HomeMy WebLinkAbout010-1078-20-020
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State of Wisconsin \ Department of Industry, Labor and Human Relations
t :a i + '7 t8 SAFETY & BUILDINGS DIVISION
10 CO 0
A
201 East wash i n*'to n
P.O. Box 7969
4495 wisconsirt
042
iY . t"iC)IB Ise}'-p*r> rP s, F
CS Dt 4ei.~3t...3 { A, tr
C- Hi l lerest ,tl`=_-+'c G Y
t;..~~L'~}~ ~ Yak: i,I~.N: C
;3(Jt'!G3y .•i„q immix
t ertiative System
01
St. Croi
cg's'' returning the plans submitted for c:t'n-Jll oiial
ff2r t 1t't tf i# 3t 5 k "M9"`si $ t+,.?t S =v fit. c1+i '-si
e f l ut,,nt, If extra peoPl e- are a L!cd t thf~ system, it. could result In instant
i _ ou haw, i1#t's" f?t3f?~~t,.7~} }ti:, c". 00i c;'`a;je3nq r~etl free u contcket
i5 'c'sffic .
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,.<t i~+} 1 C. i? 'iJLZA St.
DILHR-SBD-6423 (N. 04/81)
Parcel 010-1078-10-000 12/30/2005 11:47 AM
PAGE 1 OF 1
Alt. Parcel 32.30.16.474 010 - TOWN OF EMERALD
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 - LUNDEEN, ANNA G
ANNA G LUNDEEN
1217 220TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 32 T30N R16W 40A NW SW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
32-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1224/261 TI
07/23/1997 1158/361 WD
07/23/1997 962/629
2005 SUMMARY Bill Fair Market Value: Assessed with:
80551 Use Value Assessment
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 39.000 6,900 0 6,900 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2005:
General Property 40.000 7,000 0 7,000
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 7,000 0 7,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROI X COUNTY
- rs
'Zen
WI SC0 N S I N
Ip / _ ZONING OFFICE
3..,
of~~ `9796-2239 (HAMMOND)
x,25-8363 (R I V E R F A L LS)
HAMMOND, WI 54015
Q U A R T E R L Y P U M P I N G REPORT
ST. CROIX COUNTY
NAME : RETURN COMPLETED FORM TO:
7
ADDRESS: ST. CROIX COUNTY ZONING OFFICE .
P. 0. BOX 98
t.J HAMMOND, WI 54015
715-796-2239 or 715-425-8363
TOWNSHIP:
PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
BY ECEIPTS FROM YOUR PUMPER
NAME OF PUMPER: C lam" i'
r-
LOCATION OF DISPOSAL SITE:
NUMBER OF PERSONS LIVING IN RESIDENCE:
USE: YEAR ROUND k. SEASONAL (CHECK ONE)
OCTOBER NOVEMBER DECEMBER
DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED
THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1986.
OWNERS SIGNATURE
mj :12-83
STATEMENT
• e ;iuid Waste Pumped DATE
Rt. 1 Box 178A
NIN, WISCONSIN 5-
TERMS:
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $
CHARGES I CREDITS I BALANCE
DATE INVOICE NUMBER /DESCRIPTION
BALANCE FORWARD
11-1
.
17
((-•J , PAY LAST AMOUNT
IN THIS COLUMN
STATEMENT
` quid Wastes Purm
Rt. -1 Bt-" < . , DATE
TERMS:
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE
DATE ( INVOICE NUMBER / DESCRIPTION CHARGES I CREDITS 1 BALANCE
BALANCE FORWARD
.
I
i
I
f&Ul PAY LAST AMOUNT
IN THIS COLUMN
r
ST. CROI X COUNTY
WI SC0 N S I N
®C ZONING OFFICE
o~syy~ j 796-2239 (HAMMOND)
ce)
425-8363 (RIVER FALLS)
HAMMOND, W 154015
`
U A R T E R L Y P U M P I N G R E P O R T
ST. C R 0 1 X COUNTY
` l
NAME'? RETURN COMPLETED FORM TO:
ADDRESS ST. CROIX COUNTY ZONING OFFICE
P.O. BOX 98
HAMMOND, WI 54015
715-796-2239 an. 715-425-8363
1.
