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Parcel 26.29.18.400 042 - 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 JAMES W & RUTH O'CONNELL O - O'CONNELL, JAMES W & RUTH 1367 CTY RD TT ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1367 CTY RD TT SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 26 T29N RI 8W 40A NWNE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 884/163 2006 SUMMARY Bill M Fair Market Value: Assessed with: 149596 Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 30,000 178,500 208,500 NO AGRICULTURAL G4 36.000 5,700 0 5,700 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2006: General Property 40.000 35,800 178,500 214,300 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 35,800 178,500 214,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 114 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 ° AS BUILT SANITARY SYSTEM REPORT OWNER +ed H 5 *,y r-~ TOWNSHIP SEC ' N-R ADDRESSST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 F9ET OF SYSTEM F, C.c', r " , e ^ 4s" 7J 3 f t 41 i [ ! t Ia-, It di at N r h rrc w ! ? BENCHMARK: p (Permanent reference Point) , yDescribe: Avl° Elevation o vsertical reference point: j Slope at site: 7 SEPTIC TANK: Manufacturer: ,/y, Liquid Capacity: _/~jl~g Number of rings on covert -Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons _ Number of gal. mp set f a cycle -gallons; Total capacity of allon: size of pump head; distribution 1'n s ZA gallon per min t horsepower- _ ;brand name of pump and model numb r Type of warni g device HOLDING TANK: Manufac r r Number of gallons Elevation of manhol over Type of warning de i SEEPAGE PIT SIZE; Num o pits _ feet diameter feet liquid depth---- see e i inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length tile dept SEEPAGE TRENCH: width- length PERCOLATION RATE AREA REQUIRED -AREA AS BUILT 94G" rG, ~LINSPECTOR- DATED- __.u- PLUMBER ON JOB- - LICENSE NUMBER j_; ,1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &.Hf.)MAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON; 53707 Fy~ CONVENTIONAL ❑ALTERNATIVE IS,,,, Plan LD. Number. (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. James O'Connell RR#1, Roberts, WI -Y BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. JCST REF. PT. ELEV. NW4 NW,-4, Section 26, T29N-R18W, Town of Warren Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number_ Henry Nechville 3258 St. Croix 43712 SEPTIC TANK/HOLDING TANK: MANUFACTURER . LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER ^7 ,j PROVIDED PROVI ED ) ~V ES LINO F:1 NO BEDDING. VENT DIA.: VENT MATL. fGH'WATER NUMBER OF ROAPROPERTY WELLBUILDING JVENT TO FRESH LAM'. FEET FROM ~~y LINE.u5~ AIR INLET. ❑YES LINO ( ❑YES NO NEAREST 77 .li w~l DOSING CHAMBER: MANUFACTURER BE DDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFA R WA ING LABE,~,. LOCKING COVER P yAFJftS"°'' PROVIDED: ❑YES NO 1 J YES LINO ❑YES LINO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL. r M F PROPF [I'LIF BUILDING (VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN E OM' PUMP ON AND OFF) ❑YES LINO N EST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing L£ TI{ DIA TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until F E the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR. PIPE SPACING. COVE INSIDE DIA #P11 S LIQUID _ BED/TRENCH / TRENCHES ✓ M4F TAL I PIT DIMENSIONS f 5'2 6 X 77 GRAVEL DEPTH FILL DEPTH DISTH PIPE DISTR. PIPE DISTR. PIPE MATERIAL. O S NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BE LOW PIPEb ABOV COVER ELEV INLF r LEICV~ END PIP. ? FEET FROM LINE AIR INLET ✓ r* NEAREST--s- ~7 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. ❑YES LINO SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WF ILLS ❑YES LINO ❑YES LINO DEPTH OVER TRENCH: BED DEPTH OVER TRENCHL BED = 1 TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES LINO ❑YES LINO ❑YES LINO 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.. DIA. ELEV. PIPES DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES NO COMMENTS: PERMANENT MARKERS: TB SERVATION WELLS: NUMBER ~OF L OE ERTV WELL❑YES LINO ❑YES LIN FEET EARESOJ 4 1 Sketch System on in county-file for audit. s Reverse Side. TITLI SIGNAT D I L H R S B D 6710 (R. 01/82) ■ DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, - FOR SANITARY 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: Property Location: City, Village or owns hip: County: /V 411/4 Nl S -2 T ;27 Ni R E (or 451y C x Lot Numb r: Blk No.: Subdivis'o re: Nearest Road, Lake or Landmark: State Plan I.D. Number: Y ! L yV,* (2 tk -7 (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: P'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 ~0 YF re HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: W E S G ,VCS EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA r~~ / (Minutes per inch): PROPOSED (Square feet): ❑ New L~r hieplacement ❑ Experimental P Seepage Bed ❑ Seepage Pit 6; /s ❑ Alternative (specify) ❑ Seepage Trench 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, MP PRS No.: Phone Number: Plumber's A ress: ,p Name of esigner: Kok o6~f?~S COUNTY/ DEPARTMENT USE ONLY Signat re of Issuing Age t: Feef/: Date: pp APPROVED Sanitary Permit Number: ~1~(O 11j'-F3 (DISAPPROVED 7- 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) 1'u rw - S '1' C 10 0 l Owner of Property--.... .Location of Property V ti 9 l ;:k 7 N h W Township_ HP,5,/ Mailing Address Subdivision Name, Lot Number Previous Owner of Property l1 L~~ Total Size of Parcel s-~ p Date Parcel Was Created Are all corners identifiable?-Yes` No Include with this application one of ti-le followi(iL: .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. ` ; 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 f the County Register of Deeds, as Document No. SI ATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICAULE) AAT- E bIGryE DATE SIGNED Wisconsin Department of Industry, INSPECTION REPORT Labor & Human Relations P LB_ 1 Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection remises Date TT-an-T.D. No. T Street City oun y Sanitary Permit Master Plumber Firm Name dress Journeyman Plumber Address Owner Address iscusse 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 REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS N INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON W 53707 HUMAN RELATIONS A) (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. I SUBDIVISION NAME: ti 1/4 1/4 .2-Gv /TN/RIY E (a (c~~}RREV ]/~O ,,Jre COUNTY: OA ER'S/BUYER'S NAME: MAILING ADDRESS: Its %-11S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence a N1, ❑New Replace r7 f . ?3 ,~C.5" 5-LT L . , sA0vy ~SUh57_1 ,17-/'9 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ! X 33 - Es ❑ U ®S [:1 U ®S ❑ U El S D U 1:1 S❑ U UPI 1,+J/ 0v/_ &TV C~/ 5 a T . If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.1163.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 2zf- 14.) )~I_- PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN f'. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 117 51"4, -F' ~6v .6y. s-4_, .75 sue, I CJ I / 7 ' A4 7E Alf 1,t1 13,9,v 1) S o r U 4szu~ - E/ ©f Grp ' ! SGL rS /`.AMr`~t~i2 v R Fu~ B Vou PSr 4'04,~a S;Pe-cv,41,z (;ua 40111 iuG- B- . 1/ S4- i r ?3 "Lam. J. SrL , •P3 3A). L .S ' OA B- l~ 10,3 y - > /.V? ' L lf'e . 13,q v,P5 of 44 G s T,4Ati, 7AAeP . S . S ' V G S 4"v Pad G-k . B .6 , '-MAJ J . S &1;jY_ G5' UCA--e--~S . tom ' 44" SeL , -75- 444 o-y S%4, S%I-, 167' o,p..S B V d'~ ~~1 0 > w.' Cx 3.F39tio0- j34A;A of -62S LS orP. h~.S" PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTER SWELLING INTERVAL-MIN. PERIOD t P IOD 2 P RIOD 3 PER INCH P P- P- 6'- f2 X_ o'f,Tt A2 SAT/U C /A/ ; P_ ~cSS 6Q ~,r va E~ P_ GFs S o1 r'-t i.V J t 5- PLOT PLAN: 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 Tshow their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~A4 t)F /34FP SYSTEM ELEVATION Cod- F /Se a"TicfL /Pe-1cL-,ec-ve,F Pe /,,j i ldi4` m . ~~tA, C7 C5, /Ief 7 i 3 r t r a r f r ~ 1 E t . I ~-,Tr1 a N . i , E . ; - - _ ffflj tlteAMROVW' ; . a septic- 1, p11813vfY1, E ,E r 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 the location of the tests are correct to the best of my knowledge and belief. NAME (print): (,vn TESTS WERE COMPLETED ON: ADDRESS: HOMESITE TI . CERTIFICATION NUMBER: PHONE NUMBER (optional): Fty.3, o'HEIL ROAD 2_ 4;,T-L- 13,P6 'RUDSONr Wis. 7401 T SIGNAT RE- C DISTRIBUTION: ` Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - s;a."1 .a,.:'~§ a k,7 .~i3NinL a s=,Yt 9t1 f_ `.a s YOPU i`,f!ooo n, " .T pfetC° le gel dem =Yr€olY ; h a.-'a nrlke,! irl(hc is a:er this €V r1 ~ ..,iE~:,t?;E` or £:+:i§il,ll£„_ ..,~s~ project', C !:B€'{{aE~€r7 Yt';.> or C;-m-n YIi'.rcial Use - ;S ~ I9S r"l, rY€.L".° ~'3i" t'€ ~Yc~GY'Y4"Y'rYt .4y5€-a`7,tr C { 1.,;:a t„=ct.7? t, ±,r r SITE i H?AL s,_ i? i.ta_ }:1V€'?,(7s1 !F AL_E. 3 Y- Ef" Y S- ENl , F' fl~ t.I irva` 1 'S',E i _ N Si- I C" C) If) 1 TI~a C~ NS; r-"LEASF" uscl €he ahbi. Bat ions .'jic„i n for .k€ a? o. .?t:: 'fc sc cE t:,oris and completing, thie f-.)IClt Plan IMIAKE A LEGIBLE diagram, , _culat~3, focatir3 " Y"-)~ur- tost (,calicknr. Drawing to scaie k prefel md. A s mt ite s+ k'(~-r may b~. rMsil cup; t the ~3lift ~ . i E E . , Sw Ovu+S 0") tWy R- r G -are, iv ? oa6'i1 _ B . Siir B! t F r I v, fit. s_ >r € r~ 5€'l 1 e k .4r t .F 0 . ?(ctE. ~)3 =E3s 2 - AYE. DEPORT ON SOIL BORiN&S I PERCOLATION TESTS l iS PLOT- PLAM PROTECT f. D. lCTI Cry: 7F DATA HiC)MESITE TESTING C4). O'NEIIL ROAD B0.8 A' A PROPOSED Hwsc.- Mosr L'E 2~ Fr• o,~ ~D.fE FpPOM t3L~ TEST f~~QE~45, PROPOSED we a M V5r w E- go r-T o~ ,~p~F F'Ot-t ,gL~ T~'ST ~j,PEf}S. S LEGEND 7- r Ao~ A 3Y r Coo AGO ~Jt ~ Ct pf-k,r b ,fit I AA4 . V ys x°-33 I zb~' I i CC, VA) en r ra ~-_3 f. - _ _ t y T T, ! 1 P 'Ala ell S -r1 G- ~-_P a