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HomeMy WebLinkAbout040-1203-90-000 0 Cz e4 t ts I } � 0 z 0 0 C 5 E LL a z a) ƒ \ .. 0 2 V 00 LO I ui % z C z ■ e ƒ a) 2 ce) � � � \ j � a) 0 On 0 C 10 < 1 0 ca 0) 11 z Z Z, 0 E i .8 C14 1 fn 0 CL 0 0 .r- a I ca CL C*4 0 V E ■ ■ E■ 5 CR) U) cc 0 0 0 CL CL a. CL B a 1 'a 0) 0) 0 U) I U- oo co 0 U=) -j 1 0) CY) z Cl) Lo co r_ 0- 1 0: U) cc LO E co = y o M r a a 0 00 5 1 — c6 C%l L) 6 12 ci) uj cn L: 0. » r (w 0 w 0 U) Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT' OWNER �/ � TOWNSHIP TR6 SEC. 3r T GP N-R I/ W ADDRESS ,7 10 A11YO'y -S Y T. CROIX COUNTY, WISCONSIN PIK SUBDIVISIOW0'k-AV)*U5 LOT LOT SIZE 14 - PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S CIE' 14 77 INDICATE NORTH ARROW mop BENCHMARK: Describe the vertical reference point used 47- i Elevation of vertical reference point• /Q0 i Proposed slope at site• APO • SEPTIC TANK: Manufacturer: VL--W Liquid Capacity: 12-00 Number of rings used: / OWk Tank manhole cover elevation: 1a Z 0 2 / Tank Inlet Elevation: /00'3(p Tank Outlet Elevation: w EsT Number of feet from nearest Road: Front,0 Side,O Rear, O > �d d feet No From nearest property line : Front,0 Side 0 Rear,0 5o feet Number of feet from: well 70 , building: �� 2 / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE l r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer• Pump Size Elevation of inlet: Bottom tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Z Alarm Switch Type: Number of feet from nearer property line: Front, O Side, O Rear,0 Ft. Numb of feet from well: Num r of feet from building: (Include distances on plot plan). ��Co C-& SOIL ABSORPTION SYSTEM ✓ C� X S W n Bed: Trench: !4-� S Width: 5 Length: Number of Lines: Z Area Built: 30,E � � Fill depth to top of pipe: 7V SO . � Number of feet from nearest property line: F ii so . O Side, © Rear,0 Ft . 2- 2- Number of feet from well: /7 S I Number of feet from building: 90 ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom seepage pit elevation: Area Built: Has either a drop box or distribution box O been used on any of the above soil absorbtion sytems? Check one) . HOLDING TAN Manufacturer: Capacity: Number of rings used: Elevation of bo om of tank: Elevation of inlet: Number of feet from nearest proper line: Front, O Side, O Rear, 0Ft. Number of et from well: Numbelr o eeL from building: Number o feet from nearest road: Alarm Manufa urer: Inspector• Dated: ' /L" Plumber on job: License Number: 140,MESITE SEPTIC PLUMBING CO. 665 G'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT 'NIS.MASTER PLUMBER LIC.N0.3307 M.P.R.S. 'INN.:N3TALLER&DESIGNER LIC.NO,00663 3/84:mj HOMESITE SEPTIC PLUMBING CO. "T 655 O'NEIL RD.,HUDSON,WIS.54016 I t ROBERT ULBRIGHT I Sy WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. MINN,94STALLER&DESIGNER LIC.NO.0060 y Q�viPM S 33 - ul 9' IV S;t Pre TAa� .S f �D I 3 a3� S . o g of TOP .f >. I i AppE-k T�€,ue.P�„ FELDS (ST �I Tor OF � � I ?G•9 3 s'PEG S a 3/4 u S S ko e�'ATE- �, � ;-� -� i � � SGG� . Z�LQ 'D I'S T• P r�,p S I � , I i , TOP i V7j�'� 1. I SG P3 Of P► 07 PLli A 2Z -10p 49F 10441A C(Ev. - goo. 0 ' *EPART*RIENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS ,\BOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING 3OX 7969 .IADISON,WI 53707 SL, SW, 35,28,19W CONVENTIONAL E]ALTERNATIVE State Plan I.D.Number: ED Holding Tank ❑ In Ground Pressure ❑Mound (if assigned) Town of Troy Lot 9, Cernhous Addition NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: DAve Meyer 425 West Division Street REF.PT.ELEV.: CST REF.PT. LE .. BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: Name of Plumber: MP/MPRSW No.: County. Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 119490 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: P OVIIDED`AB�NO PROVIDED OVER ❑YES [DYES ONO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT LE FRESH ALARM: LINE: AIR INLET: FEET FROM DYES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. PROVIDED DLABEL PROVIDED OVER ❑YES ❑NO OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH LINE AIR INLET: (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO NEAREST LENGTH. 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: LIQUID BEDfTRENCH WIDTH: LENGTH: NO OF DISTR PIPE SPACING MATERIAL PIT INSIDE DIA #PITS DEPTH. TRENCHES 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 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 NO PERMANENT MARKERS: OBSERVATION WELLS SOIL COVER ITEXTURE [DYES El NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER. EDGES: YES ❑NO DYER ❑NO OYES ONO [DYES PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER: WIDTH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. E' 1 EN H` TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MA )FOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.- ELEV.- DIA_ ELEV.: PIPES. DIA.: E f:EttATIOhi ANI C1iSTRIBtTl4hl COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED IIKC�FIMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY PLANS [DYES NO DYES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER,OF, LINE: WELL: BUILDING: R OYES ❑NO ❑YES ❑NO Nl!! SA Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator DILHR SBD6710(R.01/82) omas U. Nelson son DILH_R SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code . rT � C,eo i�C STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than // y 7n 8%x 11 inches in size. 1:1 Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. N PROPERTY OWNER PROPERTY LOCATION M/Q• Ae5 Se '/4SW%4,S3S T29, N, R /( E(o W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# Z5 W - 'DiurSj0� ST' . 9 ,QTY,STATE / ZIP CODE PH NE NUMBE SUPDIVISION NAME O CSM NUMBER N/ (� /• 4o Z 37 S I�•i �.�LIS S �' ? Ft?�' 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD El Owned ❑ VILLAGE; "'�" Q ,e v� 4 ❑ Public 9-# 1 or 2 Fam.Dwellin of bedrooms T- PARCEL TAX NU BE ( ) r III. BUILDING USE: (If building type is public,check all that apply) 1/0 f 10 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) 1.1 F-4 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� Seepage Trench 22 El In-Ground 42 11 Pit Privy 13 ❑ Seepage Pit Pressure �� �G 43 ❑ Vault Privy 14 ❑ System-In-Fill Z `j,Ve _ ,Cry VI. ABSORPTION SYSTEM INFORMATION: �1 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQU RED(sq.ft.) PROPOSED(sq.ft.) (Gals day/sq.ft.) (Min./inch) 6 G t NATION Cpd 0 0 070 ` tj Feet dvoo Feet VII. TANK CAPACITY Site in as llons Total ¢#of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber Vllll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Sig�t (No Stamps) /MPRSW No.: Business Phone N mber: %4Dar ZlG6�r GGtT 330 7 (� " �� S Plumber's Addresfres h State,ZigCode): 9 O,%V L � /Y y IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater a e ssue Issuing Agent Signature(No Stamps) Surcharge Fee) , Approved ❑ Owner Given Initial f u�' (l S-3B-JP? Adverse Determination 7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 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 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) i e 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 joaa, j 01— Location of property s 1/9 sW 1/9, Section , T Z� N-R ` W ZA Township I gr4 Mailing address "L S YT ' Address of site �1 Subdivision name �i-of_no46"r Lot number Previous owner of property !//'A . ( el-nd �S Total size of parcel �• / �C!Le2_ Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes X No Volume d / r and Page Number bN 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 warrant recorded in the Office of the County Register of Deeds as Document No. iV� �U ; 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, or the construction of said system, and the same has been duly recorded in a Office of the Count ppRegister of Deeds, as Document No. ) . C� Signature of Owner Signature of— n-Owner (If Applicable) Dati of S gnature ate of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA '! STATE BAR OF WISCONSIN FORM 2—1982 448230 vc. 841►A E 594 REGISTER'S OFFICE ST. CROIX CO., WI Michael P. Cernohous, a single man Recd for Record ..--- -•-•----••--- --------------- ------------------------------------------------------------ -••---•-••------•-----•-.---- MAY 2 at G 1989 •- vo P M ..--- --- •-- ------- - ----------------- --••----------•---•----•---• •-------------•----- _ l� conveys and warrants to -David E. Meyer and Karin M. Meyer, _husband and wife as survivorship ma property RegisterofD� - -.. wife ............................__..._...__...........................•----------------.............................. RETURN TO ............................................................ ----------------------------------------------------- ji the following described real estate in ...... St. Croix .......... ...........................County, State of Wisconsin: LD 3 +D Tax Parcel No: .............................. l Lot 9, Cernohous Addition to the Town of Troy. i4)Fa I{ ii it it is i I' This .__._._.._ls not -_ homestead property. (115) (is not) Exception to warranties: easements, restrictions and rights of way of record, if any. Dated this --------------------------------- day of ----- ----May- --- 19.89 (SEAL) ... -..(SEAL) I' I Michael P. Cernohous •--•----------(SEAL) ------ •---•------- ....(SEAL) •- AUTHENTICATION ACKNOWLEDGMENT I Signature(s) ------------------------------------------------------_...._ STATE OF WISCONSIN i ss. -------------------------------------------------------------------------------- CU-cam— i --------------- ----County. authenticated this --------day of--------------------------- 19------ Personally came before me this ----- &. day of ---- May----------------------------- 109--- the above named ----- ------------------------------------------------------------------------- i • Michael P. Cernohous it ----- ----- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------•---------------------------------------- i authorized by § 706.06, Wis. State.) to me known to be the person ---- ---- who executed the j! foregoing inst umen.�,,andc66wlgd a ame. i THIS INSTRUMENT WAS DRAFTED BY ♦ C Joseph D. Boles, Rodli, Beskar & Boles, S.C. �! r jl - - - - - - - - - - - - P.0. Box I38--- , I ' 4-"!� S1 A. _ .c._., 219 North Main Street, ,y �__/(/.3.!51!✓....._.. River--Fa------ WI--54022-------------------------------------- Notary Public fi -:5iy-ot'v ='+Count Wis. (Signatures may be authenticated or acknowledged. Both My Commissiod ish p�r5an ntt.0-f .not,zstate expiration " are not necessary.) date ` I •�-�• � 0 F •Names of persons signing in any capacity should be typed or printed below their signatures. + 'K ... STATFORM No. g ISC82 SIN Stock No. 13002 L -' STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER DcL ROUTE/BOX NUMBER FIRE NO. CITY/STATE /�l�I'' aS . �'v/'S. ZIPy�o� eZ S � p PROPERTY LOCATION: 1/9 1/9, Section S , T �4 N, R—LEW, Town of `l'"Ot,( , St. Croix County, Subdivision � / nohouS �cycS-o'1 , Lot No. �. Improper use and maintenance of your septic system could result in its premature fail6re 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. l SIGNED DATE 1,9-3 St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-9680 Sign, Date, and Return to above address REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DEPARTMENT OF DIVISION INDUSTRY, 1 P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS (ILHR 83.090) & Chapter 145) L ATIO . , ETT16`TI Z OWNSHIP/fVltliaff'FPitthfiY: LOT NO.:BLK.NO.: SUBDIVISION NAME: SE�/ 5� / 35 /T �' H/R►�' E to ►W T'R o y ! c�,QNtiovs ,�fDDiT COUNTY: OWNER'S BUY R'S NAME: MAILIN ADDRESS: i(�ae� //s &/jr S fi0� S/�iPO%1C � M,E/�� �i $ W • �j i U,U'iD,tiJ �. USE 4ZS' -7 3-7 DATES OBSERVATIONS MADE PR FI D IONS: R A N _ES TS: NO.BEDRMS.: COMM IALDESCRIPTION: XNew Replace �J�j� �S (JJ 2.5 P91 RR esidence 3 N S'CS �� i 1101� ' �'�If'O T-f - w c S S s S RATING:S=Site suitable for system U=Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRES'SURE: SYSTEM IN FILL HOLDING TANK: RECOMMENDED SYSTEM:Ioptio �EAJ C S Sou sou as ❑u osQu osa If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b►,indicate: CG/t.S S �- Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS CILJLUI NIOMA RING ER DEPTH TOTAL 065 RVG p UND ESTERi INCEHES CHARACTER IOF O OIERVED (SEE I ABBRV ON BACK.)EXTURE,AND DEPTH ELEVATION TO B. / 9.0 pr > 9,o ,,y • �i r I I l ,3_31 •S . 7 ' �/tN v B- z 9, 0 /oo.3S ' 9, �� r , v cS B. 3 7, 0 9�ya Ito > 9- o B- �o� �y . "o ' a/,mss;; 53 - TAN s , � G� ?P� 41AnyC's 9, z S � > - /0 B- SD��w �f �pvf AR,Q PERCOLATION TESTS 1,o CS DROP IN WATER LEVEL-INCHES RATE MINUTES TEST DEPTH WA IN HOLE TEST TIME PER INCH r, NUMBER INCHES AFTERS WELLIN INTERVAL-MIN. PE I 1 PERlOD2 P R s P- P-y /00-d P- a P- r 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'?t ` 6r.J �P�U �S. O •D of land slope. L T SYSTEM ELEVATION - ' SEE' pLoT- �1,AQ TN f D ems, gor a conventional sap tip 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- FAD print : . TESTS WERE COMPLETEDON- 655 O'NEIL RD.,I IA)SON,WIS.54016 /�,�jP/� Z S 11 ` ROBEI ULBRIGHT _ N� ESS: 11S.MASTER PLUMBER LIC.N CERTIFICATION NUMBER: P p NUMBER(optional): 71II N 013TALLER 6 DESIGNER LIC.NO.00663 dolt/O e 5 CS IGNATUR z„_n /`iV,e­ DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.10/83) —OVER — PL-OT P&,AAJ 51C,441F - 30 = B,4ce llOC- 80,01,06—S x = Plepa s i-ws ® 4�79(5Tla5 fok-rgci FIEUAT1005 ,D •tE y$ a HOMESITE SEPTIC PLUMBING CO. ,$hest$� septic 656 0-NEIL RD.,M)DSON,WIS.54016 "C t'cn C Y�Z lQC come NIS.MASTER PLUMBER LII NO.330 M P.R.S. ii!3TALLER&DESIGNER LIC.NO.00663 N o �o T- c.,•�F- , ppoposEO Gvt/l .10 �- - - - - - - -- -- - - I y. ?Roposf `F (3-gde�1-4 - a ' IS = 99.0 j O `� Sfprlc TASK $Z . ALTERNATC R-RE-A-. 9G A' so STtiTE �p��OVEO S x CoG BS .4r S-G" B S rX GG' 13 ` k P 3 e is y8` sytTC,-1 = qs-o ' V sO°l /o t "V Uf�r ,�t� Mr ° 7e71p 3 b0 phdar Pev AT 5.F: 107- roRo e k . I� FLEVtTtoo = /00.0 ' , Fresh Air Inlets And Observation Pipe N, — Approved Vent Cap Minimum 12" Above Final Grade fd _ 4" Cast Iron Above Pipe Vent 'Pipe -To Final Grade ear-0r Synthetic Covering MiLe 2° Aggregate Ope Distribution Z�2y Tee Pipe 0 0 0 0 G " Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System 1 to �,.�• Fresh Air Inlets And Observation Pipe �] 0 � Approved Vent Cap Minimum 12" Above Final Grade .....-•--- Div%Sff�f� ��, � I J or i 4" Cast Iron Pipe _ Above Pi �2• P Vent Pipe -To Final Grade ' I l Synthetic Covering Min. 2" Aggregate Over Pipe Distribution 4 274 Tee Pipe — 0 0 0 0 0 f l ' Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At Bottom Of System Fresh Air Inlets And Observation Pipe I Approved Vent Cap Minimum 12" Above Final Grade �.v -Stf6P Fb 100 . 6 4" Cast Iron Above Pipe — Vent =Pipe' 'ro Final Grade Me �i--Hey-0r Synthetic Covering Min. 2' Aggregate Over Pipe Distribution L72-9 Tee Pipe 0 0 0 0 0 , l G " Aggregate o Perforated Pipe Below Beneath Pipe V o Coupling Terminating At Bottom Of System U-) V w vJ v Fresh Air Inlets And Observation Pipe �J 0 _ Approved Vent Cap Minimum 12" Above Final Grade Q� �AAP 4" Cast Iron May Above Pipe -To Final Grade Vent Pipe Mefsh Hey--6r Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 �v " Aggregate 0 Perforated Pipe Below i Beneath Pipe 0 Coupling Terminating At Bottom Of System P -0 I� � I Lot C,-,ev&6os 4,0o7' Ni E ; — 30 � a = 13ACKff+�E 8Q�/N�-S x = PERK s�T�s E!E UAT1005 eID HOMESITE SEPTIC PLUMBING CO. r�$�g5t s�o�a�sep�.�c sy 655 C'NEIL RD.,I§)DSON,WIS.54016 ROBERT ULBRIGHT e Sr ZY - conVeflU NIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. fora * �t GTALLER&DESIGNER LIC.NO.00663 PRAPoSE� _ GJt�� 0 1 40 _� - - - - - - -- -- ^ i 2--v ?RO(�oiE D �OxC' qk 3 54 T-rc TASK $y Ai-TERNATC A-R-IFAr wr• yG so . 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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 O-MEYER, NORBERT E&DOROTHY E NORBERT E&DOROTHY E MEYER 15 DRY RUN RD RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): `=Primary Type Dist# Description " 15 DRY RUN RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.030 Plat: 0164-CERNOHOUS ADD SEC 35 T28N R19W 1.03A CERNOHOUS ADD LOT Block/Condo Bldg: LOT 09 9 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1107/173 WD 07/23/1997 // 841/594 Celw 0 V Lbrm 2006 SUMMARY Bill M Fair Market Value: Assessed with: 159319 246,200 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 38,700 185,900 224,600 NO Totals for 2006: General Property 1.000 38,700 185,900 224,600 Woodland 0.000 0 0 Totals for 2005: General Property 1.000 38,700 185,900 224,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 104 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00