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-0 C) 7o C) tr O 60 c ni r r O C7 C O Q !0 c C o a (6 N N-6 Y.C - O V N O > N ~o v) Ew o m ID-o L _ o (aUL a1 O °oS 00 o a _ N o c c ti v _ C E > Y M O O .U -O L w C > C x U Q O c" Q U N c e wcwa 9oE~voioL oc_a c o w c 3 E m N U F m y o _ m Ci N Y'L" M'O Q OO>> = a N c 3 O NI N O N (n 0> N cn C .0-0 0 p fn O Cc -p 0-) N -30 N a) 'D ZO 3~~w Mcca w c 3 o I1 c E c voi °c ti c~ pa -;.>>N E ° 0 c N g (n a a) .Q _ in > .c p 'co C 'C} N N C =pl = •O O `n E t L (D x E d w c(nn E d~ co amcnw o U U I 9 M (6 N W E E W- E E co a~ o £ o Z `m m m a~i M a m (L co M F- (n C -O III o Z C U X r- 7 N a) Z O c c Cn I-' r O a? U C E r E y, '0 Cl N O O C y~f 0) N as _ a' Q N N O O O O + - U) a1 _ O - O O L O p L N N h O O ~ Q ON ON Cz* Z m z L 2 Z Z c 0 (D L E Z m E N U `m - m E O y a1°i a~ O O 'a a to 0) Y c m a .0 O D a o f 0 V) (n cn z3 `0 m E F E c cn cn cn E (6 L O U M I L d~ c F F H d (n +Z"I 0 0 0 0 0 0 0 0- CL CL (L (L 0- "4 EL M Q Z cc) o cn N a) 0_ } to J U _0 N ~►V O O J a N v 0 0 ~ M N L O O i co y ~ 1 0 O O c: O O 1- N m co M V O +~~y ~ to N L ~ u> a) ~ M 3 :a 3 O V O N N N R' V N C a N O C U') (D co C4 M O U ID O O O O O O O ~ 0 cl O a1 d a m 0 0 G co co v) c E E a) 04 N 41 O O 73 - N .r c C2 T O z c N U) C z'.J M M :4 1 co ° L o f L W c') i ° = v *r1 y' °o MU N H E E -c o Ui E E cv £a £a . II ' d • a m a a ' `m a o m 3 :a o 3 :a o C U (L EL l O N U O cn c) E U E C.2 0 C 3 A a y coq-?6 ST. CROIX COUNTY ZONING OFFICE ~St. Croix county courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 service of s The St. Croix County Zoning office offers the Realty Firmseptic and water inspections to Lending Institu private individuals. Qwii;;Ial C' a b&_ lst~.otasi • Please provide the following information, enclose appropriate fee made payable to St. Croix county Zoning office, and mail, received will be dons as aig as witssib a address. Testing soon Po WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria)FEEs $175.00 WATER TESTING (For VOCts) --FEES $25.00 SEPTIC SYSTEM INSPECTION--------------- (Determines if system is properly functioning at t me of inspection) A'~;Iaq Property vwner•s name 17 56 /L- Property owner's address C~ Legal Description hjr,- 4 o the .1/4 of Section , T_N-R_ 17 l/ Town of Lot Number --Subdivision Name 0-y-, e b. k9- 0 ati Color of house Realty sign by house? a If so, list firms FLSABB INCLUDE, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocksure turned off, making access to the home necessary. this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number , REPO T BE SENT TO: 1-7 i- ltJ%/~ Gu.~ S a Closing date / - 7- 20- Signature -0 0 c W a I O °o -0 N a~ o mU I O = N C I' m ~ I V U O _O - C 0 Fr .c . N I O M Cl) J +N' N O O N > Z c m 30^ LL. c O o - (D I E m N O_ 7 III, N i I O W i' U) ` o Z ) m Cl) CO o I _o z w U P - 0 2 'd' C N i- m E -a M ~+V D •,y a Z c O 1 00 Z Z O E z c m -o C n O c C) -7u E _ N U m - m W N N > N d N O 0 0 0 Y -o G C a 7 N N _ m 0 N U) N N M 0 0 0 Z O Q N Z N M m v1 U 0 rn rn O M LO i-N O O co O N O N O O NO E t` N C CO y n- ~ N N N CS`, O Cl) V 7 M N ~ N O N O E O O O I C C = 0) co M O M - O N N N Q CL O O O CO M r Lq 30: 0 CL E E C,4 1- ~ N V 42 O O~ O N C O O 57 O N O C c N H I- L M M • O M T o v ( N E E ~s U L O M U M O N F L U7 O ~ CC 0 m y a s L: (9 LL '2 4) rrIwV E c c w° _1 A U a O v~ v i DEPAf?T;iWNT OF WINGS INDUSTRY, REPORT ON SOIL BORINGS AND ISION LABOR AND PERCOLATION TESTS (115) P.O. 7707 HUMAN RELATIONS MAO I 707 7:~L 9~ (ILHR 83.09(1) & Chapter 145) co p to LOCATION: SECTION: TOWNS HIPPNt§;tYMLITY: LOTNO.:BLK SU 610 jVA SW 1/4 SE 1/4 33 /T31 H/R16)j(or) W Cylon n/a n ! n ~s+ jt:j COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: V-/_4111,42 St. Croix Douglas Johnson R.R.~~l, Box 69, Boyceville5 USE DATES OBSE O DE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILED SCRI N4~ O . P A TESTS: I ZIResidence 3 n/a ❑ New Replace 5-20-91 - -91 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PPR~REI1SIS'~URE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S Qll ®S ❑U ❑ S Ou ❑ S ®U ❑ S QU mound with variance If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: n /a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 22 SiA 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. ON BACK.) B-1 6.51 98.60 3.92 2.09 .92bl.1. 1.17bn.sil. .75bn.mot. s.l. 3.67bn.mot.gr. B-2 4.25 98.60 3.25 1.17 .67bl.1. .50bn.sil. 1.08bn.mot.sil. 2.00bn.mot.gr. B-3 4.59 98.55 3.50 1.59 .17bl.1. .42bn.sil. .58bn.mot.sil. 3.00bn.mot.gr. B- B- B- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD -2 PERIOD PER INCH P_ 1 1.67 none 30 3/4 5/8 5/8 48 P-2 1.67 none 30 3/4 5/8 5/8 48 P-3 1.67 none 30 2-2 2 2 15 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 100.43 a 3 A 11 3 E 1 3 ov~ Ad r4 ~1 I o O rn 0~. N E i 30 J'A 3 E 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 5-21-91 ` ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ;46-6200 1554 200th. AVe., New Richmond, Wi. 54017 2298 715- CST SIGNA DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. (ILHR-SBD-6395 (R. 10/83) - OVER - t T( I 4 o i ~ ~ II cn y v o c 0 w l' a O 00 ) N ~ N C L y f0 2 y M ~ C I O O) - y y M N y O V) 9 Z y ~ c 75 O^ Li c o a f D E U m N CL I ~ N w E ~ ~ = o I ~ v E Z ~ d m II m H U) i ' _o o z i o I v z U) H ~ .a 3 0ZZ V O N 0 LS 0 - ~ N O d Y G N y o D D IL E E m co E C~ C N U) N L V ~7~ c) E ~ O 0 d U •N G. d d y IL J U) V } O Cl) 0) 0 '~1 N N- N O O ° O • N co o N c m y c d Cl) O O N d ~y I U 'C d Q~ Cn N I 'i m \j O o 'o Al + ° o c c E LO co O o o M c y a Ui y v d ('q LO 3 d d C-0 e- N O a~D I- c S O O = C N N H N H 1- C y M M li c N 61 t6 U • O M T O O N E E ~ at E m V t d c0. • cc d d .2 d rr`I~~l E c 3 ~1 A ci IL o v ci 1 ~ YTA ON O G. ts►~lt~ .6~1 S. S. Beebe- FO U RT H 5 T. 7.~ 2 Gp e' 2. U) al z 9 n 44- 7j Z~ b r - i f 12 . aTHIRO ST. a ti 5 ZN 3 70 e U) L j W ' 3 7 .Zsi. w~ 4: 3~n COAq EGT M •~~,ST ~fC ST. 1 i Td d9b=60 SO 60 qa_A LOCATION: CYLON 33.31.16.598,SW,SE,33 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Bufldings Division ST. CROIX ' ` (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149277 Permit Holder's Name: ❑ City ❑ Village] Town of: State Plan ID No.: JOHNSON JEFFREY CYLON CST BM Elev.: Insp. BM Elev.: BM Description: y f Parcel Tax : C r ci /C0,ce c `°>'r?C~ .~`y' ` 00 8980000 TANK INFORMATION ELEVATION DATA A9200123 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3-g 2, Dosing Aer Bldg. Sewer Holding St IX inlet Ewe s fc8 TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic 30~C NA Dt Bottom Dosing -&~5 >/60' NA 44oadw/Man. Aer NA Dist. Pipe /J/, 2S Holding Bot. System 160,50 PUMP/ SiP++@N.INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lifti t~ Loss System TDH gyp, t Head Forcemain Length Dia. a Dist. To Well'),) SOIL ABSORPTION SYSTEM t , xr,k.r..irFS' BED/TRENCH Width r Length No. Of Trenches PIT o. Inside Dia. Liquid Depth DIMENSIONS DIM N I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ufacturer: SETBACK INFORMATION -Type O CHAMBER t Model Num System: Zsu~ ^-~,ZS >16C7 OR UNIT DISTRIBUTION SYSTEM M Nanifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length stn n Dia. ~ Length Dia. Spacing 36 Y& ' Sd 7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over N „ xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Zsewektenter A~ Bed /edges/off Topsoil es ❑ No 9-yrs- ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ?IDv l n S rQ kC+4 c,J! f`Q~c U S,: 9 $ 3 3) Plan revision required? ❑ Yes Id'No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. pppr' ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION OIL R In accord with ILHR 83.05, Wis. Adm. Code CouNTY v.....,..., e _ STATE SANITA RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ l q c1,1 8% X 11 inches in size. Check q! revision to pre sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER P 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Ld% '/a,S 33 T3/,N,R l6 E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # t'3 Gc T~ a- All CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER cW c` d d w~ O 7 ~ 11. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILLLLAGE NEAREST ROAD ❑ Public [Al or 2 Fam. Dwelling-# of bedrooms _Y_- PA EL RAMIE/K(b) 111. BUILDING USE: (If building type is public, check all that apply) 9~r ~Q 10~Q ~Q - O C o 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Z Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 ftund 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 430 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 3~ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION dl 3 -20:~ 111-0• -72 Feet /ex. sz. Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank F1 I I F-1 11 _1_1 Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: s Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San' ary Permit Fee (Includes Groundwater Date Issue Issuing gent Si re (N to Surcharge Fee) pproved F-1 Owner Given Initial Adverse Determination cl5 5 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 tark(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 !ine 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 aid/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 131A x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawr 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 suing-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) STC-100 I'bis application form is to be completed in full and signed by tilC 0c~nct(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,(s ec douse), 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 e ~r 4.ti Location of property-.:5?~1/4 S t1141 Section T~N-RW Township Mailing address / Tk (j is rnor>~ LcJ ~ S ~i~/o l ~ Address of site Subdivision name Lot no.~- Other homes on property? yes bc' No Previous owner of property wee a Total size of parcel Date parcel was created e) 7'- ll Are all corners and lot lines identifiable? Yes Is this property being developed for (spec house)? Yes No Volume /F-and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARIWITY DEED which includes a DOCUMENT NUIWER, 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 the property described in this information (are) b e owner(s) of warranty deed recorded in the office of the County Rvirtue a egisterfof Deeds as Document No._01 and d-~ own the proposed site for tl~e sew ages disposal t system ) orr I e(we) obtained an easement, to run the above described rty, for the construction of said system, and the same haso b eh duly recorded in the office of County Register of deeds as Document No. Signa u of ant Co-applicant Date of Signature mate of signature 'b as+uww n w 1! St.,..... t Tax rwmd JA . .-a 3 Srn1m (7) ~ ~ t (a) and Mine (9) 9 on. go or Q h h , i r Phis ....:~A..1. Iminvotead pram Y. 01 (is not) Z3111,11100011, to warrantbsc Subject to easements, rights-of-way if any, >,uttl ' soning ordinances. , - - • r, "-4`~'. . is 91 t ~v. day of . Dated this ..(SEAL) 43jja as Johnson • Rj~becca..J.. Johnson. a/k/a Rebt*► 4 s Johnson a f k/a•. Dougl.. i. (SEAL) xVT=S]tTICATIOPi ACKNOW LSDGMIBXT } ' 1 ra STATE OF WISCONSIN .~C~~~itj:` t~.. k a ~Gb..~.~......... ra'. ...........County. / PersonnIIy eame before we this {1 ; EIIBLR l4TATE BAR OP IWISCONSIN ,E. ws Sats.) to me known to be the person foregoing iastrumest and 111dt,1swkdRe YH4i pTpyMENT yrAa ORA1•TE0 by F.)C#AS.1Ei.~a:.R1~fAI*t Glenwood City. W1 54013. NoUrv Public (fir NY ('an „uc~tion is f tuerx a+ary be authentkatMY or arkw.•kAged, Both r t~ SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS : _ l V 3 ~p 7rk FIRE NO:-- LOCATION: _1/4, i% 1/4, SEC.!-~T N-R W, TOWN OF: ST. •CROIX COUNTY SUBDIVISION: LOT NO. 3 - 7 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. SIGNED: V17MAY-7 1. DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 INDUSTRY, L\r:rur~ 1 ~►tl • t a!4! a '4 il~lt~ ~?t ti`u~✓ P.1~(sloN LABOR AND HUMAN RELATIONS PERCOLATION 'TESTS (115) MADISON, W1 53707 (ILHR 83.09(1) & Chapter 145) LOCAT1t5N: SECTION: - TOWNSHIPhIrVJNWI jjL!TY:~ OT NO.: BLK. NO.T UBDIVISION NAME: SW 4 SE 4 33 /T31 143164(or) 1N C lon n/a n /a n /a COUNTY: OWNER'S BUYER'S NAME: MAILING A15U-R SS. St. Croix Douglas Johnson _ R.R.ft , Box 69, Boyceville, Wi. 54725 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL ES R PTION: PROFILE DESCRTiPTY 7s: ERCOLATION ESTS: C~Residence 3 n/a ONew EjYReplaee I 5-20-91 5-21-91 RATtNG: S- Site suitable for system Ud Site unsuitable for system ONVENTTONAL: MOUND: IN-GR UND-PRESS U N-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S ®S ❑U S ,ZU S ®U ❑ S ®U mound with variance if rPcrc:olation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the und.jr s. ILHR 83.09i5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n (lecimaal' PROFILE DESCRIPTIONS page 22 SiA i1L BORING TOTAL ' DEPTH T GR UPJDt',ATER-1INCHES C:•IAr i7dTER OF SOIL WITH THICKNESS, COLOF:, TEXTURE, A.JO DEPTH NQMBFRID.EPe"il M. FLEVA--- Oi3Si RVED EST. HIG~ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 13-1. 6.51 98.50 3.92 2.09 .92bl.1. 1.17bn.sil. .75bn.mot. s.l. 3.67hn.Inot.);r. S_2 4.25 98.60 3.25 1.17 ,67bl.1. .50bn.sil. 1.08bn.mot.sil. 2.00bn.mot.gr. B-3__./A.59 98.55 3.50 1.59 .17bl.1. .42bn.sil. .58bn.mot.sil. 3.00bn.mot.gr. B- B- PERCOLATION TESTS decimal' IEST DEPTH WATER IN HOLE TEST TIME O IN WATER LEVEL-INCHES RATE MINUTES Nl1MBEhi ~ AFTER SWELLING INTERVAL-MIN. PERIOD I E PER INCH p.1 1.67 none 30 3/4 5/8 5/8 48 P.2~ 1.67none 30 3/4 5/8 5/8 -48 P. 3 17.67- none 30 2 2 15 P- 1 r- PLOT PLAN: Sltow 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 .I land ope. , SYSTEM ELEVATION 100.43 ~ ~il o} I / 1 I 1 r: ' ~ i , k44- kv' ojln;fr { 5 ` r° ' !of 1 I I I Od j ) Z % 141 j f H i ( I I i I ( - `Q S ka A`3 3 ' 4 I I I i ) i 15 ~ " 'til REPT131 CYLON ST. CROIX COUNTY ZONING PAGE 1 07/29/92 10:32 REQUESTS FOR INSPECTION WORK SHEETS FOR: 7/29/92 AREA: TN ,Activity: A9200123 7/29/92 Type: MOUND Status: PENDING Constr: Address: CYLON 33.31.16.598,SW,SE,33 Parcel: 006-1089-80-000 Occ: Use: Description: 149277 Applicant: JOHNSON, JEFFREY Phone: Owner: JOHNSON, JEFFREY Phone: Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121 Inspection Request Information..... Requestor: WM. SCHUMAKER Phone: Req Time: 14:07 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION 1 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 BOB ULBRICHT Owner: JEFF JOHNSON HOMESITE SEPTIC PLUMBING 655 O'NEIL ROAD 1813 COUNTY ROAD "0" HUDSON WI 54016 NEW RICHMOND WI 04017 RE: Plan Number: S91-03118 Date Approved: December 3, 1991 Gallons Per Day: 450 Date Received: November 20, 1991 Project Name: JOHNSON, JEFF - RESIDENCE Location: SW,SE,33,31,16W Town of CYLON County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative cAe. This approval is for the following components only: - REPLACEMENT PETITION - REPLACEMENT MOUND I i i SBD 6928 iR.OIMU a ' SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations BOB ULBRICHT Page 2 Inquiries concerning this approval may be made by calling (608) 266-2889. r :9PAGL Section of Private Sewage Division of Safety and Buildings PPP013/0009n/ 3 cc: JEFF JOHNSON Private Sewage Consultant County UW-SSWMP Plumbing Consultant -Owner -Plumber -Environmental Health SRI) 6928 (R. o1MU 'peQ .08 2 i PROJECT INDEX SH iET OWNER: J-0I-t v 5,0,0 vc- '/S ` 2- V6 74/ S D ADDRESS : 1913 Cev-vT y i'D `U 4u 4,-1 o-*~o SITE LOCATION: Sw Sc/ 33 , T.3 t ti, 9 I y~o Ta~v-~ Sh`%~ ~1 PROJECT DESCRIPTION: T C~c'pi aC nova ry r~o~~,e y y rt A.) r,-. s t~ 7~eo yv . thk 4foEj je ~0~1 Er 4045 CO~t/~tJEC Tfl7 7-0 7',Q G-- I ea,U 0 e v7 /,OV f f'eoa'V D Sys TE'Ay 6y COLuu) y Zo o e:o _-D&: p T R t U f-,,t L 'Tl -rQ So ?.f ~U S t9 t` T~ (3 IE L F~v ~f alp v-vD S~/ S 7>?--4 , 74e o wti t-4 utiD c oD, 5 `Fa ~-~-e ~o.~, rY ao~; u ~PT". his `(o uti - .tieGr GU i~ I~~ Ti T is N `~D /Z, ~1oDl I'c~tT to.v %V Sys . /I pPP-ouA~ - ~rov.~v sysT~~ PAGE 1. PLOT PLAN VI-WS I S P-v 1 d S I PAGE 2. MOUND CROSS) SECTION u SYST' M PAN VI14""'IS~ PAGE 3• PIPE LATERAL LAYOUT 'e!' v`~` 4 r tt ll 2 ~e,~sLr y F ; PAGE 4. DOSING OR SIPHON CHAMBER CROSS S IQNS;T, PAGE 5. PUMP PERFORMANC SPECS OR SIPAT PLUMBER : Uj,. 5444 Ao-e4 SITE EVALUATER/ DESIGNER /gyp ~ 6-s ,1 Nr,MESITL z lEe riC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 DATE : ZZ7Zj ROBERT ULBRIGHT ! NIS. M' 7-A PLUMBER LIC. NO. 3307 M.P.R.S. SIGNATURE: `4,ft If, PESIGNCR LIC. NO. 00663 I QS~ AS-01 t)i 1 ~ CTS 1~1 V ' I t,yo, 1 1 r1 I I I I °<J N I , w r za ~ ~ ~ n C' 1 n• b ' pp w - t sa. 303 Y o _._N c fi. ~ r 3 C x c c Q C5 L a rn o -°r a I so ~ ~r, c o r c... Q a - c ~ ~ q "a ? cn 0 ~7 i i 5G EV4Ti'O,v S TJ p OF ]:~O c K /d SL z Of S Page - i Top OF y lh7t f?~L, , /D/ 3-2- Synthetic Covering Distribution Pipe Medium Sand s y rTeM H kaak" - ~ G CIEVATI oN ~ Topsoil = - F dap, 72 3 b ' UaiFo.e~'" 0 % Slope -ro,~;- LiNE Bed Of 2~+d 1 Force Main Plowed ccl vA7-00 Aggregate Layer J~ 72- 9~• ~a D .z. 0 Ft. Section Of A Mound System Using E -7L, i Ft. . 0'O I ry~,rc r~ A Bed For The Absorption Area F Ft. G C2 Ft. • e ' ~ J .R'a s r ~yS A (o Ft. H Ft. A, B SS Ft. II K~ Ft. - i Y L Ft. - ~o•~a' p y `C; 1 2- Ft. Ft. S W 3. Ft. 77- Observation Pipe i~- Distribution Bed Of 2 Pi pe Aggregate Observation Pipe Permanent Markers y " PdG GrJ~p~D s ~E~L ,poo5 • ! Plan View Of Mound Using A Bed For The Absorption Area I~ i I' i Page -3 0 f ~'uc FoRc~ voio Uolumc 30 2- Perforated Pipe Detoil ZV kl'Gti r ke VAI VME VAr U 4 i I'VAZ 0 End View t s` r Pertoroled End Cap?, PVC Pipe Holes Located On Bottom, Are Equally Spaced R P PVC Manifold Pipe Distribution Isr Pipe Hole Should 8a 1! Next To End n \C is ' MgN~fo►D 3 o C71 Distribution Pipe Layout P Ft. R 3.o FoPC~' ~r'I.41;V x Inches f'UG 6, °F L Y ~ Inches Hole Diameter _ Inch Signed: Lateral " ~~Inch(es) it License Number: Manifold " Z Inches Force Main 2 Inches Date: # of' holes/pipe y Invert Elevation of Laterals/O/'2- Ft. • DC'ST'RIBU7'10A) P1,54~Aeee k197-~ 6-1161L /47-ER/I 38 ~~/natc.w ' 7 7. . /f T R i 13 U T/o,) D I'S oti. AR GE 3 74; SYSTEM a s 7 1, ' 9~,T10NS Lip, , g E co 1-, PUMP CHAMBER CROSS SECTION AIJD SPECIFICATIONS Pf} E OF S - VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOGKIAIG JUNCTION BOX MANHOLE COVER 25' FROM DOOR, (v,4jeuGo(!IA13EI WINDOW OR FRESH 12 MIU. AIR INTAKE GRADE I Y° MIIJ. q1, I I6" Mlu. q, CONDUIT 3. 0 11~ - PROVID 9~D.d - AI RT GHTESEAL I I I - LILET i~E I 1 i APPROVED JOINTS APPROVED JOIIJ7 A W/C.I. PIPE ALARM EXTENDING 3' 1J/C.I. PIPE EXTENDING 3~ ~0 ONTO SOLID SOIL ONTO SOLID SOIL B 10 I I c 1~ ELEV. FT. 1 PUMP _-J IQ ~ ~ OFF B~ocK K UPPI A) 6- ,(AP pgRISER EXIT PE.RMI-I ED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECI FICATIOUS SEPTIC f F TANKS MANUFACTURER: M~ow~S/ ,O~E~/1✓ LIUMBER OF DOSES: PER DAB TAWK SIZE: GALLOIJS DOSE VOLUME. ~~Jf" INCLUDING BACKFLOW: GALLONS ALARM MANUFACTURER: /i S MODEL IJUMBER: 'D' L' V CAPACITIES: A= /I INCHES OR GALLONS SWITCH TYPE: T B = 2 INCHES OR X38 GALLONS PUMP MANUFACTURER: ZOEIIE/~ CINCHES OR 1!/.(_5 GALLONS 3a.loa D= INCHES OR 11 GALLONS MODEL NUMBER: 97 I/2 11P 1151) SWITCH TYPE: Q~ ~((3ACKED NOTE: PUMP AND ALARM ARE TO BE qm- GPM INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE S VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..7 FEET AA9k p,ECS i 2.5 FEET EAGL1., ~ o{" + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . n 00 loo FtFRlCT1oIJ FACTOR.. ' FEET +FEET OF FORCE MAIN X F/ ~UrIS b TOTAL DYNAMIC. HEAD = ~a FEET J fol INTERNAL DIMEMSIONS OF TANK: LEAIGTH ;WIDTH LIQUID DEPTH I ~ r lye .,r 4' . ' , ~ to H HEADI LL 115 ~ 34 ~r ~~1 A CITY 32 110 105 CURVE 30 100 85 26 90 26 85 I I EFFLUENT 24 80 MODEL and a 75 MODEL 189 DEWATERING = 22 70 165 V 20 65- - a } 16 60 55 _ 16 MODEL 50 163 O MODEL 14 45 188 12 __40- 35- 10 MODEL 30 137, 139 MODEL 185 SEWAGE and 6 25 DEWATERING 6 20 MODEL 15 MODEL _ 161 4 7 . 4N V\ 10 - Q 2 MODEL W W , 5 53, 55, - - LL 57,59 0 GALLONS 10 20 30 40 50 60 70 80 90 100 110 24 LITERS 0 80 160 240 320 400 75 22 FLOW PER MINUTE 70 j 20 16 60- - MODEL - - - Ir _ Q 295 - S = 18 55 - - - -'CJr1 50 zy Z 14 45 I -MODEL - - 40_ - 294 12 T t - 35 - Q - - - 293 ~ 10 O 30 MODEL I 284 e 25 MODEL - B 282 20 - l 4 15 10 MODEL 2 6 267,268 l 0 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 15P 160 170 160 190 P.O. BOX 16347 Louisville, Kentucky 40216 LITERS 0 60 160 240 320 400 480 560 640 720 (502) 776-273 FLOW PER MINUTE r "97" Vast Iron Series I HEAD CAPACITY ~ UNITS/MIN Fact Meters Gal Aulornalic or Nun-Automatic. . Ltrs. • 5 1.52 57 :16 • t. H.P., 1 Ph., 115V or'23OV. 10 3.05 51 193 + Non-clogging vortex impeller design. 15 4.57 43 163 ~ Passes "K•"-s sphere). zo 6.10 27 104 • 1 V.," NPT discharge. Lock valve: 24.5 • HQat operated submersible (Nema 6) mech- anical switch 97 Series • Automatic reset thermal overload protection. listed sc-2225 grrtu • Stainless steel screws, guard, handle and arm and seal assembly. • Watertight neoprene "1 I ring between motor and Cwwdwj. Standards Assoc Approval pump housing. CID aumlable N9%, non-automatic, dvadabld packagud with it piggyback mercury (lout switch. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations December 4, 1991 JEFFREY R JOHNSON 1813 CTY ROAD 0 NEW RICHMOND WI 54017 Plan I.D. No. S91-03118-P Dear Mr. Johnson: Re: Jeffrey R. Johnson - Residence Private Sewage System SW,SE,33,31,16W Town of Cylon, St. Croix County, WI Your petition for a variance to section ILHR 83.23 (1)(d), Wisconsin Administrative Code, has been reviewed. The rule being petitioned requires a mound system site to have a minimum of 24 inches of suitable natural soil. The variance requested was to install a replacement mound system on a site with 13 inches of suitable natural soil. The following comments were made in the petition analysis: 1. In reviewing the petition, it was noted that the request was similar to other petitions accepted by this department under petition numbers S89-03304, S89-03318, and S90-00072. 2. Based on the precedent established by the previous petitions, this petition for variance is being processed as permitted by Wisconsin Statute Section 101.02 (6)(g). Departmental Action: Approval. SRD 6928 (R. 0 1/81 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations JEFFREY R JOHNSON Page 2 December 4, 1991 This approval is granted with the understanding that all of the petitioner's statements and any conditions of approval cited above will be carried out. Prepared by: Peter E. Pata Departmental Signature: Date: eyer, rc Director, Office of Division Cod s and Application PEP:486:wpp4 Enc. cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Robert Ulbrich t, Plumber Soo 6928 iR. OIMI ST. CROIX COUNTY WISCONSIN ZONING OFFICE ' a - ST. CROIX COUNTY COURTHOUSE f7" 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Oct. 29, 1991 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 Douglas Johnson property, located in the SW 1/4 of the SE 1/4 of Sec. 33, T31N-R16W, Town of Cylon, St. Croix County. This onsite revealed suitable soils for a replacement mound with 13" to seasonally saturated soil while meeting the A+4" rule. This site will require 23" of sand fill beneath the mound. Should you have any questions, please feel free to contact this office. ncerel , f ames K. Thompson Assistant Zoning Administrator cj i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: SW 1/4 SE V4 33 /T31 N/R161(or) W C lon n/a n/a Ouse #1813 COUNTY: RNMDEILWUYER'S NAME: MAILING ADDRESS: St. Croix Jeff Johnson 870 11th. AVe., Baldwin, Wi. 54002 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DE RIPTIONS: PE OLATION TESTS: ~esidence 2-3 n/a ❑ New 5&eplace 11-29-90 n/a RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S ®U ❑ S QU ❑ S S ~U EJS ❑U undetermined at this time If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 22 BPA BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHIM ELEVATION OBSERVED EST. 1GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B_ 1 6.25 99.48 none 1.08 1.08b1.1. 1.67bn.mot. sil. 3.50bn. mot. l.s. B- B- B- B- -1 _T B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scal or i Descri& what are t i- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at ~ riff fii}e dirC,3jpn and t of land slope. /4v+~ SYSTEM ELEVATION n/a a , d E 4-- st } ern=~ _ - _3 E 4E N r i ~ E r E 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 11-29-90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. AVe., New Richmond, Wi. 54017 2298 71A-246-6200 7/7 CST SIG E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ( DILHR-SBD-6395 (R. 10/83) -OVER - Il V R, `-7r JCTION FOR CCU` ETIN " % " 5 - HD - 61395 To be a comp :e. ~e soil tesr, vot.u ort rn 1- complete legal clescril , n; hr"s is "s " re," . c.omralerr.;ial project; , r t is . - rnu t clearly indicate 2. The use section s 3. MAXIMUM nurnb' t,Aroorrrs orcrsm 'cial use plarrnec'; 4. Is this a new or rr . " , ; systeila; 5. Complete tile s --ing boxes. A SITE. IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEP RULED Cif 3ASED ON SOIL CONDITIONS; 6. PLEASE use the abbr _ Lions shi~ ,r - for vo'iting profiles des( ptions and completing the plot plan; 7. MAKE A LEGIBLE fram accu locating your test Drawing to scale is preferred. A separate sheet ma i if : ` S. Make sure your bent, rk and', r o ) reference point & e clearly shown, and are permanent; 9. Complete all app ""<s4e boxes as to da names, addresses, flood plain data, percolation test exemp- tion, if ap •ca ~ 10, If tine info flood pla` ,n) doo- -n place NI A. in the appropriate box; 11. Sign the f< - -:cur current a._. your, r °.(-ion raurn' r; 12. make lecg" ~ and distribute as r(A7-L ' )IL TESTS ;T BE FILED WITH THE LOCAL A'" Y WITHIN 30 BAYS C OMPLETiON. A REVIAT:~, .OR CERTIFIED SOIL TESTERS Soil Separates and Textures C t~=ols ss, (over 10") 8l~ col - 10") SS qr i (under 3„) LS L r.=~ HGatr If ~"3€er ,c1 Perc F se v' - Wdcl > l .ra is 1 S", a ~3 spa - Loarn sic! L ;im mot 3ttles - s4 Y1 [t i sic- Silty Cr". - few, fine, fain' c - Clay - comnao co; pt Peat Many, rr rn Muck - distinct p pron13n I1 High Sixgeraa i ext,i rl Bench IV ZL` Ver-tic.2 f? FC3i'lt ,x r 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 sulamitted 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. l DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS 5 P.O. BOX 7969 ' HUMAN RELATIONS (115 MADISON, WI 53707 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: t~~/ SECTION: TOWNSHIP/ O touse UBDIVISION NAME: SW SE J4 33 /T 31 N/F116Lgor) w C lon n/a n/a #1813 COUNTY: UYER'S NAME: MAILING ADDRESS: St. Croix Jeff Johnson 1870 11th. AVe., Baldwin, Wi. 54002 USE DATES OBSERVATIONS MADE NO.BEDRMS: CO M R A DESCRIPTION: O IO TESTS: ~iResidence 2-3 n/a FNew ~Eteplace I 11-29-90 n/a RATING: S= Site suitable for system U= Site unsuitable for system O"J`✓ S 6]AL: MOUfvD' IN-GROUNESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) lT~.. 1U ❑ $ QU ❑ S ®U I ❑ S ~c U] ❑U undetermined at this time [under Percolation Tests are NOT required DESIGN RATE: i If any portion of the tested area is in the s. ILHR 83.09(5) (b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 22 BPA BORING TOTAL P H T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS ELEVATION BSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 6.25 99.48 none 1.08 1.08bl.1. 1.67bn.mot. sit. 3.50bn. mot. l.s. B- B- B- B- B- PERCOLATION TESTS FTF~1331' DEPTH WATER IN HOTEST TIME DRO IN WATER L V L- NCHES RATE MINUTES ER INCHES AFTERSWELLING INTERVAL-MIN. p 1 i P I PER INCH P- - r 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 n/a t ; i 1~ K515~~-t 5 I I ; i i rS~ /.60 i I -I I l i I 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 the location of the tests are correct to the best of my knowledge and belief. NAME print : ' TESTS WERE COMPLETED ON: Gary L. Steel 11-29-90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. AVe., New Richmond, Wi. 54017 7 -246-6200 CDISTRIBUTION: Original and one copy to ..ccal Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R, 10/83) - OVER - c ° C) I -a ° to O o h r p 060). p M a) 112 c N 0. O O tl n :O a c I o c' o mN~ c~ y c 0' N 160 cn Ew o (0 a~•oo o. a a~ co UL O.0 a). N o UE w o-a'acc ° no C a 0 0ZL0 c E C4 f0'E num a d o ~mLo0E) ~o -022 o y x o o a~ °L p C ( 0 U- ~p O y O w O' N m O a - w 0 - c N ' N O ' O'OY g ! N Mw aw O> ~ m co S 4) N N V7 V7 O .4J to C: T " a pfn mc0C O O a7 O U _j p H O c Z 3 a`" c Z c~- co o'o E a~ o 30 7 3 N (6 O w= m i. LL C E C w _ N C U. C O d ) N~E o i a) N _ O O O O - > n Cl -le U) 0 m = a> o o ~g EM_ a 0 E d c U) E d d co EA o a Q O M O N C C 0 0 Z d m d m co I o Z `i c LX ! =3 d Z ~ ~ ~ I C I fA F- r- m CD I W E E a) N N N O n 7 c0 0 a) ! ~p O N O_ 't a CD co • o a> 'n o 0 0 0 8 L V L t5i 0 N N O N N CL -0 ~CJ Z co z c Z Z 0 Z O O E E n c I ~ c m I LO w 3 H o a 'Y o a .M Y ?~i N N H 1A a~ m (D Y `l 0 c o G a` m -o o o a` E 1~ _ o] t) t) N o !01 fn U) >M 33~ CL ~f-t- dcn 3 3 3 • 3 a a a o a as i U a z ~y m p N Cl U) 0 U) N J V 0) 0) a) 4) 1 CO rn rn ca 7- 7- 1 M Vn F~V 0 0 a N a) 00 00 0 0 E O O p r- N M N - U N N 0 co CO M a J) (A N N ..3 w N `F~i U c d} i C m d} n ea 'a H c v~~i c Q Al R o0 o m o o c c E LO co co Q o c o 1) ~ c a) a) ow cn u CL :3 0) m 0 0 rn o 0 c N N M o 3! D o a 0. o c m CD o n CD c o o r_ 0 N 00 O V Z L L N ,6 .1 c pM M I~ M O O N • ?a O M c UI -Oi h = H -07 O w fn O ~ = w v~ a a a L: a r a w r`I~1 £ 0 'o I c a m c t A 0 a ~ i', O in 15 c ~ 0 v) cU t :iajuaj uStsaa uvl!lodoriaN fo uotssttu tad ayI gltM pasl2 •vjosauugy fo djtstaituf I aril fo slua8ay © ologd •sasn puui ivijuapisoi puu jupisnput womgaq jotguoo asn pu*ei jptjuajod :wouog -4lgNrauj.'vd sgv7 uotsuajx9Alf2 `tlldOX j tagod fo rLsajinoa ojorTd as nq putiatoys uploni /qunoD upiaup ut auzog duo .10 tAk :13 3D :tajuaD u.~tsaQ uvltjodotjaN fo uotssttutad atll tllpt pasf2 •vjosauu!N fo djtsiaazun atlj fo slua2ad Oa ologd •Outsnoq juaovfpn puu itd pAtB ua3nn43q jotguoo asn put'i pljuajod :doj, :soloed .tanoD sj cagoH naaagaH pue uivyxavW uug-l 9002 uoMpH PuZ siuadd,V pue juaugsnfpV jo sp isog 2uiuoZ uisuoasiA iol 3I009QNVH (MVOft ONIKOZ r AS BUILT SANITARY SYSTEM REPORT SEC.33 T.?IN-R6W g OWNER TOWNSHIP d ~~1 ~ t Y~ ~ 1? ADDRESS ST. CROIX C UNTY, WISCONSIN. SUBDIVIS N ( 7. G LOT 3 ?10'C1k"q LOT SIZE PLAN VIEW 006 16J9,-36 Distances and dimensions to meet requirements of H63 ~.S93 ) qj4QW EVERYTHING WITH N 100 PEET OF SYSTEM 4 4- 's A, ~W i f c~v I di a e o th Arrow SC L : BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point:-41-00- e_u o e at site SEPTIC TANK: Manufacturer: toee k S Liquid Capacity: ),000 _ Number of rings on-cover Tan manhole cover elevation: d° Tank Inlet Elevation ?,F" Tank Outlet Elevation: koly PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size o pump head; gallon per minute horsepower, bran name of pump and model number Type of warning evice HOLDING TANK: Manufacturer Number of gallons Elevation of manhole-cover Type of warning device SEEPAGE PIT SIZE: um er o pits feet diameter feet liquid dept seepage it in et pipe-elevation bottom of seepage pit elevation -feet. I /I SEEPAGE BED SIZE; number of lines Tilt length5,7 tile dept0y SEEPAGE TRENCH: width lengt h ' PERCOLATION RATE 0</v AREA REQUIRED A AS BUILT >y INSPECTOR DATED ST f , F PLUMBER ON JOB LICENSE NUMBER 3d3j l REPORT OF INSPECTJON - INDIVIDUAL SLWAGE SVSTLM Sun< taAl1 VvArn-(.t S.ta.te. Septic St. LIL4)4X l,,uYlit.l Se,cxia►2Lu t N Subdi Vie4 on tNf yak xu na Nurnb e.A o6 c o rnpa L tmen-ta (~~lum: wett- 8u.ikdinq 12e .6tope Highwa,teA 1'I(AM6ER _caYCona.. Pump Manu6aexuaeA MudeP Numbest 1 ANK ga.E~on4 NumbeA o6 Compan.tmevr-ta. AEatim Sya te.m we Pk bu-ixd-i.ny_ I Z$ akupe_-- - N~yhwaten.i_ • A NI11. Tnen(ih r u, : W e f k B u d e n y- 12% a t o p e-_--_ z. II4 ghwa.ty 11 I11 DIMENSIONS '"z l; tAevlch- , At Re(iuA'Avt/ ate s t 11 vach, 14,n C) 1 6t Deplh uA Aoch be i)w tife 411. vre.a Uv.pth u6 Aoeh oveit tifv 2 4111 rcki,1th u6 Zinea. 6-t Depth o6 -ti e bvIuw yAadv 4111 he twee n 14'.n.ea__ _.6t SXo1jv u6 xAeneh____ <n. IIe'l 100 At r I l,n I,Ap te.un aAeu 6t Tgpv X10 Coven: c,A I 11,4w li .ta GtiavvP a4ound pi.ta yva 111 ,i(~ ,trr,ittp t U('Crth bv•PUW -ivrYet I I • i' !1 I 1 ( 1 i YI ! h (1 6-t • it II 1 !1 l' (I ~ (~d. ~ TI TI E "'o DAH 19 b UAT1 1Nb 1"1 11 I' -I 1014 C, Z r PLB 67 State and County State Permit Permit Application County Permit # Pee to, # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: Dawn, s~ ~ "Ile 01% B. L CATIO '/a '/e, Section, T 14 N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township W-a C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 600 Total gallons No. of tanks 'IF HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTE Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Li eal Ft. Width Depth Tile depth (top►_No. of Tryhes - f Tile depth (top) sQR No. of Lines S Seepage Bed: Length 3 Width Dept Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land I % Distance from critical slope 4eME WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, 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 Ce ' ' d Soil Tester, U OfJ and other information NAME ton h C.S.T. # S~r-Op obtained from d r (owner/builder). 72 Plumber's Signature MP/MPRSW# Phone #90!r ~16~ Plumber's Address 1 .1 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E 3 r I ~n i E Do Not Write in Space Below FOR COUNTY AND STAT DEPARTMENT U E ONE G Date of Application 6/ Fees Paid: State c~v County . ate c~ a Permit Issued/Rejected (date) "7- 3 O-fz Issuing Agent Nam Inspection Yes No State 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 7/1/78 - J DEPARTM€NT OF REPORT. ON SOIL BORINGS AND SAFETY & BUILDINGS dNDU6~RY', DIVISION 7969 LAWR,AND PERCOLATION TESTS (115) P.O. MADISON, HUMAN RELATIONS \ / WI 53707 3707 LOCATION: SECTION: TOWNSHIP/MjJ~I IPALITY: OT O.:BLK. NO.: SUBDIVISION NAME: SW'14 6 33 /T3JN/R/AE(o Jhh COUNT : w R'S/BUYEPAS BUYE A E: AILING DDR SS: ` .1 i r S' a Sf. r::~,In r U4 4- USE DATES OBS VATIONS MADE NO. BED : COMMERCIAL DESCRIPTION: Residence ❑NewJieplace TUA (7 F5 Id RATING: S= Site suitable for system U= Site unsuitable for system So I"/ See CONVENTION IN-GROUND.PRESSURE: SYSTEM-IN-FILLHOLDIING TANK: RECOMMENDED SYST M:(optional) U ❑ S ❑ ❑U F-1 S ❑U ❑ S ❑U 11-1 If Percolation Tests are NOT required DESIGN RA T If any portion of the lot is in the under s.H63.09(5)(b), indicate: ilia .4 Co / I Floodplain, indicate Floodplain elevation: ~-~SS aS' . $C~ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUP. WATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- V7. r+~l5 t I6 ,~A s , rr p S.~ ~o B- ©o E, W6.7 qyr~ if, B- ~L~" f bp'' "1~1s i /a'~3hs i 1 ~8" ,S.d~ I~'. B- B-., PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE UTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P P I CH P_ 3~ t S t P- 2 3.7'1 T + rt P- 3 to C P-. v; P_ PLAN VIEW: 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 slop. SYSTEM ELEVATION /ft 1 i - } s ( _ t i 7 'lu tV~ P e I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: a a 4" lxtx 1 ADDRESS: f/ ;I d CERTIFICATI N NUMB R: PHONE NUMBER optional): io© 1J ~a e e~~ IJ~S 5~~ d CST ATURE:~ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHRSBD-6395 (N. 03/81) x P. i ~ w 'y v ~ S_ . . i . . ~ r- t t i ...y: L' +.i ~.4t*: l :.a $ _ ~ t ~ i ~ 7' ~..~C. II i ~I 1 ,i 1 . 1 r /it . : v o pr ~s e ~t _ _ _ _ - _ - - - i . _ _ _ _ . _ i _ . rl- _ ~ j f- I _ _ _ i A_..__ _ . _ _ . _ _ . . _ _ ' _ f t' ~I - _ _ . _ - - _ . i _ _ i . II ii _ I i - _ ~j ii _ _ _ _ ,t. j•: F i_ Wisconsin Department of Industry, Labor & Human Relations P# ` - INSPECTION REPORT Safety & Buildings Division Bureau of Plumbing, Plattin & Fire Protection 'D.7 j .Name o remises Dare an No. g-f Str et i y oun y sanitary erm SUJ f T 6 /lo/5S as r m er it ame ress WAN* ` U,E4L.t, Gtl~ oPlumber Address r owner Address u J~ ~Sa C u)j w li3 j J1.`r V IV ,A 10 Ed f " `a iscusse w1 gnattr ( )See Attached. DILHR-SBD-6192(N.09/80) Signature o Dist. um l up pec is White-Inspector Yellow-Local Inspector Pink-Plumber or Responsib Party; Green net E a r-q E 40, T 2) . •