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HomeMy WebLinkAbout018-1009-80-100 0 v,0vv d `r1 o 3 .fD•r cn 2 y z O rn = o o O n o q N a H • OD O V U1 ID 3 ID fD W CL 3 N co r~ Oo ~ Q- N Z d = y O N O A N D N y W 7 O :II 7 v 0 O N N N N 0. z o y = Q-4 (O p p CD O W O O N oo 0) c fD ! _ -0-1 3 01 f o v c C CD m D a O V co ow CL ill co co -U N N O A a K N O O 0 L" CA N C, C) C) CL w -4 CA S CD co CD (D D n c 00 I cn cn mll~ ~ Q O O O 3 it U) 12 0 010 CD N y ccnn a o D - Q v v o o fu v ID = m cn I r ~ w w w I ~ M D D o l O I m 0 c ~ C) =r c C < N N• A llVl CD' R fN = C Oro CD 3 N o v a 3 m' CD m cn to N c A Z n v -4 N' A 6) 0 W ca '7„ O. O (n N CT G< co a z c 3 X -gyp A Ln N (D -o 0 ~ D c =r 3 N O 3 6 fD O. G) (D 0 a 3 -n _ D) C CQ O N z d C) CD W W 0) y 3 u) 9°cv y c a n' 7 5 CL 0 w in 0) V (r O 69 O 'a C) 00 c. O w O A c I va p 0 00 ~ A N DQ Oo A i C, O O fD a O d ~ ? PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing C ILHR o s,a o p., P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 I OFFICE USE ONLY Plan Identification No. 9 Gallons Per Day z w - m - too ~t PRIORITY PLAN REVIEW ONLY r' Plan Review $ ~ Petition For Modification Project Name Project Location - Street No. or Legal Description Cou ❑ City ❑ Village 1~ Town of: i rte. The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: This approval will expire two years from the'4ate approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ r 't cc: )C] OWS ❑ DIPS ❑ H&R & Rec. San. Section 11 County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other RECEIVED Gc>pr~°f ~h f 1,7 198 Bross S ptUMBING BUREAU A l ~ -Z lzo~- ®7 STATE OF WISCONSIN DILHR DIVISION OF SAFETY & REAU OF PLUMBING BUILDINGS LI,DILlHR PRIVATE SEWAGE SYSTEMS BU 201 E. Washington Avenue, Rm 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 608.266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The balk side of this fofm describes required plan information. Plumbing codes can be purchased from the Department of Administration, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. 1. PROJECT INFORMATION Type or print clearly) Revision To Plan Number: Name of Submitting Party (Plans returned to same) Project Name G A" k' . '.5 ot~7 L_ 044-"& Street & No. or ural Route Project Location - Street & No. or Legal Description 9 e8 /0• 6hQr - Or- 5'60 y -~5ed S. S'-fz5~ ~i760 City or Village State Zip City ❑ County Co Village ❑ OF 1 Yy► d`r1 (A 1 5-(~'-- 0 Town Telephone No. (Include area code) 7 (;-zdC' Designer Telephone No. (Include area code) Owne~s~ame Telephone No. (Include area code) Vol/;? '-11--a_1 F_ 9 - z '7 Street & No. Street & No. City or Village State Zip City or Village State Zip Q/ • /S 2. APPLICATION FOR: ❑ New Mound System (3a) ❑ Groundwater Monitoring (7) ❑ Conventional System - Public Building (1) Replacement Mound (4a) ❑ Holding Tank (2) ❑ Replacement Pressurized System (4b) ❑ System in Fill (1) ❑ Petition For Modification (6) ❑ New Pressurized System (3b) ❑ System in Flood Fringe (1) ❑ Other Alternatives (5) 3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank - 50.00 4a. 3b. 1,501 2,500 gallon septic tank - 60.00 4b. a O , 00 3c. 2,501 5,000 gallon septic tank - 80.00 4c. 3d. 5,001 9,000 gallon septic tank - 100.00 4d. 3e. 9,001 - 15,000 gallon septic tank - 150.00 4e. 3f, Over 15,000 gallon septic tank -250.00 4f. RECF i( zr=p 3g. 500- 1,000 gallon dose chamber - 30.00 4g. tv!A Y 17 i985 3h. 1,001 - 2,000 gallon dose chamber - 50.00 4h. .SO- o v 3i. 2,001 4,000 gallon dose chamber - 70.00 4i. PLUMB-ING Bit 3j. 4,001 8,000 gallon dose chamber - 90.00 4j. ~~OT 3k. 8,001 12,000 gallon dose chamber - 110.00 4k. 31. Over 12, 000 gallon dose chamber - 150.00 41. ~ 3m. 500- 5,000 gallon holding tank - 30.00 4m. 3n. 5,001 - 10,000 gallon holding tank - 55.00 4n. 3o. Over 10,000 gallon holding tank - 100.00 4o. 3p. Revisions - 20.00 4p. 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal Ila • 00 3r. Priority plan review: walk through) 4r. /la, 00 Submittal of plans in person, by appointment, with double fee 3s. Petition for Variance Setback - 25.00 4s. Site evaluation - 50.00 Total Fee Z Z©.00 Note: Fees pursuant to Wis. Adm. Code, Chapter Ind. 69 may be subject to change annually DILHR-SBD8748 #R. 03/84) /~/c/) Effective July 1, 1984 -OVER s ST. CROI X COUNTY WISC0NSI N 1 !y ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 13, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: u An on site investigation was for the Honor M. Hyde property located in the SW!4 of the SWk of Section 5, T29N-R17W, Town of Hammond, St. Croix County, revealed suitable soils at a depth of 2.58 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, RECEIVED Thomas C. Nelson (►!AY 17 1985- Assistant Zoning Administrator PLUMBING BUREAU mj 85o2296 WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location sw 1/4, sw 1/4, Sec- 5 T 29 N, R17 AAMYJ W Town X0MMbVtTLdg Hammond Street Address Lot No. Block Subdivision Landowner's Name: Honor M. Hyde The application for this site is for: ❑ new construction use. D replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: (_1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers s ue3~o you.) [ ]one of the applications needing a quota number. The quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. D for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the RECECIVED department. [1AY 17 1985 [...for an application on file prior to February 1, 1980. [_]for a lot that meets the criteria for a conventional private sewage ys~em~0 BUREAU If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing:t © a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and,in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Siq4w Ure y County Official) Title Assistant Zoning Administrator Date May 13, 1985 DILHR-SBD-6158 (R 12/82) i DEPARTtt+IENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS !'iVDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (1151 P.O. Box 7969 -iUMAN RELATIONS \ ! MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LCCATIOIN SECTION: TOWNSHIP/MWN;Q4RA4.LTY; T NO.: BLK No.: SUBDIVISION NAME: 1/- /4 /VIN/RI /k(oo.w .4 COUNTY: OWNER'S/ S NAME: MAILING ADDRESS. ~JSE DATES OBSERVATIONS MADE ~9NO. B : COMMERCIAL DESCRIPTION ❑New I RO -INS: IPERCOLAT ION STS: Residet±ce g Replace SATING: S- Site suitable for system U- Site unsuitable for system -ONVENTI NAL: MOUND: -GROUN_ -IN-F LL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑s u s ou os Lau os as u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, AU/1- Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH T R UND ATER-INCHES CHARACTER OF SOI WITH THICKNESS, COLOR, TEXTURE, AND DEPTH _EST. HIGHEST NUMBER OEPTH- N, -OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B f9 1j/. .'5;1, A07 40 e , k1 4 _25 86 S8 trp , 7S a Z, 13- A16 4A B- '2 B- B- RECEIVED B- 01 2 2 9 6 o 17 1985 PERCOLATION TESTS IlIkA011M EAU TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES MINUTES NUMBER IiVGU" AFTERSWELLING INTERVAL-MIN. P15:1410 P I PER INCH P. P_ 3o 30 P. 100 p -1--Z 4 A 1.1 z, 3 2- P_ P_ . LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- 3ntal 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 J land slope. SYSTEM ELEVATION i ' p0 Iv . lUd-E ~o 5oA1~ y 0-4 RECEIVED -Fv Ileo~s~ y m 17 1985 35PLUMBING BUREAU 8502296 r (zoo •,►(9"N sal. PuMQ CAftober Z5, - - ~~i Loo. C IT PLUMBINGO ,l/~ X303¢ C2J-fwo I0009 at, LgspR P.'ND HUMAN RELATIONS DEPARTMENT 0 ►%DUSTR TY AN BUILDINGS DI SEE CORRESPONDENCE i Page _ Of _ Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H G Topsoil -~r- F E D 3 PLU" ape M N jo~ Bed Of 2 12 Force Main Plowed sw ~ , 2 Aaaqregate Layer f LAT10 t rs:7St, LIEU` ,~:~1 UiLUlr1 D Ft. U. SA~ ss.,Section Of A Mound System Using =E ' "Ft. EE CORRESPONDS F 7.5 Ft. Bed For The Absorption Area .G Loa Ft. A' jr Ft. H ,00 Ft. Signed: B Ft. License Number: K Ft. Date: L c? ' Ft. f"~1Y 17 1985 j C?, l3 Ft. Alternate Position PI"UI~Bl1iG BUREAU T ,so Ft. t Forcef Main W Z7,42 Ft. 852296 - L bservation Pipe--,,,, B :K]j A (•-----T--------------- Force Main Distribution Bed Of 2u- 2 Pipe Aggregate 40 Observation Pipe 4-Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area ' Page _ Of Perforated Pipe Detail 0 End View Perforated End Cap) PVC Pipe p.4~o Holes Located On Bottom, S Are Equally Spaced S P PVC Force Main PVC 7 Manifold Pipe ~I+ Distribution Alternate Position Of Pipe Force Main ,F . Last Is Should Be Next To End Cap y1"~r - f , End Cap Distribution Pipe Layout P Ft. R S XInches 6~u =Y Inches Signed: Hole Diameter Inch Lateral ~ Inch(es) License Number: Manifold Inches Date: Force Main Inches rt:tIMBING r # of hol es/pi pe Invert Elevation of Laterals`Ft. L n r, RELATIONS r i SEE CORRE PONDENCE • PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEMT GAP 11"C.I. VEMT PIPE WEATHER PROOF APPROVED LOCKING JUAJCTIOAJ BOX MANHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MID. AIR INTAKE GRADE I 4" MIN. COIJDUIT INLET PROVIDE I !,LUl' 3IWIQTIGHT SEAL I i' lr;r 0- VRTT!AI I I APPROVED JOINTS APPROVED JOINT A W/C.2. PIPE I I III W/C.z. PIPE EXTENDING 3' - I II ALARM EXTENDING 3' ONTO SOLID SOIL RElAjli~~~~ I ONTO SOLID SOIL oi'N GS I ow U 3 89 I ~ I 1~~p. ^1~+1z:~ ~ aa:b ELEV.CIGL_ FT. SEE CORRESPONDENCE PUMP OFF ~~+0 D CONCRETE BLOCK 4-#l%iG BUREAU 22 96 RISER EXIT PERMITTED OIJL`J IF TAUV MANUFACTURER HAS SUCH APPROVAL SEPTIC E .5 PECIFICATIOUS DOSE TANKS MAIJUFACTUR.ER: NUMBER OF DOSES: PER DAS TAWK SIZE: I?--o1 ~0 rGALLOMS DOSE VOLUME ALARM MANUFACTURER: `K alk INCLUDIMG BACKFLOW: 3 GALLONS MODEL NUMBER: CAPACITIES: A= INCHES OR ?-GALLOWS SWITCH TYPE: B = INCHES OR S GALLONS PUMP MANUFACTURER: 0 (L C = INCHES OR GALLONS MODEL NUMBER: D= INCHES OR 7'"'"-' GALLONS SWITCH TYPE: NOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 1 GPM J INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREWCE BETWEEI I PUMP OFF AND DISTRIBUTION PIPE../at FEET + MIUIMUM METWORK SUPPLY PR~ESSURL7,,E//. . . . . . . . . 2.5 FEET + ~ FEET OF FORCE MAIM X I (~S F loo FtFRICTION FACTOR. t Z" FEET TOTAL 013MAMIC HEAD = ~3 FEET ( , INTERNAL DIMEWSIOMS OF TANK: LENGTH ;WIDTH i.~;LIQUID DEPTH SIGNED: LICEMSE DUMBER: DATE: Madel 3370 : W7 , , ib!e Effluent Pumps 120 ~A yy , 100 PLUMBING wp DEPARTIZ 4 RELATIONS Div L yTO, OPP- r kip SE CORRE9,P©NDENCE 9 Hp •Yhp s 10 WpHO3, h /y p WP1~03. `h H.P. 1 19B ~ ~ BUREAU 20 wPO3. H.P. . UMBING 7 0 20 40 T 60 180 100 120 CapaG2y - Gallons Per PAlaute WA max. W1. H.P 4 IwLtio.~_ `as Ph.w Ampr RPM iolleq (Ids,) K vri,tE 115 9.4 > yv-i12E. 1750 V12E 230 tb 1.7 WPM' WP►1157 WP►1p512E 230 8.0 eo W2M3YC 20&1230 3.4 30 t ip534E 460 1.7 4, 1 W, ry. WPH0712E 230 ib 9.0 % WPH0732E 20&/230 5.4 WPM734E 480 3b 2.7 70 WPH1012E 230 10 11.6 34V 9t' " t WPH1032E 208/230 30 6.4 WPH1034E 460 32 WPH1512E 230 10 13.3 WPH111.2E 208/230 92 1 WPH1534E 460 3b 4.6 80 WPHH1512E 230 10 13.3 T ~r +WPHH1532E 208/230_ 9.2 ~WPHH1534E •460 4.8 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE A ~ 3 OPTIONAL WORKSHEET 1. MOUND SYSTEM r 11. IN-GROUND PRESSURE SYSTEM-Continued- Wastewater Load, Total Daily Fiow gal. 10. Force Main: Y/ Use s. ILHR 83.15 (3) (c) Minimum Dosing Rate = iDm• Adm. Code and PROVIDE A DETAILED Diameter = in. LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor = ft. k System Head = 2.5 ft. % 3. Landsiope Vertical Lift ft. 4. Distance from Dose Chamber to Friction Loss: ft. Distribution System = 6-6~ ft. TDH = ft. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = d' 17 ft. Pum9f,~'i~ll,, 'discharge at least_.C.L~._ gpm 6. Absorption Area Sizing: at 1A, 29 total dynamic head. Area Required = ~E.=_ sq. ft. Pumpstrodel and m#nufae rer: Bed or Trench Length (B) _ 70 ft. ' Bed or Trench Width (A) ft. 13. Dose Volume: Trench Spacing (C) 10 Times Void Volume of 4 7. Mound Height: Distribution Lines= gal. Fill Depth (D) = 6C' ftt p Daily Wastewater Volume + Fill Depth Downslope (E) = ;U, 4 Doses in 24 hrs. gal. Bed or Trench Depth (F) = ft. Backflow = gal. Cap and Topsoil Depth (G) = ft. Minimum Dose = ` ` gal. Cap and Topsoil Depth (H) = ft. 14. Dose Chamber: 8. Mound Length: Volume gal. End Slope (K) _ ' - ft. Total Mound Length (L) = ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal. Upslope Correction Factor = , y3 7 Use s. ILHR 83.15 (3) (e) , Wis. Upslope Width (1) = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (1) = /,/,so ft. 2U Required Septic Tank Capacity = gal. Total Mound Width (W) _ -2"?, a-3 ft. 3. Percolation Rate = min./In. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in eh. ILHR 83 Natural Soil gal./sq.ft./day and PROVIDE A DETAI 1Ll5 FL Basal Area Required = 101-3 sq. ft. SIZING ON PLANS. J u 4b Basal Area Available = .E-~ sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter ILHR 83 Length = ft. are-used, Indicate Table # Width = ~ ~ ft. 12. For the Distribution Network, Use Numbers 5-14 In Section It. Number of Trenches = p Trench Spacing = MAY 17 1925-- ft. Ii. IN-GROUND PRESSURE SYSTEM 5. Distribution System: 1. Depth to Limiting Factor = ft. Lateral Length = FUMBING BREA= ft. 2. Landsiope = % 96 Number of Laterals 3. Percolation Rate min./in. Lateral Spacing = in. 4. Proposed System Elevation = ft. Distance from Sidewal) to Pipe in. 5. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use s. ILHR 83.15 (3)(c), Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All Items from Section ill Required Septic Tank Capacity gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = min./in. 1. Capacity = gal. Area Required = G77 -7 sq. ft. 2. Manufacturer: EE s (r) C System Length = ft. 3. Show Site Constructed Tank Details on Plan System Width = =9 , ft. 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Size = In. 1. Capacity = Sal. Hole Spacing = ft. 2. Manufacturer: _T- Lateral Length - It. 3. Pump Manufacturer: Lmeral Size In. 4. Pwnp Model: Lalcral spacing - ft: 5. Operating Head= , t ft. Distance front Sidewall-io Pipe 6. Flow Rate= gpm. H. Distribution Pipc Discharge Raw: 7. Show Site Constructed Tank Details on Plans Number of i toles Per Pipe 1 low Per Pipe gpm. VII. IIOLUING TANK 9. Manifold Sizing: 1. Capacity = gal. Type (center or end) - n~ 2. Manufacturer. Length = it. 3. Show Site Constructed Tank Details on Plans Diameter in. -SHOW ALL INF~ ION ON PLANS- DtLHR SBD-6761 (R.03/82)~ n ,0 3vn d v1 C F r M O lD 7 CD W 1 3 3 ` cn 3 -I Z z o rn== o o 0 4~, < o~ cn • 00 G d CL Z a H CD CD 3 ~a N c O M co o G1 d N CL m o N v : a-4 to "1 m x °o ' m o co o O O C O CD H. 0 PO Z N N 0 o p I-~ H ! t7 y m a ° CD 07 ~ D m a CD to O N a 00 0) \ C a N W O O N ~ 3 Q ft N j > a O ~l CD (D r`1 N co o< y r cn o, cn cn m 3 rnV- N Z~ I o y y ai a', o~ D r - cr C) Ut O m' o a' (~~y oll °t Ui 42 cn co N ro r H H N 3 _ cn 0o Q N CL co Z o o ~ -.1 D D o O c O 4~ rt, v~ =r o • ti W (D CD H- v Cn O c'. rt G G W m u, a 0 p Z ~p 0 `A z O 0 W CL z c 3 A ~ I o co U1 m Dai N a I 3 v - ~ a~ o - CD a n N - z O O O X O W ww 3 N p O N I C I A. C A CL F O O A I m S O A N N C) w 3 °o A O b w A w CD O Do O b3 0 ti b I O o m Parcel 018-1009-80-100 01/23/2006 03:25 PAGE 1 OF 1 F 1 Alt. Parcel 05.29.17.758 018 TOWN OF HAMMOND 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 - FRITSCHE, GRANT A & LAURA H GRANT A & LAURA H FRITSCHE 1622 110TH AVE HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1622 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 6.090 Plat: N/A-NOT AVAILABLE SEC 5 T29N R17W SW SW LOT 1 OF C.S.M. Block/Condo Bldg: 6/1578 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 03/01/1999 598509 1406/505 WD 09/25/1985 405499 721/633 LC 2005 SUMMARY Bill Fair Market Value: Assessed with: 90040 Use Value Assessment Valuations: Last Changed: 05/13/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.090 32,300 128,500 160,800 NO AGRICULTURAL G4 2.000 100 0 100 NO Totals for 2005: General Property 6.090 32,400 128,500 160,900 Woodland 0.000 0 0 Totals for 2004: General Property 6.090 32,400 128,500 160,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 I Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T -N-R _~W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t A 414 a } ~5 C 0005.0 ~ ,,4'& INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used41l' Elevation of vertical reference 1point: Proposed slope at site: '--=--~o SEPTIC TANK: Manufacturer: GV~ ~S Liquid Capacity: pd~ Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,Side,o Rear, Ofeet From nearest, property line Front Side,ORear,0 feet Number of feet from: wells building: ._-,5:/ (Include this information.of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: S _ Liquid Capacity: Z D Pump Model: '/~/o/')P° 94s iphon Manufacturer: K~11 cj_I Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: (96 8 Gallons per cycle: Z Alarm Manufacturer: `1~1^ L Alarm Switch Type: Number of feet from nearest property line: Front, Side, O Rear, 0 Ft. Number of feet from well: r Number of feet from building:& (Include distances on plot plan). SOIL ABSORPTION SYSTEM '0d 6e" d Trench: Bed: 3V X P (3 i Width: j( 7 ~ Length: ' Number of Lines: Area Built: Z Fill depth to top of pipe: Number of feet from nearest property line: Front, /9hSide, O Rear,O Ft-0 i Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: ZNumber of pits: Diameter: Liquid d the Bottom of seepage pit elevation: Are Built: Has ither a drop box O or distribution box O been used on any of the above soil sorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings use Elevation of bottom of tank: Elevation of i et: Number of eet from nearest property line: Front, O Side, O Rear, 0Ft. t Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on j b: ' z r ~/~~G~ License Number: 3/84:mj r 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 E] CONVENTIONAL LTERNATIVE StfaatePlanl.D.Number: ned) El Holding Tank 1:1 In-Ground Pressure El Mound (l uig 85-02296 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Honor Hyde Hammond, WI 54015 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.. SW SW Section 5, T29N-R17W, Town of Hammond Name of Plumber MP/MPRSW No.. Tnty, Sanitary Permit NumberGar L. Steel 3254 Croix 64896 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: 4TANK INLET ELEV.: TANK OUTLET ELEV.: WARNANG LABEL LOCG COVER Z `PROVIDEDPROVIDED 71 L DYES ONO DYES BEDDINGVENT NT MATL.: HIGH WATER ER OAD: ,d PROPRTY WELL: BUILDINGALARMFROW LINEOYES ONO DYES NO EST -19- DOSING `CHAMBER: MANUFACTURER- kD G : LIQUID CAPACITYUMP MODELPMAN C 00 URERWARNING LABEL LOCKING COVER P~OV EDPROVIDED: ES NO / "DYES ONO U"FES ONO GA LONS PER CYCLE: PUMP) ND TROL RATIONAL NUMBER OF PROPERTY WELL BUI G VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIj PUMP ON AND OFF) YES ONO NEAREST-- '~C/ to tsPG7_ SOIL ABSORPTION SYSTEM. Check the soil moistureat t~Ke epth of plowing era 6TH DIAMETER FORCE MATERIAL AND MARKING y or excavation. (If soil can be rolled into a wire, construction shall cease until fr . U the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF IDISTR PIPE SPACING COVER INSIDE DIA !P TS LIQUID TRENCHES. MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE .DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF RO RTY WELL BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER: ELEV. INLET. ELEV. END: PIPES. FEET FROM LI AIR INLET: NEAREST 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- ES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVERT XTURE PERMANENT MARKERS OBSERVATION WELLS. ES ONO YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED rF TOPSOIL. SODDED. SEEDED: MULCHED. CENTER. ~ ~ EDGES: 0 DYES O YES ONO ES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO. OF LATERAL S GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS PACING: (11 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR DISTR. PIPE DISTRIBUTION IPE MATERIAL &`MARKING. ELEVATION AND ELE '7 C_ EI- V.: CIA EL PIPES DIA.:' L DISTRIBUTION L[j / ( y- f,~ 1.73 l IIIII INFORMATION HOLE SI HOLESPACING DRILLEDC RRECTLY + L COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED _ 0 PLANS: YES ONO DYES ONO COMMENTS: PERMANENT MARKERS: ORSERV TIO WELLS: NUMBER OF P PERTV WELL: BUILDING: FEET FROM trTf YES ❑ NO ES ❑ NO NEAREST L z/ S F r t i Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. ,..my DILHR SBD 6710 (R.01/82) wlsconsln APPLICATION FOR SANITARY PERMIT -1 COUNTY DILHR i UNIFORM SANITARY PERMIT # nouSTRV, LRY,LR OF (PLB 67) - nOUSBOR 6 MUTRn RELRTIOnS 6 Ile V4 -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 PROPER Y OWNER MAILING DDRESS l a C ~ PRO E TY LOCATION U44-_1 A!`C. ~u3i 14SO1/4,s5 , T~N, R ~K(or) W TOWN OF: / /gabwV~r~ Cy/ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEARE ROAD AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED K 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement ❑ Revision ❑ Privy r 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed 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 000 Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. o Name f dumber (Print): Signature: ME/MPRSW No.: Phone Number: Plumber's Addr s: Name of Designer: r l l i COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial 0 Approved Adverse Determination Reason for Disapproval: i 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION BOX HLABOR UMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.09(1) & Chapter 145.045) LOCATION: SECTION:~f ~J u p / TOWNSHIP/ 6kRALLTY: OT NO.:BLK. NO.: SUBDI,~VIJSION NAME: ,5o ~14VI S IT2 NIR/ ~(or) n / 1/,4 COUNTY: OWNER'S 'S NAME: AILING A DRESS: dUSE DATES OBSERVATIONS MADE Residence NO. BEDRMS,: COMMERCIAL DESCRIPTION: ❑New ,Replace PROFILE DESCRIPTIONS: ER OLATION TESTS: ~ / -mss RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rYSTEM-1 N-F I LLIHOLDI NG TANK: RECOMMENDED SYSTEM: (optional) "I R ❑S, M S❑u ❑Szu ❑S®v ❑SKu If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(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 DEPT+thN, ELEVATION OBSERVED EST. HIGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9 ?PC 0 7 "Z. B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER '^'~S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PER INCH P- o P- 2, -3a Z Z--/ P_ z. `3 Yz_ 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 I ~ i i ; IN _ , 11 € I i 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: - CC?s ADD CERTIFICATION NUMBER: PHONE NUMBER (optional): % Z z !vim !L;,"-( zao CST SIGNAVFV. C DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) - OVER - I "'--RUCTIONS FOR CON-nLETI F" 7 115 - SBD -i6395 Tc ~d ate sail t( RIM 1 _ eject; use 4 TANK ONLY IF ALL 7, p- TH THE 11.. 3C vI ' S FOR .c.s stu€es ~r ~d Mot W/ PT I STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location : Township hip/ Hun ie4pa1iLy: ~SC6 % S T Z!j N/R -94r)W cz Street Address: Subdivision: / ~County: Landowners Name: Mailing Address: nap I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than. a conventional private sewage system and as such will require detailed inspection during construction and monitoring aftgr the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or mPECEDVED agent (the contractor) to begin installation. If the system is approved, ~s> 1 7 1985 Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have b obtained. PtBjG BUREAU t.. I agree to give notice to any subsequent buyer that an application foff aiT ~ Ilk alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. ;a Signature of Applica Date STATE OF WISCONSIN Subscribed and sworn to before me SS. , COUNTY OF This day of J~lc 195 . Notary Public, State of W sconsin LINDA M. ROMBF,"G Z Notory Public - Cro'z Lo.. Wis. DILHR-SBD-6413 (N. 05/81) myCommission E 3Fes-0a ,S19d9n Expires: j/_/ J r e 9 ST. CR0IX COUNTY WI S C 0 N S I N y ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 May 13, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation was for the Honor M. Hyde property located in the SWZ of the SW;4 of Section 5, T29N-R17W, Town of Hammond, St. Croix County, revealed suitable soils at a depth of 2.58 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, , To, d/ 61n.44, 0, Thomas C. Nelson Assistant Zoning Administrator mi WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location sw 1/4, sw 1/4, Sec. 5 T 29 N, RI _c) W Town Anxt Hammond Street Address Lot No. , Block Subdivision Landowner's Name: Honor M. Hyde The application for this site is for: ❑ new construction use. ® replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ~..1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota nu- mT)ers sueU-Fo-you. ) ]one of the applications needing a quota number. The quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F.1for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (_J for an application on file prior to February 1, 1980. (_]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ® a failing conventional soil absorption system. Fla holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Sigat. re County Official Title Assistant Zoning Administrator Date May 13, 1985 DILHR-SBD-6158 (R 12/82) PLAN APPROVAL Safety and Buildings Division i DILHR Bureau of . .umbing P.O Box 7%9 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 OFFICE USE ONLY Plan Identification No. 9 Gallons Per Day 4 r~ PRIORITY PLAN REVIEW ONLY Plan Review Q°_ Petition For Niodification Project Name Project Location - Street No. or Legal Description d.clo / de S M V oZ % / fit/ County ❑ City ❑ Village Town of: Q M M p ^ d t ~cr t7 X The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: &N This approval will expire two years from approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact ♦ - 497 r cc: OWS ❑ DPS ❑ H&R & Rec. San. Section County ❑ Local PI ❑ Facilities Need Analysis Sectior, ❑ UW-SSWMP ❑ Plumber ❑ Department of Agricultur: DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other v U) r n x x N c a3 v o w w 3'< w a °2 z 3 cco~ p 7 Q % O N N i Z n c(D N p 0. 131 w Nom,,, CD 0 cp ID n O N CD Cl n M. p co W O MS 5 9O w 0 w 0 0 L C w p cA 3 Z ° c <o S. 3 o. Oo r w w? I ~ m w w.. N N o E 5 - % v o ~o a a' 7 N u0i = p cO D 'v 'O n N ~~NC-•.+ < O N co a O A G) c D c cu o ° =w o CO o CCD o O w O ..ate' uwi C ~A ~a = N° v m -R cn Z D Q_ o m w ~p v Z 0 m CA l~ a m 3 N M Ncw °w=ono QN m m v; =acc M 3wo va,Nww~ -I cD 'v CD O N ? 'tm 0,cs 0 CD~~n C7 t$ rt O E 7 N Q w N " a 0 0 = C f0 o m cr° N w O t C= CD CL 0 c nN a c m N S. CM cp. N ~o w 29. aaCLCL • N o m Q 3 ~ s w Q < ° w m 3 0 N O G~ tG O p c/~ cD f) N s °'O>.° oa ~cCD 00 10 , 0) -4 CD m co p ::.J • 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/contractgr,("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 PO's Location of Property ' _14, Section , T -)--7- N - R /;7 W Township Mailing Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel- Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume 6 Z3 - and Page Number /S as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3., Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) cettti6y that aU statements on this Jonm ate true to the but ob my (out) knowledge; that 1 (we) am (ate) the owner (s) o6 the pnopehty desvA bed in this in6oAmati.on ~onm, by vi tue o6 a wa4Aanty deed neconded in the 064ice of the County Reg-cstet o J Deeds as Document No. 3 9sO, 3 ; and that 1 (we) pnesenti'y own the proposed site Jon the aewage disp sat system (on 1 (we) have obtained an easement, to nun with the above duets bed pnopenty, Jot the co ns tnuc do n o J said system, and the same has been duty neconded in the O j 6ice ob the County Register oA Deeds, as Document No. i SIGNATURE OF OWNS SIGNATURE OF CO-OWNER (IF APPLICABLE) :Z: 8 S DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AN P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION:$ SECTION: TOWNSHIP/M44WAP4U_l.IY: OT NO.:BLK. NO.: SUBDIVISION NAME: ,::~;0 1/ V1 5 /L27 N/Rl ,f (or) W ,yam COUNTY: OWNER'S 'S NAME: AILING ADDRESS: 7 lit/✓. USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROF E DESCRIPTIONS: 1PERCOLATION TESTS: Residence ❑ New Replace RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-(PRESSURE: SYSTEM-IIN~~FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ElS U ,S S OU [:]S [2U [:]S jgu If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: - Floodplain, indicate Floodplain elevation: p~ ( PROFILE DESCRIPTIONS 14" C BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH-M, ELEVATION OBSERVED EST. HIGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I S8 50 ,9 as ~s B B- Z - /V n om' , /3n.6„ L, h 'Y' dt. Z. B- B- B- PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INGIal:S AFTERSWELLING INTERVAL-MIN. PER D I PERI0132 PERIOD PER INCH P- P- 2, -7 V0 -30 P Zv_ 420 o s 1.-, 3 Yi- 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 ' 17Q, ' f I i 2 V too' , r TN v }}yy,'hry'I E f / i z 1, 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: Al - - 9s ADD C/ : CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNAVJFF.j DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER -