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HomeMy WebLinkAbout038-1164-10-000 B v CD •D 3 at a~ O co z z I o rn cn o oW 1 J v o o m y v • CD CL m N W a CO 0) w LI). o Z) r -4 n 0- :3 CD O OD , (D CD 43 a Ooo 7 N D O O C CD p w z D m A F5 (n D a T1 c 3 0 < O 8 m C] cn U) E i o o f O W O a a` ' z CO CD r- ((D d o co co ol m O v_ 3 (D rd ti CrJ (D to r \ o m "wA r'~ rt o z O O O CCD • O r• t p o in ~f Cn C" C' ~ Z o ~ o D _0 A _ ~1 x O ~ N N !V 7-~ f9D A (D W J ~ 0 N oN Q CD m n_ N ~ rD - a 3 N Z O D D a o O T 1 N Z \ F- N I n V] H Z C 01) rt rt w Lx7 w m (D W - ° (o -1 (n CA Cn ` Z ~ p Z rD r-P I CrJ F O n c .n. C b 7y r• A z 7 CL N W oo ~ y r• rt C W~ m w o (D oo r0 Z rrt ra 3 ccn o w H Z o 0° r"' S ~ T 97 C z a o CD A. m 4. O n c zz- z 0 N O O R 0 O CCD ~0 N m cn O a o c~D °o a a ST. CROIX COUNTY WISCONSIN ~u ZONING OFFICE 796-2239 (HAMMOND) loss; - 425-8363 (RIVER FALLS) HAMMOND, WI 54015 January 13, 1986 Michael E. Wilson R. R. 4, Box 183D Amery, WI 54001 Dear Mike: We have been holding the Sanitary Inspection Sheet for the following system (s) : Lynn K. Wandel - Town of Star Prairie, Lot#ll, Crestview Add. Please turn the As-Built into this office as soon as possible, so that we may complete our file. Until such time as all As-Builts are received by the Zoning Office, no further permits will be issued, or inspections made. If you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj :1/86 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS L.Ik;O,A & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, X11 53707 state Plan LD Number c In CONVENTIONAL El ALTERNATIVE (If assigned) D Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER'. INSPECTION D E. Lynn K. Wandel Somerset, WI J BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. E EV.: CST REF. PT. ELEV. NE SE, Sec. 30, T31N-R18W, Town of Star Prairie, Lot#ll, Crestiview Add. Name of PI urn Fer' MP/MPRSW No. County. Sanitary Permit Number_ Micahel Wilson 6388 St. Croix 54993 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED. EYES ENO EYES ENO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL'. BUILDING-. jVENTTOFRESH ALARM. FEET FROM LINE: AIR INLET'. DYES ENO DYES ENO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI TY PUMP MODEL JPUMP,SIIHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. EYES ENO OYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BU ILDLNG.I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I FNC;TII DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF DISTR. PIPE SPACING COVER INSIDE 1114 ¢PITS LIQUID TRENCHES MATERIAL'. PIT DEPTH. DIMENSIONS GRAVEL DEPTH I-ILL DEPTH DISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO DTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH HE LOW PIP -S. I ABOVE COVEJ~ ELEV. INLET ELEV. END PIPE LINE. AIR INLET. q. 2~ ? NEAR ESTO--► 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- EYES E meets the criteria for medium sand. TION.S MEASURED. NO SOIL COVER TEXTURE PERMANENT MARKERS S ERVATION WELLS DYES ENO EYES ENO IR DEPTH OVER THENCH'BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED MU LCHED CENTER EDGES. EYES ENO EYES ENO OYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. CIA ELEV.' PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. EYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL'. BUILDING: FEET FROM LINE. OYES ENO OYES ENO NEAREST 30. Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TIT LE. DI LHR SBD 6710 (R.-011/82) F1r1O consin APP LICATION FOR SANITARY PERMIT DILHR COUNTY (PLB 67) UNIFORM SANITARY PERMIT # FIRTTT1EnT OF USTRV,LRBOR6NUTGin RELRTIOns -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS L AC L- ,,r, - L 4d -.e cT f c S O 2 T PRO RTY LOCATION CITY: VILLAGE: sv~ 1 /4 SE 1/4, S Ts j, N, R /!i° E (or)dT LOT NUMBER IBLOCKINUMBER SUBDIVISION NAME , LAKE OR LANDMARK STATE PLAN I.D. NUMBER / / vv * G Udd . sv TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: L/ ❑ Public (Specify): L~~'sf THIS PERMIT IS FOR A: 9- New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity tya ✓ Lift Pump Tank/Siphon Chamber s-0 Holding Tank capacity "/110 Manufacturer: L./c r S L' - l e /i"CdI AWC1"J' IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): a-~ /,2 4 c) /S-00 X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: PRSW No.: Phone ~Nlumber: i'c= 1iy 4 C./76M J ke (ab yl -a-t- 3 7 Plumber's Address: Name of Designer: /f V /Jau ~Y3 Q 04ft a L✓ '.r c 5"5/09d /Z_'/'_,40 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial 44ytl 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 F 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. H tll- U] 7 - ~ y ` r S T C - 105 r y H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County d OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/ STATE _`MP1= Z 11, PROPERTY LOCATION:'JL `4, S(=- %4, Section 3G~ `1' N, R W, Town of sAm.~('U1(` St. Croix County, S u b d i v i s i o n(- fe j~~~ ~CKJIC~l~l7 Lot numb e I 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 punier. 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 tor 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. W yo I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x r-, the standards set forth, herein, as set by the Wisconsin Depart- 'd ment 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. j" ,1111 SIGNED K7 7 ZL~/ ~XVI DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 1I k, (oi~~lC~lc(~ Location of Property /liE Section , T N - R W Township T 21 k` Slitan Mailing Address ; D X / q Cfi' S~6yrer ~e%. w~ J~. Sr/D 1 Subdivision Name C ire S]- Lot Number ~I Previous Owner of Property _~~S j~ y' tf ~~lCt I~ Tel Total Size of Parcel A CI t S Date. Parcel was Created Are all corners and lot lines identifiable? y~ 5 Yes No y~ Is this property being developed for resale (spec house) ? YesNo Volume q7 and Page Number SOL- 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 1 (We) eetti,Ay that a(t otatementA on this loom cute cue to the best of my (out) knowkedge; that I (we) am (ante) the ownel(A) of the pnopetty deActibed in thin igonma t%on. Aosm, by viktue of a watmanty deed seconded in the Office of the County Register of Dee.A as Doeumo No. and that 1 (we) pn et en tY y own the proposed site A ox the sewage MpoA at 6 ymem (on 1 (we) have obtained an easement, to nun with. the above deseoibed psopesty, An the constsuction of said system, and the name has been duty seconded in the Office o{ the County Regi6ten of Deeds, as Document No. 1 SIGNATA E OF OWNER SIGNATURE F CO-OWNER (IF APPLICABLE) 6 1 /f' DATE SIGNED DATE SIGNED WISCONSIN REAL ESTATE TRANSFER RETURN Wisconsin Department of Revenue r,RANTdR: GRANTEE: Z+ , Name ''L's ? . i ~ Name LYnn K. Mandel Social Security Number (Voluntary) I I Social Security Number (Voluntary) Full Address - New address if property transferred was residence Full Address € : 1 'low I" Route I 3nx 1490 >omcrsrrt s 'Q1 54025 Sorncr;et, %'I 54025 Is grantor related to grantee? Relationship includes, Name and address to which tax bills should be sent if not the same as above marriage, blood relative, partner, lessee-lessor, co-owner, parent corporation or joint owner. ❑ Yes E~No Grantee is ❑ Individual ❑ Partnership ❑ Corporation ❑ Other Telephone: Grantor ( 71.`) 4 - '37'97 Telephone: Grantee ( 7151) 247 - j165 PART I - PROPERTY TRANSFERRED Check proper box and enter name of municipality and county Street address of property transferred include road name and/or fire number. ❑City ❑Village 0Town of: Star PvilrlY= ~31,ts I County of: p~ar t. =ro.i.x Star Prairie VII 54025 Legal Description (Fill in complete legal description in space below or if metes and bounds description attach 3 copies of it as shown on the instrument of conveyance. If certified survey map number is used in description list town, range, section and acres.) Lot No........... Blk No........... Section........... Town Range Plat Name...-.......................................................................................................... I Property Parcel Number I-ot Eleven (11), Crestvield Addition, located in the SO of the SEt, the NWI of the SE}, and the NE* of the SE} of Section Thirty (30), Township Thirty-One (312 North, Range Eighteen (18) West. I PART II - PHYSICAL DESCRIPTION AND INTENDED USE 1. Kind of Property b. Residential Units, if any 2. Principal Intended Use 3. Land Area and Type Estimated a. n Land Only ❑ One Family a. [N Residential d. ❑ Agricultural a. Lot size 80 x 3J~'0Irr ❑ ❑ New Construction ❑ 2 and 3 units b. ❑ Commercial e. ❑ Recreational b. Total Acres ❑ ❑ Building Previously Used ❑ 4 or more units c. ❑ Industrial f. ❑ Other (Explain) 1. Tillable Acres ❑ Solar Design c. ❑ Rental 2. W.T.L. Acres ❑ Earth Sheltered Home 3. F.C. Acres ❑ Condominium c. Ft. of Water Frontage ❑ PART III -TRANSFER (Ans as many as apply) 1. [N Sale 2. ❑ Gift 3.15 Exchange 4. ❑ Deed in satisfaction of land contract - What was the date of the original land contract? 5. ❑ Other transfers (Explain below) 6. Ownership interest transferred ❑ Full ❑ Other (Explain below) 7. What is the amount of mortgage assumed by grantee? $ 8. Does the grantor retain any of the following rights: ❑ Life estate ❑ Easement ❑ None PART IV - COMPUTATION OF FEE OR STATEMENT OF EXEMPTION {"f. Total value of REAL ESTATE transferred (purchase price, etc. rounded to next even hundred. Do not include personal property) $ 2. Value of personal property transferred but excluded from line 1 . . . . . . . . . . . . $ 3. Value of tax exempt property (solar, wind, waste treatment, mfg. M&E, other) included in line 1 $ 4. TRANSFER EXEMPTION NUMBER if exempt for Reasons 1-13 (see instruction). . . . Sec. 77.25. ( i 5. Fee - thirty cents per one hundred dollars of value (line 1 times .003) (Make check payable to Register of Deeds) . . $ PART V -CERTIFICATION The transfer must be reported regardless of the Grantor's state of residence. Information on this return will be used to administer Wisconsin Income and Franchise Tax Laws. Disclosure of the social security number is voluntary. We declare under penalty of law, that this return (Including any accompanying schedule) has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Signature of Grantor or Agent Date Print or Type Agent's Name SIGN 3u1 3i 1984 Lester H. Martell HERE Signature of Grantee or Agent Date Print or Type Agent's Name Aurymt 1,198 n K. W andel Document No. Vol. (Reel) Page (Image) Date Recorded Date and Kind of Conveyance LEAVE 395290 693 514 8/1/84 8/1/84 W.D. THIS Parcel Number 19 19 Code: County Tax District Assm't Dist A REA L L BLANK I. 1 1 Office 2 Field 3 Use 4 Reject A B C D E F T T Ratio Consideration PE-500 (R. 11-81) School District No. PROPERTY OWNERS COPY INSTRUCTION A c nipi, t aetuan is r6quiied for all cu,aveyar:ces of passa3e u! (}w.rs. Ehip interests in :wtal38"n'dt , all parts of this form intact to the Register of Deeds with the instrument of conveyance. If -'a Cf pa, api ~ to Ppgister of Heeds, GRANTOR: Usually the former owner of the property, (Seller if property transferred by Salo: GRANTEE: The new owner of the property (the purchaser when property transferred by Sala, Indicate whether or not grantor and grantee are related by blood, marriage, lessee-lessor, co-owner, parent corporation or joint owner, Eater the name and address to which tax bills are to be sent. PART I - PROPERTY TRANSFERRER Enter the name of the county and the municipality in which the transferred property is located and check whether it is a city, village, or town. Enter the street address of the property transferred. If rural property, give the fire number if known, The legal description is the legally accepted statement which identifies the location and boundaries of this property and can be found on the instrument of con- veyance (deed, etc,). Enter the full legal description or attach three copies of the legal description as it appears on the instrument of conveyance to the front of this form, Also enter the town, range and section in which property is located. Enter the property parcel number opposite the space provided. The number can most readily be obtained from the property tax bill at the time taxes are ascertained for proration purposes. PART II • PHYSICAL DESCRIPTION AND INTENDED USE OF PROPERTY Item 1a: Check all boxes that best describe property. One box must be checked. Item 1b. Check only one box, (If "Land Only°" is checked in 1.e. omit this item.) Item 1c: Check if property is to be rented. If non-rental leave blank. Item 2: Check only one box which best describes intended use, If (2a) is checked answer (1b). If (f,) is checked please explain. Item 3a: Enter lot size. If unknown, enter estimated size and check box. Item 3b: Enter total acres, If unknown, enter estimated total acreage and check box. Item 3b I: Enter number of tillable acres, if none leave blank, Item 3b2: Enter number of acres under woodland tax contract, if none leave blank, Item 3b3: Enter number of acres under forest crop contract, if none leave blank, Item 3c: Enter number of feet of water frontage. If unknown, enter estimated footage and check box. If none leave blank. Note: Owners of forest cropland are required by lave to notify the Department of Natural Resources of transfer of ownership. PART III - TRANSFER Check the appropriate boxes (1 through 8) to show how the property was acquired, i.e., by Sale, Gift, or Exchange and what property interests were retained or transferred. If (4) is checked L.C. date must be entered. If Other (5 or 6) is checked, please explain in space provided. In (7) shove the amount of mortgage assumed by the buyer, if none leave blank. PART IV - COMPUTATION O FEE On Line 1 enter the full actual consideration paid or to be paid (rounded to the next even hundred) for Real Estate inclu- ding the amount of any lien or liens thereon, DO NOT include consideration for personal property such as household furniture, farm machinery, boats, etc. In case of a Gift, nominal consideration or Exchange of property, enter the estimated current fair market value (the price which could ordinarily be obtained for the property at a sale in an open market between a willing buyer and willing seller), On Line 1 if the value does not end in even hundreds (i.e. $11,520) for computational purposes round to next even hundred (i.e., $11,600). On Line 2 show the value of personal property purchased but excluded from Line 1. On Line 3 show the value of real estate included in Line 1 but exempt from property tax. On Line 4 enter Transfer Exemption Number (1.13) if this transfer is exempt, See Exemptions Below, Also, if this is an original land contract (no fee is imposed) enter the words "Original L.C." on this line and state value on line 1. Also state value on line 1 for Exemption No. 8. On line 5 enter the amount of fee if none of the exemptions apply to the transfer. The fee is based upon a rate of 301 per $1001 on Line t Fees for deeds exe- cuted in fulfillment of an original land contract dated: Prior to Dec. 17, 1971 No Fee Dec. 17, 1971 - Aug. 31, 1981 101 per $100 Sept. 1, 1981 or thereafter 301 per $100 PART V • CERTIFICATION The transfer must be reported regardless of the grantor's state of residence. Information on this return will be used to administer Wisconsin income tax laws. Disclosure of social security number is voluntary. SECTION 77.25 • EXEMPTIONS FROM FEE The fees imposed by this subchapter do not apply to a conveyance: (1) Prior to the effective date of this subchapter (October 1, 1969). (2) To the United States or to this state or to any instrumentality, agency or, subdivision of either, (3) Which, executed for nominal, inadequate, or no consideration, confirms, corrects or reforms a conveyance previously recorded, (4) On sale for delinquent taxes or assessments. (5) On partition. (6) Pursuant to mergers of corporations. (7) By a subsidiary corporation to its parent for no consideration, nominal consideration or in sale consideration or cancellation, surrender or transfer of capital stock between parent and subsidiary corporation. (B) Between husband and wife or parent and child for nominal or no consideration, Between agent and principal or trustee and beneficiary without actual consideration. (10) Solely in order to provide or release security for a debt or obligation except as required by s. 7712(2)(b). (11) By will, descent or survivorship. (12) Pursuant to or in lieu of condemnation. (13) Of real estate having a value of $100 or less. • ID =r o 3 O (D O - ~ O~Q•3 Cp tD ~,~O C° 3 cc co o D (,rr C 3 O Z O ~ M a (D cD O - CD ca a 00 woc CD'cm o. -O m cn w s M• CD o ~ co c~ 3 a o~°co o CO 0M,.. coCD oco > > O• O O = O SD p < LC ¢«c %G -w n 3 c o C _3oao Q ~ ? cD o w w N „s w wD cn - C a m M M I (D -N NEW O w N OD D CD w M C"P.* N Q O 0-0 A CD 0 O C Co C G) C co W M O a N M co M Q w F - N C V1 0 w cn Z (D o ~ ' r M N w w CD g New N0)= Z ENO 3~o~DSa a M n ~ CA -1 N+O CL ,mow.?C O Q Co O 0 w N a S a co U) acf cD~ C rn viw =r o N o w w - CD m 3 ~ o mac? oN C~ O °-co - .c 0 = c co Q o o - - cD M O C C cn ~ w - w 0. c Q o c rn CL 0 cn c c a 00 w cD • ~ cp cn ~ ID =r Q c •,(a0 coo o~C oyo a 0 O C co W m (D c 0 (w CL 0 0 CL =r 0•c3 O~cDO°3 m d O O CID 1 O C) J DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO. [SUBDIVISION NAME: 1/4~~/4 30 /T 3I N/R/S E for Sra v rya r e 1A/A eal COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: T. C r r L l `t o n USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCI,~L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ,Residence LJ ®New ❑Replace e. - ) rI l~ RATING: S= Site suitable for system U= Site unsuitable for system V ( / CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) 8-Q-0 3ox-sv If Percolation Tests are NOT re uired DESIGN RATE: Q If any portion of the tested area is in the n under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /]~Y/ Su.~ac PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION E ST. HIGHEST TO BEDROCK IF OB ERVED (SEE ABBRV. ON BACK.) 11 (J'4 ry r, B- ) /70Y1 7 C 7[~ -C 3 r 6,. 4 s~ fir B- -7, (1 ;Fl 7 :7 Z / 7@Ser 7_ 'C°[, 7T /Oal,~ ;~1 ^ {•(~.r(.t/7, ,..nr4:'n L B- U I•F 7 7 g CrGr j t%~'.v.,,.~~ rf.,f(~~ ,'•x / ~ . /,l'7 c _'fn~So./ LY6.c 1.:-Z; L7drm~f7-fs••~l B- ~7 C / / G'[CT~a,[ L33 /C~4rtni,., aCf6<Cosir7 x.(07 r~~FLr.~i'fc4r B- ~.t! 77•C/Z ' }f. c nd f ~fiSrr ntr«ial B- C° &Col C, 0 /9 0 F ; l PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PER OD2 PERIOD PER INCH P- a n 0 P- 3 Los, e! / _30 d t:~_ P P_ 2-- 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, mss`. pp• 7 ' .f1C,co. 'l I i_ . G T-_ . ) ~ IJo sY rn. I I q 1] I©6' i i I I ?i 981 / j za' P~-: 3 10 163~ V-0 _T- ,3 Y 1 X617 E o.~ ! 9~,s _ , 1 q ~c 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. i NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): nR ~f C"!Ak7 wL, C:)-' 34/01 l-6(. 2 7 CST SIGNATURE: 1N: Original and one copy to Local Authority, Property Owner and Soil Tester. / 15 (R. 02/82) - OVER - T D H HEAD CAPACITY CURVE Ch W W LL 100 TOTAL DYNAMIC HEAD/CAPACRY PER MINUTE 30 EFFLUENT AND DEWATERING 95 SERIES 53-55-57-59111 97 137.139 163 165 FT M GAL LTRS GAL LTRS GAL LTRS GAL LTRS GAL LTRS 28 5. 1.52 43 163 65 248 104 394 61 231 - 81 231 90 EFFLUENT AND DEWATERING 10 105 34 129 57 216 79 300 61 231 61 231 15 4.57 19 72 43 163 64 242 60 227 60 227 26 85 SEWAGE AND DEWATERING 20 6.10 27 104 36 136 59 223 60 227 25 7.62 8 30 57 216 59 223 ` 30 9.14 55 206 58 220 24 80 % 40 12.19 46 172 55 206 \ 50 15.24 - 33 125 51 191 75 80 18.29 15 57 43 161 22 70 21,34 30 114 \ 14 53 \ 80 24.38 70 Lock Valve 9' 24.5' 26' 66' 8T MODEL\\ MODEL 20 163 ` 1165 TOTAL DYNAMIC HEADICAPACITY PER MINUTE 65 \ SEWAGE AND DEWATERING ` SERIES 267 268 282 284 293 FT m GAL LTRS GAL' LTRS GAL LTRS GAL LTRS GAL LTRS 18 5 1.52 106 408 102 386 1 492 1 681 \ 10 3.05 60 227 72 273 9 360 15 598 55 \ 15 4.57 20 76 43 163 238 13 511 16 \ 20 6.10 6 30 125 1 401 50 \ 25 7.62 7 288 ` 30 9.14 163 77 292 14 \ 35 10.67 60 227 45 \ 1 40 12.19 46 174 13.72 28 106 45 12 40 ► 15.24 12 45 so MODEL Lock Valve: 18' 21' 26' 35' 53' 10 35 ` 293- 30 MODELS 8 25 137 139 6 20 MODEL 284 4 15 MODEL MODEL 282 10 268 \ 2 MODELS 5 53,551 MODEL MODEL 0 57, 59 97 267 U S. GALS. 10 20 30 40 50 60 70 80 90 100 110 120 30 140 150 160 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . Box 16347 O Louisville, Kentucky 40216 ' (5502) 778-2731 QUAL/TY PUMPS ~NCE 1939 b I C t b f7 tl^ S H U S i- T i e o p 1j -r i s ~ S t A 3 a ~ Pp cq .77 loc. ? n - r rn 0 7JI n `I f I s K~ N I r. ~ S S r r O s f- K T r cam' ^ J n ^ J •b 0' c i Ca R O L s ~ z to ti Ir I r e 1 f ~ C A s v, a T > l `d ..1 C v r a b n c 14 y Q s ~ r L ~ S ill n v N ii ,D 1~,, ti h 2. `s ? CA n K \ h ► v ' R to 4 S n Vii L~ v 2 .y