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HomeMy WebLinkAbout020-1129-10-000 n cn p 3 v n r_ o m c m o CD "0 3 'm CD v m 0 n a c ((D 3 - ~ O O O 4, (D C J O • 3 (D (D CEO d ? W Q m z c, (n ? O 7 O C) (O N (r fv (n N Q O A O O 1 O O ry 7 CD * m C? N (D Ln O 3 N v r ° °0 0 77 Cn D Co m n w a CD _0 CD a CCC) 0 3 a ) rn O N N co (0 0 r- (n (n co co ? O C w "Olt x O oooCl) G Z C N. p, O (D G ~ o ~ ~ N ~ N cn v ~r/y~ ~rt a G o oo~ O v < c~ ° °m T m U) CD 3 GI U) Ul N ;I. N H N O n y ~ U, rr p J z rt m o z m z Q W N• D CD O n rt o CD CD Z. a 'z a (n U) cc Fl I p W (D CD N I w CD CL ~O W (D c J z O ' Z CD v a H ~ in c M O N CL A P 7 V O z m O K v~ WCD ~ c z N x Z G (D o z (D a 3 O o n ` rt H z W G H. CD ~ O ca C" r~ ~ D (D C -S . CD m N (n (ll O N Q X G) Q (3) n CD O (S CL ti o N O O A n O b C 00 ti m O EA O e O Cl ti Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP LV4~'S-T~ SEC. T 2-7 N-R W ezv h//l Z-Al - ADDRESS ~l/ 172r 5 ST. CROIX COUNTY, WISCONSIN ~j ~f . SUBDIVISION LOT LOT SIZE .2- 4 PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM B[u f f I as I--- --y-i 20 Zo ' i - - - fo N6 ( 71'r da 10 Sys' ro ~ 'I 01 3 2 15L I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~OS T dN EriSr Go r I-ivLr-- Elevation of vertical reference point: Proposed slope at site: 4 O SEPTIC TANK:: Manufacturer: Liquid Capacity: 2060 Number of rings used: 1 Tank manhole cover elevation: Tank lalet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,@ Side,O Rear, O feet p i From clearest property line Front,0 Side,® Rear, 0 ~G feet Number of feet from: well Vy7 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVEPSE STI)R PUMP CHAMBER Manufacturer. Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of i t: ~Bottom of tank elevation: Pump off witch elevation: Gallons per cycle: Ala Manufacturer: 1~1 m Switch Type: Number of feet from nearest property line: Front, O Side, G Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: K Trench: -(3 fI Width: ~C1 Length: 13, 2- Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O/ Side, 0 Rear, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: ameter: Liquid depth: om o e pit elevation: Area Built: Has eithe drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: apacity: Number of rings used: Elevat f bottom of tank: Elevation of et: Number f 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 ranufacturer: Inspector: HOMESIN SEPT46 PLUMBING 60. L RT. 3 VNEIL RD.: HUDSON. WIS. 54016 Dated: Plumber on job: ROBERT ULBRICHT Mt. MASTER PLUMBER LIC. NO. 3307 M.P.R.9 License Number: MINN. INSTALLER & DESIGNER LIC. NO. 00663 3/84:mj 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/contracwv,("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 ; r 9Ra/' Section T N- R r W Township (,16 n t:` Mailing Address Subdivision Name ~"t~ r~► t w• > a ' Lot Number Previous Owner of Property W 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 '.----No Volume and Page Number as recorded with the Register of Deeds ~TIH INCLTHIS 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. It the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eeAtii6y that aU stateinents on this 6onrrl ane tAue to the best o,( my (ouA) knowledge; 4hat I (we) am (ane) the ownelc (s) o6 the pnopenty deanibed in ,tkL6 .ivr6o4mat ion jonm by viA tue o b• a waAAan-ty deed &eeon.ded in -the 06 6,i.ee o ~ the County Reg-i~stefd o6 Deeds avs Document No. ; and that I (we) pnesentey oun the pnoposed sit?- ~o~L the sewage di6po.5 system (oA 1 (we) have obtained an eaaement, to nun with the above dnc&ibed pnopehty, bon the con s ttuction o A said system, and the same has been duty neconded in the 0 ~ 6 ice ob the County Regiz teA o~ Deeds, as Document No. SIGNA TARE CF OWNER. SIGNATURE OF CO-OWNER (IF APPLICABLE) t DATE SIGNED DATE SIGNED 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969 HUMAN RELATIONS ON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNS HIP/~Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: N E '/4 '4 IT /T21 N/R ►9 E (or vD o,J S ,11g,P,~vi sT~T~s COUNTY: OWNER'S/Be-t` WS NAME: MAILING ADDRESS: S , Coo/X -r C k LE E q/// G,v eePiiw c`sT 7{10,P o,J S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS PERCOLATION TESTS: Residence 3 ~ A _ Y~ New ❑ Replace 1 ~1 0 j L 00 - e~ / 44,f f UC RATING: S= Site suitable for system U= Site unsuitable for system -~/L e5f,-44, 7- IS CONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDEDSYSTEM: (optional) ©S ❑U 0 S ❑U ®S ❑U ❑ S DU ❑ S LIU (7,u V&jTi0AML Q-0- l S so Fr• If Percolation Tests are NOT required DESIGN RATE: Q ~ 2 If any portion of the tested area is in the under s.H63.09(5)(b), indicate: IPA 14100,4 00_ Floodplain, indicate Floodplain elevation: 1,v _D-QC e~ FF - J>RA/af'IELD . PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-IN F,-. 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 3 > Y-0 B z y. D ' /o y ~ 3 ' IA&- > 7. D All 13,a . ceuA r4,V c s 3 3 ' 16N • 4azwd-0 S ( i A,v as B 16.6' /v ~ 3o, >/O, 4 ' . 3-13,v. 44--,-e Is, F. f- ' rjw e s y TN s B-S /1. p ' //2.3 S ~ 24- > B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI0D1 PERIOD2 PERIOD3 PERINCH P- P_ SbiG OiPi' Gs E4 z t?/~~4 /E1? ~1M 7- 4/9 P- S M < P- SC S P_ or. C/1 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. /307~~ ~E~ G X~~~~j~o~ ~r• SYSTEM ELEVATION 3 y sr~ To E Aecllf-- f3 - /3 - l3 - . 3 _3 T T 3 ~ 70',--~ E 't'his V nt site APPROVED oo r A cgmntional septic sYGtem E E 1 E ; E 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): CO. TESTS WERE COMPLETED ON- STATE APPROVED SITE EVALUATIONS (PERC TESTS) ADDRESS: MINNESOTA CEFjTIJCATION NUMBER: PHONE NUMBER (optional): WISCONSIN LICENSE NO. 55-02482 S -D L ~IP 2- 3d" - RT. , ONEIL RD., HUDSONs W! WI6 CCSTSIGNATU L~i(/lit DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - , i . Chi' . r, s 9 . ; a r '4.z 4>a , :r . F L..„ N"3 HOW A b ;.1 't E'. ct`il u'CCtl, ca, (:}1 teat, yc)L(1" rets£.r 4 n, ,rst !Ilclrjdea .,ps.`-r, LFSC 4r C ' t kadv .r, €:hcat., %?."th ther ,h,. , :€'SidC}oef, project; nu, r',,ne v~ 3~F~~+, ..FF. PF :€.}li tl i.,d E~~ t 491€1:~: (.1r 0. _ f,~,l Aty Who t;t~,es, A S 6 T E IS A ~L~ ~ L FOR A P{€.~.. _N~_ TANK N r. one r ONLY ' IF ALL OTHER SY_ 1 L W ARE ROLE C) P,ASEO _''C)P'J ,9 TiOkl"S; PLEAS use Q Ah[ i evicit ions sh oln hat' k i- W r ! s Mk dam !(3omis and t omp leti g the (}1£)' plan; ;:'`1AKE A LEGIBLE 'wis am ::Cr`tca .trt' y lca£:ming y "t.'r gat E,a,;,t3, ons, D §„bfimi to scaii is Prete,rrecL Mi` k e vim y um l 79,r`ama t and tr f a `ct' e'ktfelurin .3, a m77 m ttwi arr- cl arl ah-)-) = €f, "'incl ate pP1 V1afi? ru,; Q yl: e 3 " o{.1plta [o-. as to . ya, nan- . , httikesa Pow! plain data, percolation tsesi r. 4 z ' r"0=9. E , . € =r, NO O v w o plain, el ,.F . E , dcan not 7=itCA , t.r a N. A. t he "rptnwm Ate [lox; E %r:. %'4A P.€r.v.,YOM t]!? HIN .;AW and yO 3r C'r CLrrr(:u1,~3[, €`Hr h, U£ - copiol „r of it " M€ bs q .,;"a w.E._ SOT = STS MUST r PLED i r ITH H'-' € r € e , `fi'r € : tome AV. 19'"' RR Owh~ C okl l (S - I s; SS s z ?x 4 We( Bldwnrl is t 4° ny S zM ~ r E . 0 W Q L aHn - L - Sit G L_.. y c r * sr.. A.. i pp r :am s Sty .x3 l c. 3 Own 0101 5E x it s3jy Cia" '"l, `am.yi21t i IV CMY Foul - WF{, nV t) it ins n, ' T - , t w _ Six janyra! W Mom, i IM: r,r? { „i°t 1 r.f Nom 1 jts1w.n£ r, , 4,` ow "wed in the ;4 cPr 3 if~IJI '110d'y'l,0 , Conk, r , .r. The is arv perno; VAN N A1z,' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 QCONVENTIONAL ❑ALTERNATIVE state PlanLDNumber (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER: INSPECTION DATE. Jack Lee Guen Mitt Lane, PcvLkview E.6t., Huds on, wl s = yAl 164 BENCH MARK (Permanent reference pant) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT ELEV. NE% W-4, Section on 17, T29N-R 19W, Lot# 25, PoAkview E/sta.,ta j own o j HudIs o Name of Plumber. JMPIMPRSW No.. 1C. u my Sannary Permit Number: Robe/!.t UtbAicht 3307 Sz. cu ix 49494 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ~j - LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELE V.. WARNING LABEL JEMOCI 9111 YES LINO 7:1 NO BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL- BUILDING VENT TO FRESH 15 Z LINE /im / (AIR INLET. f ( ALARM. FEET FROM ~SKjjyO 6 / DYES N O DYES INE A REST LINO o DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI 1Y PUMP MODEL JPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER !~t PROVIDED: PROVIDED: DYES LINO / /'11. OYES LINO DYES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NU FN OPE RTY JWELL BUILDING VENT TO FRESH UV )0 (DIFFERENCE BETWEEN FE LINE (AIR INLET PUMP ON AND OFF) DYES ENO N REST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ;TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until E the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR. PIPE PACING; COVER INSIDE DIA -PITS LIQUID BED/TRENCH ~ , TRENCHES ro RIAL P!T DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO. TR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BE LON(PI PFS ABOVE cOZVER. ELEV. INLET ELEV. END PIPE FEET FROM LINE) AIE. JNL~T: p 4 ❑ NEAREST L~ J S- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES meets the criteria for medium sand. TIONS MEASURED. LI NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES LINO DYES LINO DEPTH OVER TRENCH'BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED JSEEDEU~ M ULCHED CENTER DGES DYES NO YES LINO DYES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING; Et. EV.. ELEV.. DIA. ELEV.' PIPES. DIA: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED . DYES LINO COVER M PLANS DYES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING. FEET FROM LINE D YES LI NO ❑ Y LI NO NEAREST I z Sketch System on - --Retain in county file for audit. Reverse Side. SIGNATU / TITLE DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT ':~IDILHR ~ COUNTY - o6PRaTTT1EnTOF (PLB 67) UNIFORM SANITARY PERMIT # I nOUSTRV, LRBOR 6 HUTRn RELRTIOnS -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 r{ V 6 S-,-/O/ r" PROPERTY OWNER MAILING ADDRESS L LEE G~t~ti ~f i /l L/V . ~ft~ ~U~ElJ S T%~3 PROPERTY LOCATION q mac ~U/~.la~v NF"1/4 N 1/4, S 7 , T2(, N, R E (or W OW o : I LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L K STATE PLAN I.D. NUMBER 2 5 M, 0kV4F4_) c`S T-t7Z7"S i~ U/EzJ N/~-- TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. ❑ 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. V 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 ~v Lift Pump Tank/Siphon Chamber /V' Holding Tank capacity Manufacturer: -'Eje s lfCi2 Q Q(t) / ~cQ t) 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 WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ..3 6 15_-_ (O 3 Q ' I If "I/?6q ~ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of PIu ESiTiEtSEPTIC PLUMBING CO. Signature: Ipn"MPRSW No.: Phone Number: p RT. 3 O'NEIL RD., HUDSON, WIS. 54016 7 3 30 (21S ) 3P&-d1p4 PlumbeSArsR PLUMBER LIC. NO, 3307 M.P.R.S. Name of Designer: MINN. INSTALLER & DESIGNER I IC NO- 00663 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved / a9 /-/1 ❑ Owner Given Initial ~r~ E'1~ s w ! 7 Approved Adverse Determination r6 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. H ST C- 105 r • y H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County tz. d y OWNER/BUYER t k r" C ROUTE/BOX NUMBER ,E Cci X~-6F.) -Fire Number CITY/STATE ZIP )<'~A PROPERTY LOCATION: r ~L___N, R W, Town of c.d St. Croilc County, Subdivision Lt 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 puu)er. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July I, 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 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- o 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 J-'--`f 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. -f-PORT ON SOIL SCRIN&S PERCOLATION TESTS pLo r p L AM ROB" Ec r r. D. 7 FP7Tf 74=-s DArff,4 Jls-,-Pl V E 7~ Ti?w ffi HOMEc ITE TESTING Co. 11T-3, O'N.Ell' ROAD BOB 3 ,X15... 54016 C S 7- 02 yet it PROPOSED Musr ~°,tr-5r s. _~Ao posy wea m usr we 50 L L '016 Ck)) .a/MA) /v-- 40,f X OED /~c~r°®ovs = H~4u~ 4011 W 13cu-5 r a yo,~it . 13 M PO/ A),?- T~ 6~X ~ saw ~ 1 ~ iosT tiE ie r3L~F.F L, A)~ o"J FAS-F Lt)T_ L/~E- LE GE N 13 \ r u F. P1 e No po 1'6-0 32 r a 2~7 T-o lee 3 AkEA T a ~E- 133-13,y- R F UTv QE- ro w ~ E y /35 3o sow Ystc- o 7,. C'~~ oaC pv P T' t Y 1, r s~ c 3 UL r ~ ,7~~~9 r~ s ~l~ t y y5 160 I,, - foi`G jEsT DTI; ~rPR . ~ l8. ~ sue"' ~ 3 ~o ~~~r s~~ OA/ p S 71 0 1157 6 7- W 16-M P0,0 /6 0 R pg-4 ~M ScA (e ( ` 3 O l~o►' NA 2' PrPaJ-,E-GT- $ W. /-V-- S ® soon) P (J~ ~v (5sT-9-Tz:~ ~/U1~So.J~ wiS. `6 NED HOMESITE SEPTIC PLUMBING CO. _)~eR1. 3 O'NEIL RD., HUDSON, WIS. 54016 ~N L ROBERT ULBRICHT M MASTER PLUMBER LIC. NO. 3307 M.P.R.S, MINN. INSTALLER & DESIGNER LIC. NO, 00663 oil Fresh Air Inlets And Observation Pipe y f f/~ Soli TESTtn15 By HOMESITE TFS !NG o'0' Approved Vent Cap RT--3, C'd EiL t2 . HUDSON, WIS. Minimum 12" Above Final Grade /a z GfY Pipe _ 4" Cast Iron Above To Final Grade Vent Pipe Marsh Nay Or Synthetic Covering 0110 Min. 2" Aggregate Over Pipe 1 Distribution Tee l) Pipe - o 0 0 0 0 Aggregate- I 0 Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At ~Q?j. d Bottom Of System Ati, G /CIO S _ 1 y ;^y I 1 ~r fl_ ~ a l~ ~ j l ~:u 1 UNPLATTED LANDS OWNED BY WAYNE .a`TTEO .!A•ri5 -.4wE0 „,-PATTED :ANDS OWNED w (RECORDED AS NORTH 350- f ) - q`• Q.&EaF 0 GEORGE BY WAYNE 0_ HARNISH 11 N0•C '00',Es' 53393' 60• IFfCOROEC WS4p65,.N 406 'C 10? a,. 16Z 10667 t 4.97 79.89 90.2 • w . 4 2 2 1 61 m 1 70. ! 2 " 4•,, , N X9,~ J m p 0~ A N m N N O ~ t~y~'rCE m ti .O o Z N~ ID' J j ~c ~ N~ O D N pO ~ 0 -1 OJ Z D- 2 m ~W~ • m - O: N 8 1 t a' _ ~N D .D D si A w ~ ~Q}1 W~ V V (I~ 10, W N ' `;i 1 70.09 off .i } n 1 ~ 9 0~4._...~. a La P'. 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