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HomeMy WebLinkAbout020-1147-90-000 (3) n N O 9 m o C~ ~1 c (D CD i, 3 CD M -0 # .r m 3 ~ 0 o v o (D CD c w N) `C • (D CD :3 o(D cc ( o U)~ Q CD 0_ z d, N w d O _ M- co 5- L- ~3 co O a) N (D CL O O N ~ CD "t (D (D CD cn Z) Cn o r 3 N a ° o 0 N N O !r CD U) D F. o c CD (C] N W L]. 71 O C 3 p o a C z C=D 0 00 00 (P Vi = fn O C Q N o O O .d. • z o 0 -n I ~ -i - o ry,~ 0 (n N N ° 3 zT v v o N CD N 7c D) 'O (P N ~y m N CD N < 3 < Q- v N z 3 CD O z W z O o !r • CD a) c CAD CD w m a CL 3 z ~ A Z O ;o A Z O m n A O Z w W ' m N w M CD (O CL a z O O m ~C N z < CD C4 Ton Ci D O_ C O (O 9+1 C1 CD a a Co v fl N N 7 0 O T n 2 7 3 N C C6 :I z a v o v m 0 O a3 N ~0 N (O Cc N a C1 CD .D j d o (D (D fi fD O O N , n R CD 00 c o 30 <o~N A N 0 (D N n ~ ~ ~ C rt w 3 O CD = C1 7 N O (D O CD W 7 O S N a: O O O C CT A 0 A O O a O Efl 0 Op CD ti ~ - 1(k AS BUILT SANITARY SY,TEM REPORT Fo rm - S T C OWNER TOWNSHIP ----Y SEC. ADDRESS T N-R - W ST. CROIX COJNTY, WISCONSIN ry A4 ~F rf SUBDIVISION:- J LOT / d~~ra.iU LOT SIZE PLAN VIEW -x Distances and dimensions to meet requirements cf H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM !Z` ~.3 ~s - .a F- r i r E INDICATE N0RA ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: ti''` Tank manhole cover elevation: Tank Inlet Elevation: a$'" 9l°•21- Tank Outlet Elevation: y Number of feet from ~'S nearest Road: ^ Front,:: Side ,0 (K~(x1 Rear, -f. From nearest propert feet y line Front,O Side,O Rear, Number of feet from: 0---- feet well building: (Include this information of the above plot plan)( 2 reference dimensions to s~pt_ ic• t<u d` pip CHAMBER Liquid Capacity: Manufacturer: Pump Size Pump Model: Pump/Svhon Manufacturer: - Bottom of tank elevation: Elevation of inlet: Gallons per cycle: Pump off switch elevation: _ Alarm switch Type: Alarm Manufacturer: Ft. 11 line: Front,CSide, O Rear, _ Number r-reet from nearest property Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: ~ Area Built: Length: Number of Lines Width: Width: --may'-'^ Fill depth to top of pipe: Side, o Rear, O ~t• Front, 0 Number of fe_t from nearest property line: Number of feet from well: Number of feet from building: (Incl,.de distances on plot plan). SEEPAGE PIT S i Number of pits: Diameter: ze: the Bottom of seepage pit elevation: Liquid d<p Area Burt: or distribution box O been used on any of the above soil Has either a drop box O absorbtion sytems? (Check one). HOLDING TAN: Capacity: Manufacturer: s used: Elevation of bottom of tank: Number of ring Elevation of inlet: O Rear, 0Ft.- line: Front, O Side, Number of feet from nearest property - Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: 4.1 Inspector : 1/1 r/ Plumber on job: _J-J-~ Dated License Number: 3/84:mj a to O 3 N o d L/1 C 'o 3 :3 CD 0 (D C Z -0 (D 3 _ z O~ C W o • O m N O 0) a N Q ::T 3 p i CD co O N co - O. Z d N W a P C O v ~'4 N Q. j O W N O O co CD ` O 0- C) O CD 7 (D n N O r' cn 3 O N Q O O N C O W (j) CD C) C CD UD N ro W Q O N 3 N O O a _ o r - CL Z~ m p co on RD o N O C cy) U, C V a- u) !V • C] V] CrJ o --1 7i O = c -1 -I O G G r a fn N U) L, c (D R CD _2 (D N rt r.l V OO a) C a N t/ o H ~ ~ N m 1 p rt G 3 00 N ° rn m C/) CL I'D o CD H G sz o z co Z O 7 ~O D O ID CL tll rll -b "mi 0 (D CD CD W W r O H klD m N r C N; L-n ro c C CD (D N~ N (D (D pC W rt r--~ a" C-1 n -i to f-- ' 3 l d 0 Z O C~ o N o 'A CD F-- z NZ, 0 ' Q 7 I rt a) v ~ r' a cn z -1 w 0o n W - m tj w n H ZN CL z G G 0 3 co m Ul ~O Cn W v N. Ste' (D J 0 C~ ~0 (1 C) G (D r t o v d m Fl- W P G oo p n N H Q C N• o G C o o° T N r+ w co 3 m c CT) I C QO G Lo C v o a a Q. 0 (D N U) Co G uro n a, ro ~ CD ro A.. ~ A 0 N A ro - N S O a A ~ A O Q to Dq N ro w ti a O O y O ro ti ~1 0 fl- 03/01/2006 04:27 PM Parcel 020-1147-90-000 PAGE 1 OF 1 Alt. Parcel 33.29.19.787 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current X 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 - NORTMAN, KENNETH E KENNETH E NORTMAN 640 COUNTRYSIDE LA HUDSON WI 54016 * =Primary Districts: SC = School SP = Special Property Address(es): Type Dist # Description * 640 COUNTRYSIDE LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.290 Plat: 0215-COUNTRYSIDE VILLAGE SEC 33 T29N R19W COUNTRYSIDE VILLAGE LOT Block/Condo Bldg: LOT 1 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/31/1998 586162 1353/209 WD 07/23/1997 693/19 2005 SUMMARY Bill Fair Market Value: Assessed with: 92655 232,900 Last Changed: 10/25/2005 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.290 76,200 161,300 237,500 NO 05 Totals for 2005: General Property 2.290 76,200 161,300 237,5000 Woodland 0.000 0 Totals for 2004: General Property 2.290 31,500 141,700 173,200 Woodland 0.000 0 0 Lottery Credit: Batch 104 Claim Count: 1 Certification Date: Specials: Category Amount User Special Code 27.00 018-RECYCLING SPECIAL ASSESSMENT Special Assessments Special Charges Delinquent Charges 00 27.00 0.00 Total DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS DIVISION ti LABOR &.HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING ;.0. 6M 7969 - MADISON„ WI, 53707 sM(CONVENTIONAL D ALTERNATIVE D Holding Tank D In-Ground Pressure D Mound F DATENAME OF PERMIT HOLDERADDRESS OF PERMIT HOLDERJames Herold & Audrey Alwell R. R. 1 , Hudson, WI 54016 ~5T PT FLEA V.BENCH MARK IPer reference p-,O DESCRIBE IF DIFFERENT FROM PLAN NE William SE, Se Sction 33chumaker , T29N-R19W, Town of Hudson, Lot#l, Countryside Vill. 