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HomeMy WebLinkAbout020-1156-80-000 ~I 0 p 3 v n d rw o c m O 3 m CCD m v CD O CD 3 i U) z m A c v N d `C • v u 0 o ~ a o (D 7 O CD m 00 N (NO a a CD N rn O M m co ° N ~O rn 0) 'co O ° CD (.n ° ~ cn :3 o 3 3 N O O CD CD w o G D CD m n CD d 7 N [D 3 o ° N CD OF ° rn m CD ° (D c N W co cc) cc) CL N O C ~1 O O Y !r m 'O * l~l • z !Fill ,n -co O_ C N v S v 0 0 a) 77 Q Q K C N CD CD O CD CD D1 N - v N) c (o CD z N - N N z co o z - o o D C1 N• o m CD D N x -1 Z CD co C O N. C CD CD W CD d p E3 7 z (D 1 N G A ~7 .Oi n' a A z O W C C " a , - z 3 o " cn ° 3 M z CD W ~ s °o N O T Dl C z a m m CD cOn w o ti W x 41 N ti CD ~ R CD ti ~ N O O 7 to A 'S w O (D r~ A O cfl O ° O b O O y O O- V AS BUILT SANITARY SYSTEM REPORT OWNER //e I- TOWNSHIP ima SEC . T ?JN-R / Q W ST. CROIX COUNTY, WISCONSIN. ADDRESS ~/¢r'jK (J/t°Lj LOT ~ LOT SIZE SUBDIVISION PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM / 1 r 1A I Indicate N :)r h rr w FS7 BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: .Zyd SEPTIC TANK: Manufacturer: ~eise Liquid Capacity: Q Number of rings on cover --rank manhole cover elevation: Tank Inlet Elevation: 7I 5J1_ 'l'ank Outlet Elevation: PUMP CHAMBEI Manufacturer : NuniL~~ r n gal.luns Number of gal. pump set for a cycle- _ gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower___ brand name of pump and model number Type of warning device _ HOLDING TANK: Manufacturer- _ Number of gallons Elevation of manhole cover-- 't'ype of warning device SEEPAGE PIT SIZE;- ----Number of pits feet diameter feet liquid depth _ seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. I/ widthZ~ _length 2 the depth SEEPAGE BED SIZE: number of lines SEEPAGE TRENCH: width _ length PERCOLATION RATE AREA REQUIRED AREA AS BUILT ? INSPECTOR DATED! PLUMBER ON JOB LICENSE NUMBER Z V6"iniERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 c . CROIX COWTY REPORT DATES 7/16/9C OtTHOtIS£ DATE RECEiVEtli ! ? S THOMAS C. NELSON .3CATION** 451 Green Mt i l i_ane, Hudson 01 1ECTORi M. Jenkins -OLIRCE OF SAMPLEi Ki tchr-7 f ORii! 0 /100 ~'tF`RETATIOi~~ Dacte=' der LCHNil;1AH: Pam Gane ,J/OFA EVEN'''. l J` (90 < Means "LESS TW" Detectable Level. Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street ' Hudson, WI 54016 r 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 primer ty 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 (For nitrates and coliform bacteria)/ WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of } inspection) Property owner's name Property owner's address Legal Descr~pt~'on 1/4 of the 1/4 of Section t l , T -R'ZL4 Town of t-Jt~okS6 Lot Number Subdivision Name il.-u ~CJ FIRE NUMBER LOCK BOX NUMBER Color of house Lc . Realty sign by house? If so, list firm: 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 gajed. Firm or individual requestjn services: Telephone Number /;24;76 u` REPORT TO BE SENT,?TO: / e Closing date Signature t it ri SERCO Laboratories 1931 West County Road C2 St Pain Minnesota 55113 (612) 636-7'73 LABORATORY ANALYSIS REPORT NO: 1908 PAGE 2 07/25/90 SERCO SAMPLE NO: 55570 SAMPLE DESCRIPTION: Charles Barr PO 0580 ANALYSIS: 1,1,2 Trichloroethane, ug/L <0.1 Trichloroethylene, ug/L 2.7 Trichlorofluoromethane, ug/L <0.7 Vinyl chloride, ug/L <1.0 Benzene, ug/L <1.0 Ethylbenzene, ug/L <1.0 Toluene, ug/L <1.0 A: This parameter observed in laboratory blank at a concentration of: 0.5 ug/L. All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO LABORATORIES. Please contact me if other arrangements are needed. Report submitted by, A Diane J. Anderson t.~~ ~fL Project Manager < means "not detected at this level". 1 mg = 1000 ug. r Member it SERCO Laboratories r-tb1931 West County Road C2 St Paul. Mnnesoia 55113 (612) 636-7173 LABORATORY ANALYSIS REPORT NO: 1908 PAGE 1 07/25/90 Commercial Testing Laboratory 514 Main St. Box 526 DATE RECEIVED: 07/13/90 Colfax, WI 54730 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE WATER Attn: Pamela Gane Samples `Waken by:Mary J. Jenkins A\S$t. Zoning Adm. SERCO SAMPLE NO: 55570 St. Croix Zoning Office 911 4th St. SAMPLE DESCRIPTION: Charles Hudson, WI 54016 Barr PO 0580 ANALYSIS: Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L <1.0 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L <0.4 2 Chloroethylvinyl ether, ug/L <0.4 Chloroform, ug/L <0.5 A Chloromethane, ug/L <0.6 Dibromochloromethane, ug/L <0.4 1,2 Dichlorobenzene, ug/L <1.0 1,3 Dichlorobenzene, ug/L <1.0 1,4 Dichlorobenzene, ug/L <1.0 Dichlorodifluoromethane, ug/L <0.5 1,1 ichloroethane, ug/ L <O . i 1,2 Dichloroethane, ug/L <0.2 1,1 Dichloroethylene, ug/L 0.3 112 Dichloroethylene, trans, ug/L <0.1 1,2 Dichloropropane, ug/L <0.1 1,3 Dichloro-l-propylene, cis, ug/L <1.5 1,3 Dichloro-l-propylene, trans, ug/L <0.9 Methylene Chloride, ug/L <5.0 1,1,2,2 Tetrachloroethane, ug/L <0.2 Tetrachloroethylene, ug/L <0.2 1,1,1 Trichloroethane, ug/L 2.9 < means "not detected at this level". 1 mg = 1000 ug. a be, LAB., INC., CULFAX,WI FAX FROM:-UTELECOPY TRANSMITTAL SHEET I ~ I DATE : t FAX NUMBER: COMPANY: ATTENTION: FROM: 'IS ANY PROBLEM WITH RECEPTION PLEASE CALL US AT 715-962-3121 INING THIS ECO~R PAGE) NUMBER Or PAGES : TO TRANSMIT TO CTL: 715-962-4030 I SPECIAL INSTRUCTIONS: 7 61 i SAMPLES RECEIVED: June 13, 1991 Fron,c SL. (roix 70r:inq', ~a~-r~ ~amnlr BARR Sample Identification: Sample Type: Water Laboratory Log Number: Target Detection Uni t Parameter EPA Method 601: 1.4 < 1,4 Chloromethane ug/L ~ 0.23 < 0.23 B,ro„omethane ug/L 0.30 < 0.30 .Vinyl chloride ug/L 00..91 26 c < 0p:•91 Dichlorodi flucromethane Ug/L .91 Chloroethane u9/L 3.0 < 3.0 Methylene chloride 0.67 < 0,87 TrichlorofIuorow thane u9/L < 0.66 1,1-Dichloroethene u9/L I 0.66 ug/L ; 0,16 < 0.16 1,1-Dichloroethane 26 < 0,28 Total 1,2-dichloroethenes u9/L 0• ug/L 4.33 < 0.33 Chloroform ug/L 0.47 < 0.47 1,2-Dichloroethane ug/L p 1..4 4 < 0 1,4 1,i.1-Trichioroethane Ug/L .4 Carbon tetrachloride < 0.44 Oroimodichl©romethane ug/L < 0.35 1.2-Di chl oropropat1e ug/L 0.56 Q4..35 < 0.18 Total 1,3-dichloropropenes ug/L 1.4 Trichloroethene u9/L 0.58 1.0 < 1.0 1.1.2-Trichloroethane uug/L g/L 1.1 < 1.1 pibromochloromethane AN ECJL!A~ OPPORTUN&. EFAPLOYcA I Interpoll Laboratories. Inc. July. 5, 1991 Laboratory Report 03297 Page 2 of 2 Comsaerciel Testing Laboratory. Inc. Sample rdentificationa BARR Sample Type: Water Laboratory Log Numbers 3_Z97-01 Target Detection Parameter units !limit EPA Hethod 601 (continued): 2-Chloroethylvinyl ether ug/L ;0.70 < 0,70 8romofo rm ug/L ,0.39 < 0.39 1.1,2,2-Tetrachloroethane ug/L ; 2.1 < 2.1 Tetrachloroethene ug/L '0.45 < 0.45 Chlorobenzene ug/L '0.23 < 0.23 1.3-Dichlorobenzene ug/L !0.46 < 0.46 1,2-01chlorobenzene ug/L ;0.49 < 0.49 1,4-Dichlorobenzene ug/L !0169 < 0.69 EPA Method 602: Benzene ug/L 0.47 < 0.47 Toluene ug/L 0.92 c 0.92 Ethyibenzene ug/L ; 0.42 < 0.42 Total xylenes ug/L 2.2 s 2,2 Respectfully submitted, i 5~C~C Wayne) A. ~1 son. Senior Scientist Organic Chemistry Department GWH/MAO/sk Invoice Enclosed less than All an&lyu4s-were Aerrors* i using EPA oi- other recognized methodologies. All units ar4, on an -as received' basis unless otherwise indicated. I COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 Afw "4,4 715-962-3121 800 - 962 - 5227 fit. `O R z CROIX COW Vi REPORT DATE I+ 6113/1i: ;URTHOIISE `l,J RECF31F1*- 6/12/x'! 'ESO61, WI 54016 s `har eB & Audrey rsarr ~ATIO14: 451 Green Mill Lane, Hudson ..LECTOR: M# Jenkins 'RCE OF SAMPLE: Outside fa .IFORM1# 0 /100 .r TERPRETATIOW DacterioIay La 1.y ON 6 PPm 'ibove 10 ppm exceeds the Drinking Water Standar0 m DEPE/yp'... 9 i' O A D f Beans "LESS THAN" Detectable Level Approved by. d A J~~~__ 'rye ERVICES SINCE 1952 v,_ PROFESSIONAL LABORATORY S `C~ ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street tt ~ n 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 propertv.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 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) 4. SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's address Legal Descri do 1/4 of the 1/4 0 ection / T N-R Town ofd. l~D Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER` Color of house Realty sign by houM If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i..e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. J-1; water requires a sample that is fresh. If Testing of residenti al 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 rues inq s,ervices:Z~ Telephone Number REPORT , TO BE SENT ~TO : Closing date Signature -a WEST HUDSON T29N-R.20-19W 25 PART 040 is St - PA X79 oLOaw r~ WILLOwly SOLD I ~ ~,z, a t •a/v~R - J `y 7 1 LA ~ r✓v i~ - O ko car r as ;PARK n c o t ` I I I Ka,.rr«i r t_ - n r_ ~ s , P~ C ~ N i~ w au~ TR eAa t e' TS REALTY WORLD ( / oo F~Wc ` d TE rxs e oes Ic,a ~ ea r St. Croix J4 F -ar . r' 4 Nud v ay-.~ ea woCO f L' y 13 Realty 386-9855 N O R U D S O N°d~~b I T~ L TNF RESULTS PFOPLF" O - t L ic,o 7s 2 _ ' p K LL,'AG/E Po~J uo .•t'a rz, rn W °AS A Tc,i " 509 Second Street - Hudson ~.I,_ ear/ x n~ ti CALL TODAY, TOLL FREE: (800) 657.4553 2 C.& N9 ~b~ y I ~XC . I' W tiOOBLIGATiON %1APK,£T ANALYSIS ~ O U ~Sp~ JAGO.35 LA. ® T sa--)3 -F t .I !c :n'.,ri„rr 00 UU unc ~ ~ d afar~ Ld W m MLS _ OPPORTUNITY 2 \ N ~'t 'tC2~ L~l as z HUDSON, WISCONSIN ` 2,5 \ HUD ON f,~d ~It aece oc j z3I ~~~C •F9 NTd~ ul .1 pp;';jJ.-3•f- 0 12 35 12 94 w v<, O ' 2 oe~ 2J S ~'~TS 4-12 e9 \ \ f AltlOifa 4 37 GMC TRUCKS PONTIAC ~ - i ,awn 9/v. efa/ yaa., 3 ~ c., 9 i eeal OLD.SMOBILE ' st~dW C.'ub ya GS o 0 /99/.Pac.F1 _d Mc//Pub/s,l No SEE PAGE /J kv- ID -R. /9 W. SALES R.20 W- SERVICE 200 s 0 4CO 500 BODY SHOP ~a Phone: 386-5155 Metro: 436-5764 1-94 & 17th STREET HUDSON, WISCONSIN Fit a--~l IL IL IL 4 v gasoline I convenience foods HUDSON DOWNTOWN HUDSON HILL HUDSON SOUTHSIDE CENTER RIVER FALLS NEW RICHMOND 100 SECOND STREET 1207 COULEE ROAD 1920 CRESTVIEW DRIVE HIGHWAY 35 NORTH HIGHWAYS 63, 64, 46 425-637 386-9491 386-7401 386-7799 1 246-5188 v I~ J ST. CROIX COUNTY f(, WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 12, 1991 Lucy Gearhart 706 19th St. S Hudson, WI 54016 Dear Ms. Gearhart: An inspection of the septic system on the property of Charles and Audrey Barr, located at 451 Green Mill Lane, Hudson, WI was conducted on June 11, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. 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 may be dependent upon proper maintenance of the system. Sin%Je P MarAssi stant Zoning Administrator cj AS BUILT SANITARY SYSTEM REPORT OWNER d of TOWNSHIP /9 u 45 y 01 SEC. T T -R~W ADDRESS-1 'cu~ o ST. CROIX COUN'T'Y, WISCONSIN. u ~ o V'/f r ~T~- ~i (C SUBDIVISION_pop LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i In di at N r h rr w BENCHMARK: (Permanent reference Point) Describe: rV Elevation of vertical reference point: Slope at site: SEPTIC `YANK: Manufacturer: Liquid- Capacity Number of rings on cover Tank manhole cover elevation AVAT Tank Inlet Elevation: Tank Outlet Elevation: 0 74" PUMP CHAMBER Manufacturer: _ - Number of gallons__ Number of gall pump sIe~ for a cycle__ 1904- gallons; 'Total capacity of distribution lines N ~ gallon: size of pump_ ~A _ head; gallon per minute; horsepower ;brand name of pump and model number Type of warning device-.____-51141- Elevation HOLllING 'T'ANK: Manufacturer _ Number of gallons of manhole cover Type of warning device A4 SEEPAGE PIT SIZE;___- '(1~- Number of pits /V & feet diameter - feet liquid depth__-'- seepage it inlet pipe-elevation bottom of seepage pit elevation____. feet. SEEPAGE BED SIZE: number of lines __width-length 3 file depth SEEPAGE TRENCH: width /Il _ length PERCOLATION RATE_____3_i_ AREA REQUIRED J f h AREA AS BUI INSPECTOR _ DATED PLUMBER ON JOB % LICENSE NUMBER _ ~t/_~~" " 3~ Z ~r A x,11 13, <11 ' :77, L 9 l l t( 5 C s o 0 3 m o d r1 a r. m v m 1 ` 1 m v -4 - ❑ FD =3 3 N 0 o CO -4 z U) CO CP l^l (D en ' N a= O 3 O 00 N O C CD A o o 3 N ° 0 0 O Z n Cn x H n G D D CL=3 O W G rt r• m y 0 4 p p a o H m C r• m G r' 3 CL - o o m -4 co • rt O rt (D O N = CD -4 0) V z co co r- U) O co co N ~ O C (D O Cfa W W C) 3 'D ~ I H O A~ W z O O O U, cn w 00 -u 1, Z c co O W D D is ON C;- (D i(D .O. Ot •NO cD (D m Cl) m ~ N C N N N l fTl W Z ~ <n 3 m N r\ 0 = O` ~I V ON D co OZ 1 n CL :3 V W H CrJ Q) -b ~ W O r\ :3 m CD N oc. CD (D cfl (D a p r• n ~ - U) 0 Z N r n oo rn a p z 0 n ? xy s r• rt r G tv Z m n ` sl ~o ca N) -4 C (D rt O Z a z O L (L = O 1 0 A Z7 d cn; O m cfl G' (D SS CD p. (n ~ G a D m CL o ° T 3 c _ z a a M z CD > C Vc ~ n I m o O v S O N A All a F» O ti v O CD Q Z Parcel 020-1156-80-000 10/07/2005 11:13 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.875 020 - TOWN OF 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 MARY L WATTERS O - WATTERS, MARY L 451 GREEN MILL LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 451 GREEN MILL LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.034 Plat: 2277-PARK VIEW ESTATES 3RD SEC 17 T29N R19W PT NW SE PARK VIEW Block/Condo Bldg: LOT 81 ESTATES 3RD ADD'N LOT 81 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 10/30/2000 632651 1554/504 QC 07/23/1997 910/243 07/23/1997 697/301 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.034 25,400 171,600 197,000 NO Totals for 2005: General Property 1.034 25,400 171,600 197,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.034 25,400 171,600 197,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 312 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 J n 0 e Pot Ti-1 ti e -41 71 _ a r• DEPARTMENT OF INDUSTRY, INSPECTION REPORT SAFETY & BUILDINGS FOR LABOR+& HUM,AfN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 , BUREAU OF PLUMBING MADISON, WI 53707 ERCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (I faaxen.d) F-1 Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller Trout Brook Road,Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF/ 9EV.: CST RE f. PT. ELEV. NW-14 SE-14, Section 17, T29N-R19W, Township of Hudson Name of Plumber: MORIVXAXJo.. County: Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 34786 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: JTANK OUTLET ELEV.: IWARNINGLOCKING COVER PRODED: PROVIDED: C/ i 7,/ YES ❑NO ❑YES O BEDDING: 'YrNT DIA.`r VENT MATE..: HIGH WATER NUMBER OF ROAD: JROPERTY WELL: BUILDING : IVENTTOFRESH !l T ALARM: FEET FROM INE. _ AIR INLET YES ❑NO / -f ❑YES NO NEAREST DO jj DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY- PU P MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING. V NTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH IDIAME TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH G LENGTH NRENCHE DISTR. PI/PE SPACING MCOVER A~rt-' IT INSIDE DIA *PITS BED/TRENCH DEPTH DIMENSIONS (J y~ J GRAVEL DEPTH FILL DEPTH DISTFI PIPE DISTR PIPE ISTR. PIP MATERIAL . NO. DISTR. NUMBER OF PR E TV WELL. BUILDING: V NT TO FRESH BE LOW P~S. ABOVE COt{ER ELEV. INLET ELE END p PIPES FEET FROM - LINE: AIR INLET. 11 - 7( It 0 NEAREST- IN, MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ❑NO OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS / ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED MULCHED CENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TNO. OF RENCHES LATERAL SPACING (',NAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH UISTR. PIP DISTHIBUI ION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA ELEV. PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECI L Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLnNs ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKER : OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑ YES I.1 NO ❑ YES NEAREST Ii 4 Sketch System on Retain in county file for audit. Reverse Side. _ GNA UHF TITLE DILHR SBD 6710 (R. 01/82) ajej State and County State Permit # 34786 p. LB 67 ' C Permit Application County Permit # 1 2 for Private Domestic Sewage Systems County St . Croix *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: W'14 E7 Y,, Section LZ, T" N, R ~I1 jV (or) V Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township ~u t, c:7 C. / TYPE OF OCCUPANCY: *Commercial *Industrial "Other (specify) *Variance Single family y Duplex No. of Bedrooms 3 No. of Persons D. SEPTIC TANK CAPACITY J 610 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation if Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) - - - - - - - . EFFLUENT DISPOSA RarP L SYSTEM: Percolation E _ Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width D pth Tile depth (top) No. of Trenc es Seepage Bed: toof Length- 3, 6_WidthI I' Depthf 12 2' Tile depth (top)--I-,L~'-No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil T ster, # ~y NAME .pe'i 1 y ? < h: A "r3-e A C.S.T. # ~ 5^ ~ I and other information obtained from 001 (owner/builder►. Plumber's Signature ¢ MP/MPRSW# -Phone #0;Zf7- 3 L Plumber's Address w c rti-a • o PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E , 3 ~ F E j t € [ _ _ 3 , . E E E 3 i 3 i 3 ~ r r e. _ . , . P _ . . w 9 r E ~ 3 . m w, mom. .g w . - _ Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 3 - 2 6 - 8 3 Fees Paid: State 14.00 County 21 .00 Date 3-15-83 Permit Issued/RkQYr16AX(date) 3-15--83 Issuing Agent Name Harold C. Barber Inspection Yes X No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 l NDUS TMENT C~rz PORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, rte. ~ DIVISION LABOR ANDS FIVEO ERCOLATION TESTS 115 P.O. BOX 7969 HUMAN R.EL:' fT ONJWAR 141983 ) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: ECTIO OWNSHIP/IfdtE+P~ctT1'~ : LOT NO.: BLK. NO.: S DIVISION NAME: MINA (or I COUNTY: R'S/BUYER' MAILING AADDR SS: / USE DATES OBSERVATIONS MADE 7NO.3 BEDRMS.: COMMERCIAL DESCRIPTION: PROFILDESCRIPTIONS: Residence PERCOLATION TESTS: ~ A New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system Jv CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) [~S ❑U [S ❑U ®S ❑U ❑S U ❑SlU ~P a Ej: :Tests required DESIGN RATE: If an y portion of the tested area is in the te: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / Q vv~ t),, .9 G ° 4/1 h' _S-c (::5, B-3 Q Xo e., > 90 7011 B- . /V ei "70', /0r,~i/ /0'r 8%? / ! r/ N Q Q - - T PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 1<711 o Z P_ Ale> 12- 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 9 Y d~" T / " ii i /o-r Pipe-' G1r~ F',(. /vo' , go, e E _ 41 Y 4 -Calf s 1 ~ 20e'1> sfrp~ s.~. c 4,,ue- a;~e rl3u~ S _ v n . -ro s leel wee- Post 1, 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): C TI5,NATURE: r c I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER. 4 ' z {.z e}tiE V k..l €v tF I1_t .r ..a 3 c, t,!i, i „t <i3 a cij S! a_'rss. an(4' u~ , p~I 1-,~ a i; Yn , y ado 'Ir '1 1. , v 3t F'7=a test E.. T ti , t E tIL:3s°t, E s y a c if I- 'A'; 3 i 3 a n a~ty ` l 0 S p_y ~ F , 5 'S' -•;i.-. .i.E Y`S F'P? ti3 ~ 3`..4 x ,i~ ~ ? a 3 ~.t.+.t~ t ln~ (t'~ 1) c S, IF a dF 6 /39 5 y ~ ~c rh ~A r h ~ x r r ~ G 34 , 3c t F7,