HomeMy WebLinkAbout022-1040-40-110 (2)St. Croix County Planning and Zoning Monday, Apif 03, 2006 at 10. 14.58 AM
Detail Sanitary Information Page of
Computer #:
022-1040A0-1 10
SublPlat:
NA
Section:
14
Parcel #:
14.28.18.223A10
Lot:
1
TNIRNG:
T28N R19W
Municipality:
Kinnickinnic, Town of
CSII:
Vol. 08 Pg. 2115
114114.
SW 114 SE 114
Owner: Hedman, Ron & Lisa 1363 county Road J Rher Falls, WI 54022
State Permit: 199991 Issued: 02/16/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: New
County Permit: 0 Installed: 02/16/1994 POWTS Detail: Trench -Seepage Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed
Not determined Yes Fogerty, Dave data from notecard $0.00
Jim Thompson Signed Off: No
Maintenance
Scheduled Pumo Date Pumped 1st Notification 2nd Notification 3rd Notification
2/16/1997 6/7/2000 04/01/2005
6/7/2003 04101 /2005
Hedman, Ron $ Lisa SWIt, SW�j, Sec. 14
1363 County Road J T28N, R18W, Town of
River Falls, WI 54022 Kinnickinnic
Lot 1 " 0'0y
Address of Site: same
Permit No.: 199991 2/16/94 David B. Fogerty
New System - Trench
St. Croix County Planning and Zoning
Thursday, April 12, 2007 at 12:31:07 PM
Detail Sanitary Information Page 1 oft
Computer p: 022-104040-110 Sub/Plat: NA Section: 14
Parcel 0: 14.28.18.223A70 Lot: 1 TN/RNG: T28N R18W
Municipality: Kinnickinnic, Town of CSM: Vol. 08 Pg. 2115 1/4 1/4: SW 114 SE 1/4
Owner: Hedman, Ron 8 Lisa 1363 County Road J River Falls, WI 54022
State Permit: 199991 Issued: 02/16/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: New
County Permit: 0 Installed: 02/16/1994 POWTS Detail: Trench - Seepage Bedrooms: 3
POWTS Pretreatment: NA
Notes
Issuer/lnsoector
Not determined
Jim Thompson
Maintenance
Scheduled Pump
2/16/1997
6/7/2003
6rr12009
As Built
Yes
',igned Off No
Date Pumped
6/7/2000
U712006
Plumber Other Requirements
Fogerty, Dave
1st Notification 2nd Notification
04/20/2006
04/20/2006
3rd Notification
Additional Notes
data from notecard
Money Owed
$0.00
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
March 11, 1994
Ms. Tammy Herbst
First Federal Savings
201 South Second Street
Hudson, Wisconsin 54016
Dear Ms. Herbst:
An inspection of the septic system for the Ronald and Lisa Hedman
property was conducted on February 21, 1994. This property is
located in the SWN of the SEN of Section 14, T28N-R18W, Town of
Kinnickinnic, further known as Lot 1 of Certified Survey Map,
recorded in Volume 8, Page 2115. At the time of the inspection
this septic system was found to be code compliant for a three
bedroom home. Should you have any questions, please feel free to
contact this office.
incere y,
J es Thompso 1,2
Assistant Zoning Administrator
mz
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER /%x z-z"kj-q-L
ADDRESS /1 G 3 fIC4(1'
CSM# t1y yc9y LOT #14
SECTION /l T ;?S N-RI;W, Town of X;wz '
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
462-
�y
#
i
lisp I ��
,z b
s,Y fr
ins V,,°(f,)
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM: / -, 5',,-!/ fni &6
SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ���� Liquid Capacity:
Setback from: Well .,S-o` House A Other —
Pump: Manufacturer
Float seperation
Alarm Location
Model# Size .
Gallons/cycle:
SOIL ABSORPTION SYSTEM
f-1 /to',
Width: 5� Length 'Fl IIX Number of trenches
Distance & Direction to nearest prop. line: :.- sod
Setback from: well: House > SoI Other
Poo
ed0
ELEVAT ONS
Yw r 91,1"y
Building Sewer_ pBy ST Inlet �'-tQ� f ` ST out let .fd- fffd
PC inlet.. PC bottom — Pump Off
Header/Mani fold l%L,o(*+y��u`M 77,
Existing Grade
Final grade
DATE OF INSTALLATION: .? X2,0
PLUMBER ON JOB:
JF
LICENSE NUMBER: 1
INSPECTOR: �.',.. C7 .�t�,��rs►`
3/93:jt
,18 gf� � g�ah�ra
LQgAn�rt�rpTltir gpnic.14.2�1iIV�TE SE E SITSrEM Y J
Labor arfd Human Relations INSPECTION REPORT
•Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT)
Permit Holder's Name: ❑ City ❑ Village VTown o
CST BM Elev : Insp BM Hew.: BM Description: s )/
/� 7 Dli • �nf aS (�'[ / _ C e,
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
--_
02 ,
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P / L
WELL
BLDG.
Au I
Air l to ntake
ROAD
Septic
NA
Dosing
NA
Aeration
NA
Holding T
PUMP / SIPHON INFORMATION
Manufacturer Demand
Model Number GPM
TDH Lift I
Friction ystei`n DH Ft Loss
ead
Forcemain Dia. H Dist To well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
ax No.:
A9400021
STATION
BS
HI
FS
ELEV.
Benchmark
(02),
Bldg. Sewer
St/ Inlet
7. i, /
1U
/A.SY
St9X Outlet
Dt Inlet
Dt Bottom
Header 3.
z
9787'
o
Dist. Pipe
`r
Y Y' O�
97
Bot. System
c
9.l� y}/
Final Grade
b�
99..27
�.
�05
%8 92'�i8,
BED/TRENCH
Width r
Lengt 11o'if
No. Of Trenches
PIT —
No Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
'5
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LE ING
Manuact
SETBACK
INFORMATION
CHAMB
ORUIfUT'
Type /lsw yrN.
a Num er:
System: {fa,"
DISTRIBUTION SYSTEM
Header I khmalb5id/
Distribution Piipe s)
„
y
/(O
x Hole Size
x Hole spacing
Vent To Air Intake
Length _L� Dia
1`
Length 11Z.
Dia
Spacing/5
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over ,0 drl
Depth Over 3
xx Depth Of
xx Seeded / ded
xx Mu
BShcTrenchCenter b
4
/Trench Edges 4 — O
Topsoil
es ❑ No
❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Kinnickinnic.14.28.18W, S , SW, ioway J �
ok.-e r
a2-k"
Plan re Ion required? ❑ Yes EPQis" /
Use other side for additional information. W • v2�
SBD-6710(R 0"1) Date Inspector'sSignature Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
cOUR�r ,
DILHR In accord with ILHR 83.05, Wis. Adm. Code \ 1 /
_ �. �...mommms .�.�
STATESTI[TA�PERMIT #
—Attach complete plans (to the county copy only) for the system, on paper not less than I `�
8%x 11 inches in size. ❑ C *OR revision to previousappuation
—See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION.
PRO TYOWNER
PROPERTY TiON
PROPERTY OWNER'S MAILING A DRESS
LOT 0
BLOCK #
CITY, STATE
ZIP CODE
PHONE NUMBER
SUBDIVISION NAME OR CSM NUMBER
•per
t_
C
11. TYPE OF BUILDING: (Check one) ❑ State Owned Ej VILLLLAGE NEAREST RO D
11 Public ❑ 1 or 2 Fam. Dwelling,# of bedrooms L TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) p V0 d ( p
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranVBar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ 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)
NeW 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
A) 1. L 1
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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ SpecityType 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:
FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./Inch) ,�/ 97.9 r 5L YAPON
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. L40177 7
SD G -3 O 70 s 2-:/ Feet: Feet
V11. TANK
INFORMATION
CAPACITY
in ellons
Total
Gallons
# of
Tanks
Manufacturer's Name
Prefab.
Concrete
Site
Con-
Steel
Fiber-
glass
Plastic
Exp
App.
New
istl
Tanks
Tanks
strutted
Se tic Tank or Holdina Tank
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Name (Print):
Plumber's Signature: (No)
No.:
Business Phone Number:
;P71ber's
r/MSW
L j
7 3<SA
u ber's Address (Str ty, Stet p Codel:
OZ
M
IX. COUNTYIDEPARTMENT USE ONLY
❑ Disapproved
Sanitary Permit Fee (Includes Groundwater
teIssued
Issuing Agent Si ature (N Stam
A roved
Downer Given Initial
Surcharge Fee)
r_/4-'70y/"
Adverse Det rmin n
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To! Safety & Buildings Division, owner, MUmDer
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 yot)r onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety 8 Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. 11 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.
