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HomeMy WebLinkAbout020-1128-80-000 0 CO) 0 v 0 C7 `+1 0, f c 0 m CD m O A~1 O f O ° W 00 W C V N• N O 3 N a N N Q ~ CL Z N Vt - p 'r1 N 3 CD O ^ N a 7 O L r,-• \ 1 I cn ' m O :3 O 3 in t o ° C p Si c pct v Cl) < D M a v CD N d CL c ~ v a W 3 p CD ° _ c r CO) CD rn co co CD o V n i o e 3 C T T !V • o 00 0 0 -CSI N ~ ~1 o 'pp C Vl W cn N C7 o m e~D tQ N d CD A IN A a a O ` Z Ch O O Z CCD Z m O D D a ~o h m • m l C, N cn N N CD N W fD Q p 3 7 Z tD cc fA O o A Z cD 0 d A z 7 o W Z N V cD z I ~ 3 a ~ 3 co z C A n? 3 a x W a c N 3 C 7 y m o a m i m N a CL I c_ ~ I b I o o o cn M p W CD hQ 0 0 V ° Parcel 020-1128-80-000 12/05/2005 02:58 PM PAGE 1 OF 1 Alt. Parcel 17.29.19.603 020 - TOWN OF HUDSON Current X' 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 - BRADT, STEPHEN J & SUSAN B STEPHEN J & SUSAN B BRADT 448 PARK LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 448 PARK LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.650 Plat: 2274-PARK VIEW ESTATES 1ST ADD SEC 17 T29N R1 9W PARK VIEW ESTATES 1 ST Block/Condo Bldg: LOT 22 ADD. LOT 22 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 749/219 07/23/1997 745/425 07/23/1997 715/396 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.650 68,600 177,600 246,200 NO 05 Totals for 2005: General Property 1.650 68,600 177,600 246,200 Woodland 0.000 0 0 Totals for 2004: General Property 1.650 35,500 153,500 189,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 305 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Stet/ ~6~ IJ~:~ I TOWNSHIP 14U450r~ SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~SR LOT v v LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM How,. . a t a Q -x5oD i r INDICATE NORTH ARROW R i. BENCHMARK: Describe the vertical reference point used Jed CJ {+G~ VolPue Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: --W S Liquid Capacity: w ~ f Number of rings used: L-Q _ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,o Side,Q Rear, a p feet r From nearest property line Front,O SideA31 Rear, O ~0 feet Number of feet from: well 55, building: _ JV1 t I (Include this information of the above plot plan)( 2 reference dimensions to septic tank) II SEE REVERSE SIDE a PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Width: LengIth: p ~ Number of Lines: o~ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,/'D~P't . r ~ Number of feet from well: Number of feet from building: c (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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: Xj 'eu.1, License Number: _ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN,RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 79FC BUREAU OF PLUMBING MADISQN, V1eJ 53707' RRCONVENTIONAL OALTERNATIVE Swe Plen 1,0. N.mt- 11f asslgnelfl ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSPECTION DATE Steven J. Bradt Rt. 5, Hudson WI 54016 BENCH MARK (Permanent reference potnl) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST PEE PT E E V NE NW, Section 17, T29N-R19W, Town of Hudson, Lot#22, Parkveiw Est. Nn,nl of PWmber. JMPIMPRSW No.. County S-.,xy Permit Numbe,. Richard Hopkins 1059 St. Croix 83825 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV M., ING LABEL LOCKING COVEH D PROVIDED U C~ v /..20 90.g YES ONO OYES 18NO BEDDING IVENTDIA. VENT MAT L. JHIGH WATER NUMBER OF ROAD: PH OPERTY WELL I BUILDING JVENT TO FRESH 1 ALARM FEET FROM LINE C AIR I,NLfjT OYES %N0 l OYES NO NEAREST 2 Z d a s~ N~ DOSING CHAMBER: MANUF ACTUREH BEDDING 111OUID CAPACITY PUMP MODEL PMANUF ACTOHEH WARNING LABEL LOCKING COVER 4 OVIDEU PROVIDED OYES ONO OYES ONO OYES [_INO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL N E PEtOPIH IY WE LI [Olt. DIN(, I VENT TO FHE SII (DIFFERENCE BETWEEN t F F OM LINE AIR INI E T PUMP ON AND OFF) OYES ONO E ST SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing LENIJII JOIA111 I I11 111AII HIAL AND MARK IN(, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH JLENGTH INI OF 11111TI PIPE sPA(.1 N(. COVER INSI DI DIA =VI I5 1 IOlllll BED/TRENCH ` THENCHFS N!;EHIAL! PIT DEPIIf DIMENSIONS L J yam. GHAVEL DEPTH FILL DEPTH I)ISIH PIPE DISTH PIPE DISTR. PIPE MATERIAL NO O H NUMBER OF PH OPEPTY WELL HUI LDING VENT i0 f Hf 511 HF LOWP ES AHOY COV)H fI lNI/F EL Q~N PIPES ILINE AIP INLET FEET FR V• $ NEARESTO ► 2 C ! O 2 U 26 f 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 ONO SOIL COVER TFx Tl/HE PEHMANE NI MAIIKI HS IIII'M 1111, IIIIN W 111, _ OYES LI NO _ O YES LINO DEPTH OVEH THENCH HIII JDIPIII OVI11 TRENCH BEU OEViH OF TOPSOIL S()DUf O O SE E Of I) MI/L ('HI I) CENTER EDGES " YES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATEHAL SPACING THAVEL uF PT 11 HI LOW PIN E Il L OF PT 1f ABOVE COVE It BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE IMAN11' OLD MATE HIAL NO OIS1.H I)ISIII PIPE DIS 1111 HIli II)N PIPI NIA 11 HIAI W AIAItKIN(, ELEVATION AND ELEV. ELEV. UTA ELEV. PIPES DIA. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING U-1_LED COHHFCI I Y COVER MATE HIAL Vf H IICAI 111 T COHHf SPONDS TO APPHOVI 1) Pt ANS OYES ONO OYES ONO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE OYES ONO OYES ONO NEAREST L Sketch System on t Ret in Reverse Side in county file for audit. . $I(iNATURE TITLE DILHR SBD 6710 (R. 01/82) wisconsm APPLICATION FOR SANITARY PERMIT r -D I L H R' COUNTY ~ OEPRI3T1EnT OF (PLB 67) UNIFORM SANITARY PERMIT # 1rV..TRV,LR60R&HurnRnRELRTIonS 9 3,?c2_.s- -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -Sege reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MA LING ADDRESS n ra rJf '~x -350, do P~jl ROPERTY LOCATION CI Y: 1/4N(l 1/4. S I" , TQ N, R E (or) (4 viL~ r,S TOWN OF;I LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATEpJ,A I.D. NUMBER Pte(/ TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. LY Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): I Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of PI tuber (Print):- J J'S ignat MP/MPRSW No.: Phone Numbfer: Y Plumber's A/ddd`r/essss:~ Na of signer: Yo w.:+' y9 ..Y' •'"~'4 w.. COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: F}e ~ Date: El Disapproved XR: ✓ ❑ Owner Given Initial CJ Approved Adverse Determination Reaso for ' ap al: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 i To be complete and accurate the permit application must include: , 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. I ' APPLICATION FOR SANITARY -PERMIT S `i' C - 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/contractca, ("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 Location of Property L~ Section T `I N - R W Township Mailing Address Subdivision Names/_r'\, iCtr~ Cue Lot Number P revious Owner of Property, Y Y` Yl iX.Y' h , C Total Size. of Parcel gG~`e Date Parcel was Created._. ~-y l 9 _ ~1 1 "1 (Gil G~(~ yfc' f}___,r_ 9~ _Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) eel a6y that aU statements on this 6oam ah:e tAue to the best o6 my (ouA) knowledge; .ghat I (we) am (oAel the owgn (,s) o6 the paopenty descAi.bed in this in6oiuiiation 16oAm, by vi tue o~ a wa4Aan-ty deed aecoAded in the 066ice o6 .the County Regiz teA o6 Deeds as Document No. L I ; and that I (we) paesentty oun the paoposed site boa the .6'Ewage posati ystem (on I (we) have obtained an easement, to aun with the above ducA,i.bed paopeA,ty, boa the constAucti.or, o6 da.td by.6tem, and the same Ilan been duty Aecoaded in the 066ice 06 the CourU y RegisteA o' Deeds, a Docwnent No. i . q SL WNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ca f H STC - I05 r. r y si,rrIC 'TANK MAIN`1'L'NANCE ACKLEi•Lf:N'1' . 0 5t. Cruix County o 0 W N E R / It U Y t. t: 0 ~e~ . - _ ROUTE/BOX N1fA BEH Fire Number CITY/STATl?%_h ~~L~SC• -%IP J'f_L 1'itt)PERT Y`LUCATJ0N IV 1_'•4i _LV 14 'a Secriun NR_ .._W, . 't'own of ~a,.-spYi St. Croix County, Subdivisi.uiZ 1,0 t number Improper Lisa and ilia utenauct, of your sept is system could rc,sult in. its pruwiaturu failure to handle wastes. Proper ilia inteliance_c'on- si,sts u puuipinf; out the septic tank every three years or sooner, if needed, by a 1 icensed septic tuti~k Lrin~l)Vi'. What you put into Lhe sysLcm Call .rf IL-CL L110 f itnct iuti of lhu ptlc Lank zis a treat- ment stake in the `waste disposal systew. St. Croix County residents wad be eligible Lo receive a f;runL for a maximum of 60% of the Cost of repl.aceiu.-ue of a failitig systeitl, which was in uperation prior to July 1, 1998. St. Croix County ac'cepLed this prrugraiii in August of 1980, witli_tile requirement that owners of all new ~SCeuis agree: to keep ttic;ir systems properly umaintaiued The prupei-Ly; owner agrees LL) subaiiL Co St. Croix County zoning a certificati_un toX~n, signed by the. owner and by a toaster plumber, Journeyman plumber, resLricLed plumber ,.)r i licensedpumper vcri- fyinb that (1) the on-site wastewater' disposal system is in proper operating condi L iou and of ter inspection and pumping (if tiec- essary), the sel)Lic 'tank is less than i/3 fu1'1-of sludge and scun►. Certification form will be scut approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, havt. read the above requirements and agree' to maintaiii the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be Completed and returned to, the St. Croix County Zoning Office within 30 days of the three year expiration date. SICNCD St. Croix County Zoning Office P.U. Box S$ If aill ln( nd W 1 54015 - 715-,96-2239 or 715-425-8363 Sign, date and return to above address. E I a i 3 ate/ PqrKview d Lit 22 L -f- OL- ,z> on 0 ° Z 4) ? O O C O C O v C O cd w aS m E - O O C 3p It It O O t o C w eke 4)75 (D F- 7 O) o v a U i ° C rn C N O 1C0 ° N ' O C C~ O N .0 ov m 3 4) ccnr~a) W O c0 'a O U) 3 0 C 3 ° oD ° v E C'f ~y V•~-m cL'a N (D- ..-..oN 0%*- . 4)~- '0 o 4) IM .0 a cc (D NN►-°~o two 4) OL (D E o~ W 3 0) "0 '0 _L IL U) co 4) ,r- C 2 Cc W O L O= to v c v1 ° `CD 3; r- ~ cn -0 E o N m Q a v t m N U U) O U) U) c Z N U) G) Uj O 3 Q U) N - cb CL c IM CD = v cco04Doa L L- rn c 4) o U) o~D .0 U)~ c `O N c0 N Q o.a-Q,- v, @ c -p O r O O O U) w cd N co 0 o L L F C 3 C T ~Z C_ &a31 U_ C O- E_ 0, = O E C t O~ Y C U) O Co O p f0 O r C C Cvj CM p) i =O Z7 E U ML C OL d Of 0 r y U) d L N a O U _ v~0CD (D p0 0 Q) C O- o O L U c 0 a 3 cn-. 3 y N O:3 a a ° I~1~ C O O N CL O c 3 c~O „ id cc o O 0.0 O " CL C ca O U U 0) 4) N .O- C L i O C t 0 U) m m ca O EN N o 3 U) ,J// C cc 01 J N G I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR'AND P.O. BOX 7969 PERCOLATION TESTS 115l DIVISION WJUAN RELATIONS (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCATION: FSECT ION: TOWNSHIP/ 7CtPf+,"Ty: LOT NO.:BLK. NO.: SUBDIVISION NAME: N~ '/a '/a 7 /T 2 9 N/Rj 9 E (o ,yvoso~v ECOUNTY: EfF;t:/BUYER'S NAME: MAILING ADDRESS: S j • G't 0: 'D O R f S f 1_A_X4 Ad.-I Q!7 , /S/vltif'a,c 7 ~~:5 USE _ NO. BEDRMS.: COMMERC ; SCRIPTI DATES OBSERVATIONS MADE Residence 171O11 LE DESCRIPTIONS: PE COLATION TESTS: 3 w ❑Replace (P Cf RATING: S= Site suitable for system U= Site ray itab o }nG ~~~T ' Ef1rEiQT .S~QNDS CONVENTIONAL: MOUND: IN-GRO R Y -FQ HOLDING TANK: RECOMMENDED SYSTEM: (optional) ES ❑U ©S ❑U , 52 : U ❑S ©U C'oNl~ i -0Aw 44 /Z,xsJ_' If Percolation Tests are NOT required DESIGN CG .r If any portion the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ;0 7-bLCJ}+AL BORING TOTAL DEPTH TO GROUNDWATER-' CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTUR, AND DEPTH NUMBER DEPTH ELEVATION E OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) q 9 oe. T,1N *40-6 Y. B- 2-- - 1 00 or I ' 75" B- X ! . v ~ s ~Zo_ f o ' -5T' Am. y, s, ' fez ' Au ~S B- 90 f~•l~ 9 0 ,S' yea-6f v. L . ,3. a ~fIv V G's lre B- 1 S-91 I 1,tV4%16,,I of 'kcS PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUMBER IN AFTERSWELLING INTERVAL-MIN. _--PERIOD 1 PERIOD 2 PERIOD RAPER IINCH ES P- , P- Z_ 3 T 7G Z s. P- Ile) So Z cxr/r 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 OFD ce_YC- j1,-I A) E E E 3 1 F_ ~ p EQ -3 #l s Po~rL _~,~s ~0 L B ~t lbisi WS ~r~~_~eptt Y I - ) to Tol- 8. E E N b16M E ~s I 'AAC 4)( yl 3 E S SyS7 ~ Tc ~-ie !N YA &6 IFA p SF• E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): HOMESITE SEPTIC PLUMBING CO. TESW~E,ReE COMPLETED ON: Rl- 3 a, I AD, -45 54019 ADDRESS: G'-'~' ROBERT ULBRICHT CEF~T^FICATION NUMBER: PHONE NUMBER (optional): 02_ 0 WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. S f -O L X710 3 OC MINN. INSTALLER & DESIGNER LIC. NO. 00663 C SIGNATURE: I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. I D I L H R -S B D-6395 (R. 02/82) - OVER - L I INSTRUCTIONS FOR COMPLETING FORM 115 - SID - 5395 R To , a n f<a r,<;A test, your report roust include: " c i .r . 2. _ u.. iier this is a residence or , M. X1 :0 rcial use planned; y 4. is'" ^E IS S4J1Tfittr P P P A":< ONLY IF ALL s- r r pl Jng t ; a 7 o scale is A y own, an 9 s percoiatio C1= 10 r3 plain, c' ? the appropiiai i1. irren 12 IV _:'Jute as E DEL D {l _ _....CIA I iriED SOIL IT Othe. t . , r i cc Pt [TIM d p L_ TO THi OWNER: This soil test report is the first step in cr a anitary permit. The county or the Department may request itication of this soil test in the f > permit issuance. A complete set of plans for the private --e system and a permit appli+ be submitted to the appropriate local authority in order to a permit. The sanitaty perr t r obtained and posted prior to the start of any construction. w 6 7 P L OT A N 1) ((J" -0 S, C T 10 1\1 I a. P R 0 J E C, T _ j~ L U~~j ► E V 2RAME LZ Pa N A M E~ 0C T 10 N r lip 'AT E z PE-0, T S -A -P r r ; ~ JJ Xpa x~ P, p3 r 157 V) _R3 1 ' i l.r 1 ff ~ pod 0J. ~ k v, I~G Q i't Cc's ! Cl ~It F 1+ y 5-4, Y j stee ~Q r L..Qk FRESH AIR INLETS AND OBSERVATION PIPE aY CP,OSS SECTION Approvers Vent Cap Lot Minimum 1211 Above "~%r, ° ? > l ' final ,raoe 4 11 Cast Iron Above Pipe Vent Pipe ?Yti To Final Grades---" Marsh Hay Or Synthetic n Cover Min. 211 Aggrcg~>(_c Over Pipe Distribution Tee Pipe _ I Aggregate- 7 Beneath Perforated Pipe Below Pipe 4--- Coupling Terminating At BOLLom of System