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WALSH ST, CROIX COUNTY REGISTER OF DEEDS SURVEYOR'S RECORD ST. CROIX CO., WI RECEIVED FOR RECORD 08/23/2007 10:30AM CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP VOL: 22 PAGE: 5440 REC FEE: 13.00 LOCATED IN THE NE % OF THE NEB AND THE SEYa OF THE NEY4 OF SECTION 7, T29N, R19W, TOWNS OF HUDSON .6j3 ►1 oo E FO N 7 AND ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN- 1. . { 25- p20N PIPE IPE Fouw Z II O CHECKED WITH TIES) J ' MARTIN & SUSAN RICHARDS 1076 TROUT BROOK ROAD LEGEND HUDSON, W1.54016 INDICATES SECTION CORNER f (AS NOTED) - INDICATES 13- ( OUTSIDE DIAMETER) IRON PIPE FOUND. O INDICATES 1"X 24' IRON PIPE WEK3HING 1.68 LBS PER LINEAR FOOT SET. (R) - INDICATES PREVIOUSLY RECORDED O INFORMATION., MOTIF. NO NEW LOTS HAVE 13EEN CREATED. THE PURPOSE OF THIS MAP IS TO COMBINE THAT PARCEL PREVIOUSLY OWNED BY THE RICHARDS AS DESCRIBED ON DOCUMENT NO. 819995 WITH THEIR MOST RECENT AOQUISITION OF THAT PARCEL DESCRIBED ON DOCUMENT NO. 8545M. THE NET RESULT IS ONE LOT AS SHOWN HEREON. TOWN, COUNTY AND STATE APPROVALS ARE NOT REWIRED TO COMBINE THESE PARCELS. 4r 0 0' 150' 300' 450' I = o 8 jIIIIIIIIII u~ SCALE IN FEET 1-=150' UNPLA' TED LANDS N88.553WE 562.00' I I `rK m N I I ~ a: THIS PARCEL DESCRIBED IN I w Go S~ DOCUMENT NO. 854563 I y ~Jw1 I * G B R i* ®1 ISNEW RICHMOND % LOT 7 f,~ ®I IUI 2EI 4x0,081 SQUARE FEET 1 s of ( m: 1-5 (10.10ACRES) d ` ~i < 1 fT X01 - PREVIOUS LOT LINE 8 I I P I ~l GARAGE Ii \O WELLe I ~l m°I ~l~l I APROXIMATE TIDWNSfiIP LINE ®i co co DWELLING BI ill THIS PARCEL DESCRIBED IN I DOCUMENT NO. 819995 SEPTIC AktA I PREPARED BY: F 1-01 f IJI GRANSERG SURVEYING, INC 9 I 1235 C.T.H. •E- - I I NEW RICHMOND, WI 54017 S88.55'22-w I PHONE (715) 246-7529 UNPLATTE (RSBr55'30-W 562.0(r) I I JOB NO. 07-M ~@dl ! UNPLATTED LANDS I EX CORNER, SECTION 7 ' THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANBERG .9-2295 (ALUMINUM CAP FOLM) SHEET 1 OF 2 MONO 1 of 2 Vol. 22 Page 5440 't) je--11 Ile- AS BUILT SANITARY SYSTEM REPORT ~ OWNER ;fe TOWNSHIP SECTION T N-R W ADDRESS ~~7CO ST. CROIX COUNTY, WISCONSIN ffUpSo.~ Gc,/ S..SyN~~ G SUBDIVISION LOT LOT SIZE PLAN VIEW N ' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM T~ i 1 544F A774C4-1 v ,0/0 r p6 P t a s Inlc 71'o (14 9 7 4s STid G- 7o.J-<" 2-2-- % Z. Foie Fo't-uRE- r 'USA re I o/~ INDICATE NORTH ARROW /36n~'4 BENCHIKARK:Elevation and description: O Alternate benchmark 4;,X1 Ir TiN(x-- SEPTIC TANK:Manufacturer: Liquid Cap. /zoo ,J Rings used:/ Manhole cover elev: Final grade elev: Tank inlet elev.: ? Tank outlet elev.: No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:FrontSide , Rear Ft. No. of feet from: Well ~d Building: ~y (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/S' on Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Ma Switch Type: Location Dist ce from nearest prop. line: Front, Side, Rear_Ft. Distance from: Well Building 3 11 koo/ SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: % Length__~~/ Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: So v'0r~_ i 20 No. feet from nearest prop. line:Front , Side , , Rear Ft. No. feet from building_ 7-Z No. feet from well: HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bot tank: Elevation of inlet: No. feet from nearest line:Front , Side Rear Ft. No. feet from: , building , nearest road Alarm M acturer: INSPECTOR : 4/1 DATE:- PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj HOMESITE SEPTIC PLUMBING CO. M50'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO, 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. 140,00663 HOMESITE SEPTIC PLUMBING CO. 0 I 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT WRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO.OD663 3y y'- z.5-- Sz - /G3 1$► i3M. 7D of Lot~s'T ST , ~!-T fr.~ovT 4AWO.4 4 b cX (SnA4_ Co- . wcEes ~zo rovk 05 oollf yy~v3 _ _ ~ DrST~i,6vt/dv , D' b~ , ' c.S. D~'~+%~ {rte Lv yea r qi, yG PI y En~sTia(r S ysTErr ay ~O ~ - = - - - - - - - - - - - - - - - - - - ' --~~--1 Sys re.~► 936 ~ 9a .5L i f~ ~ ro 9/✓`? sys7~► 5F/S0 ;Fa' 30 133 9/. 3'1 Sovy~ LOT' G • j,P~-cx~ S~G's ~ LeuhTCoA.1 S 8 = 9 1/ 3 • ~~s ova j32 813 = S 3, 3 O,~o p (St ress' f Cet r T1ev, 9/. v SGAcr : 30 ,11;9 Tko f.,4j C ~C. 9/. 5_0 LOW 776A)CW~ L ~'i's part~`~ntof4~i~~3tFryPH 7.29.1WQ4)~~~~ Ykdj,E SRY& BROOK R County: Labor and Human Relations ^~w YY Safety and Buildings Division INSPECTION REPORT S C OIX (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 180306 Mermit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: JQT4~ & THERESA.- SHI ST. JOSEPH _FYffERre`v.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1d010 5 4. T - % O o- 030-1028-50-000 TANK INFORMATION d 6 1 ELEVATION DATA A9200387 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S / 9, 0 ( Benchmark .d (oo,Ut{ Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent G 3, u TANK TO P/ L WELL BLDG. Air Ito ROAD Inlet `-7 Air ntake 1 I (orj Z < FS ~ Septic 7 ( b a > g Q ( y / NA Dt Bottom Dosing NA Header / Man. 7 52- a i 44, s~ Aeration NA Dist. Pipe 1,7 Qa• 3 V,4 q I Holding Bot. System 8,sy ~gssa a, s4 `~n~so PUMP / SIPHON INFORMATION Final Grade 5,grfl q ~l , l 8 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width LencLth No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z~ DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O f CHAMBER Model Number: System: o20 7 a aoo OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over r~ Depth Over ~y xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center d Bed /Trench Edges a 1 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No 4f COMMENTS (Include code discrepancies, persons present, e" LOCATION: ST. JOSEPH 7.291.19.107 NE TROUT BROOK f } l ) ~.-1 -T r Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: z SANITARY PERMIT APPLICATION Ea DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ sT f STATE SERMIT # -Attach' complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ c I if 0evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. Al i¢- PROPERTY OWNER j PROPERTY LOCATION V_ T e sfi STOP 7e, E/4,vE/a, s 7 T N, R 7 E (or) W PROPERTY OWNER'S ILING ADDRESS LOT # BLOCK # /07 & Vovr Aeoae • - CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME'OR CSM NUMBER o,~ lv/. S 4& 3PC / cs,m 3 i 3 z oQ vo 9/ • . 2-0 7 IM-1 CITY STROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned O VILLAGE : 0-,10 NTiovT ❑ Public X1 1 or 2 Fam. Dwelling-# of bedrooms PA A MB 111. BUILDING USE: (If building type is public, check all that apply) 3 a 1-02-9 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. R] Replacement 3. ❑ Replacement of 4.0 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 ❑ 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 2. ,3 -Mev* S C,44°`- Vl. ABSORPTION SYSTEM INFORMATION: Q2. `!~S• O 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9/ ,s• ,~..._.y g~VATION l ~•ZO a 5- 10 d ~0 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 structed Septic Tank or Holdin Tank .2 00 Lift Pump Tank/Si hon Chamber -e 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) MP/MPRSW No.: Business Phone Number: n % Z!/, X/47- 3 Ze 7 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Iss ' Agent Signa o Stamps) to Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination (J X. 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. 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, 60+3-266-3815. 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. II. 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. Cornpfete 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 (8.11/88) 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), thenta 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 sT~° Location of * property ~ /4 *4 -1/4, Section , T Z~N-R lZW Township 54- Tos~7 Mailing address 13 /e-t:P p Address of site Subdivision name 3Z'o f , v0 y f/ Lot ono. a Other homes on property? yes n No Previous owner of property e 'Le Total size of parcel Date parcel was created Are all corners and lot lines identifiable? =Yes No Is this property being developed for (spec house)? Yes No 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 & 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 in the office of the County Register of Deeds as Document No._ //10 , 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 County Register of deeds as Document No. S' nature of licant o-applicant /Z -Z1- Date of Signature Date of Signature S T C - 105 -3~~ SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS /Q 7 Co -2n 117- 134oaIt" - FIRE NUMBER /0-2 CITY/STATE ~C9•~/ ZIP ✓~~f Gl PROPERTY LOCATION:.Z ~1/4,°U 1/4, SECTION 7 , T a -R_/ _f W TOWN OF St. Croix County, SUBDIVISION 3 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/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance I with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be I completed and returned to the St. Croix Co. Zoni g Officer within JJI 30 days of the three year expiration da SIGNED: DATE: Z St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT n FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the J 4 yM'4 ~ residence located at: 1/4, We- 1/4, Sec. / T~N, R W, Town of S7' J oS Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced dG Did flow back occur from absorption system? Yes2LNo (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /~z Q d 16;+/-S Construction:- Prefab Concrete Steel Other Manufacurer (if known) : 4V 6Z ~5 41.v 61C 7(e ~j-- , Age of Tank (if known): (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name EO"T Wlhitl'6.4 T" Signature 4; i /MPRS 33 5/88 `abor and Human Relations us AND SITE EVALUATION REPORT Page _Z of 3 I SOIL 'i Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code 9 z 7~E'S T 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 % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE k PROPERTY OWNER: PROPERTY LOCATION J'4G S7O~~ ~e GOVT. LOT NC 1/4 NE 1/4,S IT 29 N,R E (aCO PROPERTY OWNER'~:S MAILING ADDRE LOT # BLOCK # SUBD. NAME OR CSM # 7~0 7if'd UT ,A/eod~ r " CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (JfOWN NEAREST ROAD (-71s) 3M0 S'r Jcfe p h'- -regur /q'eoo& O New Construction Use[ [ Residential / Number of bedrooms y Addition to existing building j~ Replacement Public or commercial describe Code derived daily flow 60 0 gpd Recommended design loading rate wed, gpd/ft2 ' trench, gpdte Absorption area required bed, ft2 17-00 trench, ft2 Maximum design loading rate / bed, gpd/ft2 ' trench, gpd/ft2 Recommended infiltration surface elevation(s) s PS . 3 ft (as referred to site plan benchmark) ,gaoi° Additional design / site cons' ations ovcy !-o~l~ Nei °~otc~ ~'E~oG► S OS - Parent material SG S y9 Aq 7 Flood plain elevation, if applicable 4 ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN 7FILL HOLDING TANK ~I U U= Unsuitable fors stem ®S Q U JO S Q U DOS Q U W S ❑ U 0S W 0S SOIL DESCRIPTION REPORT Boring # Horizon pepth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 2j S*h& 13 re <:u 13 13 30 /o Yl- Ob S/ 2, ~►t, sb/~ ~R S ~t / G Ground /0 vie ca TS el f Sh 9 a ft. G d-P ioyr2 S/ Depth to limiting d factor 16 N 30 ye Of s6r4t- ~"►l i Remarks: &41 Zo'y G Cfl.~rfii~S ~ 7_5 7- Boring # o-12- /o Yle yl~ - s/ z f, s bK /P1f7-_/e s 2-f 123G /0 y/e yl~ 5-11 2,. A,,sh& -i, y S -2 3(, 5i4t 'S y4e 13 Ground elev 0 VR 31 O1JS/ 5/ / 1 56/~ ~rT i s y5' 6Y tt. _ 76 0 Ytf -5/6P Depth to limiting ~O factor 464 Remarks: 371 2 - CST Name:-Please Print 655 O'NEIL RD HUD IS. r Phone: B _ S1 CROL Ct,1 J _ Address: WIS. MASTER PLUMBER LIC. 7 OFFiCE Signature: Date: CST Number: F2_ 1 l~~ Z i PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # • Depth Dominant Color Mottles Structure •GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tr~~ch Y?:>:ivcciiQ:i U ~ 3 ~ ~ / to S ' Z,-f s6,~ ~•►~7z.2. S 2 / G Ground Ft/, 7-~!l? V~6 S~ f lie S <i elev. 93-G3ft. Depth to C2 D " ~lf 4-p limiting factor Remarks: 20 C 3~ 70 ~f a.9,v~E1~ Boring # Ground elev. hP C.f fvL a„> o~ fAA_ t. Depth to UCG1 S DU~°r'.o /t~Sl/ Tia-.~ - ~P s limifing 7D Zke-OW 71W( factor L i~ ~ooooo srr.vr 7 x7WE- ,Av r .v T , Remarks: SG"/-S' Td ~1CGET ~iF'~~pLy 1.'"Si~ryv Boring # OF. xio g a Ground elev. ft. i i Depth to limiting I factor ~ Boring # Remarks: i aA Ground elev. IL ft.'s Depth to limiting factor Remarks: SBD-6330(R.05/92) HOMESITE SEPTIC PLUMBING CO. ' 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 /63 I y ~8 To of Lo~sT STEP , ,fT f,Bo,~,,T /00' O e - o ~ ~ D~Lf7 f y o6 Q i q J ~ y i' C1. jJA'ilia/7Fi'c`L!~ DF,a9 T ' Ex'sTia(r S ySTE rr o E'/ev"tTro~ r-o' S', i 2- YCJ /V /j 00 z . 133 ~l ~ Sov~. LOT- G i L- LeVATCojo S z T3 S3 ~3 3 ~c ~~oM~revy~y s%srE.y ~ G>~vrtT/d•~S TIe£A► &4. 9 2 , 0 ' SG A LE yip Ti~f..w~ G` 9/. ~p _ /3,gcKko~ Pi 'TS LQl,J HOMESITE SEPTIC PLUMBING CO. 0 r 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. VtNN. N "TALLER & DESIGNER LIC. NO, 00663 acw ~.~1. TD`'_°f LGt~t~ST STEP , o4T {.~cvT oneno'o /EV~ITio~ = /OO' 0 w i {I I / D~L~ r To `AIDE ~ L ' _ S~jE °i`Q ' 4 t y ~ o ~ Ex ~'sna~ S ysTE ~ o i E'/E v~tTYO~ O~ T3z 5'( ~O a.~ ~i'Niflf~D /30X - 9,~AOE- . yid 5r 7em /01 u 0 SySr~M - SO _ /x~~ l 133 s Sovy~ LOT G - e LeVATCoA3 -S f1/3 y 132' GP 3 )3 = 3,6 ~~COM~e,vDy s%STF.y 4>~vtT/o,~s w Alp 7kOe..Aje i 111'6'14 IAE4; Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade r 33 Above Pipe 4" Cost Iron . -to Final Grade Vent Pipe' . Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee pipe 0 0 0 0 0 . ~r r Aggregate 0 Perforoted Pipe Below Beneath Pips 0 Coupling Terminating Al Bottom Of System m Tipp GG~ Fresh Air Inlets And Observation Pipe 1 Approved Vent Cap C 0' Minimum 12" Above Final Grade f~:v~s ~yF (30 Above Pi 4" Cast Iron -ro Final Grade Pe Vent Pipe • Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe ' Distribution Tee pipe 0 0 0 , S/S7FM " Aggregate o Perforated Pipe Below Beneath Pipe ~ Sv o -'Coupling Terminating At I Bottom Of System 40k) • Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12".Above Final Grade :VK1,1640 3 7,5'- 33 ,`?•~s " Above Pipe _ 4" Cast Iron . 'To Final Grade Vent Pipe' Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 Aggregate 0 Pertbroted Pipe Below Beneath Pipe o CouPling Terminatin9 At STEA1 .-,T/a• Bottom Of S.ystem y i i Fresh Air Inlets And Observation Pipe Approved Vent Cap r- oft~ .Minimum 12" Above Final Grade now 4" Cast Iron Pipe - -ro Final Grade Vent Pipe' • Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe F0 0 0 0 0 , Of Aggregote o Perforated Pipe Below Beneath Pipe Coupling Terminating At Bottom Of System -REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 10/22/.92 '08:55 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/23/92 AREA: MJ Activity: A9200387 10/23/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 7.29.19.107D,NE,NE, TROUT BROOK RD. Parcel: 030-1028-50-000 Occ: Use: Description: 180306 Applicant: STORER, JOHN, & THERESA BUBNASH Phone: Owner: STORER, JOHN, & THERESA BUBNASH Phone: Contractor: ULBRECHT, BOB Phone: Inspection Request Information..... Requestor: ULBRICHT, ROBERT Phone: Req Time: 13:10 Comments: /;3 d / Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION c~G/vim Inspection History..... Item: 00012 FINAL INSPECTION t Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 3(-K a'I ( TOWNSHIP 1I.l~..a S 4 SEC. T N-R1® ADDRESS I Y 3 1-'~ I I I V Q, ST. CROIX COUNTY, WISCONSIN S~v~C~ Qutzr~sy ~~e MN, S S3?~ SUBDIVISION I Rq k~ 400K ~~J (SLOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IrLUR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lao~ 9~,1 ~SaNK ~ Qe~ Roo,h~ co )Ou ayx~3 8~d TR~~~ ~3 ~ oaf --------T"°" INDICATE NORTH ARROW 1 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: i/. Proposed slope at site: SEPTIC TANK: Manufacturer: W --tA YS Liquid Capacity: V Number of rings used. Tank manhole cover elevation``:// Tank Inlet..Elevation: os la Tank Outlet Elevation: d t. T1 Number of feet from nearest- Road.: Front,O Side Rear, feet c From nearest"property line Ftont,O Side,O Rear, Y0 feet Number of feet from: well 30 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest. property line: Front, O Side, O Rear Pt. Number of feet from well: Number of feet from building: (Include distances on plot plan). He►~ol e2 . I. I a ~ 10 I. ► a SOIL ABSORPTION SY EM Bed: Trench: Width: Length: Number of Lines: Area Built:- ~1 Fill depth to top of pipe: 36 Number of feet from nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspectof: Dated : / d Plumber on job: License Number: r q~ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. 19160 989 , . BUREAU OF PLUMBING WADISON, WI 63707 (CONVENTIONAL ❑ALTERNATIVE S'a", Plan I.D. Number: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER INSPECTION DATE Jack StoneA 114312 117th Ave. S.,Bunnesvitte, MN 55337 -8> a:3V BENCH MARK (Permanent reference-point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.- SE NFU, Section 7, T29N-R19w, Town o6 Hu6on, Lot#3, Tnoutbnook H,c.M Name of Plumber: JMPIMPRSW No.. County Sanitary Permit Number: Richard Hopk n6 1059 St. Cno.ix 69675 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TAN INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: BEDDING: W VENT DIA.: VI NTMATI HIGHWATEH YES ❑NO ❑YV ❑NO ALARM NUMBER O ROAD: ` IL ROPERT WELL. BUILDING: VENT TO FRESH FEET FROM INE li 1AIR L YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP; SIPHON MANUF ACTIIHER WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST-1a SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ulArt E TEIf MATE HIAE AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO. OF UIS7H PIPES COVER JINSIDE DIA aPITS LIQUID THE NC iIAL: PIT DEPTH DIMENSIONS GHAVFL DEPTH FILL DEPT H UISTH PIPF pISTR PIPE DISTR. PIPE MATERIAL N -TH NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EIEV. INLET ELEV END PI FEET FROM LINE-~/ v AIR1NL T ~S /73 /01. n Q v N_ EAREST_ s 0-%3 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PF HMANF NT MAHKF HS JOIIIEHVATCON WELLS _ ❑YES ❑NO _❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED UFPTH