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018-1061-50-000
n cn p~ c7 cn O ', 3~ n d I ~ ~ ~ I ~ ~ ~ ~ ~ ~ ~ ~~1. I 3 I - ~ ~ ~ ~ ~ ~ I I r. r; ! ~ 0 d O O C 0 2 ° I Z ~ O ~ ° o? 2 i S a o "e~ • 3 v' d c N N N ~ c ~ m ~ N O ~ ~ N R~ ~ ~ C 1~1 -~ . y ~ Z Z O O ~ ~ I V_ CD jJ fD c 7 N- O V~ O /mi N N a 7 O O N D I ~ 7 y ~ I C j C ' ` l 1 C 7 7 ( W O 7 l1 O N C ~ y i3 O ~~ tD ~ O f D ~ I O ~ C W ' W -" ~ ~ I c!~ ~ D i 5 Aga. ~ l (n Z D m ~ ep a m co y ~' I a s co D ~' a ~ I Wo ~ ~ a W ~ .~~ I I a W o~ ~ I p ~ O N ~ O N ~~ 0 O ~- N 2 I ~~ ? 2 l~ rn y -' w a0o 3 1 0 p j °0 3 ~ o c ~+ v v 3 m 3 ', 3 :" v I ~ I ~ ~ ~. ~ ~ ~ a I 'o ~ ~ n °: ~. 0 2 'o ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ < Z t~1 I o~ a ~ uitnur~l ~ ° vlvJtn~'~ ~ D I ~ O 7 C~ N ~ A y ~ I ~ ~ o ~~ y ~ ~'! N °' 7 g ~ ~ ~ ° ~ ~ ~ ~ v ° o I e ~ ~ ~ ' ~ I ~ I ~' 3 .. N z I o ~ a D a O =+ I D a ~ ~ - ~ \i1 w I O ~ I O w' ~ j ~ ~ ~ ~ ,. ° ~ ~• I I • f° N m C, N' I ~, ~ a I ~ a n °- Z ~ ~ ~ I ~ 3 7 ~ m p Z~ I ~ ~' ~ I in ~ ~ ~ ~ •~•• ~ • a I m o. ~ A~ 7 .. I = I W ~ W ~ CZ ~ N < CNp V I c 3 I c 3 ~ z ~ r: I :» ~ ~ ~ m v I 3 I ~ y I v I v ~ ~' W N W 01 I moot-'~ a ~ I mn~id•°- D a ~ ~ ~ f m . -_q °' ~ ' I ~ m 'c ,o a ~ ~ I 0 N O -i N 7~~ 7 T I _ N O p• 7 7 ?1 7~~ •° 7~ 57 C ~ (D N fl? ~~ C c I cmi 3 a, ~ ~~ O -i C ~ a a I ~ o a Z S . ~ ~ 7 ~ ~ ~ ~ CD ~ ~ !A U y ~ ~ _ N N N . O S O ~ ~ O O O H ~ ~." I 7 01 a I Q O a ~ ~ A. I ~+ -, N a °-' ° ~ a N I m 3~ a ~ `° o ~: (D O o I s a ~ ~ O ~' ~A ` \ ~ yo m N I m ~ s~° o~ ~ I an d •m " fi ~ I m~~~ m ='d I a w7 'o D~ , ,~ N I m ~ N ~ I m Qaam N _ w ~ S w~ m ~co~ o O N O 7 n I O SU fD ~ O `a ~ a ~ I ~ n. ~~ o ; ., I ~ o I ~ o b ~ I ~ ° I ~ ° do 0 I I "~°~:~ I o °o g i I o g o° a e ~ ~ ~ L/°, ~a` °. , . , Parcel #: 036-1079-20-200 os/z3/loos 02:59 PM PAGE 1 OF 1 Alt. Parcel #: 31.31.17.4888 036 -TOWN OF STANTON 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 CaOwner O - ROBERTS, CHRISTOPHER O & BECKY CHRISTOPHER O & BECKY ROBERTS 1851 OAK RIDGE LA NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1851 OAK RIDGE TRL SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.000 Plat: 3773-CSM 14/3773 SEC 31 T31N R17W PT NE SE BEING CSM BlocklCondo Bldg: LOT 2 14/3773 LOT 2 2.OOAC EZ-U-1501/340 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-31N-17W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 05/31/2006 826464 WD 01 /03/2000 616307 1481 /253 W D 11/20/1998 592079 1379/182 WD 02/11/1998 572822 1295/327 QC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 20,000 203,500 223,500 NO Totals for 2006: General Property 2.000 20,000 203,500 223,500 Woodland 0.000 0 0 Totals for 2005: General Property 2.000 20,000 203,500 223,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r ~ ~ Parcel #: 036-1079-20-000 os/23/2oos 02:58 PM PAGE 1 OF 1 Alt. Parcel #: 31.31.17.488 036 -TOWN OF STANTON 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 O -CHRISTENSEN, ANNEXED 7/5/2001 ANNEXED 7/5/2001 CHRISTENSEN Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 33.000 Plat: N/A-NOT AVAILABLE SEC 31 T31N R17W NE SE EXC CSM 12/3265 & Block/Condo Bldg: EXC CSM 14/3773 ANNEXED TO CITY OF NR 7/5/2001 1N 1674/302 NKA 261-1281-00-100 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 31-31N-17W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 07/23/2001 651899 1685/468 WD 07/23/2001 651898 1685/465 LC 07/05/2001 650259 1674/302 ANNEX 11!20/1998 592079 1379!182 WD more... ~nnt1 ci innnneQV Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09!27!2001 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Speciai Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 WisconsiGDepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division a INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Holzer, Steve Hammond, Town of CST BM Elev: Insp. BM Elev: ~ BM Description: 9~s9 9~• ~'B3 TANK INFORMATION TYPE MANUFACTURER ~+16scY~ ~ '~Q ~"' fP'~ CAPACITY Oc7a eptic 4+ks / ~~,,~(~~ ~ `'4'""~ St irs~ S c,,3 (mss ~-2 ~ s"a Aerat' Holdin TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic /`~ S~/ C Dosing .1.2. S , ( ~~ "~' 2 ~ r Z ~ r A ~_ 2 ~ ~ .~ rumrfsir~ri~n tnr~KmAi wn Manufacturer / / ~,2C'" Demand L~~'~+-t Q GPiv~ Model Number I~ ^, 5-`' TDH Lift fir- Friction Loss System Head TDH •~1 ~A ©, L'~' .,. ~.,Z. Forcemain Length ] Dia. ~~ Dist. to Well Z SOIL ABSORPTION SYSTE ~~ . ,. ELEVATION DATA County: St. CrOIX Sanitary Permit No: 499102 0 State Plan ID No: Parcel Tax No: 018-1061-50-000 Section/Town/Range/Map No: 27.29.17.415a STATION BS HI FS ELEV. nchmark .~ 3.~ b o! ~ ~ t. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet ~ ~ ~ ~ ~ i Dt Bottom ~ D • G Z ~ 9/• Header/Man. ~ ` , ~~.,~ 6 ~ ~ Dist. Pipe • t ~ ~ Bot. System b -3'~ c~~! (o 7 ~~ Final G`ad~e ,~ ~ S a t• N St Cover ~.~.~- ~-3~ 9 .93 ~ft.~l...... ~l EN idth Length No. O Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ g vim; ~-S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf urer: INFORMATION CHAMBER OR Type Of System: I ~ t UNIT Model Nu~{ DISTRIBUTION SYSTEM (1~ ~e.~Q 2 ,D , c..a' ) Header/Manifold 4 ~S ~ Distribution iPe(s) x Hole Size x Hole Spacing Vent to Air Intake Length Dia Le Dia acin SOIL COVER x Pressure Sy~tpms Only YY Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ;] Yes ~ No 0 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~r'"`1~f 2~6 Inspection #2: % / Location: 1873 Highway 12 Hammonld-,~W~I, 54015 (NW 1/4 NE 1/4 27 T29N R17W) NA Lot 1 J Parcel No: 27.29.17.415a 1.) Alt BM Description = fl , j , ,,,,r~n.~o~- G~t~ 1 2.) Bldg sewer length - 1 R.~L ~ ,J -amount of cover Plan revision Required? ~ Yes No ~ . ~~-' ~ , Use other side for additional informati6n. ~ _ '^'v Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ,r Safety and Buildings Division 201 W. Washington Ave., P. ox 7162 County ~ ~T, G,eO ~ (/ ~ ` , , 'sC~~~ ~~ Madison, WI 53707 2 Sanitary Permit Number to be tUed igby Co.) Department of Commerce (608) 266-3151 (/// l cs~-- Sanitary Permit Ap lice '"` • Plan LD. Nu ber In accord with Comm 83.21, Wis. Ad ersonal info ' n u prov e may be used for secondary pu ses ~1~~ ~ roject Address if different than mailing address) I. Application Information -Please Print All format to ~ i ~ ~~, ~` V ~ S~/j'j~JQ, ~ ~ ` ~ Property Owner's Name ,~` ~'~v~ ~l ~ ~ lze inr~ ~~z- 06 ot! Parcel # t # o~ ~-~ o--d J Block # Properly O~mer's Mailin ddress ~ ~ C °U"T Property Location ~f 7 ~3 1 ~ ~ ~ ~ ~7 Cit tate Zi C ~~ ~]JJ`` b ~ ~I p e ~ ~ Phone Num ~9~ ` a ^J~ ircle one) T P N R~E W II. Type of Building (check all that apply) ; or ~l or 2 Family Dwelling - Number of Bedrooms ~ l~g Subdivision Name SM Number ~ ~ ~/ ^ Public/Commercial -Describe Use /' S ^ State Owned -Describe Use ^City_^Village Township of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New System ~ Replacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ ag~7 ~~ a~ P7 IV. T of POWTS S stem: Check all that a ~, Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Grou ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Ching - I ber ^ Dri Line ^ Grave(-I s Pi ^ (expl in) Y. Pj71,et V. Dis ersallTreatmentRrea Information: , Design Flow (gpd) Design Soil Ap lication R a ' t) Dispersa Area Required sf) ispersal Area Pr sed (sf) System F,levatio ~ LG T / j V i ~4~ r ~~t1. ~ (/~j 1177// • VI. Tank Info Capacity in Total Nu ber Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Units Concrete Conswcted Glass New Existing Tanks Tanks septic or Holdiag rank Aerobic Treatment Unit ^ /' J~ / ~ / / Dosing Chamber P ~_ ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. lu ber's Name (Print) ~ ~ Plu 's S ignature ~ MP RS Numbe ~ ~~~ 9 Business Phone Number ~~ ~~.s ~ ~ ~ Plumber's Address (Street, City, fate, Zip Code c ~ I°r ~~ ~r ~~~~ ~ VIII. oun ,De artment IJse On Approved ^ Disapproved Sanitary Permit Fee includes Groundwater Da Issued I ing Agen Sign re ps) Surcharge Fee) J~ ^ Owner Given Reason for Denial W ~ ~- 1X. Conditions of Approva!/Reasons for Disapproval 3 CO ~ `~/ _~ //,~ ~, ~C~7 `7"~' SYSTEM OWNER: t filt ffl d ti t k S LL (/ t Gl/~d ~~ "T" s '~ er an uen an , e ep c 1 / dispersal cell must all be serviced /maintained , ~A yG ~~~h,J ~`'J^ ^ w ,lj J _ - 1 ~~c- as per management plan provided by plumber. ~ ~~-d ~ v"" / ` 2. All setback requirements must be ma ; ~ / L ~ ~ intained a ~~~ ~~ ~ as per applicable code/ordinances. ~4.al~r~J... 0~ >y ~~'~''' no AttachMCplmplete plans (to the C unty only) fo/r the systegf on ppaper M(less than 6S.11~2 -: l l inches in sru SBD-6398 1/03 (/ ~ Gt=/ (R. 0 ) CST a 0,.3~lact ~• u. s. ywy 9B. O' cor,ta ti r ~, _.. ,_ ~ 5t 5y5 ~1°~° k ~` ~~ ~~~ ~ ~ , ,. ~ f ~ 1 ~s~' ^ C ~ ~ c~ ' ~. ~ ~ r4 ~ ,p ~ Y'~ ~ ~ ~, ~ ~ 1~ ~, r 3~ ~• L• i a ~ E ~ "/S~j,°oY -'~ •%EcilSaJl'c~ ry W'~4~1~-i~m !~/u cry ~~'/~ E/ev: ¢ ~ ouf(~~ F,ri3~i~~/ 3 6~d.~~, to s,d~nce ~u.ra~c ~z i .~C's ~aC ~ ~r~e ~ Ch. { ~~ ~~ 1 ~~.~ Ugl~e `N P.-E • E/eda ~i o>-~ Fe,-,ce%~, e ''f0~ ~e~ ~ /A~6 S~cd~nt .~/~~PT~ /off/~CS/~ l/~~,G~a'ZSi nwy~r~EyY, Sec.~2/7 7'r2~'/i; aP. l7~~ T . of ,i~ = 93! ~p~* ~~~~~~1_ EjYiSti'n /, ltk~~J~ Prv,cr•.~f J ~r"'/t = 97.80' ~ vGo6~t~n~E! ~9 7. so' camo u i ~SD Qa~ p~-.L~'1 P ~~rnb~~~ GL~' ~~eue~.l" 1~olz e~ ~~~o~ ~hs~l~ A(~..~ aa~ybq S'~~~~6 ~~ ~3 y_~b; ~~_ u~ s. y~y. ~.~ 98.O~cvti,totir ~ f J ~~ ~ 7 ~~ "tTE~-CN'~S W~ 1 a ° ~ ~ dam ~5 ,~a. C ~ ~'~'e ~t C ~l ^ ~ ~) . _ _.. _ - 5,~c. Sx~,,, ~ ,~ L~~o ~sy ~ S~ ~le~, 7~ t 83 ~ ~ 0 1 S~ c ,^, 3 ~ ~ ~ ~ ~ ~ ~ ~ ~ C4. _ EXi~v1'~q E,yis~' ~ ,'p.Y t. P ~ ` U cell a ` o /'e s,d~nce ~ o ---------- ~ ry ~ ~ n p~ y uva t : /+~LIX+QI~GiE • (/ ~~~~1~-,~ ~~~ 1 ~u~ U~ l~ ~ eFF/u 6n ~F'/~ 4r ~ E/ev: ¢ ~ ou~~' ` \ > ~: ~ ~ ~1 ~ ~jCiSt~i'rt /,llXl ~ C'u-rcr~t = 9s! ~o~-" °X%~i~i ~radc s 47 80' U ` ~ ~ 3a . {~n 5Ga6r ~. 9 7. so' corr~o k ~ ~~ ~~o ~a~ ~~.~- P ~~~b~t~ .~~ S~eo~,r~.~ ~olzet~ l~a.~,~o~ ~ h S~l~ `N P,'~ -~-E~-S~:.~ Fe,-,~e% e „~, ~e~ ~ /~6 S~cd~n ~..~/,~~~o rUI` /off/,CSC do~.2/~.zs- hwy~nEyY, ~.cc, 27 ~{i~nnro~d, 5£-c,~d,~G ~AL~..q aary~/~ Q 8'>~~66 ~~ y_~b: iL_ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with ~ 85, Wis. Adm. Code 1996 Page 1 of 3 A.C.E. Soil 8< Site Evaluations ' County Attach complete site plan on paper not less than 8'/: x 11 inches i e. P incl de b t li t it ti l d h i l f d t t i t B i st St. Croix u , u no m e o: ver zon re ca an or a erence po n ( o n percent slope, scale or dimerr~ions, north arrow, and location and distan ' nea ad Parcel LD. 018-1061- -000 Please priest E~ R i B D t Personal information you provide may be sect for rposes (Privacy Law, s. .04 (1 ev y a e e- ,s Property Owner 4 2006 operty Location u ~ 2 Steven I. Holzer Q vt. I_ot NW 1/4 NE 1 S 27 T 29 N R 17 W Property Owner's Mailing Address COUNTY L t # Block # Subd. Name or CSM# ST CFtOIX 1873 Hwy 12 1 CSM Vol. 2, Pg. 521 City State Zip C m er J City ~ Village ~ Town Nearest Road Hammond ~ WI 54015 (715) 796-2648 Hammond U.S. Hwy 12 I ~~` ~ c u ~b~ ~,°~ f ~~ ~'°~ ~i 39. ,J New C nsRPRetiec>\ Use: yj Residential /Number of bedrooms 3 Code derived design flow rate 450 Ir' Replacement _) Public orcommercial -Describe: Pare ma erial Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.5 loading rate. System elevation to be >94.64'. Dosing required to reach proposed system elevation. '-' GPD a Boring # ~ Boring Pit Ground Surface elev. 98.05 ft. /~ Depth to limiting factor / 77" in. Sod A ication Rate ppl' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-13 10yr3/2 none sil 2fgr dh cs 2fm,1 c 0.6 0.8 2 13-22 10yr4/2 none sil 2fsbk dh cw 2fm,1c 0.6 0.8 3 22-36 10yr4/6 none sil 2msbk dh cw 2fm 0.6 0.8 4 36-42 10yr4/6 none Is Osg dl cvn 1fm 0.7 1.6 ,I 5 42-77 10yr5/6 none trat s&g Osg dl cw 1fm 0.7 1.6 6 77-86 10yr5/6 f2f 7.5yr5/8 trat s&g Osg dl gw - 0.7 1.6 7 86-96 10yr8/2 f2d 7.5yr5/8 SSBR Om dh - - 0.0 0.0 Boring # -.~ Boring Pit Ground Surface elev. 97.95 ft. Depth to limiting factor 77~~ in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dtft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *E 1 0-9 10yr3/2 none sil 2fgr dh cs 2fm,1c 0.6 0.8 rig 9-21 10yr4/3 none sil 2fsbk dh cw 2fm,1c 0.6 0.8 ~ 3 21-27 10yr4/6 none sl 2msbk dh cw 2fm 0.6 1.0 4 27-31 7.5yr4/6 none Is Osg dl cw 1fm 0.7 1.6 5 31-77 10yr5/6 none s Osg dl cw 1fm 0.7 1.6 6 77-89 10yr6/8 none oft SSB Osg dsh gw - 0.0 0.0 7 89-95 10yr7/6 f2d 7.5yr5/8 SSBR Om dh - - 0.0 0.0 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 g/L u nt #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (please Print} 'nature: CST Number James K. Thompson - 3602 Address A.C.E. Soil 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. 54020 7/11/2006 715-248-7767 Property Owner Steven I. Holzer Parcel ID # 018-1061-50-000 Page 2 of 3 a b~ 9~~j~ 35.E Boring # -:~ Boring ii/ Pif Ground Surface elev. 97.59 ft. Depth to limiting factor 84" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/2 none sil 2fgr dh cs 2fm,1c 0.6 0.8 2 1218 10yr4/2 none sil 2fsbk dh cwr 2fm,1 c 0.6 0.8 3 18-35 10yr4/6 none sil 2msbk dh cw 2fm 0.6 0.8 4 35-44 10yr4/6 none Is Osg dl cw 1fm 0.7 1.6 5 44-84 10yr5/6 none s Osg dl cw 1fm 0.5 1.0 6 84-98 10yr5/6 f2f 7.5yr5/8 s Osg dl gw - 0.7 1.6 H#5 contains 1/8" - 1/4" bands of 10yr4/4 fs. Loading rate of horizon adjusted to reflect permeability restriction associated with banding. 10YR8/2 SSBR encountered at 98". ^ goring # J Boring „_j Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # --~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. Soil & Site EValuatlons ~/~~ u• s. ywy /2 Jo~~ev~~ua.~i'~ P,•~ Fe-r,c.el ~e „~, ~e~ ~' /996 ~cd~n 2"..~e%cr~o ~~ /off/,CS.-~ da,,~,~/~ •.Z.f/, ricvy~i~Eyy, S.cc. z7 ~~nrrrond, ~,c.~a.~~, ~, 3~~ t 1996 € SOIL EVALUATION REP Wisconsin Department of Commerce Page 1 of 3 Division of Safety and Buildings in arrnrdanrp with Cnmm R5 Wis Adm Code A.C.E. Soil & Site Evaluations y~~~ '~~' \' ~"" County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix inducts, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . 018- 061-50-000 Please print all information. Revie d By Dat Personal information you provide may be used for secondary purposes (Privacy l.aw, s. 15.04 (1) (m)). / ~ J~ Properly Owner Property Location Steven I. Holzer Govt. lot NW 1/4 NE 1 /4 S 27 T 29 N R t7 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1873 Hwy 12 1 CSM Vol. 2, Pg. 521 City State Zip Code Phone Number City Village t/ Town Nearest Road Hammond ~ WI 54015 (715) 796-2648 Hammond U.S. Hwy 12 J New Construction Use: yJ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 1/ Replacement J Public or commercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable nor General comments and recommendations: Site suitable for conventional dispersal cell t 0.5 gpd loading rate. ystem elevation to be >94.64'. Dosing required to reach proposed system el _.__ ^ Boring # ~ Boring 2 l~ 3.7 77" 1/ Pit Ground Surface elev. 98.05 ft . Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GP D/ft' ,, in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1.' 0-13 10yr3/2 none sil 2fgr dh cs 2fm,1c 0.6 0.8 2 13-22 10yr4/2 none sil 2fsbk dh cw 2fm,1c 0.6 0.8 3 22-36 10yr4/6 none sil 2msbk dh cw 2fm 0.6 0.8 4 36-42 10yr4/6 none Is Osg dl cwr 1fm 0.7 1.6 5 42-77 10yr5/6 none trat s&g Osg dl cwr 1fm 0.7 1.6 6 77-86 10 f2f 7.5yr5/8 trat s&g Osg dl gw - 0.7 1.6 7 86-96 10yr8/2 f2d 7.5yr518 SSBR Om dh - - 0.0 0.0 sr 2 Boring # =~ Bo ~ „ f/ Pit Ground Surface elev. 97.95 ft. Depth to limiting factor 77 in- Sod Application Rate Horizon Depth dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP DIft' in. Muruell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/2 none sil 2fgr dh cs 2fm,1c 0.6 0.8 2 9-21 10yr4/3 none sil 2fsbk dh cw 2fm,1c 0.6 0.8 3 21-27 10yr416 none sl 2msbk dh cw 2fm 0.6 1.0 4 27-31 7.5yr4/6 none Is Osg dl cw 1fm 0.7 1.6 5 31-77 10 r5/ e s Osg dt cHr 1fm 0.7 1.6 6 77-89 10yr6/8 none oft SSB Osg dsh gw - 0.0 0.0 7 89-95 10yr7/6 f2d 7.5yr518 SSBR Om dh - - 0.0 0.0 ' Effluent #1 = BODS> 30 <_ 220 mg/Land TSS >30 < 150 g/L u nt #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) 'nature: CST Number James K. Thompson- 3602 Address q.C.E. Soil 8, Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 54020 7/11/2006 715-248-7767 Property Owner Steven I. Holzer ~~• ~~ ~~'~ yg ~f~~ Parcel ID # 018-1061-50-000 Page 2 of 3 Boring # .J Boring /~ Pit Ground Surface elev. 97.59 ft. Depth to limiting factor $4" in. Soil Application Rate Horizon De th Dominant Color Redox Descri tion Texture Structure Consistence Boundary Roots ' p in. Munsell p Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-12 10yr3i2 none sil 2fgr dh cs 2fm,1c 0.6 0.8 2 1218 10yr4/2 none sil 2fsbk dh cvd 2fm,1c 0.6 0.8 ~ 3 18-35 10yr4/6 none sil 2msbk dh cvir 2fm 0.6 0.8 4 35-44 10yr4/6 none Is Osg dl cw 1fm 0.7 1.6 5 44-84 10 r5/6 none s Osg dl cw 1fm 0.5 1.0 dl W - 6 84-98 10yr516 9 H#5 contains 1/8" - 1/4" bands of 10yr4l4 f Loading rate of horizon adjusted to reflect permeability restriction associated with banding. 10YR8/2 SSBR encountered at 98". ~,- - ~ - J ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate H i D th minant Color D Redox Oesci tion Texture Structure Consistence Boundary Roots or zon ep in. o Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate i H D th l D i t C d x D i R ti Texture Structure Consistence Boundary Roots or zon ep in. om nan o or Munsell p e o escr on Du. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. a f F Srul W Site EvaluaAons .~~ ~ ~ u ~ s. Hwy ~z f 98.0'cc,,toar ~ `~i - _ '~ -~ ~ ~_ _ k .~io 51 by s ~a c ~ ~r-e ~ c~, _o . ~ ,~ ~~5~ ~~eyp s~ 83 , i? 1 T~~t C 3 ~e ,,a . ~~'- - -- 3 6cd/cm•r, o re s,d~nce '` E ~~r~;~J a/ /~ 1G ~~ ~~rG~G c/ e : ~~s~r~-qua dull (~u.~ ~ ~ ~ ~ V fad/u cry ~~'/~ ~ << ~ ` ,J = 95! ~O"' h~~~'~ ~ fro-~/c : y7 8o ' ` E~CiSti'n /~PkI ~ C'u-,cr•~t ~ 3a . . ` ~~,o~ ~n 9 ~ so ~- ~~u~ ~ 7~0 ~Qt ~~~ P ~1~~ber .~~ ~ ~ev~,~ G~~~D ~lolz.e~ ~ ~hs~l~ N o. _ ~ ~o./evt?/ua.~.~ P,~~ • E/e~/a~io>-~ -~F~~s~:.~~9 Fe,-,ce/,~i e „~, ~e~ ~ /996 S~cd~'i Z..~e%~~o rUI° ~w~j<nEyY, 5~c. 27 7-2~'il; ~. l7cJ; T . ~~ Ab~..q aary~l~ Q ~'~~~a6 ~i y-yb: y ~ bn -. .. _ PUMP CHAMBER CROS5 SECTION AMID SPECIFICATIONS ' y,. C.I. VENT PIPE ~ 25~ FROM DOOR, WIiJDOW OR FRESH AIR IWTAKE 18"MIAI. NU LE T APPROVED JOIAlT A t3 C D W~C.2. PIPE EXTENOrWG 3' OtJTO SQf-10 SOfL ELEV. Fl: ~-VEIJT CAP . WEATHER PROOF JUAICTIOA! BOX 12"MIU. I GRADE I COIJDUIT ~ -"' PAGE OF APPROVED LOCKIN MAtJHOLE COV W~ ~4- r 11i I~Q ~Q ~C~ ~ J yu MIIJ. V ~ \\~; PROVIDE I AIRTIGHT SEAL i i PUMP -~,(r-,~ GOAICRETE BLOCK ~ ~. - 18=MIiJ. I'' _ _ =~~ ~I) ~ ' APPROVED JOINTS I ~ I W/C.I. PIPE ~ ~,( ALARM EXTENOItJG 3' i ,-t _ ONTO SOLID SOIL I b oN I OFF ~ ~! 3" APPRQv RISER EXIT PERMITtED L'J F TANK MAIJUFAGTUR6R HAS SUCH APPROVAL gEDO~NC SEPTIC E SPECIFICATI~I~lS DOSE ' ~` TAAIKS MANUFACTURE .~ It-~''~r NUMBER OF DOSES: '~ PER OAS TANK SIZE : ~ ~ C~A~I.OIJ 005E VOLUME ALARM MANUFACTURER: ~ ~ CJ INCLUOtUl6 BAGKFLOW: ____~~ GALLONS MODEL IJUMBER: ~ CAPACITIES: AcSL~_IAICNES OR .~!.~ 6ALLOUS SWITCH TYPE: ~,~~~ B=~iWCHES OR GALLONS PUMP MAAIUFAtTURER: ---1:2G,-.tti C = 4WCHES OR /~~ GALl.01J5 MODEL IJUMBER: D= INICHES OR ~L ~r~ GALLOIJS SWITCH TyPE:._ MOTE: PUMP ARID ALARM ARE TO BL MIAIIMUM DISCHARGE RATE GPM INSTALLED OW SEPARATE CIRCWTS VERTICAL DiFFERENtE BETWEEAi PUMP OFF ANO OISTRIBUTtON PIPE..~~1V ~ FEET •}- MIt~IIMUM NETWORK SUPPLY P~~REj~S~~SURE .=. ,_. 2.5 FEET -I- _.~_3L FEET OF FORCE MAIN X ,L`~L_F~oFTFRICTioN FACTOR.. i3~ FEET TOTAL DYNAMIC HEAD = FEET INTERAIAL AISIONS OF TANK: LENGTH ~-~ ;WIDTH .--~~LIQUID DEPTH firr,AiFn: LICENSE -JUMBER: ~ DATE: ~ ` ~4 ~E o~;= GGUIGS ~~]~~37~~'~1~3~ ~ ~E~`~l~1~~3$ ~~~~ ' ~ ~V 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/a"maximum. -- , • Capacities: up to 55 GPM. `"' • Total heads: up to 24 feet. • Discharge size: l'/2°NPT. • Mechanical seal: carbon- rotary/ceram ic-stationary, BUNA-N elastomers. • Temperature: 104°f {40°C) continuous 140°F (60°C)intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3~4° maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: l'h°.NPT. • Mechanical seat: carbon- rotary/ceram ic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. I ... .+ • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 I1z,1550 RPM, built in overload with automatic reset. • Power cord: l 0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERSIIFEET 10I- a 31 a 2: o ~ a U 6 2( z 5 C 1; J 4 Fa- 0 3 1C 2 5 1 0~ 0 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for. mechanical seal protection. ^ EP05 Impeller: Thermo- plastic'enclased design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• CanadianStandanisAssociatian (CSA listed model numbers end. in "F" or "AC".) . t ~ _ I ; y , j ' i LL__..__JJ i ;~'~2s Fr: .} ~ _ ,_. ~ ~ I i I ~ I I loi ~q ~ ( ~ I EPO'~ . _EP04' i r I~g'O ~ I ( , I .. . i ,,. , i - - ~ I r vu ~u GPM 0 2 q g g CAPACITY 10 12 m°/h ~9 T993 Gouftls Pumps, Inc. ' Fffartiva AAav 1Q°F r~v i - ti v- 'r' C1C C'l ~ 1CJ~~~-~-tU C:r= ~v~z. v ~-. ~"_' "uyer Mailing Address Property Address /~/,~ ~W t~ (Verification regiJired from Planning & Zoning Department for new constructiol j~ City/State ~j.~'Ij'( (~ ~~, Parcel Identification Number D ~ ~ ' d b j ~ ~ ~ ~ d~~ LEGAL DESCRIPTION c~ n ` y/s..~~ Property Location ~ 1/ , ~ ~ '/ , Sec. ~ ( , T d j N R 1 W, Town of ~/y1/~dn(~ Subdivision Lot # ~. Certified Survey Map # ~ ~ ~ p~ ~ ~ ,Volume ~ ,Page # ~~ f Warranty Deed # ~ ~ ~ / / Volume / ~ J ~ Pa e # l ~ g Spec house ^ yes no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number a~ bedrooms SI~NA gl 1 /a~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OW~N~ERSHIP CERTIFICATION FORM /,~fj/2/°N` (REV. 08!05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the _ UC'h D, ~~~^ residence located at: ~ILV'/4, ~'/4 Section ~ 7 , Town~N, Range~_W, Town of ~~~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service / ~,3 ~~j Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: ~'j Construction: Prefab Concrete _,~~ Steel Other Manufacturer (if known): !' Age of Tank (if known): (Licensed Plumber Signa ) (Print Name) r~P~s ~r,,,e, v (Date) ~~~~ (License Number) M RS Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) a, • ~~~`~~~~ STATE BAR OF WISCONSIN FORM 3 - 1982 QUtT CLAIM DEED DOCUMENT NO ~0~ 1,3.3~9acE454 quit-claims to the following described real estate in ~ T- G~~ (k County, State of Wisconsin: `_ PARCEL IDENTIFICATION NUMBER D 1 f1 ~ /D~/ 3D ~~ ~ rr This ~~ (~s) (is not) homestead property. Dated this / _ day of ---~% ~~ ~ . A.D., 19~ ~ EAL) . Jo ~1. ~' (SEAL) AUTHENTICATION Signature(s) authenticated this day of , 19_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not. , it,:. t: t,, authorized by §706.06, Wis. Stats.) '~ t THIS INSTRUMENT WAS DRAFTED BY ;. (Signatures may be authetnicaced or acknowledged. Both~re not ,, necessarvJ :~ .• ~.t REGI;TER ~ 0~~ i'',E , fac';. '..r ^'.^ . ! JUN ~ 9 1999 3:15 P Raalslar of 0~®Aa _ TNiS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADORES jT£ v~ ~Z~ ~-~D ACKNOWLEDGMENT (SEAL) (SEAL) State of Wisconsin, /~ ss. ~~ . ` r' O 1 X County. Personall came before me this ~~ day of .~ u--+r~e , 19 ,the above named O .t ~ _- to me known to be the person who executed the foregoing instrument and acknowledge the same. . ~ au~e~.JLi < 1~4 Nolary Public, ~ ~ ~ County, ~Vis. 'M+y commission is perm~spent. (if not, state expira[ion date: i a.~~ ~o~ 1.`3`3lloacf ~~55 (,~ The west 246.00 Feet of the following described pr•cels That certain parcel of land located in the NE 1/4 of the NE 1/4 and the NW 1/4 of the NE l/4 of Section 2', T 29 N, R 17 W, Town of Hammond, County of St. Croix, Wisconsin, more fully described as follows; Commencing at the NE corner cf said Section 27, thence qo N 90°00'00" W 866.00 feet; thence gc~ S 00"00'00" E 29.25 feet to the point of beginning of the parcel to be herein d-scribed; thence qo S00.00'00" W 20.00 feet; thence qo N 90°00'00" W 927.25 feet; thence go N 00.00'00' W 20.00 feet; thence qv N 90°00'00" E 927.2 to the point of Beginning, the above described parcel containing .43 acres, more or less. For purposes of this description the North line of the NE 1/4 of said erection 27, is assumed to bear N 90.00'OU" W. •~~ That certain parcel of land located in the NW 1/4 of the NE 1/4 of Section 27, T 29 N, R 17 W, Town of Hammond, St. Croix Cou~y, Wisconsin more fully described as follows: ~-r ~' o csrns Ilo~- Z~ ~A~~ S2~ 3•~ That certain parcel of land located in the NW 1/4 of the NE 1/~ of Section 27, T 29 N, R 1T W, Town of Hammond, St. Croix County, Wisconsin, more fully described as follower Commencing at the NE corner of said Section 27, thence go N 90.00'00' W 1793.25 feet to the POINT OF BEGINNING of the parcel to be herein described= thence qo S 00.00'00' W 239.5 feet= thence go N 90°00'00 E~8.00 feet= thence qo N 00.00'00" W 239.25 feet; thence qo N 90 00 00 W 8.00 feet to the point of Beginning of the parcel herein described, the above described parcel containing .04 acres, more or less, together with an easement over the :forth 41 feet of the parcel described herein for U.S. "HWY• 12 purposes. Por purposes of this description the North line of the NE lj4 of said Section 27, is aasur.~ed to bear N 90 00 00 W. `+•~ part of the p 1/2 of tJE 1/t of "ection 27-29-17 described as follows: Lot 2 of Certified Survey Map filed December S, 1977 in Vol. •2', page S2I (No. 631. EXCEPT E I3 feet thereof, St. Croix County, Wisconsin. ~, .*~: ,K ~~ r "~, .~ , ` 345203 '~. CE 'TIFI-~D SURVF.'y r:iAp ~oN xoux ~ Fart of the '.:~. !_~1i of the NE 1~4 & rIW 1~4 of the Ivls 1~4 of ~ect,ol. :~ Township 20 north, Range 17 ;,lest, Town of Hammond, St. Croix County, ?.'~_sconsi.n. F L1r1 932.25 NE COR.SEC. ~~q ~ ~ U.S. HwY s2 ~ 27• T29 N, R 17 W ~ ~ O p ~ 41• ZuW 4l~ .~~- _' ~_ DUE WEST --` ~~ - LJ ~ '---* CY c}O ~ I- li 1.1_~ Q ~ ! EXIST. a~ p 4~ ~ ~--L o Ts10. ~ O~-~ E X 1 5 7~ I N G F•A R.-..t s'r><At, ~ p p U E V~ ST ~V ~ ~ ~ W ~(" r~ 1.35 Ac. ~ j 3. 81! oA-r 2 E 5 9 c~v ut c9 u.l 3 .40 J ~ 238.00 ~~\ ~ 694-.25' O° `, o zzr _ Fwd' i•6 ~ \~ 12• GARAGE fJV E EAST ~ WOZ EOCRq RIHF~/IENT ENCROACW MT;NT ~~ mu.~~ 932.25 ~ Z N O Indicated 1" x 2411 iron pipe stake set weighing 1.13 lb~ft. 4 J ~-- SCR s_ E I)E.script-.on: 1..' 200• That certain parcel of land located in the ~;E 1~4 of the i\IE 1~1+ & iGW 1~4 of the ivE 1~4 of Section 27, T 29 rr, R 17 W, Town of Hammond, St. Croix County, Wisconsin, more folly described. as follows; Commencing at tY:e IJ$ corner of said Section 27, thence go due ?Nest a distance of ~53.C0 .feet• ( all hearings referenced to the .:orth line of the IuE 1~4 of said Section 27, assumed due ,vest ) to the Foint of Beginning of the ^arcel to be herein described; thence go due :vest 832.25 feet; thence ro due South 239.25 feet; thence go due ;5ast 932.25 feet; thence go due North 239.25 feet to the Point of 5,>_minnin>~ of the parcel herein described, the abova described parcel containing 5.12 acres, more or less, including the idorth ~~1 feet presently being use~3 for U. S. "i~hvra-: 12 purFoses. State of 'disc~:nsin) County of St. Croix) I, James L. Murphy, Remistered Land Surveyor., do hereby certify that by direction of the Caner, Don Houk, I have surveyed am civided the lands as shovln hereon an~i tha~`, the map and description shown. hereon are a true and correct. representation and description of the lands a.s divided; and that I have c~mnlied U*i.th all the provisions of Chapter 236.34 of the Wisconsin Statutes =nd the St. Croix County Sub-division Ordinance in surveying, divi.din~, mapcin~ and descri'~•ing said lands. ~ -7~~ ,~,~y uated: 31 Cct. 77 ~y1« /` ` i~~~A James L, Murphy Vol.~_ Fa~•e._ 521 / egistered Land Surveyor Certified Survey .•iaps St. Croix County, "dis. 34 5 ~ 0 ~'' ,~.. ~, \``\,~~\\\141111!1!Illfllrq//////'//''/ APPROVE[ .,. ~' ;,,,`~~~~_o~v~~ ~,,, ~lOV 2 3 lUi7 [.` ~' :'. '~ ,a _ `~`' ;\:'J:2Pi-IY `~I- t S- 1 p ^> 2 ST. C~OIX l;.-JU•-.I t !c., ` K - COMPREHi2NSIVi: PARKS FpA;v~INii ~ .~~`•= ~~" "!•;C;2 F%~F-LS. ~•Q ,_ AND 20NIN0 COMh~if Fir ~ ~ ~ ~~ ~~ VJ:SC. ~ J~~ ~ /~~~~~~//Orr L~14 i~ a tus ~~~~~~\~. APPROVA! OF THIS MINOR SUBDIVISION DOES NOT MLAN APP,;C1Vg1 FOR 8t11LDiNG 517E OR SEPTIC SY„TtM, REFER 70 H62.2Q Volume 2 Page 521 ~ • I I I I i n~ o O N O ~ ~~ ~ n. ~ ~ ~ W ~ C ~ Z ~ ~ N O 00 ~p a ~ fp ~ Q I O O~ n 7 ~~ fD (D Ut C ~ CD n. d O ~ Cn Z D I ~ m ~ D ~' I w ~ n. ~ I N ~ O ~ L ~ I N I A o 2 ~ N ~` C C N pnj N °o o ~ m rn ~ o I m N I Q I Z O_ I =" _O I o ~ ~ ~ I ~ I ~ c W I ~ ~ Z ~ ~ N I m I ~ I I I I I oD. Q I o: I v Z o_ I ~ N I I I I I I I I I I o I m I o O I a :- c~v,o, ~3vn -~ ~ ~ d o ~ ~ m ~ ''', ' m O ~° ~ 3 ° ' - r: 0 0 0 ~i ~ ~ o ~ ~ ~ N V _ ~ ~ ~ V ~ fD ~'. I O" , CT N ~ ~ ~ ~ ~ o W O C Ct ~p = a a I ~ ' .. ~ ~ i ~ a N -~ j O N N Oo N 2 ~ J ~ ~~' ,w N ~, M ice O 7 I . . ~ ~ ~ ~ j ~ N N ti a Z D v v a °' m :°. rn cn . ~, -~ d ~ ~ = ~ ' i d ~ 3 .°'. 3 .+ Z W Z D a ~ N m ~, m ~, ~ ~ ' I m ~ I a 3 O ~ ~ ~ II A Z n c ~ ~ •*. O. A ~ ~ .. W ~ a ~ o .-. o •. 3 m v W ~ m m ~_ c a ~ ~ Z a ~ m ~ I m N d O. A~ 5 Q Z ~• "~ ~C ti a z ~^ N 0 0 a b°o ~ ~ ~. v, `, a ~ ` `~ Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT ~,~ OWNER .STeVG ~o /Z ~ r- TOWNSHIP ,~arr~mon(~/ SEC. Zl T Z ~ N-R1~,W ADDRESS {~'f~ ~ ST. CROIX COUNTY, WISCONSIN ~q ~'I'ImD!?~1 SUBDIVISION /(~~ LOT /V~t LOT SIZE ,~'"~ PLAN VIEW Distances and dimensions to meet requirements of I•I.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM x~ ;~ ~~~. ~~ ~g2 3 ~~ F //~~ ,r .ny,~+~ crQfQ~P. s~ v 13 ° ~ ~s' Nous~ I V ~ IO rC~• ~rMr \\ ~1 I ti 5Z I t~ ( ~ Z ~ i ! ~~ ,, ~a , ' ~` Ve n~ ~ Q ~ sz' If ~ _ y,r~Qy ~Z INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~Jop o7 CerY1C~~.~ore,/~ /`/rfc~. Elevation of vertical reference oint : /DO ~ ~ C.,° sn c.' p ~ Proposed slope at site: / p SEPTIC TANK: Manufacturer: Gt,.,~~ec'.~5 Liquid Capacity: /000 ~4~~ PUMP CHAMBER Manufacturer: o' Liquid Capacity: Pump Model: Pump/Siphon Elevation of inlet: /~ Pump off switch elevation: Alarm Manufacturer: Number of feet from nearest "proper ynufacturer: Pump Size, i~ tto{n of t' nk elevation: / Gal s per cycle: r- / arm Switch Type: line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~C S Trench: Width: /z/ Length: ~Z ~ Number of Lines: z Area Built: ~ z~ Fill depth to top of pipe: Z ~~~ Number of feet from nearest property line: Front, O Side, O Rear,© Ft. 35 Number of feet from well: 7Z _: ~'' Number of feet from building: ~ ~ Z. da • {Include distances on plot plan). SEEPAGE PIT' Size: Number of p Liquid depth: Bo Area Built: ~tts : ~~ Diameter /om of seepage pit elevation: ,, /';" Has either a drop box O or d tri ution b x O been used on any of the above soil absorbtion sytems? (Check on sy HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: f • tit - Elevation of inlet: Number of feet from nearest proper y41 Number. of fee from Number of feet ~~'rot~t, O Side, ORear, OFt. 11: ;~ ' ing : j ~ ; Number of feet froiy nearest ro Alarm Manufacturer: Inspector: DEPARTMENT bF INDUSTRY, INSPECTION REPORT FOR 4ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 79'69 ~Ap;SON~~yI'5S17,T29N-R17W CONVENTIONAL ^ALTERNATIVE Town of Hammond ^ Holding Tank ^ In-Ground Pressure ^ Mound Hisrhwav 12 West SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING Scare Plan I.D. Number: (If ass~pnedl 7~ ~ NAME OF PERMIT HOLDER: S teve Holzer ADDRESS OF PERMIT HO LOER: Route 1, Hammond, WI 54015 INSPECTION D TE: aZ. ~ ~~~ ~-~~~ BENCH MARK (Permanent reference pomr l DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber. MP/MPRSW Na.: Counry: Sanitary Permit Number: Dale E. Hudson 6629 St. Croix 102827 ~erlw rrrrn/nvwnr~a re.rrr.. MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. / ~ : TANK OUTLET ELEV.. C WARNING LABEL PROV ED LOCKING COVER PROVIDED. <:~.~'`""-~ /~!7'T~ ~ V ~ /J ~ YES ^NO ^YES NO BEDDING-. VENT DIA.: VENT MA L ~ HIGH WATER "EARN. NUMBER OF FEET FROM ROAD: ~/~ PROPERTY LINFr-~ ~ Fi WELL: ~ ~ BUILDING. VENT TO FRESH AIR INS ^YES NO ^YES NO NEAREST / DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUF ACTLIRER WARNING LABEL PROVIDED: LOCKING DOVER PROVIDED. ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTROLS OPERATION A L. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH AIR INLET (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ^YES ^NO NEAREST Check the soil moisture at the depth of plowing SOIL ABSORPTION SYSTEM LENGTH. DIA METER MATERIAL AND MAR KwG . Ilf soil can be rolled into a wire, construction shall cease until or excavation FORCE . the soil is dry enough to continue.) MAIN vrrr ~rrrrvrrr+a. V WIDTH:• LENGTH NO. OF DIS .PIPE SPACING COVER INSIUE PIA aPITS LIQUID DEPTH BED/TRENCH ~ ~n rRE~s ,~ M~TSaIA ~: PIT DIMENSIONS ~ G~ - G;.---~r. ~ GRAVEL DEPTH FILL DEPTH UISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. TR. NUMBER OF PR OPE RTV WELL BUILDING VENT TOF HESH BELOW PIPS f f+' ABUER ~ f ELEV IN ET ~ E~j Vp END PIPES. FEET FROM LINE. ,... i :,; f ~ ` AIR INLET ,~ 1 .~ .; ~ ~' J • ~17 f NEAREST --- `.. ~ . ., ~ , / 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 ^NO SOIL COVER TEXTURE PERMANENT MARKERS OHSEH VATIUN WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCHlBED DEPTH OVER TRENCHIBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BE LI BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. ELEV.. ELEV.: DIA. ELE V.. , ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING. DRILLED CORRE CTLV COVER MAT INFORMATION ^YES ^NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. 1 , LI ~ ^YES ^NO ^YES ^ d ~•~~ ~.g~ o~ $~~ ~~ __------ ~y, ~ 1 ~ ~1 Sketch System on Reverse Side. DILHR SBD 6710 (R. 01/82) • 1 S IDIA VERTICAL LIFT Cf PLANS ^YES NUMBER OF PROPERTY FEET FROM LINE: NEAREST _fie~;2ftn•rn county file for audit N DS TU AYYHU V E D ^NO BUILDING. _ - ,.~ ~,»nq , TITLE ~>_~..~--,, t Zoning Administrator SANITARY PERMIT APPLICATION COUNTY ~ DILHF~ X ~' e r' Adm Code Wis In accord with ILHR 83 05 o~ . . . , ~`~~~~~~ STATE SANITARYPERMIT# ~~ y •-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 (~ I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. FOR VARIANCE ^ YES.LJ No PROPERTY OWNER PROPERTY LOCATION -~~e a ~ /~Cf~'/a /`/~'/4, S Z7 TZ , N, R /7 for) W PROPERTY OWNE~S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME / /TV ~, J / CITY, STATE ' ZIP CODE PHONE NUMBER Z~y , LAKE OR LANDMARK R A D CITY ~ // NEARES O VILLAGE : ,,/~ /~ ~ . on i - ~ /~A/!~ II. TYPE OF BUILDING OR USE SERVED: '- dL~' ~-~~_ Number of Bedrooms if 1 or 2 Family -~ OR ^ Public (Specify): N~ III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. ^ 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. ,See a e Bed b. ^ See 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): • ,3 ~~~ ~ ~~ ,cam 9Z'J ~ Feet Private ^Joint ^ Public VI. TANK CAPACITY in allons Total # of ' N M f Prefab. Site C St l Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks acturer ame anu s Concrete on- structed ee glass App Tanks Tanks Se tic Tank or Holdin Tank /00 ~ /100 C Lift Pum Tank/Si hon Chamber Q ^ ^ ^ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb is Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ^~a~e ,E ~ ~~sor~ ~E~cz.~..~ ~~,~,., ~~ Z ~ ~r~ ~Si~ .3.37 Plumber's Address (Street, City, State, Zip Code): ® ~~ ~~ Name of Designer: 5~4~DD Z S l ' S~ ~ ~ ' ~~ ~ ~ .. rn 2 d~vi a ~ Gl/~ ~ a , VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) ~ ~~~ ~~ Pho~Numberi ~ ~~~ /mil ~ ~ : ~ ~ ~n~rQ ~ X - ~~ IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved S Hilary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial ,r-~~\~ ~~~ S charge Fee ~ ~ ~ , ~ 7 ~ / `~ ~ ~ ' Adverse Determination ~ W p • - 7/ ~ 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 , 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'wher~iiever necessary; usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your loco; 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 mai'ing address. Provide the legal description where the system is to be installed; li. Type of building or use served: If public is checked, indicate type of use (i.e. 10 uni# apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. 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 SYZ 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 included the creation of surchai ges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water tha? is used ir: your building is returned tc the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. ~ _''` ~- Grounduvater-~~-'~ Wiscar~in's a burie:~ reasur~ -'~ ~ ;~ ~ ~~ , ~-, The monies collected through these surcharges are credited to thu groundwater fund adminis- tered by fhe Department of Natural Resource.;. These fund a9-e ~.~sed for monitoring er-our~d- water, groundwater contamination in~estiga6ons and estauli4hmert of standards. Grr~_~ndwat=:r, i°'s wortfs protecting. ~8D-6398 i=t.03i86) . 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 inadequavies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgr.,("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. Os•mer of Property -~~7e t/~- ~~~~ ~ ~" Location of Property Lc~ ~ N ~ ~, Section ~, T ~ N - R ~ 7 W Township ya/yIh'IO~~ Mailing Address ~, .~ ~C~/.5" Subdivision Nama /~~ Lot Number /U~ Previous Owner of Property ~ar1~~C~' 1Yl~Ll7~ Total Size of parcel Date Parcel was Created Are all corners and lot lines identifiable? ,~ -Yea No '/ Is this property being developed for resale (epec house) ? Yes ~C No Volume ~ and Page Number~~ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING; ~ 1. Warranty De ~-_ 2. Land Contract . • 3.• Othex r.eeordinge filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing.proceea. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. ~_ PROPERTS/ 0(UNER CERTIPTCATION i (U1e1 ePhti.~y ghat a.f~ s.tatements on ~u,s 6onm wce ~.ue ~o .the be6# o~ my (owe) hnow.~edge; ghat i (we) am (evicel the owne~.(6) 06 .the pnopenty deaeh,i.bed .in .t<ua ~.n6onmation ~on.m, 6y v.ihtcie o6 a wcvchan~ty deed neeonded .in .the 066~,ee o6 .the County Reg.e,s~¢n o6 Deeds as Uoeument No. ~~~~ and .tha.t T (we) pnesentCy own .the pnoposed s.cte bon .the eewage. pos eye.tem (on T (we) have ob.ta,i,ned an ea:semen.t, ~o .n.un w.i,#h the above desc~c,i.bed pnopenty, bon .the c'ons~c.u.eti.on o6 eai.d a ys~em, and .the same has been du,Cy neeonded ~.n .the 066~.ee o~ the County Reg.Z.a.t¢h, 06 Deeds, as Doeume-tit ~/o. ) . STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYE'R S~~/e `~>/~~'~' ROUTE/BOX NUMBER ~f~ ~ Fire Number CITY/STATE ~~,,?rr0/Ipl , ~~ ZIP S~~OI~ PROPERTY LOCATION:1~~~, /VL ~, Section ~/ T ~~ N, R ~ ( W, . Town of ~/y~/~~/7~~_, St . Croix County, Subdivision !V~ Lot number N~ 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, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_Z' 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 stems 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- 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. SIGNED DATE ~3 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. DEPAR ~ . dT OF INDUSTRY, LABOR AND , HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (H63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON., WI 53707 LOCH Gt] ~~ ~~ SE O ~ /T29N/R 1 ~ for W TOWNSHIP/MUNICIPALITY• ~/Q.nmon~ LOT NO.: ~/~ BLK. NO.: N~4 SUBDIVISION NAME: n/~ COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: USE NO. BEDRMS.: COMMER IAL DESCRIPTION: Residence .~ A/ i jr ^New .Replace RATING: S=Site suitable for system U=Site unsuitable for system DATES OBSERVATIONS MADE PROFI E D IP IONS: A ON TESTS: I ~U /~- S ~ /O' / 7- ~7 CONVENTIONAL: S ^U MOUND: ~S ^U IN-GROUND-PRESSURE: ~S ^U S STEM-IN-FILL ^ S ~U HOLDING TANK: ^ S ~~ RECOMMENDED SYST~~M:loptional) ~ ve o 7 or, .~ a " If Percolation Tests are NOT re uire DESIGN RATE: q If any portion of the tested area is in the 4 under s.H63.09(51(b), indicate: ~ ~i ~QSS ~ • g3 Floodplain, indicate Floodplain elevation: ~// F~, PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH FiIE ELEVATION D PTH TO GROUN OBSERVED DWATER-INCHES EST. HIGHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.1 B' / ~i B- B- 6- r~ PERCOLATION TESTS TEST DEPTH ~ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERI D 1 PERIOD2 P R PER INCH P- +~r 0 3 G ,, -- . 5 P- Z ~ _ on S ~„ ,, ~~ 3 P 3 . ~ .G.. ,. 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 9z-.5'!' . _ __ ~ i -- -- I _ _ __ ___ ___. ~_.._ __. c c ,~ ,i ~ ~ i ~_~ i f - r---; --- I ~ .. ~ _... ' ... _ ._ ~ ~~ i W,._-- ^ ~~ ~ ; ~ ~ TN INSTRUCTIONS•FOR COMPLETING FORM 715 - SBD - 6395 . ;~. ~~T~p be a complete and accur:ate'sail test, your report must include. 3n ~ - ___ _. - 1 Complete legal description; ' 2 'Ttie tise_sectiori must clearly"indicate whether this is a residence or commercial project; '', ~ - 3.,MAXIMk1M number of bedrooms or commercial use liianned; __ ' "~ 4: Is~this a new'or replacement system; '~. ~'o`:. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONtY 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; Z. MAKE A LEGIBLE diagram accurately;lacating your test locations. Dravving' to scale is preferred'.'A , _ `,separate slieet may be used if desired; - 8._Make sure your benchmark and vertical elevation reference point are clearly shown, and-are permanent; 9.:Complete all appropriate boxes as to dates, names,,addr_esses, flood plain data, percolation~test exemp- ton,'if appropriate; ' _ __. _ . 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; -- . ;- 11. Sign the form and place your current address and your certification, number;, _ _ _ 12. Make legible copies and distrihute as recXuired. ALL<SOIL-TESTS MUST BE. FILED'WITH THE`' LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS ' Soil Separates and Textures st -Stone (over 10") _ - _ cob -- Cobble {3 - 10") _:_.,_ ___....._- ...___. .__.._ _. gr - GraveL(under.3") r ,vtra ~,.a ,~ :_._ *s .~=Sande. " l cs ~ -- Coarse Sand _--_ ., ._ ., med s -Medium Sand ~. fs - Fine'Sand _ <:. _ ' Is -Loamy Sand .. __ ___ __ _ .--_-_i.. _ - ' *sl _ -Sandy Loam *I - Loam *sil -Silt Loam si. -Silt *cl -Clay Loam scl -Sandy Clay Loam sicl -Silty Clay Loam sc -- Sandy Clay sic -Silty Clay *c -- Clay pt - Peat ` -m -Muck * Six general soil textures for liquid waste disposal Other Symbols BR -Bedrock SS -Sandstone LS -Limestone HGW - High.Groundwater Perc ~- P~ercolatiori-Rate , W .- Well Bldcj - Building '* -Greater-Than -Less Than Bn -- Brown BI - Blark Gy -Gray Y -- Yellow R -- Red mot _. Mottles wi -- with fff - fe4v, fine, faint cc - cornmon, coarse mm -Many, medium d -distinct p -prominent HWL -High water level, surface water BM -Bench Mark VRP -Vertical Reference Point TO THE OWNER: - - ~ --- ~wne r: ,/ • Steve Ho/z~ r R,'- j ~prnmonG~rj ~~~ S~4/~ / / ' ~ M;n. F; 11 rove ///~/ ~/ ~ /g COVe.f 1 IG ~s O O ~ ~~ V NO ~ ~// F,6 re Cover 3~ db. ~~, ~ ~{/, ~ ~~ ~ ~~ o,p ' p.~ a o a ~Z fo 2/Z e a ,..,o~B ,,• ~.. • O, 7 O. p~ e1 O ~ 1~0• ~ `f" Pef~orote~ I I I LF I - r ~~ I I I .'~ f~'-I ~~ ~ ~ Ga ra 9e - - io 0 EXiS1. f /oc~s~ g.M . +~o,r1, z9 82 o' \ ~ ~ ~ B3 ° ~ va 27 3Z Sec . 2? us. z Stte T No• ~w~ JVE% Tz9'N >e 17W 'Q' B,M, -~enofe s $enc~i /~'JCI~'l. ~# D - 17erlole5 Bo~Z f"~°~e5 ~ P# o _ ~enofes Pere, doles _~ ~. ~. _ _ ~ i _ ~enofes /2X52 Be o~ 0 .~~awn may: l,~a,~ ~, llu~~- M P (GZ9 CST 31/ /3 u.s. Oyu'°% iz p; pe a~ 2y~ o ~-~ P= z, ~. ; ~~~~ '~W n, e~'r- • • ~ "re v~ ~ ~yo ~Z ~ -'~ ~ .-Y rl~y Y.. ,W :. Rt, 1 J~Q/n /71 Or1c~l~ C.U/. S~fo/~ A AA~rpved --r,-- F.'6 ce 'over ~o ~ _ ~. ~,Je 1I ~~ L ~-- ~ I _ Garage ~'; - - /L ~ ' Ex;s~t ~ N ._ ~~r ~ovsc B,i I ~. ; - r~ . ~o~b _ 1 ~~ ~ _ $ 2 I =2H z~ ~_,, Bz - 9~ ~ 8~ ~7' B,M, -~ nofes ~enc~i J~'(ar~ ~# p - 17enofes $o~ a loo%S ~ p# o _ 17enofes Pere doles _~ '- _~ - Denoi'es /2X52 a~ - Bed o ,~ r~acJ !) ti ~~ ~~ ~~ M P ~G29 CsT 31,1 i3 Sa ~ _ ~n ~ / / S Cov~f ,' ~~ 0 OO p:IQ OpVV L ~'/ 3' °G~ ~~ ~ `f" 1` No• ~W i NEB . TZgN ~ i7W ono 'bb° n s ~.~ 10• •eons :~,. ~" Per~vrofeof' . P~'~ G15 • f~Yu'a % /Z