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HomeMy WebLinkAbout020-1152-10-000 Q o (D ° o p ova o ~ ~ I O rn rn c I ' I n O L > (D ` w M 4O-. J O) ~ O ~^V C C V r c m z E U) a I LL C I O (6 N Q +L+ (n 3 co a III z H E (n ± p Cl) N W a co N F- U) c O Z d er O N Z c CD z E '2 C p n a N ~ CL N C • Ai d U p C C O U O Z F- Z w N z I I W E N T C N T m z a5 U c, > O 0 a L LO N I F ' N ° o Z O O O M a a c ~y a g y I to -j U 3 0) ~ } 0) o o o N n a CO m d CO 3 V; O O OOD y 0 +1 0 E CD 0) O Tr O N 30 a N C y U d CD p C 00 a CL E N y.+ C C M a) o C'4 t -p 0) cn LO Q) C,i (0 U) tp O N I fA O Ini r' dt a `m a C a w _1 A ciao '',oUS0 AS BUILT SANITARY SYSTEM REPORT OWNER & j °i Q e~ f~ , w P. I I4~ Q TOWNSHIP C J S o rv SECTION O l T Q a I ~N-RJ ,y9 W ADDRESS W M0 p 0 ST. CROIX COUNTY, WISCONSIN 7t Sfyl SUBDIVISION 1-0x V aAf-t4 LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s s` 3~va~ ~.}ow6 !r 0 G` ~\5 3 7 ° ~poo~.lytt~c.: 4' 3S` INDICATE NORTH ARROW BENCHMARK: Elevation and description: P-yeT rr Ivy aewf-Y Oole.t444H►o4 Assµw Alternate benchmark S j) &,,$enwj%7 eaT1'cD d oo r 9 a . Gor F -L' to 0,0a SEPTIC TANK: Manufacturer: \AACStvs Ca^t Liquid Cap. 1600 I Rings used:-I-Manhole cover elev:q Z,91 Final grade elev: 93.0 Tank inlet elev.: X10,. -Tank outlet elev.: 46,3 No. of feet from nearest road:Front_L(QO, Side, Ft. Rear From nearest prop. line:Front , Side ri, Rear Ft. No. of feet from: Well 3r? , Building:- 19 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE r a PUMP CHAMBER Manufacturer: 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: Trench: Seepage Pit: Width: ` Length Goy Number of Lines: ---?-Area Built 0 0 te1 41, 01 *1 1 q1. o l Exist. Grade Elev. " 2 B8. os Proposed Final Grade Elev. ; i 88,os Fill depth to top of piper Z a, ~ I No. feet from nearest prop. line:Front , SideZeiz, Rear Ft. No. feet from well : L S No. feet from building--2-17 HOLDING TANK W A- ~ 2- S A'II 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: ~~~-~+^,r3o~ DATE : 1 / a ",I4 3 PLUMBER ON JOB : tuale 2l~ LICENSE NUMBER: MM 5 33 ?e 6/90:cj Fresh Air Inlets And Observation Pipe - Approved Vent Cap y F'o r Minimum 12" Above Final Grade 20- 42" Above pipe. -4" Cast Iron ,17•,?G..(~jl BY Vent Pipe _ To Final Grade synthetic Covering. R tSFA 1`~L ~-W Min. 2" Aggregate Over Pipe Distribution Pipe o 0 0 - Tee 6" Aggregate !f 8~. Qyl Beneath Pipe a cc,2 84.~~ _ 7rGNr~ ' IL I~ 14).?arc ww-t ~ 3. lkP.1A gM TmPTroy Pt PQ L.-t d 1h ti-J, t r 4u L6' 6 P be 17 aw Qowe r port ANNIoIo $Sr..w ( ~1 ~ 1 db ,b0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION N L:ABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: SOW NS MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 5 '/s ;3 /Ta9N/Rt4 corlW s0a 1 w)#- ox uallr'v COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: i 151, yn t A 9G,1111 Qcc~ s 6 NI o~e7 I S /~~a 1 s~ H $SOv USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~N (PROFILEDESCRIPTIONS: 1PERCOLATION TESTS: Residence 17 W IR eN1 ❑pRe lace ld-s-9Z IO-(,-~2 RATING: S= Site suitable for system U= Site unsuitable for system ONVEN STIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDIING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑ S ZU ®S ❑U ❑ S OU ❑ S ®U Conye.,rttok Tr~ee~<I SLo 717-%a If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: IV 14 lp ~S ' Floodplain, indicate Floodplain elevation: tV j' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- a- re- i 1 T v o 0 c, ± ' w B- B- B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- 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 I 1 1 ! re i C O,rM G! LG 7'o( 3 7 ~ ~ I ~ ` ELI )0~, r , E ~ Kl. 3 3 I 81' 1 I i 1 € I , t i i E I G.1 laji Iv~ C 12 ~t n QO W~/ 0Iq d I, the undersigned, hereby certify that the soil tests reported on this form werethOety m~n accord'ith 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 COMPLETED ON: fl- ADDRESS: CERTIFICATION, NUMBER: PHONE NUMBER (optional): l04Z. S 5 QwYk 'J. t..~ g4o2. I 4 -at~~ CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - W""TRUCTIONS FOR COMPLETING FIRM 115 - SBD - ~ . i To be a corn;I --curate soil test, your report mrsst illClude: 1. Complete le, s, 1ption; 2. The use clearly i.t whether this is a residence or commercial project; 3. MAXIML . of bedrooms cornrnerciai use planned; 4. Is this " °t -nent sysr 5. Cc ity -atinr A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL Ou': ~E . RU'_ tT BASED ON SOIL CONDITIONS; 6. _ tior~ here for writing profile descriptions rid completing the plot plan; ~ . agram locating your test locations. F -7 to scale is preferred. A u :d iI rk ar elevation reference point are cL_)wn, and are permanent; 9. C. late boxes s , elates, narnes, addresses, flood pL. i ; lata, pereolalior ~ ,t exemp- o 713. Bch as flo-1 in, elevation) do-- t -)ply, pli 111 N, in the apl sux; I)' ce your c address and year tion nu I. r };cries and distrib as requited. ALL TESTS N IST BE FILED WITH THE ,L AUTHORITY WITHIN 30 DAYS OF COMPLE _,.EVIATIONS FOR CERTIFIED SOIL T_ Sail Se 1 C r /mbols st - j BR cob SS - ne gr - _ ) yr v_._E. rneci - I GN Is Bldg is Id Isl am lit, I Btu ~sii L'arn BI k si Gy "cl - Y os. Sci R sicl _ mot st, +C Pt r~- d p - I HWL E' P , t l y. -'(ttlre3 s disposal Bm - VRP tit Point T rt first s! p in ;u rig a sari-, icy Depart r,~ n _ for io } is t of pla o must: be sil' 7 t I )Cal au must be obtained ~ posted prior to start of any LWfi @ art }~j,st ,3.29.19.8~AdXy SgE,_ _ CT S LANDS RD County: 3E if Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 186534 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: INFBWEIev.: Insp. BM Elev.: BM Description: HUDSON Parcel Tax No.: &<,. 020-1152-10-000 TANK INFORMATION ELEVATION DATA A9200418 ~-7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEVAks . Septic Benchmark Dosl n Z . Aeration Bldg. Sewer L6 Holding St/ Inlet TANK SETBACK INFORMATION St/Yf Outlet 6, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake NA Dt Bottom Septic 37/ Dosl NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Ma !Number urer Demand ~0 0 o { S'!` / Z 4,0' ModGPM el Lift Friction Syestem DH Ft Forcemain Length Dia. FFii Dist. To wellSOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Length i No. Of Trenches PIT Inside Dia. Liquid Depth DIMENSIONS S o~ DI SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma acturer: INFORMATION Type Of ~ ¢A.0 CHAMBER t Model Num i System: 6,3; Ef'A4,!s-* OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length pacing 4 4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over tt n o II Depth Over q ~r xx Depth Of xx Seeded/ Sodded xx Mulched Trench Center U Bed /Trench Ecles o r Topsoil Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 23.29.19.829,SE,SE, LOT 1, BADLANDS RD. ed> ~ I n (~Y1c1 ( j C1 r ( C>'r i+ Plan revision required? Yes ❑ No Use other side fr additi nal inf mat' SBD-6710 (R 05/91): ~ Date Inspector's Signature Cert No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: PP_ SANITARY PERMIT APPLICATION ~ DILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERYvious # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. c if revP.i.n 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 A G, a/w.L (460-CC-14, S 5 % s E Y/4, S;t 3 T,,l , N, R 1,? .9 (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Opt t 5' Au'e, N „-3 wA- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0rt YMn! ~rJb03 X V 6A .fir II. TYPE OF BUILDING: (Check one) ❑ t t Own d CITY u NEARESTRQAD S a e e ❑ VILLAGE ¢,j 6,~.C4 ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 3- PARCEL AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) C) a U i t S a 0 1 ❑ Apt/Condo 20 Assembly Hall 6 El Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ 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. lXl 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 ❑ 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 10 of REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) # i 907-3 Egff10N rJ 595 r 7,5 c ` " 2 $ Q •7 Feet "z 9 3.7 Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank /00 0 1 coo F] El c 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) r P/ S 7Business Phone Number: Carl I~ t~ c,ba caf 6, 1 339 Bli 4as-ales Plumber's Address (Street, City, State, Zip Code): 1 042 S, YNU, . 57, d .,Vt, r-wl.() l., t s S4oz~- IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) pproved Surcharge Fee) A El Owner Given Initial 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,sanitacy'permit is valid for two (2) years. 2. %YOtir'sahitarypermit 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 septictarik(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. 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 1J5 form; and F) all sizi;flg.,lnformation. GROUNDWATER SURCHAR61E 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 issuanco. Should this development be intended for resale by owner/contractor,(spec house), theni~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 Poum.k G. ..a AeCca.. A. !~;wLlloylcl Location of property 5C 1/4 3C--114, Section a3 , T o?9 N-RAW Township ±\LkA50^ Mailing address _ ad I ,10 Ave- 6.. *3 , 6worl, MN SSbo3 Address of site t subdivision name_ Fr~X V0.&-y Lot no. other homes on property? yes_ No Previous owner of property t OCft%aM G• MeioucS "-4 FcaAk L-4P6VIt'e. Total size of parcel 67.7~ Acres Date parcel-was created Are all corners and lot lines identifiable? t~ Yes No Is this property being developed for (spec house)? Yes ✓No Volume and Page Number 3a 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 X(we) certify that all statements on this form are true to the best of y< (our) knowledge that, (we) (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. 141.aJ33 3 , and that (we) presently own the proposed site for the sewage disposal system or _X_ (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 applicant Co-applicant Date of Signature Date of Signature r Vo ' 983PAGE 282 DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 4r 92133 Frank LaPlante and Norman C. Mears as R~~? Vrt=iC:E . ...."""~2-ff~,"rit"S---ri---common" . $7. CR 1 O., WI Recd for Record - """"""Paul. '-G":""-Swe2"T"and"""A A. of NOV2 51992 11:50 A. M conve an{l Warr nts to . ewe land, husband""and iaife ftepbter of Deeds RETURN TO S W~..,'(~-.•~! S -----------------------------------------S4- 6 2 z i N, 1 AA'_' -----------------------x~~-~- nl N ssao 3 the following described real estate in ..__.__..St••. Cro1X County, State of Wisconsin: D- 1/57 OO Tax Parcel No: Lot 1, Plat of Fox Valley in the Town of Hudson, St. Croix County, Wisconsin. FE This is not homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. i November----- 19..9~.. Dated this - - - - - - - day of - - - - - (SEAL) .....--(SEAL) Frank La lance Norman C. Mears (SEAL) -----......._.._.....-----(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. i - - County. authenticated this day of 19 Personally came before me/' ~jthris, 5.....day of 14A~ _ -the above named - - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, A authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foe ping instrume d acknow a the same. THIS INSTRUMENT WAS DRAFTED BY ` Kri st-ina- 0 gland Attorney at Law ,gyp CO~lltOTS Notary Public up J~,~s. 411 op (Signatures may be authenticated or acknowledged. Both Mt' Commission is permanent. (If n ` tle of ~ ~n -a are not necessary.) date: -----------------------g---"- •Names of persons signing in any capacity should be typed or printed below their signatures. ~z • sue. , -Y sue' , , \ TZ-OT 1 qlq fp IV I I,/7J'G / 7 Y C~I~iG'MGNT ~ \ mar/ 5is. 00 ~ \ I LOT ~ ' i ~ \ ~ ~ceEs cos g,. 0 i SOT ~ i N Z-07- -Z Ice. ' X T''. ioG4✓ RUO. ~ 11~n/ EGA✓•9rlO.t/ ~C9. i0 , ~ / ~ •ri- s ~ .s•s~~ 'ate. + y II S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix county OWNER/BUYER- ?OuL d l~ • G1hC~ i?e6eGG0. k - 5 w lIauIc ADDRESS FIRE NUMBER CITY/STATE Pu b Sort v ; ZIP S° PROPERTY LOCATION: SE 1/4, -5-' 67 , SECTION z3 , T_2~_N-R__J2_W TOWN OF ~ `u.~5ah , St. Croix County, SUBDIVISION Fs,Y. ~QjleI LOT NUMBER--L_. 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. fre, 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 ate. SIGNED DATE: "Z- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 - DEPA~TMENT , , OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JNDUS NDUSTRY ,RY DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: LQaNSH UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sE1/sF_V a3 /TQ9N/R)'?4(or)W y 050 I a Fo v~ COUNTY: MAILING ADDRESS: S~- Cva l,~ Pa .L 4 aachy Swe LL4.vlk aa~ 157 q„, A,,43 (has-Port ran 55603 USE Gil? - 430 `41?69 DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPROFI DESCRIPTIONS: 1PERCOLATION TESTS: q-2- ®Residence 3 Iv A- XNew ❑Replace Il /d- S- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U ❑ S ®U ®S ❑U ❑ S U ❑ S I~JU Con ch! Aa/ T eH <s so e>1,2 If Percolation Tests are NOT required DESIGN RATE: I If an any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: )aSs Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. GHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0-4 Q~51 q-l5 ~yg~S;l ~s-a9 Q«5;~ aG-,3d R$h Coa~k~y,- B- q6 gq.Alp NO r1E Q$ 3vp - qS LT 0, rvirl5 Q 4 3,~ > I 00 0-6 PkB-st 8-1.5 L`6- 5L IS-7S R13, -a-6 ?5-loo LIP- B- iao rup ru Z SJ 1- t o- 2 5 Rd ~ rn s 6 - G 0!L R. S L~ -/0 6. SL to/ B- 3 P0 gr),b hlOauE > 7/, 05-110 LTS~ rnd sd r a-r) fik F3,5/- - I? Qn SL W~GJbIk 17- R~ Yht/ S B- 9 8 q 2.2 No yj 7 9~ 30 , q g L-t 6, 0,.t S l r 0 .i4 Dk13,5L 14-25 i`'fl&, Si 3S 3o 911, ZZ...S-lir 3o-4e B- 5 9Z S9• fj ON 92 Rib, WJS 40-12 4.Tf3. SJ~r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ ► 30 Nowt D raw G P- 2 94 .,10 .r all w 't r ru~~ s' P-.3 30 w 10 miw is S ,i min G 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 ~n lot ~kite,,,.To at T~ z bf.»,7pIr.T~ew € -_9 L . -T o ~ c C.0 nt r OT N i 3( 7t € I•i WiM i 8-fl Cynic Ir %n owcr pa)L /44 10/0 /1-SS v m w EL 1 0 0.00 ' I, the undersigned, hereby certify that the soil tests reported on this form were m3~e 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 COMPLETED ON: 0- a,rl P Nets-e )0-G-gz- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1042 -S wla:~ 51, (L,uc, Falls Wt's 5402, 33/4 'IBS 42-5 al~~ CST SIGNATURE: Ca4l/ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 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 scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS I Soil Separates and Textures Other Symbols st - Stone (over 1U') BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under W) LS - Limestone .s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than .sl - Loamy Sand < - Less Than 'I - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint .c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. ~L Fresh Air Inlets And Observation Pipe ~ ='~__F?L ` Approved Vent Cap for minimum 12" Above Final Grade pikL$Ch! .SWELLRIVA 20- 42" Above Plpe. 4 Cast Iron _ ~~.D.. IR~ To Final Grade Vent Pipe Synthetic Covering. win. 2" Aggregate Our Pipe Distribution Pipe 0 0 0 0 0 -Tee 6" Aggregate 0 p 92 Beneath Pipe o L* 2- ~~ru~~ ~ e a~ ~►c~~l, F I 4' A w c '1'rv r ~ ~I i I 4- )00 v G pL y_.TM g_ I Sc +i ~ Tw++h.. 9 9 a" r.,F G'434 t3~r] Bre Top iron LPTCPY*i,r ?3 €1..t 010 Is- }~wFi 2 G31 QQpZ IoovJal 0WELL • scr~,'G ey~►.~ bol'r, ~ vvww pdc~~►ii ~ ~ ks54»~ ~1. ►oo.va' C3o~ts,~~ (L0w1 R{EPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 01/27/93 09:54 REQUESTS FOR INSPECTION WORK SHEETS FOR: 1/27/93 AREA: JT Activity: A9200418 1/27/93 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 23.29.19.829,SE,SE, LOT 1, BADLANDS RD. Parcel: 020-1152-10-000 Occ: Use: Description: 186534 Applicant: SWELLAND, PAUL Phone: Owner: SWELLAND, PAUL Phone: Contractor: HEISE, CARL P. Phone: (715)425-2175 Inspection Request Information..... Requestor: HEISE, CARL Phone: Req Time: 13:01 Comments: V.30 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION