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HomeMy WebLinkAbout030-2080-40-000 c _NO 30 c C7 ~1 c 3 R 3 M 7! 3 3 4~ ID = 3 N W N O O O O_ N Z 0 N O 7 N N NO CD 0 ID o F o O 0 C) -0 _ n F A O r tD O A7 3 O 7 N v N o N N :p O S O 00 d A FO Cn G D c ~ CD CD 0 (D N ISco a a O o A N N O i W N N 00 co = O Z N w w OC LT *A O lV 'U s O O z ° -aT ***4~ 0 f C N cn N A O 6l (D ~ v v ~ a 7 N N 'N6 N 7 - a CD m co 2 N 7 3 - (n 7 (D CL 7 z ~ C 07 Z 7 (D o 0' O ? a 7 o m (N N (D 92 C N (D w m a 0 A Z (D 0 ~ O N a A Z 3 M w CN17 (D CD m o (D CD 1 t z a 3 a o z o 0 m m z m I o ° Osn D 0 N• m a co -0 (2. n _a N (D 7 (D a O Q ~ fll 3 ° c o 0 f 7 z a CD (=D (D pj N O :z -0 CD 0 C 07 N (D C O 7 a 0 aCD y =r 21 T =Or N CD O S N A N ~C (D 0 N G C (D N c 0 a v _m m m CL CL ti 2 cb CL y a I o ° CD a < o f v °o Cl ST. CROIX COUNTY WISCONSIN ZONING OFFICE p a x n x r n p,■„~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 ~ - (715) 386-4680 March 8, 1994 6 v J Ms. Lucy Gearhart Century 21 706 19th Street South Hudson, Wisconsin 54016 5~ U~ RE: Water Inspection for Keith and DiAnn Kemp Address: 1378 Pine view Trail, Houlton, WI 54082 Dear Ms. Gearhart: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please let me know. S' erely, f> jam' ies K. Thompson Assistant Zoning Administrator mz Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 G FAX - 715 - 962 - 4030 ROIX GTY GOV.CTR REPORT MATE: 3/04; CARMICHAEL ROAM ONa WI ATION 1378 FineYiew Tr., Houl. :J_LECTOR'* Jim Thompson -`E COLLECTED. 3-01-94~+° , c COLLECTED: 31*40p : INT _IFORM,MFCC3 D f144 m1 ' ' ERFRE'fATION. 8acfe~r - 5 fi; v~ 04.NDEGEHpENr( ~ F O y u y PROFESSIONAL LABORATORY SERVICES SINCE 1952 0 1. 2 7. 04 0I'D : 5C PI'I PO 1 r_ CENTURY 21 HUDSON 7153866651 P.02 . L _ ST, CROIX COUNTY WI C.QNSIN ZONING OFFICE ST: CROIX COUNTY COURTHOUSI n?x 411 FOURTH STl SST 9 HUMN, WI 54016 (715) 386.4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Spooify desired test(s) & remit appropriate with application. Outside water lines aro often turned off during winter months, making acQogs to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. 0 water (VOC'S) $185.00 XSeptic__ g JEi.c?C Water (Nitrate & Bacteria) X35:04 qcu(visual inspection) Owner: RegUeasted b Address: Address: City & Stage: / / City & St. Zip CadaT 1V,~)J~Z Z Code: Telephone h4• (7 }C~%/7D,1 Telephone W; (;0 Prope7-ty address (Vire N1 & Strut) Location: ~W 1,7 , Sec. N, R,:V W, Town of St. Croix -Co, , . WI. Tax TD Parcel TO W~ vv Houses color: ~p~Jil Realty firm: 21 Look Box C_'oiabo: Water Sample tap~ocation : TO BE CONX EL TED, $Y PRQ?E$j,Y OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYST£KaN REVERSE OF THIS FORMS Is the dwelling currently occupied? Yes El No Tf vacant. date last occupied: Septic system installed by: r<~~t~~s c~uh1Q~ Year: Septic tank last serviced by: -ter m Se Dater , . q Previous Owner's Name(s): ~ P 4 * ~ A Have any of the following been observed ❑Y rN Slog drainage from house. GY N Sewage Back-up into dwelling. UY ON Sewage discharge to ground surfacer T road ditch or body of water. DY AN Slow drainage from the dwelling, ❑Y ,ZN Foul odor's. Other comments relative to system operation. i certify that the above information is complete and true to the beat of my knowledge. OWNERS SIGNATOREt • ?L DATE: D 1: .2 7. 94 040 1 Pld F0 1 CENTURY 21 HUDSON 7153866651 P.03 OWNERS DRAWIric; OF HOUSE & SEPTIC SY$TFMW YACATXoN - 1N I U G / 147A 4, ~i O-A To DE COMPLETED BY INSPECTION A0EHOY System design &/or permit on file? OXgs ONo Soil series per SCS Soil Survey: sheet Type .o sp i absorptign system: 08elow qrd OAt-Grd OMour,d ApprOX. size ❑Gravity 000se nPressUrized Ft- z OBed Trench ❑Dry X o11 C7Holding' Tank ❑Out1;all pipe OBSERVED DEFICIENCIES Dother DUnknown SSgptic tajnk setbacks: OHouse ❑ie11 Oprop. line Clothe t j~ose a n k Setbacks: ❑Rouse UWell OProp, line OOthet OLocking cove: OWarning label upump/rloate DAIarm 0EIec. w ring- Sail Ab6p.rption System setbacks: OHouse GWell. OProp. line Uather Oponding: ODischarge: G~n~ral comments: INSPECTORS 6XETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN - - ZONING OFFICE '4NxUgllrn~ x~~N( - _ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - Hudson, WI 54016-7710 (715) 386-4680 March 3, 1994 Ms. Lucy Gearhart Century 21 Premier Group 706 19th Street South Hudson, WI 54016 RE: Septic Inspection for Keith and DiAnn Kemp Address: 1378 Pine View Trail, Houlton, WI Dear Ms. Gearhart: An inspection of the septic system on the property of Keith and DiAnn Kemp located at 1378 Pine View Trial, Houlton, Wisconsin, was conducted on March 2, 1994. 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. Also at the same time, a water sample was taken. Once we receive the results, we will forward the same on to you. Should you have any questions, please contact this office. Sincerely, /s/ James K. Thompson James K. Thompson Assistant Zoning Administrator mz AS BUILT SANITARY SYSTEM REPORT SE~1e 1 TOWNSHIP } SEW OWNER ADDRESS ~f - ST. CROIX COUNTY, WISCONSIN. LOT SIZE SUBDIVISION Z7Q1~(~/-}~1~ LOT PLAN VIEW Distances and dimensions to meet requirements of 1-163 D.W.- LVLRYTHING WITHIN 100 FEET OF SYS F14 I di a r nr, rh~ A roe j SCn1 : BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: %G~ f1 ! Slope at site: SEPTIC TANK: Manufacturer: },z,---<f Liquid Capacity: ~l- /T,%(19,- Number of rings on cover : Tank manhole cover elevation: ~lJ.jQ Tank Inlet Elevation- /fC Tank Outlet Elevation:/ PUMP CHAMBER Manufacturer: Number of gallons number of gal. pump set or a cycle gallons; tota capacity o distribution lines gallon: size o pump head; gallon per minute horsepower bran name of pump and model number > Type of warning evice HOLDING TANK: -Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: um :11 o pits eet iameter feet liquid dept seepage pit in et pipe-elevation bottom of seepage pit e evation feet. SEEPAGE BED SIZE: number of lines _w1 th-~_ _lertigth~ the depth - SEEPAGE TRENCH: wdth length A REQUIRED ___XREA AS BUILT," _ ARE PERCOLATION RATE INSPECTOR DATED PLUMBER ON JOB 6ks - LICENSE NUMBER < DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & !OUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ®CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: IIf assignee) F-1 Holding Tank ❑ In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Mike Nelson Minneapolis, MN 13j -_h BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. SE NE, Section 25, T30N-R20W, St. Joseph Township Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Cal Powers 1563 St. Croix 34810 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: JWARNING LA EL LOCK CO PRO~I D: PROV:NOD ' n O _ / La`YES ❑NO S O HI NUMBER OF RoA BEDDING VENT DI~ VENT /MATL / H FEET FROM D. PR PERTY JELL: BUILDING: VENT TO FRESH ALARM: ❑YES ❑NO / LI E Z AIR INLET~~._.. ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUF URER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO °"-OYES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: U BEFr."' PROPERTY WELL BUILDING . VENT TO FRESH (DIFFERENCE BETWEEN F T ROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO N AFi1 ST 2150 g FO L H ULAME TER MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check thesoil moisture at the depth of Plowln E or excavation. (If soil can be rolled into if wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE DIA SPITS LIQUID BED/TRENCH ` TRENCHES / M PIT DEPTH DIMENSIONS J` L.~ GRAVEL DEPTH FILL DEPTH UISTH IPIPF DISTR. PIPE ISTR. PIP MATERIAL . N Dls NUMBER OF R E V WELL: Bl~IWp1y G. V NT TO FRESH BELOW PIP ABOVE COVER ELEV. NLFf ELEV. END. PIPE" FEET FROM LIrN~F, / J ~i Ala-Ir><LE7, AA.511 l1.1 Lam/ 1 NEAREST P !1 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/., certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ meets the criteria ~r medium sand. TIONS MEASURED. YES ❑NO e SOIL COVER TEXTURE P@RM ANENT MA KERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOI L. DEp+SEEDED MULCHED CENTER EDGES. ❑YES .QNO R ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERA SPACING GRAVEL DEPTH BELOW PIPE ' FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DIST PI E MANIFOLD MATERIAL NO DISTH DISTR. PIPE DISTHIBUT ION PIPE MATERIAL & MARKING ELEV. ELEV.. CIA ELE PIPES CIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COWL I Y# COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS I:j YE, ' NO ❑YES ❑NO COMMENTS: PERMANE NTMARKERS: OBS ERVATIONWELLS. PROPERTY WELL. BUILDING. NUMBER OF LINE DYES NO OYES ❑NO NEARESOM - O' 8 C`t ~D Qq ~ ~ ~O °9 yam, ti•3U l~ Sketch System on p0 Retain.in county file for audit. Reverse Side. SIriNA TURF TI LE D I L H R S B D 6710 (R. 01182) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS JNDUSZRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: r' Mailing Address: I r~ l 7 / L C Mao.! v Property Location: _ erty-ifi}}foags sFTownship: r J Cou ty: m.s2S/T30N/R2C)Q(or) W was/ -7-- uC7 GA!!!_OI.I, Lot Number: Blk No - T6u,-, bdivision Name: Nearest Road, L ke or Landmark: State Plan I. . J~uTber: 0( , / Al-e el Y, 6 / (If assigned) f ~ BSC TYPE OF BUILDING ❑ Public* ❑ Variance* [I Other (specify)* NuBedmber of rooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA y~ (Minutes per inch): PROPOSED (Square feet): / New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit Cj / ❑ Alternative (specify) ❑ Seepage Trench Water Supply: T-nneer's Name a Listed on Soil Test Report (If other than present owner): rivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of a private sewage system shown on the attached plans. Name of Plumber: Sig re: 0ffF/MPRSW No.: Phone Number: i Plu a 's duress: Name of Designer:i e- C, t COUNTY/DEPARTMENT USE ONLY Signature~of Issuing Agent: t Date: APPROVED Sanitary Per~m}it Nu'`mber: 7-~~ ❑ DISAPPROVED 6 I Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) Form - S T C 100 ~O Owner of Property Michael D. Nelson / Susan IYI. Johnston W j of NE-41 & Location of Property SE 4 NE 4, Section 25 T 30 N R 20 W Township` Sty Joseph Mailing Address Subdivision Name 111nnri1and Hi l Is Lot Number-Qt #4 Previous Owner of Property_ Timothy D. Cott' Total Size of Parcel 2.4 acres Date Parcel was Created_ march 25, 1976 Are all corners identifiable? XYes No Include with this application one of the following: XCertified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property I PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed r ord d In the Office of the County Register of Deeds as Document No. - 3 z ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the ount Regi a Dee as Document No. 381 932 ) Michael D. elson Susan M.-Johnst/ SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLI ABLE) `l Z lg~. 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BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: 4e%, 911., Section 2 t_, T~bN, RZV 6)(or ownship or Municipality Lot No. Block No. 0C 'I 1lS t~ County 57~. Su division Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 4 ? 7 ? PERCOLATION TESTS - - 2 / SOIL MAP SHEET Z_ a F-- l 7- -3 SOI L TYPE '1 o fee PERCOLATION TESTS i TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE f NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL - BER 1STWETTED SWELLING INMINUTES PERIOD 1 PERIOD 2 PERIOD 3IMIN/IN P- IV SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) "r 7~Jr !`t4 I, e z r r« / ' rYr is Z B- 3 1, 3 96 .6 el; e u Ts /I e d S 9e A4W ",4,e_J1 _5 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indira num er squ a fee of absorption area needed for building type and occupancy. ~t ~ Indicate scale or distances. Give reference point. Indicate sloe!r / f.s' -1-~ i 00- I I t / ,Q o~ *T_ t ~ f thl e S v ~ ~ a r ~ a ~ sir`- ZY~+( Ztr Z 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 location of test h s are correct to the best of my knowledge and belief Name (print) Aj"A ~~LrF3 F _10 ~Signatu Certification No. -1599 Name of installer if known Cop DEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR HUMAN'REDLATIONS PERCOLATION TESTS (115) MADIP.O.SONBOX WI 53707 (H63.09(1) & Chapter 145.045) % LOCATION: SECTION: TOWNS HIP/f9V0XICIPALITYY- LOTNO.:BLK.NO.:SUBDIVISION NAME: 1 >z 1 /TjflN/Rz~ (or)W UJ v WQOOLr4 - COUNTY: OWNER'S/BtJY-E V-644AME: MAILING ADDRESS: i 1 c71 r- y rrl r) - - USE DATES OBSERVATI NS MADE NO. B_EDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace J J? RATING: S= Site suitable for system U= Site unsuitable for system C F. CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM- N-FILLHOL ING NK: RECOMMENDED YSTE :(optional) ❑U ❑S U ❑S ❑U ❑S U ❑S. U CO ,I If Percolation Tests are NOT required DESIGN ~j~TE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 7/1 P OFILrE DESCRIPTIONS F,✓ • ~ H. BORING TOTAL DEPTH TO GROUNDWATER- S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH..-M, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) L 60SI, -2 -J, 5 j. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERIOD2 PERIOD 3 PER INCH P- 0 P_ 2- Z 0 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 1Q _ © - - - a ; 7e PC, _4 F #=t~C, i;~ r J -S~t7Zijje.. A C_Q _ d I~~ ) .w... _ _ _ _ X55 2.7`-111a, 1 E , e- 9 3 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and method`s 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: ~L AfgRESS: f~ CERTIFICATION NUMBER: PHONE NUMBER (optional): 3 I AT E:! i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - L