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AS BUILT SANITARY SYSTEM REPORT
~ rr
' TOWNSHIP"11,,, SEC._`j. N-R I W
AD DRESS.:~,,:~+,-.c~ ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET 0 SYSTEM 3 V~
IN,
`a
I di at N r h rr w
BENCHMARK: (Permanent reference Point) Vescribe:
Elevation of vertical reference point: r Slope at site: /O
SEPTIC TANK: Manufacturer:, Nr2._ Liquid Capacity:`
Number of rings on cover -42,,e Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: _ Number of gallons
Number of gal. pump set for a cycle _ gallons; Total capacity of
distribution lines ---gallon: size of pump head;
gallon per minute horsepower---- ;brand name of pump
and model number _
Type of warning device
HOLDING TANK: Manufacturer_____ _ _ Number of gallons
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE; Number of pits- feet diameter
feet liquid depth seepage pit inlet pipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length the depth
r--j
SEEPAGE TRENCH: width- length- /
PERCOLATION RATE L AREA REQUIRED 6,, AREA AS BUILT
INSPECTOR
DATED 3 PLUMBER ON JOB
LICENSE NUMBER 3~/
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, tr:11' 53707
[X CONVENTIONAL ❑ALTERNATIVE State PlanLD.Number
Ilf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPE N )DATE,
Robert Luepke Gtenwood City, W1 IL
BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN. REF. P EL V.' CST REF. PT. ELI V..
SW SAW, T30N-R15W, Town of Gten.wood
Name of Plumber: MP/MPR$Wj4 Cou ^~U~x Sanitary Permit Number.
Wayne Lmen.z S(l ` 43656
SEPTIC TANK/HOLDING TANK:
MANUFACTURER . LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING V
PR V ED PROVIDE
YES ❑NO ❑ ES ❑NO
BEDDING: VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILD( G: JVENT TO FRESH
C, 1 ALARM. / LI AIR INLET.
[:]YES ❑NO / FEET FROM ~J
❑ S ❑NO
DOSING CHAMBER:
MANUFACTURER IBEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUF TIIRER WARN G LABEL LOCKING COVER
PRO ED. PROVIDED:
❑YES ❑NO YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL MBER k3F PJIVE LL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN I F ET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO EA ST-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing f' NG JDIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FOR '
the soil is dry enough to continue.) MA
CONVENTIONAL SYSTEM:
WIDTH JLNO. OF pISTR. PIPE SPACING COVER JINSIDE DIA -PITS. LIQUID
BED/TRENCH TRENCHES MA IIW kC' PIT DEPTH
DIMENSIONS TJ ~Cd - 5 if GRAVEL DEPTH FILL DEPTH 12 DISTR. PIPF DISTR PIPE DISTR. PIPE MATERIAL NO. DI R NUMBER OF PROPERTY WELL BUILDING: VENT TO
FRESH
BELOW PIPES ABOVE COVER ELEV. INLET ELEV. E D r PIPES FEET FROM , LINE. AIR INLET.
~C1 2 7 Z ! Z NEAREST--o- 11-1, ')71 GUf
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-
meets the criteria for med' ^m sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER TEXTURE PERM ANE NT MA KERS OBSERVATION WELLS
V ❑NO ❑YES ❑NO
❑YE
UEPTH OVER TRENCH;BED DEPTH OVER TRENCHBED pEPTH OF TOPSOIL SO DED SEEDED MULCHED.
CENTER EDGES.
j ❑YES ❑ O ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. No. OF LATERAL SPACI G } JCRAJEL DEPTH!BELOW PIPF,. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES: t -
DIMENSIONS f
MANIFOLD PUMP MANIFOLD DISTR. PIPE r MANIFOL MAT f{LN O. DI TR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA. ELEV.'. I PIPE S. DIA.:
ELEVATION AND
K
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
J L S ❑ YES ❑ NO ❑ YES ❑ NO NEAREST
} ~t
tr)
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Sketch System on Retain in county tIIe(Jor atu~it
Reverse Side.
SIGNATU~j,E....--.^-..- f:^ TITLE.
DILHR SBD 6710 (R. 01/82)
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page 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.
Property Owner: Mailing Address: _
J 14.
t_1 S~Q
Property Location: + City, V Ilage or Township: County:
t/as - %S NCR/5-- E (o W ~J C
of Number: Blk No.: Subdivision Name: earest.Road, Lake or Landmark: State Plan I.D. N mber:
12 (If assigned)
TYPE OF BUILDING
Number of
❑ PybJic* ❑ Variance* ❑ Other (specify)* Bedrooms:
1 or 2 Family *State Approval Required. f
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New q,.Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) epage Trench
Water Sur Owner's Name as Listed on Soil Test Report (If other than present owner):
rivate ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumb r: Signature: MP/MPRSW No.: Phone Number:
P umber's dress: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing Age~nJj: Fee: / (tV Da ? APPROVED Sanitary Permit Number:
rZ4 t,~ic~~ ❑ DISAPPROVED 16
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
Norm - S T C 100
Owner of Property
.Location of Property Section_.~j,T ®N R/ W
Township
Mailing Address
rY 'j c '--E t r.x.
Subdivision Name
Lot Number
Previous Owner of Property Z
Total Size of Parcel ~D
Date Parcel Was Created
Are all corners identifiable? Yes No
Include with this application one of the following:
.Certified Survey Map
.Dead
.Land Contract, or
.Other Legal Document which describes the property
PROPERTY OWNER CERTIFICATION i
I (We) certify that all statements on this form dre true to the best of my (our)
knowledge; that I (we) am (are) the owner( ty described in this
information form, by virtue of a warrant deed recorded in the Office of the
County Register of Deeds as Document o. ; and that I (we)
presently own the proposed site for the system (or I (we) have
obtained an easement, to run with the above eseribed 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.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER tIF APPLICABLE)
DATE SIGNED DATE SIGNED
f
" ST. CROI X COUNTY
s~ WI SC0 N S I N
ZONING OFFICE
ET~
~1nfPI
796-2239 (HAMMOND)
425-8363 (RIVER FALLS)
W',Mi O NG, WI 54015
August 1.8, 1.983
Mr. Wayne Lorenz
R. R. 1
Boyceville, WI 54725
Dear Mr. Lorenz,
The application for a sanitary permit for the Bob Luepke system
has been rejected by the Zoning Office for the reasons indicated
on each form.
Under the provisions of H 63.06 4(c) you do have the right to
appeal this decision.
Should you have any questions regarding this, please feel free
to contact this office.
Sincerely,
Thomas C. Nelson
Assistant Zoning Administrator
`I'CN :mj
cc: Bob Luepke
EncLosures
DEPARTMENT OF APPLICATION SAFETY & BUILDINGS
FOR SANITARY DIVISION
INDUSTRY,
LABOR AND PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/1 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page 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.
Property Owner: Mailing Address:
? , r~ J C'
Property Location: _ City, Ilage or Township: County:
(_I '/n, "/4 Sr N/R_ /i . E (p W ; _1 C hi-eA 4 ~a lcr t.
_ot Number. ro.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. N mber:
(If assigned)
TYPE OF BUILDING
- Number of
❑ Pu ic" 0 Variance` L-] Other (specify)" Bedrooms:
1 or 2 Family "State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT ISpecity)
SEPTIC TANK CAPACITY
I10LDING TANK CAPACITY
LIFT PUMP TANK/SI NON CHAMBER
[MANUFACTURER
EFFLUENT DISPOSAL SYSTEM
I'EHCOLAT ION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New Ci-Repfacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
❑ Alternative (specify) ~ge Trench
Water Suppjyr' Owner's Name as Listed on Soil Test Report (If other than present owner):
rlvate ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shovvn on the attached plans.
Name of Plumber Signature: MP/MPRSW No.: Phone Number:
P umber's idress: Name of Designer.
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ APPROVED Sanitary Permit Number:
❑ DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHH-SBD-6398 (1\1.03/81)
I>LPART IVT°F REPORT ON SOIL BORINGS AND I I IY & IiUILI)INC,S
INDUSTRY Y" I>IV ISION
L!\I_iQR ,
illMi>N HI_
fit L_AF1ONS PERCOLATION TESTS (115) MADISON, WI 53707
(H63.09(1) & Chapter 145045)
II OCA ION ECTION I NSHIP/MUNIC IPALITY: 1 1 BLK NU_ ~,UBDIVISIOP NAME'
5~"NTY O 1 H'SIBUY R'S NAMEMAILINADetc _ t -
' -v~ /
- USE
DATES OBSERVATIONS MADE
]NO- BG)RMS. COMMFnciA /~.DESCRIPTION [PIR - OF/1/r E D SCRIPTIONS PERATON TESTS:
fResidunce Ncw eplace r / - - 3-..
HATING: S= Site suitable for system U° Site unsuitable for system
uNVI NIIONA1 0UNl): IN GIiOtINDIRISSURF ,YSTFM IN FILL IIOt
N s!u S Eus uu- I EIsuc~DIsNG TANuK R EC~OM MENDE D SY, I LM (o ut, l) II Petc(laliuii l ur,l s die NO I ietluiied Df SIGN RATE
It my pm lion ul the tested uti is in the
ender s.Hfi3.t1`>l'~11b1, indicate: F-hx dplain, indicate Floodpl un clevation:
PROFILE DESCRIPTIONS
-
)RING T OTA I - - -
D PT11 TO GHOLINDWAFL fi INCHES CHARACTER OF SOIL WFTH THICKNESS, COLOR, TEX rUHF, AND DEPTH
UMBF3i DEI1111 IN, ELEVATION 0f3 ,EHVED E T. HIGHES_F TO BEDHOCK IF OBSERVED (SEL- ABBHV_ ON BACK)
rV
- i_- -
n r
r ~1
f3 __~~~c~ _l ~i1r.L_, f r)
13-
13-
13-
PERCOLATION TESTS
TEST DfFRI WATER IN HOLE TEST TIME DROP IN WATER LEVEL INCHES RATE MINUTES
~UNIBFH Nt 11 AFII fiSWFI LING INIENVAt-MIN_
..r - - 4.r---- P E Fi I_Q_~. 1. PE RT'~(S7D~=- - f 1=INCH
•
Ill OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon-
-ral 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
,I land slupu_
SYSTEM ELEVATI~N
\ "NOT APPROVED"'
Datut 1 0
Inspection I C 0 ,
teA,
'L1~~ Tom.'/ t~ ' ~ f ,tJC') • .
rjt)
I, the unh:rsulnud, hereby certily that the soil tests iepurt tq>s loan were made by nw et acwrd with the procedures and methods SpecAlu:d ut the Wlsctw%m
n iinisunl ivy Code, and that the data recorded and the locauoii of the tests are correct to the best of my knowledge and behet-
} TES 1/iIERE~'OMPLLTI-:DON:
l ~1 y - -
ADDRESS C-ER I Q-ICATION NUMBER: PHONE NUMBERIoptiorl'i
J`
CST S,I tVATUH)
l/ l
UISFRIBUTION: 0,,q nal d ui one cope u, L.neoi Auiho,lty, Piupe,ity Ownc, dnl Soil lu,un
I~IL.HR-SBU-639!) (Ii.C)VLIt
lr y
l
dnaip,QM'd+d
a
/II CC~.t~-' A~lt_ l uc ~T~unJ Iti~~u~'r-t~7iu~
( C rr 'r 6r~ Lr~ W l l~T
t 0 ( t r-. v4, G= S , r L
X - ~F< t c~N r= ~~lrlrr.Jr'r k"LTA w/ Sy S'i6'i~t i [t(irl
a.y `>/k~(~1Fr;~ Dr 1Flucf (J 1"5Fr( io 0 1AJ r(_, ~
`srl/.ILL SIGN DN.,rl. Hn~D CGr~~
Kl LL 1 v161- (~i ~C~I ~--~L6~r~jc> ~ ~ i
1 N .
071 -
0 C c ~ vrr-..- C
ST. CROI X COUNTY
WI S C 0 N S I N
ff
~I
ZONING OFFICE
796-2239 (HAMMOND)
` 425-8363 (RIVER FALLS)
HAMMOND, WI 54015
August 19, 1983
Mr. Wayne Lorenz
I:. R. 1
Boyceville, W1
The application for a sanitary permit for the Bob Luepke
system has again been rejected by the Zoning Office for the
reasons circled or checked on each form. Please correct
.end return to this office.
Under_ the provisions of H 63.06 4(c) you do have the right
to appeal this decision.
Should you have any questions regarding this subject, please
feel free to contact th=is office.
Sincerely,
'11 somas C. Nelson
Assistant Zoning Adminstrator
TCN:mj
Enclosures
cc: Bob Luepke
LeRoy Jansky, State On Site Waste Specialist
FiEPAR-fMENT OF APPLICATION SAFETY & BUILDINGS
IivousrrfY, ~K~ FOR SANITARY DIVISION
I A13013 AND PERMIT P.O. BOX 7969
IUNV>N ICI -CATIONS (PLB 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8'/, x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
.+nd vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
i 1-63, Wis. Adm. Code, must be shown. An index page 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.
i Property Owner: Mailing Address:
~O
Property Location: City, Illage or Township: County:
_ / S
l '/a ~ /'4 /T 9,c, NiR/5 E (o W
Number: Blk No.: Subdivision Nama: earest Road, Lake or Landmark: State Plan I.D. N mber:
(If assigned)
TYPE OF BUILDING
Number of
1_1 Pu ic` F_ Variance" D_ Other (specify)" Bedroom(:
[IL 1 or 2 Family "State Approval Required.
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
r SEPTIC TANK CAPACITY ~1+O V
BOLDING TANK CAPACITY
LIFT PUMP TANK/SIkHON CHAMBER
Iv1AN_UFACTURER:
1 FFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New acement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
/ - ❑ Alternative (specify) epage Trench
I Water Supp Owner's Name as Listed on Soil Test Report (If other than
~ present owner):
rivate ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of e
r: Signature: MP/MPRSW No.: Phone Number:
J 2
P m rei's ss: Na
me of Desig
ner:
1
COUNTY/ DEPARTMENT USE ONLY
(signature of Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number:
❑
DISAPPROVED
Reason for Disapproval:
Alternate course(s) of Action Available:
I
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
110u (N 03/81)
'0 ' 75
I)I'l PA )>A',-MI T1IDENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
!
AROR AND P.O. BOX 7969
It.1MAN RELATIONS
PERCOLATION TESTS (115) MADISON DIVISION
, WI 53707
3707
r1Cl1TtON SECTION
t / ~s TOWN$H /MUN C ICI t?-V
PALITY LOI~NQ.:BLK. NQ: S U B D I V I S M
I ly E,
J"l Cam,/ / / c N/R/ E (or ~[TJ
LINTY - -
OWN R',' HUYE ~S NAME: MAILIN AD R SS:
or'vw ---(jJ
DATES OBSERVATIONS MADE
NO B€ Ri'1'1CT~75 F R I P r I O N - -
f )fz,„ t ~ „ /~J Pia-FTL-E E~O(T~R'iT~ STS:
❑New M {eplace ( MI.)
13 717Z
RATING: S= Site suitable for system U= Site unsuitable for system
()f~VLNJIONAL JM~~. ~U IN-GROUND-PRESSUh F. SYS- M-IN FI
-LLH0LDING TANK: RECOMMENDED SYSTEM-(optional)
r-~ I N-,S F l c MU I c M -
i i r rcolat ion Tests are NOT required DESIGN R TF: SY$rF [
,uicr s_flb.3 0915)(b), indicate: ~ [Eloi:odplain, ny portion of the lot is in the
indicate Floodplain elevation: r
PROFILE DESCRIPTIONS
LING TOTAL QEPTH 70 rFUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR TEXTURE, AND DEPTH
~ n~IHER DEIrFH IN, ELEVATION _ OBSERVED HES-
- L TO BEDROCK IF OBSERVED (SEE AB8HV. ON BACK.)
lox
qr-
11-_-3 &G _3
n s 13~ ~
r~-
r3-
B-
I
PERC LATION TESTS
TEST DEPTH R7 ER IN HOLE TEST TIME DROP IN WATE LEVEL-INCHES
NUMHER INCHES Af I F ELLING 1 RVAL-MIN. RATE MINUTES
lI P R PER I N C? H
h ~
i-. ns of .AN nld : Show
elevation reference percolation tests, soil borings and 7trt\im sions of s itable soil areas. I dicate scale or distances. Describe what are the hori-
points and show their location on a lot plan. ow the surface levation at all borings and the direction and percent
and slop.
;YSTEM ELEVA
K
{al, E t l
1
I I~ V
I ( - Dxurll -
,
~ t ~0 I 1 ~
l t i
the undersigned, hereby certify that the soil tests reported on this fdrm are made by me in accord with the procedures methods specified in the Wisconsin
,,,imistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
~ME (print)
(I TESTS WE C7LETED ON:
~LilIESS
CER IF CATIgN NUMBER: PHO E NUMBER optio al):
CS S N,ATt,)RE:
y~ ~ l
j_
,
r
APPROVEI.
(~ytL-o
I v I-
STtz-" ~l vATlu►J
CCa'Ellr.
1/t rr~ r..) ( r~~~1 w~tJL rt
N r: l,~l-'r[~NI-~Lf~ w/ SySi~i~ f c~,l rfl~
ut
-1 t fir, k S F_/( ib D l' N FrF c i~
("t -~ei IIL k_ IQ
41
r
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, cc DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707
LOCATIO : SECTION: *TOWN5;,HIP/MUNICIPALITY LOT N ]IBLIK. N SUBDIVISI N ME:
/a d 4/ /T3o N/R/ E (or - ~
COUNTY: OW. R' BUYE 'S NAME: MAILIN ADDRESS: USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIPTION: L-1 R NS: IPERCOL E1 I~i•TESTS:
I / - A/-- Z 3
LXR.sidence 3 A ~ New ~eplace
RATING: S= Site suitable for system U= Site unsuitable for system (9
X NTIONAL: M~ D: IN-G~ND-❑U RE. S❑ S IZU L HOaLDING,TANK: RECDED SYSTEM;(optional)
If Percolation Tests are NOT re uired DESIGN R TE: SYSTE EL V.
4 I If any portion of the lot is in the I /J
under s.H63.09(5)(b), indicate: A/ Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
t.: .
13- -JDRJ~A
B.:7
sj_
13 R
B- Y' y
i)k'Alz S4,
PERCQLATION TESTS
TEST DEPTH ERIN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHE AFT ELLING I RVAL-MIN. PE D t PE I ~/2 PERT PER INCH
P- ~z
P- 3
P- r
P-
2. :~,'.3
PLAN VIEW: Show locations of percolation tests, soil borings and im sions of suitable soil areas. I~ clicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on e lot plan. Show the surface Alevation at all borings and the direction and percent
of land slop. \ \
SYSTEM ELEVAT,ON
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I, the undersigned, hereby certify that the soil tests reported on this 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 WE CO LETED ON:
! C k
ADDRESS: CE/R IFICATI N NUMBER: PHOPE NUMBER (optiorlal):
C rS NAT RE:
^nthority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester.
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Parcel 231-1041-10-100 12/29/2005 11:29 AM
PAGE 1 OF 1
Alt. Parcel 26.30.15.708B 231 - CITY OF GLENWOOD CITY
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 - RASSBACH, DANIEL & CYNTHIA
DANIEL & CYNTHIA RASSBACH
695 E OAK ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 695 E OAK ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 13.454 Plat: 0058-OUTLOTS/ASSESSORS PLAT GLENWOOD CIT
SEC 26 T30N R15W NE NE O.L. 44 EXC PART Block/Condo Bldg:
LYING N & E OF FOLLOWING LINE: COM 66'W
SE COR O.L. 44 N 327' NWLY 269' TO PT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
500'N S LINE O.L. 44 NWLY 282' TO PT 26-30N-15W
550'N S LINE O.L. 44 W= S BOUNDARY TO W
LINE O.L. 44 AND EXC P715 AND PART DESC
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 816/183
4
~ UC
2005 SUMMARY Bill Fair Market Value: Assessed with:
126470 123,700
Valuations: Last Changed: 09/21/2005
Description Class Acres Land ,Improve., Total State Reason
RESIDENTIAL G1 3.454 20,400 86,200 106,600 NO
AGRICULTURAL FOREST G5M 10.000 12,500 12,500 NO
Totals for 2005:
General Property 13.454 32,900 86,200 119,100
Woodland 0.000 0 0
Totals for 2004:
General Property 13.454 14,300 61,600 75,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 127
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
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Parcel 231-1029-20-000 12/29/2005 11:33 AM
PAGE 1 OF 1
Alt. Parcel 26.30.15.524 231 - CITY OF GLENWOOD CITY
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 - RASSBACH, DANIEL
DANIEL RASSBACH
695 E OAK ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 227 OAK ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
SP 0026 TID #3 GLENWOOD CITY
Legal Description: Acres: 0.000 Plat: 0177-CLARK'S
LOT 11 BILK 4 WARD 3 CLARKS ADDN G.C. Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1070/287 W ID
07/23/1997 878/229
2005 SUMMARY Bill Fair Market Value: Assessed with:
126377 32,100
Valuations: Last Changed: 09/21/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 0.000 8,300 22,600 30,900 NO
Totals for 2005:
General Property 0.000 8,300 22,600 30,900
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 6,300 18,300 24,600
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
Parcel 231-1028-90-100 12/29/2005 11:35 AM
PAGE 1 OF 1
Alt. Parcel 26.30.15.519B 231 - CITY OF GLENWOOD CITY
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 - RASSBACH, DANIEL
DANIEL RASSBACH
695 E OAK ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 227 W OAK ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 0177-CLARK'S
THAT PART OF LOTS 4,5,6 BLK 4 CLARKS ADD Block/Condo Bldg:
G.C COM NE COR LOT 9 BLK 4 CLARK'S ADD
TH N 75'W 40'S 75'E 40'- POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 727/616
2005 SUMMARY Bill Fair Market Value: Assessed with:
126374 7,000
Valuations: Last Changed: 09/21/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 0.000 6,200 500 6,700 NO
Totals for 2005:
General Property 0.000 6,200 500 6,700
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 9,500 700 10,200
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
Parcel 231-1007-10-000 12/29/2005 11:35 AM
PAGE 1 OF 1
Alt. Parcel 26.30.15.129-130 231 - CITY OF GLENWOOD CITY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
CYNTHIA A RASSBACH O - RASSBACH, CYNTHIA A
228 E WALNUT ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 228 E WALNUT ST
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 2249-ORIGINAL PLAT / GLENWOOD CITY
LOTS 7 & 8 BLK 7 WARD 2 ORIG PLAT G.C. Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
Notes: Parcel History:
Date Doc # Vol/Page Type
04/29/1999 602225 1422/505 WD
07/23/1997 962/549
07/23/1997 961/81
07/23/1997 489/25
2005 SUMMARY Bill Fair Market Value: Assessed with:
126196 116,300
Valuations: Last Changed: 09/20/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 20,000 92,000 112,000 NO
Totals for 2005:
General Property 0.000 20,000 92,000 112,000
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 11,500 68,700 80,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 520
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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GLENWOOD CITY
® ♦ CO-OP SERVICES
GLENWOOD CITY, WISCONSIN 54013
Glenwood City EX-PRO
Ford Phone: 265-4224 FARM SUPPLY
Mill: 265-4827 C Fertilizer Plant: 265-7212 Custom Blended Protein
Sales & Service Computer Balanced Rations
Phone: (715) 265-4877 GAS * FUEL OILS * LUBE OILS * TIRES Custom Extruded Soybeans
LP GAS ACCESSORIES * SEED * AG CHEMICALS ON 170 - GLENWOOD CITY
Glenwood City, Wisconsin
54013 FERTILIZER * ANIMAL HEALTH * FEED, BAG & BULK 265-4239
I
Parcel 016-1055-70-000 12/29/2005 09:17 AM
PAGE 1 OF 1
Alt. Parcel 25.30.15.391A 016 - TOWN OF GLENWOOD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
04/19/2004 00 4
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - DRAXLER, RETIRED
RETIRED DRAXLER
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 11.890 Plat: N/A-NOT AVAILABLE
SEC 25 T3 N RI 5W NW NW EXC CSM 11/3193 & Block/Condo Bldg:
EXC CSM 3/3700 CSM 18-4730 WAS CREATED
FROM PT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
25-30N-15W NW NW
Notes: Parcel History:
ge Type
Date Doc # C822/628
07/23/1997 k -
-D k
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/17/2005
Description Class Acres Land Improve Total State Reason
Totals for 2005:
General Property 0.000 0 0 0
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