HomeMy WebLinkAbout020-1103-60-000
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Parcel 020-1103-60-000 01/31/2005 04:09 PM
PAGE 1 OF 1
Alt. Parcel M 34.29.19.411 F 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): = Current Owner
" NYKANEN, RONALD & SHARON
RONALD & SHARON NYKANEN
651 EDIE LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 651 EDIE LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.700 Plat: N/A-NOT AVAILABLE
SEC 34 T29N R19W W1/2 SW1/4 LOT 4 OF Block/Condo Bldg:
CERT SURVEY MAP IN VOL II PAGE 544 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 746/143
2004 SUMMARY Bill M Fair Market Value: Assessed with:
48451 285,400
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.700 44,200 176,600 220,800 NO
Totals for 2004:
General Property 2.700 44,200 176,600 220,800
Woodland 0.000 0 0
Totals for 2003:
General Property 2.700 44,200 176,600 220,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 208
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
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;COMMERCIAL TESTING LABORATORY, INC.
514 Win Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121 'Itj
800 - 962 - 5227
ST. CROIX ZONING REPORT NOA 14365/01 PAGE 1
ST. CROIX COUNTY REPORT DATES 11/27/91
COURTHOUSE DATE RECEIVED+ 11/26/91
HUDSON, WI 54016
ATTNS THOMAS C NELSON
i
2a-- l 16-3 6 {
OWNER•. Ronald Nykanen 3 lei yiIF
LOCATIONS 651 Edie Lane, Hudson
COLLECTORS M. Jenkins
SOURCE OF SAMPLES Outside faucet
COLIFORMS 0 /100 ml
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NI 2 ppm
Dove 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ail
Nitrate-Nitrogen, mg/L
LAB TECHNICIANS Pam Gane O G~ N=
r a c'9 a
WI Approved Lab No. 19 ~0~~Q~
it ~.\N~PEN~EM L
V
A C Means "LESS THAN" Detectable Level Approved by!
47
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
~~11 ST. CROIX COUNTY ZONING OFFICE
r` 911 4th Street
Hudson, WI 54016
Telephone (715)386-4680
The St. Croix Co. Zoning office offers the service of septic and
water inspection to Lending Institution, Realty Firms, and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED.
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. ZONING, and mail, along with form
to the above address. Testing will be done as soon as possible
after fee and form are received.
WATER TESTING FEE:$ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE:$175.00
(VOC'S)
SEPTIC SYSTEM INSPECTION FEE:$ 25.00
PROPERTY OWNERS NAME:
PROPERTY OWNERS ADDRESS :(p$t E bla- "C CITY:... Legal Description 1/4, .1/4, Sec. , T N-R W,
Town of aUbS'6Q Lot: No. Subdivision
FIRE NO. (p S-1 LOCK BOX NO.
Color of house J~LkIt' Realty sign? Firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY OF PLAT
BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: aci,{~t,12
Telephone No. 3(x(0-JA0"7Q
REPORT TO BE SENT TO: Rbt j N%JKquej
CLOSIN
Signat e•
-7 L< Sifm.
ST. CROIX COUNTY
a yY~ .
WISCONSIN
ZONING OFFICE
ra ST. CROIX COUNTY COURTHOUSE 144 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Dec. 3, 1991
I
Ron Nykanen
651 Edie Lane
Hudson, WI 54016
Dear Mr. Nykanen:
An inspection of the septic system on the property of Ron
Nykanen, located at 651 Edie Lane, Hudson, WI, was conducted on
Nov. 25, 1991. At the same time a water sample was also obtained
for testing. The results of that testing will be sent to you as
soon as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in
any way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
sincerely,
Ma • Jenkins
Assistant Zoning Administrator
cj
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N-R//~;W
ADDRESS X~LC ~r' ST. CROIX COUNTY, WISCONSIN
it / '
SUBDIVISION' LOT LOT SIZE
~S
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Ile
I
3$ C y~
k ~ 29~
o E
~ ~7Ce 5 f / ~ I ' I
r f I
v.C of l~'C k
INDICATE NORTH ARROW
Ile
Ta °
/ ~G``t'e osr
BENCHMARK: Describe the vertical reference point used 7z ZE, ~~lo /err.7, ~,~~L
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity: /IJn C)
Number of rings used: 0 Tank manhole cover elevation: y 4, y'
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front 0 Side 10 Rear, O feet
.From nearest property line Front 10 Side 10 Rear, 0 feet
Number of feet from: well J B building: /
(Include this information of the above
Plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
i
PUMP CHAMBER
Manufacturer: It'll 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, 0 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: Len th• 241~ Number of Lines: 3 Area Built: to y~
Fill depth to top of pipe: 2t'
Number of feet,_from nearest property line: Front, O Side, Rear,0 Ft. C7
Number of feet from well: ~g
Number of feet from building: 36
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Ligpid-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: % V 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:
Inspectors
Dated • Plumber on job:y
License Number:
3/84:mj
DEPARTMENT Or, INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
,P.O. BOX 7969 BUREAU OF PLUMBING
MADISON,rl 53707
P7CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number:
)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE:
Ron Ny Kanen Rt. 1, Hudson, WI 54016 /0-
BENCH MARK Wermanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV. CST REF. PT. EL V.
NW SW, Section 34, T29N-R19W, Town of Hudson, Lot # 4, Stewart Addn.
Name of Plumber: MP/MPRSW No. County. Sanitary Permit Number:
Roger Timm 3224 St. Croix 83785
SEPTIC TANK/HOLDING TANK:
MANUF CTq URER. LIQUID CA CITY. TANK INLE ELEV.. TANK OUTLET ELE V.. WARNING LABEL JLOCK:NG C OVER
PROVIDEDPROVDED.
ONO OYES ONO
BEDDING: VENT DIA.. VENT MITI HIGH WATER NUMBER O ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM LINE AIR INLET.
YES ONO FEET FROM
OYES NO NEAREST
4J vw
DOSING CHAMBER:
MANUFACTURER. 7ING
LI
QUID CAPACITY PUMP MODEL PUMP;SIP HON MANUF ACTORER WARNING LABEL LOCKING COVER
PROVIDEDPROVIDEDS ONO DYES ONO OYES ONO
GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL JBUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE IAIR INLET
PUMP ON AND OFF) OYES ONO NEAREST 10
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing „ I,IAMFTEH ArF RInL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH. LENGTH INO OF DISTR PIPE SPACIN COVER INSIDE DIA -PITS LIQUID
THEN(;yFjt' h tAPL! PIT DEPTHDIMENSIONS / (0 ~F .VFL CrCPT ri FILL DEPTH DISTR PIPF DISTH PIPE DISTR PIPE MATERIAL N NUMBER OF PROPERTY WBUILDINGBELOW
PIPES ABOVE~J OVER EI EV NI F II ELEVENU as/1 , N E A R ESTO ► o
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-
OYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PF RM1IANE NT MARKERS OBSERVATION WELLS
OYES ONO DYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DFPiH OF TOPSOIL ISOODFD SEE DFD MULCHED
CENTER EDGES
OYES. ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE- FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE JMNO UISTR IDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA. ELEV. PIPES DI A..
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
OYES ONO OYES ONO
PEgMANENT MARKERS: NUMBRTY WELL:
COMMENTS: OBSERVATION WELLS ER OF [PRO PE BUILDING:
FEET FROM LINE'
OYES ONO OYES NO NEAREST_
Sketch System on Retain in county file for audit.
Reverse Side.
SI AT ~Ry s TITLE.
DILHRSBD67101R.01/82) LG CL~
SANITARY PERMIT APPLICATION COUN Y
70ILH In accord with ILHR 83.05, Wis. Adm. Code '
PERMIT #
3 17 P'5
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8'% x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO
PROPERTY OW R PROPERTY LOCATION
1~0 1 Ndaneii S aJ%, S T 9-57, N, R I k (or)
PROPERTY OWN R'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
if a,k 111,4 e50 c2
CITY, STATE ZIP CODE PHONE NUMB CITY NEAREST ROAD, LAKE OR LANDMA
/ ❑ VILLAGE : ~O 5t T WIN OF7 II. TYPE OF BUILDING OR USE SERVED: AW - CO-- 3
Number of Bedrooms if 1 or 2 Family 3 OR Public (Specify):
Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. a. ® New b. E1 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.
4.0 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- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. 0 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): REQUIRED (Square Feet): PROPOSED (Square Feet):
3 ~0 1-5- to 50 • ' Feet O Private ❑ Joint ❑ Public
VI. TANK CAPACITY Site
INFORMATION in gallons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
New Existing Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank Q L(JCYj (.J2¢~ES ❑ ❑ ❑ ❑ ❑
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/MPRSW No.: Business Phone Number:
b m 3ZZ~ 7/S 7 7Z
Plumb s Address (Street, City, State, Zip Code): Name of Designer:
/ .
!s N. ? !l Z l /-50111 C~~S ~flv 7i/~?
VIII. SOIL TEST INFORMATION
Certified Soil Tester (CST Name CST #
ST's ADDRESS (Street, City, State, Zip Cod) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps)
Ix Approved ❑ Owner Given initial 0, Surcharge Fee 8
Adverse Determination 1490 &W4)
X. COMMENTS/REASONS FOR DISAPPROVAL: 7- 67
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
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 systern, 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:
1. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'/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" Vrater
included the creation of surcharges (lees) for a number of regulated practices which Wisconisin's a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure
'is used in your building is returned tc the groundwater through your soil absorption '
system or the disposal site used by your holding tank pumper. 1
The monies collectec through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring around- t
water, groundwater contamination investigations and establishment of standards. C.aro.jndwater,
r"s worth protecting.
SBD-6398 iR.03/86)
APPLICATION FOR SANITARY PERMIT
S T 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/contractQZ,("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 ~pYl h n
Location of Property n , k S Lj k, Section, T Z~ N - R_ W
r
Township 7r0
Mailing Address
Subdivision Name C04-V
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? A Yes No
Is this property being developed for resale (spec house) ? Yes A' 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) eentiby that aU b-tatementa on thi4 bonm are tAue to the bat ob my (ouA)
k.nowZedge; that I (we) am (ate) the owner (b) o6 the pro peh ty deb cA ibed in this
.inbonmattion bonm, by viAtue ob a waAnanty deed teco&ded in the Obb.ice ob the
County Regi6 teA o j Deed6 ab Document No. L ; -10 ; and that I (we)
p4e.6 enttty own the pna pob ed bite boA the a ewage pob alb yb,tem (oA I (we) have
obtained an eab ement, to nun with the above deb c4ibed pnopeA.ty, bon the
conb.tAu:ction ob baid 6ybtem, a;ad the aame hab been duty neeonded in .the Obbiee
:eCounty Reg"teA ob Deeds, as Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
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STC-105 r
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SEPTIC TANK MAINTENANCE AGREEMENT H
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St. Croix County z
d
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OWNER/BUYER
ROUTE/BOX NUMBERFire Number
.CITY/STATE gitkA)" ud1l S ZIP 5ilal 0
PROPERTY LOCATION: S (A) ;4, Section , T 2,5 N, R W,
Town of St. Croix County,
f
Subdivision sj.~- 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 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. Ho
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- It
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.`
S I G1d ED
DATE
St. Croix County Zoning Office
P.O. Box 98£,
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
TMEN,T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUS DUSTiY, 1 1 DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
BLK. NOT SUBDIVISION NAME: t
SH
SECTION: OWNIP LOT NO.:
LOCATION:
Al a/ 14 1/4 .3 y /UU97N/R/4y7j ((oo rr 40
514
COU TY: OWNER'S BUY R'S NAME: MAILING ADDRESS:
S O!
S ~ ud t x 7 7 STi SO• asp W': F.
USE DATES OBSERVAT ONS MADE
(PROFILE : PER OLATION TESTS:
NO.BEDRMS.: COMMERCIAL DESCRIPTION: DESCRIPTIONS
Residence New ❑Replace l! S•-!Y 6
IG
-3 1 A LJ
RATING: S= Site suitable for system U= Site unsuitable for system A'011 ery Q
rZS ONVENTIONAL: MOUND: IN-ROUND-PRESSURE: YSTEM-IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑U O S ❑U X S ❑U ❑ S ®U ❑ S ®U Co Bid
D
If Percolation Tests are N ESIGN RATE: If any portion of the tested area is in the
OT required I ~/A
under s.H63.09(5)(b), indicate: tV Floodplain indicate Floodplain elevation: y
P FI E DESCRIPTIONS
G
BORING TOTALS DEPTH TO GROUNDWATER~Fi~}6FME3 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH I-W ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) poll
B- ?.,s Q 7 B / • C ~e y Cod ~t•S
'7 I&Y 3 A,
B- aZ 7, f' od•o' 7 7.S' 3 6, n Cs .B.C.o As
o R3/ 1, Fy On B-3 7.S' q7.6 7 3 C-SL Y-e,-e CO6 lS
•7,81f 36Yeh/ A(oOn/S, &1 C5,
B- 7• s ` o ..t s[ ~ 7 7-1' L •erc Cu rs 6
6- oLAycr1l Iylo b es a~t,4,-~F.B A-~- Ap/ 67~ Ca.•.so%~
® t B-e
PERCOLATION TESTS 11-06AP.4- T #Ad J%Cfj% ~4
k_3 DEPTHS WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
*NQHC"5 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
3 3
3.
71 A O 9 6 6 6 -3
3.34 o 2
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 dire tion and percent
FC . 7"h.`'s SO sly.-/~ y.,:74`aw :s C-#---A e_*/ P.ce-
of land slope.
SYSTEM ELEVATION 9G• 3 T L G ew,
7ex7f,83 4~4_ 1 - ' - -
Eve.-t r- " A_441-1
,C3
3
F i I d A,f - -
L 3. T~ Y
`FS O Y C ~t 53 _ _
, _ T
2.uce.• r G"
f R j ~as y" TAP
9y~ ' / ,Cv fi pp
o
y gss~,~G N
r
- , _ -~Ib~'
i
w
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to ( I 3°~ Tee f"I _
10 e_3
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): TESTS WERE COMPLETED ON:
,.r c c4c..r /0 4"- C _/16 - A, 60
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
,4u . 1~,u WCx~ o/( 17/1--34-ISTI/
CST SI NA URE:
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
'IONS FOR COMPLETING FORM 115 - SBD - 6596 ~ K
To , i ;i , ; accurate sail test, your repo- - -dude:
-(y Indic; Iv this is < nce or commercial project;
_ .ial use € k
Sull TANK 0, 5,L
7. as ,
a
opr iate `
_ IlUbT F FILED WITH THE
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9
JOB Imo() 1~ /Vll ~Li 61 Q H
ROHL & TIMM EXCAVATING Z
310 Arch Street SHEET NO. OF
w HUDSON, WIS. 54016 CALCULATED BY ~ 1/lY. 1 DATE
(715) 386-8664
CHECKED BY
SCALE
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PRODUCT 2041 ees Inc., Groton, Mass. 01471. -
i
PAGE Z OF 2
CCro5S Sec~lon O~ A Seo S Y ste ^'l ~
Fresh Air Inlets And Observation pipe
Approved Vent Cap
Minimum 12" Above
Final Grade
i
20 - 42" Above pipe _ 4" Cost Iron
To Final Grad• Vent Pipe
Mash Hoy Or Synthetic Covering
Min 2" Aggregate
Over Plpe
Distribution
Pipe 0 o o 0 0 - Too
V Aggregate 0
Beneath Pipe Perforated Pipe Below
o -Coupling Terminating At
Bottom Of System
Prt)po5cD ?'Inert 1grAcl<
~L~cJtiT t on / t
SOIL FILL
DISTI',BUTIOI.1 PIPE
APPROVED $4MPETIC COVER
WWI.
c` "'--PIATERIRI- OR 9" OF STRAW
2"OFg6GREGATE OR MARSH HAy
b (e OF %2-212 AGGREGATE
MEV. oFf , 3 FEET--._
,6
4 16'
DIS-rRIgUTlrDM PIPE TO BE AT LEAST --2- A
BELOW ORIGUAL CRAOE
QL) AT LEAST20 ICHES BUT 1.10 MORRE1THAKI 42 IMCHES 0 LOW FIIA)AL GRADE
MAXIMUM ®EQTH OF EXCAVAT160 FROM OWNAL 6RAID€ WILL BE 3, 7 FICHES
PUI41MUM ®EPrM OF EXCAVATIOM FRoM OIK11411bAL GROE WILL BE Z, 3 INCHES
S I IS E 1)
LICEM51- ULJMBER:
f
DATE: 4~_` 3 S(,