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020-1156-50-000 (2)
c~ v,o' ~v, o ~ ~ ~ d o ; g o m f ~ ,' ~ 3 ~ ~ ~ ~ fD ~j' A ~ ~ K T ~ `G T ~ '6 ~ C ~ 3 `~° 3 ~ er _ ~ .. ~ 3s V • O 41 ~ ~ O ~ O - ~ ~ ~7 N < r O O W v ON r~ O ~ N ~ ~ " ~(D 7 ~ ~ CO N " CD ~. N N (D ~ ~ C m C!> m G7 ~ -1 c0 ~ O O W N ~ N Q ~ ~ N O ~ ~ ~ ~ ^S 7 6 ~ (p O -D ~ ~ N ~ (D ~ N O ~ C o ~ 3 0 3 o ~ ~ ~ o _~ ! N p ~° y y p ° `~" ~ ~ d C fD ~ Lf ~ (D ! m N ~ a ~ iv Z D `° °- ~ !~ Q7 ' `~ ~ _ C -' - ~ _ o - M .. N W O Q~ ~ O ~ O N Oo ~ ~ N ! ! ~ ~ ~ o m ° ° c C7 r' Vi ~ N J J . N o o O O ~ O ~ O 7 O ~ ! 'fl ~ ! O O ~ 0 0 0 ~ ~y! o ~ U~1 ~ N ° ', c0 fah N y o ~ m V ~ a 'o ~ v O °' 3 ~ ~ ~ ~ O O fD rn x G ! CD ~ ~ d 'yp N CD ". ' N 01 'O _ ~ ! ~ t ~ ~ d (Q ~ N .. _ Z W z z M Z I p D n ~ p D O ~~ 1 a @ ~ ~ ~. ~ °' ~ ~ 1 can ~ ~ v N ~ ~ ro N i N ~~ ' d C (Q (D N. ~ ~ ~ ' ~ N~ 7 CD n ~ a a m ~ _ ~ m ° O ~ ~ - ~ ~ -1 to n t ir ~ ~/' N C ~ ~ ~ p_ ~ D_ .p .. Z ~ O 3 W ~ W ~ m ~ ~ Q 1 ~ fl. ~ ~ ' Z 0 O _ • ~ N ~ N ~ I A ~ W W N A fD boo a .mom Q ~ C N ~ ~ N R C .~-. < N X N O C ~< O. Q~ n d W ~ T ~ ~ CD ~ T ~~~ 'o~ ° 4: C a a~ Z Q a - m m~ z m a ~ ~ ~ ff ~ _ m ~, Q j ~ a° ~.~o a3°o z ~~ m~°~ a 4 ~ i N O ~ ~ .Z1 O p w ~. N i < Q 0 N (D .~. ~ tD ~ C !p 7 N N ~ n .r, 7 ' N ? ~ O~ R C G _. A ~ '~ N o O f ~ ~ J ~ Q) ~ 1 V '11 N ~ OT 1 N ~ ~ ~ A O O ,° :~ m m x ~ y ~ o ~ o Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 j(m)]. Permit Holder's Name: City Village X Township Butler, Tom Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: J~ ~M TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic F-~L 2~, ~:-~~... 8~. Aeration ~~ ~ / Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic lam! ~ , ,~ Dosing ~ ~ 50 7 a~ zs' ~ ~5/ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Hea TD Ft Forcemain L th Di Dist. to well Still ORSnRPT10N SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 499224 0 State Plan ID No: Parcel Tax No: 020-1156-50-000 Section/Town/Range/Map No: 17.29.19.872 STATION BS HI FS ELEV. Benchmark 3 . ~(~ X03. tb ~cr~ Alt. BM a~f; 1~ I+~S /~~ 13~ Bldg. Sewer ~ ~, St/Ht Inlet ` ~ SUHt Outlet S•y$ ~,' (o~ F i ~ D,,~ s •~`3 9 7.3~ Header/Man. 7. -(p Dist. Pipe 7.G(p 9 Bot. System ~ • Z ~~ Final Grade 3• 99~`~~ St Cover ib~n` S o~..~. /. ~S l6l • 3 ~ Q ~t\ v~,X. 5 .c.o ~ 7. Sc~ ~I 1 ik~l~~, S • ~ 9 7. 5 (o BED/TRENCH DIMENSIONS Width i 3 Length ~ Z , s No. Of Trenches 3 Tl'e~nc.~ PIT DIMENSIONS ~_ No. Of Pits ~_ Inside Dia. ~_ Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer ~~/'~ .L.~f ~~/ r 1u.~ INFORMATION Type f System: ( ~O~v~l d / 3~ ~ z~ / 5~ ~ UNIT Model Number S~a n{STRIRI ITInN SYSTEM I _ lec.{--- %0-~ /0 ~f 111 =~._SL~ HeaderJManifolc~ ~~ ~ Distribution \ Pipe(s) ~ ~ \ x Hole Size ~ x Hole Spacing Vent to Air Intak ~ S ~-- Length Uia Length Dia pacing ,_ SnIL COVER v Procenra s~~rpm~ n.,w YY Mnund Or At-Grade Systems Onlv Depth Over "" ~~ / Depth Over u~ xx Depth of il ~ T xx Seeded/Sodded xx Mulched Bed/Trench Center y. 5 Bed/Trench Edges \ opso \Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 441 Green Mill Lane Hud on, WI`54016 (NE 1/4 SE 1/4 17 T29N R19W) Park View Estates III Lot 78 1.) Alt BM Description = QJ~ •~ J ~'~~- ~J2-C~ 2.) Bldg sewer length = t ~ - amount of cover = k t~ ^^~ Plan revision Required? Yes Use other side for additional information. Date S8D-6710 (R.3/97) Inspection #2: / /_ Parcel No: 17.29.19.872 6~ 3r.~ Cert. No. ____. ` Sakty and 13uildinas Division County 201 W. WadtittStott Ave., P.O. Box 7162 O m ~~~~,~ Mtlison, WI S370T - 7 t 62 Sanitary Permit Number (to be Ilad n by Co. (~) 266.3151 9 zZ De artment of Commerce Sanitary Permit Application sate Phn l.D. "stubs ,~ `~ Adm Code panatsl iaforrratlon `"_ ' Wb 21 In accord with Cantu E3 , . . , . may be used for seeondary purpaea Mvsey l.aw, 1 Project Address (if difliereat mailing addroaa) 1. Applieatian lnformatioa -Please Print All Informal G* Prot-aty_S)vmer's Name N l,ot N Blak N ~- OCT 2 9 200 ~ Property Owner's Mailing Address Property lion `~/ /'- r ST. CROtX COUNTY ~ ~~ ~-~- y'• ~~1., Section ~~ (J ^ f Zip Cade tote Ciry S Il. Type of BnildinE (ckeck all tfiat apply) ~~ CSM Nwnber ame ~ ~.1 a 2 Family Dwelling - Number of Bedrooms ~ Subdivision N ` - ' a ~ e j ~- r/ ~~ _ ^ PrdtlicACanmacial - Dacdbe Use , ^City ^Viilage ~7'ovmahip of ,~Iudson ^ Stattowned -Describe Use IIIh Type of Permfit: (Ckcek ally one box on line A. Centplete line B if applicable) d 20 - (/$~ - - dC0 Z. A' ^ New System ~#teplaarttatt System ^ Traunatt/Hotdiug Tank Replacement Only ^ Other Modification to ExiRing System • d. ^ Permh Rettewttl ^ Permit Revision ^ Change of ^ Permit Transfer to New ~~ ~'~s Perm umppr,~a Da O ~b~~Is Bd'ae Expintt~tt Plumber Owner 6s. IV. T of PO S Cbeck aU tkat • 1 x • SZ'~ Non -Pressurized in-titaund ^ Masd > 24 in. of suitable soil ^ Motttd < 24 M. of ~titabk soil ^ At-(irsde ^ Singk Pau Sand Filter ^ Cattsertteted WeWnd ^ Pressurized ln-0round ^ HoWktg Tank ^ Pat Rita ^ Aerobic Tratmatt Uttit ^ lati Filter ^ Media Rita Clamber ^ ik' I.irte ^ (iravd-ku Pi ^ Odter ') ~" `•"P V. seataaettt Ara Intot~a a. Pkwv (~ Datp- Soil tcation Rue(gpdsf) Dispersal Ares Requirod (at) Dispersal Ara Proposed (a0 System Elevation ~ VI. Tank info Capacity in Wilon: Total Clallona N ofU Manufacturer ^~ ~~~,~,.t.Q A-~/~ ~'C~ Prefab race Site Constructed Steel Fibs Olasa plastic New Taiu Exbtixa T~kt /Z~ yam,, ~ Qtis 'F't Scpic or Hotdinl{ Tank _ ~ ~ ®Q J ! n Aarobk TteMment Unit Dories (:kanrba VII. R bil Statement- >, the atttutsro for bastallatba of toe POW'I'S aMoara oa the attsehett Phmtba'a Name (Print) t MP/MPRS Number a 71.E ~~ - -~ Plumber's Addreu (Street, City, State, Zip C ) !~' J VIII. Conn / De rt of Use Onl Approved is t+wu~ Pertnit Fee (inc Groundwater Date Issued IssuinS ( Stamps) Surchuge Ea) ~ 6 '~~ Resat for Denid IX. Conditions ~ ~~ ,t n ~ / n SYSTEM OWNER; 3) ~Se~i>~ ¢JLbL l~ .Q~tQ.Qd( 1 Septic tank, e#t`luarit filt~F and ~ „~,pr~ Z dls ersal cell must all be serviced !maintained ~ ( - - --" - ~~~ tc /' X " " "" "' , 1 ~ V as per management plan provided by plumber. nn ~ 2. All setback requirements must be maintained ~-wS) ~ ~_ ~y,Q~~ - r~ tPtt.x~t1~. , as per applicable code/ordinances. Atbta IMIpItN'Yiti (M rae t+w4' ~') pr rae ayaam N pprer na rm awiw.us a ^ • aacwa ....rs ~, z) SBR-6398 (,R. 01/03) v ~ u~kl ~Si ~ ~ ' ~ ` /~' ~ uJ~ ncle rs. .~.i.:. _ .--.. ...._.__ _ ...-- - --- .l_~l. .~. ~ _..... __. __ ~lc~~-- ............._....._. ~~M_ L- ~ _.._.. / .__.-._ 3 -T~~-c~c ~x ~-~-.3~J S~~ lUC~~r~~~.~~s t~,~'1',~o„he`w, ____- * a31 /A-abv ~p~1 ~~ lea . ~ N ~,~~ 1 ~'bs ~e w~ i ,~~ ~~ ~ 3 e: a- 3 ~~.~.~,n-5 S~s~-fir.. aa~ ~Ult ~L~ ~i~~,,~ YRD ~O Olvti ~~~ ~oac(~t'Yt S'~b p~~ ~tpV ~ 1(yU, ~) ~ 'fie ~ ~~ 1,~. _~l ~I~v ~ ~~~, a~ ~~~~ ~~ c~~'~ ~s~ ~ o I O ~ . ~ ~~ ~~ PB 3 -T~N~~~ ~~ ~.~-SUS SSA !tic}~~~ia.~+ci ft~'1~,~~~, ~~ /A-~ bn ~plel ~- I~art '~,~ ~~1,~ } ~ , ~ ~~ 3 3 8' I 4- 3 ~~:,.~,~~ sys~e~, ao~ ~~11 ~,~~, V~h~~ JJ~D ~O plv- ~o~ ~~, mil, Tp CoH c (dt . b ~ ~+ ~(YC ~~ eV ~ ~ ~, 0 ~x,~~~ti~ 1~~05~~ Ian-seri ~"~~-k ,~ ~- ~ ~ '~e ~ ~~, Iv1pR,~. ~ ~ 0 SQ ~ c 'P ~-IpN ~b~ ~14v ~ I~~, a7 .> cl ~ r.s_ ,_ ~ c~~..~s... .. ---.. ...._._..._ ....- . __ / ~, - _ --- - __-- ~1X.~. l ~....... ... ~~ ~ a ~ r~, cr1' ~ R.~ ht ~~1 ~S~ O O ~ e-ii '~ .. A N m ,~ zoo9 5©#L EVALUATION R Wisconsin Department of Comn-erce Page 1 of 3 Division of 5afetY and Buildings ,,, ,.r,,.,,..,..,.~ ,..;.,, ~,,,„„, QG ~.r~ ~,,,„ ~,,,~ A.C.E. Soil ~ Site Evaluations ---- -- -- - - - - - ~ County Attach r~mpl~e site plan on paper not less than 8%: x 11 inches in size. Plan must St. Croix include, lxrt rat limited to: vertical and horizontal reference poird (6M), direction and Paroel I D percent slope, scale or dgnemsions, rmrtit snow, and to~ion and distance to nearest road. . . oaa-11513-50-000 PJease print aO infarma R - BX Date Personal information You I~i (P acy tzw, s. t5.b4 (i) (m)}, T ©G y . Z`j Property Owner Property Location Thomas M. & Marjorie E. utter Govt. Lot NE 1/4 SW 1114 S 17 T 29 N R 19 W Property Owner's Mailing A ss Lot # Block # Subd. Name or CSM# 441 Green Mitl Lane ~~~ 78 Park View Estates 3Rd Addition City States ip Phone J City J ~Ilage ~/f Town Nearest Road Hudson Hudson Green Mill 8r Wert Road -j New Construction Use: ~ Residential / Number of bedrooms __. _ _ _ 3 Code derived design flow rate 450 GPD t/ Replacement J ~ Public or commercial -Describe: Parent material Gladal Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.5 gpd loading rate. Existing dispersal mil elev. =96.20'. New dispersal cell elev. to be = 95.00'. ('`''~``} t 7 t Soring # --1 Boring 6 9 ? ~ ~ gt~ i n. ~,_,,,__,f ~ Pit Ground Surface elev. 9 .2 ft. pepth to limiting factor Soil Applicaton Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G *Eff#1 *Eff# 2 in. Muruell Qu, Sz. Cant. Color Gr. Sz. Sh. , t 0-9 10yr32l1 none I 2fsbk mvfr as 2f,1 me 0.6 0.8 2 9-32 10yr4/6 none Is Osg ml cw 2f,1 me 0.7 1.6 3 32-58 10yr4/6 none s Osg di gw 1vf,f `9,Q 4 58-1 t 9 10yr5/4 none trot s&I 0 sg dt - - 0.5 1.fl i SY•12 -t2 Load ng rate o horizons 3 4 reduced to reflect reduced pemteability associated with 1/4" -1" ban oft /6 is spaced at 4" - 8 intervals throughout horizon. _ Boring # _l Boring r ~J Pit Ground Surface elev. 98.23 ft. Depth to limiting factor > 114 in. Sod Application Rate Horzon Depth in, Dominara Color Mur>seH Redox Description Qu. Sz. Cont. Dolor Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'E t 1 3/6 10yr32/1 none 1 2fsbk mvfr as 2f,1 me 0.6 0.8 2 4-16 1 Oyr4/6 none Is Osg ml cw 2f,1 me 0.7 1.6 3 16-; 9 10yr4/6 none s Osg dl gw 1vf,f 0.7 1.6 4 59-114 10yr5/4 none trot s&l 0 sg dt - - 0.5 1.0 i - `{- Loading rate of horizon #4 u Ct Ced permeability associated with 1 r'13" -1" ands of 10yr3 IS spaced at 3" -1 " intervals throughout horizon. ~~ * Effluent #1 = BODS> 30 <_ 220 mg/L TSS >30 < 1 0 mg/L * E nt #2 =GODS < 30 mg/L and TSS <_30 mg1L CST Name (Please Print) Signatu CST Number James K. Thompson ~ 3602 Address A,C.E, 3oH & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceo t 54020 1!1!6!2006 715-248-7767 Property Owner Thomas M. & Marjorie E. Butler parcel ID # 020-1156-50-000 Page 2 of 3 a Boring # -~-~ Boring Pit Ground Surface elev. 98.44 fl. Depth to limiting factor > 110" in. ~ A~ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mansell Qu. S~. CoM. Color Gr. Sz. Sh. "Eff#1 *Eft#2 1 0-7 10yr32/1 none I 2fsbk mvfr as 2f,1mc 0.6 0.8 2 7-16 10yr4/6 none is Osg ml cw 2f,1 me Q.7 1.6 3 16-48 10yr4l6 none s Osg dl gw 1 vf,f 1.0 4 48-110 10yr5/4 none strat s&I 0 sg dl - - 0.5 1.0 Loading rate of horizons 3 & 4 reduced to reflect reduced permeability associated with 1/16" - 2" bands of 10yr3/ti Is spaced at 4" - 8"intervals throughout horizon. ^ Boring # --~ Boring ~ Pit Ground Surface elev. fl. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Cdgr Redox Description Texture Stn-cture Consistence Boundary Roots in. Murrsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 Boring # J Boring _f Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs in. Mansell Qu, Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R 01/00) A.C.E. Soq A~ Slte Evaluatbns T (,(~Gl~ 2oQ~ G' I'2 er1 V~l~ l~ /..~~ -T~e45 ~,Br'~ • ~/eda-Eion / 5ca/e~ / `-~f~0" '~ ,Qe,l,' ~o 09 7~ornas r'Yj, Q /JJurJ o~~'e E, ~cc. ~/c,- ~ ey~s~iy S~ c. i7, r. ~9~•~ ,P, i9.li.'•, Tom. rac.C• ~ o~ - ii.s~ -so'-coo 3~ ~ '~ ~ eG, ar o of ~cncrc ~e 4 2 er i E'Xj3~i'r!y ~// r--~---" 99.0 ~ • i~ a, /'C~,R.'a:n r - - _, ~~ w~~ ~ o ~„ Qr _, 9Q'e' ~~-- 97 ~~- --- ~, .,ems -~ - , ~ Xi;S~i n ~,, .'" 3 bc~~'oDm E,Kf:S-f;'n~I ct,~ cst/ C'or,c~~~c ~ /o~~l~ StP~.•e ~~-~0 6e 4~ '4PP~oX"/oca,~,yn a{' e Xi36~ ,t9X .3b d:s~O ersaQ~e //, f e - ces~ Z'n uer~ o.~ °ufJe~ ~(// •f 5 ys~gn eie~ ~ 9G.zo" = 97. ~ ,~. 8 ~o/~ as S.7"iY1a.. /w/e ~ E/e ~` : /oi 27 ~ a .~ ~ ~ 3~' l~ Tjo e~',2 "/o ~E Sit ~. E/e ~`, = / ..3 °~`'? POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner Permit # L! ~ 9 2 2 DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ~ NA Estimated flow (average) 3 (~ O al/da Design flow (peak-, (Estimated x 1.5) gal/day Soil Application Rate - allday/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean- 510" cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page _ (_ of Septic Tank Capacity ~ l) (~ ~ al ^ NA Septic Tank Manufacturer W e) ~~, ^ NA Effluent Filter Manufacturer ^ NA A Effluent Filter Model ~ - / O ~ ^ NA Pump Tank Capacity NA al Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model NA Pretreatment Unit NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA ~In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other. Other: ~ NA Other: -C7 NA Other: ^ NA ~~ ~~~ ~ ~~~I'11~VC IIY~71 rSVl.r I IlJ1V.7 Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface, The dispersal ceII1s1 shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the focal regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (y3- or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5i 2 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. 7o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls. to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance. with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: '~', A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptian system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank, may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time: ` ~ ~~ <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT: ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. - ADDITIONAL COMMENTS POWTS INSTALLER Name ~~ y„~ y yy~ Phone 1 /I^~~, ! ~ ~ ~ L "' V SEPTAGE SERVICING OPERATOR (PUMPER) Name ~, Phone ~ ~, S ~ U~ POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name l..Kp X p l.-) ~r ~ Phone ld I ~~~ ^ 3 a'b^ T l0 This document was drafted in compliance with chapter Comm 83.22(21(b-11-(d-&If) and 83.54(11, 12) & 131. Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIl' CERTIFICATION FORM ,-.... OwnerBuyer ~ ~ ~~ ~ ~ ~~ ~ ~ (,{ % L L%~"~.. Mailing Address ~ -1 ~ ~ ~~~ ~ (L C.- L/~" Property Address ~ ~ ~ ~,s ~ ~~~ /L'l l L ~-- [` ~~ (Verification required from Planning & Zoning Department for new construction.) City/State ~ ~S~ ~ P ~ ~ LEGAL DESCRIPT,I~ON Property Location ~ ~%• '/4 , .S W Parcel Identification Number pa Q ~ / ~ (, -,~~ -pqp ~Z Subdivision PA- ~- (L y j ~Lts Certified Survey Map # ~ ~ 3 Warranty Deed # `~f 3 ~ 7 7 e„ ~~vuse yes no T ~N R~W, Town of ~ U ~9~ ~l ~ I rJ /9-~b[~ ~I~ n1 ~ ~ s~-nrLo~~ a~ °'"~ `' •• ,.Volume _~_, Page # Z 8 ~ °~. •~ ,Volume O 1 ,Page # T gs Lot lines identifiable yes) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1J3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Depertment:of:Conunerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning~Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms -~ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08!05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic .tank presently serving the ~~%%y,~us ,~~,~-~~~ residence located at : ~'/,, _5 btf ~, Sec . ~, T~N, R~W, Town of ~-/~c~~c~iJ St . Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced ~~~' ,~ a~Ulp Did flow back occur from absorption system? Yes line. Approximate volume or length of tii Capacity: ~QU b Construction: Prefab Concrete '~/ Manufacturer (if known) : W~", Age of Tank (if known): ~$ (Sign ure ~,~ (Title) ~~ (Dat ) No~J ( i f ~ gallons Steel Other no, skip next minutes (Name) Please Print (License N tuber) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name ~_ ~IYI_ ~ct1_JY)s'zr?.5 ~~(` Signature MP/MPRS ~a, b Description of Parcel "A" Located in the NE1 /4 of the SW 1 /4 of Section I7, T29N, R 19W , Town of Hudson, St. Croix County, Wisconsin, being also part of Lot 78 of Park View Estates Third Addition described as follows: Beginning at the SE corner of Lot 78 of Park View Estates Third Addition; thence S89°15' 14"W (bearings referenced to the Plat of Park View Estates Third Addition) 25.00' along the south line of said Lot 78; thence NO°06'30"E 155.00' to the southerly right-of-way line of Green Mill Land; thence N89'15'I4"E 15.00' along said right-of-way line; thence SO°06'30"W 155.00' to the point of beginning, containing 2325 square feet (0.053 acres) more ox less, and being subject to ail easements, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify to the best of my professional knowledge, understanding and belief, that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance and the Town of Hudson, Subdi 'on Ordinance. -~ 9 r ~g ~te3-GONSr~ Harvey o son S-1899 ~} NAAI/EY Q ~ Rusch Surveying Inc. JOHNSON 407 Second Street 8~-1860 Hudson, Wisconsin 54016 ~ H W SpN ~i~i !~'~ str Rv ail VOLUME 7 P14GE 2019 ~~ ~~~ Q v i • 4~ r .~ ~. ~~ "; t '~ ~AiC N~"3. ~ ~'- ~ f?~'1`i sdt wtscoi~N Ppi>It f - f~ w.»..R,...lf~~~~x..__~..m~,n~~..y~e~r~n ............................................... w.r3s sed wsrrsmta m ....11lnm4:s..M.-.& r..and..Mar flrie..E.__._... .....~..hua~..~ ~,-.uu..uurxixQr . • - -------.. t1s fs~awias deeera'Ded real esGats h+ .............$~:...~r4~x._._....._....._ saa .t wi..e..i.: ~;,,N .3~~ ~. ewe sswee sesesplP wlt sssessssll ,~ R•~e~ ~~ Jas. 1a', 1 -- lo: ~s ~1owi ,~-~tiMw,E( a uaa•aa n. y ~~ ~+v. "`~""" 7O 1013 Edmund Ave. ~ St. Paul, !91 55104 ?.+c t:rat Ne:..._._ ....................._ 'lrrh: _---- i~ _ not--------_-- hoa,estead property. ~1 (~ ~) )bseeptie~ m warnsties: Existing highways, easements, rights of way and restrictions of record. Dew tt~ .....---°---•--- ..................... a.y of --------••---..,Ianuary--------....----•--•----•------------.., 11..88... ~~,~,,~~ ----_-_..._._.-....----• ......................_.._..........-----..(SEAL) -'~4GJ`'' '-~---~~,....- - --•------•--•--....---....(SY.AL) ~` .................:..... (SEAL) ~Uf Lot 78 Park View Estates,. Third Addition to the Town of Rudson •Z?!>il/?IO•?20l/ ?1PiZlE; 1~1Q STAT= litAS 01- Q-IfgCONBiN ss~iMee~~b 1 70A.0lr~wia Slats.)--------------------- TMs ~s~rwusasirr wws owwneo nr ~'•~ salhentkamd es aehaowtedsed. 13etb ----------------~•------•---._..._..-......-----••--............... (SEAL) STATS O! Q-ISCON3IN 1Persoasily caa;s before s~ this ._...l~.....dq ai -------- January..._--__-___•--._.., 19~---. the abeN named .._.~i-.~.._ki3.J.7.at.--a--aingle._perann ............... m sne known m be the person ._...-_--... wbe a;uaeutad tM torKufas imtrament snd rime.' F„ . , . . Notary Pnblie ._......... ~ s.- czo3T i.~i . qtk Yy Commis~sMa i. pern;anent. (1l; -C ., .. data . .....................4-~4........-•---- ~ -••,:-- .. ....) .4~ ... < 441136 CERT1 FI ED SURVEY MAP Located in the NE 1 /4 of the SW 1 y4 of Section 17, T29N, R 1qW , Town of Hudson, St. Croix County, Wisconsin, Being part of lot 78 of the plat s Park View Estates Third Addition. ~:' Surveyed for: Pat Zezza N~~~M~ 445 Green Mill Lane ~ ~?~ G ~ Hudson, Wisconsin ~~~y O S/~ 54016 ~~ ~2:.~ and ~ ~} HARYEY D. ~ ~ Thomas M. Bi*:ler ~'~' J~3HN30N ~ Green Mill Lane p °i S-7899 Hudson, Wi. 54016 ~~ ~~ N~ 2- I Q I ~ I ~ 66~ I ~ I !Y W r REEN - ~~~ ~ ~ _ MILL LANE N$9° 15 X14"E I S. 00 ' --r-- 1 LOT 78 f 44170 SO. FT . (EXCLUDING PARCEL°A° ) 1.014 AC. I ~s ~~ J so W O i t ~ O O F ~ b oW W M r` W y d' W W W3 W W l ~> N Y tl~ i t ~ O W IL mo LOT 79 ~__ SE corner of lot 78, 2" iron pipe found. BCAIE IN FEET ~ " e 100' O' 2S' S0' X00' 200' 300' LEGEND ~ Z" Round Iron Pipe Found • 1" Round Iron Pipe Found 0 1"X24" Round Iron Pipe Weighing 1.68 lbs per lin, ft. set. NOTE: This map is a sale of exchange of parcels of Land between owners of adjoining property and as such is not required to be approved by the Town Board and/or County. Refer to St. Croix County Zoning Ordinance Section 18.02(4)(b)(3). O ~ M W U ~ 4 ~ GAR. o HSE. z 15. oo' / S89° 15~l4"W -IE PARCEL A CONTAINS 2323 SO. FT. (.OS AC. 1 VOLUME 7 PAGE 209 This instrument drafted by: DWG 488-1479 C) O O w O ffi~ O ~ D. .~-e ~ Z ~ fD t fi ` N W C (D ~ (D O ~ N O- ~ O 3 N I O ~ ~ O ~ n ~ ~ D_ ~ cn -< D ~p ~ m ~ u, ~ -z ~ W ~ ,.' ~ Z O i Z o ~ -~ =^ N c 3 6 a ~' ~ m 0 C N ~ ~ Q ~ Z u' 0 v _O o' 3 m ~ ~ ~ I ~ w m ~ a 3 Z ~ 3 ~i o y n o' i I ~ o a ~~ a ~ ~ x o 1 W ~' 97 ~ ~ O Q N O _C "' I ~ ~ ~ C Q Q o v~ p g v c~ ~ ~ c m o v ~ c'' ~ ~ .. ', ~ ~ m 3 ,~ xc ~ ~ ~ v N O C N O ~ ~ O ~ ~ ~ N ',, = ~ N A 17 O N O 3 N ~ ~ O O f/1 d N C + (D fD N Q' ~ Q ~ N ~ N 7 fD w ~ ~ _ n r to O ' ~S C O ', •• 'U ~ ~ 0 0 0 ~ ~ N o ' ! ~ w f A /1 f ~ ': ~ ~ o v < ~ .0.. / H m ° ' m ~ m N m ~ m ~, N N 7 „ I (D ~ Z W Z D a 3 m m m ~° ~, v c m ~ p Z m c -~ I ~ ~: ~ a A .. 2 O ~ 3 W ~ a ~ o r. o •• 3 ~! z m w ~ C Q. m ~ " -' Z ~ ~ m ~ i p . Form - S T C - 104 f,u, '~ AS BUILT SANITARY SYSTEM REPORT OWNER ~.;/f~ ~J~,~l,~ TOWNSHIP ~ >Sfl`/ SEC.~~ Tp~N-R~~~ ADDRESS f~~2 ~~~oY''~~~L. ST. CROIX COUNTY, WISCONSIN ~~/ ~~ ~ -~yo /,~ SUBDIVISION ~r ~[ ~~cJ~S OT # ~ ~ LOT SIZE ~- `~'~~J ~~'~'1/ S ~, LAN VIEW ~` A z Distances and dimensions to meet requirements of I•I.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Cl ~ a /o ,D ~,~ '' .~ 1, - loo, o . ~~' P 35-x_ 3~ -~ sr - s-~' otis~ ~..~fc !Si o - - - - ~- 7 ~` 1j~ ~ ' 1 ~L N ~. 3s N2~ ~ Q I ~~~ 5n«~~ l6t ~~'na.. INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 2 ~/O~~p.~;~. S /i/~o,,~a,r Elevation of vertical reference point: 1Q~.0 ~ Proposed slope at site: 3 SEPTIC TANK: Manufacturer: ~~~~ y-' Liquid Capacity: /OC)Q c,+~ /, PUMP CHAMBER ~/~ Manufacturer: ~~i"' Li uid Ca acit q P Y Pump Model: Pump/Siphon Manufacturer: Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: 'r`! • ~ Pump Size. Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~If~,,~'f;~a..-f Trench: i Width: ~ f Len$fh: Number of Lines:,~_ Area Built:~y~~sq" Fill depth to top of pipe: ~{~ r~ Number of feet from nearest property line: Front, O Side, Rear,O Ft 3 ~ / i Number of feet from well: f Z Number of feet from building: SO ~ (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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: r I 4EPARTMENT •F INDUSTRY, INSPECTION REPORT FOR LABOR ~ HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS 1'.~. B!X 7969 MA®ISON, WI 53707 NEB, SEA, S17,T29N-R19W CONVENTIONAL ^ ALTERNATIVE Town of Hudson ^ Holding Tank ^ In-Ground Pressure ^ Mound 7 ,. ~- 74 ~.....t.~~~,. L'~..s-.. a.... TT7 SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING State Plan I.D. Number: (11 assigned) NAME OF PERMIT HOLDER: ~ ADDRESS OF PERMIT HOLDER: INSPEC710N DATE: ~ ~`~~a t3 ~~ Sam Miller R BENCH MARK IPermanem referen ce Pointl DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE V.. Name of plumber MP/MPRSW No.: County: Samlary Permit Number: MP5432 5t. Croix 102812 ..,r.,,",..... . MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL P OVIDED: LOCKING COVER PROVIDED. y S //~~ ~ 1.~/ YES ^NO ^YES NO BEDDING. VENT DIR.: VENT MATL. HIGH WATE ALARM NUMBER OF ROAD ~ 5 OPERTV LINE. WELL. .-y BUILDING ^ VENT OFRESH AIR INLET ~ FEET FROM ~~ ~ l/ ,//• ^YES ^NO ^YES ^NO NEAREST DOSING CHAMBER : MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL PROVIDED. LOCKING COVER PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CY CLE: PUMP AND CONTROLS OPERATION AL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH AIR INLET (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ^YES ^NO NEAREST Check the soil moistu SOIL ABSORPTION SYSTEM re at the depth of plowing LENCrH DIA MErER MAT ERIAL AND MAR Kwc . or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue,) MAIN v,--~•-••v,-^`V WIDTH' LENGTH. NO. OF DISTR. PIPE SPACING. COVER INSIUE DIA #PITS LIQUID BED/TRENCH Q, ~ TRENCHES. ( r MArLaI L: l PIT DEPTH DIMENSIONS U ~ ~ lG ~ G -J GRAVEL DEPTH FILL DEPTH UISTH. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PR PERTV O WELL BUILDING V NT TOF RE SH eE LOW PIPES,, / ABOV COVER. ELE V. INLE T ELEV. END ~ ^ ~ 'L PIPes FEET FROM ryN ~~ LI '7 / (~ ^ 1 G - ~ AI~F.T ( y Z ) 1/ } 55 ~ ~ S NEAREST -=~ S J / 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. ^YES ^NO SOIL COVER TEXTURE PERMANENT MARKERS. OBSENVATION WELLS ^YES ^NO ^YES ^NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LE NGTH. NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTH DISTR. PIP UISTHIBU TION PIPE MATERIAL & MAHKIN(~ ELEV.'. ELEV.. DI A. ELEV. PIPES DIA . ELEVATION AND DISTRIBUTION INFORMATION HOLE 512E HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL PLA NSCAL LIFT CORRESPONDS TO APPROVED ^YES ^NO ^YES ^NO COMMENTS: PERMANENT MgRKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL-. BUILDING FEET FROM uNE. ~r ~L ^YES ^NO ^YES ^NO p EAREST L`J ~ ~~ / ~.~' ~ o .R7 Sketch System on Ret ~ in county file for audit. Reverse Side. SIGNATURE. =- TI E. ,,~ Zoning Administrator DILHRSBD67101R.01/82) HR SANITARY PERMIT APPLICATION ~ ~I COUNTY~~v` t` ~ L Adm Code Wis 05 ith ILHR 83 I d l V . , . . -~~'~~ n accor w RMIT# ESANITAR YP E STAT ' ,r / ~ ~~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8'/z x 11 inches in size. -See reverse side for instructions for completing this application. PETITION ~ NO ^ N 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. YES FOR VARIA CE PROPERTY OWNER PROPERTY LOCATION ~~. vVl n1 ~ ~ a. / ~'/a SL~J'/o, S / 7 T oZ j, IV, R E (or PROPERTY OWNER'S MAILING ADDRESS o ~ Z ~Z LOT NUMdBER 7 O BLOCK NUMBER SUBDIVISION NAME .~/- ~W~ (~i ~s.cJ ~5~.~,1 ~c.3 CITY, STATE / c,c~l .SO ~/L ZIP CODE S~c'~/ S. PHONE NUMBER 7/S llllZ7~•' CITY ~ NEAREST ROAD, LAKE OR LANDMARK VILLAGE : u . ~ JON a c~~ 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family -3 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. ,~ 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) 1. a. ®See a e Bed b. ^ See a e Trench c. ^ See a e 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): ' ' q~ ~ Z bli ^ P ^ ~. 3 5 ~T ~o /~ f 8 CO S ~T / ~ Feet c Joint u Private VI. TANK CAPACITY in allons Total. # of ' N f t M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks ame urer s anu ac Concrete strutted glass App Tanks Tanks ' ^ Se tic Tank or Holdin Tank aid ~ ^ ^ ^ ^ Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumbfjr's Signature: (No St s) ~ ~~~ MP/MPRSW No.: ' ' '~ Business Phone Number: c~ a s S'r ~ '. .e'" Dt!/ : / j ) P S S Z... / S Z 7- 3 Z Plumber' Address (Street, City, State, Zip Code): /L rL ~ ~( /t/~ w /2,'c- h ,+~t o ~ ~ 4J L . Ss~~ / Name of Designer: .b o c.i /2 S ~ 1 " /` o h b ~a.t~ VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name ~~ vt K ~ S r, C~ir 'S~D ~ d/Sca CST # CST's ADDRESS/(Street, City, State, Z/ip(Code) / Phone Number: ~yy `Cj {~ IX. COUNTY/DEPARTMENT USE ONLY A roved pp ^ Disapproved ^ Owner Given Initial Sanitary Permit Fee ~~ Groundwater Su h rge Fee ~ ate ~ ~ ~~~ Issuing Agent Signature (No Stamps) /~ ~ ~ ~~ ~ ~ r ~ - l Adverse Determination X. COMMENTS/REASONS FOR DISppAPPRO~V~AL: - SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION ~f 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 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; 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 a//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 .Ground at8r included the creation of surcharges (fees) for a number of regulated practices which WisCO i'n's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea5uri3 is used in your building is returned to the groundwater through your soil absorption o d 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC-100 This application form ie 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. Amer of Property ~~- rj/ ~l~~~~er Location of~~~~P~~rop//e''rty -,/~~ -~C S ~__~, Section 1 ~ , T,~N-R~ TownehiP ~s__Q~_-- . Nailing Address _ ~ ~ ~ / ~ o ~ Z, ~ Z. ~~a arm a ~r ~ ~' -S' ~/o ~ L . Address of Site _ ~ fa c ~ /k i ~ ( I a, „~ ~ rFtid sar. w~~5 syo~~, . Subdivision Name __~av k ~i ~W ~ sTo_"~ a.3 ~ ~' .Lot Number ~ ~ ~ Previous Amer of Property ~a~J /'~.~ Vl.~c~-.~` Total Sise of Parcel ~ ~ ~- Q (01 /~ c d r g . Date Parcel vas Created S ~~/~$~ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? ~_ Yes _~ No Voluse S ~ 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 yage number, and the Seel 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 O(VNER CERtiFICATION i (tVel coJ~ti.6y .that a.f.C tiza.temen,t~s on .th,i~s bohrn cth.e -th.ue xo the be~s.t o6 my (oun) hnauCedge; .that i (we) am (wcel .tho_ n-.uHOh t~ ~[ tao nhnrinl.f~. .I...,...:r.,..J ... .-_ ~. i" J i i. I :~ r ti~ i .~. d .. ., ... ; .r ` ~:. .r.. _, t"~~~ •`' ~ ' , ~, { _ . ~ I . ~ $1JAY2TOwtS CLRT1nCJkTL.. ~• . . t~~'•':4'.: ^~'' I, 3aatttA t. Aoro~ Aajdsttrod Wtaa•arie Lsai 9urvyor. Dax•Dy erztily to ilia D•at e[ t+eiy paolo•atoowl lnort.dt•a aad•rwtaodatat aad bsla•!t TAae I hate rssvoy~!a diradal aad rbapywd Park Vtenv £wtstof :Poutth Additioe~. toaat.d ins t>.v Hal/{ tt tD• SW l!i and tb• Cl'M:'I14 0[ tl• 5T1/4 0l S•etloa' 17, ?29T1, K t9Yt, 7otra.ol Htadsoe. 9t. Croix Coaaty~ W4teee•in; That I leYa meta auclt surwya teed dlYiwtop aad plat by tDa dlsaaa~lon o/ Darsal E. 7rarCtaw! DtwrlY.A. Yfart. owtr• o! acid land, d•sulDad as toltwn: Go~aecaacieQ at,tDo I1/{ coraar el said S•eliee 11; tltret St9.2w~?t"W (usatr-od Daasie0tt ralotr+eeod'so tla ttweuw.atad 7G,AJ? :-E3T 1 /• Saploa Lwa at' ]•ctioa l7. l.rasla0 sasa+s•d St9'22Wt"1r) (saoo:d«t as 36y'21t40'^Jil o~ t-a! CartYl~d SyrTay 1da~ rrwriti to Yalree• 1~ A ti4), 1]72,9at alarat aald R.~S7.WtJ?' l/i 5+ctioa llwat . tkew i0'O6r30" tr.Z27.tJ~wtta• radat of +a•Aioaieti tDatta• NtyS2t40"A! 112.00+: thstrse.. . x0'Oi•so"SG:u.oo+ is tl. s•.sl.rly stilt-o/-wy tit-. o< C:«.111U Laat; tl•eca • 11S9s~240"M 64.OC~ alo.-t raid rl hi•ofw.ay lies: tAaae• SO'Obt30"1r Z31.4At; !h•ne• :i7Y2b+S2!'W 194.]St; tDaoco 989'~St14'"gl 276.T6t; tD•aa• Y7S'S7WS"'M /42.171; tl•m• _ S8y"1St14"7/ SSir~t:.thaec• lY0'O6'30"L I04.UOti tbaett 3ty'1S+I{'+t ~4.OWi tbtnea NOr!vt30"E 135.00 ;tttaaao 9t9'13t14"w 64,O1tt tlasNa SO'Oit30">r` 716.'3]+: tl-saar. ' ' 309'IStI{'!p' 131.00•i ebaaeo N0'37tS 1"X S{.1Dt; tAoeea ay'22'09'a'o l{!'..30t1 tl•oe• 30'ONIO"w 204.{A+: eb+aea N09'lYi4"I 150.00+; ttweaa 90'ON30"M•!1L 97'1 t~•ee• 4l09'lSs14"L~1S0.00!;•tlaaea 9oetl•a•t•.rly b6.23* wltn~ tl- ara.ot t- 3a3.00t rsdlu• csrw<oacsra Noat~•atrrljr rta••• chord lsar•34'SO$0"Y 6{t17~ithvs.:lt4'1St14"L L7.Olt1 tltaeco 3ontl.ast•s1y.136.S6t aloof tl• at~i el. 3i1.00s'radle• ev«. eoeeav Yosfl•aetarti~yrAo•relord boars 924 03t0ZnL.13K.Sit; tlraeo i36'23t30 «' li],14t; t/ataes 1t7!!'3S!40"S 160.96ti tDanea Nt!"iStl4"E24].ON; thtoct BtrOd'3!^'ir loe,00'; tbtwseo ~S]r36t30"7r. 239.1{'I tbteea 9outb•irta:ly 9L. t{t a1 t6o t-ra d r 2 17.00+ . stadlas;xw'vs.oaoeaYa NostL•iat•:1y.,rrti•.• ahord Doetia a7!'0 ~lb"S 93.iatl t`-aneo • 1it+!!I'itlk"L',~ 9ZO.OOti ttt•eeo !)ertlaeastarly 91.5 is cleat tAo es•P o! a ]00.11gt srdius ees+isone+iw HestMra.taty rsora elozd bear. KtOr32f40"ie.9p.5S~ tbaaart Nortts~ , w+•ttriT9I;4Sralont ilia asa el w 300.OOt redluo evrYt eebseYS NostA•satasl~r .tws• clord>aana• Vir37t2b'^A 91.09ri t4ease NO.04t34"l: ISO,OOt: theca TIt9.1Sw14 47t,01~y ttaant:o Ji0'06t30"3c t]4.S6t te. ttae poL+t of t»tiaolnt, , Tl+et ttwfa plc! 1o a twrtoat rap:r~.atatloa e/ aQ tAo e+ROrlet beatdesia• of eho heal e.trYaye4 eed t1-d sabdfYlnios th•saed made, -ad Tlaa I ha.o fatly oanyUrd +ith tlas provlwlow• of Cbwpt•r E36 of tD• M!t•eoe•la aratMsit~ t1t leDdlYttlee aaA Zoeltt Rexalsilttaa of 9t. Crela Cewty~ lSa : ewe ul - --_ _ llndaaa }Jaldirlwloa Osdlasoaa, aeri sbo Clay nl Hvd•oa laDJinia~ois cad 1-wtriy{ OTAI. eaaea~ !M awrr+7lM. tt~S and mepplnt ela •am•. taatad tiii..11;~ dry o[ tVlwxisl, ; 198-0 ~'Ca'7'(~ir- R v!•ad t 1 13tA d~a of_April, 1984. ~ 7 dZt atzeed atroat •' ~~ Hedeow, Mlecoeala S40t6 ; " ~ ~ cotletTT zlttsasvnlsR*9 e1exTlncnTl: '~~ aT~,is or aracaHx:I+) ~ AVR~~ ST. CAOiX COpHTY ) I. 111rsy,TwO Llwrmorat balat duly alaet•d, gwllli•d sad uain5 Ir~assur•r oI 3t. Csols Caoetya de M»by t»rtlly fiat thr r•aow+d• 1n my olAco •har m uerodeamad tas traits tod tas oupald taati•s ar spact•1 assossm•Mr as of ~~~ ~~' J! s!laetfet tlto iwtuls laalaad•d to tla Plwt of Park Ylw ICtrtat•• Itn+ril Addttan, f' p. f~ , ./ .. Dna linty T:•+surer . ZOMIOG CO>vf?.tI'lTlvlb AL6OLUTI~JN This pint to h•raby approY•d by th• 5t. Croft County Compr•lrnsiv Pwrks, i+lwwatot wad T.odnt Commttt.e, Cla~li"Ity l11 94, '~ Data - .. ._sfl~_.., Admiwlstrstor r .. .. . ~ .tE~1STflri nl~trs 1 r,~nK VIF'4~/ ESTATES FOURTH ~ ADDI~ON ~ ;~ r:t.;RAt SV'fx^,tV1SICN L.CC~IIED.IN THE ;tiE'+~-•S1tIWt~NW6h~S~Vii,ScCTICN I7, T29N., R19tN., 1 7G"rtlN : Cam. HtASC~V.. S7: CRGX CAUNTY, WISCa'11S1N _ _ `_~. ' ' 'p •~ - . .. ~ ~ ' yr.. .. Ct7tT27ICAT£ Ol TO'MTtTItLlSO>!ZR STAT3: OT ~-T3CGNSL`h ~.~:';;,,+..: •.• . I', ]f soosiy A. Jobrtioii~,. ~pea~ ttse duly alaelyd, gttalfllad'Ynd setlab ?trwo Tsaarusrs a! the Town of ittrdtaw, do itsreby certify that !n seaosdaaee : rda fa my oifia•, t3asa are no unpeld lasso or oyxlal araerrrgeatr ra of . ' . oa say land iaafaded is the Fiat of Park Vfaw Lstatar Fourth Add3rioa.~j • yta Brrerl "_~~ y . ..ohnro owa tatrarer i .TONY BOARD R:.SOLL'TION • HESOLi/ED, that the Plat o! park View, Crtater Z:ovsth Addition in the Town of f Hudron, f:arrel F., Vest and Barr A, tiYrst, n•xn•cr, la Itrseby approved by the 'fo•.r B rd• /' l ~ ,ate • pproved Dan scorn ~ I /' ` / ~ ~ y /Z C/ D ijned uwa l,,urrman ~ :~errbr eertliy that the for.,toiny it a copy o1 x reeulutlon adopted by the Town • Doasd of the Towr of tiudawt, Oat• ov-n Glerk • 1 O1M:IZASt CdRTiFfC,ATE OS' DEDIGA?!ON Ar owners, we hereby t;ettif- tkat we t:aured the t:nd deresibsd on thi: Plat to br auzv.y,l, 2:•jl3ed, :rapped and dedicated rr :Dore+.nted an thlr Plal.. W• elro certify tSat ::Jr Plat lr :egnlred by S, 236.10 or 3, 230, 12 to b• rubmltted to the fofluwtnR for :-ppwrsl or objection: Arpartrneot c( Dardopmaat ~ liepaztmrnt of Indurtry, Labos snd ttutnan Relatlo•tr, ~ Town of fludwn, C[qr of Hodwa and St. Croix Co•roty, I , Y.':Tv:SS the ha:u1 and real of raid owners thle _/- .t day of ,..,~!r~~ .. .~~ .-_ :----.- ~~-- ln~uence of: _ _. - .....__.. .I t /~ ~ ~~~~ V '1L7 riot • CTL ri t '-(/~'^ ftrverly A.,WJ~~,~~-• J, 1 STATE OF WISCONSIN) 5S ST, CROTX COUNTY ) - Yerronally cam: brio:: me thlr .' • "" day at _ // ,+ /_~ • ~ _.... the above ' namel Darsel l:, Mer! .+ad Beverly A, Wert, to me known to be the prrrcnr w5o exseutrd ' the forrRoinR instrument sad acknowledOrd the same, t Notary Publle rr' i,,,, . •~ ~"!, ~ 1Nieconain My eommlrrlon explrer~1 r l~lar~Rnrc/ h, ~fotr~ tbllc i ~~,- Cli"rtTIFTCATE Of' TOWN CLERK .STATC OF WISCONSIN) . •~. ST: CROIX COUNTY ) I. Afa :irrne, brlad tht duly appotnwd, qualified and scHn~ Town Clesk of the '?own o! :!c•dron, do hereby t:rr~~}f~!~y that copse of thle Plat wort toewardad ar required by .r• 2lb• 12 on thes~day of ~~, 1904, and that within the 20•Cay llrnlt rot Fy r. 23b, I2 (3) (no objrctl nr to the plat have boon (fled) (aU Dhjntann+ to •ha plat hays De.n met). .i Sl Y t? a~J rl'> Drtr slit Nosnr, own Clerk STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S~~ ~~' ~ ~y ROUTE/BOX NUMBER ~ ~~ / ~o~' ~ Z~ Z Fire Number CITY/STATE l~4dSo~t G~~~ ZIP $-~O ~~ PROPERTY LOCATION:~_~, 5 U~ ~, Section~~, T~~N, R / 9 W Town of /~cc ~~'O N ....}},... St . Croix County, Subdivision~Qdk yiCcO ~91~.~~J~ 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 tYie septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may. a maximum of 60% of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be eligible to replacement o July 1, 1978. of 1980, with to keep their receive a grant for f a failing system, St. Croix County the requirement that systems properly The property owner agrees to submit to St. Croix County Zoning a certifl.cation 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards seC forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 7.oning Office within 30 days of the three year expiration date. S I G N Ef1~~~?S YYY'/ ! !./'r ~ .~,iZr' DATE 1 ~ c~ ~ ~ `~ St. Croix County Zoning Office P . 0. Box 9E~ Hammond, WI 54015 715-796-2239 or 715-425-8363 H z H 9 r r a H H 0 z d 9 H H 0 E z x H b Sign, date and return to above address. DEPARTMENT OF INDUSTRY, LABOR AIVD HUMAN F3ELATIONS~ REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) fH63.09(1) & Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATIONS ~/ ~/ SECTION: / 7 /Ta9 a/R/ ~ 1) TOWNSHIP LOT NO.: ?d BLK. NO.: ~- S BDIVISION NAME: Tl~ k ' ~ w so ~ ad r . ir COUNTY: ~ OWNER'S BUYER'S NAME: MAILING ADDRESS: S"~O/~ ` ~~Q S /`~ i ~ d ~ d~ o .. r wT ~c/ s ~ I ICF Residence NO. BEDRMS.: 7 COMMERCIAL gESCRIPTION: ~ /j~ New ^Repl RATING: S= Site suitable for system U= Site uneuitahle for evstem ~r C-.i9 DATES OBSERVATIONS MADE (PROF~IL+E D SCRIyPTrI7ONS: PERC~OL7ATI_ONyTESTS: ace 7 -~~~ ~ I! / I ~`~ a/ CO NVENTIONAL: ® s ~u MOUND: ®s ou IN-GROUND-PRESSURE: ~s ^u SYSTEM-IN-FILL HOLDING TANK: ^s ~u ^s ~u RECOMMENDED SYSTEM:loptional) f r~ ~' c i . _ x3 o~~~ d~ ~ i If Percolation Tests are NOT re wired DESIGN RATE: q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /' /~ P~,OFI~E DESCRIPTIONS BORING TOTAL• DEPTH TO GROUN DWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHiId' ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~ rv t 04 s~f ~ ~ ~ ~ t r S , O ~h S ~ .' E. L° Q ~. c pK B•, /s ~, c Bn mss, . y 8.1 /cs B- ~ I~t ~U ~. ~~ d~[e.,. ~ 7 O ~O ~/~Bh~S/ ~i8BI7~sj •q O'/l ~Csi 3 ~ e ~ 3 e B-s ror ! ~ OOs10 ~/ /~d~~ 7 rV' /, O ~/~ Iw'1 /S' /r3 ~/- ~S r ~o ~ ACS .` Q CS ' ,~ e. B- PERCOLATION TESTS TEST DEPTHS - WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER ti*N6i~M eC AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P_ / ,3' 0 3 ~ ~ P_ dt. ~ ~ 0 3 (m ~ 3 P- 0 6 < 3 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 9(. ~- ~ ~Q (~.~ TN ~ . ' ~1 INSTRtJT141V ~3F~ ~QIVII~LETING RIB '115 - S®- f? Tc~ b~ a complete anti accurate soil test, your report mast ir~c:lucle: 3. Complete legal descriptior7; ~. The use sectlan roust clearly indicate wh~ ~.~~r t~iis is a residence or commercial firoject; 3. MA?CIMUtVi number of bedrooms or c: ~~ ~~ial use planned; 4. Is this a new or replacement syste~r~; 5; Corr~~rlete the suitability rating boxes. A SITE IS SUITABLE FC}R A HOLDING TANK ONLY IF ALL t?TI-IEFt SYSTEIViS ARE RULED C)UT BASED C7N SOIL CC}NDITIC7NS; ~i. F'L:EASE 'use the a,~~l?reviatior~s shown here for w~ritir~g profile descriptions and completing the plot plan, 1. I AKE A LEGIBLE diagram accurately locating your test {ovations. Drawing to scale is preferred. A ~'~ .?recut mad be >~:ci'~"desired; _. >a t~saolr br.,.... ;rk .;nd vertival eleuatian referer7ce paint are clearly shown, and are permanent; «IE apprc>pri, ;<~ t~oxes as to dates, names, addressese flood plain data, percolation test exemp- tic. , if <~~~prorrriate; 1Ci. If the information {such as float.! plain, elevation}does not apply, place ~3,A. in the approl~~riate bax; 11 . Skin the form acrd place your currer7t ~°~Idress ar7d your certification numf~er; . 12. J~llake leciible eopiES and distribute as required, ALL St~IL TESTS I~~IUST BE FILED UVITF6 THE LC)CAL AUTFIC~RITY l+'UITHIN 30 C ~S t~3F CC~MPLE7!£~N. ,~ A13RRE01`IATI~3N FAR CEf3TIIE® SAIL TESTERS ~,+ c~i ep and Textecrgs Cbther Syrrabals st -- 5,~ {cv^~ 1B"~ B(~ - Bedroek cop __ r ~ {`i - 90"} SS - Sandstone gr - ~; r :; {undr~r 3"} LS -- Linaestor~c ~s - Sa~ NC,GtV - (- Ih Carourrr~water ~ _ _ vs ~" rr ~ Pere - I 'ion Ratc= . rued s ~ .v ~ ~ S,:nd V~ - ti.. fs -- o Bldg - € "di is -- L ~<I ~ - (`~ # Than ~`sl __ ~.o =~ ~ - L - rr~ k l _ ~ ,- f, mil - Loam _. - E~.~ _ si - _. Gy - Gr ~`cl -- ' yam Y - Yello+,v scl - !~, Clay L<sam 1` -~~ Fled sicl~ - _ lay Loc:m mat - (Vic~ttl€;s sc: -- .. ;~ Clay w;' -with sic -- ~ C(ay ~ fff - fevst~firac, c ....., n cv -- cc~mmcr- e ' p~t -- ~ ~~.; cram -Many, rr- n~ --- ~.. ~''w;~~ ~ -- d;stinct p = f~romirre ;: "' t-rG~f~ - k~f~gh thiatc:r level, ~` Six s~ ' ~textur~s surfav~ uvater .for lice. ~a~~e disf»sal ~ ~ BUJ! -- Bench IVlark ~tRP -_ Vertical (~eferenve Pairrt f ,, o. :.,. r. ,4 .~ ,~ • ~: t"! T4.i d"iinf9tEGC2, ~-z--~ s.~i -~-~~.~~ moo/ s.s~ ~ d ~ ~ ~;, d o C" ~ = 3~ ~ s ~ Ao N ~N ~ r a ~ u- o ~ `~ ~ $ ,~ ~ \~ ~ " ~ d N ~ ~ s a ~ ~~ J o d i LLI ' ~~ tl s tp ~' ~ ~ ~I ~ ~ > d ~ ti ~ d d .~ ~ ~' r ~ ~ ~ -d u, ~ a F~ ~~~ ~ d t ~ ~ ,n - ~ J cn s ~ v , - ,~ U vi ~ d d ~ '' pa V~ ~ ~? 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