data recorded and the location of the tests ate correct to the best of my knowledge and belief. TESTS WERE COMPLETED ON: b95T 3 6 9/1 BER: PHONE NUMBER(optional): z. �,�. CS NATURE: :ii�A1� �A y,+ 1 ... ` _; I j w"k4,�1 y �*�� 1 i '. .. • � �1 ar 77u yj}copy*to Local AuthorityA ProF'+er;y�OiNtib+.8nd Soil Tester• " ` , ,car =OVER- DILHR Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C. Labor and Human Relations Safety&Buildings Division REPORT 13 E. Spruce Street Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date � �'`�oio9 (715) 723-8786 1-!4,1 -? , 19 Name of Premises Addressor Legal Description OityfTownship County Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. i_yLt. r-t-ts=r� Rt- Z b—, 47A Sanitary Permit No. Yz (t VIOL p w T- 54-7Z15 J r/Soil Tester Licensed Person's Name(s)and License Number(s) O�n'LD CUQ'MICAfJ C'�r 3G4 ta Owner's Name and Address f� 1 �j,.V,L,� /'f-f`-c-c 1•__Y��-T{�'�/:..f.,I,v,.`t /�'Y�I''`�->!<�--1"1nt .� .%`'L'-G �'��.. �..1 'Qu..� ,��T_� � Y�1.. ��G`•�`'Yi: '�`%e✓ r'�'` (�.�=li`'�7�`^�?/ �°Z /✓+"f /f'-L`:J /:^•`�.(�. ..��'�Gl�� ' �/f L �r..7� / .:,i:, ,, r`.�r f _r 3�,� C� W'- - �, �/ ti.. -/:./CL1 �LA QG _ fo' i1'.. /..•� l�: �c'4'�•�!-�.Ar /�u'ilr_/.i'( .��.�?� 1^mil � M� 1Lne��-� �+,�{ �jU%<-(iia'L7`s,..!/"Y/"v�iu'Z F4\S V `� `�! � " !; ?:` y �� kSii '71 J" Yy ''�� `l'•. L.J �J 51G -t_x� alp a >1 _ _ (, ;'J tilo ! L4,2- V. .1 L 'iO r i it 'Jr"L REcFjvED F i MAY 3 0 1989 SAFF7-y$ eLDGS. DIV. ' r Page Of Signature of Responsible Licensed person(only one needed) Signature of Plumbing C1pnsultanVPrivate Sewage Consultant Original _ Copies to: t hatapply� 1 SBD-61e2(R.t,rss) District ElDILHR C3 Plumber C)Owner 0 County/Local Insp. 0 Other DILHR Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C. Labor and Human Relations 13 E. Spruce Street Safety&Buildings Division REPORT Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date (715) 723-8786 Hai Name of Premises +flew Legal Description Ody/Township County CAMP CL64kwATZ-�- s SI , 7 ,3l, 19 L &T-. CP—o)>C Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. Ly LE. MIt ET!-�- (Z.t. Z e)(,x y-7A Sanitary Permit No. -vi w= -Slf7Z5 JONAFROYFAUR PIMPA oil Tester Licensed Person's Name(s)and License Number(s) Vt»aa'--D COP M IC CST_ 3(0�( Owner's Name and Address � P c ,,► - (Z Rt 1_ :3�,,E X08 c SG�I SE i wZ 5 L5 , -� ,.�T � _. E � -Wi �f �Xz- 19 °_ I.Z I✓?`�( 4.i ._. . N _ . . cams._._ . staE. Iq,1f i4q— (P`7 iaiv �slZ+ +N .P�P4E. (PI — :Cn. IQWfz -6 tt. M0 k S;i_•� ,+ _ _ ST. '+t-'Ut5{. Cdr_ 54 r t S > q M t t V, ..PoI377- ' EC�I '� .. •.. 1-: LF Vf i, Y 3 4 1989 W�- t` ST cX , C0UWY � ° �. z , (`` Page—/—Of Signature of Responsible Licensed Person(only one needed) Sig`at o Co f Plumbing Consultant/Private Sewage Consultant pies to: �Check all 1 Original: Co thatapply) SBD-6192(R.11/85) District XDILHR Plumber 0 O er'® 6- my/Local Ibsp. 0 0#(err 1-4 cRo�+�E _ •/ Wiscottsinbepartment of Industry, INSPECTION DI LH R Labor and Hufnan Relations Leroy Jansky P.S.C. Safety&Buildings Division R REPORT 13 E. Spruce Street Bureau of Plumbing - Inspection Date Chippewa Falls, WI 547.29 t (715) 723-8786 Name of Prefts s Address or Le al Description 7ownship County L 4 ..1 7 is V4LL-,l `�, 13, 7 ct Igc,J t 450Ili 5T• CQU(,�C Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. 0%0 (e on _... a-7 ,08/ ua (2t \ 8")L '-1 Z4"> Sanitary Permit No. 44Ao�yfv; w? �` at LL 112-7�5 J ep 1 01 lyer/Soil Tester Licensed Person's Name(s)and License Number(s) X,1 1JJE6t " C , Owner's Name and Address A�i F , �L1 v Y- z!: +. .�+2 ?�a'7 , 1 L"t'• './t- ��ar rte ,,i y14 'f'4�! E t t_ � 5 Page---L of Signature of Responsible Licensed Person(only one needed) /( Signat ,K-of Plumbing Consultant/Private Sewage Consultant Copies to: \thaeapply/ ,� Original. / SBD-6192(R.11/85) District O DILHR 0 Plumber D Ova" r`W nty/Local ji ip. 0 er Dimensional Data & Performance + iI§e w 40 10 9 MODEL:SK60A MODEL: SK60M n SK75M, 36 '--a5r,e ev,e- —� rtDischarge SK100M, 36 ro 45he— 8'''e rLDischarge '+f/ ` \ \ 0 ' 411 \ 6,he 2 N.P.T. 0 ' 011 3"N.P.T. 311/,e FLANGE t 3°N r-.T. 1. FLANGE '� 18 � . :'�• �_ _jam:-1 6 R ;3114 �t 6,12 MODEL:SK75, SK100 ' SINGLE PHASE 1- 1211a - 45176 6'i+• SK601SK751SK100 -- MAX SOLIDS 2" SPHERE — 1750 RPM �i0 — SK100 T FULL LOAD — 36 AMPS AT 16 1152. 32 --- _�---- — 18.5.AT 2302.9.25 \ , / 2"N.P.7. tj ------—_ _ I FULL LOAD 3131 / a hP if AMPS AT 36 2335 Oa 1 AT 460`! ^.35 - 0.- , 28 4.7, 3"N.P,T. Z 24 -- — a FLANGE c hp i t0 hp I -- I a a 16 SK60 SK75 O FULL LOAD FULL LOAD 12 - AMPS AT 10 115V. AMPS AT 10 115V. 11.5,AT 23OV.5,75 17.0•AT 230V 8.5 ` 8 FUILLOAD I FULL LOAD t - AMPS AT 3d 230V. AMPS AT 36 230V. 4 -2.25,AT 46OV. 1.125 3.6,AT 4602.1.8 __ - - 2111>s 00 20 40 60 80 100 120 140 160 18113 U.S.GALLONS PER MINUTE .M I }` I --- 61;2 MARL'EY• THE MARLEY PUMP COMPANY l � HYDROMATIC PUMPS F Bulletin 210.9 Box 327,Ashland.Ohio 44805(419)2893042 Rev. 12-12-84 ht Canada-Marley Fluid Systems,126 East Dr.Brampton.Ontario L6T 1C2 International Sales-Mi9swn.KS Te!ex 716875045 MARLY UW PRINTED IN U.S.A. m CD Ui ZZA IK r., ryl CIO REM z r 9 r'A-1 - � LP 4 p tA CD h 1 G F 4 � p 3 J � C G Vk, �` n n �— r �,• �. � r � l� to 7 � ��''- ! .✓1 �� f � A S �" s � f n lZ t ) LA Ir ` r ' 0 t l�cy ,P r i. 1 e e• A op, 4 '✓ p �A I � x ,� � w F.J! � I � j tad A �� � • � •��' '1, � a CJ i y ���' s 4 ,� ' ,� r 3 ' rn �`�✓ (lb 1 Q � JU 15. j16 -�' Oil, r. s '(p f h r r 89 109 cr OP 3 -rl D _ a Q TZ to ( ) m LA o� LA R\ CA -n 'r r r O � k -� COP tzu ear � C: rT CD cn 4 1} U) �. 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