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HomeMy WebLinkAbout161-1053-40-002 ncn0 !Imm0 C7 _ 3 cp cD v A~ CD 0 CD \1 3. F O 0 0 o m 0 o ° co cri w C w m °C co =C C:7 3 rn m v co o o cn o ^ CL C GI y N y y ! W \ N p Q z A CD CD 3 ° m s ° ra 7 y 7 2 N O 01 CD !I Q O o V] x 76 ~ I v cn < D m a O w G r N (a CD y a d r3. ~ I ~ O W m ~ cn cts cn a ! b o rt GJ 3 O °~P r> rt (D Up Cs7 ' 0 N o O P G7 CL rn cn H. (D m o W o0 0 o c j o rt H In ri a 00 n p 9 m fl: h Z 110 O z O O O CD N) O Z o z o D N z n 3 g to cn to = ! D r~ . f _ H v (D D O Q C. 9? N (l ° y y A !\i jC it ~ lwV _ N V 4 W N I z 0 z m z CD o Cn H H Z o' ~ cn ~ l►1. I O N cz7 O CD y ty 2i 112~ (D w I LTJ O c FCD CD O N - a F-h ' W m CD cn G o N A cn z m N ° t- r ° A z o O O O v c~ F-d p rt o O : _ z* N z N W c(D v oo v m ~ ri N C z m 0 O z o a M C) y W CD D a a S z 7 CL CL o CD CD O_ 0 0 1 d y Z A N W N O I O a ' A N • N p O N a (D -0 ° i ti I Parcel 161-1053-40-002 06/23/2006 12:26 PM PAGE 1 OF 1 Alt. Parcel 13.29.20.5111 161 - VILLAGE OF NORTH HUDSON 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 - HOWARD, ROBERT S & CAROLE S ROBERT S & CAROLE S HOWARD 1115 RIVERSIDE DR N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1115 RIVERSIDE DR N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 1176-CSM 04/1176 PART OF OL 71 .67AC LOT 2 CSM 4/1176 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 907/475 07/23/1997 888/558 07/23/1997 858/483 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 79,500 220,400 299,900 NO Totals for 2006: General Property 0.000 79,500 220,400 299,900 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 79,500 220,400 299,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 307 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 161-1053-10-000 06/23/2006 12:22 PM PAGE 1 OF 1 Alt. Parcel 13.29.20.511 D 161 - VILLAGE OF NORTH HUDSON 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 - MCDONALD, STEVEN A & RITA J STEVEN A & RITA J MCDONALD 1152 RIVERSIDE DR N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1152 RIVERSIDE DR N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 0055-VIL OF N H ASSESSORS PLAT PT OL 71 GO S 75'S 23 DEG W 70' ALG ST Block/Condo Bldg: TH S 39 DEG W 135' ALG ST TO POB; S 56 DEG E 190' TO LK SWLY 200' AKG LK TO S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LN OL 71 W TO E LN ST NELY ALG ST TO POB 13-29N-20W VIL NH (1152 RIVERSIDE DR N) Notes: Parcel History: Date Doc # Vol/Page Type 03/16/2006 820812 AFF 02/24/2006 819232 EZ-1 07/23/1997 975/562 WD 07/23/1997 886/101 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 307,200 266,000 573,200 NO Totals for 2006: General Property 0.000 307,200 266,000 573,200 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 307,200 266,000 573,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~~~~'(.S~LX°6 h J TOWNSHIP w/`tom Qp_ ~j SEC. TN-_W ADDRESS ST. CROIX COUNTY, WISCONSIN i SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a - _4NDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Capacity: Number of rings used: - Tank manhole cover elevation: 3 Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Fron t,0 Side 10 Rear, _ feet From nearest property line Front,0 Side,0 Rear, feet Number of feet from: well building: /G (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE t ~ 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: _T Length: ~2, Number of Lines:_ Area Built: is Fill depth to top of pipe: jo Number of feet from nearest property line: Front, O Side,(-[/ Rear,O Ft Number of feet from well: 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 DEPAR_fMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAR►RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION MADISOBOON, ; WI 969 53707 BUREAU OF PLUMBING MA [CONVENTIONAL ❑ALTERNATIVE State Planl).D.Number F-1 Holding Tank El In-Ground Pressure ❑ Mound (If assigned NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE. Cornelia Waasbergen Riverside Dr., Hudson, WI ,OCR BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: d CST REF. PT. ELEV NE NE, Section 24, T29N-R20W, Town of Hudson, Lot #2 Narne of Plumber: MP/MPRSW No.. Co."" Sanitary Permit Number. Cal Powers 1563 St. Croix 58920 SEPTIC TANK/HOLDIN TANK: MANUF ACTI~VENTDIA, LIQUID CAPACITY. ITANK INLET ELEV.. TANK OUTLET ELEV. . WARNING LABEL JLOCKING V R PROVIDE ENO ❑ O BEDDING. VENT MA TLIGH WATER PP(UILDING VALARM LINE AYES ❑ YES ❑ NO NEAREST 4 " ~ o S N DOSIN G CHAMBER: MANU FACT URER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MAN ACT RER WARNING LABEL LO G COVER PROVIDED: PRnV ED'. EYES ENO EYES NO ❑ ES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERA TI ONAL. y~fUM ER OF PROPERTY WELL 6 VENT TO FRESH (DIFFERENCE BETWEEN FEE FROM LINE I AIR INLET PUMP ON AND OFF) EYES ❑N NE EST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLENf, rf DIAMETER ImATERI L A D MARKIN 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 EN ODISTRPIPE SPACING COVER JINSIDE DIA.PITS LIQUID BED/TRENCH RENCHES M,aT IAL DEPTH DIMENSIONS S L( PIT GRAVEL DEPTIY FILL DEPTH IDIST' I. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DI R. NUMBER OF !PROPERTY WELL. BUILDING: VENT TO FRESH BELOVy~PIPESJ., ABOVE O~C-IR ELEV. INLET ELEV. END / PIPE LINE_ AIR INLET. 1 7 2 FEET FROM L 3 n `'r N~ 2-4 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVXbE A IAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON:-REVERS SIDE. SHOW ELEVA- meets the criteria for mediu nd.~ TONS MEA URED. EYES NO SOIL COVER TEXTURE PERMANENT RKERS. SERVATION WELLS Pr _ EYE f 0~' J EYES NO DEPTH OVER TRENCH; BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL ISOCtED ED MULCHED CENTER EDGES / EYES ❑ Nob t EYES NO OYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO 5F =GR~VEL DEPTH BELOW PIPC FIL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS a f MANIFOLD PUMP MANIFOLD DISTR. PIPE MAN,iFOLD MATERIAL. NO. D T DISTR. PIPE D TRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.' DIA. ELEV.'. PIPES; DIA.: ELEVATION AND a DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIA VERTICAL LIFT CORRESPONDS TO APPROVED 'PLANS. EYES EYES ENO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. M LINE FEET F 1 EYES ENO DYES ENO IN RO 69 r o -l ( 35 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: DILHR SBD 6710 (R. 01/82) APPLICATION FOR SANITARY PERMITL H R ~(PLB 67) UNIFORM SANITARY PERMIT # R 6HUTRn RELRTIOnS Ez::: -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 PROPERTY OWNER MAILING ADDRESS , r PROPERTY LOCATION 64 TY--: ~i)csr 1/4 ^ 1/4, ~ N, f (or)11~ vlLt~E: TOWN OF: _j{7 LOT NUM ER BLOCK NUMBER SUBDIVISION NAME NEAR T ROA-U. LAKE OR LANDMARK STATE PLAN I.D. NUMBER 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 i~ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit El 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 l,i Lift Pump Tank/Siphon Chamber Holding Tank capacity 4 -77 -7 Manufacturer: ~s_ ? r 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): L: 4 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation oft ivate sewage system shown on the attached plans. Name of Plumber (Pri Signat e: MP/MPRSW No.: Phone Number: Plumber -Address: Name of [Designer- -COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: ll Fee: Date: ❑ Disapproved 4 El Approved Owner Given Initial 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. i 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 i Location of Property,'-. Section 1J, T N - R<C~ W Township/,r Mailing Address Subdivision Name Lot Number Previous Owner of Property a),,: 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 INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I ((fie) eehtL y that at 6tatement/s on th.v5 Aonm ate Ptue to the best o~ my (ouh) knowledge; that I (we) am (ahe) the owneh(,s) o6 the pn peaty de~scAi.bed in -thvs in~otcmat%on Aonm, by vi tue ob a wwftanty deed neeottded in the OA{ice ob the County Regi.6teA o A Deeds " Document No. / ; and that I (we) pnL"entLy own the ph.opoied site {ion the Isewag1~o,~sScaystem (on I (we) have obtained an easement, to nun with the above d"ni,bed pnopeAty, Aotc the co"t,tucti.on o6 .5a.i.d system, and the same hay been duty neconded in the 06{ice o~ the County Regiz en oA Deeds, as Document No. ) tom' - , j SIG TURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ST CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN PART OF CERTIFIED SURVEY MAP, VOL 4, PAGE 1066 OF OUTLOT 71 OF THE ASSESSOR'S PLAT OF THE VILLAGE OF NORTH HUDSON, ST. CROIX COUNTY, WISCONSIN C~jl -LOT ;2 - - - - - - N THE N1 RTH LINE OF OUTLOT 7. OF THE ASSESSOR'S PLAT N 880 - 46'- 58" W rn 328.37' X 6 _ c z ° D' iz m u 0 T AREA OF LOT- 1 z JO (46 4 i Q O TOTAL'. 114,006 SG. FT. ~O c ( 2.62 ACRES) w _ W - T I N EXCLUDING - m r0 c EASEMENT Ql) ' Itl, 366 SG. FT ~ 1 ' < { Op Q S m= _ Gj• Q r D o N AREA OF LpT=~ THE WEST LINE OF lrC), o TOTAL: 25,090 SQ. FT. OUTLOT 71, ALSO BEING 10 ? ° EXCLUnING (0.57 ACRES) THE EAST LINE OF EASEMENT KASK ADDITION IS rn I 20,789 SO. F T. I n D .y ASSUMED TO BEAR cn N 232 13' - 53" S 00°- 29'- 24 " E to `o t m AREA OF m OT TOTAL. I= ,227 SQ.FT. (0.67 ACRES) 9 / IOC EXCLUDING EASEMENT S ` IU ----_SE COR. 21, 357 SO. FT. 900-O • ~ O 0- O O z .1 LOT 8 4g E O / D w 0"37 w N 69 Ip6 79 'O/ O 0 <c NOTE'. THE EASTERLY R/ W OF O tij~ 00 RIVERSIDE DRIVE AS SHOWN _ S 87°-53'-48"E ON THIS C.S-M. IS PROPOSED Q tij0 AND 1S NOT RECORDED. N 170. 8 7' / 33. 4 _ o LOT- 3 M O - - O ti 1 m N O c- C) z N N o p- ~ O~ PO cn I co LOT - 2 o vS-, ~,h ~~i A~ N ® ° ° LEGEND 74 1 m o"g`7" O m 0= I " X 24" IRON PIPE SET WEIGHING 1.68 LBS./LIN. FT 25' 125' C 1" IRON PIPE FOUND 03 S87°-53'_ 48"E"E 152.16' - ~ 25 Off' ' 1- 112" IRON PIPE FOUND S87°- 6.23 53 -48"E 170.87' THE SOUTH LINE - `203.93'tS870 -53'_48"E-- RIVERSIDE © I VE OF OUTLOT 71_ 100 50' 0' 100 C.S. M. VOL - I SMALL- TRACTS SCALE = I" =80' PAGE 11 A CURVE LOT RADIUS CHORD CURVE NO. NO. LENGTH LENGTH CHORD BEARING CENTRAL ANGLE ILENGT 1 - 2 3 179.12' 110.52' N 56°-57'-13"E 35°- 6'- 22 112,35' ' 3-4 146. 12' 130.66' N 65°- 32'- 37" E 530-07'- 10" 135.46'1 2 146.12' {8.70' N88°-26'-04.5E 7°-20'-15" 18.71' 3 146.12' 113.67' N61°-52'-29.5"E 45°-46'-55" 116.75' `-i OWNER 8 PLATTER ROGER JORGENSEN _rl VOLUME- PAGE L P CERTIFIED SURVEY MA v ~I ST. CR01X COUNTY, WI :B N0. 8C-?8- 181 , ..1_-..._ r` Z _ -7 T_ X11 '~f I , ~i. ~Li:. 2 l - . - - _ T J ? T 1 l 'u 1'1 'he E . ♦ C J, 4-V 7 -vv , -4- 4he U t _ v _ cC C-1 ti .r.].1 w ~2 Ala r CE 11 U. i C. i.YSC sv" • - cn ' H a ST C- 105 r a H H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d ~ a r7l ,t ~7 OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE ~ a, ZIP s -14 i y~4, SectionT~N, RW, 14, ~ PROPERTY LOCATION:'_ Town of~pn St. Croix County, Subdivision Lot number -2 I I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, i er. you put into ~ if needed, by a licensed septic tank pump What 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 G I/WE, the undersigned, have read the above requirements and agree cn to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Off,t~e within 0 days of the three year expiration date. c SIGNLAD DA'rE 1'2 St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715--425-8363 Sign, date and return to above address. - v W27 1^ -I to w N 0 ~ O N~ lD (D ~ O C) n tD j O o~~o ~oww~'`~w (°n 'o C (?D N IDD a M 2° O A g m O c1 n w Oo (pN O * - (D OS! D 6 CD W ~ a A~ n 'Wo =CD gr a oID omma O 3 w >>g 10 owo Y~ ° :3 O _ w _ N 3°c° C- cFmc (p O S-3 0 a n ww= Q=~j CD ID O' S 0 w N CD 0 :3 CD - Oco !a a ~ D D mm Q (ovo v En W-, o D c- (~D o ^ O n = w n n CD C~a w0 ~o~mO~ -CD o a0_ v w \m ? cnCD ~a-°owN C ~A U) l< :E 4) 5D f _ D - 1 "1 w Aw M n to v m CD m 9« ci J (D Z CL CD n 3 (D m ?a D i NEa ~w,o~" R1 ~ (a CD CD in-- =or a w cn w a a c o w v 3D~ m~ww-~ C tT1 CD r- OL =3 CIA (D O (A (D 1 N ♦ / a (Q w ° (o Q N~ _ '0< ca Cc =Cn - CD =aof air.°cfa-~' w 3 w CD - v m y fli a~~ °-o aa.« CO' `G cn w (D ~ c~ o G) =3 c (D a) 3 w n CD c (o m o ° m o g 4 d j O w (D - I (D c (D m q a = _3 O CD O O 0 -3 ' CD CL O< co xl~ 0 Q o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: / SECTION: TLOTNO.:BLK.5_6 SUBDIVISION NAME: COUNTY: OWNER'S/BUYER'S NAME: AILING ADDRESS: USE DATES OBSERVATIONS MADE ~NO.BBEEDDRMS.: COMMERCI kL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: ❑Residence I -y~ u New ❑Replace i RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: JIHOLDING TANK: RECOMMENDED SYSTEM:( ptional) ❑S❑U S❑U ❑S❑U ❑S❑U EIS zU - ' If Percolation Tests are NOT reQuired ! DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate:; Floodplain, indicate Floodplain elevation: r PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 13d, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- S B 7 U_ i _ B- 7 7 > / B- LJ~ / r - i5 - Alf) A/,47 7, B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCH-& AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH P- P- P_ P_ P.- PLOT PLAN: Show locations of percolatio tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference point ati~rttteir foc'atiatro"tW-ptatptart--Shuw--thefsurface-eievation-ataff" bminy and the direction and percent of land slope. III -/7/ SYSTEM ELEVATION?;' t I l V / 4104 _ 1 - ~ _ .rrOtat.~ O 4'3 2 T II y ( 7!~o - ( - 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 COMPLET DON: AD RES l ) CERTIFICATION BE PONE NUMBER (optional): z4ioz '7 CS SI N DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DII_HR-SBD-6395 (R. 02/82) - OVER S_ , e Fps N_ wD O 1. ,,"=t a. §u s F" iX ~t{'. L,: ..e ~ ' < c '-sz L - n i.. S3 'a FL,. r. . }i< T})2. 6`~ IIw e=i.> L_ _ ill 1 SYSTEMS ARE RULD) OUT WKED ON S 1I L' `L.._. 1F de. .}'fc= d, art .E„t i, : Mt<t iev s, a y q"L a ,.,aS', m W«. tllS i' _ ! Ew „ .0€tr} ov .ooy V`7uv to! €0CRa Fs. 10 4. ~ t . Rkk~ r a. . w and vatoo A"Winn t. W _F , pod w a M.', yf a pel 7=a= wK :1 arqvOIN ale, I r"f, WAY. W°=, yon o rn any O Ct 7` rrav ,'<KC b Ag yam 3EJt pE. e W1 . y W Esc on, 0 L, u , }„s > E S'S ' : Ear(3 1 - p S FA w % Akan '.r s,~ u. 'f 11 's " E L own , W E cal . . i E E'}l - R 6. , - i lip a._ SwNy i. v NOW ann". 3 W u `.'p in [He 1XIMIn"In may ..quesz, r= 01 W l PAGE OF Cross ►U11 0~ ~Ay1 Fr h Alr "nick And Obcervallon Pipe Approved Vent Cop u"~/rlmum l2" Above Pinul Grude "U- 42° Abuve Pipe _ 4" Cast Iron fu final Grade Vent Pipe Mal in Hay Or Synthetic Covering - Min 2° Aggregate Over Plp• Distribution Pipe ~ 0 0 0 0 0 - Too 6' Aggregale 0 Perforated Pipe Below 84060th Pipe _ H1 Coupling Terminating At Buttom Of System I00 SOIL FILL DIYTRIBUT101.1 PIPE APPR.7VE0 SyMTI-IETIC COVER '"e"-MATER14 oP 9" OF STRAW OFA6(57RFGAIE-~~ ~j OR(AAKSN HAy 21/1 Z AGGREGATE ELF v. oF4Z FEAT-- . 3! DISTRiP,i~;TIO1J PIPE T(_) BE AT LEAST i1JCHE5 BELOW OR IGIIJAL GRADE AFIU AT LLAS-120 IUCHE-'~ BL1T 1.10 MORE THA1J H2- RICHES 6LLOW FlUAL GRADE dry ! MAXIMUM ®EPrH OF F-X~*AVAT100 FROM 0Ki&VVAL bWM WILL BIL -t-~ IMCHES MINIMUM ®rPrh OF EXCAVATIDO FKot. 0IIK►6114qL 6949E will. BE 4'~ ~NCNES SIGAIED: 0"t LICE►JSE- UUMBER:./~C~ i DATE Rio • J~iy<~7 dlj ~I /f/r--.r,o.r~~ ~7/ A /-0