TOWNSHIP
PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
BY RECEI FROM VOWR PUMPER:
NAME OF PUMPER: l~ r k e',S
LOCATION OF DISPOSAL SITE: lt~l~~ ~'7 t'L' Sr-c Sys
NUMBER OF PERSONS LIVING IN RESIDENCE:
USE: YEAR ROUND SEASONAL (CHECK ONE)
JULY AUGUST SEPTEMBER
DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED
THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1985.
OWNERS SIGNATURE" C ~
STATEMENI
LICKNESS CESSPOOL SERVICE
Liquid Waste Pumped DATE
Rt. 1 Box 178A
BALDWIN, WISCONSIN 54002
(715) 684-3730
TERMS: $
PLEASE DETACH AND RETURN WITH YOUR REM Tl ANCE
I
I
DATE INVOICE NUMBER 7 DESCRIPTION CHARGES CREDITS BALANCE
BALANCE FORWARD
.
-rte
4
PAY LAST AMOUNT
IN THIS COLUMN
LICKNESS CESSPOOL SERVICE
STATEMEN-i
LICKNESS CESSPOOL SERVICE
DATE
Liquid Waste Pumped
Rt. 1 Box 178A
BALDWIN, WISCONSIN 54002
(715) 684-3730
TERMS I
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE CREDITS BALANCE
I CHARGES
I INVOICE NUMBER / DESCRIPTION
DATE
BALANCE FORWARD
" •i
- f .
.
PAY N THIS COLUMN
LICKNESS CESSPOOL SERVICE -
a
ST. CROI X COUNTY
W I S C O N S I N
.v`~ .rzr - ?2-fY 3 l'
ZONING OFFICE
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
Q U A R T E R L Y P U M P I N G R E P O R T
ST. CROIX COUNTY
NAME RETURN COMPLETED FORM TO:
J
ADDRESS ST. CROIX COUNTY ZONING OFFICE
P.O. SOX 98
-%r; HAMMOND, UPI 54015
715-796-2239 an 715-425-8363
TOWNSHIP
PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
BY RECEIPTS FROM YOUR PUMPER:
NAME OF PUMPER: l
LOCATION OF DISPOSAL SITE: r/ %i"%
NUMBER OF PERSONS LIVING IN RESIDENCE: 5
USE: YEAR ROUND SEASONAL (CHECK ONE)
APRIL MAY JUNE
DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED
THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985
OWNERS SIGNATURE -
STATEMENT
LIC'KNESS CESSPOOL SERVICE
Liquid Waste Pumped DATE
Rt. 1 Box 178A
BALDWIN, WISCONSIN 54002
(715) 684-3730
1 ,
TERMS:
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE
I I
I
DATE INVOICE NUMBER /DESCRIPTION I CHARGES CREDITS BALANCE
BALANCE FORWARD
`267 CPO
_
PAY LAST AMOUNT
IN THIS COLUMN
LICKNESS CESSPOOL SERVICE VV
STATEMENT
LIEKNESS CESSPOOL SERVICE
Liquid Waste Pumped DATE
Rt. 1 Box 178A
BALDWIN, WISCONSIN 54002
(715) 684-3730
TERMS:
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $
I CHARGES CREDITS I BALANCE
DATE INVOICE NUMBER /DESCRIPTION
BALANCE FORWARD
PAY LAST AMOUNT
~J IN THIS COLUMN
LICKNESS CESSPOOL SERVICE
r
ST. CROI X COUNTY
A-_L hW I SC O N S I N
Ix Y /
ZONING OFFICE
or~y~y~,796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
HAMMOND, WI 54015
Z
Q U A R T E R L Y P U M P I N G R E P O R T
ST. C R 0 1 X COUNTY
NAME RETURN COMPLETED FORM TO:
ADDRESS ST. CROIX COUNTY ZONING OFFICE
P.O. BOX 98
HAMMOND, WI 54015
715-796-2239 an 715-425-8363
TOWNSHIP
PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
Piy RECEIPTS FROM YOUR PUMPER,:
NAME OF PUMPER:
LOCATION OF DISPOSAL SITE:
NUMBER OF PERSONS LIVING IN RESIDENCE:
USE: X YEAR ROUND SEASONAL (CHECK ONE)
JANUARY FEBRUARY MARCH
DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED
THIS REPORT MUST BE RETURNED NO LATER THAN MAY 15, 1985.
OWNERS SIGNATURE
STATEMENT
IICKNESS CESSPOOL SERVICE
Liquid Waste Pumped DATE /
Rt. 1 Box 178A
BALDWIN, WISCONSIN 54002
(715) 684-3730
r"r?
TERMS:
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE ` $
I I I
DATE INVOICE NUMBER !DESCRIPTION I CHARGES CREDITS BALANCE
BALANCE FORWARD
~G
xlll~
r................
PAY LAS'S AMOUNT
IN THIS COLUMN
LICKNESS CESSPOOL SERVICE ~l
. w
ST. CROI X COUNTY
~r
r WI SC O N S I N
ti: Vii' b,}_ {r _ y; ~~e j..
t a yw
ZONING OFFICE
loy~ ? 796-2239 (HAMMOND)
425-8363 (R I V E R F A L LS)
HAMMOND, WI 54015
Q U A R T E R L Y P U M P I N G R E P O R T
ST. CROIX COUNTY
NAME : f `0 11~ ` RETURN COMPLETED FORM TO:
ADDRESS: ST. CROIX COUNTY ZONING OFFICE .
y~ - r P. 0. BOX 98
a-, Irl ash HAMMOND, WI 54015
/ 715-796-2239 or 715-425-8363
TOWNSHIP :
PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
BY RECEIPTS FROM YOUR PUMPER:
NAME OF PUMPER : C A r 'l
ca / C k,d ~~S
LOCATION OF DISPOSAL SITE:
NUMBER OF PERSONS LIVING IN RESIDENCE: Z/
USE: YEAR ROUND L--' SEASONAL (CHECK ONE)
OCTOBER NOVEMBER DECEMBER
DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED
THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1985.
OWNERS SIGNATURE G7,4 C~
mj:12-83
L
. y3~y ST. CROI X COUNTY
' WI SC O N S I N
00 ZONING OFFICE
As 796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
T HAMMOND, WI 54015
QUARTE_RL Y HUMPING RE P 0 R T
~O ST. C R 0 1 X COUNTY
NAME
R1=TURN COMPLETED FORM TO:
ADDRESS ST. CROIX COUNTY ZONING OFFICE
P.O. BOX 98
/00..~ HAMMOND, WI 54015
TOWNSHIP a 715-796-2239 an 715-425-8363
PLEASE PROVIDE THE FOLLOWING INFORMATION ACC04PANTED
BY RECEIPTS FROM YOUR PUMPER:
NAME OF PUMPER:
LOCATION OF DISPOSAL SITE: ~p
T P ilk - / ` / w S ~ • c%~- ' ~4;~~ ~y Y c' i/
NUMBER OF PERSONS LIVING IN RESIDENCE:
USE: YEAR ROUND SEASONAL (CHECK ONE)
APRIL MAY JUNE
DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED
{
711
THIS REPORT MUST BE RETURNED NO LATER THA JULY 15, :1199844
OWNERS SIGNATURE
X &tA
y ST. CROI X COUNTY
yN"}z"~°a L r~ WI SC O N S I N
~~ra ~
ZONING OFFICE
IOHs j90 - 796-2239 (HAMMOND)
.tom 425-8363 (R I V E A FALLS)
HAMMOND, WI 54015
U A R T E R L Y P U M P I N G R E P O R T
S T. C R 0 I X C 0 U N T Y
NAMERETURN COMPLETED FORM TO:
ADDRESS: ( ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98
t ,i--u---,-~ HAMMOND, WI 54015
715-796-2239 or 715-z~25-8363
TOWNSHIP. U~ ~~tL
PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
BY RECEIPTS FROM YOUR PUMPER:
NAME OF PUMPER : - n n. s G p ~~n cs
LOCATION O,iDISPOSAL SITE: ~~~n~f Vy•~ s~G_JJ) 2~~,~i._~.L~
NUMBER OF PERSONS LIVING IN RESIDENCE:
USE: YEAR ROUND SEASONAL (CHECK ONE)
OCTOBER NOVEMBER DECEMBER
DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED
c>
- -
THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 15, 1984.
OWNERS SIGNATURE
mj :12-8 3
HOLDING TANK PUMPING REPORT
Name o6 Ree 'dence/--~~
Addneaa J!
-ice
Te.tephone_
Legat: 14 o u..' % o6 Sec.t-ion T",,-,N-R44
fiown.ahip
Date Pum ed Amount Pum ed Location S n.eadJJJ Remank.b Pum et St natune
Zoning 066.cce U, 6e:
Date I na pec.ted
Conditions Found
the above in6on.mation shat be sent to the St. CAo.i.x County Zoning 066ice,
Poa.t 066.ice Box 227, Hammond, W1 54015, monthly through the first four_
nonths, thereafter on a quarterly basis. The township receives a copy of
these reports quarterly. Yearly a report should be submitted to the state.
Periodic inspections will also be made by the St. Croix County Zoning Office
to inspect the success of the system at the above location.
DEPARTMENT OF INDUSTRY,
LABOR & HUMAN RELATIONS INSPECTION REPORT FOR
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS SAFETY & BUILDINGS
MADISON, WI 53707
DIVISION
CONVENTIONAL BUREAU OF PLUMBING
❑
®ALTERNATIVE
Holding Tank ❑ In-Gro State Plan LD Number
)
and Pressure ❑ Mound nr all" 9 n d
NAME OF PERMIT HOLDER:
ADDRESS OF PERMIT HOLDER:
Marion De Jon INSPECTION DATE
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FR Baldwin, W1
NW SW Section 32, T30N-R16W, Town of Emerald REF. PT. ELEV. CSTREF PT ELEV
Narne of Plumber.
MP/MPRSW No I
Bennie Hel eSOn BnUr
3 015 SamtarY Pe.it Number
SEPTIC TANK/HOLDING TANK: St. Croix 4 3 7 04
MANUFACTURER.
LIQUID CAPACITY TANK INLET ELEV
✓ {,Q tJ
L TANK OUTLET ELEV.: WARNING LABEL
BEDDING - C CLOCKING COVER
: C. C PROVIDED: PROV .
VENT DIA VENT Mq.TL. n~aR°^grER NUMBER OF RonD ES ~NO IDED YES
❑YES NO L- - C1 FEET FROM PROPERTY wELL ONO
❑YES c LINE: / BUILDING JBER' VENT TO FRESH
DOSING CHAMNEAREST NR O
MANUFACTUR ER. ~~•1
BEDDING: LIQUID CAPACITY -
PUMP MODEL PU MPjSIPHON MANUFACTURER
❑YES ❑NO WARNING LABEL LOCKING COVER
GALLONS PER CYCLE: PROVIDED PROVIDED
(DIFFERENCE BETWEEN PuMPgNDCONrROLSOPERAnoNAL ❑YES ❑NO ❑YES
PUMP ON AND OFF) NUMBER OF PROPFRrv WELL ❑NO
TO FRESH
SOIL ABSORPTION SYSTEM. Check the soil YES
soil wing n FROM LINE BUILDING I AIR INLET
NO
moisture at the depth of plo NEAREST
Or excavation. (If soil can be rolled into a wire, construction shall cease until
the is dry enough to continue.) FORCE ENG iH
th DIAMETER MATERIAL AND MARKING
CONVENTIONAL SYSTEM: MAIN
BED/TRENCH WIDTH LENGTH
NO. OF DISTR PIPE
DIMENSIONS rREN SPACING COVER
CHEs
GRAVEL DEPTH MATERIAL' INSIDE CIA -PITS BELOW PIPES PIT LIQUID
FILL DEPTH DISTH. PIPE DISTR. PIPE DEPTH:
ABOVE COVER ELEV. INLET ELEV. END DISTR. PIPE MA 7ERIAL
No OlsrH
PIPES NUMBER OF PROPERTY
. FEET FROM WELL. BUILDING: VENT 70 FRESH
LINE.
