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Wisconsin Department of industry, PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing Name o remises Date an T.>5 o Street TIFF o u n y Sanitary Permit Master um er Firm Name dress Journeyman Plumber Address Owner ress r i f! . f .«....a..».,...».a.~.:A ..«»-.--...o~ ....~lr•'a. e,,,...,_ ~.....,.o.._._ ~...o, .~r._.==„ °~'ffr e-...,~........ wA.,m e.H........~.®......,, .....w,,,,, T -7f, / j t _ i t4l Discussed with Signature,. ( )See Attached. DILHR-SBD-6192 (R.10/82) Signature of is Plumbing up, n- i e as e peci ] Inspector Local Inspector Plumber or Responsible Party d.vjmer LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022-1039-50-100 Parcel Number 14.28.18.217C OWNER NAME: First AXEL & STEFANIE GEISE Last BOGDAN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 1341 CTY RD J SECTION 14 TOWN 28N RANGE 18W '/160 1/440 Line Description Line Description PARCE L VOLUME & PAGE HISTORY TYPE VOLUME PAGE DOC# NOTES WD 1238Q/0,81 559158 HOWARD TR J Use Arrow Keys to Select, F7-ROD, F10-Exit 10 o cn O 3 v 0 rte. o m o CD v1 C _ = 1 M d 'D CD d ' A I ~ 0 n O N cp o O(D 0 II ' ? K) (?D 3 3 O C (~D V F 7 tJ N 1~ W d Z O. 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CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022-1039-50-100 Parcel Number 14.28.18.217C OWNER NAME: First AXEL & STEFANIE GEISE Last BOGDAN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 1341 CTY RD J SECTION 14 TOWN 28N RANGE 18W 1/4160 '/440 Line Description Line Description TOTAL ACREAGE 7.000 PLAT LOT BLK 01 SEC 14 T28N R18W PT NE SW 15 02 COMM W 1/4 COR S 16 03 89'E 1479.26FT; TH S 5V E 17 04 TO A PT 182FT E OF W LN & 18 CSC 05 POB- TH CONT S 5V E TO A PT 19 1/l~ b 06 [ON EXT OF SLY LN 166' 20 ,IIv'CG-C- 07 Y TO W COR CSM 1/166;TH 21 08 NLY TO E/ W O 22 09 A PT 182FT W OF W LN; TH SLY 23 10 TO POB 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit I ,eVr~ eoTN - • N - R.I 8 W i air N 4- Fed SIFE PAGE 29 • a LenUt hrR /7'a 3 /ya,- ~¢ymond,ti eem 77es 65 ~ Luc://e, IF t~,Ce, J L be. 79B F/'ed [/O~w¢/¢' L v a 116.7 " /%Qw"Cp 76.76 Si/7,ZJ/7sd7eta/ Le7,e.~ /se /B9 6a A1007AaO 776a u~Y 'Y~ Jose efoJ • b~ Losent~sen ~no/d F7 V~ 2/e4 b~o~ i ~ C n ,7o.sa/oh{/he l 0 E /sz.b ~s 6i crk ~ ~ a d y n fJaja'e!% Bo ¢o ~~.0~ Th//e/' tl ~ obe~tf • N4rood V o ~~v r 6 Mo/-,F f ears / n7 3z 94 • • <T[L77eS O s \ W O Laude vo o/ z6 q J /se Q 6~ ~ -rck/e/- 0 • Lubich, ICJ 0 R be."t C /20 efa/ `y\`, rcR/er Oo /o~e~ n f + n C V' 60 ,zo /s397 ~ o ,Q, t 0 YE. Vl~ ~ y Wm. ELouise sk C' M y ~ Ol C /40.6 L b.c/7 • ~a'7J~H, 60 ~°b ect f~oi-in SKY(INE Q, N c Gordon y~$h~ • vr6E/a,ne .Pith ter e Mae/%/ F.e ~C may o~fin • RD. ~ • • N c 7594. L/stT/c.F d 0 17 117 .9i~~n zoo 60 tlh Ma c%/af Bo C•'c.