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HomeMy WebLinkAbout040-1198-30-000 U .-i d ,1 p p, w O n, a ) U U) s ci U) Sri `O ~ ~ cry ° 04 m °~,f ri E+ ^n 4j ~:3 rU N ?4 a >4 c U] 1 al ul r_ CL ) Ul \ o r~ U) (0 O -P UI NQ 3 O x Wit= v ~o _ £ a~ cn uJ N r~ m a U 4l 4l 14 M 1 I1, 01 14 - tT >4 ro o , O a, O c, m N -4 4 m !4 Ql r O C) C o EA., O Q) 41 3 OA ° i U U'~~ N A A U L) ra C) Q.3 Q) Q) Q) t Qcc F L ..y , 1.1 I E•+ (n („I 2.",az pun Sup~unid ~(7unn,7 .gnat 0 y p t_ m o d ~ ce ~ li ~ n 9 ~ -1 # c rr ' o v` Z 0 rn m a Z 3 o ro CD m o W -R `C N C fD Z a P/I W 7 j N Q h~ C iz~ Y) O pi N W -I N c Q p O to O 0 O O 0 O c° m c cn 3 I ~ I o 0 0 o m O p N co 0 n.~. C t7 y' N O O r~`r p x 7 to C D m D !v W G H CD D o' CD n m 4 p i^ LL trJ 9 c y W a ((D Hd Cl) ~ 3 a c N (D O o II P- n W L N• p) O lot O H. O z m tzi a rt by C; O CO 2 W H w 00 c ` rn (7) (.n cn y n t' fn CO) 0 c a K 0 ~f H C,^~~ tTJ Z (D W Ul 00 O O O Q D • H CA -n ' Z H o i cn ~En Cn~ CD yy~o' m r fD y' r N H d _ y c CD CD F-1 O H a _ U) Gj 00 00 Z M I L N u, ' 1 I Z W I lv C) (D 0 O D ~OiI O ~ lV co O OH H CD ~ N N U) CD 0) m m' 00 n Z c d O 2 O a l17 Fh N v _ _ O o m 7 00 ~l GQ (D o 0 (D o A Z fo 3 P. p' Q A Z O rt 00 O L c `C p O 1 rt - o) Z O cD N C') W ( m 3 O X 3 m o CD O v n ni O. 0 0 p _ p m ° c. a) N l o_ O I E L I n1 H Z I ti I ti 0 0 A 0 O ti CP rb Oo p o O O L ~ ON I • J Form- STC- 10 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP O SEC.13 -17- N-R,40 W _aev S74t'j ADDRESS 14jL ST. CROIX COUNTY, WISCONSIN 17 SUBDIVISION LOT LOT SIZE /igo "6 PLAN VIEW wry . Distances and dimensions to meet requirements of 111IR 83 SHOW EVERYTHING WITHIN 1170 FEET OF SYSTEM A _01 I i is-/, c „ yv - N /~z - w INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used site Elevation of vertical reference point: &0,0 Proposed slope at SEPTIC TANK: Manufacturer: 1~~,~~C3 Liquid Capacity: T- Number of rings used: Tank manhole cover elevation: /QO,I Tank Inlet Elevation: _Q/.1;~ Tank Outlet Elevation: jowft~ Number of feet from nearest Road: Front 10 Side 0 Rear, O > i feet ~ feet From nearest property line Front,0 Side,011~ear, Number of feet from: well > 15 0 building: s 3 (Include this information of the above plot plan)( 2 reference dimensions to septic tank' SEE REVERSE SIDE PUMP CHAMBER s Manufacture?': ---Ly 'elchi Liquid Capacity: Pump Model: tS-T Pump/Siphon Manufacturer: ~ Pump Size Elevation of inlet: y/ it Bottom of tank elevation: 7f Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: /,w,0 Alarm Switch Type: ^ Number of feet from nearest property line: Front, O Side,~JRear,() Ft. Number of feet from well: S'D Number of feet from building: > !f'D " (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width:_ / Z Length: cS`2 Number of Lines: Z. Area Built: Fill depth to top of pipe: y ~r Number of feet from nearest property line: Front, O Side, @4ear,01?t.Z,~2_ Number of feet from well: > / /p© Number of feet from building: „ CE Je (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: T Wede'm Dated: u- Plumber on job: License Number: 31 B~ 3/84:mj DEPARTMENT OF RELA ON INSPECTION REPORT FOR ~~aa SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOA 7969 PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING MADISW' '✓d 53707 CONVENTIONAL ❑ALTERNATIVE slw anlD N-ber. (lf assigned) Holding Tank ❑ In-Ground Pressure ❑ Mound I NAME OF PERMIT HO LG't H. ADDRESS OF PERMIT HOLDER. INSPECTION DATE: Doug Stein R. R. 3, Box 88, Hudson, WI 54016 BENCH MARK IPerr.;anent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PL ELEV NW SE, Section 13, T28N-R20W, Town of Troy, Lot#10, Bomer Heights Name of P W tuber -r- C M P!MPHSW Nn. y Sanitary Permit Number. Dave Fogerty 3289 i St. Croix i 64933 r _ SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER - % PROVIDED: PROVIDED I SU - YES ONO OYES ONO BEDDING. VENT DIA.. VENT MATL. JHIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDIN Q'. WENT TO FRESH ALARM. .FEET, FROM LINE AIR INLET. OYES ONO OYES ONO NEAREST TcT DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI TV PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER R.V IDED: PROVIDED: OYES NO YES ONO 4ES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. rFEE UMBE R OF PROPERTY WELL BUILDI G VENT TO FRESH (DIFFERENCE BETWEEN T FROM LINE AIR"LET PUMP ON AND OFF) OYES ONO EAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FN(;T', Uf) IIAMETER 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: BED/TRENCH WIDTH FINLEETT NO OF DISTR PIPE SPACING COVER INSIDE DIA SPITS LIQUID TRENCHES / MATERIAL: PST DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH R. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF LINE PR N OPE AIRINLE EERTV WELL. BUILDING. VENTT FRESH BELOW PIPES ABOVE COVER. ENO PIPES FEET FROM u 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 cert~(n that it ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium nd. TIONS MEASURED. I SOIL COVER TEXTURE JPERMANENT MARKERS JOBSERVATION WELLS i OYES ONO OYES NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BE O DEPTH,bF TOPSOIL / JS D SEEDED MULCHED CENTER f r OYES ONO OYES NO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUS?~P MANIFOLD DISTR. PIPE MANIFOLD MATERIAIE IN0DISTR ELEVA TION AND . DIS PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELFV. [_LV CIA.. ELEV. PIPES: Diq(: / DISTRIBUTION I INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY / COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED I PLANS I OYES LINO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING: FEET FROM a"E' i~ ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ° 1 C, 0 U 1! Sketch System on Retain in county file for audit. Reverse Side. TITLEDILHR SBD 6710 (R. 01/82) rGNATUIRE wlsconsln APPLICATION FOR SANITARY PERMIT COUNTY ILHR ' (PLB 67) 'OEPRRTMEnTOF UNIFORM SANITARY PERMIT # iii- InOUSTRV, LRnOR 6 HUrrlRn RELRTIOnS ,1/ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/Zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP TY OWNER MAILING ADDRESS 4 -o~ P P R LOCATION G4T__y, - cU 1/4 51'-'- 1/4, S T N, R r=~ E (or TOWN OF: /ro LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, AKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 2"1 or 2 Family Number of Bedrooms: Public pecify): THIS PERMIT IS FOR A: ❑ "New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: P 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~ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N of Plumber (Print): I MP/MPRSW No.: Phone Number: Plumber's Address: Name COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved i p ❑ _ Owner Given Initial 0 _JV Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractpr,("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 av' 14 Ste , Section T ' N - R W Township ~ror.1 Mailing Address ;e7` / k y Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Z ,~--Date Parcel was Created l - f Are all corners and lot lines identifiable? t/ Yes No Is this property being developed for resale (spec house) ? Yes t," No I Volume l1`' and Page Number 4= as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: (::,.__.,Warranty Deed SOW _ rv~,v 2. Land Contract y- 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 (We) cuLU6y that att 6tatement6 on th,i,6 6onm aAe true to the befit o6 my (oun) knowe.edge; that 1 (we) am (cute) the owneh (6) o6 the pnopeAty de6CA bed in thiA .in6o4mati.on 6onm, by viAtue o6 a waAAanty deed neeonded in the 066.iee o6 the County Regi.6ten o6 Deed6 ab Document Nod(- ; and that I (we) p4e6entey own the ptopoded Aite bon the eewage podaFeydtem (on 1 (we) have obtained an ea6ement, to nun with the above ducAi..bed pnopenty, bon the eon6tnuction o6 eaid Aydtem, and the name ha.6 been duty neconded in the 066.iee o6 the County Reg-i.6ten o6 Deed6, ab Document No..- ) . SIGNC URE/O OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ~I z H a ST C- 105 r -r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ° z d a OWNER/BUYER H _-z~ i LyLf 9 Ci W t7l ROUTE/BOX NUMBER /Z t 3 ,fI' Fire Number- CITY/ STATEZIP PROPERTY LOCATION:/2~/41~' _Sr 4, SectionT N, RG W, Town of / r p y St. Croix County, SubdivisionLot number 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 z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- It ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 'honing Office within 30 days of the three year expiration date. SIGNED i L_ - 4~~_ DATE 40 1J 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 C a) :f3 C_ O q O Y O O L C #r U ca"=3 c ` 7 0) 0 c V m V V) E O O N O. O U) L- L cc rn C 6 0 m U) L Y C .a L O 70 c m N v ca 0 W o ccv > > cOn 3 0~ +3 O L 7 -a E C cc N N.C °)O= O O Q c U to 4 O C (D C: tma tj q-- ca (D - CC N cn a) O U) Q) U) a L O O W C V L C_ a) c d " E O W H 0 3O N c`d U n ~ d C' C U N O TN L Y V cz O t O L ca ` 6 C C N p) O L. N ~w a) Q (D co - co c~1- 0 U) CO L Q N'3}?c~u3v>i u)H~ Wcv~l CO cn a) c 0 O - Cc 0) ` «s c~ cc O U 0 O a i 0 j 0 Q ~ O N N ~ a) > j " O a) 14 a) C C -0)= V) C O O O C C (n =3 N Y c 3 c~ L c O fl O O ~Z E > cti v > C C L C C LOMO:3 "a)o Co O) O U co a) 0 o 0~ m L v) u rn L ) c m e r Y co M - F C: O O c V -0 a$ a) 0 ° 3 a) cn O a ci o 0 0- a) CD ~ Q a) Y O C O 0)0)c E C -Y Z i co L- " cm cC O a O -o `O a°fo (ti L L E N C O D U Y 0 3 O C O ~ i a) c Q) ~ N m O O E N U) (n Y -cu (D m r w ~ J N C DEPARTMENT OF SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND LABOR AND P.O. BOX 7969 PERCOLATION TESTS ( / 115l DIVISION HUMAN RELATIONS (H63.09(1) & Chapter 145.045) ` / MADISON, WI 53707 LOCATION: SECTION: TOWNSHIP/fb> +EtP~kf_:++y: LOT NO.:BLK. NO.: SUBDIVISION NAME: COUNTY: /BUYER'S NAME: M ILING ADDRESS: USE . j NO. BEDRMS, : COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE Lle-Residence PROFILE DESCRIPTIONS: PERCOLATION TESTSDNew ❑Replace / S~ RATING: S= Site suitable for system U= Site unsuitable for system CONVE(NTIONVL:M O~U]N~ D: INGRnOUNN~DRES'I:SEs FILLH (OLLDIING TANK: RECOMMENDED SYSTEM:(optional) U d ~ U J ~ 1~ o L I_`J J 11 -2 W F rcolation Tests are NOT required DESIGN RATE: r s.H63.09(5)Ib1, indicate: If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: z PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, EXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) -Z 3 c B Z f s 6n /s 9 ' B- y , q V B 7 ~/1.S 3.3~/3n z 5 > cs PERCOLATION TESTS RTEST PTH WATER IN HOLE TEST T IME CHES AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-ICHES RTE MUTES PERIOD 1 PERIOD 2 PERIOD 3 PER INCH 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. SYSTEM ELEVATION _ 9C ~6 7,4 car ei S 13 ! E - , ~you: s~ 170414 F t ~n 7'ev IC C /f /~A 7Z "W- ?PP 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. NA rint): :::::jr::: TWERE COMPLETED ON: 2 Y_ p 2 y A's- ADDRESS: CERT ICATI N NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRI¢UTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI LHR-SED-6395 IR. 02%82! - OVER - KOO _ sa OUT S r ` ekSF ,E4„ a i vEuex,l~t~ ;f €4e:± `_3> >=t r1..Ex x. _ _FZ, t .x1 ~13 r:.'a s WAVE A ; E ,Af F yco SJ Ufa#,t. to Wong yaw W W3 W . W" ty ,3 , ;.q = Son 1 1°: t k ho "I i 14=0 eat n ; t t i r ma t ni J,nt , 1x a i4 shcom, a. -h.>1 Ymn, Von AMC d= no dpqV pmm e s~ EE x' r y, vnni~Qd 1 r BR .r ,x,,., 3`s1 BR Sma W3 CAMP, is, r " 0, e c " o:. k; F .l FCC Lm 100 lympy Sam W- Lon TW 00,; X33 _ o-',i tf~ g 3 E~ ypon SO.% , e . , _ ~ . MTV ch-', . E5T s3l.. 1 Tom pl-~" „ DEPARTMENT OF SAFETY & BUILDINGS INDUSTRY REPORT ON SOIL BORINGS AND LABOR AND ' DIVISION HUMAN RELATIONS PERCOLATION TESTS 115) P.O. BOX 7969 (H63.090) & Chapter 145.045) MADISON, WI 53707 LOCATION: SECTION: ' / /~Z ( TOWNSHIP/ }p =OB : S UBDIISIN ME: COUNTY ~4 OWNER'S/BUYER'S NAME: MA ING ADDRESS: USE i Gt YQ (P NO. 75m [ DESCRIPTION: DATES OBSERVATIONS MADE esidence PROFILE DESCRIPTIONS: PERCOLATION TESTS: _ ®'New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS A EIS ❑U 0S ❑U ❑S ❑U ❑S ❑U [under Percolation Tests are NOT required DESIGN RATE: s.H63.09(5)(b), indicate: ~Y If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: PROFILE 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- 7 9. ~ rr+ . 7 M f/ .2 /l~h GS w / Ah B- B- B- B' 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 PERIOD 3 PER INCH P- 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 borings and the direction and percent of land slope. SYSTEM ELEVATION r t _ E i r. . 3 -r r I t t r a i F F E j 3 E t 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. E (print): s T ESTS WERE COMPLETED ON: ADDRESS: 2r CERTIFIC ION UMBER: PHONE NUMBER (optional): C 4 SIGN~AT RE: 3 S DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILi9R-SBD-6395 (R. 02/82) - OVER S 6 rJ'~ t E ' h , i, i z[ ~ t . a , ~ _ t 5 J t s 4 f :j 5} 4 'D.", i tC EI .F - 5 7 P j r t{'d rfl ` 1. ,,ji .t, co 3-. t.i, E 6v zt t r- E' ~ 3 .F 1 t ~ 7 ~E Cfi b E t` y ~ 3 e.._.. r ai EE tsE 7 d€ Y> 'N \1 D ~ W L' D o ~ Y 1 b h i o o v ~ N c:1 ~ a o ~ t o a ;n I_ I I 7T-T - - 1 ~ n y~ _ l j1 ~ _ b , ' ! I I r d ~z r ~ qo X11 - a • 1 i PAGE OF • BUMP CHAME~Fll iRCJSS ~FCTILIK! ANIP 'iPFCIFI! ATIC)AlS to V>V WT CAP 'i"C 1, VCNT PIPE" WEATHER PROOF APPROVED LOCKIMG JUNc.'rio J BOX AWHOLE CL)VE:K FKCM CCpR, W-;CUW OK FRESH Iz~Mlll. AIR INTAKE GRADC f (AJ!_.1_T PROVIDE _ I _ t + AIRTIGHT SEAL I I T APPP.OVEC JCIN? A I III P,PPROVED _CIIJ5 W%C.T. P I P F I III W/C.I. P;P~ EXTENCIkl(- 3' I 11 EXTEN0i),;, 3' ALARM OK1T0 O;.ID SC!. B ( II OIJIO SOLID SOIL I I cN C I I y PUMP i OFF D CONCRETE BLOCK RISER EXIT PERMITTED GNLJ IF TAIJK ",%A~j'JFACTURV-R HAS SUCH APPROVAL SPEC.IF ICAT IOKJS SEPTIC ANp 124'~; 'trAQKS MAIJUFACTURER: NUMBER OF DOSES: Z PER DAy TANK CIZE: 9C- GALL0KIS DOSE 'VOLUME 2ws A LA R M MADJUFACTUR tlk4Et UffiG BACKFLOW: GALLONS ELR: ~ MODEL NUMpER: CAPACITIES: A= -z~ INCHES OR .2.~ GALI - 0~15 SWITCH 7yPC: WCHES OR =G~.4LCl;S PI_)MP /'1AIJUFACTURER:. tG= G x iAJCNES OR --Z2 2_ GALLOWS MODEL. NUMBER: _ 3 3 -~/Y S v 1'7~~ / D-..L_.INCHES/O~ GALLONS o` `ter` ~/5'` ~ W 77~ 74~ SWITCH TYPE: M MOTE' UMP AMD ALARM ARE TO BE INSTALLED ON 5EPARATE CIRCUITS + PUMP tJ15CHAR4.E RATE Y.~ GPM VERTICAL DIFFEREMLEC ei5e acu PUMP OFF AUD DISTRIBUTION PIPE.. FEET MIUIMUtA NETWORK SUPPLY PRESSURE , , , , , , , , FEET + Z2-(f FEET OF FORCE MAIN X t~9> FYoFT.FRICTIO+J FACTOR.. FEET TUTAL DtjlJAMIL HEAD FEET ys 1NTE:c{3.lAI., pftIE►.lSIoW;: Of 'iAAlK: LEPdIC9TN _.._„_,_,;Wt$T-H .;LIQUID DEPTH 11Crt3 GL~: I_lCEQSE KALIME;ER:_ DATE: 1- w Parcel 040-1198-30-000 09/15/2006 07:59 AM PAGE 1 OF 1 Alt. Parcel 13.28.20.906 040 - TOWN OF TROY 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 DOUGLAS R STEIN O - STEIN, DOUGLAS R 334 AHRENS RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 334 AHRENS RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: 0121-BOMAR HEIGHTS 1ST ADD SEC 13 T28N R20W PT GL 3 BOMAR NIGHTS Block/Condo Bldg: LOT 10 1ST ADD LOT 10 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 06/13/2002 681672 1909/646 QC 07/23/1997 716/48 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 60,500 197,300 257,800 NO Totals for 2006: General Property 2.000 60,500 197,300 257,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.000 60,500 197,300 257,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1198-40-000 09/15/2006 07:59 AM PAGE 1 OF 1 Alt. Parcel 13.28.20.907 040 - TOWN OF TROY 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 DOUGLAS R STEIN O - STEIN, DOUGLAS R 334 AHRENS RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: 0121-BOMAR HEIGHTS 1ST ADD SEC 13 T28N R20W PT GL 3 BOMAR HEIGHTS Block/Condo Bldg: LOT 11 1ST ADD LOT 11 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 06/13/2002 681672 1909/646 QC 07/23/1997 929/554 07/23/1997 848/197 07/23/1997 847/200 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 60,500 0 60,500 NO Totals for 2006: General Property 2.000 60,500 0 60,500 Woodland 0.000 0 0 Totals for 2005: General Property 2.000 60,500 0 60,500 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