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HomeMy WebLinkAbout042-1047-60-000 a o j o C o N N N i' C ,p s I Fti I 0 jl C Z U. m 0 c N E 4 U N M Iq V� O ti N 3 a m 0 E Z v o o m z U) F- .- CD Z -o 0) _� m N Q � N N ti <n CY 0 N z NI E O N L I y d 05 N .+ y N C N C'', G G a .L] > � I E H F- 1- N �_ d Z O Z •N R maa *�. a V1 -i U 0 rn rn } o ((0 > o C) E U) " N NC liyi i O O OCC Oi m C C U N a = O U� n- O N F Y NO 'CS N v � pj -- C N i w •— C C C N C :S 04 N > L Q W c6 E m 0) L •O y -Ui O N H fn ca � I °' #t a y a • C a 'R m y E 'c C `�1 A c°� a 'I' ov� c°� Parcel #: 042-1047-60-000 02/22/2007 02:19 PM PAGE 1 OF 1 Alt. Parcel#: 17.29.18.271 B 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-SEGEBRECHT, DENNIS C&CAROLE L DENNIS C & CAROLE L SEGEBRECHT 1084 HWY 12 ROBERTS WI 54023 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description * 1084 HWY 12 SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE SEC 17 T29N R1 8W PRT SW SE 1.5A Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-18W I Notes: Parcel History: Date Doc# Vol/Page Type 09/06/2002 689529 1970/128 WD 01/05/1999 595053 1392/584 QC 07/23/1997 708/508 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.500 31,500 111,800 143,300 NO Totals for 2007: General Property 1.500 31,500 111,800 143,300 Woodland 0.000 0 0 Totals for 2006: General Property 1.500 31,500 111,800 143,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 15 PUMP CHAMBER 5 Manufacturer: Liquid Capacity: 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: i Width: Length: / Number of Lines:_ Area Built: /Q Fill depth to top of pipe: of Number of feet from nearest property line: Front, Side, Rear, Ft . _� O Number of feet from well: i> Number of feet from building: ? (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: Number of feet from nearest road: Alarm Manufacturer: j Q Inspector: / Dated: to O / Plumber on job: License Number. /84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER &N ,g�,te T,9� A&/TOWNSHIP �.�y' y� SEC. T ADDRESS -, ,L.� ST. CROIX COUNTY, WISCONSIN dty SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .,..._,,.. ,.,..� ..., .w i ! J" j' 7S7 AN INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /0Dt Oa Proposed slope at site: __ SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side&<Rear, O �`�;�� feet From nearest- property line Front,OSide,O Rear,���, /l f/ feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tanv SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADI`SOII,WI 53707 SW-1t., SEA*, S17,T29N—R18W 10 CONVENTIONAL El ALTERNATIVE State Plan l.D.Number. (lf assigned) Town of Warren F-1 Holding Tank El In-Ground Pressure F-1 Mound HWY 12 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DAT Donovan Johnson HWY 12 Roberts, WI 54023 /(3_a6- 9N1 I I" 3o 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: enry Nechville 3258 St. Croix 99114 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: \000 Qlot33 gl"of YES ❑NO ❑YES 5<NO BEDDING: VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH ALARM. FEET FROM LINE 1:1, JAIR INLET. DYES QNO Iclr_ ❑YES 54-NO INEAReST--j DOSING CHAMBER: MANUFACTURER-. 71NG� LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑NO DYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF =PROPERTY WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH 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.) I MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH. WO_0F DISTR.PIPE SPACING: COVER JINIIDE DIA.. #PITS. LIQUID BED/TRENCH TRENCHES 1 MATERIAL' PIT DEPTH IS . OtM N ff . °J a l9 4- GRAVEL FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: nNOR UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END. LINE: AIR INLET: EET FRAM�tl q3.� EAREST ►8 � 3s 30�- 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- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS: OBSERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. ISODDI D. SEEDED. MULCHED. CENTER. EDGES DYES 1-1 NO I DYES 1:1 NO ❑YES El NO PRESSURIZED DISTRIBUTION SYSTEM: BI:C!/TREN�FI WIDTH LENGTH LATERAL SPACING GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER TRENCHES: . R3IMkN IONS ''.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.. ELEV.. PIPES. DIA.: E4EVATRON ANo iTRBUTrON HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO ❑YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PRIOEERTY WELL: BUILDING: Q FEET FRO!M ,o 8 F-1 YES El OYES El NO NEAREST S 0 2 2r o 4 0 �.a Sketch System on Retain in county file for audit. Reverse Side. IG TURE: � TITLE. # L1HR SBD 6710(R.01/82) Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT , APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: !. Property owners name and mailing address Provide the legal description where the system is to be installed; I#, Type of building or use served: If public is checked, indicate type of use (i e. 10 unit apartment. 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more , c::amrr only- known as the groundwater protection law. This change in statutes was then su of .:ve! 2 years of steady negotiation and public deirate. Th�-- groundwater bid Gt'ou:rdyrater —'�� ,)cIL­.ed `le creatior of sur:'`-'.aiges (fees) for a ni;mbe,r of regula'ed p.'act._-es which e t,'VisCOr1l�irt 5 in fFc gr ,nc,j watr+ 1 e .urf"arc took Pier" on july ?, 1,984 AI' of tf w.�:jer '.hW ? u ry yoijr b_,nduig I, returned tc the grol;ndwate th;augh y ur soil absorpti n to ist. i or the disposal site used by y�_)ur noic.ng tank pur: pe s;; „!, to thr: ug°` th:,5e Jtc Iar� S ct'e 11?Cr rad ,, tr gr" ,Jn,.ya. r i_^.Ci idr7 i5 .t c e p rtn -n' f N-.tu d F- so :rce Thasf un•.s a ed �:)r in !or g our )nt. 'nil'itiC i ,st gat -nS ?nC s .: tlls lrr,i t .. st da"!;S ,rC% f?ti d3TE v, ;rt' oro ect•no. D�LHF� SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/2 x 11 inches in size. —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES Q NO PROPERTY OWNER PROPERTY LOCATION ry. r. 1/4 1/4, S T ,'r N, R E (or)'!11 PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIW$IONPAME CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK r' ❑ VILLAGE : Aa If El'TOWNOF ' x' II. TYPE OF BUILDING OR USE SERVED: /� /zo Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ❑Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: SCheck one) 1. a. ❑Seepage Bed b. ❑See a e Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): r Feet ❑Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks, structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber , , " � _ -- VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: eq IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty 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 AC>110zd_ Location of Property ,S 40- 1% ���, Section / -7 , T _-2 N-R Township L(JC., h d' ,=—/,1 Bailing Address 5o k"' Q Address of Site Subdivision Name Lot Number Previous Owner of Property 11,A-_,,jL_S Total Size of Parcel a- Date Parcel was Created / Are all corners and lot lines identifiable? i/ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number S'D F 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - .- - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 IWO ceAt16y that &U atatementh on thin onm cute tue to the best o6 my (oun) hnowCedge; that I (we) am (One) the ownen(a� o6 the phopenty descAi.bed in thiA i"A"ma ion 6ohm, by ViAtue 06 a waAAanty deed neconded in the 066.ice o6 the Cc mty R¢.giA ten o6 Deeds" Document No. 73 ; and that I (We) pneaentCy sun l e pnopoaed 6 to bon the sewage dispo,6at d ya em (on I (we) have obtained an EOAC +ent, to nun with the above deAcAi.bed pnopehty, bon the con.atnucti.on 06 said aya.t", and the came has been duty neconded in the 066tce o6 the County Reg.iaten o6 Vetch, Vocwnent No. ) . SIGNATURE Op OWNE SIGNATURE OF CO- ER (IF APPLICABLE) DATE SIGNED DATE SIGNED s DOCUMENT NO. ATEE FR OF WISCONSIN FORM 1-1988 +.HIe MADE RESERVED FOR RECORDING DATA ') WARRANTY DEED 4o0"�a3 VOL 1 U O PAGE - - - - taa„►t��L*6 OIFf-f J~ This De made between ..Harvey R. Mollers and ST. C�C+1X CO.,W>5 I; ....." Pearl--Mollers.,•"husband-and wife ---- ... ............................. I.e c r!.£cx Record this 1st. ................................................................................................. Grantor,. e-2e7 tlf APril A.D. 1485 j and.........Ron.o. an...H ....JQh11SOn"._and""Glenda.-J.-.Jo'hnson," 4:00 P M. .......husbalxd...and..wffe, as"_-3oint_-tenants .................. Grantee, I 9p19t9r Decd Witnesseth,That the said Grantor,for a valuable consideration...... ................ .......I..................................................... i!. conveys to Grantee the following described real estate in _... RETURN TO 57.e.:.CrOi_�c-""-•"-"" County, State of Wisconsin: I; t i; South 255.6 feet of East 255.6 feet of Tax Parcel No:................................... i' SWk of SEk of Section 17-29-18. �i i I� '3SFER FEE This .._.is.................... homestead property. P Y• (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; it And........Harvey..A- MO]1.e r.s--and---P arl---Mollers................................p........................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except jeasements and rights of way of record i I I and will warrant and defend the same. Dated this ...............1-5.1:......---............... day of ....................Apri.1.................................... 19.85 -• .......... ..... -- ........... ...... ...._.....(SEAL) - (SEAL) I Hary R. Mollers --(SEAL) (SEAL) I, _ _ _ � . Pearl Mollers ............... ....................°......°......--°---- ..............................-- ................. I i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ........................................•---...------...........------.......... Pierce �I .................................County. authenticated this--------day of...........................19...... Personally came before me this ---lst......day of I, --.--AP.K. l................... 19.85... the above named ............................."--•-•--...._.....................•---............. Harve- R. and Pearl Mollers II ...............•---.............------...-----------........................-- ..................................................... " TITLE:MEMBER STATE BAR OF WISCONSIN (If not,.......•-°•---.....•.................................... .................................. ,,.................................... authorized by§ 706.06.Wis.StatsJ qJ to me no to be the o$..f who executed the for stn acltrib led��-the same THIS INSTRUMENT WAS DRAFTED BY lT `� C. L. Gaylord Attorne It ......t ................ Cr Cr 1$ R< River Falls, WI 54022 """"" g 'U-- 1 z is Notary Public s+ :..County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission il; nent.(If.Iigt,'statei expiration I are not necessary.) date: ................. � fr tSCG, 1985 ) i it sNarose of persons signing in any capacity should he typed or printed below their signatures. ""^�� I II; ®® STATE BAR OF WISCONSIN M.C.MiIIa.CamprrylfHl FORM No.1-1992 Stock No. 13001 H z H a STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z OWNE BUYER btyA O1* Z—Ok I Jam'' 011 9 H 1,' CrJ ROUTE/BOX NUMBER Z$-6 /TW /,� Fire Number CITY/STATE D� J,� �s'� i� � ZIP PROPERTY LOCATION :-5k' 14, S Section /7 V TAN , R `-g -W Town of , St . Croix County , Subdivision /4x_ 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 put 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. 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with 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 Zonin Office within 3 days of the three year expiration date . SIGNED ✓�T/r.�,c�t DATE /Z'4- St . Croix County Zoning Office P.O. Box 9S- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . J/11 LI I tX YVIL{J 11\Llvl INGVSTRY, L V DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUM/;N RELATIONS MADISON,WI 53707 (1,163.090)&Chapter 145.045) TOWNSHIP 6FPfa64T•a(: OT NO�B �UBD�IVISION� NAME: 50 1� 1/ 17 �i4 N/ReE(o W "R ti LOCATION:--,C COUNTY: OWNER'S/BUYER NAME- MAIL ADDRESS: 5�-44(X b0AJ6V4N Z760Ns6AJ ISO f N� . rL I�o�,EQ _5 USE — 367Z DATES OBSERVATIONS MADE DESCRIPTION: PROFILE DESCRIPMNS: COLATION TESTS: Residence ❑New Replace 3 ii/. /¢ , RATING:S-Site suitable for system U-Site unsuitable for system � r �f�. ONVEN I NA MOUND: IN-GROUN : S STEM-1 N-FILL OLDING TANK:RECOMMENDED SYSTEM:.optional) E S DU ®s oU ©S ou EIS EU EIS Eu 1 OA,114 -�T,o,Y I- 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: e ld s S �_ `?G�^ /T Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS i BORING TOTAL P H R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUWSER DEPTH IN, ELEVATION BSERVED HET TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- / 9.0 97`/0 > 9 �.o ' sir. ��. s;/� 2.0' 13,,3 s y. s. �. G ' N V&x V C q Q ' 1,5' Dt'.Z4 .-6y. S#' .G? ' I3Aj S' 1. 33 B-2' 9,o qG le Miy of 002 C$ 4 0 B- r t -T Y v R y f i g m S fl N D w r dt, f ry S l v GKE t 5 tloo .Lr o S B- 3, o ' Tq 8-13 9 D ` 5 7 q ?t�, > . �,0 ' ok. RA 5 y. s� , �,o � o k �. 0 B- PERCOLATION TESTS DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. p p p PER INCH P ` Z P- / P- 2- 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 93.a,� Nark ; Pl�4cE sYsrE�r A s �/oSE .�-s -- POT 9I'ALC- To__ 13 3 -- 0 -z o E Vd C&st sit i a! -e TH 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. NAME(print): iulk,)ilk SEPTIC PLUMM W. TESTS WERE COMPLETED 0 RT. 3 VNEIL RD.,HUDSON,MS.54016 S e, �/ 1�_ l� �7' � ADDRESS: x� . ASTER PLUMBER LIC.NO.3307 MARI CERTIFICATION NUMBER: PHO NUMBER(optional):: �I. TALLER&DESIGNER LIC.NO,OW 2 yp Z 3 , CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 INDUSTRY, L ANU� � I 0 . wkill okil DIVISION LABOR ACdD PERCOLATION TESTS (115) P° BOX 7969 HUMAN F�EL.ATIONS \ / MADISON,WI 53707 (H63.090)&Chapter 145.045) LO ATIQN: SECTION: TOWNSHIP OT NO.:BLK NO.: SUBDIVISION NAME: s�' '/ '/ 17 jT14 N/R l8 E(o WtR Ew COUNTY: OWNER'S BUYER'S NAME: MAIIING MAILING ADDRESS: 'D0A)0U A.) a6OJsone Isv fi Huy. iZ 12o13LRrS toj3 USE — G 7 DATES OBSERVATIONS MADE NO.BEDRMS.: COMM AL DES RIPTION: Residence RATING: N /f ❑ Replace 5'� PT- New RATING:S-Site suitable for system U-Site unsuitable for system �ONVENTI NAL: MOUND: IN-GROUND-PRESSURE:ISYSTEM.-IN-FILLIHOLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U I©S� ©S ❑U ❑S ElU I ❑S ©U CB�U�-yT�o�v�l— TipE�v��•P S If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ✓� _ under s.1-163.09(5)(b),indicate: e,//f S s lFloodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN ELEVATION OBSERVED EST. I HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- / 9.v , 970 , - y /• O silo 2.0' S►,� S'/. Si ,v v c .a -&y. s1' .67 • as-sy s', 3 ' s-Z 9.0 9G l� 90 n� a - 3 OR, S•1 �. 5 4I'� of. o� CS OR B- 51'L—Ty DRY -F i )e m Sfl N o wig -d-x Sr11+fl n S(,l v L,-E 1'S C&)o .H OIL S e- 3, o ' Tq•, c s . B-3 50 > S. o ` '-o vim. . 5ycs� , 2.o ' Ole, . S, , o ' s- PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P P PER INCH I P- Z 4 I P- P- Z P- P- 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. 93.0✓ / /(/o re / 14CE s ys'TE.y -4 5 C,lose- As I SYSTEM ELEVATION PosSiAt.F To B #- 3:_ a1-� - — - o - _� e, l _ es site, A Op t I I 3ep Ic sy t m a �.. _ Q I,the undersigned,hereby certi a 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): ;UmL60E SEPTIC TESTS WERE COMPLETED O :b RI. 3 O'NEIL RD.:HUDSON;WIS.5401` S (Q- l C ADDRESS: 1 _`*3fiER PLUMBER LIC.NO,3307 M.P.R.S. CERTIFICATION NUMBER: PHO ,UMPE��ptionall: "!tiTALLER&DESIGNER LIC.NO.00663 2 'P 2-- 3 S CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER— f" REPORT ON SOIL SORIN &S PERCOLATION TESTS IIS L � N �' S o� OT � P P�q� PRoTEc I ='. D. DA rE _ s 17- / q P 7 HOMESITE TESTING CO. AT-3, O'NEIL ROAD BOB ULVRj(';r r UDSON, WIS. .,.- 54016 Cs r S3--02y PROPOSED HoosE moor LIE 2� Fr• p,� MODE FePOM qLc TEST f3,PEAS. PRo POSE 0 WLaLL M V5T LIE 50 FT. O� tiO�P� FiPO�! ALL TEST ,PEAS, • = DAG�/j�gE /�iTf 0 = EXIMIW 6- WELL #,4uP 409EQEP o,Q 546dEL Boers • ` yoeiZ . BM ® _ VE IQ AL &rtPtA14F Pour- B 1T 0 " P06-E— LE GE N p e1AV,41i0 v o,A v"r. REF Pr. /00. 0 No7f : l,32- lies 32-' Sootf.. of FEJcE'\ ►vo . for LiNc ? ) �2 pX 'L This test APPROVED c sY em. for a conventional Se {n, O ,of I Exrsr�NG- y��oE- S/( RY ' { • 1� Al- S%T+F 'OF � m,Nj BLOC, PleoPose D zs �ij t4 tw R 1-04 3 Atom . PERCOLATION TESTS 115 . UIVlSIUN rl LA50R AND ( P.O.BOX 7969 HUMAN RELATIONS 1 � ����' -� �" MADISON,WI 53707 I (H63.090)&Chapter 145.045) ;, = TOWNSHIP OT NO. VISION NAME: s�? y 1/ 7 SECTION:T14 N/R tf E(o W "R Ew COUNT/Y„- WNER' R NAME: MAILING ADDRESS: 'S�• /.X -DO�J �V 0V4,4.) 7 6 HA.)J ON ISO T- Po 6ER7-3 USE 0 7 jr DATES OBSERVATIONS MADE b,�t, NO. 7- COMMERCIAL RIPTION: Residence New Replace S Is N, d'� � ISEE pT !I � � �T'. Is , ? RATING:S-Site suitable for system U-Site unsuitable for system ONVEN NAL: MOUND: IN-GROUN :S TEM-N-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) t ®s Du ®s EJu ©s au EIS ou EIS ©u �'e.�U454.741,1 ,- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s,1-163.09115►(b),indicate: C/�f S S �_ Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION BSERVED HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) U 9�`�0 > 9 ' A ' �K- $a s�l� 2.o' 3►J Sy. Sir(� 6, G ` Al II C i,5' �K6a .- Gy. S11 .G? ' &2 9.0 q�• Id� 9 0 oR. s,� �. s �s 4 oR n R y f► )e M s fl N 0 w rd't, .g"r S.1,41 B- SO l v GKE t 5 0- Af 01f S B= B3 90 97, 9 -- > .0A�, o , %O � Q,.i Sy. Sl , .2,0 ' 01Z B_ PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER INCH P- / ` Z P- - P- G t 1 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. 93.00 / /(/a rk ; / 14E, f ys,re--f A S Close- /f-S SYSTEM ELEVATION J P o s S_a e< T-0 34L 3 • I . I 0o Z o E _ o / _ - -.-_...__._ Ilk J corterOioln all s.. 5� 'Slq M11 � I t N I • .4 - Y 1,the undersigned,hereby certify that the soil tests reported on this forni we`rg made by r t�in ac th the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests 'ray rrect to the bed knowledge and belief. NAME �`w.k” (print): ivim&alTE SE TESTS WERE COMPLETED 0 RT.3 O'NEIL RD.,HUDSON:ft 54016 S (P_ , 7 ADDRESS: *STER PLUMBER LIC.NO.3307 MARI CERTIFICATION NUMBER. PHO NUMBER(optionaq: > TALLER&DESIGNER LIC.NO.00668 00 CST SIGNATURE: 66, DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) OVER- REPORT ON SOIL C3OR�N &S PERCOLATION TESTS IIS PLOr PLAN PROTECT ='. D. D6IJ0 U4ta TO HAJ So.`j DA rE 17- r g S 7 HOMESITE TESTING CO. RT.3, O'NEIL ROAD BOB ULBRIG,. r UDSON, WIS. ...- .5,4016 Csr SS-a2 yez PROPOSED mouse Mos r Cie 2,;' Fr. o� A0,fr FROM .41 c rEsr ^ee,,15. PRo POSED wea M VSr LIE 50E-r. a,e MORE F�PO,ti ALG TEST A,PE�S, • = l3Atkiya,E /�i1'S Q = zrisn v e, W F,4 )( a #4.0 A0 j CAW o,Q S400,EL 134eE5 • ` lyo�iz . S M ® _ V0rl cA &04Rtw4E- PO/'A.) R 0 T o ' >6-E or S r D 03 Cf— 0,3 Ho use ,4 -r- ". Co e/02, LEGEND e/EVArIoAv oR v"r. REF Pr. /00- 0 No 7r : /3Z 4es 32-' Soolf, "r- for Lioc This test site APPROVED for a conventional septic system. SGAIE • � �= 2 (� 4xsuE f. 0 EXrst�Nlr- � Al- s%Tit of 133 P�eoPoseo ZS 3 Atom . /-1w Y. .Z-- - --- REPORT ON SOIL BORINGS PERCOLATIoAI TESTS IIS i Poor PL.AN PRo3,Ec l s r. D. D6Aj ouAa 3T6"Ai so^-) DA rr 2jA - [7- r q HOMESITE TESTING CO. AT-3, O'NEIL ROAD BOB ULL'Rluil Al it UDSONt WIS. ,- 54016 CST sY-dZ ygz PROPOSED mmse mv-sr LIE 2..; r-r- p,� Mpt'E F�POM ALc TEST ft�PEAS, PRo POSE D wEa M UST LI E ,So MD,PE FiPo�l �jLL TEST �,PE�}S, • = eAt�/f'�OE Pif,S O = EXist/.�1!r WELL 1( : Ave- 10c,0114 f #,4,Vp 40 EQE0 o,Q 540,rL Sownf • ` yo,�iz . B M ® = VE,Pric,#t .PEF,rpjA Poi )7- R o TT o," r06-6- nk3 FlouSt A T- N. 60 Ae N� LEGEND a10, ioA! of 1101 /00- 0 " A10 7t : 1.3Z 32-1 Soot(, eF FEJcE No . loT Liar � XI z This test site bPPROv D for a conventional septic system. ( +1_ Z v' 4ziSVENf .SGA IE pp 0 FKI'S7Wlr y'R?DE Ar, SiTE OF P�eoposco i 1 3 N�tw 13 L Dfr . ZS ��IJ Iv Lw R�d�,SA,-At- \ j i • = ®�jG('/yfo,E /oils O 4OW1.4 G- MAIP A`t)f EKED aw s4"1- SowES • /,%fit . B M = VFRtic,44 POi 0 r' R o Tt oM L006-6- D� 0 (,— 00 fl AT N � . COkO � LE 6E N D op vWr. /00, 0 " NOTE : 13i lies 32 Soo-tt, of FE4jcE tito . for Liam ? • 57 tip' F SGAIE : _ v 4`' „EN i ,'xrs7wc.- :47- 577'E pF PRoposeu _ / S 'n�,iw 13�DG• • \ � 'r 3 t 'o __� i Cti , MC w R k i FrrT to A t � r . i 33 ...... -- - 1� : y m om o m o a Aa