HomeMy WebLinkAbout012-1030-80-100 Wisconsin Department of Commerce
Safe and Buildings Division PRIVATE SEWAGE SYSTEM
INSPECTION REPORT County 8t. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) sanitarx
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 1
Permit Holder's Name: 3 / %° '
Rhone, Kevin El City O(m)1.
y ❑ Vi�9 e Town.Q�f: State Plan ID No.:
CST BM Elev.; in rle 1OWnshl
Insp. BM Elev.: BM Description:
TANK INFORMATION w - �° - �'` S ( arcel T d 2-- 1 . 030 - 80 - 100
TYPE �
ELEVATION DATA 'Z " 5 0, r7, i 7-7
MANUFACTURER CAPACITY
Septic STATION BS
HI FS ELEV.
Dosing Lr&tD 600 Benchmark 0
o to t. OU • O
Aeration MBA
Holdi Bldg. Sewer
TANK SETBACK INFORMATION St /Ht Inlet
lo. f3
TANK TO St / Ht Outlet
P/ L WELL BLDG. qe Intake ROAD Dt Inlet -'
Septic '. p ' r 1 �^
3 r, 3 6 NA Dt Bottom r
Dosing L 4� o -(00
n° r ader / Man C9
Aeration NA He vo,�8) 3.08 97 _�r
NA Dist. Pipe (�� 3, I6
Holding 97- r- f:) /
P UMP/ SIPHON INFORMATION Bot. System
Manufacturer Final Grad .21)
t✓ 12 '+
o
del Number Demand St cover 4 ��
l
o' b 3�'�GPM
TDH Lift l Friction 91� S stem
Forcemain Length r Dia.
8 2, � t Dist. To Well
SOIL ABSORPTION SYSTEM
Ka Width
IM N I N I Length i � i f PIT
No. Of is Inside Dia.
SYSTEM TO DIMEN I N Liquid Depth
SETBACK P/ L BLDG WELL LAKE / STREAM LEACHING
INFORMATION Type O Manu
System: rte— .y �O CH
DISTRIBUTION SYSTEM / - OR UNIT Mo el r .
Header /Manifold Di
stribution Pipes)
Length pia. � - f �l x HoleSize
Length J �v pia 2 x Hole Spacing Vent To Air Intake
Spacing � ' 3 t,
SOIL COVER x Pressure Systems Onl 2 4 k
Depth Over y xx Mound Or At -Grade Systems Only
Bed /Trench Center Depth Over xx Depth Of
Bed/ Trench Edges xx Seeded/ Sodded xx Mulched
Topsoil ❑ Yes No
COMMENTS: (Include code discrepancies, persons present, etc.) U) 1.,, 4- ❑Yes E] No
Location: 2047 170th Avenue, New Richmond, WI 54017
1.) Alt BM Description = Nu/A- (NE I /4 NW 1/1/4 1 12 T30 o n� #27 - r -- � -- �
of 1
2.) Bldg sewer length= 3 ' 0/ f=
R17W)
amount of cov = LZ.L' �' / g
e = ee5+'
Plan revision required? Yes No
Use other side for additional information. to /0 00
SBD -6710 (R.3/97) SZ(•
Date Inspector's Signatu
Cert.No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
f
s
}
S
E
}
I
r _ -
1 4
ti
m
{
}
_�
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
lV i sconsin Personal information you provide may be used for secondary purposes Madison. WI 53707 - 730^
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if r
state owne<
Attach com lete plans (to the county copy only) fort a er not less than 8 -1/2 x 11 inches in size.
County / // State Sanita ry5rrmit Number !(e is olW f application State Plan 1. D. Number
I. Application Information - Please Print all Informati < Location:
Property Owner Name (, / /� `J Property Location
T K E W
Pro rty Owner's Mai lm ddress l / ) -` Lot Number Block Num
City, State Zip Code \ INtp� �` Subdivision Name or CSM Number
_" �� 24gq
II Type of Building: (check one) __7 \ ❑ City
. 1 or 2 Family Dwelling - No. of Bedrooms: —� `-� ❑ Village
❑ Public /Commercial (describe use): wn of
❑ State -owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest
A) 1. ❑ New System �" 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System
Tank Only Existing System 01 , —
B) Permit Number Bete }zswd
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
t -grade f ❑ Aerobic Treatment Unit ❑ Recirculating 0 Other:
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) l Elevation
G p . e7 c— 6, / 0, 0
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
c� IOC2
❑ ❑ ❑ ❑
VII Responsibility Statement
1, the undersigned, assume responsibility for ins} lla ' n of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's n e o s ps): MP/MPR5 No. Business one Number
Plumber's Address (Street, City, State, Zip
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
) Approved ❑ Owner Given Initial Adverse rcharge Fee)
Determination ' 3 9- ZZ , Z�o0
IX. Conditions of Approval /Reasons for Disapproval:
A-(� s az pz c
(' �•o.�- ��a� -vi { -,,�_ �"� Dpi p.� rz`.c.��ea
--o
's
SBD -6398 (R. 07/00)
•.. Safety and Buildings
1340 E GREEN BAY ST STE 300
visconsin SHAWAN WI 54166
TDD #: (6088 ) 264 -8777
Department of Commerce www.commerce.state.wi.us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
September 11, 2000
CUST ID No.226900
ATTN. POWTS INSPECTOR
SHAUN R BIRD ZONING OFFICE
1008 192 ND AVE ST CROIX COUNTY SPIA
NEW RICHMOND WI 54017 1101 CARMICHAEL RD
HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/11/2002
• Identification Numbers
Transaction ID No. 429705
SITE: Site ID No. 197553
Please refer to both identification numbers,
ation nu
Site ID: 197553, KEVIN RHONE above, all. correspondence with the agency,
ST CROIX County, Town of ERIN PRAIRIE, 170TH AVE
NE1 /4, NW1 /4, S12, T30N, R17W
FOR:
Description: AT -GRADE SYSTEM FOR KEVIN RHONE
Object Type: POWT System Regulated Object ID No.: 757475
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following condition shall be met prior to issuance of the sanitary permit:
• Pursuant to Comm 83.21 (2)(c) 5., documentation shall be provided to the County to show that item #3 of the
management plan has been recorded with the register of deeds.
The following conditions shall be met during installation:
• The piping used for the force main and manifold shall comply with Comm 84.30 2 e .
• The distribution piping shall comply with Comm 84.30 (2)(d). ()( )
• The aggregate used in the distribution cell shall comply with Comm 84.30 (6)(i).
• The synthetic fabric used to cover the aggregate cell shall comply with Co mm 84.30 6
• Documentation shall be provided to the County to show that the effluent filter is a State-approved product and
to show that it is capable of filtering out all particulate matter that is greater than 1/8 inch in size.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
constr uction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
VA SHAUN R BIRD
Page 2 9/11/00
Sincerely,
_ , o DATE RECEIVED 08/15/2000
FEE REQUIRED
$ 175.00
KEITH A WILKINSON, POWTS PLAN REVIEWER FEE RECEIVED $ 175.00
Integrated Services BALANCE DUE $ 0.00
(715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM
KWILKINSON @COMMERCE.STATE. WI.US
w"i'S de
cc: KEVIN RHONE
PROJECT Kevin Rhone
PLOT PLAN
NE 1/4 1 /4S 12
ADDRESS 970 8th Ave Baldwin Wi 54002
/T 30 NW
/ 17 W TOWN Erin Prairie
COUNTY ST. CROIX
MPRS Shaun Bird 226900 i 8/13/00
CONVENTIONAL DATE BEDROOM 3
-GRADE XXX CONVENTIONAL LIFT
HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE
HOLDING TANK SIZE DOSE TANK SIZE 600
kk LOAD RATE .4 ABSORPTION AREA 1130
BENCHMARK V.R.P. Top of We ll Cell SIZE 1 0'X 113'
❑ BOREHOLE O ASSUME ELEVATION 100'
WELL H.R.P. Same as Benchmark
P.O.W.T.S, SYSTEM ELEVATION
Conditionally 96.1 q
APPROVED
DEPARTMENT OF COMMERCE
b `lISION OF SAFETY AND B ILDINGS
E CORRESPONDENCE Scale > 1/411= 10'
�O � 5 Propert y Line
95.2'
B -3
96.0'
J B-2
0 3%
m Slope
.z Laterals are B _ 1 96.0'
,— to have Huffcutt
m cleanouts Combo Tank
Alt\ n y ,
d� �
B.M. • m is 0? Pro 3 e -
ell✓ Bedroom insta long o
House t v
Garage m
ontour Ii .�
r—
�Tank is to be m
® properly bedded and
with lockdown covers
To Be Pumped O Inspection pipes are to
And Buried DW installed 1 /6th of distance
from the end of the cell
170th Ave
Pl�x /des3gnex �ig�acure:
• Livenee N �ber � � �j 9 � ".�"
• r►r..w �! I C �
�• •' ice • do .�_� � ►, "' +n•
Y •
w'
• ft �, I -- et 1/28 � tt
... !t. W ■ r ft
ft
4
Fabric
O +�.b'► � � �e.�4 Q i st�•ib�uti� !,,.�#� -cal
bserva►tfon
Well
S44 c o
k bib
ti, R MOU4
A vft
b&tos. zftjw� the ad
ct'oss secti
$fie AW"PtiM Area O� a Sl wi in At' de tsrtit W it h
cPi9 site
Fags of
1
Page Of
Distribution Pipe Detail For Noilateral Network
IWO
t
Holes Located On Bottom
Are Equally Spaced
PV Force Main
Y X x PVC Distribution Pipe
* Last Hole Should 'Be Next" To
t• V
S i p
:~ L
P ` , ��
- Ft Hole Diameter � Inch
X
Lateraj,Diameter Inch(es)
Y C thches Fores .Main Diameter
Inches '
c Of Holes /Pipe
, Invert Elevation' f Later
Signed:
License Numbd�
Date:. �'' /✓ ra �:�:
xr
*J* la .S
��r .1
C T i Wt CHAM �,�, 0 � T ON �` OATY Obi•
WZATHM PROOF
ve - JUNCTION SOX APPROVZD
WITH CONDUIT MAMMOldz COvIR
W/ PAU= t
,
PINTS GRADE _ WgNZW JABIL
,/1 N
--tt � y
$ i/�j p e�p M •
i1fLTT , t ` i
4 ,
WATER TIGHT SEALS GAS- + +�
7 TIGHT
A SEAT. �
1" 3' �; ! � e r $ ON i1fIGbVSD 1+SPi i
MU So '� ' � am man IO
PUMP OFF OFF
D !'�R NLY
�lAO
2" APPROVED SEDDIHS UNDER TANK
HAS A1rPROVAL
COMM PAD
SPECIFICATIONS �`t o 4�0
SEPTIC / DOSE 0
TANK MANUFACTURRlt t HUMDER DOSES PER DAY t ,,�....�.�..
" T_;,ANK 5� Imo DOSE f3AL. DOSE voLUME FLOWSACK� -� SAL.
ALARM HANtlIeACTURER: � CAPACITIES: A
. MODEL NUMBER:
SWITCH TYPE: S '' B = �2 . IN'1�I • 3 „GAL.
PUMP MAMJFAC'1UlXR : a- C = INCaS • � GAL.
MODEL NUMB' "'°••.
SWITCH TYPE D ll�IINCHEs GAL .
REQUIRED DISCHARGE RAT � PM PUMP 6 ALARM WIRING AS PER I LJlR � . 3�C
VERTICAL, DIrFRRic=2 BETWIEN PUMA orr AND DISTRrOUTION PIPE ZO IPZZT
• MI IMUM NETWORK SUPPLY PRESSURE . z. S 3 ZET
+ r'� FEET FORCEMAIN X3� FTC 34D FT. FFtiCTlow FA CTOR FLL"'T �• `�
TOTAL DYNAMIC HEAD 0 FEET 13, 9
INTOMAL DIMENS O OF PUMP TANK: LENGTH WIDTH �•� �^ DIAM�EIt �,,,,.�
LIQUID DEPTH N
1I CENSE wilhi$ER _ �` DAT
0 G
��
Per once Data
40
Purr Characteristics
Alioler 0* sere�rs,l. C: 20
Stttf40A1 tiNM40A2
4 10 1Q
f� ANN t2 6.5
Meter Shaded Pele 4 Peb
10 20 30 60 70
its 210
1Nrsht 60 Total H ead ( ) 10 14 17
+ tY0' F Max. ibhl _ __� Z! ?� �0 35
I�MA (nro) i 3.0 4. 3.2 6.1 f,A, 7
A GPM (1i5 GPM) 70 yp �p 40 30
�delbe Close A oft) 4.4 3 20 10 0
114
s• Nn •3 1.li
settle M41 Dimensional Da
1a w.
PWO Grd 10/1, um 20 eN. (fie ?42: "► 8fe c,� 7 1. AN dimenswns in inches. (Metrk for
isQ' opieed) � s• (' , internatialld ass).
Mvtari of Construction (se 4 2. Component dimensions may
vary 1 1/8 inch,
&ddft of 1111210; 04 i 3 -ire• 3. Not for construction pwpa
(ae.a2! _Dt r "PE
t•t2 wT UrdeSi certified.
WAF& 4. Dimensions and weights are
approxbttete.
� Seal Seal Feget Carr /Cerarde '' � .
Seal Mdy: Awd[ei Steel . �,�., S. We reserve ffie fi to mak
Staide, :steel revisions to out pfmw and titer
If. y ,
WON= without lattice.
ss -3va s
tarsa.ea! �o�
(a IX
1u0NMeed >ierra�(esMt 2 (a3,.
1 Hydr +c' Pvlvs, As land, Ohio A!1 RiOts Roserved.
F ,Wsb HYDROMATIC `� 998 V�r ih0rizad Local Ohio 44905 Tel; 414.209$042 NX; 4 1 9$81.4081
She; WWWOntakp"A,to
fN All AWJft CMIS ANDtW A yj"&S WY OXW sl yew PMMn � Yow /or „rr w 02 d61k1 a r 1ocF1 Qryy,ter l �+ + d
van-_
J
Lateral Manifold
X,2 x Lateral Le�nwh
Figure 2 — Number of Orifices in a Lateral
S. Determine the number of orifices in a distribution line The number of orifices is determined by
using the following equation. See figure 3.
n =d/x +1
Where: n = number of orifices
d = distribution line length
x = orifice spacing JT
Lateral Mlenifoid Lstv►al
x X x J x X J, x x
e Let a 5ingth
Di i ' n Lin
Figure 3 — Number Orifices in a Distribution Line
6. Select orifice size of 1/8, 3/16, or 1/4 inch.
7. Determine lateral diameter - Using Graphs 1 through 6.
S. Select distal pressure - A design option based on site specific elevations and effluent delivery
Preferences and requirement of Tables 1 through 3.
9, Calculate lateral discharge rate using Table 4. (orifice discharge rate at selected distal pressure
multiplied by the number Of holes per lateral).
10. Determine manifold diameter - Determined by using Table 5.
7 of 28
. Nl�ina�rn� -YID
and Contingency Plan for a At -Grade System
e Plan CORRECTION NEEDED
1. Septic Tank is to be pumped once every 3 years SEE CORRESPONDENCE
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter. <—
4. Once every 3 years the at -grade is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. The owner agrees to save this plan.
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump with out float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If at -grade fails, determine cause of failure, test another area or remove at- grade, retill
soils, and install a mound system.
3. Replace any other failing components as needed.
Sha Bird
#226900
8/28/00
i5 a
P � �
1
Wisconsin Department of Commerce SOIL EVALUAnON R POR�'t'`�1 Page of
Division of Safety and Buildings 1 )'-- -' - --
in accordance with Comm �/1 is Adm! Go6e, -'
Attach complete site plan on paper not less than 8 1/2 x 11 i po' nc s \ Plarust ounty 5 n � x
include, but not limited to: vertical and horizontal reference ), dir `� I
t/
percent slope, scale or dimensions, north arrow, and locatio a istanoad. O z,
lo U
Please print all informatio o r Z��� , wed by Date
n
Personal information you provide may be used for secondary purpo e3ivacy), s. 704 (7 )).
Property Owner tgcation
A- GLQ�� \. t3b1iN T/g /4 S �� T 3 D N R� E (or W
Property Owners Mailing Address „ of # Blp5K# ubd. Name or CSM#
,r
PO
City State Zip Code Phone Number U City ❑ Village CR"roW Neare§t Road
/ ktk--
New Construction Use:2r-Residential / Number of bedrooms � _ Code derived design flow rate _ — GPD
f E01 Replacement 173 P blic or co m vial - Describe:
Parent material 7 0L / Flood Plain elevation if applicable - ft.
General comments
and recommendations:
1 7 1 Boring # Boring
pit Ground surface elev. � ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
zx
o'
a tc
Boring # ❑ Boring
Pit Ground surface ele ;� ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
o
i
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mgA. and TSS < 30 mg/L
CST (Please Print) natur CST Number
s ue-1
Address Date Evaluation Telephone Number
' e
Property Owner Oarcel ID # Page of
F51 Boring # ❑ Boring
pit Ground surface elev. � Ift. Depth to limiting factor'X'y in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth . Dominant Color > Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # E] Boring
1:1 pit Ground surface elev. ft Depth to limiting factor in.
' Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mg/L ' Ef fluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R.6./00)
Soil Test Plot Plan
Project Name Kevin Rhone Sha it
Address 670 8th Ave
Baldwin Wi 54002
CSTM #226900
Lot 1 Subdivision ----- -- Date 8/13/00
NE 1/4 N W 1/4S 12 T 30 N /13 W Township Erin Prairie
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Well
System Elevation 96.1 *H13P Same as Benchmark
Alt. BM Top of Garage Slab @ 100.7'
Scale = 1/4" = 10'
Property Line
95.5 B .
96.0 3% 95.0
-Slope
� B -2
rn �—
0
m B -1
r
co w
Alt.
B.M. B.M Pro 3 v
0
Well Bedroom 0 CD
House
Garage r
CD
0�
DW
170th Ave
INDUSTRY, Y, OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
INDUSY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON W 53707
HUMAN RELATIONS
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP /(CN�� LOT NO.: BILK. NO.: SUBDIVISION NAME:
NE 1 /4 11 '% 12 /T 3 7N/ R 17fXor) W Erin Prarie n/a n/a n/a
COUNTY: OWNER'S NAME: MAILING ADDRESS:
St. Croix R.noornink & H. Hielkema 841 220th. St., Baldwin, tidi. 54002
USE DATES OBSERVATIONS MADE
NO, BEDRMS.: COMMER IAL DESCRIPTION: [� PROFI E DESCRIPTIONS: PERCOLATION
TESTS:
�fiesidence 3 n/a 4X vew ❑Replace 5 -6
5 -9 -92
RATING: S= Site suitable for system U= Site unsuitable for system
DO NVENTIONAL: M IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
S ®U l� ❑ U ❑ S ® U ❑ S 14 ❑ S E U mound
If Percolation Tests are NOT required DESIGN RATE: I If an 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 page 30 JeB
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 4.25 102.80 none 2.25 5 4/4 s.l. 2.00, 758 4/ 4mot.ssl' •67
l,
B_ 2 5.08 102.80 none 2.58 j 92 , , r4/ 0 4 3 s3 , 1 1. 10 4/44
B _ 3 4.58 102.20 none 3.08 •75, 10yr3 /3, 1., 1.08, 10yr4 /4, sil., 1.25, 7.5-
r3 4 s.l. 1.50 1 314 mot. s.l.
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERT D 2 P PER INCH
P_ 1 24 none 30 34
P_ 2 24 none 30 1% 1 1
P 3 24 n on P 30 1 1
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 103.80
t
I I 1
4 TT
J! -_ .r .. l .
I
3
( I
r -
_ }
I
y ._ ..,_. 'i f..!
t i
I
E
� �A-
I, the undersigned, hereby certify that the soil tests rep e o 9 e by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and th !� n of the tests are c to the best of my knowledge and belief.
NAME (print): N t TESTS WERE COMPLETED ON:
Gary L. Steel (a 1 i o T, � � - 5
ADDRESS: 6 -.► CERTIFICATION NUMBER: PHONE NUMBER (optional):
` '700th. Ave., New Richmon i.' 229 71A246-6200
N CST E:
& ity, � d Soil Tester.
— OVER — /—�
r
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your report must include.
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5� Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
0� Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11, Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10 ") BR — Bedrock
col:) - Cobble (3 - 10 ") SS -- Sandstone
gr — Gravel (under 3") LS Limestone
*s — Sand HGW — High Groundwater
cs Coarse Sand Perc Percolation Rate
med s — Medium Sand W — Well
fs - Fine Sand Bldg - Building
Is — Loamy Sand > — Greater Than
" sl - Sandy Loam < Less Than
*1 — Loam Bn — Brown
* sii — Silt Loarn BI Black
si — Silt Gy — Gray
* cl - Clay Loam Y Yellow
scl — Sandy Clay Loam R — Red
sicl — Silty Clay Loam mot -- Mottles
se - Sandy Clay wI — with
sic — Silty Clay fff few, fine, faint
* c Clay cc — common, coarse
pt - Peat Furn — Many, medium.
m Muck d — distinct
p — prominent
HWL — High Uvater level,
Six general soil textures surface water
for liquid waste disposal BM — Bench Mark
VRP — Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction.
ST CROIX COUNTY
SEPTIC "TANK MAINTENANCE AGREEMENT'
: AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer kCV1rQ C' . f' �Ao
Mailing Address (o n EVt FALD umrQ I xL SY00 a
Property Address r9Q L4 `l I � 0 {�V� ^ i�_•4,J �or�1� c✓s5 c�1
(Verification rogaired from Planning Department for new construction)
City /State AJEQ LCANOD Wl, . Parcel Identification Number o /Z O 3 O -- � / O O U
LZgA& N
Property Location N 9 1 /,, iv W 1 /4 ' Sec. 11 ,.,, TAN- RJ�I._W, Town of C[CS:J PRtt zkre .
Subdivision s Lot #
Certllled Survey Map # 3� S� . Volume q . Page #
Warranty Deed # �� `�y� Volume • Page # —
Spec house ❑ yes J4 no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAT11fi'ii!NAN
Improper use and maintenanceof 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 ncoded by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
Ile property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master P =ber.3OuMeyman plumbe4 restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain tLc private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
� a
GNATURE OF APPLICANT DATE
OWNER CERM CATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property de 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
/A 160
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- representedmay result in the sanitary permit being revoked by the Zoning Department.
** Include with this application; a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
DOCUMENT NO WARRANTY DEED TWIS bPA C. RESERVED IOW RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
515443
Reuben.,W., 00-ornink .and Dorot
_q T i u s b a n d
and.wife,holding as
eri' APR 15 1994
1 y a- Q-0e-"l-f --!nt017q$t P.QTm.Q0,
ienan nd H N. Hi.elkema,_ a_,.qn.e ... i 0 tg! T e. 5 11: 00 0. 1 ?
conveys an warran 0 r.. . ..........................................
..... ..... ---------------- ---- ----
Kevi-n ... pers-on ..... ................... ...........
... ......... ........ .........
........... ....... --- - ----- --------- -- ------ ------- ---- ----- PMT NATIONAL 8AW OF MM
� 7
.... .... . ....... ........ .. . ------- --- ..... .. .. ......... ..... .... RETURN TO 11* Ave.
..... ..... . .. — ------ ...... . .. .... .......... 54M
the f ollowing des cribed rea estate in S t r o i x
............................. .......... County,
State of Wisconsin:
Tax Parcel No: ........... ........ .........
Part of the NE 1/4 of the Nw 1/4 of Section 12, Township 30 North,
Range 17 West, St. Croix County, Wisconsin described as follows: Lot
1 of Certified Survey filed July 1, 1992 in Vol. 11 Page 2499, Doc.
No. 485375.
17ANSFEb
$33-00
FEE;
This ..is not
- 94 , (i s ' --- n home property.
Exception to warranties:
Dated this
'Lp
day of --- ---- 104
EG.� . ivi,
(SEAL) (SEAL)
qben .......... -Har.yey ........... .. ...... .... .
---- - --- Hielkema
.......................(SEAL) ----- - ..... .. ..... .... --- -- ...(SEAL)
Dorothy.., 0 ornink
. .. ......... . ... . ........ .. -- ............ ..... - -- - -- ------- ----- ---- . . ... .....
AUTHENTICATION ACKNOWLEDGMENT
Ii Signature(s) ............................................. ... ... .... STATE OF WISCONSIN
........................................... . ................................... 83.
--- - � S. r _Q1. X ------------- County.
authenticated this ........ day of .......... .............. 1 19 ......
Personally came before me this ...
............. day Of
................ Ur-L1 ............... 199.4— the above named
..............
Do
.............................................................................. ornink and Harve
....................................... y .. N' - -. ie lk-em.q ....
TITLE: ]MEMBER STATE BAR OF WISCONSIN
................................................................................
(If not . ............................................................
authorized by 1 706.06, Wis. Stat,&) - - -------------------- ---- ----------------------- - ---
-- ---------- ............
to me known to be the person --$ ....... . who exectite thq
foregAo g instrument and Acknowledge t4 -
Ii THIS INSTRUMENT WAS DRAF. ED BY
0 ............ J;)
( ----
Reuben D ornink
.................................... ...... ----------------------------
0 1 It
!� -- . - ; .
....... B .......... aldw .. i ... n A� �AQ02 .... ..... ------------------- - ..... .
.................................... Notary Public .........
-A� ....... *I�roZnty,
Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permane Ao a
"t t t4 a*# ibn
are not necessary.)
date: .. ..........
<;?J - ------- -- ---
-Nanum of Persons signing in any espacity should be typed or Printed below their signatures.
WARRANTY DZI&D STATR BAR OF WISCONSym Wisconsin Legal Blank Co.. Inc.
FORM No. 2— IV82 Milwaukee. Wisconsin
a �
9 JUL 0 11992► 12
�HJ �J JAMES O'rn.NNELL
C� gegister at Roods J
SL Croix Co•• Wi
CERTIFIED SLFNEY MAP
LARRIE QUAM
Pert of the Northeast 1/4 of the Northwest 1/4 of Section 12, Township 30 North, Range
17 West, Town of Erin Prairie, St. Croix County, Wisconsin.
UNP A T L A N DS
S 88•.77' 59 "E 2626. 8/ . 70 TH A_V - . N 114 COR. SEC. 12, T3O N, R /7W,
b II " IRON PIPE FOUND)
2453.8)' �� 173.00' %1.
3'
N L /NE NW 114—� W W
N 88f, 07' S9 " N/S //4 LINE
W /73.23 ' ? _
v �
NW COR. S£C. I2, T JON, RI7W, �Oq /VEWAY /� V
"IRON P /PE FOUND/ �.
C/) A SEPT /C O` Q y
�I BU /L D/NG SET BACK L /N E b W
Q Q lb Z
O Indicates 1" x 24" vl �' o ° h
iron pipe weighing O -' o ,^ n O t
1.13 lbs. /lin. ft. 4 J �+ ® b a W
set. ~ .�.' WELL
- n
�— Indicates fence. Q LOT
O
1.500 ACRES H p
2
65,337 SO. FT. p b �►
Owner's Address jl 1.368 ACRES EXC. ROAD
712 Thorbeau Drive 39, 5 W.
590 SOFT.
Burnsville, MN 55337 15' 9' m
Phone No. y
1 -612- 890 -7676 N 84 Q c
UNPL A T W
SCALE /" r /00' `— ._, b
M S 114 COR. SEC. /2, T JON, R 17 W,
O 50' /00 150' 200' 300' 0 /COUNTY SURVEYOR'S NON./
m
a
Description:
That certain parcel of land located in the Northeast 1/4 of the Northwest 1/4 of
Section 12, Township 30 North, Range 17 West, Town of Erin Prairie, St. Croix County,
Wisconsin, more fully described as follows; Commencing at the North 1/4 corner of
said Section 12, the POINT OF BEGINNING, of the parcel to be herein described; thence
S 00 "W (assumed bearing on the North /South 1/4 line of said Section 12) a
distance of 360.31 thence N 84 "W 197.38'; thence N 03 "E 346.371; thence
S 88 "E 173.00' on the North line of the Northwest 1/4 of said Section 12, to the
°DINT OF BEGINNING, containing 1.500 acres, being subject to easement over the
Northerly 33.00' thereof for town road purposes and also being subject to easements
of record. ` %%%41
4 GO/V'S
Dated: March 26, 1992 ��
1
Revised: May 13, 1992 ° LAURENCE':
0' 1` -��2' = W MU WH
E
. LS.,r' J �
' ,R01X WISC
' •... .... .. . .. Q,
Vol 9 Paoe 2499 = �'�,�r�amive Planning, '�i FO •SJ %% g
Certified Survey Maps P•., x4mmittee <\ ��� �A1 �D �•`,,,
St. Croix County, Wisconsin.
if rnri7acawded Laurence W. Murphy
rw4uw days of Registered Land Surveyor
mor oval date
v*po*W'sha4 be S H EE T/ OF 2
-4 W void
1 .
9 JOL 41199 12
4 85375 JAMES r1•nrNNELL
Flegistai G 00uds
% Ciob( Co., WI I
CERTIFIED SURVEY MAP
LARRIE QUAM
Part of the Northeast 1/4 of the Northwest 1/4 of Section 12, Township 20 North, Range
17 West, Town of Erin Prairie, St. Croix County, Wisconsin.
UNP A T L A N DS
S 861 • 37' 39 "£ 2676, 8/' L70 r-y A VE N 114 COR. SEC. /Z, rd0 N, R /7W,
/73.00'± b // " IRON P IPE fOUNDI
? 45J. 8/ • Z
N L /NE NW 114 I 5'
W
N 881 3 7' 39
N/S 114 L /N£ v
NW COR. SEC. 17, T JON, R /7H!, O
IRON P /PE FOUND/ OR/VEWAY
'• O
A SEPTIC O` � 0 C
I - \
b BUILD/N'; SET BAC/fL /NE b Q ti W I
O Indicates 1" x ?4" i �
v F4
a
iron pipe weighing 4 �' M h p
1.13 lbs. /lin. Ft. ~ W "' ® W
set. I WELL
-•y- indicates Fence. Q h LOT / Q W
o
1,500 ACR[S
63,337 SO, I r. O b h
Owner's Address jl 1.368 ACRES EXC.ROAD H 2
712 Thorbeau Drive R, a, w. J
59,s90 so.rr. •c
Burnsville, MN SS337 15' W
Phone No, s W
1 -61? -890 -7676
N84.
.4 -'Zo.,W Q O
7'F48. /97.38
SCALE / " = /00' N� S //4 CO R. S£C. /P, r 30 N, R 17 W,
O 30' /00 /50' 700' 300 `+ /COUNTY SURVEYOR'S .VON.)
m
0 '
7
Description:
That certain parcel of land located in the Northeast 1/4 of the Northwest 1/4 of
Section 12, Township 30 North, Range 17 West, Town of Erin Prairie, St. Croix County,
Wisconsin, more Fully described as Follows; Commencine at the North 1/4 corner of
said 0 Section 12, the POINT OF BEGINNING, of the parcel to be herein described; thence
S 00 Ol'Ol "W (assumed bearing on the North /South 1/4 line of said - Section 12) a'••
distance of 360.31 thence N 84 "W 197.38 thence N 03 ?8 11 E 346.37 thence
S 88 "E'173.00' on the North line of the Northwest 1/4 of said Section 12, to the
°DINT OF BEGINNING, containing 1.500 acres, being subject to easement over the
Northerly 73.00' thereof For town road purposes and also being subject to easements
OF record.
alOVED
Dated: March 26, 1992
Revised: May 13, 1992 ' .LAUREN •.. •
m W MUF�PHY/`
�. • yRf ER�FlAi LS,
;>;nIX %COUNTY Q �
WISC.
Vol 9 Pag 2499 ' i;i uu / PhRUMV0 PlanninV. ��� 9F ....... •' J `�
Certified Survey Maps �owncj and ��,� LAND
St. Croix County, Wisconsin. q-'.s s�4omtriittee ,'Fig Lfill&%%
, f 'not rrpcorded -Laurence W. Murphy
vnauw'30*days of Registered Land Surveyor
.mvpuoval date
-,�Vshaltbe SHEET / OF 2
�tt�& void
I r�n ENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
INDUS DIVISION
LABOR HUMAN A ND MADISON PERCOLATION TESTS (115) MADISON WI 7969
(H63.090) & 'Chapter 145.045)
LOCATION: SECT ONr TOWN5HIP /MUNICIPALITY: OT N j BLK. .: SUBDIVISION ME:
e '/a '/a /T3oN /Rn I (o �;y» Reqi rl AM
COUNTY: OWNER B ER'S NAME: MAILING A
USE DATES OBSERVATIONS MADE
L NO.
BEDRMS.: COMMERCIAL New ❑Replace AL DESCR PTION: R DESCRIPTIONS: STS:
Z r4' 11 �• -
eeconnect - ra;ler
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTI NAL: MOUND: IN S STEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
$ ❑� �$ DU $ ❑U ❑ $ .®U ❑ $ 2 U ice_
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: A14 lFloodplain, indicate F elevation:
PROFILE DESCRIPTIONS
BORINGI TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER IDEPTH IN, ELEVATION OBSERVED EST. HIGH E T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
/ i'
B- ,��, /Ion e /o�G 7 ✓.o' ' - / 7� s.f�• , 'z =a'.�
B- 2.33 rn ea/s re r P 3 • '
B-
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD PERioD2 PERIOD 3 PER INCH
P-
P-
P-
P-_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil reas. 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
i C /
I
r _
mP
j I I I
L
x
.__.
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:
96
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
J. i�� Zzo �- 3�y�3 . 7 GSA -"o6
CST SIGNATURE:
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 - SBD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately, locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10 ") BR — Bedrock
cob — Cobble (3 - 10 ") SS — Sandstone
gr — Gravel (under 3 ") LS — Limestone
* s — Sand HGW — High Groundwater
cs — Coarse Sand Perc — Percolation Rate
med s — Medium Sand W — Well
fs — Fine Sand Bldg Building
Is — Loamy Sand > — Greater Than
*sl — Sandy Loam < — Less Than
*1 — Loam Bn - Brown
*sil — Silt Loam BI — Black
si — Sii't Gy — Gray
*cl — Clay Loam Y - Yellow
scl — Sandy Clay Loam R — Red
sicl — Silty Clay Loam mot — Mottles
sc _- Sandy Clay w1 with
sic — Silty Clay fff — few, fine, faint
*c — Clay cc — common, coarse
pt - Peat mm — Many, medium
m — Muck d — distinct
p — prominent
HWL — High water level,
* Six general soil textures surface water
for liquid waste disposal BM — Bench Mark
VRP — Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field Prior to permit issuance, A complete set of plans for the private
sewage system and a permit applicatir>n "MISt laE; SUbolitted to the appropriate local authority in order to
obtain a permit. The sanitary permit roust be obtained and posted prior to the start of any construction.
k
t�
�U
J
v
o a V
r
AR
Cl—
N w A p
1 ' mss
� o
o �
u �