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HomeMy WebLinkAbout040-1182-20-000 c; o I 3 0 o ao ~r C o a x f~ O ~ O w c y c c . O ~M ~ O ? N Y C c t c LO O U U n~ _ N N r Q) O O O n O O V z n C _ O O C LL `o m n Q) E <t 3 a m a~ U LO ~ ~ a N rn Z E Z d d 00 a m (D 04 M f- (n O z d c V c E y _ N 0 O 7 O ~V c O Mr• O O • ~Il d L L_ N N_ c O O c 04 O 0O z I- z p N N zo c LL LL N i N W d L m Cl) o o a 0 N Q o H z 0 o O o •r m 6 a a a CL N q co 7 ~ N fn J U O rn rn } O 00 N Co E O N c- CL N O (O 'O rn a) 0 'O N Q' La x 4) ~1 ~ ~ N N O il v O = N C ca LO a) O Lr p~ O .0 N~ C LL O O r G O N In ~ ~ 'U r N 00 0 a) (0 U V (o 0 > W co O co O CV D w It ✓1 m t m CL L CL ACC CL d U d C - j +r i r- C O 2 V O t9 O O C.` V a 0 co 0 1 07 04:45 PM Parcel 040-1182-20-000 11/02/20 PAGE 1 OF 1 Alt. Parcel 36.28.19.734 040 - 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): O = Current Owner, C = Current Co-Owner O - WILSON, ROBERT & ROSEMARY,&LEANN ROBERT & ROSEMARY,&LEANN WILSON 71 OAK RIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 71 OAK RIDGE DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.620 Plat: 03-058-DANATE PARK SEC 36 T28 R19W LOT 18 & THE E 14 FT OF Block/Condo Bldg: LOT 18 LOT 17 DANATE PARK ~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 975/417 WD 07/23/1997 671/270 07/23/1997 528/54 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.620 44,000 158,400 202,400 NO Totals for 2007: General Property 0.620 44,000 158,400 202,400 Woodland 0.000 0 0 Totals for 2006: General Property 0.620 44,000 158,400 202,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 515 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506380 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: JEMS LLC Hudson, Town of 020-1466-21-075 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 27.29.19.2983C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft I Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 El Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 748 Exchange Drive Hudson, WI 54016 (NE 1/4 SW 1/4 27 T29N R19W) Hudson Business Center'06 Lot 3 Parcel No: 27.29.19.2983C 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD-6710 (R3/97) Date Insepctor's Signature Can. No. AS BUILT SANITARY SYSTEM REPORT OWNER, 42 TOWNSHIP Fo r/ SECTIONT g N-R-?W ADDRESS 7%~* ~1 ~•h - ST. CROIX COUNTY, WISCONSIN 01 SUBDIVISION LOT LOT SIZE PLAN VIEW " I SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s• i t 3' , 9 H A /7 IS t " s INDICATE NORTH ARROW BENCHMARK: Elevation and description: a1f Z L=- ~a k A~eA 4 = lot' Alternate benchmark ` Aq-V=9:~;Zt-A 4 J, OF IF SEPTIC TANK:Manufacturer: 40 CoAl Liquid cap. l.'Z ,6 6 Rings used: _3--Manhole cover elev: j2Q,17Final grade elev:_ 464,V0 Tank inlet elev.: 4.0 Tank outlet elev.: _5. 7_e,"l Rear Ft . No. of feet from nearest road:Front_~ Side From nearest prop. line:Front ' , Side , Rear Ft. No. of feet from: Well Building: ? / (Include this information in the above plot plan) (2 reference dimensions to septic tank) 17 SEE REVERSE SIDE 3 f PUMP CHAMBER Manufacturer: ~a&A Gm~rr Liquid Capacity: x'000 QAZ Pump Model : Pump/Siphon Manuf act mil/ r Pump Size_ j~ -,p Elevation of inlet: 2s, 70 Bottom of tank elevation 9/1 7/ i , bVallons/cycle: Pump on elev.: ~33 Pump off elev.:9P Alarm: Man.: y Switch Type: Location ~ Distance from nearest prop. line: Front AO, Side-, Rear_Ft. Distance from: Well > G Building 9 e SOIL ABSORPTION SYSTEM Bed: Trench: ko-010, Seepage Pit: Width: _:L-Length _ 3 Number of Lines : pµArea Built to ~Q Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: 3 01 P I ;L No. feet from nearest prop. line:Front Side Rear, _Ft.___Jylb " t~ No. feet from well: 6D No. feet from building 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: I/ DATE : PLUMBER ON JOB : LICENSE NUMBER: S g 6/90:cj I Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lal~or and Human Relations Safety INSPECTION REPORT St. Croix an.J Buildings Division 1NE,NW,Sec.36,T28-R1 9,Oak Rdg(AlftCH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 186523 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: M Description: Parcel Tax No.: /O . Q wit; ` %7 k 1_i TANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /0010 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 3 g y 7 ga 9,0'7 TANK SETBACK INFORMATION St/ Ht Outlet , lY 9.S,7S Vent irIto ntak ROAD Dt Inlet dd TANK TO P/ L WELL BLDG. A Ar e Di ?d Septic NA Dt Bottom ( t , 11. L4 L4 Dosing 9 " ~O a y' l; NA Header/ Man. (7 a 4 17 ti -V L4 - CIL Aeration NA Dist. Pipe 5 03 N. Holding Bot. System 9, ? 1 PUMP/ SIPHON INFORMATION Final Grade 51 Manufacturer S Demand dY I o 3, 8~ , 1 !o 77 Model Number GPM TDH Lift Friction System TDH Ft Forcemai n Length [Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH widthC Length No.renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J 3a O T 11,57 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O a a , / Model Number: System: Is' 33 >~0 14A OR UNIT CHAMBER 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 22,, t! Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter o'~/` (a A Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons rent, etc.) 3,57, = s°; t 1:fE,NW,Sec.36,T28-R1 Oak Rid rZ, 9 1? ; -rG t7 _ Nr 3 L=per ' • ~s, 1 I:`v- t . CID Plan revision required? ❑ Yes ❑ No Use other side for additional information. E:tIt-l no a 6 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. r- LQQ&'1'sT4MpertWAPX 1n4,3tty28.19.734 , & ff1 SMAHM& County: tabor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX - GENtRAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 186523 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: e Insp. BM Elev.: BM Description: TROY Parcel Tax No.: 040-1182-20-000 TANK INFORMATION ELEVATION DATA A9200407 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit ir Ito ntake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. I-f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: 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 36.28.19.734,NE,NW, OAK RIDGE DR. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY ^ STATE SANITAR PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ~ / ~~c~l `7 8% x 11 inches in size. if evls1oo t. -.ous 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 R E (o r Rohr ~`i 15~''/a U) '/a, S T t PROPERTY OWNER'S MAJjING ADDRESS LOT # K # 71 ozi k /Ct"~ i u r CITY, STATE zip CODE PHONE MBER SUBDIVISION NAME R SM NUMBER u Z'11 713- y~-~ AAA ADeL :a.~ 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD State Owned ILLAGE : - ~~f d b v ❑ Public U 1 or 2 Fam. Dwelling-#of bedrooms PARCEL TAX N BER( ) III. BUILDING USE: (If building type is public, check all that apply) /11 q6 11JFP c20 1 ❑ Apt/Condo V `L 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreat I 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 onl one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 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 N 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 E}EV. 7. FINAL GRADE REQUIRED (sq.ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) I. E ~EjAj pN r 3 h- 3 96 p a Feet ° Feet r VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks struct d Septic Tank or Holding Tank A- 11 AX 5 C-W /"O Lift Pump Tank/Siphon Chamber r Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumbe 's Signature: (No Stamps) MPRSW No. Business Phone Number: Plumber's Address (.treet, C p ity,/State, Zip Cod /fl ll~is !L~- 57)~ IX. COUNTY/DEPARTMENT USE ONLY P ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Is g Agent Signa Stamps) Surcharge Fee) pproved ❑ Owner Given Initial 06.17 Adverse Determination 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. 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 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 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 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) APPLICATION FOR SANITARY PERMIT 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. r Owner of property Location of property ~1/4 Alal 1/4, Section 7 Township -7 Mailing address Address of site Subdivision name- Lotnumber Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? A----Yes No Is this property being developed for resale (spec house)? Yes k 0 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. 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 ,dg recd d in the Office of the Count Register of Deeds as Document No. _ 1 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 con ruction of said system, and the same has be my recorded in the Office of a ount Register of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) A Date of Signature Date of Signature I I I I I 17 ` T fR4 ~S ' < rr ' C1000MENT NO. ! low, Sir- STATE BA1 I ; 4901M { Robert H. Wilson Rossm L. Milso lws a>ad-. wife as joint tenants , ! Robert R. Nilson a>adas!!!rar L conveyx and warrants to Mf tal Wilson, husband and vlfs of surviyolcphAR property and LeAnn M, Wilson, of. .10st J:.4natlts ~eTUww o j~ BOX yMt %A* rrpj; ...........Corety. I{ the following described real plate in Stab of Wisconsin: Tat Pared No: 1 " kfr Lot 18. Dente Park Subdivision in the Township of Troy. I 5 ~h } I This R......... hoaatstead ptopertY. tie) tins) ~ ~ ' $xceptiN to warlemuse: " sasewsnts, restrictions and rights of way of record. if an)r. ~i October ~~+s DauA this 15th day of < gym. i SEAL rt B. Wi ITT ASKALI ♦INlt1■llCw?IOI1 AC KNO W L21 OUSM? STATE OF WISCONSIN h' 8iesetaee(a) Fierce. Ces~b~• I9...... Persona" caaar Wwo se - . anbeaRieaMi t►ie . dsy et. Robert. s Roses+ar L. YiLon r r• HBMXR STATZ BAR OF WISCONSIN . (If. S ~e setlsrir~nl b i MW Wis. Mats.) to tee known to be dam twe[o[as anti►.: THIS 1.IanWmCMT YFAa DRAFT[D Br i.a.9+.w = Josgh D. 'Boles. Attorney at Law + Uhf- C River Falis WI 54022 ....<~5 Notary Public my i It ask soft aq be acted or admowledted• Both on Monona.) dates atiatsa as asw *spasm bmld 1w t"ed or priatd Edo.'t►.it sIfYM!lil.• . - `'~'i~. i~ ~~ii " one,, s !low STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 6 Ci5"r l7 L~i~ t s d ROUTE/BOX NUMBER Z~ ~~r dep Pr40 E FIRE NO. CITY/STATE /T / U'V` P~A I tg CL) ZIP ~ D 4-4- PROPERTY LOCATION: S-2s-1/4 1/4, Section, T':? N, R W, Town of Toy 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 .Cro' County Zoning Office within 30 days of the three year expiration date. i SIGNED DATE f~~c9L1 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 INDUSTRY, DIVISION LABOR AND - PERCOLATION TESTS (115) ' P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 (1-163.090) & Chapter 145.045) ~ ~ ~ T ON: k3 1~/iA /1 L (or) w TOWNSHIP tl t?TY: LOT NO.: BLK. NO.: SUBDI VISION NAME: COUNTY: OWN 'S AM MAIL ADDR SS: ,V -Ct,o t AR. lf4,4S Po o 5 W 1 ISo ~ 7/ USE DATES OBSERVATIONS MADE $ 0 2 Z NO. B DR : COMMERCIAL DESCRIPTION: PR FI E D NS: PERCOLATION TEST aside-, /J/, A.. ❑ New v V O RATING: Ss Site suitable for system U- Site unsuitable for system ONVENT N : MOUND: IN-GROUND PR ESSURE:1SYSTEM-IN-FILLIHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S DU US ❑U ©S ❑U ❑S Ell ❑S 2U r,~~Ncs ~~F to tiou-- ,0 M So~~ T6 T If Percolation Tests are NOT required s. DESIGN RATE: If any portion of the tested area is in the under s. H63.09(5) (b), indicate: G Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / S /o% -7 5 ` >'f , 0 5' ~e s i o - a2, ~;x~ 7V F ~c s J a. 15 5- ?rt.~ nw-a. S- U A/7 , ID yy. S/' '/.s--' 1,3. V A/ 7 • o,f S 8.2,- S 9F 5_o > s 60 N s' R w fJyl N 15 Pb G /lf TS B- . Si / 0 5r • Si (f p Sit" a4. S i • 6 13N -5y s '3a. S 3. S' ?~a lr-060P S 3 _v It .1 B- yE;1'~N sr S•~a.~ f S ~ 1`.Pit►'vi 7~-t ~ A 50le-' uc_ Fl'&Vif T,OUS 4,/ C+ - PERCOLATION TESTS ~ TEST G DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES --1 NUMBER INCHES AFTERSWELLIN INTERVAL-MIN. PERIOD 1 PERIO 2 PER INCH P- , t7 7 J/ O P_ P_ 0 D 0 Z P-. P- / L Z 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- rontal 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. T R C 10 ct- SYSTEM ELEVATION 'r1FW 6,k ids } arc- 7* ~,wG>~.s Cv f ~ r W _ xi2_ -i= 7 . i ^lop If ej!F'_AfJE1 If-- ! ! rp L -,L- O C'j T E l~ 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 : HOMESITE SEPTIC PLUMBING CO. TESTS WERE C MPLETEDSN© 655 O'NEIL RD., HUDSON, WIS. 54016 SS ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. -OP/e.57 CST IGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER BAS<l~ 'l3o Res Pic S 1 Te- f , f SSA/E ' Z ~ To p of / ~E vkr~ o s~. /o f 6i.✓~' / / 0 0 O ' / '~l• LS! _ Imo. ~ ' sy V / We Q ~ 0'/ V /FGA/~ ' ~ 1-1 i / / /40 FXiSTiu S~`Id T/G - / of ?,lN,CNOtrr✓ SiZEi .Hq~'E~ c o,~D~fioa • N . N I ~ { sow ff~ . w f W~f r LO7 L 6, z :.r.:::::.. Y:vin•:h•':.:•:.vv::::vi%: ik tt•viuiki.:::.u.. mvl m4.a%uv nvvv...A..bikv:4:i•::n0..: y: f..vY.vi: iin2:i v •:ry:• i}•...: ::O; v. v.:: x. x: t: v::'• ' Y++Wn.u :.lvO.v2....vv::.::Am2•:i:•Y:•v.•x.:rv..n:..r.4ri :.y:::v'.•'.:'>'%'::::: •Yixiit:G$vW:Fin ?ii"• : - - - - - - i. 'm'f•% HEAD/CAPACITY CURVE TOTAL OYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT and D EWATER I N G EFFLUENT ANO DEWATERINO WARNING: Model 185 should not be subjected to 11 less than 30 feet TDH. 34 32 TOTAL OYNAMN:NEAKAPACITYPERMINUTE EFFLUENTANODEWATERMO 100 l74b MRS$ 0740 p 107-120 101 1 110 105 1K' m 10 9S 2e Fr. <H Oat L*6 of Lit* Od Los 04 'Ltm Oa6 Lhs: Od :Lh 04 Lki " Lb. Oat L!► Bl L6t:. 5 1A2 43 16S 72 .172: 104 '.$04 106 .101. 11 2a1: 61 YOt M 2" 136 07 163 .$47 26 OS 10 2.05 34 121 a 221 76 UQ 100 374 : 61 231 61 221 M 220. 148 W 161 <672. 15 417- 16 72 45 '.i1064 .242 61 Su 60 227 60 2V 54 no 112 au> 1/S 610 24 20 6t0 25 03 M 136 62 210 56 2" 60 227 $6 220 126 513 140 320 7525 7.62 6 30. 74 260 57 216 66 M2 51 220 126 464 122 500 q 22 lab 20 0.16 65 246 55 200 58 220 10 210 51 220 121 IN 127 :4$1 s of 7 40 1210 K 174 46 .172: 63 206 75 265. 56 220. 103 .361. 114 431'. 65 50 '1424 21 t0 u 117 31 101 H 214 5/ .220 64 541: 166 176. 163 s0 `162➢' 13 >5T' 42 1st M 126 $6 220 71 261 65 j 70 '2134 20 111 10 :7/ 62 107 $1 102 70 R16. 16 16 10 2434 14 $3 45 170 26 104 61 .264 00 2W 22 x.121 2 4 11 10 50- N 100 2OJ6.. t6 :.a Tf I» . 45 110 n",p. 1 26 6 1* 12 ' Leak Va6a 1635' 22• 21• 56• w a' 73' 115' 01' 112' iB I 35 to a 2s s 15- 161 4 I~ 2 98 HEAD/CAPACITY CURVE 1 57.5 Is 0 SEWAGE and DEWATERING 10 20 0 30 40 50 60 70 80 00 100 110 120 30 140 150 160 ao 160 240 320 40o 4a0 Ho 640 WARNING: Model 293 should not be subjected to 0 FLOW PER WNV7E less than 15 fee! *9H. !vr • i 47• L G "i qg~~ F y ~ -rte q y,~ A Cr- p~ T J L~ i 1 c ' 3-Lva :839Wnn 3SfV3011 :03(Y91S 41 S3HON1 30 111M -16VV9 VVF1191~0 'WO\JA NoLLV/%VlW3 AO Hu.)30 WAWINIW S3H7f11 39 111M %Vb9 1VMI91VO WQWd Q4v11VAV2)(3 ;J0 14-td10 WnWIXVW 30141!`] 1t/Nld 0139 S3H-)N1 ZH NVH.L 3'dOW OI`I 1119 3H3N1 07.1.$1431 1V Wly 3OV)d-) 1t/(4I%1b /M0-139 S3H7Nl 1.SV3-1 id ~9 Ql 3dld noi-Lni jib..t.Slla s - 80 •31`d%3 d9°J14 ?/I dO d o a o u RvH rlsbvw 'do 31v~3b'I9V~oaZ M141i1S 40 „b 40 iVi~I 1vW 113A07 7113FIAS 03/\CZiddd 3dld 011.I191m-Lsi4 1113 109 13 " ~ ~ ~ } JvJb~ ~v1 UaSa~~J 1 I ~ d wollAs 1O W011o9 IV DYIIOu1WNj DUlidnop / O 010109 *did POIOJo1+Od,/T o *did Vlo/wg $1050jDDV „9 j OQlipig ~l _ 0 0 0 0 0 • `uoIl10 Odld 1DA0 qoD DD V „Z Ulm DUIJOA *11044U AS JO AOH YG/4 Odid IU*A •po'9 uld of Odld DAOOV „ • -OZ Uoq pop „y - L OpOj9 Iould DAoQV „al -wluIM1 dop IUOA pOAOJddV ---~Q wild UOIJDAjosgo Puy ItillUl MY 49OIJ 1.j~~S~c Ua~ ~4 uol~aaC SSC)J .10 39Vd REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 11/12/92 12:22 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/13/92 AREA: JT Activity: A9200407 11/13/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 36.28.19.734,NE,NW, OAK RIDGE DR. Parcel. 040-1182-20-000 Occ: Use: Description: 186523 Applicant: WILSON, ROBERT H & ROSEMARY Phone: Owner: WILSON, ROBERT H & ROSEMARY Phone: Contractor: NECHVILLE, HENRY Phone: 749-3322 Inspection Request Information..... Requestor: NECHVILLE, HENRY Phone: Req Time: 09:11 Comments : CJ'111 36 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 11/16/92 14:20 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/17/92 AREA: MJ Activity: A9200407 11/17/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 36.28.19.734,NE,NW, OAK RIDGE DR. Parcel: 040-1182-20-000 Occ: Use: Description: 186523 Applicant: WILSON, ROBERT H & ROSEMARY Phone: Owner: WILSON, ROBERT H & ROSEMARY Phone: Contractor: NECHVILLE, HENRY Phone: 749-3322 - Inspection Request Information..... Requestor: NECHVILLE, HENRY Phone: Req Time: 13:11 Comments: 1i36 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION I i