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HomeMy WebLinkAbout020-1187-10-000 / ¥ I 2 \ � \ 0 , \ � /k � & c ] � ` / ] § , °3 � 2 / k % } 7Z Z f )/ 3 ° k.F 1 0C< eo � � \ » C 2 $ j - § - � k 2 @ / § ! a m § � k § + c co k k k D k § -0 &\ Cl) j ) / (D j ( f 001 c Q 7 j ' ) k k k £ $ .. } C:& ƒ 2 E u ~ CD 2 \ 0 CL ca ■ = o CS a / 2 * (D E C,4 3 ■ _§ $_ \ k k k 0 a a 2 a E k B � ] 0 _ © n u � 2 / / 2 2 _ § § a £ to $ = 0 A? a) « ) E w 2 . 2 . � a I � § ° E 0 E O / / \ \ ) J CD % a ( / § ® : ) k © 6 ) j 2 r \ 5 -� / \ j � $ / \ } / / \ m j � % . M \ ) — , : � � a » ( 2 ' § @ a § $ J Parcel #: 020-1184-10-000 01/07/2005 03:27 PM PAGE 1 OF 1 Alt. Parcel#: 20.29.19.1160 020-TOWN OF HUDSON Current OX ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): "=Current Owner * LARRY S&MARY L HEBERT HEBERT, LARRY S&MARY L 497 LASSIE CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "497 LASSIE CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.170 Plat: 2328-PINEGROVE HEIGHTS 1ST ADDITION SEC 20 T29N R19W NE SE LOT 20 PINEGROVE Block/Condo Bldg: LOT 20 HEIGHTS 1ST ADDITION TOWN HUDSON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 08/18/1997 1258/367 WD 07/23/1997 1098/601 WD 07/23/1997 812/26 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49200 278,400 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.170 21,700 193,700 215,400 NO Totals for 2004: General Property 1.170 21,700 193,700 215,400 Woodland 0.000 0 0 Totals for 2003: General Property 1.170 21,700 193,700 215,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 120 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ST. CROIX COUNTY WISCONSIN --- --- L ZONING OFFICE ppaIla11 ST. CROIX COUNTY GOVERNMENT CENTER ,F 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 September 26, 1994 Ms. Lucy Gearhart Century 21 706 19th Street South -- Hudson, WI 54016 RE: Water Results for Residence Located at Greg Gelbmann: 407 Lassie Circle, Hudson, WI 54016 Dear Ms. Gearhart: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions regarding these results, please do not hesitate in contacting our office. Sincerely, J� Mary Jenkins Assistant Zoning Administrator js Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 REPORT NO.S 70;52/01 PAGE 1 ST. CROIX COI�lTY'ZONING OFFICE REPORT DATES 9!21!94 ST.CROIX CTY GOV.CTR 1101 CARMICHAEL ROAD DATE. RECEIVED! 9x'15/94 HULA, WI 54016 ATTN*# THOMAS C. NELSON i-j ; OWNER! Greg Gellman ° LOCATION: 497 Lassie Circle, Hudson c;ti COLLECTOR! M. Jenkins DATE COLLECTED! 9-14-94 TIME COLLECTED*# 11S30am ' *,. �'"�� cu SOURCE OF SAMPLES Outside faucet 7- ► DATE ANALYZEDS9--15-94 TIME ANALYZED1#2SOOpm COLIFORM,MFCC*# 0 /100 ml. INTERPRETATION*. Bacteriologically SAFE NITRATE-N*# 4 ppm Above 10 Fpm exceeds the recommended Public Drinking Water Standard. ,F Col.iform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN*# Pam Gane WI Approved Lab No. 19 pF.NDEPFHpfMr " A S Means "LESS THAN" Detectable Level Approved by'. 4� PROFESSIONAL LABORATORY SERVICES SINCE 1952 W -�4' ST. CROIX COUNTY WISCONSIN - ---� ZONING OFFICE Npxxpxrn• - p��rb --- ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 September 14, 1994 Ms. Lucy Gearhart Century 21 706 19th Street South Hudson, Wisconsin 54016 RE: Septic Inspection for Residence located at 497 Lassie Circle, Hudson, Wisconsin Dear Ms. Gearhart: An inspection of the septic system on the property of Greg Gelbmann located at 497 Lassie Circle, Hudson, Wisconsin, was conducted today, September 14 , 1994 . At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Also, water samples were taken. Once we receive the results we will forward the same on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. Sincerely, Mary Jenkins Assistant Zoning Administrator mz . ►.�. ST. CRO IX WISCO y� ZONING OFFICE s� A Y N U 111111 q■ .1..6 ST. CROIX COUNTY.GOVERNMENT GEf�fT'ER M 1101 Carmichae[Road .. 1 _ _ 710 t -7 , _...�-------- Hudson, -I X40 (7 15) 38 -4681 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185. 00 0 Septic <' $50. 00 ❑ Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria retest $15. 00 Owner: jL1 /�/�/ //��'/ Requested by: Address: f/� L� Address• ZIP�` /6 G/7 / ZIP Telephone N4: Q�±) mil_ -7 a� Telephone N°: Property address Fi e N2 & Street) Location- '„ Sec. �� , T,�N, R 1-7 W, Town of Dr! �����i Realty firm: Lock Box Combo: Closing Date: x.� x TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM Water sample tap location: &q Sl 3 k U u L Is the dwelling currently occupied? N Yes 0 No �^ If vacant, date last occupied: Age of septic system: rS f ' �$ `« Septic tank last pumped by: —it," Date: w� (A Previous Owner's Names) Have any of the following been observed? ❑Y -8N Slow drainage from house. ❑Y 1N Sewage Back-up into dwelling. ❑Y BN Sewage discharge to ground surface or road ditch. ❑Y EN Foul odors. Other comments relative to system operation: 0 1 I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: � DATE: ) 0 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1N _. TO BE COMPLETED BY INSY)ICTION AGENCY System design &/or permit on file? Wes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: Below grd OAt-Grd ❑Mound Approx. size 6- ' X [dravity ❑Dose OPressurized Z ,SOU Ft. 2 ❑Bed Wrench ODry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other OUnknown Septic tank Setbacks: ❑House5z- []Well- -' []Prop. lines" []Other Dose tank Setbacks: OHouse ❑Weller_ OProp. line✓ ❑Other ❑Locking cover OWarninglabel OPump/Floats ❑Alarm OElec. wiring Soil Absorption System Setbacks: OHouse ✓ OWell '� ❑Prop. line c-' OOther OPonding: /rty)u, ❑Discharge: /YL4'Ka General comments: INSPECTORS SKETC OF SYSTEM LOCATION IY 1_ � i r Inspector _ Title Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ��,� F (� TOWNSHIP � SEC. 07� TN-R W ADDRESS � / �92 it,, t ST. CROIX COUNTY, WISCONSIN SUBDIVISION �,✓� 7J4 4J5 LOT ZQ LOT SIZE PLAN VIEW TT Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICA NORTH ARROW BENCHMARK: Describe the vertical reference point used �/� Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ` ,� Liquid Capacity: Zrl-e , Number of rings used: --�—-- Tank manhole cover elevation: 9!i 94 Tank Inlet Elevation: 60 Tank Outlet Elevation: 0 z Number of feet from nearest Road: Front,&Side,0 Rear, O l feet From nearest property line Front,O Side,O Rear, & feet Number of feet from: well 1 building: ' Include this information of the Above lot plan) ( 2 reference dimensions to septic tank) ( P P PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pumg./-Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch evation: Gallons per cycle: Alarm Manu . cturer: Alarm Switch Type: Number f feet from nearest property line: 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: Width: S Len the Z Q� ( Number of Lines: Area Built: -600 Z,S Fill depth to top of pipe: Number of feet from nearest property lint: Front, O Side, O Rear,(9 Ft /S Number of feet from well: ZA �Y ^-^yr 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 B t: Has eit er a drop box O or distribution box O been used on any of the above soil abso tion sytems? (Check one) . LDING TANK Manufactur _ Capacity: Number f rings used: Elevation of bottom of tank: E1 ation of inlet: /Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: NumbS�r of feet from nearest road: Alarm Man acturer: Inspector: Dated: / L Plumber on job: License Number: -:5 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.DOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE' ,SE4,S20,T29N-R19W kilCONVENTIONAL ❑ALTERNATIVE BllaassPgnedliD.Number. Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 20 Pine Grove Heights NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTIO19N DATE Gregor Gellmann '1v' �� 1 �''s BENCH MARK(Permanent reference p—O DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber. JMPIMPRSW N. Co nTy Sanitary Permit Number Gary L. Steel 3254 St. Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED PROVIDED OYES ❑NO DYES ONO BEDDING. VENT DIA I VENT MATL.. NIGH WATER NUMBER OF ROAD' PROPERTY WELL BUILDING (VENT TO FRESH ALARM FEET FROM LINE AIR INLET DYES ❑NO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY I PUMP MODEL 1PUM11S11HON MANUFACTURER WARNING LABEL LOCKING COV ER PROVIDED PROVIDED. OYES ❑NO ❑YES ❑NO OYES ❑NO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY [V111- JBUILDING IVINTTOIIIEIH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check thesoil moistureat thedepth of plowing LENGTH DIAMETER MATERIAL ANDMARKIN( 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 IDISTR PIPE SPACING COVER 1N".I LTE DIA -PITS LIQUID BED/TRENCH TRENCHFS MATERIAL' PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH JLHSTR PIPF DISTR PIPE DISTR.PIPE MATERIAL NO DISTR NUMBER OF PR OPERTV WELL BUILDING VENT TO FRESEI 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 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. ❑YES ONO SOIL C VERI TEXTURE PERMANENT MARKERS jObSEHVATi0PN WE LtS ❑YES ❑NO EYE 1:1 NO DEPTH OVER TRENCH!BED JOEITH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ED YES El NO 1-1 YES F-1 NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE IMANIIOLDMATIHIAL N I:I$TR PIPE DI$THIBIITIONPIPE MA7ERIAL&MAHKIN1, ELEV ELEV. CIA ELEV PIPES 111= ELEVATION AND [DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES 1:1 NO DI YES NO COMMENTS: PERMANENT MARKERS: JOBSERVAT11 N WELLS NUMBER OF PROPERTY WELL BUILDING FEET FROM NE Z C DYES ❑NO ❑YES [�NO NEAREST Sketch System on % Retain in county file for audit. Reverse Side. SIGNATURE �LTLI DILHR SBD 6710(R.01/82) Zoning Administrator �ILHR SANITARY PERMIT APPLICATION COUNTY ix Gro .st In accord with ILHR 83.05,Wis. Adm. Code STATE SANIT Cro MIT## —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/z x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES �O PROPERTY OWNER PROPERTY LOCATION Gregory Gellmann NE '/4SE '/4, S 20 T 29 N, R 19 x5i(or) W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME Baldwin / Wi. 20 n a Pine Grove IfRtss. CITY,STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD,LAKE OR LANDMARK Baldwin, Wi. 54002 n/a ❑ VILLAGE 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4, if applicable) 1. a. QNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a.16�Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ 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): 94.55 lower <3 495 500 97,24 umm UPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App. Tanks I Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber — ❑ ❑ ❑ ❑ ❑ V11. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installat'on of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' gnature: St ;�F/MPRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Plumber's Address(Street,City,State,Zip e): Name of Designer: 988 N. Shore Rr. New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. , New Richmond Wi. 54017 715 246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S charge Fee Adverse Determination X. C MMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INDUSTRY., OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ' INDUSTRY., G DIVISION BOX 76 HUMAN REDLATICNS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ (; LOT NO.:BLK.NO.: SUBDIVISION NAME: NE �/4SE/4 20 /T29 N/R19)&(or)W1 Hudson Pine-Grove Ht COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Gregory Gellmann Baldwin, Wi. USE DATES OBSERVATIONS MADE NO.BEDR IS.: COMMERCIAL DESCRIPTION: IPROFIL DESCRIPTIONS:1PERCOLATION TESTS: Residence 3 n/a ENew ❑Replace 5-13-88 5-13-88 RATING:S=Site suitable for system U=Site unsuitable for system CSYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑U ❑S EA ❑S)E U step down trench If Percolation Tests are NOT required DESIGN RijaE: If any portion of the tested area is in the n/a under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS page 58 PIA BORING I'j D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 6.92 98.05 none >6.92 1.42bl.1. 1.50bn.sil. 4.00bn.c.s&gr. B- 2 7.00 98.05 none >7.00 1.00bl.l. .75bn.sil. 5.25bn.c.s.&gr. B- 3 7.08 100.74 none >7.08 .75bl.1. .50bn.l.s. 5.83bn.c.s.&gr. B- 4 6.50 102.45 none >6.50 .50bl.1. 6.00bn.c.s&gr. B- 5 6.50 102.45 none >6.50 .58bl.1. 3.00bn.c.s.&gr. 2.92bn.m.s.. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PER PER INCH P 6 <3 P 6 6 6 <3 P 6 <3 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. 94,55=lower trench SYSTEM ELEVATION 97.24]ti,.pper trench C TN c S' > Z �` of . a 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 5-13-88 ADDRESS: - CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. New Richmond Wi . 54017 2298 1715-24fi-6200 CST SIGNA 8. DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — l Gregory Gellmann i NE4SV4- S20 T29N. R19W j Hudson, township r AW I-IT AT lobo r��2o t4. e. 83. 1 a 3 ,�' 306�a VYV4 t� � q-9 3Y 97 Gary L. Steel 988 N. Shore DR. New Richmond, Wi. 54017 MPRSW 3254 ' ST. CROIX COUNTY WISCONSIN ---- `t ZONING OFFICE ""'■d ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 September 6, 1994 Mr. Greg Gelbmann 497 Lassie Circle Hudson, Wisconsin 54016 I RE: Septic Inspection/Water Test Dear Mr. Gelbmann: On September 2 , 1994 our office received a request for a septic inspection/water test for property located at 497 Lassie Circle, Hudson, Wisconsin. We must have you complete a drawing as to where the septic system is located adjacent to your house. Please sketch this in the box at the top of the second page and return this form to our office as soon as possible. Thank you for your prompt attention to this matter. If you have any questions, please do not hesitate in contacting our office. very sincerely, Marilyn Za ' Administ tive ecretary mz Enclosure i -P A4 • ST. CROIX WISCONS1 �°` � f -- _ ZONING OFFICE mrraau■ar ,,,,ii6 ^o ____.:� •� ST. CROIX COUNTY GOVERNMENT CENTER �.'-• - 1101 Carmichael:Road - :,.• - --- Hudson W1 ,54016-77i 0 �$6-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM, Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185. 00 0 Septic ,K' $50. 00 ❑ Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria retest $15.00 Owner: Requested by:��/'/L/C���� `� Address: /� `/C Address:- S ZIP�' /6 4� mil/ ZIPS' Telephone N°: (��) _'mil-7a.Z Telephone N°: Property address Fire N° & Street) : z,:/: Location: d7 ;, „ Sec. T, N, R W, Town of Realty firm: Lock Box Combo: Closing Date: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: &g Sl S d 3 J k Q U S Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Age of septic system: rS Septic tank last pumped by: ►r , Coj n _ Date:--�.` Previous Owner's Name(s) : Have any of the following been observed? ❑Y -®N Slow drainage from house. ❑Y 19N Sewage Back-up into dwelling. ❑Y QN Sewage discharge to ground surface or road ditch. ❑Y ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: )� DATE:" . h 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1N TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd OAt-Grd OMound Approx. size ' X ❑Gravity ❑Dose OPressurized Ft. 2 ❑Bed ❑Trench ODry Well. Molding Tank OOutfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: OHouse ❑Well ❑Prop. line ❑Other Dose tank Setbacks: OHouse ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label OPump/Floats []Alarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell []Prop. line []Other OPonding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N i Inspector Title Form - ST C - 104 t AS BUILT SANITARY SYSTEM REPORT OWNER d T TOWNSHIP SEC. °�� T N-R l ; W ADDRESS ICk��L r �, ST. CROIX COUNTY, WISCONSIN ozv-- SUBDIVISION LOT 20 LOT SIZE r� PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s lb 4 Y Y 1 1 INDICAT21 NORTH ARROW BENCHMARK: Describe the vertical reference point used �AJ, Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: !,(� g r Liquid Capacity: j Number of rings used: , ( Tank manhole cover elevation: 9 Tank Inlet Elevation: Gd Tank Outlet Elevation: y 7 z Number of feet from nearest Road: Front a ,�Side,�Rear, 0-- feet From nearest property line Front,O Side, Rear, feet i Number of feet from: well — d1A building: sj� (Include this information of th ABove plot plan)( 2 reference dimensions to septic tank) �_ SEE REVERSE SIDE 1 PUMP CHAMBER r Manufacturer: iquid Capacity: Pump Model: Pum iphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch evation: Gallons per cycle: Alarm Manu cturer: Alarm Switch Type: Number f 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: i Width: Length: r Number of Lines: Area Built:-_500A' 2� Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, 0 Rear,(F*_ . ! 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 B t: /Haseit er a drop b ox O or distribution box O been used on any of the above soil ion sytems? (Check one). TANK Manufactur Capacity: Number f rings used: Elevation of bottom of tank: E1 ation of inlet: umber of feet from nearest property line: Front, O Side, 0 Rear, Ft. Number of feet from well: Number of feet from building: Numb 'of feet from nearest road: Alarm Man acturer: Inspector: Dated: -It) , Plumber on job: elz License Number: ,)i L3e7 S 3/84:mj Y DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS v LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE!4,SE14,S20,T29N-R19W j5JCONVENTIONAL ❑ALTERNATIVE IS,,,,Plan VD,N"Iblr: Town of Hudson El Tank El In-Ground Pressure El Mound I If assigned) Lot 20 Pine Grove Heights NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gregory Gellmann Q:f`W 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: Gary L. Steel 3254 St. Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER. JILIQUib CAPACITY: TANK INLET ELEV.: ITANKOUTLET ELEV.. WARNING LABEL LOCKING COVER j PROVIDED. PROVIDED. DYES ONO EYES ON BEDDING VENT DIA. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT 70 FRESH ALARM FEET FROM LINE AIR INLET DYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. OYES ONO DYES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO IRE SH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing 1 LENGTH DIAMETER 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. IN O.OF PIPE SPACING. COVER INSIDE DIA -PITS LIQUID BED/TRENCH TRENCH MATERIAL: DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH JOISTR.PIPF DISTR.PIPE IPE 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 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 1:1 NO SOIL COVER TEx TURE PERMANENT MARKERS OBSERVATION WELLS ❑YES 1:1 NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED fGES PTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. . 1:1 YES ONO El YES El NO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL N DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKINi ELEVATION AND ELEV.. ELEV.. CIA, ELEV.. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED DYES ❑ COVER NO PLANS OYES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPE RTV WELL: BUILDING. FEET FROM LINE: ❑YES ❑NO ❑YES NO NEAREST 2,G'z 7 o Cv 7 v Sketch System on �� O \Itain in county file for audit. Reverse Side. 0 � n / / rNATURE TITLE' I Zoning Administrator DILHR SBD 6710(R.01/82) I DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm. Code St. Croix ` .o.....�..a. STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%s x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES �KO PROPERTY OWNER PROPERTY LOCATION GregoLry Gellmann NE '/4 SE Y4, S 20 T 29 N, R 19 x1i(or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER B SUBDIVISION NAME Baldwin / Wi. 20 n a Pine Grove 11Rtss. CITY,STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD,LAKE OR LANDMARK Baldwin, Wi. 54002 n/a ❑ VILLAGE 19 TOWN OF� TTi id son Ta II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. [aNew b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a.361 Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ 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. 61See a e Trench c. ❑ See a e Pit 2, PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 94.55 rower <3 495 500 97,24 u Private —]Joint ❑ Public CAPACITY VI. TANK Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber — ❑ 1 ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installat'on of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' nature: St )W/MPRSW No.: Business Phone Number: Gary L. Steel 3254 715 246-6200 Plumber's Address(Street,City,State,Zip e): Name of Designer: 988 N. Shore Rr. New Richmond, Wi. 54017 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Gary L. Steel 2298 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 988 N. Shore Dr. , New Richmond Wi. 54017 715 246-6200 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved §Anitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S charge Fee Adverse Determination � i�8 �V V �• X. C MMENTS/REASONS FOR DISAPPROVAL: v SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT x APPLICATION r a TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81,6 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 $ff�F . included the creation of surcharges (fees) for a number of regulated practices which Wisco irt' e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuro: 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. a 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- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the 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 t o r&_6 =d;i ate`-IM109` 19 Location of Property Ic G tt, Section 20 , T N-R W Township duS n--y°"� !tailing Address � 1 d. ,.�1,V1 # t,J Address of Sits .. r7 ,1_os / + Subdivision Hasa _ ro, ""C' "s . Lot Number Previous Amer of Property Total Size of Parcel _ 1, 171 C Date Parcel was Created Are all corners and lot lines identifixle? C� Yea No Is this property being developed for resale (spec house) ? Yes No Volume �� and Page Number "2 (- 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (roe) cv(ti.6y that aU 6tatementA on this onm ane true to the bat o6 my (ouh) hncwtedge; that I (we) am (one) .the ownerc(s o6 the pnopehty de�scAi.bed in this .in604maLf.on 6o4m, by viA-tue o6 a waAAanty deed heeonded in the 06 ice o6 the Coamly RegiAten o6 Veedsah Document No. �l , and that I f We) pnesentty c4un •the pkoposed e•e to 6oit the �6ewage d!Apo�s 6 6 em• (on I (we) have obtained an ecu¢ment, to 'tun with the above der cAtbed pkopeAty, bon the eon tAucti.on o6 eaid ayatem, and the aa,ne ha.e been duty neeohded to the 066tee o6 the County RegiAteA 06 Dttde, 44 Voewnent No. ) . SIGN A Oil OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) .. . 4 - z DATE SIGNED • __ DATE SIGNED DOCUMENT N0. STATE BAR OF WISCONSIN FORM 2-1984 THIS SPACE RESERVED FOR RECORDING DATA 0 WARRANTY DEED ` 26 BOOK REGISTERS OFHCE ST. CROIX CO., WISE Wd. for Rewrd this 26th day of May—A.D. 1928 12:35 conveys and warrants to ---- ' James O'Connel RETURN TO the following described real estate in - I'C ' County, ' State of Wisconsin: . ' , a`1T1cE'3'uVt �=i5 itil>„s y Tax Parcel No. _.. - "ion 1'- TR NSFER $ ' FEE This homestead property. (is) (is not) Exception to Warranties: Dated this _ day of ,19 - j i i l r {it C \ (SEAL) ,�i�`rf o� ` `�_i 1!ii i �) i,:'(SEAL) 1 i1 i LuU"L (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. Cep p.�Oj County., authenticated this day o Personally came before me this day of • 19 the above named • TITLE:MEMBER STATE BAR !QI Cr0•• IN•.%4 (If not, F S� to me known to be the person who executed the authorized by§706.06,Wis.State.) foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ^~ Notary Public _ County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date' 19 ) 'Names of persons signing In any capacity should be typed or printed below their signatures. NTF 2280 WARRANTY DEED STATE BAR OF WISCONSIN Neico Forms,P.O.Box 1075,Green Bay,WI 54305-1075 Form No.2—1982 1 H I to • t-J . a STC - 105 r . a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE 1 �.�� h W ZIP .l PROPERTY LOCATION : !,SC 14, Section -2-0 , T zq N , RZ_W, Town of 14� CIS 0_; � , St . Croix County , Subdivision y/ y��1 �S , Lot number Z,D Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , I if needed , by a licensed septic tank pumper . What you put into I( the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . 0 E I/WE, the undersigned , have read the above requirements and agree En to maintain the private sewage disposal system in accordance with x H the standards set forth , herein, as set by the Wisconsin Depart- �d ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SICNED DATE St . Croix County Zoning Office P .O. Box 98 Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, REPORT DIVISION LABOO HUM AN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090)&Chapter 145.045) LOCH I N: SECTION: TOWNS HIP/1Mdjk5tFjd=: OT NO.:BLK.NO.: SUBDIVISION NAME: NE ��4SE/4 20 /T29 N/R191(or)W I Hudson g COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: St. Croix Gregory Gellmann Baldwin, Wi. USE DATES OBSERVATIONS MADE L�1 NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: p�Residence 3 n/a E New ❑Replace 5-13-88 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ®S ❑U �S ❑U IS ❑U I EIS ❑ U I ❑SOU step down trench If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n/a under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS page 58 PIA BORING 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.) B- 1 6.92 98.05 none >6.92 1.42bl.1. 1.50bn.sil. 4.00bn.c.s&gr. B- 2 7.00 98.05 none >7.00 1.00bl.1. .75bn.sil. 5.25bn.c.s.&gr. B- 3 7.08 100.74 none >7.08 .75bl.1. .50bn.l.s. 5.83bn.c.s.&gr. B- 4 6.50 102.45 none >6.50 .50bl.1. 6.00bn.c.s&gr. B- 5 6.50 102.45 none >6.50 .58bl.1. 3.00bn.c.s.&gr. 2.92bn.m.&.. B- 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 3 PER INCH P 6 <3 P 6 6 6 <3 P 6 <3 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. 94, =lower trench SYSTEM ELEVATION 97.24 per trench 1 I I k .. --4 3 � _ r TN ZQ i e I . . _. _ ..... I I q� - I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 5-13-88 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. , New Richmond Wi . 54017 2298 715-2 -6200 CST SIGNA DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6335 � To be a complete and accurate sail test,your r-M)Ort must include; 1. Complete legal description; 2. The use section roust clearly indicate whether this is a residence,or commercial Project; 1 MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement system; B. 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; 8. PLEASE use the abbreviations shown here for veriti ng 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 rnay be used if desired; 8. M111<e sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9, Complete all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exernp- tion,if appropriate; '10. If the information (such as flood pEam, elevationi)does net apply, Place N,A.in the appropriate box; 11. Sian the form and place. your current address and your certification number; 12. Make legibie, 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 Soil Separates and Textures Other Symbols St - Stone (over 10") BR - Bedrock cob ._ Ccbble (3- 10") SS - Sandstone c1r Gravel (under 3") LS Lirnestone "s - Sand HGW - High Grocrradvvater s - Crouse Sand Pere percolation Late I'lled 'S — Medium sand tit -- well fs Fine S<aod Bldg - Building Is Loamy Sand - Greater Than 'sl Sandy Learn ' Less Than 'I — Lo<arn Brt - Brown �sil Silt Loam BI Black si -- Silt G --- Cray 1-cl - Clay Loan Y -- Yellow rscFl Sandy Clay Loam R - Arad sic! — Silty Clay Loam not - Mottles sc, Sandy Clay wf - with sic - Silty Clay ftt ._ fc.w, Khoo faint _ Claa cc cornrnorr,coarse i })t _ Peal, ll2n Mariy, rnediUrn Muck d — distinct 13 °- promment HWL High watat<ieve'lr Six general SLIT{ teXtUres SUrfaGr ?,,Vater for liquid waste disposal BM -- Bench Mark VRP - Vertical Reference Poi€rt . t r A � ' ,1 TO THE OWNER: This sr Il test report is the first step in securing a sarritary permit, 'The county or the Department may request velificanor, of this soil test era the field pri or to permit issuance. A complete scat of plans trJr the prsvate ,sti,tt; system and a Pero it application roust be subnaitted Cc, the �Eptsrc>priate l€> al audior.ty in or(fir to .rldm a perratlt. The ani�ery permit must bra obtained and posted piiorto;rr:start of any c_,rFstructior,. Gregory Gellmann NE4SE4 S20 T29N. R19W Hudson, township at rim IZ--A S, L. !4. )e. 83. 16 f7 3 106/ �� 3001 yak C4 e' ►'r L 1 V YV4 r5vy .31 v+�cjz s04 9� Ga L. Steel 988 N. Shore DR. New Richmond, Wi. 54017 MPRSW 3254