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HomeMy WebLinkAbout038-1054-60-100 ~ I o a c I I o I N ~ I I I : I I C Z 7 c4 LL CO Q I I M I z CC) E Z = O E 0 z M cn w a m r- z o I 0 z d c v cr o o m Z = z 03 r CD -o m O a) N O Q CD C N c -0 Q o a w Z co z N z I 0) d N m ~ ~ al N p ~ (D (O CL i U) M 2 O O w/~ O a al CO N N ~N C I- F' Z F- N N E O O O d m z o ° r- a a a m a Q o a) w rn aNi V1 J U Z rn to ~ = N O O > 1 04 Q 0 0 Q ~ n in (n N N a) Q L„ O 3 O M N C o pp M~ C N C N a- O 0 r- -0 04 a N O N C to CO C 4) O O r (O O a = am O 'O H O M M v, cs z m o E v • sue,' o in 'z o v z cn I ~ I r/~ m AI a CL 4) 4) t 0 y = _ o A u a m 0 i L) r r~ DEPAF6TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LAIB'OR AND G P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: O UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: ~4 4 N/R/ (OKYR ar 4ra"*1, 'e- - 000NTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: to i' , n hl, 994 3 4W.. -el C~lir►o h c/ aJ, &1 USE I Jr DATES OBSERVATIONS MADE a 6 o NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CON ENTIONAL: MOUND: IN-GRO)ND-PRESSURE: rYSTEM-IN- ILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S DU SS ❑U FIJI O S IRU E:I S ,CCU o 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: Floodplain, indicate Floodplain elevation: 0 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. O BACK.) a- '6 .6- 5 !6 - 46Lsue, B- I # F A C9 - 0 B- d' B- 1~ eo 3 ro I A~ * -/~e15®-.36o B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R D PER INCH L P a 4:0-1 6 P / G P- 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 X 40----- 3 I E I ell S } o I } a E 1 CIO iCOUNTY tN~O 7d~ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the p e a to s -f-cified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge eli f. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): jdg,'!~!CL air CST SIGNAT DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - R INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate v. 1 this is a residence or cornmercial project; 1 MAXIMUM number of bedrooms or cor anercial use planned; 4. Is this a new or replacement system; 5. Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A `"GIBLE diagram ace 'y locating your test locations. Drawing to scale is preferred. A -ry he used if - £ . rhmark ~ )d 'saatian referc r point are cl-, loin, and are , -n >nent; i' Eriate boxes ates, narnes, ads flood pl pr?rcolation to nl ti 10, If Lich as flood plJ „in) does riot )ply, place N.A. in the appropriate box; 11 . S nn your current a rr „d your n number; 1~ IV and distribute as ALL St TESTS MUST BE FILED WITH THE L y h ;'Y WITHIN 30 DA' 1PLETI(",'. ABBREVIATIONS FCrrt € T IFIEO SOIL TESTERS and Textures rmbols st col ne gi 1 3") L - Lin estone s HC High Groundw, r cs Percolation Rat, reed s Weil f.< l _ Buil i Is F ref > Gr n sl Loarn < - L an l Bn--F s i I - L _ am BI I si Gy - G ; cl _oam Y l ,Tow scl C / Loarn R F sicl - v . it Loam mot - V sc - F lay wl - 1 Clay - t'r y fif f ~ ;'ie, fa r Y C cc - C pt rmn N :ly, medn " rn - (3 - oi,tinct p - prominent HWL Nigh water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE GINNER: 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. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 1.,:. 1101 Carmichael Road • Hudson, WI 54016 - 1- - - (715) 386-4680 June 22, 1993 C(Dply RE: Hartman Construction P.O. Box 326 Somerset, WI 54025 FROM: St. Croix County Zoning Lot #1 - 1349 220 Ave., New Richmond, WI 54017 NW 1/4, NE 1/4, Sec. 13, T31N-R18W, Town of Star Prairie St. Croix County, Wisconsin St. Croix Co. Zoning Department personnel inspected the installation of the septic system which is to serve the dwelling located at the above described property. The inspection was conducted on May 28, 1993 and revealed that the system was designed and installed in accordance with all local and state requirements. Should you have any questions, feel free to contact this office. js s STC - 104 AS BUILT SANITARY SYSTEM REPORT 6 OWNER 0, e4, ADDRESS W } • `t" ` Av< SUBDIVISION / CSM# (VIA LOT # SECTION 14_T _N-R 19 W, Town of Cra l r i ~2.. ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SG' g, INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s BENCHMARK : ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W t j . ' / Liquid Capacity: Setback from: Well D we House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width: 12 Length co, Number of trenches (7 Distance & Direction to nearest prop. line: i Setback fro//m: well: 0 C)~/ House 5V Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 5- PLUMBER ON JOB: ,(C~ yT hr. ID ) d-Cl d c LICENSE NUMBER: INSPECTOR: 3/93:jt i L 'A;%ilp;,tA5 l,FWRIE 13.3~FtNAf Sf&AGeff! ET / . County: Labor and Human Relations INSPECTION REPORT Safety and ~Ruildings Division (ATTACH TO PERMIT) Sanitary -Permit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village (Town of State Plan ID No.: Al BM Elev.: Insp. BM Elev.: BM D =pt ion: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300051 ~p 9`3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Sr G~ Benchmark Dosi n Aeration Bldg. Sewer Holding St/ )A Inlet 2 36 TANK SETBACK INFORMATION St/* Outlet -2,(A3 /D .3 r TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake /2 E" NA Dt Bottom ~dte Septic NA Header /Vr Aeration NA Dist. Pipe y G~. Holding Bot. System PUMP / SIPHON INFORMATION Final Grade ~o a S T i Manu a turer Demand Model Number GPM TDH Lift Friction System T Ft oss Ife Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 4Length& No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 NS ~a 0 DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM CHAMBER INFORMATION Type O Model Number: OR UNIT System: DISTRIBUTION SYSTEM rHe er / l j ~aTn ' c DistributionPipe(s) x Hole Size x Hole Spacing Vent To Air Intake th ~2 Dia Length ~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over i~ Depth Over xx Depth Of Txx Seeded I Sodded xx Mulched Bed/Trriw*Center~ Bed/Tper+elrfdges~ ~_3~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 13.31.18,NW,NE 2 0TH AVE. Plan revision required? ❑ Yes (~]'ho - Q~ Use other side for additional information. CP SBD-6710 (R 05/91) Date Inspector's Signa re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ :C3: ILHR SANITARY PERMIT APPLICATION COUNTY v` In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PER # -Attach complete plans (to the county copy only) for the system, on paper not less than El ~ 8% x 11 inches in size. Ch k i revision toLpre ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OW PROPERTY LOCATION 4-C A? J21 H /a '/a,S T N,R E( W yf~ PROPERTY OWNER'S MAILING ADDKESS OT # BLOCK ~ CI ,S ATE ZIP CODE PHONE NUMBER SUBDIVISION NAMEB.CSpA NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE 7 ❑ Public LCI or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER(b) III. BUILDING USE: (If building type is public, check all that apply) z p S © d 1 ❑ Apt/Condo v 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 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. 0 New 2. ❑ Replacement 3.E1 Replacement of 4.0 Reconnection 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) 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 ❑ 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) ELEVATION 4,C f- Feet Feet ~j-149 1 2.2o , 6 G,3 '9 - -5r 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 Se tic TankorHoldin Tank Pi F1 [j_ n - F1 Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print r Plumb ignature: (No mps) MP/MPRSWNo.: Business Phone Number: ) PIC ,~6/kv,~n Plum is Address (Street, City, State, Zip Code . r1 e J72 C s^ a CD IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issui Agent Signatur o Stamps) Surcharge Fee) Approved ❑ Owner Given Initial 4- a _ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS t` 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 `or 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 1 f 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 tan'<s; 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) • - APPLICATION FOR SANITARY PERMIT 8 T C - 100 This application form In to be complatod in full and signed by the owner(s) of the property being developed.