HomeMy WebLinkAbout032-1039-50-000
~ c I I a-°i o I
o 0 6e
04 0
o ~ ~ I
`c I
C O
H ~
o
M' O
s,
D
v N I
O
a x
I
y
~ _o
F. Y
C
~ I
as U
o a
6 Z N
C _
7 m
LL C f6
O O>
B O O
Q ~ m I
3 Cl)
I
Z U1
O z " O
Z G1 N
co UJ a M
O z v C:
m Z d' ° c
C
N O O
c
d
N O
a)
a) a)
0
® Z CO Z
N 'I
o £ c
CL N p,
C N m 20 o c
in o a O
LO E
~ z~>I ~ooo
•N a a a
g E
(y
V - O N N
}u~~1 ! U ~ 0) (M
}
T}
M
V 0
0 0
m 0 0 oN
Z p p S N
= C N r
p N Q m
O O N N N
O C J N C
LL LO co
O M 0 co C a M 0
D1 _
0 :2 e N
M Cn N Q' C N N N co N_
C ° o m N
tryj' M
c®c
C ~ Y, E
o ac n a T
• ca a m .2 a y c
A 0CL2 0 m0
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Q~f !7` i L d,'c TOWNSHIP S n y, ~-s P 7
SECTION_ Y T -'T/ N-R_L_~_W
ADDRESS I R n, z -3 ST. CROIX COUNTY, WISCONSIN
mow. e.-t; ; S-yo a/
SUBDIVISION yV/da LOT~LOT SIZE P; d6
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
n
oo~
6~ NNf ~ `''y
pie
f
V ~r',-• C /uo' Tor o~ ~ `s ~~e ~ /~'/°'P
INDICATE NORTH ARROW
n
.
BENCHMARK: Elevation and description : f 0o~ T 4,e 5 STeeC d;,• e
Alternate benchmark
SEPTIC TANK:Manufacturer: CJ.°erers Liquid Cap. /700
Rings used:14 Manhole cover elev:/r,,._/6 Final grade elev: /o,2. De
Tank inlet elev.: %,L6 Tank outlet elev.: 96, Y.2-
3 D r
No. of feet from nearest road : Front , Side , Rear Ft. ,a
r
From nearest prop. line:Front , Side , Rear--~-Ft.
No. of feet from: Well ~ as-' , Building: 3U'
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
I
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: X Trench: Seepage Pit:
a'
Width: /,;2-' Length 6Z ' Number of Lines: z_Area Built
1',
Exist. Grade Elev. S X--~ Proposed Final Grade Elev. ~ J",7
Fill depth to top of pipe: ~/z
No. feet from nearest prop. line:Front Side">,-, Rear Ft..C.L:
No. feet from well: 7-V No. feet from building S~
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: 6o.P'Y
6 90:c'
/ J
LOCATION: SOMERSET 14.31.19.195F,SE,NE, 215TH, LOT 4
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Muman Relations INSPECTION REPORT
Safety Ad Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 149325
Permit Holder's Name: [I City ❑ Village] Town of: State Plan ID No.:
HELBIG ROBERT LYLE SOMERSET
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
032103950000
TANK INFORMATION ELEVATION DATA A9200170
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St Ht Inlet 44 Q1b 9r,e
TANK SETBACK INFORMATION St / Ht Outlet 7 97
Vent
ir Ito ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Septic } 0' NA Dt Bottom
Dosing NA Header/ Man. t D.3 3 0155 o3
Aeration NA Dist. Pipe /0, 59 Q8, 3S
Holding Bot. System l . o qy1 q(1
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand -5 0Zd"' 7
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Oenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION /
S - to DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION ypem / y, Jc3 i ~ OR UNIT CHAMBER Model Number:
System: DISTRIBUTION SYSTEM
Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 1 II
I S r l/
a
91
Q
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. -
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
I,LHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
_77
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1
8% X 11 inches in size. Check i 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
.90k 141~_ ~ 4.5 $E Y4 FY4,S / T.:)/, N, R E(or)W
PROPER OWNER'S MAILING ADDRESS LOT # BLOCK #
R 1X_ ~3 lio L / /68' /t/
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TY E OF BUILDING: (Check one) ❑ State Owned ❑ VI LL AGE s, t NEAREST ROAD
❑ Public ~i1 or 2 Fam. Dwelling of bedrooms-3 PARCEL TAX NUM
III. BUILDING USE: (If building type is public, check all that apply) 0,3;c AJ 39- 6
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home f10 ❑ Outdoor Recreational Facility
3 ❑ Campground. 7 ❑ Merchandise: Safes/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 lineB if applicable)
A) 1.A New 2. ❑ Replacement 3. ❑ Replacement of -4-El 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 300 Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 Vault Privy
14 ❑ System-In-Fill
v
VI. ABSORPTION SYSTEM INFORMATION: r
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. ' Y TEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
ys_o 7-2o ' 6 4.3 o 7, o7 F et OtS. Feet
CAPACITY 'w- .
VII. TANK # of Manufacturer's Name Prefab. ConSite- Steel Fiber- Plastic Exper.
INFORMATION in gallons Total New F-xisting Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank 71-" AAP w,rises-`
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) /MPRSW No.: Business Phone Number:
t4l :C-I- C.-e ( G :/-.r 'j., ~ ^Z_~ -C 24 2- r 7
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S a ry Permit Fee (Includes Groundwater Date Issued Issuing Agent Signet a (No Stamps)
Approved El Owner Given Initial 1/6- 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. 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.
1 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 end/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'/s 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, 'ocation 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 manufa.-turer; 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.
S11 D-63911 (R.11188)
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER nDQ~ Lyk_ Pel&,
ROUTE/BOX NUMBER JX ZZ3 FIRE NO.
CITY/STATE A elw ~ W l ZIP r7'-~00 I
PROPERTY LOCATION: S~ 1/4 1/4, Section, T 'Si N, R l9 W,
Town of S01N-% S-SR_'} , St. Croix County,
Subdivision , Lot No. `i
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
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master plumber, journeyman plumber,
restricted plumber or a licensed pumper 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 form 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 Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date. /
SIGNED WQ~J
DATE 17,11 7
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
(715) 796-2239 or (715) 425-8363
Sign, Date, and Return to above address
_r A 7 N w f ~ <
r i Y
w.. .IM14 • '
. . ate it ftwrt.Lyle-.k NUAa.......... xCA
T 4 i .
l
?
MT.. to
Mix S
1 l..
y.. Y.:'...
' toy Wwg dssU*W rsai estate in S>;-....jwCQix ...County, Tax Pahl Me:.-......~.,.
Pert of the SE% of NE%a of Section 14, Township 3`1 North, Plan"— 1
St .Qroix County, Wisconsin ds:ecsil~e~_-a"-nllowst Lot 41r
rk pf•: tified Survey Map filed April 18, 1975 in. Vol. 1, Pegs 1QS,
bso. No. 326432.
F err with a non-exclusive easement for ingress ohd agrees to
s1ls above-described property over Lot 5-A of the Certified liurvex
ftp O set forth above.
y
'!'Ais i nOt- homestead property.
_21OW-ion to warreatim- easements, restrictions and rights-of-way `
~w
of record, if any.
Dated this ...-l day of _ August 19.91
_ (SEAL) L`t.t CL`f `t~.`L >'t,rL~t1i.}
Darryl Edward Germain
• . _
.(SEAL) .(SEAL)
r
la
AOTURNTICATION AC=NOWLSDOMENT.
U) QtrrXI...r;-Ownrd...Germain........ STATE OF WISCONSIN
~1 sa
--.County.
1day August . 19-91 Personally came before me this ...............dq et
l t . . 19-------- the abaft so ed
f. Kristine Ogland Lundeen a
Tr#U: lJ=ZR STATE BAR OF WISCONSIN
b - -
Of iy f 708.06. Wis. State.) . .
tome known to be the
person . - .
who esecstsd tM
foregoing instrument and acknowledge the tame. 4¢!'
IrWO #NX= U9W WAS ORArrEo eV
Kristine Oglsnd Lundeen . . r
-Kztsoi y7jif Y'ww - . . -
. r}- Public - Cos
t tra thaT be auSNptiested er selcnowiedged. Both Commission is permanent.(If not, sate
Aid
Mt `may') date: .
SOW Is OW ~a4 ad4 Q..1d ►e typed or pdoWd W. tYeit citna.wrn. i
We" K'
APPLICATION FOR SANITARY PERMIT
STC-100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property -~Ob e--Ct Lyle- N e1 b f u
Location of property ~J 1/4 h,JF 1/4, Section T _I _N-R'j W
Township -So (Y-1
e C~S e-C
Mailing address qRt \ a ZZ~
/NY -'P-rV wk ~5qUd
Address of site
Subdivision name
Lot number
j 0~ l~e('cA,, VN
Previous owner of property pe.f_T ~
Total size of parcel
Date parcel was created Ni, r- -15
Are all corners and lot lines identifiable?10 es No
Is this property being developed for resale (spec house)? Yes No
Volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
---------------------------------------------------------7---------------------
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. Z/731371 ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No.
&&A L - &&
Signature of Owner Signature of Co-Owner (If Applicable)
/7/-I12A `)Z
Dat- a of'Signature Date of Signature
J
32641"
SCALE WEST,
200 0 100 200 4.30
NE CORNER
SECTION 14
R31N, R19W
POINT OF SEGINNI,14G N ~
o 0
87° I' E
66` 6l7 04 70AI`
1 88°59' 91001'
SE 1/4- NE 1/4 3
I -0O Ow.0
o 4 Q co N
N~ 5,06 ACRES ~ j N o I OD
5 I r` M M - 3 Sri WESTERLY RIGHT-OF-
U) N -co WAY LINE OF STATE
(gA 91°01' 88° 59' a TRUNK HIGHWAY "35"
N 87° 3I' W cn
ASSUMED BEARING 88° 59' 617.04
Q 91° 01' CENTERLINE OF
I STATE TRUNK
p w o 1 HIGHWAY "35"
g 0-
ON 3 ,p CO
'n .5.02 ACRES M C N
z
I NORTHERLY RIGHT OF Z
WAY L NE °
N 1028'. E_ 66. I / 91001, N87031'W 88 59 _01
33.00 M 617.04' se
LEGEND E 1 /4 CORNER
SECTION CORNER MONUMENT SECTION 14
O 1" X 24" IRON PIPE
WEIGHING 1.68#/LINEAL FOOT.
SURVEYED FOR: EDWARD GERMAIN, Box 66A, Somerset, Wisconsin 54025
DESCRIPTION:
A parcel of land located in the SE1/4 of the NE1/4 of Section 14, T31N, R19W,
Town of Somerset, St. Croix County, Wisconsin, described as follows: Commencing
at the NE corner of said Section 14; thence West 4.30'; thence S1°28'W (assumed
bearing) 1860.88' along the centerline of present State Trunk Highway "35" and
the Northerly extension thereof; thence N87°31'W 70.01' to the point of beginning;
thence S1°28'W 712.00' along the Westerly right-of-way line of said State Trunk
Highway "35"; thence N87°31'W 617.041 along the Northerly right-of-way line of an
existing town road; thence N1°28'E 712.001; thence S87°31'E 617.04' tb the point o
beginning.
I certify that the above description and map are correct and that I have fully
complied with the provisions of Sec. 236.34 of the Wisco sin Statutes.
DATE : April 3 1975 i~ a~~~7
41 F NC S H. GD N -882 Map No. 5-434
NOTE: ASSUMED BEARING REFERENCED TO CENTERLINE OF STATE TRUNK HIGHWAY 1135".
r r, ,,~N1~~IN~~t
8~J``~~ FRANCIS H.
OGDEN
5882
APR RIVER FALLS, Q'
Volume 1 page 108 i ; " OUR
~
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
. INDUSTRY, C DIVISION
LABOR -RAND P.O. ELATIONS PERCOLATION TESTS (115) MADISON wl 53707
HUMAN RE
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSH /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
E '1 E'/ , /T3, N/R, (or)W so'.'e. y w t' 3zcy,z
COUNTY: O NE BUYER'S NAME: MpAILING ADDRESS:
p rl ~d a /9i-, er G✓ ' S Aso
USE DATES O SERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTION S: PER OLATION TESTS:
29,14esidence New ❑ Replace
S y-S
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rYSTEIVI-IN-FlLLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
E~LS ❑U ®.S ❑U 2S ❑U ❑S CCU ❑S ®U i~x6o'
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: w Floodplain, indicate Floodplain elevation:
t'Gt7° PR ¢F I. DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-IN@MES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH 111, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- c) i,r A/o,, a .7 O'- . ~ ~ " o c C " . C~ = 1' Q., S c. • ~ ' - S ' r .
B- z 99 Lz woh e 4 0'-. ' c ' . 6 ~.r' sic • .6 = 'o., sa+ .
B- .3
o at 2..r
B- Y ft scC ' y"-p' a., s♦ •
Irv* 0% A
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER LWQU.FS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P_ O G
P_ No 3 C C J
P - ~ y) ' w C 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 9 y. ba'
I
E
.
4..1lTR P ID.w.m_Lrgv'_~~D
S
$L v e E
Y
~ z a1
r
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
A-1 c 4 4r 4, E U 4,1 n S
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
P4 Ai y.. iP'?ip [,a. a r )~ra6P23",~7
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
l
"L.ETIN 11
{m..•
. '.lot plan;
er
am
1. ctE£,Ci. _ TH THE
and Tex { r
10 TO THE C
This soil test report i y , r. r ~t =Y~ay request
verification of this soil ti- private
sewage system and a pt, yin order to
~obtain a permit. The sa,~litary i _ o"
J
S
NO
7E
7`
16
4
N
f ~
~ILI s -
a
a
? T n a O a C3 l
4 Cl
d A CZ
i ~
¢ Z I
I
,7j ° ✓1
t... r IA 1 I
I 4 I 1
ICI ~
r o d b
40
s
3 ~ a
REPT131 SOMERSET ST. CROIX COUNTY ZONING PAGE 1
05,/06/92 16:37 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 8/92 AREA: MJ
Activity: A9200170 5/ 8/92 Type: CONVSEPT Status: PENDING Constr:
Address: SOMERSET 14.31.19.195F,SE,NE, 215TH, LOT 4
Parcel: 032-1039-50-000 Occ: Use:
Description: 149325
Applicant: HELBIG, ROBERT LYLE Phone:
Owner: HELBIG, ROBERT LYLE Phone:
Contractor: WILSON MICHAEL E. Phone: 268-2537
Inspection Request Information.....
Requestor: MIKE WILSON Phone:
Req Time: 14:05 Comments : 6.4p .1s, f• m•)
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
i
REPT131 SOMERSET ST. CROIX COUNTY ZONING PAGE 1
05106/92 16:37- REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 8/92 AREA: NJ
* * * * INSPECTION REQUEST SUMMARY
Address Time Activity Type
SOMERSET 14.31.19.195F,SE,NE, 215TH, LOT 4 14:05 A9200170 CONVSEP
Item: 00012 FINAL INSPECTION