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HomeMy WebLinkAbout038-1059-30-200 o o O Qq d o a c w ~ n e O I 0 N o~ O 01 GL I ai fl Z C LL c O Q d' I N z H I ~ W E z ~ a m I ~ ~ ~ II I o o z a c a w r o d Z c fn F- ~ ~ ~ Z c ~ •v ~L]^ O M •c a ~ N O O o O z m z 16 z 16 N E N N O N R C d C d _ a : o -co d 2 N O 21) ° G G a m m •0 N , N U) U) Z N>! c U) U) m 5'2 E 3 3 ° 00 Z0 • ~aaa ~ I IL m U z rn rn CD Q o uB fl c0 w o o a v m a m 3 Q Z in 0 O O 0 N C N m ° 1 r O c E~ ~Ol O O 0~ N c N V 7 d rn C? 0 ~ N c` N o m :G -1 ~ ao C 0 c c p ° o Co N U) `w z v m c w Cl) f° € n o w o E R v • o v~ o z H 2 cn Q Rs I 0 CL -6 t A uCL I,oaC~ W r ~,rsr at DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUS'f'4', DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: 2SECTI N: r TOWNSHIP/ ITY: LOTNO.:BLKO.: SUBDIVISION NAME: S ' ~ /T3 N/R C (or). COUNTY: OWNER'S BUYER~S,VAME: MAILING ADDRESS: . l ,X h s>✓r S-1,41 USE - r DATES OBSERVATIONS MADE rO.BEDRMS.:ICOMMERCI L DESCRIPTION: IPROFIL DESCRIPTIONS: ER OLATION TESTS: Residence ZNew ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system c - ENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDE SYSTEM:(optional) rMS ONV❑U ®S OU ©S ❑u OS u EIS ®u 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: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS _ BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL- WITH THICKNESS, COLOR, TEXTURE, AND PTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 L - - - W'; e4 - B- 7 9,7 _ W al B- 3 9S 7 Al B- 99 d - r S 7 _ B- Aq S. Is g_ s PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER P _-1 3~2 ell P- Onl,~ P- S'S' lveAlh~ 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 , 3 E l7 - ? ~ a , ~Gf t 4SI-- AeltC ri! _ ~f N , 14 F E 3 . 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. NA E rint): TESTS WERE COMPLETED ON: 1, & I ~ ~ 0 ja' 1, j x 91 A RESS: CERTIFICATIQN NUMBER: PHONE NUMBER (optional): V CST I G AT R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - ,.wR c ec a. AL 6. 12,„ F ' THE t_ IL. TO THE OWNER: This soil test report is the first ste t verificc 'an of this soil test in the f '_d p~ i e sewage sy rn and a permit applicat,un ;,use o obt_n he sanitary permit must be ~ ' _ ~ AS BUILT SANITARY SYSTEM REPORT OWNER e u'- ay1 TOWNSHIP S r ^ Cam,,,,, SECTION -T 3V N-R,W ~ 1V 4 I V .g ADDRESS ~~L' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ~ LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V ~ ayo ~ L INDI TE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. eP d Rings used: -e-)Manhole cover elev Final grade elev: Tank inlet elev.: Tank outlet elev.: i No. of feet from nearest road:Front, Side , Rear Ft.65~'/D From nearest prop. line:Front , Side, Rear Ft._ / 'O No. of feet from: Well D w~ < Building: ~3'~; (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear`Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width:- Length Number of Lines:- rea Built46~-' Exist. Grade Elev._ --Proposed Final Grade Elev. Fill depth to top of pipe: 3~ o2cf No. feet from nearest prop . ne : Front , Side,,, Rear Ft . No. feet from we11.1~ No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR: DATE: /Z PLUMBER ON JOB: \ LICENSE NUMBER: 3~1 6/90:cj LOCATION: STAR PRARIE 13.31.18.238D,SE,SE, CO. RD. C WiscoNin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Haman Relations INSPECTION REPORT ` Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171424 Permit Holder's Name: ❑ City ❑ Village )p Town o : State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: PRAIRIE Parcel Tax No.: TANK INFORMATION ELEVATION DATA A92 0188 (P// TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y. 21L J . Benchmark 312, ~ e'0, Aeration Bldg. Sewer Holding St/ Inlet 33 TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ) NA Dt Bottom Dosin NA HeaderJAAex+- 9, 97 e3 ' i i Aeration NA Dist. Pipe t~ 9171,3~9 Holding Bot. System 2 3 j} PUMP/ SIPHON INFORMATION Final Grade Man Demand 7. 97,70 Model Number GPM TDH Lift Friction SY M,_ TDH Ft Forcemain Length Dia. Dist.To e SOIL ABSORPTION SYSTEM BED / TRENCH Width / Length i No. Of Tr nches Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN 1 N manufacturer: C~l SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHIN SETBACK CHAMBER INFORMATION TypeO ) 6,2 r OR UNIT Moe Num er. System: LY DISTRIBUTION SYSTEM Header / Manifold //y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _L Dia. Length ~ Dia. __V_ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over r i r Depth Over t, /1 xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Trench Center ~~r3 ! Bed/ Trench Edges 2( -07 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes to Use other side for additional information. (o ~2 2!t gendA2~:= SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH , • SANITARY PERMIT NUMBER: r {~1], SANITARY PERMIT APPLICATION • MLHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY . MEMO STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than [j 4/a ious application 8% x 11 inches in size. c/24 on to Ypev" -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 6t /^iGc Cam'/e '/a, S / T , N, R E (o W PROPER OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ILLAGE rrrcy ~ ~ , G_ ❑ Public K1 or 2 Fam. Dwelling-# of bedrooms 2V 'PARCEL Ax N MB R( ) III. BUILDING USE: (If building type is public, check all that apply) 67 1 ❑ ApUCondo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 9 ❑ Office/Facto 13 ❑ Other: Specify 5 ❑ Hotel/Motel Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2.0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) 1:1 A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 KSeepage 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) c~EL7EVATION Feet Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New k=visting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank l S 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 a (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber' dress (Street, City, State, Zip Code): IX. COUNTY/ PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includ oundwater Date Issued Issuing Agent Signature (No S ps) /'y Approved ❑ Owner Given Initial Surcharge Fee) / Adverse De ermin tion 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 l 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 (SB0 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being Check only one and complete of bedrooms if 1 or 2 Family 9 9 served. Y # Dwelling. 111. 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 3'f2 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; close 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 usec' for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 1 T T C - loo 7'hi~ application form is to be completed in full, and the oWncr(s) of the signed by property being developed. Any inadequacies will only result in delays of the ec development be intended for resale byt owissuance. ner/contract rd (spths liouse), then a second form should be retained and completed when tile property is sold and submitted to this office with the appropriate-deed-recording. Owner of property Location of proper ty,-iA/4~ 1/4, Section //4-/- T - Yf N-R ~f rW- Township Hailing address Address of site Subdivision name Lot no. Other homes on property? yes____~_No Previous owner of property Total size of parcel G' Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house r_ ) Yes LN Volume ,.50 and page Number as recorded. with the Re ister of Deeds. g INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRA.ITY DEED which includes a DOCUMENT NUIMER, 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 Me shall also be required. p 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 form, b e owner(s) of warranty deed recorded in the office of the Conty Registerfof virtue a Deeds as Document Ito. y~ oand th I (we l,.n the proposed site fob t ie sewage disp salt system) orr I e(we) obtained an easement, to run the above described ert for the construction of said system, and the same hasopbeen,duly recorded 1iGOffice of County Register of deeds as Document No. Sig a ap~li.cant Co-appl cant Date of Signature Date of signature DOCUMENT NO. WARRANTY DEED THIS APACE RE%¢RVED iOri RGGORO4dG owTk ;:STATE BARF WISCONSIN P'oitM 2,-1982;: 483282 VOL GE 2(r'~"'~'/4 • REGISTER'S OFFICE i t S.~ Q.t.t.. 7.,....C9:?I ; ST. CROIX C4.0 W1 x...end.,.~.t~v~._.k'~....P.~.t.~x,~an - w Recd for Record MAY 131992 conveys and warrantq to .....Jeffre.y...A.-Marman--and..Lauxi.e.... Ct 10:45 A. J.....T•arman.,...husb.anal..and...wi.£e•,••.as sLl>ru,i,uarship ..mari-tal..pr•op.er-ty..... 19*91 2ofD"di H4TURM TO the followinj.: described roul estate in S.t:......ero.ix...........cotlnt y` State of Wisconsin; Tax Parcel No: Part`of SW4SE4 Sec. 14-T31N-R18W described as follows: Lots 2 and 4 of Certified Survey Map filed October 9, 1991 in Vol. 9, gage 2411. fRAN'Si ' w i i This • 5 TIP t ...4 ~4.,..........., homestead property. OW (i5 not) Exception to warranties: Existing highways, easements and rights of way of record, II Dated this ........................1.../......... y y 29..2... I (SEAT,) (SEAL) . Seg. t..J.. o~unt,~ ..............(SEAT,.) t ......(SEAL) .Steve...F....,Patexson AUTHENTICATION ACKNOWLIRDOMENT Sigrtatu're(s) STATE OF WISCONSIN ss. ...S.t....Craix County. authenticated this ........day of 19...... Personally came before me this ..........day of .my. 19.92.. the above named w ...Pters4.............. TITLE: MEMBER STATE BAR OF WISCONSIN (If not , ''is. Stats.) .'•'""'""W""'.-"""'""""'"""""'""' authorized by § 706.06. to me din to b. the,persons. who executed the tore i -fristiumentr'.qi d acknowledge the same. THIS INSTRUMrNT WAS DRAPT90 BY (.I t' azzzey...]?v~.d._,I.....at~eext.....-•----...... i 621..SE''~Ax1d...SZ...._~i11SSAZ1~..x • Notary Fu c county, ty, I9. (Signatures may be authenticated or acknowledged. Both My L~oinm; io• isP~n~ilnent. (Tf not, state expiration !f are not necessary.} date; it •Namea of yor8anu i4nins in any capacity nhuuld bo typed or printed below their sisnaturen. is WART(ANTY DEED STATE BAU OF WISCONSIN Vtken.i.in Leiptl litimit l..: MAN lrn. R 1!.'V MAY 18 '92 15:10 RIV VA!,c,A13S`RACT 3867664AAAAAAAA P.1/1 DOCUMENT NG, WARRANTY DEED THIS hF"AGE Ai~IMVED FOIJ RLG0R04N4 DATA A , STATE BA ~OF WISCONSIN FORM 2,-1982: r - YOL 950PAGE 207 - . . - ; ~ REGISTER'S OFFICE ST CROIX CO ' ._.~~~.~.~,.J.,.-..~Qun~~~:..__a.17d,.s.t~V~._.~'~,.•P.~.t-e~.Ss~.n,.... I 0 W1 Reed for Rwad . . MAY couv4~N•s and warrants to F.effre.y.-..A...... armam__and...Lauri,e at 10:45 A. ~_....Tarman,. -h-usbLand--a.nd w_iXe_,...a-s sztzv.zv>arsL~i}~ maz i.ta ..,prpAert • . Realstof deeds INTURN TO . . . the following described real estate in C.-...-..,,,..CoUnty, State of Wisconsin: Tax Parcel No Part of SW4SE~ Sec. 14--T31N-R18W described as follows: Dots 2 and 4 of Certified Survey Map filed October 9, 1991 in Vol. 9, page 2411. 1-7 This 1P.J!-Qt homestead property. 090 (is not) Exception to warranties: Existing highways, easements and rights of way of record. Dated this day of Y (SEAL,) - _ (SEAL,) . Scott aunter_ (SEAT,) (SEAL) _Ste.ve.._F..-.,Pete-rs,o.n._..........- AUTHENTICATION .A.CKI\' 7V ,F1)GIMENT Sigxsatu're(s} STATE OF WISC( a1N ss. .7. t••-Cr41~C-------..-.__C:ounty, authenticated this day of........................... , 7g„_-• Personally came Y a before rrti this .--/Z ------day of 'my , .9__9.2 the above named -W- _ CQ~.~--J....~ounter__ and;•-S•tev.~.. Peterson TITLE: MEMBERS'CATE BAR OF 'pVISCQNSTN - (If not . Authorized by § 706.06, Wis. . State..) . to me n to'b. the,persons_.__....,.. who executed the Pore 7nstrumcnt grid aeknowledr;e the same. THIS iN57RUMEAT WAS DRAFTKU BY • A. Ll t..'' t_ - N'otari! pu is .__--county, Wis, (Signatures may be authenticated or acknowledged. Both My a~ainmi iop is.. , P~,i1yllneret. (If not, stag expiration are opt necessary.) - r t date . txt_?r~-_..._.._..... 18 "Names of porsor,n efxri Anz in uuy capAcItr nhOuld bo W.Ped Or printed below their sionetures. WARRANTY 1)IiED STATE BAR OF WISQON9'f4 VnA . K'in; n.;ain [.,rtirrtl fSSi~.n; !'n. lu, M 476. 2__ r v'+ J SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS: FIRE NO: LOCATION: 1/4, :L 1/4, SEC.- N-R 11~ffrWf TOWN OF: ST. • CROIX COUNTY SUBDIVISION: LOT NO. 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 ree Y o sooner, if needed, by a licensed septic tank years or put into the system can affect the function of the septic tank yas 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:, A DATE:_ Sf~IIS 2 St. Croix County Zoning office 911 4th St. - Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION HAND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHI UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: '/a 4 l /T N/R/ ( - - 4-11 ) 000NTY: OWNER'S B ER'S NAME: MAILING ADDRESS: USE c~ o~f o DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: 15Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN_ -GRO INND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U V~l S ❑U [S ❑U E ]S U❑ S 4j I 'U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: 5 .lam Floodplain, indicate Floodplain elevation: O PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHE T TO BEDROCK IF O SERVED (SEE ABBRV. ON BACK.) B- 6 f. / Xlev_. B-4 702 ,S 701 5= Al a,~ -~aB✓s .T.3--'tea B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- P- P- P-. P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. 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 E I F ~ - 3 r E ~Lj/ de 0,5 _4 E 9l 0 = }I i : t 9 - - r r j t 3 I t 3 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): `T /j y y` c f ✓c- c~' SIC CST SIG TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SI C? - 5395 To be a complete and accurate soil test, yornr report must include: 1. Complete legal description; 2. The use section mast clearly Indic ether this is a rr or commercial project; 3. MAXIMUM numl of bedrooms r .:.mmercial use pia ar 1; 4. Is this a nn ° r r 'acement sys, 5. Complete ility rating A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER S~ _ ARE RULEF . JT BASED ON SOIL CONDITIONS; 6. PLEASE a` )reviat ions sf n here for writing profile descriptions and completing the plot plan; 7. MAKE A L _E diagram !ly locating your test locations. Drawing to scale is preferred. A separate sh. 1 > used if 8, Make sure yo, ,n -ark an i _ I elevatio,-i referent ; point are clearly shown, and are permanent; . Complete - ,)priate boxes o dates, names, add rlood plain data, percolation test exemp- tion, if appro~ 10, If the inforn r;.h as floes elevation) does not , 1, place N.A. in tl ,arizrte box; 11, Sign the fa Ace your cur ldress and your certi < lion number; 12. Make legible and distril. required, ALL SO _ TESTS MUST BE '_ED WITH THE LOCAL AUTHOI Y WITHIN " BAYS OF COMPLETION. _EVIATIONS FOR CERTIFIED SOIL TESTERS Soil S, rd Te !r Symbols St (over 10") BR Bedrock cola Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limesto,. s - HGW -High Gr4 rater cs - C Sand Perc Percola'tis EI:ate med s - i Sand - Well fs f nd Building Is Sand > -~:ater Than sl - IV Loam < L Than I L Bn sil Loarn BI si - Gy >am y ovv Clay Loarn R Jay Loarn ntot Clay IN/ C'ay fff N~ roam n - d - I} : U 111 t H'041 L Six soil textrtres rrlacr . waste disposal BM - Ech (i , VRP Vertical Ri Point TO THE OWNER: 7 '1 test report is the first step i- wring a sani'-ary 1-rrtnit. The county !y rt quest m of this soil rRer in th , rior to psrmi a priI/ate ~rr and a Tait must be su m c 'der to ry -nust be obtained a l : i PLOT PLAN PR~O^JECT_~ ADDRESS r`~ ~Se F C Cc~i S ~t c, 1/4/S/ /T N/R/ W TOWN COUNTY ~f MPRS Byron Bird Jr. 3318 DATE BEDROOM -CLASS PERC_.;2=_ CONVENTIONAL.IN-GROU PRESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE -1LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE _gED SIZE / X / 16, Benchmark V.R.P. Assume Elevation 100' Location of Benchmark H. R. P. , X: ❑ Borehole Q Well Scale = Feet O Perc Hole System Elevation I1ent 12" i TYPAR COVERING 2 12" 3' 4 6' 3' 1 6% Sewer Rock 12' i I G~ rK~ ~ l i i r REPT131 STAR PRAIRIE ST. CROIX COUNTY ZONING PAGE 1 0610/92 16:24 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/11/92 AREA: JT Activity: A9200188 6/11/92 Type: CONVSEPT Status: PENDING Constr: Address: STAR PRARIE 13.31.18.238D,SE,SE, CO. RD. C Parcel: 038-1055-60-000 Occ: Use: Description: 171424 Applicant: TARMAN, JEFFREY A & LAURIE J Phone: Owner: TARMAN, JEFFREY A & LAURIE J Phone: Contractor: BIRD, BYRON JR. Phone: 268-7616 Inspection Request Information..... Requestor: BYRON BIRD JR. Phone: Req Time: 13:06 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION