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HomeMy WebLinkAbout032-1047-10-000 (D ° N ^ p uc ry 4 O ^„ S C h O : N j N ti � I 1, c O N m a 0 0 6 c z c m E LL cc O Q V M O w C Z d m o z y 'Z v ° c O 0) F- •' m O M (9 N N Q N CO o O Z m Z = N z co d y E C N L L cu IL a w U c °o ! o C C a .0 °- 1 Z > `n N H o w �i O O O Z •ry a a M LL NI 7 0 U) O) !n J V (p O2 OM) Z n FV N N N N I N N E I CD d O O N c O C N — ' c E o «s O U O 6 C O O i 7 M H J N C N U LL p CL 1V\ y1 N N J y y E f` O p M Q> 0 ;;q Z r- N E C 7 ~ ,G N N • ?> M ° o ° ° m o E U Ln O f/1 M O z y F M UJ EL r v C� CL .� m 0) w rrIwV r.+ E L c c :: _1 A 0CL Il0U) 0 Parcel #: 032-1047-10-000 02/12/2007 12:07 PM PAGE 1 OF 1 Alt. Parcel#: 16.31.19.238A 032-TOWN OF SOMERSET Current X 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 LYNDE K&KAREN M JOHNSON O-JOHNSON, LYNDE K&KAREN M 474 210TH AVE SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description '474 210TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 19.230 Plat: N/A-NOT AVAILABLE SEC 16 T31 N R1 9W 19.23A SW SE LOT 1 CSM Block/Condo Bldg: 6/1684 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-31N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 836/483 07/23/1997 834/533 07/23/1997 752/584 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 135,900 183,900 NO PRODUCTIVE FORST LANDS G6 16.230 64,900 0 64,900 NO Totals for 2007: General Property 19.230 112,900 135,900 248,800 Woodland 0.000 0 0 Totals for 2006: General Property 19.230 112,900 135,900 248,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 139 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 b Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER rl TOWNSHIP SEC. T _U_N-R L_7 _W ADDRESS � z 'J!2s 3 y 0 ST. CROIX COUNTY, WISCONSIN SUBDIVISION A) /4 LOT /�f LOT SIZE Ilf� PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I 60 CO L44 ' t l � i . SQ, •t INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used TeAn T`STc�r S-ra K e Elevation of vertical reference point: Jo o.t Proposed slope at site: SEPTIC TANK: Manufacturer: P c.p Liquid Capacity: _ �jp 1 Number of rings used: _ Tank manhole cover elevation: Z Tank Inlet Elevation: /OZ,1 L Tank Outlet Elevation: jNumber of feet from nearest Road: Front, Side, Rear, O p� feet From nearest property line Front 10 Side,©Rear,O 2!94 feet Number of feet from: well N building: 601 III (Include this information of the above plot plan) ( 2 reference dimens septic tank) PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Len$'th: Number of Lines:_L_ Area Built: O2 r, Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, ®Rear,0 Pt a � d Number of feet from well: Number of feet from building: !1�0 (Include distances on plot plan). SEEPAGE PIT a, . A. Size: Number of pits: Diameter: t Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). .z HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: a Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: °�® � Plumber on job: ��'� ,,Z c... _r� License Number: 3/84:m d1EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: 56vs,-,Std,S16,T31N-R19W [T CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Somerset ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound WA%WLMYERMW D ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Lynde Johnson Route 2, Box 347A, Somerset, WI 54025 2 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. 1563 St. Croix 119413 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑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: I PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: 1 BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST---00- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I 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 I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; [DYES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED. MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV: ELEV.: DIA.: ELEV: PIPES: DIA.: 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 o_ Sketch o System n Retain in county file for audit. y Reverse Side. SIGNATURE: TITLE: Zoning Adm nistra,t0 SBD-6710(R.06/88) r SANITARY PERMIT APPLICATION COUNTY T DiLHR In accord with ILHR 83.05,Wis.Adm.Code / , D/k/ "ME STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION n We S So '/a JPRJ%, S 1(o T3 I, N, R 9 r) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION AME ►� �o,r 3y A- A r/ k- N nr CITY,STATE _ ZIP CODE P O VILLAGE HONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK S W1 StIOZs II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 13 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. �K New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.X Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.1:1 Pit Privy d. El Vault Privy e. 1:1 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b.W Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORP ON AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED,(Square Feet): PROPOSED(Square Feet): 9c� ,A/d �3 ! 75 s©o o D 9 / Feet Wrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank -vmz 11 Lift Pump Tank/Siphon Chamber I - - 1 ❑ ❑1 VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. PI ber's Name( n t): Plumber's Si ure:(No Stamps) MP/MPRSW No.: Business Phone Number: �4L�U I h e�� � � 6� 3 7 5/6$/.3S Plumber's Address Street,City,State,Zip Code): Name of Designer: �I !� WA 6/ 15_11 VIII. SOIL TEST INFORMATION Certified S,QiI Tester(CST)Name_ ,� CST# � ^ � �y CST's AD/DDRESS(St et,City,State,S„taate,ZZipp Code) Phone Numbbe(r: jf IX. COUNTY/DEPARTMENT USE ONLY ,�¢¢ ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) 19 Approved ❑ Owner Given initial Surcharge Fee Q I Adverse Determination ���� Q� `+��`J �C 34�_v " ho X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if_ tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees)_for a number of regulated practices which Wisco 1r1*S ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried T9e+1# is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) 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 4nd'e— 41 � o"Jsov% Location of property AIU) 1/4 IVW 1/4, Section � , T N-R1-5'W Township 5e>rn-eh- Mailing address Address of site �� � -ter Subdivision name Lot number Previous owner of property Total size of parcel r g / Date parcel was created L J� Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes o Volume co and Page Number A&V 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. ------------------------------------------------------------------------------- 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. Y/4 G 03 ; 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 Count egister of Deeds, as Docume t Mo. ) . El r L Signature of Owner Signature of o weer (If Applicable) Date of Signature Date of Signature rtvtENT NO. ATE BAR O�WI 6'1'�i WbRM 11 -1982 i1S SPACE RESERVED FOR RECORDINGOAT A LAND CONTRACT �+�+(� (r Individual and Corporate / 4V GO S S,B0000 IS FINANCED TRANSACTIONS N OTHER NON-CONSUMER ?• / ACT TRANSACTIONS) RESTERS C FFlCe Contract.by and botwoon_ Joanne A. Seibel a single women ST. Mix CO., WIS. Reed. for Record thh r t b Who ther one or more)and__ Lunde K. Johnson and Karen M. (aVondora, oy of $e pt_ A.D.8 19 86 Johnson, husband and wife as ioint tenants . _�—`M (aPurcha3ora,whothor one or mono). Vendor 30113 and agrees to convoy to Purchaser, upon the prompt and full por., tormanco of this contract by Purchaser, the following property, togelhor with .lho rents, profits, fixtures and other appurtenant Interests (all called tha 'Prope'rty,), In St. Croix County,Stalo of Wisconsin: RETURN TO Tax Parcel No Part of SA Of Sk of Section 16-31-19 described as followaf Lot 1 of Certified Survey Map filed July 16, 1986 in Vol. 11611 G�S. 9 , page 1684. i l33?.t:8 /3 3r;.5s. +3oY-�F • This -i s not homestead property. S Net Adj.(total) _.... T I'Al Indicated Value Of Subject $ t, $ $ a rcmments cn Sales Comparison: - - ,-• - •r „a1-.1 8G ,+,3_±,}-,.a_ rr.r.G t n r c,nt c i gl,y - r'- i�;it� r�-N'iFisr- in 4hir_ � _ _ - �� -I�� c�,i ,.��,+a X11 i ,�� � - +Fwl3 i1ra r,a,.,1 fr.,+ 1-,e-,m.�c .�f +h�-.� '^ i � iil1C� I..=r-t3 f,:41 t +.•� hr. nei iQdirntnr u�,re-e� I e,ne ov -Rece�nmvnwenw annera-u STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Imo- C� �c`�1�Yx$o Y-"- ROUTE/BOX NUMBER q-7 FIRE NO. CITY/STATE S _ l ZIP PROPERTY LOCATION: ( W 1/4 111 x_1/4, Section , T 3 1 N, R 19 W, Town of , St. Croix County, Subdivision /U� , 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 Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. 1 S I GNEDr� DATE t / St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INAUST"Y,, CC DIVISION HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION: TOWNSHIP 6+RAI-ITY: LOT N . SUB DIV SIGN NAME: "/• 1/a � /T N/R �uor)W s`,0 M� � - CO NT : OWN E ' M MAILING ADDRESS: USE DATES OBSERVATIONS PXADE NO.BEDRMS.: COMMERC AL DESCRIPTION: PROF D ESCR I PT IONS: OLATION TES TS: Residence ZNew ❑Replace 9 RATING:S=Site suitable for system U=Site unsuitable for system / C� r ON�[VE�NTIONAL: MOUND: IN-GROUND-P�URE: S�STEM-IN-FILL HO�LDING�NK:RECO➢11MENDED SYSTE4�"'til)LTV ❑ Y 7�J ❑ Juyc U S S U �Sp�� 1pc o-CJr7 If Percolation Tests are NOT required re DESIGN RATE: 4 I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: L Floodplain,indicate Floodplain elevation: , PROFILE DESCRIPTIONS �lk /d BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEI;T�4N. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 75 B- � fo q o A } , �0 ' 5_0, ' .s. 'fir B- ,� �/� / PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1WG4EES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ / 3 .3 P_ z o P- 3 3�� 6) 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. SYSTEM ELEVATION �� ��; � yam, 1� C/ r - - - a I � r _- ! +�►. - j- 3 i E ----- ----- — r � l 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: ADDRESS- CERTIFICATION NUMBER: IPHONE NUMBER(optional): CS=GT'R�: 4' DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — I INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To he a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systern; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates,names,addresses,flood plain data,percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HW - High Groundwater cs Coarse Sand Perc. - Percolation Rate med s - Medium Sand W - Well fs Fine Sand Bldg -- Building Is - Loamy Sand > - Greater Than sl Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow sci - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w,r' with , sic - Silty Clay fff few, fine, faint C Clay cc common, coarse pt - Peat mm - Many, rnedium nra - Muck d -- distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark if RP - Vertical Reference Point 1 I TO THE OWNER: This soil tes report is the first step in securing a sanitary per€nit. The county or the Department may request L� iil�atwm c1 toss soil test it) the field prior to ;i!rmit issulint'c�. A cornpleae sett of plans, for the private wstew and a hermit applicatit-m muu: bO, ,`aLA)NlittOd to thta ar�pr->t F «tee local author,ty in order to .hl #1=3 101',r"M611 i`#7e sanitary pormit mull, be!.'hf' fined an d posted tar for to tr (. ;tart" of any constluction.- y�p �r ",� i PAGE OF CroSS .� ec � lor, lco � A Zoto S yen Fresh Air Inlets And Observation Pipe ( APprovsd Vent Cap Minimum 12"Above Flnol Grad• 20-42"Above Pipe _4"Coat Iron To Final Grade Vent Pipe Marta May Or Synthetic Covering Mtn 2"Aggregate Over Pipe OIs1rlDullon — pipe o 0-- o a Tee Aggregate Beneath Pipe Pertoroted Pipe a Below o —Coupling Terminating At Bottom Of System 9S: s SOIL FILL DISTkIBUTIOF.I PIPE APPROVED S4MTHETIC COVER ° !'—MATERI^I OR 9" OF STRAW rOFAGGREGATE -�� c OR MARSH HAy (eOF 2�� AGGREGA tL E V. O F I FEET--#. D15TR15LITION PIPE TU BE AT LEAST INCHES BELOW ORIGIAIAL GRADE AQU AT LEAST20 INCHES BUT 1.10 MORE THAIJ 42 IAICHES BELOW FIUAL rKADE MAXIMUM DEPTH OF EXCAVATiewl FKoM oKi&wAL 6RADF- WILL BE INCHES MUNIMUM ®EPrtt of EXCAVATION MOM 0+K16IaAL ()RaV€ WILL BE Q0 INCHES SIGMEO: LICEUSE AJUMBER: ' DAT E 110 �- h � o� s�Y\. _ •* � � � 3Y> w �4 5-c�p�«lallk PC P/ a-DA tp Y Q �sw 1563 n Q rn CkrL 0 1 too r* U ry 5� �s CERTIFIED SURVEY MAP LOCATED IN PART OF OF THE SE} OF SECTION 16, T31N, R19W, TOWN 0 SOMERSET, ST. CROIX COUNTY, WISCONSIN LEGEND OWNER O 111 x 2411 IRON PIPE WEIGHING 1.68 LBS/LINEAR FOOT, SET. JO ANN SEIBEL RT. 3 BOX 309A NEW RICHMOND, WI. 54017 unplatted lands owned by others ----- ---- ---- ------------------ N890 2614411W 629.911 north line of the SWJ of the SE} sa. ' 1.5' SOUTH OF FENCE N rt N• 7 N O rt Ic s Ic 10 A 17 1� O N Iv NI r c #4, 1,-. 1N cn I W CIO CT 1 rt CT ° I rt m m -* rlr N 1rt w Irt 1A s t�B �• Id m A 1d N tC I CA 1 C N I w m I►-• o a LOT 1 .. N I N w 1 N ° c 837,505 sq. ft.) '." CCD i o INCLUDING ROAD R/W w O o I: r 19.23 ac. cn) r I: co 0 N rh 17 0 C+ is c2 816,921 sq. ft.) C io. m )EXCLUDING ROAD R/W 18.75 ac. I _ 1 I� 1 tr 7 c 1 W 1 Irh �+ Irt W 1 S � I A tJ1 I N A 1 w I-1 eD o I H � CJ7 1 H -ti I rt Si corner SE corner section 16 section 16 County Monument S8903814711E 623.821 55' County Monument S8903814711E 678.671 W Town Roar w w south ine of the at W 4i W w unplatted- - lands owned by others ---- ----- ---- - --------------- KALEIN FEET 200 100 0 200 this instrument drafted by Douglas Zahler job no. 79-35-186 't