-°/d 9 • 96s V ~ N i/.~~ !/ate 6e - ie I E ~Peuben h'C y L-ecx~ 5~~ Fi.fsche I,~ csQt b Cl/~n6• U Trsacr . Isr ~ )'C ibo Ca.o/ • b\ Kaarie 'U .e. .e _ O 7zo 760 V 0 Feye~e ~sen ~ B ~ . 9 b~ A' bs~ N /zo V J E h C • Thomas 7a Ba/ba/Q tl /6 z. z9 ~ h .S$ ~V ~ V,a 0 /-c .i a / s • Thomas ob> . 0 m 40 3 c5'ta ~ ede..c.F 1tJ J i 1-3 P *n ~/e N /~4.s 4a• v~ ~y 4ss C Lene/73 h -P Ens Nod /zo Phi//~~,s /vo deO mzs .Inc. LEE p Wppp,,,,p y wa ch '7 vo -ao ,•.o ad Cje a/d q hift l 0 \ s e9 7o en Emha/f 90 /zo d v¢ .ce U' d /se. e/ = r~ • 3 p Frame M C~1 \ go 60 / N 4yce E z 4. ~Q /zo Yr/N ~ V C ~ ~ ~ ~ He%n v rr ✓ • o ~ • W v ti o~ ti ~ l/anasse F l7 V 0 V t Ham W 0 /ao w W a 99 r .nits s .~/.ne e beer 0 ~°u~ liec%"/-' V, s`7ue/% Cv_ ~de F //ec 2 • Do rhy PD/Ps 7y tl /4o q 90 e1a/ /s7 90. Bs owa iTfy r tl O ~ W %'0 ~s7 ~3 • • 7s Sz, S Meier _ b 0 laude W C y 7s6 es . rs ~ ~ Phi//~ V W ~1V O h s rv .so `son Phi//Ps H C . qqy Bo V soT s ° Pefe - V~n4 4 tl 0 6 • F ~ Thomas Fna ~.E [.E ti a 0 b T ow as ~ /40 'UV a s'eQ7'~ o Ch es E 27p CTery Cj:bsori, L e, d • fi/iS/ianson L1-f1 ich (,V e t r zo IN • • eta / siz. s es-ux Q.~ ymy BO Bo a o W • 59 • Fu/ E-mi/ JE J /zo a ! N h ,/J z7¢ sVa/sore /ao 7.~ a ~o ~ ~a ay f O/ -tee T~K L ~ TN i ° /tO'' ~Tacobsor7 Lou/s r Oscar-~ d.~ /d`,,,ew C 40 ~ 4-a /Yu/oioa/t yHQ7ti f ori,s Le s8 • Car/ - ~ h'o rd se.~ • AVE. b .3oz 8 1 C /67 Eyl /6 c wR9• N • 7/B• • dyy0 0 p l 173..x7 • o L47o7 Donn /yar o. a h Rob f -717 M w '0 r s E ~r sn. ~r. AV . C F Gordo n G~ ffey /6 0 l" o ~T Hi// / 3.95 W9e Norm¢ 40 'C~00 C 9~Ln g7 C N~ V = EG sM RS 3.35 Tha .son vo 34B.s .0 C0 ag v C ~ Dw: ht 0 0 oo. • 0 4o Lr~J ~ ~Cp y 9de 5 2K/0/i9'e/'a67- r 4_> IET ~oehins ~ `y 8L -e ,7 kQtfB.~o 63 w 'E Cpy ~tl V J D G.:-,~o a 61 ~ Pec%Un~ 4O 40. _ 4a ao k ubich q~ a 5 '7s s W l rp ~ ~ cS o°n ~s v . h e / ~ AVE. Wes a~ `b c 70 .8 522 Bo 4 ✓ ~tiUa qye -z~¢ e7R V p L4Mo1ne 2 7 Mel/e ~,o s ~ lam. by vtl I/e/'non f v £ F va et •.°es,.Ea s Krea M¢x ne s..o Q F f/.~ /3¢ tSfan/y cF. /oo /7a.35 /Yie/ ell '~0 %eskar of 79 1117z Peskn~ 66 c7 C 0 • 6ss /s3 40 ~ /Lrn E ~r,Bi~ P,D ~o. ~ Ba E gel, an.~ o i3 P¢u/ ROSe Pes,E-¢ z -P f eO;~,S ~ //B. B PTO n L' .aetty 90 V ratf • David f [✓un.~e~ 7z/s Hon on f Fl is c5'wernson ~Bd L¢ s saonr¢. s e. ¢O U 4o a .son zoo W / oo Voh.7 40 40 • • "DO~othy /L/a.~9/e W //'a S 40 74/ C /oTN • AVE a° f/ansen c'7° P~[i/ /74 oq • 80 Fa us7-, Mar~a7ef E9 ~e f sriy.ic£ 'C U !y i3o •yOv / Ti / ~ /1/4/ke~' E e a 4o Peskary x q o L32vi fDebn2. 6 rn'm/' opt ./0 1 ¢ j ~ N ~ Ovsa.E a © • • • • • /ia /Bo 40 Y 40 cry f~r~^ Th d AI 2[65 e ne tQ%t nf~ l~~ R~ Luci// E ~ fl t v i.~ '°ecs L °'"Q~ :Wi//o/d 6D th f ~Pu/h Lee Lens3 ~c t (?V //er°an ~ Ke/y R F LL5" y ~h t9s a e . ,zo b_v /,ART s 17B i/~ Sx. ar77.t7n t - n/_je • CS 0 " c.Ef d r7o sours i UE G/acc CI a 0 P%u6/s,1 c. 90 -o zse \\~Q i PIERCE COUNTY • i River Falls; NOIKKA Grain Drying Medical Clinic, Ltd. Makr^s tO Grain Banking 1 River Falls, Wisconsin = IMP. INC. Bulk Handling Liquid IHC - Gehl - Fox Custom Grinding f RFMC/lonas-I(laas H & S - Lindsey g -Mixing Medical Clinic (715) 273-5068 DEISS & NUGENT FEED CO Ellsworth, Wisconsin ELLSWORTH Phone: 273-5066 IN WISCONSIN East Ellsworth , Wisconsin 54010 T,, x„ LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022-1039-50-000 Parcel Number 14.28.1 .21713 OWNER NAME: First RETIRED ast FRIEDELL PROPERTY ADDRESS: se ree ame-- Type SD Apartment SECTION 14 TOWN 28N RANGE 18W 1/4160 NE 1/440 SW Line Description Line Description TOTAL ACREAGE 5.054 PLAT CSM 16/4359 LOT2 BLK 01 SEC 14 T28N R18W NE SW 15 02 THAT PT OF NE SW LYING WITH- 16 03 IN C*S`Vf1T&6 17 G~Jt 5 04 18 05 06 20 l 0 D I07 21 08 22 09 23 10 24 11 25 12 26 13 27 I 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F-77Valuations, F8-History, F10-Exit 9-1 -7 T-28-N • R-18-W E NIC PLAT KINNICKIN F ut' See Page 112 For Additional Names. rN, (Landowner) WARREN PAGE 32 1500 1400 1100 60th AVE 1200 1300 1000 ueP D&c 20 &M23 ,6 n 1 900 tr t sou !1j , w o Jac H Simonson K,G,G&I I Dan & 21 ue 19ll z Farm Inc ,d N F ' Gloria Nelso31. Oz Lenertz Vorwald ''jj~~ ~'3 Oq = 3 Harold I b-J MZ 2 = r " 193 Hunter 197 40 w 94 Y 198 Y¢ ♦ o' Heinbuch TOWER RD o ,Galrn N° tr 1 F o „roha oo urn IThomP- x so.~ s ,Nn - Trust 59 BaxWra u N emw" w gepM,,, ~ son rd Robert & C ^ d TROUT Gart, _ 346 W a w z' Barbara u q as 5 BROOK 7z w s ° ~p a v ~ 40 'G I Alvin 4a & o I Ickler wG ro 'r 170 _ x RD g § lam„ I \ N c a 3 E s smanw Ha uneeek S lom etal < N, E O sr_A"aao' r 1 52 ' N tr 34 Lubich u' °8.S r l2o s _389' _ _ 60 50 75~ 118 James x w ,o &j usan aZ 8-Fs,.a~° 'Fisk trz old& Benson u I Za rJ a aKS 30 Kc : ao tl , x t Pinski 2 s< Joa na 35 a0 M ames ar w~ u > Su 1 R5 '<a' mner Marcella zno w a Trust - ~ Q eb K°Ba Lueck , LE v-T'1 r Elaine 80 cxa,~,~ a s' " " c agi B win rq Ray Thomas cal zo c v ry L Jr & usa R to W F K&D R > B ras B MaN sec Marvin 180 ~oss 45 160 1 80 80 m_ ns p ro COULEE Jones ra i"ro z0 HW 3TRL 157 z 21 zr) 73 } a i Johnson - 3a 17a a ~oac o,,,a, pwac J wa a ~im J y Randy 65 ¢ Jr Oppenheimer 266 104 f tr 0 R°~ 3 ewrrt a.s""` u z c M n. a s ha o""io r,s s w sz j r &J°1ei 107 ` • •a ' 160 w rust STEEPLE DR ja a20 AVE M Ax"xna p F rdsrn 65 SS I~a r„~ rrderk.s ho<bm-. IJ ~ I rh<m hh" s Muk o+.,a rr 1 r sv ux a sMder aulsxu K.mn„ _ _ MIN IIa~a &M c a ea ux. .su"o« smm''" 159 rothy H 53_ J_110 - ao a w aaK &I 111 n _ _s3 e c ~w _ - - x Ro rr Nam ~i'~d J - ~ 3 ±Stdte A Domthy L_' e tr Mirhad a u, ld Wisconsin Harol hBRpps Lenertz u a s fr 'o John Gera L Emh ld i D R Mono I too 5 -a- s Sehwdt _ I Mickelson w ` nc 3 40Agronomics I E 117 s` o°0 1T #g z O Inc a^ 154 &S tr i 186 2 Ms) 4 113 h ° Lenezt 31 8 222 122 2 J Todd K& EE ' 66 N " N `t' 1 oTOHALL E- m p 00~D J tr Jeffrey LL Y 2 Wulf _s 8 ¢ °KO d^ C; x u n WN " ,wa wi n S T o ' w r ¢ F & Nancy o wER kinnic p 4 5" ~ a Christensen Kinnic- 00 0~0 66 Es& ther . River da~ m°az m" fz° e~°'-«I c< a n Bloom s ° N m~ 0 77 0 & Fuller ~nsc e o e a I'dc v Donald w^ d cw*dsoa Trust PB & " s° m ut w o v ^ r e ono a E r w o r a r~ u al„d;o, m mQ RWer 39 5 - L7 n ro P p & Gloria Oa. ausa QN u 208 =,&_I12 _ Ir 57 z _ 154 80 18 E J Terese i`„°Q tr " o Glenn & O~ Wml-~ Ross& ' w C ~I14 Mueller z can ET I Higgins 53` KKF Don a Judith I Albert 6 1 w John Emu & 80 m xw s Badje 80 z sl 20 ~p pOp~ I G no Boettendorf 80 ^ 2 3 BThezoe r & 1oz u o Fuller Family I pile & Vs s rt • i= T•~`^- ge x A ° t<if& LOWG \N ~e ¢ 140 rust Griffey =;,y OAK DR 1. o.so~ zWIODB N 79 w , Partners i rick- ° N~ ludlth 36fr HORT 176 ' ao • " ` N oae 40 °o^ is LLP 120 so /Z 1 Delahuerta D tr K&V 31 53 " N Madse~ir , oward D 15 Gordon Robert Jr & r ` Daniel s' "=F ^'+e &2 y f R& „",~°a o j 3o RIVER M n tr 0 40 Griffey IRobert ~l Arm M H m &w l .e o ~ ~ , - • ° " • o DR Maxm n E - - , Keatley & o a' i1 ; o w . ' Dawa S g o to s8 Krumwtede Fars a° s w an • a m y o s za ¢p. l ~,uu.a th-;-n Kvr °9~` 30 250 801 160 m o 3 E ^e" ' 9 _ ii a r-¢~Qa o N _ _ s3 iz _ " w:im ay nommie o 169 60 z~ ° xe~i Kama - = - = o s JJ u N K ' E p I w 1 a^ Iu t0 4o cua Leota $I _ Llndi D5 ' > fr a9K D6.. G Hebert s &C r&IE ' Ardrea Andrea a River E VWE R Y' es t s ° • b € N 4 EN DR w•E u K75 zrL Dll RB&¢ c 1 w x Falls Ctlnn 4m ^ v .°:c N"N,. ~'S `~'o3^=y ae o 36 rwr JP 33 ¢ c ° ' Trust 2, Of a :°yna ,be A °e n a dg ' I eEs ¢ uxa tr wo xr tr ,gym LS z 1 I -7 St Croix 8 e",m„ x 3 s' a " L 833 = 40 al• 10 2t tr "Wayne Jeffreyz c ~n ,Mae ttg oV ss,,..& o D-1. taro ° s 9 /1 lac zt, • Soder- & Jane 1] s °uqe Wolfe & Betty Kramer J / beck R~ ra&h eaumnet ¢ ¢ '9p~~c 315 °r fr 5 4t Hinz 36 Swenson r 94 113 x ' x a i"+w m `most & ^ Adeline 'o K xar*r ormsa rr'r 63 Trust J / ¢oo Stanley 916 Peskar tr I o -32. F M&S 2z - - 200_ r a"`a w 2 x w0¢ d Vernon Peskar Rose IM 6 Tr,x,t 40 3s Kessler i aM xa+ m O Peskar 104 _ 316 Yunker i 10 r114 6 21' 40 HALO R g _ ei a Iz t3 °w n 3 67 _3fl 5 val a H ea P r x udith I < H_ a o,dr~. I W Ga Paul& Cudds T r7' z•~. tr t4 i Jorgen- Ow°._ ai.," w ' ry Janet ' - ; al EM R oN son 54 w s."e. Cuaa Mobile 65I & Gerald Carol 2 % 40 Q Judi Yli I¢ 33 1 ' 40 f 3 ouzo vn Be 73 DaAd & mm trust 62 Home Court w Pa & aaL r, a °eno°a w`' ~ D6. zKi ea John ' Williams m m ~-'-9 walkers E L e " E 3 z O Os'~k 8 & Alice I AC ~ u `o M rt Hanson , ~ M -itr m x Ste- Gary & ' m Vem n & I F p Ix ' Truster TS N 3 wart )udith Lucille 1 Ralph RIVER 35 11110 Lnt: Grimm a1 a $ 196 +d Kelly 8 26 3 = Tucci 55 40 39 Q p J ° ro Todd & °o c FALLS tr 1 * "x°L_ O Q Grace D~ Patricia - g U vs Robert a J&Ruth 00 Nelson OrxU Bergseng Robey l 6t & Karen 6 wrmiw" 17 P J _12 I - 65 z Miner 130 Lee L 40~ _ _ 100 _w v _ 14y _ L - - - - COTTONWOOD N PIERCE CO The 9 N%dwest Appraisal Service, int. Kinnickinnic - TERRYD. BLAEDORN River d wiscot5 CEi(IIFfED RESIDENTIAL sER #56 Land Rick McMonagle R~ AN DUCKLow Trust Executive Director WkONS94 CERTIFIED PRAISER WCGA t i i -0I{) ?ENNIS Ro SCHULTZ 715-425-5738 phone 219 N. Main St ISG N rEanr~eQ FESIDENTrAt APPRAISER #98 PO Box 87 r F _ 715-425-5771 fax KinniRLT@pressenter.com River Falls, WI 54022 13 8 `NI7 TREET OFFICE (71 5) 425_1 l Tb rER FALLS; W 54022 FAx (715)425-11 i 0 Conserving natural resources and scenic beauty in the Kinnickinnic watershed - Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~C(_ ~ ~ TOWNSHIP SEC. T ~N-R~ W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances. and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L - -V(i 3 ->i 3 ' Z 5 4z' r I ~I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used r1• Elevation of vertical reference point: Proposed slope at site:' SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: r" Tank manhole cover elevation: Tank In4et Elevation: "'11i Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,O Rear, Q feet From nearest property line Front, 0Side, 0Rear, 0 feet Number of feet from: well building: I' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE RRVERSF- Sl ut?. 4 A PUMP CHAMBER Manufacturer: / t'l 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, O Ft Number of feet from well: 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 0 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, Side, Rear, Ft. 0 O O Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: _ Dated: Plumber on job: a ,f License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON,/V1 53707 I.D. Number ❑CONVENTIONAL ❑ALTERNATIVE State Pland) ~ El Holding Tank El In-Ground Pressure ❑ Mound (If assigne NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE 9~ 9=i.3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. / REF. PT. ELEV.. CST REF. PT. ELEV. Name of Plumber: MP/MPRSW No~.j. 1 ounty. Sanitary Permit Number: _'t" i 19 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING R PR YVIDED: PROVMDE S ❑NO Eby 'S !❑NO BEDDING: VENT DIA.: VENT MATL. JHIGH WATER INUMBEIR OF ROAD. PROPERTY WELL: BUILDING: VENT TO FRESH FEET F ALARM LINE AIR INLEtK { r 4~ ❑YES ❑NO ❑YES ❑NO NEARESTOM DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY JPUMP MODEL JPUMP/SIPHON MANUFACTURER WA G BEL LOCKING COVER P VIDED: PROVIDED: ❑YES ❑NO ❑YE ❑NO ❑Y NO GALLONS PER CYCLE: 77ND CONTROLS OPERATIONAL NUMBER PRO RTV WE L BUILD ( VENT TO FRESH (DIFFERENCE BETWEEN FEET FR LI E AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEARE SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LEN( 1~ IDIAMETEH KIRIAL AN ARKING l 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 CIA -PITS LIQUID BED,/TRENCH TRENCHES MRctEHIA~'. PIT DEPTH'. DIMENSIONS GRAVEL DEPTH FILL DEPTH 1111TH PIPF DISTR PIPE DISTR. PIPE MATERIAL ,L . NO. DIS R ROPERTY WELL. UILDIN ENT TO FRESH a BG'. V HE LOW PIPES A801E COVER ELEV INLFi ELEV. END PIP FEET INE AIR INLET ` d, NEAR BFROM L / r j `-I EST y ~ MOUND SYSTEM: F 01 ii;--s) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASUR ❑YES ❑NO / SOIL COVER TEXTURE P MENT M RKERS O EHVA ON WELLS ❑Y S ❑NO YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENC BEU DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES YES ❑ NO YES ❑YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH . NO. OF LATERAL SPACING. GDEPTH 8 LOW PIPF V'ILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS / MANIFOLD PUMP MANIFOLD DISTR. PIPE NIFO LD MATE IAL- NO. DIST DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA.. ELEV.. PIPES. DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY CO ER MAT I A L VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES FIND COMMENTS: PERMANENT MARKERS OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: ❑ YES ❑ NO YES'; ❑ NO NEAREST f 1 ~ t4~~ L ~~.GL `+1a0~ tip .tot- ~ f Sketch System on Ret in in county file for audit. Reverse Side. J d +e ti - E 6 SIGNA_TLAE-- TITLE DILHR SBD 6710 (R. 01/82) L, ` . - wlsconsln APPLICATION FOR SANITARY PERMIT DILHR COUNTY Jd_ (PLB 67) 1EnT OF UNIFORM SANITARY PERMIT # ~ OEPRRTTr - ItlOUSTRV,LR90R 6 HUmRn RELRT10nS - -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER 1 MAILING ADDRESS PROPERTY LOCATION CITY: V GE: C 1 /4 ' w 1/4, S T2 e, N, R E (o06' WN oF:. LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED - ©a l - Le-1 or 2 Family Number of Bedrooms. ~j Public (Specify): THIS PERMIT IS FOR A: 1 New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. E Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ` IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic } Gallons Tanks Concrete Constructed Septic Tank Capacity /7 Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): LJ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sera system shown on the attached plans. Name of Plumber (Print): Signature: MP MPRSW No.: Phone Number: 0-11 Plumber's Address: Name of Designer: % COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 6- 1- 1 Zr i, 7 41 1 ❑ Owner Given Initial ~y J / 7 1 X' Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLLCATION FOR SANITARY PERMIT S `I' C - 100 Thi.s 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 Location of Property 4 L Section T N - R W 'Township ~l- ✓}'/V A, ie/~Y/(~~ _ Milling Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created _ ,/YfQ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume f and Page Number -1- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - PROPERTY OWNER CERTIFICATION I (We) ee,WQ that al statements on this 6onm cute Aue to the best Q my (ou& knowledge; that I (we) am (ahe) the ownuc (s) o6 the pnopvLty dan ibed in this in6onuiiation 6onm, by viQue o6 a waltAanty deed neeonded in the 066ice o6 the County Regis,tw OA Deed as Document No. ; T ; and that 1 (we) pwn e.ntty own the proposed site jon the sewage dinpomt system K A I (we) have obtained an easement, to nun with the above descAbed pnopelcty, ion the cowstnuction o6 said system, and the same has been duty neeonded in the 066ice o6 the County Regi6ten o{I Deed, as Document No. ) . ~ r rn SIGNATURE OF OWNER SIGNATURE OF C OWNER (IF APPLICABLE) 51 DATE SIGNED DATE SIGNED H U) a- S T C - 10 5 rr- y SEPTIC TANK MAINTL;NAN CE ACLI?EMENT r~ C St. Crui_x County G Jr OWNEk/BUYEt: - LOU'I'E/BOX NUMBER Errs Nuinher C; 1 'I' Y / STATE 151-i c, ill tio'cl w'; tT 1. 1 P 1'LUl'ERTY 1, OCAT10N: Sectiuu T N, 1, / j W, TO w n u 1:`Y,iy S L C r u l x Conn L Y, Subd iv Is; iL,n Lut uuniltur I lnipruper tlsc -and maintenance ui your septic system unld result in itrl premature failure to handle wastes. Proper Ill it ini:enaIi cc. coO- slsts ot- putttplni; Out the. septic tank every three years or sooner, if needed, by it 1i-c.ensed sti)tic- tank pumper. What YOU put into the system can aff'oCt the function of the septic tank cts it treat - .uent stage in the waste disposal system. St. Croix County rCSideit ts ❑La_y 1)e o tU rei oive !t f;rant - fur a maxiIll it Ill of 60% of the cost Of repl.acentent Of it lit iI III g systeill , which was in operation prior to July 1, 1978 St. Croix Ci>unty accepted this 1) ro6rit ill iit Au} ust of 1980, with the ret1 it ireIll ettt that Owners of all new _,yatuni: ~ty;ree to keep their systeIli r; pruper_Iy maintained. The property uwucr ;IgI er, t~_,iihillit to St. Croix Cuunty Zortiilg a certification lurut, signed by the owner and by it master plumber, jOurueyniau plumber, restricted plumber or it licensed pumper veri- iyinl; t hat (1.) the on- si.te wastewater disposal system is in 1) rmper Operatlni; condit_foit and (2) alter inspection and 1) uIli1) inl; (i.1 nec - essary), t tie septic tank is less than 1/3 17 u11_ 01- s_iit di;c and scum. Certification form will be Gent approximately 30 days prior to three year expiration. 0 I/WE, the urndersif;ued, hiAVe read Cite above reyuireuteOts and ttErce U Lo inaLntaiu the private sewage disposal system ill aCCUrdauce with the standards set forth, herein, as set by the Wisconsin Depart- :u meat of Natural Resources. Certification furor must be completed and returnee} to the St. Croix County Guniitg Ulfi-ce w i -thin 3 0 days of the three yt'ctr exp}rnL full dale. I S I C N E D 1) ATE St . CT Ol.x Cuunty Zoi>1.n1 01; f LC-(.P.O. Box 98 Hammond, W1 54015 715-796-2231) or 715-425-8363 Si};u, date and return Cu <tbovc nddr~~s~; DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 P.O. BOX 76 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) WNSHIP/ LOC;;TION: SECTION: 7Kinnick LOT NO.: BLK. NO.: SUBDIVISION NAME: NE 1/4SW1/ 14 f T28 N/Itl8 ( W innic - - - COUNTY: OWNER'S- MAILING ADDRESS: St. Croix Walter Howard 9629 Upton Rd. Bloomington, Nn. 55431 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ®Residence 3 N/A ©New ❑Replace 4/17/84 N/A RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL~ffMIEEIJI GROUNDPRESS11ii SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S ❑U Ex ❑U ❑ S x❑U ❑S ©U Conventional Beds 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: Class 2 Floodplain, indicate Floodplain elevation: No P 5h.9 PROFILE DESCRIPTIONS BO G TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 102 101.5 None 7 102 24, dark Bn sl; 78, Bn Is. 2 100 99.6 None 100 18, dark Bn 1; 18, Bn sl; 24, light Bn fine s; B 12, l s; 12, to fs; 16, Bn Is. B- 3 104 98.1 None > 104 24, B1 sl; 80, Bn ls. B- 4 96 95.8 None ) 96 18, B1 sl; 48, Bn ls; 30, Bn sicl; BR. B- 5 102 98.8 None >102 18, Bl sl; 6, Bn sl; 78, Bn Is. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- NONE REQUIRED PER H63,09 )(b) 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 and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 0&01 a1/v,.L Cj /,s SYSTEM ELEVATION '4Lr" V,¢7-E' 74.,6- e TE~EP.yovE vF .T,' BoX IR0N P/Ar 23~ IZ~ \-O 0 NGE c B! • - 80kmq ^/o Lec.ATio v R 3 % 0'r- w . e~ ,~vE O - o e/4i / ti ~L Boo t N 9 321 4 9n y~.o 4L TAR A14 7~C RCD ~ S9a 3S' _ /O' 3s' • Q o ~a~ ° I / SET h ~ -Sill 3 • 7~o S9 ~ 9D N`~ ~ t B 2 7-Of f ° ' ~°/PE ELoE'U, / X02I..DPeo N PIC0 LpISeSE E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WFrCO~APLET~h•OfJ: Walter J. Gregory, Ogden Engineering Co. / 3 ADDRESS: ~CERTIFICAI(UN NUMBER HOUMBER(optionai): 123 E. Elm Street, River Falls,_Wi.- 54022 _ 55-588 1715) 425-7631 CST 51 N I s 1, ,nl O;;,; ;,a, n Job No. 84-1474