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HomeMy WebLinkAbout030-1017-40-000 O N O h ti 0 6°9 N 0> O O � ' C O O N tl � I �L Z C 7 (6 LL O Q 3 ce) v � z Li rn Z c 0 N w a m Lf) z 0 O z c U v � p 4 p (%� H a� rn N Z c E 0 N co N O) O O O O N Q O U z 00 z :o Ln N Z d N co E N y E a I � d AFL- o ° ° G o a E 21 bap Z a0 - o o •ti r � aoa. IL zo A ` N IL o u) }fA J U 2 CO rn wv > i+> co o w 0 E -o o ) � rn m d Q } � o Lq o co �.+ u o rn o o I c c a o rn o n 6 o lU = T d co co li 40. O o � N N O Z w -O ^ O -Oj Y+'' O N E U �- F1 p N p ++ •O � ooin Arno zs � w L: • cl a m 0) y c 8 c c r A maw oaic°� Parcel #: 030-1017-40-000 02/18/2005 10:40 AM PAGE70F1 Alt.Parcel#: 05.29.19.74D 030-TOWN OF SAINT JOSEPH Current [X_', ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): =Current Owner PRATT, STUART C STUART C PRATT 496 BLUEBIRD DR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description 496 BLUEBIRD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.880 Plat: N/A-NOT AVAILABLE SEC 5 T29N R19W N 447 FT OF E 335 FT OF Block/Condo Bldg: FRL NE NE DESC IN VOL 575 PAGE 87 EXC N 83 FT ALSOKNOWN AS PART OF LOT 1 CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 7/1805 ASSESS WITH P63C 05-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1213/422 QC 07/23/1997 779/590 2004 SUMMARY Bill M Fair Market Value: Assessed with: 4836 237,200 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.880 98,400 135,000 233,400 NO Totals for 2004: General Property 4.880 98,400 135,000 233,400 Woodland 0.000 0 0 Totals for 2003: General Property 4.880 57,900 101,000 158,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 117 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER a Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: 1 Width: (8�-Cl'' Length: �O'' Number of Lines: ,3 Area Built: b Fill depth to top of pipe: 3b�� Number of feet from nearest property line: Front,, O Side, O Rear,0 Ft . Number of feet from well: Number of feet from building: Soy-1P (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: i �i Inspector- Dated: �'���" a Plumber on job: License Number: �f Rs 05— q,2 3/84:mj Form - S T C - 104 p AS BUILT SANITARY SYSTEM REPORT OWNER STuge:r 41wi, TOWNSHIP _ �� � SEC. T Z9 N-R 19 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION /1l LOT lj I LA LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Sau-.11„0-r Cva�c .VIVes 0 i 310 �1 N } _ °AF_� . .� LL N INDICIT E NORTH ARROW BENCHMARK: Describe the vertical reference point used �"z,qp� Pwe 9-t ljj L rl'&w4sy+� Elevation of vertical reference point: "-00 Proposed slope at site: 4010 SEPTIC TANK: Manufacturer: �zF� ,�;. Liquid Capacity: Iwo lAuejej Number of rings used: �, Tank manhole cover elevation: 164- 10 Tank Inlet Elevation: IUI.46 Tank Outlet Elevation: 160-16 Number of feet from nearest Road: Front, Side,O Rear, 0 0,4C job' feet From nearest property line Front,0 Side,®Rear,O oww'160 f feet Number of feet from: well {p4-zO building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDI LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVIS P.O.BOX 7969 BUREAU OF PLUMB[ MADISON,WI 53707 NE,1k, NE' ,S5,T29N—R19W 3W CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D.Number: (if assigned) T'own of St. Joseph ❑Holding Tank El in-Ground Pressure ❑Mound Bluebird Drive NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A E: Stuart C. Pratt 1116 2nd Street, Hudson,WI 54016 /J'— / L- ? 7 �.3d BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: JMP/MPRSW No County: Sanitary Permit Number: Thomas H. Cody 6593 St. Croix 99042 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL YILDING:LOCKING COVER PROVIDED: PROVIDED �,/1E`3�CG �✓Cb �d ,Ci� �� I , SYES ONO OYES RNO BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WE LL VENT TO FRESH _ ALARM: LINE: AIR INLET: DYES ®NO EYES LANO NEARESOM \� -- DOSING CHAMBER: MANUFACTURER. =1:1 LIQUID CAPACITY. PUMP MODEL. JPIMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: O OYES ONO, DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF ;PROPERTY WELL. BUILDING:JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YES ONO 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.) f MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH- jNO,OF DISTR.PIPE SPACING. COVER INSIDE DIA.. #PITS. JLIQUII ^' Fi.IM TRENCHES- I MATERIAL' PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D R NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH BELOW PIPES. ABOVE COVER ELEV.INLET ELEV.END. PIPE FEET FROM LINE: AIR INLET: " 'S(o q(.,;1 5�..a`J C�1 �-� 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. DYES ONO SOIL COVER ITEXTURE PERMANENT MARKERS JOBSERVATION WELLS OYES FIND ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER: EDGES. DYES ONO DYES ONO [—]YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: B {� EN�iI'�• WIDTH. LENGTH. LATERAL SPACING: GRAVEL DEPTH BELOW PIPE TRENCHES- . FILL DEPTH ABOVE COVER. °"° - MANIFOLD PUMP MANIFOLD DISTR,PIPE MANIFOLD MATERIAL. JNO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: " ELEV.: ELEV.. DIA.. ELEV.. PIPES: DIA.: LE'AtAT1 Air pIST F3IBLIT'ttN HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED #NFC1fiMATtON PLANS: DYES LINO DYES 1:1 No COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NLII�IBER° ,` PROPERTY WELL: BUILDING: LINE: FEEt.FI�fi1M I' —1 YES 1:1 NO (DYES 1:1 NO NEAEST 3,6 -� t Sketch System on Retain in county file for audit. Reverse Side. ATURE: TITLE: Zoning Administrator DI LHR SBD 6710(R.01/82) CQ1E'�' 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 a licensed pumper.whenever.,necessary'usually every �to 3-years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8''/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundt9f -- included the creation of surcharges (fees) for a number of regulated practices which Wisco in.s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaSU W ° 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. !io 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 COUNTY (�Y DILHR In accord with ILHR 83.05,Wis.Adm.Code STAT SAN ITARY PERM IT# 9� -Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. –See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NNO PROPERTY OWNER D �( PROPERTY LOCATION ttiaw` C- r/ tl %Nt-1/4, S Tc�I , N, R � � E (or W PIA TY OV11N S M.WNG ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE rCC11II [ZIP CODE PHONE NUMBER Q CITY REST OAD,LAKE OR LANDMARK VILLAGE: I T24N OF, Op 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. El Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an 1 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.W Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding C.E] Pit Privy d. 1:1 Vault Privy e. El Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): (4 ( 19'M6 Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site Fiber- Exper. in allons Total #of Prefab. INFORMATION New xisting Gallons Tanks Manufacturer's Name Plastic Concrete strr cted Steel glass App Tanks Tanks Se tic Tank or Holding Tank (.� t ❑ Li Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for ins Ilation of the private sewage system shown on the attached plans. Plumber's Name(Pri t): Plumbe 's ignature:( St ps PRSW No.: Business Phone Number: re Sa P u er's Ad ess(Street,City, t ,Zip ode): Name of Designer: a c 0� III. SOIL TEST INFORMATION Cer Hied Soil Tester(C T)Name CST## 4 �.s , ( G CST's ADDRESS(Stre t,City,State,Zip Code Phone Number: 'all IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee Groundwater ate A Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial ``\\ Surcharge Fee Adverse Determination �v• � Aj X. MMENTS/REASONS FOR DISAPPROVAL: , -,,( -E- , J �rv~c�o C. 0.e SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - K O�+ner of Property � Location of Property IcE , Section qj , T -N-R �G( W Township !tailing Address V((-" Address of Site Subdivision Base Lot Humber (� Previous Amer of Property Vt. CtIL119, CA 6-L Total Size of Parcel Ct Cc�eS Date Parcel was Created �( CID Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: 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 ( We) certify that ail statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty de ecorded in the Office of the County Register of Deeds as Document No. _ . ;and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds,as Document No. � s1®NATURE OF 07NIf SIGNATURE OF CO.OWNER (IF APPLICABLE) DATk IG►(VED y �— DATE S GNLD . . ...., .5 •...4.Y............................................... •• ...........................-4......... .. -....� ..... ........y LA PAA do 0 Y an AIMPOPme dowbed rod allow be .................................. C*Nft. state's[Winnows: Fa Nos t. " Vii. Fort of M 1/4 of M 1/4 of Section 5 and Part of 1 4 of M I/ 4 cot A in 29-19 described as follows: �Wt..l-of owtifted wavy !gyp 1957 in Nbl. "r, page 1805, as aoclloe* #425095. r r Fi S}� { �< t �S. Toodbw wkk SO P!.and E rwtie..sr as b�i..d�Itl. : - - *%numb dm tiao ftbf ii giM bd�Wr M !« WPM and free and doer K ftcomb mm - r easesectts, sastricti+on and costs of if any, and wE warrasrt a"debod Ne wee. .67 >r Dated tide .:.............. --------------- day of ... y:.:. ............... ...... ......................................................................(SEAL) � "f I-r•�..l..r • ........................................................•--••--•-• • ..M.. -•.............................................(SEAL) .. . _. 1�. g _ E. Black _ • .........................................•--••••---••--•-•........ ....... .............._..... ...... AUTRRUT>IOATYON ACKNOWLROOMMUT (a) ..............................•-------.......---•----...... STAT= OF WISCONSIN ..............._.......--•--......................-----.................----• St. Cmi7t sutbes"WAN tbie ........day of........................ .. 19..... Penooally eame before'ae• �.. ' .........••... ... • .................................................... ..- • s •N1iEB STATE SAR OF WISCONSIN tu" ----- ................••••-•............ : ed' l zoe.oa,�i..stata.� s .. to�.known to be the pereoa .---....... wi . foregoi THIS 1NfTR_�lhiR,(IT WAS DRAFTED BY _ r +vHCi a. • ��a*j*l C - .iSii -.fR>iM./. ........... ... - j' 5 Seoorid , P.O. root i5i •-• - s � .� 2� Hudem..WI.� .......................................... Notary Public --- . �_. (Signatures way be authenticated or acknowledged. Hcth My Cotamiseion t.(if not egde are not nwmary.) date. ........ 19-• •xImm at so".-Aim 1■fin,eao•eiti sbould be Uwd or Prima bdow tech dg••turi•. tsJtWMIT WATM SA&M _ giul t x r-. z; H En a STC - 105 t H` SEPTIC TANK MAINTENANCE AGREEMENT ►-+o St . Croix County z 0 C/ H OWNER/BUYER C ROUTE/BOX NUMBER Fire Number CITY/STATE (�$�� ZIPS PROPERTY LOCATION: ')4, , Section , T N, R W, Town of Jae St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents m_ y be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank. is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E z 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- b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date. SIGNED (� DATE 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 INDUSTRY, CC DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1)& Chapter 145.045) LOCATION:N ' SECTION: TOWNSHIP LOT NO.:BLK.NO.R1B2!.,ISI) A E / S'/T�9 N/RJ? �(or s -T, G, — !s/<<+� //q�o�� �d COUNTY: OWNER'S/BUYER'S NAME: MAI LJII G AD D/R�ESS: - /-` /'a I��C Cit1,�.(CS � �t�V VV� V� J,• ��, �/I/�' / •G�.�a �+��L USE DATES OBSERVATIONS NfADE NO.BED MS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence �i ,t/ A XNew ❑Replace I /s rl So://v//4�0 !9x c , RATING:S=Site suitable for system U=Site unsuitable for system 6-- SO atr — e C QM /e ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-1 -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) LS_0_U ®S ❑U ®S ❑U ❑S 2U ❑S ©U I ' �6. 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: A//7 Floodplain, indicate Floodplain elevation: /x PROFI E DESCRIPTIONS .Cope BORING TOTALr ELEVATION DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. IIUHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) -3 Oaf O r &1 S- .O fii Z 4, di; , •z gn r B- 3 .C) r d.�.3 vtit� 7 .� g�/ • �B/t r C �s' j �t.� 3,1,0, S of B- y ff'o I Z 46"e kso n x /0c), 7' 0 C1. 7' we— �7 t 0 � r 11 , n ..� r /S 6•/ s S B- G •o o.Z.� au¢r •v / . , Sl 1. /s S de, s PERCOLATION TESTS TEST DEPTH$ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHE$ RATE MINUTES NUMBER +W6ibF6 AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD PER INCH P- '/vID 3 6 < 3 P- " PLOT PLAN: Show locations of percolation tests, soil borings and the dimensioy�sr pf .1 ble sojl areas. Indicate scale or distances. Describe what are the hori. zontal and vertical elevation reference points and show their location on the pl pjan. Flow the S084b eleva+n at all borings and the direction and percent of land slope. p SYSTEM ELEVATION _ 9cP � � �e G-P,-, r /"o✓Th 0 f A61 t , I -�c r 3 tN r I� r ; is (/�& . ��� ri P I l _ 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): TESTS WERE COMPLETED ON: " .j . 1,�r `,2 7 ',Y 7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST TUBE: J DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — San. Permit NO. _, na! 'E H63.05 PLOT PLAN , h Show: � 7-i Location of building served NA Dosing chamber Septic tank r� Vertical/horizontal reference point System elevation is °1 Building sewer L" t Effluent system Well Replacement system area tvA Property lines w/in 50' of system N►� Distribution boxes Scale or dimensioned = ' �� _, NFL Pump and controls: — Mfr. & Model No. Vertical Lift Size Force Main I Friction Loss T. D. H Vol. Dist. Pape Gal. Per Niin. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: L4-1 S ' aI4 "'�b'SS Aj N � 0183 b B6 / I .4,\]t3JT �E�R txAl PVC PLij t` ZS'oF v"PYC � �v o o Gtr L• w�'`SE�i2 CAS-�C.Cc.� SC-PTt C_ Y r 0 0 -� LOT Div e__ _ -- - � B�UCBI RD DRt yE � � By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St.Croix County and the St.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omissi examination ov r-sight, construction, or any damage that may result in or a*-ter Stallat•on. r's- si -nature License o. Ud to rJhNG CROSS SECTIDIJ OF A BED S�ST�M t �VE1�1T TJtPE \Z" �t30V�. �11J\Sllt7— GRNDE I L.. OF AGGREGATE �-- SOI t FILL --� S(Z 11 RX. DISTRIBllT10►,= PIPE---i —APYROVED SSUTHE7IC COVE. MATERIAL OR � OFD MARSH NAB ° 1� I/M A6GRo GAT E- L �V_ OF Ggg E - FEET _pap—C>FZATED P 7"o -�pT1-pM � 2EQ DISTRIBUTIOU PIPE TU BE AT LEAST 3 ) INCHES BCLO�-' OR1G1►.lAt C.RADE A,"D AT LE.ASTZO IAICHES BUT MO MORE THAQ 42 IUCHES B-'-OW F'K'A.L GRADE _ � 11.1CHE5 MAYIMU/'+ DEP: fa CAF LXCAVATIpIJ FRDM pRIGI►JAL GRADE LJILL BE Ll ) jAINIMUM DEPTH OF EXCAVATIOIJ FROM DRIGIUAL GRADE WILL BE 7 INCHES SIC-►JED: - ------ L IC E IJ SC 1JUM`BE R: —_ -