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HomeMy WebLinkAbout030-1021-40-000 y ti Q O O d O d F m 3 CD 0 (D o • 3 m CD m m O N N O O EPO G) 0 z 2 CU 1 0 W O v w o O •P CD O OW `C • w G) L •y Z a 0 m A 3 O_ d g z Q N O N O N CO O rw S CD CO Cn N C 3 O - (D :3 N 0) Cn CD 03 5 W N N _0 C- i~3 CL 0 0 O 7 CS CD v O = 7 CS 0 L 11 S CD A 31~~om O CD 3 • 0 o Wo „ ~01 O y_ CO 3 N N 7 O Q C C O .`3 Z O 0 d CD O N a -4 CL -4 l sv u> < D O G CD Cf] CD U) d 7 W O 7 y c o c c O O~ \ CD 3 O N N 7 jZ CD l< CD =;z Ul CY) CL "*04 cc CD z CD N N 2 O 000 003 Q N r N N to ° a (n (n O O O - N 0 N c -4 -4 -1 -o c f~A N N n - c fl y N - p Z M ro 'D ~o _O o o ' m O _C I' D ~ v C o O y N Oi y O N > CD ~ d 'O CA ~ 7 O CA 0 y _ y (O O w Cn =3 9 E co a ~ N zco o z z W 03 0 Z o I D D CL 7 v O ° 7 s 1 CD CD (D CD (D !~i • m (D CD cn N cn -1 C C (DD CD c O CD c CD cc N CD o w - m CD n CD ~ Z -I fn cn p O 7 A Z O c _ rn c I ~ n d ~ a LZ,' 7 O. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - GAUMITZ, JAMES W & PATRICIA A JAMES W & PATRICIA A GAUMITZ 1197 MCKINLEY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1197 MCKINLEY RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 6 T29N R19W NW NE LOT 1 CSM 21587 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 91,200 153,100 244,300 NO Totals for 2006: General Property 3.000 91,200 153,100 244,300 Woodland 0.000 0 0 Totals for 2005: General Property 3.000 91,200 153,100 244,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 St, Crnir CnunryPl-d g m"d Zoning l ,`J o G ST. CROIX COUNTY WISCONSIN l nNUnpnn~ - ZONING OFFICE °"""b ST. CROIX COUNTY GOVERNMENT CENTER E 1101 Carmichael Road - - - Hudson, WI 54016-7710 (715) 386-4680 July 25, 1994 Mr. and Mrs. Jim Gaumitz ~1197 McKinley Drive Hudson, Wisconsin 54016 RE: Water Results for Residence Located at 1197 Mckinley Drive, Hudson, Wisconsin Dear Mr. and Mrs. Gaumitz: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. Please note that there was an error in the printing of the address. The correct address on this report should read 1197 McKinley Drive, Hudson, Wisconsin. If you have any questions regarding these results, please do not hesitate in contacting our office. ince ely, C mes K. Thompson Assistant Zoning Administrator mz Enclosure L COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 cz: FAX-715-962-4030 c €!.L•1~ i,~~if4i il~~ilttia i:hr ~i,:. ht* C+h i r<u. ~c..~,~tf:"v3 ~~:sr. i .ROIX CITY $omn ? EPORT DATE! r/?1/94 :..101 CARMICHAEL ROAR _Irr ei ?4 UDSON t WT - a'!ION: 1195 McKinley Dt., Hudson LECTOR: Jim Thompson. COLLECTE:D* 7-12-94 ,,C COLLECTED,' "',CE OF SAM LE 4 , ANALYZED .7-14-x't ANALYZED' .11*#00m, -0LIFORM,MFCCI 0 INTERPRETATION: ' I NITRATE-NII r..i.-.: ~ i,41" 1 tt3' 4'.'1t! W,etti''i ~sio.~7 00 Coliform 6acteria/l.~O m: WI` 'litrate-Nitrogen, my9L ~ ~ s 3 G rs TEC'BNIL: ANr 3 .OF.NDEVENOENj a ,pproved Lab No. O i 16 A y PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ~1 r r ■ r ■ u ■ a: - ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 ❑ Septic $50.00 Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria retest $15.00 Owner: J ~ W. Requested by: S'ayr_ Address: (IW`i (`(\eIK'n\~7 C Address: t1 - ZIP ZIP ( \Telephone N°: (11T ti (ao~ Telephone NQ: ( ) I Property address (Fir6 N4 & Stredt4) : Location: 1 1 Sec. , TN, R W, Town of S~, .Jo6ep Realty firm: Lock Box Combo: Closing Date: TO TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: r..,~s.~,~~ ~n~~r e„~2~° Is the dwelling currently occupied? R Yes ❑ No If vacant, date last occupied: Age of septic system: 11 s$C5. _ Septic tank last pumped by: I i: Date: 1'i'0 Previous Owner's Name(s): Have any of the following been observed? ❑Y ;KN Slow drainage from house. ❑Y ~&N Sewage Back-up into dwelling. ❑Y E~N Sewage discharge to ground surface or road ditch. ❑Y EIN Foul odors. Other comments relative to system operation: I certify that the above information is com lete and true to the best of my knowledge. \ OWNERS SIGNATURE y I DATE : - 7r-5J 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION ~fM TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: []Below grd []At-Grd []Mound Approx. size 'X []Gravity []Dose []Pressurized Ft.Z []Bed []Trench []Dry Well []Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: []House []Well []Prop. line []Other Dose tank Setbacks: []House []Well []Prop. line- []Other []Locking cover []Warning label []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: []House []Well []Prop. line []Other ❑Ponding: []Discharge: General. comments: INSPECTORS SKETCH OF SYSTEM LOCATION I~ Inspector Tit1.e AS BUILT SANITARY SYSTEM REPORT i OWNER [ r7 n, / / TOWNSHIP S~: SCE F~ SEC . T&N-Ri/jW ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION S (..uAt, nKt) FF LOT A ~ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 1-163 .W_ EVERYTHING WITHIN 100 FEET OF SYSTEM J - - Y-A 44 - - - - - ~cJ - - - t - - - . top _ - - - - - 1 1 I~ di atie or, the A row I p I I -ti S CALF:: 14►"t i) I BENCHMARK: (Permanent reference Point) Describe : 6F &-vOf Elevation of vertical reference point: joc,,~ Slope at site: %c -rA SEPTIC TANK: Manufacturer: t S c f"4S Liquid Capacity: 12no 6.'911610 Number of rings on cover : - Tank manhole cover elevation:_ Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o 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 Type of warning device SEEPAGE PIT SIZE: um er o pits feet diameter feet liquid depth seepage pit in e t pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width/,?'/_le~%th~tile depth SEEPAGE TRENCH: width length _ PERCOLATION RATE A REQUIRED V 2ti AREA AS BUILT INSPECTOR DATED A f Ialo PLUMBER ON JOB LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN F."ELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 XI CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: D Holding Tank D In-Ground Pressure 1:1 Mound (11 assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: t 1 - e CH " (Permanent reference pmnt) DESCRIB IF DIFFERENT FROM LAN: REF. PT. ELEV.: CST F. PT. ELEV. Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number: SEPTIC TANK OLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER } i PROVIDED: PROVIDED: V -4,L DYES ONO DYES ONO BEDDING. VENT DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH 1 V / ALARM FEET FROM L; AIR INLET OYES ONO L +f DYES ONO NEAREST ,.+!„r DOSING CHAMBER: MANUFACTURER. BEDDING LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTUR WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO ZjA ~❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL, N 0PERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN EIN AIR INLET PUMP ON AND OFF) DYES ONO E T SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FOR LE DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAI the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LE NGTjf NO.OF DISTR PIPE SPACING OV INSIDE DIA tt PITS LIQUID / 8 / TRENCHES MAT C' DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DPIPE DISTR. PIPE ISTR. PIP MA RIAL. NO. DISTR/ NUMBER OF PR PE TV WELL BUILDING: V NT TO FRE 9E LOW PIP ABOV VER . INLET ELEV. END PIPE ( LINE AI INLET I FEET . I 2 71-° / se~ NEARESOM 0 /V 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: JOBSERVATION WELLS DYES NO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED CENTER: EDGES DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS TRENCHES. s MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MA EHIAL NO DISTR DISTR. PI DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA ELEV. PIPES CIA: DISTRIBUTION INFORMATION THOLESIIF HOLE SPACING DRILLS U CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES NO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING. LINE DYES NO OYES ONO _ NEARESOM -~~1 ~l91 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TI LE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABQR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 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: Mailing Address: Jd 51 Property Location: rW City, Village or Township: County: / N [v % /Vr%S & , T Z N i R E (or) W `sT &10/* Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) v~ TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms:- 1 or 2 Family *State Approval Required. J TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT ISpecif ) SEPTIC TANK CAPACITY JlJa-U HOLDING TANK CAPACITY N 54 LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PIR ED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit L z ~7~ ~r9 3C' ❑ Alternative (specify) ❑ Seepage Trench Water Supply: O TOName as Listed on Soil Test Report (If other than present owner): A Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sig re: MP/MPRSW No.: Phone Number: -7 > C S Plumber's Address: t Name of Designer: 72yAV 0~ COUNTY/DEPARTMENT USE ONLY Si HaAo-UL. ure of Issuing Agent: Fee: C~ Date: APPROVED Sanita]]ryPermit Number: t "IS' ❑ DISAPPROVED "t Reason for Disapproval: I 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) PLB ~7 rtA PLOT an8 CRO55 X09 ~~Q C0~57k~GT/o v r,5 rw v-0 5 /~oMG FOP# t8 6, 13 y~ 1 _ GiEy 7 ~J 61- zo /0 Efy 1A)410ofF / i G K` N,U L Fresh Air Inlets And Observation-iRi-__-_ - Approved Vent Cap Minimum 12" Above Final Grade ,t1i.vi~t v~ D~ 3 " Above Pipe 4" Cast Iron i o Final Grade Vent Pipe pe, Sol L r~5 ! Marsh Hay Or Synthetic Covering Min. 2" Aggregate ~l y o Distribution Over Pipe Tee Pipe 0 0 0 0 0 (P " Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System r ,"Tf~_OF REPORT ON SOIL BORINGS AND 7,-F5r-/ SAFETY & B DI LDINGS INDUSTRY, IVISION • BOX L HUM RE, ARQR FCN NDLATIONS PERCOLATION TESTS (115) MADISON WI53707 (1463.090) & Chapter 145.045) LOCATION:. SECTION: / ] TOWNSHIP/MUNIICIPALITY:: LOT NO.:BLK. NO.: S_UBDlVISION NAME: 1/4 1/4 ( /T~' N/R/ / E (or) W COUNTY: OWNER'S/BU ER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence _3 XNew ❑ Replace I I-U/./y ?2 11zyj__ r~ RATING: S= Site suitable for system U= Site unsuitable for system 45W(; 1,"5 N' " ' l-j`XA~1'rT ~ Oel,2_ 6 W-2 r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 6/ s _521p, fr, WS❑ '$❑U $❑U ❑S0U ❑SZ eolw fley4 t/3cp /?X s Fr If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09151(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS S~~' fI T.3U,E',f!~-~- 5Z- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WIT CKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ,r,t eel, 2-2- IfJL B- 2- 150 %,2q r n&nfe- > 150 B-_3 130 to jo 9Zoh..e._ >13o B- % 1'~5 y~ ` ~2L~-tom > 42-fit - B B- /)FjOf~i /J fT PERCOLATION TESTS TEST DEPTH WAT HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AF SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 3 93 i~ F'- Jo-- Z- P- IV -2- CL 3 - ' F / 43 P- itl P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. /3LITT0-1 .4T /,-V 710 v o% E; AC7-LI SYSTEM ELEVATIONy Nl ~r. o~P / /U • ~y ~j' lae /ow LlTic,~% 0; , _ E I Q /50 770--r I~~tTa v f. • X. e)lc-- AA . _ TN 3 I B ~ e ~ ~ ~ V a57R~.rlad w PrR~,S,~f~~ o }~uv$ )CRo~~ , 9 34 f~ yo, All 9' v CA O-L PC )Crevyc 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: -I i 06-T-2-6 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTFsaC,i,"[ ^.,q ^3i anr+n r~;~y ~ ~ ' / C1,n~ra^ y aS a aW C . _ run uAe i_-.,, It Kai FOPP _ T, , cfv tk h:te end ac'' _s I=d.m"O pp ' ..3, t•r?F~ l} t'..tt, , .t<~ IxJ-? .3 r1a K.. .s ,t sst 3,t iE e,FOi ;fd„ 0 MA E E ,.u, .t, . , k ai, = a m ;t kiu,' ore3 . ? .3L to s a€t, (tY#~, ,3tt}C~. MKOXWO Will .rev to u ( +Et sh d; v Ot 60P € ip .js, , fixes a W i , ( a'? , Uf a,.. , Mu l A W Mix , €,f . it rm to v f a{fir rrp €6S' e . , , 3 ufi _.oo,3 ~Wt L,t t«tsm, Now no r rA, rttmJEt t.A. m W. ~pycr b me QM y'[ ,U y, ui 4 t;t€ . ;i. yto"e t? rt _ OWN, r, n ! orAm ,°c , _ , md A , wtt °t . Bit 00 13 zz<, S S. d LS own, -I KI VV - la t t 1 410 Medium A " „ F Boy S - Lm. my v3am: G Woo Lown SmAn Go, SP h Pon; I ow-r. Swan c h", i ! F ti l 'A rca~ 10, One P~Ow-"' i . ST. CROI X COUNTY W I S C 0 N S I N r 7 t Z O N I N G O F F I C E 386-5581 Ex. 49 & 56 i,a COURTHOUSE HUDSON 54016 I _ October 25, 1982 Mr. James Gaumitz 14900 61st Street North Stillwater, MN 55082 Dear Mr. Gaumitz: The State Sanitary Permit # 28154 has been rejected after thU + system inspection was conducted. Due to the fact that the residence was placed too close to the initial area tested, the plumber chose to install the system in the alternate area. Before the residence can be occupied, a new percolation test will have to be conducted in this area and new permits must be obtained from this office. If you have any questions on this matter, please feel free to contact this office. Sincerely, r~^~w TAW'ri~D C , I ~iCJIL~.+V~ THOMAS C. NELSON Assistant Zoning Administrator wjo cc: State of Wisconsin, Bureau of Plumbing Leroy Jan'sky Tony Zappa, plumber J CA CIO QA 1 e `^X- r r r y ! DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR 'gvb0'--' SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS Ora O DIVISION P°.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI :3707 IQCONVENTIONAL ❑ALTERNATIVE ~O.O StatePlan ID Number (If ❑ Holding Tank El In-Ground Pressure F11 Mound asslgnedl NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE'. m 1 Q BENCH MARK (Permanent reference Po,ntl DESCRIBE IF DIFFERENT FROM PLAN. REF. IT. ELEV.. CST REF PT. ELEV. j, f) g I q N.~mi of PlumRer. MP/MPRSW No.. County Sanitary Permit Number. (6 1 1[ SEPTIC TA /HOLDING TANK: ( I MANUFACTURER r LIQUID CAPACITY . TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOC I G VEFi t / P,R-~V ID~D. PR Yy ED C 1 °C t C f' C1 ~lf~ t{ _~1 ES ❑ NO YES ❑ NO BE DDI'G VENT DIA.. VENT MAIL HIGH WATE - INUMBER OF ROAD: 1PROPERTY JVVELL. BUILDING jVEI&TTO FRESH Z /1 ALAH FEET FROM LINE f / AIR INLET ONES LINO ( L YNO NEAREST + le-217~ h~ <7 DOSING CHAMBER: MANUFACTURER BEDDING. IIOUID (;APACITV PUMP MODEL PUMP: SIPHON MANUFACTII WARNING LABEL LOCKING COVER PROVID ED. PROVIDED: ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CON I HOLS OPERATIONAL . NU ER OF "IF DPEHTV WELL BUILDING VENT TO FRESW (DIFFERENCE BETWEEN Y FEET ROM ENE AIR INLET PUMP ON AND OFF) 1 ES ~L\R NEARE SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing - TER MATEHIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until RICE I the soil is dry enough to continue.) CON VENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR PIPE SPAC'IN. COVFI; IKSIDE DIA aPi ITS LIQUID BED/TRENCH THENCHFS %I PIT r DEPTH DIMENSIONS 56 ^L TILL DE PTH DISTH PIPE DISTR PIPE DISTR PIPE MATERIAL O DISTR LF UMBER OF PROPERTY WELL BUILDING VENT TO FR ESH ABOVE COVER V INI F I E END Z EE T FROMINLEr F2EAREST--s G, MOUND SYSTEM- S 1 e`~ r~ Mound site lowed perpendi ular to slope Check t text e of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrow thrown upslope: mound systems ake certain that it ON REVERSE SIDE. SHOW ELEVA- meet he teria for medium sand. TIONS MEASURED. Y NO SOIL COVER _I[ Y,TUR[ PERMANENT MARKERS OBSERVATION WF I LS ❑YES LINO ❑YES LINO DEPTH OVER THEN(:II RE ID 1 PTI OVEH TRENCH RE 11 DEPTH Of TOPSOIL SODDED SFFDFD MULCHED CFNI EH F _ ❑YES LINO ❑YES ❑_NO ❑YES LINO PRESSURIZED DISTRIBUTION YSTEM: I DTH ENG TH NO. LATERAL PACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH THE ES DIMENSIONS I tf ~,ANIFOLD PUMP MANIFOLD DISTR. PIPE IMANIFOLDMATIHIAL NO DISTR jn~STRPIPE DISTRIBUTION PIPE MATEHIAL Fi ~.1ARKING f LF VEI EVDIA ELEVPIPES DA ELEVATION ANDT DISTRIBUTION I INFORMATION ~HOLF SIZE HOLE SPAC G DRILLED CORRECT V COVER MATERIAL VERTICAL LIFT CORRESPONDS TOAPPROVED PLANS _ ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF PROPERTY WELL BUILDING C FEET FROM LINE I ❑ YES ❑ NO ❑ YES ❑ NO N 1 c . 01 t Sketch System on Rel in count " or10udlt. Reverse Side. swNAruRL ~ - rn I F D I L H R S B D 6710 (R. 0 1/82) DEPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & B 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'/z 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: Mailing Address: Property Location: City, Village or Township: County: Al~ %,&"C, /4S J Z9 N/ R E (or W 5T C►!X Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: U Gl/L~iP~/`jrG (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY Z HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: (,~~/,rte ~(j~ QG EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSE (Square feet): ❑ New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit -43 Q1 `?X la4 El Alternative (specify) E] Seepage Trench Water Supply: V Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Si re: MP/MPPF1538 No.: Phone Number: Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuingg A nt: Fee:. Date: APPROVED Sanitary Permit Number: f / i 7t DISAPPROVED 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 D I LH R-SB D-6398 (8.07/81) EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , C DIVISION LABOR AND ' P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 f (H63.09(1) & Chapter 145.045) jjz- LOCATION: SECTION: TOWNSHIP/MUNICIPA! ITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: !Nltl '/a '/a Gry /V-yN/R/9 E (ar) W ' 4 t / t~~ Ii~ftLD~Pa~~ CQ~NTY~%X OWNER'S /BUYER'S ilLlrf2 MAILING ADDRESS: 5 et ~~11TT'rYYI~ lV000 62hr 5./- NOXI A -5;1 W4_T6( v USE DATES OBSERVATIONS MAD NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ( Residence 3 A/ New ❑ Replace ZZ l f p RATING: S= Site suitable for system U= Site unsuitable for system CS / 9 F 0 CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL_IK HOLDINGTAN ECOMMENDEDSYSTEM:(optional) If Percolation Tests are NOT required DESIGN RATE: [Floodplain, any portion of the tested area is in the Zj _ under s.' t' .09(5ts indicate: "indicate Floodplain elevation: ~~lS 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- r W g® S" A,) -6- 54Iq -1~1-GAJ -OR 51- , 2v G _ o~'• 67 " C'S ~d ~orG- eve ~P B-2- /30 96,29 cr 74'e- > % '34~y LIS 13.u. CS . Pr 4- ISAJ C5 B- ? /go ?6,30 hn'x > 1,30 sue,, s , /a Orr - B- l1~ 5~.`~Y > /mar &y, , 2Li Gm es w;, - B Fr } /2 AV -6,y s L, " G~ ~u . SLR ~.l cs 4 - B- OtPV'_ au r+ET PERCOLATION TESTS TEST DEPTH WATE HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFT SWELLING IN RVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- ! U 3 P_ P- /GfJY~C < P- FSI E~ 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. /,)OTTQM d) 13 Eli ~X~gU~97~b~cl RGL L.E hT ''1etr#T/'Ov ©F ~X~4~rcy ilz SYSTEM EL VATION dl9 0 F- 04ft&0fpy /0,.5y fr l w P" F. Akc-r T- I-eQZ. f-tM _ 4q,. 04k wow s t PC- ion Tyr ~-~E~ . JJJ S °~7 w..`~ ;Z ' F lU~Rri t - ` - a AF~E N b lao~ ur l5'~ •13 > - aF Ivoop f3s_ za - /3 - - ~Ve S~AkE ~J 3 C% 61evnT100 or V rer- REF P/, ' /00. 1► 41 _ _ ; ~ E flab- Pa~~' Tf,~/SQV ~%111r 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 A ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ME (print): TEST WE E COMIPLETED ON- ADDRESS: CE „FICATION NUMBER: PHONE NUMBER(optional): 0 CST SIGNATURE: . I DISIRIE"U I O; i,7 n, n co^y ~_:7c21 Auth~~:.y, Prn; k"LMH Ti'; k.3€s. 3~~L. + + ,j. 6;€ t i 'isle € e . v r-i l U 3~! ti.l s'7; }F.I t7#i( a ~f I' C', .h:a, 7a> it3 r, € C4-r Jf to ae 't?c It ..s cx e.31,- s _ _ D CO i C)" 0. ~E ++c; r ,cg .z{ iY? r ~j IA i ss_. €a ,~ptz+ ~ a l-l t d aov, X.- ~x4 ;.i. , t, 1 t, "s`c .7 aI= «e,Gi F. I a ' + r P r ~ ~ e P^065CLU WEI L (,IT 1445r SD IWAI StpTiC t we sort, 7~ sI' ~1 PLB ~7 Nog-. fly Nr So~L ~~o. ~01 ass PI.~OT a d CRO 5c-, 10ooP - y' `P'tes S EC71 O N P l A N 5 "-0 P 61D f O)v 9 X(p } x 5rf7t.41IXeOCP A1-7aAlh-rF r ~B1 ,9RE ;K r ° 3~x yD ~ i ~ i ~S L8 x ,Q ~ls - - -1Fr x t I fay ~3 3s i9EUMl Si744C111 T' D~- G s ~iCAI- - - - - - - - - - - - - r - - C ~i /O 20 .~o X , gpa- TEST' Si?~S P~PoS2GT- ~/tvAiJor~ or Ut,erlc,gL ►ts ~u~if Z Hof ~~t~ poIaT ~s /oo, o f r w~~DRof~ s 61. 1.1w y NE y S~e~ T 2 yt1, R l 9 w S%GAIED `/cE s T ~9 TE- 2- Fresh Air Inlets And Observation Pipe TIO~ r1o~ ~p Approved . Vent Cap ~a11o~ Minimum 12" Above Final Grade Svi L i . Aa Above Pipe 4" Cast Iron To Final Grade Vent Pipe Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee I Pipe &-0 0 0 0 0 ~ "Aggregate Beneath Pipe Perforated Pipe Below 0 0 Coupling Terminating At Bottom Of System ~R opOSED LULLL (,Ir zkosr 30 frog 54?vr,C ,l DA K SOIL, T aco .57/4c PL M B~ Paz. a fla D1NT; f ,5T Pt-QT anJ CRO55 ~t>c r6 f ~ k, y /.Vjms SECTION QlA 64 L, OOOP IQ ; - X~ y9 y6 v +u 1206 . -i i ~ Ay7ERNA7"E .9REg ;K v r 3 cox y0 4: I ~p X ~ ~ 3 ~EU~,+df 1~ Fr x ' r , Gib f { y 3 5~ simwGle To E /of eR,-bitAL S Y~ 5 1 ~o~~ T~S>' SiTFS I X P1Po 7~e-GT- j ~lt UAi ~o~ ol= Ut~'T f~,~L , ~c~,►,~t 5~r~if z ~o f ~ t~ fr. s()a,p tiw y NEy s.~~. T 2 9it1, R,y ~v S; GNED 7, i' c~ A/ E S 1 Fresh Air Inlets And Observation Pipe ` r)D~ r~ol✓ ( - Approved . Vent Cap Minimum 12" Above Final Grade 36 Above Pipe 4" Cast Iron Vent Pipe ?o Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe ' Distribution o 0 0 0 o Tee Pipe ~ "Aggregate o Perforated Pipe Below ~ Beneath Pipe o Coupling Terminating At Bottom of System l U All TZ ~y CERTIFIED SURVEY MAP NW. 1/4-NE. 1/4 - SEC. 6, T29N, R 19W CO. MON. N 1/4 COR. SEC. 6 S 00- 11- 12 E 66 66.0' - - - fi6.5S 89 48-42 E 424.66' ~ O o tij o;L O 0 c!p r v- r~ ~o O ,D rn LOT- I O M 3.0 A t BEARING ARE ASSUMED 424.65' SOD° - 11' - 12~E ON THE S 89=57~-43 E WEST LINE OF THE NE i/4 75' 150 300' - IT LEGEND - - o r- r ALE IN FEET o 0 = NO. 6 (3/4x24") RE-BAR O LOT- 2 to SET, WEIGHING 1.5 LBS. E M 3 0 A PER. LIN. FOOT ^v •Q = FOUND 1" IRON PIPE :W N 3 424.65' V v N S 89°-57-43"E 8N rn (V 424.65 V) O f o` S 890- 57-43 E z I o 4 ~ Q r t` p LOT- 3 ro M 3.0 A. M I 424.65 THIS INSTRUMENT WAS DRAFTED BY AC,N. S 89'_57'43"' E JOB NO. 78-05 ~tS? 16y'^4 dl~yF a' 3 0 A4 ALL!"N C. o' ',s tT s 'S- 4L7 + TOWN RD, 16.5' Is 424.65' 66' S 89-53-16 W fi' ~t•'~ JJL. 1•'A..r~ / 179 suKVE~~x~ s clx'r~rI~.r►'x~t I, Allen C. Nyhagen, Registered Land Surveyor, hereby certify that in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and Section 5.4.2 of the St. Croix County Zoning Urdinance and under the direction of Dave Waldroff, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such survey correctly represents all exterior boundaries and the subdivision of the land surveyed and that this land is located in the NW 1/4 of the NE 1/4 of Section 6, T-29-N, Town of.St. Joseph, St. Croix County, Wisconsin, further described as followst Cormnencing at the N 1/4 corner of said Sec. 6; thence S 00-11-12 Z along the West line of the NE 1/4 of said Sec. 6, 60.00 feet; thence S d9-46-42 E, 16.50 feet to the Easterly RIW line of a `town Road and the point of j beginning of this description; thence continuing S 89-48-42 E, 424.66 feet; thence S 00-11-12 E, 1294.74 feet to the South line of the Nw 1/4 of trio NE 1/4 of said Sec. 6; thence S 69-53-16 w along said South line of the NW 1/4 of the NE 1/4 , 424.65 feet to the East R/W line of said Town Road; thence N 00-11-12 W, 129b.97 feet along said R/W line to the point of beginning. Above described parcel contAins 12.64 acres. t., .s 1~ .SJl M 4 ~ 0-- RTIr'IgATE OF T04N O''' ST, J'JSEP" I, Carloyn Barrette, being the duly elected, qualified and acting 'town Clerk of the Town of St. Joseph, do hereby certify that this Certified Survey Map has been approved by~t1e 'YPwn board of the T n of St. Joseph this day of 197 r Carloyn barrette, 'town Clerk, A11PROVAL OF THIS MINOR SU3DIV►S10I ' APPROVE DOES NC BUILDING;, y .1 A'"P.,CVAL FOk REFER TO 852_,~O VE13 1 5 1978 CJ0 .;NG CQMP,tENE~~SIVc PACKS M{Illt AND YpNING com a WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Section -.T-N, R _/1E (or) W, Township or Municipality 5 7 Lot No. , Block No. County 7- C Y4 Subdivision ame tf Owner's Name: C~ ?C5,6A9 0ir AIzSe ;0041 Mailing Address: TYPE OF OCCUPANCY: Residence N( No. of Bedrooms 3 Other. EFFLUENT DISPOSAL SYSTEM: NEW ~1( ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS IWY 3/ f U0 PERCOLATtbN TESTS Q R' k'.,.... '~-r y ...r... SOIL, Mf1P.SHEET !-~°~-SF3+E---•~ 4 PERCOLATION TESTS HOURS WATER IN TEST TIME DROP IN WATER LEVEL-, INCHES RATE TEST DEPTH CHARACTER OF SOIL SI NUM- INCHES THICKNESS IN INCHES NCEHOLE HOLE AFTER ' INTERVAL MIN/IN BER 1ST WETTED SWELLING' IN MINUTES PERIOD J PERIOD. 2 PERIOD 3 P_ PI f"Ecif1l 0 131 PE FE: re, P_ E, 1_0 Lk; SOIL BORING TESTS TEST TOTAL DEPTH DEPTH,TO GROUNDWATER, INCHES CHAR ACTER,OESOIL WITH THICKNESSJNCHES z~ NUMBER INCHES OBSERVED ESTIMATED HIGHEST <'•,-(DEPTH TO BEDROCK IF OBSERVED). _ 72. 3 -r- 5 la- S sr }rug' j N :.SL r: C' s' 7C: 3 7 r5; '31 PLAN VIEW (Locate percolationtestssoil bore holes and suitable soil areas.). r, Indicate on the plan the location and square feet of suit :ndca.c nu,:bzr :,f r "uar~ fta of c)SOrptiGf1 area '•e•;~ , r able areas. needed for building type and occupancy. !EC 1C w_!Q If llh [n~ ' ~'ot2 Indicate scale or distancei. Give horizontal and vertical reference points. Indicate slope. k' •,4! E ra L• _ ~ EL 17•E - i i - t:• -e (_i i- ~ ~r t V t l l j~ i i 6 -4~ ti^ 7 t l - t~ ! h~- 01 ¢ I, the undersigned, hereby certify that the soil tests reported on this form were made by me to accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are'correct to the best of my knowledge and belief. j 5 Name (print) Certification No-_ c7 Address ,j>- t i { I~); _ t` ; ( ~l { .,J .~1 ~y,t r•l~ C Name of installer if known CST Signature -