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HomeMy WebLinkAbout020-1062-80-000 I'. -O O 0. c Q) o C O y C^ C ~n C N O Oa N O O I O O N I h L I 3 ' i O 00 Er bo y x U C ~ rn 7 U LL C L O U O ' Q N z Z d y N 3 a m N I- Z c C7 O z C N 0> Z d O N H ~ ~ 01 c O a) 'a 0) CD co .N a p~ N O O O • AJ d L t m pCV ON C O N N o a o z F- Z z o o ~ N E E c 'C 7 ~o o L O CL i N O N 0) U L n N a o a a U cn (n (n E ~ X000 • a a a a 0 `i 7 p a N N O (n _I U = a) 0 0) It (9 (O O Q) 0) O O O O N N O O O - N M M 0) y 2 (f) 00 f- w ' Y 'd v> d (B 0) d Q u M +y ❑ N N O p O J N C O R O m C p O O N a> 0 0 0 c co O 3 m u C c rn o 0 0 a0 N N a Y 'C3 N N N O (Np M C U N O 0) 0 0 0 w O 7- N M M 00 a) N (n a0 I -0 Z) O N N :L- N -C E cu 64 Cj Z) : 3: O N 2 O M Cn • ~I y',~' f~ .ten L ID a~.a as • ca a a~ v y 1v E i 'c c o 3 3 o v~ U - 1 G~ U a 2 0 3 P6 - ZOcQ~ AS BUILT SANITARY SYSTEM REPORT OWNER G~PFG i 54N9y GIJA /TOWNSHIP ~vDSO-✓ SECTION -2 3 T Z l N-R -1/ W $i%E ADDRESS 6>31 eel" leA ST. CROIX COUNTY, WISCONSIN ,~fUpsd.✓ SUBDIVISION ® '~S LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s CRIG114NL INDICATE NORTH ARROW 01 BENCHMARK: Elevation and description: P6waL- 40x ??2L le~° /~.w = i a o• O Alternate benchmark L/ E NDT SEPTIC TANK: Manufacturer: Liquid Cap. ~~-Dd dam" Rings used: Manhole cover elev: 16S'.S6 Final grade elev: /0 ' Tank inlet elev.: /03.340.• Tank outlet elev.: ~d gZ , ';P 200 , A No. of feet from nearest road:Front Side Rear Ft. . ,Po~of~ From nearest prop. line:Front 17y Side , Re r Ft. Q wEil Z;Vr itiStri/-tom 22 I 1, No. of feet from: Well A> DA-rE' • , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE h n ~ 1 P PULP CHAMBER Manufacturer: Liquid Capacity: _ Pump Model: Pump/Siphon Manufact.• Pump Size Elevation of inlet: Bottom tank elevation Pump on elev.: Pump of lev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from rest prop. line: Front_, Side, Rear_Ft. Distance f om: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: I< Seepage Pit: 135. Width: Length ?0' Number of Lines: Area Built 13i 1 /0 3o /o 2.O ' Exist. Grade Elev. io .o Proposed Final Grade Elev. Fill depth to top of pipe: 34 4v Lf I- Of ke'4~ No. feet from nearest prop. line:Front~l3, Side , Rear Ft. No. feet from well: No. feet from building l 3 L Vo r 1'-v s -6tl/-4Q -~v ~r~7F HOLDING TANK Manuf acturedA winn Cap Y No. of rings used: Elevation o ottom tank: Elevation of inlet: No. feet from nearest-P:top. line:Front , Side Rear Ft. No. feet from: ye-l , building , nearest road Alarm Manufdcturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER: /LJ~'f s 3 '3 O 7 6/90:cj o ~ oZ ~ t , o ~ b ~ s NA ~ 3 o oc Z -s ao ~ ~ 1'Oq 1e 1 ~ op C n ~n . ~ 11 Z ~ ~ N o x it ll` 11 ; o ` ~ oQ i 1 1 1 \ ~ G .11 11 ~.1 ~ 1 1 1 1 O 1 1 ~ 1 1 0 h ~I~ 11°~ O v ) 1 0 C ~ 3 a V~ ~ V z ~ C _ ~ p O V1 n; rm 1 low IA Q-CPn )CO 4.: rn C ~ 12 o n ,'`'VGis~'~conls 9r:,tmeUD,fSO~Tust23.29.19.239A NW SW KELLY RD. County: Labor Human Relations PRIVATE' SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 180282 'Permit H'older's Name: ❑ City ❑ Village [Town of: State Plan ID No.: WHITE, GREGORY L & SANDRA M HUDSON CST BM Elev.: Insp. BM Elev.: BM escription: ` Parcel Tax No.: e ev . a~ ` 4 ( 017 020-1062-80-000 TANK INFORMATION ELEVATION DATA A9200361 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. II Septic , Benchmark V (D kw-,e f4, Ing Aeration Bldg. Sewer Holding St/ Ht Inlet p7/ p3, S- TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD .-Qs Wips Air Intake Septic noaS~ NA Dosi NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System / PUMP/ SIPHON INFORMATION Final Grade Manufac Demand yF Model Number GPM das. TDH Lift Friction em TDH Ft Loss ea Forcemain Length Dia. Dis . o Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length ' No. Of Trenches PIT o. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI EN 1 N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH WQ, Manu acturer: CHAMBER INFORMATION Type O _n~- Mo er: System: t/' - S >16V f >/6e 'LenSlr. OR UNIT DISTRIBUTION SYSTEM Header / r Distribution Pipe(s) t if / x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Lengthj!j~417 Dia. Spacing _af SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ,r k Depth Over ~J mfr xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Z Bed /Trench Edges ' t Topsoil E] Yes ❑ No E] Yes []No COMMENTS: (Include code discrepancies, persons present, etc.) CLt~`c.` LOCATION: HUDSON 23.29.19.239A,NW,SW, KELLY RD. f q 4 G ,Q, h& j( t`~Z,, I sY s{m-`c! . ~~sL~- P,~e~G/, ~r~r►c j = 9G,s~ #z = 1 S~ toj? .1 - 790 8 , Plan revision required? es ❑ No Use other side for additional information. 1/(4 SBD-6710 (R 05/91) Date Inspector's Signature Cert No. DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY 6r-r. cf1vt'x STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. Cn k evasion to previous pplicatfon -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. /v pROpER OWNER ~~N~ PROPERTY LOCATION C/P NWI. s4) %a, s 13 T 74 , N, R E (or) W PROPERTY-2O.-WNER'S MAILING ADDRES& LOT # BLOCK # vN CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 17'V 19S" It 3 11. TYPE OF BUILDING: (Check one ❑StateOwned ❑CITY E NEAREST ROAD M Y_ JQWN : xt// /e ❑ Public N1 or 2 Fam. Dwelling of bedrooms Y_ PARCEL TAX NUM ER( ) 111. BUILDING USE: (If building type is public, check all that apply) d Z l✓ ` /0 CG Z - 90 " OC)C) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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. Ex New 2. ❑ Replacement 3.E1 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 ❑ 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 El System-ln-Fill 7~ ,U 64"57 j!-46j~k S x S Z VI. ABSORPTION SYSTEM INFORMATION: 9 • d f ©2 O 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE /mfr REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9,7a LEVATION 7 90 76 -5,3 ~ S• 7 S Feet ~ /7e 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 h Lift Pump Tank/Si hon Chamber V 'Z- VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Prin * Plumber's Signatu : ( Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ) ❑ Disapproved S itaryPermit Fee (Includes Groundwater ate Issued Issuing ent Sign lure (No O.WPO Approved El Owner Given Initial Q~ a Surcharge Fee) /v 10 1 Adverse Determination (A/ ' 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 r 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, 60B-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. 111. 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, -lumber of tanks and :manufacturer's name. Indicate prefab or site constructed and tank material. Cornp) ete 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'f2 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 b owner/cn o' tracto by r►(spec house the n 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 ' 54,V O y. &)1 /AC_ Location of, property /1/&)1/4 1/4, Section 2-3 , T Zf N-R ~ W Township Mailing address 2- t=LL~.cc.Qp Address of site 0.31 Subdivision name Lot no. other homes on property? yes_ , No Previous owner of property Total size of parcel Date parcel was created x Are all corners and lot lines identifiable? Yes No Is this pro arty being developed for (spec house)? Yes _Z_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 ,i the office of the County Register of Deeds as Document No. y~s~ ' 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. Signatu e f applicant Co-a icant Date o Signature Dat of Signatur i T 1 47 F: t Y N - ✓Y~ A ~z ~ ~ilS sJJ{{~~ 3, L p. ~ ~ M ~v F i~h5, j ,f _ SEE PAGE 41 / FALLS W I L. LOW # h.'` rJ" y c v;ce :~e a,"a Lh/:m: fed I PON ro~ 28' Pah/C ~'eicha~ d 40 un/in G'/ub, Inc. 9 RIVER A ` ~bn" ao ,gee y9s .Panda// f 6 fQ7~/iCiQ . $4 mi t e s e9. Z5 L 4,1-?;' /SI¢. ,t ~ }Cohtn 2/.4 9/bpi UcJ///7a17 ' ~ ` Hcnd- ei 5 20 ly a r; h t r C E 4l S TA TE PA R K,. P/.z ~~f sm`,~h minks /4,02 ~t X00 s7`C'tfe O w:SCO/ZS:.7 C L off Na/r//Q/ 74G m / Z./IVC5P s n 4o 14 ces 9!~/ein sue: -:.T.Y,.Q•.~::::: _ 60.s. 969 : TRS: . . 1 /Push ti sfor 2Ct5/ FJeanone 10 AVE. tl n v, N owe l p~ QrQA , h I~~ Kaf.7e~- i 61'ow17 3M .Y.R • ' '(~P . • /04.29 Cn va//ey C CU CHEQ+/^ Gin/ :FVv":: tRAC h SCOUt Ca/7~/oS v /73.41 C MQ.. ' NE:' • ::C:Q:: tl < _57C. I sTa~io /3/ a:: T 5 ~o q o &0 _57 h ti V h oben fIr s AFe/7 e• 2Bo t P-A . tS::::: POO ~ cab 7o krCe~ T Inc ISS9 rdson 4i aeobs t %ak David } L /G.99 e 1 /i 74//'eS M'• WoVu~ie a 70.7¢ ~1.0~,• 1R. snn.... n 53 C' 8 N' 20 )i a !D YE s. a i9`3 low 12 W 4. A/ LL! q Ley/e G. 93 /o s ~Ct /e ' d i f/en/yi7 Ben ' / 4~ fjCter C. //9.Z5 `Ory Isabe// efQ/ J Q Q 74.07 • GN. Qua//s /70.8 P' cy tU/ynf 2Fcdenct/ zsD. :::::::::G/s Uacob ~Y I) Beno~in : Roh/,~h Load Bank B0/2o Fo::::::::: Genar C 40 76 4 ' o ~St Pau/ : VRCL Y.::: h Q : eYux Mo ty PI,2711R1 2. H . V a74 3 JQ 9 T. y:vfSTA : " / ¢o N Dc2vid ° ° i/en S 9. G 4~.LSfADI3~ ~ ~ 3S ~e// cTn •ti' • ~ xU y ~ wtr~ ..N.. m C.B. RS -WTRS S SSi 2 ~Q~~1l,Q v20/ 14tALL FLU S)III TrznGrs 5 udsppn /ie. f s st /ve/s C•ty~t Lson 9ss Po/e/7 aVid t Mar` y K.17. e Be~nai a/ odiand N. A<1771e C • G.C.Conp /60 .ee/ine 2GG37 y 1/6 n ~ q ' /'`O 0 : 0517 Knne~ 874-4 40 • Z¢o C V ~ cC. ~ 2 ~ cfiDAR HI lLS G. }S, enn } US Fish tl \ 6 EtYRti;so:::: A//en Bei.~LZ~ d yeet(z 42 5 h atniacz 3 orn ay~d Kinney axon 2.74 / Ke/y 8 0 Con/~. • 0 , don 9B Land : 176 A/QSCPJJr° of 2cY. .S ' HIiiH::: .rJ p h 94 MEADOW I'a 22 7. O's- 35 /2 17 B . ' Lobon, kith. L...C vS ~S. kE cTames C a n' /~I7 aai p G/cnn 4 cc//a Do/o><ht//' a>C Lam. `y` DQ /e ~ 27 eta! n ~ A~L• . axon 179 SYY TRA4t~4 •s>• 92 s N +a, cQ `V N •v ro . 9i s C/ate ~G OUN7Yt y .ZS A t v} Z?, vi IA Q rah s/DcrR. 50 8r € Es l70~/ t f • 2S. ~o /484 Ile - 3 • S' /vesf'er' ,Bonb 3 - }AHor d k of Cj eoiye E'. ?}1 ~ w:. .:tE ` ~a/cer GQlbe in9t2 _ ~ O N fCieonyii~a ~;4) ! V Ijyvh s• _ 3s Zoo 339 CjQ~ 7~ 245.4 S o~..~/ z ' JC Sr10LL Cd Wi/l~a/n N h~;s741) } 1Y"on l • per. aTS r o freh -r y DR. /o BR IJ 7/0 Z n O /968Roc o~d r/ate Pu iCs., nc. SEE PAGE /S RD. v`f Croix o~.r,>y l ✓~v ~I WORKING S lo u10% C- f W s 2: { t G (l~ m - l7 47 :X f~ O lam- V p 0 to Q co Ou, S O to H V J 1 C* ► (y O O c+ IV f,✓ ~2 m (n m 3 z O x •Qh p m Q .r P :p f0+ r O co O H *,3 0 0 U, PO 1-4 J ' n r~• m y o cn C+ 0 (a t ~h ~L p h O cn v m L` W O D r v; to w C+ m Qom; a~ c~ ao ca ~a r. O N F. I A. c,r F•" CA Q s to 0 (D O T y . 7 •K r C+ CA C' O p t~ I ~ J~ O m F~ O •r m cs: ' I c~ Q y,, to ra P3 0 0, C+ #1 p C- 4` f 17+ (M Cr r 'Y to ` O f!} ?U Ml Z Po Ir, G N , pi • L7 ~1 . n y Jy cL 0 M • 1 C+ t7 t- h. 'fit a t . O co m .3 Cl. ,4~~e t~ tigg~*~F w u ~ c+ i[ O t` Z.1ri G N• y Cct 1-4 N) 0-1 Ar, • 4, Ct C Y• r~ 2 f~ O_ O 'Y Y• ~ O O K T v f. . 0°14'57"w - KELLY - - - - - -NO° 14ST'W _ 1326. 05 ROAD 6 79. 02,1'. 6 4 6.02' w • O~ O o~ o --1 0 c ^I n = 33 i r • ~T m y co N o _ 2 m co O W CA co V ~i rn ! Ln rn ov mOD rn . Z L. QD Z, -4 C) Ln e ko Q C) N r+i s y ~I m n - ( to Ch C1 (71 V w ;tow 41- v 3333.00 - 646.02 679.02 S0°04'27 "W O m ~ F cn 2 rn I z~ m o rn n D O (A o r. Z o 0 y C ~ A O V) rn 2 c-I m D ~ Z O F O rt _ a N O F ' - t• a N t Qn \ ~I 0 I , C' 1 leo. S T C - 105 Q (p SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS led FIRE NUMBER CITY/STATE //v,P5e1.~ 4.)4_5 ' ZIP PROPERTY LOCATION : f " A)1/4 f 's 1/4, SECTION -2,3 , T N-R-!-L-W TOWN OF "Sam , St. Croix County ~ SUBDIVISION r 61c- 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 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. Croi o. Z ning Officer within 30 days of the three year expiration d SIGNED: DATE: a- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION 'LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53969 0LHR 83.09(1) & Chapter 145) LOCATION: SE TION: TOWNSHIP OT NO.: LK. NO.: SUBDIVISION NAME: ;VU) 1/ -s&) 1/ 13 /TAN/R E (o f+VDSO - Ct57- PART- PA r o 20 ACAt s COUNTY: MAILING ADDRESS: 5Y, C,Qdlx e-PE 6- 3 SANDY wL ME Ski ~u.uDy L.~ -Ho0Swti1 40I 5. S y0,re& USE 33 Cg - 2D DATES OBSERVATIONS MADE NI().BEDRMS.: COMMERCIAL DESCRIPTION: TESTS: 17RAUFFIrLEEF"DESCRIPITIONS: PERCOLATION Q~Residence 14 XNew ❑Replace / 101 (L 9, (q Q J SAS S~ PE- Si L t-/ C s S TPA T.t S RATING: S= Site suitable for system U= Site unsuitable for system .5747-T ONVENTIONAL: NS MOUND: IN-GROUND-PRESSURE: ISEI Y STEM-IN FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) ou ®s ❑u ©s au s ©u os au TRE,_)C&tS-1At- CROP aoX D S T 1' U Tt o n.1 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. I LHR 83.09(5)(b), indicate: G L~ S S r Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS T,,.) 1JECIM^L Tt`E~ I BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION 0 SERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) d . I.S 111 k. 0 e6-_ Srl 7-. S. , ,33' D,r.M.3 S;l~ ,G7' i3N. B- 5 /00.7 L1 > ~.S srl~ I.5'7,t,a Sil y. S ' 11 A.1 . CS 3 6R % 13lk.oe6-. S;l 'r-S. .'7S'Ze,0Aa.Sr 2.0 B- Z 5'~ /6/.~Jl~ ,S > cl oR, eoupk 5eA,uuLAf2 SI ) % 5.5 q q .'75 ' Blk. 60S. SI'I 1's Dr. 3a . S;111 1.5 ' B- 0 ~O Cp.l B - / r~ 6 R , g,o. r d u f? k S I 6 ~ 7, 1,) tw-@J. S . B- / / ,O' /D y 7p, 7,0 /S S13 Z 0- G , r, /4 2SD 'T-+3 n+ S 111k. 7-5_4,61 B-5 7,0 /O2.~Z3• ' ~a . uau s I s, B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RAT MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIQD I P RI D PER INCH P. Y. S ' 'ko / O Z I ' YZ Z p_ ' f7 14~ 13 I f 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. 7s ~D ~i1E`S i T•~E-v a. SYSTEM ELEVATION. - p - E i I i SEE- PLOr Pt,PIA-) et-0CPSE S IDc ~ TH t^1 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 (prinW HUmtSilt: PM PLUMBINCr6G_-- TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 d P lRi L 1 O_ ( I C 0 ROBE RT ULSRIGHT I / ADDRESS: WIS. MASTER PLUMBER LIC. NO.3307M.P.R.S. CERTIFICATION NUMBER: PHONE NUMBER (optional): Z- Z 3 " Q ~Q S MINN, INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHA-SBD-6395 (R. 10/83) OVER j v a ¢ H CL: h ~1 ~1 ui ci 1141, W lL M~ Q w w 'C q H h A, III o o C AL nl \ i LfN \ ♦ _ ♦ cP ♦ \ ♦ • bo o1 l• 1~ It w M W O \L %A ~ who O M M 01 A 0 ~ ?p rn r H o, 00 N b w w L ~b 10 d 41 - \ 11 N? - 0 - rt ~C p ^ o R g a p L W o ~o.. r fl) 'tt, 70 r ' # 6 Fresh Air Inlets And Observation Pipe C~.---- Approved Vent Cap y Minimum 12".Above Final Grade 2, O 4" Cost Iron 3G "Above Pipe •Vent Pipe' 'To Final Grade ' Synthetic Covering min. 2" Aggregate Over Pipe Distribution . z7yy - Tee Pipe 0 0 0 0 0 Aggregate 0 Perforated Pipe Below Boneoth Pipe 0 Coupling Terminating At Bottom Of System Fresh Air Inlets And Observation Pipe I . Approved Vent Cap Minimum 12" Above ' Final Grade /04 0 4" Cast Iron Y6 Above Pipe Vent Pipe' -to Final Grade Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe o 0 0 0 Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System . • Fresh Air Inlets And Observation Pipe • Q.----- Approved Vent Cap Minimum 12".Above a Final Grade i-o-I .UIShi!~ jip 7.J ' . 4" Cost Iron , 360 " Above Pipe Vent 'Pipe' to Final Grade ' Synthetic Covering min. 2" Aggregate Over Pipe Distribution -P- -Tee . 4cft Pipe 0 0 0 0 0 G 'Aggregate o Pertbroted Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System .00.001~ S Fresh Air Inlets And Observation Pipe Approved Vent Cop -Minimum 12" Above ' ' Final Grade Above Pipe 4" Cast Iron • . ' lo Final Grade Vent Pipe • Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee pipe 0 0 0 0 0 . " Aggregate 0 Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 1f/1b/92 09:47 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/10/92 AREA: JT Activity: A9200361 11/10/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 23.29.19.239A,NW,SW, KELLY RD. -Parcel: 020-1062-80-000 Occ: Use: Description: 180282 Applicant: WHITE, GREGORY L & SANDRA M Phone: Owner: WHITE, GREGORY L & SANDRA M Phone: Contractor: ULBRECHT, BOB Phone: Inspection Request Information..... Requestor: ULBRICHT, ROBERT Phone: Req Time: 13:11 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Insp ttion History..... Ttem: 00012 FINAL INSPECTION