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030-2028-60-000
h I 0 a o 0 o N 0 o e oY o N C Cl) O p O V>>N '�M O C@ OMjr b N >. �... O N N > U p C 3.0 Op O 0I j� O O j- w_,0 tl O N Cpe tM Oa.x (6 2: v a ;D��� $m i� c�co ?, ZNocmL GGo $. ni>vof0E € I 'e y CD Mr- � M ca� cv oar I (ao o CD m-o 10 $� c� o a a:z moo) � m auiEnyo > I 3CC L ° c vm � NyM— oo N N ai y f0— N C O N O O N a) N p W :? cz m my o Lo o f c m °� z E 0 G)ioY z `� ai c z N�a���rn C a)t ii c °: ENv� �ca} LL c €'�' UO c oao`� 6mo� I m cwo I 3 ' I - r 'Mao0 :3 GD -o OMO O_cC O o�� Q HU. 3 c I M M (D M aa) z y z iii z I O r 00 I Z J m m € d at d N M O d m a m a m N I- O O Z c w o w y c o I d Z v c c c z to F- -E I m Cl) 7 7 N cm N d D! C C N O Q Q O O Q Q != z to z 2 z z Z Z z I N c C N N E R E cc I CL CL c CL �l o N O G a .0 N C G a .n a N G C d Q o CX) U) rm � L I o trn rm v> > a o N N N _> n zN > ', i3 a- " ° z I • a a a a a a a a a u, a .. o .c°. co o I v co N N J U = rn rn } = Z = Z v I �l O O N 0 a) 0 O) C1 •0 c, v_ co _v 1� M CL o a—' ¢I r in o d ¢ z v� m m Q z Fn o I 1� p O !, y N d' N N N C O C p N C O N C O E I O N 3S I p O ` O ` d O o o � O o y o a CD 'e N -e cc f Cc -0 N Cc Cc Fn N p N UJ C m N fn C m C m M N N M -) CO E c s c c :: E c c L o f cc o N (0 O U co ca • O N fn S Z S Fo- 2 Z N S Z O O N E d E a a aY' at a L a a L: a �+ m c y E § c ° c A () a2 OUnU 0U) 0 Parcel #: 030-2028-60-000 01/03/2006 02:07 PM PAGE 1 OF 1 Alt.Parcel M 22.30.20.440F2 030-TOWN OF SAINT JOSEPH Current X' ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-HORSCH, LAWRENCE L&KATHLEEN J LAWRENCE L&KATHLEEN J HORSCH 1404 HILLTOP RIDGE HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description ' 1404 HILLTOP RIDGE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.500 Plat: N/A-NOT AVAILABLE SEC 22 T30N R20W GL 4 LOT 2 OF CSM 3/822 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-30N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 845/600 2005 SUMMARY Bill M Fair Market Value: Assessed with: 84339 747,200 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 348,300 331,300 679,600 NO Totals for 2005: General Property 3.500 348,300 331,300 679,600 Woodland 0.000 0 0 Totals for 2004: General Property 3.500 348,300 331,300 679,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 308 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 � as PUMP HAMBER Manu turer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: '-Pump Size Elevation of inlet. Bottom of tank eevation: Pump off switch elevation. ons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from near property line: ont, O Side, O Rear,0 Ft. mber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL RPTION SYSTEM Bed: Trench: Width: Length: Numb of Lines: Area Built: Fill depth to top of pip Number of feet from nearest oper line: Front, O Side, O Rear,0 Ft . N er of feet from wel . Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: 136Q Number of pits: �' Diameter: Liquid depth: 15-6 it Bottom of seepage pit elevation: i'L, 3 Area Built: .60 Has either a drop box O or distribution box(V�been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK M�re Capacity: Number of ring sed: Elevation of bottom of Elevation of inlet: Number of feet from nearest prop e l' Front, O Side, O Rear, OFt. Number of fee rom wel . Number of eet from building: Numbe f feet from nearest road: Alarm nufacturer: Inspector: Dated: � Plumber on job: License Number:�S 3/84:mj 2 f- 60 2401 yyvF Z Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �� -/�/ ��n �, TOWNSHIP �2, L�SF_i} SEC. T N-R W ADDRESS RT ST. CROIX COUNTY, WISCONSIN 5 / , SUBDIVISION LOT Z LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A /. ' /,000 C SePT � ORy ��sf TAN/ L Lt 13 i% -\� W (..° a r 7 04 Ice (M � OM4M,E J I � I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used PATAO -5/-A/3 190JAt7' Elevation of vertical reference point: `ale'r Proposed slope at site: SEPTIC TANK: Manufacturer: t e- , _S Liquid Capacity: 140,716 Number of rings used: �_ Tank manhole cover elevation: Tank Inlet Elevation: OkAi Tank Outlet Elevation: 9 S (c Number of feet from nearest Road: Front,Side 10 Rear, 0 feet From nearest property line: Front,O Side,®Rear,O 'ye feet Number of feet from: well building: J8 i (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HOMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P!O!-BOX 1969 BUREAU OF PLUMBING MADISON,WI 53707 MCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: III assigned) ED Holding Tank ❑ In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Stan Hanks 301 S. 3nd St. , St -Ua teA, MN h9—III Al /O r 3o a,�'t, BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: SE SW, SEct on 22,T30N-R20W, Lat#2,Hatcomb Sub,Tawn v4 St. Jvlseph Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dan Schmitt i 3205 St. Ct oix 5$868 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TA NLET ELE : TANK OUT ET ELEV.. WARNING LABEL LOCKING CO ER WA6 ��© � 7 Y t P OV ED PROW D �/C✓" (/J /y YES ONO S El NO_ BEDDING: VENT DIA.: VENT MATL: HIGH WATER OF ROAD: PROPERJJJV WELL: BUILDING: NT TO FRESH ALARM: EEt—FROM ,C)J / LINE` � r � N AIR INLET: ❑YES NO ❑YES ❑NO NEAREST /t DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. JPIMI MODEL. UMP/SIP ON MANUFACTURER: WARNING LABEL ING CO R PROVIDED: IDED: ❑YES 1:1 NO ❑YES ❑N Y NO GALLONS PER CYCLE: PUMP AND CONTROLS O E AT ONAL. INUtu1BE R''©F PROPERTY JIVE LL. I ING. RESH Ir(DIFFERENCE BETWEEN ! FEET FROM LINE AI INLET: PUMP ON AND OFF) EYES NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of owl ng LENGTH DIAMETER MATERIAL A D ARK or excavation. (If soil can be rolled into a wire,construction shall cea a until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO DISTR.PIPE SPACING COVER INSIDE DIA.. #PITS: LIQUID � i N T�R'ENC MATERIAL: PIT �I t9fl�fylE?NS J GRAVEL DEPTH FILL DEPTH IDISTR.P E Df TR.PIP DISTR.PIPE MATERIAL: NO.DISTR NUMBER Of PRO RTY WELL: UI LDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.I LE JFLEV.EN( PIPES: FEET FA M LINE: . AIR INLET: INEAREST-----�►- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material r PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain t tit ON REVERSE SIDE.SHOW ELEVA- meets the criteri medium sand. TIONS MEASURED. DYES ❑NO SOIL COVER TEXTURE PER ANENT MARK E S OBSERVATION WELLS. ❑YES 1:1 NO ❑YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOI DDED. SEEDED: MULCHED: CENTER. EDGES: �+ DYES 1:1 NO j ❑ ES NO —]YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. TRENCHES: LAT SPACING: GRA L PTH BELOW PIPE- FILL DEPTH ABOVE COVER. FfT MANIFOLD PUMP MANIFOLD D .PIPE IMANIFOLATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.- CIA_. PIPES. DIA.: L" T7a� �f✓ir•.I�Ayrlri D Rf©UTHOLE SIZE HOLE SPACING. DRILLED CORRE LY: COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 'INF OR A;t"1QN:, PLANS. [11 YES El NO ❑YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: �IUNI�SOF LRNE ERTV WELL: BUILDING: El YES ❑NO 1-1 YES ❑NO 1NE}IIREST Sketch System on Retain in unty file for audit. Reverse Side. SIGNA TITLE: DILHR SBD 6710 (R.01/82) " 1--::� ;: 1 ✓� " f r INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system,type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size,separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. I wlsconsln APPLICATION FOR SANITARY PERMIT 64. ,®1 L H R (PLB 67) COUNTY w UNIFORM SANITARY PERMIT# �DEPRRTTEnT OF �j InDUSTR V•LRBOR&mumRn RELRTIOnS S-/R 4 —Attach complete plans in accord with s. H 63.05,Wis. Adm. Code for the system,on paper not less than 8'/zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER F MAILING ADDRESS _) 0 3,vo 54 571 414 PROPERTY LOCATION CITY: ,5C-114S /4, S gg2 , T,'30, R JOE (or TOWN — ' LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER tfo�c TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: OC New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench 51� Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity FJOV-12 I YVA Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: � e IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total of Prefab. Site Steel Fiberglass Plastic k Gallons T Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /.3 Q Private El Joint ❑ Public I,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signat S Phone Number: Dow (7/st S ya-SW C Plumber's Address: Name of Designer: T s�- o 1EE �` y ,_ COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved D�O4"Y El Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber . BOX 7969 - MADISON, Wi, 53707 IO FOR THE USE OF AN ALTERNATIVE SYSTEM Township/Raw"Nw Location: . St Joseph St . Croix Su SE3y SWf 3� 5 22 T 30 N/R 20 )W County: tree_t,. Tess: v eion: George Holcomg Lot Mailing Address: -Landowners Name: George Holcomb ✓�A� �� ' w ' Sf • ,S�a///u�ATEii? /�1iAIA/ I (Me) , the undersigned, hereby make applicatioO for an alternative system on the above—described premises. I recognize that the above premixes are not is suited for a conventional private sewage SWO IPthe Bureau's granted, a_ to have the system installed in conformance with of plans and specifications. I further understand that an alternative system is more complex dein nature than a nd private sewage system and as such inspection during construction and monitoring after the system is put in use. I agree to permit both county officials charged with administeringunty sanitary ordinances and Bureau employes or other authorized persons to have access to the above d4 scribed premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will 'send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been ''` obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the promises are served by an alternative system and further agree to Kive the bvper a copy of application. The Bureau accepts this application subject tc this understanding and subject to all the conditions and obligations set out ;n this application. r Sign1rture of Applicant ate STATE OF WISCONSIN Subscribed and sworn to before me SS COUNTY OF This <�, r� day of Notary Pu c, Late of Wisconsin My Commies Expires: DILHR-SBD-6413 (N. 05/81) Form - S T C 100 Owner of Property ` to/y &d,n• � Location of Property -Cg � $4/ 4i Section 2Z, ,T 30 N R ZD W Township Ph Mailing Address Subdivision Name__��,�« Lot Number Previous Owner of Property !; iL) cz� Total Size of Parcel 3,5 Date Parcel Was Created Are all corners identif able? No Include with this application one of the following : . Certified Survey Map . Deed . Land Contract , or . Other Legal Document which describes the property 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. 3 dR Z ;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. ). ,9 f SidNAi E OF OWNER SIGNATURE OF CO.OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 9 HOMEVTIS TESTING CO. FILED RT. 3, VNEIL ROAD JUL 2 1979 i 35 i X60 a`Croiof Cowls. tv CERTIFIED SURVEY MAP W'"°"'`' S37°04'W � ° PART R p O N 1/4 CORNER f"H o SECTION 22 T30N,R20W co CCD Cn 5° POINT OF BEGINNIN LO � M 1Wi —j.-1e'5° 158.70' Co �� S 7°0q,W ul T� Z � s G _ _ __ a of ROAD g6°�9.� FX1gTIN G 0 cam• •o ���� 16 ° sD DWAY f ING EASE MENT 1 ROADWAY to N700,4' ► EASEMENT W 0 166.00' 227.5 247.5 LL a Q tv N W J F►b>�E Z a� N :; Z o 2 1 ►- z RT M BLUFF LINE u ZI OW 'A _ ,,i� _ Lc '�' 1 N o F i 1 +I +' APP` VA[ CF This � o - - N v �---^" ` ,� ' M os DO_ .. : YRt CC., 3 d 9U�_i:f.ty a - ;i.i ;k?,IC. .`.Y. _ Lu co TF EFER Io Ii62.4. . 3.5 ACR�_S± 3.6 ACRES± s, at + SCALE IN FEET 1.3 ACRES zo Cq C; �� or-_ Io0' 20' " % APPROVED L0 W1 , `yMT tu � t�\ O O to a W ( ° h �, �1 JUN 2 1979 Z +> O) c �O �` N Z _, N 7010.204, N CO to O I o COMP.:_MENSIV- PAk4S PLANNING ` — — 3158"E �m LEGEND AND ZONING COMMITTEE MEANDER iq 249.55' v 0 1"x24" IRON PIPE WEIGHING _ ,• .68 ET 1 #/LINEAL FOOT,. S a +I BAY 'Ln 4 +� • 1" IRON PIPE, FOUND ,� m O LO CAT 1ON +I ±1 COUNTY SECTION CORNER, Xth1AT PEN1NSUl A HERNTSEN MDNUMEMr, FO!-ND + AppRO � OF BLUFF LINE I 1 Q o 1"x30" IRON PIPE WEIQiING� WATERS ESE 1.68#/LINEAL .FOOT, SET CR04 X I ST .01 I"x60" IRON PIPE WEIGiING 1.68#/LINEAL FOOT, SET LAKE NET PROJECT. AREA ��► OWNER TRUE BEARING George Holcomb R.R. #1 Stillwater, Minn. 55082 This instrument drafted by James T. Swanson. �a _ DESCRIPTION A parcel of land located in Government Lot 4 , Section 22 , T30N, R20W, Town of St. Joseph,, St. Croix County , Wisconsin , described as follows : Commencing at the S1/4 corner of said Section 22 ; thence S89°40120 (true bearing) 189 . 57 ' , thence" �J89°15 'W 93; . 4; ' to the point of beginning; thence N89°15 'ti�J 550 . 70 ' to a point which is 130 ' , more or less , from the water ' s edge of Lake St. Croix ; thence along the meander line along the lake N8 005158"E 249 . 551 ; thence N7 010120"E 228 . 92 ' to a point which is 2561 , more or. less , from the water 's edge of Lake St. Croix and the end of the meander line • the c °' 1 ; ° , n e. S89 1S E 573 . 11 thence S37 04 W 25. 591 ; thence: S52056 'E 66. 00 ' ; thence Southerly 279 .66 ' along a 534 . 11 ' radius curve concave Easterly whose chord bears S22°04 'W 276 . 48 ' ; thence S7°04 'W 158. 70' to .the oint p of, beginning, . including all the land lying .between the meander line and the water' s s edge..of said Lake St. Croix. . Contains 7V acres, more; o , ;less = TO A I certify that 'the a bove `description and map are correct and that I have ,`fully complied with the 'piovisions of Section 236 . 3.4 of the Wisconsin Statutes . � ...._ -. L Date : August 8, 1978 . Revised: September 6 1978 . Francis H.. , g en S-882 Jo o, _ ,gS Revised: September 1§, 1978 . Ogden Engineering Co. 123 E Elm St. River Falls ,,: Wis . 54022 i�OTE: Access to .the above," - T described from a public road must be provided.,,by a separate document. ` I hereby certify that this map has 117 en approv d by the Town Board. Date :---- CURVE DATA TABLE h... URVE LOT= RADIUS', CHORD CHORD CENTRAL TANC>ENT N ��--O. N0. LENGTH �,R . LENGTH UNG . _ ANGLE BEARING L-2 - 600.11' 13-0.6 ' 2 4'E 30°bT' . l4rE l .. 600.11' ' ' 83.87' N11 004'26"E 8 000152" . 2 600.11' 228'.86' N26004'26 11E 21 0591081' i_4 - 534:11' 276:48' : S220041W 30 000r S7o041w The roadway shown on this map is a private roadway. Any maintenance costs of the private roadway, after its approval �%\SG� �i,� • by the Zoning Administrator as a �1� NS/ standard road, shall be shared pro- rata by the adjoining property FRANCIS OGDENH IL certify that the bluff ot,mers. Should the roadway be taken s882 line and the net project over by a municipality as a public " RIVER FALLS. Z area shown on thisr-man road, maintenance costs thereafter would be a public expense. ' �S' 4 Wis. Q� are :correct to the best 40 -��,�.. of .my :'knowledge and. belief. 4#00, f G H � r - n s � w CA Lr :: fD W ? C C N 0 ,C3 N N O 7C o o (D 7 1 w m !: ?;a 0 O m cc on I A Cl. m� (�D �» o n z cN� �c D o a c) � j N O p 0 ir 0. o c o -. 0 ' w o Oc `< 3 m o c Joao ww ,. a � wQ; y. c � O � O_ a - O (D w (p C R a Q Q N $ = D O A w ) a n(O 0m w w O (c am. m C w w w 0 A o � wD * c D, p N CD O N m a a 3 , (Am0 M war: =r _. e (D w ? am C f�t1 :r �r CD c =r oaw a C1 O � a A c c O c . f to Q 3 � -% A a m � w Cl% 3a co Cawo m a 0 M - O (D N 7 ao crm -+ w (A O G)Q 7 C to n N o O a C C maA a °c t° w = :+ =r S. } .>.. ago- c � woO3 ...:< ga aC oo °d3 so a O < CD oQ c >;<. :: o TES> a� rvFw ,(/,f?60ocv 4eF7* - 20 X7. INDUS TMENT'OF Q,�j� PORT ON SOIL BORINGS AND SAFETY& BUILDINGS LQBnR ANa LV MIO - DIVISION P ;PERCOLATION TESTS (115 PACrE 6F P.O. BOX 7969 HUNAN RELATIONS p ADISON,WI 53707 • (H63.09(1) & Chapter 145.045) Z pf}(rFs LOCATION: SECTION: TOWNSHIPbMk+Pdi@hPt'�t Y: LLI� NO.: O.: SUBDIVISION NAME: SE 1/ 1/a 2-L /T3 N/R 20 E (or)W S>/ s �- - 3 "7q6 o �2 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: R LATION TESTS: IrResidence ` y New /SCS 33 s�"�A ��ip�OW /1,PE'�¢� RATING:S=Site suitable for system U=Site unsuitable for system i90JA U CONVENTIONAL: OU IN_ -GRR�OI1UND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) S ❑U IMOUND: RIS ❑U uS ❑U ❑S ®U ❑S ©U DEurr COAWEA)41 aAL DAYWd//s E w — S If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicat(: CL1{S$ Floodplain, indicate Floodplain elevation: / o ,fTt ; PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B / Zo.o y�Zs' - >�O.O ' - 33 ' RA)-Gy S A3? ,�. G/ s �.o i.r c4.c12 ax. n�q S/ /S .o � �� as 14y u B- /5 /f 0 ' /°EA yR.l vim/ d CS M/')( w i d(. 0_2- /90 f3. /p� > /8. 0 s.l a.o V A"i. /S w 0 C 4-,L 4S 1'• B- ' ./D. O pso- ` R,. , C s- 104• C*.d- B ?3 , V- y 7 N G 3 O O , ,q r. 414A.PPS 0a 13-J.15 a rbfL aR PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT t PERIOD PERIOD PER INCH P- E L vff i,UE Gdfi)S E ED . Evious- P- D dKa,- T,—UrS �A "O G 74W L AJ E 4V rR£ Zi�vl•1��P G�i V P- 6 V Y M L / Nh,( I" Z'Z/016 6 A oelo yo/4s_w � P- G i A),+Z P- P_ 7 k-S' eO /.S 5'0/r E- FV11 000) Eti i ,0 4- 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. 060 f o-1 !//���f//•S 1 2 . -7 J {T' SYSTEM ELEVATION 4 _r -his hest site APPROVED I -- � S S8 nve� i_ uctystem ' CPCOGAT/o,✓ ' lesTy k i Acv l� — - �S p s� i E Ile i/If s ( (3 0 -H o I o / � Q _ 'wYJ� J - ;-_ � i _m. S Co" 40 IAI ..5A,r -' Soi G fY %r�GS > 0 , t f tt r I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and meth* . ' 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): �1 TESTS WERE COMPLETED ON: MOMESITE-SEPTIC PLUMBING CO. 5��7 ADDRESS: UDSON,WIS.54016 CER IFLCATION N MBER: PHONE NU ER(o_ptional): ROBERT ULBRICHI �f 'O L y0 CST S ATURE: MINN.INSTALLER&DESIGNER LIC.NO.009.'-' DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. 1 DILHR-SBD-6395 (R.02/82) —OVER — REPORT ON SOIL SORIN &S PERCOLATION TESTS 115- tof Z Poor PLAN PRoT Ec i ='. D, Siit� �i9N�S CUM 3S 7 76 0 DATE Ile g92- :) k•IOMESITE TESTING CO.11T.3, O'NEIL ROAD BOB ULBXj(;.:r i4UUS0Nj WIS. -- 54016 C57- SS-02 yeZ PROPOSED HoosE MosT LIE 2-;' Fr. pe Mote "o,'1 ALL TEST �9,PEAS, PRo POSE 0 WL u M vsr LIE 5p FT o� ttORF FRom A�� TEST ��PEigS, • = 8,4a ,hr PI 73 O - XXiSr1,0 6r W el-l- �( _ AEQG Icew-/ONf -A = f f,4,vP o,Q 54odEL /.34ee5 r ° yoriz . B M Vtkl'IcAl- let-AAAWcr- PoiA)T r'lo 9 covr' t 64act- FENCE P05r Ph Ti o si DEZJ/f j�/K - 2C>yR y4,e O LE GE N p 6 1-041-10AI of t1lar. ,pE` Pr /0 0 . 0 ona C�CifrcA-� � r31�ofP ys /L 3 �iPM ho�rF SGopES 2`0--y 5,� 30 6 1� VERT• /3L pr• iN �',cccsf � °F 3o /o I e'Poi,c /?iUE�_ R 1, Pars n A� ,pox. ' �� ' 1 POO A fiD R 3 to r d A s test gto fa�00 sY t�,,�priver► f}�76RNAT�" y02631 � � 1 , i ` I 1 : j Er 50 f � FLU�' r r,I 7iT 3 S 00 L3 0 L3-3 I� D I i I� ,I U I i 1 L ` _ p1 I ew' - �e ; 14311 $yo pR4&)/N�- BUR ' DRS uNry e- 1 i Rb i I ' I ' SST, cTvsE�� �•��' + _;s �!(��,� ;�o.�' =� ; L'ti0�` I Y � , 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 El CONVENTIONAL XALTERNATIVE [tfate Plan I.D.Number: assigned) El Tank ❑ In-Ground Pressure P? Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Stan HankS 301 S. 3nd St., StittwateA, MN BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: SE SGI, Section 22, T30N-R20W, Lot #2, Town o4 St. Joseph Name of Plum ber: MP/MPRSW No.. County Sanitary Permit Number: Robert UtbAicht 3307 S Ctcoix 54944 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO BEDDING: VENT DIA.: VENT MATE. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: TO FRESH I ALARM: FEET FROM � LINE IVENT AIR INLET. DYES ONO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING Liy LOCKING COVER PROVIDED: PROVIDED: ❑YES 1-1 NO DYES DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY IWELL. ILDING. V ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) 1:1 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: ` WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING. COVER JINIIDE DIA.. #PITS. LIQUID . ° " TRENCHES. MATERIAL: PIT, DEPTH: 'bl�+lENS�t GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER F 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 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 NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS. ❑YES ❑NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEE DED. MU LCHED. CENTER. EDGES. 1:1 YES 1:1 NO ]YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: �yt WIDTH. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. '8E42 EN H ` `' TRENCHES L?( E 1415 ' MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.. ELEV: DIA.: ELEV.: PIPES: DIA.: " ',hv'. OR�t1AT11N•. HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED A PLANS. ❑YES ❑NO -]YES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMOE #'Oipr; PROPERTY WELL: BUILDING: FEE T',F IOM° ❑YES ❑NO I ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710(R.01/82) INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city,village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years.Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. wls`°neln APPLICATION FOR SANITARY PERMIT DILHR / OUNTY DEPRRTmEI-IT OF (PLB 67) UNIFORM SANITARY PERMIT# InDLISTRV,LABOR 6 HLIMRn RELRTlOns (�..I.J_//17 41 y -Attach complete plans in accord with s. H 63.05,Wis.Adm. Code for the system,on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS 5 �N /FN e 3 o/ Sa . 3 PROPERTY LOCATION 1/4 SW 1/4, S Z2--, T R N, R 210 E (oO JN ro OF: LOT UMBER GLOM N�MSBrER PSUBDIVISION O nN%ME NEAREST ROAD LAKE OR LANDMARK ST�ATE�LZN�.D. NUMBER TYPE OF BUILDING OR USE SERVED I►/ 3 //j/ 33- O Y 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: I&NeW System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System M ou /t/0 ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System In Fill In Ground Pressure ❑ Vault P ' ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is Permit # issued ❑ An Existing System That Has Been Inspected And Is �tA Far As Soil Conditions. otal #of efab. Site Steel Fiberglass Plastic Gallons Tanks Concr Constructed Septic Tank Capacity Lift Pump Tank/Siphon Cham Holding Tank capacit Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity MUD Lift Pump/Siphon Chamber /dvv Ll- 4 Nxe Manufacturer: & c 401t—foo— C CA R _— WE j PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3, / ) 5 aAs''C A4F4 /,1 S • ] Private ❑ Joint El Public I,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print . gnature: MIT -/MPRSW No.: Phone Number: R .3 O'NEIL ROBERT I It 8140T I RD.,HUDSON, MS. 016 `41 — 133 Q Plumber's AddressMS.MASTER PLUMBFA LIC.NO.3307 MARS N me of''Delsingner: MINN.INSTALLER&DESIGNER UC.NO.00663 • �KKi� l�i(4 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 1,14w !TV- 17 1,9— Owner Given Initial /" a! Approved Adverse Determination Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber J w T ,D E X S i7',E- G o r z C.S./V. Z)o c. #t 3:5 7q 0/ 6101 311 SE/y S to 57-7-z 7-3 o A) X z o v S>t. L,e , 3oi So 5--74- . S 7-i/l W,-t 7-&"f h t4,t, . PE ,1�ESr'61V 14 � Lt' /VI el p SysTE," SS'I'fE' ��/�C�L fI/3dU� sf}tifE d w,v�i ptri�vE� /� �%�/'ER �n�f}-pr1E�'i�•v�'// Ei'PE c rev r�/O vS� d vER Oft �G-i�tl�p-L lfP/R p v'5D /?p v v,p 5/7 67- / ��t ">�• 7 30 q 233 1 T6��4 4 �4 e. SE/EG7`E!9 17�e`57-E19 ouv p INNS "V c/o Sfl 41"Af . m E w e iP�r 13 0 F t" ,PA I G y T%e5 �r/1 T"ED w>g s �=/o cv �s V3"O PI-5 . PAG E 1 . P/°T PG,4N 11115 Gvs Z M0�1JD CROSS SECTI01`1 SySIEN} PLAN VIED PAGE � PAGE 3. P( PE L,�TERAL LAYOU I C HAM fat R cP OS .s SEC 110 S y . PAGE s PUMP PERFOPM At,) cE SPECS . 5. t ' Mm 211984 V003 14(3 HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD.,HUDSON,WAS.54016 ROBERT ULBRICHT WIS.MASTER PLUMBER LIC.NO. 3301 KKR.& MINN.INSTALLER&DESIGNER LIC.NO.00663 5CAIE ( "30 Noadt, AD-(— may' G w Ppf OSE-P �9 R� t p sil�Grro� c r t Lot Z t � �,Fr �p o . ice° S mow= t5 3y ,SAY 2 1994 W '� P z•` �Q3 Q�nU BUREAU .� � PLUM (n 0 gg P�. EQ 1. REF A0 'kip 131D IoT L+aE � 73' �- --=• CST a /*" r SE LOT AN � / f Lo+ 3 OJ 01357ERVArIoN P119,c' Page , Of _ D,5T,4iGS �obSE 1= Straw,Straw, Marsh Hay, Or RE.13AR IN sE� S;nthetic Covering 7v A th � Distribution Pipe ! of3SER Medium Sand Topsoil Ef. _ n CJ b U /0 % Siope ^ 07 yOU Bed Of .12,N- 2 Force Main Plowed Aggregate From Pump Layer D Ft; 3 n S/J'TS Ar 13f{SE (2-) Cross Section Of A Mound System Using F Ft. 7v A!/ow rope /doNDiw F .7 S Ft. fpIU,-.ui To �P,4lfE- N A Bed For The Absorption Area G I Ft. y.,'�pUC 1 . A 9 Ft. H 1. 5 Ft. Signed: Y B 4/1 Ft. License Number: K _jj Ft. Date: L 2(� Ft. d 7 Ft. Alternate Position I 17 Ft. of Force Main W 32- Ft. L r --------------- Observation Pipe--.-,\ ------ 1 A L---------_------ ----------- �o-_--�- ----- -------- ----------------------.f Distribution Bed Of 2"� 2 2n Pipe Aggregate 1 Observation Pipe Permanent Markers s7E�z- k /IAA s, SEr /vim Plan Vi0w..Of Mound Using.A Bed For ,The Absorption Area ��CEI��•C� I AY .211984 AO PIABMG s. .. ....,.v..::...,,.M-N va.. :::y,:.,.__, ,u..,•,,: ?�:�j}�,_^+r�a•.YN`!e'+.<;�s.'i'��:d:i'Ltii�' +:'. e..x•,z:>`:L��...i "a". '�- Page w. Of WT SET Perforated Bipe Detail urRi� T f End View Perforated End Cop] a \, PVC Pipe • J �4�a Holes Located On Bottom, S Are Equally Spaced '�T� •Fi �^c PVC Force Main r Q/ PVC Manifold Pipe Distribution �`�IVIED k Pipe 1 1984 w Last Hole Should Be 1YlM� Next To End Cap 1 Q�IR�A� End cap / D�srrip�t�on Pipe Loyo�t 23 P GPaAt31R!G P Ft. R 3.2— a, Inches . Signed: • Hole Diameter Yl Inch Lateral �t J Inch(es) License Number: Manifold Z Inches Date: Force Main ►` 3 Inches _ # of holes/pipe 01 15T U!�D� Pl t DiSCh11�' R�1Tt Invert Elevation of L.aterals9y� ft. r3 P - �2 hfAD . 5 (� : I - I I 5 5 .n ost D tRUoI �ME SPECS C9 5 -164 I of 3 FoecE M iN 23. s U yy' .�T"',. _ ___'��•� n PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOMS VEII i CAP WCA-FI1_il ZO O PO _APPROVED LC.KIi.IG _ ` fl,*]HO_E COVER i2 � I I � �oVrII T COUDUIT ---------- t�. I _ APf POI)ED WATEP 86•� �' �' .r \ ll1 ST b _ PROVIDE U-ILL- T A AIRTIGHT SEAL I I I � I III i + C i� III �,pw:.R:4 APPR* VE0 _. _ A i,i'Y t�t� .urs i r I I I w/C.r r> w/.r.T, PIP,' r r e••�lt ; PF�t'T 'rR1T Oc 11VL4 I I I EXTENDIMG 3` EXTEMMUG 3' 1 ALARM ONTO SOLID SOIL ONTO SOLID SOIL _., :�� I II Fr. _ I I ON g y 90 c ELEV. FT. t IEVA7-i0a, : X3,75 Fr. PUMP OFF IAJ 5i PE 0 TRuK 130"' G CONCRETE BLOCK AY 2 � 1984. RISER EXIT PERMITTED GNLy IF TAUX MAMUFACTURER HAS SUCH APP NG L,�;;=AU SEPTIC E 5PECIFICATI0US .DOSE NU / TANKS KS MANUFACTURER: �E�SE� COWG�{JL MBER OF DOSES: PER DAB (� TANK SIZE: /0-3rV GALLONS DOSE VOLUME GOcr LU 'P /= $' c INCLUDING BACKFLOW: GALLONS ALARM MANUFACTURER: I' Z3 z MODEL NUMBER: LAS '1— CAPACITIES: A= 2�0• INCHES OR � � GALLOAIS SWITCH TYPE' �F�'CuRy B=-pZ INCHES OR 3 7. Z" GALLOQ5 PUMP MANUFACTURER: raj OULV �Z H! ✓ C,= 0• S INCHES OR /7Y GALLOWS MODEL IJUMBER: ///" _4J/)0 5 ` "I'f_S D= /IS' INCHES OR GALLONS SWITCH TYPE: Afc"pGU/Z f/ F 104 )_3 MOTE: PUMP AND ALARM ARE TO BE AT�a,�rNE MIMIMUM DISCHARGE RATE 7-GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DtFFEREAICE BETWEE4I PUMP OFF AND D13TRIBUTIOIJ PIPE..� _ FEET %AN1[ S�EC� + MIIJIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET -F . FEET OF FORCE MAIN X ` F 00 FT.FRICTION ACTOR. ''7D FEET q&p J� TOTAL DYNAMIC. HEAD = 1-1, 70 FEET INTERNAL DIMENSIONS OF TANK: IWIDTH ;LIQUID DEPTH A SIGNED: LICENSE 1JUMBER: DATE:. A ' k x l &....v. { Model 3870 Submersible Effluent Pumps a 140 120 �I js r .'1, '• _ - 100 -jt- 1 � I t_T�Y.Y _ _ _ i.. i - ' ( a 80 �. T i d c gp t. r� wPy �) } y — _ y WPM03,1/3 H.P. 7 1- -- - - r 20 ^ WP03 1/3 H P. _._.. - 14fT 0 20 40 60 80 100 Capacity—Gallons Per Minute y 2 �194 IS r vL Max. Wt. H.P. Order No. Volts Phase Amps RPM Solids (tbs.) e q r WPM03 1E ' 115 9.4 € W { 1750 56 P0312E WPM0312E 230 j 10 s 1F WPHO511E 115 16.0 /a WPH0512E ! 230 8.0 ° 60. WPHOS32E 208/230 i 3� 3.4 I 1 p n # �� WPHO534E 460 I 1.7 e �? WPH0712E 230 10 9.0 �$ ,1 3/4 WPH0732E - 208/230 i 5.4 z M i s m rt A € a 30 -� sa xt WPH0734E 1 460 I 2.7 70 WPH1012E ! 230 10 11.6 1 3450 '/:' M -2. f t 1 WPH1032E ! 208%230 6.4 WPH1034E 460 30 3.2 WPH1512E , 230 i 1m 13.3 fi WPH1532E j 208/230 9.2 - y!`} WPH7534E 460. 30 j 4.6 I 80 WPHH1512EI 230 1 10 13.3 1 f ` y WPHH1532E1 208/230 30 9.2 x wRsr x fi WPHH1534E! 460 ! 4.6 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. 3 it ---. ___.._.. _-.- _._._.. .. .-.-.... -...z jArl .. ..._ � n I Y ST. CROI X COUNTY WI SC O N S I N ZONING OFFICE El 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 14, 1984 Division o6 Sa6ety and Buitd%ng Bureau o6 Pturhbing P. 0, Box 7969 Madison, WI 53707 Dean Sit: An on site investigation bon the Stan Hanks pnopenty Located on Lot #2, in the SRI.- o6 the SW 4' o6 Section 22, T30N-R20W, Town o6 St. Joseph in St. Croix County, keveated suitable 6oitA at a depth o6 34 inches, betow which seasonabte high ground waxen was noted. This site shoued be su.c ta.bte bon a mound system. Showed you have any questions, ptease beet 6nee to contact #L" o66ice. Sincenet y, J Thomas C. NeU on Assistant Zoning Admin%sfitaton TCN:mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS • DIVISION OF SAFETY b BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Ctoix Location SF 1/4, SW 1/4, Sec. . 22, T _N, R�Q � C W Town dW)0Ci& &)02*>d?§K St. Josyh Street Address Lot No. Block . Subdivision Landowner's Name: Sian Hanfz�5 The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: 1XIto have one of the first five approvals guaranteed for this year. This is number 59 - 05 - 5 of those applications. (Use one of the first five quota numTiers ssue to you.) one of the applications needing a quota number. The quota number assigned to this application is - - L._Jfor one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ]for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. 1 .1for an application on file prior to February 1 , 1980. 1__.1for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. 11 I certify that the above information is true and accurate to the best of my knowledge. Name Thomab C. Netzon ---Signature County Official Title M4iztant Zoning Admini6tAaton Date May 14, 1984 DILHR-SB)-6158 (R 12/82) STATE OF WISCONSIN-DtAlftNT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING • P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Townsh ip "Wd : SE kj SW k S 22 IT 30 N/R 20 mw St. Jo.aeph ST. Cuix Street Address: Subdivision: County: Landowners Name: Mailing Address: Stan Hanizz 301 S. 3nd St. , StiUma teA, MN I (We) , the undersigned, hereby make application for an alternative-system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted , I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. 1 agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved. the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19_ Notary Public, State of Wisconsin My Commission Expires: DILHR-SBD-6413 (N. 05/81) 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 cormercial project; 3. 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; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagrarn 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; 9. 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 appropt iate 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 - Nigh GrouMdwater cs - Coarse Sand Pere - Percolation Rate rned s - Medium Sand W - Well is - Fine Sand Bldg - Building Is - Loarny Sand > --- Greater Than `sl Sandy Loarn < -- Less Than 'i - Loam Bn - Brown *sii -- Silt Loam BI Black Si - Silt Gy - Gray cl - Clay Loans Y Yellow scl -- Sandy Clay Loam R - Red sic[ - Silty Clay Loam mot Mottles sc ..- Sandy Clay w,' vvIth sic - Silty Clay fff -- few, fine,faint c Clay cc .- cornrnon, coarse pi_ -- Peat tarn Many, medium m Muck d - distinct p - prominent H W L - Nigh water level, Six general sail textures surface water for liquid t aasle{disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securmo a saniLary permit. The county or the Department rnay request ve ication of this soil test in the firlcl larior to pwrnit issuance. A complete set of plans for- the private s ag;e, sysi�eni and a permit application mr.st he srabmitted to the appropriate local aw,o€pity in order to buain a permit. The sarsitar r €rr rit must I,e of tainted and posted l��i for to �tnc start of any construction,: DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION INDUSTRY, LABOR AND P.O. BOX 7969 T 115 _ HUMAN RELATIONS PERCOLATION TES T115( ) MADISON,WI 53707 (H63.09(1)&Chapter 145.045) .3.,5 Aae5 LOCATION: SECTION: .TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 5e- 1/ 1/ az- /T3o N/RZO E (o ^5-/• Mo s E P 1- Z C M. 3S 7'76 o 1/0/ 1 P .Uzi COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: T _ / . USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: rrtte� PROFILE DESCRIPTIO-Nj� ERCOLATION TESTS: 04Residence 3 — IAJNew ❑Replace 7WA �� /��Y r �Q i RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) os u asou - osau osau osau MoUA � If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: � 'OXCr�to2 Fr ,," PROFILE DESCRIPTIO/A.) NS $ 33 11V, MAP S— 441-111 5'i0Y5vbS7"P'125tS BORING TOTAL DE PTH TO GROUNDWATER-IN • CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) I •67' 13AY.fl;,, S, /,53' Z'f• 0a. S" '7.571 B- (0.0 l�2.�j8 Z.8 �3 y . 4 7' t 13P4- S C L w I 4G, vrs r. cem.,s-9- o,s-6 N Of S •7S o,P S W cown*a M01St / 7S' B- AAA Scl. w ea-+ - oR-6 , M6fs aT G.p '—LiatES-toAE I ,R, 3-"40. /S -t3' I3N-(-Y- S, -247' "t .5.)mo .� .S' ae. B- z 3 S' . 70 3 . 7 3 9 sjq. s /.33'of SIC/ &Ht, 3is1'. 60-6y. no+s , ' 38' /v-6y. S /33' /-/-93a . /5 • 2-' L/' Q4 v"P. S/ B- 3 &.6 P2- 3 e f � is S ' N f� S'I B- ro F _r., B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P- P_ 3 / / 2• Cv P-_ P- 20 l PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Descr �1 a, e hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and gil'ey�tio d,p� nt of land slope. Pi pr IAVER7- _ c�`� yU F7'. ��, � n .� SYSTEM ELEVATION __ - • 1 �' j I x fi m € j s _- ---_ ._ L tN _4--- #. _.. 'Ole' !. �- 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 loceltion of the tests are correct to the best of my knowledge and belief. NAME(print)- TIOMEST I E I ES I TIM CO. TESTS WERE COMPLETED ON: aTA72 APPROVED SITE EVALUATIONS (PERC TESTS) 9A� /O - / ADDRESS: MINNES0 I A LICENSE NO.U0663 CERTIFICATION N14MB ER: PHONE NUMBER ptional): WISCONSIN LICENSE NO.55-02482 s f ^`0 L •L- /S'3�(o—�/ HUDSOY2 W! 54016 CST SIGNATU E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — REPORT ON SOIL BORINGS ; PERCOLATION TESTS 115 Pear PLAM PRoJ-EC-i I'- D. 5T-AK� t4�� Ks EIS Mc pAT-E ( .5 - s� iy Sw%y s'z Z,7-3O, 1?20 w Go /- .Z o'St9 3 12 16 o HOMESITE TESTING CO. oaf.3 - VT. 3, O'NEM ROAD BOB UL VI; (,.;. AUUSOM, WIS. _ 54016 C57- SS-aZ yeZ pROpo5ED Hw5z moor UE• o4 MORE "oM iyLt rirv- lcmE,45, PRo poSE D weu M vsr LI a: 5o F-r. ae AeRw PrPom i 11 rEsr ^ez-.4S, gAaWoE P%rs wU "AM/Al 6- WELL PEQG /ocw-lowf = f/ANp f}t19E.PE0 o,Q S�odEt /jorES BPS (TIP) 2 54,E t L 1 P' p E-5 OF /T 1 6-ff' Vol-7 �90w LEGEND csT . /fv�row ©f v0r. fir. cc)(S T/,V 6 - ,C)c �3, E x,'S r1A) fw�+E Co c1 SfiPvc-IMA) 15 3 s-,j e4j,)' Pot? S ou u cj�a G� a T r rS' a• 3 0 10 c T (4 pip 1�4 uc /010 R r R p r p t i t Pip 3 oti 2,3 Fl 50of-k [of- 1 IX3 E- • y5' • pill "'�°""" SANITARY PERMIT DILHR County GROUNDWATER SURCHARGE WNXJSTFW.Lo Sanitary Permit No. S�y yy On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground Wisco h,F, •„ SlOnature of Issuing A ent: Groundwater Fee: Date: �`��'��"€ • buried DILHR SBD•7289(N.05 184) 1 Department of Industry, Labor and Human Relations ��•UMSCCX1SW1 I Division of Safety & Buildings DILHR Bureau of Plumbing R �° � P.0. Box 7969 OEPRRTrMrrT OF ;FC "9 adison, WI 53707 Ir=USTRY.LRSOR 6 R MUWr1 RELRTK3nS A �� *9F 'i 1. (608) 266-3815 ?l IDy'2�� N CORRESPONDENCE � 0%F��' 8le I °� IFICAION PLAN NO . N OF PRO T �RIVATE SEWAGE ONLY - ❑ GENERAL PLUMBING PLANS Q Fee Received: Z_© 2 0 AT Priority Plan Aeview Only CITY OR TOWN Examination of plumbing plans and specifica or this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of when required inspections are to be made. Tgl t,30 laVant, iArta,llatioa 11&6 Agt b@9wA within two yearr. ;Er.--m thic- date, approval will 130 vaid and Poll! plan approAgal shall he obtainarl h-f QM-wack-AAY - _ In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. For F'sivate Sovvage Systems On:y: Sincerely, This approval ;S valid for hrNo years or it will be v;ilid until yj ,; the expiration date of tAs initial James Sar9 t, sanitary permit. Bureau Dire or DAT 7 cc: D S {'6GJS� Owner H & R & Rec. San. Section Loca`�'TT� Plumber Bur. of Health Fac. & Services ounty Other DILHR SBD-6099 (R. 05/82) DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&7HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON,W1 53707 BUREAU OF PLUMBING ❑CONVENTIONAL I NALTERNATIVE State Plan l.D.Number: 111 assigned) ❑Holding Tank ❑ In-Ground Pressure 91 Mound 18304233 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Stan Hanks 301 S . 3rd St . Stillwater , MN BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: SE SW, SEction 22 , T30N-R20W, Lot 2 Town of St . Joseph Name of Plumber: M .: C ounty: Sanitary Permit NumberAnthony Zappa St . Croix 38548 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO OYES ONO BEDDING: VENT DIA.: V jALARM GH WATER . , ROAD: PROPERTY WELL: BUILDING:IVENT TO FRESH NVQ. „,FROM LINE: AIR INLET: OYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: :nI NG: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL F NG COVER PROVIDED: DEDES ❑NO ❑YES ❑NYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF" PROPERTY WELL: :IVENTTOFRES;T (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) 1:1 YES ONO NEAREST SOIL ABSORPTION.SYSTEM.Check the soil moisture at the depth Of plowing I 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 CONVENTIONAL SYSTEM: y WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER JINIIDE DIA.: #PITS. LIQUID TRENCHES: MATERIAL: DEPTH' C;�ItU�ElSMONS .. "'. . GRAVEL DEPTH FILL DEPTH 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: PIPESEET FROM LINE: AIR INLET: NEAREST 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- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑ DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. ❑YES ❑NO YES ONO SODDED SEEDED: MULCHED: CENTER. EDGES: ❑YES ONO 1:1 YES ONO 1-1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BEEI/TfI;ENCI"I WIDTH: LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: DIIkN1Sf� - MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. ND.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.. ELEV: DIA.. ELEV.. PIPES: DIA.: E EVATIQN,ANIP .QRB♦ IflN HOLE SIZE HOLE SPACING: DRILLED CORRECTLY 7ATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED IbRM%'1T1 PLANS. ❑YES NO ❑YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: aE PROPERTY WELL: BUILDING: FEET f#OM` LINE: DYES ED NO ❑YES ❑NO lit Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: DILHR SBD 6710(R.01/82) TITLE: INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city,village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm.Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system,type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. wm`°nsin APPLICATION FOR SANITARY PERMIT , ^ �r DILHR OUNTY (PLB 67) UNIFORM SANITARY PERMIT# �OEPRRTTEr1T OF VIOUSTRY,LRBOii 6 MUTRr1 gELRT10i15 n 0 —Attach complete plans in accord with s. H 63.05,Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNJEJ3 MAILING ADDRESS � .A/v 36 sa vJ4� 3., ,� s PROPERTY LOCATION CITY: 5� 1/45a)1/4, S 2'2- , T3�N, Rw E (or) vl GE: s�- VOS�I� LOT NUMBER BLOCK NUMBER ISUBDIVISION NAME NEAREST ROAD, OR LANDMARK STATE v��I. NUMBER Z M # 3 5 / &o j>6/. 3 �zz- ST S 1 . 3 TYPE OF BUILDING OR USE SERVED IX 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: NNew System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy 29,Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench F-1 Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber U Manufacturer: t-/ ,(J PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): '�"V 7S SfE S�-C.l + �/�NS Private ❑ Joint ❑ Public 1,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Pri t).Signatur MP/MPRSW No.: Phone Number: Z %gyp/ (7/S► 3Y6��Q Plumber's Address: Name of Designer: 72 Z /�'IONDt /Uo,� DSc�.v Lt1/S . COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: n El Disapproved Q ❑ Owner Given Initial �/p �(Q f(J 0 y Approved Adverse Determination Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber . . . ~ ` . INSTRUCTIONS FOR COMPLETING R3R8A 115- SBD 6385 To be complete and accurate soil test,you, mpou mum include: ' 1� Complete |oox| description; 2� The use section must clearly indicate whether this is residence orcommercial project; 1 MAXIMUM number of bedrooms or vornmerd*| use planned; 4� Is this o now or mploo*menusystem; 5. Complete the suitability rating boxes. AS|TE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 8� PLEASE use the abbreviations shown here fo,vv,ihny profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test |wuodnns. Drawing to mm|e is preferred. A separate sheet may be used if desired; S. Make ouruyo", benchmark and vertical elevation reference point are clearly shown,and are permanent; 9, Cmmn|m, all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; iO� If the information (Such as flood plain,elevation)does not apply, place N.A. in the. appropriate box; 11. Sign the form and »|ncu vou,runent address and your certification number 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTH0R|TYVV|TH|N 20 DAYS OF COMPLETION, ` ABBREVIATIONS FOR CERTIFIED SOIL TESTERS ` Soil Separates and Textures Other Symbols st — Stone (over 10") 8R — Bedrock nob — Cobble (3 10^) 5S — Sandstone O, — Gravel (under J^) LS — Limestone °n — Sand HGVV — HiyhG,vondWatC, m — Coarse Sdnd Pam — Percolation Rate medx — MediumSaod VV — Well Is — Fine Sand B|dg — Building ' Is — Loamy Sand > — Greater Than °s| — Sandy Loam ( — Less Than °| — Loam Bn — Brow" °oi| — Silt Loam B| — Black oi — Sill Gv — Gray °d — Clay Loam Y — Yellow s| — SnndvC|oy Loann R — Red uid — Silty Clay Loam mot — K8cudes Sc — Sandy Clay vv/ — with sic — Silty Clay fff — few' fine' faint ~c — Clay no — common, coarse p« — Peat mm — Many, medium m — Muck d — distinct p — prominent HYVL — High water level, ° Six general soil textures Surface water for liquid waste disposal BM — Bench Mark VRP — Vertical Reference Point T0 THE OWNER: � � � This soil rest report is the first stop in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit ioua»ov. Aoon!p|!te eu,of plans for the private sewage system and o permit application must be submitted to the appropriate |ono| authority in order to obtain a permit, The sanitary permit must Ue obtained and posted pin^tq the,start ofony rnn�mntion. / M M OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INdUST RY,IJ�T C DIVISION BOX 7 LABOR HUMAN NDATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63. 09(1)& Chapter 145.045) LOCATION. SECTION: TOWNSHI /MUNICIPALITY: LOT NO.:BLK.NO.: S DIVISION NAME: ;r' 1/ 1/ Zv /T30 N/R20E (or �' sePo& �- GC-om 8 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 19-/,0-001x L V 301 Soles w5'1• y-////0j AB- USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCR PTIONS: ER OLATION TESTS: XResidence DONew ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system 2-5 / CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RE MM DED SYSTEM:(optional) ❑S ®U DS ❑U ❑S ®U ❑S ®U ❑S U Movvv o/uILY If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: M41eh-9 By 3111",Pj1rs. PROFILE DESCRIPTIONS SC5 3 yUh,(j4RD - SiGTy fubSTiC'-4T,q$ BORING TOTAL DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- AO' /o%36" 5.. 6 , p •s"QA'`Gy.�`'�� �s, yy,, �� ,e�,. coofsc l-s, 4/-.0,0 5c L -G . H o fS X 3 IF S�GTy GS �W£T AT ✓rho �� B- 47- �.�" 9�' yy` 3 8 ' %,�'14.a,�-�y L , -2,3 - 13�- IS, .83 'Zf.Qv_�,. , sCL Wi D/' / GT• -Cr •/tiO�S ./ i,uE AV- Lswi4�. .0%ST• Of.IA40tSjl -;I.Icy' G,PAy ''G Y B- w 010 7,f B3 6.0' 7732- a •8 /, $ 'L r' OAP-G . Mo 267. 75-, ove. 51 (0/ oR-A) -G-y. ,4o S, /. 73 '6%eAy Vc4 ' B- 4ciff, AAi!q Mo . 0,e- -.uo s — $•U,emcr /N fT PERCOLATION TEST TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN-fr. AFTERSWELLIN INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P- 0 P- P- eg. O 2u, I P-_ P- 0 , 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 showL their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. W�1E�?£ hAv/�dt'/.v S1hTE ,/9P/�iQOVEb $ � F � A1eeTS Of SYSTEM ELEVATION R_O_.G�"v _ � > � _t T ' - � "C S I - w _ w 1 E I 3 4 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. BOB UL&VIM NAME(print): 7316 TESTAS WERE COMPLETED ON: l3�-_� d, ADDRESS: CERTIFICATION NUMBER: 1PHONE NUMBER(optional): T =0Z Z R ,3 O'N EIL ROAD NUDSOK W& o.. C T SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— U L'`;� PLOT P,1-AM Ppzoa-Ec i D. �. HOMESITE TESTING CO. ;ri:9I: SON, WIS. , _. 54016 L'S r �- ()1.Yet PRoQoSED "ovsE mosr Lie 2.15 Fr. a� 1,0,?E �,QO� 444 re-sr 1%eE-45. pp-oposEo wELt M yr LI So Fr. ,gLL • = 9.4a*09' P;,r f Gtr = EXis» G- UJ,E l-4 X ¢ Aeve_ leehriowf = hAvP R u�,C,4zD n e 5kov,11- 13 5 a ` /�� '' . SAS %t L f taJt ' oi.+JT' T p C2 3� S7 tfo,4y I o,40, r" or 3 �� lotj if NcRd�G.. LaT' L- r L aT 2- Xp 7r> t t h 1 � t r I � o ! s G � ' 0 ti t 4 (A y ----�• o° �` r 7 4` co- o A y ? 10� will partment of Industry, Labor& Human Relations Division of Safety& Bldgs. State of Wisconsin gUGCF/f/1 "o Bureau of Plumbing Platting& Fire Protection IQ r 19� ti. P.O. Box7969 j '3 �-+ Madison WI. 53707 NA0 Tel. 608-266-3815 /Gr ti INALL CORRESPONDENCE REFER TO PLAN IDENTIFICAT/ON NO. NAM�4F P/ROJECT TYPE OF APRROVAL ' STREET AND NO. t CITY OR TOWN f OUNTY r, STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed.'ln accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. t The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. t�TPf TiTt tr iTas rrot�ee rrrmefleeet�rrri#h in-t�roer-yenrs fir h+is da#e ap v s�Ii�TC 6�cb?R tli5ii7" ii Pf�Vl�dpp IU UVPyovai-ottliese-i In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions,examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. t ,- Sincerely, For Private Sewage Systems Only: This approval is valid for two years or it �% li ce valid until tho ex ;ra lo;; date of the initial sai iital-y Per n-14. James Sargent-Bureau Director PLAr4S REVIEWED BY: DATE: cc: DPS-OWS Owner DI LHR Local PI Plumber H& R (2) County Mfg.Rep. Bur.of Health Fac.&Services DILHR SBD-6099(N.06/80) Rec.& Env.Services Department of Industry, Labor& Human Relations ' r `►, Division of Safety& Bldgs. State of Bureau of Plumbing Platting& Fire Protection P.O. Box7969 Madison W1.53707 Tel. 608-266-3815 r7 IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAM PROJECT e/ / TYP SAP ROYAL > STREET An NO. TY OR TOWN C T STATE 21P OWNER i Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications,plan omissions,examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. FCr Prnvate, FE''V' atr!a Systems Only; Sincerely, Tilic, ap-prow—1 is valid fic;r tvvo j:fDCirJ Or I} :•'Jill valkd until the date of the initial Sanitary pernnit. James Sargent-Bureau Director li PLA EVI Y: DATE: 2;7 cc: DPS-O S Owner DI LHR Local PI Plumber H&R (2) County Mfg.Rep. Bur.of Health Fac.&Services DILHR S8D-6099(N.06/80) Rec.&Env.Services t PRo�F"c% C'ausT�Puci�o�v O/C �1e�.uv St�oTic SysT�-M a!v 4 / icto Gor Nor ro,�vE,ui�o,�AL 57 y 5TEM . Go r .� ST PZ4 &,r Z- pl,oT AAN MOSS PA 6-4- � -L PI PE- GATa4L 7�hol— IAyou e +' P Pay �� Pll&f- -7 6;k, k o f� P t 7z 2- Mo,v Rom /s S yoo P� Ujtf/� s �� Ni c��P� _ S RT. I, WNEIL ROAD HUDSON+!, WIS. Seib ate' STATE OF WISCONSIN DILHR . . ' IL HR PRIVATE SEWAGE SYSTEMS BUREAU OF PLUM ING BUILDINGS 201 E.Washington Avenue,Rm 178 PLAN APPROVAL APPLICATION P.O.Box 7969,Madison,WI 53707 608-2663815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The bask side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales,202 South Thornton Ave.,Madison,Wisconsin 53703,Telephone (608)266-3358. 1. PROJECT INFORMATION Typo or print clearly) Revision To Plan Number: Name of Submitting arty(Plana returned to lame) Project Name / ��� c .SZO'y" t•2 L j/ j��}. '4 % Street&No.or Rural Route Project Location-Street&No.or Legal Description -7)-2- /-1elvPot" S/-- su/3,01VISio.-1 City or Villlage' 1 /� State�/,r*� Zip City ❑ County D 0� Village o OF: 5�. �or � 'CIC � Town J21 Telephone No,llnclude area code) 7� = 3 .' -) '?3'0 Designer Telephone No.(Include area code) Owners Name Telephone No. (Include area code) RQ,ht;er` :W4,Qich 7/ - - / 51-,441 l�st,v�s Street&No. Street&No. A 3 30/ so . City or Village State - Zip City or Village State Zip yvpso v 4w . '5410167 s-f� /cv�T��' Z APPLICATION FOR: Conventional System-Public Building(1) New Mound System (3a) ❑ Holding Tank(2) ❑ Replacement.Pressurized System (4b) ❑ Replacement Mound (4a) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Fill (1) ❑ Other Alternatives (5) ❑ System in Flood Fringe (1) ❑ Groundwater Monitoring (7) 3. FEE COMPUTATIONS(Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750- 1,500 gallon septic tank -30.00 4a. 3b. 1,501- 2,500 gallon septic tank -40.00 4b. 3c. 2,501 - 4,000 gallon septic tank -55.00 4c. 3d. 4,001 - 8,000 gallon septic tank -70.00 4d. 3e. 8,001 •12,000 gallon septic tank -85.00 4e. 3f. Over 12,000 gallon septic tank - 100.00 4f, 3g: 500- 1,000 gallon dose chamber -30.00 4g. go 3h. 1,001 - 2,000 gallon dose chamber -35.00 4h. 3i. 2,001 4,000 gallon dose chamber -50,00.. 4i. 3j. . 4,001 8,000 gallon dose chamber -65.00 4j. 31k.J 81001 -12,000 gallon dose chamber -80.00 4k. 31. Over 12,000 gallon dose chamber -95.00 41. 3m. 500-' 5,000 gallon holding tank -30.00 4m. 3n. 5,001 • 10,000 gallon holding tank -40.00 4n. 3o. Over 10,000 gallon holding tank -50.00 4o. 3p. Groundwater Monitoring Per Lot -32.00 4p. (other than a proposed subdivision) Subtotal 3q. Priority plan review: (walk through) 4q. Submittal of plans in person, by appointment,with double fee 3r. Petition for Modification Setback -20.00 4r. Site evaluation -50.00 14 _. Total Fee OrU 4 DILHRSS80.6748(R.02/83) NOTE: Fees subject to change on July 1,annually. -OVER OPTIMAL WORKSHEET �toM I. MOUND SYSTEM 11. IN-GROUND PRESSURE SYSTEM-Continued- 1. Wastewater Load,Total Daily Flow= gal. 10. Force Main: Use section H 63.15 (3) (c),Wis. Minimum Dosing Rate= gpm. Adm.Code and PROVIDE A DETAILED Diameter= in. LIST OF SIZING ON PLANS. - 11. Total Dynamic Head: - 2. Depth to Limiting Factor= 3_45 ft. System Head= 2.5 ft. 3. Landslope= e/ Vertical Lift= ft. 4. Distance from Dose Chamber to 5 Friction Loss= ft. Distribution System= ft. TDH= ft. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System= 7. ft. Pump will discharge at least gpm 6. Absorption Area Sizing: at ft. total dynamic head. ; �� Area Required= sq.ft. Pump model and manufacturer: Bed or Trench Length(B)_ ft. Bed or Trench Width(A)_ _ ft. . 13. Dose Volume: Trench Spacing(C)= ft. 10 Times Void Volume of 7. Mound Height: / 8 Distribution Lines= gal. Fill Depth (D)_ ° ft. Daily Wastewater Volume r Fill Depth Downslope(E) ft. 4 Doses in 24 hrs.= gal. Bed or Trench Depth(F)_ S ft. Backflow= gal. Cap and Topsoil Depth(G)= ft. Minimum Dose= gal. Cap and Topsoil Depth H = � ft. . ( ) 14. Dose Chamber: 8. Mound Length: Volume b = al. End Slope(K)= ft. Total Mound Length (L)_ _52 ft. III. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: ,,- 1. Wastewater Load,Total Daily Flow= gal. Upslope Correction Factor= Use section H 63.15 (3) (c),Wis. Upslope Width (j)_ ft. Adm.Code and PROVIDE DETAILED h Downslope Correction Factor= LIST OF SIZING ON PLANS. Downslope Width(1)= ft. 2. Required Septic Tank Capacity= gal �( Total Mound Width(W)_ --f--_ f[. 3. Percolation Rate= min./in. 'h 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of r Refer to Table 2 in chapter H 63 Natural Soil= `� gal./sq.ft./day and PROVIDE A DETAILED LISTOF wt Basal Area Required= -37- sq.ft. SIZING ON PLANS. Basal Area Available= sq.ft. Required Area= sq.ft. 11. If Standard Tables from Chapter Length= ft. H 63 are Used,Indicate Table No. Width= ft. 12. For the Distribution Network,Use Numbers 5-14 in Section I1. Number of Trenches= Trench Spacing 11. IN-GROUND PRESSURE SYSTEM 5. Distribution System: 1. Depth to Limiting Factor= ft. Lateral Length= ,'` ft. 2. Landslope= % Number of LZterals 3. Percolation Rate= min./in. Lateral Spacing= 2' in. 4. Proposed System Elevation= ft. Distance from Side Pipe in. �,.,. 5. Wastewater Load,Total Daily Flow: gaL System Elevation= '. ':�' ft. Use section H 63.15 (3) (c),Wis. Adm.Code and PROVIDE A DETAILED 1V. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. Fill in All Items from Section III Required Septic Tank Capacity= gal. 6. Absorption Area Sizing: V. SEPTIC TANK ��� Percolation Rate= min./in. 1. Capacity= gal. Area Required= sq.ft. 2. Manufacturer:Gy /S6.P 11OhJ c,P'S�Tr System Length= ft. 3. Show Site Constructed Tank Details on Plan System Width= ft. 7. Distribution Pipe Sizing: VI. DOSING TANK -7 Hole Size= in. 1. Capacity= g al. Hole Spacing= ft. 2. Manufacturer: Lateral Length - ft. 3. Pump Manufacturer: 6aLl _ Lateral Size • in. 4. Pump Model: _ /0_4�65 Lateral spacing- It. 5. Operating Head= ft. Uislarnce from Sidew.dl4o Pipe in. 6. Flow Rate= gpm. 8. Distribution Pipe Discharge Rate: 7. Show Site Constructed Tank Details on Plans Number of holes Per Pipe I low Per Pipc gpm. V11. HOLDING-LANK 9. Manifold Siting: 1. Capacity= gal. Type(center or end) - 2. Manufacturer: Length= ft. 3. Show Site Constructed Tank Details on Plans Diameter= in -SHOW ALL INFORMATION ON PLANS- DILHR SBD-6761 (R.03/82) Soil TEST 11a r1CA/ etg pj 0,A hb,ez- 1 ..-I P/,o P`j� iS 3/y 'ri�f1E L p, 60,rr, 13 fi° A10A e� 5�/,o7-STS /f S AeO je- tr- EN�tR -. LCO�i� SU 3y 1----8 r 13 � P r r i "go I l �.'<10/�'�� 0.43 , ��t 1 ( /Y a Ofi OF I PU 0 gDc J I � ,. OB LBRICHT NflMESITE TESTING CO. RT. 1, WNEII. ROAD , HUDSoM, wll, M16 MoPt �r o o �,�o�cs�A u9�L�' • ,2�M �flv,vp 0 fi ne M�i'E r Alm Al Z .ff. 6 �4 • FIEVATte►J (SfE SONG %SST) P1/01 Strav�, Marsh Hay, Or /S loo . 3 () F7 Synthetic Covering Distribution Pipe Medium Sand G Topsoil F —J1 3 � � D b % Slope Bed Of 2M- 2 %Z Force Main Plowed Aggregate From Pump Layer D I / Ft. Crass Section Of A Mound System Using E /.,5 Ft. F•7. Ft A Bed For The Absorption Area // `l Ft d' /, A Ft. H S Ft. S i rt"� r- 9 d B �/-7 Ft. - License Number: K LD Ft. Date: L 67 Ft. ri 1Ga3 j Ft. Alternate Position Ft. of •� cJ Force Main W y Ft. — L Observation Pipe--,,\ -F 3- F ' I K ------T--------------- ----- t-------------•I. Force Main Distribution Bed Of 2~— 2 2 Pipe Aggregate 1 Observation Pipe Permanent Markers ART,,-s74'U'P1V y , GAPPED S?fFL �E/tifo,��ag ,20Ds POD VWJUCHT Plan View Of Mound Using A Bed For The Absorption Area HOMESITE TESTING CO. RT. It O'NEIL F40AD X e �o V Perforated Pips Detail l o YAL End View )Perforated End Cap) ,�� PVC Pipe - X91 Holes Located On Bottom, S Are Equally Spaced ' S / PVC Force Main ) Q PVC Manifold Pipe Distribution Pipe Lost Hole Should Be Next To End Cap �,) End Cap Distribution Pipe Layout P �J aJ Ft. ti R �y " s 32- X 30 F Inches - ; a Y Inches i �i9oe, .�.w Hole Diameter Y/ Inch Lateral " / Inch(es) License,' lumber. Manifold Z Inches Dater Force Main 3 Inches # of holes/pipe /V Invert Elevation of Laterals Ft.. HOMES" TESTING CO. RT. I, WNEIL ROAD HUDSON, Wis.. 5 A6 PUMP CHAMBER CROSS SECTION AND SPEC►FICATIOUS J..�. /3cDQ0��w �,gy Hq4 wA7-t'R A44,em 136 x Cau me S To QE VENT CAP 1(4 0 0A) e"fpl'cUOUSLy /v h�OVS� y"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKINIG JUVCTIO�3 BOX MAMHOLE COVER � 25' rRCr^1 co-OR, WIMCOW OR FRESH 12"MILT. l A,;', 1 (TAKE I 1 w GRADE --\ —r Y CouDUIT L- 16°M'tU, IIULET PROVIDE E AIRTi`GHT SEAL C k •►�1 APPROVED,.WUTS APPROVED 31NT A I I � C.Z_PIPE J r C.= P IP_ EXTENDImG 3' "O _ 3� �� - _ _ _ _ _ III ALARM EXTE1ctafkir. 3 ONTO SOLID 5011_ 8 - -- V� �• -- _ _ - - _ ) I I ONTO SOLlD SOIL IE a E _ ! U ELEV. F7 _- - - D PG�.cla PUMP-� �[ " OFF f f Fr. CONCRETE BLOCK t /. J "ilSER EXIT PERMITTED GIJLH IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC,IFI*CATJOKES - DOSE �cJ_F/St/� �y6LO) C �d- / TANKS MANUFACTURER: IJUMBEFt C[F DOSES: PER DAS L- TANK 51ZE: 7S O GALLOMS DOSE VOLUME /a ✓`� p • �OUL,D • LNCLUOIAIt, BAtKFI.OW: bAlL01JS ALARM MAA.IUFACTURER. MODEL 1vUNtI3ER 7 .,#'L;. W CAPACITIES: A=� IMCHES OK 3p b GALLCUS SWITCH TYPE: GG/c %ice• .3� B= z INC14ES OR J2 � CALLOUS PUMP MANUFACTURER: 6roUL'o - r =-SZ...rtmcmES OR �J� SALLOKI.S, MODEL NUMBER: P S .z /o D- IIICHES OR CsALI.QNS SWITCH TYPE: 14EV FG�'9T DOTE: PUMP AMD ALARM ARE TO BE MIIJIMUPI DISCHARGE RATE 7r M INSTALLED ON SEPARATE CIRCUITS� ,....GP y_. _ ,4. VERTICAL DIFFERENCE BET WEE0.1 PUMP OFF AkJO DISTRIBUTION PIPE_ FEET NOl6_/ WeS le ;49x, 0c + MINIMUM NETWORK SUPPLE PRESSURE . . . . . . . . . . 2•` FEET �/tT. + �(•5 FEET OF FORCE MAIM X /�� FYo nFRICTIOM FACTOR. ° FEET TR'vl =20 J J;o /2,� F.P0ti1 'T�4-✓K MA.V�f.K7rJ�PE� TOTAL 09MAMIC HEAD = FEET (26 0Al,0 IMTERMAL DIMEAISI CIi' TH ;WIDTH ` ;LIQLIID DEPTH _.. G RT. 1, ©'NEIL ROAD - GOU LDS �f Model 3370 . i Submersible Effluent Pumps � Q e DIMENSIONS CHART (in inches) B---�---*, H.P. Model No. Phase A B C D E W P0312E 10 i 93/a 11'/8 5'/a 17 4 1/3 WPM0311E j WPM0312E W PH0511 E to 81/'2 113/8 5"1s 165/8 35/8 - WPH0512E 1/2 WPH0S32E WPH0534E 30 {+ 0 WPH0712E ` I 2" NPT Discharge 3/4 WPH0732E WPH0734E 8'/2 113/a 5"/,s 19 35/8 WPH1012E 1 WPH1032E WPH1034E 1 0 & E WPI-H1512E 30 WPH1532E k WPH1534E 1'/z WPHH1512E WPHF11532E i WPFIH1534E c' �Cc'�f�+�t�' � acitl�s.tg 1: �GPt� ��X1.1 -� . pp rs# � ;� wLrk r avQ�(C�S��aCl g �ic"ic7 r u TD faC4°l !sr l t CROrloctiC3 {r�y{' yy��ypr^�htrwy�P { '_ k +/M�IIiVl JI5J3 ypq IE 1V arcur.y.,d..O et' ��. olyeq.ylen Basle p rd NQ,S'v' F? 3 I L r SlE1JPa11E331 t E . 1 GOULDS PUMPS, INC, SENECA FALLS, NEW YORK 13148 Printed in U.S.A.s aGoulds Pumps, Incorporated 1982 Form No.820423-1A 4 ! 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"�'"�'� Maur vi'/�w�,ws°ie swMwwli!■w■■wliili■snlls#!!■lsw�* I sss■isss#islwst■sssliss■isata/w#■►'�tsR isles �sss► e ■i#ii■■R■■i#■■■t■■■wtR#■■■tai■■#■■■o■■■■,a■►a*its aR►etailin iiiiiiiiiiiiiiiiiiisii■°iii nameiiielniiii wlii■uam In wlwww num l ■ 4 4 t C 0118 M-S WIM i 4 ST. CROI X COUNTY W ! S C 0 N S I N < 3r;i 'i3w1 �`"'a ZONING OFFICE 7f,`.�• Y 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 25 , 1983 Division of Safety and Building Bureau of Plumbing P . 0. Box 7969 Madison , WI 53707 Dear sir : An on site investigation for the George Holcomb property located at the SE34 of the SWk of Section 22 , Lot 2 , George Holcomb Addition , T30N-R20W, Township of St . Joseph in St . Croix County , revealed suitable soils at a depth of 3 . 25 feet , below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions please feel free to contact this office . Yours Thomas C. Nelson Assistant Zoning Administrator TCN :mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53101 i Verification of Exception Status for an Alternative Private Sewage System In the County of St . Croix Location SE 1/4, SW 1/4, Sec. 22 T 30 N, R20 x W Town 1§Ilt}t4GIDiap1i St . Joseph Street Address Lot No. 2 , Block , Subdivision George Holcomb Landowner's Name: George Holcomb The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: 1 1to have one of the first five approvals guaranteed for this year. This is number 59 - 07 - 4 of those applications. (Use one of the first five quota num --Fe— ssuecTfo you.) ]one of the applications needing a quota number. The quota number assigned to this application is - - _]for one additional homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. 1 .1for an application on file prior to February 1, 1980. L] for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: [x a failing conventional soil absorption system. Ll a holding tank that was installed and in use prior to February 1, 1980. Fla privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of in knowledge. Name Thomas C. Nelson Signature County Of-,`icial Title Assistant Zoning Administrator Date July 25 , 1983 DILHR-SBO-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Towns hip/$(f.Ntl04=fr: SE! SW k S 22 T 30 N/R 20 §kY&)W St . Joseph St . Croix Street Address: Subdivision: County: George Holcomg Landowners Name: =RR Address: George Holcomb 1 , Stillwater , MN 55082 I I (We) , the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that ,the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county orriclaI2 charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: L 115 Rev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS Yl-,r ;r'W WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES '—f• J!"Fi�OSr P•O. BOX 309,MADISON,WISCONSIN 53701 LOCATION:S '/a, ' _ .�/a,Section ZL ,T 3�N,R?E (or)W,Township or Municipality s (� f3 Z L � ' o St9 iU/ io�t/ County N Block No. ✓�' /N V s Lot o u rvlsi n Name \ a �aL /3 10 Owner's/Buyers Name: nn Mailing Address: U /`/+% y A OU/-G � TYPE OF OCCUPANCY: Residence No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT /� ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: OIL BORINGS DW- 30 /9d y PERCOLATION TESTS SOIL MAP SHEET SAS 33 NAME OF SOIL MAP UNIT/�uhh9.�� � ✓ 'S'y� �� PERCOLATION TESTS 's'�oJ��`�r L��� Sr�/,3ST•P.sTu TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE mum- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P— G P— /o"/- o I..;.P LS 16"Z,/-AV.fk4 J K I � 2•Co P— L f P-3 "/g l!• flint LS (a.,G/ Ao- f'Lk 1 71or� is Z Z P- L SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B 72- /1/oAA "i13a1.Auq L s) /7"C7/13N.L S f"ow f w.r L S 00 B— cL wl m.4: A's r. of. e'g'otS •,OAO S4 w O B— HA1o.� Di' Ti,vtT hoof 2 " SGL w ,POMi e— 011"ley 6W-eV• Hods. A1- 72"- L s1r�.J, /3 B- / Nom- t3e�Iw•es' 30'= o"c�aN -Gy. f,,..e �s / ,��/,Qa.�s ��-M o p-�,�aN B— wig, N- r o�P J10 fS 14T PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. SEE �i98E,3 o LaT Li N6 ---------- E G I �Y E qe _ _ k1 ., i �► t c Q(do �/® ,OBE/ �3f of O ♦ __ 4. _ N n 7 Y IU F _ 3 1 . .. a E � - - �- �a I x I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. �i Name (print) �ohee/ "`/r✓�/G�T -Certification No. Address T 3 11VPr04 Gc�j S .Name of installer if known S• L /A--' les 01T Copy A—Local Authority CST Signature �V' Y `Hc 1 1 5 Rev.9/78 Pfl(r�S REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 LOCATION:,(L %S„ _%,Section ZZ T L0N,RwE(or)W,Township or Municipality Lot No. �- , Block No. I • � �' � y - County S�- rloe�X �/Azra-* � u Ivlslon Mailing Address: Owner's/Buyers Name: /./2o,4bS�v TYPE OF OF OCCUPANCY: Residence No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE; SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL,INCHES RATE NUM- INCITES THICKNESS IN INCHES SINCE HOLE HOLE AFTEF INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- P- P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B_ 3 �, o>r.R. „ 6.� ./>'i�.G . 1S 22"41 (3N. •r• GS /& �. B- aR-L+13,j. Sc L ¢ do f B_ "�w�Q L l3N "(; Pt"U C1,4 W /MAAJ B- P2Om . Q,,,c v--'?- - Nd 7-S. AT If, PLA VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy -4,6E �DhAE 3 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 7— _..,. I _ RD / Rog 13 E i E l E , N .�� i _ 3 � y --3.,�.' ......mom _�. ._......qt..,..�.... e.� - _ _....... ...__ �."V1 ._ • I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. ����p��� Name (print) 2&1 -"'uS1/ Cf<►7i Certification No.✓ J �2 y�22— Address ,� ,3 &Q210A-) Name of installer if known W rtJ Copy A—Local Authority CST Signature GIX��%CVt F-- EH 115 R- AW-r 3 s ev.9178 ' REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 LOCATION: �E '/a %a,Section 2Z TLO N,R:0E (or)W,Township or Municipality s� ToSJ�I Lot No. , Block No. ,° /�o%a`I►'�_ �L�/SO/U�`S/�it/ County Sy' `�D1 X "o Owner's/Buyers Name: �� Subdivision Name Ma Address:. D�Eo A VZ � =- 7,14 • /_/_uS 110eV(J/,:::- TYPE OF OCCUPANCY: Residence No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM INCHES THICKNESS IN INCHES SINCE HOLE BOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- ��'ZiN(� vIC- N/o!l v tE ao RM F o P— q 0 r L w iJ44 �-I.ta• (�-t Sl t=S P- I = 6 E ET SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- C'D.v I8' L�'G' - N. JCL tv Cp,y. ,d l zrr 7K4. OAP 3 G/. Afe 1 B— (o " c9,a ev./3.9. 5 As�e eat. CLA w IMCA41. B— ltz Ot..— -D,e . �f p f• B- /O N®at " 8"G/• Ila.CR9 `rwk LS 28"L •BA). LS " /0" SC B- 19,6v-vi) oau%�_ o,e•--v o fS. Z G " f'r wv 13JV.S PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. �voTF r® R ,APP *L 5 ES7" SiTE". f NoT .,< !r L 'e v . f f.Jif9 G[»F�.J_ . fJ or S'olt/91�. ie • F C E 7t� C4 ? 4 N E E � LA �? cvm c 001i POP044- ot 4 650R 4 , s .m r V r . 3 _ j 1 s b I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. Name (print) XERr Certification No. S^✓ DZyeZ— Address 'eT•3 N U�S0�1J C,J/S .Name of installer if known . 16 C Of r/.V a"' Copy A—Local Authority CST Signature EH 11 Rev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 LOCATION: Y40_1/4,'/4,Section Z Z ,T. 0 N,R?aE (or)W,TQwnshia or Municipality ST To_s_e - Lot No. Z , Block No. �,' /401,111' S013LJ111115 ' County .5,1- e�pOl X ` `` / � ubdivisiT on Name Owner's/Buyers Name: , Mailing Address: 13 ';3114f, Ir UkD411 G TYPE OF OCCUPANCY: .Residence No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM— INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— P— P— P_ P- P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, NUMBER INCHES TEXTURE,MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- b A)&•� Ar' f B- 8AJ. S u 0 atia a v;2t A h,'X. �4 aN. s B- �,.Q. f ore•&,j. s� . w -Fa - - ' o�P sYo tS B— Z 6 "G k _V ' / Gf.7f LJiV^ /1r.A.o P,�rl N/VE-v B- Aaaw— 3 0 . -to t PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ,Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. e t . 3 �. C� i T N • T a 3 \? J v J L ' ' " 1 �' 1 � . � ts a _ F 3 rF 5 _j I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. L Name (print) R. 7411h�/G�T Certification No. �y —O Address _ .Name of installer if known O h CST Signature % Copy A—Local Authority f � i 1 66 6N AOPE�vvM -A Solt- 7Z57- 6F `DE-c' 1q,?0 - Rn��T�oa�t Refs weer- 7-E-srY7v 47-O&.4.14Rs DRE55R MENTOF3U�� `48`' REPORT ON SOIL BORINGS AN � '��-9� Y& BUILDINGS INDUSTRY, /� .� / DIVISION LABOR AND CC �� '�� .O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (11J) / MAC F/1j N,WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: NO.: I AM s� - z1/ '/ )Z /T;ON/R 20E (orW T4zq#- COYNTY: OWNER'S/BUYER'S MNG�/ R�Oc7�� USE DATES OBSERV NO.BEDRMS.: COMMERCIAL DESCRIPTION: ❑ NS: PERCOLATION TESTS: tVbr Residence New 116414 AZ /f,?/ No 7' ¢046c,,,_—Z7 MR/ 03-3Zs RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) 5 gCOM ES ©u 14S ❑u ❑S Wu oS au oS ©u d. IEC.3/ x486 - M00 Jo If Percolation Tests are NOT required DESIGN RATE:S STE If any portion of the lot is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS SCS 33u,B,B},Q�J BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION vv OBSER'VED E T. I TO BEDROCK IF OBSERVED(SEE ABB RV.ON BACK.) B-1 72, /0ff3 /i/ V-. L5 1 y/11 41.15�j. 'rk't s. .2 y" a wit •AiST. Cc.",-tcr4 0ie-6 Ko'fS 4'r qpp w k'T- t 1r r o`r B-� �� /�•�f r L w-e sy SA). s N��.� -6y.45 50 L>< ate. Ls 2-.0 co'-f,so v Ai S r. Ff 9„ ' A4-6- xo-f A r T?" IfaA.°Gy. Ls /9' ki'A4. Ls, I- I am' j, s , /S"'B- 1624 ,S7 •om,G src wi 'i f4IJc,07- W_oR-G /-tal`s B-/0 /a�1y�r 5 q ;' G5S,_6y- �vpySr r YVI it- ff� R_#' 2-dy hotf B- -70 /07 � � „ 16 t>•d 6y. Z s, 2 6"/-�.-4� � s, (0 D/1-fir% FIST. CdK�J .��`S AT y7.. 70" B- RE-6peorD mny 11-Ii, jgjoZ PERCOLATION TEST f-H&-w c7' �EfSf.VC� F S y TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P R PER INCH P- P- *440 4&41 o S L Lr ON 2 t1/^ /?-T)' a4' iV 0 r O P_ cajjE O rO LC 7-/d 0 Id ,Q i d_ P COAj u ti A SO / N S E-1 01,9 vE /}N 0.5 1200%4 Sv c— P- o s fv1— 17 OF 0e 4 PLAN VIEW: 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 slop. :1 t I S �ECf1�r wE.vI�E77 y ?%/� 5aiL TEST, - �t �&)-J,0 S/�ST�iy SYSTEM ELEVATION �e IO sIA LLE-P 60" ti,' c 571,e- rtFs TEv Fo,e A A.o o ki y of AT _. . P , ap . ..� Ole R 1. > r R€4cEs F Qua. .. ? I: . T N -APPROVED" gates 'VLoh z- i ` Ilnspiectdr• s r s e i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. IF NAME(print): TESTS WERE COMPLETED ON: A I •E 3 { 05tq Aj w i_ 5701(R 5,5 ER: ��.� ER: 3,0 6 NUMBER P/6�(optional): " CST SIGNAT RE: DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. DILHR-SBD-6395(N.03/81) 1 Ore,&kn_ rz!l1r Mvok roF jew�- FIIEI� zoAjjuG—+ts PuAL;C- _9ocU,-ENj ' s,A,3 • k �.� _ � '. �. •. ,.r �� � ��, ,, �"�; � � ,. _, _ µ� . � �;", rR ,�s ,; r = o R. , . _ a ;, ' r �; .jj �`�' _ ,. x, _ e � f. I -- _ f ..- I " �`� ,, �, \ _ }`v\ -,- `may. � n .. _ f= _. i l.lw��` i A t j � � - i I . . r ( 7 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, c DIVISION BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 5E '/ / 22- /T �1/R 2q(or)W ��- ®0s�114-- tfn j_Co K a COUNTY: - OWNER'S BUYER'S NAME: MAILING ADDRESS: -5�- &&y- ---Pjzd—. 5-1- 2ep�k &J15 USE ---]-NO DATES OBSERVATIONS MADE N PERCOLATION TESTS: FK ResidenceN1-W� New ❑Replace ,�,.Q RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑S ®U 1Z ❑U ❑S (1U IDS ®U 1 ❑S ®U If Percolation Tests are NOT required DESIGN RATE:S STE If any portion of the lot is in the under s.H63.09(5)1b1,indicate: I Floodplain,indicate Floodplain elevation: �� PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 72_ P"Av, -4 G 51 17 G '40 G , 11 pQ,B- Oerotrar- Z4 AAJ 5 CL W * D/Sj. d/r. ffp7Fc .. B- SCL w .�-tl.v Cd H rto u B- M O f S,. A r- 7 2 " 1-4+,Ze 57,'� 13< B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- P- P- P-- P- P- PLAN VIEW: 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 slop. PGAA3 UJ O &0r ,V014 6.4— 'q Z V ELEVATION F a fir• Al iVoQb{ti LOT I,IJe" J 1 I• I � , . Fr elf zore E � , Est F es. _ 1'&i i c ,y �, r�"C✓ t QOM b l� Y1� 12�pvr 6 . ^a� 3 I a . CD J, ....e . . _ .. _ . .. _. ._..._ _... IF I, the 6ndersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): Q��n� �/��/,��� TESTS WERE COMPLETED ON: ADDRESS- �\ , q! CERT COON NUMBER: PHON NUMBER op i net vpS A) l is S . Y®� 5 S © �-- S0 Y l CST SIGNATURE: DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. DILHR-SBD-6395(N.03/81) 89 Pic EO tea. JUL sr R R rxC AUNTY » a 1979 •e�p�l[ 357960 CERTIFIED SURVEY MAP ° N ti 1/4 CORNER Z S37°04 W PART SECTION 22 "25.59' °� RT O F_3 ° 00 T3ON,R2OW 00 , 50 POINT OF BEQNNIN D i r V1 A W M i WII �_16tP 158.70' Z SI N' �• �'� S•7°04'WI 31 uI ` \ 5° ROAD g6�\9b E l TIN G 6 oA o WAY EXISTING ei _ co EASEMENT j ROADWAY N 70 AE ____ I EASEMENT ca ° 24 5'166.00' 27.5 0� N a ' W V J O N O N Z � JZ In o Ix BLUFF LINE U) gi N o PART_ \ _/ O F °+I APPR VAL OF THIS MINOR SU 3D,VISICt' +1 W +1 CD M AfP,L VAL FCC►, AN CD (DO i CD BC1 DING ,.t.. 0,t SEPI'IC SYJEM, 3 W a EFER TO H62.20. -- 00 a �.5 ACRES# 3.6 ACRESt r� SCALE IN FEET N �F 1.3 ACRES± `�N F 1.3 ACRES± o, � 20 2�. APPROVED p N �fi` 3 W 1 W p C ( E- iA M �� ° h ` ° JI JUN 2 8 1979 w O` N zl — N 7°10'2_011 �, S1. ,OiX L—. r N 2 2 8.92 — _— 051q„ to COMP,dHENSIVi PARKS PLANNING __N_80E °c�� LEGEND AND ZONING COMMITTEE MEANDER M. 249.55, --_ 1"x24" IRON PIPE WEIGHING O 1.68#/LINEAL FOOT, SET m o +1 BAY +I I • 1" IRON PIPE, FOUND cc o N L OC P L ON +, COUNTY SECTION CORNER, PpROX�MA?E 1� PENINSULA N BERNTSEN MONUMENT, FOUND A � OF - $L�TF LINE +r 1"x30" IRON PIPE WEIGHING ° EDGE 1.68#/LINEAL FOOT, SET WATERS CROI X II 1"x60" IRON PIPE WEIGHING ST. 10r 1.68#/LINEAL FOOT, SET L AYIE NET PROJECT AREA OWNER l� George Holcomb TRUE BEARING R.R. #1 Stillwater, Minn: 5508 This instrument drafted by James T. Swanson. Vol. 3 Page 822 tD