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HomeMy WebLinkAbout020-1117-50-000 7 � Qm . � R o� A + 7 ƒ k} } cxe LL ) k%/ t » \ k § k � { k \a\ CL ¥ / I E $m . o CD § ) a ■ / / j \ f z ■ e - q \ \ ° � Ce) } � % -� � f 4) § k co k \ 2 \ _ t { . .� m ■ k m £ � � ■ $ 2 / m / \ \ 7, 2 0 o a § a � _ U) ■ U k 2 C ) \ § a a a ! 2 0 U 2 00 � 2 � v � § / / p = � 2C) : m § § % \ E N o CO wo L? k 0 ■ - §a k 2 k k\ k } � )\ o : ® ® � ® % , ¢ § C . k ) / Q J a o & J PUMP CHAMBER f Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: k" Trench: Width: 2y' Length: Y,�' Number of Lines: y '' Area Built: 141,;,2 Fill depth to top of pipe: / ' /d -'?j' Number of feet from nearest property line: Front, ®Side, O Rear,0 Ft ./p Number of feet from well: 7* ' Number of feet from building: ' (Include distances on plot plan). SEEPAGE PIT Size: ZW Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK ,,// Manufacturer: /l� fP Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Al Dated: Plumber on job: _. License Number: ,S'e7S" 4 3/84:mj Form - S T C - 104 1 A AS BUILT SANITARY SYSTEM REPORT OWNER ,`P� ,�c��e�s TOWNSHIP SECT q T a7? N-R W ADDRESS Area 11e,3,4 T ABT• CROIX COUNTY, WISCONSIN SUBDIVISION !/; LOT LOT SIZEi�ea7e� PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -Yoga, _ v INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: a SEPTIC TANK: Manufacturer: Capacity: 4::�rL 5- /A/e4/Number of rings used: / Tank manhole cover elevation: er'f/ Vp r 9ct.?' A14-Tank Inlet Elevation: qm / ' Tank Outlet Elevation: Number of feet from nearest - Road: Front,O Side ,O Rear, O feet From nearest property line Front 10 Side,O Rear,O feet Number of feet from: well building: " (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE -DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION ,LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,W 1 53707 !!!�Number:NEB„QE4,S1•9,T29N-R19W CONVENTIONAL ❑ALTERNATIVE Town of Hudson ❑Holding Tank ❑In-Ground Pressure El Mound Lot 17 Willow Ridge 1 INSPECTION DATE: NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Lee Schwebs I Rt. 5, Box 77 Trout Brook Road, Hudson 54016 L/d J-87 3 REF.PT.ELEV.: 7STREF.PT.ELE(Pe(Permanent - BENCH M A 1,K refere point)DESCRIBE IF DIFFERENT FROM PLAN: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Jack A. Bowman 5875 St. Croix 92505 SEPTIC T K/HOLDING TANK MA FACTU R: LIQUID CAPACITY: TANK INLET ELEV.: ITANKOUILt'ELEV.'. ROVIOED`A8 L PROVIDED OENF DYES ❑NO ❑YES NO ROAD: PROPERTY WELL: BUILDING, VERESH EDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF LINE: AI . ALARM: FEET FROM ❑YES ❑NO YE ❑NO NEAREST DOSING CHAMBER: RR MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. PROVIDEDLABEL PROVIDED: V NN ❑YES ❑NO ❑YES ❑NO OY ES ❑NO GALLONS PER CYCLE: PUMP AND CON TROLS OPERATIONAL: NUMBER OF PROPERTY WE BUILDING. AER NLOET RE_ SH FEET FROM LINE (DIFFERENCE BETWEEN OY ES ❑NO NEAREST PUMP ON AND OFF) LENGTH: DIAMETER MAT ERI AL AND MARKING SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE or excavation. (if soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE DIA rPirs (QUID —No BED/TRENCH IWID1111LEN TH: 71DISI­P1 F DISTR.PIPE SPACING COVER DEPTH CHES. MATERIAL' PIT DIMENSIONS NUMBER OF PROPERTY :WE—LL:: BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH IDISTH.IPIFE OISTR.PIPE MATERIAL: P PESISTR. LINE AIR INLETBELOW PIPES: ABOVE COVER. ELEV. NLET : FEET FROM NEAREST--0 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES El NO PERMANENT MARKERS. OBSERVATION NATION WELLS OIL COVER TEXTURE DYES ONO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER. EDGES: ❑YES El NO OYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL'. F OEDISTR CIS R.PIPE UISTHIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.: CIA.. ELEV.. , ELEVATION AND DISTRIBUTION HOLE SIZE =ED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: C ENT FEET FROM LINE: ❑YjEs ❑NO NO EAREST 11 Sketch System on l Retain in county file for audit. Reverse Side. \ SIGNATURE TITLE Zoning Administrator DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A-SANITARY .PEF MIT APPLICATION t ; TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the tFme of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater ftw (number of.bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; - VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix,(e.g, MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco [l1" 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 buried T$ # system or the disposal site used by your holding tank pumper. Ni e The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. 3D-6398(R.03/86) =Zah SAN ITARY PERMIT APPLICATION COUNTY LN� In accord with ILHR 83.05,Wis.Adm.Code St. Croix STATE SANITARY PERMIT# 996-4915- —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION.. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION Mr. & Mrs. Lee Schwebs NE '/4 NE '/4,S 19 T 29 , N, R 19 fX=)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME Route 5 Box 77 Trout Brook Road 17 Willow Ride 1 CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK Hudson WI 715 235-002 ❑ VILLAGE: Hudson 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family -� OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.0 Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Q Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k _ V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Z seepage Bed b. ❑seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 19,2 l v 3'2 ��� Feet ❑X Private ❑Joint El Public VI. TANK CAPACITY Site in LGallons #of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New sting Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank / 02 G.i -X �«f Lift Pump Tank/Siphon Chamber E] VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's S• nature:(No Stam s) MP/MPRSW No.: Business Phone Number: Jack A. Bowman 5875 715 235-3650 Plumber's Address(Street,City,State,Zip Code)• Name of Designer: 2819 Knapp Street Menqii6nie, WI 54751 VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# Robert Ulbricht 2482 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: Route 3 O'Neil Road Hudson, WI 54016 386-8185- IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps). Surcharge Fee Lpi Approved ❑ Owner Given Initial 4'/Do e)- 15^ Mil f av�g� �� �I'I r111C-. Adverse Determination lJ d t1C.i X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber fjM APPLICATION FOR SANITARY PERMIT r S T C _ 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec k .- house"), then a second form should be retained and completed when the property is '% sold and submitted to this office with the appropriate deed recording. t } - - - - - - - - - - - - - - - - - - a '� Somas ,n- Owner of Property - /�� Section T Z( N-R �f W /U Location of Property k , �� ' � �cSON =" Township , Mailing Address �Id aP/t�Gr, �f C!�!%f /�IE'HD�rdvi� LIJiS. S`y'7 S/ r-Address of Site /v/, AY- 77 2.p ar ep 5y Subdivision Name W/I�D� Lot Numbez K. •Previous Owner:of Property� ? S a -o a s cicnx cZ d ;._ } Are4ll corn and lot lines Identifiable? ! ( Yea No •`; Is this property being developed for resale (spec house) Y Yes_ No v^'' Vohme ` Wand Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: u•,. A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- •ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION (We) ce&aiy that att statements on this 6oAm ane true to the beat o6 my (oun.) knaotedge; that 1 (we) am (ane) the ownen.(a) o6 the pupenty deacAi.bed in .th,i,a cn6ohmation 6onm, by vihtue o6 a wahnanty deed seconded in •the 06 cce o6 the Count Regiatvh 06 De�sas Document No. and that 11We) pneaentfy awn the pup"a.ite bon the sewage dibpoe sya em (oa I (we) have obtainned an easement,-to nun WA the above deacnibed pnopehty, bon the conbtnuction o6 said bybtem, and the same has been duty teeoAded.in the 06b.ice o6 the County Reg<steh 06 :Needs, as Document No. 1. W.` ` • SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE,SIGNED W�x t k zr WARRANTY DkED DOCUMENT NO. STATE OF WISCONSIN—FORM THIS SPACE RK89RVKD FOR RECORDING DATA 309291 THIS MENTLYR16 Made by......Kftbaej...W,R4ze-and........................ e...»......_..»....... ...........».............. REGISTERS OFFICE ST. CROIX CO., WIS. ....................i................................. grantor..R. of.. St. ...............I......a... UnT isconsin, Rec'd for Recoid this-16tli- Le an 96WIWOs nx hereby conveys and warrants to...-. an ..... day of__-L,�PLImb_-A.D.19_72•e.,...........p .........................K......... .............................. -te ... M. r..rAAmt§ ...».......I..................................................................................................... ..............»..............................................................................................ff........ ..»»»..».....,................................_............................» of ....grantee........ R S t 61 St. Croix W, . for Pe .........................I...............f.............a.........hcounw. Tcon 00) Dollar an other oo ansla va ua of x , Te i'RETURN TO one....Ul.t. • ....................._»............................... cons iderWE1o"­n­* ...... ............................... ..............................I............................................................................. ...................................................................gf....Zby�................I............................. ..................County,' the following tract of land in....................................................... Wisconsin: ..................................................................................................I.................... Lot 3,7, Willow Ridge Addition,, Township of Hudson. MMSFER Flamm .......... hand...9. and seal...A this J�ess Whereof, the said grantor...S he-me. hereon jp_set.......thfdX 19...1.1; ......A.................. day of.........IftKCA........................ A. D. ... ........................(SEAL) SIGN=AND SIDAT-21 IN PMHENCE OF i A�ci i?�.e 1�Z ice JSEAL) ............I........11........ ........... ... .... ............................................................................................ 'Ellen Ann..... %ice........ ............................... ..................(Sm) ......................................».......................................................... _... ............................................................................... (SEAL) State of W*man, larch 72 . .......... .....Conall. Personally camaberf .4�W day f_........�.f..............A.D., 19........, 'y1me, is... ,l......X&S14 ', L. a . I en, Ann x e. wi e. the,I R ...0-an................................................................................................................ ........................... .......... .............. ............................................................. ........................................ to me kjiowA 6 6:the Persone...V ted rqoins Instr me ind acknowledged the same. ..... ........................................................ THIP I NWRUMI[Iff WAS oRAPT. igo state of ................................ .............. Wis. ..�,;• tmiwon`gi Yale!'R'hic4.d oe��oaaoo:to a tea to w wle j man. , IMP 7 77 7 77, VY D70t4D Wimeouft Leval Blank company Ac IWO. 6 mawaukee,Wis, (Job t"36 a STC - 105 a SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z v a OWNER/BUYER �`"`'�`' W m $i7'E 7.Poor keooK ROUTE/BOX NUMBER '� OX ? ' Fire Number CITY/STATE �so� ' ZIP PROPERTY LOCATIONAr i , 14, Section �/ T Zy N , R // W, Town of �C1��o� St . Croix County , Subdivision Lot number /7 Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , I if needed , by a licensed septic tank pumper . What you put into ` the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980 , with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber., journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank. is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . ° E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- mentlof Natural Resources . Certification form must be completed and returned to the St . Croix County Zoni Office within 30 days of the three year expiration date . ;,. SIGNED DATE St . Croix County Zoning Office P .O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . INSTRUCTIONS FOR COMPLETING FORM 116 - SBD - 6395 `v To be a complete and accurate; soil test,your report must inciucle: 1. Complete legal description; 2. The use section roust clearly indicate whether tiais is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. is this a new or replacement syste n; 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; 8. PLEASE use the abbreviations sho,.,Nw here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scab; is preferred. A separate sheet may be used if desired; 8. IN1ake 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- timic if appropriate; 1C. If the information (such as flood plain, elevation)does neat apply, place N.A.in the app;opliate box; I 1. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as rcquired. 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 - Stea=k= {over 10"= 3R -- Bedrock cols Cobble (3, 10") SS Sandstone g - Gravel (under 3' LS Limestone 's -- Sand HGW Nigh Groundwater cs Ccaai s e Sand Pere - Percolation Rate ?;mt d s NlIs dium &ind s'll _. V'V"c 1i Fine Sancti Bldu -_ Building is - Loamy Sand _ Greater Thzsra "sl - Sandy Loarn <I - Less Than Loam Fs,ri Brown �sil - Silt Loam Bl Black si - Silt Gy - Gray ci - taiGay Loam Y Yel(a4^u scl - Sandy Clay Leant; R - Red sic! - S€ia_y Clay Loam mot - Mottles sc Saocly Clay wf with S;Ii lv Clay fff flew, fkle. faint AC Cray cc r o,r nmon,coarse 131 Peat rpm - M ,', nnedium ni -_ I`.1ucA d - dist nc; p - p;otninent 11lNL - High level, Six general soil textures sw co sE -'Jur for liquid waste disposai BM - Bench Mrik VR _. Vertical Reference Point TO TIME OWNER; Tnis s011 Ins, rerlort is the first st�;p in securinrl a sanitary permit, The country or the Department may request nfinal:")n of %his soil test in the field pri ,I io -rr€raid issuance, A complete set of plans for the private e0 s stsrn and a pernin must he suhraait`ted to =he appiopriatn local authority in order to i`}t nit ?m, sarr lar°ar ,3errnit must be e.ht4ai led and posted prior to the start of,any constrsaction� ,fPPfe.r-c OF SiTE. eY. 1' Sax 77 T.PovT .8A4dK 0P0 hlva,.rd"i wf.x . ,I T OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS 'INDUSUS TRY Y,, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 IW IAN RELATIONS \ / MADISON,WI 53707 ` (H63.09(1)&Chapter 145.045) LOC TIO SECTION: OWNSHIP/*ft NtetIa*b+TY: OT NO.:BLK.NO.: SUBDIVISION NAME: NF �/ �/a /9 /TL9N/R/9E(o f/vosa.✓ � � ��/ w T COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: ST ne,91,4 sc //o jo �elGu_ /411"71 AD• 4)15% Sy / USE Z 3 —60 2. DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: �17R__OFILE D RIP IONS: ION TESTS: Residence /i d ❑I New Replace S�•� 0( J-U I ZS — oc RATING:S=Site suitable for system U=Site unsuitable for system ` J �A 'a T V CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILCH G TAN STEM:(opt'ona i OS ❑U F7S ❑U IS ❑U ❑S ©U ❑ x ou11wirldw4l 1y//y3 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: Cl/JfS-t =— 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.) B- / /�Q /D/. ?0 ' // . 33' i3/ . o p�. s 3- 51 y! Qom,. Coo v e , 3 ✓JN S� to 3 ltv v C S" ? �•� . . S • Qom,. oc s O ,dx y� s, . 08 B- B- B- PERCOLATION TESTS —kl�IiU�l� TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 1 PERIOD 3 PER INCH P- P- 50, ee-5- r7z� - P C S 14-1 rPLOT 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. all O SYSTEM ELEVATION A101 /,or L/NE • _ ---------; �til ��ona�sp _Ao 1 -- ¢ t-7_4_1 j t 1 r , __ . 77 ! t E We V y C _' __ . _ or �I/�tT/ON = /o o O I,the undersi ne8, hereby certify that the soil tests reported or.Lbis4t!T�n 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. PDR mt)� /� TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. ' IF" RA W11060N,Alm 5016 is CERTIFIC„Q,TION NUMBER: PHONE.NUMBE (optional): G 1 � PLUMBER LIC.N0.3307 M.P.R.S. �� 3 ZONIING _ NN.INSTALLER&DESIGN CST SIGNATURE -� OFFOtE DI 1 YTI Orkgma6and one copy to Local Authority,Property Owner and Soil Tester. DILHR.SB` - `'(8.02/82) —OVER — r -Lee Schwebs 11(38 Rjver Heights Road Bowman's Plumbing Menomonie, WI 54751 Jack Bowman . Proprietor NE1,411E14919T29N/R19W Master Plumber No. 5875 St. Croix County Town of Hudson 2819 Knapp Street Menomonie, WI 54751 (715) 235-4634 U. Svc sTort /'/cam. �j j os r � . �, r 6d ,0► a.�r/.� o y5 5 u T' Ae 4,3&44o$(#- �\ t h Vy y r.rt 79 v y, C Eircf �i c v o , /3�•/ A"-;,Y.?