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HomeMy WebLinkAbout022-1008-30-101 Q o °o 3 0 ~ O ~ a+ o o o rn N 0 o m p a) 2 y C 0) C Y N C i~ w ~ : d Cn a7 O X N U) 0 Z 0 Y c 0 C c ti -0 as 1L c a) . c0 Y C a a a) E Q a) U O M CL m w o 4 Z o 'D 4-J ai C\j ~ a m ~ v H > j ~ G \ bD c r O N p O I ,4 w O 3a Z + U i cd - v 3 3 Q of o o cn 00 in P m a z J - w E -2 P; o "D 2-) M 3 I Ii U') U)z 9 N Co, 00 C5 1 Q) ~4 El O • L C00 C O I O O (1) Q w - I Z m z o 1 N z p W v w > co H d CL 'R rI Z ~ N d a) o N U tn' H 0 00 Z > Cl) H H F Ny 7 O U W N > a. LLB • 000 z o H ro ►~1 ~n a a a 3 p a _ x Cx o i LO U') 00 00 cn W U] ~4 +J I~ 3 o in Cl to U aei o o } I ~ N G 0. N p N ~ T Z v CD o -a Z) D cn U _ m w a) d = v ~ Q ~ cn !a ~1 C CO 3 R N C .a _O O Q) O O m~ O O M O U C c L) n- O lO •C O C -O N 00 m 0 C p O C 2 0) 42 T = 0 00 U 4 Ln Z y N C a) C~ C~ C: 00 E -1 • ice. o o Y > c "t o o Z F°- C-) E .r sa ° a w • a m a) y c ~~`1wv E _1 A U a 2 O N 00 Parcel 022-1008-30-101 09/15/2005 07:41 AM PAGE 1 OF 1 Alt. Parcel 4.28.18.508-10 022 - 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 ROGER & SANDY VAN BEEK O - VAN BEEK, ROGER & SANDY 578 HWY 65 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 11.500 Plat: 1592-CSM 16/4409 SEC 4 T28N R18W LOT 1 CSM 16/4409 Block/Condo Bldg: LOT 1 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 04-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 80,000 301,000 381,000 NO AGRICULTURAL G4 7.500 1,100 0 1,100 NO Totals for 2005: General Property 11.500 81,100 301,000 382,100 Woodland 0.000 0 0 Totals for 2004: General Property 11.500 33,100 234,800 267,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 568 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1008-30-015 09/15/2005 07:40 AM PAGE 1 OF 1 Alt. Parcel 4.28.18.50A-15 022 - 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 ROGER & SANDY VAN BEEK O - VAN BEEK, ROGER & SANDY 578 HWY 65 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 578 HWY 65 SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 26.239 Plat: N/A-NOT AVAILABLE SEC 4 T28N R18W NW NE 686/01 EXC LOT 1 Block/Condo Bldg: OF CSM 6/1513 EXC CSM 15/4150 ASSM'T INC 022-1008-30 100 & EXC CSM 16/4409 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 04-28N-18W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 686/01 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 03/01/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 26.239 3,700 0 3,700 NO Totals for 2005: General Property 26.239 3,700 0 3,700 Woodland 0.000 0 0 Totals for 2004: General Property 26.239 3,700 0 3,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1008-40-010 09/15/2005 07:41 AM PAGE 1 OF 1 Alt. Parcel 4.28.18.51A 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 ROGER & SANDY VAN BEEK O - VAN BEEK, ROGER & SANDY 578 HWY 65 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 33.700 Plat: N/A-NOT AVAILABLE SEC 4 T28N R18W SW NE 686/01 EXC CSM Block/Condo Bldg: 16/4409 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 686/01 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/11/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 31.700 4,500 0 4,500 NO UNDEVELOPED G5 2.000 200 0 200 NO Totals for 2005: General Property 33.700 4,700 0 4,700 Woodland 0.000 0 0 Totals for 2004: General Property 33.700 4,700 0 4,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 y ~ AS BUILT SANITARY SYSTE11 REPORT OWNER TOWNSHIP SEC. T N-RIU' W ADDRESS z- 1 leTL ST. CROIX COUNTY, WISCO14SIN SUBDIVISION LOT LOT SIZE 4 PLAN VIEW Distances and dimensions to meet requirements of ILH-R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope t site: SEPTIC TANK: Manufacturer: G(J«~_c 5 Liquid Capacity: e~e r Number of rings used: Tank manhole cover elevation: /OD "ea Tank Inlet Elevation: Z~ Tank Outlet Elevation: Z7 Z Number of feet from nearest Road: Front, ~j Side 0 Rear, 0 ~2_2© feet From nearest property line Front,0 Side,0 Rear, 0 2;2" feet Number of feet from: well ::-7/,S-~ building: 1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: et, Pump/Siphon Manufacturer: Pump Size Elevation of inlet: S4~' Bottom of tank elevation: R Pump off switch elevation: Gallons per cycle: 11~ Alarm Manufacturer: G EcJ ~ Alarm Switch Type: 1~u Number of feet from nearest property line: Front, O Side, &Rear, 0 Ft.~Z Number of feet from well: s-00 r Number of feet from building: 3~0 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: rj Trench: Width: -7 Length: Q Number of Lines: _ Area Built: / U ' Fill depth to top of pipe: Number of feet from nearest property line: Front, GSide, O Rear, 0 Pt Number of feet from well:- ` SD Number of feet from building: (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, n Side, ORear, nFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: ~cJ1 Inspector: Plumber on job: Dated: 'Yx f- License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, Wi 53707 - BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan LD. Number. ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound nt assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Roger Van Beek Hwy 65, Roberts, WI 54023 BENCH MARK (Permanent reterence ` G7t I J ~V point) DESCRIBE IF DIFFERENT FROM PLAN. _ : . NE SW, Section 4, T28N-R18W, Town of_ZarrA>, REF. PT. ELEV. JCST REF PT. ELEV ' Name of PWmher MP/MPRSW Nn.. County. Sanitary Permit Number: David B. Fogerty 3289 St. Croix 64852 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ^ LIQUID CAPACITY. TANK INLET FILE V. YANK OUTLET ELEV. WARNING LABEL LOCKING COVER C D PROVIDED: PROVI BEDDING. O DE N (Jv _ v/J YES ❑NO ❑6NO VENT CIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH C ` ALARM / FEET FROM L INE All IN ❑ L T YES NO l( ❑YES(/ NO NEAREST 2 Z DOSING CHAMBER: MANUFACTURFFy. BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER / WARNING LABEL LOCKING COVER /Vn~l ❑YES NQ OO ~S3 ~a ~/1~ PROVIDED. PR~~OV/IDED GALLONS PER CYCLE: JIUVBANIICUITRO soPERArIONAL YES ❑NO LYYES ❑NO NUMBEPt OF PROPERTY WELL BUILDING vENTroFRESR (DIFFERENCE BETWEEN FEET FROM 1-1%E AIR INLET PUMP ON AND OFF) O~ IYYES DNO NEAREST /0' SOO1f OGf -Tov SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing T=F v::rl~- ulAn~(TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until T FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH. LENGTH NO OF DISTR PIPE SPACING COVFH INSIUE DUTA =PITS LIQUID f TRENCHES MAi ,YAC PI~ DEPTH DIMENSIONS 2- `7 5 d 40 GRAVEL IJFPT11 FILL. DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. j0D TR NUMB ER OF PRPER iV WELL BUILDIN GVENT TO FRESH BFI()WPIPF( ABOVE CO VEH ELE VINLET ELE V. END AIR INLET S- Zti 95. /3 Z 7 Z FEET FROM 5 / J NLET. /J NEAREST--s 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SAIL COVER] TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DEPTH OVER TRENCH BED ❑YES ❑NO ❑YES ❑NO DEPTH ovER rRENCH,BED CENTER DEPTH OF TOPSOIL SODDED SEEDED MULCHED EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH TH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES DIMENSIONS "1i1NIFOLD PUMP ELEVATION AND MANIFOLD :EL TR PIPE MANIFOLD MATERIAL'. NO. DISTR DISTR. PIPE DISTHIBU iION PIPE MATERIAL & MARKING FI EV.. ELEV. DIA V. PIPES. DIA.: DISTRIBUTION _ INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS: NUMBER OF (PROPERTY WELL: BUILDING: FEET FROM ILI NE: L1 YES 1:1 NO 1:1 YES ❑ NO NEAREST--~ ob, Sketch System on tain in county file for audit. Reverse Side. Y SIGNATU TITLE. J DILHR SBD 6710 (R. 01/82) - Wisconsin APPLICATION FOR SANITARY PERMIT I LHR ~ COUNTY OEPRRT EnT OF (P L B 67) UNIFORM SANITARY PERMIT # MN~ InOUSTRV, LRBOR 6 HUmRn RELRTIOnS / //,P57 -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 ~PRO RTY OWNER MAILI G ADDRESS v OPE TY LOCATION C TY: < 114 1/4, S T 8N, R E (or DI OWN g c c'~~~YL~~'~~✓~~j~i,C~z~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AREST ROA LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED CZ1 or 2 Family Number of Bedrooms: .3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ 1Vew System LJ Tank Replacement ❑ Repair V Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System L1 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 11410 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total # of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): [4 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. 11 e of Plumber (Print):-----~,~ gna MP/MPRSW No.: Phone Number: 1 o ( 365`6 Plu er's Addr ss: C.-4 I Name of Designer o yo 1 4'A :Z 01 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved 0 Owner Given Initial / ~ Llpproved 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 f 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 perm it; 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. S 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 limo v enaz .or Location of Property It Section _0T N - R W Township sA 0 Mailing Address Subdivision Name Lot Number ` Previous Owner of Property - Total Size of Parcel -Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes t,-' No Volume f; 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. PROPERTV OWNER CERTIFICATION I (We) een ti.6 y that att s.tatementa on .thi.6 6onm ate thue to the best o j my (out) knowt.e.dge; that I (we) am (a/Le) the owneh (s) o6 the pnopu ty des c- ibed in .th" in6oAmati.on 6onm, by vixtue o6 a wannanty deed neeonded in the 066ice o6 the County RegiAten o6 Deed6 a6 Document No - ; and that I (we) pneaentty own the proposed site bon the Sewage di4po4at 4, tem (on I (we) have obtained an easement, to nun with the above deacAi,bed pnopenty, bon the conStAuation o6 Said S y,6 tem, and the Same has been duQy neeonded in the 066ice o6 the County Reg.c.s.ten o6 Deeds, as Document No~ C-1 r & , SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H H . a ST C- 105 r r a ti SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z c7 a OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE_ ;n&.1 ZIP PROPERTY LOCATION:z=2-~4, .f , Section TZJN, R _W, 'I A&6/1 Town of St . Croix County, Subdivision 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. H 0 E 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- u 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 'r.A I C D ATE 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 s ~ s m m c m w ~cn m n~3 0 v Cn w_-, m 0 0 N v CD CD fD 0 C7 CD 7 o °'3 SS Z S 3C=:,: fD co p A TT11 4 :3 CD En p m O a 00 O N J ccoo 0 CD C, iF 1 9 r 'm ~po~mo°o n 0 3 a O w '01D w O CD c so w o~? ° .-off 0 w 3p o -~c c~N 13: -+c oc3oa0 w S c CD _ p) w N Cn - ~ 30 0 0 10 a-, CD w CO "a < o CD to C 0. ° Ja C CD N Ca O con, D CD w - m :Idl cQ 0 0 m m 0 ~~~wFuwi a V1 ((,,,,m CD N CD w N Z D Sw ww Z N CD CD C) S CD o aCD 0 3 Nm U) a D Nam R *-,0 R1 wo- a.- c A S-0>> ip ca~ww ~ CD ~ C v 3 •0CD~ m CDcSD COi~ao~wN 0 ~ C)L 2L C, r- 9 (tit N CD 0 N w u c( , j Ri w= w 7 CD w as a0 Q3 acv,' cr C7) U) =r CD 7, :3 c cD (D 3 N' q CD O 7 C "C-`• n C ca O CID a o d C (-N w c (D S N C C7 i = p 0. a C O CD O 0 Vn y =3 0 w 3 # -CCDD Cn ° a O Z - CD € o c y o A j Pe e \ i c~ s i Y-00 Iwo I ~ i( rG X~~ at 1,~ r '7X t D3 a- r F i w i f~ 1 f P Fl _w 9 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION ,LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969 HUMAN RELATIONS (H63.090) & hapter 145.045) LOCATI ON: , SECTION: TOWNSHIPS +PA_t r6-yy/ ~reL/ LOTNO.:BLK.NO.: SUBDIVISION NAME: laz- ~y1 y /T,~N/R/yE(or COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: LIResidence ❑Neweplace RATING: S= Site suitable for system U= Site unsuitable for system DS I CONVENTIONAL: M(ODUNQD: IN-GROUN(~D-(PRREES~S~URE: S(YSSTTEQM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) EU l~J ~U ~J UV l~J ~U ~U Z SIX '17 /,Z If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicat N,~/1 Floodplain, indicate Floodplain elevation: !v PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF S IL WITH THICKNESS, LOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- d-9/ 97. Y I1,01~ > 6 y , q' w B- r cr? i B- B- 2 , L ' l zw w B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-IN HRATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P_ P- 2- O E P- P- 3 z C y ` 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 ps!r E f 1 I t i F ~ N EE a : - _ t ,cam.. Y _a. _ .,....p ~ . A,. o ~ 'r _ ~ n { f 3 3 t i ~ ~ r ~t i t ( i : 3 ~ v I ~ ( : ( ( i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. KIT"(print): ^1 TESTS WERE COMPLETED ON: e ADDRESS: CER FICAT N NUMBER: PHONE NUMBER (optional): CS SIGNA DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DII-HR-SBD-6395 (R. 02/82) OVER E;sf:w 01 ni j, Ef 'r T- T F 3 j..4 fs; ,3. oa;:c, sw ,t, s a_s tG Was, ,_n! i iu-v pe,+ {almi.,, W) e i` Q W Son! { tai ~ t < at 3 : r.. Cow, Anni W i" c: rF _ s e Won? Wn? t, a _ a ~ guy d< t L .w t i-,,,... soq N W s - ;t Kin „ re ofi Vale, n _ 'An 11 st in a =5~ t .wl E. t e 7°t3F Yt st, qw l,.e g b'. ? j .mwc4 ho PA61 OF PUMP CFIA.MF i R CRf? 5 `EC,TI0KJ >+J-Jt', ~;F(~If"ICrt1 i(~'15 VGKIT CAP '1 C T. VCt.IT PIPC APPROYL) 1.CCKING JUA1C-TIO}J BOX- MA}iHOLE COVtK FR:,M ODOR, 4ii}JC,01' OK FRESH 12"MIU. AIR Iti TAKE I GRADE ~ CoFJDUIT-~ _ i~11.F:1' PROVIDE _ I AIRTIGHT SEAL +T~ I I i ~ r I I APFR.OVE-C JOIN? A. I I I APPROVED _;IWTS w/ C.I. PIPF. I III W/ 11,1. PIF E EXTCNDIAIC- 3' I 1 i i EXTE}JDIUG 3' ALARM ONTO ',OIA0 SC!' 9 I (I ONTO 50L'sD SOIL I ON c I I I t . PUMP --J OFF D C0?JCRZTE BLOCK- RISER EXIT PERMITTED GJLy IF TANK MAI.IUFACT:JRZIK HAS SUCH APPROVAL SPEC.IFICATIOKIS SEPTIC AND DQSC l-,4 `IKS MAWUFACTURER. HUMBER OF DOSES: PER DAy TANK SIZE: GALLOtJS DOSE VOLUME ALARM MAtJL1FACTURER: _ : , tkt[ b 6ACKFL.OW: GAt~-ONS MODEL FJUMBER: CAPACITIES A=,._L? _IMCHESOR 2<L GAL_CWS SWITCH TdPE: _ g = Z I}XHES 0[", _ vArl.O1J5 PLJ,MP MAMUFACTURCR: G iy?3" I JLHL, OR GAL''-~W5 MODEL MUMEIER: 3 D-INCHES OR GALLCIJS SWITCH TYPE: 1„0 TE: PUMP AND ALARM ARE TO BE INSTALL-E0 OM SEPpRa,l-E CIRCUITS PUMP OISGHARNE i"iZ'!°E ~ GPM VERTICAL WFFEtl.CUC[ b~}"r•:EE?J PUMP OFF AUO O15TRIL-,UTloIQ PIPE- S _ FEET + MikilMUM sJZTWOiRK SUPPL.~j PRESSURE//. . . . . . . . _2.5 _ FEET -4- FEET OF FORCE 1`^,3.tPl X _ F/4C~F1.FFlcTlo~1 FACTOR..lL -L FEET "I •T 07/21 D'JKJAMIL HEAD FEET lQTL:KMAi,.. DIPILK)S1oWi OF `t°AXIK: t_EKIGTH _;111D'(1s ;L I0ll1o G PTH 5 1c-,vEG: LICE.IJSE 1JUMBER: (}A-FE: -117- ST. CROIX COUNTY WISCONSIN ZONING OFFICE N y,: 796-2239 (HAMMOND) i 425-8363 (RIVER FALLS) HAMMOND, WI 54015 July 2, 1985 State of Wisconsin, DILHR Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Attn: Carolyn Haag Dear Carolyn, When this permit was issued on April 4, 1985, the plumber and soil. tester listed, in his information given, that the property was lo- cated in the Town of Warren. Just recently, upon using the application for the Wisconsin Fund, it was discovered that the property is, in fact, in Kinnickinnic Township. Please make any changes that are necessary at the state level. Thank you for your cooperation. Sincerely, Mar J. Jenkins Secretary St. Croix County Zoning Office 10 + I h\9 Af 1 j C Rr -rrti.t c is • N 8 9 P i~ so " ~ t, 0 ~$1 e< ' I - `iJ! I t/ ' IIV i s.T, r U i ~G ~o I ~vt~CC ~ I I i T I i f c/,t / i II i' 30 , 1 I /Sca~ L = ~/Y1 0 I ~ t E 6 3 J