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030-2009-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572865 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Yoder, Kevin A. & Barbara St. Joseph, Town of 030-2009-20-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: ryl I G'5 T 34.30.19.382C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER `��j CAPACITY STATION BS HI FS ELEV. Septic .n y Bench ark ` 3 /6413 166 9 V Alt. BM '/ Pa l a��, cJZ S 0- 6a 5�T 76. 5(. Aeration Bldg.Sewer QQ G C Holding St/Ht Inlet 16. ,8 93. 5 TANK SETBACK INFORMATION St/Ht Outlet Jd•$ 73 • S TANK TO n oP/L� WELL BLDG. Vent to Air Intake ROAD Dt Inlet '` v^ Septic ( / / Dt Bottom �a•t 7 /da /p Sao — � Dosing Header/Man. '�•� �!` Aeration Dist. Pipe t2 I• Holding Bot.System i !v PUMP/SIPHON INFORMATION Final Grade *4,3 3 ;o K 0 Manufacturer Demand St Cover $•7 5 S GPM s Model Number =��/ TDH Lift Friction Loss System Head Ft Forcemain ength Dia. ist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 �Z� �� it –rj�� _.f \ _ ^� SETBACK SYSTEM TO P/L BLDG 1 �'WEE^L+L�'� LAKE/STREAM LEACHING Manufacturer: ll INFORMATION CHAMBER OR Type Of System* � n �( Gcv,�e•>A `O V �A- UNIT Model Number. DISTRIBUTION SYSTEM tie.54-- 57 d-p/.--Q- Header/Manif Distribution x Hole Size x Hole Spacing Vent to Air Intake / Pipe(s) \ WaSd-- Length is T Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 4 Bed/Trench Edges � Topsoil \ ° Yes ❑ No Yes � No COMMENTS: (include code discrepencies,persons present,etc.) Inspection#1: �z/ /��� Inspection#2: Location: 616 CTH E Hudson,WI 54016(SW 1/4 SW 1/4 34 T30N R19W) metes&bounds Lot Parcel No: 34.30.19.382C 1.)Alt BM Description= WA10 - �`Je'� CA„n.6 j- I�e S 6✓- 2.)Bldg sewer length= q -amount of cover O� Plan revision Required? ❑ Yes 'N0 Use other side for additional information. SBD-6710(R.3/97) Date Insep ors Si ire Cert.No. A�me�u�°h^ �� S�IO►Ir( + DPkL 0�1& 4 6A 4 E��� =�,Uk, ���y � 3�an�► "ro (fie Pu Mpe d �- (5 � I�►nnt rM4 r � t I(.) b s►�l k L4 S1S d 3 -TRtWOLs 6 3 \<('0 K c bti61tE FnL� Count Safety and Buildings Division �- 201 W.Washington Aye,, P.O. Box 7162 �-i��-- Sanitary Permit Number(to be filled in by Co.) `Y Madison, WI 5 -z s* -�, L-f'-3 _ - �,.pplicatxon "�`� State Trvnsactum Number Sanitary Permit In accordance with SPS 38121(2).Wis.Adm.Code,submission of this form to the a b- ��, Pr P'� 4'ftitefnr) lyt is requited prior to obtaining a sa _ nitary permit. Note:Application forms for stat�M."W T"s arc-gUbih' Qd ro Project Address(if different than mailin r address) the Department of Safety and Professional Servies. Personal information you provide may be used Ipr' cbtyt7 purposes in accordance with the Privacy Law,s. 1.5.04(I)(m),State. .j /_// I. Application Information-Please Print All Information _ --- (�/(Q Propertv Owner's Name Parcel# - Property Owner's Mailing Address -- -_--.._.--__ 0—._—._ �p Q Property Location —`-` — -=—=_ Govt.Lot _ lzity,State Lip Cade Phone Number �r t (n1 /F,S�j /�, Section_ �7✓�i -- — ` ��� -- �hv(J7`0' u - (circle one) -- II. 'Type of T3uilding(check all that apply) � Lot# —~ - — T 3U N; R_� ' ---E or W� ___ _ �.I or2 Family Dwelling-Number of Bedroom Suhdivisiou Name— -- - -Bloc # —---- - ❑Public/Cotnmercia]-Describe Use-- — p��QfN" _--------- _- __—._ -- City of State Owned Owned-Describe Use CSM Number ------ C] Village of -� l�l lL 'town of I:II-Type of Permnit: (Cb k only one box 4n linn7e A. Conhplete line ❑New System Replacement System C] Treatmettt/Ifolding Tank Replacement Only ❑ Other Modification to Existing System(explain) List Previous Permit Number and Daze Issued B. I l Permit Renewal ❑Permit.Revision (�Change of Plumber���I>ernut'I'ransfer to New Before Expiration _ Owner Type of PO4VTS System,/Con onent/Device: Check all that a �— —� - � • 7- — Non-Pressurized In-Ground ❑Pressurized In-Ground l_7 At-Grade Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil J5 Lu molding Tani: ❑Other Dispersal Component(explain)_,_,-- ----- G �S D Pretreatment.Device(explain)____ L V.I7ispersal/Treatment Area Information: - rv---`—_�—�----- _-------- ----- i Design Flow(gpd) Design Soil A plication Ra.e(gpdsf) Dispersal Flrca Re aired s —�--—� - Dispersal Area Propos (s System ElevationV8'3.Sa V an — -� i __L __�LY o M-1010- tTs- s .0 I.Tank Info Capacity in Total #of ----- -- - AT T Manufacturer _ Gallons__ Crallons l.lnits °' n New Tanks "> o Existing Tanks 2 U � �✓ Sz y a Septic or H nk olding Ta --- t' --_ — --i L Dosing Chamber — —� ____ —__-- -- ------Y -- --� LVII.Responsibility Statement- 1,the undersigned,assume resp Inility far installation ol'the POW TS 9 shown on the attached plans.- Plumber's Name(Print) Plum s. � atu —-- , t MI/MP.RS Number T3usiness Phone Number 1--- 7 � p Plumber's Address(Street,Ciiy,State,Zip Codc;) - - —'---"---- ��--•...-- �� -- '---'-_--- - `� __ll�� � 2 VIII.C ant llae ae Eme►1t Ltse Only-V — _ proved I 1. Perms Fee Date Isued --Issuing A Signature - — �___ wrier liven Reason for Denia 75- Y7£.Cond' ' /r2easons farAisa royal --- --- -__ i %ft pp ''Septic tank,effluent filter and 3) 04" dispersal cell must all be servtces/maintains+ / as per management plan provided by plumber. �,o pa,- Gd L 2. -,A# acic requirements must be Maint0fned iblap Attach to comp e e p' n. dr the sysxem and submit to—the L ounty only on paprr nox tees than R 1/7X 7 A inches in sire -—y SBD-6398(R. 11/11) CONVENTIONAL CDOMPONENT DESIGN ResidOtlfiaf Application [Ill:X ANT D ITTLE PAGE Projert Name: Owner's Name: Owner's Address: Legal L gal Descriptioll- 53 Y �r-IU Township: County SubdMslon Name: Lot Number: Parcel ID NuMber: -013-0 - P a ge, I Irl"div,and Utle Pq,(,,2 Plot Plan Page 3 , �KtiE,9�iz inj& Cross-aeli-o dan Page 4 Filter Page 5 Pace Maaaq:ejmv�tPlan Page 7 St. Croix Ct a fic Tank Maintenanz�,, Form Pap 8 Warrant m D e"."ed -- Page 9 C,9m or plat Attduhmpvits: Sail 7,c,_,5t& 1-1rol.1,S0 I m Designer/Plumber: LiC*Gnar., Nmbsr: P-hono Nhimber to the in round Soil Absorption Componont Tv74nLfRl for PC)VVT.:, Version 2.0 page 1 -- Ab a r-t-n .,�....._.__.__ �"S�^f1^:.r�trir•.+eta 16'lAf l'!( 5PeM pipe, '� Wiifh Vent Cgip J , lao ChaMber f �� 'L � 5� System Eleavation y tq- FR a S View 4"Die. �19W Or ObgLl v ation Pips �r�r�cG) 2 HcSder d Mx lltaCur er And r��cl�l t - ---_cam.►►�--�_ USA A Rating � U fi Por chanetbei Soil,Appli(afic) q Rate -- Snii APPlicrOtion ate %row, of l '___ - - - / ^ 'post y• tw*rvluver MOINVA AUS JP WZY42-i-AW-40 P 1&41?o L U!4;1'vk A.'Ijqq O*A.0"3p1tDW!ErV'Jf W44,Qa PUP44QJd"I U$49'-Pt1&6?J eVtAJW$V g Aq pvw4o4xoxi eq 1;8�u'sq;wcjLu-Ls p I w MupLp,146 Alga,wu lull un I V y wswzswmd luvwecvoo peopplifoad J6 1110JU34vew lalgj� wvlj�s Jw auvIUDS 84'-H as p4lq1,IOU I nq but njot,I =1111'10 11V 't b b 4[N 18*40 am RojePAVVIR lal,�0 WWOM�P PU J00,100 OUPIAISS UUUME.; re Aq ;wjl,muUj 2q PW 4um. sq j• Slum= si4o vq1 liomtw quo 04;p:wpw as (.k). pjj,wi-mlv sp-lbe vj woe pue appifs I'D UqVimurma psugwzo eql VeLim s4 majaw purl Ut41411Jumv v w!puj AVL-w Inap'lls pkmo'lo mi;UU;Usmi"p;o 5UjpUW;q-qj. !1mign6 puncli"b 941 ut)wd•111j;s 10 oulp • d Aug govosp %go eadid w4pNO-1-40$44 U1 ?L11�Iwp oz P94013duuj Ajjv'nsy'ti aq jpq% (Sl)jo�JaMdRip 0141 .001Rpne puriva aq vo 4-14ontoT a%ftjp,ad JT d04�Uldq Aurl ,4�DeqU Q:� tl�Ujt PUO eNPMJS FgUti�LUF" 1,W OUID101% eqZ Ojr19EfSW '$tPOj 113 V%VZJS AW 4,41SPI wmpg, U"oAq jig Ouj$R1W AUe AkIw;jqj in jsl.7Ijwl a4C4v uoi fmld •uj JklIVIA�APhjVW=W VU*j3;;9dSU1 uvl 'Jowdo-UalAiss oft W- 4.114nirew op S..LN-kg UVIDSM1111 Sjt)j%()d 'AX S8 pin'0140-08 ivowmid jixuuy z'Javulml'i IR4:ivv.v we A OPULS 04 IAS III= 1V*;WdkP PUW 01% J,Q 2UQ3v4CI17U1 VN 1:1 VN :3 0 7 IV Ulaep'l 4112,14UC."a dwrid 'VN VN 0 VN M t;WNSMIKKIN-) (A-WO"i VN a ft PUMOU-MO 610bi?W-MV0 OU tOP�!'Ifl A -AxAe et?UQ VN Ll wovA a wow.low. AM VN ri VN 0 VN a vi owillod.uVrOg tae VN 13 rj iwom/%Q tio1; UMPUI-1100 pane"13 SPWO-W 0 VN ri 085 U11 UpIlos p"Pla"dons tloos) pldewac UQF.Axo VN 0 obvivivo Al L guUUV wuvIL48 pxmw�d `14-44 os I.$ omv spilus oqliedvn�pw-1 0040,M. 0. uoplvv 0 'YN(J- 1/duj ofrp J10,E) ptwSt�UoeAXO (0jW&qVc?!e M3110 jw%1vjE)jp S 0 '11OLIJ,!7Es (votd) ipoeie re 110 'n"3d VN LJ wull *508AVAV Ajq-wq� 4(psio�uunj*.qj4uw1ipj pAquo4S ......................... -6.A duind Y POWW110.1) 'Nvsd) mom U•jso(j Q0 AV, pswupq YN _LVN ......................... aIuoj O—Ujvxrl VN t3 A•1I1rJEJ := JII4f"I P 164wW MN YN ewacUM A lsq;WnN Z-vi OIA MIA VN a VN tj V # I Ono) 191 JoUmo SM44MO $1M- -Od cA Nov-f1-20^,0 10:45 AM St. Croix County P1ajr/ZDnjng 715-3,96-16,96 Pogo of START UP AND OPERATION For new conetruction,parr to p*a of the Pt AIT-11 check treats znTtank(s)for then Presence of painting pmduots or other Chemicals that may impede The treatm-ent proaass and/or damage the dTsperW amll(sb If high nanconmatlona are detao%ad hAV8 1110 COMOntS of thatanR(s)removel by a seplage servicing parator prior to use System start use shall not corur when soil oonditlons are frozen ar,The InfiltratIve surface. During power owtaoss pump tankm Moy VI abovis normml htshwektmr Pt vets, When power its restared the amaess Wastewater will ba dlach'ariled to The disporsal 0611(s) In one JaMa does, overloading the call($) and may mault In the backup or swrkas 419ohWee of effluent. To ;avoid this sltvatlon have the contorns of the pwmp tank removed by a Septage Sorviolng Qpotator prior to rast-OrIng power to the affluant Pump or colitaot s Flv.rnber or POWTS Malntaln%r to assist in manwally operating the pump 0ontrols to restore normal levels within 0fe P'UTTO tank Do not drive or park Vahlolas 0l10r Tanks and djaparsal calls. Do not.d4ve or park over, or otharodoe disturb or compoot, the area within 16 feet down slope Of any m0t4nd Or at-gads 9011 a'MaOrPti011 Was. Raduotl&m or olimination of the following ffam the wiast-emratar stream May imVM tyre POrfOrMS1100 arld PrOlmns tha life of the POWT$. entibiatIft; baby wipas, 0190retta butts; condoms,, 00"tor $'waba' dagraRnars; dem%l floss, d1apstr, fat; foundation drain (suM,p p=p) W�tor" fruit and Iragotabls pseling.4; gasoline; groase, horbin1des; mriat sampa'. MedlogtIons" all; painting products;;sstigjd6%j$$tfjt$ry napkins,tampons; altd water softener Wine. ABANDONMENT Aften the FOWT$foils snalm Is parmanantly taken cut;of seMue ybe fmiloWing stators$11411 iil TMk*n to 1MAN that the syntOM Is proporly and safely abandoned In compliance with ahsptsr Comm 81,32.'Wits2onsin AftanlstrotlVe Code: All plp7nq to-MIO and Pits shall be diwonnstted end the Qbandcrlad PiPO 0PMnin26,%"19d, The contents of all TznRs arid pits shali be removed and Property disposed of by a$Qptsaa SaMmIng Operator. After pumping, all tanks and pits shall be exaQviverl crud ramov9id or TheIr covers Mmoved and the VOld 80"e fill0d with soil, Rravel or another Inert SOW mMrlaf, CONTINOMMY PLAN If the M- WTS falls anti cannot be repaired the following mesasures have been, or must,Fear taken, to provide a 0040 CornpIl4int repla"m ant system. A suitable raplaoomam area has been e4rrrlusatstl and may be utilized for The location of a roplaosm.-ant soli alasorptlon ex systoffii, Tha,w.glaizom-ent Area Should be proteotad 4,rOM disturbance isne cam 940,lore and vhavIO not be Infringed W;Qn IDY required aet"oks Vorn 0XIVIM; end proposed structUre, lot 11nea,and Wells. Fal[Wre to protect the roplUe M.-ant area Will result,In the nAad for m new no![;and site evalpatlon to sistablish a suitable rap.israsrrAent zraa, Raplaosmant systems Must comply with the rule In affactat that tuner 2 A suitable replaosmanT. srost I& not avallable due to seftsok pindlor soil limitations. MarrIng advances in POWTS toohn.ology a holdlMe tank May be instsllsd as a lost rasort to mplave the f Wfad POWTS. 13 The site has not ba✓sn eveNated to identify a suitable replacam,e.nt area. Upon failure at the POWTS a soil and alto evalustTmn must be parform ad to Inaz%0 a gultebla,7,apj&rement area. if no replace m- ent:aras is evallglals a holding tank may be inatitired as a lost resort to replaaa the fs1lad Flowl's, 13 Mound and atMQrad\s 8011 absMr;tign systems may be remonstruated in place follow-Ing rarnoval of the We= at the Infiltrative swrfaca� Ra orttrtrucrtlona of suah oyRtanis mus',cc min with than M104 IM Offect at that time, <<WARNING:>> SEFTM, PUMP ANO MT y4' TREAT-MINT TANKS MAY OONTAIN LETHAL 0AMS ANDIOR INSUFFIVANT 0XVIS91611, 0-0 NOT ANTIR A SEPTIC,PUMP CA OT149ft TA1ATME%-t TANX UMpgR ANY, 01R4UM7TANOft, DMATN M-AY RESULT. FINSOUS OF A PERSON FROM THP INTERIOR OF A TANK MAY BE DIPPICULT OR WMISM ARM.LTIONAL C ..X''I SI TIS POWTA MI UgM PUTS MA Name Rhone 8 Phone LOCAL RZdMM?_r0AXA9nM=I , Name EN Phone Nam" - �a- hone 44, 42 1 Thlo deournwt WOO a Mftgfi In cornAllfin0a With chapter'Gramm and 85.5401,M)ar ird►,Mona—Adminlatrativa ova&, ,c ;o:f 3ttrr,.� Filter", Pap 0 A,' f'raM«Ac imt, A 6irfAeitA RAvc1,6Aiatlingfoi-A CT CS4S;Z 00,11 Toll F..r { ................... t�7,81Al;pttA;Wint{c'-ntra ......................_....... _ .._.........,........ EFFLUEN16" FILTER 109 tho bar In fluter tach1r.oj PL I''olyink,Inc 1,5 plpRscd f'o adO its M4,10mrS arcial filter,L)itA oxlsting ling of ri1.1,111ty Offli,tont I 119 9 A aACTM " 'fYt'C:rS.1"hp I"'i_-575 is mted fnr ovsr IC.I 000(.3po(Gallaris Par Day)m )cincl!i)nc�r„^�'f tht! largest turltnter+„iraY fltar in its rlrasc;.i9;I'Ikl:0,??i iinr�r fejet o 7/'16”t#1tr�atinn atc�t�r. I_il<w thr 9� i & k'i�r�t W A Pr�ly(nk PI-1^fin the n{n+ro i\rltrlr I'I^628 itwl t rJl'i a+atr+rnraifc S l'It of(6011 int tialleq tinritYl every h es 1ldPce3n tha )Csr Y�3nt�Mionr for ci~srrin , the kaiap will i`16Rt at "Ind teM PrArily sltl.rt Off Distr(bwti,e"BOX an ! i+l t'he a\r 1;�afYi the tttlYrrrsFlt Urc1n't Ira v;1 MO C10, hfn viral'4IRW An thP,MOrkSt ran � I Acosta—�S �^l ' ' r..i�Ym! .»n n'r>al<r•,�I1at '4�N�,?�,�r� r�r+ttrir! Ind sv'trr• � P4lA'b , �;��Pn�', PrdtY%p ,�at;isarr,....� i�r�gt,lrr+t f lwote 6 f�rn�lr.rrfia I YA 3 -toy!;�ysftims ta,el tuntl Serb./ag swa 5�7 , %Arftry Tama r. hated for'1 G,00Q(L7 i^n(Gallons nnr r.)ay} ( �►tM"I��z A as G79 liner,eel 0; fill-ration Enlarge for details Accepts 4"and(��'y'^HD,.gip pipe J �C�11�tr Sh ACOrs 13OR in GalR AlnfieQtc)r o AwToTi m IC nhuli-nff ball whan tips~iq rimavocl h� 'N� + Recarwan, +� �farrn s�ctw^rvsalhllity '��'�*�,�°""^a^^'°"'•0a'�.'m•M Awapts P\It,,axt&n:Yon hatrdir;: ' igri�a ' i01ryµRPAlm RNIMx,MUntlµq•�WlYliIxWµy,.e.,^wtw.wry„ The Pl_-.525 Ffiryi,irsnt i Ater shtfi.rlr1 0psrat6)r tffr;;leItly frlr srrvr eal ct�nclition t�fifnrr regUidrta,aleaninc�. Yt Ys rscmm�lenrir3l�tlsat th ;It 'bA tieel1ed every PAb o tin,n the tan%is Pornped Prat every tl'trap yeal,a. n{}9:Ycrnai 31ar rr the,aWMIF will lm%nntifieel Y7y to alarm in+hRn the fllY vr,i7eetP ak�IV'rginr�, �caniins 1i1 { A3 +t�it14 �ianllcinci 5hor,11ci be crone!lay a arrt('fierl 9eptic tank 17un7(t�,r c>r iniFlilrar. 10110lreik''R.1,cCeSA ONIRS 1. %oardtc�tl,e oiaki+t of f.'hr �e�flr.,tat,lc. 1m ?, 'Rernobc tan<cover'anci ptjMp tank if ne;cc wary. i. FJQ r,rj;raga pIul1liaiPtg 1Nhe n'0rhe!Y I:>rr,�f lt7vr"s to rn�, nYrj CM1, A t's.rll F'I.-52S oi.rf:of the horain F1 RArrQrA'RA?4 £;. hose ryf biter over the^c�ptrc tank.Nlqlcm..^...i.lre all anlicic fait ^ Ynsert tfte iitPr'Cr.7rirlti E!h�e,1<into the liact�)nl�maklnA sure the filter i3 I�ir1tG,sOPVC,tome, Roar slr�rrd f�� aiicfrrod n T:Mplotvy in al4MC1. 7. A91'P_fl nr��fir tank cavt r.Ft._5 B7lsigll.atir,n;Ielw I �a!`rcr�Yc�erlCiel anct r.,nnln1C�rriAl —'—•—•----L andpe rrget^finwa lip trs 10,000 Ctiailons!�r �krP'��ibr•�z�n��e� Tulhirilazi SpenfW � :&9ta IAtsAPx ��at� F*"A-^^, ^~nM�a.N� 7. P_racata thw nl,rtYnt nF thrl ra it and<. f? Prat�r�PrOO14 2. i7gmavia tank 6"w/Or Ind n'fm,t i PUMP, PULar rind St.ln �. Que the ttit�r i7nlaainc�Co%hn�"tnr cif llac'a„nary, i 2^t"x 12"Riarir the Avtt r sap, nba wn_a Palyrnk r-x nPrt, ik�a.�If tho filtn�i,r'rcit rerrrtr�r el«nrlrr Filter Alarm NMI an �. frrsert the F I.-n;;g filter fnto i%hou in, ar a'�c s of t,i�e l.Gs os!titer filter. MArtFl1mrTM I-nn�to� I hr'in %/�uia�u; ,•! 'cl„1, ,99()f. °N i•- .�,._.-,. .,,._..�,� ,.^N.�..�.^.. hrr,.r,: r•lr�rnbic ss•�,'7K`+,•n�?„�a �i�-q I11Nll :h (i! (17 yi ,n i M VA !, r r 1'ri r ��r%r�+Jrl1+ 9'�lllr�f,r' jFrrlfr1J11/IIrI�/�r,�, r y�l f��r;�����)r r �r�J+ e rJ rr l�%/Jr�/�����'„!!%�/`�`�J•l/r�r ll��e�/J�rrJ�J{1%�llln%%lJ�JIJI�",, * /+r� 7r, Jrlr � r/'," 1/r r r r r J•rrrJ , rJ+ rl r J,rl;Irrr/rl/IIi-�'ll/�Ij��l rl 111l�I�I�rfllfl/IIIJ/����//rrr i!%1�I/��� ' A� mow,_ w, + �wr�/iJr7rtr r rlAJl�Jlll ilJ��+ r � �'� 7 r�n l l lrl � 'l f J rl l r/rfi�, J �rJ�ir J lil l /JJr / /1 it r li I �� �J��)<l�r�r� :r'•c B''II��I' !I iil If III He IJII�I'j I�I+IIIQ Illllljlll� R I I:NIIiI��'I'�l�l ►u� ;I I IIIL , I ��I��r�ll I I��, I ?�����I�il��►����,��I��'ll,�lf,I�I� I;�II�I f1►alll?If � il,,,l 11 �.,,�� , I, III �.lil I i i .,I Il IP i I JIBE ;11 � I�I� I I I 'I i� 'i i i i � 'I�IIII Ills Illlllilil Il it I III 'I I I 1 `S I � il I I , I ��.����11�1��I��11��II:�I���II I111�1�) �� ��III' �I�� ��III.,I I� I• i �� I II� r ' �111� � ' '; ��III '” •I''' ''i�l 1 '...I �,L��'1./ ;!�III� 1�i ',I� ...� � IPP�I �:.� r,IJ�I 11s:.I�r�1►�LJ� L II ��}I����I�fll(�1llili��I1�11�I�al L��I ; J I �,� I n, I!�' ��� P �!i 74 I��I I rs':,I � I �II;I I �1B�61PRBIPRIBUI�mI RPBIf16iEB1�lIBBp�I�I�'i✓�'t �- i 1�1�171jtIlII9lf�ullE,l n fU�rlry'ol?a,�,eluu.�r IT .,'�6�hIJl1(IlhBllli!Ilila Jllil61111�iii11i61i11��!116t1'If��'Iull'll�l �IbIG'JIIIIflIIB11�J�1�b'a9�'�16g ��I";_�I � !lill'!�Ii�IIIVE�h,�� I JIl, 1fBBillfiN�(lfila1111�11R a �B119118i111�If�l��I111gP9 jfl ll'�I$�Ilf l��1.1�1f�l��Llf���BI�EIl19�1�1 1�II41P�1��I���hP.W'191ti.'11�1�'III���I"''1�'!!VIII'I'i1i�'ll'!'((ild'�''llhlw"I�J 'I I'II'Ij;II'I!I! 1 fl'III'�III�6�I�hW�(l'r(i6ill'II�Il illf��l'ili'I►(IIPii�lflll1�1114111'�IIIli11116i JIB'IPA(l�fi'I'illil�i',l'Il11i►�1111�4f1,lll''9lll,�';�. ►J`',IB[l6BRi'61B&'161�BBIIIEBiu�I r�r IIIIJ iIl�tibP��B€I1�a��1lRldiI�prl,RiBGI ffBI1R911BBk�IRBili�iliffBBlhl�lB;III�BI� , �1111�11111111�IaI�I���IPIII��IIh� I ,i��l�a4�ll�il,��111����11�1�111I°I�iI4��FI���N4ll�!IIIIti'��IhI'llla�iihlll' ���' �,I!���I�. r �I 9: 112AM No, 1066 P, zr, m cz rQ TI -T7 co rA- �28 cn zol- fa� ST. CROIX COUNTY SEPTTC TANK MAINTENANCE AGREEMENT AND OWNERSHTP CERTIFTCATION FORM Owner/Buyer �6,lAk Mailing Address Property Address (Verification required from Planning&Zoning.in -5epartm n ent.for new construction.) _ -- City/State Parcel identification Number 03 0—Q 0 Q 6 LEGAL DESCRIPTION Property Location sec.3 't T -3N R W, Town of Subdivision Lot4 Certified survey Map# Volume Page Warranty Deed 2007)Volume (before Pa,ge Spec house,C yes D no Lot lines identifiable,D yes 0 no SYaT--E—M--XLA1N-T—ENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping e out the septic tank every three,years or sooner,if needed,,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. $3.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in pr less than 1/3 fiall of sludge. OPer operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is Mve,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as sct by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be Completed and returned to the St,Croix County Planning& Zoning Department.Within 30 days of,the three year expiration date. I/we certify that all statements on tbi form are true to the best Of 111Y/Our knowledge. l/we am/are the owner(s)of tile, property described above.,by vii-tue of a war nty deed recorded in Register'of Deeds office, Numb f bedrooms Numb I bedroom" SIG T G AT OT, IG E OF.— E APPLICANT(S) DATE information*'**'Any information t,al Is misrepresented may result in the sanity pen-nit being revoked by the Planning&Zoning Departt-nent. at , m Include with this application a recorded warranty deed fi•oln the Register of Deeds Office and a copy Of the Certified survey map if reference is made in the warranty deed. (REV.09/07) Ix +VOL 1531FAG: 262 Es27'-ex 6.8 STATE BAR OF WISCONSIN FORM 2-1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. rROIx CO. , WI Document Number RECEIVED FOR RECORD This Deed,made between Scott D. Stenstrom and 09-02-2000 10:15 AM Jennif(r R. Stenstrom, husband and wife WARRANTY DEED Grantor, CERT COPY FEE: CORY FEE: and Keyin A Yoder and Barbara A. Yoder husband and TRANSFER FEE' 425.70 wife as survivorship of marital property RECORDING FEE: 12.00 PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County,State of Wisconsin: SEE Attached Re�:ording Area RETURN TO: TITLE ONE 706 19TH STREET SOUTH HUDSON, WI 54016 030-2009-20-000 Parcel Identification Number(PIN) T1 is 1.5 - homestead property. (is) (is not) Exceptions to warranties: easements, roadways and restrictions of record Dated this � ay of l' 4 *Scott D. Stenstrom * nnifar Stenstrom AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix County. Pea=Il came before me tly�s_ day of authenticated this day of tTie above named Scott D. St n strom and Jennifer R. Stenstrom TITLE:MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed (If not, the foregoin.;instrument and ac cnowledged the same. authorized by§ 706.06,Wis.Slats.) IL THIS INSTRUMENT WAS DRAFTED BY *Tracy L. urnar Michael H Eoreck1 Attorney Notary Pub]ic,State of Wisconsin Eau Claire Wisconsin My Comm ion�e nt- not, state expiration date: (Signatures may be authenticated or acknowledged. Both are �1- -) not necessary.) Tracy L.Turner Note -Names of persons signing in any capacity must be typed or printed below their signature. ate of Wisconsin STATE BAR OF WISCONSIN WARRANTY DEED FORM No.2-1998 Produosd with ZipForm^by VeniaoR Inc.18025 Fiaeen Mile Road.Clinton Towm hip.Mmhigan 48035,(800)383-9805 Attorney Michael H Forecki 1$30 Rmektt Ave.Eau Claire Wl 54101-4627 Phm, (715)835-3029 Fax: (715)93S-4112 l2 • Grantor- Stensstrom voi. 1531pAGE 2v3.antee- Yoder Commitment Number. 1901S SCHEDULE C PROPERTY DESCRIPTION The land referred to in this Commitment located in St. Croix County, State of Wisconsin, is described as follows: Part of the Southwest Quarter of the Southwest Quarter (SW 1/4 of SW 1/4), Section 34, Township 30 North, Range 19 West, described as follows: Commencing on the South line of said Section 34, 647.53 feet East of Southwest comer thereof; thence N 2 deg 48'W 329.22 feet; thence S 79 deg 04 ' E 201.63 feet; thence S 1 deg 18' E 70.24 feet; thence N 86 deg 53' E 124.46 feet; thence S 1 deg 43' E 227.15 feet to South line of said Section 34; thence West on said South line 314.8 feet to the place of beginning. ALSO Commencing at the Southwest corner of said Section 34; thence N 90 deg 00'00" E, along the South line of the Southwest YA of said section, 617.72 feet; thence N 02 deg 14' 14"W, along the Easterly line of Lot 1 of Certified Survey Map recorded in Volume 3, page 843 at the St. Croix County Register of Deeds Office, 321.73 feet; thence N 87 deg 45'46" E, along the Southerly line of said Lot 1, 30.00 feet; thence S 78 deg 29' 11" E, along the Northerly line of a parcel of land recorded and described in Volume 900, page 351 at said office, 131.26 feet to the Point of Beginning; thence continuing S78 deg 29' 11" E, along the Northerly line of said parcel, 70.28 feet; thence S 00 deg 44' 52" E, along the Easterly line of said parcel, 70.07 feet; thence N 87 deg 27' 08" E, along the Southerly line of said parcel, 148.02 feet; thence N 01 deg 01' 18"W, 523.67 feet; thence S 90 deg 00' 00"W, 216.28 feet; thence S 01 deg 01' 18" E. 446.15 feet to the Point of Beginning. ALTA Commitment Schedule C A a �4. 2383 Wisconsin DepartmefJ�'G ,,`;, SOIL EQUATION R RT page 1 of 3 Commerce � � ``� 'nv�rlanceyvith Comm 85,Wis.Adm.Cod( A.C.E.Soil&Site Evaluations Attach complete site plan o �cj�� i 8'/:x 11 inches in size. Pla County include,but not limit%ktoi Nins,®tid'15orizontal reference point(BM),directio St.Croix percent slope,scale ortLa� north arrow,and location and distance t( Parcel I.D. M 030-2009-20-000 ease print all information. e Revie By Date Personal information you provide may be used for secondary purposes(Privacy Law,S. t Property Ownel Property Location Kevin&Barbara Yoder Govt.Lol SW 1/ SW 1/4 34//T 30 N R 19 W Property Owner's Mailing Address Lot# Block# I Subd.Name or M# ct 616 Co. Rd. E Na Na Na 3�z City State Zip Code Phone Numbei City Village ✓ Town Nearest Road Hudson I WI 1 54016 1 (651)206-9951 St.Joseph 1 61St St. New Constructior Use: v' Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD ✓ Replacement Public or commercial-Describe: Parent material Glacial Outwash Flood plain elevation,if applicable na General commentec and recommendations: Soils suitable for conv. dispersal cell at 0. d. linfiltrative surface elev's to be approx.48"-60"below grade. Rec.system elevs.=90.0', 89.5', 89-6—'&-8M'. 4-Z a Boring# Boring J� ✓', Pit Ground Surface elev 95.06 ft. >102° Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structur( Consistence Boundar Roots GPD/ft' in. Color Qu.$z.Cont.Colo Gr.Sz.Sh •Eff#1 2 1 0-11 1Oyr3/3 none sil 2fgr ds cs lfmc 0.6 0.8 2 11-18 1Oyr5/4 none sil lfsbk ds cs 2fmc 0.4 0.6 3 18-41 1Oyr4/4 none sil 2msbk dsh cw 2vf,fm 0.6 0.8 4 41-52 1Oyr5/4 none Ifs Osg dl cw 2vf,fm 0.5 1.0 5 52-7$ 1Oyr5/6 none s Osg dl gw 2vf,fm 0.5 1.0 6 78-102 1Oyr4/6 I none s Osg dl - - 0.5 1.0 Horizon#5 contains approx.40°6 cobble. Horizon#6 contains 114"-2"bands of 10yr4/4 Ifs at 4"-8"intervals. Loading rate reflects reduced permeability I horizon associated with banding. ti aBoring# Boring � ,1t 47 Pit Ground Surface a ev 1 92.57 ft. Depth to limiting factor >98" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structur( Tdsh Boundar Roots GPD/ft- in. Color Qu,Sz.Cont.Colo Gr.Sz.Sh 'Eff#1 'Ef 2 1 0-12 1Oyr3/3 none sil 2fgr cs 2fmc 0.6 0.8 2 12-16 1Oyr5/4 none sil sfsbk cs 1fmc 0.6 0.8 3 16-33 1Oyr4/4 none sil 2msbk cw 1vf,fm 0.6 0.8 4 33-79 1Oyr4/6 none Ivfs,fs,ls Osg dl cw 1vf,f 0.4 0.6 5 79-98 1Oyr5/6 nonols Ivfs,fs,ls Osg dl - - 0.4 0.6 Horizons#4&5 consist of several layers of Ivfs,Ifs,fs, &s too n merous to differentiate. Loading rate reflects most restrictive permeability found with horizon.Horizon#4 contains approx.40%gravel&cobble. 'Effluent#1 =BOD >30<220 4L and TS >30<150 mg 'Effluent#2=BOD.-30 mg/L and TSS<30 mg, CST Name(Please Print) Signature. CST Number James K.Thompson <r--- 3602 Address A.C.E.Soil&Site Evaluat' V Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 54020 12/4/2014 715-248-7767 Property Owner Kevin&Barbara Yoder Parcel ID# 030-2009-20-000 Page 2 of 3 FBoring# Boring VF Pit Ground Surface elev 92.13 ft. Depth to limiting factor >96" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft2 in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh *Eff#1 *Eff#2 1 0-12 1Oyr3/3 none sil 2fgr ds cs 1fmc 0.6 0.8 2 12-18 1Oyr5/4 none sil sfsbk ds cs 1fmc 0.6 0.8 3 18-40 1Oyr4/4 none Sil 2msbk dsh cw 1vf,fm 0.6 0.8 4 40-54 1 Oyr4/6 none gr strat s Osg dl cw 1vf,f 0.5 1.0 5 54-96 1Oyr5/6 none Ifsfs,ls,S Osg dl - - 0.5 1.0 Horizons#4&5 consist of several layers of Ifs,ft,Is&s too numerous to differentiate. Loading rate reflects most restrictive permeability found within hor' Horizon#4 contains approx.30°x6 cobble&stone. F-1 Boring# Boring Pit Ground Surface elev ft,. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GP /fN in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh *Eff#1 *Eff#2 III F-1 Boring# Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft2 in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh *Eff#1 *Eff#2 *Effluent#1 =BOD 30<220 mg/L and TSS>30<150 mg *Effluent#2=BOD 5<30 mg/L and TSS<30 mg The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(8.07/00) A.C.E.Soil&Site Evaluations �' , &7�iS�i�9�adeel2d! o ee r/.�7 ifxva yodc.-p�do See.3,.,f T.3oeG /QuJ.,T.of'sE-z"V-C, 6W 5v M � b oFS:di . /�Ss�cwtcc/ �rm�+ ar on a • �, 3 btdrooa" M /s _ 9728 0 . �?csi dcwtce h of k tad R►ruc{Pole 3 ' eo. Qa� Q c (D 3 oer� it O e 00 > 4 c o o 0 0 O w co-o O N O f6 U c w C O © f6 V O o a)Y a) N > N o_ @ @ E aE C Ni a) +-' a) C d C a 7 N '0 C N E N E N t' O mmwNcaa o Q .. 3 0 M2a�EiEve 99-a �_ o o�' 0 - 0. z a> cd c o $-�rn - c m o as Ea'�.- I m N E as °loci c m o no Q o c > coi t as as N C o �L CE co (U a° �o' c com r- o 0 LL o y°0' any 3 o_ 3H O. f0'O N .0+ V E N�O Q 2w v axi� Ocr�i 3 m'Sad � I v � Z N _O U) „ 0 7 LO Z d a7 m I- U) ! d m c O I O Z d U aUi v ° N o Z N Z E a) N c N C a s o o o Q z z z - NZ I "i 0 °1 O �v 06 d v U) a " c m N t O G a L a � O I h w O to v) to = a_ co E to o o o a 7 Z •N a a a CL �l 7 Z.; fn , O r> ch -o � o Z _° w o o - o 1 E ) a U ° °1 Q Z a m �j o c I' CD w c Q o o _ ° w ~ m aa) V Cl)°' O N E E N r„r O M 7 C N • yT,�' O M U) O N Z Z U) O � i a1 t6 £ d r.+ N i' . a ;0 a w 41 r `�1 A O U S a j O in Ci r t PLOT- Rt—A^3 i HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT 'VIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. "INN.INSTALLER&DESIGNER LIC.NO.W663 p y� 75 O vmr P� 15 80 VD^^ -- - - - �- Eo�� a� p gc £ McTA� EO/D 4o RA- �><oR�4s • s%D� 6F AfiS�.yt A;r o z s ----- 0 R ,O 3 i 1 Z°Q vCa T To 7A't.4T.jEV7' TANK Of t/ eVOWAA IB Si2f d COap ITf0�1 1 UEN r' A,45 (Oa*vf1TEO I A55 of o PAow 143 �o v I P 51�M � aR P CT y. �D• � DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS I,NDU: Parcel #: 030-2009-20-000 07/13/2007 05:06 PM PAGE 1 OF 1 Alt. Parcel#: 34.30.19.382C 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 KEVIN A& BARBARA A YODER 0-YODER, KEVIN A&BARBARA A 616 CTY RD E HUDSON WI 54016 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description *616 CTY RD E SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.500 Plat: N/A-NOT AVAILABLE SEC 34 T30N R19W SW SW COM 647.53 FT E Block/Condo Bldg: OF SW COR SEC 34 TH N 2DEG W 329.22 FT TH S 79DEG E 201.63 FT TH S 1DEG E 70.24 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT TH N 86DEG E 124.46 FT TH S 227.15 FT 34-30N-19W TH W 314.8 FT TO POB ALSO COM SW COR SEC 34; TH N 90 DEG E ALG S LN SW1/4 more... Notes: "� I Parcel History: �• / p ���� Date Doc# Vol/Page Type �1 08/02/2000 627468 1531/262 WD Imo- ,� t ,,�� IM"", h 07/23/1997 100/351 WD Q I}" i�/ �/(�I't 07/23/1997 900/351 �V 1" 07/23/1997 885/433 more 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.500 120,000 96,100 216,100 NO Totals for 2007: General Property 4.500 120,000 96,100 216,100 Woodland 0.000 0 0 Totals for 2006: General Property 4.500 120,000 96,100 216,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 142 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 .:.� .� �D .20Q9 9� �Oo 38zA•ro FILED Z9 N FILED 1 9 1 ,of� 0 C T 994 moo- JAMES 522628 SL Croix Co.,W1 CERTIFIED SURVEY MAP Located in part of the SW; of the SW4 of Section 34 , T30N, R19W, Town of St. Joseph, St . Croix County, Wisconsin. CURVE DATA 1 -2 AREA OWNER Radius 1839.86' Lot 2 Malo Duden Central Angle O1°45'28" 3.38 Acres Inc. R/W 610 County Highway "E" 9 147,325 Sq. Ft. Hudson, Wi. 54016 Chord Bearing S88 053109 11E 3.05 Acres Exc. R/W Chord Length 56.44' 132,789 Sq. Ft. W C/) w Arc Length 56.44' Lot 3 r o M c a Tangent Bearing S88°00'25"E 1870186rSs q, Ft. y s o rn r a C .+• N Tangent Bearing S89 0 451�311E PARCLE� OF LXND a o ou I\133,133 x „—S 8905'5L 1711-W 726.20' c T M" f Co Co Co N -32.78'; 347.39' 346.03' 34.03' -31 8 0.17'- w z o . N r x m m o o o 6 .23 n 0 r0.W v �~'U C N Cn O o ° LOT 3 r C2 rr r ° o fD IC T r1 m _� ♦� 7N N I Z N 7 I� 60 r I ti - v h7 I—I Ln 1> I� N8042136 11E I� 27.001 0-a $78.76'� zo I—I 58.19 320.57' 250.00' o a T N87°45'45"E 628.76' iP o o it \SF C2 wo -�j C C�1 Ln 9 9 �9 N I�r�!-1 ;° w cn _ �- �- - rn I�I— v o °- - /[Tl CT rn m cn 1 m rn w W �11 i= Cca�mittc�o O o N N ON In-• I N n°i 78029 1 11 v ,° - o j3j•26 j E tay :i�days of I+ - 't:l'ovp3 date CO I . II m m I 0 1 i ;,.•..f.�t s!,alt e: S79 35 E b 9 � SW Corner Section 34 --N90 000'00 11E °_ CD LEGEND 962.54' - a .. —J L. I.H. Aluminum County Section Monument Found South line of the SW} •-- 1" Iron Pipe FounB !JNPLAT T ED LANDS 0 1" x 24" Iron Pipe Set, weighing 1.68 lbs. per linear foot .�'��;��� ���* 100' Roadway Setback Line a ALLEIN C. Existing Fence Line 1 N%'HA0E,l p Septic S-11,07 SCALE IN FEET `�r� M.•••,,^�_y) „,` 100 50 0 200 400 No SHEET 1 of 2 SHEETS VOLUME 10 PAGE 2831 • = JjA-C�l ynE ���rS HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.5401 ROBERT WRIGHT NIS.MASTER PLUMBER LIC,NO.3301 M.P.R.S. ,!INN.INSTALLER&DESIGNER LIC.NO.00863 % 75 lic O — �' I E'/ev,= ioo,a 9 VeRf r IS 9 0 7MM so Of -- F v A 40 14L- 'p g c E M�TA� • �sf��/G� d" V 3y �- ?�soRMS • s%OE 6F �3 Bz I ` A fis��r AT S s 2`t' •P Z4 FC•u r To 0efr..YBNr �$ SiZf"$ c0a0itloa PEN f A f3 Allt eOvoCt7E0 of ov�P�ow 143 �D VIP fm W lo, , C T t 6� J DEPARTMENT OF REPOR OIL 130104bb ARV DIVISION INDUS'RY, Tom P.O.BOX 7969 LABOR AND PERCOLATION TESTS S (115) MADISON,WI 53707 e1UMAN RELATIONS (ILHR 83.0911)&Chapter 145) LOCATION: SE TION: TOWNSHIP/ OT N0.'11 NO.:r UBDIVISION NAME: s� t� s� �/ 3 y /T 30 N/R/7 E (or)W sr. ,iasE,O#--:- [_ COUNTY: i=EO ffp.�r6 Ld,f v .yo`PyT, MAILING ADDRESS: eeVr ,R y 21 E�1L �'ST•rTLc COUNTY: x �,�P. �a a%M --mye,",s �>-y v�y% DATES OBSERVATIONS MADE S'Y02 L USE NO.BEDRMS.:rOMM E FI IALDES RIPTION: I (AResidence �/, ❑New Rep— �jtjtJ./`J` /�7 =i� -ION TEST f q RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUNOPRESSURE: SYSTEM-IN FILL OLDING TANK:RECOMMENDED SYE p nil) �d X �S ❑U S ❑U ❑S OU ❑S ©U ❑S ©U ,Q�,r✓e s.3 uT,e? eG/e05 71 If Percolation Tests are NOT required DESIGN RATE: �_ Ii any portion of the tested area is in the under s.ILHR 83.0915)(b),indicate: GGf9-SS Floodplain,indicate Floodplain elevation: w/iuTEie 71ST GOuGYTiO✓S : AoR7AY s��"y, PROFILE DESCRIPTIONS 33 f 1 BORING TOTAL P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED H TO BEDROCK IF OBSERVED( ABBRV.ON BACK.) rr / i 12" RAI. 6� &-41�d ey S/r /i- ow• 4,v. /SAT y r) 8' o.P 6,a . B. �OZ 9 7102 arouCy s, 8 u,E-� �r;,., s f 12„ ne•.w-nee• s S-�,. SN- cauv-u St PoCAre7"S, w,A B- r „ f' ae-6N- _5V ly'*bN.s, u4�aT-44,C 0777 , 20.. Bu. 31.c&,y S/� /o" aiu• G Alixfuoe B- /0 Ito AF 13,3. t o U R bt 5 t3 a•r>^c�Q. sr� B " .. y" .0 IeUh Ri�� Sr I Z i, �f '✓/ /dL/I)`y s% 20 B. 3 �a, 5��4 �v > �,� •131.0 cley -(1 km 51* � M sN. �r,�A' s/ (; ' 41�c f�,P c �F ate. . S, .�,.,¢ 3A1 . Pwc foAbic� PERCOLATION TESTS } T DEPTH . WATER IN HOLE TEST TIME DR I WA LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFT RSWELLING INTERVAL-MIN. l D PER INCH r y P- 0 �S Is l9 . 7 P- P 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 show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. !L SYSTEM ELEVATION Fo.60 r I i I - T T__ , Pis- � I1 � I t I _T_.._.� .... I ' i I I > 11 I 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. > — TESTS WERE COMPLETED ON: r' t NAME(print):N 1p _ HOMESITE SEPTIC PLUMBING CO. � ( C S l HUDSON,WIS.540 19 � l 655 O'NEIL RD., _ ROBERT ULB Gam'- "— - CERTIFICATION NUMBER: PHONE NUMBERIo tional►: ADDRESS: - / 7 M.P.R S s y z 36'�O � �5 N)S.MASTER PLUMBER LIC .N0.330 CST NATURE: / DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. L "I 10� ,n1a•11 -OVER -