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P AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC . S N-R W
ST. CROIX COUNTY, WISCONSIN.
ADDRESS G%,~) / V
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Glil //714
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Ii di at N r h rrc w
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: ~ Pv' Slope at site: ~
SEPTIC TANK: Manufacturer: /UL'~~4 _ Liquid Capacity
Number of rings on cover 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
SEEPAGE TRENCH: width length /
PERCOLATION RATE / AREA REQUIRED -REA AS BUILT S fir;
J r INSPECTOR _
DATED PLUMBER ON JOve<• i ~z
LICENSE NUMBER__e~CSGi1--L-01J
CERTIFIED SURVEY MAP
SW 1/4 SW 1/4 SEC. 5, T 2J N - R 18 W
~
WARREN TOW I I SHI P, ST. CROIX CO.
W 18"CON SI N
.
OWNER ; GLEN E. FRANCIS
NEW RICHM0ND,WIS.
SURVEYOR: MARTIN;E. HALVORSEN
HUDSON, WISC.
N 89 ° 38' 00" E
367.00'
a x 7190-
190 0
z ~ c~2
-j 1.955 ACRE O
2 O O
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F- N N
w IiD~8A8~EO~d01PP
90 o PAP
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o} MARTIN E. Y.
o 367.00' -
HALVORSEN i
Q 90
° of O : S-1302
0 2 - HUDSON, s
O ~ O Az-
Lo ~ WIS. ~
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11- _ - O 2.020 ACRE E e
DC O N0 S U R m®O
w z o O 2 0= s,~a,efleoas
Z tV N 1--
N N
V' O DATE; APRIL 15, 7
1 ap 3a 900 REV: 4/ 17/77
r (n i N 89D38'001' E 2
1 367.00
°
Z 90, y cV 0 2.020 ACRE O
co
9 1
o oo
33' ® 367.00
S 89 ° 38 00" W i~
M
q TOWN ROAD
-LEGEND
,-I I/4" X 24" IRON BAR, MI N. \NT.
1.13 LB. PER LIN.FT.
0 100 200 300
SCALE : I"= 100, (SEE OTHER SID
E
Surveyors Certificate
I, Martin F., Halvorsen, Registered Wisconsin Land Surveyor'
do hereby certify that by order of and under the direction
of Glen I+rancis, I have surveyed and clapped the property
described. The plat shoran on this sheet is a true and correct
ropresentation of the exterior boundaries of the land surveyed
and that I have complied with the provisions of Chapter 236.34
of the Wisconsin Statutes to the best of my knowledge and belief.
RLS 1302
D3 s cripti on
A parcel of lard located in the SWf SW 1 of Section
T 29 N- R 18 W, Warren Township, St. Croix County,
I-Tisconsin described to wit:
Ccmmencing at the Southwest Corner of said Sac.
T001# E
Plorths assumed bearing, 59 Thence
33.00 ft. Thence l1 89° 38• e •
D3.00 ft. to a 1 1/4" iron bar located on the Easterly right-of-way
of an existing town road and the point of the beginning of this
survey. Thonco conti0jM!~jgalong said right-of-way, North,
620.00 ft. to a 1 1/4" iron bar. Thence 11 89° 380 00" E,
367.00 ft. to a 1 1/4" iron bar. Thence South 620.00 ft* to
a 1 1/4" iron bar located in tiro Northerly right-of-way o2`
an existing town road. Thence S 890 380 00" W9 right-of-way 367.00 ft. to a 1 1/4" iron bar and the point of
the beginning of this survey.
°j This parcel contains
lands used for town road 5.995
purposes.more or less including
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41
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HUDSON,:
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UST Y, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
USR DIVISION
9
_ABGR AND PERCOLATION TESTS 'N
!~INiAN RELATIONS (115)
(H63.09(1) & Chapter 145.045) M -O N: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIV Sla \ NA
sw sw~/ 5 /T 29 N/R 18'f CE
(or) W Warren r - i, -
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ;j,
St. Croix Tim and Sue Roodell Rt. 2 Box 189A New Richmond, 540Y6#
JSE DATES OBSERVATION E
N'Mrilz
O,BEDRMS.:COMM FffC1ALDESCRIP T~- L9-15-$ON RCOLA'1410N TES
(X~Residence 3 ONew ❑Replace 04/30/83 0/83
IATING: S= Site suitable for system U= Site unsuitable for system
'ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1N-FI LL OLDING TANK: RECOMMENDED SYSTEM: (optional)
ES ❑U 0 S ❑U ES ❑U ❑ S EU EJS aU Two trenches to accomodate slopes.
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
IORINGI TOTAL DFPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
\IUMBER DEPTH IN, ELEVATION OBSERVED ES HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 78 100.9 None > 78 11" dark brown sil, 13" brown cl, 6" sl,
48" med s
B- 2 69 93.9 None 69 11" dark brown sil, 18" brown cl, 40" med s to
B- 3 77 97.3 None 77 12" dark brown sil, 12" brown cl, 43" med s to
cs 1011 red sc
B- 4 60 93.1 None > 60 8" dark brown sil, 3" brown sl, 41" med s to cs,
811 red sc
B- 56 102.3 None 7b 13" d rk brown sil, 15" brown sl, 26" med s
" es r " red se 10" med s '
B 8" dark sil 16" brown cl 43" med s to CS)
- 6 67 100.0 No ne ) 67 @ 6711 red sc
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DRQP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERT D P R PER INCH
P_ 1 35 N.A. 3 5.14 5.14 5.14 4 1
p. 2 3 NT.A. 3 5.1 5.14
<1
P-
P-
P-
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,
;YSTEM ELEVATION Trench No. 1 @ 97.4 Trench No . E 4 95.7 '
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4 I Sep, sheet 2for sketch
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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
Aministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
AME (print : TESTS WERE COMPLETED ON
Thomas E. Swenson _ 04/30/83
,DDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
Rt. 1 Webster, IdI 54893 2153 715-866-8445
CST SIGNATURE:
/ `J c7YJ Q ~ d Gt ~Ylf ch
,ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. j}1c7At 1 Of 2
)ILHR-SBD-6395 (R. 02/82) - OVER -
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Sheet' 2 of 2
ED Tim & Sue Roodell Perc,l
W April 30, 1983
o v Located in SA, S"v
, Section 5, T29N, R18,,4
N rv ~
4 b~rJ I~v NM 0.1
Wisconsin Department of Industry,
PLB=1 INSPECTION REPORT Labor & Human Relations
Safety & Buildings Division
Bureau of Plumbing, Platting & Fire Protection
Name o remises Date an No.
Street city oun y Sanitary Permit
Master Plumber Firm Name dress
Journeyman Plumber Address
Owner ress
- -
Discussed with signature
( )See Attached.
DILHR-SBD-6192(N.09/80) Signature o is Plumbing up. On-Site Waste Specialist
White-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Party Green-Owner
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR HUMAN RELATIONS
P.O. 131;*1159 , PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
Mf;DISON, WI 53707
2I1 CONVENTIONAL ❑ALTERNATIVE Sl umber
Holding Tank In-Ground Pressure 1:1 Mound 11 1 igned
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Tim Roodell RR# 2, Box 189 A, New Richmond
BENCH MARK (Permanent reference p-d DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PL ELEV
SW SW, Section 5, T29N-R18W, Warren Township,Glen Franic
Name of Plumber.
MP/MPRSW Nn. County U 1 V . Sanitary Permit Number:
R. Hopkins 1059 St. Croix 38450
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIOU D CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCK( CO
/ ^ ^ / OVIDEO PROVVI O 17
0
nNO UO(r`I YES ❑NO LtAS NO
BEDDING: VENT VENT MATLHIGH WATER NUMBER OF ROADPROPERTY WELLBUILDINGVENT Tp FRESH
ALARM FEET FROM LINEAIR,`?
❑YES t ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFN(,TH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER
BED/TRENCH INSIDE DIA
#Plr LIQUID
DIMENSIONS 5~, rREN Es ? M vlA : y PIT l j DEPTH.
Z
GRAVEL DEPTH FILL DEPTH U TV PIPF DI IP DISTR. PIPE MATERIAL: N0 R NUMBER OF PROPERTY "ELL: BUILDING: VENT TO FRESH
BELOW PIPES Ae( . E )eR ~r EL N PIPF
-7 FEET FROM LINE AI 'NLE
NEAREST-- ► -5~
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-
❑ YES ❑NO meets the criteria for medium sand. PIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH: BED DEPTH OVER TRENCH .'BED IDEP:THOFTOPSOIL SODDED SEEDED: MULCHED
ICENTER EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH 0, OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA ELEV.' PIPES: CIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO U l ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WE NUMBER OF
2J PROPERTY WELL BUILDING.
5,1 FEET FROM LINE:
❑YES ❑NO ❑Y NEAREST
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Sketch System on Ret in county file for audit. Cir `7•(
Reverse Side. GC C) 4
SIGNAT TITLE.
DILHR SBD 6710 (R. 01/82) ~ ~ _
DEPARTMENT OF APPLICATION
SAFETY & BUILDINGS
INDUS'MY, FOR SANITARY DIVISION
LABQR ANC' 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. A legible reproduction of the soil test report or the owner's copy must be
included.
Property Owner: Mailing Address:
Property Location: GMX,-VWFlege-or Township: County:
t/,- iT ,;2° N/R (or) W 1,9
Lot Numbe : Blk NoA.- Subdivision Name: Nearest R d Lake orLandmark: State Plan I.D. Nu er:
~ / (lf assigned)
TYPE OF BUILDING
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
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: Z,
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): New ❑ Replacement El Experimental ❑ Seepage Bed El Seepage Pit
3 s~j jQ ❑ Alternative (specify) Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
'Z~,Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signa e: 1~/MPRSW No.: Phone Number:
Plum er's`AJddress: Name o Designer:
COUNTY/DEPARTMENT USE ONLY
SqL; f Iiinnng~Agent ! Fee: Date: ~ ~f~ .LAY gppROVED Sanitaarrry Permit Number:
G /-V - V - ❑ 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 T C 100
1 Owner of Property_,
~
Z '19
ahG~w /
Location of Property SLy Section 'I N R W
Township
r
Mailing Address
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 a lication one of the following.
Z--Certified Survey Map
.Deed
.Land Contract, or
.Other I:agal 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 two) 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. -_-'_1 2presently own the proposed site for the sewage disposaLsystem 1or~I (we) have
obtained an 0asement, to run with the above described property, for the
construction of said system, and the some has been duly recorded in the Office
of the County Register of Deeds, as Document No.
t ~ y
SIGNATURE OF
ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED
DATE SIGNED
♦ M
Parcel 042-1012-10-000 10/16/2006 08:31 AM
PAGE 1 OF 1
Alt. Parcel 05.29.18.75C 042 - TOWN OF WARREN
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
MARK D, & PAT A SCHLIEF FRANTA O - FRANTA, MARK D, & PAT A SCHLIEF
1002 110TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1002 110TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.020 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R18W SW SW LOT 1 CSM VOL Block/Condo Bldg:
2/546 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
05-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 868/01
i /
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/19/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.020 37,500 131,600 169,100 NO
Totals for 2006:
General Property 2.020 37,500 131,600 169,100
Woodland 0.000 0 0
Totals for 2005:
General Property 2.020 37,500 131,600 169,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 105
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
,SI. Crnic Count}' P[amiing and Zoning
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