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HomeMy WebLinkAbout020-1173-30-000 'D 0 N ~ O va h f c ti 4 0 c I I c O p O N N O O C N p c v ~ I ~ a v Its t L N O F N a ~ c I z € ° o c {L C U O O a ~ ~ I I of v z r` N a m c o z c a~i Z ° c E Z '2 a) m 5 c y ~ I I ~ I • ti a~ c N n c O Q z H Z Z N w r~ ~T cu E y N rn o ~ o LA ca` ° I _ 0 U) U) U) E Q= 0 z •N 3aaa a c I O N N CD a) fA J U = co co O Z N O O _ U) O 0 co C d p o N Of w O d n in p 0 U) O O co N C vy` O 'O E O OD C U O Q1 > O M O '4N c C V a p N co N A E tc6 _'D ems- c _ ~ c c _ O H ~ N O N co rtol .0 :3 E c • O ON 2 S O N H Z g fn C~ L: (L C~ d d c E ` c c r r~ O a 3 O `r 1 A U 0 U) Parcel 020-1173-30-000 03/23/2006 11:51 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.1085 020 - TOWN OF HUDSON * Current *1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner MELINDA S FISHER O - FISHER, MELINDA S 448 OVERLOOK PASS HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 448 OVERLOOK PASS SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: 2627-WILLOW RIDGE EAST SEC 17 T29N R19W LOT 86 WILLOW RIDGE Block/Condo Bldg: LOT 86 EAST Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/11/2000 629625 1541/420 QC 07/23/1997 1206/568 WD 07/23/1997 1018/503 WD 07/23/1997 997/529 C~C mor 2005 SUMMARY Bill Fair Market Value: Assessed with: 92908 215,400 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 53,000 166,700 219,700 NO 05 Totals for 2005: General Property 1.000 53,000 166,700 219,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.000 27,000 150,100 177,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 223 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 r d t . ea- Ira 4 •LAT~ Im- oS AS BUILT SANITARY SYSTEM REPORT OWNER • 4VE11 TOWNSHIP SEC. 7 T 2y N-R a ADDRESS "Of A I- Rd( ST. CROIX COUNTY, WISCONSIN if 19 So•~ 441--s . 5,q02_-2_ wellow RiD6-F SUBDIVISION -E/{ S T- LOT CO LOT SIZE 2 rtCti e S PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f IOMESITE SEPTIC PLUMBING CO. 655 G'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT VIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. NIN. INSTALLER & DESIGNER LIC. NO, 00663 S E p4- r) 1- INDICATE NORTH ARROW TOP cF (CA)CI_Lf E PA/7 +T Mw BENCHMARK: Describe the vertical reference point used t6PA)ER_, of , c tg 3~?tip~t &E t~OO/2 -Elevation of vertical reference point: 10L/ 53 Proposed slope at site: Z SEPTIC TANK: Manufacturer: 60, /0 Liquid Capacity: Number of rings used: 1) Tank manhole cover elevation: /4 7S Tank Inlet Elevation: Tank Outlet Elevation: 15 0 Number of feet from nearest Road: Front, D Side10 Rear, O > /0 0 feet Wt-// t/ o r ..From nearest property line : Front ,O ide0Rear,0 ys 7'0 D/1Y~` feet Number of feet from: well 13 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SRF. RRUR.RSR RTnR i 0 ,r: Liquid Capacity: ' o Pump/Siphon Manufac er: Pump Size r inlet: tom of tank elevation: ramp off switch elevation: Gallons per cycle: Alarm Switch Type: Alarm Manufacturer: Number of feet f nearest property line: Front, O Side, O Rear, Q-,_,•.~.. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM 1 L~%v E S I ~ ~ ~`1 p S Trench': Bed: ` S S Number of Lines: Area Built: Width: S Length: 3(0 ¢ a Fill depth to top of pipe: , Front O Side, O Rear,0vt 2_ Number of feet from nearest property line: , wll NO T ~~VSf**V Number of feet from well: 7o ptr & Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Number of pits: Diameter: Size: ottom of seepage pit elevation: Liquid depth: Area Built: Has either a dr box O or distribution box O been used on any of the above soil absorbtion terns? (Check one). H0L G TANK Capacity: Manufacturer: Number of rings used: Elevation of bottom of tank: Elevation of in Front, O Side, O Rear, 0Ft• Number eet from nearest property line: Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector:- on job: Plumber Dated: License Number: I VOMESITE SEPTIC PLUMBING CO. 656 G'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT 3/ 84 :m j ViS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ,'N, iN3,ALLER & GtSIGNER LIC. NO. 00663 1L,. , IAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 i ST. CROIX COUNTY GOVERNMENT REPORT NO.. 43403/01 PAGE 1 CENTER REPORT DATE! 6/22/93 1101 CARMICHAEL ROAD DATE RECEIVED. 6/18/93 HUDSON, WI 54016 ATTN. THOMAS C. NELSON OWNER4 Larry Plourde LOCATION. 448 Overlook Pass, Hudson COLLECTOR. M. Jenkins DATE COLLECTED. 6-16-93 TIME COLLECTED: 2.45pm SOURCE OF SAMPLE: Outside faucet DATE ANALYZED.6-18-93 TIME ANALYZED.11.00am COLIFORM. 0 /100 mi INTERPRETATION. Bacteriologically SAFE NITRATE-N. 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L RECE~VEO a ,1993, w LAB TECHNICIAN. Pam Gane 0004~pFICE a O,.WpEVENpfryr So WI Approved Lab No. 19 5 V A Means "LESS THAN" Detectable Level Approved by..,>1 h ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 29W y ' 3 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. l Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 '4 Septic $25.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: /4Yy F>L ~yD Requested by: N7 ~2 ~ Address : EZ,~-Zp, ~ v~~-je 4a22 --Address: City & State: City & St. "yvDcv 1 , 1C, Zip Code: Zip Code Telephone N°: (-,/S) Telephone N4: (7/5)~,~_- g7_ 3~ Property address (Fire NQ & Street) Location: Sec. 1'L, T 2 N, R W, Town of itdSO~ St. Croix Co., WI. Tax ID N2 Parcel ID N2 House color: 7•~ Realty firm: £-QI OJit~ Lock Box Combo: K o~1G~ Water sample tap location: c~~ 1 LDi- TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: 2 Septic system installed by: ? Year: ~~qU Septic tank last serviced by: Date:_ Previous Owner's Name (s) Have any of the following been observed? 14 lJ~~ ❑Y N Slow drainage from house. ``Sc?❑Y N Sewage Back-up into dwelling. ❑Y N Sewage discharge to ground surface, road ditch or body of water. iffy ❑Y N Slow drainage from the dwelling. ❑Y N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: ud, OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 4 IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption s stem: elow grd OAt-Grd OMound Approx. size 5'- 'X 55'' a- ravit ❑Dose OPressurized ~sy Ft z ❑Bed rench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House OWel l > 56 OProp. line /,rl OOther Dose tank Setbacks: OHouse ❑Well ❑Prop. line OOther OLocking cover ❑Warning label OPump/Floats - OAlarm OElec. wiring Soil Absorption System Setbacks: ❑House-d OWe117Sb' ❑Prop. lineal-o OOther ❑Ponding : ODischarge : y f- General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N - R S x 5^U - - Inspector ~rr~~ E ;,Title r , ST. CROIX COUNTY ' WISCONSIN y q. rL} r ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 1101- Carmichael Road • Hudson, WI 54016 1 - (715) 386-4680 June 16, 1993 Jim Henry 700 Second Street Hudson, WI 54016 Dear Mr. Henry: An inspection of the septic system on the property of Larry Plourde located at 448 Overlook Pass, Hudson, WI was conducted on June 16, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. incerely Mary J. Jenkins Assistant Zoning Administrator js Form Approved (y~' OMB No. 2900-0088 VETERANS ADMINISTRATION/U.S. DEPARTMENT OF HUD/FHA OR VA CASE NO. 913 HOUSING AND URBAN DEVELOPMENT HEALTH AUTHORITY APPROVAL HUD/FHA OR VA OFFICE INDIVIDUAL WATER-SUPPLY AND SEWAGE-DISPOSAL SYSTEM IMPORTANT-This form should be completed and filed as required by existing law 38 U.S.C. 1804 and 1810. PART I - TO BE COMPLETED BY HUD/FHA OR VA MORTGAGEE NAME AND ADDRESS (Include ZIP Code) MORTGAGOR OR SPONSOR Roy G Gruel Metropolitan Federal Bank,fsb PROPERTY ADDRESS 6800 France Ave S Suite 200 Edina, MN 55435 448 overlook Pass Hudson, WI 54016 SUBDIVISION/LOT NO. Lot 86, willow Ridge East Town of Hudson TOTAL NUMBER IS THERE A IS THIS A NEW CAN THE ATTIC OR OTHER AREA BE MADE INTO BASEMENT? INSTALLATION? ADDITIONAL BEDROOMS? (If "Yes," how many?) LIVING UNITS BEDROOMS BATHS ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO'S WATER-SUPPLY BY: SYSTEM DESIGNED FOR ❑ PUBLIC SYSTEM ❑ COMMUNITY SYSTEM ❑ INDIVIDUAL NO. OF BEDROOMS GARBAGE DISPOSAL SEWAGE-DISPOSAL BY: ❑ PUBLIC SYSTEM ❑ COMMUNITY SYSTEM ❑ INDIVIDUAL ❑ YES ❑ NO PART II - TO BE COMPLETED BY HEALTH DEPARTMENT OR COMPLIANCE INSPECTOR INSPECTOR'S SKETCH (TO REPORT AS-BUILT DEVIATIONS FROM APPROVED PLAN) 1 ' 3 1 Skcy~ C. Z~ It is the opinion of the ❑ State ❑ County ❑ Local Department of Health that this individual water-supply system ❑ is ❑ is not satisfactory as a domestic water-supply for the subject property. It is the opinion of the ❑ State I$ County ❑ Local Department of Health that this individual sewage-disposal system with proper maintenance XCan be expected to function satisfactorily, and is not likely to create unsanitary conditions ❑ Cannot be expected to function satisfactorily. DATE SIGNAT RE TI E NOTE: The health authority should complete the app priate opinion statement above and affix date, signature and title in a spa provided. NOTE: Use of the reverse side of this form is at the option of the health authority. PART III - FOR USE OF FIELD OFFICE I have reviewed the foregoing and the pertinent Compliance Inspection Report and recommend that the individual water-supply system be considered ❑ acceptable ❑ not acceptable and that the sewage-disposal be considered ❑ acceptable ❑ no acceptable. DATE SIGNATURE TITLE ❑ HUD ARCHITECTURAL SECTION CHIEF OR DEPUTY CHIEF ❑ VA CHIEF APPRAISAL SECTION OR DESIGNEE VA FORM 26-6395, APR 1982 SUPERSEDES VA FORM 26-6395. OCT 1976, HUD FORM 92573 WHICH WILL NOT BE USED. EFS 540 (11,/86) 1 REPORT OF INSPECTION - INDIVIDUAL SEWAGE-DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank ❑ Cesspool r Septic Tank: nn n Distance from well, >501 feet. Material, -e~kS C're'w-c-- cy-ckj Numberofcompartments Total liquid capacity, 00 0 gallons. Capacity inlet compartment, gallons. Inside length, feet. Inside width, feet. Liquid depth, feet. Cesspool: Distance from well, feet; foundation, feet; nearest lot line at ❑ front ❑ side ❑ rear feet. Inside diameter, feet. Depth, feet. Liquid capacity, - gallons. Lining material SECONDARY TREATMENT consists of ❑ Tile disposal field ❑ Seepage pits ❑ Other (Specify) T-i+e Disposal Field: (-D, 7Fre41C%w-SX so ) Distance from well, ) feet; foundation, /3 feet; nearest lot line at ❑ front 13side ❑ rear '715_ feet. Total length of t`,~1r'1,``^; r' 5-D feet. Number of lines, -'2- Distance between lines, feet. Trench width, inches. Total effective absorption area in bottom of trenches, square feet. Length of each line, feet. Depth, top of tile to finish grade, inches. Type of filter material: ❑ Gravel ❑ Broken stone ❑ Other (Specify) Depth of filter material beneath tile, inches. Depth of filter material over tile, inches. Seepage Pits: Number of pits, Outside diameter, feet. Depth, feet. Lining material Distance from well, feet; building foundation _ feet; nearest lot line at ❑ front ❑ side ❑ rear feet. Inspection made by: ❑ State County ❑ Local Health Authority ' Inspected by Date of inspection 191 (Title) REPORT OF INSPECTION - INDIVIDUAL WATER-SUPPLY SYSTEM f Distance to nearest public water main feet. Size of main, inches. Individual wells are ❑ are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood ❑ are ❑ are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide, feet deep. Dwelling set back from front property line, feet. Individual water supply from: ❑ Drilled well ❑ Driven well ❑ Dug well ❑ Bored well. Distance of well from: Building foundation, feet; nearest lot line at ❑ front ❑ side ❑ rear feet; cast iron sewer, feet; tile sewer, feet; septic tank, feet; disposal field, feet; seepage pit, feet; cesspool, feet; other sources of possible pollution, feet. Well construction: Diameter, inches. Total depth, feet. Type of casing, Depth of casing, feet. Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: ❑ Cement grout ❑ Puddled clay ❑ Ordinary backfill. Well cover: ❑ Concrete ❑ Wood ❑ Metal. Openings in well cover watertight: ❑ Yes ❑ No. Pump: ❑ Shallow well ❑ Deep well. Length of drop pipe, feet. Pump capacity, gallons per minute. Located in: ❑ Basement ❑ Pumproom off basement ❑ Pumphouse above ground ❑ Pump pit. Pumproom properly drained: ❑ Yes ❑ No. Pump mounting watertight: ❑ Yes ❑ No. Type of storage: ❑ Pressure ❑ Gravity. Capacity, gallons. Has bacteriological examination of water been made? ❑ Yes ❑ No. If answer is "Yes," give date '19 Quality of water ❑ is ❑ is not satisfactory for human consumption. Installation ❑ does ❑ does not comply with approved exhibits, if any. Inspection made by: ❑ State ❑ County ❑ Local Health Authority. Inspected by Date of inspection , 19 (Title) GPO 1983 0 - 411 -779 v 'o a m _ m cn O N O d pp ~r a o -A C N M U C Ol N O ~ v :)'v N O ? Q W (1) _ U N U 8 U) - lL ^ o V17 a Z o N W •v ~ N d 0 ~ C:) CD O C13 O co cn c) W O to ' \O M O O N a ~ O a- y cn. Q E-4 Lu o H E Lc Z :E 0 Z d ° H 2 z L O O .16 F= Hly to H C U. O 0 LL a) C 0 N 0 t (A vi vi m o m oZ m v L L j 0.01 August 2, 1993 Georgia A. Gruel 488 Overlook Pass Hudson, WI 54016 Dear Ms. Gruel: You informed our office that you cancelled the water test and septic inspection for Larry Plourde, Enclosed you will find a check for $60.00. If you have any questions please feel free to contact our office. Sincerely, Jackie Stohlberg Secretary Enclosure July 13, 1993 Attn: Tom Nelson St. Croix County Zonning Office 1101 Carmichael Road Hudson, WI 54016 Dear Mr. Nelson, Enclosed you will find the documentation received by Metropolitan Federal Bank, fsb from your office on Monday July 5, 1993. I had called you and asked why the water test was completed and the septic certification completed even though I had contacted you and the loan processor, Scott McGovern, had contacted you and informed you not to follow through with the request. You indicated that if I provided you with the documentation you would refund my $60. You can mail the refund to 488 Overlook Pass, Hudson, WI 54016. If you have any questions, please call me immediately! You can contact me days at (612) 225-7013 or evenings at (715) 246-7230. Sincerely, 01 sl~o~ 612xe~ Georgia A. Gruel 12 f 1 ~v 0Y.'. r ~ . Form Approved OMB No. 2900-0088 VETERANS ADMINISTRATION/U.S. DEPARTMENT OF HUD/FHA OR VA CASE NO. HOUSING AND URBAN DEVELOPMENT HEALTH AUTHORITY APPROVAL HUD/FHA OR VA OFFICE - INDIVIDUAL WATER-SUPPLY AND SEWAGE-DISPOSAL SYSTEM IMPORTANT-This form should be completed and filed as required by existing law 38 U.S.C. 1804 and 1810. PART I - TO BE COMPLETED BY HUD/FHA OR VA MORTGAGEE NAME AND ADDRESS (Include ZIP Code) MORTGAGOR OR SPONSOR Roy G Gruel Metropolitan Federal Bank, f sb PROPERTY ADDRESS 6800 France Ave S Suite 2.00 Edina, MN 55435 448 overlook Pass Hudson, WI 54016 SUBDIVISION/LOT NO. Lot 86, Willow Ridge East Town of Hudson TOTAL NUMBER IS THERE A IS -THIS A NEW CAN THE ATTIC OR OTHER AREA BE MADE INTO BASEMENT? INSTALLATION? ADDITIONAL BEDROOMS? (11 "Yes," how many?) LIVING UNITS BEDROOMS BATHS ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO WATER-SUPPLY BY: SYSTEM DESIGNED FOR ❑ PUBLIC SYSTEM ❑ COMMUNITY SYSTEM ❑ INDIVIDUAL NO. OF BEDROOMS GARBAGE DISPOSAL SEWAGE-DISPOSAL BY: ❑ PUBLIC SYSTEM ❑ COMMUNITY SYSTEM ❑ INDIVIDUAL ❑ YES ❑ NO PART II - TO BE COMPLETED BY HEALTH DEPARTMENT OR COMPLIANCE INSPECTOR INSPECTOR'S SKETCH (TO REPORT AS-BUILT DEVIATIONS FROM APPROVED PLAN) ~QE t ~r 6 ~ C It is the opinion of the ❑ State ❑ County ❑ Local Department of Health thatthis individual water-supply system ❑ is ❑ is not satisfactory as a domestic water-supply for the subject property. It is the opinion of the ❑ State gl County ❑ Local Department of Health that this individual sewage-disposal system with proper maintenance XCan be expected to function satisfactorily, and is not likely to create unsanitary conditions ❑ Cannot be expected to function