MOUND SYSTEM: NEAREST---,. AIR"LET:
Mound site plowed perpendicular to slope I
and furrows thrown upslope: Check the texture of the fill material for
mound system"s to make certain that it PROVIDE A DIAGRAM OF SYSTEM
❑YES meets the criteria for medium sand. ON REVERSE SIDE. SHOW ELEVA-
SOIL COVER TEXTURE ENO TIONS MEASURED.
PERMANENT MA RKERS.
OBSERVATION WELLS
DEPTH OVER TRENCH BED DEPTH OVER TRENCH;BED
CENTER DEPTH OF TOPSOIL ❑YES ❑NO
EDGES SODDED ❑YES ❑NO
SEEDED
MULCHED
PRESSURIZED DISTRIBUTION SYSTEM: YES ❑NO ❑YES
❑NO ❑YES ❑NO
BED/TRENCH wlDr" LENGTH -
NO OF LATERAL SPACIN G AVEL DEPTH BELO PIPF J
DIMENSIONS TRENCHES.
FILL DEPTH ABOVE COVER
MANIFOLD PUMP
ELEVATION AND ELEV ELEV MANIFOLD DISTR PIPE MANIFOLD MATE IAL NO DISTR CIA ELEV. DISTR PIPE
,
DISTRIBUI ION PIPES DISTRIBUTION PIPE MATERIAL & MARKING
DIA.:
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY
~COVER MATERIAL:
VERTICAL LIFT CORRESPONDS TO APPROVED
COMMENTS: ❑YES ❑NO PLANS
PERMANENT MARKERS:
OBSE RVA 1 NWFILLS : ❑YES NO
❑YES NUMBER OF PROPERTY WELL. BUILDING,
❑NO ❑YES ONO FEET FROM ~'Ne
NEARES
Sketch System on
Reverse Side. Retain in county file for audit.
SIGNATURE:
)ILHR SBD 6710 (R. 01/82) nrLE
DEPARTMENT OF PLICATION
INDUSTRY,/ J SANITARY SAFETY & BUILDINGS
LABOR AND t let ERMIT DIVISION
HUMAN RELATIONS LB 67) P.O. BOX 7969
MADISON, WI 53707
Attach plans for the system on paper n han 8'h x„ es in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points mu ppropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index age or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Propert#Owne
Mailing Address:
Propert
h`. or Township: County: NR E (or Lot NumSubdivision Name:
Nearest Road, Lake or Landmark: / State Plan I.D. Number:
C1G'cf (If assigned) /
TYPE OF BUILDING j ~JG3S
LOP c* ❑ Variance* ❑ Other (specify)* Number of
Bedroom I
FK1 2 Family *State Approval Required.
i
)
F TANK S CONCRETE POURED-IN _
CAPACITY
PLACE STEEL FIBERGLASS INSTAL ATION R MENT E (SpeER) §MANUFACTURER:
K CAPACITY
NK/SIPHON CHA;WN
)S 1
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ,New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
/I/ / ❑ Alternative (specify)
❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
❑ Private Joint ❑ Public
s
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumb Signature:
MP/MP
RSW No.: Phone Number:
Plumber's A ress: ~y
,l Name of Designer:
1
d! 111 ~SGs
COUNTY/DEPARTMENT USE ONLY
F e:
Date: Sanitary permit Number: ~
(J d ~ APPROVED /J
DI~j DISAPPROVED 7 3 ~O
s
i
7ternatec tAv.,Iabl
Change of ownership, buildi ng use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to
stallation. Failure to comply will void the sanitary permit.
ai-
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumper
DILHR-SBD-6398 (N.03/81)
NDUSTIii, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRYY, , y C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUM N RELATIONS
LOCATION:A SECTION: TOWNSHIP/ y; LOT NO.:BLK. NO.: SUBDIVISION NAME:
/T3j f6,E<r) W rr~ f
COUNTY: OWNER'S MAILING ADDRESS:
~k C R l ~3~1~DLviN Gv/ SS/avz
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: R DESCRIPTIONS: PERCOLATION
TESTS:
Residence New ❑Replace 1 / 83 AJ
RATING: S= Site suitable for system U= Site unsuitable for system 'PCL e 1-i ( 4::r G>_ 0
CONVENT iONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL LDING TANK: RECOMMENDED SYSTEM:(option I)
❑S NU ❑S SJU , ❑S ®U ❑S a]U S ❑U +1olA i'~ I «
If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. I If any portion of the lot is in the
under s.H63.09(5)(b), indicate: N J+ `I Floodplain, indicate Floodplain elevation: ~k) 4
P OFI E DESCRIPTIONS
BORING T6FOk+- ELEVATION DEPTH TO GROUNDWATER-11 S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER D~II-I N, OBSERVED EST. HIGHEST - TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B C lD~, o h e (f/ 54 t 1_2A., S; .-2 Rd 8n SC. L
n M-, t
8R/ f )'l '.pQ' `o
B- /4• 3ej~~{~ V/ IDY.V{~~ l ~ 1 s 'tt gyp/ S. ' TJ ! •V e, :5 off
f s , OR'4 8"
.ir 0 ®~~,-L
r
;'81 'S;1 54
B-3 / e• 8 a S n 3 lT l • r tom-/ J' M ~{.IO
Cf . 7 kid S~ $ L r~l-+. /~f l7 p
B- 5 1-3 erg. Ate
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 PERIOD PER INCH
P-
P-
P-
PP
P
LP
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 at all borings and the direction and percent
of land slop.
SYSTEM ELEVATION N ilk
~ r4
.
b '
tad' sq
_n
4 ,
A 1L
+JuR.P: s
_ Q, h U.R. / d~ • o
Drl✓:. (3erbin.' 6f Ste C Fen CC It
y
n. i
IV" e-h_$tOh
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 belief.
NAME (print) TESTS ERE C MPLETED ON:
~a~e'smrl~ 8 /
ADDRESS: I CER IFICAT ON NUMBER: PHONE NUMBER (itional):
'sor-1,14 e ( 11 hlp~' 3025~
CST SI NATURE:
DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
DILHR-SBD-6395 (N. 03/81)
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Form - S `r c 100
Owner of Property
Location of Property
4, Section T N K W
Township rae_c d
Mailing Address B21dra -
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel Was Created
Are all corners identifiable? Yes
No
Include with this -D21ication one of -the following:
.Certified Survey Map
.Deed
.Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION
i
(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No.. _ FZ ; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No. 3'-;;/1SGk's )
SIGN TUBE OF OWNER
SIGNATURE OF CO-OWNER (IF APPLICABLE)
Za-
DATE SIGNED
DATE SIGNED
` sT. cROiz couNTr
wiscoNSi N
4. f ~f ~t wj .(rte
~ ZONING OFFICE 796-2239
q ij 4i'7' c v,
Pob.t 066Jice Box 227
F f~ # , Hammond, WI 54015
O (d N E R
P U M P E R
A G R E E M E N T
PLEASE BE ADVISED, chat untit you ane again not.E6ied, I w.itt
Q ,g Z'/
r Cr
~ i s '
contkact with L ;c A'
n r S e ~ f.ccue ~
Wi4eonsin, (Pumpe)L), Jon the punpose o6 nemoving att wa4.te Jnom the
♦ani.tany 4y4tem to be Pocated on the pnopenty and 6utule home .bite
Located in St. Croix County, Wi,6 conetn, Townahip o6 ~ •,,~~L,r
be,i.ng in the ~ W : o6 the h % of Sec. T.
(Ox mo1le 6ut.ty descnibed ao 6otxowe: )
Dated this day o6 (tft 19 XJ
A- (OWNER
State o6 W.J-'.6con4in)
46
County 06 St. Cxo.ix)
PeKeunnattyappe,✓ced bea'one me ';i•is /(o day o6 19 ~3-
the above named , to me knouln to the
pVuon who execute the bon eg oiii .en scum ent and acknow.tedg ed the same.
u tic, t. lLoix oun y,
My Co! m. ( Expi4e41
C' heaeinbe6ote 4e6enned to a4 Pumpet,
;oiK Zn the above agreement zo _ e extent that I have a contnaet with t
Own" aA above 4.tated. v
~
~ (PUMPER I
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Iapka ST. CRU1X COUN1Y LUNIN(, 01t1)1NANI:I'..
LoCa[iau: SW'tC 01 SW'-
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