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HomeMy WebLinkAbout040-1188-10-000 `y y 00 4 > o 0 ~ y v 0. 0 c + n :2 ~ O ) O O N C C O _0 Y ~ q m O a C U O co - N C CL 3 I N LN O O O z O ` 0 -0 (D N O) 0 0 O C Z .X > -co a 00 3 6 O > - U. N N N O j C "O O L E Q .C m (D N U (O m Q O E O z C -;t o z r d 0 00 M F- ~ a m I o z ;t li c CD z ? C N N Q ca. N N C O c (C) 7 O L O CL ~ (b N i Q U O 04 O Z 00 Z Z o N Q E U N L mo E C\j 'O ~ N N y F- •N 'N a a a N ca a LL 3 G N > N N N to J U rn rn ~ O N - O O i. N C o m a aj Q Q o m V) o U w c ® .N O N _ _ O N N Lo m 0 O O 0) O y C C 0 0 k. O C Y Y O N O _O O 0 J O N 00 n..i ot (6 N 11 NO 7 Z' Z. t O (~x,+ O >>O V ~ a w ` 'c c :3 0 C~J11 r~ U a 0 in U rY o m C) d h o h ' O N ' O ' 1 V ~ I N w ~ Z C 7 t0 c LL O E a V O O Z w 0 ~t p z y m co d m co FN to c O C z U O Z :!t w It w o In H a~i Z E P a~ m N ~ m a> ~ ~ C • L Q O Q ~ Q U N zco z z N C ~ ~ d c E N Q ~ N y GI E ~ d l~0 w O ~ 76 rD G ra E J M N a ~ O CD $ 3 z ~a ,n000 •ti _CL IL IL CL ' o U) U) J U LL rn rn Z j 0 0 N O O h E J m ~ d N Q ~ m Qz Cn o C) U H c Al o •o E LO 04 O 8t O c U co d rn co c a) m -0 z_- 00 a) W a v w O li -J n C - ao T N .yam. a~i v O N O >>N O O O U O y„i O M F- > O Z c Z (n vs d ~ a #t o ` a E w c c O r A t~ Io in ti Parcel 040-1188-10-000 03/01/2005 05:01 PM PAGE 1OF1 Alt. Parcel 36.28.19.804 040 - 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 * ROBEY, DERWIN A & LESLIE J DERWIN A & LESLIE J ROBEY 812 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 812 CTY RD MM SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.459 Plat: 2237-OAK RIDGE ACRES SEC 36 T28N R1 9W LOT 51 OAK RIDGE ACRES Block/Condo Bldg: LOT 51 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1016/475 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 27596 145,800 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.459 35,000 111,100 146,100 NO Totals for 2004: General Property 0.459 35,000 111,100 146,100 Woodland 0.000 0 0 Totals for 2003: General Property 0.459 25,300 101,600 126,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 103 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDOSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SEC ION: OWNS NICIPALITY: LOT 71BLK. NO.: SUBDIVISIO NA / Nlv'/a XT N/RIPE (o W ~►o eAjdfd kA ~►j C U~NjTY: 41 1~ ~~4 e t ;K7k PA' WN /BUYE 'S NA MAIADDRESS: e(d c r /VA. I QQ{W~ CC USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPT ONS: ER LATION T y~T Residence ~L ❑New Replace T q 31 J! = RATING: S= Site suitable for system U= Site unsuitable for system ~ IN-GROUND-PR RE: SYSTEM-IN-FILLHOLDING®NK: RECOMMENDED SYS7EM'(ptional) , r ONY ~TI❑~ . IMOUND: 2 S U ~ S U fRJrCJ} Q 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: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- p" aY" ay- y,2„ arIt B~ M e s ! Ya'~ B- me4 t6o.5e B- ay-yc?",Oars' 6nmeds; Ya" B- & yik e tntl doss B- -N" 1 s r ay-36 B- Dos e SA 6 r &n r~~v " /2 Ouse PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P RI D PER INCH P- l ,r 0 / l 81 P_ a" 0 /U to 7 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 E E XAAOo 70 F,,'s?in U6771-0p. pro x • /gX 3 6.4x;Sf ~ ` J4 ~ . = ~.1'►? 1 ~0 t a .__*we r C _b (ir tI ,ri 1~ E 3 t~ boy cart i A4. undersigned, hereby certify that the soil tests repor ed on this wer tl~ a i rd with the procedures and methods specified in the Wisconsin :trative Code, and that the data recorded and the location of the tests are correct to t e best of my knowledge and belief. 'n ESTS WERE C MPLETED p "k4 T /I q , er / t J ,"CERT ) PI ION N BER: PH ~F~iJ„tional): S CST SIG T E: WeI YC✓ v V wL Original and one copy to Local Authority, Property Owner and Soil Tester. i (R. 10/83) - OVER - h, O NS . JMPL TC1' 1 115 - SIB ~1 , 2. ? r;l £ a£ 6, i, 4. 6'L1i r 11~ ALL ralTi plot 1.) [all; f, ting yan reterred. A ~t_L ~i r a fr y; HE t Ct)re5 ,,tools t? i n). d _ TO THE C-.. This soil test report is the first step in securing a sanitary permit. The coin `y or the Department may request verification of thi; soil test in the field prior to permit issuance. A p.`.tns for the private sewage system -d ---nit application must be submitted to the foc;' a~thority in order to obtain a permi` Mary permit must be obtained and posted prior the tr€action, AS BUILT SANITARY SYSTEM REPORT OWNER 1,ee LileDA TOWNSHIP 6 SECTION 3 6 !E--T--V -ON-R ~W ADDRESS 0 T ST. CROIX COUNTY, WISCONSIN SUBDIVISION (f LOTLOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I60,o B. two Top OtAf (!AF b 514Ile- J 614 1-01 va lt/ ~x;~'firr►►qqI~ovbQa Preca s~ S~p~~ ~ 7y~f~ INDICATE NORTH ARROW BENCHMARK:Elevation and description: i ~ -t CQ Vrx,h~,e Alternate benchmark y~G SEPTIC TANK: Manufacturer: l~l~kdlDu ~ ti 1Liquid Cap. Rings used: Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front/ ' Side Rear Ft. L% From nearest prop. line:FrontSide Rear Ft. No. of feet from: Well_ , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE r ' PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: / , . Width: Length l~ Number of Lines:-3-_Area Built lJ Exist. Grade Elev. Proposed Final Grade Elev. c 4 Fill depth to top of pipe: JU No. feet from nearest prop. line:Front X , Side , Rear -Ft..//,)' No.. feet from well: 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: Z'/ i T- 7 DATE : PLUMBER ON JOB : LICENSE NUMBER: 'Jill, l J' 6/90:cj LOCATION: TROY 36.28.19.804,SW,NW,LOT 51, CO. RD. MM Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 180286 Permit Holder's Name: ❑ City ❑ Village EXTown of: State Plan ID No.: EBB, LEE R & SANDRA TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /0-01 v S Q S CST - 040-1188-10-000 TANK INFORMATION 19 ELEVA ON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark jU~ / U IbU~U Dosing Aeration Bldg. Sewer Holding St/Ht Inlet - TANK SETBACK INFORMATION St/ Ht Outlet Vent ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic NA Dt Bottom Dosing NA Header/ Man. cl (o Aeration NA Dist. Pipe D =)c( 5 Holding Bot. System SU ~3 ~j PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System Loss Head 1TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TVANCH 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 CHAMBER i OR UNIT Moe Number: System: D DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) / r x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length - o 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 No Bed/Tr nchCenter Bed / Trench Edges' Topsoil E] Yes C] No E] Yes E] COMMENTS: (Include code discrepancies, persons present, etc.) J,OCAT~I..OON: TROY 36aQ8.19.804,,1~RT,NW,LOT 51, CO. RD. MM cr) [ ,r V i r~ ,.9 _*to f Plan revision required? ❑ Yes ❑ No L// Use other side for additional information. CZ.. b SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~a Ali STATE SANI ER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 f ^ 8% x 11 inches in size. (fie aQre ousapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPS TY OWNEkg 6 PROPERTY LOCATION S, <-6) Y. NIA) %,S 36T P",N,R l E(or PROPERTY OWNER'S MAILIN ADDRE LOT # BLOCK# 21 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISIO NA E OR M N MBER a oa, to PC II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE ~ ~G 1,=N OF. ❑ Public IN 1 or 2 Fam. Dwelling4 of bedrooms PAR CEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo VJ o !v 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ 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) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed /Q XYD 1 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 q~o REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/da ft.) (Min./inch) ~j ELEVATION ao a0 6 Feet t Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncret strutted glass App. Tanks Tanks Septic Tank or Holdin Tank Iwo y. d Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the ttached plans. Plumb is Name (Print): Plu r' Signature: (No mps) MP/ Business Phone Number: Plumber's Address (Street, City, S te, Zip Code): 6 V 0 d~ 16'uC ' ~i/)s k;,, ®d 0 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanity Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial $ x Surcharge Fee) Adverse Determinati n X. CONDITIONS OF APPROVAUREASONS 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. ; Y,oar,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) STC-100 This application form is to be completed in full and signed b the 01ti11er(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 Location of property~1/41/4, Sectio T, N-R~W Township To Mailing address (T P P k e FAA L , Address of site Subdivision name r Lot no. ~ . other homes on property? yes No Previous owner of property C~ X Total size of parcel L Date parcel was created l,~) •--7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume-and Page Number Y l 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 in the office of the County Register of Deeds as Document No. 2~ i5lo own the proposed site for the sewage disposal t system ) orr I e(we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly r ecordd ,in t e office of County Register of deeds as Document No. gnature of applicant Co-applicant Dat f Signature Date 6 f Signature WIN J. Siadra J . Greater day ' ~ekb plot --talmmil t7r 1W .100106 Thai * s&WGnaw far a valoew can.w..ajan Fo.Liy-on4__ i MONNOW x 14,01Mtt cru.e t.W estate in L • CTQ j( 'cowry. IKyOw to x v LOt 51, ;Oak :Ride Acres in Township Tax Key of Irv. This is 4,. OPI w41. F r. " iv FEE wMl~dll+t fi j1p p►illoom-rs t #.a Te Mire Wo a a M "i •a.~:... . ,Lenten arr~°osesa~y nz M • ►!r M.$rr+ aNM Ivor-of em brhtiv. • xcvpt . A SAN 0 war off' rocor Jim .y r i~70 Xi#cons n tb.. ~ day a~ Novawbsr a~ f, a qt Mrsa~tNC~s are trl i_ WNW" 1-11N, IT M ti tl ,y 7+~1e nmOrr li1r1• tier of N ur ansin or Olow P" }N A uih:,►u.Q Wt&t Bert 7(M o yrx. 'iv MYoei' w.r ~i"f~ : • ~ • ~ '~1101(er+lA X. " • ~►woAd onzen arc ` osewarY It" `Lenten 'a By►:too~i J. X~ns~a aad Ao~ar,►. Lims.~q .r MF vow! low f rYq «>shru~.•4 ~+r r.+ra,,enR tnst►veent vud c d tu.. x i )otarntly F 1 w Y~.' ~t~11~~At ,.~M~rrttl gi►i w n- d+~;- ~ ire ~ ~ J - r ~ ,.i s T. ~1. •a• ~~•r.. ~M- STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 4CC use - ROUTE/BOX NUMBER P l ` OT~ It ~ ( FIRE NO. CITY/STATE K. t o l/- Zip l~3 PROPERTY LOCATION: 1/4 lY 1/4, Section , T 91'~_N, R-&-W, Town of - , St. Croix County, d S f Lot No. Subdivision G j f 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 7. 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 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify1 that //I have inspected the septic tank presently serving the residence located at: 1/4, 1/4, Sec. T OPN, R,r!-L-W, Town of Upon inspection, I certify that I have found the tank d baffles to be in good condition, and it appears to be functioning properly. Last time serviced Od Did flow back occur from absorption system? Yes No_~< (if no, skip , next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known): 0A[j)jcv;i (if known): _ Ag f Tank ~ L~ , (Signature) (Name) Please Print (11.t1 /f Zn ~ r~ .5 (Title) (License Number) l 0 (Da e) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition. I certify that the tank to the best of my knowledge will conform to the requirements of IL HR-8 , Wis. Adm. Code (except for inspection opening over outlet baffle). Name ) U~ 41Signature MP MP 5/88 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR"AND PERCOLATION TESTS (115) MADISOP.O. BOX N W153969 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SEC I N: OWNS NICIPALITY: LOT N BLK. NO.: SUBDIVISIO NA G 1 MA4 /To~N/RIP E to ,^o r---- f C UNTY. OWN BUYE 'S NA MAI N ADDRESS: -F, * Ci T l icl r / I USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: R A T I Residence r:~ ❑ New Replace 31 431 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYS EM:(optional) Q S ❑U EIS ❑U © S ~U F_1 S [0 1 04 4 U ❑ S ®U 8 [under~s.'ill_HR83.09(5)(b) Perotion Tests are NOT required DESIGN RATE: If any portion of the tested area is in the , indi cate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-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- 7T 11 0 j=' 7 O" 0y w ' 1,2y- yq „ Pit r~ B Mle s! ya B- 8" 8 nee Jwe S B- /6 le s it a y-yd" ar,~ Bh thle Ya" B- g" tcxl do If B S; 1,)Y- ~76 /zlleA B- oos e S4 G r &n = "!/t nose S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERT D 1 PERIOD 2 P PER INCH P_ 0 / t / P- a" D /v 11.2, 7 P- a / ib 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 93. . B~ io Top~+57in IlenI~4(~ WC a 4ot a Rollo _ . pro x l~X 3 6'' ~xist~~ ~d _ Joa.~ = 0..15. m _ ~ o p o 152 i t ftnq P6, t ICA P©werl Cab (rs ba,r~ 3 3 y b. 9 woo r; ~e T N s fre3ciott 1,voS e~tvc 33 'L ,II Cry M 3 Ste. d' wtl~ _ ~noCd,~ ion.. CTy T1( M M 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 TESTS WERE C MPLETED QAI~ n~ S !y ADDRES : CERTI I ION N BER: PH E NU tional): CST SIG T E: V v'~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. '9-SBD-6395 (R. 10/83) - OVER - $fa ~T~~ ~ 3a3 ~ 10tv ~e ~ ~L.C2 ~~evl~ r ii o\. ko Top EX i9rt' 01 tiSCo, G k 5-tk W 1 Cam U~ lot 3~~ese~,~ I~ooDe~a (`3e,~f.C S4Z ta` 4t) REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 10/22/92 11:51 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/23/92 AREA: MJ Activity: A9200365 10/23/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 36.28.19.804,SW,NW,LOT 51, CO. RD. MM Parcel: 040-1188-10-000 Occ: Use: Description: 180286 Applicant: WEBB, LEE R & SANDRA Phone: Owner: WEBB, LEE R & SANDRA Phone: Contractor: WANG, TOM Phone: 425-9958 Inspection Request Information..... Requestor: WANG, TOM Phone: Req Time: 11:10 Comments : 6 I : U4 Items requested to be Inspected... Action Comments ~O Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION