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HomeMy WebLinkAbout020-1041-00-000 -0 C) c ° CD p ) o c 0. O a ~ I I 0 0 N N h b~.p 4L I I I N z c ti c 0 3 - I E ° d. C a I z o zr €v CL m rn - z o o wz~I/ c aoi Z d rn c z V) F- r i N c E a N N 3 II m y y o o ~ ~ o I O o N z m z o N z o d N E o L w Y CL cc co y Gl N C p O w o G G d Cp O UL o I E U o v 0 0 0 Z o •N _a oaaa N ~~yv a ~ Y I U) J i N } V ; m rn rn N y o o ° w p co v ° m a; co ~ d a > l4 co a N Y! ca 2 O O LL 'O U O p p et O N W N C w V d O ~ Y Y E C -0 M Q r 0 V C E C N~ 'vr a-- C In p ° d 7 N -5 r- H a+ 'O c0 of y d co E O m c_ m H O' N O a+ 7 -1- C-4 O p p o cA co E N • n 2 ! o Z J' rd f 0 cO ~ v ~ E m I #_t _l a CL 7 rr~~ c ~1 A ciao 0) LDINGS DEPARTIVNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NW 1/4 NE 1/4 19 /T 2911/11 19E (or) W Hudson xx xxx xxxxxxxxxxxxxxxxxxxxx COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: St. Croix Ed Doubrock 876 Trout Brook R Phone DATES OBSERVATIONS MADE USE rMM PROFILE D S PTIONS: PER OLATION TESTS: ~N~OBEDRW_' IAL DESCRIPTION: New Replace ®4 20 91 4-20-91 RATING: S= Site suitable for system U= Site unsuitable for system Omm CONVENTIONAL: TMOUND: ~U IN-GROUND~ ❑URE: SYSTEM-IN-FILLHOLDINGaU NK: RECOMMENDED COIIVention8lSTEM:lo8p;ional)4 , ~ S ❑ LL~cnJJ SS U SS DESIGN RATE: If Percolation T If any portion of the tested area is in the Tests are NOT required under s. ILHR 83.0915)(b), indicates- Floodplain, indicate Floodplain elevation: none. PROFILE DESCRIPTIONS BORING TOTAL D PTH 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.) 2.7'Bnms. B- 6.6 none >96 1'Bkls 1.7'Bnls 1'Rdls w/gr,cob 1.7'Bnms w/gr,cob B- 2 94 9529 none > 94 .7' Bkls 2' Bnls 1.8' Rdns w/gr, cob 3.4' Bncs. B-3 97 97.0 none >97 1.6'Bkls 1.4'Bnls 1.8'Rdas w/gr,cob,rk 3.3'Bncs. B-4 98 95.7 none >98 1.8' Bkls 2.5' Bnls w/gr, cob 3.9' Bncs . B- B- PERCOLATION TESTS TEST DEPTH WATERIN HO LE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIO D 2 PERIOD PER3INCH P- P_ >than 6" dr in 3 min. P_ o 3 P- 5 3 P- 3 35 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. well SYSTEM ELEVATION 92 8' exiatig-.oua~ 3 3 E Scale 1" sa 30' BM,a84ume 100.0' ITop of -next brketakg wa to steps II orn - jo pert. old septic tank. 0 = old cry well,- (aling. 3 E Trout BrOO T Oa 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: DAVE FOQERTY PLUMPiumer B bNG 4-20-91 ADDRESS: #3.133 #3280 CERTIFICATION NUMBER: PHONE NUMBER (optional)* F e Heights Road ROB CST N U Phone 749-3656 / J DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - J FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP S ECT I ON__Z,g _T'.;?~? N-RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT Z LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y~ fi,ZL wo usxl` , INDICATE NORTH ARROW BENCHMARK:Elevation and description: /4 Alternate benchmark SEPTIC TANK: Manufacturer: f~l_c~c Liquid Cap. Rings used :S Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side , RearZFt.~ From nearest prop. line:Front Side , Rear J~ Ft. a No. of feet from: Well l , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 1 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_, RearI(Ft. 5 Distance from: Well S,$"- Building -Z7e SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: J9 Length Number of Lines: __~Area Built_s,,~ Exist. Grade Elev. Proposed Final Grade Elev. 97 Fill depth to top of pipe: &XI No. feet from nearest prop. line:Front , Side, Rear Ft.-~& No. feet from well: Jj~~ 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: - 91 PLUMBER ON JOB: a~~Xll LICENSE NUMBER: 6/90:cj Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St. Croix ~ Safety and Buildings Division NW,NE,19, (ATTACH TO PERMIT) Sa ryPermitNo.: GENERAL INFORMATION 29,19W 149085 Permit Holder's Name: Trour Munk ❑ City ❑ Village Town of: State Plan ID No.: Ed Dombrock Hudson CST BM Elev.: ~>l Insp. BM Elev.: BM nption: n Q Parcel Tax No.: C~~'- 172E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , (o 16.G~5 DosingS e Aeration Bldg. Sewer Holding St/Ht Inlet ZS -10 i TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet J` Air intake 9Z. Z7, Septic NA Dt Bottom 7f 721/ Dosing NA Header n" ,ro ' Aeration A Dist. Pipe r Holding Bot. System PUMP / 5~PF161- FORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Sysatem TDH Ft I Loss Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length s No. Of Trenches PIT is inside Dia. Liquid Depth DIMENSIONS DI EN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING facturer: INFORMATION Type System: Mode Num er: grl CHAMBER pZ~p p 1 J ° OR UNIT DISTRIBUTION SYSTEM Headerrhilm fold r~ Distribution Pipe(s) x Hole Size x Hole Spacin Vent To Air Intake i Length ~ Dia. ~ Length ~ Dia. : Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodd rMdrinpri Bed ertehCenter Bed Edges E] Yes ❑ No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc..)) , 04A&4 Ile lei Plan revision required? ❑ Yes [~'No Use other side for additional information. WA/M SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION CO NT ' 701LHA In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PE M T # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ CdeckTf re7visio 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 t/4 Ajj~ S N,R E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # _40, 14- CITY STATE! ZIP CODE PHONE NUMBER SUBDIVISION NAME OR M NUMBER l NEAREST ROAD 11. TYPE OF BUILDING: (Check one) ❑ State Owned 61 VILLLLAGE : I AV 4QUN OF LTAX. ( ) 11 Public M 1 or 2 Fam. Dwelling-# of bedrooms :Z PAR III. BUILDING USE: (If building type is public, check all that apply) / 1 ❑ Apt/Condo / .:7 nain 2 ❑ Assembly Hall 60 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. ® Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ 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 ,t ,/,go Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Concrete Con- Steel Plastic New istin Gallons Tanks glass App. Tanks Tanks structed F1 F1 I Li Ll 0 F] Se tic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install Ion of the onsite sewage s tern shown on the attached plans. Plumb is Name (Pript Plu:V~17177'7 MP/MPRSW No.: Business Phone Number: 3 / 9 umbers Add ss (Street, City, te, Zip C de): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date sue Issuing Agent sign ure (No Sjpmps) Ea/Approved El Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber II n, APPLICATION FOR SANITARY PERMIT STC-100 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 21-194zat' Location of property 1/4 ,,/4, Section Z2T,,-2? N-RW Township ~,co Mailing address ,I ~,4 1.1, 2 Address of site s~~~ ,¢s ~~~rgcl~ Subdivision name Lot number Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume 6~ pp 2 ~ and Page C~( Number ~ as recorded with the Register of Deeds. S 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 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 (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No.fS~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the my Regis er of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) ja,, lqql Date of Signature Date of Signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER -,4/ ' ROUTE/BOX'NUMBER T FIRE NO. CITY/STATE ZIP G PROPERTY LOCATION: A)A) 1/4 Section Tcz;;2 ~LN, R__,/_ L~W, Town of , St. Croix Cou ty, 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 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 for a MAXIMUM of $3000 of the cost of 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 systems properly maintained. The property owner agrees to submit to 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 form 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 Department 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. SIGNED1 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address 'L'''"" N'Lw' REPORT ON SOIL BORINGS AND SAFETY & BUILUINGS VDUSI RY, DIVISION AILIA ANA PERCOLATION TESTS (115 P.O. BOX 7969 ) j RL n71OIVS __.-.MADISON, WI 53707 707 . (ILHR 83.090) & Chapter 145) _O TI N - TI5W'____ TOWNSHIP/MUNICIPALITY: LOT NO.: BILK NO.: SUBDIVISION NAME: '1W 1/4 NE V4, 19 . /T 29N/R 19E (ox) W Hudson xx xxx 'OUNTY WNS 'S/BU R'S NAME: MAILING DRESS: it. Croix O Ed bombrock 876 Trout !SE_ Phone 386-63 a _ DATES OBSERVATIONS MADE N . BED_R MM R DLESCRIPTION: _ - 'PROFILE PEFICULATiON TESTS! Residence 4 UNew Replace 14-20-91 _~anocx~cr~Yir 4-20-91 IATING: SO Site suitable for system U= Site unsuitable fur system :ONVENfIONAL MOUND: NDPRESSURE- STEM-IN-FILL OLDINGTANK:RECOMMENDEDSYSTEM:(optional) ®S ❑ U US oU QS EU Tr-is ©U s❑ U conventional 18' ' f Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ender s. ILHR 83.09(5) (b), indicate n'a T LFloodplain, indicate Floodplain elevation: none. PROFILE DESCRIPTIONS 30RING 1DTAL ETH T GR U DWATER-INCHES CHARACTER F SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH DUMBER DEPTH IN. ELEVATION OBSERVED EST. I HE TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) 2.7'Bnms. B- 1 6.6 none X96 1'Bkls 1.7'Bnls 1'Rdls v/gr,cob 1.7'Bmw v/gr,cob B-2 94 95.9 none '>94 .7' Bkls 2' Bnls 1.8' Rdms v/gr, cob 3.4' Bucs. B-3 97 97.0 none >97 11.6'Bkls 1.4'Buls 1.8'Rdms v/gr,cob,rk 3.3'Bucs. B-4 98 95.7 none >98 1.8'Bkls 2.5'Bnls v/gr,cob 3.9'Bacs. B- L - - - - - PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATPR LEVEL-INCHES RATE MINUTES NUM8ER INCHES AFTER SWELLING INTERVAL-MIN. QD 1 P R, PER INCH P - 3 P- >than 6" dr in 3 min. P- 3 ~4- none 3 P 4 34 -none 5 3 3 3 P- LOT PLAN. Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- )ntal 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 f land slope. well iYSTEM ELEVATION 92.8' existing house gip, 3p~.. ' . ,Sole 1" - 30' p = BM, assure 100.0' Top of _ to steps. perk - old septic tank. s. ~X - • - - - _ _ - dV, Trout IOC Road 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 4dministrative 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: DAVE FOGERTY PLUMBING peFJc-T"ter.& Number 4-20-91 notSHFS Licari #3233 !x';3289 CERTIFICATION NUMBER: PHONE NUMBER(opt;onal He*hts Road Phone 749-36$t56 CST N U DISTRIHOT ION c: :.m! r ,r !w, Authority. Property Owner and Soil Tester. L~ oxes4l) Se ac' 355 Q 35" o ~3 %o,rt~~ /yl,Ru~ R G lZ a 3/ PAGE OF ` • ~7~ ~7S~du/ ~if'po,r~~ fisOt All InIalt And ODtsrvallon Plp• { ~ Approvld Veal Cop Ldwmum 12* Above Final Credo 20•42•Above Popp ~~•c.u boo To final O/.d. V.nl PIP. N.rvn Iloy Or Srnmolk Co..81ny Min 2' AVOr.pol0.01 Plp. 0141/111 lion O Plp. ~-T.. ° o o t ti- A/Yi.Ya. Beneath Pip. ° 1`611614144 Pip. 6.10. I, -CoMpllnII T.1min41ing At egoism 01 Srtl.m T-1cJ..T ton SOIL FILL DISTRIBUTIOM PIPE APPROVED SyI~ETIC COVER r --MATF-RiAl. OR 9" OF STRAW 2" oI' hGGRE6ATE OR MAKSN HAy WIT (.•OPa'/2 AGGRC6ATC ELEV. oFi FEAT-._ DISTR15UTIOU PIPE TU BC AT LEAST Z-9 INCHES BELOW ORIGIWAL GRADE AUU AT LEASTtO %WCHES BUT 1.10 MORC THAW 4Z IMCRES BELOW FINAL GKAOC MAXIMUM DEPTH OF E-ACAVATIOP FKoM OKI&WAL 6RAoJ~ WILL BE _ INCHES r"MIMM pEff" OF EXCAVATION rAOM elik'41WAL (3Rnp€ WILL ec _ INCHES SIGIJEO: / LIGE►JSC DUMBER: DATE: I