satisfactorily. DATE SIGNAT RE > TI E NOTE: The health authority should complete the app priate opinion statement above and affix date, signature and title in a spa provided. NOTE: Use of the reverse side of this form is at the option of the health authority. PART III - FOR USE OF FIELD OFFICE I have reviewed the foregoing and the pertinent Compliance Inspection Report and recommend that the individual water-supply system be considered ❑ acceptable ❑ not acceptable and that the sewage-disposal be considered ❑ acceptable ❑ no acceptable. DATE SIGNATURE TITLE ❑ HUD ARCHITECTURAL SECTION CHIEF OR DEPUTY CHIEF ❑ VA CHIEF APPRAISAL SECTION OR DESIGNEE VA FORM 26-6395, APR 1982 SUPERSEDES VA FORM 26-6395, OCT 1976, HUD FORM 92573 WHICH WILL NOT BE USED. ' EFS 540(11/86) REPORT OF INSPECTION - INDIVIDUAL SEWAGE-DISPOS4L SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank ❑ Cesspool Septic Tank: p Distance from well, 50r feet. Ma4o9al, pSIL'e-e_kS~t[Cr-LJc.1 fcj Number of compartments Total liquid capacity, /,000 gallons. Capacity inlet compartment, gallons. Inside length, feet. Inside width, feet. Liquid depth, feet. Cesspool: Distance from well, feet; foundation, feet; nearest lot line at ❑ front ❑ side ❑ rear feet. Inside diameter, feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of ❑ Tile disposal field ❑ Seepage pits ❑ Other (Specify) Ti}e Disposal Field: (-D, TY?ivtChw-S~csv ) i Distance from well, 5 t) feet; foundation, /3 ~ feet; nearest lot line at ❑ front Qside ❑ rear `6~ feet. Total length ofm-`,£~ feet. Number of lines, Distance between lines, feet. Trench width, inches. Total effective absorption area in bottom of trenches, square feet. Length of each line, feet. Depth, top of tile to finish grade, inches. Type of filter material: ❑ Gravel ❑ Broken stone ❑ Other (Specify) Depth of filter material beneath tile, inches. Depth of filter material over tile, inches. Seepage Pits: Number of pits, Outside diameter, feet. Depth, feet. Lining material Distance from well, feet; building foundation feet; nearest lot line at ❑front ❑ side ❑ rear feet. Inspection made by: ❑ State T' County ❑ Local Health Authority Inspected by Date of inspection 19~ (Title) REPORT OF INSPECTION - INDIVIDUAL WATER-SUPPLY SYSTEM Distance to nearest public water main>f feet. Size of main, inches. Individual wells are ❑ are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood ❑ are ❑ are not being developed with both individual water-supply and sewage-disposal systems. Lot size: feet wide, feet deep. Dwelling set back from front property line, feet. Individual water supply from: ❑ Drilled well ❑ Driven well ❑ Dug well ❑ Bored well. Distance of well from: Building foundation, feet; nearest lot line at ❑ front ❑ side ❑ rear feet; cast iron sewer, feet; tile sewer, feet; septic tank, feet; disposal field, feet; seepage pit, feet; cesspool, feet; other sources of possible pollution, feet. Well construction: Diameter, inches. Total depth, feet. Type of casing, Depth of casing, feet. Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: ❑ Cement grout ❑ Puddled clay ❑ Ordinary backfill. Well cover: ❑ Concrete ❑ Wood ❑ Metal. Openings in well cover watertight: ❑ Yes ❑ No. Pump: ❑ Shallow well ❑ Deep well. Length of drop pipe, feet. Pump capacity, gallons per minute. Located in: ❑ Basement ❑ Pumproom off basement ❑ Pumphouse above ground ❑ Pump pit. Pumproom properly drained: ❑ Yes ❑ No. Pump mounting watertight: ❑ Yes ❑ No. Type of storage: ❑ Pressure ❑ Gravity. Capacity, gallons. Has bacteriological examination of water been made? ❑ Yes ❑ No. If answer is "Yes," give date 19 Quality of water ❑ is ❑ is not satisfactory for human consumption. Installation ❑ does ❑ does not comply with approved exhibits, if any. Inspection made by: ❑ State ❑ County ❑ Local Health Authority. Inspected by Date of inspection '19 (Title) GPO : 1983 0 - 411-779 ST. CROIX COUNTY WISCONSIN ~5h " ~,Y ~czy= 5 ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 1101 Carmichael Road • Hudson, WI 54016 - 1= _ - (715) 38 - 680 04 June 16, 1993 Jim Henry 700 Second Street Hudson, WI 54016 Dear Mr. Henry: An inspection of the septic system on the property of Larry Plourde located at 448 Overlook Pass, Hudson, WI was conducted on June 16, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not -discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. incerely Mary J. Jenkins Assistant Zoning Administrator js i V 0 k U LL as M M O CP. "N C M N OD E ' O N m 10 a er u G U1 LL 6i C5 1-0 wrl S y y~ ~ N W N n C) CC w ev LL O tC kill m u W GC La ~ Cl- 'a a o E E 3 W M 0 G O- E =1 4 E a. pCi. 4i S U 47 O a r~ M CL -4 ix C~ A O N A m o o 44' > Z <Or d4 0 C-4 A M CL U U N N O W W i Q z0 O O OJ O ¢ Q 0 W Q c U U U W ir Cc C4 CL. 10 CC w u cr- O O -y U -j w~ = W w U. W Ix <r ~t F-- = J F- -a LO O co CD C H co N F~- tai J N E X LI J J O N Co Cl) cj Cl w E W 0 V O Fes- J a OL 4- `n v z5 w c i - a c _ u m cr) rn o JQ N C N N N U z u 1-4 F-4 a) - N O X M O z C7 LO O Cl W V E S.- CD W C_ 3 N N U U z 14 UO! Z o w- R7 O(7) F: L3 W O w f- Cf) 14 C C O Lo O Q U Z V n U r~ 00 LL ~oqT 1 r I 1 ~;Ttile ~dusc 3i~° v~Rr. ,e>£F ~r 3 10 P of r~v~tTio~ " ~ ~gEr~eh. pi E /00, 0 t-lo NEi okiA)6- 5c i3 , ~F~T• EEt• PT• ~ 1 4 ?~F of sc,Ia ~T • N,w. Co~'~1EB O /04.53 55 c•s ~ Iv ~ ' w 4.~ Nr ~Rop3ox ga' , IMSpELT/O~ 3b1 y [ .S pi p,c.. I I I • I ' I I -rap of I I I w ~~r To RO P , , . ~ 1 I I ~ I I I I 1 I I I I I I • TR~~C.~. E►E UhT~'a.~ S ~ ; ~ ~ ~ b l b I ' Torn s of 3.7.1-f A,:S7'01'80+-,*Aj pips I i 4T PPO P 40w 6->L L 9' 1// b b I , I ~ I ' I hT iNSPEcTio..~ pipts = J733 ; _ J I I • of 3/M" klrbEy,«TE Zra13"2 i~t7f./s r p sy s7err 'So-tl~ ~s • 7 yp,Il~-- fAdJ0 - 00ek L19'T£t-ttfl1~OC& . TY~EUGG~s ' • 94• so ' 0 i 1-01 It 00 'i2 r 126-F- ~ k S t- f4D So,Pof,La T' of 5u'' • GO ~E'N~~ I S'C4 /6- 20 A S- u~ LT 7~ /\J 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. NO. 00663 i N S * / A w ~nU t l 0 , l Q e j 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 MADISON, W1 53707 State Plan I.D. Number: SW,) S` I 17, 29,20W CONVENTIONAL El ALTERATIVE (If assigned) Towli of Hudson ❑ Mound L I ing Tank ❑ In-Ground Pressure AM ERM L ADDRESS OF PERMIT HOLDER: INSPECTION DATE: • 589 Cty. Rd. UU,Hudson, WI 54016 Of 1.11rd0 ermanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW I, County: Sanitary Permit Number: Robert Ulbricht 3307 t. Croix 128634 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 1 ❑ NO El YES ❑ NO ❑ YES ❑ NO ❑ Y GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) I ❑ YES ❑ NO NEAREST 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: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 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: TRNO.OF ENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: 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: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ~I Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: Zoning Administrator SBD-6710 (R. 06/88) Thomas C. Nelson i SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code 7 x STATE ANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~01N A 8% x 11 inches in size. El C eck if revi§lon'Co previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNEV~ PROPERTY LOCATION ffltk IE7/// '/asW '/a, S ? T 2f, N, R 2,0 E (or PROPERTY OWNER'S MAILING ADDRESS LOT BLOCK C-/ 1,2,1 W Ri ~~f S NE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY, S T ZIP CODE OX4135 v.o.✓ his • ~~o/~ 01 CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned ~j ❑ VILLAGE i 1~1~.1Q~J IM =N QF: H ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PAR ELTAX UMBER(S) ` l ~lP 'J Ill. BUILDING USE: (If building type is public, check all that apply) 20 .2-1f, 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) 1.91 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued /N~s S0 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 El Mound 30 El Specify Type 41 ❑ Holdin9Tank 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. 17. FINAL GRADE REQUIRED (sq. ft.) PR POSED (sq. ft.) (Gals/day/sq. ft.) ( in./inch) p ELEVATION o d 0 0 Feet Feet VII. TANK CAPACITY Prefab. Site Fiber- Exper. in allons Total #of Manufacturer's Name Con- Steel lass Plastic App INFORMATION New Existing Gallons Tanks Concrete structed g Tanks Tanks @2~_A~ Se tic T ank or Holdin Tank d Q Lift Pum Tank/Si hon Chamber S Vlll. 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) MWMPRSW No.: Business Phone Number: 126 U-kT Z(WichT 330 '76 316-A"00 Plumber's Address (Street, City, State, Zip Code): J' T d~~ &SS- a / A..?Ei/ IX. COUNTY/DEPARTMENT USE ONLY E!!rgent& n ❑ Disapproved Sanitary Permit Fee (includesg roue Water =s7e App roved Owner Given Initial V Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety S 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 r 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. Il. 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; 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 (8.11/88) i APPLICATION FOR SANITARY PERMIT i STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property _L w 1/4 S W 1/9, Section W Township _ /,l ~n . Mailing address ,R `l y-y " u Lt ~+~-rl~*'i- It J y D / ('o Address of site / Subdivision name 4J/110IJ 4F4 s 7- Lot number Previous owner of property Total size of parcel Date.",parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? --.k,-Yes No Volume -&~!&nd Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. r PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) 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. 39 "S'QQ2j:~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. L of caner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature =b_ i~ Fj .r 4 ~ i ~ f 3 ~ -~i, ~ ~ty~ . Pc S y c 3;' i ~ ~ , ~ a 5~ ~ ~ ~ ~ roYr 1 ~ f~ 4 '°R k ¢ ~ '4,,::y- ~ ~ x y ~5. C fi a {9 q r t 4 t~ ~ `'7~i J STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER {tc•.w l~`G~-"~' ROUTE/BOX NUMBER FIRE NO. CITY/STATE /7/ ZIP S 1~ C~ PROPERTY LOCATION: LJ 1/4 w l/4, Section Rat? W, Town of , St. Croix County, Subdivision IVAW Rr e 464464S7_ . Lot No. Improper use and maintenance of your septic system could result in its premature failfire 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 Resources. Certification form must be completed and returned to the St.Croix County Zoning Office vi n 30 days of the three year expiration date. )9 : SIGNED( St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address r DEPARTMENT Y,- OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,- ` DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN RELATIONS J (ILHR 83.0911) & Chapter 145) ~~5 ~ L ION: SECTION: TOWNS HIP/Ib4tfN42f•PAt~: LOT,fU~.:BLK. NO.: SUB/DIVISIO~N%DME: 5W 1/ s.a 1/a /7 /T29N/WE(or)W Htj o sd,~ aaCC%% (T COUN Y: OWNER'S S NAME: MAILING ADDRESS: r~is S Sf~ X 13M ~gpwEl( S~'y C~Cy. P4- Z( f}~~SD.~, y0/Co USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 2 , New ❑Replace •J SCS 3vra~~i,9ieo ~V - l~~f.fitTdd V sail RATING: S= Site suitable for system U= Site unsuitable for system rT s CONVENTIONAL: MIS ND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑u au ❑S Zu ❑S ®u ❑S ©u TV o(L is c or _F%i/4Eo F Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the der s. ILHR 83.09(5)(b), indicate: CG,f Floodplain, indicate Floodplain elevation: 171~ PROFILE DESCRIPTIONS 10 'DI:!CiAj+L f&,6-r BORING TOTAL DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) a- X00 0( 3.0 ' B,J . s fei)' S ES ? S • s- Z 5 /01 6s . s. o f~~ Y cs 9'. /,0, 6~' % ~ • 5- T~r^~ & e S(7, 9-10 B- 3 r U/ 3 G L ~DO.Sd. S/k/- •C, 7' 1-11.0 s, 4,.3 B- DD OA > p, S- - v s - D~ 7 0 'TAN 5 - " cs s- 1' 44FAC,r Flev..4 %"5 PERCOLATION TESTS /A.) &C,0 C S TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER WELLIN INTERVAL-MIN. PERIOD 1 P RIOD 2 P D PER INCH P- / 3.6/OD./ - c 2 S° P_ Z . D < P- , 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 r SYSTEM ELEVATION , I SEA L T pe /4~~ E~ 2,f E` Sr J> E , i . I° _ , a ~ 1 d ~ a j 7 T..._.._..,. _F..._ J. ~_..._1 __..s ..a._._ ..,a....,. 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 : HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 L 1 (63 1 ADDRESS: CERTIFICATION NUMBER: PHONE ~ NUMBER (optional): WIS. MASTER PL• UMBER LIC. NO. 3307 M.P.R.S. Z / 2 3 d~ ~p ACl S CST SIGNATURE: QD ic ^ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R, 10/83) - OVER - ~$~MSRoaT JCTIONS FOR OMPL.ET ° RM 115 - SR _ c urate soil test, your ret? >r cl cfe= 1 1- 2. The this is a iesidence car cornnlercia7 ~Yrec# CO lips 3. 1Vli,i; 1 rlr c_.. ercial use planned; 4, Is this a "t system; i S. Complete ti > ~ing SITE IS SU ~,`31_E FOR R HOEDING TANK ONLY IF ALL OTHE4 SY the El, ":RE RLIL D ' J', ~3ASED 1" ONDITIONS; . PLEASE us u` E3 eviatio sha e for writ h , fe ~,uscriptions and completing the plot plan, i 7, MAKE A LEGIBLE diagram aci locating yc locations. Drawing.to scab is preferr d. A separate shee° may be see if des ; 8, Make sure your 111kachnaark and vertic I elevation - po,,it are clearly shown, and are permanent; 4. 9. Compete all appJ*iiQk?kaces asp to dates, names, es, flood plain clata, percolation test exenip- ti I Lion, if appropriate N 1.0, If the information (such Vs Tood pI , ele=vation) does not apply, pi Ser" thr&p~rrc~ *b c,<; 1 11. 4w"the for"' art l04kW(~rrer~t dc'r and your certificat:ic~rt 12 Make legl0if co ies a st chute s it "red. ALL SOIL TES~' 4 0~ILED WITH THE LOCAL AU HO ITYV'ytIN 30 C 1COMPL.ETION. /OU~O zP, , 60OPE I -31 J 1R l pYFI 3 S 3L T ERS ZS~ ~ 99 0 30 O ~il<Separates and Textures Other Symbols s - stone (over 10"} BR Bedrock ca Cobble (3 10") SS Sandstone gr -Gravel (under 3") Gy ~ LS Limestone - BZs~.._.. Sand HCtJ High Grplu~dti$:hr I cs Coarse Sand P€>rc - Perc(Wor Rate- med s Medium Sand G Well i fs - Fine Sand Bldg - Building Is LoarW Sand > - Greater Thin ~ S€* m < Less Thar= I - oam Bn Brown Silt Loam 13E Black 3 Silt Gy Gray *CI Cap -T Vte S 5ySrCoNtkow p~ Loam R Red I aLyd oam mot - Motties idy Clay w? vai th 1 c - "3 ty Clay fff - few, fine, f int _c cc - comm ;cars x. pt rrm - I I tld corn • d distir"t" • ~ l p prominent 3 HWL. High water' level, Six ieral sail textures surface water waste disposal BM - Bench Mary VRP Vertical Reference Point i j I' i :;CA IE This soil test report is the first step in securing a sanitary permit. The county or the Department may request • B&,e1 Q~;ficaf_o,&"0 test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit -application must be submitted to the appropriate local authority in order to #&_R&bta~A jjr37 The sanitary permit must be obtained and posted prior to the start of any construction. 1 i a I' Q i- vJ O O NpMES1TE SEPTIC PLUMBING Co' O'NEIL RD., HUDSON, WIS 5016 655 ROBElIT ULBRIGNT 7.M.P.R.S. WIS. MASTER PLUMBER LIC. N0. MINN. {NSTALLER 6 DESIGNER L1C. N0.00883 I 1,6& ; C' '0 J .3-7 b Ex)f cn L Foe 301t, o f 2- TAE'`' S v Fresh Air Inlets And Observation Pipe 00 Approved Vent Cap:- . ~ Minimum 12 Above Final Grade y/N/S nU 4" Cast Iron yZ" Above Pipe Vent 'Pipe' -To Final Grade , Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Ect, ..2-72 Tee Pipe 0 0 0 0 (0" Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At • 5 y STEM ~L.----~ Bottom Of System 10 . I R 0 iJ V ~QoP°SE~ f # F G ~o+ ~ w~ii # sus w - So! cv~// I a Boo2M . UE~f R pi ti 07 H Drl a SEi / y /~GfC ~/~t 2N' SMkt V ~ 1=/EImrl- J DUT ~ /o0•D zP l0 3~, ZS ~ 30 ~ 9q,0 S O I ZQ f ~ N~r6NlSorP'S Dls~it/6U~`i~ I SC4 ~O x o~ Z`o I I I I i I I SK I -I I Sol R~T~R~ flTE ~ I i i R~~k I I I ~ to .I I o I IY i ~ I I. I I (n I i i I T1 B3 • . . y Sy STt 5 3-0 SIC PL~SING CU 16 HOMESITEPHUOSON W►S• j / 655 p NEHOT ~L C N0.0 M.P R•S Q MA R PLUMSER SO.00 SL /4 E kraiO u0 ~,dSTAILE~&GG MINK ~ ' V~ . , . s j Mc s~ r~s I PLOT pLAA