'NUmrier \L,,,- of Plumber- IMP/MPRSV1 N,i. C^~~ 6382 St. Croix 69693T SEPTIC TANK/HOLDING TANK: FE L EV WARNING LABEL LOCKING COVER - MANUFACTURER. qq LIQUID CAPACITY (ANK INLE~f_LF V. TAN~jK /OUTLE. PROVIDED PROVIDED ~lJ"Z~ KYES ENO DYES LJO NUMBER OF ROAD PROPERTY WELL. BUILDING VENT TO FRESH BEDDING. VENT DIA. VENT MA1 t HIGH WATER LINE AIR {NLET, C ALARM FEET FROM DYES NO DYES ENO NE (MANAREST___ WAHNING LABEL LOCKING COVER DOSIU NGC CHAMBER: T U E R APACIiy PMP MMP PH()~.IA NIIUHEIi PROVIDED PROVIDEDDYES EN_ DYES DNO DYES ENO FAR BEDDING TL UIDC. FEET FNUMBEROF HEIPFRrv WELL BuILOmG ~gERiN~oTFRESH PUMP A7CONTROLS OPERATIONAL r(DIFFERENCE ALLONS PER CYCLE: ROM LINE _ BETWEEN MP ON AND OFF)ENO NEAREST 1111, I%'v'*~~ U1A", iEH 41ATE HIAL AND MnHKIN U SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) - CONVENTIONAL SYSTEM: TN. =vlrs uoulD EII()T H LENGTH NO OF )ISI1i PIEE DEPTH B DE RENCH THE%,CHES PIT DIMENSIONS C_F E RTV WELL BUILDING VENT TO FRESH ( i ,VEL OFPTH DEPTH IIST ft PIPE UISTH PIPE DISTR. PIPE AIRNLFTR aFLOw PIPES ECOVEH EIEv INLE I ELEV END FEET FROM OF !J f/ ~F { i CS ~G 1 `1_ I I NEAREST - - MOUND SYSTEM: OFSYSTEM Mound site plowed perpendicular to slope Check the texture of the fill material for PROVID7EARED and furrows thrown upslope: mound systems to make certain that it ON REVHOW ELEVA- meets the criteria for medium sand. TIONS MDYES ENO iMANENEMnriKEHS EtLs SOIL COVER TExTUHE YES ENO YES ENO D ~FE UFU MULCHED _ DUDE I1 i1FPTH OVER TRENCH BED DEPTH OVER TRENCH HEf) I)E P7H OF TOF'S()IL '7,, EDGES ❑ ❑ YES ❑ NO DYES. ENO El YES NO PRESSURIZED DISTRIBUTION SYSTEM: - u DEPTH ABOVE covEH WIDTH LE N(,TH NO-OF LATERAL SPACING GHAVEI IJ PTH HE LOW PIP( BED/TRENCH TRENCHES I DIMENSIONS STH "EL" 'ON PIPE MATEHIAL& MARKING Il, A MANIFOLD PUMP MANIFOLD DISTH PIPE MANIFOLD MATERIAL Pk S151H UU IISTR PIPE UI FLF V. ELEV UTA ELF V. ELEVATION AND DISTRlBUTiDN U covER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED - GRILLE PANS HOB. E SIZE HOLE SP ACIN G (,O I HHFCI I Y DYES NO INFORMATON L EYES -NO PROPERTY WELL BUILDING PERMANENT MARKERS. JOBSERVATION WELLS NUMBER OF LINE COMMENTS: FEET FROM DYES NO FEET FROM 1 I DYES 0NO - ( 4-o ( l C t Re n in county file for audit. Sketch System on ,J TITLE Reverse Side. FT11.1R-._ 'DILHR SBD6710 (R. 01/82) j m Z 00 IIL 1I m z 9 c co m 7 H > -0 co m CD (n co rri CD (n rn Ct :E 6 a < O ~ m z D L > D i m OT W c 0 C) T. 03 m~ > CD N pr`z D ~ C ~ ~ Z z m r ~ 00 'Z rfn m O L CD m G) v' tT { CO w z 03 M c m °r fo z D 1 G z = H O Z o C cn LA z o m m p D C~ 6 r Z\ n D T 7J U~ o D m o o --I D O m m \ m m z g ZZ D C O o oo ~p m O O Q1 ~ o D mg mm m m CD 0 m mz n z c cn \ o { m G 3 Q c CD y o y D r _ 03 00 CD z > m m m N 7 N D m K D O D N 77 C ~A Z D 3 n Z O 7- - m D o ~m Z 0 0 0 0 ~N n m ~D m O d D T D v p o~ _ Z m z - 'D (n rn c Cn m `J ~D 0 1 z m C~ 3 m ? ~O # a-. 7mJ l n v C D = 0 O co cI \ o m m CL n O C z e co co z N v_ CO) 33 p O N W CD p cD Ci O 7r C7 C1 cD 7 N O a 3 Al m t00c cn Q p C p W N S. `<3 3ccncoo~ a Cc D' 0 0 A N > > CD N 0- g«~ m~0o C') co i m~ ~ m ww~ N $ (O N w n ? p cD T ~ n. o S' ° co C =Dr owo >>s cc N = > > p 300 .<~.C~. w Z~ c am :3 f ~ C W w N :3 N C-" D 0 0 C'. D CD < m N c ACa Q A mN~ pDc m 0 =r 73 o " W C) 0) o Moa0-= W a a = cD c0 p S.0 W_ N C :NUO, N`D0)C!r- Z D w Z w CD , - w = ' ca D = CD cD O S CD .e ao n 3 C o N.a D D N m o Er , o • a 0 C =r p m cn N n a c o C A D c m =r 0 rj) 0) SD (D C: =r 0 CA 0 m u, N CD (A CL CD (D N 4 c r. c ~ cD vi w o =1 CD = w 0 c~~ NM m a a CI- ao CCD Q.~ * a~vi N~c `"°a'o ,CD ca 3 m~"g CD G) (a :3 o n m o a o :3 o ca a c N C CD Si C: o a ~ c.D SAS -0 ~ ac ~c cD = o o v 3 0 3 :3 CL CD r CD ' N to a CD z 0 ° t~~ DEPARTM F INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'LABOR& t " 4 N REL.ATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7965 BUREAU OF PLUMBING y MADISON, 1.1/1 53707 XXCONVENTIONAL OALTERNATIVE S[a[ePlanLD.Number (If assigned) O Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. James Herold & Audrey Alwell R. R. 1, Hudson, WI 54016 BENCH MARK (Permanent reference P0,10 DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. NE SE, Section 33, T29N-R19W, Town of Hudson, Lot #1, Countryside Vill Name of Plumber jMP,'MPRSW N,. IC,,,,,,. Sanitary Perini[ Number. Paul Cudd 2739 St. Croix 69693 SEPTIC TANK/HOLDING TANK: RNING LABEL LOCKING COVER MANUFACTURER LIQUID CAP ACITV. TANK INLET ELEV.. TANK OUTLET ELEV. ffIR IDED: PROVIDED. OV OYES ONO OYES ONO BEDDING. VENT CIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PHOPERTV F BUILDING. JVENT TO FRESH ALARM uNE AIR INLET FEET FROM EYES ONO OYES ONO NEAREST DOSING CHAMBER: _ MANUF ACT UR FR BEDDING: LIQUID CAPACITY PUMP MODEL PUMP, SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. OYES ONO OYES ONO DYES ONO GALLONS PER CYCLE: PUMP ANO CON TROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING I VENT TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES 1:1 NO NEAREST IIII. SOIL ABSORPTION SYSTEM. Check thesoilmoisture at the depth of lowin I,r,T,i j1)1,',r,1FTEH MATERIAL AND MARKING or excavation. 0f soil can be rolled into a wire, construction shall cease until LCE N the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR PIPE SPACING; COVER INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS 17AVF1 DFP1H FILL DEPTH DISTR PIPF DISTR PIPE DISTR. PIPF. MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BF Lr)Lb'I'll'FS ABOVE COV EH ELEV. INLET ELEI END PIPES FEET FROM LINE AIR INLET. N 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. OYES NO SOIL COVER. TE xTURE PERMANENT MARKERS. OBSERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOI L. SODDED SEEDED MULCHED. CENTER EDGES OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: _ WII:TH LENGTH NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELF, ELEV. CIA. ELEV. PIPES DIA.'. DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS _OYES ONO _ OYES ONO COMMENTS: PERMANENT MARKERS loesERVATION WELLS NUIViBER OF PROPERTY r LL: BUILDING: FEET FROM LINE OYES ONO EYES ONO NEAREST- . Sketch System on Retain in county file for audit. Reverse Side. DIL_HR SBD 6710 (R. 01/82) SIGNATURE. TITLE wlsconsln APPLICATION FOR SANITARY PERMIT ' COUNTY oERRRTmEnT OF (PLB 67) UNIFORM SANITARY PERMIT # ® In DUSTRY, LRBOR 6 HUMAn 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 0 carne,.. I, Frold ti._ _e S. A"Wel_.._ fit. 1, Hudson, 1 540" PROPERTY LOCATION }C]tJ, XGC.1C dds on 1/4 ah~ 1/4, S 33 T%- N, R EF- ) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 1- Co:antr„Ts ic~,e 4j'"11a.-~ J'oan.ts~Tside l:an e TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIPERMIT 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 F-1 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 n Septic Tank Capacity _ Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: :'io_--,er : er` to rr'oduct ; 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): ~ _S E, ? ® Private El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Sigriatuxe: MP/MPRSW No.: Phone Number: T=aul 73:9 (715 )425_2 Plumber's Address: Name of Designer: 4- f ox _'~TT'r <..1 _ "'.T't :io-ei'er (576) COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial 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. l~ r ui '3 1' is i. o o c?nea° of Proper. cy_ t cSZr _ cl oz~4~ ion of 11ruparty-- Sc= S~ctioii -.T N h lJ _1~ i t;,~~.~. I....._ ;_e0 l; Number e w i o u n Owner of P r o ii e r t Total. siztt of Parce3-- . 2 c - P. ate Parcel W"a Croated 00 er a%:de wit11 this aE~i +ic ttiuaz on' oY t11e foiiowi~ C"artifiev'cd Survey Map !and Contract, or Other t.ogai- Documt.tit we,ich describe;; tilt! pa-operty PF't, ERTY OWNER CERTIFICATION (We) certity that all staternants on this to(n),srra true r.n the best of nl (our) nowledue; that I (isms) am (dre) the owntrr(;n) of tho property dear_-robed in this s'R rrZiatilln form, by virtue of a warranty dead acorded in the Oftwe of the ~uunty Register of Doods as Document No.3-Y' I___, ; and th,ad I (we' la+e. ntly owyn th(3 propo d site for the sewage; disposal system (car I (we) haft, v:air~rzd an 0asernent, to rein Ew4i the dtxr)ve described pre pe, ty, for th e ,Istruction of said systarn, and the wrries has been dui'y recorded in the. %J lhU COunty filegistar tat Deeds, Document Rt OF ow h k riC PdA'r3JkE OF CO(J~ily rt (IF >Of3Wl.si..EltJt t;, H H a ST C- 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z r~ a OWNER/BUYER - r~ ROUTE/BOX NUMBER K.> Fire Number CITY/STATE 4kA C<,` C C.c:L ZIP _rj J4(,jJ , re, PROPERTY LOCATION: 14 , -5c-- Section 33 T ;Z N, R_/ Town of AC n ~o"u) St. Croix County, Subdivision a ul ~ Lot number 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 put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned, have read the above requirements and agree M to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- "U ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 'boning Office within 30 days of the three year expiration date. SIGNED DATE f 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 wg x =r CD N = f n3 a9 ssco 0 0 D) (TO =3 3 c cn co o C EP FD' a CD CD CD En cD a - a p COD o m '61 0) 4, tom. ~ ID 'a p) ID =r o ' c?D oho P ~ » coo n 3 a o --.cow w o tD r. c o w o M :3 (a w p p C- c w c N 3-,c oc3on.o ~Zc° c~ Q° F ° ww~ -~~~wwcn cn Et E; o o ~o n~ ~ -~~'0 w 00 CCD N co, Dc Cc co~~ ~o~ O w°w oE; ma cn 0 CD Ch CD Nn Z ° w cD g D w U) Z wn~~m CD CD CD o °n~° 3M ~oNa D ° c ° n w 17 1 -4 mr - Co =r o Q N CD A 7 O p~ n cDN=o.co~ N co w w w C Rt ~w $ cc CD -can m m (3D c O Q. cD ~N« N n cD w Qw 2 CD o a90 N.o-~~°- D h o c .7CDm- o (j) A not N~ O cawo m w a a a N o ao CCD Q:3 :E a?vi ~9GQ !o c_wcm3 g co 0 G) (a :3 A CD 0 m00 :3 oco n c @ -am c'D r c -4 w " m ~Z - =r ID 0 .CL O C n ? C (D = O O l~ n~ 3 2.3 0 3 a: w K-- no o °a °CD r 0 0 'COMPANY I2'J - m greet OGDEN ~NGI NGERI 11G . OS Q River :a\\//i. 54022 Telephone 1\715) 425-7651 Z 7- o v~v aS 1~ VIZ FL: ort/I Ip',' `9 198¢ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'INDV''.iTRY, DIVISION LABOR HUI~IAV fRELATI'ONS PERCOLATION TESTS ( P.O. BOX 3707 (H63.09(1) & Chapter 145.045) MADISON, WI 53707 7d -X6,.3 LOCATION: SECTION: TOWNSHIP/ LOT NO.: K. NO.: SUBDIVISION NAME: A/ir /ash/a /T29N/11/f Ill. 11C/O510AI t oar vr,P srvE s~it,C~ COUNTY: OWNER' NAME: MAILING ADDRESS: SSr. eAd IX "AA/CI S h! 4 D£N 112 3 E. EL1.27 APl VCiP ~"ALLS lf// _A#o22r USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE 7204 SCRIPTIONS: PERCOLATIpN TESTS: Residence 3 w///► XNew ❑Replace /7~j~ 'J/ A~' RATING: S= Site suitable for system U= Site unsuitable for system f CONVENTIONAL: FFf__isi_: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANRECOMMENDED SYSTEM:(optional) o s ❑u xu ~s w s ©u E:1 s au eOA/i/~/VT/oyALo 12 F rcolation Tests are NOT required DESIGN RATE: I If an C L/7 JS y portion of the tested area is in the A 1114 r s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: L FILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF ,OBSERVED (SEE ABBRV. ON BACK.) B- I 120 93.6 NONE' 7 /za 401~ "04 9 B 2 g~ 9.~/. rJ /1/DAlE 7 96f 3°' B 3 93I. / ivo•~/E 78 o, B,~ ; ~z .o 3d ~,,a B- S~ ~4yoT E.P Lo Ti~/J/ !1/yle t rE's T£'o B- 4N 44f sT / /9 y 2 i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P_ P- s/Y w . 01-7 P_ j 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 92 g4 ,9LE' °N° ~G >G~it/Q - 8~ o V'~ 933..E z 932> / 93/ / i~~ "mss 2~ /,Qo.a PIPE' Fa.~Avo _ ~o A01 17 Aw Al T ,C' arAle_ Pd ST ✓C--C'7- ~g a 0 33. ~DG'~1774At/ 9 932, / -mss ":'.P ~Ar/ 7'- 3'LD,oE 171.Pf~Tss•~/ All 938,3 ~X /ST !fir ~.Pi00E B~ f A0 B "W T N ' 932,/ ~•P~Ao4 SE"O ~'PA~Lr ~2' IV 11jt' ,d!5_ //,I/ 33.68 n 9 ~2, / o Q 1600 7- 40 14- t4_ZZ.,W 7~e4 16-115- 60 Z"/.Pan/ i°,PE you t/p /Pon/ oioE LovNO T FEye~ Po.ST b ET CQ 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: GYAL TEAP G"~E"~Q.@~_- e 6DG~Av~d'. ~o ~ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): q ~"s CST SIGN RF: ssl p E L...c 0 F. St "L, ri plate and C The Saab a~_ n~ a ~ vtt° 1A X € ii j ' uin, E i"Ji . r I t f:<3 ~ f k Y+ ..ia- stir. z i7.. : s l av., 3 Ike t8 4if~`! , M10 i`: .x _ e a"_, c,ix,.,~ `f.1 f"i ck~artv t; ,S,E sk ,x .,i ?3.)•)3 soxcs ;iG f _oh-d i : n F~ 3.3, if rj k? t~ aPi c I;i;'. ~W y' - J t ,z~ ,r.. ~c f t ~ r r .E 't r. to Ti ..d DEPARTMENT OF REPORT ON. SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRN,• P.O. BOX DIVISION LABOR ~t PERCOLATION TESTS (115) P.O MADISON, W1 7969 53707 HUM , RELAT40NS (H63.09(1) & Chapter 145.045) {LOCATION: SECTION: TOWNSHIP/ - LOT NO.:Bt_K. NO.: SUBDIVISION NAME: i NF '/4544 /T29N/R/9Mo y!/vso~/ i *el; -.VIA e 1/i11~ COUNTY: OWNER' NAME: MAII_.ING ADDRESS: i 444 IX r,00 _lC i S /2 3 E. 4ZA7' el hWo f ALtS~ .~.¢s?2 USE J_ _ DATES OBSERVATIONS MADE i NO BEURM~' COMIUIEFi( IAL DE,CI-IIPTION: I'R01 ILF D 'S~RIPTIONS: I'E~~(~LA t N TESTS. f ®Residence 3 Al 14 New (Replace RATING: S= Site suitable for system U= Site unsuitable for system - - 'CONVENTIONAL MOUND: IN GROEIND-PRESSURE (SYSTEM-IN FILI HOLDING TANK: E E( OMMf NDED SYSTEM (ohtion, l) E1U _1 E1$ XU- $ C! u 1_~ $ $ C© /~~iVTioiVAL -~Qw /2 1 P nl +U:)ri are O r c n ~rl DE' ,N R/~T E It wy poi non of +r sty the jnd sH63.0 15)(0, i c te'. E to dpl ii indi< log. rl r~r tan: 111 - - PR0FILF DESCRIPTIONS :-30E LNG TC Al DEPT i TC: (ROU'`dDWAT E_R li IGHF CIIi1RACl ER ~)F SOII TH THE :KNE SS, CC c O1i 1 E XTUItE, 4ND DEPTH JUG' ER DEP' +IN, EI V ;TION 01 ;ER'/FD_ FS]. HIC IESI TO BEDROCK IF_ OBSE10 ED EL ABBFIV. N RAUK.)~ B / 120 NNoAl E 7 go `f ' B- NONE 38,E J 12 .D 3o r,,a B B- A1076': T _/s 0- o' _ / _ A~ o0'0 E.P Lo Tio ,t!/.s!i~y .1` 7-,4r5- TE'o B Sr B 4N_ 4 4V s T- - 10~ -wl PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. ,pERI_OD_1_ PERIOD 2 RIOD 3___ PER INCH P- - - 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 boring; anC the direction and percent of land slope. ten} n, 9 3.,5 SYSTEM ELEVATION .z 932, / EGA~NQ 7 f-T' ~ 2 Aeo w f01,00E' FO"V-V a ..F i~ yO ~~'.P C' E.t/ T .3'LD ro.G°r O1•PfiO•f/ ° 9,e-Al'i4' Mo0',eAe u,oi/f -/4V 33.6 ✓ n~ , 4,00 7- d F 2 G~L✓yJ 7' 4F-le 932, h / ~o Y 9s ' 601 2"i Pa ti/ P oc you f/p /'el F<v 7-- ~t/eF Posy SET Co uwT~ysw.E L•9.r~~ 1, the undersigned, her,:by certify that the soil tests rfjLorted on this form were made by n,~ in accord with tlu~ proceduraland i~c!huJs ~,nc~ci~.etl it th+Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the hest of my knowledge and belief. NAME (pnntl - - 1 E TS 4NEHE COMPLETED ON !'YAL TE,P G".PE'~D•E'y - e 6OE.a _iU~ _ Zoo } 4 F'11r;NE IJU JIB. I~I,o ttionall ~ ADDRESS F If is ft, ION I'IUMBF I ,23`,3"-~~'~'