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HomeMy WebLinkAbout020-1162-50-000 0cn0 K-0 0 d o d d c m o co CD 'a m v' c I (D CD m ^ 3 xt O Cn -1 - z o A CO C N) ON ~C H m o N o Z~l Q c z m c oo m 0 CD ~p I C = ? CO rn O o- N O N ~1. CD -0 :E CI7 _ _ 7 H -4 ~ o p m CD CL CD p I N cp CD c CD c CD - o = 0 N O N ~~co w I Z7 CD co co a h o c N CA Vl M i5 C z o o o = l.~Vil w , § w 0 3 f/1 fn fn N '0 v~ v o v A = m a o z w m CD rn = 3 d N =5 CD C3. z N O O zz W z 0 CL (D CD !1 D N N !V CD N C c CD ((D W D CL Z _ Z CD N O O A Z n - s c s .Z1 = A z O n o N) A co NA CL z 3 3 N z CD 41 :E N a O N ti C < ~Z d N O CD N N O O y x A A v ` s Q. ti N O O H A O O ~ V O O ~ ~ O O Parcel 020-1162-550-000 05/18/2005 11:34 AM PAGE 1 OF 1 Alt. Parcel 29.29.19.932 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner " WEEKS, ROBERT, & JANE M MERCK ROBERT, & JANE M MERCK WEEKS 726 GREENBRIAR DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 726 GREENBRIAR RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.490 Plat: 0200-COUNTRY HILL ADD SEC 29 T29N R19W NW SW COUNTRY HILL ADD Block/Condo Bldg: LOT 03 LOT 3 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1061/429 WD 07/23/1997 715/443 2004 SUMMARY Bill Fair Market Value: Assessed with: 49015 244,700 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.490 29,900 159,400 189,300 NO Totals for 2004: General Property 1.490 29,900 159,400 189,300 Woodland 0.000 0 0 Totals for 2003: General Property 1.490 29,900 159,400 189,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 220 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 'RCO„J'MEACIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 962 - 3121 A16 800 962 5227 cz: FAX 715 962 - 4030 G 1'i O1x. CTY GOV.CTR REPORT DATE:' 1X1.4/94 CARMICHAEL ROAD (7) 2, Z) ATION. 726 ...ECTOR. M. Jenki COLLECTED: u COLLECTED. 10.0 FORM, MF ' i.4 a m RPRETAT lka .411,-i,'; 4 ove G0LIi01-m Bacteria/100 mt Nitrate-Nitrogen, mg/L ~ , r t °E•1t,~ \A EI az I 'F E t CL, ;_AB TECHNICIAN. Pam i oF.\NOEGEI.~FN O ~ . n J d a J I 6g ~ r PROFESSIONAL LABORATORY SERVICES SINCE 1952 7L Y2 ST. CROIX COUNTY WISCONSIN •Y'J{; 1 r ZONING OFFICE ST. CROIX COUNTY COURTHOUSE OQrln 0 HUDSON, WI 54016 4 - (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ J~ater (VOC's) $185.00 (`Septic $25.00 Water (Nitrate & Bacteria) S.- $35.00 (Visual inspection) Owner: q-C6&Z~Q ' &!ix) Requested by:~/~ 5 Address: ( Address: r n0/ 57 City & State: 0so'u,&~ I City & St. 'vOSClou, , Zip Code: sg j (y Zip Code: Telephone N°: ( )lp-'~,t~ Telephone N°: ( )~-3tv Property address (Fire N° & Street) : 72o & (a,C&5x-) Location: h, Sec. , T N, R W, Town of St. Croix Co., WI. Tax ID N° Parcel ID N4 House color: ~3,4o Realty firm: /~+4 Lock Box Combo: Water sample tap location: /-r<fAjE,t~ TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? Ries ❑ No If vacant, date last occupied: 6LjA Septic system installed by: (>a?K,(►ay Year: Septic tank last serviced by: j)AXA;6c4;Av Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y NK' Slow drainage from house. ❑Y PIT- Sewage Back-up into dwelling. ❑Y LK' Sewage discharge to ground surface, road ditch or body of water. (]Y MJJ Slow drainage from the dwelling. OY R4 Foul odors. Other comments relative to system operation: A?q6 I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE. G! -rat DATE :6- 4 2 r OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN 0 f TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd ❑At-Grd []Mound Approx. size- 'X []Gravity []Dose []Pressurized Ft.Z []Bed []Trench []Dry Well []Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: []House []Well []Prop. line []Other Dose tank Setbacks-: []House []Well []Prop.'line []Other []Locking cover []Warning label []Pump/Floats - []Alarm []Elec. wiring Soil Absorption System Setbacks: _OHouse []Well []Prop. line []Other ❑Ponding: []Discharge: General comments: INSPECTORS SKETCH OF-SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ;a - - - - = Hudson, WI 54016-7710 (715) 386-4680 January 11, 1994 Kernon Bast 700 Second Street Hudson, WI 54016 Dear Mr. Bast: An inspection of the septic system on the property of Roger & Joann Branson located at 726 Green Briar, Hudson, WI was conducted on January 11, 1994. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact this office. Sincerely, Mary Jenkins Assistant Zoning Administrator js y ST. CROIX COUNTY WISCONSIN „eunnnxn~ ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 January 19, 1994 Wyman Julius 1061 65th Ave. Roberts, WI 53023 Pear Mr. Julius: T received your water test application. In order for our office to ,o the water test you must use the new application form. You will find the new application form enclosed. Please fill out the new form and return it to our office as soon as possible. Tf you have any questions, please feel free to contact our office. i ncerely, Jackie Stohlberg Secretary i Form- S T C - 104 k ~,qCM_ Z AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 'fo .l SEC. / T N-Rfi W ADDRESS /~~f_S~ o/✓ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM nor 0( 13,11 = Tor, vl-- O~to,,cr- ~unv,_YonS 0 t ioc i bST Parr ~ALY..SSt£ T 6~ ~S q4' GA/era GL ~ Furu2Ev p OF UC A&J! ~ / ROPRt~SE~ Grzaor- ~ 0tZXV_C wAy r r 11~~ fe --/_/zoPoS~FU k1cLL INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 7,-,',.g 0'r-7 funvr ,oi~ F~ no.C- v Elevation of vertical reference point: /J i Proposed slope at site: SEPTIC TANK: Manufacturer: i_ iz Liquid Capacity: S i ~LLOn l Number of rings used: o~ Tank manhole cover elevation: /D w Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side0 Rear, O feet lCy .From nearest property line Front, 0Side ,0Rear, 0 feet Number of feet from: well G/_ , building: ~f (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE J I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: %L S Trench: Di Width: /0 Length: L/ Number of Lines: '2 Area Built Fill depth to top of pipe: 2 Number of feet from nearest property line: Front, O Side, ( Rear,0 Ft. 22 Number of feet from well: 11.E Number of feet from building: --fz (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: r u Plumber on job: A.- r License Number: U C3 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISCi,N, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan I ed D. Number (1f assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER JADDRESS OF PERMIT HOLDER. INSPECTION DATE J Roger Branson c/o Za a Bros. Hudson, WI _i1~~j40(a BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF- PT. ELEV.: CST REF PT. ELEV SW SW Section 29, T29N-R19W, Town of Hudson, Lot#3, Country Hill _ Nat-of Plumber. jMP,MPRSW N,,. C1),-1, -n,tar~ Pe m'I Number. Gar Za a 3300 St. Croix 74969 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV. WARNING; LABEL LOCKING COVER PROVIDED PROVIDED p ❑YES QVO / YES LINO BEDDING. VENT DI A.. VENT MATT 'HIGH WATFFi NUMBER OF ROAD PH OPERTV WELL JUHLII~~VENT O FRESH JALAHM LINE IFEET FR ❑YES ❑YES LINO NERE5TOM o O DOSING CHAMBER: _ MANUFACTUHFH JBEDDING LIQUID I:APAG.ITY PUMP VO111I Ptlt.,~P SIPI~nN `.A'-I, Ac.TUHE.P WARNING LABEL LOCKING COVER PROVIDED PROVIDED. ❑YES LINO ❑YES LINO DYES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPE HTY ~VF LL BuILDIN(I I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES LINO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing . IAM11ETEF1 '.TATEHIA,ANDMAHKINI; or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH NO OF U157R PIPE sPACIN t. CCVf H ~iNSl ut nln -Plis LIQUID BED/TRENCH -7 THEN"IQS nTEHInI PIT DEPTH DIMENSIONS / / _ GRAVEL DEPTH FILL DEPTH DISTH PIPE DISTH PIPE DISTR-PIPE MATERIAL NO DISTH NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BEU1W PIPES ABOVE COVER E IE V INt t i E V ,E NDpy c, PIP LI 3 ALE FEET 97.-O- fJ NEARESTO~ 75 / 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- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER TExTUHE PE It nt A NF NT%i HKE HS OBSERVATION WE L IS _ C_1YES LINO ❑YES LINO DEPTH OVER THE NCH BED DEPTH OVER THFNCH BE U DEPTH OF TOPS(1IL lsn[mf D SFEDFU MULCHED CENT EH EDGES [-]YES LINO OYES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LENGTH NO. OF LATERAL SPACING (;NAVEL DEPTH BELOLN ['It'! FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MAI EHIAL NCI DISTH DISTH PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HoLFSPACING; DHILL EDCnHHECUY coveHMATEHIAL VERTICAL LlFrCORRESPONDS TOAPPROVED PLnnls ❑YES LINO L , DYES LINO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS T-NUMBER OF PROPERTY WELL. BUILDING'. FEET FROM LINE ❑YES LINO OYES ~_.INO NEAREST Sketch System on Ret inl county file for audit. Reverse Side. S I G N - AT c RE JTITLE DILHR SBD 6710 (R. 01/82) ? ~ wlsconsln APPLICATION FOR SANITARY PERMIT D ILHR 1141~ COUNTY OF (PLB 67) UNIFORM SANITARY PER # OEPRRTfT1EnT = = InoUSTRV, LRBOR 6 HUMRn RELRTIOnS -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 nJ i /o d /v i ROPERTY LOCATION etT.Y- 1/4fW1/4, S , T N, R 13 E (or W TOWN oF: 4 W LOT NUMBER BLOCK NUMBER JSUBDIVISICN NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER /v J Ll -1 TYPE OF BUILDING OR USE SERVED ol.w_ln - 5?'7--C100 M 1 or 2 Family Number of Bedrooms. L Public (Specify): THIS PERMIT IS FOR A: ■ New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. . Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: N n 00 A ho 15 -r-C IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 0 Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: W/MPRSW No.: Phone Number: Plumber's Address: -Tame of Designer: szetj4 M, COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: Disapproved D 1/0 Owner Given Initial r pC J •J Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 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 h). r1 k) s- 0 S < Location of Property ~4 ~)vf ~4, Section 2 T T N - R W Township Mailing Address ,I 13nx s SQI t Subdivision Name (Du- t,.}-? r Lot Number Previous Owner of Property Jul k) Total Size of Parcel Date Parcel was Created r G , Are all corners and lot lines identifiable? 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 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 1 . , (G/e) eentc.{ y that cZY.Y ~ 5,ta~temen~ on this 6uhm cvice due to the bc~st u ~ my (oulc ) knowledge; that 1 (we) am (cute) the owneA (,s) o6 the pno pet ty del n ibed in this -in4o~wiation 4onm, by vi,,utue o4 a waAAanty deed Aeeonded in the 066 ice o6 the County RegiztetL oA Deeds ah Document No. - ; and that I (we) p4esent y own the pnoposed site 6oA the bewage ~o~ae /system (on I (we) have obtained an easement, to nun with the above descAibed paopeAty, Ooh the conztAuction o6 /said /system, and the Game ha/s been duty neeonded in the 066ice o4 the County Regizten ob Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H y S T C - 105 r y SEPTIC TANK MAIN'T'ENANCE AGREEMENT 0 St. Croix County d OWNER/BUYER ROU'T'E/BOX NUMBER Fire Number CITY/STATE ZIP ":5- 46((p N SW PROPERTY LOCATION: Section a~ T 2q N, R W, Town of f is 50~-~ St. Croiy. County, t,f l Subdivision F. r 441 Lot number I Improper use dnd 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 s_eptic 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 tor 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. CD F 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. SIGNED DATE ` St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. v N . 'r m x x m CAD N C C N v a CD CD °oo0~ o<- o c ° ..co° 3 cco cD cocD o °o a z g ?o =V;" c o m ~ N o~ o N~~~ _ ? to ° Mo CD N ~ 0 w -0 Cp CD M. o ~ Rr CO w m o C=D w ° 3 a o -•~coo w ° w o > > c o ~ ~ .off c oE3oo.o =r oZo c~ vm f ° I m w w ~ ~ ~ = w cn C ~ o o C3 W 1 7 w - C, Cr :1, CCD C: CD ID (n Q K A CD N c o y c w o ~0w ~omC(DLo~ O ~kz w o ~aQV con) C Z m :D conCD cDMmm?a D D m awn 3~_(A cn -1 uw, ° °D); = to ? ao m o a s c w _ v_ N cD (A CD v; ? a c0 in m f C R1 \v 3mo vCCADW ~ 'a a s X4 'aco w~mQCCD D < n co l N w o 0 0 ,u,-HOC ' CD °4 ~c mo O ao Cf cca w o Ai CD v CC ,)L v w r;~ aa~ a~N -1 M Q G) N 0• l< to w 3 o g C_ vi 0 G7 C=p m vi 7 o cD 0 a c CD S a° a c w CAD ~ N - 0 o a =r c CD o 0- c w/ p~ 0 3 0 0° 3 1 at',°N• ~a 00< `~O3 CD cn 0 m ZZ c DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRI'', DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAI~J, RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWN LOTNO.:BLK.NO.:SUBDIVISION NAME: ,Sw 1/ 1/ 19 /T19 N/R/? E (o) 3 COV TRy ttI II COUNTY: OWNER'S/BUYER'S NAME: i M ING ESS: s~ c(~ni ~oG R ~R~NSa dUL ,pos. Na.,yvosoo, 60 1',5, s USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL D RIPi PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 21 f /L Va. UJ G eplace I Q c % . ~o /98S /a - ~l oCT• / ! P RATING: S= Site suitable for system U= Site unsuitable fo CONVENTIONAL: MOUND: IN-GROUND-PRESSURE S N+] 'R LDIING TANK: RECOMMENDED SYSTEM: (optional) U NIJE~ITioAr~~~R~ /P rl 'X 3~v S ❑ Y ff ❑~J ❑U x ❑J~ If Percolation Tests are NOT required DESIGN RATE: If an C,L+S, S any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS +a -Df ci MnIf f pot BORING TOTAL DEPTH TO GROUNDWATER-IN; CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBS RVED (SEE ABBRV. ON BACK.) + ' . 8leo+rG-. .r3'af 60. /.G7' .o B /,.U oa.oy r 7/,~,p Teti cs le. C 15.1 0 s 7t C, 0,0u- B Z q /o o. y0 > i•s J9 'fA/ cs . B- 3 /0. S /o% 3 i, 2-46- CO. 51, . 7S QN • S , s I , %~,v cS /v+ las•~y1 v B B-13 /v + 16.1-76" //O 7 7-i ,.,j c S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN FT ' AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P- P_ P- 2- Oft P- 3 < 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 COTE: SoArE' S%,TE ~l7~YECt (+Q/ SYSTEM ELEVATION 130 -27 Om_ 9~'0 s,~~ S<aPF 4Vr7- Re S. Ueq +n. rt+C+~,at ft,- /31- 13 _~'ci,AFp3A-J !Oy+ ~ Fov30 SuRveybRS S?teL Pe,,jcE pOS7- C407- / eo.u) L 4t To P PbST = 100-0, CGIC- R 'D Q u LkA) D !oD I. T'°P <oT 383 ~ SvQy~~o~P `s STE~'L 4;~~ P~,u c~ /J o 5 T M~r~+1 ~y • ,gs SC 6 9+TO t N . o P~ z 3 \ yy' P 2y Cor#3 t x This ~ est site APPR NED for a ~ct~e'ntional septic stem. rqC soutk L,," I, the undersigned, hereby ertify 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: `-RoBER-r _ZtL-R R is H T ©cT /o ~ /9oO5 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 3 D~Nc i ( ( ~{UDSo,J i S. syoi~ 17rs JO/P CST SIGNATURE- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER W! 100 tools &W O&M Koo, 1 c p a _ 11,17 T; € 'I N > 't€HFR E MaAR J ID M {fix. E O SOIL GOOMMUN, , , rg , w< umf ;1y x. Ung yw,r n9 1mGE3 a _ ~ . . Q W, is - 11, AM (Rini (UM& IS LAwn- &wd HOW HQ 0, x r 5, H n: c CA, ~ 3 3 So &V U._, may, `s9 ~ t, :r Many, ~ i t A , . c.,'t= a .E i _ j E., yr 3 n'': :-'e iicAi dr Vi=i ='xNgs !he +t naj,' ) 0,0 of ~J un vEVoat / ANC Parr ~L ~U b / Ci/v /1/O/1TH LOT Cln,E/i OF Z"T 3.o,,b Lor / )ofL>T E)- V. _ JO 0. 00 1 7- r Q .D t-=C t f O.v J~Y 13 30/ vEu7 7TA c l c Q~ ZAST RbG E/Z 12n"Q SOh/ ~ ~/.tOF.~~TY 93 , ~ a 6 rNF L v7 .3 cou,,.Tay # LL Y6 /,luor o k/ To rNZp ~ O GIORoGE /JLoPE yp/ /t~~s-i RzopvsEo l~2uPose~ p Rg.MUACGE p~ 0LjE/Z 100' ' To .JO~tTI~ ss ~/1nl~afFO /'iz.oPe2-rY wt« LsJ,e Gh~~ti~F~ na 1 iF WtsT l°~opr~rY LrNt c`'~q NO SCALE J'pG. SOU, /J 1012uL'Earv Ll-~ LSCE,~st S)4 AZQ -DvLr.?S Aivo ©f3i1 21i/7; rJN I PI SOS I. TESTi~v v l3 Y RD/3E2T ULL3n.zc,~~T' ~]~--/~6'Przor~:.G? VE~~r CFP Aob VE / -T A L GRADE 'I `1 » Cyr' IT Y/""j ~A'C Z/yt t.lat OF y~'., /~QU✓~' /".1 fyX: V~ /l.///yG7Y.G ~vE/tSJC~ /,L,, cZ" A66AE6ATF- ov-cti lO[pF- I-)ZST/L114 U TZv"., 7~- r PsPf ~r-~ O O O O L JASSV~ or' 13L® G A66RF-C.A-TE ~3vrsw►, PE2.r02L Ce N A,T,,, 6 TF_ a rns SAT--vG 7-1517 ZS 9G vv fT do 13 a-r -ors OF,