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HomeMy WebLinkAbout026-1079-50-100 3 C5 n p v> o~ 0 o c 3 N N w Oq N I C C f0 a •o N N ~ N y O Z > C - LL c R _ O Y _0 d Q U CL I 3 Cl) g z fl! c~0 O ~~I o z € n C. w d m N F- U) C O O 2 U v y z N F ! N O E m M I ~ O c ,O L O C co 0 z z O N Z Q N N N LO 3: CL ai 0 co N m m N- O ° o o a > z - § U) CA U) :3 0 d z 0 X 000 Z i oaaa 2 IL E O ~ cn O J U) U !~rnrn Z O Fes, Z N N N a, > n n Y ° O m a w p y y (O I M ~ m Q} O O C ° N N C ~ N C C,4 E Q 3 d LO H C C " d p m C N rc) c6 O C 4 m O N N O co y = o M .E G N U) N~ O N n 00 • C14 n o c o R O O CV a Y O z z E to la • c'e CL m m d `Iv +r E c c A c°) a 1, LO) Parcel 026-1079-50-100 08/12/2005 08:46 AM PAGE 1 OF 1 Alt. Parcel 27.30.18.419A-10 026 - TOWN OF RICHMOND 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 - KELLER, BRIAN J & DEBBIE M BRIAN J & DEBBIE M KELLER 1246 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1246 130TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 4.440 Plat: N/A-NOT AVAILABLE SEC 270 T30N R1 8W PT SE SW BEING LOT 1 Block/Condo Bldg: CSM 8/2377 EXC PT TO PARCEL DESC 1075/335 & EXC PT TO PARCEL DESC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 1077/169 27-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1077/169 WD 07/23/1997 1075/335 WD 07/23/1997 909/391 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.440 53,600 191,600 245,200 NO Totals for 2005: General Property 4.440 53,600 191,600 245,200 Woodland 0.000 0 0 Totals for 2004: General Property 4.440 53,600 191,600 245,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 133 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 hN'DUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 W 53707 HUMAN RELATIONS MADISON, (ILHR 83.09(1) & Chapter 145) 07/_ c 0_16CJ LOCATION: SEC ION: TOWNSHIP/ OT NO.:BLK- NO.: SUBDIVISION NAME: 1/sw 1/ 27 IULAIRI? E (or) VI-C x,410 A~ CsM I3E- o, AJ C_- COUNTY- MAILING ADDRESS: 5+. CR X 2 QI A AJ Ilt iz (sa Y--,e) 2X• V&cv USE Z 6 - 722/ DATES OBSERVATIONS MADE NO. B DRMS.: COMMERCIAL DESCRIPTION: TESTS: MTOME DESCRIPTIO S: PERCOLATION I Residence 3 OP- 4- if XNew ❑Replace k> 2- t 4 `j / M4Y 3 - 15 1t/ f}mea 6ko'Al wl lei/( Sr'/ . RATIPIG: S= Site suitable for system U= Site unsuitable for system __C& 0 C JNVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S ❑u OS ❑U EIS OU ❑S DU ❑S EA Mou,jD oo w 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: Gli/~' JC' s Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. I E T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I ~UDDIEQ 47, U- Yk 2s ye 315i C,/ L-15bA,w B- &0 10q,7o /G"-ay' /d YR 4/G Si/ 2,w, sb.c %;-F, 2f-?p /a YR S%G P~ 9.MuEiy' VO / ~fND' 3D-GOB /o ~ S ZA^+DEO j.c l✓f tw f r. g.Z (Po ~(~(~,70r Pv00~ O >4T- ZS o-/L" /11 f4 11L 5;/ 1-'5bK Mir j /2 /G"/oyt 3/fi 9 ; ZA, sb.E' m.ff' G-3G"/~ Y4 f/'& i, //%1 5,64- ' V--P 3G"yGp" /oyR //G 'S/, 5 f eW wi cz~ 14 O'T5 Ar ~q r D- 22 " ro yR 1/( 5'' 1,,5b lid , an V f1^~ 2z"-3 " 16 VA 2/1 5,4 B- 3 (D 1.~¢Z qz- Z*A bk,wP'; 3y~.w /0 VA, 5'.1K 3C,5; J. 1 t i 4W-GO" B- ~S ~c7/, y0~ b-/ly is YAP 3/z 5/1 lIm 5bk) Mtvfr; /y-2o" 7S YR 3/ L10 1/0 sl I,,,Ib14 of r - 20 2M,Sbkt;w,•F. B- r B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES 4 f NUMBER INCHES' AFTER SWELLING INTERVAL-MIN. P RIOD t PERIOD 2 PERIOD 3 PER INCH P. 1 Z 36 i/ I y/4 I¢ Zy p- 2 2 'ytQ- 30 12/ Z P. L 0 tl 11 11 O 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. S!}1JD ~O c~ A- G2 Gtr/ SYSTEM ELE"TION. A-725? f~ 1 i" S,~ 1-5:D _ 102_0 t1 i i 1A 4~P P4Y I ~ i , _J_ - - li I } J M I, thn undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedur 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: HOMESITE SEPTIC PLUMBING CO. M^ -5 - I -j T f 6-O'NEIL R11-HI In.AQN. WIS. 54016 / ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): LUMBER LIC. NO. 3307 M.P.R.S. !MNN. INSTALLER & DESIGNER LIC. NO, CST SIGNATUR : ud l to DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nn uo cnn ronc ~n 1111e1i l n+,r_a PL07 PL-A4, 0sr { .FU U,.tp R old 0 .I I curl/ 15 I sy I I V 90 ~y yo qv i V _ x PZ IS T s~Z x Z 5c~t/~ : / = 3 o x HOMESITE SEPTIC PLUMBING CO. PtiPG ~AC.t T/O.~ 5 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT e r r -F - YP 2- 13. A f . S e v . M. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. j ~ n y UL n p-p lllNN. I14STALLER & DESIGNER LIC. NO. 00663 A-l a o Gr tm C-Q- l CAJt . Y' kBOOE EIeVATlaA3"-' . 9 ,/00,0 /YC' u1 ynrrr V y U ~4.; /gig 1`r t h cJ ~~7 / ~S'/YL ~d 3 '77 5 . 297 6tia~ 471392 CERTIFIED SURVEY MAP LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION 27, T30N, R18W, TOWN OF RICHMOND, ST. CROIX CO., WI. N 1/4 CORNER SEC. 27. SOUTH LINE OF THE E.30 RODS OF THE I COUNTY MONUMENT FOUND). N 92 RODS OF THE E 112 OF THE SW 1/4. N p, O U NPLATTED LANDS M M OWNED BY: v10 GERRIT AND JAN VAN DYK N89° 42'18"E 370. 00 ' 1004 130 TH. AVE. _NEW RICHMOND, WI 54017 I ~ I • I BUILDING SETBACK 1 LINES ~ I N NOTE: BEARINGS ARE REFERENCED 1 TO THE SOUTH LINE OF THE SWI/4, I I (ASSUME.DL ( BARN ( M 10 r•• F I in W I { !~4//1 I W 1 SHED I ^ S I I ° cn • S I _L 0 I o Go Z• ~o I 5.937 ACRES Z' 1 2 58, 634 SO.FT. ) N Z' Q' t0 I 5.862 AC. EXC. ROAD R.O.W. Q• ~e t _J. I 1235, 334 Sp. FT.) 10' J• ~ SHED m JUL 11 r,!1NNE L M e „r Of D88dS 0 W; 0 1 - -I 0. 00 J ►W- 13' Red; 3 , -•1 O 0 S89°36 25 W: W• Z► St.CP01k0o.,W1 GJ.• ,'o j ..I ' oo ~ a' 2• -10, o V n. I O o: AR A 1 PAR :.cL REC. iN a ,lUL 1 1 1991 I ° W 3 ,o VOL, 720 ST. CROIX COUNTY I COMPREHIROVE PARKS PLANNING I I AND ZONING COMMITTFE M • , o Z, I0 I N EXISTINd' I" LP, FOUND NO.46'32" DRIVEWAY 1. 07' FROM TRUE CORNER r C I :C SOUTH LINE OF THE SW 1/4 p M 2285.41: IO .00' S89.36'25"W 270.0011'"""-- M 1307H. AVE. S89° 6251,y.. . . . ` M SW CORNER SEC. 27. ro I COUNTY MONUMENT FOUND). ! S 1/4 CORNER SEC. 27. U•NPLATTEt? • ANDS I IRON ROD FOUND). 03 SET I"X 24 IRON PIPE WEIGHING 1.13 ~(JAM'S ~ ~~"vaS~ow LBS. PER LINEAR FOOT. a 'v ss 9-- 1"IRON PIPE FOUND. A ~ M. WEBER 'a S- 1804 S C 4 L E 11 5 0' s NG VALLEY J WIS. 0 75 150 •r~ ~ % 300' SHEET I OF 2 sir°ee' S; kq& 91-68 THIS INSTRUMENT DRAFTED BY J u ~•+t 1 ARV . V . \1.S►~ ti `rte FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~.J/%,,R,dl q+t TOWNSHIP h, SECTION_,2_7 T_2,,p_N-R-LF_W ADDRESS h rry r ST. CROIX COUNTY, WISCONSIN 1 t ~'Jtz-lz u~. c y a 7 SUBDIVISION A/ A LOTLOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM } UJ i o --INDICATE NORTH ARROW r f; BENCHMARK: Elevati n and description: FL Ev . Ioo,o Q m :L rr -t P Alternate benchmark SEPTIC TANK: Manufacturer: Liquid cap. Rings used:-Y-LManhole cover elev: D',2BFinal grade elev:1&"6 Tank inlet elev.: ~fla S (A Tank outlet elev.: 106 3' A--Ft. No. of feet from nearest road:Front Side Rear From nearest prop. line:Front , Side ~ Rear Ft. 3 S 7 No. of feet from: Well J 3 ~ , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank`) SEE REVERSE SIDE i 1 PUMP CHAFER Manufacturer: j'~ Liquid Capacity: Pump Model:_Pump/Siphon Manufact.: Pump Size Elevation of inlet: `Bottom of tank elevation O`Pump on elev.: Pump off elev.: Gallons/cycle: /4zP Alarm: Man.: b L 1~ Switch Type:: Location Distance from nearest prop. line: Front, Side Rear_Ft.~Z. Distance from: Well ;;z Yd Building ~-r- SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. P'oposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , 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' DATE : PLUMBER ON JOB: , n rt/~' LICENSE NUMBER: 6/90:cj /4 C? I Wiscgnsin 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 SE, SW, Sec. 27,T30-R18, 130th 149118 Permit Holder's Name: ❑ City ❑ village t] Town of: State Plan ID No.: Brian Keller Richmond S91-01288 CST BM yE`l~ev. Insp. BM Elev.: r BM D/~escription: Parcel Tax No.: TANK INFORMATION ELEVATION DATA - TYPE MANUFACTURER CAPACITY STATION '444.10 BS HI 'FS ELEV. Septic 41 ' Benchmark ~Z6 /lam, 0o~ Dosing), i6v. Aeration Bldg. Sewer q ~o Holding St/ Ht Inlet k ~ a. ;-,6 TANK SETBACK INFORMATION St/ Ht Outlet 166,31 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet 98 97. ` C_ Air Intake Septic NA Dt Bottom / i- 1 Dosing 5a ~Yb 6S ' y~~ ' NA /Man. 14 -Z az Qr Aeration NA Dist. Pipe' ' /Pi1 rQ / Holding Bot. System PUMP/ SHMON INFORMATION Final Grade Manufacturer Demand GPM Model Number 97 OACI TDH Lift Friction System TDH Ft Forcemain Length r Dia. ' Dist.ToWell >I/o, SOIL ABSORPTION SYSTEM BED / Width a Length / No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J DIMENSIONS LEACHING Manu acturer: SYSTEM TO P/L BLDG WELL LAKE/STREAM SETBACK INFORMATION Type O ~,~+J r r CHAMBER Mode Number: System: (I/(G yd (y~, `210 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) 4 x Hole Size x Hole Spacing Vent To Air Intake r C' Length Dia. ' Length Z;?/ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over , a xx Depth Of r ; xx Seeded / Sodeled xx Mulched Bed /Trench Center it Bed /Trench Edges Topsoil' ❑ Nos E] No 1. IL COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. , SBD-6710 (R 05/91) Date rr~ Inspector's Signatuu (f: Cert. No. SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNT STATE SANITARY PE~ IT -Attach complete plans (to the county copy only) for the system, on paper not less than 8/z x 11 inches in size. ❑ Yeqkf to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ~g PROPERTY O ER < PROPERTY LOCATION F` jF Y4 S (0 Y4, S T-3 N, R E (or PROPERTY OWNER'S ILI A RESS LOT # BLOCK # Cr Wq IF TATE/ tI~.9 ODE . PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5 Q 13- II. TYPE OF BUILD7%or Check one CITY NEAREST ROAD ❑ State Owned LAGE fC c.~W ❑ Public 2 Fam. Dwelling-# of bedrooms _ PAR Ax N BE ) Ill. BUILDING USE: (If building type is public, check all that apply) jq l9)g - le o,2 ~p - to ZP _Sn 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 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE O PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 0 2. 0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System 1 System Tank Only Existing System Existing System Permit was issued. Permit B) El A Sanitary previously # Date Issued - V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressuriz d 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 so 7 /0/, SO Feet U Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank OOP 'off Lift Pump Tank/Si hon Chamber QG~ C ' 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) MP/MPRSW No.: Business Phone Number: x f ~Gl~o `4R L~ t 3.2 5,3 (7/5 ? Plumber's Address treat, City, State, Zip Co e): ?e- 7 IX. C LINTY/DEPA TMENT USE ONLY ❑ Disapproved S itary Permit Fee (includes Groundwater Date Issued ssuing ent Signa re (Poo m Approved ❑ Owner Given Initial L rcharge Fee) A vers Determination ~ 13 ~~,1~ 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 • APPLICATION FOR BANITART PTRMIT • 9TC-100 This application form Is to be complntod In full and slgntd by the ovnst(s) of the ptoperty being developed. Any lnadoquacles will only result In Ways of Lila pit a+lt lesuance. -Should this development be. Intended tot ttsale by owner/contractot,(apac hauaa)e thou a second torn should be tatalned and completed vhan Lice property Is sold and submitted to this attics vlth the appropriate decd rtcord)nq. .-------------------w---- --w------w--------w--------------- Omar of property _ 4 6jj Location of property -SE 114 S 1/Ia Bectlon 7`, jA--x-it Township _ C-~f N yr'\p_j Kalllnq address K~11 oo~ L Y;hAp, a)r~Vs~ orj -7 Address at ■lte lubdtvlslon newt • Lot number Previous owner of property T Total size of parcel _ e190 Acres Date parcel was created Are all cotnsts and lot lnss ldentltlable? =Yia ,._xo In this pro patty being developed tog resale (spec house)? an Yolvnw end Page Humber _ a■ tacctded with the Ae91stet of Deads. ----------------------------------w-------w------------------------------------ 1"CLUD9 VIT11 711I8 APPLICATIO11 71111 POLLOVINCI A VAAt1ANTr DVID which Includes a DOCUHINT HUMIR, VOLVIIR AND PAOt RLTHa[R, and the AtKL OT Tilt ABOIDTHR OF DHEDD. In addition, a certified survey, It available, would be helptul so as to avoid delays of the tevleving process. it the deed deaeclptlon taterencas to a cettltled lutvay Hap# the Cattltled tutvty Hap shall also be required. PROPERTY OVIIER CBRTIFICATIOH live) eott(ty that all statements on this torm are true to the best of my (out) anovledgel that t (we) am (are) the owner(s) of the property desctlbtd In this Intotmatlon form, by virtue oL a werranty dead teeo dad In the ottles of the County Reglatet of Deeds as Document No. a n d t h a t t (VI) pceaently own the proposed alto for tha newage disposal systcn (at 1 (vet have obt■Intd an easement, to run with tite above daactlbed property, tot 1.he constcuctlon of ■sld nyatetn, and the same has been duly tecordtd In the Ottlce of he-N~Covnt Aeglat t L'Deadsl as Document No. 1lgnatvte of nec signature aL Co-owner -(IL jkP cable Drte.pl s g,natute Data of Signature Ii DOCUMENT NO. ij THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-198211 471651 VOL 9f09 IPAGE 391 REGISTER'S OF. FICE ST CROIX CO. WI Jan Van Dyk and Rom Van Dyk.,_ husband a_nd wife ..an... - - i- - - _ RAc"~I for Record II an undivide__d on. I half interest as on.t,tenants at L: P.M apid and- - Gerrit-Van Dy k _ .and--Patricia Van.. Dyk a' 81991 l~ wife an co ey5ban taarrta tns` t.g-.B----- JV1I{e.llare.ancllf interest'; Debbie . .M. . _Keller.....husp husband and d__.wife .as ...D....... Register of Deeds survivorship__mari.tal. pey...._... . RETURN TO . j the following described real estate in St....Cro.ix County, State of Wisconsin: Q4 D Tax Parcel No: ~I i ,I li i I I Part of the Southeast Quarter of Southwest Quarter of ~i Section 27-30-18 described as follows: Lot 1 of Certified I Survey Map filed July 11, 1991 in Volume "8", page 2377. ! ~I I~ ~I I it ANSFEb Lie A In I, i i I This s---not......... homestead property. (is) (is not) Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. I Dated this -----18th----------- day of . --.--July._.._._....._..._.. 19.9.1 (SEAL) (SEAL) . I~ J_an Van Dyk Gerrit Van Dyk _ - n W--~'s"~-.!...................(SEAL) t-i oc-s./... (SEAL) I) v i; Rom Van Dyk Patricia Van Dyk . I j AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. ST. CROIX County. l authenticated this ........day of 19...... Personally came before me this ._1ath---- day of Jul-'..................... 19- 91.. the above named Jan. Van..Dvk..and- Rom Van. Dyk, husband k and - - - - - and wife and Gerrit Van Dy TITLE: MEMBER STATE BAR OF WISCONSIN Patricia Van Dyk,_... usband and wife ! f~l (If not- authorized by § 706.06, Wis. Stats.) to a know to be the person .__.__5---- who executed the f regoing i trument nd acknowle a the s THIS INSTRUMENT WAS DRAFTED BY REMINGTON LAW OFFICES ~iic7i£Ti emirig on - *-::..Jo n.ne---M.....W-agner- . N Cbi-- R].S',hum.nd.j---SqI.......... 0Notary ublic CrOlX County, Wis. (Signatures may be authenticated or acknowledged. Both _ My Commission is permanent. (If not, state expiration are not necessary.) date: 0.9/13 199.2....) II l - - - ~j 'Names of persons signing in any capacity should be typed or printed below their Signatures. SEPTIC TANK MAINTENANCE AGREEHENT a~ ' Sr. Croix County p V- OtdNER/BUYER"}'~`~ 0 0 ROUTE/BOX NUMBER ' ' r~ty~Fire number _ d ZIP 5~~ l 7 p 11 fj CITY/STATE R C_V, r-1 ~ k, Section a T =O N, R $ W PROPERTY LOCATION:-.Ig Town of IC` o j St. Croix County, Subdivision 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 licen*s'ed* 's'ebt'ic tank pun Ter. What you put into the system can aYFect t e' .unct on o, t e•aeptic 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, wh'ic 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 's sY terns 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), ,-he 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. ~j 0 INE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- Y meat of Natural Resources. Certification form must be completed •v and returned to the St. Croix County Zoning Office within 30 days of the three year expiration.date. SIGNED DATE ___7 --r St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. low L,~ JY. Q/ 5E~ rVdT>E' LAf=EtY 6 DEPARTMENT OF AEPORT ON SOIL BORINGS AND 111LDINGS INDUSTRY, r TESTS (115) DIVISION LABOR AND PERCOLATION P.O. BOX 7969 HUMAN RELATIONS 5 tiAAbISON, WI 53707 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: 10 • TrO~WNSHIP/~: T NO.:LK. NO.: SUBDIVISION NAME: J1 ~/45W 1/ Z~ A?6 N/R (9 L (or) W ►Ci'C Vim O 1 p C iM (DC ~Jp/~J,(t!'•- r:OUNTY: MAILING ADDRESS: 57--c of X ~Ri N (~'>r IIER.. ► (I oA 1e 'R i DGE' IA. lu.ew USE ZYC - 722 / DATES OBSERVATIONS MADE Sy0INO. OR : COMMERCIAL DESCRIPTION: Wesidence 1,3 IONew ❑Replace V VAJF20 -tt~ l` ~It L' ~ T"UAJ1 k 24 5 ~ S ~f4 sus •4S 'i31'~ st r ~ c R y _ ~ RATING: S- Site suitable for system U- Site unsuitable for system . C OM W 6 STEM CONVENT©~ : M®~: ou IN-GROUNDORE: SYD S loU L IHOLD ~ SING TANK: RECOMMENDED SYSTEM:(optiohat) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ~i under s. ILHR 53.09(5)(b), indicate: GLr4-S S Floodplain, indicate Floodplain elevation: rte, PROFILE DESCRIPTIONS f BORING TOTAL DEPTH T ROUNDWATER-INCHES CHARACTEA OF SOIL WITH THICKNESS, COLOR, TEXTURE. AND DEPTH { NUMBER DEPTH IN, ELEVATION OBSERVED EST H T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) O-9" 16YR 3/3 S,/,„ s6A mvI A j (0YR S I,. R B- j C`o0 9~ ~Z y Z ~,V 4 3o' /o Y4 3,4/ '30"> Y/Z C, f 5 Of 9 F_ n«1Z w i t- _ +f-F PA of-S B- B- B- I B- B- PERCOLATION TESTS j,r. /S sew/s TEST DEPTH E WATER IN HOLE TEST TIME DROP IN WATER V H S RAT MINUTES NUMBER INCHES' AFTERSWELUNG INTERVAL-MIN. PERIOD t P RI PER INCH P_ L y1o /d / y; t, 13 ; / z 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 hnri• zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings ahd ! R 040m, and percent of land slope. SYSTEM ELEVATION. S-0'` I ( . A r ~ T C S - S ,~,ivdv c-D Tv 2,15 /Fly . ! e 1h Ll G,' I LA 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methel 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, t NAME print : NO MSrrE 1 TIC TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 Ro9EB?~l18EISatff_._ ADDRESS: VS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. CERTIFICATION NUMBER: PHON NUMBER (optional): aIINN, INSTALLER 8 DESIGNER LIC. N0.00663 1 y ?2 - CST SIGNATURE- ~j~~ r PLOT hLAAJ c v~~tk - Z&... of j o ~S j, ~ ! !u Sz x \ti `o ~j 9o ~ I i i 70 • P R V 33 II 35 k { SCALE; / =30 70 (3 M I m Top OF . I 8o s~ PV(- p; p s 06, 0 a_ . = i3~gckffoE 2 X *p Pars _ _ _ " 32 x = Pic . ~ ~ /OCR riovs k EXiST/~) 6-- 0 Ho a w Y `tip HOMESITE SEPTIC PLUMBING CO. 665 O'NEIL RD., HUL.ON, WIS. 54016 2-'1,P2- 41S. ROBERT ULBRIGHT Cs r -11MASTER PLUMBER LIC. NO. ?307 M.P.H.S. Cam' Q 0 ~E 3TALLER & DESIGNER Lit;. "1O.0C1ii63 '41r+N Itd3 Sir, ~ MQ T3:M . 1" 5f L Counui7-/0 F/I' v,4 716.0 r I.L.H.R. 83.08(2) PROJECT INDEX SHEET = Owner: ~FZ. 13Riq~ Ktf(C~ i-~lS-1~(Q 722- Address: D c 41/9. 55017 K D(rE `~f~ . ~ HMO D Site Location: JE-, Sco c S,-ec, 2 ~ T30 Rig TOwA-) OF RI'Ckm0-QD - 5T7 cf o0 K C'ooA-~ry Project Description: K)ELF 3 3LE aRm . HOHE'. AveRA-6' E- 4-14iLy W,4rTE-1,o co - ~54 ~j.4/S 50i/ PL-)e i',t Q1-,F- Sul $&riSDvl L e-y 2-E „ ~OV,OD S~ S7-,6,4y /S PI~OPOscL7 Page 1. PLOT PLAN VIEWS Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAYOU-I Page 4. DOSING CHAMBER CROSS SECTION j Page 5. PUMP PERFROMANCE SPECS PLUMBER: I` F to icy N EC-G Lm i ff' DATE: SITE EVALUAZ t " r SIGNATURE HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULSRIGHT NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. P S • 3 S -E "^~11. INSTALLER & DESIGNER LIC. NO. 00663 r, PL07 PL-AkJ o s f PRIVATE SEWAGE SYS f tM Conglitionalitt A malllp ROVED P 1 5 DEPARTMENT OF INDUSTRY. LABOR AND HUMAN RELA CIU~~S DIVISION OF SAFETY AND BUI~LINu5 ~ I, J SL.f_ Lvt11"tElL. :i ` I i ~ ~ n ~ 3 t3Ea~ 16 Ho~•~E i ' 90 1 I ~ G1~~ru ~i"u~ - SEPTIC- Tgak ! \ y C3 C I''IAuU fACTO PeR % t 2p W6L 'f"54.90 PUL O ~INSVLhT~D~L{IJDCR 'Y 3 p3 PUMP gPnuti- DRIUE -fo-f4l Of 36 1uP L_ U c fv,ece hAiN ; SC At,E % 30 t s - j`, ~ ` B.?1. 1 - Top o f If i 1, ~p PvC PIPE /0010 x J q R/ 775 _ 0 32 x = Pic fi4 T/o,.~ Lij V eau ! ~ I o \ a`,~p~ L~ = EXiST/-) G- Ar, V4 ~W 190 ? q HPPRok -600 ro C v&e \ 8 11 0 X HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT Cr r # -Z y,P2 ✓ ~OW t~ 41S. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. G ~.4iRUv. IRJSTALLER 8 DESIGNER LiC. N0.00583 GET 2,wk T3.N1. 10'j.),6- 130f6 ST, /~U~47'/4.v = /O!) MM kl 0 wig Gg~i~ PRIVATE SEWAGE SYS rtM Condldionafff~ A P P11' 1`0 DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY AND BUILDINGS Page Z' Of S EE ~0~i~ESPC E;ti'CE ~(cuhT~oa of Uri FoizM T•oC L~'Nt Synthetic Covering 7-op aF I , 19.0 Distribution Pipe Medium Sand { y s y SrEH G Topsoil = Er~vS-0 3 7 % Slope Bed Of i~ Force Main Plowed Aggregate Layer o Ft. E/3 Ft. Cross Section Of A Mound System Using .75 IVIA Bed For The Absorption Area F Ft. ( G 1, b Ft. A g Ft. H S Ft. B y% Ft. I K /O<<'SFt. L (0 Ft. j b' Ft. /2- Ft. Force Main W Z9 Ft. Observation Pip l J, g 7K Distribution Bed 0' z Pipe Aggregate I Observation Pipe Permanent Markers ~ \ L/ ~ ~[~G G/~~PEfl 5{ESL .~DnS j tj•~S / i Plan View Of Mound Using A Bed For The Absorption Area 1 i ~ Page 3 Of 5 V010 1101vmE Fo~E' SO FT pF 2 Luc FoRc~ /A ST 49 le- Perforated Pipe Detail u~ Ri'bti T f UPI GvHE End View )Perforated End Cap \e,y~• PVC Pipe Holes Located On Bottom, Are Equally Spaced R Q r P PVC Manifold Pipe Position Of Distribution Force Main Pipe P Last Hole Should Be Next To End Cop 1 End Cap J Distribution Pipe Layout P 2-2• Ft. X q? Inches Y y Inches Signed: Hole Diameter Inch Lateral Inch(es) License Number: Manifold Inches Date: Force Main " -2 Inches # of*:holes/pipe CO Invert Elevation of Laterals ft. DI S T/Z ~ v7'/0A l 1isel4je~ e -0,1 T~6- ~d,2 Eg c ~f} Ts'/? 9 / 7. 0 2 541A% ?kL. DTI5 y7 • ?07'x/ ~isTRi/~uTio,~ [~~'Sck A,~GE ~qr~' .FoR ~•C~~vo,Pr~ 2 ~ d-"` -~"K~„~ PRIVATE SEWAGE SYSitM G~i/~dQ oft BUD WMD C.,ondc'fionall S 012 8 8 APrn DEPARTMENT Or INDUS'' FY . LABOR +1~1; HUMAN Dib'IS101U Or SAFETY ANG UILDINRELATI;rdS tca VV~IrSIr~JiJV1~iL . . I I , of 5 p~` i PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER -1 1 25' FROM DOOR, 12"MIU. Aa/ f=$H I WINDOW OR FR AIR INTAKE I GRADE I I `I" MIIJ. Its l~ ~ ~ 19°MIN. /0% SD coIJDUIT /0 PROVIDE I INLET AIRTIGHT SEAL I (i I nn` I I APPROVED JOIN" A 5 vG I III APPROVED JOINTS IN ~(aN I III 1J/C.T. PIPE ,r(D1A W/C.I. PIPE i I I ALARM EXTENDING 3' CXTENDING 3' to ONTO SOLID SOIL B i i ( ONTO SOLID SOIL (3'G) I I oN ELEV. FY. ~ItV PUMP-~ OFF ,J ~ D I~ /AIJ7O q3,` 0 BLOCK 4ANk o 130 RISER EXIT PERMITTED OQLy IF TANK MANUFACTURER HAS SUCH APPROVAL j sEPrlc E SPEC.IFICATIC)US DOSE IL) ('ONC !°ET~' TANKS MANUFACTURER: OD40 C7-5 IJUMBER OF DOSES: PER DAy TANK SIZE : GALLONS DOSE VOLUME 150 Q-2 ALARM MAIJUFACTUKER: LEUEL A t'.ghM Ca- INCLUDUJG BACKFLOW: GALLONS MODEL NUMBER: U, CAPACITIES: A= IC0'~ INCHES OR ,300 GALLONS 5WITCH TYPE: Ma 2CyR y FI'y^T- B= Z INCHES OR 3C GALLONS PUMP MAAIUFACTURER: zoo I) e 2 C='INCHES OR 160 GALLONS P MOREL NUMBER: 91 V2- NP 115 V- D=I(p' 7 INCHES OR 30~ GALLONS SWITCH TYPE: pIGGy(3A~K KER(vFZy f)UhT"$ NOTE: PUMP AND ALARM ARE TO BE I, pp MILIIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET -"Aok 9 PlEGS + MIIJiMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EAG(-, Of' -,D{ P th C FEET OF FORCE MAIN X I'5 FYoFT.FKICTION FACTOR.. FEET 4Ur~S 2- 1 C tD- OS 1r?~~ - TOTAL 013MAMIL HEAD = FEET 12ou,~D a INTERNAL DIMENSIOWS OF TA►JK: LEKIGT ;WIDTH iLIQUID DEPTH 77 A SIGNED: LICENSE HUMBER: DATE: PRIVATE SEWAGE SYS f LM j' l.rondt'fiona APP DEPARTMENT OF INDUSTRY. DIVISION OF SAFE!')" SfE I N F 9C LU ~ LL HEAD/ 1 115 - - 34 110 I- 32 105 - - " - 30 100 - 95 - CUR VWME" 28 - 90 26 85 - I I EFFLUENT 24 90 - - MODEL anrJ G 75 MODEL 189 DEWATEYYRI NG z 22 77 165 - V 2° 65- z 18 - 60 - - Q 55 _ 76 MODEL 50 0 163 MODEL 14 45 188 12 -40_ 35 - - - 1° MODEL MODEL 137,139' 185 SEWAGE and 6 25 - DEWATERING 6 20 MODEL 15 MODEL 161 4 r 97 114 10 W 2 MODEL W W 5 MODEL 53,55, - W LL 57,59 P 0 i GALLONS 10 20 30 40 50 60I 70 BO 90 100 110 24 - -T~-T LITERS 0 80 160 240 320 400 75 22 FLOW PER MINUTE 70 20 60- - - MODEL - - 1 --i- - - 18 Q 295 W 55 - - 16 V 50 - I - - 2 14 45 MODEL Q - - Z 294 12 MODEL - 7... - --r- - Q 35 10 293 - T i - O MODEL F- 30 - 284 - - ' 6 25 11111111 -41 MODEL l I 6 20-- - 282 - - - - - 15 4 10 MODEL - - - "Aw 2 - 267, 268 0 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 X130 140 150 160 170 180 180 P.O. BOX 16347 Louisville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 (502) 778-2731 FLOW PER MINUTE 6977 ~s{ Iron Series HEAD CAPACITY UN17S/MIN Feet Meters Gal. Lim. i( • Automatic or Non-Automatic. 5 1.52 57 :1~ + H.P.. 1 Ph., 115V or 230V. 10 3.05 51 193 15 4.57 43 163 I Non-clogging vortex impeller design. 20 6.10 27 104 • Passes 'i"s Sphere,). Lock Valve: 24.5' • t'/:" NPT discharge., e Float operated submersible (Nema 6) mech- anical switch. 