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Parcel 032-1046-90-000 11/15/2006 02:04 PM
PAGE 1 OF 1
Alt. Parcel 16.31.19.237A 032 - TOWN OF SOMERSET
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 - PARSONS, JAMES O & MARILYN
JAMES O & MARILYN PARSONS
2148 CTY RD I
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 2148 CTY RD I
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE
SEC 16 T31N R1 9W 20A N1/2 NW SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 723/569
07/23/1997 460/170
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 48,000 140,400 188,400 NO
PRODUCTIVE FORST LANDS G6 17.000 68,000 0 68,000 NO
Totals for 2006:
General Property 20.000 116,000 140,400 256,400
Woodland 0.000 0 0
Totals for 2005:
General Property 20.000 116,000 140,400 256,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 145
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r J C~i(..CiW"Ly
October 31, 1997
James & Marilyn Parsons
2148 Co. Hwy. I
Somerset, WI 54025
RE: TOWNSHIP BUILDING PERMIT
Dear Mr. & Mrs. Parsons:
I have reviewed the information which we have on file regarding the
septic system which serves your existing three bedroom home and the
recently completed soil evaluation submitted by Kim O'Connel,
CSTM#2344. The septic was designed and installed to treat and
dispose of the waste generated from a 3 bedroom home. It is my
understanding that you wish to obtain a building permit for an
addition to the house, which is to include adding a fourth bedroom.
As the septic system will be undersized after the addition is
completed, you must complete and submit the enclosed affidavit
attesting that you are aware of this fact and will make this
information available to any parties who may be interested in
purchasing this property in the future. It appears that this
system meets current code requirements in all other ways.
Accordingly, the only permit needed to proceed with this project is
a building permit from the Town of Somerset.
We have no objections to this addition being constructed provided
that the addition does not encroach upon the required setback
separations from the septic system. The addition must be at least
5' from the nearest edge of the septic tank, and at least 25' from
the nearest edge of the drainfield.
Should you have any questions or concerns regarding this matter
please feel free to contact me at his office between the hours of
8:00 am - 5:00 pm, Monday - Friday.
ly,
Since
mes Thompso
ssistant Zoning Administrator
enc.
• ST. CROIX COUNTY
WISCONSIN
,,4r ZONING OFFICE
y~k.,.. ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
EXISTING SEPTIC SYSTEM AFFIDAVIT
The existing septic system which serves the dwelling being added on
to must be inspected by a licensed soil tester for compliance with
high ground water and/or bedrock seperation requirements as set
forth in s. ILHR Chapter 83.10(2) WI. ADM. CODE. The results of
that inspection must be made available to this office. If the
existing septic system meets these minimum requirements, and is
properly functioning, an addition may be added to the dwelling
without updating that system. This addition must not, however,
encroach upon the required septic system setbacks as setforth in s.
ILHR Chapter 83.10(1). t
Property_ Owner (s) E, CA PiSc7 N 5
MNL-~?j - PAK%1,,,JS
Property Mailing Address:_ coo
Property Legal Description: Lot# CSM/Subdivision
V6c) 1/4 S C1/4, Sec., T. N., R.19 W. , Tn. of
I, as the owner of the above described property, hereby affirm that
the septic system serving this dwelling meets the above referenced
state private sewage system codes. I realize that this addition
may cause the existing septic system to become undersized for a
dwelling of the resulting size, and I will make this information
available to any future parties interested in purchasing this
property.
Notary Public
Subscribed and sworn to
O before me on this date:
signed:- Dom- 7
Date: )Q Q'
My commission expires:
County Approval : EVOOM Moon
MYTARV PUBLIC - WISCONSIN
Date: Commbdm Expires: Ap it 30.2000
Wis%on-sin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road
Parcel I.D. #
APPLICANT INFORMATION - Plea It informaG Reviewed by Data
Personal information you provide may be used fo ry purpA&s ~P&aq Law, s. .04 (1) (m)).
g F...
ProPe Owner Ppt erty Location 3A97 Alk)
Lot 1/4 1/41S T N,R E (or) W
Propefty Owner's Mailing Address w.. 1--- r*_ I Blocc# Subd. Name or M#
G . / sT CRS
City Stal Zip Phi ❑ city ❑ Village ® Town Nearest Road
ELL
❑ New Construction Use: Residential / Number of bedrooms -5'--Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow ✓ 9pd j' '10 Recommended design loading rate a bed. 9Pd4'P trench, 9pd*
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate --,~bed, gpd* 2--trench, 91
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system s❑ u J0s❑ u 10sEl u ®s ❑ u ❑ s lXl u F _ I ❑ s Q U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2
Bed Trench
Z 5e- ?/j A114
13
Ground
elev.
ft.
Depth to
limiting
factor
~~Lin. F4-1
Boring #
l
Ground
elev.
ft. r1~`
Depth to v
limiting
factor
in. I
CST Name Telephone No.
Addre CST Number
SOIL DESCRIPTION REPORT page of`
PROPERTY OWNER
PARCEL I.D.#
Horizon De th Dominant Color Mottles Structure 2
Boring # P Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 1 Trench
Ground
elev. ;
ft.
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
~ SJe s
/yoas/~ ~s /
O`
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Jaj~,? r_<e--'40WNSHIP /C .SQ ~rsF SEC. /oE- T 21 N-R j 1 W
ADDRESS CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•hHR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
el-
49061'
1I
r .
/ROO
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used (~~~E r
Elevation of vertical reference point: / Proposed slope at site: fS~~L
SEPTIC TANK: Manufacturer: LJ e,~ Liquid Capacity: j43-Op
Number of rings used: C Tank manhole cover elevation: l
Tank Inlet Elevation: Tank Outlet Elevation: 9' 2,
Number of feet from nearest Road: Front, 0Side Rear, O r~2/ or feet
g From nearest property line Front,OSide,ORear,t"V*' -,70 0 ~ feet
Number of feet from: well 7,S;l, building:
"(Include this information of the above plot plan)( Z reference dimensions to septic tank)
SEE RF.VF.RRF. RTnV
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, Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: J 7-~ Length: Number of Lines: e1Z~ Area Built: E~
Fill depth to top of pipe: / t
Number of feet from nearest property line: Front, Side, Rea,0Ft Sao 1 /11
Number of feet from well:
Number of feet from building:, l
(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:
Inspector:
f
Dated: Plumber on job:
License Number:
3/84:mj
-7
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
[IN£ONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
E-1 Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned)
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
James 0. Parsons 4618 Colfax Ave N., Mpls. , MN 55412 11- a l'l-Ad o~ ~ tJ
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV,
1.
NW SE, Section 16, T31N-R19W, Town' of Somerset
Name of Plumber: JMPIMPRSW Nn.. Cnunty Sanitary Permit Number:
Byron Bird Jr. 3318 St. Croix 79182
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
U J a'). 9 j? J" RYES ONO DYES NO
BEDDING: VENT DIA.. VENT MATL HIGATER NUMBER OF ROAD PROPERTY WELL BUILDING: VENT TO FRESH
A_ FEET FROM LINE J AIR INLET.
OYES NO~ DYES NO NEAREST. N DOSING C AMBER:
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMPS HON MANUF ACTIIH EH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ONO DYES ONO
GALLONS PER CYCLE: 7CONTROLS OPERAT NdL., NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN' FEET FROM LINE AIR INLET'
PUMP R AND OFF) DYES ONO INEAREST-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FOR j tAMF TEH MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until CE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
6
BED/TRENCH WIDTH. LENS H NO. OF JDPIPE SPACING COVER [NIIIII. DIA SPITS LIQUID
TRENCHES MArEHIAL' PIT DEPTH.
DIMENSIONS, ..J
GR IVFL DC PT II FILLDEPTIT 051 H. PIPE DISTH PIPE DISTR. PIPE MATERIAL NO DIS.TFI NUMBER OF PROPERTY WELL BUILDING- VENT TO FRESH
BELOW PIP S ABOVE COVER JE I'EV INLF 1 E V NO PIP n AIR 2,
'S ! ~ ! Lr I n FEET FROM
'V 4V ~G
NEAREST-,
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
DYES O NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE IPIIIIIANINI MAHKEFIS OBSERVATION WELLS
OYES ONO EYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH AEU UFPTH OF TOPSOIL IS001)[1) IIE1111( MULCHED
CENTER EDGES
DYES. ONO DYES CNO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. OF LATERAL SPACING (;NAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.ELEVDIAELEVPIPES DA:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE S HOLE SPACING CHILLED COHHECT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ONO DYES ONO
COMMENT PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING:
FEET FROM LINE:
DYES ONO
DYES ONO NEAREST- -
I _j
1 c~- u
Sketch System on county file for audit.
Reverse Side.
SIGNAT TITLE
DILHR SBD 6710 (R. 01/82) P Z777 1
1
wisconsin APPLICATION FOR SANITARY PERMIT j
D ILHR COUNTY
- OEPRRTT
EnT OF (PLB 67) UNIFORM SANITARY PERMIT #
InOUSTgY• LRBOR 6 HUMRn RELRTIOns ^ / fl8~
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'%x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
dtn. e e ,,5,0,o7 G o~ to s f!l~a/~
PROPERTY LOCATION CITY:
&10/4 5,1/4, S 6 , Td/ N, R E (or VILLAGE:
VO
LOT NUMBER BLOCK NUMBER ISUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
O
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.
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):
pZ Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of PI mber (Print): Signatur MP/MPRSW No.: Phone Number:
Plumber's Address: / Name of Designer:
® !O G/, ~17C- ~f1d/ r
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
Q p/ ❑ Disapprover!
Approved ❑ Owner Given Initial
Adverse Determination
Reason for a o .
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
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.
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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property
Location of Property/Z 14, Section T~N-R W
Township
Mailing Address .7 / Co X
Address of Site /,3(!:>x
Ca m Q&S cz= .5 cf n, S J
Subdivision Name
Lot Number 419
Previous Owner of Property
Total Size of Parcel AO
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes t/ No
Volume 7.3 and Page Number A`9 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warrant Deed which includes a Document number, volume and paae_number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) eetrti6y that att statements on this janm alte tAue to the beat o6 my (auto)
knowt edg e; that I (we) am (a-te) the owneh (,s) o6 the ptto pW y d" cA i b ed in this
.inbo&mation 6onm, by viAtue og a watvcanty deed &eeotcded in the 066iee ab the
County Reg.usten o4 Deeds ass Document No. Off,/ 3 ; and that I (We) pnesentey
own the ptcoposed site 6otc the sewage d,us) ~sy~5tem (o& I (we) have obtained an
easement, to teun with the above descAibed pnapehty, 4ote the eonvsttcucti.an a6 said
zydtem, and the same hays been duty uco&ded in the 046iee a6 the County Reg.usten ob
Deed6, ad Document No.
Aw OA--
/y
GNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
1: / i~g
DATE SIGNED DATE SIGNED
l
H
z
' cn
a
STC - 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
J a
OWNER/BUYER ~f~}rr~~-5 ~_~.0►,2~olys
ROUTE/BOX NUMBER go U TL ~ Fire Number
.CITY/STATE 'Sorn,~-►12S~T WISCC"JS1,"J ZIP
N i/Z
PROPERTY LOCATION:(&)_14,3L, Section, T N, RW,
Town of ~b:.,rnYLS~T St. Croix County,
Subdivision N Lot number.
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you 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. y
0
I/WE, the undersigned, have read the above requirements and agree N
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
PaA.4-0,ja-
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.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR ANTS PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707
HUMAN RELATIONS
ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: I~OWNSHI /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
COUNTY: W ER'S/BUYER'S NAME: MAILING ADDRESS:
G -10 '>t G> v a fir, o ~6 / ®lieX 1/!/Jz
51,
USE /t G DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: IPERGOLATION TESTS:
Residence New ❑ Replace L,r~ G[ _ly
137-5
RATING: S= Site suitable for system U= Site unsuitable for system ~a r1( a ,1 -T -tl
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
~s au s Qu s ❑u ❑s u as ~u ~a~
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the /
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES 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- O-6 7,04 15 6°4;244*2 /5
~ t~FI~ Oti
Q -(o %s G-a o~ 25 a.2r z ~p S
9'0 944,5-
B- a
B- 3.3
B- 44 1 7a > v 7a .s
B- ~ 42 ~ ~ - 7 ~n /5 7- ~ yr /S a~ - Job lf~a► ~
B-
G~-- PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 11 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
P- / .3. v;t L
P- -3t
P- l
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 / Q • ~e Cc,"
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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 (prin TESTS WERE COMPLETED ON:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
er C- 0 0 0~.3 7 s a Z l
CST SI ATUR :
t
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R, 10/83) -OVER -
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PLOT PLAN
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PR ~sn Goiz~lU„r~u~iao%
1145-Or' 1 /4/S/j /TA N/R /,1N TOWN ~rse/COUNTY
RS Byron Bird Jr. 3318 DATE
BEDROOM CLASS PERCCONVENTIONAL)( IN GR PRESSURE
CONVENTIONAL LIFf_ MOUND HOLDI G TANK
SEPTIC TANK SIZE IFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA go< PERC RATE BED SIZEe,~-a
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark f '
s • ~ in Q~~ c Gcr
* H.R.P. c ~,o .z c
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Borehole Q Well Scale
V . --,/o Feet O Perc Hole System Elevation`
TYPAR COVERING
2"
331 33
1 Sewer Rods
12' 18' 24'
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