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M O V) N O '6 U Q CT fo Y 2 0 U Q Q U Q I I Independent Risk Factors For Is the statistical association between Bacterial Diarrhea (n=20) holding tank density and infectious diarrhea biologically plausible? • Holding tanks constitute 1/3 of all septic systems in study area • Estimated that 40% of holding tanks have some illegal discharge to surface • In Wood County, year 2000,40 millions gallons of holding tank wastes were unaccountable • 19% of conventional drain fields were constructed before 1970 and are assumed failing • Pathogenic bacteria and viruses can be transported long distances and survive for months in the environment Univariate Associations between Potential Confounders with Diarrhea Etiology and Drinking-Water Septic System Density Source • Livestock density • Waste water landspreading Etiology Risk Factor OR 95%cl v • Access to medical care viral Household uses 2.08 0.80-5.42 0.134 • Some unknown risk factor correlated n=18 wad ~d municipal with septic system density Bacterial Household uses 2.44 0.91- 8.87 0.078 • Children and pet densities are not rk20 private well correlated with septic system densities in this study Well Water Analyses -191 Water Quality Indicators and Samples Infectious Diarrhea by Etiology Frequency Percent P-value from Univariate Logistic Regression Total coliforln + 44 23% n=8 n=14 n=10 rr30 Fecal enterococci + 7 4% Risk Factor Viral Bacterial Protozoal Unknown Total 0.95 0.49 0.22 0.61 E. soli + 2 1% coliform+ Pathogenic bacteria 1 0.5% Fecal 0.98 0.99 0.98 0.02 enterococci+ E. coli+ 0.99 0.99 0.08 0.99 6 i Independent Risk Factors for Adjusted Population Attributable Diarrhea of Unknown Etiology (n=30) Risk Percent 85% Cases adjusted caalaence Risk factor Adjusted 95% cl p Etlology Risk Factor Exposed PAR Interval OR viral Number ofholdng 28% 20% 2%-42% Private well 6.18 1.22 -31.46 0.028 n-19 tanks In same 640 acre positive for fecal sec0on enterococci Bacterial Number of Irotdng 35% 19% 0%- 39% M." IuNa in same 40 acre / Household 4.06 1.66-9.94 0.002 1/4114 sectlon member had Unknown Private well posltive 13% 11% 2%-23%. diarrhea past 4 1=3o for fecalonteroeoeal weeks Study Limitations Summary • Case and control study does not show Holding tank density was associated with viral cause and effect and bacterial diarrhea in children • Small number of cases could lead to • The observed association may be due in part overestimation of adjusted odds ratio to the correlated effect of other septic system • Findings may not be generalized to types other areas with different proportions of • Groundwater did not appear to be a septic system types transmission route from septic systems • Potential selection bias from enrolling • As much as 20% of viral and bacterial only those children seeking medical diarrhea in rural Marshfield may be attributed treatment . to holding tank density Study Team Acknowledgements 7 COU~ o CRD~X PLANNING ZONING May 16, 2008 Mr. Chris Hanson P.O. Box 487 Hammond, WI 54015 RE: Sanitary Permit Application for new POWTS Code Administration Subject site: #136-1031-10-100 Lot 1 of CSM #781608 715-386-4680 1656 Clyde Hanson Rd., Village of Hammond Land Information Planning Dear Mr. Hanson: 715- 386- 4674 This letter, in compliance with Wis.§ Chapter 145.20(2)(c), provides written notification that Real Property the St. Croix County Planning and Zoning Department has disapproved the POWTS 715-386-4677 sanitary permit application submitted for review on May 14, 2008. Recycling The application was for the installation of a new holding tank on the above referenced lot, 715-386-4675 which was created in 2004. A building was constructed on the lot, but there is no existing Private On-site Wastewater Treatment System (POWTS). As per St. Croix County Sanitary Ordinance Chapter 12.F.5.a Prohibited POWTS - Installation of the following technology, designs, or methods as POWTS components are prohibited: 1) Holding tanks for domestic wastewater for new construction. This prohibition has been part of St. Croix County ordinances since 1986 and because there is no existing POWTS that is in need of replacement, a permit cannot be issued for installation of a holding tank on this lot. A soil report completed 4/22/08 and submitted with the permit application indicated that areas on this 1 acre lot had been altered during excavation for the building and driveway construction. Due to fill over existing soils and seasonal high groundwater, the Dept. of Commerce would have to conduct an on-site evaluation to determine if an individual site design mound could be considered for wastewater treatment. Wis.§ Chapter 145.20(2)(c) also requires that you be notified of the right to appeal the disapproval according to the procedures contained in Wis.§ Chapter 68. If you have additional questions regarding this denial, you may contact me at the Code Administration phone number weekdays between 8:00 a.m. and 5:00 p.m. ' cere ('Pamela Quinn Zoning Specialist Cc: Todd Sinz, POWTS installer Village of Hammond Kevin Grabau, Code Administrator ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715-386-4686 FAx ,i ` Safety and Buildings Division Counter ~ n ~ 201 W. Washington Ave., P.O. Box 7162 CGS C.. Cb 1 aff ~seonsirn Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co,) (608) 6-3151 Department of Commerce Sanitary Permit Applieati State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informat ou provide IS 3 ~0 may be used for secondary purposes P ' 1 Project Address (if different than mailing address) 1. Application Information - Please Print All Infor ation me Parcel # Lot # Block # ProperCC~X~.( v OH'nef '~s N~a MAY 14 2008 S s Property O is Mailit Address L ST. ROIX COUNTY Pro a -Location V~b ( ZONING OFFICE v t Section j~ City State ',,At Zip Code //Phone Number y`~/` ~A~~ tSJ~ 1~~~"~C~3Z, / ^{circleone) 10 Y0 ( T N; R t ( E or(! H. Type of Building (check all that apply) Subdivision Name CSM Number Pr or 2 Family Dwelling - Number of Bedrooms I ❑ Public/Commercial - Describe Use ` ❑ State Owned - Describe Use ❑Ciry_ jllage~. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. (New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B List Previous Pennit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expirat'i'on 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. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation D " VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks .,5SpijGAr Holding Tank 00 L O Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi , a ume sponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum be Si at a MP/MPRS Number Business Phone Number a p~ G Siff Rp 135(t Z 17(S'- 239 26q,;( Plumber's Address (Street, City, State r,Z p Code F, r(o 0 g o Y ,e ~.yr vx, i s t,./ 7, VIII. Coun /De a ent Use Only ❑ Approved D' pproved Sanitary Permit Fee (includes Groundwater Date Issued I utg A nt Signature o Stamps) Surcharge Fee) Q/ t IR/Owner Given Reason for Denial UGC IX. Conditions of Approval/Reasons for Disapproval Oct 2. S__ PIYOA~ 0( _A 4 -4 L-0 ,ems-- p-ri- .41i~-c•~ ~g~( B~i.~t,,~~rvc~o . Attach complete plans (to the County only) for the system on paper not less than SW it 11 inches in size SBD-6398 (R. 01/03) I f~ t VOL _ 19 PAGE 4887 rn- XA H. NAI-~--- 1RN1 J. REGISTER OF D1333M ST. CROIX CO. VI RECEIVED FOR RECORD r 12/63/2004 12z40PD1 ACRES ASSOCIATES CERTIFIED SJJRVE7 MAP 3433 OAKWOOD HILLS PARKWAY EAU CLAIRE. WISCONSIN 54702 430256.h.DON Ta-• CREC OPY ERR : 1 .0 ' ST. CROIX COUNTY CERTIFIED PAGJ35t 2 SURVEY NAP NO. 4887 LOCATED IN THE PART OF THE NE 1/4 OF THE SW 1/4; SEC: 28. T29N. R17W. VILLAGE OF HAMMOND. ST. CROIX COUNTY. WISCONSIN W '14 COR. UN_PLATT_£_D_ LANDS E COR. SEC_ 28 _ SEC. 28 - - - - 5216.091- - - = S89.25' 46"E - - - 2702.78L ' 2305.53' POB 208.75' 66. 02'~~t 1 1 NE-sw . g1 1 al 1 # W Wr 1 ^1J s ~1 a0 1 J ' r kn nor 1 N 6 ' lz ~ 0 1.000 ACRES c V g{ o N 43562 SO. FT_ N a a 1 J~ 1 i1 ~ v°1 Iw $11 ~o Iln M 1 VI Vf 1 OW\zil _0~+._ 10 Ci~ , 1 D Y N Tr 'ji Z N = ►~.1 R LLH - 208.75' - ; LL g o N89.25'46"W w UNPLATTED LANDS wCi6-4m 1388.215' x x ° 1 i--5869.46.17"E H LEGEND: 1 : Ma I O SET 1" 00 x 24' IRON PIPE 1 - .0 11 N 'WEIGHING 1.13 LBSiLF m v► a FOUND 3" ALUM. MON. 0 3o so • FOUND 11/4" IRON REBAR 0~ In POB POINT OF BEGINNING SCALE: 1"-60' - N89.46'17"W 1388.21' ClTYOE HANSON OR 1. Horey-B. Warden'. Registered Land Surveyor. hereby certify to the best my Of knowledge and belief: That I have surveyed. divided and mapped part of the Northeast Ouarter of the Southwest Ouarter. Section 28. Township 29 North. Range 17 West. Village of Hammond St. Croix County. Wisconsin bounded by a line described as follows: Commencing at the west quarter corner.of said Section 28: w~ Thence 589125'46"E. along the Bost-west one-quarter line of said sectlq ~ 2305.53 toot to the point of beginning: Thence S89125146"E. continuing along sold line. 208.75 feet: "•.•s~ Thence 500.55153"E. 208.75 feet: ..t Thence N89'25'46"W. 208.75 feet: srs• RY B. ' Thence NOO 55'53"W. 208.75 feet to the point of beginning. WARDEN I Parcel contains 43562 square feet or 1.000 acres, more or less. ` u S-2182 and is subject to easements of record. y MOMDOVJ (continued on Shoot 2 of 2• VVJ 9N0 su~~:r~=~;;~ ~ DATE A PROVED eewo4~: V(LL GE F HA ON BY • Sheet 1 of 2 Vol 19-Page 4887 i R Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in actor ce with Comm t35, Ws. Adm. Code Attach complete site plan on p ~11 inches in size. n must County include, but not limited to: verb OWN! ntal reference point (BM), di n a Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance st r Please print all information. n eview d by Date tJ Personal information you provide may be used for sec ary pu ns (~j ~YW 15. Property Owner Prope y Loca J_ U V-S 4 20 Q lGovt. . It S U) 1 /4 f U) 1 /4 S 7 N R 17 Property Owners Mailing Address Lot # Block # Subd. Name CSM# C j0%.,CR0IX COU TY City State Z ode Pho City Village Town Nearest Road 10 New Construction Use: Qa Residential / Number of bedrooms 7 Code derived design flow rate 7 GPD C] Replacement Public or commercial - Describe: Parent material Flood Plain elevation applicable ft• QQ p - ~ Q ` General comments e CLyrL g)CLgd0.Ct4ti a-WT and reco mend ions: (J / ~oY- Cov+.~paf,-~cptti 04 el l^QLL_ c,) Wes' -64-4u,U ~ ~tx,-w~, •@- S cCC~ c~ w~ h°` 5 ~e2r~ Ct~ o is er- t~w.CS~' tk i S 4'e- Boring Uj Boring # ~ Pit Ground surface elev. ft. Depth to limiting factor in a Soil Application Rate ounda Roots GPD/ft= Structure Consistence B ry P . Eff#2 Redox Description Texture Dominant Color Horizon De th 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff# lD`14 3 G ZJ 5 rw c~ Z 2/-313 7L L( 6,3 o S a s Boring Boring # ft. Depth to limiting factor -:?C in. Pit Ground surface elev. ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 T cIF~S C 5 _ 46 59- Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Prir~tl,lll 1181dt Sig tur WW i 4 b L?4 -Z_ Dort Evaluation Conducted Telephone Number Address W 3503 Hemlock Rd. o2.b C Mondovi 54755 715) 832-0020 Property Owner C' `r 5 ~I~ t^6 0✓~ ParceLtb '6age Z F-31 Boring # Boring IM Pit Ground surface elev. ft. Depth to limiting factor Z 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 0-9 oY or d-~ 6( k2s 5''Z c~yn,. y s ~..5 2 -j -Y Q 4-12 -3p ,~j-y 5 CZ ~`'1/z 5~ ~5 ~m~ S fs,L ~ z p-3 36-y 7y1~~ 3 2 ~s C/ n Boring # o Boring Q l ~ I *-pit Ground surface elev. ~y3 ft. Depth to limiting factor Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 P 6-1 ILL v4l ~ C$ ZZ z ~ y C Boring # Boring Ground surface elev. Depth to limiting factor in. 9 Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 'Eff#2 6-q 2Y orv~ 5 vri. r ~g p- 09 z P'l s~L y 5 z 3 ► 5 -Ac O -q 9 3 IL14Z4 s wr'~'r S Z- p-z- © 3 2 c2f?5'i2 4r S Z~ 0-7 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L - Effluent #2 = BOD, < 30 mg/L 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. SBD-8330 (8.07/00) C5D a q 40 i d N ~a co .2 o _ 2 F- rn a O cn Parcel 136-1031-10-100 05/14/2008 03:36 PM PAGE 1 OF 1 Alt. Parcel 28.29.17.227B2 136 - VILLAGE OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/03/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner CHRISTIAN C HANSON O - HANSON, CHRISTIAN C PO BOX 487 HAMMOND WI 54015-0528 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC / Legal Description: Acres: 1.000 Plat: 4887-CSM 19-4887 SEC 28 T29N R17W PT NE SW BEING CSM Block/Condo Bldg: LOT 01 19-4887 LOT 1 (1.000AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-17W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 12/21/2004 783104 2719/351 WD 12/02/2004 781608 19/4887 CSM 07/23/1997 744/463 2008 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: st Changed: 10/19/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 1.000 200 0 200 NO Totals for 2008: General Property 1.000 200 0 200 Woodland 0.000 0 0 Totals for 2007: General Property 1.000 200 0 200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ?'83104 k` u1 2 7 1 9 P 3 S KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX Co., MI State Bar of Wisconsin Form 2-2003 WARRANTY DEED RECEIVED FOR RECORD 12/21/2004 11:15AK Document Number Document Name WARRANTY DEED EXEMPT # THIS DEED, made between Christian C. Hanson and Evan E. Hanson, d/b/a REC FEE: 11.00 Hanson Farms, a Wisconsin Partnership TRANS FEE: 3.00 ("Grantor," whether one or more), COPY FEE : and Christian C. Hanson CC FEE: PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more Name and Return Address - ~..o...~., space is needed, please atfacn addendum): - 900 Main Street P.O. Box 54 Located in part of the NE '/4 of the SW N R17W, Village of Baldwin, WI 54002 H n , t. Croix ou onsm, described as: Lot 1 of Certified Survey Map recorded on December 3, 2004 in Vol. 19 Page 4887 136-1031-10-000 Document 781608. Parcel Identification Number (PIN) _ This not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this day of December, 2004. - (SEAL) (SEAL) * Christian C. Hanso/n~ (SEAL) (SEAL) Evan E. Hanson . AUTHENTICATION ACKNOWLEDGMENT Signature(s) Christian C. Hanson, Evan E. Hanson ) STATE OF WISCONSIN authenticated on this day of December, 2004. ) ss. • ST. CROIX COUNTY ) * Thomas R. Schumacher Personally came before me on December 1 , 2004 , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Christian C. Hanson Evan E. Hanson (If not to me known to be the person(s) who exec he fqrp 'J* authorized by Wis. Stat. § 706.06) instrument and a nowledged the same..` THIS INSTRUMENT DRAFTED BY: • ' * o Thomas R. Schumacher, Bakke Norman, S.C. ~ -70 6w_ :O Notary Public, State of Wisconsin My Commission (is permanent) (expires: f ' :07. . (Signatures may be authenticated or acknowledged. Both are not necessary.) • • s ~ NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEAR IFIED.S WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN 3 ' Type name below signatures. a _ Safety and Buildings commercemi. ov 3824 N CREEKSIDE LA g HOLMEN WI 54636 TDD (608) 264-8777 i sco n s i n www.commerce.wi.gov/sb/ Department of Commerce www.wisco isconsinsin.go .g©v Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary May 07, 2008 CUST ID No. 139462 ATTN: POWTS Inspector TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751-5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/07/2010 Identification Numbers Transaction ID No. 1534671 SITE: Site ID No. 737117 Chris Hanson Please refer to both identification numbers, Clyde Hanson Street above, in all correspondence with the agency. Town of Hammond St Croix County SWIA, SW1/4, S28, T29N, R17W FOR: Description: One Bedroom Holding Tank / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1181516 Maintenance required; 150 GPD Flow rate; System(s): Holding Tank Component Manual, SBD- 1057 1 -P(R. 6/99) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • The activities relating to evaluation and monitoring POWTS components after the initial installation of the POWTS in accordance with an approved management plan shallbe conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(4), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, whichmay include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. P.O.W.T.S. Conditional v .APPROVEU Acow nr.~~.._ TODD L SINZ Page 2 5/712008 • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • In the event this POWTS or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety &Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe builling, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others Wio are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 60.00 `Fee Received $ 60.00 Balance Due $ 0.00 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G JanskY, POWTS Wastewater Specialist, (715) 726-2544 Friday, 7:00 A.M. To 3:30 P.M. i MAY 0,# 2008 -°vILDINWNCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Chris Hanson Personal shed Owner Chris Hanson Address 1655 Clyde Hanson St Hammond Wi 54015 Legal Description SW1/4 SW1/4 S28 T29N R17W Township Hammond County St Croix Subdivision Name na Lot No. na Parcel ID Number No (03CA 15 a00 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Designer Todd L Sinz a Signature Phone No. 715-235-2644 License Number MP 139462 Date 05/02/08 Designed pursuant to: Holding Tank Component Manual For POWTS SBD-10571-P (R.6/99) Version 5.0 (10/05) Page 1 of 4 t}t.€-AR7TVIENTOFCori ":r\:.is DIVISION OF SAFETY AND 6UJLD1J-dGS SEE C h SF~pA a m v ~ V J q Jt) r ~ vl~ S. O' t 4ru If 2L 4 J~~C y o 3 'd 5Z5l.2£851l. IC13H Rd ZO,-Ot 8002-ZZ-K HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6/11/1999), and the St Croix County Sanitary Ordinance. 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 600.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in _ the attached Holding Tank Servicing Contract and Maintenance Agreements. _ 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to _ empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer Todd L Sinz T L Sinz Plbg Inc. Phone: 715-235=2644 b. Service Provider Todd L Sinz T L Sinz Plbg Inc. Phone: 715-235-2644 c. Co. Zoning or Health Dept. St Croix Zoning Phone: 715-386=4680 11. I I Project: Chris Hanson Personal shed Transaction Number: Page 4 of 4 05/09/08 FRI 10:13 FAX 715 386 4686 9 002 HOLDING TANK SERVICING CONTRACT Contract Date 5I) 2log This contract is made between the Holding Tank Owner(s) Name(s) and Pumper's Name (2,,N*S 4"1S '7~ L - r r a- TucPA6 Jr-1 -17 1 rUC We acknowledge the installation of (a) holding tank(s) on the foil owin property (Provide legal descriptions: cbFb t/ 1~ a 1,j 7 Ll) Q 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(-)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Deparbnent. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for r" -barges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has ~I -mod to the County, a report for the servicing of the holding tank(s) on a se agrees to include the following in the semiannual report: a. The name and address of the person responsible for serv ~C b. The name of the owner of the holding tank; C r~ ! 8 c. The location of the property on which the holding tanI e6D d. The sanitary permit number issued for the holding tar_ e. The dates on which the holding tank was serviced; £ The vohune in gallons of the contents pumped from the holding tank _ g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's ignature(s) Subscribed and sworn to me on this date: 'rodays late Pumpers Name (Print) Pump s at Notary lic Signature c )o 7- Pumper's Registration Number Commission "xpira i a35~ ~ a~ ~ot~ 05/09/08 FRI 10:14 FAX 715 386 4686 11003 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer CA 12\ S A kll~ ISO 1J Mailing Address -?6 ll(3 ot,33 Property Address 1 d0 (Verification required from Planning & Zoning Department for new construction.) City/State l~_~Q K~D Parcel Identification Number. _ l3 (03l -~D-Ibd LEGAL DESCRIPTION Property Location Y., Sec. , T oN R 1 W, VTawwof Subdivision Plat: , Lot # Certified Survey Map # Volume I 'Page # U 8~ . Warranty Deed # _ A (before 2007)Volume Page Spec house ! yes,~to Lot lines identifiable 1-1 yes L, no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber 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. 1/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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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, by virtue of a warranty deed recorded in Register of Deeds Office. Number f ,,rooms - "o, SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 05/09/08 FRI 10:12 FAX 715 386 4686 IIII II++ II 0 I IIIIIt I~III IIIfI II~~I I ~ ~IIII f I l * 1 ~~~~'II~~I IIII III 8 7 4 7 6 0 1 DOwmentNumber Document TO 87,4 760 KATHLEEN H. WALSH St. Croix County R EGISTER OF DEEDS Holding Tank Agreement ST. CROIX CO., WI RECEIVED FOR RECORD [state Plan Transaction Number- 05/14/2008 10:15AM HOLDING TANK AGREEMENT Name - (Owner) Typed or printed EXEMPT r Being duly sworn, states, under oath, that: REP FEE : 11.00 1. He/she is the owner/part owner of the following parcel of land COPY FEE: 2.00 1 located in St Croix county. wisconsin, recorded in Volume 7 L~l PAGES: 1 Page &S 1 Document Number JY"O t Croix County Register of Deeds Office: Roccudifur Area A parcel of land hoc tact in the of the~_W'/. of Section N'"" and a°w`"'tda""` ~Z , T, N - R T W, Town of e pa t + ~ 71 wt tl ~.P t,•/ L o h MM elJ , St Croix County, wisconsin, being p r ~J ` duly described as follows (include lot no. and subdivision/CSM or .3kQ j0-3C)1C5-aG0 detailed legal description): klonliftiallon Number (PIN) Apreerherd044: 12 6 1 La rl of CSPI 9 -'qfi st l'34-j031-to -tco We admoaledpe tai applk;ation is being made lorths In sisdis on of (a) noldkg tank(s) on tie "bow deaoribad properly or tlW eerhWted use diha exlelidg premises requires set a holdkg tank be bswied on the property for the purpose at proper containment Of sswege. Also, a muddpet seair osridbt raw serve tins properly, or any Otw type of prvate walls wastewater treatment system a Psm9lted undo XV1 n 83, Wb. Admin. Cod", a § Ch. 145. Wit. staff. indwarnent to to county to issue a sanitary permit for the above desarlbed properly. we agree 10 do the following: 1 , Corer sprees to oonforrn b at app0able requirements of Comm 83, Wis. Adm. Cods o hok lnp tanks. N to owner falls to hew the tickling talc properly serviced In raporae to orders Issued by Ow ow4am uncial unit or of C vanace b proveni or abed a human heath hazard as described in s. 254.59, sate., to govenrrenbil urad (Town) may ever upon the property and service l he adu Or cause to taw Via tank to be serviced and charge the owner by placing the charges on the ax bill as a special assessment for ounert mvbn rendered. The charges wit be assessed a proscribed by a. 68.0703. Sale. 2. The owrw agrees. parsuent to Comm 83.64(2) and Comm 82.40(3xe), Win. Adm. Cods, to have a water meter Installed in !ins structure. The water meter Ned be Installed by a pknt)er wYhodzod by the Veparhnent"Of Ocinmsme• 10.make such-m"vora, with laid-IhalMddtf' complying with sate regulations and manufacturers spsd8catlons. The owner egress w to flnenclely responsible for the purchase. IrMelsfbn, maintenance, and repak at the water meter, and apross to allow the govwnmentai unit or the Department of Commarce lo enter the above-dactbed properly on a regular basis to read andlor Inspect the waar mater. 3. Owner egress to pay AN charges and cosa'Inowed by the g tal unit or county for inspection, purnpkm. hauling, or otherwise servicing and maintaining to holding teak In tueh. a manner as to prevent or abate any human health hazard caused by to holding ar& The governmental unit shad no6y the miter or any costs tat Nall be pakt by the owner within thirty (30) days from to dale d notice. In In and to owner do" rot pay the costs within WWh~yy (30) days, Ye owner speaceliy agrees that all the costs and charges may be plecadon the mill as a specaiN assessment for the abalerilerht of a human heft hazard, air In tax shat be collected as provided by law. 4. The owner agrees to contract with a person who is Iiansed under Ch. NR 113. Wis. Adm. Code, 10 thaw to holding tank serviced and b Ise a copy of the contract with to gowmmw* unit. The 00anr further agreed 10 NO a copy Of any Chwgat to to semis 00000Ct, Or"Copy Of e now servtos contract, with to govemmemal unit within ton (10) business days from the date of change to the service contract 6. The owner .pressloombectwith a person Ncensed under Ch. NR 119. Wis. Adm. Code. who" submitto the county on a sordenmd basis a report deleting the servicing of iHs holding tank The govemmenW unit or county may enter upon the property to kwesagaM to COrdtlon of the holding tank when pumpl reports and meter reading* may bdicale Bast the holding tank w rat bainp properly maintained 6. This agramert wit remain In effect Ody ' the county office responsible, for the regulation of private mom wadswelar treabnenl systems certities that NYer a mwrtclp l sewer or private onsts wastewater trwimerd system that Wmpda with Comm 83. Whs. Adm. Cods servos the property. In addition, this epreeriwnt be cancelled by wwouting and recording sold oedMcNbn with reference to this ag t M such manner which std psmtt the of the aAMwBon lo be determined by reference to the property. 7. This agreement shard be binding upon the wamr, the hairs of the owner, and assignees of the owner. The owner shall submit this egreenfort to the regWer of deeds, and the iignfem t sherd to recorded by to register or deeds In a mermen tat will permit the existence of the agreement to be determined by reference the property, where the holding tank is Installed. r a) Na s) - Plante PA kr_ Subscribed and swam to before me on this date; +``w(t C AR 11A -V5 1110~1 121100b IQ T n O Note rtes Notary Public 2 T~ - emmental UnkkWkW Name, Tide - Plsasq Print Comrnieston Ines $ `\G 2 PO,OA)e,y 7av-4 1 Urtt signatwa i craned ':I'" O~, lW llnG Personal bfor anon you a may be used for secondary purposes (Privacy Low s. 15. 1 xm ) 'THIS PAGE PART OF TN 8 LEGAL DOCUMENT - DO NOT REMOVE" This kiarmaggt must be complied by au name b rotum addretbt end M (1l mquked). O(her kdbme5on such a Ye granikg dauses, kgal desafp*4 eta may be ced on this flat page of the document or may be placed On ad*WW Pages of ire docrmerrt Tv Plame 131 K EEN H. WALSH RISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD 08118/2003 12:00PN CERTIFIED SURVEY NAP EXEMPT * AYRES ASSOCIATES REC FEE: 11.00 3433 OAKWOOD HILLS PARKWAY TRANS FEE: EAU CLAIRE. 715-834-3161 WISCONSIN 54702 011824EH.DGN COPY FEE: 2.00 ST.CROIX COUNTY CERTIFIED CC FEE: - PAGES1 1 _ s U/ SAP NO. 4589 LOCATED IN THPARTX0 THE NE 1/4 OF THE SE 1/4 OF LU / rc3~' ID3c1 ~S o~QO SECTION 28, T29N, R17W, VILLAGE OF HAMMOND. ST. CROIX COUNTY, ISCONNS N UNPLATTED LANDS - - - - - - - - - . S89°32'07"E- - - - - - -5215.86'- - - - - - - - - - - - 2580.18, - - - - - - S89°32'07"E- - - - 357.881 - - 2277.80'- - E1/4COR. POB , Y00-00' W/~COR. ~ I 157.88' • ~ LOT 1 LOT 2 W FND."10 ' r 65178 SQ. FT. 87227 50. FT. a W 1.496 AC 2.002 AC I I ~ c 000 I AR a O V1 N 11v O~ 1 it N N Z W ~D S Jz Q J p I NI 1 BIT. w N ) WLLN LL 0 W I C 1 N m O W r' z CO W~ Q z o a ~c oL rA CJ 1~ Z I I r 1 ' MT-1 a z o o 04 VQL.6,P_A € A OJ r Z o ~W m ZI Www S W SV~i o m,- a: IV O O OO~ 0 50 100 N89°32'07"W SCALE: 1"=100' I 200.00'0 LEGEND: z SV O SET 1" OD x 24" IRON PIPE o i 200.00' WEIGHING 1.13 LBS/LF o , N89432'06"W 0 FOUND 3" ALUM MON. I • FOUND 3/8" IRON REBAR (UNLESS NOTED) SV SEPTIC VENT N89°32'07"W 357.88' WL WELL 3T Jr 1 4s POB POINT OF BEGINNING UNPLATTED LANDS I. Gregory J. Raymond. Registered Land Surveyor, hereby certify to the best my of knowledge and belief; That I hove surveyed. divided and mopped port of the Northwest Ouarter of the Southoost Ouarter, Section 28, Township 29 North, Range 17 West, Village of Hammond. St. Croix County, Wisconsin bounded by a line described as follows: Commencing at the West one-quarter corner of said section; Thence S89°32107"E, on the east west quarter line. 2580.18 feet to the point of beginning; Thence 5.89°32'07"E; on said line, 357,88 feet: Thence S1.02115"E; 426.00 feet: Thence Ne9°32'07"W; 357.88 feet; Thence N1°0'1'15"W; 426.00 feet to the point of beginning. Parcel cortains 152405 square feet or 3.498 acres of land, more or less, and is subject to easements of record. That I hove made this survey, land division and map at the direction of Evan Hanson, owner of said land. That said map is a correct representation of the survey and the land division thereof mode. That I have complied with the provisions of Chapter 236 Section 236.34 of the Wisconsin Statutes and the subdivision regulations of the Village of Hammond in sur eying, dlvidj,ng and mappin the some. 1-t kwl~ Z_ 0 Gregory J. R mond. S 5-2506 Doted this aay of _C? 2003 at Eau Claire, Wi. f M i -2506 s Vol. 17 Page 4589 ~,v3STRUM ' WI -1AF6 "s-se SUR Sheet 1 of 1 s , Parcel 136-1030-955-200 05/14/2008 03:24 PM PAGE 10F1 Alt. Parcel 28.29.17.227A2 136 - VILLAGE OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HANSON, CHRISTIAN C CHRISTIAN C HANSON PO BOX 487 HAMMOND WI 54015-0528 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1655 CLYDE HANSON DR SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.496 Plat: 4589-CSM 17-4589 SEC 28 T29N R17W PT OF NW SE LOT 1 CSM Block/Condo Bldg: LOT 01 6-1572 NKA LOT 1 CSM 17-4589 (1.496 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-17W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 08/18/2003 736131 17/4589 CSM 06/24/1986 744/463 QC 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/19/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.496 44,900 280,400 325,300 NO Totals for 2008: General Property 1.496 44,900 280,400 325,300 Woodland 0.000 0 0 Totals for 2007: General Property 1.496 44,900 280,400 325,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 05/14/2008 Batch 08-05 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00* 0 00, 0 00'0 1 8101 se6Jeya;uenbullea seBJego leloadS s;uewssessd leloadS ;unowV tioBa;ea opoa leloadS Jasn :slehads 431ea :a;ea uol;eol;lpaa 0 :;unoa wlel0 :IIpaao Aaano'1 0 0 000'0 puelpooM OOb 0 OOb Z007 A:pedoJd IeMeD :LOOZ Jo; WWI 0 0 000'0 puelpooM 00-V 0 OOb Z00'Z A:pedoJd [MuOD :9002 Jo; sle;ol ON OOtb 0 OOb Z00'Z tiJ -iv~Inlif101Ljov uoseeM a;e;S Ie;ol anoJdwl pue-1 Sojov ssela uol;dijosaa 900Z/61/01, :paBue4a ;se-I : suOljen IeA ;uawssassy amen ash :y;lnn passassb :enlen;ai{JeW J!e3 1118 Jluvwwns 8O0Z £9,V/t7t,L L66 UEZ/LO WSO 689t,/L6 6£69EL MOM/ /80 (IM Z09/OOt?Z 9,99£L EOOZ/t,0/60 ode j. abed/Ion # ooa a;ea :tio;slH IaoJed :sa;oN 3S MN ML 6-NK-8Z (ti/6 09l tb/6 Ob Buhl-unnl-oaS) :(s);oeJl (Od ZOO-Z) 689b-L L ZO lOl :Bple opuoap10018 WSO Z 10l 3S MN 30 id MMA N6Zl 8Z O36 689b-L6 WSO-699t, Ield Z007 :saJObr :uol;dl.iosea Owl OilM OOL6 dS -1V8iN30 X1080 1S ZZtZ OS uol;dijosea #;sla edAl tiewud . , :(se)ssaappy A:pedoJd leloadS = dS Ioo4oS = OS mowsla K90-Mt,S IM 4NONINVH L8t, X08 Od O Nb'IlSRJHO `NOSN`dH - O NOSNVH O NVUSI2]HO launn0-o0 jualm0 = o 'jauMO juanno = 0 :(s).ieunnp :ssaJppy xel 0 00 edAl;Iwaad #;!wJad # uol;eollddy eaJy sales # deW 93ea IeolJO;sIH a;ea uoneaJa NISNOOSIM '.llNnoo XIO~1O '1S X ;uenno dNOWWt1H dO 30VIIIn - 9E6 £`dLZZ'L6'6Z'8Z IaoJed IIV L 30 L 39Vd Wd 117:0 sOMM4/90 00£-56-0£U-9£ 6 IaOaed ,~7~A' E aF ~~+r~?PL a.✓,U LED 1 Au% 301985 N a SA" 06 oowNBL of DO$& t.ohMr • CERTIFIED SURVEY MAP NO. VOLUME= , PAGE 1572 . LOCATED IN THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 28, TOWNSHIP 29 NORTH,RANGE 17 WEST, VILLAGE OF HAMMOND, ST. CRO/X COUNTY, WIS. .C., (...F~:"-•> ..~~-era>~ , ,"J,~~ UNPLATTED LANDS NORTHWEST CORNER OF THE NORTHWEST QUARTER OF THE SOUTHEA S TQUARTER WEST QUARTER CORNER PER THOMAS G. KUESTER, 1983. EAST QUARTER CORNER SECTION 28, T. 29N.,R.17W. CENTER OF SECTION PER SS. 59.62 SECT/ON28,T.29N.,R.17W. --•2580. I8 .36, ' S 89° 32 X07"E ~T17 ----2435.80---- 200.00 ' LITY EASEMENT 6OREC., P. 545 LOT / o m O 65,178 SO. FT. 0 b BILE 1.50 ACRES tit it ly m ~ 'm io o ~o r in Ir HOUSE N iy m a WELL BEARINGS REFERENCED TO THE NORTH O O LINE OF THE SOUTHEAST QUARTER OF SECTION 28-29-I7. RECORDED AS ASEPTIC I~NT N 89°32 X07°W. N 89032'07"W 200.00 ► UNPLATTED LANDS SCALE' I " = I00' 50 160 2 33' 1 33' T NOTE, ACCESS TO LOT TO BE PROVIDED BY LEtt~El~lD SEPERATE DOCUMENT (IF NECESSARY) FOUND BERNTSEN ALUMINUM CAP PREPARED FOR : CHRIS HANSON O RESET I I/4 "x 30" RE-ROD WEIGHING HAMMOND,WI 4.30 LBS./L.F. O SET 314 "x 24" RE-ROD WEIGHING 1502 LBS./L. F. ' • • • s • MONIE i WIS. ~ Ofesess Ole Su Vol. 6 Page 1572 CEDAR CORPORATION 604 WILSON AVENUE MENOMONIE,W/ 54751 X151 235-9081 PAGEIOF 2. a o a o ,r 03 O °Fn ti v Q c c a 0. O O es j o > = C'. M w0 UL Oa O i! O O F- = > N o O O 45.9 C N M ~ p 0 c a c M o a m oa3c fn v oUm).NQ o_m A oow o L a o cZ a c E m I I 0 ~ y Z! X y N 0 p L N CL m a~ I - m a a~ - o - c c = o 0 0 cc u v z L 000 a z L~ U = C N -v - - O ' c ~ m U m a I a~ i II"I c LL C U. O LO U O O N y N L - a0 C - - ~0 - a ~ c 3 ~ a ~ a o M = a E O N o a a Q U m o 7 Q vo, ao m I' M M CL 3 W Z y t O a+ O 00 N 3 a co a co N F- Z II I O Z a li c c d Z~ o c o (n F- e- N N E E m m (D N N 4) m N CL C O N N N N N • N N N N L li ' a` a` I O Q O O "'zmz O z N mz LO U) ° N co m =m LO a o o a +m` o E ' E o _0 co a ` a o 'co ` a z > _ Fy- H Fes- d = = H H F dl z O O O ' O O O •N p`mmm oaaa a c c In 0) 0) U) Lo Lo a U) 00 co fn J U= rn rn Z = a) a) } C~ C) U O O a U O O a (D N ~1 0 LO O - O N c a rn LO m c LO co cD a m O c0 a w a) v m ¢ zU) a Q> (n m a U 3 1U O c y y = N ^!1 r„~ O N E U) C 0 -O O N C O E O O N N Q E _ N ip O S 'O 0) N O L N C C N t N O c V a O O O VV O N= O O C -O N N N U) Co C) r": (n U) CO 7@ C CN ° o o y Z d o co y v Z a CY) cp N m ''I c c E a c~ c° E L M ao - m o N o o m o o w m o • IV' N > 2 o Z 2 F- Z = c0 O Z UJ €a € v e~ 3 EL L: a L: a a r~ o M o 3 '0 1 3 'o r A 0 a2I';0 mU 0 rnU DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: W4, SE-,, S28, T29N-R17W] CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hammond ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound E E : ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Chris Han son Route 1 Hammond WI 5401 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FRO PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale E. Hudson 6629 St. CrQix 119457 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO 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 ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE- DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 110- MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED. MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST---- ► Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) Zoning Administrator =Dff1jLn SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY _5~1 If STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 119"9,S,7 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTYpWNER PROPERTY LOCATION (fh ri 5 p/~ p 6()'/a S,A S Z~ T Z9, N, R / a (or) W PROPERT Y OWNER'S MAILING ADDRESS LOT # AIX BLOCK # 01 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER -z~68 Gv N4 II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) ❑ State Owned VILLAGE : 4~0~ r ❑ Public 1411 or 2 Fam. Dwelling-# of bedrooms= PARCEL AX NUMBFSR( ) III. BUILDING USE: (If building type is public, check all that apply) a7 l' 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2.,1ns1 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM -INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ki / ELEVATION 1 ZD •7.3 S13 /.L 16 Feet 16 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New lExistin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank /O00 /000 / ec_ S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 017ZO 140"n 5f Bo ,'n S D IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Ias 'ng Agent Signature (No Sta ) Approved I El Owner Given Initial ~~pD / ► Surcharge Fee) Adverse De rmination I yS . oo 0 0 X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) s APPLICATION FOR SANITARY PERMIT STC-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 Location of property NW-114 -s, 1/4, Section , T,29 N-R 17 W Township Mailing address Address of site e Subdivision name ~I1rJ Lot number //X Previous owner of property x1a17.50'7 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes Al 0 Volume 3 9 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed re orded in the Office of the County Register of Deeds as Document No. 237.-03-5 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of t e unty egister of Deeds, as Document No. ignature of owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature imvf* _ 'r 'fit y; it .;tti; ,1 i -~'g "'i^ Iva 016WO s. . r to .4 ¢ Nita •MItb<.~' t Q1004 r - fa~pIN ~~s to GnrltM tY~ "lowing desCf"iM1 "&A is mow. 1/4) of ` 17 Weft tLld.tacl C. aadi41 C,, B~RUan i>Lt V lp l►S , J& Vd.k 115W# 'per X74. 14 ~ y~ lM~cs~d ~ 1~ ill - Of S91.04 RAIW 17 WbxttA In R 1 q+~i l.•r. '1't ; it i.. ;e ' Y 1f 'o,'`!3 S • 1-y+~7 p.~ _7 y,} 1 ~ 4 x Y,Jf M~} y~ ~i 'h. } i ~ ' 4~~' 3 Jt W, t ~ w -r, ~ u ~ s till yx:.: ' .r • rrt i r y. w~ ...a " "N: dftd u1fi111dnt o> a r ad' Ma h 7 in of Raaprds•,pan pa ollik, 4 97 V. tt - Q, so ummum -1 o!` De~dr ~8t Not Up bcoAestead`PtoPe•ty.` 4• ~a E'` t 1, 5'~1F eAI•ICIIE~b 4 besi-Mitit' •!l ind singular the heceditawdats aad appwrt y the title 1s food, isidefeasibl . in tee simple *rml fm lad ,Flat of mncele 4 ~ ~ ~ 'rq F-i t1 A `[G, _ A+.i: 311 ~;N.. £'Fd ~~`~:_r'"''F~3fi.,~.~ ,>dIF11~L~i x det nd ie s~i e~ t< P a s+' e 144 ;4 0 M Ow a~ ~tT { or 9 r day -P!, yr v 4. ` iii'" v is o x u 6l ~~11E 'T ;#f"t ilk .'fit 4 'S i-'~ ►1 `~C.A~ ~'7,. app .~S } t,. }r„'~' ; W. . (SEA ,Ft-U C., ~ 20 !w i ~ .A11TiiENTICATiON,; ACOHi alum ambamdastd this daY of S! A~` .~Penbmlly Opole Tti1.F,:+ the BAR OF NISMQ sm At a a 706:06, ~~w ~ t3 ~ 1 1 S. I r',i~ada4'~y.. s+•rir ~ ~ t ~ ~ 6f^ EMI r.t~it@1 'I• yyi r - •.ry - v 0. *4 , t !^F+w Qdte. Attormy. a I" 7' r he wls ADDRESS: Rlopt CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Amnority, Property Owner and Soil Tester. D I LH R-SB D-6395 (8. 02182) - OVER - H ' H 9 S T C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER r/S ~~~'ISn~'J r7l ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP S4D/-5, PROPERTY LOCATION: Section 2, T Z9 N, R /7 W, Town of fYgmrr;~nQ( St. Croix County, Subdivision /M Lot number. I Improper use and 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. 0 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with ❑c H the standards set forth, herein, as set by the Wisconsin Depart- 'v 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 DATE St. Croix County Zoning Office P.O. Box, 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR Ah BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.09(1) & Chapter 145.045) LOCATIONS SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: Grp'/41.114 Z /T29N/R / 1(or W 1;~aI92 r2 r d /V COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ~ ~ .J7L Yv 017S r) C7/~l/y~d zel / • ~7d/✓ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: Z Replace DESCRIPTIONS : PERCOLATION TESTS: I 9 Residence I ❑ New ,ISJ Replace _ RATING: S= Site suitable for system U= Site unsuitable for system / T o CONVENT NAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) NS DU 1225 ❑U IMS DU 1]S ®U EIS RU ~'or~v~• ;or» / If Percolation Tests are NOT required DESIGN RATE: (lf any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- ZZZ B- r✓ r S B- B- B- Ff" PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERT D 1 PERT D2 PERIOD PER INCH P- e a a 2"5 P-Z o P_ fz 3.3 P- 2 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 C/, 3 r _._ry J f N { 1 I I i t._._ 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: _Z)n/e 3-Z-/ 7Z - g9 ADDRESS: ) CERTIFICATION NUMBER: PHONE NUMBER (optional): 5e~ S4O /Z .341..3 _ ? -36'66 CST ~J NATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. D I LH R-SB D-6395 (R. 02/82) - OVER - r L NDUSTIVIENTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION N LXBOR BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON W 53707 (H63.09(1) & Chapter 145.045) LOCATION:< SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: Grp'/a2'"/a 2 /T29N/R/ 1(or N COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: .Sf e,^vi r°/ S 0176 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: X Replace D R PT NS: E A ON TESTS: Residence ❑New ,4sJReplace It 491 RATING: S= Site suitable for system U= Site unsuitable for system ros ONNVENTIONAL: MOUND: 1~ IN-GRROOUND•PRESSURE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDED SYSTEM:(optional) L U S ❑ U IM S ❑ U ❑ S ®U ❑ S Da~~ If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- Pr ' L r ' , B- B- B- P PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER -tWOWQ£s AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 PERIOD PER INCH P. O -i e o4 0~ , S 01 P- O Z 3 1 i 3 P- 2 Ahv) f, 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. 44 SYSTEM ELEVATION 9 TN 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: _D0 le- ~r uo~sd~ 3-Z-0Z - g9 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): z"57 anx Z/ e)-'Q ..5-~XD/z 3 1_3 --310 CST NATURE- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Q 0 ~ ~ h M c h U ~y ~F C O CJ ~ j CV t NO O Ila/ 0 h O ~ ~ C~ a ~i ~ ~9 ~ ~,°~~s• e O ~ e a ~Lc AC ~ oho v v h o o Ike Na to Q o h ~ o C a U ~F 4 v j '1 e ~ K 1 ~ o. Vl o ~ ~ ~ ~ ` ~cr o ee KAw ~ 'Q► `Qe h 0 a M ~i 1g se lit; Q 00 too V 4y Parcel 136-1030-95-200 01/19/2007 05:15 PAGE 1 OF 1 F 1 Alt. Parcel 28.29.17.227A2 136 - VILLAGE OF HAMMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HANSON, CHRISTIAN C CHRISTIAN C HANSON PO BOX 487 HAMMOND WI 54015-0528 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description 1655 CLYDE HANSON DR SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.496 Plat: 4589-CSM 17-4589 SEC 28 T29N R17W PT OF NW SE LOT 1 CSM Block/Condo Bldg: LOT 01 6-1572 NKA LOT 1 CSM 17-4589 (1.496 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 28-29N-17W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 08/18/2003 736131 17/4589 CSM 06/24/1986 744/463 QC 2006 SUMMARY Bill Fair Market Value: Assessed with: 173491 328,900 Valuations: Last Changed: 10/19/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.496 44,900 280,400 325,300 NO Totals for 2006: General Property 1.496 44,900 280,400 325,300 Woodland 0.000 0 0 Totals for 2005: General Property 1.496 44,900 280,400 325,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Parcel 010-1050-90-000 01/19/2007 05:05 PM PAGE 1 OF 1 Alt. Parcel 21.30.16.314 010 - TOWN OF EMERALD Current XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SPEER, MARY L CLANIN MARY L CLANIN SPEER 2346 140TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 21 T30N R1 6W 40A SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1225/154 QC 07/23/1997 994/102 WD 07/23/1997 797/22 07/23/1997 693/383 2006 SUMMARY Bill Fair Market Value: Assessed with: 168132 Use Value Assessment Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 2,200 0 2,200 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2006: General Property 40.000 2,300 0 2,300 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 2,300 0 2,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a AUG a~ Nom of go*& Ob CERTIFIED SURVEY MAP N4• 1572 VOLUME 6 , PAGE LOCATED IN THE NORTHWEST QUARTER OF T TOWNSHIP 29 NORTH,RANGE 17 WESTVILLAGE O~UNAMMOND, ST. CROIX COUNTY,WIS~ , e ~ &a„ ' P,2 ~11VPLA_LLFzP ,f,ANOS NORTHWEST CORNER OF THE NORTHWEST QUARTER OF THE SOUTHEASTOUARTER WEST QUARTER CORNER PER THOMAS G. KUESTER, 1983. SEEAST QUARTER CORNER CT ON 28,T. 29N. R.17W. SECTION 28,T. 29N,R.17W CENTER OF SECTION PER SS. 59.62 - 4.5 FENCE - -2435.80- - 2580.~s 36. ' S8903207"E ,r---X .x----x ,L00.33 25' UTILITY EASEMENT VOL. 660REC., P. 545 o LOT I o O° y O 65,178 SOFT 3 N 1.50 ACRES b i BILE z OM£ it Hb- o - R1 l' m r im im rn - i ~i HOUSE ,p FOUNLIATI w, k- a WELL O ~ 01 ~ 41 BEARINGS REFERENCED TO THE NORTH tv lT~ LINE OF THE SOUTHEAST QUARTER OF O O O SECTION 28-29-17,~~ ~ ED AS O p SEPTIC VENT N 89 3 N 89-32'07"W 200.00' SCALE: I11=100 UNPLATTED LANOS 5 0 160 2 33' 33' 616 NOTE I ACCESS TO LOT TO SE PROVIDED BY LEGEND SEPERATE DOCUMENT (IF NECESSARY) FOUND BERNTSEN ALUMINUM CAP CHRIS HANSON O RESET 11/4°x30° RE-ROD WEIGHING PREPARED FOR HAMMOND,WI 4.30 LBS./L.F. O SET 502 x 2 "RE-ROD WEIGHING i J . OMONIE i Wis. OQ . 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Z£.68S - - - - ' - 7 BT' OBSZ - - - - - - - - - - - - - 98'STZS-------3„L0,Z£.68S SONVT0311V1dNf1 NISNOOSIM 'A1Nnoo xIOMJ '1S 'ONOMRVH 3O 30V IIIA 'MLTM 'N6Z1 '8Z NOIl03S JO 3S 3H1 30 3N 3H1 30 1MVd 3H1 NI 031VOOl 685fi ' ON deW A3A8ns T :s3oYd 03IJIi83D AiNnoo XIo8o, is :33d 30 00 •Z :331 Ad00 NOO'H3►ZOT10 NOOSIMf'VIV 3331 SITY&L ZOL►S NISO~SIN 3alIY~~ rn3 03~i AY OOOI V►f 00'11 1331 S31VIDO ~OSSV S3 aA 31V dYN A3Avns 03IJUH33 Alio O 5,:;~1,~ltlf1S hliufl(io Owls NdOO=ZT EOOZ/8T/80 k 4a003a a0d 03AI303a yu 0 Z Am IN • •oo xloao •rs s 50334 40 H SIe a - i HSIYA 'H H33" ``+A f T E: T C9 C.- le- Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP Oia99/J~4/~~ SEC. ~T T Z9 N-R W ADDRESS I~f ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW I Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y S' ppo -"70' /D ~ ' ~ ~ooo qA/ se pf Q 2z7 are. 52' ~z ve 4f Ike L cn INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used//OP o j~'o sl ' e Elevation of vertical reference point: /DO.,O~ Pr--o"pTooAsed' slope ats sit ~a SEPTIC TANK: Manufacturer: Liquid Capacity: Z200 a,2 IS• Number of rings used: 400 Tank manhole cover elevation: /Of •JG ~s Tank Inlet Elevation: Tank Outlet Elevation: 9 717 Number of feet from nearest Road: Front,O Side 0 Rear, O /O S feet From nearest-property line Front 4) Side .0 Rear, 0 105- ~ feet Number of feet from: well 500 1, , building: :~161 Aclude this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid CakSwih acit- Pump Model: Pump/Sipho ufacPump Size Elevation of inlet: B tt oion: Pump off switch elevation: Gale: Alarm Manufacturer: Al pe: Number of feet from nearest p perty line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: >Ies Trench: i A Width: Length: S,2 Number of Lines: /o Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, Q Side, O Rear,O Ft Number of feet from well: 75 Number of feet from building: lo (Include distances on plot plan). SEEPAGE PIT Size: Number of pit Diameter: Liquid depth: Botto f se pag t elevation: Area Built: 6 1j Has either a drop box O or distri utio ox been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Ele a ion of bott f tank: Elevation of inlet: Number of feet from nearest prop y Vine: r nt, O S ide, O Rear, 0Ft. Number of fee rom Number of feet f m buiNumber of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION Xr7969 i BUREAU OF PLUMBING 153707 I State 11 Ili Plan LD. Number CONVENTIONAL ❑ALTERNATIVE ( assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound so NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE: Chris Hanson R. R., Hammond, WI 54015 7 1 (o-!3 S BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW SE, Section 28, T29N-R17W, Town of Hammond Name of Plumber MP/MPRSW No. County Sanitary Permit Number: Dale Hudson 6629 St. Croix 69598 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPAC/TY: TANK I L E TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL. HIGH WATE NUMBER OF ROAD: PROPERTY WELL: JBJ ALARM FEET FROM LINE: AIR I L OYES / ❑ '6 AN (1V DOSING CHA BER: MANUFACTURER BEDDING: LIQUID CAP ACITV PUMP MODEL. JPUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO EYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PR OP ERTV WELL. BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) EYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 rrar,T1I JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH- NO. OF DISTR PPE SPACING: CO JINSIDE DIA.. #PITS: LIQUID BED/TRENCH ~ ~ TRENCHES / ERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO R. NUMBER OF PROPERTY WEL BUI ING: VENT TO FRESH BELOW PIP S. ABOV COVER. ELEV. INLET ELEV. END PI ES. LINE. AIR INLET: e 9 71 2- 2 / FEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. EYES ONO SOIL COVER TEXTURE PERM ENT M RKERS OBSERVATION WELLS E: 14 7Y O ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. ODDED SEEDED MULCHED.. CENTER. EDGES. ES NO DYES ONO EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: : WIDTH. LENGTH. NO.OF LATERAL SPAC NG G AV DEPTH BELOW IPE: FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MAN OLD MATERIAL: O. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEVATION AND ELEV.. ELEV.. DIA.: ELEV.. WES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER TERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: Q FEET FROM LINE: U ❑ YES ❑ NO ❑ YES ❑ NO NEAREST 30 0 IL - 12- 7V. 3 1 12 3~ Sketch System on Retain in county file for audit. Reverse Side. SIGNATJ,_ TITLE DILHR SBD 6710 (R. 01/82) Wisconsi APPLICATION FOR SANITARY PERMIT COUNTY ~In H R (PLB 67) aRRTrnEnTOr UNIFORM SANITARY PERMIT # STRV;LRBOR&HUMRn ReLRTIOnS ~ 9 (9 1 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION a "117 i": 14A/43,C1/4, S Z?, TZ9, N R /7 (or (W) TOWN OF: /Y~"71YJ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection L_1 Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ,X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy D Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued L 1 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: S IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total f Prefab. Site Steel Fiberglass Plastic Gallons Ws Concrete onstructed 04 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): 3'3 G15 ~ 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: j «l f 17150 3O, Plumber's Address: Name of Designer: COUNTY/ DEPARTMENT USE ONLY _ Signature of Issuing Agent: Fee: Date: L_1 Disapproved V /+y C p~ ❑ Owner Given Initial C, - /-x 0 X 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 t. I 14 CI, \ T ` r ,8 Ira w +~1 ti► i 1. ( <R: I I~ t'l APPLICATION FOR SANITARY PERMIT STC - 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 Location of Property// L~ ~ 14 14, Section , T Z9 N - R /7 W Township aa~ Mailing Address Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created, Are all corners and lot lines identifiable?Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 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. PROPERTV OWNER CERTIFICATION I (We) eeAti6y that att statements on thiA 6oAm aAe true to the beat o6 my (ouh) knowledge; that 1 (we) am (aAe) the owneA (d ) o6 the pAopen ty deal c4 i.bed in this in6oAmation 6oAm, by vi tue o6 a waAAanty deed Aeeonded in the 066ice o6 the County Reg-i.eteA o j Deeds ad Document No. ; and that I (we) p4aentty_ own the phoposed site 6oA._ the sewage dlapo.6at system (oA I (we) have obtained an easement, to Aun with the above dedelubed pAopeAty, bon the const4acti.on o6 said system, and the same had been duty %ecoAded in the 066ice o6 the County Regi4teA o6 Deeds, a6 Document No. 1. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED I {M q ~.3 4 r xg: LL ~ G. 1 r z t-A a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z 0 a z H OWNER/BUYER `S l-~✓1SCl~ ~ ROUTE/BOX NUMBER I-&- 0/' Fire Number CITY/STATE lla'xYlnl!Q2 JZIP PROPERTY LOCATION:A/W 14, 5r k, Section,0 T N, R~W, Town of Cl ~I n1#13 St. Croix County, Subdivision AL Lot number. Improper use and 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. 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- rv 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 DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. •+;ri .fit..:: Z ~.}t.. y C N O'* s.:.. A O V~ O C C C p 3 ? 2:. , o'^ E , o c 0 _ CC CC 'D 0) 75 0) CD r- 0 cm 0 v to N Dom to c~ L o i O3~ C N N C.- N ~ co C W ~3~0.0 -3vEc co al C cm ~ - V 00 O'D o Q N ~ = N C N N 0 C .p. V co NOO SON w~ Q. CC f c c0 tv y N O L D W 0 3, 0 -a ~ CC M IL U) CC c r- 0 cn CC = :E = c S w m (n co O Q cm F" Q C L U O N C y m C H V O N O L N m Q N 3 N O N N~ C U U) Z N CC at C 0) 0 0 3 CC C-0 O L- U «1 OR 3o~CDoa co CC CD L) to 0 0 0 u) O O j +O' U O Q N V C N co CL CL ~v-N O 0 O (D O C N o td L r N Co Ca O L 3c.0 >.0 rnZC O'D0E5 3~►-E Nc~-~-5 00 cts 0* c c rn s c c O 0 o 6 'M 0) " . 0 v E 0 co d O o V N p) Cy) L C w D U" 0 C N (n N i N d f~ U -0 ( m (D 3 0 $ Go CC Co V -14 C) C (D o0 c0 U C Q of F N N r.+ O. N t = a C Im -4 C o v- d O C «O L Z o E C rn w of cc 0 cts co o a E~ o a N C N U 0)~ o Y 3 p C .0 L: O C y' N C L i N N a► Q Q .J N ~ DN INDUSTRY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRYY, , DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN..RELATIONS 1 / MADISON, WI 53707 (H63.0911) & Chapter 145.045.) LOCATION ~ >J~S~~ ~SECTION: ~ /~~~~/K w/~~(or TOWNSHIR'MU d11-11 LOST/NO.:BLK.NO.;SUBDIVI~SIjONNAME: COUNTY: OWNER'S BUYS 'S NAME`. MAILING ADDRESS: USE DATES O ERVATIONS MADE NO.BEDRMS.: !COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION TESTS: I-PgResidence 3 IgNew ❑ Replace 17- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 0S [It ❑S ®U ]S ©U ❑S UU [:Is C1U c / If Percolation Tests are NOT required DESIGN RATE: ,4 If any portion of the tested area is in the under s.H63.09(5)(b), indica te: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH It. ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) / / . i B- 17,33 10 100,'-15 73 Z, zz s-~ ?,3 1 160,62' > 7•33 - B_ 3 7,_33 99019111, 7,33 B-1 '77, 0) lot ;7' 0" Z-3 Pad: QP z2y~ds- c 70 >1 710 PERCOLATION TESTS F TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER .IAiC"& AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 305 P- P-- P- P- PLOT PLAN:. Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96a2q~ 1 , , , , TH 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: ADDRESS: r CERTIFICATION NUMBER: PHONE: NUMBER Ioption>al) get- 1. CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Anti ority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - D 4D lk~ CZI Nll °j , o !3 J \r I~ Q (y.. 11 1A VIC 15 I t