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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - RUKSTALES, BRUCE A BRUCE A RUKSTALES C - LEVENHAGEN, LORI D LORI D LEVENHAGEN 448 HWY 65 N ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 448 HWY 65 SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE SEC 9 T28N R18W PRT SE NE COM 135'S NE Block/Condo Bldg: COR NE SE, W 20RDS, NWLY 65 RDS TO PT 29 - RDS W OF E LN NE 1/4, E TO E LN, S TO Tract(s): .c: i~an -Rnr, V1 1 POB ASSM'T INC 022-1026-50 09-28N-18~J Notes: /'arc ~l Hi-t-,y Date Doc # Vol/Page Type 11/16/2004 780087 2696/555 WD 09/02/1997 1261/462 WD 07/23/1997 985/13 V VD 07/23/1997 780/128 more... 2011 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.000 85,000 151,000 236,000 NO Totals for 2011: General Property 6.000 85,000 151,000 236,000 Woodland 0.000 0 0 Totals for 2010: General Property 6.000 85,000 151,000 236,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00 0 00 0 00 ,0 lelol sa6aeLi0 luonbulla4 se6ae40 leloodS s;uawssassy IeloodS junowy Aao6ale0 apo0 lelaadS iasn :slelaadS uo3e8 :Ole(] u011e31p1Ja0 0 :luno0 wie10 :Iipaao /(a8110-1 0 0 000,0 puelpooM 0 0 0 000,0 AljadoJd leaauaE) :OLOZ Jo; sle;ol 0 0 000'0 puelpooM 0 0 0 000'0 A:padoJd IeaauaE) 4 60Z ao; sle;ol uosead GMS Ie101 eno.idwl pu" saaoy sse10 uol;duosap :pa6ue40Ise-1 :su01}enIL-A 000-0 L-4ZO L-ZZO 0 :y;lnn passassd :anlen;a1aeW sled We mwwwns m z -aj ow SZ L/OSL L66 L/EZ/LO (IM £ L/996 L66 L/£Z/LO aM Z9b/ L9Z L L66 L/ZO/60 C1 AA 999/969Z L8009Z b00Z/9 L/ L L adAl abed/10n # ooa a;ea :fuO3slH laoaed :SOION MSL-NSZ-60 0 -tbZOL-ZZO/M a3SS3SSd (b/L 09L tb/L Ob bud-unnl-aaS) :(s);oeil 90d Ol S 'N-1 3 Ol 3 17/L3N N-1 3 30 M Sad 6Z id Ol SCRI 99 AWN 'Sad OZ M 'd00 :6PIS opuo0/){oo1e 3N S .9U WOO 3S 3N 121d MSLd NSZl 6 03S D~OVIldn`d lON-H/N :Md 000'0 :saaod :uol;dlaosaa Ie6a-1 H0310n AEMVn dIHO OOLO d; I S-1-1HJ d3nld 1SI0 HOS £62b 05 uol;dlaosaa #;sla adAl :(sa)ssajppV A:padoad lelaadS = dS IoouaS = OS :SJOIJIS!a £ZOtb9 IM S1d390d N 99 AMH 9t7t, N3JdHNDA3-1 a IdO-l Q IdJM 'N39dHNDA P - O s3rivis>im1 d 30(ld9 d 30f1d9 'S3-iH1S>inH - O 1auMp-00 luaam0 = O 'jaumo }uaim0 = p :(s)aauMO :SSaappy xel 0 00 silun }o # adAl;lwJad #;lwaad # uol;eollddy eajy saleS # deal a;ea Ieouo;slH a;ea uol;eaJO NISNOJSIM 'J.1Nf100 XIOdO 1S X' ;uaiin0 JINNI>iDINNI>i ~O NMOl - ZZO 907L'SL'SZ'60 laoaed III L 30 l 39Vd wd L9 vo L LOZ/90/LO 000-09-9ZO VZZO laaaed EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: 5L%, ' 41/4, Section A, TdG1N, R taE (or)gTownship or Municipality </vJNiCI_ [1M C Lot No. , Block No. County Subdivision Name Owner's Name: K1f'Y lJ%3 A L-t-) Mailing Address: ~c e5. TYPE OF OCCUPANCY: Residence )k- No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW p / ADDITION -REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS LQ X79' PERCOLATION TESTS QAJ C- & L_ / i7~~( SOIL MAP SHEET SOIL TYPE dte- PERCOLATION TESTS TEST DEPTH CHA R OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE= NUM- INCHES q CHES SINCE HOLE HOLE AFTER INTERVAL BER1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P_ P. rv~ P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) Jo* 5-b" ~ _ j ii 1.IC ~i L ~ n B/~1 ✓1 L. ~ ~ L , ~ - 4~ B~ Notoe "S,i- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Ca' Indicate on the plan the location and square feet of suit ble areas. Indicate number of square feet of absorption area needed for building type and occupancy. NQT _ L AAt-~F- Indicate scale rr or distances. Give horizontal and vertical reference points. Indicate slope. +_5 T U a-5- W4 04 Rn' {I ~ I ~ I 3 I t~~ l I ).=71 t k- r (I I '~0 I! 71€fP 11 l i 1 rl 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 location of test holes are correct to the best of my knowledge and belief. Name (print) i~ FF Q Certification No. Address Z()( 14hyr, 1 c,7-0(t' t✓ZQ / FJCL tS~ 0 ,j Name of installer if known CST Signatur o cn O n c_n O 3 v n r_ d o v 1 a -3 3 `D (D 3 `D o o o Z v 7 a ~ xc 3 CD d ^ 3 CD 001 cn~ -I[cD Z ~°O zf(D z ° o 0° n(n N I~1 D Oo I~ Z N W 7 3' WO C O N O N C 1 K (n 4, N) CL 0 D o y cn c _ o 0 CD 7 N p- 3 N 0 ° O N N O N_ C l0 7 ~1 D <D 4/ N * O (V v> Z D ¢ a 1 Cl) D F a a t ca O N a A (D (70- CD N C. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner " RUKSTALES, BRUCE A BRUCE A RUKSTALES LEVENHAGEN, LORI D LORI D LEVENHAGEN 448 HWY 65 N ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 448 HWY 65 SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 6.000 Plat: N/A-NOT AVAILABLE SEC 9 T28N R18W PRT SE NE COM 135'S NE Block/Condo Bldg: COR NE SE, W 20RDS, NWLY 65 RIDS TO PT 29 RDS W OF E LN NE 1/4, E TO E LN, S TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB ASSM'T INC 022-1026-50 09-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 11/16/2004 780087 2696/555 WD 09/02/1997 1261/462 WD 07/23/1997 985/13 WD 07/23/1997 780/128 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/24/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.000 40,000 96,100 136,100 NO Totals for 2005: General Property 6.000 40,000 96,100 136,100 Woodland 0.000 0 0 Totals for 2004: General Property 6.000 40,000 96,100 136,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1024-10-000 05/12/2005 11:21 AM PAGE 2OF2 Parcel History: cont. 07/23/1997 766/390 I St. Croix County Map Output Page Page 1 of 1 St. Croix Count Mapping NE1 N0114-NE l A NO 114 NW 1/4 NE 1R1-NE 1A • LO'n N. m z x I Z y{ I i r O Sy ~ } Lori t I LOI2 i SE 1/4 NFU 114 SW IF4 NJU 1Rl SW 14NE 1/4 SE 14 NE 1A I I i ftinnickinnir 9 10 I I LOT5 j LOT4 LO•n NJU1/4 SE 114 NE 1R7 -SW I14 PNE 14 SE IRI MN1145W 114 3 cSU var_7 ac urs ry i j A0 I R, ~ I 2 F~~ l I - --LOT4 LCIf6 a t Land St. Croix County Planning Department ,-t.-4171: 'IMF 1101 Carmichael Road Hudson, WI 54016 L~ P• Phone: (715) 386-4674 Arai r-sge DISCLAIMER : The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was D. prepared. It is not intended as a substitute for an accurate field survey. P~11ety,y e AERIAL PHOTOS : Aerial photography is date-sensitive. Features that exist presently in the County may not be present in the photos. http://72.21.230.178/servlet/com.esri.esrimap.Esrimap?ServiceName=StCroixOV&CIient... 5/12/2005 MC DONALD, WOODROW SE NE RR#2, Box 72 T28N_R18W Roberts, WI Town of Kinnickinnic PLB-67-T#38501 10-21-83 R. Timm Conventional,-Replacement INSTALLED 11-10-83 y AS lilt 1 I,T SAN I TAI:Y 5YSTFM 1:1,:1'01y'1' t> W N F k vU Cl - JJ r✓ O W N S I 1 1_ P~ S L C. ` 'r k, W - 741- - - '4 l-- 1)1)hl''~S CROIX COUNTY, WISCONSIN. ~Ulil)IV 1- IJON! LOT SIZE - - - PLAN VIEW Ui:;tance~s acid di- mcns.i- ous t o meet requirements of 1463 SHOW t?VERYTHING WITHIN 1-00 FEET OF SYSTEM TT R - - Indic at - N r It rr(w U,N 7J K kNCITMARK: (Permanent reference Point) Describe : /C,1, tJ au-`- kIevation of vertical reference 1) oint:__~!J~J Slope at site: `JIPTIC; 'T'ANK: Manufacturer: ~_.~1L~2✓~ Liquid Capacity: /Q7JC~ Number of rings on cover Tank manhole cover elevation,. y5p TaIIIc IIII(,t: I,;Ievtt -t_) It : 97y 3 'L'ank Out IeL Elevation: II_IMP CIiAMBLIt Manufacturer. Number of gallons Number oT ga_1.. pump set for a cycle gallons; Cotal capacity of clLsrrLhuttou Dines gallon: size of Pump head; gaallon per mi-note horsepower brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer--- Number of gallons _ Elevat.Lon of manhole cover ; 'T'ype ol. warn._i_ng device SEEPAGL PIT of pits feet diameter _ feet liquid depth- seepage pit inlet pipe-elevation _ bottom of seepage pit elevation feet. SL :1'AGT~ BED SIZE: number of lines ~ width--fg -length-~~ -tile depth SLI? ACL 'C ItIi;NCTI: width length PERCOLATION RATE - AREA REQUIRED /S - AREA AS BUILT l0 IN SPECTOR DATE' D PLUMBER ON TOB L [(I?NSE NUMBER / C~~ z~/ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. P,,7X 7961D PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING C~d CONVENTIONAL DALTERNATIVE State Planl.D.Number E Holding Tank ❑ In-Ground Pressure D Mound u, asslgnedl NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Woodrow McDonald RR#2, Box 72, Roberts, WI f BENCH MARK (Permanent reference POmnN DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. ST REF. PT. ELE V. SE NE Sec.9,T28N-R18W, Town of Kinnickinnic Nenm of Plumber: MP/MPRSW N<,. ['"Sy Sanitary Permit NumberRo er Timm 3224 t. Croix 38501 SEPTIC TANK/HOLDING TANK: MANUFACTURER. t LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: WARNIN LABEL LOCKING COVER F y ~ _t PAOVIOED: PROVIDED-. i~ 1 4rt/. l YES BU ENO DYES E N BEDDING. VENT DIA.: VENT MAT} HIGH "AI R O NUMBER OF ROAD: PROPERTY WELL. ILDING. E NT TO FRESH N ALARM. LI AIR INLET rr~ FEET FROM NE IV DYES CjNO D YES ENO NEAREST 1 DOSING CHAMBER: MANUFACTURER. BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER RNING LABEL LOCKING COVER DYES ENO ROVIDeD PROVIDED. GALLONS PER CYCLE: PUMP AND CONTRO soPERAT oNAL ❑ ES ❑ O DYES ENO (DIFFERENCE BETWEEN NUMBER OF PRO RTV - ELL BUILDING I VENT FRESH FEET FROM LI AIR INLET ' PUMP ON AND OFF) EYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN ,TH , AVETER ERIAL 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 TRENCHES. INSIDE DIA _ S~.PITS. LIQUID DIMENSIONS TE-RIAL: PIT DEPTH. I1 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO qISTR. NUMBER OF BE LOW PIPES ABOVE COVER ELEV. IML¢-r ELEV.E DPROPERTY WELL. BUILDING: VENT TO FRESH / PIPES FEET FROM uiE' AIR INLET. NEAREST--i- 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 cer n that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria fo mediur san TIONS MEASURED. I DYES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH BED DYES ENO EYES ENO DEPTH OVER TRENCH :'BED DEPTH OF 70PS01 L. SO MULCHED CENTER EDGES. SODDED ISEEDED. EYES ENO DYES DNO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH FF LATERAL SPADING GRAVEL DEPTJI BELO PIPE FILL DEPTH ABOVE COVER DIMENSIONSMANIFOLD PUMPDI STRG PIP NIFOLD MAT RIA NO DISTRDISTRPIPE ELEVATION AND ELEV ELEV ELEV PPES DlnDISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING CTLY C R MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED r DYES ENO PLANS DYES ENO COMMENTS: PERMANENT MARKE SOBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING. FEET FROM LINE' EYES ENO DYES ENO, NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE FTITLE. DILHR SBD 6710 (R. 01/82) ` JOB ROHL & TIMM EXCAVATING SHEET NO. OF L 310 Arch Street ~/7 ! r HUDSON, WIS. 54016 CALCULATED BY (715) 386-8664 L- 715) 386-8664 ` ' CHECKED BY DATE _i d SCALE Ale-) r 41- J i I PRODUCT2041 OInc., Groton, Mau. 01471- JOB RORL & TIMM EXCAVATING ` 310 Arch Street SHEET NO. OF HUDSON, WIS. 54016 CALCULATED BY Z G~ (715) 386-8664 ~ ` CHECKED BY DATE-/_0 l7 c.l SCALE l { t-, ✓ _ ' ' • - ' ' c~.~vr-rte U! r - I r' PRODUCT204I Inc., Gmton, Mast 01471. Cl r y _ c~ .a z v ~ v cis D ~ + 3 l ~ o CD r- r- w m i yrY' y a 2 M,, ,0 Di y 0o m W 0 ~ ~ -4 co co to v~ D m c D z p D m n fl) n O p 3 ~Y r m r m Z 76 m m ` D U) -n m z D c? r+ m p 2- _ C') 9 D D m e~ -'m z m O O n O co n Z L) V "z m co ° m p~ m - v ° c z 3 o< C D O W < 4 tz s G i~: D to 6 m z 2 C c~ N CD 0 3 Co V` z m b Q° O m yl m 0 M z pp co O C 3 XO<r < co W V N_ 0 Q 7J 0 0) V co Z G7 U Q C002 cc TJ s a+ + O co -D CY) o m, Az) _,.j Cf) M . "'rl . JI ~y I 1 'fiery' aL~V+y+ 7~~, ''}J I (7 r7 --Tj m _ 0 - ~y m o f a C~ 00 u 10 Cf) v, f7~1' II I~L~:isl t. "?,k~.' rt o+ _ n u a u n ti cr ry -I 7J to n u o -I -1 ~d +?,sJC, auir.~:Ji,..,.,..~w a ro r w i v + .•iN Nag 7 aJ c ~ ~ d ci ~r v CTS •rkt Y p] - ~i U CL L 7 7 N b0 cc 1. o :r Ill. t/ ~u O fn V l~.J ~ °-1 vm ~ ca r j n v ~ M1 Ul ;t VO ) Cl U i CWn t I C <u cll ci, ~cJ U O L. cu xb tff `i N Q u C 0 ;low a o a Tj D 1 0 b ai ~ D V ~ Ll.~ O CLD .S N 1 ~ G U - "J W ~U L 7 _ S ~ J IG r = z 0 r U) COO* r _ C C W Cf) 0 rn CY) N -o o z CC) o 01) :too Do DD m F- -n 111 x Coe,) -a < :D U) m m U) C n. CD m -n CID 0 r r Sts 0 C7 r ~ ~ X °o D C7 _ -I m c-) C) -Tl m ~ . m r Cf) n ■ m n 0 O -n z c .z..~ U) zz D ^ Z / 1 z., T N S N O ~D j a ry 3 y O~ 1 \RMI., a i 1,, Q 3 v m V v ° ET m o z " m w 7 w 3= 0 m '-o C7 m D me me v -f co = ate- a -0 m = v n m= a oo _D o~ a 3 5 E° ~ o -V 0 ° (o - 3 o m Q 3 o D. 3 ~ m J rn A m c C n a N U m Q U1 m 00 d m C m a C ~ ~ ~ ~ 3 3 ~ ~ o ~ ~ m to O c N m = GI 3 °.m c)' m o o N D 3 O co m = ? m m y t 0. c7' m j cm 'za 3 m d a o -v m a f D C~ D - M ° 3 c m v 3 m 171 cn N Q 7 3 m m o m ~ p' O 3 0, Y ° s o m c S m DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABORT&'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 , BUREAU OF PLUMBING MADISON, WI 53707 ~I aJCONVENTIONAL -]ALTERNATIVE IS,,,, Plan l.D.Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE Woodrow McDonald RR# 2, Box 72, Roberts, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST FIEF. PT. ELEV. SE NE, Sec. 9, T28N-R18W, Town of Kinnickinnic Na- of Plumber. JMPIMPRSW No.. County. Sanitary Permit Number: I Henry Nechville 3258 St. Croix 38501 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. EYES ENO EYES ENO UMBER OF ROAD. JPROPERTY WELL. BUILDING. JVENTTOFRESH. BEDDING: VENT DIA.: VENT MATL.. HIGH WATER ~NEAREST"L--l~, ALARM EET FROM LINE AIR INLET EYES LINO DYES ENO DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACP11-PANEI PUMP MODEL PU MPiSIPH ON MANUFACTURER WARNING LABEL LOCKING COVER PROV IDED. PROVIDED EYES ENO DYES ENO EYES ENO GALLONS PER CYCLE: CONTROLS OPERATIONALENUMBER OF PROPERTY WELLBuILDINGENT TO FRESH (DIFFERENCE BETWEEN ROM LINE AIR INLET PUMP ON AND OFF) YES ENO ST SOIL ABSORPTION SYSTEM. Check thesoil moisture at the depth ofplowinil DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. ILING,TH NO. OF JDISTR. PIPE SPACING; COVER JINSIDE DIA -PITS LIQUID BED/TRENCH 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 PIPFS ABOVE COVER EI EV. INLFr ELEV.END . PIPES. FEET FROM LINE. AIR INLET. NEAREST 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 medium sand. TIONS MEASURED. EYES ENO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO EYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCHBEL) DEPTH OF TOPSOIL. SODDED SEEDED J MULCHED CENTER EDGES. EYES ENO EYES ENO DYES 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 VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS EYES NO EYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: FNE BER OF PROF ERTV WELL: BUILDING. T FROM LIN EYES ENO DYES ENO REST Sk etch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 IR. 01/82) DEPARTMENT OF APPLICATION ,INDUS TRY, FOR SANITARY SAFETY & BUILDINGS DIVISION ,LABOR AND PERMIT P.O. BOX 7969 HUMAN -RELATIONS (PLB 67) MADISON, WI 53707 Attach 'plans for the system on paper not less than 8'/z 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. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: ~T .G X -72--Property Location: q City, Village or Township: County: ~ 5 At 1/4 A-__%S / iT )-f N/ R E (or W °--'el""C'elev~e Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING l9 Number of ❑ Public* ❑ Variance* ❑ 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 (Specify) SEPTIC TANK CAPACITY om 1__\ i HOLDING TANK CAPACITY A~ LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: 4Q Cd, ~rc~~cJ ~oS EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): El New °Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit >11\ X ?0 54). /c7- ❑ Alternative (specify) ❑ Seepage Trench fJ Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: M / RS o.: Phone Number: Plumber's Address: Name of Designer: JzT/ cv 4)/ S . COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: /e: fir} Date: 9 APPROVED Sanitarry~ Permit Number: /u ~(r' -~,71f~ J ❑ 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 DILHR-SBD-6398 (R.07/81) Form - S `1' C 100 Owner of Property T .Location of Property 1 Z I~a, Section - 'I' N R W Township , 'q ~y I ~ , t vl yi Mailing Address c Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel / . A. , Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION i 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, ; 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. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED OFPARTMENT Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .IN[~1*,1S TRY; ,LA&7R AND P.O. BOX 7969 HUMAN REL PERCOLATION TESTS DIVISION ITIONS (115) MADISON, WI 53707 t (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO. SUBDIVISION NAME: ` I_ /TAN/R/T E (o W ~N,v/ c kivcoI 4: : OUNTY OWNER'S BUYER'S NAME: MAILIN ADDRESS. S~ C 'Qo Gv oot> /1 c Jc~,v.4 [ /v RJ~ Z 13o X 7< ~Pc~bc .c~TS ~c ~i s USE _ _ DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: P FILE DESCRIPTIONS: PER OLATION TESTS: 1-(Residence ~ N ❑New Replace / - e3 _ HATING: S= Site suitable for system U= Site unsuitable for system V~ ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) zS ❑U ®S ❑U -®S ❑U ❑S NULEI S©U ila ~Up!Dx.4L 13,- 1, 5'Q F7 ,11 Percolation rests are NOT required DESIGN RATE: If any poriion of the tested area is in the cinder s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: i_ F% PROFILE DESCRIPTIONS ;ORING TOTAL ELEVATION DEPTH TO GROUNDWATER ~ r HC ARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH JUMBER DEPTH OBSERVED ST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 716P. Zy ' .A , ~o Y2 N. 5, L ~~.I?,), - A)- SL k 0-n . B SAVD ~QOSE, M4,f/.?/EV wl,, /-c a.~Q Er` rat S' :Uo MOT ~R ~ B-2- 73_ 5,~ 7 i' Mors fee,, 10'~v '64) 5', -/'.1 3. 59~J w, dC` -70 13- 7 ny ~~~~75 of G_S; fr SQL w/ -Q J. Her B-j 1,33 '-19V" ,Q✓ . 3"'l-, r 6 7',6,V, s; c , . ,?3 Z/. o . s,-c. 7 &V, hr-4 . S. 3 , L o CX-,-_j_- 15 B- fT PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES "NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH - - - - z G " wgTe R A6 ~ ,v Z ,E-S S -1 v < 3 P I'A P 3 Z Z- P 14-) LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori ,ntal 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 land slope- ,Qo TTO~( OF lYeP "601V-104) 4~AA G/F &XAC 7-,Y Y O ? f -r, SYSTEM ELEVATION /mow Uri . ~PtF /-'T tir cr-/Eo, Tpo,) F,- 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 ,dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. GAME (print) TES S WERE COMPLETED ON: /fobekT Zi heleG, 6 - S3 ADDRESS: C TIFICATION NUMBER PHONE NUMB Rlo n nal): O .0 E/ L ~j~IJI~SD v S . 5yo& f =61 y~,L - / C'T SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester_ "il-HR-SBD-639518.02/821 - OVER `REPORT QN SOIL 13vRiN,S PERCOLATION TESTS 115 All Poor PLAN PROTECT r.D. DArE- HOMESITE TESTING CO. RT. 3, O'NEIL ROAD BOB AUUSON, WIS.- 54016 C5T -4S- 02 yfZ PROPOSED HOUSE MUsr sic Z~ Fr o,t 4otr "e,4 gzi- rESr fIee,45. PROPOSED weu M vsr we 5O FT off, H p pF F.POti AFL TEST i9,PE~S, • = OAci-*E P,-T3 0 =EXIST/.~1 !r IC~ELG X = ~EQG /oC~1"/ONf = AMAID AvgEQED e,e 54oart cyFS ■ ` //0,.*iz . B M VCRri e, ,t ,QEFEReAXr Pour 5 aMr" /t s d T /?r r P% 11 /,Dk',4,0T A 7XT 14m LE GE N D e/6l/ArldAl of l/Mr. ~PEF. Pr D fr ~y►~AyE a~v ~ FA;~E~ House sysrfM 0 N I 13/ X 36 • x /3 L pl- I i y,~AaE ~ ~~~vc 50 Rr p~~ q PAII i oqp well P PL B Co 7 PLOT and CR o55 SECTION PIA 5 1 I o I I1~ J l j 14\ I j 11 IL ~I i°/f 6 S11c: -GT- r - t y y ~ , % , S t T-)- e.tJ &,VFD (A 4 (r 0A 7 T ~c,, ~lo~ TATS 3 8 6 7- Fresh Air Inlets And Observation Pipe SOIL TesrINg ay MOMESITE TEST.'NG Approved Vent Cap RT.-3, O'WkiL R0,') HUDSON, WIS. ~Y4016 Minimum 12° Above Final Grade M~~,AoA lot- Y)- "Above Pipe 4" Cast Iron Pipe ~c5 o Final Grade Vent Spl Marsh Hay Or Synthetic Covering Min. 2'1 P ggregate ~[10 ~ Over Pife Di:>tributian ~ Pipe 0 0 o Tee A01 c> fr vA4 G Bene gr'ig pe o Perforated Pipe Below l>~ 0 Coupling Terminating At Bottom Of System