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HomeMy WebLinkAbout020-1183-30-000 \ K o 2 0 \ j � \ § ' � � . � ƒ z U. \ 3 t � 7 � � z / § k i � 0 � @ / (L c § B : C: )R ) J z z U) k c $ " f ) I c § \ z z \ ) � / k c ^ 3 k 2 0 [ i - co 2 � ] ® ' �E ® ■ ® a a \ M k a t 2 - m ■ 0 2 , 3 § e§ 3 t o0 � 0 § § _ G % / L) \ = e § co a 2 f � 2 J � ) ; 2 ° § cc\ LO § m k 0 \ \o . n ° m E a S_ / & ƒ / 2 ) ) k k / , \ / 2 55 G o@ E 0 C, 04 _ � m - o z _ m ■ n � © � � 0 k _ = a E & ' ' ka § / J a o v I � t Parcel #: 020-1183-30-000 01/07/2005 04:23 PM PAGE 1 OF 1 Alt.Parcel#: 20.29.19.1153 020-TOWN OF HUDSON Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): '=Current Owner *SCHMITT, DONAVIN L&JUDITH DONAVIN L&JUDITH SCHMITT 586 VALLEY VIEW TR SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description `482 FOX CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.260 Plat: 2328-PINEGROVE HEIGHTS 1ST ADDITION SEC 20 T29N R19W NE SE LOT 13 PINEGROVE Block/Condo Bldg: LOT 13 HEIGHTS 1ST ADDITION TOWN HUDSON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 794/304 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 49193 167,000 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.260 22,600 106,600 129,200 NO Totals for 2004: General Property 1.260 22,600 106,600 129,200 Woodland 0.000 0 0 Totals for 2003: General Property 1.260 22,600 106,600 129,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 i PUMP CHAMBER r � Manufacturer: Liquid Capacity: Pump 1: Pump/Siphon Manufacturer: mp Size Elevation of inl Bottom of tank ele on: I Pump off switch elevation: Ga ns per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from neare property line: t, O Side, O Rear,0 Ft. mber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: 1 2- Len th: 6-2r Number of Lines: Area Built: 6,Ztl Fill depth to top of pipe: 3�• ti Number of feet from nearest property line: Front, O Side, ( Rear,0 Ft . Number of feet from well: l� Number of feet from building: fQQ f (Include distances on plot plan). PAGE PIT Siz Number of pits: Diameter: Liquid dep Bottom of seepage pit elevation: Area Built: or stribution box O been used on an f the above soil Has either a drop box O absorbtion sytems? (Check one HOLDING TANK Manufacturer: city: Number of rings used: Elev ion of bo m of tank: Elevation of inlet: Number of feet from nea st property line: Front, O S , b Rear, OFt. umber of feet from well: of feet from building: Z--Number ber of feet from nearest road: cturer: Inspector: Dated: 11—a3—R2 Plumber on job: AMI_4_� License Number: 1/84:mj Form - S T C - 104 I AS BUILT SANITARY SYSTEM REPORT OWNER /1/A/ �jj#/7°/'T TOWNSHIP SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SO,o-EL-2SAC 7 SUBDIVISION 1Ls /1py� &LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N c, 5�o 1 i�zs � C U QL s�YLrel'47 dy t r S pctTN �� 13M 4L /00 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /( 61tj9 Proposed slope at site: SEPTIC TANK: Manufacturer: w,6FAw.A'S Liquid Capacity: Number of rings used �� _ Tank manhole cover elevation: 10/1 Tank Inlet Elevation: t.t4 Tank Outlet Elevation: %(,0, 94, --r Number of feet from nearest Road: Front160 Side,0 Rear, O 135 " feet From nearest property line Front,OSide,�Rear,O S� 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 LABOR,& DIVISION HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS .P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NEk, SE14, S20,T29N-R19W CONVENTIONAL El ALTERNATIVE Stlate Plan I.D.Number. Town of Hudson El Holding Tank ❑In-Ground Pressure El Mound Lot 13 Pine Grove Heights NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION EVAlt. Donavin Schmitt Route 2, Box 295A, Somerset, WI 54025 3; 0 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: JCSTREF.PT.ELEV.. Name of Plumber: IMPIMPRSW No.: County: Sanitary Permit Number: Donavin Schmitt 3205 St. Croix 102793 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.'. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER ""`mss✓J PROVIDED. PROVIDED. �Q V O -1. ,0 S I 06YES ONO OYES ZINO BEDDING: IVENTOIA.. VENT MA TL: HIGH WATER NUMBER OF ROAD, PR OPERTV WELL'. BUILDING. (VENT TO FRESH 1 ALARM FEET FROM LINE (� c AIR INLET ❑YES NO L ` DYES 1:1 NO INEAREST----)OI " 'S DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY JPUMI MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ONO OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES -]NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO OF JDISTR.PIPESPACING. COVER JINSIDE CIA =PITS LIQUID BED/TRENCH C TRENCHES MA�ER IA Lt PIT DEPTH DIMENSIONS Z J Z GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO DI R. NUMBER OF PROPERTY WELL BUILDING V NT TOFRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.CEND: PIPES. LINE / AIR INLET CD I r OS 11 J•t�7 NEAR ESTOM— l� � c9-D� L 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ONO SOIL COVER ITEXTURE 1PIERMANINT ARKIRS OHSEHVATIONWELLS OYES ❑NO El YES El NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ONO El YES 1:1 NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH'. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DI R.ST PIPE MANIFOLD MATERIAL. NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND ELEV.'. ELEV,. DIA.. ELEV. PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED ❑YES 0 N El YES El NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS-. NUMBER OF PROPERTY WELL: '. FEET FROM LINE: ❑YES El NO ❑YES 1-1 NO NEAREST I Sketch System on a tin in county file for audit. Reverse Side. SIGNATURE'. TITLE DILHR SBD 6710(R.01/82) Zoning Admin' r INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: , 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions`to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system Nation, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; _ 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form,(SBD 6399) to be r submitted to thezounty prior to installation; _ 5. Private sewage systems must be property maintained'.The septic tank(s)'-should be pumped by--a licensed pumper whenever necpssary •"usually evfiry a.to.,3,�y gars; 6. If you have questions concerning your private sewage system, contact yDur 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; ll. 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; `w 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 CILHR; 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'h x 11 inches must be submitted to the county. The plans must include the following:,A) plot plan,'drawn to scale or with co►gpiete 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 aIBT- Y included the creation of surcharges (fees) for a number of regulated practices which Wisco, ins_ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried teBSute! 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. ° a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) -- '� SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05,Wis.Adm.Code X STATE SANITARY PERMIT# /oa 7 .—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 t4NO PROPERTY OWNER PROPERTY LOCATION � '/a, S Q T 17, N, R E (o W PROPERTY OWNER'S MAILIN ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 0 1T 1.3 A s' CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK /5 y �� O VILLAGE II. TYPE OF BUILDING OR USE SERVED: #e!1 r-- © °�d Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. U New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The 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. gConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.JX seepage Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): s"Q Feet Private El joint ❑ Public CAPACITY Site in allons Total #of Prefab. Fiber- Exper.Con-VI. TANK INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass Plastic App Tanks Tanks Se tic Tank or Holdin Tank E� ❑ ❑ Fo�—�+--a Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb 's Signature:(No Stamps) MP&PRSW No.: Business Phone Number: Al 1 umber's Address(Street,City,State,Zip Cod Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST#AA CST's ADDRESS(Street,E,State,Zip Code) Phone Number. EuJ a 15' IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) CA charge Fe Approved Owner Given Initial `��,� 5_,d3 /&J-?—,?7 Adverse Determination 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 APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property _ L. uA,,&1,,A, &&,n2 /7-,,,,- Location of Property - A/.&-^ Section �d► , T_g-N-R L? W Township - NUaSa/y Mailing Address RZLI aP Address of Site r Subdivision Nara a&x= . Lot Number /3 Previous Amer of Property A,Q&A Sag T Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? XI Yes No Is this property being developed for resale (spec house) ? X_ Yes _ No Volume V and Page Number 3 8 3 L as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, 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 I (tie) ceAti.6y that ctU statements on thus 60AM ah.e -tAue to the beA-t o6 my (oun) hne+wtedge; that I (we) am (ahe) .the own eA(Al 06 the phopenty dmcAi.bed in -thiA in6o4ma.ti.on 6o4m, by viAtue 06 a wahhanty ,deed kecokded in the 066.tce o6 the Coruntyy RegiA ten o6 Deeds ah Document No. ? // ; and that I (We) pneeen.tey own il�e pitoposed bite bon .the Aewage di6po�s b yes em (oh I (we) have obtained an eaa"Cn-t, to Run with the above deh c) i.bed phopeA ty, 6oh the eon6tAuc tc:on o6 6aid eyd.tem, and the dame hae been duty heeokded .tn the 066.tee 06 the County Reg,i,e.ten. o6 Verde, ae Voc m n t No. /-- j 1 � ) , SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) Al ;-?y--,P 7 DATE SIGNED • DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 431311 AM' 794PA004 REGISTERS OFFICE ST. CROIX CO., Wl&' Richard 0. Stout, Janet P. Stout and macod. for Record ffih 21st Maud H. Stout day of Oct. gyp, 1987 t 11:00 conveys and warrants to Donavin L. Schmitt an Judith A. Schmitt RETURN TO the following described real estate in Croix County, State of Wisconsin: Tax Parcel No: Lot 13, Plat of Pinegrove Heights First Addition, Town of Hudson EEF is not This homestead property. (is) (is not) Exception to Warranties: 20th October 87 r Dated this day of , 19 (SEAL) (SEAL) Janet P. Stout Richard 0. Stout �1 (SEAL) • Maud H. Stout by Richard 0. Stout, P.O.A. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this day of , 19 Personally came before me this 20th day of October 19 87 the above named Richard 0. Stout, Janet P. Stout and Maud H. Stout by Richard 0. Stout, P. 0. A. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the perso s who executed the authorized by§706.06,Wis.Stats.) foregoing in ment k o edge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout Terry . Pirius Notary Public St. Croix County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: Jan. 1, , 1g,$9_.) 'Names of persons signing in any capacity should be typed or printed below their signatures. NTF 2280 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 1075,Green Bay,WI 54305-1075 Form No.2—1982 H . z H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St . Croix County z d a H OWNER/BUYER L/�y d/SC,:� tN &&,gokte ITT ROUTE/BOX NUMBER i?r,Z Fire Number CITY/STATE�7� s�T' �` V, ZIP PROPERTY LOCATION : &,ff 14, _14, Section ® Tt?N , R _W, Town of #460SOA/ St . Croix County , Subdivision AV,6F 4� QUA &T+ Lot number. ' I Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . 0 E I/WE, the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED ° DATE �� 'Y7 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 115 - SBD - 6395 x w To be a complete and accurate soil test,yOur report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commerciJ use planned; 4. Is this a new or replacement systern; 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 diagram accurately locating your test locatigns. 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; 0. Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required= ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St - Stone (fiver 10") BR - Bedrock cob Cobble (3- 10") SS -- Sandstone gr -- Gravel (under 3") LS - Limestone "s - Sat id HGW - Nigh Groundwater es - Coarse sand Perc Percolation Rate Hied s - Medium Sand W - W e I I fs - Fine Sarni Bldg - Building Is - Loarny Sand > - Greater Than Isl - Sandy Loam < ..- Less Than 'I Loarn Bn -- BroLvn ;il - Silt Loam BI - Bl<s<,k si -- Silt Gy - Gray ' cl Clay Loarn Y Yellow sci Sandy Clay Loarn R - Her{ sicl - Silty Clay Loam not - Motlies s€. Sandy Clay vV -_ "'vith Sic __,. Silty Clay fff -_ fever, firm.,, faint IC -- Clay cc - cornmon, coarw rat - Peat mrn - Many, medium n - Muck d -- distinct. p - pro€ninent HWL - High water level, Six yoneral soil textures surface,vvater for liquid vvast€z disposal BM Bench Mark VRP - Verticai Reference Point TO THE OWNER: This soil test r£rporr: is the first step in securing a sanitary hermit. The county or the L7epartnierrt rTaay request verification of this soil test in the field prior to per€nit issuance= A complete set of plans for the private sc matte system and a permit application must Ia(, suhiri tted to the appropriate local authority in order to or)taw a permit. The sanitary permit must be obtainer!card posted rrrior to the s;art:of mlv cot)structiorr. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1)& Chapter 145.045) LOCATION: SECTION: ITOWN S HIP/ QIrY: LOT NO.:r/a LK.NO.: SUBDIVISION NAME: NE 14e 1/4 20 /t9 N✓8191(or)W Hudson 13 jPine Grove Ht s. COUNTY: OWNER' AME: MAILING ADDRESS: St. Croix Richard Stout R.R.#2, Box 340, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: OResidence 3 n/a ®New ❑Replace 10-2-87 10-2-87 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL rETITS 9ff1 K:RECOMMENDED SYSTEM:(optional) EiS EA MS S ❑U IS ❑U ❑S E conventional If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: n/a Floodplain,indicate Floodplain elevations/a decimal' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL W H THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHN4 ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.42 99.04 none >7.42 1.17bl.1. 1.58bn.sil. 4.67bn.c.s.&gr. B- 2 7.16 99.03 none >7.16 1.33bl.1. 1.50bn.sil. 4.33bn.c.s.&gr. B 3 7.17 98.37 none >7.17 1.42bl.1. 1.581bn.sil. 4.17bn.c.s.&gr. B 4 7.17 97.79 none >7.17 1.25bl.1. 1.92bn.sil. 4.00bn.c.s.&gr. B_ 5 7.42 97.97 none >7.42 1.42bl.1. 1.83bn.sil. 4.17bn.c.s.&gr. B- decimal' PERCOLATION TESTS TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER3 AFTERSWELLING INTERVAL-MIN. PERT D1 PE 1002 PER D PER INCH � r_ 3 none 4.00 none 3 6 6 6 <3 3.33 none 3 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. SYSTEM ELEVATION 95.04 � F 11V ? _ I _ i qc T G 19 t t j 1 x £ t } t { t E _. _.. �. � � r� _ } N _ } E b t j i 3 Yr�` m.. - r ,�� �► 1,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. NAME(print): TESTS WERE COMPLETED ON: Gary L. Steel 10-2-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 988 N. Shore Dr. New Richmond Wi. 54017 2298 1 ,716)6246-6200 CST S H E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — J IIII � ilk � I - i Iliilll , � IliI rll ii t iii III I f ' . I i i III i � II� � I � I I � III i I i I i i i i i tqt � I� � III i � � Ill� l l � lEli , r i r � � ■ I ■ I ■i■iii■ ■� ■■ N i 11 11 1 P:�qi V VA Now ■■I r'^' N■ ■ r ■ R