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Parcel 042-1071-80-300 01/19/2007 08:39 AM
PAGE 1 OF 1
Alt. Parcel 26.29.18.404F 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/25/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MORRIS, ROBERT O JR & LORI LYNN
ROBERT O JR & LORI LYNN MORRIS
1309 CTY RD TT
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1309 CTY RD TT
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 19.270 Plat: 5054-CSM 20-5054
SEC 26 T29 R18 PT NW NW BEING CSM Block/Condo Bldg: LOT 01
20-5054 LOT 1 (19.270AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-29N-18W NW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
08/25/2005 804399 20/5054 CSM
07/26/2000 627090 1529/465 WD
07/23/1997 709/502
2006 SUMMARY Bill Fair Market Value: Assessed with:
149607 Use Value Assessment
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 30,000 170,500 200,500 NO
AGRICULTURAL G4 11.000 1,800 0 1,800 NO
AGRICULTURAL FOREST G5M 5.270 7,900 0 7,900 NO
Totals for 2006:
General Property 19.270 39,700 170,500 210,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 10/30/2006 Batch 06-18
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
Owner Worrall, Gecrae
Co-owner
County Permit 161
State Permit 18779
Permit New
Issued 08/27/1981
Installed 09/17/1981
WI Fund
POWTS Dispersal Non-Pressurized In-ground
POWTS Detail Bed- Seepage
POWTS Pretreat. NA
# of Bedrooms 3
Verify Info
Add Notes Add Maintenance
Record Change Status:
pamq 1/16/2007 2:05:05 PM
q6L/6
• AS BUILT SANITARY SYSTEM REPORT
OWNER dt N `t c, ky2 TOWNSHIP tx yV`FN SEC.;.?.-, T;~y1N-R(l~
ADDRESS ST. CROIX COUNTY, WISCONSIN.
SUBDIVISION LOT 121LOT SIZE J
PLAN VIEW
Distances and dimensions to meet requirements of 1163
W_ EVERYTHING WITHIN 100 _F1?1'T OF SYSTEM r~...
TT,
9
i
J
_A II
Cf
I di ate North A r014
SCAT 1' :
✓Z~'~-~~~'''~'
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: /00' Slope at site: SEPTIC TANK: Manufacturer: . Liquid Capacity: /r
Number of rings on cover : /V,n;L:-:: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Number of gallons
Manufacturer: 1 '4
Number of gal. pump setj or a ge gallons; total capacity o
distribution lines gasize of pump head;
gallon per minute powe r brand name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer N ber of gallons
Elevation of manhole cove
Type of warning device
m er o pi eet diameter
SEEPAGE PIT SIZE: Number-of-
feet liquid depth seepage pit inlet ipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines y width y ' lerigthtile depth
SEEPAGE TRENCH: width length
PERCOLATION RATE AREA REQUIRED ISI S- AREA AS BUILT 1/o
INSPECTOR
DATED PLUMBER ON JOB P
LICENSE NUMBER__? S~
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969` PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
MADISON, WI 53707
Planl.D.Number:
CONVENTIONAL ❑ALTERNATIVE I S Halatauigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
74-VA 0M Lif
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N DATE: Li /l -j
John Graham RR# 1, Roberts, WI
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
NW-14 NW4Section 26, T-29N-R18W , Warren Townshi
Name of Plumber: MP/MPRSW No.'. County: Sanitary Permit Number:
Henry Nechville IMPRSW 3258 St. Croix 34781
SEPTIC TANK/HOLDING TANK: 3 1/
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL LOC G C V
4 ) J P O IDED: PRO DE
V/ / PClY 3 YES ❑NO Sr NO
BEDDING: VENT DIA.: VENT MATL: HIGH WATER UMBER OF ROAD: ! PROPERTY WELL: BUILDI : VEN, T F SH
EET FROM A f r+"~ LINE 3
1 t /Y ALARM: Al~rNEARE
❑YES NO 1~• ❑ S
Tn J(Y''
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIOUID C 91CIT~. UPM L. PUMP/ SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
~ _ PROVIDED: PROVIDED:
❑YES ❑NO l ❑YES ❑NO [:]YES ❑NO
WEL BUILDING VENT TO FRESH
GALLONS PER CYCLE: PU VAND NTROLSOPERATIONAL: NUMBER OF PROPERTY L
(DIFFERENCE BETWEEN FEET FROM LINE AiR INLET
PUMP ON AND OFF) ' YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check lesoi ols re atth depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (if soil can be rolled ' to a re, c nstructi n shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH JNO. OF DISTR. PIPE SPACING COVE
JINSIDE DIA #PITS LIQUID
BED/TRENCH D TRENCHES 1 MArl .AL: PIT DEPTH
DIMENSIONS ~t1011-..?
GRAVEL DEPTH FILL DEPTH DISTH PIPF DISTR. PIPE ISTR. PIP MA RIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: V NT TO FRESH
BELOW PIP~jS ABOVE COVER ELEV. INLF I ELEV. END -7 PIPES FEET FROM LINE r AIR I~NLE T.
A 2-5 11 NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular tq slope
00 Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound 'systeniIs to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑N(J
SOIL COVER TEXTURE ( PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENq /BED..' E OF TOP 'IL. SODDED SEEDED MULCHED
CENTER. EDGE, !
' ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. F LATERAL SPACING (iHAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH THE CHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD r DISTR. PIPE MANIFOLD MATERIAL INO UISTH 10:STRPIP DISTHIBU 110N PIPE MATERIAL & MARKING
ELEVATION AND ELEVELEVDIA ELEVPIPES DA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DHILLEO COHRECIt Y MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ONO 7 ❑YES ❑NO
COMMENTS: PERMAN;kNT MA; KERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE
DYES INO OYES ❑NO NEAREST
66 Yz)
Sig 2-
c.
33S
12.17 Sketch System on tain in county file for audit.
Reverse Side. _
SIGNATURF TI LE
D I L H R S B D 6710 (R. 01/82)
DEA9"-rMENT OF APPLICATION
IN,f ? R'Y, FOR SANITARY SAFETY & BUILDINGS
LABOR AND PERMIT P.O. BOX 7969
HUNAN 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: MailinAddress:
T-l ,y ~ CC t,yt- /7 " i,- A)o fJ - t5 s
Property Location: City, Village or Township: County:
%S V /T ,-,-><I N/R /S' E (or) W 5 G r c.- i x
Lot Numb r• Blk N_o::_ Subdivision Name- Nearest Road, Lake or Landmark: State Plan I.D. Number:
!1/1 (If assigned)
TYPE OF BUILDING
p' / Number of
Ppblic* ❑ Variance* ❑ Other (specify)* .AAzt ~ ^ 4Z`- ~ ) Bedrooms:
Le 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 y;;? 5 YE 5 27i
41~~ Al
c
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: ` j
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ New R placement ❑ Experimental Seepage Bed ❑ Seepage Pit
//l - / 5 7 S -f/,- ❑ Alternative (specify) ❑ Seepage Trench
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
rivate ❑ Joint ❑ Public ; e-
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: MP/ _BSW No.: Phone Number:
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
igna ure of Issuing A 99.0t:
S i ary Permit Numbrr:
. e Fge: Date:/
PPROVED
XIA
G~ (l''~~ % ❑ 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)
jo j,A/ 1 <e~ c//>rr>'r~~~s. - , ~',ykT y stt~~x9y. %E`///t~@97Gil~s .26°F fc _3,3 `f.
I N
DEP TRY, OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
DSTRY c DIVISION BOX HLAB-UMOfl AN
REDATIONS PERCOLATION TESTS (115) MADISON W 53707
W (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
,V td 1/a '/a 26,. /T 11 N/R E (or) W e -,v cAtf, ,177 6o 46-e. r4,A l
COUNTY: OWNER'S/BUYEF'S NAME: MAILING ADDRESS:
St GRc/X r~a,~,a Tr PT is, X13
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ❑ New xReplace
f
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: JMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(op onal)
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:
l~aPl~-)- PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B ICE7' 9T- "/~U .6y 1.3` /3N, S'd (Wer),& C'f° 13a. 5L-) '
19-2" 4f - 4 NAf2 p 51- op, , S As- Re4, 9c l- - St t RLrE- A r'
~,J .-C y S;c 13 ;'Ai'k c? a HAeD, M*5'$-Ce SL e°.
Fr f
Ik- Ni'X• .5L -4 S rug' h0
(Q B 03: l1cFr /-0/® ✓ ,'fsN.- x. n_, 13 8'j. SiL_, I~a~1>~ki>, ~ , xs~iss:t~ C~k. SLR ,
-3 Am ~
ec0.f~ SZ- W•~ wig SeLr F1LHS 19 m, P-0s.
r,A! (yy, 5 , 13a. 5 do H,440.O4y, ?1- 9 r y R+P- of
B- //0 12 "
AJ B-✓~^ / 6yo lot. 2 %/00 f?~' 4A! -6y- Sit. ~ 4J /3,i1. sr`[ , " 14iJ. /'o•~. i (lif'
lxiu'F OF LAN. AK'V HAa.Sr vr S,L (j9%) A.-
~t 'Tl~'t 'a2 It~id(n ~C>C~fJS Of 5ei le
B if"E~'Wl~.l~iXCO lcA.t>a b~hSQcv' (y"6~tJi'CNt laGu
PERCOLATION TESTS N~'rs SLAY f~'LMf aQc4lb- ~C/~5 Lz3 dl.
A.-Re- P--PH, i,v l_EE_T
/i~v~ -GR-Gti ~tiA~r~RI MAID f .
7
TEST DEPTH WATE HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTE WELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH
P 76. F 6, G, r~ fZ
P--2 0
P- U 710- J; &
P- rf
a
P- (0 V ,S-Q 3Q 17-71
P-
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 show their location on the plot plan. Show the surface elevation at all borings~"arld the direction and percent
of land slope. f3c)/~/1~~ .~~r V6Xj1l,4Z Pte .
SYSTEM ELEVATION P'4,0i F Al., 21"'
6
PL w' P-D = Ff"EL
woo fAd ~Y- Ins rf o~
RE~t~ncf
jqc,,,,z, 139
RFD t t~a® . _ ' - ' Ic>zi
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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 the location of the tests are correct to the best of my knowledge and belief.
.At -,o 7EsT-Ey iv &yOoi)4l`T DLIF rt' 110r1_-11V t- OR '51;r r"oei3T/~ v .
NAME (print): TESTS WERE COMPLETED ON:
Co. d a $1.2 q /I
HOMESITE TESTIS
ADDRESS: RT.3, ®~NEI` ROAD CERTIFICATION NUMBER: PHONE NUMBER (optional):
H
6>c e A V4 r1dy +~vT C ~~i CST ~ SIGNATURE:
wyx emT/4)6- f~RAPE !vi// A'Eyr~/APE CuTT/Vt, ^ b/1 AL
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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