Loading...
HomeMy WebLinkAbout030-1028-20-000 n CO C O co 0 m o It C I 1 Y) w Z O la I S ' N v N C .. Z A O CO fn. O p W C lD LS. N w 9 1 a. > > _. m w' p p y V O w • N r i a ° �' m voi c o c $ C h 7 a' fD I N O. ] N 'D N co O 00 c en 3 O p 3 fi O C Oh o ! p ir CD co owl c C m a c l cfl D y c f � l C W p `� O I 3 a o Ks 1 N i 14 W .0. O p l � r O Op a 1 N (j W ! i—�'A c I N 0) ppj (A 0 c �voi a v o Z P O � N� 3 tntntn �1 y (yt� cr $ o' 0) O _O" c I3 to to O D .s �l 1 CD I o ^' 1 a p� C i Z QT Z 1 D u o 0 o s o CD m o D m ) y N• a o m a w p m 3 m x a CD aft a z Z m h 3 =i y O I O .7 S cG7 ..► v � =� y 3 a �Zca CL v I�� o a m a �� Im�� CL ++ Z 3 ° re, �? 3 m N c ID n afa o' m y g 3 _ '� �� o o� n fDm o 4 3 N3 N = o a I `�° `� ( m 3 'a aC `� CD �0. p°'� m d n Z 0 3 C f a N CD a M a N O CL O p o ON I m o c om 0 CL O V d rra cr o o � rn d 3 co o � J N � A 0o W a H IU M to H ('Q C/) C/) U J Wiscons'n De¢artment of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499154 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Waggoner, Charles I St. Joseph, Town of 030 - 1028 -20 -000 CST BM Elev: Insp. BM Elev: Description: Sectionrrown /Range /Map No: /Oc) BM � N\, \ - 8XI 07.29.19.107131 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 102 -le Septic Benchmark /i91! C/ /P» easing Lit � Alt. BM Aeration 5Z 3 Cw _' L - IIS� _ — Bldg. Sewer C Z J Holding �'� ` St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 7. 6 I b Z • 1. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5 t ! 5 i Dt Bottom Dosing Header /Man. ia.3 9z 3 Aeration Dist. Pipe Holding Sot. System 1 //--3 ZA 3 3 PUMP /SIPHON INF ORMATION Final Grade Manufacturer Demand St Cover GP /, $ /67. Model N er TDH Li Friction Loss System TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / i No. Of Trenches, PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -pZ I � SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: t INFORMATION CHAMBER OR Type Of System: i / UNIT Model Number: tCo",ZJ t 3o J �( > Zod IJ Q v ► c.. DISTRIBUTION SYSTEM Z3} -- Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) \ '*1 -;;, /S / Length (P Dia I f Length ` Dia \ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 7 Bed/Trench Edges \ Topsoil Yes -j No \Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 Inspection #2: Location: 1090 Trout Brook Rd. Hudson, WI 54016 (NE 1/4 NE 114 7 T29N R19W) NA Lot 1 r Parcel No: 07.29.19.10781 1.) Alt BM Description = ��a J✓5 {�Dt�i�..j �� 2.) Bldg sewer length - amount of cover= I S o + �:t) Plan revision Required? Yes \ / No Use other side for additional information. Date Insepctor's Sig ture Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County tr 201 W. Washington Ave., P.O. Box 7162 �> �GY© r� �sconsR Madison, WI 53707 - 7162 Sa»i Pe t umber (to a filled to by Co.) Department of Commerce (608) 2 66-3151 _ JS Sanitary Permit Application State Plan I.D. Number In accord with Comm $121, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project A ress (if different than mailing address) I. Application Information - Please Print All Information - - R r-u � X O fi Parcel Block N 1 roperty Own is Nam S E D O 5 Zn ` 7 C• c x I U 1 �. Property Owner's M ailing Addr ST. CROIX COUNTY Property Location 4' �..� j �Q ��►- el _ e o tk, - 1 A.Section City, State Zip Codt Phony a Number T II. Type of Building (check all that apply) - 1 or 2 Family Dwelling - Number of Bedrooms Subdivisio ter CSM ?\umber V. ❑ Public /Commercial - Describe Use _ _ — ❑ State Owned - Describe Use _ _ - DCky Rtownship o ere l i t 1T. Type of Permit: (Check only o ne box on line A. Com plete line B i f applicable) _ _ Replacement System _ L TreatmendHolding Tank Replacement Only ❑ Other Modification to Existing System (A f I B. ❑ Permit Renewal ❑ Permit Revision ❑ Cnange of i7 Permit Transfer to New List Previous Permit Number and Date ssued Before Bxpiration Plumber Owner 1 - IV. T ype of POWTS Syste (Check all that apply) No e -Pr s urized In- Ground ❑ Mound ? 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter w �) Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Fitter i ❑ Recircu Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less P L Other (explain) _ f V. Dispersal/Treatment Area In form ati on: _ Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) llispers Praposed (st) System Elevation VI. Tank Info Capacity in Total Number Manufacturer I Prefab Site Steel ? Fioer Plastic Gallons Gallons of Units I Concrete Constructed I Glass New Existing Tanks Tanks _ _ _- Septic or Holding Tank Aerobic Treatment Unit Aosing Chamber VII Re sponsibility Statemen I, the Uii ders i brted, assume re_spoiisibility for allatio of the POWTS sho wn on the attac pla T Plumber's Na me (Print) Plumber's Si gnature _ , ? P N Number Business Phone Number Gp 3-1 al Plumber's Addre ss (Street, City, State, Zip Code) VIII. County/Department Use Only _ _ _ Approved 11 Sanitary Permit Fee icludqss G Date Issued Issuin Agent Signaru e ' Stamps} i Surcharge tee) , L en Reason for Dental IX. Conditio pprov 3 SYSTEM OWNER: ER. � f Ate. 5�+� S C aG•eQ I ' 1 Septic tank, effluent filter and dispersal cell must all be serviced maintained as per management plan provided by plumber. 2. All setback requirements must be maintained "- verr $�a.� t � • s �as per applicable code /ordin _ Attach complete plans (1a the l'ounty twlyl for the syste on pape`not less tb 1/ x 11 f s e O• 2— orrri 4-4'90 �1v� rn , 2v '3111 DX3 NIM-lt� ll�$SW� FROM :S LUMBING FRX NO. :7153863121 Sep. 06 2006 07:58RM P1 09»8.08 TUE 13:18 FAX 715 386 4886 ST CRI CO ZONiN6 lg;vu� , lJ,r..