97 seder listed (emfu~7f sc-2225 + Automatic reset thermal overload protection. + Stainless steel screws, guard, handle and arm and seal assembly. + Watertight neoprene 11" ring between rnotor and Canadian Standards Approval pump housing. nss tSP ,ore - j Cyr N97, non-automatic, available packaged with a piggyback mercury float switch- arrrrtr~. CERTIFIED SURVEY MAP OCATEO IN THE SE 1/4 OFTHE SW 1/4 OF SECTION 27, T30N, R18W, TOWN OF RICHMOND, T. CROIX CO., WI. NI/4 CORNER SEC-27. ,W ( COUNTY MONUMENT FOUND). SOUTH LINE OF THE E. 30 RODS OF THE a N 92 RODS OF THE E 1/2 OF THE SW 1/4. p, O U,NPLATTED LANDS. M OWNED BY ' Vi0 GERRIT AND JAN VAN DYK N8904218"E 370.00' ~y 1004 130 TH. AVE. NEW RICHM•OND,WI 54017 •I ~ 1 BUILDING SETBACK LINES I I I' I NOTE: BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SWI/4. I I O (ASSUMSDI, I BARN I M I 1 to I0 r i W W I SHED I n $ I I O mI LO 5.937 ACRES Z. ( 2'38, 634 SO.FT. 1 I N Z` Q• t0 I S.862 AC. EXC. ROAD R.O.W. Q• O (255,334 SO.FT.) 10' J, J• I a SHED IWi 2 W p c nn it ~I S89°36 25 W w; n --120.0 0 8903625 W H Q: J W ' J' _ z J • . -10, /WAEI) ' 0 0: t I ~ e' 60A! I A Z ca I t0 t.,• I 1 PARCEL SEC. j N RoIx COUNTY, lt. °0 3 11i~~°n/( PARKS I W VOL; 72PG. 618 I o z • . 4t 1 • I ( ~g1991 I +I N EXI STI N 1" 1. P. FOUND NO046'32° 1 DRIVEWAY y R ' _ I l: ,e ~fyl t`tL1h~;pSt~yr'ACOUNTY 1.07• FROM TRUE CORNE (','-,I-KSpLA O r .•nr. % `r. hp. TLc 0 O SOUTH LINE OF THE SW 114 in lM M -M rt~ ' M .TH. AVE. N89.36'2?'F,~,2285.41 100.00' S89•38 2b"W 270.00, 130 - - CORNER SEC. 27. S 1/4 CORNER SEC. 27. I COUNTY MONUMENT FOUND). UN-PLATTED LANDS ( IRON ROD FOUND). 0 Os SET 1P"% 44 IRON PIPE WEIGHING 1.13 Z mr,~~ i LOS. ER 'LINEAR FOOT. I s 1"IRON PIPE FOUND. a,' 1 JAME'SM.~• WEBER S-1804 SPRING VALLEY 1 SCALE 1 150' s WIS. rim o 0 75 150' 300' SHEET I OF 2 _ U•'ti'~a 91-68 THIS INSTRUMENT DRAFTED BY F ~o 16.4 /r • SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 HOMESITE SEPTIC & PLUMBING Owner: DR. BRIAN KELLER 655 O'NEIL ROAD 1811 OAK DRIVE HUDSON WI 54016 NEW RICHMOND WI 54017 RE: Plan Number: S91-01288 Date Approved: June 26, 1991 Gallons Per Day: 450 Date Received: June 25, 1991 Project Name: KELLER, DR., BRIAN Location: SE,SW,27,30,18W Town of RICHMOND County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected.` All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 267-4434. S11D 6423 (R. 0"1) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations HOMESITE SEPTIC & PLUMBING Page 2 Sincerely, C)II ~ko MARY A/ KLUZ Section of Private Sewage Division of Safety and Buildings PPP061/0009n/11 cc: DR. BRIAN KELLER -Private Sewage Consultant County UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health I I SBD 9423 i8. 01/911 ST. CROIX COUNTY WISCONSIN x, ' ZONING OFFICE a ' ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 24, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Brian Keller property, located in the SE 1/4 of the SW 1/4 of Section 27, T30N-R18W, Town Richmond, St. Croix County, revealed 25" of suitable soil for onsite sewage disposal making this site suitable for a mound septic system. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj I; }ppE.vvy ?clTVo:.•4i~!Y L`1.4._1. se N>~Q DEPARTMENT OF REPORT QN' SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 p5.- 2,,f z P.O. BOX 7969 HUMAN RELATIONS \ 5 MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) PVLOCATION: SECTION: TOWNSHIP/Mtn"CTPALTT9: OT NO.:BLK. NO.: SUBDIVISION NAME: 1/4 561 1/4 z,7 A?o N/R19Elor►W 21'C_Vim 0aD cs,~ ap~~~-- COUNTY: MAILING ADDRESS: 57-.cebI 1C BRi Pf/J ll~~ )PH 0r1-fK 'R iDG-E- 1A. N-ew R (C,4 AteaD ~l . USE 2-z16 - 22 / DATES OBSERVATIONS MADE S4/o/ NO. B : COMMERCIAL DES R TION: C _ New ❑Replace PROFILE DESCRIPTION9.1POTCOTXTION TESTS: &esidence 3 TU,VE- 2 O - C( ~ C S ~4 Sfibws ,qs BPOI 5d A"6A RATING: S= Site suitable for system U= Site unsuitable for system r C/2 OM W ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEMr(optional) ❑S ©U ®S LU OS MU ❑S RU DS ~U Mouty 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: GLs~-SS ~ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HHIGP_EST_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) n 9 r 0_9. 16YR 313 S,/.,„s6,- .V1 R; fLP`/0YR St 111,jle~ B- J!` 0 l 7 Z L Z /h, v ~R 4 30' !D y4 3/y f 4-g /e ,n» v'F R) 3 4 G p Y/R'/Gf5 VT5R1o.,9-,wi't'_ff+Kofs B- B- B- B- B- PERCOLATION TESTS l5 Soi~f TEST DEPTH WATER IN HOLE TEST TIME DR I WATER L V -N H S RATIES NUMBER INCHES' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD TER NCH p_ ~3/ ~z Co 62.00 P_ P- P- P P--1 1 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 W d`ff1 `direction and percent of land slope. SYSTEM ELEVATION. F. -1 n r : t) 0.7'E7 Y-5i - `~2u r{ . 0 A, oe~ I, l S T' ti?c , r4 ~v.Gcv T of L /3 0A#/A) 6. ~'p ,DEG i 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 : TESTS WERE COMPLETED ON: ' 665 O'NEIL RD., HUDSON, WIS. 54016 Z U/~ E Z O I 4? f RORE8T111. B1Sd111_ _ ADDRESS: .AS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. CERTIFICATION NUMBER: PHON NUMBER (optional): 'I. INSTALLER 8 DESIGNER LIC. NO. OD663 7 6 3 6 S CST SIiN&T l DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. L nu uo can ruan to tntogi ost" PL07 PI.-At fu ~y Jp old wt I/ 0 ~'v SZ lJ i r r I I I 9a i 134 70 R P. ZO 33 • ~P 35 36 . r.Qy ti I 30 x P . = f3~ck~fo~ x J \ ~/5 U,g 190, III x HOMESITE SEPTIC PLUMBING CO. \ 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT Cs r 4- 2 V 2- iM. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. O o Ic 1AINK INSTALLER 8 DESIGNER LIC. NO. 0068;3 SET 1" 57`E.-L Co unuiT /0 ;0,-- DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) Pi • t of z P.O. BOX 7969 HUMAN RELATIONS' (I LHR 83.09(1) & Chapter 145) p~G-.~S MADISON, WI 53707 _ LOCAT SECTION: TOWNSHIP/ OT NO.•BLK.NO.: SUBDIVISION NAM : 1/540 1/ -7 /T30N/RIB E (or) W 121.0141+-ro.ID CSI l P S- o1"AJC __U_ J COUNTY: MAILIN ADDRESS: Cip0 IC Q(,(/4N c'llt R (~`'y><R~ 1~l/ ,~/DGE ~2 ,UEw ~ictiyo u~ Dui sy~~~ USE Z ~P - 722/ DATES OBSERVATIONS MADE B DR : COMMERCIAL DESCRIVT_1_0_N_T___ ROFILE DESCRIPTIONS: PERCOLATION : C TESTS: I Residence 3 CR 4- WNew ❑Replace 1-• 1~( t ~ Mow 3-155/ ~MER y- C~a~+w X11 ~ Rr/l Srl . RATIFIG: S- Site suitable for system U- Site unsuitable for system s ~ • ROUND-PRESSUR -F I LLrOLDI JSTI©U• IMEsOUND:ou ING0S Qu E:S S~TEM'IN❑A ❑SGQU.RE~OU~D~EDSO~L~tiohal) ❑ If Percolation Tests are NOT required DESIGN RATE:~r I if any portion of the tested area is in the Ito- under s. ILHR 83.09(5)(b), indicate: Gt /A- S .S l Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) ~0 l0 NODIZZO n'9,./DyR a0s S,-/ I,„1S,tik k*fl^ • -fie "/o ye 3/y J'% L A"5bA- nw. B. 9,7Q !G"-21/ /o YA 4/G fi/ 2nr; abK~'e:,f,' 2y. 30 /o YA S%G P~ griwti,y' B yd *fNo 3D-60" /o ~ S Ts A , *-.c rf qw A0 f . r PLWO/Eo AT- O-/L" "0 f4 '/Z 5;/, 5hk ti. -F r ~ /z /G "/oYA 'Sly 5W zAw S6A- n:. f,' G'3G` Al yRy/& s/ Inn 5h4- f ti..v,' 3G'-Gp" B- Z- (420 ~~d z5 Z S f c w w r f t, 1'- Z At A4 o' Ar " Gp r 0-2.2" /O yjZ 2/1 $ , SbK, nnvf r; 2Z" 3 " /o VA z/1 5,/, B. 3 &o l '7 2.. 6 bk, ~SL y/-~ .51/, 3C S6,K rM~I;I y~/-~a 73 ' b-/'y /a yR 3/7 S,' /,.H56/~ , AK vfr. Ise-lo" 7 S Y/P -3/Z B- 65' l0l• yoL10 `f O S I I,„,s b f r • 2C, - G Y s/ , 2„SbkiV:f r . B- B- PERCOLATION TESTS ES TEST DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t ---PLR I P. 1 2r 36 t3j 1 y/ t Zy p- 2 z IV- 30 I z/ l Z P_ Z O ll 11 It O P_ P_ 1P_ PLOPLAN: 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. Shoyw~ the surface elevation at all borings and the direction and percent of land slope. sf}tlQ ,ep C/~ /NT~ fib c.2 W ~ .'Z-t\ ,Srq ,~D = ~Q ~ so i SYSTEM ELEVATION. f? L-A t'i E! au 0/) A4 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 /,dministrative 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 OQN: HOMESITE SEPTIC PLUMBING CO. ADDRESS: NfiLRb.,klUl~l~.Y~lb, 1 AOBERTULBRIGHT CERTIFICAT N NUMBER: PHONE NUMBER (optional): MBER LIC. NO. 3307 M.P.R.S. 2 e14?2- 3 ~6 00/S' S NN. INSTALLER & DESIGNER LIC. NU. OOM CST SIGNATUR MI 021 . Gc. / DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. °s r (~U fu u--)D old we I/ 0 15 I ~ SZ I i i \V \C~ Lo A17 9a 1 J3 y /0 RP ZO V ~3 ~r • P3 yi0 I i i i i SID I XI2 75 • 13, x / 30 ~ ,8~4c~1f/oE x,•7--5 X HOMESITE SEPTIC PLUMBING CO. 'e P~Pc /GIC•t T!©,~; 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT Cf r # L ;ills. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. n IAI"M. INSTALLER & DESIGNER LIC. NO.00683 (y ~ U L ~ I r ~ M as 6- I I N • .p' ,4 QoU E E- G IeUAT1oa ° /one o