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HomeMy WebLinkAbout026-1115-10-000 S -0 o m~ ° s o p e» o c. 0 o ry N X N CS ~ U C N :n O ~ Y 7 i LL C (6 O 6> "a O Q ° 3 co ~ ~ z w co Z 0 L Z y y M w a Co U) c o a 0 2 v c d Z c N N a c N q~ CL a N d _ (6 N C N O o Z F Z Z O N C E N 4) N ~t r J d v 0. L cu o Lo 'c a a a a U O O O •wy o a a a E w~ ® C ^Y r U N N N !A J C) 3 T (D M U7 M\) Z p 77 O O O E r Q ° ° N IL m ) N +U. r W a Q co `Ftii it m ~ D Zt 6 ° 3 w O M VJ U) O C N C E L, (0 00 O C6 ° O 6 O O r N O "6 LJJ 0 (n (n _ O C 07 _0 _ M r~ E N o 'IT 0 E E N~ I~ W Z3 S- N U N cn O O U ® i r :ii r Y E at c a a CL 0 0) 0 AS BUILT SANITARY SYSTEM REPORT OWNER 6' C V I TOWNSHIP i C~ 'l I"n=(7 r1 SECTION_L-T 3 U N-R W ADDRESS %A_'~~ 0 ST. CROIX COUNTY, WISCONSIN SUBDIVISION Z/0/r~lr~GC' e,, LOT LOT SIZE07,V .3.~3 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 I r INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer:_I I) c6 cF_. Liquid Cap. 1 600 i . Rings used:' Manhole cover elev:Final grade elev: 'L Tank inlet elev.:, 4g Tank outlet elev.: `f No. of feet from nearest road:Front\, Side , Rear Ft. I From nearest prop. line:Front , Side , Rear K Ft. No. of feet from: Well fv , Building: I i (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liqui apacity: Pump Model: Pum Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.• Switch Type: Location Distan from nearest prop. line: Front_, Side_, Rear-Ft. istance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Z Area Built Z-L O Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front Side , Rear_,V-Ft._Zf No. feet from well: No. feet from building 3C~ HOLDING TANK Manufacturer: Capacity: No. of rings used: ,Ri/evation of bottom tank: Elevation of inlet: No. feet from ne est prop. line:Front Side Rear Ft. No. feet fro Well building , nearest road Alarm nufacturer: INSPECTOR: DATE:. PLUMBER ON JOB y' LICENSE NUMB lZ~iey' 6/90:cj ~ Q 2~ 'Ak 4 01.30.18 pRIVi~T S~ A'GF?tSTEMGG. , LOT County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 171449 Permit Holder's Name: ❑ City ❑ Village)[R Town of: State Plan ID No.: NELSON, ERfIN C & H EN F RICHMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 026-1115- 0-00 TANK INFORMATION ELEVATION DATA A9200214 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6.e zv(,v /,o v~ Benchmark 105W -S ya /Os Y Dosing Aeration Bldg. Sewer Holding St/Ht Inlet 6,72 9 TANK SETBACK INFORMATION St/ Ht Outlet 9) Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Ar 7 Septic IVI/ NA Dt Bottom Dosing NA Header / Man. 7-97 Aeration NA Dist. Pipe 8.7t G, $ Holding Bot. System g,~ S 9'~i•/S PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 60 ✓61 Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM z d 25--, BED/TRENCH Width Length No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S S DIMENSIONS LEACHING Manufa , urer SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O / n .rfi` 3 0 - CHAMBER M N er: System: OR LINT 1~ LtX 6~/J DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) ole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spa g SOIL COVER x Pressure Syste O xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes No ❑ Yes E3 No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. g~ e? If SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY f=„e St. Croix NNW" STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 7~ ~ 8% x 11 inches in size. ❑ Ch,1Kif r~isio pre ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Ervin C. Nelson SE y4 iAJ y4, S 1 T30 N, R 18 f(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1436 176th. Ave. 11 n/a CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER New Richmond, Wi. 154017 715 246-2454 Willow River Meadows II. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ CITTLYi4GE NEAREST ROAD Richmond Co . Rd . #GG ❑ Public ®1 or 2 Fam. Dwelling4of bedrooms 3 10 NO . PARCEL Ax NUMBER(S) 6_ S 16-67 d d III. BUILDING USE: (If building type is public, check all that apply) 0130 18 663 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. IK New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) __0 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 450 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 585 CP m O 7 <3 96.14 Feet 99.64 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank x 1000 1 sleeks C. P . Lift Pump Tank/Si hon Chamber n a VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install 'on of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's ature: (No Sta )PRSW No.: Business Phone Number: Gary L. Steel ?/M 3254 715 246-6200 Plumber's Address (Street, City, State, Zip C e): 1554 200th. Ave. New Ric , nd, TATi. 54017 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Age Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sahitarq 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. It. 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 rr?a:iufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; `replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross gection 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) • v APPLICATION FOR SANITARY PERMIT S T C - 100 r This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~,lLIP11C~ G .eZSON Location of Property fir„ Section T 30 N - R W Township lei C."A4 O"D _ Mailing Address `7 b 7 ' AVE Subdivision Name /i-Uouj P-1 (0ti2 /U+----AO OW1 Lot Number l / Previous Owner of Property &..//I-LOQJ Zvez jol"- y F!"PLIP Total Size of Parcel cl~ Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number 5/(0 as recorded with the Register of Deeds F WITH THIS APPLICATION ONE OF THE FOLLOWING: Warranty D 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the. Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - V- - - PROPERTly OWNER CERTIFICATION I (We) ee.htc.{y that a.P,P /sta.-temen.tA oft thus Bohm alt.e thue to the best oA my (oust) knowtedge; that I (we) am (one) the owneh(s) o{y the pn-opetty deg cAibe.d in '.this in(jonmatton 4o)tm, by v.vttue o{ a waioanty deed AeeoAded in the. Mice o6 the County Regi-Afeh o4 Dee4 a6 Doctimen.t No. _ 04^7-7 and that I (we.) ph.uentty own the. ph.opo6ed Aite ~oli, the. he.wage i6posa -5yAte.m (ox I (we) have obtained an e.a6e.me.nt, to hu.rt w.~th the, above. deAwibe.d phopeAty, Holt the conAtAtuctton oh bai,d Gyhte.m, and the Acvne haA be.en~u.P.y ne.con.de.d in .the. 064 ce o{ .the. County Re.giAtek oA Deeds, az Document No. 700"7 LLctt~_ SIGNATURE OF OWNER SIGNAT'URF OF CO-0 F.R (IF APPLICA13LF) 9 DATE SIGNED DATI? SIGNED MM9 THIS SPACE RESERVED FOR RECORDING DATA ISoCUMENT No. WARRANTY DEED I~ STATE BAR OF WISCONSIN FORM 2 - 1'32 470077 REGISTER'S OFFICE VOL ST. CROIX co., wi Rec'd for Record ! Willow River Joint Venture? a Wisconsin l - - - - - - - - JUN 0 1991 partnership - - 01 8:30 A. M - - - - - - Re9 er of i cony Ervin C. rr Nelson and- Helen.- P,_ Nelson - - - - - Deeds I husband and wife-as._ survivorship marital property,__._ I, - I~ i - - . _ RETUR ErVjnT0 - and Helen - - - - - - - - - - - . 1 P P. Nelsoill 1 j 0 rospect Drive -------.11 . prospect Heights, IL 60070 the following described real estate in St Croix County, - State of Wisconsin: Tax Parcel No- I! i I I I I I. ii ii Lot 11 Willow River Meadows Plat in the Township of Richmond, St. Croix County, Wisconsin. ! i' ii I. I ! TMNSM i ~_ys~ dog: li i I This is not........... homestead property. (is) (is not) I Exception to warranties: municipal and zoning ordinances, easements, covenants and restrictions of record. it I Dated this 3rd------------------------------ day of - June 19._91.... I I WI W Ij~I R JOIN ENTUR (SEAL) -(SEAL) I I Ron L. D - - - - i - is ----------_.-(SEAL) * - - Michael RR.- - -'Stevens AUTHENTICATION ACKNOWLEDGMENT i! I i Signature(s) STATE OF WISCONSIN ss. ___St.__ Croix _ _ ----County. authenticated this ________day of___________________________ 19______ Personally came before me this ____3rd day of - - -June-------------------- 19__91__ the above named Michael R. Stevens and Ronald L. l Derrick partners of Willow River TITLE: MEMBER STATE BAR OF WISCONSIN Joint Venture, a Wisconsin partnership ~I (If not- s - aut orized by § 706.06, Wis. StatsJ - - - ~i to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - 1 MERIDA CHRI$fD,"MIN li ----if------ Nq- P!#i(; Willow River Joint _ Venture W1aib I * Merida Christensen 1505 Iii hwa.... 5 New_Ri..mond-, WI 54017 Notar - y Public _.__:--St.---Croix ---------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission 1s permanent. (If not, state expiration are not necessary.) November 20 94 date- P 19--------•) *Names of persons signing in any capacity should be typed or printed below their signatures. I WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Illank Co. Inr. FORM N2 P. 1982 wi., SEPTIC "AMK MAtVTEMAWCE AGREEMENT Sr.. Croix Cuuncv OWNER /BUYER lEK-V MA C . N E~-SO 1.4 ROUTE/BOX NUMBER fdm.,lo 17(a Fire Number lg3(0 CITY/STATE M.7~t je/c44mOg© 4U-T- ZIP Svc/7 P^OPERTY LOCATION: SE 'Z, /V--J Section ~ , 7 30 N, R/ 9 W, Town of 1St. Croix County, Subdivis ion ZA//"W 411t M- Lot number o0wS Improper use 9nd 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 licensed seocic tank pumper. What you put into the system can affect the funcciun 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 607 of the cost of replacement of a failing system, which was in operaci.on prior to July 1, 1978. St. Croix Cuuncv accepted this program in August of 1980, with the requi.reme•nc that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit co 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 co 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 sec by the Wisconsin Depart- ment of Natural Resources. Certification form muse be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration data. GATE St. Croix County ':oni.ng office P.O. 3-ox 2'_7 Hammond. '.JI 54015 i CS-795-__3'~ Si..n. lar.- rnnct ~n :1hl,ve address. REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DEPARTMENT-OF DIVISION INDUSTRY, P.O. BOX 7969 LABQR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS OLHR 83.09(1) & Chapter 145) LOCATION:II''~~ SECTION: TOWNSHIPTY: OT NO.: BLK. NO.: SUBDIVISION NAME: ,SE 1 ~U/' 1 /j 30 N/R18tor► W Richmond 11 n/a Willow River Meadows 1 1K COUNTY: OWNER'S SAME: MAILING ADDRESS: St. Croix Derrick Construction 1505 Hy. #65, New Richmond, Will 54017 DATES OBSERVATIONS MADE USE R FI R I N: R A TESTS: NO. BEDRMS.: COMMER IAL OES RIPTION: Mlew ❑Replace Residence 3 n/a 5-8-91 5-8-91 RATING: S= Site suitable for system U= Site unsuitable for system N1:11i 1:: 1 YSQTEM-INFILL OLDINGHu RECOMMEND ~ conventional EM:loptionall ONVENTIONAL: MOUND: IN-GROU DD Cf S H S ir SS `c` J UU SS UU DESIGN RATE: If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: n /a Funder Ts. tion Tests are NOT required LHR 83.09(5)(b), indicate: n/a PROFILE DESCRIPTIONS page 28 ShA BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. I HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.42 99.86 none >7.42 .75bl.1. 1.17bn.sil. .75bn.s.1. 4.75bn.c.s.&gr B-2 6.91 99.81 none >6.91 .83bl.1. 1.17bn.sil. .58bn.s.1. 4.33bn.c-s- B- 3 7.00 99.64 none >7.00 .83bl.1. 1.50bn.sil. .42bn.s.1. 4.25bn.c.s. B 4 7.26 99.91 none >7.26 .92bl.1. .92bn.sil. .67bn.s.l. 4.75bn.c.s. B-5 7.08 99.11 none >7.08 .92bl.1. .83bn.sil. .50bn.s.1. 4.83 bn.c.s. B- PERCOLATION TESTS --E-ST DEPTH DROP IN WATER LEVEL-INCHES RATE MINUTES WATER INHOLE TESTTIME I D NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERT D PERINCH <3 P_ 3.72 none 6 < P_ 2 3.67 none 3 6 6 3 6 -6 <3 P- 3 3.50 none 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 0,4' t 96.14 40 L OIL ADO _ t....~ ~.~r wo~ 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. TESTS WERE COMPLETED ON: NAME (print): 5_8_91 Gary L. Steel ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 2288 715-246-6200 1554 200th. Ave., New Richmond, Wi. 54017 CST SIGNA E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - OVER - nu WE sRn.fi395 (R. 10/83) STEEL'S SOIL SERVICE Gary L. Steel 988 N. Shore Drive C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 eY Ervin C. Nelson ~k SE4NWu S1-T30N-R18W Richmond, township k 4i A40 < < to m~ LO 4- c 100, S~ Yn S A.U QE~cc~Nm~s ~ _ a~ 02 83.10 11 soot 0 ~Jr ~q( ~ a7ay A-10 4E Gary L. Steel 6-4-92 REPT131 RICHMOND ST. CROIX COUNTY ZONING PAGE 1 09/15/92 14`:47 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/16/92 AREA: TN Activity: A9200214 9/16/92 Type: CONVSEPT Status: PENDING Constr: Address: RICHMOND 01.30.18.663, SE,NW, CO. RD GG., LOT 11 Parcel: 026-1115-10-000 Occ: Use: Description: 171449 Applicant: NELSON, ERVIN C & HELEN P Phone: Owner: NELSON, ERVIN C & HELEN P Phone: Contractor: GARY STEEL Phone: 246-6200 Inspection Request Information..... Requestor: STEEL, GARY Phone: Req Time: 15:09 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION rr ~ ~ .41 7 0 oil nn v1 ~ G'~ 9G.IS S DEPARTMENT OF AND SAFETY & BUILDING INDOS S INDUSTRYY, , REPORT ON SOIL BORINGS DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP TY: LOT NO.: BLK. NO.: SUBDIVISION NAME: .SC ~4 A) 0 1 /T30 H/R181x(or) W Richmond 11 n/a Willow River Meadows COUNTY: OWNER'S155565RAME: MAILING ADDRESS: St. Croix Derrick Construction 11505 Hy. #65, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: ER OLATION TESTS: I Residence 3 n/a Liew ❑Replace 15-8-91 5-8-91 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) IES ❑U Eis ❑U R S ❑U ❑ S )EU ❑ S ®U conventional ]DESIGN RATE: I If an If Percolation Tests are NOT required 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 PROFILE DESCRIPTIONS page 28 ShA BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED. I EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.42 99.86 none >7.42 .75bl.1. 1.17bn.sil. .75bn.s.1. 4.75bn.c.s.&gr B-2 6.91 99.81 none >6.91 .83bl.1. 1.17bn.sil. .58bn.s.1. 4.33bn.c.s. B-3 7.00 99.64 none >7.00 .83bl.1. 1.50bn.sil. .42bn.s.l. 4.25bn.c.s. B 4 7.26 99.91 none >7.26 .92bl.1. .92bn.sil. .67bn.s.1. 4.75bn.c.s. B-5 7.08 99.11 none >7.08 .92bl.1. .83bn.sil. .50bn.s.1. 4.83 bn.c.s. B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES PERIODt RAP ES ER INCH NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PEj PERIOD P_ 3:72 none <3 P_ 2 3.67 none 3 6 6 6 < P- 3 3.50 none 3 6 6 6 <3 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 P-,O' 96.14 3 E E 3 Q: E PI; E ~Y ~ ~ X00 00 C_ (5 106. U Zx I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the pro s a Rpec ii in th onsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowled li 0 0 b NAME (print): TESTS WERE D ON: Gary L. Steel 5-8-91'.V ADDRESS: CERTIFICATION VU ' MBER(o tional): 1554 200th. Ave., New Richmond, Wi. 54017 2298 715-246-6200 CST SIGNA E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - ~r FHE 1