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HomeMy WebLinkAbout022-1089-20-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER &OLL (I'bA W6f17feqrr ADDRESS 2~z aaLzL04 ed, Eu-~r 2 fill! SUBDIVISION / CSM# A~ LOT # SECTION 30 T g U N-R,Zyj) Town of h~'/~(~ /~'i /?off ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM d e Qu~rv ~d: AF- Pl.. to vk aa' 30 )00,0 Q a , ran INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: l9U-ner A,{ C MO.U ALTERNATE BM: SEPT TANK / CHAMB / HOLDING TANK INFORMATION Manufacturer: (,,}ePUMPS Sf Liquid Capacity: AM P~ G ~Q Setback from: Well House Other Pump: Manufacturer ~6U lc~ ModeWO3`11 Size f Float seperation Gallons/cycle: /x6r~ Alarm Location SOIL ABSORPTION SYSTEM AV / r Width: Length Number of trenches i - - -----Di-stance -&-Direction-to--nearest-prop..--line:- - 5 5 - _ - Setback from: well: House > 50 r Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLAT PLUMBER ON JOB: L LICENSE NUMBER: C9 3 INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State PIA009; 9: HOFFMEYER, FRANKLIN X CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No.: TANK INFORMATION ELEVATION DATAs TYPE MANUFACTURER CAPACITY STATION HI FS ELEV. Septic Benchmark o2, i,~' 3. &3 Zo Dosing Aeration Bldg. Sewer Holding St/ Inlet C! ~Z 9 off/ TANK SETBACK INFORMATION St/ Nt Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic SSA ' ' NA Dt Bottom &F Q~ c. Dosing 30 NA HaWei:4 Man. 37 ' Aeration A Dist. Pipe Holding - Bot. System - PUMP /IWFMN INFORMATION Final Grade 3g 9%d Q~7 2' Manufacturer 5 Demand a/ 5, T % ' a, Sd 27 . CO .C . a ho Model Number GPM <C!. r_ta'., `tee' T. 'D ~o TDH Liftq / Loss SysterrL TDHFt H Forcemain Length, / Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengthy No. Of renches DIMEN I No. Of Pits Inside Dia. h DIMENSIONS UJ SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACH a INFORMATION Type O Model NMberF System: /y,, o%, OR UNIT DISTRIBUTION SYSTEM Header /fold- Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 3(o ri Dia. c~ Length POO / Dia. Spacing 3~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over S~ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed / T•~--!*! ®nter le Bed / Inopykdges ,;2 Topsoil g-*Vs`__ ❑ No E} 25~ ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Kinnickinnic.30.28.18W, Np,, SE, Quarry Road /06. 13 r, Plan revision required? ❑ Yes to Use other side for additional information. (p - PTI/91 SBD-6710 jR 05/91) Date Inspector's Signat re Cert. No. 1r)1V;n- ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN STATE SA MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than p~, $ql 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S Sid PROPERTY O,WNE PROPERTY LOCATION a 1 Q e IF/a 3,F S 30 T,9~_, N, R E (or W PROP C OWNEfj;~S MAILING ADDR LOT # BLOCK # Li rr 11 0 $7, ST glk IP DE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBS ,5 W) 11. TYPE OF BUILDING: (Check one) El State Owned VILLAGE : ' ` NEA ST ROAD f ❑ Public IN 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply), 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. M Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 M Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 430 Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIR(E~,Df sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. It.) (Min./inch) ELEVATION D b 3 kq 'C 51 Feet Feet VII. TANK CAPACITY Site in al Ions Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Opt) ( S S Lift Pump Tank/Si hon Chamber ( t f Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb is Name (Print : Plu Signature: (No tamps) M 11SAI-lip- Business Phone Number: Plumb is Address (Street, Ci tat ,Zip Co cU-Is ~1, : S/ IuUM2 Q 7~ '1 /0 Uc IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (includes Groundwater Date Issued I wing A m Signa No Sta surcharge Fee) Approved ❑ Owner Given Initial .2 au I O Adverse Determination C1 Orr X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 4 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) n~ ►~y S£ Vy 5cc 30 IS c) ~r 26 /V 9 Ile Li ki n k i a x in n i C ~pwn sh ~ p ~r Cro ~ x C'o e f ur r r g,E, ti Cc yx 1~ ~P~Ga 1001, V~ IN tOUlld 3ed -tt):c l►oW cbIT U( 0 p~ M t oo COrne~ Abu J d 401 aae, l~ SEWA~E~ ondition o Ns R aE~~ iN 1J ~l1A n iDEM OF S 1. ~ ESpo -3o 3 ~ SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations May 31, 1994 2226 Rose Street La Crosse WI 54603 WANG EXCAVATING W9672 770 AVE RIVER FALLS WI 54022 RE: PLAN S94-40381 FEE RECEIVED: 180.00 HOFFMEYER, FRANKLIN NE,SE,30,28,18W TOWN OF KINNICKINNIC COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, erard Swim' Plan Reviewer Section of Private Sewage (608) 785-9348 4027R/ 1 SBD-6423 (R. 01/91) f A r Page Of t Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand _ H G 6" Topsoil F -J 3 E N D u 3 % Slope Bed Of 2 %2 Force Main Plowed Aggregate Layer (6" Below Pipe) D I.0 Ft. E Ft. Cross Section Of A Mound System Using A Bed For The Absorption Area F Ft. G I Ft. A ~A Ft. H 1,5 Ft. Signed: B Ft. License Number: r~ K 10 Ft. 9 L Ft. Date: j Ft. 2ir SCE A ~:tern to Position I Ft. mAiN o e W ~ Ft. L Observation Pipe--,,, J 13 K r--------- ---------_0 A KK X- - u u Distribution Bed ArLE EM Pipe A re Qt 111 I ondi to Observation Pipe Perm e i, tJ►~ INGS ` DEV • ~y Plan View Of Mound Using A Bed F he A i D (VCE SEE Go E5 P,Pe' VR Q ID) 000, 1 1 Las+ hole shoolk 6G hcxt {o e.nA Cap 0 x( ELI S Q9 3,0 Fi- X r% chc Ine-kes SYSTEM y C SoA hole dl,~L.~- f 1 _1 t 1~10nally 1 0.l C~~f^^ a.~A Cl IA 1'j ch Q~d mo"iFolck A, 1 n~~ CAS Ponce (16n n dIa . I n c~ e.s NPPIV ~F p1 H h o I e. per s+ lnuerl ~elotu.W OerL) DFq• 004% of E 5 EE Go SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 8 X 4" CI VENT PIPE 12" MIN. ABOVE GRADE S WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W/ PADLOCK & 7 6" MIN. i WARNING LABEL ABOVE GRADE - 4.~4" MIN. F-I d= _ 18" IN. 6" MAX. INLET rl IN ` , ~ I' WATER TIGHT SEALS GAS- V TIGHTf.'A 4 11 °t`a o I$AFFLE A SEAL APPROVED I CI PIPE JOINTS W/ C 3' ONTO B PIPE 3' ONTO SOLID ~.~odd®L' SOLID SOIL SOIL C V . $R•5 FT. RISER EXIT PPROV&3 D PERMITTED ONLY DEPT. 0 NDUSTRY, & HUNAN RELATIONS IF TANK MANUFACTURER Map MW oulmirlub A q HAS APPROVAL ' PPROVED BEDDING UNDER TANK Ike SEE CO ES ONDENGE CONCRETE PAD SPECIFICATIONS 15. 6S/lN SEPTIC / DOSE 'TANK MANUFACTURER: n) idUleJT NUMBER DOSES PER DAY : TANK SIZES: SEPTIC loco GAL. DOSE VOLUME INCLUDING DOSE (p 50 GAL. FLOWBACK: ~ (D,CO GAL. ALARM MANUFACTURER: 65*V4C4,rO CAPACITIES: A = INCHES = 301 GAL. MODEL NUMBER: 101 -01 H SWITCH TYPE: NQ B = 2 INCHES = 3), 70 GAL. PUMP MANUFACTURER: C = INCHES = GAL. MODEL NUMBER: 3 $5 1))£G3L SWITCH TYPE: g D = INCHES = 190.2 GAL. . REQUIRED DISCHARGE RATE '30_ GPM PUMP S ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP O::F AND DISTRIBUTION PIPE _9 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET + _25 FEET FORCEMAIN X 1,5cJ FT/100.FT. FRICTION FACTOR yam FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER LIQUID DEPTH ~J .SIGNED: LICENSE NUMBER: J DATE: 1/88 4 0 s Bulletin CL2.1A July 8, 1983 • For Homes G O U S • Far ms • Trailer courts Model 3885 •Motels (Supersedes Model 3870) .rte . . • Schools • ' Submersible • Hospitals EHIueM Pump Effluent Pumps • Industry • Effluent Systems Pump Specifications Solids Handling capability to 3/4°. anywhere effl uent or drainage must be 22" NPT9e Size disposed of quickly, Semi-Open Impeller quietly and .efficiently. e 3 vane design, threaded on shaft. Three phase units use impeller locknut to prevent accidental back-off. Pump out vanes on backside of impeller for protection of mechanical seal. Casing Volute type for maximum efficiency. Stainless Steel Fasteners Heavy-Duty Solids Handling Series 300 stainless steel for corrosion Dependable Capability to 3/4" resistance Mechanical Seal Ceramic vs. Carbon sealing faces, stainless steel spring and Buna N elastomers. Maximum Temperature IJ 1/3,1/2 H.P. 60 Hz 160°F. Capable of Running Dry Single Phase 115, 230 Volt. without damage to components. Motor Specifications 1/z, 34, 1, 11/2 H.P. 60 HZ f < Motor Fully Submerged in high grade turbine oil for permanent lubrica- Single Phase 230 Volt. Three I tion of bearings and mechanical seal and efficient heat dissipation. Motor sealed from A Phase 208-230, 460 Volt. environment by rugged cast iron enclosure. T , Bearings Heav -dut all ball bearin construction. Y Y 9 Stainless Steel Shaft ~rT Series 300 stainless steel for corrosion resistance. Threaded shaft. Single Phase Units All single phase units have built-in thermal 90 overload protection with automatic reset. Three Phase Units 80 M, Overload protection in starter unit. 208-230 or 460 volts. Threaded shaft 60 Hz operation. f 70 3 i Power Cord w Water and oil resistant. Epoxy seal on motor end LL 60 acts as a secondary moisture barrier in case of O p A = 50 damage to outer jacketing. Corrosion resistant gland nut. 2 4- y z Single Phase Units Q 40 { H.P. models equipped with 15' of 16 3 2 SJTO with 3-prong grounding plug.'., models equipped with 15' of 14;3 STO power mom O 30 Q cord. F- 20 ~ ~ . 4 SPECIFICATIONS ARE SUBJECT TO CHANGE 10 i WITHOUT NOTICE. 0 0 . 10 20 , .30 " 40 50 60 70 80 90 100 110 ` 120 u GOU LDS PUMPS. INC. GALLONS PER MINUTE SENECA FALLS NEW YORK 13148 L STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Fnzdlt~ MAILING ADDRESS r PROPERTY ADDRESS ~~~C 12'l e (location of septic system) Please obtain from the Planning Dept. CITY/STATE OCP l'e lj /-A))%, PROPERTY LOCATION L~~ 1/4,_ 1/4, Section , T Oa N-R_,/F W TOWN OF I G7 l ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME~'X'_ PAGE, LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the ;three Zyearex ' io date. SIG DATE: 47 7 7 St. Croix County Zoning Office Government Center ` 1101 Carmichael Road Hudson, WI 54016 11/93 • S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property n e P ~r Location of property.NF 1/4S E 1/4, Section _-?,OT o J N-R-Z!;?--W Township NI IC cyih iC! Mailing address Address of site Subdivision name Lot no. Other homes on property? Yes /X No Previous owner of property He 1,76k, t e Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? KYes No Is this property being developed for (spec house)? Yes Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 i 4~he/Affice of the County Register of Deeds as Document No. p, and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run 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. / 3 7r Signs ure of 7pant/ Co-Applicant ~ h) FJ ~ C Dat of ignature Date of Signature No. S-11. Quitclaim Deed---Common Form (STATE OF WISCONSIN) Publlehed by Eau Nalre Beet A atatleaewy Co. (Sec. 236.16. Wis. Statutes) 013 5 ~Gfji Jri~enture, Made this 9,ro day of lp r/e A. D., 19 55 , between George E. Hoffineyer and Ethel TA. Hoffineyer, husband arid v,lfe, arr(, eZjch in their own right, and Part ies of the first part Franklin 11o£fineyer and Eileen Hoffineyer, husband and wife, part ies of the second part. Mitntoottg, That the said parties of the first part, for and in consideration of the sum of One Dollars, to them in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, hNe given, granted, bargained, sold, remised, released and quitclaimed, and by these presents do give, grant, bargain, sell, remise, release and quitclaim unto the said part ies of the second part, and to tiiodr heirs and assigns forever, the following described real estate, situated in the County of St. Croix , State of Wisconsin, to-wit: A dzircel of land loct.ted in the northea; t quarter of the southeast. ,darter of section j0, torn 23, ,North, range 13 test, St. Croix coi rit,/, Y,isconsirr, further describea as: beginning at a point on the south lice of srid north- eat t -.iuarter of the southeast yu,,rter a distance of 1317 feet nortii and "S feet Kest of the southeast corner of said section 30; ee :forth 44045' Hest a distance of 450 feet, more or less, to the ceutl~rliae of the tows road, thence southwesterly along said town road to the south line of said northeast quarter of the southeast quarter; thence east along saia south line of the northeast quarter of the southeast qur.rter of section 30 a dictanco of 585 feet, more or less, to i)oint of Lri;inr1111g, co,,taining approximately 2 acres. 4ZO 1?abt attb to 1)o1b, the same together with all and singular the appurtenances and privileges thereunto belonging or in anywise thereunto appertaining, and all the estate, right, title, interest and claim whatsoever of the said part ies of the first part, either in law or equity,.either in possession or expectancy of, to the only proper use, benefit and behoof of the said part ies of the second part, their heirs and assigns forever. 3111 UU Me00 Zi bertot, the said part ies of the first part ha ve hereunto set their hand s and seals this 9th day of x4yil , A. D., 19 55 - Signed and Sealed in Presence of (Seal) ss•.~~I ~ ~ ,,(te~e (3^^r Ho ricPer ~fy..r _._.G.~.......i Seal) . Le Gaylord E iA f , W Marian E., avlord %tatt of Mi0conoin, ss, St. Croix County. Personally came before me, this 9r, day of M,%,,q , A. D.,19 55 , the above named George E. 1offineyer and Ethel Me Hoffineyer, husband and wife. to me known to be the persons who executed the foregoing instrum ackn ,edged' tht+, same.'r i VC'~~ . Gaylord. Notary Public, Pierce Coun>ay, Wis. My commission expires J V1,24 ,'A:,D.,19~7 `'w tnnii59 s am Ste 1 1'1 1', JI. l 1i , YY7~: bW° ~ tlwnw W aaaasa W 9-64M grantees. Re ~'d Record this,._g6tth.-day of r'aro 1 A. D.19 67 at.-1L0 P., M. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 HUMAN RELATIONS R 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHI MUNICI ALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: E1/ S E1/4 D /TQ8 N/R/g E (o COUNTY- MA LI G ADDRE S: . ~`o X i i o C tr 1 r QU USE DATES OBSERVATIONS MADE a NO. BEDRMS.: COMMERCIAL DESCRIPTION: P OF IONS: CRIP PERCOLATION TESTS: Residence ❑ New ~ Replace 3 1 7 RATING: S= Site suitable for system U= Site unsuitable for system NVENTIONA OUND: STEM O❑ S HU M©S E1U IN-G0 S P[EU RESSURE: SY1:1 S I©U L HQ SG®U TANK:IREC Q mu WYSTEM:(optional) If Percolation Tests are NOT required DESIGN RATE: ( If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 64 s I & SO BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~a II /C~. D 6 n -7'79 O:Z? /W s l 3v"Bh S;136-)2 ",en S W i t I B- 2'I 0 a~' ls 6-30" Yl Si 3o-341 It. s one B- ~a r U 3 ~ ` " lBn S l usf mots 41(91? B- 3 "70 ll 6, 3 " ? IS 'I -A)'' s ; 30 - R9 ~f~h s l w B- k P42 (f a►` fan d g PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 P RIOD2 P PERINCH P- D Y D S P_ D9 0 P- tY S P- P- 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 and the direction and percent of land slope. SYSTEM ELEVATION D rr I~a~ ~•E. 5 i Oil- - = O I r . i Sit I 3 1 I [ ~ ` E I t 3 f I I ~ 1 l L 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. NAME (pnom,q_ TESTS WERE CO PLET D ON: S 9 L~ t a /9 ~ 3 ADDRES : , CERTIFIC I NUMBER: PHONE NUMBER(o tional): ~O 7 70 14 A le,`0 er h ll'q!~ 1) 5T CST SIC ZITURE: X DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement 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 CONDITIONS; 8. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; It. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate mod s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand 'C - Less Than 'I - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.