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HomeMy WebLinkAbout020-1124-00-000 ti U) 0 0 v p ~j 3 7 7. N '30 H. a y r: O n N N uNi O O W C O O <C • cu rn n i.~ r-+ m 3 3 ro ~ m o CO n CD a a 'o N~~ W W N v "ti N n N S17 3 O Q Q N O O O COD p W O M 0) W p _ co p O 3 (n N (n fp d p I ~ D Q a m N W r o n ° o m N 3 O N N= O N F W C CD 0- O_ n ~n H J W C ` ° N n r cn o w sr J N O ~wO r~D ~d o` v v v tr • 0 0 0 w v :::I rt U o (D !+l cn M cc L' N O 3 - Z.. CL N ~t z co O 1 c: D n m CD C m m +y P-+ r; ~ UQ fit-. (D a J: o w (D (D H Z a 3 7 -4 cn N N z Q ? Z n N O ~ Z1 00 tad Vp O N• Z 'a z o 00 C) w ; OQ 7 (D z c M m v m :,D, (D (D CD CL I A O V, 1 rt a rt O r: m 7 5 ri cn H. O O O O O 3 rt ~J ( A (D H N v ca (D 00 D p T 7 SV C z a O N y A, Q, A A N O O a A_ • W O ~ A :E ti O c 0 CD ti S I ~ fOMMERCIAL TESTING LABORATORY, INC. 514 Main `street, P.O. Box 526 Corfax, Wisconsin 54730 715-962-3121 800 - 962 - 8378 (WI) 800 - 962 - 5227 CROIX COUNTY REPORT DATE; 7!11: ' 5IRTHOUSE DATE RECElVr, f+: 7-11' TGON, WI 54016 14.' THOMAS C. NFL 7: ,H :3CATIONt 438 Kratt Ley Lane, Hudson, WI ?LLECTQR: Mary J. Jenkins - St. Croix County Courthouse ARCE OF SAMPLE! Outside Fain: "F L 2 PP 1 F'am Dane Fr .ved i..an Nf" 19 r CPO ;fl~11NG~ F e T o I.cR'vel Approved bil b~hb..~r yT Al PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~r - • • k ST. CROIX COUNTY k r~~ WISCONSIN t •.Ys i~a~y^,'?b'~.~ ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 July 13, 1989 Brian & Donna Boettcher 438 Krattley Lane Hudson, WI 54016 Dear Mr. and Mrs. Boettcher, An on site investigation of the septic system on your property located at 438 Krattley Lane Lot 28 Eagle Ridge, Hudson, WI was inspected July 11, 1989. At the same time I also obtained a water sample and submitted the sample to the laboratory for testing. The results of that testing will be sent to you after we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator MJJ/sa 6/29/89 PLEASE DO AS SOON AS POSSIBLE. THANK YOU. 4v r~ Y ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 x (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 X (Determines if system is properly functioning at time of inspection) Property owner's name Brian & Donna Boettcher Property owner's address 438 Krattley Lane - Hudson, WI Legal Description 1/4 of the 1/4 of Section , T N-R Town of Hudson Lot Number 28 Subdivision Name EAgle Ridge FIRE NUMBER 438 LOCK BOX NUMBER Color of house Cedar/Brick Realty sign by house? yes If so, list firm: Century 21 Bertelsen-Cudd PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Jenny Olson - Century 21 B/C Telephone Number 386-8207 REPORT TO BE SENT -TO- _ Jenny Olson Century 21 706 19th Street S - Hudson, WI Closing date 7/10/89 Signature 715 962 40730 CiiMM. TEST LAP. 07 ; 13 89 15:55 F. iti ys FAX FROM= COMMERCIAL TESTING LAB., INC., COLFAX,WI TELECOPY TRANSMITTAL SHEET DATE: FAX NUMBER = -3 F(p - COMPANY : ATTENTION: FROM: 0 Win'` - - PLEASE CALL US AT 715-962-3121 IF THERE IS ANY PROBLEM WITH RECEPTIO NUMBER OF PAGES: (INCLUDING THIS COVER PAGE) TO TRANSMIT TO CTL= 715-962--4030 SPECIAL INSTRUCTIONS: 'i`EST_RESUL'['ST y .r FFFFFF A XX XX ST. CROIX COUNTY COMMUNICATIONS FF AAA XX XX 911 FOURTH STREET FF AA AA XX XX HUDSON, WI 54016-1698 FFFFF AA AA XXX FF AAAAAAA XX XX FAX TELEPHONE # (715) 386-9329 FF AA AA XX XX FF AA AA XX XX TO: t, ATTN : DATE: NUMBER OF PAGES INCLUDING THIS PAGE: FROM: Departme N FROM: ame of per on from department Non Emergency Business Directory: (non-fax numbers) St Croix Emergency Communications Center (715) 38'6-4701 St Croix County Sheriffis Dept. (715) 386-4640 or 436-5440 Minn. St Croix County Courthouse & (715) 386-4600 all other County Offices or 436-6888 Minn. B 715 962 4030 COMM. TEST LAB. 07/13?89 15:56 P.02 COMMERCIAL TESTING LABORATORY, INC. 514 Maln Street, P.O. Box 526 Colfax, Wisconsin 54730 715.962 .3121 800 - 962.8378 (WI) 800 -.962 - 5227 CO& Q ST, CROIX ZONING REPORT NO.I 31243/01 PAGE 1 ST, CROIX COUNTY REPORT DATEI 7/13/89 COURTHOUSE DATE RECEIVED! 7/12/89 HUDSON, WI 54016 AT* THOMAS C. NELSON OWNER* Brian & Donna Boettcher LOCATION: 438 Krattl,ey Lane, Hudson, WI COLLECTORS Mary J. Jenkins - St. Croix County Courthouse SOURCE OF SAMPLES Outside Faucet COLIFORKI 0 /100 el INTERPRETATION. Bacteriologically SAFE NITRATE-NI 2 ppo Under 10 ppa is safe for huaan consuaption. COLIFORM + NITRATE LAB TECHNICIANS Pao Gave WI Approved Lab No. 19 t Means "LESS THAN" Detectable Level, Approved by/ PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ~.k WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 July 13, 1989 ii Brian & Donna Boettcher 438 Krattley Lane Hudson, WI 54016 Dear Mr. and Mrs. Boettcher, An on site investigation of the septic system on your property located at 438 Krattley Lane Lot 28 Eagle Ridge, Hudson, WI was inspected July 11, 1989. At the same time I also obtained a water sample and submitted the sample to the laboratory for testing. The results of that testing will be sent to you after we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of this system. .Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator MJJ/sa AS BUILT SANITARY SYSTEM REPORT OWNER G 61if TOWNSHIP -H4t/ a~ ~;O /I SEC. 7 T)' 'l-R l "(_W ADDRESS 7-r ~Cf~ ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT 1, OT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f/ L I di at N r Urrw BENCHMARK: (Permanent reference Point) Describe: I' /P S.. F. l o f c v.^ ~ ~a Elevation of vertical reference point: 1GU1, Slope at site: 2 o~ SEPTIC TANK: Manufacturer: L~l~ 5rr Liquid Capacity: ( G' Number of rings on cover Tank manhole cover elevation: 0.)3S Tank Inlet Elevation ~Fank Outlet Elevation: - - - - - .---yY"~- PUMP CHAMBER Manufacturer-:- Number of gallons- Number of gal. pump set for a cycle __//4~gallons; Total capacity of distribution Lines /V/4 gallon: size of pump head; gallon per minute - horsepower --;brand name of pump ,A~ - - and model number Type of warning device---_ ,A HOLDING TANK: Manufacturer- 4-IA Number of gallons Elevation of manhole cover Type of warning device ./(i'/*- _ SEEPAGE PIT SIZE _LVNumber of pits /V'4 feet diameter feet liquid depth_ -_~1/ seepage pit inlet pipe-elevation bottom of seepage pit elevation ,AI/ feet. I / SEEPAGE BED SIZE: number of lines width length ~tile dept 2 SEEPAGE TRENCH: width /f length PERCOLATION RATE AREA REQUIRED-C/ ~7- AREA AS BUILT INSPECTOR _ DATED PLUMBER ON JOB f.ICENSE NUMB LR (Ile f ~ r CD e a a /At `e~ AS IIU1I.,T SANITARY SYSTEM REPORT OWNER iHsv',---- TO WNSit 111 Z)J-6V SECit/~ W AllllItESS ST. CROIX COUNTY, WISCONSIN. SUBDIVIS10N L01 LOT SIZE PLAN VIEW Distances and dlmuuSluns to meet requirements of H63 SHOW EVEKY'CHING WI'T'HIN 1.00 FEET OF SYSTEM I U.5 -T- I n ~~at N r h rr<w ]-4- . I J BE'NCILMARK: (Permauent re.tercncc Point) Describe: Elevation of vertical re.fereucc at Site: SEPTIC 'T'ANK: Manufacturer:-~,(/GI~C°•-i- Liquid Capacity: ~ODd Number of rings on cover Lank manhole cover elevation: 9 'l'ank 1ulcC El.evatiuu. ~ 'l'ank Outlet Elevation: D• ~5" PUMP CHAMBER Manufacturer: Number of gal.Lons Number of Taal. pump set for a cycle gallons; Total capacity of distribution l lueb gallon: bite of pump----- Bead; gallon per Minute horsepower ;brand naute- of pump and model number _ _ ; Type of warning device _ HOLDING 'L'ANK: Manufacturer Number of gallons Elevation of manhole cover > Type of warning device _ SEEPAGE PIT SI-l.E;_- _Number of pits - feet diameter - feet liquid dupth- seepage pit inlet pipe-elevation- bottom of seepage pit elevation _ _ feet. SEEPAGE BED SIZE: number of liaes__.-~ widthl~ lengtf> tile dept SEEPAGE TItENCH. width length-- _ _ PERCOLATION RA'1E--_-_B_~ AREA REQUIRED--~_,S` AREA AS T3UIL1'~ IN SPI:C'1'OIt _ "n D PLUMBEk ON JOB ~ - / LICENSE NUM11Elt 7 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 IN CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number. lt assigned) ❑ Holding Tank F:1 In-Ground Pressure El Mound ( NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER' INSPECTION DA E: Sam Miller Trout Brook Road, Hudson, WI z~`"~ j"Ja BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN. R PT. ELEV. . JCST REF. PT. ELE V.. NE SE, Section 7,T29N-R19W,Lot 28,Eagle Rdg.Town of Hudson a A~e ~ Name of Plumber. MP/MP RSW No.. County. Samtar e-t Number_ Doug Strohbeen 5432 St. Croix 43699 SEPTIC TANK/HOLDING TANK: 'rjl• Z r MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER r~ _ PROVIDED PROVIDED 17 Aiu~ ~~/-(/(l D ~7 ~ps YES ❑NO ❑YES ❑NO BEDDING. JV A.: VENT MATL. HIGH WATER NUMB R OF ROAD: PROP ERTV WELL. BUILDING. VENT TO FRESH L~ 11 ALARM FEET FROM LIIN E y~ r~J C JAIF~I~FT YES ❑NO YES ❑NO NEAREST & DOSING CHAMBER: MANUFACTURER BE DDINN . LMODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I VE NT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST 1.1 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL 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 1`3 N H4 NOEO~S DISTR PIPE SPACING ~VMCOVER AP&PIT NSIUE DIA 5P1T5 LIQUID DIMENSIONS t/ DEPTH. GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIP MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL. JBUILDING. VENT TO FRESH BELOW PIPES r ABOVE C VER EL/EV INLET ELEV. END PIPE !PROPERTY _P / AIR TC- FEET FR ol, l0.r~ O V •l, NEARESTO-r MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL PD.~ SEE ED MULCHECENTER EDGESS ❑NO ❑YES ❑NO ❑YES ❑NO 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 JMANIFOLD MATERIAL. NO. DISTR ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV.. PIPES. DIA.: ELEVATION AND DISTRIBUTION 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 PR OPERTV WELL: BUILDING: FEET FROM uNE ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNA E. TITLE. DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT ~t~, DILHR (PLB 67) 6~3~' COUNTY ) OEPgRTTT1EOT OF 7 1111111 InOUSTR4, LRBOq 6 HUTRn RELRTIOnS UNIFORM SANITARY PERMIT # _7491y -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 ,5 PROPERTY LOCATION q etT-Y- V/5 /4 SEl /4, S 7 , T.1%, R ) w TOw~ N OFr LOT NUMBER BLOCK NUMBER SUBDIVISION NAME f~ NEAREST ROAD, LAKE OR LANDMARK ~ STATE PLAN I.D. NUMBER r Q f A 1 Gl t~ f ~s r L- D ~ TYPE OF BUILDING OR USE SERVED 7 1 or 2 Family Number of Bedrojms: ❑ Public (Specify): THIS PERMIT IS FOR A: Imo' 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. '~J 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 c c, f Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 1 q 5'r h IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic I Gallons Tanks Concrete Constructed Septic Tank Capacity fit/ T Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 4, ✓ r P "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): Signature: MP/MPRSW No.: Phone Number: 6 C 4.1 32_ (.147 Plumber's Address: Nam of Designer: 1't v r' \ l rr sM rl el c f 5 7 v (4 ti, a 4' 7 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: (J ❑ Disapproved o,3 1/ ❑ Approved Owner Given Initial ll [t 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. DE.PA,RTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION -LABOR AND PERCOLATION TESTS (115) MADISON, W 53707 P.O. X 76 -HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: W05W;NS~HIP/A6.~p~„T••: LOT NO.: BLK. NO.: SUBDIVISION NAME: /4 ~/a /T..~`j' N/R/ytor COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: Sf Croix S` M ,.v, A ok u As 0"'(F wl s. 414 USE DATES OBSERVATIONS MADE r~~ NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: I~ltiesidence , p New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system A7A, On J9;?- CAL: •G COIF /~X CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) / 9S ❑ U XS ❑ U ❑ ❑ S Cx~ll ❑ S C°p,o F rcolation Tests are NOT required DESIGN RATE: [Ffloodplain, any portion the tested area is the r s.H63.09(5)(b), indicate: N indicate Floodplain elevation: PR FIL DESCRIPTIONS e BORING TOTAL° ELEVATION DEPTH TO GROUNDWATER-_- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- A 7 A" 4- -2 On _51, 3 7 9,1 el B-3 A-112, V • ~K 1?-- 7 ~/p Q ' r *716/1119 en / le" ,S l 3.7 cs r. J'J9/ odh 11791741 c, B ° / ` Gt - r G~ ♦ p// , Q 01'i l /r 7 / J: I An Cs T" B- PERCOLATION TESTS TEST DEPTHS WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER PWwW.68 AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH ;2- P-.,2- o 3 + 3 P- 3 p P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 7.1( 0 4e6 e, 1 3 • i /_krr Aeoc Ab;,"t Afi . q~# 3461 fs lot- y _ _ e t?a p/ t t A per Cse«-ti e-me) 1P`~'©L~ ~ ' '~1?r 4~ r '7t ® pat r SN+ 17 Acres CA.~~l#e) 1 o 6T, 0. A g). 44 If 09 e4 ~ ~ S~A~ t C e -SAC W/'? q': slop e- e, a~~ ~ SvK~t4 rAS ` 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): moo/ /.S "9q 171~=MX=s9,r/ CST TURF. 00, i 5 a , s < s r, use SgYa;'t tC3>= t;'axP .c Cig°.i iy a _r {3x € ~ chi E t 'J x 7 i t 5? x r'e. 1 1 f- x IJ" a, l F ie~a S' e 1f ' v"c. a, cul"mw E`.ia1i Y LE_, , to_ not ~?l,l lie s e t 1-uza" L l' l€it } 11 .lt.'`.; ''d: '}€..wa C' ~h r.. ..E t: tisxx ,>t_;. ;L,S' 4 y; 1 x r•t^ x eP c i s `1 3~ + i ~ 3 r ~ i y a 'yam '+s ~ j TTI v 'All y r ~ j t1 f y r i ♦ i ti w i F f i p ~y H z U] H ST C- 105 r' r a ti SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER/BUYER 3_ > ti ROUTE/BOX NUMBER ~9*- in;& 2) R Fire Number CITY/STATE ZIP PROPERTY LOCATION: i~ ~4, Section, T.2!!~ N, R _W, Town ofy/ k ! S en St. Croix County, Lot number. Subdivision "-514'19t "Z, d ~ 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 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. 0 E 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- 10 ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequaoies 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 Ct- V, ± • Location of Property W= 3t Section T ~Zcjl N - R W Townshipt-i- k c) tx Mailing Address ' L~ - Subdivision Name, Lot Number Previous Owner of Property 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 :Z'2- 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. PROPERTV OWNER CERTIFICATION I (We) eeAti.6y that aU .6tatement6 on .thib 6oAm aAe tkue to the but o6 my (ouA) knowledge; that I (we) am (aAe) the ownen(6) o6 the pnopehty de6Cni,bed in .thiA in6onma.ti,on 6o4m, by viAtue o6 a waAna.nty deed Aeeoh.ded in the 066ice o6 the County Regi--ten. o6 Deedb a.6 Document No. 41-v C? and that I (we) pneb entfy own the ptopoa ed A to bon the 6 ewage dizpo.6at a y.6 tem ( oA 1 (we) have obtained an e"emen.t, to tun with the above debehibed pnopeA,ty, bon the eon,6tAucti.on o6 eai,d system, and the same has been duty tecokded in the 066ice o6 the County RegiAteA o6 Deeds, as Document No. SAC G ~ ~ 1 1 SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED