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CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042-1051-60-000 Parcel Number 19.29.18.293A1 OWNER NAME: First KENNETH & CHERYL Last WARNKEN PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 927 HWY 12 SECTION 19 TOWN 29N RANGE 18W '/4160 '/440 Line Description Line Description TOTAL ACREAGE 7.630 PLAT LOT BLK 01 SEC 19 T29N R18W 7.63A IN NE 15 02 NW LOT 1 OF CSM VOL 5/1405 16 ORMERLY WN AS LOTS 1 & 2 17 04 OF CSM VOL 3/615 ALSO 1/2 18 05 INT IN PRIVATE 66' RD AS 19 06 SHOWN ON CSM 3/615 (883/616) 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit Form - S 'I' C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER l~ e /J Lk/R 19 Nk ra TOWNSHIP SEC. I `I' N-R W ADDRESS S, I* CROIX COUNTY, WISCONSIN N, SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM + 30 a 3 i Ar 1 s` INDICATE NORTH ARROW i BENCHMARK: Describe the vertical reference poinL used irAP Elevatiop of vertical reference point: J U U Proposed slope at site: SEPTIC T4,NK: Manufacturer: s_e-4 __Liquid. Capacity: Number of rings used: _ U Tank manhole cover elevation: l C>t~, `f Tank [islet elevation: 10s'".7 Tank Outlet Elevation: !JS`, Number of feet from nearest Road: Front,0Side,0 Rear, feet From nearest property line Front,0Side,0Rear,0 feet Numbe-- of feet from: well Vpbuilding: 75 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVF.RS1. SIDE PUMP CHAMBER ` 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, 0 Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include ijistances on plot plan). SOIL ABSORBTT.ON S'r~)iLM Bed: /y Trench: ? Width: } G Length: 1f Number of Lines: J Area Built: Fill depth to top of pipe: _ Number of feet from nearest property line: Front, Side, 0 Rear, 0 Ft Number of feet from well: Number of feet from buiIdinq;: (fncludc di5tanck's on plot plaii). 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, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: a-z Inspector: Dated: Plumber on job: Z:4~ u License Number: 3/84:mj DEPAF FMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABO' & HUMAr' REL•*\TIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969• BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number L:1 Holding Tank El In-Ground Pressure ❑ Mound (I1 assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER. INSPECTION DATE: Ken Watt ken 131 7th St., N. HudIsan, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NE NW, Section 19, T29N-R 18W, Town o4 Wwften, I.at# 1 Name of Plumber. IMP/MPRSW N,, Coumy Sanitary Permit Number: Stephen Aaby 5184 S CnLoix 54943 TRANSFER SEPTIC TANK/HOLDING TANK: MANUFACTURER LIOU D CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER pgyy- PROVIDED: PROVIDED (17 i 1 DYES ❑NO DYES ❑NO BEDDING: VENT DIA ENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. I ENT TO FRESH y p, ALARM. FEET FROM LINE. AIR INLET: DYES NO DYES ❑NO NEAREST DOSING"CHAMBER: MANUFACTURER. [71 GJ LIQUID CMODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: CONTROLS OPERATIONAL NUMBER OF PROPERTY WELBUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) YES ❑NO NEAREST 10 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I FNC;TH JDIAMETER JMATERIAL 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 ILINITH NO OF 1111TI PIPE SPACING COVER P SIUE DIA 'PITS LIQUID NO NCHES. ry1ATERIAL' DEPTH. DIMENSIONS 7 3- GRAVEL DEPTH FILL DEPTH UIST R. PI F DISTR PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BFLOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIPES FEET FROM LINE. AIR INLET: NEAREST--s 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- DYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ❑NC DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH,'BED DEPTH OF TOPSOIL SODDED ISEIDE D MULCHED CENTER EDGES. DYES ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NOOF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL. NO. DISTR. fSTR P IPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVELEVDIAELEVPIPESA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE ❑ YES ❑ NO ❑ YES ❑ NO NEAKE It 0,~ 2 Sketch System on ° Retain in county file for audit. Reverse Side. ~ SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) ~~L~R SANITARY PERMIT 7 COUNTY 1^ r oa, umFrgE SFER/ UNIFORM PERMIT # (PLB 67-T) 4 y< P_RMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: PROPERTY LOCATION: '/a `mss '/4,S/ 'T_% % N,R I (or TOWN 0.412 t ,+'t /mot LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: NEAREST ROAD, LAKE OR LANDMARK: ? 'Z/ PREVIOUS SANITARY PERMIT HOLDER "4NWMff4jkD); SANITARY PERMIT TRANSFERRED TO: NAME: _ SIGNATURE: NAME: PHONE NUMBER: ADDRESS: ` / j PHONE NUMBER: ADDRESS: 1, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLUMBER'S SIGNATURE: A PREVIOUS PLUMBER'S NAME (IF CHANGED): PLUMBER'S A DRESS: /PREVIOUS PLUMBER'S ADDRESS: + ' J G as 1 /Z G f! l41Sr:.., MP/MPRSW NUMBER: PHONE NUMBER: MP/MPRSW NUMBER: PHONE NUMBER: rSIGNWA~TURE O0F ISSUINGAGENT: DATE APPROVED: DISTRIBUTION: Original - County ~ Copy -Bureau of Plumbing 821 Copy - Owner NLI N i i I ~oa / 00o GpL. SgpT G Ta 7 S' 351 - ~Coxxa- Wo sc tL Q3 • $~~c~ l1pnI -GRr _-Lr ST~~L )Za rT- tE 36 © 41 s i 5r Gv s-T S s- Tip y~ ~z - T ~ / Ss' b~l S Tx ~ k_ G )q)7 -rN J~ s r By or3q Sy sT 6' 1 6'' 13' o -I D -I ~ Orv N U) p C 0 COO* Z ° m O z m O m 00 r- -n m x m < ~ n r m 0 O C or ° p r O m 0 O p N u) z o Z D o c ~ W k C M z z < n O m 0 n 0120 r" ? ~ z n O O Z U' m c m s m o a ° o" o Q a m Z d 7 _ ~p -I z 3 < D 2 m s n o m r (n o~ a- oa D ~c = O p H o ~ n < 7 C Q Q°< d 3 o m o m m f „ o o E W =r , ° D 0 rn 3 m m c o am 70 m °:m~ o~ "corr. ~`D p ' 1 " 7 = m save' a~ Jo cn c H O < 0 T o D Om ^3 3 ~a < mm to JlJ j m t'j " m c w fA D o < ' o'm m d a m ~ o Z N d ~ a ~ d ti z ° ct s ~ ° o -i 0- CL a s D 1 0 0 (1-1 D ° y _l 'D d ? F o m 3' c m Q s 3 3 - o C1 c' ° y m m 3 Dd S. -0 s, -Pth 3 0 ' 0 ° co DEPARTMENT OF, INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR 8i HUMAN RELATIONS P .O. SEWAGE SYSTEMS DIVISION .O. BOX 79 MADISON, WI, . 53707 BUREAU OF PLUMBING WrONVENTIONAL ❑ALTERNATIVE [,ate PlanI Number!• a El Holding Tank El In-Ground Pressure El Mound If ssigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Ken Warnken W1, Highway 12, Roberts, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV NE-14 NW4, Section 19, T29N-R18W, Town of Warren - Lot#1 Name of Plumber. MP/MPRSW No Cou~tC Sanitary Permit Number: Robert Ulbricht 3307 oix 549 43 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. PAA ATER NUMBER OF ROAD: PROPERTY W : BUILDING. VENT TO FRESH ALARM FEET FROM LINE'. AIR INLET. EYES ENO ES ENO NEARE ST DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. EYES ENO DYES ENO EYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE IAIR INLET PUMP ON AND OFF) OYES ENO NEAREST BUILDING V SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILFN,(,TH JDIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall cease until L FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING. COVER JINIIIII DIA -PITS ILIOUID TRENCHES MATERIAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLF F ELEV. END PIPES FEET FROM LINE. AIR INLET. NEAREST-----o-MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- E YES ENO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS EYES ENO EYES ENO DEPTH OVER TRENCH RED DEPTH OVER TRENCH. RED DEPTH OF TOPSOIL SODDED SEEDED MIU:1 LCHED. CENTER EDGES. EYES ENO EYES ONO Y ES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. IN OF LATERAL St DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. DIA ELEV.'. PIPES DIA.: ELEVATION AND DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY OVER MATERIAL RRESPONDS TO APPROVED PLANSEYES EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS'. NUMBER OF PROPERTY WELL. BUILDING'. FEET FROM LINE EYES ENO DYES E N O NEAREST- Sketch System on Retain in county file for audit. Reverse Side. T ITLEDILHR SBD 6710 (R. 01/82) [GNATURE Wisconsin APPLICATION FOR SANITARY PERMIT cb-L COUNTY 1~DILHR (PLB 67) !~1 oEPgRTR lEnT OF UNIFORM SANITARY PERMIT # - InOUSTPY, LABOR& HUMRn RELRTIOnS /9 -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 MAILING ADDRESS Aj 130)1 PROPERTY LOCATION c~ 1/4 N41/4, S , T ly N, R If E (or) W TO E. LOT NUMBER BLOCK UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER C S1_1 ~s 11 nor. s lyo w I . / L ti~ TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: NNew System El Tank Replacement L] Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ,N.Seepaye 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity X 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 Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): v jp ~G 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): HOMESITE SEPTIC PLUM ure: RkP/MPRSW No.: phone Number: RT. 3 O'NEIL RD., HUDSON, IS. 54016 C/( SCSL~ /C C ,3 , O (7!f Plumber's Address: ROBERT OWN1011 Name of Designer: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. N. INSTALLER & DESIGNER LIG. NO. 00662 COUNTY/ DEPARTMENT USE ONLY Date: Signature of Issuing Agent: K'/ _tf Disapproved / ❑ Owner Given Initial LA d.*41 v 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 i 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. APPLICATION FOR SANITARY PERMIT S 'I' 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/contractwz,("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 Arc- ~4 AL,' _'>4, Section / i TN - R W Township Mailing Address Subdivision Name Lot Number J i Previous Owner of Property Total Size of Parcel / • 6_ -S 14, Date Parcel was Created Are all corners and lot lines identifiable?- Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number 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) eeAti6y that aU 6tatementz on .th, , 6oA.m ate t)Lue to the bat o6 my (out) know-edge; Aa.t 1 (we) am (ate) the owne.A(s) o6 the pA.opetty desehi.bed in this in6o.,mation ,6oAm, by vi tue o6 a wa vtanty deed AeeoAded in the 066.iee o6 the County Reg(s'teJc o~ Ueedh as Document No, j5 ; and that 1 (we) p4ment,ey oan the pnoposed .bite 6oA the sewage zpdio~syStem (oA 1 (we) have obta,i.ned an easement, to ,tun with t1te above de5c&ibed pAopehty, 6oA the co"t uctioy, o6 said system., and -thw same hay, been duty Aeconded .in the 066ic.e o6 the CounAy RegE6teA o6 Deeds, as Doecunent No. - i Z SIGNATURE -k'& OWNER SIGNA`T'URE F CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r~ < r-1 - Y S "i' C - 105 r ~ SLPT LC TANK MA 1 NTLIN ANCE AI;KLLFiI'.NT 0 St. Cru_ix CO unLy v c1WtJI I\,/ Is U. Y I., i\ tiOlJ'1 1;/ lsUX NUP11sh:1: F i re NuluhL'r Poo 1_~- - - - - - C 1 'I' 1' 11 , RILl _L u't s-l-_1 PIMP1:KTY LOCATION:- /V cl ic,n ~q N, I: Town (.)I t Cr'ctix COMIL Sllbdiv LSiun LOL ultuikul- I Inll,rupur II cl ued Ili aitttuIIIIICI ul vuit r u, LI~ yr;tI,Ili c.uuici r~r:uIL in pru III atI I rc lailur~ Lu It IIkiIc: Wa:;Lc: I',uilur III aiI I Luuanl~ Cull - I gisLs ul 1) LI1111) u}~, 0LIL Lhu su1~LiC La1HK eV Iy LltrC~u yuarS ur r;uu11C1-, it lluud~d 1, a 1 is <u:.~ I .,u L IC tusk lutll L.I tJIIaL yI) LI 1>11 t into L.hu sy:>Luu1 c.IU all CL L11r t IIII luu ut t IIU L iC La1Ik ZL I l:r'Uat- III CIt L. ..L iI 111 Chu Wa., Le d.i 1)0S I1. y.~LI, Ili. St. Croix L:uurlLy rusidellLs way tie uLi1)1c Lu fUCUivu a 1, r:1llt fur a Ilia xi_luIt ill of bU~ ul LIt c curit of re1)LaI:I-u1I•nL of a lcti I iu~', sysicul, witic11 war; iu 01,urLi tiull prior Cu Sul; I 8 St. Croix County accepted tllir> 1,1(Igc Ill iu lkk LlsC 01 1.98 wl11 Litt rL-LIU I-Ili L'nt tltaL uwuur:i ul I now st~uls ruC t.0 kI,I_;> ~It~ i r }'st~-u1~. 1:rupcrl y ua L it L Li l it II,I 1 11 k. p r e 1) u r I- y W 11 u I I l r L I S t I I, Ili I- L L I, l 0 1 X C It It t 11 t 11 : t rtiLLcIL1 11 1u1- w, sLlr111, I,y Llle uwIt I'r 1 11 1! by a Ill '.I LC1 pi11Ili1, j I) Li r11c y ma tt 1) 1u1111)c I- reL.rtc. 1.cd pl u1111)t2C ,>r I liC 11S~•cl l; U Ill pt.•: vuri- fyin} L hat (1) Lh~~ uu-siLC was LewaLer i1:ia~iusaL sysLUUI prupCr u1) aL L I I I'ulld 1 L Lun and it Lur Lliap,-cL i,tu and pump int,, ( i 1 uuc- ~sSary), LII -t c,cpLic LtI11< is 10,t. ttl:iI I 1/ i iull ul LLL dll,I, ,Iitd scum. Certif iCaL ion lurid will- l,u ,1uuL appruxiulatCl_y 30 days prior Lo t11IF c:t2 your cxpiratiun. 1:/WE, tie unclersi.gnud, havt. read thc' cltlovu ruyu-Lrt-lllents and agree' v1 to waint:aiu the private suwuLe di-sposa1, systum in accc>rdaucu with r the StandardS set forth, herein, as set_ by Lite WisCollsiil U0parL- me1:t of NaLLlral- KCSOUrCeS. COI-LifieaLic111 Io['111 west he uIli pleLLd and ruturLit d Lu Lhu St. Croix Cuuuty 'l.uni1 ULtiCe wILi1L11 30 days 01~ the three year UX1) r41 L I I date. S 1 C N L: ll DATE - 0 SL . ( ru.ix County `l.uni111~, Ut l -Lcu 1'.0. Box a 11unlnu ltd, tJL i40L5 11.5-i t) 6-"22 31) or 715-425-8363 Sign, date and ruturn to above addruss. SANITARY PERMIT DIL 1~~HR County T cm GROUNDWATER SURCHARGE WX3U5TRV. Lggpq 6 M NJfi1R11 FEWT10r1S Sanitary Permit No. -1u q 3 On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation c surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground ~Rt~f' Sig a ure of Issuing C, L Age Groundwater Fee: Date: Wisco i x a buried $tx' , DILHR SBD-7289 (N. 05/84) ~i t w_ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN'RELATIONS N LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: NE /a 19 /T ~9 N/R iFE (or) W u~~9~' 'F,v /9- 7 ? . T114--T COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 5 f- MIX s ACV fs(/A / 7V4 5-1• 11ve95-c7,v Chi S . Syo/('~ USE " DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER A SC IPTI R FILE TONS: 1PERCOEATION ? TESTS: 1 Residence New ❑ Replace 6L T • 2 o / ,e/ OC / • 2--2-1%211 RATING: S= Site suitable for system U=S Y. suiQa;fo vlS st 1CONVENTIONA S ❑ L: IMOUND: ®u IN-G 0.P~~j~OFf STEM-INFI LHO❑LDING®NK: RECOMMENDED SYSTEM: (optional) U S u S S U O v dE-coT"~9,4l a L- S ."T SYST ~ If Percolation Tests are NOT required DESI ,i 1 I If any portion of the lot is in the FS under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /K3 PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 2- /0 FT 7/2Z s4- , /a" r N. 54, y • L-1 13A.J. C S, fI N !r/ 6A-) - S B- Z 120 /o/, y es w ' „ ~ - /s/., to B IOD. l / - .,e.,U . e-&-4,y, 2/ " L f3N • y" o.P..SL, 6O " '04 C B y/j ! L/ F %g 4 lS L .C3.a . L oiP. s, 5-y ISO J ~6~CQ 'w' O 7r ~1~•. (3~ Si- , h PA Qy. L~ uJ/ Q . B " - /3IJ . G' a IQ B- 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 2 PERT D 3 PER INCH gI1.L, P-0 2, P- P_ (.o > > i P- > > r P-- 9 PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- W 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 slop. OorPo.M of 13t,D T'v 4'r /,EUAT/o.) of Y6. U FT. SYSTEM ELEVATION °Ri <~xacjcY y rT ~elaw""~ \ NAKED OO" IOT£ 6tJE// MJSi / Piles "bm TE5r fl i • _ ~p L Z- _ ' Ir-I U7 Pax. X_PZ~~ t M . P3 a~` 11~P%~AL Aeim'E'dcEp ~e V~ , (7ro pC~/,JT i S >l.e,Pmv~vD 'Z5 19 7 -:43E o of 0' r pR • l .10 I /a o FTC `t • g ~XGAIOAT/Ns /(,DOTE" FT. F 10P16i L Ta - o of SePTic SIT . • /3 t C v ~ f7F w c NoR~i•t. Ed2 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures me hods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. L~UE NAME (print): TESTS WERE COMPLETED ON: Poke Zf14,1'6h7(9-' T 2Z /yR/ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST SIGNATURE: page-Property Owner, 4th page-Soil Tester. PLE3 ~7 PLOT and . FIANS T➢0 /e4t f i i 5D /jypf -5 pTic T 1 r~ 6 r? 1 6 soil j/33 Mar k To 314 S~`E G ` ,~osd J~E-67 - '19 T pfVA7 0 ~O AfFA 141 I ~ X 5 3" 'tf S ~ GNeD yi Fresh Air 1nlafis And Observatio In Pipe SOIL. -rp-sn.55 Qy ~ q HOMESITE TESTING Vent Cap u'CJc:~l. d2C~ s Approved RT.-3, HUDSON, Wis. 1-14016 Minimum 12" Above Final Grade Above Pipe a~~ Vent Pipe o Final Grade / 5 Marsh Hay 4~ i _ erin FT Min. 21I Aggregate 16.0 Over Pipe Distribution Tee pipe ® 0 0 0 0 Aggregate ® Perforated Pipe Below Beneath Pipe ® Coupling Terminating At B.-ilorn Of Sysion) ,iv,~uSlhfY, REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISION !-ABCJLR P.O. BOX 76 HUMAN REDLATIONS' PERCOLATION TESTS (115) MADISON WI 3707 L0C,A'r10N: f;t,'i SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: N ~ /T N/R t E COUNTY: Oy~S BUYER'S NAME: MAILING ADDRESS: 'a ~ . if , ~ . n ~ - L 6'U~~~ iS%F~-~` J x -i r ~ 1 _ f ~'/i,",L"'~•":- ~ fi ~ ~t.> t`.)f ,,a USE DATES OBSERVATIONS MADE r~•~ NO. BEDRNIS.: COMMERCIAL DESCRIPTIO PROFILE TONS: PERCOLATION TESTS: I Residence 3 ~IVew ❑Replace ( 6e. 7 7 G) ~C,'' "IJ , T 22-1 RATING: S= Site suitable for system U= Site unsuitable for system CSYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑S ❑U ❑S ❑U ❑S ❑U/'.U If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL 'x If any portion of the lot is in the _t under s.H63.09(5) (b), indicate: ( Floodplain, indicate Floodplain elevation: r~ z PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF RVED (SEE ABBRV. ON BACK.) f F7 c 1 46~• S~ f f,?PL t, r r~. 5 1 i,f. C' S L^ / a3 ' )mot L•/. fS..IJ , f';~ rzr"L,, pf(} . 04 p,~ ~y,i L Il C .ZZ B i ti ~D f .'z7h• 7 ts' cu a . f ^ 4 '0 f' cE.1 ~r; ` I u, 1 'IGt~' ~ ~ ~C~•y>...~. "~C f ,~..•~v/ L~~ 1 ~ p .c ju • 2 . ~ d G: , L B- 5 B LJ F11 9 rr j r (n <'n/1. i3~1. L j J otv. _5 % B- Z B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWEiLLING INTERVAL-MIN. PERIOD 1 PER D2 PERIOD 3- 1 PER,INCH P- e - P- P- P_ y T r t: to PLAN VIEW: 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 aj II boringsend the direction and percent h of land slop. !?C'T J!1M /I 7' /E U,r3710A) C/ j , . ® r SYSTEM ELEVATION _ , t - ~ ~ 1 ~ ~ . I x ~ i ~ irs~'t -s ~ 1 hJof,E ~f ~lP 14-1 % ~ ~ T1~ ~ ~ ~ ~ ~ ~ ~ f ~ ~ I I f r ~ ~ Sr ~ f 40 L1_~ 0 4- j- - f t A,4 r I , _ _a 4 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge,and~bel~ef- A I/ J(' ` A NAME (print : ! TESTS WERE PLET, +r~.F U/i~/4~J / EC~~ Ofd: f. ADDRESS)1• CERTIFICATIQN;NUMBER: 0 H01 NE;NUN4B~FRt6~tional): CST SIGNATUgJE: ! XaDISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHRSBD-6395 (N. 03/81)