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HomeMy WebLinkAbout040-1217-90-000 z (D o Q s o ~ U N y 44 4 c i ~ I ~ I c I b a I a I I N r i cn O O I O Y C LL. C m O 0) C) Q O O Z N U) : O Z y co w cwn a m o z 'd' c I v fA I- r ~ `y N ~ CD O • ►~i a U ~ U o I O ` o O Z F- Z p N N z~ 0 Y ` j 0 C r w O LL 0 d i N ° o o a E - U) 't FN- Fy- FN- 0 0 N O O O LL LL • ►r~1 ~ a a a I [V p N 0 N N CY) a) = ro I a~ ca E 3 N '6 N Q tl5 LL O O O N C O O' U') O y0 U O y 0 0 0 O 0 0 0 U O C LL N O N ~ r rl ° N ` N O N ~ N U r N O N O O ~ I i.. a+ ~ E d a; m y n. tz S at a a ~ E L C C w 3 A Uam 0 v)U Q o ( ° V ~ 0 0 60~ o~ C w C ' y O ' N N N i N 0 i c z LL c 0 Q 3 c Z y 0) w O Z c°D.,w d m am I c 0 o Z a d Z a c N Z (n H r E '2 d co C. d •N L o c O L) 0 Z F`- Z *o N O m > (mil Y f0 O w 0 LLf) L O O w c o a E N _ o U) FL LL Z r ° o CL IL CL CL n o N J U p rn rn Z fn O E O G y c V D 3 Ze m a v a o li ® m Q Z 2n O pppp U) 7 a~ w op c d rn 0 = V c a 8 Ft O p fn O N 4w F- N v N N -gyp n 00 In w C N =xV) ~ N 2 >~a O C N ~O R U t, r- ~ m R € a am'w mad` raw y r A Vaa !,o~ai L) Parcel 040-1217-90-000 07/22/2005 10:43 AM PAGE 1 OF 1 Alt. Parcel 7.28.19.1051 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WARREN, SCOTT A & DIANE C SCOTT A & DIANE C WARREN 407 S FORK CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 407 S FORK CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.030 Plat: 2478-SOUTH FORK ADDITION SEC 7 T28N R19W SE SE LOT 14 SOUTH FORK Block/Condo Bldg: LOT 14 ADDITION 2.03AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 953/512 07/23/1997 896/27, 07/23/1997 788/464 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.030 48,400 216,500 264,900 NO Totals for 2005: General Property 2.030 48,400 216,500 264,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.030 48,400 216,500 264,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 130 Specials: Cate o Amount User Special Code g ry Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT OWNER ~lc'? TOWNSHIP SECTION / T N-R ; W ADDRESS>. ST. CROIX COUNTY, WISCONSIN SUBDIVISION T' `(a LOT-L,4-/LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 74 ~~r < 66 0 INDICATE NORTH ARROW 'opz BENCHMARK:Elevation and description: r ~kP Alternate benchmark SEPTIC TANK: Manuf acturer : Liquid Cap. 14 Rings used:fLManhole cover elev:?J.t~ Final grade elev:-,9X,9 i Tank inlet elev. r_Tank outlet elev.: No. of feet from nearest road:Front , Side , Rear_L,-/Ft. From nearest prop. line:Front , Side_j,-/, Rear Ft. > /m© i No. of feet from: Well , Building: 7 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 1' 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: i Width:__Length ~,~Number of Lines: -,Z Area Built ?-VD Exist. Grade Elev. roposed Final Grade Elev. 97. ,~q Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side A~ Rear~Ft.~ No. feet from well: /vAf No. feet from building- 2 ? 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: s' DATE: / PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj tK71i `sr'rYi~EaTtmfrtitftindGsir8. 19.1051~~y~,SEWAGE $~($M RD. E County: Labor and Human Relations r INSPECTION REPORT Safety and Buildings Division ' (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 196-519 Permit Holder's Name: ❑ City ❑ Village ❑kown of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: I 00, D fluVr>1 4 S I~ls Cu~ ~ eel ~ , ~040-1217-90-000 TANK INFORMATION ELEVATION ATA A9200405 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic QOd Benchmark I OJ 1~ , p~-- I U I .OZ Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 05 Crj q7 Vent TANKTO P/L WELL BLDG. A irito ntake ROAD Dt Inlet Septic 1 A JA -1 ~ NA Dt Bottom Dosing NA Header/ Man. p ~3 , d Aeration NA Dist. Pipe < d °l a Holding Bot. System cl,() PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O I~ / CHAMBER Model Number: System: T 02.7 ` !\j A OR UNIT 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.) LOCATION: TROY 7.2~.19.1051,SE,SE, LOT 14, CO. RD.A 15 C~ Its Plan revision required? ❑ Yes ❑ No Use other side for additional information. /0~ e c ~lz ~7 6 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: LHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code v STATE SANITAR RMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ff44.1. 8%.x 11 inches in size. Zvlous 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 S QE S~=- Y4, S TZ 8, N, R E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1610 &0&,eagQ~~ 41 CITY STATE zip CODE PHONE NUMBER SUBDIVISION NAME OR CS-"UMBER s ©6 1 _?5-o II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned LLAGE : ❑Public 191 or 2 Fam. Dwelling-# of bedrooms .7-- PARCEL TAX N UMBE 111. BUILDING USE: (If building type is public, check all that apply) G' n ~ - 41 7-90 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility . 3 ❑ 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. 2 "New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.E] 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank A9 f 77 1 M__ _T7 I _H 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. er's Name (Print): Plumber's Signature: N mps) -kt"PRSW No.: Business Phone Number: PI: Plumber's Address Street, Ci , State Code): O OZ' D 2 14 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ' ry Permit Fee (includes Groundwater Date Issued Issuing gent S ture (No PlEamps) Surcharge Approved E-1 Owner Given initial Adverse Determination 000, 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 news criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly 'maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only'orie and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to 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) soiLtest 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) II , S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then .a second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. ----------------------------------------------,-,--1---------------------- Owner of property b~-~ lX~~ ,u W AAA" `J Location of property 5a1141/4, Section , T N-R W Township Mailing address - Vc ,_J_ 'b~ An - S_Y_o A2 Address of site Subdivision name Lot no. Other homes on property? yes No Previous owner of property Total size of parcel Date parcel-was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) Yes No Volume q S Sand Page Number /7✓ 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 the o£fice of the County Register of Deeds as Document No. 3 V7- 3 , 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. I~J S gnature of applicant Co-applicant Date o Signature Date of Signature °'OOGtlMfaiT Nd. .fir ,wrs araea! 1 ETATS EAP OF WISMNSIN FOw =-IM' Mm 512 ZAPPA BROTHERS, INC., a Wisconsin corporation, `~M a/k/a Zappa Brothers Excavating, Inc., Grantor ,uNo, SCOTT A. WARREN. and. DIANF. C.._ WARREN, d 10:45 11 • µ r convvy'n and warrants to . husband.and wife as..survivorship. stsxital..property. Grantees,... . - - bOIM~r y F t':' N TO R _ the following described real estate in St....Croix County. state of 'Wisconsin: Tax Parcel No)~-`.1--.-~-.1.•-~ Lot 14, South Fork Addition in the Town of Troy, St. Croix County, Wisconsin. ~:I N t'k F, 1 TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-of-way of.record, if any. •ti T1,1, is not t,owc,trad pr, twit. QF14 ti. uot) Ev-vi,tirm t,•-tt•arranties: 1st dad June 92 LAYN.A gRUI"Hl:k~, INC. 1:11. i y ALAI. BY: Y:trv I. Z.ippa, 1'rrsident ISEAL ;l AUTHENTICATION A C K N 0 LEI)GMHN Signature t - r _ tit. t roix ! urthcnticatrd t! t (tat of ib r isC ~ pt 'F~" j lunk 9- ce rkwt,I TITLE MF:?1(iF.R ST-*,9 h: Ei:1l: 1F' \1'i1+ T~i r ~Yr t t rect. lludsun..e3 Itltr\~~ ' . ~ yCRt ~~s. -11• ' 7 1 ~ k ~t'A lc;-R 161S~5DAt'+1\ G• sa:.;i tfiz: Q' j DI' St1 < _ MOT" t STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ` -►..J~ W ROUTE/BOX NUMBER ~ ~ o4~✓t. FIRE NO. CITY/STATE ZIP PROPERTY LOCATION: V-1/4 -S 1/4, Section 7 , T 24 N, R_Lq W, Town of , St. Croix County, Subdivision , Lot No.. 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 DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUST' iY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RF ATIONS \ / MADISON, WI 53707 - (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MbNtCtPA-MY: LOT NO.:BLK. NO.: SUBDIVISION NAME: s, X44 sr'/a 7 /TaY N/R y E (o i ~-a / rock COUNTY: OWNER'S BUYER'S NAME; MAILING ADDRESS: S r' k c o 7L / ' V r . / /d we a~ Pr, A1146,11, cyr_ - o USE - So DATES OBSERVATIONS MADE -7 .4 NO. BEDRMS.: COMMER IAL DESCRIPTION: R 3 ❑Replace DESCRIPTIONS: A ON TESTS: Residence E!aNew .t F 1 .~L 1 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUN~`D: 1 IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDIING(TTA]N~K: RECOMMENDED SYSTEM: (optional) PS E1U EIS E9U V EJS EA E] S 2u .Z - 57 5-If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate I Floodplain, indicate Floodplain elevation: 11-11, , PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED S GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B Q7 / I 3 /.3 13/s/ :Z. 23 ~ m,' I Z 0 10 S~ cs a+ 9, 0' h m h .x s . .t..t ' /3n ex a- e 6. A a'6 B /!Z / V •~//Z .7 N - ~7n / s 'rYr ~o r'Ts J 1gyer IV- 6 n M , B- 3- /_7 > 3/ S~' S' w / 3',3~ i 7 , B&I r w =r' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D PER INCH P- P- P_ 3 P- P- 3 771 P- J _ 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 %repekr r i Ilk E i i r ii i } 1 1 I I i P a.,_.._ N t ' i 1 i _ I i ~^N_ 1 i , i i i } 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 (print : DAME FOG&44! TESTS WERE COMPLETED ON: Licensed Perk Tester & Plumbcr 3233 #3289 ADDRESS: oge y etg. s o8 CERTIFICATION NUMBER: PHONE NUMBER (optional): DER TS, WISCONSIN 54023 C TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - ~r fi i 1 ~ O ik, 1 ~ H N ~ O 0 ~ A 1 -t A .-s 1 cv 30 a Q~ < ir7 Sk . Ch r' c~ I 0 u r o r o v ~ \ o DEPAR'MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION LABOR AN6 PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/1%b'NtCtPA-MY: LOT NO.: B -K. NO.: SUBDIVISION NAME: $F r- % 7 114Y NIRzz, E (o ~-,-r / JI J6 COUNTY:: " 0 S NAME: S-/ eL ,,k r 7C / vre /d jl ""40 / c~ v F W4 USE 7 9 - SO DATES OBSERVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION- 'PROF I TESTS: LE DESCRIPTIONS: PERCOLATION QResidence 3 QNew ❑Replace I RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-F1 LL OLDING~TAANK: RECOMMENDED SYSTEM: (optional) CAS ❑ ❑ S QU LJ S ❑ US [DU El S LJ U ,lur rG~i .z - S x S9 If Percolation Tests are NOT required DESIGN RATE: HR 83.09(5)(bl If any portion of the tested area is in the under s. IL, indicate ~L Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES IV E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- f Q7. / 3 /•3 13/s/ :Z 5-" z r-+ 9 L74 Mr B- Z ~ r 9 ii. ' ~/lr t > .3 Q Ix Af "Pi, e..r w A i ,1( ,t,s.'Snew-If •ce6- AG'i3h-f B- 3 ,7 ;i3 S/ /,f l3n / s rrr w r '-rs /r/ewvy s/ /.3'Bn <s .7,8',sn rxs, i,vl/ If °Y`r n wt , B- S' 5'f. i /Ynf t > 31 9' T /Z 5-1 W Zjr A 3' XI A Zje 's, . . 7 , Z61 r !!d4 r, PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p I PERIOD PER INCH P. / r7~ 3 P- P. 3 )AP > .r -7 P"41 P- P- -C 3 4 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 to tion on the t plan. Sflow, the surface elevation at all bnrings and the direction and percent of land slope. N44A.,j AEG o~~Ay p' Q2.0 r SYSTEM ELEVATION / <k1,-kK -W/ -L *i 91,` • 7 r ohs / ,-1s yi Ir„e- r , AW ',8,j ~4, 7 r j 37~ 0" r, 7 I-A _ y a C>< r i ~ I F-F i 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 (print : "E F0G&,,44s kW#l t TESTS WERE COMPLETED ON: Ucensed Perk Tester & Plumber 3233 #3289 ADDRESS: ogger y Heights H0210 CERTIFICATION NUMBER: PHONE NUMBER (optional): POSER TS, WISCONSIN 54023 C I TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. J DILHR-SBD•6395 (R, 10/83) - OVER - `~r 1 v s t v ~W IN ~ I i 3 a T ~ V coto o. O \ I e IM6 R lag C Q ~i ? J ki ctia ti [ ~ v A v ~I r U n NN, t - - - - o Ail UP r ~ N W H v 1 I~ 0 W - i _ _ . _ _ . _ - - _ r--- i s. v i ~ j _ r - ~ ~ -s~ _ - ` 'r '4-:ter f~_. . s .r r i ' 6. - III y:. _ . r i 4 a ti M OS .e(, A W - - °i SCL. ~ N ti S I t I I i i I n' :V C• >zp a i ~ I I j I 1 I } i i t i { i I { i REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 12/17/92 09:19 REQUESTS FOR INSPECTION WORK SHEETS FOR: 12/17/92 AREA: MJ - Activi},.y: A9200405 12/17/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 7.28.19.1051,SE,SE, LOT 14, CO. RD. E Parcel: 040-1217-90-000 Occ: Use: Description: 186519 Applicant: WARREN, SCOTT Phone: Owner: WARREN, SCOTT Phone: Contractor: FOGERTY, DAVID B. Phone: 749-3656 Inspection Request Information..... Requestor: FOGERTY, DAVE Phone: Req Time: 15:12 Comments: Items requested to be Inspected... Action Comments yy Time Exp 00012 FINAL INSPECTION ~VVllti1~JUo Inspection History..... Item: 00012 FINAL INSPECTION -DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B DUILDINGS DIVISION IVISION INDU,RY, G P.O. BOX 76 -LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 H,V,MAN*ELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/Mb'NtetPAMY: LOT NO.:BLK. NO.: SUBDIVISION NAME: s~ /4 1/ 7 /T~~ N/R Y E (a ~k rock ' COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: S ~r'k c yr l !a 7I wo m USE SO DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: PER OLATION TESTS: Residence 3" New ❑Replace F a 1~ i RATING: S= Site suitable for system U= Site unsuitable for system CONNVyE~NTIONAL: MOUND: IN-GROUND-O']yU,NN~D-PRESSURE: SYSTEM-IN-FILLHOLDING~TANN(K: RECOMMENDED SYSTEM: (optional) U6b ❑U [:]S LJJ [:]U [_]S ❑S LJII .rG~ - Sx s9 ` DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: i 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- Q7, / 3 /•3 f3ls/ z.zr' z .4g. el 9 d h m . B- 2 96, ~fleyr e /3 h 3 h 44-0.;j /s J' '04f " e d~ B- _7 ~3 /s- / /'3- 1V";/ 3 , 's r r r ~o r 'cs /oli-iav)r s/ 43 '8r) <s .?ap'aq rxs, B- 2 8, 0 1 > ,8 s/ 7` c s w r t e,~V r -'yam n m B- ! 3 !^S. z /y/yr t > PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERI0D2 PERIOD 3 PERINCH P- P- P- .3 ? .r "70 1 P- P- -C 3 J' P- 5-- ZI .3 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 7, n des -ill k : i E 1 . E cry r 3 E N F i2 F ~ l E A ~ W E 3 G i z I E E i j 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 (print): DAVE FOGEPG4 TESTS WERE COMPLETED ON: Licensed Perk Tester & PIUmber 3233 #3289 ADDRESS: Fogerty Heights Koala CERTIFICATION NUMBER: PHONE NUMBER (optional): ROSE F" , WISCONSIN 54023 .-ft-P 749-21666 C I TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) OVER - e x a,. 1 -HU ® N FOR O ETI FORM 11 - C - 6395 To be a and a, ~>>il test:, your repo (I Jude; 1. Compl~"' : scriptior 2. The use clear ,ate ,rhether thi a residence car commercial project; 3. MAXIMUI E:(jrnrv)erci«' ")need; 4. Is this r ne,v h, Complete th _ A SITE IS SU JR A HOLDING TANK ONLY IF ALL C3T1 ER SYS= T LASED ON SOI1 CONDITIONS; 6- PLEASE L- -e for v.ritiny profile descriptions and completing the plot plan; 7. MAKE A I-F-,IBL._ -cram 'ly locating your test locations. Drawing to scale is preferred. A separa`° may be used if " 8, Make sc.,< Jr benchroark an ' it elevation reference point are clearly shown, arsd are permanent; 9. Complete , ,propriate boxes z s dates, names, ad flood plain data, percolation test exemp- tion, if app 10, If :;7e - ` ;€,h as €l( It, elevation) dons . F i, place N,A. ill the appropriate box; 11. Sign th;, is pl ice your c. ~ lcfress and your c ication number; 12. Make 14'-l€' E,=s and dis:'ilrequired. ALL. °r1L TESTS MUST BE FILED WITH THE LOCAL A _ ~11 ( WITHIN '-".YS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS I Textures `Imbols st _ lover 16") BR jedrock cots C, _ {3 - 10") SS Sandstone gr Eder 3"'; LS Lilliestone S LiGv^a - P'-h Groundvvater cs ~c1 Pare olation Rate reed s 'ja'nd t•;= fs N)d Bldg - Is i Sand > )at) Iy Loam < . . Bin n 131 Gy Gr, y Loam y Y - Sandy Clay Loam R RI Silty Clay Loa mot - MC, Sandy Clay w" - wi;~i sic - `'"°y Clay fff - fet' aint ~c c:c - cot coarse pt Illm Ma eriiurr~ rn ck d - cz p - 1 .c IAWL H level, Six nr:, i textures 3te, r for ! disposal BM I k VRP Y°, I' ("rence 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 sul)mitted to the appropriate local authority in order to obtain a permit. 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