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HomeMy WebLinkAbout040-1031-70-000 h ~ O 64 o� M a o a � h O M O C K N 60 0— CL.2 ~ E Y O C U D N O U d z � a a d �I rnv c U N cc rn 0 Do C Z 25 {i c O O O O r CL CD 3 Cl) � I � Z O a O E Z 1 '20 F a m n Z c 0 O 2 � U C Z o p fA F r Z O N M N W O C m N O M •A, d N L UO C 'O o U O Z m Z N p z 00 V d N N � E H .. E a a c H m 41 `1 � �"" p D o a o) ow o o o z •ti on. aa O N N U) -j V a - - Z N p �1 0 E °o E a o o .5 � C a N m 0 y � v d Q } m � ►� ° m co O O N c °p N In O O C CO C TVV- y 42 C7 O O N N n O LO N U p O T C O y p c L * O • r O 2 N c 0 o Oy„i O O F- m (n O Z — F- a �, #6 a a • Cl 0. c c �1 A cia2 10 U) 0 • A - Parcel #: 040-1031-70-000 12/16/2005 09:46 AM PAGE 1 OF 1 Alt.Parcel#: 7.28.19.104F 040-TOWN OF TROY Current XJ ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-FLUEGEL,CURTIS A&SARAH M CURTIS A&SARAH M FLUEGEL 430 WHISPERING PINES RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *430 WHISPERING PINES RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.510 Plat: N/A-NOT AVAILABLE SEC 7 T28N R19W 2.51 AC NW SW LOT 7 OF Block/Condo Bldg: CERT SURVEY MAP IN VOL I PAGE 148 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 04/23/2004 760565 2556/280 WD 04/02/2003 715565 2191/346 QC 877/345 874/66 more 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 102234 395,200 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 100,000 280,400 380,400 NO Totals for 2005: General Property 2.500 100,000 280,400 380,4000 Woodland 0.000 0 Totals for 2004: General Property 2.500 242,000 387,900 629,9000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 209 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • a f �L �s PUMP CHAMBER j/40"d1i S� ,-e�aS Manufacturer: Liquid Capacity: Pump Model: Z-F6 5'/1 Pump/Siphon Manufacturer: A"A Pump Size I Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: , IpC IfoGallons per cycle: Alarm Manufacturer: 11 Alarm Switch Type: k Y Number of feet from nearest property line: Front, O Side, O Rear, Ft. i Number of feet from well: y..0f� Number of feet from building: r,2 (Include distances on plot plan) . SOIL ABSORBTION SYSTEM Bed. Trench: Width:__ �� Length: 6 Number of Lines: Area Built:���_ l Fill depth to top of pipe: J Number of feet from nearest property line: Front,, Side, ( Rear,O Pt . /S Number of feet from well: 11,6 7 V.*. � C Number of feet from building: � I (Include distances on plot. p.l.an). SEEPAGE PIT Size: Number of pits: Diau)eter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: — Elevation of inlet: Number of feet from nearest property line: Front, O Side; O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarqi Manufacturer: (� Inspector,: Dated: , „ f Plumber on job: License Number: I 3/84:mj ' Form - STC - 104 w AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R/ W ADDRESS ST. CROIX COUNTY, WISCONSIN �'-- U 1 �� SUBDIVISION �----� LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y' }6' 1g�x3b $Ea aJ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used -tile S T4 � QV r Elevatign of vertical reference po nt:-ro n p ? Proposed slope at site: SEPTIC TANK: Manufacturer: (,)c iquid Capacity: T p C,Q Number of r .ngs used: _ Tank manhole cover elevation: Tank Inlet ':levation: Tank Outlet Elevation: ,O , � � feet Number of ffi:et from nearest Road: Front,©Side O Rear From .iearest property line Front,O Side,0 Rear,a feet Number of feet from: well �d building: (Include this information of (he gbove plot plan) ( 2 reference dimensions to septic tank) ' SEE REVERSE SIDE "qq4 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& DI LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.d.BOX 7969 BUREAU OF PL UMBI MADISON WI 53707 Ip� NW4,SW&�,S7, T28N—R19W UCONVENTIONAL ❑ALTERNATIVE StateP9n . I.D.D.Numbe Town of Troy, Lot 7 El Holding Tank ❑In-Ground Pressure ❑Mound CTY F NAME OF PERMIT HOLDER: RESS OF PERMIT HOLDER: INSPECTION DATE ADD : Mylan M. Brenk 7 Villard Court, St. Paul, MN 55116 -97 d- U BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT,ELEV.: Name of Plumber: MPIMPRSW No.: County: Sanitary Permit Number: Thomas A. Wang 3231 St. Croix 92485 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID ICAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: DYES ONO EYES ON BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM' FEET FROM LINE AIR INLET DYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMPMODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ONO ❑YES ONO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING.IVENTTOFRE5H GALLONS PER CYCLE: LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I LENGTH: D 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: BED/TRENCH WIDTHI j LE GTH: NO.OF IDISTR. PIPE SPACING COVER JINSIDE CIA #PITS LIQUID S TRNCHES. MATERIAL: PIT DEPTH. DIMENSIONS i I GRAVEL DEPTH FILL DEPTH UISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER. ELEV.INLET ELEV.END: PIPES. FEET FROM LINE. AIR INLET. NEAREST-----p- 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 OIL COVER TE%TUBE PERMANENT MARKERS OBSERVATION WELLS El YES NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER: EDGES. —]YES ❑NO 1:1 YES ONO DYES El 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 UISTHIBUT ION 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 ❑YES 0 N 1:1 YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE �. DYES 1:1 NO E]YES El NO NEAREST Sketch System on \� . Retain in county file for audit. Reverse Side. g 6�v\,1 SIGNATURE: TITLE Zoning Administrator DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county'prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owners 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; 111. 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% 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 ove( 2 years of steady negotiation and public debate. The groundwater bill Groundyv ,tef included the creation of surcharges (fees) for a number of regulated practices which INiscorigtn` can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that burEedreasur @' is used in your building is returned tr, the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. \ Tile ononies �;ollecteo througi; these ,�jrcharges are credited to the groundwater fund admini>- o ie:re6 by the De =rtment of Natural R,,sources Th es e funds are used for rnon;t r !rg g°au° J o contamination Ino Stiiat in nS and eStabllch mF't G?i' sta ndards. _r e,_ '� ;its`..: f ?, D F;398 031�irl SANITARY PERMIT APPLICATION COUNTY (�I DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# a —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER $'/z x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES © NO PROPEPITY O NER PROPERTY LOCATION )w 2 h 6rcnk 'A/A I %a /� '/a, S 7 T ; , N, R Ig E (or W PROPERTY NER'S MAILING ADDRESS LOT UMBER BLOCK NUMBER SUBDIVISION NAME CITY,S ATE ZIP CODTTPHONE NUMBER CITY LAKE OR LANDMARK 'T El� VILLAGE: v 11. TYPE OF BUILDING OR USE SERVED: 7 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. tKNew 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. 56conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.X Seepage Bed b. ❑See a e Trench c. ❑Seepage Pit 1 3� 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): /d l� aD y�'" ,: ® Feet Private ❑Joint F-1 Public VI. TANK CAPACITY Site in allons 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 o Lift Pump Tank/Siphon Chamber ❑ Li ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plum Per's,Name(Print): PI s Signature:(No tamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,S a ,Zip Code): Na Designer /v(Sq C ) � e iib, is T v (�9✓y Vllll. SOIL TEST INFORMATION Certified 5oil Tester(CST) ame CST# A0 k14 —1 n J_7 CST's ADDR SS(Str t,Ci y, late,Zip C Phone Number: IX. COUNr NT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S charge Fee Adverse Determination /W.�a X. COMMENTS/REASONS FOR DISAPPROVAL: i SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber ,. t 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 Aj4zi2 yJ�1 Location of Property /Mj 1% W h:, Section ?-2f31J9 , T N-R W Townships Hailing Address tuNaL lILe Address of Site _ Z/bzA_ r 55za�� ,l LAS Chi ,�­;' /0 7 1161 Subdivision Name AbAle_ . Lot Number Previous Owner of Property or oelln S� e44jj/_ Total Site of Parcel Z 1717 Asks. Date Parcel Was Created Wall-e Z 1Q'j✓� Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume - C7 and Page Number 1�7 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 (toe) ceAti.6y that aQt statements on .th,ia orun ane ticue to the best o6 my (oua, knowledge; that I (we) am (cute) -the owneA(b� o6 the pnopee ty de,6C i.bed in .th. .in6o4ma.Lion 6onm, by vi&tue o6 a waAAanty dtved neconded in the 066.ice 06 .th County Reg.i 4teA o6 Dee&as Document No. bpd ; and that I (We) pne, own the phoposed bite bon the sewage dispos system- (oh I (we) have ob' ecu ement, to nun with the above de d ch i.bed p)topen ty, bon the constAuc ti ,system, and the eame hae b¢ duty neconded in the O65.ice o6 the Cov Veedb, a8 Vocument No. �,_Px, � SIGN Or OWNER SIGNATURE OF CO-OWNER A, DATE SIGNED DATE SIGNED Kc Mdbr Compaq DOCUMENT NO. A �r STATE BAR OF WISCONSIN—FORM I „ BOOK I64,eAsE15 t. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA R � , 4206''73 ' THIS DEED, made between Deno J. Wedes and Caryl H. Wedes, WHIM husband and wife respectively ST. CCROIX 00., WNW Recd. for Record dais 26th , . Grantor Cf Dec �a IQ 86 p' and 1 :50 P fA == joint tenants N Wi t n e s s e t h, That the said Grantor, for a valuable consideration Grantee, j RETURN TO conveys to Grantee the following described real estate in St. Croix i County State of Wisconsin: parcel of land located in the Northwest Quarter of the dSouthwest Quarter of Section 7, Township 28 North, Range 19 West, and in Government Lot 1 of Section 12, Township 28 No Range 20 West, Town of Troy, described as follows: Lot 7 as Tax Key No. awn on the Certified Survey Map recorded in the office of the Register of Deeds for St. roix County, Wisconsin, on June 23, 1975 in Volume 1, page 148, document 327702. ALSO a non-exclusive easement to use the roadway easements described inthe affidavit of John F. Alden, recorded August 27, 1976 in the office of the Register of Deeds for St. Croix County, Wisconsin, in Volume 542, page 57, document 335092, as access roadways and for the installation of utilities serving the above described land. a nm.-exclusive easement permitting the grantees, members of their family and house j sts to use the private park described in the above affidavit, This easement does not clude the right to cut trees or brush or erect any dock or structure or to otherwise ify the surface of the park. AvANStrImmin- This is not homestead property. �' �• 0 (is) (is not) FEE "s�`.Together with all and singular the hereditaments and appurtenances thereunto belonging; And anants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, restrictions and reservations of record, if any +iAd will warrant and defend the same. �tbt day of December , 19 . �jY•x"a a (SEAL) "e "' (SEAL) * Deno J. Wedes (SEAL) (SEAL) Caryl H. Wedes { AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this._ aay of STATE OF 1IMMUM MINNES= • 19 RAMSEY as. County. Personally came before me, this �� day of { * December, 1986 the above named TITLE: MEMBER STATE BAR OF WISCONSIN A i—mo J. (If not, authorized by §706.06, Wis. Slats.) V. bt gwe s- This instrument was drafted by 40Na ky/`E CIIA(S to me known to be the perso S who executed the fore- . SSS- PE,9f/E:y going i r tnent end no edged the 1' AU.14iIPW saQ7,_ (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public1AWiVeW/ �dgjLV Wis. My Commission is permanent. (if not, state expiration date: *Names of persons signing in any capacity must be typed or printed below their signatures CHRIS H. BERNDT all�a, NOTARY PUBLIC•MINNESOTA 1FP N COUNTY WARRANTY DEED- STATS g,LR OF *-SCONSIN FORM NO. 1-1979 z y • a ST C - 105 r a SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a y OWNER/BUYER ROUTE/BOX NUMBER ' �f��i �r� G'T Fire Number CITY/STATE�'j ,�.a�� /�/r _`I. I P 67S-"/ -7 /9 PROPERTY LOCATION : *P'l k4, _S'Al 4, Section T_ N , R W, Town of 7J3Q St . Croix County , Subdivision Lot number .,7 Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , ! if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix . County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- ro 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 715-796-22351 or 715-425-8363 Sign , date and return to above address . 1 s INSTRUCTIONS FOR COMPLETING FORM 115 - SI C? - 6395 To be a complete and accurate soil test,your report mr€st include: 1. Complete legal description; 2, The use section must clearly indicate whether this is a residence or commercial project; 1 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; & PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. INTAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may Eat; used it desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 5. Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; W. If'the information (such as flood plain,elevation)does riot apply, place N.A. in the appropriate box; 11, Siv the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 MAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED OIL TESTERS Sail Separates and Tevtures Other Symbols st - Slone (oven 10") BR - Bedrock cosy Cobble Q- 10") SS Sandstone gr - Gravel (under 3") LS — Lirnestone S - Sand HGkN - High Gror.rr;riwalei r C oxarE,e Sarr<.f f li�rc P=,rcolation Rate ryw,'i s Mcdi€,arn Sand PJ - 'Ve11 Fine Bri gs f fdq __ Builclhig ._._ L..jamy, Sara(! __ Grkrater Than I _. Say d"l Loran Less Than Bro — B-wvn l I (a<eni BI [31zck £i _' OC3;i Loani 'af Yl`I1C7L", di — &v..€d G la,!, Lnarn R ..-_.. fled a c - Silt,J Clay Lraarr naot: Motti(s s=.'. S Ely May S.F - tb•ttI c - y t r tr:;n tai Pc'O ;rarer - !vl any, rrwd;wn rr - 1uc.l: cf _,. cii,tiract I-1VJI_. — High vvatt r level, Six c,(>vi p �i ;' textures surface tvate'r Etf ord' ?str;disposal BM - Be ac1r Il lark k,,'RP _.. Vertical Reference= Pol' at TO THE OWNER: This sail test report is the first step in securing a sanitary permit. The county or tire Department may request Vol ification of this soil test in the field prior to permit issuance. A complete set of plans for the private wage system and a permit application must be submittOrl to The rappropriwe Focal authority in order to imam a pCrrnit. The sania°ary permit muss be obtained and posted prior to the start of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTR-Y, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (H63.09(1) &Chapter 145.045) LOCATION: SECTION: TOWNSH UNICIPALITY: [OY.:IBLK.NO.: SUBDIVISION NAME: COUNTY: O E YE 'S NAME MA LING ADDRESS: _ S 1. 'SI USE DATES OBSERVATIONS MADE NO.BEDR : COMMERCIAL DESCR PTION: PROFIL D SCRIP S: O A I N E TS: ��Residence � ®New ❑Replace. � 3 � 3 n RATING:S=Site suitable for system U=Site unsuitable for system O Ms ENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDE SYS EM:(optional) ❑U E s ❑U S DU ®S DU ❑S CCU coo, �Pa� 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: (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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- f ,• ,Sa }�Dt� /.CCU � ��I'i �,ao �6r �rec�s� do 5��� <, B- �,00 /00.60 0 ;1' ��� lsi 1 `�SD,B ntec�sl 3.YsI12 3P';r,_ B- t © ,do eml?/5't' d•�o �� Al1 B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD PERIOD 3 PER INCH P_ . Q 112 I P- V. 00 / a P- ,D P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION lb, C, S ems' �� P 1. �� e .� _ _ _ � ! _ _ ' • i E _ I = _ , tt , 1 i I � 1 , 3 1 I 1 _J, 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 Wis' Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(prin TESTS WER CO PLETED ON: Dq� 30 / ADDRESS: i /� CERTIFI 10 NUM ER: PHO 1,0021 tJ s. 6 5� CST S G URE: y DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — Ilk- I � •r v 1 L - _.. _._ _.. __ __ __.. _ _ __ __ _.. _ _ - a rk e6 t )P/T6 g�4 min _ ert P v� fill Sei ae s 10 e.om l LH k 8301 b - �o�asp� re4 b � foo, _ Sao C a a + i ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) = 425-8363 (RIVER FALLS) - HAMMOND, WI 54015 April 20, 1987 Thomas A. Wang 1009 West Maple River Falls, WI 54002 RE: MYLON M. BRENK SEPTIC SYSTEM Dear Tom: This is to inform you that you need to meet the 100 feet setback from the bluffline before you start the system. As the system is now, it is only 40 feet from the bluffline. If you should have any questions regarding this matter, please do not hesitate to call me. Sincerely, Thomas C. Nelson Zoning Administrator TCN:rmc x i