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HomeMy WebLinkAbout040-1117-60-125 5! > (D c 0 72 (D 0 Z C E LL �2 M -0 0) w co 0 cq c .2 0 z a i 2 '2 E 2 Cl) N (D 0) a N w c co z 'a A 0 m(D z z 0 C, C*4 12 —E O I . —:- I E N a I I a —0 4- 9 c ) - 0 04 IL .0 0) 0 E c 0 U) z > '6 o 0 0 z CL IL IL M LL (D 0) � Go 00 U) -J U Z tr_ (D o 0 E co co U) 0 co m 0 E 7 0 4) 0 M 0 c C9 c 0 0 D- C) 0 CL c -0 Q I 0) E m o , -5 U) co o -1:: z z co CN 0) C, C6 2 4 E C CD 0 E cv) mm 0") cod M CL EL CL L IL .2 c c E Q 0 IL 2= m 0 o Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER j� �' `' 'I ( �jc' TOWNSHIP SEC. T N-R W ADDRESS 1V4 d S0/t L t" ST CROIX COUNTY, WISCONSIN SUBDIVISION ��- LOTS LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i� �tenC��'S INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 5pij J/ tC f' 41 v� �/lPC'S �F//'✓1 Elevation of vertical reference point: �e��7, L� Proposed slope at site: SEPTIC TANK: Manufacturer: 6-6"C4%(Liquid Capacity: / Ooo Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: , Number of feet from nearest Road: Front,QSide,ORear, O feet From nearest property line Front G Side 10 Rear,0 35- 1 feet Number of feet from: welln0p jj , building: /)> t (Include this information of the above plot plan)( 2 reference dimensions to septic t, SEE REVERSE SIDE ,A 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 liner Front, O Side, O Rear,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: 4 Width: Lenith: 50 Number of Lines: ! Area Built: �L� J/ t, Fill depth to top of pipe: / Number of feet from nearest property line: Front, ' Q Side, O Rear,0 It Number of feet from well: h-d I V ,R-e Number of feet from building: (Include distances on plot plan). SEEPAGE PIT 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). 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: A __7 Dated: Plumber on job: License Number: 30 3 3/84:mj J DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING ;l,AQ0R..&i.HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION ,MADISON,WI 53707 State Plan I.D.Number: SE 4i SE 4,S30,T28N-R19W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Troy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound E HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A E: Steven T. Sylla 11600 Pinewood Lane, Hudson, WI 54016 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: Thomas A. Wang 3231 St. Croix 119428 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: PUMP MODEL: PUMP/SIPHON MANUFACTURER: i WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: E:1 YES ❑NO ❑YES F-1 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 NEAREST---111111- 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 I DISTR.PIPE I 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_—1110' 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 I 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: iAREST MBER OF PROPERTY WELL: BUILDING: COMMENTS: ET FROM LINE: ❑YES ❑NO ❑YES E]NO —► Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) ZOning AdminiSt 4LI,LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COUNTY STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than / / 9L70 y 8%x 11 inches in size. ❑ Check If revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER c PROPERTY LOCATION 5 u � J '/4 S /4, S 0 To�'; N, R (ornV PROPERTY OWN '�MAILING ADDRE S LOT# BLOCK# A 1( d t� 0 66 ( 1-4 nee CI ,S T TEL � E ZIP CODE� PHONE NUMBER SUBDIVISION NAME OR PSDM NUMBER II. TYPE OF BUILDING: (Check one) CITY 4RA NEAF�EST ROA) ❑State OWn @d ❑ VILLAGE❑ Public DQ 1 or 2 Fam.Dwelling-#of bedrooms PA EL X NU 1111. BUILDING USE: (If building type is public,check all that apply) `y 7 9 5 Qqo— 1 ❑ Apt/Condo t 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. 't-' 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 r Seepage Trench 22 El In-Ground 42 El 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(s .ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) -�l:d� ELEVATION ��i V yg !j • 10 C16 :2-P9 aFeet -60 Feet VII. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 11h puy iT�5: Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb is Name(Print): e fl, P s Signature:(No tamps) MP/MPRSW No.: Business Phone Number: P75'fP Plumber's Address(Street,City, te,Zip Co�: LAJ .L IX. COUNTY/DEPARTM T US ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater roue Water ate Issued Issuing Agent Signature(No Stamps) IT Approved ❑ Owner Given Initial ( ),/� Adverse Determination /y dj X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. 6nsite 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. 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 systerrr,i�f required by the county; E) soil test data on`a1 15.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) I I + 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 5 7",c Z/CN T, S r &z- Location of property 5 t 1/9 5� 1/4, Section 3 O , T 2 N-R Zf W Township Mailing address fGp 6o Pj NEwoo t7 L A ALE f'Z /yr� SoAt 1n/ ( , "!5-f01C, Address of site �' "T ''l w/ P1 l�'I VET r Subdivision name Lot number Previous owner of property P/IUL 1f, T 0 i-'NSdIV Total size of parcel �0t Date parcel was created Are all corners and lot lines identifiable? Y_Yes No Is this property being developed for resale (spec house)? Yes _N0 Volume 7 _and Page Number lZas 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. ; 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. ) . '_j Signature of dwner Signature of Co-Owner (If Applicable) 3 �s�� Date of Signature Date of Signature .:. ... ...... . ..:. ... ... ........ it 318 .: •� `tb `tom �# 31. "a. tit '1Ie►Z�r "7", � � � �` OL nM.y� fyry luA�i sw}i•�°'°Ye.fi�i �.L r.tr. NY.a..'{�i.M!'..Y+»st.»a •»«... .r. � •�+... i. �..f.: iyy ►, + ;"F"'«.... ,...................... ........($riAL) 1 s' .......... ..... .... ...... ........ .... ltOAt 011 ACKNOWL&Do* ...• »<• ......................................... •TATZ OF WIW*NN<N w.N.MtMM.....«..............«...• a..««..... ............ . »....................19...... !'/ € ...it.. »... «...... ......................... .......».....�' wlt.ia..Y.H .AR M' ..........« },. 4 vim' » . ............s........ ..... ....................... .�••...... -wt.R»..�....M1 (�Y��� �� •111 • a.a .................. • '���+� '. + ... ! ♦. +f��i�. R. .Mv yY` ltr (L� i (i . ,a-3 ppr I 0 O 442 L", lI. 698 �, �>�,d 5 fit.Crotx Co•,�VI 1 CERTIFIED SURVEY MAP w �' Located in part of the SE4 'of the SE4 of Section 30, T28N, R19W, Town of Troy, St. Croix County, Wisconsin. E} Corner of o; Unplatted Lands cl --------- ----- Section 30 NI J 1 S00004 ' 27"W Co 124 . 87 ' a l N89055 ' 33"W N8905513311W 372 . 00 566.001 NI .+1 00 d l O cl \_ ' "' rn \ \ d,t , M LOT � \ Area Including R/W: 113,557 Sq. Ft. N °' \ 2.61 Acres 41 o o \ `\ Area Excluding R/W: 41 o N 95,985 Sq. Ft. 4 ti 2.20 Acres o v I c <n o 0 I w o O LO C=1 ,.l y ar l L. a o o fiA ��, A• .r ++I 10 ..0 O O 4- c:a H z y U ♦ `SS, c l c o a, c N ...1 N 4J ca ado.°, ��(? a��•,,;v \�1'�0 \ ���� e6. '7-+ r \\o \ t SCALE IN FEET \ ) \ OWNER 0 50 100 200 \ — M Paul Johnson LEGEND \ a; �\ Route 3 River Falls, WI 54022 County Section Monument \ \ 0 1" x 2411 Iron Pipe Set, weighing SE Corner of 1.68 lbs. per linear foot. \ \ Section 30 Lot Radius Central Chord Chord Arc Tangent Tangent No. Length Angle Bearing Length Length Bearing Bearing 1 572.96' 15003147" S49026155.511E 150.201 150.63' S5605814911E S4105510211E 2 605.96' 17003146/1 S50026'5511E 179.79' 180.46' S5805814811E S41055102 11E APPROVED OCT 27 1988 VOLUME 7 PAGE 2042 ST.CROIX COUNTY L iBrM PARKS PfANW4 , This instrument drafted by Fran Bleskacek Job No. 88-40 A D Z0NNC SURVEYOR' S CERTIFICATE I , Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby certify that by the direction of Paul Johnson, I have surveyed described and mapped the land parcel which is represented by this Certified Survey Map, that the exterior boundary of the land parcel surveyed and mapped is described as follows : A parcel of land located in part of the SE4 of the SE4 of Section 30, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; further described as follows : Commencing at the SE corner of said Section 30, thence N00O04 ' 27"E along the east line of said SE4, 1130 . 00 feet; thence N89 055 ' 33"W 566. 00 feet to the point of beginning of this description; thence continuing N89O55 ' 33"W 372 . 00 feet; thence 500004 ' 27"W 124 . 87 feet to the centerline of C.T.H. "MM" , said center- line being a 572 . 96 foot radius curve concave southwesterly whose central angle measures 15003 ' 47" and whose chord bears 549026 ' 55. 5"E and measures 150. 63 feet; thence southeasterly along the arc of said curve and centerline, 150 . 63 feet to the point of tangency; thence :;41055 ' 02"E along said centerline, 385. 27 feet; thence N00O04 ' 27"E 508 . 71 feet to the point of beginning. Subject to right-of-way for C.T.H. "MM" as shown on this map and subject to all other easements of record. I , Also certify that this Certified Survey Map is a correct represent- ation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provision of Chapter 236 . 34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. " �.a Allen C. Nyhagen S_ rsi'; VOLUME 7 PAGE 20142 � IV \ ^ `) t STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER T , S V L 4 ROUTE/BOX NUMBER-3 8r, C 7 y ,P1 Al FIRE NO. 3 � CITY/STATE_ G S ZIP PROPERTY LOCATION: X1/4 S 6 1/4, Section _3, T_ ZEN, R f y W, Town of T&O_'� , St. Croix County, Subdivision , 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 within 30 days of the three year expiration date. SIGNED P,/J� DATE --2 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 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR•AfVD PERCOLATION TESTS (115) P.O. BOX HUMAN RELATIONS 1 / MADISON,WI 53707 3707 63.0911)& Chapter 145.045) L� ,/ � �6 (o�TOWNSH /MUNICIPALITY: LONO.:BLK.NO.: SUBDIVISION NAME: C NTY: OWNER BU ER'S N MAILING ADD ESS, 5_�414 4 - // kl.2 USE DATES OBSERVATIONS`MADE �3 NO.BEDRMS.: COMMERVIAL DESCRIPTION: PROFILE D QNS: EPC LA I TEST {�esidence `� rR p , �J(1 Y`i'n / New ❑Replace i RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTE (optional) ®s ❑u as au as ou ❑s Eu osEu ���5 -�a If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevati PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO 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.) o). 0 , c 0, 'Dd s B- 7,dD 161.190 d � n ► :5, B- 3 00 �C ed, 6 iy s do pose ��dr, �g B- ' B- 7 DU 9y D U0 S a e e y so j`�12 cbS e S�G'r. B- uv PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERT D2 PERIOD 3 PER INCH P_ �.00 �O /y P- 3,04 0 /0 / S' P- v0 ? 3 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 vert+cal 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. -/-{� i ek, ` *I g(,04) SYSTEM ELEVATION/ ,lea X100 _ r— a � I �_ i t I,the undersigned, hereby certify that t e soil tests reported on this form were made by me i accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data r I corded and the location of the tests are correct to the best of my knowledge and belief. NAME( r• t : TESTS WERE COMPLETED ON: a SC o ADD S: CERTIF PHOYNP �MyR'.EGe'( onal):O a PK CST SI A RE: U � DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. D1 LHR-SBD-6395 (R.02/82) —OVER— INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report must irrclucle: . 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or c<rmmcxrcial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TALK 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 p§ot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used it desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; g- Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exernp- 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 t.rlace your current address and your certifi€.anon number; 12. Make legible copit;°s 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 Otter Symbols St — Story' (over 10"') BR Bedrock coh cobble, (:3- 10") SS Saildstone gr _ Gtavel (under 3") LS - Lk testone "s — Sand HGVU High Gro€t icivvatot Perc - P:tcoltrttOrl Rate rt — Mk"diu,t S'rnd iNeII B!(Ig Bu ldinci s Loamy gbnd > _ G titer 7Pl.trt d Sandy [o ml l Le,," Than Bn - f ti vvn Lo,im 11141 13 k ?Ili. sly ....., St<:ty ; - Stt Glay Lom!"n R Red Sic! '-- b tty Clay L.oarn mot lr.rie'b s6ty clay r7' (117,30; r1 _,.. dlst!nc! P --- prorntrl6Ptt H W L -- High level, Six g€,• € 11'0 Sail textures swface }ater loo lit, id ^k+sst disposal BM I3encli M irk. V R P Vertical Rf erw3 , Pt3is[' TO THE O"INER: This soil test report is the first,>t:ep it) sr;rurinu a sanitary permit. The county orthe Department may rettuest verification of this soil test it) the field prior to permit issuance. A complete set of plans for the private Sir cage system .tnd a permit application must. be Submitted to the appropriate local authority in order to oblairt a i of alit. The sanitary permit mast be obtained ar3d posted pilot to the start of arlyr 0r1strc3c€i0n. r Y13) g � y� f( 1 ff s � b' �ro pos e l okte IQ t,ocv3al s` S e�til gi gad �recc tT� a6 r e Parcel #: 040-1117-60-125 06/27/2006 12:15 PM PAGE 1 OF 1 Alt. Parcel M 30.28.19.479B-10 040-TOWN OF TROY Current XI ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 11/03/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner STEVEN T&ROBERTA I SYLLA O-SYLLA, STEVEN T&ROBERTA I 386 CTY RD MM RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description '386 CTY RD MM SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 30 T28N R19W PT SE SE(2.61AC)LOT 1 Block/Condo Bldg: LOT 01 CSM 7/2042 EXC PT TO HWY AS DESC 2688-455 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-28N-19W SE SE Notes: Parcel Histo ry: Date Doc# Vol/Page Type 11/03/2004 778853 2688/455 WD 07/23/1997 835/527 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.560 55,000 221,300 276,300 NO Totals for 2006: General Property 2.560 55,000 221,300 276,300 Woodland 0.000 0 0 Totals for 2005: General Property 2.560 55,000 221,300 276,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00