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HomeMy WebLinkAbout038-1066-40-100 'a CD m 03 °a et C N N p C ~ N ~ W m Z I O CL i;~ w v; h ~L M m N 5 ,a o = z n € I c U. a~ a 00 m E ¢ r°n w m I v I O M CL H I E o v z € m z a co _o I c z o Z m z ° o H E 'Z° 2 M C N y N N M U) ~ CDJ C • 4 L = O C O Q Z H Z 0 N 0 ' N M ~l 0 N N ` C W o O L O a, d° G G a ° o a5 Z •N CL CL CL N E c) cD to J V fn rn rn Z ~i fl M * CD "Wail N co O N co 0) z L :3 N 00 m W C d O V1 N m ~ m Q (n o I l~1 ~ O I~ 7 r I 11~ C) 3 N N C O N CO Q O _p O N C 7 O U') ~ y N C U) V 4. c N co N C E to C C C E 41.1 O M O d O f~ 00 C> r ~ M O p LO E O N O U • lF~ra o f/~ d o Z O Z:9 ~L (A 0 I V ~ a . E ` c c ~1 A c°~a~ '',ov~ci FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER.M4'k l~E,88~ ~.eT-G1So~✓ TOWNSHIP -s Ae ~iP1f~jP~E SECTION T N-R /a W ADDRESS ST. CROIX COUNTY, WISCONSIN ~d e~ SUBDIVISION LOT LOT PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,U/4 Aye oT QL~N ff TTi~e~LS`~' INDICATE NORTH ARROW 3oTTo," EDGE o~ Si~in~ G- 4 T I~ BENCIDIARK:Elevation and description: Alternate benehffi-ark. ltllcc51'p'e- OF 11-160-r& r _ SEPTIC TANK: Manufacturer: Liquid Cap. X040 Rings used: C, Manhole cover elev: ~9 oL Final grade elev: S S Tank inlet elev.: Tank outlet elev.: Ic 7. 2-'7 No. of feet from nearest road:Front X , Side , Rear Ft. > 30o > SO o From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well 3 -1 Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: uid capacity: Pump Model: Pu Sipho Manufact.: Pump Size Elevation of inlet: ttom of tank elevation Pump on elev.: p off elev., Gallons/cycle: Alarm: Man.: Switch Typ • Location Distance f m nearest prop. line: Front, Side-, Rear-Ft. Dista a from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: X Seepage Pit: Width: S Length 75- ' Number of Lines: Z Area Built ' L 3 uPPc2 TrZ- 44 yo.I? 9©, o . Exist. Grade Elev. 90-o Proposed Final Grade Elev. Pl'? 3 Go406-2 rZe-w c <L B Yc~ Fill depth to top of pipe: Z D U~ So 6 No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well: No. feet from building 72- HOLDING TANK Manufacturer: C acity: No. of rings used: Elevation bottom tank: Elevation of inlet: No. feet from nearest op. line:Front , Side , Rear Ft. No. feet from: We building , nearest road Alarm Manufa rer: Z INSPECTOR: 1114 ~~l _f'D DATE: / 0 PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. N0.00663 v6 445 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETIr& BUILDING DIVISION LABOR & HUMAN RELATIONS P.O. BO,7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE 4, SW 4, Sec. 16 ,T31-R18 El CONVENTIONAL El ALTERATIVE (If assigned) Town of Star Prair ❑ Mound Holding Tank ❑ In-Ground Pressure E ERMI HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 0~ ers 2144 104th St. Somerset WI 54025 ENCH AR (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL V.: CST REF. PT. E 3 ~r c?7 Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: 0 St. Cr ' x 135543 SEPTIC TANK/ MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVF~R~ PROVIDED: PROVIDED: J~ItLJCS 1 c~ct ~t ~D 9 . •2 7 YES ❑ NO ❑ YES NO BEDDING: NTDIA.: ~T MATL.: HIGH WATER NUMBER OF ROAD: PROPERT WELL: BUILDING: 11 VENT O RESH C.O C -0 ALARM: FEET FROM LINE / ~7/ / AIR INLET: ❑ YES NO - ~ ❑ YES NO NEAREST Bala. MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARM PROVIDED, LABEL pROVIDED:OVER ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VIER TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE: PUMP ON AND OFF ❑ YES ❑ NO NEAREST -1111110- 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 R. PIPE PACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH / qA►✓p,... TRENCHES: MATERIAL: DIMENSIONS GRAVEL DEPT q ILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPEMAT RIAL: NO. I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH r f "o..i t? PIPES: LINE: , AIR INLET: , BELOW PIPES: BOVE COV R: EL ET: E D: OM FEET FR 6=S!"_Z73 _jo Ar. Y NEAREST~~ S 9a S MOUND SYSTEM: r.,o bz 3' 3.l0.~ 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: I E ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND 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: LINE: COMMENT: FEET FROM ❑YESE] NO YES [1] NO NEAREST S r ✓ ~G ~ lY f I J,. 1 7 Z) P ?D QTl n 11-fn.C~,t,.'--/ tcr~ y '.~-r~,a,K-~- ~lCr t.:-., I i ~ t etairl)n county file for audit. Sketch System on Reverse Side. SIGNATU E: TITLE: SBD-6710 (R. 06/88) / " ` SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 3- 7-- C/l'O/' ITDILHR STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. C ec if revision previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. Al, PROPERTY OWNER PROPERTY~LFION p '/a '/a, S T 31, N, R If E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK 2-14-4-- D¢ 4y,► S T' CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Dot 4Pf 15-402-5 G 27) ! lP,4ie 7- 6 D ,g &e II. TYPE OF BUILDING: (Check one) ❑ State Owned 3 viLU4GE • NEAREST ROAD ~7., . e-xw ❑ Public K 1 or 2 Fam. Dwelling-#of bedrooms - AR EL Ax UMBER( ) III. BUILDING USE: (If building type is public, check all that apply) QQ S5 1F] 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. N Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E1 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 Z~ S g~f S -7Y / VI. ABSORPTION SYSTEM INFORMATION: 949,0 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM EL 7. FINAL GRADE ~ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals//day/sq. ft.) (Min./inch) Y4, F ELEVATION / / _o ~ -0 750. tp L Y `7 ( se, 3 F e (9F• 3OFeet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed IF I Septic Tank or Holdin Tank ~D 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) PRSW No.: Business Phone Number: AD&-W 7- 2&~n le'_4 rJ33 ® 7 '715 396 Plumber's Address (Street, City, State, Zip Code): S75 O ) !E-/ Z_ A)~ IX. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued issuing gent Signa No S Surcharge Fee) ~J Approved ❑ Owner Given Initial Adverse Determination 4~u'2 rel. 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 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. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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 a/i 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 191 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; close 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 8TC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - Owner of property Location of property ~ 1/4, Section T f N-R ! ZW Township Melling address 2- AF- 7- 57 Address of site 094.1- ;Ot/ e4- Subdivision name 0 f` Lot number 7` 'OF Previous owner of property Total size of parcel o i S Date parcel was created I--- Are all corners and lot lines identifiable? Ho Is this property being developed for resale (spec house)? Yes _No Volume 73 and Page Number z 5 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 sous to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (out) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 4/ 6 47 C-2 7 ; and that I (We) presently own the proposed site,jogthe sewage disposal system (or I (we) have obtained an easement, .to Sun with'![* above described property, for the constructloA- gt;; KAM system and the same Ua been dy(l~ycorded in t Office oE~ n %y o le mn-so document No. 77 1. Signature of Owner Signature o Co-Own (If Applicable) Date of signature Date of 7 nature 000UMENT NO. STATE BAR OF WISCONEN FORT[ 6-1M w } Au asesavsa roR se?eowol9Ee owTw PERSONAL REPRESENTATI S DEED 133PPAGE 226 - RgGISTER5 OFPIC~ i{rl° .a , ----3►~a.A Sk W ST. CROIX CO., W18e~ b ' • as Personal Representative of the estate of ' Reet for Record this 27th ; C^~ Sand - 12:50 P p.< 7 r° ("Decedent"). I • for a va' .uable Consideration conveys, without warranty, to N Michael 'L. Peterson the following described .real estate in ......St. Croix Grantee, I~ *[TURN To ...............County. f It "An. State of Wisconsin (hereinafter called the "Property") : ¢ Northeast Quarter of Southwest Quarter; East Half of Northwest Quarter of Southwest Quarter and West Half y of Northwest Quarter of Southeast Quarter of Section 16, Tax Parcel No:..... Township 31 North, Range 18 West. i f ! FEE + Pes'aoaal Representative by this deed does convey to Grantee all of the estate and interest in the Property WWfeh the.Demdent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the i C Personal Representative has since acquired. Dated this 27th day of -_._....._.Februar y . , ~I ......................(SEAL) L...c.._:t.4G........_(SEAL ~A Cf Muril n 0 Skea h Pena9oal Representative J Personal Representative AUTBENTICATION Ij ACHNOWLBDGI[BNT Signature(s) STATE OF WISCONSIN as. authenticated this ........day of C.._.GxQi?F_................. County. 19 Personally came before me this ebruar -th•i l...day of F..._..........y...._-.._............, 19.86.. . - named ~iuriyn--0, Slceathx Persona,,:gtative „y e of the Estate of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, V.`e. - A authorized by § 706.06 Wis. Stats.) - • to me known to be the person sv}lp`eaecuw the foregoing instrument and acknowledge t y, THIS. INSTRUMENT WAS DRAFTED BY • Q ~t f: Samuel R• Cari of HEYWOOU, CAR1 & itURRAY. hn ll. a od 1-071- P.0 'Box 229, Hudson WI 54016 • - St. CT011.7c Notary Public (Signatures may be authenticated or acknowledged. Both My Commission is ""•'•••••••__county. Wis are not necessary.) permanent. ( 7tbOkXafitstzahmag E 1 kn.. alit:........ , 19..:.:....) a •Navm of persons siroing in any capacity should be t)i-l or i,rin" below their eiKnaturon. w•~w~°a^!'?'~'Rns a nRRT STATE: IIAR OF WISCONSIN Wiseonsin lAsa1. H1aNt ~q, j,,, . ' . FORM Nw 6 - 1963 M - - 3fawwlue, wi~.~: .s., a.,• ;:eSc.kT'-~ r i. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /"`l/k ~ ROUTE/BOX NUMBER FIRE NO.< CITY/STATE J UJ"1[.S~_T ZIP J PROPERTY LOCATION: /1,1L1/9 5 1/9, Section , TL.? ( N, R 40 W, Town of St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Res ces. Certification form must be completed and returned to the St within 30 days of the three year expiration date; MSIGNED DATE / St. Croix County Zoning Office, P.O. Box 98 Y Hammond, WI 54015 (715) 796-2239 or (715) 925-8363 Sign, Date, and Return to above address • DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 573969 HUMAN RCLATIONS (ILHR 83.0911) & Chapter 145) NO LOCATION i.-1 SECTION: TOWNSHIP - Pool, LK. NO.: SUBDIVISION NAME: / ~1/ /6, /T3/ N/R)9E,o►W sPRAI~i er of o .9cte COUNTY: MAILING ADDRESS: Sf~ ~o%X MI'k,e~ DFt3131~ ~eTeRSoa ion ~T 50MERS&7- wIS. 5102 USE Z ItA DATES OBSERVATIONS MADE NO. BEDRMS : COMMER IAL DES RIPTION: rte, TESTS: [PROF1 LIE DESCRIPTIONS: IFERCOLATION VoResidence 3 N, A El New A I Replace J A a l C a C CO RATING: S= Site suitable for system U= Site unsuitable for system ✓C ID A "1E R y S, ONVENTIONAL: JMNIN-GROUN~~``DPRESSUR E: SYSTEM-IN-FILL OLDIING TANK: RECOMMENDED SYSTEM: (optional) OS ❑U ES ❑U ©J ❑U ❑S Elu ❑S au )ST,-£/rutT oaf w/ bkciP 6l( Z i 1 0 Traw 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: G 1_,,t,5 S Floodplain, indicate Floodplain elevation: 0,u7e-iQ BEST 'O-caA 7744 f' SuAJAJy .30o F I F'RoS T - XN~ R Fa2e~r L4At e'dOtt PROFILE DESCRIPTIONS r,, BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED 17H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ~p pZ' s' ~r RA -Gy. SO l .9, ou-sy ~(octr s;., a(ocKy ~ I i, G 7 ' 12 "ec- OR S of, . SAy0 51P+TA-- I'0 ' OP, . -F'-' S. w1 AhNvS of B- `~~"`SL S Si 1 <n tt LL P B_ 2- 7, 6' X2 C,5-' be a - tsy 51'i ,.S .a~ -5Y. 6lockY Sr ~ 167'0,p- 4 - Qa focK 51 ' 1 OR CouR oo Sl B ~k~ Rya i`t0 t S B- 3 7, Q 9. 30, Dr R ~ ~rY 5i'I1 1,01 BN- Sy Q(ocky S.% S' o,~ 3a C lock D o o C V s' S~ 40, B '"."c -fcv..e Sy-3,.3 Sr•! 4"1 f-C., smkit At4-oR "tafs . su~pfq~t f~ev. of F~t.P~S PERCOLATION TESTS (aosF Goc~RSE S~ STipti t~S TEST DEPTH . WATER IN HOLE TEST TIME DR I WATER L V -IN H RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P PER INCH P. -2,5 PP-P' 30 I `/ice s I Z Co. P- Z 3. -)co- y Z. • 7 ~ o * y s ¢ 00 P. 2(6' 12. 3' rr 3 Jh/ r, 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. J) ~Pj ~ Mr'OGZ'.E' Ti(~E'tiGGL = b " SYSTEM ELEVATION. La_c... _ T E.~ c = i I I r + i ~ t fir' Q~J j S i TEr f t 'C A TI'DAJ Ot= 0IZ- eV 7o,r~ IV es-IL5 o I - 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): - TESTS WERE COMPLETED ON: HO.'JESITE SEPTIC PLUMBING CO. 655O'NEIL RD., HU_DSQN ADDRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Z Z/ F Z • DESIGNER LIC. N0.00663 CST SIG~~E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 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J:>a,Yle 'Ban ~ ~H ~ f l • Uw P„ ( awo < • C ~ - ~ 9i ~Drsu/.. ,lo iru ~ ~~ti zco "'<vo Y ~ va z ti6as l a y b kV/er e r f y y~G T Ab1E ' Z, 7 N b 0 States _ ~O I. ` ° U _M i/.sf V - .U2-72 _ . v.o m & a fr wa a tlo 90 Cc ss Co. W .1 o o 'S•q "d ~~Q ~ 3 ~ n &Kk T! 9~r) \7e~ +y U 1F ~m Jrl.,na L L_>.-u ...r Nd AV • s Iw~he/k de, C ;zc~ Zas~/ .8a' A F/E j~ I µyR[` _ i 79 runt/s . h use c ~N q.~ 1/~• c /9a/ L 64 P so L ~ Si . I O c. = I 'o ~ eNYO C a ~ a, / % _ . _ / G / ~ lC=cx{~f ° •+~ra'. o ('.r ✓o..sc• h ~ ~v'C Ruse// l t=-ay ,1 v. a _ •.,y erg y~ 0 vU-~ F/vidr/ck, /rz y a x/o ~I ~ 4t o ,E:varst ell. /eB h .I 1e2v°E. yo%Ea '~93 nF~ i ,.i r. p,C yti H;a t+IikJ-~c-fE ~`2.:. JEW R...'1.~ yrags< ,(~.wc / ~;h vti;1„tom of .:.sl1 c r! .zt 5 cs~ W T.Lca! SM 64 ro'8472 R.K wµ;r f Cain/ 1 .•i'c t t .>n N.~, rr. cta/ ; C~~ f~ 61 ,.r D+ns do Q /[.v ~ ° „ so, .•zd CsrF?y B.> . O I tl /5d5oc~ /"'7. Q{ 6 s nr. QI I /do TMTH,~- SEE• PAGE 43 AVE. c5•f G'roix C nt<-y w.~ SEE PAGE 53 D,S BERNAR NORTHT+OWN UTGAARD'S HATCHERY HIGHWAYS 64 & 65 NORTH POULTRY BUSINESS SINCE 1901 NEW RICHMOND, WISCONSIN 54017 year Round Poultry Service POULTRY FEED - EQUIPMENT - REMEDIES PHONE: 246-2236 Phone: 248-3200 or 248-3209 TWIN CITY rt luiysi... t] STAR PRAIRIE, WISCONSIN 54026 • j PHONE: 439-2905 . + 4t w f 'r 1 WEll Huvsc ,/1,,11yy y/ f rt,J (6v' l I X4, 1 / 0 nRdP° so) wkll ~ , 9 25 ~I~S ~EaT f 1~ , i OF ~yST• ~ ~~pQ ~ ~ II, ~a - IJ P34cHo L~3o~Pi%vs - E,< t'S r l,9 g Qr~a'r` VeR7,. Re F. p I 1 d► (3 oT'rnt, EObe i~ kyt'3~D S I DIa G- - E (E u ~4, 1 gp, ,40 s . 303 y ~~c 1t I v L.~ ~D~ 1! r G` o i II', 4 ?~~T pL : HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. SaS ROBERT ULBRIGHT C S zYPL WIS. MASTER PLUMBER LIC. N0.3307 M.P.R.S. I-AINN. INISTAILEA & DESIGNER LIC. NO. 006M j .~i rresh Air Inlets And Observation Pipe Approved Vent Cap 1 Minimum 12"Above ✓ if Final Grade j t`1 4" Cast Iron Above Pipe -to Final Grade Vent 'Pipe' Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution 2-1 T Tee pipe o 0 0 o o Aggregate l o Perforated Pipe Below Beneath Pipe U 0 Coupling Terminating At' Bottom Of System s , V Fresh Air inlets And Observation Pipe -Approved Vent Cap Minimum 12 Above Final Grade 36) 4" Cast Iron Above Pipe Vent Pipe' t -to Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution ? T~ -Tee Pipe o o 0 0 0 , Aggregate Beneath Pipe o Perforated Pipe Below o Coupling Terminating At mono - 1 Bottom Of System d7 (.0 0- zl~ S - V i L SLOT ~G, /0 37 1 ~ - i , Z o Y'~ G r I 1 - 1V07-f .PtcG~r,POid Cr r1~~f vOD,~-~r ~ Tj Ems. ~EF nF r o/J STi~ T~v f ~1FTfz i.~~t~F v µ ~Q6 ~ O~ uti/ji;OG G~if S ~f cc,^~,u Et?I<v ~ `n~% l~° a~ -r r?oH ot~ f ~oo~e De.+l~, - T a ti,n.<r SSA' : /oo,o ''I ~3 rvv . ~~v~ M New sY STS H , AA, /~JJrr'~~ f S,De wltbl Gf BriSE~+t.~T - DldL l Tfoe- I©c~vttD y i f Fse~ ~3 y &-4L cf► Ott ,A., - 13 r aY~s pwKt~t~ GB " , 63 Pe R°X - - s 's aSPECtIo^~ Q~~ , - - - ! '7 ,oc ct" Co g7Z s lop o~ p~. 30 SGT 1) ),1 po c PEpf- ~evt~D w~~ syarf~2 c f~ ~ c \ • ~E y.Qfi7~ S lcJi4cfrO 344 • ups rtQ~a~- ~('~~~s ~s r v,',~ / NOMESRE SEPTIC PI.WMW CO. 656 O'NEIL IS., HUMM, WIS. 6 016 ROBERT ULOM14T WIS. MASTER PLUMBER LIC. NO. 3M7 M.P.R.S. eAINN. IN6TALLER 8 DESIGNER LIC. N0.00663 ~A 2,,~l 7 3,JQ S v a r 14D f111 ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUS USTRYY, , C DIVISION LABOR AN P.O. BOX 796 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP OT NO.:BLK. NO.: SUBDIVISION NAME: Aji_: 1/ SE /6 /T3/ N/R IF E (o) W Sr'l P_ PRKI RiIE- peer of 2 o 4 e4-(e -14.e,y COUNTY: MAILING ADDRESS: S/ Go;X MI'kz' DvaRi~ _PeTERSo~ z/ ~y ~O`rL~~ ST 50MERSz wIS. 59oz S USE - 2"7 DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: rr~~ PROFILE DESCRIPTIONS: PERCOLATION -TE-STS: Residence 3 ❑ New .LV Replace ( ~->4 l - I `j !o d Tj( A3 . 1 0 - / 50 S RATING: S= Site suitable for system U= Site unsuitable for system sC S DO I A I-%E R -t ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ICEIS ❑U O S D S ❑U ❑ S DU ❑ S DU YST~ Fi n,T "S tv/D aOP fS T t O TtaN 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: GLIt,ss =7 i I Floodplain, indicate Floodplain elevation: tu;N7't4 7eS7- 4bvAr77o-vS ' SUau+y .306E I " FRost- KNDeR FoRggT LCA _ e^6VZ - PROFILE DESCRIPTIONS ~•a 17~Gr'rlfiL- F T', BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / 16.5 ' CV ~Z S ' De- as Gy. 6i I l . S ' 00- Sy. 131 oc tr SO , p3' Sy. Bl OCk y _;1V- 5. S DR 5 aee.,l¢ 2 or, % 5.4017 5 Tit A-TA,5 I, D' o R. T N ~I S. ur Q A-,0 S o f B d"-~e 5 Y. Si +t LED •G7'o1p- B- 2. 7. 6 192 C, S I,S'B"-5Y giocky S'//, 0' Block SI ' ' oR co OR loo S/ 'DA'A ~-t Fie ~{/-B,~ . sal w/ nk SM ntlL B- o!?- It a no rt s B- 3 7 0~ • s, Dr- 3a-Gy SO 1.0' EA. Sy 13loc~y S' P-30 cv, O o,F 3~ Q lock S( D o o c o l E S/ 4 6- ye Sy-%..j sr! w/ f s.,n It &"-on fiS • Su~fA« ~lcv_ of Pt.2c5 PERCOLATION TESTS ry f 6os F (faa"E S S T K X45 } TEST DEPTH . WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES t NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ 2- 3. qz• 7 to y s P_ S' . 3 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. (-l i& h T (2 eA.)C 9• S M i'OlXE Ti(~E u G = P - g d SYSTEM ELEVATION. , - } r i l ~ s 3 , E ' a - 4- IJ S ~T~- UE~ ~ I~~t'~'l~Tt'D~J Ott $ D1L5- 'v r'~i. 7o,y.' E 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 (print): TESTS WERE COMPLETED ON: HO.MESITE SEPTIC PLUMBING CO. _ 655 O'NEIL RD., HUDSON. WIS._54016__ ~ C, ADDRESS: ROBERTULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER (optional): VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ZZ~FZ P'9 DESIGNER LIC. NO. 00663 CST SIGNATU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - wt tl HuuS~ INSTRUCTIONS FOR COMPL,91 ING F RM 115 - SBD - 6395 To be a complete and accurate soil test, yo3r report must include: 1. Complete legal descripY - p f 2. The use section must cl arly indi ate hether this i resident roedkr~tTnercial project; ApE^_ 3. MAXIMUM numb drooms r co mercial,(Ae planned;~ 1 Of 4. Is this a new or r placement syst m; fA sYST 5. Complete the sui abili n b xes. /SUITABLE FOR A HOLDING TANK ONLY IF NALL6 HER SYSTEMS ARE OUT BA ED N SLC ONDITIONS; r= 6. PLEASE use the bbreviations shoVvn ere for writing profile descriptions and completl4¢tAtc pwt pIal, 2-0 E A LEGIBLE Idgram accu#Aely I cating your test locations. Drawing scale is pre 12% may be used if de8. Make sure your bark and rtic elevation reference point are clearly sho\tA, and 9. Complete all aproboxes as to d es, names, addresses, flood plain data, pToIj1tion~hE~si~p~emptj~, )€ES appropriate; f~~7r 10. If the information (such s flood lain, levation) does not apply, place N.A. in tWp0opri6WS; rl, 3c_ 5112010e- 11. Sign the form and placeprour currient dress and yur certification number; '~L eAS 12. Make legible copies and distribute quir~ e-d7-A IL TESTS MUST BE FILED W H O AUTHORITY WITHIN 30 DAYS OF COMPLETION. ` VC RT. ReF. IPi iS Q o T Toh I E06-&- OF 4000D S 10►a - 1r. lE u hT r oa ABBREVIATIO IS FOR CERTIFIED SOIL TESTERS i Soil Separates and Textures Other Symbols i st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") g0 SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand - Well fs - Fii-i 6ie-\ San ~ Bldg uil g Is- Loamy Sand - Greater Than 'sl - Loamy Sand - Less Tho YY~ - Loam Bn - Brown 'sit - Silt Loam BI - Black IN v si - Slit Gy - Gray cl - Clay Loam L Y - Yellow 4 scl - Sandy Clay Loam - • R - Red 0 f sicl - Silty Clay Loam ~~x 1 mot - Mottles a w/ - with 0 sc - Sandy Clay sic - Silty Clay Ill - few, fine, faint 'c - Clay cc - common, coarse . pt - Peat 3 D mm - Many, Medium m - Muck d - distinct a ; p - prominent • HWL - High water level, 3 ( surface water Six general soil textures 70 BM - Bench?rlvlark for liquid waste disposal VRP ~--~Veti`c&I leference Point TO THE OWNER: This soil test report is the first step in securing i06y permit. The county or the Department may request verification of this soil test in the field prior to perm t isance. A complete set of plans for the private sewage system and a permit application must be submitted to the ppropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the tart of any construction. _JD L0 T PL A X3 HONiESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT C S Y- 0 2- 4 - WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. !1INN INSTALLER a DESIGNER LIC. NO. 00663 r. well e Hausa / ,°sSjg,,AA- kll P~D5. Eaf W F^`sysr , ~o~ 1.0 fic Ii ~ = ~E,PG s'~TES . = E ~c ~'s r l ac. 5 eno~ - EICv~T~ as S VC RT. Rd F. 'PI iS L3oTrv^ Eln-c- of woOD S I DIa G- - E IE V AT t Oa lC9D.D' I go n w ~ ~z 0 nAi a 30 e; w 3 70~ w~ Q, 90 lip ?L-0T- PLAX3 HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RO., HUDSON, WIS. 54016 ROBERT ULBRIGHT C S lr# 242, ~NIS. MASTER PLUMBER LID. NO.3307 M.P.RS MINN. INSTALLER & DESIGNER LIC. NO.00683