OF TOPS11I1 =E UFO MULCHED CENTER EDGES S. ❑NO ❑YES ❑_NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING 16HAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATE H IA INODISTH jU:1TRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.ELEVDIAELEV. IS DA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑N0 COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. AEAREST UMBER OF PROPERTY WELL: BUILDING: EET FROM LINE: ❑YES ❑NO ❑YES ❑NO - Sketch System on Retain in county file for audit. Reverse Side. SIGNAj E'. q TITLE'. DILHR SBD 6710 (R. 01/82) r' ~%unsconsim APPLICATION FOR SANITARY PERMIT ;$7 C"ro • DILHR UNTY ~ (PLB 67) Y PERMIT # 'OEPF OF R - II-IOUSTR~TRV, i, LR FiBOR6MUmii1"IRELfiTlOr15 UNIFORM SANITARY -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPEUY OWNER MAILING ADDRESS JACK STQ je(~6) 1 2 1/2 A✓E So 11eA1S0 LLo it .5 3,37 PROPERTY LOCATION S 1/4 !d1/4, S 7 , TA N, R 19 E (o Tow o : 4,03 U ,L) LOT NUMBER BLOCK NUMBER ISUBDIVISqN NAME NEAREST ROAD, LAKE OR LANDMARK S ATE PLAN I.D. NUMBER 3 ~crr ie~Q~c tkL& i our eQQ~c R fl IN/ TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): ;.j y S 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. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ 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 Conc to Constructed Septic Tank Capacity 00 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: (jt1 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): a J X Private El 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. . UPfMPRSW No.: Phone Number: 4 AA44n I /p (7i ,,2W Plumber's ddress: Name o esigner: r COUNTY/ DEPARTMENT USE ONLY Disapproved Signature of Issuing Agent: Fee: Date: ❑ Q 7 p ❑ Owner Given Initial ~l S~ / mol d e Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: I DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber F 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 locations, 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. APPLICATION FOR SANITARY PERMIT STC - 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 Location of Property S14, Section 7 , T21 N-R --~J~W Township l4 ,D SO k Mailing Address ' z 31 Z f ~f /db~ spy G/~iVS !1 ALL ~S3 3 °1 Address of Site GQUI BecaK, Subdivision Name T HOC! j®OrC/GLS Lot Number 3 Previous Owner of Property O Rp , Total Size of Parcel S. o-5 a c ee~ Date Parcel was Created C-~ - ,I Z S-5- Are all corners and lot lines identifiable? Yes No. Is this property being developed for resale (spec house) ? Yes No Volume ` and Page Number 621,41 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I ((ale) eekti.6y that att Statements on this botm aloe tAue to the beat o6 my (out) knowtedg e; that 1 (we) am (ate) the owneA (s) o6 the p to pen t y dens cA i.b ed in this iniotmaz%on botm, by vi tue o6 a wattanty deed tecotded in the 066ice og the County Register o6 Deeds" Document No. y ; and that I (We) ptes entty own the ptopo.sed .bite Got the zewage d"pozaZ (ot I (we) have obtained an easement, to tun with the above descAi.bed ptopwy, Got the eoN/sttucti.on o6 said dyetem, and the .same hays been duty tecotded in the 046ice o6 the County Regi.6teA o6 Deeds, a3 Document No. JAW SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) q-- 14 dpco- DATE SIGNED DATE SIGNED /A , H z . H _ y ST C- 105 r r H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z 1 p t7 OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE j~k Ds W /.5 ZIP 14 PROPERTY LOCATION: Ste , A)V k, Section 7 T ,91 N, R/`! W Town of c( p$~~ St. Croix County, Subdivision 1eW_r&V1( Lot number -3 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- I'd ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE fb St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. O y 9 N N N 3 O C N w `D CD w `D A A O 7 O L ~ a3 ~co w w w~ w O o v► aa 0 ~co'<' : z m O~co 3~am(cN=0 'Om c^D m cD m a N ~ S 0 m mm ~m 'Coo r 3 a o Q p0^' cc0 C.. C 3 °.c 3: c c 3 0 ao C7 n r- ~ c~ M o 3 ° a~ w (COD 10 'or c N c or c~ 0 a % Dw a 0 0 o =cam C(I)Lo~ ~1 oym c(AM CD N Z S o a Nmn 3 MMJ) 0?a D D y m 0 3 y cis ° w o C)o Q w D (D N 0 acc N N a ac0~cv C 1'11 =r m O fn (CD m r N m N O 0 =St Q p) N _ D =c~c D to a+ 03a cv0 y E. cf- IT1 i S.0* M ao°u' ~ cD - w ~ a CD as asN ca C3 g Q cr fn O Om 7 p y O N $ c m m n c co a c --4 CD CL 0 D j o 0. T c CD =r N 0 00 4 ac3 0= 0y,3 3 06 (D < y;. O N 3 a o z Viz': :a ~o c o All • INDUSTRY, DEPARTMENT OF REPORT ON SOIL BORI AN , SAFETY & BULDINGS 707 DIM ON °R7AND PERCOLATION TES 1 ~ P.O. BOX 37969 -HUMAN RELt-TIUNS MADISON, WI 53707 • ("§2,09(l) & Chapter 145.0 'N '310 LOCATION: SECTION: TOWN Y: L9 19K. VISION NAME: SC i/pUl/ 7 /Tza H/R~~,~'(o u~soN U-r 8400-K _l_411" COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: Cko)X JACk ToV'jt 14 12 /1T"AV4 a ,M SS USE ATIONS MADE NO. BEDRMS.: COMMERCIAL DESC IPTION: IPTIONS: R A N TESTS: FFA 1 Residence A, a JONew ❑Replace 3 Z,S 4~ `T /V A g01 &s ooK , 49 -5ta L-S o A'ri4a IZ60 RATING: S= Site suitable for system U_= Site unsuitable for, system NVENTIONAL: MOUN~+D: IN-G(ROUND-PRESSUR : SYSTE~+M-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) NS ❑U ❑ S EU I LJ S ❑U ❑ S jzu S ME 11CONVIENTIONAL If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: N Floodplain, indicate Floodplain elevation: N•A _ PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHW. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 <64 /w as N6Ni > 84 6-i2 dt $r, Sd /2-ZA sLl ZS-a4 S w -F cob1~S~ B- 2 ~4 /64.S4' NoNt > 84 o-s dK Br, S,/ 8 -Z'!g 5,1 W/5 PCic..M LS-84 5f B f6 104.34' Nwg >84 0-13 Br.51/ /3-24 511 24-86 S w -r B. 4 ~ s /03.x9 > as -a dk 8hsl/ iZ-Z95f1 z9-43'S w1Vco6 43-8S 5 B-5-1 /OS.17 >$7 ©-a dV&SI/ 8-33 51/ w/S 33-e7 S B- ' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP N WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D PERIOD PER INCH P- NcxiC- 3o z, '/e 4 Y4 9 P. 2 24 Na tlr 0 S 2' 2 / /33 P--3 3 &Q C. 0 3' 3L 9.6 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 16 00" to I SZJ ' i ( t i r ~ gym. F G A t¢, sa ue " ` W/1 i I 3 mss' 4~~ TN Nat ~!.!4c?t~►''gQ4K PrLCY 0 /ob. B Q~ F 4 0 , - • , a Jl~ .3/a 7/. v5, - •51.x.. _ ~ . p ~ - _ I~...f O . r~ Q ioo ^ o ~ r/a :e ~ 'DI' ~tl~ j 1, ~•a- _p F' ~ &z, SON rCb ll u 3e ( c% v F m ~o 09 1„ r elPr9n1 ~eP . LL V 100. Ij 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 (print : TESTS WERE COMP} ETED ON: 14aQvav G Jo/aNSoN 9/27/8T ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(oplional): 407 13EcdvpS-r, NUAScol k/1-sc. Cs-r 3464 71S 3®C-40aO CST SIG ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DIL.HR-SBD-6395 (R. 02/$2) - OVER - t 1 qwo~j ~oer~~ 1nv~ d~ d 4L ,Q N 40 Q ~ QOM r Q ! -J %4j J Q Q m x40 J PP B 6 7 P L OT A t>> r-IO S S SECTION _ l (3 L U H-1 M E N A M E--2~=lto Rp r L AT 10 R _ LT I - Ni P_ L O [\iI A_P L/ 4dRoo 000 v CIO, to ` .5' r- -C W /JJ *4; , kW P Pe - S£ loft CoRWP, ~f2o~n~ pre C', FRESH AIR IFILETS AND OBSERVATION PIPE C]tOSS SECTION _ Approved Vent Cap Minimum 12" Above / Final GraSl~ 4" Cast Iron Above Pipe Vent Pipe To Final Gradc----_.__. Marsh Hay Or Synthetic Cove.ririg Min. 2" Aggrey';i 1 r! Over Pipe on i, Distributi Tee Pipe Aggregate t Perforated Pipe Below orn oV Yy-OPt\ Beneath Pipe Coupli.ng Terminating At J/ Bottom of. System