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HomeMy WebLinkAbout040-1134-60-000 4 o I a3 ° I N p °va N Oi M 0. ti O co p a~ -o a d. ~ N N ~ L N 0O E c ` C Q Y ~ m m ~ L O O 'O eC U N O N ca"a) U y U7CL O m c w E !y EO a U L E U j'- U - a8 as my y E y U f0 m 7 C CM a c a rn c_ Z a c x 0) o ti c Q• > _0 o _ o co m o 7 y C "CJ a) y U L 3 7 E Q w C L E U N V CL v ~ 0' y rn W E C z a! d LO N W ! a m Cl) F- Z c a c C7 as O 2 d U r y Z ~ c o fA F- ~ a) z E ~ h~ m ~RJ c a~ c 04 a O Q Z z o z N I~ y 'D l cn E N w ~v N ~i LL - m E CL .y U c m > T ai a~ ~ g °p O O CL L ~ _N a~ N0) o _ w E U F- F- F- ' _ N N O O O a Z° • Ai F- m m a m I' ~ I ' c N a fq J U rn rn Wftak a 0 0 _ N N i:z - too p ;0p ,j E I` I~ > CD Q • y N 1V Q > co O p N N (a N C _ C C o Y v ~ Ern C C4 0 (0 0 ID CL 0-) a 10 U') 3 m E E a~i M a CH M U O A L L a3 00 n...l N >c .ate 7 a) ° o a~ °1 o y E E • ice' o M F- U) O Z cn 0 c° I v~ v m a t ° L: a w CL 2 F►l E L C I.. C r j 7 A v a 2 0 U-) 10 o 0 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP t` r SECTION T N-R J W ADDRESS rl i , 1t /;x ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~r~rl LOT LOT SIZE t` PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ~~t.~,~~1 rt c I J~ . ~u INDICATE NORTH ARROW BENCHMARK: Elevation and description: G~rl~ ~Lttrl~r lL(i. J Alternate benchmark SEPTIC TANK: Manufacturer : Liquid Cap. A) m Rings used:-J-Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER J Manufacturer ~C~i,J~'j Liquid Capacity: n l,~lv Pump Model: 1?1~3~ I! Pump/Siphon Manufact.: Q; Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: ] Pump off elev.: Gallons/cycle: Alarm: Man. d',P-Ut 1 ~ j jh Switch Type: / ftkr Location Distance from nearest prop. line: Front, Side, Rear-Ft. Distance from: Well ~F/&0 Building SOIL ABSORPTION SYSTEM P61h` Bed: Trench: Seepage Pit: r1 Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top-of pipe: )e " i No. feet from nearest prop. line:Front Side, Rear Ft.~ No. feet from well:__No. feet from building i 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: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laboranan Relations INSPECTION REPORT St. Croix Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION N F.:14 S, F. c- 7,5 T28-RIQ R~PQX~A- 149110 Permit Holder's Name: ity Village own o : T ate Plan ID No.: Richard Sternberg Troy S91-40434 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA a TYPE MANUFACTURER CAPA ITY STATION BS HI FS ELEV. Septic e-, , ` =rv IZQv BenchmarkS~.,~ _o 26Z U DOsI , Ae Bldg. Sewer Holding St/#f Inlet TANK SETBACK INFORMATION St/IV'Outlet spa 9/,z~' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom 6C ZS , 3g- ~7a Dosing. / NA Header/ Man. t/ 48 , Aeration Dist. Pipe 1 r Holding Bot. System a• 70 03, 97 PUMP / SINFORMATION Final Grade Manufacturer C_ &U-W Demand Model Number ~,,ApM TDH Lift 9 41 Loss q4 System2TDH ,9oFt Forcemain Length3 / IDia. HH " Dist. To Well ~JrO SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tr riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S 7 DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER ~ r t Model Number: System: OR UNIT DISTRIBUTION SYSTEM k~¢adtN Manifold Distribution Pipe(s) ,r x Hole Size' x Hole Spacing Vent To Air Intake Length 3~ Dia. Length _ Dia. Spacing a6z 34 ?,/Ge) SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Bed/ h Over , xx Depth Of „ xx Seeded/ Sodded xx Mulched Depth Over is, rt Dept - Ir Topsoil es E] No es E] No Trench Center id Bed /Trench Edges COMMENTS: (Include code discrepancies, pers present, etc.) IV C/1 C~ z~2 Plan revision required? ❑ Yes [2-No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. SANITARY PERMIT APPLICATION =ZZTOiLHA In accord with ILHR 83.05, Wis. Adm. Code COUNTY Emmmmmmmmm 1 & STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ S'r~ X 11 Inch@S In size. lhecklif Is on 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 OWNER1 PROPERTY LOCATION i t - e 'Ste e E% S S T N, R 119 E (orb PROPERTY OWNER'S MAI ING ADDRESS LOT # BLOCK # 3 k) a a tf e C.I1y, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5,wo a CITY NEAREST R AD 0 2 II. TYPE OF BUILDING: (Check one) El State Owned ❑ VILLAGE : &eO L. Ten? _ ❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms X PARCEL AX,N`UMB 111. BUILDING USE: (If building type is public, check all that apply) 0`-L0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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) 1.0 New 2. ® Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 M 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 Q O 37C/, fOy d S~ Feet c4, Feet Site VII. TANK CAPACITY 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 Holdin Tank aU i es e I El Lift Pump Tank/Si hon Chamber w D Aohdives7erfre&st VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb Signature: (No tamps) MP/MPRSW No.: Business Phone Number: ~ 2XA., S k_lk of 14 3 3 l yes pQs~ Plumber's Address Street, City, S te, Zip Code): IX. C U TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing gent big ture (No Sta Approved El Owner Given Initial O Surcharge Fee) Q / Adverse D rmination 7 1000, X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber I • 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/contractot,(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 Cc. Location of property 1/4~~1/4, Section , T 20,N-R V Township Mailing address / Address of site P Subdivision name Lot number Previous owner of property Total size of parcel 'q'4 r' Date parcel was created ~ -U Are all corners and lot lines Identifiable? es 0 Is this property being developed for resale (spec house)? Yes No Volume nd Page Number PDO as recorded with the Register of Deeds. ~a INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which Includes a DOCUMENT NUMBER* VOLUME AND PAGE NUNBZRj 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 (out) knowledge; that I (we) am (ate) the owner(s) of the property described in this information form, by virtue of a warranty def d ~jorded in the Office of the County Register of Deeds as Document No. ~G 22a ; 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 bee corded in the Office of 0 Co nt Register of Deeds, as Document No. Si na ure of owner Signature of Co-Owner (If Applicable) 7A 4~) o !Date gn tune Date of Signature 't, - md" RECsiT MOPPIMM t ► *1 ► Mmaice F. LeBreck, Jr. ST. CIbOJli Rata. to Rs Grantor day of 3 of 21i3Q, WOW Grantee, Whae4iiat h.- fta. the said Granter, for a valuable consideration _ p tb• t1m,"oving described real estate in St. ix Statarof#isc~ia: the Northeast,Quarter of the Southeast L_ of SEA) of 'Section Thirty-five: (35) , . Tax Key NO. qty-eigh'k (28) North, Range Nineteen st,=,escrihed as follows: Beginning at a point on the South line of said a. 3 distance of 732 feet West of the Southeast corner cf said !f•: Ste p8ra1i e; along said South line a distance of 181. feet; thence 1Vorth . It ine.. of said NFA of Sit a distance of 250 feet; thence WYest -*th said South line a distance of 168 feet; thence Southerly to thee: _ rf beoming, the above described parcel containing 1.0 acres. S -AOAction, of a land contract which has been assigwd tv the-. a2 „ ]9T( ; ~ceco>n~d Sepumber 27, 1975, in d,1ti ~e a , isier `of b ms far. St. Croix CculftyI; t apMttrteaaaaes ttcstptoo i` icUi k 3S 2 -77717- •Tl:~ s.rde. . (SEAL) T #M~~jR icate4 tih of. STAYlE"t> f~ plevio 3'. 7 . r 374Tk BAR OF 0 rt+ s -4r 1%.W via. S*t.} . , . k. S,~iaxt, J., hrileer AYrr co sw~ 11. i3 .AL 1 Street _ Ii W1, MN, ' r, ~ , h ~cNr SEPTIC TANK MAINTENANCE AGREEMENT ~ St. Croix County w 0 UYER Fi(41 he ~ 0 2 1 U lG rl ROUTE /BOX NUMBER Fire Number :J d el'u CITY/ GTATE Cr ZIP Ct T.N► RW, PROPERTY LOCATION:.,?F ,!3 Section '3s~ Town of St. Croix County, Subdivision Lot number: Improper use and 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-septic tank pumper. What you put into the system can a7fect the function o. the-septic tank as a treat- ment'stage in the waste disposal system. St. Croix Counter residents Ma be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County r III accepted this program in August of 1980, with the requirement that owners of all new .s stems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater 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 to three year expiration. H I/WE, the undersigned have read the above requirements and agree 0 ICI to maintain the private sewage disposal system in accordance with 9 the standards set forth, herein, as set by the Wisconsin Depart- ::r of Natural Resources, Certification form must be completed V went and returned to the St. Croix County Zoning Office within 30 days . of the three year expiration-date SIGNED DATE 9 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 1 C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHI UNICIPALITY: LOT NO.IBLK. NMer DIVISION NAM SE 10/ /TORN/R/ E (or ~o r__ 1 i c COUNTY: E BUYER'S NAME: MA ING ADDRESS: S?~ ~~~1 (udm,ra ~2`er~t 6~r ~1 GJ Oc- eke USE DATES OBSERVATIONS MADE n~eX NO. BEDRMS: COMMERCIAL DESCRIPTION: PROFILE DES I TIONS: LA N TESTS: NRLpl.ce RATING: S= Site suitable for system U= Site unsuitable for system ~o CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDE9 SYSTEM: (optional) OS ®u ©S ❑U ❑S ©U os ®U as ou AhhCl 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: Floodplain, indicate Floodplain elevation: Pa f )enra. PROFILE DESCRIPTIONS BORING TAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 6 A2 ',6 04~ s/ e *6,1 si 3 ~'6n ~reS B- ~6r UPr ar Ae f6- a t B- a66 104~~0 3 X11 " sr a"~~ T'~hp5 66r B- COf 44 1,)141"1 t2 S D S « B- 3 5` oa.~~ / ( l~c' ~~~n Pn S i 3.ao~S~ ~e1~ aC~`~d w ,K n~s ?~s 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 P R PER INCH 3 41 k~ Y 0 4? P_ y P- y D 3o P- P_ p_ I 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 I6 3' Sd e P. „eri e lerr , ~ rho ~ Q sepfi~~ , r t ( i t ~ t S ~ t 1 T I ~ I I t 3 t t ' t , i .OA~ _ _o D - gorCl ~ ~ ~ ' 3 as ; e( 6t Rio werCa ~ I i ` I - 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 (p TESTS WERE CO?P ED N: N66 as ~A LE7 9 ICATIO MB R: PHONE NU BE ptio al): ADDRESS: CERT40 Q 3) A kit) e r IiV1, ~ ' ~~s CST SIGN 'BUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. iD-6395 (R. 02/82) - OVER - ~c~r, P 4~c'l:P ri c,e 1i~re t yS Pit tc~ Rp-, M* 110ao ~.,1 Fkm p 1'aa laopC~.l ~~d Sip y ~ e ~ room 5 f o a S91-40434 V1, i CIO ~z Awl v SEWAGE SYS'TSM (fjiliona fly i 1Oiw'S R AND NuMAN OVED - !'NOBS;RY. ~ g OPAt~Q~~S! N of SEE CO D 1 Page - Of - Straw, Marsh Hay, Or 891-40434 Synthetic Covering Distribution Pipe Medium Sand H G Topsoil F -J i D E 3 . A G,ySI~E SEW a lope t Bed Of 2~- 2 %2 (Force Main Plowed Cjpitiona a IV%:ngregate Layer P boo WM- P D / Ft. RAN MAN RE1„AT10NS . LABO E Ft. OF 1NDUSTRY ND C 'on Of A Mound System Using GL~''''"i' 1SION a For The Absorption Area F -75 Ft. NCE G 6)_ Ft. Go A S Ft. H A r Ft. Signed: B y Ft. License Number: K I JAVt. VA 191 L M_ Ft. 69.9$ Date: j 10 Ft. Alternate Position T I _ Ft. of Force Main W 31 Ft. L 1 Observation Pipe J B K of - - r - i- _ _ Force Main _ Distribution Bed Of M- 2 i Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page _ Of _ x; 8 1 ® 404 34 Perforated Pipe Detail \I End View Perforated End Cap PVC Pipe Holes Located On Bottom, IIIYYY s Are Equally Spaced ~A is* 110 Lt: NUT 7'o (AAPtFoLD PVC Force Main Q Distribution Pipe Lost Hole Should Be Next To End Cap Distribution Pipe Layout P y~ Ft. R S X 36 Inches 36 Y 1--C Inches r Hole Diameter Inch Signed: Lateral Inch(es)' License Number: Manifold Inches .Date: bbl Force Main Inches ONSITE SEWAGE SYSTEM # of holes/pipe lG ~od•EiobtaDB Invert Elevation of Lateral s/09-ayFt./, LL) 'DEPARTMEN E INDUSTRY, LABOR AND HUMR ELATIGNS D is ON OF B Gl I SEE COARESpO AiC / ' PAGE OF PUMP CHAMBER CROSS SECTIOU AMID SPECIFICATIONS VENT CAP X91 -40434 4"C.I. VENT PIPE WEATHER PR APPROVED LOCKIM& PROOF 25' FROM DOOR, JUNCTIOM BOX MANHOLE COVER WINDOW OR FRESH 12 MIU. I AIR INTAKE i GRADE I 4* MIM. I IB"MIN. COIJDUIT-- - IB"MIN. X11 _ INLET SWp,GEIa GHTw9EAL I I i I APPROVED JOINT 7l'' A '~tn,( G I I APPROVED JOINTS W C.I. PIPE ~jQn~ctw I III W/C.I. PIPE I II EXTENDING 3' EXTENDING 3' ALARM ONTO SOLID SOIL ' lp 0 V ED OA1T0 SOLID SOIL B O* I Woo ~ I o►J G TME+~ Of 1~1~~SS► LA I p4PAA 0 T-s ELEV. y.0 FL ~UMP-~ ^yJ OFF CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TAUK MAIJUFACTURCK HAS SUCH APPROVAL SEPTIC E " SPECIFMCATIOUS DOSE TAUKS MANUFACTURER: fnito~es)l ~fcC-0 IJUMBER OF DOSES: PER DA-4 TANK SIZE: -7STO GALLOWS DOSE VOLUME ~f ALARM MANUFACTURER: 1 w- ft IMCLUDING BACKFLOW: GALLONS / MODEL MUMBEK: W R CAPACITIES: A= INCHES OR ILLIMALLONS SWITCH TYPE: B =0-~ INCHES OR 2-4~fJ-1-1CALLOUS i PUMP MANUFACTURER: ~T'OU19G C uJCHES OR wALLONS MODEL NUMBER: D= INCHES OR I - vsGALLONS SWITCH TYPE: < C NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 3~,~~ CiPM ~INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE 15ETWEEU PUMP OFF AND DISTRIBUTION PIPE..FEET ©~~5 + MIIIJIMUM NETWORK SUPPLY P~~IRESSURT,E//. . . . . . . . . . . 2,5 FEET + ~ FEET OF FORCE MAIN X °/ioortFRICTION FACTOR.3~1• FEET TOTAL DYNAMIC. HEAD FEET Z- IMTERWAL D SIOU% OF TANK: LENGTH bt 7~ ;WIDTH L~ I --;LIQUID DEPTH 14 91GIJE0: LICEIJSE 1JUMBER: DATE:r. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHI UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAMg: E 'kV1 /TO$N/R/ E (or bo ie c COUNTY: OWN BUYER'S NAME: MA ING ADDRESS: S ~ 66 t k ; ar ~~r s1 bar 3 ~1 C ~4 h e Ae USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE P ONS: PERCOLA N TESTS: n a2uLe x 11MIl„ N Replace t RATING: S= Site suitable for system U= Site unsuitable for system ~o ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDS SYSTEM:(optional) DS ®u DS DU DS Du C]s ©U OS Nu a/ 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: Floodplain, indicate Floodplain elevation: P'R 1enre PROFILE DESCRIPTIONS BORING TAL D P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ES IGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) e- j ~1,~0 91, 0 a 3" la Yf ~'l,~ s t ~6iz ire s i 3 nbn c S 13-6r dPv aro7`s a t 3 B- B- ~~kc h i ~2 S o S p« B- B- S' O~~r ~elh ct C?`"P.d w U/K 6 ds jto 7`s 361 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P I D PER INCH P- y 0 30 b Y P_ U 0 3o /6 yy P. 1 ~O 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 163,'50 d e ri neri ll e Tiro I d y r~_.'_ ! ? - - E IN 1 I i e i 0 - g r io _0 r~ a_ - 4 ? 1, 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 (prinLL4 • TESTS WERE CO PL ED N: a a s~► 7 9 ADDRESS I, n CERTI ICATIO MB R: PHONE NU BE ptio all: CST SIGN E: ~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. GL/ DILHR-SBD-6395 (R. 02/82) -OVER - ST. CROIX COUNTY : ~r tl`n WI SCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE x 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 4, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: i An on site investigation of the Richard Sternberg property, located in the SE 1/4 of the SE 1/4 of Section 35, T28N -R19W, Town Troy, St. Croix County, revealed suitable soils at a depth of 32". This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely cl, James K. Tho n / I Assistant ing Administrator cj M O M U 4t c3 W N of>OY _ ,£LI ,Z9£ , 0££ I ,05Z O ,Ob i 2 N In N Z9£ 0££ Cq Cq V) V) N N LC) N 3 M Lt) ' Ll.. 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