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HomeMy WebLinkAbout030-2048-60-000 n 3 D o d o E; :E 1 7 > N -0 3 v 3 ^ 3 I c+ o --I Z CD Cn 4 101 "o- 3 m x o o N 'D QD N 7 N N CD O 0 O N N Ch ~ A O d N N ? p N Q 7 O o 7 L p O L" x O 7 N = p fl1 <D CD D a a UD (D N 3 N W 0 Q p Q~ N C lot O N 3 ~r 0) p. CD r- Cl) CD 00 00 c O C (n C, r! cr 7 ~ z O 00 CS O N U -I A~ N Z ° -~O fn fn fn Co v v Q vovNl o e~ a) (D O a (D N A (D d 3 41. CL N N Z W Z o y o o a :3 v -b h O D O N Z o (D ( C ~ C CD N CL W CD n O 3 = --1 m Z a A Z V) » O C ;o O p Z O n a 3 o D G) W ° wo -4 < a , - z M CD 0 3°r. N) 3 " N Cp y Z C (D Cl) p 7 O O ? ° a3 m o N CL I @ - "O 7 p, 7 7 N 0) N C N - 7 - mFm z n CD V) =r =3 -0 m O N N Q O N v _ CL 3 m ° 'c a ° o m a CD N°m e N N N C D - CD (D O7 ° O 3 p 0 7 O 7 N 7 N~~ A 0NC~ a m ~E0mo c Po c Q CQD , O CD ? O i O H T 3 a A i j (D E N A CD A N sa O " O O p Parcel 030-2048-60-000 02/18/20 P05 12:31 AGE 1 OF n1 Alt. Parcel 27.30.20.51 OR 030 - TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 r' Tax Address: Owner(s): Current Owner ' HOLMBERG, RANDY S & CHARLENE B RANDY S & CHARLENE B HOLMBERG 21 HILLTOP LA HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 21 HILLTOP LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.340 Plat: N/A-NOT AVAILABLE SEC 27 T30N R20W 1.34 AC IN GL 2 LOT 2 Block/Condo Bldg: OF CSM IN VOL I P 144 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 27-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/15/2002 684075 1926/431 WD 07/23/1997 750/511 07/23/1997 692/457 2004 SUMMARY Bill M Fair Market Value: Assessed with: 6124 261,600 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.340 56,200 201,200 257,400 NO Totals for 2004: General Property 1.340 56,200 201,200 257,4000 Woodland 0.000 0 Totals for 2003: General Property 1.340 33,000 158,200 191,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 302 Specials: User Special Code Category Amount 070-OTHER CHG SPECIAL CHARGE 204.91 Special Assessments Special Charges Delinquent Charges 00 Total 0.00 204.91 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER `JAG/ , lO/yASf TOWNSHIP 5 ;/0-ft-r? 174- SEC. :-7 T 30 N-R'20 W ADDRESS 10T / S7' ST. CROIX COUNTY, WISCONSIN 0 L 0 30 • o SUBDIVISION LOT ~Lr( LOT SIZE PLAN VIEW fR'F'rR d7E~ Distances and dimensions to meet requirements of ILHR 83 92. fN SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r - - - - , C Z~, C2 x 400 41 M j • E 1 j `v► ` N , 1 , U R Cam' 1 D cn (C/e vit _bA o ~ 93. Fr 7 ~U <Y_ eyc~ 3 %.U INDICATE NORTH ARROW Tj N,? BENCHMARK: Describe the vertical reference point used P'' 10)( PA CON K-2 ~R Elevation of vertical reference point: 0 FT Proposed slope at site: Sao Co SEPTIC TANK: Manufacturer: Liquid Capacity: 12. SCE QL a~ Fl~E Number of rings used: 1t16,V~- Tank manhole cover elevation: lO• ;Fz Tank Inlet Elevation: Tank Outlet Elev ~7• 3 e-S 0 w Number of feet from nearest Road: Front, Side , ear, O feet From nearest property line Front, Side,)( Rear, O 112-- feet Number of feet from: well 13 fr building: /'p f~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liqui apacity: Pump Model: mp/Sip. Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elev,ion: Gallons per cycle: Alarm Manufac rer: Ala Switch Type: Number feet from nearest property line: Front, Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: IO ) Trench: _ 3 G3 13S - Width: Id Length: 3 Q Number of Lines: Area Built: Fill depth to top of pipe: 30 c 3 G " 43 Es 7 Number of feet from nearest property line: Front T O Side, O Rear, 0 Ft Number of feet from well: O d U , Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Num its: Diameter: Liquid depth: Bottom of see evation: Area Built: Has either a drop box O or distribution box O been used on any of the above so' absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used* Elev of bottom of tank: Elevation 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: SC/~~ 'W - / ( ~J Dated: Plumber on job: ` le * I If License Number: Z (21 3/84:mj DEPARTMENT" OF INDJSTRY, INSPECTION REPORT FORA SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.0~ BOX 7969 BUREAU OF PLUMBING MADISON; WI 53707 MCONVENTIONAL ❑ALTERNATIVE state elan LD. Number: • (lf assigned) • ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSP CTION DATE Jack :.:40Xne&S c/o Nowcvcd LaVentcvice,RR# 1, St. Joaeph., W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF_ PT. ELEV.: CST REF. PT. ELEV. SF NW, Section 27, T30N-R20G1, Town of St. Jo,6eph.-PaAt ob Gov't-Lot 2 Name of Plumber. MP/MPRSW N... Cou n[y. Sanitary Permit Number_ GoAy Zappa 3300 St. Croix JC'Al Y &V/ SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. ITAN INLET ELE V.. JTAN~ OUTLET ELE VWARNING LABEL LOCKINDG COVER PROVIDED- PROVIED- / / 'J [:]YES ❑NO ❑YES ❑NO BEDDING. VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. JVENT TO FRESH ALARM. FEET FROM LINE:. AIR INLET ❑YES O ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL JIUMP,SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER PROPERTY 1111E LL BUILDING (VENT TO FRESH (DIFFERENCE BETWEEN FEET FROLINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NSOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JLENGTH JDIAMETER MATERIAL AND MARKING or excavation. Of soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER INSIUE DIA. #PITS LIQUID ___j J BED/TRENCH TRENCHES. MATERIAL: P!T DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTFt. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH RI LOW PIPES AB( VE COVER. ELEV. IN ELEV..END PIPES LINE. ? AIR INLET. FEET FROM f 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- ❑ YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WILLS ❑YES ❑NO _❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH, BED CE DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZE.r DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TREN::H TRENCHES. DIMENSIONS DISTR IBUTION PIPE MATERIAL & MARKING • MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. 1=1 ELEVATION AND ELEVELEVDIAELEVPIPESDISTRIBUI 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 PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES ❑NO YES ❑NO NEAREST 1 C, -5 Sketch At m on Retain in county file for audit. Reverse Side. j/ SIGNATURE: TITLE , DILHR SBD 6710 (R. 01/82) au+sconsln APPLICATION FOR SANITARY PERMIT , ~DILHR ~ COUNTY - OEPRRTTEnTOF (PLB 67) - InOUSTRY,LRBOR&HUMRnRELRTIOnS UNIFORM SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS /`16 G 0/10 wq~Pl~ 1A EFV7-a . f 1~ lei PROPERTY LOCATION 1-'7 I~ CITY: 59' 1/4 P ~1/4, S T3~N, R -0 E (o W VI WN GE: S f SE~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK 4-6 V STATE PLAN I.D. NUMBER ST~9TE w 3s Al TYPE OF BUILDING OR USE SERVED K 1 or 2 Family Number of Bedrooms. 3 ❑ 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. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: R/ IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOZ,17,06 uare Feet): WATER SUPPLY: ' Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (mint): Signature: N4WMPRSW No.: Phone Number: Plumber's Address: 33ov (715 1~6-f Name of Designer: 1 ~V /G lTa•v ICJ COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Age 0 nt: Fee: Date: El f~'C Disapproved ❑ Owner Given Initial 7 - 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 class, 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 revievl/ of tl x: 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 y ST C- 105 rr- SEPTIC TANK MAIN'T'ENANCE AGREEMENT 0 St. Croix County z OWNER / B U Y E R ,~A"_-,Y_ 1 I ROUTE/BOX NUMBER fT Aloa c:,iC~i✓ Fire Number CITY/STATE / pi-,- ZIP _5 A; (4-1V Lo-t 2- PROPERTY LOCATION: ' ~41 Section ~7 T 3,D N, R 'Zy _W, Town of .5;-t `~dSFPj-r- St. Croix County, Subdivision4)PAk,) LaT~~crt~~el:~ Lot number 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, 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 in 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 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 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. 0 I/WE,'the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ~ 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. SIC (ED 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. 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 douse"), then a second form should be retained and completed when the property is :gold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 70 10T" Location of Property -7---~4 ~4, Section z I' J N - R Zc% W 't'ownship J ( J~fjr~~l f- e S Mailing Address f~ t Tz;,J Subdivision Name /Zr1k-A-c Lot Number ~2i Previous Owner of Property 'total Size of Parcel f 3 Date Parcel was Created Z% Are all corners and lot lines identifiable? L/ Yes No is this property being developed for resale (spec house) ? Yes i/ No Volume / and Page Number A/V 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 (Mfl eeAti 6 y that a,Y f' 6 to tements on this {ohm ate tAue to the best o6 my ( ouh ) hnowtedge; that I (we) am (ane) the ownete(,s) o4 the pnopenty dactci,bed in .thi6 ,in6otmation 4on.m, by vittue o6 a wa"anty deed neeon.ded in the Oj6ice of the County Reg~ztetc o j Deeds as Document No. ; and that I (we) pnezentty own the pnoposed site 6oh the 6ewagedi~pasae System (on I (we) have obtained an easement, to nun with the above de~setr,ibed paopetcty, bon the consttuet-i.on o6 said system, and the same has been duty necoteded in the 06{i,ce tthe County Reg,i~s,teA o6 Deeds, as Document No. ) . GNATUR OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ""SCOTS"' SANITARY PERMIT " 13ILHR county ° uaeo LPM30a c Fwwrrsi w GROUNDWATER SURCHARGE KXJSTF inousTAV,Elwr~ons Sanitary Permit No. 9'? /-1 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 over 2 years of steady negotiation and public debate. The groundwater bill included the creation of 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. r Ground 1 Wisco $K. Si net re of Iss n AgeGroundwater Fee: Dat$:,, buried C/ 7e 6) DILHR SBD-7289 (N. 05/84) f1 . D lP,9N u.,,j 6,ei kxl f L ,P,640,e T of jil~ I ~P3 f ° 4_6M /31IS-Li -P&_-&jQk- 5 ys14~__, D DL)SSTRTRYENrOF 2 SAFETY & BUILDINGS INDU ; REPORT ON SOIL BORINGS AND LABOR AND P.O. BOX 7969 PERCOLATION TESTS (115) DIVISION HUMAN RE(,LATIJONS (H63.09(1) & Chapter 145.045) MADISON, WI 53707 LOCATION: SECTION: d TOW N SHIP /MUNICIPALITY: LOT NO.:BLK. NO: . SUBDIVISION NAME: 56- 1/ 27 /T36N R--EI.)W $ . i U-T Lor Z CO N Y: OWNER'S UYER'S NAM . MAIL NG AD RESS: / JA Ck C,e kl c c o a wA L,9 UE J fu t:~ ,P / s7I Cc7i' USE 7 r NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE Residence PROFILE DESCRIPTIONS: K11L : 11/0 ATION TESTS414- K New ❑Replace -3 1 ?e 2 ( 4 - RAT ING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE:SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U ~S ❑U ©S ❑U ❑S ZU ❑S ©U COvUFUj/4v71 IgAj kJ o91 'U FT. If Percolation Tests are NOT required DESIGN RATE O G under s.H63.09(5)(bl, indicate: If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBS VED (SEE ABBRV. ON BACK.) B- B- ~S B- ~ ~ ~ 7~ Ui o-uS B 1-6 4 3 ° v S r' ~ B- ot= /}Y . 3 - / Pt o ie i-- SuR`'¢CC- (51ZV*T1ov5 6G ~iPC ~r PERCOLATION TESTS TEST DEPTH WATER IN HOLE ST TIME DROP IN WATER LEVEL-INCHES NUMBER IN- AFTERSWELLING TERVAL-MIN. RATE MINUTES PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 2- P_ 2- P- (D Z P_ P 2- 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. SYSTEM ELEVATION ;80770-Al 44 X ta l / 0 d FT mom aPU~-Tio,,J of /Fd 3 F Sys, 13 13 9y~ /o° 3 ~N Be-a _s . _ L ?r ~s test site eve - n 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 E (print): ' ri TESTS WERE COMPLETED ON: 140 . 13-- ADLWATEAPPROVED S? 1 E E AiLUATI0NS (PERC~ CERTIFI ATION NUMBER: PHONE NUMBER (optional): ~j s 62- 1/02 - WISCONSIN LICENSE NO. 55-024$2 IGNATUR =S6 OTILFAL RDy i"J SONS WI-s" DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ~ . amd j g4 ,E aai S tt~ e?,t~E`3~ 1t SU, _1C TI t @ # ; t J 1 €Yfl'J1 lIk #.-.2i~l v ~"~C"" ✓ ~f - ~i O ND 10 E ijk, iC)€ U tt { lt~ C'E i4s t,:': % t aifaP5C1 (llt5 _z f E^te y pY . `t.._ "t BL i10cilr fens. lia,, in, to, d m ti"~ s i ?.~z,= .rt v.t<=~, tacl"~ nt,.k° ~;c ! ww f,3t iv shown, ii}d in p amo ate! + C, 13 t C'i" f~ -:i _t ¢t1"111 1ovattC;-.- F of akoi-`'s, NA In the apiwow al-0 t e ,.:il it x,d t s~' til t{ d€E'': 1t t OW J BE ' A S R ''d' 4 4 wY 1 3.P tj 'a f T i1dE3 C,"wv Lei:w, F", 11 vv; 44 t •i< olct ;~f st cCtt 6 t t;3T ,t M1 i I tcr~3.~i~e1}` i34oiE- r1,1 C u .fit •REPOR`; ON SOIL C30RIN&S PERCOLATION TEST5 IIS Pao T' PLAN PRoTEo i S'. D. T . DAr-E-~~uh_~ f - ! y 3 HOMESITE TESTING CC). R . 3, O'NEIL ROAD BOB U[J,' j,,s ,j, ~'1 i3 1, v1/0S.... _ 54016 C 5 7- SS GZ yfZ PROPOSED HOUSE M05T LIE' 2-;' Fr 04 MORE FiPOM .4L~ TEST f~~PE~S• PROPOSED WELL M v6r LIE 5o Fr o,~ t,ORF F.Po.-1 A1-4 T£ST" i9~Pe,45. a = L3i4 fjroE /~iTS 0 = EXI571,V (J- aJELL Uf = y~N~ Av9E~Pf0 op S~iadEL /jo,~ES x yotiz . B M iPfEooF%i. Pl r VC01L PEFERtAL)e'6 Yo 1 v Z0' I J I w \ r + \ ?O A~ 3S > ,I a ~O 6ic x 3 l< mil I 0 4/ /oD 3 x r I ~ This test for ~ conventsote AppROVED ~ , nal septic system, i I~ 11OR Z _ 13M /~~0/91D r ,{UoTr ' /~,P.c, Sr~ITE r . o~ _ ti,~o~ ~gtiv OF Mow PLB ~7 C o EXC~1 flit Fr. • PLOT and C D$5 r~ S,oPE, to ~5 x 4 SECTION P ANS 5-f S o I l~ E"gar 5 ~a a • , ~ S/a~~s J c~~ 3 CA I 6 t ~0' LA I • f ' I a I- - - B i G / S 6 J]-F6 7- 12 ~74ck a SoO*7" Z-07--2- //-6 UG 7-0A-) 110,P z D07- S 'n GA/FD - A I o 1~115 c..c)R. S T- L-o T- L-; 0 t `/CE,~SE 0--0 ~(F- U -DoT- = 100,0 Fr T>.4T~ Fresh Air Inlets And Observation Pipe SOIL TE5rj,05 By MOMESITE TES ;NG rc. RT..3, 0,tgEjL Ro,,,) Approved Vent Cap HUDSON, WIS. '-14016 Minimum 12" Above Final Grade -F T-~~ ? ~C7- ) I M o r- S. M~iMU 4" Cast Iron ~z 'Above Pipe - 'o Final Grade Vent Pipe P~A/ Marsh Ray Or Synthetic Covering min. 2" Aggregate D11/i U Over Pipe Distribution Pipe 0 0 0 0 0 Tee Ft 1.0 Fr. Aggregate Beneath Pipe 0 Perforated Pipe Below o Coupling Terminating At Bottom Of System • Wisconsin Department of Industry, PE13-1 INSPECTION REPORT Labor & Human Relations • Safety & Buildings Division Bureau of Plumbing Name o remises a e an o. S-t-re-et - y - County Sanitary Permit- Master Plumber Firm ame dress Journeyman um er Address Owner Address , J. -4 • r ( . r w f Y' _ X, f .r i r , l I ~m r s , L iscusse with signature ( )See Attached. DILHR-SBD-6192 (R.10/82) Signature o Dist. Plumbing up. n= i e Waste Specialist Inspector Local Inspector Plumber or Responsible Party Owner PCB-1 Depat of INSPECTION REPORT Wisconsin LLabort&eHuman Relations Safety & Buildings Division ame o remises Bureau of Plumbing a e an o. S:t:-.i ~ o u n y i Sanitary Permit as er um er irm ame dress J~~l ..a 3 ; r .~fi~PAB- ~.4 h3'~h'T 1 ~4 s vz.ar.e ress ress ' s m~ x, -a • f ~,~•~v5,J { ~ 7 -a .m:~ ~~~-1~-~Mf~=,aC~~...~.1.~1:~_`.:!'~~».!.cw O mC j.•...,,..._ r i _.~......~f.,~~, ~.-~":~:5!.,~~ , r•._. ,'`-l^• ,.t , ;/`fir,. . iscusse with Signature - ( )See Attached. DILHR-SBD-6192 (8.10/82) Signature o is um ing up. - i e P~Vs e pia ism Inspector Local Inspector Plumber or`ResponsiMe Party Owner -k k .r ST. CROIX COUNTY t., n WISCONSIN ZONING OFFICE r= Jam'- - c 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Juty 11, 1985 MA. Jack Moxne~ss c/o Howard La Ventutte R. R. 7 St. Jo,6eph, WI 54082 Deatt Mtt. Moxne~ss : In ttegand to 6an.itatty petcmit #54981 i4sued on August 24, 1984 by this o~~ice, the 4ottow.ing shatt be done be4otte St. CUix County wilt in- spect and appttove the Aani taAy ~system: 1. The septic tank shaU be ttemoved and bedding is to be pta.ced undett it. 2. Att stock shaU be ttemoved in the seepage bed. 3. The septic tank shatt then be instaUed by a ti_censed ptumbett, ticensed in the State o4 Wisconsin. 4. The seepage bed sha.U be in,6ta-tted by a .ti-censed ptumbett, who is ti,censed in Wisconsin. 5. When the pt.umbett eomptetes the system, this o~6ice wits make an inspection o6 the syste, 16 this is not done within the next ten (10) days, tegat action witt be taken by thin o4Kice and the Di tt i,ct Attottney Got v.iotat on o6 the St. Ctto.ix County Zoning Ottdinanee, and State Ptumbing Code,, on insta.P, ing a sewett system -i ttegatty. Finm Cott viotations o4 this ottdinanee ate atom $100 to $500 4ott each o44ense, and each day o4 viotati.on constitutes a separate o64ense. Should you have any questions ttegattding th.,s subject, ptea6e contact this o~4ice. SineeAef-y, Hatc.o2d C. Bcvtbett V41 Zoning Admin%stttato& mj cc: Howa~td La VentuAe L etto y Jans k y f nM it ~4ASI U.S. POSTAL SERVICE It ¢ CERTIFICATE OF MAILING' w Received From: usA ! 7 ~ .fly One piece of ordinary mailaddressed to: n / i' Lr C 729 A,~ MAY 8E USED F DOMEST AND I TERNATIONAL MAIL, DOES NOT PROVIDE FOR INSURANCE - POSTMASTER PS FORM 3817 *U.S GOVERNMENT PRINTING OFFICE: 1983 - 754-216 MAY 1976 Ib' 1-A s Wisconsin Department of Industry, D.I.L.H.R. Labor & Human Relations Leroy Janslky O.W.S. Safety & Buildings Division 13 E. Spruce Street Bureau of Plumbing :;hippewa Falls, WI 54729 ;715) 723-8786 PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT lame of Premises LuT L ` ~ NW, Z7. 3O a0W STS Ja° S- C201X Location Township County faster Plumber46e+1-Tesor (~;8JLj ~ tnPF Address ,wner_JAC-K r.t 0CV- ESC Address anitary Permit # SCI 9&I Plan I.D. No. NA- Type of Inspection S`fSTEM ersons Present at Site Or', N 6LSG,J MRS . M Uc K NESS ype of Building: ❑ Public Single Family eF DUPIex- NEVI RIEF, FACTUAL COMMENTS AND SKETCH: zK1 i 444 04 i 1.~ Cam. ~,~,Q J - . _ j + 1 I , r ✓ .~./~64 YV^ """''Yt"'{VV/ ~+'L4L~'`17•Q Li~l`t~!~-~C~yC.. - J" • ✓ I 1 ' ! A- i f i i i - - j i t-- i 1 I r SEE ATTACHED orl+t Ltp~ SCUSSED WITH PLUMBER/CST SIGNATURE NTE OF INSPECTION L ' 19 -ES . Signatu f Inspector Inspector Local Inspector Plumber or Responsible Party !_HR-SBO-6799 (N. 5/82) PA Coe- ► o -ddL r` • cJALK MOC-"E.SS (o - 1 ~1- lb s Pam c 2 o F Z T4 eL- ALt