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HomeMy WebLinkAbout042-1086-80-100 nw0 a"a0 G ° 03 o `r1 f c I `D m (D \ 1 >v (A3 z o-4 =i, ro - = y p Off' 01 N N ICI N 7 _ M (D O C 1 y CO ~ N fD ~r7 I rn Z a N N W p co Co 0 N 1 A ry ip N a ° = °D p Tp R O ro n co 0 1v O 7 N M O Q C N U1 lV (n CD D m ts] N CD a WILD i c CD C 3 p N o _ o En CD z (D ((D d rt N U] ° rn co 3 !°2 Q (D rt .0 !~I S'\ F- b~ C] N+ TC '0 'O p w ll d, z C 3 S J v v F- 7- y N y m X11 0 CD 4- SD V 90 (D 0 W N 3 N a y co z N F-3 o~ D (D o r ~ 2 U) Fr X ~ fO 0. m CA) I o' a ° - 0. U) cn CD (6 ON 0 Q) C t-h 7 M CL J\ x tfc i En W (D n cn N (D 1 m H. m~ mco o a z co X " t t co o w B r, w~ F+ y z ti5 y A 7 ro C, CL Win, d n I ° o a a fD ~ N :F 4 x 9 y CD a o. co b uai A I ~ I o v tv I V w O ~ CD `D 1~0 c O N o CD b 0 Parcel 042-1086-80-100 02/07i2007 PM PAGE E I OF 1 Alt. Parcel 31.29.18.484D 042 - TOWN OF WARREN 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 - REITER, PHILIP & CATHERINE PHILIP & CATHERINE REITER 945 65TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 945 65TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 22.250 Plat: N/A-NOT AVAILABLE SEC 31 T29N R18W 20.52ACRES COM S 1/4 Block/Condo Bldg: COR SEC 31, N 1131.97' -POB N 1228.34' S 89 DEG W 296.43'N 122.66'N 54 DEG E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 119.14'N 61.20'S 89 DEG W 164.09'S 31-29N-18W 273.14'S 89 DEG W 380.13'S 874.63'S 33 DEG W 157.41'S 56 DEG E 225.09'S 83 more Notes: Parcel History: Date Doc # Vol/Page Type 04/01/2005 791152 2776/122 WD 03/03/2004 755776 2520/594 QC 04/28/1999 602172 1422/352 WD 07/23/1997 1113/172 WD more 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 22.250 95,000 142,500 237,500 NO Totals for 2007: General Property 22.250 95,000 142,500 237,500 Woodland 0.000 0 0 Totals for 2006: General Property 22.250 95,000 142,500 237,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10103/2006 Batch 06-15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 042-1087-90-100 02/07/2007 12:41 PM PAGE 1 OF 1 Alt. Parcel M 31.29.18.487C 042 - TOWN OF WARREN 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 - REITER, PHILIP & CATHERINE PHILIP & CATHERINE REITER 945 65TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 31 T29N R18W SE SW THAT PART OF $ Block/Condo Bldg: E IN 797/07 ASSESS WIT P484D 752/293) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 04/01/2005 791152 2776/122 WD 03/03/2004 755776 2520/594 QC 04/28/1999 602172 1422/352 WD 07/23/1997 1113/172 WD more... 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 042-1086-80-100 Valuations: Last Changed: 11/24/1987 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 63707 MCONVENTIONAL ❑ALTERNATIVE srole Plan l.D. Number: 111 effigncd) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Carl Hibbs Rt. 2, Box 114A, Roberts, WI 54023 _h 96 Z BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.' CST REF. T. ELEV NE SW SE SW Section 31, T29N-R18W Town of Warren Name of Plumber. MP/MPRSW No Cnu nly. Samlary Permit Number: Henry e ille 3258 St. Croix 79211 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER A PROVIDED PROVIDED ( 0'~.94 10 L)79- rZ YES ONO DYES ONO BEDDING: VENT DIA.. VENT MATt NIGH WA EH NUMBER OF ROAD: PROPERTY WELL BUILDING IV ENT TO FRESH 17 ALARM FEET FROM L'^E~ 2/ / AIR INLET DYES NO i DYES NO NEAREST Hof DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI TV UMP MODEL jP111,4P,SIP110N M ANUI ACTOREH WARNING LAB EL JLOCKING COVER PROVIDED PROVIDED OYES ONO P OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 1PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES NO NEAREST Of SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ! N(,Iif 1111A1,11 T111 111AII HIAL 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 19ID H LENGTH JNO1 OUISTH VIV! SI'ACIN( COVIH 1,51131 111A -PITS QUID DIMENSIONS C~- THENHES & I M TEHIAI: J PIT DEPTH G AVEL DEPTH 1 f FELL DEPTH UIS111 PIPE UISTH PIPF DISTR. PIPE MATERIAL NO I , t17 NUMBER OF PH OPERTV WELL BUILDING VENT TO FRESH BELOW PIPES ABOV OVER Et f V INt f t ELf V f.NU p PIPES LINE q / AI INLET 2 rl ~'.q3 q9 7' 7CJ .Z 7 ! NEARESTO--► Ec1 7 ! to l (v l MOUND SYSTEM: 7 S $ / S.Ci S 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE P I 1111 A N I N T MA HK I I(5 JOBSIFIVAI YIN WE LLS _ DYES ONO _DYES ONO DEPTH OVER TRENCH BED JEPTH OVF H THENCH HED OF VTH Uf TOPSOIL ()[)()1 1) 5f f OF 1) CENTER DGES MULCHED DYES. ONO DYES DNO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIOTH LFNGTII TRENCHES LATERAL SPACING GHAVEL DEPTH Hf LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MAiF. HIAL NO UISTH JUISTH PIPE DISTIIIHUIION PIPE MATERIAL & MARKING ELEV. ELEV. OIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILL ED COHHECI LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO DYES ONO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS. t UMBER OF PROPERTY WELL. BUILDING: EET M LI"EDYES ONO DYES ONO EAREST o~ L 9 - 0 X6..0` ,rte ~S. Z/ T 0 13-C, `t Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710 IR. 01/82) ` - SANITARY PERMIT APPLICATION COUNy; 1.I DILHR In accord with ILHR 83.05, Wis. Adm. Code n STATE SANITARY PERMIT # 17901 -Attach complete plans (to the county copy only) for the system, on not less than paper STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION G R ir-1- 111W-5- ,4 s r r, , S 3 / T N, R /S E (o PROPERTY OWNER'S MAILING ADDRESS 1-T N R BLOCK N MBER SUBDIVIS199N NAME /PT /3mx J y~1 ata* h1 ~Y = - 141 CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK Ej- V REwE!`fS J.~t 5 y~z3 7/S' TOWN OF: ILLAGE : .or, 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms ' br 2 Family -3 OR ❑ Public (Specify): O III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. El EONew 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. ❑ 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. LJ6onventional 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. ❑ See a e Bed b. 1 See a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM LEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIR ~ (Square Feet): PROPOSED (Square Feet): J Q 7.5 Al 9 5 95 , Private Feet et I~ ❑Joint ❑ Public VI. TANK CAPACITY Site INFORMATION in allons Total # of Manufacturer' Prefab. Fiber- Exper. New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank r Holding Tank %©oe% / 9E~ s C yQ g h0 F"I Lift Pump Tank/Si hon Chamber A, A 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.: ss Phone Number: Busine 7/ S 'i~y9- 33 Plumber's Address (Street, City, State, Zip Code): Nart,e of Designer: 1 x -;;l- art A,E'/ Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # /0 el- 5 ~ N 8ti0 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given initial /oo SutchargCe Fee n Q f Adverse DeterminationaJ ` e b X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT 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 (SDD 6399) to be submitted to the county prior to installation; I rl. 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 syste 3, contact your local code administrator or t` 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; II. 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; 111. 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 Groundlwater - included the creation of surcharges (fees) for a number of regulated practices which Wiscor>~in's 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 to the groundwater-through your soil absorption, system or the disposal site used by your holding tank pumper. The onon es collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- d v,;ater, groundwater contamination investigations and establishment of standards. Groundwa+t:=; - it's worth protecting. 5BD-6398 (R.03/86) 13 Q©>,E 01 R -r:z Q nx 11,gA R"b e-pts w ; PA 4 ~e r 7;" a..,eQ loot-..z , rE-~pt .top e-F r" The ear Nw,-O^opsi7~ ,ScaLE U~""C0.Ps Ni/ Y ~ Ti,~~vcti flJ `7 V1 Nc q FL, 97.0 s' moo' S . 95'60 13 g°u°1- gousE 1 1 4, poi 8 1 Ilk -ate 8s 0-3 - H • z H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d OWNER/BUYER cr r/_ /`T b~ -S ROUTE/BOX NUMBER . &px 11-Y, Fire Number 160,E .CITY/STATE ZIP`;'5/0_2 PROPERTY LOCATION: / 3L,Section 3/ , T_:;t 7 N, R IS W, cx S }j s){ Town of er- St. Croix County, Subdivision y ,y Lot number li-CE/. #f • 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 pit 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 cn 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. SIGNED P DATE 1,. 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. =MIR 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 Cal LL Ct 42 © ~ Location of Property Section T N-R W 3 E S ur y Township 9~f Mailing Address _-z Wo Address of Site ' I Subdivision Name Vr_ Lot Number s I, e- ,c Previous Owner of Property La ewej ZL ~ «S Total Size of Parcel 2 , ~^Es Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes d~ No Volume 7 s2 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 page 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) ceAti6y that att statementd on this bonm arse thue to the beat ob my (ouJt) know.eedge; that I (we) am (ahe) the owner (,s) o6 the pnopW y dens cAibed in this inboAmation boAm, by viAtue ob a wa4Aanty deed neco&ded in the Obbice ob the County Regi,6ten ob Deedd ah Document No. / ; and that I (We) prtedentty own the pltoposed site bon the sewage di,3poz dy.6tem (art I (we) have obtained an ea6ement, to nun with the above duck bed p>toperty, bon the constrtucti..on ob said system, and the .same had been duty neco,%ded in the Obbtce ob the County Regi4tert ob Deeds, as Docament No. SIGNATURE O1 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED N DUS DEPART,~ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRYRY, , DIVISION LABOR A(~1D, PERCOLATION TESTS 115 P.O. BOX 7969 HMM,A N R' RATIONS pp MADISON, WI 53707 Qo r f a't l~ I (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNSHIP UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: N 3 ( /V N/RfiE(or ar(pewi COUN,T(Y: E!EVirg $ BUYER'S NAME: MAILING ADDRESS: / l lfo 1 1 ° #116 118M f 7? S F Gld SC3Yj `,J `'S. USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: PROFILE DESC IPTIONS: PER O ATIO TESTS: Residence New ❑ Replace. RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: IMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TRECOMMEND 5D SYSTEM :(optional) OS ❑U ©S ❑U ©S ❑U EIS ©U EIS 54:1 7~et17~ieS a^ssO' If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the under s.H63.09(5)(b), indicate: (I( ff Floodplain, 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.) B- ~.ov o .Q o 760 , So ~~s a.~o fs LA 6 >l ~d S B- ~.v0 >700 .sa s1 x.66 S B-3 9F S 7700 .~7~ bjs► 9.oo k ~ s% Y,d,:~ B filed S B- 7bt~ 15 5C~ D r~o $IS r 3.bo ~s .5o B ✓je S B-` 7oa 9y,SC) ?700 (s t~Tgi 3,T~ by e B- PERCOLATION TESTS TE DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERI D 3 PER INCH 3 P- , p d o /;V11 /t 7 P- ? 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. _ re tn, Z n_XI 1, 00 1-oCa T-e a Eas I o f(S 14 6 a w SYSTEM ELEVATION frehcka '9:`Qb ~,ser~fecl g~tweeK tren~ ~ow~~ 2d , F a.s~S f_ e OW, ~ T~ 00 _ - 'e go S oi6 TN 'TZ Pry,63 . E ~ci~t pa - - AOZ_ E y. 3 ~ , 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 CO PLETE ON: S vq' z )eU0 P0 ON ,6 R~p( s ~`S. CERTIFATI NUM ER: PHOI~^NUMBER( ptional): AD~~~S: ?j Q Auq r il~ CST SI URE: ~ a' JJ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ~ n INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 639 ~ To be a co,-olete and accurate soil test, your report must include;: 1. Cc alc° -l ~-scription; 2. Tl- rust clearly indicate whether this is a residence or commercial project; 3. Mt aX r umber of bedrooms or commercial use planned; 4, Is CF j or replacem€ _ system; 5. _ suitabi' g boxes. A SITE IS SUITABLE" FC 'OLDING TANK ONLY IF ? L r nr LED OUT BASED ON SOIL C_ N S; B is shown here for writing profit I- ins at 2 pI 7. _ A LE i'tram accurately locating your test D A el ,d if desired,- B. --nd vertical c'n ^arhand arv _rmanent; S i__ _ _xes as to date , r rin c' s'3tion test exemp- 10 ich as fl( "c r , k in the appropriate box; 11 ace your n noer; -d distrit r-, TL-'--- MUST BE FILED WITH THE f'-CV. 10 Y-1ITNIN )AYSU £ 3 ABBREVIATIONS FOR CERTIFIED SOIL TESTERS ar9 ' es Is st _ y r 10") col:, C 1011j gr. 3„} L r id ar sl - Loam ` an si m s `c : Y aarn - L-.am r t ;y p - rYk AGeC. HWL a Six generC s~ for lip: ` T THIF t s a Tl- corty r re Departme- r -°t of n5 aU A I Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP S y y Ew" SEC . Z T g~_ZN-R ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE ~F PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'C> exf i/ V ~ 'ate how 3 INDICATE NORTH ARROW B7eev=ation Describe thecae tical r fern a oint u ed E of vertical reference oin . '~.-4~ti P t/O/9 Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side,(DRear, O 5-9 7,6 feet From nearest property line Front 10 Side,O Rear, O feet Number of feet from: well ©c?,y 5"D , building, (Include this information of the above plot plan)( 2 reference dimensions to septic tank) L SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capac Pump Model: Pump iphon Manufac rer: Pump Size Elevation of inlet: Bott of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest roperty lin • Front, O Side, O Rear, Q Ft. Number o feet from well: Number of feet from building: (Include dista ces on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: g~A /Number of Lines: Area Built: DSO !l Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, O Rear,0 ht O Number of feet from well: Number of feet from''building:/ (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, Q Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector. ob: Plumber on j Dated: License Number: 3/84:mj