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HomeMy WebLinkAbout020-1141-80-000 M 0 E» c � a 4 0 I! `o o a� N CL ti E M 8 C c C a i I, c 'Cs o 0 C m � a> c N E o O 1 D C Z y y tL c O C CD O O z ?i � E c a o rn QH �n D . O r� H z d °° c 0 o wz�I/ v' c ''d^^ `Z` O c Z U) r r Q) z CD CO Q� M U C 1 C •� d r a o c C O U o O N < w Z H Z O N Z E N Q t0 N }1� N C d O) �l f0 H d e N O O 3 O o a a E N w N N N cn LO rr rr d o a a 0 IL Z o •N R CL o w F 00 00 o CO) J 0 y rn rn Z O N p N C O 00 •_ � E � J m to 2 CO (n m W d 3 0 Al O (D E U m L cq N C N A N O V y E N N O Z V .d O C N •O O chi 2 S O Z C H (n V CA a • ed a m d 0 CL 0 MERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 CN ST. CROIX ZONING C REPORT NO.: 36990/01 PAGE 3T. C'ROIX COUNTY REPORT DATE: 12/08/89 COURTHOUSE DATE RECEIVED: 12/06/89 HUDSON, WI 34016 ATTN: THOMAS C. NELSON rl 02-0-11 OWNER. Edward n i4ichelle Hinchman . 2°1. 1 LOCATION; 653 - Hudson ,t COLLECTOR: St: Croix Zoning SOURCE OF SAMPLE: K i tc{iten faucet COLIFORM: 0 /100 mt INTERPRETATIONS Bacterjologically SAFE NITRATE-N: 2 ppe Under 16 ppm is safe for human consumption. COLIFORM + NITRATE 1? LAB TECHNICIANS Pam Gaffe S: WI Approved Lab No. 19 V� < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r lk ST. CROIX COUNTY ZONING OFFICE St . Croix County Courthouse 911 4th Street nn O7� Hudson, WI 54016 Telephone - ( 715 ) 386-4680 The St . Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals . Completion of this form is essential so that the property can be located . Please provide the following information, enclose appropriate b t . County Zoning Office and mail fee made payable to S Croix Co y g , , along with form to the above address . Testing will be done as soon as possible after fee and form are received . WATER TESTING----------------------------FEE: $ 25 . 00 XX (For nitrates and coliform bacteria) WATER TESTING FEE: $127 . 00 (For VOC' S ) XX SEPTIC SYSTEM INSPECTION-----------------FEE: $25 . 00 ( Determines if system is properly functioning at time of inspection ) Edward C. and Michelle M. Hinchman Property owner ' s name Property owner ' s address 653 Edie Lane, Hudson, Wi 54016 Legal Description 1/4 of the 1/4 of Section , T N-R Town of Hudson Lot Number 5 Subdivision NameStewart's Addition FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house?no If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh . if the home is vacant, and has been so for some time, the water line must be Y r ur ed b running the water for several hours before the p g g test can be conducted . WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If • this is the case, please make proper arrangements with this office to ensure time when entry may be gained . If need to access home please contact Michelle at 386-9622 or Work 386---586 Firm or individual re nesting services : a first National Bank of Hudson Telephone Number 715/86-5511 Y REPORT TO BE SENT TO• The First National Bank of HUdson 307 Second Street, Hudson, Wi 54016 Closing date December .15 1989 Signature // I Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT a.l. i OWNER TOWNSHIP -7-41U� SEC. -341 T _�:LN-R .Ll W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION _S ekZ�,& ' LOT S LOT SIZE PLAN VIEW o me requirements of I•IHR 83 Distances and dimensions t et e q u SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o . ' I ,V for Q� t "INDICATE NORTH ARROW /Z"tea k. Lrr� BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ALPJ Proposed slope- at site: 13 `lc SEPTIC TANK: Manufacturer: "ks e,P Liquid Capacity: Number of rings used: Z Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side 10 Rear, O /UU �'- feet From nearest property line Front,0 Side,0 Rear,0 l feet Number of feet from: well _ building: (Include this irkformation of the above plot plan)( 2 reference dimensions to septic t SEE REVERSE SIDE • PUMP CHAFER A 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: A Width: ,5 Length: 6 4� Number of Lines: Z Area Built: 1 3 Z Fill depth to top of pipe: 'el'-, Number of feet from nearest property line: Front, ©Side, O Rear,0 Ft .3 9 Number of feet from well: Number of feet from building: y� (Include distances on plot plan). SEEPAGE PIT �,/q Size: /I/ J Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box(3 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: Z-- 4, 3/84:mj is DEPARTMWT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LANOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 MPiDISON,WI 53707 �yq�, NW',SW4,S34,T29N-R19W [CONVENTIONAL El ALTERNATIVE State assigned) Numbe 111 asslgneel JI Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 5 Stewarts Addition NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N A Ed Hinchman Route 1, Hudson, WI 54016 - � �� BENCHMARK Wermanenl reference Poml)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumbe. --Imp Roger No.: Coumy: Sanitary Permit Number: Ro er Timm 3224 St. Croix 1 106129 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. OYES ONO ❑YES ❑NO BEDDING VENT DIA.. VENT MATL: HIGH WATER ROAD'. PROPE RTV WELL. BUILDING. VENT TO FRESH NUMBER OF LINE AIR INLET ALARM FEET FROM DYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON WARNING LABEtMARKIN OVER PROVIDED: ❑YES El NO ❑YES ONO ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. R OF PROPERTY WELL ENT TE FHE SH LINE IR INLET (DIFFERENCE BETWEEN ROM PUMP ON AND OFF) ❑YES ❑NO ST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing DIAMETER MATERIAL AN or excavation. (If soil can be rolled int o a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH- LENGTH NO.OF DISTR.PIPE SPACING COVER IN:iIDE DIA rs PITS LIQUID BED/TRENCH TRENCHES MATERIAU PIT DEPT/f DIMENSIONS j GRAVEL DEPTH FILL DEPTH UISTH PI F DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPE RTV 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 ❑N� PERMANENT MARKERS OWE LL S SOIL COVER rexruRE ❑YES ❑NO -]NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES ❑YES El NO OYES ONO [—]YES 0 N PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL jNkJ DISTR DISTR.PIPE UISTHIBUTION PIPE MATE HIAL.&MAHKIN(i E LE V. ELEV,: DIA.. ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL PLANS DYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'. FEET FROM DYES ONO ❑YES 1:1 NO NEAREST -1.�> GA ri - Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHRSBD6710(R.01/82) SANITARY PERMIT APPLICATION COUNT DILHR In accord with ILHR 83.05,Wis.Adm.Code ' ° Cko STATE SANITARY PERMIT# l,�)Ci —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. —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 (n %5U), %, S 3 T Z�, N, R rf (or PROP5RY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME CITY, TAT ZIP CODE PHONE NUMB, CITY NEAREST ROAD,LAKE OR LANDMARK 6VC> VILLAGE I iQffl OR If II. TYPE OF BUILDING OR USE SERVED: '/� � At. 0av--- I1 q Imo- ?U',-G0 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. 9 New 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. 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 it 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): GG Feet Private ❑Joint ❑ Public j� VI. TANK CAPACITY Site in gallons Total ##of Prefab. Fiber- Exper. INFORMATION New xi sting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Fj Septic Tank or Holding Tank ?.� -.�S' ❑ ❑ Lift Pump Tank/Siphon Chamber El 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/MPRRSSW No.: Business Phone Number: Plumber' ddress(S� ity,Slate,Zip Code): Name of D 'gner: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## CST's ADDRESS( reet,City,State Zip Code Phone Number: �D 7 Lc��s /cd 1g., IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee Groundwater ate IssT' Ag�ent Signature(No Stam ) rcharge Fee Approved ❑ Owner Given Initial 12c, y�Adverse Determination G J W X. CA_MM_ ENTS/REASONS^`FOR fDISAPPROVAL: �� 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 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 revispris 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 mainftkinedf 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. Prcaerty owners name and mailing address. Provide the legal description where the system is to be installed; 11. 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 Drily 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 mate,ial. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimenta 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 81h 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 T included the creation of surcharges (fees) for a number of regulated practices which Wiscortin'S rt can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuIre I ° is used in your building is returned to the groundwater through your soil absorption ` o 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. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT S T C - 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/contractgr, ("spec louse") , 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 d IitC- Location of Property diA) 14, Section t:? y , T ? N - R _ /� W r Townshipt//,t, ,� Mailing Address Subdivision Name ���- Lot Number Previous Owner of Property ",q ev, o cep Total Size of Parcel c, �? es Date Parcel was Created I `►�O�-{ �� _ __ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes -Xi No Volume and Page Number lf>� as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office I In addition a certified ied curve Y if available, would be helpful so as to avoid delays s of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - PROPERTY OWNER CERTIFICATION I (We) eentijy that all atatementa on thi,6 6onm ane .true to the beat ob my (oan) knowxedge; that I (we) am (cute) the owneA(a ) o6 the pn.ope cty duckibed in thi.6 knbon.mation 6ohm, by vixtue ob a wanAanty deed neeon.ded in the 06jiee o6 the County RegUten o6 Deeda as Document No. /I f and that I (we) p-7eaentey own the pl.opo.tie.r' s4te bon the sewage upos ay�;fr'n (on I (we) have obtained an eabement, to &un wr:ijh the above deaeA bed pn.opeAty, joa the conet/cuc Lion ,o 6 a aid a y6tem, a,ad the e ame ha4 been duty neconded in the 0 6 6 ice o6 the County Regi6t. en. of Deeds, as Document No. J SIGNATURE 'E `W'NER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. WARRANTY DEED I THIS SPACE RESERVED FOR RECORDING DATA I �I STATE BAR OF WISCONSIN FORM 2-1982 I, 41143 ~�? - 5Q_ �— ._._.- —---- --------=_!_c�_ :P AVE - - . 9EGJSTERS OFFICE � •.Roger. W._ Dahler._and_.Barbara D. Dahler, husband and 7. C1tOtX CO. V�!!S: wife-,_-i nd•i vi dual ly__and_.as_•�oi_nt, tenants floc"Id. for Rewrd Hzis 2nd _$6 ........................................... y of M ay A.D. 19 {! ....................................................- i -•---. ...-•--- ........... ...--... ... ........ .... ! I conveys and warrants to Edward C.-.Hinchman-•and__Michelle....larie 1.40 P ....C-lose.............................. ........... .....•---•-----......... •--..... ;:; .........................................•----................................................................... use.R IK of DNdt./ 1) ...........................................................................................•;....................... i ' .... RETURN TO ................................................. ..................................................... ......... . ........................................................... ... .. ....•..............._ .......... the following described real estate int. �rOl X .County, • � St•1te of Wisconsin. - ---• • - x >tc_ 1: Tax Parcel No: .............................. Lot 5, Stewart's Addition to the Town of Hudson. I ��;t-��• it i 1, f I� it 1 . This ........i.s..nOt._...... homestead property. i I (is) (is not) Exception to warranties: Easements and restrictions of record, if any. Datedthis ...................1 st....._.........._...... day of ..............._... ---• May-----•-•••••---.......•---........... 19...a6.. .....................................................................(SEAL) .... (S1:A1') I Y = ....................(SZAL) ............................................................. AUTHENTICATION ACKNOWLEDGMENT Signature(s), of Roger W. ahler..and........ ______ STATE OF WISCONSIN- ....... Barbara D. Dahler SS' 1 -.---------•------------------------•-- - ----------------------------- County authe of._.___��a�!............... 19.8 Personally came before me this ................day of ii n _ ............................ .............. 19........ the above named II ............. ........ * Wi 11 i am J. Radose ---•----•----•---•-----•--.._....•......-•.................•-•---............... I� ... ..... ......... ........... II TITLE: MEMBER STATE BAR OF WISCONSI\ II (If not. ............................................................ •------•--•---.....-----------...............-------•---...---............•--•-- it authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the j I foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich Attorne at Law J --------------•......_._•....�. y..---•--•-•••--• i ------•---------------------------------------------------------•-•---•....... I 5Q2._Secfln�l_.Stroet.,_.J LudsoCt,.._t�fI..5!�Ql.f..---•-- * 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, 11 i WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blnuk Co. Inc. FORM No. 2— 1952 Milwnukeo. Wis. j u• STC - 105 r y . H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County ° C � � OWNER/BUYER ItOUTE/BOX NUMBER f,_ .__ Fire Number C I TY/S'L'ATE � C`GG _ � __ _....__...----•---Z 11'— I'ItOPERTY LUCATION :_ �W%a , S.,jJ +; , SeCCic)n i. d _N Town o1: �_--_— --' St . CCroix County , Subdivisiun--1,:4 Lot number 'Improper use and maintenance of your SepLIC system could result in ies premature: "failure to handle wastes . Proper maintenance cun- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed . i is tank pumper • What you pelt into the system can affect the function of the septic ,tank as a treat- ment stage in the waste disposal system . St . • Cruix County residents ucay be eligible to receive a grant fur, a maximum of 60% of the cost of replacement of a failing sySteM, which way ln. operation prior to July 1 , 1978 . St . Croix County accepted this program ill August of 1980 , with the requiremunt . that owners of Lill uew systems agree to keep their systems properly maintained .— The property owner agrees co submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , ,journ.e-yman plumber , restricted plumber ur 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 . ° he above requirements and agree I/WE, the undersigned , have read t ave :4 to maintain the private sewage disposal system in accordance with the standards set forth , he'rcin , as Sec by the Wisconsin mp.let - 'd uient of Natural .Resources . Curtifie:ati011 form must be completed and returned to the Sc . Croix County Zoning Office within 30 .days of the three year expiration date . S ICNED • UA.;.E St . C:•oix County Zoning 'Office P . O. iiox 9h. llammo-pd ; WI 54015 715-7 16-2239 or 715-425-8363 Sign , date and return to above address . I�I_FARTMFNT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS I JG-:JST�FcY', DIVISION tABOR AND PERCOLATION TESTS (115) MADIP.O. W 7969 HUMAN RELATIONS (H63.09(1) & Chapter,145.045) LOCATION: SECfiON: FOWNSHIP/MUNICIPALITY LOT NO.:BLR_ NO: SUBDIVISION NAME: NW_�/ �/ 3/ /T�� /R/�f (o _ yuDfa.c�_—� �?'0,c1 S�tw�vT /'i) ';r 1,.j COUNTY: OV7ft f" BUYER'S NAME: MAILING ADDRESS: ADO &.-le- JPT / Yuyf0, Avis . US_E_ _ _ _ _ DATES OBSERVATIONS MADE �� lace Residence NO.BEDRMS.: COMMERCIAL DESCRIPTION: New Re P OFILE DESCRIPTION'S': .PERCOI-ATIO`,3-ESTS: !' �. � y— ----�� p 2�l is/7 /�� 2 _j RATING:S=Site suitable for system U=Site unsuitable for system —C1� -FI❑r� -�P�1� —❑��N GR❑OUNDPFa )RE:I'SYS�—TEM-I N�FILL H ING�NKECL3^.�MENOED SY'STEV:(opticmal) — X S 1 S U (J+ U a�' 7�" 1 _ S � )cSIt,N RA1 L. iIf P �c.�;;tio t rs .::r r i T i an :'r y po- ion of th r t- t.* is 'n he lundu s.H63.09(5)(h) indi_oe _ I I Floodplain, indicate Floodplain eievd on: 1 tv .?----- PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-li. CHARACTER OF SOIL WIT14 THICKNESS, COLOR, TEOCTURE, AND C11-.PTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED{:SEE ABBRV.ON BACK.) /05 55 ? > 0 , 0, 4v-6 y. sip . t' � . u . "s --- /G-- > .7f .6,1j-6 y. S/, , '7r 13,V, B-2— //. 0 —_ B-'3 /D-G)� fv/. ��� >/d• Q �7 ' /�� s , , f�'�iv ins TAN ' • c; �� �, > �p•d ' -3"Ac'/30. S/ A"2' j'A.' /s, yl • sk,r9»�•E,o �„ B- B,4,2PS rJ S. 3 e /s . ( TQ /6'J y� �/' �� . s/, •z 33 B_ 1A) may'-. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES M.TE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1_ PERIOD 2 PERIOD 3 PER INCH P- ? P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicatae scale ar distances. Descrlte what are the hori" rontal and vertical elevation reference points and show their !O location on the plot plan. Show the surface elewdian at all borings and thee direction and percent of land slope. y,�3o�la.I '&L,f G _.. Cj Fes, SYSTEM ELEVATION i.e �j fT �s� vim/• .&Y p7` tN This test site APPROVED for a conventional septic system. I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and met4ide.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: TTOMVS TES I co. z o- ADDR ESiSIWM AXPROVED SITE UATEST.-; CERTIFICATION NUMBER: JPHONE NUMB ERtoptional): MINNESOTA LICENSE NO. 00663 WISCONSIN .55-024S2 CST SIGNATURE: RT.3,ONEIL Mar RUDSON,WX 54015 DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — • g E v U Oar SOIL 60RIN &S p f CoLATIUtI TEST5 115" Pao r P L AM P Roy'Eo T F. D. 72 DT"E / J?h -`P7 ti<<' %mow y /� 9��� p, HOMIESITE TESTING CO. p-r.3, 0-NEIL ROAD BOB Ul ,'Jj'L 6, , r'UL)SON WIS. .._ 54016 G'ST. 5'�— C2 yT Z P .oPoSED vjo0sE MOST Li c r O-4 Aletr F/PdM �L T"E3� .�r?E� • PRo POSED w i u M Vst w E 50 r,T a'f J'fORF Fif'o�-r �} 'l- w = ©Aa'114E Pars wU = zowlA G- u��« X = Aeve- �oc#rlmlf NAND Rv�EQED o,Q S a�v,EL ofES F ric�L �PE�ERr-�ICE- o, / � 2 B� V � Pa - mza-A'�( /- Z yZ 4-�-- IU /af c a.�,�ei► LEGEND ' /i'URrl1A! PA 1101 �'�'� & /0-0 -------- 2q n xp P, I t ti `C Zs• - /3 o B 2-- y This test site APPROVED for a conve-Mionai septic s ystem. � pR6170SEl> � HAAdPwaa DEPARTMENT OF REPORT ON SOIL BORINGS AND DIVISION SAFETY&BUILDINGS INDUSTRY,LABOR AND- C P.O. BOX 7969 L LABOR PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS 09(1)&Chapter 145.045) LOCATION:.e/�.�►+( I N: ITY: OT NO LK.NO SUBDIVISION NAME: ' UNICIPAL 1/4 / ?4 /j2�p/R/q dlo0 ubso V S STtrL,A4TS O'b iwTl COUNTY: WN A MAI : <I. Coto Ix G� �, cW��►a ?07 �jSCONs►N ST /f i�Rru Ua ) USE DATES OBSERVATIONS MADE NO.BE CO 1O Residence UNk New ❑Replace /HAY M.V /9 /9sr8� ►cs «< �6 - Sd►c s Ar-e` ERA RATING:So Site suitable for system U-Site unsuitable for system ' %TG 14E Y rNNV 11.'� MQUU(ND: t IN- Fit -FILL OLDING TA K:R�EYCOMMENDED SYSTEM:(optional) S ❑Y A�JS CJl S C�U US ❑H ❑S U t._ONvENnoN i>C CNCz If Percolatioi Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.1­163.09(5)(b),indicate: (_�p55 / Floodplain,indicate Floodplain elevation: I A/ A PROFILE DESCRIPTIONS BORING TOTAL GROUP DWATER-INCHES HA A R OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH W. ELEVATION BSE V TO BED ROCK IF OBSERVED(SEE ABBRV.ON BACK.) B' 1 r 98,-1'► � ! /a"BLLTS 1e geru5l t lt�'ft,tSt&A /3'' B+�N C5 �y,5NE _>e./7 V'ISRr4 M'S 8"8arA CS 4&*. 37"&N MS T(,R 3 � 8 /3 B«Ts i2"BtwS, /6"KOA&,4 MS (A B- Z ONE M'LTB-ed F-MS /Z°BkNCS+4F, /O"BLLTS ll' BR>^,S r N S" ReM 5 V-60 B- 3 6._7S 97.S P46WE > 6.75 Zq" M5get 9'1GvSr As Y mer/z- R Nsc M 5 B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIM RATE MINUTES NUMBER INCHES AFTERS ELLING INTERVAL-MIN. PER INCH P- I 2.9a tq6 1>L P- Z 4.80 0 ti /O Z Z 7 P- 3 z.,o 97.G 3 i r + 3 P- Ltd N 10 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 - /:S _t Rr �z h TN N�►aRK )SoUQLa: _ Sui,xe 1 -20' �Ltv= 106.06 " i LocarION) S srcTCN oN P v� Se / NoTe RR4\houS P40c Tdsr bONE N^( Ndw Co*N2bP- P-3 , f* CoTCo-iTAW-S Ai teA Roil Ac.'r_QNATC 39 a 1,the undersigned,hereby certify tFrat 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 West of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: dpveY Jou SoN Rulcw 'Sole vc::t'IAK" ZINC M,4 /9 /9ro' ADDR SS: CERTIFICATION NUMBER: PHONE N MBERloptional►: 6-7 Sr✓c�A. 5r /J I) S4o►� 3 ¢ 3�c, duo CST S ATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — J a N � p � o� � W N W J N W 1 �JIK v \ m 3 � v z V 3 �- n � to Z � � 0 i N 0 r MFRS 3224 WI M PCA 696 MN JOB ed c A w�a•-- Tim $MEET NO. OF -- CALCULATED BY DATE Excavating Co. CHECKEDBY ��� �2z R I, Box 192, Wilson, WI 54027 SCALE 715.386-5443 ROGER TIMM 715-772.3214 ....... _ . v. /d \ _ t ,d N • � . 3".< _Cm o, 3 t-0 4�%. x � _. PROOOC,ION�I..,GOP.Mn 01111. 1 MKS 3224 WI r MPCA 696 MN JOB • T-imm SHEET NO. OF g v CALCULATED BY DATE �7 $Y. Excavating Co. CHECKED BY AV R5 �Lj R I, Box 192, Wilson, WI 54027 SCALE 71&386.503 ROGER TIMM 715-772-3214 i . .. ... .. .._.... x.. ..... t)t - rn ... c t,Y 1 i e ! /'� 6 roaoucr2a�t®ice.sue,w�mn,. '