- Any inadequacies will only result In delays of the pztmlt issuance. -Should this development ba intended for itiala by owner/contractot,(spac house)# then a second form should be retained and completed whon the property is sold and submitted to this office with the appropriate deed recording.' Owner of property L'~/~~•,J ~.vy`~ S~-LlE >/U/ ~5 Location of property 1/4 1/4, Section ~J T 3/ H-R~y Township Agt'- 7/'a Hailing address 'g! Address of site ZZO f'~ 44 New ~~''~o r.C~' lubdtvtston name Lot number Previous owner of property Cs-e-ege ~ 'e Total size of parcel Z 3z. ~Cic7-S Date parcel was created lye Are all corners and lot lines Identifiable? _7e■ No Is this property being developed for resale (spec houst)1 Yes '~__xo Volume y ---5 and Page Number. an recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWINCt A WARRANTY DYED which Includes a DOCUMENT NUMBER, VOLUME AND PACK 1tUxB[R, and the SYAL OF THE RZaISTER OF DEEDS. In addition, a certified survey, If available, -vould bs helpful so &s to avoid delays of the reviewing pcoceax. It the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) ctrtlfy that all statements on this form are true to the best of pky (our) knovltdgej that I (we) am (are) the owner(s) of the property described In this Intormation form, by virtue of a warranty deed ~ecordad In the Office of the County Reglster of Deeds as Document No. G/ Gf ,y~ '7 and that I (ve) prtsently own the proposed site for the savage alaposal system (or I (we) have obtained Aan easement, to run with the above described property, [or r.he c•ontfrIle- r tree user dtd In the O([lct of the 91o ty R gist of Deeds, as Document No. `GxL i. u--.~ ltgnatuce t Owner 8 gnature of Co-Owner (If Applicable) Date of Signature Date of 819nature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 4951-37 993fArA SO e, fn r, kb I FRE 1SiEi,1^S ~~e 1 r T. CRC(X C~~ , 1':'i c3 *7" ~'--c-j fi . qui~laims to 0 i~ A E B 1 6 1993 ~~LA A1 -S n 1:40 P. M J!: " Register of Deeds j the following described real estate in St. Croix County, State of Wisconsin: RETURN TO Tax Parcel No: Located in part of the NEJ of the NWJ of Section 13, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. Vol 9 Page 2494 EXEMP' This I$ homestead property. (is) (is not) ru-a Dated this I day of (SEAL) Z21 /6 (SEAL) C42,o e__ it K k (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN v "N' _ ~Y L' County. SS. SEPTIC TANK MAINTENANCE AGREEPIENT VU St. Croix County OWNER/BUYER 14-1114 So.J 0 ROUTE/13OX NUMBER :5;-l - Fire Number-- CITY/STATE /'Lj Ail ZIP r PROPERTY LOCATION:'.' IVi~'k', a Section /,3 T~_N, R_k1, Town of St. Croix County, - Subdivision Lot number Improper use and maintenance of your septic system could result in its premature. failure.to- handle wastes.' Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licen's'ed' 's'ept'iV.,.tank pumper. What you put into the system can a ect t e unet on o, cne s-ep&ic tank as a treat- ment*stage in the waste disposal system. St. Croix County residents*-ma'be eligible to recieve a grant for a maximum of 60% of the. cost.o£ 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 's't'ems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater 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. r^ Ihn i inA rIrnirnnr~ } r... r~ 1 hl.n n~„,.. rnn~~o •nrr n,_r~~. IT to maintain the private sewage disposal system in accordance with the standards set forth, herein, as..set by the Wisconsin Depart- r: ment of Natural Resources, Certificatio form must be completed and returned to the St. Croix County Zon ng Office within 30 days of the three year expiration date SIGNED VJ DATE Z g_- r St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. CERTIFIED SURVEY MAP LOCATED IN PART OF THE NEa OF THE NW4 OF SECTION 13, T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. N SCALE 1" = 100' LEGEND Found county monument of record, 100 50 0 100 aluminum cap in concrete. Set 1" x 24" iron pipe weighing Bearings are referenced to the o 1.68 pounds per linear foot. north line of the NWa assumed to bear N89'06121 "W. COUNTY GENERAL NOTICE: Each parcel shown on this map is subject to state and county laws, rules and regulations (i.e.., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning office for advice. UNPLATTED LANDS NW CORNER NI/4 CORNER SECTION 13-31-18 SECTION 13-31-I8 NORTH LINE OF THE NW 1/4 S890 06~ 21E 392.00' w 21 W 220TH AVENUE W Z; 70.00 „ w N89 06 21 W -41 IC w RD. R/W-- N89°0 '~W 392.00 - W IZ O O IC I-p C; O -°o O o IZ i~- W 97, 216 SQ. FT. (j1 1-p 2.232 ACRES W r ~D .W i OT i INCLUDING R/W fV , ID (D ' . *4 - v . 1 1-1 t)I BUILDING SETBACK ; 84,280 SQ. FT. -P (O I--j IM M 0 1.935 ACRES O Im 10 N 0- EXCLUDING R/W IQ r 1 ao PGE r IZ 0 O~P\/ OD 1 Z I N89006 211 W 392.00 ~yX UNPLATT_ED LANDS JAI OWNER SURVEYED FOR SURVEYED BY George Birkholz Brian Nielson A & E Land Surveying 2175 32nd 367 W. 9th St. P.O. Box 325 New Richmond, Wi. 54017 New Richmond, Wi. 54017 New Richmond, Wi. 54017 This instrument was drafted by Douglas Zahler IiTM F OF REPORT ON SOIL BORINGS AND SAFE( & BUILDINGS INDUSTRY, , DIVISION LABOR AND PERCOLATION TESTS (115) MAI (SON W 7969 HUMAN RELATIONS (1-163.090) & Chapter 145.045) LOCATION: SECTION: O! UNICIPA,LITY: LOT NO.: BLK. NO. SUBDIVISION NA IE: M0 /T'/ N/R,/~f to car ,r~ LIN ADDRESS: I COUNTY: OWNERS BUYER'S NAME: T-M:-~al 4f Jil / USE DATES OBSERVATIONS MADE 6' .7 41ZC9 III o~ NO.BEDRMS.: COMMERCIAL DESCHIPT10N: PROFILE DESCRIPTIONS: ER CLATION TESTS: L-(Residence ~ New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-G ROUND PRESSURE': SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optionall ~s ❑u [Esau 0s ou as RU as 2U - If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.1-163,09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTL!RE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ST. HES TO BEDROCK IF OBSERVED (SEE ABBRV. O BACK.) - cs~ ~ ~ io ~ ~ ,,t a - " ~ may, B-~ D i A~ e2 A) --3 Ai B-- I MOA ~1 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES R'1TE MINUTES NUMBER I PER INCH jef,S AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD P- _ _ • - P P. P- P- . PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Descri ,e what are the hori- :rontal and vertical elevation reference points and show thei location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION L~---- I y rte- _ anti !Ile ~G 1 I, the undersigned, hereby certify that the soil tests reporter on this form wet,, n~by me in accord with the procedures and methods spec tied in the Wisc nsut Administrative Code, and that the data recorded and the location of the tesu, .;rat correct to the best of my knowledge and belief. FNAMF (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): d r,-. Cyr GrJt .7 0 0 3 ~ 7 iy- 'd<<; 76/,l _ CST SIGNAT E: /l DISTRIBUTION: Original and one copy to Local Authority 'roperty Owner and Soil Tester. • r P PROJECT& 4/1 ~/dyi ADDRESSJ~ /-70 ~;1 /4 ~ 1 /4/S/ /T N/R W TOWN ~u t _ _ 7 COU TY ~f Gvoi MPRS Byron Bird Jr. 3318 DATE BEDROOMS CLASS PERC H CONVENTIONAL_,L<IN-' G 6K RO D PRESSURE CONVENTIONAL LIFT MOUND_ HO DING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE k Benchmark V.R.P. Assume Elevation 100' Location of Benchmark L Borehole Q Well Scale Feet 0 Perc Hole System Elevation Uent 12" Grndp TYPAR COVERING 12' 3' 4 6' 3. I Sewer Rock r~ 6 12' A / r 1 3 eP.4J ism : 151- l 1 ~ ~f t lye 5 p iGo REPT131 STAR PRAIRIE ST. CROIX COUNTY ZONING PAGE 1 05/27/93 11:43 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/28/93 AREA: JT Activity: A9300051 5/28/93 Type: CONV93 Status: PENDING Constr: Address: STAR PRAIRIE 13.31.18,NW,NE, 220TH AVE. Parcel: 038-1054-60-100 Occ: Use: Description: 193394 Applicant: NILSON, BRAIN Phone: Owner: NILSON, BRAIN Phone: Contractor: BIRD, BYRON JR. Phone: 268-7616 Inspection Request Information..... Requestor: BYRON BIRD JR. Phone: Req Time: 12:05 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION