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HomeMy WebLinkAbout040-1115-60-000 r v o I I ~ I � I °o N I � I N m I ti I y I C\ I y I C z IL C o I C 3 E C M � � I °' O z € Z $m y °° a m M H Z c O I O Z C a0i Z m ►- � �' E v `"1 a� 0 C aai N a) C U ° z m z N � I z W I N y C C 'I O t6 N N CL CC r ayi C C a ° v N f a1 E LL a 5 0 o I a`1 0 0 z a Iv I rn rn aa'i O ° N } N O Ln N 0 0 = E O (7 m c d N �_ Q M d Q Z fn CC C, � a u1 0 ' °o U 0 y c ° o ao 0 O C L C 0 N a - - I V C 30 N C N v 7 N N �. � a �- H `) 'D Z C y co v in I ~ • O M d O •R U IL 0 s 01 O Z y Z I U) • 'ea o a1 d a c rr`i�v o R 3 o �1 A C) d2 ', 0 U) 0 PUMP CHAMBER ' Manufacturer: Liquid Capacity: ? Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom o ank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from ne •est property line: Front, OSide, O Rear,© Ft. ^ umber of feet from well: Number of feet from building: Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: u Trench: Width: /0 Length:: 7 Number of Lines: 'Z Area Built: Fill depth to top of pipe: W.cl 7— • Number of feet from nearest property line: Front, O Side, O Rear,01ft .��` Number of feet from well: 70 +� Number of feet from building: �� r (Include distance.,g. on plot plan). SEEPAGE PIT Size: ,,., Number of pits: Dia r: ' Liquid depth: Bottom of se ge pit elevation: Area Built: Has either a dr o box distribution box O been used on any of the above soil absorbtion s,�tL&AS? eck one). `. "OLDING T Manufacturer: acity: Number of rings used: evation of bottom of tank: Elevation of inlet: Number of feet nearest property line: Front, O Side, O Rear, OFt.�_ 0 Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: /Z` C� ./ .��C ✓�" License Number: 3 30 7 dOMESITE SEPTIC PLUMBING CO. RT.3 O'NEIL RD.,NUBSON,MS.$Wig ROBERT ULBRbiT 3/84:mj 11%*"TER PLUMBER UC.N0.3307 M.P.0 'qh MSTALLER&DESIGNER LIC.NO.000 HOME5ITE SEPTIC PUIMBIMG Co. RT.': 0'14€IL RD.,HUDSON,MS.54014 Form - S T C - 104 ROBERT ULBRICHT ••ylS.#*STc LUMBER LIC.140.3307 M.P.R.S. dm jk$,A,LER&DESIGNER LIC.NO.OO6fi3 AS BUILT SANITARY SYSTEM REPORT �7 / � SEC. 3t9 T'� N-R � W OWNER 9W firCA 1�'r" TOWNSHIP �� ------- ADDRESS 'PJ .3 S(6"oaT '"' ST. CROIX COUNTY, WISCONSIN ICE i or- SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 4► SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM £'x i sr,.u(T Z41--W. PV'''C Pe0 • 3oFLL 13/jfFt�s /a+7�}C�', UeR r i2eF- Fr- foK eat SEPT'iG T��1� i S E i La U wFiQ . We# viref fcR s,J ttt^'► �Df a 6- V s fIw(s�OO,U �/ Ev.P i 70 0 fro,✓ fro k-'ef,,,p E�STfi1`��0, f ;�GAIE 0 x by , 73e0 w i-I'G• Ce ' R r,ck a1.«.Q¢t 8 ��• y 242-f Pepe- r T aA R P4 PrQ 6leVAf007- INDICATE NORTH ARROW N,GO. TO p 0 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: tF;(,•s,1A)lr- tioT ,e"wla SEPTIC TANK: Manufacturer: Liquid Capacity: /000 o- Numb r of rings used: / Tank manhole cover elevation: �,9ssv�Eo ) �}!/ p ( tiEw covE PUr OA.' Tank Inlet Elevation: ` a a Tank Outlet Elevation: cE•�TcX � q Number of feet from nearest Road: ) Front,©Side,O Rear, 0 / feet v)�s Ir- From nearest property line Front.0 Side,©Rear,0 2 feet C, .5 Number of feet from: well J , building: (Include this information of the above plot plan)( 2 reference dlmensions to septic tank) C&1' nF`jjrVCV QTnQ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P,O.BOX 7969 MAE?ISON Wi 53707 State Plan I.D.Number. NWT, SE!,a,S30,T28N—R19W Iq CONVENTIONAL El ALTERNATIVE IIf assigned) Town of Troy ❑Holding Tank ❑ In-Ground Pressure ❑Mound Glenmost NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Da 'e Fayerweather Route 3 Glenmont Road, River Falls, WI I �Ffr2Oj Dy ' g REF.PT.ELEV.: CST REF.PT.ELEV. BENC 4 MARK(Permanent reference point)DESCRIBE IF IF/F�ERENT FROM PLAN: t k 4 U Sanitary Permit Number: e of Plumber MP/MPRSW No.. County obert Ul richt 3HSW St. Croix 96001 SEPTIC TANK/HOLDING TANK: MANUFACTURER /� _ 1 f LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: F ARNID DLABEL PROVIDED OVER L� ` �, l�t��l,%��N��',? t'A,1 i© `� YES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MAT L,-. HIGH WATER NUMBER Of ROAD: PROPERTY WELL: BUILDING:IAER INLOET RESH _ ALARM- FEET FROM LINE: DYES O l.� ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. ROVIIDE[D. PROVIDED,OVER ❑YES ❑NO ❑YES ❑NO ❑YES ONO PUMP AND CONTROLS OPERATIONAL: 111UMBER OF PROPERTY WELL. BUILDING: A R INLET RESH GALLONS PER CYCLE: FEET FROM LINE (DIFFERENCE BETWEEN OYES ❑NO NEAREST PUMP ON AND OFF) LENGTH. DI AMETER. MATERIAL ANDMARKING SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I FORGE or excavation. (If soil can be rolled into a wire,construction shall cease until NFAI(�t the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE DIA: #PITS LIQUID WIDTH LENGTH. NO.OF DISTR.,PIPE SPACING. COVER DEPTH: I TR ENCH ES. _� MATERIAL' �!#'f" PROPERTY WELL BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR PIPE DISTR.PIPE MATERIAL: NO.DISTR NO BER',OF LINE' AIR INLET. BELO PIPES COVER. ELEV INLET.ELEy NDp -Al C� PIPES FEET FROM �� lJ "G� � l NEAREST 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. OYES ❑NO P ERMANENT MARKERS OBSERVATION WELLS SOIL COVER TEXTURE DY E S ONO ❑YES ONO DEPTH OVER TRENCHBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EDGES: DYES ❑NO ❑YES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER: R WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIP F. TRENCHES: -::MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. D'$ATR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. y� �L ELEV.: ELEV.: DIA.. ELEV.. PIPES: tl.11<VII��N COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED 111 R +�4.#I'� HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. PLANS. ❑YES ❑NO DYES El NO NER` �RfOEPERTV WELL: BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: R DYES ❑NO OYES El NO NEA i '. bit IV ) oft Sketch System on etain in county file for audit. Reverse Side. 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 bye 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; v 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 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'/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. GROUNDWATER-SURCHARGE on May 4, 1984, 1983, Wisconsin Act 410 was signed into IaWKThis legislation is more commonly known as the groundwater protection law.This clii9nge in`statutes was the result.of over 2 years of steady negotiation and pi►blic.debate.Thd groundwater bill GroundAter-- included the creation of surcharges (fees) for a number of regulated practices which Wisco [nt5 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried #'E'c'sure 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) ILHR SANITARY PERMIT APPLICATION COUNTY l -x In accord with ILHR 83.05,Wis.Adm. Code C '"°" STAT ANITARY PERMIT# –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 NO PROPERTY OWNER p� PROPERTY LOCATION /4y ft`wJFi4'� �'/ar%a' S30 TLS, N, R 147 E (o W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME r4TY,STATE F A t`� /_.,• ZIPCuOl PHO��U ���� VILLAGE: T�O �I R&N MD�O NDMARK 1.5iLTOWN OF: 11. TYPE OF BUILDING OR USE SERVED: - Q Q-Ill(--4O—O Q Number of Bedrooms if 1 or 2 Family OR d Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.,L Replacement c. ❑ Replacement of d. El Reconnection of e.El 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 e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) /6 f J 2 e D e 1. a. See a e Bed b. ❑Seepage Trench c. 1:1 See a e Pit 1� !/ 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: 1Minutes per inch): �UIRED(Square Feet): PROPOSED(Square Feet): & O(� Z (p Z0 d Feet Arivate ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. anuac N INFORMATION New xisting Gallons Tanks Concrete stCon- glass App.T- Kfj 604 Tanks Tanks Septic Tank or Holding Tank [�� N O ­f5, 0 1 0 _H_ 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) MP/MPRSW No.: Business Phone Number: `F2o Bar ?,1�/sti64 3 34 7 Plumber's Address(Street,City,State,Zip Code): Name of Designer: O/•J�EI L U 1750-J VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name HOMESITE SEPTIC PLUMBfMG CO. CST# Z 740 D Z_ RT. 3 O'NEIL RD.,HUDSON.MS.5WIS CST's ADDRESS(Street,City,State,Zip Code) WIS STER PLUMBER LIC.NO.3307 M.PIM Phon��ber 0/— ^ / X. COUNTY/DEPARTMENT USE ONLY 1 ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial ;+� rc�har�g+e Fee / f r Adverse Determination `W. c)0 tai. . (?'/( �IV . 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 r.. ' APPLICATION FOR SANITARY PERMIT STC - 100 This application fords 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. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Oomer of Property 3o IF-- /:,:4 Y�6k ew if,-el Location of P e r t y NU) ' 5,dl� 1%, Section 34 , T jV N-R �L W Tow4iship } l�taifing Address /1-r- 3 U' p�JT Geis. sya �- � • ,Address of .Site t,4 1 Ad Subdivision Kate t Number r ' Previous Oener.of Property AY11 14 Ga/V/,Sow r Total Size of :parcel 'Date'Parcel was'.,Created Are all corners and lot lines identifiable? K_ Yes No F Is this prope iy being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. yr 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. 4, .. .: y - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eenti6y that att .6tatement6 on this 6anm ane true to the but o6 my (out) know.tedge; that 1 (we) am (ate) the owner(.a) o6 the pna peaty deb cAibed in thin .injonmati,on 6onm, by vi tue. o6 a wamanty deed %carded in the 066ice ob the County Regi6teA o6 Ueeda ae Document No. (). 2, and that I (We) pne�sen ty awn the pnapoaed •6.ite bon the sewage wpa��y,6tefn• (on 1 (we) have obtained an eabement, to tun w.cth the above de cAbed pnopenty, bon the eonbtnucti,on o6 said e ¢m, and fine .6ame has been duty kecaded in the 0 ice a the Count Re izten o6 Na y tS� 6 y 9 V¢¢:db, dA Document Na. ) . $1dNATURE or R SIGNATURE OF CO- ER PLICABLE) 4� r'' DATN SIGNED DATE SI " A�:` t n, 4 x .R{.�RtlI{Y�7..aI.1...�a�.�.A��.�K�...�IM1I..��.M.�•�..�.!•�•�•�'��.�• . �` j��� �,#• ». � ... ... ..................•.. .....:..........:............... .. s warrants to e... •. d ...� convey, .. ........Kelly..F.ay-er'weather-, hu#tba�►d. si�d•.KS�is.. as..JA1nt...te4=tS,.................................. ' ' . .... .....-•.............................. —1.1..... ......... .. .. ................ ... .._ ..... .. ................................ .. .......... ...................................... ... .� r� ¢ ... .. ..... ...... JI :. - ..... .... 9�Crt the following described real estate in .. .....Cep, state of Wisconsin: The West 168 feet of the East 840 feet of the- Nft' � `R y of the SW% of Section 30, 'Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. 3� a _ e a moo.oo � A. .;, I � - This is ._. .. homestead property "' '> s. (is) (is not) € Exception to warranties: none., sixteenth Octobe _ t Dated this ... ._.... ......_..... day of ........._ ...... . .. _,..... ` .......(SEAL) Carri E ' --.Da ...C... .. . . ... (SEAL) - '�°`'If .. _..fi�/ • it " .. _ .... .. . • . .---. . ... '.. oseann Carrison ........ . v x r AUIRM tTICATIQIt AC=M01FL1>IRO/[l 3ignaLure(s) Dahn C. Carrison_ and ....... STATE OF WISCONSIN Roseann Carrison u ................................................. j ----..----•-•-----•- 16 Oe t o e r ___.._. 19Y5.. Personally came before me LID. ' authenticated this --.-. .day ot...... _ •,�?•••••- :' _. .� �.. .' ' ±• �`.•:`�:. ... ........................................... 19 tMe 'Y i' Kristina Ogland Lund en _ ......................... TITLE: MEMBER STATE BAR OF ISCONSIN -. ...................................... _._..._.. ...-•••_--•........ ....... . ..w.. ,jam (If not.•--------------------------- .. authorised by 1706.06.Wis. Stag.) to me known to be the peesog ._.... foregoing instrument and aWcowle r W ` THIS INSTRUMENT WAS DRAFTED 51' ......Kr-istina...Ogland... und .ern.................. . Attorney, at: Law .............................. ,sue - � � �a ,.,3�• .. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County = OWNER/BUYER / h- ROUTE/BOX NUMBER Fire Number CITY/STATE W 5, �y� V�ZIp PROPERTY LOCATION : ��' , 1L, Section v , T 'd N, R�W, *' 1 Town of I 0 , St . Croix County, Subdivision Lot. number _,. i 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 pdt 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, j 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-pite 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. o ic I/WE, the undersigned- have read the above requirements and' agree to maintain the private sewage disposal system in accordance with N the standards set forth, herein, as set by the Wisconsin Depart- b went of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning Offl,pe w thin 30 days of the three year expiration date. A:;SIGNED DATE lk St . Croix County Zoning Office P.O. Box 98. xr Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 'p1 4P s n4 G— Sys re-4i A100e"s Try Be- iw <4fjrva411y _i;ty v e rr&Z;, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY:, DIVISION LABOR RE PERCOLATION TESTS 115 SEA P.O. BOX 7969 HUMAN RELATIONS 3dx'r- MADISON,WI 53707 (1.163.0911)&Chapter 145.045) 41- �. LOCA ION: SECTION: 4TO WNS IP/ Y: OT NO.:BLK NO.: SUBDIVISION NAME: ; 1/ �/ 30 /TL? Wile E ?;nV1 COUNTY: WNER'S R'S NAME: MAILING ADDRESS: sT Ck1o1)( TAla 3 VE// 69 EkW> 4 1T•3 GjkAjp4"-r �O. ` iuCk- Fitl(s LUis . USE 1S" 7 3 f` WC DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: r� S: STS: Residence 4, d , ❑New 16Replace R 3 — ? 7 mow V 4 RATING:S=Site suitable for system U=Site unsuitable for system �/ 'Sf rrF� BV��K�YlOT ONVENTI NAL: MOUND: IN-GROUNDPR�SSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) rMSou ©sou ©s ❑u os ou IHEIS Ku eau���,�l /0'x4eae-D 0 OIL T " S If Percolation Tests are NOT to DESIGN RATE: If any portion of the tested area is in the �i�--- under s.H63.09(5)(b),indicate: Cljjf,s S J� Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS W brCi�&+A-C Fr'- BORING TOTAL P H T GR UNDWATER•INCHES CHARACTER O SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH MI. ELEVATION OBSERVED E H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.1 B- I 8'0, /,Q Q O , i �, ' 8 I ' O R/W cov Gl s! ' IIN. "- S. s $1 Al 1'X . B-2, 9 S � 93./D � - > vs' -0 cI� , .�s ' a� rs�l . ►s �1 9R , P B. 3 f 0 9y, D - , s , 3K. 8.3. s i 1, /.0 s,' ./7 40. � r; DR. C00pir SL d G-IQ (, pOIQ• Ve-A CS 3 9 d tk sr , I. o , T,,� T,,,� Ear Zs �t T WET' ti tr f tiN E B- i Ll y sew D (&vw,� Z tsr- oR-4y. A4ofs PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. I PER INCH P- P- P_ ., P- r < +r P=-- n, utje PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 5111"44 rto 1A'1WJ// SYSTEM ELEVATION ��• • ° ,BAcl I ic�0 �111 .`-t- � �'s��i�j �� f _ __ __.I_._ /rTl$. �_ -_ _ _�'` fi o , ►�I _ El���� � .. r_vrrRr �`- . B�T'rq,�_�_. .� __9 � �_ . ..�_ _.�_. p�G y , (�jl-,- xt 1-700 I 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- f� HOMESHE SEPTIC PLUMI3ft Ca rl PF(a� �e I ` O 7 ADDRESS: L HUDSON,ft—Ho CERTIFI �jTION NUMBER: P ONE NU ER(optional): ROBERT ULBRICHT L�b I.- y CST SIGNATURE: iW INSTALLER&DESIGNER LIC.NO.0060 i DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHN•SBD-6395 (8.02/82) - OVER — dle/lOtll —%t> MO 04rP v E x I'S Tim f s��► /�'� ( '�r� ( 'zl /J I �d - ✓✓ c g E L&ec o a V•4- I �g -Foe c o R kcwt COOL- COrtP 11'Api ca,, 0P-4 All, O uJElt 1 VEtT• 1?c F ?T �.,� � I3otTowt Ea�R o of Si01N(r , p �w ,Q iv 0 f v + • Ss 1070 SCALE • i - 3 73 • `� 3 V i /0'x(023&D W j+L ua;foeP4 --- - G 1",wa^rr- Ruh tom- • vFresh Air Inlets And Observation Pipe i Qv O N *. - Approved Vent Cap k• Minimum 12 Above Final Grade Al y' 2 , 30 A40, 4" Cast Iron !�y Above Pipe Vent Pipe To Final Grade Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe T0 0 0 0 0 0 , " Aggregate O Perforated Pipe Below Beneath Pipe o Coupling Terminating .At �A `� 1 Bottom Of System gg' a ~ / S 1� VG I I la( 3 06/27/2006 11:20 AM Parcel #: 040-1115-60-000 PAGE 1 OF 1 Alt. Parcel M 30.28.19.473C 040-TOWN OF TROY Current X', )13a , ,I 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 GERALD W GUSTAFSON O-GUSTAFSON, GERALD W 306 GLENMONT RD RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *306 GLENMONT RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.090 Plat: N/A-NOT AVAILABLE SEC 30 T28N R19W 5.09 AC W 168 FT OF E Block/Condo Bldg: 840 FT OF NW SW EZ-UT-1508/431 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1198/492 WD 07/23/1997 724/105 07/23/1997 465/558 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.090 71,500 160,500 232,000 NO i Totals for 2006: General Property 5.090 71,500 160,500 232,000 Woodland 0.000 0 0 Totals for 2005: General Property 5.090 71,500 160,500 232,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 315 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00