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HomeMy WebLinkAbout020-1112-00-000 A r c N O 'I 3 v n C7 r~ _ C 0 ~ 7 7 A 3 k 0) CD A *k c) v N O O C N O `C N• a' o m acn - Q m W CD W O n 7 O N O ! N N d 0 CD (D 0 0- - O ° cn ° O O O M CD U7 N 00 C 90 7 n O 0 3 N D O O co cn d (D N "J v to { (n a C cr CD D m (n a m Z3 m 03 a_ N (D o (0 8 (D O N (0 O O a W l nrcn CD W 00 (nn can o ° Q n+. a ~ N 0 0 0 C O O O a o v) CL cn cn a3 vvv~'' ~ ° o O ((D - N •P G) 'O cn x (D - O I'I N y rn m N) CD O =mt CL 3 z o C z z :3 D o O o cn N C C N co (D CL a 3 Z N (p fn O Z CD CA C ~a rn v d A C 3 co _ C N CD (D C. , z , 3 A O U N i C COC N Z C < ~ I A O cn g D m a (n a 0 :3 m 'o v (n z o. S' o N (D ~ - N CL d~ < {y V! ~ O 1 n N CD ,A p7 < (D A 00 A Q C7 ~ x O x' ~ A o_ m da a LL o O o a 0 n Parcel 020-1112-00-000 01/14/2005 08:53 AM PAGE 1 OF 1 Alt. Parcel 12.29.20.454C 020 - TOWN OF HUDSON Current ' xi ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner CARL J & ANNALISE DYRBYE DYRBYE, CARL J & ANNALISE 168 STARR WOOD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 168 STARR WOOD SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 1.200 Plat: N/A-NOT AVAILABLE SEC 12 T29N R20W PT GL 3 COM NE COR LOT Block/Condo Bldg: 11 ST CROIX STATION TH N 89DEG W 152.53' N 48.88' TO N LN 3RD AVE-POB N 148.27'N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 82DEG W 297.48'S 18DEG W 186.03'S 12-29N-20W 88DEG E 353.2' POB Notes: Parcel History: Date Doc # Vol/Page Type 03/02/2001 639591 1594/475 QC 07/23/1997 716/330 07/23/1997 699/264 2004 SUMMARY Bill Fair Market Value: Assessed with: 48532 888,800 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 179,800 507,800 687,600 NO Totals for 2004: General Property 3.000 179,800 507,800 687,600 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 179,800 507,800 687,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 102 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 J Form- S T C - 104 . s AS BUILT SANITARY SYSTEM REPORT OWNER ~'-AAL (JGtKh~E TOWNSHIP NtAb-5'Ut4 SEC. T N-R ZO W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION Nl4 LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I111R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i'Il.)t~,S E B li 1t `P " °g~ N INDICATE NORTHIARROW BENCHMARK: Describe the vertical reference point used ~"~eant lice SW Lc^r ~aszww_ Elevation of vertical reference point: 164.32- Proposed slope at site: SEPTIC TANK: Manufacturer: r Jze:s Liquid Capacity: 1z 7O {~r~t,~-r . Number of rings used: Z, Tank manhole cover elevation: Tank Inlet Elevation: %_37 Tank Outlet Elevation: 9 6_y-7 Number of feet from nearest Road: Front,0 Side,Q Rear, O ovE (Qp` feet .From nearest property line Front,OSide,ORear,' lob -U`feet Number of feet from: well ~ building: Z(o'-C (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: z. Width: Length: 4V-C>' Number of Lines: Area Built: Fill depth to top of pipe: 46" Number of feet from nearest property line: Front, O Side, (2) Rear, 0 -pt Number of feet from well: (nNAS;R-- 1 CM Number of feet from building: Ofttt- 1[aC (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector. Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF•INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &.HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION ?.b. BOX" 7969 BUREAU OF PLUMBING ,'!iADISON, WI 53707 RPS CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Numbe r: (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 1 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPE ION ATE. Carl Dyrbye 1600 Cty Rd "F", Hudson, WI r BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. R E PT. ELEV.: CST REF. PT. ELEV. SW SW, Section 12, T29N-R20W, Town of Hudson, Lot#3 Ileo N,- of Plumber. MP/MPRSW N, Count y Sanitary Permit Number: Paul Cudd 2739 St. Croix 69650 SEPTIC TANK/HOLDING TANK: , MANUFACTURER LIQUID CAP C V. TANK NLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER 0 PROVIDED: PROVIDED 1 YES ❑NO ❑YES ❑NO BEDDING: VE T IA VENT MATL HIGH WATER NUMBS OF ROAD: J PROPERTY WELL. B DING. VENT TO FRESH / ALARM. FEET FROM LINE AIR"LEZ-' YES ❑NO i c ❑YES ❑NO NEAREST DOING CHAMBER: MANUFACTURER. :Ej:l N G'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCCOVER PROVIDEDPROYES ❑NO - YES LINO ❑YES FIND GALLONSPERCYCLE: PUMPANDCONTROLSOPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST 30. 1 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR. PIPE SPACING COVER JINSIDE DIA. -PITS ILIQUID BED/TRENCH TRENCHF,s t rERIAL DIMENSIONS PIT DEPTH 1 GRAVEL DEPTH FILL D PTH DIST PIPE DISTR. PIPE DISTR. PIPE MATERIAL O. 4STR NUMBER OF PR OPERTV- WELL. BUILDING. VENT TO FRESH BELOW PIPE ABOV COVER ELEV. INLET ELEV. END PIP LINE- qlR INjL ET. FEET FROM fy s i NEAREST---o- MOUND SYSTEM: / Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. FI SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCHBED DEPTH OVER TRENCH DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.. DIA. ELEV.. PIPES. DIA.: DISTRIBUTION INFORMATION QLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES FIND ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE ❑YES ❑NO ❑YES ❑P, INEAREST-_~ Sketch System on Retain in county file for audit. Reverse Side. SI rURE. ~ ~ TITLE. - - DILHR SBD 6710 (R.01/82) APPLICATION FOR SANITARY PERMIT DC ILHR (PLB 67) St* Croix COUNTY OEPggTTEnT OF - InOUSTPy, LRBOR&HUTRnPELRTIOnS UNIFORM SANITARY PERMIT # 61 94~,5'~ -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 Carl Dyrbye MAILING ADDRESS 1600 Cty. Rd. F, Hudson, 41 54016 PROPERTY LOCATION XXX Ot'l 1/4 SW 1/4, S 12 , T29, N, R 20~p~) W owN~oxF: Hudson LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 3 NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED ,~finn 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: IX New System ❑ Tank Replacement ❑ Re air El Replacement Soil Absorption System p Revision ❑ Privy ❑ Alternate System L1 Reconnection ❑ Petition for Modification rF1 THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System In Fill El In Ground Pressure L1 Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions, issued Total #of Prefab. Site Septic Tank Capacity 1 1 X Lift Pump Tank/Siphon Chamber Holding Tank capacity Gallons Tanks Concrete Constructed Steel fflFiberglassPlastic Manufacturer. Wiese Concrete Products IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground PressurTotal #of Prefab. Site Gallons Tanks Concrete Constructed Steel Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: Class 1 7 0C Lx Private ❑ Joint El Public I, the undersigned, hereby assume responsibility for-installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatufe: Paul R • Cudd MP/MPRSW No.: Phone Number: -c~ PRS2739 (715 )425-2049 Plumber's Address: Rt. 5, Box 364, River Falls, Wl 5 Ro 4022 NaRWo f be Designer: rt Ulbrich' COUNTY/ DEPARTMENT USE ONLY Signatur of Issuing Agent: ee: Date: ❑ D7ved O~~ ~vr(L/ ❑ Reason for Disapproval: Approved AAlternate 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 Fo 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 inadequasies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractgr,("apec 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 Ct9l~,[ J_ ~N Location of Property 5~ 1T7~tttt-~J , Section , T N - R W Township f1uZ>S~ Mailing Address 1 '76 j ?bSc9~! tv `Dttc+I Subdivision Name /V_ Lot Number N _ 19 , Previous Owner of Property /43)91ivi Total Sire of Parcel 2 /G/2E~ 5 Date Parcel was Created Are all corners and lot lines identifiable? X Yea No Is this property being developed for resale (spec house) ? Yes X No volume 716 and Page Number 33n 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 Surve Map, the the Certified Survey Map shall also be required. y ~._~...r;------- PROPERTY OWNER CERTIFICATION I (We) ce ti6y .that att d.tatemen to on thi.6 4o4m ah.e t ue to the bed.t o6 m (oun knowtedge; at i (we) am ( cute) the owner (b) o6 the y ) .~n6°nma.tion 6onm, by v~t/s-tue o6 a 6 pn0penaty dea ~,i.bed in .thi,a 6 walvs.anty deed neeonded in the 066ice o6 the County RegiA teA o6 Deedb ab Document No. pAu entty own the p.4opoa ed e.c to bon the a ewa a :Y 5-3 ;and that I (we ) obtained an ead ement, to 4un with the above des cA bed o eiLty ( oa I (we) have eout4uction o6 said 6y,6tem, and the Game has been du.eyyneco4ded6in the 066ice 06 the County Regia.ten o6 Deed6, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF PLICABLE) DATE SIGNER DATE SIGNED H • a STC - 105 rr- a SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a OWNER/BUYER CPI L J, ;kA 1.)Ajtr~L154 JV 11`rJ'~3Y H ROUTE/BOX NUMBER G / "S6 "x -yig Fire Number 9C,;y CITY/STATE 1~t71a.Sc?r~ ~G~"1 'LIP Stt~,J(~, SEE f?77i~C".iyZ~D PROPERTY LOCATION: ' 14, Section T_ _N, R _W, I Town of St. Croix County, Subdivision Lot number N-13. 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 'honing a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 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- i ment of Natural Resources. Cer.tificat:i.on form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED _ DATE C! 7~` 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. HOMESITE SEPTIC PLUMBING CO. 715/386-8185 RT. 3, O'NEIL RD., HUDSON, WI 54016 • CERTIFIED SOIL BORINGS & PERCOLATION TESTING • SYSTEM DESIGN & • SEPTIC TANK PUMPING INSTALLATION • ELECTRIC ROOTER SEWER UNCLOGGING Client Address DATE CHARGES/CREDIT BALANCE DUE cce sS - ~ L , 1211" f G' In G 4 CPU f,AP~ Nom Unless otherwise arranged, Payments are due in full within 30 days. A 51.00 billing fee or 1.s% Interest on unpaid balance applied monthly. c w 'r 9 O ~m0o`~oo m Co :1 44 o m Q ~S~•<pK 0 i 0 'c, r 3 ~coco 0 a -0 o 0 =a, $ o m o_ mom 0" 0 -0 ~N r a, F %D ~"t« m ? O O c=D CD Oo o 3 n O "coca (D O " to O j (A w ~ ~ .1m w w m o~~ o~o ~w '0-0 0 cu,o w clo., < ( N Slr O CCDDCA oDwci~CD 37 C) cn o o cn ° o mco f O COD (=r ET m m -i`~ c<~~~ O Z =N~ m~C~ a a n ao 0 3 NCO N ' ° N c c~ o r = m N Qcon- m mvic:nco°1 U) W a a c 0 * CD C m =r m O N N 7 go m Mr Cn CD CA CJ W (=Dt n co N _ > y cnom r«°c co N n ~ % CD " 0 O m3CL 0c or cca.00 1T1 Q o f N m m- M CD ~ aana-* ao m Q~ Q G) lt co w? o 3 s o m m 1 0 G~co~ ~ oOUCD,~ c~ c n CD ro W, on c -~0 c no C c ~ coo =r w 0 CL o 0. =r c m o nc3 0~ 003 (moo ps a n o 0 0 " 1 3 on 0< C w c~D ~p o N 0 DEPARTMENT OF REPORT ON S 11 INDUSTRY, OIL BORINGS AND Y&~V S LABOR AND PERCOLATION TESTS (115 ~ 7 I~UMAN RELATIONS tyvU f • of,3 (H63.09(1) & Chapter 145.045) { 537 F I0 4Lo SECTION: f]OC• # Zf~U~ ;.s TOWNSHIPtfvfP7 Y: LOT NO.: BLK. NO.: SUBDI N NA r //TN/R DO E CS/1 Uo/ 33 TY: CERF/BUYER'S NAME: MAILING ADDRESS: /'X CA"L -;Dyk'/3 y~ 1600 ~ Qn USE /t ~C F / j~U~SD•tI S, S-, NO. BEDR :COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE lResidence 3 ? A New PROFILE DESCRIPTIONS: PERCOLATInNrFCrg: /V ❑Replace QG f • r RATING: S= Site suitable for system U= Site unsuitable for system / CD: IIN-GROUND 11 E1 : RE: SYSTEM-I I FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑u , Qs ❑u EIS ou EIS ©u C4~UDE-vf~a~l /3t1, 7-,P~,~l s [under Percolation Tests are NOT required DESIGN RATE - / S~ SQ f7~ FOiQ /3EQ s.H63.09(5)(b), indicate: If any portion the tested area is the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS SGS G BORING TOTAI DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WIT ~I HICKN ~SCp OR, IXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ~s G B / ~0~ f %A -w1.A. ,00- / s 3 G,e .3. • s - a 52-elE ; GAP B- 12 d S ? > .0 ' • s ' P/-- Av. /s, i 1 s ' /~N- i0 sq~, i C5 w; c ,e B,S 15.3 - S _ • j- '.Pe C3,0. IS - •S aN - 6y (P. - ae. B- cs w PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME NUMBER INCHES AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PERIOD 1 PERIOD 2 P- S(y/' ~OX//t/ ~'Q~ O PERIEO_D 3 PER INCH P- le" P vE v f Co.v "S' o f 7- _ O/ s A2 % Dti V L~ CS 576% P M s' F/~O I-e- 0K_ (65 i P_ 5/ D Cpl Air To --'A) M i r1'3i i c i i,v /.v - IS' - AIW - O/C 4 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. 13o-#Om °F FT. SYSTEM ELEVATION D A°ka /3a.PE-s This test site APPROVED 3 /i u fQr a convent! onat septic system. pRO/'osFo r,or• 0-- PT• = F60.0,01 Pike ON BZ~ 0f•F/ Sto A2, c-0 ,Pn36'k~ c5 i t7V 4TiarJ = k 2 /00.0 Fr= y r 2 41TERQ,9TE' 5 y S BEM _ ~ SLA~v~ / /-'36 v ~I ~ ~ 6 _ _ r /~EFE.PE•vGE ~%VE 10 _ ~ 1D Sow Lof LitiE ocv Wo ROAD 6454.fewT I - A) I NoRd'l~ /ot L~ 7 AfIS. ()E~ . S~. Ctfli1~ 3yf _/i'o,v /07(- 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: 4DDRESS: 0 C T - IS- - 1W CERTIFICATION NUMBER: PHONE NUMBER (optional): BECAUSE o STS _ 1=0L 4{0+9.2~ F s~o/oES /N ALTEi~V,}TE fifEfJ - CST SIGNATURE: o AvolP Cv -t riNy 13,4Nk- Pow,v _-VeQ- P,POp 40Y ~ i A.) C,4 A~ AE COAf,44 ,vDEL~ T[ON: Original and one copy to Local Authority, Property Owner and Soil Tester. 95 (R. 02/82) -OVER - ~n1a, and u iC; I l;.e . C. r,s ec)r,t_~ ,3 NAIA XiMUP r !s t+llc n r t r+ axf"3 6`7 =?i r 5 E ` r' ~ A SE FE.. ' .2. F ~"J ~.3. w j q fie k l? V ~7 ~,F r! riesCi,piio r nd co t,l} c 10 tie tis x SF: i ~e~ iE 1c t! t 1 7 .ii rt . foc'kla£?E i our } E, A itla, , f, if M)Lii tii3: _t .1s: 4 Ff L ~x k 0 €.e „1FiC. r: Ec. i i,r Hale J i N E Y aElzlmc .a ~x s, £ s L --n V,t t !s, i 3 2 l iIply x8-F 4Zx • _ F l '0 w . A r c k{ } ° ;?"2 s r et } a k V a a. k r '"i"g Y t't# 1€ t ss a? fs 4 plans i f rs a,s~ ~)t l4 £3} ~y 1 i ,Y „ ask z , i F k~ O ~ r ~ (n W O t lc~ SoiL FILL P 1 OF,? -?-'z AG G AT V. OF Ftt i - -1 - - r -57 -j f c t: an , ✓ ~T r i.. ! l/ ' I O- - ' - _ _ - . = _ . `l BU1ldinq sewer \ r _ _ E-f fluent System "v - Replacement system a, -a r7 c.:: - 7,Di str-~hution Uoxec 1A Scale a, I - m - ` _ -I-- t - T: Gal. per Cycle - C}; 71a lndlca 11-1 g l -L-em 1S 5:704;7 Or, _Jot f?1an DeiOw: Q) S ` I i I f SJ . 1L I By the granting or a orovina of the above P• any or ll,On the event of a S-Obsec-UeT'it 77!i_ t hei nC 1 s:SUeG~ .J~i. Zvi O, COtmty and t 2 s ~:r0,~?;COl]7-i Zoning Acm' ni StratOr~ -.'c 7)0 t a_>Sli Ic, Or r101(3 1- `;ail l4?)-,1.e for a_ly aefects -Jr, _,]ans or 5reci'1.cc%10nri -S: 1-, t umission, examunation`Oversiont, conStrllcti0ny Or any da:i,age that may result in. or nStallatl0 -N c e Do -,e Rev. 3j! •'y Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER t,I~KL /,Ju~'R~t TOWNSHIP 0(4bSUf-J SEC. T N-R Zo W ADDRESS X617 C~u. ST. CROIX COUNTY, WISCONSIN 4k -!r SUBDIVISION LOT . LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t F~L , ID o N INDICATE NORTHIARROW BENCHMARK: Describe the vertical reference point used I"-zvbn! V'is•= 5W Lor elzfzw V__ Elevation of vertical reference point: _16,3 Proposed slope at site: U SEPTIC TANK: Manufacturer: _'V►~mx5.~ Liquid Capacity: '~Q Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: qw---~ Tank Outlet Elevation: 91o.1'y Number of feet from nearest Road: Front, Side 10 Rear O16 feet ..From, nearest property line Front,0Side,0Rear,O lo feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Site 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: Trench: Width: -Q Length: 41P+_.00 Number of Lines: 3 Area Built: j7 Fill depth to top of pipe: 146 Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: (nVSV.- Number of feet from building: 011~w rtX~~t~t' (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: / Dated: Plumber on job: License Number: 3/84:mj r zz y '3 J~' ~ W ~ ~q ! 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