HomeMy WebLinkAbout040-1205-60-000
AyO 3-0 n d
° 0 3
c O w 0 O O t0 QQ~ 01 A •
h i
S O_ C A O a K io Q H
\ C Z G y O N M
CD 'X.
O
0 c _ O
D O O C (O~
3 0 7 N a O
O
o y M
ee o
-0 CD
( a c
C (D d
~i C~
~J (D
O O
r Fri n L
I.j. H r° O N i ~
W ° m co
3 N M M
~p w N m
•
7a W
oo 7d o c~ rnO
cr 3 m to th Q o
o CD vvo o
t o
O U) 7 1 V cn
H ~ Z ? d ~ ~ 'I ~ N
N ~ A
rt
rn a y ` ~I
z °N y °0o Or
a oo O B ' t~
° m h•
° y
v ~ 'o c
I t"' y ~ I co ~ ~ ~f
~ ~ O N ~ c ro ~
rt 0 p w a
z Z ? c -1 CO)
\
N Fr- v ° V °c .o.
110 cn
m a A
rt
o
(N C rt
i (D t-t o o A ~ co
c') Q CL ~ z
rr
(ON 3 CO
r~r ror
N. ! z
K Q w a
0
CL n
I °
3 d c
'o a
o
m m
n a.
D,
I
I
a
I ~
I o
v
N
O
V
o ~
b °
V
A 0 r W
~y
CD L ~ ti1
„i Form - S T C - 104
ij
AS BUILT SANITARY SYSTEM REPORT
OWNER C•e:~Asor,-AAOWNSHIP y o SEC. Td-6 N-R1.7 W
ADDMS Nr 3~" Noy t~j ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT S LOT SIZE
PLAR VIEW
Distances and dimensions, to ifieet requirements of I-LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
y
N
614
I°
•
k.,
T
7 ft S 3
r: . Q
Oil.
VA
/0
10 r o
Z. 9-b
a
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used e4~!r're r Y. g,l~c d~,.e ~v,g J
Elevation of vertical reference point: .14'0 -00 Proposed slope at site: IZZIO~
SEPTIC TANK: Manufacturer: Liquid Capacity: ~OOOSd
Number of ripgs ued: Tank manhole cover elevation:
rod, U ~,p p.
Tank Inlet Elevation: ?LS`:OO 'dank Outlet Elevations
Number of feet from nearest Road: Front , Side, Rear, s 13 fdet
.From nearest property line Front,O Side
Rear, Z9 °Z feet
to 0
~c e!/.,dfy e~
I Number of feet from: well 45'-. 114/
~ SUildiug: 1. -14 1
(Include this inf6rmation of the 06Ve plot plan)( 2 reference dimensions to septic tank)
Ste REVERSE SIDE
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, Q Side, O Rear, 0 Ft. _
Number of et from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: TrenchV
Width: )4k Length: S U Number of Lines: Area Built:-
Fill depth to top of pipe: J mil'
Number of feet from nearest property line: Front, Side, O Rear10 Vt. _
Number of feet from well: ti •f ,~a~` s!~///'e t"
Number of feet from building:
(Include distances on plot plan).
SEEPAGE 1PIT~
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 ///7/
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, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
/
77
Dated: Plumber on job: L' ~e 1,r-e` -4e'~Xe License Number : 4~~7 1<2
V
i
3/ 84 :mj.
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. 80X"7969 BUREAU OF PLUMBING
MADISON, WI 53707
[VCONVENTIONAL ❑ALTERNATIVE State Plan LD. Number.
(lf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE
Production Credit Association River Falls, WI 54022
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. LEV- IcST REF. PT. ELEV..
NW NW, Section 16, T28N-R19W, Town of Troy, Lot 6, Glover Station
Name of Plumber: MP/MPRSW Nn.. County Sanitary Permit Number:
Charles Webster 6589 St. Croix 79188
SEPTIC TANK/HOLDING TANK:
MANUFACTURERA fff~~~}}} LIQUID CA PACITV. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROV DED: PROVIDED:
/000 ri 1 ' f y
_ ES ONO DYES NO
BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING. JVENT TO FRESH
C ARM FEET FROM ^ LINE ` AIR INLET.
OYES NO AYES ~Ibo NEAREST
DOSING CHAMBER:
MANUFACTURER. BID CAPACITY PUMP MODEL PUMP;SIPHON MANUF ACTH"'H T ABEL LOCKING COVER
PROVIDEDONO DYES ONO
GALLONS PER CYCLE: AND CONTROLS OPERATIONAL NUMBER OF PROPERTY BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE IAIR INLET
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing j,,IAMF TEH IMATIRIAL 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 1110. OF DCOVER DIA zPILS LIQUID
THE S MAT HIAL' PIT DEPTH.
DIMENSIONS
H'-'LLDLPTAI FILL DEPTH UISTH PIPE DISTH PIPE
I 4
DISTR PIPF MATERIAL NO DI H NUMBER OF PROPERTY WELL. BUILDING. VEjL TO FRESH
BELOW PIPES ABOVE COVER EINLLF T ELEV ENU PIP FEET FROM
C/ LINES AI ET :
>S '3~ 2 NEAREST ► 3
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-
D Y ES NO meets the criteria for medium sand. TIONS MEASURED.
O
SOIL COVER TEXTURE III RMANENT MARKERS OR S E H V A T10 N VV E L LS
_ DYES ONO DYES ONO
DEPTH OVER TRENCH BED DEPTH OVFR TRENCH RED DEPTH OF TOPSOIL JSODDED ISEEUEO MULCHED
CENTER EDGES
DYES. ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF LATERAtE PTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIERIAL NO ISTH DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV. DIA. ELEV.' PIPES'
IA."
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING CHILLED CORRECT LY ER MATEHIAL VERTICAL LIFT CORRESPOND S TO APPROVED
PLANS
DYES OYES ONO
COMMENTS: / PERMANENT MARKERS: ORS ERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE
DYES ONO DYES ONO NEAREST- 5
_2~ a•
rf:05149P Q
0A. 0
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE TITL„~,~
DILHR SBD 6710 (R. 01/82)
wlsconsln ' APPLICATION FOR SANITARY PERMIT u
(~ICHLHR COUNTY
(PLB 67)
- OEPRRyTT1EnTOF UNIFORM SANITA Y PERMIT #
InO1JSTRV,LR80R&HUMRn RELRT10ns ^I/ A
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
}°~o, IPA, -Qi ssecrG 'rl~Lc ?C
PROPERTY LOCATION G°FFY-;
'vim' 1 /4 'VW1 /4, S A6 , T- q N, R 7 E -W) W TOE WN OFF:
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
4,4
TYPE OF BUILDING OR USE SERVED
or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
["ew 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 EAke-epage 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
47
Septic Tank Capacity ~Q orv
Lift Pump Tank/Siphon Chamber
Holding Tank capacity a[/~
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 9
Manufacturer: 'c-
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ~ Q
3- l~~~ Pr~te ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/MRQfiA..: Phone Number:
S- 67~5
Plumber's Address: / Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
W / o OtD Approved ❑ Owner Given Initial
Adverse Determination
Reason or Dis r
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.
14 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 ~Co~~•.c.~~br. l.Ce.U~~ ~;cic,l~cv~ o~ ~:yt~ ~IIS
Location of Property ~14, Section , T _,.2e N-R~ W
r
Township lt'O ~1
Mailing Address Nw`l SS 20, 43,)J,
Address of Site AA110,1
yv. s,.) , wT
Subdivision Name Z-j`q*t-e SkaAT a
Lot Number ~P
Previous Owner of Property ~•M~~t arJ ~e n~~ ~Jc.ul~ 2
Total Size of Parcel ,~•02 ~~C2s
Date Parcel was Created
Are all corners and lot lines identifiable? l/ Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and gage 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-
encesto a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) eenti.by that at t statements on thin bo&m ane true to the beat ob my (ouh)
knowledge; that I (we) am (ahe) the owne& (,s) o b the pnopenty dens cA i,b ed in th-i 6
inboAmation bonm, by viAtue ob a watkanty deed uconded in the Obbice ob the
County Register ob Deedsa,6 Document No. ; and that I (We) ptuentty
own the pupoz ed Site. bon the 6ewage digs pops a ys em (on I (we) have. obtained an
easement, to nun with the above de,6cAi.bed Pnopenty, bon the convstAucti.on ob.said
byetem, an&the name ha.6 been duty recorded in the Obbice ob the County Reg.usten ob
Deeds, ab Document No.
SIGNATURE OF.OWNER R;vCf FC.ils SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
C!1
• H
. a
STC - 105 r
' a
H
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
. cy
~ a
\ H
OWNER/BUYER M
ROUTE/BOX NUMBER *wX 3S W. ~,0 PS-3r Fire Number
CITY/STATE ~".V~c ZIP 54102-
.
PROPERTY LOCATION:jL$,%j_k, N~14, Section T_ N, R ( 1 W,
Town of St. Croix County,
Subdivision 'CFoy4.c CAc_ VOvl , 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.
0
• E
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- v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date. eAAWU'v%`
SIGNED DATE G - L " Sly
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.
H
• z
H
• a
STC - 105 r'
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County 0
. t7
a
OWNER/BUYER S r~✓<i✓ M
ROUTE/BOX NUMBER Cd ) ULi t ~ Fire Number
.CITY/STATE /~,G}~L n-, N ZIP0~1--
PROPERTY LOCATION: tlE~ 1, Section T~)FN, R~ W,
Town of „ St. Croix County,
Subdivision C1__ o t11r/2. 5'fA-~'j•,,,4 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 zn
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.
DATE - Co(
St. Croix County Zoning Office
P.O. Box 981
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
c N
r n
x
a o
O ~ cn A* ~ ~ o cD ~ ~ ~ O o
7C
44 7
7 °'3 ~A~As0fD
e 0~,Vo c w c~ N
3 co co
' -o =r v Q CD C ° O -
in s
0 a A 0 ~ N 0 m~ CO (D 00
°w w m aim R_
co A =r
(CD, > > cD n
co Ain o°~~0 C:
> > O
3p0 ~C- C =w
::r c cr :3
N W
C (=r
CD w - (D C -
ai C D (CD O
a-
° c o o~ ~
c t°~w m O
CD co o cn C
'Nc m°~z a
=r. to 0=rCD Z
a n 3 (A a > n
Nccu °?f~A-'- M
W a 0) C O ? =
a m w ?aco N
0 w a C A g fD C m
6\0
°
3~ ~mnCD
CD =r o CL
CS~ w a~ N Q N
0 CD CD
O cn ~0 M _ .C+tp
N O CD C 7 (n
~ A
w0* (A ;~N~ m
a a
o Q3f - =n
C ~C) N 0 3 y A
~N0 G) cc~ to °
C A C -4 O N A (D O c
a0M 0Uoa c m 14 cm m '
p; S 3 0~ 0°3 •
ce W a a (D O
w rn N. M• a O< 3
- CD
C ' c° o O~ c
m
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND LATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76
HUMAN RE
N WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ Y: LOT NO.: BLK. NO: SUBDIVISION NAME:
Vw '/a wv/4 >6 N/R /9%w)W ~i-e) a~er s,d
COUNTY: OAR'S tIYER MAILING ADDRESS: 1
S2! Cr- d) ./CTCa < ~~CG LI. ~C. ,Pa'1 7 i f~
USE DATES OBSERVATIONS MA 15E
~ ~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DE CRIPTIO PERCOLATION T STS:
21Residence / , ew ❑RepIace
S: A~
RATING: S= Site suitable for system U= Site unsuitable for system CJ .7
❑
CON TIONAL: MOUND: IN-G URE: SYSTEM-aILLHOLDING TANK: RECOMMENDED ~SYSTEM: (optional)
UU Q SS []U I~j]J J.lr U ❑S PO
If Percolation Tests are NOT required DESIGN RATE: [Floodplain, n
y portion of the tested area is in the under s.H63.09(51(b), indicate: k- 1 - i
1 indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
G' t? e ski /Z /3•,JS ~ /3 B~ $S~ j-3-~., CS.
B- lVo" 0
a s s , ~ z 6-1 A. C s
B-
g 9~ ~8 , > C;
mod„ e > -7 a,e s ah:~s 9 a„ .es 6%ze' s
p'ti 2 s S'1-B~
B-~ 3 /vJ t 6 8 2 s /4 S
6' /fit s;0 ~Z d-. sarp~ 13 r,47 -e s,,55 TBy c s
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P_ Z Y- 3 3 3
P- .S, a o rs' 6- aS
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. T'r 1= 9 V . F e~lJ c e ~ eht r, of s~
SYSTEM ELEVATION r- = . , s3 r~ 'F = 9.r s3 B~ ~s~
e ft
e ( _i ~~r .urn h Q 'e I C- I 1. P
!L1 Ol
~ ..a£..
- f & d X mm,~ _ h _Z _M _
01
~ _ - T~~.__f SI sI ~1 3w
r
03
{
6vaft + ~_(n_ rg _ _ X1 . C _ X = 9 2 !
p...ct/i J d s i i1 ' X4g
>A_ 98a.-a e~ r
_ - ' ' J/R"L"-~~_"~Y~.~ ~,1. s _.~..W.P ~ c~n-Z~-C. p~,2~iY TvC~ir~~
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in ccor with tYSe pro?eecQures and mettoflssOecified 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:
CGJv /rs L. GtfP lvs ,5_// /
ADDRESS: CERTIFICATION NUMBER: P ONE NUMBER optional):
CST SIGN RE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
p® g~'qg gyygpg/pg .+p9 gyty 1
_ -`JCTION/+p FOR COMPLETING FORM B 15 - SBD 6395 y
To ! -St, your report mus' "-cl>. de:
2 tn111etiler th or C project;
3, I` nmei
4.
5. C A 1 TANK ONLY BE ALL
6, -L pleting ti p t plan;
A
7, MX'
-T I set
THE
L;
f
F
Six Gael res
rent may r est
o ~u G f Cln 1:_ t- i As e C.." erg ?'`r
'Owner's name San. Permit No.
r
r
H63.05 PLOT PLAN
Show:
ED- Location of building served u4 Dosing chamber
`may Septic tank U~ Vertical/horizontal reference point
Building sewer System elevation is
Effluent system e -1 Well r`°I'9eJ-,' 1 d i ' 93 3
Replacement system area ~ Property lines w/in 50' of system
t.rcelP,,~~tt~~r 2Y~
Distribution boxes ~ Scale = /,a= Ir , o-r- dimensioned
Pump and controls: -
Mfr. & Model No. Vertical Lift Size Force Main
1-111
Friction Loss T. D. H. Vol. Dist. Pipe Gal-per Min- Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
fu ch d °
r c/rp,l ti ell VAP
U ~ tvc dlo~4:f 9~rdbme
mss..
fill yt~rr~i~GPr,P/~
Ilk-
-y r.- ~k l~s d f
1 C ~ry ter
OYC ✓ /®d t~ !d vv~ y t tip e„ c Jl1 s .r/d h
f
T^ a/`~t"
. CaY.,~ ~x ~ JfG+ h eQ~ea CP ~O k .r Q~ ~ .a~. ~ !df ~ fO~d''I
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, Pierce County and the Pierce County Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
P
um r s signa ure icense a e _
Rev. 3/8
* Parcel 040-1205-60-000 02/07/2007 10: 13 A
PAGE OF I
1
Alt. Parcel M 16.28.19.960 040 - TOWN OF TROY
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 - HUFFMAN, BRIAN M & CLAIRE M ZAJAC
BRIAN M & CLAIRE M ZAJAC HUFFMAN
552 OMAHA RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 552 OMAHA RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.160 Plat: 1993-GLOVER STATION
SEC 16 T28N RI 9W 2.02A GLOVER STATION Block/Condo Bldg: LOT 06
LOT 6 (EZ-1-1128/17) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
16-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1131/176 WD
07/23/1997 969/33
07/23/1997 749/345
2007 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.020 90,000 264,500 354,500 NO
I
Totals for 2007:
General Property 2.020 90,000 264,500 354,500
Woodland 0.000 0 0
Totals for 2006:
General Property 2.020 90,000 264,500 354,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 205
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00