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CL 3 m m ° 0 y m a, w a I CDv A i ~ m 0 CD 0 O CD ~ RJ 0 O-" O• n t X O p R ? 01 O 5 A 1 V < o 0 0 o S Nov N CL a c o m o0 a ~ ry CD a0 ~O 69 O w v ~yo~ o~y V 22 5 ti0 o~ ~ 5 00 4V (6 0 , 1 4~y G~,~ 02/01/2006 08:00 AM rye 5" ' PAGE 1 OF 1 ~o•~Qy \ b~ ST. - TOWN OF KINNICKINNIC y~ CROIX COUNTY, WISCONSIN es Area Application # Permit # Permit Type 0 Ta., ' ~ p Owner(s): O = Current Owner, C = Current Co-Owner MAE A Vr O - WOLFE, MAE A 117 CTY RD j,. RIVER FALLS W, Districts: School SP = Special Type Dist # Description Property Address(es): ' =Prima SC 4893 SCH D OF RIVER FALLS * 117 CTY RD JJ Primary SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: SEC 27 T28N R18W 2.5A IN SE SE LOT 2 CSM 2 500 Plat: N/A-NOT AVAILABLE IN VOL 1/292 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 08/26/1998 585877 1351/607 WD 07/23/1997 1124/319 WD WD 2005 SUMMARY B;II Fair Market Value: Assessed with: 143817 259,200 Valuations: Description Last Changed: 08/11/2005 RESIDENTIAL Class Acres Land G1 Improve Total State Reason 2.500 50,000 212,100 262,100 NO Totals for 2005: General Property 2.500 Woodland 0.000 50,000 212,100 262,100 0 0 Totals for 2004: General Property 2.500 20,000 Woodland 0.000 162,700 182,700 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 308 Specials: User Special Code Category Amount Special Assessments Total 0.00 Special Charges Delinquent Charges 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, Will 53707 SE4,Se4,S27,T28N-R18W ❑CONVENTIONAL RRALTERNATIVE sttatte Plan I.D. Number: Town of^ Kirinckinnic ❑ Holding Tank ❑ In-Ground Pressure XX Mound 7-05989-S JJ NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Robin & Mary Herbon Route 2,Box 60, River Falls, WI 54022 j "iC) 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: Robert Ulbricht 3307 St. Croix 99056 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO BEDDING: VENT;DIA.: VENT MATLL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET DYES ❑NO' DYES. ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING' LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER PROPERTY WELL: BUILDING. JV('DIFFERENCE BETWEEN FEET FROLINE: AIR INLET: PUMP ON AND OFF) DYES ❑NO NSOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I ',',TH 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: LIQU BED/TRENCH WIDTH LENGTH TNO OF RENCHES IDISTR PIPE SPACING MCOVER ATERIAL: PIT NSIDE DIA *PITS D PTHD DIMENSIONS GRAVEL D€FTH FILL DEPTH DISTR. PIPE DPI PE DISTR. PIPE MATERIAL NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENTTO FRESH BELOW PIPES ABOVE COVERELEVINLET LEV. END. PIPES. FEET FROM LINE: AIR INLET: NEAREST--r 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. DYES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DYES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOI L. SODDED. - SEEDED. MULCHED: CENTER. EDGES. DYES ❑NO DYES ❑NO DYES ❑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 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 ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ❑NO DYES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator DILHR SBD6710(R.01/82) j` Form S T C 104 K E AS BUILT ANITARY SYSTEM REPORT OWNER/'o~iy yF~/S~►.✓ TOWNS iV/G.E'~/~✓/G SEC. 2? T N-R` 14 W ADDRESS ~07~ r' f ST. CROIX COUNTY, WISCONSIN L p IV F/f //s IV/ f D oof 4.e~ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,y w j s i It i t INDICATE NORTH ARROW i ! BENCHMARK: Describe the vertical reference point used 1-AeK ra A 10y 01 H Erg s j Elevation of vertical reference point: Proposed slope at si o l~'~ ~il~ Q G /DO D SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: % Tank Inlet ..Elevation: Tank Outlet Elevation.: 1016 puaLi4- Number of feet from nearest Road: Front, Side Rear, feet O~soa NOR ` = From nearest-property line Front,OSide X Rear,O felt . 's Number of feet from: well Q building: 1100 (Include this information of the above plot plan)( 2 reference dimensions to septic ta01- ' SEE REVERSE SIDE z - i PUMP CHAMBER Q EELS ,v G . o a Manufacturer. Liquid Capacity: E 137 y2 Pump Model: Pump/.Siphon Manufacturer: 2 Pump Size Elevation of inlet: / if 30 Bottom of tank elevation: 8 3 0 J10 /1 2 Pump off switch elevation: • 2 Gallons per cycle: Alarm. Manufacturer 4flltl AWI/ Alarm Switch Type: • NOiP Number of feet from nearest property line: Front, O Side, Rear, Q Ft. Number of feet from well: ` ' Number of feet from building: /r3 ' (Include distances on plot plan). SOIL ABSORPTION SYSTEM d 3, ! Bed: x Trench: y x d'y z er, o Lines: Area Built. O h: Numb f Len Width. Fill-depth to top of pipe: fie.. !VO s~ r L =o- Number of feet from nearest property line: Front, O Side, © Rear,OFt .-3 ~rF Number of feet from well: / l Y1.~ ✓ Ilk, Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: ameter: Liquid depth: Bot of seepage pit elevation: Area Built: 'tae either a d ox O or distribution boxO been used on any of the above soil r M absorbtion sytems7 (Check one). HOLDING TANK Manufacturer: apacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: _ Number of.feet from nearest road: Alarm Manufacturer: .1~~ / ~ Inspector: _ 7 Dated: Plumber on fob: License Number : HOME" Rpm PLUMAMMO C0: fi. I ON IL K, NUbof 64011 ~ El~t ~lMkl~Ht s NI 1;16. 10AII f . i; LlEl11k '~h'tR1E11 !.1' to, v/ n8ia MAOY HERt3oA-) I fy - f r Qua 1197 A v ~y sEpT~c mar P~~~ ~ i $cA l~ _ / " = Z o ~cr wsp~~~~p j fovea ,w~.tc p- s- 7 z OF of to C - 01.0 PtAc WAS i3 R o/cF,u iN tf AO-F iris71 NEw G~ r ~ C~t~E~ ~ v ~ on► 0 h ~ • ~E~~ wjtk 9 V Z~o~,y,wAle v o ffS~T' iv DF p fin SNP , New 3015 SysMH ~J T 4z ~~n q Al o z ~ K b V~ ac 0 r IL -.--Y TOPS H~~•{o~~7 Of All fiecs ; CE`s 17 " qs~y MAO -jp ~j whiff AA)CE INFQ,MATION & 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 perrOl-must Aapprovedby thty permit issuing authority~A• nb.~tv,permit maybe rieede, ,rt 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; r, ..4.. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted'to the county prior to instai,lAon; tt F 5. Private sewage systems must be properly maintainqAK The septic tank(s) should-be pamoed 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: 1. Prcaerty owner's name and mailing address. Provide the legal description where the system is to be installed; Il. 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 ohAMDer 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.gv MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test informati.on: Certified'SQiI tester's name, certificati:on~.number, address, and phone number. r., 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'Y2 x 11 inches must be submitted to the county. The plans must include the following-r,A) plot pL~n, drawn to scale or with complete d%.nensions, location of holding tank(s), septic tank(s) orpther treatment tanks huilding sewers; wojls; Water rrkins/water service; streams and lakes; dosing or pumping chambers; di'stribGtlon boxes; sail 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 raqu# iced by t lip county; E) soil -test data on a 1-#5 or rr. kr i------------••---`------ ~ Ii. ^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 4n statutesr.was the 1 ? resuafof Over 2 ears of stead negotiation and public debate. The groundwater bill y steady Grounter-a ' included the creation of surcharges (fees) for a number of regulated practices which Wiscor4i,n's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure 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. 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 C UNTY (Z~DILHR In accord with ILHR 83.05, Wis. Adm. Code ."~..v..,.. ~,.o. STATE SANITARY PERMIT # oI 0 ~ -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. 67- QS' rR37 --s -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES R NO P PERTY OWNER a PROPERTY LOCATION ~ /00 d ~!N $~E % S ~ T 149, N, R E (or W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME r% f- -z &X 6 o Y STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, j~i4E9}1'tRRQ1A7TRK / ZS fC ❑ VILLAGE : J 4` a JJ i i II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ❑ New b.KReplacement 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. ❑ Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding C. ❑ Pit Privy d. ❑ Vault Privy LD f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Msee a e Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: A.3 nutes per inch): REQUIRE .Square Feet): P POSED (Square Feet): y 375 % 10 ~L' ~O Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 410 lw ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Si nature: (No Stamps) MP/MPRSW No. Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDR SS (Street, City, State, ip ode) Phone Number. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Arv) itary Permit Fee Groundwater Date Issuin Agent Signature (No Stamps) Approved ❑ Owner Given Initial 6.06 Surcharge Feed Adverse Determination S1, ~ 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 'r It'llm 111:111, AMM. ..w.. ,.N ....1rb. .......y ` a. Af~1ftl....iA . w . loft - 1h That the said (ieastse. fie a .alsaNs .....sasatissatiw. 1 , F r a . . , as+aar w esms*' r Gnat" IM aftwft dsseta I nd.stale is St. Crois t1wsM NMiI af! w'Ywssla: Tax Pascal No:.. , Past of the South halt (S;) of Southeast Quarter (SED of Section Tw aty-sewn Mn Towmakip ll*fty-iigpt (28) North. Range Eighteen (18) Vests, described as follows Let 2 of %.'=Ufied Survey Map filed September 1, 1976 in Volume 1, page 292. Croix County, Wisconsin. - _ FEB This bomestead propesty. (le) tB 1106) 'lIISa@ mill all esd shouter the beeeditanwnts and apparonses s tbw*wMe bdowehie; Asi.....« Hat /M /leis Y fieA isdahasiblo is fie simple and free sad clear of swuArances emoe~t 1aemimmts, restrictions and rights of way of record, if any. j' <9~y met Will aesssest asd dslrsd the same. , If... r now Ws ...........1.0 day of Fabrtu=X r (SEAL) 7f....... i T Ericson • • . _ 4 (SRI►L) z • Ericson.. AoaisNTICATION ACKNOWLEDGliu> NT STATE OF WISCONSIN . -b !'f Cea b. wlbaslMslad His ........day ef.......................... 119 Personally elses befess see Februar AM 1*14 ' Valie•.Ericsaaz ..........numasolk . l 87 eon amsei . 1[lMMIL STATS'All: Oh WISCONSIN .wu.e...R t tab 1 '1M:N. Wis. Stab.) N me known to be the pesos .....s• . on Isla W final vmmt and + Tma )NaTVA MCM WAS OR^"= BY D. Doles Attorney at Law 119 Morth~•MR" Street, cox 13•....W. ~ ~ ~ ~..IfI.. O.Z.Z Ny PaNk t ally be woMmm lwhi +r MdprMdded. )Isfh Tt ssm F {tf ~ Msit acs art seesssaryl passeR ~ ~ - .10„ `s of Pn ft OWN" ft }p,asperpr .Inds in try •r s+1•w below artr,.NvAlma"r. y ti .i State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLATY APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 HOMESITE SEPTIC PLMG. CO. Owner: MARY & ROBIN HERBON RT. 3,0'NEIL RD. RT. 2, BOX 60 HUDSON WI 54016 RIVER FALLS WI 54022 RE: Plan Number: 87-05989-S Date Approved: July 31, 1987 Gallons Per Day: 450 Date Received: July 31, 1987 Project Name: HERBON, MARY & ROBIN Location: SE,SE,SEC.27,28,18W Town of KINNICKINNIC County: ST CROIX Fees Received (Priority Review): 160.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based, on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50--64 of the Wisconsin Administrative code. This approval is for the following components only: - REPL MOUND Inquiries concerning this approval may be made by calling (608) 266-8230 Since ely, rH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/17 cc: MARY & ROBIN HERBON Private Sewage Consultant County UW-SSWMP Plumbing Consultant Owner Plumber-Environmental Health DILHRSBD-6423 (N. 04/81) ~I State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 HOMESITE SEPTIC PLMG. CO. Owner: MARY & ROBIN HERBON RT. 3,0'NEIL RD. RT. 2, BOX 60 HUDSON WI 54016 RIVER FALLS WI 54022 RE: Plan Number: 87-05989-S Date Approved: July 31, 1987 Gallons Per Day: 450 Date Received: July 31, 1987 Project Name: HERBON, MARY & ROBIN Location: SE,SE,SEC.27,28,18W Town of KINNICKINNIC County: ST CROIX Fees Received (Priority Review): 160.00 The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPL MOUND Inquiries concerning this approval may be made by calling (608) 266-8230. Since ely, H STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/17 cc: MARY & ROBIN HERBON Private Sewage Consultant County _µUW-SSWMP Plumbing Consultant Owner Plumber Environmental Health ILHR-SBD-6423 (N. 04/81) ST. CROIX COUNTY s WISCONSIN ZONING OFFICE rt' 1 y '798-2239 (HAMMOND) Y; N 425-8383 (RIVER FALLS) HAMMOND, WI 54015 July 30, 1987 Division of Safety and Buildings Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Timothy Ericson property located in the SE 1/4 of the SE 1/4 of Section 27, T28N-R18W, Town of Kinnickinnic, St. Croix County, revealed suitable soils at a depth of 3.0 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, 0 ' Thomas C. Nelson Zoning Administrator TCN:rmc APPLICATION FOR SANITARY PERMIT STC - 100 `This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house'% then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property /",I 14 / ~rlA/ I►ocation of Property S~ 1% s~ 14, Section Z7 T2~ N-R /0 W Township Mailing Address Address of.5ite ~0 . Name subdiviaon Lot dumber - v Previous Owner of Property Aj Total Size of Parcel Date !Parcel wda Created l Are all corners and lot lines identifiable? Yes No is this property being developed for resale (spec house) ? Yes A No "'Volume v and Page Number 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 t (We) ceAti6y that att .btatemente on thin 6otm ace true to the beat o6 my (out) knowledge; that I (we) am (ace) the owner (b) o6 the ptopeh ty deb cr ib ed in this injotmation 6otm, by vchtue o6 a wavcanty deed %ecot ed in the 066ice o6 the County Reg"teA o6 De¢daad Document No. ]V I I I/ ; and that I (We) pteaentty own the ptopoaed z to Got the sewage diApob Zystefh (ox I (we) have obtained an wement, .to.*%C& At above d"cnibed pup", bot the con.6ttuction ob ba.id '4 rr amt Naha been duty t.,eoaded in the 046ice off( the County Reg.i,a.tet o6 ;;SIGNA'Y'URE OF OWNER SIGNATURE OF CO- R APPLICABLE) y {tom SIGNED DATE SI H. t . S T C - 105 r. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County; OWNER /R Igo)( W '`ai a ROUTE/BOX NUMBER 2- Fire Number CITY/STATE ~frUGl,j~~ ~~f• ZIP ~~~'"Z.._~ ' • " i PROPERTY LOCATION: Section 2 7 , T No R W, I Town of St. Croix County, Subdivision Lot number Z . 3 f Lam' 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 ptit 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 stems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning s j 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. c I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with i the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification forts must be a pVfk~ed and returned to the St. Croix County Zoning 0 fi~pewit 30 As-ye of the three year expiration date. 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. 0 UCTIO IS FOR COMPLE' oG FORM 11 SBD - 6396 T be a cc l accurate soil test, your t, - )c:lucle: 1. Complete leggy ~rrscription; 2. The use sectic lust clearly wheiher this is ,sidence or commercial project; 3. MAXIMUM ser of becir commercial u r d; 4. Is this a r, mt 5. Comp _ lity s. A SITE P'..-ABLE FOR A HOLDING TANK ONLY IF ALL G~ `APE Rl1L: i 'T S ')IL CONC11T9OiS, 6 'eviatior ,lg profile descriptions and completing the plot plan; 7. _E diagram rri your test locations. Drawing to scale is preferred. A used if c` imark a ion reference point are clearly shown, and are permanent; 3 date boxes ies, addresses, flood plain data, percolation test: exemp- t 1 f Uch as floc' 1) dc-,s nr' . E.A. the to box; 11. place your d yc- ; 12. pies and di: tri ;uired. ALL S " T. 1ST BE IL WITH THE NURITY WITHIN " )AYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil :tares Other' m€sols st BR - I colt C (3 - 10") SS - S gr I (under 3") LS L' - H GVfir` - F, s } i Perc f W - b BIdg - Be Is nd > - f ~n `sl _ 'n < I ss r y cl y - se.I :'I y L R sicl L not SC 'lay Vvi sic - ay fff P1. - =Tim - ce PoinT l r . t' y st i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: &OWNSHIP401UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: St Se% '/a 2`~ TAN/R ~%E I. \-GI I.N7L~_ Aj ka 1 C Z - C2 0 WL I Z9 Z COUNTY: WNER' UYER'S NAME: AI LING ADDRESS: 1ZT Z >30~G bo SS • C,~ UC h l7 1 CS 2), u can E*us Lev 1 S U o 11 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~Elesidence '3 N~ ❑New -Replace (PROFILE DESCRIPTIONS: PERCOLATION TET RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL MOUND: IN-GROUNDPRESSURE:S STEM-IN-FILL HOLDINGTANK:RECOMMENDEDSYSTEM:(optional). Os®U: ®s❑u OS Nu EIS EISOu s Y 4 S P~ orv~ If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: N Floodplain, indicate Floodplain elevation: A' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-111SI WS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH It ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B_ 6.6'_ 9-4,o' No>JC Yho't jl-b' o•'b'b~ASi1_)S; 1-z'@r sil;o.~'3><s!; ~•s"B>, I -IPs w sP_ovc,I✓ cEtieqlV~i Dlc~ s~ tbuas • o.s' ' ~-t LS RES I D~ Uly > So°,61t Z2M Sal >;t '~'s l .6 B- 2_1 6.E!31 ' ql•S' *no~T CS.2' o•~'blrstl TS' 1-8'8h s{I • 1•t7"Sn S1 w/ sal spoTS L S p~Ec~S 9 ' e)l w~ Dlz t~th s77z-o+~~~ Y B- s~ Bemis sc l s ~bts • 1 • ~1 "A Z- t S w c S tags 6•6' qk/-a' IJOti1;_~ MOTa 3.S' 0•8'~l~t~Isi1TS ; 'a,Si I ; 1.z-'ti~► s 1 ; \•1' ~ `Fs-- B- w 1~lc$► S' MZNUCl CISIV&AZZ % Ny* S • 1.6 "Vh ~S WAS Re's B- p.-~'~t~B►ISiI TS; 1.6'%nSII; 1.V IN S1;\.9'_Bnfs_ w/STR.W►GLy L-NjVb ak. (3Al HA'pwAs B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD3 PER INCH P- 1'~0 u Per _Ptl 2 _n M _Z1U G S C) P- P- L) ue vI2-Eb FROST s P-- GO" E . Cr tJJ - O/U WI u- S U! P- Z'"--$ l!~ 08 SSrS Nv E 1.-v uN 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. 1V L C).L/V SYSTEM ELEVATION N) - P ' '-`R `-`'"lb s4 zq• 9' Iv tz m_ rat T+k hold az, s 8i C ~j I 1 ~ b i - --j - ~ ~3- ' h i 10 i l r 3S 6 5rptc!` f !OO ~ 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. 8 NAME (print : TESTS WERE COMPLETED ON: ADDRESS: l]6X 'Z?, CERTIFICATION NUMBER: PHONE NUMBER(optional): t~L-LSwaXe_rH W S4 U _ Sib lS-4~ZS-o~ 6y 01Vl1', y~`r r CST SIG NAT L,~l E: G f -r 04114 DISTRIBUTION: Original and one copy to Local Authority, Property So D I LH R-SB D-6395.(R. 02/82) - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDU,S~`RY, 1 G DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: 4 TOWN UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: se-SE1/a '/a 2-, T ,N/R~bli t_j IC Z - csh Von I, z92- COUNTY; OWNER' UYER'S NAME: MAILING ADDRESS: 1Z-~- Z iSOX, G'Z . .~W ZK Y1 l7 ~C~ 1 GS' Q }J 1 U ~SZ f ,tL_ S, [AV) 5 V 0'2- -7- USE DATES OBSERVATIONS MADE N TIONS: PER OLATION TESTS: I NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCZ esidence IN ❑ New -Replace ~ N . A,RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional), OS ®U ®S OU Ell OS NU OS ®U • l- 'r~ 2h SSCT~ v OuJ -Tr-_;St If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ~j under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-Ifle"ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ft ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) t,3 oQC YhoT o•e'b 3 -tsil; 1-`z'er sal ; 0.`~'3h s1 ; $"Bh B 1 _ ~s L" STR0A-,G(_y cEM~s-_-) --'syc_B>7 s1 N►vas o.-S 'Z SC-1 0k.6' ~t t'FS w L.S ~FSID~uy > sb%2 B- Z .6- 91•S' 1J~saJ~, '4'A&TC 3•2' o.~'blrr~~si1 TS' \•8rl S ; \•©'s>7 sl w/ sci S_FbTS ff L S Q[ECES j 1.9 W1 DtC trh ' 'T'T ~GL Y B- ci ~ s~ B+ s SC I s ;X~.7s • N ."4 Z-' is W )o 6.6' ~f(/-a' ►JOrVi_~ mo'`-3.S' o•BbtL~+si)Ts; \•°t'~t,si1; 1_z'~h sl;\•1'>t`Fs_-- z CLy CZV-1 TED s 1 R rv • 1. b 'Bn' S LOAS 2eS B- w 1~h BYt TTv 6.0' C9•S' 1JCNXJC Y,o~~ b.-1'D4tBhS1I T.5 6,ah.T B- L/ w/sr~_1CAJGLy eEJ-7C-v`[E~ t 1z (3h s J S> as o.'~' $h `~S w/ L S ~ 14~v.M B- _ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER OD P- No u FIT - ~U ~i L~ CP P_ _T* t L) ta S Itl G JJ f S. iEE U 1 R- E b I-A = 'FTzOST 1 S P 6C))Q E . \ L lDJ lh f~ O/v ILL L U } ~T7 )'JL P- Z'-~t"~I 1~R ? 08 SKIS Ct\ dv 4' l.~U DN . 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. 7 ~'hG~ R Z C)I=,I lV SYSTEM ELEVATION b I L_d 'u ►j E' 6 3 I _g}~ ED-Q i I : ? By _ - - - f~ r ~3 'tv r, rt I i ~b4b ~ i I ~ I ( .0_ ~ ~ ~ -o t3ri ' ID NI T N - Q q, I 1t , i i Iva Is 1. _L- - -I - - - s Z'7 - S, C-N ~Lz } I, _ l o o, SAC -2:7 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. NAME (print): TESTS WERE COMPLETED ON: pp ADDRESS: pVT 4X CERTIFICATION NUMBER: PNUMBER(optional): ~t -sSl3 ~zs-or6y CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - F~ INSTRUCTIONS FOR COMPLETING FORM 115 - S BD - 6395 To be a complete and accurate soil test, your report must include: 1 . Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as re(Juired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cot) - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone "s - Sand HGW - High Groundwater cs Coarse Sand Pero - Percolation Rate rued s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > Greater Than "sl Sandy Loarn - Less Than *1 - Loam Bn - Brown *sii - Silt Loam BI Black si - Silt Gy - Gray *cl Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay wl - with sic - ty Clay fff few, tine, faint C cc - common, coarse pl. - mrn - Many, medium m - Muck d - distinct p - prominent HWL - F h wag 'evel, Six ier-l soil textures fi 1, jaste disposal BM VRP - ti rtic =rence Point T - r TI . < > . _ may ref r ;t f r th- in o I~; ` of any construction, DEPgRTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ILiNDU~vfRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (H63.0911) & Chapter 145.045) <,r-- LOCATION- SEC ION: OWNSHIP/~: LOT NO.:BLK. NO.: SUBDIVISION NAME: S€ / / l ~Sr1 Ua/ / }?6- z92- COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: S 5f C,Qoi ~ MARY 3 ~oBi A) NE ES Oa 2-! , Z 06 l0 0 Pi LX k fA 115 W [S . yO22- USE 15, ^ DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: _3 Residence A/ ❑ New Replace I Z - 7 ~v/!/ [S~ 7 RATING: S= Site suitable for system U= Site unsuitable for system l CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S [311119 S ❑U ❑S ®U ❑S U DU IqoyA~p If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- 5AP plot P-4LVI CIS g_ lr0 le T L - 0 7 B-/Sri c,S -r- ~ 13- 13- s- _T_ S004(E 1!F&K ANIF Of- /',VCs PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING NTERVAL-MIN. PERIOD 1 PERIOD 2 P RI PER INCH P_ ?uric., 3.S1~ 30 3 1.7 7-0- P_ P- L 3 30 . P-_ Z P_ 6 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. Of -70 SYSTEM ELEVATION s o - 9S•2 . - 74 I ~ N t i E i LA /04 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. I NAME (print): TESTS WERE COMPLETED ON: , HOMESN'E SEPTIC PLUMflM1G CO. 16 / 9v Q ADDRESS: ROBERT ULBRICHT CERTIFI O NUMBER: JP~ ptional): ®TIWIS.JIWTER PLUMBER LIC. NO.3307 MARS A ~ a d VNIV, INSTALLER & BMW LIC. NO. OW CST GNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY.&PUtl. " INDUS-TRY, . LABOR HUMAN REDLATIONS PERCOLATION TESTS (115 P,0~1 H 3 09 1' 'Cha tai 146. ( 6 . 1 1 ~ p OA6f NO.:BLK NO.: SUED SI : Q OWNSHIP/kV**AQ4RAL : [OT . l /TV NAME (0 W ) ~k COUNTY: OWNS ME: IAILING ADDRESS: hllr, , t 5F 444/'X Huy foo A.) HIE;es"OA3 5q.. >a ~OrQ, . ! tl -4-L5 - DATES OMRVATIMs"" Residence NO.~. N~ DESCRIPTION ❑NewReplace RATING: S- Site suitable for system U- Site unsuitable for system ONVE NAL: MOUNDS IN-GROUN DPRESSURE: S S EM- -FILL OLDING TANK: RRGOM IENPF- r S RAEIS [DU [EIS If,Percolation Tests are NOT cegyired GNRATE: ISI If any portinln of tho,tegoO p~fwj 1a >i N O= I I lunder s.H63.09(5) (b), indicate: [FI00dPlain, Indicate Flpodplair~ PROFILE DESCRIPTIONS "T BORING TOTAL T R NDWATER-INCHES CHARACTER SOIL WITH TW KN C EX RE, DEn NUMBER DEPTH IN, ELEVATION V TO 13EDFI -OgKjF.Q13JJ5yFQ B r y G :r•, ~k 7 7P 7, 1 B fUOwe- tf€yfr/wf ®f Ave S PERCOLATION TESTS 4i0:, DROP IN WATER LEVIL-INCHES PATE MI TEST DEPTH, WATER IN HOLE TEST TIME NUMBER INCHES AFTERSWELLIN NTERVAL-MIN. PERIOD I PIE M'00 3 ER INC 3 .S P_ t"1 P- 7.,,~. P-" 6 4/6 .47 P-or 2, P- i PLOT PLAN, Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or disunaea. Dascribe what we fw ~ zontai and vertical elevation reference points and show their location on the plot plan. Show the surface elevation it all>.boslftplCl►r► l;4 direction ; of land slope. I/ ! w NE f5fvlo SYSTEM ELEVATION e 0 7L/ -77-T Mi~ VU Pi 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and MR# K4 4 Administrative Code, and that the data recorded and the location of the tests are correct to the bast of my knowledge Intd 41t1 f. 1ud li~ta ' W: NAME print T44T. WE 7_ HI MME SEPTIC PLU" 00 ADDRESS: ROBERT U1.61 IT GERTI1. Q~TIO NUNr4 I+id.l E (opt ! "SAPP PLUMI ER LIC. NO. 3307 M P.R.i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - . ' ~,.A, SAFETY h 13l REPORT ON SOIL BORINGS AND ALD NGS QEF'AR iMFNI C i-)IVISION INDI!STRY, C N U. box 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATI N (H63.!)911) K Chaptc( 11,> (14b) TOUVN (,11J,!,A11114WIPALIIY I t,ll rib- :BLK NO SUBDIVISIONNAME: sr_, 1/ 1/4 "J fTZgN/R'bfi r~W _`ti.ll_~y.~~~~ ~1::~~► I: t~_ ~Sh Ue~ I ~a?.9z. 000NTY: OWNER" UYER'S NAME: MAIL IN(, AUl)111 1 Z{-'~ UV IC. (viU 1~ c~~ O N I ~ti l l l - f _T~ f._ISJ )+V J~ U O Z.. LIATES OBSERVATIONS MADE USE - NO,$EDRNIS.: COMMERCIAL DESCNIPI IUN:I T PRUILE ISESCRIP`PIO S: FR~5LA1~IbN~ESTS: Residence I N l I i tJUw ~ll i~ 111w e RATING: S= Site suitable for system U= Site unsuitable for system `ONVENTIONAL: MOUND:. - IN-GROUND•PRESSURE: SYti'I1 h1 1fJ I II LHOI l)IiV(, I t~IVI~. HtI;OMMENDEDSYSTEM:loptionall, ~El S ZU 1 C S C_u-~~l_~ DS NU 1C ~S [.~u I ~S I 'rlcl =gi=n 5scb ~Z_ r~ r) :)"-j II Percolation Tests are NOT required~DESIGN RATE: - III r,,y 1,,,, t,t,,, nl th+: tested area is in the , under s_H63 09(5)(b), indicate: ILF io-oj~Lun, u,uu .uc Floodplain elevation: NRaI11.L DESCRIPIIONS - - - LUII THICKNESS, COLOR, TEXTURE, AND DEPTH - TOTAL EPTH TO GROUNDWATFli Itv-Kf (;ITf "CI I tj (if WITH rB DEPTH ft ELEVATI_ON OBSERVED EST. 111(ilit IS 10 BED1jt,t K 11 (In l HVi: D (SEE ABBRV. ON BACK.) 6.~' 9b.o' No~C YYto'T Ts 1_`Z'VV,S~I ;o•~'Bn SJ i 1 fa'Br, e UYc By► S Pain S. ' Q • 5 ' By, Si. L if *-J NN t1,► L S RES I D)u So°,~R.IC >,-I'r,„ ST4 ah Sp /Br, SI w/ L Y ql,sc~ W\6-) b6clY-W fn o'` bo•8TIT'l •q'`tr,siI ahS►SNfMit'S' 1,b IBhiS WJGS DNS i3 n S y 6, 0 ' 9 • S ' 1JO )vC w, ~l ' c~ . , ' l~r~ t i, 4 1 Ts 1. r 'bh s 1; \.9' g_ w / sT5':=v.1... ~ y t.. rJ c:~,v DI`G t3 $ r~Lo s • .7 ' .J/ S I C!; IpiUM NIA Nfa)I.ATION Ti: S I S II TEST DEPTH WATER IN HOLE TEST TIME µ - DROP i-N Wn ff H l (v[ L•iNCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. '."1'I EUi;j?_~ 1 6f'tl(rly 1 . PER INCH P_ T- P' - - p. C' tom` !JU 1" `r? P_ I PLOT PLAN: Show locations of percolation tests, soil borings no the ,luuunsions of ►.++tablc sml alias. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their Iocatarn on Ihr plot plan t )ulov the surface elevation at all borings and the direction and percent 9 of land slope. CA I rv SYSTEM ELEVATION 1 I I ~J 1321 O 1 of " CLnpTI I I ? I 49 BB~ JN N- j I h t O WS I, the undersigned, hereby certify that the soil tests reported on this fuun vvcre made try ,nr m at-old with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of thr tests are cutrect to ttw hest (11,11y knowledge and belief. - - NAME (print). I LSTS WERE COMPLETED ON l:t!NTIFICATIONNUMBER:. PH E NUMBERIupUOnall: . (J as - 0! 6y t':iF SIG ATURE: ~ DISI RIBUTION: O ,gu,al and one copy io Local Antnolrty', Piupei ty O1VIIU1 and Sail I esta, ; PROJECT INDEX SHEET KOWNER 7-1;41 4 'RI c ,rso,u ADDRESS : Z '136y, CAD ep UE R F 11 s ~ i S . S4 ©2 ~ SITE LOCATION: S y4 SE %q Sic . 2'~ T28 N R 1 Tdwa D F k CAJ i C k uAj i s s'1 c'Rn r C' o ua T~ PROJECT DESCRIPTION: ~K;ST,~~ No~~ 3 ~seo~ooH5 , PA ILy Cd's-r,,4oiTe, u-> fl 54 ea l o~ p A i s y s~l > , © Oe P--NoLi - w -5 u CE'-s- 0'-~ L_ kf-3 I 7 csT 's soil pe pop* t PSGQ~i s A5 O~-S~`tE ~1E~~ f►'cgTio►J iS s'ysT E ie~'-(1'~- IS'-T-•--#' PAGE 1. .,.PLOT PLAN VIEWS PAGE 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERFORMANCE SPECS OR SIPHON SPECS HUMESITE SEPTIC PLUW* 00. kit 3 O'NEIL RD., HUDSON, MS. 51016 PLUMBER : ROBERT ULBRIDiT SITE EVALUATER/ DESIGNER ~1k.,'►~k pIUMpER UC UC. NO. 3307 M.P.RO. -101WER It DESIGNER LIC. NO. OM Aer wrer e7'e" DATE: SIGNATURE ~~CEIV E,D BIMa SECTION Pl-~ .f Project I . D . AfAeY ~0/3/ill 1E~/34~t1 - - - - HOMESItE SEPHC PLUMPING 09 I EG'~ ND A1.10'NEII IUD., HU060N, WIS SIIy ROBERT UUWHT • _ ?3a c kh o e ''its WIS. MASTER PLUMBER LIC. NQ 3301 M.P.U MINN. 4MSIAUER i DESIGNER UC. N0. OW X = Perc Locations . 7,e4,OC d"«rrr:a,~s C.S.T. 2482. Q =:existing Well = Vertical Reference Point ; Top of 'Bi-[LmwoUS PRIG` C ~~D DoTI F'_evation of Vertical Reference Point mEy -P o 6ARDto SHED - Lot Line 2 /0,9. 0 t7-. - SCALE: 1"=30 59 A110- Loc. s r - - - ~ - . - # _ - - - - --~E O LDf~ Z C4t _ ~15 p ~~y ~ ~ 9a.~~ 4~ 6 9~•6G ` sHtD ys . • O NEw , C 9~.0 uM N M duPa 35' af0 cE '7E ' + o `v A,Pfri- ` ySTE~"O h t/oA+e' RECEIVED coal PRd DED FOR 'ODE' Co►-tPtiAacE ~ooD ~ p1tp~18IN~~~ ~o,,p~Tto►J . ~ J P V x . Page Z Of Synthetic Covering Distribution Pipe Medium Sand s y from a El4V*TI4 + Topsoil -~r- F 9 •70 lip y 3 T-E (p % Slope I' Bed Of Force Main Plowed 2 Aggregate Layer Ft FIN 4'e 'on Of A Mound System Using E Ft. F S Ft. Bed or The Absorption Area ~t A O Ft A Ft. Q H A S Ft B Ft. K /O Ft. L 7 Ft. J Ft. x /3 Ft. Force Main W Z Ft. Observation Pipe K B A I•---------------------- t---- w o -•i I I - Distribution Bed Of 2" Pipe Aggregate Observation Pipe Permanent Markers y Ale- c1topr'o SfEE[., RODS Plan View Of Mound Using A Bed For The Absorption Area RECEIVED ilk 5 1 *87 Page 3 Of jkSf f(0 SET t v,4C t.1tTION job VA UdV/i,~ AW r l~ Perforated Pipe Detoll 0 End Vlew 1 Perforated End Cop) PVC Pipe i . bye e Holes Located On Bottom, S An Equally Spaced S x P P PVC Manifold Pipe Distribution Force Main Pipe Lost Hole Should Be / Next To End Cop 1 I D ZZ- Z End Coq gist lion Pi oyout P Ft. 9 4 1~lt i" jam} S 3 2 X 30 Inches k~ Y Z/ Inches Hole Diameter ~f Inch Signed Lateral / Inch(es) License` m'b Manifold Z Inches Date: Force Main J Inches # of holes/pipe /O/ ~p Invert Elevation of Laterals Ft. R~G~\v S~{ N D ,PoC,C_ s~STE'~ f/EV~Tio AJ TC r. 9V r Fr Q 5~ . 40 l/0/P UDI(1.y~ Jto~' 35 ~ 946~~lv 6d S`1' R i 13 0 ! o t,3 ?,A'I jF 12- 'To 2) i5l I iVe,oTio" iZN-tc FOF- Ne IlwoeK. C CQ. foes) ~Z - PAGE CF 4 PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOUS VENT CAP 4"C.I. VENT PIPE f r--T WEATHER PROOF APPROVED LOCKING JUMCTION BOX MAWHOLE COVER 25' FROM DOOR, WIMDOW OR FRESH 12"MIU. AIR INTAKE ' 5 V~Fr~~E &OeVE- GRADE CONDUIT N Lit'PtROW10E > A INLET ' - AIRTIG `titi• APPROVED JOIRIT ti v`~ ' ~ I I ( APPROVED JOINT W/C.I. PIPE W/C.I. PIPE ( I EXTENDINC. 3' EXTEMI)ING 3' Ill ALARM OWTO SOLID SOIL 4t .s } ~ I ONTO SOLID $OIL S / p4 Fr~A t~/`f'e~ I i 011.1 op Z 5 c 5y LL~r ' ELEV. FT nI 0~ 1/IaK PUMP Off 1),01V Z~ `t CONCRETE BLOCK Q 7 0 f `~Zy RISER EXIT PERMITTED DULY IF TANK MAMUFACTURE:R HAS SUCH APPROVAL SEPTIC E SPEC.IFItAtIOUS DOSE ~il~f,E~S 4~OVclx/R P~4DivCTS --5 TANKS MANUFACTURER: HUMBER OF DOSES: PER DAJ TANK SIZE: GALLONS DOSE VOLUME 1-:09 S"e- t-- 13 LeVcI INCLUDING 6ACKFLOW: -0N( - 1(0 GAI.LONS ALARM MAUUFACTURER. MODEL NUMDEIR: CAPACITIES: A= ~ IIJCAES OR 82- GALLONS SWITCH TYPE: -H S 12 CU P- A r / 5= Z' INCHES OR GALLOWS PUMP MANUFACTURER: hQ C=INCHES OR~~ 3 GALLONS MODEL NUMBER: Z3 7 z H• D= 12- INCHES OR 21 GALLOL16 SWITCH TYPE: `P''GG'l! (&AC,(-- M009y FlOA17; MOTE: PUMP AND ALARM ARE TO DL MINIMUM DISCHARGE RATE 72- GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 7 FEET + MINIMUM NETWORK SUPPLY PRESSUR~1E~~.. . . . 2.5 FEET + 5 FEET OF FORCE MAIN X F/oonFRICTIOU FACTOR.- "3 FEET TOTAL DYNAMIC HEAD FEET ~O UIV~ 77 w INTERNAL. 0{MEIJSIONZ OF TANK: L H ;WIDTH l,. -..lLIQUID DEPTH . SIGUED: LICENSE HUMBER: DATE:... P ~ F LL W HEADI W 115 - _ _ 110- - CAPACITY 3z 105 - CURVE 36 11 95- 28 90 28 85 EFFLUENT 24 60 MODEL Q 75 MODEL 189 and DEWATERING = 22 70 165 - U 2 65 a Z 18 -60 55 _ \ IN 16 So _ MODEL 163 MODEL 14 45 - - 168 ~ 3 Ka ..d 4.k 12 - - 40 4- 35 - 10 MODEL 30 137 139 MODEL 185 SEWAGE and 6 25 DEWATERING 6 -20 - - i- MODEL 15 MODEL 161 Al 10 97 to 2 MODEL 1W- 5 53, 55, lu ~ 57,59 0 80 GALLONS 10 20 30 40 50 601 70 601 90 1001110 24 - - - - - ---i LITERS 0 6o 160 240 320 400 75 - 22 FLOW PER MINUTE 70 - - 20 85 - - 18 60_. - - - - MODEL-_ - - - - 295 a W 55 - - - - - - _ 16 - 1-- - U 50 - - - 294 - --r-- - - RECEIVED 2 14 Z a 45 1A(~ p 12 - - - - - MODEL r . --1 - - JUL 3 1 9Q 87 Ja 35 MODEL ~O 10 293 - MODDEL - - I- - - - . ~I .V►C1C711YA SGG✓ 1 I()R1 30 i 8 25 - --MODEL 6 20 - - - 2112 _ - - - - - - 15 - r - 10 MODEL - - - 4 OElLE/P O. 2 ff 267 266 ~ i o 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 P.O. Box 16347 Loulsv/lle, Kentucky 40216 LITERS 0 00 160 240 320 400 480 560 640 720 (502) 778-2731 FLOW PER MINUTE "137" Cast Iron Series - UNITS/MIN "139" Bronze Series'' MEAD CAPACITY Feet Meters Gal. LtrS. rl 5 1.52 104 394 s.- e Automatic or Non-Automatic. 10 304 79 300 0 V, H P , 1 Ph , 115V. 200-208V or 230V. 15 4.57 64 242 I • 'b H.P., 3 Ph., 200-208V or 230V. 220 5 610 36 6 136 762 • Non-clogging vortex impeller design. • Passes'/,, inch solids (sphere). Lock Valve 26' is 1b," NPT discharge. O Canadian Standards U • Float operated, submersible (Nema 6) meth listed P AssOC avadabie anical switch. • Automatic reset thermal overload protection. 137 Sairies SC-2225 • Stainless steel screws, bolts, guard, handle and 139 Safe Se-1115 arm and seal assembly. 'Bronze motor and pump housing, switch NOTE No UL listing for 200-206V/1 Ph. case, base and impeller, pumps Mercury floal switches are available for non-automatic models. 1