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HomeMy WebLinkAbout020-1066-80-200 f o © \ § % > 7 2 0 ■ o \ � A 02 aƒ ( \/ � ƒ � 0 / � } CL § k ■_ W a §O 2 § 0A % £tat ) f CL 2 .0 CD ■ 7 r j 2 #2J � ; J z' 2 Z « f 2 \ § k C . 0z 2 \ ' ■ - , cz - k f ) $ E 2 '0 e n i N j � : 5 0 o a - ; ! § § c z w D ' z _ k % E ~ 6 M _ © a : � 2 J \ § & a a k % \ _ i o o U) U) U) \ G 2 2 2 .« \ 2, 2 2 a a « 0 B \ o Q / k 7 § � 0 � f G / ES - � o \ ƒ ƒ � ) c 2 0 C k k 4.0 E B % 77 - - �. � o o G 6 c 0 c r- - o o z \ B k 0 § ) « ° - \k o 17 0 c , z a ¥ , 6 � ) % � ° o � I J ° o z ■ n « � m I � E l k k f Q u � 2 / 3 2 PUMP CHAMBER 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: Trench: Width: 's Length: /,,�, Number of Lines: Z. Area Built:<'6a Fill depth to top of pipe: Z J Number of feet from nearest property line: Front, O Side, O Rear,0 Pt . layt Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: rj h' Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: ��,i��' 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: , t t: License Number: 3/84:mj i t 4� Form - STC - 104 y ' AS BUILT SANITARY SYSTEM REPORT OWNER __� yr �� TOWNSHIP -<.r_;a r SEC. --;? 'l TAN-R ,/ i W ADDRESS f,'j;�,c� / ST. CROIX COUNTY, WISCONSIN SUBDIVISION C,5^) (/ LOT �/'l ' LOT SIZE //W q. 144 1 A— PLAN VIEW Distances and dimensions to meet requirements of I•TZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L� s i7 _ .._._ __ .._.. ._ _- ._.�. _,._......_. ,r� � �i�,�'ax�rd✓W e l/ l - t '4 4� l �<Y f ' r 3 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference poInt used Elevation of vertical reference point: 115U Proposed slope at site: 2 SEPTIC TANK: Manufacturer: &,�L4 ,� Liquid Capacity: _/? s Number of rings used: L�) Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Frcat 10 Side Rear, 0 feet From nearest property line Front ,0 Side 0Rear,Q feet Number of feet from: well builaing: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REV3RSE SIDE + + i ',ijEPA$T%ENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SW-'4, SW4, S24,T29N—R19W NCONVENTIONAL ❑ALTERNATIVE State Plan I)D.Number: Town of Hudson El Holding Tank El In-Ground Pressure El Mound Will Bradley Drive Y7 80 1 za NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: George Reed Route 1, Hudson, WI 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Roger Timm 3224 St. Croix 102834 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER OH O 1 n'\ �PROVIDED. PROVIDED I,-.D U �d rC� q�, /V ES ONO DYES 9NO BEDDING. V;DI A.. VENT MATL. HIGH WATER NUMBER OF ROAD A]PROPE TY WELL. BUILDING. VENT TO FRESH ALARM 'l\ lA1R INLET ❑YES ®NO t�1— ❑YES �10 INEAREST---.*O M �DU � I DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO OYES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PR OPERTV WELL BUILDING VENT TOFRESH (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 1 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 DISTR.PIPE SPACING COVER INS(UE DIA -PITS LIQUID BED/TRENCH TRENCHES MATERIALt PIT DEPTH DIMENSIONS (0(0 — GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL. nPIPE�l NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COV ER. ELEV INLET ELEV.END. ^^/�^^ FEET FRO M LINE AIR INLET(J, l J0 o /a� NEAREST IOD 4,46 3D f 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 NO SOIL COVER ITEXTURE PERMANENT MARKERS JOIISIHVATION WE LLS DYES 1:1 NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES ❑YES 1:1 NO ❑YES ONO ❑YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING JGRAVIL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBUT ION PIPE MATERIAL&MAHKIN(' ELEVATION AND ELEV.- ELEV.. DIA ELEV. PIPES DIA: DISTRIBUTION VERTI INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS 70 APPROVED ❑YES ONO 1:1 YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE DYES ONO El YES 1-1 NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. ' IGNATURE TITLE. DI LHR SBD 6710 (R.01/82) �' Zoning Administrator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION Y 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 location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be,properly maintained. The septic tank(s) should be pumped by a licensed pumper WhenevIer.necessary;'us-Dally 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; 11. 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 titer included the creation of surcharges (fees) for a number of regulated practices which Wisco iCi'S e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reastlre is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are cred!ted 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) DILHF SANITARY PERMIT APPLICATION �� C�v/ In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT#/ /©CV 3�/ —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 R NO PROPERTY OWNER PROPERTY LOCATION ?vy'cr ';�0x/45t.u '/4, S L5/ TZS , N, R r (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUM ER B SUBDIVISION NAME IL w%/ 7 144- ;113 CITY,STATE / l ZIP CODE PHONE NUMBER CITY / I NEAREST ROAD LAKE OR L NDMARK 4t, _a? 4t.J ��i�j;�G d///9 VILLAGE; �[�d5i}- JI. TYPE OF BUILDING OR USE SERVED: �(//y " •• l.` Number of Bedrooms if 1 or 2 Family i OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check##2,3 or 4,if applicable) 1. a. X 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. M Conventional 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. El ,cCS seepage Bed b. I See a e Trench c. ❑ See a e 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): 3 �p7 d Feet MPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank 2v) Lift Pump Tank/Siphon Chamber ❑ I ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Sta ps) MP/MPRSW No.: Business Phone Number: . 2z 7 72, 3 z./4,1' Plumber' Address(Street,City,State,Zip Code): ,_ l Name of Designer: VIII. SOIL TEST INFORMATION Certified oil Tester(CST)Natng�� CST# /.GIB e ' \.JT CST's ADDRESS(S eet,City,S� Zap Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) fQ Approved ❑ Owner Given Initial ( Surcharge Fee Adverse Determination 1 04_c�tnb X. COMMENTS/REASONS FOR DISAPPROVAL: pl&,91 r SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber jo 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 witl� the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property >CC r Location of Property $ �,J -1% 5 cJ 1%, Section Z. �±� , T Zy. N-R .1�y W Township — �lu.._-sCJyA Mailing Address __ ecru2 Address of Site Subdivision llama ; r Lot Number 1 Previous Owner of :property Total Site of Parcel 1�/ i--f Date Parcel vas Created Are all corners and lot lines identifiable? '� Yes No Is this property being developed for resale (spec house) ? __...__ Yes No Volume � and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: ch 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 (We) eehtc.6y that ate atatementd on thiA cute thue to the beat o6 my (oun) know.tedge; that I (we) am (ahe) the owner(a for the phopenty dea eh f bed in this .in6ohmation 6o4m, by vi tue o6 a wahhanty deed recorded in the 06 ice o6 the County R¢g cateh o6 Ueeda as Uaeum¢nt No. 4/ / ; and that 1 f We) phew entey own the phopoa ed a,c to 6oh the a ewag a d z poa a ya tem (oh I (we) have obtained an easement, to hun with the above deAcAibed phopehty, 6oh the eonathuction o6 ea.id a yatem, and the name has been duty kecohded in the 066.iee o6 the County Regi6teh o6 Heeds, as Document No. ) . JOc SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) /Z � 4 ✓ z 8 - ZU w. r��....rr.i■r�r.. ■ DATE SIGNED DATE SIGNED �_ �r z II V� li 4Z, dF'_ k�`'q�,�,� �' ..UU a. �. -t F, I �5Y Is pv - 1 k tand lr" wees" ai �� m� ? and f roe '*� 3 a and el�e�eNnbraicut of record, J. b YF yy i.( �,p�•- ..jjam�� lovamber a..: r L ♦ 'd- F n 1) a 1 Og _ �� ♦f L�.. yl'. - /:.• J.-1._ Q •........ . y... - V7 4 k` 3. r SEA ; gryrh� ',�.�+e�'.f tk`- ` -�gZt'�jX;�i�k r�t� yr::kr�r •r�.'�="L.��.y�p,j ex^' - � _. .... ...................... MMI �i "'Lknw k sCl; lOaa[sl�z fir" fr�t • i� j"1{p t ��JF s .r - ` _ ._: Ty 5 P 1rI t � kC FS co FILED NOV 51987 ti Q0 MAM a COMM ftOdW of hook 4 431870 4 , �a CERTIFIED SURVEY MAP Located in the SW 1/4 of the SW 1/4 of Section 24, T29N, R 19W , being also Lot 1 of that Certified Survey Map recorded in Vol. 1, Page 288, Town of Hudson, St. Croix County, Wisconsin, USA W I/4 CORNER SECTION 24 3 n a� LEGEND �\ UNPLATTED LANDS 5 \ pO o M (S88°57'00"E 403.07') SECTION CORNER, BERNTSEN CAP S88004'00"E 405.94' O 1"X24° ROUND IRON PIPE WEIGHING 1.68 LBS/LIN. FT. SET �, • 2„ ROUND IRON PIPE FOUND kri W' _p LOT 1 • 11/4" REBAR FOUND IwI I • 5/8" REBAR FOUND 206,871 S.F. (4.749 AC.) ODl l rcl (403.07') PREVIOUSLY RECORDED INFORMATION o � a 7 vI I al 0 >I I ml " FOUND IRON IS 2.48' WEST OF Uj I3I� SECTION LINE. a J >I / e BEARINGS REFERENCED TOOn THE X / WEST LINE OF THE SWI/4 "OF /33, ti SECTION 24 , ASSUMED N0003'47"W p n in m a M 3: 3 NI N v ZI ,, - N88 004'00"W � ►- o �\ 203.12' W W ° u o�) N - c 0 o m 10 6 w w y ti C Uj SCALE IN FEET Z N88 004'00"W ao 10 o f °j 203.12 O 0 50 0 150 300 0 0 0. O H Z N In l LiL 0 T 2 2.33153'S.F. ` j,5-.352 ACRES -0z 10 INCLUDING R.O.W: nlc OR 2A8,718 S.F. _ w7 HARVE S ti 5.0 2;It ACRES _ s Y EXCLUDING R.O.W. N JOHNSON a - N o HOODUSE HUDSON �s 0I _o : %.- was v? g►I<I/V . �Q z i�0, � SUR LOW } SPOT ,,,I Z' is .'d a > °\\q2 / �I 566 69 ��(I 6e "1 /�" .� 4 Surveyed for:. J. Joseph Daly ml n 5 2\s'6 �N O Po R t. 1, Box 167 ' O 33• M.. n$ art q�5 y0 , Hudson, W i. FOUND IRON IS 1.78 N68°11'42°W CJro °x OF CORNER. W °42 00 `S6q 1,10003'47"W 134.26' This instrument drafted by: HGJ ( NORTH 13520') i SW CORNER j SECTION 24 487-1319 VOLUME 7 PAGE 1913 Q 5 V,C�Okx 'Coulm :U'AUP,:'!r,Ehc E MWS �LAiyi/71� L "\c AND 2"041*G ZOWl7 iltil� A parcel of land located in the SW 1/4 0 the S'W'1/4 of Section 24, T29N, R19W, being Lot 1 of that Certified Survey Map recorded in Volume 1, Page 288, Town of Hudson, St. Croik County, Wisconsin, described as follows: Commencing at the SW corner of Section 24; thence N0003147"W (bearings referenced to the West line of the SW1/4 of Section 24, assumed NO°03'47"W) 134.20' along the West line of the SW 1/4, (recorded as North 135.201) thence continuing NO°03'47"W 1171 . 85' along said West line(recorded as North 1169.601); thence S88 004'00"E 405.94' (recorded as S88 057'00"E 403.071); thence S0005'52"E 995 .68' (recorded as South 996.631) to the centerline of Badlands Road; thence S68 011'42' W 437.41' (recorded as S67 042'00"W 435.58') along said centerline to the Point of beginning, containing 440, 0024 square feet (10. 102 acres) more or less, and being subject to all easements, restrictions and covenants of record. I, .Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that I have surveyed and mapped the above described property; that such map is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the subdivision regulations of theTown of Hudson, St, Croix County, and Set:tion 236 .34 of the Wisconsin Statutes, to the best of � � e, understanding and belief. i HARVEY G. Harvey n S1899 JOHNSON y Rusch Surveying Inc. 5-1899 407 Second'Street HUD S N Hudson, Wisconsin 54016 � 4 S U Ri1; This map is hereby approved by the Town B t the Town of Hudson, Date Town Clerk VOLUME 7 PAGE 1913 J_ �l rn . H a ' ST C - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYER rya ROUTE/BOX NUMBER_ ts .K / Fire Number CITY/STATE AzzZ.,t•�V-,^ lA Jt-s ZIP PROPERTY LOCATION : 3(j 14, S L-0 k, Section Lyi T_;F N , R W, Town of /crSQ-� St . Croix County , Subdivision CAS I'� [�a[. /f�l� Lot number_. s 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 m_ y 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 . H 0 E I/WE, the undersigned , have read the above requirements and agree En 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 Z 0 L(5 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 . DEPARTMENT OF ' REPORT ON SOIL BORINGS AND ,. SAFETY & BUILDINGS )t1DUSTRY, DIVISION BOX LABOR AND PERCOLATION TESTS (115) MADIS N WI 53707 HUMAN RELATIONS (H63.0911)&Chapter 145.045) LOCATION: SECTION: T UNICIPALITY: OT NO.:BLK.NO.: SU DIVISION NAME: S W 1/ y i4 T zq N/Ri 9 E (or) J'V uD 5o,n/ ! CSM - Voi 7 P4 /94 COUNTY: R'5 YER'S NAME: MA IN ADD SS: s, C�lx 6coQGE b��cLvN4 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM R L DESCRIPTIO FICE N A E S: Residence �uK — WNew EIReplla+ce NO� �8�i9�? Alb /9 �, 5 SOIL.- oy___ 41>r J 1 JO7(.S _ dc,r"t I►+Yh�1QT RATING:S-Site suitable for system U-Site unsuitable for system �I � - S AT-r O VL_NTI❑N�: IM_QUND:❑� IN-G ❑U S ❑AL EIS SG rP�fV� .R-rkligo4 SYSTEM:loptional) If Percolation Tests are NOT required DE IjIGN RATEt. If any portion of the tested area is in the under s,H63.09(5)(b),indicate: 1..«tSS l Floodplain, indicate Floodplain elevation: AI r r i PROFILE DESCRIPTIONS BORING TOTAL -DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IK ELEVATION OBSERVED EST.HIG E TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B l pg ,,%L oN L > q,0$ / Qcsc s iz $aNSL Zo°84.vC-11 6,e ilcob S4"I.T RaN MS B- ? ./-7 /06-73 NdNE >1111-7 7'&srrs /6''tea$� stC„�49"�TIQ a M'S14a -%;toN M v 3 Lr aly B. ZS Fs1 aJ,� . >9.25 �l'f csl i5 9'BteN075 44 &-1C-/415.4 4 e 4?' B- ` y"$1.�, IS 3o�Yt$eNSt 4Zp K4,@AN ('S' oQt(;A s,b4LL /0,�5 0.53 N�N� >/ot75 �' cS�cSe - 9"SLIT'S 2tS" QN sty / e� B- No�l� > 8,67 AS B- arc -'r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IUC*MS AFTER SWELLING INTERVAL-MIN. PERIOD t [% PER INCH P I S.Z.3 NO r,>< 111?3 3 --.*Z ->Z < P_ 2 6.O/ tL 60.S 1 3 Z 2 P- 3 Z ems. < 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. SYSTEM ELEVATION 30 4 oY CAAA& '3o To (ATLw� sc,ad � __ 5a Sob � �— � � •3v Apt 3 zZ, Si-' N1E4k C.,&4AR- f $ASF.UNE NO�R•l•N F'A«. oF' Neusr v AIawiR FAct aF PROP6%t A qau / 4 P,QoR�se�, I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and mrtt suds specifiad in the Wisconst Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: N ^� ARY&/ ON►�SSvn/ 1rUS��_Su��c'/IN�a-- Mov /9 /9Fi ! ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(opt ional): o S�CONI�, S-r ku4_ sory W, RE_ CST SI ATIJ DISTRIBUTION:0tuWut1;md unnc,q.y it) I nc.0 Aiiihomy,I'tntartty Ownet anti Stttl Icslrt. DILHR-SBD 6395 (R.02/82) -OVER -- L DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS I R STFiY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WOI 53707 HUMAN RELATIONS (H68.0911)& Chapter 145.045) LOCATION.-S- SECTION: T_W UNICIPALITY: OT NO.:BLK.NO.: SU DIVISION NAME: S w �/ �/ i4 T z9 N/Rr9 E (or► ti/��s�N l V SNI - Von 7 P4 /94 COUNTY: R'S YER S NAME: MAILING ADD SS: „ Ceolx 666pe4c���Ya/V4 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM R RI TIO A TS: P Residence lavl< Newer--q❑Replace NO l/. 18,/"? Alo V /9 f 7977 SO f LS OK. Ae t. I SO�I.S _ L^� – ru m ctgT RATING:S=Site suitable for system U=Site unsuitable for system `S I Ig - SATYP 41. O VENT ONAL: D: �NG a : S EM-IN_FILL E TyNK RETO�C�C SYSTEM:(optional) s ou M s au u 23SEM Is ®IYI If Percolation Tests are NOT required ]DESIGN RATE If any portion of the tested area is in the A under s.H63.09(5)(b),indicate: �'�-KSS Floodplain,indicate Floodplain elevation: u LE,�.� PROFILE DESCRIPTIONS BORING TOTAL P H TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH NUMBER DEPTH to ELEVATION OBSERVED EST.HI EST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 1 pg ,-64 40NE > q.01K i'8c< iz"$,¢NSA z0'Be,vG16 17%e fcoh sq'4-r 8a 5 B- ? /ob.73 NbNLs >//,/7 7$�s�-rs i6'��p$Q 3tC�IQ 9 Cr$Q MS14k '%iPo S "W" jr18Q#W ` B- a ,Z< /oo.Fs� r�nl >9.ZS >�'i3cS�is 9'BaNMs 44°$ttNC-MS44e 04 s- 4 WAI s,F-S 3o'y$e►.�5, 4Z"' KtaBAN (=S oRt QA S,6aLc ,0.75 o,S3 NU�r� >/ol�� g' c t6* q"RLLTS 2G" RniS,L. tLraMv lMS B- �; 6� /.q3 NONt > 8.67 •,BaNCS>S UR B f- 11114< Mr PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP N WATER L V -INCHES RATE MINUTES NUMBER IUCZM AFTERSWELLING INTERVAL-MIN. PERIOD t PERI O 2 PERIOD 3 PER INCH P I S Z3 0 4 91.73 3 1Z <3 P. P- 3 Z 1.4 ." a,77 D,. 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. SYSTEM ELEVATION 94 30' qL W I T' e�Nq .. `Tt BAR m \ a pZ q�1 e3 P I r3� r�______�, !ScAt6 fttNC_64kti -1 '►�N Pier � c.�nAR- �, z7 7 , _ — — _ 76 .d BASELINE ,I NORtN 'PAC% oF' NeUSr Alog"IJ FAIL alp �oomt Q 14.5US, A \ �P foi 'e b I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and met cods specified in the Wisconsi 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: / QV8) QNN1 ,,vry —__�1-SSW �ut/c. INU�— Alov i9 /9%7 ADDRESS: I' CERTIFICATION NUMBER: PHONE NUMBER(optional): 0-7 S ��N S-r Nu OSaN �r �o/ m 4 -- - �E�-40iz o . CST SI A'fURE DISTRIBUTION:Orngncal aml,mv r.t,pV ire I,w.il Anllwuly,I—1wely Ownwi awl!;ml lv%wf. DILHR-SBD-6395 (R.02/82) --OVER -- DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & f3UILDINCN If1DUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS (1-163.090)&Chapter 145.045) LOCATION: SECTION: T H UNICIPALITY: OT NO.:BLK.NO.: SU DIVISION NAME: 1S W y '/ 14 Tr N/R►9 E (or) /JU*b'suN — �sM - Voj-7 A /9/3 COUNTY: R �1 AILING ADDRESS: M USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTIO : 10 NS: PERCOLATION TEST Residence (aAJ 1 — WNew ❑Replace Nov, 18, /9�1?�7 So,c.s MCAT RATING:S=Site suitable for system U=Site unsuitable for system �q RECOMMENDED y- g 1 - SATTR4 O VENT ONU: M UN(►D: N-G UN QU : S 1DU OSG�U R 1 SYSTEM:(optional) S ❑U S ❑U IYI If Percolation Tests are NOT required DEIGN RAT LFloodplain,any portion of the tested area is in the under s.H63.09(5)(b),indicate: C LdSS indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH NUMBER DEPTH [ OBSERVED TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- I pg .-64 46N > q.Og "B�S�TS iZ"$eNSL zo''8e,vcS€L,te t�cob S9'LTSt2 5 B- ? 1117 /ob.73 NdNL >11.1-7 7'94St7S 16"RQ$R stL��Q 49��T$A M S,14* B k#NFS ':W" onl >9.25 i,'f3cs�is 9''BaNMs 41 "9#,jC,A,7,544e 4>' B- 4 9„8t S,iS 3�'yBe 4Z” �4�AN �'S. aRtRQ s,der-t /0.�5 o.S3 N�.�� > 5 �' B- $ 6� ,� t 9"gLCt� 2G" tRn,StL i Qry q3 /VONV ' > $,67 •,B4n,CSB` GR 49" 1-r am !yS B- t�gc Tr PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IUCUP'S AFTER SWELLING INTERVAL-MIN. PERIOD t PrzFits PER INCH P 1 <;.z3 � 4 99.73 3 ->-Z <3 P- 2 6.a 66's i ? 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. SYSTEM ELEVATION 94.5 '-fo joc 1,4 30" q Al CLAa& 13o To �t(,IN ' Sc.IcE To 12o4D - �►IPaN i°jPC 8- I ,NuciJ ft+a�ti - 2 SCT NE 0 C.fza�4 R- BASE.LINE - oP Neusr lJo��ru �Ac� NaatW FAu; aF NoPo--?Q tjol,sk' /l PQoib�t!1, 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and met tads specified in the Wisconsi 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: / A�vS-/ 0NnL'Sun� -- C.W_�c��V�:%tNU __ — AiOy /9 /%- ADDRESS: ' / CERTIFICATION NUMBER: PHONE NUMB ER(opt ional): o S�coN►� S-r ku OSofv yV ► S 40, _N ---i ---- CST SI AT� .QU�R�E:: -- DISTRIBUTION: f)ttupnal and one copy to I oc.d Authmily.l'topvtty Ownct anti!;ml Icsmt- DILHR•SBD-6395 (R.02182) -- OVER - Timm A JOB * SHEET NO. OF Z Excavating Co. CALCULATED BY i �+ t /`�Plfs -3�-L R 1, Box 192, Wilson, WI M7 i CHECKED BY DATE - SCALE i j.. ...... !► ��poae we.EI_ ..... r . t , 4 � a I r- — eJ4 Io off. _1�o _ L5 A o ..... .... ! L P. b7 V. _ / - V� Timm, JOB �'eolb a/ 1 _ � SHEET NO. '� OF 2 Excavating CQ• CALCULATED BY ✓ �"V 4A�E- �' - 22 t,� , R 1, Box 192, Wilson, WI B027 CHECKED BY DATE SCALE eL f6 Clt� ? r� C 5 ._' j; ..... I .. .......... ,shnc.crccn_Mr.>.min.