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HomeMy WebLinkAbout034-1044-80-000 { yz a o r S-+-.L ~e~ ~o Coy. ao ~ ~C> STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Zarnj V'\ eclut~' v~ . t5.3o~ p tq. ADDRESS a7 7 1 ~l SUBDIVISION CSM# /L LOT # SECTION _TN %,S-W, Town of S r- ` ST. CROIX COUNTY WISCONSI PLAN VIEW SHOW VERYTHI G WITHIN 100 F E OF SYST M ~ ~3S ~~cwr► 103,(66, _ b IN I GATE NORTH ARROW Provide setback and elevation information on reverse of this -form. Provide 2 dimensions to center of septic tank manhole cover. 1 BENCHMARK: loo, C) 0 A4. (gytj~r ~S - ALTERNATE BM: to~~~,.~ SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION G~C~ J ` Manufacturer: ~~~~,5 r- C,, Li id Capacity: / 12, 'V -7 Setback from: _->$p ~ House ~ 7`7 Other Pump: Manufacturer-(" Model #-~3 S i z e 'Q-~-~- Float seperation ~ Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM i Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well:, House 305 JOther ELEVATIONS Building Sewer ST Inlet; ST outlet /C),~ . PC inlet 3 , $ PC bottom n , lt2 Pump Off a~ Header/Manifold Bottom of system c>,-,z;- Existing Grade 5-,06 Final grade 6 DATE OF INSTALLATION: !a3 PLUMBER ON JOB: G,~.- LICENSE NUMBER: / INSPECTOR- 3/93:jt I L(TXQ#P;rt§tAWJyELD 19.29 V&~,Aq SEWAGE SYSTEM S County: Labor Human Relations Safety ah ahd Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: BM Elev.. Insp B// Ele/~v..`~: BM Description: / Parcel Tax No.: 52 7~~J7e TANK INFORMATION ELEVATION DATA A9300306/o/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark D,/S' ,lr GJ~1i1~ Dosing 03, (o~v~ Aeratio Bldg. Sewers Holding St/ Inlet ~S /O"?, 39" TANK SETBACK INFORMATION St/ v Outlet a~ /Do? /a Verit TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet 9,3, / r Air Septic NA Dt Bottom 90.16 Dosing SIGI~~ ? ~ ~ NA H L/Man. 3' 6,67 Aeration NA Dist. Pipe Z i Holding Bot. System s PUMP/ SINFORMATION Final Grade Manufacturer ~O Demand 6,4 6 ~5 'I Model Number -,6~ GPM TDH Lift Friction System. TDH Ft oss Head Forcemain Length _3ciL Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i 1 No. Of Trenches PIT f Pits Inside Dia. Li h DIMENSION cJ DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ufa er: INFORMATION TypeO n& CHAMBER odelNumber: System: >166 >/Ga /4 OR UNI DISTRIBUTION SYSTEM Header / M nifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Int ke A~~ Length 36AS Dia. Spacing y 3~p Z Length Dia SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only I Depth Over Depth Over xx Depth Of / rim xx Seeded / Sodded xx Mulched BE1g~french Center lD Sel <Trench Edges f 2 - 4f Topsoil !Q J fP ❑ No [ f ❑ No AASV? COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRIN IELD 19.29.15.304 f r~ ~9 d~~ a -k 1~~•eel~ l , t•!l s ? t /Q/r✓1C"Ut-~ v, k /7F71M1~1 JWct fil/YY1 A PTan re islon req fired? E] Yes p b q p q Use other side for additional information./ « o 1 SBD-6710 (R 05/91) Date Inspector's Sign ture Cert. No. ADDITIONAL COMMENTS AND'SKETCH SANITARY PERMIT NUMBER: T DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY - ST CR IX STATEWvI -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /hlf 8% x 11 inches in size. applica tion -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S92-40598 PROPERTY OWNER PROPERTY LOCATION LARRY RICKARD SE Y4 SE t/4, S 19 T 29, N, R 15 E (66/W/ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1779 80TH AVENUE N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER WOODVILLE WI 54028 715 698-2041 N/A 0 CITY VILLAGE NEAREST ROAD II. TYPE OF BUILDING: (Check one) 1:1 State Owned E3 .SPRINGFIELD ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms -a- PA EL YTAFX'NU MBER -1 280TH STREET 111. BUILDING USE: (If building type is public, check all that apply) 034-1044-80 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 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. ❑ 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 E 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 REOUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 450 375 375 .6 N/A 96.00 Feet 98.25 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 100 1000 1 MIDWESTERN PRECAST- Lift Pump Tank/Si hon Chamber 750 750 1 MIDWESTERN PRECAS'r' 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): 4]un Signature: (No Stam ) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W 1229 770TH AVENUE, SPRING VALLEY, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (Includes Groundwater Date ssue Issuing em re ( Stam Approved ❑ Owner Given Initial Surcharge Fee) Adverse D t rmination ~~CJ 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 pt-mit is valid for two (2) years. 2. Your unitary 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 (E BD 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 Fami y 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 nine B if permit is for tank replacemen-:, reconnection, or repair. V. Type of system. Check appropriate box depending en 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 gallors, 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 13'% x 11 inches must be submitted to 'he 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 main,-/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; rep acement 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.11r8:3 t , ST C- 105 SEP'T'IC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER LARRY RICKARD RO•UTE/BOX NUMBER 2779 80TH AVENUE Fire Number q77 9 I I CITY/STATE WOODVILLE, WI Z I P 54028 i PROPERTY LOCATION: SE Z, SE Section 19 T -29 N, R 15 Town of SPRINGFIELD St. Croix County, Subdivision N/A Lot number N/A Improper use and maintenance.of your septic system could result in its premature failure to handle wastes. Proper maintenance con- lists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you ptit into the system can affect the function of the septic tank as a treat- ment 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 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 veri- fying that (1) the on- site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office t ti of the three year expiration date. i , SIGNED 1) ATE' E Z- 7- ?2- St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2231 or 715-425-8363 Sign, date and return to above address. ` FPS /)u pro~~- Ty rP, F 5 S 0 7 p+ C ~y T ,6~ R 'O l lln G ~ O 0-b oNStTE SET AGE SYSTEM w i L QJ o- ~ c \ I a 0 u f, " D A I Y E LABOR AND riU ' ; . DEr AR" i i ; F iNo FETY RY'W BUl lti S OF ?l 5 SEE CORRES 3 a~ ol~l Ib y -E. ~.q O P o r P Ll p_ P CA T 7 A V7 ~ n co eo cb a UA e~ Qry,ti OLIV Page Of u Cross Section Of A Mound Using A Trench For The Absorption Area _ H e~ . 7( 6 Medium Sand Fill F - 6" Topsoil 1512v• 96.00 -J1 3 E D Eltu. r.; QEY TEM, Plowed Layer 0WIrR&rsp ggregate, 6" low Qe, C real" With D l Ft. St avbko*@. Synthetic Fabric 1 np',~! E 1.3 Ft. G Ft. F .77 Ft. H 1,S_ Ft. RELATIONS ItDi.lSlri`v', LABOR 3OAR AND H DEPARTiviENT 1:1i~'. OF FETY AND QU! INuS 5€€ COR €S Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe Permanent Markers Observation Pipe .7- 1 i___ - - - - - - - - - - - - - A 0 W B •T• K Trench Of k" - 21i" Aggregate I r L A S t. 1 11.•~y Ft. K IO.Z Ft. W a3,-3 Ft. Q 7!~-- Ft. J 7,K, Ft. L S,Sa? Ft. License Signed: ~~z Plumber: 3~~ S Date: 7-7 a Let- p='cLr•oRF,'~t~ Pt P~ i~='~ ~ ~ L ~?vc P,PE °U~ CJ1D / ~ I ^T CUB. OF EN CH L/,TL-MAL Y+~,D GAP Q 1-PULES LC):..KTLT'J Oil cUTi D H O~ + _.~I•PE AUK J.•R~ t'OJRI.IY SPhCA~ , t .ar'-F•pRGE M F~ ~ tit FRpf-1 T~uhP PLhCE L TT lYOL~ 1J°KT ~U E1.~D CRP -'~J~STR..\ $U77 ~!J • Pl P E .L~4 ~ U_T_- 1 p 3 6- FT. ONSiTE SE\NAGE SYSTEM! x 3 tiol , -V F " A 0 V PLC UTAncTZ_._ U . l,a L DFPARTN"EPi F Its is~JTRY, LABOR AND~kDDG5 RELATIONS ,ION OF S FETY N ~oRC~ rla~u is OF 1-Vm-lz-vpJ PE .3 SEE f.OSRE - ItJV, El£V. OF v.~LS Ala .5 F=l'• LNc- ) sT HO (E I TROY) TEE w1-r~i Sv GC~ZSD)IJ G HDLE~-. T.._3~r,)):~TERUhc s LAcST No t-E To ~ u ex r TO E' E1`I D Cwt- P- . I C~~InPr( t~~4YY'!, kickard PAP.F •~F PUPl,P CHA.MB.-_R CROSS SEC-: !C;J AkjC, SPECIFICATIO`!S VEUT CAP y`C.I. VEUT PIPE WEATHERPROOF APPROVED LOCitIA;G JUNCTION BOX MANHOLE COVER 25' = R0.^1 DOOR. WINCOW OR FRESH 12"MIU. `'~'U~trh~nC Ian..( AIR INTAKE I GRADE 4, MIN. CODDUIT \ ill INLET PROVIDE I ONSITE SEWAGEA `Y ~tt(3 AL APPROVED JOINT A ( I I APPROVED JCu W/C.T. PIPE Conltionaff~ W/C.I. PIPE EXTENDING 3' I II ALARM EXTEUOIUG 3 OWTO SOLID SOIL B A I II ONTO SOLID SC a I ( li4t • E 0, V CUEC'~1RTI':8 N F I llc USTkY. LABOR P% D D HUMAN RELATIONS ON ELEV. v F T. IVISi{11~ OF, SP~F TY UI{-D{NG5 I OFF I` 0 ME CONCRETE BLOCK 3 ' RISER EXIT PERM17rrD OIJLH IF TANK MAIJUFACTURZR HAS SUCH APPROVAL /GCO G0.{ SEPTIC E SPE GIFICATIOUS DOSE TAIJKS MANUFACTURER: WMBER OF DOSES: PER DAy TANK SIZE: 7SU GALLONS DOSE VOLUME ALARM MANUFACTURER: 5- tc_tIr0 <~ts [,51NCLUDING 6ACKFLOW: /y`~~• T? GALLON MODEL NUMlSER: 14 CAPACITIES: A=I I(c IUCHES OR, 00 GALLON SWITCH TyP[: _ A Q = pp~~y INCHES OR .a31 1 GALLCQ PUMP MANUFACTURER: r C= IUCHE5 OR /s93) GALLOI.J MODEL DUMBER: I D= ~IMCHES OR,251 GALLOL SWITCH TYPE: ho-W, MerrUsr ~C10 MOTE: PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM ~j,INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD DISTRIBUTION PIPE.. SSZ 6 FEET + MINIMUM NETWORK SUPPLY PRESSURT,E~. . . . . . . . . 2.5 FEET + - 41 FEET OF FORCE MAIN X LS po,,FVICTIOU FACTOR.- • {°s FEET" TOTAL DyWAMIC. HEAD = 9-1 FEET' .vi M(m.) I ~I IUTERUAL DIMEUSIONL OF TANK: LEKICsTH ;WIDTH 1 -;LIQUID DEPTH YU SIGI`lE D: ` LICEIJSE NUMBER: ~~-2 DATE: ' r Submersible MODEL: 3871 SIZE: 3/4" SOLIDS Effluen Pump RPM:1550 j HP: 0.4 METERS FEET 8 25 7 LIJ 6, 20 = t 5- < 15 4 J Q F- 3- 2 1 5 ~ 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY ~GOULDS PUMPS. INC. SENECA FALLS NEW YCW DI48 OW 13e-r'. L- 6-r r LA It 1 Ck 21 Effective October, 1988 O 1988 Goulds Pumps, Inc. :;P20IFICATIONS ARE SUOJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. APPLICATION FOR SANITARY PERMIT 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 i house"), then a second form should be'retained and completed when the property is i .sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property TARRy RICKARD - `Location.of Property SE 14 SE 14, Section 19 , T_29. N-RW "Township SPRINGFIELD Mailing Address 2779 80TH AVENUE WOODVILLE WI 54028 Address of Site ,Subdivision Name. N/A Lot. Number N/A - Previous*Owner.of Property C_ ~c Total Size of ` Parcel © C L^S S -Date Parcel was `Created Are all corners and lot lines identifiable? Yes No / Is this property being developed for resale (spec house) ? Yes y No Volume' 02.,_ and Page Number 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, 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) eeAti6y that att atatement6 on th.ia 6onm ane tAue to the but o6 my (oun) knowledge; that I (we) am (ate) the owneA(d) ob the pnopenty ducAi.bed in thiA .in6o,mation 6oun, by viAtue o6 a waAAanty deed neconded in the O~6iee o6 the County Reg-i6teA o6 Deedba,b Document No. and that I (we) ptuentey own the pno poa ed z to 6oA the d ewag e d z pn d yb em (on I (we) have obtained an eab ement, to nun -w.c th. the above de,6 cxibed pnopeJc ty, bon the eon6tnuc ti.on of said d yatem, and the came had been duty neconded in the 066ice o6 the County Regi.6teA ob ;'Deeds, a6 Document SI URE OF WNER TURE OF CO-OWNERLIJF APPLICABLE) ';DATE SIGNED DATE SI ED i nocuMCr)T NO WARRANTY DEED 161.6 arses rrscav" roe sltcewNN oM~ STATE BAR OF WISCONSIN FOIILM Y- 19111111 4x9423 VOL 902 PAA33 Eugene Larson REGISTER'S OFFICE ST. CROIX CO.r WI - Recd for Record MAY 1 G 1991 My Irrt ~r.,rrant.; Laurence J. Rickard and Diana at 11:25 AA M. as z i t le d C~'►+~ Rptwr d DNdlt the f,.lluuin, lescrLbed real estate to St. Croix Cwt State ui W,,consin: Tax Parcel No: East Half of Southeast Quarter (E~ of SE4) of Section Nineteen (19), Township Twenty-nine (29) Nor*h, Range Fifteen (15) {Jest. fi~ANSE~ TI is not homestead property. (AX (is u0t) Exception t„ warranties: Easements and restrictions of record. I{atcd chi; day of 1! 91 . EA[. (SEAI.r Eugene Larson . ,T ISEALP (SEAL) AUTHENTICATION ACKNO W LEDOMENT Signature(s) _ STATE OF WISCONSIN ' us . St. Croix CW,fit). I authenticated this day of......... 19 I cr.;tnc,ll} , ale bef•.re n,e this I r clay of I l ` f 1J91 the. ahove named • uye[1e arson TITLE: MEMBER STATE BAR OF WISCONSIN \is (If not, 'rtia authorized by $ 706.06, Wis. State.) to rue 1,uu.:u to he the per-on who who executed the fure~run C in= t wiwnt and aekny-W10.1g` tiid !(Thies f. - T•,'.S INSfRUM,NT WAS DRATTED BY Thomas A. McCormack Baldwin, I4T 54002 Nnt::• . Piihlit County, Wis. (Signatures may he authenticated or aeknoulc 1, td. Itr.'h ~t> t' ,o: i ,iwi i, nrvntan, nl III* not, state e,:p.rution are not necessary.) / 4- ?1 date: 1'J eNsum of persons signing in s,.y rapb,ty --A I., tyr f ui••1 L I• h v n WARRANTT DEED STAIR BAR Of WISCONSIN Mr •.arsta } d wew _vORU A SOIL' AND SITE EVALUATION REPORT DILHR in accord with ILFIR 83.05. Wis. Adm. Code vw.M.w .I nt'wwc,~nw..aw«.w~R>w COUNTY Attach complete site an on a er not less than 8 1/2 x 11 inches in size Plan must incIude but not limited to vertical and horizontal reference point (BM), direction and / o of slope. scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTYONNER p p PROPERTY LOCATION 0.''Y- ~j T, I L kQc C'~. GOVT. LOT S F 1/4 i/4,S (9 T N.R / S E (or)g) PROPERTY OWN F1:'S MAILING ADDRESS LOT BLOCK N SUED. NAME OR CSM N' / CITY, STA E II II ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE WN NEAREST ROAD n t 1 W t< 5`I X12$ ( 1!)I 6qg_Doll [X r n e ~ 80 t~ S~f". ( ew Construction Use ( Residential /Number of bedrooms Replacement (J Public or commercial describe Code derived daily flow gpd Recommended design loading rate , ~ bed, gpd/ft2 • 6 trench, gpd/ft2 Absorption area required 37 S- bed, ft2 trench, ft2 Maximum design loading rate 5 bed, gpd/ft2 . (o trench, gpd/ft2 Recommended infiltration surface elevation(s) 9~ • 00 ft (as referred to site plan benchmark) Additional design / site considerations t n~ Parent material Flood plain elevation, if applicable AM ft S - Suitable for system CONVENTIONAL MOUND INGROUND_PIFSSURE AT S l) ❑ SYSTEM _FU HO S NG TAN U = Unsuitable tors stem El S 19 1-3" ❑ U ❑S E T ❑ L9'D SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Moores Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed Tre t Ground 3 =a I C) v : - - S, / C b to S , (o elev. 0 ►ix 3k S 67 Depth to u k c limiting fac~tor~ - Remark's: Boring # C'~` o v R r ~~c a u) of S- 1 . S to „?s `L I bl~ r uJ 114 Ground 1 - . 3 C s Irv k 0- uS 14 4 -5-F. elev. Depth to - - - - limiting factor n f I Remarks: CST Name:-Please Print / Phone' _ ^7 Vl t ~ ° ~ S O'H'O c~ , Stiff / Address: 1 i &P i n I S p..~.. ~ ~ r q 'lam ~ Signature: CST Number. SOIL DESCRIPTION REPORT Borin # fHorizor Depth Dominant Color Mottles Structure G9 D ' g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botndary Roots . a'M Bed Tra 10 yp s l a s 6 h., S. Ground - p J S I d s cv , (o elev. t fit' a- t~ v .s v cr . Y 5 Depth to limiting factor FSf ka Ld Remarks: Boring # 4. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. h. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting 1 factor Remarks: I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDIJION, INDUSTRY, DIVISION, • LABOR PE~COLATION TESTS (115) MADISONi BOX 3707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATT(N: -9 _E TION: WN /MUNICIPALITY: LOT NOTLK. NO,: SUBDIVISION NAME: ~'/'„5 RI4 /T - /RI (o rt Al el COU TYY: MAI L%MG ADDRESS: A/,A, r USE DATES OBSERVATIONS MADE :,ZO NO. QEDRMS. 1COMMERCIAL ES RI TION: ❑Replace R rtHUULATIUNTES7: %esidenca : ew RATING: S= Site suitable for system U- Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PR STEM-IN-FILL HOLDING TANK: RECQMMfNDEDSYPSTEM:(optional) 0S EI EIS E1 EIS CCU CIS EU ❑S ❑U DESIGN R PTE; Percolation Tests are NOT required PTE: If any portion of the tested area is in the , under s. ILHR 83.09(5)(b), indicate: Floodplan, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND Dqp,,- H. NUMBER DEPTH IN, ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) B An C B- B_ & BII I II' ~ i. B- r PERCOLATION TEST TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 I OD2 PERIOD PER INCH P- p. P i, P; P-' PLOT PLAN: Show locations of percolation tests, soils borings and the dimensions of suitable soil areas, jlndlcatl 1e, or ¢is;Iances. Describe, what Mt! i+ zontal and vertical elevation reference points and show their location on the plot plan. Show the surfpge po#i1j ► t @1II, ArinA= and the direction alrld t of land slope. SYSTEM ELEVATION 141 ~ I I [ i If I „{,,t : k4 ~ . . ' ' { t 1 F f [ , , I v+ 0 N • I _i : : -~s•n+~- i 2 [ L4PO a'/le, i, J'O.A 14 ,r I, the undersigned,' hereby certify that the soil tests reported on this form were made by me in accord with the procg0lu ,tT~hods-specified in the Wi nsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and t~elipf NAME (print : t TESTS WERE COMPLETED ON: ADDRESS: _ CERTIFICATION NUMBER:, PHONE NUMBER (optional : 6 CST SIGNATURE: ail RIBUTION: Original and one; Property Owne, and Soil Tester. „ r a. -i- 5 14 6 t ~ G G w - 15 15 ~L9 o G CA O A 5 O 47 Q S -z ~ F A 3 s 1 . -ZP ro LA I ~ v ~ P o ~ !n P - P ~ U 6s Y ~~e a f SOIL' AND SITE EVALUATION REPORT D I L H R in accord with ILHA 83.05, Wis. Adm. Codo . .~-..M.•..•..,.,,.+•~> COUNTY Attach complete silo plan on paper not less than 8 112 x 11 inches in size. Plan must include, but _'r C l not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. w dimensioned, north arrow, and location and distance to nearest road. r APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEOBY DATE PROPERTY OWNER PROPERTY LOCATION . 1 _ QV-'r y 1, t C kt71r C'x GOVT. LOT s F 114 SE 114,S 9 T N.R ! S E (a PROPERTY CN N R:'S MAILING ADDRESS LOT JB:6CK SSUBD. NAME OR CSM 0 9 S o -t1, /1/ CITY, STA IE 1 ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE WN NEAREST ROAD o rl)~ M 15`l02$ IS-) e-_-) O` A X80+k St. ( 4-9ew Construction Use ( Residential /Number of bedrooms 13 Replacement (J Public or commercial describe Code derived daily flow gpd Recommended design loading rate 5 bed, gpd/ff2 • 6 trench, gpd/fi? Absorption area required -3-7!:;- bed, 112 trench, R2 Maximum design loading rate S_ bed, gpd412 , 6 trench, gpd1ft2 Recommended infiltration surface elevation(s) 171,.6y-) It (as referred to site plan benchmark) Additional design /site considerations ty\~~ 0" sA, A Parent material Flood plain elevation, if applicable it S - Suitable for system CONVENTIONAL MOUN 94GROUND_PWSURE AT DE SYSTEM _%L HMDING TAN U - Unsuitable fors stem ❑ S C E 3" 11 U ❑ S 8 TJ ❑S EI'Ll ❑ [9.10 ❑ S al SOIL DESCRIPTION REPORT Boring# Hodzo Depth Dominant Color Mottles Texture Structure Consistence Bwxialy Roots GPD/f1 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tre ' U Lk o-S v QW -~J Ground 3 I cC to S. lev - c) - S Depth to r•3L u It C I .S limiting factor ~5C 11.V,U~ Remarks- i Boring # t~ r v Y~ c Li M 0_ Ground v Uj IUI .4~ VV, elev. Depth to - - a limiting factor r r - - N- V tY i~ - Remarks: CST Name:-Please Print Address: I Signature: £ Dal : CST Numboc SOIL DESCRIPTION REPORT Boring # Horizo Depth Dominant Color Mottles Structure GPU tttt Texture Consistence ©0U Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. SIB. 'd`~ f3o TrtY - r r 13 s( a s bk W, Ground - o . Su s (o elev. t ~53.5t a- tv• u s u cr . 4( S Depth to limiting factor kl Cr U). Remarks: ' Boring # 's Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor' Remarks: Boring # < w n... ~wu3:v. Ground elev. ft. . Depth to limiting 1 factor L Remarks: 3 G ~W~ 15 15 o cp G c 0 10 Q 3 f LA 'C ~ i Oy F ~r a -C v c ~ ro^ ST. CROIX COUNTY WISCONSIN } ,t4 ; ZONING OFFICE x ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 r , Yt. _ (715) 386-4680 {W June 30, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Larry Rickard property, located in the SE 1/4 of the SE 1/4 of Sec. 19, T29N-R15W, Town of Springfield, St. Croix County has been conducted. This onsite revealed suitable soils at a depth of 2611, making this site suitable for a mound for new construction. Should you have any questions, please feel free to contact this office. 9ames rely, K. Thompson Assistant Zoning Administrator