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HomeMy WebLinkAbout040-1018-30-000 I n CA p N O 9 d o p r o m f o = a 3 f Dr r1 o o a m a y I CD co ' CD 3 3 O C Z= Z ° rn 7 -i Z p j T -1 A `C w O cn O co p :n O p N p ~~~111 m v m N 3 CO CD 3 Q (D in A (p z O C) M N N (p (D O N ~ . 00 0 N j fl- S O = N W O T °o (°w h m o :3 C, 3 ° cn ° iE- CL - m - - N ° - n N o p (n N C n N W ~V E; C C (D CT y o D Dn d a 0 n CD D a a 0 tCT cA " a = CD (D a - m f7 (n TJ 7C ~I, CL0 - O I*t CD CD PQ CD -7j o r- cp 0 00 CC) cn (o (71 w w ° w^. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " SMITH, RON & MARY RON & MARY SMITH 535 OLD HWY 35 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 535 OLD HWY 35 S SC 2611 SCH D OF HUDSON SP 1700 WITC it Legal Description: Acres: 4.682 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W LOT 1 CSM 6/1686 ALSO Block/Condo Bldg: LOT 3 6/1686 NOTE-ONLY THAT PT OF LOT 3 LYING DIRECTLY S OF LOT 1 IS DESC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 04-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2004 757617 2534/092 WD 07/19/2001 651574 1683/298 WD 07/23/1997 1215/118 WD 07/23/1997 847/188 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 26247 178,600 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.682 68,000 111,000 179,000 NO Totals for 2004: General Property 4.682 68,000 111,000 179,000 Woodland 0.000 0 0 Totals for 2003: General Property 4.682 48,400 102,800 151,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ay Y y 0 O co) O II 3 n 0 M CC C I~Y C A G C 1 ° co~ 3 W (D 7 (D 3 n M ID 3 m 3 a ~n Q ° m o Z ° ° N• o y o CD o a (D A 3 3 (p m to l< N° S o ° n 3 O 7 S N N W nS (D ° S -Il O a 3 v 3 o b p' 7 N w 7 N C4 00 Ell N U1 CA N W M ° C W to Z D ' a " c D y C O (a N (n o° p l' (D Q IW a ° O m m O c°n °a ~o N\,(D 2 (n 00 00 rn M rn 3 c h• C, 0 0 V Q O c O O O 0 O O O C a3 tiNO~ 3 cnNN 0 D G m O _v o D m ID DJ O It, ID M Vt Dt ' • O fD ID O (a 7 7 00i C OO Z C co Z O ° 7 CD p O ° O a =r -a CD 3 O co :E CD y 7 a y a) Ch N (O f N cc C C N D I- CD CL CD d 3 CD 3 5 ° -4 Ch (n o o p z c , . CL 0. A 3 I I ~ co Z - a CL CL ~ Z 00 0 3 ~ 3 i o o ° a I I ~ I D a w n w (D (D N a m o a 3 n 3 0• a (D N :3 o' ° c v v ~.o a ao CD Q a w Q fi a ° a I ° I 9o CD O CL o 00 a o a o o o m a ti o0 00 b 0 ! 0 a I Fo rm - S T C - 104 yye AS BUILT SANITARY SYSTEM REPORT OWNER DM 1~/GO/f1 TOWNSHIP SEC. T N-RZZW ADDRESS T3y 35 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT P LOT SIZE T! r~ PLAN VIEW = 1 'Q Distances and dimensions to meet requirements of ILHR 83 < ~s tom, n~ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM T ti~4 q3 ~i~►• ~•~~~A~%o~ Rte` ~.`~S ~f-. lot a - y 13- Ito . M 'Qp p• 10 1. 3 ~~.P,er► . sy N, r p INDICATE NORTH ARROW O PAZ Soil 707 % 6p j:c of BENCHMARK: Describe the vertical reference point used #Vv'x- s1;PIW6- "~lLt9 ~'O.RtIl,~ Elevation of vertical reference point: ~00•C~ Proposed slope at site: 3 -5 ~o SEPTIC TANK: Manufacturer: Liquid Capacity: ASV cfox ' Number of rings used: ~ Tank manhole cover elevation: t~,G Tank Inlet Elevation: Lei Tank Outlet Elevation. Number of feet from nearest Road: Front,O Side, Rear, O lof feet From nearest property line Front, XUSide,ORear,0 feet Number of feet from: well re5 , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: Liquid C city: Pump Model: Pump/Siphon nufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevati Gallons per cycle: Alarm Manufacture Alarm Switch Type: Number of f from nearest property liner Front, O Side, O Rear, Ft. . Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTE Bed: Trench: 61 Width: Length: 36, Number of Lines: Area Built: Fill depth to top of pipe: TT Number of feet from nearest property line: Front, ® Side, O Rear,O Pt.•3 7 Number of feet from well: /07 , Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: ' Liquid depth: Bottom of se a pit elevation: Area Built: Has either a drop box r distribution box O been used on any of the above soil absorbtion sytems? Check one). HOLDING XANk' Manufacturer: Capacity: Number of rings used: Elevation of bottom of Elevation of inlet: Number of feet from nearest pro y line: Front, O Side, O Rear, 0Ft. Num of feet from well: umber of feet from building: Number of feet from nearest road: Alarm Manufacturer: HOMESITE SEPTIC PLUMBING CO. RT. 3 O'NEIL RD., HUDSON, WIS. 54016 y Qj Inspector Q (Q WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Dated: Plumb fir on job: b INN IN3TAl;,.~ R ncstraFe L IC. NO. 00663 License Number: 3/84:mj 3 n d LZ C.) 3 C1 0 3 co n, co c r ~ 0 A ~ I st A n m ~ o VI 1 I T r+ 0 3°o~ (.0 0 Z Z N G ° ~ I O N N N m CD ' o ~ co N 1 3 .Z @•+ c CD I N CD ' WO O m, d N .p T N 0 C) a 3 (~D O N ? I N n N O O O Z3 i s 3 3. CD 3 0 3 N N t~l CD CO .D q 7 CD O 0) I H N ca c(o3 a QO a N d QCn t °n o CD D a O CD CL 0 N Z D o O (n IW °Cf) d ~ D N a I Q c v°, a$ l►r CD U7 O 0 O ' r Cl) CD 3, rr (D 'n, Zo a z N cn !r • o LT, = 0 p 0 m l 0 0 0 y C n O o D 6 c N N to o o - I '4 3 o O c? rn CA A _ a 3 G ^ o H CD T N 00 3 m rn N to z CD o tw D a ? o Z CD Z O -p D cn !+l O a CD cD N 0 o CD CD U) N CD to ro o La n c. m a m 5 -a N 7 CD o - V m N ~ A Z 0 O a O !v x rt C p ~ o- I ZN~ Ip b O W OD (D m Z o r-7 W o 3 v' p rr x c 3 3 m W N I N U-1 Ln CD A t1 o co mo cvi ~d N) ('ID ~ W n 3 ON CD CD O :s CD (D z D m O N o T tO eo a o N 4- N CD O U , I 3 I a Ry (3N o V ' O ca :3 (n ~p Z a I a ~ I ~ tyg I o 0 o v p 6 v r3 \ ° CD c ~ C) 7 C7 C_ I 0 CD c~ rt \ CD CD o O o ¢ a o a 0 c "1 0 I 3 .may ID `D a T m 1 loft) 0 Z Z ° 0) A --j A A • a m rn a p CD y M o c m O co O CD su co N N 7 Cn S 7 m fQ -4 o N A ID 3 O Q O N to o O ~1 I Q Sl ~ O O lV m~D C a-I CD Q ((]N N p z CD a o o 3 N o CD O °m N , n ° aoo co c ai 0 c 4 -4 N o o ooo 3 c y o N D - 6 0 O p 7 X CD N W (A ! p O ' D N z rn ` ~I Z D m o 0 a CD CD tol v N CD N N w n a 3 7 Z m (6 -4 CA p N O A` CD m a ? 3 j Z -I W -0 e M co z C Cl) co m N z m A w I D 0 CL sc a <a _ C CD z a a o 0) CD I y CD m ~0 a I r. ~ I A co I ~ v ti oD °o co a A O Oe Op A p 0 I O ~ ti DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. GC0 7969 BUREAU OF PLUMBING MADISON, WI 53707 ' EirONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number ~ El Holding Tank El In-Ground Pressure 1:1 Mound (lfassigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE: Thomas Krommer Rt. 3, Hwy. 35, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. EL NW SE, Section 4, T28N-R19W, Town of Troy Name of Plumber. MP/MPRSW No., County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 79126 SEPTIC TANK/HOLDING TANK: MANUFACTURER: j' LIQUID CAPACITY. TANK INLET ELEV,: / TANK OUTLET ELEV.: WARNING LABEL [IR OCKING COVER t (ry[ t - PROOVIDED: O VIDED DYES ❑ NO ❑YES ❑NO BEDDING: FE DIA_: VENT MATL. JHIGH WATER NUMBER OF ROAD. PROPERTY WE7TBI. ILDIN G: VENT O FESH ALARMc LAIR INLET: FEET FROM r ❑YESNO ❑YES NO NEAREST / DOSING CHAMBER: EGALLONS FACTURER: BEDDING LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELLBUILDINGVENT TO FRESH FERENCE BETWEEN FEET FROM LINE AIR INLET: P ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing TH DIAMETER JMATERIAL 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: fE NGTH NO OF DISTR PIPE SPACING COVER INSIDE DIA #PITS LIQUID TRENCHES. MATERIAL: PIT DEPTH: DIMENSIONS f GRAVEL DEPTH - FILL DEPTH R PIPE IDISTR PIPE DISTR. PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH. BELOW PIPES. ABOVE COVERSINLE=T_ LEV ENDAIR INL T.~ , PIPESFEET FROM LNE 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- ❑YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/TED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED: SEEDED. MULCHED: CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BE WIDTH: LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.. DIA.. 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: BFEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST ell ,h System on + Ritain in county file for audit. Side. SIGNATURE. TITLE: ,D 6710 (R. 01/82) unsconein APPLICATION FOR SANITARY PERMIT COUNTY .~DILHR SiC~'° DEPRRTmErIT OF (PCB 67) UNIFORM SANITARY PERMIT # .1..ST. 1, LRBOR 6..I.R. RELRTIOr15 1 V -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OW ER MAILING ADDRESS ~o M ~OM•~l Ems. ~T 3 114a y, 3 s 1111p sax) 401 S Sy0/(a PROPERTY LOCATION C71-Y: N#l 1 /4 SF 1 /4, S , T , N, R /1 E (o OW TO F: _rR01 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER //w 3S -row CQ'P_ a. TYPE OF BUILDING OR USE SERVED X1 or 2 Family Number of Bedrooms: 3 ❑ 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. X 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity /a Q 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):, < 3 &%r %s It '~e 3 yi 4 Private ❑ Joint ❑ Public I, the undersj#WF~t{eg@O"EUMN%QWnsibility for installation of the private sewage system shown on the attached plans. Name of PI ( t mbbsolt Wis. 504.6 Signature: jUE/MPRSWNo.: Phone Number: ROBERT ULBRICHT WS MASUR 211 IMBER IIG NO, 3307 Iw.P.~.s 330 (715 ) V63C45 Plumber 4l 9dfl rALL,ER & DESIGNER LIC. NO. 00663 ~ Name of Designer: 3 0 A3e.I~rP-D V &J COUNTY/DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date: + ❑ Disapproved Y c Approved L1 Owner Given Initial a~ ~J e~J O 6 Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: `-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 s 14 14, Section T ZO N-R~ W Township ::r&/ Mailing Address /I% • 3 ~y 3J Address of Site Subdivision Name °-S' ` Lot Number 00 Cy o Z-D Previous Owner of Property ~V Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? ~ Yes X No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and pa&e 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 1 (we) centi,by that aU statements on this Sonm au t.ue to the beast o5 my (oun) knowledge; that I (we) am (are) the owner(z) oS the pnopenty descAi.bed in thiz insonmation Sonm, by vi tue o6 a wa,)vcavrty deed neconded in the 066ice o6 the County Register o6 Deed<sas Document No. , and that I (we) pnesentty own the proposed site Son the sewage diz poz ~ y~ (o& I (we) have obtained an easement, to nun with the above descAibed pnopenty, Son the cowstnuction o6 zai.d .system, and the dame hae been duty neconded in the 046ice o6 the County RegisteA o6 Deeds, as Document No. 44 SIGNATURE OF OWNER S ATURE OF CO-OWN, (IF APPLICABLE) ' - / ~_J~L DATE SIGNED z cn H 9 STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County d OWNER/BUYER AA ROUTE/BOX NUMBER )Ovr Fire Number .CITY/STATE /Tl/~✓SO~rJ ) ZIP W PROPERTY LOCATION:~i9e k, St 34, Section / T Zf N, R W, Town of St. Croix County, Subdivision 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. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ru 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 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. O y m O m a5(nwN30 Uf w ~ ~ O (D ~ -Oi `G p O V ~ CD (D 7C A A (D O . CD 0- fO c I w ((n 77 1< o ° c 3 OM z m ° ~ cu p :a3. N ~MC mw+ A (o m *j (D 0 CI) ~ ~ CD -P, CI) ° (D W A Y 0 (p - = (D > > (D n °(o co w o 3 a 0' 2 p o C- c r vi 13:~Za c 20, 3 a; CO) te-% W ° j (WD p ° a f~D 7 (A D ao ~ v 'o < ((D Q A~ Q' O A CD 00 > C co W O (D 0 W O~ O W A O O O IV m = to N (D N (n Z !D :E n 0 Z ~ M M N (~D (D (7 (D am N M ?a D -1 ~ 0 D V CA C ° " A m a (o v, =r CL (a to 0- c0Z`m~ C 171 Cl) m 3cpvaDm~? m m - CID Ca O O N p tp D 1 0CL woo ~o ~ A l1w wow CD ~ 03 171 .0 0 0 1 ,y w CL * a0 O'm a~ui cr '3' C C loco' 'm A pA S A C 0 d O (A A N O 7 G g a° °a c w c S 1 O ? 0 A ° ° -3 W aCD O O B a p < _ CID to CID v c IT OF RE f- OR I- UIt DIVISION' P.O. BOX 7969 - PERCOLATION TESTS (115) MIADISON, WI 53707 , (H63.090) & Chapter 145.045) - - Jiv' r'ALITY t J - Irtl'JI~ r u FP'SF'AtoE: - Ni4lLIN' ^GDRESS: - - DATES OBSERVATIONS MADE I.SE_ -ION ----NS:P-E TI -ST_ - LAONT ENO.REDRtir_17- -G, MERCIALDESCRIPT PROFILE DES RIPTIOIv Replace fence T S° Site suitable for system U Site unsuitable for system - - . 'UNAL MOUND. IN GROUND-PRESSURE: SYSTEM-tN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 'S DU ly_S C_UI_QS DU DS GNU DDU ~g'~=3s'co►~~` Fe cul .on are NCI O T eouired DESIGN RATE: 11. any portion of the tested area is in the de; s. io'.aE+ t(b!, i o ate: I ~1 • .y • Fioodplain, indicate Floodplain elevation: 1 V I PROFILE DESCRIPTIONS - - - . - - - - - ~ TOTAL ELEVATION DEPTH TO GROUNDWATER-If'3c-'-F~S CHARACTER OF 501E WITH THICKNESS, COLOR, TEXTURE, AND DEPTH 3'JUURMIENERGI DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK) r , o:-) ' si 1 7( t t O V~>c.3n Lis; 3•y $h ''1.3n $ S-S B- 3 a. a' 98.3' o,ib' ~vv-vvL rs; a-3 ~ B1 L ; y., B- - B- B- - - - PERCOLATION TESTS DEPTH DROP IN WATER LEVEL-INCHES RATE MINUTES - TEST tNATER I N HO LE TEST TIME NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT Dt P Rt D2 P RI D PER INCH Z j .r P Ju P- + 9 3,0 P. i 77•S' 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. 7')'t'~tLsm" LOAM? SYSTEM ELEVATION ;i-C2, -T`-t t✓._._ ; 1 t + ; d lJ ~ ~ ~ C:~ Y,~ Jrz - L ©O_ O ~ fJiJ 1 , car- tiGSc ! lD►uG 1 _ , _ t-tR~iF•-IVf~I yZ Gev ~ ~ I ~ our on- - - _ , i ~ i - ~ - SulAr pj',~Otz.,P~utit ~•i~le ~ - ~ I I t 1 ' hii ~0, I ' J ~ i I I + - - - I I.AttLL sere- ~ci = yo• sue- ' y I, the un,lrr,iynrd, hereby certify that the soil tests reported on this form were made by mein accord with the procedures and methods specified in the Wisconsin ;fir: st of :r Code, and that the data recorded and the location of the iesis are corect to the best Hof my Lnowledge and belief, TESTS WEREc:dWPL7 i , .5 CERTIFICATIpN NUMBER: PHONE NUMBER(optional): Du. _'.ul) Sib -)1C.-14 ZS-ot6c/ - - CST SIGNATUR `S7 j,Ieu I iON O,y ,a a,:o v,+r Copt to Local Authority, Piope'tY Owner and Soil Tester, - C ~F^. i " S>5 ,R C: '8?1 - OVER - t_ HOMESITE SEPTlUC PLUI;iBING CO. Bz• RT. 3 O'NElL RD.: HDSON: WIS. 54016 ROBERT ULBRICHT ~INNINSTALLER & DESIGNERIC3NU 00663 v t t~ Q R~~ off. 13 O/ P O P01- L011-All ~ S67-Tom of #a-Vj"- ytp"v ?01A /0 6 0 Sat Gov, o V V Fresh Air Inlets And Observation Pipe ~ h 0 Approved Vent Cap Minimum 12" Above Final Grade y,~►~- 9 7. 3 MAf4" Cast Iron yy Above Pipe - Oro Final Grade Vent Pipe Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution It. Pipe G770 0 0 0 Tee It~~f~DIJ Aggregate Q'J,Q' • • Beneath Pipe o Perforated Pipe Below 1 2 0 Coupling Terminating At Bottom Of System Parcel 040-1018-30-000 10/26/2004 08:03 AM PAGE 1 OF 1 Alt. Parcel 04.28.19.62F 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * SMITH, RON & MARY RON & MARY SMITH 535 OLD HWY 35 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 535 OLD HWY 35 S SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 4.682 Plat: N/A-NOT AVAILABLE SEC 4 T28N R1 9W LOT 1 CSM 6/1686 ALSO Block/Condo Bldg: LOT 3 6/1686 NOTE-ONLY THAT PT OF LOT 3 LYING DIRECTLY S OF LOT 1 IS DESC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 04-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/25/2004 757617 2534/092 WD 07/19/2001 651574 1683/298 WD 07/23/1997 1215/118 WD 07/23/1997 847/188 more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 157,100 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.682 68,000 111,000 179,000 NO Totals for 2004: General Property 4.682 68,000 111,000 179,000 Woodland 0.000 0 0 All 4.682 68,000 111,000 179,000 Totals for 2003: General Property 4.682 48,400 102,800 151,200 Woodland 0.000 0 0 Total 4.682 48,400 102,800 151,200 Lottery Credit: Claim Count: 0 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Dom( 1~~0/61~i TOWNSHIP SEC. T N-RZZW ADDRESS r3 35 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE T PLAN VIEW Distances and dimensions to meet requirements of IL-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 93,14 -ro? if 0 O 1 , M 16 90 /oi' 46 lve( ~~yt . 15 (d5 N, SCsec : / = 2 D INDICATE NORTH ARROW O k A4 P-4- Soil ?41ST FD~t of BENCHMARK: Describe the vertical reference point used HVVIE 5'AAIA0 " M"~/W ~Dnn~~GL Elevation of vertical reference point: Proposed slope at site: •3~ S /D SEPTIC TANK: Manufacturer: lt)e'd CS "O'* Liquid Capacity: Arm ( ''Q Number of rings used: \3 Tank manhole cover elevation: !or, ~i 7 , 9 qy , . Tank Inlet Elevation: /7' /'7 7 Tank Outlet Elevation: / • ZG l ~ Number of feet from nearest Road: Front,O Side,Q Rear, O feet i From nearest property line Front,0 Side,0 Rear, 0 f feet Hwy. 3s Number of feet from: well ~aS building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE :jaqumH asuaoTZ 69900 'ON '31181 N : qo ~ uo aagmnTd : pa28Q 'S'8'd'W LO66 'ON '011838Hn1d 831SVW 'YIM f I N GIA 48MON : aoloadsul 910#9 SIM 'NOsam -di 113N,O E iv '00 9NINWmd 31ld3s IMAM :a9anjoe3nuvK masTV :pBOa aSaaEau moa3 ~aa3 3o aagmnH :$uTPTTnq moa3 laa3 3o aagmn :TT9m moll 199J JO mmnnmm aagmnH •33 O 'asag 0'aPTS 0 `~uoa3 :auTT A oad isaasau moil 2aa3 30 :38TuT 3o uoTIsnOTg 3o moiloq 3o uoTIsnaTg :pasn s2uTa 3o aagmnH :dlToedvo :aaanjos3nuvK 9HIQ'IOH •(auo ~oag0 6 som9ap 348 uoT~gaosgB TTos anoge aqj 3o Aue uo pasn ueaq O xoq uoTjngTajsTp ao xoq s aalpp s8H :ITTng saay :uOTIBnaTO jjTd a as 3o mo:ljog :gidap pTnbTZ :aa:lamBTQ :SlTd 3o aagmnH :azTS lid MUM •(usTd IOTd uo SaouVISTp apnToul) 0~! :$uTPTTnq moa3 39a3 3o aaqumH i L 0/ :TTam moat iaa3 3o aagmnH L f.•~~ O`asag O `ePTS ® `:uoa3 :auTT 6laadoad iseasau moa3 39a3 3o aagmnH 1 :adTd 3o dol of g3dap TTT3 : ITTng Baay : sauTZ j o aagmnH 9 : q*ua'I : q:IPTM uoueay :peg HZSxS ls0IZd2 om 'IIOS •(UuTd IOTd uo saousisTp apnToul) :$uTPTTnq moa3 laa3 3o aagmnH MOM moa3 39a3 3o aagmnH •a,3 0 asag O 'OPTS 0 I:iuoag :auTT Aliadoad aseasau moa3 3 3o aagmnH :adAl gDITMS mJETV 9an2oE3nuvH masTV :aTOA3 aad SuoTTUD TIBnaTO VITMS 330 dmnd :uoTIBnaTa AUVI 3o m01109 :48TuT 3o uOTIsnaTg azTS dmnd :a9an2oslnu uogdTS/dmnd :TapcW dmnd i : A:ITo 0 PTnbT'I : aaanaos3nulaN 1019 MO d na 1 DEPARTMENT'OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, Will %0707 ENCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: • ❑ Holding Tank 1:1 In-Ground Pressure ❑ Mound [if assigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Thomas N. KAomeA R. R. 3, Hudson, W1 54016 '5- ;2 -76 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. I N W SE Section 4, T28N-R19w, Town ob Ttcoy Name oI Plumber. IMP/MPRSW No Cnumy Sanitary Permit Number Paul Cudd 2739 S cuix 69674 SEPTIC TANK/HOLDING TANK: MANUFACTURER: P LIQUID CAPACITY. TANK INLET ELEV.. TANK UTLET E L E V.. WARNING LABEL LOCKING COVER / PROVIDED: PROVIDED. y t~ IVI((ES ONO OYES ONO BEDDING: VENT DIA.. VENT MATT HIGH WATER rN UM BER OROAD: PROPERTY WELLBUILDING JVENT LE FRESH ALARM EET FROM LINEAIR INLET❑YES NO ❑YES ❑NO EAREST DOSING A AMBER: MANUFACTURER JBEDDING: LIQUID CAPACITY UMP MOUE( JPUMP/SIPHON MANUF ACTUFIEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ❑NO P ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMPANDCONTROLSOPERATIONAL - NUMBER OF PHOPEHTV JWELL JBUILDING IVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINe AIR INLET. PUMP ON AND OFF) ❑YES ❑NO NEAREST_ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I,IAMF TE H 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 IN OF DISTR PIPE SPACIN(, COVER INSIDE UTA -PITS LIQUID BED/TRENCH TRENCHES MATAFIT IAL. PIT DEPTH DIMENSIONS F; I)F PTH FILL D PTH UIS1H PIPE DISTR PIPE DISTR PIPE MATERIAL [ TRYx NUMBER OF PROPE R7V WELL BUILDING . VENT TO FRESH I'm I BELOW PIPES ABOV COVE IP El Ev. 11-L I ELEV END P IPE FEET FROM LINE AIR INLET: ® 1? 2 I NEAREST 1110 32 `77 ja 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. , It ❑ SOIL COVER TEXTURE 111111,111NINT MAIL 1 JOBSETEVATIONIVIII-S ❑Y S ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH 11E11 1111 PTH OF TOP51)IL )SEEUF1) CENTER EDGES YES. ❑NO OYES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: i WIOTH. 7LENGTH LATERAL SPAC G LOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UIST DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA. ELEV. PIPES CIAJ ELEVATION AND DISTRIBUTION INFORMATION 'TOLE SIZE HOLE SPACING DRILLED CORTE-'I LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑N0 ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: JBUILDING: FEET FROM LINE. ❑YES ❑NO ❑YES ❑NO NEAREST- . Sketch System on Retain in county file for audit. Reverse Side. SIGNAT I TITLE. DILHR SBD 6710 (R. 01/82) wlscCnsln APPLICATION FOR SANITARY PERMIT (~iDILHR (PLB 67) St* !r _0'X COUNTY 0 DEPRRRTr1EnT OF In-STRM,LRBOR&HUnlfin RELRT10 UNIFORM SANITARY PERMIT # 1"IS ~ ~ 7 1~/ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Thomas N. Kromer Rt. 3, Hudson, WI 4016 PROPERTY LOCATION X: NW 1/4 SE 1/4, s 4 T 28 N, R 19 \KI IK. Troy , rd W TOWN OF: NE LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER S T H "35r~ TYPE OF BUILDING OR USE SERVED 7 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair X7 Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. a 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1000 1 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Wieser Concrete Products 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): Class 1 615 630 ® Private ❑ Joint ❑ Public f, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Si tur MP/MPRSW No.: Phone Number: Paul R. Cudd 1PRSW2739 (715)425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364, River Falls, WI 54022 7 Arthur Wegerer (576) COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved N q ❑ Owner Given Initial X_LAka'1Z1 Approved Adverse Determination Reason for Disapproval: IF Ar Alternate course(s) of Action Available: D I L H R -S B D-6398 R.5 ( /82) DISTRIBUTION: Original to Count 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. i u rul S 1' C 1 00 Owner of Property- -2 - A_yPw A )L)d Locatiut► of Property'fA) '-E_m' Se ctun N tt yW TownshipTe6 - . Mailing l~dtlr~5s T 21> ~ ~ 4~,SQlt~ Subdivision Names Lot Number Previous Owner of Property4 p,trft$ ~ t~a2~-t, r Total Size of Parcel /¢~S Data Parcel Was Created Are •411 corners idetttiflable? Yay, Nu - Include with this a p1ic_,,t inn uu~ ul Chu fu11_UWj'tjt;; Certified Survey Map . Deed .Land Contract' or -Other gaga1 Document wtricit describes the pru~,~'rty PROPERTY OWNER CERTIPICATIQN l (We) ramify that all statements on this form are true to the best of my (our) knowledge;. that I (we) am (argil the owner(s) of the property described in this information form, by virtue of a warranty deed reco n the Office of the County Register of Deeds as Documant'No.: ; and that I (we) Presently own the proposed site for the sewage disposal system (or l (we) have obtained an pasemrjnt, to run with the above described property, for the construction of said system, and the came has been duly recorded in the Office of the County Register of Deeds, as Document N s)4f. ^TuRf of awmc _ IGN TUNE OF Co-0wNEft (IF AP r_r '0 AULt) 4ro LrHII- S14Nkt:1 " i z R H a STC - 105 r r SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z ~ OWNER/BUYER 7 DA4 A, $ N- -4-A) L4 TNNET T. ,eje- 04404 ROUTE/BOX NUMBER RT 3 13©x 3 LU Fire Number 3,7/,7 CITY/STATE 117'q CIE -6 k) " (,t9 GS ZIP .6--41Q14 PROPERTY LOCATION: A)W 14, St.) k, Section , T -Z9 N, R Q W, Town of Trk,O L/ St. Croix County, Subdivision 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. H 0 E I/WE, the undersigned, have read the above requirements and agree czn to maintain 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 Zonin Office withi 0 days of the three year expiration date. SIGNED 41• 74~~_ DATE '7 St. Croix County Zoning Office P.O. Box 96- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. v y 'r a x m V) c v W w 1 J 1 O 40 e ~0, c pcoco m ~m v am m o? 44CA ~cmto m~~mm~~ 1131 'tmW,<N ~ tp O ID a O .+-.~p W C O_ w O_ w - O w c 3 o c o c 3 o am Ei. Z~ S Qm: wp:.. N~mw~m O p a m 7 p o O w N ID Q pC'O , (~D C G n m umi ~ p D C (~"D Boa CCD 0 a w o Q C CNC(D (1)m Z D W of0 Z CD (D CA 0 -A yam o?c-, m C w o w a O it 0 v; w a ac n m C m v 3m° vaMm~~ m m m CA m ` N m ~o C N ID =1 2: Z;3 'o< f m o c ~cco ~ m y_ ~m "4 ~ m , 0= (A w ° = n o 0 c c a a W m o m 11) CD I. (D ao m aaf CL!tm v cn c `co w m CD 3 r M. co C 0 10 OR O o ui A D O m CL o co c -gym c CL c w v ;r c o = c CL CD E` CC 0 V ` 4 ry. wh fi.:: $ G m 7 1 (D CD o 0 INDUS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRY, , DIVISION LADOR-,AND PERCOLATION TESTS (115) MADISOP.O. BOX N W153969 HUMAW RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: T WNSHI UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: tw3 SE.I/ 1/ TzbN/R 1aE (o -t-~,oY - - COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS: Si • ~.zo1x o~AS N . K~zs~►~-) E12 o.rt~ 3 t' t'So'kj , i u I _ S 4lol USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ray PROFILE DESCRIPTIONS: PERCOLATION TESTS: ®Residence N • ❑ New Id Replace I q _Z 'a s C RATING: S= Site suitable for system U= Site unsuitable for system / CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) .ES ❑U ,®.S ❑U ®S ❑u ❑S ®U ❑S ®U ti$'X3s' c~IVVeorJ~ Bey If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n under s.H63.09(5)(b), indicate: N • N. I Floodplain, indicate Floodplain elevation: . PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-lf#e -66 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN7 ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- C? C/ lvov~ > 8.3 ► bi n L s ; 8n L ; ` p' `~c $n Si I ; S•3' ~ S B- Z 72- L`Zs a 3.`J' 'By\ V • 3 ' ~r, ~ g B- 3 a C' 'IVO>v E 7 ~•8' o.~' 'vDk L 3.3' Bn I_ ; y .1 ' Qn ~S B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- o 7t3 Pts-;. l sz. c)-7 C S~ 'i 6 " c-~+ul" uu < n1&AJT'L- < 3 P- Z S < 3 P- SS 1% < 3 P-_ 9 B.O.' P- Z q7•S' 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. $O-M" pt= B ~PcG~ -7 ~L P~~Co't `-ORr'1 SYSTEM ELEVATION o-• 3-0 ~II .4fi 1.DO 4ti1E='~l ~W1'Ri i►a Sd 'oF DcaD , 's eyl(tti EFO ' tQ10- b' bli' !~~-Pcc~" F'ip,~c~1~Ur?i C~uU ~R P~pcs. loo-TToI"1 cal- f-}u~S~ .SIDI,~G p C", 0 -7 n 2Z 10 t; S W C oTt i~ lZ o>= E IN I i g 4 r~, I cH 40 E . N I ~ I - i SE .__-w_. -s. _ _ - S~° 1'C l~L tt~ _ t..E ~ • ~ S~'~~OtJ l~ 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: ~~}U12 L. WEG~1Z °C-Z~ - 85 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional)-: ~~-`IUox Zz6 ~uSw>gr~.- ►,v1 situ S--)6 I-), S_ q IS- 01 6V CST SIGNATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ` DILHR-SBD-6395 (R. 02/82) - OVER - w 1V 7_J"._.-- `--R COMPLETING FO,r" 115 - SB - 6395 ` To be a cc n°' it teat, your report mus cornnl . Th sther this is or commercial project; mercial use plat IS SU1 / ?P A HOLDING Tt`nrk' ONLY IF ALL ? -"N , ONS; 6. a d plot plan; 7. C preferred. A .t cle = Pei rnm ooc:1 pla tes e; T TH THE C? ,4 FOR C E " "CS I r °'F S Other - vs`,er Id - ~ CC d F :"1 u ct w r CRC SECTID)J OF BE D JS T I`+ -c 1: F ! FI x-l I ttv-=~ C~ lZ Act)= C SLJ31=- !b>` UIZA)#J c11 ~ f e- SOIL FILL L„ OF AC; REGATL A y2nRx, DISTRIBUTIOU PIPz-~ - ~ APPROVED Su1.17HETIC COVCR I'IhTLR1kL OR 5OF STRAW C ( ( OF, MARSH (010 %2-21/z AGGRJiEGATL E LT- V OF ~ FEET DtSTnIBU71OU PIPE TO BE AT LEkST IUCNES BELOW OP.IGIIJAL GRADE f tlU AT LEx STZO IFJCHES BUT MD MORE TRAM Lit IUCHES @=L01n' FINAL GRADL lrlur, ULP: N UF_ LXCAVkTIDIJ FRGM ORIGIIJAL GRADL -JILL B ~T IIJC-HES t,owimUM DLPTH OF EX[AVATIOU FROM DKIGIIJAL GRADE WILL BE 4? INCHES 51c k3E L IG E IJ 5C IJ0MBE R: UAT C ro;e. err 41 _c an C-r an. - - J '--C oy. r e Place check mark in appropriate box, indicating item is shown on plot plar, below: , f ro g~TRtBvnorJ PIPES C=m I s J - I 30 of 4aPVC ~~i D PI PE ~ 90~ »s ►ooo GPFL. s s s;-~- car,, e, sr_~~c TP~,k \O'OFF 'i C-Z. ~ Bn ~ k ~ J !}RP 1~0 se YJ - EL. lbu•OG&I 8 uTT01~ of I46uSE S'Zj i4JG By the grantinq or approving of the above plan, o_- upon the evert of a subsequent :rei 1+ '_°_ln^_ c :eG,~t.::T 017: -ounty and the St.. .."O~.ZC?L^.T!' [GOn1nC ~'.irJ 1T'L n- ator, doe-, R1 ` n- - C Se' r !_ble for any C7e: ec-s n "1 cns or s`)ec- 1Cc -1oP.S. ^l a: U>*:1_51o n, ci:a .::ice ]OP. oversight, construction, or any Gam,-,toe that may result in or aFter Stalla%1on. - - 5 ~_cno Fuze Rev. 3 'E3