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FILED
- JUN 1 2 1997 R
561015 K%qm
3
CERTIFIED SURVEY MAP F
Located in part of Outlot "89" of the Assessor's Plat of the Village of North Hudson, St. Croix Cou ~aoo
Wisconsin; being Lot 1 of Certified Survey Map in Volume 4, Page 952. Also being in the Northeast
Quarter of the Northwest Quarter of Section 13, Township 29 North, Range 20 West, Village of North
Hudson, St. Croix County, Wisconsin.
Prepared for: NOTE: The parcel(s) shown on this map is/are subject
OWNER: to State and Village laws, rules and regulations (i.e.
Robert H. and Virginia H. Boman wetlands, minimum lot size, access to parcel, etc).
335 Station Lane North
Hudson, WI 54016 Before purchasing or developing any Parcel, contact
At the request of: the Village Office for advice.
BARTHOLOMEW & MILLER, S.C.
ATTORNEYS AT LAW
James R. Bartholomew
P.O. Box 27
220 Locust Street
Hudson, WI 54016 UNPLA17ED LANDS
(715) 386-7070 NORTH LINE OF THE NW -
Drafted by. Kristl A. Eylandt 114 OF SECTION 13 NORTH 114 CORNER
PLAT OF SECTION 13
R=N88'34'00"W (ALUMINUM MON.)
ST. CROIX STATION------- ------N 88'34'00" W 2641.86'-------
DOC._NO, 343630
LOT 1 R=N88'34'00"W 328.76'
-T \
Y4,~_ p~3$ -------S 88'34'00" E 328.72'-------
f AI _ R=2p2.20' I _-1
R=126.56'~`.
--M=202.28'---- M=126.4V----
~1 80.55'
R= 680.55' ----___225.72'-
-
i` 103.00'-----' i.M-832.89=
LOT 4 23.44' / 1 R=632.59'
W FND f- f/2" GP. is
Z \ 28,532 SQ. FT. SDO'2957W 19.64' I 1
Z 33 0.66 AC FROM FIVD 2" ~P. LOT / 1
V CERTIFIED of SURVEY MAP /
DOC. NO.
3 Z Z 4 N g 364518 i
Z 4 \ ME _4 A PAGE 952 N
Z p N N ~1 co/ h/
01/
\ \ ~ 3 ~l ~.l cul
LOT 3 N o
do Q 20,165 SQ. FT. iJ/ l o/ r , 0.1
0.46 AC
1,0\ 8 1 -JJ
400,
13
,
` .29.,94, 1--A4-129.94,
B \N 4
co ~S`j .r N ~4•?s.~ ,`10000-__
31/28 9 '~d S~4.28452.. w 3 9 94 _ \
RONALD F. 1 0 .
• JOHNSON 00'
5-1186
N
* AMERY, ONP/~ (FOR _'v QR
WIS. /fp ENO ` MERCY
a 0 S A17~~,
9 ~ ENE
SURDS <<~
~~t+ttMtN~~
ARC CHORD CHORD CENTRAL TANGENT
CURVE RADIUS LENGTH LENGTH BEARING ANGLE BEARINGS
A-B 200.21' 247.10' 231.71' N 39'04'38" W 70'42'52" N 74'26'14' W N 03'43'22" W
R=200.00' R=247.13' R=231.71' R=S39'04'55"E R=70'47'54" R=S74'28'52"E RNOY40'58"W
County Section Corner Monument
of Record
0 Set 1" x 24" Iron Pipe weighing
a minimum of 1.13 pounds per
linear foot.
O Found 1-1/2" Iron Pipe
O Found 1" Iron Pipe N TH
O Found 2" Iron Pipe
M= Measured As It^
R= Recored As 60 0 60
JOB #97014
Prepared by. GRAPHIC SCALE
A & E SCALE IN FEET: 1 inch - 60 feet
LAND SURVEYING & CIVIL ENGINEERING
Phone No. (715) 246-4319 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE
109 East Third Street, P.O. Box 325 NW 1/4 OF SECTION 13 TOWNSHIP 29 N., RANGE 20 W.
New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR N 88'34'00" W.
Sheet 1 of 2
CA-
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FORti1985•A
364518
CERTIFIED SURVEY MAP
ST.~CROIXISTATION North Rine of Section 1:3 UNPLATTED LANDS
i 1 Point of Becinning - - - - - -
231 1 61.19' N 80341 N88034 I
,90 202.20 126. 232.43' 400.16'
1 ` ~9 ,
400.1' RpN1 4 /
6 6' ~p O3 2 8. 7 6 0
4,1 ~ corner !i
N b~ Section 12
2 T29N, /R201ti
~QS•, 1.12 Acres 1.09 Acres ti 1
4~1 ti~ M
0. 0 ~l o
~ I
U,~p Cen``1-~;`61.38r 121 3'8, ~y° S 651/
I
LET 112e o S743 k28
T of ham` S 1
-of rattle_ `2rr l~ 1
Lane '~0 L-
Scale in Feet - -_TR I _JE_NW _
BEARING
0
65'/
r
LEGEND
• EXISTING 2" PIPE, WEIGHING 3.65#/LINEAL FOOT
O 1" IRON PIPE, SET,-WEIGHING 1.68#/LINEAL FOOT
JUN 3 1980
JAAES O' Co?gNELL Q.
269111W of Deeds
OWNER & SUBDIVIDER s; Croix County,
Wluonsin
NORBERT KOCH G 9
METRO SQUARE BUILDING
SUITE 742
121 E. 7th ST.
ST. PAUL, MINN. 55101
r+
Volume 4 Page 952
This instrument drafted by Wade Hartenstein.
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LAW4 & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
NE14, NA, S13,T29N-R20W MCONVENTIONAL El ALTERNATIVE State Plan 1. D. Number:
Village of North Hudson (ltassignad;
❑ Holding Tank El In-Ground Pressure 1:1 Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: - INSPEC) DATE 0
l!
Robert H. Boman 13892 Woodbine Street, Anoka, MN 55304 41
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 99104
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
~ ~ f~~J (Vl~ PROVIDED: PROVIDED:
YJh~+'~~ l DYES ONO DYES ONO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: IVENT TO FRESH
ALARM. FEET FROM LINE* AIR INLET:
DYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO OYES ONO
GALLONS PER CYCLE: _TM P AND CONTROLS OPERATIONA L. NUMBER OF PROPERTY WELL BUILDING: JVENTTOFRESH
FEET FROM EE LINE AIR INLET.
(DIFFERENCE B TW N
PUMP ON AND OFF) DYES ONO NEARESTOM
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LErjc,Tll 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 PI JINSIDE DIA.. #PITS. LIQUID
BED/TRENCH TRENCHES MATERIAL: T DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER. JELEV. INLET ELEV. END. PIPES. FEET FROM LINE: AIR INLET:
NEAREST
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-
D meets the criteria for medium sand. TIONS MEASURED.
YES ONO
SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS.
DYES ONO DYES NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED. MULCHED.
CENTER EDGES.
DYES ONO DYES ONO DYES ONO
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. N0. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEVATION AND ELEV.. ELEV.: DIA.. ELEV.: PIPES: DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES NO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES ONO NEAREST
~t
t
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
Zoning Administrat
DI LHR SBD 6710 (R. 01/82)
SANITARY PERMIT APPLICATION COUNTY
1~-l flILHR In accord with ILHR 83.05, Wis. Adm. Code
STATF§ANITARYPERMIT#
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8Y2 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 C~eNO
PROPERTY OWNER PROPERTY LOCATION
Ya,tJ '/a, S T,q , N, R E (or) 6y
PROPERTY OWNER'S M (LING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
i Jam C 5- /W
CITY, STATE,;h,~~Cj OW ZIP CO tl PHONE NUMBER 71 CITY VILLAGE : NEAREST ROAD, LAKE OR LANDMARK
11111 TOWN OR
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify):
111. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable)
1. a. LgNew 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. A 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. See a e 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): .1 a
Private ❑ Joint El Public
yS 911,11-1 Feet
e - 161 911,11-1 Feet
VI. TANK CAPACITY in gallons Total # of Prefab. Site Fiber- Exper.
Manufacturer's Name Con- Steel Plastic
INFORMATION New xisting Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holding Tank j ❑ ❑
Lift Pump Tank/Si hon 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 Stamps) P PRSW No.: Business Phone Number:
Plumber's Address treet, City, State, Zip Code): Name of Designer:
L.✓ '
VIII. SOIL TEST INFORMATION
Certified Soil Tester (CST) Name CST #
CST's ADDRESS (Street, City % a e, Zip Code) Phone Nu ber:
~2 X11 D
Af "y aw~
IX. COUNTY/DEPART ENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issui Agent Signature (No Stamps)
Approved ❑ Owner Given initial !!11 urcharge Fee
Adverse Determination Ir\ Z,~S"of~ L2 X12 64e-0
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
a j
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
i; issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property ~ ~ P--)(J1Y, a
Location of Property k /J (J k, Section 3 , T o1► N-R~ W
Township (Ud~~h I-GSG
Mailing Address 1 15? 1 a W ao J A) ,.e-
~hok~. , hnr, SS 3a~(
Address of Site l Q t C- S hn S C~ro~i~a.ra-, r3 ~G►.
jut M~dseo
Subdivision Name _ S h Cso.~x S
Lot Number C.5 h1 f
Previous Owner of Property C ~q.-des urger a N6,64 T KdC~
Total Size of Parcel I4c~ e
Date Parcel was Created ~Q
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume ?6 9~ and Page Number 7 ~s as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (tie) cutti.6y that a.tt e"tatement6 on .th.izform arse -thue to the but 06 my (out)
hnowtedge; that i (we) am (cute) the owneA(e o6 the phoperrty dmmi.bed in .thiA
.in6a matc.on 6onm, by viAtue 06 a waAAanty deed kecokded in the 066.ice 06 the
Countyy Reg.us.ten o6 Veedh a6 Voeument No. ; and that I (We) p4uentLy
own .tAe pnopoeed bite bon the sewage dLsPoe bye em (ore 1 (we) have obtained an
CdA"ent, to nun with the above de6c i.bed pkopexty, 6orL the eone•tAuetion o6 said
ayatem, and the name has been duty hecohded .in the 066.Lce o6 the County Reg•ce"teA o6
VCUL6, ab Document No. ) .
SIGNATURE Oh OWNER SIGNAT F CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
is
DOCUMENT No 6AITE BAR OF WISCONSIN FORM _1 ~ Z l " THIS SPACER I;ER%IEU 1O[~ N CORDINQ DATA-
t~ WARRANTY DEED.,;;
REGISTERS OFHCE
BOOK
A^
r
f
vE 15
ST. CROMCO., WIS.
This Deed,'
made y between ? '.LeB ti 'S6 neea. for ~ _ro fI11S_..Z. d
rya. NQrkzext J.. KOC•'A1i =LI~4~r?i1D1?.« ~r 4f Feb aD. 19, 87
~ . . t 12:35 P hAe
Grantor, •
and....... ,
Rabex't.:H...Homan _and .~Iirgjnla._H-_. man,:.husYzand. ax1d......_ James 0' Conne l l
_ _wi£e_.as..surv1.v_ar-sbi p .mavita..7.: propex ty
.r
Grantee,
D:___---- epu i.
y, a;,y Witnesseth, That the said Grantor, for a valuable consideration.::.-'.
conveys to Grantee the following described real estate in RETURN To
County,' State. of Wisconsin:
i
Tax Parcel No: Part of ,;Outlot 89 of the Assessor's Plat of the
Village of North Hudson, des6ribed as follows: Lot 1, 4
Certified,Survey Map filed June 3, 1980 in Volume 4,
Page 952 as Document No. 364518.
FEE
This is not homestead property.
(is) • (is note
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And-I'11tOr
warrants ,that the title is good, indefeasible in fee simple and free and clear of encumbrances except !
easements, restrictions and rights-of-way- of record, if any,
and will warrant and defend the same.
1F 4+ . r uary 87
his Feb .
day of - 19
.
-
.....:.........•--(SEAL) --Yrt
!......(SEAL
Charles E. Larson T
..Koch
•
.
(SEAL) .......(SEAL)
°AUTHENTICA'TION ACKNOWLEDGMENT
Signature (a), La. -St
j STATE OF WISCONSIN
ss;
...........County.
re6rua~-L~
authenticated this °~...day of. 19
Personally came before me this
d ay 0
- 19 the above n:------- amed
K215 (IU,~ Cl~c(rV D [-(>N1~EEiV -
_
TITLE: MEMBER STATE BAR OF WISCONSIN -
(If not,.
authorized by § 706.06, Wis. Stats.) . - • •
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristin, Ogland Lundeen
Attorney--at--~w------•----•-----------•--------------------
Notary Public County, Wis.
(Signatures may be authenticated .or acknowledged. Both 111y Commission is permanent. (if not, state expiration
tire, not necessary.)
date: 19.........
)
*Names of persons signing in any capacity should be typed or printed below their signatures.
L _
1
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ST C- 105 r
9
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
' d
9
H
OWNER/BUYER (36 pz' ~A rnG..
ROUTE/BOX NUMBER Fire Number
CITY/STATE NOA, ZIP SqC114
PROPERTY LOCATION: NE 14, N41 Section 13 T ' j N, R old W,
Town of NOr4% N~dS'c►r. St. Croix County,
' Lot number 14/CSC,
Subdivision S~ C.ra~x ST4 ~6~
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or'sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. yo
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- lid
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.
1-C
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, P.O. BOX 7969
HUMA3 N ARNED LATIONS PERCOLATION TESTS (115) MADISON, WI 53707
HUMA (ILHR 83.09(1) & Chapter 145)
DIVISION NAME:
LOCATION SECTION: TOWNSHIP NICIPALITY: LOT NO.:BLK-NO.rB
N E 1/ NW 1~ I T Z9 N/R ZOE (o P-,) ocZ'~ 1*\j ►v 1 - ~
NTY: OWNER' UYER'S NAME: MAILING ADDRESS: $ Gj Z W Oo~BI/Ll~ ST-.
COU
DATES OBSERVATIONS MADE
USE PROFILE DESCRIPTIONS: PER OLATION TESTS:
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (New Replace
(iesidence 3 N- K DI L
RATING: S= Site suitable for system U= Site unsuitable for system
i;ONVENTIONAL: MOUND: JIN-GROUND PRESSURE:SYSTEM-IN-F ILLHOLDINGTANK:RECOMMENDEDSYSTEM:loptional)
S DU ZS DU ® S DU ®S DU Lis Zu \Z' x 79' CbXJ0E) `f7WJA L.
DESIGNRATE: If any portion of the tested area is in the
li Percolation Tests are NOT required J V J~
f under s. ILHR 83.09(5)(b), indicate: f k 't~S S Z Floodplain, indicate Floodplain elevation:
1-_..
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INOML - CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 6.6' ~8-$~ 1vorJ~ > 6.61 ,o.-~'~1z.Bn~s~;z.3btt~>,1s;1.3'B~G~.ls;z.3`8nme~s
B Z !~•-7` q~l•O+ p.~` « 3.2`t J-Z.,q,bn`~S'O.3; Gan
B- 3
B- y 3 q9•y
B_
PERCOLATION TESTS
PE R T D RAPER INCH ES
TEST DEPTH WATER IN AHOLE TEST TIME
INTERVAL-MIN. PERIOD t DROP IN E R I WATER OD 2 LEVEL-INCHES
NUMBER INCHES
P- 'v
P-
P-
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. 113 I`r 14 L - E S Z t S
SYSTEM ELEVATION z~►~cY- gs.s '
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in-acrord-Aith 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.
NA ME (pant) - TESTS WERE COMPLETED ON:
nI~T~-tvR ~ . w~ GOER ~ 9- Z3- S~
- -
- CERTIFICATION NUMBER: PHONE NUMBER optional):
ADDRESS C~ l,>-j"~ y p K Z Z-
s~~ pis-~zs-o~by
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- CST SIGNATU E
DISTRIBUTION: Ot iginal and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10183) OVER -
i
12,o~-T" • 8~~'t fl~N
San. Permit No.
Owner's name
i
H63.05 PLOT PLAN
Show:
Location of building served N Dosing chamber
Septic tank Vertical/horizontal reference point
Building sewer Q System elevation is
I V-! Effluent system Ea Well
EJ Replacement system area Property lines w/in 50' of system
~ i
Scale = _ Ij O , or dimensioned
FN Distribution boxes
A1A Pump and controls:
Mfr. & Model--No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal, per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
EL to3.o43, C+m la P of
Z`-:cP- EL 100.00
ivpTL_ 11JSr'ct-t W% LL AT-
yvv~T ti t33 0 ° Uet ST jL1 ~Z(Y 1
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BL/ / \ 3 \6/\ 3 ` P.nTL
puC N
'9 \ ` \ S F
\ \ \ o\o
by+G SZ S~11C TPOQVK.
event of a subsequent
By the granting or approving of the above plan, or upon does
'nistrator,
permit being issued,St.Croix County and theSt.CroixCountyy Zningecifica_tat plan
not assume or hold itself liable for any defects in plans hat may result pl n
omission, examination oversight, construction, or any damage t in OL
after installation.
0-7
v z, rcz r~ r h G-
,
CROSS SECTIDIJ OF A BED 5-13STLPI`
2" OF AGGREGATE
..r.-- SOtL FILL
DISTRIBUTIO10 PIP> APPROVED SSUTHETIC COVER
MATERIAL OR 9" OF STRAW
OF, MARS14 14t"j
1. 0 F%2-Z' °AGGREGATE
ELEV. OF 96'~ FEET T
DISTRIBUTIOU PIPE TO HE AT LERST Z IIJCHES BT L0~✓ ORIGIIJAL GRADE
ALID AT LEAST ED I"r-HES BUT UO MORE THAU 42- IIJCHES BELOW F1A1AL GRADE
_ JCHE5
MAXIMUM DEPT 1{ C) ~XCAVATIOU FROM ORIGIIJAL GRADE VJILL BE Sl i1 ~
3~ INCHES
MINIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL BE
LICEUSE DUMBER: `