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HomeMy WebLinkAbout022-1084-90-000 n cn O 3 v n O d m ° 3 CD CD ID m x~ Z O N h• 0(n v 0 o O CO W 3 (D O C N N r-0 CD ~ O ID i O C 7 N CO 0- z CD- 7z N co CJ O _ 77 O O~ ~I (D O W N D 7 co N (1 4i W (n A a Co O Ci 7 CJ CD < n CJ7 O ! v O rn O R' O W O 3 3 in °o p cn Cn m Q m m ° CD us CD D D' n ° d , m W _0 c ° C1. « O N `Z (D ao CL CL x O O n K C CD OD 00 - U) Cn A < Q ° c D 0 3 N N n s m D . (n O CD Pli p lD N o !r CD O CD ° Q 3 N z O Z -i z O D m ° v O 0 o. ? lrr • CD N CD (D =S ° N CD a 3 CD z Cv I to ° D o a z CD m c _ 0 A Z O m a O Z N (o ca -0 W m m co 0 3 z O (n 3 Cw CD A W E COD Q Cn CD C1 CD O < CD (n o CD N ° - n rn ~ n ° -1 Q~ C1 CD C Q CD 0 O a m cn CD m a. CD o~CD ° 3 °p CD ° a ~CD U1 a - O X O A t_ p (fl S W ID O cn N G W cn Cn (1 j Q Co W CD N O a A ti O < ryq O O Q ° L O = O ti St. Croix PAMELA M WELCH Municipality: TOWN OF KINNICKINNIC 149 E QUARRY RD Permit Number: 58928 RIVER FALLS WI 54022 Parcel Number: 022108490000 Alt Parcel Number: 29.28.18.4576 Site Address: 149 E QUARRY RD Components Component Manufacturer Description Last Next Status Schedule Service Service Septic Tank Septic Tank 07/17/2014 07/17/2017 Current 36 Conventional Trench - Seepage Trench - Seepage 07/17/2014 07/17/2017 Current 36 Drainfield Maintenance History Service Date Maintenance Name Gallons Pumped 06/01/2006 Not Available 0 05/1312010 Not Available 0 05/11/2012 Not Available 0 07/17/2014 Not Available 0 Notes Date Text 7/4/1776 12:00:00 AM ADDITIONAL NOTES: Reused existing 1000 gal. septic tank (baffles inspected) to 3 trenches, 5'x 49', 55', and 53', POWTs 68' east of private gravel road notecard filed w/permit in 1984 archives MIGRATED ON: 09/04/2015 *No data found for Notices, Violations BYRAM, DAVID NE SW, Secti C1129) R.R.2, Box 227 T28N-R18W River Falls, WI Town of Kinnickinnic San.Permit#58928 12-19-84 R. Ulbricht Conventional, Replacement INSTALLED 5-17-85 Parcel 022-1084-90-000 02/08/2006 11:07 AM PAGE 1 OF 2 Alt. Parcel 29.28.18.457B 022 - TOWN OF KINNICKINNIC 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 - WELCH, PAMELA M PAMELA M WELCH 149 E QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 149 E QUARRY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 29 T28N R1 8W 5AC NE SW COM W1A COR Block/Condo Bldg: SEC 29;TH E 1410.86' POB;TH E 659';TH S S 467'; TH W 419.03';TH NLY ALG 66' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) PRIVATE RD TO POB 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/27/2004 769879 2624/409 QC 06/25/2001 649168 1666/479 WD 07/23/1997 902/232 07/23/1997 843/113 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 143897 302,700 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 226,100 306,100 NO Totals for 2005: General Property 5.000 80,000 226,100 306,100 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 40,000 163,000 203,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1084-90-000 02i08/2006 11:21 PAGE 1 OF I F Alt. Parcel 29.28.18.457B 022 - TOWN OF KINNICKINNIC 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 - WELCH, PAMELA M PAMELA M WELCH 149 E QUARRY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 149 E QUARRY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 29 T28N R18W 5AC NE SW COM W1/4 COR Block/Condo Bldg: SEC 29;TH E 1410.86' POB;TH E 659';TH S S 467'; TH W 419.03';TH NLY ALG 66' Tract(s): (Sec-Twn Rng 40 1/4 160 1/4) PRIVATE RD TO POB 29-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/27/2004 769879 2624/409 WD 06/25/2001 649168 1666/479 07/23/1997 902/232 07/23/1997 843/113 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 143897 302,700 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 226,100 306,100 NO Totals for 2005: General Property 5.000 80,000 226,100 306,1000 Woodland 0.000 0 Totals for 2004: General Property 5.000 40,000 163,000 203,0000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 122 Specials: Category Amount User Special Code Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 LDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, P.O. BOX 7969 LABOR AND, PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOT NO.:BLK. NO.: SUBDIVISION NAME: LOCATION: SECTION: TOWNSHIP : SE 1/4 1 47 /DrN/R /~E (o) W i,Ua,~'cK~,v v~' c COUNTG%o OWNER'S/ fttrrl~WS NAME: MAILING ADDRESS: , • / L)t l~ 1~ S S S5/a 2 13 Rf~ T Z Q 1P ~ ~ 5{•i'~( uE USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIA DESC I P OFILE D SC'-RyIgTIONS: PERCOLATION TtSTS: ❑New Replace Nou•00~ I -d Residence `j N SG h 46.4 Sig scs 9r 13ooNE RATING: S= Site suitable for system U= Site unsuita le for system r11ESE1U1 ONVENTIONAL: MOUNDINGROD-PRESSURE: SYSTEM-IN-FILL OLDING TANK: ECOMMEED SYSTEM:(optional) ®S ❑u o S ❑u ❑ S Qu ❑ S ou rlfirwe4es 7ed ,P,'z DESIGN RATE: If any portion of the tested area is in the S~IaE If Percolation Tests are NOT required J . under s.H63.09(5)(b), indicate: CG,~ S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ~N ~jEG i h+~ F7f BORING TOTAL DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSER ED (SEE ABBRV. ON ACK.) .s , ra"g 4. S~ s- ~ S• 0 r, > 7 D w a~2 tG •+w~i a Y,." i Pck A A Os 5,410 . s ' Z-/- 12,3. s 3.~ l 43 • a &/S w7 sk 333P ~N DS of "De-Or-- S/ B- S I o~ •CP ~o iVF Ra' W fT L. w +-F oR • hot ~3 $9A> - s0' Ae - a b . S , • 9i ' T~ B AOD 10/ 'IV," .AJARA04,0 , -A-ZDS of 15 1, 6' Wer -P" SA D (y . O ND 70' e B- 0~. S ~ > 70' w 8 f4,'Ck /34 17,P4. OR s D ^ 3. 3.L b/ _Zr 1.23 &Y S, o 'J ru,pr►lrc~ la s !S` B 5 D ~j y Z NotS a7^ 3. i' b) w -a f -F(,;.4 914 AJ D (r0-17-7 L- FD) . B %U,f rovs PERCOLATION TESTS * PFA30fGS ~~sTS S. ST DROP IN WA TER LEVEL -INCHES RATE MINUTES TE DE PTH WATER IN HOLE EST TIME NUMBER INCHES AFTER SWELLING TERVAL-MIN. PELR- IODt P%iJO2 PER~D3 PERINCH S- P_ 30 /0 2.2• O P_ a ~oo.o v ~ s- 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. %/~'EN(~ 1 %,fEV Tel Z-VC& 7 SYSTEM ELEVATION ~O a 9 = Y7 s 113~ (0 J, id S~AIE~ =-3v e~~ ' 3s iz w_ N I( • = /~q ck~aF ~i,~s r, Piz P, Q RPP,eox. 0 To~ Psi. 35 hod p``° 3 13 /Et~A Tio J ' /00-0 I, the undersigned, hereby certify that the soil tests rep t n this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded an~~~ation of the tests are correct to the best of my knowledge and belief. NAME (print): yJ TESTS WERE COMPLETED O HOMESITE SEPTIC PLUMBING 54016 / I d(~ ADDRESS: CER~TIFICATIONNUMBE PHHONE NUMBER (optional): ROBERT R LBCINO, 3307 M.P.R.S. 7 } 0 Z 1/1 jETE ~JNSTALLER& DESIGNER CST SIGNATURE: U. NU. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Er{:. {Pz S1j i{rfl~i, 4I e . f e 1 X11 ArsL F P 1 ;.,~i 1 4 E c -"y -7 _ v CASEE o se s i err G { 4 X11€{i' { 1 i o f13 (lest°riptio s c,I) f cc,ynplt F AK A LE. I L E di i Mq Ci. ~i ~i !,vving, to Tf"J jsw if t1emtcdc YC)d ,L., ,,.3@ ca d =:mcal elevation c~Be a-{' shown, L L€? e,€t r ~[);'E va, ci `f to dates, J(.[. 0 W J n~o~i-na~ioo ac, 14 r "t tt~ ,,4 rj3{-t'. 4i 1 i 10' ,,sp[ a LIB 7 i3!1E' ;,"Eii J81,: s ' E IT { s B' r a, R if€4 r y{ Si: n£e s ?II°' , r3 rf. , Form- S T C - 104 • AS BUILT SANITARY SYSTEM REPORT ~f p OWNER TOWNSHIP GC1Nile%(i SEC . Z / T N-R a W ADDRESS -ST. CROIX COUNTY, WISCONSl* 2 SUBDIVISION I"GAAJeA-- LOT LOT SIZE PLAN VIEW HOMESITE SEPTIC PLUMBING CO. RT. 3 OWEIL RD.; HUDSON: WIS. 54016 Distances and dimensions to meet requirements of ILHR 83 WIS. MASTER PLUMBER LIC. MINN. INSTALLER & DESIGNER LIC. NO. 00663 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0'V 7- 1 I ' 'vi i I i I ~ i cJE1/ I '1( I IK I +X I ~ ~ I b CgsT C4.19-Q t-avbfC y„ c/f~N RI ~osr S/Eeve S'a -I 53.5 t , 8~• (/E.v7- D/57R%l3. / Oy f~0~ !/~/vt f a oGD SyS~P.w. INDICATE NORTH ARROW fa NEB T/F'S~-t' S 7-0/0 Pte. / _k -P-4 3 011- / BENCHMARK: Describe the vertical reference point used e~ Elevation of vertical reference point: l00,0 Proposed slope at site: SEPTIC TANK: Manufacturer: /~E//PdeD Tv NOT ~itl~w~ Liquid CaPacity to o O G-14-/ . Number of rings used: ~2_ Tank manhole cover elevation: A./I,o/PpvrwA15> l°ce/''/G- ll 1 2-;P. qq C OvE".e - Tank Inlet Elevation: 3~ Tank Outlet Elevation: '(0 < ` f3 S feet Number of feet from nearest Road: FrontR-11) ,0 Rear, /0 S. `os`s feet From nearest property line Front Side, ®Rear, O Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensiE SIDE septic tank) SEE REVERS PUMP CHAMBER S Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation inlet: - Bottom of tank ation Pump off switch el tion: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from neare property line: Front, O Side, O Rear, 0 Ft. N er of feet from well: umber of feet from building: (In lude distances on plot plan). yf cT SOIL ABSORPTION SYSTEM f.57 Bed: Trench: Width: s ' ' ? Length: Number of _Lines: J Area Built: Fill depth to top of pipe: '/X S S , 3 Number of feet from nearest property line: Front, O Side, © Rear,0 Ft C Number of feet from well: ~l6 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: its: Diam Liquid depth: om of seepage pit e ion: Area t: 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: Capac' Number of rings used: ation of bottom of tank: Elevation of inlet: Number of fee rom nearest property line: Front, O Side, e Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: r / ~J Inspector Dated: Plumber on job: HOM~$ITFccripl,IMBIN6 SA RT. 3 O'NEIL RD., HUDSON, WIS. 54016 License Number: ROBERT ULBRICHT MINN. INSTALLER & DESIGNER LIC. NO. 00663 3/84:mj ~tPARThIENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7,969 BUREAU OF PLUMBING MADISON, WI 53707 MCONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number ( E-1 Holding Tank El In-Ground Pressure El Mound If assigned) ~y d NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Dave Byram RR#2, Box 227, River Falls, WI 54022 M BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. E EV. NE SW, Section 9, T28N-R18W, Town of Kinnickinnic Name of Plumber MP/MPRSW No.. County Sanitary Permit Number Robert Ulbricht 3307 St. Croix 5d 9 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPA ITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED . PROVIDED. ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.. VENT MATL. HIGH WATER UM R OF ROAD: PROPERTY WELL. IBUI LDING. VENT TO FRESH ARM FROM LINE. AIR INLET. AL A ,v- ❑YES ❑NO Ela NO N AREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKIDEING COVER PROVIDED: DYES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING. ILINE AIR INLET. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGT i DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until =FR the s oil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH- LENGTH NO. OF jD ISTR. *AE ACING VER NSIUE CIA PITS BED/TRENCH r S TRENIES Mga.~alALPDIMENSIONS CRAVE[ DEPTH FILL DEPTH UISTH IPPIPE IAL. NO. DIST NUMBER OF PR OP ERTV 71LdTB;L D VENT TO FRESH BELOW PIPABOVE COVER ELEVN EL EL~VPIPES. FEET FROM LINE~~/ 05 AIR INLET. f 3 S f NEAREST -f 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- i meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO } SOIL COVER TEXTURE PEHMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH: BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL. ED SEEDED JMULCHED CENTER EDGES ❑YE ❑ ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPA NG. GR EL D BELOW PIP FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PI E MA FO MATERIAL NO. ISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV. CIA.. ELEV, pip DIA.. ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATE AL PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING-. FEET FROM LINE. t%~ ❑ YES ❑ NO ❑ YES ❑ NO NEAREST J l 1 (2 Le G, 2 J' Sketch System on R tain in county file for audit. Reverse Side. SIGNATURE. TITL&. DI I_HR SBD 6710 (R. 01 /82) - r ~~.wlsronsln APPLICATION FOR SANITARY PERMIT St ~~,C NTY ILH (PLB 67) UNIFORM SANITARY PERMIT # ~ A OEPRRTMEnT OF J 7 Ml InouSTRV,LROOR 6 HUMArIRELFITIOn5 /JG -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT P OPERTY OWNER MAILING ADDRESS 1AVE- (3 "11-1 P4 Z 80X 227 TiUm F,4 1l S W (S. PROPERTY LOCATION q pp ~Y' NE1/4s~1/4,S T, N.R/e&or)W Tow C NEST ROAD, R I nWIDUAi~W STATE PLAN I.D. NUMBER LOT NUM EAR BER BLOCK NUMBER SUBDIVISION NAME J~ r GD N _71 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): ill 0 Ov THIS PERMIT IS FOR A: /M. 0~ '1,vaG New System Tank Replacement El Repair ❑ ❑ Privy Replacement Soil Absorption System ❑ Revision ❑ Reconnection ❑ Petition for Modification ❑ Alternate System IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed N Seepage Trench ❑ Seepage Pit El Holding Tank System-In-Fill In-Ground Pressure ❑ Vault Privy El Pit Privy issued ❑ 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. 9ztsri10 (r Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed ~E • 2t s e D - p- f l,~ u~ I' S-~_ Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: W EA S 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): / /YW IS C9 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Pri Signature: AA nn /MPRSW No.: Phone Number- R1. 3 D'NEIL RD., HUDSON: WIS. 540 6 G /3 ~ O/s) Plumber's Addr Name of Designer: *I . MASTER PLUMBER LIC. NO. 3307 M.P.R.S MINN. INSTALLER & DESIGNER LIC. NO. 0066- COUNTY/DEPARTMENT USE ONLY Fee: Date: ❑ Disapproved Signature of Issuing Agent: hall/~~ r • 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. 9H17 0 ce 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 Location of Property /jit) 34, Section 2T 2 N - R /PC Township /~/V~ C-- Mailing Address ~J`- L ~UjPjey 1 7 Subdivision Name ? tiU ti V Lot Number ? ~UCj IU F- Previous Owner of Property Total Size of Parcel S, Date Parcel was Created l`1 /A71--' 5 - 197 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 I Md eeA-t%6y that a,e.e 5tatement6 on th.i s 4onm ahe tAue to the best o6 my (ouh ) knuweedge; that I (we) am ( ane ) the owneA (,s) of the pno po ty da nibed in ,th,&s in6ohmat%on 6orm, by viAtue o6 a wa~ftanty deed necon.ded in the 066-ice o6 the County Regizte/c o6 Deeds a,5 Document No. 3 216 6 4 ; and that I (we) pne,sentty own the pnoposed site bon the sewage disposat system (oa I (we) have obtained an e"ement, to Aairw.i th the above de/scAibed pupetty, bon the co"thuction o6 said system, and the same hay been duty neconded in the 066.ice o6 the County Regis.ten o6 Deeds, as Document No. ) . 7 SIGNATURE OF OWNER SIGNATU OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H y S T C - 105 7' rr H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d OWNER/R r ROU'T'E/BOX NUMBER Fire Numberz4273 _ CITY/STATE /~/~/t~l~ ZIP ~/Q L PROPERTY LOCATION: Section, T 2PN, R_4?_W, Town of %N~/ St. Croix County, Subdivision 'C'>)C~ _ Lut number ,'tJtr"~j( 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 septic tank pumT>er. 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 tar 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 propti operating condition and (2) after inspection and pumping (if nee essary), the septic tank is less than 1/3 full of sludge and scan: Certification form will be sent approximately 30 days prior to three year expiration. ti 0 V. tK~ 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- 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. SICNE u DATE 12__g -g- - - 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. O t" y S m S ~ m N c rr m m M CD n n m o y 0 Q3 ~`O raw o c o w w w Z _ co 3 co co 0 o m '0 0 - (D "D =c:, , CD CD 0 _N ~ CD N CD D " * E ! ~ * H i w~ m w w ig w m ~ m v,.a= $r CD - 0 3 a o 0 o 0 m 00 o CD c co w o w o w .0 (p w c~ 0- ao c S CD w w cn (n -N N = Co D 3 ~o w A°m C , n. CD (n c cn A c o n o D c m ° c =r v -w wm~ o°CL w O CD cn o c ~0"-0w C CD c a w =rw M w cwi co Z • 0CD-1 0m=-+ Z =r c~ ~CDo 3cDa a a QOL~ mN~>>=r m w w CL (a T\m m c CD 0 -0 CD :3 3 0 a m0 \i : (n CD 3. C ( 6- CD A) n OL CD m m o co N CO) 70 L7 ao F a, . c0 aw o R1 w 3.~ aa'aCD v, O agm a c N o c0 S: ~~0 O(a mc l< mom, 3 c y A a :3 o 0 a O N 0 N 0 g c n. w =r (D 0 0 wa3 aCD 00 m cn o o < 3 0 c.Q z DEFARTM-EJNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,- DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADP.O.ISONBOX W 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO. SUBDIVISION NAME: F 114sq'/ l7 /T.2rN/R /d2E (o) W c COUNT OWNER'S/f3C7PEh?'S NAME: MAILING ADDRESS: S~ of X a. u E- 13 RA ~-r • Z C~ P Ko x ~PD. -P; o' ~l S W i s sya 2 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: P OFILE D SCRIp TIONS: PER OLATION TESTS: Residence N~ ❑ New 4 Replace 3 O 'r+^t5~ NO U .'0 . _j . /0- / y secs 9/ 13o4/~sc 4 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:N-FILL HOLD INGTANK: ECOMMENDED SYSTEM: (optional) ©s [--]U ®s ❑ I ES au ISYSTEM-1 -a s Qu ❑ s a u {ms s - 9v--F- lo Ai,- _-D ipizo S ~~Xi-yam If Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the S'--~oE u0i1// under s.H63.09(5) (b), indicate: C44 S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS "N tje-r~ A, 4 Gf . BORING TOTAL DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSER ED (SEE ABBRV. ON ACK.) Is J, - 71 B 7.0 0 7D 54VD w FPS xe ~ia Ys" t~'cK R,aOs IS . Z 7 s' fQa2.l (o 03' /.33'Ab S ~3 Ril S -3.G ";ve Z/ - 9,a, s w;4 3^ p,%.JDS of 'De~sE s/" y' C4E7- B o - 51 /T- L.. U J/ -F 09 - H o t r~ " 03'4,0 -6y. s . s,p ' CW - a A3, IS, . 1.4 B-~ 7 d . O . O ,413D w/ 0AR10040 b-AQDS of is 1, O wFT -rw:,R S~ o t7 S N , $ ct^ ¢ N D B 1.0 0~. S A,-- > 70' O w *4,-c t< /3,4 uDs oiE' . ~S NOfiS AT- 312 ~ ~ 11 ~1?T ~,PA1C0 (3a • S B- S /A_.l S~~T~ S~iPF7`i~S S~PF.~CE ~1~U1¢TOf/S ~-ecCS PERCOLATION TESTS * ~F~Of61 7,C-S7- TEST DEPTH WATER IN HOLE EST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING TERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ 0 /0 P P- O /0 2. z p / P- P- O ioo.O U i 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 percen of land slope. T"PE,Val 1 7-'e4EN6 - _ZT- 7,l EuGI~- SYSTEM ELEVATION 7 ~ = p 7 - " GR+f V~ / v~ cv~sy A / 1 vE~PT REF /9T.. III 6z . 1 E• 30 /2- Tel • _ ~gcklfoE- Pigs; ~ N 4f PROY, Tp/J P V3 3 S /EU~Tio) o- /DO d G 13_ • ys C e4 /10 5 I, the undersigned, hereby certify that the soil tests rep rt 0% n this form were made by mein accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded ann of the tests are correct to the best of my knowledge and belief. V NAME (print): TESTS WERE COMPLETED O HOMESITE SEPTIC PLUMBING CO. - WIDSON WIS. 016 ADDRESS: CERTIFICATION NUMBE PHONE NUMBER (optional): ROBERT ULBRICHT = 3307 M.P.R.S. 0 L y j 2___ 3f6-5 /P R IIC. N0. VAS. MASTER RPqA1 MINN. INSTALLER & DESIGNER L CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - f ~ ' 301-2- T,oPLE3 ~7 PLOT and CR 055 a, C-CrION PIANS ~Z " CE17eA- i CE-V7124 i NFLV 3 ' i T 6 ~ ~6 5'Tit7E ~~~RO ' i cE.u7ER ' c ~ ~ ~ . , E,VTEiQ , j C i - ovFk MoD 13, d A 00cle 90 XCS . PiP6 72-r- -X~a vE IJYe,4 1(1 AE0 s ys7.4. . El( l7'ES v~ Cta ! w S' l b 0 S ~ G it/ED HOMESITE SEPTIC PLUMBING C(! RT. 3 O'NEIL RD., HUDSON, WIS. 5,+-.15 R~RT ~-IRP1"T; WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 Fresh Air Inlets And Observation Pipe Solt, TESTIJNSy By MOMESITE TES- NG t:G. Approved Vent Cap RT.-3, O'WkiL RCj HUDSON, WIS. -44om Minimum 12" Above F i n a l Grade I36*M 4/ oS"v 4" Cast Iron Z S L T&S/- yD Above Pipe - F,- '>"o Final Grade Vent Pipe /0(,.0 Marsh Hay Or Synthetic Covering min. 2" Aggregate T.PENGG` I Over Pipe 3 /O A a Distribution _ Tee Pipe 0 0 0 0 0 twa4 Z- " Aggregate o Perforated Pipe Below Beneath Pipe o Coupling Terminating At ~~~N664,J Bottom Of System GfR%f •CAri~&) 6r -'oi L CoM~JC,'fiNCE- - JA✓ 1 er,4 oP o40 Fifi /Ev S V57c Af DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & JB INDUSTRY,, LABOR AND TIONS PERCOLATION TESTS (115) MADISON, WI 53707 .41 HUMAN IiE~LATI (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNS HIP/Trt7Y: LOT NO.: BLK. NO.: SUBDIVISION NAME: 5',:5 1/ 1/ )-/T VN/R IF E (o) /I(`-/:4W . COUNTY: OWNER'SVBT7Yt-F=5 NAME: MAILING ADDRESS: 3W. ~►oi ~A~~ Y/~2A-~ L Qulae~. S USE DATES OBSERVATIONS MADE 2 L NO. ~EDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:: PERCOLATION TESTS: Residence ❑New Replace h404 _i 3 N ,4 /4~ - Nor ~r-~ vi RATING: S= Site suitable for system U= Site unsuitable for system CIN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) Qs au , as ❑u os Qu as au TiPctichPs If Percolation Tests are NOT required DESIGN RATE: LF'l an --y~'y portion of the tested area is in the under s.H635)(b), indicate: CGrfSS "n oodplain, indicate Floodplain elevation: /"/t-PfV~`~El~l PROFILE DESCRIPTIONS BORING TOTAL. ELEVATION DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABB . ON BACK.) 64 160S-- e 6 00 Z-7 - 1-3)4 -5, ,3..2 $ ' %AN ND~~ a Still' A~^+f! ~`i E~ $ ~fb~ DN S V C > O 6'4 - B B- Sv~ ~>O }rUO7~f~O P Cw a B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PE RIOD3 PERINCH P- P_ .So,L (r A r ~ a N - D,v i 33 Vc ~.,,,,t X a o,~> vi P- - /P£ r{So A i N ore D it 7-0 SA ,1 OLD ' SE'} /'e"k ~iPgr c~ fit Gp P- ` C m o 8 c 7' 1-f- o -K,2 SUE s • JeM A S A(j o v X % 40 P- S 4 i o ve - f4 r! A.) 111'h- 0- V tL ,C-- ?C O"eI.U ct- W S P ?D 3e7e N 1-f-- so:/5 AD.TAc ,ter- % 7` cooE oti Lin AJT . 70 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 NO( Necess'111~ L t~ w N 'a C- A,4 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. HOMESITE SEPTIC PLUMBING CO. NAME (print): HUDSON, TESTS WERE COMPLETED ON: ROBERT ULBRICHT ry,~~,~, l _ l f NO. 3307 MARI VAS. MASTER PI UMBER 11C, f ADDRESS: MINN. INSTALLER & DESIGNER LIC. NO. DOW CERTIFICATION NUMBER: PHONE NUMBER (optional): SS - Q 2 4(,? CST SIGN ATUR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Y 1 ` 55 pp ~ t ua„,i" d`T L3fi 834...4 xL. s,`a s C :t._e cc) in p! ei e and acc, Vii" €3S£°~~'S, ~S€`C? 3~€~~~ f•F:-; IF, ahis a w lac,w sy:,uw ':71inq bwo A Sl P} e 4 _i2'(;=tct?i 1•C , T.) 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