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HomeMy WebLinkAbout040-1162-40-000 .r D 0 1-0 U~ O r .0 n> r l 0 Co - Nla 3 2 = w O ✓ N N 'O i,^\ a CD N I 7 I~ "OkA t> O !mil O W C t76C G~ c ~P Z (D (D L Frt (D orc~ N N s N OC - o _ o p a F o J) n I CD cn o H v 3 N Ul Z i> a In ° o N n e D (D o rt v - (0 7. 00 ~ a 'm w (10 I to z lip a 0o y y o N 0 N n 00 M z c o o h N O W CD (D CIL o ,Or., 0 o o o, N d N• ~ N M Ln c 7 a 61 j, a O < O (D 0 (D = -n D'a0 0 :r 7 fD N < CL N O _ y C)o C CD cl) (D ~ ~ O a O W N 0 7 al W n p~ W 7 O N ? O_ < f (D =r N 4 Z N O N = a ~ n CL O CL ~ A 3 ~ I~;p N 'Yq V ~ .p to O '7 a O r Parcel 040-1162-40-000 12/13/2005 09:03 AM PAGE 1 OF 1 Alt. Parcel M 25.28.20.631C 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 GLENMONT TRUST O - GLENMONT TRUST 1215ELAKE DR FT LAUDERDALE FL 33316 Districts: SC = School SP = Special operty Address(es): Primary! Type Dist # Description " 205 GLENMONT RD ~~tl/ - SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Y ~t 13 Legal Description: Acres: 3.420 Plat: N/A-NOT AVAILABLE SEC 25 T28N R20W PT G L 1 LOT 3 OF CSM Block/Condo Bldg: 5/1350 INC 040-1163-10 630G) & INC 040-1163--20 (631 K a vUa Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) (~,Z 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 11/06/2000 633108 1557/14 WD 02/18/1998 573272 1297/353 WD 07/23/1997 1032/426 QC 07/23/1997 771/49 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 103300 2,345,700 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.894 475,200 1,782,500 2,257,700 NO Totals for 2005: General Property 4.894 475,200 1,782,500 2,257,700 Woodland 0.000 0 0 Totals for 2004: General Property 4.894 475,200 1,782,500 2,257,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 311 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1163-20-000 12/13/2005 09:04 AM PAGE 1 OF 1 Alt. Parcel 25.28.20.631 K 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 O - GLENMONT TRUST GLENMONT TRUST 1216ELAKE DR FT LAUDERDALE FL 33316 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 25 T28N R20W PT G L 1 LOT 2 OF CSM Block/Condo Bldg: 5/1333 ASS'D W/040-1162-40 (631 C) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 11/06/2000 633108 1557/14 WD 02/18/1998 573272 1297/353 WD 07/23/1997 1032/426 QC 07/23/1997 721/314 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/1995 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 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 Parcel 040-1162-10-000 12/13/2005 09:06 AM PAGE 1 OF 1 Alt. Parcel 25.28.20.630G 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 GLENMONT TRUST O - GLENMONT TRUST 1216ELAKE DR FT LAUDERDALE FL 33316 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.284 Plat: N/A-NOT AVAILABLE SEC 25 T28N R20W PRT NW SW LOT 1 OF CSM Block/Condo Bldg: 5/1333 ASS'D W/040-1162-40 (631 C) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 11/06/2000 633108 1557/14 WD 07/23/1997 771/49 07/23/1997 711/372 07/23/1997 673/535 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/1995 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 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 04 a 162-40-000 09/06/2005 10:11 AM PAGE 1 OF 1 Alt. Parcel 2, 28.20.631C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN C. > ,.ion Date 1- :torical Date Map # Sales Area Application # Permit # Permit Type 00 0 Ta : :dress: Owner(s): O = Current Owner, C = Current Co-Owner GLE Nf 10NT TRU O - GLENMONT TRUST 12 -5 E LAKE- DR FTL'~_:DERDALE 33316 Di<frics: SC = School SP = Special Property Address(es): Primary Ty; r Dist D:: "ription * 205 GLENMONT RD SC; 4893 ~D OF RIVER FALLS SF' 01,00 C VALLEY VOTECH i i i Lc Jescriptioi Acres: 3.420 Plat: N/A-NOT AVAILABLE SE` 25 T28N R20 ' PT G L 1 LOT 3 OF CSM Block/Condo Bldg: 5/ c50 INC 040-1 3-10 (630G) & INC 04:?-'1'33-20 (6311 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 25-28N-20W Nt Parcel History: Date Doc # Vol/Page Type 11/06/2000 633108 1557/14 WD 02/18/1998 573272 1297/353 WD 07/23/1997 1032/426 QC 07/23/1997 771/49 more... 2 SUFJIVY Bill Fair Market Value: Assessed with: 0 V: _ttions: Last Changed: 07/21/2004 D: ,tion Class Acres Land Improve Total State Reason RE N-[ [AL G1 4.894 475,200 1,782,500 2,257,700 NO :s for 2005: :neral Property 4.894 475,200 1,782,500 2,257,700 Woodland 0.000 0 0 s `or 20C I: eneral Property 4.894 475,200 1,782,500 2,257,700 Woodland 0.000 0 0 L I ' Crec, Claim Count: 1 Certification Date: Batch 311 $ ':ial?s: U. >a)ecial Cc Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 ` AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC._ T N-R W ADDRESS VJ$T. CROIX COUNTY, WISCONSIN SUBDIVISION - LOT - - LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILIIR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t ~ Hors AA h~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: - SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: `Y Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,`X. Side,O Rear, O feet From nearest property line Front,0 Side,0 Rear, O - J feet Number of feet from: well ;X 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 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: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: ay ; F Number of feet from nearest property line: Front, O Side, Q Rear,0 Ft. i Number of feet from well: 7 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, 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: Dated: Plumber on job: License Number: 3/84:mj !TA"5:h1' g . s t 5 • d ~ t ~ 1~ ~ s4 Y ~ ~ sP ' . ~ sl*tW k fi' acYt d d$e} 1 'i r~ el r_l~ t t S j y" 'F9k ..i45 '"i Z ` • it{ f w i"~ l a:n+, b~ All R,t d 11 k ttAlj~ a ( a ? F ga { i. ~ $ a d fia F r r'Ss,i r fa 5' t <4g~' ~ ~ 1 M' s ~ v ,3 $ > 'F• 9 qe l~r Y`=~ pr ~i ~'~~~~~~x5t tFe 7°,' ~~~~~SY{ 7~~e k r ts~°'~w.r~f n r Yt~ x 4 'k;*e.r t jt 1 f r ;~it~ 11 f1ti lyy; 4 'f r, -~^gl y m,0. isf. ~7. + 7 4j'7` {1hv~dPl£' 1'Sif''~4 P.,F> Y`4i~{,1 i `y F5 8 K L,s 'Y~ Vr b Jf i~i'`1rr33 I { 4 ~f;`tar *+rt 7 +4 Via,{ k,y.,,~y .1 v'~,~f Y `Cv, •~(e ' t t •e5 ~ ysy. '3,~`4C~ '3+f1" '~+~y P f~ } y~' " _ ,rnS,~' 7 r' ~fl t Ik 1[ rf'tt , !S''` ~ r e, 'i r : fi fi7, {a. r vy f ~ ~s~. n > d 3: ~rrya~c .,2 s ' i tl'' t ! H` i -'q, wgp3g~yk~ fir.¢k1+ `r 'P'S` ; k:' 1411 9 al.*w Cftnd~, d"+.al~ ~~Pc k ti Df w$`r } *i' Nw~ j. j ` 44 'NA 4 _'l Al, i.. r Y(~ i '4 d g _ s{ 2' i~H 1 ; ~8 a'~.4 A. t et~ `7 a Ry'1}r ~l. .s`E ,{~7 yLh ~ .f $zk 'F „off B 5~ ~:fi,+rA Y 3 + '~r a`$'" r':aLSg ~+<5a W$ >s r red.`s ~'x.~~ ~7 a.t.:. i y~3 d+o7 ~~ft ~f F~G 3' ,~a ~~cr ~"~`r ~i',. ?s. ',,,p" n~!' 4~. _.t } _ @ Aga psi {vi4t €e. fi:e.,tgea-. r<¢J~ t x.N H 4 r i P*ro c9tp5^ y ar :.i~ aid s k A4.k v •a, fit, at},gIV 1~ 'q , '"Y'''~~ fit: +T~r. A #1 S ~ x FA fx,~~1z m°'iy~ta fFri ~ ` F~~s € & ! i k fr f~q'p,TM., f I« "j, t 4 1, ox dp r ' "s' 3y4 s {e dx F > ~ r°`-#B e~~i`~~- . ~e +y,tic t~« t r~~ j, YF it y~.3 { A s' 79t r t 4 4~ . 5 w E r+ t t e j C S~a + ; ~4 b ~ X 44 ar ` k i JL @ a a 8 a r i$ ~ 1 a a ~ ~ p ~i ~ ~ _ <4~' a t 7.N~ ~ ,i ~ ~ ~ ~ r g 9 ~ F"# Fy ~ .'z as ♦ w~., _ ~ ~ 'y r. ~7 t~.. ~ 7~, t ~ ! ~ ~ a 4+e.e hr~ `f { ~ i ~~.t 'rot i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &NUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION ' C. BOX W BUREAU OF PLUMBING :9ADISOiJ, Wl I 53707 CONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number E Holding Tank ❑ In-Ground Pressure 1:1 Mound (if assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. H. C. Vogel 113 Glenmont Road, River Falls, WI ) BENCH MAR K (Permanent reference poiml DESCRIBE IF DIFFERENT F ~ ROM PLAN. REF. PT. ELEV.: CST REF. PT. EiEZ . NW4 SW 4, Section 25, T28N-R20W, Town of Troy Name of Plumber MP/MPR SW No.. County Sanitary Permit Number. Richard Hopkins 1059 St. Croix 69613 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER y r P OVI ED: PROVIDED YES ONO ❑YFrS~=NO BEDDING: VENT DIA VENT MATIL HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. VENT TO FRESH . C ALARM. FEET FROM r LINE LAIR INLET 11 OYES NO OYES NO NEAREST rsJ )J 2-7 12 DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: OYES ONO OYES ONO EYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. - NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET PUMP ON AND OFF) OYES ❑ O ` NEAREST SOIL ABSORPTION SYSTEM. Check thesoil moistureat thedepth ofplowing IFNGTH DIAMETER IMATFRIAI ANDMARKLNG 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 LE NGT NO OF DISTR PIPE SPACING COVER JINSIDE DIA -PITS 11_111111D TRENCHES. MpZ.~RIAL' PIT DEPTH. DIMENSIONS, L GRAVEL DEPTH FILL DEPTH DISTF PIP DISTR. PIPE DISTR. PIPE MATERIAL NQ_p1ST H. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BE LOW _PIPES a,BOV COVER ELEV IN 1 ELEV E D.. PIPES LINE. AIR J,NLET f C r FEET FROM NEAREST-► 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- OYES ONO meets the criteria for medium sand. PIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH ED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. OYES ONO OYES ONO EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.. CIA ELEV.- PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO OYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPE RTV WELL: BUILDING. f FEET FROM LINE. ( OYES ONO OYES ONO NEAREST _ i Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. - TITLE'. r DILHR SBD 6710 (R. 01/82) ® wisEOnsn APPLICATION FOR SANITARY PERMIT ' L H R ( / COUNTY OEPRFIT 'EnT OF (P L B 67) inOUSTPV.LP60P&'UmanPELPTIOns UNIFORM SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS( U nj~ PROPERTY LOCATION CITY: V I- E: 1/4' . fl1/4, S T N, RE (or),W o wrvor LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L E OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED _/w ~ 1 or 2 Family Number of Bedrooms: L If ' Public (Specify): 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. n'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: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total # of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic 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: ❑ Private El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Narrrt9 of Plumber (Print): r FSignatt;re: MP/MPRSW No.: Phone Number: 7, Plumb er's. Address: Nam@ of Designer: '/Z COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: F e: Date: ❑ Disapproved l' Jl r7 / ❑ Owner Given Initial /~-/'4y 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 . 'i INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - S.BD 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. Q, R, 6 7 PLOT I 0, J ,t(- O J T 1 L U M f r> _f N A M E- 1\1 n M E LOCA~ ION PL C 1 k it A P y rn P, f ! R F pal VV e7 ICI LA 7 B 3 ~3 l'. f f~ FRLSI3 A1:P .Ihi1~T".t'S AND OBSERVATION Pi C~PC~S; S]CTION Approved Vent Cap Minimum 12" Ahmf(i f F j na l C i I Above Pipe j Vent- t i_pe To Final Grade---- Marsh II~)y Or Synthetic Covc r.-i.nIa Min. 2" Agg~'c'<]~;i Over Pipe Ir, I i Di stri.but:i.on,_ 7'ee Pape i Aggregate Pel-fora C-ed Pipe Below ~J•'f 13eneaLh Pipe Terminati.nq At i3oLiom of Systern 6 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .INDUSTRY, DIVISION LABOR HILIMA AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECT?/TE,~:8N:/:RIT OWNSHI MUNICIPALITY: 7LOT : SUBDIV SION NAME: 01'143014 E (oW V ' COUNTY: OWNER'S/BUYE 'S NAME: M ILING ADDRESS: C ro r X ! 6/ f sc'- 'i ~~e r~I 1 s t IS USE DATES O ERVATIONS MADE NO. BED MS.: CDESCRIPTION: PROFILE ESCRIPTIONS: PERCOLATION TESTS: esidence ❑ New Replace U n~ p 1 RATING: S= Site suitable for system U= Site unsuitable for system CON ENTIONAL: OUND: IN-_ ROUJVDPRESSURE: SYSTEM-IN-FILLHOLDIN TANK: J RECOMMENDED SYSTEM:(optional) L.' Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the nder s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) ! os' ~~~SI A~) or,,E ~9a'BI I S /,6, / br fs, a 5 7255 zrCS B ,q `~,I rv r3r 3 ,9a ► o6.'~1 S'' Ss9~ c' 1,19 ' gr-/ f5 ~`t~' r s .33 KDorn -l,0r B- I-",C) B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELL NG INTE VAL-MIN. PERIOD 1 PERIOD 2 PERI D 3 PER INCH P- L • i s b P- 1 P 44. ~ ! tK_ Of 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 an percent of land slope, 1 1~( SYSTEM ELEVATION 96). 61 Y~, UD G~ Jl 13i.,zC 44 dam-( _z0 p©jWc # le o~ &I e Sr,, tit , 5 ' s f ) 3 ~z 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): via_ TESTS WE E C M PLETED ON: n 7 I5 ADD~E S S: CERTIFICATION NUMBER: PHONE NUMBER (optional): uA ~ so r) u) Q~f 0Q3(P4r1 -715~3K-U?J CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - i=tc legal desc=~~~Et'3'tYt usp s:~Ctkon M "*t _F... - 1 .3"r ;i ia'a ...a t }Ji ,1`k,~lP~Eq TrUi71 f" c€ 1 ,",'t ~..i i~,?x,"i W .,°„s a r=ovv 0E" !-E'kti.1 t1f~ ' 'ti43; rx[t~,r t Y t C, t fC;. g g'" a t„- 1S f j~ FpcF. L, , tt¢~ta,~e 4,E r ci€~r= g S ON SOIL ("UNDiTICY ARF I'M 00 a~~ 'o ia.~ e F A LEG 1'=t"sLE air '~,C 314 ,y" k t ~43,t }a: 4 'our v~st locat . nt jtr€id 'h'i, id ml~, k. "ind ? Ek3 € d point are c1 arly ~,hc i=~, <,.d <"Sre pE"'.t'3 aellr n t°'t.E aai C3?44 i} a,«47 box(":) a3S 1(3 na mes, acic14._3Sc"s, it£Sod plain di, oofcol',-o ion test h? Grmalion a-, „oc>d, piat:a, F.Er a3 ,l is doc,, ii Ct. 2; 3K) s, i3t ~s 1;F, NA, the a}ii ".I) iate Ehi, <er<Fl anfl p lac=e w)", i._t r t,. <add1 e and you! ceI-F ,-1~ . vW, ~'°j "2 - f. tf)C. Co, Sand 'Al rj . y,!,,. f ldy, Cola %;'I?i1t:. Thw ha n rr Silt Lo, Clv c 4 :.:k s S r„ a < t - . r t l:.` .r: tfk t.3ti:.t,.Ct1I CYa?y tE,`itcal m 1 ~ N? 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Croix C0Unty Subdivision Lot number t Improper use and maintenance of your suptic system could r suit in its premature failure to handle wastes. Prupur maintenance con- sists of pumping out the Septic tank every three years or sooner, if nuuded, by a licensed septic tank LmLer. What you put into the system can altuet the function of thc~ S ptie rank as a tr_ them sra~-Ie ~n the waste uisf: Tsai Sys teu1. St. C r 3 ix Linty res iden is 1= ~ el i~-'I Die to rL Y J -,I a maximum tuf 60I of the cuss of replacumunt of a e`aiiin. which was in operation, prior to July 1, 1978. St. Croix Co:. t;- accepted this prugraw in Au,-,us! >f 1980, with :ite owners of ail nu systu:.s ~e Lo keep their s~u...~ • ro waintained. The property oWnur agrees to sub::iL to St. Cru!-_ certilicatiun turui, signud u_ t..= ownur and by i' journcyman plumber, resrrict-d Jiu:ilber ol- a 11~~nSe~ )c lying that (1) the on-site waste'.Water disposal systc-.:: is in operating condition and (2) after inspection and pu,uping (if nC-- essary), the septic tank is less than 1/3 full of sludge and scu.=_ Certification form will be sent approximately 30 days prior to three year expiration. 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- b went of Natural Resources. Certification form must be completed and returned to the St. Croix County Zonin fwit]in 30 days of the three year expiration date, SIGNED 1_... ~JC DATE St. Cijoix C_,unty Zoning Office P.O. E-ox 9s Hammond, WI 54015 715-7~ 6-2239 or 715-425-8363 Sign, date and return to above address. • J APPLICATION FOR SANITARY PERMIT S ' 1' 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/contractqz, ("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 - n 1=.- f v & { 1 Location of Property 'i 5 3~, Section T N - R W Township Mailing Address. 6 F 7 tr a3 Subdivision Name Lot Number .e Previous Owner of Property Total Size of Parcel Date Parcel was Created lft;; _y Are all corners and lot lines identifiable.? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number f 3 -,,3 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: I. Warranty Deed y 2) 1 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. PROPERIy OWNER CERTIFICATION I (We) cckti,6y -tGla.t aU 6tcLtenten.L on .tU6 60'Lm a,'Le ttAue to the bm t o6 my (ouh.) hnowtedge; Bia.t I we.) ai '(ane,) the ow~,tcA (a) o6 the p~Lopenty de,6cAibed in .thi,5 n6o,urnation j6onm, -b, vi,,aue o a wc i vuiarity deed aeeatde.d .i.n tte 066ice 06 Vte County Regiu'ty o6 DeecL " Document No. BQ ~Ye,)-land than I r~uieT p~tmentty oun the p~t.opo,~ed .5 te. 6on..the Aeojagt.tapo, a 'Sy'stem (OA I (we) have obtained ari. eau6emak-)t, to h.un L,i.th -the above d«c/uilcd pnopenty, bon .the con5thuctiox o6 said 6y~.tem, and the carne. ha,5 been &L y rLeconded in the 066ice o6 the Coun l y RegZ. ten o6 Deed S , ad Docwml-iLt No. "tA " -A- SIGNATURE CiF OWNER SIGNATURE OF C04WNER (IF APPLICABLE) DATE SIGNED DA'I'S SIGNED