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HomeMy WebLinkAbout016-1017-40-100 (2)St. CYOI.x LOG[Ilty' PlQI1Jtlitg Q12dZ012711g Thui-sdaj%.4Pri1 05, 200 / at 4:25:14P,4f 1.)a ae I of I Detail Sanitary Information ------- Comp I uter #: 016-1017-40-100 Sub/Plat: metes & bounds Section: 8 Parcel #: 08.30-15-138A Lot: TN/RNG: T30N R15W Municipality: Glenwood, Town of CSM: 114 1/4: SW 114 SE 1/4 Owner: Perry, Marcia 2860 160th Avenue Glenwood City, Wl 54013 State Permit: 12906 Issued: 08/28/1979 POWTS Dispersal: Holding Tank County Permit: 201 installed: 08/30/1979 POWTS Detail: NA POWTS Pretreatment: NA I S 5 U e r/1 ns e Or As Built Plumber Other_Ee uirern-ents P Harold Barber Yes Smith, Gale Not determined No Owner: Klinger, Eugene 2860 160th Avenue Glenwood City, VVI 54013 State Permit: 171517 Issued: 08/04/1992 POWTS Dispersal: Mound County Permit: 0 installed: 01/26/1993 POWTS Detail: NA POWTS Pretreatment: NA Permit: New Bedrooms: 2 W1 Fund: Additional Notes Money Owed 1750 gal. tank to a mobile home; now removed for $0.00 mound system. File with 1992 permit Permit- Replacement Bedrooms: 3 WI Fund: yes N Issu e rfi n s to:' As Built Plui-nber Other Re"quirernen-ts Additional Notes - - ----- pe�� --- --- Owed $0.00 Not determined Yes Bird, Byron Jr. Jim Thompson Yes Scheduled Purnqp) 'Date Pumped 1st N o t'! it a t I o n 2nd Notification 3rd Notification 1/26/1996 1/31/2003 04/20/2006 1 /31 /2006 04/20/2006 n AS BUILT SANITARY SYSTEM REPORT s OWNER - ,E-f� �. �`�`" �" TOWNSHIP %Z�<e C. SECTION ` T N—R /, ---W ADDRESS 6 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .} "f K 4 T / -- 1.2 ;17 , INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark''` SEPTIC TANK :Manufacture ;�1-G� r . � Liquid Cap. 1 Rings used: - Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road : Front , Side.,, Rear Ft . ,:;�5 From nearest prop. line:Front , Side, Rear Ft..� No. of feet from: Well Building: %"- (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE r f r AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION T N-R ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4g6 "� �r p �r 2 s � oe eT 7 ©� / / �� or INDICATE NORTH ARROW BEN :Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. Rings used; Manhole cover elev: Final grade elev: Tank inlet elev.; Tank outlet elev.: No, of feet from nearest road : FrontSide,.,, Rear Ft. From nearest,prop. line:Front , Side , Rear Ft, No. of feet from: Well , Building: (include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 0-0t� 4C4 ;e-74 0-CATION: GLENWOOD 08-30,15.138A SW SE 160TH AVE. isconsin Department of Industry, PRIVAYE SWAG E SYSTEM Labor and Human Relations INSPECTION REPORT Safet\,L and Buildings, Division (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name: ❑ City F I ] Village [Town of: (LINGER, EUGENE T & LINDA M GLENWOOD CST BM Elev. Insp. BM Elev.: BIVI Descriptil EP Sr TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aerati`dn_� Holding TANK SETBACK INFORMATION TANK TO P L WELL BLDG. I Dent to Air Intake ROAD Septic %MNINMEEENM� >/ NA Dosing 166 *> t-70 NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand + Model Number GPM Friction 5ystem 3F' t TDH Mea TDH�/,� L!25s Forcemain Length Dia. /'0' Dist. To Well > SOIL ABSORPTION SYSTEM BED/TRENCH Width Length( DIMENSIONS �s q SETBACK SYSTEM TO P L INFORMATION Typeof System: ,�r �, DISTRIBUTION SYSTEM H*ad-er / Manifold I Distribution Pipe(s) '1 Length Dia Length ELEVATION DATA County: ST CRQTX Sanitary Permit No-: 171577 State Plan ID No-: Parcel Tax No.: 1 0 16 —10 17-4 01 1 0 0 PiAoc&o Ue Sr A9200284 STATION BS HI FS ELEV. Benchmark Bldg. Sewer 171 St / I L.W Inlet All Outlet 7 Dt Inlet Dt Bottom;- 4/6 1 2 LE OE Man. 9 o,3 Dist- Pipe Bot. System Final Grade kn "91 o No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth z DIMENSIONS Manufacturer: BLDG WELL LAKE/STREAM LEACHING CHAMBER Model Number: 07 OR UNIT x Hole Size x Hole Spacing Vent To Air Intake i4l '> Dia. I- Spacing I I I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over It xx Depth Of xx Seeded /� xx Mulched /Trench Center a4W&� Trench Edges Topsoil D,-Yes E] No 0,Yt1rs' Ej No COMMENTS: (Include code discrepancies, persons present, etc.) -2, zx Z" (17e k4r C) C el Plan revision required? El Yes 0__�o 00I)c 9� Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert No umom3nnom aak, — — — — — — RANITARY PFRRAIT APPI MATKIN Pff In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than ' 81/2 x 11 inches in size. ElecCeif ev Vono p Zious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ,0011- ,// GZ To < OW"� -Y 14 1%4, S 71p' T, N, R LOT # BLOCK # PROPERTY NER-S MAILIN& AD-D-REK§ <-- CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER I1.- TYPE OF BUILDIN16: (Check one E] S Li CITY INEAREST ROAD tate Owned VILLAGE - C) (_ . 4a) OC) C TOWN OF .X6 ❑ Public 121 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 111111. BUILDING USE: (If building type is public, check all that apply) 7 Yam( 47 e7 1 El Apt/Condo 20 Assembly Hall 6 El Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 E] Campground 7 E Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 4 0 Church/School 8 El Mobile Home Park 12 0 Service Station/Car Wash 5 El Hotel/Motel 9 1:1 Office/Factory 130Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑New 2.,X Replacement 3. El Replacement of 4. El Reconnection of 5. ❑El Repair of an System System Tank Only Existing System Existing System B) ❑EIA 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 El Specify Type 41 0 Holding Tank 12 El Seepage Trench 22 ❑ In -Ground 42 El Pit Privy 13 El Seepage Pit Pressure 43 El Vault Privy 14 El System -In -Fill V1. 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 I N! REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION I C37--.5-0 . --*5* �15 -0 , /,r .2, N Feet Feet = V11. TANK INFORMATION CAPACITY in gallons W_ Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- strutted Steel Fiber- glass Plastic Exper. App. New xisting Tanks Tanks Septic Tank or Holding Tank Z& < Lift Pump Tank/SiEhon Chamber, ve El F Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb nature: (No Sta IMP/MPRSW No.: Business Phone Number: 2000'�46 s Z Address (Street, City, State, Code)- Pt67w6 IX. COONTYIDEPARTMENT USE ONLf Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) Date Issued Iss g Agent Signatur (Stamps) IT Approved F-1 Owner Given Initial 00" �N Pr Adverse Determination X. CONDITIONS OF APPROVAUREASONS FOR DISAPPROVAL: I SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber PROJECT ADDRESS V41 N/ 14 lot TOWN -1 MPRS Byron Bird Jr, 3318 DATE COUNTY CLASS PER CONVENTIONAL IN-GF�&"-�D PRESSURE CONVENT.1110NAL LIFT MOUN D.,�>� HOLD 1�4G TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE 4�;) e . HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE Location of Benchmark 13 Borehole Well ;Scale 0 Perc Hole System Elevation Inch Inches) Inches Inches Ft 0 / 4 r,"/ Page of arroar_ I Straw, Marsh Hay, Or Synthetic Covering-"� Medium Sand Topsoil E % Slope Distribution Pipe mom Bed Of "2 1" Force Main 12 16� Aggregate' From Pump Cross Section Of A Mound System Using A Bed For The Absorption Area G Plowed Layer D E F t Ft. G Ft 0: S i g n ed A Fto H Ft B Ft* License Numb6'r': K Ft L /-7 " "V .4 Ft, Date / , : ./ '� ,-- Ft. Alternate- Position I Ft of W t Force Main Observation Pipe—,,," --uroo—aroo ware."" -"��Waawraru A owaralft-0117 "Mauro awa.ft _orwa--- Force Main W rL ONS fa n Distribution ()F IN AF P I p e NII Aggregate 0 b s e r v a 0 on Pipe r s SEL. Plan View Of Mound Using A Bed For The Absorption Area PUMP CHAT` EER CROSS 'ZIC710tj AKjo SPECIFICAT10kJS 4"C.I. VEMT PIPE N Z5' FROM DOOR, W4JDOW OR FRESH AIR INTAKE IMLET A c ELEV. I FT VEIN CAP WEATHERPROOF JUUCTIDKJ BOX lz 0% m1u. GRADE Ile, C 0 Q D U I T v PROVIDE AIRTIGHT SEAL APPROVED LOCKINIG MANHOLE COVER ot4SITE SEWAGE I *APPROVED JOINTS WITH �� �,:�, - .� � � APPROVED INDUSTRY, LABOR 31 ONTO \j II AA SOLID SOIL MAN RE jLgINGS > OFF RISER EXIT PERM11TED OUL� IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE 17� TA M KS MAMUFACTUFLER. �JUMBER OF DOSES: P E R DA!d TAWK SIZE: GALLOklS DOSE VOLUME �`'. ��- � ,/� v� �.'� �.� � / � .'_ r .�IlUCLUDIKIG OACKFLOWO &ALLOWS ALARM MAIIJUFACT UR.ER'.' MODEL KJUPA15ER: CAPACITIES: A= giltlKIC14ES OR GALLOWS SWITCH TSPIL: • INCHES OR GALLONS Eump MAMUFACTURER'&. C, = WC-HES OR GALLOUS MODEL MUMBEKO. R Dw INCHES OR GALLOUS r- PUMP AMID ALARM ARE TO 115E. 5W17CH T�SPE: L ;V7 MOTE. MIKIIMUM DISCHARGE R ArE G PIA ,INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEKE KICE BETWELU PUMP OFF AUD DISTRIBUTIOM PIPE.. .2—. FEET + MIUIMUM A.IETW©K SUPPLE P ESSUFLE 2-5 ... FEET il L FT + FEET OF FORCE MAIM X Y10C) FT FRICTIOLl FACTOR F E E T TOTAL Dt:IMMIC HEAD FEET 7- /11, _ IMTERUAL DIMEWSIOUS OF TAUKO* LEklCvTH 1--l' ;WIDTH ----;LIQUID DEPTH LICEMSE UUMBER. DATE* OPTIONAL WORKSHEET K MOUND SYSTEM � �'� 1. Wastewater Load, Total Daily Flow= gal. Use section H 63-15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED LIST OF SIZING ON PLANS. 2. Depth to Limiting Factor= 3. Landslope = % 4. Distance from Dose Chamber to = 5. Distribution System Elevation Difference Between Pump and Distribution System = ft# 6. Absorption Area Sizing: Area Required = 22:2 sq. f t. Bed or Trench Length (B) Bed or Trench Width (A) = ft. Trench Spacing (C) ft. 7. Mound Height: Fill Depth (D) Fill Depth Downslope (E) = ft. Bed or Trench Depth (F) zio ft. Cap and Topsoil Depth (G) = Cap and Topsoil Depth (H) = ('Z- 5 ft. 8. Mound Length; End Slope (K) Total Mound Length (L) 9. Mound Width: Upslope Correction Factor Upslope Width ()) = ft. Downslope Correction Factor =-4L Downslope Width (1) = t• Total Mound Width (W) = ft. 10. Basal Area. 1 F: I t +; r-.i nrit of 15, 7 Natural Soil = gai./sq.ft./day Basal Area Required = sq. ft. Basal Area Available = !Z6 9f)- sq. ft. i i if Standard Tables from Chapter H 63 are Used, Indicate Table No. 12. For the Distribution Network, Use Numbers 5-14 in Section II.. II. IN -GROUND PRESSURE SYSTEM 1. Depth to Limiting Factor 2. Landslope = % 3. Percolation Rate = min./in. 4. Proposed System Elevation ft. 5. Wastewater Load, Total Daily Flow- gal. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED LIST OF SIZING ON PLANS. Required Septic Tank Capacity gal. 6. Absorption Area Sizing: -3 Percolation Rate min./in. Area Required 7 sq. ft. System Length = ft. System Width = ft. 7. Distribution Pipe Sizing: Hole Size = - - / in. Hole Spoacing Literal Length - Lateral Si/C SI),lCilig Dishillce 11-oll) sidew.ill lo Pipe 11 S. Distribution Pipe Disch.irge Raw: Number ()I I lolc,, Per PiPe I low Per Pipe = 17 6, 9. N1,111il-old Sl1* � Center Y Tyl) Center �,yr end) Length = Diameter = in. IN -GROUND PRESSURE SYSTEM-Continued- 10. Force Main: Minimum Dosing Rate in. Diameter = 11. Total Dynamic Head: System Head .5 f t. Vertical Lift _ ft. Friction Loss = ,.` ft. TDH = 12. pump Selection: 1;21 Pump will discharge at least- gpm at 1,-2- lift. total dynamic head. Pump model and manufacturer: 13. Dose Volume: 10 Times Void Volume of Distribution Lines Aal. If COR Daily Wastewater Volume + 2yien 4 Doses in 24 hrs. j9W, g a 1. 2gal. Backflow = Minimum Dose jy.4 .2 gal. 14. Dose Chamber. gal. Volume = CONVENTIONAL PRIVATE SEWAGE SYSTEM 1. Wastewater Load) Total Daily Flow gal. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE DETAILED LIST OF SIZING ON PLANS. 2. Required Septic Tank Capacity = ga 3. Percolation Rate = min./in. 4. Absorption Area Sizing: Refer to Table 2 in chapter H 63 and PROVIDE A DETAILED LIST OF SIZING ON PLANS. Required Area = sq. ft. Length = ft. Width = ft. Number of Trenches Trench Spacing = ft. 5. Distribution System: Lateral Length = ft, Number of Laterals Lateral Spacing= Distance from Sidewall to Pipe = in. System Elevation = ft. IV. SYSTEM -IN -FILL Fill in All items from Section I II V. SEPTIC TAN K gal. 1. Capacity = ,� - 2. Manufacturer: 3. Show Site Constructed Tank Details on Plan VI. DOSING TANK gal� 1. Capacity -- 2. M.inufaclurer: 3. Pump Manulacturcr: 4. Pump Model: .s. operatilig Head:- (). I- low Rldtc-_ g P ill. 7. Show Site Constructed Tank Details on Plans VII. HOLDING TAN K gal. I , Capacity = 2. M,jl1U1aLtU1T1_: 3. Show Site Constructed Tank Details on Plans 0 E D! LH R SBD-6761 (R.03/82) -SHOW ALL INFORMATION ON PLANS- REPORTING LOCATION AND ELEVATION DATA FOR SOIL TESTING DR I V� way } WELL C, ARAE !+AwHOUSE r� �., 55 �D � i'•,Z Y � 1 y r 240 yo 3S" 0 rZop LEGEND BM Benchmark which is the uer t lc;al and horizontal reference point w/ the top of well at assumed eleva- tion of 100.0 feet. Soil bore holes (backhoe) . A Percolation tests. Suitable soil area. ELEVATION DATA PT BS HI FS EL 100,0, B--1 5,51 97 .0 B2 5.4' 97,1' B-3 6,01 96 .5' PT = Point BS = Backe iSh t to the reference paint HI = Height of instrument HI . BS + BM FS 0 Foresight to some point EL a Elevation EL a HI -- FS ROD L rL VET RaA q C ��+� •••� .,ram rr. r r.. �R14D►� � ----� i�i 5,S' RG�D�N6 .01 = Ma" .26 = 31/8" .51 -- 6% .76 .= 91/a►• .02 = 1/4" .27 ,.... 314 " .52 =. 61/4 ►' .77 = 91/4" .03 = V .28 ` 3%" .53 .=-. 6%" .78 = 9% .04=1 .. .29=3%" .54=61/2.79=91/2" .05=V .30=3%" .55=6%"' .80=9%," .06 = %" .31 = 3%" .56 = 63/ " .81 := 9% .. .07--%a" .32=33fi" .57=63" .82_938►. .08 = 1 " .33 = 4" .58 = 7" .83 = 10" .09 = 11/8" .34 = 41/e" .59 = 71/8" .84 = 10%■. .10 = 11/ " .35 = 41/4 `' .60 = 71/ " .85 = 101/ " .11 = 13/" .36 = 4%" .61 = 7%" .86 = 1 Q-Ya" .12 = 1112 .37 = 41/2" .62 = 7%1# .87 = 101h►. .13 = 1 %0' .38 = 4%"1 .63 = 7%" .88 -- r 10%" .14 . = 13/ ►• .39 = 4% " .64 = 73/4" .89 = 10% "1 .15 = 1 Y8" .40 = 4 %" .65 = 7%" .90 = 10 ie" s .16 =.41 = _ .66 = .91 .17 = 2" .42 = 5" .67 = 8" .92 = 11►► .18=21/a" .43=51A .68 =81/a" .93=111/V .19 = 21/ " .44 = 51/ " .69 = 81/ ►' .94 = 111/4.. .20 = 2%" .45 = 5%## .70 = 83/8" .95 = 11%" .21=2;'* .46=51/2" .71=8��" .96=111/2.. .22 = 25/a`! .47 = 55/8" .72 = 8% .97 = 115/8►► •.23 = 2%" .48 = 5% `0 .73 = 83/ " .98 = 113/ " .24 = 2;$" .49 = 5 %" .74 = 8 /8 .99 = 11 %•• .25 = 3" .50 = 6" .75 = 9" 1.00 = 12" Sat L �0 rrom a F _,.. .sy STEM Table for converting decimal feet to inches. cc w HE w U. wADI 34 110 CAPACITY SEWAGE and DEWATERING Cr 1AJ LLJ w 24 - so 75 22 - 70 20 Gs 0 18 w 55 m 16 — L) 510 14 - 45 z 12 —40---- 3S -- :> 10 0 30 - - 25 6 20-- is - 4 — 10 - 2 - 5 0 GALLONS LITERS 0 jlt 30 100- 95 26 90 - 26 --as- EFFL UEN T 24 so J - F , MODEL 0 75- MODEL 189 and `4( w 22 - 165 DGCWATERING 3: 70- 20 --65-- --60 16 MODEL 3 MODEL 14 45 - 12 --401- 35- 10 -- MODEL —MC 30 - 137,139- o - 25 6 --20- MC MODEL 2 53, 5 S. 57, 59 0 GALLONS 10 20 40 so so 70 60.1 90 100 11 LITERS 0 so 160 240 320 4 DO FLOW PER MINUTE tO 30 40 50 60 70 10 90 100 1110 120 130 140 150 160 00 180 10 so 160 240 320 400 480 560 640 720 FLOW PER MINUTE 3280 Old Millers Lane P.O. Box 16347 Louisville, Kentucky 40216 (502) 778-2731 TOTAL DYNAMIC HEAD FEET/ METERS CAPACITY GALLONS/LITERS CAPACIT HEAD UNITS/Mll FEET METERS GAL Q 5 1.52 57 2 10 3.05 51 1 15 4.57 43 1 20 6.10 27 1 Lock Valve 24-51 CONSULT FACTORY FOR SPECIAL APPLICATIONS • High water alarms available. • Electrical alternators for duplex systems available with mercury float switches. • Long cords available. • Mechanical alternators available for duplex systems. • Over 1300F. - 54°C. special quotation required. • Variable level long cycle systems available. Zoeller Co. can provide complete packaged systems or combination of components including, controls, pumps, polyethylene and fiberglass basins. SINGLE PHASE UNITS Cast Iron Model Ph H. P. volts RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is an engineered/design part of every Zoeller pump. 3280 Old Millers Lane P.O.O�/ / C� Box 1634 7 Louisville, Kentucky 40216 O. (502) 778-2731 Manufacturers of .. . ICKAGEE BAILABLE r IL - DEPARTMENT OF INDUSTRY, LABOR AND HLrMAN RELATIONS SAFETY &B REPORT ON SOIL BORINGS AND UILDINGS DIVISION P.O. BOX 76 PERCOLATION TESTS (115) MADISON W153707 (H63.09(1) & Chapter 145.045) /ram. LOCATION: SECTION: OWNSHIP NICIPALITY: LOT NO.. BLK. NO.. SU COUNTY: OWN R'S BUYER'S NAME: MAILING ADDRESS: 7,7 6V USE DATES OBSERVATIONS MAbE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence D New ,.Replace — /0 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GRQUND-PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED S EM:(optional) S ZuWS LU ESrU ES MU [IS 2U 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: f �� Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GROUNDWATER -INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON`BACK.) OBSERVED EST. HIGHEST 46 B '_76 �' — =-;!5%1 r B' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME NUMBER AFTER SWELLING INTERVAL -MIN. P- L'a p_ O P- P- P- P- DROP IN WATER LEVEL -INCHES PERIOD 1 PERIOD 2 PERIOD 3 Xe RATE MINUTES PER INCH Ad te RLOT 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. ,�_ I x;� C/ 1�'r,rn r � SY$TEM ELEVATION% c� .11 l� o NIP .tN ' � ` .... .....E .,:. .. ` r S` / i 4,3 n ow. r 00 160 r/ I� _ 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: 1-7 f Z 3 � 2 ADDRESS 1_77�2 CERTIFICATION N .,, MB R: PHONE NUMBER (optional): vtjr CST SIGN `" TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ')ILHR-SBD-6395 (R. 02/82) — OVER INSTRUCTIONSFOR COMPLETING FORM 115 m SBD - 6395 o be a compi to and accurate soil test, your report rt 0st €ncl d-a I o Completa legal description; , The use section rnLJSt c1lar-ly irl(:liQlte IIP�thPr- this is a residence or corer erciaiproject; , MAXIMUM number of hedreaoms or cora metcial use planned, 4s is this a new or replacerra t system; 5. Complete the, SUit bility rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL, CONDITIONS: , PLEASE use the ibieviaticarrs shown here for writing profile descriptions and completing the Mot playa; , MAKE A LEGIBLE diagrarn aMlrately loCating your test locations, Di'awing to scale is preforre€ , sel:) t,ate sheet may bp used ifdesived; , Make sure your banchaiark and vertical r:Ylevati n reference point are clearly 5hoojrag are l en.r.ranent, . Complete ail appropriate boxes as to dates, n arnes, addresses, flood plain data, percoiat:iorr test exe'm — tion, if p row fate; '10, if tlke Information (such as flood plain, Plevatiora) do-'s riot apply, NY . In the appropriatebox; Ile Sign the form and place your c�arren,i; cr(:J( ress and Your Certification number; 12, Make, legible copi,Ees �a�acl clistr-i ute as required. ALL SOIL TESTS ML)ST BE FILED WITH THE LOCAL AUTHORITY V,"I T H IN 30 DAYS OF COMP1.,.ETION, ABBREEVIATIONS FOR CERTIFIEDL TESTERS Soil Separates and Textures Other Symbols � t, ­ Stone (Ove� 10" BR Be(' I r o c k- c(.-)b C c,1.)ble Q - 10° ) SS Sandstonr, car Gravel (under 3" LS Lrr iestone s an d H Gi V`vf .".... High ( rCat.rradwater Coarse �, anc.1 Percx)latlon RaL,,,, Y y Sg Is Lo aivy *.. ,,, 3�.5 v I-101i y Less yy L�, aA 4py P.. w.._ r' t i c! w. c lay Loam y ye11ow sr,,! Savidy Glay L. wn R R € d S C mq�fi�"tea S'1 I Clay Loam a�. � t1eS s aj�3Ny��`};�$�r�33'`� : 75�, q y i 933� n �r 3 }'�F € ..,.,.. 3 ) I4 3 #5,� H 1 i 4 "�s�v( to II $ 1,,,�i i'S l r .. Six !."ra tt y'ry ( y 5 rg -{- ars$t so' �.�'�,l for rlc.luid write disposal _ Bench $BM 's% RP, ........ $i'� $p�'ar p5_ y / ,-,i cal t {? Rd~. " rTfiis so!soii test report is t ha` fir,sertur`mg a �anits`,ary tn it, ThecE::)unv y or ths' v,3rlTrc{atinii c,f dais soil i�� ,�; rr-�; f,£ Id� to ,. s„ jh, � y, � �, S vs,r a i a �`����.. € t sa�."8'��hca, on rY°tis' e s,.9�.� fib?€ f, tC.� 1.�9�' r � t;� � ? Ik..��. �� ea4�'.. � � 3��s €3" 41 €<. € a f.. 0 t, T lr s.';r r � a •,.;-':v �����a��s � rya DEPARTMENT OF REPORT ON SOIL BORINGS AND INDUSTR �, G HUMAN REDATIONS PERCOLATION TESTS (115) (1-163.0911) &Chapter 145.045) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION: SECTION: 1T 0 W/VGA t) �HlNICIPALITY: *,o LOT NO.: - BLK. Np.: ._.�. SUBDIVISION NAME: --� -0. COUNTY: 0WNFR'5 A3UYER'S NAME; MAILING ADOFM ESS: / 151- 06 4?e& iif JW/ ill .0 - V'% USE DATES OBSERVATIONS mA,6E 26 t� Residence NO.BEDRMS.: " COMMERCIAL DESCRIPTION: ❑ New XPleplace PROFILE DESCRIPTIONS: 17-- ERCOLATIO T STS: , ✓ � j � -�- RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND. IN -GROUND -PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED S EM:(optional) []S [SU��S ❑U S MU El SUU El S M 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: ,/c� Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GROUNDWATER OBSERVED -INCHES EST. HIGHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV, ON BACK,) 17 B,3 B- B- R- %/- PERCOLATION TESTS TEST NUMBER DEPTH WATER IN HOLE AFTER SWELLING TEST TIME, INTERVAL -MIN. DROP IN WATER LEVEL -INCHES RATE MINUTES PER INCH PERIOD 1 PERIOD 2 PERIOD 3 P- kd_� P- .2 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. SY TM ELEVATION CA tN I } I I 1 ! s I } r t i 1 - 1 # '� 41 I k �'• I } ' � I 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 CERTIFICATION N MB R: PHONE NUMBER (optional): `- 1 CST S1GN TURE: f DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -- OVER — S92ym20703 S T C - loo "'tlis a1)P"cation fOrm is to be Completed ' t1le o;,�r�cr (s 7 ©f t1�e pL- p ed in full and signed by ©perty being d�velo ,well only result in dela s of t �ed Any inadequacies development be intended he permit issuance. Should this ended for resale by owner/contractor,(s ec liouse) , then a second form should be retained P tile property is sold and submitted to 'and completed when appropriate deed recording, this office with the w r - r - r r wwr-r r r--r - w wr rrwrr wrww �w wwri wrww w- w- w w w w---k A Owner of property Location of property_;; ' !' v 1/4 ��" 1/4 , Section � T �N"R Township Hailing address Address of site,,;Y Subdivision name Lot no. Other homes on property? es Y No Previous owner of property C, Total size of parcel Date parcel was created Are all corners and lot lines identifiable? 'Yes No Is this property being developed for (spec house)? .� .� � Y e s Volume( Page 2fiu of Deeds. Numb_. er as recorded. with the Register wsrrwn..rr rrr-rwrw•ww....w...w-wwwrrw ww+rr!ww rww www"wwr rwww wwwwrwrwa�wrwrwwrrwwwwrw � w I14CLUDE 19IT11 THIS APPLICATION THE rOLLOWItIG : A WARIWITY DEED which includes a IOCUMENT NURDER 11U1.113I It & THE' SEAL of THE ItEGIST Z of DEEDS. ' VOLUME AND PI�Gl; certified survey, if available; ;would be helpfulIn addition, a delays of the reviewin so as to avoid references g process. If the deed description to a Certif3.ed survey Maps the CeztitSQd Serve Ma Shall also be required. Y p PROPERTY OWNER CERTIFICATION I (c4:e) certify that all statements on this form are true to the best Of ray (Our) knowledge that I (we) am are the property described in this information farm the owner(s) of warranty deed in in the office of the County virtue of a t�ecd as Document tto. �''J j -? , and that Y Register of o�:n the proposed site for the sewage disposal s (We) presently Obtained an easement, to run the above described ystem or I (we) ttie construction of said system, and the lamed property, for recorded in the office of County and of deeds s been duly No, -- as Document 4inaLt—uure o a �lic • Co --applicant 91 Date of Signature Date of Signature SEPTIC TANK MAINTENANCE AGREEMENT St. Croix county OWNER/BUYER e V1.4 /Y 2 � _C� 4 ADDRESS: FIRE NO: LOCATIO14: 1/4, SEC T NR TOWN OF: -ST.-CROIX COUNTY SUBDIVISION: LOT NO* Improper use and rqaintenance 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 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 to help with the cost of the 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 the 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-l site wastewater disposal, system is n,,proper operating *condition and (2) after inspection and pumps. -mg (if necessary) the septic - tank .°.s -less than 1/3 full of and -scum. Certif ication: from Will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements -a-hd agre . e tomaintainthe private sewage disposal system -in accordance with th.e standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix- Cou-nt-y Zoning Officer within .30 days of the three year expiration date, SIGNED: DATE: St. Croix County Zoning Office .911 4th St. Hudson, WI 54016 7F. ­7 77 7 77 �7 ­7 `7 7:77 WARRAWY am c s000 q t i,-) Ir r,*Ot Ott n P 1 0, V A STATE BAR OF WISCONSUS 702M S—UN 47T72G vmpo W"ma A.M REGIo i r k..V-00 ST. CR*X Wo * W I Marcia R. P� 0 n ,,;ingle ptrson Rec"d fcw Rwwd NuV1 41991 Of 8: 30 A. M "%Won* T* Klirijvzo irA Llnd!�i He &W04U& #. . husband "linger mW wife as survivorsi. p an kj "low of Do$& propertylk St., Croix ow following descrikwd mal "t,4tv iri nsin: gut* of W10coo r. The ,;t 800 feet of the Soh 600 feet of th- Wr, SO.. Quarter (SW "outheast Quarter (SP 1/4) or section (8), Township nArty (30) Ncrthq Ranj,o lo ft,,#)n W"St. Rivard lAw Office P 0 0 0 BOX 9 Gl*nwood Cityv Wii 54013 Tax Para] NO Thi* is not F W a ,zerption too waktrunIt0%; Subjec# n ii muniC11,11 ijr;q !Ounty zt)rjj,.,q; �r%llnancere 1 1.114 .1 twits 'A J�000 Marcia H. Perry AUTHNNTICATION Sirnature (s) f, 04 o" *,!cd tt".4,W", day of ;ITLF� MF.M*IF.k sT A T F. It A It F % I ( not. authorized 14k 151 7W')1W1. Wit, Francio Y. ACKNOWLIKIDGMENT *VNIT ov %WA,41N, Glenwood o7 i ty W PkAft A V" V".0 VlAjIF. Art 117 %%t-4 aP 9 tl,.ft ff -.— tit! st extovotod 1"t ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET * HUDSON, WI 54016 (715) 386-4680 July 13, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the property being purchased by Tim Klinger, located in the SW 1/4 of the SE 1/4 of Sec. 8, T30N-R15W. Town of Glenwood, St, Croix County has been conducted with the assistance of Byron Bird Jr., CST #34790 This onsite revealed suitable soils to a depth of 1711 which meets the A+411 rule for a mound with 1911 of sand fill. Should you have any questions, please feel free to contact this office. %-I e ere,ly., m s es K. Thompson Assistant Zoning Administrator cj Ability Business Co. AB Ci Complete Sewer Services KNAPP, WISCONSIN 54749 MENOMONIE, WISCONSIN 54751 Phone: 665-2112 Phone: 235-1666 =.. rid S �ww�2 Sw%r� �5�� Act. P/4s� s���, aoop `To��st��P q / 0 z -S /67 P 6 fec) Po�bc 0 0 ,firMAJ �U U � Giit: �, Boo xGco // 4Q,kirs Wisconsin Department of industry, SOIL DESCRIPTION REPORT Labor and Human Relations (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Additional Remarks: Safety &Buildings Diviiw P.O. dox 7969 Madison, Wl 53707 Page of Other Site Features: -* CS Signature Date Signed Telephone No. C�T- Limiting Factors/Depth: SBD-83 30 (N, 0 1 /90) Wisconsin Department of Industry, SOIL DESCRIPTION REPORT - Y Safety & Buildings Division, �« P.O. Box 7969 Labor and Human Relations (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, lr► l 53707 I 7 Rage of Customer Name Soil Ev luat on Da a Current land Use or Vegetative�Cover Parent Materials %/ �IZJ2 Customer Address Estimated Shaul west Groundwater Flood Plain Elevation Cownty Tax Pa'r'ce-1 No. System Loading Rate in Gallons Per S . Ft. P Day 4 Lot Legal Description System Geometry and Depth Slope and Aspect Yl gk%� 76 Z6� !�Q610 Horizon Depth Dominant Color Mottles Structure Remarks: clayskins Loading In. M u nsel I u. Sz. Cont. Color Texture G r. Sz. Sh. Consistence Roots Bou ndar ores Hand ether G PD1ft. 2 I - /' / - r Z P7 If de- . C)— 1� 1, I )--N Aca j �I• . §, j/�/r �/'� k� �F . •i � ! � Lam' � � � � 1 Additional Remarks: j r Other Site Features: od F7 tj /t,7 4 1123F9�� - 0mitin 9 Factors/Depth: CST Signature Date Signed Telephone No.. CST SBD-8330 (N. 01/90) Wisconsin Department of Industry, SOIL DESCRIPTION REPORT Safety & Buildirgs Divisior,. Labor and Human Relations �- P.O. Box 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, WI 53707 ion Da Current La Parent Materials Page of Cu erName Soil Evaluation Curr Use or Vegetative Cover ram, 10001A L4 14t )C:- �' Usto'mer Address Cou my leg Tax Parcel N6. ;�;T Lot Legal Description Esti afed Shalfowest Groundwater Flood Plain Elevation System Loading Rate in Gallons Per Sq. Ft. Per Day -_ 01v System Geometry and Depth 'Slope and AsPe lltvz�wwfvo 7-4N-tv P109/0 0,� 1 _2 Horizon 71 Depth Dominant Color Mottles Structt n. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. if5l rlsl 42 7 S�ijyt 7 4L Additional Remarks: Aeon IJ 17 Other Site Features: 17 V9 /J_ Linviting Faktors/Depth: re Sh. Consistence Roots Boundar Consistence +eR r Remarks: clayskins oores, r)H. and other ACE Loading GPD/ft.2 0 Da CST 5ignature te Signed Telephone No. CST # SBD-8330 (N. 01/90) O. Wisconsin Department of Industry, S SOIL DESCRIPTION REPORT P.Oety. Box 7969 Buildings Division Labor and Human Relations kA ch Soil Profile Location Map - To Scale - On A Separate,, Signed Sheet) Madison, Wl S3707 Page of Custor4er Name Soil Evaluation Date Currq4and Use or VeUtative Cover Parent Miaterials -% �- 16 - `7-/ P1 ZZ /)Vfiy d d . j Add Estimated Shall westGroundwater Flood Plain Elevation County Tax Parcel No. System LoaJing Rate in Gallons Per Sq. Ft. Per Day t Lot Legal Description s j System Geometry and Depth 0 , 1 0 1 If Ph Slope and Aspect Horizon Depth Dominant Colo . r Mottles Structure Remarks: clayskins, Loading In. Munsell . Cont. Color gy. St. Texture Gr. Sz. Sh. Consistence Roots Boundary _pores, pH, and other G P D/ft. 2 1 14 60 16 VR L )i M0 Additional Remarks: V0 Other Site Features: 6�s 746 2 'Limiting Factors/Depth: CST Signature Date Signed Telephone No. CST # S3D-8330 (N. 01/90) Wisconsin Department of Industry, SOIL DESCRIPTION REPORT Safety & Buildings Division Labor and Human Relations P.O. Box 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, W1 53707 Page of C-?lame SV!, aluation D5 Current La Use or Vegglative Cover Parent Materials Cus-romer Address EstimafedSh owest Groundwater Flood Plain Elevation Coun Lot't7e'ga'l Description fr Horizon Depth Dominant I Colo I n. Munsell Additional Remarks: /6 o Tax Parcel No. To P I, Q 4d r Mottles gu. Sz. Cont. Color Texture L System Loading Rate In Gallons Per Sq. Ft. Per Day System Geometry and Dept -ri4l a D Structure Gr. Sz. Sh. Consistence Slope and Aspect Remarks: clayskins oores, nH, and other Load i ng GPD/ft.2 Other Site Features: 401 A) 4 1 f`j f timiting Factors/Depth: CST Signature Date Signed Telephone No. CST # SRD-8330 (N. 01190) OF Wisconsin Department of industry, Labor and Human Relations SOIL DESCRIPTION REPORT safety& Buildings Division P.O. ox 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison,, Wl 53707 r qvf 0 Page of custQm r me S a I u a ti D -Cu—storder Address Counter Tax Parcel No. C- x- Current Lgrfd Use or Vegetative Cover Parent Materials Estimated Sh,aMowest.Groundwater Flood Plain Elevation System Loading Rate in Gallons Per Sq. Ft. Per Day AT Lot'legal Description IS 1-14) AA----- �r If " System Geometry and Depth slope an spect 111-7 'r- Horizon' Depth In. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz.Sh. Consistence Roots Boundary Remarks: clayskins 2orespH, and other Loading G PD/ft. 2 mvet- %.00r Additional Remarks: ILI- zw7 L4 , Other Site Features: CN Limiting Factors,/Depth--. CST Signature - --�/ -2%- Date Signed Telephone No. CST # S BVID -8 3 30 (N. 0 1 /90) -h I I Ability Business Co. A B • CompClete Sewer Services KNAPP, WISCONSIN 54749 MENOMONIE, WISCONSIN 54751 Phone: 665-2112 Phone: 235-1666 D z :SwA - A-QP. 1!�4 S ­�­ q70says $-3 Bowl �& GIl N feD PpsE 0 D WN)€2 T3oN Rise 6'/�N NOOO 7o.uJsN�P Sgro0i r+RP11� oN r ZoningSt. Croix County Planning nThursdt October 12, 2006 at 3:51:51 PYvl Page 1 of I Detail unitary Information Computer #: a16-1a17-40-10a SulalPlat: metes &bounds Section: 8 P TNIRIVG: T30N R15W Parcel #: 08.30.15.138A Lot: 114 114: SW 114 SE 114 Municipality: Glenwood, Town of CSM: - ---------- - ------ - - ..... ------ - -- - - Owner: Perry, Marcia 2860 160th Avenue Glenwood City, WI 54013 Permit: New State Permit: 12906 Issued: 08/28/1979 POINTS Dispersal: Holding Tank Bedrooms. 2 WI Fund: County Permit: 201 Installed: 08/30/1979 POWTS Detail: NA POWTS Pretreatment: NA Notes Money Owed Issuer/Inspector As Built Plumber Other Re uirerents Additional Notes Smith Gale 1750 gal. tank to a mobile home; now removed for $0.00 Harold Barber Yes mound system. File with 1992 permit Not determined Signed Off: No Owner: Klinger, Eugene 2860 160th Avenue Glenwood City, WI 54013 State Permit: 171517 Issued: 08/04/1992 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 01126/1993 POWTS Detail: NA Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA Notes Issuerllnspector As Built Plumber Other Re uirements Additional Notes Not determined Yes Bird, Byron Jr.. Jim Thompson Signed Off: Yes Maintenance Scheduled Pum Date Pumped 1st Notification 2nd Notification 3rd Notification 1 /26/ 1996 1 /31 /2003 04/20/2006 1 /31 /2006 04/20/2006 — — — — — — — — Money Owed $0.00 W AS BUILT SANITARY SYSTEM REPORT R 3 &11 A 9 TfJWNSHIP /_ e-tVA-#,v f, EC . * Tti ` ' N,, R / � --� W .0. DRE S S� � # � ST. CROIX COUNTY, WISCO'NSIN. iv ,_3DIVISION - , LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Cula (S) Z MFGR. r, = °• CONCRETE_ STEEL NO. of rings on cover... Depth DRY WELL :INCHES NO. of width length area _J no, of lines width length area depth to top of pipe upLEGATE r,R RATE AREA REQUIRED AREA AS BUILT _sciaimer: The inspection of this system by St. Croix County does not imply complete .Mpliance with State Administrative Codes. There are otter areas that it is not possible inspect at this point of construction, St. Croix County assumes no liability for .stem operation. However, if failure is noted the County will make every effort to .termine cause of failure. 7ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. INSPECTOR DATED- _*Zf PLUMBER ON JOBzz Lo�. LICENSE NUMBER 1 i Z REPORTjOF-INSPECTION—INDIVIDUAL SEWAGE SYSTEM Sanitary Pe),Lmit State Septic/L/T ST. Croix County NAME i owns hip Z�� L o c ati o n o Section a I . P . 0 Size gattonz. Number o6 Compartments Distance From: WeU —6t. 120 on greater zZope 6t Suitding 6t. Wetf-ands 6t. Highwatet DISPOSAL SYSTEM —6t. Distance From: wetz 6t. 12% ot greater scope 6t. Buitding 6t. Wettand/s Ft. Highwate4 —6t. FIELD DIMENSIONS: Wid,th o4 .trench —6t. Depth o6 rock betow -tile in. Length o4 each tine it. Depth o6 tock oven tite in. Number o6 Zines Depth o6 .tile beZow grade in. Totat Length o6 Zines 6t. Stope o� trench in per 100 6t. Distance between Una 6t. Depth to bedrock 6t. Totat ab.6orb tion a/tea g L Depth to g.,,t-oundwate,,L it. Requited area �t 2 Type o6 Cove,�,: Papek or St&aw PIT DIMENSIONS: Number o6 pits Gkavet around pitz y e/s no Outside diametct- 6t. Depth betow inlet it. 2 TotaZ ab6mbtion area 6t Area ttequired 2 rn 6t INSPECTED BY TITLE APPROVED REJECTED DATE DATE 1 7 EH 1 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:�%, Section T-N, RW, Township or hip, Lot No. —, Block No.—, Subdivision Name .County Owner's Name: .111A—A d 'e]A R Y_ Mailing Address: k."Poo 41 .1' TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION --REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SO I L MAP SHEET e SO I L TYPE &P A AW* rZ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS SINCE HOLE WATER IN HOLE AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE PERIOD 1 PERIOD 2 PERIOD 3 NUM- BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES MIN/IN P_ )q 40 P_ P_ J SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES (DEPTH TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST B- Aj Al fir " C, / 13- -3 4 72 NO et'. a X ___;C---- PLAN VIEW (Locate percolation tests,soll bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. Z es A] I t i r i IS 4040 r- N Rig, 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Cam, Via- 4 ._/M / tY Certification No. _/;7� IV / a C% 0( Address tv Name of installer if known e— I 'IS* Yll* tN CST Si COPY A-" LOCAL AUTHORITY nature State and County State Permit # PLB67 Permit Application County for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: 1/4�5 1/4 , Section T.�TC� N, R -,&47 MW 0 �7W L o t # C'i ty Subdivision Name, nearest road, lake or landmark Blk# Village__,___ Township C. TYPE OF OCCUPANCY: *Commercial- I industrial *Other (specify) *Variance 001 Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder A_ YES NO # of Bathrooms Automatic Washer )< YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks *Holding tank capacity X 17&6­41 Total gallons No. of tanks New Installation —Addition - Replacement -- Prefab Concretes *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) &PO' 2) 3) M_Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth TileDepth No. of Trenches Seepage Bed: Length Width Depth _Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land- Distance from critical slope AV 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifi4cj Soll Tester NAME le, C.S.T. # and other information obtained from (owner/builder). Plumber's Signature 'e. MP/MPRSW# Phone Plumber's Address ,PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). le7g-y rC iWA? Raid Do Not Write In Space Below FOR DEPARTMENT USE ONLY I e� 0 C, Date of Application Fees Paid: State C 0 to Permit Issued/REJeIFFRI (date) -71-Issuing Agent Name Inspection Yes No Valid# Date Rec'd 1. county (wh;iie—copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 ............... 1, 4e Z 'A I-N L 44 4)L j, 4.i 4F' j- lit 40 v I '74 Wl Ar 7. j�� 'Y gr it S" 4P; 4k 4 4: 'I. 4 . ......... L.,y IIL ',j�m 4k!�- A iv OL 'IC i Ar I't7 .1 II4.i I jig 4'. 4k 4L 46. . T -1 4 - . ... . -- 4 : - - - I I - . . jL , tA WN jobL. 44 Oka J* kt 7.1 IFA 6-i ;L _f qL I _A6 fy, A rk % A Ilk. 16 tl . ......... - ;:� 44 ik to. T4 . , . r ,J ,F � mr ^ 6 4 ."r' 441 ,.... r } ter• -` ... r r v M` , ,. ■� %. ... w f � +�. .^.� n A^ x k r w� '.� M • d "�r �'",ry }�0" �` P ., '$* . J� .- � .. - ., x 4 y�,��� _ k .I .�• yy 4 ^.„ 1 ,i ^• i- 4 Kh' A.rP' � � •, n � w t ' � ^, � F w+. -,J. .. k x "E '4H• .m ' n r� � a. 4i�r � a.. r . q � „ ♦ �F S b �0. i,• ;gym � �+,,. ., $ �� ., 4 x » ,.� k.r �t_e .r �i ..- a,,.,� . p - No 0 .. I. r�. yo ,� v� y A�. ..A • Y n c ..., m Jy •e , ..� M �3 �t .... '� u.,� t,"N " +4. 1V ^: �6 .. - F , �. �' - d... '� NP ' r :` .. „[ � _ •�t * ���i4 'mim ;} � �•.� vJ� � .� i , '#„ • �YI "� � m.q �ni» F,�aj > w� �... uY..M' ' ,, a ..i. .. •!n '�,:. _ W '�o ." �4 .q V w W r k m A .'✓ k 'xr� �� $ .... jj J •i, M JY 'rA � .:: Mx r q ,.:' dx ..' i� �i 5w .,..m ay,.r ,.," a J an < � �', .. t i �. i�• . " M� r .. 5 — 1 w w {� . ,Smith Plumbing PHONE (715) 265-4838 GLENWOOD CITY, WISCONSIN 54013 A GSA E E P%IE q 71 This agreement, made and entered on this day of 19/ /7, by and between the Township of, Pddress, C00000, V.,hEREA-S: 1- n application has been made for a sanitation system on the following described property: V►EERE.P,S: Septic tank drainage does not meet the minimum standards of the ordinance of St. Croix County and state codes. E R E.P� S: The owner agrees to install a holding tank for septic tank p-urposes purpoges, NCV`,, THEREF (DRE-- For and in consideration of the issuance by the Town- ship of of a permit for the above premises, the parties do hereby agree and bind themselves as follo\A,-s: Owner agrees that they will conform to all the rules and regulations pert . aining to a holding tank system. They agree that 2nytirne said township deems it necessary to pump out said tank, the owners shall hCave samc pumped out in 2A hours, or township will have sd 1d work doneand charged to owners and place same on their tax bill as a special charge, 2. The Township reserves the right to assess a bond if they desire to cover any possible pumping charge in the sum of $ IT IS UNDErtiSTGOD that this agreement shall be binding on the owners., their heirs and zassigns-, IN l'I'NESS WE *ERLOF the parties have hereunto set their hands and seals V".0 the day and year first above written, Township of by Developer or owner r P4--� STATE OF, V41'.-JCONSIN) SS: i U= 1,979 COUNTY GE SDI" . CRCE) 1 Subsc.&"ibed and swor before mday of 19. e this / 7 P 7 or C MMUN W. SEVERSON ,,. * a "My PUUC - stwe oaf wimc� �My EXPk" May 17t IM Notary Pubi1c,Xte %,Iroix County