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HomeMy WebLinkAbout020-1148-30-000 C) t o O O C E .0 C) C$ CO1 c P, c ° c_ 3 I, , 7 (1 o 3 - Aw m 0 3 0 • m `ii) 3 p 0 n 'S N O w O O O ( O O N O O A N ! G W N m 3 m m � a m o n o c Q ^ VI Ul c m m (D m o ly °� cn 3 n o ° CS) 0 o 3 N 7 N p O p N N pp .N. W .= !V d m C) a o co 0. :aci:31:1 cn Z D S a o U) -< D � c co D a j �n y m G 01 cri co d 0: _ m N co N N 0 O .P 0 N ,•• • Q lV 9 z 0 0 0 ° O O O N O " Z 1 ° w 13 * * * . 1 v 3 ' c C) rye 0 a 3 cncnco - v>toto c Vq � _ cn Q � O g cn 1 0 -0 O O 0 Q = N c y 10 O� N m 'C O N !V O ca d1 co N O N 3 N 1 = 3 d 01 N co : . N Z N Z (D O O N Z o D n 0 Co Z O D O c � o y m y ' 1 CD to o -, I m m S. ki l c W N a a. �' CD a °- m n ' �I. 3 all '. -' -4 co Z = O O A Z N o w c N c _, 73 o a I n a 0 0 O. I Z N co CO 13 c oco M m co a co Z a 3 3 7J p • 0 r o : Z m co 3 I Q Z W v W f • . I g 1 • 1 X m a m e n o. * 2 - a 9 0 1 o `° = 3 w c (p N N c CD 3• o o 0. i . o a c ° o m N 01 3 N N n 7c y 0 3 � t- 0o y `` 1 ° -I, a a O I z ' O N mm I o kse °en I a Et K ti 0 0 (v K o dQ A 6) 0 ffl ..... O� O F I co `2 O p co O 0 b O n O O. ti 1 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division S anitary Permit No: INSPECTION REPORT 405054 0 GENERALINFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Reisdorf, Mike Hudson Township 020- 1148 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION / i gLEVA1ION DOA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic al-4j, l !/ �Ir 1 Benchmg1 e Dosin �' t -y / .2 (.' �, a if ��" ( C i t Alt. M . 4 , vt u ,,-� 't?,,,, f t ', r g I. ,j i 01. C7 Aeration Bldg. Sewer Holding pttinlet ` ?- ` C7" �I � F)It Outl TANK SETBACK INFORMATI N 5 ..--- F -7 , , ) f;/X. �`, `j `t' TANK TO P/L WELL DG. Vent to Air Intake --ROAD D >ti oJ 1 ri G _ N I 1 irz I Dt Qt Septic E \J?1I /�'� -SL, I l ) / _ • . ' Header /Map/ a� C�. T 9 . `> Aeration Dist. Pipe Dosing \ �(/,?('ry' M a.. 1 � 3. r l =7 q _ _ ` l 3 , ' _ _ f i1 4 C 11(;i`rn JJ - K. - 'A V V /0- 2 • 4 Holding Bot. System l � � c. ` � � _ ii, 5 _\ L qfi ,� . Final Grade ; _ q &- PUMP /SIPHON INFORMATION �{', ' ( "tip - ti' 5) 5 w* /q1 67 Manufacturer GPM d St Cover I .S - 1 `t- — k e l // 4- Model . mber TDH'Lift Frictio ass !System Head TDH Ft Forcemain - gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM {: --; ( ; , 1 -- „,i , +I 1 . ;, t< ' BED/TRENCH Width ) Length </ / No Of Trend PIT DIMS Di� IONS No. Of Pits Inside Liquid D pth DIMENSIONS SETBACK SYSTEM TO P/LI BLDG WELL! 'LAKE/STREAM CHAMBER OR p Manyfac rer: INFORMATION g Ty j . Of System: / 1 UNITS Model Number: ) ` DISTRIBUTION SYSTEM . Lc.�` ,.C�. Header/Manifold Distribution J t wt Y; 6 ''J .--4- l �_____ x Hole Size x Hole Spacing Vent to Air Intake d ! Length / ) • 4 . d �( t h1�„" ., - C > 4-c. 6 16i Length Dia `�' Lengt (U '0 Dia pacing 14) SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center > Bed/Trench Edges Topsoil °, Yes ,'I No Yes , , No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5 it ((. / C .-) Inspection #2: / / Location: 648 Countryside Circle Hudson, WI 54016 (NE 1/4 NE 1/4 33 T29N R19W) Country Side Estates Lot 5 Parcel No: 33.29.19.791 1.) Alt BM Description = 0 ti VU j y t _ �cLt - ;{ 2.) Bldg sewer length = IC) --i7 _ amount of cover = y , J - ^ ^ ,,-,„2i. ,- -}� .)' - -_ _, - /, / � 6�5`��f Use other de for additional information.) No I -L 1 "' , ` __ t - : i f l , W , .L_ , / - 2 Date Insepctor's S/ nature Cert. No. SBD -6710 (R.3197) ;:\ r 1‘ 1\ 9 1 41 - OA 2 5: • v I ' 7 -1 , 4,-otcP ot (,\ P\ \ 3 r\ I \ - v r r , Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ) 1- , l r of NMseonsin Madison, WI 53707 - 7162 Site Address n /� Department of Commerce 1,-7 -d Z_ O / 7' CY 8 bun ij.A 1 d t.l ( Sanitary Permit Application Permit N r In accord with Comm 83.21, Wis. Adm. Code, personal information you .rovidRC��r ;ice•,' - Revision > �� o 6-1/ may be used for secondary purposes Privacy Law, s15.04(1)(ma C L• C 1 t� I. Application Information - Please Print All Information State P . . I.D. Number I•. , e ' I i• rcel berg y' Property Owner's N ; L / / S T. _ —0Z16 / `�/ � / ,S • ��75,rb - CROIX Co ■ Od0 - // cl� 3 Property Owner's Mailing / / / OFFIC_Prope Location l � GG Ill L 044 a rTr S I o / t%72,>.. � / i4 J�%',4 ; SJ 3 T 2/N, i�/ G City, State Zip Code Phone Number Lot umber — Block Nfunber i9 Subdivision Name Vl ,)M N ber /4 (A}i 5 VO/4 7/ -r- 5r6- (1 /74€4 4- II. Type of Building (check all that apply) J ❑Ctry r 2 Family Dwelling - Number of Bedrooms A C S ( T' ❑Village ❑ Public /Commercial - Describe Use J h ip ❑ State Owned Nearest Road Se -1 -- R ��a 3x (01 J/ 1 / O4aon bv -r vA_ a„2 /�- ' . J,r. ,. 1 III. Type of Permit: (Check only one box on line A (n scheme for internal use). Complete linvB applicable) A. ❑ Re lacement of 6 ❑ Addition to For County use cement System 3 1 0 ep ceme Sy Replacement Tank Only Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued 1:V. of Permit: (Check all that apply)(numbering scheme is for internal use) 4 6 olr - Pressurized In- Ground ✓ 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: 2 S ir, eg i v1 -Ji+v, n L, g (`? 'l 3a4 ►� /E7S/k nz 3/ -I d1 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation System Elevation co G Required / Proposed Rate(Ga1s./Days /Sq.F . (Min./Inch) Elevation i�. — 6 6 A a 9 7:( VI. Tank Info Capacity in Total Number Manufacture Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks �Z ' - A II Concrete Constructed Glass New g 1104' Tanks Ttan Tanks / / i& / VL Septic or Holding Tank / f X - /clued / Ce/e i s ro_. Dosing Chamber VII. Responsibility Statement- I, the undersigned -. ,.. responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's9'�ture MP/MPRS Number Business Phone Number J y� Plumber's Address (Street, City, Sta ji - i . e) / /Oo 8 /9 /; Lei �'/,/e.Gt/ /Z) S >/t 7 VIIVounty/Departnlent Use Only Sanitary Permit Fee (includes Groundwater Date Issued • . :ent Signa (No Stamps) VApproved ❑Disapproved Surchar Fee) /� ❑ Owner Given Initial Adverse 2 ZS' . 67/o Determination IX. Conditions of Ap �roval/Reas for Disapproval � G� r1 2 o� n .a. / ‘1-11 z= Ff -vc.o f 1 .. -10 s s/e� V .1g-ii > R viz /Ve i caltorkd u.�u. 41F Vs 5 / '1 4i 511 0 4 /Zo e 5�(T .! «. - 0 f- - -- , funA) ke rr PGr l en . - rs . Attach come Plain to the County only) for the system on Pa' not less than 81/2 x 11 Inches Iq sae ` SBD -6398 (R. 05/01) , , p OT PLAN PROJECT Mike tRisdorf j A , s ° , 648 Countryside Circle Hudson Wi 54016 NE 1/4 SE 1 /4S 33 /T 4 /R 19 w TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 / DATE /25/02 BEDROOM 3 CONVENTIONAL XXX IN- OU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 688 # of chambers 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filt r Zabel A -100 ❑ BOREHOLE WELL *H.R.P. Same as Benchmark op nt 2 SYSTEM ELEVATION 92.5/91.5 E1/'Q���cQ --�" 7 >6 Standar I n ltra � of Cov r ach amber— Plans Designed Using _ --- with 31 1 ft2 �f Area Conventional Powts 6' Long Manual Version 2.0 Grade at System Elevation Alt. BM Tgp of Basketball Slab @ 97.8' 200' Country Property Line Side 0' Circle 10 ' Vents 7% B : -2 Slope )r � '��, • , 1 2 -3' X 69' cells with iAO >3' Spacing / Alt A valve is to0e 70' CV , :.M. installed * 10' 11 4—Vent a 25' Old System has failed a t 0 1 30' 10 ' I /�( r-ha - u, _ - sits 1, / �., 30, �h��t -g, A 6 10' Existing 3 Bedroom 1 25' o . Existing House well 1000 gallons V . • 4P4-'t(i/ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 7i Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code / Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must COuntY 4 O /JC include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 00 0- / - ,3o---1--a) . Please print all information. 1p ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). kin 1.44.2i (/ Property Owner Property Location �� /< / i A - - ra O f - Govt. Lot �J /jam 1/4S 1/4 S 3 3 T ,2 N R/f E (orJ W / Property Owner's Mailing Address Lot # Block # S,t. Name or CSM# . f � � `� e -, f 4e. 7 s /c/.o /� �v > --S 64 ,� S/ v ✓ City State Code Phone Number ❑ City ❑ Village �Ti Nearest Road / s�3V �` L. ._ ) -514/ a ( l, - >, / .. _.IL i .,di. / a. L. Mew Construction Ussidential / Number of bedrooms 3 Code derived design flow rate y-. GPD Replacement ❑ Public or mmerdal - Describe: Parent material 6LCJ7 Gt: Flood Plain elevation if applicable S J r� ft. General comments .5 4.,...., e /�vL'C'i�'' -�'J� f S , ,..5" RECEIVED and recommendations: O� �ck t _ 3t,//p-L J 6 1c, <_Q_c.� APR 2 6 2002 ('�� ST. CROIX COUNTY / I Boring # 0 Bo � / ZONING OFFICE .30 - Pit Ground surface elev. f ? / ft. Depth to limiting factor < �C In Sal t cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 / z. - ,y/6 — x/ �„-. 7 , y (-g - - 3 , ../ 2 ,,, y./ s o , � /v/ft tw 2, m _ i a. 'I .' f (.5 N 'Tis , ie C4144ti," -- " e 2 Boring # I! Boring 9 Pit Ground surface elev. / / t ® ft. Depth to limiting factor / L 0 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ,- 2• 3l / ,s G ot4,., / S - z 2, 20- A •►.....- // ( e J 1r%iKe .S IMM 1 7 ralf=111101111111111111111111111 '-64 wasTalimm �'�riil� � " .- f ( � * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 m ' Effluent # 2 = BOD < 30 mg/L and TSS < 30 mg/L CST -/l / 1.--- e Number � Z 7 2 �Lli✓ / � Evaluation Conducted Telephone Number 7 /P J / ./ 2 ,.e A/ �?�� G //i - sra` 2 72:7s -02._ 76-- .y6- ' s4 • Property Owner Parcel ID # Page 2 of 3 Boring # ❑ Boring J - 1 n pit Ground surface elev. q 6 % 0 ft. Depth to limiting factor / 1 V in. I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color , Gr. Sz. Sh. *Eff#1 'Eff#2 ) — /- .e, , , 14 ------. X/ r73frx; /— /71//ze () , ,5 . i r 31 , 9--/71 '- _s 0_5 1,7/ /1;/,,o' /w , )/,„z 4, qtai - 5iilly . /10 I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑ Boring 1 1 Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L i provider The Department of Commerce is an equal opportunity service and employer. ployer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.6/00) r • 1 Soil Test Plot Plan ProjeCt Name Mike Risdorf i � ,; 1 S ha i Address , _ 648 Countryside Circle , '� Hudson Wi 54016 "1 M #226900 Lot 5 Subdivision Date 4/25/02 NE 1/4 SE 1/4S 33 T 29 N /R19 W Township Hudson ID Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 92.5/91.5 *HRpSame as Benchmark Alt. BM Top of Basketball Slab @ 97.8' 200' Country Property Line Side 09 Circle 0 7% B -3 B -2 97 35, Slope x .0 • IW °' B -1 Alt. � ' i � :.M. ,* 10' :‘Bki a 1 —0 Vent r 5' Old System has failed rE 30' 10' 30' ■ +y 10' Existing 3 Bedroom /Existing House ° well 1000 g allons y • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM y� G � c Owner/Buyer i� //t' � Mailing Address E 7 F 6 6r y / e.ry ,(/�.c Property Address X� / / (Verification r i ed from Planning Department for new construction) City /State Parcel Identification Number rJd. 0 // 'f 3° — 0e) Gv� LEGAL DESCRIPTION Property Location/_ i/4, '/4, Sec. 3 3 , T Z7 N -R Are Town of Subdivision G D Si / �// , Lot # • Certified Survey Map # , Volume , Page # Warranty Deed # 311a Z/ ( � /i 0 /8L1) , Volume (a/ , Page # / & 2 Spec house ❑ y Lot lines identifiably —yes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St Croix County Zoning Office within 30 days of the t year ira; j� date. - ` iL.� SI ` TURE OF PLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above,i, virtue of a w • ty deed recorded in Register of Deeds Office. ( /� SI ATURE OF • ' ' L C DATE * * * * ** Any information that is mis -re • ented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I hav: inspected the septic tank presently serving the/ 0/; / resid nce located at: 0:' %, �E ; , Section 47, TZ7N, R/7 W, Town of . Upon inspection, I certify / that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. , Last time serviced: 5 2 - GP2... Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete X Steel Other Manufacturer: (If known) : Lc��3 Age of Ta.k (If known): /ff -cz5 (Signature) (Name) Please print (Title) (License Number) • Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the bes of my knowledge will conform to the requirements of ILHR 83, Wis /Adm. Code (except for inspection opening over outlet baffle). Nam 4 �/ Name Signatur- na - MP MP RS� g / • • Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 z _ 31 q z ' ti2e csv-- /o- - - 36 ` c6 86 Shaun Bird #226900 { DOCUMENT NO. STATE OAR OF WISCONSIN FORM 2 -111112 THia SPACE RESERVED FUR RECORDING DATA WARRANTY DEED 396213 'J4i mr,o,,,ifi REGISTERS OFFICE ,i = C ST. CROIX CO., WIS, Cr. E CT Nk Rec'ct. for Racal! this lfth • u of Sej CA.D. 19__84 Conveys and warrants to _a • C a e! tt i S o� R f nya 1: s I l .) —I. 1RP i ( n by h r , D quo � ..1 � r7' �/ • tiMNter of • • RETURN TO the following described real estate in _ S L r C v 0% County, State of Wisconsin: Tax Parcel No: Lo G Co ,I.si ry S' 0-. Vii1c* , ; `4. Tow,, o; it cJ s „,v4eel -fo ser -.e, 4 e_l r v4' Prolec_Le_ Covet.l r'L 0.N to reSTr'Alonii r „� e5er zrekritts n.141) � ic StxcCec.Sw& i 4;41, ie iA o ncl 9 'L ri }4 I'o 0..Se `tZ.t LoC0.42t ea) Lois Cp. ! c..01 9 Q. S C s�,� Qr�r�d were- tk L ; � cc�le RKe. • CI.Nq cV"AntiAc� S A i/V)J�e- ri5kt o 41„e s d€r 4Y� Qn4;r� pomp -le the grc"^ `) 04-4 'hei 1r S tt cceS.SoRS ; `t, '� a5 owyleRS o� 161 S This 15No T homestead property. * TT Ito (snot) ,C�►. Exception to Warranties: Gated this /0 %ilk day of • (SEAL) / -'.... ► . t _' (SEAL) • • ICE. N N S_ ,4 E RZNk (SEAL) (SEAL) °' c) � z C 3 9 7 '93 4 ..... ?47. 93` 14 0 ry \ CAI 0 Z N89 °44'16 "W 208.62' W N 4 ro .A o N r m Z 100••" zn 0 , 5 N89 °• • •'I: W m zv N 0 dc • , • m N 0 v \4"' ° 0 o m 0 (4'1 ;x' 110-00' v \ \ \ m m In a' % / n8a a , � � N w �Im IV f at f. x rn N o ��� �- 262.67' °1 �c im w A 10 00 77.01 188.66 'm v ` 4 c 1 1 P - 0 ' ' ,N89 ° 44'16'W 372.67' z W =C pp S 1 a it •ta C7 ' o m is._ 1 < L n iG) Im N AI S SIVO . ) ' N .4 Im N 0 0 � ! � ` I + dip � 1 j� 3 w N86 11 1.24 „ cn u) z ti 0 o i ?Aria- 1L�L` co alp 9 5\\ P ‘ iN 6a M., _ a 1 ""lt o till c)._ I ml r' o w �'° 0 `• N ti •� r O 4 C - --- -- 1 cb 41 b y� • ' • m d o'' N N m I C In v � -o a 1 r- 1 _, D w Nz ` m m Z t3 !TI - o r-.4_ s' v Im i r v) -o R o � ��, = :1)("tit. .w in y v z ry jC m g 1G) l< 276.81. 100.19'' ' N ig 332.57 RECORDED 889 ° 29'50 "E 377.00' I Aninc AS SA4°Ra"w i �� 0 Co: 0 n N O 3 m C d eD • • !D CD 7 (D 0 0 13 p9 • n d N O N O p CD N 0 O W O ° CCD C W 0 ` p• c .« o 01 y 3 c rn iv (--i CD 3 3 a c� co ° a a c� 0 p Q ' 1 y CO p lAl C p y A Z 0 y V O i j ny N Q 0 7 O y s O j co G3 O ° o <D U CD 1 (D n N 7 O la °i 3 ° g y °� n o- a °, o Si c ° c co C �� (n Z N A a ° c c co a �i 0 :00.°)3- c a a ° w a • • • m W a D o cc" y d co rn w 0 Co m c 0 m • { m ° o ° o - I o a o n o e y N N 0 A A y l z i t cr _ I _ z 0 0 0 0 O O OC 0 lV• Z G ltV a c f fA CA v c f/! +- c •v w Q -0 CI C7 c.n v 0 C7 CI cn o 7 ° S d y ° • • 3 m c 3 'c I co 1 n 1 co ET ` �1 0 1 1 m 1 -.72) > o D CO o O M m o m m cD m , , ' y y Po. c • 0) N I p N • c � �' n a ° a • 1 °- 3 a 3 Z m m co -i N O p N p A? n co a C C — A a 1 a 1 • 0 R I o I '', Z -I w 1 CO 1 00 m cNO w a CD • a MI Z 3 -g 3 +' 0 r: Z -> I 3 3 m I N (0 \ y I :it: w c (D Io 7. a j v c a • o f O 0 S o p 7 T co y T (p (D 0 N C 3 o N C j • �� 0 o a ° °. 3 0 a • 3 ° ° o m iii o y • I --9") 3 y (/1 CO 1 : 3 I N y CO CD a y a c ` < o -' (D A 7 - 3 J a x v fD co 3 p W - O N ti I = " • N 1 �c I ° I I El • I o I 1.... < I cD D ro a • A • 1 Iv A n1 C ti 70 i 1: - k il ' ,... t)( o ,___\ rptl o t 4 • V' 1-+ G nu, 1 r rn tN � � On w 1 Ocl 00 1 Z (4 v h At. w w co cn P Form- ST C- 104 414p. ptc. AS BUILT SANITARY SYSTEM REPORT etiprn 4u 1 i 4 e J. j � O £ ° TOWNSHIP / s 4 SEC. ,33 T 2f N -R /7 W S Lc Ja � Z:Dy�� 84 OF IDRESS 14 / / / i ✓L ST. CROIX COUNTY, WISCONSIN e SUBDIVISION Coc 911ey side, la/dJOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 0 , t r^ z 1 Q C � • 2 1 1 t 1 1 ' 1 1 � 1 1 r r 6 tht. INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used r .1,R /' Elevation of vertical reference point: q Proposed slope at site: �v SEPTIC TANK: Manufacturer: ti./ Co R Liquid Capacity: ! 2 0 U ' Number of rings used; 3 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearl:st Road: Front,OSide,O Rear, O Z. p 0 feet prom nearest property line : Front,O Side,ar, O /r z feet Number of feet from: well , building: /2-- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE { N PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufart•_:rer: _ Alarm Switch Tyne: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number o.f• feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 2c4— JP d Trench:__ Width: L r U 4,/ G LI Length: Number of Lines: 1 Area Built: q 442 Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Qar,O Ft. CO Number of feet from well: Number of feet from building: 2 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, °Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Danufacturer: Inspector: ( f Dated: 0 ( - I Plumber on job: 24 C) License Number: S / � ' D 2 7 4 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 ♦ BUREAU OF PLUMBING MADISON, WI 53707 ,�(� gcONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number (If assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE: y6 V Ki.chaet ReZsdoni 8786 Indah.e Ave. S., Cottage Gnove, MN $'..- /a '4' /Dares BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.: NE SE, Sec.33, T29N- R19W,Loi #5,CounJcy&Lde Vittage, Town. o6 1-1ud6on Name of Plumber MP /MPRSW No County - . Sanitary Permit Number: Stephen Aaby 5184 St. Cnoix 54901 SEPTIC TANK /HOLDING TANK: _ MANUFACTURER LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET E "EV WARNING LABEL PLOROD CK G V : �,� lad ���.5 ��� PRfJV .ED II YES ❑NO VJ7ES O BEDDING: VENT DIA., VENT MOTL.. HIGH WATER ' NUMBER OF ROAD: PR ERTY WELL: BUILDING: VNT TO ALARM: FEET FROM Li - ! �� AIR / L' OYES ONO _ OYES NO NEAREST tC�C L 1 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED PROVIDED: El YES ONO • , LI VES ONO , OYES ONO `GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER:OF PROPERTY WELL. 'BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM ' LINE: AIR INLET: PUMP ON AND OFF) OYES ❑NO NEAREST = - SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGYTha•- 'DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until F ORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: ...kkk... 'WIDTH LENGTH. NO OF DISTR. PIPE SPACING. Calk-la INSIDE DIA #PITS LIQUID ME I S TRENCHES: f / MATERIAL' PIT DEPTH lV� l'.. GRAVEIL, 7 DE FILL DEP H DIS PIPE (DISTR. PIPE DISTR. PIPE MATERIAL: NO. R NUMBER OF • 'PROPERTY WELL BUILDING VENT TO FRESH BEL PIPES A B E�OVER. E V. INLET EL V. PIP LINE AIR INLET: 'I-ICI I t)77 n � ,.2..7 Z � FEET FROM NEAREST . f MO D S STEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. El YES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER EDGES. OYES ONO OYES 0 N OYES ENO PRESSURIZED DISTRIBUTION SYSTEM: ,WIDTH: LENGTH: TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: S B a 8' S MANIFOLD PUP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. 1E N ELEV.: EL : DIA ELEV. PIPES DIA.: b1 JON ` HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. 'COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED 2t °I: . A�k f ,° PLANS , ' OYES ONO • , OYES ONO COMMENTS: 'PERMANENT MARKERS: 'OBSERVATION WELLS: 'NUMBER OF PROPERTY WELL: BUILDING: FEET LINE ! I3 OYES ONO rO OYES LINO NEAiE ° — O r � t � ftt LINO O �T J ��� ._16 , .2 S op, 9: ,,,:, SS r "---- r — L:; ---,, tr 1 a L l- Sketch System on _...... 0 -' - - ' - fn cott i le for audit. Reverse Side. ...,- / ♦ .....`. ....� -_.►� (<''''':-..--.1 '. ,.: .. DILHR SBD 6710 (R. 01/82) r "t. , r c ` , - WISCDnSII, APPLICATION FOR SANITARY PERMIT . LJ DILHR STcRAr COUNTY - DEPRTTEr1T OF (PLB 67) R UNIFORM SANITARY PERMIT # InDUSTRV, LRBOR 6 HUTRrl RELRTIOr1S /] y� / 0 ^ — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILI NG ADDRESS 7, C 4 RE L R,■E i sdos- F - P19.5" IN d ghL Mehl. .5 Cancypc F it• u 4 NA PROPERTY LOCATION &Me': /- l Aa 1 /4SE 1/4, S 3 3 , - 01 N, R /? IS (or) TOWN OF: ) 44d' - LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK 'STATE PL. D. NUMBER S C,(ZM7/Ity SId/F ii/ a97 4 TYPE OF BUILDING OR USE SERVED E.PJ ''('• 6 — Y, —1'C X 1 or 2 Family Number of Bedrooms: 3 Public (Specify): / 10/ THIS PERMIT IS FOR A: Q New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity led0 / Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: In fd,, , sr , ERK Pit & Gf�St 7h G IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In - Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): C6'? 0 SS ? 1. / cc ? PO 6 0 IX Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP /MPRSW No.: Phone Number: SIXiMIt ii. L flz4y X Gli--G7 $ / <9 V ,kt f8► 2 07 Plumber' Address: Name of Designer: u ,..�v1ziA 14. _ 5''Ya A sTj,Asn L Ng 1 • COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: ,y� D ate: El Disapproved J/ e/ � n x / 6 Y W �" / p- D CI Owner Given Initial ¢ r/ (�� ( p + / O A Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR - SBD - 6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber i INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. • wR APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) ul the property being developed. Any inadequacies will only result in delays of the permit issuanco, . Should this development be intended for resale by owner /contractor,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property /C 1- , '4 \� 4.74.5pcle awe / / ! Q E /r e SE Location of Property S Section 3 3 , T - R � W Township a ► S Ma1441 Mdreski Subdivision --Nam" C() r ajf- � l� C * i 0,,G2 J � - -- hot Number cJ Previous Owner of Property t rckn; C i y Total Size of Parcel , f/3 6-e r e Date Parcel was Created S /97 7 2 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Y No Volume 4; n, and Page Number as recorded with the Register ui Deeds • • INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) eehti.by that ate atatementd on -thin ionm ane -t'tue to the beat ob my Iota) Fznowtedge; that 1 (we) am lane) the ownen(a) o6 the pnopeAty deaeh.i.bed in this JLr oama ..on Loam, by viAtue o6 a waAnanty deed neeonded in the O44.ice o6 the County Reg.i,#we o6 Deeds ass Document No. 7 ; and that I (we) pneeentty own the pnopoaed a-c to l ion the sewage • • pouct aya-tem (on I (we) have obtained an eadement, to nun with the above de c.'li.bed pnopehty, tion the con tAucti.on oli said system, and the Game has been duty neconded in the O6 Lce o the Count4 Regdeten of Deeds, as Document No. 140/14E_ ) . &Vq4 :e- . __e-e- 44414 e ? b/44 ( 7 / ./ i‘St'n,J bcde DOCUMENT NO. STATE BAR OF WISCONSINI— FORM' 13 1 SATISFACTION OF MORTGAGE i l VaL t ,.� r Y � ` clot n THIS SPACE RESERVED FOR RECOROING ,DATA 3891 AJI 4 l}M./[ Their / de rsigned hereby certify, that the mortgage executed by 7 " //(7 AEL. �\ "� T - - OFFICE � ' .C DOR1 : fa —_ iR , L 4�/j C1� f5 /, /) (1R.F . C � , >ar'( „ V� i � �� _ _�__ kec° 3 : for ' �a. ->rc�f ik la to _ /`'Anl( 5 7 < Ga1I� —__ — -- :; 10 Nov A.1 ✓. 19.•,—, dated the y day of. �\ /! /! 4 A.D., 19 and f ?D` 1 :4c A ♦ ' 1 recorded in the office of the Register of Deeds of t5T CAI& County i State of Wisconsin, on the ra' % day of _. 1./1.1(. A.D., R� a! ps • 19 at J( 4 ' o'clock A. M., // in Volume 6/49 of Mortgages, on j page / Document No, 3860 hL' ., is fully paid and satisfied and that RETUR TO j the undersigned is the owner of the above described mortgage and has the right to satisfy i F 7 ! the same. ;r fr x I c! • t . I p4 . - • • At° Executed at __:` Vi// -- ""` _ _:' ay of , 19. �� • j. , SIGNED AND SEALED IN PRESENCE OF X t) 1 i l''' . j i __,,,,.///' E.P,..siz)r:,_5 . W. . igraz)F4.1 , , 4.,: . .. 1 , _ ___. " ^ 1 :1 4 + - -:7 -- 1111 ft Signatures of _ . _ __ __ _. __n _ 31 7 — ,,r j 4i, i s �1 i authenticated this ___ ...- ___ _.day of__ .__._,_._________ ___._-__ ____.____.�.- , I9_ _ . .p , - ' Title: Member State Liar of Wisconsin or Other Pasty i l4 f Authorized under Sec. 706.06 viz. ____ _:_..- _,.+,, tc STATE OF WISCONSIN i # r,""`� y s s. j _ rev 1 Personally came bef m e, this � __�_ sr.__ ._�_. da , �. s" �..__._. __,__.. _ Count ��Q1� : __ day of _�____ N�V. a 1Q :A°sb lQ1C1 i the above named __.__ .__1 a 7r► � 3_A __tq.. . _ k3, _._ __�_�___ 'I 1 to tee known to be the person _ who executed the foregoing instrument and acknowled • ..d the same. { ' 1 t. This Instrument was drafted by _ b„.‘ . : 2_74,...1.",... •_ ,,1 1 t /.r/ / . i • r1 c + ' ` if [X w \-.--I _ I L 1l. LSeL Notary Put xxc r � a .4t4 Yr T. � _ _ �. _ � 41!aurit' ) Y* •; r t The use of witnesses is optional. My Commission (Exp'i( 1•(1ej - `'_8. _ # = 1 Names of persons signing in any capacity should be typed or printed below thr rr sipnptrnres. — ! ,, li SATISFACTION OF MORTGAGE —STATE BAR OF WISCONSIN, FORM NO 13 — 1971 w". rare. a BINDERY1 , MILWAUI EB ll ' r ■--i J- r S '1' C - 10 5 r" J• rl SEPTIC TANK MAINTENANCE AGREEMENT '-i 0 . • St. Croix County o 0 W N E R / li UYla e -- __ pi ROUTE/BOX NUMBER ���� // t � _— ��l ire Nuwb4r_ —. (ei PROPERTY 1.UL'A'1'ION; /VE =i„ j ,._'a, Sectiun '1 ' a9 N, R_! /.___W ' O W L f — / 6 : 4 9 . __-____-__—._- , S t . Croix County, Subdivision &W/'JTie G �lQiE - ._ -- -, Lot number . improper use 'and maintenance ul your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years ur sootier, it needed, by a licensed se3Lic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage In the waste disposal system. St. Croix County residents may be eligible to receive :a grant for a maxl.mum of 60% u1 the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber Of a licensed pumper veri- fying that (1) the u11 wasLewater disposal system is in proper operating condition and (2) alter inspection and pumping (if nec- essary), the septic tank is less than 1/3 lull of sludge and scum. Certification form will be sent approximately 30 days prior to ri three year expiration. o tel 1 /WE, the undersigned, have read the above requirements and agree v, to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart ro meat of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkce within 30 days ol.' the three year expiration date. AO SICNLI) -- i, �/ / / /ice.. ___ —_-_4./...0 _________111 i St. C county Zoning Ultice P.O. j ox 9t., Hammond, Wf 54015 715 -7 -2239 or 715 - 425 -8363 �t Sign, date and reluiri Lo ul���v.: .. ress. h1 8 ¶A,ENToF 1 TBI , • REPORT ON OIL BORINGS AND , AND • • PERCOLATION TESTS (115) 10 ` '� , l. HUMAN RELAT \ / MAD Q� , 37 (H63.09(1) & Chapter 145.045) lO4 , '83 LOCATION: SECTION: TOWNSHIP /MI : LOT NO.: BLK. NO.: SUBDI t'LlhN N • 'r- NE 1% S1% 33 /T 29N/R 19E4) W Hudson Township 5 - Coun , ide llag- COUNTY: O6 /BUYER'S NAME: MAILING ADDRESS: 1 j St. Croix Michael Reisdor�f 8785 Indahl Ave. S. Cottage Grove, Mn. ° ' 4 7 ' 4 #M "� USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 N/A ®New ❑Replace 6/16/83 N/A RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) © S ❑U ©S ❑U CAS ❑U ❑ S ©U ❑ S ©U Conventional Bed 24'x40' If Percolation Tests are NOT required DESIGN RATE: under s.H63.09(5)(b), indicate: Class 2 If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: N/A 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 - 1 96 100.6 None >96 14,B1s1; 16, Bn 1 s; 66, Bn s $ gr B - 2 96 100.6 None > 96 12, Blsl; 18 Bn 1 s; 66, Bn s & gr B - 3 102 100.1 None X102 13, Blsl; 17, Bn 1 s; 72, Bn s & gr • B. 4 96 98.1 None > 96 15, B1 sl; 14, Bn 1 s; 49, Bn s; 18, Bn s & gr B - 5 102 100.3 None >102 13, B1 sl; 11, Bn 1 s; 78, Bn s $ gr B - 6 126 104.1 None >126 14, B1 s 1; 18, Bn 1 s; 94, Bn s & gr PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P- P- NOT K,CQUIRED PER S. H63.19(5) b) 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 ORIGINAL - 97.0 / ALTERNATE - 96.0 '�. _ INE LOT 5 { _ ) N . . mm 1 . t . _ 4 �� Z ' f � tHM tK T-1 O O F 1'' IRON IPE Incl.. B3 , � 4 pr t % � _ ? __ ... _. _ _ # i .. _ _ _, ___ ' _ _, _. - �' m ate IEG ' , . _. E. - 1 OIL BORING I I.ER 1 , i I .8:4114 ) � - ___:� ,,. , _ _,_ _ , ,t . € 6% 1I , _ T ' �"" IRCT E_ ;.. _ ___ _. ;-*:■ — - � _ SON B ; ; [ ' • I 4 L . - E `SCALE ? 1 3 ; 1"450 X0 '1_.. _ } 1 j 1 ` _ 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: James T. Swanson, Ogden Engineering Co. 6/16/83 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 123 E. Elm Street, River Falls, Wi. 54022 55 -2152 715 - 425 -7631 CST SIGN y RiBUT €,M: Original an. nna copy to Local Authority, Propel ty Owner and Soil Teter '; ; 02/8: ?; OV — • • INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 • To he a complete and accurate soil test, your report must include: 1, Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDENG TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shove =n, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data percolation test exemp- tion, if appropriate; 10. 0 the intnrmation (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 1 1 . Sign the - form and place your current address and your certification number; 12= Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st Stone (over 10 ") BR -- Bedrock co - -- f,:)')05 (3 - 10") SS - -- Sandstone • nr Gravel (Linder 3 ") LS -- Limestone. -- 0319 HGW High Groundwater cis _.. C O {I. =r- Saved Pe'ri; _. P rcolatinn Hate med s Ps, dit Sand ` ; --- l %r.Ei t - Fine t Saud Bldg Is --- L.:)a;ny Sand Greaterr Than Bandy Loam t _ Less Than Luau) <,l is Silt Loam Bt • Gy Gory GI — Clay Loam Y Ilow ic; S Ivy Clay Loam ,nti' so Sandy Clay ith sic Silly Clay silt few, I ,, n: ye t _. Peat iT');' — ,t",1-,tt.'0, IshiAtio Hit} c-. Owe!, Six general soli It Ft,-Ii es for iiit; l i 1.:t.: ,1 strosa! 1339 ,. E final Refereoce Referee Point_ TO THE OWNER: T.,.' soil rest 'sport Is the first step in sC',rirllit3 a sanitary peimit. The county or the Department may request 1„,31,,:;x1, ti of this soil lest in 1he. field prior t1) permit. issuance_', /1 esenpli (1' set of pi.J! , for the private seirat'ine system and a permit '9911 sa,1 )(l rtltlit Iu3 s ldmit±t?cj to the apo o l 1_ , ' local al:dim ity In order 0 d permit. 1 5" sari:diary permit ;Wild be r),r eu18e', 1 and r } +,sl 'CI f?I "Mi this start of any construction. I I <� °cP