Vl. 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.
Vill. 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/Depilrtment 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 it
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GAOUNDWATER 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.
SBD4398 (R.11/88)
fort/ roaa0
ao /eff �'//NNNYS< /rprr,)Y/ PiI ;
l7et
eet
LjvwWd jqS Te j!e .& PNxnber
Pit dw
er
C
Lif e1 /
/fy
Q BMA �.� •11 ww.'1, "S 40,41� m,,t �i �e lo�'+.O' O�IG6L
X
err f.� mks ,�c.r-� .,,:.,:.►.N».r .
t(w i�/ -77d" #ri /i o'
T A3003 3VAG
gamut d
an,j ":: Dave Fogerty Plumbing '
SEWER SYSTEMS & PERK TESTING •'}
r � FOGERTY HEIGHTS ROAD ROBERTS, WISCONSI
(715) 749.3656 4 ► •r..
T.
f
r1[v.
--4�-- S I
a-
S�oP�
cNY'. Me
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of �
Labar and Human Relations
Division of Safety a Buildings in nc rd with ILHR 83 OS Wis Aft Code
'
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
PARCEL I.D. ><
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION
PROPERTY OWNER:
PROPERTY LOCATION
All — ` or�a
GOUT. LOT S&I1/4 1/4,S T N,R E (rV
PROPERTY OWN R':S MAILING ADDRESS
LOT x
BLOCK •
SUB0,4AME OR CSM If
3
09f/
CITY, STATE ZIP CODE PHONE NUMBER
[]CITY ❑VILLAGE OTOWN
NEAREST ROAD
Cevr/- is w .i ( ) ltlAi c
Z
New Construction Use/ Residential / Number of bedrooms 3 ( ] Addition to existing building
I ] Replacement [) Public or commercial describe
Code derived daily flow ZS'O gpd Recommended design loading rate iy_bed, gpd/ft2 . f trench, gpdltt2
Absorption area required 6 r13 bed, ft2 s L 7 trench, ft2 MaAmum design loading rate _,Lb ed, gpd/ft2—,Y trench, gpollt2
Recommended infiltration surface elevation(s) PK _ I ft (as referred to 'te plan benchmark)
Additional design / site cortsiderations o*rr ;'Z S t — m.c�ces.v f. L
Parent material Flood plain elev lion, if applicable It
S = Suitable for System
CONVENTIONAL
❑S ❑U
MOUND
❑S ❑U
IN -GROUND PRESSURE
❑S ❑U
AT -GRADE
❑S ❑U
SYSTEM IN FlLL
❑S ❑U
HOLDING TANK
❑S ❑U
U= Unsuitable for sstem
Boring #
JA'I
Ground
elev
ff. I/ ft.
Depth to
limiting
factor
5_1v_
Boring #
7
Ground
elev.
j2.fL
Depth to
limiting
lector
SOIL DESCRIPTION REPORT
�t�F-
-
��■■■
Oom�'L'0-
T Name: —Please Print r o Phone: 7 � j`s6
Address: wl �Yp2 j
Signature: Date: CST Number:
� 7 233
PROPERTY OWNER vc SOIL DESCRIPTION REPORT Page/'of_/_
PARCEL I.D. /- - 4-'M Rf / —<-S w
Ground
el
ft.
Depth to
limiting
factor
149—
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Ou. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Bouclay
Roots
GPD/ft
Bed
Trench
Q-L
m ?
lopIf
Z
2-
L l
lYi
3
s sif
Ts� .syf
Zoec/
✓
—001
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R 0"2)
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
m � tAsA 4 � I�O�lA 4
ovvlvER/BUYER I /
MAILING ADDRESS 46 f V &C EY
PROPERTY ADDRESS C1
CITY/STATE
rrPA 10-
(location of septic system) Please obtain from the Planning Dept.
2l1J_Q'( P*41S
PROPERTY LOCATION S/ j 1/4, � P' 1/4, Section I T d-0 N-R�W
TOWN OF / \ ,,(y /I' I0 � K I V M L , ST. CROIX COUNTY, WI
SUBDIVISION UV I n , LOT NUMBER
CERTIFIEEDSURVEYMAP. VOLUME PAGE?- LOT NUMBER-1
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 tluee years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment 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 system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
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 DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
s� 11
SIGNED: R'N
DATE: / - ,? S - fi
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016
11/93
STC -loo
This application form is to be completed in full and signed by
jhe owner(s) of the property being developed. Any inadequacies
will only result ,n delays of the permit issuance. .Should this
development be intended for resale by owner/coptractor,(spec
house), thenia 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 ,m 4Lfca- 14 r6m
Location of,property-'jIl/4 E=E,1/4,
Township t
Mailing address 07 �Q -2 n,S
V -IN �
Address of site
Section ,T � ILL.
Subdivision name \
Lot no.
Other homes on property? _t r �vespTNo
Previous owner of property �ko Q(JJ4 P
Total size of parcel l! Jib 90 S
Date parcel -was created
Are all corners and lot lines identifiable? .yes No
Is this property ¢sing developed for (spec house)?_ -,_Yes ]A -No
volume
�and.Pago Number Z_%�� as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEhD which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & 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.
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 recorded ir}�tliA6Xfice of the County Register 4of
Deeds as Document No. ALL YY``ff aaCC_JJ and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recordp�,,,, Fe office of County Register of deeds as Document
No.�, - n�IKK�� (_
Signature of applicant Co -applicant
Date of signature Date of s gnature•
, - INWITRYREPORT ON SOIL BORINGS AND
INDU9'7
LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115)
(H63.09(1) & Chapter 145.045)
SAFETY & BUILDINGS
DIVISION
P.O. BOX 7969
MADISON, WI 53707
_
1/V/4
lbyN/wkE
OWNSHIP/MCN1CtfRtTY:
OT NOBLK.
NO
SUBDIVIVISION NAME:
_%W
/Y (
/r,•
C.
COUNTY,NAME:
r
Fes%
1
�LrT.'>;irJsZ>��1l1
ra c ■..:
O•TIIJft• s. CN. mi.a1.1. /n..wr..n 11. Cif. .'...'u..61. r'.. ..'af.'w
UA I ES 0ML H V A I IUIeO MAUL
PROFILE DESCRIPTIONS: PERCOLATION TESTS:
ONVEN L:
CAS ❑U
MOUND:
CAS DU
IN-GROUN
IDS ❑U
- -FILL
CAS OU
OLDING TANK:
GAS ❑U
RECOMMENDED SYSTEM: (optional)
-2' '
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: / Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS 7
BORING
NUMBER
TOTAL
IN,
ELEVATION
AT R•INCHES
CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
g V
EST.
B.
B- 3
S7
> 157
; ' -/ " G
B t�
3R7,1
' In , r
B- Sx0p—
L
r3
w c w{ 4c PERCOLATION TESTS
TEST
NUMBER
DEPTH
INCHES
WATER IN HOLE
AFTERSWELLING
TEST TIME
INTERVAL -MIN.
DROP IN WATER LEVEL-1 H S
RATE MINUTES
PER INCH
PERIOD I
PERIDI32 PER10123
P 2
��•
�7
J
J
C
P-
P-
2 2-
Ala Re
i t
2
P-
P-
D
I
y
7
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 ell borings and the direction end percent
of land slope.
SYSTEM ELEVATION RIK 9
buwrjs ../
n
0
I.-T 1.__
1 i
fi'J`IN! sdc
I
%N
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures end 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.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner endAil Tester.
DILHR-SBD-6395 (R. 02182) - OVER -
b A6
-A,y �v., Jl..y_ &
PA.-jv =
40,wll= 0
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I -PH EVER
isq+NMd 7 aml lied Off1
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f)
y
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prl?e
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,. DIVISION
UBM h AN4& ONS PERCOLATION TESTS (115) MADISON WI 53707
(H63.090) & Chapter 145.045)
LOCATION:
5Av %5VI
SECTION:
/g! /by N/R/.? E l
TOWNSHIPIMtl I CIPAI: Y:
OT NO.:BLK.
NO.:
SUBDIVISION NAME:
c �-t
COUNTY„
NENAME:
MAI LING ADDRESS: _
I'
r ti Eye -1
JSE
,,..yyam�
V(Plesidence
3
C TIO :
E! ew ❑Replace
RATING: S- Site suitable for system U- Site unsuitable for system
(DATES OBSERVATIONS MADE
PROFILE UESGRIP NS: PERCOLATION TESTS:
ON-�VVE
DS QQ
MOUND:
DS �Q
IN-G
DS �V
-IN-FILL
Lid �Q
OLL]D.IINNG TANK:
91 DO
RECOMMENDED SYSTEM: (optional)
2 r /
If Percolation Tests are NOT required DESIGN RATE: If any Portion of the tested area is in the
under s.H63.09(5)Ib), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING
NUMBER
TOTAL
DEPTH IN
ELEVATION
DEPTHTQraR=DWAT
-INCHES
HARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
OBSERVED
B- i
X
e
>>
J s
B-
4S
37, 7
s
; ' y ' 'G
B- v
r
B S
L 42.
1,25"optJJS 'w�t
PERCOLATION TESTS
TEST
NUMBER
DEPTH I
INCHES
WATER IN HOLE
I AFTERSWELLING
TEST TIME
INTERVAL -MIN.
DROP IN WATER LEVEL -INCHES
RATE MINUTES
PER INCH
P. 2
.?
l
P-
P.3
2Z
Alm W-
10
a
.7
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. �y!
SYSTEM EL VATION 9 >' , '.A
81
SOMEONE
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.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner ands O'tester.
DILHR-SBD-6395 IR. 02/82) - OVER -
:-� INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
n
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;
r 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
OCHER 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 ate per manent,
9. Complete all appropriate boxes as to dates, n`omes, 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. lit 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
gi - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs Coarse Sand Perc Percolation Rate
med s - Medium Sand IN -- Well
Is - Fine Sand Bldg Building
Is - Loamy Sand > Greater Than
sl Sandy Loam < - Less Than
'I - Loam Bn - Brown
A - Silt Loam BI - Black
si - Silt Gy - Grwy.• .
cl - Clay Loam Y - Yellow
sel - Sandy Clay Loam R - Red
sict Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ -- with
sic - Silty Clay fff - few, fine, faint
Clay cc - common, coarse
pt - Peat min -- Many, medium
lit - Muck d -- distinct
p - prominent
HWL - High water level,
Six general soil textures surface water
for Ifrinid waste dispns:ll BM - Bitch Mark
VRP Vertical Reference Point
TO THE OWNER:
III , ,,,;I r• ;t I. port n the test step in secuting a sanitary permit. The county or the Department may request
. il,c.t „w If this snr trSt ill the field prior to permit issuanr_e. A completo set of glans for the private
..i" sv,h:m and a permit application must be submitted to Iha appropriate local rut To, ity in order to
r n a r•� unit. The sanitary permit must be obtained and posted pUdfSkOAg start Of agx90str gvAfj
• 1i ,4 8I �_ .;15'7 JSS.;. n i
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DAVE FOGERTY PLUMBING
Lk*nsod Park Tester & Pluffitw
03233 03289 oad
R04T"F R
SVOWSIN 54023
Phone 749-3656
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03533 N3SW
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River Falls
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H O I K KA
Grain Drying
Grain Banking
Bulk Handling
Medical Clinic, Ltd.
Makes iappen
IMP. INC.
River Falls, Wisconsin
IHC - Gehl - Fox
Liquid Fertilizer
Custom Grinding - Mixing
RFMCI)onas-Klass
H & S - Lindsey
DEISS & NUGENT
Medical Clinic
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(715) 273-5068
FEED CO.
Ellsworth, Wisconsin
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ELLSWORTHWISCONSIN AEast
Phone: 273-5066
Ellsworth, Wisconsin
54010
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Da ted : June 25 1 88
CUiTIFIID SURVEY MAP
WALTIi H. HOWARD AND DOROTHY B. HOWARD
Part of the Southwest 1/4 of the Southeast 1/4 and
also a roadway easement located partially in the
Northwest 1/4 of the Southeast 1/4 of Section 14,
Township 28 North, Range 18 West, Town of Kinnic-
kinnic, St. Croix County, Wisconsin.
m=Wmu)(P
LAVER LLS, f ,�
F9 •., •wise..,,. •' :
LA►io
Laurence W. Murphy
Registered Land Surveyor
O Indicates 1" x 24" iron pipe weighing
1.13 lbs./nn. ft. abt.
OWNbt'S ADDRESS: Route 2, Box 329
River Falls, WI 5402�
FCALE 1"+100'
0 JO' 10d /so, 100' 500' 400' Soo' 600,
O 1:
UNPLATTED LANDS
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1. O7r SOR VEr OR 'S MON.1
Hol. Page
r t i t'i ed Survey Maps
,t. !,roix County, Wisconsin
S LINE SE 114
SHEET / Of 3