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HomeMy WebLinkAbout020-1024-80-000 § � Q _ & e k � , eee % ARcn k 0 £ IDIa Do` ®/\ E{§7 z x i \ LL gym\§» k �C) E \ /f]\ # � � � i j \ t z .( \ % LO w a ■ $ 2 z \ � 0 _ @ ml ) E f ® E . } k § { \ z co\ \ z E .. 0 2 { � c� k / . 3 ■ E _ - C % 3 co 1 \ & o* a } k B < ' a % � n Z > E k k K 2 \ \ k � k 2 2 2 CD \ B ® ° ) } } } - � } j / E a c c ® _ U) \ G 0 , . a � f , i < » n 0 1 2 § ƒ $ ■ r _ _ - - ® N _ = Cl = 6 k ) § ) I E E E § 8 k § ) k \ \ � \ \ I 4C. @ 2 Cl) - z c $ r- R w - § . _ §k 0 @ § a g -� � .0 2 Q = z _ e ■ e 2 � kk � L: aW- \ [ \ j 2 2 § : ' c o ■ / 0 § u , : 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). NeFD:b' 9Y-3f/ --- 9�• 3 SOIL ABSORPTION SYSTEM g�� rou ` Bed: Trench: 4 3 _ u(A Width: ]� Lenjj h: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, 0 0 Pt . - 10 Number of feet from well: 5 4 Number of feet from building: - f (Include distances on plot plan). SEEPAGE PIT 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 of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: _&A�lt License Number: P b 84 3 :m / j •;fir• r Form - S T C - 104 w AS BUILT SANITARY SYSTEM REPORT OWNER �'; ?r�� ,a �' TOWNSHIP Jk Ltj SEC. _ T ct� N-R�_� J ADDRES - � i ` IC'.�t,� �;131ST. CROIX COUNTY, WISCONSIN SUBDIV SION I,� LOT �' J tai LOT SIZE ly PLAN VIEW Dista es and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l w INDICATE NORTH ARRQhL `.y1cC�.;r 1 . BENC RK: Describe the vertical reference point used rl Elevation of vertical reference point: j Proposed slope at site: U� � SEPTIC TANK: Manufacturer: Liquid Capacity: j l Number of rings used: Tank manhole cover elevation: g ( ! lank Inlet Elevation: g � ! Tank Outlet Elevation: • ��° ' Number of feet from nearest Road: Front, Side Rear, O feet - From nearest-property line Front,(aSide0 Rear,O J feet * amber of feet from " " , building: (Inc ude this information of � ,plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE rY. DEPARTMENT OF IN USTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&WUMAN RE ATIONS PRIVATE SEWAGE SYSTEMS DIVISION `P.O.BOX 7969 BUREAU OF PLUMBING MAZISTO�TLN�-WS15,T 9N-R19W i I !,, CONVENTIONAL ❑ALTERNATIVE Stassignnl.D.Number: - (if assigned) Town of Hudson ❑Holding Tank ❑ In-Ground Pressure ❑Mound McCutcheon Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Greg Corcorai Route 5, McCutcheon Road, Hudson, WI %016 BENCH MARK(Permanent refe ance pointl DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: Richard Hopki s 1059 St. Croix 95993 SEPTIC TANK/HOLDI IG TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER c/ PROVIDED: PROVIDED. l ITYES El NO DYES DO BEDDING: V T DIA.: VENT MATL: HIGH WATER (`� ROAD: PROPERTY WELL: BUILDING: VAENa;'NCR ESH ALARM. FEET` rc a. LINE V / DYES O ❑YES ❑NO NEAR188C lM,' DOSING CHAMBER: MANUFACTURER. IBE DING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ONO ❑YES ONO ❑YES ❑NO GALLONS PER CYC E: PUMP AND CONTROLS OPERATIONAL 14UMSE'R O PROPERTY WELL BUILDING JVENTTOFRESH LE °LINE. AIR INLET. (DIFFERENCE BET EN E�ET FROM �° PUMP ON AND OFF) DYES ONO SOIL ABSORPTIONS STEM.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 I= 1GE" ° the soil is dry enough t continue.) ° CONVENTIONAL SY TEM: WI TH: LENGTH. NO.OF DISTR.PIPE SPACING. COVER ° INSIDE OIA.. *PITS: LIQUID " �...... I TRENC S. ( M RIAL: ° ';, ° DEPTH. CIO I GRAVEL DEPTH FI L DEPTH DISTR_PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NQ DISTR. R: PROPERTY WELL BUILDING: V NT TO FRESH BELOW PIPES _I A VE COVER. ELEV.INLET ELEV.END PIPES. ° LINE. �� AIR}N LET T 1 q �� 2 2 7 2-� ° %1 ! MOUND SYSTEM: Mound site plo d perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrc wn upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYE! NO SOIL COVER TEXTUR PERMANENT MARKERS: OBSERVATION WELLS OYES ❑NO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER. EDGES. DYES El NO DYES El NO DYES ❑NO PRESSURIZED DIST 11BUTION SYSTEM: W TH: LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. � y TRENCHES: g p 5 M NIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. DIA.. ELEV.: PIPES: DIA.: MIAT-1 I H LE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. A,, ❑YES ❑NO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: N� _ ;-PROPERTY WELL: BUILDING: LINE: S • ❑YES ❑NO DYES El NO lc �c. ' oa Sketch System on Retain in county file for audit. Reverse Side. TITLE. SIGN Zoning Administrator DILHR SBD 6710(R 01/82) 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 revision$ to this perriit must be approved.by the permit issuing authority. A new permit n)ay be needed if there is a change in your building plans, systerri location, estimated wastewater flow (number of bed rooms, etc.),depth of system, or type of system; "� i 4. Changes iri ownership or plumber 'requires a Sanitary Permit Transfer/RenewaF Form (SBD 6399) to be submitted to the county prior to installation; 5. Privete"sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed t pumper whenever,necessary, usually every,Zto_3,,yeaCs; �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: Air 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. 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; Vl. 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, certifica#ion number, address, and phone number. IX. County/Department Use Only;h 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 dime . ns, 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 foam. ---------------------------------------------------------------------------------------------------,------------- -------------------- --------------- . GROUNDWATER SURCHARGE On May 4,19$4, 1983, Wisconsin Act 410 was signed into law. This legislation is mode commonly known as the g;oun.dwater protection layv. This change in statutes was the {{ result of over 2 years of`steady negotiation and ps�blic debate. The.groundwater bill Gr ` o u duJa#Qt included the creation of surcharges (tees) for a number of regulated practices which wisco; in`s a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buries: reasul'e 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. a The monies collected' through. these surcharges are credited 'o th-y groundwater fund adminis- tere6 by tine Department of Natural Resources. These fun-Is a¢e used for monitoring ground- T eater, groundwater contamination in�estigations and est<blis•' ,m-^t of standards. Ground+vary s vicr&! protectina. I :3�a(z.o3%86) l DIL R SANITARY PERMIT APPLICATION COO Y , 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 ir size. —See reverse sidd for instructions for completing this application. PETITION 1. APPLICANT IN ORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 5<NO PROPERTY�WNER PROPERTY LOCATION (v— S T , N, R E (or)W PROPE TY OW ER' AILING ADD ES LOT N ER BLOCK NUMBER SUBDIVISIOI�NAME CtATcK N j N A N CITY,ST TE t ZIP CODE PHONE NUMBER CITY NEAREST A AK OR LANDMARK Ili Sd S C 0 J O VILLAGE: ®N II. TYPE OF BUIL ING OR USE SERVED: -�. derO _/;y— a v Number of Bedro ms if 1 or 2 Family OR ❑ Public(Specify): C6NVQ I ONAI III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ Ne% b.X Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an Sysl am System Septic Tank Only an Existing System Existing System 2. ❑ A Sanit ry Permit was previously issued. Permit## Date Issued 3. ❑ An Exis inI System has been inspected and soil conditions meet minimum requirements. 4. ❑ The Sy 11 em 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. Con ntional b. El Alternative C. 1:1 Experimental 2. a. ❑Syst m- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See age Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATIO 4 RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): <3 \p ['s (D • 3 Feet �Private ❑Joint ❑ Public VI. TANK CAPACITY Site in alions Total ##of Prefab. Fiber- Exper. INFORMATIO New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank COQ Lift Pump Tank/Si ho Chamber ❑ I ❑ VII. RESPONSIBI ITY STATEMENT 1,the undersigned, issume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Pri ): Plum is Signature:(N Stamps) MP/MPRSW No.: Business Phone Number: C.�A R y N b� �` 10/139C-70-DO Plumber's Addre s(S reet City,rotate,Zip Code): Nam r)^(_KAP_j f Des' ner: Kt c. rn N l W D HUKAS Vlll. SOIL TEST It IFORMATION Cert'ied Soil ester( T)Name CST## i c. 7A 'K, VAN W9 4 CST's ADDRESS(Str ldverse,City,State,Zip Code), n Phone Number: b '� ,S , U �1 IS 1M _ (0831 IX. COUNTY/D RTMENT USE ONLY ❑ approved Sa itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) urcharge Fee Approved ❑ ner Given Initial^,, \� I p� Determination C) U X. COMMENTS/ ASONS FOR DISAPPROVAL: SBD-6398(formerly PI 67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber f �. L 6 7 P L. OT t,, n (. � 0 SS C. T C..� 1\I r *E'0 CAT 10 .Lil o 1 IC E NJ S_E - ._.:. I. PLO 1� MAP t { U7'4` y t t aR 11 �3 � . Old N K + so as PA X ea �/ u Pj Id 10 p -� � 1; woo) 40, V, SIN am 1 , House 33, �'Aatjotj IN ,y c��r�tiR o £,�►S iNJa Nov st © Well me,as ate N R , Gael) t'o zA►►•rF�t)d Is 9ReeRh�aN0' F ' fF r nICtntGhtvN Rd k r 7+ { '; mess u��n►�e � s -frcar-. Ba to Ropy 1'I�e"�s �'6 Fd 0-F BlAcKtor 5 ' Ali. 1 FRESH fl L AI II`iLrS AND OBSERVATT(SN PIPE C,n07S SEGTI0N Approved Vent Cap n ' h Minimum 12" Above / 'tiNA) a��p t ; Final Grad,Q.---._.\ , e, Y0 In Mc 4" Cast Iron Above Pipe �/ vent Pipe k d"' To Final Grades-- y, arsh Hay Or Synthetic Covering 1 ti- �� Min. 2" Aggr.eg'r.�l.e Over. Pipe � - a Tee istributio Pipe _-._-.__ Aggregate Perforated Pipe Below 3� ,} Be`n'eath Pipe < Coupling Terminating At \Y_.. ..._-- . Bottom of System ail APPLICATION FOR SANITARY PERMIT STC - 100 �. a This applicat on 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. Sh uld 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 subm tted to this office with the appropriate deed recording. Owner of Prop rty rrrela (sores QraAj Location of Property Al k Al 14, Section / , T N-R I W Township Mailing Address .Address of Si e K •B _ giro/Iwl Subdivision Name . Lot Number Previous Owner of property , Total Size of Parcel Date Parcel v a Created 1 1 7 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house') ? Yes No Volume � � and Page Number Z SJ as recorded with the Register of .Deeds. e INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty De d which includes a Document number, volume and page number, and the Seal of the Lister of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process.' If the deed description refer- ences to a Ce rtified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) eeh ti y that at t atatement6 on this 604M cute t1Cue to the best o6 my (oun) hnowtedge; at I (we) am (cute) the owneh.(s ) o6 the pnopvty deg cAi.bed in this in6onmati.on ohm, by vi tue o6 a WaAAanty deed n con d in the 066ice 06 the County Regca en 06 Veedh a3 Document No. ` and that I (We) pAU ente.y own the pnop ed hite. 6oh the sewage dispos byb em (on I (we) have obtained an easement, to &un with the above deachi.bed pnopehty, bon the eonatnuctti.on o6 said .d ydtem, and Ahe came hat been duty teco&ded in the 065ice o6 the County Reg.i.a.ten o6 V eeda, aA Document No. ) . SIGNATfkE-C/OV±MER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 4 , To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 5. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet:may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 5. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does not apply, place N.A.in the appropriate box; 1 1. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob — Cobble (3- 10") SS — Sandstone gr — Gravel (under 3") LS — Limestone *s — Sand HGW — High Groundwater cs Coarse Sand Pere - Percolation Rate med s — Medium Sand W — Well fs — Fine Sand Bidet —. Building Is — Loarny Sand > _ Greater Than sl Sandy Loam < ..-.. Less Than 'I — Loam Bn — Brown #sil — Silt Loam BI - Black si — Silt: Gy — Gray cl — Clay Loam Y _ Yellow scl Sarkdy Clay Loam R Red siel — Silty Clay Loam mot — Mottles se - Sandy Clay W/ with sic — Silty Clay fff few, fine,faint c — Clay cc — common,coarse pt -- Peat mm — Many, medium m — Muck d — distinct p -- prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal BM Bench Mark VRP - Vert'ical Reference Point TO THE OWNER: This soil test report is the first step in securing a sarri ary per€iit. The county or the Department rnay request V,31-ifiCation of this soil test in the field prior to permit issuance= A complete set of plans for the private sWsage system and a permit application must be suomitted to file appropriate local authority in order to obtain a permit. The sanitary permit must be obtained Arad posted prior to the start of arty construction. I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION ' INDUSTRY,, 5)LABOR AND PERCOLATION TESTS (11c P.O. BOX 7969 MADISON,WI 53707 HUMAN RELATION (H63.09(1)&Chapter 145.045) LOCAJ,ION: SE TOWNS TY: LOT N :BLK. SUBDI I N NAME: � /�� �/TZ`�N/ g�(or CO N Y: OW R'S BUY�R'S NAME: MAILING ADDRESS: 6f )ee USE DATES OBSERVATIONS MADE ['56esidence BEDRMS.: COMMERL DESCRIPTION] eplace PROFI D S RI TIONS: ER O AT N TESTS: Y RATING:S=Site suitabi for system U=Site unsuitable for system CQNVENTIO❑NAL: MO J:�� IN-GROUND-P�URE:rySTEM-IN-FlLLHO❑LDING TANK:RECOMMENDEJD T�EM:(opti al) If Percolation Tests are r OT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),in icate: lFloodplain,indicate Floodplain elevation: q_14 PROFILE DESCRIPTIONS BORING TOTAL!, DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHH AE. EL VATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 4q I B- 2 7 97' B- :5 17W 3 :,Ao" > 7 f 3 � /� 11 W:5il, /, 8 3 ' ,�Ns��gY� y YL�3h�sOyrti/ c B- B- B- PERCOLATION TESTS TEST DEPT ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER TE ELLING INTERVAL-MIN. PERIOD 1 PERI D 2 PER PERIOO 3 PER INCH P 5 G C 3 P- `Z. , S 3 3i 2 2 y 3 P- 3 1415 Z ;ax < 3 P-_ P- PLOT PLAN: Show loc ions of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical eleva ion 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 �3, 37 _ ggjj �Q] �q L E 99 �. Ide Al C 'S .tom tN W 1 I - � - !014,1 4tiD 4 w ) I I,the undersigned, here y 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,an J that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print):.A TESTS L71 E OMPLETED ON: /Al 1 ADDRESS: CERTI IC TION UMBER: PHONE NUMBER(optional): CST I DISTRIBUTION:Origi al and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R. /82) —OVER — J J 4 r Y . � INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 ' To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; . Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE cliagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; . Complete all appropriate boxes as to dates,names,addresses,flood plain data, percolation test exemp- tion, 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 distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 CLAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob - Cobble (3- 10") SS — Sandstone gr — Gravel (under 3„) LS — Limestone *s — Sand HGW — High Groundwater cs Coarse Sand Perc — Percolation Rate coed s — Medium Sand W — Well fs Fine Sand Bldg — Building Is — Loamy Sand > -- Greater Than sl Sandy Loam < — Less Than 'I — Loam Bn -- Brown *sil — Silt Loam BI Black si — Silt Gy — Gray *cl -- Clay Loam Y Yellow scl — Sandy Clay Learn R Red sicl — Silty Clay Loam mot Mottles se — Sandy Clay vv/ - with sir: — Silty Clay fff few,fine,faint Y c Clay cc — common, coarse pt: Peat mrn Many, rnedium m — Muck d — distinct p — prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP — Vertical Reference Point TO THE OWNER: I ” This soil test report is the first step in securing a sanitary permit. The county or the Department may request � verification of this soil test in the field prior 9_0 permit issuance. A complete set of plans for the private a sewage system and a perrnit applicati,)n must be submitted to the appropriate local authority in order to obtain a perruit. The sanitary permit must be obtained and posted prior to the start of any construction. m , r r rAR7ME SO NT OF REPORT ON IL BORINGS AND SAFETY& BUILDINGS fINDUSTRY, DIVISION INDUS Y `' P.O. BOX 7969 HUMAN RELATION PERCOLATION TESTS (115) MADISON,W1 53707 (1-163.090)&Chapter 145.045) W LOC TION:il SE TION: T /MUNI IPALITY: LOT O. BLK .: SUBDIVISION NAME: '/a 6_/Ta9N/R19fr(o ud5on ,I COUNTY: O ER'S BUYER'S NAME: MAILING ADOR SS: Crol Gr CbrCorcen i�4, S Yd�C Cufcheon {��, �c U,4 USE I DATES OBSERVATIONS MADE .BEDRMS.: COMMERCIAL DESCRIPTION: �PRO FI LE DE CRIPTIONS: OLATION TESTS: Residence A r /� ❑New Replace i /^TL g g I RATING:S=Site suite a for system U=Site unsuitable for system CON ENTIONAL: MC UND:' IN-GROUND•PRESSURE: SYSTEM-IN-Fl LL OLDING TANK:RECOMMENDED SYSTEM:(optional) $ ❑U E S IS ❑U ❑S U ❑S U �b ven41 o / 66 If Percolation Tests are OT required DESIGN RATE: I If an portion of the tested area is in the h fl under s.H63.09(5)(b),i dicate Q Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH E NATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) f , 9.2'8/51 >3.d` •� o% Iryv MP 3, •� > ' �,08� S; .s psi r- C S� B- B- B- PERCOLATION TESTS TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES N ER ING41ES FTER SWELLING INTERVAL-MIN. PERIOD I PERT D 2 PER PER INCH P_ N KI 16 to 3 P_ a L4,5 3 3 y A ' L. 3 P_ 7 S y a Ya G P-_ P- P- PLOT PLAN: Show loc itions of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elev tion 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 ELE VATION ` 3 � i Xi ( r � e+' iSi SC !A �� _.�_ _ - ;_._ pA 'S �... I F ,5 � N € t c I I3 : i tjl E _ I,the undersigned, herE 3Y 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,ar 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): sue) iJv` Zvi 00 y q CST SIGN or r DISTRIBUTION: Origi ial and one copy to Local Authority,Property Owner and Soil Testet. DILHR-SBD-6395 (R. 2/82) —OVER — ¢ �I' pli of �F • Of `t r .75 ': rlplgiir'-to sstdntsi3riM �lia� �3d0 la�tt `to as�d c�Cetlibor� ��, , <$ loot, to Placiv0t +p ast il a"b" of alortba :of, S±i�r�tl a�,15, dry { t c w:r�iFr; _��K I�-. 1 rl �}7�r - r .ii. `t _: K'1 m'`T,Mq; • , CMrA�r. g• � � JI i- 'L CA A y S T C` - 105 r , ' A 1 LN'1 SLi 1IC TANK MAINTENANCE >� St . C roix Count v . Y I OW eIt/BUYE1`� CdrC'_of` n1 m RO '1'E/BOX NUMBER�-� , .�ed� � Fire Number 3 3 CI Y/STA1'EA SOIJ U'1 J YRl', ! Llt'1'Y LOCATION : a , Sec t ion i' m it W Town of 191Ae _ _ St . Croix County , Subdivision r be number t Lo wig l Imlro roper use and maintenance of our septic system. could , result in L P Y I it premature failure'' to handle wastes . Pruper maintenance can si is of pumping out the septic tank evury three years or sooner , if ! needed , by a licensed septic tank umLer . What you -Jut ' into Lh ' system can affect the function of the sL•JILic tank as a treat- III e 11 t stage in the waste disposal system . St -Croix . Cuurnty residents maj. be eligible Lu receivu a granL f ur. a r axi►uunr of 60% ' of the ; cos t of replacement of a', failing system, wh ch was in operation prior, t'o:;July 1 , : 0978 . . St . .Croix County % ac opted this 'prugram ; in August :of 1980 -.with th'e ru'qulrement chat, uw► ers of all new , systems agree"; to. keep their systems proper I y ma nLained .- — -- Tll property owner agrees to submit to St, Croix' County Zoning; a c i tification form, signed by the owner and by a` master '1)1umher , jo '' rneyman plumber , restricted11)1umber or a licensed 1)uniper L veri- fy , ng that (1) the on-site wastewater disposal sysLeur is in proper op rating, c'ondition and (2) after inspection and puu1ping ' ( if nec- es ary) , the septic 'tank is less than 1/3 full of sludge and scum. Ce tification form will be sent approximately 30 days prior to l t ee year expiration . o I/ E , the undersigned , have read the above requirements and agree N to maintain the private sewage' disposal system in accordance with th - standards set forth , herein, as set by the Wisconsin Depart- i me ' t• of Natural Resources . Certification form must be 'completed an returned to the St.. Croix County Zoning Office within 30 days of the three -year expiration date . ' SICNEll DATE X7 S t I Ct of x C.�un t y Zoning Office P.. Uox 9& Hat i mord , WI 54015 9 71 -7S:6-2239 or 715-425-8363 Si n ," date and return to above address . 1 i DOCUMENT NO. WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS 1443 PRGc 288 ST. CROIX CO., WI RECEIVED FOR RECORD Gregory J. Corco an and Charlene A. Corcoran, husband and wife, Grantor, conveys and warrants to Peter J. schmit and Jill L. Schmit, 07-211999 9:30 AM husband and wife as survivorship marital property, Grantee, the following dencriooed real estate in St. Croix County, State of QTY DEED Wisconsin: EXEMPT N CERT COPY FEE: COPY FEE: part of the N8 114 of HE 1/4 of Section 15, Township 29 North, Range 19 TRANSFER FEE: 477.00 West, St. Croix County, Wisconsin described as follows: Lot 2 of RECORDINS FEE: 10.00 Certified survey Map filed October 5, i990 in Vol. "8", Page 2279, Doc. PARES-. I No. 462977. . . . . . . . . . . . . . . . . . NAME AND RETURN ADDRESS 1 std'Y,.*), I� � P o /all This is homeste d property. klw�ma Exception towarranties: 020-1024-80 All easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN) Dated this 121" day of July, 1999. (SEAL) (SEAL) Gregory C r (SEAL) . �� A l PL,� •/Ii'1 (SEAL) Charlene A. Corcoran A UZUTICATION ACKNGNLZDGNSNT Signature(e) STATE OF WISCONSIN ) as. ST. CROIX COUNTY ) authenticated his 1? day of . 193 C Personally came before me this 121" day of July, 1999 the above named Gregory J. Corcoran & Charlene A. Corcoran to me known to be the persons(s) who executed the foregoing instrument and acknowledge the same. TITLE: REMBEP STATE BAR OF WISC NSIN (If not, authorized by 5706.06, Wis. Stats.) ` THIS INSTR WAS DRAFTED BY: Notary Public County, Wis. My commission is permanent. (If not, expiration date: Joseph D. Soles Rodli, Beaker Boles & Krueger, S.C. P.O. Box 138 River Falls, 111 54022 4 29'77 E R T I F I E D SURVEY MAP ocated in the NE 1/4 of the NE 1/4 of Section 15, T29N, R 19W , Town f Hudson, St. Croix County, Wisconsin. ' Owned y: Greg Corcoran East line of the NE1/.4 of $.eoti;ohl 5. r 690 McCutcheon Rd. Hudson, Wi. 54016 NE Corner S 100228"W E1/4 Corner Section 45 1311.69' 1311.69' Sectio ' T29N,R19W n l ti UNPLATTED_ LANDS_ m M I ci I s1 I/ 3 0 '57'21"W 256. 180 zl WI c1 2 828.27' ( Ql JI p l ( al Oa 0 5 lL G 7 1 N zI O'°o�o"eeE,u �I Ca,W� 371,D63 Square feet (3.920 acres) ti al- a Including right-of-way N �0 -,p BAKKE �U 1153,841 Square feet (3.7151 acres) I 1 ROAD_ Excluding right-of-way I • �——T28.20' S 1 N 1 South line of the NE 1/4 m of the'NE1/4 of Section 15. N0066e.39'E I •;� ( of the NE1/4 o� al w LL ® 7F 2 I n l J1 0171, 136 S.F.(3.929 Ac) M Inc. ROW Shed ►i0la W W�NI LU � 'NO 163, 835 S:F. N aMi cv �► °-' 0 _1 cl (3.761 Ac) -- -- --lz o°Di =a1 I c� Ua WI _ .- l v�l 4 a� 51 Exc. ROW House- . --'Ito S c ICI JI 629.17' 1• �^ WI � z 1 � N 00'11'30"W 656.67' 3) I �I o 01 a01 W oi0 -� W O zu 264, 343 Squ® feet (6.069 Acres) N lz W �I Ln Including right-of-way I Z3 + 0 228-,981 Square feet (5.257 Acres): �- — ;rt *' . i2 Excluding right-of-way ( M N0°11'30"W—�— 3 ^ ZI 152.92 ' vll NI yAxr C I ZI W. C Z( Q p r W N �� Q M �- West line of the NE 1/4 of JI a �' al a the NE1/4 14, w U,N � z m ( W {� 1 ' _ I_Z_ _ 8 00'11'30"E 474.28_ Wf' � Z OTT g , +-� SC` ROAD ( QI D _ _ W J N 00 41'58"E 503. 1.5' z1 a - - - - - v UNPLATTED LANDS �) �� N LEGEND I6 6. - S ction Corner monument I , G 1 'X24" Iron pipe weighing 1.68 lbs per lin. ft. set. — l - • 1 I round iron pipe found s Bearings referenced to the East line ,— F NCELINE .:;'.'_ of the NE1/4, of Section 15, assumed tR) reviously recorded information. S 1°02'29"W This in trument drafted by: OY 489-1648 VOLUME 8 PAGt 2279