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HomeMy WebLinkAbout018-1030-30-000 d v 0. 0 ~ ~ o I e ry o'o 0 o E m M p N C N COL C ~ Y N Q N '.L. O N M y T N N c O N a c Z 7 co N LL c 0 O A) V m m .c - - 'O N N O O Q 7 N E Q U en LL a ~ N (D z o 0 ° o V a I z c d m a) > a m N > cn Mn I N O z 3 d Z c r- a fA H ~ N O M ~I! E Q ~ E _ 7 u 3 p> O m a O O O a L O O R m i°~v E 0 Z Z O E o o 0 Q N ~zo I I U) 'o LO a o LO d a o ~ w a~ v~ v~ m > j I 0 a a a a a_ 0 0 } N U rn rn "V ! d co o o fn _ O N m) N a v 'p ~ Q } fn m 0 rn H H C7 0 O O c N H C O O m O O d j IT C00 ) N G M In f- Q N c C_ V a m 0 y N a y Y a N N O c .O-. c C c N p~ Lo _(D 4) 42 O aj E N y Z 2 'd O V N ICI 00 N E .da 7 E L :3 En C • ' o 2 m o z H H U) I • ce a a> m a E ` c c A co a~l',ov~ici ~ n"'v CROIX cou NTY e PLANNING & ZONING FAx MEMo F DATE: ZD 1 Z To: Ce. e V, CodeArtio❑ 715-386-4680FAXNUMBER: Land Information & Planning FROM: T Gt ~iv~L( t~ vt 715-386-4674 FAx NUMBER: 715-386-4686 8 715-386-4677 PHONE NUMBER: Rec i -cling 715-386-4675 NUMBER OF PAGES, INCLUDING COVER SHEET: RE: As I y qcS ~ q,04-1i S -r-e v, , t C) r\ ST. CROIX COUNTY GOVERNMENT CENTER 7 1 5-386-4 686 1 AX PZ@CO.SAINT-CROIX.WI.US 1 101 CARMICHAEL ROAD, HUDSON, W1 54016 WWW.CO.SAINT-CRO.X W, '.i: Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER eyl~ TOWNSHIP L,-kol,23~ot GZ SEC. T _N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR.83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ NI 6c)(0), fl~ . i 1 cc), 00 BENCHM.APK:. Describe the vertical. reference point used Elevation of vertical reference point: 1(~. O U Proposed slope at site: SEPTIC TANK: Manufacturer: C e S Liquid Capacity: jpCOO Number of rings used: Tank manhole cover elevation: fRr~ Tank Inlet Elevation: q 3 Tank Outlet Elevation: 7-5 i Number of feet from nearest Road: Front,O Side 0 Rear, ~ 0 feet From nearest property line Front,0 Side,&R-ear, O w feet 00'e✓ ~ Number of feet from: well QCP , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: We.t k-; Liquid Capacity: 8bU Pump Model: Pump/Siphon Manufacturer: Pump Size,_ Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: /h, Alarm Manufacturer: SZ, Gfef --h-c.) Alarm Switch Type: Lk A Number of feet from nearest property line: Front, O Side, ear, 0 Ft.(,/ Number of feet from well: J ~~7 U Number of feet from building: 3 (Include distances on plot plan). SOIL ABSORPTION SYSTEM ~ Bed: Trench: Width: Lenith: (~C . Number of Lines: _ Area Built: 0c,) .Fill depth to top of pipe: ~ 0, - Number of feet from nearest property line: Front, O Side, Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: --r Dated : Plumber on Job: License Number: 3/84:mj Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division St. Croix SW a NW%,14 , 2 9 (ATTACH TO PERMIT) Sanitary Permit No.: GENERALINFORMATIbN 17W, 190th Street 149215 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: Albert Burmester Hammond S91-40635 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 70 4 CS-r) t018-10303-000 TANK INFORMATION ELEVATION DATA 6 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic )exs 1 a(3o Benchmark's 3 Dosing S 8 00 Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet u, 6°I 93 -1,4 Vent ir Ito ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air ntake o,-75 `I L 1 Septic ~ao0 ao I NA Dt Bottom jq 3q,Sj Dosing ' a p d a ?)f NA Header / Man. 1 a, Aeration NA Dist. Pipe Holding Bot. System 10 j 0 PUMP/ SIPHON INFORMATION Final Grade gwo 02, Sy Manufacturer Qd4~ Demand Model Number t//z, O 311,1-- GPM TDH Lift Friction System TDH /a,XFt oss mead Forcemain Length 60 ' Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH WidtFy Length_ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS G D ~1' DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: a OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _ Dia Length Dia. 1,14 Spacing I u O G &27 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 /Trench Center Bed /Trench Edges Topsoil Yes ❑ No 12/yes COMMENTS: (Include code discrepancies, persons present, etc) 0,7 - I i 4r /0- -ter Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. l ADDITIONAL COMMENTS AND SKETCH , SANITARY PER6I1 NUMBER: 1 L 4 A c =:Zalh LHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 5y ~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~j IF 67 / 8% x 11 inches in size. ❑ C15eck ifrevision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. C?/ '7O6/1 PROPERTY OWNER PROPERTY LOCATION X116 e_ r- /2 ~,rr/y'c'J Sit='/4 /jj1'14, S `f T,,?~, N, R i 11(o W PROPERTY OWNER'S MAILING ADDRESS LOT # A// BLOCK # CITY, STATE ) 21P CODE PHONE NUMBER SUBDIVISION NAME OR CS NUMBER II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned VILLAGE! ❑ Public 'f~l 1 or 2 Fam. Dwelling-# of bedrooms PAR EL TAX NU BER ) III. BUILDING USE: (If building type is public, check all that apply) ' ` 16 303 _ v (01 ❑ Apt/Condo V 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 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. ❑ 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 ,N 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 Z 50 3 dC] /,0 -30 `O -D. Feet --'OZ -ZFeet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed -77 71 1 Septic Tank or Holdin Tank le Lift Pump Tank/Si hon Chamber 4_?o VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) r P/MPRSW No.: Business Phone Number: ~ a le F, ~.1~~✓on `E y ~ GSA-3375 -1 1 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature o stamps) Surcharge Fee) KApproved ❑ Owner Given Initial / Determination `l `V O Adverse X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber • 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. Owner of property Location of propertysy-)1/4 Y114, Section T.~51_N-R_Zf W Township Mailing address Address of site Subdivision name Lot no. Other homes on property? yes p~ No Previous owner of.property 2 Total size of parcel iy® n Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes U No Volume/{/y and Page Number las 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., 15-9 , 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 5~ignature o applicant Co-applicant ate f Signature Date of Signature y SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYERm~(,Z tea) 9~~ - ~ 9 0 .5 T i ADDRESS: FIRE NO: LOCATION : 1/4, l~ 1/4, SEC. / T~N-R_L~W, TOWN OF: #X 'Q J 4,01 Ain( ST. CROI X 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 to help with the cost of the 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 system properly maintained. The property owner agrees to submit to the 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 from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : 1 St. Croix County Zoning office 911 4th St. Hudson, WI 54016 N°- ~rawr2 $Y i9lber~' T3ur,~es/er- gotk- csT 3-d1/3 n"oPerty L,ne Ae4NOcN T-RE ex%STtj4G Sep*riC _ SysTkM -AS PER IL~IP. 8-be - ) Se c 40 S; tc Z~ M `N S1~+F- ~ ~ Garage GJe'~~ i s _ ~$~o►' 159 so~+fh s~ t ~ ~ ~i n e Garaq e Alto B = 97#7 0' 1000off, 1 Grore ;,C, •o 3Z = 9?-y$~ SSE CQ Neu> Poo al. /o° House 0 = 97•$8 133 Bcoc- ~ rnar7 is ~oP 7~%P l one pec%s~4/. ` oz v °Z o Cl~ lrn`xOdC'~ I 11(i TtIE AREA 2 ~a Ft, BELOW Tti f-- ra / p z• BIE------~5 ~ ----3~t----33083 DOVJhiSIrCX'E ev-Se CF ''1' Af-- MOVND MAST ~Eiv~~N V►.►0~5"~a~.~iGt~ 6-3 8.M . /~/ep~lov►e Yep /90''x' sfi r 7, 71 0f $tf9w,' MQr h'Hq,y Or ythex'ia to veriq ~a ;b{etrigt~an Pike Medium Sand TgRsoil G ~NSITE SWAGE StT , b.. 1 L f il A. r OR i 0 R4 K=1 C?.t Forca, iloin PIoW.~d ' ~ ~a AN REL 4*0re ..e ~r4r, P(11P` 4o:y'or: 0..51 Y, 11i31NG5. LlpAF~T'i df ON o D E'CORt~ pON ,prlOgn, ,Of A MO P4 ~Y0tdrvy,sln9 E - A Pod For The :b' 0ePt,ro Ad,~p F c~.nse NuO, r t s / ar Pate: 'i - Al ternatd PoS ia.i pn of forceMai i t1 a2 r , Obdr~plI Qn Rips K yR •r 1r'r 7+trt~TR ^.+'Ar. .TT nwT 777-7 1 A ~F t~ ti'7 l•11wT'lr wl ' W Th T..w~r ~~.~rL~TT2Tn ~~..4r Force ylbin f: From P.urtp O14trik?ut,i'Qn Qed 0f P"(pQ Ap~re9 gt' l1n R pe rmanent ,MJQrkers 1 Plan View Qf Mound U"inp A Be For The". Absq r p '.t.1 R ,re~i '7~SLi~7""'1~'1~►. •K• ( , t - Its s1 R.. ~!N b F~f r IBS y r. ~ t EAlF e 1r ~,.1~~'`►. rz~Ttfri'~I'.`' 1 1 :I' ~ y rr ~ 4 Rage 2 Qf w P a'4 ! ~ , ' ~ it y , Porforated plpp Detail Ail- 4 k ~tlr ~R VIeW ~ I~ ~'t ~ ~ I~ 3 ! Goi~ r"1 PVC pi 4o i~ r u~* HAIR~k I-"pied Q 64t'~A ~ r r, f lry b * I.1 PVC Foro~ Malq p 4 ,j~nUold Pine . ~a , 4 Odsiripufion 4~{ a~rPa{lt~oq ~1(s { t gA4i H~1~, &hAuld 8~ ~~t , 1. , E"CAP D~.af.~ib~tion.'R(' a ~qyouj zT, Sri @8 . f > 'r 1,str LYE Inc,h(es) ~~ens.e i~umr' Magi f Q d Z Inches riches TEM SON AG # Q P'. h4~ a Pi pe•, 4 ti 9 fit .I f~ 1 x )VLwD' N'AELA"ilc, F IN' DUSTY `LABOR AND DEPARTMOT p. g IN 5 t ' iSION OF , 3 SEE PAGE OF ' PUMP CHAMBER CROSS SECTIOM AND SPECIFICATIDUS VENT CAP 'CC.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTIOM BOX MANHOLE COVER 25' FROM DOOR, dINDOW OR FRESH 12"MIU. AIR INTAKE I GRADE `i'MIiJ. Am. 19"MIN. INLET cr~ ~GVy ~11 OVIDE I - /ON~Jt~G IRTI4. T SEAL I I i I Ins. APPROVED JOINT A CQb~o I I I F APPROVED JOINT I W/C.I. PIPL R~~AIp5 I III W/C.I. PIPE EXTENDING 3' ~~111A I II ALARM EXTENDING 3' UNTO 60L1D SOIL ONTO SOLID 6011 U~~ti I r i~ SPA I I I ow ~•7 p pPR1~1~. ~,Iv~S~O~ ~ ~~5~ i I CLEV. FT. $ c rv~} S~ PUMP-~ --j ~ OFF D CONCRETE BLOCK la APPRO RISER EXIT PERMITfEO GNLy IF TANK MANUFACTURER HAS SUCH APPROVAL gEoo 00 I Ni NG SEPTIC E SPECIFICATIOUS DOSE TANK MAWUFACTURER: Lt..° NUMBER OF DOSES: PER DAy TANK :,IZE: ~OU GALLONS DOSE VOLUME ALARM MAIJUFACTURCR: /ocle t INCLUDING BACKFLOW: GAIEONS MODCL WUMBCR: / CAPACITIES: A= ~+l 'J INCHES OR Y-27' 1"~GALLON5 SWITCH TUPC: _INCHESOR 21'241 PUMP MANUFACTURER: G(►LLOIJS / C=~ 5 INCHES OR~/o 63GALLOIJS MODEL NUMBER: O=-L-=IAICHES ORZoy`?/GALLDIJS SWITCH TYPE:==rCG/r'Y IJOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE- GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ANO.OISTRIBUTION PIPE.. 9 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . FCCT + FEET OF FORCE MAIN X ~'G FjofLFRICTION FACTOR.. FEET TOTAL DyAJAMIC HEAD = ' ^21- FEET INTERNAL DIMLWSIOW~ OF TANK: LEM&TH ! _;WIDTH L/ / .-;LIQUID DEPTH Y SIGNED: LICEUSE NUMBER: OAT E' . Performance ersoble Effluent Curves PUMPS o I' METERS FEET 90 MODEL 3885 25 80 SIZE 3/4' Solids WE15H 70 Z 20 WE10H J H 60 WE07H 15 50 WE05H 40 10 30 WE03M 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L 1 1 0 10 20 30 MI/h CAPACITY [qGOULDS PUMPS, INC. SBECA FALLS FEW VCW 13148 \ METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3/4" Solids 30 100 90 25 80 70 2 20 60 O F- 50 WE05HH 15 40 10 30 20 5 10 0 0 1 10 20 30 40 50 60 70 80 90 100 110 120 GPM I 0 10 ~ CAPACITY 20 30 rn /h a ~ 01985 Goulds Pumps, Inc. EMecuve July, 1985 I D PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) ILOTNQ:BLK.NO:SUBDIVISIONNA E: LOCATION:t J SECTION: WOWNSHIP/MUNICIPALITY A74 /T29N/R / 71 (or 11,?,W12;9o 17 /Ay COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: = C,~///~e~^~ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence ❑ New Replace 7 _ J/ - G'- z- '7 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GRO)ND-PRESSURE: STEM-IN-FILL HOLDING TANK: RECOMMENDEDSYSTEM:(o tonal) ❑S U f2S❑U ❑SRU ISEISZU ❑SMU 11V 0c~~7 If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b)I indicate: ~ Floodplain, indicate Floodplain elevation: //W PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER ELEVATION OBSERVED EST. HIG EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 3,47 q-7,7 /l1 /1 r t 3.4-7 ' 9~ / S/l' ~(~/?Si • f b /3~5~' •~3 B- B-7- 374 9Y'y5 llne me?YL mz•6'7~ "g3$/si~ /33~ ns~~• ,~~'g 13n B- _ l I B ,d 9 97~5v~ ~(lvtt e of 3.09' /-ZS,1 is/ ' .1S' s/ B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER ' ~ AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ 2,0' ol? e o Z 3 P- Z 2, 0' _36 V P- .0, 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. i SYSTEM ELEVATION /0/• 04~ f E I ~ I ~ ~ ~ I I T-1 E P^ ? s E E r T N , s _ 3 I E ~ _ • ~ I E 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. NA nE(print)*>> TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST GNATURE:1 Tlr ')ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - I LH R-SB D-6395 (R. 02/82) OVER F* Qtc~l'1 e/' ; 1 No• ~rquJri gl Al be-r~- 13 r','Yl es/e r / 9o-fi` sf: cS7r 3-1"/3 P,,F e- 'ty Ll ✓1L' S; to /s9 soy i' n e Garaq P Atua i /ooo off. 7 = 97'70 V (>rc✓e s w;, L Exis . Z = 98,`1:5 Soo a1. ~ •0 e L3 New o NouSe = 97•$8 133 Berl. rnor7(' is /oP o~ 7o' ~ePlorle pee%-7a II Ql oz ° PS F nc P1erosed mound /Qre(1 i v, Z' v3 z a< 5`S ~l °~0- -3~t --33 -gyp 03 B► e T/epbene Pent! /90~~ St SAFETY & BUILDINGS DIVISION State of Wisconsin ;nt of Industry, Labor and Human Relations epa, ~wf*,! street lt)'-i Lit( ~.;~•4E Wrsc.ullsitl 5,103 i,LiL,f:)T' S f r;U .13I;' , t)ctiltt'! : ALBERT Ett i<'tESTER 820 x1TN 4T= '1 f, i0(.'TH ST 54(2 2 HAM'S ONO W1 54415 L'ALDWIN RE: Ply Number S91-40635 S,I, t FO r Y Ft tl.lec't Bl' MFSTE.R. ALBERT f'ot:(it L 4.) HAMMOND I±atr: i'.vre.iz(:d: 8,06,%91 This le*.Ltt te) rti l rtc>1v1t>,1 6 rt r:'eic)t ,+i' t.t e t~lt!~tlt~.ir+. r'latz; which r[)l:l submitted to 0:e Office W [',t".is;o7 cudes and of Pr'l al_e Sewage. fit. .,'antlot: h(►t :(_,1., lif,ocl c;ti %')11t St-.i:inli td1 ltl we receive: 1) ?ft,t_o-,' Jtif~ ~uTttz' stittino" that t 4f-? pipes (`t-rvlni? they cf. fluent to the ditril tz(Pf i%1 19,11? al flilr(~ 21 'trl alls:li t, i.(i111, ()I l bbl` ific 1l' 11)+ ,1)°(,; osed nl )t11.4.' i:- [It`av tht-: p0 h of the III, ',.licit:` ) vot:.1..e t~"l 1,110 di-tc:h, i41,owitig 1i1 .'~tit;tl.lllt of 24 iiwhes oC stli.tttb.le ~5oil in ) An additionil Co(inty 0n-sit_e of thf horin-, togf hol with the count,v's opil'i_on of the itest:rttitg the lintel of t4'aivf- (7:t F:i pt''titiotl &t 11111s site l'1 _zsc r e t_raip one vv )t t 111°, letter, foi S ~ fP ! f ltl.t' iind t et Surd the. other With 1r2<t t C~ f l a f 's r"+i76~1 i:. ~ t F'si Moult' !-laris will. be p?L"~it4.,Sr7t: within 15 h-.) the 'S.ie-t3.tll of, Sewage f(?13t>w:r;g t`ec,erl71 of 0)- re(;11 :.sted tken;s. petitions or plans :,a1??lllitt~'. t,c) 1.lls offiice which l,,ct,iEc<> adOit:ioniA1 Information wvill ')k% IwI' 94 lvorlcirig diiys for re elt')t- M' fh±- iitt4xl~lxztir)il. If, after 90 days. rt, , r)U?isc 1.0 this ?Noel' has ilt) t 13<-!P.r3 , ('S;C"' Ved . yout: i. 1 iv i l 1)e ro t uri.ed i ,.,o!l f3110 It d!'AIt: ,t::tr\.? to contl'ict a !'egl d-ng your s1r1)nit.ta~l, pte"ise call us at (608) 78 5-9;~C.i anti rf!for 1.U the pl vi iwilibo!' s11(). 8 g S1ri(:Erel~'_ '1 J N O C) Gn MC-3 l 149 M section Of P:'-ivale C) x COMP: 11 A',,/} ALBERT B 'RMLSTE f ~ r 0 r t e It SRO-84239R.01/911 ST. CROIX COUNTY ~Y~ WISCONSIN t a I ; ZONING OFFICE 'rw%~N ST. CROIX COUNTY COURTHOUSE ~•T - 911 FOURTH STREET • HUDSON, WI 54016 - - 715 386-4680 Aug. 2, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Marion I. Burmester property, located in the SW 1/4 of the NW 1/4 of Sec. 14, T29N-R17W, Town of Hammond, St. Croix County, showed 30" of suitable soil requiring 12" of sand fill beneath the proposed mound. Should you have any questions, please feel free to contact this office. Si cerely, James Thompson Ass' tant Zoning Administrator cj i