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REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IND STRY, DIVISION
NDUSTRY, T OF 1 P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (ILHR 83.0911) & Chapter 145)
TOWNSHIP UNICIPALIT : OT NO.: BLK. NO.: SUBDIVISION NAME:
LOCATION: SECTION: p q S'1'. CRU l y S7•'f~Tl o N
SW ~ gW ~ lZ /T~t N/Ift~E (o IJOFz~TI'}-iN `ADDRESS: Cl ` 1 L) ~ ST_
COUNTY: MAILI U~ S O)l W I S 4/0 / 6
Sl • L~U1X \z 3" N S (J) V
USE DATES OBSERVATIONS MADE
:
NO.BEDRMS : COMM R IAL DESCRIPTION: A ESTS ,-New Replace 1 Z3- 90 Tv - F~
Residence L) N • p\ ,
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN FILL ji, OLDING TANK: RECOMMENDED SYSTEM:(optional)
®S ❑U ®S ❑U [Z ❑U ❑S ®U EIS ®U 18'x~p' GDn1Vl~l`l~ul.►~C 18
DESIGN RATE: If any portion of the tested area is in the ,
If Percolation Tests are NOT required
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- ~oU~ t z~ Ste. prlv6E Z of 2
B- Z 0t Z 0a.o~
B- 3 qe 8`>•y 4 7 q8
B- \4 S 6• S a 7 ~l S li
B- S a~ 81-4•`a- 9 9
B-
PERCOLATION TESTS
D I WATER L V L-IN HES RATE MINUTES
D 2
NUMBER INCH DEPTH ES AFTER WATER IN SWE HOLE NG INTERVAL-MIN. TEST TIME P RIOD 1 p RIO P R PERINCH
P_ Ov -
P-
P-
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 ion at all borings; an~lh`d!~tion and percent
of land slope. 1N1~1ftL
SYSTEM ELEVATION
ri = N
-
r ~
4tN
s
8'-
c- ..e _-~-I
j-iv*n'R4 A% trn Y AST t~h7e
~~1?A
e .f i
3
I
~Rr~IwR6E = ~hSE1~_C1vT`'
C ~ -
I tiv
m
60
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.
TESTS WERE COMPLETED ON:
ME print : AND
CERTIFICATION NUMBER: PHONE NUMBER (optional):
11 [ADDRESS
ST OOl1 S76 -)Is- ?-5-0/4-s
: C
CST SIGNATURE:
RIVER FALLS. WI 54022
715-425-0165
6E: , p}=
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHRSBD-6395 (R. 10/83) - OVER -
SOIL DESCRIPTION FORM
Attach Soil Prot lle Locatio Ma On a So orate Sheet!
-::Zo n ~S 1V INEAR ING RATE:
PURPOSE: "V~LU~~ Sb►L ® SYSTID-) SLOPE,
u12 L • GE1Z..~`R nsrrcT: S 6 0° ~ -
DESCRIPTION BY:
0101 Q~ CURRENT LAND USE: LAj,* 0o. LU r
DATf.:
COUNTY/ST T ST• G~~ 1k CAV1j r*f Lt,J J EG T V COVER, T~ S G~ LG, AV S
LOT DESCRIPTION:' INAG CLASS•
Sw~/y-Swy St:c tz., Tz9N, Rzow D. Lis
LOCATION.. ut~-~-tom ~F NpT2 O ON GALLONS- PER S FT. PER DAY: kF' SOIL SERIESt Fl C-1.'z , S
PARENT MATERIAL S / PTII:
FIORI20N OEPiH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CCOATINGSS/ PORES ROOTS PII BOUNDARY REMARKS
i~, nbist Gr. Sz. Sh .
oe. G 1 2 S
1 s 1-~sb1c ~ v~r C, w
3-11 10~1~ 31.3 - C, S solo Giz,u~l-
3 11-23 to-11z !6 . - m S o s YYI\
13o tw6 Z 0. S
1 0-~ 1otiZ Z1Z - ~ s 1 ~ ~r wi
1 s l sbh ~ v~~ cw
Z 3_z8 1.u~-[ tz- 313
c s
i s 1 sblz yt-
~ Zg~.. 1{ m w ►oK~t 3 t - r ;
o s
VA,
3 r~..S
~ o- 10 ~ZZIZ - Is 1~ mu cs
1 s ) ~sb m -E~• 5
~ 17Z 10`112. 3) q u 41%
w/ F's Q rn ti sr, v~ _ Qs.
~ 43-98 lb`I4z- ~I _ `FS o S m
~o v"6 a~ 5
2 -Liz, ) g J m y
1 s I.~S~k wi v ~ c>ti
_z 3.11 Il~`tl~ 313 -
) •S 1 ~ sl~k m v ~ s
31
3 )1- sZ. 1.1 TL
I,Y `w► TL. S-puTS ~ S al° ct2•n-u~T_
z 20 )o-1FZ 3~Y i'l°' S ° S
S ~b -9 s I b-m Y 16 - s
iu G S
3 bk ~ U ,l- i: 3 )y Yn v'~ t0°)o 6r~►luet
ril S
lo~tti 3~ _ S 0 S
S 6Z -99 lrw-t y 16 - s O s 3 m l
vs D~
I ~
z,~ So I ti. Z ~
OTHER SITE FEATURES/NOTES: 0 pO~S-7~ Z '2-
/~n F'^ Ge of
Signature Date CST M
LIMITING FACTORS/DEPTH:
,VDUS RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
1
I 'DUST DIVISION
c P.O. BOX 7969
H LABOR UMAN R ANED LATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(ILHR 83.090) & Chapter 145)
LOCATION: SECTION: TOWNSHIP UNICIPALIT LOT NO.:BLK N ) SUBDIVISION NAME:
SL 1/ Sv3 1/ l z /T-,-R N/R zo E (o tv aft n+ )-+Q\ > s oN GT - ST. Ctu3 l Y. srn-n 0 N
COUNTY: MAILING ADDRESS: Ql ` Ll `aL ST.
S-1- C,ZO15C \\x_ :!!Z o~~ti► S 13)\_~ v~_-) s o)_3 w I S X10 6
USE DATES OBSERVATIONS MADE
JPERCOLATI
c~!i NO. BEDRMS.: COMMERCIAL DESCRIPTION: j15ROF1,LE DESCRIPTIONS:
2t esidence L) N - R New ❑ Replace CI 0 - =
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IIN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
®S ❑U ®S ❑U [ZS ❑U ❑S 0U ❑S ®U )i S'x7p' GU>vUL1JT1u1JKL 13L~
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: C-~ ASS Z Il Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL P H TO R UNDWATER-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- 1 ~-Z to qZ .3' 6M t z~ S PPvi,E of Z
B- 3 q F"~ • 4 r if 7 9 8
B- \4 qS "a 6•S~ n
B-
PERCOLATION TESTS
TEST . DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATTER IINCH ES
1
f NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 P
P_ Pv -
P-
P-
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. 1Nt111 - as•s 7~V~ L~ I ~1rf't)f~) FIL'LU $
SYSTEM ELEVATION 8 3 s
S6" L-4.
j d F TE '~~F1o~ ~~DC sTn~ ~ 4L L-4 , o =~'N
S W
i
HtO • `Y-p ~ ~ ~T , L.L"R S Sp' Fl~.~~
-
s , `a>J s `ter N
o
n
)"VIn 144 (~6iT tNhT~ ~C'~'r1Cb) Olizu
i
, s
S d-Ar- C 1 t I= 6 O
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 COMPLETED ON:
AND 1 - Z 3- O
ADDRESS: DESIGN SERvieEE CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST Sou 576 ~lS-yZS-0/65
• . BOX 74 421 N. MAIN . CST SIGNATURE: p
RIVER FALLS; WI 54022
715-425-0165
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 1 ' \cs(~-_ Or Z
I~ DILHRSBD-6395 (R. 10/83) - OVER -
w 4 J,
SOIL DESCRIPTION FORM
Atta So 1 r lu LOCatiO Me OR a So state Shoe
\T LINE ING E:
S o
~UhLUPt t=01Z Spil~ Aci~'~SORP p0~ yS TSII SLO
PURPOSE: P 1 °
ul2 w~ GE12.~~2 ASPECT: S - -
DEMIPTION BY:
°°ULO T
pATf CURRENT LAND USE; w
N
S GP-I~ S~ , L3AV S
-72
ST. GZ1J lx ~juxJ T W VEGETATIVE COVER
COUNTY/STAT :
LIIT - ST-~Zplx UN DRAINAGE ASS. G-y-C S'slU6Lly ~Rflat )Q
LOT DESCRIPTION:'
w //y St=C t2., T Z9 N. R-ZO u`' a.
LOCATION: Vt~t $'Ira ~F NOR O ON GALLONS PER S FT. PER DAIN
SOIL SERIESi ~~-h~l rl e~'U 1 S
PARENT MATERIAL S / III: -
CCOIAITINGSS/ PORES ROOTS PII -BOUNDARY REMARKS
WRIZON DEPTH MATRIX COLORS MOTTLES TE%TLYtE STRUCTURE CONSISTENCE
in. Rnist
o~Z. 6 1 4. S
o _ 3 tia~-t~z z.1 Z - 1 S 1. w,v ~r
1 S 1-~sbn in \3 c L.~J
Z. 3 -11 10`'t R 313 - C, 5 S°1o G>`At.~
3 \~-23 ~r3,-vR- Ll 16 - mQ9 S o s m 1
z3-~Zb Vow .0 s Yl
w lkQ 6 Z Q S
i s i s alt m y c w _
Z -s val2313
~ s 1~ sbtL rn u c s
Z? 40 11311 R 71
y yo-RZ tio`T~ y!G - .FS o S wt
~u N~ 3
as
Z y_ 1Z tO`t~Z 3l3 - 1 S ~'F Selz X'I U ~ C S
C°. S
w/ vS .
)-4 43-98 WI R. y /1. - ~ S S M rn
~o w6
CL_ 5
v - 3 `O R Z - ) S ) vh \V
z 3.11 I ~ R 313 - 1 S 1. ~ ~k v c w
S 2 1 O -117- 31 - ) S Sl~lt m y Fv G S
3 )1-
_ MICA1 „~/w tzoy " 1-L sptTS \SVr, lZmAuett
-
S 7b -9 s l o-m y 1(,
p-~f 10`iCt Z/2 - ~S ) h NI U 1~
Z y- ►y ~o~ti 313 - 1 s ) bk u fl.
v~~ c s
-
15 1 ~tk VA
)y-y4'~ IUY'. 3)y s e s l0o)p 6Z►~uet.
y _6Z Kj 4p 3) - 1maq- S O 8 w1
S 62 _9 ~ -j a y /6 - S O S 9
Z.~1 SO t L Z w
OTHER SITE FEATURES/NOTES:
\--2,3_90 oooS'76 tjnbe?'oF?
Signature Date CST N
LIMITING FACTORS/DEPTH:
J
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
l~SLL A 6E__nI'
OWNER- TOWNS DA/
SECTION T _N-R_2.(? W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION S Cii~ix fTAna~ LOT_ _LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
7",- of ;r&Lr 'iV"r Aw 'Fzov. _ ADO. DD '
STA7ZoN CSJ;LCL£
CvORAG E
P/tol~sEO tlruvewAY 39 ,
PnoPoSEO wrt~
/~szoF~vcr ^
°
67 1°
Eivs-rz.,iG
~ S'T2ucr✓tiE
54RO
AL >E _ /0
VEv7 STACK fS7 fLoPk'y
S
INDICATE NORTH ARROW
/vo SCALE
BENCHMARK: Elevation and description : EZey = /oo Ov' Ton of TECFdHON} ~0
hh i
~(iSLcr/~76r~iT ~ry• ,/I
V,
Alternate benchmark
SEPTIC TANK:Manufacturer:-L✓7~r~~ Liquid Cap. /~S o ryL,
Final grade elev:
Rings used: Manhole cover elev:~9~ g1
Tank inlet elev.:0. 6,5 Tank outlet elev.:
,
No. of feet from nearest road:Front/,'?-O, Side , Rear Ft.
From nearest prop. line:Front-??, Side , Rear Ft.
No. of feet from: Well 21 , Building: a
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
w h
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: Y',,t-S Trench: Seepage Pit:
Width:-,/X Length ~LZ Number of Lines: __,?__Area Built-e",
sp,r"r
Exist. Grade Elev. $g,6' Proposed Final Grade Elev. $$,5'
Fill depth to top of pipe: No. feet from nearest prop. line:Front 4 , Side , Rear Ft.
No. feet from well: /L3 No. feet from building JS-,!(
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 : 020 PLUMBER ON JOB :
LICENSE NUMBER: /`~'i%t,C _ ?3QC~
6/90:cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number:
SW -4 ,SW-,Sec. 12, T 2 9 - R2 ® CONVENTIONAL El ALTERATIVE (if assigned)
'Pi 11 age' of N. HudsR~ Holding Tank El In-Ground Pressure ❑ Mound
OF P MIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA
Eric & Rosemary Johns n 637 S 13th St. Hudson / V 9•.6a
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: , REF. PT. ELEV.: C REF. PT. ELEV.:
14 61 o fn's d 33 '7 tv. 0
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Za a Brox. Inc. 3395 St. ix 128877
SEPTIC TANK/ 670 O'F AV,,)-Oce Cc 7 3~ .53
MANUFACTURER: LIQUID CAPA TANK INLET ELEV.: K OUTLET EL15 ARNING LABEL LOCKING COVE j`~
/ i PROVIDED: PROVIDED: ^y
jSZ) " • o. O. Y
ES ❑ NO ❑ YES NO
Y or
BEDDING: V" DIA. 9A4*tv1ATL.: HIGH WATER UMBER OF ROAD: PROPERT WELL: BUILDING: VENT T ESH
Q... C-0 • LARM: FEET FROM LINE: O
/ ~O / AIR IN Ty
_Z -A S7 7-
E:1
YES NO A/ CA O-A ❑ YES O NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
ES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GA ONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: Ift OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FR LINE: AIR INLET:
PUMP ON AND OFF El YES ❑ NO NEAREST -00-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: ND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.) -
CONVENTIONAL SYSTEM: 13 m Of 5 C{rn 29 r
BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. P G: COVER• INSIDE DIA.: QUID
DIMENSIONS ii PIT'S.
(oD TRENCHES: / MAT IAL: P D
PIPE
el 1 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NNO. S R. NUMBER OF PROPERTY WELL: BUILDING: AIR NLOFRESH
BELOW PIPES: ABOVE COVER: ELEV. I L y: ELEV. END: FEET FROM
it /$'=3 8fo $!o. - -z? NEAREST & SS 7 lo el
MOUND SYSTEM:
Mound site plowed perpendicular to z
Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM y~,Z7
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
ES ❑ NO is the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: I PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH B PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE RIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: VER MATERIAL: VERTICAL LIFT CORRESPONDS TO
APPROVED PLANS
INFORMATION ❑ YES ❑ NO CO ❑ YES ❑ NO
COMMENTS' PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
Sketch System on Re in ounty file for audit.
Reverse Side. SIGNAT RE: TITLE:
SBD-6710 (R. 06/88) ,
S
SANITARY PERMIT APPLICATION
ILHR In accord with ILHR 83.05, Wis. Adm. Code CoUN
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITARY PERMIT #
8% x 11 inches in size. c
❑ Z6 f r X. to re ou f1X 77
-See reverse side for instructions for completing this application. a application
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. STATE PLAN I.D. NUMBER
PR ERTY OW ER 1 PROPERTY LOCATION ptJ
iG joNs£M/bPY Jo. so v Sw / Sw /4, S /2 T N, R a?o E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
:5,7- AoT- so
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
pSo.J G✓, SyO/ 0" S
ST dix Al
~11-T?oII. TYPE OF BUILDING: (Check one) El State Owned VILL NEAREST ROAD
VILLA
GE ~ OSoAI
=N QF:
❑ Public 1 or 2 Fam. Dwellini}TioaJ
g- # of bedrooms PARCEL TAX NUMBER( S)
111. BUILDING USE: (if building type is public, check all that apply) / '9
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
50 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..rf%_S_J1 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 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
DO fo?0 sv.Fr, Qillp sQ fr - I? ! ? 'rt S
Feet Feet
VII. TANK CAPACITY
INFORMATION in alions Total # of Prefab. Site Fiber- Exper.
New istin Gallons Tanks Manufacturer's Name oncret con- Steel Plastic
Tanks Tanks structed glass APP•
Septic Tank or Holding Tank i~Sp / ~is!
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber' ign re: ( m
a ) MP/MPRSW No.: Business Phone Number:
r4rC~4 ~U o S. ~i c . tlO,PS 33 4,~ ~~S 3~~ f ~'So
Plumber's Address (Street, City, State, Zip Code)-
--A
5'T /~tcOSati fv f 54ia/~
IX. C LINTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater -Tlma e ssue issuing ent Signat No Sta
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determina i
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
z .nom
• APPLICATION FOR SANITARY PERMIT
8TC-100
This application farm Js 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 lot resale by
ovnec/contractor,(spec houus), than a second form should be tetalned and
completed vhcn the property is sold and submitted to this office with the
appropriate deed recording.
Ownet of property ►C, V~
~cau'~, Cod
Location of property ~ 1/4 s /41 section
Township .1,46i
'3 ~P4> 30
Melling address Vl
Address of site
Subdivision nawse_ c5~. Chvix S)rt-d7y,0
Lot number
Previous owner of property _,44g6g1`~ CA
Total also of parcel - / ► / ~ /?0- f_0 _5
Date parcel was created
Ace all corners and lot lines Identifiable? _)LY68 No
19 this property being developed tog resale (,spec house)?__Yes ---moo
Volume -and Page Number as recorded with the Register of Deeds.
I"CLUDS WITH THIS APPLICATION THE FOLLOWINCt
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUMB AND PAQE mullein, and
the REAL Or THE REGISTER OY DEEDS. In addition, a certified survey, it
avallable, would be helpful so as to avoid delays of the reviewing process. it
the deed description references to a Cet:tlfled Survey Nap, the Certified Sutvey
Map shall also be requited.
7
PROPERTY OWNER CERTIBICATION
i(Vel cattily that all statements on this form are true to the best of my (our)
knovledgel that t (we) am (ate) the owner(s) of the ptopetty described In
this intocmation form, by virtue of a warranty dead recorded In the office of
the county Register of Deeds as Document No. f and that i (we)
Presently own the proposed site for the sewage disposal system (at I (we) have
obtained an easement, to run with the above described
construction property, roc the
r old Ryatem, and the same has been duly recorded In the Office
o.
of ou R later of beads, as Document ~T)_'
Slgnatute Owner 81 acute o o Owner (if Applicable)
Date [Sig acute Date o Sign Luce
77
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1- im TWO srncs asesavsD saw wsCaaniwa awrw Ei
WARRANTY mm
451-4302
~ 12 1
REGISTER'S OFFICE
This Deed, made between T. CRM Co.
Norbert T. Koch, Jr. eed for I
Rscord
DEC2 7 Nq
and Eric C. Johnson and Ro Grantor, at
as Joint tenants Begin , both unmarried 11:05~.AQM {
Misr Of - s&
Grantee,
Witnesseth, That the said Grantor, for a valuable consideration t
Norbert T. K{ ,~h, Jr.
conve s to Grantee the following described real estate in :t, Croix..
l nMi8nal Bank of Auds"
('uunh', State of Wisconsin: 307 2nd Street
Hudson, Wi 54016 -r
Lot 9, St. Croix: ;tat ion in the 'v111aF-e of 1Jor*.h
Hudson, :'t. Croix :'otuit. Wisconsin. .Tax Parcel No
~._llpl~.! 0
!
i z not
B This
property.
(is) (is not 1 homestead
-
Together with all and singular the hereditaments and :.pp.:rtf r...rrrs tFcreunt., }...,ur.~ u,~;
And .+Orbert r:. Koch. Jr.
warrants that the title is good, indefeasible in fee simple and :rt- -A -lea., cr.cur thr:.r,(t , ex,,-;"
easerlents, restriction:- and
and will w'arr'ant and defend the same
bated this
d a% rrEai•i SEAL)
SEAL
f
AUTHENTICATION ACKNO W LE DGMENT
i
Signature(s) ~I \TF' ' tt'i of\.'!~
authenticat.,d thi+ dac of
da} of
tl.e l'o r.j+rrlfvt
No-r lGOc~f, d r . fr
TITLE: ~IF:StkF:ft ~'F>'1'F: R\!' , ,
' I If f. , . ' ice,,,. ;rr"') ~ ,~~rcri • _ ~ t
R'i~
Jr, not ' ~
•h.ei....r' y'
WAMANT1 Wmt) ~L%Tt: 0.4N 1)F
STC-105
W
SEPTIC TANK MAINTENANCE AGREEMENT rt
St. Croix County
w
OWNER/BUYER
S
0
ROUTE/BOX NUMBER Ce 13 20 Fire Number :J
tv
CITY/STATE ;5 • ZIP ~
Got E . 4vt
PROPERTY LOCATION::Section o~ T~N, R.~W,
Town ofSt. Croix County,
Subdivision (!A2i C Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed 'septic tank um er. What you put into
the system can a ect t e .unction o the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
whcTiN -was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all'new systems agree to keep their system properly
maintained.
The property owner agrees to.submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2).after inspection and pumping (if nec-
essary), 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.
H
I/WE, the undersigned have read the above requirements and agree o
to maintain the private sewage disposal system in accordance with 9
the standards set forth, herein, as set by the Wisconsin Depart- W
went of Natural Resources. Certification form must be completed .d
and returned to the St. Croix County Zoning Of ice within 30 days
of the three year expiration. date.
SIGNED
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
REPORT ON SOIL BORINGS AND SAFE, Y"" "U'
DEPARTMENT OF DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
LO A ION: E ION: TOWNSHIP UNICIPALtT SUBOIVIS :
sw 1/ sv3 \z /T N/RAE (a ►vaR`n+ 1~tQossr. ctzul)< srnTruN COUNTY: A LI ADDRESS: C~11. 1 1 L( 11L ST.
S; -I, CJl~ IX GE~Z\\t zzo"-)> j S my M QZz) s o» LJ S C/o/ b
USE DATES OBSERVATIONS MADE
NO.BEDR A DESCRTP_TTO_N-I PROFILE DESCRIPTIONS: F1ffCDTA7T(YNTES
WE7CIL I
r~-•o~!i
lGStjesidence New ❑Repiace \ Z 3._ CIO 0
RATING: S- Site suitable for system U- Site unsuitable for system
CONVEN ZONAL: MOUND: IN-GROUND•PR U M-IN•FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional)
®s au ~s ou 2s ou as ®u as ®u 18
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: A Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL QEPJ~LTO R UND ATER-INCHES CHARA TER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION __0_ffURVED_ EST. HIGHEST- TO'BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- \ \z(~ 9Z.3' ~w~k~z 1 Z. Z (0 SES P C- Z c~F Z
B. Z C1 L 0 R• O' it B- 3 q8 8~•y 7 ~8
B- ~4 qs g6.5 a 7 a S
B
B-
PERCOLATION TESTS
TEST. DEPTH , WATER IN HOLE TEST TIME DROP IN WATSA LEVEL-INCHES RAT MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p I PER INCH
P_ eTL.W . P. \ 2 NO VC) l i b 1 3l$ 1 -31 e) 7. ®-1. S
P. Z -37- Iv tJ 1.0 -718 5 8 8 - ~
P. 3 Z G I 1V O -A p 2! /6 S 8~ '1
P. ti T R Oi.~ 1i-2-4/
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. 1fJt n t- - $S,S ' 7P, C, t-! L)9 ~LN1►JF•1l_'LL> ~ S
SYSTEM ELEVATION s , s
K-1 tS
_qQ
T&I
I
I
I
I.
I o i
L _ INt4 ALTL~RNhTLi - -
4_
1 i e. f lei
sl
A
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. V kMML# W 11~1`s
7.%3" oN
NAM print : WEGERER 601L TESTING TESTS WERE COMPLETED ON:
AND \'~-"I -4D
QTR P'j 6 S O►J 3- 0
ADDRESS: CERTIFICATION NUMBER- PHONE NUMBER (optional):
CST OW3 S 76 -11 S- y2S- 0/6 S
Pe BOX14 421 N, MAIN Si • • . CST SIGNATURE:
RIVER FALLS; WI 54022 ,
715-425-0165
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester, 16~ Or Z
DILHRSBDS395 (R, 10/83) - OVER -
J ~ I
SOIL DESCRIPTION FORM
taC SO P oC Na Oi a So grata Shoo l
~INEAg_ 0 E•
l= lZl ~ 'S'td tfi 1V S O N ~ °
o -
LMPO ~•Uh~-U~~ SbtL. Pr'CZSi RU'u 'S'OS TB-1 p 1 D
e G~1ZN-12 Asrrc • S 404
wnlrl ON BY p Ul2 w
Z3 l~°To CURE AN U • WOOUt.AT
ST• C.21J lx CAvyj T-V W vE
COUNTY/ T L. xct-sS tu61- L~R►'~„u ~-Q
S7' ~ZplX ON TNA CLASS;
LOT D CRi ION:' ski //y 5t_C Tz9Nr J;LZOw D,yg
sw 5!- O 0A► f;ALLONS• PER 5 FT. PER DA)
L T oN• vt` t of ►.1eR
~Ll~r-I e`~- 1 S
lYv
SOIL SERIES,
AREN1 MATER AL s / E I: "
IXXilZON DEPTH MATRIX COLORS MOTTLES" TEXTURE CSTRUCTUR~ CONSISTENCE CCLLAkYSKINS/ PORES ROOTS P11 •80UNDMY REMARKS
in. anist
l
1 O - 3 C L.~J
Z. 3-11 ib`~tR 31.3 - 1 S 1-~sbt~ M v~r C 5 Soto
3 \1-23 toy-tom. Lt /to - m~• S ~ s yn ~
130 ~v6 Z ..0.S '
Z 3-z8 >uH~-313 - 1 4 I Soh m
s
c_
Zg_l4o mmA3l - is 1~ sbfc m ui►-
o-
3
~u NCB 3 0..S
\r J-1 z 1s 1~ tinv
1 s s bh. v~ c s
cm \q- 14 _tl
S O S wl ' w/ m 1r h V S
14 43-48
v -3 2 ZJZ - ) S J Wm v
G lv
_z 3.11 I ~ 9 J3 - 1 S bk v ~
- ) s 1~ sb►t wl v c s
3 )1- Si io`tR 31 - °u s Salo ctz-~u~t
~ ~ O S wt l w~ w~ tz~Y ~ `i1. sQ. .
Sz ,0 10,1 L 3j mvA S
S 7D_9s io-1 CL 4/ 1(0 u W _r -s _cl S
-~J I011 cL Z/Z - is ) + v
Z y- ~ !o iZ 313 -
1 S S1~ Yr± v H 5
3 )14-14b iuYt,. 3)y
e s , toa....6pukuet
O s m)
y16 s O s9 m l
_ I
Os D~ -TVA __LL
OTHER SITE FEATURES/NOTES: n \ Z3_90 pO0S-76 Z Z
CJ~f ~ , 1~~ 6E: of
Sipnatuie Date CST M
LIMITING FACTORS/DEPTH:
f~JcNA1&C_ /oP of Tt~coNauE ~~0. C-60 vt
PLOT & CROSS SECTION PLANS
. f~EV BOO' ZAPPA BROS. EXCAVATING INC
PLUMBING UNIT
G scr/ Wo A4C $c' LP~i uE PROJECT
oPe3~~"'kq
D~ 35 3031 Pvc /VFwCav ✓~~nir, fc SYSTEM
F
Y I
~~P~S~q X~~ \ /'kRkv /a 50 ~A[ P!',( ~.bv,C ST C X STATia-v
A O//T// 14D292w
` a
R~h~O ,Qc7Aµlcv " '
`~Ac c yy,.
o~
~O' I/Gi/f V
fl
tl
c>
NO
SCALE
FRESH AIR INLET ND OBSERVATION PIPE
APPROVED VENT CAP
MAXIMUM 12'
ABOVE FINAL GRADE
4' CAST IRON VENT PIPE
MAXIMUM OF 42' ABOVE
PIPE TO FINAL GRADE
SIGNED: ' :f-5 ~,~z
MARSH HAY OR SYNTHETIC COVERING
LICENSE: ,~,~5 33 %S
MINIMUM 2' AGGREGATE _
OVER PIPE J DATE:
DISTRIBUTION PIPE ~ ,-J
TEE
• + _ SOIL TESTING BY:
I
I ~T/~Gr/! WE~~iO
ELEVATION BED 6' AGGREGATE •
BOTTOM PER. SOIL ` BENEATH PIPE • PERFORATED PIPE BELOW
T°ST !S COUPLING TERMINATING
S- ~ / FT. I I I AT BOTTOM OFSYSTEM