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HomeMy WebLinkAbout030-2020-90-000 (2) ti I ap c C !r N O I •N N m Cl)O � I = � I C O CON I C i ill O N C Z O.0 III 3 N LL o co N O N N E ¢ a U c M 1i1 a C N O d• i � � z a m I o I o Z c c E v N WI � N 0 :E Q. C •� Z m Z Z c .. N CO N E CD l6 n III d• a M Y t17 — C CO W d V 0) O ° > d U N E .0 � Z > C F- I- F- L a_ O IL IZ LL ;n CL N U) j to oo co a)to J u 1 0 rn rn 0 I v CO � � •° °° I L O p .� N LL � m N C N a E a) ¢ > cn o U U) c i, C O a 3 E N It O v n v O L� N N O v N O ' O N Z C C0 w C •N O n O N � • �' O 000 O Z C H 0) •ate+ �II .�_'. E RS E m CL s rte• Cd C• d V -1 PUMP CHAMBER • Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacture Pump Size Elevation of inlet: B m of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of f from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: i Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM pp Bed: Trench: R Q1, A3 Width: Aa"' Lenith: 71 Number of Lines: 2 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Pt . Z Number of feet from well: 4yeil Ivor 5,4mlep 7o p47- Number of feet from building: (Include distance,.g. on plot plan). r SEEPAGE PIT Size: .. Number of pits: Diameter: Liquid depth: Bottom of seepage pi evation: Area Built: Has either a drop box O or distributi box O used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of r gs used: Elevation of bottom of tank: Elevat n of inlet: ber 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: Inspector: Plumber job: Dated: Plum on j e� ' t License Number: HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD.;HUDSON, WIS.54016 ROBERT ULBRICHT CIS. MASTER PLUMBER LIC.NO.3307 MART 3/84:mj UN. INSTALLER&DESIGNER LIC.NO.00663 _ p ,ui,AESITE SEPTIC PLUMIRK M tl. 3 O'NEIL RD.:HUDSON:AS,54(1}i ROBERT ULBRICHT ;ASTER PLUMBER LIC.NO. 3307 M.P.R1 Form — S T C — 104 • '' ;ER $DESIGNER LIC,W.00Eafi3 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP /P SEC. T N-R 20 W ADDRESS ,PT y lfwy 3S' ST. CROIX COUNTY, WISCONSIN #-Up soy Wig - esM 35Sff l -2- �j s SUBDIVISION Rio/ 3 /3 • o LOT LOT` SIZE PLAN VIEW I Distances and dimensions to meet requirements of I•IHR 83 i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SC/}�� : -20 r I 4E// NO 7- Jklt ' 3 RM 0D)LAE- I z' 17-00 9 -rill' 15 5� VEQf. r -203 \ ( PT •.. ��0 hl,4cs �'O� S ysTE-K E/€v�rTio✓ x71 Btv fop of rlr.4D bj &Vf TeP 00' 00 r✓b T ,O �/•vE5 eo'' Rock ZcND�Q D�'S-► • ,-yP00 F�1dC�c Gov I E�cv�NT INDICATE NORTH ARROW - Top 6F C ovc ee7'E 9,Mo beep_ RT BENCHMARK: Describe the vertical reference point used Nw CO,p,JEA 04-J' QLJ-Pf Elevation of vertical reference point: 00'0 ' Proposed slope at site: °2 /p SEPTIC TANK: Manufacturer: NeZcJ ejC4Mg&Q Liquid Capacity: Number of rings used: Tank manhole cover elevation: �' 2-8 Tank Inlet Elevation: /✓/' Tank Outlet Elevation: Number of feet from nearest Road: Front,(D Side,O Rear, O feet No. � From nearest property line Front,OSide,�Rear,O �� feet N O T // Number of feet from: well Df0ED building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) QFF RFURRCR gTflF. 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX`9969 BUREAU OF PLUMBING MPIDISON,WI 53707 `CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: (If assigned) ❑Holding Tank ❑In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Don 6 CaAAie Johnson I Rt. 2, RiveAview Ached, Hudson, W1 54016 II-X°S7 �Uc� BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: 7F.PT.ELEV.. SE NW, Section 1, T29N-R19W. Town o4 St. Joseph., Lot #1 Name of Plumber: IMP/MPRSW No.: County: Sanitary Permit Number: RobeAt U.2bAi.cht 3307 St. Ctoix 88468 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER (� ` T t� t PROVIDED: PROVIDED .ao . 54YES ONO ❑YES �N(VO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELT BUILDING: VENT TO FRESH ALARM. FEET FROM Q�'�''� LINE: 1 AIR INLET. : YES AND � `+� ❑YES E4NO NEAREST 1Wd 1 II DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ENO EYES E NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) 1-1 YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DISTR PIPE SPACING. COVER JINSIDE CIA. *PITS. LIQUID BED/TRENCH TRENCHES AA --I MATERIAL• PIT DEPTH DIMENSIONS 0 "1 lh 4_ RAVEL DEPTH FILL DEPTH DISTR.PIPE D JDISTR.PIPE MATERIAL: NO.WTR. NUMBER OF PROPERTY EL{{r� BUILDING: VENT TO FRESH BELOW IVES: ABOVE COVER. ELEV.INLET ELEV.END: I�^/� PIP LINE ) AIR INLET: ,/ �"' 1&-9a q4, 4 1 e�J 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- meets the criteria for medium sand. TIONS MEASURED. 1:1 YES ONO SOIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS ❑YES 1:1 NO OYES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES. ❑YES El NO 1:1 YES ONO ❑YES ❑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 ELEV_: ELEV: DIA.. ELEV.. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED DYES El NO OYES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: JEIUILDING: FEET FROM LINE: ❑YES ❑NO S AYES ❑NO NEAREST t D 0 �. Sketch System on Retain in county file for audit. Reverse Side. SI wR�•E� TITLE DILHR SBD 6710(R.01/82) Z�o •nq I i 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 aaicensed pumper whenever necessary, usually every 2 to 3,years; 6. If you have questions concerning your private sewage syster:i, 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. Property owner's name and mailing address Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must:sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 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. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATEfl,.$I RCHARGE 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 i.n,statutes.was the result of over 2 years of steady negotiatior 6d public debate. The groundwater bill Ground Or included the creation of surcharges (fees) for a number of regulated practices which Wisco EIIt can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaslire a 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. 0 The monies ,ollected through these surcharges are credited to the groundwater fund adminis- tered by the .Department of Natural Resources. These funds are used for monitoring ground- v,�°ater, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(8.03/86) 1 i R SANITARY PERMIT APPLICATION COUNTY fl 0ILH In accord with ILHR 83.05,Wis.Adm.Code 5T'CeGlok STATE SANITARY PERMIT# � 8y6 g -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. Ij. ,rf , –See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES OC NO PROPERTY OWNER _ PROPERTY LOCATION �O N 3 Ch�'��t �, d �l�.�Ol� �E '/aIJll�'/a,S f T2� , N, R 2-0 E(or W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAM P—T � P-WEP- le") ItGt e.S CS�r 3 S / — We. ITY,STATE vpilce.)l ODE PHONE NUMBER CITY NEAREST ROAD,L (p G/3a ❑ VILLAGE: $T� 7a Kw y 3 S 11. TYPE OF BUILDING OR USE SERVED: d 4— 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. 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. E]Alternative c. El 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) X 1. a. R5 Seepage Bed b. El seepage Trench c. El See a e Pit /�- CO � 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): /REQUIRED(Square Feet): PROPOSED(Square Feet): QL1 i 1 3 615 0 � / /.0 Feet PQ Private ❑Joint ❑ Public CAPACITY VI. TANK Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New Misting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Zve Septic Tank or Holding Tank X Lift Pump Tank/Siphon 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 Signature:(No Stamps) - tPtMPRSW No.: Business Phone Number: `RoBMT_ 4(meicti -3307 Plumber's Address(Street,City,State,Zip Code): Name of Designer: fiT3, a/ a t_ Q-& • u DSDA-) W15. VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name HOMESITE SEPTIC PLUMB,'NG CO. CST# RT.3 O'NEIL RD.,HUDSON: WIS. 54016 7 d CST's ADDRESS(Street,City,State,Zip Code) RUtIERI ULURICHT Phone Number: / MS.MASTER PLUMBER LIC.N0, 3307 M.P.R.S. 7l� P IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved Owner Given Initial rc ar a Fee PP ❑ n Adverse Determination v �� 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 HUMESITE SEPTIC PLUMBING CO. RT. 3 O'NEJL-,D,, HUDSON, 4VIS, 54014 ROBERT ULBRICHT APPLICATION FOR SANITARY PERMIT WIS.MASTER PLUMBER LIC,NO, 3307 MAR.& MINN. INSTALLER&DESIGNER LIC.NO. 00663 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 'P6,v - Location of Property �L 14, Section , T_�-f N-R lQ W Township ✓; T' Mailing Address Address of Site 9 r yo /,6 Subdivision Name Lot Number Previous Owner of Property Total Size of parcel S0 Date Parcel was Created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 1J g s as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and Eagle number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) cent ijy that att .statements on this bonm a&e t.ue to the beat ob my (ouA) knowledge; that I (we) am (ane) the owneA(d) o6 the pno peAty dea c tibed in thus .i-nbarmation bonm, by vi tue ob a wa4Aanty deed tecmded in the Obbice ob the County Rega steA o6 Deeds a6 Document No. 41S',31O and that I (We) pnea entty own the pnopoz ed site bon the sewage dispoz (on I (we) have obtained an easement, to nun with the above ducnibed pnopenty, bon the conatnucti.on ob said eyatem, and the .same has been duty %econded in the Obb.ice ob the County Reg"ten ob Deeds, as Document No. dl.�-3 /b ) . S T OF OWNER SIGNATURE F CO- WNER (IF APPLICABLE) DA E SIGNED AT SIGNE r'. r ,4ot IW 0 11 11 oil I { T a4 q • ^ . ct. � r •v�tit!o�! r�1 WA= OIP WORO MI Is. gum IRM d� r F € a IAP M11 ID bi w love"+akh.yww� my b % RT _D SURVEY- MAP LOCATED IN GOVERI MENT LOT 21 SEC �ION 1 , T29N , R 20W , TOWN OF ST. JOSEPH , ST. CROIX COUNTY , WISCONSIN. ; RE- SURVEY OF THE MONUMENTED BOUNDARY AND SUBDI` ISION OF THE CERTIFIED :,URVEY RECORDED IN VOL .3 OF CERTIFIED SURVEYS , f G. 866 . OWNED BY: ON2AND C114DRIVER OHNSON HUDSON , WI 54016. *SE SHEEP 1 OF 2 FOR MAP INFORMATION* DESCRIPTION I, James M. Weber registered land surveyor, hereby certify: Th.it in full compliance With the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction o: Don and Carolyn e S, id parcel of land Johnson, owners of sai,. land, I have surveyed, divided and mapped p , that such plat correct: y represents $11 exterior boundaries and the subdivision of the "� land surveyed; and tha this land is located in Government Lot 21 Sc -tion 1 , T29N, R20W_, Town of St.Joseph, St.I'.roix County, Wisconsin, to-Wit: o Commencing at the S4 corner o". said.Section 1 ; Thence NO 49118"j along the N-S - Quarter Section Line o: said Secti )n a distance of 2626-471 ; thence WEST 774-171 ; Thence NO 121W 380.421 said ai 380.301 )to an existing iron pipe at the SE corner of the Certified Surve;• Map recorded in Volume 5 of Certified Survey Maps, Page 1433; Thence N001914011E 369. 5' (Recorded as 369.70' ) along the East line f said Certified Survey Map to the NE ci,rner of said Certified Survey Map; Thence N89 5511811W 201,011 (Recorded as WEST 201., 21 ) to an existing iron pipe, 1so being the yoint of beginning: Thence continuing N890, 511811W 282.47' (Recorded as W,,ST) to an existing iron pipe; 'Thence N890 1913011W 663 941 to the monumented SW corner of the Certifi id Survey Map Recorded in Volume 3 o. Certified Surveys, Page 8669 said point also ►eing the beginning of a meander line alon. the ST.Croix River; (TOTAL LINE REC. AS WEST 9 33.55;FROM P.0.8) Thence N3600011611W (Re orded as N34024119"W) 415.62' to the end of sa d meander line; Thence N4601211411E (Re.erded as N45 03 2 1 0611E) 336.761 to the monuments . NW corner of the Certified Survey Map r corded in Volume 3 of Certified Surveys, Par i 866; Thence S8605810211E 619 74' (Recorded as S86o5215311E 620.01 ' ) to t%e monumented NE corner: of the Certified Survey M: p recorded in Volume 3 of Certified Sur-:eys, Page 866; Thence S31o06140"E 636.x..:' (Recorded as 636.561 ) along the ;asterly line of said Certified Survey to the point of begi.. ping. Contains 12.15 acres of land, mop - or, less, to the wr',er's edge of the St.Croix River, or 11.55 acres to the meander line. SUL*pct to easemen.s of record. Dated this V5i`=' day of A.��.�s't 91985. ��9 n►- �`+�•�J � - James M. Weber S-1804 Wegerer, Weber and Assoc.,Inc. River Falls, WI. `�`�jG ONS�'�i♦ . OPRINUVALLEY This Certified Survey Plap- is hereby = approved by the Town of St. Joseph. Date pq � �`� Carolyn Barrett - Clerk �, itieR.,% Toim of St. Joseph SHEET 2 OF 2 . V� CERTIFIED SURVEY MAP — •LOCATED IN GOVERNMENT LOT 21 SECTION I , T29N , R20W, TOWN OF ST. JOSEPH , ST. CROIX COUNTY, WISCONSIN. OWNED BY: R 2 DON AND CAR 4 YN JONSON ( RE- SURVEY OF CERTIFIED SURVEY, VOL.3 , PG. 866.) HUDSON, w) 4 RIVE LEGEND —SEE SHEET 20F2 FOR DESCRIPTION- `��t>��W11/�NI -°► c DIRECTION OF SLOPE: co/v R ="RECORDED AS" i O ■ SET 1"X 24" IRON PIPE WEIGHING 1.13 LBS = JAMe6M, PER LINEAL FOOT. ✓ WEBER S- 1804 = • = I" IRON PIPE FOUND SPRING VALLEY 1 ; < WIS. few, riZ jq- COUNTY SURVEY MONUMENT. SCALE' - 1"> iD0' '✓a / so.` yl�4, ••� ���♦ .`\ O' 75' 150' 300' Q ,,f41122 0111% - 1 -4 d2° y,?/ �, 'G JAMES M. WEBER S- 1804 �\ f O 6\' pc/ 4 •�A DATED THIS 15T`'DAYOF�"� 1985. �• 1 / ,.11"9\ yDZ 6 ' • ` REVISED AUG.15, 1985. I► � �0 �. q m Z 9 /Z S 6`� •'� 0 e'Lp / 3 m � 2 / m � r :Z m .N En p ) 01.4 Z 07 N (D > N m (n O O O) CD •� t0 .. to A -� OD o I .1r: O N d� .;] - N (n 3 ' O N 1 A-1. tD�, m a, x rn Iv ( _ Q� l - - - N :rr! N 3 O cZi :U 7� OD r m p n ` rn o is m rn L N rn rnm -q� w v :Zt w -1 C O & to U -- •r(Z W r `-C cn m ('n, C.0 _0 i m '• :r— z — ----;cn-- ---—----- / 0 0 rn (n N N o •\` / GJ O 9/ 4 \_ .Z. to r Ody 99 o\ �a w Z �On O�e< 90 y'd aO rn /gL s 0 ti Y NOTE: BEARINGS ARE REFER- ..�" r\' / C Q� NCED TO THE -S QUARTER cx) ��� •02 v (t.9 E nl LINE. (RECORDED BEARING) 2 . Nw M L- •y- v 9�91 O oz-1 � O 1771 1�9 �-12 - -'_-_ _-____:f}"1z (D--_. l N - L. .. �tn "(nm z a rnD�_� +N89°55'18"W -A d v NO 2 NO 9'4 ' ( 201. 01' N O 0 Fp (WEST 201.42 R) 4 36915 A_ SHEET I OF 2 . 06tn 380 . 3809.70R)j62 THIS INSTRUMENT DRAFTED Nn°4918 a B ( INE ___.(PROJECT NO. 85- 76 ) z y HOMESITE SEPTIC PLUMBING CO. H RT.3 O'NEIL RD.,HUDSON,WAS, 54010 9 • S T C - 105 ROBERT ULBRICHT r r. WIS.MASTER PLUMBER LIC.N0, 3307 M,RR,& Y MiNN.INSTALLER&DESIGNER LIC.NO.00663 SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d 9 '00,t OWNER/BUYER ROUTE/BOX NUMBER er Z �iy � y��`� S Fire Number .CITY/STATE &Va.SO� �/ s' ZIP 546- PROPERTY LOCATION: '�, Section T ` N, R W, Town of Sf` /�/T St . Croix County, M Subdivision —'" Lot number Improper use and maintenance of your septic system could result in VV 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 P $ 3 a and scum. . is less than 1/ full of sludge Certification form will be sent approximately 30 days prior to r expiration.three. yea 0 p o E z I/WE the undersigned, have read t he above requirements and agree En to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- •v 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 . y SIGNED 04124� 1 a DATE St . Croix County Zoning Office P.O. ;Box 9&i Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign', date and return to above address . l ` J INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 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; 9. Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10. If the informGrtit>rl (such as flood plain,elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form anti place your current address and your certification number; 12, Make legible copies and distribute as regUired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures tither Symbols st - S`tom-� {over 10") BR Bedrock cob Cobble (3- 10") SS Sandstone gr Gravel (under 3") LS Limestone S - Sand FIG'SAJ -- High Groundwater cs Coarse Sand Perc - Percolation Rate rrwd s - it cAiumn, Sand VV - well Is -- Fine Sand BI(I l - Building is Loamy Sand - Greater Tha€t sl - Sandy Loam < _ Less Than .- Loan's Bn - BroV>rn siI Sift Loarn BI - Black si Silt riy - Gray c1 - Clay Loam Y - Ye11o+ru sci Sandy Clay Loam R - Red sic! -- Siity Clay Loam mot - Mottles sc -- Sandy Clay W/ t„ritlt sic - Silty clay fff frw, fine,faint CC _ c0l'unlon coarse pt - Peat nin', -- Nilany, r7iodium rill Muck d -- distinct P - prominent HWL -- High water level, Six general soil textures surface water for liquid Waste, disposal BM - Bench Mark VRP -- Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may reoUest verification of this Soil test in the field prior to permit issuance A complete set of plans for the private sewage system and a permit application must be sutrmitted to the appropriate local authority in order to obtain a permit. The sanitary hermit must be obtained and posted prior to the start of any construction. Gtr/NtFR TESL �o�o�Tio,vS 5aA-Al', 3 FRO57-, -4,f �R(,Q �0/� ?i NDUS RY, OF REPORT ON SOIL BORINGS AND �� ` SAFETY& BUILDINGS 'INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 IdUMANWELATIONS MADISON,WI 53707 (H63.09(1)& Chapter 145.045) ,�,4Qj of rlovT laf 4$e- Z- LOCATION: SECTION: TOWNSHIP/ H'AtiTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: sE 1/ 1/ /T 4HIR1dE(o ►W ST= �"os�Q COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: ST Ctieor X 1000 3 CA R R I I= J-0HOSOA) 2 12111,OJ7!/ieZO f/G 4 1�la D.f o'v lv1 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS:IPERCOLATION TESTS: Residence 3 1 &/�_ ❑New Replace J' X11, /1 /��7 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) ©s ou �]S au IS ❑u DS EA OS au If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C6/f s S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS - BORING TOTAL DEPTH TO GROUNDWATER-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.) ' /,S' N• S ��� ' B- B- 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 PERIOD PER INCH P- P- .v ivy Fes° fir- •oo.��c CS P- C 0 1 x Co Q Al P-e&AAA i' i L i T l G P_ C •� - ,(,! v SO% P_ P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _ ._ L.... 9 aF I 701 n � -i E � J : i01 3 ' �giT of I i ,9 1 Ci s T �Qw �Td - - _._ _ _ _ __ _ �_ _ __ ___. _ r_ ._ r ( � I,¢v� f I T ..� TiO '-ALL t I T i--- � i t Ir. e -- - ` 7 � f I D �?c f�• 1 #a ��3 9/y� _. �...�� 4 1,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.: J�j TESTS ERE COMPLETED ON'. +� HUMESITE SEPTIC PLUMBING CO. ., <` 7C a(� ADDRESS: d 0�0 IFIC TION NUMBER: PHONE NUMBER(optional): ROBERT ULBRICHT �� MINN.IN9dALLER&DESIGNER UC. N0.DO ia* (� IGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owne it Tester. v�� DILHR-SBD-6395 (R.02/82) —O — `° i INSTRUCTIONS FOR COMPLETING FORM 115 - SRC - 6395 ' ' • To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2_ The use section must cle*arly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacernent systern; 5. Complete the suitability rating boxes. A SITE 13 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 cliagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Male sure your benchmark and vertical elevation reference point are clearly shown,and are Permanent; J. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; ?l). If the information (such as flood plain,elevation)does riot apply, place N.A. in the appropriate box; 11. Sign the form and I:alace your current address arad your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st — Stone fovea 10") BR — Bedrock cob Cobble (3- 10") SS - Sandstone gr -- Gravel (under 3„) LS - Limestone �s — Sand 1-1 GV%1 — High Groundwater CI, Coarse Sand Perc Prarcolation Rate coed s Medium Sand W illeII fs Fine Sand Bldg Building I Loamy Sand j Greater Than ”sl Sandy Loam < _ Less Tri an Loam Can -- Brown sil — Slit Loarn Rl Black Si Sill Gy — Gray �ci - Clay Loam Y -- Yellow sci — Sandy Clay Loam R iced sicl -- Silty Clay Loatn rnot Mottles sc - Sandy('lay w/ tvitl r sic — Silty Clay H f fevr, fime, Taira;: e — Gi<iy cc -- cornillora coarse P>at nam n�ediur — Many, m rn _ Muck d distinct P — prominent H W L - High water level, Six general soil textures surface uvater for liquid waste disposal BM — Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this sail test it) the field prior to perrnil issuance. A complete set of plans for the private sr.Ewage system and a permit application must be submitted to the appropriate local aurl-rority in order to obtain a hermit.The sanitary permit must be obtained and posted prior to the start of any construction. -0`6S Aw 4,0A_-,vv-y (up e0&.12 ) ox ,FpORT Oef•!O 1t'7,9 6;le'- 2 C"pc Z DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS •INDUS'YRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 3707 kIUMAN'I�ELATIONS \ / MADISON,W153707 (H63.0911)& Chapter 145.045) Aj f7- OF GO 0'7—Ld 74-950"' Z LOCATION: SECTION: TOWNSHIPftb' MGtl"O *'FY: LOT NO.:BILK.NO.: SUBDIVISION NAME: SE 1/ 1/ 1 /T N/R 20E(p ST Toss P tf- COUNTY: OWNER' R'S NAME: MAILING ADDRESS: S7(AOI X CUPie Pwo ?b 1yN44w ,Z7. Z. „@ v.Fw .,,5►cc��-s 1141,0 so d USE DATES OBSERVATIONS MADE NO.¢EDRMS.:1COMMERCIAL DESCRIPTION: New Replace IPOROL DESCRIPTIONS: A�O�N STS: Residence j 4 , `—, # /• � c� � /c RATING:S=Site suitable for system U=Site unsuitable for system CONVENTn AL: MOUND: IN-GROUND-PRESS SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) wi� oZ f O$ u ❑sou ©s ❑u ❑s ©u ❑s ®u rov� �T%a o O.Al -4 2V ",IF- O 10'47C E If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the �/- under s.H63.09(5)(b),indicate: CG sS Floodplain,indicate Floodplain elevation: Imp PROFILE DESCRIPTIONS S� y� BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH T CKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / p 7� ?v- S� , /7 �.LS, /./ 7" AJ. 111 ,o 1 B- / 90 ! � % Teti CS B- 9 y7 'IV ` Ao— > 'F a �� s, �, s, 3� 8N. , ss ?-,k, CS. B- 3 �� � g,yL" ? rl,� �S' ;iN, 5 l,ya e.�' (QN• s , .33 � �� R,,. Si , , 31 S S 2, se CS B- 3-o ' 3A)• CS 3 6-;t . B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P- P- L G•D P-_ P- G P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION i 9 _ � 1 E I I I 3 j � � , ! 4 I X� ( ( •r � I , Z, i [ _ sr E 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): S WERE COMPLETED 0 HOMESITE SEPTIC PLUMBOVIS CO. ���, EIL RD.,HUDSON: WIS. 54016 ADDRESS: ROBERT UL 2 ,/}� ICATION NUMBER: PHO E NULL EB(optional): f'z�-/r"S.MASTER PLUMBER LIC.NO. 3307 M.P.R.S. T ATUR C0 DISTRIBUTION: Original and one copy to Local Authority,Property Owner an i ter. DILHR-SBD-6395 (R.02/82) —OVER — r I 1 � _ 1 � 5cO AREA A � / 00 - - °F �;'C / o 3 i uN���R~ C�SS�ao w/ 7° '130 i11ED '� ' �0 f o /►f G,4 V 7 � Q 1Q' � \ i l E S i 3 U i j •B3 1s --� MOA44 1 w�ll M '`—38 - w ,0 p5F,,eD�, 5115TE O E- c \ �\ `1 Po uJ E Q. ?016 2103 Qr W ` ' �flEV. of 9f'gDE RT or- PC W. c o,�N"R L"�/&V47'10 ) _ /00.0 V � o QI .it, Q Fresh Air Inlets And Observation Pipe 'J 0 o r Approved Vent Cap Q 6 A Minimum 12" Above F i n a I Grade ��A of 4" Cast Iron ,�2 " Above Pipe Vent Pipe to Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee f Pipe 0 0 0 0 0 " Aggregate 0 Perforated Pipe Below Beneath Pipe Sod efr , 0 Coupling Terminating At ��0 rv' Bottom Of System