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HomeMy WebLinkAbout040-1178-80-000 o ° M c 0. O I a C h 1 O C, ~ O d U Z ~ U N h ~ I aNi cn I a~ C z t !L C O N y Q U I 3 " II ~ a~ Z y z °o v €m N F- fn ~ I 0 O Z C 3 r p .U. 0 Z ~ 2 Z fA H r ~ N C E O N M N 0 U C O O N ~ a ni 4) y • a U 00 O N Q O 4? O Z m Z C N Z' d 4 > E C N ~1 O ` > ~i x O s y U O y d 01 ~i 0 U ooIL ~w ~ ~~~ti as w z •►v aaa a g 0 C N i fn J V yo rn rn Z ~~l 2 N N 'O 0 N _ Q ~ I cca00 v ~ m~,c a I',U d d Q}<A o I 2 34 O O ctn y C y 00 N ? cD O C O O N S U n. p ~ w DO O C C •p N O ~ 0 O CO O ~ C N t, Ci ao ~ Lo( d N'0 C 0) M ~C O 2 O 00 '-V) N O N O R t=i • O N d O Z C Z fA xt a ~ a ~`I.a E 'c c 3 1 t A ti a 2 o vii c°~ t FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION- ry~.T;-2,f N/-R,,-26 W ADDRESS Ate A ST. CROIX COUNTY, WISCONSIN i SUBDIVISIONS' rY%~~r LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Y / alA.SC i t'ld~s f~ C S- } GSA INDICATE NORTH ARROW I BENCHMARK: Elevation and description:, ~M Alternate benchmark ~ I J SEPTIC TANK :Ma ufacturer:~ ~ d Liquid cap. ,14?7da Rings used: Manhole cover elev: _ZL1.L-,,-Final grade elev: P i Tank inlet elev.: Tank outlet elev.: i k, R No. of feet from nearest road:Front , Side , Rear_,~ Ft. From nearest prop. line:Front , Side , Rear, Ft. No. of feet from: Well, Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 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 c_ Length _,a ~F-Number of Lines: Area Built,1-6'1~7 Exist. Grade Elev.-~ Proposed Final Grade Elev. ~ Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side_Y , Rear Ft.,6a''J No. feet from well: djl~ ,_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: LICENSE NUMBER: 0Ij 6/90:cj y Aql 00 it-3 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.Q. BOx'791159 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION State Plan I.D. Number: ^81''4, ,t 4, c . 2 4 , T 2 8 - R 2 0 Town of Troy, Lot 48 CONVENTIONAL E] ALTERATIVE (If assigned) Cove Lane ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jeff W. Peterson 13404 Robinwood Dr.,Minnetonka, M S' BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: 1_ / REF. PT. ELEV.' CS REF. PT. ELE Name of Plumber: MP/MPRSW No.: T~ County: Sanitary Permit Number: Calvin Powers 1563 St. C 48993 c1✓et'' SEPTIC TANK/'ffi@ffi Oil MANUFACTURER: LIQUID CAPACITY: TANK INLET TANK OUTLET ELEV' WARNING LABEL LOCKING COVE5,g. PROVIDED: PROVIDED A YES ❑ NO ❑ YES ONO BEDDING: VEPfT DIA.: VEk~T MATL.: HIGH WATER UROAD: PROPERTY WELL: BUILDING: VENT TO FRESH r r'>. ALARM: FEET FROM _ LINE: AIR IN T: ❑ YES NO sS _11 ❑ YES NO NEAREST DOSING HAMBE : MANUFACTURER: BEDDING: LIQUID CAPACITV: MP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: I L-1 YES NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN F cr- M LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ~FORCE LENGTH: DI ER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: 3, ? "5 f rl-Cr C = % WIDTH: 1_071171`17- NO, OF DI R. PIPE SPACING: COV R INSIDE DIA.: Rjj LIQUID BED/TRENCH TRENCHES i MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO I R. NUMBER OF PROPERTY DING: VENT TO FRESH BELOV~r~IP 1 ABOVE COVER: ELEV. INL~jT ELEV. E D:/ n > t -PIPES: FEET FROM LINE t~ r AIR INLE/T: NEAREST D MOUND SYS TEM r 3 - -t-Mound site plowed perpendicular Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES E] NO ►'lc-r-d % meets the criteria for medium sand. ELEVATIONS MEASURED. reh c SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/B DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: MULCHED: CENTER: YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LA ACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIA ISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPE DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: -VfiRIICAL LIFT CORRESPONDS TO INFORMATION APPR LAMS ❑ YES ❑ NO EJYM ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST---* a Sketch System on i R a~n in county file for audit. Reverse Side. SIG TURF TITLE: SBD-6710 (R. 06/88) DLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COON STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / 9j 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE TY OWNER PROPERTY LOCATION F 1.), ' .SC % S E Y4 (.r3/4, S Z T 22, N, R Z U* (or) W PROPERTY OWNER-'q M ILING ADDRESS LOT # BLOCK # /5 q C / lud it Cd 49 CITY, STATE ZIP CODE PHONE MBER SUBDIVISION NAME OR CSM NUMBER y., M V1 M .j4 ~ V~ /J/~ II. TYPE OF BUILDING: (Check one) CITY ^ NEAREST ROAD ❑ State Owned ❑ VILLAGE : C.) LU U C NU TOWN OF: Ln ❑ Public 14 1 or 2 Fam. Dwelling-# of bedrooms AR EL AX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 70J 1 ❑ Apt/Condo 2 ❑ Assembly Facility/Nursing Home 10 El Outdoor Recreational Facility Hall 6❑ Medical Facll 30 Campground 7 El Merchandise: Sales/Repairs 11 El 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. 14 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 el 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/ y/sq. ft.) (Min./inch) p T~ bELEVATION U 0 l -as I! V Feet % 1Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank U f' (1 C) Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pr' q: Plumber's Signatur • No Stamps) MP/MPRSW No.: Business Phone Number: 2 Y4 -5-1 3s- P mber's Address (Street, i te, Zip Co V LINTY/DEPARTMENT USE ON ❑ Disapproved Sani ryPermit Fee (Includes Groundwater Date Issue Issuing A em: Signat re (No Sta ) ) roved ❑ Owner Given Initial Surcharge Fee Adverse Determination 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 APPLICATION FOR SANITARY PERMIT STC - 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 E W -Pte~'E 12-<-, CD t-A Location of Property Section , T N-R 20 W Township Mailing Address S,4-O 6- F:)Qjl NWo00 DaAvz N lJ -1-ON ie-A Pj W Address of Site X x x GoVe LA "S V6A05cm4, \tvi S401 (,a Subdivision Name " Glt-O IVC COV:C, 5 i~P AeOD i"=► O N Lot Number Previous Owner of Property 6,HAW- l.ES M" Total Size of Parcel o AC4<E,~ Date Parcel was Created MA:~t S , Ict$°I Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes No Volume e)%O and Page Number 107i as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ceta6y that att ztatementb on the 6onm ane true to the belt ob my (ouk) knowledge; that I (we) am (are) the owner (b) o6 the pro pent y deb cAibed in thiA tn6oAmati.on 6ohm, by viAtue ob a waAAanty deed neconded in the 066ice o6 the County Reg.i step o6 Deeds ass Document No. 41 "4 S~ ; and that I (We) pnes entty own the proposed .bite bon the .6ewage di6poz s yb em (on I (we) have obtained an eadement, to nun with the above des i.bed pnopenty, bon the condtnucti.on o6 .aaid .aybtem, and the .name hab been duty %econded in the 046ice a6 the County Regi6ten o6 Deeds, ad Document No. 44--95,0 ) . Q// W. GN OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 3-Zo-q~ DATE SIGNED DATE SIGNED % U/ R "150G'rJMENT IVO. STATE SA8 •QF WI~COE , 21-•3!p e,~ erne as~ss •tew_*teeatlele+• e~nM CONRULar • t~ g TOM YOM-= •wiinta' v: ( , sliM1 1: AXW Eff t ~i'QI3 by and bdo CharXtath NRIBem AMA - zit tie Belson., husband and •wiieT _ 'd18oond . - (-v wan, MAY I wbdlsa>•' ow or more) anal 3:00 11 JA Peterm - fmakind avd art fe. an verrely f a.. tat ~ • j I (°~tbaose, wholibm *QM o: more). O+. A Yendar sells sad Rate m to aw-a to Purchaser, up= ft r ow I Mad ft H pa- t4raaree of tb1s eoairaet by P+a dma6. the follawfuS prop' W. Updbw w.TA the , s I pivdts, isztaaes and attar abet west (*a eased Sm a t ipffin, ~.5r~:_._Sr GoXtr, Slate of Wbeonsia: i p' ~i . ITax Pared No. M~ 4••;~ ti Lot 48, St. Croix Cove 4ubdivisian No. 3 in the Townsbtip of Troy. F j Thhz 60t heeasstmd property- + iQ1 cis WA) I' ' I Purchaser WE" to purchase the Property and to pay to Vender at lia the son of i~~. . Q~~~ in the tellavbti manner: (s) SAS-0.00 • r r.. at the execution of this Contract: and (b) the balance of S-23.92 AM L - together with inteh•eet [rum data hereof an the bdmft ootatand% from ti= to time at the raft of....-_._A1kYlL . per tout per annum . ~l Wdl paid is i'a]!, as Wows: ,.If• I llont:hiy payments.of three hmdred and twenty nine' dollars and fifty cents, 0329.30) for a period of two years. Fmymrats to com6nce on I=* S.'1989. tt'I O •j Provided. boirevet. the entire ourmtandmc be a:m shall be paid in. fun o4 I befaoZe ~----SS1i------. daw of 19-91 l the maturity date) I Fallowing any defhtalt in payment, lptemt. shall accrue at the rate of J'"._% per sunum on the entire amount in default (which shall include, 'Without limitation. delinquent Interest and, upon ".*ration or maturity. .the entdfe principal balatut). j UMMSCko Wax MR -W- - --W F Nei lb- M0111,11, q I-'-d IN an W.- bw 11 1 Moto 1` I Payu mts shalt be applied East to interest an the unpaid balance at the rate specified and then to principal. Any Umou t. may bp prepaid without premium or fee upon prinerpai at any tlme after ..-~1y..~.. , 19.84...E I AMNEWLAMM Ell the a of arty psepayment, this contract shall not be treated n= in default with M-t m to ra}-meta re Iona as the unpaid balaaee of pr{aeipsl. and intezmt (and in suci. c-L-r err-,hia2 intern +t frum m.lnr h to month -hall he treated as unpaid principal) is less than the anovat that said indebtedne-.- would Lave been La l the monthly payment been made as &at speed above; provided that monthly payments shall be enntinual in the ••vent Of credit of any proceeds r of Insbrunm or condemnation, the condemned premises being then-aft;r exCluJcd irer•elrtom- P~lteser states that Pnreha=er is slti~ed with the tltl•. as -:-awn be the cale evidence errbmittcd to Purchaser ter motion eseept: 1988 taxes due In the amount of $209.57. ' I I Purchaser axrees to par the cast of future title evidence- l: title evidence 10 in the form of an abstrnet. it shall be retained by vendor until the full purchase price is paid. i Purchaser shall beentitled to take pobsession of the P"'Aocrrr on May. 5 I . 19 82. oc. Out One (ACT-Iadt!leaar and STATr BAR DrW0W'P\-i1 W.-r- i.•t.l 0146k Co. la,. FORM ~a 1 t 17es }1,,.w...r• V, tl.. 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'~'?`i•' ':y`yv' ,1: x .tk : `vi:'`• 035 Q II o J °i te) i 0: • :•O1I ! 33 m p L7 t {IM •tm , 340- > 'i,:•a:e, .,T;(4Yf~6F,: • Spy 30 e O o ;:'I 1 ~0 n~p0 HUDSON ofe2 w.wrrarrvrs Ordinory hyh .voter 679 ~ •(0 to ..+a•t ILml.to st.Paul .0L 1 % w $ O,`P p d A/ormo/ poe/ a/ero/ion 6TS „M 500 2 o ~a ~y o R o~5 - 8a SOLD "SOe O r:{~ y' i" Highes/ Jvoler 690 SOL01►••0 __1 r SOLO 5 ~ ~ ~I IIIAIFTON ° ' Sr C'me&C Co~~ ~Re OsoLO G c 'Y, `taa68 9 T o r Ott s by ~o 9 a rJ-R S LE -BY - 7 It - - 1 ¢IOSHINNeLOfi suetvzut CA.27311 90 9 or14 I fitf, ` / / r ko v ° o o .o IS~~ loco 3 \.)9 ~I!Ilil~ 90 9p~ O• c ~ Z ,SOLO t' l ~ p V 1° . 4 o 2 "i '0o 17 rft3 u 05 19 ~e5 •e5 O ip Z~ S\~ tai Ife 150• Tae 6N i5 a tr yc!'' tZtZ 7 Q. O is itl . to ue nt ,,Y~~.',a,. v V~ sn~ `),nC/ n 9 0 eo 1 dl/1I.r. e / ` to~-~ U% Z'j .10 a 2.4 _ 0 6 ~O- tip % 7 r S z ,SOL p 1 1 - B- \A 166 0 F. t)►- rtr, l•'ao.e \ .,+o x, • 9o J +3e.a - Z9 ( , It f" I La. ite 1A It IS04,0 I:r loo too °zo tsA Ittlf .+2 N / \ ~ `yp, 1 SOLD t \ ' ( ' • loo 150, 350 t d . ' , .Le. t t, ~4T e.e to) 4.3 ter $GLO I r soco 04O 152 ~ ,4'G 55 o 5~ , 2.' zz.ll~ t7a /3.1 - .g . a 4/~ t/ r•44 S ` ~ 2.1,-\' 50 ~ ~ tl,'-• - l.Oa -4J i.) I ) 1 41 \ rf. ,!i ~ 200 v !!V X45. / teo ~fe IJa 1 sei.4~ 1 ` O 1 \ l ' ~oJ I _ r i' z . cn H ' a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d OWNER/BUYER M ROUTE/BOX NUMBER V54a4- vomit-Awauo Da- Fire Number . IF CITY/STATE 1Nlc=rNk-A MN ZIP SS34 5 , T Z3 N, R 7-0 W, PROPERTY LOCATION: S' a 3z, K\A/ Section 1-4 Town of :P v , St. Croix County, Subdivision (nCI1t 60VZ , Lot number 4OC3 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 pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% 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 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. Ho • E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ro ment 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 C~ V DATE V 5 -2-C) -q St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. INDUSTRY, 1%L_1 VIA # Will vV1116. ayrvat►n~~.t~v ,.s~v UIVISIUN P.O. AND PERCOLATION TESTS (115) MADISON W 53707 t.HUWIAN RELATIONS (ILHR 83.0911) & Chapter 145) EOCATION- rEOTTON:- TOWN SHII'1U 1N 'IPA ITY: LOT O.FBLK. O. : SUBDIVISION y iWY4 Zt/ /TzrN/RzoE(o) Ti`oy yd~ r. ,ealk SS: MA LIN ADDR S BUYER'S NAME: ' COON Y: OWNER • C'oi M a 11" . JEFF '%r,ERSo Aj S yo ~ '~o R~ u WOOD ze . i ~v vE?e.~,t-rf A. USE lZ 33 - Is 12 - DATES OBSERVATIONS MADE S S' 3 : I-t NO.BEDRMS.: COMME ('iTESCRIPTION: ATI ON T STS ence New ❑Replace 17,707 "c Wf'ovi / Sc s~ ~ EH M EQ7- 1 S, a i/G~, o s Sol? s RATING: S- Site suitable for system U= Site unsuitable for system _ M99 VENTI NAL: MOUND: IN-GROUf~pRESSUR : SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) $ ❑u ❑u ❑U ❑ $ 0~ ❑ $ ~'evv~rT~D,vf~ -~.A~.u~c s 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: 0//}.f S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL TH T GROUNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. EESTO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) o 7-1o > ~ ' • ~a~ s 2 9A.) g..Z Ot0.7a- 7V cs .e 177. 9 S Tip S' G 2 /,o' ~a, s I.S > S! S B;~ ..S 9s, f -_J . s ' B,) . IS d ' ole. -(31) mss, A 1s Oie. B- _ PERCOLATION TESTS DROP IN WATER LEVEL-INCHES RATE MINUTES TES DEPTH WATER IN HOLE TES r TIME NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIQi t PEA RI_ 2 P PER INCH P. It- p_ E Mi 1G is P. -2-0 HR. -.Ole P• p F_ .t.I ~C Q .v ~X i,JG- - LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hors. ttfntal 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 land slope. ~ Q /V r,4 U ,B1_ Rs SYSTEM ELEVATION fora his test site APP conventional se OVEO ,ptlc system, 00111'eu SEE 07' 10 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): HOMESITE SEPTIC PLUHUING CO. TESTfS~W :RE COMPLETED ON:G 65S O'NEIL RD., MOSON, WIS. 54016 ` p R f I I -V - I ADDRESS: ROBERT UL CERTIFICA ION NUMBER: PHON NUMBERIoptional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. L y Z 3 F(6 c c 3 CST SIGNAT RE: f• bISTRIBUTION: Original and one copy to Local Authority, Pioperty Owner and Soil Tesler. ;,,,:'DILHR-SBD•6395 (R. 10183) - OVER - L D'f' u ~ S . C ~,p i I( Cot) t= ..lµ, ,t 3 ~9 C~~aE' l3 0 {21.V CT- stop S -1a% 4 pit; HOMESITE SEPTIC PLWilull%., t,G. 666VNEIL RD., HUDSON, WIS. 54016 I ROBERT ULBRIGHT c rT 7y,- I-YP2_ , WIS. MASTER PLUMBER LIC. NO. 3307 M.P.H.` MINN. MISTALLER & DESIGNER LIC. 140 1zr~ vuz r' Gt c R `0 I x~ G 90 SyST~M Ij RE PT ' S Top OF -l/ Pi E- w 00 r I Tht~ I ppoeosp- I fora z con test site HoM~s~lE I yontior1~~A p$0~~ r °ptio SyS'~ °c I. i m• ~ I r Z t ' . s SvMcO /y T /Q~Ter~~ o r~ S- y ~~,r,~►~~z,oKn.- 3 -T J, 5 D o z. - 3 2- O,tp,,-p6b) L,.,-- C,hu~~~~5 Jr r 3 A\ y AIT 4c'e F PAGE OF rvsS SYs en-) rh I 0,) e"T-b r% q_ r1l n Fresh All Inlets And Ob►e1110110A PIPS n A rorie PD Vans Cop Mlnlmuno 12' Above . final Grede 20. 42' Above Plpr 4' Coal Iron To final Grade Venl PIPS - wren liar Or SynlhelIc coveting uin Y Aggregole Over PIPS ' Oleulbvllon Pipe o 0 0 -Tee + b' AggrSgdle 8Sne4111 Pipe Pertoraled PIDa below o _CovPling 11manlaolln0 AS Bollom 01 Syelene - ITI. 7~ -F Pro 0, pine-1 c~cf.e1< oO SOIL FILL; DISTRIBUTIOI.I PIPE • APPROVED S4gptETIC COVER PIATERI^t- OR 9" OF STRAW 2"OF,\GG9EGA1E Ott MARSH I.1AJ (.rr0Fl2-21/2 AGGRCGAT Ae ELEV. OF- UFEET DIS'►"RiBUTIOM PIPE TO BC AT LEAST - INCHES BELOW ORIGIAJAL GRADE A►JU AT LEAST LO MCHES BUT 1.10 MORE THAW 42 IIJCHES BELOW FINAL GRADE MAZUMUM DaMi OF F-XCIIVATIOP FKOM of< WAL 69AK WILL BE _ Imr-HES 111KIMM 0EMi OF EACAVATION rA01A 0~16INAL rjRAgF. WILL BE INCHES SIGIJCO: LICC►JSC IJUMBER:_ .r V . DATE: I F s COMA ERCIAL TESTING LABORATORY, INC. 514•Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 27155/01 PAGE 1 , .:ST.< CROIX COUNTY REPORT DATE: 8/10/92 COURTHOUSE DATE RECEIVEM 8/06/92 HUM t WI 54016 ATTNS THOMAS C. NELSON OWNERS Jeff 6 *e► Peterson D AT~q3 LOCATION. X56 Cove Lane, Hudson,WI COLLECTORS Id. Jenk i'ns DATE COLLECTED! 8-5-92 TIME COLLECTEDS 34100PM SOURCE OF SAMPLES Outside faucet DATE ANALYZEDS 8-6-92 TIME ANALYZED-* 1200pm COLIFORM## 0 /100 ML INTERPRETATION: Bacteriologically SAFE NITRATE-NS 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Conform Bacteria/100 mL Nitrate-Nitrogen, mg/L 12 rn ~~1992 w +l~ pea fir. ~~V~p~F~GE A LAB TECMICIAN: Pam Gone ZpN~NG p y~.\NDEOfNOENr WI Approved Lab Not 19 9 Z4 Ao f Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 s ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 VV Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form j essential -zQ that t]3-Q property S-II be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING----------------------------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) v SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 /l (Determines if system is properly functioning at.,time of inspection) y~ PROPERTY OWNER'S NAME : PROP. ADDRESS: Cr)U42- L&Y) e CITY i a~seil-n Legal DescrIiPtion ~5E- 1/4 of the MW 1/4 of Section _ Qq_, T-2-LN-RO--00 Town of -I f 0,l Lot Number 14!&_Subdivision: 5E Cro n( 00 * 3 FIRE NUMBER LOCK BOX NUMBER l L 7&2 Color of house fY'-►_•ItI ~Realty sign by house? _nl-,-~ If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: f1) PmcriCU- 8p--nK Telephone Number ~ L cta,("(-0 - REPORT TO BE SENT TO: IDCY-) 6 a C~~f [)I qO& CLOSING DATE: 7~ 1 Signature r t wericlient Jeff Peterson ert Address 256 Cove Road ity Hudson County St. Croix Stale zip code 54016 Lender Mid mrica Bank ~ arr.r ` - /9! y. 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STREET SCENE a► l l a t i~ r4p"iYa{{ ~tif..9„a''t ,ti ~rli ~ka ~0 C: •~t~ ti i {#f (1 Tr?. 3 r A~4y~~: yk Ns fs,l 1 ; I.R. d COMMERCIAL TESTING LAW-DORY, INC. • 514 Mafn Street, P.O. Box 526 Coisax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 STEVE MARTELL WELL DRILLING RE''ORT NO.: 06866/01 PAGF 1 LOX 28 REPORT DATE: 6/24/91 DATE RECEIVED: 6/20/91 SOMERSET. WI 54025' OWNER: Derrick Construction LOCATION: 256 CS& Lane, Hudson COLLECTOR: Mick roster SOURCE OF SAMPLE! Faucet COLIFORM,MPN: < 1.1/160 ml INTERPRETATION: Bacteriologically SAFE WISCONSIN UNIQUE WELL NUMBER: DS121 LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 i yO,.\MOIOtp~`N ` a'~ g f Means "LESS THAN" Detectable Level Approved by: 4A ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY • ,.~f4 WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE MOHER -11- 911 FOURTH STREET • HUDSON, VA 54016 (715) 386-4680 June 24, 1991 MidAmerica Bank 600 2nd St. Hudson, WI 54016 To Whom It May Cbncern: An inspection of the Jeff W. Peterson property, located at the SE4 of the NW4 of Section 24, T28N-R20W, Town of Troy, Lot 48, St. Croix County was conducted on May 16, 1991. At the time of the inspection, this septic system was found to be code compliant for a three bedroom home. Should you have any questions, please feel free to contact this office. Sin rely, James K. son Assi nt Zoning Administrator cj ST. CROIX COUNTY WISCONSIN ZONING OFFICE " ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Aug. 6, 1992 Michelle MidAmerica Bank 600 2nd St. Hudson, WI 54016 Dear Michelle: An inspection of the septic system on the property of Jeff & Theresa Peterson located at 256 Cove Ln., Hudson, WI was conducted on Aug. 5, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Si cerely, Mary J. Jenkins Assistant Zoning Administrator cj