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HomeMy WebLinkAbout004-1032-80-000 0 2 CD 0 20 cu cn 0 z U, ) \2 0 0 o c C-4 CL 0 U) U) 0 E Z co 4) IL m z 0 z (D z :!t fj) c z i E ED CO .14 cy 4) CD 0 0 m z z 0 z C-4 C14 CD E U 00 U) CL C w 0 0 0 0 0 0 CL I 0) 00 U) —0 j co CO 0 � � § z 0 C, tr_ CD 0 a 0) co (n r_ IL C') 4) 2M Cl) 2 S -u 0 0 E:3 Lf) 0 o c9 04 04 0 0 -0 C'4 CL a M 0 M 12' co i z z C, -0 Z3 0 0 C\! 0 E E o o z U) I'L 0 CL EL L: E 0 m CL 0 U) Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER�;+LlV r1'k TOWNSHIP SEC. I T N-R_-W ADDRESS ST. CROIX COUNTY, WISCONSIN , (so� SUBDIVISION /V k LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t Z , .3) CD o INDICATE NORTH ARROW i BENCHMARK: Describe the vertical reference point used Lae, r v6- Elevation oLvertical reference point: ffin no Proposed slope at site: /W1,'LTa',,k Man acturer• • o Liquid Capacity: Number of rings used: Tank manhole cover elevation: � , � Tank Inlet Elevation:_ Tank Outlet Elevation: Number of feet from nearest Road: Front,(S`ide 0 Rear, O — feet From nearest property line Front,0 Side,orRear,O - � feet Number of feet from: well , building: v (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Pt . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: 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: A , Q Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Q� Number of feet from nearest property line: Front, O Side, \►► � �Rear, 0Ft'2 Number of feet from well: �C y - --✓✓ Number of feet from building: �� i Number of feet from nearest road: Alarm Manufacturer: _��y-C� 4rW\ Inspector:.T - Vels Dated: 7 f e Plumber on ,job: ZCd, ,T � ex T^ License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 rphs� NW4,SW4,S14,T28N-4, MCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number . of asslenedl Town o f Cady ❑Holding Tank ❑In-Ground Pressure ❑Mound Wilson Road NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Alvin Iverson Route 1 Wilson WI 54027 l —lCf— gy, BENCH MARK(Permanent reference F-0 DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELI V. Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: Bennie Hel eson 3215 St. Croix 106109 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ILIOUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ONO DYES ONO BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF A ROAD JLRINE OPERUILDINGJVENT TO FRESH LARM FEET FROM : AIR INLET ❑YES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ❑NO ❑YES ENO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH JDIAMITEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO OF DISTR.PIPE SPACIN INSIDE DIA aPITS LIQUID BED/TRENCH BENCHES PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR PIPE DISTR.PIPE MATERIAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET ELEV END'. 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 OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OliSEHVATI(lN WELLS 1:1 YES ❑NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED IMULC HEU CENTER EDGES. DYES El NO DYES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE F I L L DEPTH ABOVE COV DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD PATERIALATN O DISTR D ISTR PIPE DISTHIBUTION PIPE MATE HIAL&MAHKING ELEV.. ELEV, DIA.. ELEV. PIPES DIAELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS 1:1 YES 1:1 No El YES 1:1 NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS, NUMBER OF PROPERTY WELL'. BUILDING. FEET FROM LINE ❑YES 1:1 NO El YES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator --� SANITARY PERMIT APPLICATION COUNTY r ®ILHR In accord with ILHR 83.05,Wis.Adm.Code St. Croix STATE SANITARY PERMIT# 8:7-68±69-&1,047 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. 87-08109—S —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ®YES ❑ NO PROPERTY OWNER PROPERTY LOCATION Alvin Iverson NW '/4 SW '/4, S 14 T 28 , N, R 15 0(or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME Route 1 CITY,STATE ZIP CODE PHONE NUMBER p 771 CITY VILLAGE: NEAREST ROAD;LAKE OR LANDMARK Wilson, QXj4 $, WI 54027 772 4581 qdV Wilson Road II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 2 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.0 Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. ❑Conventional 11am��,, b. ❑Alternative c. ❑ Experimental 2. a. ❑System TS, C�1 Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint El Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks I Tanks Septic Tank or Holdina Tank 2T2 2000 1 Midwestern Precas Lift Pump Tank/Siphon Chamber I I ❑ ❑ . F-I VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Sta ps) MP/MPRSW No.: Business Phone Number: Bennie Helgeson � 3215 715 778-4425 Plumber's Address(Street,City,State,Zip Code): Name of Designer: Rt. 2, Spring Valley, WI 54767 Bennie Helgeson VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## Bennie Helizeson CST's ADDRESS(Street,City,State,Zip Code) Phone Number: Rt. 2, Spring Valley, WI 54767 715 778-4425 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater r Iss ng Agent Signature(No Stamps) pp�� y rcharge Fee ICJ Approved ❑ Owner Given Initial `m�i�� � � �5,..,' �f Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION s 'r TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. --------------------------------------------------------------------------------•--------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground ate included the creation of surcharges (fees) for a number of regulated practices which Wiscorl ilt'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure ! o is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. 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T < Bc WQ wv Ma�orie o ami /ao \ c t/�.d y 1 f'•r'9 90 /7a 7CLd n J2B s sa e ,6o SO �V 97/6 Bo 0 h. 01 PP 0 '• 7sa s.: i S hrrd ico 1 <.9d� ,�i / 6 tl C WW%.2as¢.- C csteos�e.� �ac.c tl, RESEjVO//¢ a Barr • G" 'y9hBr E� Zee qc/es,Sac. �e' ar // f sand V�� WS KaPPir/9 vPP-� y /.RRSRocFfbad Mar°,� /s I c • • eoq 0 ¢O9 p� r cR RC0/X PIERCE COUNTY ST PHONE(715)698-2471 La Pea n Im n l. Inc. �® SONS TOOL INCOPpopATED icon 460 THOMPSON RD.SO.,WOODVILLE, WISC.54028 METAL STAMPINGS — TOOLS& DIES East Highway 12 - Menomonie, Wisconsin 54751 SUB-ASSEMBLIES PHONE: (715) 235-7909 or 235-6851 Parcel #: 04-1032-80-000 09/29/2006 04:24 PM PAGE 1 OF 1 Alt. Parcel#: 14.28.15.220 004-TOWN OF CADY Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner ALVIN G TRUST IVERSON O- IVERSON,ALVIN G TRUST 1020 YOUNGFIELD GOLDEN CO 80401 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 14 T28N R15W 40A NW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-28N-15W Notes: Parcel History: Date Doc# Vol/Page Type 05/21/2003 722288 2248/318 EZ-U 02/19/2002 671460 1838/582 WD 10/29/2001 660292 1747/311 TI 297862 455/195 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/17/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 6,700 34,700 NO AGRICULTURAL G4 34.000 5,400 0 5,400 NO UNDEVELOPED G5 4.000 2,000 0 2,000 NO Totals for 2006: General Property 40.000 35,400 6,700 42,100 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 35,000 6,700 41,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch#: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT QF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, REPORT DIVISION BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION: OWNSHIP UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVI, ION NAME: NW/SUY/4 1 � /T.2.2 N/R�sE (or W c� 1J rUkl �' /�; COUNTY: OWNER'S/13ktYE'R'Sid7lMtf: MAILING ADDRESS: t. e Ir So t. S' C 2 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence / ❑New Replace ff A/k A �$�,'�Zcr yhen� or C1 (�ouSe/ RATING:S=Site suitable for system U=Site unsuitable for system et e m e r L Q. r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-I -FILLHOLDIN TANK: ECOMMENDEDSYSTEM:(op onal) ❑sou ❑s au osWU DS [NU ©s ❑u If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the tested area is in the under s.H63.09(5)(b),indicate: 0 Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH jN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF-OBSERVED (SEE ABBRV.ON BACK.) ' 7' i S' S / Ia ,.3i 'l B- / & �1, O o Or- a ZVI B- Bil /t A 6� v 0 A, I`✓c�' B- 3 5 C' q . 7l� l Q Srl `i a / ( L HO 1R p B- S Oi q(o li /, ('' ,�'�g/ S;/ TS .� ' .6'►+ Sr/ /� Sr` p orlj 5 , j Ho ,4' l TS L �ji> ra - B y S L C 6. B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PER1003 PER INCH P- 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 A,A - $} 1 3 , - i F , i i _............_ ._ __ ___ .___G__ _.P._ _. _ _ - - _ f i 3 ' 3 , r �. ........�-.- ..._..,.._ ..._e 3 t I t 3 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.4print): t TESTS WERE COMPLETED ON: J1 en e l ,c �e ♦o _� �2 'r? ADDRESS: CERTIFI ATIO NUMBER: PHONE NUMBER(optional): L3n� — CST SIGNATURE: i DISTRIBUTION. Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — r { INSTRUCTIONS FOR COMPLETING FORM 115 - SRC} - 6395 To be a cornpiete and accurate sail 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 corrmneicial 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 to scale is preferred. A separate sheet may be user) if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,arid are permanent; 9. Complete all at>prohriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10 If the information (such as flood Main,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and places your current address and your certification number; 12= Makc legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Snail Separates and Textures Other Symbols St - Stone (over 10") BR Bedrock coh Cobble IS- 10") SS Sandstone gl, - Gravel (under 3"J LS Limestone s _-. Sand HGW - High Groundwater cs Coarse Sand Pe.rc - Percolation Rate bled s - MedIUM Sand tN - Well ;4 -.. Fine sand Bldg -- BLIii(ling is - Loamy Sand Greater Than sl - Sandy Loam < - Less Than "1 -- Loam Bn -- Brown `sir Silt Loam BI Black si - Silt Gy - Graff, cl _._ Clay Loam Y - Yellow s<ci - Sandy Clay Loam R - Fled sic1 Silty Clay Loans mot - Mottles sc Sanely Clay wC - V01t11 sic Silty Clay fff few, fine,faint C - Clay cc, common,coarse; J)1 - Peat rurn - Many, mediuni nl - muck d - distinct p -- prominent HWL - High vvater leve=l, Six general soil textures surface vvater fo r liquid v"'aste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: Thi,,sail test report is the first steep in securing a sanitary permit. The county orthe Departmen=t Iflay request ration of ti=is sail test in the fi'cld pricer to lrermir. issuance", A c;o:riplete set of plu�rns for the private cte systals� <:r c a permit alalalicatit;rr most he suhmitt€�d t the appropriate local authority ir? order to oh!. i'n l p6f'ihiz' .zte swi i'tar"}1 permit must 3Ue oblwilled and po led pJor to the start of and/ co) )struction. l2k ill��. ;��'v'th L:�rSoh 6 P! t.- �cncc + -oiler l t � Wi ;Lt 5' I t� F��Id a reX i BMoeyl � I i _ ^�/ - - - . - • - _ tae �'^c- - - - -�---�- ,� y� VVeli Nods C- �keA ccl4;_1 E)cce p� ks Shoct)A e Kc� A)CCLF.,s f ifso �.� 6Lild �D. E 315 8.M} U-R.P loo-oo F 14 Aoctse- Q MovK 4 I`ouse, PS 60 � 25 v OOS� f F OF S �QP��MEN'( 0 SON Ul n¢� 0 shr� Ca� '' . ' 0 -e. l �o SZ xc��p} s showv� O9 �rh �ri�e HOLDING TANK CROSS-SECTION AND SPECIFICATIONS Approved Approved Locking Vent Cap Weather Proof Manhole Cover Junction Box with Warning Label 4 C.I. 12 Min Vent Pipe 4" Min Final Grade---,;b, Approved Joint 18" Min Water Tight ,SO Seal - -High Water Alarm Switch _ Approved Joint w/ WAS SC,,-,1a � C.I. Pipe 44 .,J 93.SO Extending 3' Onto G Solid Soil Im-000 N n�A V OF NG P 0RREg SPECIFICATIONS gEE TANK Manufacturer: I�r�W¢S crr. &ca,511 T'h c , Tank Size:- Gallons ALARM Manufacturer: Model Number• JQ( 44 L Ce� Switch Type: _-M NUMBER OF BEDROOMS: _ OWNER'S NAME: p ADDRESS: S n AL DESCRIPTION: ' ULT,&L—V, Sec. , TAN, R L TOWNSHI MUNICIPALITY: COUNTY: SIGNED: LICENSE NUMBER: DATE: � � . � � State of Wisconsin. � Department Of Industry, Labor and Human Relations SAFETY m BUILDINGS DIVISION PRIVATE SEWAGE PLAN APPROVAL office of Division Codes and Application 201 East Washington Avenue P.O- Box 7969 Madison, Wisconsin 53707 QENNIE HEiGAH.'EON Owner: ALVIN IVERS0N ROUTE l ROUTE 1 SPRING VALLEY WI 54/67 WIL3DN WI 94027 RE: Plan Number: O7...08100—S Date Approved: November 19, 1087 Gallons Per Day: 800 Date Received: November 16^ 1087 Project Name: IVERS0U, ALVIN — RESIDENCE Location: NW,SW, 14'38' 15W Town of CADY County: ST CR0IX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. 'This approval is based on Chapter 145^ Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . 'This approval is contingent upon compliance with any stipulations shown on the plans . All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department' s approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires , The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirenento oat forth in Section ILHR 02 for general plumbing or in Chapters 50-64 of the Wimoonoin Administrative code. This approval is for the following components only: — REPL HOLDING TANK � Inquiries concerning this approval may be made by calling (608) 266-6952. � � �i l / X ^/ �_ - ROMAN A. NAMINIsNI Section of Private Sewage Division of Safety and Buildings PPP026/0009n/26 cc: ALVIN IVERS(N ___Priwate Sewage Consultant ---.--County ___UW—SBWMP ___Plunbing Consultant ___Owner Plumber —Environmental Health | 000'6423 m.10/87) ST. CROIX COUNTY WISCONSIN y 1 ZONING OFFICE 796-2239 (HAMMOND) } + 425-8363 (RIVER FALLS) �f - - HAMMOND, WI 54015 October 28, 1987 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Alvin Iverson property, located in the NWT of the SW,4 of Section 14, T28N-R15W, Town of Cady, St. Croix County, revealed that there is no suitable soils for any other approved conventional system. This site should be suitable for a holding tank. Should you have any questions, please feel free to contact this office. Sincerely, c�.,,3 C• �I�,t�t , �r�.c, Thomas C. Nelson Zoning Administrator TCN:rmc HELGESQN TRUCKING INC. Spring 'Valley, VII 54767 ' j' 1� October 27, 1987 ' Tom Nelson St. Croix County Zoning Office Hammond, WI 54015 Dear Tom: Enclosed are the copies of the 115 for Alvin Iverson in Cady Township. Please send us verification of the on-site inspection to be included with the Holding Tank Plans for the State. Thank you. Sincerely, Bennie Helgeson 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 Location of Property—JA) Section f , T 2_6 N-R_KI W Township Mailing Address R 1z D _ B©6 �041 LJ I 6_40J, Address of Site Subdivision Name Lot Number Previous Owner of Property C/ Ali 2 ���� esn9jrZ Total Size of`parcel 40 Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes >< No Volume `J `J~ and 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 age 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 refer ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ceAti.jy that att statements on tW bonm ane tAu.e to the best of my (oun) knowledge; that I (we) am (cute) the owner(,$) o6 the pro pen ty dens crab ed in this inbonmati.on bonm, by vi tue of a waiAanty deed neeotcded in the 044ice o6 the County Register ob Deedsas Document No. �2 9 and that I (We) ptcesentty own the proposed zite 6otc the .sewage dizponz z yz em (on I (we) have obtained an easement, to nun with the above de6cAi,bed pnopenty, bon the con3 tcuction o6 paid .6y6tem, and the .same has been duty recorded in the 046.ice o� the County Reg.usten o6 i Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) - 3 - Y7 DATE SIGNED DATE SIGNED No S6P—EXEctrrOR'S OR ADMINISTRATOR'S DEED. Chtaptii 316. N.C.PIMA M.YIMAUK[f 29'7862 it To All To Whom These Presents Shall Come I.............................Iioward..H.e..I"i.PX:RbY............ ... .......................,of the....U7..1A90.:.of..........$PrI ag..Vslley:... ..... itPi© IPA....................State of Wisconsin..............Aftl ai.otr&taor ..........of the Estate of , ' in the County of........... .. II ......................I i;aar...Steir.4?. .:..:.... ...............:deceased,late of.............St.....GmIx.......................county, i Wisconsin, send Greeting: WHEREAS, by a made by the County Court of......... .........St.....Croix......................County, on the ........ ...............day of.. , 19.6 ..., I, the said. ..... Howax'd..H.:..Murphy...... .............., in my capacity af..............A.dmini.0txatOr...............of said estate, was authorized and empowered to sell at plat j (t*private sale the real estate of said ......... .........FU21A,r...St.eIr.o .........deceased,hereinafter described; r WHEREAS, in my capacity aforesaid, or) no further or additional bond is required pursuant to the order of the Court; \' HERF.AS, in my capacity aforesaid, I have entered into a contract for the sale of said real estate with /.1�.. ....... . .�. ; to approval'of the Court; �} ....., subject WHFREAS, in my capacity aforesaid, I have made report of my proceedings, upon said order, to said County Court of said County and the Court having concluded that the said contract is for the best interests of the estate, and having the... !; .....t...1........................day of.........ftl..rtt.1A,.S..........................., 19...�i�.,made an order confirming said contract and directing a deed of said real estalte to be executed and delivered to the said I C-s. 1.. 4.a2Sv .J .. 1�1�� .......... . .�.G. . ...... �..p.�-�v.tK.l .mn�......... upon performance of all the conditions of said contract by........h..........to be performed.; AND, WHEREAS,all the conditions of said contract have been fully performed and the'-purchase money` has been fully paid according to the terms thereof; AND. WHEREAS, it appeared to the Court that such public sale was legally made and fairly conducted and that the sum bid thereon was not disproportionate to the value of the property, or, that a,greater sum cannot be obtained, and the Court has directed a conveyance to be executed; NOW,THEREFORE, KNOW YE,That I,the said..... ........Howard H. MurFhy................. i. in my capacity of........... Adlniriatrator ........................ aforesaid,,by virtue of the power and authority in me vested ........_..... � 8v Q _ b i, as aforesaid,and in consideration of the sum ofJ;I.!YIt " Dollars to me in hand paid by the said..40O U.%.ri ►'.t4 CA I' the receipt whereof is hereby acknowledged, do hereby grant, bargain, sell :nd convey unto the said 0%. ca....p ...m!. :.C. . t% ..: .IJC.I��.P..! ............ ..+k&;.n....he' `' 1` heirs and assigns,all of the following described real estate In the County of..............at.....Croic.....: ... .,State of Wisconsin,to-wit: �I ...... li l ...........:............_.....ZownaU..2e..XT Q, I ,..lianggo:...a..k eat................ ....:.. :. :.....:.. ::.:.... ..»....... ...........................................:....................................................................................................................................... ............. i .......................................... ....... ......... ...................... ........... ....... ... ....«..». ......... ..... ........ I ........: .....:::. .. .... .. ......»..»...:..........»..».....»...».»..» .:.»......»». .. »... . ........ .,. ..... ......... i ....» .... .».. ..... .... ....... ........... ...... ....... ........................................................ ...» ........»............................ .......... ......... .......... .............. ...: ..................«.. .. .....»..... ................. .. .... . ...... ....... ».» _ i ............................ .......................................... . .... ..... . ... ...... ..: ..». . ........................................ ............ ......•. ..,:................r.................. ...r ...... ..w.... .................... .................. l' BOOK No.IMP--RXRCUTOR'S OR ADMINISTRATOR'S i -.+h Ni (•/"ANA7f�!yb?�"s.�'9'! •.l ,y''' s `:� �-y- •r.�.r;y;.�..,..�. 1 s y +«W +i L i•••• I .••.N jif•Nifi.►iwNN••a• LN..L.i•i ••i•.•• NL• .•I.LW w:L«. ..G.. .•.N.. • «•f« .•• r .. . .•• .. ww . • ......................................... `, 1 .. «.... ....t i + .•. .......... •L........ •..+ � .I.�C C . ...... UL ..Y.YY........« .•..................... .•... ........ .•........ ..... ........................ ....... . ..... ........... ................................ ...1 .......o•............., ............................................. ......................... TO HAVE AND TO HOLD the above bargained real estate "•- to the said .!'!. ...C? .............(RS ..> IN WITNESS WHEREOF, I, the said.. Ho ''•"'••'heirs and assigns, FOREVE-4t. ward H. Mur h ' P..Y............................. as ...... Administrator .......•....................... ..aforesaid have hereunto set my hand and seal this.'..., day of..... Si ned,Sea...................................19.. ...... n I d. er In P e ence of . ........... .....•-- istrato ....... -........._. ..e......... • ~" owar Murph ...(SEAL) gbert J. char son ..A(.#A ........of the Estate r ara Rudesill of.... .. Einar Ste .-.:... iro ..........., Deceased. STATE OF WISCONSIN, ... Pierce ss. County. - On this _ ...........day of ............................... .. ..., before me personally'appeared ......• Howard H r . Pared Murphy............... e , known to me A l. ` . to be the......... dm i�tra#,R - of the estate of..:......... Einar � .....:... E nar .................... Stei�o •......•••..... deceased, late of......S Cro Wisconsin, - the within conveyance, and ackngwledged that ..........he gzecuted•aJ�e s3fic��uch mentioned m .................. .......................•. /freely an o u y,forte ses _�l . r'oses' e�n,e�t•sscd. Drafted by Cavic and Richardson Attorne s' g Valley" .7 .•• Y a Law, Sprin ert J. ... ..- 'P Wisconsin Ric ztdson """""' otary Public.........................Pierce........County.Wisconsin. c1b%0 w 0 �?is H Aa �, . _, � SO _M. �+ o 10 � _ 1' 1 �b o b" 44 c , w ^0 1 HIELGESON TRUCKING INC. Spring Valley, W l 54767 February 25, 1991 Mr. James K. Thompson Asst Zoning Administrator ST. Croix County Zoning Office 911 Fourth Street Hudson, WI 54016 RE: YOUR LETTER DATED JAN. 30, 1991 HOLDING TANKS Dear Mr. Thompson: W6 do not hold a servicing agreement on any holding tanks located in St. Croix County. On 1/29/91 we did service the tank located on the property of Alin Iverson in Cady Township. At the present time we are not pumping any other holding tanks in the county. Sincerely, Bennie Helgeson MPRS HOLDING TANK SERVICING CONTRACT This Agreement is made and entered into this f�Oday of CC 4&,— 19,"7 r by and between AJ-y/a -'VViLAM I VP fR&O '7 ; hereinafter called the "owner" and 0 l/=L-cJ�J2 � �'U/l'F hereinafter called the "pumper." We hereby acknowledge the installation of (a) holding tank(s) on the rol'lowing described property: /� Yl ' ` l D avY► 1. �j �Q V V jv W w 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of 5;.KrV1A 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all weather access road. or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. 'The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code and to the county a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to submit a report which shall include: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County of S+ C'TO;A within ten (10) business days from the date of change to this service contract. • n SIGNATURE OF OWNER(S): r� SIGNA RE OF PUMPER (Inc de License.Number) : State of Wisconsin ) before me this;G day of % �. A.D., 19 ) o me known to be. the person who executed the foregoing County of Cc ��`� )instrument and acknowledged the same. Subscribed and sworn to before fie this �C= day of 19 Notary My commIss on expires-�_%� /-e� 19 This instrument was drafted by the State of Wisconsin Department of Industry, labor and Human Relations, Bureau of Plumbing. 431798 �9�Pa�F597 HOLDING TANK AGREEMENT This Agreement is made and entered into this day of A)o Of M B 19ffl, by and between the TWrJ Of- hereinafter called the "municipality" and 1.0/itJ t a. JtLacco G' • DF-P-S-00 hereinafter called the 'owner." We hereby acknowledge that application is being made for the installation of (a) holding tanks) on the following described,property: /V W ��{ J� S4U '/51 at Sec'-�(�h 70—w-n ltitnSe_ I Sr K) or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. We also acknowledge that said property cannot now be served by a municipal sewer, any other type of private sewage system as permitted under ch. ILHR 83, Wis. Adm. Code, or ch. 145, Stats., and that the property does not contain an area of soil suitable for any other type of private sewage system as permitted by ch. ILHR 83, Wis. Adm. Code. Therefore, as an inducement to the County of sR/N T 21M A to issue a sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Stats. and the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner hereby specifically agrees that all of the costs and charges may be placed on the tax roll as a special assessment for the abatement of a nuisance, and the tax shall be collected as provided by Wisconsin Statute. 3. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under ch. NR113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or their registration with the municipality and with the. county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 795FAVE59S "oO 4. The owner agrees to contract with a person licensed under ch. NR113, Wis. Adm. Code `T who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s. 146.20 (3) (d), Stats., the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit ' responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with ch. ILHR .J 83., Wis. Adm. Code. In addition, this. agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner: The owner shall file the agreement with the register of deeds which , shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by referenceQ to the property where t�he�holding tank is installed. SIGNATURE OF OWNERS): ` t— /" "`� 4, SIGNATURE OF MUNICIP L OFFICIAL (Inclu a Title): T4.4y. Y�4 mate of'Wi" consi n )came before me thi n� day of Nov_ A.D., 1981 a el )to me known to be the person who executed the foregoing s. ("aunty Pierce )instrument and acknowledged the same. 11S �a'bed and sworn to before Me this 3rd day of 19 —$Z ,waves Notary My commission expires Oct. 13 1991 RECEIVED FOR RECORD 3rd day of November A.D., 19 8T , at 2:30 o c ock P w M. and recorded in Volume 795 of Records page 597 & 598.' gister of Deeds St. Croix County This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS I�IDUST^Y, � cc DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1)& Chapter 145.045) LOCAA�T�<�ON: SEC�TIION: W OWNSHIP/ UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVI, ION NAME: COUNTY: OWNER'/T_2� (or n �AIb ADDRESS: �� VA-1 kV 3"• eirSo (. 54c2 `1 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: ER ATI N TESTS: Residence ❑New WReplace I 1 d/a I/fJ? N� R,p/o_.e yhe L-r oir 6-z,+6o-SQ/ v RATING:S=Site suitable for system U=Site unsuitable for system e WK AM,-rLZ CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-I -FILLHOLDIN TANK: ECOMMENDEDSYSTEM:(op onal) osou as ®u osEfu as ©u as au If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the , ) under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DE[[P'THWd, ELEEVATII/ON OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) J� B- .7• I /3,Db v�`� / • V , 7j4�/ S Sd 7.; ..�d h S,/� . � '1 u.4,-� �'�rf(� l7F ; . a7� /� IS7 --led B- 0 �`�. 7�0 , 9'' 1 Si rS� S'B1 Si' 1 r1D Mo' /,.s _&SL B- $04 I` ,�'BI S./ r5 "S. Sly .,5-40 S,' >' o r`9 . H o U rs .G .. SrlP �►� � f 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- 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 A� Pj k I i 1 i i j I tN 1 ?- i _ L-J i f ' ) t 1 _J.._ 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. NAM;4rint): J TESTS WERE COMPLETED ON: 15enni-e N eI s©1,— /v �ZsY7 ADDRESS: CERTIFI ATIO NUMBER: PHONE NUMBER(optional): �0 Cl 7 8 2-LE CST SIGNA URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 o i P ro�� till s : 1 --� + IoL r -—------ - - I : IS ' I , i I - �r�ro�z`' I I i � I T Shed : : I ( 1 - i 1 - r n , I : � r i I i T PS FORM 3304 /C fj//� II LIT O IN U.5.A. _.1++ �`�_ (�� �w�, 1 I I : i REEA °� REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUNDUSTRY,, ' DIVISION 'LABOR AND PERCOLATION TESTS (115) MADISON WI 537 HUMAN RELATIONS 07 ' (H63.09(1)& Chapter 145.045) LOCATION: E O OWNSHIP/ UNICIPALITY: OT NO.:BLK.NO.: SUBDIVI ION NAME: NWT/454/ / y /T_2,2 N/R/5 E for W _ -A D 14)14 /U COUNTY: OWNER'S 501r R'S N:rf t: MAILING ADDRESS: erso 11. S LA C, 2 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER U AL DESCRIPTION: R F NS: N STS: Residence ❑New Replace 1 Rorjace v ert oi- 4n,+6oU&V RATING:S-Site suitable for system U-Site unsuitable for system ct e t,r t ONVENT NAL: MOUND: 1N-GROUND ESSUR STEM-1 -FILLHOLDIN TANK: COMMENDED SYSTEM:(o onal) DS ®U DS ®U DS �U DS ©U ®S E: If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the /1 under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: A4 PROFILE DESCRIPTIONS ,BORING TOTAL PTH TO GR UNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTHin. ELEVATION OBSERVED ES IGHE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 7'[31 S• Sr/ 73; . 3 �,� . �►' � .,� ` B- 5 9/. 8 s��a ,s- --P Aid s�7W.-vi .,n Mo n V YW uv,_ IB-Lj It C�' S,/ Ts & Srf B- .S_ .5� I I y . r q, , ; TS ,6 9 !e,1,4,, P?�f P G�r G .►1oj' B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD2 PER INCH P_ P. P- P- P_ LP=_ 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori• ontal 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 )f land slope. SYSTEM ELEVATION Al A ( r I 1 i __- � I ff . 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 4dministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM rint : TESTS WERE COMPLETED ON: t •-7 CnnI_2 EI 413DR S :CERTIFI ATIO NUMBER: PHONE NUMBER(optional): CST SIG URE: v )ISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. )ILHR-SBO-6395 (R.02/82) —OVER — F- TY Bu I LD I NGS Sop--- I _ -- --- ---- _. �t►�Lc .,r., .{7}.pp`� I -- he G�0.rQS•F Pro �-�� I��„rt, i 1 i l I • . � 1 ' I I j At - -- use., ; t I . � 00 BM I I I � I I : _ I i , II j � s j I I I I I f I i - I I I I : 3cEr, h: i t 1 _ � I I : I i TIC PS FORM 3304 LIT 0 IN U S A. I I I I _ Show-