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HomeMy WebLinkAbout026-1117-50-000 N ` 0 C 04 N O v O O N a N d 0 O ~ (V i U ~ X I r O O S U -o z a~i I c a, LL C f6 ~ O LF) N z N O O z y y ° w a m Z I o z u m z E N N _ Cl) r- w 3 a, c (.0 N (3) O O ° cli '6 4 ® 3 z° co z Z C c N O C ►r~~ m ~i > U yl l6 U CL 'm Q) T) d d N tq o z o o s C) o O O O •r~~ 0aaa Q T O N = rn rn fq U o rn rn - _ U LO ce) 00 O N U N O U N ~ p p E N N 0. N cnl U) e~~y O 1 'a V~ a) q > 3 r+ O c N C ° 3 0 o c c E In CC) C6 OU') F- N N N Cf 0 0 Lo co 7 _ E O O r` \J (0 In E E N C6 'c c O O a0 N ~ N N O E N 4a-) I O N F- F- N ]r^/J) ~ N M_ _U - vii E E U • yY,i' O O O N Cn ® fm Waft Ck = E d cl CL 4) t~ E 3 `~1 A ciao Oinc0i + X A ` Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT ~L 2 I c h n SEC. _ Ted N-RZg9 W OWNE TOWNSHIP ADDRESS 4cc,4 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ---33 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i t i 4a' 34, INDICATE NORTH ARROW 7q s_ BENCHMARK: Describe the vertica reference point used ~ u.) s Elevation of vertical reference point: /00,.0 Proposed slope at site: -ITo ct3¢.rs. SEPTIC TANK: Manufacturer: /oZJ Liquid Capacity: -P - Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: ®f Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,O Rear, O _g3 feet '..From nearest" property line Front,&ide,O)Rear,0 AAr feet Fl- tuber of feet from: well building: _3%1 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) Ak SEE REVERSE SIDE i • PUMP CHAMBER Manufacturer: Liquid Capacity: ` Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: ~ r Width:__ __2 a Length: Number of Lines: p~ Area Built Fill depth to top of pipe: ~3d Number of feet from nearest property line: Front J O Side, Rear, Opt Number of feet from well: Number of feet from building: ^ (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: a Alarm Manufacturer: Inspector: Dated:y J Plumber on job: License Number: /S(y 3/84:mj LOCATION: RICHMOND 01.30.18.685,NE,SW,I,GD.Qg•,.P, Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No... GENERAL INFORMATION 149263 Permit Holder's Name: ❑ City ❑ Village )p Town of: State Plan ID No.: STEVENS MICHAEL RICHMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 16 026111750000 TANK INFORMATION ELEVATION DATA A9200107 z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~E Benchmark ' 6 03.38'' Aeration Bldg. Sewer Holding St/~If Inlet g, TANK SETBACK INFORMATION St/V(Outlet S (v9' TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic >f / »6 3 NA Dt Bottom sln NA HeadeN 5 70 91P, Aeration NA Dist. Pipe Y, 33 Holding Bot. System 8z~ 91, PUMP/ SIPHON INFORMATION Final Grade or 5, 7. Day M Demand Model Number GPM TDH Lift Friction Syst TDH Ft Forcemain Length Dia. H Dist. To SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~v2 DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O CHAMBER Model Number: System: w, OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) ~i x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over TDepth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center ~Q ed /Trench Edges ~y f~ ~Q Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons pres nt, etc.) r s~.R. (:v LO-Iff 01~. 4a Plan revision required? ❑ Yes to Use other side for additional information. `~Pj 92 K77 I ell ~1 i[~ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION . 7AIL R In accord with ILHR 83.05, Wis. Adm. Code COUNTY .e.,.,...e,....,..,,_,.,e. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION p Mk C_ h -euc. s NI '/%5W)%,S T3D,N,R O Ar)W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # o 5 w Cow CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Se(o f 7 k ow v 1111. TYPE OF BUILDING: (Check one) VITM NEA EST ROAD El State Owned 0 VILLAGE : R 1771 ❑ Public ~1 or 2 Fam. Dwelling-# of bedrooms -PARCEL T NUMBER(5) U2 i &A G G III. BUILDING USE: (If building type is public, check all that apply) 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) 1X New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 511 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 957,/4 6/04 v'7 R / q7/ t) Feet Feet Vill. TANK n as Ins Prefab. Site Fiber- Exper. in allons Total # of Manufacturer's Name Con- Steel Plastic INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank /X1 11?60 _T +&4101 Irs W F1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Sig atur No St mps) MP/MPRSW No.: Business Phone Number: - d-eg 551.3S umber's Address (Street, C7'e_ State, Ziprode : 9 t'(_ ~c rv~-o ►'~el C.J r IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes roun Water Data issued Issuing gent Signature (No ) Surchee) Approved El Owner Given initial ~v Adverse Determination 7AR X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I 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 rene'sal 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 subrajtted to the county prior to installation. )t 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 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 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 STC - 100 his spplication form is to be completed in full and signed by the owner(s) of the roperty 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 'x141k_L~ow J2k\/E2 Salmi \/1E_Nj-v1ruE LX41CA4AP-7L_ ~"~=Yr.NS Location of Property V-1 E7 ~W 1t, Section , T 30 H-R t ~jc W Township Zi lA4M 0 t4 0 . Mailing Address V; C S 4wu/ (Oro Pa e) © Y. ►VCrw tc t-A MM0 N 0, vV 1 4 o 1-1 - Address of Site l44- -L_ 6D LA t~lTlf eo (A U 1~1Ew t C44 M 0 eJ D, VA S 4 O o 9ubdiiiion Vasa11,~. ow_~V~~ MEA~cv`5 Lot Number t ~3 Previous owner of Property 61WE JCA-4MX Total Size of Parcel Date Parcel was Created 10 - 19 _q0 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) Z X Yes No Volume 'N1 and Page Number 4~6~O as recorded with the Register of Deeds.. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey,,,if available, would be - helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Hap, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION 1 (101) co~1.Li.6y that dU stdtementA oil .thus bonm aAe true to the be-At o6 my (ouh) h►ncuitedge; that 1 (we) am (ahe) the owileAl3) o6 the phopeAty deACAi.bed in VUA .in6onmaGton 6oAm, by va.tue o6 a wa.nAanty deed neconded in the 06 ice o6 the County Rega teA o A Dee& ass Document No. AsS Ze b ; and that I fWel phew entty c.un the pROpoa¢d Ai-t¢ 6oh the eetvagQ duspoA5 byes (o)t I (we) have obtained an fdArt +ent, to nun with Vie above d6c ibed pnope&ty, 6oh the eonbthucti.on o6 said eya.tvn, and the same hae been duty hecoitded .tn the 066tee o6 the County RegiateA o6 VeedA, ab Doe ment No. 4c to ca ) , SIGNATURE OP OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED SEPTIC "'ANK MAtyTENA;ICZ AGREEMENT Sr_. Croix Cuuncy Wig-LC-'w 2►V-CrL 3c>l"T VE"7144C OWNER/BUYER nl►o,E►.- Sy'~t-ts ROUTE/BOX NUMBER ~SC'S ~1 L-1 \A VAS/ CAS Fire Number CITY/STATE CW 2tL4AMON~ \t4k zip 5~fl 11 P^nPERTY LOCATION: 1~, Section 1 T -30 N, P. W , Town of V,%C"'t1,.A 0"0 St. Croix County, Subdivision J\A, INOovJS Lot number 33 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 3eotiC tank oumoer.' What you put into the system can attecc the Euncciun of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for ~ a maximum of 60% uE the cost of replacement of a failing system, which was in operaci.on prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requireme•nc that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix Cuuncy 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) af'cer 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. IN E, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards sec forth; herein, as sec by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED -3 - OnTE ~ 1 9 St. Croix County Zoning Office P.U. 3ox 2':7 Hammond. '.dl i34015 7L5-796-=229 Si.~~n. Jar.- :inti rerrlrn "n ;ingjvc address. i irir rn ' ic) WARRANTY DEED TIM S SPACE RCSCRVED FOR RCCORDMG DATA Sr•kTI; tIAH Elr WISCONSIN F(IR6t 2-1982 455206 861PAGE QS6 REGISTER'S OFFICE Michael. R._ Stevens, William H. Derrick, _ SL CROIX CO., WI William. .M... Derrick, Thomas E.....De.rrck. and......... Recd for Record Ronald L.. Derrick as. tenants-in-Common.-......-... JEAN 19 IJUG at 8: 30 ~ . M I-onv ys and na,~;cnt:: to Willow. River.. Joint....... . Venture . . j 1"011:6WRO91der of Deeds ~I i~ it RCTURN TO . I: th; followiov deserihcd real est.,kte iiu St. ..Croix.. Count~., Stale of Wisconsin: i Tax Parcel No: Southeast Quarter of Northwest Quarter and Northeast Quarter of Southwest Quarter of Section 1, Township 30 North, Range 18 West. rRANSF.~ FLT i II Thk is nOt.._.. honmslead prnpcrl}. j (is) (is not) Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. Daled uli~ . / _ 'lay of ..Jana ry. _ - t 90. . Michael R. Stevens William M. Derrick (.`SI:AI,) (SP.A1.1 William H. Derrick Thgmas E. Derli.ck AL'7'11JIN:a'ICATIZO •i 11011di C _N LEAS MERIT I .Mic,hae1 R. -Stevens, STATE OF WISCONSIN j S3 . William H. Derrick, William M. Derrick-.-Thomas-E- Derrick-.and Ronald L. Defjck County. authenticated this . !~ay_ of...... Januiary_.., 19-.90 Pel•snnally came before me this ................day of C •7►`>~ t.C , l~l>`Lt~1 V0 . IJ the above named ,dI - Judith A. Rem ngton TITLE:: n1101BER STATE BAR OF WI SCl)NSIN a (If not............. - uthorized by § 706.06, Wis. Stat4.) -who executed the to me known to be the person foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - _ .RjEMINQTON.LAW OFFICES 1VeWlct~monaml on54017 Notaly Public Count, Wis. (Signatures may be autheutic:ated or aclromVIed w(l. Both My Commission is permanent. (If not, state expiration are not necessary.) (lute: I9.........) •Namo9 of permnl sinning in Illy 1-;Ipnrii) Al"Illd I'riut-A How Ibeir nirullures. F~ qo 0.4 ell a h~ p-~ X33 ` • w-slonlon Deva'lmrrl of Irdultry, WIL Ut:)Ll%iv I guto nu vrt I Lai~rit and l^jman Relations ° U (Attach Soil Prolile Location Map • To Scale . On A Separate, Signed Sheet) Madilon, Page Cu,"A Wk IVA►. DAIS CUr4VMMO LOW V166ca t V~1AAtlnV~A AVICT R rtor+as Derrick Construction 1028-92 grass outwash n/ a Aco"M CRV arAII Dr CON" 1'1~l,QAQ•al O•o'44 1505 H . 65 New Richmond Wi St.. Croix ~J~UJ .54017 10CAIV7rl 16=74 rCAa.+1Hra [X 1Aa1AK0.1AlA1M ' NE 114 SW 1 30 Ul 18 nd CSM/ A LOT 33 BLOCK 1 susowisloM Willow River Meadows -x rrtw - ALLACII B- Morison Death Dominant Color Mottles Structure llmlltng FACldrr Loaanew 14 rt. 1 In Murrell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary Oaprh trench Sad 1 0-9 10YR4/2 none 1. 2/m/sb mfr 1/f c none .3 .2 Elcv = 2 9-2210yr4/4 none sil. 2/f/sb mfi 1/f c none .0 .0 100. 3 22-211 10yr4/4 none l.s. 1/f/gr mvfr 1/vf G none .8 .7 4 29-8 '10yr5/4 none c.s. 1/ml 1/f n/a none .8 .7 Houton Depth Dominant Color Mottles Structure Lim-ling Faarort Loaang.GPDso n. _ In. Muntell u St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary Depth T#1nch Bad 1 0-11 10yr3/2 none 1. 2/m/sb mfr 1/f c ' none .3. .2 A, Elev = 2 11-2 10 r4/3 nnoe sil. 2 f sbk m c none 0 .0 01.7 3 23-3 10yr4/4 none s.l. 2/m/sbk mvfr 1/f g none .6 .5 4 31-9 10yr5/4 none c.s. 1/m/$r ml 1/f n/a none .8 .7 B-3 LoadInBOPa/4 n. Horton Depth Dominant Color Mottles Structure Umtung FaClal/ In. Mun ell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds Oorh iranch Bad 1 -9 10yr3/2 none'' 1. /m/sbk mfr /f c none .3 '.2 Elev = 2 -21 10yr4/3 none:` sil. 2/f/sb mfi 1/f c none .0 E3::3_~1-31 10yr4/4 none ' l.s. 1/f/ r mvfr 1/f •1 none .6 .5 c. s 1 m/s ml 1/f n /a none .8 .7 4 1-10 10yr5 /4 none!' 13- 4 (Horton Depth Dominant Color Mottles 'Structure Lim; llne Facsad Loso~nfaPo'14.ll. In Mun ell u. St. Cons. Color Textur Gr. Se Sh. Consistence Roots Boundary - Daprh i,anch Bad 1 -11 1 r3/2 none 1. 2/m/sb mfr 1/f c n Elev = 1-26 10 4 3 none sil. 2 f sb mfi 1/f C none EP 6-32 10yr4/4 none l.s. 1/f/gr. ml _ 1/f G none .6 .5 4 32-9 10yr4/4 none C.S. 1/m/s ml 1/f n/a none .8 .7 Morison Death Domrnanttolor Mottles Structure Umlling Faalorl Loading0li0so.h• B 5 In. Muntell u. St. Cont. Color Texture Gr. St. Sh. Consistence Rootl Boundar of Ih Aaneh Sod 1 0-7 10yr3/2 none 1. 2/m/sbc mfr /f c none .3 .2 Elev o 2 7-16 10yr4/3 none sil. 2/f/sb mfi' 1/f c none .0 .0 99.8 3 16-2 10yr4/4 none l.s.. 1/f/gr ml /f G none .6 .5 4 3-8 10yr4/4 none C.S. 1m1b ml /f n/a none .8 .7 Additional Remarks: RECOMMENDED SYSTEM TYPE: an t e in an direction page # 28 Soil series SHAD lot on back bm= to of N.W. lot stake at el. 100' Other Site Fealutel: 97.45 1029092 1715 1246-6200 2298 SyStClll Elevation gnature f ' Dalf Signed Telephone No. C • Gary L. Steel 1554 200th. AVe.New Richmond, wi. 54017 CST Name (Point) City Slfls Zip , f 4~ ` i - he~ I I ~ I ~ I I I I I I /546S - a ~ ~ I I ~ I I i ~ ; I i ; I /4' r y I - ._E + r r F K- ~~r J i I ~ I I i ~ , ~ , I ; I I I e l I ~ I ~ _ t I I i 1 I i 1 ~ I i ~ -l- I 1 I I i I I I +I , I I I f I I I i I r - - - --I 1 - - ' - - I - i- ± - - f I I ' - I 1 ~ I ~R i I I i I I I , ( I I t ~ - I I ~ ~ j I I I i ~ I _ I II I ~ I ' r I , - ~ - - t d.~r t- I I t I I I I I ~ I i ~ , I I I I I ! I i ~ i i E I t. {-Si c I dt _ Q )l i I I I 7 i cJ' ' I l a 1 ~ ~ I I I I ~ ~ - I I 1 ~ aJ ~ I l ~ ~ f I t f~ ~ ~ I I I ! ! I I U4 k t t-- - _ I I I I - I IF I I , ihp i 1 - r r ~ L r r- I t I t I L~ men r I I I I I I I I II t I I I - - - - - i - It I ' I I I ~ II I~ - I t I I I 1. 1 I I I I I ~ I I I 'I 1 I r i I I I . , I Y ~ ...E ' i I it I I I I I I _ I I I I i { I I ~ I t I I i } II I I { I _ I - - - I I I I I ~ i I f { I i ~ I T- ~ I I I I - ~ I I I i I I i i I ---f- r- I I I 3 I ` ~ ~ i - i rl I i I I i 1 L I C I i ~t~ne:.l S~{e~CrS CfUSS ~~c~1Ur~ pF r't zit1-3 ~'t 7 Fr„n All 111811- And Objelvallon Pipe Appro•ld Vent Cap ~j 411Mmum 12'Abore RI~Jt ??~rnt31~7 Final Creda 20' 42' Abora Plpr _ 1' Call Iron To Final Oroda Vent Pip, w.rn NeY Or Srni Mik Co erinu win 2' AVprapala Over Pip, - Dlrlrlb„Ilon Plp, 0 0 0 - Teo b' Appregal, B&Aooti Plpe a Perlarol,d el". 6elar o ~Cagllnp T•rminoiinp At Bdllom 01 sTelem SOIL FILL 'EISTKIBUT101.1 PIPE r APPROVED ZZ` JTI<TIC CoV.[a 2"OF 1tGGREGATE-/~ MATER10~1- OR 9" OF STRAW OK MARSH HAy ELEV. OF?7 FEET-,._ °Y d1OPlz-21/Z AGGREGATE ~P.vp o OIS1"11I6iJT1U1J PIPE TU BE AT LEAST - INCHES BELOW ORIGIUAL AUU AT LCAS7L0 INCHEL BUT 1.10 MORE THA1.1 tit IAICI{ES BELOW FI►JAL GGRADE RADE, M AMUM DEQtH OF EXcAV 100 AT FXOrl OKIGWgi, 6~11pF WILL BE INCHES nNIMUM CKPT-}i OF EACAVATlmtl FROM 0,ikIla0AL_ GRADF- WILL. BE INCHC S 5 LIG E IJ SC I.IUMBE IZ: DATE: VUMAN TMEI\iT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION PERCOLATION TESTS (115) MADISON W153707 P.O. BOX 76 ATIONS (H63 .090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/QTY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NE 1/4SW1/4 1 /T30 N/R18)k(or) W Richmond 33 1 Willow River Meadows COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Derrick Const. 11505 Hy. #65, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE I NO.BEDRMS.: 1COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER ATION TESTS: Residence 3 n/a New ❑Replace It 1-28-92 1-28-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ® S❑ U BS U S❑ U S gU ❑ S® U conventional If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTFDM ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B-1 7.17 100.2 none >7.17 .75bl.1. 1.08bn.sil. .58bn.l.s. 4.75bn.c.s. B 2 8.25 101.70 none >8.25 .92bl.1. 1.00bn.sil. .67bn.l.s. 5.67bn.c.s. B 3 8.33 101.70 none >8.33 .75bl.1. 1.00bn.sil. .83bn.l.s. 5.75bn.c.s. B4 7..50 101.00 none >7.50 .92bl.1. 1.25bn.sil. .50bn.l.s. 4.83bn.c.s. - B-5 7.00 99.80 none >7.00 .58bl.1. .75bn.sil. .58bn.l.s. 5.67bn.c.s. i B- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER btg2lgS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH p-1 4.25 none 3 6 6 6 <3 P none 3 6 6 < P-3 4M none 3 6 6 6 <3 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 97.45 11 N i ( r 6 -q- _ _ v I i l I i a t ~ ~ } 1 i X53 ~1 I, the undersigned, hereby certify that the s I tes s reported on this form w _ r ith the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the test r fe t to the bes nowledge anti belief. NAME (print): _ o1,.e.'.iV iV T ERE COMPLETED ON: Gary L. Steel -28-92 ADDRESS: K AIR J.:.. CEF ATION NUMBER: PHONE NUMBER (optional): 1554 200th. AVe. New Richmond, Wi. 54017 ;l 715 46-6200 %anl UNTY C~ ~I A RE: GOFFICE \ DISTRIBUTION: Original and one copy to Local Authority, Property OstJrCj~ DILHR-SBD-6395 (R. 02/82) -OVER - J („(f~ dill ~ INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a coEand accurate soil test, your report mu 1. Complete' ,scription; 2. The use secti( -tust clearly indicate whether this is a residence or commercial project; 3, MAXIMUM nurof bedrooms or commercial use planned; 4. Is t` ' a new ( r cement system; 5. Con .,.--e the --J . y rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OT _R SYSTEM;;- ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for rriting profile descriptions and completing the plot plan; 7. MAKI L=' :IBLE diagram accurately ' ig your test locations. Drawing to scale is preferred. A se° y 'r used it desired; 8. M •,tchmark and vertical i i . ferenee point are clearly shown, and are permanent; 9. Cornpf date boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, i _ 10. If 't as floor; Lion) does not apply, place N.A. in the appropriate box; 11. Sign t your cur . -ess anal your certification number; 12. Mare -le ~I distri' require;f. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUT.AC. Y' _'ITHIN , DAYS OF C _ETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Ss Ad Textures Other Symbols ;ver 10") BR - Be0, r 3 - 10") SS S ne; r 'te 1 (under 3") LS - L, t ne s - HGW - h >undvvater cs Sand Perc F ion Rate med s - n. S-'n:f W fs _.:nd Bldg Is I qty sand > Th._n `sl Loam < - I ian *1-, "I Bn- "sil - Cult Bd si It Gy - Loam Y < aw 'lay L_ R - y Clay Lc mot -'e, - " dy Clay wl sic - Silty Clay fff line, fai c - Clay cc _ C pt - Peat mrn - medium Y ray - Muck d p - 1 iinent HVJL - High watt Six soil textures :,-face tt i i agitate disposal BM - F - it M: V R P tical F 'oint TO TI This iii test report is t'~ first step in securing a sanitary permit. The coin ry orthe Depart,- ' it may request ver; ";(,n of thi- ~~'l --t in the field prior to permit: issuance. A i- s, o r Ve private .:tern and a . application must be submitted to the _ ;al a order to t a permit. The sanitary permit must be obtained and posted prior 1.+ of r,)y uctdon- L_ WitconUn Deoa'tmort of Irdustry. ~UIL ULbl-Wr I Ivrs nu vrt r Labor and human Rlfatlont U COI (Attach Soil Profile Location Map • To Scale . On A Separate. Signed Sheet) r.iadtson.:.I 5):l:' Page cur"AA -tvAL.oare wrtrentA04OUWVfOCMM P~ 14AttltMl "rscT R rwrat Derrick Construction 1028-92 grass outwash n~a AOOrESa ctrm aTAte tl► CotlrrY lvsyt~Qwo.o.a+ 4017 1505 H #65 New Richmond Wi St..Croix bUU A!►AKILKae)tn BORM NE r LOCAICH sactxa+ ~11__Ricbmond 4 114 to 30 18 CSStr lelAC! LOT 33 BLOCK 1 suBDIviBIDN Willow River Meadows NEW 11 - B- Norton Depth Dominant Color Mottles Structure Limiting Factod LoaangGPD•sq. n. 1 In Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary Depth trench Bad 1 0-9 10YR4/2 none 1. 2/m/sb. mfr 1/f c none .3 .2 Elcv - 2 9-22 10yr4/4 none sil. 2/f/sb mfi 1/f c none .0 .0 100. 3 22-241 10yr4/4 none 1.s.,l/f/gr mvfr 1/vf G none .8 .7 4 29-8 10yr5/4 none c.s. 1/m/`ml 1/f n/a none .8 .7 Horizon Depth Dominant Color Mottles Structure Limiting Factod Lwdnq.GPDsq n. B-2 In. Munsell u St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundary Depth trench Bed 1 0-11 10yr3/2 none 1. 2/m/sb mfr 1/f c none .3. .2 Elev = 2 11-2 1 4/3 nnoe sil. 2 f sbk mf' 1 none o 01.7: 3 23-3 10yr4/4 none s.l. 2/m/sbk mvfr 1/f g none .6 .5 4 31-9 10yr5/4 none C.S. /m/$r ml 1/f n/a none .8 .7 1 Horizon Depth Dominant Color Mottles Structure Limiting Factor/ LwdingflPDeq. n. B-3 In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds Depth Trench Bed 1 -9 10yr3/2 none 1. /m/sbk mfr /f c none .3 . .2 Elev = 2 -21 10yr4/3 none sil. 2/f/sb mfi 1/f c none .0 .0 E1_3 1-31 10yr4/4 none l.s. 1/f/gr mvfr 1/f none .6 .5 4 1-10 10yr5/4 none c.s. 1/m/s ml 1/f n a non E. 4 (Horton Depth Dominant Color Mottles 'Structure Limiting Factod LoadrngOPdaq.n. In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounds Depth Trench Bed 1 -11 1 3/2 none 1. 2/m/sb mfr 1/f c none Elev = 2 1-26 1 4/3 none sit. 2 f sb mfi 1 f c none IDG3 6-32 10yr4/4 none l.s. 1/f/gr. ml 1/f G none .6 .5 4 32-9 10yr4/4 none C.S. 1/m/S ml 1/f n/a none .8 .7 Houton Depth Dominant Color Mottles Structure Limping Factor/ LoaoingaPDS4.ft. 13- 5 In. Muntell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Boundar Depth Trench Bea 1 0-7 10yr3/2 none 1. 2/m/sb mfr 1/f c none .3 .2 Elev = 2 7-16 10yr4/3 none sil. 2/f/sb: mfi' /f c none .0 .0 99.8 3 16-2 10yr4/4 none l.s.. 1/f/gr ml /f G none .6 .5 4 3-8 10yr4/4 none c.s. /m/ ml /f n/a none .8 .7 Additional Remarks: RECOMMENDED SYSTEM TYPE: any type in any direction page # 28 Soil series SHA lot on back 10 bm= top of N.W. lot stake at el. 100' -y' is, .p N Other Sue Features: - 2298 97.45 IYL- - 1029092 '07j1 19 1 gnature OsteSigned cif Systcm Elcvation Gary L. Steel 1554 200th. AVe.New Richmond, wi. 54017 CST Name (Print) City Slale tip MAO r L ~d qo ' ~il Old h~ o4 X33 ~d