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HomeMy WebLinkAbout030-2087-40-000 A04 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C)171, /E7-#&X T ADDRESS 1'.3A y T 0WO 1612 ~ SE 7- ZZ1j .5- zu-5 SUBDIVISION / CSM# gA SS JN KE lVd /1 rho, LOT # SECTION__Z 2 T3cl N-R_L2 W, Town of S7( rTSe~/V ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 8h Y /?o 14 v R F, AIL 61T ef-' 1,00 Sop ( p/'oposeo ~d 11 SC' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of.septic tank manhole cover. { x ~ . r BENCHMARK : Z& -4 dD/P& ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Ll1E~IrS Liquid Capacity: f Setback from: Well House Other Pump: Manufacturer NA Model# &A Size Float seperation A h Gallons/cycle: ZV Q Alarm Location SOIL ABSORPTION SYSTEM Width: Length -5-7 Number of trenches Distance & Direction to nearest prop. line: &ST 4:' Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet, ST outlet 9i3 PC inlet A( PC bottom Pump Off Header/Manifold 9 3 Bottom of system Existing Grade 9 Final grade DATE OF INSTALLATION: ,`j - 9 3 PLUMBER ON JOB: LNUMBER: 3 CQ INSPECTOR: 3/93:jt r 1 s BENCHMARK: Ro STere 4 d0/Pi ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: !.ll&e S Liquid Capacity: f Setback from: Well House Other Pump: Manufacturer SA Model#& A Size AAA Float seperation &A - Gallons/cycle: IVA Alarm Location N 1 SOIL ABSORPTION SYSTEM Width: Length 5_7 Number of trenches Distance & Direction to nearest prop. line: eJ~STZ' Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet, ST outlet PC inlet ( PC bottom /VA Pump Off Header/Manifold 93 Bottom of system S / 75~~3 Existing Grade Final grade DATE OF INSTALLATION: 9 3 PLUMBER ON JOB: La~a'_ pC LICENSE NUMBER: 320 INSPECTOR: 3/93:jt r - t'?ns&N,1 • STf JOSEPH 2 2.3 0.19 , NE NE LOT 4 , CO . RD . I partmen of Industry, PRIVATE SE`IVAGE SYSTEM county: nd Human Relations INSPECTION REPORT ST. CROIX S~afetXtand Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 193426 Permit Holder's Name: ❑ City ❑ Village ❑xfown of: State Plan ID No.: DIETHERT TODD st.joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r TANK INFORMATION ELEVATION DATA A9300090 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ! Benchmark Dosing Aeration Bldg. Sewer z C/ Holding St/ Ht Inlet /,75 TANK SETBACK INFORMATION St/ Ht Outlet g y Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Septic /01 ~-/o NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe y? ~6-z3 6.0 Holding Bot. System S'a 7 PUMP/ SIPHON INFORMATION Final Grade i,3 9%,, ~r Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Loss Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 21- DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type0 nc.r r Model Number: System: 74-u-z X2-7 /19 OR UNIT ,r i DISTRIBUTION SYSTEM Header/Manifold f Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake' Length Dia. Length Dia. Spacing i© 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.) LOCATION: ST. JOSEPH 22.30.19,NE,NE, LOT 4, CO. RD. I t,L G 1~.... Plan revision required? ❑ Yes ❑ No lD 1 Use other side for additional information. U <<.~ (o 1 2-1 K(O SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH , ~e• SANITARY PERMIT NUMBER: ' i i i I DIL,HR SANITARY PERMIT APPLICATION _OIL In accord with ILHR 83.05, Wis. Adm. Code C"ET - Cv 0 1-)( STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than `93 qa 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 OWNER PROPERTY LOCATION O ,6- /VF %4, S 2-2 T Q , N, R / 4:MnW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 83-A PD. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned VILLAGE : Qs~ ` Pal TOWN OF: S ❑ Public X~ 1 or 2 Fam. Dwelling-# of bedrooms -1 PARCEL TANUM ) III. BUILDING USE: (If building type is public, check all that apply) 0,30 -208-1--?yo 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ^ New 2. ❑ Replacement 3. El 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 300 Specify Type 41 ❑ Holding Tank 12 M Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft. (Gals/day/sq. ft.) (Min./inch) 9,6. p 2 ELEVATION S® 563 r S Feet 9. g Feet VII. TANK CAPACITY Site INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank f Lift Pump Tank/Si hon Chamber F-1 F~ F1 Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu 's Signature: (No Stamps) M MPRSW No. Business Phone Number: - - - 77- Plumber's Address (Street, City, State, Zip Code): 596 IJAZL&~~ 7-1? IX. C NTY/DEPART NT USE ONLY ❑ Disapproved Sa ' ry Permit Fee (Includes Groundwater Date Issued Issuing A ent Signat r No Approved El Owner Given Initial Surcharge Fee) Adverse Determination Oo' X. CONDITIONS OF APPROVAL/REASONSFOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS j 1. ,A;s nitary ypprmit is valid for two (2) years. 2. ~Yousaliltary 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 isft Ve installed. IL Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If.building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county: The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) i I , i j j IVA 34 f ~ ' f I ~k ~ 3t1`d m I. / 7 j I i j _ uxy~f I ' l ' I h' 407 F74 pi# l ' t , #a15 ~Ug 0, C) I *17 01 PIZ s a le i, l j i i I i I I I j I . g I C Cri, 153 T11-7 f , i cs a r zoo i ~r I -4 4 I /I r I , ~ ~ ~ i I ~ I i ~ ~ ~ j { _ i , I I i ~ ~ f i i i 1 I M. I I I ~ ~ ~ ~ ! 4 1 ~ t ~ i i i _ ~ j - ~ ~ - - ~ ~--4-- . i ~ ~ ~ ~ I ; ~ ~ i t ~ ~ ~ ~ ~ ~ i i i i ~ ~ ~ i - - i ~ ~ - - ~ f j -i ~ i 1 _ i i I j } i j i . _ ! ~ _ I - - . - ~ i 1 ~ i _ i i ~ _ _ . _ j j ~ i _ , I i - - _ i a pYk BASS LAM" M&. .LOCATED IN PART OP THE NE 1/4 OF THE NEIl4 of" S'ECYION 22, T30N] R19W. TOWN OF ST. JOSEPH. ST. CROIX COUNTY, WISCONSIN url~e?aeo u~y~ f 71[[i l 07 Nom I'm" OF TNi Ow. t/ 1RTItN ]t -[otMt/l A ttt+ew'w [aT1]II ai i 1ss•SS'13'w 319.aT' ilw.7r uaw' i r E a036 OI NI 1 "'1 > I ` I vi LOT 6 • ' ' zl sl )-14" all 4.68 1 C.) w 1, f I I I .q i wl Zi . 171.19 w. 7T. y~M u" ' • OI y'I Vol, ls I~ WI I ~QT I 1 I ' 1 zl u it CERTIFIED SURVEY MAP `~l zl I it ' IN VCIUME 8, PbGE 2351 1 h•'J I 1 DOC. NO. 468392 I NORTH BAY ROAD L r ! _ . 1 TV • ^ ' t I _.41'11 11 Two \ 1ww7a •IMITI.1. I I •r•u•w 11 s' ~ 1 A DEDICATED 7D TH[ .~U •~tt1.7i'. N1. M' i17.M'~~« ~CJR :.l st'b~K p x oil yo4 t J nl zl~ z ml Y I Cal I— LOT I ; LOT 2 ~1p "LOT 3 a LOT zzi 1 1 p Q1 UI ~ O, ].b KN[1 ~ N t0 1C1f1 t=~ 1. K1[t v lil . I_ 1N.114 N.' IT., IN.111 N. R. Nli.)1! N, R. 7.M KN[1 '•s ZI I I p ` M.1]] ta.±• LOT J ~'A a 411 J .~•II f01 ~i • ►-1. a W _ ~Kf.' i. W KNt . ''.I r F•.1 f IF I u k 43.c smw 319'49'37'f U.53' I i fOYTN 1/Ill A TM[ KIN M TI.! KI/. A t[C110N 1 UNP6ATTE2 LANDS i i I I I I • i i • ' I I I N ro -0 ap 0 O co v V I 1 z I cn. a a tr N 10 oN N ~ ly io SOO°32' 16"E ' 628.79' O 1 10 I (v N N ~ W O I O - N t~ l0 N n I V O Vl iiiiiijililljllllllliillillilllllllllllllllllilillilljllllI I 0 $096 , ,sg~ w V A N 638. spy N Sp' ; c J u W f-- 10' N D r :0 71y 0 .p C p ss9~a30'p 4.40 , s "k, O O~ of 00=D ; o► c z .0) j A cm j Ww r QUO mo, y O O Y °A 2 L LRA + o.Zm CA ca A a O O -i N v 11%1 n O ow CAM ze!mc O m t~ m U) r i; 10 -n 50 0 rA 0 A 2 l m / 460.38' 33'.09'- NOW 3243"W 493.47' 0 - LEAST LINE OF THE NEI/ OF SECTION 22 UNPLATTEV L AN DS % 7 R d 4a `tw rand Human Rentof In ustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Robert Swanson GOVT. LOT NE 1/41`1E 1/4,S22 T 30 N,R 19 M(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 696 N. Bass Lake Rd. 4 n/pa Bass Lake North CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGEx6YOWN NEAREST ROAD Somerset, WI. 54025 (715)247-5605 St, Joseph Co. If y. #I New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 5643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2.8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96,02-95.17 ft (as referred to site plan benchmark) Additional design / site considerations step doign trench system j• 5 i lipl ow snrfac e 1 of slope Parent material outwash Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U OS ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundwy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench r>< 1 0-8 10yr3/2 none L. 2/m/sbk mvfr g/w 2/f .5 .6 2 8-36 10yr4/4 none sil. 1/f/sbk mfr g/w 1/f .2 .3 Ground 3 36-80 10yr4/6 none S. 0/sg mvf_r n/a n/a .7 .8 elev. 98.92 ft. Depth to limiting factor >sn Remarks: Boring # 1 0-6 10yr4/2 atone sl. 2/m/gr mvfr g/w 1/f. .5 .6 2 2 6-14 7.5yr4/4 none J-s. 0/sg ml g/w 1/f- .7 .8 3 14-80 10yr5/4 none co, s.. 0/sg ml na/ n/a .7 .8 Ground elev. 98.2 ft. Depth to limiting factor >f30 Remarks: CST Name _Please Print Gary L. Steel 715-246-6P ff Address: 155/3_'200th.. Av,g-. r1 '7 Richmond, WI. 5401.7 r''ure - Date: CST Number: 4-23-93 2298 PROPERTY OWNER Rohert Swanson SOIL DESCRIPTION REPORT Page? of J :a -PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-4 7.5 r4/4 none sl. 2/m/r. mvfr c/w 1/f_ .5 .6 t' 2 l-y/// none ,o.s. 0/s8 M.1 n/a n/a .7 .8 , 4-121 r h + Ground elev. 102.52ft. Depth to limiting i factor >12_.1 i Remarks: area cut to el. aprox. 99.52 Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # i4'iYt• Ground elev. ft. Depth to limiting factor Remark,;:.-- SSD 8330(R.45192) STEEL'S SOIL SERVICE 1554 200th. Ave. Gary L. Steel C.S.T. 2298 Robert Swanson New Richmond, WI 54017 MPRSW-3254 NE%NE% S22-T30N-R1911 (715) 246-6200 town of St. Joseph lot #L4, Bass Lake North. ASS k a 0 v• V3 ---tzt 2 0 -Y) 1kg AI ei qv, 1-4 - 2-(F c1 L_ O C- y 441 Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 Of 3 L Human Relations _ wf$afety Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Robert Swanson GOVT. LOT NE IIANE 1/4,S22 T 30 N,R 19 f(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 696 N. Bass Lake Rd. 4 n/a Mass Lake North CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGExOOWN NEAREST ROAD Somerset, WI. 54025 (715)247-5605 lI #I St. Joseph 1CO. T kkNew Construction Use U Residential /Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 . 8 trench, gpd/ft2 Absorption area required 5643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2.8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.02-95.17 ft (as referred to site plan benchmark) Additional design / site considerations step down trench system' 5 i 1;a1 nw surfa(-P 1 of slope Parent material outwash Flood plain elevation, if applicable n/a ft for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK table 7==~Uuni suitablefors stem EIS ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-08 10yr3/2 none L. 2/m/sbk mvfr g/w 2/f .5 .6 2 8-36 10yr4/4 none sil. 1/f/sbk mfr g/w 1/f .2 .3 Ground 3 36-80 10yr4/6 none S. 0/sg mvfr n/a n/a .7 .8 elev. 98.92 ft. Depth to limiting factor >sIl Remarks: Boring # 1 0-6 10yr4/2 none sl. 2/m/gr mvfr g/w 1/f .5 .6 2 2 6-14 7.5vr4/4 none Is. 0/sg ml g/w 1/f .7 .8 ~ 3 14-80 10yr5/4 none co. S.. 0/sg ml na/ n/a .7 .B Ground elev. 98.92 ft. q, ~0 Depth to limiting. factor N >SO OZ C cJ G Remarks: c' cy p~ CST Name:-Please Print P Gary L. Steel 715-246-6!ff Address: 155 th. Av. N Richmond WI. 54017 Signature: --.gym Date: umber: 1 4-23-93 2298 J-- PROPERTY OWNER Robert Swanson SOIL DESCRIPTION REPORT Rage 2 PARCEL I.D. # t" rt Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends gl~ 1 0-4 7.5 4/4 none sl. 2/m/gr. mvfr c/w 1/f .5 .6 *r= 2 4-12 1-yr4/4 none o.s. 0/sg ml n/a n/a .7 .8 Ground elev. 102.52ft. Depth to limiting factor >121 Remarks: area cut to el. aprox. 99.52 Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 4(, Ground elev. ft. Depth to limiting factor Remarks: Boring # ~v44 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEELS SOIL SERVICE 1554 200th. Avin Gary L. Steel C.S.T. 2298 Robert Swanson New Richmond, WI 54017 MPRSW-3254 NE%NF%, S22-T30T\T-Rl9W (715) 246-6200 town of St. Joseph lot A, Bass Lake North CN )co, ~I ern UJ In A- 1~ Cl) pk~,~o Vy Leo po SW~1' `30, X00`-V- till, i INDURTMEZVT Oft REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IR1Dl~STRY, . DIVISION LABOR P.O. BOX HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: ITOWNSHIP/CITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: NE %N1 / 22 /T 30 N/R 191d or) W St. Joseph 4 n/a Bass Lake North COUNTY: OWNER'S NAME: MAILING ADDRESS: St. Croix Richard Stout 11353 Awautkee Trl., Hudson, WJ. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER LATION TESTS: Rk~esidence 3 n/a EINew ❑Replace I 4-26-92 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK7RECOMM EN DED SYSTEM:(optional) S ❑U S ❑U ❑ S ~U ❑ MU onventional split t 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: class 2 Floodplain, indicate Floodplain elevation: ri/a d.eciaml' PROFILE DESCRIPTIONS page 34 BxB BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH?M, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 98.30 .75,10yr3/2, 1., .92, 10yr4/4, sil., 3.92, 7.5yr4 4 B- 1 7.09 none 5.59 co. s., 1.50,7.5yr4/4, sil. w/occ. not. B- 2 7.17 98.10 none >7.17 1.00,10yr3/3, 1., 3.17, 10yr4/4, .s., 3.00- B- co. s. B 3 6.50 96.10 none >6.50 1.00, 10yr3/3. 1., 1.50, 10yr4/4, s.l., 4.00- 10yr5/6, co. s. 4 6.66 94.10 none >6.66 .83, 10yr3/2, 1., 1.83, 10yr4/4, s.l., 4.00- B- 7_5yr414, qn- s- 93.90 none >6.58 1.003 10yr3/4, 1., 1.83, 10yr4/4, sil., 3.75,- 5 4 co. s. B- PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- P-see design rate P- P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 95.71=upper trench SYSTEM ELEVATION 93.60=middle trench 4-1 Ilt ( 1 ( [ a t I k I a ' _ - ._J tH 1 c . I r- ~ ~ , 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: Gary L. Steel 4-26-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave. New Richmond Wi. 54017 2298 1714-246-6200 CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - l ' r t INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a cc t Mete and accurate soil test, your re~>ort must include. 1. Comp' scription; 2. The use set ion rnust clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a r, or, c placement system; 5, Complc,,,, ,a s..itability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A s- r°~y be used if desired; 8. Mr: it _ =nchmark and vertical elevation reference point are clearly shown, and are, permanent; 9J Corr )k appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. - -n the form and place your current address and your certification number; '.e legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE )CAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St - Stoney (over 10") I Bedrock cob - Cobble (3 - 10") - Sandstone gr - Gravel (under 3") - Limestone d F. High Grvur d, e Sand rE Percolatioi, Jium Sand Well r re Sand Bldg Building Is - L -rmy Sand Greater Than sl Loam < - Less Than 1 err Bit - Brown t Loam BI - Black Silt Gy - Gray "cl - Clay Loans y Yellow scl- Sandy Clay Loam R - Red sicl - Silty Clay Loam mot Mottles sc - Sandy Clay w' with sic - Silty Clay fff few, fine, fair' K c Clay cc common pt - Peat mm - Many, medic rn - Muck d - distinct p prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point 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. 1 vv SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 64) DrE-P ,,Z% lys o , omens ADDRESS: Aiii r, irk z~ FIRE NO : LOCATION: 1/4, ,VE 1/4, SEC. T :30 N-R_j~J_w, TOWN OF:- S-r j as Epq ST. CROIX COUNTY SUBDIVISION: J74ss L ~4kZ We LOT NO. `"1 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every 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 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. r SIGNED' r DATE : St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 i . T j STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property~--- Location of propertyZLZE_1/4 IVE-114, Section ZZ , T 3C N-R_~a_W Township Mailing address ~~4 ail A4 " V Address of site eA Subdivision name_ 1SS Lot no. Other homes on property? yes-- No Previous owner of property CfG GyZt- Total size of parcel 3• Date parcel was created Are all corners and lot lines identifiable? --X-yes No Is this property being developed for (spec house)?-Yes No Volume and Page Number 163 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 recordeWw 'office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site or 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 office of County Register of deeds as Document No. 'J S gn e o applicant Co-applicant Date of _ 3 nature - _ g Date of Signature • • ~ 64CUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 498096 VOL 1005PAGE.,•6J r ..t- . 6'e,r~.~: I,~ ►rlt v Ur i Q E i, CROIX Co., Vd ~'c'd for Ret:ord Ri rnarr3 n Stnut and Tanet P c+-ou ~ APR 2 8 1993 E-111 „chand-anc3 wife survivorsh?~ marital A property w 10.25 A'III conveys and warrants to Tnrjd T Diethert .t RETURN TO i the following described real estate in St _ CrO i xi County, I - State of Wisconsin: Ill Lot 4, Plat of Bass Lake North, Town of Tax Parcel No: St. Joseph. rRANbTEEI ~laij 11A I ELIE N This i nGlt homestead property. (is) (is not) Exception to Warranties: nc=e easements, restrictions and rights-of way recorded or unrecorded day of , 19 9 3 _ Dat,Qd thi (SEAL) (SEAL) r h a r Janet D Stout- not Rir7 (1 -(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. Rt- C`rni x County. authenticated this day of , 19 Personally came before me this 1 t h day of n n r i 1 193 the above named Ri r•13 a d (1 gfint,t nnat P g i- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the personw authorized by § 706.06, Wis. Slats.) fore oing instrument and--a owJed Dy THIS INS'11,RUMEN-7 WAS DPAUfy,,,,RY 4` , Jane L ti \ Linda M. Hudson, W1 54016 Notary Public St. Croix oun (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If n are not necessary.) date: 01-13 ) tat $f32 NTF 7774 Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208 Form No. 2 - 1982 REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 5/26/93® -®AREA: -MJ-- 05`26/93 09:34 REQUESTS FOR INSPECTION WORK SHEETS FOR: ' Activity: A9300090 5/26/93 Type: CONV93 Status: PENDING Constr: Address: ST. JOSEPH 22.30.19,NE,NE, LOT 4, CO. RD. I Use: _ OCC: Parcel: Description: 193426 Applicant: DIETHERT, TODD Phone: Owner: DIETHERT, TODD Phone: Contractor: SCHMITT, DONIVAN Phone: 568-4948 Inspection Request Information..... Requestor: SCHMITT, DON Phone: Req Time: 10:05 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION .9