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HomeMy WebLinkAbout020-1172-10-000 '0 (D C> CD 0 v). > (D 0 r_ 9b Cz e4 V z 0 U. .0 '0 'a <1 0 cn c 0 E 0 z 0 2 CD z '2 E co (D N co IL 0 0) < z co z 0 z t5 '2 LU 04 0) L) :2 CL c AO c boo co E m a. m o 0 0 0 0 z IL CL CL 0 U) 0 r (n co co zz co Cl) E a. o CD ca m c ti CD (D 2 s :3 9 V (D E C14 CD c L) r- a- C:, 0 cc C� 0 .4 co Q) CD 0 t - Z oi C,4 co C ID 75 r. ICI CD D E C, r� 7 0 o co CD z U) IL CL E 0 E a C 0 (L 0 V) r :aagwnN asuaoTq :qo� uo aagwnla ;palaBQ :ao;oadsul :a9anjou3nuvx waBTH :puoa Isaaeau woa3 laa3 3o aagwnN :BuTpTTnq woa3 laa3 3o aagwnN :TTaM woa3 laa3 3o aagwnN •3d 0 `asag O `apTs O `quoa3 :auTT Aliadoad isaaeau woa3 laa3 3o aagwnN :10TuT 30 uoTIBnaTa :xuul 3o wolloq 30 uoTIenaTg :pasn sBuTa 3o aagwnN :AlTouduo :aaanlou3nuvK IRVI oNITIOH • (auo XoagO) LswalAs uoTIgaosqu TTos anogB aqi 3o Cue uo pasn uaaq O xoq uoTangTJIsTp ao O xoq doap B aaglTa s8g :3TTng Baal :uoTIBnaTe ITd aBBdaas 3o wolaog :gjdap pTnbTZ :aalawBTQ :siTd 3o aagwnN :azTS ZId aoHdaBs • (uuTd aoTd uo saouB4sTp apnToul) :BuTPTTnq woa3 :Iaa3 3o aagwnN :-[Tam w0a3 :Iaa3 3o aagwnN ®laea-d O `apTS O `quoa,. :auTT Aliadoad isaaeau woa3 aaa3 3o aagwnN :adTd 3o dol of q]dap TTT3 , t :ITTng Baay :sauTZ 90 aagwnN :tl:Buaq :q:3PTM ! 4 L•�►o l Q L u;)." :Paa mass s NoIJ aosge zlos �� •/1 D 7�. ► l `• ��Q171�H -(uuTd joTd uo saouBisTP aPnToul) :$uTPTTnq woa3 laa3 3o aagwnN :TTaM woa3 laa3 3o aagwnN • O'JL'9HO ';DPTSO 'IuOad :auTT Aiaadoad Iseaeau woa3 laa3 3o aagwnN :ad�ClIgD:ITMS UUBTV :aaanjou3nuvK waBTV . . _— :aToAo aad suoTTB9 �. :uoTIBnaTa uoITMs 33o dwnd :uoT3uA9 Ta Vul 30 MOIIOq :IaTuT 30 uoTIPA9TB azTS dwnd :aaanjoB3nuvN uogdTS/dwnd :TapoW dwna :AiToudvo PTnbT7 :aaanjoe3nueyl Ilaq MD dWlld Form — STC -- 104 r 4 . AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP A 1A c�I.Cc�,,j SEC. T N-R W ADDRESS W'11 ®W I& t ST. CROIX COUNTY, WISCONSIN � AS 1 SUBDIVISION d s ' 09 LOT LOT SIZE Eiqs PLAN VIEW ,! Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t asx+' i yp � r S d INDICATE NORTH ARROW �1 BENCHr RK: Describe the vertical reference point used I e N (p }m /� a Elevation of vertical reference point: Vr Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: t' Number of ring: used: �_ Tank manhole cover elevation: RIO Tank Inlet Elevation:_ Tank Outlet Elevation: _ 1�. 9S Number of feet from nearest Road: Fron t,�Side 10 Rear, 0 _115 feet From nearest- property line : FrOiit,0Side,�Rear,O 70 feet � Number of feet from: well ��_—' building: 0�e (Inrlu e this information of the above plot pl.an) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF I DUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN R ELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 79f9 BUREAU OF PLUMBING MAF?ISON.*WI 53707 TN CONVENTIONAL ❑ALTERNATIVE IState Plan l.D.Number: ❑Holding Tank ❑In-Ground Pressure El Mound Ili assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Wayne Moser 627 Fairfax, Altoona, WI 54720 BENCH MARK(Permanent ref rence point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: SW SW, Section 17, T29N-R19W, Town of Hudson,Lot 75, Willow Rdg. E. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Richard Hop ins I1059 St. Croix 88469 SEPTIC TANK/HOLD NG TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: V '�� S ES ONO DYES MNO BEDDING: V NT DIA.: VENT MATL.: HIGH MAT R NUMBER OF ROAD: POPERTV WELL: B TO FRESH / ' r ALARM. FEET FROM LINE: IRAAI� T DYES NO '^� \ ❑YES ❑NO NEAREST I O SQ 0A DOSING CHAMBER: MANUFACTURER: TODING: LIOUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL L:RO KING COVER PROVIDED: PVIDED: YES ONO DYES ONO YES ONO GALLONSPERCYCLE: 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 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 FORCE the soil is dry enough to continue.) MAIN CONVENTIONALSY TEM: BED/TRENCH WI TH: LENGTH IN O.OF DISTR.PIPE SPACING: COVER DIA #PITS LIQUID 5 TRENDS: M ERIAL: J:ErSIDE DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D R. NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH BELOW PIlPE s i ABOVE COVER: ELEV.INLET ELEV,END PIPES- LINE AIR INLET lY G�{t"2 .7 27 2� .1 NEAREST--► 3 gS �� 6 A. MOUND SYSTEM: Mound site plow(d 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- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS JOBSEIIV WELLS OYES IONO OYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES-. OYES. ONO DYES ONO DYES ❑NO PRESSURIZED DISTR SUTION SYSTEM: BED/TRENCH WI TH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MA IFOLD PUMP MANIFOLD DISTR.PIPE JMANIIOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND EL V. ELEV.: CIA.: ELEV.: PIPES DIA.: DISTRIBUTION INFORMATION HO E SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 1. PLANS. ❑YES ❑NO 1:1 YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: 7 FEET FROM LINE: l ❑ NO YES ❑ ❑YES— ❑NO NEAREST 4 1 , 05 �1, jo Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. — --- TITLE. I_Z DI LHR SBD 6710(R.0 /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 revisions to this permit must,be approved by thepermit 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 alicensed 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; I!. 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; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more ` commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Atler included the creation of surcharges (fees) for a number of regulated practices which Wisco Wr can effect groundwater The surcharge took effect on July 1, 1984. All of the water that buried >adStlrEr is used in yo it building is returned tr; the groundwate, through your soil absorption system or the disposal site used by your holding tank pumper. -1 ht. monies col!ectec through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resource.:. These funds are used for monitoring ground- t g .urdwafer contamination investigations and es1�-Ibllshment of standards Groundwat , s wcrti: protecting. `:3D-6338 iR.C3%85) (`�j SANITARY PERMIT APPLICATION COUNTY `—' DIL R In accord with ILHR 83.05,Wis.Adm.Code C g O STATESANITARY PERMIT# =Attach com let P lans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/x 11 inches i i size. —See reverse Sid for instructions for completing this application. PETITION 1. APPLICANT IN=ORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION 5 % !j %, S T, , N, R E (or)40 PROPS TY OWN MAILING ADDRESS LOT NUMBER BLOCK NUMBER Cf,PIVISION NA A d 1� Sit CITY STATE ZIP CODE PHONE NUMBER CITY NEA T RO D,LAKE L DMARK, Q O ❑ VILLAGE N1 TOWN OF II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family_ OR ❑ Public(Specify): C N\1 e&,Nal Bed III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. K New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The SyE tem is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑Syst m- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fil Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. IR Seepage Bed b. ❑Seepage Trench C. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Mi nu tgs per inch): REQUIRS uare Feet): PROPOSED(Square Feet): © 11. C3.50 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ¢#of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holdin Tank __L+WeZk_5 Lift Pump Tank/Siphon Chamber I I 1 ❑ ❑ 1 0 VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print: Plumber's Signature:(No amps) MP/MPRSW No.: Business Phone Number:fly 11 4 7i5 y 9 Plumber's Address(V,S te,Zip ode): Name of D signer: 0 VIII. SOIL TEST ITION r ertified o�t Tester(C T)Name CST#Ig 2y CST's AD RESS(Stre ity,State,Zip Code) Phone Number: e Hujsom ( 711 - 4080 IX. COUNTY/DEP RTMENT USE ONLY ❑ D approved Sanitary Permit Fee Groundwater at E01 Issuing Agent Signature(No Stamps) W�7 a Approved O ner Given Initial Fee J� Surcharge • Averse Determination f �� X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-1 7)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPI.ICATION FOR ` ANITARY PERh1L'T S 11' C - 100 This application form III to be con,pleLud ill full and signed by the owner(s) of the property eing devulopo.d. Any inado(Inacius will. only result in delays of the permit issuance. Should tha.s duvelopmetiCbe .Intonded for.resale by owner/contractq-c, ("sper ,�,.b house") , hen a second to m uliould bu ri:Lalned and completed when the property is sold and ubmitted LA) Ll,ln officu with I.ho appropriate deed recording. Owner of Property Location 3f Property / '� d 1.✓S1 , Suctlon �2, T ---Z N - R Zy"W Township Mailing A dress 1 Subdivisi n Name L.ot Number�— Previous Dwner of Property Total Siz2 of Parcel ,Z z iPi_c J Date Parc 1 was Created Are all c rners and lot lines identifiable? _�� Yes No Is this property being developed for rusal.e (spec house) ? _/Yes No Volume 6 and Page Number as recorded with the Register of Deeds INCLUDE. WITH TUTS APPLICATION ONE OF THE FOLLOWING: 1 , darranty Deed 2. Land Contract 3. )ther recordiiigs filed with thu Register of Deeds Office In addlLi n, a curtA1'. Io(I t+urvc+•y, 117 )1 v,il 101)1l+, would be helpful so as to avoid delays of the rc: iewi.ug procultl,. I I' 1.ho dt•,- 1 rIpclon references to a Certified Survey Map, L111.: Lho UrL I f I us) Hill vtly Mill, 1111.11 1 ii I nn hi+ roqu.l red. I'l'00 I'11' 1 110111 I' CI h I I V-1 CATI ON I (We) c e c6y .that a l't b.ta,temejt(,5 o,t tb i,s 6o)nn ane -thue to the but 06 my (OUA) knowledge; Aa.t I (to. ) run (wted .fate. olUnel (s ) 06 the pltopeAty dedcAibed in .thus in6atma.tti n 16oaun, bit vih tue o6 a w,r1,,nt,'I hi deed )tecoatded in t1te 066ice o6 the County R63.iAtut. o6 Ueetls as Uocometlt. No. <=r-'��7� and .tha;t I (we) pnezentt.y oun .the p!topit,St,tl e i0 6o)t .tl,(, selvage. atzpo'sa-Z ays.tem (on. I (we) have obta,tned in ea.eeme.nt, to )tu►t tci.th .0w ahove desc4. bed rmope&ty, bon the consttfact'ox 06 said , 1/a (em, ,tlld .Olc, s,une hits been h,l.y Jteconded in the 066ice 06 the C0 my Regis.t:c�+ 116 UerclS, tts Uu� ttmeil No. Z 7�L ) ' G A'L'UR iF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE' SIGNED i I I i �! DOC JMENT NO. STATE BAR OF WISCONSIN FORM 1-1982'i THIS SPACE RESERVED FOR RECORDING DATA II 421718 W WARRANTY DEED 630: I O PACE 21? ! ST# 001' . Reed. fo•- �%- :•• .! this 27th This I� s Deed, made between ----�.&._11.�melop1T at.,..- C_,..._.... I 8 - ------------------------------ i day of Tan A.D. 19 7 ----- -- ------------- --•-----------•------------- • ............. ••---•-----•-----••---••---------------••------ ................................., Grantor, and........ _.._Wa.yne.Maser..................................................................... ,,..,.S.�Tames_O'Connell ...... Re�oH11oR, , Doan ./ --------------------------------- -•--•----------------------------------•------•--------••---------------------- ' -----•--•---- ------------------------------------------------------------------------------- --• , Grantee Deputy itnesseth, That the said Grantor, for a valuable consideration_._._. li ran ors. --------- RETURN TO conveys to Grantee the following described real estate in ______St.---CT'•o1.x--------- County, State of Wisconsin: i� ` Tag Parcel No: ----------------------------------- iI I I� I IIt 75, Plat of Willow Ridge East in the Town of Hudson, St. Croix County, Wisconsin. M I This --------iS_not........ homestead property. (is) (is not) ` Tog4 ther with all and singular the hereditaments and appurtenances thereunto belonging; And -------Grantors. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements., restrictions and rights-of-way of record, if any. I, and will w rrant and defend the same. - 86 I Dated this `-� ---- day of December , is B & H Development, Inc. , by: �.:. �. ---------------• ---------------------------------- --_---_--------(SEAL) ---- -------- - G!� ----•----..._.(SEAL) I Donald B -----..-- --•-----•• orestad ............... I --•-----••------ ----------------------------------------------------(SEAL) ........ t - �' (SEAL) s �I AUTHENTICATION ACKNOWLEDGMENT Signature(s) Donald Bjornstad it -----------------------------------------------------.... STATE OF WISCONSIN William Harwell ss. -------------------------•-------------------------------- ----- ------------------------------County. j authenticated this-�---day of------_�c.............. 1986. Personally came before me this ................_ y _ ....__.__.da of I r 1 r✓����t� rtsl �LG� tt«��I/ I' /. .. .-(.. c�---------------------•---------------- ..ui 19 the above named Krist'na Ogland Lundeen -------------------------------------------------------------------------------- ----- ------- ---------- R STATE BAR OF WISCONSIN I -------------------------------------------------------------------------------- (If n t- ------------ authorized by § 706.06, Wis. StatsJ to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kris ins Ogland Lundeen ---------------- -•------------------------------------------------------------- II Attorney at Law -- --------------------------------------------------------------•---------- j Notary Public ------------------------------------------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not nec(ssary) date: *Names of persons signing in any capacity should be typed or printed below their signatures. II WARRANTY nEED STATE R4R OF WISWONMN wiz n�in Leval Blank ('n, In(-. .tt-toc _ �.►a.oa.QO w I c,00 s -sit .80 Le ° f f ' f f OD e , � � e _ Q1 0 1 •� . �. .► N ci �► 01 s • .t�•wt � N N N ti O O ' W tq •� Oi • c t0 1 N � • O M• N - i3� 's� -15 0,Xf • , OF 1 � � I H S T C 105 r SEY1'IC TANK MAINTENANCE AGREEMENT St . _ Croix County. 0 z 0 9 OWNER/BUYER ROU1'E/BOX NUMBER �� ����:�7 Fire Number C I T /STATE vTDt1N/ 'LIP- YRO 'L'k'1'Y LOCATION : s 4 , E,�/ 4 , Sectiun �, 1' �y N R l W Town of f'J`/aw/J St Croix County', Subdivision (A)ILLG ¢//U� ,/� Lot numb'e.r Irnp oper use and maintenance of your septic system could- result ' n its pren►ature failure '.to handle wastes . Pruper maintenance 'con- s is s; of pumping ,out the _septic' tank every' three years o_r soo`ner , : if ceded by, a licensed septic tank �uuiLer . What you put into the system can. affect the function of the sc:htic tank as a treat - uien stage iii ' the waste dis1)0sa1 system . Sr Croix County residents ma be eligible to receive a .b rant, for s; a- Inc x fin um of 60% of the,cost of replaceuienl of a`;. failin whi it', was in ,o eration b `system, p prig to July; l , .,1978 St , Croix County a C e pted this prugram it Au.'f,u'st of•-1980 ,; wieh .t lie rcqutrcinent` that Own r.s of 4 11 new sysCeins abree : to keep 'their ,systems properly ... -- main t,ained . 11.Ite pruperty owner agrees to' submit to St . Croix'County Zoning . a . certification form,. signed ,by the owner and by a' ma5ter plumber , journeyman plumber , restricted .�plumber or a ;licensed pumper v.eri-. fyinb..that (1) I t on-site was't'ewater disposal system is 1,i n proper operating c'bndition and`, (2) after inspection and pumping. (i.f the septic 'tank is less than, l/3 full of sludge, and scum. Certification form will be sent approximately 30 days prior to t h r e e ;year, expiration. - ...E I/WE,- the undersigned ,. have read the above requirements and 'agree to m intain the private sewage disposal system in` accordance with x the- tandards set forth , herein, as set by the Wisconsin Depart- u ment of Natural Resources . Certification form must be completed and eturned to the St . Croix""County Zoning Office within 30 days. of t e three year expiration date . SIGNED DATE St , 110 1 x Cc)unty Zoning Office p..0. E•ox 98 • Hamm r'd , .WI` 54015 715-'?S'6-2,239 or 715-425-8363 Sign date and return to above address . oEPARTMQNT OF REPORTS ON SOIL BORINGS SAND snFET,r& BUILDINGS INDUSTRY, REPORT DIVISION LABOR AND ,- P.6.BOX 7969 PERCOLATION TESTS (115) HUMAN RELATIONS MADISON,W1 53707 (1-183.090)St Chapter 145.045); LOCATION:I ; HIP NAME: S W 4W, s NIR�9 ( w &4k- [r S ( T COUNTY: 5-1 CP(-sla -VELOPMENT /NC- 11-6m S,•(' wy ST ao1�7r N wuid USE DATES OBiERVATIONS MADE NF..BEORVIS.: COMMERCIAL DESCRIPTION: Residence. New I❑R lags N K — •p Oc rokerk Z4 -86 1 Ic'. ZS a6 5014S &oK - A14ESl% SOILS $ t4#4 1Wr RATING:S-Site suitable or system U-Site unsulteble for system ONd : M - I K: ECOMMENDED SYSTEM:(Ational) S oU S ov S clu S VIlls I C0NVdNtrf6N4L ft-& If Percolation Tests are NOT required DESIGN RATE: eq If any portion of the tested area is in the under s.1-163.09(5)(b),indi at Floodplain,indicate Floodplain:elevstion: ►V A PROFILE DESCRIPTIONS BORING IOTA N A A 08 THICKNESS,C T URE,AND DEPTH NUMBER DEPTH ELEVATION HIUMEST VIED EST. TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK.) - 9 $C Stt_T'S 20 Rn1 S.t( /0 $Rst L 6'' Is$kr( QK B' � /o.OS 9 .70 46 >1o•a� 3"' S 7 N S k �"BLsttfs IS"Alt Stc 3 9kN MS4' 414CSt -7 R 13- Z 1? 67 9-, 9 No It > 1,67 74" beX MS V &P B- 3 $.� 7 7"gL"lok: S 17," RNSiL �, RNSC 6R S RAGS{ Q 95�C ON�= > $ 67 72" &-4 M S tb#. /�gLLTS 17'��k Rrr S.L;.9'rdaNS�. B- 4 4r$RN MS*6 R 00 9 g6 No t L > .00 6 " M s 6 k B- S 9.41 97 97 NONE >4.4Z 10 9LLTs z�"BQnS,� 6"I�HcS*41t 70"6" MS �6 B DE,-FT PERCOLATION TESTS TEST DEPTH WATERINHOLE TEST TIME - NUMBER It> AFTER S ELLING INTERVAL-MIN. PER PIERIDD 3 PER INCH P.. z.4S b&K 9s.9s 3 3 8 6 P. z 4 4Z P- ZO p r.r 1 r P- P- PLOT PLAN: Show locatio s of percolation tests, soil borings and the dimensions of suitable soil areas,indicate.scale.or distances.Describe what are the hori. zontal and vertical alevatior reference points and show their location on the plot plat. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 93.So __.. _...._._. -.. ....yr____--•-- - - t 1. — 5 txt . . _ i l.ar ' ' I wX+s j tN A • '!13/n 1 � i. t l4^i l �(>, /....� -' ' �t6 glee • ,, .. ; i,the undersigned,hereby certify that the soil tests re Is form were made by me in accord with the procedures and methods spec led in the Wisconsin Administrative Code,and thtt 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: ���aR Jorlry SO n/ pS : A 2s 1K ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional); 407 SE on►i4 S—, /�u+�svN W►. S�pl6 g� 3�s�•4o�� CST S URE: OU DISTRIBUTION:Original a d one copy to Local Authority,Property Owner and Soil Tester. DI1_HR-SBD-G395 (R.02/8.) -OVER - � B. 6 ? PITT ar� � , � � (-' 0S , ECTI 1\1 _ PROJECT I L0) MHF I � M AV E -LIB__- NAME_ t '6��"v /Als, L 0 C A I 0 _._._lJ.to _.lEpist I- I .0 E ICI E :7/t- 0-..C .5 1_ ) ATE k'IAP "'WBrn-50't 'IN V AIM Elea= Ioo.00' 130. r: of 7 5 fi{ \ 3 'y8' Lot Pa a�X53 ; ; 57' Io o 9p/ t' V710 t I � w ■ = $o EWE s y BedRoom A=TkRC hales Nom _ 3e ch IY1pRkp'�k IN 8 a. G Lill Elev.= 100.0 � lv (C/ass Y Perk FRESH All) INII.TS AND OBSERVATION PIVE CPpSS Si:CTION Approved Vent Cap Minimum 12" Above Final G.r a� _ �(_- FINA I GRAM- 4" Cast Iron Above Pipe I vent Pipe To final Grade------ arsh Hay Or Synthetic Covering Min. 2" Aggreg'al o Over Pipe istribution r !t v �+ Z — Tee Pipe -� Y-.---­--.1( _ Aggregate Perforated Pipe Below 3,�6p Beneath Pipe 4 Coupling Terminating At BAd _ -.._._ . ��_. Bottom of System