HomeMy WebLinkAbout030-1082-90-000
0 v, O v n C7 r~
O d f ~ 11 ° rD `~1
c
3
741
CD c
v \ 1
3
0
fif CYl
C--
' W 3 O N
co W
CD N
C Z d ~'h
,~a 3 (D co O CD cD O O 1
Q N
N p N S N N
co
CO C:) :3 cr 0
0 CD (0
O
rn 3 ! _ O
7 N 7 O
O
o O
m
M -4
(n D a W
co N m a ~
W o
v
C
3 O CO
C D
N A N N (n 0 C
C~ Q
O W 'j r1 b O 2
C co H SL
O O O !V,
(D Cn T)
rt n U r N CrJ 0 3 E N co N ° D
F'• ` rt v .
O N Q O O
rt a c~ co N ~ cn
fu v
I- In ( r. H O (0 ('p (D 000 (o
CD I N)
Z W t. fD
H
Hr. ~
z z
Z D m p ty
O 0 N
lei
H f p' CD
N ~r
r C (CD m S /yam
L~7 -o N
d v @ f j (c d
W (D
Oo l (D j -I fn
4- O = O A Z CD
m
L4 C:
CL C)
d Z
oo _0 co o °
r
M (D
ti M a z
o :2~ (D 0 3 x
rt r7 O ^f z
rt 3
F- 3~ zt
O o O N (ZD
W
lid
Fn Q
K
i cn
rt O
ca N C I
a
`1) O
N
I
A
i
I b
m
n
i
I m
I a
z
~ N
O
i O
a
I A
0 tv
O
O O'Q
EA 0 ti
0 a
0 .
ti
00'0 00'0 00'0 le3ol
sa6jeya;uenbulla(3 sa6je40 leloadS s;uawssessy leloadS
;unowy fjo6a;ea epoa leloadS assn
:sleioadS
yo;ee :a;ea uol;eoilpea 0 :;unoa wlel0 :IIpaao A.Ial;O"l
0 0 000'0 puelpooM
0 0 0 000'0 A:podoJd IWOuaE)
:SOOZ -jo; sle;ol
0 0 000'0 puelpooM
0 0 0 000'0 A:pedo.ad IejauaC)
:90OZ jo; sle;ol
uoseeM a;e;S Ie;ol anoidwl pue-1 savoy ssela uol;dinsea
:pa6ueyO;se-1 :su01}enlen
000-06-N 6-0£0 0
:y;Inn passessy :enleA;a)ljeW .i!e3 ING J12 wouns 9002
adAl a6ed/10A # ooa a;ea
:iGo;slH IaoJed :sa;oN
M6 6-NO£-6Z
(17/6 096 tl/6 Ot' 6u~J-unnl-oaS) :(s);oeal
V66Zd HilM SS3SSV t,6t6/9 WSO 30 U
:Bp18 opuoapiool8 10-l - 0O i i dd lb'Hl 3N MS M66b NO£16Z 036
3-I8d-11` AV ION-V/N :Ield 0000 :sajoy :uol;dljosea Ie6a-1
OilM OOLL dS
13Sb3WOS Z£b9 OS
uol;dlaosea #;sla edA.L
Ajewlid :(sa)ssajppy A:podoJd leloadS = dS Ioo4oS = OS :s;ola;sla
ZM79 IM NOl-lf10H
Hl 3901b XOd £L£6
b'~-3ObdW '8 O N3JOb'2i30`d1SOH - O b3J`d1SOH d~-130bbW '8 O 2J39021
aaunnp-00 juaiino = o 'jaumo juaiino = p :(s)Jaunnp :ssajppy xel
0 00
edA.L Mwaad #;Iwaad # uol;eollddy easy sales # dept a;ea Iealao;slH a;ea uol;eaJa
NISNOOSIM '.11Nf10O xnjo as x ;uaiina
Hd3SOf 1NIVS 30 NMOl - 0£0 Vt76Z'66'0£'6Z laoaed 'IIV
L 30 6 30Vd
WdLVZO 900Z/84/ZL 000-09-Mb-0£0 IOOJed
I
Parcel 030-1082-90-000 12/18/2006 02:48 PM
PAGE 1 OF 1
Alt. Parcel 29.30.19.299A 030 - TOWN OF SAINT JOSEPH
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 - HOSTAGER, ROGER C & MARCELLA
ROGER C & MARCELLA HOSTAGER
1373 FOX RIDGE TR
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1373 FOX RIDGE TR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 10.260 Plat: N/A-NOT AVAILABLE
SEC 29 T30N R19W SE NW THAT PART OF LOT Block/Condo Bldg:
10 OF CSM 5/1414 ASSM'T INC P294A
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1012/66
2006 SUMMARY Bill Fair Market Value: Assessed with:
169226 416,900
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 10.260 163,800 197,900 361,700 NO
Totals for 2006:
General Property 10.260 163,800 197,900 361,700
Woodland 0.000 0 0
Totals for 2005:
General Property 10.260 163,800 197,900 361,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 221
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
e ~
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N-R v W
r/ -
ADDRESS' ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT J LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
5 IlGyti1^ Fyen.,
-'v=mar ~uj
K y-
t✓la~ /01 4A re
E ' ! 1
~J IN CATE NORTH ARROW
5-
BENCHMARK: Describe the vertical reference point used 'S
r
Elevation of vertical reference point: / 37y' Proposed slope at site:
SEPTIC TANK: Manufacturer: L Liquid Capacity:
Number of rings used: Z, Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side 10 Rear, O 1-- feet
From nearest property line Front,0 Side,O Rear, O v~ feet
Number of feet from: well, building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
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: _ Length:_ )o° Number of Lines: L Area Built: -`>~c
Fill depth to top of pipe: 4~~ r
Number of feet from nearest property line: Front, Side, X Rear,O Ft•,~
-0
Number of feet from well: y _
-
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT y°
/
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box(,-, or distribution box O been usr,d on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK '~4
a
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:
3
Dated: Plumber on job: License Number : j Z GL"
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, W`f 53707
CdCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
assign ed )
El Holding Tank ❑ In-Ground Pressure ❑ Mound (If
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTtt)N PATE..
Somerset, WI 54025
Hosta er i%I - '
BENCH M RK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'. 7,PT. ELEV.
SW NE, Sec. 29, T30N-R19W,Town of St.Joseph, Lot#10, Fox Ridge
Name of Plumher. IMP/MPRSVV No. Cou my Sanitary Permit Number.
Roger Timm 3224 St. Croix 54937
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
1 l `~C PRO IDED PROVI~ED
YES ❑NO LAS❑NO
BEDDING: VEN VHIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. JAIR VENTTO FRESH
ALARM
LINE INLET.
ETF -7
❑YES NO I ~I ❑YES ❑NO NEAREST OM G
DOSING CHAMBER:
MANUFACTURER BEDDING . LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PR OVIBED . PROVIDED'.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM NF AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IL FNC,Tr+ DIAMETER IMATIHIA1 AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF DISTR PIPE SPACING COVER INSIDE CIA -PITS LIQUID
DEPTH.
DIMENSIONS S J TRENCHES MATE IAL PIT
GRAVE_ DEPTH FILL DEPTH UISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL'. NO. DI VTR NUMBER OF PROPERTY WELL- BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END PIPE 1 LINE AIR INLET
~ ~ FEET FROM I L ~ j ~JJ
L. .3 :
11-=1 -147 to .59 z 7 2 NEAREST
--I ~
~J Z
MOUND SYSTEM: 10113 ol. Z 21,
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 ERMANENT MARKERS JOBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH'BED DEPTH OVER TR EC H;BED DEPTH OF TOPSOIL JSJIDED MULCHED
CENTER EDGES
❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO. OF LATERAL SPACING. jGRAVELD~PTHBN1_OVVPIPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS if
i
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD M TERIAL NO. DIS R. f1l. P IPE DISTRIBUTION PIPE MATERIAL & MRKING
FLEVELEV.CIA ELEVPIPES,.
ELEVATION AND
DISTRRIBUTION
INFORMATION HOLE SIZE HOLE S~µ^ CING DRILLED CORRECTLY OVER MATERIA VERTICAL LIFT CORRESPONDS TO APPROVED
Q.,gb PLANS.
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION ELLS: NUMBER OF PROPERTY WELL. BUILDING.
LINE:
❑YES ❑NO ❑YES ❑NO NEARESOM
~2 Si ~1•'~~ 11 I:L
o
Sketch System on Retain in county file for audit.
Reverse Side. - T- -
SIGNA.T _ TITLE
DILHR SBD 6710 (R. 01/82)
~ Wisconsin APPLICATION FOR SANITARY PERMIT ~i
COUNTY
DILHR (PLB67)
UEPRRTTEnT OF UNIFORM SANITARY PERMIT #
In OUSTRV, LRBOR 6 HUMRn RELRTIOnS 91
-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
A "I
660,1,
PROPERT LOCATION; CITY:
,'01/4 YV 1/4, S 'L, T VILLAGE: ✓
r~N, R / (or) To FD t
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, E O LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED w
1 or 2 Family Number of Bedrooms. Public (Specify): ~lll
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed V 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 w
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
p
Manufacturer: r 't_' i. c'? 1;~,,• `c' !i" ,~'r`.
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
4 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):
o ✓
3. ~04 Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print):. =ure: MP/MPRSW o.: Phone Number:
Plumber's Address: ' Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date:
Disapproved
i-C n f~ ❑ Owner Given Initial
Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
APP'LICATTON FOR SANITARY Pt:kMIT
S 'I C - 1 UU
ThLs applicatiou fonu La to be cumplet~d in full and -iLgned by the owner(s) of the
property being developed. Any inadequacies will only result in delays of- the permit
issuance. Should this de,velopme-nt be intended for resale by owner/contractor,("sew(
house"), then a second form should be retained and completed when th,
gold and submitted to this office with the appropriate deed recordinf
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
iiwnc•r of Property
Location of Proper. h' 34 %o, Section Id T to N - R W
.
'township 'ST.JOSSPH
Ma i l i-ng Address -SCUI_M NAM. AVE ~Q.
Subdivision Name
Lot Number- IO
1'r(,vious owner of Property ; ~ -
Total Size of Parcel.
Date Parcel was Created
Are all corners and lot lines identifiid)fe? Yes No
Is this property being devel.ojwd for r~:;~~le (s sec huu~;e} ? Yes No
a ~ $613 o1¢ 414-
Volume nd tine wu bet# a, - _dL~d wLth the Register ul Deeds
1NCLUll1? Wl'I'H 'PHIS APPLICATION ONE Oi~ THE FOLLOWING:
f. Warranty Deed
2. l,mid Corm t-;wt
3. Other t Lied with thy. Rc i, f Ste_r 1)(2C. ; M t ice
to addition, a certified survey, Lf~ available, would be hutpful so rs to ._rvoid delays
of thcr reviewing proces5. If the deed descr-iptioi] referenc:-: to Certi-ti_ecf Survey
Miip, the the Certified Survey Map sh.,A I also be required.
PROPERTY OWNER CERTIF=ICATION
i (We.) eeAt,i6y that af-e bta,tements on this ~ m ane,thue t,_, the- best 1)6 rmj (uun)
Tznuwkedge; that 1 (we) am (a)te) the owneA(b) o~ the prcope-nty des en'bed ,itt titi6
i.n~johmatiun 6ovri, by v.ihtue o6 a waAA(tn-ty deed aeeonde.d in -the 066.iee 06 the.
County Regist i o) "Deeds as Document No. 31~" ; and that I (we)
i_>>tesent y own the p~toposed site 6n ,the sowage pose sYStem (oA I (we) have
ob-tamed an easement, to rain whit the above desehibed pnopen.ty, bon the
cokb,-tAuetion o{f haid stj, -tem, and the btutw has beert do-e.y A.e-CoAde.d in the 06{f-i-(T
of~ ,the Cuurfta? Req.i,5 fc~~{ o6 Deeds as Document No. ) .
SLG ATURE 01' OWNER SIGNATURE OF CO-OWNER (IF APPLICAB )
DATT: SIGNED DA'TI LGNH'0
U1
"
y
STC - 105 r
y
"
SEPTIC TANK MAINTLNANCE AGREI MENT o
St. Croix County
0
y
' , nA,_.a? i- ,t "
OWNER/BUYERFOW&C4MN
111
__F1 re Number S,~•
ROUTE/BOX NUMBER $ _
CITY /.STATE 9::0jT~a JfiVAVE, m Z I P _Sso Ma
PROPERTY LOCATION: 14B_`-4, Section IL, T_30_N, R _W,
Town of dbT, Jc?%r:*% St. Croix County,
Subdivision fox 19106 Lot number. 10
Improper use and maintenance of your septic system could result in
its premature"tailure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank evury three years or sooner,
if needed, by a licensed septic tank uwLer. 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 e1.i81:.11e 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 Chat
owners of all new stems 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 piumber,
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 furtu will be sent approximately 30 days prior to
three year expiration.
0
T/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- to
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zuni Office i rin 30 days
of the three year expiration date.
SIGNED
D Al ' E
SC. Croix (aunty Zoning Office P.O. Box 91i
Hamtuojtd, W1 54015
715-7)6-2239 or 715-425-8363
Sign, date and return to above address.
"ff-`°"SI" SANITARY PERMIT
'Z~DILHR County ^
tea, K'X3UsTrri+,LAeons.w,n,wn GROUNDWATER SURCHARGE
w~w~rn Sanltery Permit NO.
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com-
monly known as the groundwater protection law. This change in statutes was the result of ov
2 years of steady negotiation and public debate. The groundwater bill included the creation
surcharges (fees) for a number of regulated practices which can effect groundwater. The
surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to
the groundwater through your soil absorption system or the disposal site used by your holding
tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground-
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.L
Ground,~M
Signatur of Issuing Agent: Groundwater Fee: Date: Wisco in3
buried #ftE UIY
DILHR SBD-7289 (N. 05/84) o
i
/~~~tijLN ~F ~c''!•i~~i/ i'~!lil S~J_'A,""~ o~,~f~~='`'t /~a !~',-~r
SAFETY & BUILDINGS
DEPARTMENT OF REPORT ON SOIL BORINGS AND
INDUSTRY, R I~ M DIVISION
HULAB AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RE LATIONS MADISON, WI 53707
' (H63.09(1) & Chapter 145.045)
LQCATION:,v- SECTION: TOWNSHIP/MUNICIPALITY: L: SUBDIVISIONNAME'`
'/4 1/ N/R ~t E (or),W COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE S T- C/
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONSIO N TESTS
Residence t New
_ /
OReplace
RATING: S= Site suitable for system U= Site unsuitable for system ✓ C% t / Z L// ~1/{~~ ~1 ,J
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL L ING TANK: RECOMMENDED SYSTEM:(optional)
[ S ❑ U C7 S ❑ U ®S ❑ U ❑ S EA ❑ $ ~ U ~!=J,~',~'a~ 6Z
If Percolation Tests are NOT required DESIGN RATE: r
J ~ .2 o-J If any portion of the tested area is in the ~U-
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
lAJ 1-)[</~ 7- PROFILE DESCRIPTIONS
BORING TOTAI_ 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.)
B- / /0, j /D 6. I ~ ' %
33 /f IJj 15 d,{ ham( 5 . j v JS
B /T/ ~/1 , • 33 G 7
oil ~N /S f~i y. f. ?f~~P . S
B- ✓ /O' C 2- 33 A0
Li QN ~75 'Aa [J,f? -5
/ 5 / 0 ~S 'vim lS v 61(, AOI a_d-Pr/lsT
Bj- 10,,5
op'o/c /o,Pf Sr
J G 13,0 - /S - P3 ' Qxf- 6 l .5-/'/ cv ~ f OA-- 6y ~-'o
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IN AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH
P_ j-
P-
P- 2
P_
LIP-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION /1¢171 = /D. 2-3 1-'
x f
.
x , e
x , 3 E
x
x
x
x
,
,
x ~
- -
i
x -
,
N
This test'sife APPROVED
for a conventional septic systern~ ~ _
41-
x x .
41
e + 3 ,
i i
7 j
E
i
p I
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:
~ 1- c c
ADDRESS: TATE APPROVED SITE EVALUATIONS (PIERC TEST
MINNESOTA LICENSE NO. 00663 CERTIFICATION NUMBER: PHONE NUMBER (optional):
WISCONSIN LICENSE NO 55-02492
• 19 O'NFJL RD., HUDSON, W1.54016 CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER
2cd_F~~iF
tV ;vlUNil th
SV S
.@T IS S I ,
Va, l_E Li a(~s ,n ',A"' s t~`3d ,_nail k,';' ~,k Fi ~,-:fix t3} 1cc nJ,- 5~ Et, sr7(C'"€} "OP` t 5l s~'~,,4110. ~S_
iut E LC,
.'6 DO t~`3, ay w'O"'vn,. od c,,w pcl F
,I'nc,j c0ain, e lov«iio, i) d cS' n ~ <_pl€.3~a pk 3c` NA tt :h(f t w knit :=t,
E , <S'K.
t
e ~
j, t
F P'
<Pti
PLOTI- PLAM PROTECT I:. D.
P-1. 3, O' NviL E3t3AD BOB x'1,1;
~.'1is.- 54016 L'57 S'3 = 02 yez
a~~ ltd t ~ ~ I'
. r
p"ROP05E.o HoosE mosr LIE 1; ¢r
PR O p05 WELL M VSr LIE 50 rT
49AaW,01- ow
1{ _ ~E`QG /DG.¢7r/DA/f ~ = ~IgIV~ ~v9£~FD c~~ S~iOdfL I.~D,~PES
e;z . SIH V£RricAl- &f~AF Cr POA)7-
5'-7 AY 61
LEGEND 110,r
vJ viL✓ v
71y~ t^
1 ~ ~ dt5~+ ~~st+it~.~ •,,.w~tiJA~Li'..~n3~y..i3~5
J i
l;
r
F
-n .
is v
vT '
I r VA
~,C-
1
CERTIFIED SURVEY MAP
L:)(-A I EL' -P THE SE1 OF THE NWI /4, THE NEI /4 OF THE Wil i4, THE NWI /4 OF THE
S1`.1 /t: OF T:I ALL IN SECTIO^: 0!\, P,19'v'TOti'r'N Or
S7. JOSE 'r., S CROIX' COUNT)', IVISCONSIN.
z Z--
2 CC 4vC
\Z UN PLATTED LAND -
.
PRIVATE - ,
~,C w S T 3 2 5.70'
1Rtc¢ v
~ W O UNPLATTED LAND
L OT 4 xa cn f~
P614 ~c
1 QQ a
s
I •C3 `
LOT 12
} Q c~ - n' 7 c
t Vrclly 421,73E S-F-t 5e ~9 k
.
I z 4 4 -ter 75 c Lc y
m
75
Ur. 1--I 3~ tt '65' - C
I+~i °C'-7p c
' A
2 7O
:r. Tr_ `l LOT I I Ss
8.87 AC
LANC_
1 630'82 386,306 S_F.+ M N J;
0•., 60• E 1-
4NDER
~ cc w
c4~o.: S 48 ` 44 57 "W p I
62.67'
586°18'12"~_.
` $ O
200.00/ 209 N7 °56 07"~y, ca ~ I--t
t 626
- N
2 ° zo rte,
-V M
co 1
~ ~ 6 S. 7 0 1
z LOT S 23.57' ~C zc)
-40
rr,
w ! V.5, P. I250 ~6, s I p \A - Io
LOT 10 1
o~m I
~1~ 10.2E L C. - cc
r
6: t4c,7=2 S.F.+ _ o:
CRArTEE, E`" V,'f L: ER J GREGORY tp
r
cp rn
q o
CENTER OF POINT OF
SECTION
/BEGINNING ~m
E2 0- r 45E.c2' w
r 1 ! 2= ~'4i= 'L !
t t. 4 -E 2' i
L S -Y.'L5- i/~ EECTION L I N O
COP.KER
Cr r. f.'r
_ _ c ~ T I ON 29
-+r'~~~
ROHL & TIMM EXCAVATING doe
/ -
310 Arch Street SHEET NO. _ OF
HUDSON, WIS. 54016 CALCULATED BY ~yJe<sc DATE
(715) 386-8664 ! 4
CHECKED BY DATE_
SCALE
j
t7,~ c e (r o ►n oje 1/ c, f
S5'.
es jf `X~ i
02 re.74
L.c.),e Ak .'5 ce ri f e
prST~c2 1~ Y[fr+'4 ~ TO ~cY~.~"M, `Zvo ~t:
a '
fff ~
/L ,
y
_
l x
t
y I / iY
G l .
e
i r
s
u~ e
PRODUCT 2041 NEes Inc., Groton, Mass . 01471.
JOB
ROHL & TIMM EXCAVATING J
310 Arch Street SHEET NO. G OF
HUDSON, WIS. 54016 CALCULATED BY /V S
(715) 386-8664
CHECKED BY DATE_
SCALE
jPSA
t~pt11L
aion r
4} 3 , ,hers ~J•
F
" rx
v •I t
00
PRODUCT 204-1 Inc, Groton, M- 01471.