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AS BUILT SANITARY SYSTEM REPORT
OWNER KIChARP 16I ORM TOWNSHIP 1`Iuosom
SECTION 0(v T N-R W
r-~ Q
ADDRESS l T A~ hN S -ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT-bA-LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
4 eD900M
40me
~a-
1,000
~ X19
6VD
N
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: GRwANo Ntx+ to 0Joobw CdRNQK Post
100.00
Alternate benchmark
SEPTIC TANK: Manufacturer: Wet. s Liquid Cap. a0 p A ~
Rings used: Manhole cover elev: U D-%inal grade elev: ~U3 sln
Tank inlet elev.: I L9 3 jank outlet elev.: I o 0 ' ;N
r
No. of feet from nearest road:Front , Side , Rear Ft.
i
From nearest prop. line:Front , Side., Rear _Ft._
I ar
No. of feet from: Well col , Building: N
(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/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 shar .6.74 Building
eAOe
Iao
108.'1(,
SOIL -ABSORPTION SYSTEM 1~ as, Emu 97- 1) - 47-11
~a
Bed: Trench: Seepage Pit: Q~7
Width: ( 8 Length .s
t~ Number of Lines: Area Built I I ~t
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe: a T 4 ~'1
No. feet from nearest prop. line:Front , Side, Rear Ft.'
No. feet from well:L)~ No. feet from building 3,
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: -1 1/b PLUMBER ON OB: 'r
LICENSE NUMBER: 340V
6/90:cj
L§O~CA%T►94artr+~R$IR&P - 29.19.2 , T AG D STEM D. County: APV Labor and Human Relations INSRECTION REPORT
Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 186540
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
HUDSON
ff
CST BM Insp. BM Elev.: ~BM' Description: Parcel Tax No.:
020-1071-00-000
,
TANK INFORMATION ELEVATION DATA A9200428 - jod . 01
I
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Ja Benchmark 7
6
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
,&3
8.13
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air lntake
Septic I/o t~ e NA Dt Bottom
Dosing NA Header / Man. -7°
Aeration NA Dist. Pipe I/,(,<
Holding Bot. System ~Sf , a
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction Syesatem TDH Ft
Forcemain Length Dia. HH Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width, Lengthr-y No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
,0 7- 1 DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type o Model Number:
System:6 OR UNIT a-D DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length ° Dia. Spacing 4-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over . xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges t~ Y..),l Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON 26.29.19.278B,NE,NE, BADLANDS RIE)
0-
Plan revision required? ❑ Yes ❑ No s
Use other side for additional information. of ®7.
SBD-6710 (R 05/91) Date vif Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
s
SANITARY PERMIT NUMBER:
I
I,
SANITARY PERMIT APPLICATION
DILHR In accord with ILHR 83.05, Wis. Adm. Code CouNTY:5 STATE SANITARY PERMIT # ,f c
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ r~4O
8% x 11 inches in size. C isio evious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
P P TY OWNER /J PROPERTY LOCATION
LrP..O i"1. Q %a t- '/a, S a T,99, N, R E (Or) W
PROP
717 ERTY OW 'AILING ADS ESS ^ ~ LOT # fj~ ' A BLO~IS
CITY, STATE Zi CODE PHONE NUMBER SUBDIVISION,NvAME ASM NUMBER ~
II. TYPE OF BUILDING: Check one CITY AREST ROAD
( ) ❑ State owned O VILLAGE
❑ Public R 1 or 2 Fam. Dwel ling-~# of bedrooms I PARCEL TAX NUM )
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑rOutdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 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)
'MA
A) 1. El New 2. LN Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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
140 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
® REQ1,IRED(sq . ft.) PROPOSED (sq. ft.) (G Is/y/sq. ft.) (M/'ln~h) _ ` ELEVATION
y1 G L J olc4eet M, JC Feet
VII. TANK CAPACITY Site
in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tanks n
Septic Tank or Holdin Tank ~b 0 e
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): PI ber's Si ture: (No St ps) MP/MP SW No.: Business Phone Number:
Plumb e~'g A ress (Street, City, Stan, Zip C
or ,
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued u g Agent Signature (No tamps)
Approved El Owner Given initial Surcharge Fee) 1rM.,.4,;:k,
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD45M (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber
}
INSTRUCTIONS
1. !-•A sanitary permit is valid for two (2) years.
2. Four 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.
ll. 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 gall ens, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. 0omplete 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 sizirig information.- ' i
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)
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 1<I A)IV O Y, R jeh ty-d %T,' -4^ 41e0AJa. .
Location of property /UL'1/4 N15114, Section T_2,aN-R 19 W
Township - HU cis o Ai
Mailing address -2 9 7 13a at /&'IVofs hoaa,
/U dSGAJ lt1 Z' S5~0/
Address of site 0_4
Subdivision name -f Lot no. A~
Other homes on property? NOWyes --No
Previous owner of property -A, At vf L/ k11 A,' e N
Total size of parcel , 8"4CR es
Date parcel was created 114
9. f 9 7
Are all corners and lot lines identifiable? X_Yes No
Is this property being developed for (spec house)? Yes X No
Volume 413,V .and Page Number S57 as recorded. with the Register
of Deeds JQ. s doe-, I a 8~7 XC ,EPT JNr *th e.vG'f v9 wl 'r-h z f ra0'
4e2d5d 70 dGl7AJ O*' /•t &(S &IV a, d le
d ve av ~j ,A/ VVI g 8 F m N )pa& G 3 5~2
41 S-_-QG..0- 3?-6_V_ A?_?_J_~_✓_ A@ 4'_~ LSaPsf
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 *y-( our ) knowledge that .1--~(we) ,sum' (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. a $qi y6 , and that, " (we) presently
own the proposed site for the sewage disposal system or e(we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recor in the office of County Register of deeds as Document
No.
O a 00
Signatur4eo ap lican Co-applicant
l~ , 3
t
Date of Signature
Date of Signature
III
DOCUMENT NO. I WARRANTY 0990
STATE OF WISCONSIN-FORM 9
THIS SPA68 RESERVED FOR U ORDBIG DATA
REGISTERS OFFICE
H1 i a sr. cRO1x co., WIS.
asT obler rine~y, r. , a s ng a man an
Bernard E. Kinney and Margaret G. Kinney, his Recd for Record this_31Et_
wife and in her own behalf day of___J_u_l_y A.D.19 67
grantor s of St Croix County, Wisconsin, hereby conveys and warrants I ~ 30 A
Richard J. Kinney and Leona M. Kinney, husband at___ M.
and wife as joint Ubnants
o eeds
grantee s RETURN TO C~v
of St. Croix ounty Wi o sin, for the sum of
One Dollar and other goo ans valunTe
consideration /-~c~~Ga►~ rv
the following tract of land in St. Croix County, State of Wisconsin;
A parcel a land in the Northeast Quarter of the Northeast Quarter
of Section Twenty-six (26), Township Twenty-nine (29) North, Range
Nineteen (19) West described as follows: Beginning at the Northeast
corner of Said section 26; thence west 900 feet to a point in the
center of the public road; thence south parallel to the east line
of said section 190,feet; thence east parallel to the north line
thereof 200 feet;thence south parallel to the east line thereof
122 feet; thence east parallel to the north line thereof 700 feet
more or less to the east line of said section; thence north 312 feet,
more or less, to the point of beginning.
Subject to existing highways and easements of record, if any.
I 11.,1.1, 1
- X11
a -
MI5 ' M. R
IN WITNESS WHEREOF, the said grantor S ha VP hereunto set PhD i r hands- and seal s this day of J y , A. D., 19 7
SIGNED AND SEALED IN PRESENCE OF (SEAL)
H. Kinne
~L (SEAL)
Mrs. Kathryn Nelson Bernard
(SEAL)
Mar ret G. Kinney
John D. Heywood (SEAL)
STATE OF WISCONSIN,
St. Croix sa.
County.
Personally came before me, this day of July , A. D., 19-L-7.
the above named R HE Kinnear, also known as Robert T -T_ q-r a--r 'single
mand and Bernard E. Kinney and Margaret G. Kinney, his wife,
to me known to be the person _f3vho executed the foregoing instrument and acknowledged a same.
n, /6.
I John D. eywood
NOTARY
SEAL "
This instrument drafted by Notary Public County, Wis.
Heywood and Hayes, H udson, My W=Cpirm (18)
(S clan 59.51 (1) of the Wisconsin Statutes provides that all i trum records V have pla" printed or typawritten thereon the
names of the grantors, grantees, witnesses and notary). ~~Q~ eh~~ "1'1 /
WARRANTY DEED-STATE OF WISCONSIN, FORM NO. 9 V 1 M. C. MILLER co.. MILWAUKEE
WARRANTY DEED
~{Ly g2v
cL4 C
THIS INDENTURE, made by Richard J. Kinney and Leona M,
Kinney, husband and wife, as joint tenants, Grantor,
conveys and warrants the property described below to
the Town of Hudson, a municipal corporation, Grantee,
for the sum of One Thousand Two Hundred Twenty-two
and no/100ths ($1,222.00) Dollars.
This deed is given pursuant to Chapter 80 of the
Wisconsin Statutes, and the land herein described is
conveyed for highway purposes.
Exempt fran fee S 77.25(12)
A parcel of land located in the Northeast Quarter of the Northeast Quarter (NEI of NEI)
of Section Twenty-six (26), Township Twenty-nine (29) North, of Range Nineteen (19)
West, St. Croix County, Wisconsin, further described as follows: Commencing at the
Northeast corner of said Section Twenty-six (26); thence South 890 32' 53" West along
the North line of said Section Twenty-six (26), 262.80 feet to the Point of Beginning;
thence South 890 32' 53" West along said North line, 637.20 feet; thence Southerly,
parallel to the East line of said Section Twenty-six (26), 38.89 feet; thence North 890
45' 56" East, 287.03 feet; thence South 0° 14' 04" East, 30.00 feet; thence North 890
45' 56" East, 20.00 feet; thence Easterly 20.45 feet on a 1370.00 foot radius curve
concaved Northerly whose chord bears North 89° 20' 17" East, 20.45 feet; thence North P
05' 23" West, 30.00 feet; thence Easterly 313.61 feet on a 1340.00 foot radius curve
concaved Northerly whose chord bears North 820 12' 21" East, 312.89 feet to the Point of
Beginning. Containing 0.588 total acres which consist of 0.46 acres as existing
Right-of-Way and 0.128 acres as new Right-of-Way.
This is•net-Homestead Property.
Executed at Hudson, Wisconsin, this LI .~J day of y►~ , 1990.
Ri.cr ird J. V'Xinney Leona M. Kinney
STATE OF WISCONSIN )
) ss
ST. CROIX COUNTY )
Personally came before me this -S~Zlr day of 1990, the above named
Richard J. Kinney and Leona M. Kinney, to me known to be the persons who executed the
foregoing and acknowledge the same.
No y Public
STG/Lv. X County, 1
My Ccuudssion
This Instrument was Drafted By: Reinstra, Van Dyk & Needham, S.C.
Attorneys at Law
New Richmond, Wisconsin 54017-0127
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER K//U Al L Y , / I~~~ y- ~O •tt~ /\~I '
-747 13ad14N-ds /E a~~ 7 9
ADDRESS: H ~d s are! r 5x/e/ FIRE NO:
LOCATION: N r 1/4, A1,E 1/4, SEC. A (o T_2_1 N-R__I?_W,
TCWN OF . f'/ 4 d S v eJ -ST. CROIX COUNTY
SUBDIVISION: A/jq LOT NO. A11W
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 (it necessary), the septic tank is less than 1/3 full of
sludge en, - „cur_ Certification from will be sent approximately
30 days prior to three year expiration.
they undersigned have read the above requirements and agree
to raintaiz the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Cert.iticata.~~n form must be completed and returned to the St.,
Crolx County Zoning Officer within 30 days of the three year
expitr+tiQn date. ,
SIGNED:
i
DATE: L" Jt1e__ A bey 30} 119Z
St. Croix County Zoning Office
91x. 4tn St.
Hudson, WI 54016
I~
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 3707
HUMAN RELATIONS ,
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNS IP/ Y: LOT NO. BLK. NO.: SUBDIVISION NAME:
#/Z 1/4 /~1/ 06 /T N/R E (or) W ~ sda /U
CO5)76,0,)"
UNTYOWN R'S/BUYER' NME: MAILIN ADDRESS: k),' USE DATES OBSERVATIONS MADE 1
NO.BEDRMS.: 1COMMERCIAX ESCRIPTION: PROFILE D RIPT NS: IPIERCOLAXON TS:
'Residence ❑ New Dxeplace
RATING: S= Site suitable for system U= Site unsuitable for system
. M0QUNS. ❑U IN-Gl=iOUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑
rONVENTIONU
I ~J SS fL~GJ SS U SS ,(jJ U ❑S
DESIGN RAT
If Percolation Tests are NOT required I If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate: 3 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSE VED (SEE ABBRV. ON BACK.)
B- Z 4,17 99, yZ C,17
3~7z, o d~/ /,i7 s 3. ~3 ~~S
B- 3 , 75 /a/0
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER S AFTER LLING INTERVAL-MIN. PERIOD 1 PERT D 2 PER PER INCH
P_ Z 2~ 3
P- Z 3,/ 3
P_ 3 tl~ 7.!rl Z G
P-
P-
P-
PLOT PLAN: Show locations of p r n tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation r f ce points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
R 1 _
r _
m ~I
VVV G~ 1 r
_ ~2 . 7
E
E
,
_ ~rC 1714
r~- tN
1
{
f
y
E
93
i 3
I, the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME 1 nt : TESTS W E OMPLETED ON:
'Gl1~e/ /4? Akk
~ / a/
A R SS: ~ CERT FIC N NUMBER: PHONE NUMBER (optional):
CST SIGN T
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
• t •
LIST ' CTIONS FOR :1 L.ET RI 115 - SB - SSE , .
To be a ~ 'urate soil try t, n ,a t elude:
1. Comp n
. The use : arly in{.iicate whether this is a residence or commercial r
MAXI :°droorrrs or comrrr rcial use planned;
4. Is this gent syst:errr;
5. Comp;et:e th. )g boxes. A SITE IS SUl, ,',BLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYS" R ;LEI) OUT BASED ON CONDITIONS;
B- PLEASE use t' ons shown here for vtritir e descriptions and completing the plot plan;
7, MAKE A I accu tely locating your ~ locations, Drawing to scale is preferred. A
separate ~y dfa :r;;
8, Makes r (a~,~ ?vaI elevation reference point are clearly shown, and are permanent;
9, Complete .apriate bo, a dates, names, addresses, flood plain data, percolation test exemp-
tion, if ate
10l If the info 'r ,,.r(-h as floc • =n, elevation) does riot apply, place N.A. in the appropriate box;
11- Sign the f 11, pl<,ce your c ar' 9ress and your certification nurnber;
12. Make , , ;cries and distrib_ as required, ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL P 1,10RITY WITHIN )AYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and T Other Symbols
st Stonp Lover 10' BR Bedrock
cob - Cobble (S - 10") SS Sandstone
gr Caravel (urider 3") LS Limestone
~,s Sand HGW High Grow-' erar
cs - Coars¢) Sand Pere - Percolat:i',
rned s Medium Sand Air Well
fs - F e z:an,: i3k](I - B€ ildim
iz Greater Than
#sl < Less -Chan
*I 13n - drown
psis - BI Black
si Gy Gray
c Y
sc, C 1 Loarn R
sicl y Loam rr3o't - I
sic s y fff i re, faint
r c~r~ CX-ri ;n, r,oarse
pt nrrn - It1(a)y, r n,
r~ - ek d - distinct
p - promrnr~rrt
1-1!"uL H lh dr level,
Si> s`reraI soi sr -hater
BM Bench Mark,
VRP V, 1 R :erenre Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county orthe 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.
r
RO S S E c T I 1\1
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T ON
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ESNS &D
I+` G(Z01ANT) Ng;-s o o~ Co2NtR P651 4 TeNc,k Z L =100,0
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FRESH All! INLETS AND OBSERVN- ION PIPE
C10SS SECTION
Approved Vent Cap 00
Minimum 12" Above
tl
9 Cast Iron
I\bove Pipe Vent Pipe
To Final Grader
Marsh Hay Or Synthetic Covering
Min. 2" Aggrcy'o►
Over Pipe
Distribution ) F_- - Tee
i Pipe I
Aggregate F Perforated Pipe !?e1 .r
j 13 loath Pipe Coupling Terminat.i.ng r
1"J, 46 r, Bottom of System
i ,
i
REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1
01/06/93 15:08 REQUESTS FOR INSPECTION WORK SHEETS FOR: 1/ 7/93 AREA: MJ
'Activity: A9200428 1/ ,7/9'3 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 26.29.19.278B,NE,NE, BADLANDS RD.
Parcel: 020-1071-00-000 Occ: Use:
Description: 186540
Applicant: KINNEY, RICHARD J & LEONA Phone:
Owner: KINNEY, RICHARD J & LEONA Phone:
Contractor: BOUMEESTER, JIM Phone: 386-9020
Inspection Request Information.....
Requestor: BOUMEESTER, JIM Phone:
Req Time: 09:01 Comments: Rlv~
Items requested to be Inspected... Action Commentsy Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION