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HomeMy WebLinkAbout161-1093-95-000 ONO K-V " C7 r 0) O CD 3 fD v _ = N z CO w rn • m CD p 3 O O C !D ~ u N ICI a A d d N NO m N M v 7 W W p = ° W O Q ~ N SI7 N r ~ "'S O n N N c07 O W W c • 7 N N S C) Q7 C ~ 6 ° (J> C D a CD m a C m ° m 9 C ° W ° Q CD C: c o o n CD 0 ~ O ~ CO m CD Z CD 0 ch o r- o c ~ 0 0 0~ Z O O O 'p N o 7 _ -1 o. w C v w v cn o Z) G) D m _ x C ° Cl) N 3 R cy) o' CL .r 7 I Z N z W °z O > CD d O a CD CD CD CD C N N N C N .0 (a C (D CD W d z N -i !R ° Z O v Q A O 0 ~ I Cz W < cNO W CD M z 3 p O z o 3 m g N z CD W (D D 7 a 0 (D N C N - m -O pZ G a N CD N 7 l N A 7 d ~ n O A CL N ~ O b O S O (D a A ti p :3 "1 t-h N A ti 69 O ti Cn O (D as p i Parcel 161-1093-95-000 01/09/2006 10:41 AM PAGE 1 OF 1 Alt. Parcel 13.29.20.743 161 - VILLAGE OF NORTH 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 O - JOHNSON, CURTIS R & VICENTA CURTIS R & VICENTA JOHNSON 246 STATION CIR N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 246 STATION CIR N SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 04/38-ST CROIX STATION 1977 ST CROIX STATION LOT 19 VIL NH Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1122/313 WD 07/23/1997 851/307 07/23/1997 710/374 2005 SUMMARY Bill Fair Market Value: Assessed with: 108576 321,800 Valuations: Last Changed: 05/20/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 112,000 202,900 314,900 NO Totals for 2005: General Property 0.000 112,000 202,900 314,900 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 70,000 126,600 196,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 MMIMM AS BUILT SANITARY SYSTEM REPORT r 1 'F OWNER d,.~ ~ 1 SEC. 0 TZ N, R W ADDRESS- .L._ 2© ST. CROIX COUNTY WISCONSIN. cj SUBDIVISION LOT l LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I 2 f I di, a e 1111oth Arrow SCAL SEPTIC TANK(S) / MFGR. J,(,) i!~ 1 S K S CONCRETE_ X STEEL NO. of rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. --I~E`L NO. GALLONS Per Cycle TRENCHES NO. of width length area BED NO. of lines width IR length :5:<,' area ('0-30 dept to top o pipe 11 NUMBER OF SEEPAGE PITS Outsi e iameter total pit area AGGRE GATE H 57 Lr>__r z 1~ <O C K PERK RATE_ ~ AREA REQUIRED ~~1 AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause-of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH IS SXTEM. INSPECTOR. _~L DATED 3 - + PLUMBER ON JOBikk_" LICENSE NUMBER jc 2iHfll~11N 3SH303'I q0f NO u3glmld aalva uoloaasm, •H3SSlS SIHI IlDrIO'HHI Q3SOaSIQ 3g I0N CFMOHS S-II0 GKV SHSY3j, •ainTTe3 go asnea auT=ajT 03 IIo33a Xlana ahem TTTm Aiuno0 aqj palou sT ainTTeT IT 'aanamoH •uoT-4ezado ma-zSt a03 XITTTg2TT ou samnsse 41unco xioz0 -is •uoTjonajsuoo 3o iutod sTgj Ie Iaadsut c, - aTgTssod Zou ST IT 2Eq:l seaze -1011-30 a.ze alagl •sapo0 aAZ:jez-3sTUTmpV aaelS q:jTm aaueTTd"' alaTdmoa AT T IOU saop no0 SV0 -:IS Xq mal T q 3 uoijoadsuT aql :jamTvj0S=i III vzav Q3~3 n 31v-d %M} . 3IV932i J~, adid go do3 o1 g2dap sacs gz~?uaT glpTM sauTT jo •ou r eaz8 q:i2uaT gzpT,% 90 *ON SUOMI 'I'I3M )OK gldaQ aaAOD uo s3uTu zo •0I4 Zzals 3I o *uDaw (S)xqvs Oiia All al ps r oa-7y Ap, 03 agEaiplai f~~I I t `~t f t F f 'g I i- f i i w3Isl,S 30 laaa 001 NIHIIM ONIHII2i3A3 L"mOHS OZ'Z9H 90 sluamaaTnbai aaam of suoTsuamTp q saauulsia- M3IA Nvia 3ZIS 101 IO'I NOISIAIQ2•' ' 'NISNOOSIM `uNROO X_IOND 'IS ` ssauccly •0 f -d `H I '03S iiHswlol ` H32iC+t - - luoaau Nalsxs XXVIINVS Illaq Sv • ST. CROIX COUNTY WISCONSIN ZONING OFFICE ~dIMIf nunu■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 April 17, 1995 1 l Edina Realty Corporate Relocation Services 3 Z 2,o .7 7 1400 South Lilac Drive Minneapolis, MN 55416 Attn: Mary Brausen Dear Ms. Brausen: At your request, I have conducted an inspection of the septic system serving the David Arenson residence located at 246 Station Circle in the Village of North Hudson. This inspection was conducted on April 10, 1995. While conducting this inspection I obtained a water sample from the property and submitted it to Commercial Testing Laboratory for analysis. The results are enclosed. Our office has no records concerning the installation of this septic system. Accordingly, we do not know when the system was installed, the construction methods used, or the size of the system. The system appears to consist of a below grade, gravity fed drainfield which does not exhibit any outward signs of past failure or malfunctioning. However, there are several concerns that I have regarding this septic system. First, you have stated that the property has been vacant since July of 1994. I assume that the septic system has not been used since that date or if so, has received very little use. In trying to determine the condition of the system, a thorough evaluation would require that we observe the system while in operation. The system's lack of use would mask any apparent evidence that the system is not working properly. You have also stated that in the past the septic system has backed up into the structure it serves. Obviously the system was not able to adequately dispose of the waste water being generated from the property. Coupled with the somewhat advanced age of this system, I believe that the system was fairly close to failing when last used. As our office has no records to either confirm or deny these concerns, I cannot conclusively state that there are or will be problems associated with the above items, but I am very concerned with them. Based upon the above considerations I cannot warrant that this system will function properly when used on a daily basis. 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 the system. It is recommended that the system be pumped once every three years when in use. The prolonged life of this system may be dependent upon proper maintenance. Should you have any questions or concerns that I can clarify for you, please feel free to contact me. ince ely, mes K. Thompson Assistant Zoning Administrator cc: file COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 All 800 - 962 - 5227 FAX - 715 - 962 - 4030 CARMICHAEL BOAT' -11N, WT ""TEDG 4--10 uTEDt 3:00[ac~ cb 3At4Fl.E: Ke =c~Fe~~ aaucr 17 15 p s~ Fox e ti re s Bader i O 2 Pp 10 aF ND[vENOEhr , 9 b, PROFESSIONAL LABORATORY SERVICES SINCE 1952 'A Family Tradition Since 1955"" FROM THE DESK OF Mary Brausen A , z2L~ '4L lei,, t T, CN(JfX C,cSUNIY ~Faxn F9 WISCONSIN ZONING OFFICE r~0E 'IAA-t4T CEl 17E~ Y~ " r- 1101 Ctn']tl72F3S Road Hudson. M 54016-7710 yw (715) 386-4660 R+LyF"1'TC ] NSpEC'1'YVPt / T4ATEiP. ''EST P-.rQTJFBT FORM s&Aease C:c.li'y desired test (s) Fg I.`ty1l1.i t appropri ie fee ?•jit:.h appt"i Outsidw w~te-r 7..i.nec are often tu:t">1'l 3 0££ curing ri frl:c frh ma. > r o the home I-:er_•F~s~!-Jr. Ple+ise T1a}-e t T `?L;} *n(:rets, With thl,5 o.C.tice to inFure that ernty `1 (vr~r ~?ptic 550.00 -I t-ra f'~.' u' ?.~v}!?i i~1 :5 1 v r7itf i3 n n3C=.~T i.a t- to t: ~ t: 1 ~ . CJ Owner:~CLV).~ B~U~~s?~? _ f~°gtlp~Itc~ l fly t Ca~lt~c~ L~. /~tcr..2~b,>1 ~~~.oc,4'r►ati~ ..N ' ~j ~CrC24~✓. z~?t<;~1.~ 're 1 ephbhe N; ~Si?.t/., ►W ! ,1 F'__~z.~~1.L~ ~c'.~~~ti~J ._.._Z I P S~,~o( ~ Property adclx:ess (Fire N° & St z°GOt} ' : r -7-~-,-.-fir, ~+~a- r.;. f. ~ JV L1. __1f~4C!!~` Realty firm: a 2q Locl, Box Combo.- r~ Cl o., inr~ r)at _ L U T` I c r .,r e J S (I 7-/,) U G c d fv~~ . ,~l v05') AJ ~~o B t l a~l,Frt n BY„ PROFEkTX OWNP t *PROVIOE; A S1;C`1''CH 01'- HOUSE & SEP11C SYSTEM Oli R>=VEF?~E OF TN ~ FOF:I`t Water sainp.la tap l.ocat: i Qn ling cuzrently ~cc'.~i_ied? U 'xc= Ito If Vacant, date last ncco,f:,l.gwA Age of 1-4eptic system: Septic Lank last PuMped b} ~2-i- _zz-,,_/ Da t- W31yc-1 Mny of the fcl.lo tn'~ rbSc?r'p c.l ny OU S1^o-: C~I31h~ 1': i '.:111 h x,15?. 'l ON Sewage b<3c.!v4,1p i1,t~ Y t71.1l1Rc~E d).Srhar to 07 C±~~ Fcul. odor:. CJrrlt?Y" GQf` {?ntS Z Iat1 t4thAt y that the r.i~r~t.e ii>f~1-~~tic>n z~ }]lets and CT'U; to the bc,ct of riy knot41edgc . F . / mo't' FF1tt ? ;91 ~.d11 04,t~4.1995 19:1 P. 2 TUE 14:01 3 861502 F.01 FROM EUINA CORPORATE RELOCATION 04.04, 1995 13:46 N0, 22 P. 3 f FROIIi EOINA REALTY HUDSON WISCONSIN uMut v', . . ~RV!'I MFtIfN 4uN1 ve•.n+L t~+.~~vii~vi _ & SF,~+7~TC Sli g'1'Et°! Tlc>CRTTOIi y, °bwtai~IRS CfEtAi~'Ir~~MbF N.dUSF - ,7jc _ T4 8 CO~.PI, ~'F13 BY rmit on file? flY94 llNO s stejr. 3eSiyn &/or - - Y StYxvey . soil per SCs Sail fza ut~aul~d a s{~ I Qa ~ ~?r~ `~Ys pB low J,,pzox. 5iz Q vi+~~i:d t~Dosr~ L3FLe~suxi7ed r Y p X UBp$ Orrenc;ti ORL:Y 51~1L ~ Df~~'ldi,nq 2anh OCutt4ll PiPP 14,'.11 e.1C b8fsy,K~'Fb U£FICILI3CilfiS Ljp'tY,or `r'=I t: }1k. UW~11_ Oprop cRou e_~ Owca.ll n, beak' ClpuY~~rg'lo~t3____ ba C?La,Y_ir~ c~ y-;-iririg. 1., Asbxl?tion a rgc,:,~__,. _~w .•-~IN ~>;');C'I`UR5 ~a~:ST'Cli c3F' SYS'i"E , , I FROM EOINA CORPORATE RELOCATION 04,04,1995 13.45 NO,27 P. i °"A Fomlly Troditlon Si,ice I B69 Colpottttc Rclocatro►t Salllccs 1400 So111.11 111g m-ny 100 Snlle 200 Mimlrnpolls, 0.11nnrsole 65,116 (612) 691-6100 FAX (612) 691-0111 0 (W OUR FAX NUMBER IS (6121 5454709 SAX TRANSMITTAL SFIEET DATE: - TO: FAX # 0 ° (J FROM: TOTAL NUMBER 00 PAGES INCLUDING THIS SHEET PLEASE CALL (612) 591-6400 IF ALL PAGES ARE NOT RECEIVED. SPECIAL INSTRUCTIONS: &4 - ~1 EDINA REALTY INC. CORPORATE RELOCATION SI=RVICES FROM EDINA CORPORATE RELOCATION 04.04. 1995 1345 NO,22 P. 2 ZONiNd OFFICE , r. rF;oiX cxjijr4r" Cho, ERNMEw UrrrEF t i01 ~1~°cl~a*3E Road -7710 •"_r (715) 386-4680 E+VVTIC 1'NSPECTICS r VATtR TE 8T RrQUEST FORS Please specify desired test(s) 4 vot,it appropri ,ts fEe t•)ith appli,catic:t). Outside wate.c 1.1ne-t art often turned off during winter months, zak;ng to the home r.eces~,ery. Plvlse hake a~.rrange~nents With t1►is orrice to ingl4re that entry can 1,e ir~ L) WatCl (VOC''s)_ $185.00 septic $50.00 water (Nitr.ateV & Bacteria)_...,.,_45.00 (J vitrat. T & Bacteria rnt.t :•15.00 04'TIEr: -6-7R /?iC'tfR~'a ; `releph8he r}': 1; d} 3 A.7 r+• •r.r erz.~ e-A 3 6 ~ c -4,C< At Froperty a,ddz-esS (EiLQ N' & Street.} L 13 long Date. 67A C ct Realty fizm:,fg Lc e--% BOX CtlN o:_ Z Qo Lo I` 1qt ST' C,Rd r $'TgTd.J, yr G . o r rvo ~J<105 ,J t fln B~{_PROFEIZiY OWNER *PRO'VID£ A 5F.ETCH OF HOUSE & ,;E111:C SYSTEM 01; REVERSE OF T1436 FORMi water sampit ti,Ap .1„ocat:iort• _ is the dwelling currently Jenctj;ied? U s ~t(o If vacant, date last, Occu.Ed sd . w_, Age of septic system: SeptfC tank last pumped by: t?dCe: Previous Ownor,S Naze H;3,.,e 0sny of tats to11c~,.;irjq s Qe» nbso.rved; nY 014 Slow dr a iha?.1' i s trlrt h ~1tS~ - Xi Qs se-wage Qt~c:k-t1p Into Y o1a So,,jagc discharce r-,) ~t~Gl:.",~ s`)r-fnC:<.` vt _C=,~ i~!•W1 COY LIB Foul odor I ~ E '1.2t 1~'r-' f,~y ~'J~t!f"? ~',t1►'" Sf : cither Comments 'us r C rGi y than t.lzc~ ove iiitorc-anion is ::c: i?lets and t-T to 04; best of my )(nowledq~. n 4 06.0.1933 10.13 P' 2 FROM ! 591 6dii 3861502 - _ . • . A a {7•~i ST. CROIX COUNTY WISCONSIN - ZONING OFFICE nuunitnnnM "ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Post-it" Fax Note Z,~ 7671, Date _ k _ ~ Pages ~ To Fro April 4, 1995 Co./Dept. Co. W 1 Phone # Phone # , V lJ # Fax # Ms. Mary Brausen Fax l Edina Realty Corporate Relocation Services 1400 South Lilac Drive Minneapolis, Minnesota 55416 RE: Septic Inspection and Water Testing for House Located at 247 Station Circle North, Hudson, Wisconsin Dear Ms. Brausen: This date our office received a very old form in which you requested a septic inspection and water test. This is not an acceptable form due to the age of it. I have enclosed a new form for you to fill out and have the owner of the property sign where indicated. On the back of this form there is a box for the owner to draw a sketch of his house and how his septic system is set up adjacent to his house. We also need the complete legal description of this property filled out on this form. Thank you for your prompt attention to this matter. If you have any questions, please do not hesitate in contacting our office. Very sincerely Marilyn K Zai Adminis ative Secretary mz Enclosure FROM EDINR REALTY HUDSON WISCONSIN OFFICE 04, 09,10 NO, 1 P. 1 • YCfS L-14 UI d~ 1U IdA U dl IJI t I IUG~ ~ i iCl i 1U / W I +yug~u • i • T'tl F+rtlIT1 ✓ r•r E Co Ce. V 0. TRI-COUNTY SANITA Dept Phone S 507 5TH SIRE Fa: 391 - '-Ian p Fa_ M l~ . HUDSON, WI Sr 715-386-2130 fr To Whom It May Concern: •Y ~j A tvi 71 t `G This is in response to the letter from the St. Croix Cou~i~yf: ' 0af't;,~E , Zoning Office, concerning 246 Station lane. Specifically paragraph three. My company, Tri-County sanitation was contacted at the end of March about the above property. It was explained to me that the septic tank had back up in the house and I was hired to see what the problem was. I went to the property, located and dug the septic tank cover. When I opened the tank I noticed there was about one and a half inches of ice on top of the tank, there was ice coming out of the inlet pipe into the septic tank, and it looked like the exit was also frozen. I pumped the septic tank and thawed the pipes. It is my feeling that the reason the system froze is because of the high efficiency furnace, which seeps a small amount. of water at all times into the septic tank. Seeing that the home was empty all winter, the septic tank froze first. Than with the water seeping from the furnace, the exit and entry. After the entry line froze there was no place for the water to go but back. It also looked like someone had done some cleaning and that is when the noticeable back-up happened. It was explained to me that this property has been vacant since July of 1994. Prior to that time, my company pumped the septic tank every two years and at no time was there noticeable signs of the system failing. With the limited information the zoning office was given, I can see how they might have reached the conclusion that the system was failing. It should also be noted that the system has not been used for nine months, and giving any drain field that amount of time to "dry out" would be good for it. It should be understood there remains the possibility of hidden defects that are not noticeable from the surface or the septic tank. If the are any question about the work that was done please feel free to call. k erely, Ben Morgan " Tri-County Sanitation REPORT OF INSPECTION INVIVIVUAL SLWAGE SYSTt M Savi ' ta,I I/ Pc'Arni t S -tot-7 S e pt' c AME Township St. CAvi x Cuuvr-ty r,tic~; _ Sec-t~on_12,Lot # S(ibdtiv,i-e.i.cin. 1 PTIC. TANK gaeeons Number o6 eampantme.n,te - i ti tanee (AomWekX Buy-~din.g 120 4f ode H-i.ghwa,te.A 'UMPING CHAMBER Size- ga~kons,_ Pump Mana6ae-tuAe.A Model' Numb eA (o''_')ING TANK_ S4' ze. gakton6 NumbeA o6 CompaAtme.nt,~ PuMpvA__ - - Atahm System 'i.4 tavnce A0m: Wei-.Q_-' Buitd.Eng 126 ~sk~ipe Hi.ghwa-teA _ ;hSURPTIUN SITE Bed-.~c TA ench ~i tali ee ~Aiom: We_ef Bu' ding---~~ r20 s eope_ - Htighwa-te A aRSORPTION SITE DIMENSIONS Width o{, tAench At Restu,iAe.d aAea ~'~l --------fit Levi gth u6 each tone 6t Depth o6 Aoch bekaw tlUe NumbeA oA in ee Depth o_6 Aoc.k oveA A To'cck .te.ncl.th. o on.th -(i t! I'O hnVrriu nhnrln , D D,i~,tance between t~ne,6 f.t SEope (,6 tneneh_~--- -i.n. pol 100 At < o 4 «ti ui,-6 u)i,p t i (I pi a A e a ~At Type- a A Cove-A: Pape_A oA tAaw 1 1 D I MEy 'Ii4~NS: NumbeA o6 p,it6 GAaveE aAound p,it6 yeti nu Oua"A t c--TI-4 -a-mere-rt- ~,t Depth b o f ow i.n P.e_ t t 1 tftl a-b-A (77 cp AACa AecCu.<Aec~_ NS1 ECTEO By ~ TITLE s( PROVED ! 7 DATE_ t l i 19 8 ~'l I1 CTED DATE 19 8 '1 ASON FUR RE JE-CTION State and County State Permit # W Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. /OWNER OF PROPERTY Mailing Address: 1. / P° 74/< Son/ '702`;- j6,c-- ~~G~f` 1, /11 6z% B. LOCATION: .5f Section 12, TZj- N, R ZO E (or) W Lot# JCJ City Subdivision Name, nearest road, lake or landmark Blk# Village Me) Hci oPu S Township CiCt7 fK 5~~~lcf1~ C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family A Duplex No. of Bedrooms -No. of Persons 4,Z D. SEPTIC TANK CAPACITY 1000) Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concreted Poured-in-Place Steel Fiberglass Other (specify) New Installation XS X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate_ Total Absorb Area ❑o!~ sq. ft. New Ix Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)i No. of Trenches Seepage Bed: _X_Length Width Depth -3~ Tile depth (top) / 7 r No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land `fie l p ' 6~ , Distance from critical slope WATER SUPPLY: Private X 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 Tester, NAME iCc f6 er, 1' A:~ j" C.S.T. # -O 2.42 and other information obtained from 0 (owner/builder). Plumber's Signature A, MP/MPRSW# I614 Phone #381 Z.8 SC) 'Z 5Ad Plumber's Address Z_ 0 c. v 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. , 1 4~ ` i F i ^ d Y ~ 4 f E j i~ t I } 3 F 3 , , _ . .m., e. e e_,. a € ~.a.}-..~ } Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT SE ONLY Date of Application Fees Paid: State , 49-C) Co nt Permit Issued/Rejeeted (date) C/ -Issuing Agent Name Inspection Yes No State Valid# Date Rec'd 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 :H 115 Rev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 -j a£ £CFjV~ ro , to .,98 i LOCATION: /4, /4, Section ` ,T_N,R_~E (o0 W, Township or Municipality U~ 0 Lot No.Block No. County S ~E Subdivision Name Owner's/Buyers Name: AIJ Mailing Address: 70 j 4 ~ i `E~cJ r" y~ ~C>L7©~`~/~~ BIZ L1'~lti S r TYPE OF OCCUPANCY: Residence No. of Bedrooms 13 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS yaU'l4E l j&c) PERCOLATIIOlN TESTS*9a' 1Q f "o SOIL MAP SHEET NAME OF SOIL MAP UNIT IeO 'le-44(y PERCOLATION TESTS Zo/&~ 6ezb TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- 3~ A0 1A 'Z / P- P- L 3 (o P- 34,- e&-,P Ap 13.1 -k 36 P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- ma- 1 "Pe-A0 12- "'40, 1-5 26 X s' .21 'i /I -4,z B- 2 /(Jcwt__ T • v : 4-5, . & . 1- " OAP e.57 ~ ,~e~ B_ Vm"p -Ae -V . 4s 25. - f + e6 L > N . s. w y 40 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy 61 /3c~'Qo~/S•,Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. Ps 30 flt3 #CPW 4r 1-6AfT ~QPJ ' r ~ v 4- ~ f 1 T-Sr C 3 N ~,P~~1SdT~ .SST ~lEyttT/d~us• -3 19t lo (3-1 13►• ,13 Ae% (3° W is , 3/log,' (3I 36 ,~~i4TTL~j~ N 1, the undersigend, 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 holes are correct to the best of my knowledge and /belief. '4'W16117- Name (print) -lnh~ Certification No.,~~-6)-!W Address ieT 3 MZL5j01V 05 yl~/ Name of installer if known Copy A -Local Authority REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at site (2 )Date of Inspection Time of Inspection a , dress, cense NO. o s a ing Plumber 3 I(VS A' N CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BEN ermanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05j80, Signature of Inspector: U n 0 V, ~e M ~ r i P - - - - - A~Q FQ Uf tip, ~ I 0-1c, t O7- i 10 loT /Ro~U ~ExT ~a'F~v ~ywE r 4 ~M J