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HomeMy WebLinkAbout020-1121-70-000 n (R O 9 -0 0 o o _d C1 C 1 ~ i GI fD O S 0 z O O C O O ~~y`• x 3 0 N C 0 Ui ~ d O N ICI O N 3 O N O O Z 00 W O W 7' O O O-0 n O (D M co A~ R O ON 0 tp n 3 p M C) O N y O O C) Cn x O C m e cWn 'O 0 P) p p U ~o w (/s A cp fl T ro N fD p F m n (n l W d r ( ND (D ~ n o c m .~i CY) cm l< N O ~ r- 0 H. H x °o CL W =3 rt W 00 co 7: (n 0 c v j rt -1-~ y ? Q rr I H " 0 d 00 (D O O O ? ~y,~~ • cn m Z W = 0 a, a, ai cn CD M (D 0 ID 8 A t=i G~ v M r- d N I N 3 d 1. Z O~y 0 00 N O D D 0 N oa ~o m N P Z p m N c~D N r W m' ❑ n Q N rt W H' r• z a z A A z o W J 0 a n cn -i V p a z (!1 0 P ~J oo r: m m< N ~ < M A 70 A p~ O (D CD- (D O N O Cao~ ~ A 3 -F,. -g o O Q O _S _3' Q j 3 9 C C =ro y - ' N 7 d v a N d-y-•. N n 00 T N C p T 7 0 2 0 7 a N y N 3 N O n y 3 f7 OZ G o 0 ao N o m w N _ M y O C y CD 0.0 ~p S O y N d y 0 N 0 CO3 O S (n N r 7 5 A (D O" O N 3 C CL 0 -0 V S y N T. N O CD O. ` 6i , N a S M N A a X U) = 41 C/) OM N N N N O C ~y N 0~.- N V W A o> 7= o v D_ 9 N Q N m A ti j O ~ ,y..8 3 co a) -4 0 0 CD N (D O d W (D 7- 7 2 O N O + y CL - _ a 0 Ut A V v ~ 'r O N O N V O a O ~ C ~a O O y C) CL Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP SEC. `I' N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN ~l;L..1d SUBDIVISION L~ e-LOT LOT SIZE PLAN VIEW lltstances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 1.00 FEET OF SYSTEM w ELL yRJ x. c l~ Jb!@w~^~FJ: ~ LrF (~N.i U z wA 70 tS f TSiv f•J Te" ~ f\ 1 ~ -,.r7_ 16 I I_ i,,. E INDICATE NORTH ARROW A r BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: .-A20,0a - Proposed slope at site: SEPTIC TA1K: M<Lnufacturer: Liquid Capacity: Numbe• of rings used: Tank manhole cover elevation: Tank inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0S4de,( Rear, _ _ _ fr!t From ouark,5t property 1_i. io Front,0Sidc,oRear,0 t (•(-L Number of feet from: weIL building: (Include this information of the above plot pl- i~,rence dimension; to :,eptic tank) f PUMP CHAMBER Manufacturer: Liquid Ca pacitv: 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 fet,t from nearest property line: Front, C Side, 0 Rear, 0 Ft. Number. of feet from well: Number of feet from bui1(1ing (Include distances on plot plan). - `;011. ABSORBTLON SYSTEM Ised : L'reucli: Length:_ Number of Lines:__-,,K - Area Built:' Fill depth to top Of pipe: Number of feet from nearest property line: Front, Side, 0 Rear, 0 vt. Nmi)[wr of I oet from well : Numhur of Pcet from buiAd:ing: (fuclude distauces un plot pli.1n). H SEEPAGE PIT Size: Number of pits: I)iamcCer: Liquid depth: Bottum of seepage pit elewation: Area Built: Has either a drop box O or distribution box 0 been used on any of thk, above soil absorbtion sytems? (Chick one). HOLDING TANK Manufacturer: Number of rinks used: Elevation of bottom of tank: LALrvatioii o1 iutet Number of fect_ from nearest property line: Front, O Side, 0Rear, 0Ft. Number of 1 eet 1-1-0111 well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: H.ited: Plumber on job: f1-, s.-~.~~ q~,e~✓ Licunse Number: 3/IS4:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WC +3707 CONVENTIONAL ❑ALTERNATIVE State Plan ID Number. (I( assigned) ❑ Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPE TI N DATE. Jim 0' Malley R. R. 2, Krattley Lane E, Hudson, WI BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: JCST REF PT. ELEV. SW SE, Section 7, T29N-R19W, Town of Hudson Name of Plumber. IMP/MPRSW No. 1C.-I, Samtary Permit Number_ Gary Zappa 3300 St. Croix 49508 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. JPROVI ARNING LABEL LOCKING COVER D ED: PROVIDED'. ❑YES ❑NO ❑YES ❑NO BEDDING. VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING: JVENTTOFRESH ALAR ! FEET FROM LINE AIR INLET ❑YES ❑NO ❑ NEAREST DOSING CHAMBER: MANUFACTURER 7ING 1 -1111-111 CAPACITY MP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDEDPROVIDEDES ❑NO PU ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER PROPERTY WELL BUILDING. I VENT TO FRESH (DIFFERENCE BETWEEN FEET FRLINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NSOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IL EN(ITH DIAMETER IMATIHIAL AND MARKwa or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH IN O. OF IDIITI PIPE SPACING COVER INSIDE DIA -PITS ILLIQUID BED/TRENCH TRENCHES MA L PIT DEPTH DIMENSIONS / Q U 7 7Z I GRAVEL DEPTH FILL DEPTH UISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DI TR NUMBER OF PROPERTY WELL. IaUILDING. VENT LE FRESH eFLOw PIPES ABvE coy6R ELEV INLET Ev EEND PIPES FEET FROM 11-1NE/ AIR~IN/T b q ` / 7 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- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH :RFU DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NRENOCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEVATION AND El EV. ELEV.. DIA.. ELEV.' PIPES DIA.'. DISTRIBUI ION 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 PROPE RTV J WELL. BUILDING. FEET FROM uNE ❑ YES 1:1 NO 1:1 YES El NO NEAREST Sketch System on Retain i county file for audit. Reverse Side. SIGNATURE. - ~ TITLE. DILHR SBD 6710 (R. 01 /82) - wlsconsln APPLICATION FOR SANITARY PERMIT D I L H R (PLB 67) COUNTY OEPRRTTr1EnT OF UNIFORM SANITARY PERMIT # Inou STRV, LRBOR 6 HUMAn RELRTIOnS ~9SIo ~ -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 b .144 /~T. z- ~~t°fITTl' G,v . rT v/7 ra J 4>~f PROPERTY LOCATION 54) 1/4 St 1/4, S 1 , TZq, N, R/I E (or W TOW OF: /yCJ/~rD.t) LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPED F BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair X Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. /j Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny 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 .1 - Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity / STr/v . X Lift Pump Tank/Siphon Chamber &~4-- Holding Tank capacity N14- Manufacturer: p OV C-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): PROPOS D (Square Feet): ' ~o Pz0 i8 ti'G Private L] Joint F-1 Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: ` R4P/MPRSW No.: Phone Number: 3360 (7 s )3~~ ~S Plumber's Address: Name of Designer: wI. 3 ' ti6R A f. sy COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved W^ y/~tj ❑ Owner Given Initial T pproved Adverse Determination 6" A 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/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 o E v Ile Location of Property-4 A) __.fOJ E Section, T ~l9 N - R W Township &Ll'joA Mailing Address AY 1Z Z~5 /~dsa,~ Gr~/ ~~lOl~ Subdivision Name, Lot Number /UJf~ Previous Owner of Property Total Size of Parcel at,,e-s Date Parcel was Created 191j~ Sr~° Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes No Volume S 76 - and Page Number 5-0,G as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: C) 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 (We) Bent 6y that a.e( statements on this 60nm ace tAue to the best o6 my (ou)d know edge; that I (we) am (ane) the owneh (a) ob the pnopeAty deg n bed in -thi's kn~onmat on 4onm, by vi&tue ob a wafvcanty deed necon.ded in the 046ice o~ the County Reyis-teA o~ Deeds as Document No. ~ and that I (we) pnesentty own the pnoposed site 6oA the sewage disposat system (on I (we) have obtained an easement, to nun with the above descAibed prtopeAty, bon the eons,tAucti.on o6 said system, and the same has been du,ey Aeeonded in the O~6ice ob the County Registers ob Deeds, as Document No. ) . SIGN URE OF CO-OWNER (IF APPLICABLE) / SIGNATURE OF OIr v v DATE SIGNED DATE SIGNED SURVEY MAP FOR LAMES 0 MALI,LL ~ NORTH GiNE/N E- GO.~?NR v E a00 00' SEC. i 8 Tc9N,,Q/9 W O /='OL N O C //V A0 E.4' 0 O CCWS7-RUC7T10N `4 ~v0 --k- ~?~4?ES/~ENCLr Q U'•Q SHOWN V)0 41 N ~~0 a ~ 8 V) N Z~J o ~~h .ti90`GCV vv" X04.00" v Description: N 400 Cent of S 200 foot of NW 1/4 of NE 1/4 of Section 18,"Q-19, Togethor with 06 Coat road e isomont from ss1d parcel to Town Road. Surveyor's Note: A fence exists on the West side of the above parcel and enchroaches by 10 feet East of the above West line. State of Wiconsin) ss County of Pierce ) I,James L. Murphy, do hereby certify that by direction of the Owner I hove surveyed the above described property according to official records and that the above map is a true and correct representation thereof showing the correct dimensions and location of the property, all structures, apparent easements and encroachments thereon. This certification is for the express use of the Owner or his designate for mortgage or title transfer purposes and shall continue for one year from the date of survey unless changes occur to said property thereby nullifying this certification. *Denotes iron pipe found O Denotes iron pipe set. Wisconsin Re .No. 5-1042 DATE /0 - /0-7e FLD SURVEY/z-~l-7e JAMES L. MURPHY SCALE DRAWN x. ` Tp~ROFESSIOIVAL ENGINEER SD 2 F ~K F;;LLS REVISED REGISTERED LAND SURVEYOR Wisc. LOCATION RIVER FALLS, W I S C O N S I N JOB No _ ! sus H y S T C - 105 r y SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County 0 9 OWNER/BUYER Number ROUTE/.BOX NUMBER Fire CITY/STATE I P-5 1016I" 9D9 PROPERTY LOCATION:_tVyj fU~ %4, Section= T 2 N, R~ W, Town of~1(/ St. Croix County, Subdivision_ AII Lot 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 mn 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. o E I/WE, the undersigned, have read the above requirements and agree Cnn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- 10 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 DATE 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. DEPARTMENT OF REPORT ON SOIL BORINGS ND SAFETY & BUILDINGS INDUSTRY, BORINGS A DIVISION LABOR AND . PERCOLATION TESTS (115) P.O. BOX 7969 HUMA(~f T ELA`fIONS t MADISON, WI 53707 i (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOTNO.:BLK.NO.:SUBDIVISIONNAME: /Un SLR-' 1 1/ J-11 N/R 11 E (o HO P.5 0AJ Qfff COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: 'I M4 1-1 1,'T 7`TL ► -,V -,4S T ~vr~so J 4~i1 . USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: JPTESTS: Residence Y AJ~Cj ❑New XReplace RATING: S= Site suitable for system U/= Site unsuitable for system ' / o d CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) PL© Q$ ❑U ©S ❑U ❑U 0S ©U 0$ DU ~Q~v~-~r~o,~~G s~.fr• /~'X ~/G aft /Z x Percolation Tests are NOT required DESIGN RATE: If an y portion of the tested area is in the nder s.H63.09(5)(b), i [uf indicate: Floodplain, indicate Floodplain elevation: IAJ ►~bA F7- PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN 77-. CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 0' W3 / ?2o- 2. P 1 a . S , yz ' o,P. s~ 6, 73- ' .ti;xf"'t TA,v ' S 7g,u c s a (3.0 . S/ _ B z d'• ~o S"l ' S • yz' aN • ~S, 2s ~N . rs s,f ' a,P. s , i 91' d,e. F S /f .3 A,.) S. ' B S BJ > Q ' .33 ' au-GJ! 2. o' B,v, Is B- B- B- PERCOLATION TESTS TEST DEP H WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH P- /0 P- P- 2- 3S ~v 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. B 6 776M 'vc, U",+7 A,, Q"~ J7 0 FT SYSTEM ELEVATION i ,ter X10 U 7• , • , , , . . _ _ RECEIV - ro ,7 1 _ I ~ ZONING _ I E A. _ 3 OFFICE ` I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: IP613,,k T" Z~'/SXOic 4 7- Aqi L_ )~6 - / f ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 3 d XJF/L ,P/~ ~vDfa.J his S~yG/ f s-- a L y~L 3~G- r CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Vol f ON `W i r ,.r cu r nu £en; I a _.e _ _ tr. ,r E . _ cIeG r. ,t:i5 DG ,E ~,t.,t?tE;'~,y r. a M us °°s 1a SITE Q ->°r~aIrIe 01 HER SYS! EMS ABE RULED WT BASED ON SAW CQfqDj00N!S, €.cJ m F h' t; tii;C,E ,M" t,.t,-ftEt} Y MS Y tW<.s t. t'n, [N < <h. t soon! , r 1 uS_. i , .,bed; e E.. e c> . . t'tvi . .d tratwal el va tii n lelGr(in("e point aw di ".Y:g shc)11lrt ar"d ate (ABP .➢rt,`~+"'t< .t1,~7t e s 4 a' Eft Ch~t%S, tl~€ilt.,,, c~ C3tv5~.. it tfV'7(1 L„=ki4, C1a"Zi, perccila re) test Cth t N ,stwi .t1 cs 100 { lln,, Pk aahnt do( s ra 3t a'rt&d, , d,€y F LA. in the ap ft}phat€' w some mom 10) S Linaw s"e d H H w (G Ccow sw'd On Pepin", AN ph Own Sol Clay lAwc-, y Yet, Swhiv (Ay Loan 3° " a SAW , c F Us,.,, sawly Clay _.tt, 1.3435.; t - - Many, nivi' , ' 1 t Wyki o . ; iS .1 :t;'* , 'InLi 1 F -t r The c "3is t); ho Ci,: nwt l o;o tits, =E-...t Lje','t `rit.,... k. _ . <<°t' t, aE? ,'t o s£o of Nan_ for !hit 3. i Ovate „ t. ,-fie- 3 "3' "T Ft, 1 '4 r PLOT AM PROTECT Z HMMESITE TESTING CO. "UDS6-4, WIS.-- 5-4016 102 PRO?055 7 w*sE m os r 6 e Z'; o=r. Odd /41&fe pRo Po5.Fo weu m sr me 50 rr 'Flog '41 T~`sr X Pc ra~~~ = fftvp f~~9~~Fv s~e~t l3cr~s var L LEGEND tlai'r X,157 Ile F RE t 6f i 42 36 C'o 4)z ` cow ~ p.~ ywE~/s ~ jd 7 i ' O1 ~ p X~3 y~ c~` i 1 ~ i e .er_._ l y X J z- Xl S j/~ ~v s > 711 ~~o'"' P/ o~6s~" r Ali . Wj ~Q t f PLW a ot') POT and C 0-55 S rI O N F IANS 10~-~~ On ~,D ' ✓ ~ l~f a So%~ T~s r % IV pKrua - ` _ ®3 ► V U o /Qo v,c,~ D P Fr- d - ~ FEZ j3o,PE s y St f P - Fresh Air Inlets And Observation Pipe -SOIL TEST7hN5 By HOMESITE TEST,!NG Approved Vent Cap RT.-3, O,tgEiL iRO,-`) HUDSON, WIS. 'y4o16 Minimum 12" Above Final Grade ~nsC'~IdC MAX ►M.r~~r yL Pipe 4°` Cast Iran. Above i o Final Grade Vent Pipe Marsh Hay Or Synthetic Covering 1~S Min. 2" Aggregate Over Pipe_.____.. Distribution _ Tee IS Pipe ----""-t--0-0-0 00 01Z fr (9 " Aggregate Perforated Pipe Below Beneath Pipe o Coupling Terminating At Roftom Of System ST. CROI X COUNTY ` r WI SC0 N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W 154015 Match 15, 1984 Divizion of Sa4ety.and Buitdi.ng Butceau o6 Ptumbing P. 0. Box 7969 Madison, Wl 53707 Deat Sit: An on site invatigation 6m the Jamea O'Maitey ptr.opeAty .located at the SG!% o6 the SB% of Section 7, T29N-R19W, Town of Hutson, St. Ctcoix County, tceveaf-ed suitabee so.i Ps at a depth o~ 2.5 feet, below which seat onabte high ground watetc waa noted. This site .6hou.P-d be au.itabte ~otc a mound system. Shoutd you have any que6tionz, pf-eat e feet itcee to contact this oj6ice. youtrs tkUty, Thomo6 C. Nett on Aa.6.usCant Zoning AdminiztAatotc TCN/mj DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI X3969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: Ct SECTION: JT IP/MUNICIPALITY: LOT NO.:BLK. NO, SUBDIVISION NAME: s10 1/4 lT N/R E (or) COUNTY: OWNER'S/BUYERS NAME: MAILING ADDRESS USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TENS: Residence ❑ New Y Replace c 4 ~N G ; l UG~cv 5 AS RATING: S= Site suitable for system U= Site unsuitable for system G tl/Ej~%C' E'QJ- - CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK RECOMMENDED SYSTEM: (optional) ❑S DU EIS ❑U I ❑S ❑u ❑S ❑U [:Is ❑U %oJw1) sr< (-1 If Percolation Tests are NOT re uired DESIGN RATE: q If an portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 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 ABBRV. ON BACK.) C) Ox B 67 ' d/Q. /5 61,~:X a 113N 11r -F4. o R - 6 MO 'f S B J. o ' TW IV-, 7- SA.uD 5T0,u E 17 13N-Cm~ ~Q, S, /.O' G//3Aj. rmt 51 B `y. U'MiX of 13N. Sl 615 z,Z ' tf.)SlJ . CI c7 < R i_ 3.5' G,PA~ c1A1 16AM, 97 ("o s{o o 7- B- 11 5 vt k).411 .5E t ,0,16 L 9 3 j 'N' 5 7' /✓,VCSC o' 9,v, C w/OrST B /n 0/1 G~ '~07 A7- 6.3 ' ~v/fti w 56t_-P,46-E ,97- 6.0/ 11 y2 33, 9,) -6x 15~ /S 'G',t~ 15' /o' 8N 15, 3,17 'Z/ /3N -C/)T - v71-; ' !J?1Cf !mil %A?%p,vf / PERCOLATION TESTS TEST DEPTH WATER IN FJOILE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSW LING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P_ Al0 P- P 7 n .7 Pv / % -3, - z P- P ' PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Descri5e 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. / ~,/f n ! 3 SYSTEM ELEVATION • Q 13 a tl _ v fA l I 3 ' ~ ~ I I This test site NOT APPROVED _ . _ . N for a conventional septic syet+em, See explanation. - - E ~ e t t f 3 a 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 cj;r clzod. e,~~tjpp the teats are correct to the best of my knowledge and belief. NAME (print): F (ll{lT((jj¢¢T((~~E((,,,,S~~((TING CO. TESTS WERE COMPLETED ON: S i ATE APP2v s , ALUATI4NS PER Y '7"I" TESTS) ADDRESS: ~iC1SEN(1.Q0663 CERTIFICATION NUMBER: PHONE NUMBER (optional): WISCONSIN LICENSE T• 39""A*MSON W1 5016 CST SIGNATURE: 6 DISTRIBUTION: Original and one copy to Local Authority, Properfy'Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - . , r _ ,e vg" ,w" ,i , a aamE K0 So . s. .gl.,,x,. ex ,F a `n ph s,_ and m.c;r+3 me KW ton `''{)E?P "Mal Ywo ' t"7£:it.:E;€t.'.. A MAX HM I .1 a N of k S ,,,am v-t" r n 0 uw .='tit6ned, Iy t= , t die: ~,~I tEi t _'!"t tf' tt yti Vii:=. E?- Go ? leta ,t..' c.33t,t r P.°,? r ,€„rcj boxes. 1% Sk # E IS ax.. ' ''s.i3l...,E FOH I WA L.?t' G TANK ONLY IF ALL 6. PLEASE w the n i,, a,1, slat,, "r CI€z1. to it €`.J'.:iloide C7fii;,.,i_pi ionF al%od i,¢'+mpletR g t€€r pica pia n; .;if-+",:.: A (_EC:dM ' 9[iE?fEC.im am W-3v I .mating your tat it3Gst;.°ons. D1 vvin€-I lfS 'S€ali[ is ,:n=°,tW A . ',l E, nl€ yr$tl ,3r utt,, wk and _ h.< diu€"t .a ten-n€,. ¢4,rti-€r w o cl s ? shovyn, and safe:', gw.,i,a-'t3%2 ; n .pie ,fix, ra r°S r3,. o,S " c' s C.3-t t"'.=€"il nt..t~b.,,,c , t ja>tc'1 1 J~,s E:.rt, p,-;ice€s"l$151i 1; e{ C"gCeCY1p- I . ; a 1, r , t , as .r„£3 it devaho rl € ca r;, r. <¢i3itw Q Vii.. in Ow am: 1 ¢€:Ei43^ Wm; f € ieS . Kr v on"" °tudr a. . 1s yt3.', _ r, €1.aE,.}, tSw.1€,r`I _ iZ vas€, A EUo, mom ph "+V disluf;3fi e as umphreT LI. SOIL TESTS UST BE FILED W! FH TI LL H 1A ° W NJ', S F 0 ,C,..r '.1, F l:,D 01It ....ES E R s rtr s.s. 71xzm d 7"A_° Olve Symbols SS smdsnom,~e LS a; CaZi 16i. cE xtQ Lumv Sam! 1; 6 v Gov C4V 3 y n S- `v t d r - Guy ;i Si> I X33 G : i' € r~ - 4 snCE' 'non May nuAbim tat c soil c , es s is !no wk Tv ajt "r , x a s a't , E. ,..r 1..'t:y .i " Tr 7C Ut) Rrtit` ,.:tYsl„'s irtm e ivhh"- a ma , t l 397 € . €n: in 4' ft ,E_€ %t } -_mal th , Ay W , 3, r clym p"m in m,, fi REPORT ON SOIL. BoaRw&s ~ P'ERCOLATI.ON TESTS 1IS- L' PLOT- PLAM PROTEc l -'C- D. ,pA T'E" HOME-iTE TESTING CO. 11 s . 3, O'NElL ROAD B- OB L''I lilt"?Ca, l noposED HwsE Mosr OF 2-~'Fr motc ALL r -5r AWc'AS. pRo posE o wELL M vsr Lw So Fr joy,- f=ALL r~'s~- s = QAoCffB /~sT's = ~f'iST/~1(- LULL X = PE°QG lDCg1/D~llf ~ ~ f~AV~ f~~9,ER~'D o,~ S~BdfL fj~~'S fir0,~/Z . M a') ` fw r: ( f ".1 P T- LEGEND e/-rvAro v op 1/E, r ,pe,,C, lp1' ' ; c XIS%s~)G T" 7 (jl All- 1 01 , R,... , v` E) wo. h s test for a conventional septic system. i See expianation. i M IR 7 /J C t ; WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Cno.Ex Location SW 1/4, SE 1/4, Sec. 7 T 29 N, R 19 XJKX~XX. W Town WMWX~Mfj Hudson Street Address _ Lot No. Block Subdivision Landowner's Name: Jamey O'MaP,2ey The application for this site is for: ❑ new construction use. /~Xlreplacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: Hto have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers ssuecT-to you.) I lone of the applications needing a quota number. The quota number assigned to this application is - - [.._]for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. (.Ifor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. 1for an application on file prior to February 1, 1980. L_llfor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USL, the alternative private sewage system is replacing: Ma failing conventional soil ahsorption system. Lla holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here. I I certify that the above information is true and accurate to the best of ii~y knowledge. Name Thomas C. Wz on Signature (County Official Title &Ss-%stant Zoning Adm,in ~stnatot Date March 15, 1984 DILHR-SBO-6158 (R 12182) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township SW 41 SE 41S 7 T 29 N/R 19 pW Hudson Street Address: Subdivision: County: St. Choix Landowners Name: Mailing Address: Jamey 0' MaUey RR#2, Knatttey Lane E., Hutson, W1 54016 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of. 19~ Notary Public, State of Wisconsin My Commission Expires: DILHR-SBD-6413 (N. 05/81)