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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER A",z D .Sc g,4j jLr TOWNSHIP---- /oy
SECTION_2
.4~,_T ar N-R-e:~2 W
ADDRESS- .S'6 Cine ST. CROIX COUNTY, WISCONSIN
SUBDIVISIO IF ST,4 7-ICW LOT~LOT SIZE NA
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
'4
/gs0 CaAc ,Se-IVT'C
A'r 01,r/, 17-
4f0
-~f"fs -1 F
C/, EA.c~('UT/.1N,$,OICT~av ' I ES LLivc~C
,GJrN 14i~i7~P~,~rG
~wPvScD
INDICATE ORTH ARR W
BENCHMARK:Elevation and description:- AAev yo-
Alternate benchmark- P✓c AAF Gov 12 "
SEPTIC TANK: Manufacturer:_ GJ,es&& Liquid cap. i~gp
Rings used:-~2/-Manhole cover elev:t519.-/2~-Final grade elev: 9~- 8-r'
Tank inlet elev.: /.9o' Tank outlet elev.: 91.53"
No. of feet from nearest road:Front , Side Rear Ft._L4Zp'
From nearest prop. line:Front , Side , Rear --Ft.-99"
No. of feet from: Well ro- , Building: -//8,
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
. r
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
A tAffv V''r yv A 'ekz v TV. "(0
Bedtitc.cv. Bs,4oTrench:A,,rj,,eLj,Mgseepage Pit:
Width: S Length le Number of Lines: Area
A %m•'~ v.~
Exist. Grade Elev. Proposed Final Grade Elev.,-,
Fill depth to top of pipe:, Xr, 02. 3 . 16 " a. a
No. feet from nearest prop. line:Front Side ~ Rear Ft.
No. feet from well : .,o ' No. feet from building .S3 `
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:/ S o PLUMBER ON JOB: J~&o
LICENSE NUMBER:-~iPS 33gS
6/90:cj
' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
L ~M7AYV~7DISON, WI 537707 ,1Y ,1 6 f 28,19W State Plan I.D. Number:
SE
CONVENTIONAL El ALTERATIVE (If assigned)
Town of Troy
Glo _ 40 Holding Tank El In-Ground Pressure El Mound
O ADDRESS OF PERMIT HOLDER: INSPECTION D TE:
Marlo Schmidt 86 Castle Ridge Ct..Chanhassen
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: - JbJi/ RE . PT. EL CST REF!-. PT. EL
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Zappa Bros.(Mark Statnk) 3395
I _-C St. roix 128804
SEPTIC TANK/HOLDING TANK 01 y ?1' '
MANUFACTURER: LIQUID CAPACITY: TANK ET EL TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
^c
//0 7 11o e3i PRQ YES ❑ NO PROVIDED:
~ YES [VNO
BEDDING: (VEN+DDIIA.V&N"1 MATL.: HIGH WATER UMBER OF ROA PROPERTY WELL: BUILDING: VENT T FRESH
C,04 ,e C-0 - ALARM: FEET FROM - LINE: I ( AIR IN ET
❑ YES NO CASE ❑ YES NO NEAREST
DOSIN CHAMBER:
MANUFACTUR UID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CON OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL A RKING:
or excavation. (If soil can be rolled into a wire, construction snce until AIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: .6 & r
WIDTH: LEN . CtSTR-MPE SPA ING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH TRENCHES: ` ERIAA ^
:
V
DIMENSIONS 195- P. AT
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE Dip T IPE A yq L: O. ISTR. NUMBER OF LPROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPS: ABOVE COVER: ELE ET: E D: !'r9 / PIPES. FEET FROM INE / I [ AIR INLET: 7
NEAREST j ~
MOUND SYSTEM: 3 '
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/B DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL CING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS r
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD L: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL ARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: S: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FRM LINE:
❑ YES ❑ NO ❑ YES E:1 NO N
EAREST-♦
Io e._ cl X17 AfZA_11~0
It a-
l
Sketch System on Retain in county file for audit.
Reverse Side. SIGNATURE: TITLE:
Zoning Administrator
SBD-6710 (R. 06/88)
-
s
LA /0-7 9 IOU,
DILHR SANITARY PERMIT APPLICATION COUNIff
accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~a ~~0
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.
PROPERTY OWNER PROPERTY LOCATION
~ Ae4o Sc h' A4t,0T S," %4 ,AAJ Y4, S T A?`?, N, R 71? E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
T6 CA5 7 i Or, Z C7- y
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
/~~4Nl~4ssE.v MAJ. 553 t5T_,4 -10A-'
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
I ( > State Owned ❑ VILLAGE ~U Sow ~N
EW-40WN OF. ~
❑ Public Lal 1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX N ER() J(j
111. BUILDING USE: (If building type is public, check all that apply) tJ J 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
40 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. El Replacement 3. El 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 0 ,Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 420 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
y50 SCOv s., .r, . 90 3 Feet Feet
CAPACITY
VII. TANK in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 000 /000 w/ESoe
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:
.,4~,4 Aeos : i C. 9,5- 0,,:c 3TZ -R S°S-o
Plumber's Address (Street, City, State, Zip Code):
s ' t'r ST . Ao . A"o 50A.Y &-e
IX. CO NTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ssue ssuing A ant Si nature (No Sta ps
Surcharge Fee)
Approved Owner Given Initial / O d J:Ds~te Adverse Determination d
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.
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 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; (Jose 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 cppilcatlon Eorm Is to be C01r.pletod in full and signed by the owner(s) of
the property being developed. Any lnadequacles will only result in delays of
the petmit issuance, -Should thiss development be intended for resale by
owner/contractot,(spee houve), tEnn 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 /"gar-/o r C/hc SC
Location of property S=1/~ IV&d /4,, Section
Township 7~-o iv.
Malling address e~ Cast l~ ?`L C.-
-lua°san G~~sca S~aI CA a47 hass~ A IVSss317
Address of alto 3511 --Sc- Line- )C4 4-Lw dSev? Lc/,Scr»s~r Sao/b
Subdivislon name Ala✓~~' S ~f~s -2 add. ~o.~ "
Lot number
Previous owner of property /~-enrr ~s i~ 5clu' Ifi /YI - yam
Total else of parcel 2, G e7
Date patcal was created 49-c-3 /,(19-7
Ms
Ate all cornets and lot lines Identifiable? on
Is this property being developed tot resale (spec housa)Tes •'k-1 )10
Volume ,and Page Number as recorded with the Register of Deeds.
ft-ft
INCLUDE WITH THIS APPLICATION TIIE FOLLOWING:
A WARRANTY DK9D which Includes a DOCUMZHT NVMBZR, VOLVMa AND VAG19 NUMatR, and
the SEAL OF THB REGISTER OF DRIDS. In addition, a certified survey, 11
available, would be helpful so as to avoid delays of the tevleving process. if
the deed description teferences to a Ceitilled survey Map, the Certified Survey
Map shall also be required.
T
PROPERTY OWNER CERTIFICATION
I(ve) catttfy that all statements on this form are true to the best of my (out)
knowledge; that I (we) am (ate) the owner(s) of the property described In
this Information form, by virtue of a warranty dead recorded in the office of
the County Register of Deeds as Document No. V and that I (we)
Presently own the proposed alto for the sewage disposal system (or I (we) have
obtained an easement, to tun with the above described property, tot the
construction of said system, and the same has been duly recorded In the Office
of the County Register of Dee as Document No.
q tore of owner 8 nature of Co-Owner (If Applicable)
/6 r go
Date of Signature Date of Signatute
'Vcr
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11 1952 THIS SPAU16 RESERVED FOR RECORDING DATA '
!rv
LAND CONTRACT
Individual and Corporate
_ 45142. (TO BE USED FOR ALL TRANSACTIONS WHERE OVER
126,000 IS FINANCED AND IN OTHER NON-CONSUMER
a---=-- ---------ACT TRAN3AOTION9) -4.--_..
- - REGISTER'S OFFICE
Contract by and between Dennis R. Schultz and CROIX CO., WI
„ C.t•, M__.•Bye-,_ each-_ in their own right - - - • Recd for Record
(.Vendor", S L- P 1 1
1989
whether one or more) and.... Mar1Q chmidt-. and Ot
12:05 PM
--------_~uxva---------•
..$-rouemty ("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- RaOisterOfQeeds
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
-
in....... ts.t cm x County, State of Wisconsin: RETURN TO C. M. Bye
l P O. Box 167
l River Falls, WI
Lot 44, Glover Station. 2nd Addition, located -
in the SE1/4 of the NW1/4 of Section 16, T28N, I
R19W,,Town of Troy, St. Croix County, Wisconsin
Tax Parcel No...........
l along with a roadway easemen across part of Lot 43 of said Glover
Station n Addition described as follows: Commencing at the NW corner
of said Lot 43; thence S88024154"t 350.00' along the North line of said
Lot 43; thence S23049140"E 300.00' along a Northeasterly line of said'
Lot 43 to the point of beginning; said point of beginning being the
most Westerly corner of Lot 42 of said Glover Station 2nd Addition;
thence S23049140"E 200.88' along a Southwesterly line of said Lot 44;
thence S50051100"E 140.00' along a Southwesterly line of said Lot 44;
thence S39009100"W 33.95' along a Northwesterly line of Soo Line Road;
thence Southwesterly 32.131.along a 266.00' radius curve concave South-
easterly whose chord bears S35041126"W 32.111 along said Northwesterly
line of Soo Line Road; thence N50051100"W 157.80' along a Northeasterly
line of said Lot 44; thence N2304914011W 216.741 along a Northeasterly
line of said Lot 44; thence N66010120"E 66.001 to the point of beginning.!
;y h
This ...1 _t homestead property.
~digicxi4~omtl~x
Purchaser agrees to purchase the Property and to pay to Vendor at ..a- place reasonably
directed
the sum of $32.090-&D in the followin manner: (a) $ 4b0,bb
at the execution of this Contract; and b the balance of ..25 60 00
( ) $ ~e...... ~ together with interest from date
hereof on the balance outstanding from time to time at the rate of......t2n (10$) per cent per annum
until paid in full, as follows: monthly payments in the amount of $544.00, colmlencirlg
,October 1, 1989.
%
MA
Provided ~however , the entire outstanding balance shall be paid in full on or before the...... 1St............ day of
~ePte 19.2.4-_. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of .__.1 % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after ---S2pte7llb2r 1 19-.89-. (OR)
6r'
In the event of an
any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated
as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except: for restrictions, covenants, and easements of record
r
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall I~
be retained by Vendor until the full purchase price is paid. I
Purchaser shall be entitle to take possession of the Property on...... Sgptember...1
. 19.89... I
•Crale Out One. J
_ -J
YHGITIIaar STATF BAR OF
No. 11 - 198 WISCONSIN Stock NO. 13011
IL
• N
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix Countyr
OWNER/ BUYER o
ROUTE/BOX NUMBER 3,54 50O &Iner 5 ire dumber 3 S V
,,JJ 0
CITY/ STATE T( ~ S6rc (:~/S h v ' ZIP S `fO A
PROPERTY LOCATION:'. i= k,/, Section TAN, R_ ,
Town of Ty~ y St. Croix County,
Subdivision ~ 'Iyz' S7-a:7-,. ,-,L Lot numb er~-
S"d a,Cd --r
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 licens'ed' 's'e t'ic tank um er. What you put into
the system can affect t e' uncC on of t e•septic.tank as a treat-
ment-stage in the waste disposal system. •
St. Croix County residents-maybe eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
wh c was in operation prior to-July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new 's' s~t'em_s 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 of sludge and scum.
Certification form will be sent approximately 30 dY prior t
three year'expiration. y
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
must be com leted b
ment of Natural Resources. Certification form
within 0 da a
and returned to the St. Croix County Zoning Office y
o of the three year expration.date.
-s
SIGNED ~ 5-~-
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
I
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
%INDUS,TRY, 1 1 C DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MWANG AA LOT NO.:BLK. NO.: SUBDIVISION NAME:
e 1/ Nw 1/ A /M N/0E (o W ~o
CO NTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: Q A N ESTS:
e 7 . f Q
Residence to vv New ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
ONV NTI NAL: MOUND: IN-GROUND-PRESSURE: rY5TjiiM-IN-FILL OLDIING TA K: REC/OIM~MENDED SYSTEM: (optional)
$ ❑U ❑S S ❑U Z'S J ❑U ❑J O-ON ur~or,~q Q ~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: C(~Sj Floodplain, indicate Floodplain elevation: ►v~
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH-0. ELEVATION OBSERVED HIGR_ESf_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- Z .Ob 9Z,s6 NduL- >9'06 ogS Cs 4c>e 72 oQcs¢c
B-
B- bB ~.2 No~►I~ > $ 0e, / 'SC,SLTS r 'SeA4~y S
B-
B- 7 q Z q ~.C iVa>N~ > 9. ZS C~ Bc 5.. 7a GrBRN 5, 6~ ~~$QN ►^)V4g ft NO&RAP.
B-
C-7 f PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES
NUMBER tJS AFTERS WELLING INTERVAL-MIN. p I p p I D PER INCH
P_ I 3 .tea 4 oN / . o ' /
P- Z 3C)6 N E 91.4o /6 jV14 a B .11 P- NaRf %X-Ao /h
P-
P. IZ LOAI 1, Ai i kc:.
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope-_... UPPLQ -r#P&r,:C.td 88AO
SYSTEM ELEVATION j"I koN ,P .h pr Lar
NOTE ° P4,11Ovs a2 c II S _ 1 4 D
4'_c0t"PAW6_S T4ls t- ■ QP _ _
4Nd Could INS A QE d Fcok
A P~, ~LrSC~.r+► T
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'$~.t.1cNMAQY. FRO~'+ UL81e►c,Nr Pt.+,~C
Q _
~arEL, F~23/ES -tt_EvAT14►J= 47.40
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
N:
W!►P_V y 364INs044 -Oq 50 04 Q LNG ~N C Z! 46
ADDRESS: CERTIF CATION N MBE : P ONE NU BER(optional):
4 0_7 Stcov6 A,-"6t'j S4 / 'i4 ~G- oho
CST SI T~U-R`E:~
rte`
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IND(JS1iRY, DIVISION
69
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707
HUMAN RELATIONS
E (ILHR 83.09(1) & Chapter 145)
LOCATION- SECTION:
N G~~ /6 /TzP N/R 19 E ( ) ~ TOW iPIP/hltifft6fP,4Li~F: OT~.: BLNO.:S VISION NAME:
o S~'`tro-~
COUNTY: 'S R'S NAME: MA L ADDRESS:
St Gw/ x 'UN/6 5;5ti,4..vf- (30& c;~ s~iE,e;o~ E (f/-. c~~,v~~s rF-v HN . ss~
USE - - 2~_ 11 DATES OBSERVATIONS MADE
COMMERCIAL NO. BEDRMS.: DESCRIPTION: J
Residence If- 4New ❑Replace
RATING: S- Site suitable for system U- Site unsuitable for system _
ONVEN 1 NAL: MOUND: -PR
R]$ ❑U r1$ 2]U 1(4GROUN S S EM-IN-FILL p DING TANK: RECOMMENDED SYSTEM: (optional)
$ ❑U DU R1 U TO-I-) w~ Di2o Ba
i1) f
If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: [Floodplain, indicate Floodplain elevation:.
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) '
B- / D ~1,Szj 9 O o.P•P s . S a • T Cs
0, es 45-4
y w .5- 17.x' 6.j. r S 'J, -0
s-3 9, D 1161. 5'i 1. d s. • ~,e
03.Sy y~0 •s'o~is.,. ~s, ~a. , Q,,,.
yo"I , s 1 , 3.j -
` PERCOLATION TESTS ~N C S , G~ S'fR~tf
EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER !NGIIE6 AFTERSWELLING INTERVAL-MIN. PEWOD_j PER INCH
P_
P-
P_ L
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what an 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
/l b
of land slope. I Lo~vE,~ / e~+~ Fio. SQ
SYSTEM ELEVATION _ ~Ile • SD
1 r
i
i
T-
_ I~ r s b u s Ts,-
- t- T N
-14
o
I
- s •,SI-
f
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 0
HOMESITE SEPTIC PLUMBING CO. C
L RD. HUDSON, WIS. 54016 F' 2-3_1 7
ADDRESS: ROBERT'ULBR*HT CERTIFICATION NUMBER: PHONE NUMBER (optional):
WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 2V rr Z 3 P6 oO/, F•S
MINN. INSTALLER d c . NV. UM3 CST SIGN
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHRSBD-6395 (R. 10/83) - OVER -
I
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PLB 87
PLOT & CROSS SECTION PLANS
1L ZAPPA BROS. EXCAVATING INC
g VeNTS''v PLUMING UNIT
• fjEn/c./MA / Pv PROJECT
By '0*, P, S t6
,63 N/PI✓~G✓R( LG7 S!N i T
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NO
SCALE
FRESH AIR INLET AND OBSERVATION PIPE
APPROVED VENT CAP
MAXIMUM 12'
ABOVE FINAL GRADE
4' CAST IRON VENT PIPE
MAXIMUM OF 42' ABOVE
PIPE TO FINAL GRADE
SIGNED:
MARSH HAY OR SYNTHETIC COVERING LICENSE:p
MINIMUM 2' AGGREGATE DATE:
OVER PIPE
DISTRIBUTION PIPE
TEE SOIL STING BY:
E Sam
ELEVATION BED 6" AGGREGATE •
BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW
TEST IS • COUPLING TERMINATING
FT. AT BOTTOM OFSYSTEM
8
B
3o(/ 5 1
b-~
15" '
B-~
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0 100' 200' 300' 400
soG~
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350.00' t,
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41
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0 116.822 S. F. a6'1
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I TEMPORARY /l O f
• TURN AROUN~
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I fi-90 • Al
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96.00' 608.40'
_ _ _ . 537.55 _ _ _ g'~~LO~~o 6 6' /
99-1 23' W G7 .9 T 68. 10 3259.76
I 5232.71' 13
ATTED ELANDS EAST-WEST 114 SECTION LINE
I UNPLATTED LANDS
0' 100' 200' 300' 400'
r
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0 117.057 S.F.
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TEMPORARY
TURN AROUN~ ° / O I
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96.00' 608.40'
_ _ 5s~.aa _ _ y~~Lm°.~o 6 6
89 2 .9 ' T 68.55' 10 3259.71
I 5232.71' !i -
_ATTEO ELANDS
EAST-WEST 114 SECTION LINE
I UNPLATTED LANDS