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HomeMy WebLinkAbout038-1031-10-000 (2) c o 'o o o N 54 O N v C tA„ O � I Pte. 4) I CL y � a I L � f0 q ° � Co CD N C L 3 ^S LL C O N - LO X 3 Cl) op w Z E Z :r 0 0 v z v m W C m m I- Z o ' o Z "* ° w C CUs Z O +N. 6 c _0 N N CD j C Q1 y N N •� N N •E O O 1� 70 d � O CL " o O O N Q Z. N Z m z Z O o � « I o Y � > N D O a .0 m r- 0 0 0 am +v ;� a a a y� a -i U Z rn m .-. O O L O O E i() O 2 N ro w O C N N C L � O @ O E E O 1 O O cn Y O N N O d .� M (D � C N • '> ? C m c0 E+S 1 yy O O (n 2 .N-- O "* In 25, Cn CL E' a' 0 a d 'U y 4' +�+ E M « o C U CL 2 O V U r Af Y Parcel #: 038-1031-10-000 CHDI 40 AM OF 1 Alt. Parcel#: 8.31.18.143 038-TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner DOUGLAS H&KATHERINE E RIVARD O-RIVARD, DOUGLAS H&KATHERINE E 2286 100TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property rty Address(es): * Prima rY Type Dist# Description *2286 100TH ST SC 3962 NEW RICHMOND SP 1700 WITC 9 S9 Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 8W NE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 849/26- 07/23/1997 738/402 2006 SUMMARY Bill M. Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 207,900 232,900 NO AGRICULTURAL G4 38.000 2,600 0 2,600 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2006: General Property 40.000 27,700 207,900 235,600 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 27,700 207,900 235,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0,00 0.00 CD $ g o 0 $ / / k i 2 t, � / m � ® m . a § } 2= }_ ) E 72§ \ )§ � _ ! (D z .. o } \ z ; 2 co § z a ■ § � § z c / k k .f z � / E { . � \ 7 a) -� § 3 ) § \ D $ \ z .. E \ 2 \ � � a , � ■ c � Its 7 Eat e k § a 2 £ b \ U) V) V) § # \ - 7 & & k a- m t - k ' E a a.a jL i ) 2 3 � % k \ ƒ Wftftil \ \ \ \ 2 «_ 0 0 ) G 2 ƒ / i 0 , , « / § ] 2 I # E � 6 n ® _ ¥ a c S £_ E m 6 o c § Cl) k 7 : c @ D @ & \ _ : f m . s e z a g - . ) ) % $ § ( k I 0 o o e : 2 — Cl z e e ■ m . � ® � I — , : ' ; a » . E " ' 2 a § k u a ' 0 2 2 0m0 ■ -00 � § § 2 �Ln # M r & ® ° ` . � @ [(D 0 ° § @ $ Cl) B % w - ' 2 } z E z a, © - / \ § 0 E \ � � 822 ' G S \ Q ° J A § \ \ 7 £ a m a =r CL T 0 m 03 CD G § CO CD z A z ' o § CO§ % § E z 0 0 0 § Bi 2 E S % � ; ^ c 0 / \ � § � CR I § � 02 a , 2 , § w CD ' z 0 .. / \ > > 0 CL , � m �- I CD . � E Z: z E 0 ° / z E � { i P R w T m 00 � f CD ; 2 2 to ) \ •• 7 : ° E k / \ J G o e ( / n A 0 $ � % § � - # \ 2 a . / % CD # ƒ kli < / t \ 0 & CD # 'Parcel #: 038-1031-10-000 12/27/2005 12:38 PM PAGE 1OF1 Alt.:Parcel#: 8.31.18.143 038-TOWN OF STAR PRAIRIE 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 DOUGLAS H&KATHERINE E RIVARD O-RIVARD, DOUGLAS H&KATHERINE E 2286 100TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description `2286 100TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R1 8W NE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 849/26- 07/23/1997 738/402 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 118775 Use Value Assessment Valuations: Last Changed: 10/05/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 207,900 232,900 NO AGRICULTURAL G4 38.000 2,600 0 2,600 NO 10 UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 40.000 27,700 207,900 235,600 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 27,800 207,900 235,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER OGt ZA �f2 a,d SHIP /G(h�/r!/y'/c° SEC. T N- �W ADDRESS �,� (gdX/,3O ST. CROIX COUNTY, WISCONSIN SUBDIVISION I--'- LOT LOT SIZE-'- PLAN.VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW IV �y BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ,/Lp`p / Proposed slope at site: SEPTIC TANK: Manufacturer: �e //j Liquid Capacity: Number of rings used: Tank manhole cover elevation: ` D ' Tank Inlet Elevation:. .--'2�--Ag� Tank Outlet Elevation: I Number of feet from nearest Road: Front W)Side Rear, 0 feet From nearest-property line ' Front,%Side0Rear,O / feet Number of feet from: well g: _� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: / Width: 1122 Length : Number of Lines: "Z Built: h Fill depth to top of pipe: O� Number of feet from nearest property line: Front, 0 Side, O Rear,0 It/qw r % a � Numbe# of feet from well:1 l Number of feet from building: 410- (Include distances on/plot plan). AGE PIT `� SEEPAGE P la Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation or bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, 0 Rear, OFt. 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: r 3/84:mj Douglas H. Rivard NEB NE12 Rt. 2, Box 130 Section 8 New Richmond, WI 54017 Star Prairie Town of Star Prairie Address of Site : Permit No. 12863 9-6-89 Byron Bird,Jr. C/14 31 Conv. New DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS -LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 INE4,NE4,Sec. 8,T31-R18W El CONVENTIONAL ❑ALTERNATIVE State Plan Star Prairie ❑Holding Tank ❑ In-Ground Pressure ❑Mound ICty. Rd. H NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Douglas H. Rivard Rt . 2 Box 130 New Richmond W15401 9-27-89 BENCH MARK(Permanent reference p—O DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV. Sanitary Permit Number- Name of Plumber: MP/MPRSW No.: County_ Byron Bird St . Croix 128639 SEPTIC TANK/HOLDING TANK: MANUFACTU ER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL ILOCKING COVER PROVIDED: PROVIDED NLY.ES ONO ❑YES 9NO BEDDING: VENT DIA.: VENT MATE. HIGH WATER NUMBER OF ROAD: PROPERTY -L eU1LDING. VENT LE FRESH ALARM FEET FROM LINE A 1 1 AIR INLET. OYES NO" 4 C a 1:1 YES �O NEAREST a �1y7 I "�� DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER ACTURER ROVIO DIED. PROVIDED:COVER El YES ❑NO ❑YES ONO OYES ONO GALLONS PER CYCLE: PUMP ANO CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT LE FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAME TEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BEDJtfIENCH' WIDTH LENGTH TRENCHES JDISTR `PE SPACING COVEN INSIDE CIA *k PITS LIQUID MATERIAL: PIT DEPTH: DiiYEfONS �'�. �j c� GRAVEL DEPTH FILL—DEPT UISTH PIPF UISTR.PIPE DISTR PIPE. MATERIAL. nDF�ANUMBER OF PROPERTY W/�ELL BUILDING V NI LE FRESH BELOW PIPES ABrO�V/E,C,�OV ER ELEV INLET ELE V.END r� INE. Iw AIR INLET. it V�V 3f3Z� � 1a2 C"y� NEAREST- MOUND 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 El NO OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS 1-1 YES ❑NO 1:1 YES FIND DEPTH OVER TRENCH'BED DEPTH OVER TRENCH;BEU DEPTH OF TOPSOIL. SD MULCHED CENTER EDGES- ❑YES ❑NO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: `BED/r RENCH.,° WIDTH LENGTH. TRENCHES: LATERAL SPACII'JG: GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR tDISTR PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. DIA. ELEV.. PIPES DIA.: ELEVATION AN DISTRIBUTION. HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED RM INPOATION PLANS DYES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSEyV TION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET LINE: ( ❑YES ❑ O ❑YES ❑ O NEARESTM -f 3 4-3 I Y I Retain in count Sketch System on Y file for audit. Reverse Side. SIGNATURE: � TI LE • l DILHR SBD 6710(R.01/82) zo�i ml is � ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COUNTY STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than - F 8%x 11 inches in size. ❑ Ch6Wifrev! on to`prevf us application –See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. '__.,.,... PROPERTYDWNER / PROPERTY LOCATION t/4 ,G ,-'/a,S -J T `, No R / E or PROPERTY OWNE S MAILING ADDRESS J W r LOT# � BLOCK# CITY,STATE ZIP CODE PHONF NUMBER SUBDIVISION NAME OR CSM NUMBER CITY NEAREST R?AD II: TYPE OF BUILDING: (Check one) ` El State Owned VILLAGE -{ � . ,.- it .- ; ❑ Public ❑1 or 2 Fam.Dwelling-#of bedroom L TAX NUMBE ( ) III. BUILDING USE: (If building type is public,checktall that apply) 1 ❑ Apt/Condo ' 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.CII New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair otan System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit¢# — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE ^ REQUIRED(sq.ft.) PROPOSED(sq,,ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION j Feet c. Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Expp. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdina Tank 'r ` - i ` Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumbers Signature:(No Stamps); MP/MPRSW No.: Business Phone Number: j Code)" um s Address(Street,City,S to Zip ,r? `r IX. COUNTY/DEPARTMENT USE ONLY r ❑ Disapproved Sanitary Permit Fee(Includes Groundwater rate ssue issuing Agent Signature(No Stamps) Surcharge Fee) Approved I❑ Owner Given Initial Adve a Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2)years. 2 Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new- criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by;the;permit issuing authority. 4. Changes in ownership or plumber requires a_Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintairied. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the ' State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the Legal description and parcel tax number(s)of where the system is to be installed. II. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all.appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line 8 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. ` VI. Absorption system information. Provide all Information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of °=tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic,pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Instalting-plumber is to fill in name, license number with appropriate prefix MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county.The c plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location o#_` i holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service`;' streams and takes;-pump or siphon tanks; distribution boxes; soil absorption systems;.replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; :. C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information: GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6M(R.11/88) DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COUNTY STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than I / 8%x 11 inches in size. ❑ Ch6ck if revisit5n to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. ' PROPERTY OWNER r' PROPERTY LOCATION S T N, R ` E(or _.� PROPERTY OWNERS ADDRESS LOT,# BLOCK# CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER I. TYPE OF B<t 1I1NG: (Check one) CTY NEAREST ROAD Ill. Owned O.VILLAGE t ZOWN OF: ❑ Public Q, `9r 2 Fam.,Dwefling—#of bedrooms_, PARCEL TAX NUMBER(S) '> III. BUILDING USE: (If building type is public,check all that apply) ! t 1 ❑ ApflCondo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Statioh/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. El New 2. ❑ Replacements 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only - 'f .% Existing System Existing System B)( ❑ A Sanitary Permit was previous) sued. Pe m-jt — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 E I Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION c- Feet Feet VII. TANK CA CITY Site in is Total #of Prefab. Fiber- Exper. a INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank /+ 1 Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print) rf Plumber's Signature:(No Stamps),, j 3 MP/MPRSW No.:4 Business hone Number: I Phim s Address(Street,City,State,Zip Code):' J ; n / IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater a e Issued Issuing Agent Signature(No Stamps) Surcharge Fee) Q Approved E] owner Given Initial Adverse Determin tion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: w SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) PLOT PLA PROJECT `Or{ DD R ES & 1/40y/T3/ N/R/W TOWN a on COUNTY MPRS Byron Bird Jr. 3318 DATE - — BEDROOM CLASS PERC_W_CONVENTIONAL,' IN-GROUN ESSUR CONVENTIONAL LIFT MOUND HOLD G TANK SEPTIC TANK SIZE �'D LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE Benchmark V.R.P. Assume El vation 100' Location of Benchmark /L� a * H.R.P. ea 0, ,L - CJ Borehole Q well Scale Feet O Perc Hole System Elevation _ 9�- Uent 12' Grade I TYPAR COVERING --- 2" 12" 3- 4 8' O V 69 Sewer Rods • I i 3 ,mss rfi • AIM �i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS (ILHR 83.0911)& Chapter 145) N NAME: ' , S IP UNICIPALITY: OT NO.:_ 1SUBDIVISIO /T N/ yE(o ADDRESS:, COUfyTY. /� JJ MAI L ING lYeid It, O E DATES OBSERVATIONS MADE US Residence WNew ❑Replace �. y RATING:S•Site suitable for system Us Site unsuitable for system ON L: MOUND: IN-G -FILL OLDING TANK:RECOMMENDED SYSTEM:loptional) ©S DU S DU S OU DS rq7I U 10 S ®U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:�& I PROFILE DESCRIPTIONS BORING AL R N WATER-INCH S HARA T R O SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION BSERV TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) S .- B.3 y s. 0-A r' � yC AO -5 yn s /G _-Wag t Orr PERCOLATION TESTS DEPTH . WAT R IN HOLE TEST NUMBER TIME H APER INCH PE PERIOD NU INCHES AFTER SWELLING INTERVAL-MIN. P. G L L 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 an 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 _0 r v.! Or tN— 1 ,p fo I 1 - t --� A4 3 f 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. NAM print : TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER loptional : 7 vL6 CST SIG A URE: loor DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD8395(R. 10/83) –OVER – Ilk •DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR / SAFETY&BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS = DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 LvE ,MAD MADISON, 18L7 CONVENTIONAL E]ALTERNATIVE Sltate Plan I D.Number: Town of Star Prairie ❑Holding Tank ❑ In Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: D u las H. Rivard Rt. 2 Box 130, New Richmond, WI 4017 BENCH ARK Wefmanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Byron Bird Jr. 3318 St. Croix 128639 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES FIND DYES FIND BEDDING: VENT DIA.: VENT MATL.: WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: JVENTTOFRESH A ARM. FEET FROM LINE: AIR INLET: DYES ❑NO DYES ONO NEAREST ' DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO IE]YES ON ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. 14UM13ER'OF 'PROPERTY WELL: BUILDING.TVENT R NLOT RESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ❑YES NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: B`DlTRENCH WIDTH: LENGTH TR EONCHES. DISTR.PIPE SPACING. MATERIAL' INSIDE DIA.: *PITS: LIQUID IT DEPTH: DIMENSIONS, GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER'.OF PROPER l y 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 OFSYSTEMI 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 ITEXTURE A] PERMANE MARKERS OBSERVATION WELLS EY ES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED. CENTER EDGES: OYES ONO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BEIET#ENCH °WIDTH LENGTH TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DMI«NSrIfiNS . , MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: f ELEV.. ELEV.. DIA.. ELEV.: PIPES. DT: -ELEVATION,AND ,.64T0I9UT IQn. HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED 1NFMAT I ON PLANS: [!]YES-- ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBI•:YR O LINE: ERTV WELL: BUILDING: FEET FRflIVh ❑YES ❑NO El YES El NO EARIT° Sketch System on Retain in county file for audit. Reverse Side. TITLE: SIGNATURE: Zoning Administrator DI LHR SBD 6710 (R.01/82) Thomas C. Nelson SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code 4 DILHR �.�...�°� � Grog STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ 3 9 8%x 11 inches in size. Ch vi n to previous application —See reverse side for instructions for completing this application. STATE PAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY WNER /'- G PROPERTY LOCATION GCi <�"J , N, R E(or PROP OWNE S MAILING ADDRESS yy�� LOT# BLOCK# CITY,§T—ATE ZIP CODE 1PHONENUMBER SUBDIVISION NAME OR CSM NUMBER 0 ITY II. TYPE OF BUILDING: (Check one) ❑State Owned VAGE IL " NEAREST R AD Qr�t71 �d ❑ Public V 1 or 2 Fam.Dwelling-#of bedroom PA EL TAX NU ( ) III. BUILDING USE: (If building type is public,check all that apply) 1`13 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY LFRiEQUIRED ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE �j (sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) q ELEVATION Feet G -0 Feet CAPACITY VII. TANK Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete glass App. Tanks I Tanks structed Septic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Si ature:(No S tamp" r r/MPRSW No.: Business Phone Number: ort /r l$� / r' Oddress(Street,City,State,Zip Code. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San7/;�mit Fee(Includes Groundwater Date Issued Issuing Agent Signature(No Stamps) yN Approved F-1 owner Given Initial $urcharge Fee) p Adverse Determination � QU '4 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licqnsed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local-code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) i 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 j 6111A-el Location of property ,(� :1/4 _/� 1/9, Section __, , T -N-R W Township fzac- Nailing address Address of s ite Subdivision name Lot number Previous owner of property pddd C-1 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? K ._Yes No Is this property being developed for resale (spec house)? as No Volume 9(1 q nd Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. �6 O/L4,42��/? Signature of ner Signature of Co-Owner (If Applicable) Da- td of Signature Date of Signature +fir 0. ,. DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA '! STATE BAR OF WISCONSIN FORM 2-198211 450681 REGISTER'S OFFICE Rodney D. Rivard and Joyce M. Rivard, his wife I R dfor CO., W� Recd d for Record - ------- - ----- .......................... .............................................................. AU G171989--------------------------------------------- - 12 G 171989 .............- -- . - ----- -- -- ----------------------- . once s and warrants to __Rou laS H. Rivard and Catherine E. Rivard, husband and wife, -as-------- Regtste►ofQ . ' ------------------ marital property, with- rights--o.f--suryyourshp--__ - ---------- -- ------------------------------------------ -- - --- ----- ---------------------------------------- -- - .......................................-..........--....................................--........ ............ ............____.-__ ____-_. _-_-_---- ---..-_-.-_. RETURN TO _ — ---- ---------------------------------------•----.._._.............................-_.--_--------_._------- the following described real estate in _.._St. CroiX .............. •---•...................County, State of Wisconsin: Tax Parcel No: . __-- __-- ............ �I The Northeast Quarter of the Northeast Quarter (NE4 of NE4) , Section Eight (8) , Township Thirty-one (31) North, Range Eighteen (18) West. NSF'�R I This --------i.s__not.----- homestead property. (is) (is not) I� i Exception to warranties: i �S Au u5t --- --- -- 19-.$9.. ii Dated this Y -- -- - - - --- -- I ----(SEAL) - /'.L_.. �GG - (SEAL) i Rodney D. Rivard oyce M. Rivard -- ---------------- --------------(SEAL) ------ --- ---- ---------------. ..-----(SEAL) * --------•--------•-----------•------------------------------------ * - ------------------------ ... --- -- - - -------- AUTHENTICATION ACKNOWLEDGMENT Signature(s) __Of---RQidDOy_ D____R].31 X�__d1� . STATE OF WISCONSIN ' _Joyce M' Riyar�d------------------------------------------ ------------ ------ ------------------County. SS. authe t ate th' __---- day of___ Au uSt 19_.89 Personally came before me this ________________day of n e� 19 the above named ' --- ---.. --------..-- _......_.. Hen dr W.ik W. Van D y k TITLE: MEMBER STATE BAR OF WISCONSIN (1�HSt,--- ------------- -------------------------------------------------------------- aubl:ori�ed-b1►�-+796:()6,-W ie�States}� to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Reinstra, Van Dyk & Needham, S.C. ------------ --------------------------- --------------- ---------------------- Attorneys---at---Law----------•....._----••-------_---•-•---•- -------------------------- '! New Richmond Wisconsin_-- 54017-0127 Notary Public ------------------------------------------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary.) 19---_----.) date --------------------------------------------------------- *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Ine. FORM No. 2— 1882 Milw+.ukee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ! LLJ ROUTE/BOX NUMBER r�--- `�`1 /C�� 3r�C�; s FIRE NO. CITY/STATE (,(�a �/irL�.- ZIP (J/ PROPERTY LOCATION: 1/4 %x/ 1/4, Section , T 2f N, R_/r W, Town of �/a,�i�c- , St. Croix County, Subdivision , Lot No. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1)&Chapter 145) LO ATION: E TION: SHIP/ UNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: y /T N/R yE(o _ - COUNTY: MAIL N ADDRESS: r 10o u J'kb ^2 o a u) - o4 c - Se10 USE DATES OBSERVATIONS MADE NO.BEDR ICOMMERCIAL DESCRIPTION: . Residence XNew ❑Replace RATING:S-Site suitable for system U-Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND PRESSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) os ❑u s ❑u s ❑u ❑s u ❑sou - If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R -INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERV D TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) AfW III B- y6 A/0-`e 0-w Syr �,S/moo /3n S� B-3 y 5= �-t t � yG B- l �v�,.� � c�' o-- yam✓/ � S— � S/�o B- �' cf�, .,,� ,7 g '♦� C��egi� S ��— /6 .fin /Gil s B- PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME D I WA LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. —PERIOD 1 PERIQQ PER INCH P. o ! L P_ G, P- .z L 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 CA/011 /011 ,� _ _ i 16� So 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): ITESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: jPtiONE NUMBER(optional): f - 7 oZ6 CST SIGNA URE: , DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R, 10/83) —OVER — DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1)&Chapter 145) LOCATION: SECTION: SHIP/ UNICIPALITY: OT NO.: .: SUBDIVISION . '/ '/ /T N/ �to — COUIYTY: MAILING ADDRESS: - ,- o A A, uJ In n 0,1 j - S4/c USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE OESCRIPT'IONS: PERCOLATION TESTS: Residence New ❑Replace —s- RATING:S-Site suitable for system U-Site unsuitable for system ONVE I NAL: MOUNcD: IN-G EM•N-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) O S EM J OU S EI V rE1SZ^_j'UrE:1S1ZU1 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P R UNDWATER-INCH S HARA CT ER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERV 0 TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) /14-w_ a Syr a yC 905W .Syr sG -0�,Z _-V7, Vi B- J9 �.- B- !� 9'3. �.,,� , g � '—i.2D�egi� S iot— /G �n v�/G �/D�ir 3�• B- PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME 15ROP IN WATER NUMBER INCHES AFTERSWELLING INTERVAL-MIN. LEVEL-INCHES RATE PER INCH P_ G L P_ G, P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _ . 09 d. n , , po Sr 7-9 -i-- - fl - 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: "AO—DRESS: CERTIFICATION NUMBER: P14ONE NUMBER(optional): -a looll ST SIGNA 0000000z- DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. IILHR-SED-6395(R. 10/83) —OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISION INDUSTRY, LABOR AND PERCOLATION TESTS (115) MADISON WI 63 07 HUMAN RELATIONS (ILHR 83.09(1)&Chapter 1451 LOCATION: SECTION: 5H1 ! UNICIPALITY: NO.: SUBDIVINION NAME: COUITY- ^/ /� /f - AIL ADDRESS: - r r o K 16.l �� D -1 1. T o E s DATES OBSERVATIONS MADE NO.BEDRMS.: COMME11CIAL DESCRIPTION] OFIEE DESCRI LATI0;ZNTZ1E5T3: Rasidence New ❑Replace �, �...r-- RATING:S•Site suitable for system U-Site unsuitable for system ON N AL: MOUND: IN-GROUND-PRESSURE: M- N-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) rms DU I INS DU S ❑U I DS ZU OS ®U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.ILHR 83.0915)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TarAL DEU T R WATER•INCH S CHARA R OF SOIL WITH THICKNESS.COLOR,TEXTURE,AND DEPTH NUMBER IN. ELEVATION g ERV D TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) A/v-te_. B-a 6.S v -, &- o -,n B/,i,,s//o ��tz � yG B_ y B- g- 9 o .� 0 "'/.2.l04ffin 64,.;L— /G �n 0 tic —W 3�y+ B- PERCOLATION TESTS DEPTH . WATER IN HOLE TEST TIME -I H NUMBER INCHES AFTER SWELLING , INTERVAL-MIN. PER INCH P. G L L P. 11 P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sale 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 .r o! . _.. . .- ---- -- -- IP - - - _ I - o IL4 -- — f -� TN t- I I 10 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. NAM (print): ITESTS WERE COMPLETED ON: A 0 CERTIFICATION NUMBER: PRONE NUMBER(optional): 7 ate S SI A U , DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DOLHR-SBO4395(R. 10/83) -OVER - PLOT PLAV i PROJECT 101- �� DDRES l-�0ee d,0 N/R�W TOWN r COUNTY - w MPRS Byron Bird Jr. 3318 DATE BEDROOM., CLASS PERC _CONVENTIONAL ' IN-GROUN ESSUR CONVENTIONAL LIFT_MOUND_HOLD G TANK SEPTIC TANK SIZE �D LIFT TANK SIZE DOSE TANK SIZE 01 IV HOLDING TANK SIZE � � ABSORPTION AREA 4 - PERC RATE 7 BED SIZE 1116 Benchmark V.R.P. Assume EI vation 100' Location of Benchmark `� a * H.R.P. M Borehole Q Well Scale Feet O Perc Hole System Elevation 9�- Uent 12" Grade TYPAR COVERING f 2" 12" 3' 4 g' 0 3' I 60 Sewer Rock i 12' _M z =- k �lee� , o