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HomeMy WebLinkAbout020-1158-00-000 � I o ti p a I a 0 I � I eo I N I N I I I I I -a I C I c Z Li c p I 3 I a � I v M y w Z E rn Z = c I I N H fn O I C Z I C_ d Z c Q �J Cl) N m N N N O • a O 00 O O N Q I Z C', Z O N _ Z d o L4 R N CL g m coo d }y N_ d v O O O G O a E c� �Up N N j U != N N 0 CD • y aaa CL o N III o Z N J V rn � M (D O N N Co 7 .`3 ►\i ." o w c O p . O O C C N CO a !M O O a N N O im I Vx +r p CnD N N Z w� ~ O N � n E c � N N CO j I m O rn O O U cO I Rt I C/1 d i0 !I! � d V CL r OW 7 ; aR+ O �1 A vat ', Ov� c� � t N PUMP CHAMBER I 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,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: �_ Trench: Width:_ /T Length:. 4";2 Number of Lines: _ Area Built: G/ Fill depth to top of pipe: -5 ' Number of feet from nearest property line: Front, O Side, e Rear,0 Ft % Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: ..----- Dated: Plumber on job: T License Number: ��Q C-:.576f� 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER JG►"lr �� Q�cLTZ^ TOWNSHIP SEC. j.9j1,_ T N-R, /y W ADDRESS , Cl Y7 ST. CROIX COUNTY, WISCONSIN SUBDIVISION 61; AL/ LOT 27 LOT SIZE ljif/ PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3� IOU 3� r W INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used .5ct ham- Elevation of vertical reference point: __4,:90r Proposed slope at 'site: SEPTIC TANK: Manufacturer: G.. -- Liquid Capacity: �a o Number of rings used: C2 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side 0 Rear, ® �� feet From nearest- property line Front,O Side,O Rear,O feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE J DEPARi1MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 State Plan I.D.Number: SW'-,, SE'-,, S26,T29N-R19W CONVENTIONAL ❑ALTERNATIVE (lfasslgnea( Town of Hudson Holding Tank El In-Ground Pressure ❑Mound Lot 27 High MEadows NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE: L7 Jerry Matz 530 9th Street Hudson WI 54016 IQ--- �� %-.)I �� 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: William Schumaker 6382 St. Croix 102776 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET EL E V.: TANK OUTLET ELE V. PROVIDED DLABEL PROVIDED OVER W UZA/1 C� C� (, (j I �, I a }'YES ON ❑YES 51NO BEDDING. VENT DIA.. VENT MAT_: HIGH WATER ROAD: PROPERTY WELL. BUILDING. T E FRESH FEET ALARM NUMBER OF LINE IVENT AIR INLET DYES NO `4 DYES DiNO NEAREST M [� 7 G 3 S DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODE L. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED'. ❑YES NO ❑YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUTY WELL BUILDING VE AIR INLET (DIFFERENCE BETWEEN FEPUMP ON AND OFF) ❑YES ❑NO NESOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LEN MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH' LENGTH. NO.OF DISTR.PIPE SPACING COVER INSIDE DIA -PITS LIDUID BED/TRENCH TRENCHES MA IAL PIT DEPTH DIMENSIONS S J 1 GRAVEL DEPTH FILL DEPTH UISTH.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DI NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPE ABU C VER. EQL E/V INLET ELEV.END'. �j" PIPES LINE AI NLET FEET I� I�Q`� �P OS .3 NEARESTOM SO �oS �S5-� MOUND SYSTEM! Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO 7ANEYNTEMARKERS OHSEH NATION WE LLS SOIL COVER TEXTURE S -]NO DYES FIND DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES DYES FIND YES ONO OYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING_] ELEV. ELEV.. DIA.. ELE V.. PIPES 7 0 A ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS OYES ❑NO EYES ONO PERMANENT MARKERS: OBSERVAT ON WELLS. 7UM B ER OF PROPERTY WELL: BUILDING. COMMENTS: � LINE DYES ONO �� LJYES ❑NO EARESOM 01 ' s �2 sq3 Sketch System on Retain in county file for audit. Reverse Side. TITLE SIGNAT UR i ---=� ��~„�:.-�� Zoning Administrator I DILHR SBD 6710(R.01/82) !l .^ 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 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 whenever-necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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 ffiff�- included the creation of surcharges (fees) for a number of regulated practices which wisco fin I ` can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried is used in your building is returned to the groundwater through your soil absorption u 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 COU Y (� DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT## 1O —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION 2 % SW '/45'C %, SAG' Tl;t 91, N, R j E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME eh cd,_4/ iJ f CITY,STATE ZIP CODE PHONE NUMBER CITY NEAR ST ROAD,LAKE OR LANDMARK El VILLAGE : S -- " O/rC — c-C II. TYPE OF BUILDING OR USE SERVED: pue,-X& Number of Bedrooms if 1 or 2 Family _-Iq OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. 9 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.iFS 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. 9 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): Feet rivate ❑Joint ❑ Public VI. TANK CAPACITY Site illons Total ##of Prefab. Fiber- Exper. n a INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank — Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system show on the attached plans. Plumber's Name(Print): Plumber's Signature:(No St mps) /MPRSW No.: Business Phone Number: X m 'r, Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Na CST## CS s ADDRE treet, State,Zip Code) Phone Number. �Q IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial �( /!�v�UC� r_c,1�arge^ ^ �y � Adverse Determination Vv Ql elm . do y X. COMMENTS/REASON FOR DISAPPROVAL: n` `'_C/Ja 'A at", t°��� lob, `7 U�-,c o (.� M, •, SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 11 10, APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgv, ("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 LEReM, E& &,A7-,7— Location of Property SW __5F fit, Section ,�,�2 , T _ N - R 1� W r Township H-Gy©,9 1� Mailing Address Subdivision Name 0 i9CC'9 -� Lot Number a 7 Previous Owner of Property Total Size of Parcel O�� D '7 .fe— Date Parcel was Created Are all corners and lot lines identifiable? �C Yes No Is this property being developed for resale (spec house) ? Yes k-- � No Volume _ and Page Number as-:recorded with the Register of Deeds r>0 C,*r- 3� INCLUDE WITH THIS APPLICATION -ONE OF THE FOLLOWING: Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ceAti.4y that a.0 atatementa on th,ia Jonm ane t4ue to the beat of my (oun) knowledge; that I (we) am (ane) the owner(a) o6 the pnopen ty dea en i,bed in tfaA in6onmation Sonm, by v.cAtue o6 a wa&.a.nty deed recorded in the 06jice o6 the County Reg"VA o 6 Deeda as Document No. 3 D V--� ; and that I (we) 1/`7 Fa ,� G a 3 pneaentty own the pkopawr4 s4t�e bon. the eewage P6dW sys`^n (ore I (we) , have obtained an eae ement, to h.un with the above deb cA bed pnopehty, jon the conatrcucti.on of aa.id 6y6tem, a,ad the aame hab been duty n corded in the 066ice ob the County Regi,6ten of Deeds, ab Document No. �f/ ) • 'SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED _ J :I OOCUM[NT No. WARRANTY DEED 1 „^s srwcc n[5c nvcn rr.n ncconun+r. 0— STATE BAR OF, WISCONSIN FORM 2—10821' 430813 ' ; F.L-O:ZTC2a OFFICE G lea..A.....Waxoa..Trust.,...G1.en..A....Waxon,....T.rus.tee.,...and the c.]. CB(.114 CO., Vr'IS. V.y.cella..M.....Waxon..Trust.,...Vyc.ella..n....Waxon,...Trustee rcbed,ac; )owed t1:h5th t.o..ea.ch...Trust...a...ane-.half...interast...as...tenant s...in.. day of Oct, A.D. 1987 c.omman........... ;............................... conveys and warrants to ......Jerome...Car l..Matz. .and l ..Gai. ..M........ 11: A+ ....Matz.,_hus ban d..and..wi.fe..as..sur.-v1uor.sh3p..marital.... t ....prop.ert.y............................................................................................ owata oe 000a. .. . ............................................................................................................ ............................................................................................................. nrr nn ,o ,_y sl- �' ..1 I St. Croix I -- — . the following; described real estate in ................................................County, -- Stnte of Wisconsin: i Tax Parcel No:.............................. ! Lot 27, High Meadows in the Town of Hudson, St. Croix County, Wisconsin. 1 � . FEB CO is riot homestead This ...................... property. (is) (is not) Exception to warranties: easements, restrictions and rights—of—way of record, if any. second October Haled this ......... day of .............__,. . . ....... .. .................. .....,•19.87.... l�'r'.. ..................(SEAL) f/ �L%! . (SEAL) Glen&.A......Wa=n................................ • ..Vycella:..M...W axon........................... .....................................................................(SEAL) ...><-................... .............................................(SEAL) 1 ,! Ii AUTHEN/TICATION ACKNOWLEDGMENT jSignature(s) _� c:!t! � G�?��':........................ STATE OF WISCONSIN ) �c�CG�QF �• �Yx Lh� ) ss. �{ � l i . ... . ..............County. authenticated tFi ,.J'. .do y ofL:�� 194"? came before me this ................day of �Cl!!rt< �:ll 19........ the above named .. ..................:....... !.............................................. ..OZ.ann...ansi..L'.Xaa11a...Wazcan.......................... ... mil. iiCf Gill ..... . I '1'ITI,F.: MFMBEIt STATE LIAR OF WISCONSIN ...................................................................... (If not, authorized by § 706.06, Wis. Stats.) to me known to be the ........ person ............ who executed the foregoing instrument and ncknowledge the snme. T1115 INSTRUMENT WAS DRAFTED nY 1 Krj.,4t.:,na... glapci_-Lundee n....................... Attorneyat Law •.............................................................................. ............................................................................ ... Notary Public County, Nis. (Sigi nturrs mny be nuthenticated or ncknowledged. Both My Commission is permnnent.(If not, state expiration arc not necessary.) date: ....................................... 19........) •Nunes of persom signing in any rnpnrity nhnuld be typed or printed below their•ixn•lurr.. 1 - iSxa�f ia�-- 5-0 R TOWN OF HUDSON PERMIT FOR ACCESS DRIVEWAY IN TOWN OF HUDSON 7 EZI- 's Permit Number, Name a d Address of Applicant Highway County TOWN OF HUDSON Ty 2 of Driveways Number of Driveways Propos�l Land Use Completion Date A' Location of Driveways side of the highway miles of Quadrant Section l Township ���r ' North Range Required Drainage Structure If No Drainage Structure, State Why Description of Proposed Work (include special restrictions, intersection clearances, other details and reference to any sketches which may be attached.) ji ✓y Any driveways shall be constructed in accordance with all requirements printed on the reverse side, and any special conditions stated herein. The maintenance of the driveways shall be the responsibility of the applicant. Issuance of this permit shall not be construed as a waiver of the applicant's obligation to comply with any more restrictive requirements imposed by local ordinances. Signatur of Applicant l` ate Approved by Town Chairman Date d ,4 2-+. :� xx i��i�.'��^t��'y'�°'S�t� c � � �• � f`-s fi " �v'F � � � ' 't � ,`p.`l-"�r '�" Lam' �' iY a�a.�? „�pt,�4 .,y �,<• �� '� °t < •st` f .,� 4 »,��,�l;� i.Y��'A s .'��,x.t\ $y r�i `:'" C vc k •.;d ''1 iv ��.s�?. c�`�' •7 �,.,t �f h�x °�� N�5+X d.•kJ •n" `t �4t+' ,+����'���x� h. a �t �a�+ �xt y s ik �r 1T fin d �x }4 `• K.�'s � , :KS�) pxY""'i" "Y :r, .r .v Yt. tl�•a37"A€ �� i,. r � � x�y_ �J.�yy�!�ir w K„�4p^S� rt; • - a.J�„ }"�� � x. ,�•. �.��� f.1e'��4. ��'��` k��,}+.�.��1�s fKStd y i :� Y j, .i $ y j' T�f�`,."kc�i`.',a �, "V a^ D A_ u. �� , � "1•n�s,�}� �"' y> �`f'�'Sl,�•kf tiro '3R' :.Y �� � � i ,y"•�+..�`L+ �.`�,' 'b�'}`� ��+ �" .'"+�r -rk-Rs"iktA �...4� �� fit�`''��r'�i*' •, {'^"+ ' ,p c:. �' r' e„3� .'� "°° } Gfi � „�,. v �Fa � � �� }� �'�"�' ^.`� tit _ � .r.• "� `< `. rho.. .,. *}+ IA IXy". � F4 ♦ i r N i• H r ST C - 105 r H SEPTIC TANK MA'INTENANCE AGREEMENT ~o St . Croix County J' H OWNER/BUYER cTfZ &1!2r,: ROU'rE/BOX NUMBER fire Number_____ CITY/ STATE G4,05 OP✓ w� _ .. _...----..._-Z 11' .3"Y D 1 PROPERTY LOCATION : Ia„ $ 14, Sect i.ui► O`1 __.• 'T N , R--L? -.--W , T o w n o f— ----_-._-_ _--_-' S t . Croix County , Subdivision �� /�/� �s , , Lot number Improper use and maintenance of your sel)tic system could result in its premature 'failure to handle wastes . Proper maintenance cun- sists of pumping out the septic tank every three years or Sooner , if needed , by a licensed septic tank �!n)e What you put into the system can affect the function of tl,e septic tank as a treat- ment stage in the waste disposal system . St . - Croix County residents maY be eligible to receive a grant fur a maximum of 60% of the cost of replac-emeut 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 G I/WE , the undersigned , have read the above requirements and agree o, to maintain the private sew.tge disposal System in accordar►ce with x H the standards scat forth , herein , as set by the Wisconsin Depart- w 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 . S I C N E --�� D ATE /� h St . C .•oix County Zon Lng •Off ice P .O. ;lox % Hammo'jktj',`W1 ' 54015 715-7 .4b-P2,39 or 715-425-8363 Sign , date and return to above address , • P C b 0 0 � � [rs�d • M c n xo� M J M x 143 rQWc Cz t is , AZ t. s 0 i rod ° q,cb a� . 8 fi4F� N x t a, N M Ad No f w `e6 h" Q AP r ` \Zoe 10'''6/ 4`"�. R N / • t' �nbe REPORT ON SOIL BORINGS AND SAFETY 4 s + .I-�,�' DIVISION Alai PERCOLATION TESTS (115) MADISON.,WI 53707 1W TIONS (1-183.0901& Chapter 145.045) O NSH UNICIPALITY: COT NO.: LK.NO,: SUPDIVISION NAME: .: -A /T N RIg or w u DSo Z7 / 6N MEAAo1 .1S MAILING ate t .4 7-4 36 q T DATES OBSERVATIONS MADE 1 t, O _ �( A TESTS.Replace N NU4 UST So 14.1s $oeK 4t 6 Solf.s x lll*61a wwsiubte syst.m _ 1=:rYSTEM-1,N-FILTOLDINI �f �1 T�A{NK:R/E�COMMENDED SYSTEM:(o tional) Y�IS V ❑S L�.IU & T) AL �f� SIGN N RATE: T^tpYlrrid /� If any portion of the tested area is in the C LA -s's Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS T INCHES A F S %- WITH THICKNESS,COLOR,TEXTURE,AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) Q b ALCTS ZS" k J•d� Z4 ��i�gRnIC.S A0*1LTI9QNMSi4Nk Q; A" E �9.Sd 3e"6�cTS 29"g1eNl. s2 BRN�s "BAw,�CL�t,� T 834 r, t! 6 >9.5rJ o•'�c�Ts 1A"9?NLA*RRNCS 48' LrigkNMS R 9•sC) 419LLTS 4 "ISRL iiRN 4Y,L41a:BaN Cs "� > .33 xrA PERCOLATION TESTS TRY TIME V H S RATE'MINUTVS INTERVAL-MIN. PER 1012 2 PER INCH 3 z — > Z < 3 :u D /O l4 4 — 4 / 1 1 T ,Z. L IOn Sri, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- Pand show their location on the plot plan. Show the surface elevation at all borings and the direction and percent PRIM „ - 94.90 6-4 S iTc. LOCs4T ION ON ;1 # v r 1.41 IQe-Q4R ScdLC AL.,ERNA-rE N&Ak RtBBonfrA LAT'r�lt soil taets reported on t f m were made by in accord witfi the procedures and methods specified in the Wisconsin and the location of:4'. ere correct t the lest of my knowledge and bi.lief. TESTS WERE COMPLETED ON: ?., ? . ., CERTIFICATION NUMBER: PHONE NUMBER(optional): e -N CST S ATURE: 1�Local Authority,Property Owner and Soil Tester. ix OVER - j�yY� f i ii � 6 /fir 5' y � fie IVAI