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HomeMy WebLinkAbout038-1114-10-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ` ADDRESS SUBDIVISION / CSM#__ LOT # SECTIONT N-R~W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lee-`. h fc i G~ INDICATE NORTH ARRDtq Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: 0 O ~L. `d~/ yllGri' ALTERNATE BM:~u Sao / 0 7J oT Q,d~ %'~~e pet s~,p/ iG/ SEPTIC ~ / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: zz'pe ne AN Liquid Capacity: Setback from: Well VM4)use Z f other R'© ~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /a Length e Number of trenches f f Distance & Direction ,t/o nearest prop. line: p Setback from: well: /!/'y4e House Other ~O I er ELEVATIONSGcv~lc~f fy. Building Sewer lp ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold !~:j6o Bottom of system Existing Grade .2-~ Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/9'3: )t Wiscofisin Apaftmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX .Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pgrt FJj`s N~rp@,AE ❑ City ❑ Village Town of: State Plan o.: CSSTLB 'M Elev.: M Insp. BM Elev.: BM Description: Parcel Tax No.: / 0.'' zoo, c -1/ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /oa. Dosing / /O!< o b /00. Aeration Bldg. Sewer 4-7, e Holding St/ Ht Inlet rU q5 A TANK SETBACK INFORMATION St/Ht Outlet 5'3 15-,7 y Verit irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Ar Septic >o?S~ / ~So NA Dt Bottom Dosing NA Header / Man. yZ Aeration NA Dist. Pipe 1'/ 95,x/ Holding Bot. System 73 q y PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM I Loss Friction System TDH Ft TDH Lift Forcemain Length Dia. hf Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IR I S DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Typeo q0' CHAMBER Model Numer: System: gr fir, ~D' OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) i n=n SU=1;`-$- LOCATION: Star Prairie X2 3 31.18W, NE, NE, Lot 1, fight Hawk Drive Plan revision required? ❑ Yes ❑ No , ) I / 6 Use other side for additional information. 1// 117 ~Y 1~d jp SBD-6710 (R 05/91) Date In pe or's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: L , SANITARY PERMIT APPLICATION `AR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ - Cr,v STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than Rl 9o ) 49 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWN PROPERTY LOCATION S T ,N,R <E (o PROPERTY NER'S MAII~NG ADDRESS LOT # BLOCK # CI TAT r ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM MBER ~ c hr o/ 6 ~ Sfro ~ II. TYPE OF BUILDING: (Check one) F1 State Owned VILLLLAGE / NEAREST R~AD 4OWN OF E] Public or2Fam.Dwelling-#ofbedrooms JARCEL TAX. NUMBER( S) Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Off ice/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.4New 2. ❑ 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 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ 36epage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) cy ELEVATION t 4 1 l X~ Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks structed Septic Tank or Holding Tank -7 ! F1 Lift Pump TankJSl hon Chamber 1:1 1 El _LH VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's me (Print): Plumber's lure: (No Stamps) MP/MPRSW No.: Business Phone Number: AZ2;d a, e" 1 1, ~ PIumbV% Address (Street, City, State, Zip Code): - , c IX. C UNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued issuing Agent 0 Stamps) Approved ❑ Owner Given initial 4J~o d ~ SurchargeFee) ~ f ? _ y Adverse Determination . CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6358 (R.11/88) ST. CROIX COUNTY WISCONSIN p o ""nil ■ ZONING OFFICE al..e ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 30, 1994 Ms. Becky Hartman Hartman Homes, Inc. P.O. Box 326 Somerset, Wisconsin 54025 RE: Septic Inspection Dear Ms. Hartman: An inspection of the septic system serving the Ranae Almlie property was conducted on November 17, 1994. This property is located in the NE k of the NE k of Section 29, T31N-R18W, Lot 1, Town of Star Prairie, 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. Should you have any questions, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator St. Croix County, Wisconsin mz STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _ KC1 na r. ,&M /i` P MAILING ADDRESS 4& PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE L S e' u l PROPERTY LOCATION N C 1/4, N PE 1/4, Section r-9' 7 T-2 j _N-R W TOWN OF P , ST. CROIX COUNTY, WI SUBDIVISION &cNq srl LOT NUMBER CERTIFIED SURVEY MAP J/,? 7 a VOLUME 'I , PAGE46,0 7, 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 b a mater by 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. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property ,Ein e? e NM e, Location of property Nc 11'q; NE/q~ Sec_;an :Pei 'T - Ig w Township ~ r rrtr; Mailing address 0rese"i f 1= Address of site )-O/ 1~ T Subdivision name A Lot no. Other homes on property? Yes D( No Previous owner of property "arles * .L 161-e- Pe)+g54yrn Total size of property F7, 4 y/ i}dre Total size of parcel aC~3;`jy0 _S L,=r ~5 A~~~s °,r►~,~„c~, ~~t~r',~»,~,,,1_ Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 1 and Page Number ~6t)!2 as recorded with the Register of Deeds. 4OX0 . -7 74t4 4 4/ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 the off' e of the County Register of Deeds as Document No. 7&7:;, , 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 in the o~ ce o he County Register of Deeds as Document No. Si nature f Applicant Co-Applicant 1.7 Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 !i THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED j. II 52276811 - F1 L-11 R~ - _ I i, Thomas-M. istiansen aa This Deed, made between Thomas. M: Christensen and and wife - - . Marcia----------------------------- RaeZ aDlR6md I - i. OPT :30 2 5 1994 A and- _.Ranae.A,..Alml.ie..................................... Grantor, II leek 1. ~i , Grantee, Ij dDMQo Witnesseth, That the said Grantor, for a valuable consideration...... j L RETURN TO I~ conveys to Grantee the following described real estate in -__St_....CrQiX------_--_.- l County, State of Wisconsin: j Tag Parcel No- i, i (See attached Exhibit "A") v ~ T. _S II II i, This.--__1S. (is not (is ) not) homestead property. II Together with all and singular the hereditaments and appurtenances thereunto belonging; and Thomas M. i iristla-Ism ,aNa'IhQmaa.ML.--Christen en c d.Mar.ria.J.Hyatt----------------------------------------------------....---•-------- warrants. that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. 'I I and will warrant and defend the same. 15th ii Dated this day of QQtQber------------------------ 19__94--. ;i j - - (SEAL) (SEAL) - * Thomas M. Chris tiansen,'a/k/a:Thomas M. Marcia J. Hyatt -Christeriseri----•---------.......................... * (SEAL) ---------•--------------•---•-•--••-----••-•--•••-----•----...-----.(SEAL) i AUTHENTICATION ACKNOWLEDGMENT MINNESOTA Signature(s) STATE OF WMXXOMM ss. 6 aU coanty. authenticated this day of 19 ' -Eeuonally came before me I/ .-/6---- day of LZ~ C``~------------------------ 19.. the above named --Thomas M. Christensen, Marcia J. Hatt Thomas.M._-.Christiansen,--a/k/a---------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by § 706.06, Wis. Stats.) to me known to be the er o e ecuted the ~j foregoin s e. THIS INSTRUMENT WAS DRAFTED BY M NOTARY PRUl Ilk"MA Kristina and CM.(CWNTY-••---- g--l-- nn OOIYMSSION EXPIRES 131.00 Attorney at Law - . . P-0 P? PPIP, - - - Yh?c - Notary Publi U rr - ~ County,mO~ia~ (Signatures may be authenticated or acknowledged. Both My Commission is" permanent. (If not, state expiration j are not necessary.) date /,C- 19 Qi_~/5 •Names of persons signing in any capacity should be typed or printed below their signatures. I WARRANTY DEED STATE BAR OI.WISCONSIN Wisconsin Legal Blank Co. Inc. R VOL ~.1Cl0Pa~~21~ EXHIBIT "A" i Part of NE 1/4 of NE 1/4 of Section 29, Township 31 North, Rangw 18 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed April 9, 1993 in Volume 9, Page 2607, Document No. 497224. AND A parcel of land located in part of the SE 1/4 of NE 1/4 of Section 29, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin described as follows: Beginning at the Southeast corner of Lot 1 of Certified Survey Map in Volume 9, Page 26071 thence along the South line of said Lot 1, also being the North line of said SE 1/4 of HE 1/4, North 89 degrees 19 minutes 06 seconds 324.98 feet to the Southwest corner of said Lot 1, also being the Northwest corner of said SE 1/4 of NE 1/41 thence along the West line of said SE 1/4 of HE 1/4 South 00 degrees 12 minutes 27 seconds West 98.80 feet; thence on line parallel to the South line of said Lot 1 and said North line of the SE 1/4 of NE 1/4 South 89 degrees 19 minutes 06 seconds East to the thread of the Apple River; thence Easterly along said thread of the Apple River to a point which bears South 00 degrees 12 minutes 27 seconds West from the point of beginning; thence North 00 degrees 12 minutes 27 seconds East to the point of beginning. TOGETHER WITH an access easement shown and described on Certified Survey Map in Vol. 9, Page 2607. `325.00 - - 71 rt( 8 EASEMENT RESERVEpOA gDY` R - S88°57t53" E r(,J 9o - 325.00 /m, ♦ ye f • _ t ~ t N t Lerf I (V t LT xG Z t CV t to O t ~ ~ cD ~ N CC) a 1` tll (D t CV.. ws N t o ~ f1Cn~L1L- ~30v IR S o DoT 7 LAN 0 t C 1 Z /6 woe w" z , L1115d £W, i00 r*lk- 1 1)e,Jf0a Scoff ~oP m ,hs'~ sl Q • t [lwI)E 6nSEM Z 9' z4 a4 AouSC ' lb 1 06" - qt k GW 2 8.23 _ &Lu /eo WAgJA ESS -SEMEN~'~~ PQcF WA a° ~2 ' 6 N89-- o ` r 0 ar3 616- DEPARTNF,NN O REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INEMSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: nUNICIPALIT n/a Y: LOTNO.:BLK.NO.: SUBDIVISION,ME: / 4 A16 N/R/-fE (o 14 4r r-r COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 5 C rdr~ /vim USE DATES OBSERVATIONS MADE - ~s NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system rONVENTIONAL: MOUND: IN-GIND- PRESSURE: ISYSTEIVI-IN-FILLIHOLDING~NK: RECOMMENDED SYSTEM: (optional) ❑UU S 91S S U EIS U ~S U o • C~-~-~- - If Percolation Tests are NOT required DESIGN RATE: i- I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: G~G Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) o/ 77.2 ::5) -,.57- ~ -,&o S Ora ^ 7 B- l a B- 7v~ d, ®7 7 Z B- S ~~i 6--e 7 9q D 'moo/S ~o l~f - '0' 37 B- led-, f~. -7 9 B-5, 2-7 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI0132 P R PER INCH P P_ e2 G p- eL 4_ L P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION i T 1 I ,4 € ~ Gti _ ~ I Y 9 ` E - A 6; All i TM . l 11 i l t . U ~ r- F N/~ cQ - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me ds's~ecified in the isconsin \dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. VIE (print): TESTS WERE COMPLETED ON: r / TESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): d ro sr+- ~r Gv r OD ? / 3~ 6 4S CS SIGN URE: V: Original and one copy to Local Authority, Property Owner and Soil Tester. ,5 (R. 02/82) - OVER - ,a INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, yogr report must include, 1. Complete -al description; 2. The use s nest clearly indicate wi this is a residence or cornmercial , 3. MAXIMUM number of bedrooms or cor IT =rcial use planned; 4. Is this a new ;rent system; 5. Complete the sui= J;%, rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTE11`'- r;RE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; ~7, ;`.1AKE A LEGIBLE diagram accurately locati,ig your test locations. Drawing to scale is preferred. A s!-- --say be used if desired; srrr renchmark and vertical elevation reference point are clearly shown, ar I :re nerrnanent; P nplete all appropriate boxes as to dates, names, addresses, flood plain data, percc' t test exemp- if appropriate; 10. ' =ormation (such as flood plain, elevation) does not apply, place N.A. in th to box; 11, w ,I roan and place your current address and your certification number; 12. M.' pies an distribute as required. ALL SOIL TESTS MUST BE FIL D WITH THE LOCAL 7. -sRITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATION FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone fovea 10") RR - Bedrock col) Cobble (3 - 10") SS - Sandstone gr Caravel (under 3") LS - Limestone s - Sand HGW - High Groundwater cs Coarse Sand Pere Percolation Rate med s - Medium sand W - Well I's - Fine Sand Bldg - Building Is - Loamy Sand > Greater Than sl Sandy Loam < - Less Than *l - Loam Bn - Brown sil Sift Loam BI Black si - Silt Gy - Gray cl - Clay L( im Y - Yellow • sc;l Sandy i Loam R - Red sicl Silty Cl"_oam mot - Mottles sc - Sandy w1 - with sic - Si' y Clay fff - few, fine, fac y cc - common, pt - mm - Many, meclrr, in - ..I. - cf - distinct. p - prornineni HWL - High water level, Six gen textures surface water for licxu 'a disposal BM - Bench Mark VRP Vertical Referen TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set 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. [ND ARtTMEI~T'OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS USTRY, DIVISION AB 0 ABOR PERCOLATION TESTS (115) MADISP.O. BOX ON, WI 53907 AN RELATIONS(ILHR 83.09(1) & Chapter 145) ATION: SEC ION: OWNSHOT NO.: BLKNO.SUBDIVISION NAME: ✓t1/a )ez-- 1/4 .2?, A-?/ N11114(or Sf~~r > '/mar ~'le OUNTY: MAILIN ADDRESS: C J,%5 -Z SE DATES OBSERVATIONS MAD G'~ C NO. BEORMS.: COMMERCIAL DESCRIPTION PROF[ I S: A N ESTS: LE DESCRIPT 53Residence I yryNew ❑Replace ATING: S- Site suitable for system U= Site unsuitable for system ` NVENTIONAL: MOUND: IN-GROUND-PRESSUR : SY TEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: ptional) l O ['S~ S El U I ii~ S 11 U 1 2 S El U El S QU El SOU I A~g If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ender s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH (UMBER DEPTH IN. ELEVATIGN OBSERVED EST. HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B ~13- ~ a, y/J; -~•.`,F-~i.~ s• ~:r•~,(.~j r:%i„r.,..a-~~//rf~ ~-~~il?'t• ~~r. PTESTS TE I I DEPTH WATER IN HOLE TEST TIME CROP WATER LEVEL-INCHES RATE MINUTES U_M_BER +ig~6tE& AFTER•SWELLING INTERVAL-MIN. p R D 1 PJ:$I D ? PER INCH P. 2 , P d" r P P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ntal 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 I land slope. YSTEM ELEVATION ~ r~l,.~~~.~:"~``~`~~~' !8 I,. f~L rA / f~ x x; ;.x_ x ndersigned, 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 'rative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ,t). TESTS WERE COMPLETED ON: CERTIFICATION NUMBER: PHONE NUMBER (opt ional): r ~'~G s,•l~1 ;fig ~3 ~ 7 " c, ~ G l'~ CST SI ~VATU E: .tjq . _nal and one copy to Local Authority, Property Owner anul Soil 'rester. 95 R 10/83 - OVER - Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of ta0tnd'44uman Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code i COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PAR ML I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP TY OWNER: / PROPERTY LOCATION 1 GOVT. LOT _ 114 1/4,S T N,R ,t (orlg) PROPERTY OWNER':S MAILING DRESS LOT # BLOCK # SUB NAME OR CSM # 2Z CITY-STATE ZIP CODE PHONE NUMBER ❑CITY VILLA [MOWN N REST ROAD ( New Construction Use Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow er gpd Recommended design loading rate _ 7 ed, gpd/ft21Strench, gpd/ft2 Absorption area required bed, ft2 '5Zi! trench, ft2 Maximum design loading rate __,~bed, gpd/ft2__trench, gpd/ft2 Recommended infiltration surface elevation(s) 9/,~ ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ' 7g h ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem HS ❑U ®S ❑U 0S ❑U ®S ❑U ❑S IOU ❑S ®U `SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft in. Munsell Qu. Sz. Pont Color Gr. Sz. Sh. Bed Trench Ground 7 elev. ft. Depth to limiting factor > Remarks: Boring # ~~ti:iiiiv J3:•'i:: Ground 3 elev. _ ' ft. f Depth to limiting factor x-90 Remarks: CST Name:-Please Print I Phone: Address: Signature: , Date: CST Number: a- Ll~ - 2Z Zel =.2 ? PROPERTYOWNER e*A-24 E SOIL DESCRIPTION REPORT Page, - ,f k PARCEL1.1). # 1 Depth Dominant Color Mottles Texture Structure Consistence Baixlary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends `.h.l. e% iA. OR f-,/ 7 1 lm Ground elev. / ft Depth to limiting factor y y'~ Remarks: Boring # Ground elev. ,qz;z ft. Depth to limiting factor Remarks: Boring # / ` Kn Ground elev. ft. Depth to limiting factor ~2L Remarks: Boring # IKI- tiUK~~ti~tf:!:4J Ground elev. ft. Depth to limiting factor Remarks. SBD-8330(8.05/92) I • ~ ~ Y ' ~ I i Imo{-.-~_r_ - - i i , ~~{~~-~~+T _ - r t---1 i - TTL~~ I I I I I I I i I - I r I } / I I -a - - S~l -4 Al i I i I 1 I , I I T i I I ~ ~ ~ I I r I - i 1 I 1 I I I I I li 1 I - I I I ~ , i I r ` - I _ I n I I I I i i ~Q p F ~I I I I I I , i I I - I FLU-1 FLAN \ 4WOJECT G~l2lQ ~/Lr~C ADDRESS 1/4/S~ N/A' W TOWN =c COUNTY -Groff s MPRS Byron Bird Jrr.. 3318 DATE - Ste BEDROOM CLASS PERC .:-7-7 C NVENTIONAL~ I OUND PRESSU E CONVENTIONAL LIFT MOUND_ HOLDING NK SEPTIC TANK SIZE FT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA _,g6%.C~ PERC RATE BED SIZE kh, Benchmark V.R.P. Assume Elevation 100' Location of Benchmark ~o a~ 10~ * H.R.P. 0 Borehole Q Well Scale = Feet 0 Perc Hole System Elevation Uent 12" Grndp- TYPAR COVERING 2" 12" 3' 4 6' ® 3' 1 6 " Sewer Rock 1.2' _X, V 13,6 8-2'