Loading...
HomeMy WebLinkAbout032-2045-20-000 O p N 0 b °o I I o I I ti I I I ~ I I w I ~ I y m a~ I 0 0 o c 0 0 z I z I c c m L c IL C LL C p _ o 0 _ y 3 C 3 N Q Z 1 E ¢ ° a~ c N C N O N a' ~ I a ~ I O) Z O O z M o d d O d 0 ~ a m a m o C 'p 'p U O z c c w y o 2 o I d z c Z m a> fq r N H c I c E a I E _ -O v M .II O N N N 7 N = a y a 1~ N N G N N d N d~ L I a~ L I c O c v v v Q Z m Z Z m Z N z I O O N N E C t6 E C M ! O H w 'j y a m cc o m- 4) U !v•`' U ° `,gam c v 3 G D a` - G C IL y ° E z N E 3 3 ° 3 3 p I a s o a s z L •N a°-aaaa Emma y (L ° I 0 „ 7 O M y M M to J C) Z 0) O) O N 0)i M O V 7 z Z N N M M O a ~ i 2C N O ^I L ° ° O ° E N 4) N - ~ II, O m y C L co c a O I p) O o r w a) 00 n ¢ ~ v ¢I cn I oo ¢I z cn is o! y y o y y RS T M O fn C1 U C C a O o - V O O~~ N C 7 N- O O C w C m J C tx, C c°~ o y `m o Z rn (D a~ v c o rN) ~ O p 00 to O N O O 7 QOj O N O O O U o Y 00 cM z- 2 F- o z Z ZL <n ~ - I _ I ~ ~ ae ~ E I E I v m a m 3 a ` a _ - a ~ I ~ • ~ a d ~ m = d= `Iv } E _ _ o = A 3 O o r~ O m r t A Vat 0U) 0U)U i L~s7+ Ipart l t 12.30.19 .*VATE S%KbSwlyl ff ff County: Labor and Human Relations INSPECTION REPORT Safety andBuildings Division ST. CRQTX (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 199961 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: v.: nsp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9200452 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well Fi SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: 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.) LOCATION: SOMERSET 12.30.19.653,SE,NW,85TH STRET Plan revision required? ❑ Yes ❑ No 7711 Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: =.777ffl L R SANITARY PERMIT APPLI CATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY armmasunvs. s STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8%x 11 inches in size. ❑ Chock 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 J . 5 % S /off T,30 , N, R/9 or) W PROPERTY OWNER'S (LING ADDRESS LOT # BLOCK # /(V 4/ _t__ _7 PVIA - WS ATE ZIP CODE PHONE NUMBER SUBDIVISI NAME OR CSM NUMBER 51612 Pt -7 s A 11. TYPE OF BUILDING: Check one CITY h?¢ r7/ NEAREk~~ ~1' ( ) State owned VILLAGE ❑ Public X1 or 2 Fam. Dwelling-# of bedrooms 12 PARGEL TAX ( ) 111. BUILDING USE: (If building type is public, check all that apply) p '3 ab p a0 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 80 Mobile Home Park 120 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. ❑ Replacement 3. ❑ Replacement of 4Reconnection of 5.0 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) I Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed JEK/Sf rvj 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 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) 6 ELEVATION -30 ° y z ~ ~x~St ~ZV N14 V Feet 17 L Feet VII. TANK CAPACITY Site in gallons Total of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank 0-M Lift Pump Tank/Si hon Chamber I F-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name Print): Plumber's Sig tur (No tamps)/MPRSW No.: Business Phone Number: ti r wt, l s~3 7/S-L - S~3S a ~ Plumber's Address (Street, ity, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ry Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No S mps) Approved ❑ Owner Given Initial Surcharge Fee) 7 1 W, Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 pumF ed 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'f 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) 4t -:3 - /9 T310 s~ .1 AA„ Rl 1nn. oY.c~ J tr s jr r 5,4.+. .Scvv 37. ~ ~~W 30, j8 50 or a D r l W m ~ l /Oc , A T p ¢aw►~~-i-~► /ate sue-- ~ yd j «12I » • - ~ ~ -rte , rIlk,. y , r' , * > ~ ° var. • ^S ~1 t f ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT n FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the jatAV-)e Ocky'a SI residence located at: S 1/4, 1/4, Sec. T20N, R_/9' W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be G functioning properly. f I Last time serviced I Did flow back occur from absorption system? YesNo(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /O©p a a,) Construction: Prefab Concrete Steel Other Manufacurer (if known): ~A, Age of Ta (if known) : 15 yr, n re n tit A I c) w~2 rS it (Signature) (Name) Please Print ~ w r~~,r~ J+~PRS L~?c.3 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code' (except for inspection open. g over outlet baffle). Name 1~ l,-~t.Y~S Ulln ~rSignature 4&/MPRS 5/88 WiisconsinDepagmentofIndustry, SOIL AND SITE EVALUATION REPORT Page of Labpr and Human Relations Division ofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach cdmplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 5f G h ° k k 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 IV L a u rim ca. ^4 GOVT. LOT Ste- 1144VW 1/4,S/o2 T.345 N,R /9 Vor) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # S' N A_- A ~ CITY, STA ZIP CODE PHONE NUMBER CITY ❑VILLAGE J9OWN NEAREST RgD tc ~rw►e»a 6JI S 617 1)ts7~ - S r $ fill [)q New Construction Use Residential / Number of bedrooms ' [ ] Addition to existing building Replacement 344D[ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation s) ~s♦w:, &A P-/ Q0,& ft (as referred to ' e plan benchmark) Additional design / site considerations Parent material ~&Lo .a+ J IV Flood plain elevate n, if applicable ft [SU = Suitable for system CONVENTIONAL OUND IN-GROUND PRESSURE AT-GRAD SYSTEM IN FILL HOLDIN TANK = Unsuitable for s stem ~Q S❑ 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 a n, 2hk n) ~ P a as 4 Ground 39-1b.2.16 G f C".► elev. q4I ft. Depth to limiting factor „ Remarks: Boring # ip4}: Ground elev. ft. Depth to limiting factor Remarks: CST Name: Please Print u/ a Phone: 71 f Address: l4 Signature: Date: CST Number: PROPERTY OWNER)-qkk *1 Dtkywvl~ SOIL DESCRIPTION REPORT Page ~of3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.rxiary Roots Bed r-iench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T Ground_ elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Y4'{::ii}iii 4ti•'.; 4*~ f Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) • r STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County I OWNER/BUYER Ulr 4 V-' d ROUTE/BOX NUMBER ~T y APS4 S) r FIRE NO. CITY/STATE /P/~Qu) /7lG~z~aCd72~ 6dz- ZIP PROPERTY LOCATION: &k1_1/4 X1/4, Section T c,-V N, RW, Town of St. Croix County, Subdivision , Lot No. 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 for a MAXIMUM of $3000 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 systems properly maintained. The property owner agrees to submit to 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 form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. S I GNE DATE t o~ " 11 St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address ti 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 4 la V. I-P 1~ kl_ Y`G1 w~l Location of property 5e 1/4 Al kJ 1/4, Section T 36N-R_/,%W Township ..5om2rs-1 Mailing address ,t &-S /Y1e~ ~!~/d wt 5 yd Address of site ( Sar-A- a s a b~4Q-~ Subdivision name Lot no. _ other homes on property? LL yes No Previous owner of property _ (2/1 n- 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,/DdD and Page Number O~?3 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 the office of the County Register of Deeds as Document No. SD/ ~Prand 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 office of County Register of deeds as Document No. ignature of applicant Co-applicant Date of Signature Date of Signature I DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 - 1982 501989 VOL- 1020PAGE 423 . , . CHRISTOPHER STOPH.ER . D. . FEATHERSTON AND TRACEY J . - . . ST. ReCROIX CO., W) .`d for R.-cord ......FEATHERSTON,...husband.. .i. f S'~ io JUL 8 1993 ...A.......~._ 8:30 A. conveys and warrants to PRI.SCILLA SEGELSTROM..AND.•._.•... at -LAURIE L., DURA.ND.. A...M A.R R-L ED. - • P.E RS.O N............................. Register of Deeds RETURN TO the following described real estate in 5t_...Cr.aiX................. County, State of Wisconsin: I 1 Tax Parcel No:6~k.7U~ . 4 SE1/4 of NW1/4 of Section 12, Township 30 North, Range 19 West, St. Croix County, Wisconsin. SUBJECT TO THE RESERVATION OF AN EASEMENT FOR GRANTORS, THEIR HEIRS, SUCCESSORS AND ASSIGNS OVER THE NORTHERLY 66 FEET THEREOF. . This i.$...nQt....... homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. Dated this da of JL11 19........ 1 ....(SEAL) ............(SEAL Christo er D. Featherston . Tracey eatherston e by p. v. A. Gi~.v'i ttn, v" (SEAL) (SEAL) * *.................,J.,....................................... AUTHEN'T ICAT10 ACKNOWLEDGNIENT Signature (s) Christopher D. STATE OF WISCONSIN Featherston, Tracey J. Featherston ss. County. authenticate i t s~!......day of.......... JU1 19 93' Personally came before me this ................day of 19........ the above named .l,~/"`.f Kristina gland TITLE: MEMBER STATE BAR OF WISCONSIN (If not . authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland . Attorney at Law Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state' expiration are not necessary.) date: 19.........) rt - - - *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY TIrRT1 STATC BAR Or 7r14C(1NSTN Wisconsin Legal Blank Co., Inc. 'r It y . V v i . 554869 MAR - 3 1997 t9 RVEYDR'S RECORD II CERTIFIED SURVEY MAP S Located in Part of the Southeast Quarter of the Northwest Quarter of Section 12, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. Prepared for and at the request of: OWNER: NORTH 114 CORNFR--_'1*: Laurie L. Durand & Priscilla B. Segelstrom SEC. 12-30-19 i 1665 85th Street (ALUMINUM MONUMENT) New Richmond, WI 54017 I ` Drofted by. Krietl A. Eylandt t 40 BEARINGS ARE REFERENCED TO THE NORTH-SOUTH O t QUARTER LINE OF SECTION 12 TOWNSHIP 30 N., I RANGE 19 W. WHICH IS ASSUMED TO BEAR S 00'28'20" W. r j t 1) ~1?LAITf Q_LA )5 NORTH LINE OF THE SE 114 OF THE NW 114 I , ~3 -----N 89'51'46" E 1158.59'----- _ I 1125.59'------ W t11Q FENCE :33.00'11 ~I i I ~N III I I o~ _ RONALD F o oVi w >!7 cD A, 100110 ~I I s-I 1" I o2 O AM... 3 ~W f .2 O I 2 v FILED 9 b 0 V1 o,~~ do s u _.~aJAN 2 7 1997 0, h N I ~~raeel40100 9- KATHLEEN H.WALSH I Register of Deeds ~0 cam, SL Croix Co., M N I I I N L.. LOT > ti Ili 1 1 (nl °zi w 1,23430TAL,924ARE>A~lIOT 1: ro ! 11 I i I I N i a gl , . J I I ml I Q 28.35 ACRES SQ. FT. -S 89'39 19 W ;380.00 o) I gi I ~i W UJI l~v ,556 SQ. FT. r 33.00' ~I I aK iv 27.84 ACRES 1 1 b i 15--l' ZIl M W i 41 i I N I a l ~I § JAI1 2.Tr' O =1 O N N I i i i b v l v 0 0 CiW OW \ n1 I rn to s X COUNTY cr_ Ix ~ I ov Irv I -,sive Plannic 3 000 a ca a 3 I IN I I wn and o no 00 ^ V N I b - b i~ :ornmltt@@ ;y N Sri 1(4 'd a N I P I I I N N 3 10 LI CTION DISTANC BARN ; t 1 8'20 W 70.01.E to / rn ava a "It OT 1 LYING SOUTH I Ili I i . LAT 2 . . I I 1 0~' t'6 2 MAY BE USED FOR I I I 0 .33.00 I RIGHT-OF-WAY OF TUR t - I o E . - 34700, Fes, TOWN ROAD. 13 - 1 I -N 89'39' 1 E 80.0 ' - -----1127.11' -----r- m ---S t8~9*39'19"_W 1160.11' io _.LlR _ 33.001-111/1, 66.01'-=~~ I EAST-WEST QUARTER LINE OF SECT/ON 12 11 31 200 0 200 I N TH I~t~P~IT~,Q_L.NDS GRAPHIC SCALE OD 1 SCALE IN FEET: 1 Inch - 200 feet ~p 1 NOTE: The parcel shown on, this mop is subject to State, County and Township N laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel, 1 etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. I I JOB #96030 Prepared by. 0 County Section Corner Monument A& E LAND SURVEYING of Record Phone No. (715) 246-4319 • Set 1" x 24" Iron Pipe weighing SOUTH 1/4 CORNER P.O. Box 325 a minimum of 1.13 pounds per SEC. 12-30-19 1 109 East 3rd Street linear foot. (ALUM/NUM MONUMENT) O New Richmond, WI 54017 Sheet 1 of 2 Vol. 11 Page 3205 1WL VL\L '`N,ER , TOTJNSHIPj,,,,,, SEC. T,~N, R 1.0. ADDRESS' ,ed,^,,t, /war ST. CROIX COUNTY, WISCONSIN. '3DIVISION LOT LOT SIZE , • PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • 1 w 'TIC TANK(S)_ MFGR.i>> •?b~ ~,c • CONCRETE STEEL NO. of rings on cover Depth DRY WELL ,NCHES NO. of width length area J no. of lines width! length area a depth to top of pipe ✓~~i~ f 3REGATE ~K RATE AREA REQUIRED AREA* AS BUILT -Pclaimer: The inspection of this system by St. Croix County does not imply complete % -pliance.with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for :tem operation. However, if failure is noted the County will make every effort to -ermine cause of failure. .;ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~INSPECT OR DATED fQ - - 7~ _ 28 PLUMBER ON JOB s LICENSE M]BER / 7 z r RFPORTOF ITISPECTION--I JDIJIDUAL SL-IA(E DISPOSAL. SYSTEI-I Sanitary Permit • r State Septic L '•.A:IE TOjIIJSHIP . • t. Croix County :size gallons. `?umber of Compartments so?~-t 9 Distance From: ?dell ft. 12% or greater slope it Building ft. Wetlands f: I~ighiaater ft. DAPOSAL SYSTE:1 Tile Field o or SeepaOge Pit(s) Distance From: hell ft. 12% or greater slope ft Building ft. Wetlands FIELD g?-iwater ft. , Total length of lines ft. Humber of lines Z-- Length of each line L~ ft, Distance between lines ft. Width of the trench Total absorption area sq, ft. Depth of rock below the in. Depth of rock over the '~7, in.. Cover f. -nver.rock,, Depth of file below grade Slope of trench ._in ners.100 £t. Depth to Bedrock ft. Depth to - ; ground water ~~£t. PITS Number of its Outside , am r ft. Depth below inlet ft. Gravel around pit: es no, -Total absorption area sq. ft. .Square feet of seepage-fr-ench bottom area required Square feet of eepage nit r quired Inspected Title':. - Appro ed Date, 197, Rejected Date 197 EH 115 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 TE LOCATION: 5~'/4, NUI., Section Z, T:V-N, R 11 #For) W, Township or Municipality , Lot No. , Block No. -County Name Owner's Name: _ p AO W 0.4A)' Mailing Address: TYPE OF OCCUPANCY: Residence- No. of Bedrooms -~T Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT _ k DATES OBSERVATIONS MADE: SOIL BORINGS /0 - -),0- 7~ PERCOLATION TESTS 2,1F SOIL MAP SHEET SOIL TYPE 6~" 0 PERCOLATION TESTS TEST DEPTH OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 N6 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- 2 -Z .2 0 - I S 13=. 3 S sz Q' S r3' T-,,,5., 6- G S B- 6 fl , S Z 0 -1 J y c, :5 -2 0- T_ To/ PLAN VIEW (Locate percolation tests,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. -4~f i Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope.G f\ V\ 0 v S' tN 1 ..J 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 be 0- Certification No. Name (print) p 2i 24. Address Name of installer if known CST Signature COPY A LOCAL AUTHORITY State and County State Permit # / C - _ / PC967 Permit Application County Permi - • County - Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY J Mailing Address: C / L B. LOCATION: '/4 Section T 30 N, R IS (or) W Lot# -City_ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms _y No. of Persons D. TYPE OF APPLIANCES: Dishwasher ES NO Food Waste Grinder YES_NO # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY /O-Zry Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement X Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _ 2) 1 3) 1 Total Absorb Area a sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth 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 ~D Distance from critical slope 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 Certifi Soil Tester, NAME Cal, it$ ✓1 Q r C.S.T. # sf S~/ and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# J t 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). r I ; _ 0 ~f Do Not Write in Spa a/Belovy F DEPARTMENT USE ONLY - Date of Application V ' Fees Paid: State . our y Date / - Permit Issued/R'lec~eel (date) C? J , /O _Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (white 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