Loading...
HomeMy WebLinkAbout020-1157-60-000 ~r p u°9 c I I ~ I °o I N I a ti I c I _U I ~ I v I c I ayi o I a z° I c U. o ° U I I 3 `e) ~ z w I rn o CO N w I a m N H Z ! O I O Z c d Z o fn H m z c •o I r`' I o. aa) I ID a) 0 • N a` m O O o N Q w z m z o Y c c I O O N 0 H E > (D CL ~y N Gl O O d N T y L G G CL E~ N N ° N N N LL o Lr- ~3 z~ •r aaa o N c N J U Z I 2 er o y m 0 0 c I Y O m c IL c v N N rn c d Q in is ° ! ~ a a o I g~ o Q=a8 v o ° C S o c v rn W O n C y L r 'O O y ce) N N ate.. N V C N CO jo N fD 7 CO N O O E U !I o N 2 2 O Z Z~ (n I r ` ~ at v COD d R a # g L a 0 CL 4) t A vam ',0U)0 , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, LABQIJAND . PERCOLATION TESTS (115) MADISOP.O.,BOX 7969 N WI 53707 HUMAN RELAI_ IONS (1-163.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ T NO.: BL . NO.: SUBDI VISION NAME: Zr3 COUNT X: OWNER'S MAILING ADDRESS: r" S^ r 0 A fX .Jl USE - Sf DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER AL DESCRIPTION: I PROFIL D ESCRIPTIONS: PERCOLATION TESTS: Residence ~ ~1Qew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) CAS ❑U IDS ❑U RS F-111 ❑ S CCU D~ ❑U J If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Al Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGH-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~!Y 3 L ? .S rls 5r$ w~ 13 B- 5- B- h 7 /O ' t , u PERCOLATION TESTS / TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t P RI D PER INCH p. 2 L Mwe -3 > C Y ' r P- P- S~ O j ~ r Aa r P- / p_ s S ' G !o P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal'and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Zr. 7~ II _ 1__~ ~ !i III I I ~Il I I I ! f ~ -I I , I ~ ~ ~ I 1 /L WI-Ale- I i417A I s P I ! I ! I I ~ I I ~ ~ I 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 (prin0: TESTS WERE COMPLETED ON: DA71 E FOGERTY PLUMBING 2 ~ Po ADDRESS: #3233 #3289 CERTIFI ATIO NUMBER: PHONE NUMB ER(opt ional): Fog_ertXHeights Road ROBERTS, WISCOR CST SI ATURE:/ Phone 749-3656 r e~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LALHRSBD-6395 (R. 02/82) -OVER _ I ti w~ 400 C _ t1~ i3► O S~ C \ O ~[!1 a C tpw g 3w ~ w y~ Q o a I r V < < ~d N v 7 f` h ~ W o 0 0 z 1 i v LOT SIZE/ACRES 4.2 Acres NOTE: Location Map, Directions and Financing Helps on reverse side. 1 I j~ 300 i I if,,L ' r7 3 SY R • o CP :2 607 ~3 a NO ~ f ' a L SAO 0 ~ ~ ~ ~ , n s 11. n l Ole I.N z z- (t 30.5 Y 69i.~ 3 1115 11 r FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION T -:?9 N-R_.~f W ADDRESS ,4J"_e ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT :~_3 LOT SIZE e PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -3 r~ 73 fZ -e lC/ ` ~'~r - INDICATE NORTH ARROW BENCHMARK: Elevation and description:- Alternate benchmark SEPTIC TANK:Manufacturer: Gf/Y-e,~-s Liquid Cap. / d Rings used: 61 Manhole cover elev: F-7a y Final grade elev: 5'Z_ o Tank inlet elev.: 1 Tank outlet elev.: Fe' yl No. of feet from nearest road:Front , Side +i, Rear Ft. >5-0_ From nearest prop. line:Front , Side , Rear ~ Ft. Sa No. of feet from: Well ? s o , Building: a ~ (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE f t ~ • 1 f PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: 5-2 Pump/Siphon Manufact.: Pump Size Elevation of inlet: ?0.-37e/ Bottom of tank elevation V Pump on elev.:J7s.3 Pump off elev.: 5'6..2 Gallons/cycle: %9J' Alarm: Man.: 9ztl Switch Type: -Location 1 177 Distance from nearest prop. line: Front_, Side l; Rear_Ft. _ Distance from: Well 3-0 Building SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Seepage Pit: Width: /-i- Length S3 Number of Lines: 2 Area Built__Zf,-' Exist. Grade Elev. 9s:d Proposed Final Grade Elev. Ye Fill depth to top of pipe: No. feet from nearest prop. line:Front Side , Rear i~Ft.aQ' No. feet from well:/©o No. feet from building 'F 7 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: r Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE: ~i PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj QEPAR-TM„ENT 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 NE 4 , SE 4 ,Sec . 2 6 , T 2 9 -R19 State asigned) 'Number: Town of Hudson lot d3 ❑ CONVENTIONAL ❑ ALTERATIVE Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: BEN MARK ( ermanent reference porn DESCRIBE IF DIFF RE T ROM LAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of lumb MP/MPRSW No.: County: Sanitary Permit Number: T'oRerty .19R9 qt-- Croix 1 198741 SEPTIC TANK/HO DING TANK: MANUFACT RER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: S D O o D. O- V 21 YES ❑ NO ❑ YES Ej NO BEDDIN : VENT IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH At ~ it ALARM: FEET FROM LINE, AIR INLET: ❑ YES O C ❑ YES ❑ NO NEAREST 5 e > 5 0 DOSING CHAMBER: MAne;Z R: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO !iPUD (f ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENTTO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: c AIR INLET: PUMP ON AND OFF ~ YES ❑ NO NEAREST :5 ,J U SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND 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: WIDTH: LENGTH: NO. OF BED/TRENCH DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID n _ TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS i o , i S GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. D TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW IPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPE FEET FROM LINE: AIR INLET: nh, ~ off - J,~ )L NEAREST > Z 0 % / G O > 0 MOUND SYSTEM: Mound site plowed perpendicular to 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 ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: 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 BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEARS 7 X15' yj-r' x 9. q 47 Sketch System on Retain in county file for audit. Reverse Side. SIGNATU : TITL .r SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION 70ILHR In accord with ILHR 83.05, Wis. Adm. Code C UN STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / '7 8% x 11 inches in size. c ec vision to revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PL ASE PRINT ALL I FORMATION. PROPERTY OWNER PROPERTY LOCATION Tom Hanson ne '/4se '/4,S26 T 29 N, R19 E (or) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Rt. 3 Box 168 23 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER River Falls. 1(425 )8355 Hi h Meadows II. TYPE OF BUILDING: (Check one) El State Owned VILLLLAGE NEAREST ROAD Rena Rd. ❑ Public ©1 or 2 Fam. Dwelling- # of bedrooms 3 PARCEL TX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 7 ~ 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 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 4.0 Reconnection of 5.0 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 IML._ Asn 615 615 .73 .5 91.7 Feet 95.0 Feet 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 Se tic Tank or Holdin Tank 1 1 Weeks Concrete Mx Lift Pump Tank/Si hon Chamber 8 800 1 Weeks Concrete x VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu ber's Signature: (No Sta ps) *H'IfMPRSW No.: Business Phone Number: 3284 715 749-8656 Plumber's Address (Street, City, State, Zip Code): Robarita- WT 540212 IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued issuing gent Signature (No Stam Approved F-1 Owner Given Initial Surcharge Fee) / C ! Q~ Adv rse D rminati on 7 ` Gm 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 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to.. the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the ' State of Wisconsin, Safety & Buildings Division, 608-266-3815, To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by ttfecounty; E) soil test data on a 11619rm; and F) all sizing information., GR0UN&dArk1% SURCHAFjGE + 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. Th monies collected through these. surcharges are used for monitoring groundwater, ground- waTer contamination investigations and establishment of standards. SBD-6398 (R.11/88) PAGE OF " PUMP CHAMBER CROSS SECTION AUD SPECIFICATIOKIS VENT CAP i'C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, '~IINCOW OR FRESH rU. AIR INTAKE GRADE I MIN. COWDUIT le"MIN. PROVIDE ~ f IAII_.F: T ~ _ I V AIRTIGHT SEAL I III APPROVED JOINT A 1 J I I APPROVED JOINTS PIPE. f' I III W/C.I. PIPE EXTENDIAIC• 3' I II gLgR EXTEUDIWG 3' )NTO SOLID SC;;, \ ` I ( ONTO SOLID SOIL I I oN PUMP __J ~ Ff . COUCRETE BLOCK RISER EXIT PERMITTED ONLY IF TAWK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS rIC AND TANKS MANUFACTURER: Weeks Concrete IJUMBER OF DOSES: 2 PER DA:i TAWK SIZE: 800 GALLONS DOSE VOLUME 10 gal. backflow ALARM MANUFACTURER: DLV INCLUDIMG 6ACKPLOW: 460 230 GALLONS 2 MODEL NUMBER: Level Arm CAPACITIES: A=-.._Z8 -IUCHE5 OR 504 GALLONS SWITCH T.4PE: mercury B= 2 INCHES OR 36 GALLOWS PUMP MANUFACTURER: Zoeller C : 13 INCHES OR 234 GALLONS MODEL NUMBER: 53 18 gal. /inch D. _2 INCHES OR 36 GALLONS SWITCH TYPE: mercury NOTE: PUMP AND ALARM ARE TO EE PUMP DISCHARGE RATE 20 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE bi9varu PUMP OFF ARID DISTRIBUTJOM PIPE.. _V_ FEET + MIAIIMUM NETWORK SUPPLY PRESSURTT,E//. . . . . . . . . . AM FEET + .60 FEET OF FORCE MAIN X •74 F/oo fCFR1CTIOM FACTOR.. .4 FEET TOTAL DYNAMIC HEAD = 12.4 FEET 45 IMTERNAL DIMENSIONS OF TA K: LENGTH 80" ;WIDTH 80_-;LIQUID DEPTH SIGNED: LICEWSE MUMBER: ~9R9 _ DATE: 6-28-90 -117- ANN 0 - - HEAD CAPACITY CURVE TDH co W H W 30 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING SERIES 53 55-57-59 97 137-139 163 185 28 M LTRS LTRS LTRS LTRS LTRS 1.52 163 248 394 231 231 EFFLUENT AND DEWATERING 3.05 129 216 300 231 231 4.57 72 163 242 227 227 26 \ SEWAGE AND DEWATERING 6.10 104 136 223 227 7.62 30 216 223 ♦ 9.14 206 220 24 ♦ 12.19 172 206 \ 15.24 125 191 ♦ 18.29 57 161 22 ♦ ♦ 21.34 114 \ 24.38 53 MODEL MODEL Lock Valve: 19' 24.5' 26 66' 87' 20 163 \ 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE \ SEWAGE AND DEWATERING \ SERIES 267 288 ?!!2 284 493 18 \ \ M LTRS LTRS LTRS LTRS LTRS \ 1,52 408 386 492 681 3.05 227 273 360 598 16 4.57 76 163 238 511 \ 6.10 30 125 401 7.62 268 14 \ 9.14 163 292 10.67 227 \ 1 12.19 174 \ 13.72 106 12 15.24 45 ` MODEL Lock Valve: 18' 21' 26" 35' 53' 10 293 MODELS 8 137 139- 6 MODEL 284 4 MODEL MODEL 268 \ 282 2 MODELS\ 53, 55, MODEL ?MODEL 57, 59 97 267 L LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . t ZffZZZA-ff O. ui Box 1 Louisville, Kentu entucky 40216 a (502) 778-2731 `QUA[/TY PUMPS SNCE ~s~i7 i V `7 v CZ, a. _ J I--°' ~ a X mN v M 3 ~ 1 DEPARTMy NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, . DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) I OCA1 ION: SECTION: TOWNSHIP! - LOT NO.: BLK. NO.: SUBDIVISION NAME: It /T,2 N/ E for e O NTXJ OWNER'S E: MAI LINU ADDRESS: _.9'A• ~7 ~lnfll~~flt f-t r?- i' i~n1 1 6' Sf DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERC A DESCRIPTION: PROFI O A ON TESTS: Residence ~ew ❑Replace I / S: RATING: S= Site suitable for system U= Site unsuitable for system CO(N~VE~`NTION ,L: MOUND: IN-GROUNO-PRESSURE: SYSTEM-IN-FILOLLDI~`NG TANK: RECOMMENDED SYSTEM: (optional) U J S ~'U U J u EiS [DuL H l_`Td U /2- r r J ~ J If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the - w f under s.H63.09151(b), indicate: ~ Floodplain, indicate Floodptain elevation: it, PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- rs rAtIf b"r3 ta/i B- P r. f /4/,6 5-, s- "'Y'l B- 5- B- o c..3 7 /o t rS PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t f!F_ F' t€7b PER INCH ~ L r p- 2 L P- p- p > o L ~u P- p So _T- /.I- 2.: PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION yi. 7' I I i I ~ ~ i j i ~ I I i ! ~ I ~ ! I i ' I ~ I I I I i 1 i ~ i i I ~ I I I i I ~ 1 ! I I ~ I' I I I ~ I i I ~ i ~ i tN SFE 477sfc/1EQ sis/EEps xf IS) 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): iTY PLUMBING TESTS WERE COMPLETED ON: DAVE FOGze Licensed P CERTIFI ATIO NUMBER: PRONE NUMB ER(npiional): ADDRESS: X3233 #3289 FogPrty Heights Road ROBERIS, CST SI, ATURE: Phone 749-3656 >Gs. ; _ DISTRIBUTION: Original and one copy to Local Authority, Property OWnn. 4.2 Acre L 5 OT SIZE/ACRES NOTE: Location Map, Directions and Financing Helps on reverse side. L~ ~ ~ ~S s 2 • l~ 200 a Of 3. ~ S~ 0 2 6o? a ~ 3 Q o•• . NAP S CSr00 d 0 c ~ e v? l IL n ~v y;`7 yR h I!3o•SY - •y4L,3G ~y5. G 9 i. 3 6 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 Lot resale by owner/conttectoc,tspec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appcoptiate deed recording. Owner of property ` PL 1/4 s i/t• Section 2 T-a--P-R q V Location of property Township AJ Mailing address Address of site Subdivision name ~ws - Lot number -0-2 Previous owner of property w to Total rise of parcel Date parcel was created Z 7 Ate all cornets and lot lines identifiable? as o is this property being developed for resale (spec house)? as 0 Volume and Page Number -q as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION T)(E FOLLOWINGt A WARRANTY DRED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NVMBER, and the REAL OF THE REGISTER OP DEEDS. In addition, a cettlited survey, if available, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a CeitiEled Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this corm are true to the best of my (out) knowledge; that I (we) am (are) the owner(s) of the property described In this 1nfatmation corm, by virtue of a warranty sed to orded In the Office of t Ifs he County Register of Deed* as Document No. ~ 'b f and that I (we) presently own the proposed site for the sewage disposal system (oc 2 (we) have obtained an easement, to run with the above 'described property, tot the conettuctl n of sold system, and the same has be H1 ecorded In the office he Cou !y Rsglslar of Deeds, as Document Ho. 97 v S19na to of Owner Signatuts of Co-Owner (I1 Applicable) 4 q (qA Fate -at 819natute Date of Signature r , Y. 'jrl~}r ltd a.. - - t ~ r ,l j~M Of !lQA.:YYJm1j-q_ ai's «•Y«i~NWYM--•.~M•A M-+-.FrNM. «-.-r.iw-»r.A. Fi, got MONOWN WM "Do Off • - - .i iri r Ml Malai►%100pei ton sdW dill asamr. didsta et': ~ ldi t 29 . !a~ 1~6 0Rdil" 1.1 in VIEW, ~l ~1> M~pbbon,, ~ ' w# li~iil ,p+•f+rrota ~ : 'lilt p 1mod, . w K~, } + f w flllt tiafi~Fb awl) ~ •MlrlrMwi .dn+Pors. 't pradis~R UE`.l!er4r itlt'~f d! 1tlnllr a1.~M1lw~ • PY P+1R Q iterwat; sad (6) the bafa4ri d , T a r~lttlssl eM! dial tram time to till lice aMrt .ot......'xOX► ill 1~,,~ . _ ••..-n••-•.•y.e 4 #d» Twsnty.-*Ax e 3 fty OF i ~ ~ dOV OIL . OSCO Oft *"r)r` 000th tbsWl -60f,404t!+ t f A.iAi3 i*irse irw She it o #$3~. ` ,f ft, 1 brr, the entire outstanding balaaee AM be paid is !vi'ew'er a Ot s . !9._.91.1. ( alw. nmtarity date)• F 'pa► defl~t k pa7*09#1 104wt e44 aorrue at 00 rat .,..:~:.lG•drer• I °!r dalgai~lt telil *Mr!*+ilt' hiieTgdy without limitation, 4elin9MU- interest and, up" a~ { W <V+Orr siagaeFt~x f 'xi1~:,lnlar by'►apoeo w pay e~otet~id► S"Ps" ±syl i lirr and a.iaaMr+~a~ pseeims-vibele'rP , F #]1tsaM w:T tot ~ wbea dus. 'Such amouats 1 Ierlaaaa i liilwtspieaF wlil to dwasked bats an uarov► faced or •tsa tea ~ ~1s a '.Beet rli i asi ari aspeld balwi w at the, tab* 1 .40 SwF . ' pr•r~a>'•. at #ny th" as , r. la► lhaal; _d a~► tbefll eoatraet owl not be teeated }s in ° a4ee a labSee of ad interest (and,is'snch Case aeeua+t'iat+reets dMl i) is tlmn the imuvt that odd indebtedness would h*ve.beef :w &A ;VnVWd that amthly panvi ode shtlY bs oslrfintted )ik, w d: the aandeasaed premiass bob* tber+esitwr Parebsiw e"tbd Airehom b wtislled witli `tba title as shown by the gale ` Vj, !hu!fr ] ..~it~►glysf the caya Off `future title a_v~ifdenseIf" Litle evidencq,ls in ` f t ,a 600040d40 tike passmasho *f the"ProoottY or1Y . .•!i'diY ~u t 41, H z a ' ST C- 105 r H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z t7 9 SCd H OWNER /BUYER 4) ROUTE/BOX NUMBER ~3 l~P Fire Number CITY/STATE v cx_ -S ZIP l ~L PROPERTY LOCATION: Section, T 21 N, R l7 W, Town of 1~ma& -Ai , St. Croix County, Subdivision f~/ Lot number . I 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. yo I/WE, the undersigned, have read the above requirements and agree cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ov 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. II,, SIGNED DATE / W q I 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.