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HomeMy WebLinkAbout020-1075-10-100 O N O N v p °v3 m N v b z, O I N a) d T O v)O ~ C Z f0 O LL c O 0 N x 3 O E N '01 0 Q U O Z O W > 0 O>i > U) O ^ Q) N -I A) 0 N F- c-4 LU Z d m 4-4 O ~4 Q o p r1r) 33 U . r 00 o Q) 11 4' a rn ra co j N N (D C14 m CD b~ I tJ N y W N O 00 I •N~ d~ ~ I Z a I ~i a L 4 A `I o N Q Wl z m z N S3 H cli d d d y (D G a .0 a FWI z > cn 3 0 0 0 F4A 0 z N c a a a N Ln 00 O, 1 y H 00 ro 4i Ln to J U 2 0) co ~~C 9C 3 • H O cad -H •rl 04 ~4 4-) pl, G O 10 Q) ° N - 0 o y 'D E N U O W N Q) Y co c d co d t~ r v co cd O 0 m •i Q inrn m cHnax UU !l O O y C ~~ll 'fi'r O E O m C U E o M O 0 N C Q C i.w H p 'Q N N f~ C U) C YN m C 7 N N O c ai N V .r~i Z' O C N CO CO O o c~~l I co o z y 2 g tu I a m a o CL 0. rr'lwwri E ` c c -S _1 A 0(Lm o(n0 Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT f OWNER U'l TOWNSHIP SEC. T -29'N-R ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION c CS, /I~f LOT LOT SIZE 3 , Z /~G a r/S PLAN VIEW Distances and dimensions to meet requirements of I1HP. 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /o© S- T. c,-o i x D i V'L' y Z r v e m S J 30 30~ 41 0 o X0 14 -14 [ram 26INDICATE NORTH ARROW lV lbb,o' BENCHMARK: Describe the vertical reference point used lZ Tfnv~ 5 (,c) ~0✓11~i~ i Elevation of vertical reference point: ©D• Proposed slope at site:,, t k SEPTIC TANK: Manufacturer: Ng' S e y- Liquid Capacity: 2 000 a 1 Number of rings used: Z Tank manhole cover elevation: /D : ~ Tank Inlet Elevation:..,/490.&O / levation: 490.&O/ Tank Outlet Elevation: 1QQ~~Q i Number of feet from nearest Road.: Front, Side ,o Rear, l ZS feet i From nearest property line Front,0 Side, Rear, O Z feet Number of feet from: well //d' , building:-)S 46n.,41-4w (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE R i PUMP CHAMBER Manufacturer: iA hk - Liquid Capacity: /V P1 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: eGhV0LT l0y\q Trench: i f Width: 2 y Length: Number of Lines: - Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,O Ft ii /0 Number of feet from well: 7 ~J Number of feet from building: 30 (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: tV ~ 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: Inspector: Dated: Plumber on job: License Number : I 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 RRCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank ❑ In-Ground Pressure El Mound (lf assigned) COMMERCIAL NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: St. Croix Diversified P. 0. Box 512, Hudson WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: ICST REF. PT. ELEV.. E SE Section 27, T29N-R19W Town of Hudson Lot #1 Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: ou Strohbeen 5432 St. Croix 88441 SEPTIC TANK/HOLDING TANK: H 10,x - 5- MANUFACTURER: ILIOUID CAPACITY: P K INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER d A ~J II PROVIDED: PROVIDED: __Q G'•~j /1~ 61 YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: j.UILDIN1: JVENT TO FRESH ALARM: LINE: AIR LET: Iwo YES ❑NO l~ ❑YES ❑NO NEARESOM j ~/1^ DOSING CHAMBER: (1 MANUFACTURER: 7ING L IQUID CAPACITY. PUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDEDPROVIDED: ES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) PU ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH: NO. OF DISTR. PIPE SPACING. MR INSIDE IA#PITS LIQUID BED/TRENCH L 7 TRENCp ~ PIT DEPTH DIMENSIONS s7C C 7 ((i GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DIST.PIPE MATERIAL: NO DISTp. NUMBER OF PROPERTY WELL BUILDING: V NT TO FRESH BELOW PIPES ABOVEXER: EL I E ELE D~ NO DIIS FEET FROM LIN ^ L AIR INL/E/T. l.~ / NEAREST--G~ J S J C G~ 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. YES ❑ NO OIL COVER TEXTURE PERMANENT MARKE S JOBSERVATION 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: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: ELEV.: CIA.: ELEV.: PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain county file for audit. Reverse Side. 111 j 51 UIALAHit: TITLE p DILHR SBD 6710 (R. 01/82) (j 77 DILHR SANITARY PERMIT APPLICATION Co~y~;' In accord with ILHR 83.05, Wis. Adm. Code d~ STATE SANITAR~Y/PERMIT # -Attach complete plans to the count co only) for the system, on not less than g I.D. ( y copy paper ST T PLAN . NUMBER 8% x 11 inches in size. O pO IV/ -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER P PERTY LOCATION 6'r- of X r s' '/a SF_ '/a, S 2 TZ ~j , N, R / g E (or r PROPERTY OWNER'S MAILING ADDRESS LOT NUMB R BLOCK NUMBER S BDIVISION NAME 0 1Z_ A 2 10, e_40:5 CITY, STATE ZIP CODE PHONE NUMBER E:l CI Y NEAR ST ROAD, LAKE OR LANDMARK 14,, Jj^- TOWN OF ❑ VILLAGE : H /,s mA4wwe_;&_1 ' 11. TYPE OF BUILDING OR USE SERVED: S• Number of Bedrooms if 1 or 2 Family W~-S V4, g~ OR D? Public (Specify): ~ f Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. A New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only, _ _.,art 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. X Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- bl folding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRtE,,D (Square Feet): PROPOSED (Square Feet): < Z T 0 d Z o o Z Feet Private -1 Joint El Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank X I- ❑ ❑ ❑ ❑ Lift Pump 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): Plumber's Signature: (No Stamps) MP//MPRSWN~oQ: Business Phone Number: A Plumbe s Address (Street, City, State, Zip Code): Name of Designer: i f Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # w ~ r S7 -7 CS 's ADDRES ( treet, City, State, Zip CI)de) Phone Number: e,T"bir, 41 lZ-'Z E S w o 9-44)11 S Z S- IX. COUNTY/DEPARTMENT USE ONLY ~y ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Sig s) IL11 Approved ❑ Owner Given Initial 1F/ Surcharge Fee Adverse Determination ` OD X_~S 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 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT r ' APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage systeEn, contact your focal code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide; the legal description where the system is to be installed; il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. 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 ta6k 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; Vill. 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 Groundwater - included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can e1teP$,'rpyndyvater. The surcharge took effect on July 1, 1984. All of the water that buried treasure is used in y'o-ur building is returned to the groundwater through your soil absorption system pr,thT disposal site used by your holding tank pumper. V t t,+ he monies collected through these surcharges are credited to the groundwater fund adminis-- T tyre'd by the-DepartrnePt of Natural Resources. These funds are used for monitoring ground- t )911 E eater, groundwater contamination investigations and establishment of standards. Groundwater, - it's worth protecting', SBD-6398 (R.03/86) - ._/YOR7 LOT LINE ST. C?,oIX DIVER sl UED SYSTEM E LV. = qa•Z' 3M E LV, = 100. 0' REPLACFME1Yt ElV z q7•s' p BDAE, (8A(kHOE) D PE RC S (T,Esr 8o77'4>1v) glV 9 \ Z J L 1 l.( 0' or) ~ t R9 SS S:t 7 3 or pcip,, t 15 i ~t eu. 1 i 'M t ~ I b4EP i - r ~ r WI sr. CRoI)( D1_VER9IFIED NEW FACILITY O lO; VI v ~I 30 W 30/ yo i s Z 33 T, gs ~ R U LAc~MENt zd ' dh AgEA Cam/ BH RECEIVED ~ So NO 10 1986 ICON P4A a . - SOUTH LOT [.ZNE ~ 0 14 A ~'~Hc►-HCvC) 7~J I-h N n-l ryl O o ba y a P ` ~ hr a 7r ° P w 7° (Ti 1.0 (In N < r-► m z H 1 0 a, o w H -rt -v sl ~ o o. Z N r-~ m ° • v s oe Q 7-7 + nz 7 ~ J ` ( I I i t7 r. oua R v~ y I ;3- 0 o` T+ , I P r~ _ i ICI L AN I d r 1 r1 ~ p ff S~ 7 f f `.j i 4 , I ~ ~ t Si'( =~~tC~~ I\ u C P E ' r r a. +H I ~ tv, r t4 P 0 p G ° 71 r i "k a. a v. DIUS ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION LABO PW, P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) jCOU CATIO SECTION: T W SHIP UNICIPALITY- LOT NO.:BLKNO.: SUBDIVISION NAME: 1/ 1/ z~ /TzgH R )9E co 5='P M NTY: OWNER' BUYER'S AME: MAILING ADDRESS: ~,p• ja S i Q.K , vt 1 U~c.S 1 F l ~t'~U~SOIV f-L} I S d f 6 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: PER OLATION TESTS: ❑Residence N ~}ES1UE ~01Jb1iV ®New ❑Replace t - sr~o~ o- f z -Z_ S 6 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ,~S ❑U OS ❑U S DU ❑ S I'll ❑ S OU ep>uvov`na,v>~ 81 -mss y Fun Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the de rs.H63.09(5)(b), , indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 1%, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 8•Z' a.q~ B)-LTS,o,a'3h L; 1,z'E3n C~vsl; 3.1' v ewf W MtT\t_LL/ C.a•t V-h jC ' Z. Z' E3 n S B- Z °1 Z~ ~bZ,~I NOEL cJ•2.' o,~` $l LTs ~o,q'lanL~n(2V3)Z_~OhGkIs• o. 0' wFz cy Gffy n I S O` L.T- 1 Q~ S B- ~l_ L TS tan GvL Vn G- sl; $nVS~ Z,1' >1Ma9- S STS; G~L; Z•y' 6V B- ~l•y 101.yI IJ~ti1~ ? 9.y 3,y` C3nGa is B- S q,6' ~b~--1` 1UO1013 ?q•(,' LTs; \,W Bh&-L'8n6►rSJ - ~n GH 1s B- PERCOLATION TESTS TIM NU BER NCHT S AFTER SWELOL NG INTERVA MIN. PERIOD 1 DROP IN W PEROD E2 EL-INCHES PE R OD RA PER INCH ES P_ ) SL{ 1~0 30 -2 /S h/$ 17/8 1 P- 2 qZ 1~0 l0 1 `S/l6 )1511(. Z S P 3 49 ~Q p 5/y i31Ib ' 315 / P-_ EFL. P_ Z EL- P_ 3 L.. 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. 1tJ l"n t'iC.. 98•Z' Pnc-~ G (o ~v~.~t.~'~'ty `2_DT - Sl~~"'1'~E. SYSTEM ELEVATION hey r - 4~ s ` - , E L _ RT LUST; Her-_ y-j F D ~ i 60 ~ E t N J i i ) / zr ~ } [mil) . 1 300 a i ) : .7 ~ ~ . , E 7a $ \~LEDOx SChLE 60t Lsc,~a?~' l~s St~wN ~ She.. 2.'7 I, the undersigned, hereby certify that the soil tests reported on this form w I e in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the to a st of my knowledge and belief. NAME (print): ct~~ to TESTS WERE COMPLETED ON: ADDRESS: Z'T- 4 ~k ZZ ~o CERTIFICATION NUMBER: PHONE NUMBER (optional): ELLSWQ*1 1-v l SYO} 57~. LS-4/Zs-cwW CST SIGNATU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner an X ster. DI LHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS EU COMPLETING FOR " 1 "BCC - 6395 To be a cot; -'-'e -~d ^urate sail test, your report must i,3cluc~ 1 . comp's 2. Th- u indicate whether this is a .ommercial project; , W s or commercial use pla n 4, A SITE IS SL'"-g-' nLDING TANK ONLY IF ALL " 3ASFD ON . PI, e for r s and completing the plot plan; 7. (VI. to scale is pre A n t t' 10, 12 BE F' r THE C l:i _ DAYSOF C" _VIATIONS F -rr_RS i Textures Other Symbols - 1g") S - L *c scl oam si, L. yam - -el, n extures fi posal TO THE OWNER: his soil test report is the. first step in secu a ::ary permit. The county or the Department may request f~ a Jon of this I test in the fic' < 1 n'= issuance. A complete set of plans for the private U; ge system and rt°mit applicati.m r ted to the appropriate local authority in order to olu ain a permit. i ary permit ML J a J posted prior to the start of any construction. 14A"~3__ . REPORT OIL SOIL BORINGS AND S~ ~ Y BUILDINGS 1N,S7 DIVISION LABOR PERCOLATION VESTS (115) ~ti ADiSP.O. BOX '06-9 HUMAN RELATIONS ON, WI 53 6.9 (H63.090) & Chapter 145.0451 LOCATION SECTION p [ 7ITOWIvSHIPNdIUNICIPALITY: LOT NO.:BLK NO. SUEDi ilSiO(~ r'AME S~'J 1/4 1/4 77 }I~ R E (or"v _-J?J~_'~?C COUNTY-, OMAILING ADDRESS~ \ ~_~K S VZ Ila Z~'. 7C 5 C~~ 1 K ` - USE _ _ DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS ❑Residence N i!tSl'Jc 8`JZ.~IJNJ 9NeW p s1 - --f- r = ❑Re-lace L- -2_ g - RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) MS DIS ElU CAS OUS OU E] S QU>u~~` -r'-~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: ~~7• Floodplam, indicate Floodplain elevation. N ' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-tN S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B 7 43•Z` -6'4' BI LT'SL; \.z 4h vvS1; 3-1 r Ii= r B- Z o1.Z' `bZ.~t ~O►JL ct,Z' 0.-7' 81 L 1S;o,~t'%r'L;Z.I'~y 1.Z'erG;-i! • O- C.=r~1 1T t'2 tih I S O r l T ~1r~ I-n Q-S -S 1.O' al LTA 1•\' ~n GvL t.9' ~3n GvsI' z•8' B 3 \OZ.3' lup~~ > g, $n ~S - i. >1 rnat~ S. $1 L _1S V b GV L ; Z, y I gh ~V s 1 ; B- °1 y lo` •y ` rJOQ v_-- -.1 91 V ' 3. y ' Z3v) Gt. S 33I LTS ~.y I Bh G'rL. ; 1.3'3n GV ST-'- B- q•6' \1z, Z_ ? 6 . S-3` ~n GH is B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 _ PER INCH P_ 1 S L/ 1~O 30 \ ~ /8 1"I18 I 8 I ~o P- Z 4Z t~0 1 5116 115116 Z [J P- 3 11q YJO Q 3/y t311b 13~~ 6 P n~ vc 1 p_ 3 I=L. oz 3' 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. iIJ ~l Ft~ - + ~lr~ d av~? ~a- 98•Z k.. 2~T - 5~-~ i TRH SYSTEM ELEVATION E loc.Atj?C'tJ.7ZS'- 774 ,p o F 7_rA ;Z-- S W CO ;ZQ tFT'-- C = ilv~ y - - - --BULL}>,JG b~ AT hST rss _C'! SY7Z5`2_' ?7 -L*-tv S~- S 0 0 ILI 1--(SA J _ TN ~ W =.AT)tyJ S t~ETC 3z; eJ - - - I JTe piJ $viZ\2~lE C~t)X - - ~ t . F + eP S t,R vt-y I I' -ice A e~ I, the undersigned, hereby certify that the soil tests reported on this form a e in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the r st of my knowledge and belief. i NAME (print): TESTS WERE COMPLETED ON: ADDRESS: T lj ~k .i tai 98 ERTIFICATION NUMBER. PHONE NUMBER(opt o-n-a : pfd 6 l^ S~~ tS- 4'ZS ol 6 CST SIGNATURE: ~ )IaTRIBUTION 0.iginaf and one copy to LAuthority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - NT OF ; REPORT ON SOIL SAFE U L IN G DIVISION • > PERCOLATION TESTS (115) MADISON, WI 53107 7969 V.AN FtFI_/~l-IONS • (H63.09(1) b Chapter 145.045) it I ION SECTION TOWNSHIP UNICIPALITY: l_OT NO.' Bl_K NO ; UPDIVI I(t~; NnME. NE7 SW'/ z-7 /T R )9Elor( N TY 0W N SaUYE- AMEN - MAILING ADDRESS uER'P \ (7. ~Oy~ S )Z DATES OBSERVATIONS MADE NO. BEDFirvtS COMMERCIAL DESZcRIPTION: PROFILE UE Cf~IPT10fJS. PEF2CbLl+TION TESI- nRel,lace - c dence N yns 1~~SIl 90LJ1wN New '7 Z -7 3- (o - - , ~ doh ~ _ r - f~ - - ~ - - - . - _ it ING S= Site suitable for systim U- Site unsuitable for system ;r•~•FIVI ZONAL- MOUND. IN-GROUN[1PF{F>SURE: SYSTEM IN-FILL HOLDING TANK RECOMMENDED SY. i fM:lo r ~nall S ❑U M$ C_JU s_ ,''y S [_IU I M-- DESIGN RATE: I'r-ie ulduon Tests drr• NOT required If any (nmo of the tt.fed area is in the r F1 :o0plain, ndi ne Floodplain r Ievatior r,•~ S.Hfi3.0`)(5)(b) indicate: - . - - PROFILE DESCRIPTIONS i!T JHC, /,Nee F) Ef'TH DEPTH 10 Gf10_UNr)';VATER M}E~tltS iARAC1E H OF SOIL WI1H THICKNESS, Ct)I R. I Y. ~If IUTAI CI H U[i'IH Imo. FLEVAI ION OBSEHVED_ _ EST HIGHEST- TO BLDHOCK IF uIi;ERVFD (SE[ ABRHV. ON PAC 1 3.Z \O\•zt 1~0►-)~ ~3•z' c:s 81 ~hL; 7.' ch Gv >'l; 3 1 Z O, c>-7' 3~ ~-TS L.~Z 3xGi,- S); 0' _w taw cw~r I S ;moo' LT - erg S T~n - \-•O' @1_L 1~ ; \•1' Zvi Gv- L ~ fib G~sl; Z.4S' f. 3 \oz.3' 1VOti > 8 8y\ 1s - as S LTS \ b'$nG~-L Z.y' ~r GVSI y' 1o\.y' ~orJ~ 9• y -A t4 a>iN C3ii 1s s 1.41 Bh Gl. l ; 1.3 ' 8h Gig S ; LT 3 5 q.6' \O\-, +NOtoj C ? g• 6 S. 3' S n Gv- 1 s PERCOLATION TESTS I ESf DEPTH WATER IN HOLE TEST TIME R IN WATER LEV L-IN H RATE MINUTES 10.413ER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD T- SRI PER INCH ~ 30 \ 7/8 ►-1/b l 8 1 Z 4Z ~p \ p 1 V5114 Z IL3 3 U9 fJ~ 'sly '31f~ 131K 6 LWL. oZ-.J' - OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ial 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 i,,nd slope. 1tJ11om~ Sr, .-*R~. YSTEM ELEVATION ~ I I - NE try bw ii aZ i~- m - ~n1 e L/ . r a • ~ l i - . • _ ~vll-~Ii~iG 1U ~E ftT i`LttST -~BS _ 1 Slt-- ' - - - - - Z IJ 'T'?i of S Y 3T151 J t' o*'►-SbST~ htz~`A r_ • ,__eFt--T-- X30 - ~ VED ' PL N1 it Cif !t" 'AU a►.a`+„ - ~..e_ Uz` ~t~J PrPE u~a ~•aT wlwfl~t ' . I _ ~ i _ - _ _ ARP 8 C3 v1 - tn.. 100, p' 1 , o pots I ; z - C P s~Q nh~_- ' L trx-tis?T PGs SYtUWW Sic. Z' 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 ; .i.),slijilive Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ME ipr ntj NESTS VVERF COMPLETED ON: - - CEHTIFICAIION NUf"fiERf HC;t'JE NUrAE:FR(o tiondl). o - i'sr SIGNATURE i 1I;, I WUU1 ION O, eruct one copy to Local Author sly. Proheity Owner and Soil Tester . H • z H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z f~ n t tv OWNER/BUYER,5T1 C 1'D ( p I'~ C S) ^I `j ROUTE/BOX NUMBER ~)•Q SOX Fire Number .CITY/STATE A4 L),A5(7'yj f J , ZIP y 01(p PROPERTY LOCATION: NE ~14, Section T N, R Town of ~J~Y~l~c St. Croix County, Subdivision -P-rOVO-se4A 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 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, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 C. I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE 1 8CQ St. Croix County Zoning Office ,,QG P.O. Box 98, Q 1`~u Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - n ~ Owner of Property Location of Property Section 2- , T 2 ! N-R~Q Township{ Mailing Address ® ~)C S il='~ ^qL Address of Site ~PVt 1M £ r' C t t- r t VC Subdivision Name 1- LD-P 0 J e4~ 1 Lot Number Previous Owner of Property 1 Y' PC Total Size of Parcel U 5 ~Y 3 Q Q G° res Date Parcel was Created Co Are all corners and lot lines identifiable? Yes No ~i Is this property being developed for resale (spec house) ? Yes No Volume 7S7 and Page Number Z2--/ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In adds on, a certified survey, if available, would be helpful so as to avoid delays of the mewing process. If the deed description refer- r RECEIVE=D ences to a Certified Survey Map, the Certred Survey Map shall also be requ red. rVUJlo#~~~----- PLUM,-3"f r, PROPERTY OWNER CERT I'CATION °1'~'~'•A(1 I (We) ceAti6y that att statements on this 6o"e true to the bust o6 my (ouA) knowledge; that I (we) am (are) the owner (s) o6 the pnopeAty dens cA ibed in thtis .in6on.mafii,on 6ohm, by viAtue o5 a wauanty deed neconded in the 066.ice o6 the County Reg.usten o 6 Deeds as Document No. ell 7 z ; and that l (we) pnez en tey own the pnopo.a ed site 6o t the sewage digs pas system (on I (we) have obtained an easement, to nun with the above descA bed pnope&ty, 6ot the con,6tAuct%on o6 said system, and the same has been duty neconded in the 06jice o6 the County Regi,6teA o6 Deeds, as Document No. SIGNATURE Olt.OWNER SIGNATURE OF CO-OWNER (IF APPL LE) DATE SIGNED DATE SIGNED I CERTIFIED SURVEY MAP Located in the NE 1 /4 of the SW 1 /4 and in the NW 1 /4 of the SE 1 /4 of Section 27, T29N, R 19W, Town of Hudson, St. croix County, Wisconsin. Owner and Subdivider: Allen Brakke Cornwall Broadcasting Rt. 1, Hwy 12 Hudson, Wi. Hudson, Wi.. 54016 Scale in Feet 0 100 200 300 E-W 1 /4 Section YE LEGEND W 1/4 Corner 1 /4 Corner Section corner monument Section 27 ction 27 2" round iron pipe found T29N, R19W N 88027'200 l "x24" round iron pipe weighing 1.68 # per ft. set : 2570.38' IN M a% O a` 714 _unplatted_ lands Point of beginning N 88012'43" W 366.00' 0 300.00' 6 6' t b~ ~I ~I _ o o o LOT 1 O N O `O O O O M 04 130, 800 Square Feet or 0M o 00 3.0028 acres ~ 0 C; 00 M +j I Z 00 3 b I - w Gy 1" IRON PIPE p O H N I o 4-4 CAS ~I _ kD M b 0V) W O map Ln 1-4 ~M r 'It d of O r- 0 En 0 0 ~ '1_4 Z p CIO Un-recorded & 300.00' 6 6_ unapproved map S 88012143" E 366_00' 66' private roadway easement _unplat - --t ed -lands 6 6' S 1/4 Corner of Section 27 Parcel 020-1075-10-100 11114/2006 11:32 AM PAGE 1 OF 1 Alt. Parcel 27.29.19.302B 020 - TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/25/2006 00 0 ' Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WANG, SCOTT G & SARAH L SCOTT G & SARAH L WANG 650 BRAKKE DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.663 Plat: 1726-CSM 06/1726 SEC 27 T29 R1 9W NE SW 3.002 AC LOT 1 CSM Block/Condo Bldg: LOT 1 6/1726 INCLUDES P302C ASSESSED BY DEPT OF REV-MFG Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 27-29N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 05/29/2002 680190 1899/243 QC 05/29/2002 680189 1899/242 QC 05/29/2002 680188 1899/241 QC 0C 08/13/1997 1257/380 .09 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/23/2006 Description Class Acres Land Improve Total State Reason MANUFACTURING G3 3.663 143,800 514,400 658,200 NO 10 Totals for 2006: General Property 3.663 143,800 514,400 658,200 Woodland 0.000 0 0 Totals for 2005: General Property 3.663 146,500 550,300 696,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1075-10-200 11/14/2006 11:32 AM ' PAGE 1OF1 Alt. Parcel M 27.29.19.302C 020 - TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/25/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - RICHMAR INDUSTRIES LLP RICHMAR INDUSTRIES LLP 642 BRAKKE DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.330 Plat: N/A-NOT AVAILABLE SEC 27 T29N R19W NE SW.33AC O.L. 1 OF Block/Condo Bldg: CSM 6/1726 ASSESSED WITH P302B Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/25/2006 823589 QC 05/29/2002 680190 1899/243 QC 05/29/2002 680188 1899/241 QC 05/28/2002 680189 1899/242 QC mo 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 020-1075-10-100 Valuations: Last Changed: 08/19/1993 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1076-20-100 11/14/2006 11:32 AM PAGE 1 OF 1 Alt. Parcel 27.29.19.307C 020 - TOWN OF HUDSON Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/25/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - RICHMAR INDUSTRIES LLP RICHMAR INDUSTRIES LLP 642 BRAKKE DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.330 Plat: N/A-NOT AVAILABLE SEC 27 T29N R19W NW SE.33AC O.L. 2 CSM Block/Condo Bldg: 6/1726 ASS'D W/020-1075-10-100(302B ASS'D BY DEPT OF REVENUE/MFG Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 27-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 04/25/2006 823589 QC 05/29/2002 680190 1899/243 QC 05/29/2002 680189 1899/242 QC 05/29/2002 680188 1899/241 o (~C m 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 020-1075-10-100 Valuations: Last Changed: 10/23/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.330 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00