HomeMy WebLinkAbout040-1216-40-000 c I
�Y o
� � I
eo o I
N N
O
� = I
V O
O
� I
"Q
�y I
S �
C z c
LL c
o co I
=p N
a t.
<t -o U
I
Cl)
Z H
O Z w
L
IL m
z
F- U)
o
o z a c
d 2 'o c Z
z
N H F O
C
m a�
rn
CL
N c
• o
N L
c o
p zmZ
NZ
� .. N
aEn 0 J c
O N T
z
IL CL IL
000
L ,t< I
��yy N V 2 rn rn o
I�j m o Z
ZZ
o o
O
w m ,W:: a I
F m 0 to m ) c
.p _ >- U) m
cOO 0 `.S a
T 14
CD
o a� H M E
0 o o �' * c c a., a o l
r \ 3 N 2 M, M I
v pj C
F @ R N Z Z a
C'4 1• O r N in
H H PL Cn
O ca
0 CL
w
Q V a 0 VJ V
C _
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. ZI' T,2,8�N-R _W
ADDRESS v��'Z /L_(l77/7L�" 2i4ce ST. CROIX COUNTY, WISCONSIN
r
SUBDIVISION ,+2 LOT � LOT SIZE G 2z=V
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I
i
L�
�dsr
13q
.5
X40
;7 — '
16r — ' n
INDICATE NORTH ARROW
�
BENCHMARK: Describe the vertical reference point used �' G ¢I IV
e �
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: f
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: I Tank Outlet Elevation:
Number of feet from nearest Road:I Front Side Rear,
11 �O ,� , 0���_ feet
t
- From nearest property line Front,OSide,&Rear,O feet
Number of feet from: well , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE __
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,Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Leng`th:1616 Number of Lines l Area Built:(/eS'
Fill depth to top of pipe: p7Q -- 2 c,/
Number of feet from nearest property line: Front, Side, �C.�CY Y Rear,0 Pt .
Number of feet from well: �
Number of feet from building:
(Include d tances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevationf
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 `
Manufactur r: Capacity:
Number of rings used: Elevation of bottom of tank:,
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on fob:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUMAN RELATIONS DIVISION
rOrg,OX►969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
4tAADISON,WI 53707 State Plan I.D.Number:
SW14-,Nw%,S 15,T2 8N-R 19W [CONVENTIONAL ❑ ALTERATIVE (If assigned)
Towle o4 Tt oy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
Lot &qo R ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Rogeh SChwantz 362 RutGi i.e Lane, Hud6on, W1 54016 0
BENCH MARK(Permanent eron point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CSMEF.PT.ELEV:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
LyZe J. Myeu 6219 St. Cnoix 119363
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
[--]YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑YES ❑NO ❑YES ❑NO !! NEAREST---
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO 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: DIAMETER: 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:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER PIT INSIDE DIA.: #PITS: LIQUID
TRENCHES: MATERIAL:
DIMENSIONS
GRAVEL DEPTH F EPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET:
NEAREST----*
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
[::]YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEV: ELEV.:, DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO ❑YES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS: iAREST,MBER OF PROPERTY WELL: BUILDING:
COMMENTS: ET FROM LINE:
O ❑YES [__1 NO ❑YES ❑NO ►
3•�
I ,� 5
Sketch System on Retain in county file for audit.
Reverse Side. SIGNATURE: TITLE:
SBD-6710(R.06/88) Zoning A
SANITARY PERMIT APPLICATION COUNTY
DILHR
o...��.. In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES N1 NO
PROSY OWNER PROP RTY I,OC�ATION
aN('uAU' /a,S TZb, N, R E(o W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCBER SUBDIVISIO NAME
36� 2
NDMARK
s
CITY STATE ZIP CODE PHONE NUMBER VILLAGE: NEARES OAD,LAKE OR A
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family rR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. 154ew 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.lwconventional 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)
rkof
1. a. ❑ seepage Bed b. Ln 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 Fe Q
i
-r/tL LI4 Feet 54 Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in oallons Total #of Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name C Concrete str cted Steel glass Plastic App
Tanks Tanks
Septic Tank or Holdina Tank !!�C>J `—" Q/V ❑
Lift Pump Tank/Siphon Chamber I Li L-
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plu tier's Name(Print): Plumber's Signatu e:(No Stamps) MPRSW No.: Business Phone Number:
P um er's p ddress(Street,Cit , ate,Zip Cod Name of Designer:
VIII. SOIL TEST INFORMATION
Certifie oil Tester(CST)Name CST#
/ C
CST's ADDRESS(Street,City,St-ale,Zip Code) Phone Number:
Li—rJG�c�e S D
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S�ry Permit Fee Groundwater ate Is 'ng Agent Signature(No Stamps)
Surcharge Fee
Approved ❑ Owner Given Initial I`1
Adverse Determination
X. COMMENTS/REASONS FOR DISAPPROVAL:
P�� J_�� 61� I�IiAcln" C-
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
x
R
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable;
3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;'
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only; r
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983,-Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
resuft of over 2 years of steady negotiation and public debate. The groundwater bill Ground stet-•=-'
included the creation of surcharges (fees) for a number of regulated practices which Wisco iit}xS.
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TeetSut�?' . a
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
0
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
:.... ............:...........
it's worth protecting.
SBD-6398(R.03/86)
a
s
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property �---
Location of Property k XJ W k, Section , T N-R� W
Township
Nailing Address
rp 0 S n A-) 1i-7 f S S�f l •
Address of Site � ,71
Subdivision Name 5e4,_:)('y Q l L-rZ i l .S 7-/v
. Lot Humber
Previous Owner of Property v5%,6-- Ll�T
Total Site of Parcel j/, (I
Date Parcel was Created
Are all corners and lot lines identifiable? ` Yes No
Is this property being developed for resale (spec house) ? _ Yes No
Volume �r and Page Number 1=-� 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, mould be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
1 We) co-A.ti.6y that att e•tatement�s on .thus orrm she -thue to the beet o6 my (out)
hnowCedge; that I (we) am (ahe) .the ownen(ef o6 the pnopenty dehchi.bed in .this
.in6oima.Li,on 6o4m, by viAtue 06 a waAAanty deed heconded in the 066.ice 06 the
Countyy Reg.us.ten o6 Veeds ass Document No. ' ,S and that I (We) pneeen.tLy
own the pf.oposed site bon the sewage disposat dye em (on I (we) have obtained an
v-dAcrent, to Run w.i..th the above d"cAibed phopehty, bon the eon.a.thucti•on o6 aaid
e ye.tem, and the same ha:e been duty keemded .tn the 066tee o6 the County RegU teA 06
Dttdd� A Document No.
OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
°' DATE SIGNED
Rf
stwt �
sits 1► M111
VOL
41 ' ., 1f�NCisp.auk caw... ' M. Bye and Dennis R. 3T.
Recd.fcr
G<s day of x
r C +iart an ut E.
c wartz
z
W as oistt tenants at
Grantee,
�i t n e s s e t k, Chst the said Grantor, for a valuable consideration To t.;
f
x iiN�s;te Gwee the following described real estate in S t TOlx-- ,k
'
of'l7isCOnsin: .�`
and Part of
putt .of SWh of NW% of Section 15 ---- ,
$E>l of N8k of Section 16, ALL in 28-19 des- Tax Key No. ,
gibed as follows: Commenc icing at the Era corner
of said Section 16; thence N1 6'31 E 33.0 feet to u
At of beginning; thence N87 16'40"W 322.0 feet along
par, Town Road; thence - 4
' ., fR�t N Right -of line of an existing a
; Rp1y ]77.8 feet along the NEly Right
feet line of an
Town Road on a 167.0 foot radius curve thenceeN2 X16'3 "`
lywhose chord bears ' 56046' 35"W 169. 52 feet, th
486,64 feet along sai48o�6y341gEt1593. 39 feet� along cthe 4SWlyfR,
�i71.65 feet; thence S St• Paul , Minneapolis and t
- of-Way line of the fgrmer Chicago, said N Right-of-Wa
`n 4Rai1>road; thence N88 5011811W 955.94 feet along
. � of an existing Town Fjad to the point of beginning. �b x
x :.
rk x
g:
q
" n
_Wwsestead proPertY. i
is twt� r _•
To/st 4. M A' a ailt+ �e hertdlta cots urtenasces tMreunto be!ongiirg;
�aa y �' Deno_ i s �, S'�c'�iu'�t zx,
' Indefeasible in fee simple and free and clear of encumbrances*Kew
ts�rt:sats that the title is pod,
. pia
for easements and roadways of record
7
h
and will warrant defend the same.
October 19 79 .
17th day of '
,r Dated this — *'•
§,.
(SEAL)
x�
.,
C. M. is
.. (SEAL) n
Dennis R. Schultz
ACK14OW'LlQO
AUTHENTICATION �aYof STATE OF WISCONSIN
Signatures authenticated this --—
19 --- Pierce Coll* .
Personally came betori�sse,
October, 1979
the abotre� %Y
TITLE MEMBER STATE BAR OF' WISCONSIN Aye and Dennis R
(if not,
authorized by 706 06, Wis. Stats.)
— yiq
This instrument was drafted by
C M. Bye , Attorney to are krvvv`,f�r� !fa•tht+Wjeo
-- -
-- going tns ent ac
River Falls WiGcons.i,n 54022
(Signature may be authenticated or acknowledged. Both Notary Pub
use not-nevessary.) My, cotsih4kittn is-
date: ,
"�'Nymps of parsons s,tnuls m MY cspact y must be type�.or ptin ed below tMltr it Rt(, ,
RApTY'
O. t-19??
OttD-a'rATt S OF WISCONSM FORM N
a �
H
z
U)
H
a
ST C - 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
d
a
OWNER/BUYER
ROUTE/BOX NUMBER___16,�t kc,'T—tw= `'k Fire Number
CITY/STATE Wry�'c��c� (,� (S ZIP
PROPERTY LOCATION : JtJ _14, Section_, T 10V N , R t _W,
Town of 7K�' , St . Croix County,
Subdivision' r6Zv4j../7y UiS?H , Lot number.
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 may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping ( if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration . H
0
E
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth , herein, as set by the Wisconsin Depart- d
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date .
SICNE�
DATE � --
St . Croix County Zoning Office
P .O. Box 98
Hammond , WI 54015
715-796-2239 or 715-425-8363
Sign , date and return to above address .
D SAFETY &BUILDINGS
VISION
SOIL BORINGS AN P.O.w 53707
REPORT ON TESTS (115) MADISON,
PERCOLATION
Chapter 145.045) SUBDIVISION NAME'
TIONS (H63.090) & LOZ NO K.NO:
T WNS IPI�
SECTION: /R 1� lor)W ® S .
I AILING ADDRESS:
p�y R'S BUYER'S NAME (, ER LA ION TESTS:
OW � 1`C DATES OBSE SCR PT ONS:ADE
Y• /Yaf i/ ' PROFILED —9f-
SE NO.BEDRMS.: COMMER
IALDESCRIPTION: ( New Replace /0
[Residence MENDED SYSTEM.(optional)
ING TA K:RECOM
U.Site unsuitable for system LL HO� ■
S=S' IN GROUND-PR URE:S'(STEM-IN-Fl®v
RATING: ate suitable for system �
CONVENTIONAL: M� &c Ou
v f the tested area is in the
®S If any portion o lain elevation:
DESIGN RATE: Floodplein.indicate Floodp
If Percolation Tests are NO T required AND DEPTH
PROFILE DESCRIPTIONS COLOR,TEXTURE,
under s.H63.0915)lbl,indicate: OF SOIL WITH THICKNESS, )
GR UNDWATER-INCHES CHARACTER
ON BACK.
p PTH T
EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBR
BORING TOTAL ELEVATION OBSE_��
NUMBER DEPTH IN.
Id
13 q
s i
TESTS RATE MINUTES
_ PERCOLATION PER INCH
B DROP IN WATER LEVEL INCHES p R UN
PERIOD 2
TEST TIME PERIOD
PEA DEPTH WATER IN HOLE INTERVAL-MIN• ,�
NUMBER INCHES AFTER SWELLING N F
P-
c
P-
P-
p_ ercent
on
P e direction and p
sions of suitable soil areas. In, ev tt scale t all Wrings
s
Describe what are the
P!_ and the dimensions lot plan.
Show the surface
Show locations of per tests, soil borings on the p
PLOT PLAN;? points and show
zontal and vertical elevation reference P
,.�
ofland slope.
a —�=-- _~-
STEM ELEVA TION
SYS _ r
4 i
Y �
l
t
}
Jatt Gov - .r_ - � •��
_r =
y
,
—°
S �
i
S
z w
��� �� in the Wisconsin
ON
Qi/C-R
D
were made b me in accord and belief.
..___ n hi fo m w knowledge
e
r PLETED ON:
I,the undersigned TESTS WERE COM
and that the data recorded and the location of the tests are correct to the best o m
Administrative Code, NUMBER(optional):
N NUMBER: PHONE
J CERTIFICATIO
NAME rint): M ,d %_ 7j
LI g A!�/ /�. CAST SIGNATURE:
AD ESS:
, a
Original and one copy to Local Authority,Property Owner and Soil Tester.
DISTRIBUTION:
_OVER —
OILHR-SBD-6395 (R.02182)
4k
INSTRUCTIONS FOR COMPLETING FORM 115 S13,
To be a c-ofyiPlete and s()j,te - 6395
'st, /Otj, "ePort 41i
10,�Ial descriptio,,,; Must include:
2�
3, us"te(-t'o` tnust clearly itirl
0-T Co Q�
`j C)
MAX JIM UjIA number 'Cate tivilether this is a reside
4- Of bedrooCtIs or�commercial or Coo
5, Is this a ""'or "'Placement syste use 11rr)e,6aI project;
Ct)r`i Plk�te the , rrl; Plarinecj; —1 (D
SL11taJ)iJjfv rating I,)oxe r-)
A SITE IS SUITA13LE FOR A HOLDING TANK ONLY IF ALL
-IER sySTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
OTI �s,
6, PLEASE use the 'rev'at'(`f)SSh0ovn here
7, MAKE A LEGIB�)f)b I �. for,vltitirfg P"ofile
SOPavatf- - LE d'awarn OCCUrately 1()cati,lq descriptions jo�j CorrfplC?trrJq
8� rtla�l be use(I ;[(� I Your test locatroffs I he plot plar);
I MSired;
benchrr, Df"�Nving to) S(,
Yom tale is
9- alk ano ref` red- A
all app1op,ia,,i Olevationietere,,,et,
tion� irapf"ofiriate; �Js to dates, names,ad(-Jl�ess )oflit are clo'arlY shoevi),�'nd are )Of rnallo�,t)t;
I if tfl�� ",f,f-C)3 ", t100d Oai�') data I S; ti0f, tsuch as t1r)0d it',- Perc"rliorl test exern,)
lot rn
`ial", elf�vltion)does
ai�d plac(� Yom
cl-11-'em ad(tre Flot apf)ly, Place N.A. in the JI"'!
fegible ('0010i dj;,J di tf, ss arld Yow-certiticJl-ioll 110rfjlri� -)toj
LOCAL AUlt-l() 'S r I
RiTY 1,1"IT1,1fN 30 DAYS SOIL TESTS vlt ST BE FILED
COMPLETIOO� THE
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil S',Pai'ates
Sint", , Other..syrrfbol,3
I I 00ver
"'Oh Cobb;e (I'll BR Be�ji,t,)ck
Giav�q j,jro(j,,)-'3_) SS
Srrrt t-S
G VV Hivil G
MV1iimn Pen-, P'(1!1-o
S�Jn?j "i'v, v"!�,f�� latinr)
is Loaqjy Sarlr,i Bulidir
0
SJDdy Greater
(fa n f
<
sit Salt Loam 13,, han
sr S;11 Bl B I
Gila Loam, Gy es{ctL�'
sc,l
-IV Loa,,,r Y Yeli,)Ov
ay Darn ol R Re(i
0')f1dV Clay Avlotdr,s
Silty ct,ly
Clay fff
IOVVF fi, e, fair)t
Peat Cc con-ernon
. coats"
Mrn Many, itlediun)
d (it f)ct
SiX wmeral soil le
HWL Hiqll latcrr ve 1,
for'liquid waste dhmoia, S U,I f ace water
BRI PeOch N411tk
VRP Vertical 130ferencc, poil,t
TO THE OWNER:
I'l-tis soil tes* tow-)"t- is It'{"" f
C)f 'his �Zoli ('s f 16,tsqq) Insecurillga Sarritary p0rinit,
e s "1W fW�Irl pf, he count�>
101 peolnil
4 Permit pjj is,�u-
Obr,01�i Cah,)n, must wrcc� 4 Connolete T)ay reqjj(,�sl
0, tnrl,
y ljevrnil itted �,(-) Ifi, for thin(" PfIva-u,
cI loCid aulifority ire rrrf
00'ited Of ior to tite r
Start of Oily C011'stfuctio'l,
rb o
V
tu�
LA
Zs
ta
W
Q S
'v
ti
R� ,
Parcel #: 040-1216-40-000 10/18/2006 09:49 AM PAGE 1 OF 1
Alt.Parcel M 15.28.19.1042 040-TOWN OF TROY
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
LELAND C CARLSON O-CARLSON, LELAND C
R1 368 RUTHIE LA
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description "368 RUTH IE LN
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.201 Plat: 2548-TRANQUILITY VISTA
SEC 15 T28N R1 9W 2.201 ACRES LOT 8 Block/Condo Bldg: LOT 08
TRANQUILITY VISTA TROY TWP
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
15-28N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 827/63
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.201 48,400 143,600 192,000 NO
Totals for 2006:
General Property 2.201 48,400 143,600 192,000
Woodland 0.000 0 0
Totals for 2005:
General Property 2.201 48,400 143,600 192,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 201
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
--ii.
Ypi=q'WT— NLN'1 le
a �T. �
ic
aa �
I
� I
TT �
i i // • L..
3
ICZ
t
D
1
Z
� / 1
.fF l21,
� " .o\ '•+\
m i o t�l a O \° •� r e lw O� � 1.
�� •� � .1a � IJ �T i ^ 2<
J \ \\ � V I I � � I I •• S[O N
_ is / \� T i v � • F i
U _ O O+f fa \FN ��� ,\ (C m
i n O
cn
rr,
14,45
lZ
> f M y y y
W A!f ii
o f
9
• S � W
pJ mIM I
m� 6 v♦ e � r 3 \ '\ \ AI
g oo oDOOOgoob$o$oo
000
-1
r-,"s 000 O�OO OON OOiOy^ \ � \ \
l ONW OWN \
40YppOJO�JOO)O�yJ.e n` \�10 \ \ I
2 Zm N IF222
i•22O2 IFfl
J C wJN.�MO JN C \ \ \
Oi -2.1j.e
> \ \ \ t
eW 74 M� ♦NFNW
p J Op• •'1
iF > \\
�y 1��rpp WONw`O9P Ri b q \
mNN ,y y.rNW W.Vt eJPM1�r A
\. ` .O•,'., r VOA• PJ OwrNJ r
/_•�z\ ''��... � �!
`h i ea S u.xo"� �• "I
IZZ
Gv
rN JJ
1 �Y
f1♦ S'a
C
y>