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CROIX COUNTY, WISCONSIN SUBDIVISION GY`G57U1�� LOT AG LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ao if 0 � ��` D p f o► ad i / �N� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 6 - 5i4ow, AX Elevation of vertical reference point: Proposed slope at site: Fl SEPTIC TANK: Manufacturer: iquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ` Number of feet from nearest Road: Front,O Side,o Rear, O feet- . . From nearest property line Front,OSideoRear,0 Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to Sept- - PUMP CHAMBER Manufacturer: Liquid Capacity: e 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, 0 Side, ORear,© Ft. ��. . Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 30 Len t !„ gth: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0Pt , Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT f-le ,-d-e� � !l/Q` �G ✓'/ Size: Number of pits: Diameter: r Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box 0been used on any of the above soil absorbtion sytems? (Check one). 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: Number of feet from building; Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: °'Z ��� Plumber on job: r License Number: 3 3/84:mj t DLPARTMENT 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: NE 4,SE 4,S30T31N-R18W ® CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Star Prairie ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound T bw ADDRESS OF PERMIT HOLDER: INSPECTION DA Wa e K. Wandel 147 54 Oakmm Lane Burnsville, ITT 5533 BEN H 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: ,Byron Bird Jr. 3318 St. Croix 119509 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO ❑YES E]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 I NEAREST—► DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: IPUMPMODEL: 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: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES ❑NO _NEJ DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH 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:I 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: 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: 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: U\ ❑YES ❑NO ❑YES ❑NO NEAREST L/ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: __7iZoninor Administrator SBD-6710(R.06/88) 7- SANITARY PERMIT APPLICATION COUNTY 0 LHR In 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 // ?L5709 8%x 11 inches in size. -�4,) j� ❑ Check if revision to previous application -See reverse side for instructions for completing this application. / STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. S PROPERTY OWNER PROPERTY LOCATION 4A,p/e/ d4E Y. &:-%, S jrC> T , N, R J E(or PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# Mn Du4,07C_-, /67 �----- CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME O CSM NUMBER / rr7 14 '✓ 6/ .Z .� a c cc1 d 11. TYPE OF BUILDING: (Check one CITY N REST ROAD \ El Owned VILLAGE:�/Lt�,���riL � (f Q �G�r ❑ Public ®1 or Fam. Dwelling,##of bedrooms L TAX NUMBER(S) 03�_ //43 -QS-..��� III. BUILDING USE: (If building type is public,check all that apply) 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. El New 2. �Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 El Mound 30 ❑ Specify Type 41 El Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION O /�—D O / 6 to o � ���3 Feet l�•�• 6 Feet VII. TANK CAPACITY Site In allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank a�Q 0 e Lift Pump Tank/Siphon Chamber ©O Vlll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumb ignature:(No Stam ) MP/MPRSW No.: Business Phone Number: &o rt r J�• 3 S .268 ?6 Plumber' Address(Street,City,State,Zip Code): y IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee(Includes Groundwater Date Issue Issuing Agent Signature(No mps) Approved ❑ Surcharge Fee)Owner Given Initial / wv fN /r�J Adverse v , X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398(formerly Pib-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: I. 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. Ill. 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. Vlll. 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'f x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment-of standards. SBD-6398(R.11/88) APPLICATION FOR SANITARY PERMIT 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 .4wile Location of property IY 1/4 Sw /= 1/4, Section ��' , T ' N-R /J"W Township _S- el y- Mailing address 2c'ff 4"'c7,kt el '_ ��•5 2 �� �t �1 4g ,jF' Address of site Subdivision name Lot number Previous owner of property ` Total size of parcel T 3 Date parcel was created ,--) u 3 Are all corners and lot lines identifiable? _Yes No I Is this property being developed for resale (spec house)? Yes �_N0 Volume qand 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. 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 warran eed recorded in the Office of the County Register of Deeds as Document No. " `S�� ; 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 ounty R lster of Deeds, as Document No. ) . '( JCL Signature of Owner Signature of Co-Owner (If Applicable) �5-_ � _ Date of Signature Date of Signature - K All 4 it Clot a ~3�aclatl in tbs� twh of SEW I . end.Abe ' tiS�C of S' w of Seetion Thirty Mort t.fat' ►4e Aghtell� i _ Ala (1010 B '�•' �[�Cd f { wa sae • YYaT'L^' ,S .. Mr .�, K'.. 1 CMah,,��ti i rr STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER A P F < C' C'_ ROUTE/BOX NUMBER N 7L C :k Yu Dj FIRE NO. CITY/STATE_ )�� �' 11 ,S, ° / F 0ei ZIP PROPERTY LOCATION: 1,1/9 S L- 1/4, Section �5 , T ' N R a W Town of ^I— r l q I j- / , St. Croix County, l Subdivision - C_S L / <�'/�%�� Lot No. Improper use and maintenance of your septic system could result in its premature failore 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. / SIGNED %C DATE_ St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIO � L (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: O : OT NO.;BLK.NO.: SUBDIVISION NAME: COUNTY: MAILING ADDRESS: IZ a� ��,r 1u...c � it/� USE DATES OBSERVATIONS MADE G/®z NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: �s R A I TESTS: Residence ❑New y Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUNQD: IN-GROUNQD-PRESSURE: SYSTEcM-IN-FILLHOLDIING Ell SYSTEM:(optional) EAU 1S DU DS J �U �J DJ Ell F? DESIGN RATE: If Percolation Tests are NOT required D 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 TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) ,p B- 6 d^.-e— > J���� �/1` — Az ,2 5,73 B- B- �o✓ �o//on o c B- B- PERCOLATION TESTS } TEST DEP WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES F NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 3.3 P- 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. SYSTEM ELEVATION _. �, -- _ . ,D t g 3 E E s i S � E ; c ` .., ..._ ( � � € I � N I 3 v t 3 ......I t t a � 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): ITESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 2 CST SIGNATURE: O� DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115- SBD- 6395 To be 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 system; 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 scale is prefered.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 apropriate boxes as to dates,names,addresses,flood plain data,percolation test exemption,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 yur 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 — Standstone gr — Gravel (under 3") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well Is — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil 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 obtain a permit.The sanitary permit must be obtained and posted prior to the start of any construction. ' nr rvn Vw bVIL W11114U5 ANU SAFETY& BUILDINi:i INDUSTRY, DIVISIO(• HUMAN A"° PERCOLATION TESTS (115) P.O.BOX 796S HUMAN RELATIONS -;MADISON,WI 5370' (H63.09(1)&Chapter 145.045) O TOWNSHIP/MUN B K�N : SBUIVIS O NAME: � .� /o Vt � 30 %T 4 N/R)r E for COUNTY: " LINO ADDRESS: a . t V✓On q2 ' I,' !tR y d /cw �t•'thrr� USE I DATES OBSERVATIONS MADE NO.8FORIM: COMMERCIAL DESCRIPTION: ®Residence y/ / ONew ❑Replace h �` (l /%. 4 V777 ` ` / /., D •I/ l x;,,10 n��' '' RATING:S-Site suitable for system U-Site unsuitable for system r NVE MOUND: I• - - Y O DING TANK:RECOMMENDED SYSTEM:(optional) S DU �1S ❑U ®S ❑U DS DU DS DU �oxsS If Percolation Tests are NOT required DESIGN RATE: . t , If any portion of the tested area is In the j under s.1-163.09(611b),indicate: Floodplain,indicate Floodplain elevation: ' I PROFILE DESCRIPTIONS BORING TOTAL P H T R UND ATER•INCHES C A ACTER OF SOIL WITH THICKNESS.COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN ELEVATION OBSERVED TO BEDROCK IF OBSERVED(SEE ABBRV,ON BACK.) Y .-41 /�. I✓ I-31/ LKIC I , 14 SL 5L, ;9711 1-+. :rn.CLI 1-1 " 1-1.1&,. IM.✓Ir, 401.4 B- ' v �� �{ 3 �, 1 !r„�1� of Serif � t •� Z B- 1. 3r Q6. `�J. limn •' P,. ,: 10"-Top.Sr.•1 I 1 ,;'13~ 1:1,..( 1 3'q/i )-oow, 1 lot . 1sontl. JAn &.1 toNA6 .0 ,, PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP T R V S RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER INCH P P- P- PLOT PLAN- Show location's 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 lend slope. SYSTEM ELEVATION_ 90� ,o v. o Lx 1 7-' /� C i�. V m! �•rl,�, i_)' / 1 ' - - - - I '*�(� I�t#} 1 7 � � t 4 z • 4 t I , , r a 0, l� -- -- - - --- - - -- • T y p rj I,the undersigned,hereby certify that the soil tests reported on this form were 1 lade by me in accord with the procedures and methods specified in the Wiaoornfn Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, t:. c y NAME(print)- TESTS WERE COMPLETED ON DF 7_ H ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERIoptional : C QHn4r ��• I �S — 3gdq Y. CSTOGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. ' • R•SBO-6395(R.02/82) —OVER PLOT PLAN PR JECT a '0'7 C C- 4/04 C/ ADDRESS /T�� N/R nW TOWN r`, COUNTY PRS Byron Bird Jr. 3318 DATE S7 BEDROOM CLASS PERC_CONVENTIONAL -IN-GROUND ESSURE CONVENTIO AL LIFT_XMOUND HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA X66© . PERC RATE BED SIZE bL Benchmark V.R.P. Assumef'Elevation 100' Location of Benchmark S/ & o �o w c.r * H.R.P. -:f2 ,, �t- 5 0 Borehole Q Well Scale = Feet O Perc Hole System Elevation Vent 12" Grade 1/01 03. 0 TYPAR COVERING 2" 2° 12" 3' 4 g' 0 3' 3' 0 3' 3' O 3' 3 4 6" Sewer Rock 8 24' 12' 1 p 0 P � r 0 Gt<ra .c y , j 0 , s Q 0 �° �' Phi JECT t/�S�b ADDRESS � O Xc� c y�lf-114SGc /T � N/R A? W TOWN---57`, �r� e COUNTY Iry° mom' MPRS Byron ird Jr. 3318 DATE _ -�3 7 BEDROOM CLASS PERC_CONVENTIONAL^IN-GROUND ESSURE CONVENT I0 AL LIFT_XMOUND_HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA 6 _ PC RATE �?_BED SIZE Benchmark V.R.P. AssumelERvation 100' Location of Benchmark ,S/� & , o g,6 w e-r �,(( * H.R.P. Ste. „w ea 5 /ice O Borehole Q Well Scale Feet 0 Perc Hole System Elevation ,/pa•-";F Uent v�r r 12" 03. '30 TYPAR COVERING 2" 1° 12" 3' 4 6' 3' 3' (D 3' 3' O 3' 3( u 3� I 6" Sewer Rock it 12' 18' 24' O 0 f \ ,( �p y `r o � # / vtjo* O J Ajo L a 371 B K ¥ 72 7 \ 2 ® \ ( > o k @)�2 � k{ k §\ 0 .0 7{ } §k :3 R \ 7/ a »2k . / §2# pew = § -6 r- U. q2c+a \ m 7@]§k » - f 2 � co w} - k ! z R § k a ■ B z \ . U) k k 2 -� § $ § \ ) k "b z { z 2 " c . } d = k k f � ( % 2 6 � 0CD0 § f o o a E 0 \ _/ C. ° k F 0 0 0 0 z o a § a a a ; g B ) 7 $ Q ] 3 a 2 ! § / 6 2 © E o / \ _ # z m a % / § a ° c . _ § ; 2 � E k a j d k \ \§ CO ; % 6 I ` 2 7 k - -S � . ■ a = CN w 0 z $ . e « e § / \ \ 2 0 z / / \ \ J 2 « m § C E $ ) \ B f � .� o 0 a j0 $ v JFRTMENTOF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION UMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 State Plan I.D.Number: • [UCONVENTIONAL El ALTERNATIVE (If a_C,.L1) ❑Holding Tank ❑ In-Ground Pressure ❑Mound INSPECTION DA NAME OF PERMIT HOLDER: ;7.ESS OF PERMIT HOLDER: Wayne Wandel . R. 4, Box 173, New Richmond, WI // 30 8 REF.PT.EL CST REF.PT.ELEV. BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. NE SW, Sec.30, T31N-R18W, Town of Star Prairie, LOt#10,CrestvieW Addn• Sanitary Permit Number: Name of Plumber: MP/MPRSW No.: County Michael Wilson 6388 St. Croix 54992 SEPTIC TANK/HOLDING TANK: FIN MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: E IDEDLABEL LO ROVIDED COVER YES ❑NO OYES ❑NO LiM ROAD PROPERTY WELL: BUILDING: VENT TO FRESH BEDDING: VENT DIA.: VENT MATL: HIGH WATER N f3ER F : LINE: AIR INLET ALARM FEET FROM DYES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: PUMP/SIPHOTMATERIAL LOCKING COVER MANUFACTURER =NG LIQUID CAPACITY PUMP MODEL PROVIDED: NO El NO ❑YES ONO PUMP AND CONTROLS OPERATIONAL: UMBEBUILDING.IAIR NLET RESH GALL ONS PER CYCLE: EET F(DIFFERENCE BETWEEN ❑YES ❑NO EAREPUMP ON AND OFF) ENGTH. MARKING SOIL ABSORPTION SYSTEM.Che ck the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE DIA #PITS: IQU1D ypy } WIDTH: /, LEN`G/TH. NO.OF DISTR.PIPE SPACNG. COVER DEPTH. r EOf"�"1! ENCH' V ) TRENCHES_ / M L PI � oodw JJJ PROPERTY WELL: BUILDING: VENTTOFRESH GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI R N MBER QF LIN AIR INLET. BELOW PIPES ABOVE COVER. ELEV INLET ELEV.END. PIPES FEET FROM q�.43 NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES El NO PERMANENT MARKERS OBSERVATION WELLS SOIL COVER TExruRE DYES ONO OYES El NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. IMULCHED: CENTER EDGES. OYES ❑ DYES 0 N DYES ❑NO NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH PIPE ABOVE COVER. WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIP EE1Ci °. TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.SIST R, DISTR.PIPE DISFR IBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.. ELEV.: &EaVA fN At � �I COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED HOLE SIZE HOLE SPACING. DRILLED CORRECTLY.- PLANS. � 0 "° ❑YES ❑NO DYES ONO PROPERTY WELL BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NiIIIEt- �" LINE: f E, ❑YES El NO OYES ❑NO MEARET; rr71� f/ 0 6v in ? , 0-7 Retain in county file for audit. Sketch System on Reverse Side. .� SIGNATURE: T SBD 6710(R.01/82) [: Wisconsin APPLICATION FOR SANITARY PERMIT DILHR ' COUNTY (PLB 67) UNIFORM SANITARY PERMIT# �OEPq¢ITTElAT OF iii InOUSTFI4,LABOR 6 NUTFin RELRTIOnS �/ / - —Attach complete plans in accord with s. H 63.05,Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS /'i J/ PROPER LOCATION CITY: VILLAGE: AiF 1/4 Se t/4, S 3o T-71, N, R / E (or)40 S irr, LOT NUMBER BLOCK NUMBER SUBDIVISION NAME EST , LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: t� ❑ Public (Specify): THIS PERMIT IS FOR A: i. New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ® Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity -,fA0a ✓ Lift Pump Tank/Siphon Chamber ✓ Holding Tank capacity Is. IW Manufacturer: ski L7 t P da IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 37 15'00 16 3.0 ® Private ❑ Joint ❑ Public I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: /MPRSW No.: Phone Number: H.` x L E C.>,' 1 i., J'2c >C. C...�iGo— 4 9' (a68► Plumber's Address: Name of Designer: C V'y©o i COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: I Fee: Date: ❑ Disapproved �/O,o �'/0��� � ❑ Owner Given Initial ) ,� Approved Adverse Determination i Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 698 ' To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city,village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi= fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system,type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size,separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. H f, W 9 r ST C - 105 r' 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z c7 H Cif OWNER/BUYER ,gyp _;?K ROUTE/BOX NUMBER R fJ� ulA,�/ l 7 ? Fire Number CITY/STATE �,�/ /f lCi"11 M 01'l C� � � ZIP %'/017 PROPERTY LOCATION : p'(E SE-- �4, Section 30 , T 31 N , R W , Town of ,S4G_ /��"G� �f''/�° 0 St . Croix County , SubdivisionC,=eS /ew Lot number Improper use 'and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St . Croix County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic •tank is less than 1/ 3 full of sludge and scum. Certification form will be sent approximately 30 days prior to ti three year expiration. E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b ment 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 . SIGNED DATE 3�- St . Croix County Zoning Office P .O. Box 9a, Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . APPLICATION FOR SANITARY PERMIT 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/contractAl:. ("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 W. t.. c)- t-y+ve t @-i✓ A r •f I Q � Location of Property IV ;L C 2 �4, Section 30 , T 31 N - R �_ w Township 1+ / e Mailing Address r R + Subdivision Name �� r-2 .i' '7� y �° t� /'h d r�/ / Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created 9 Are all corners and lot lines identifiable? �C,L_ Yes No T Is this property being developed for resale (spec house) ? Yes _ No Volume �-3 and Page Number Sr .Z- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 0 Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) cexti6y that aU statements on this 6onm cute tAue to the best 06 my (OuA) h.nowtedge; that I (we) am (are) the owner(s) ob the pnopenty de c i.bed in this kn6o�una ion Aonm, by vixtue o6 a wa Aanty deed Aeconded in the Oj6ice of the County Regiz teA oA Deeds as Document No. ,C' ; and that 1 (we) phesentty own the phoposed s.cte {oh the sewage dczpobat system (oh I (we) have obtained an easement, to nun with the above des cAibed pnopenty, soh. the con6tAuction o6 said system, and the same has been, jc t �ne�c)jd in the 066ice o6 the County Reg.csten o6 Deeds, as Document No. `1 j -1.)a SIG ATURE OF OWNER SIGNATURE 0,F -OWNER (IF APPLICABLE) r DATE SIGNED DATE SIGNED No , COUNTY /4 OF 'THE- SE 1/4, THE AND TH:E 'NE 1/4 OF THE i T31N R18W. 1 NME: CrMMr,N Ck1vE'.v.:tS °nA__ PE RECJIRED . - F f R -17 TS I ar;f _ CTP :6%•N .17" A N r I cF Awret.: iJaO. -CTS 22 :.Nr i �Y 1�lHV A_L STREETS Sr1a.L iiC PFIVATE STFFETS U�1TIL SUCn TIME AS THEY COMPLY K'17M R.L ) W r'J�,3 THE ST. CNnIX C,-,GNTY HO.:J RUILDIh '1 E C I F I C a T 10 N S. ARE n, ACK'^ rEU aS 1 NS` L, PEH THE TOWN nF STAR F•HAIFi1E REOJIRE- SCALE l-1`.tl_' MENTS ANri ARE a S r E P T E D 9r THE TOWN ART►R3e E. r.•tis .s - - OF STAR P k 4 1 HIE. SECTION 30, Tan. 11 WlC.CRlR. .t g S. I t} PRAIRIE, ST.CPC L + w C u RVE l~`• PLAT 6EARINSS REFERENCED 1MQ S� yOQ : —w TO THE N-S I/4 SEC71 JN n9 i n0 F+c•. t[ c.. w.,,,,,,,,,,.•"'�� ` _INE OF SECTION 30.ASSUMEC -z + 3r7oo 306.2 BEARING Now20'05'-w 3'4 3 ! z73 c223 6/ ` 3 s-6 !-T 46 o01 33 C �: 7 6C.00 112.207 ac x es 60 �\ SCA:.E IN FEET �560eo�72t KM I 6 9000 f{9!� 7-e 6 1 40 00 33.40 ` 247 160 120' —0 127• 240, 9-I -7.93 60e_T 9� 7 u77-93 1,0.01' •'� a u�7,9s z9�7z' Ir 329_00 2,9.97 ' "F /, r`.w• . LEGEN� 9 3t600 I4t 94 �!0 3z 9.00 80.0c '� `�. Fc C �. - :.o_ U-12 13.04.05'3 5.3 7 t "w4•..E.� _ N..._.�:.. _ `n:,� _.yC.. � y10 730a00 '16i-6 2 ' STA..E 113 4_12 4ce.00 272.39, �5•y � �.` ,7 � _._i_ _ - - I . 1. 1: ,'_ 6__,..—«.3x2:07 iz8.32 13 3x2 00' 171.92• 34i 00 ' 5"4' 16 '5.70.00' 130.34: 370:00 N9,11 wV ' �9 � •TTF __-Iy 3ro:oo s9.a re-19 19 263.00 17175.64 9.20 (111,93 374.6e 9. 'f ,n• 8T + v9 Vlu_.93 103,6) 1-11 u 93 471 99 Avo 1 22 23 20.•00 top 13' Q:. 27-26 ;21 2520r'-/SSIt' .; .829 6900 13733' 4 Ole AC 5. z, 6o a9'?LZxo7' ,20„ 6000';130.36' 9-30 20 232 07' 1`34':11' ! 31-32 20 17.1T� 19.1x• OC / .c Qy I.698 Ac If07AC, >t _ i5 - .- 2/ 96. ;9r % 535 14 n`, ^ m Lc ^ .+ to 3 r9 x 46 a: )z T W 10 c _ n ~ T� � .is►G ?•+� - 9 :. �;'� 1 a•:�:c °_. �+ 7-. 1 w SC.60 0 . sa� cs'1E; ' cry 4 f •R�i'�. 1 np.-, 49 J^ -uy 4i II .24 - 1 { 1275.76 n., sf/4 GoRNE 4. a •��� ��� SEG.JO,TSI M,RIIMp'I u' 2668.-a4' ¢. 0, } ; W : fp �� •a �. N��7 :—FTED BY- /OJ+�...!.C�•\.sl`�i��. N• r } y > VIM t 4 cx h"t j h t k dy pt K F„; DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA 3����8 WARRANTY DEED VOL 69WAGE 51.2 REGISTERS OFFICE Lester H. Martell ST. CRCNX CO,, WAS, Recd. for Record this__] -lay G Au ust A.D. 198_4 conveys and warrants to Wayne K. and Margaret H Wandel at 4:25 P M. as point tenants �. • aoMW of D*W RETURN TO the following described real estate in St . Croix County, i State of Wisconsin: Tax Parcel No: Lot Ten ( 10) , Crestview Addition , located in the SWA of SEA , the NWA of the SEA , the NEA of the SEA of Section Thirty (30) , Township Thirty-one (31 ) North, Range Eighteen ( 18) West . r� rill Vim This is not homestead property. (is) (is not) Exception to Warranties: Dated this 31St day of July 1 s 84 ''��.��1�/ (SEAL) �,,�/� / Z",a—Lt-� (SEAL) Lester H. Martell (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St . Croix County. i authenticated this day of 19 Personally came before me this 315t day of Jul y— ' 19 84 the above named LeRter H Martell TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who executed the authorized by§706.06,Wis.Stats.) foregoing i st ument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ACORN REALTY — -- 245 Main -- -- z, Somerset, WI 54025 Notary ublic :r 1= ��a= y —_ County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission js pVhanent. (If not, state expir ion ` are not necessary.) date: Names of person,signing in any capacity should be typed or printed below their signatures." NTF 2280 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms.P.O.Box 1075,Green Bay,WI 54305-1075 Form No.2—1982 i' v CA � n m m m Lr ? � � N30 �« -+ cr o C ° i ?CO-4 3 � CO CO o 30 c3mN .1 * 0 r-P �n 8 � m � � o. � XmamA ir tC a N n O (D m OODD A3 0 -. -1 coco 4 V-0 =r wpo � C- Cp: � rA co 0 ? 1 cr co - 'M @.*. 0wa o. � oac� o (D co w P, m r- 3) A < N Q - t0 Q0 A CD y p > C . �p A -. N _ A m p C A — w m( c ? o a - m -, w � m m o O p; A O O a CO r = C o s-0 a: - N N m m Z A CO Z = w �' w _— '� 0 �1 w m m — A ? '� m CO 2 (D o ? � � A � R1 M PIP QNm a ( ? ac' w CO) 'o v; wa acAIE m � C m v 3 �D ° -v (D S m cDC ? oam � � C1 ? (D wo CL m - b ..., o �c gym = Ilk aof NcCa0o At w m a* aCLaOL 0 C0 0. 3w ? � vi � 0 M c � co 0.0 3 m (A c �`° a ov, CDC) N0 ao :3 oco � -� mCm S w ;,... _ ; r o o DEPAR.1 IVIENT OF REPUR F ON SOIL BORINGS AND SAFETY& BUILDING: INDUSTRY, DIVISION LABOR • AND PERCOLATION TESTS (115) MADISON,WI 537 HUMA N RELATIONS 07 HUMAN (H63.090)&Chapter 145.045) .LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: / 0/ 3/ /T�� N/R JrE for =a f w.a io �(��� COUNTY: OWN ER'S BUYER'S'NAM/E: MAILING DDRESS: nn INd W C►n p e l � y is ox �C u✓ I C f. rr,O fl USE DATES OBSERVATIONS MADE NO.BEDRMS : COMMERCIAL DESCRIPTIO 1PROFILE DESCRIPTIONS: PERCOLATION TESTS: ®Residence / / 'y //f ONew ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) 0 S OU El S OU SOU 0 S OU ❑S DU .pox f If Percolation Tests are NOT required DESIGN RATE: I7an portion of the tested area is in the under s,H63.09(5)1b1,indicate: Fplain,indicate Floodplain elevation: i PROFILE DESCRIPTIONS BORING TOTAL PTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) r r" r M�� 13L SL d{n j.+,�Ir, ('L ) 1111 B- q r , n< hT.1`:r�. Mf,�, 1 B- - b.'1�. �`�-��r � �. -/ �,�-;. ly Q,L SL, a7" L4. �.,«.nn�..L_� ►.1 „ La. X7,-,1 �,:—1 -171—Full.. bo,.< :. sio B- ._33 j rr 10 (z.L 5,I..I l3"0. Fi,,-CL, )'e'2' ),oars B- ! r r�. �.r r )O To(�� 1( � �' ('I,,.' 3'q�l j onn fin. ro e) '., r•�,Ilc )- �S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RIOD 1 PERIOD 2 PER INCH P .j a' 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 9 (. _ i _ r 1 ' iCr ! 1 r � t i 0 _ } _ , _ cP E �_ ttt tN I , t 14 'f , . } �l ...... 19,47 / - i t � , 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUM13ER(optional): CSTOGnnNATURE.- DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. AR-SBD-6395 (R.02/82) —OVER — TDH, HEAD CAPACITY CURVE W � W a U 1 OO TOTAL DYNAMIC NEADICAPACITY PER MINUTE 3O EFFLUENT AND DEWATERING 95 SERIES 53-55-57-59 97 131.139 193 199 r2m. M GAL LTRS GAL LTRS GAL LTRS GAL LTRS GAL LTRS 28 1.52 ;43 183 es 248 :104 394 °6t 231 231 90 EFFLUENT AND DEWATERING 3.05 34 129 ws�, 216 ;:"79 300 " Bt 231 =e, z31 4.57 t9 72 43 163 64 242 - 227 ,eo: 227 26 \ 8.10 27 104 "'36 136 j#59 223 1e0 227 85 SEWAGE AND DEWATERING ,' 57 216 -y59 223 8 30 62 e 14 :55. 206 '�SB 220 24 0 ♦ 19 y - :48 172 *55. 206 a,� J \V 24 s .?''?�' Y 33 125 .'41 191 75 29 1 ?. ?5 57 � 43 161♦ 34 '30 114 22 .38 53 7O e: 19' 8T .� MODEL\♦ MODEL 20- 65 163 165 TOTAL DYNAMIC HEADICAPACITY PER MINUTE ` \ SEWAGE AND DEWATERING s " ` \ SERIES 287 289 282 294 293 18 \ ` FT M GAL LTRS GAL LTRS GA LTRS GAL LTRS GAL LTRS 1.52 108 408 102 386 .1 492 1 1 `55 \ 40 3.05 °'60 227 72' 273 360 ;1 598 \\ % a5 4.57 ;20 76 ".'43 163 ._ 238 -1 511 16 �- 20 610 x; 30 125 t 401 50 \ 25 7 62 286 \ ` -30 9 14 :"` -r 163 -77 292 14 5: 35 10.67 Bo zzi 40 12.19 <'.. _ 1G 174 - 1 45 13.72 "28 106 12 4O 50 15.24 45 % MODEL Lock VMve: 18' 21' z8' 35 53' 10 35 ` 293 8 30 MODELS 25 137 139 6 20 MODEL .�� F-�,Z 284 4 MODEL \ MODEL 10 268 282 2 "- MODELS �v 5 53, 55, MODEL MODEL 57, 59 97 267 .S GALS.X10 ' 20 30 X40 50 =60 70 80 90 100 10 120 30 140 ,150 160170 .180 190 imumm awl LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of. . . ` OELLE/'P O. P.O. Box 16347 p ( )Louisville,- Kentucky 40216 � 3 aob s , b � n o, -D T � _ W o r' Q cE n j Ci A � Z Z � •. n 1 V n Lorl r w a ro r � n � n 0 3 T tL fb P- A o n � sW M 0 r 3 it, L,hy� 1 i r { t tOf 0 S � _ o Ki tz O W i� k"Ir 3 t` Q A � O 17 r� e