�•�r - ; f J� I r{ irgre J, Q J6 ; re . / � y v 1 h , � O k ar ° i i { "� a: FROM :S LUMBING FAX NO. :7153863121 Sep. 06 2006 07:58AM P1 9/03.06 TGE 15:98 F.-Al 71S 986 488d ST CRI CO ZONING q6 s� �` B All e 4 4 A-Yo" J I, t fl ir t� fro a 1 ti 9 , Is I ' ---r jr T 0-. 21 0 pyk AOF 8f P 0 J �L t� 6l a ��3 a ' R A LD Wisconsin Department of Commerce SOIL EVALUATION REPORT Page (_ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions north arrow, and location and distance to nearest road. Please print all information, R vi ed by ti Date - Personal information you provide may be used for secondary purposes (Privacy Law, s. 4 (1) (m)). Property Owner Prop Location A l ct- c, d G Govt ,1i.- 1/4 &E 1/4 S � T " N R E (or� Property Owner's Meiling Addre ZO Lot # Block # Subd. Name or CSM# �( SEP 0 city State Zip Code P one Number X C 0UN Y❑ C' ❑ Village OTown Nearest Road +� L-J( S CI ( CRDi _ + ❑ New Construction Use: ® Residential / Number of bedrooms 3 y Code derived design flow rate y SZ _/to GPD (g Replacement { ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: Sys� e /� " V' J U ( arc 1 Cf 6 Z 4 Boring # ❑ Boring ® pit Ground surface elev. . ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 I p —j t .3f 3 -(r - Z il - c Y / ( m r^ C 's , 6 3 q© - 81 m Ll T Bering # n Boring p pit Ground surface elev. ! �� ft. Depth to limiting factor - ,u -L— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 G- S'/ 3 '2"'S 4 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOO < 30 mg/L and TSS < . 30 mg/L CST Name (Please P' t) - ature CST Number CX y Address Date Evaluation Conducted - Telephone Number Property Owner UJ61 (A O A t' Parcel ID # Page Z of ® Boring # [� Boring u� pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. I Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff #2 Z- F-1 Boring # n Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 Baring # B t F ring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPDlfF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = SOD, > 30:E 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L She Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD-8330 (RAM) f to PAaa — E— OF ,.�._ N AME WCLG LOT# L. AL DR CRIPTlQ Q/.�% 8 T N R $ OR 4 i r I aM 1 E LEVATION IBM ! DasanipTioi+ SM 2 ELRVATION SM 2 Da sc RlrTiON SYSTiM E L IfVATio 7G u �Vrn! U� ✓� SYsTSM ' r v px oil i i i 4 7 L ' 1 1 D ATE $lQNATtaRSIGNATURE '' -- u STANDARD CHAMBER Qu1ck4 Standard Chamber _ _ _�__.. _. _ _---- -.. ^ -- 421" - - - -- ___ (EFFECTIVE LENGTH) 12 f „ I� 1 1 1 r> �ii'_ 1 i — SIOF VIEW 34 —� SECTION VIEW — - -- — MultiPort End Cap �. %. ...__._.__ .._— 34 "--- - - -•-- — —'—" SIDE VIEW TOP VIEW FRONT ViEW t2" an kultiPoit'•nd Ga 'Nominal S eciticsitions� , r_t Quic Standard CiiatmberKOMI ai Speciiicatians� �, � 3q x S 1s' x 12" Size ;W x L x H 34 " x 52'` x S ; iXe W x Lax H� - 4g" invert Nei ht 8' or 1.25 "_ EttBCtive L ength - -- --- --�--- --- invert Height a' 4NFILT OB �`CST_�,1 F�1C. a$TAI" PIR& -L�M1T �BfIF K . r , N I ,.!, r n i.. k v r -, iv nm,ar rr ni:dr.. wuUW arN /Nner ACR'eFtfirJ tWw .r tnrl Vllnl Il,.p {MtJ'Ma In ��i 9� a lew Iwo. '.o,iC 3ystgrr n, Acr.r.',anfN won rw.t atrn z inYl Kl Wn3, !. 0 4etN1[. symot vv ihn lA v; t vrlcrl, .. 9I al anr, W(k N 7 1) Ilx ,fl,h y11a Attu 1M'A; t'late tmg wariifl y {lfrk,(t wa �0 °�'t .M' 11Ala 1t1Ar U *I:gIaINN Uf IM eM,l +. lyelA, CC^ Me^'rN � • - ;!,� a ieptir uer i; ,1 rgtr,xrerf try BOWICdh'B IAw � �. ate Moacw,Y.,.ulnla M (Jxl StlY�'Ok, f nrrycEcul w.hln Moen (15) � O f 11 ";o ilttlrlBr rIW5t fptlh/ IIIRItrelPf NI WfM nL UNTN'r InU ..Atl14r1 YdYrranrl n To .z,..c.,se n� wa ar, reolecemrn!r tlr.rs , rn „rts aaas.n,a,Ad r ndltralrx to bBn[,w[ra1 M t- s I amxrW A , '!' t arlr' Btdn7ln S( r �By 9a�tu17B51r1B COSt rd rf[nTTib flrklr�' ^ "8iagalNn RF (d 0 ,1m15 Vtr illl•IFFl WARf�nt�ilE i W(r/ HF.;i : SYSTFM i �+ v � 5:1 Kl,A4 M WARFAY �YANC ,Al[wAFlAAMIESOF+AER(:HAN.AG TY0R�F1 Wurt5tViiA ANl:7.kAF � E1111✓ 1 F ,$ �w "Ut1w r.. TI 11(L.ltf�r. INl ll Citri Ni)tAhPt, r edl 11nT Ltn itwl W.'J: gttty 4w, 1 N>•:. tatnba` SY�eT l5 nlanlllar:flJrerf i y nr�01t r � � .��Ier111amM!!tu nr.LlAmg M%xr � sl U. vc'd ;1 MW t>0A o ,- ;Itrva snap acct he a1.IB r F r �dcWr or afry ttlkd trativ Srrrsn: efn' Park �tOad ' t • gOX '/ fJ6 k 4 t yr o i,• dr r rYRb v d. sC BCl/ x n M Bct O�nelF s ' ' net ce, aburn a nng eel of 6 BuSdte3S Pa nj ,; A tN. 'M.C1 GM1.I Is wi,l(p nr(1 r1AIMk4s. ove(tteBd t5 fn the th,d6 •IoA tU CKr.KCr'1tBfY S IBRr,C1UlrieM1. itt ;IrjrAN, ,e: IgIIYM tP raNrMaM ;Mi h V 1' p�id7 f� c'vaegB nAr tliu ,age d r:onF wn�' :are not :nnrtdrlwel hJ `tra At'Jtdpet'etl IrotrUgl "7 s, 1 0' O ld Setybrook, v 1 V V c r1h1t . ntM Ii:antY errl :(xpAr A,B �. F AX pC1, G .,ul Irp ar o ve}IPM frAIJIC ar rrlildr tA7n �e f11A0e90d. ar tfrlpr�I!r! ntl�rAllm' r,r C' • F AX pV V - d % �-7001 rt n rI1J , g'>✓^. nR , iEtt fMn,n 1`t9Ine7ell3tbn i'IStNttlorts ihA c 0 w�+ we1W ` Wg• WiMR la t tb'ri17 ge torch 0% to t.r+atae � t7 -7000 c nx :ute ,u ;mproaer eMlnp a U^trorr� 9 g' I lna NnVkr it�1e to cc *nuN ,EMI n le 4 r`..115 ,>i qX+ fAM y5' NO Utnited War w" J�•71'1576 ' w kdul Flo pcvn r8lo nikn 7 nMt 800 -227 -4436 V:arra y y nrr IMkg, a FltYf 11tkrf peftY raeWle!R t t aon,rdb!cn Xr kN arty 1(M6 !)f CIBrnB]B In it'f' r�`r� ; ^.�. r uttha n n;r evCn. ;tY In;,a aa+ tre tt!<i �,: eRy tnaA t7a'!Y• nr Mq i.rrruait Warl erny ro eyph'• tt^B r]htl61M'•S'M ingltlMBd tr4c1 ar y , dt h ala W . crakes of Fwo : a , of yr BPO C y 71B bws: urd LNUI a1rN'e ;netaMaNw �Y1n� liti3la bC21 ti0C9 141 81ny an'. 00 owl the erq t rgquilOd'JY NIis LGnMrYI Wean.•:y Mwontr'aY arq'a� u rtdtr�,a has it» alAl'IOrMY Io chat �yB a Bxtetd 'id�N01�'J'estlttativrd ....... warolNyrecplko N glpl� 1tN1 fAlrtRfe:l ltMe r'•'te'2ltl ny 11010e A It{ndrxi r"r+tktP" lurrhAea, 10 obtut a i WantAgy .PpNd by InINnBla. u#l "� f1ri F',VrNr%>k. G.'INKA.lw1A. error W' 4 t re (lucre rovIo" nl" c',rn0ant u,MW Ste neOW il.ya , �rNle. r •�;�!1 .M Urals gnnui0 cMg7M r�hgt &rdtMY tNK^ 10 Iht :nr'• '. ,, M'rr ,tv' warranW, eM gFlWllr nutty of lttA AWWC�calr'e - {�� n 6 r rfl(3,7715.f 53 �.fS aA d '1 Arrr.L 5,5 alcrceea 17', 5.A01.11E. �, G , new Ire,'. a+ .156 aE�t, 9.33f�r0 VAN-to• ' kin ,= tgi1L6, cut, V4 e, r9 , 3au ais. ?.Ot a.sBa other natentg pentl ng Inc 11114111 m a tcrt;i6te'ic l , ,111k tx p0.4! nGk, �l tCk c • ^• "y'� ": rac} k COMM."$ of at<xttaeor ,,�slcn '; 10, SMut tusk. Gnartlt,sitSq�B „ - .tdt: c,lor. En'.'•o. -e• and ylpgW;ntler are r9g,Sle rnitlGN0m. NM.lol.r'�Ut•r »1Q. POIY C ,.:, rarrstered trarit not m 104"w, iiOnItA14 Cv'itour Svvtvet W f,1 b SA _,. 7 l 7M9 InfdIrRlOr ucAiP: �11G. Pf Mtt •r II ST CROIX CO &A a U I PLANNING & ZONING FAx MEMO DATE: TO: G I L-L Sct,F" ` >w ' Code u -386 0 FAX NUMBER: 8 3% Land Information Planning F ROM: �(-,J/AJ 715 -386 -467 FAX NUMBER 715 - 386 -4686 RealP erty PHONE NUMBER: 71 6 -4677 R cling -386 -4675 NUMBER OF PAGES, INCLUDING COVER SHEET: RE: 1 ) Nees c� cq-A tCot 6,^ co r T ) i T 73 WAZ i\. . /a aw s Sr &OIX COUNTY GOVERNMENT CENTER 1 10 1 pgmicHAEL ROAD, HUDSON, W 54016 715.386 FAx PZ @CO.SAINT- CROIX.WI. S WWW.CO.SAINT-CROIX.WI.U S ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the C - t,,j.A46W62, residence located at: 1�G _ 1 /4, NE 1 /a, Section , Town Range / ' W, Town of S -. - Taw/+ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly: Most recent date of service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): (Licensed Plumber Signature) (Print Name) (Title) (License Number) MPIMPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page — of FiLE INFORMATION SYSTEM SPECIFICATIONS Owner Permit ft Septic Tank C apacity f �$' �j gal ❑ NA I- Septic Tank Manufacturer ❑ N A DESIGN PARAMETERS Effluent Filter Manufacturer Z � � O NA Number at Bedr ❑ NA Effluent Filter Mod el p NA Number of Public Facility Units Q NA Pump Tank Capacity l 90 1 0 & ❑ NA Estimated flow (average) al /da Pump Tank Man W ��Se.� DNA -- 61 01 Design flow (peak) ( Estimated x 1. b C3 d gallds Pump Manufacturer C.s �, d y ❑ NA Suit Application _H 7 •�' al /da /W Pump Model ❑ NA Standard Influent /Effluent Quaflt Monthly average" Pretreatment Unit _ q Fats, Oil & Grease (FOG) ; s30 mg /L 0 Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (SOD,) <_220 mg /L ❑ NA 0 Mechanical Aeration ❑ Wetiand _ Pr Total Suspended Soli (TSS) :51 mg /L ❑ Disinfe ❑ Other: etreated Effluent Quality Monthly average Dispersal Cella) ❑ NA Biochemical Oxygen Demand (bop s30 mg /L Kin- Ground (gravity) ❑ in-Ground (pressurized) Total Suspended Solids (TSS) s30 mg /L ❑ NA Q At- tirade ❑ Mound Facal Coliform (geom mean) 510 cfuiIo ❑ Drip- 0 Other: Maximum Effluent Particle Size Y in dia. p NA Other: 13 NA Gther: V ❑ NA Other: ❑ NA ''✓slues typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event S ervi ce Frequency Inspect condition of tank(si At least once every: mont (Maximum 3 years) O NA N years) Pump out contents of tanks) When combined sludge and scum equals one -third Q of tank volume D NA Inspect dispersal cell(s) At least once every: 3 Y 3 mont (s) (Maximum 3 years) ❑ NA Clean effluent filter At Least once every: © month(s) At ears) C7 NA Inspect pump, pump controls & alarm At least once every: ,�,WT ❑ months) ❑ NA _ Q year(s) Flush laterals and pressure test At least once every: ❑ month(s) El NA _ ❑ years) Other. At least once every: M Q month(s) p NA O h yoar(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber: Master Plumber Restricted Sewer; POWTS Inspector; POWIS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, 'identify any cracks or leaks, measure the volums of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal ce!I(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface, The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the focal regulatory authority. Whan the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, 'including but not limited To the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. I •epoZ) 9AijVJjS1u,wpy ulsuaas!M '(£) lB (Z) 'I t)v9*c8 pup U)'i?(p1l t)l911Z)Zt'£$ wwo, aidtgz) 4um eauviiduiu� u, P94ujP Senn luawnaop Ra4l euoyd suoyd (Vj (v .�_11YQ 7I) ( ;� eweN aweN UMBER Av 1VOo`i {t13dwnd) >i01V83dO ONIaIAl13S 30V1d3S auoyd l'C r �-- 8 5 L au eweN �T�7 S ��. {T 1 e weN a3MV1NlVW EMU a311VJ.SN1 91MOd S1N3WW001VNOLMOV '3181990dW1 WO 11AOIAM 38 AVW ANVI t/ d0 t1011131N1 3H1 WOW NOSa3d v d0 mom '11fiS3a AVW Him '830NV13WA0di0 ANV MWA )INV11N3W1V311J. d3H10 uo dwnd 'OLLd3S V vaIN3 ION 00 'N30AXO 1N31ownSNl UO /GNV 93SSVO WHIM NIV1N00 AVW SXNV1 1N3W1Vll I a3H10 GNV dWnd '011d3s < <oNINUM> > 'aw1l le4i 1e loo; ;D uI solnj e43 yilM Aldwoo isnw $W eiSAS 4ons ;o suolianjlsu000H •aoe ;.ms aAllejil!jUI a4i ie lewolq a4i ;o IeAO B UIM011o; soe ld ui pe 48nj39u o oe i eq Aew swelsAs uoladjosge itos apejB - pue punt ' 'S1MOd PORN 841 a0eldej of ijosei luel to s Dllei , q Aew 4, Uel 6ulpio4 a algg)leAV sl sole waweoeld9j ou 11 'ee1U luaweoeldej elgeilm a sleool o; pewjo ;jad oq uollenleAg ails pue I!os e S1 MOd 841 ;o ejnl!e; uodn 'eeje lue wa oeldej elgellns a A;!luapi 01 oelenleAD us iou se _9 041 {� 'S1MOd P011e1 0 41 eaeldai of tlossi 1991 a se pollelsul aq Aew I ue; Bu a e Af30 ou ae 1 1 1 , P! 4 I 4 S -PAOd ul seouenpe Buuj9g •suoliellwll l!os jolpue Kaegtav of anp algel►ene iau sl sale luewaasldal algellns y C7 •swll W41 le ioeoe ut setnj 841 41 1M Ald woo isnw swalsAs luewaoeldad 98je luswooeldej e1gellns a 4 01 u01lpnlBA9 oils pue [lot Meu a j0; pest, 041 ul i)nsej II!M ease i va w ea e ldej syi 13910id of sjnlled 'sIIDM pue 0 eu11 401 'ajni=ls pesodoid pue Bultelxe woj; sjoegies peimbej Aq uodn paBulj;ul aq IOU pin042 pue uopoodwoo pup sauegjttiastp woj; paiostojd eq P1no4s vois i vawsoeldej n4L uta1SAs uolidjosge I!oe luaweoeldej a ;o uolleool 641 jo; pezll►in 0q Asw pue pelenlene ueeq 8e4 eaje luaweoelde elget +.ns V ❑ :weisAs lueweoeldel iuelidwoo spoo a OP!AOjd of `uo> e aq i snw jo 'useq SA94 selnSe B uimollo; 94i pojtede) eq icuueo pue s1! S1MOd 0 41 {1 NV1d AON30MIN00 ye!je18w P1109 1jaul j84loue jo IaneJO '1!as 41iM pelll; eaeds plop 04; pus penawej sjenoo ,1941 jo panowej pue pst aneoxe aq IIe4s slid pue sjuej Ile 'Buldwnd jai ;*y 0 •jolejedo BUIOIAASS eBpideS a Aq ;o pasods!p Apedoid pue pah0w eq Ile4s slid pue slluei Ile jo s 941 0 'peless s6uluedo ad psuopuege syi pue peloeuuonslP aq ile4s slid pue spool of Bu!d!d lid a :apo0 BAlle11SIUIWpt/ UISUOOSIM '£>r'S$ WtUO0 jeide4o yiim aouelldwoo uI pouopuege Ale ;es pue Aliedwd st weis" 044 48141 ajnsul 01 uellel aq 11949 sdels 6u1MO11o; 041 001AJOS ;o ino u j91 Atiueuewjed sl jo/pue sl!e; S1MOd 941 u04M 1N31ININOGNVBV euuq jsueuos jolem pue :s uodwe4 'sui ldeu Aiev 'soplatised :sionpojd Bunuted '110 'suoliea!paw 'sdejas leaw :saptolgje4 :eseaj8 'eullos06 ts6ullood algsleBsA pue iguj 'ja tdwnd awns) uteip u ollepuno; .191 'siue)oe;utslp 'sjade!p :evol; 1elusp !sjoseei6sp !SgeMs uolloo ,swopuoo :silnq a11e1e610 :sediM Aqeq 'soijolgllug :S1M0d 941 ;0 spi 941 buolojd pue aouewjojjod 941 9AojdWl Ae w1mle J616MG499m 0 41 ww; BulMOpo; 943 ;o uolleulw11e jo uollonpea •veje uolldjosge llos opeid jo punow Aue ;o edols uMop 19919 t u141!m gem a4i 'wedwoo jo gjnlslp e9lMje410 10 'jsna )ped jo enlj tou o0 'sllea lesiodslp pub sllttei JOAO 9010140A 1ljed jo DAIjp lou oQ >♦u91 dwnd syi u!43IM signal IeWjou ajoisaj of slojiuo0 dwnd a44 8ullejedo A11snuew ul islsse 01 jeulelu4eW 51MOd jo :egwnld a l WOO jo dwnd iuenl; ;e e4i al jeMod Suljolsoi of joud jolviedo SwaIA1eS e6eideS a Aq peAautej 11ue3 dwnd o41 ;o ciustuo0 044 ene4 uol3enl!9 $141 pions o1 ivanl ; ;a ;o e6je4oslp uoe ;jns jo dnjoeq eyt u! 11new Aew pup (sjH40 soy Su p8oljeno 'e90p eBjel Duo ul 19)I)ea Iesjedslp e4i 04 pe61e43slp eq 111M jewmeisem sseoxe e41 pejolsei si jamod ue4M 's)ansl 4840m40I4 lewjou 9AOge Ill; Aew sl uei dwnd seBelna jeMod 6u!jna we ;jne 9Allel:4l 841 It uezOJJ 6je suolllpuo0 )I09 us 4 M inaao i au 0 do Uels welsAS -*on bi jolid jolsjedo Bula►Ajes Qbw4des a Aq penowej (s)jluel 941 ;0 si u81 uo a a4 9Ae4 patoalep 9je suollv4usau00 4 h '(s)II90 jusjadslp 943 obewep jo /pue 36e0ojd xuawieau v4l 9pedwl Aew 194l sleoiweyo je410 jo slonpojd bulluted ;o aoussajd e4l jo; ( WOUJI844 110940 S1MOd Dui 10 esn of joljd uOQ3nj1su03 Mau jai 10 abed N0I1Va3410 GNV do Midis ST. CROIX COUNTY" SEPTIC TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � �� r I � S �. r n �,� l� � Mailing Address or vk Jr r>1C D iQ /f�.rl, •. w� ` G� Property Address /2 l ro � ��rpo ��o1a � 5y 6l t. (Verification re ed from Pl &. Zo nt for new nstruction.' � � � Tkgarmte co I City /State AL0,11, W _ _ Faucet Identification Number L ' CAI, ESC jPR. ON. Property Location t /4 , �� ',/4, Sec. R 7 , T R F N 11': W, Town of ` + Subdivision �.�D' , I'ot # l Certified Survey Map # 3 ' , volume C�L Page #F sS Warranty Deed # -- , Volume Page # - Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE ADQ OWNZR CEit C QN Improper use and maintenance of your septic system could result in its premature failure to handle astes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. Wlwt you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Cor.un. 83.52(11 and in Cltapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification t'orni, signed by the owner and by a master piumbet, journeyman plumber, restricted pl u im or a licensed ptunper verifying that (t) the on -site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Vwe, the undersigned have read the above regttitements and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Department of Commerce and iho Departmnt of Natural Resources, State of Wisconsin. Certification stating that your septic: system has been maintained must be completed and rest med to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of tnyiour knowledge. Fwe amlare the owner(i) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er of bedrooms ! �1 Q(4 SIGNATURE OF P ICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. 4 ** luclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map If reference is made in the warranty deed . 6 RL4. p8 1t15 STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED KAT4LE OF WAL SS Document N V01 1U19PAGE umber 30 ST. CROIX c o., WI RE This Deed made between Gary E. Nourse RECEIVED FOR RE CORD s incll a RECEI E 4 R AN UARRANTY DEED Grantor, EXEMPT N and CERT COPY FEE: COPY FEE: aC joint- s tenant -c TRANSFER FEE: 930.00 RESDING FEE: 10.00 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsi (the "Property "): Recordin Area R E TURN TO: �' Name and Return Address Burnet Title arl s M. wa oner 7550 France Ave S. L'nda Melro First Floor 1Q 0 Tro t Brook cad Edina. NIN 55435 xuds n, w 54016 POc ,t Closing Centr l ©1_ rG3$ 030 1028 20 000 Parcel Identification Number (PIN) This i (( 1 s ll ho d property. Lot 1 of Certified Survey Map in Volume ^2", page 525 as DocuA 3452 1, recorded on December 7, 1977. Records of St. Croix County, Wisconsin. Abstract Property. Together will all appurtenant rights, title and interests. none Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except Dated this 30th day of March 2001 (SEAL) (SEAL) ry No se (SEAL) (SEAL) WENDY SWATZINA AUTHENTICATION NOTARY PU STA Signature(s) State Of Wisconsin, 1 68- St. Croix County. authenticated this day of Personally came before me this 30th day of March , 2001 , the above named Gary E. Nourse single TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me (mown to be the person who executed the authorized by §706.06, Wis. Stats.) foregoing trument and knowle ge the same. THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 01 -05938 1301 Coulee Road * 12_ d t Notary Public, State of Wisconsin Hudson WI 54016 My commissi01>7Ient. (If not, state expiratio date: ( Signatures may be authenticated or acknowledged. Both are n ) not necessary.) =k-- Names of ersons si ing in any ca parity must be tYp or rinted below their si ature. WARRANTY DEED S S isconsin ga B an o., nc. FORM No. I - 1998 Milwaukee, Wis. CERTIFIED SURVEY MAY 2Tpsf f so�oT' +s' scwk` . is sEfT rl - �2 i t it8f Titus r 4ARili6 �(`� _ V D a we um 4 '1 0:. s t�' WW+LwtT£D LA#0f)3 # VOL. ! ,PAGE 449 VOL., 142? 8 D4 # • IG7 #.Ot' # - Uf: ti lt : 64,18L. ai , z ISOi T '4 . Y r + SAO• -. _ � p+ 14 E � � � O + a: 4 � a ' 4M Ate$ - _ raFw'-tpagms� -aaoFp # a q s�er, uapLStTEa N E .' NE 3 L GENU This_instTusent drafted EXISTING FENCES by. Japes T.. Swanson. :SECTION CORNER, FOUND • P: IRON PIPE, WEIGHING 3 /01MBAL FOOT; FOUND 2" IRON FIFE FOUND, WEIGHING 3.65 # /LINEAL FOOT NOTES. ALL OTHER LOl' - C01MERS STAKE.I� NIT 1" x 2A" IRON PIPE WEIGHING 1 .- 684(bI #Eli. F40 _ - OiVNER StIE7ltViiH3R , a� xt.�tt� Mlt�CiR8l�/Vf�IQ1�1 'DbDt tA�A1i IIPP1lCVAt::.: R. RZ PAD srit 8r!'itC HUDSON W S C,caMM 54016 aEAG 7 W t r Jab: No. 71-8+{€+' AMMS Viewer Page 1 of 1 F,rf V 1 AR IMS/Ma Frame.as ?PIN= 9/5/2006 httpa /72.21.230.178 /website/LRPorta / C p p a r 2 $an i7 - - L =r 0) � � 0 ) io I »a— za .0 wf, @� d\B 0 CD '% ƒ2; ` 7\ Q \ �> � § § � ¢ ' \ 2 E c _, Z \ / "-ftft-4 co Q & & !T c . / o o o \- „ / t % CO) 3 / § { (j) / 7 \i 8 2 ■EE�" ® k (D ® z ■ � \ m ¢ - � 2 � m ■ v z ' k G � � ; � ■ � G a ¥ $ ƒ w M : 7 w E to $ z § e / 7 N £ ,q � f \ c ƒ0 % § ICA 0 \ CD § / � A q � 7 f CL \ 91 0 ¥ < � 8(D � �2 0� ST. CROIX COUNTY ZONING ICE � Z� �� U7 5/ St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 I The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion gL this for J& gssential $Q that tIM property can I, located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 t� (Determines if system is properly functioning at .*time of inspection) PROPERTY OWNER'S NAME: PROP ADDRESS: Zo 9f, CITY - Legal Description x_ 1 /4 of the X 1/4 of Section _ , T ° N -RZff_4<,2 Town of Lot Number / Subdivision: s 1W 1 � :fir -ozv�f X676 FIRE KMER �� �,ei LOCK Color of house Realty sign by house? If list firm: / ./Oc.e�/ z ,, ` 12 �JC_c e-, 7 -- PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT HOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services. Q =� Telephone Number I,- /1 - 23 REPORT TO BE SENT TO: CLOSING DAT : z z a; o Signature 0 y9 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street .Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion %t this form Ja essential A2 that g property V= bg located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office,'and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION ----------------- FEE: . $25.00 I� (Determines if system is properly functioning at.'time of inspection) , PROPERTY OWNER'S NAME: _7 << •� -J c� i( < �-L P PROP. ADDRESS: to 90 "i w 1g rU�� l� /2 <�/, CITY Legal Description ,x_ /4 of the 04' 1/4 of Section 7 T ,,z v N -R 2.: 2 Town of j. Lot Number I Subdivision: FIRE NUMBER lr yr LOCK DQK WMER Color of housed n �Realty n sig by house? If so, list firm: /J.- irli�k' /c' c -el !J� !Ci ✓r'/ V J� t� (n � ^ ✓'[c� / /v. - /�.*.0 Lv / P.tr 4�/'v�l PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SKEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: ����, -� Telephone Number L-/-L -711- - w, 3,c, •,3_ _ REPORT TO BE SENT TO: CLOSING DATE z a; o „ Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE 4 t l SrY , d+� Yp 'S t I }} � ST. CROIX COUNTY COURTHOUSE 3, in 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 Apr. 24, 1992 Fran Fisher Eastern Heights Bank 7525 Currell Boulevard Woodbury, MN 55125 Dear Ms. Fisher: An inspection of the septic system on the property of Gary Nourse, located at 1090 Trout Brook Rd., Hudson, WI was conducted on Apr. 23, 1992. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. in erely, James K. Thompson Assistant Zoning Administrator cj I o ° © \ cu ? C ( £ t \ \ R ° 0 m § a 4t ( @ � r k_% oƒ /\/ o t E $\ 7 . Q 7 e® m% g 2 § 2 M :z ` ® (D > 9 ® 7§\�a 2 \ /\\ ) 8@ 2 7 3$ Q\ o \/ J \ ( \ \ ! E & c c < a ■ � / / CD r aJ ) 2 \ § a g a > «B\ Sm 4 j\ � ° CD § \ \ ° ° k V z J o J ) \ �• i 2 / O � § � 7 � j j j / � ( Q a w i T o o Gƒ ®$ a E a\ 2 ° k : w / i f § 2 0 g } / \ } �. m ) @ CD m § § / } / ` ` { § E ƒ I Q 2 J \ z \ ■ ; m g i g } \ / $ o r \ \ \ 2 - ƒ \ G ± \ w m Z \ / % § 7 ( . � 9 x \ ? cr CD > « f 0 a : < \ % @ ? \ % � Parcel #: 030- 1028 -20 -000 01/04/2006 12:44 PM PAGE 1 OF 1 Alt. Parcel M 07.29.19.107131 030 - TOWN OF SAINT JOSEPH 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 - WAGGONER, CHARLES M CHARLES M WAGGONER C - MELROSE LINDA S MELROSE LINDA S 1090 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description * 1090 TROUT BROOK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.960 Plat: N/A -NOT AVAILABLE SEC 7 T29N R19W NE NE LOT 1 CSM 2/525 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 04/16/2001 642915 1619/30 WD 08/25/1999 609200 1451/401 TI 07/23/1997 647/204 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 83349 371,200 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.960 128,800 208,800 337,600 NO Totals for 2005: General Property 4.960 128,800 208,800 337,600 Woodland 0.000 0 0 Totals for 2004: General Property 4.960 128,800 208,800 337,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 301 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 34525: 1 K 01X COUNTY j1 cvn kafol CERTIFIED EY MAP cr o , n N 89 38 E 2 ?Qol6 69.14 a: 914' 70007'16" z: a� o: W; W >: W y tr :>: 1-: W N' o H SCALE IN FEET o: W W: 3 a: O 01 z: a 0 200' 0' 20V W TRUE U: iv BEARING —SAN W 0 W tJ� lO v W ocn 1j °°oa�a o� ° S E — " SE - c W 04 C <D 2 — Z Z rte N N ✓.�� J O o $ se1j " �� ° "'� z Tr 3 a J W CA S Go O �� _j I a- + C ' V N W: OIJ �0 NORTH LINE O NE 1/4 1�, oQ a a p CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP 1 I N O: O UNPLATTED LANDS VOL. 1 PAGE 249 VOL. PAGE 127 , „ 6 6 { 1 I , S8 44.65 14W IS 3 6�4 I 12 71.8 2' I 648.24' z 1, N 10 0 9* 4 14 POINT OF x 1 a: 33.00 89 04 14 E S89 'W 3 " 10 ` 3 {� 9 O BEGINNING �� 3 0 1 J co iv v W 0 ao = 11: a 0 2 N I Z d °°10' nj 1. W'� M 4.96 ACRES p M 4.96 ACRES >- M o O t -� H: o z a _ a 1 a a:z: O •''� S 88° 4 ' 10" W (PREVIOUSLY RECORDED g N a a 1: z o h r O 1296. 8' AS S 88 � ? 1 $ 648.29 648.29' � ' 333 1 / 1 1 6 6' Jf ir t UNPLATTED i LANDS t I ................ J ...... t1r W cn f•- NE— NE 3 LEGEND This instrument drafted EXISTING FENCES by: James T. Swanson. 6 SECTION CORNER, FOUND 1" IRON PIPE, WEIGHING 1.68 # /LINEAL FOOT, FOUND 0 2" IRON PIPE FOUND, WEIGHING 3.65 # /LINEAL FOOT NOTE: ALL OTHER LOT CORNERS STAKED WITH 1" x 24" IRON PIPE WEIGHING 1.68 # /LINEAL FOOT OWNER & SUBDIVIDER APPROVED APPROVAL OF THIS MINOR SUBDIVISION JOHN E. SCHIMSCHOCK R. R. #2 DOES NOT MEAN APPROVAL FOR HUDSON, WISCONSIN 54016 D C 7 1977 BUILDING SITE OR SEPTIC SYSTK REFER TO H62.20. ST. CROIX COUNTY COMPREHENSIVE PARKS PLANNING AND ZONING COMMITTEE Job No. 77 -846 Vol 2 page 5 (over) * 8 AS BUILT SANITARY SYSTEM REPORT N FZ ot" TOWNSHIP SEC. T2yN -R jtW "RESS CTILX �QN T Y WISCONT� t 4, w SUBDIVISION LOT J LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i a. e 3 z t i s r h rr w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: ! 3 , Slope at site: (D /m 0 SEPTIC TANK: Manufacturer: Liquid Capacity: 1,9 ,0 0 Number of rings on cover : L-1 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- 1-0 length 42, tile depth SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED �'- Q - �� PLUMBER ON JOB o-t ..t LICENSE NUMBER T. P. Qa? ? 'DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &,HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P'.O: BOX 7969 1 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D. Number . El Holding Tank El In-Ground Pressure ❑ Mound (If assignetl) NAME OF PERMIT HOLDER: I ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Gat Noatse 2290 13th Ave. E., N. St. Pau. , M `f /7ff y 1111,4;�, BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.. SE, Sec. 6, T29N -R19W, Lot 1,Ridge Bnookjown o6 St.Joz h Name of Plumber: MP /MPRSW No.: County - . Sanitary Permit Number: Steve Aaby 5184 St. Cnoix 43643 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY - . TANK INLET ELEV.. TANK OUTLET ELF&, WARNING LABEL L":NG VIER PR V ED: P L . YES ❑NO ONO BEDDING: VEN .� VENT MATL: HIGH WATER NUMBE F ROAD: PROPERTY WELL BUILDING IVENT T TO FRESH ALARM: FEET FROM �O LINE ^ DYES NO � /� Al INLE ❑ DYES ONO NEAREST ..�'/ // DOSING CHAMBER: MANUFACTURER. BEDDING; LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO DYES ONO I DYES ONO GALLONS PER CYCLE: AND CONTROLS OPERATIONAL: PROPERTY WELL. BUILDING: I VENT TO FRESH (DIFFERENCE BETWEEN fi C? uNE AIR INLET: PUMP ON AND OFF) DYES ❑NO ARE PUMP SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing GTH I IIIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall cease until FO E the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: �r WIDTH: LEN T NO. OF DISTR. PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID 4 7171. 2 TRENCHES- AL: PI'j, GRAVEL DEPT FILL DE H rSTR, PIPE DISTR. PIPE DISTR. PIPE MATERIAL - . O Dl R NUMBER QF LINE, TY WELL: BUILDING: VENT TO FRESH 104, 9 BELOW PIPES NEAREST ABOVE COVER PV I T. ELE V. ENO. PIPE -' LINE ..y. AI INLET �j FEET FROM / _C Z ( -- ^�- ---► / .0 N MOUND SYSTEM: Mound site plowed perp s ope Check the texture of the I material fo PROVIDE A DIA RAM OF SYSTEM and furrows thrown upslope: mound systems to mak rtain th it i4'E1�SESIDE.SHOW ELEVA- meets the criteria for me sand. TIONS MEASURED. DYES ONO SOIL COVER TEXTURE / / PER N T M KERS: OBSERVATION WELLS. ❑Y ❑NO I DYES ONO DEPTH OVER TRENCHIBED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SOD ❑ ED: MULCHED: CENTER. EDGES. YES N SEED O DYES ONO DYES 0 N PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELO I : FILL DEPTH ABOVE COVER : TRENCHES:°' MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATER( NO 1 DISTR. IPE DISTRIBUTION PIPE MATERIAL & MARKING: �± ELEV.: ELE V.. DIA.: ELEV.: j' DIA.: •YST�l,#!tTliCl,`r HOLE SIZE HOLE SPACING DRILLED CORRECTLY 7 l_� R MA RIA VERTICAL LIFT CORRESPONDS TO APPROVED = !F�'�#1eM4F fi PLANS: DYES ONO E YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS +j PR J WELL- BUILDING: ❑YES ❑NO ❑Y,E3 Q 4 iIEAtSr �. X 7 �cIV �' 4- Ir Sketch System on _ ,! `"R y y file for audit. Reverse Side. -� "� 2' / DILHR SBD 6710 (R. 01182) � Lumconsln APPLICATION FOR SANITARY PERMIT I DLHR �� C OUNTY OEPRRTmEI1T OF (PCB 67) UNIFORM SANITARY PERMIT # 1 In0USTRV, LRBOR S HUMArI RELRTIOnS hl,.?d y.3 — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /Zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Gwyn searm 2290; 1 3t h Ave. PA&t North St PwAl, XV 55 PROPERTY LOCATION CITY: 32' 6 VILLAGE: 1/4 1/4, S , � , N, R �9 E (or) W TOWN OF: Sty Joseph LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK T7 LAN I.D. NUMBER X R1419eE Brook TrMt Brook lid ILIA TYPE OF BUILDING OR USE SERVED 11 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ® New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1250 1 IL Lift Pump Tank /Siphon Chamber NA Holding Tank capacity Manufacturer: Weiaer Conereie Prodl�ete IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch) REQUIRED (Square Feet): PROPOSED (Square Feet): 10 X LW 2 4q* ]lily ® Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP /MPRSW No.: Phone Number: �seali Aabyr 514 1 R15: l, 6W24a? Plumber's Address: OF Name of Designer: 1 Mash ., W6adVi11&, W1 50)A S"tenraat AgAy COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved SO, a3- 49.3 x A ❑ Owner Given Initial y pproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR•SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber / INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank.lodations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Forw - S '1' C 1u0 I ' Owner of Propert - l Location of Property S'E '�Z S %�, Section 1' -y N R i y W Township _�j�.1.�_�� Mailing Address f -1--00 Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel f, �3� lCr Date Parcel was Created ^Z /Z /Z� 1-11 11 Are all corners identifiable? a/ Yes No Include with this application one of the following .Certified Survey Map . Deed .Land Contract, or .Other Vagal Document whizh 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 thi s information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 3- 6 k—'-" 2 _ ; 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. _ ). UR9 Of NER SIWNATURE OF CO -OWNER (IF APPLICABLE) DATE SIO D DATE SIGNED • - - 11CMillcrCompany® ' coon.., w,ueuq / .''.— '°"'"'fir. ^• - - .-.�:�,.a:�:� »...._.1 -._� ,..... " """" ".- ."��"' ' DOCUMENT NO. STATE BAR OF WISCONSIN —FORM 2 VOL 6 11 ,�' ) Jtj V WARRANTY DEED 384178 THIS SPACE RESERVED FOR RECORDING DATA George E. Glatz' and Maralee Glatz, KEOISf£RS OffICE .�. husb a nd ST. CROIX CO W*. sba d , and wife �..- n a w -� ^i;mv. c 26Ch +� t Rv d. for R�oord this day of A2ri1 A.D. 1983 ' a conveys and warrants to Gary--FL. Nourse and Jan M. Nourse husband an wwife, as joint tenants, at 9:45 A d � M. �� 5 y� bobler of Dor ds f i. RETURN TO r a1. c M1!Yx'.4qq the following described real estate In CroiX County, State v^f Tax Key No. y �- Lot 1 of Certified Survey Map i Volume 11 b A90 525 As 40C UM ent #345251, recorded on 12 - -7 7. TRANSFE`R 4 .. This Deed is given in satisfaction of that certain Land { � �•i Contract dated May 28, 1982 and - recorded on June 1` 1982 in Volume 647 page 204, as document number 377861.' + r ,t This i not --�_ homestead property. i x etc x (is) (is not) r Exception to warranties: �^ SO Subject to easements, reservations and restrictions'of: record,' Dated this day of 83 r t, (SEAL) (SEAL • GEO GE E. GLATZ Y� (SEA!) • MARALEE GLATZ = AUTHENTICATION ! Signatures authenticated this ACKNOWLEDGEMENT day of STATE OF PEMSYLVANIA ' k Personally came before me, this TITLE: MEMBER STATE BAR OF WISCONSIN 18 (if not, the above named •;' authorized by § 706.06, Wis. Stats.) Geor a E Glatz and Mara lee Glatt t: ps e This instrument was drafted by f k Stephen J Hudson, Wi scoriGi n to nia known to be the pers0e who execute strumen and acknowledged the same. q¢''. + F (Signatures may be authenticated or acknowledged. Both are nit - "' Names of persons signing in any capacity must be typed or printed below their slgnaluroN�t i y Public — ster ; • ft3oynii*. W /Commission is permanent. (if not, at O piratlon'''� `Y f t0taty AM si r I WARRANTY DEED —STATE BAR OF WISCONSIN, FROM NO. 2 — 1977 23,19t# � Stock - lVo: 1"315 /#nD�.vU ,QEnO� T S,EF if/OtE' /� l0 zv INDUS TA Y, OF REPORT ON SOIL BORINGS AND S AFETY &BUILDINGS INDUSY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 53 69 H RELATIONS li M63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: ,5e_ 1 / 1 / & /T N /R /I E (o +'.s T To 5'& //- - ox dIx (T�/pI OWNER'S/ "' V SO M 22 N D .5 ;r, �O /�I/�P C/tST. 4,04 S/ pa.,—e USE DATES OBSERVATIONS MADE NO. BEDR IS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: LA ION TESTS: Residence New ❑Replace / f /ate `ej t RATING: S= Site s uitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN- GROUND - PRESSURE YSTEM -IN -FILL OLD TANK: RECOMMENDED SYSTEM: (optional) os ❑u ®s ❑u �s ❑u au IH EIS au eo,�af,�T;�� 9 s . �. , If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n_ under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: F1 PROF E DESCRIPTIONS sCJ! / �7,yt�/ `D�}.�► BORING TOTAL D PTH TO GROUNDWATER- ITOee4;ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH PN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 11.0 /a o. 0' - /a. a 11 - 7T ' 40 - 6y• L , .2. 58 ' ,v, 4, "F3 • o�P. 51- W/ m. O L D . S B- / /4 3. �3 t 7 Id, ©' . �// ' /.�a -try L ) 2 , ZS ' L/. ,( V , -0.0 . G .,'3 " o�P S4 o S B- 3 17, o u w r a B- y 70 93.. j�� / SEE D i (r %t/� L_ ewo R T of ho I / / 2-- B- 9 d / ©o. 3 f°2 go S # q &Vt #s B- Sut?f�te E /ev �� PECS PERCOLATION TESTS FT /.v f e r TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER I716"ES AFTER SWELLING INTERVAL -MIN. PERT D 1 PE RI002 PERIOD PER FERIUD 3 PER INCH P- I7 v /D P- P- DO. (� P P- 3 . y 20 P- _ —_ Ra•N Hg y Z. 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 � �-b o�n the plot plan. Show the surface elevation at all borings and the di rection and percent a3 of land slope. 67"/ T l3 0 Of CXCA Vh! ZOA u S (?. / /r7/ . 11e jam- SYSTEM ELEVATION ll/k727t i,* L- 3. FT t tE o f 3 � .. 7 S y�Tv._.. T` >-a2. U!e�?. 7�r � . Aft' -1 �tT o , _ _ r tN w t _ - - - a . � 4_ S 1 { � s t I 1, 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. O8 NAME (print): "OkE TIL MfE TESTING RICHT 0 TESTS WERE COMPLETED ON: id ADDRESS: CE TIFICATION NUMBER: PHONE NUMBER optional): HUDSON, WIS. , 5 , 401 -a YV Z____ -' / T SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate sail test, yore" report most include: I. Oompleto legal description; 2. The use section mint clearly indicate wbetlter this is a residence or cornrnercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4, Is this a nevv or rc:0acement system; 5= Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITION S; 6. PLEASE use the abbreviations sr;own here for writing profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagrarn accurately IoCating your test locations, D to ,erase, is preferred. A separate she at may be used if desired; S. Make suer your benchni aik and vertical elevation ieferencet point are clearly shown, amid ate permanent; 0. trample °e all appropriate boyc3 as to dates, names, addresses, flood plain dada, pc r€ oiaition test exemp- tici appropriate; f0. (* ih,.i information (suc as flcad plain, elovation) does riot apply, place N A. in the aplptoprisate box; 1 .l. ;ir;n O form and place your current addi SS AWd your certification number; 12. kflra e legible copies and diSliibUte as required. ALL SOIL TESTS MUST 13L FILED WITH THE LOCAL. AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and To, xtores Other Symbals £3R --- Be(Iirack SS SAIndstone ,11 __ Giavel 3 ") LS "- Limestone Safld i GVV High Grc�r rJlc;cfiurn L ;r E a . _. c r,E ..rli W BI,)tr t - Lf)ci tTl �/ � �; - i t.' ;, ..- . i .at €?( {tic; - .{i ,'. ... -. Sandy L{7'lfTt �� < -_ [- `a Tt2oki S�i � L.lti nl 131 ._ 1B, I: t "1! Si Sill G r< s z — ..vli3y Lamar)) y - `i .117.'U t „ ;t<tt d L I: t cl atT) R tie i s1Ci -..- Silty Cla Lfxrl T rrio! ikil `)ti(eS sc f)illy cla'v fii f}" •.v, fine, f�jlnl Cl {; - Cc <,y Cc: f t +t' >u %Iluck d — distinct 1'iV> L -- Hif 4I vaatoi lOb'E'I, .. Six, t';e1){:i7i SOil textur {!s swldf,;, later fo; line ti I vvast disposal OM Ern h Mo k VRp ral Lt fern cti Poi €at TO THE ER; (RSt repoo is th f #r`,t tr) sf'cWi;lq .a s�mitark perrn t. The county fH tl IX ,artmenn! may te(plest .' c on . `his Soil ves t I.f, = #?i <y �)r{C.¢ . i - ":)rT,,. ?,;; .9r A CC)it riI S3, , ':; f i #Ic3s`i5 :Jr 112e private oWd o JIOF it i t)Iicatk ri n,w. he .i: <i t)ISL(>t)'- 'i<r #,: (Oi`ai aittliC}{ "1t}1 in order to Oh la . , E ,' r,�t zlt3rar f:C 1.1 ' :: >t,.0 ,�( z.t;�j L.f:)i15Lt "tSc ^,I:di7(t., i i i i y I {S .. REPORT ON SOIL BORINGS � PERCOLATION TESTS A p ,u 0 TESTS > c d� PL.o PL.AA1- PRC TECT r D. - Cr. Rpt 1t10,M.tf HOMESITE TESTING CO. R s , 3, O'I`IEIL ROAD BOB ULBRj(; j it U DSOAI, WIS..., 54016 CST !S 02 yez PROPOSED M oVSE MOST 66 2� Fr. p� Mote "of A1u. rr f e-45. - PRoQOSEO WELL MVST LIE 5o FT o,f mvfs' FiPoH i 9ct r£sT �,P 45. . = 49A4#4C pars u>Ft4 X = pEvG locA ImIf �{ = HAND A09ERE0 ow S 13 otr 5 M Pi n r 5ET .v�-x j" pLA,vs _ LEGEND Ae &*V ,4rro v of 110r, R Pr /oo • Q fr , �e4 x x � ; •�..1' C* a` Z �. w y� Jt t] r 2z- E' - 7 X991 .kt. DEPARTMENT OF REPORT ON SOIL BORINGF 7 N SAFETY &BUILDINGS INDUSTRY, DIVISION HUMAN REDLATIONS PERCOLATION TESTS ( P.O. BOX 7969 MADISON, WI 53707 LOCATION: f SECTION: r T OWNSHIP / MUNICIPALITY: O.• IVIS NAME: SE 1/4 D 1 / t' /T 19 N /R� E (or) W I I V COUNTY:, OWNER'S B NAME: W MAILING ADDRESS* !p Aft ��Iof USE DA ADE NO. BEDRMS.: COMMER ,1AL DES RIPTION: N TESTS: Residence 4New ❑Replace /Z O Z l �� Y RATING: S= Site suitable for system U= Site unsuitable for system O�IN�-GRO STEM- N -FILL OLDING TANK: RECOMMENDED SYSTE :loptionaq ❑ s ©u a s ©u �o� ?�� ,��•, 53 . If Percolation Tests are NOT required DESIGN RATE:jSV9TSM ELEV. If any portion of the lot is in the under s. H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS SC$ y F,p LOf1 9 flu .Y M BORING TOTAL DEPTH TO ROUNDWATER- 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- / 9 2- 99,/ Fr �z Z y lv,eln 4.6- . L j �, p 01- Fr -R,— fO � N 8W L� /( '�,t3,v -Gy. L, 6 ' �iP- rte. sue, 8z "�,Xf B- 3 az /d0, 6 Fr - , �� Ae- 4 . � 3 Z .. N �� G „ a,� s , 3 8 M: / 0 3 o - caG- o B- 99 jT '�✓ �4v �I►iX�u�.c „� o s o - 8y" l o p B -S /0S 1-03 7 fr )�y— > /off sc ' s N 6- Soil 5&WlAec 2Pd� IgJk PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PE RIOD 1 P ROD 2 P PER INCH P- & 22 d / G Z O P P- J. P- P - D G PLAN VIEW: Show location ns 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 and the direction and percent of land slop. 1&7.16M 1 &D ,EXCAU,AT /o.,), fp //g AMC71-1 3 Fr' l Jelou.� 134ep- ae SYSTEM ELEVATION F laltoow of 9l0 / FT oR l �. fT .( _�_ro_R. _ ...__. A _.... .,. .,........, ...... .,. t ., .. _ .� ,... .�......,.,. _ t I � � yr"t ► � # AN &Y' . 4 DoT LruE w _e. f , I I 7p DP q or tA Aci Sdr� __. .... ...... _ + w , E a to ..... tN 6 /FA it 7 in i4oO 1 i 5! o t st 4 } v a t r . Y , .. T� � W (o �; ........... 1, the undersigned, hereby certify that the soil tests reported on this form 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 WERE COMPLETED ON: A DDR E SS: #UP fO , } S , C�ICy�O�UMBER: f ONE Nl� /� ER (optional): CST SI NATURE: .� a r DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page-Soil Tester. DILHR -SBD -6395 (N. 03/81) ' ��� r „a yr:" � r,�' niu r, �_ •.'�y1xo �errr+'N'v� 1. M�v fi i'� 7,f A �aA'tw.i ,.�, � ,x.. p,e� '� - a �. V i ���J7S :m r y7 ? vl, e - ,R b 9 2f wWd h S 1,5 CCL vlo�lo Y -1 S r Y I Z G hof F 1d oo/ l __ - -- - — �eh / i i � t l I !I � e ( 14 ,, oS�t I �'.71 E Y7 I } s