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HomeMy WebLinkAbout022-1017-80-000St. Croix County Planning and Zoning Monday, July 11, 2011 of 2:12:47 PM Detail Sanitary Information Page I of Computer X; 022-1017-80-000 Sub/Plat: NA Section: 7 Parcel 9: 07.28.18.100C Lot: 1 TNIRNG: T28N R18W Municipality: Kinnickinnic, Town of CSM: Vol. 02 Pg. 470 114 114: SE 1/4 NE 114 Owner. Danielson, Larry 470 Cty. Rd. SS Roberts, WI 54023 State Permit: 218862 Issued: 05/31/1994 POWTS Dispersal: Mound 24" or more suitable soi Permit: Replacement County Permit: 0 Installed: 05/31/1994 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Mary Jenkins Yes Wang, Tom Mary Jenkins Signed Off. Yes Maintenance Scheduled Pumo Date Pumped 5131 /2005 10/1 /2009 10/1/2012 10/29/2009 10129/2012 w 1116 Other Requirements Additional Notes Money Owed soil report in active files shows 30" of good soil $0.00 and location of existing failed system - no permit record for original POWTS. 1977 soil report fof SW/NW 114 by Jeff Cudd said mottling <4' in 3 test borings Notification Notification 04/20/2006 DANIELSON Larry SEC, NE�q Sec. 70 470 CTY SS T28N-R18W, Town of Roberts, WI 54023 Kinnickinnic, Lot 1 Address Site: Same as above. Permit No.: 218862 5/31/94 Thomas A. Wang Replacement System - Mound STC - 104 AS BUILT SANITARY SYSTEM REPORT c OWNER C° D ADDRESS S SUBDIVISION / CSMI `- SECTION 2 T C 0 N-R�W, Town of ST. CROIX COUNTY, WISCONSIN LOT Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ISO ALTERNATE BM: (,,n�rnFu' AtI.4SC qU Lv SEPTIC TANKS CHAMB / HOLDING TANK INFORMATION Manufacturer:_ �Z►dweS 1 ct Liquid Capacity: Setback from: Well �50House fp Other gg// // _ Pump: Manufacturer �QGII Model 311G Size �T Float seperation_ Gallons/cycle: i 6 Alarm Location SOIL ABSORPTION SYSTEM Width: ?' Length Number of trenches Distance & Direction to nearest prop. line: 1 S Setback from: well: 7 J D House 225 Other Building Sewer. PC inlet Header/Manifold Existing Grade ELEVATIONS ST Inlet. PC bottom ST outlet Pump Off Bottom of system. Final grade DATE OF INSTALLATI / j% PLUMBER ON JOB: LICENSE NUMBER: ✓ 3j INSPECTOR: 3/93:jt Wis.;on* Department of Industry, Labor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) PefrWIMEMI i : LARRY T & RUTH ❑ City ❑village "i Town o 7� NTMNTCKTMMTr CST BM Elev.: Insp. BM Elev.: BM Description: 60 r ` TANK INFORMATION `� ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing, Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD Septic S p' 1 0 > / L), NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer Demand Model Number * GPM TDH Lift _ C Frictior' '"- S ste CHea) TDH (�>Ft Forcemain Length pj I Dia. a U Dist To Well )rjr)r SOIL ABSORPTION SYSTEM ountyST. CROIX Sanitary Permit No State P an ID No.: Parcel Tax No STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/Ht Inlet St Ht Outlet r Dt Inlet :rS✓, fv i Dt Bottom Header / Man. Dist. Pipe p Bot. System Final Grade BED/TRENCH Width Length No. Of Trenches PIT No Of Pits Inside Din Liquid Depth DIME SIONS y7DIMENSIONS SETBACK SYSTEM O P/L BLDG WELL LAKE/STREAM LEACHING Manuacturer: INFORMATION CHAMBER OR UNIT Type , r y Moe Number: System: 7 ,� 75 75 N DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Au Intake ��VV Length Dia ¢_ �I Length � Dial Spacing � I� 1 3 (o SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over N Depth Over n Q // d0 xx Depth Of II A- xx Seeded /SoddMIr— xx Mulched Bed/Trench Center 1� Bed/Trench Edges Topsoil L, [es ❑ No J R- es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) �)c,,Ij -Ci 6 0 E o3 L- LOCATION: KINNICKINNIC 7.28.18.100C,SE,NE,LOT 1, CTY SS 131tiL- 3.G� _ QJ J3,k --__ IG.D d:- 9 - f `e 1.45 Plan revision required ❑ Yes ❑ No , Use other side for additional information. F � � SBD-6710(R 05191) Date spector'sSignature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 0wIk11twev nrnaaIr AnnI Ir►ArI^aI �ILHR vr�I�■ I rasa ■ 1- �relwoI I r%r r 16Ivr+ I Mil' I'm In accord with ILHR 83.05, Wis. Adm. Code UO x STATE SA IT,Q�Y PERMIT k -Attach complete plans (to the county copy only) for the system, on paper not less than aGVCDL/P_ 1 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 I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PRO RTYOWNER PROPERTY LOCATION %� f� llrelSOi , �Ya,S T-�N,R E or W PROPERTY OWNE MAILING / I LOT k 9 BLOCK k C J J / ITY, STAT% ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER f C C3 CITY II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST R A� :1 LiLl /1 ❑ Public bedrooms- ✓ ©1 or 2 Fam. Dwelling,# of x Nu III. BUILDING USE: (If building type is public, check all that apply) C } _ AN 7 - Dodd 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) A) 1. ❑ New 2. F;�j 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 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 LJ 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 14.LOADINGRATE 5. PERC. RATE 16.SYSTEMELEV. 7. FINAL GRADE i REQUIRED (sq. ft.) PROPOSED (aq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPACITY in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concreteglass Con- Steel Plastic App. New iatl Tanks Tanks strutted Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber t, $ %' Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print(: Plu a Signature: (Ntamps) M Business Phone Number: r ✓ r Ao � �>>( yes ) f15T lumber's Address ( p ): toNw 0 AUE etc 11_ 4�,oxd IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Penult Fee (includes GroundwaterrDale IssuedIssuing AgentSignaturo (No Stamps) Approved ❑ Owner Given Initial Vv/S Surcharge Fse) Q y Adven4e Determination —r X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb$7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8. Buildings Division, Owner, Plumber INSTRUCTIONS S a = 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 (SBO 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintai ed. The septic tanks) 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: 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. 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. 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/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 6% 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) K.; SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations November 18, 1993 WANG EXCAVATING THOMAS WANG W9672 770 AVE RIVER FALLS WI 54022 RE: PLAN S93-41184 DANIELSON, LARRY NE,NE,7128,18W TOWN OF KINNICKINNIC MOUND SYSTEM 2226 Rose Street La Crosse WI 54603 FEE RECEIVED COUNTY OF ST CROIX The Department has reviewed the above -referenced submittal. 180.00 Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Gerard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 2118R/ 1 S"D4M4x,01ro1) rq teisoYI N 9-AP TORI�pU XInnI r kifin;c- 7wwhs (' c 10,0 S 9 3 - �/// 9,41 (.dale Il, KeUiecv PRIVATE s ConditionsII Y 0V ED AST g�tJlilUNS Or. of w smew eFailed SqS, Comm abandogeall 10T4W�6 New 7�0%ad painp r C60,*ber I S e Uol c to b e pa.,l �-ZnspecYed JRPuse, REPAIRI katnFY oft RcrwA k IF N"a&D - r SCaie 1'I= 40J p = well a = Bore Ho/es /00. 0• K 1 B, M, Top pipe S93 41 1 t3 4//l/ 3/93 SAFETY S BL^ Sarraee N S93 41184 Straw, Marsh Hay, Or Synthetic Covering1 Page — Of — Medium Sand 6" Topsoil \ ' S t. S % Slope Distribution Pipe 1, TE _ Bed Of 4 — 2 %2 Aggregate - (6" Below Pipe) Force Main Cross Section Of A Mound System Using A Bed For The Absorption Area Signed: License Number: _ 3D 31 Date: Z13%3 Alternate Position of Force Main �► _ L A Ft. B Ft. KFt. L �_ Ft. Ft. I Ft. W It. 1 Observation Pipe �•--------------------- ----------------- Al i --• -- TEM � 1 - eRIVATE SE�IAGES -------- --�I Force Main w-------- . i iOVE Bed of Z'— 2 %2 quTloNii A g g r e g a t e tp%G 1iM+ a Permanent Markers G Plowed Layer D I • Ft. E 1.5 Ft. G2 "uJ. F j7q Ft. G 1,0 Ft. H _4.T Ft. SEE Plan View Of Mound Using A Bed For The Absorption Area S93 41184 ?VC rnanir"Id PopR. bNt Des}r� -V LRs+ holc shoolk bc, ncxt to ena Cop p � 5 F+ S I F} n c:+c holt . ��2`� i n cti I `a4CCJ d1A �= ��'1 ck (o) r/�t�lan,Foldl AI,. 2- 1nCk(eS rOrCC nrA; n a�" • --- i n C.l e.s # l,olc p« Pipc Inueri ,eltd.,X I.ier•) Al 'F+- rj,. � "-� pRIVATE SEWAGE SYSTEM 3 •onaliy 2 3 I Conditl �� �gSlONB /V/3; LAW i �gIMAN F DEPT. Of o mom", LAW AND W c SEE CO 1'I\I.1 VI PUMP CHAMBER CROSS SECTIOrJ A►JG SPECIFICAr10k1S 893 VELIT -CAP 41184 180AIN. h INLET I WEATHERPROOF JUNCTION box IL'MIU. I GRADE I I CO DUIT -- APPROVED LOCKING MANHOLE COVER QRPIArArl M v Conditionally} PROVIDE I 1APPRO �AIRTIGHT SEAL OF Y.i HUMAN `. � p1111 OF An ILG Y' MIN. I SEE COB I T D TH I I Ou I ELL1G 14 FT-- APPRO D PIPE 3' ONTO Pump OFF p SOLID SOIL CONCRETE BLOCK RISER CXIT PERAnmo OWLU IF TAIJK MANUFACTURER HAS SUCH APPROVAL SEPTIC li SPEG FICATIOAI DOSE TANK MANUFACTUILER: MI S e 14 t IJUMBER OF DOSES: —PER DAy TAAJK SIZE: 750 - G � LLONS DOSE VOLUME /�1 )p ALARM MANUFACTURLR: TL.c I k C I ? IL� INCLUDING BACKFLOW: / d / 0 .—GALL PIODEL ►JIJMDER: it A CAPACITIES: A= INCHES OR li�L CALL( SWITCH TSPL: a B= 11% INCHES OR —2./5-GALL( PUMP MALIUFACTURER: C■�rL1NCHESOR 12ya-GALLI MODEL NUMBER: U) £ 03 I- 0 m 1_ INCHES OR 111 GALL SWITCH TWPE: NOTE. PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE ` G►M INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE.. _L.i - FEET + MINIMUM NETWORK SUPPLY PRESSURLE/.. . . . .. . . . . 2•SS FEET + a FEET OF FORCE MAIN X ly2 FT,/QPiFKICTIOLA FACTOR..._J11 FEET = TOTAL OtlNAMIC. HEAD = FEET INTERNAL DIMJEL1610Ni OF TANK: LEW&TH T7 II ;WIDTH _SG —;LIQUID DEPTH LI 91G1JED: LICENSE MUMBER: 3,:2" / DATE: /(_���" DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDING' INPUuTh',', DIVISION LABOR AND PERCOLATION TESTS 115 MADISON WI 5370-, HUMAN RELATIONS IILHR 83:090) & Chapter 145) TOWNSHI MUNIC19ALITV: OT NO.:BLK. NO.: SUBDIVISION NAME: Al E% N F1/ i /T4N/rr E (or �yrh I (-%I to ic` t. USE �Rasidenca NO. BE7:C?-)MMERCIALDESCRIPTION: � ❑Now IOF1ePlaca RATING: S- Site suitable for system U- Site unsuitable for system ❑U I EIS ®U I O SS IPaberfis { —))r SYoC?-2 DATES OBSERVATIONS MADE ED If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.0915)(b), indicate: I.,------�� Floodplain, indicate Floodplaln elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN. ELEVATION DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) OBSERVED -r9T-PTTH=T e- �1 9 t o i 1 /a' � y //� n T;oe S r D` D fl6 1 Si B- Mt l VeAs� �dS d e f5 a- 19-30"'16rl Till S; 30�b0,f B- /91 B- 3 q$�t a� lI �' �S i ?— z "n ;nPS I B. OPA e 1 4S PERCOLATION TESTS MIN�L7�i��ili��ll.��>f.•i�r>��'• PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hor tontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and pereen of land slope. SY ■■■■�■■i ■■■ 11■■ ■■■■■■■■■ w `r1\ a ■■ ■■ Y , 9mmm i■.■11 ■ ■■■■ �...� ..... ■■■■■■■ ■■■1■■ ■�■■—■■ ■ ■■■ ■■■■■■■■■ ■■■■■ ■ ■`�l ■01' ■■■■■■■■■■■. EN Emig th - o P1 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 ()Wner and Sod Tester. DILHR•SB"395 (R. 10/83) - OVER - STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County BUYER V '` tO 51 MAILING ADDRESS y o s PROPERTY ADDRESS SZh't P (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 3 1/4, 1/4, Section �, T c 0 N-R�W TOWN OF i(, I W i ('A`/ ,n �1 C , ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP . VOLUME , PAGE , LOT NUMBER 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 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, journeyman 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. fl SIGNED: 4. DA DATE: /) St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 recgrding. ---------- --------.�; --------- Owner of property � d 1/ 1-" --- n .�0 ------ - Location of prop / tpS1/4 *1/4, Section �_, T E N-R�W Township _'Ca. Io Mailing address C' ►' Address of site C� Subdivision name Lot no. Other homes on property? 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 (spec house)? yes No Volume S� and Page Number l/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 & 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 in t fice of the County Register of Deeds as Document No. y , 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 recorded a office of County Register of deeds as Document No. a vo S j,, LAA , Sig ature of ap�l cant Co- ppl cant Date of Signature Date of Signature ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 October 27, 1994 First Federal of LaCrosse P.O. Box 307 River Falls, Wisconsin 54022 ATTN: Marlene Linn RE: Septic Inspection for Larry Danielson Dear Ms. Linn: An inspection of the septic system for Larry Danielson was conducted on June 22, 1994. This property is located in the SEh of the NE-. of Section 7, T28N-R18W, Town of Kinnickinnic, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, MaryrJenkins Assistant Zoning Administrator St. Croix County, Wisconsin mz EH 115 (11.74) WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH i P.O. BOX 309 MADISON, WISCONSNSIN 53701 �� / REPORT ON SPOIL BORINGS AND PERCOLATION TESTS W'%- LOCATION: , �4, Section M, Q N, R � g E (or) W, Township or Municipality K//JnJ /C Lot No. , Block No. Subdivision County Name �n r"ame V INn�e I SII sI Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms er EFFLUENT DISPOSAL SYSTEM: NEW ADDITION 00 ////''.. LA ENT DATES OBSERVATIONS MADE: SOIL BORINGS PERL'dLi4TadG// SOIL MAP SHEET SOIL TYPE PERCOLATION TEST NUM- BER DEPTH INCHES CHARACTER OF SOIL THICKNESS IN INCHES HOURS SINCE HOLE 1ST WETTED WATE HOLE LEA SWELLING EST TI I N=PERIOD P IN WATER LEVEL, INCHES RATE MIN/IN 1 PERIOD 2 PERIOD 3 P- P- P- SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES (DEPTH TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST PLANVIEW (Locate percolationtests,soil 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 reference point. Indicate slope. 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 location of test holes are correct to the best of my knowledge and belief. Name (print) Certification No. Name of installer if known Local Authority Signat tN Y _. �JEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) IILHR 83.090) & Chapter 145) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 E IstU641 Aow So ...... - --C- T SSedillfpls t S DP USE DATES OBSERVATIONS MADE [�Reslclence B T O ���� — ❑New LiZoplace RATING: S- Site suitable for system U- Site unsuitable for system d Oils RI MLES Qu INGOS ®� �S ElPR OSG©u:RECOM d1ED u,AS .(optional) If Percolation Tests we NOT required DESIGN RATE: If any portion of the tested area is in the under f. ILHR B3.0915)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TOGROUNDWATER-INCHESCHARACTER S IL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B V B 41f % ,o 0 W 11 S 1 Is I "6 n 6)e S 1 B t. } p CnS &'rdS V e �6 Af l9 B- Dt 3a'/ - 0'I la-3o'fe4 Tjje si 30 --go„ B- Si rvse�� s 3 /' �s i g- 6 �l n �aPS r 36 B v1 S r Oe o e&AS PERCOLATION TESTS PLOT PLAN: Show locations of percolation tests, sail 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 / D /t 6 �//■■ ■■■ KIA-1 I .- I ■,I MENIMMM190MENN r/ PER - e R R" rya► 01 - o ■■ MEMO a SMIIIIIIIIIIIIIII !REDEEM n ■N■■ . `.. ■ ■ t _.� ■011 11� ■■■E MS re ra■ ■V■ _� ■ ■■■N■�il�iiii�■ ■—■■■■ ■■ ■ ■■■ ■� ■■■ ■■■■■■■ ■■■�■■■ ■■■�MEN ■■■■1■■■■■■■11 ORL 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ui rstitsus mule: unglnal ano one copy 10 Local Authority, Property Owner and Sojl Tester. DILMRSOD-6395 (R. 10/83) - OVER - J. INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description, 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement system; S. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; S. 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 scale is prefered. A separate sheet may be used if desired, 9. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9 Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate. 10. If the information (such as flood plain, elevation( does not apply, place N.A. in the appropriate box, 11 Sign the form and place your current address and yur 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 Separate* and Textures at — Stone (over 10") cob — Cobble (3 - 10") gr — Gravel (under 3") 's — Sand cs — Coarse Sand mods — Medium Sand fs — Fine Sand Is— Loamy Sand 'sl — Loamy Sand 'I — Loam .sit — Silt Loam sr — Silt cl — Clay Loam scl — Sandy Clay Loam sicl — Silly Clay Loam sc — Sandy Clay sic — Silly Clay 'c — Clay pt — Peat m — Muck Six general sod textures for liquid waste disposal TO THE OWNER: Other Symbols BR — Bedrock SS — Standstone LS — Limestone HGW — High Groundwater Perc — Percolation Rate W — Well Bldg — Building �* — Greater Than < — Less Than Bn — Brown BI — Black Gy - Gray Y — Yellow R — Red mot — Mottles w/ — with 111 — few, line, faint cc — common, coarse mm — Many, Medium d — distinct p — prominent HWL — High water level, surface water BM — Bench Mark VRP — Vertical Reference Point This sod lest report is the first step in securing a sandary permit The county or the Department may request verification of this soil test in the field prior to permit issuance A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit The sanitary permit must be obtained and posted prior to the start of any construction