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HomeMy WebLinkAbout020-1168-50-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER , rbu /c•►-r~-> ADDRESS c v!v SUBDIVISION / CSM#LOT # 7~V SECTION -7 T '2I N-R lel W, Town of ra q: ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I / / 'tb a LA~ TZ / - - -----FNDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. e BENCHMARK: ? ~A ti t 7✓~SYI -U h.J~ i- c,6 Q ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Wepi/_5 C,~0 Liquid Capacity: /Ozsn Setback from: Well House /f"' Other I Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location I :SOIL ABSORPTION SYSTEM Width: Length S Number of trenches Distance & Direction to nearest prop. line: 4; Setback from: well: House ;:jZ - 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 INSTALLATION: _ Z~- PLUMBER ON JOB: LICENSE NUMBER: j ZZ:~ INSPECTOR: 3/93:jt TIMM EXCAVATING gHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BYy'Cr DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . : i...........,...........;... ......:...........;............................................t........ . . fr2o l1 .s ~~t x..11...... . .tars,. . . .N ..................fir .........:......L.ln:~ d w,' Tom.. .......r: ` t /ba fh f,k::....,~,_....a4~ 3' ~e .r ~~f.f F 4. I _ i e ~ ~6 ey `-(3 Y ln4'~ r e c~ . Sz' - ~y T ~0 . ZZ Ae P'1 PRODUCT 205-11".......i lnc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1.800-225-0380 Fro''s3ctipartbie#bus{wy7.29.19.1iVI~IEwC~EY31 ENf WINDLOF oun y: Labor and Human Relations INSPECTION REPORT Safety and e4ildings Division ~ROTX (ATTACH TO PERMIT) Sanitary fpehi it 0... GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Q Town of: State Plan ID No.: 31 HUDSON Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300032 5/,e/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Aeration Bldg. Sewer „i Holding St/ Inlet TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake NA Dt Bottom Septic pl, r ` D NA Header /Man. (N Aeration NA Dist. Pipe /1n Holding Bot. System d PUMP/ SIPHON INFORMATION Final Grade M a n u f agtarer- Demand Model Number GPM TDH Lift FLoss riction System H TDH Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH width / Length No. Of Tren Q PIT Of Pits Inside Dia. Liquid Depth DIMENSIONS -7,51 3 DIMEN N LEACHING Man turer-. SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O 1 CHAMBER Model Numbe . System: OR UNIT DISTRIBUTION SYSTEM Header /14.,ff4SId / I Distribution Pipe(s) 7 , , x Hole Size x Hole Spacing Vent To Air Intake i Length ~ Dia. Length s~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over i Depth Over _ xx Depth Of xx Seeded/ Sodded xx Mulched 0e4-/Trench Center Lo Bed/Trench Edges 5j -6,-~ Topsoil E] Yes E] No I-] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) eq~ LOCATION: HUDSON 07.29.19.1043,SW,NW, LOTS 0WDLOFF SAN -2. Plan revision required. Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) / _ i3c I1 Dat~- Q~elr- Inspector'sSigna re Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 7 DILHR SANITARY PERMIT APPLICATION couNTY , In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8'fi x 11 inches in size. check revision to pr sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPPERTY LOCATION D ~ $L'/aA) W%, S -7 T :V, N, R 119 (Or PROPERTY NER'S MAILING ADDRESS LOT # BLOCK # 3 1 4j d CITY, STATE ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR CSM NUMBER kjr 1640/4 715 3 - 1r tiC l~ II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) 1-1 State Owned ❑ VILLAGE - TOWN OF. (-Ji , O ❑ Public ❑ 1 or2 Fam. Dwelling-# of bedrooms 3 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 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ 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 Al q. ft.) (Gals/day/sq. ft.) (Min./inch) /7 ELEVATION f~1~ REQUIRED (sq. ft.) PROPOSED (s -ift 8Z . 1,0, 5 r/' 7 r Feet . / 7 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted . Septic Tank or Holdin Tank /vO Gc1 Pie F] L1 I I Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) r P/MPRSW No.: Business Phone Number: /FIX 7/5' 77 z- 32A( Plum is Address (Street, City, State, Zip Code): -io /-A e &J/" 16, 7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Per mit Fee (Includes Groundwater Issuing Agent Signature (No Stamps) y I? Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination 7N . CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. %A sanitary. permit is valid for two (2) years. 2. Your sanitar i 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 syAiiiii-is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. 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 11jform; 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) APPLICATION FOR SANITARY PERMIT STC-100 This application form Is to be completed In full and signed by the ownet(s) of the property being developed, Any Inadequacies will only result in delays of the permit Issuance. -Should this development be intended for tosale by owner/conttectot,(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 Location of property _J/4 ~JW 1/41 Section T~l~•R~.-y Township H VC so N Balling address (a J %e- 01"U 5f' . Address of alto 3// Wl',\ V( a L4we subdivision name R_=Gk,_ 0.0 d - • Lot number Previous owner of property ~ctllv A N N W Total size of parcel 1.030 tic-PEs Date parcel was created Lgt -13. 19 BS Are all corners and lot lints Identifiable? _X Yes 0 Is this property being developed tot resale Capec house)? as 0 Volume j1a7 and Page Number 3`I as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE POLLOWINCt A WARRANTY DIED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUM![R, and the BRAL OT THE REOISTER OF DEEDS. In addition, a cartified survey, It available, would be helpful so as to avoid delays of the revleving process. 1t the deed descclption references to a Cestlfled Survey Map, the Cattlfled survey Map shall also be required. PROPERTY OWHER CERTIFICATION I(ve) certify that all statements on this form are true to the best of my (out) knowledge; that I (we) am (are) the owner(s) of the property described In this Information form, by virtue of a warranty deed recorded In the Offies of the county Register of Deeds as Document No. q'-7703 1 and that I (we) presently own the proposed site for the sewage dispose systeA (or 1 (we) have obtained an easement, ,to run with the above described property, tot the construction of said mystem, and the same has been dull to otded in the office of t ty RegletSx-ort Deedsp as Document No. _477:2 3 Signatur Owner Signature of Co-Owner III Appiicablel no 0 of 1019nWtuts Date of signature 917 FA' 40 v~ ' 477038 VOL STATE OF WISCONSIN CIRCUIT COURT ST. CROIX COUNTY MIDAMERICA BANK HUDSON, ST. CRW Cam., WIS4 Plaintiff, Rec'd. for Record this 23rd pia Dec. A.D. 19 91SHFORECLOSURED ON VS. 8:00 Al Blue Pacific Car Wash, Inc. Donald H. Sukowatey, trr1 w`• .d' Case go.: 89 CV 506 Mary Ann Windolff, State of Wisconsin, and United States of America Defendants., Y• 3~ qlun Whereas, pursuant to a judgment of foreclosure and sale rendered in the Circuit Court of S~. Croix County, Wisconsin on May 18, 1990, in an action between the parties shown in the heading; And, after due advertisement, a portion of the premises were sold on November 26, 1991 as follows: Lots 9-10, Plat of Ranchwood, St. Croix County, Wisconsin to Troy K. Timm, the highest bidder, for the sum of $16,005.00; and Lots 13-14, Plat of Ranchwood, St. Croix County, Wisconsin to MidAmerica Bank Hudson, the highest bidder, for the sum of $16,000.00; And, whereas, Troy K. Timm and MidAmerica Bank Hudson are now entitled to conveyance according to law, Now, therefore, the undersigned, in consideration of the payment to him of $16,005.00, the receipt of $1,600.00 of which is hereby acknowledged and the balance to be paid upon confirmation of sale by the Court, conveys to Troy K. Timm the following land in St. Croix County, Wisconsin: FL~fi'~~O 2 Lots 9-10, Plat of Ranchwood, St. Croix County, 1ol2 Wisconsin ~kK ~19g ti • r' Vol► 9217 PAGE:341 Now, therefore, the undersigned, in consideration of the payment to him of $16,000.00, the receipt of which is hereby acknowledged, conveys to MidAmerica Bank Hudson the following tract of land in St. Croix County, Wisconsin: Lots 13-14, Plat of Ranchwood, St. Croix County, Wisconsin This conveyance is subject to the rights of redemption of the United States of America within 120 days of the sheriff's sale as provided by law. i Dated this o2~~1day of November, 1991. W,49 &9 R lph ader, Sheriff St. Croix County, Wisconsin STATE OF WISCONSIN) :ss ST. CROIX COUNTY ) On the, day of e 1991, before me came Ralph Bader, known to me to be he individual and office described in, and who executed the bill of conveyance, and acknowledge that he execut,,,,,~:•,, the same as such sheriff, for the uses and purposes therein s'~ forth. ~ - • 4, oI Rotary is S Croix Co. WI.` -J J ! My Commission Expires: - o _ ~9s2 ~ Q. o This Instrument Drafted By: Robert F. Wall Attorney at Law Wall & Harris [MABBLUE.DED] 3STOR10FRCL 522 Second Street Hudson, WI 54016 2 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER--1-P,-0,"y ~iYl~1 ADDRESS 38 1i lnd© a- FIRE NUMBER CITY/STATE _ l/yCAO /,J ZIP__ ~~'I C~ I PROPERTY • S W LOCATION. 1/4 ,tJW 1/4, SECTION_2-, T a-9 N-R I•S_W TOWN OF_ bIu d5d /^J , St. Croix County, SUBDIVISION 9anek vvoec( , 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 a 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/Ile, 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 Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: ---AO~3 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) L%,A~ ION;,/ SECTIO~~~ N/~f flor OWNSHIP"I~~': LO~O.:BLK. NO.: SUB IV~ 0`N~ ME: r~ COUNTY: OW NEWS BUYER'S NAME: MAILING ADDR S: SDy~ O 1 / 'troll , ~f yt~i/rD~ ~~~/L USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER I DESCRIPTION: PROFIT' DE RIPTIONS: PER 0 ATI TESTS: Residence New ❑Replace f ? 3 / RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDE SYSTEM: (optional) ]MS []U 2S❑U M❑U ❑SOU ❑SM : If Percolation Tests are NOT required DESIGN 7qTs, If any portion of the tested area is in the under s. ILHR 83.09(5)(b), i ~ R :5 d,(-- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W, ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERV D (SEE AB R . ON BACK.) B- , ya' /®p, B- 7 70 9g.17~ \ B- , egy' /ad" 2. > 6 7 470 2- 5- B- > ~ B- rzi_ TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. PERT D t PERT D2 PERIOD PER INCH P- 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 9~~7 I F , E y,, Cv .;c . F e wv- TAP ~ ~ l P;ck S . 3 y r ~ r G. 3 1 x 6171 60 1, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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 LnrAit)- TESTS WER 'COMP ETED ON: / 4L 444e0 31Z , .4 ADDRESS: CERTIFI ATIg1 NUMBER: PHONE NUMBER (optional): L .077 CST SIGN TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER JOB TIMM EXCAVATING SHEET NO. OF 2- Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE 32 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE r in doIlr ne Cu l d,C . t . ......:...........o. rG J►d .z~. J".xa4 401, d lfd Od c Xq _jt, 7.wt b? ~l~nc/zas .~.J~...0' . L s ic... ~ 11 *,role 1 C .V h~ 1 . , i... A 1 1...___. , y (O 1~.~ 1,~.hac ✓ 93 T 3 f lo" ~+~f... mm PRODUCT 205-1 ~Inc., G wn, Mess, 01471. Ta Order PHONE TOLL FREE 1-800-225-6380 JOB TIMM EXCAVATING a z a SHEET NO. OF Route 1 Box 192 -r cy a WILSON, WISCONSIN 54027 CALCULATED BY DATE • (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE i........ . . . z~ . Ytb•C i ~ o r y'~ . , P P PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800.225.6380 DEMRTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION ABORTANO PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) L%.ATION;SECTION: u/~ ~ lor OWNSHIP/~': LO~IO.:BLK. NO.: SUB IVY ON NA~DME: i)w OWNER'S/BUYER'S NAME: MAI LING ADDR ~ S: 4xO`"e i 'COUNTY: l t 'U ,NAM T.! 2- USE DATES OBSERVATIONS MADE NO.BEDRMS.: ICOMMER I DESCRIPTION: PROFILE DE RIPT ONS: ER O ATI TESTS: Residence XNew ❑Replace ZS 93 RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ros YSTEM-IN-FILLHOLDING TANK: RECOMMENDE SYSTEM:(optional) AS ❑U l?S ❑U M ❑U f~U ❑S / If Percolation Tests are NOT required DESIGN R I' If an portion of the tested area is in the under s. ILHR 83.09(5) (b), indiicate: C iTE: $5 d. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH LIE' ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERV D (SEE AB R . ON BACK.) VY Fr.? y fT /00, D ,67d i 2, Jr Hs .43 1 S, Bh 9r~g~ B- a CK 17 > 7, 1 0111 B ,25 /0, '122 /A 7 *7, , 2- h .S/ ' 9a d41 /sdy.~. B- .S n ;Old, ~rf > '19 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN, WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PER PER INCH P- a, S P- 7. P- 4; 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 R /0/ 1 e- i E E E _ _ - , . . r°~ 1 1 130rr 4.6 s,•ks ~N , E E x ~ti~ o(~ E _W _ _ , E~ i _ E e I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proced ~n -rnelho. if di he Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and be TED ON: NAME t): TESTS WER 'CO7~, 3 2, ADDRE S: CERTIFI ATI NUMBER: PHONE NUMBER (optional): 0 77 &ty s A/ sYaA` M314+1y 3 re ~ g3/ CST SIGN TU f DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - fir ti INSTRUCTIONS FOR O IPLE' FORK! 115 - SRO - 6395 O b)c a complete arid accurate soil test:, your report n, r„ 1. Complete le,tal description; 2. The use section must clearly indit - hethei this is =ce or cial pi~oject; 3. MAXIMUM number of b_'droorns or commercial Use,r€ned; 4. Is this a new ( ~'r)t system; 5. Complete the sc °t ping e boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS i..RE RULED OUT BASED N SOIL CONDITIONS; 6. PLEASE t -;her ?v,, tior€s show€i here for writing pr-, ~ '~)tions and completing the plot plan; 7, MAKE A ~ im a(:-curatPly locating your t =Is. Drawing to scale is preferred. A separwe s! if desired; 8, Make sure ~ k and vertical elevation Dint are clearly shown, and are permanent; 9. Complete a: boxes as to dates, names, ~ ;es, flood plain data, percolation test exemp- tion, if ap ,z 10, If the information (such as flood plain, elevation) does a,ot apply, place N.A. in the app€opriat:e box; 11. Sign the form and [)lace your current address and your 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 FAR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st Stone lover 10") BR - Bedrock cob Cobble (3 • 10") SS - Sandstone gr Gravel (unde€ 3") LS - Liar€estone Is - Sand HGW High Groundwater cs Coarse Sand Pe',rc - Percolation Hate reed s- Medium Stand W W i` fs - Fine Sa C Bide; - Is Loz ay - si Sanely t `1 - roar t B= sil - Silt Loarn Bi Si - Siil. Cis,; ay ~....1 Y Y scl . r ' Lc aarn R l I sicl Si)' rnot - fa_ leg sc - Sandy C iy zN,, - V, (ti sic Silty Clay `ff - few, fifaint C cl-Y e'c - c mno ' cotar- pt P t nana Many, M, in r) - d distinct p prominent I- WL High water level, Six g o: tu, ".s surface water for liqu sposal Bid[ Bench M. VR€' Vew- 'v .,enc„e Po€nt tl TO THE OWNED: 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. ST. CROIX COUNTY new, ' WISCONSIN < < ti Exf i t ~ . ' ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 1101 Carmichael Road • Hudson, WI 54016 (715) 386-4680 June 18, 1993 O RE: Certificate of Compliance Troy Timm 311 Windolff Lane Hudson, WI 54016 FROM: St. Croix County Zoning Lot 9 and 10 of Ranch Wood Subdivision SW 1/4, NW 1/4, Sec. 7, T29N-R19W, Town of Hudson St. Croix County, Wisconsin St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on April 28, 1993 and revealed that the system was designed and installed in accordance with all local and state requirements. Should you have any questions, feel free to contact this office. js