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HomeMy WebLinkAbout034-1049-50-100 4 0 ~ ° I r\ 03 °er~ I N O C C a a 0 O > O o ~ N Q C ~ O m E 0 v, O L r Co h a ~ y OT O CO a C Z E 7 U LL c y O E N D C Q U d O N Z tl! NLn Z 0 LL L z 0) d d a m N F- (n c i O O 2 d c O t} 2 15 fn F- O CD z C N E -O a) co d ~ N uJ L C • N O L C 4 U C O O o Q C.) Z F- Z o N ZI 00 Ci N ~ E - m CL M m 11 }~}yy O C m C7 ° a v L ~ o ° G a a~E i N Z j U H H H 3 E N 3: a U) a 0 0 0 0 Z 3 a a a c a g _v O N O O O o N J U Q) 0) a) ty Z ~l Q p p w N O r- ::D E 04 M C=01 O 'C y C7; O 00 N ❑ O O 0) w 3 3 y 0) U) c -0 E C) 0 C h Eo o 0_ o m :3 y l o v, v d° p ui v v c u~ E v a V u' M a v E ° .o N 0 r- 7a co N o- O• N C O E • V y O N (n ! U) O Z i Cn O ~ I E eke w m 4) M CL • a d u Lm 0 r`1w E 'E c 3 r A 0 a j'' o c~ 00 SAFETY & BUILDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AND INDUSRY, DIVISION P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION SECTION: TOWNS HIP/fvirdAl~4lPA~IiY: LOT NO.:BLK. NO. SUBDIVISION NAME: i , 1/4 N/R j,`elor) W al ! - I --I 000NTTYr:, OyW-NER'S 819i~R'S NAME: IWAILING ADDRESS: VC_ GLr'N 4,10CdG' l f USE______ _ DATES OBSERVATIONS MADE j _ NO.BEDRMS.: COMMER IAL DEESCRIP/TION: v IPROF,ILE DES RIPTIONS: PEATION TESTS: ue LZ/N nhLh vyNew FiReplace I y/ Z:F /..Z /G> RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: rYSTEM-IN-IFI L L HOLDING TANK: RECOMMENDED SYSTEM:(optional) s out IMS ❑u as au EIS EXu os Zu ~o If Pr-rcolazion Tests are NOT required ESIGN RATE: If any portion of the tesiad area is in the under s. ILHR 83.09(5)(b), indicate: MAN. 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.Hl HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) > 7, /Z 44 L, kl-Atv med-sc* B-__ 7, #A ;;V, 3r'B.vSiL~dAifS S"c~~s'El/~, / % •d ' B- 7,2- f 7,9 /Ve • 5 2 ! BBL 13°. da / tied S L_ B 7 ♦ r r Y o L . ; L~ /_t co, I B_ PERCOLATION TESTS I TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES (NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD-tPERIOD2 PERIOD PER INCH P- 'P 'LOT PLAN: Show iocations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction an-d~,-percent tf land slope. M , A0C &e i/ 47 SYSTEM ELEVATION 9/, 6 .si-ave-Y P, e yy, P3 - (7y- yy g2 h 30 II pi ILI ~`4` 1 4r11~r•i.f e~ 4tis~ j ! eb 31o t-H S.t tlo mi.asupu•.1, Iw5eby cattily that the soil teats reported on tills form w~:rr ni ule by nil. 111 accord w11h4ie ploceduies and methods specified m the Wlsconsm "+nunrstlat,ve Code, and that the d; w recorded and the location of the tests are,correct to the best.0iftfy knowledge and belief. AVIE ipllnt): NESTS WERE COMPLETED ON: _ F~ s M i~1f'f~ _ -a- 2 - aDDRESS: - CERTI ICATI N NUMBER: PHONE NUMBER (optional): ,CST SIGNATURE: 1 ;tSTRIBUTION; Original and one copy to Local Authority, Property Owner and Soil Tes!e1. ~iLHR SED-6395 5 (R. 10/83) - OVER - . ~13y-ia1 S~ o Ct?_ ~c__._ a9x! 1~ r OCT101990► 2 JAMES O'CONNELL Regi9ter010eeds 3 463115- CERTIFIED SURVEY MAP Located in the SE 1/4 of the NE 1/4 of Section 22, T29N, R15W, Town of Springfield, St. Croix County, Wi- OWNER: Merwin McGee NE Corner 2581 170th Ave. Section 22 Emerald, Wi. 54012 T29N, R15W UNPLATTED LANDS o SCALE IN FEET ` I I 0 100 200 I 1 S 89°53'36"W 376.08' I 6 ' I (1"-100') 33.00' 343.08' LEGEND 1 0 I -0- Section Corner Monument 0 1"x30" round iron pipe - z weighing 1.68 #/ft. set o O A Existing well ~ 8 ,W O iit" - Existing fence i o LOT 1 0 Io o, N N oQt~ltib.: awev~d ; 174,243 Sq. Ft. incl. R/W (4.000 acres) 0. ;En 'A rt 0) ON 158,952 Sq. Ft. excl. R/W w :m w r JAM u, (3.649 acres) '.n Irr Ln (D 45 Ln 10-h r~S o UdSon ® i I E Z rr ::s' ° W1~t N 0 (D CC 'Z, N S U (D K) (~DD 10 OMWri IM z 0 ~ ft Dated this 24th Day of August, 1990 i 0r I H. 4-2 661 0 4901.11' + 343.08' 33,00 o _ 1 W Corner N 89°53'36"E '376.08' *a Section 22 E-W 11-Section line E 4 Corner UNPLATTED LANDS Section 22 _ - T29N, R15W Surveyor's Certificate I, James E. Rusch, registered Wisconsin Land Surveyor, hereby certify: that by direction of Merwin McGee, owner, and the Town Board of the Town of Springfield, purchaser of the following described real estate, I have surveyed, mapped and described the following: A parcel of land located in the SE4 of the NE4 of Section 22, T29N, R15W, Town of Springfield, St. Croix County, Wisconsin, described as follows: Beginning at the Ea Corner of said Section 22; thence N 0°48'20"W (assumed bearing referenced to the East line of the NE4 of said Section 22, bearing assumed N 0°48'20"W) 463.35' along said East line; thence S89°53'36"W 376.081; thence S 0°48'20"E 463.35' to the east-west 4 Section line; thence N89°53'36"E 376.08' along said line to the point of beginning, containing 174,243 square feet or 4.000 acres, more or less, and being subject to all easements, restrictions and encumbrances of record; that the attached map is an accurately drawn representation, to scale, of the above described; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the subdivision regulations of St. Croix County to the best of my professional knowledge, understanding and belief. This instrument drafted by J.E.R. ` VOLUME 8 PAGE 2280 Q Q'~ M10 ! 5T, crzoix c0 NT%1 r1Srv C13M1?: Wt gSJVC- PArakes PLAN . it~r l~rc,(-0.AAiIN- f w _ - FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER,' TOWNSHIP SECTIONT N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE" PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTE , 7e 1 y INDICATE NORTH A OW BENCHMARK: Elevation and description: t-e Alternate benchmark /i SEPTIC TANK: Manufacturer: Liquid Cap. .rC~' tea' Rings used: 0 Manhole cover elev: O Final grade elev: Tank inlet elev.: ,Fo Tank outlet elev.: 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 Manufactu er: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: P Size Elevation of inlet: Bottom of tank ele ion Pump on elev.: Pump off elev.-i allons/cycle: t c5 Type: Location Alarm: Man.: Sw,* Distance from nearest op. line: Front_, Side, ar_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench:--.4---Seepage Pit: Width: r Length _Number of Lines: •,c~ Area Buil Exist. Grade Elev. .l Proposed Final Grade Elev.' Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side \ , Rear Ft.P No. feet from well: No. feet from building LZ~HOLDING TANK Man f acturer : Capacity: No. of gs used: Elevation of bottom Elevation of 1 t: No. feet from nearest p ne:Front , Side , Rear Ft. No. feet from: We , building nearest road Alarm Manufacturer: Y INSPECTOR: DATE: 1C S PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj ,4. Qo ao /~3 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION L LAB BOX ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION P.O. 7969 ° [f 45; §6 C , 2 2 , T 2 9 - R 15 State Plan I.D. Number: A CONVENTIONAL E:1 ALTERATIVE (If assigned) Town of Springfield 310th St. El Holding Tank [:1 In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Town of Springfield 13028 100th Ave., Glenwood City, W /'-~/IOAF) BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CS R . PT. ELEV . Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: A Gale Smith 5690 St. Cro' 128872 CN SEPTIC TANK/ mil1@t8aN8;FAAk:z&&"k: -I a.r = 5 ' \"b MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK O - WARNING LABEL LOCKING COV i PROVIDED: PROVIDED:, a G ~d~ 5(o YES ❑ NO ❑ YES fffNO BEDDING: 77 C. VEhf•F MATL.: HIGH WATER UMBER OF ROAD: PROPER WELL: BUILDING: VEN 0 RESH C. J' Q'C7, ALARM: FEET FROM LI~ , AIRIy~ $ YES ❑ NO ❑ YES NO NEAREST ~l~ MANUFACTURER: BEDDING: PUMP MODEL: PUMP/SIPHON MANUFACTURER: RWARNING OVID DLABEL PROVIDED:OVER YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GAL S PER CYCLE: PUMP AND CONTR SO ERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH (DIF ERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES 0 NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing RCE LENGTH: DIAMETER: MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAI the soil is dry enough to continue CONVENTIONAL SYSTE S ~s 5r? fz L WIDTH: L NO. OF DISTR. PIPE SPACING: COVER tOf~ # PITS: LIQUID BED/TRENCH / TRENCHES: MATERIAL: DEPTH: DIMENSIONS 37 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL: N . DISTR. NUMBWELL: BUILDINGVENT TO FRESH BELOW PIPES: ABOVEQOVER: ELEV. INLET: ELEV. ENDPIPES: FEET FAIR INLE~ NEAREU 5/ MOUND SYSTEM: Zit~ 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 TEXTU PERMANENT MARKERS: OBSERVATION WELLS; E:1 YES El NO ❑ YES ❑ NO DEPTH gVn TRENCH/BED DEPTH OVER TRENCH/ BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTkP: EDGES: [__1 YES ❑ NO ❑ YES ❑ NO YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRNO.OF ENCHES: LA AL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOV OVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE ]FOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIB N PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MA VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: y~ ~L£ ,/Ced ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Re in in county file for audit. Sketch System on Reverse Side. RE: TITL SBD-6710 (R. 06/88) c 7DIL SANI TARY PERMIT APPLICATION 00 HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STAT~~TAj,Y RMI # -Attach complete, plans (to the county copy only) for the system, on paper not less than ((ff((~L 8% x 11 inches in size. ❑ check if revs on previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION a &o 'p ® '/a, S o TcZ 9, N, R 4W or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # o ;2 - Ave CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY s j~J~ iIy NEAREST ROAD ( ) State Owned VILLAGE : d ®f/~ ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TNUMBER(s) 1 O cf? - 57Q - III. BUILDING USE: (If building type is public, check all that apply) O 1 ❑ Apt/Condo 2 R Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 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. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 300 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.) PROP( ED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) gELEVATION I ~Q JQ / C~ / / CZ O U' Feet /,7.- O Feet 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 19 LU Lift Pump Tank/Si hon Chamber 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: 6~ 4,4 e 1v 6-M1 r7` a G~ - /~1 ~yo ;z6 " Plumber's Address (Street, City, State, Zip Code): IYA-AV 170 (5;Ve2v&,,00o1 Lit IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary rmit Fee (Includes Groundwater Date ssue Issuing gent Sign lure (No Sta s) Approved ❑ owner Given Initial Surcharge Fee) /a O Adverse Determination 11, X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a 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. k 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 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. III. 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 systE'm. 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 the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) • APPLICATION FOR SANITARY PERMIT 9TC-100 This application form Is to be conplatod In full and signed by the owntr(s) of tht property being developed. Any Inadequacies will only result In delays of the pzrmlt Issuance. -Should this development be intended for resell by owner/contractor,(spec house), than a second form should be tttalntd and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property _N- 1/4, Section _ 2 T.-R /yZf`_Y Township Mailing address .~D u ~D4~U2 Le~y~a 0 ~L1 i✓ P Address of ■itt _1 ~~Lw~•a~ _ ~_I~; subdivision name • Lot numbet Previous owner of property _ ~►1~.7r~. ~i~, _ .17~ Total slit of parcel 4 d wz° Date parcel was created Are all cornets and lot lines identifiable? ~_,Yts = o 19 this property being developed fat resale (spec house)?_ as x1_ Volume nd Page Number as recorded with the Reglstes of Deeds. w--w-w-.rw----------ww-.uww----.w-w-wwww------------w--ww-w----ww-ww--- INCLUDE WITH THIS APPLICATION THE FOLLOWING1 A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAOE NUMBER, and the SEAL OF THE REGISTER OP DEEDS. In addition, a certlfltd survey, it avallable, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Ceitliltd survey Map, the Cattifled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1(Ve) certify that all statements on this form art true to the best of my (our) knovledgel that 1 (we) am (ate) the owner(s) of the property described In this Information form, by virtue of a warranty deed recorded In the office of the County Register of Deeds as Document Ho. 1 and that I (we) presently own the proposed site for the sewage disposal system (or 1 (we) have obtained an easement, to tun with the above described property, for the construction of said system, and the same has boon duly recorded In the office of the Coyn y aeglate of Deeds, as Document No. slgnatu • o Owner signature of Co-owner (if Applicable) l Date of signature Date of signature • SEPTIC TANK MAINTENANCE AGREEMENT Ct St. Croix County ~ w OWNER/RD'N /d/N9 o /~n 7`~/ P s ROUTE /BOX NUMBE Fire Number 0 RS „ t7 z~P ~0 /3 * - o CITY/ STATE 6;t- r PROPERTY LOCATION: k, k, Section ` ;l T,,2- N.. _5-V. Town of , pg'//St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed's'eptic tank Pum2er. What you put into the system can affect the .unct on of the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-may be eligible to recieve a grant for a maximum of 607. of the cost-of replacement of a failing system, whit 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 .sys'tems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or_.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2).after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year-expiration. H I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- w ment of Natural Resources. Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. I 1 ~r►~~ SIGNED C' / , yu DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTR-Y, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) iLOCCATION SECTION: p TOWNSHIP/MW4W.4 4.w- Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: 6,E 1/4 Wo=- V4 ? or) COUNTY: OWNER'S 9'S NAME: (LING ADDRESS: dG' vc-- 61- z1V4.10 0 USE DATES OBSERVATIONS MADE NO. RMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: r-, ~ D Replace H. ;s Bence New RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-P~R-EISSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ~ S ❑U ® S ❑U ZS LJU EIS ®u ❑ S ®U e-eyy y G'A/ rze A/ A [under Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the s. ILHR 83A9(5)(b), indicate: /4//V. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- a 4#9 4 r of L :L _~:''d~fs S"cis''' 'd If Jr B- idAl 14 Col" 1 1B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD PER INCH - ' ; - -----L-- P- .2 Q p 3-v 3 P- Y Lam' P- LO1' PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ontal 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 A land slope. ,M /cc, 'rc) R 0 F, j/ YSTEM ELEVATION 9/, 6 W pwelpe r Lue ?e"q et Si. e, -V/, y.j-, 76 F3 17 5491 'T -!jw- r tr ~ the undersr.7rux1, hereby certify that the soil tests reported on this form "se 5nftde by rnn irvriQcorf}~vit ie procedures and methods specilied in the Wiscorisut administrative Code, and that the data recorded and the location of the tests ar ctSrrX't to the best?QNr+J/iowledge and belief. a 'ANIE (print): NESTS WERE COMPLETED ON: DDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. )ILHR-SBD-6395 (R. 10/83) OVER - pAc~ e ' r rff?~~B'cs t.li.^t/ ~tl/7 II This I rr ri` st :d G rYE y i C,f;de "o appfovZ,A is AM /0 0 ~x►Stik~ ~~eLL /n©v GhL YePr,C r4 NK NA~~ JAI) N, I/© f e d v N t0 q 5 A Pl- L 1`w / 9"n.. y~'jL..L .yr 37 - - - - - pe , "c') RN te- d P lac' !f v e- pt~~, a l P,4,fe ,t C SS' G'rlorY " V6?ty ,xJ3 © D C C) O ®na © I ed U C~ sy~ te~ DA 21-4 /ooo GAL, C li R /VIPtN~O~Ae t~~4~a by: ee mss' ON a Re re ~',~r'C W 77.s /vE? ~ 0~ iC hi ~ d ov o; 4.+ 0 . ,S`"ay o y Se p t ~c rA N /f' CAA ss 2. RAt -~p~`~y~~ •~©Y~~~~$'~~v ~~~~ssry X3..2 e` ~c'RSoAl C.4/',4 S%fl~y~. 1--4v0 R afl~AiN r ld`W t',1_,,4 0_40567