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HomeMy WebLinkAbout020-1185-20-000 N c c 4 O ~ I `O I 0 II N I o ~ I ~ I ~ I ~ I I I .N0. 0 I o z c ~ {i c o 3 :o ~ I I Q c I M rn ~ _ O I Z d m N H fA I I O I c zv' y z~ o c o I Z E ' I v M N N 7 7 a C O o N z co z o N a z E N > a Y ` ~r N y d~ O N O O c rG r G a E L io N U) U) U) 2 a co `033 n to ~O z c I •N 0000 CL N N O N rn z ~}yy m J V o 00) - to O O O Y O O N C O O 'O O Coo J ml ~ a C 'O O) d co W cn m cc o O ° O i M W C O r'd O ~O N c 7 In co to .9 w a CL 0) o 0) o 1. 's c U) R N H v d• tD 1 LO E O a 0 o 139 LO -Z a) CD 0 0) f- y N d CD '0 C_ N • ~ N N 7 - T O N O E R U o N 2 o z z~ ~L fA m R € a L: 0. • C9 a d m E O c d rw I t A c0 IL ;oaic°~ FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Sam /~J,' //Q ✓ TOWNSHIP SECTION 21 T Z-7 N-R / W ADDRESS-20.z.. frz 6z_ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT w LOT SIZE a `YG5C` PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 2 j, S /o e y 0 O ~8. 3t ld' a,. J l r''` u i q~ 5c~1~ = 1O ~Q \S ~y INDICATE NORTH ARROW oo _ BENCIiHARK:Elevation and description:_ S w /.J- ee,N« Alternate benchmark A j„Gk -7o40,t'~,,w F1 = 2.70 SEPTIC TANK: Manufacturer:_ wd', se r Liquid Cap. C7 o Rings used: / Manhole cover elev: ,Q3 Final grade elev:_,57(0 _ Tank inlet elev.: 7 Tank outlet elev.: 7_5-S No. of feet from nearest road:Front)( , Side , Rear Ft. 1 70 From nearest prop. line:Front , Side_, K_, Rear Ft. ~ No. of feet from: Well_ 5(, , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 71 i i PUMP CHAMBER Manufacturer: _41) Liquid Capacity: _ Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed:6w0&Af-&,1 Trench: - Seepage Pit: Width: Length Number of Lines: 3 Area Built 72y s,,-~T" Exist. Grade Elev. _-7~ 3 Proposed Final Grade Elev. Z_ Fill depth to top of pipe: No. feet,from nearest prop. line:Front , Side k , Rear Ft.S No. feet from well: g/O No. feet from build. ng SS HOLDING TANK Manufacturer://- Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER: ti V ~-t 6/90:cj T r?t"•ArTtTnw" TJTTn C_nWT n1 0 1 n / 1 Cif CT_7 CV 1) 1 T AP Cn T T AATV Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: La,hor and Human Relations INSPECTION REPORT Safety and &uildings Division cm nnnT y (ATTACH TO PERMIT) 5anitary Permit No.: GENERAL INFORMATION , A p*?Orz Permit HofiI er's Name: ❑ City ❑ Village NE] Town of: State Plan ID No.: Q VTif1V tTT, DT VT7 V K- f1ArP1J7DTMv _ VTTTIC_"IT CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: oo~ tr O~'7 n~n~ 1 o~~nnnn An~nn1 ~o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ' Septic Benchmark 166 'Co r Dosin 03.25 Aeration Bldg. Sewer r Holding St/W Inlet 8./9 776 TANK SETBACK INFORMATION St/)0 Outlet g,~s TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic .~.!~Zo NA Dt Bottom >~p 44-. NA Header , 0 re Aeration NA Dist. Pipe Holding Bot. System ,Z5' J. V PUMP/ SIPHON INFORMATION Final Grade+A W Manufacturer Demand fa S' y" ,Gs o? "rte Model Number GPM S U TDH Lift Friction Syste TDH Ft Head Forcemain Length Dia. Dist. To We SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth DIMENSIONS / DI EN I N Manufacturer: SETBACK SYSTEM TO P /L BLDG WELL LAKE /STREAM LEACHI _ INFORMATION Type Of I , CHAMBER Mode eL _ __j System: 9 ~ OR UNIT DISTRIBUTION SYSTEM Header /+A*m4e4_ Distribution Pipe(s) x x Hole Spacing Vent To Air Intake g __Z;2Z Dia. Length Dia. ~ Spacing Len th SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s Only Depth Over t. Depth Over „ xx Depth Of xx Seeded/ Sodded xx ulched N. Bed / Tfe►1E~1 Center Bed / Fren, Edges Topsoil C] Yes C] No E] Yes E] COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes o _ q Use other side for additional information. ~p 5~- SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' 77DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Co \ STATE SANIT PERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than /417 0?1?5- 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. PROPERTY OWNER PROPERTY LOCATION h o t/4 5 F_ Y4, S Z/ T 2-7, N, R E (otrn PROPERTY OWNER'S MAILING ADDRESS LOT # BLiC K # 3D ?t AI CITY, ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILLAGE : NEAREST ROAD (7 k Ael s m'n Lq it =W OF: ❑ Public ©1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX UM ( ) M. BUILDING USE: (If building type is public, check all that apply) 0 :k- 0 2 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 40 Church/School 8 ❑ 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. ❑ 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 N Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 12 Seepage Trench 220 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSOrP AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE (jS O REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ( &40 -7 Z O el~l• Feet 7 T D Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION Tanks Tanks structed Septic Tank or Holdin Tank 40 we; s el✓ Y_+ El 1 0 1 Lift Pump Tank/Si hon Chamber ' VIII. 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: roti6 ~ ;~~~2~ /41A~ 3233 Plumber' Address jStreet, City, State, Zip Code): IX. COUNI(TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 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.`- ' Ybur'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. 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. 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 fil'i 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) 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 an av AaK 70 Location of property SG 1/4 S67 1/4, Section z / T_,LN-R W Township -14 Mailing address _7G,~g #k "/S o L.- 10 = Address of site J~,~ La,, Subdivision name Lot no. other homes on property? yes_.,X_No Previous owner of property S k n 4 Id re L rs d Total size of parcel 2. oeGs- 14e- Date parcel was created 3- 3/ - 64 Are all corners and lot lines identifiable? - X Yes No Is this property being developed for (spec house)?Yes No Volume 735- 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. and that z (we) own the proposed site for the sewage disposal system orrI e(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. Signature of a p lican Co_a 1 pp cant Date o~il gnature Date of signature _ ~•IY_ _ INe-DATA TMI/ /•AC[ a[/[av[O FOR aaCO110 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 6-lYe= ` I PERSONAL REPRESENTATIVE'S DEED 41o4z~, j 4- - c3_p - 1i ' 4 co, 1(1/!S. Harry J. Stewart X;, ,x)t-i ?I 31rst . I esentative of the estate of ' i as Personal Repr March --•--Jahn..Al~xa..MYx~ll_.I.nxaell,._a/.k/.a._~?ohn._A.~dxs..~a?c~e~~••----.-.. I, _ ai l1.D. 19 8 9:45 A>1 ~jS~B..A~dl o._I:]G$ebl_. („Decedent"), .Y for a valuabin consideration conveys, without warranty, to ..--.----.Y-- raalAO'1r 00 W/41 and. Ca the r,tne._A.__Benox-,._as••husband•_ ife-•as--mari-tal-- ro ert wt h ri h of survivorship E..__E.__...Y_.....4.._...._S Grantee. ecru To St. Croix the following described real estate I. County, State of Wisconsin (hereinafter called the "Property") West Half of the South East Quarter of Section 21, Tax Parcel No: Township 29, Range 19. ;ar T,LI.I..ZQ Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. ' 19 86 Dated this Z6.01 day of IM"rcb _ . .....-(SEAL) ..,.-..'...~:~..~:•:~~~r.-~-~:-'~.......... . Harry .l- ew i. Penon•I ReDn•+entdive 1'ernnnd I:epre.entalive ~ - ~ r\" ~ ~ V AUTHENTICATION ACKNOWLEDONCrV'T~,., C]' Signature (a) STATE OF WISCONSIN 7 Q tiL.-Graix_-- ..--.-County. I authenticated this day of...... Personally came before me this 2W)_day of plaxsb 19.$G the above named Ilar1_y-.,1 . StewaTt,_i4s .Ilersgnaj--f;egre entative for eels .csl;k~.-Of -~~?I)n-Aldrg•hly~en• La•;sen, TITLE: MEMBER STATE BAR OF WIS('01SIN a/k/a. John Aldru.-Larsen, a/k If not. -a--Aldr~-••--- Larseii authorized by 706.0A, Wie. State.) to me k own to be the person who executed the foret~ instrumcut and ack w/lcdt;e t/he same. THIS -ti inUMFNT WAS (DftAFil'D f-iV t. Lois A. `lurray of IiGYWO01) (:,1K1 L `itkk,1i P.O. Lox 2Z9, lluclsua, hl. 54,01-6 Not;i-v I'u),lir St. Croix County, Wis. 11y 1•nnrrulssuin is permanent.(if not, state expiration (SiRnatun•< may he authenticated or urkn•.vkIr~IL•r,I. 11,011 ~ LL re. ~ - 13.Q->) are not ) datr: ko l ll WAR OF N'ISI w,ve..n.in L,unl 111ank C. lur. bLlwwket•, Wis. PERSONAL REPRESENTATIVE'S DEED 1 ORV N.. '-17X2 i • I SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 4+~ llayyi ?3i: ti fu ~.sa wt /~/ar'_ ADDRESS:- A* pia n FIRE NO: LOCATION: 5 U-) 1/4, SE 1/4, SEC. TOWN OF:41dt -SO ~ ST.•CROIX COUNTY SUBDIVISION: ~R ; ~f 5~ct LOT NO. (o 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix county Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning office 911 4th St. - Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS • INDUSTRY, DIVISION P.O. BOX LABOR UMAN t-EDLATIONS PERCOLATION TESTS (115) MADISON WI 5376 707 H (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP UNICIPALITY: LDIVISION NAME: w 4s6 1/ 11 /h9N/R/9E(or)W1 LL N 6 VrsY C NTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: x Caa1x SAM M,«1EP, USE DATES OBSERVATIONS MADE PIC O ~A~TI~ TESTS: NO. BEDRMS.: COMMERCIAL DESCRIPTION: I ROFILEDfES R IONS: Residence New ❑Replace 9~ 9 )~S ~o ~IL.S - PI RATING: S= Site suitable for system U= Site unsuitable for system Q. -i9nkLk/*Q&r ND-PRESSU C NYENONA STI❑~ . M S. QU IN-GROUS ❑U RE: SYSTEM-IN❑FILLHO❑LDING T : RECOMM N D SYSTEM: pt~iLal) 0 O If Percolation Tests are NO T required S N RATE: ~J ~C~l.) L~~S ' If any portion of the tested area is in the AM under s. ILHR 83.09(5)(b), indicate: DE Floodplain, indicate Floodplain elevation: ILV PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 4. ELEVATION OBSERVED EST. HIGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-9.67 39 N N~ 7 `&<,t. 3s &_N AiSi 4(r _ b _70"6R.,iM-6 B- Z 7•3? C)%.61 r l~ > 9.33 16"B~SLTS 56"$ QN AIS4-64--rco b, h'J$ B- 3 10.00 C?-7.SZ > /D .d0 /4"Ekst Ts. 34`$e.,.j MS* 6 e-Qb 72-8q l VhS B-4 .7S 96 anlE > 9.75' jS-#&Sz-r5 2~"$aN~iS ¢-scab 7~"$aN MS B- 9.Fs3 91.30 Novi I( > 9.F3 6"8c6~wscd-fie Z~s'$a~a X15 54 ~ geN MS~EG~ B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. P RI D 1 P RI D 2 PERIOD PER INCH P- 1 Nome o > .43 P_ .30 dr Q7 6 2 ? 3 P- 3 .00 No 61 97 ,00 > 2 > > < P- P_ fdT Y., 1 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 .60' , E 1 0, ..'3. 3 I~ T ~2 Akm t i ~ r i R' t *V ) 1 I ~ ` 1 1 t LINT ji -4_j s o ?el~~t F o J00. d I, the undersigned, hereby certify that the soil tests If orted 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 I tion of the tests are correct to the best of my knowledge and belief, NAM (print): ` TESTS WERE COMPLETED 0 J. ~AQVIIy JON~►So~.I Jd~1NSa~ R~~Y1NG ma-eu Z ADDR CERTIFICATION NUMBER: PHONE NU BER(optional): (~~SO n1 > S gb CST GNATIJFI T E: 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 - SBD - 6335 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use ;Manned; 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; 6. 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 to scale is preferred. 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 appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place 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 FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS Sandstone gr Gravel (under 3") LS - Limestone *s - Sand HGW High Groundwater .cs - Coarse Sand Pere - Percolation Rate med s Medium Sand W Well I's - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than *si - Sandy Loam - Less Than *l - Loam Bn - Brown *sil Silt Loam BI Black si - Silt Gy - Gray *c1 - Clay Loan, Y Yellow scl - Sandy Ciay Loam R Red siel Silty Clay Loam mot - Mottles sc - Sandy Clay w;` with sic Silty Clay fff - few, fine, faint *c - Clay cc - Common, coarse pt Peat mrn Many, mediurn m - Muck d - distinct p - prominent: HWL High water level, " Six general soil texttnes surface water far liquid waste disposal BM - Bench Mark 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. Cmsf /07'' / . e LL V ~SD 0 ~au° A ado U N y v LA (Zr, s P J- Y ~ j s Imo. ~ , ro ~ I I , J b ~ I o ~ I I .r ~ I I I - ~ ~o N In r1` tl 1_ Q y N 'w d to VI ti J p ~9 a o M n o k, a 0 is- n- 1~ I or s s it I 4 'N A- p fi ~ ~ u 3 V► t I► N tea, ~ v .rte ~ ai W vl 4 o Vl Q4 M q Ci~ c~r~ LL) z ~ ~ r Rrt O LLJ CL. ~ LJ 4 ~ ^ F- X O E { 8 cr) O 0 r" CJ ~ O ' O z { O E z it E t, ~ I iii ~ y !E (i ~ !f i i f:~ a U i?! i ( o. ' I i E= jt Z ~ a. O I Ln Is! E ~ + ~Ii 0. i~~ L ~ EE n E LLI Ii{ 19 I` } 'I i f,1l; ;I i1~ t ! i ff ii ~ t~ Lj Li ;I i w ~~;If i t j; o it~ h' i! { U O ~f ( ~ ~ > ~ s~i ,gyp ~ i NJ 7 REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 06/02/92 10:29 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 2/92 AREA: JT SELECTION CRITERIA INSPECTION DATE - 6/ 2/92 INSPECTOR AREA - JT REQUESTS SELECTED - 1 REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 06./02/92 10:29 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 2/92 AREA: JT Activity: A9200138 6/ 2/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 21.29.19.1164,SW,SE, 21, LARSON LANE Parcel: 020-1185-20-000 Occ: Use: Description: 149295 Applicant: BENDY, VERLYN E & CATHERINE A Phone: Owner: BENDY, VERLYN E & CATHERINE A Phone: Contractor: STROHBEEN, DOUG Phone: Inspection Request Information..... Requestor: MIKE MCDONNEL Phone: Req Time: 14:06 Comments: Time Ex Items requested to be Inspected... Action Comments p 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION