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HomeMy WebLinkAbout020-1142-50-000 a o 0 0 t . a 30 30 ti y O t 0 Ai c a e., 0. o o o Y N as •• U O N a a) C y w a)•. 1' : € I I y U N ' � 0 a a I LT, . - a 1 13 15 as 0 I • . a O o - I a I z 'ooL z I w° m _ c • I C u a g. 3 a o _ 3 - p E 3 o < N U a I E ¢ I I 8 1 N a y M 1 Z y I R' y I °) cn c 1 °o E cc E 'O I E C chi H z a m a m 1 I o I C Z 4 c I c 0 w re , 7 7 "= a) z v 2 c I 2 c o I to F- E 1 7 E I . m I v E r) I N •7 N 7 c C) a) c o I its ca fh N C 3 C C •� a �o r 1 a o ° 1 Z c 0 c 0 .0 Q Z m D Z Z D w N z I 0 y c I a) - r N v co a EE v m A E a) I w� ro �T v a N Q o L• .. R 2 0 e .. R o tt 7t 3 CI oa e) T 3oca o u m et 1 t v a w 0 1 • , =aaa 1 =a u, a a) a) c I c 8 cn CA ).. a) N N >- V- - •�l 11J -- O W O N a ) ' to co 0 I o o _ 0 E O O w 'O O O .-� 'O co c .mi • p d Q in y 0 < Z in co C' 0 Ai O O t y C ,C oo y C O O C 7 03 , In O t C N C- O 0 ' ~ ',, O N O m O N I 1 W 0) C � O D O ' O - C 3 N C • • rn u) a a) ) ° m a N i m Z CO . • m c c cl -(31 No ci a > L CC • O in; o ce 2 0 Tr o Z H 1 C7 113 A v o Z c Y E i n V € I v� €a da S it a `az. 1 caz. 1 • es o. 47) . c) o m c c E , I o r� 3 COI A c� a ti wc° Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453489 0 GENERAL INFORMATION (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: 1 Graetz, Joseph & Mary Jo Hudson Township 020 - 1142 -50 -000 CST BM Elev: ccL�� sp. BM Elev: BM Description: Section/Town/Range/Map No: ION l D� � a� St 34.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic //�� fl Benchmark V"" ) W \� / � � Alt. BM q/ (oct.3b) o4. to° Dosing 1 _ --" I. t Aeration Bldg. Sewer Holding St/Ht Inlet (4 i r �� 97'2q , l !><' -----......) St/Ht Outlet TANK SETBACK INFORMATION •k TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , > I 2 ( _"^ Dt �� 1 .O St �� , Z 1u �{ � ,� t Header/ ` r Aeration Dist. Pipe ( 5 ,i ` Holding Bot. System PUMP /SIPHON INFORMATION Final Grade s it 1 I Manufacturer Demand `t ^ St C � / VA/ ` ` ALL . GP , t ` ) Model Number - i D r IO .p`(� . t I 6,4 ' O � ` aO TDH ILifine Fricti n Loss/ System,llead TD y`` Ft }��� 1 I. I � zit ��� < I mo ) , 7 0 l Forcemain Length 1 Dia t t Dist. to Well / SOIL ABSORPTION SYSTE 21) Q . / , ,p1CL ENC Width Le nt ii No. re c (es PIT DIMENSIONS No. Of Pits Inside Dia. Depth DIME 3 /�' 1Liquid SETBACK SYSTEM TO o l ( P/L BLDG WELL LAKE /STREAM LEACHING M of ct rkr * INFORMATION Typ Of System: CHAMBER OR - v, (3 / IS 98 UNIT Model N er.� L I DIST IBU IQN TEM ( �,,.�p V Head r /Man I ' Di ribution V x Hole Size Hole Spacing Vent to Air Intake V v Pi pl .....• Leng Dia Length Dia Spacing > 2 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ���` 0 Yes [] No 0 Yes No M NTS, (In d code dis a nci s, persons present, etc.) Inspection #1: Seer. r . 23 )4pection #2r -- 7 ---- 7 -- / / t 2 g Location: 644 E e Lane ,�. ane Hudson, WI 54016 (NW 1/4 SW 1/4 34 T29N R19W) Ste . , .di . of I tttillia 1.) Alt BM Description = /V /A ) ' S —,`r� 2.) Bldg sewer length = ? iiiQ /� ( = le2. l''42 = 1 ' amo'�n of = 'O A 1 n , 96 �. IO2.3'f, . 9 (9 — 1 ) )- - 4. _too E� ; ¢u�.1^1,. Z % °2.t: g,! s 101. 1 • Plan revision Required? j Yes X No ,. Z3 Z � �' (1 Use other side for additional information. E ` — � S Date Insepctors Signature = A lin oa, SBD -6710 (R.3/97) o /�� , 2 ` � , 6 40 - � c..03 \ 0 � . — Wisconsin Safety Buildings Division Gant 201 W. Washington Ave., P.O. Box 7082 5- t' G '`'� ( f ` Madison, WI 53707 - 7082 Sanitary Permit Number (robe filled in by Co.) Department of Commerce ( 261 546 2 /5 2) S'q Sanitary Permit Application I C State Plan LD. Number N/ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide cl may be used fa secondary purposes Privacy Law, s15.04(1 )(m) Project Address (if different than mailing address) I. Application Information — Please Print All Information ": -' ' X 20• fill 2• -p-� Property Owner's Name Parcel # Lot # Block # Toss p &. ' nxtiy 5o 6-*A- l ' '4 / Z Property Owner's Mailing Address Property Location I (, y y a'j LN - - • _ . SW 3 / City, State Zip Code y - -- PhoneNumbet .' ., r - N w ' /` %h Section TTvDSO*0 Ws'. 5Y6 /( j ui5 386' T Z1 N R (i(cioIC W) 173 II. Type of Building (check all that apply) SCI or 2 Family Dwelling - Number of Bedrooms 41 Subdivision Name 6914p1rma6 .. ❑ Public/Commercial- DescribeUse s'1 L'/.!lf�il°7�S /9-f�D.'T7a,u ❑ State Owned - Describe Use (6 3) A i ❑City ❑Village Township of I+ I)/bSSOA.) C . , ) rr -- k cIWV III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Of Replacement System ❑ Treatment/Holding Tank Replacement Only • 0 Other Modification to Existing Systern. List B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Pecrnit Transfer to New Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) /°"' Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. DispersaUTreatment Area Information: Design Flow (gpd) Design Soil App ' n Rate(gpdsf) Dispersal Area Required (0) Dispersal Area Proposed (sf) System Elevation 0 (0 • / 20 0 /2,3Y /o /. 0 VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units �, : Concrete Constructed Glass New Existing c X ('S r , Tanks Tanks c� Septic or Holding Tank 4 /� 2O 00 it/ / EjT� . • x Aerobic Treatment Unit ..�.,,_ - - J j � T : - co- i �TG7C l Dosing Chamber "� �t O • (v 50 6 s1) VII. Responsibility Statement - I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature 1 ittP/MPRS Number Business Phone Number R. Zit R R (cc - Lei - - 2. 2 _ 4 31.S 7 15 . • 7'1.Z • 3yV__ Plumber's Address (Street, City, State, Zip Code) 2 27/2- /o ..- 4v. . Me /.1)7 /14/1 4 ". Aiv s-Y74, 7 VIII. Conn artment Use Only Approved ❑ Disapproved Permit Fee includes Groundwater Date Issued in Agent Signature • Stamps) Surcharge Fee) ray ' < ❑ Owner Given Reason fa Denial v ^ S►., . ! 0 i!: ',..L� IX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: t 3) 'S Sa -in Io¢Z - 1 Septic tank, effluent filter and , rj4, v (..t Q_ dispersal cell must all be serviced / maintained 0 as per management plan provided by plumber, 2. All setback requirements must be maintained as per applicable code /ordinances. Attack complete plans (to the Canty oaly) for the system ea paper mot less than Max II Inches In size SBD -6398 (R. 08/02) ___A cC\ -_,- / N i / 6 }‘ ' ›fi \I/ V1 , / -C 11) / N .\ , o / , . N. ` n \ Lrf •,- r' ,.4t. ...: z ......._---,..... 1 c.n tt C a ► • c fi 6', - -_ -p - _ - 0 p i )t " I 1 i 0, 1 1 L ( ) I (.. ..,r 7 \ s.'% IN I \ 7 *..431-1. idl 1> W I O Z � � N % $ -- C‘ *0 --.,, ti 0 R „ ,.. .,,A..„ . . ,,, , v:. , , tb,„ , ,,... _.,.., A . (v.-KO 6, ''' ..1.1 o N c . ' , 1 1 % ti i • -• 0 0 1 kl) "v . - - - - vti 1. c- ‘. . , 3 ' " PQ 1 6 'k _ ..(/‘ ‘ it - isg- - . _ j \ p c� \''' V.I ■ hr GO o i 7`E Vei iPtci! /o.V 4p -0/6‘ S et) 'p& f /w ��/f� 2.0,0/.06— 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT 3 C rivisiori of Safe4y and Buildings _ Page of in accordance with Comm , Wis. Adm. Code ��� Attach complete site plan on paper not Tess than 8 1/2 x 11 inches In size. Plan must County /1' _ K Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and dislanc- • nearest road. Parcel I.D. d a 0 • ��y� • s. • �� Please print all lnformatio, e® Re ewed by Date Personal Information you provide may be used for se •..,•- .1 6g\ &vacy Law, s. ..04 (1) (m)). ■ I 1 ' Property Owner mot` -� a - k` '`/ 1 • U eh. •�• / Do J Pro r - rty Location tte tine)/ � /eT ` 0 1 Govt. of A /14 / 1/4 S 1 /4 S 3 7 T x y N R/ II (or) W Property Owner's Mailing Address G00` . Lot # Block it Subd. Name or CSM# C& yy EJ / LA • s N�> j 5 7 - akilR7 - 5 4,0.0 City State Zip Code- Pho ." ❑ f�f U/7So,.� (��• � "•4 City ❑ Village 0 Town Nearest Road 5Vo /cp ( 71 ) �% • 661/ opro,%) gyp Ij • ❑ New Construction Use: I1 Residential / Number of bedrooms 3 Code derived design flow rate i'43-47 GPD IN Replacement ❑ Public or commercial - Describe: Parent material /QE's 0114T S4NQD Flood Plain elevation if applicable /V /14- ft. General comments Dti 4, 4s/ and recommendations: • , e '�, t- TE.ST.� Rs-36-6-7 /9 Svi T t.� /..e. (' 4- 4"c ve:.dr /04,4 [- ,,,ygevvL2 sy$rj - 13v r t/ // F�Qa /,i'E- At 4 r`r•,00ip Tswk ❑ Boring Ge • t "�+ 91 Boring # ! 7 • O S.S. s • ce . pit Ground surface elev. fl. Depth to limiting factor / 7 in. ` Soil Application Rat ' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. $h. Eff #1 Eff#2 1 0•10 /OR 3/3 L affew ,fR w 3 f -5' - .& �. Z 6 • /7 /oge,3 /1- 1 47 7 1A,47 - & - p - / /fsbe Anfte c4 .2.7 • y 3 if ,'7.36, /op? h Mfr/ op' 5/4 /fSbK Avi V.6 • _ 44 — • Z • 3 A /Oyu yf czd iror 1 SL / f7R /►s'R/ • 4-t , V . 6, .oyg Ol s y o w` V •� * . 3 �• /ON Kt, -Fri no rs 5G. 0, ,mil Ai • 1/i o 0 ' �•s }Ye VG, circa &,v7 -� %-ss � ?A6�' s 1 Boring ,� ❑ 9 �S Boring # Q . 9 3 1 > I pit Ground surface elev. ft. Depth to II w 0 � p Smiting factor in, Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Rate In. Munsell ry GPD //f1l= 2 Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft #1 'Eff#2 / o -, /DY(3 f3 st, /foe Avifie Cs 3 . 5 •9 •(, : Co • / /61,Ps/ 111=11WAI S O,S IIPAI c — •Z o s WA e 7 1! Pig I � •s -,oi•o BANOS 35 ..q -!e • :7-4 ' Effluent #1 =-13013, > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BO; < 30 mg& and TSS < 30 mg/L CST Name (Please Print) I Signat eza N R • ?lG /3 R •c4 7— t i CST Number Address ZZ 3 s • Date Evaluation Conducted �f Qd (D d Telephone Number Ulbricht a Associates '1.4,,,t.1- )o Z ! ! •' S • J ( �/O ( S Private Sewage Consultants • 655 O'Neil Rd. Hudson, Wis. 54018 • s4' 244_ ?- 57 /A) Vett) /WM ORIGINAL 1 h Property Owner Rit . . Z -- 0 20. //41,Z • 5-61 • 2. 3 Parcel ID # Page of I /_ I Boring # ❑ Boring ,D y.Q ' � �P X pit Ground surface elev. ft. Depth to limiting factor ! In. FHorizon - Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In Munsell ry GPO/ft' Qu. Sz: Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 / o•5 i y43 /y s .11'she 7 A.s a: 7 s 0 2 S • /7 /O N s/V ---- Av _ S O, S it C S -- .7 /. a 3 17f7 /am SAY 7c5 e, s d t V -- . s . f . /1Z I �J / 1 Boring # ❑Borin /O � > 90 ,� Pit Ground surface elev. f . Depth to Iimiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence' Boundary Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color ry GPD /tt= Gr. Sz. Sh. •EN #1 •Eff#2 / v -e iOyR 3/3 s5.. Ifshx 40fie cs (3 f - Y . A z P•3/ ioyr ,- if . F5 O. s . d cs . — .5 . 9 .s •y 3 3 1' 7 , 5 4 / 4 r s A f G$ / 4 5ie d J. 4,5 .7 i z..7 II N /op s / ' 5 P. 5- el,e ec 5 •. 7 /. Z. .? r-� Boring # ❑ Boring n surface elev. ft. ❑ Pit Ground f Depth to limiting factor in, • Soil Application Rale Is Horizon ` Depth . Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD /N' in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 • EN #2 • • EMuent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 112 = HOD, < 30 mg/t. and TSS < 30 mg/L • The Department of Commerce is an equal opportunity: service provider and employer. 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. SI•r), R130(R 6/60) - - • r • ► • _ NC //N.(11 4 In 1 /' / t'l J / tl t��• /. N. . ., / 7 v, , ,,, I . (11'- . / Li --■ 4 i t ,, e., �� -, " 4. . . /,e Z . Us Z _._.--. / %-.0 � m si w - 1 .1 I 0 ' 1 NI kiV \‘‘‘ I I I c' I I v I \ :- I I I 1 N —=r ° O l 6, I `'� ' m w Zr. O � c t -- • w N o O - - - ‘-.t... j 1 �, p � ■ 3' 4 t5 __ __ _ _ 3')1 ° p { do - • ` $� / '1 11 i 1 ,. . . _ --- Z _ E CG C \ O N o o , k o , [ % r , .5, ..- co 74 `w Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 ►ivision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach cornplete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County sy ., GmQ ,. include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ��„ 0 • ��yoZ • ,S' . �� Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s 15:04 (1) (m)). Property Owner I , � � n�� Properly Location .3.0G- /"I /C Govt. Lot NW 1/4 1/4 S f T " N R 1 9 1,(or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# to y y Eh /6 LA./. /2- Srozei e r 4pD %T'; &-' City State Zip Code Phone Number 0 City 0 Village ® Town Nearest Road > (1/9SO,t) cvt 5 (7/5 3n. '591 b' UPS' 0 New Construction Use; VI Residential / Number of bedrooms 3 Code derived design flow rate f' •'Q ��qq R eplacement GPD ya - ❑ pu blic or commercial - Describe: Parent material /€2,5 0Ve , *WS ► Flood Plain elevation if applicable W M n. General comments pk rate 5 �y 4!/ and recommendations: (� ,�'� % S .S��trS4 S/ ,,f. 7•-� Q �(s n • ` 4 ' i t* 7 5 7ZV ,f .S if /y'vv!' sysr7't7 -- a4 cr�v ( A oti • st 7 di, ' 49%/'li. /e471/k1 �l'f X1'/54 2I Z041/06- "We.2 '/ I S . / I Boring # 0 Boring 9S•Ay 5. s ,S 7UA)k" / , pit Ground surface elev. T t t . Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color` Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 • Eff#2 o a yg 3/3 5 L yam► sag . ds w 3 r- . s - 9 z X0 iow y!o 3 4.h 7 •S yR CIA It" r SG /�y� ��R C'S 1 f- . r • 6 yf� '°YR � /.i 5 /L._ /fsbfl_A„f�• . I .. . 3 - ' o,v 4 3 G(4 5 ,S 4 -- h,44, vE,a 7' - L,_42 i /WE'. S- t/4r ./ A ,i I 2 I Boring # IJ Boring 7? s f 5 s' S S pit Ground surface elev. Q ft. Depth to limiting factor u In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Elf #1 'Eff#2 5L z M+ s 41/0" J 3 f . 5 • 7 Z , , - ; s 4 /I66X nvocg . 'w .z r . y .6 3 - 4 5L. 1 f s bk 4wee es — 9 C. 2, KOT L D API - l r• ioliP Glz., ' / 41 /4 /Au D • rex i Ai (r AYes¢se's tDA.7"�. coArTLV GG,4 55 'Effluent #1 = BO; > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature T �o��- 216,�,pic'� T (. CST Number Address 2.2.. 4 7 S ' Date Evaluation Conducted Telephone Number A /tyZi• Ave, L 7 /5 •3g6•gx.rtS Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 Before local zoning permits Gan be r anted - THIS PROJECT WIAU � ECUIRE STATE LEVEL PLAN APPROVAL. Plans will ed su�mitte� by a qualified desneigner to be per Comm. 83.22(2)(C)1. 1 ORIG1NAL 1 1 • j lJ Property Owner ghEr 2- •0.Z 0 • //f • Yo •t/ `' "' Z 3 Parcel ID # Page of I 3 1 Boring # El Boring hg ` / ba Pii Ground surface elev. • 6, �1 . Depth to limiting factor / 9G in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil Application Rale In. . Munsetl n' GPD /flt Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff #1 •Eff#2 / •/. Jo yie) /3 LS /. 1 4 vcip o pt) 3-1 ? / Z 1 3 is•3s 4 oyRy /4 - SL zfsil 414.0 CS /, • 5 - 7 35.(96 7.5 We V,/� 6 1 / f Ali -,; e 5 -- • r • 4 if GQ • fi 7 s_y4 y .i /)447.4. of I Sc. / y d s 4,c. , • y • 4, „ ,, /0 vie s/ P5 0, S Ali - 4.c' — • y • 6 . . I. B /Pe •.z v * i- ze j, /74C T /%e RP • Ztf-t 01.¢. 8v// u i Boring # ❑ Boring r Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth Dominant Col Redox Description Texture Structure Consistence Bounda Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry . GPD/11 'EH #1 •EIM2 } I I Boring # El Boring ❑ Pit Ground surface elev. ry . Depth to limiting factor In. • ; Horizon Depth Dominant Color Redox Description Texture Star ' Soil Application Rate Consistence Boundary Roots GPD /fl' In. Munsell Qu. Sz. Cont. Color r. Sz. Sh. . 'Eff#1 'Eff#2 • • • ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ing/L • ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L I The Department of Commerce is an equal opportunity'service provider and employer. 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. snn In3n (R.6/00) - .. I • 1 • a e K, / /1t•I'l , AI t i „ / • // vl N t> N ;% 1 .1 1 )(:' Z, / ' ------- (A) 4 / . N.4) '')"".. ( 11 ,4,. 7 1 _./Z ) n Q C. ,b " C.) / ‘ U1 W r vi , - - -I \'C I 1 0 1 .%■ \% 1 tr% P ‘ I 1 ."?.7 I I • \I\ __ ± \ (\__ o ' I ..______ V _____,. I I _ _ _ _ _ 1 ,, '■Al 0,, LIT m NJ s , ' - % „, , , ) W 1 ■ 1 4 k it c_ tt ) -,*) v3 o � , N 1 . . _.__ . _ __ — N•-L _ j 1 1 t V4 CI UV ---N • r ULBRICHT & ASSOCIATES CO. 2812 10th Ave. •Spring Valley, WI 54767 4 Reg. Designers ofErgineening Systems 715- 772 -3442 Private Sewage Consultants • PROJECT INDEX r . PLAN ID # N/ DATE • 2 7 _ OWNER J"ost'Plx. ? MAR/ Jo GRA eTZ. PHONE 3e6 • 6 ADDRESS Cp / 1 ' G > ..S yO / (p LEGAL DESCRIPTION LOT /2 . 57 - tJ rS A- 'o"-i p j A) o2-0 • /1 • 5 o • 0 "-'4) 5u9, _sac. . T 2-f R l `l w TOWN OF V DSo•) Sr. C (ZO COUNTY CSTM R.7 r 2 � 4 3Z5 LOCAL AUTHORITY/ SUPERVISION 5+ • GizO j $ CT y . z o) j PROJECT DESCRIPTION: • 1e ib4-cene-v r- s - 4 E14 . HOAX rite CO Ot • edAtia 1/4.1) 7 Oro 1 5-tte 5.r 511.411 & • Z'i D . i 4It iSri v S ?r' Z t 2 ( -1491 )( v &) 54 ,E -1/ 'k Lef7 /u r*cr Fog APP • z(se d/ A. 4- /30// pi/at . N ee,w kil -S e f,- AM pi. Alk *IC "rftv k /5 xize.tteX /e y f4-Ce T 203e-or - zf a ie t c4 7 ORIGINAL Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, Wt 54767 yip R_s S ftWiti6e64 Pg.1 INFILTRATOR SIZLNG WORKSHEET -0 L- Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 it It " 11 /1 Pg.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /Ol. . g' ki\ . ;:)A. 7.-A NK:-) %Ize ---- ,.. -,.; ‘ 17.-p ,..„... :!,.. --(... - --s-:. r.- ts, g . \ , ,.....;„ ° 11 . 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' 1 _ ___ _ _ _ 7't \ ... cS11 • tt.,,Z j - - .1\ R gt — ,,..... , _.. . •... "•1 '''., -- I \ ' '. th .- .,.., •-.)'• . v .... ...,t ......,) ' 1 Cl• ki ---z' • . . )'''t ,,' Z 4v3 L- 1 —4.-- "ltz, 4 ■1 g. . 1 - V \ - 1> t1 • \ ' VI \ '' -•'. ' i 1 1 tti > i 1 1 ( N . 1 N r 1 - _61 -_ _-_ -_ -._ 2 . ___.,....... v , - ‘,....". . -.._ ..._<.. :.`•• ---\, o - \r, - D /5-t'4 bv_s /2G 1 t f A) e4 ____°,'"?, t/ •3071' 4 , ,0-2____ 4 f'4 W19 UE(' T CA" i '(/ bus, EcT /o v ,//LE. ,'i'v. i 2- 1f( ! V// '2 - _ /ivi S /fFED V.1 1/ 5e e# ,�__.. /6 of x F r� '- /ilir;e/X,fTd� n--�vc �W / / tmLETT 11)1,0 f •Y a '01.61111*; iiii * i�11 i �Yi iii iiC iMi! k1► i�il� mall ,t - . .W4�t+Aiirmissi:.:wasi LA I / LL. PA r D Tit°6 ,- : - S y -, 7 -� I"/ a, /O /. d -.r C/?0 SS SEc T io,) of 7-43E"Avc ':s. , \ II " . ( w5f/t) 6- //uf ( ec;K qs .00,... attwei).-/ _ u' ijk ! q • > 54 pr ,f//A90 c . ic?-, '' pzi. , 5 e T/" 5' . c� Std. -�-� , c - p,ictry / S C4,5 . -.2...— 4 1 / t ? 1 UE4'T C4, 1 U,(/' i JffEC 77',) ,Dt NNW. /2 '' if( - 1 ill/ - 2.__... :0/5 /t4-D I( 54. la R "tp- /0 9. 0 K P1 - 7 , 1 ..: i .r. % -'! = • - .. _ r Z - i i" :ri�■ s :ii: ' • aro i1i i1ti �ti i . t. � a �i i il ti ii ;tar,: :.Y. .. = iii _ : 2 = ii MO wit: itif d ;Simi, .. . - iti - • Aims • - • ;Rai iVia zk Ve OWED rrh e4 , S 5 7 4 y OVER: See Reverse Side for Vent/ Observation Pipe Details. !D . 2 A f 1--- - t Leaching chamber tops are at or below the .original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface forstone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance >_ 4inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. • Water tight cap k Top of r,1 4" min. dia. -` r leaching • Repair couplings chamber Slot 6" min. min. 4" min. Infiltrates surface Water Closet Collar B art341° min. dia.) Figure 5 - Observation pipes Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4 inches. C O SS SEc T/04 Of TA 6 S 6- ) 7,, '4 7'04)S Q U f C K y f /ow. /rt/ - T! ®,cj e ` e t(1/ 54, 1.0 214 /V0Ue 1, fiz.zmr ©�' u ��- 9 '�� / f fRE • alai AMC I /( D 7 E>Ve4 t / fQ /. • �'z 1 ' 4 SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS * N ( 74 . .5fir : �� r l' 4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PROOF 1 t > _ LO' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR AIR INTAKE WITH CONDUIT MANHOLE CC r- .W/ PAD LOC r WARNING LP 't VI t 1 t , i ; 7 ` 7 --�-.. ---- 4" MIN. # I s ►t 3E �t 1 } _ ��` � p 1 NLET t , ► .,---- p '4 U _ i ' �• �' GAS , i ii 1"'"?..._ r.4,- - S TIGHT i \ �f / a 1 ./1 �1 Et,. r � T A t Ts EAL ) PPROVED 'G.D. 40 # F i t,'j B 1 1 , ; ALM JOINTS r W/ '(R UC Pi P , 1 0 EL 4 /0 , . ON PIPE 3 ON o soLID -e-0 3 SOLID SOIL ; C A SOIL PUMP OFF ELEV. q FT. — 1 I 1 -- G q OFF ** RISER E D j PERMITTED t '1.70 f IF TANK 0 -�{�1 1 1 MANUFACTUR i �� HAS APPROV ,�. 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE GviElVeR TANK MANUFACTURER: /WM1JT NUMBER DOSES PER DAY: 150 TANK SIZES: SEPTIC ZQ ° GAL. DOSE VOLUME INCLUDING /4Z DOSE ( GAL. R. FLOWBACK GAL. ALARM MANUFACTURER: 6J1Le/ 4,61644 CAPACITIES: A = 25 INCHES = ifiro G: MODEL NUMBER: Pt/L. SWITCH TYPE: iG /04-77 B = 2 INCHES = 33 G, PUMP MANUFACTURER : cire:W /4 t ._ C = /0 INCHES = 14.2 GI MODEL NUMBER: yk__y (.P3 SWITCH TYPE: P -r - fo.i D = INCHES = ' G/ REQUIRED DISCHARGE RATE zs GPM PUMP & ALARM WIRING AS PER ILHR 16.231 - VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . ° FEET + MINIMUM NETWORK SUPPLY PR SSURE __ FEET f. + 75 FEET FORCEMAIN X 3 / FT /100 FT. FRICTION FACTOR . . 7. ' FEET TOTAL DYNAMIC HEAD = g,41_ FEET N // INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _ t ; WIDTH 67 ; DIAMETER — vOIP VOJLMe fog 75 of a H LIQUID DEPTH / 0 /' foie Cc" A1, 41N = I_ Ks . SIGNED: LICENSE NUMBER: DATE: pfc spEcs THIS POWT SYSTEM SHALL 64 r y O F De Pitt- INCORPORATE PER COMM. C' 1"" 83.44(2)c A PROPER ZABEL _ FILTER MODEL # A — /DD 1( , Z S .5-4-es >Y X aok . --1 SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fiiter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a licensdd service pumper. r P �. PI W Ai T" ZOELLER EFFLUENT PUMP MODEL' 98 . • 1 V HEAD CAPACITY CURVE 3 7 /a • I/ �— MODEL "99" / S/e ,I a . L. 25— — - I a e/s • § 6 _20— ' . • . . l:: I I &AHL.N . ■ —. , . . .- 14 4 �,, ' l i t! —. � ) 4 3/is 0 to t 1/2 -11 1/2 aPt .4‘14114)11\....._ t— 4 A • t • • o U•$• GALLONS 10 2 3o 40 5o so 70 ao ' &111 Sts SO 160 240 1 0 FLOW PER MINUTE -. 1 tout &mama Hutmtove rtft+n,wtt - - er rlutnt *Me otwanwmme CAPAt111 12 I on 11SItO YMgeM MI rums eAla lrml , Iit lyo es Y :n' • • CONSULT FACTORY FOR SPECIAL APPLICATIONS $ Electrical eltelnalors, for duplex systems, are available end • Mercury stoat switches are available for controlling single and sirppiled Oh en alarm. three phase systems. • to Mechanical allermnote, Iir duplex systems, ere available wflh or • Double piggyback mercury float switches we avaiable for w*hotA alarm switches. variable level long cycle controls. • SELECTION GUIDE Standard an models - Weight 39 tbs. - r>> RP. - 1. eraegr.Ieoel op.t.I.d 2pole mechanical control ch, no external con'' 1.qurred. Q 5. Slagle Piggyback mercury Noel switch or double Oagyback mercury. float SO lanai Control Setsdton switch.11de to 1110471. . Modal VPh♦ -Ph :od A • llm 1. • . Du • tex 3. Mechanical vernal« to - 10-0072 or oows. 11911 115 1 u 0.6 1 1 « !; 4. ass f1.10712, for owed model of Electrical ANirnuor, "E-Pak". 1190 116 1 IBM 2 of 2 II S. Mammy .snsor float switch 10.0225 ueid at a control activator +icily Auto � 1 or 1 s 1 duplex tat ot 44) Nord system. oer 230 1 R D ee 130 1 Non t • x 1 7 s a t ft a .. a 1v 141 bpi, "IPA". Iun<uon bon. roe T rdeix eonn.cnon or wiraddn.im- fiat et duple* operation. 100002. �. ,f&,,. -- • 1. lbw ss bole ".1-1 lei vtaiarll9H tonne - -.• ot `0-"^e pedals aloe on Cornbtmeon guru., r1.10014; At %ma ago. el coattaic, dasdon lore en/ MMM Moaq MOM; Deckled Mernnior, 11.104011; Vvehtnical ARe,M10f, M t*' 4 eMiN ~forme i quail �/ UM* Ales Psd�gs 1T Su l$. mao. baatnr, MMOal1; end n; 5.4 M ,ec• an. All 1.ci,l +t eel sal* comae .Acute ►a Ioeo, N 1 ^ 4 4.4- , � e.pLx Corded Me IM wed wa.ni Ndlowai Melds Cad. (NEq erne Si. C ceapaew.l sir* and H..Mh Ad (OSHA} RESERVE POWEpED DESIGN • • For unusual conditions a reserve safety factor la dnglneered Info the design of e:rery Zoeller pump. Man rar r.a. BOX 1fi3N loultvirt, 40236 -0317 Manul�clwers 01.. . p 1 E`R : ,, , LL INiP ai m0AY fi lane :911.41/11 vs /9„�S a tSOn 711•2731 + fAt j,402) 774 3624 OWNER'S MAINTAINCE OF "- SEPTIC SYSTEM 1 PORTS - P5 7 f �- ( landowner) is reponsibl maintena a for. proper nce of this system. Re ular ri operation ininspection Regular periodic inspections and servicing is necessary system. The owner is required by healthy operation of, this y code to submit all necessary maintenance /inspection reports to the controlling , authorities. , authorities. ' SPECIFIC CONTACT AGENTS Y. * Governmental authority/ inspectors: 5-1-. e" IQ o r' K cr 1$ . 3 n ' ¥ o Z t/V(� -. »_�Q * Licensed installer, responsible for � maintenance "Users" manual: Providin g an operation/ * Licensed service �/ / inspection agent other than installer: �/P/ - c 1' • ,5 4-4 , //7 - 4-9 , --10-ti p ll rt * Electrician for pump, electric controls wiring units: C eN - 04 - Ci dj_ IMPORTANT p , WNER MAINTENANCE RE!UIREMENTS 1. Winter traffic `(sleddin area shall not'be g, sh °veering, etc -) across the the ep�pmthees,r frost can /will penetrate into c vac action em. Discont' winter cell, freezing in the action trip, resulting ;n use e r use) can an 'also lead to freeze ups.` g in no wate 2. Water c onservation ervation needs to be exercised,► hYdroiicaily overloaded and destroyed. Ths system can be i designed for a maximum wastewater flow of s sysem was 3. POWTS are designed gals. daily, not —�— Any unit, any other u so accomodate wastes from a garbage rb Y ntraduction unnatural sources of: g age ... An of such r l s stro waste waste. m Y this syste materials will overload and 4. If a power outage occurs ` o r a pump fails, it may in a temporary overload of effluent being y result g pumped into the cell, which may adversely y impact the cell is recommended a licensed (le dosing )• coended that n , allowing the Pumper empty t pump mA to P Y the dos' Co return in Consult ur to su n t g nk 3 t to tank, your installer dly for he tadvicerect amounts. immediately o advice. 5. Neglect of erosion the vegetative the cover (the cells insulation & traffic also ca ) can lead to failure. taffic n destroy t he system. 1SmCSn or heavy REGULARLY NECESSARY G WATER THE VEGETATION OVER EfflueA SYSTEM!! fflue TO Ystem beneath IS NOT sufficient maintain a nt ,; vcovwr. nt alone tO in 6. Periodic inspections by the owner, necessary. Inspection or his agents, is into necessary. system: pipes and ports have inspec on the mound basal be en incorporated laterals pipes), cleanout terminals on area ( effluent pressurized , at each tip - for flushing he prngsurized ground g and cleaning the eaterals out. The filter system in the cover /manhole). Only a tanks (via a locked above person should be Y licensed & severe shod performing this work which involves lvesi,6i l system's safety risks. Evidence of effluent pond g in health treltment cell shall also be regularly - in �l 9 in the �!/✓1 1 inspected. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer SOS E i Mailing Address may .�n/� L A) . Property Address (Verification required from Planning Department for new construction) City/State PSo A) ea/• Parcel Identification Number e)Z° ilyZ • 50 ' Oda J EGAL DESCRIPTION t / c 14) .Sw 3y 'Z7 �! W Town of /� !l D.�D,J Property Location %, %, Sec. , T N -R , S?E /4 / �S 4j2P/' ri of , Lot # / Z Subdivision Certified Survey Map # , Volume , Page # 3 fen /i o 4 Warranty Deed # , Volume , Pag # Spec house ❑ yes i ,no Lot lines identifiablegyes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failureto 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, jounuymanplumber, 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 fall of sludge. Uwe, the signed 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 three year expiration date. imo / X / v OF APPLI DATB 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 , • - described above, by virtue of a warranty deed recorded in Register of Deeds Office. C Ivo_ .� ,_ _ v 8 .4,26 /2f „ ONA , • : 0 - AP' DATE * *** ** Any information that is mis- represented 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 cettitied survey map if reference is made in the warranty deed . ! DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-19811 THIS 'PAC* RRRRRRR 0 •OR IICCOROINO DATA WARRANTY DEED i . ,. 352110 . i vot. 6S 4 pA(.,E 6 OFFICE This Deed, made between Gaylord Law Offices,...S,C„ ....... PrAfil...5haring Tru*t - ST. C.:01X CO., 43 c'ci. for Ream! ftis 30th Grantor, , . 12:30 P j o f March A.6 19 84 and JosephL Graetz and Mar Jo A, Graetz .... ,: husba7Uiid as Jo n tenan s vit • i _ , Graitee, sr of Nods WitleSSetil, That the said Grantor, f.' a valuable consideraticn RETURN TO conveys to Grantee the following described real estate in ...... St.,....Cr9IX County, State of Wisconsin: Lot Twelv4INS Stewart's Addition to Tax Parcel No: the Town o - uison, located in the NW4 of the SW1/4 of Section 34, Township 29 North, Range 19 West. TRAIN sFsa ■ This i.S _mot (is) (is not) homestead property. Together with all and singular the hereditament' and appurtenances thereunto belonging; And Gaylord Law Offices,...SX, Profit.$har.ing Trust warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights of way of record and will w4rant and defend the same. Dated this .,:i ; 74 day of GAMAWL - 0 ICE StV ST / (SEAL) B. .:. (SEAL) • C. L. G ylord; Trustee (SEAL) .By ......S.4n e--A ----4 -tc-e-•- (SEAL) • • Sandra Price, Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) C. L. Gaylord and STATE OF WISCONSIN Sandra Price County. autce cated this )!f .' -1 ( -1-- , 19_3_ Personally came before me this day of \. ,..:,t • - C'i .z- ' , ', c-7'.-- , 19 the above named • Brian D. Alton TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by i 7n6.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord Attorney 4, River Falls, WI 54022 Notary Public County, Wis. (Signatures may he authenticated or acknowledged. Both fift My Commission is permanent. (If not, state expiration are not necessary.) date: , 19 ) •Names of persons signing in any capacity should be typed or printed b,,lov, their signatures. WAREAI•TY DEED [ STATE BAR OF WISCONSIN FORM No. 1-1982 WiAronsin Leen! Blank C. Inc. Milwaukee. Wis. z T �D� w N 0 f1T A o UNPLATTED LANDS r 1 -- 2 70 � o G I L BE RT EAST RIGI O 2' 658.01 ' \ c3 m z D 4 8' , .6.02' 5 9 N 9 c , ° 292.01 3 z ;+ z Z ' N 0 25'36" E i. ii w g et. 6 1 eo m z rn '38 `'%95,„ 6 47: fn n ©, ` 2 °' _ / / O v N cn / / co cn al .ss to ra„.41 z cn D N 0 / �Z n IV 0 01 n t A uj z / / 1 0,, xj o rn m —+ m cs cam w 0 rnm ��'� / o ° cn 0 0 cn _44 z %.,, X•_ o / / , m 0 a �z �9- / / , XI -Ti `% Sp / / /.. 4 /0 ' D D : ^a r c -..4.?' � 61 / � M xi o . ® - ��� '' t 3 Q., - : Y / 9. / N N 7°1 8'39"E N 0° o /N u'' I 01 73 234.7 3 o! 3 c' !�cn 4 !80.001 � � 1 w I 0 � , , O. U ' 0 . A ^ / w ; �' �; rn a f N 2 6 6 ( ° co / n 0 ( 0 N -A 0) l o o i • = D O o A ° O n cn •a ti 0 � ' • m (0 D t � to 0 1 23 ib a l i D K► ' S ? o \ , +9.9 " m , • � �'. Cii'` 110° N / 2 00 .0 0' Dm ^ ���3 � � � 0 03 g 8 07 o m o `," ,A 0% S i 8 °0 ? ' C q 5 20 9.31' co al Z a N / U 3 q N E 2 w W w �' °05 �� � �� `�� uti., q 3 4 q 8� • iv sop 29' 127. Td r N 3, sq •s •O us rn � � z t D U (1) 0 0 tD m oo �' cis_ g (71 D (0 w N rn rn r. 01 cn 0o �! Z (n m C► t0 z A -+ _ a 0) CO - Z z - 0 D w to . 0 C71 0 N "4- .A (7 c 1 O) p rn N 0) - _ 0) -J •A D - 0 0 Ir _______ t . Form - STC - 104 . ___V- AS BUILT SANITARY SYSTEM REPORT OWNER J ll U' y Q 2— TOWNSHIP HGOSC7 SEC Y T ?N-R)? W ADDRESS 9-0 't / I 5 51 40417. CROIX COUNTY, WISCONSIN fi js c, 0 CL "15 SUBDIVISION Rh Stew :0+ LOT j LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM . Nou,e. - g - CYO 1 ii >i3.7° 1 r 1 ti a . A 6 e loll cror^ lot the- • . 3 'vo ra d ` , 1 6`I 3 INDICATE NORTH ARROW Greek Stet\ ;'entt - p°5+ ig _f1 ®J I q�V D BENCHMARK: Describe the vertical reference point used)CtI inpt'ixj by 9vet" sire( �Q►te IVA- a�7� d Elevatiori..3f vertical reference point: 10070 ! Proposed slope at site: I SEPTIC TANK: Manufacturer• 1 pj� �� Liq uid Capacity: ' ® Number of rings used: 3 Tank manhole cover elevation: Tank Inlet Elevation; / l" Tank Outlet Elevation: 5 1'1 7r.S .----- Number of feet from nearest Road: Front , Side,O Rear, O )4; 'O feet from nearest property line Front,O Side, Rear, O i(). , feet Number of feet from: well 1 10 , buii4ing_: 3 (Include this information of ttie above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I • PUMP CHAMBER Manufacturer: Liquid Capacity: Pymp Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm,Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear , Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: f$31/, 5 Trench: Width: C� Length: i �l c 3 y Number of Lines: 3 Area Built:CAI Fill depth to top of pipe: 1O' Number of feet from nearest property line: Front, O Side( Rear,OFt .1.27 _ YY``.// Number of feet from well: fr 41.1 Number of feet from building: // 20 (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() 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 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 Manufacturer: I � Inspector: Dated: 3 U h e. 7 n L1 Plumber on job: X k .Q / License Number: /'2 P R5 3 3 0 3 3/84:mj r DEPARTMENT OF INDUSTRY, k% j t L4 ^c �� ������ INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS ` ..� DIVISION P.O. BOX 7439 . BUREAU OF PLUMBING MM)ISPN, WI 53707 XRVtONVE.NTIONAL ALTERNATIVE State Plan I.D. Number. 111 assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound 4 -8d/ NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE Joe Gtcaetz 206 W St., Apt. 305, Hudson, WI � oo / 4 .r BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV NFU% S(11%, Section 34, T29N- R19G1, Lod #12, Ron Stewart Add.Town of Hudsov Name of Plumber: MP /MPRSW No County: Sanitary Permit Number: Bruce AUen Web4 ten 3303 St. Cno..x 49480 SEPTIC TANK /HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER n (A) iS �f Gj n PROVIDED: PROVIDED I � / qr 1 S 9 I.a-5 ❑YES ❑NO ❑Y S N BEDDING: VENT DIA. VENT MATE : HIGH WATER NUMBER OF ROAD: PROPERTY WEL : E TO FRESH ALARM L INE: f r � BUILDING V A l fj,INLEy1� OYES 0 ❑YE ❑NO NEAREST I• 10 0 f �0 1 "j' N / /// DOSING CH MBER: MANUFACTUR R: BEDDING LIQUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED PROVIDED: OYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL � 7 ' ER ® ` PR WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN F . ; LI "E' AIR INLET PUMP ON AND OFF) OYES ONO .R T`€ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing EORGE 1 ENI T DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FOR the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: 3�y WIDTH. LENGTH. NO. OF 'DISTR. PIPE SPACING. COV INSIDE DIA.. *PITS : LIQUID .ET TRENCHES: RIAL: PIT DEPTH # IM NiSIONS I 0 35 GRAVEL DEPTH FILL DEPTH DISTR. PIPE (DISTR. PIPE (DISTR. PIPE MATERIAL NO. DISTR NUMBER O' F' PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPEE AB VE COVER E LEV INLET. E LEV END PIPE �. . ` LINE AIR INLET Co` � 9 7 ' 2 8_1 LE 7. i `3 2_7-L.1 NEAREST: ., ' . ` ► � O P -.1 3,0 MOUND SYSTEM: M Mound site plowed perpendicular to slope Check the texture of the fill material for PR *VIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to ma , ertain that ' 0'1 REVERSE SIDE. SHOW ELEVA- meets the criteria for 'di m sand. 'IONS MEASURED. OYES ❑ NO SOIL COVER TEXTURE PERM OBSERVATION WELLS DYES 0 N OYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOI SODDED • EEDED. MULCHED CENTER. EDGES ii ES ONO OYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: "" WIDTH: LENGTH NO. OF AT AL SPACIN GRAY DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER ° °E TRENCHES .„.pI NS r r MANIFOLD PUMP MANIFO a DISTR. PIPE MA FOLD MATERIAL NO D TR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.. DIA.. ELEV.: PIPE• : DIA.: ' L ' VATIC AND I F ,w T R ION � M : f HOLE SIZE HOLE SPACING D''LLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED , N, i! - PLANS . ❑YES CI NO OYES 0 N COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER Oo ' PROPERTY WELL BUILDING: - 7 ,00 CI YES ONO _ OYES LINO NEAREST ).' A p 'Y (J ,I L : ' 63-6L 7Z AI 21 t nom. .46 W 15a C,0 x `- q I - 0 7.75 '7P 9. -) ti �.s2 Sketch System on 7.o '� Q. • Reverse Side. SIGNATURE: '/ " I Rein in county file for audit. TITLE DILHR SBD 6710 (R. 01/82) ~ i AS BUILT SANITARY SYSTEM REPORT Form - S T C - 104 OWNER !. J(��, t-" P747 (Ira 1L' _TOWNSHIP HUd5C' SEC. T r N -R W ADDRESS )0 j (j.5 cf- R 5— // T. CROIX COUNTY, WISCONSIN HUd5 li MS SUBDIVISION et i c " i't- LOT ) ' LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM rc�rJ plaX - 100.6 51-vowrcrv4 61tntiT .-/-) k7. 3 '1 --- �MI6•74 ,f;6v R'6.S3H "`�` _ .9E , IF; f ei 1 t La areS ����� w l ave P\- \10 gy5lem / \-) 75G a�, A iO 4- ti CI . � � t f►,., t i G FPS 0, it 4,..., 303 ] , ti i 1.evr- F , . eb5e:;xthOn PTt 6ttx.241'e ‘t Crete s-teel F 'eE 75 nevi- 10 �h�6 :v;?h h� aix not- tc B it l ` 1 Q stU1 Re) Lao, � � tnk� fer,c�e, Pi 4 • t E-da Ro a,�) `( INDICATE NORTH ARROW 6,6 0€Y-t to I veeri S1reI f-chce... BENCHMARK: Describe the vertical reference point used p N1-- k SyvVe oY Elevation of vertical reference point: / ( Z Proposed slope at site:-7q SEPTIC TANK: Manufacturer: Ol CSC F c ee Liquid Capacity: WWOO al IO125 Numhor of r? used: ` Tank manhole cover elevation: r _. Tank Inlet Llevation; Tank Outlet Elevation: Number of ft:et from nezArest Road: Front,O Side,O Rear, O feet • From nearest property line : Front,OSide,ORear,O feet NumbEr of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic t' SEE :REVERSE SIDE 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 Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,O Ft . Number of feet from well: Number of feet from building: (Include'distances on plot plan). SEEPAGE PIT Size: Number of P its: 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, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj 1■• wlsconsln APPLICATION FOR SANITARY PERMIT DILHR �ire�.ey' f'OUNTY (PL 67) oE UNIFORM SANITARY PERMIT # InDUSTRV, LRBOR & HUmPn RELRTIOfS 1 7 1 9y14 — 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 MAILING ADDRESS j Ot t (nary CM t e7 _ ,) 0 6 (A/is 5t B 305 I/ dsoh Ii/sc_ PROPERTY LOCATI qq CITY' NW1/45W1/4, 3 I , T - ,N,RV/ X (or() TO � ` w o F: ���5 0 i LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LA DMARK 'STATE PLAN I.D. NUMBER 1 2 N/A Ron S+e►va ` i ' Fdd fi TYPE OF BUILDING OR USE SERVED (e.&.C-d' /a 4 00 - l / C� a _ s --- L* 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): W THIS PERMIT IS FOR A: N I 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 U Seepage Pit ❑ Holding Tank El 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 ) ®Q(9 I k Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: 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): e L I fJ 15 6 3 0 xs Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of lumber (Print): Signature: - No.: Phone Number: Web Qv'vc R lie h Q4 4_ - �. (76- ) 273-5 77G' Plumber's Address: Name of Designer: kt y EI I6wor U/)5 3 bare Ellen 144-ls1 - ek COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: /1 Fee: Date: ❑ Disapproved , ` /y r / �) 6 0'd �/ J -g1 Approved ❑ Owner Given Initial f 11 . / /`� Adverse Determination Reason for Disapproval: Alternate coursels) of Action Available: DILHR - SBD - 6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber t. 1 1 A 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. /. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. 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 )0e._ P9Qky (7; f Location of Property f.PW ' 5 w 1/4, Section 34-i , T � N - R 1 g W Township 0 t vC. 0 ''1 Mailing Address a (Nj vV 'SC J /9�.�r}hcyt • l U ,J6OI� 1� Subdivision Name �l�}"„ bvCtY �'��(�`� 1 „ Lot Number 1 0 1 of Q Previous Owner f Property L�PS f ��/ � Y tor Total Size of Parcel o I / 9 C y Ps Date Parcel was Created Are all corners and lot lines identifiable? . / Yes No Is this property being developed for resale (spec house) ? Yes X No Volume CI5 and Page Number 60 J as recorded with the Register of 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 I (We) cen i,4y that att 6ta-tementt6 on thus 'onm cvice titue to the beat o4 my (outs) hnow!edge; that 1 (we) am (arse) the owners (A) ob the pnopen-ty dese't,%bed in .th.us i nknma ion 4onm, by viAtue o{ a watvtanty deed neeonded in the O44ee o4 the County Register o4 Deed4 as Document No. 3q . JI 0 ; and that 1 (we) pneoen ey own the proposed site 4on the sewage dtdposat bybtem (on 1 (we) have obtained an easement, to nun with the above descAibed pnopeAty, {yon the conAtkue t ton o{ ba,td system, and the same ha4 been duty neeonded in the 044ice o4 the County Reg .ten o4 Deeds, as Document No. 3 _ IGNATURE OF OWNER SIGNATU . ,, OF 0 OWNER (IF APPLI E) _ / DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED U(p. c,B4 Pt...„6„. 3 This Deed, made between Gaylord .Law Offices, S , C , 31 , Grantor, and Joseph E. Graetz and Mary Jo A. Graetz, husband and wife, as joint tenants I I , Grantee, Witnesseth, That the said Grantor, for a valuable consideration St • Croix � RETURN TO conveys to Grantee the following described real estate in J 1. County, State of Wisconsin: Lot Twelve (12), Stewart's Addition to Tax Parcel No: the Town of Hudson, located in the NW; of the SW; of Section 34, Township 29 North, Range 19 West. I1 ,I This ii homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; I And __ Offf..e._. - -- .. - Profit Staring Trust warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except , easements and rights of way of record and will warrant and defend the same. Dated this day of 19 83 GAYLORD S:C. PROFIT SHARING TRUST (SEAL) By . (SEAL) I C. L. Gaylord, Trustee (SEAL) By: . , ... 411JCAL► • Sandra Price Trustee A vTBa hlT to♦ = ION AOILNOINLIOOSidalt Signature(s) .. �.a... !�! 1 Q d... ri ........m...., . STATE or w111041111011 Sandra Prigs) .... authenticated this 111 , .10 1"MIIM#Iwlsday satyrs 1M111MM tat NMat t1S Brian D. ' Al tuft ......- n. b y ,-. TITLE: MEMBER STATE SAE OP w N (If roe. authorised by M OW &rrwoo No II Us Main Wimp 410111111011111 fie - IIrr+I rwls isuir riall Obi iiii0116040 00 NNW TMII INeTI1NMANt *1.. or ,go Of • . _-.Rir.uar F411#4,. 1f f$04# ruk4w (Signatures say las salittatiliteitat airearearialgoi. /w.ur 117 oormilemos M (ii oak etirls are oat adtcserary.) rats s Ii •a •Maraas at s+aaaaa ulaaree w emir +rw+s ar..M h. w«+ at Suety ►.I,.. Woes . - ---... z > STC - 105 9 H SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 2 OWNER /BUYER J n€ ir' C 2 - ROUTE /BOX NUMBER / p� Fire Number CITY /STATE 140d5 U/ e s' ZIP C90/6: PROPERTY LOCATION:N 6 , 3 1 , Section) f , T / / N, R W, Town of H ud)a`) , St. Croix County, Subdivision R011 Si-O/c/C , Lot number 1'.2_ . Improper use dnd maintenance of 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 or sooner, if needed, by a licensed septic 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 maximum of 60% of 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 maintained. 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 or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H o I /WE, the undersigned, have read the'above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED t!%/ DATE 1' St. Croix County Zoning Office P . 0 . Box 98 Hammond, WI 54015 715 796 - 2249 or 715 -425 -8363 Sign, date and return to above address. 1 • PAGE 1 OF • • Crass S zc ' torl O r A Zc 0 S -- Fresh Alr Inlets And Obcervatlon Pips r Approved Vent Cap Minimum 12" Above r� Final Grad 4 h 20- 42" Above Pipe _ 4" Cael Iron To Final Grade Vent Pipe _ Marsh Hoy Or Synthetic Covering Min. 2" Aggregate • Over Pips , Olehlbutlon Pipe ^L A 0 0 0 0 0 —Tee 6" Aggregate [ o t Beneath Pipe Perforated Pipe Below o — s-Coupling Terminoting At w bottom Of System I P rupoSeD sin 1 19r tom ",clt - i OD.6 may may �teJ..T �\\��I' / + �ir� �/J� ' SOIL FILL DISTRIBUTIOVI PIPE ER r`•4:' °•- ~--MATERIAL- OR 9" OF STRAW 2" Of 1►6GRE6AZE ------4.- • � • "All OR MARSH HAy 'q (o . OF % -2 -•••••-..,:r-.00.4,-........"-...::'' 2 AGGREGATE 8' �\2 �. v aF FEAT % - --4 `76 /6 , i t t DISTRIBLITIOIJ PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE AND AT LEAST2O INCHES BUT MO MORE THAI.I LIZ INCHES BELOW FINAL GRADE MAXIMUM D PnI OF excAvAT U rito 1 OKiowaL bi(ADa WILL BE 6 INCHES MIKIMUM QEpfli OF EXCAVATI01.1 f•KOM t> i(,la4L. C WILL BE 5 INCHES . / l / , 0 SIGNED: ALL f f IP MFRS 3303 LIGE►JSE IJUMBER. DATE :..L I & ) 16 P / DEPARTMENT � D ENT OF REPORT ON SOIL BORINGS AN i ro ? , 1 y FETY & BUILDINGS DIVISION HUMAN AND BOX : PERCOLATION TESTS (115) t., 0 � MA D' P ON WI 53707 HUMAN RELATIONS 5a..) (F163.09(1) & Chapter 145.045) CT �.t : LOCATION: SECTION: p TOWNSHIP/MUNICIPALITY: LOT NO. NO.: �;?r'+ a IS ' F� , ,. NA) 1 / ' /a 3 /T27N /R19 E (or /7 � OA / / ' 2 1 ''' +' - " ' 7779.1 /. COUNTY: . OWNER'S /BUYER'S NAME: V MAILING ADDRESS: I S cw / X To E 3 R y 6- P4TE -zol /u . Si • fl 3o UIO,s'o. t / 5 . USE 3(P- , ff/ DATES OB • RV ON y 1+!� NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DE :°` R •LATION TESTS: X Resi 3 AM- XNew El Replace ✓E . ? 2 '� •-. O 7- - 3 /� RATING: S= Site suitable for system U= Site unsuitable for system �S iy e$ 66 Cn - - v / i L Dv/IA-fig ' _ / . CONVENTIONAL: MOUND: IN- GROUND- PRESSURE:'SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) * se-f- »o? ❑ S ❑U ❑ S ❑U ❑ S ❑U ❑ S ❑U EIS ❑U Cove -.ur' t' -. gE� Raw If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the 'f under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: /4 Cr ` is Cr. PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER -IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /�, 0 ' > / /. .53' D,t%�11. L s, / t5, /o' cr.0C{,�• yOeys B /02.77 '� / Ls, ,:ij'aLT• y .e./uvs dF 0, P. 2M 9 • S. P.' . y, ' . / 43 �BN /. 3'. LS, 6 7'40•'IA) . .0,P S . . B- 2- 1 J /0/.51/ / 9 5 D,(. /O 7 44v1 , S ai 44)- Xe.4 $. eis4 714J `s, X5 ' ill) S. // / / •83 .P3 'In1.SL, 1.08' 7AA) Si /$ 'TA,/ B- 3 /e9,0 /00,66 ' ` 7T > /e9. 0 1 40 L5 5:7 5 - Hit( . d) &L Ls Q,Q� SL , ? 1 $)J . 71••4;[1 S . i , / . < 0 7 ' „ D m ,5'4.) . L. S, /, 08 ' 4.v . SL. , 22.5 ' G 7. 7. . cs..p SCI Up)/ B- / /O'() 11,f7 7 /0.0 ,5'L;, .47 iA•v . 5 4 LS, -5' T✓!^/ sc . cu,d f B- 4C 3.P ' - A.) CS . �- 1 ' , • ,, • L 1 + ' / 3 " . SL, /.67 / Q. 54 • 7f 'Av• --R LS, B - .J q5 ia• 9.5 G.Zs 'M;r. / P.s,Av. -se /s, AgeP -80. 5 c. , PERCOLATION TESTS TEST DEPIIi WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES P U � ! ER r¢ / AFTER SWELLING INTERVAL-MIN. PERIOD PERIOD � � e �R�� PER INCH G. P Z ' S ? r ,.. / 'VG / �(� /W6. P -_ P - y s .s-" / i� � � <A /�G yV P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the sure ace � elllevation at all borings and the direction and percent of land slope. 130 7 T 0M l c of 1EP . fiT/a� �� v�- � G x`. TL f 3, k y 17 ' SYSTEM ELEVATION Been() vE r- RfF• PT. A T / /t-rQti 0p +., )T. wz la I i — . _.. i_ -_. I is best si PoR0 D i i ; tOr = eon entio a saPtip s ste III ��—� ! � F / `� , 6 1._ 1 1 / _' v3 t i 1 ' ' c a�. t i / 1� 1 -, _ „ , l ' F i I., i 1 _i_ _ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. BOB UL8I uC$,I NAME (print): TESTS WERE COMPLETED QN: HOMESITE TESriNe' _m: Oe - i , 3. 9 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): RT.), O'NEIL ROAD s's - 6 2 z-692___ 3,6- p/ s>f 1 IUDSON, Wis. . 54016 c IGNATUR : . �� W I " DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 ' To be 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 HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. 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 shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. 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 cob Cobble (3 - 10 ") SS — Sandstone gr — Gravel (under 3 ") LS -- Limestone s — Sand HGW — High Groundwater cs - -- Coarse Sand Pere Percolation Rate rnnd s -- Medium Sand W -- Well fs • - -- Fine Sand Bldg — Building Is — Loamy Sand > -- Greater Than "sl — Sandy Loam < Less Than '`I — Loarn Bn - -- Brown *sil -- Silt Loarn BI Black si -- Silt Gy — Gray `cl — Clay Loam Y -- Yellow scl -- Sandy Clay Loam R — Red sicl — Silty Clay Loam mot -- Mottles • sc - Sandy Clay wf — with sic — Silty Clay fff ,fevv, tine, faint c -- Clay I, r cC -i common, coarse pt — Peat .,. „ rnlh, - -,Matey, medium — Muck d — distinct p — prominent HWL — High water level, `" Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP -- Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set plans for the private sewage system and a permit application must he submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. • REPORT OW SOIL r3oR IN 66 t PER C. L AT IOrd TEST S ./67-746 /1-- /Pew Sbed ,4 -r /A/2 7 pLoT pLAkI pI o rEc T Z". D. ; ;" . c,R,¢TF.2._ DA rE ac-/ L/, i ,J7,,,• .... I40MES•ITE TESTING CO. grr r RT.3, O'NEIL ROAD 130B UL i Ic.ii ALIUSON, W S...._ 54016 es r cc-02 ye'. . P ?o ?O5ED licusE HOST LIE 25 Pr• dR Mote /'O..1 hiz. r /}rPE45. p' Pose' I WELL M V 6T or , 0 FT et ii veer fifer, ALL resr 4A' 5. • r B,4 ''ij ,O,?" j . ,57,,t) 6- LULL• X r Pete- /ocitne.+t = # WP Ailg£RED e,e 54al1EL /3 w5 is = ��,�i�z . C a'! Vtprier►[. krirEp -wcr- Pour 7-0 oow luf3 A 6RAPz Al E T - io Girt 5 k - e - /7 1 :41.4e. /dos r .S5 4. 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